Chapter 9: School-Age Children My Nursing Test Banks

Chapter 9: School-Age Children

Multiple Choice

1. A school-age child has been weighed at the well-child checkup. He has gained 6 pounds since the previous year. This is:

1. An average weight gain for a child of this age.

2. Too much of a weight gain for a child of this age.

3. Too little of a weight gain for a child of this age.

4. None of the above.

ANS: 1

Feedback
1. A school-age child gains about 3 kg per year.
2. The weight gain is adequate for this age.
3. The weight gain is adequate for this age.
4. A school-age child gains an average of 3 kg each year.

KEY: Content Area: Physical Growth | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: Chapter 9 | Type: Multiple Choice

2. A mother is being educated about the changes puberty will have on her daughter. The nurse knows the mother understands the beginning changes for puberty when the mother states:

1. She will have underarm hair development.

2. She will have an increase in body odor.

3. She will start to have breast buds.

4. She will have acne issues.

ANS: 3

Feedback
1. Underarm hair appears after the breast buds start to appear.
2. The body odor usually occurs after breast buds appear.
3. Breast buds are the key indicator for the start of puberty in girls.
4. Acne usually occurs when menarche occurs.

KEY: Content Area: Physical Development | Integrated Processes: Teaching/Documentation | Client Need: Physiological Assessment | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

3. As puberty starts to occur for a boy, the scrotal sac will:

1. Increase in size.

2. Decrease in size.

3. Grow at a slower rate than the penis

4. Become loosened and the testicles will enlarge.

ANS: 4

Feedback
1. The sac increases only if the testicles enlarge.
2. The scrotal sac remains the same.
3. The penis grows at the same rate.
4. The testicles become larger, thus stretching the scrotal sac.

KEY: Content Area: Physical Development | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

4. A 9-year-old boy is going to have a lumbar puncture performed. The nurse asks if he would like his mother present for the procedure. The boy states, I can do this on my own. The nurse knows:

1. A child of this age wants to be independent and does not need assistance.

2. A child of this age is independent.

3. This childs statement is normal for a child of his age.

4. In reality, this child wants the parent to come with him, but does not want to be seen as weak.

ANS: 4

Feedback
1. The child needs both independence and support from a parent.
2. The child does want independence, but also needs support.
3. This is a normal statement for a child of this age, but does not state the reason for the statement.
4. The child does want the parents help and wants to demonstrate his personal strength.

KEY: Content Area: Growth and Development | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

5. The difficulty in using the FACES pain scale with school-age children is:

1. The child does not understand it.

2. A child is not old enough to learn what the faces indicate.

3. A child will choose the smile because it is desired.

4. The pain scale is the most appropriate scale for children and does not have any difficulties.

ANS: 3

Feedback
1. The child is cognitively able to understand the FACES pain scale.
2. The child has the cognitive ability to comprehend the FACES scale.
3. A school-aged child attempts to comply with what the adult is asking.
4. The pain scale is not appropriate for this age range because of the desire to be compliant with adults.

KEY: Content Area: Pain and Development | Integrated Processes: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

6. Evan has been brought to the outpatient pediatric clinic because he has complained of a headache for the past two days with no known cause. What would be an appropriate assessment question for Evan?

1. How long have the headaches been going on?

2. Where does your head hurt?

3. Have you been having trouble will school?

4. All of the above are correct.

ANS: 4

Feedback
1. The length of time aids in identifying causes for the headache.
2. Locating the pain can aid in effective pain management.
3. Identifying stresses in the childs life can aid in identifying pain.
4. All the questions would be appropriate for the nurse to ask the patient.

KEY: Content Area: Pain | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

7. A classroom of 8- and 9-year-old girls are discussing rules for their secret club. These children are demonstrating _____________ development.

1. Pre-Conventional

2. Psychosocial

3. Formal operational

4. Moral

ANS: 1

Feedback
1. Club formation is a normal activity for the pre-conventional level of development.
2. The girls are demonstrating Kohlbergs social development level of pre-conventional development.
3. The girls have not reached this stage.
4. Moral development is still occurring during this age.

KEY: Content Area: Development | Integrated Processes: Nursing Process | Client Need: Psychosocial Integrity | Cognitive Level: Knowledge | REF: Chapter 9 | Type: Multiple Choice

8. Dante, a fifth grader, has come to the school nurses office because he has a stomachache. The nurse assesses Dante and sees no physiological reason for a stomachache. The nurse attempts to send him back to class, but Dante asks if he can stay until after the spelling test. The nurse knows:

1. Dante is attempting to avoid the exam because of fear of failure.

2. Dante needs more time to rest.

3. Dante knows he will not get better and needs to go home.

4. Dante is worried he will get sick in the classroom.

ANS: 1

Feedback
1. The stomachache is a somatic response because of fear of not being successful on an exam.
2. Rest is not needed for the child. Speaking about the issue would help to decrease the childs school phobia.
3. The stomachache is a somatic response, and going home will teach the child that it is acceptable to avoid exams.
4. The child is nervous and is avoiding the exam. He is not actually physically ill.

