Wongs Essentials of Pediatric Nursing 9 Part 2 of 2 By Maryln – Test Bank

Complete Test Bank With Answers

 

 

Sample Questions Posted Below

 

Chapter 17: Health Problems of School-Age Children and Adolescents

MULTIPLE CHOICE

1. Which statement is true about smoking in adolescence?

a. b. c. d. Smoking is related to other high-risk behaviors.

Smoking will not continue unless peer pressure continues.

Smoking is less common when the adolescent’s parent(s) smokes.

Smoking among adolescents is becoming more prevalent.

ANS: A

Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to

use an illicit drug. Teenagers begin smoking for a variety of reasons, such as imitation of adult

behavior, peer pressure, imitation of behaviors portrayed in movies and advertisements, and a

desire to control weight. The absence of peer pressure alone will not stop smoking. Teenagers

who do not smoke usually have parents and friends who do not smoke or who oppose

smoking. The percentage of young people who report current cigarette use and frequent

cigarette use has declined significantly.

PTS: 1 DIF: Cognitive Level: Understand REF: 527

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

2. Smokeless tobacco is:

a. not addicting.

b. proven to be carcinogenic.

c. easy to stop using.

d. a safe alternative to cigarette smoking.

ANS: B

Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to

children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw.

The nicotine in the smokeless tobacco is addicting, and therefore it is very difficult to quit.

Because the product is addicting and can cause cancer, it is not a safe alternative to cigarette

smoking.

PTS: 1 DIF: Cognitive Level: Remember REF: 528

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

3. A child has been diagnosed with enuresis. TCA imipramine (Tofranil) has been prescribed for

the child. The nurse understands that this medication is in which category?

a. Antidepressant

b. Antidiuretic

c. Antispasmodic

d. Analgesic

ANS: C4. 5. 6. Drug therapy is increasingly being prescribed to treat enuresis. Three types of drugs are used:

tricyclic antidepressants (TCAs), antidiuretics, and antispasmodics. The selection depends on

the interpretation of the cause. The drug used most frequently is the TCA imipramine

(Tofranil), which exerts an anticholinergic action in the bladder to inhibit urination. Tofranil is

in the antispasmodic category. Analgesics are not used to treat enuresis.

PTS: 1 DIF: Cognitive Level: Remember REF: 499

TOP: Integrated Process: Nursing Process: Evaluation

MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

A 12-year-old male has short stature because of a constitutional growth delay. The nurse

should be the most concerned about which of the following?

a. b. c. d. Proper administration of thyroid hormone

Proper administration of human growth hormones

Child’s self-esteem and sense of competence

Helping child understand that his height is most likely caused by chronic illness

and is not his fault

ANS: C

Most cases of constitutional growth delay are caused by simple constitutional delay of

puberty, and the child can be assured that normal development will eventually take place.

Listening to distressed adolescents and conveying interest and concern are important

interventions for these children and adolescents. They should be encouraged to focus on the

positives aspects of their bodies and personalities. Thyroid hormones and human growth

hormones would not be beneficial in a constitutional growth delay. A constitutional growth

delay is not caused by a chronic illness.

PTS: 1 DIF: Cognitive Level: Understand REF: 507

TOP: Integrated Process: Nursing Process: Planning

MSC: Area of Client Needs: Psychosocial Integrity

Which syndrome involves a common sex chromosome defect?

a. Down

b. Turner

c. Marfan

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.

PTS: 1 DIF: Cognitive Level: Understand REF: 507

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Turner syndrome is suspected in an adolescent girl with short stature. This is caused by:

a. b. c. absence of one of the X chromosomes.

presence of an incomplete Y chromosome.

precocious puberty in an otherwise healthy child.7. 8. 9. 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. This young woman has 45 rather than 46 chromosomes.

PTS: 1 DIF: Cognitive Level: Understand REF: 507

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

An adolescent asks the nurse what causes primary dysmenorrhea. The nurse’s response should

be based on which statement?

a. b. c. d. It is an inherited problem.

