Chapter 1: Approach to Care and Assessment of Children and Adolescents MULTIPLE CHOICE
1. A nurse is reviewing developmental concepts for infants and
... [Show More] 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
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.
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.
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
1 | P a g erequires 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.
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 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
b. formal operations
c. concrete operations
d. preoperational
ANS: C
2 | P a g eConcrete 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.
5. The theorist who viewed developmental progression as a lifelong series of conflicts that
need resolution is:
a. Erikson.
b. Freud.
c. Kohlberg.
d. 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 this thinking progresses and differs from adult thinking. Stages of his theory
include sensorimotor, preoperations, concrete operations, and formal operations.
6. What does the nurse need to know when observing chronically ill children at play?
a. 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.
ANS: C
3 | P a g ePlay 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
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
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 autosomal dominant genetic disorder) best demonstrates an understanding of the
mechanism of inheritance for the disease?
a. My babies will probably not have neurofibromatosis.
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.
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
4 | P a g egene 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?
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
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.
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.
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
5 | P a g ehave 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 4-
year-old child?
a. 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.
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.
12. Which should the nurse evaluate before administering the Denver Developmental
Screening Test II (DDST-II)?
a. The childs height and weight
b. 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.
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
6 | P a g eANS: 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.
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)
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
d. DTaP, Hib, HepB, PCV, IPV, HepA
ANS: C
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?
a. DTaP
b. HepA
c. IPV
7 | P a g ed. Varicella
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.
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?
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
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.
19. Which behavior suggests appropriate psychosocial development in the adolescent?
a. The adolescent seeks validation for socially acceptable behavior from
older adults.
8 | P a g eb. 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?
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
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.
21. Which factor contributes to early adolescents engaging in risk-taking behaviors?
a. 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
9 | P a g eANS: 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.
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
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
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 primary immunizations. Which immunizations will the nurse consider? Select all that
apply.
10 | P a g ea. 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.
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.
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 in
cloth may also provide comfort for inflamed gums. Nurses should explain to parents that over-
the-counter topical medications for gum pain relief should be used only as directed. Home
remedies, such as rubbing the gums with whiskey or aspirin, should be discouraged, but
acetaminophen administered as directed for the childs age can relieve discomfort.
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
11 | P a g emotor milestone attained.
a. Turns from abdomen to back
b. Lifts head off of bed when in a prone position
c. Walks holding on to furniture
d. Turns from back to abdomen
e. Sits unsupported
ANS:
B, A, D, E, C
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.
Chapter 2. Physical Assessment Parameters
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 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.
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.
12 | P a g ec. 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
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.
3. In which section of the health history should the nurse record that the parent brought
the infant to the clinic today because of frequent diarrhea?
a. Review of systems
b. Chief complaint
c. Lifestyle and life patterns
d. Health history
ANS: B
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
systems. Lifestyle and life patterns include the childs interaction with the social, psychological,
physical, and cultural environment. Health history includes birth history, growth and
development, common childhood illnesses, immunizations, hospitalizations, injuries, and allergies.
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.
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
13 | P a g ecircumference 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.
5. A nurse is conducting an assessment on a child during a well-child visit. Which of
the following includes the components of a complete pediatric history?
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
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 problem- oriented history includes
specific information about the chief complaint. Pertinent developmental and family information
are part of the complete history.
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.
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 an accurate measurement of a childs blood pressure, the cuff should cover which
portion of the childs upper arm?
a. Two-thirds
14 | P a g eb. Three-fourths c. One-half d. One-third
ANS: A
The blood pressure cuff should cover two-thirds of the childs upper arm to get an accurate 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 reading.
8. Which chart should the nurse use to assess the visual acuity of an 8-year-old child? a. Lea chart [Show Less]