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Neinstein's Adolescent and Young Adult Health Care A Practical Guide 6th Edition Test Bank Chapter 1. Health of the World's Adolescent and Young Adults
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MULTIPLE CHOICE 1. A nurse is teaching an adolescent about Tanner stages. Which statement best describes Tanner staging? Predictable stages of puberty that are based on chronological age
b.
Staging of puberty based on the initiation of menarche and nocturnal emissions
c.
Predictable stages of puberty that are based on primary and secondary sexual characteristics
d.
Staging of puberty based on the initiation of primary sexual characteristics
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ANS: C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. They are not based on chronological age. The age at which an adolescent enters puberty is variable. The puberty stage in girls begins with breast development. The puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the basis of Tanner staging. DIF: Cognitive Level: Comprehension REF: p. 151 OBJ: Nursing Process Step: Implementation MSC: Health Promotion and Maintenance 2. Which behavior suggests appropriate psychosocial development in the adolescent? The adolescent seeks validation for socially acceptable behavior from older adults.
b.
The adolescent is self-absorbed and self-centered and has sudden mood swings.
c.
Adolescents move from peers and enjoy spending time with family members.
d.
Conformity with the peer group increases in late adolescence.
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a.
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ANS: B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. The peer group validates acceptable behavior during adolescence. Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. Conformity becomes less important in late adolescence. DIF: Cognitive Level: Comprehension REF: p. 154 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 3. The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a.
Your teenager needs clearer and stricter limits about her behavior.
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b.
Your teenager needs more responsibility at home.
c.
During adolescence, this behavior is not unusual.
d.
The behavior is abnormal and needs further investigation.
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ANS: C Narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity. Stricter limits are not an appropriate response for a behavior that is part of normal development. More responsibility at home is not an appropriate response for this situation. DIF: Cognitive Level: Application REF: p. 154 OBJ: Nursing Process Step: Implementation MSC: Health Promotion and Maintenance 4. Which factor contributes to early adolescents engaging in risk-taking behaviors? Peer pressure
b.
A desire to master their environment
c.
Engagement in the process of separation from their parents
d.
A belief that they are invulnerable
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You need to be stricter so that your teenager feels more secure.
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ANS: D During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors: they believe negative consequences happen only to others. Impressing peers is more typically the factor influencing behavior of older school-age children. Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training. DIF: Cognitive Level: Comprehension REF: p. 161 OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance 5. Which statement is the most appropriate advice to give parents of a 16-year-old teenager who is rebellious?
c.
Increasing your teens involvement with his peers will improve his self-esteem.
d.
Allow your teenager to choose the type of discipline that is used in your home.
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You need to allow your teenager to make realistic choices while using consistent and structured discipline.
ANS: B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Setting stricter limits typically does not decrease rebelliousness or increase feelings of security. Increasing peer
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O M
involvement does not typically increase self-esteem. Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness. DIF: Cognitive Level: Application REF: p. 156 OBJ: Nursing Process Step: Implementation MSC: Health Promotion and Maintenance 6. Which statement by the nurse is most appropriate to a 15-year-old adolescent whose friend has mentioned suicide? Tell your friend to come to the clinic immediately.
b.
You need to gather details about your friends suicide plan.
c.
Your friends threat needs to be taken seriously and immediate help for your friend is important.
d.
If your friend mentions suicide a second time, you will want to get your friend some help.
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ANS: C Suicide is the third most common cause of death among American adolescents. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. Instructing a 15-year-old adolescent to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. It is important to determine whether a person threatening suicide has a plan of action; however, the best information for the 15-year-old adolescent to have is that all threats of suicide should be taken seriously and immediate help is important. It is imperative that help is provided immediately for a teenager who is talking about suicide. Waiting until the teen discusses it a second time may be too late. DIF: Cognitive Level: Application REF: p. 162 OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity 7. When planning care for adolescents, the nurse should: teach parents first, and they, in turn, will teach the teenager.
b.
provide information for their long-term health needs because teenagers respond best to long-range planning.
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a.
c.
maintain the parents role by providing explanations for treatment and procedures to the parents only.
d.
give information privately to adolescents about how they can manage the specific problems that they identify.
ANS: D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and healthcare provider. Teenagers are socially and
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b.
Moral development
c.
Psychosocial development
d.
Psychosexual development
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Cognitive development
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cognitively at the developmental stage where the healthcare provider can teach them and can receive explanations about healthcare directly from the nurse. Teenagers are more interested in immediate healthcare needs than in long-term needs. DIF: Cognitive Level: Application REF: p. 157 OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance 8. A 17-year-old adolescent tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area?
Have you talked with your parents about this?
b.
Do you have plans to continue school?
c.