KEY: Content Area: Development | Integrated Processes: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

9. Middle school is a time for children to:

1. Attempt to find areas they excel in.

2. Place a value on social and peer relations.

3. Have a large amount of interests.

4. All of the above are correct.

ANS: 4

Feedback
1. Middle school children are finding areas of interest.
2. Middle school children begin to put an emphasis on social and peer relations.
3. Middle school children have a variety of interests and start to identify what activities they excel in.
4. All the answers describe the growth of middle school children.

KEY: Content Area: Development | Integrated Processes: Nursing Process | Client Need: Psychosocial Integrity | Cognitive Level: Knowledge | REF: Chapter 9 | Type: Multiple Choice

10. Identify an action that a school-age child would do to demonstrate concrete-operational development.

1. A child follows the directions from the teacher to write his name on the board.

2. A child is playing dodgeball and decides to throw the ball at a person with a ball.

3. A child takes her friends pencil because she wanted it.

4. A child is able to think through a math problem and check the work for a correct answer.

ANS: 4

Feedback
1. This action is concurred earlier in life.
2. This action occurs earlier in life.
3. Possession of materials occurs earlier in life.
4. A school-age child has the cognitive formation of completing a problem and checking the answer.

KEY: Content Area: Development | Integrated Processes: Nursing Process | Client Need: Psychosocial Integrity | Cognitive Level: Knowledge | REF: Chapter 9 | Type: Multiple Choice

11. The nurse is preparing immunizations for an 11-year-old boy who is current on all immunizations. The nurse will plan to administer:

1. MMR.

2. IPV.

3. Tdap.

4. Varicella.

ANS: 3

Feedback
1. A booster is not needed at this age.
2. An IPV booster is not needed.
3. A Tdap booster is needed at this time.
4. A Varicella booster is not needed at this age.

KEY: Content Area: Immunizations | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

12. The nasal cavity of a 9 year old appears to be blue on assessment. This is an indication of:

1. Epistaxis.

2. Allergies.

3. Rhinitis.

4. Fractured septum.

ANS: 2

Feedback
1. There is no indication of blood in the nares, thus not indicating epistaxis.
2. The bodys response to allergies will cause the nares to become blue in color.
3. No continuous mucous is noted in the assessment.
4. A fracture will not cause the blue areas to appear within the nares.

KEY: Content Area: Physiological Assessment | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

13. The S1 and S2 of an 8 year old should:

1. Have regular heart sounds.

2. Have a murmur.

3. Have a thrill.

4. Have an abnormal sound.

ANS: 1

Feedback
1. Should have regular heart sounds
2. A murmur is an indication of an abnormal assessment for this age.
3. A thrill would require further assessment and should not be heard at this age.
4. An abnormal sound is an indication for further assessments at this age.

KEY: Content Area: Physiological Assessment | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

14. The nurse knows that an 11-year-old child is in acute respiratory distress. The assessment may include all of the following except:

1. Clubbed nailbeds.

2. Pallor.

3. Rales and retractions.

4. Nasal flaring.

ANS: 1

Feedback
1. Clubbing happens in chronic respiratory situations, not acute situations.
2. The child may become pale because of the lack of oxygen within the blood stream.
3. The rales are an indication of fluid within the lungs, and the retractions occur because the body is requiring more use of accessory muscles to breath.
4. Nasal flaring may occur to open airways larger to help obtain oxygen and blow off carbon dioxide.

KEY: Content Area: Physiological Assessment | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Evaluation | REF: Chapter 9 | Type: Multiple Choice

15. A mother calls the triage nurse because her son continues to have enuresis at the age of 7. The best response by the nurse is:

1. This can occur up to about the age of 12.

2. When your child exhibits enuresis, it is important to not be critical because it is usually not controllable.

3. When enuresis occurs, the child needs to be disciplined.

4. Enuresis occurs in boys and should not be a concern because he will grow out of it.

ANS: 2

Feedback
1. Every child is different, thus enuresis may stop sooner or later than the age of 12.
2. Enuresis is usually uncontrollable and should not be condemned.
3. Discipline during this time is not appropriate because the child has no control with enuresis.
4. Enuresis can happen in boys and girls.