Excessive estrogen production causes uterine pain.

There is no physiologic cause; it is a psychological reaction.

There is a relation between prostaglandins and uterine contractility.

ANS: D

The exact etiology of primary dysmenorrhea is debated. Overproduction of uterine

prostaglandins has been implicated, as has overproduction of vasopressin. Dysmenorrhea is

not known to be inherited. Excessive estrogen has not been implicated in the etiology. It has a

physiologic cause. Women with dysmenorrhea have higher prostaglandin levels.

PTS: 1 DIF: Cognitive Level: Apply REF: 508-509

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says

that a friend recommended she try an over-the-counter nonsteroidal anti-inflammatory drug

(NSAID). The nurse’s response should be based on which statement?

a. b. c. d. Aspirin is the drug of choice for the treatment of dysmenorrhea.

Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief.

NSAIDs are effective because of their analgesic effect.

NSAIDs are effective because they inhibit prostaglandins, leading to reduction in

uterine activity.

ANS: D

First-line therapy for adolescents with dysmenorrhea is NSAIDs. This group of drugs blocks

the formation of prostaglandins. NSAIDs, not aspirin, are the drugs of choice in

dysmenorrhea. NSAIDs are potent anti-inflammatory agents that inhibit prostaglandin.

Although NSAIDs have analgesic effects, the mechanism of action in dysmenorrhea is most

likely the antiprostaglandin effect.

PTS: 1 DIF: Cognitive Level: Apply REF: 508

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

The school nurse is discussing testicular self-examination with adolescent boys. Why is this

important?

a. b. Epididymitis is common during adolescence.

Asymptomatic sexually transmitted diseases may be present.10. 11. 12. c. d. Testicular tumors during adolescence are generally malignant.

Testicular tumors, although usually benign, are common during adolescence.

ANS: C

Tumors of the testes are not common, but when manifested in adolescence, they are generally

malignant and demand immediate evaluation. Epididymitis is not common in adolescence.

Asymptomatic sexually transmitted disease would not be evident during testicular self-

examination. The focus of this examination is on testicular cancer. Testicular tumors are most

commonly malignant.

PTS: 1 DIF: Cognitive Level: Apply REF: 510

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Which is the usual presenting symptom for testicular cancer?

a. Hard, painful mass

b. Hard, painless mass

c. Epididymis easily palpated

d. Scrotal swelling and pain

ANS: B

The usual presenting symptom for testicular cancer is a heavy, hard, painless mass that is

either smooth or nodular and palpated on the testes. A hard, painful mass, an epididymis easily

palpated, and scrotal swelling and pain are not the clinical presentations of testicular cancer.

PTS: 1 DIF: Cognitive Level: Understand REF: 509

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The

nurse’s discussion of this should be based on which statement?

a. b. c. d. This is usually benign and temporary.

This is usually caused by Klinefelter syndrome.

Administration of estrogen effectively reduces gynecomastia.

Administration of testosterone effectively reduces gynecomastia.

ANS: A

The male breast responds to hormonal changes. Some degree of bilateral or unilateral breast

enlargement occurs frequently in boys during puberty. Although individuals with Klinefelter

syndrome can have gynecomastia, it is not a common cause for male breast enlargement.

Estrogen is not a therapy for gynecomastia. Administration of testosterone has no benefit for

gynecomastia and may aggravate the condition.

PTS: 1 DIF: Cognitive Level: Understand REF: 510

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4

months ago. She has not received any medical care. She smokes but denies any other

substance use. The priority nursing action is to:

a. notify her parents.

b. refer for prenatal care.13. 14. 15. c. d. explain the importance of not smoking.

discuss dietary needs for adequate fetal growth.

ANS: B

Teenage girls and their unborn children are at greater risk for complications during pregnancy

and delivery. With improved therapies, the mortality for teenage pregnancy is decreasing, but

the morbidity is high. A pregnant teenager needs careful assessment by the nurse to determine

the level of social support available to her and possibly her partner. Guidance from the adults

in her life would be invaluable, but confidentiality should be maintained. Although it is

important to explain the importance of not smoking and to discuss dietary needs for adequate

fetal growth, because of her potential for having a high-risk pregnancy, she will need a

comprehensive prenatal program to minimize maternal-fetal complications.

PTS: 1 DIF: Cognitive Level: Apply REF: 510-511

TOP: Integrated Process: Nursing Process: Implementation

MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

An adolescent girl calls the nurse at the clinic because she had unprotected sex the night

before and does not want to be pregnant. The nurse should explain that:

a. b. c. d. it is too late to prevent an unwanted pregnancy.

an abortion may be the best option if she is pregnant.

Norplant can be administered to prevent pregnancy for up to 5 years.

postcoital contraception is available to prevent implantation.

ANS: D

Several emergency methods of contraception are available. Postcoital contraception options

do exist. It is nontherapeutic to tell her it is too late or that an abortion is the best option.

Norplant is not a postcoital contraceptive.

PTS: 1 DIF: Cognitive Level: Apply REF: 514

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A sexually active female adolescent asks the nurse about the contraceptive Depo-Provera. The

nurse should explain that it:

a. b. c. d. requires injections every 3 months.

requires daily administration of medication by mouth.

provides long-term continuous protection, up to 5 years.

prevents pregnancy if given within 72 hours of unprotected sex.

ANS: A

The contraceptive Depo-Provera is administered by injection every 3 months. Oral

contraceptives, not Depo-Provera, require daily administration of medication by mouth.

Norplant, not Depo-Provera, provides long-term continuous protection for up to 5 years.

Postcoital contraception, not Depo-Provera, prevents pregnancy if given within 72 hours of

unprotected sex.

PTS: 1 DIF: Cognitive Level: Understand REF: 511

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Which statement is true about gonorrhea?16. 17. a. b. c. d. It is caused by Treponema pallidum.

Treatment is by multidose administration of penicillin.

Treatment is by topical applications to lesions.

Treatment of all sexual contacts is an essential part of treatment.

ANS: D

The treatment plan should include finding and treating all sexual partners. Gonorrhea is

caused by Neisseria gonorrhoeae. Syphilis is caused by T. pallidum. Primary treatment is with

different antibiotics because of N. gonorrhoeae resistance to penicillin. Systemic therapy is

necessary to treat this disease.

PTS: 1 DIF: Cognitive Level: Understand REF: 515

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Which statement regarding chlamydia infection is correct?

a. b. c. d. Treatment of choice is oral penicillin.

Treatment of choice is nystatin or miconazole.

Clinical manifestations include dysuria and urethral itching in males.

Clinical manifestations include small, painful vesicles on genital areas.

ANS: C

Symptoms of chlamydia infection in males include meatal erythema, tenderness, itching,

dysuria, and urethral discharge. Some infected males have no symptoms. Oral penicillin and

nystatin or miconazole are not the antibiotics of choice. Small, painful vesicles on genital

areas are clinical manifestations true of chlamydia infection but may also indicate herpetic

lesions.

PTS: 1 DIF: Cognitive Level: Understand REF: 515

TOP: Integrated Process: Nursing Process: Implementation

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

A nurse is conducting a class for adolescent girls about pelvic inflammatory disease (PID).

Why should the nurse emphasize the importance of preventing pelvic inflammatory disease

(PID)?

a. PID can be sexually transmitted.

b. PID cannot be treated.

c. PID can have devastating effects on the reproductive tract.

d. PID can cause serious defects in future children of affected adolescents.

ANS: C

PID is a major concern because of its devastating effects on the reproductive tract. Short-term

complications include abscess formation in the fallopian tubes, whereas long-term

complications include ectopic pregnancy, infertility, and dyspareunia. PID is an infection of

the upper female genital tract, most commonly caused by sexually transmitted infections but it

is not sexually transmitted to another person. PID can be treated by treating the underlying

cause. There is a possibility of ectopic pregnancy but not birth defects in children.

