Description

Wong’s Nursing Care of Infants and Children 11th Edition Hockenberry Test Bank

Chapter 1.Perspectives of Pediatric Nursing
MULTIPLE CHOICE
1. The clinic nurse is reviewing statistics on infant mortality for the United States versus other
countries. Compared with other countries that have a population of at least 25 million, the nurse
makes which determination?
a. The United States is ranked last among 27 countries.
b. The United States is ranked similar to 20 other developed countries.
c. The United States is ranked in the middle of 20 other developed countries.
d. The United States is ranked highest among 27 other industrialized countries.
ANS: A
Although the death rate has decreased, the United States still ranks last in infant mortality among
nations with a population of at least 25 million. The United States has the highest infant death
rate of developed nations.
DIF: Cognitive Level: Remembering REF: MCS: 6
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
2. Which is the leading cause of death in infants younger than 1 year in the United States?
a. Congenital anomalies
b. Sudden infant death syndrome
c. Disorders related to short gestation and low birth weight
d. Maternal complications specific to the perinatal period
ANS: A
Congenital anomalies account for 20.1% of deaths in infants younger than 1 year compared with
sudden infant death syndrome, which accounts for 8.2%; disorders related to short gestation and
unspecified low birth weight, which account for 16.5%; and maternal complications such as
infections specific to the perinatal period, which account for 6.1% of deaths in infants younger
than 1 year of age.
DIF: Cognitive Level: Remembering REF: MCS: 7 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
3. What is the major cause of death for children older than 1 year in the United States?
a. Heart disease
b. Childhood cancer
c. Unintentional injuries
d. Congenital anomalies
ANS: C
Unintentional injuries (accidents) are the leading cause of death after age 1 year through
adolescence. The leading cause of death for those younger than 1 year is congenital anomalies,
and childhood cancers and heart disease cause a significantly lower percentage of deaths in
children older than 1 year of age.
DIF: Cognitive Level: Understanding REF: MCS: 7 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
4. In addition to injuries, what are the leading causes of death in adolescents ages 15 to 19 years?
a. Suicide and cancer
b. Suicide and homicide
c. Drowning and cancer
d. Homicide and heart disease
ANS: B
Suicide and homicide account for 16.7% of deaths in this age group. Suicide and cancer account
for 10.9% of deaths, heart disease and cancer account for approximately 5.5%, and homicide and
heart disease account for 10.9% of the deaths in this age group.
DIF: Cognitive Level: Remembering REF: MCS: 7 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
5. The nurse is planning a teaching session to adolescents about deaths by unintentional injuries.
Which should the nurse include in the session with regard to deaths caused by injuries?
a. More deaths occur in males.
b. More deaths occur in females.
c. The pattern of deaths does not vary according to age and sex.
d. The pattern of deaths does not vary widely among different ethnic groups.
ANS: A
The majority of deaths from unintentional injuries occur in males. The pattern of death does vary
greatly among different ethnic groups, and the causes of unintentional deaths vary with age and
gender.
DIF: Cognitive Level: Applying REF: pp. 7-8
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
6. What do mortality statistics describe?
a. Disease occurring regularly within a geographic location
b. The number of individuals who have died over a specific period
c. The prevalence of specific illness in the population at a particular time
d. Disease occurring in more than the number of expected cases in a community
ANS: B
Mortality statistics refer to the number of individuals who have died over a specific period.
Morbidity statistics show the prevalence of specific illness in the population at a particular time.
Data regarding disease within a geographic region, or in greater than expected numbers in a
community, may be extrapolated from analyzing the morbidity statistics.
DIF: Cognitive Level: Remembering REF: MCS: 3 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
7. The nurse should assess which age group for suicide ideation since suicide in which age group
is the third leading cause of death?
a. Preschoolers
b. Young school age
c. Middle school age
d. Late school age and adolescents
ANS: D
Suicide is the third leading cause of death in children ages 10 to 19 years; therefore, the age
group should be late school age and adolescents. Suicide is not one of the leading causes of death
for preschool and young or middle school-aged children.
DIF: Cognitive Level: Understanding REF: MCS: 6
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
8. Parents of a hospitalized toddler ask the nurse, What is meant by family-centered care? The
nurse should respond with which statement?
a. Family-centered care reduces the effect of cultural diversity on the family.
b. Family-centered care encourages family dependence on the health care system.
c. Family-centered care recognizes that the family is the constant in a childs life.
d. Family-centered care avoids expecting families to be part of the decision-making
process.
ANS: C
The three key components of family-centered care are respect, collaboration, and support.
Family-centered care recognizes the family as the constant in the childs life. The family should
be enabled and empowered to work with the health care system and is expected to be part of the
decision-making process. The nurse should also support the familys cultural diversity, not reduce
its effect.
DIF: Cognitive Level: Applying REF: MCS: 8
TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
9. The nurse is describing clinical reasoning to a group of nursing students. Which is most
descriptive of clinical reasoning?
a. Purposeful and goal directed
b. A simple developmental process
c. Based on deliberate and irrational thought
d. Assists individuals in guessing what is most appropriate
ANS: A
Clinical reasoning is a complex developmental process based on rational and deliberate thought.
When thinking is clear, precise, accurate, relevant, consistent, and fair, a logical connection
develops between the elements of thought and the problem at hand.
DIF: Cognitive Level: Applying REF: MCS: 12
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
10. Evidence-based practice (EBP), a decision-making model, is best described as which?
a. Using information in textbooks to guide care
b. Combining knowledge with clinical experience and intuition
c. Using a professional code of ethics as a means for decision making
d. Gathering all evidence that applies to the childs health and family situation
ANS: B
EBP helps focus on measurable outcomes; the use of demonstrated, effective interventions; and
questioning what is the best approach. EBP involves decision making based on data, not all
evidence on a particular situation, and involves the latest available data. Nurses can use
textbooks to determine areas of concern and potential involvement.
DIF: Cognitive Level: Remembering REF: MCS: 11 TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
11. Which best describes signs and symptoms as part of a nursing diagnosis?
a. Description of potential risk factors
b. Identification of actual health problems
c. Human response to state of illness or health
d. Cues and clusters derived from patient assessment
ANS: D
Signs and symptoms are the cues and clusters of defining characteristics that are derived from a
patient assessment and indicate actual health problems. The first part of the nursing diagnosis is
the problem statement, also known as the human response to the state of illness or health. The
identification of actual health problems may be part of the medical diagnosis. The nursing
diagnosis is based on the human response to these problems. The human response is therefore a
component of the nursing diagnostic statement. Potential risk factors are used to identify nursing
care needs to avoid the development of an actual health problem when a potential one exists.
