Solution Manual for Child Health Nursing 3rd Edition by Bindler Cowen

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Ball, Child Health Nursing, 3/E

Chapter 5
Question 1
Type: MCSA

While being comforted in the emergency department, the six-year-old sibling of a pediatric trauma victim blurts
out to the nurse, "It's all my fault! When we were fighting yesterday, I told him I wished he was dead!" The nurse,
realizing that the child is experiencing magical thinking, should respond by:

1. Asking the child if he would like to sit down and drink some water.

2. Sitting the child down in an empty room with markers and paper so that he can draw a picture.

3. Reassuring the child that it is normal to get angry and say things that we do not mean, but that we have no
control over whether an accident happens.

4. Calmly discussing the catheters, tubes, and equipment that the patient requires, and explaining to the sibling
why the patient needs them.

Correct Answer: 3

Rationale 1: Ignoring the child's outburst will not help the child understand it really was not his fault.

Rationale 2: Asking the child to draw a picture might be appropriate later, but the nurse first needs to make sure
the child knows the trauma did not occur because of anything he said.

Rationale 3: Magical thinking is the belief that events occur because of one's thoughts or actions, and the most
therapeutic way to respond to this is to correct any misconceptions that the child might have and reassure him that
he is not to blame for any accident or illness.

Ball, Child Health Nursing, 3/E

Copyright 2014 by Pearson Education, Inc.
Rationale 4: Addressing the sibling's needs and equipment reinforces the child's magical thinking that the trauma
was his fault.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-1

Question 2
Type: MCSA

Utilizing Bronfenbrenner's ecologic theory of development, the nurse caring for a child would discuss the parents'
work environment as part of an assessment of that child's:

1. Chronosystem.

2. Mesosystem.

3. Macrosystem.

4. Exosystem.

Correct Answer: 4

Rationale 1: The chronosystem involves the perspective of time in the child's life.

Rationale 2: The relationships of one microsystem to another involve a child's mesosystem.

Rationale 3: Political and cultural beliefs comprise a child's macrosystem.

Rationale 4: A child's exosystem is composed of the settings that influence a child even though she is not in daily
contact with that system.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-2

Question 3
Type: MCSA
Ball, Child Health Nursing, 3/E
Copyright 2014 by Pearson Education, Inc.
The parents of a one-month-old infant are concerned that their baby seems different from their other child, and
they ask the nurse if this is normal. The nurse informs them that it is normal for babies to have different
temperaments and that according to the "temperament theory" of Chess and Thomas, one of the characteristics of
the "slow-to-warm-up" child is that he:

1. Initially reacts to new situations by withdrawing.

2. Commonly has intense reactions to the environment.

3. Displays a predominately negative mood.

4. Shows a regularity in patterns of eating.

Correct Answer: 1

Rationale 1: Slow-to-warm-up children adapt slowly to new situations and initially will withdraw.

Rationale 2: Commonly having intense reactions to the environment is a characteristic of "difficult" children.

Rationale 3: Displaying a predominately negative mood to the environment is a characteristic of "difficult"

children.

Rationale 4: Showing regularity in patterns of eating is a characteristic of an "easy" child.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-2

Question 4
Type: MCMA

While in the pediatrician's office for their child's 12-month well-child exam, the parents ask the nurse for advice
on age-appropriate toys for their child. Based on the child's developmental level, the nurse should suggest which
types of toys?

Standard Text: Select all that apply.

1. Soft toys that can be manipulated and mouthed

2. Toys with black-and-white patterns

3. Toys that can pop apart and go back together

Ball, Child Health Nursing, 3/E
Copyright 2014 by Pearson Education, Inc.
4. Jack-in-the-box toys

5. Push-and-pull toys

Correct Answer: 3,4,5

Rationale 1: One-year-olds are more mobile, so they have less interest in placing toys in their mouth and more
interest in toys that can be manipulated.

Rationale 2: Babies at 12 months tend to enjoy more colorful toys.