PTS: 1 DIF: Cognitive Level: Apply REF: 514

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential18. 19. 20. 21. Which statement is correct about childhood obesity?

a. b. c. d. Heredity is an important factor in the development of obesity.

Childhood obesity in the United States is decreasing.

Childhood obesity is the result of inactivity.

Childhood obesity can be attributed to an underlying disease in most cases.

ANS: A

Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to

resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to

distinguish between hereditary and environmental factors. The number of overweight children

is increasing in the United States. Inactivity is related to childhood obesity, but it is not the

only component. Underlying diseases such as hypothyroidism and hyperinsulinism account

for only a small number of cases of childhood obesity.

PTS: 1 DIF: Cognitive Level: Understand REF: 518

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

The psychological effects of being obese during adolescence include:

a. sexual promiscuity.

b. poor body image.

c. feelings of contempt for thin peers.

d. accurate body image but self-deprecating attitude.

ANS: B

Common emotional consequences of obesity include poor body image, low self-esteem, social

isolation, and feelings of depression and isolation. Sexual promiscuity, feelings of contempt

for thin peers, and accurate body image but self-deprecating attitude are not usually associated

with obesity.

PTS: 1 DIF: Cognitive Level: Understand REF: 519

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Psychosocial Integrity: Coping and Adaptation

Anorexia nervosa may best be described as:

a. b. c. d. occurring most frequently in adolescent males.

occurring most frequently in adolescents from lower socioeconomic groups.

resulting from a posterior pituitary disorder.

resulting in severe weight loss in the absence of obvious physical causes.

ANS: D

The etiology of anorexia remains unclear, but a distinct psychological component is present.

The diagnosis is based primarily on psychological and behavioral criteria. Females account

for 90% to 95% of the cases. No relation has been identified between socioeconomic groups

and anorexia. Posterior pituitary disorders are not associated with anorexia nervosa.

PTS: 1 DIF: Cognitive Level: Remember REF: 522

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Young people with anorexia nervosa are often described as being:

a. independent.22. 23. 24. b. disruptive.

c. conforming.

d. low achieving.

ANS: C

Individuals with anorexia nervosa are described as perfectionist, academically high achievers,

conforming, and conscientious. “Independent,” disruptive,” and “low achieving” are not part

of the behavioral characteristics of anorexia nervosa.

PTS: 1 DIF: Cognitive Level: Understand REF: 522

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Psychosocial Integrity

The weight loss of anorexia nervosa is usually triggered by

a. sexual abuse.

b. school failure.

c. independence from family.

d. traumatic interpersonal conflict.

ANS: D

Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation

or a traumatic interpersonal incident; situations of severe family stress, such as parental

separation or divorce; or circumstances in which the young person lacks personal control,

such as being teased, changing schools, or entering college. “Sexual abuse,” “school failure,”

and “independence from family” are not part of the behavioral characteristics of anorexia

nervosa.

PTS: 1 DIF: Cognitive Level: Understand REF: 523

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Psychosocial Integrity

Which symptoms should the nurse expect to observe during the physical assessment of an

adolescent girl with severe weight loss and disrupted metabolism associated with anorexia

nervosa?

a. Dysmenorrhea and oliguria

b. Tachycardia and tachypnea

c. Heat intolerance and increased blood pressure

d. Lowered body temperature and brittle nails

ANS: D

Symptoms of anorexia nervosa include lower body temperature, severe weight loss, decreased

blood pressure, dry skin, brittle nails, altered metabolic activity, and presence of lanugo hair.

Amenorrhea, rather than dysmenorrhea, and cold intolerance are manifestations of anorexia

nervosa. Bradycardia, rather than tachycardia, may be present.

PTS: 1 DIF: Cognitive Level: Understand REF: 523

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Which is descriptive of bulimia during adolescence?

a. b. Strong sense of control over eating behavior

Feelings of elation after the binge-purge cycle25. 26. c. d. Profound lack of awareness that the eating pattern is abnormal

Weight that can be normal, slightly above normal, or below normal

ANS: D

Individuals with bulimia are of normal or more commonly slightly above normal weight.

Those who also restrict their intake can become severely underweight. The adolescent has a

lack of control over eating during the episode. Patients with bulimia commonly have self-

deprecating thoughts and a depressed mood after binge-purge cycles; they are also aware that

the eating pattern is abnormal but are unable to stop.

PTS: 1 DIF: Cognitive Level: Understand REF: 522

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Psychosocial Integrity

An adolescent teen has bulimia. Which assessment finding should the nurse expect to assess?

a. Diarrhea

b. Amenorrhea

c. Cold intolerance

d. Erosion of tooth enamel

ANS: D

Some of the signs of bulimia include erosion of tooth enamel, increased dental caries from

vomited gastric acid, throat complaints, fluid and electrolyte disturbances, and abdominal

complaints from laxative abuse. Diarrhea is not a result of the vomiting. It may occur in

patients with bulimia who also abuse laxatives. Amenorrhea and cold intolerance are

characteristics of anorexia nervosa, which some bulimics have. These symptoms are related to

the extreme low weight.

PTS: 1 DIF: Cognitive Level: Apply REF: 522

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Which is descriptive of attention deficit hyperactivity disorder (ADHD)?

a. b. Manifestations exhibited are so bizarre that the diagnosis is fairly easy.

Manifestations affect every aspect of the child’s life but are most obvious in the

classroom.

c. Learning disabilities associated with ADHD eventually disappear when adulthood

is reached.

d. Diagnosis of ADHD requires that all manifestations of the disorder be present.

ANS: B

ADHD affects every aspect of the child’s life, but the disruption is most obvious in the

classroom. The behaviors exhibited by the child with ADHD are not unusual aspects of

behavior. The difference lies in the quality of motor activity and developmentally

inappropriate inattention, impulsivity, and hyperactivity that the child displays. Some children

experience decreased symptoms during late adolescence and adulthood, but a significant

number carry their symptoms into adulthood. Any given child will not have every symptom of

the condition. The manifestations may be numerous or few, mild or severe, and will vary with

the child’s developmental level.

PTS: 1 DIF: Cognitive Level: Understand REF: 501

TOP: Integrated Process: Nursing Process: Assessment27. 28. 29. MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

The nurse is teaching the parents of a child recently diagnosed with ADHD who has been

prescribed methylphenidate (Ritalin). Which should the nurse include in teaching about the

side effects of methylphenidate?

a. b. c. d. “Your child may experience a sense of nervousness.”

“You may see an increase in your child’s appetite.”

“Your child may experience daytime sleepiness.”

“You may see a decrease in your child’s blood pressure.”

ANS: A

Nervousness is one of the common side effects of Ritalin. Decreased appetite with subsequent

weight loss, insomnia, and increased blood pressure are other common side effects.

PTS: 1 DIF: Cognitive Level: Apply REF: 502

TOP: Integrated Process: Nursing Process: Implementation

MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Which is an important consideration when the nurse is discussing enuresis with the parents of

a young child?

a. b. c. d. Enuresis is more common in girls than in boys.

Enuresis is neither inherited nor has a familial tendency.

Organic causes that may be related to enuresis should be considered first.

Psychogenic factors that cause enuresis persist into adulthood.

ANS: C

Organic causes that may be related to enuresis should be ruled out before psychogenic factors

are considered. Enuresis is more common in boys than in girls and has a strong familial

tendency. Psychogenic factors may influence enuresis, but it is doubtful that they are

causative.

PTS: 1 DIF: Cognitive Level: Apply REF: 499

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

The nurse is assisting the family of a child with a history of encopresis. Which should be

included in the nurse’s discussion with this family?

a. b. c. d. Instruct the parents to sit the child on the toilet at twice-daily routine intervals.

Instruct the parents that the child will probably need to have daily enemas.

Suggest the use of stimulant cathartics weekly.

Reassure the family that most problems are resolved successfully, with some

relapses during periods of stress.

ANS: D

Children may be unaware of a prior sensation and unable to control the urge once it begins.

They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family

counseling is directed toward reassurance that most problems resolve successfully, although

relapses during periods of stress are possible. Sitting the child on the toilet is not

recommended because it may intensify the parent-child conflict. Enemas may be needed for

impactions, but long-term use prevents the child from assuming responsibility for defecation.

Stimulant cathartics may cause cramping that can frighten child.30. 31. 32. PTS: 1 DIF: Cognitive Level: Apply REF: 501

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

A mother calls the school nurse saying that her daughter has developed a school phobia. She

has been out of school 3 days. The nurse’s recommendations should include which

intervention?

a. b. c. d. Immediately return child to school.

Explain to child that this is the last day she can stay home.

Determine cause of phobia before returning child to school.

Seek professional counseling before forcing child to return to school.

ANS: A

The primary goal is to return the child to school. Parents must be convinced gently, but firmly,

that immediate return is essential and that it is their responsibility to insist on school

attendance. The longer the child is permitted to stay out of school, the more difficult it will be

for the child to reenter. Trying to find the cause of phobia will only delay the return to school

and inhibit the child’s ability to cope. Professional counseling is recommended if the problem

persists, but the child’s return to school should not wait for the counseling.

PTS: 1 DIF: Cognitive Level: Apply REF: 505

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Psychosocial Integrity

Parents have a concern that their child is depressed. The nurse relates that which characteristic

best describes children with depression?

a. b. c. d. Increased range of affective response

Preoccupation with need to perform well in school

Change in appetite, resulting in weight loss or gain

Tendency to prefer play instead of schoolwork

ANS: C

Physiologic characteristics of children with depression include change in appetite resulting in

weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern,

insomnia or hypersomnia, and constipation. Children who are depressed have sad facial

expressions with absence or diminished range of affective response. These children withdraw

from previously enjoyed activities and engage in solitary play or work with a lack of interest

in play. A lack of interest is seen in doing homework or achieving in school, resulting in lower

grades in children who are depressed.

PTS: 1 DIF: Cognitive Level: Apply REF: 506

TOP: Integrated Process: Communication and Documentation

MSC: Area of Client Needs: Psychosocial Integrity

A teen asks a nurse, “What is physical dependence in substance abuse?” Which is the correct

response by the nurse?

a. b. c. d. Problem that occurs in conjunction with addiction

Involuntary physiologic response to drug

Culturally defined use of drugs for purposes other than accepted medical purposes

Voluntary behavior based on psychosocial needs

ANS: B33. 34. 35. Physical dependence is an involuntary response to the pharmacologic characteristics of drugs

such as opioids or alcohol. A person can be physically dependent on a narcotic/drug without

being addicted; for example, patients who use opioids to control pain need increasing doses to

achieve the same effect. Dependence is a physiologic response; it is not culturally determined

or subject to voluntary control.

PTS: 1 DIF: Cognitive Level: Apply REF: 527

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Psychosocial Integrity

Which is descriptive of central nervous system stimulants?

a. b. c. d. They produce strong physical dependence.

They can result in strong psychological dependence.

Withdrawal symptoms are life threatening.

Acute intoxication can lead to coma.

ANS: B

Central nervous system stimulants such as amphetamines and cocaine produce a strong

psychological dependence. This class of drugs does not produce strong physical dependence

and can be withdrawn without much danger. Acute intoxication leads to violent, aggressive

behavior or psychotic episodes characterized by paranoia, uncontrollable agitation, and

restlessness.

PTS: 1 DIF: Cognitive Level: Understand REF: 529

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Psychosocial Integrity

The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine

is believed to be the drug involved. Data collection should include what information?

a. Mode of administration

b. Drug’s actual content

c. Function the drug plays in the adolescent’s life

d. Adolescent’s level of interest in rehabilitation

ANS: A

When the drug is questionable or unknown, every effort must be made to determine the type,

amount of drug taken, the mode and time of administration, and factors relating to the onset of

presenting symptoms. The actual content of most street drugs is highly questionable.

Pharmacologic agents should be administered with caution, except for the narcotic antagonists

in case of suspected opioid use. The function the drug plays in the adolescent’s life and the

adolescent’s level of interest in rehabilitation are important considerations in the long-term

management during the nonacute stage.

PTS: 1 TOP: DIF: Cognitive Level: Apply Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Psychosocial Integrity

REF: 528 | 530

A school nurse is conducting a class with adolescents on suicide. Which true statement about

suicide should the nurse include in the teaching session?

a. b. A sense of hopelessness and despair are a normal part of adolescence.

Gay and lesbian adolescents are at a particularly high risk for suicide.36. 37. c. d. Problem-solving skills are of limited value to the suicidal adolescent.

Previous suicide attempts are not an indication of risk for completed suicides.

ANS: B

A significant number of teenage suicides occur among homosexual youths. Gay and lesbian

adolescents who live in families or communities that do not accept homosexuality are likely to

suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of

acceptance from their family or community. At-risk teenagers include those who are

depressed, have poor problem-solving skills, or use drugs and alcohol. History of previous

suicide attempt is a serious indicator for possible suicide completion in the future.

PTS: 1 DIF: Cognitive Level: Apply REF: 531

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Psychosocial Integrity

Which is the most commonly used method in completed suicides?

a. Firearms

b. Drug overdose

c. Self-inflected laceration

d. Carbon monoxide poisoning

ANS: A

Firearms are the most commonly used instruments in completed suicides among both males

and females. For adolescent boys, firearms are followed by hanging and overdose. For

adolescent females, overdose and strangulation are the next most common means of

completed suicide. The most common method of suicide attempt is overdose or ingestion of

potentially toxic substances such as drugs. The second most common method of suicide

attempt is self-inflicted laceration. Carbon monoxide poisoning is not one of the more

frequent forms of suicide completion.

PTS: 1 DIF: Cognitive Level: Remember REF: 531

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Psychosocial Integrity

Which is the most significant factor in distinguishing those who commit suicide from those

who make suicidal attempts or threats?

a. Social isolation

b. Level of stress

c. Degree of depression

d. Desire to punish others

ANS: A

Social isolation is a significant factor in distinguishing adolescents who will kill themselves

from those who will not. It is also more characteristic of those who complete suicide than of

those who make attempts or threats. Level of stress, degree of depression, and desire to punish

others are contributing factors in suicide, but they are not the most significant factor in

distinguishing those who complete suicide from those who attempt suicide.

PTS: 1 DIF: Cognitive Level: Understand REF: 532

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Psychosocial Integrity38. 39. 40. An adolescent girl tells the nurse that she is very suicidal. The nurse asks her whether she has

a specific plan. Asking this should be considered:

a. b. c. d. an appropriate part of the assessment.

not a critical part of the assessment.

suggesting that the adolescent needs a plan.

encouraging the adolescent to devise a plan.

ANS: A

Routine health assessments of adolescents should include questions that assess the presence of

suicidal ideation or intent. Questions such as, “Have you ever developed a plan to hurt

yourself or kill yourself?” should be part of that assessment. Adolescents who express suicidal

feelings and have a specific plan are at particular risk and require further assessment and

constant monitoring. The information about having a plan is an essential part of the

assessment and greatly affects the treatment plan.