DIF: Cognitive Level: Understanding REF: MCS: 13
TOP: Integrated Process: Communication and Documentation
MSC: Client Needs: Safe and Effective Care Environment
12. The nurse is talking to a group of parents of school-age children at an after-school program
about childhood health problems. Which statement should the nurse include in the teaching?
a. Childhood obesity is the most common nutritional problem among children.
b. Immunization rates are the same among children of different races and ethnicity.
c. Dental caries is not a problem commonly seen in children since the introduction
of fluoridated water.
d. Mental health problems are typically not seen in school-age children but may be
diagnosed in adolescents.
ANS: A
When teaching parents of school-age children about childhood health problems, the nurse should
include information about childhood obesity because it is the most common problem among
children and is associated with type 2 diabetes. Teaching parents about ways to prevent obesity is
important to include. Immunization rates differ depending on the childs race and ethnicity; dental
caries continues to be a common chronic disease in childhood; and mental health problems are
seen in children as young as school age, not just in adolescents.
DIF: Cognitive Level: Applying REF: MCS: 3
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
13. The nurse is planning care for a hospitalized preschool-aged child. Which should the nurse
plan to ensure atraumatic care?
a. Limit explanation of procedures because the child is preschool aged.
b. Ask that all family members leave the room when performing procedures.
c. Allow the child to choose the type of juice to drink with the administration of oral
medications.
d. Explain that EMLA cream cannot be used for the morning lab draw because there
is not time for it to be effective.
ANS: C
The overriding goal in providing atraumatic care is first, do no harm. Allowing the child a choice
of juice to drink when taking oral medications provides the child with a sense of control. The
preschool child should be prepared before procedures, so limiting explanations of procedures
would increase anxiety. The family should be allowed to stay with the child during procedures,
minimizing stress. Lidocaine/prilocaine (EMLA) cream is a topical local anesthetic. The nurse
should plan to use the prescribed cream in time for morning laboratory draws to minimize pain.
DIF: Cognitive Level: Applying REF: pp. 8-9 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
14. Which situation denotes a nontherapeutic nursepatientfamily relationship?
a. The nurse is planning to read a favorite fairy tale to a patient.
b. During shift report, the nurse is criticizing parents for not visiting their child.
c. The nurse is discussing with a fellow nurse the emotional draw to a certain
patient.
d. The nurse is working with a family to find ways to decrease the familys
dependence on health care providers.
ANS: B
Criticizing parents for not visiting in shift report is nontherapeutic and shows an
underinvolvement with the parents. Reading a fairy tale is a therapeutic and age appropriate
action. Discussing feelings of an emotional draw with a fellow nurse is therapeutic and shows a
willingness to understand feelings. Working with parents to decrease dependence on health care
providers is therapeutic and helps to empower the family.
DIF: Cognitive Level: Analyzing REF: MCS: 9 TOP: Integrated Process: Caring
MSC: Client Needs: Psychosocial Integrity
15. The nurse is aware that which age group is at risk for childhood injury because of the
cognitive characteristic of magical and egocentric thinking?
a. Preschool
b. Young school age
c. Middle school age
d. Adolescent
ANS: A
Preschool children have the cognitive characteristic of magical and egocentric thinking, meaning
they are unable to comprehend danger to self or others. Young and middle school-aged children
have transitional cognitive processes, and they may attempt dangerous acts without detailed
planning but recognize danger to themselves or others. Adolescents have formal operational
cognitive processes and are preoccupied with abstract thinking.
DIF: Cognitive Level: Understanding REF: MCS: 4
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
16. The school nurse is assessing children for risk factors related to childhood injuries. Which
child has the most risk factors related to childhood injury?
a. Female, multiple siblings, stable home life
b. Male, high activity level, stressful home life
c. Male, even tempered, history of previous injuries
d. Female, reacts negatively to new situations, no serious previous injuries
ANS: B
Boys have a preponderance for injuries over girls because of a difference in behavioral
characteristics, a high activity temperament is associated with risk-taking behaviors, and stress
predisposes children to increased risk taking and self-destructive behaviors. Therefore, a male
child with a high activity level and living in a stressful environment has the highest number of
risk factors. A girl with several siblings and a stable home life is low risk. A boy with previous
injuries has two risk factors, but an even temper is not a risk factor for injuries. A girl who reacts
negatively to new situations but has no previous serious illnesses has only one risk factor.
DIF: Cognitive Level: Analyzing REF: MCS: 4
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
17. The school nurse is evaluating the number of school-age children classified as obese. The
nurse recognizes that the percentile of body mass index that classifies a child as obese is greater
than which?
a. 50th percentile
b. 75th percentile
c. 80th percentile
d. 95th percentile
ANS: D
Obesity in children and adolescents is defined as a body mass index at or greater than the 95th
percentile for youth of the same age and gender.
DIF: Cognitive Level: Remembering REF: MCS: 3 TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
18. The nurse is teaching parents about the types of behaviors children exhibit when living with
chronic violence. Which statement made by the parents indicates further teaching is needed?
a. We should watch for aggressive play.
b. Our child may show lasting symptoms of stress.
c. We know that our child will show caring behaviors.
d. Our child may have difficulty concentrating in school.
ANS: C
The statement that the child will show caring behaviors needs further teaching. Children living
with chronic violence may exhibit behaviors such as difficulty concentrating in school, memory
impairment, aggressive play, uncaring behaviors, and lasting symptoms of stress.
DIF: Cognitive Level: Applying REF: MCS: 6
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
19. The nurse is evaluating research studies according to the GRADE criteria and has determined
the quality of evidence on the subject is moderate. Which type of evidence does this
determination indicate?
a. Strong evidence from unbiased observational studies
b. Evidence from randomized clinical trials showed inconsistent results
c. Consistent evidence from well-performed randomized clinical trials
d. Evidence for at least one critical outcome from randomized clinical trials had
serious flaws
ANS: B
Evidence from randomized clinical trials with important limitations indicates that the evidence is
of moderate quality. Strong evidence from unbiased observational studies and consistent
evidence from well-performed randomized clinical trials indicates high quality. Evidence for at
least one critical outcome from randomized clinical trials that has serious flaws indicates low
quality.
DIF: Cognitive Level: Remembering REF: MCS: 12 TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
20. An adolescent patient wants to make decisions about treatment options, along with his
parents. Which moral value is the nurse displaying when supporting the adolescent to make
decisions?
a. Justice
b. Autonomy
c. Beneficence
d. Nonmaleficence
ANS: B
Autonomy is the patients right to be self-governing. The adolescent is trying to be autonomous,
so the nurse is supporting this value. Justice is the concept of fairness. Beneficence is the
obligation to promote the patients well-being. Nonmaleficence is the obligation to minimize or
prevent harm.