Rationale 3: Both gross and fine motor skills are becoming more developed, and children at this age enjoy toys
that can help them refine these skills.

Rationale 4: Toys that the child can manipulate and have music will draw the child’s attention.

Rationale 5: The 12-month-old child is learning to walk and will prize toys that promote mobility.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-3

Question 5
Type: MCSA

While assessing the development of a nine-month-old infant, the nurse asks the mother if the child actively looks
for toys when they are placed out of sight. The nurse is trying to determine whether the infant has developed:

1. Transductive reasoning

2. Conservation

3. Centration

4. Object permanence

Correct Answer: 4

Rationale 1: Transductive reasoning is when a child connects two events in a cause-effect relationship because
the events occurred at the same time.

Rationale 2: Conservation is when a child knows that matter is not changed when its form is altered.

Ball, Child Health Nursing, 3/E

Copyright 2014 by Pearson Education, Inc.
Rationale 3: Centration is when a child focuses on only one particular aspect of a situation.

Rationale 4: A child who has developed object permanence has the ability to understand that even though
something is out of sight, it still exists.

Global Rationale:

Cognitive Level: Analyzing

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 5-3

Question 6
Type: MCSA

A nurse is assessing language development in all the infants presenting at the physician's office for well-child
visits. The nurse would want to evaluate the child further who is not able to verbalize the words “dada” and
“mama” by the age of:

1. 18 months.

2. 8 months.

3. 5 months.

4. 12 months.

Correct Answer: 4

Rationale 1: By the age of 18 months, the child will have names for more people than just “mama” and “dada.”

Rationale 2: By eight months, infants will be making the sounds “mamamamam” and “dadadada” because they
like to repeat sounds. At this time, they do not use these as names for the parents.

Rationale 3: A five-month-old infant makes sounds, but the sounds are not words.

Rationale 4: A child should be able to verbalize "mama" or "dada" to identify her parents by one year of age.

Global Rationale:

Cognitive Level: Analyzing

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 5-4
Ball, Child Health Nursing, 3/E
Copyright 2014 by Pearson Education, Inc.
Question 7
Type: MCSA

Two three-year-olds are playing in a hospital playroom together. One is working on a puzzle, while the other is
stacking blocks. The mother of one of the children scolds them for not sharing their toys. The nurse counsels this
mother that this is normal developmental behavior for this age, and the term for it is:

1. Cooperative play.

2. Solitary play.

3. Parallel play.

4. Associative play.

Correct Answer: 3

Rationale 1: Cooperative play is when children demonstrate the ability to cooperate with others and to play a part
in order to contribute to a unified whole. The school-age child participates in cooperative play.

Rationale 2: Solitary play is when a child plays alone. Infants’ play style is described as solitary.

Rationale 3: Parallel play is when two or more children play together, each engaging in her own activities.

Rationale 4: Associative play is characterized by children interacting in groups and participating in similar
activities. Preschoolers’ play style is associative.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-5

Question 8
Type: MCSA

A neonatal nurse who encourages parents to hold their baby and provides opportunities for kangaroo care most
likely is demonstrating concern for which aspect of the infant's psychosocial development?

1. Attachment

2. Assimilation

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3. Resilience

4. Centration

Correct Answer: 1

Rationale 1: Attachment is a strong emotional bond between a parent and child that forms the foundation for the
fulfillment of the basic need of trust in the infant.

Rationale 2: Assimilation describes the child's incorporation of new experiences.

Rationale 3: Resilience is the ability to maintain healthy function even under significant stress and adversity.

Rationale 4: Centration is the ability to consider only one aspect of a situation at a time.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-5

Question 9
Type: MCSA

While trying to inform a five-year-old girl about what will occur during an upcoming CT scan, the nurse notices
that the child is engaged in a collective monologue, talking about a new puppy. The nurse's best response would
be:

1. "You must be so excited to have a new puppy! They are so much fun. Now let me tell you again about going
downstairs in a wheelchair to a special room."

