Deck 17: Social and Environmental Influences on the Child

Question 1

What are some common health problems associated with the poor and/or homeless child? Select all that apply.
1) Asthma
2) Sexually transmitted infections
3) Good dentition
4) Mental illness
5) Tuberculosis

Answer 1

2, 4, 5

Question 2

The school nurse is implementing a program to decrease bullying. Which interventions are appropriate for the school nurse to implement? Select all that apply.
1) Train teachers about the behaviors
2) Ensure adult supervision in the hallways
3) Teach children to report behaviors
4) Ensure that immunizations are up-to-date
5) Set up anti-hazing policies

Answer 2

1, 2, 3

Question 3

A high school student calls to ask the nurse for advice on how to care for a new navel piercing. Which response by the nurse is the most appropriate?
1) "Apply warm soaks to the area for the first two days to minimize swelling."
2) "Do not move or turn the jewelry for the first 3 days."
3) "Avoid contact with another person's bodily fluids until the area is well healed."
4) "Apply lotion to the area, rubbing gently, to prevent skin from becoming dry and irritated."

Answer 3

3

Question 4

A social service coordinator is consulted to arrange for a phototherapy blanket at discharge for an infant/family with multiple social difficulties. Which social difficulty is more than likely to have the greatest influence on discharge?
1) Cultural practices and rituals
2) Financial difficulties
3) The family is homeless
4) The family does not have a healthcare provider
5) Religious beliefs

Question 5

While the nurse is conducting the history of a school-age child, the parents admit to owning firearms. Which safety measures are appropriate to include in the teaching plan for this family? Select all that apply.
1) Using a gun lock on all firearms in the house
2) Taking the child to a shooting range for lessons on how to use a gun properly
3) Storing the guns and ammunition in separate places
4) Keeping all the guns in a locked cabinet
5) Explaining the dangers of a gun to the child and telling her explicitly to never touch it

Question 6

In counseling an adolescent female about safe sex practices, which question is the most appropriate for the nurse to ask?
1) "Do you and your boyfriend use a condom every time you have sex?"
2) "Do you have a boyfriend, and if so, are you sexually active?"
3) "Do you have one or more sexual partners?"
4) "Have you and your boyfriend ever had unprotected sex?"

Question 7

The pediatric nurse is working with a parent who is suspected of Münchausen Syndrome by Proxy. Which action by the nurse is the priority?
1) Confront the parent with concerns of possible abuse.
2) Carefully document parent-child interactions.
3) Try to keep the parent separated from the child as much as possible.
4) Explain to the child that the parent is causing the illness and that the health team will prevent the child from being harmed.

Question 8

While working at a weekend "free clinic," the nurse is assessing a toddler when the mother of the child confides that it has been very difficult providing for her family of four children on her limited budget. She is not sure that she has enough money to buy food for the rest of the month and the antibiotic that is needed for the child's ear infection. Which intervention would be the most beneficial for this family?
1) Giving the mother enough free samples of the antibiotic for the recommended course of treatment
2) Putting the mother in contact with a local agency that provides food on a regular basis to needy families and helps them access other resources in the community
3) Talking with the mother about the factors that increase a child's risk of acquiring an ear infection
4) Talking with the mother about the importance of a balanced diet in the growth and development of children and providing her with a list of inexpensive, nutritious foods

Question 9

A child is admitted to the hospital unit with physical injuries. The nurse is taking the child's history. Which statement by the parent would arouse suspicion of abuse?
1) "I did not realize that my baby was able to roll over yet, and I was just gone a minute to check on dinner when the baby rolled off of the couch and onto our tile floor."
2) "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor."
3) "I placed the baby in the infant swing. His 6-year-old brother was running through the house and tripped over the swing, causing it to fall."
4) "I was walking up the steps and slipped on the ice, falling while carrying my baby."