Will you be able to support the baby?
d.
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ANS: B The appropriate moral development for a 17-year-old adolescent would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is selfabsorbed and egocentric. Although a task during adolescence is the development of a sexual identity, the teenagers dependence on the parents sanctioning of right or wrong behavior is more appropriately related to moral development. DIF: Cognitive Level: Analysis REF: p. 157 OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance 9. The best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby is:
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Can you tell me how your life will change if you have an infant?
ANS: D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teens perception and reality orientation. Asking the teenager if she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. A direct question about continuing school and how the teenager will support the child will not facilitate communication. Openended questions encourage communication. DIF: Cognitive Level: Application REF: p. 153 OBJ: Nursing Process Step: Implementation
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MSC: Health Promotion and Maintenance 10. In an interview with the nurse, a mother states that she is concerned that her 14-year-old teen is critical and finding fault with her. The nurse counsels the mother that: the family needs to change its value system to meet the teenagers changing needs.
b.
the parentteen relationship is important for the teenager and conflicts are to be expected.
c.
teenagers create psychological distance from the parent to separate from the parent.
d.
parents need to relinquish their relationship with their teenager to the teens peers.
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a.
Testicular enlargement
b.
Facial hair
c.
Scrotal enlargement
d.
Voice deepens
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ANS: C The teenager uses critical and fault-finding behavior as a mechanism to separate from the parent and become independent. Changing the familys value system to meet the teenagers needs is not realistic and will result only in the teenagers being critical of the new system. The parentteen relationship is not as important to the teenager as it was in earlier years. Friends and peers become more important. Parents should not relinquish their relationship with their teenager to the teens peers. Maintaining a consistent parental relationship with the adolescent is important. DIF: Cognitive Level: Application REF: p. 149 OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity 11. A nurse is teaching adolescent boys about pubertal changes. Which is the first sign of pubertal change seen with boys?
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ANS: A The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered. As testosterone secretion increases, the penis, testes, and scrotum enlarge. During Tanner stages 4 and 5, rising levels of testosterone cause the voice to deepen and facial hair appears at the corners of the upper lip and chin. DIF: Cognitive Level: Comprehension REF: pp. 151-152 OBJ: Nursing Process Step: Implementation MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? Select all that apply. a.
Plans to try out for the debate team at school
b.
Skips classes to go to the mall
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c.
Hangs out with friends they have had since childhood
d.
Has an unexplained source of money
e.
Fears the police
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ANS: B, D, E Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is another sign, so hanging out with friends they have had since childhood is not a sign of gang involvement. A change in attitude toward participating in activities is another sign of gang involvement. Plans to try out for the debate team at school are not a sign of gang involvement. DIF: Cognitive Level: Application REF: p. 156 OBJ: Nursing Process Step: Implementation MSC: Health Promotion and Maintenance OTHER 1. Place in order the signs of female sexual maturity beginning with the first sign and ending with the last. Use the following format for your answers: A, B, C, D a. Growth of pubic hair b. Menarche c. Appearance of breast buds d. Ovulation is established ANS: C, A, B, D Sexual maturation in girls begins with the appearance of breast buds (thelarche), which is the first sign of ovarian function. Thelarche occurs at approximately age 8 to 11 years and is followed by the growth of pubic hair. Linear growth slows, and menarche begins approximately 1 year after the peak height velocity (PHV). Ovulation occurs with menarche but may or may not accompany the first 2 years of menarche so it is not established until later.
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Chapter 2. Normal Physical Growth and Development
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MULTIPLE CHOICE 1. A nurse is reviewing developmental concepts for infants and children. Which statement best describes development in infants and children? a.
Development, a predictable and orderly process, occurs at varying rates within normal limits.
b.
Development is primarily related to the growth in the number and size of cells.
c.
Development occurs in a proximodistal direction with fine muscle development occurring first.
d.
Development is more easily and accurately measured than growth.
ANS: A
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Development, a continuous orderly process, provides the basis for increases in the childs function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. An increase in the number and size of cells is a definition for growth. Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods. DIF: Cognitive Level: Comprehension REF: p. 50|p. 52 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 2. Frequent developmental assessments are important for which reason? Stable developmental periods during infancy provide an opportunity to identify any delays or deficits.
b.
Infants need stimulation specific to the stage of development.
c.
Critical periods of development occur during childhood.
d.
Child development is unpredictable and needs monitoring.
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ANS: C Critical periods are blocks of time during which children are ready to master specific developmental tasks. Children can master these tasks more easily during particular periods of time in their growth and developmental process. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development are orderly and proceed in a predictable pattern on the basis of each individuals abilities and potentials. DIF: Cognitive Level: Comprehension REF: p. 52 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 3. Which factor has the greatest influence on child growth and development? Culture
b.
Environment
c.
Genetics
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ANS: C Genetic factors (heredity) determine each individuals growth and developmental rate. Although factors such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate the effect of the genetic endowment, which is permanent. Culture is a significant factor that influences how children grow toward adulthood. Culture influences both growth and development but does not eliminate inborn genetic influences. Environment has a significant role in determining growth and development both before and after birth. The environment can influence how and to which extent genetic traits are manifested, but environmental factors cannot
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b.
formal operations
c.
concrete operations
d.
preoperational
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eliminate the effect of genetics. Nutrition is critical for growth and plays a significant role throughout childhood. DIF: Cognitive Level: Comprehension REF: pp. 52-53 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 4. A nurse is planning a teaching session with a child. According to Piagetian theory, the period of cognitive development in which the child is able to distinguish fact from fantasy is the _____ period of cognitive development.
Erikson.
b.
Freud.
c.
Kohlberg.
d.
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ANS: C Concrete operations is the period of cognitive development in which childrens thinking is shifted from egocentric to being able to see anothers point of view. They develop the ability to distinguish fact from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infants world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. The preoperational stage is a period of egocentrism in which the childs judgments are illogical and dominated by magical thinking and animism. DIF: Cognitive Level: Application REF: pp. 56-57 OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance 5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is:
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Piaget.
ANS: A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development in which certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piagets. Jean Piagets cognitive theory interprets how children learn and think and how
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this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations. DIF: Cognitive Level: Comprehension REF: p. 57 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 6. What does the nurse need to know when observing chronically ill children at play? Play is not important to hospitalized children.
b.
Children need to have structured play periods.
c.
Childrens play is an indication of a childs response to treatment.
d.
Play is to be discouraged because it tires hospitalized children.
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ANS: C Play for all children is an activity woven with meaning and purpose and is a mechanism for mastering their environment. For chronically ill children, play can indicate their state of wellness and response to treatment. Play is important to all children in all environments. Although childrens play activities appear unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on. Children who have fewer energy reserves still require play. For these children, less-active play activities will be important. DIF: Cognitive Level: Application REF: p. 66 OBJ: Nursing Process Step: Implementation MSC: Health Promotion and Maintenance 7. Which child is most likely to be frightened by hospitalization? A 4-month-old infant admitted with a diagnosis of bronchiolitis
b.
A 2-year-old toddler admitted for cystic fibrosis
c.
A 9-year-old child hospitalized with a fractured femur
d.
A 15-year-old adolescent admitted for abdominal pain
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ANS: B Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. Young infants are not as likely to be frightened as toddlers by hospitalization because they are not as aware of the environment. The 9-year-old childs cognitive ability is sufficient enough for the child to understand the reason for the hospitalization. The 15-year-old adolescent has the cognitive ability to interpret the reason for the hospitalization. DIF: Cognitive Level: Comprehension REF: p. 56 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 8. Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of inheritance for the disease? a.
My babies will probably not have neurofibromatosis.
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b.
My babies have a 50% chance of having neurofibromatosis.
c.
Whether my babies have problems depends on the father.
d.
My babies have a 25% chance of having neurofibromatosis.
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ANS: B Neurofibromatosis is an autosomal dominant genetic disorder that occurs when the abnormal gene is carried on the affected chromosome with a normal gene. Because the abnormal gene is dominant, an individual with the defective gene has a 50% chance of transmitting the defect to an infant with each pregnancy. Neurofibromatosis is not a sex-linked genetic disease; therefore, either the father or the mother genetically transfers it to the infant. A parent with the defective gene will genetically transfer either a normal or abnormal gene to an infant. Because the defective gene is dominant, there is a 50% probability of the child inheriting the disease. DIF: Cognitive Level: Application REF: p. 61 OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance 9. During a routine healthcare visit, a parent asks the nurse why her 9-month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates an understanding of child development? Shes a little slow.
b.
If she is pulling up, you can help her by holding her hand.
c.
Babies progress at different rates. Your infants development is within normal limits.
d.
Maybe she needs to see a behavioral specialist.
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ANS: C Ninety percent of infants walk by 14 months of age. The infant is within normal developmental limits. It is inappropriate for the nurse to state that the infant is a little slow. Infants will walk when they are developmentally ready. Hurrying an infant does not result in the developmental task being achieved at an earlier time period. Consulting a behavioral specialist for diagnostic evaluation is indicated when a child demonstrates developmental delays. The child has no evidence of a delay. DIF: Cognitive Level: Application REF: p. 52 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 10. Which expected outcome would be developmentally appropriate for a hospitalized 4-year-old child? a.
The child will be dressed and fed by the parents.
b.
The child will independently ask for play materials or other personal needs.
c.
The child will be able to verbalize an understanding of the reason for the hospitalization.
d.
The child will have a parent stay in the room at all times.
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ANS: B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrate developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4year-old child cannot be expected to cognitively understand the reason for his or her hospitalization. Expecting the child to verbalize an understanding for the hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times. DIF: Cognitive Level: Application REF: p. 55 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 11. A nurse has completed a teaching session with parents of preschool aged children. Which statement made by the parent identifies an appropriate level of language development for a 4year-old child? The child has a vocabulary of 300 words and uses simple sentences.
b.
The child uses correct grammar in sentences.
c.
The child is able to pronounce consonants clearly.
d.
The child uses language to express abstract thought.
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a.
The childs height and weight
b.
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ANS: B The 4-year-old child is able to use correct grammar in sentence structure and typically has difficulty in pronouncing consonants. Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child. The use of language to express abstract thought is developmentally appropriate for the adolescent. DIF: Cognitive Level: Application REF: p. 58 OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance 12. Which should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)?
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The parents ability to comprehend the results
c.
The childs mood
d.
The parentchild interaction
ANS: C The results of the screening test are valid if the child acted in a normal and expected manner. The childs height and weight are not relevant to the DDST-II screening process. The parents ability to understand the results of the screening is not relevant to the validity of the test. The parentchild interaction is not significantly relevant to the test results. DIF: Cognitive Level: Application REF: p. 65
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OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance 13. Which children are at greater risk for not receiving immunizations? Children who attend licensed day care programs
b.
Children entering school
c.
Children who are home schooled
d.
Young adults entering college
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ANS: C Home schooled children are at risk for being underimmunized and need to be monitored. All states require immunizations for children in day care programs and entering school. Most colleges require a record of immunizations as part of a health history. DIF: Cognitive Level: Comprehension REF: p. 70 OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance 14. Which developmental assessment instrument is appropriate to assess a 5-year-old child? Brazelton Behavioral Scale
b.
Denver Developmental Screening Test II (DDST-II)
c.
Dubowitz Scale
d.
New Ballard Scale
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ANS: B The DDST-II is used for infants and children between birth and 6 years of age. Brazeltons Behavioral Scale is used for newborn assessment. The Dubowitz Scale is used for estimation of gestational age. The New Ballard Scale is used for newborn screening. DIF: Cognitive Level: Application REF: p. 65 OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance 15. A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? DTaP, Hib, HepB, IPV, varicella
b.
DTaP, Hib, HepB, MMR, IPV
c.
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a.
d.
DTaP, Hib, HepB, PCV, IPV, HepA
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DTaP, Hib, HepB, PCV, IPV, rotavirus
ANS: C DTaP, Hib, HepB, PCV, IPV, and rotavirus are appropriate immunizations for an unimmunized 2month-old child. The child should not receive varicella until at or after 12 months of age. MMR is not given to children until at or after 12 months of age. HepA is recommended for all children at 1 year of age. DIF: Cognitive Level: Application REF: pp. 68-69 OBJ: Nursing Process Step: Analysis MSC: Health Promotion and Maintenance
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DTaP
b.
HepA
c.
IPV
d.
Varicella
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16. You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunization cannot be given?
b.
DTaP
c.
Hib
d.
MMR
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LD
ANS: D Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine, and should not be given except in special circumstances. DTaP, HepA, and IPV can be safely given. DIF: Cognitive Level: Analysis REF: p. 71 OBJ: Nursing Process Step: Planning MSC: Physiological Integrity 17. Which immunization can cause fever and rash to occur 1 to 2 weeks after administration?
R
SI
N
G
TE
ANS: D MMR is a live virus vaccine and can cause fever and rash 1 to 2 weeks after administration. HepB, DTaP, and Hib do not cause fever or rash. DIF: Cognitive Level: Application REF: p. 70 OBJ: Nursing Process Step: Analysis MSC: Physiological Integrity MULTIPLE RESPONSE 1. The nurse is preparing immunizations for a healthy 11-year-old boy who has received all his primary immunizations. Which immunizations will the nurse consider? Select all that apply. Meningococcal
b.
DTaP
c.
.N
U
a.
d.
Smallpox
W W W
OPV
ANS: A, B Meningococcal conjugate vaccine should be given to all children at age 11 to 12 years. The American Academy of Pediatrics recommends one dose of DTaP vaccine for children at age 11 to 12 years, as long as they have received the primary DTaP series. Oral polio vaccine is no longer administered in the U.S. The current smallpox vaccine is not recommended for healthy, low-risk children younger than 18 years of age. DIF: Cognitive Level: Application REF: pp. 68-69
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