2. "Please stop talking about your puppy. I need to tell you about your CT scan."

3. "I'll come back when you are ready to talk with me more about your CT scan."

4. Ignore the child's responses and continue discussing the procedure.

Correct Answer: 1

Rationale 1: When a child becomes engaged in a collective monologue, it is best to respond to the content of her
conversation and then attempt to reinsert facts about the content that needs to be covered.

Rationale 2: Asking the child to stop talking about her puppy and then abruptly talking about the CT scan will
alienate the child and possibly make her shut down.

Ball, Child Health Nursing, 3/E

Copyright 2014 by Pearson Education, Inc.
Rationale 3: Coming back later is not usually an option, as radiological exams are scheduled for a certain time.
The nurse needs to address the inattention but should listen for a few moments before directing the patient's
attention.

Rationale 4: Ignoring the child's obvious lack of attention will not help prepare her for the upcoming procedure.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-5

Question 10
Type: MCSA

The mother of a six-year-old boy who has recently had surgery for the removal of his tonsils and adenoids
complains that he has begun sucking his thumb again. The nurse caring for the child should assure the mother that
this is a normal response for a child who has undergone surgery and that it is a coping mechanism that children
sometimes use called:

1. Repression.

2. Rationalization.

3. Fantasy.

4. Regression.

Correct Answer: 4

Rationale 1: Repression is the involuntary forgetting of uncomfortable situations.

Rationale 2: Rationalization is an attempt to make unacceptable feelings acceptable.

Rationale 3: Fantasy is a creation of the mind to help deal with an unacceptable fear.

Rationale 4: The correct answer is regression, which is a return to an earlier behavior.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Ball, Child Health Nursing, 3/E
Copyright 2014 by Pearson Education, Inc.
Learning Outcome: 5-6

Question 11
Type: MCSA

Prior to giving an intramuscular injection to a two-and-a-half-year-old child, the most appropriate statement by
the nurse would be:

1. "It is all right to cry. I know that this hurts. After we are done, you can go to the box and pick out your favorite
sticker."

2. "We will give you your shot when your mommy comes back."

3. "This is medicine that will make you better. First we will hold your leg, then I will wipe it off with this magic
cloth that kills the germs on your leg right here. Then I will hold the needle like this and say 'one, two, three, go'
and give you your shot. After the shot is over with, I will hold the cotton ball until it stops bleeding and then put
the Band-Aid on. Are you ready?"

4. "This is a magic sword that will give you your medicine and make you all better."

Correct Answer: 1

Rationale 1: The most appropriate response would be to acknowledge the child's feelings and give him something
to look forward to.

Rationale 2: Waiting for the mother to come back would be inappropriate because toddlers do not have an
understanding of time.

Rationale 3: Giving elaborate descriptions and using colorful language are inappropriate because the instructions
are unclear and lengthy.

Rationale 4: The nurse should not make statements that are not true and might confuse the child.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 5-7

Question 12
Type: MCSA

A 14-year-old with cystic fibrosis suddenly becomes noncompliant with the medication regimen. The intervention
by the nurse that would most likely improve compliance would be to:
Ball, Child Health Nursing, 3/E
Copyright 2014 by Pearson Education, Inc.
1. Give the child a computer-animated game that presents information on the management of cystic fibrosis.

2. Set up a meeting with some older teens who have cystic fibrosis and have been managing their disease
effectively.

3. Arrange for the physician to sit down and talk to the child about the risks related to noncompliance with
medications.

4. Discuss with the child's parents that privileges, such as a cell phone, can be taken away if compliance fails to
improve.

Correct Answer: 2

Rationale 1: Interest in games might begin to wane at this age.

Rationale 2: Providing an adolescent with positive role models who are in her peer group is the intervention most
likely to improve compliance.

Rationale 3: Adult opinions, even from a physician, could be viewed negatively and challenged.

Rationale 4: Threatening punishment could further incite rebellion.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 5-7

Question 13
Type: MCSA

The home health nurse is visiting a family at home when the toddler has an “accident” and has a bowel movement
in his diaper. The mother becomes angry with the child and calls him a baby for messing himself. The nurse
considers Erikson’s theory and recognizes that the mother’s behavior may have an effect on the child’s:

1. Cognitive development.

2. Sense of independence.

3. Conscience.

4. Development of superego.

Correct Answer: 2

Ball, Child Health Nursing, 3/E

Copyright 2014 by Pearson Education, Inc.
Rationale 1: Erikson’s theory is related to psychosocial development. The mother’s criticism will not affect the
child’s ability to think.

Rationale 2: Erikson’s toddler stage is autonomy (independence) versus shame and doubt.

Rationale 3: Conscience is what controls our knowledge of right and wrong and is a component of Kohlberg’s
theory.

Rationale 4: In Freudian theory, the superego is the moral and ethical system of the personality.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 5-4

Question 14
Type: MCSA

The clinic administrator has suggested that the nurse teach all children newly diagnosed with diabetes in a single
class to save nursing time. The children recently diagnosed range in age from 6 to 15. The argument the nurse will
use in to advocate for more than one group session would be based on:

1. Freud’s theory of psychosexual development, which states that the six-year-old child’s sexual energy is at rest
while the adolescent has developed mature sexuality.

2. Erikson’s psychosocial theory, which discusses how children learn to relate to others.

3. Piaget’s cognitive development theory, which says the six-year-old learns by concrete examples while the 15-
year-old can think abstractly.

4. Kohlberg’s theory, which says the young child is conventional in his thinking and will want to learn to please
others while the older child can internalize values and will learn for his own principles.

Correct Answer: 3

Rationale 1: This theory would not explain why it would be best to separate the group by age.

Rationale 2: Erikson’s theory is about relationships, not learning ability.

Rationale 3: The younger child will need to handle the equipment and observe demonstrations while the older
child will require more discussion and less demonstration.

Rationale 4: Kohlberg’s theory may explain the reasons the child learns the material but does not discuss the
learning style.
Ball, Child Health Nursing, 3/E
Copyright 2014 by Pearson Education, Inc.
Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-4

Question 15
Type: SEQ

As children grow and develop, their style of play changes. Place the following descriptions of play styles in order
from infancy to school-age.

Standard Text: Click and drag the options below to move them up or down.

Choice 1. Plays beside but not with other children

Choice 2. Plays games with other children and is able to follow the rules of the game

Choice 3. Plays alone with play directed by others

Choice 4. Plays with others in loose groups

Correct Answer: 3,1,4,2

Rationale 1: This describes parallel play, seen in toddlers.

Rationale 2: This describes cooperative play, seen in the school-age child.

Rationale 3: This describes infant style play, called solitary play.

Rationale 4: This describes associative play, which is seen in the preschooler.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 5-3

Question 16
Type: MCSA

Ball, Child Health Nursing, 3/E

Copyright 2014 by Pearson Education, Inc.
A 10-year-old child has been struggling with his self-esteem. Which activity would best help this child have a
positive resolution of Erikson’s Industry versus Inferiority stage?

1. Playing sports with his older brother and the brother’s friends.

2. Have his mother compliment him when he completes his homework.

3. Encourage the child to participate in boy scouts and earn badges.

4. Suggest to the mother that she allow the child to babysit his younger siblings.

Correct Answer: 3

Rationale 1: This would not help the child develop a positive self-esteem because the older boys will be more
skilled at the sport than this child.

Rationale 2: Positive reinforcement is beneficial but does not support the development of Industry.

Rationale 3: The badges will be a visible documentation of his accomplishments.

Rationale 4: The 10-year-old cannot safely babysit the younger children, and this is unrelated to Erikson’s sense
of industry.

Global Rationale:

Cognitive Level: Applying

Client Need:
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-5

Ball, Child Health Nursing, 3/E

Copyright 2014 by Pearson Education, Inc.