Chapter 9 My Nursing Test Banks

Ball/Bindler/Cowen, Principles of Pediatric Nursing: Caring for Children 5th Edition Test Bank
Chapter 9

Question 1

Type: MCSA

A 17-year-old female presents at a nurse practitioners office and requests a signature for working papers. The nurse reviews her chart and notes that the last physical examination was two years ago. In addition to providing the signature for the working papers, the nurse should use this visit as:

1. An opportunity to discuss birth-control measures.

2. A time to discuss exercise and sports participation.

3. A health-supervision opportunity.

4. A chance to discuss the importance of pursuing post secondary education.

Correct Answer: 3

Rationale 1: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

Rationale 2: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

Rationale 3: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

Rationale 4: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 05. Plan assessment and interventions appropriate for health promotion and maintenance during health-supervision visits of school-age children.

Question 2

Type: MCMA

A teenager is accompanied by the mother to the annual physical examination. The nurse is aware of privacy issues related to the teenager. While the mother is in the room, the nurse should avoid questions about which of the following?

Standard Text: Select all that apply.

1. Sexual activity.

2. Cigarette smoking.

3. School performance.

4. Use of alcohol.

5. Car seat-belt use.

Correct Answer: 1,2,4

Rationale 1: The nurse must maintain the nurse-client relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seat-belt use and academic performance without breaching confidentiality.

Rationale 2: The nurse must maintain the nurse-client relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seat-belt use and academic performance without breaching confidentiality.

Rationale 3: The nurse must maintain the nurse-client relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seat-belt use and academic performance without breaching confidentiality.

Rationale 4: The nurse must maintain the nurse-client relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seat-belt use and academic performance without breaching confidentiality.

Rationale 5: The nurse must maintain the nurse-client relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seat-belt use and academic performance without breaching confidentiality.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 07. Apply communication skills to interactions with adolescents and their families.

Question 3

Type: MCMA

The school nurse performs screenings on all students in the high school. In addition, the nurse will perform selected screenings on individual teenagers. When planning the screenings for the year, the nurse will include screening all teenagers for which of the following?

Standard Text: Select all that apply.

1. Scoliosis.

2. Height and weight.

3. Blood-pressure measurement.

4. Hepatitis B profile serology.

5. Chest x-ray.

Correct Answer: 1,2,3

Rationale 1: Routine screening for adolescents includes checking for scoliosis, height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all adolescents. A chest x-ray is not a routine screening test for adolescents.

Rationale 2: Routine screening for adolescents includes checking for scoliosis, height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all adolescents. A chest x-ray is not a routine screening test for adolescents.

Rationale 3: Routine screening for adolescents includes checking for scoliosis, height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all adolescents. A chest x-ray is not a routine screening test for adolescents.

Rationale 4: Routine screening for adolescents includes checking for scoliosis, height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all adolescents. A chest x-ray is not a routine screening test for adolescents.

Rationale 5: Routine screening for adolescents includes checking for scoliosis, height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all adolescents. A chest x-ray is not a routine screening test for adolescents.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 06. Identify the major health concerns of the adolescent years.

Question 4

Type: MCSA

A school nurse is performing annual height and weight screening. The nurse notes that three females who are close friends each lost 15 pounds over the past year. The priority nursing action is to

1. Call the respective parents to discuss the eating patterns of each adolescent.

2. Speak with the girls in a group to discuss the problems associated with anorexia nervosa.

3. Refer these adolescents to the school psychologist.

4. Obtain a nutritional history for each of these adolescents.

Correct Answer: 4

Rationale 1: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

Rationale 2: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

Rationale 3: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

Rationale 4: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 08. Apply assessment skills to plan data-gathering methods for nutrition, physical activity, and the mental health status of youth.

Question 5

Type: MCSA

An adolescent who recently moved to a new school in a different town presents to an ambulatory care center and describes the following: I have no friends in my new school, and I no longer want to go to college. I know I will be lonely there, too. Which of these takes priority when speaking with the adolescent?

1. Helping the adolescent realize the value of post-secondary education.

2. Promoting healthy mental-health outcomes.

3. Acknowledging the fact that it takes several months to make new friends at a new school due to adolescent exclusion behaviors.

4. Stressing the importance of remaining in a close parent/child relationship during these stressful times.

Correct Answer: 2

Rationale 1: The adolescent is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of a college education at this time, since the adolescent must deal with the loss of friends and developing new friendships first. The parent/child relationship should not be used as a substitute for the development of new peer relationships.

Rationale 2: The adolescent is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of a college education at this time, since the adolescent must deal with the loss of friends and developing new friendships first. The parent/child relationship should not be used as a substitute for the development of new peer relationships.

Rationale 3: The adolescent is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of a college education at this time, since the adolescent must deal with the loss of friends and developing new friendships first. The parent/child relationship should not be used as a substitute for the development of new peer relationships.

Rationale 4: The adolescent is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of a college education at this time, since the adolescent must deal with the loss of friends and developing new friendships first. The parent/child relationship should not be used as a substitute for the development of new peer relationships.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 06. Identify the major health concerns of the adolescent years.

Question 6

Type: MCSA

An adolescent reports participating in an exercise program at school each Wednesday throughout the school year. Further history reveals that the adolescent does not participate in any other physical activities. Which of these outcomes is consistent with these data?

1. The adolescent is reporting information consistent with what 60 percent of adolescents report as participation in physical activities.

2. The adolescent is not meeting the recommendations of the Healthy People 2020 initiative.

3. The adolescent should be encouraged to continue this program of exercise, since something is better than nothing.

4. The adolescent should be encouraged to vigorously exercise for at least five minutes each day.

Correct Answer: 2

Rationale 1: In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

Rationale 2: In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

Rationale 3: In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

Rationale 4: In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 09. Intervene with adolescents by integrating activities to promote health and to prevent disease and injury.

Question 7

Type: MCSA

An adolescent reports the following: I get up at 6 am, I attend early-morning band classes three times each week, I play sports for two hours each day after school, and homework takes me three hours each night. I always feel tired. The priority history question is:

1. How many hours of sleep do you get each night?

2. Do you consume foods high in iron?

3. Do you think you are doing too much?

4. Have you considered talking with your teachers about decreasing your homework, since you have so many extracurricular activities?

Correct Answer: 1

Rationale 1: The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

Rationale 2: The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

Rationale 3: The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

Rationale 4: The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 08. Apply assessment skills to plan data-gathering methods for nutrition, physical activity, and the mental health status of youth.

Question 8

Type: MCSA

The nurse working in the clinic includes an adolescent history in every client intake interview. Which of these issues should the nurse address when the parents are not present?

1. Possible domestic violence.

2. Teen job responsibilities.

3. Activities that are done as a family.

4. The adolescents role in the family.

Correct Answer: 1

Rationale 1: If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or health-care provider.

Rationale 2: If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or health-care provider.

Rationale 3: If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or health-care provider.

Rationale 4: If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or health-care provider.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 07. Apply communication skills to interactions with adolescents and their families.

Question 9

Type: MCSA

A nurse should review the immunization record for hepatitis B status as a priority for which of these adolescents? An adolescent who

1. Has chronic acne.

2. Has overuse injuries from playing varsity sports.

3. Has chronic asthma.

4. Is planning on getting a tattoo.

Correct Answer: 4

Rationale 1: The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

Rationale 2: The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

Rationale 3: The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

Rationale 4: The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 06. Identify the major health concerns of the adolescent years.

Question 10

Type: MCSA

An obese adolescent who adamantly denies sexual activity has a positive pregnancy test, which was performed in the adolescent clinic. The appropriate nursing statement to the adolescent is:

1. Tell me how you feel about your body image.

2. When was your last menstrual period (LMP)?

3. Lets discuss some activities that you have done within the past few months that could possibly lead to pregnancy.

4. Were you involved in a date rape and are you hesitant to speak about it?

Correct Answer: 3

Rationale 1: The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

Rationale 2: The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

Rationale 3: The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

Rationale 4: The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 08. Apply assessment skills to plan data-gathering methods for nutrition, physical activity, and the mental health status of youth.

Question 11

Type: MCSA

A mother reports that her adolescent is always late. The mother states, She was born late and has been late every day of her life. Which response should the nurse make to this mother?

1. You need to establish specific time frames for your adolescent and be certain she adheres to them.

2. You should not expect your adolescent to be an on-time individual unless you set specific alarms and then reinforce the value of being on-time.

3.

4. You have a major problem. There must be a lot of screaming in your home.

Correct Answer: 2

Rationale 1: The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parent-child conflict and/or make assumptions about household communication.

Rationale 2: The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parent-child conflict and/or make assumptions about household communication.

Rationale 3: The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parent-child conflict and/or make assumptions about household communication.

Rationale 4: The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parent-child conflict and/or make assumptions about household communication.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 07. Apply communication skills to interactions with adolescents and their families.

Question 12

Type: MCSA

When examining a 7-year-old, which action by the nurse would be most appropriate?

1. Allow the child to participate in the exam.

2. Ask the parent what kind of food the child likes to eat.

3. Ask the child whether he plays outside for at least 30 minutes a day.

4. Allow the child to decide whether he is ready for his next immunization.

Correct Answer: 1

Rationale 1: At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

Rationale 2: At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

Rationale 3: At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

Rationale 4: At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 01. State components of growth and developmental surveillance needs for school-age children.

Question 13

Type: MCMA

The school health nurse recognizes that children who display certain characteristics are at risk for poor school performance. The nurse will, therefore, observe each school-age child for which of the following characteristics?

Standard Text: Select all that apply.

1. Decreased ability to perform visual tracking.

2. Decreased auditory stimulation.

3. Decreased muscle tone.

4. Multiple dental caries.

5. Chronic tonsillitis.

Correct Answer: 1,2,3

Rationale 1: Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Rationale 2: Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Rationale 3: Children with problems with vision, hearing, and muscle tone are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Rationale 4: Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Rationale 5: Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 01. State components of growth and developmental surveillance needs for school-age children.

Question 14

Type: MCSA

A nurse obtains a nutritional health history from a 10-year-old child. Which of these food selections, if consumed on a regular basis, should lead the nurse to become concerned about the need for improving oral hygiene?

1. Peanuts and crackers.

2. Sorbet and yogurt.

3. Gummy bears and licorice.

4. Fluoridated water.

Correct Answer: 3

Rationale 1: Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

Rationale 2: Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

Rationale 3: Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

Rationale 4: Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 02. Describe the nutrition, physical activity, and oral health needs of school-age children.

Question 15

Type: MCSA

The school health nurse is evaluating the home environment of several children as it relates to child safety. The nurse visits the home of each child and gathers the following data. Which of these activities places a child at greatest risk for bodily harm?

1. The parents are in a methadone program.

2. The parents consume alcohol on a daily basis.

3. The child is permitted to target practice with a revolver, unsupervised.

4. The child is a latchkey child.

Correct Answer: 3

Rationale 1: Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

Rationale 2: Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

Rationale 3: Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

Rationale 4: Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 05. Plan assessment and interventions appropriate for health promotion and maintenance during health-supervision visits of school-age children.

Question 16

Type: MCMA

The school nurse is teaching a class about safety. The nurse will teach the children that they should wear protective athletic gear when participating in selected activities. Which of these activities require protective athletic gear?

Standard Text: Select all that apply.

1. Skateboarding.

2. Playing football.

3. Swimming.

4. Playing lacrosse.

5. Performing acrobatic tricks.

Correct Answer: 1,2,4

Rationale 1: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, and lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Rationale 2: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Rationale 3: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Rationale 4: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Rationale 5: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 09. Intervene with adolescents by integrating activities to promote health and to prevent disease and injury.

Question 17

Type: MCSA

A 9-year-old child who has been followed in the same pediatric home since birth is at the health care center for a well-child visit. A nurse who measures the height and weight of the child documents 35th percentile for height and 90th percentile for weight. How should the nurse interpret these data?

1. The child is beginning a growth spurt.

2. The child is obese and needs dietary counseling.

3. The parents are most likely below the 50th percentile for height and weight.

4. As soon as the child begins the adolescent growth spurt, the height and weight measurements will normalize.

Correct Answer: 2

Rationale 1: These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

Rationale 2: These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

Rationale 3: These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

Rationale 4: These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 01. State components of growth and developmental surveillance needs for school-age children.

Ball/Bindler/Cowen, Principles of Pediatric Nursing 5th Ed. Test Bank

Copyright 2012 by Pearson Education, Inc.

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