Wong's Essentials of Pediatric Nursing, 10th Edition - Test Bank

Wong’s Essentials of Pediatric
Nursing, 10th Edition – Test Bank
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Sample Test
Chapter 03: Developmental and Genetic Influences on Child Health Promotion
Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition
MULTIPLE CHOICE
1. An infant gains head control before sitting unassisted. The nurse

recognizes that this is which type of development?
2. Cephalocaudal
3. Proximodistal
4. Mass to specific
5. Sequential
ANS: A
The pattern of development that is head-to-tail, or cephalocaudal, direction is
described by an infant’s ability to gain head control before sitting unassisted.
The head end of the organism develops first and is large and complex, whereas
the lower end is smaller and simpler, and development takes place at a later
time. Proximodistal, or near to far, is another pattern of development. Limb buds
develop before fingers and toes. Postnatally, the child has control of the
shoulder before achieving mastery of the hands. Mass to specific is not a
specific pattern of development. In all dimensions of growth, a definite,
sequential pattern is followed.
DIF: Cognitive Level: Understand REF: p. 38
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
2. Which refers to those times in an individual’s life when he or she is more

susceptible to positive or negative influences?
3. Sensitive period
4. Sequential period
5. Terminal points
6. Differentiation points
ANS: A
Sensitive periods are limited times during the process of growth when the
organism will interact with a particular environment in a specific manner. These
times make the organism more susceptible to positive or negative influences.
The sequential period, terminal points, and differentiation points are
developmental times that do not make the organism more susceptible to
environmental interaction.
DIF: Cognitive Level: Remember REF: p. 39
TOP: Integrated Process: Nursing Process: Planning

3. An infant who weighs 7 pounds at birth would be expected to weigh how

many pounds at age 1 year?
4. 14
5. 16
6. 18
7. 21
ANS: D
In general, birth weight triples by the end of the first year of life. For an infant
who was 7 pounds at birth, 21 pounds would be the anticipated weight at the
first birthday; 14, 16, or 18 pounds is below what would be expected for an infant
with a birth weight of 7 pounds.
4. By what age does birth length usually double?

5. 1 year
6. 2 years
7. 4 years
8. 6 years
ANS: C
Linear growth or height occurs almost entirely as a result of skeletal growth and
is considered a stable measurement of general growth. On average, most
children have doubled their birth length at age 4 years. One and 2 years are too
young for doubling of length. Most children will have achieved the doubling by
age 4 years.

5. Parents of an 8-year-old child ask the nurse how many inches their child
should grow each year. The nurse bases the answer on the knowledge that
after age 7 years, school-age children usually grow what number of inches per
year?
6. 1
7. 2
8. 3
9. 4
ANS: B
The growth velocity after age 7 years is approximately 5 cm (2 inches) per year.
One inch is too small an amount. Three and 4 inches are greater than the
average yearly growth after age 7 years.
DIF: Cognitive Level: Apply REF: p. 41
TOP: Integrated Process: Nursing Process: Implementation
6. Parents express concern that their pubertal daughter is taller than the
boys in her class. The nurse should respond with which statement regarding
how the onset of pubertal growth spurt compares in girls and boys?
7. It occurs earlier in boys.
8. It occurs earlier in girls.
9. It is about the same in both boys and girls.
10. In both boys and girls, the pubertal growth spurt depends on growth in
infancy.

ANS: B
Usually, the pubertal growth spurt begins earlier in girls. It typically occurs
between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The
average earliest age at onset is 1 year earlier for girls. There does not appear to
be a relation to growth during infancy.
7. A 13-year-old girl asks the nurse how much taller she will get. She has
been growing about 2 inches per year but grew 4 inches this past year.
Menarche recently occurred. The nurse should base her response on which
statement?
8. Growth cannot be predicted.
9. Pubertal growth spurt lasts about 1 year.
10. Mature height is achieved when menarche occurs.
11. Approximately 95% of mature height is achieved when menarche occurs.
ANS: D
At the time of the beginning of menstruation or the skeletal age of 13 years,

most girls have grown to about 95% of their adult height. They may have some
additional growth (5%) until the epiphyseal plates are closed. Although growth
cannot be definitively predicted, on average, 95% of adult height has been
reached with the onset of menstruation. Pubertal growth spurt lasts about 1 year
does not address the girl’s question. Young women usually will grow
approximately 5% more after the onset of menstruation.

TOP: Integrated Process: Teaching/Learning
8. How is a child’s skeletal age best determined?