Question 10

The nurse is conducting a health promotion class for adolescents. In counseling an adolescent about lifestyle choices, what should the adolescent eliminate in order to decrease the risk of the most preventable cause of adult death?
1) Alcohol use
2) Obesity
3) Tobacco use
4) Cocaine use

Question 11

The school nurse is planning a smoking-prevention program for middle school students. Which intervention is most likely to be effective in preventing middle school children from smoking?
1) Having a local high school basketball star come to talk to the students about the importance of not smoking
2) Having the school's biology teacher demonstrate the pathophysiology of the effects of smoking tobacco on the body
3) Developing colorful posters with catchy slogans and placing them all over the school
4) Having a pledge campaign with prizes awarded, during which students sign contracts saying that they will not use tobacco products

Question 12

A mother of two school-age children tells the nurse that her husband has recently been deployed overseas. The mother is concerned about the children's constant interest in watching TV news coverage of military activities overseas. Which suggestion from the nurse is the most appropriate?
1) "Allow the children to watch as much television as they want. This is how they are coping with their father's absence."
2) "It will just take some time to adjust to their father's absence, then everything will return to normal."
3) "The less that you discuss this, the quicker the children will adjust to their father's absence. Try to keep them busy, and use distractions to keep their mind off of it."
4) "Spend time with your children and take cues from them about how much they want to discuss."

Question 13

During a well-child exam, the parents of a preschool-age child inform the nurse that they are thinking of buying a television for their child's bedroom and ask for advice as to whether this is appropriate. Which response by the nurse is the most appropriate?
1) "Research has shown that children with a television in their bedroom spend significantly less time playing outside than other children, and physical inactivity in children has been linked to many chronic diseases such as obesity and type 2 diabetes."
2) "Research has shown that watching educational television shows improves a child's performance in school."
3) "Don't buy a television for your child's room; he is much too young for that."
4) "It is okay for children to have a television in their room as long as you limit the amount of time they watch it to less than two hours per day."

Question 14

A school-age child has been seen in the pediatric clinic three times in the last two months for complaints of abdominal pain. Physical exam and all ordered lab work have been normal. Which question by the nurse would most likely help determine the etiology of the child's abdominal pain?
1) "Have there been any changes in your child's school or home life recently?"
2) "How many meals does your child eat each day?"
3) "Are your child's immunizations up to date?"
4) "Has your child had any fevers or viral illnesses in the last three months?"

Question 15

The nurse teaches a group of parents' strategies to reduce the risk of lead exposure for their children. Which statements indicate an appropriate understanding of the content presented? Select all that apply.
1) "We will provide our child with frequent snacks high in iron and calcium."
2) "We will wash any surfaces that have peeling paint."
3) "We will store leftovers in a ceramic pot."
4) "We can continue to use our traditional-medicine treatment, Azarcon, for any GI upset."
5) "We will sand the windowsills to remove the lead-based paint."

Question 16

A recently divorced mother who must return to work is concerned about the effects of placing her child in day care full time. In counseling the mother, which factor does the nurse share as the most influential in determining whether or not day care has a positive or negative effect on the child?
1) The ratio of day-care workers to children
2) The closeness of the parent-child relationship
3) The amount of time that the children spend playing outside
4) The cleanliness of the facility

Question 17

The nurse is conducting an admission assessment for a preschool-age client in the emergency department. When using the resiliency theory, which findings place this client at risk? Select all that apply.
1) Loss of health insurance
2) No primary care provider
3) Incomplete immunizations
4) A grandmother who is able to room-in
5) High level language skills from the child

Question 18

When examining a toddler-age child during a well-child physical, which assessment is the priority?
1) Visual acuity
2) Helmet use
3) Risk of lead exposure
4) Whether household drinking water contains fluorine

Question 19

The nurse is providing care to a toddler-age child. Which assessment finding is indicative of abuse?
1) Parents indicating that they did not see the event occur
2) Inconsistency of stories between caregivers
3) Bruising noted on the knees and shins
4) Acting out behavior of the child

Question 20

Concerned parents call the school nurse because of changes in their 15-year-old adolescent's behavior. Which behavior would the nurse indicate as indicative of adolescent substance abuse?
1) Buying baggy, oversized clothing at thrift shops and dying her hair black
2) Becoming very involved with friends and in activities related to the basketball team that she is on; never seeming to be home; and, when she is home, preferring to be in her room with the door shut
3) Receiving numerous detentions lately from teachers for sleeping in class
4) Becoming very moody, dramatically crying and weeping one minute and then being cheerful and excited the next