Pediatric Physical Examination An Illustrated Handbook 3rd Edition Duderstadt Test Bank by rnstudent

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Pediatric Physical Examination 3rd Edition Duderstadt TESTBANK Chapter 1: Approach to Care and Assessment of Children and Adolescents

O M

MULTIPLE CHOICE

1. A nurse is reviewing developmental concepts for infants and children. Which statement best

describes development in infants and children?

O R

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

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.

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2. Frequent developmental assessments are important for which reason? a. 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

O M

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

O R

pattern on the basis of each individuals abilities and potentials.

3. Which factor has the greatest influence on child growth and development?

a. Culture b. Environment

c. Genetics

d. Nutrition

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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eliminate the effect of genetics. Nutrition is critical for growth and plays a significant role throughout childhood. 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. a. sensorimotor

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b. formal operations c. concrete operations

O M

d. preoperational

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

O R

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.

5. The theorist who viewed developmental progression as a lifelong series of conflicts that need

resolution is:

a. Erikson.

b. Freud.

U .N

W W W

ANS: A

d. Piaget.

c. Kohlberg.

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

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theory closely parallels Piagets. Jean Piagets cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory

6. What does the nurse need to know when observing chronically ill children at play?

a. Play is not important to hospitalized children.

O M

include sensorimotor, preoperations, concrete operations, and formal operations.

d. Play is to be discouraged because it tires hospitalized children.

O R

c. Childrens play is an indication of a childs response to treatment.

b. Children need to have structured play periods.

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.

7. Which child is most likely to be frightened by hospitalization?

a. 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

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d. A 15-year-old adolescent admitted for abdominal pain 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

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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. 8. Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an

O M

autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of

inheritance for the disease?

a. My babies will probably not have neurofibromatosis.

c. Whether my babies have problems depends on the father.

d. My babies have a 25% chance of having neurofibromatosis.

O R

b. My babies have a 50% chance of having neurofibromatosis.

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.

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?

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a. 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. ANS: C

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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

O M

evaluation is indicated when a child demonstrates developmental delays. The child has no

evidence of a delay.

10. Which expected outcome would be developmentally appropriate for a hospitalized 4-year-old

O R

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.

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 4-

year-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

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have the support structure to stay in the room with the child at all times. 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? a. The child has a vocabulary of 300 words and uses simple sentences. b. The child uses correct grammar in sentences.

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c. The child is able to pronounce consonants clearly. d. The child uses language to express abstract thought.

O M

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

O R

developmentally appropriate for the adolescent.

12. Which should the nurse evaluate before administering the Denver Developmental Screening

Test II (DDST-II)?

b. The parents ability to comprehend the results

a. The childs height and weight

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.

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13. Which children are at greater risk for not receiving immunizations? a. Children who attend licensed day care programs b. Children entering school c. Children who are home schooled d. Young adults entering college ANS: C

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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.

O M

14. Which developmental assessment instrument is appropriate to assess a 5-year-old child?

a. Brazelton Behavioral Scale

b. Denver Developmental Screening Test II (DDST-II)

O R

c. Dubowitz Scale

d. New Ballard Scale

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. 15. A 2-month-old child has not received any immunizations. Which immunizations should the

nurse give?

a. DTaP, Hib, HepB, IPV, varicella

b. DTaP, Hib, HepB, MMR, IPV

c. DTaP, Hib, HepB, PCV, IPV, rotavirus

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ANS: C

d. DTaP, Hib, HepB, PCV, IPV, HepA

DTaP, Hib, HepB, PCV, IPV, and rotavirus are appropriate immunizations for an unimmunized 2-month-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. 16. You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunization cannot be given?

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a. DTaP b. HepA c. IPV

O M

d. Varicella

ANS: D

Children who are immunologically compromised should not receive live viral vaccines. Varicella

O R

is a live vaccine, and should not be given except in special circumstances. DTaP, HepA, and IPV

can be safely given.

17. Which immunization can cause fever and rash to occur 1 to 2 weeks after administration?

a. HepB

b. DTaP

c. Hib

d. MMR

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.

18. A nurse is teaching an adolescent about Tanner stages. Which statement best describes

Tanner staging?

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a. 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

ANS: C

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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 basis of Tanner staging.

19. Which behavior suggests appropriate psychosocial development in the adolescent?

O M

puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the

O R

a. 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.

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.

20. 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?

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a. Your teenager needs clearer and stricter limits about her behavior. 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.

ANS: C

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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

21. Which factor contributes to early adolescents engaging in risk-taking behaviors?

O M

situation.

a. Peer pressure

c. Engagement in the process of separation from their parents

d. A belief that they are invulnerable

O R

b. A desire to master their environment

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.

22. Which statement is the most appropriate advice to give parents of a 16-year-old teenager who

is rebellious?

a. You need to be stricter so that your teenager feels more secure.

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b. You need to allow your teenager to make realistic choices while using consistent and structured discipline. 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.

ANS: B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Setting stricter limits

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typically does not decrease rebelliousness or increase feelings of security. Increasing peer involvement does not typically increase self-esteem. Allowing teenagers to choose the method of

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discipline is not realistic and typically does not reduce rebelliousness.

MULTIPLE RESPONSE

1. The nurse is preparing immunizations for a healthy 11-year-old boy who has received all his

O R

primary immunizations. Which immunizations will the nurse consider? Select all that apply.

a. Meningococcal

b. DTaP c. OPV

d. Smallpox

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.

2. Parents of a 4-month-old child ask the nurse what they can do to help relieve the discomfort of

teething. The nurse should include which suggestions for the parents? Select all that apply.

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a. Provide warm liquids. b. Rub the gums with aspirin. c. Over-the-counter topical medications for gum pain relief can be used as directed. d. Administer acetaminophen (Tylenol) as directed. e. Provide a hard food such as a frozen bagel for chewing.

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ANS: C, D, E To help parents cope with teething, nurses can suggest that they provide cool liquids and hard foods (e.g., dry toast, Popsicles, frozen bagels) for chewing. Hard, cold teethers and ice wrapped

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in cloth may also provide comfort for inflamed gums. Nurses should explain to parents that overthe-counter topical medications for gum pain relief should be used only as directed. Home

acetaminophen administered as directed for the childs age can relieve discomfort.

remedies, such as rubbing the gums with whiskey or aspirin, should be discouraged, but

O R

OTHER

1. Place in order the gross motor developmental milestones a nurse expects to assess in an infant.

Begin with the earliest gross motor milestone expected and progress to the last gross motor

milestone attained.

a. Turns from abdomen to back

b. Lifts head off of bed when in a prone position

d. Turns from back to abdomen

c. Walks holding on to furniture

e. Sits unsupported

B, A, D, E, C

ANS:

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The infant lifts its head off of the bed when in a prone position at 3 months, turns from abdomen

to back at 4 to 5 months, turns from back to abdomen at 6 to 7 months, sits unsupported at 8 to 9 months, and can walk holding on to furniture at 10 to 12 months.

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