9. Assessment of dentition
10. Assessment of height over time
11. Facial bone development
12. Radiographs of the hand and wrist
ANS: D
The most accurate measure of skeletal age is radiologic examinations of the

growth plates. These are the epiphyseal cartilage plates. Radiographs of the
hand and wrist provide the most useful screening to determine skeletal age. Age
of tooth eruption has considerable variation in children. It would not be a good
determinant of skeletal age. Assessment of height over time will provide a
record of the child’s height but not skeletal age. Facial bone development will
not reflect the child’s skeletal age, which is determined by radiographic
assessment.
9. Trauma to which site can result in a growth problem for children’s long
bones?
10. Matrix
11. Connective tissue
12. Calcified cartilage
13. Epiphyseal cartilage plate

ANS: D
The epiphyseal cartilage plate is the area of active growth. Bone injury at the
epiphyseal plate can significantly affect subsequent growth and development.
Trauma or infection can result in deformity. The matrix, connective tissue, and
calcified cartilage are not areas of active growth. Trauma in these sites will not
result in growth problems for the long bones.
DIF: Cognitive Level: Comprehend REF: p. 41
10. A nurse has completed a teaching session for adolescents regarding

lymphoid tissue growth. Which statement, by the adolescents, indicates
understanding of the teaching?
11. The tissue reaches adult size by age 1 year.
12. The tissue quits growing by 6 years of age.
13. The tissue is poorly developed at birth.
14. The tissue is twice the adult size by ages 10 to 12 years.
ANS: D
Lymphoid tissue continues growing until it reaches maximal development at

ages 10 to 12 years, which is twice its adult size. A rapid decline in size occurs
until it reaches adult size by the end of adolescence. The tissue reaches adult
size at 6 years of age but continues to grow. The tissue is well developed at
birth.
DIF: Cognitive Level: Analyze REF: p. 42
TOP: Integrated Process: Nursing Process: Evaluation

11. Which statement is true about the basal metabolic rate (BMR) in children?
12. It is reduced by fever.
13. It is slightly higher in boys than in girls at all ages.
14. It increases with age of child.
15. It decreases as proportion of surface area to body mass increases.
ANS: B
The BMR is the rate of metabolism when the body is at rest. At all ages, the rate
is slightly higher in boys than in girls. The rate is increased by fever. The BMR is
highest in infancy and then closely relates to the proportion of surface area to
body mass. As the child grows, the proportion decreases progressively to
maturity.
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and
Development
12. A mother reports that her 6-year-old child is highly active, irritable, and
irregular in habits and that the child adapts slowly to new routines, people, or
situations. How should the nurse chart this type of temperament?
13. Easy
14. Difficult
15. Slow-to-warm-up
16. Fast-to-warm-up
ANS: B
Being highly active, irritable, irregular in habits, and adapting slowly to new
routines, people, or situations is a description of difficult children, which
compose about 10% of the population. Negative withdrawal responses are
typical of this type of child, who requires a more structured environment. Mood
expressions are usually intense and primarily negative. These children exhibit
frequent periods of crying and often violent tantrums. Easy children are even
tempered, regular, and predictable in their habits. They are open and adaptable
to change. Approximately 40% of children fit this description. Slow-to-warm-up
children typically react negatively and with mild intensity to new stimuli and
adapt slowly with repeated contact. Approximately 10% of children fit this
description. “Fast-to-warm-up” is not one of the categories identified.
TOP: Integrated Process: Communication and Documentation
13. A 12-year-old child enjoys collecting stamps, playing soccer, and

participating in Boy Scout activities. The nurse recognizes that the child is
displaying which developmental task?
14. Identity
15. Industry
16. Integrity
17. Intimacy
ANS: B
Industry is engaging in tasks that can be carried through to completion, learning

to compete and cooperate with others, and learning rules. Industry is the
developmental task characteristic of the school-age child. Identity is the
developmental task of adolescence. Integrity and intimacy are not
developmental tasks of childhood.

14. A nurse is conducting parenting classes for parents of children ranging in
ages 2 to 7 years. The parents understand the term egocentrism when they
indicate it means:
15. selfishness.
16. self-centeredness.
17. preferring to play alone.
18. unable to put self in another’s place.
ANS: D
According to Piaget, children ages 2 to 7 years are in the preoperational stage of

development. Children interpret objects and events not in terms of their general
properties but in terms of their relationships or their use to them. This
egocentrism does not allow children of this age to put themselves in another’s
place. Selfishness, self-centeredness, and preferring to play alone do not
describe the concept of egocentricity.
15. The nurse is observing parents playing with their 10-month-old child.
Which should the nurse recognize as evidence that the child is developing
object permanence?
16. Looks for the toy that parents hide under the blanket
17. Returns the blocks to the same spot on the table
18. Recognizes that a ball of clay is the same when flattened out
19. Bangs two cubes held in her hands
ANS: A
Object permanence is the realization that items that leave the visual field still
exist. When the infant searches for the toy under the blanket, it is an indication
that object permanence has developed. Returning the blocks to the same spot
on the table is not an example of object permanence. Recognizing that a ball of
clay is the same when flattened out is an example of conservation, which occurs
during the concrete operations stage from 7 to 11 years. Banging two cubes
together is a simple repetitive activity characteristic of developing a sense of
cause and effect.
16. A father tells the nurse that his child is “filling up the house with
collections” like seashells, bottle caps, baseball cards, and pennies. What
should the nurse recognize the child is developing?
17. Object permanence
18. Preoperational thinking
19. Concrete operational thinking
20. Ability to use abstract symbols
ANS: C
During concrete operations, children develop logical thought processes. They

