WCC Pedia Set A Ratio

WORLD CITI COLLEGE
PEDIATRIC NURSING
PRINCIPLES OF GROWTH AND DEVELOPMENT
SET A
SITUATION: Knowledge of several principles, issues, and theories help nurses understand holistic
optimaldevelopment and care.
1. Freud believed that the most important life instinct was which of the following instincts?
a. protector b. hunter c. sex d. comfort
ANS: C
To Freud, the most important life instinct was the sex instinct, which changed its character and focus according to
biological maturation. (Freud’s concept of sex and sexuality was broader than what is implied in the use of these
words today, and indicates sexuality in its genital manifestations as well as any kind of pleasure seeking.) As the sex
instinct’s psychic energy (libido) shifts from one part of the body to another, the child passes through five stages of
development: oral, anal, phallic, latency, and genital. Each stage is related to a specific body part (erogenous zone)
that brings primary pleasure to the child during that stage. According to Freud, adult personality is profoundly
impacted by how each stage is managed.
Ref: Potts. Pediatric Nursing 3ed
2. Erik Erikson’s psychosocial theory of development differed from Freud’s ideas of development in that Erikson
viewed:
a. children as being controlled by caregivers and society with little room for exploring the environment on their own
b. children as being controlled by the superego and being afraid to displease the caregivers
c. humans as rational creatures with the ego controlling thoughts, feelings, and actions rather than the id, superego,
or conflicts
d. children as having no sexual interests or conflicts of any kind, with this issue not arising until young adulthood
ANS: C
Erikson differs from Freud, however, in that he believes children actively adapt and explore their environment instead
of being passively controlled and molded by caregivers and society. Erikson also assumes humans are rational
creatures whose actions, feelings, and thoughts are controlled primarily by the ego instead of the id, superego, or
conflicts between the three components of personality.
3. According to Harry Stack Sullivan’s stages of interpersonal development, the primary task of the first stage is:
a. learning to rely on others, especially the primary caregiver, to gratify physiological needs and achieve satisfaction
b. to satisfy egotistical and narcissistic needs
c. to learn how to please the caregivers and others
d. becoming independent of caregivers and separating self from the environment and significant people
ANS: A
The first stage (infant) encompasses birth to when the child is able to use words that convey the same meaning to the
child as they do to others (18 months). The primary task of this stage revolves around learning to rely on others,
especially the primary caregiver, to gratify physiological needs and achieve satisfaction.
4. According to Piaget, the coordination of the secondary schemes phase of development (eight to twelve months)
occurs when the infant:
a. is interested in novelty and repetition as seen in activities such as continual hitting with a hammer
b. understands concepts of space and object permanence and anticipates actions of others
c. is able to think before acting and use memory for simple trial and error problem solving
d. can name and locate familiar objects and demonstrate symbolic and ritualistic play
ANS: B
The coordination of secondary schemes phase (8–12 months) occurs when the infant understands concepts of space
and object permanence, learns to direct actions toward an intended goal (searches for hidden objects; drops, throws,
examines objects), and anticipates actions of others (caregiver comes with crying). They can differentiate objects
(caregiver and stranger; familiar toy and unfamiliar toy), and begin developing individual habits or ways of learning
about the world.
5. According to Kohlberg, the first level of moral development is called:

