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Wongs Nursing Care of Infants 9th Edition Hockenberry Wilson Test Bank

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Wongs Nursing Care of Infants 9th Edition Hockenberry Wilson Test Bank

ISBN-13: 978-0323069120

ISBN-10: 0323069126

 

Description

Wongs Nursing Care of Infants 9th Edition Hockenberry Wilson Test Bank

ISBN-13: 978-0323069120

ISBN-10: 0323069126

 

 

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Hockenberry: Wong’s Nursing Care of Infants and Children, 9th Edition

 

Chapter 20: Physical Health Problems of Adolescence

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Tretinoin (Retin-A) is a commonly used topical agent for the treatment of acne. Nursing considerations with this drug include which of the following?
a. Sun exposure increases effectiveness.
b. Cosmetics with lanolin and petrolatum are preferred in acne.
c. Application 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

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.

 

DIF:    Cognitive Level: Analysis                REF:   p. 777             TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which of the following 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

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 the normal scrotum.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 779

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. A 13-year-old boy comes to the school nurse complaining of sudden and severe scrotal pain. He denies any trauma to the scrotum. The most appropriate nursing action is which of the following?
a. Refer for immediate medical evaluation.
b. Administer analgesics and recommend scrotal support.
c. Apply an ice bag and observe for increasing pain.
d. Reassure adolescent that occasional pain is common with the changes of puberty.

 

 

ANS:  A

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.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 780

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. A 14-year-old boy of normal weight and his parents are concerned about bilateral breast enlargement. The nurse’s discussion of this should be based on which of the following?
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

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 in boys.

 

DIF:    Cognitive Level: Application           REF:   p. 780

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. 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:
a. explain that this is not unusual.
b. refer adolescent for an evaluation.
c. assume that the adolescent is pregnant.
d. suggest adolescent stop exercising until menarche occurs.

 

 

ANS:  B

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.

 

DIF:    Cognitive Level: Application           REF:   p. 781

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. 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 antiinflammatory drug (NSAID). The nurse’s response should be based on which of the following?
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

First-line therapy for adolescents with dysmenorrhea is NSAIDs. NSAIDs are potent antiinflammatory 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.

 

DIF:    Cognitive Level: Application           REF:   p. 782

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which of the following is a major physical risk for the young adolescent 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 adolescent’s development.

 

 

ANS:  B

Teenagers less 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 as the tasks of motherhood are superimposed on the adolescent development tasks.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 787

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse’s role in facilitating successful childrearing in unmarried teenage mothers includes:
a. facilitating marriage between mother and father of baby.
b. teaching the adolescent the long-term needs of the growing child.
c. providing information and feedback about positive parenting skills.
d. encouraging infant’s grandmother to take responsibility for care.

 

 

ANS:  C

Competence in the 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 infant’s grandmother to take responsibility for care would decrease the mother’s 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.

 

DIF:    Cognitive Level: Analysis                REF:   p. 788

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. A priority goal in the postpartum care of the adolescent mother is:
a. prevention of subsequent pregnancies.
b. ensuring father of baby cares for child.
c. returning mother to prepregnancy lifestyle.
d. facilitating formula feeding to minimize interruptions.

 

 

ANS:  A

Postpartum care of the adolescent is directed at preventing subsequent pregnancies and enhancing life outcomes for 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. Breast-feeding is recommended for the infant. The nurse and mother should explore the best nutrition for both the mother’s needs and those of the infant.

 

DIF:    Cognitive Level: Analysis                REF:   p. 789             TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. A pregnant 15-year-old 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 this:
a. is a frequent reason given by adolescents.
b. suggests a poor parent-child relationship.
c. is not a good reason to not get contraception.
d. indicates the adolescent is unaware of her legal rights.

 

 

ANS:  A

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 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.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 793

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. An adolescent girl calls the nurse at the clinic because she had unprotected sex the night before and does not want to be pregnant. The nurse should explain that:
a. 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 minimum so no action is necessary.
d. postcoital contraception is available to prevent implantation and therefore pregnancy.

 

 

ANS:  D

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.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 792

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. 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 which of the following?
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

Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain composure while hiding the inner turmoil. Since 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.

 

DIF:    Cognitive Level: Analysis                REF:   p. 795

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Psychosocial Integrity

 

  1. A sexually active adolescent asks the school nurse about prevention of sexually transmitted infections (STIs). Which of the following should the nurse recommend?
a. Use of condoms
b. Prophylactic antibiotics
c. Any type of contraception method
d. Withdrawal method of contraception

 

 

ANS:  A

When used appropriately, condoms provide a barrier to the organisms that cause STIs. Prophylactic antibiotics are not recommended; they are effective only against bacteria, not viruses. Only condoms create a physical barrier that prevents contact with the organisms.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 797

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. Which of the following statements is true about gonorrhea?
a. It is caused by Treponema pallidum.
b. Treatment of all sexual contacts is essential.
c. Topical application of medication to the lesions is necessary.
d. Therapeutic management includes multidose administration of penicillin.