are able to classify, sort, order, and otherwise organize facts about the world.
This ability fosters the child’s ability to create collections. Object permanence is
the realization that items that leave the visual field still exist. This is a task of
infancy and does not contribute to collections. Preoperational thinking is
concrete and tangible. Children in this age group cannot reason beyond the
observable, and they lack the ability to make deductions or generalizations.
Collections are not typical for this developmental level. The ability to use
abstract symbols is a characteristic of formal operations, which develops during
adolescence. These children can develop and test hypotheses.

17. A visitor arrives at a daycare center during lunchtime. The preschool

children think that every time they have lunch a visitor will arrive. Which
preoperational characteristic is being displayed?
18. Egocentrism
19. Transductive reasoning
20. Intuitive reasoning
21. Conservation
ANS: B
Transductive reasoning is when two events occur together, they cause each
other. The expectation that every time lunch is served a visitor will arrive is
descriptive of transductive reasoning. Egocentrism is the inability to see things
from any perspective than their own. Intuitive reasoning (e.g., the stars have to
go to bed just as they do) is predominantly egocentric thought. Conservation
(able to realize that physical factors such as volume, weight, and number remain
the same even though outward appearances are changed) does not occur until
school age.
TOP: Integrated Process: Nursing Process: Diagnosis
18. Which behavior is most characteristic of the concrete operations stage of

cognitive development?
19. Progression from reflex activity to imitative behavior
20. Inability to put oneself in another’s place
21. Increasingly logical and coherent thought processes
22. Ability to think in abstract terms and draw logical conclusions
ANS: C
During the concrete operations stage of development, which occurs
approximately between ages 7 and 11 years, increasingly logical and coherent
thought processes occur. This is characterized by the child’s ability to classify,
sort, order, and organize facts to use in problem solving. The progression from
reflex activity to imitative behavior is characteristic of the sensorimotor stage of
development. The inability to put oneself in another’s place is characteristic of
the preoperational stage of development. The ability to think in abstract terms
and draw logical conclusions is characteristic of the formal operations stage of
development.
19. According to Kohlberg, children develop moral reasoning as they mature.

Which statement is most characteristic of a preschooler’s stage of moral
development?
20. Obeying the rules of correct behavior is important.
21. Showing respect for authority is important behavior.
22. Behavior that pleases others is considered good.
23. Actions are determined as good or bad in terms of their consequences.
ANS: D
Preschoolers are most likely to exhibit characteristics of Kohlberg’s

preconventional level of moral development. During this stage, they are
culturally oriented to labels of good or bad, right or wrong. Children integrate
these concepts based on the physical or pleasurable consequences of their
actions. Obeying the rules of correct behavior, showing respect for authority,
and engaging in behavior that pleases others are characteristics of Kohlberg’s
conventional level of moral development.

20. A school nurse notes that school-age children generally obey the rules at
school. The nurse recognizes that the children are displaying which stage of
moral development?
21. Preconventional
22. Conventional
23. Postconventional
24. Undifferentiated
ANS: B
Conventional stage of moral development is described as obeying the rules,

doing one’s duty, showing respect for authority, and maintaining the social order.
This stage is characteristic of school-age children’s behavior. The
preconventional stage is characteristic of the toddler and preschool age. At this
stage, the child has no concept of the basic moral order that supports being
good or bad. The postconventional level is characteristic of an adolescent and
occurs at the formal stage of operation. Undifferentiated describes an infant’s
understanding of moral development.
21. A nurse observes a toddler playing with sand and water. How should the
nurse document this type of play?
22. Skill
23. Dramatic
24. Social-affective
25. Sense-pleasure

ANS: D
The toddler playing with sand and water is engaging in sense-pleasure play. This
is characterized by nonsocial situations in which the child is stimulated by
objects in the environment. Infants engage in skill play when they persistently
demonstrate and exercise newly acquired abilities. Dramatic play is the
predominant form of play in the preschool period. Children pretend and fantasize.
Social-affective play is one of the first types of play in which infants engage. The
infant responds to interactions with people.
22. In which type of play are children engaged in similar or identical activity,
without organization, division of labor, or mutual goal?
23. Solitary
24. Parallel
25. Associative
26. Cooperative
ANS: C
In associative play, no group goal is present. Each child acts according to his or
her own wishes. Although the children may be involved in similar activities, no
organization, division of labor, leadership assignment, or mutual goal exists.
Solitary play describes children playing alone with toys different from those used
by other children in the same area. Parallel play describes children playing
independently but being among other children. Cooperative play is organized.
Children play in a group with other children who play in activities for a common
goal.

23. The nurse observes some children in the playroom. Which play situation
exhibits the characteristics of parallel play?
24. Kimberly and Amanda sharing clay to each make things
25. Brian playing with his truck next to Kristina playing with her truck
26. Adam playing a board game with Kyle, Steven, and Erich
27. Danielle playing with a music box on her mother’s lap
ANS: B
Playing with trucks next to each other but not together is an example of parallel
play. Both children are engaged in similar activities in proximity to each other;
however, they are each engaged in their own play. Sharing clay to make things is
characteristic of associative play. Friends playing a board game together is
characteristic of cooperative play. A child playing with something by herself on
her mother’s lap is an example of solitary play.
24. A nurse is planning play activities for school-age children. Which type of a
play activity should the nurse plan?
25. Solitary
26. Parallel
27. Associative
28. Cooperative
ANS: D
School-age children engage in cooperative play where it is organized and
interactive. Playing a game is a good example of cooperative play. Solitary play
is appropriate for infants, parallel play is an activity appropriate for toddlers, and
associative play is an activity appropriate for preschool-age children.
25. Which following function of play is a major component of play at all ages?
26. Creativity
27. Socialization
28. Intellectual development
29. Sensorimotor activity
ANS: D
Sensorimotor activity is a major component of play at all ages. Active play is

essential for muscle development and allows the release of surplus energy.
Through sensorimotor play, children explore their physical world by using tactile,
auditory, visual, and kinesthetic stimulation. Creativity, socialization, and
intellectual development are each functions of play that are major components
at different ages.
MSC: Area of Client Needs: Health Promotion and Maintenance:

Developmental Stages and Transitions
26. Parents are asking the clinic nurse about an appropriate toy for their
toddler. Which response by the nurse is appropriate?
27. “Your child would enjoy playing a board game.”
28. “A toy your child can push or pull would help develop muscles.”
29. “An action figure toy would be a good choice.”
30. “A 25-piece puzzle would help your child develop recognition of shapes.”
ANS: B
Toys should be appropriate for the child’s age. A toddler would benefit from a toy
he or she could push or pull. The child is too young for a board game, action
figure, or 25-piece puzzle.
27. Which is probably the single most important influence on growth at all
stages of development?
28. Nutrition
29. Heredity
30. Culture
31. Environment
ANS: A
Nutrition is the single most important influence on growth. Dietary factors

regulate growth at all stages of development, and their effects are exerted in
numerous and complex ways. Adequate nutrition is closely related to good
health throughout life. Heredity, culture, and environment contribute to the
child’s growth and development. However, good nutrition is essential throughout
the life span for optimal health.

28. A nurse is counseling an adolescent, in her second month of pregnancy,

about the risk of teratogens. The adolescent has understood the teaching if
she makes which statement?
29. “I will be able to continue taking isotretinoin (Accutane) for my acne.”
30. “I can continue to clean my cat’s litter box.”
31. “I should avoid any alcoholic beverages.”
32. “I will ask my physician to adjust my phenytoin (Dilantin) dosage.”
ANS: C
Teratogens are agents that cause birth defects when present in the prenatal
period. Avoidance of alcoholic beverages is recommended to prevent fetal
alcohol syndrome. Isotretinoin (Accutane) and phenytoin (Dilantin) have been
shown to have teratogenic effects and should not be taken during pregnancy.
Cytomegalovirus, an infectious agent and a teratogen, can be transmitted
through cat feces, and cleaning the litter box during pregnancy should be
avoided.
29. What should the nurse consider when discussing language development
with parents of toddlers?
30. Sentences by toddlers include adverbs and adjectives.
31. The toddler expresses himself or herself with verbs or combination words.
32. The toddler uses simple sentences.
33. Pronouns are used frequently by the toddler.

ANS: B
The first parts of speech used are nouns, sometimes verbs (e.g., “go”), and
combination words (e.g., “bye-bye”). Responses are usually structurally
incomplete during the toddler period. The preschool child begins to use
adjectives and adverbs to qualify nouns followed by adverbs to qualify nouns and
verbs. Pronouns are not added until the later preschool years. By the time
children enter school, they are able to use simple, structurally complete
sentences that average five to seven words.
30. A nurse is observing children at play. Which figure depicts associative

play?
31.
32.
33.
34.
ANS: C
The children depicted in the figure at the carnival ride are demonstrating
associative play. They are engaged in similar or identical activities. The child
depicted playing alone is demonstrating solitary play. The children playing on the
beach depict parallel play. They are playing side by side but are participating in
different activities. The children depicted playing a board game are engaging in
cooperative play.