DIF: Cognitive Level: Analyzing REF: MCS: 11 TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
21. The nurse manager is compiling a report for a hospital committee on the quality of nursingsensitive
indicators for a nursing unit. Which does the nurse manager include in the report?
a. The average age of the nurses on the unit
b. The salary ranges for the nurses on the unit
c. The education and certification of the nurses on the unit
d. The number of nurses who have applied but were not hired for the unit
ANS: C
Nursing-sensitive indicators reflect the structure, process, and outcomes of nursing care. For
example, the number of nursing staff, the skill level of the nursing staff, and the education and
certification of nursing staff indicate the structure of nursing care. The average age of the nurses,
salary range, and number of nurses who have applied but were not hired for the unit are not
nursing-sensitive indicators.
DIF: Cognitive Level: Applying REF: MCS: 15
TOP: Integrated Process: Communication and Documentation
MSC: Client Needs: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. Which responsibilities are included in the pediatric nurses promotion of the health and wellbeing
of children? (Select all that apply.)
a. Promoting disease prevention
b. Providing financial assistance
c. Providing support and counseling
d. Establishing lifelong friendships
e. Establishing a therapeutic relationship
f. Participating in ethical decision making
ANS: A, C, E, F
The pediatric nurses role includes promoting disease prevention, providing support and
counseling, establishing a therapeutic relationship, and participating in ethical decision making; a
pediatric nurse does not need to establish lifelong friendships or provide financial assistance to
children and their families. Boundaries should be set and clear.
DIF: Cognitive Level: Applying REF: pp. 9-11 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
2. The nurse is conducting a teaching session for parents on nutrition. Which characteristics of
families should the nurse consider that can cause families to struggle in providing adequate
nutrition? (Select all that apply.)
a. Homelessness
b. Lower income
c. Migrant status
d. Working parents
e. Single parent status
ANS: A, B, C
Families that struggle with lower incomes, homelessness, and migrant status generally lack the
resources to provide their children with adequate food intake, nutritious foods such as fresh fruits
and vegetables, and appropriate protein intake. Working parents and single parent status do not
mean the families will struggle to provide adequate nutrition.
DIF: Cognitive Level: Applying REF: MCS: 2
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
3. The nurse is preparing to complete documentation on a patients chart. Which should be
included in documentation of nursing care? (Select all that apply.)
a. Reassessments
b. Incident reports
c. Initial assessments
d. Nursing care provided
e. Patients response of care provided
ANS: A, C, D, E
The patients medical record should include: initial assessments, reassessments, nursing care
provided, and the patients response of care provided. Incident reports are not documented in the
patients chart.
DIF: Cognitive Level: Applying REF: MCS: 14
TOP: Integrated Process: Communication and Documentation
MSC: Client Needs: Safe and Effective Care Environment
4. Which actions by the nurse demonstrate overinvolvement with patients and their families?
(Select all that apply.)
a. Buying clothes for the patients
b. Showing favoritism toward a patient
c. Focusing on technical aspects of care
d. Spending off-duty time with patients and families
e. Asking questions if families are not participating in care
ANS: A, B, D
Actions that show overinvolvement include buying clothes for patients, showing favoritism
toward a patient, and spending off-duty time with patients and families. Focusing on technical
aspects of care is an action that indicates underinvolvement, and asking questions if families are
not participating in care indicates a positive action.
DIF: Cognitive Level: Analyzing REF: pp. 9-10 TOP: Integrated Process: Caring
MSC: Client Needs: Health Promotion and Maintenance
5. Which are included in the evaluation step of the nursing process? (Select all that apply.)
a. Determination if the outcome has been met
b. Ascertaining if the plan requires modification
c. Establish priorities and selecting expected patient goals
d. Selecting alternative interventions if the outcome has not been met
e. Determining if a risk or actual dysfunctional health problem exists
ANS: A, B, D
Evaluation is the last step in the nursing process. The nurse gathers, sorts, and analyzes data to
determine whether (1) the established outcome has been met, (2) the nursing interventions were
appropriate, (3) the plan requires modification, or (4) other alternatives should be considered.
Establishing priorities and selecting expected patient goals are done in the outcomes
identification stage. Determining if a risk or actual dysfunctional health problem exists is done in
the diagnosis stage of the nursing process.
DIF: Cognitive Level: Understanding REF: MCS: 14 TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
6. Which should the nurse teach to parents regarding oral health of children? (Select all that
apply.)
a. Fluoridated water should be used.
b. Early childhood caries is a preventable disease.
c. Dental caries is a rare chronic disease of childhood.
d. Dental hygiene should begin with the first tooth eruption.
e. Childhood caries does not happen until after 2 years of age.
ANS: A, B, D
Oral health instructions to parents of children should include use of fluoridated water and dental
hygiene beginning with the first tooth eruption. In addition, early childhood caries is a
preventable disease and should be included in the teaching session. Dental caries is a common,
not rare, chronic disease of childhood. Childhood caries may begin before the first birthday.
DIF: Cognitive Level: Applying REF: MCS: 2
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
7. The school nurse is explaining to older school children that obesity increases the risk for
which disorders? (Select all that apply.)
a. Asthma
b. Hypertension
c. Dyslipidemia
d. Irritable bowel disease
e. Altered glucose metabolism
ANS: B, C, E
Overweight youth have increased risk for a cluster of cardiovascular factors that include
hypertension, altered glucose metabolism, and dyslipidemia. Irritable bowel disease and asthma
are not linked to obesity.
DIF: Cognitive Level: Applying REF: MCS: 3
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
8. The nurse is reviewing the Healthy People 2020 leading health indicators for a child health
promotion program. Which are included in the leading health indicators? (Select all that apply.)
a. Decrease tobacco use.
b. Improve immunization rates.
c. Reduce incidences of cancer.
d. Increase access to health care.
e. Decrease the number of eating disorders.
ANS: A, B, D
The Healthy People 2020 leading health indicators provide a framework for identifying essential
components for child health promotion programs designed to prevent future health problems in
our nations children. Some of the leading health indicators include decreasing tobacco use,
improving immunization rates, and increasing access to health care. Reducing the incidence of
cancer and decreasing the number of eating disorders are not on the list as leading health
indicators.
DIF: Cognitive Level: Analyzing REF: MCS: 2 TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
9. Which actions by the nurse demonstrate clinical reasoning? (Select all that apply.)
a. Basing decisions on intuition
b. Considering alternative action
c. Using formal and informal thinking to gather data
d. Giving deliberate thought to a patients problem
e. Developing an outcome focused on optimum patient care
ANS: B, C, D, E
Clinical reasoning is a cognitive process that uses formal and informal thinking to gather and
analyze patient data, evaluate the significance of the information, and consider alternative
actions. Clinical reasoning is a complex developmental process based on rational and deliberate
thought and developing an outcome focused on optimum patient care. Clinical reasoning is based
on the scientific method of inquiry; it is not based solely on intuition.
Chapter 2.Social, Cultural, Religious, and Family Influences on Child Health Promotion
MULTIPLE CHOICE
1. Children are taught the values of their culture through observation and feedback relative to
their own behavior. In teaching a class on cultural competence, the nurse should be aware that
which factor may be culturally determined?
a. Ethnicity
b. Racial variation
c. Status
d. Geographic boundaries
ANS: C
Status is culturally determined and varies according to each culture. Some cultures ascribe higher
status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity
is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It
is one component of culture. Race and culture are two distinct attributes. Whereas racial
grouping describes transmissible traits, culture is determined by the pattern of assumptions,
beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of
people. Cultural development may be limited by geographic boundaries, but the boundaries are
not culturally determined.
DIF: Cognitive Level: Analyzing REF:
MCS: 39 TOP: Integrated Process:
Teaching/Learning MSC: Client Needs:
2P.syTchheo nsoucrsiael i Isn atwegarriety t hat if patients different cultures are implied to be inferior, the emotional
attitude the nurse is displaying is what?
a. Acculturation
b. Ethnocentrism
c. Cultural shock
d. Cultural sensitivity
ANS: B
Ethnocentrism is the belief that ones way of living and behaving is the best way. This includes
the emotional attitude that the values, beliefs, and perceptions of ones ethnic group are superior
to those of others. Acculturation is the gradual changes that are produced in a culture by the
influence of another culture that cause one or both cultures to become more similar. The minority
culture is forced to learn the majority culture to survive. Cultural shock is the helpless feeling
and state of disorientation felt by an outsider attempting to adapt to a different culture group.
Cultural sensitivity, a component of culturally competent care, is an awareness of cultural
similarities and differences.
DIF: Cognitive Level: Understanding REF: MCS: 35 TOP: Integrated Process: Caring
MSC: Client Needs: Psychosocial Integrity
3. Which term best describes the sharing of common characteristics that differentiates one group
from other groups in a society?
a. Race
b. Culture
c. Ethnicity
d. Superiority
ANS: C
Ethnicity is a classification aimed at grouping individuals who consider themselves, or are
considered by others, to share common characteristics that differentiate them from the other
collectivities in a society, and from which they develop their distinctive cultural behavior. Race
is a term that groups together people by their outward physical appearance. Culture is a pattern
of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and
decisions of a group of people. A culture is composed of individuals who share a set of values,
beliefs, and practices that serve as a frame of reference for individual perception and judgments.
Superiority is the state or quality of being superior; it does not apply to ethnicity.
DIF: Cognitive Level: Understanding REF: MCS: 39
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
4. After the family, which has the greatest influence on providing continuity between
generations?
a. Race
b. School
c. Social class
d. Government
ANS: B
Schools convey a tremendous amount of culture from the older members to the younger
members of society. They prepare children to carry out the traditional social roles that will be
expected of them as adults. Race is defined as a division of humankind possessing traits that are
transmissible by descent and are sufficient to characterize race as a distinct human type; although
race may have an influence on childrearing practices, its role is not as significant as that of
schools. Social class refers to the familys economic and educational levels. The social class of a
family may change between generations. The government establishes parameters for children,
including amount of schooling, but this is usually at a local level. The school culture has the
most significant influence on continuity besides family.
DIF: Cognitive Level: Remembering REF: MCS: 33
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
5. The nurse is planning care for a patient with a different ethnic background. Which should be
an appropriate goal?
a. Adapt, as necessary, ethnic practices to health needs.
b. Attempt, in a nonjudgmental way, to change ethnic beliefs.
c. Encourage continuation of ethnic practices in the hospital setting.
d. Strive to keep ethnic background from influencing health needs.
ANS: A
Whenever possible, nurses should facilitate the integration of ethnic practices into health care
provision. The ethnic background is part of the individual; it should be difficult to eliminate the
influence of ethnic background. The ethnic practices need to be evaluated within the context of
the health care setting to determine whether they are conflicting.
DIF: Cognitive Level: Applying REF: MCS: 34 TOP: Integrated Process: Caring
MSC: Client Needs: Psychosocial Integrity
6. The nurse discovers welts on the back of a Vietnamese child during a home health visit. The
childs mother says she has rubbed the edge of a coin on her childs oiled skin. The nurse should
recognize this as what?
a. Child abuse
b. Cultural practice to rid the body of disease
c. Cultural practice to treat enuresis or temper tantrums
d. Child discipline measure common in the Vietnamese culture
ANS: B
This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the childs
oiled skin. The mother is attempting to rid the childs body of disease. Coining is a cultural
healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse
or discipline.
DIF: Cognitive Level: Understanding REF: MCS: 41
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
7. A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the
child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles,
and juices, are left. Which statement best explains this?
a. The parent is trying to feed the child only what the child likes most.
b. Hispanics believe the evil eye enters when a person gets cold.
c. The parent is trying to restore normal balance through appropriate hot remedies.
d. Hispanics believe an innate energy called chi is strengthened by eating soup.
ANS: C
In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe
certain properties completely unrelated to temperature. Respiratory conditions such as
pneumonia are cold conditions and are treated with hot foods. The child may like broth but is
unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of
imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe
in chi as an innate energy.
DIF: Cognitive Level: Applying REF: MCS: 40
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
8. How is family systems theory best described?
a. The family is viewed as the sum of individual members.
b. A change in one family member cannot create a change in other members.
c. Individual family members are readily identified as the source of a problem.
d. When the family system is disrupted, change can occur at any point in the system.
ANS: D
Family systems theory describes an interactional model. Any change in one member will create
change in others. Although the family is the sum of the individual members, family systems
theory focuses on the number of dyad interactions that can occur. The interactions, not the
individual members, are considered to be the problem.
DIF: Cognitive Level: Analyzing REF: MCS: 18
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
9. Which family theory is described as a series of tasks for the family throughout its life span?
a. Exchange theory
b. Developmental theory
c. Structural-functional theory
d. Symbolic interactional theory
ANS: B
In developmental systems theory, the family is described as a small group, a semiclosed system
of personalities that interact with the larger cultural system. Changes do not occur in one part of
the family without changes in others. Exchange theory assumes that humans, families, and
groups seek rewarding statuses so that rewards are maximized while costs are minimized.
Structural-functional theory states that the family performs at least one societal function while
also meeting family needs. Symbolic interactional theory describes the family as a unit of
interacting persons with each occupying a position within the family.
DIF: Cognitive Level: Remembering REF: MCS: 19
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
10. Which family theory explains how families react to stressful events and suggests factors that
promote adaptation to these events?
a. Interactional theory
b. Family stress theory
c. Eriksons psychosocial theory
d. Developmental systems theory
ANS: B
Family stress theory explains the reaction of families to stressful events. In addition, the theory
helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative,
are cumulative and affect the family. Adaptation requires a change in family structure or
interaction. Interactional theory is not a family theory. Interactions are the basis of general
systems theory. Eriksons theory applies to individual growth and development, not families.
Developmental systems theory is an outgrowth of Duvalls theory. The family is described as a
small group, a semiclosed system of personalities that interact with the larger cultural system.
Changes do not occur in one part of the family without changes in others.
DIF: Cognitive Level: Remembering REF: MCS: 19
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
11. Which type of family should the nurse recognize when the paternal grandmother, the parents,
and two minor children live together?
a. Blended
b. Nuclear
c. Extended
d. Binuclear
ANS: C
An extended family contains at least one parent, one or more children, and one or more members
(related or unrelated) other than a parent or sibling. A blended family contains at least one
stepparent, stepsibling, or half-sibling. A nuclear family consists of two parents and their
children. No other relatives or nonrelatives are present in the household. In binuclear families,
parents continue the parenting role while terminating the spousal unit. For example, when joint
custody is assigned by the court, each parent has equal rights and responsibilities for the minor
child or children.
DIF: Cognitive Level: Remembering REF: pp. 20-21
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
12. Which type of family should the nurse recognize when a mother, her children, and a
stepfather live together?
a. Traditional nuclear
b. Blended
c. Extended
d. Binuclear
ANS: B
A blended family contains at least one stepparent, stepsibling, or half-sibling. A traditional
nuclear family consists of a married couple and their biologic children. No other relatives or
nonrelatives are present in the household. An extended family contains at least one parent, one or
more children, and one or more members (related or unrelated) other than a parent or sibling. In
binuclear families, parents continue the parenting role while terminating the spousal unit. For
example, when joint custody is assigned by the court, each parent has equal rights and
responsibilities for the minor child or children.
DIF: Cognitive Level: Remembering REF: MCS: 20
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
13. Which is an accurate description of homosexual (or gay-lesbian) families?
a. A nurturing environment is lacking.
b. The children become homosexual like their parents.
c. The stability needed to raise healthy children is lacking.
d. The quality of parenting is equivalent to that of nongay parents.
ANS: D
Although gay or lesbian families may be different from heterosexual families, the environment
can be as healthy as any other. Lacking a nurturing environment and stability is reflective on the
parents and family, not the type of family. There is little evidence to support that children
become homosexual like their parents.
DIF: Cognitive Level: Understanding REF: pp. 21-22
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
14. The nurse is teaching a group of new nursing graduates about identifiable qualities of strong
families that help them function effectively. Which quality should be included in the teaching?
a. Lack of congruence among family members
b. Clear set of family values, rules, and beliefs
c. Adoption of one coping strategy that always promotes positive functioning in
dealing with life events
d. Sense of commitment toward growth of individual family members as opposed to
that of the family unit
ANS: B
A clear set of family rules, values, and beliefs that establish expectations about acceptable and
desired behavior is one of the qualities of strong families that help them function effectively.
Strong families have a sense of congruence among family members regarding the value and
importance of assigning time and energy to meet needs. Varied coping strategies are used by
strong families. The sense of commitment is toward the growth and well-being of individual
family members, as well as the family unit.
DIF: Cognitive Level: Applying REF: MCS: 22
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
15. When assessing a family, the nurse determines that the parents exert little or no control over
their children. This style of parenting is called which?
a. Permissive
b. Dictatorial
c. Democratic
d. Authoritarian
ANS: A
Permissive parents avoid imposing their own standards of conduct and allow their children to
regulate their own activity as much as possible. The parents exert little or no control over their
childrens actions. Dictatorial or authoritarian parents attempt to control their childrens behavior
and attitudes through unquestioned mandates. They establish rules and regulations or standards
of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents
combine permissive and dictatorial styles. They direct their childrens behavior and attitudes by
emphasizing the reasons for rules and negatively reinforcing deviations. They respect their
childrens individual natures.
DIF: Cognitive Level: Remembering REF: MCS: 24
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
16. When discussing discipline with the mother of a 4-year-old child, which should the nurse
include?
a. Parental control should be consistent.
b. Withdrawal of love and approval is effective at this age.
c. Children as young as 4 years rarely need to be disciplined.
d. One should expect rules to be followed rigidly and unquestioningly.
ANS: A
For effective discipline, parents must be consistent and must follow through with agreed-on
actions. Withdrawal of love and approval is never appropriate or effective. The 4-year-old child
will test limits and may misbehave. Children of this age do not respond to verbal reasoning.
Realistic goals should be set for this age group. Discipline is necessary to reinforce these goals.
Discipline strategies should be appropriate to the childs age and temperament and the severity of
the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental
capabilities of a 4-year-old child.
DIF: Cognitive Level: Applying REF: MCS: 24
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
17. Which is a consequence of the physical punishment of children, such as spanking?
a. The psychologic impact is usually minimal.
b. The childs development of reasoning increases.
c. Children rarely become accustomed to spanking.
d. Misbehavior is likely to occur when parents are not present.
ANS: D
Through the use of physical punishment, children learn what they should not do. When parents
are not around, it is more likely that children will misbehave because they have not learned to
behave well for their own sake but rather out of fear of punishment. Spanking can cause severe
physical and psychologic injury and interfere with effective parentchild interaction. The use of
corporal punishment may interfere with the childs development of moral reasoning. Children do
become accustomed to spanking, requiring more severe corporal punishment each time.
DIF: Cognitive Level: Analyzing REF:
MCS: 26 TOP: Integrated Process:
Teaching/Learning MSC: Client Needs:
1P8sy. cThhoes opcairaeln Itsn toefg ari tyyo ung child ask the nurse for suggestions about discipline. When discussing
the use of time-outs, which should the nurse include?
a. Send the child to his or her room if the child has one.
b. A general rule for length of time is 1 hour per year of age.
c. Select an area that is safe and nonstimulating, such as a hallway.
d. If the child cries, refuses, or is more disruptive, try another approach.
ANS: C
The area must be nonstimulating and safe. The child becomes bored in this environment and then
changes behavior to rejoin activities. The childs room may have toys and activities that negate
the effect of being separated from the family. The general rule is 1 minute per year of age. An
hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does
not start; the time-out begins when the child quiets.
DIF: Cognitive Level: Remembering REF: MCS: 26
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
19. A 3-year-old child was adopted immediately after birth. The parents have just asked the
nurse how they should tell the child that she is adopted. Which guideline concerning adoption
should the nurse use in planning a response?
a. It is best to wait until the child asks about it.
b. The best time to tell the child is between the ages of 7 and 10 years.
c. It is not necessary to tell a child who was adopted so young.
d. Telling the child is an important aspect of their parental responsibilities.
ANS: D
It is important for the parents not to withhold information about the adoption from the child. It is
an essential component of the childs identity. There is no recommended best time to tell children.
It is believed that children should be told young enough so they do not remember a time when
they did not know. It should be done before the children enter school to prevent third parties
from telling the children before the parents have had the opportunity.
DIF: Cognitive Level: Analyzing REF:
MCS: 27 TOP: Integrated Process:
Teaching/Learning MSC: Client Needs:
Psychosocial Integrity
20. Children may believe that they are responsible for their parents divorce and interpret the
separation as punishment. At which age is this most likely to occur?
a. 1 year
b. 4 years
c. 8 years
d. 13 years
ANS: B
Preschool-age children are most likely to blame themselves for the divorce. A 4-year-old child
will fear abandonment and express bewilderment regarding all human relationships. A 4-year-old
child has magical thinking and believes his or her actions cause consequences, such as divorce.
For infants, divorce may increase their irritability and interfere with the attachment process, but
they are too young to feel responsibility. School-age children will have feelings of deprivation,
including the loss of a parent, attention, money, and a secure future. Adolescents are able to
disengage themselves from the parental conflict.
DIF: Cognitive Level: Analyzing REF: MCS: 29 TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
21. A parent of a school-age child tells the school nurse that the parents are going through a
divorce. The child has not been doing well in school and sometimes has trouble sleeping. The
nurse should recognize this as what?
a. Indicative of maladjustment
b. A common reaction to divorce
c. Suggestive of a lack of adequate parenting
d. An unusual response that indicates a need for referral
ANS: B
Parental divorce affects school-age children in many ways. In addition to difficulties in school,
they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite,
and sleep disorders. The childs responses are common reactions of school-age children to
parental divorce.
DIF: Cognitive Level: Applying REF: MCS: 29
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
22. A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, I
want to go back to work, but I dont want Eric to suffer because Ill have less time with him.
Which is the nurses most appropriate answer?
a. Im sure hell be fine if you get a good babysitter.
b. You will need to stay home until Eric starts school.
c. Lets talk about the child care options that will be best for Eric.
d. You should go back to work so Eric will get used to being with others.
ANS: C
Asking the mother about child care options is an open-ended statement that will assist the mother
in exploring her concerns about what is best for both her and Eric. The other three answers are
directive; they do not address the effect that her working will have on Eric.
DIF: Cognitive Level: Applying REF: MCS: 32
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
23. A foster parent is talking to the nurse about the health care needs for the child who has been
placed in the parents care. Which statement best describes the health care needs of foster
children?
a. Foster children always come from abusive households and are emotionally
fragile.
b. Foster children tend to have a higher than normal incidence of acute and chronic
health problems.
c. Foster children are usually born prematurely and require technologically
advanced health care.
d. Foster children will not stay in the home for an extended period, so health care
needs are not as important as emotional fulfillment.
ANS: B
Children who are placed in foster care have a higher incidence of acute and chronic health
problems and may experience feelings of isolation and confusion; therefore, they should be
monitored closely. Foster children do not always come from abusive households and may or may
not be emotionally fragile; not all foster children are born prematurely or require technically
advanced health care; and foster children may stay in the home for extended periods, so their
health care needs require attention.
DIF: Cognitive Level: Applying REF: MCS: 32
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
24. The nurse is planning to counsel family members as a group to assess the familys group
dynamics. Which theoretic family model is the nurse using as a framework?
a. Feminist theory
b. Family stress theory
c. Family systems theory
d. Developmental theory
ANS: C
In family systems theory, the family is viewed as a system that continually interacts with its
members and the environment. The emphasis is on the interaction between the members; a
change in one family member creates a change in other members, which in turn results in a new
change in the original member. Assessing the familys group dynamics is an example of using
this theory as a framework. Family stress theory explains how families react to stressful events
and suggests factors that promote adaptation to stress. Developmental theory addresses family
change over time using Duvalls family life cycle stages based on the predictable changes in the
familys structure, function, and roles, with the age of the oldest child as the marker for stage
transition. Feminist theories assume that privilege and power are inequitably distributed based
upon gender, race, and class.
DIF: Cognitive Level: Applying REF: MCS: 18 TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
25. The nurse is reviewing the importance of role learning for children. The nurse understands
that childrens roles are primarily shaped by which members?
a. Peers
b. Parents
c. Siblings
d. Grandparents
ANS: B
Childrens roles are shaped primarily by the parents, who apply direct or indirect pressures to
induce or force children into the desired patterns of behavior or direct their efforts toward
modification of the role responses of the child on a mutually acceptable basis.
DIF: Cognitive Level: Analyzing REF: pp. 22-23
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
26. The nurse is caring for an adolescent hospitalized for asthma. The adolescent belongs to a
large family. The nurse recognizes that the adolescent is likely to relate to which group?
a. Peers
b. Parents
c. Siblings
d. Teachers
ANS: A
Adolescents from a large family are more peer oriented than family oriented. Adolescents in
small families identify more strongly with their parents and rely more on them for advice.
DIF: Cognitive Level: Understanding REF: MCS: 23 TOP: Integrated Process: Caring
MSC: Client Needs: Psychosocial Integrity
27. The nurse is explaining different parenting styles to a group of parents. The nurse explains
that an authoritative parenting style can lead to which child behavior?
a. Shyness
b. Self-reliance
c. Submissiveness
d. Self-consciousness
ANS: B
Children raised by parents with an authoritative parenting style tend to have high self-esteem and
are self-reliant, assertive, inquisitive, content, and highly interactive with other children.
Children raised by parents with an authoritarian parenting style tend to be sensitive, shy, selfconscious,
retiring, and submissive.
DIF: Cognitive Level: Applying REF: MCS: 24
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
28. Parents of a preschool child ask the nurse, Should we set rules for our child as part of a
discipline plan? Which is an accurate response by the nurse?
a. It is best to delay the punishment if a rule is broken.
b. The child is too young for rules. At this age, unrestricted freedom is best.
c. It is best to set the rules and reason with the child when the rules are broken.
d. Set clear and reasonable rules and expect the same behavior regardless of the
circumstances.
ANS: D
Nurses can help parents establish realistic and concrete rules. The clearer the limits that are set
and the more consistently they are enforced, the less need there is for disciplinary action.
Delaying punishment weakens its intent. Children want and need limits. Unrestricted freedom is
a threat to their security and safety. Reasoning involves explaining why an act is wrong and is
usually appropriate for older children, especially when moral issues are involved. However,
young children cannot be expected to see the other side because of their egocentrism.