 

 

ANS:  B

The treatment plan should include finding and treating all sexual partners. Gonorrhea is caused by Neisseria gonorrhoeae. Syphilis is caused by T. pallidum. Systemic therapy is necessary to treat this disease. Primary treatment is with different antibiotics because of N. gonorrhoeae resistance to penicillin.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 798

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which of the following statements regarding chlamydial infections is correct?
a. Treatment of choice is oral penicillin.
b. Treatment of choice is nystatin or miconazole.
c. Both men and women may have asymptomatic infections.
d. Clinical manifestations include small, painful vesicles on genital areas.

 

 

ANS:  C

The incidence of asymptomatic chlamydial infections is as high as 50% of men and 75% of women. Symptoms of chlamydial infection in males include meatal erythema, tenderness, itching, dysuria, and urethral discharge. Oral penicillin, nystatin, or miconazole are not the antibiotics of choice. Small, painful vesicles on genital areas are clinical manifestations of herpetic infections.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 798

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Prevention of pelvic inflammatory disease (PID) in adolescents is important because it:
a. can be prevented by proper personal hygiene.
b. is easily prevented by compliance with any form of contraception.
c. may have devastating effects on the reproductive tract of affected adolescents.
d. can potentially cause life-threatening and serious defects in the future children of affected adolescents.

 

 

ANS:  C

PID is a major concern because of its devastating effects on the reproductive tract. Short-term complications include abscess formation in the fallopian tubes, whereas long-term complications include ectopic pregnancy, infertility, and dyspareunia. PID is an infection of the upper female genital tract, most commonly caused by sexually transmitted infections. Personal hygiene, oral contraceptives, and many other forms of contraception do not prevent transmission of the disease. There is a possibility of ectopic pregnancy, but not birth defects in children.

 

DIF:    Cognitive Level: Application           REF:   p. 799

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. It is important that women with anogenital warts caused by the human papillomavirus (HPV) receive adequate treatment because this sexually transmitted infection increases the risk of which of the following?
a. Gonorrhea
b. Cervical cancer
c. Chlamydial infection
d. Urinary tract infection

 

 

ANS:  B

Infection with HPV is associated with cervical dysplasia and cervical cancer. A vaccine has been developed and is recommended for young women.

 

DIF:    Cognitive Level: Application           REF:   p. 799

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse is talking to a group of adolescents at a community outreach program about advantages and disadvantages of various contraceptive methods. Which of the following statements by an adolescent would indicate a correct understanding of the teaching?
a. “The calendar method has a high rate of success in preventing pregnancy but does not protect against sexually transmitted infections [STIs].”
b. “The cervical cap must remain in place after intercourse for at least 6 hours to prevent pregnancy and does not protect against STIs.”
c. “A spermicidal foam can be used without other protection to prevent pregnancy, and it is an effective barrier against STIs.”
d. “An oral contraceptive can be taken at any time to prevent pregnancy and has some minimal protection against STIs.”

 

 

ANS:  B

The cervical cap must remain in place for at least 6 hours after intercourse but no more than 48 hours. It only comes in four sizes and is not recommended for women with abnormal Papanicolaou smears or a history of toxic shock syndrome. It does not protect against STIs. The calendar method has a high failure rate because it requires a regular, predictable menstrual cycle and great awareness of the girl’s cycle; it does not protect against STIs. A spermicidal foam should be used with a condom for best prevention of pregnancy; the foam alone does not protect against STIs. An oral contraceptive also has a high failure rate with teen girls because it must be taken at the same time consistently to be effective. Birth control pills offer no STI protection.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 791

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

MULTIPLE RESPONSE

 

  1. The nurse is performing an examination on an adolescent female with a diagnosis of herpes simplex. Which of the following findings would the nurse expect to observe? Select all that apply.
a. Painful, enlarged inguinal lymph nodes
b. Clear, raised, painful vesicles
c. Raised, polypoid mass
d. Hard, nontender, red lesions
e. Foul-smelling vaginal discharge

 

 

ANS:  A, B

Manifestations of herpes simplex include painful, enlarged inguinal lymph nodes and clear, raised vesicles that are painful and the first lesions to appear. The patient would also have intense burning or itching at site of outbreak and flulike symptoms. A raised, polypoid mass is seen in human papillomavirus. Hard, nontender, red lesions are manifestations of primary syphilis. Foul-smelling vaginal discharge is a manifestation of vaginitis.

 

DIF:    Cognitive Level: Application           REF:   p. 801

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential