Pediatric Primary Care: Practice Guidelines for Nurses – Test Bank

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Sample Questions Posted Below

Chapter 1 Obtaining an Initial History

MULTIPLE CHOICE

1. The nurse is seeing an adolescent and the parents in the clinic for the first time. Which should

the nurse do first?

1. Introduce him- or herself.
2. Make the family comfortable.
3. Give assurance of privacy.
4. Explain the purpose of the interview.

2. Which is considered a block to effective communication?
3. Using silence
4. Using clichs
5. Directing the focus
6. Defining the problem
7. Which is the single most important factor to consider when communicating with children?
8. Presence of the childs parent
9. Childs physical condition
10. Childs developmental level

1. Childs nonverbal behaviors

ANS: C

The nurse must be aware of the childs developmental stage to engage in effective

communication. The use of both verbal and nonverbal communication should be appropriate to

the developmental level. Nonverbal behaviors vary in importance based on the childs

developmental level and physical condition. Although the childs physical condition is a

consideration, developmental level is much more important. The presence of parents is important

when communicating with young children but may be detrimental when speaking with

adolescents.

4. Because children younger than 5 years are egocentric, the nurse should do which when

communicating with them?

1. Focus communication on the child.
2. Use easy analogies when possible.
3. Explain experiences of others to the child.
4. Assure the child that communication is private.

ANS: A

Because children of this age are able to see things only in terms of themselves, the best approach

is to focus communication directly on them. Children should be provided with information about

what they can do and how they will feel. With children who are egocentric, analogies,

experiences, and assurances that communication is private will not be effective because the child

is not capable of understanding.

5. The nurses approach when introducing hospital equipment to a preschooler who seems afraid

should be based on which principle?

1. The child may think the equipment is alive.
2. Explaining the equipment will only increase the childs fear.
3. One brief explanation will be enough to reduce the childs fear.
4. The child is too young to understand what the equipment does.

ANS: A

Young children attribute human characteristics to inanimate objects. They often fear that the

objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment

should be kept out of sight until needed. Simple, concrete explanations about what the equipment

does and how it will feel will help alleviate the childs fear. Preschoolers need repeated

explanations as reassurance.

6. When the nurse interviews an adolescent, which is especially important?
7. Focus the discussion on the peer group.
8. Allow an opportunity to express feelings.
9. Use the same type of language as the adolescent.
10. Emphasize that confidentiality will always be maintained.

ANS: B

Adolescents, like all children, need opportunities to express their feelings. Often they interject

feelings into their words. The nurse must be alert to the words and feelings expressed. The nurse

should maintain a professional relationship with adolescents. To avoid misunderstanding or

misinterpretation of words and phrases used, the nurse should clarify the terms used, what

information will be shared with other members of the health care team, and any limits to

confidentiality. Although the peer group is important to this age group, the interview should

focus on the adolescent.

7. The nurse is preparing to assess a 10-month-old infant. He is sitting on his fathers lap and

appears to be afraid of the nurse and of what might happen next. Which initial actions by the

nurse should be most appropriate?

1. Initiate a game of peek-a-boo.
2. Ask the infants father to place the infant on the examination table.
3. Talk softly to the infant while taking him from his father.
4. Undress the infant while he is still sitting on his fathers lap.

ANS: A

Peek-a-boo is an excellent means of initiating communication with infants while maintaining a

safe, nonthreatening distance. The child will most likely become upset if separated from his

father. As much of the assessment as possible should be done with the child on the fathers lap.

The nurse should have the father undress the child as needed during the examination.

8. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most

appropriate nursing action is which?

1. Ask her why she wants to know.
2. Determine why she is so anxious.
3. Explain in simple terms how it works.
4. Tell her she will see how it works as it is used.

ANS: C

School-age children require explanations and reasons for everything. They are interested in the

functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to

explain how equipment works and what will happen to the child so that the child can then

observe during the procedure. The nurse should respond positively for requests for information

about procedures and health information. By not responding, the nurse may be limiting

communication with the child. The child is not exhibiting anxiety in asking how the blood

pressure apparatus works, just requesting clarification of what will occur.