KEY: Content Area: Physiological Growth | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: Chapter 9 | Type: Multiple Choice

16. A school nurse is speaking to a group of fifth grade girls about menarche. The nurse knows she has not been successful in her teaching when a girl states:

1. I may have my first menses at any time.

2. I can become pregnant even if my menses is not regular.

3. This is occurring because I am getting older.

4. I need to plan on what types of products I should use.

ANS: 3

Feedback
1. This group of girls may begin menarche at any time.
2. Pregnancy can occur with an irregular menses because an ovum is being released at various times.
3. This is not a clear understanding of what is occurring to the girls body.
4. Planning on the type of sanitary pads or tampons can be difficult because of embarrassment. Teaching the girl to ask questions about products is an important step in taking care of her body.

KEY: Content Area: Sexual Development | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Evaluation | REF: Chapter 9 | Type: Multiple Choice

17. A nurse is assessing a 10-year-old girls physical maturity. The nurse notes that the girl has breast buds and sparse growth of pubic hair. Identify which of Tanners stages of sexual maturity is correct.

1. Stage 5

2. Stage 3

3. Stage 4

4. Stage 2

ANS: 4

Feedback
1. Stage 5 is a fully developed woman with breasts and full pubic hair.
2. Stage 3 is usually indicated by a thickening of pubic hair and breasts start to develop more tissue.
3. Stage 4 usually has an abundance of pubic hair and the breasts are developing a larger areola.
4. Stage 2 has the sparse pubic hair and breast buds.

KEY: Content Area: Sexual Development | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: Chapter 9 | Type: Multiple Choice

18. A nurse is assessing a 12-year-old boys physical maturity. The nurse notes that the boy has some enlargement of the scrotum and the testes. Identify which Tanners stage of sexual maturity is correct.

1. Stage 4

2. Stage 3

3. Stage 2

4. Stage 1

ANS: 3

Feedback
1. The boy is not physically mature.
2. The boy is not physically mature.
3. The enlargement occurs in the second stage of the Tanners stages of physical maturity.
4. Enlargement has occurred, and the boy is beyond this point.

KEY: Content Area: Sexual Development | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: Chapter 9 | Type: Multiple Choice

19. An 8-year-old boy has been brought to the clinic because the mother is concerned about the sexual maturity development of her son. Upon assessment, the boy is taller than average and demonstrating a change in his voice. The boy is in Tanners Stage 2. This child is demonstrating:

1. A use of growth hormones.

2. Precocious puberty.

3. Delayed puberty.

4. A normal growth pattern.

ANS: 2

Feedback
1. The mother does not indicate the use of growth hormones in the patients history.
2. Precocious puberty occurs due to the advancement of the Tanner Stages. Boys at the age of 8 tend to be similar in height to females.
3. The child is too young for delayed puberty to be occurring.
4. The child is ahead of the normal growth pattern for an 8 year old.

KEY: Content Area: Sexual Development | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: Chapter 9 | Type: Multiple Choice

20. Scoliosis checks should begin in school-age children at the age of:

1. 9.

2. 5.

3. 17.

4. 12.

ANS: 4

Feedback
1. On average, children have not stared to have significant linear growth at this age.
2. On average, children have not started to have significant linear growth at this age.
3. On average, children are past significant linear growth at this age.
4. On average, children have started to have significant linear growth at this age and should be evaluated.

KEY: Content Area: Physical Assessment | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Knowledge | REF: Chapter 9 | Type: Multiple Choice

21. A new nurse is attempting to calculate the correct dosage of acetaminophen to give an 8-year-old boy. The nurse mentor knows that the new nurse will need to base the dose of the medication on:

1. The age of the child.

2. The weight of the child.

3. The pain level of the child.

4. The length of time between doses.

ANS: 2

Feedback
1. Children have varying degrees of height and weight at any age, thus the dose should not be based on age.
2. The weight of the child gives an indication as to the amount needed to effectively medicate the child.
3. Attempts to control pain should be done with as low a dose as possible. The pain does not give a clear indication as to the amount of medication to give.
4. The length of time varies from each child because of metabolism rates and response to pain. Dosing should not be determined by this method.

KEY: Content Area: Pharmacology | Integrated Processes: Teaching/Learning | Client Need: Safe and Effective Care Environment | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

22. When approaching a 7 year old for an assessment, a nurse should do which of the following steps?

1. Assess

2. Discuss

3. Touch

4. All of the above

ANS: 4

Feedback
1. A thorough assessment will aid in obtaining the status of the patient.
2. The nurse should discuss what will occur and what he/she is assessing for prior to the assessment of a particular area.
3. The nurse will need to touch the child for the assessment and should inform the child of the process.
4. All of the techniques should be used for approaching any child.

KEY: Content Area: Physical Assessment | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: Chapter 9 | Type: Multiple Choice

23. An anti-bullying program is being launched in the community by a multidisciplinary team. The community health nurse has been asked to help facilitate a conversation about factors that are associated with being a bully. Identify the factors.

A. Parents/caregivers with lower educational levels

B. Small stature

C. Good academic standing

D. Age

E. ADHD (Attention Deficit and Hyperactivity Disorder)

1. A, C, D, E

2. A and D

3. A, B, D

4. A, B, D, E

ANS: 3

Feedback
1. Academic standing and ADHD do not have a higher rate of risk for being a bully.
2. Not all the risk factors for being bullied are noted.
3. The three factors are leading indicators for a child to be at risk of being bullied.
4. ADHD does not have a higher risk for being bullied.

KEY: Content Area: Psychosocial | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

24. A school nurse is speaking with elementary school parents about sexting. The best explanation of this activity is:

1. Sending text messages.

2. Sending e-mails that contain rumors.

3. Sending nude videos or pictures to cell phones and via e-mail.

4. Sending text messages that contain rumors.

ANS: 3

Feedback
1. Sexting includes, but is not limited to, text messages.
2. Sexting is not limited to rumors via e-mail.
3. Sexting includes nudity or highly provocative images delivered to cell phones and via e-mail.
4. Sexting is not limited to rumors via text messages.

KEY: Content Area: Psychosocial | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

25. The nurse explains the treatment room to a mother of a 9-year-old boy who is about to have a lumbar puncture. Identify the best explanation for the room.

1. The room is a special place where your son will be more comfortable.

2. The room is used for the procedure so that he does not associate his hospital room with pain.

3. The room is for painful procedures so that you do not have to hear him become upset.

4. The room is easier for the staff to obtain the needed laboratory results.

ANS: 2

Feedback
1. The room is not always comfortable for a child. Labeling the room as special can indicate pleasure. When the procedure is not pleasurable, this can discredit trust with the child.
2. The procedure room helps the child not associate his room as a scary, painful place.
3. A parent is welcomed in procedures rooms to help calm the child.
4. The room may be easier to use for the staff, but the most important measure is attempting to keep the child calm and comfortable.

KEY: Content Area: Psychosocial | Integrated Processes: Communication/Documentation | Client Need: Psychosocial Integrity | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

26. A nurse is speaking with the child life specialist about the plan of care for a patient. An appropriate activity to delegate to the child life specialist would be:

1. Entering doctors orders.

2. Using medical play to prepare the child for a procedure.

3. To provide the family with discharge instructions.

4. To prepare the treatment room for a procedure.

ANS: 2

Feedback
1. A child life specialist is not responsible for entering orders.
2. Providing support for the child on an appropriate cognitive level is the responsibility of a child life specialist
3. The child life specialist may participate in the discharge recommendations, but does not do the teaching.
4. The preparation of a treatment room is important, but the child life specialist does not have this responsibility.

KEY: Content Area: Psychosocial | Integrated Processes: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

27. The school-age child will gain approximately how much weight during this phase?

1. 10 kg/year

2. 3 kg/year

3. No weight gain at this age

4. 1-2 kg/year

ANS: 2

Feedback
1. 10 kg/year would be too rapid of a weight gain.
2. 3 kg/year is the average weight gain of a school-age child.
3. No weight gain would indicate a health issue that should be investigated.
4. 1-2 kg/year may be too little weight gain for this age and should be monitored.

KEY: Content Area: Growth and Development | Integrated Processes: Nursing Process | Nursing Process: Assessment | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

28. When do growth spurts occur in school-age children?

1. Boys start their growth spurt first at about 8 years old, followed by girls at about 11 years old.

2. Boys and girls will start their growth spurt at the same time, at about 9 years old.

3. Girls start their growth spurt first between 10 to 12 years of age, followed by boys at about 12 years of age.

4. No growth spurt occurs in this age group. Only steady growth occurs.

ANS: 3

Feedback
1. Boys do not start until about age 12, and they will start their spurt after girls, who start at about age 10.
2. Growth spurts do not typically start at age 9, and girls will start before boys, at ages 10 and 12 respectively.
3. Girls typically start first between the ages of 10 and 12. Boys start later, typically at or after age 12.
4. No growth spurt may indicate a health issue that should be evaluated.

KEY: Content Area: Growth and Development | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

29. The nurse will assess the patient to determine which pain scale they should use based on their cognitive understanding. Which pain scale would typically be used by an older school-age child (10 to12 years old)?

1. Visual Analog Scale (0-10)

2. Cries Scale

3. FACES Scale

4. FLACC Scale

ANS: 1

Feedback
1. Most older school-age children will be able to understand and accurately rate their pain using the 0-10 visual analog scale.
2. The Cries scale should be used for newborns and young infants. The scale will not assess pain in the school-age group.
3. The FACES scale should be used for preschool age and some younger school-age children.
4. The FLACC scale will be used for older infants and toddlers.

KEY: Content Area: Physical Assessment | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

30. Which of the following is a consideration in the assessment of a Spanish-speaking patient?

1. There is no need to consider a Spanish-speaking patient since the nurse is unlikely to encounter one.

2. There are many easy to use Spanish pain reporting tools out there.

3. Spanish-speaking patients should learn to report pain using English scales to make it easier for the nurse.

4. Finding accurate Spanish tools to assist in the reporting of pain can be difficult since colloquialisms vary greatly between Spanish-speaking countries.

ANS: 4

Feedback
1. The Spanish-speaking population in the United States is in the millions and has increased in recent years. The nurse needs to be able to assist the patient in reporting their pain.
2. There has been very little research into pediatric pain reporting tools in Spanish. This can make it difficult for the nurse to find an easy way for the patient to report pain.
3. Expecting the patient to learn English terms to accurately describe their pain can lead to undue stress during the illness as well as underreporting of pain due to lack of knowledge of appropriate terms.
4. Colloquialisms for pain generally vary greatly within Spanish, depending on what area the patient originates from.

KEY: Content Area: Physical Assessment | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

31. What is menarche?

1. Not something to worry about with this age group

2. An adverse reportable condition

3. Early menopause

4. A girls first period, the start of menses.

ANS: 4

Feedback
1. Assessment for menarche is an important consideration for school-age girls.
2. This need only be assessed and documented. No reporting is necessary.
3. Menarche is not menopause. Menopause will not be found in this age group.
4. Menarche is a girls first menses and should be assessed and documented. Supportive care and education should be supplied to the patient and parents.

KEY: Content Area: Assessment | Integrated Processes: Nursing Process | Nursing Process: Assessment | Client Need: Health Promotion and Maintenance/Aging Process | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

32. What is precocious puberty?

1. Puberty that starts after the age of 14.

2. Puberty that starts before age 7 for girls and age 9 for boys.

3. The term for a patient that does not experience puberty.

4. Puberty that starts before age 3.

ANS: 2

Feedback
1. Precocious puberty happens early. Age 14 would not be precocious puberty.
2. Precocious puberty is an early puberty, which happens before age 7 in girls and age 9 in boys.
3. Precocious puberty is early puberty, not nonexistent puberty.
4. Puberty is not seen at this early age.

KEY: Content Area: Growth | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

33. Up to 25% of children may have a benign murmur that will resolve by age 12. The murmur sound is often caused by:

1. Constriction of the bronchi.

2. Rheumatoid arthritis in the vertebrae.

3. Turbulent blood flow at the aorta or pulmonary artery.

4. 3rd degree heart block.

ANS: 3

Feedback
1. Constriction of the bronchi will cause wheezing and is not related to a murmur.
2. Rheumatoid arthritis does not create the sound of a murmur. This affects the joints.
3. The majority of benign murmurs in children have this origin.
4. Heart block is not benign and will change the rhythm of the heart. This will not cause a benign murmur.

KEY: Content Area: Developmental Stages | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

34. When applying EMLA cream, you should:

1. Rub the EMLA into the skin until it is absorbed.

2. Place on the skin and quickly remove.

3. Leave the EMLA on for 24 hours before the procedure.

4. Apply a large glob and cover with an occlusive dressing.

ANS: 4

Feedback
1. Rubbing it into the skin will not allow time for it to absorb deeply to help with pain.
2. Removing EMLA cream from the skin too quickly will not allow it to absorb to help with pain.
3. Leaving EMLA cream on past 4 hours will cause it to lose its effectiveness.
4. This is the correct procedure. Place a large glob on the skin and cover with an occlusive dressing, allowing EMLA cream to absorb into the skin.

KEY: Content Area: Medication Administration | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

35. When starting an IV on an older school-age child, which of the following considerations would not apply?

1. Getting enough calories through snacks

2. Determining which hand is their dominant hand

3. Consultation with a child life specialist to assist with distraction and explanation of the procedure

4. The older school-age child can assist with decisions, such as location choices for the IV and going to the treatment room or staying in their own room.

ANS: 1

Feedback
1. Getting enough calories will not be a consideration for the procedure of IV insertion.
2. If possible, do not use the dominant hand for the IV as this will allow them to continue to do homework and crafts.
3. A child life specialist is the ideal person to assist with distraction during the procedure and explaining the procedure in age-appropriate ways.
4. The older school-age child will have less stress and fear if they are able to help make decisions regarding their care, including where to have the IV inserted and whether to do it in their room or a treatment room.