DIF: Cognitive Level: Applying REF: MCS: 25
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
29. The nurse is discussing issues that are important with parents considering a cross-racial
adoption. Which statement made by the parents indicates further teaching is needed?
a. We will try to preserve the adopted childs racial heritage.
b. We are glad we will be getting full medical information when we adopt our child.
c. We will make sure to have everyone realize this is our child and a member of the
family.
d. We understand strangers may make thoughtless comments about our child being
different from us.
ANS: B
In international adoptions, the medical information the parents receive may be incomplete or
sketchy; weight, height, and head circumference are often the only objective information present
in the childs medical record. Further teaching is needed if the parents expect full medical
information. It is advised that parents who adopt children with different ethnic backgrounds do
everything to preserve the adopted childrens racial heritage. Strangers may make thoughtless
comments and talk about the children as though they were not members of the family. It is vital
that family members declare to others that this is their child and a cherished member of the
family.
DIF: Cognitive Level: Applying REF: pp. 27-28
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
30. The school nurse understands that children are impacted by divorce. Which has the most
impact on the positive outcome of a divorce?
a. Age of the child
b. Gender of the child
c. Family characteristics
d. Ongoing family conflict
ANS: C
Family characteristics are more crucial to the childs well-being during a divorce than specific
child characteristics, such as age or sex. High levels of ongoing family conflict are related to
problems of social development, emotional stability, and cognitive skills for the child.
DIF: Cognitive Level: Understanding REF: MCS: 29 TOP: Integrated Process: Caring
MSC: Client Needs: Psychosocial Integrity
31. The nurse is discussing parenting in reconstituted families with a new stepparent. The nurse
is aware that the new stepparent understands the teaching when which statement is made?
a. I am glad there will be no disruption in my lifestyle.
b. I dont think children really want to live in a two-parent home.
c. I realize there may be power conflicts bringing two households together.
d. I understand contact between grandparents should be kept to a minimum.
ANS: C
The entry of a stepparent into a ready-made family requires adjustments for all family members.
Power conflicts are expected, and flexibility, mutual support, and open communication are
critical in successful relationships. So the statement that power conflicts are possible means
teaching was understood. Some obstacles to the role adjustments and family problem solving
include disruption of previous lifestyles and interaction patterns, complexity in the formation of
new ones, and lack of social supports. Most children from divorced families want to live in a
two-parent home. There should be continued contact with grandparents.
DIF: Cognitive Level: Applying REF: MCS: 31
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
1. The nurse is presenting a staff development program about understanding culture in the health
care encounter. Which components should the nurse include in the program? (Select all that
apply.)
a. Cultural humility
b. Cultural research
c. Cultural sensitivity
d. Cultural competency
ANS: A, C, D
There are several different ways health care providers can best attend to all the different facets
that make up an individuals culture. Cultural competence tends to promote building information
about a specific culture. Cultural sensitivity, a second way of understanding culture in the
context of the clinical encounter, may be understood as a way of using ones knowledge,
consideration, understanding, respect, and tailoring after realizing awareness of self and others
and encountering a diverse group or individual. Cultural humility, the third component, is a
commitment and active engagement in a lifelong process that individuals enter into for an
ongoing basis with patients, communities, colleagues, and themselves. Cultural research is not a
component of understanding culture in the health care encounter.
DIF: Cognitive Level: Analyzing REF:
MCS: 38 TOP: Integrated Process:
Teaching/Learning MSC: Client Needs:
2P.syTchheo psoarceianlt sI notfe ag r5it-yy ear-old child ask the nurse how they can minimize misbehavior. Which
responses should the nurse give? (Select all that apply.)
a. Set clear and reasonable goals.
b. Praise your child for desirable behavior.
c. Dont call attention to unacceptable behavior.
d. Teach desirable behavior through your own example.
e. Dont provide an opportunity for your child to have any control.
ANS: A, B, D
To minimize misbehavior, parents should (1) set clear and reasonable rules and expect the same
behavior regardless of the circumstances, (2) praise children for desirable behavior with attention
and verbal approval, and (3) teach desirable behavior through their own example. Parents should
call attention to unacceptable behavior as soon as it begins and provide children with
opportunities for power and control.
DIF: Cognitive Level: Applying REF: MCS: 25
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
3. Which describe the feelings and behaviors of early preschool children related to divorce?
(Select all that apply.)
a. Regressive behavior
b. Fear of abandonment
c. Fear regarding the future
d. Blame themselves for the divorce
e. Intense desire for reconciliation of parents
ANS: A, B, D
Feelings and behaviors of early preschool children related to divorce include regressive behavior,
fear of abandonment, and blaming themselves for the divorce. Fear regarding the future and
intense desire for reconciliation of parents is a reaction later school-age children have to divorce.
DIF: Cognitive Level: Understanding REF: MCS: 29 TOP: Integrated Process: Caring
MSC: Client Needs: Psychosocial Integrity
4. Which describe the feelings and behaviors of adolescents related to divorce? (Select all that
apply.)
a. Disturbed concept of sexuality
b. May withdraw from family and friends
c. Worry about themselves, parents, or siblings
d. Expression of anger, sadness, shame, or embarrassment
e. Engage in fantasy to seek understanding of the divorce
ANS: A, B, C, D
Feelings and behaviors of adolescents related to divorce include a disturbed concept of sexuality;
withdrawing from family and friends; worrying about themselves, parents, and siblings; and
expressions of anger, sadness, shame, and embarrassment. Engaging in fantasy to seek
understanding of the divorce is a reaction by a child who has preconceptual cognitive processes,
not the formal thinking processes adolescents have.
Chapter 3.Hereditary Influences on Health Promotion of the Child and Family
MULTIPLE CHOICE
1. Which genetic term refers to a person who possesses one copy of an affected gene and one
copy of an unaffected gene and is clinically unaffected?
a. Allele
b. Carrier
c. Pedigree
d. Multifactorial
ANS: B
An individual who is a carrier is asymptomatic but possesses a genetic alteration, either in the
form of a gene or chromosome change. Alleles are alternative expressions of genes at a different
locus. A pedigree is a diagram that describes family relationships, gender, disease, status, or
other relevant information about a family. Multifactorial describes a complex interaction of both
genetic and environmental factors that produce an effect on the individual.
DIF: Cognitive Level: Understanding REF: MCS: 46
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
2. Which genetic term refers to the transfer of all or part of a chromosome to a different
chromosome after chromosome breakage?
a. Trisomy
b. Monosomy
c. Translocation
d. Nondisjunction
ANS: C
Translocation is the transfer of all or part of a chromosome to a different chromosome after
chromosome breakage. It can be balanced, producing no phenotypic effects, or unbalanced,
producing severe or lethal effects. Trisomy is an abnormal number of chromosomes caused by
the presence of an extra chromosome, which is added to a given chromosome pair and results in
a total of 47 chromosomes per cell. Monosomy is an abnormal number of chromosomes whereby
the chromosome is represented by a single copy in a somatic cell. Nondisjunction is the failure of
homologous chromosomes or chromatids to separate during mitosis or meiosis.
