Maternity and Pediatric Nursing 2nd Edition by Susan Theresa Kyle – Test Bank

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Maternity and Pediatric Nursing 2nd Edition by Susan Theresa Kyle – Test Bank

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chapter 02

1.	The nurse is caring for a 2-week-old girl with a metabolic disorder. Which of the following activities would deviate from the characteristics of family-centered care?
	A)	Softening unpleasant information or prognoses
	B)	Evaluating and changing the nursing plan of care
	C)	Collaborating with the child and family as equals
	D)	Showing respect for the family’s beliefs and wishes

 

 

2.	The nurse is providing home care for a 6-year-old girl with multiple medical challenges. Which of the following activities would be considered the tertiary level of prevention?
	A)	Arranging for a physical therapy session
	B)	Teaching the parents to administer albuterol
	C)	Reminding the parents to give the full course of antibiotics
	D)	Giving the DTaP vaccination at proper intervals

 

 

3.	The nurse is caring for a 4-year-old boy with Ewing’s sarcoma who is scheduled for a CT scan tomorrow. Which of the following best reflects therapeutic communication?
	A)	Telling him he will get a shot when he wakes up tomorrow morning
	B)	Telling him how cool he looks in his baseball cap and pajamas
	C)	Using family-familiar words and soft words when possible
	D)	Describing what it is like to get a CT scan using words he understands

 

 

4.	The nurse is educating the parents of a 7-year-old girl who has just been diagnosed with epilepsy. Which of the following teaching techniques would be most appropriate?
	A)	Assessing the parents’ knowledge of anticonvulsant medications
	B)	Demonstrating proper seizure safety procedures
	C)	Discussing the surgical procedures for epilepsy
	D)	Giving the parents information in small amounts at a time

 

 

5.	The nurse is making a home visit to a client who had a cesarean birth 3 days ago. Assessment reveals that she is complaining of intermittent pain, rating it as 8 on a scale of 1 to 10. She states, “I’m pretty tired. And with this pain, I haven’t been drinking and eating like I should. The medication helps a bit but not much. My mom has been helping with the baby.” Her incision is clean, dry, and intact. Which nursing diagnosis would the nurse identify as the priority for this client?
	A)	Impaired skin integrity related to cesarean birth incision
	B)	Fatigue related to effects of surgery and caretaking activities
	C)	Imbalanced nutrition, less than body requirements, related to poor fluid and food intake
	D)	Acute pain related to incision and cesarean birth

 

 

6.	When caring for childbearing families from cultures different from one’s own, which of the following must the nurse accomplish first?
	A)	Adapting to the practices of the family’s culture
	B)	Determining similarities between both cultures
	C)	Assessing personal feelings about that culture
	D)	Learning as much as possible about that culture

 

 

7.	After teaching a group of students about the changes in health care delivery and funding, which of the following, if identified by the group as a current trend seen in the maternal and child health care settings, would indicate that the teaching was successful?
	A)	Increase in ambulatory care
	B)	Decrease in family poverty level
	C)	Increase in hospitalization of children
	D)	Decrease in managed care

 

 

8.	The nurse would recommend the use of which supplement as a primary prevention strategy to prevent neural tube defects in pregnant women?
	A)	Calcium
	B)	Folic acid
	C)	Vitamin C
	D)	Iron

 

 

9.	Which action would the nurse include in a primary prevention program in the community to help reduce the incidence of HIV infection?
	A)	Provide treatment for clients who test positive for HIV.
	B)	Monitor viral load counts periodically.
	C)	Educate clients about how to practice safe sex.
	D)	Offer testing for clients who practice unsafe sex.

 

 

10.	When assuming the role of discharge planner for a child requiring ventilator support at home, the nurse would do which of the following?
	A)	Confer with the school nurse or teacher.
	B)	Teach new self-care skills to the child.
	C)	Determine if there is a need for backup power.
	D)	Discuss coverage with the family’s insurance company.

 

 

11.	The parents of an 8-year-old with cancer are telling the nurse their problems and successes when caring for their child. In response, the nurse arranges for social services to meet with the parents to help them obtain financial assistance for the equipment and supplies. The nurse is acting in which role?
	A)	Educator
	B)	Advocate
	C)	Case manager
	D)	Direct care provider

 

 

12.	When explaining community-based nursing versus nursing in the acute care setting to a group of nursing students, the nurse describes the challenges associated with community-based nursing. Which of the following would the nurse include?
	A)	Increased time available for education
	B)	Improved access to resources
	C)	Decision making in isolation
	D)	Greater environmental structure

 

 

13.	When integrating the principles of family-centered care for a pregnant woman and her family, the nurse would integrate understanding of which of the following?
	A)	Childbirth is viewed as a medical event.
	B)	Families are unable to make informed choices.
	C)	Childbirth results in changes in relationships.
	D)	Families require little information to make appropriate decisions.