a. postconventional c. conventional
b. instrumental realistic orientation d. preconventional
ANS: D
The first level (preconventional morality), characterized by an egocentric focus, is divided into three stages: Premoral
stage (Birth to 2 years), Punishment and obedience orientation stage (2 to 3 years), and Instrumental realistic
orientation stage (4 to 7 years).
SITUATION: Growth and development of an infant
6. The nurse is teaching the parents of an 8-month-old about what the child should eat. The nurse should include
which of the following points in the teaching plan?
a. Items from all four food groups should be introduced to the infant by the time the child is 10 months old.
b. Solid foods should not be introduced until the infant is 10 months old.
c. Iron deficiency rarely develops before 12 months of age, so iron-fortified cereals should not be introduced until the
infant is 12 months old.
d. The infant’s diet can be changed from formula to whole milk when the infant is 12 months old.
ANS: D
Infants should be kept on formula or breast milk until 1 year of age. The protein in cow’s milk is harder to digest than
that found in formula.
Option A - The infant cannot digest fats well, so some foods from the four food groups are not necessary in his diet
during infancy.
Option B - Solids are introduced into the infant’s diet around 4 to 6 months, after the extrusion reflex has diminished
and when the child will accept new textures.
Option C - Iron deficiency develops in term infants between 4 to 6 months when the prenatal iron stores are depleted.
Fortified cereals can be added to the infant’s diet at 4 to 6 months to prevent iron deficiency anemia.
Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition Page Page 724, 843.
7. The mother of an infant asks you when to begin tooth brushing with her son. Your best response would be
a. as soon as the first tooth erupts. c. when weaning is complete.
b. by 12 months of age. d. as soon as he begins to eat fruit.
Ans: A
Tooth brushing should begin with the eruption of the first tooth.
Ref: A. Pillitteri. Maternal and Child Health Nursing 5ed
8. A mother seems concerned as she asks why her infant is walking sideways while holding onto furniture. The best
response by the nurse is:
a. “You need to get a neurological consultation for your baby to rule out some pathology.”
b. “If you will hold the baby’s hands while the baby walks, you can break the baby of this habit.”
c. “Infants start walking sideways while holding onto furniture before walking or standing alone.”
d. “You need to make an appointment with your pediatrician and have this problem checked out.”
ANS: C
From 10 to 12 months, infant locomotion progresses rapidly. During this time, deliberate steps will be taken while
holding onto something (cruising). The infant will start to walk sideways while holding onto furniture, before walking
or standing alone. Once infants can stand alone, they will attempt to take a few steps alone.
9. When mother plays peek-a-boo with a baby, the mother is helping to teach the baby which of the following?
a. object permanence b. coordination c. visual skill d. vocal rhythm
ANS: A
The infant knows that an object or person still exists even if covered up or removed from sight; this is why babies
respond so strongly to peek-a-boo.
SITUATION: Growth and development of the toddlers
10. A 2-year-old holds his breath until he passes out when he wants something his mother does not want him to
have. You would base your evaluation of whether these temper tantrums are a form of seizure on the basis that
a. seizures are not provoked; temper tantrums are.
b. seizures rarely occur in toddlers.
c. seizures typically occur with fever; temper tantrums do not.
d. with seizures, cyanosis rarely develops.
ANS: A
Temper tantrums occur because children are angry or frustrated; seizures occur without respect to provocation.
Ref: A. Pillitteri. Maternal and Child Nursing. 5th Edition
11. The way you would advise a toddler's mother to handle temper tantrums would be to
a. appear to ignore them. c. promise him a special activity if he will stop.
b. distract him with a toy when he begins breath holding. d. mimic his behavior by also holding her breath.
Ans: A
Rewarding temper tantrums can teach children that they are an effective method of interaction. Ignoring tantrums
teaches that they are ineffective.
Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition Page Page 724, 843.
12. Caregivers complain to the nurse that their two-year-old child insists on having his own way and is very stubborn
about wanting things done at the same time in the same way every day. The best response by the nurse is which of
the following responses?
a. “Usually stubbornness can be corrected with behavior modification.”
b. “You will need to teach your child that the caregiver is the one in charge.”
c. “Routines provide a sense of security and control over the environment.”
d. “Coming up with a way to change this presents a challenge to the caregivers.”
ANS: C
Many caregivers feel they become slave to the schedules of their 2-year old. When a toddler com-mands things to be
done in the same way at the same time, the child is not acting out of stubborn-ness, but asking for needs to be met.
Routines provide sense of security and give a framework to master new skills while providing sense of control over the
environment.
13. A toddler's mother tells you that no matter what she asks of her child, he says, “No.” A suggestion you might
make to help her handle this problem is for her to
a. pretend she does not hear him. c. tell him never to say, “No” again.
b. ask no further questions of him. d. give him secondary, not primary, choices.
Ans: D
Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices
encourages this without disrupting family life.
14. A toddler insists on brushing his own teeth and being left alone in the bathtub. What advice would you give his
parents regarding this?
a. Helping with his own tooth brushing allows him to experience autonomy but are not safe alone in battubs.
b. It is unusual for 2-year-olds to have such strong opinions.