31. Which syndrome involves a common sex chromosome defect?

32. Down
33. Turner
34. Marfan
35. 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.
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
32. Turner syndrome is suspected in an adolescent girl with short stature.

What is the cause of this syndrome?
33. Absence of one of the X chromosomes
34. Presence of an incomplete Y chromosome
35. Precocious puberty in an otherwise healthy child
36. 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.

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
MULTIPLE RESPONSE
1. Play serves many purposes. In teaching parents about appropriate

activities, the nurse should inform them that play serves which of the following
function? (Select all that apply.)
2. Intellectual development
3. Physical development
4. Socialization
5. Creativity
6. Temperament development
ANS: A, C, D
A common statement is that play is the work of childhood. Intellectual

development is enhanced through the manipulation and exploration of objects.
Socialization is encouraged by interpersonal activities and learning of social
roles. In addition, creativity is developed through the experimentation
characteristic of imaginative play. Physical development depends on many
factors; play is not one of them. Temperament refers to behavioral tendencies
that are observable from the time of birth. The actual behaviors, but not the
child’s temperament attributes, may be modified through play.

2. What factors indicate parents should seek genetic counseling for their
child? (Select all that apply.)
3. Abnormal newborn screen
4. Family history of a hereditary disease
5. History of hypertension in the family
6. Severe colic as an infant
7. Metabolic disorder
ANS: A, B, E
Factors that are indicative parents should seek genetic counseling for their child
include an abnormal newborn screen, family history of a hereditary disease, and
a metabolic disorder. A history of hypertension or severe colic as an infant is not
an indicator of a genetic disease.
3. A nurse is preparing to administer a Denver II. Which is a correct

statement about the Denver II? (Select all that apply.)
4. All items intersected by the age line should be administered.
5. There is no correction for a child born preterm.
6. The tool is an intelligence test.
7. Toddlers and preschoolers should be prepared by presenting the test as a
game.
8. Presentation of the toys from the kit should be done one at a time.
ANS: A, D, E
To identify “cautions,” all items intersected by the age line are administered.
Toddlers and preschoolers should be tested by presenting the Denver II as a
game. Because children are easily distracted, perform each item quickly and
present only one toy from the kit at a time. Before beginning the screening, ask
whether the child was born preterm and correctly calculate the adjusted age. Up
to 24 months of age, allowances are made for preterm infants by subtracting the
number of weeks of missed gestation from their present age and testing them at
the adjusted age. Explain to the parents and child, if appropriate, that the
screenings are not intelligence tests but rather are a method of showing what
the child can do at a particular age.
COMPLETION
1. The nurse is recording a normal interpretation of a Denver II assessment.

The nurse understands that the maximum number of cautions determined for a
normal interpretation is _____. (Record your answer in a whole number.)
ANS:
Interpretation of normal for a Denver II is no delays and a maximum of one

caution.
OTHER

1. Place in order the sequence of cephalocaudal development that the nurse
expects to find in the infant. Begin with the first development expected,
sequencing to the final. Provide answers using lowercase letters separated by
commas (e.g., a, b, c, d).
1. Crawl
2. Sit unsupported
3. Lift head when prone
4. Gain complete head control
5. Walk
ANS:
c, d, b, a, e
Cephalocaudal development is head-to-tail. Infants achieve structural control of

the head before they have control of their trunks and extremities, they lift their
head while prone, obtain complete head control, sit unsupported, crawl, and
walk sequentially.
Chapter 04: Communication and Physical Assessment of the Child and Family
Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition
MULTIPLE CHOICE

1. The nurse is seeing an adolescent boy and his parents in the clinic for the
first time. What should the nurse do first?
a. Introduce self.
b. Make family comfortable.
c. Explain purpose of interview.
d. Give assurance of privacy.
ANS: A
The first thing that nurses should do is to introduce themselves to the patient
and family. Parents and other adults should be addressed with appropriate titles
unless they specify a preferred name. During the initial part of the interview, the
nurse should include general conversation to help make the family feel at ease.
Clarification of the purpose of the interview and the nurse’s role is the next thing
that should be done. The interview should take place in an environment as free
of distraction as possible. In addition, the nurse should clarify which information
will be shared with other members of the health care team and any limits to the
confidentiality.
MSC: Area of Client Needs: Psychosocial Integrity
2. Which is most likely to encourage parents to talk about their feelings

related to their child’s illness?
a. Be sympathetic.
b. Use direct questions.
c. Use open-ended questions.
d. Avoid periods of silence.
ANS: C
Closed-ended questions should be avoided when attempting to elicit parents’

feelings. Open-ended questions require the parent to respond with more than a
brief answer. Sympathy is having feelings or emotions in common with another
person rather than understanding those feelings (empathy). Sympathy is not
therapeutic in helping the relationship. Direct questions may obtain limited
information. In addition, the parent may consider them threatening. Silence can
be an effective interviewing tool. It allows sharing of feelings in which two or
more people absorb the emotion in depth. Silence permits the interviewee to sort
out thoughts and feelings and search for responses to questions.
3. Which communication technique should the nurse avoid when interviewing

children and their families?
a. Using silence
b. Using clichés
c. Directing the focus
d. Defining the problem
ANS: B
Using stereotyped comments or clichés can block effective communication, and

this technique should be avoided. After use of such trite phrases, parents will
often not respond. Silence can be an effective interviewing tool. Silence permits
the interviewee to sort out thoughts and feelings and search for responses to
questions. To be effective, the nurse must be able to direct the focus of the
interview while allowing maximal freedom of expression. By using open-ended
questions, along with guiding questions, the nurse can obtain the necessary
information and maintain the relationship with the family. The nurse and parent
must collaborate and define the problem that will be the focus of the nursing
intervention.
4. What is the single most important factor to consider when communicating

with children?
a. The child’s physical condition
b. Presence or absence of the child’s parent
c. The child’s developmental level

d. The child’s nonverbal behaviors
ANS: C
The nurse must be aware of the child’s developmental stage to engage in

effective communication. The use of both verbal and nonverbal communication
should be appropriate to the developmental level. Although the child’s physical
condition is a consideration, developmental level is much more important. The
parents’ presence is important when communicating with young children but
may be detrimental when speaking with adolescents. Nonverbal behaviors will
vary in importance, based on the child’s developmental level.
5. Which approach would be best to use to ensure a positive response from a

toddler?
a. Assume an eye-level position and talk quietly.
b. Call the toddler’s name while picking him or her up.
c. Call the toddler’s name and say, “I’m your nurse.”
d. Stand by the toddler, addressing him or her by name.

ANS: A
It is important that the nurse assume a position at the child’s level when
communicating with the child. By speaking quietly and focusing on the child, the
nurse should be able to obtain a positive response. The nurse should engage the
child and inform the toddler what is going to occur. If the nurse picks up the
child without explanation, the child is most likely going to become upset. The
toddler may not understand the meaning of the phrase, “I’m your nurse.” If a
positive response is desired, the nurse should assume the child’s level when
speaking if possible.
6. What is an important consideration for the nurse who is communicating

with a very young child?
a. Speak loudly, clearly, and directly.
b. Use transition objects, such as a doll.
c. Disguise own feelings, attitudes, and anxiety.
d. Initiate contact with child when parent is not present.
ANS: B
Using a transition object allows the young child an opportunity to evaluate an

unfamiliar person (the nurse). This will facilitate communication with a child this
age. Speaking in this manner will tend to increase anxiety in very young children.
The nurse must be honest with the child. Attempts at deception will lead to a
lack of trust. Whenever possible, the parent should be present for interactions
with young children.
7. A nurse is preparing to assess a 3-year-old child. What communication

technique should the nurse use for this child?
a. Focus communication on child.
b. Explain experiences of others to child.
c. Use easy analogies when possible.
d. Assure 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, experiences of others, analogies, and assurances
that the communication is private will not be effective because the child is not
capable of understanding.

8. A nurse is assigned to four children of different ages. In which age group

should the nurse understand that body integrity is a concern?
a. Toddler
b. Preschooler
c. School-age child
d. Adolescent
ANS: C
School-age children have a heightened concern about body integrity. They place
importance and value on their bodies and are oversensitive to anything that
constitutes a threat or suggestion of injury. Body integrity is not as important a
concern to toddlers, preschoolers, or adolescents.
9. An 8-year-old girl asks the nurse how the blood pressure apparatus works.
What is the most appropriate nursing action?
a. Ask her why she wants to know.

b. Determine why she is so anxious.
c. Explain in simple terms how it works.
d. 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. A 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, just requesting
clarification of what will be occurring. The nurse must explain how the blood
pressure cuff works so that the child can then observe during the procedure.
10. When the nurse interviews an adolescent, which is especially important?
a. Focus the discussion on the peer group.
b. Allow an opportunity to express feelings.
c. Emphasize that confidentiality will always be maintained.

d. Use the same type of language as the adolescent.
ANS: B
Adolescents, like all children, need an opportunity to express their feelings.

Often they will interject feelings into their words. The nurse must be alert to the
words and feelings expressed. Although the peer group is important to this age
group, the focus of the interview should be on the adolescent. The nurse should
clarify which information will be shared with other members of the health care
team and any limits to confidentiality. The nurse should maintain a professional
relationship with adolescents. To avoid misinterpretation of words and phrases
that the adolescent may use, the nurse should clarify terms frequently.
11. The nurse is having difficulty communicating with a hospitalized 6-year-old

child. What technique might be most helpful?
a. Suggest that the child keep a diary.
b. Suggest that the parent read fairy tales to the child.
c. Ask the parent if the child is always uncommunicative.
d. Ask the child to draw a picture.

ANS: D
Drawing is one of the most valuable forms of communication. Children’s

drawings tell a great deal about them because they are projections of the child’s
inner self. It would be difficult for a 6-year-old child who is most likely learning to
read to keep a diary. Parents reading fairy tales to the child is a passive activity
involving the parent and child. It would not facilitate communication with the
nurse. The child is in a stressful situation and is probably uncomfortable with
strangers.
12. The nurse is meeting a 5-year-old child for the first time and would like the
child to cooperate during a dressing change. The nurse decides to do a simple
magic trick using gauze. How should this action be interpreted?
a. Inappropriate, because of child’s age
b. A way to establish rapport
c. Too distracting, when cooperation is important
d. Acceptable, if there is adequate time
ANS: B
A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It
is an excellent method to build rapport and facilitate cooperation during a
procedure. Magic tricks appeal to the natural curiosity of young children. The
nurse should establish rapport with the child. Failure to do so may cause the
procedure to take longer and be more traumatic.
13. The nurse must assess a 10-month-old infant. The infant is sitting on the
father’s lap and appears to be afraid of the nurse and of what might happen
next. Which initial action by the nurse would be most appropriate?
a. Initiate a game of peek-a-boo.
b. Ask father to place the infant on the examination table.
c. Undress the infant while he is still sitting on his father’s lap.
d. Talk softly to the infant while taking him from his father.
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 on the father’s lap. The nurse should have the father undress the child
as needed for the examination.

14. The nurse is taking a health history on an adolescent. Which best

describes how the chief complaint should be determined?
a. Ask for detailed listing of symptoms.
b. Ask adolescent, “Why did you come here today?”
c. Use what adolescent says to determine, in correct medical terminology, what the probl
d. Interview parent away from adolescent to determine chief complaint.
ANS: B
The chief complaint is the specific reason for the child’s 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. A detailed listing of symptoms
will make it difficult to determine the chief complaint. The adolescent should be
prompted to tell which symptom caused him to seek help 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. The parent and adolescent may be
interviewed separately, but the nurse should determine the reason the
adolescent is seeking attention at this time.

15. Where in the health history should the nurse describe all details related to
the chief complaint?
a. Past history
b. Chief complaint
c. Present illness
d. Review of systems
ANS: C
The history of the present illness is a narrative of the chief complaint from its
earliest onset through its progression to the present. The focus of the present
illness is on all factors relevant to the main problem, even if they have
disappeared or changed during the onset, interval, and present. Past history
refers to information that relates to previous aspects of the child’s health, not to
the current problem. The chief complaint is the specific reason for the child’s
visit to the clinic, office, or hospital. It does not contain the narrative portion
describing the onset and progression. The review of systems is a specific review
of each body system.
16. The nurse is interviewing the mother of an infant. She reports, “I had a
difficult delivery, and my baby was born preterm.” This information should be
recorded under which of the following headings?
a. Past history
b. Present illness
c. Chief complaint
d. Review of systems
ANS: A
The past history refers to information that relates to previous aspects of the
child’s health, not to the current problem. The mother’s difficult delivery and
prematurity are important parts of the past history of an infant. 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
present illness. The chief complaint is the specific reason for the child’s visit to
the clinic, office, or hospital. It would not include the birth information. The
review of systems is a specific review of each body system. It does not include
the preterm birth. Sequelae such as pulmonary dysfunction would be included.
17. Which is most important to document about immunizations in the child’s

health history?
a. Dosage of immunizations received

b. Occurrence of any reaction after an immunization
c. The exact date the immunizations were received
d. Practitioner who administered the immunizations
ANS: B
The occurrence of any reaction after an immunization was given is the most
important to document in a history because of possible future reactions,
especially allergic reactions. Exact dosage of the immunization received may not
be recorded on the immunization record. Exact dates are important to obtain but
not as important as a history of reaction to an immunization. The practitioner
who administered the immunization does not need to be recorded in the health
history. A potentially severe physiologic response is the most threatening and
most important information to document for safety reasons.
18. When interviewing the mother of a 3-year-old child, the nurse asks about
developmental milestones such as the age of walking without assistance. How
should this question be considered?
a. Unnecessary information because child is age 3 years
b. An important part of the family history

c. An important part of the child’s past history
d. An important part of the child’s review of systems
ANS: C
Information about the attainment of developmental milestones is important to

obtain. It provides data about the child’s growth and development that should be
included in the past history. Developmental milestones provide important
information about the child’s physical, social, and neurologic health and should
be included in the history for a 3-year-old child. If pertinent, attainment of
milestones by siblings would be included in the family history. The review of
systems does not include the developmental milestones.
19. The nurse is taking a sexual history on an adolescent girl. Which is the
best way to determine whether she is sexually active?
a. Ask her, “Are you sexually active?”
b. Ask her, “Are you having sex with anyone?”
c. Ask her, “Are you having sex with a boyfriend?”
d. Ask both the girl and her parent whether she is sexually active.

ANS: B
Asking the adolescent girl whether 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 to the nurse to provide necessary care.
The word anyone is preferred to using gender-specific terms such as boyfriend
or girlfriend. Because homosexual experimentation may occur, it is preferable to
use gender-neutral terms. Questioning about sexual activity should occur when
the adolescent is alone.
20. When doing a nutritional assessment on a Hispanic family, the nurse

learns that their diet consists mainly of vegetables, legumes, and starches.
How should the nurse assess this diet?
a. Indicates they live in poverty
b. Is lacking in protein
c. May provide sufficient amino acids
d. Should be enriched with meat and milk
ANS: C
The diet that contains vegetable, legumes, and starches may provide sufficient
essential amino acids, even though the actual amount of meat or dairy protein is
low. Many cultures use diets that contain this combination of foods. It is not
indicative of poverty. Combinations of foods contain the essential amino acids
necessary for growth. A dietary assessment should be done, but many
vegetarian diets are sufficient for growth.
21. Which following parameters correlates best with measurements of the

body’s total protein stores?
a. Height
b. Weight
c. Skinfold thickness
d. Upper arm circumference
ANS: D
Upper arm circumference is correlated with measurements of total muscle mass.

Muscle serves as the body’s major protein reserve and is considered an index of
the body’s protein stores. Height is reflective of past nutritional status. Weight is
indicative of current nutritional status. Skinfold thickness is a measurement of
the body’s fat content.


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Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

1. An infant gains head control before sitting unassisted. The nurse

DIF: Cognitive Level: Understand REF: p. 38

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

2. Which refers to those times in an individual’s life when he or she is more

DIF: Cognitive Level: Remember REF: p. 39

TOP: Integrated Process: Nursing Process: Planning

MSC: Area of Client Needs: Health Promotion and Maintenance

3. An infant who weighs 7 pounds at birth would be expected to weigh how

DIF: Cognitive Level: Understand REF: p. 41

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

4. By what age does birth length usually double?

DIF: Cognitive Level: Remember REF: p. 41

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

DIF: Cognitive Level: Apply REF: p. 41

TOP: Integrated Process: Nursing Process: Implementation

MSC: Area of Client Needs: Health Promotion and Maintenance

DIF: Cognitive Level: Apply REF: p. 41

TOP: Integrated Process: Nursing Process: Implementation

MSC: Area of Client Needs: Health Promotion and Maintenance

At the time of the beginning of menstruation or the skeletal age of 13 years,

DIF: Cognitive Level: Apply REF: p. 41

MSC: Area of Client Needs: Health Promotion and Maintenance

8. How is a child’s skeletal age best determined?

The most accurate measure of skeletal age is radiologic examinations of the

DIF: Cognitive Level: Remember REF: p. 41

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

DIF: Cognitive Level: Comprehend REF: p. 41

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

10. A nurse has completed a teaching session for adolescents regarding

Lymphoid tissue continues growing until it reaches maximal development at

DIF: Cognitive Level: Analyze REF: p. 42

TOP: Integrated Process: Nursing Process: Evaluation

MSC: Area of Client Needs: Health Promotion and Maintenance

DIF: Cognitive Level: Understand REF: p. 42

TOP: Integrated Process: Nursing Process: Assessment

DIF: Cognitive Level: Apply REF: p. 43

TOP: Integrated Process: Communication and Documentation

MSC: Area of Client Needs: Health Promotion and Maintenance

13. A 12-year-old child enjoys collecting stamps, playing soccer, and

Industry is engaging in tasks that can be carried through to completion, learning

DIF: Cognitive Level: Understand REF: p. 38

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

According to Piaget, children ages 2 to 7 years are in the preoperational stage of

DIF: Cognitive Level: Apply REF: p. 45

TOP: Integrated Process: Nursing Process: Evaluation

MSC: Area of Client Needs: Health Promotion and Maintenance

DIF: Cognitive Level: Apply REF: p. 45

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

During concrete operations, children develop logical thought processes. They

DIF: Cognitive Level: Understand REF: p. 45

TOP: Integrated Process: Teaching/Learning