Advanced Pediatric Assessment 3rd Edition Chiocca Test Bank by rnstudent

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Advanced Pediatric Assessment Third Edition Test Bank

Chapter 1. Child Health Assessment: An Overview

MULTIPLE CHOICE

O R LD

Which current trend in the pediatric setting should the nurse expect to find?

1. A nurse is reviewing changes in healthcare delivery and funding for pediatric populations.

a. Increased hospitalization of children b. Decreased number of uninsured children

c. An increase in ambulatory care

d. Decreased use of managed care

ANS: C

One effect of managed care is that pediatric healthcare delivery has shifted dramatically from the acute care setting to the ambulatory setting. The number of hospital beds being used has

decreased as more care is provided in outpatient and home settings. The number of uninsured children in the United States continues to grow. One of the biggest changes in healthcare has

been the growth of managed care.

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DIF: Cognitive Level: Comprehension REF: dm 3

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OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment 2. A nurse is referring a low-income family with three children under the age of 5 years to a program that assists with supplemental food supplies. Which program should the nurse refer this

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family to?

a. Medicaid b. Medicare c. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program d. Women, Infants, and Children (WIC) program

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ANS: D WIC is a federal program that provides supplemental food supplies to low-income women who are pregnant or breast-feeding and to their children until the age of 5 years. Medicaid and the

for well-child examinations and related treatment of medical problems. Children in the WIC

Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program provides

program are often referred for immunizations, but that is not the primary focus of the program.

O R LD

Public Law 99-457 provides financial incentives to states to establish comprehensive early intervention services for infants and toddlers with, or at risk for, developmental disabilities. Medicare is the program for Senior Citizens.

DIF: Cognitive Level: Application REF: dm 7

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

3. In most states, adolescents who are not emancipated minors must have parental permission

a. treatment for drug abuse.

before:

c. obtaining birth control.

b. treatment for sexually transmitted diseases (STDs).

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ANS: D

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d. surgery.

An emancipated minor is a minor child who has the legal competence of an adult. Legal counsel

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may be consulted to verify the status of the emancipated minor for consent purposes. Most states allow minors to obtain treatment for drug or alcohol abuse and STDs and allow access to birth control without parental consent.

DIF: Cognitive Level: Application REF: dm 12 OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment

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4. A nurse is completing a clinical pathway for a child admitted to the hospital with pneumonia. Which characteristic of a clinical pathway is correct? a. Developed and implemented by nurses

b. Used primarily in the pediatric setting

c. Specific time lines for sequencing interventions

O R LD

d. One of the steps in the nursing process ANS: C

Clinical pathways measure outcomes of client care and are developed by multiple healthcare

professionals. Each pathway outlines specific time lines for sequencing interventions and reflects

interdisciplinary interventions. Clinical pathways are used in multiple settings and for clients throughout the life span. The steps of the nursing process are assessment, diagnosis, planning,

implementation, and evaluation.

DIF: Cognitive Level: Comprehension REF: dm 6

OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment

5. When planning a parenting class, the nurse should explain that the leading cause of death in

a. premature birth.

children 1 to 4 years of age in the United States is:

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b. congenital anomalies.

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c. accidental death.

d. respiratory tract illness.

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ANS: C

Accidents are the leading cause of death in children ages 1 to 19 years. Disorders of short gestation and unspecified low birth weight make up one of the leading causes of death in neonates. One of the leading causes of infant death after the first month of life is congenital anomalies. Respiratory tract illnesses are a major cause of morbidity in children.

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DIF: Cognitive Level: Application REF: dm 9 OBJ: Nursing Process Step: Implementation

MSC: Safe and Effective Care Environment

O R LD

a. The report assures the legal department that there is no problem.

6. Which statement is true regarding the quality assurance or incident report?

b. Reports are a permanent part of the clients chart.

c. The nurses notes should contain the following: Incident report filed and copy placed in chart.

d. This report is a form of documentation of an event that may result in legal action.

ANS: D

An incident report is a warning to the legal department to be prepared for potential legal action;

it is not a part of the clients chart or nurse documentation.

DIF: Cognitive Level: Knowledge REF: dm 14

OBJ: Nursing Process Step: Implementation

MSC: Safe and Effective Care Environment

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7. Which client situation fails to meet the first requirement of informed consent?

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a. The parent does not understand the physicians explanations.

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b. The physician gives the parent only a partial list of possible side effects and complications. c. No parent is available and the physician asks the adolescent to sign the consent form. d. The infants teenage mother signs a consent form because her parent tells her to.

ANS: C

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The first requirement of informed consent is that the person giving consent must be competent. Minors are not allowed to give consent. An understanding of information, full disclosure, and voluntary consent are requirements of informed consent, but none of these is the first

requirement.

DIF: Cognitive Level: Comprehension REF: dm 12

O R LD

OBJ: Nursing Process Step: Implementation MSC: Safe and Effective Care Environment

8. A nurse assigned to a child does not know how to perform a treatment that has been prescribed

b. Make the childs parents aware of the situation.

a. Delay the treatment until another nurse can do it.

for the child. What should the nurses first action be?

c. Inform the nursing supervisor of the problem.

d. Arrange to have the child transferred to another unit.

ANS: C

If a nurse is not competent to perform a particular nursing task, the nurse must immediately

communicate this fact to the nursing supervisor or physician. The nurse could endanger the child by delaying the intervention until another nurse is available. Telling the childs parents would

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most likely increase their anxiety and will not resolve the difficulty. Transfer to another unit

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delays needed treatment and would create unnecessary disruption for the child and family. DIF: Cognitive Level: Application REF: dm 11

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OBJ: Nursing Process Step: Implementation MSC: Safe and Effective Care Environment 9. A nurse is completing a care plan for a child and is finishing the assessment phase. Which activity is not part of a nursing assessment?

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a. Writing nursing diagnoses b. Reviewing diagnostic reports c. Collecting data

d. Setting priorities

ANS: D

O R LD

Setting priorities is a part of planning. Writing nursing diagnoses, reviewing diagnostic reports, and collecting data are parts of assessment.

DIF: Cognitive Level: Comprehension REF: dm 19

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

10. Which patient outcome is stated correctly?

a. The child will administer his insulin injection before breakfast on 10/31.

b. The child will accept the diagnosis of type 1 diabetes mellitus before discharge.

c. The parents will understand how to determine the childs daily insulin dosage.

d. The nurse will monitor blood glucose levels before meals and at bedtime.

ANS: A

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The outcome is stated in client terms, with a measurable verb and a time frame for action. The verb accept is difficult to measure. The goal of accepting a diagnosis before hospital discharge is

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unrealistic. Outcomes should be stated in client terms. Nursing actions are determined after outcomes are developed in the implementation phase of the nursing process.

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DIF: Cognitive Level: Application REF: dm 20 OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment MULTIPLE RESPONSE

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1. A nurse is reviewing the nursing care plan for a hospitalized child. Which statements are collaborative problems? Select all that apply. a. Risk for injury

b. Potential complication of seizure disorder

c. Altered nutrition: Less than body requirements d. Fluid volume deficit

O R LD

e. Potential complication of respiratory acidosis

ANS: B, E

In addition to nursing diagnoses, which describe problems that respond to independent nursing

functions, nurses must also deal with problems that are beyond the scope of independent nursing

practice. These are sometimes termed collaborative problemsphysiological complications that

usually occur in association with a specific pathological condition or treatment. The potential complications of seizure disorder and respiratory acidosis are physiological complications that

will require physician collaboration to treat. Risk for injury, altered nutrition, and fluid volume

deficit will respond to independent nursing functions.

DIF: Cognitive Level: Application REF: dm 20

OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment

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2. Which nursing activities do not meet the standard of care? Select all that apply.

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a. Failure to notify a physician about a childs worsening condition b. Calling the supervisor about staffing concerns

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c. Delegating assessment of a new admit to the Unlicensed Assistive Personnel (UAP) d. Asking the Unlicensed Assistive Personnel (UAP) to take vital signs e. Documenting that a physician was unavailable and the nursing supervisor was notified

ANS: A, C

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A nurse who fails to notify a physician about a childs worsening condition and delegating the assessment of a new admit to a UAP do not meet the standard of care. Calling the supervisor about staffing concerns, asking the UAP to take vital signs, and documenting that a physician

could not be reached and the nursing supervisor was notified all meet the standard of care.

O R LD

Chapter 2. Assessment of Child Development and Behavior MULTIPLE CHOICE

1. The nurse is performing an abdominal assessment on a child. When percussing over the

stomach, the nurse should hear which sound?

a. Tympany

b. Resonance

c. Flatness

d. Dullness

ANS: A

Tympany is a high-pitched, loud-intensity sound heard over air-filled body parts such as the

stomach and bowel. Resonance is a low-pitched, low-intensity sound elicited over hollow organs

such as the lungs. Flatness is a high-pitched, soft-intensity sound elicited by percussing over

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solid masses such as bone or muscle. Dullness is a medium-pitched, medium-intensity sound elicited when percussing over high-density structures such as the liver.

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DIF: Cognitive Level: Application REF: dm 170

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OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 2. A nurse is preparing to begin an assessment on a newly admitted child. The nurse should be

aware that the single most important component of a pediatric physical examination is: a. assessment of heart and lungs. b. measurement of height and weight.

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c. documentation of parental concerns. d. obtaining an accurate history.

ANS: D

An accurate history is most helpful in identifying problems and potential problems. Heart and

lung assessment and documentation of parental concerns are not as important as an accurate

O R LD

history. A single measurement of height and weight is not as significant as determining growth over time. The childs growth pattern can be elicited from the history.

DIF: Cognitive Level: Comprehension REF: dm 171

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

to the clinic today because of frequent diarrhea?

3. In which section of the health history should the nurse record that the parent brought the infant

a. Review of systems

c. Lifestyle and life patterns

d. Health history

b. Chief complaint

ANS: B

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The chief complaint is documented using the childs or parents words for the reason the child was brought to the healthcare center. The review of systems includes past health functions of body

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systems. Lifestyle and life patterns include the childs interaction with the social, psychological, physical, and cultural environment. Health history includes birth history, growth and

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development, common childhood illnesses, immunizations, hospitalizations, injuries, and allergies. DIF: Cognitive Level: Comprehension REF: dm 171 OBJ: Nursing Process Step: Implementation

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MSC: Health Promotion and Maintenance 4. A nurse is reviewing pediatric physical assessment techniques. Which statement about

performing a pediatric physical assessment is correct?

a. Physical examinations proceed systematically from head to toe unless developmental considerations dictate otherwise.

O R LD

b. The physical examination should be done with parents in the examining room for children of any age. c. Measurement of head circumference is done until the child is 5 years old.

d. The physical examination is done only when the child is cooperative.

ANS: A

Physical assessment usually proceeds from head to toe; however, developmental considerations

with infants and toddlers dictate that the least threatening assessments be done first to obtain accurate data. Having parents in the examining room with adolescents is not appropriate. Head

circumference is routinely measured until 36 months of age. Children will not always be cooperative during the physical examination. The examiner will need to incorporate

communication and play techniques to facilitate cooperation.

DIF: Cognitive Level: Comprehension REF: dm 168

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OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance 5. A nurse is conducting an assessment on a child during a well-child visit. Which of the

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following includes the components of a complete pediatric history?

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a. Statistical information, client profile, health history, family history, review of systems, and lifestyle and life patterns b. Vital signs, chief complaint, and a list of previous problems c. Chief complaint, including body location, quality, quantity, time frame, and alleviating and aggravating factors d. Pertinent developmental and family information ANS: A

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Statistical information, client profile, health history, family history, review of systems, and lifestyle and life patterns are included in a complete pediatric history. Vital signs, chief complaint, and list of previous problems do not constitute a complete history. A problemoriented history includes specific information about the chief complaint. Pertinent developmental

and family information are part of the complete history.

O R LD

DIF: Cognitive Level: Comprehension REF: dm 171 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

6. At what age can the nurse expect a childs head and chest circumference to be almost equal?

a. Birth

b. 6 months

c. 1 year

d. 3 years

ANS: C

Head and chest measurements are almost equal at 1 year of age. Head circumference is larger

than chest circumference until approximately 1 year of age. By 3 years of age, the chest

circumference exceeds the head circumference.

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DIF: Cognitive Level: Knowledge REF: dm 174

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OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 7. A nurse is teaching unlicensed assistive personnel (UAP) how to take accurate blood pressure on children. The nurse knows the UAPs have understood the teaching if they state that to obtain

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an accurate measurement of a childs blood pressure, the cuff should cover which portion of the

childs upper arm? a. Two-thirds b. Three-fourths c. One-half

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d. One-third

The blood pressure cuff should cover two-thirds of the childs upper arm to get an accurate

ANS: A

reading. A cuff that covers more than two-thirds of the childs upper arm will result in a false low

reading. A cuff that covers less than two-thirds of the childs upper arm will result in a false high

O R LD

reading. DIF: Cognitive Level: Application REF: dm 173

OBJ: Nursing Process Step: Evaluation MSC: Safe and Effective Care Environment

8. Which chart should the nurse use to assess the visual acuity of an 8-year-old child?

a. Lea chart

b. Snellen chart

c. HOTV chart

d. Tumbling E chart

ANS: B

The Snellen chart is used to assess the vision of children older than 6 years of age. The Lea chart

tests vision using four different symbols designed for use with preschool children. The HOTV

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chart tests vision by using graduated letters and is designed for use with children ages 3 to 6 years. The Tumbling E chart uses the letter E in various directions and is designed for use with

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children ages 3 to 6 years.

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DIF: Cognitive Level: Comprehension REF: dm 180 OBJ: Nursing Process Step: Implementation MSC: Health Promotion and Maintenance 9. Which action is appropriate when the nurse is assessing breath sounds of an 18-month-old crying child?

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a. Ask the parent to quiet the child so the nurse can listen. b. Auscultate breath sounds and chart that the child was crying.

c. Encourage the child to play with the stethoscope to distract and to calm down the child before auscultating.

d. Document that data are not available because of noncompliance.

O R LD

ANS: C

Distracting the child with an interesting activity can assist the child to calm down so an accurate assessment can be made. Asking a parent to quiet the child may or may not work. Auscultating while the child is crying typically results in less than optimal data. Documenting that the child is

not compliant is not appropriate. An assessment needs to be completed.

MSC: Health Promotion and Maintenance

OBJ: Nursing Process Step: Implementation

DIF: Cognitive Level: Application REF: dm 186

10. Which is the most appropriate site for the nurse to use to measure a pulse rate on a 1-year-old

child?

a. Apical

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d. Femoral

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c. Carotid

b. Radial

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ANS: A

Apical pulse rates are taken in children younger than 2 years. Radial pulse rates may be taken in

children older than 2 years. It is difficult to palpate the carotid pulse in an infant. The femoral pulse is palpated when comparing peripheral pulses, but it is not used to measure an infants pulse rate. DIF: Cognitive Level: Comprehension REF: dm 172

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