DIF: Cognitive Level: Understanding REF: MCS: 48
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
3. Which is a birth defect or disorder that occurs as a new case in a family and is not inherited?
a. Sporadic
b. Polygenic
c. Monosomy
d. Association
ANS: A
Sporadic describes a birth defect previously unidentified in a family. It is not inherited.
Polygenic inheritance involves the inheritance of many genes at separate loci whose combined
effects produce a given phenotype. Monosomy is an abnormal number of chromosomes whereby
the chromosome is represented by a single copy in a somatic cell. A nonrandom cluster of
malformations without a specific cause is an association.
DIF: Cognitive Level: Understanding REF: MCS: 48
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
4. The nurse is assessing a neonate who was born 1 hour ago to healthy white parents in their
early forties. Which finding should be most suggestive of Down syndrome?
a. Hypertonia
b. Low-set ears
c. Micrognathia
d. Long, thin fingers and toes
ANS: B
Children with Down syndrome have low-set ears. Infants with Down syndrome have hypotonia,
not hypertonia. Micrognathia is common in trisomy 16, not Down syndrome. Children with
Down syndrome have short hands with broad fingers.
DIF: Cognitive Level: Understanding REF: MCS: 82
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
5. Which abnormality is a common sex chromosome defect?
a. Down syndrome
b. Turner syndrome
c. Marfan syndrome
d. Hemophilia
ANS: B
Turner syndrome is caused by an absence of one of the X chromosomes. Down syndrome is
caused by trisomy 21 (three copies rather than two copies of chromosome 21). Marfan syndrome
is a connective tissue disorder inherited in an autosomal dominant pattern. Hemophilia is a
disorder of blood coagulation inherited in an X-linked recessive pattern.
DIF: Cognitive Level: Understanding REF: MCS: 53
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
6. Turner syndrome is suspected in an adolescent girl with short stature. What causes this?
a. Absence of one of the X chromosomes
b. Presence of an incomplete Y chromosome
c. Precocious puberty in an otherwise healthy child
d. Excess production of both androgens and estrogens
ANS: A
Turner syndrome is caused by an absence of one of the X chromosomes. Most girls who have
this disorder have one X chromosome missing from all cells. No Y chromosome is present in
individuals with Turner syndrome. These young women have 45 rather than 46 chromosomes.
DIF: Cognitive Level: Understanding REF: MCS: 53
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
7. Which is a sex chromosome abnormality that is caused by the presence of one or more
additional X chromosomes in a male?
a. Turner
b. Triple X
c. Klinefelter
d. Trisomy 13
ANS: C
Klinefelter syndrome is characterized by one or more additional X chromosomes. These
individuals are tall with male secondary sexual characteristics that may be deficient, and they
may be learning disabled. An absence of an X chromosome results in Turner syndrome. Triple X
and trisomy 13 are not abnormalities that involve one or more additional X chromosomes in a
male (Klinefelter syndrome).
DIF: Cognitive Level: Understanding REF: MCS: 53
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
8. Parents ask the nurse about the characteristics of autosomal dominant inheritance. Which
statement is characteristic of autosomal dominant inheritance?
a. Females are affected with greater frequency than males.
b. Unaffected children of affected individuals will have affected children.
c. Each child of a heterozygous affected parent has a 50% chance of being affected.
d. Any child of two unaffected heterozygous parents has a 25% chance of being
affected.
ANS: C
In autosomal dominant inheritance, only one copy of the mutant gene is necessary to cause the
disorder. When a parent is affected, there is a 50% chance that the chromosome with the gene for
the disorder will be contributed to each pregnancy. Males and females are equally affected. The
disorder does not skip a generation. If the child is not affected, then most likely he or she is not a
carrier of the gene for the disorder. In autosomal recessive inheritance, any child of two
unaffected heterozygous parents has a 25% chance of being affected.
DIF: Cognitive Level: Applying REF: MCS: 57
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
9. Parents ask the nurse about the characteristics of autosomal recessive inheritance. Which is
characteristic of autosomal recessive inheritance?
a. Affected individuals have unaffected parents.
b. Affected individuals have one affected parent.
c. Affected parents have a 50% chance of having an affected child.
d. Affected parents will have unaffected children.
ANS: A
Parents who are carriers of a recessive gene are asymptomatic. For a child to be affected, both
parents must have a copy of the gene, which is passed to the child. Both parents are
asymptomatic but can have affected children. In autosomal recessive inheritance, there is a 25%
chance that each pregnancy will result in an affected child. In autosomal dominant inheritance,
affected parents can have unaffected children.
DIF: Cognitive Level: Applying REF: MCS: 62
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
10. Which is characteristic of X-linked recessive inheritance?
a. There are no carriers.
b. Affected individuals are principally males.
c. Affected individuals are principally females.
d. Affected individuals will always have affected parents.
ANS: B
In X-linked recessive disorders, the affected individuals are usually male. With recessive traits,
usually two copies of the gene are needed to produce the effect. Because the male only has one X
chromosome, the effect is visible with only one copy of the gene. Females are usually only
carriers of X-linked recessive disorders. The X chromosome that does not have the recessive
gene will produce the normal protein, so the woman will not show evidence of the disorder. The
transmission is from mother to son. Usually the mother and father are unaffected.
DIF: Cognitive Level: Understanding REF: MCS: 64
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
11. A father with an X-linked recessive disorder asks the nurse what the probability is that his
sons will have the disorder. Which response should the nurse make?
a. Male children will be carriers.
b. All male children will be affected.
c. None of the sons will have the disorder.
d. It cannot be determined without more data.
ANS: C
When a male has an X-linked recessive disorder, he has one copy of the allele on his X
chromosome. The father passes only his Y chromosome (not the X chromosome) to his sons.
Therefore, none of his sons will have the X-linked recessive gene. They will not be carriers or be
affected by the disorder. No additional data are needed to answer this question.
DIF: Cognitive Level: Applying REF: MCS: 64
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
12. The inheritance of which is X-linked recessive?
a. Hemophilia A
b. Marfan syndrome
c. Neurofibromatosis
d. Fragile X syndrome
ANS: A
Hemophilia A is inherited as an X-linked recessive trait. Marfan syndrome and
neurofibromatosis are inherited as autosomal dominant disorders. Fragile X is inherited as an Xlinked
trait.
DIF: Cognitive Level: Understanding REF: MCS: 64
TOP: Nursing