- Tretinoin (Retin-A) is a commonly used topical agent for the treatment of acne. What do nursing
considerations with this drug include?
a. Sun exposure increases effectiveness.
b. Cosmetics with lanolin and petrolatum are preferred in acne.
c. Applying of the medication occurs at least 20 to 30 minutes after washing.
d. Erythema and peeling are indications of toxicity and need to be reported
ANS: C Applying of the medication occurs at least 20 to 30 minutes after washing.
The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning
sensation. The avoidance of sun and the use of sunscreen agents must be emphasized because sun exposure can result in severe sunburn. Cosmetics with lanolin, petrolatum, vegetable oil, lauryl alcohol, butyl stearate, and
oleic acid can increase comedone production. Erythema and peeling are common local manifestations.
- What is the usual presenting symptom for testicular cancer?
a. Solid, painful mass
b. Hard, painless mass
c. Scrotal swelling and pain
d. Epididymis easily palpated
ANS: B Hard, painless mass
The usual presenting symptom for testicular cancer is a heavy, hard, painless mass that is either smooth or
nodular and palpated on the testes. Pain is not usually associated with a testicular tumor. Scrotal swelling needs
to be evaluated. The epididymis is easily palpated in a normal scrotum.
- A 13-year-old boy comes to the school nurse complaining of sudden and severe scrotal pain. He denies any
trauma to the scrotum. What is the most appropriate nursing action?
a. Refer him for immediate medical evaluation.
b. Administer analgesics and recommend scrotal support.
c. Apply an ice bag and observe for increasing pain.
d. Reassure the adolescent that occasional pain is common with the changes of puberty.
ANS: A Refer him for immediate medical evaluation.
Any adolescent boy with redness, swelling, or pain in the scrotum is referred for immediate evaluation. These
are signs of testicular torsion, which is a medical emergency. If the possibility of testicular torsion is
eliminated, appropriate interventions include administering analgesics and recommending scrotal support. applying an ice bag and observing for increasing pain. and reassuring the adolescent that occasional pain is
common with the changes of puberty.
- A 14-year-old boy is of normal weight, and his parents are concerned about bilateral breast enlargement. The nurses discussion of this should be based on what?
a. The presence of too much body fat
b. Symptom that a hormonal imbalance is present
c. Most likely part of normal pubertal development
d. Indication that he is developing precocious puberty
ANS: C Most likely part of normal pubertal development
Gynecomastia is common during midpuberty in about one third of boys. For most, the breast enlargement
disappears within 2 years. Although breast enlargement in overweight children can indicate too much body fat, in children of normal body weight, it is a normal occurrence. If the gynecomastia persists beyond 2 years, then a hormonal cause may need to be investigated. Precocious puberty is the early onset of puberty, before age 9 years in boys
- A 15-year-old girl tells the school nurse that she has not started to menstruate yet. Onset of secondary sexual
characteristics was about 2 1/2 years ago. The nurse should take which action?
a. Explain that this is not unusual.
b. Refer the adolescent for an evaluation.
c. Make an assumption that the adolescent is pregnant.
d. Suggest that the adolescent stop exercising until menarche occurs
ANS: B. Refer the adolescent for an evaluation.
A referral is indicated. Menarche should follow the onset of secondary sexual development within 2 1/2 years. A careful examination is done to reveal any physical abnormalities, signs of androgen excess, and congenital
defects of the genital tract. The lack of the onset of menstruation at this age is a potential indication of a
physical problem. Assuming that the adolescent is pregnant is inappropriate. The nurse does not have any indication that the adolescent is sexually active. The amount of exercise should be assessed before suggesting that the adolescent stop exercising until menarche occurs.
- 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 nurses response
should be based on what?
a. Hormone therapy is necessary for the treatment of dysmenorrhea.
b. Acetaminophen is the drug of choice for the treatment of dysmenorrhea.
c. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief.
d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.
ANS: D. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.
First-line therapy for adolescents with dysmenorrhea is NSAIDs. NSAIDs are potent anti-inflammatory agents
that block the formation of prostaglandins, resulting in decreased uterine activity. Hormone therapy may be indicated if there is no physical abnormality and NSAIDs are ineffective. Acetaminophen does not have an antiprostaglandin action. It can help with pain control but will not be as effective as NSAIDs.
- What is a major physical risk for young adolescents during pregnancy?
a. Osteoporosis frequently develops.
b. Fetopelvic disproportion is a common problem.
c. Delivery is usually precipitous in this age group.
d. Pregnancy will adversely affect the adolescents development
ANS: B Fetopelvic disproportion is a common problem.