 

 

14.	A 3-year-old boy with encephalitis is scheduled for a lumbar puncture. Which of the following actions by the nurse would demonstrate atraumatic care?
	A)	Applying an anesthetic cream before the lumbar puncture
	B)	Having his anxious mother stay in the waiting room
	C)	Explaining, using medical terms, what will happen
	D)	Starting the child’s intravenous infusion in his room

 

 

15.	The nurse is caring for a 14-year-old girl with multiple health problems. Which of the following activities would best reflect evidence-based practice by the nurse?
	A)	Following blood pressure monitoring recommendations
	B)	Determining how often vital signs are monitored
	C)	Using hospital protocol for ordering diagnostic tests
	D)	Deciding on the medication dose

 

 

16.	The nurse is providing care to an ill child and his family. Which of the following activities would deviate from the basic principles of case management?
	A)	Collaborating with the family throughout the care path
	B)	Focusing on both the client’s and the family’s needs
	C)	Coordinating care provided by the interdisciplinary team
	D)	Ensuring quality care regardless of the cost

 

 

17.	A nursing student is reviewing information about documenting client care and education in the medical record and the purposes that it serves. The student demonstrates a need for additional study when the student identifies which of the following as a reason for documentation?
	A)	Serves as a communication tool for the interdisciplinary team
	B)	Demonstrates education the family has received if legal matters arise
	C)	Permits others access to allow refusal of medical insurance coverage
	D)	Verifies meeting client education standards set by the Joint Commission

 

 

18.	A pregnant client tells her nurse that she is interested in arranging a home birth. After educating the client on the advantages and disadvantages, which statement would indicate that the client understood the information?
	A)	“I like having the privacy, but it might be too expensive for me to set up in my home.”
	B)	“I want to have more control, but I am concerned if an emergency would arise.”
	C)	“It is the safest method for giving birth because there are no interferences.”
	D)	“The midwife is trained to resolve any emergency, and she can bring any pain meds.”

 

 

19.	After teaching a group of students about the different levels of prevention, the instructor determines a need for additional teaching when the students identify which of the following as an activity at the tertiary prevention level in community-based health care?
	A)	Teaching women to take folic acid supplements to prevent neural tube defects
	B)	Working with women who are victims of domestic violence
	C)	Working with clients at an HIV clinic to provide nutritional and CAM therapies
	D)	Teaching hypertensive clients to monitor blood pressure

 

 

20.	A nursing instructor is describing trends in maternal and newborn health care and the rise in community-based care for childbearing women. The instructor addresses the length of stay for vaginal births during the past decade, citing that which of the following denotes the average stay?
	A)	24–48 hours or less
	B)	72–96 hours or less
	C)	48–72 hours or less
	D)	96–120 hours or less

 

 

21.	A nurse is educating a client about a care plan. Which of the following would the nurse use to assess the client’s learning ability?
	A)	“Did you graduate from high school; how many years of schooling did you have?”
	B)	“Do you have someone in your family who would understand this information?”
	C)	“Many people have trouble remembering information; is this a problem for you?”
	D)	“Would you prefer that the doctor give you more detailed medical information?”

 

 

22.	A nurse is developing cultural competence. Which of the following indicates that the nurse is in the process of developing cultural knowledge? Select all that apply.
	A)	Examining personal sociocultural heritage
	B)	Reviewing personal biases and prejudices
	C)	Seeking resources to further understanding of other cultures
	D)	Becoming familiar with other culturally diverse lifestyles
	E)	Performing a competent cultural assessment
	F)	Advocating for social justice to eliminate disparities

 

 

23.	A nurse is considering a change in employment from the acute care setting to community-based nursing. The nurse is focusing her job search on ambulatory care settings. Which of the following would the nurse most likely find as a possible setting? Select all that apply.
	A)	Urgent care center
	B)	Hospice care
	C)	Immunization clinic
	D)	Physician’s office
	E)	Day surgery center
	F)	Nursing home

 

 

24.	A nursing instructor is presenting a class for a group of students about community-based nursing interventions. The instructor determines that additional teaching is needed when the students identify which of the following as a role of the community-based nurse?
	A)	Conducting childbirth education classes
	B)	Counseling a pregnant teen with anemia
	C)	Consulting with a parent of a child who is vomiting
	D)	Performing epidemiologic investigations

 

 

25.	During class, a nursing student asks, “I read an article that was talking about integrative medicine. What is that?” Which response by the instructor would be most appropriate?
	A)	“It refers to the use of complementary and alternative medicine in place of traditional therapies for a condition.”
	B)	“It means that complementary and alternative medicine is used together with conventional therapies to reduce pain or discomfort.”
	C)	“It means that mainstream medical therapies and complementary and alternative therapies are combined based on scientific evidence for being effective.”
	D)	“It refers to situations in which a client and his or her family prefer to use an unproven method of treatment over a proven one.”

 

 

26.	While a nurse is obtaining a health history, the client tells the nurse that she practices aromatherapy. The nurse interprets this as which of the following?
	A)	Use of essential oils to stimulate the sense of smell to balance the mind and body
	B)	Application of pressure to specific points to allow self-healing
	C)	Use of deep massage of areas on the foot or hand to rebalance body parts
	D)	Participation in chanting and praying to promote healing

 

 

27.	A pregnant woman asks the nurse about giving birth in a birthing center. She says, “I’m thinking about using one but I’m not sure.” Which of the following would the nurse need to integrate into the explanation about this birth setting? Select all that apply.
	A)	An alternative for women who are uncomfortable with a home birth
	B)	The longer length of stay needed when compared to hospital births
	C)	Focus on supporting women through labor instead of managing labor
	D)	View of labor and birth as a normal process requiring no intervention
	E)	Care provided primarily by obstetricians with midwives as backup care

 

 

28.	A nurse is preparing a teaching plan for a woman who is pregnant for the first time. Which of the following would the nurse incorporate into the teaching plan to foster the client’s learning? Select all that apply.
	A)	Teach “survival skills” first.
	B)	Use simple, nonmedical language.
	C)	Refrain from using a hands-on approach.
	D)	Avoid repeating information.
	E)	Use visual materials such as photos and videos.

 

 

29.	A group of nurses is engaged in developing cultural competence. The students demonstrate achievement of this goal after developing which of the following?
	A)	Cultural knowledge
	B)	Cultural skills
	C)	Cultural encounter
	D)	Cultural awareness

 

 

30.	The nurse who is scheduled to work in a clinic in a Hispanic neighborhood takes time to research Hispanic cultural norms to better provide culturally competent care to people at work. This behavior is an example of which of the following cultural components?
	A)	Cultural awareness
	B)	Cultural knowledge
	C)	Cultural skills
	D)	Cultural encounter

 

 

 

Answer Key

 

1.	A
2.	A
3.	D
4.	D
5.	D
6.	C
7.	A
8.	B
9.	C
10.	C
11.	B
12.	C
13.	C
14.	A
15.	A
16.	D
17.	C
18.	B
19.	A
20.	A
21.	C
22.	C, D
23.	A, D, E
24.	D
25.	C
26.	A
27.	A, C, D
28.	A, B, E
29.	C
30.	B

 

Chapter 04

1.	After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections (STIs)?
	A)	Oral contraceptives
	B)	Tubal ligation
	C)	Condoms
	D)	Intrauterine system

 

 

2.	When discussing contraceptive options, which method would the nurse recommend as being the most reliable?
	A)	Coitus interruptus
	B)	Lactational amenorrheal method (LAM)
	C)	Natural family planning
	D)	Intrauterine system

 

 

3.	A client comes to the clinic with abdominal pain. Based on her history the nurse suspects endometriosis. The nurse expects to prepare the client for which of the following to confirm this suspicion?
	A)	Pelvic examination
	B)	Transvaginal ultrasound
	C)	Laparoscopy
	D)	Hysterosalpingogram

 

 

4.	A client is to receive an implantable contraceptive. The nurse describes this contraceptive as containing:
	A)	Synthetic progestin
	B)	Combined estrogen and progestin
	C)	Concentrated spermicide
	D)	Concentrated estrogen

 

 

5.	The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only with a prescription?
	A)	Condom
	B)	Spermicide
	C)	Diaphragm
	D)	Basal body temperature

 

 

6.	When developing a teaching plan for a couple considering contraception options, which of the following statements would the nurse include?
	A)	“You should select one that is considered to be 100% effective.”
	B)	“The best one is the one that is the least expensive and most convenient.”
	C)	“A good contraceptive doesn’t require a physician’s prescription.”
	D)	“The best contraceptive is one that you will use correctly and consistently.”

 

 

7.	Which of the following measures would the nurse include in the teaching plan for a woman to reduce the risk of osteoporosis after menopause?
	A)	Taking vitamin supplements
	B)	Eating high-fiber, high-calorie foods
	C)	Restricting fluid to 1,000 mL daily
	D)	Participating in regular daily exercise

 

 

8.	When teaching a group of postmenopausal women about hot flashes and night sweats, the nurse would address which of the following as the primary cause?
	A)	Poor dietary intake
	B)	Estrogen deficiency
	C)	Active lifestyle
	D)	Changes in vaginal pH

 

 

9.	A client states that she is to have a test to measure bone mass to help diagnose osteoporosis. The nurse would most likely plan to prepare the client for:
	A)	DEXA scan
	B)	Ultrasound
	C)	MRI
	D)	Pelvic x-ray

 

 

10.	The nurse is reviewing the medical records of several clients. Which client would the nurse expect to have an increased risk for developing osteoporosis?
	A)	A woman of African American descent
	B)	A woman who plays tennis twice a week
	C)	A thin woman with small bones
	D)	A woman who drinks one cup of coffee a day

 

 

11.	Which of the following would the nurse emphasize when teaching postmenopausal women about ways to reduce the risk of osteoporosis?
	A)	Swimming daily
	B)	Taking vitamin A
	C)	Following a low-fat diet
	D)	Taking calcium supplements

 

 

12.	Which finding would the nurse expect to find in a client with endometriosis?
	A)	Hot flashes
	B)	Dysuria
	C)	Fluid retention
	D)	Fever

 

 

13.	After the nurse teaches a client about ways to reduce the symptoms of premenstrual syndrome, which client statement indicates a need for additional teaching?
	A)	“I will make sure to take my estrogen supplements a week before my period.”
	B)	“I’ve signed up for an aerobic exercise class three times a week.”
	C)	“I’ll cut down on the amount of coffee and colas I drink.”
	D)	“I quit smoking about a month ago, so that should help.”

 

 

14.	A woman has opted to use the basal body temperature method for contraception. The nurse instructs the client that a rise in basal body temperature indicates which of the following?
	A)	Onset of menses
	B)	Ovulation
	C)	Pregnancy
	D)	Safe period for intercourse

 

 

15.	A woman using the cervical mucus ovulation method of fertility awareness reports that her cervical mucus looks like egg whites. The nurse interprets this as which of the following?
	A)	Spinnbarkeit mucus
	B)	Purulent mucus
	C)	Postovulatory mucus
	D)	Normal preovulation mucus

 

 

16.	The nurse is reviewing the laboratory test results of a client with dysfunctional uterine bleeding (DUB). Which finding would be of concern?
	A)	Negative pregnancy test
	B)	Hemoglobin level of 10.1 g/dL
	C)	Prothrombin time of 60 seconds
	D)	Serum cholesterol of 140 mg/dL

 

 

17.	A nurse is preparing a class for a group of women at a family planning clinic about contraceptives. When describing the health benefits of oral contraceptives, which of the following would the nurse most likely include? (Select all that apply.)
	A)	Protection against pelvic inflammatory disease
	B)	Reduced risk for endometrial cancer
	C)	Decreased risk for depression
	D)	Reduced risk for migraine headaches
	E)	Improvement in acne

 

 

18.	After teaching a group of students about the different methods for contraception, the instructor determines that the teaching was successful when the students identify which of the following as a mechanical barrier method? (Select all that apply.)
	A)	Condom
	B)	Cervical cap
	C)	Cervical sponge
	D)	Diaphragm
	E)	Vaginal ring

 

 

19.	After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing dysfunctional uterine bleeding. Which statement by the client would support the nurse’s suspicions?
	A)	“I’ve been having bleeding off and on that’s irregular and sometimes heavy.”
	B)	“I get sharp pain in my lower abdomen usually starting soon after my period comes.”
	C)	“I get really irritable and moody about a week before my period.”
	D)	“My periods have been unusually long and heavy lately.”

 

 

20.	After teaching a group of students about premenstrual syndrome, the instructor determines that additional teaching is needed when the students identify which of the following as a prominent assessment finding?
	A)	Bloating
	B)	Tension
	C)	Dysphoria
	D)	Weight loss

 

 

21.	A nurse is describing the criteria needed for the diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following would the nurse include as a mandatory requirement for the diagnosis?
	A)	Appetite changes
	B)	Sleep difficulties
	C)	Persistent anger
	D)	Chronic fatigue

 

 

22.	When reviewing the medical record of a client diagnosed with endometriosis, which of the following would the nurse identify as a risk factor for this woman?
	A)	Low fat in the diet
	B)	Age of 14 years for menarche
	C)	Menstrual cycles of 24 days
	D)	Short menstrual flow

 

 

23.	A client who has come to the clinic is diagnosed with endometriosis. Which of the following would the nurse expect the physician to prescribe as a first-line treatment?
	A)	Progestins
	B)	Antiestrogens
	C)	Gonadotropin-releasing hormone analogues
	D)	NSAIDs

 

 

24.	A woman comes to the clinic because she has been unable to conceive. When reviewing the woman’s history, which of the following would the nurse least likely identify as a possible risk factor?
	A)	Age of 25 years
	B)	History of smoking
	C)	Diabetes since age 15 years
	D)	Weight below standard for height and age

 

 

25.	A couple comes to the clinic for a fertility evaluation. The male partner is to undergo a semen analysis. After teaching the partner about this test, which client statement indicates that the client has understood the instructions?
	A)	“I need to bring the specimen to the lab the day after collecting it.”
	B)	“I will place the specimen in a special plastic bag to transport it.”
	C)	“I have to abstain from sexual activity for about 1–2 days before the sample.”
	D)	“I will withdraw before I ejaculate during sex to collect the specimen.”

 

 

26.	A nurse is preparing a class for a group of young adult women about emergency contraceptives (ECs). Which of the following would the nurse need to stress to the group. Select all that apply.
	A)	ECs induce an abortion like reaction.
	B)	ECs provide some protection against STIs
	C)	ECs are birth control pills in higher, more frequent doses
	D)	ECs are not to be used in place of regular birth control
	E)	ECs provide little protection for future pregnancies.

 

 

 

Answer Key

 

1.	C
2.	D
3.	C
4.	A
5.	C
6.	D
7.	D
8.	B
9.	A
10.	C
11.	D
12.	B
13.	A
14.	B
15.	A
16.	B
17.	A, B, E
18.	A, B, C, D
19.	A
20.	D
21.	C
22.	C
23.	A
24.	A
25.	C
26.	C, D, E

 

chapter 25

1.	The nurse is examining a 10-month-old boy who was born 10 weeks early. Which of the following findings is cause for concern?
	A)	The child has doubled his birthweight.
	B)	The child exhibits plantar grasp reflex.
	C)	The child’s head circumference is 19.5 inches.
	D)	No primary teeth have erupted yet.

 

 

2.	The nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which of the following describes a developmental milestone occurring in infancy?
	A)	By 6 months of age the infant’s brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth.
	B)	Most infants triple their birthweight by 4 to 6 months of age and quadruple their birthweight by the time they are 1 year old.
	C)	The head circumference increases rapidly during the first 6 months: the average increase is about 1 inch per month.
	D)	The heart triples in size over the first year of life; the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

 

 

3.	The nurse measures the head circumference of a 6-month-old infant. Which measurement would the nurse interpret as most appropriate?
	A)	33 cm
	B)	35 cm
	C)	43.5 cm
	D)	47 cm

 

 

4.	The nurse is helping a new mother prepare for breastfeeding her infant. During which of the following newborn states of consciousness would the nurse recommended attempting the feeding?
	A)	Light sleep
	B)	Drowsiness
	C)	Quiet alert state
	D)	Active alert state

 

 

5.	The nurse is assessing the respiratory system of a newborn. Which of the following anatomic differences place the infant at risk for respiratory compromise? Select all answers that apply.
	A)	The nasal passages are narrower.
	B)	The trachea and chest wall are less compliant.
	C)	The bronchi and bronchioles are shorter and wider.
	D)	The larynx is more funnel shaped.
	E)	The tongue is smaller.
	F)	There are significantly fewer alveoli.

 

 

6.	A new mother shows the nurse that her baby grasps her finger when she touches the baby’s palm. How might the nurse respond to this information?
	A)	“This is a primitive reflex known as the plantar grasp.”
	B)	“This is a primitive reflex known as the palmar grasp.”
	C)	“This is a protective reflex known as rooting.”
	D)	“This is a protective reflex known as the Moro reflex.”

 

 

7.	Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned?
	A)	Plantar grasp
	B)	Step
	C)	Babinski
	D)	Neck righting

 

 

8.	A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse’s best response to this observation?
	A)	“This is normal behavior for infants unless the stool passed is hard and dry.”
	B)	“This is normal behavior for infants due to the immaturity of the gastrointestinal system.”
	C)	“This indicates a blockage in the intestine and must be reported to the physician.”
	D)	“This is normal behavior for infants unless the stool passed is black or green.”

 

 

9.	The neonatal nurse assesses newborns for iron-deficiency anemia. Which of the following newborns is at highest risk for this disorder?
	A)	A postterm newborn
	B)	A term newborn with jaundice
	C)	A newborn born to a diabetic mother
	D)	A premature newborn

 

 

10.	The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which of the following statements accurately describe the typical infant’s achievement of these milestones? Select all answers that apply.
	A)	At 1 month the infant lifts and turns the head to the side in the prone position.
	B)	At 2 months the infant lifts head and looks around.
	C)	At 6 months the infant pulls to stand up.
	D)	At 7 months the infant sits alone with some use of hands for support.
	E)	At 9 months the infant crawls with the abdomen off the floor.
	F)	At 12 months the infant walks independently.

 

 

11.	At which age would the nurse expect to find the beginning of object permanence?
	A)	1 month
	B)	4 months
	C)	8 months
	D)	12 months

 

 

12.	The nurse is teaching a new mother about the development of sensory skills in her newborn. Which of the following would alert the mother to a sensory deficit in her child?
	A)	The newborn’s eyes wander and occasionally are crossed.
	B)	The newborn does not respond to a loud noise.
	C)	The newborn’s eyes focus on near objects.
	D)	The newborn becomes more alert with stroking when drowsy.

 

 

13.	The nurse is assessing a 4-month-old boy during a scheduled visit. Which of the following findings might suggest a developmental problem?
	A)	The child does not coo or gurgle.
	B)	The child does not babble or laugh.
	C)	The child never squeals or yells.
	D)	The child does not say dada or mama.

 

 

14.	The nurse observes an infant interacting with his parents. Which of the following are normal social behavioral developments for this age group? Select all answers that apply.
	A)	Around 5 months the infant may develop stranger anxiety.
	B)	Around 2 months the infant exhibits a first real smile.
	C)	Around 3 months the infant smiles widely and gurgles when interacting with the caregiver.
	D)	Around 3 months the infant will mimic the parent’s facial movements, such as sticking out the tongue.
	E)	Around 3 to 6 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo.
	F)	Separation anxiety may also start in the last few months of infancy.

 

 

15.	The nurse is performing a health assessment of a 3-month-old Black American boy. For what condition should this infant be monitored based on his race?
	A)	Jaundice
	B)	Iron deficiency
	C)	Lactose intolerance
	D)	Gastroesophageal reflux disease (GERD)

 

 

16.	The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which of the following is the most effective anticipatory guidance?
	A)	Encouraging breastfeeding until the sixth month
	B)	Advocating iron supplements with bottle-feeding
	C)	Advising fluid intake per feeding of 5 or 6 ounces
	D)	Discouraging the addition of fruit juice to the diet

 

 

17.	The nurse is teaching a new mother the proper techniques for breastfeeding her newborn. Which of the following is a recommended guideline that should be implemented?
	A)	Wash the hands and breasts thoroughly prior to breastfeeding.
	B)	Stroke the nipple against the baby’s chin to stimulate wide opening of the baby’s mouth.
	C)	Bring the baby’s wide-open mouth to the breast to form a seal around all of the nipple and areola.
	D)	When finished the mother can break the suction by firmly pulling the baby’s mouth away from the nipple.

 

 

18.	The nurse is providing discharge teaching regarding formula preparation for a new mother. Which of the following guidelines would the nurse include in the teaching plan?
	A)	Always wash bottles and nipples in hot soapy water and rinse well; do not wash them in the dishwasher.
	B)	Store tightly covered ready-to-feed formula can after opening in refrigerator for up to 24 hours.
	C)	Warm bottle of formula by placing bottle in a container of hot water, or microwaving formula.
	D)	Do not add cereal to the formula in the bottle or sweeten the formula with honey.

 

 

19.	The nurse is caring for a 4-week-old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance?
	A)	Promoting the digestibility of breast milk
	B)	Telling how and when to introduce rice cereal
	C)	Describing root reflex and latching on
	D)	Advising how to choose a good formula

 

 

20.	The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred?
	A)	“I’ll start with baby oatmeal cereal mixed with low-fat milk.”
	B)	“The cereal should be a fairly thin consistency at first.”
	C)	“I can puree the meat that we are eating to give to my baby.”
	D)	“Once he gets used to the cereal, then we’ll try giving him a cup.”

 

 

21.	The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which of the following topics would be most appropriate?
	A)	Advising how to create a toddler-safe home
	B)	Warning about small objects left on the floor
	C)	Cautioning about putting the baby in a walker
	D)	Telling about safety procedures during baths

 

 

22.	The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which of the following is the priority intervention to promote adequate growth?
	A)	Monitoring the child’s weight and height
	B)	Encouraging a more frequent feeding schedule
	C)	Assessing the child’s current feeding pattern
	D)	Recommending higher-calorie solid foods

 

 

23.	The nurse is caring for a 7-month-old girl during a well-child visit. Which of the following interventions is most appropriate for this child?
	A)	Discussing the type of sippy cup to use
	B)	Advising about increased caloric needs
	C)	Explaining how to prepare table meats
	D)	Describing the tongue extrusion reflex

 

 

24.	The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. Which of the following is the priority intervention?
	A)	Performing a developmental evaluation of the child
	B)	Encouraging the parents to speak English to the child
	C)	Asking the mother if the child uses Spanish words
	D)	Referring the child to a developmental specialist

 

 

25.	A 6-month-old girl weighs 14.7 pounds during a scheduled check-up. Her birth weight was 8 pounds. Which of the following is the priority nursing intervention?
	A)	Talking about solid food consumption
	B)	Discouraging daily fruit juice intake
	C)	Increasing the number of breastfeedings
	D)	Discussing the child’s feeding patterns

 

 

26.	The nurse is educating a first-time mother who has a 1-week-old boy. Which of the following is the most accurate anticipatory guidance?
	A)	Describing the effect of neonatal teeth on breastfeeding
	B)	Explaining that the stomach holds less than 1 ounce
	C)	Informing that fontanels will close by 6 months
	D)	Telling that the step reflex persists until the child walks

 

 

27.	A mother is concerned about her infant’s spitting up. Which suggestion would be most appropriate?
	A)	“Put the infant in an infant seat after eating.”
	B)	“Limit burping to once during a feeding.”
	C)	“Feed the same amount but space out the feedings.”
	D)	“Keep the baby sitting up for about 30 minutes afterward.”

 

 

28.	The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week old baby. Which of the following recommended guidelines might be included in the teaching plan?
	A)	Place the baby on a soft mattress with a firm flat pillow for the head.
	B)	Place the head of the bed near the window to provide fresh air, weather permitting.
	C)	Place the baby on his or her back when sleeping.
	D)	If the baby sleeps through the night, wake him or her up for the night feeding.

 

 

29.	The nurse is counseling the mother of a newborn who is concerned about her baby’s constant crying. What teaching would be appropriate for this mother?
	A)	Carrying the baby may increase the length of crying.
	B)	Reducing stimulation may decrease the length of crying.
	C)	Using vibration, white noise, or swaddling may increase crying.
	D)	Using a swing or car ride may increase the incidence of crying episodes.

 

 

30.	The parent of a 6-month old infant asks the nurse for advice about his son’s thumb sucking. What would be the nurse’s best response to this parent?
	A)	“Thumb sucking is a healthy self-comforting activity.”
	B)	“Thumb sucking leads to the need for orthodontic braces.”
	C)	“Caregivers should pay special attention to the thumb sucking to stop it.”
	D)	“Thumb sucking should be replaced with the use of a pacifier.”

 

 

 

Answer Key

 

1.	C
2.	A
3.	C
4.	C
5.	A, D, F
6.	B
7.	B
8.	A
9.	D
10.	A, D, E, F
11.	B
12.	B
13.	B
14.	B, C, D, F
15.	C
16.	D
17.	C
18.	D
19.	B
20.	B
21.	A
22.	A
23.	A
24.	C
25.	D
26.	B
27.	D
28.	C
29.	B
30.	A