c. His mother should continue to give full care in all aspects.
d. Leaving him alone in the bathtub is a good way to encourage autonomy.
Ans: A
Toddlers are not safe alone in bathtubs; most toddlers have strong opinions; helping with tooth brushing is a good
way to express autonomy
SITUATION: Growth and development of the preschoolers
15. When providing therapeutic play, which toy would best promote imaginative play in a 4-year-old?
a. Large blocks b. Dress up clothes c. Wooden puzzle d. Big wheels
ANS: B
Dress up clothes enhances imaginative play and imagination, allowing preschoolers to engage in rich fantasy play.
Building blocks and wooden puzzles are appropriate for encouraging fine motor development. Big wheels and tricycles
encourage gross motor development.
Reference: Pillitteri, A. (2007). Maternal and Child Health Nursing: Care of the childbearing and childrearing
family. Volume. 5th edition. Lippincot William & Wilkins. Page 888, 893.
16. Which of the following would the nurse identify as the underlying rationale for a 4-year-old who tells the nurse
that her doll is in the hospital because it was bad?
a. Egocentrism b. Past experience c. Magical thinking d. Oedipal conflict
ANS: C
The fantasies of preschoolers can result in a sense of guilt. Because they cannot discern cause and effect, they see
hospitalization as punishment for some real or fantasized misdoing. Magical thinking causes preschoolers to view
illness as a punishment. Moreover, preschoolers are experiencing psychosexual conflicts and fears of mutilation,
making them especially fearful of procedures such as rectal temperatures and urinary catheterizations. Egocentrism
accounts for the preschooler’s inability to see another’s point of view. Past experience can affect the preschooler’s
reaction to hospitalization, but this is not the underlying rationale here. Oedipal conflicts do not directly affect
hospitalization.
17. The mother of a preschooler reports that her child creates a scene every night at bedtime. The nurse and the
mother decide that the best course of action would be:
a. Allow the child to stay up later one or two nights a week. c. Encourage active play before bedtime.
b. Establish a set bedtime and follow a routine. d. Give the child a cookie if bedtime is pleasant.
ANSWER: B
Bedtime is often problem with preschoolers. Recommendations for reducing conflicts at bedtime include establishing a
set bedtime; having a dependable routine, such as story reading; and conveying the expectation that the child will
comply. Allowing the child to stay up late one or two nights interferes with establishing the needed bedtime rituals.
Excitement, such as active play, just before bedtime should be avoided because it stimulates the child, making it
difficult for the child to calm down and prepare for sleep. Using food such as a cookie as a reward if bedtime is
pleasant should be avoided because it places too much importance on food. Other rewards, such as stickers, could be
used as an alternative.
family. Volume. 5th edition. Lippincot William & Wilkins. Page 895-896.
18. A nurse compares a preschool child’s height and weight with standard growth charts and finds the child to be in
the 50th percentile for height and in the 45th percentile for weight. The nurse interprets these findings as indicating
that the child is:
a. Average height and weight. c. Underweight for height.
b. Overweight for height. d. Abnormal in height.
ANS: A
The values of height and weight percentiles are usually similar for an individual child. Measurements between the 5th
and 95th percentiles are considered normal. Marked discrepancies identify overweight or underweight children.
family. Volume. 5th edition. Lippincot William & Wilkins. Page 1794.
SITUATION: growth and development of a school aged child
19. Which of the following statements should the nurse stress when teaching parents to maintain a consistent bedtime
schedule for their 9-year-old?
a. The child’s need for sleep is greater now than in adolescence
b. Nightmares and night terrors are common
c. The child often is unaware of his own fatigue level
d. Ten hours of sleep every night is the minimum requirement
ANS: C
School-age children are often unaware of their own fatigue level. If allowed to remain awake, they will be tired the
next day. Because of the slowing growth rate during this period, school-age children require less sleep than
adolescents do. Nightmares and night terrors are common during the preschool period. Although the requirements
may vary, younger school-age children typically require 10 to 12 hours of sleep each night and older ones require
about 8 to 10 hours.
family. Volume. 5th edition. Lippincot William & Wilkins. Page 923.
20. Which of the following activities, when voiced by parents following a teaching session about the characteristics of
school-age cognitive development, would indicate the need for additional teaching?
a. Collecting baseball cards and marbles c. Considering simple problem-solving options
b. Arranging dolls according to size d. Developing plans for the future
ANS: D
The school-aged child is in the stage of concrete operations, marked by inductive reasoning, logical operations, and
reversible concrete thought. The ability to consider the future requires formal thought operations, which are not
developed until adolescence. Collecting baseball cards and marbles, arranging dolls by size and simple problem-
solving options are examples of the concrete operational thinking of the school-age child.
21.A school-age child enjoys playing games with friends. At what age are children typically ready for games that
include competition?
a. 7 years. b. 9 years. c. 10 years. d. 13 years.
Ans: C
Before about 10 years, children are unable to lose a game and still maintain the self-concept that they are good
people.
22. A 10-year-old spends 2 hours by herself every afternoon before her parents arrive home. Which of the following
would be the most appropriate safety measure to suggest that the parents teach the child?
a. Telling people at school she is by herself for added safety.
b. Wearing the house key prominently around her neck.

c. Lighting candles in case there is a power failure.
d. Preparing a no-cook snack for herself.
Ans: D
Latchkey children need to learn to be independent but to respect fire safety rules.
SITUATION: Growth and development of adolescent
23. Which of the following predisposes the adolescent to feel an increased need for sleep?
a. An inadequate diet c. Decreased activity that contributes to a feeling of fatigue
b. Rapid physical growth d. The lack of ambition typical of this age group
ANS; B
During growth spurts, the need for sleep is increased. A, C, and D. Rapid physical growth, the tendency toward
overexertion, and the overall increased activity of this age contributes to fatigue.
Ref: Hockenberry, et al.: Wong's Essential of Pediatric Nursing, 8th Edition
24. A nurse is preparing to consult with an adolescent being seen in a clinic. Which principle is most important for the
nurse to consider when interacting with the client?
a. Avoid a straightforward approach because adolescents cannot fully process their health needs.
b. Reassure the teenager that it is unnecessary to answer all questions; however, before the examination is complete
the client will need to provide all information.
c. Avoid conveying surprise over comments made by the client.
d. Because adolescents want to be treated as adults, the same cognitive information should be provided as if they
were an adult.
ANS: C
The adolescent needs the trust of the nurse. If the nurse appears surprised over comments or information provided,
the client may not feel safe or valued and may not be forthright in giving information. It is important to provide
honest, straightforward information to the client. There may be questions the client does not want to answer, and that
is acceptable. Adolescents are not adults, and they should not be addressed in the same manner as adults.
Reference: Ball, J., & Bindler, R. (2006). Child Health Nursing: Partnering with Children and Families (p. 178).
25. According to Erikson, the psychosocial task of adolescence is developing which of the following?
a. Intimacy b. Identity c. Initiative d. Independence
ANS: B
Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of
identity. A. Intimacy is the developmental stage for early adulthood. C. Initiative is the developmental stage for early
childhood. D. Independence is not one of Erikson’s developmental stages.
SITUATION: Communication and Physical and Development Assessment of the Child
26. The nurse is seeing an adolescent boy and his parents in the clinic for the first time. Which of the following should
the nurse do first?
a. Introduce self. c. Explain purpose of interview.
b. Make family comfortable. d. Give assurance of privacy.
ANS: A
The first thing that nurses must do is to introduce themselves to the client and family. Parents and other adults should
be addressed with appropriate titles unless parents specify a preferred name.
B. During the initial part of the interview, the nurse should include general conversation to help make the family feel
at ease.
C. Clarification of the purpose of the interview and the role of the nurse is the next thing that should be done.
D. 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.
27. Which of the following is most likely to encourage parents to talk about their feelings related to their child’s
illness?
a. Be sympathetic. c. Use open-ended questions.
b. Use direct 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 answer with more than a brief answer.
A. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings
(empathy). Sympathy is not therapeutic in the helping relationship.
B. Direct question may obtain limited information. In addition, they may be considered threatening by the parent.
D. Silence can be a very effective interviewing tool. It allows a 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.
28. Which of the following is considered a block to effective communication?

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. After use of such trite phrases, parents will
often not respond. Silence can be a very effective interviewing tool. Silence permits the interviewee to sort out
thoughts and feelings and search for responses to questions. Option C: 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.
D. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention.
29. What is the single most important factor to consider when communicating with children?
a. The child’s physical condition c. Developmental level of the child
b. Presence or absence of the child’s parent d. Nonverbal behaviors of the child
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.
A. Although the physical condition of the child is a consideration, developmental level is much more important.
B. The presence of parents is important when communicating with young children, but may be detrimental when
speaking with adolescents.
D. Nonverbal behaviors will vary in importance based on the developmental level of the child.
SITUATION: Family Influences on Child Health Promotion
30. Which of the following statements is true concerning the role-transition experience of new parents?
a. Parents’ marital relationship can have a positive or negative effect on the role transition.
b. Infants with special care needs help strengthen parents’ sense of confidence in their new role.
c. Young parents adjust to the new role easier than older parents.
d. Parents’ previous experience with children makes the role transition more difficult.
ANS: A
If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles.
When marital tensions alter care-giving routines and interfere with the enjoyment of the infant, then the marital
relationship has a negative effect.
B. Infants with special care needs can be a significant source of added strength.
C. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits,
and less time for each other and other children.
D. Parents who have previous experience with parenting appear more relaxed and have less conflict in disciplinary
relationships and are more aware of normal growth and development.
31. When assessing a family, the nurse determines that the parents exert little or no control over their children. This
style of parenting is called:
a. Permissive. b. Dictatorial. c. Democratic. d. Authoritarian.
ANS: A
Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own
activity as much as possible. The parents exert little or no control over their children’s actions. Options B and D:
Dictatorial or authoritarian parents attempt to control their children’s behavior and attitudes through unquestioned
mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and
unquestioningly. Option C: Democratic parents combine permissive and dictatorial styles. They direct their children’s
behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the
child’s individual nature.
32. When discussing discipline with the mother of a 4-year-old child, the nurse should include which of the following?
a. Children as young as 4 years rarely need to be punished.
b. Parental control should be consistent.
c. Withdrawal of love and approval is effective at this age.
d. One should expect rules to be followed rigidly and unquestioningly.
ANS: B
For effective discipline, parents must be consistent, and parents must follow-through with agreed-on actions.
A. Realistic goals should be set for this age group. Parents should structure environment to prevent unnecessary
difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child.
C. Withdrawal of love and approval is never appropriate or effective.
D. Discipline strategies should be appropriate to the child’s age, temperament, and severity of the misbehavior.
Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old.
33. Which of the following is most characteristic of the physical punishment of children, such as spanking?
a. Psychological impact is usually minimal. c. Children’s development of reasoning increases.
b. Children rarely become accustomed to spanking. d. Misbehavior is likely to occur when parents are not present.
ANS: D
Through the use of physical punishment, children learn what they should not do. When parents are not around, it is
more likely that children will misbehave, because the children have not learned to behave well for their own sake, but
rather out of fear of punishment.
A. Spanking can cause severe physical and psychological injury and interfere with effective parent/child interaction.
B. Children do become accustomed to spanking, requiring more severe corporal punishment each time.
C. The use of corporal punishment may interfere with the child’s development of moral reasoning.
34. A 3-year-old was adopted immediately after birth. The parents have just asked the nurse how they should tell the
child that she is adopted. Which of the following guidelines concerning adoption should the nurse use in planning her
response?
a. Telling child is an important aspect of their parental responsibilities.
b. Best time to tell child is between ages 7 and 10 years.
c. It is not necessary to tell child who was adopted so young.
d. It is best to wait until child asks about it.
ANS: A
It is important for the parents not to withhold information about the adoption from the child. It is an essential
component of the child’s identity. Options BCD: There is no recommended best time to tell children. It is believed that
children should be told young enough so they do not remember a time when they did not know. It should be done
before the children enter school to keep third parties from telling the children before the parents have had the
opportunity.
35. Children may feel that they are responsible for their parents’ divorce and interpret the separation as punishment.
At what age is this most likely to occur?
a. 1 year b. 4 years c. 8 years d. 13 years
ANS: B
Preschool-age children are most likely to blame themselves for the divorce. The 4-year-old will fear abandonment and
express bewilderment regarding all human relationships. Option A: Infants may have increased irritability and
interference with the attachment process, but they are too young to feel responsibility. Option C: School-age children
will have feelings of deprivation, including the loss of parent, attention, money, and secure future. Option D:
Adolescents are able to disengage themselves from the parental conflict.
SITUATION: Care of children who are hospitalized
36. Which of the following represents the major stressor of hospitalization for children from middle infancy throughout
the preschool years?
a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain
ANS: A
The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic
depression. This is a major stressor of hospitalization. Options BCD: These are all stressors associated with
hospitalization. However, separation from family is a primary stressor in this age group.
37. During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and
he refused the staff’s attention. Now the nurse observes that Eric appears to “settle in” and be unconcerned about
seeing his parents. The nurse should interpret this as which of the following?
a. He has successfully adjusted to the hospital environment.
b. He has transferred his trust to the nursing staff.
c. He may be experiencing detachment, which is the third stage of separation anxiety.
d. Because he is “at home” in the hospital now, seeing his mother frequently will only start the cycle again.
ANS: C
These are the behavior manifestations of the separation anxiety phase of detachment. Superficially it appears that the
child has adjusted to the loss. Options A and B: This behavior is a sign of resignation, not contentment. Option D:
Parents should be encouraged to be with their child. If parents restrict visits, they may begin a pattern of
misunderstanding the child’s cues and not meeting his needs.
38. When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child
may likely see hospitalization as which of the following?
a. Punishment c. An opportunity for regression
b. Threat to child’s self-image d. Loss of companionship with friends
ANS: A
If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to
punishment for real or imagined misdeeds. Options B and D: This is a reaction typical of school-age children. Option
C: This is a response characteristic of toddlers when threatened with loss of control.
39. Because of their striving for independence and productivity, which age group of children is particularly vulnerable
to events that may lessen their feeling of control and power?
a. Infant b. Toddler c. Preschooler d. School-age child
ANS: D
When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity
and inability to cope with stress usurps individual power and identity. This is especially detrimental to school-age
children, who are striving for independence and productivity and are now experiencing events that lessen their control
and power. Options ABC: Children in these age groups, although affected by loss of power, are not as significantly
affected as are school-age children.
40. A 10-year-old girl needs to have another IV started. She keeps telling the nurse, “Wait a minute,” and, “I’m not
ready.” The nurse should recognize that:
a. This is normal behavior for a school-age child.
b. This behavior is usually not seen past the preschool years.
c. The child thinks the nurse is punishing her.
d. The child has successfully manipulated the nurse in the past.
ANS: A
This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices
about when the IV will be inserted. Option B: This can be characteristic behavior when an individual needs to maintain
some control over a situation. Options C and D: The child is trying to have some control in the hospital experience.
41. A spinal tap must be done on a 9-year-old boy. While waiting in the treatment room, the nurse observes that he
seems composed. When the nurse asks him if he wants his mother to stay with him, he says, “I am fine.” Which of
the following is the best interpretation of this situation?
a. Child is unusually brave.
b. Child has learned that support doesn’t help.
c. School-age children do not usually want a parent present during the procedure.
d. School-age children often do not request support, even though they need and want it.
ANS: D
The school-age child’s visible composure, calmness, and acceptance often mask their inner longing for support. It is
especially important to be aware of nonverbal cues such as facial expression, silence, or lack of activity. Usually when
someone identifies the unspoken messages, the child will readily accept support. Options ABC: This age child has a
more passive approach to pain and a nondirect request for support. Their visible composure, calmness and acceptance
often mask their inner longing for support.
SITUATION: Chronic Illness, Disability, or End-of-Life Care for the Child and Family
42. The nurse case manager is planning to have a care conference about a young child who has complex health care
needs and will soon be discharged home. Who should the nurse invite to the conference?
a. Family and nursing staff
b. Social worker, nursing staff, and primary care physician
c. Family and key health professionals involved in child’s care
d. Primary care physician and key health professionals involved in child’s care
ANS: C
A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family
is involved and key health professionals that are involved in the child’s care.
A. The nursing staff can address the nursing care needs of the child with the family, but other involved disciplines
must be included.
B. The family must be included in the discharge conferences, which allow them to determine what education they will
require and the resources needed at home.
D. A member of the nursing staff must be included to review the nursing needs of the child.
43. Which of the following represents a common best practice in the provision of services to children with special
needs?
a. Care is now being focused on the child’s chronologic age.
b. Children with special needs are being integrated into regular classrooms.
c. Children with special needs no longer have to be cared for by their families.
d. Children with special needs are being separated into residential treatment facilities.
ANS: B
Normalization refers to behaviors and interventions of the disabled to integrate into society by living life as persons
without a disability would. For children, normalization includes attending school and being integrated into regular
classrooms. This affords the child the advantages of learning with a wide group of peers.
A. Care is necessarily focused on the developmental age of the child. C and D. Home care by the family is considered
best practices. The nurse can assist families by assessing social support systems, coping strategies, family
cohesiveness, and family/community resources.
44. Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been
determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse
about this and state that they didn’t realize her disability was so severe. The best interpretation of this situation is
that:
a. This is a sign parents are in denial.
b. This is a normal anticipated time of parental stress.
c. The parents need to learn more about cerebral palsy.
d. The parents are used to having expectations that are too high.
ANS: B
Parenting a child with a chronic illness can be very stressful for parents. There are anticipated times that parental
stress increases. One of these identified times is when the child begins school. Nurses can help parents recognize and
plan interventions to work through these stressful periods.
A. The parents are not in denial; they are responding to the child’s placement in school.
C and D. The parents are not exhibiting signs of a knowledge deficit; this is their first interaction with the school
system with this child.
45. Approach behaviors are those coping mechanisms that result in a family’s movement toward adjustment and
resolution of the crisis of having a child with a chronic illness or disability. Which of the following is considered an
approach behavior?
a. Is unable to adjust to a progression of the disease or condition
b. Anticipates future problems and seeks guidance and answers
c. Looks for new cures without a perspective toward possible benefit
d. Fails to recognize seriousness of child’s condition despite physical evidence
ANS: B
The parents who anticipate future problems and seek guidance and answers are demonstrating approach behaviors.
They are demonstrating positive actions in caring for their child. A, C, and D. These are avoidance behaviors. The
parents are moving away from adjustment or maladaptation in the crisis of a child with chronic illness or disability.
46. Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability.
After the shock phase, a period of adjustment usually follows. This is often characterized by which of the following
responses?
a. Denial b. Guilt and anger c. Social reintegration d. Acceptance of child’s limitations
ANS: B
For most families, the adjustment phase is accompanied by several responses that are normally part of the
adjustment process. Guilt, self-accusation, bitterness, and anger are common reactions.
A. The initial diagnosis of a chronic illness or disability often is often met with intense emotion and characterized by
shock and denial. C and D. Social reintegration and acceptance of the child’s limitations is the culmination of the
adjustment process.
SITUATION: Impact of Cognitive or Sensory Impairment on the Child and Family
47.A young child who has an intelligence quotient of 45 would be described as which of the following?
a. Within the lower limits of the range of normal intelligence
b. Mildly retarded but educable
c. Moderately retarded but trainable

d. Severely retarded and completely dependent on others for care
ANS: C
Moderately retarded IQs range from 35 to 40 to 50 to 55. A. The lower limit of normal intelligence is approximately
70. B. Individuals with IQs of 50 to 70 are considered mildly retarded but educable. D. An IQ of 20 to 40 results in
severe retardation.
48. When a child with mild mental retardation reaches the end of adolescence, which of the following characteristics
would be expected?
a. Achieves a mental age of 5 to 6 years
b. Achieves a mental age of 8 to 12 years
c. Unable to progress in functional reading or arithmetic
d. Acquires practical skills and useful reading and arithmetic to an eighth-grade level
ANS: B
By the end of adolescence, the child with mild mental retardation can acquire practical skills and useful reading and
arithmetic to a third- to sixth-grade level. A mental age of 8 to 12 years is obtainable, and the child can be guided
toward social conformity. A and C. This mental age is characteristic of children with moderate retardation. D.This
level of skill development is not descriptive of mental retardation.
49. When should children with cognitive impairment be referred for stimulation and educational programs?
a. As young as possible
b. As soon as they have the ability to communicate in some way
c. At age 3 years, when schools are required to provide services
d. At age 5 or 6 years, when schools are required to provide services
ANS: A
The child’s education should begin as soon as possible. Considerable evidence exists that early intervention programs
for children with disabilities are valuable for cognitively impaired children. B. The early intervention may facilitate the
child’s development of communication skills.
50. Which of the following should be the major consideration when selecting toys for a child who is mentally retarded?
a. Safety b. Age-appropriateness c. Ability to provide exercise d. Ability to teach useful skills
ANS: A
Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for
children who are mentally retarded. B, C, and D. These factors should all be considered in the selection of toys, but
safety is of paramount importance.

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5. According to Kohlberg, the first level of moral development is called:

SITUATION: Growth and development of an infant

SITUATION: Growth and development of the toddlers

SITUATION: growth and development of a school aged child

b. Wearing the house key prominently around her neck.

SITUATION: Growth and development of adolescent

SITUATION: Communication and Physical and Development Assessment of the Child

28. Which of the following is considered a block to effective communication?

SITUATION: Family Influences on Child Health Promotion

SITUATION: Care of children who are hospitalized

SITUATION: Impact of Cognitive or Sensory Impairment on the Child and Family

c. Moderately retarded but trainable

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