Teenagers younger than 15 years of age have increased obstetric risks. Fetopelvic disproportion is one of the
most common complications. Osteoporosis occurs later in life and is not related to adolescent pregnancy. Prolonged, not precipitous, labor is common in this age group. Teenage mothers are socially, educationally, psychologically, and economically disadvantaged. Support is necessary because the tasks of motherhood are
superimposed on adolescent development tasks.
- The nurses role in facilitating successful childrearing in unmarried teenage mothers includes what?
a. Facilitating marriage between the mother and father of the baby
b. Teaching the adolescent the long-term needs of the growing child
c. Providing information and feedback about positive parenting skills
d. Encouraging the infants grandmother to take responsibility for care
ANS: C. Providing information and feedback about positive parenting skills
Competence in a teenage mother is increased when feedback is provided about positive parenting skills and use
of community resources. The nurse can identify and refer the mother to programs such as support groups for
adolescent mothers, infant stimulation programs, and parenting programs. Facilitating marriage between the
mother and the father of the baby may produce additional stress and detract from their ability to care for the
infant. Encouraging the infants grandmother to take responsibility for care would decrease the mothers ability
to develop successful childrearing behaviors. Supportive families can provide assistance to enable the teenage
mother to complete school. Many adolescents do not have a future perspective for themselves. The nurse
includes information on normal infant development to aid the mother in having reasonable expectations.
- What is a priority goal in the postpartum care of an adolescent mother?
a. Prevention of subsequent pregnancies
b. Ensuring that the father of the baby cares for the child
c. Returning the mother to a prepregnancy lifestyle
d. Facilitating formula feeding to minimize interruptions
ANS : A Prevention of subsequent pregnancies
Postpartum care of the adolescent is directed at preventing subsequent pregnancies and enhancing life
outcomes for the teen parents and child. Health care programs should provide comprehensive contraceptive
services at the same time the child is seen for appointments. Ensuring the father of the baby cares for the child
is not part of the postpartum care of the mother. The adolescent mother cannot return to a prepregnancy
lifestyle. She now has an infant to care for. Breastfeeding is recommended for the infant. The nurse and mother
should explore the best nutrition for both the mothers needs and those of the infant.
- A pregnant 15-year-old adolescent tells the nurse that she did not use any form of contraception because
she was afraid her parents would find out. The nurse should recognize what?
a. This is a frequent reason given by adolescents.
b. This suggests a poor parentchild relationship.
c. This is not a good reason to not get contraception.
d. This indicates that the adolescent is unaware of her legal rights.
ANS: A. This is a frequent reason given by adolescents.
This is one of the most common reasons given by teenagers for not using contraception. Although it is
optimum for the parents to be involved in the health care of adolescents, some adolescents require confidential
care. Privacy is important as they develop their personal identity and establish relationships. The adolescent
may be concerned about parental judgment. The adolescent should discuss with the health care provider
contraception that meets her needs; some of the longer acting birth control methods may be preferable. The
adolescent did not tell the nurse that she was unaware that she could legally obtain contraceptive materials; she
was concerned about her parents.
- An adolescent girl calls the nurse at the clinic because she had unprotected sex the night before and does
not want to be pregnant. What should the nurse explain?
a. It is too late to prevent an unwanted pregnancy.
b. An abortion may be the best option if she is pregnant.
c. The risk of pregnancy is minimal, so no action is necessary.
d. Postcoital contraception is available to prevent implantation and therefore pregnancy.
ANS: D. Postcoital contraception is available to prevent implantation and therefore pregnancy.
Several emergency methods of contraception (ECP) are available and appropriate for use after unprotected
sexual intercourse. A progestin-only ECP (levonorgestrel [Plan B]) is approved by the U.S. Food and Drug
Administration and has high effectiveness and low rates of side effects. Plan B is effective if given within 72 hours of unprotected intercourse. An abortion is not indicated. Although the risk of pregnancy depends on the
time during her menstrual cycle, a low risk of pregnancy exists. ECP is indicated.
- An adolescent girl is brought to the hospital emergency department by her parents after being raped. The
girl is calm and controlled throughout the interview and examination. The nurse should recognize this behavior
is what?
a. A sign that a rape has not actually occurred
b. One of a variety of behaviors normally seen in rape victims
c. Indicative of a higher than usual level of maturity in the adolescent
d. Suggestive that the adolescent had severe emotional problems before the rape occurred
ANS: B. One of a variety of behaviors normally seen in rape victims
Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain
composure while hiding the inner turmoil. Because the observed behavior is within the range of expected
behavior, there are no data to indicate that a rape has not actually occurred, that the adolescent is unusually
mature, or that she had severe emotional problems before the rape occurred.
- The nurse has determined that an adolescents body mass index (BMI) is in the 90th percentile. What
information should the nurse convey to the adolescent?
a. The adolescent is overweight.
b. The adolescent has maintained weight within the normal range.
c. The adolescent is at risk for becoming overweight.
d. Nutritional supplementation should occur at least three times per week
ANS: C. The adolescent is at risk for becoming overweight.
Adolescents with BMIs between the 85th and 94th percentile for age and gender are at risk for becoming
overweight. Adolescents with BMIs greater than the 95th percentile are classified as overweight. Nutritional
guidance, not supplementation, is needed.
14. The nurse is teaching a class on obesity prevention to parents in the community. What is a contributing factor to childhood obesity?
a. Birth weight
b. Parental overweight
c. Age at the onset of puberty
d. Asian ethnic background
ANS: B. Parental overweight
There is a high correlation between parental adiposity and childhood adiposity. Obese children do not have
higher birth weights than nonobese children. Early menarche is associated with obesity, but the age of puberty
is not a contributing factor. African Americans and Hispanics have disproportionately high percentages of
overweight individuals, but Asians do not.
- During a well-child visit, the nurse plots the childs BMI on the health record. What is the purpose of the
BMI?
a. To determine medication dosages
b. To predict adult height and weight
c. To identify coping strategies used by the child
d. To provide a consistent measure of obesity
ANS: D. To provide a consistent measure of obesity
A consistent measure of the degree of obesity is important to determine whether modification of the body fat
component is indicated. Body surface area (BSA), not BMI, is used for medication dosage calculation. The
BMI is not a predictor of adult height. A child with a high BMI may use food as a coping mechanism, but the
BMI is not correlated with coping strategy use.
- During a well-child visit, the nurse practitioner provides guidance about promoting healthy eating in a child
who is overweight. What does the nurse advise?
a. Slow down eating meals.
b. Avoid between-meal snacks.
c. Include low-fat foods in meals.
d. Use foods that child likes as special treats.
ANS: A. Slow down eating meals.
When a child slows down the eating process, it is easier to recognize signs of fullness. If food is consumed
rapidly, this feedback is lost. Regular meals and snacks are encouraged to prevent the child from becoming too
hungry and overeating. Low-fat foods are usually higher in calories than the regular versions. Nutritional labels
should be checked and foods high in sugar and calories avoided. Food should not be used as a special treat or
reward; this encourages the child to use food as comfort measures in response to boredom and stress.
- The middle school nurse is planning a behavior modification program for overweight children. What is the most important goal for participants of the program?
a. Learn how to cook low-fat meals.
b. Improve relationships with peers.
c. Identify and eliminate inappropriate eating habits.
d. Achieve normal weight during the program.
ANS: C. Identify and eliminate inappropriate eating habits.
The goal of behavior modification in weight control is to help the participant identify abnormal eating
processes. After the abnormal patterns are identified, then techniques, including problem solving, are taught to
eliminate inappropriate eating. Learning how to cook low-fat meals can be a component of the program, but
the focus of behavior modification is identifying target behaviors that need to be changed. Improving
relationships is not the focus of weight management behavior management programs. Achieving normal
weight during the program is an inappropriate goal. As the child incorporates the techniques, weight gain will
slow. In childhood obesity, the goal is to stop the increase of weight gain.
- Descriptions of young people with anorexia nervosa (AN) often include which criteria?
a. Impulsive
b. Extroverted
c. Perfectionist
d. Low achieving
ANS: C. Perfectionist
Individuals with AN are described as striving for perfection, which may manifest in other compulsive
disorders. They are also academically high achievers. Impulsive and extroverted personalities are more
characteristic of bulimia nervosa.
- What behavior is the nurse most likely to assess in an adolescent with anorexia nervosa (AN)?
a. Eats in secrecy
b. Uses food as a coping mechanism
c. Has a marked preoccupation with food
d. Lacks awareness of how eating affects weight loss
ANS: C. Has a marked preoccupation with food
Individuals with AN display great interest in food. They prepare meals for others, talk about food, and hoard
food. During meals, food play may occur to appear as if the person is eating. Persons with AN consume a small
amount of food, so they have no need to eat in secrecy. Individuals with bulimia nervosa (BN) usually binge
privately. Food is not used as a coping mechanism in AN, as is common in BN. Individuals with AN know
about the relationship between calorie intake and calorie expenditure. They can regulate intake and then
exercise to not gain or to lose weight.
- During the physical examination of an adolescent with significant weight loss, what finding may indicate
an eating disorder?
a. Diarrhea
b. Amenorrhea
c. Appetite suppression
d. Erosion of tooth enamel
ANS: D. Erosion of tooth enamel
Some of the signs of bulimia include erosion of tooth enamel and increased dental caries. Check the back of
the hands for abrasions caused by rubbing against the maxillary incisors during self-induced vomiting. Diarrhea is not a result of vomiting. Rather, it may occur in patients with inflammatory bowel disease and other
gastrointestinal diseases. Amenorrhea can occur with anorexia nervosa, but it can also be a result of the weight
loss from other causes. It can also indicate pregnancy in adolescent females. Appetite suppression can occur
from central nervous system lesions or from oncologic and metabolic disorders.
- What goal is most important when caring for a child with anorexia nervosa (AN)?
a. Limit fluid intake.
b. Prevent depression.
c. Correct malnutrition.
d. Encourage weight gain.
ANS: C. Correct malnutrition.
In children diagnosed with AN or bulimia nervosa, the priority consideration is to correct the malnutrition. Severe malnutrition, electrolyte disturbances, vital sign abnormalities, and psychiatric disorders may be
present. Careful monitoring is necessary to avoid complications. Often fluid intake is restricted by individuals
with AN. Fluid balance must be restored. Preventing depression is important, but the correction of potentially
life-threatening malnutrition takes precedence. After the initial malnutrition is corrected, then a plan is established for nutritional therapy.
- What do nursing responsibilities regarding weight gain for an adolescent with anorexia nervosa include?
a. Administer tube feedings until target weight is achieved.
b. Restore body weight to within 10% of the adolescents ideal weight.
c. Encourage continuation of strenuous exercise as long as adolescent is not losing weight.
d. Facilitate as rapid a weight gain as possible with a high-calorie diet.
ANS: B. Restore body weight to within 10% of the adolescents ideal weight.
The restoration of body weight to a target weight or endpoint within 10% of ideal body weight is one of the
main goals of therapy. Strenuous exercise is avoided as part of the need to modify behaviors. Tube feedings are
intrusive and are avoided. They should only be used when other measures have failed. Weight restoration is
accomplished slowly. The goal is 1 kg/wk to avoid the risk of metabolic and cardiac problems. Slow weight
gain can minimize anxiety and depression
- An important distinction in understanding substance abuse is that drug misuse, abuse, and addiction are
considered what?
a. Voluntary behaviors based on psychosocial needs
b. Problems that occur in conjunction with addiction
c. Involuntary physiologic responses to the pharmacologic characteristics of drugs
d. Legal use of substances for purposes other than medicinal.
ANS: A. Voluntary behaviors based on psychosocial needs
Drug misuse, abuse, and addiction are considered voluntary behaviors. Cultural norms define what is abuse
and misuse. Addiction is a psychologic dependence on a substance with or without physical dependence. Physical dependence is an involuntary response to the pharmacologic characteristics of the drug such as an
opiate or alcohol. Legality is not always a factor in substance abuse. Legal substances such as alcohol and
tobacco can also be misused or abused and can cause addiction.
- What statement is true about smoking in college students?
a. The rate of smoking cigarettes is declining.
b. Smokeless tobacco use is rising dramatically.
c. Regular cigar use is becoming more common.
d. Students in the health professions do not smoke.
ANS: C. Regular cigar use is becoming more common.
Approximately 8.5% of college students smoke cigars on a regular basis. Among college students, the rate of
cigarette smoking is rising. At last report, 28.5% of this group smoked cigarettes. Use of smokeless tobacco is
declining overall. Students in the health professions do smoke.
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Chapter 25: GI50
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Chapter 27: The Child with Cardiovascular Dysfunction52
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Chapter 28 : NEW48
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Chapter 28: The Child with Hematologic or Immunologic Dysfunction48
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Chapter 30 : The child with cerebral Dysfunction50
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Chapter 25: Select all14
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Chapter 27: Select all9
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Chapter 28 : Select all10
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Chapter 30: Select all14
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chapter 1425
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chapter 1625
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Chapter 1845
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Chapter 2351
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Chapter 2658
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Exam 1 sellect all that apply60
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Chapter 19 : Family-centered care of the child with chronic illness or disability33
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Chapter 22 : Pediatric Nursing interventions and skills10