KEY: Content Area: Medication Administration | Integrated Processes: Nursing Process | Client Need: Psychosocial Integrity | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

36. A good approach to assessment includes all the following except:

1. Look.

2. Touch.

3. Talk.

4. Move quickly.

ANS: 4

Feedback
1. Look to make quick assessments of the patient before starting anymore invasive assessments.
2. Touch includes palpation and auscultation. This should be done at the level of the patient whenever possible.
3. Talk with the patient and parents to obtain history.
4. Do not make any sudden or quick movements, as this can create fear and anxiety.

KEY: Content Area: Health Screening | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

37. Studies show bullying occurs in what percentage of children?

1. Bullying is overemphasized and is not really a major problem.

2. 20% to 50% of children

3. 100% of children

4. 5% to 10% of children

ANS: 2

Feedback
1. Bullying is a significant problem in school-age children and is increasing with new social media.
2. Some studies show 20% while others show up to 50% of children have been bullied.
3. 100% of children is significantly higher than has been found in studies.
4. 5% to 10% is much smaller of a percentage than has been reported in studies.

KEY: Content Area: Assessment | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

38. Common factors for why a child can be bullied include all of the following except:

1. Age.

2. Socioeconomic status.

3. Following the crowd.

4. Sexual orientation.

ANS: 3

Feedback
1. Older children may tend to bully younger children, as they are easier targets.
2. Children who come from a family with a lower socioeconomic status may be bullied due to many factors, including not maintaining the styles and clothing the other children do.
3. Children who follow the crowd are not bullied as often as those that dont. Bullies tend to gravitate toward those that are different in some way.
4. Reports of bullying due to children who identify with a sexual orientation that is not traditional are significant.

KEY: Content Area: Health Promotion and Wellness | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

39. Sexting is defined as:

1. The practice of sending nude videos or pictures on a cell phone, across the Internet, or posting to an Internet site.

2. The practice of having sex while talking with friends on the phone.

3. The practice of checking in with parents on a regular basis so as to be sure the child is not having sex.

4. The practice of sending text messages that contain the word sex or a reference to sex.

ANS: 1

Feedback
1. This is the correct definition of sexting. It involves pictures or videos of a person naked or in a sexual act.
2. This is not the definition of sexting, though it could still be a concern.
3. This is not the definition of sexting. Check ins with parents are not a cause for concern.
4. This is not the definition of sexting, but this is still a practice that should be monitored by parents.

KEY: Content Area: Wellness | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

40. The primary cause of death among school-age children is:

1. Suicide.

2. Cancer.

3. Unintentional injury and homicide.

4. Sickle Cell Disease.

ANS: 3

Feedback
1. Though suicide is a concern and a cause of death, this is not the leading cause of death.
2. Cancer is in the top 10 causes of death, but is not the leading cause of death.
3. Unintentional injuries are the leading cause of death. Education and safety are important to help prevent these injuries.
4. Sickle cell disease is not a leading cause of death for this age group.

KEY: Content Area: Safety and Infection Control| Integrated Processes: Teaching/ Learning | Client Need: Safe and Effective Care Environment | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

41. What is the role of the primary caregiver/parent in the acute care setting?

1. The caregiver/parent should not visit while the school-age child is hospitalized in order to prevent anxiety.

2. The caregiver/parent should be involved in the care of the school-age child as much as possible.

3. The caregiver/parent may visit, but only for brief visits during the day.

4. The caregiver/parent should stay with the patient, but not ask too many questions or assist with the care of the school-age child.

ANS: 2

Feedback
1. No visitation with the patient will lead to increased anxiety. School aged children will look to their caregiver for reassurance and comfort.
2. The caregiver should be present and active in care to decrease patient anxiety.
3. Visiting only briefly and not being involved with care will lead to increased anxiety of the patient.
4. The caregiver should ask questions, as the patient may not know what to ask about or be able to comprehend events and procedures. They should assist with care whenever possible.

KEY: Content Area: Coping Mechanisms | Integrated Processes: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

42. A child life specialist using a doll to explain a procedure is known as:

1. Playing house.

2. Physical restraints.

3. Behavior modification.

4. Medical play.

ANS: 4

Feedback
1. Playing house would be a game that the patient may play at other times to reduce stress and entertain himself/herself. It does not involve understanding procedures.
2. Using a doll to explain a medical procedure in no way restrains a patient.
3. A medical doll would be used to explain procedures to a patient. This should be educational and not used for behavior modification.
4. Medical play is using toys or dolls to act out procedures that the patient may undergo. This will help to reduce stress and increase understanding.

KEY: Content Area: Coping Mechanisms | Integrated Processes: Caring | Client Need: Psychosocial Integrity| Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

43. Stress on a family from the time, effort, and expense of caring for a chronically ill child is known as:

1. Boredom.

2. Caregiver fatigue.

3. Post-traumatic stress disorder.

4. Chronic Fatigue Syndrome.

ANS: 2

Feedback
1. Caregiver fatigue is the correct answer. Boredom is not a proper diagnostic description.
2. Caregiver fatigue should be assessed for any caregiver with a chronically ill child. Resources should be made available to them.
3. Post-traumatic stress disorder is diagnosed after a severe psychological stressor has occurred. The care of a chronically ill child is unlikely to result in this diagnosis.
4. Chronic Fatigue Syndrome is not associated with caring for a chronically ill child. This is a physiologic condition.

KEY: Content Area: Family Dynamics | Integrated Processes: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

44. If a nurse suspects child abuse or neglect, his/her role is:

1. To maintain patient safety as well as notify social work and authorities immediately.

2. To notify the patients physician, who will address any issues.

3. No action is needed if these concerns are not the reason for the patients visit.

4. To confront the caregivers and tell them they are bad parents.

ANS: 1

Feedback
1. The first task of a nurse is to ensure patient safety. Once that is addressed, it is law that the nurse must report any suspicion of abuse or neglect.
2. The physician will be notified, but the responsibility of reporting is not removed from the nurse.
3. Not reporting suspicion of abuse or neglect is criminal and negligent to patient safety.
4. Confronting the caregiver could place the nurse and the patient in danger. Maintain safety and let the proper authorities address the concerns with the caregivers.

KEY: Content Area: Abuse/Neglect | Integrated Processes: Nursing Process | Client Need: Psychosocial Integrity | Cognitive Level: Application | REF: Chapter 9 | Type: Multiple Choice

45. When administering oral medication to a school-age child, the nurse can help the child make choices by asking:

1. Would you like to take your medication?

2. Would you like to take your medication now or tomorrow?

3. Do you want me to ask the doctor if I can quit giving you this medication?

4. Would you like water or apple juice with your medication?

ANS: 4

Feedback
1. This is not a choice since the medication needs to be administered. Since the nurse will be giving the medication anyway, this can lead to mistrust between the patient and nurse.
2. The medication schedule is typically not changed by a whole day based on patient preference.
3. If the patient needs the medication, it would not be appropriate to give the patient the option of not having to take it anymore.
4. This is appropriate. The medication needs to be given; the only choice available to the patient has to do with factors around how they take it, such as with a drink.

KEY: Content Area: Coping Mechanisms | Integrated Processes: Communication and Documentation | Client Need: Psychosocial Integrity | Cognitive Level: Synthesis | REF: Chapter 9 | Type: Multiple Choice

46. During an assessment of a school-age child, the nurse should:

1. Not speak to the child, as this might frighten them.

2. Speak only to the parents, since they are the only ones who will understand what you are doing.

3. Sing lullabies to soothe the child.

4. Speak directly to the child, giving rationale for all actions.

ANS: 4

Feedback
1. Not explaining your actions could actually frighten the child, as they will not understand what you are doing and what to expect during the exam.
2. Informing the parents of what is occurring during the exam is appropriate, but the nurse should not ignore the child, who also needs to know and understand.
3. This intervention may be more appropriate for a baby, not a school-age child.
4. It is best to speak directly to the child and explain your actions, as the child will better understand what is happening during the exam, which will decrease fear.

KEY: Content Area: Basic Care and Comfort | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

47. The nurse does not have to assess which of the following in a school-age child?

1. Drug and alcohol use

2. Anterior fontanel

3. Start of sexual activity

4. Tobacco use

ANS: 2

Feedback
1. Older school-age children may start experimenting with drugs or alcohol.
2. The anterior fontanel will close at 18 months and should not be assessed in this age group.
3. Older school-age children may start experimenting with sex.
4. Older school-age children may start experimenting with tobacco.

KEY: Content Area: Lifestyle Choices | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

48. The treatment room should be used for:

1. A place for the child to play and relax.

2. A place for parents to get away.

3. Invasive procedures or painful/uncomfortable procedures or exams.

4. A safe area.

ANS: 3

Feedback
1. A treatment room is used for invasive or painful treatments. This is not an area suitable for play.
2. A treatment room is used for invasive or painful treatments. This would not be an area that should be used for parents to relax.
3. As a place used for invasive or painful treatments, this will ensure that the patients room is a safe place.
4. The patients room should be a safe area. The treatment room should be where any painful or invasive treatment takes place.

KEY: Content Area: Coping Mechanisms | Integrated Processes: Nursing Process | Client Need: Psychosocial Integrity | Cognitive Level: Synthesis | REF: Chapter 9 | Type: Multiple Choice

49. While performing an oral assessment on a school-age child, which of the following would not be an expected finding?

1. Loose or missing teeth

2. Wisdom teeth

3. Orthodontic treatment

4. New adult teeth

ANS: 2

Feedback
1. School-age children will be losing teeth and starting to have adult teeth come in.
2. Wisdom teeth do not emerge this early in development. That would be an assessment finding for late teens.
3. Orthodontic treatment may begin or be in process for school-age children.
4. School-age children will be losing teeth and starting to have adult teeth come in.

KEY: Content Area: Developmental Growth | Integrated Processes: Health Promotion and Maintenance | Client Need: Nursing Process | Cognitive Level: Analysis | REF: Chapter 9 | Type: Multiple Choice

50. Which stage of Ericksons developmental theory should school-age children be in?

1. Industry vs Inferiority

2. Trust vs Mistrust

3. Intimacy vs Isolation

4. Initiative vs Guilt

ANS: 1

Feedback
1. This is the correct Ericksons developmental stage for school-age children.
2. This is the stage of development for infants.
3. This is the stage of development for young adults.
4. This is the stage of development for a preschooler.

KEY: Content Area: Developmental Stages | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

51. What safety measures should a nurse teach/encourage for school-age children?

1. Have a gate blocking access to the stairs

2. Wearing a helmet when riding a bicycle as well as a helmet and pads for rollerblading

3. Always check mirrors before starting to drive

4. Keep sharp objects out of reach

ANS: 2

Feedback
1. This action would be appropriate for infants and toddlers, not school-age children.
2. This is an appropriate safety measure for school-age children since they learn and participate in these activities.
3. School-age children are too young to drive, so this advice is inappropriate.
4. This action would be more appropriate for toddlers and preschoolers. School-age children should be taught safety and/or avoidance of sharp objects.

KEY: Content Area: Accident/Injury Prevention | Integrated Processes: Teaching/Learning | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Choice

True/False

52. It is appropriate to let a 9-year-old boy assist in taking his daily ADHD medications.

ANS: T

Feedback
1. A sense of independence is given to the child. By age 9, the child can comprehend assisting in taking medications.
2. A sense of independence is given to the child. By age 9, the child can comprehend assisting in taking medications.

KEY: Content Area: Physical Assessment | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | REF: Chapter 9 | Type: True or False

Multiple Response

53. A school nurse is speaking to a group of first graders about pedestrian safety. Identify an important concept to teach the children. Select all that apply.

1. Stranger danger

2. Walk on sidewalks and in crosswalks whenever possible

3. If there is no sidewalk, use the right side of the street

4. Look to the right when crossing the street

5. Running in a crosswalk is not safe.

ANS: 1, 2, 5

Feedback
1. Children should be taught about trustworthy adults.
2. Sidewalks and crosswalks are made to keep pedestrians safe.
3. A person should walk on the left side of the street if a sidewalk in not present.
4. When crossing the street, it is important to look left to right, then left again before stepping into the street.
5 Staying calm and walking in the crosswalk is safer than running and not paying full attention to traffic.

KEY: Content Area: Safety | Integrated Processes: Communication/Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Response

54. A nurse is assessing a 10-year-old girl that has a BMI of 33%. The nurse knows that this child is at risk for: (Select all that apply.)

1. High blood pressure.

2. Precocious puberty.

3. Atherosclerosis.

4. Type 1 diabetes.

5. Hyperlipidemia.

ANS: 1, 3, 5

Feedback
1. The child is obese and has an increased risk for high blood pressure.
2. The child is not at risk for precocious puberty with a high BMI.
3. The child is at risk for building plaque on her arteries and veins since a child with a BMI of 33% more than likely has poor nutrition.
4. Weight does not determine Type 1 diabetes.
5. The child is at risk for increased lipids because a child with a BMI of 33% more than likely has poor nutrition.

KEY: Content Area: Physical Assessment | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Synthesis | REF: Chapter 9 | Type: Multiple Response

55. A nurse explains to an 11-year-old boy that he will be receiving an IV. The boy is concerned about the pain of the needle. What can the nurse do to decrease the pain of the IV insertion?

1. Let the child assist with the decision on where to place the IV.

2. Apply EMLA cream at least 45 minutes prior to the insertion.

3. Apply lidocaine to the area.

4. Have the child focus on playing a game with a family member while the IV is inserted.

5. Insert the IV into a teddy bear to demonstrate the procedure to the child.

ANS: 1, 2, 4

Feedback
1. The child is old enough to make some decisions and comprehend the process. By giving the child a choice, the anxiety may be reduced.
2. EMLA cream will help reduce pain and decrease the anxiety of the procedure.
3. Lidocaine is not commonly used in IV insertions for children.
4. Divisional techniques may help reduce the anxiety of the insertion.
5. This technique should be used for younger children.

KEY: Content Area: Pain and Development | Integrated Processes: Communication/Documentation | Client Need: Psychosocial Integrity | Cognitive Level: Comprehension | REF: Chapter 9 | Type: Multiple Response

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