9. The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which

technique should be most helpful?

1. Recommend that the child keep a diary.
2. Provide supplies for the child to draw a picture.
3. Suggest that the parent read fairy tales to the child.
4. Ask the parent if the child is always uncommunicative.

ANS: B

Drawing is one of the most valuable forms of communication. Childrens drawings tell a great

deal about them because they are projections of the childrens inner self. A diary should be

difficult for a 6-year-old child, who is most likely learning to read. The parent reading fairy tales

to the child is a passive activity involving the parent and child; it should not facilitate

communication with the nurse. The child is in a stressful situation and is probably uncomfortable

with strangers, not always uncommunicative.

10. Which data should be included in a health history?
11. Review of systems
12. Physical assessment
13. Growth measurements
14. Record of vital signs

ANS: A

A review of systems is done to elicit information concerning any potential health problems. This

further guides the interview process. Physical assessment, growth measurements, and a record of

vital signs are components of the physical examination.

11. The nurse is taking a health history of an adolescent. Which best describes how the chief

complaint should be determined?

1. Request a detailed listing of symptoms.
2. Ask the adolescent, Why did you come here today?
3. Interview the parent away from the adolescent to determine the chief complaint.
4. Use what the adolescent says to determine, in correct medical terminology, what the problem is.

ANS: B

The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital.

Because the adolescent is the focus of the history, this is an appropriate way to determine the

chief complaint. Requesting a detailed list of symptoms makes it difficult to determine the chief

complaint. The parent and adolescent may be interviewed separately, but the nurse should

determine the reason the adolescent is seeking attention at this time. The chief complaint is

usually written in the words that the parent or adolescent uses to describe the reason for seeking

help.

12. The nurse is interviewing the mother of an infant. The mother reports, I had a difficult

delivery, and my baby was born prematurely. This information should be recorded under which

heading?

1. History
2. Present illness
3. Chief complaint
4. Review of systems

ANS: A

The history refers to information that relates to previous aspects of the childs health, not to the

current problem. The difficult delivery and prematurity are important parts of the infants history.

The history of the present illness is a narrative of the chief complaint from its earliest onset

through its progression to the present. Unless the chief complaint is directly related to the

prematurity, this information is not included in the history of the present illness. The chief

complaint is the specific reason for the childs visit to the clinic, office, or hospital. It should not

include the birth information. The review of systems is a specific review of each body system. It

does not include the premature birth but might include sequelae such as pulmonary dysfunction.

13. Where in the health history does a record of immunizations belong?

1. History
2. Present illness
3. Review of systems
4. Physical assessment

ANS: A

The history contains information relating to all previous aspects of the childs health status. The

immunizations are appropriately included in the history. The present illness, review of systems,

and physical assessment are not appropriate places to record the immunization status.

14. The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine

whether she is sexually active?

1. Ask her, Are you sexually active?
2. Ask her, Are you having sex with anyone?
3. Ask her, Are you having sex with a boyfriend?
4. Ask both the girl and her parent if she is sexually active.

ANS: B

Asking the adolescent girl if she is having sex with anyone is a direct question that is well

understood. The phrase sexually active is broadly defined and may not provide specific

information for the nurse to provide necessary care. The word anyone is preferred to using

gender-specific terms such as boyfriend or girlfriend. Using gender-neutral terms is inclusive and

conveys acceptance to the adolescent. Questioning about sexual activity should occur when the

adolescent is alone.

15. When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet

consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet is

which?

1. Lacking in protein
2. Indicating they live in poverty
3. Providing sufficient amino acids
4. Needing enrichment with meat and milk

ANS: C

A diet that contains vegetables, legumes, and starches may provide sufficient essential amino

acids even though the actual amount of meat or dairy protein is low. Combinations of foods

contain the essential amino acids necessary for growth. Many cultures use diets that contain this

combination of foods. It is not indicative of poverty. A dietary assessment should be done, but

many vegetarian diets are sufficient for growth.

16. Which parameter correlates best with measurements of total muscle mass?
17. Height
18. Weight
19. Skinfold thickness
20. Upper arm circumference

ANS: D

Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves

as the bodys major protein reserve and is considered an index of the bodys protein stores. Height

is reflective of past nutritional status. Weight is indicative of current nutritional status. Skinfold

thickness is a measurement of the bodys fat content.

17. The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse

gives her the option of her mother staying in the room or leaving. This action should be

considered which?

1. Appropriate because of childs age
2. Appropriate, but the mother may be uncomfortable
3. Inappropriate because of childs age
4. Inappropriate because child is same sex as mother

ANS: A

It is appropriate to give older school-age children the option of having the parent present or not.

During the examination, the nurse should respect the childs need for privacy. Children who are

10 years old are minors, and parents are responsible for health care decisions. The mother of a

10-year-old child would not be uncomfortable. The child should help determine who is present

during the examination.

18. With the National Center for Health Statistics criteria, which body mass index (BMI)for-age

percentiles should indicate the patient is at risk for being overweight?

1. 10th percentile
2. 75th percentile
3. 85th percentile
4. 95th percentile

ANS: C

Children who have BMI-for-age greater than or equal to the 85th percentile and less than the

95th percentile are at risk for being overweight. Children who are greater than or equal to the

95th percentile are considered overweight. Children whose BMI is between the 10th and 75th

percentiles are within normal limits.

19. Rectal temperatures are indicated in which situation?
20. In the newborn period
21. Whenever accuracy is essential
22. Rectal temperatures are never indicated
23. When rapid temperature changes are occurring

ANS: B

Rectal temperatures are recommended when definitive measurements are necessary in infants

older than age 1 month. Rectal temperatures are not done in the newborn period to avoid trauma

to the rectal mucosa. Rectal temperature is an intrusive procedure that should be avoided

whenever possible.

20. What is the earliest age at which a satisfactory radial pulse can be taken in children?
21. 1 year
22. 2 years
23. 3 years
24. 6 years

ANS: B

Satisfactory radial pulses can be taken in children older than 2 years. In infants and young

children, the apical pulse is more reliable.

21. The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too

large and one is too small. The best nursing action is which?

1. Use the small cuff.
2. Use the large cuff.
3. Use either cuff using the palpation method.
4. Wait to take the blood pressure until a proper cuff can be located.

ANS: B

If blood pressure measurement is indicated and the appropriate size cuff is not available, the next

larger size is used. The nurse recognizes that this may be a falsely low blood pressure. Using the

small cuff will give an incorrectly high reading. The palpation method will not improve the

inaccuracy inherent in the cuff.

22. Where is the best place to observe for the presence of petechiae in dark-skinned individuals?
23. Face
24. Buttocks
25. Oral mucosa
26. Palms and soles

ANS: C

Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark-skinned individuals

unless they are in the mouth or conjunctiva.

23. During a routine health assessment, the nurse notes that an 8-month-old infant has a

significant head lag. Which is the most appropriate action?

1. Recheck head control at next visit.
2. Teach the parents appropriate exercises.
3. Schedule the child for further evaluation.
4. Refer the child for further evaluation if the anterior fontanel is still open.

ANS: C

Significant head lag after age 6 months strongly indicates cerebral injury and is referred for

further evaluation. Head control is part of normal development. Exercises will not be effective.

The lack of achievement of this developmental milestone must be evaluated.

24. The nurse has just started assessing a young child who is febrile and appears ill. There is

hyperextension of the childs head (opisthotonos) with pain on flexion. Which is the most

appropriate action?

1. Ask the parent when the neck was injured.
2. Refer for immediate medical evaluation.
3. Continue assessment to determine the cause of the neck pain.

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