PTS: 1 DIF: Cognitive Level: Understand REF: 531

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Psychosocial Integrity

An adolescent has been diagnosed with lactose maldigestion intolerance. The nurse teaches

the adolescent about lactose maldigestion intolerance and notes the teen needs further teaching

if which statement is made?

a. b. c. d. “I will limit my milk consumption to one to two glasses a day.”

“I should drink the milk alone and not with other foods.”

“Hard cheese, cottage cheese, or yogurt can be substituted for milk.”

“I will take a calcium supplement daily.”

ANS: B

Most people are able to tolerate small amounts of lactose (1 cup of milk per day) even in the

presence of deficient lactase activity. It is recommended that individuals with lactose

maldigestion who do not experience lactose intolerance symptoms continue to consume small

amounts of dairy products with meals to prevent reduced bone mass density and subsequent

osteoporosis. Hard cheese, cottage cheese, and yogurt are sources of lactose that may be better

tolerated. A calcium supplement should be taken daily. Milk taken at meals may be better

tolerated than when taken alone.

PTS: 1 DIF: Cognitive Level: Apply REF: 526

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

An adolescent has been diagnosed with Chlamydia infection. Which medication should the

nurse expect to be prescribed for this condition?

a. Ceftriaxone (Rocephin) IM

b. Azithromycin (Zithromax) PO

c. Acyclovir (Zovirax) PO

d. Penicillin G benzathine (Bicillin) IV

ANS: B

Azithromycin is used to treat Chlamydia. The patient should be rescreened in 3 to 4 months.

Ceftriaxone is used to treat gonorrhea, acyclovir is used to suppress genital herpes simplex

virus, and penicillin G benzathine is used to treat syphilis.PTS: 1 DIF: Cognitive Level: Understand REF: 514-515

TOP: Integrated Process: Nursing Process: Implementation

MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

MULTIPLE RESPONSE

1. 2. 3. A nurse is recommending strategies to a group of school-age children for prevention of

obesity. Which should the nurse include? (Select all that apply.)

a. Eat breakfast daily.

b. Limit fruits and vegetables.

c. Have frequent family meals with parents present.

d. Eat frequently at restaurants.

e. Limit television viewing to 2 hours a day.

ANS: A, C, E

The nurse should counsel school-age children to eat breakfast daily, have mealtimes with

family, and limit television viewing to 2 hours a day to prevent obesity. Fruits and vegetables

should be consumed in the recommended quantities, and eating at restaurants should be

limited.

PTS: 1 DIF: Cognitive Level: Analyze REF: 520

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Health Promotion and Maintenance

Which strategies should the school nurse recommend implementing in the classroom for a

child with attention deficit hyperactive disorder (ADHD)? (Select all that apply.)

a. b. c. d. e. Schedule heavier subjects to be taught in the afternoon.

Accompany verbal instructions by written format.

Limit number of breaks taken during instructional periods.

Allow more time for testing.

Reduce homework and classroom assignments.

ANS: B, D, E

Children with ADHD need an orderly, predictable, and consistent classroom environment with

clear and consistent rules. Homework and classroom assignments may need to be reduced,

and more time may need to be allotted for tests to allow the child to complete the task. Verbal

instructions should be accompanied by visual references such as written instructions on the

blackboard. Schedules may need to be arranged so that academic subjects are taught in the

morning when the child is experiencing the effects of the morning dose of medication.

Regular and frequent breaks in activity are helpful because sitting in one place for an extended

time may be difficult.

PTS: 1 DIF: Cognitive Level: Apply REF: 503

TOP: Integrated Process: Nursing Process: Implementation

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Which side effects should the nurse monitor when a child is taking an antipsychotic

medication? (Select all that apply.)

a. Extrapyramidal effects

b. Hypertensionc. Bradycardia

d. Dizziness

e. Seizures

ANS: A, D, E

Common side effects of antipsychotic medications include dizziness, drowsiness, tachycardia,

hypotension, and extrapyramidal effects, such as abnormal movements and seizures.

PTS: 1 DIF: Cognitive Level: Understand REF: 506-507

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies