(Test Bank) Pediatric Nursing Caring for Children and Their Families

Potts, 3

Nursing

Test Bank

3rd Edition

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Test Bank for Pediatric Nursing Caring for Children and Their Families, The downloadable file consists of 339 pages, and the total size of the file is 4.6 MB. Purchase now only for highly discounted price.

Author(s): Potts

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Med C TEST BANK FOR FOR Med C TABLE OF CONTENTS Unit I: PEDIATRIC NURSING IN A CHANGING SOCIETY 1. Overview of Pediatric Nursing. 2. Legal and Ethical Issues. 3. The Child in Context of the Family. 4. Community and Home Health Nursing. 5. School Nursing. Unit II: GROWTH AND DEVELOPMENT OF CHILDREN 6. Theoretical Approaches to the Growth and Development of Children. 7. Growth and Development of the Newborn. 8. Growth and Development of the Infant. 9. Growth and Development of the Toddler. 10. Growth and Development of the Preschooler. 11. Growth and Development of the School -Aged Child. 12. Growth and Development of the Adolescent. Unit III: UNIQUE CONSIDERATIONS IN CHILDREN 13. Child and Family Communication. 14. Pediatric Assessment. 15. Infectious Diseases. 16. Care of Children Who Are Hospitalized. 17. Chronic Conditions. 18. Pain Management. 19. Medication Administration. 20. Loss and Bereavement. Unit IV: ALTERATIONS IN NUTRITION AND ELIMINATION 21. Fluid and Electrolyte Alterations. 22. Genitourinary Alterations. 23. Gastrointestinal Alterations. Unit V: ALTERATIONS IN OXYGEN TRANSPORT. 24. Respiratory Alterations. 25. Cardiovascular Alterations. Med C 26. Hematological Alterations. Unit VI: ALTERATIONS IN PROTECTIVE MECHANISMS . 27. Immunologic Alterations. 28. Endocrine Alterations. 29. Cellular Alterations. 30. Integumentary Alterations. Unit VII: Alterations in Sensorimotor Function. 31. Sensory Alterations. 32. Neurological Alterations. 33. Cognitive Alterations. 34. Musculoskeletal Alterations. Unit VIII: OTHER ALTERATIONS TO CHILDRENS HEALTH 35. Psychosocial Alterations. 36. Child Abuse and Neglect. Med C CHAPTER 1: OVERVIEW OF PEDIATRIC NURSING MULTIPLE CHOICE 1. Which of the following major problems results from the denial of preventive services (such as prenatal care, dental care, and immunizations) to any given population? a. spiraling costs for emergency medical services b. health maintenance organizations losing money c. extensive waiting lists for clinic health care services d. closing of small community hospitals ANS: A Feedback A Correct : By denying preventive services minor health problems are not detected and treated early. Therefore, the problems become more serious, often requiring treatment in acute care and emergency settings, a more expensive approach than prevention. B Incorrect: The rationale for health maintenance organizations (HMOs) is to provide preventive services by a primary care provider to contain costs. If individuals have to be treated in the more costly acute or emergency settings for problems which could have been detected earlier, the HMOs may lose money. However this is not the most important problem resulting from denial of preventive services. C Incorrect: Preventive services are provided in clinic settings. However, if these services are denied, individuals will be utilizing clinics less frequently, thereby, reducing waiting lists. D Incorrect: Denial of preventive servicdes should not have any effect on small community hospitals. PTS: 1 REF: p. 5 - Immigrants OBJ: Cognitive Level: Comprehension 2. Poverty rates are highest in which of the following types of families? a. two-parent c. adoptive b. single -parent d. foster ANS: B Feedback A Incorrect: Poverty rates in two-parent families are much lower than those in families headed by a single parent. The potential exists for both parents to work which would increase household income. B Correct: Almost half of all poor children live in single -parent (usually women) households. The risk of poverty is high for the following reasons: low wages for women, low educational attainment for single mothers, and low rates and levels of child support from fathers. C Incorrect: When a child is adopted, there usually is adequate income to raise the individual at a decent living standard. D Incorrect: Foster parents are typically compensated and/or receive public benefits by state or federal programs. Poverty is not an issue in these families PTS: 1 REF: p. 6 - Poverty OBJ: Cognitive Level: Knowledge Med C 3. Which of the following factors most increases the prevalence of illnesses such as asthma and anemia, as well as respiratory and gastrointestinal infections? a. household smokers c. poverty b. family history of these illnesses d. education ANS: C Feedback A Incorrect: Household smokers may increase the prevalence of asthma and respiratory problems. However, second had smoke will not affect the prevalence of anemia or gastrointestional infections. B Incorrect: Heredity plays a role in the etiology of asthma and other respiratory illnesses such as cystic fibrosis because these disorders tend to appear in families. However, a family history of other illnesses such as anemia and gastrointestinal infections does not increase their prevalence. C Correct : Children who live in poverty have diminshed physical health, higher mortality and morbidity, and decreased access to health care than nonpoor children. Therefore, they experience an increased incidence of physical and emotional health problems. D Incorrect: Lack of education and skills are at the root of poverty. So family income has significant effects on the well being of children. Yet, poverty is the major factor that increases the prevalence of illness. PTS: 1 REF: p. 6 - Poverty OBJ: Cognitive Level: Comprehension 4. The children who are at greatest risk of infant death are born: a. to mothers under age 18 c. to fathers and mothers over age 40 b. into families in poverty d. into families with alcohol problems ANS: B Feedback A Incorrect: Birth weight is the major determinant of infant mortality rate (IMR).The lower the birth rate, the higher the mortality. Adolescent pregnancy is associated with low birth weight which contributes to infant mortality, but it is not the major factor. B Correct : Racial disparities exist for infant mortality. The IMR for African Americans is twice the rate for whites because of the high rate of low birth weight infants born to minority mothers. Poverty is the most important factor in determining IMR. More nonwhites than whites are poor in the United States. Women who live in poverty are unlikely to be in good health or to have access to prenatal care which are vital during pregnancy. C Incorrect: Infant mortality rate is higher for mothers over the age of 40. However, this does not apply to fathers. D Incorrect: Although substance abuse such as alcohol does affect birth outcomes, it is not the greatest risk factor of infant death. PTS: 1 REF: p. 6 - Poverty OBJ: Cognitive Level: Application 5. The chance that a child will have to repeat a grade in school or be placed in special education classes: a. is the same for the general population, regardless of circumstances b. depends mainly on the quality of the schools and the teachers c. increases a small amount for each year the child lives in poverty d. depends mainly on whether the child has moved during the school year Med C ANS: C Feedback A Incorrect: School achievement declines with the time a child spends in poverty, thus increasing the possibility of having to repeat a grade or be placed in special education classes. A child living in poverty does not have the same chance of succeeding in school as a child in the general population. B Incorrect: Poor quality of schools and teachers may adversely affect a child’s performance in school; however, it is not the major predictor of a child having to repeat a grade or be placed in special education. C Correct : The chance a child will be retained in a grade or be placed in special education increses 2% to 3% for every year that the child lives in poverty. D Incorrect: Moving during the school year may affect a child’s performance in school, but it is not the most significant factor. PTS: 1 REF: p. 6 - Poverty OBJ: Cognitive Level: Comprehension 6. The fastest -growing segment of the homeless population consists of which of the following groups? a. alcoholics refusing treatment c. single males b. mentally ill people d. families with children ANS: D Feedback A Incorrect: Many individuals become homeless because of substnace abuse, but they are not the fastest growing segment of the homeless population. B Incorrect: Mental illness is one reason for homelesssness, but mentally ill people are not the fastest growing segment of the homeless population. C Incorrect: In the past the homeless population primarily consisted of single males; however, this is not true today. D Correct: Currently the fastest growing segment of the homeless consist of families with children, most commonly single mothers with two or three children. PTS: 1 REF: p. 7 - Homelessness OBJ: Cognitive Level: Comprehension 7. Which of the following groups of people disproportionately represents the homeless population? a. African Americans c. Hispanics b. Caucasians d. Asians ANS: A Feedback A Correct : The homeless population is disproportionately represented by African Americans. Chronic and peristant multigenerational poverty is the primary driving force resulting in this group’s homelessness. B Incorrect: Caucasian’s poverty rate is the lowest among these racial and ethnic groups. C Incorrect: Hispanics poverty rate at 21.5% as compared to 25.3% to the African American group is the second most likely racial/ethnic group to be affected by homelessness. D Incorrect: Asian population like the Caucasian population is 50% or more lesss likely to be entrapped in a chronic, persistent cycle of poverty. Med C PTS: 1 REF: p. 7 - Homelessness OBJ: Cognitive Level: Comprehension 8. A teacher confers with the school psychologist and the school nurse about a child who has poor attention span, aggressive behaviors, delayed speech, and shyness, and who tends to withdraw. This child often falls asleep in class, saying he is not sleeping at night. Which of the following situations or conditions is most likely to cause or contribute to the behavior exhibited by this child? a. sharing a room with a sibling b. attention deficit disorder with hyperactivity c. homelessness d. narcolepsy ANS: C Feedback A Incorrect: Sharing a room with a sibling might result in sleep problems but none of the other behaviors. B Incorrect: ADHD is a physical disorder which may result in the poor attention span and aggression but none of the other behaviors. C Correct : A homeless child is a child experiencing traumatic insecurity and will exhibit all cited behaviors and more. D Incorrect: Narcolepsy is a physical disorder causing a child to fall asleep at any time but should not contribute to the other behaviors cited in the situation. PTS: 1 REF: p. 8 - Homelessness OBJ: Cognitive Level: Comprehension 9. Psychological problems most often identified among homeless children are: a. conduct disorder b. oppositional defiant disorder c. depression, anxiety, and behavioral problems d. personality problems and difficulty with authority figures ANS: C Feedback A Incorrect: Conduct disorder is a psychological disorder characterized by irresponsible, delinquent behaviors such as truancy and running away; violations of the rights of others, and overt physical aggression. Conduct disorder is acting out behavior; where as, depressed and anxious individuals (homeless children) do not tend to display antisocial behavior. B Incorrect: Oppositional defiant disorder (ODD) is characterized by hostile, negativistic, defiant, and disobedient attitudes and behaviors, especially toward authority figures. C Correct : Psychological problems identified most often among homelesss children include anxiety, depresssion, poor attention span, trouble sleeping, delayed speech, shyness, withdrawl, and aggressive behaviors. D Incorrect: Personality problems are manifested in behavior that deviates markedly from the expectations of one’s culture. Difficulty with authority figures is a symptom of ODD. PTS: 1 REF: p. 8 - Homelessness OBJ: Cognitive Level: Comprehension Med C 10. Because of their age, children are most likely to gain access to a firearm in: a. the home or the home of a friend or relative b. a pawn shop c. a local gun dealer or a gun and knife show d. a sports store ANS: A Feedback A Correct : The presence of a gun in the home increases the risk of homicide, suicide, and accidental shootings. The majority of firearms used in these incidents are stored in the home of the victim or in the home of a relative or friend. B Incorrect: Natural barriers would preclude a children or adolescent from obtaining a firearm from a pawn shop. C Incorrect: Natural and legal barriers would preclude a children or adolescent from obtaining a firearm from a local gun dealer or a gun and knife show. D Incorrect: Natural and legal barriers would preclude a children or adolescent from obtaining a firearm from a sports store. PTS: 1 REF: p. 11 - Violence OBJ: Cognitive Level: Comprehension 11. The infant mortality rate (IMR) is the number of infant deaths: a. during the first month of life for a given country b. during the first year of life per 1,000 live births c. compared to live births in a given location d. from natural causes in the first year of life per 100 births ANS: B Feedback A Incorrect: The first month of life is automatically included in the first year of life, but the statistic is not kept separately by most nations. B Correct: The international health care community has determined to keep a statistic which includes all live births that die within the first year per 1,000 live births. The statistics are self reported by nation states. C Incorrect: The statistic reports the number of infant deaths per 1,000 live births by location/nation/state. D Incorrect: The statistic reports deaths from all causes in the first year of like per 1,000 live births. PTS: 1 REF: p. 12 - Infant Mortality OBJ: Cognitive Level: Knowledge 12. Which of the following racial groups has the highest infant mortality rate? a. Caucasians c. American Indians b. Asians d. African Americans ANS: D Feedback A Incorrect: Caucasians experience the lowest infant mortality rate (IMR). B Incorrect: Asians IMR is less than African Americans. C Incorrect: American Indians IMR is less than African Americans. D Correct: The IMR for African Americans is twice the rate for Caucasians. Med C PTS: 1 REF: p. 13 - Cultural Considerations box OBJ: Cognitive Level: Knowledge 13. The United States has which of the following ranks among the developed nations that have the lowest infant mortality rates (IMRs)? a. 1 c. 23 b. 17 d. 30 ANS: D Feedback A Incorrect: The United States ranks 30th in the statistical rankings reported in 2008. B Incorrect: Seventeenth is better than 30th, but also incorrect. C Incorrect: Twenty third is better than 30th, but also incorrect. D Correct: The United States ranks 30th in the statistical rankings reported in 2008. PTS: 1 REF: p. 12 - Infant Mortality OBJ: Cognitive Level: Knowledge 14. At the beginning of the 20th century, the major cause of child mortality for children aged 1 to 19 was: a. farm accidents c. infectious diseases b. firearms d. industrial accidents ANS: C Feedback A Incorrect: America has become increasingly urbanized over the 20th century with only a fraction of children being raised on a farm. B Incorrect: City life has reduced children’s exposure to firearms as compared to living on the farm. C Correct: At the beginning of the 20th century, people moved from the farms into the cities. As a result we live in closer and more crowded quarters, providing easy transmission for infectious diseases. D Incorrect: Child labor laws were enacted and enforced in the late 19th century. PTS: 1 REF: p. 12 - Child Mortality OBJ: Cognitive Level: Comprehension 15. Today, which of the following causes of death accounts for the majority of deaths in children ages 1 to 19? a. unintentional injuries c. suicide b. homicide d. respiratory illnesses ANS: A Feedback A Correct: Deaths from all diseases among children ages 1 to 19 are dwarfed by the number of children who die from unintentional injuries. A nurse must conclude that some of these deaths from unintentional injuries may be preventable. B Incorrect: Homicide affects a minor portion of deaths among children ages 1 to 19. C Incorrect: Although suicide is more common among adolescents, it still represents a small fraction of deaths in this age group. D Incorrect: Respiratory illnesses represent a minor cause of death in this age group. Med C PTS: 1 REF: p. 13 - Child Mortality OBJ: Cognitive Level: Knowledge 16. For children under 1 year of age, what is the leading cause of unintentional injury -related deaths? a. motor vehicle occupant injury c. drowning b. suffocation d. fires ANS: B Feedback A Incorrect: The laws require children to be secured in child safety seats, and the number of motor vehicle injuries among this age group has declined. B Correct: Typical causes of suffocation include choking on food or objects and entrapment of their head and neck in cribs or bedding. C Incorrect: Parents rarely leave children under the age of 1 unattended around or in water. D Incorrect: Fire codes and their enforcement has caused a dramatic decrease in deaths in children under the age of 1. PTS: 1 REF: p. 13 - Child Mortality OBJ: Cognitive Level: Knowledge 17. The leading causes of injury -related death for children aged 1 to 4 years is: a. choking and drowning b. fires and burns c. fires and neglect d. drowning and motor vehicle occupant injury ANS: D Feedback A Incorrect: Choking is the leading cause of injury -related death in children under the age of 1; drowning is a leading cause of death over the age of 1. B Incorrect: Fires and burns follow injury -related deaths by motor vehicle accident and deaths by drowning. C Incorrect: Fires follow deaths by motor vehicle accident and deaths by drowning. Neglect can lead to death or injury by several means. D Correct: As toddlers and young children become more mobile, they fall into swimming pools, lakes, and creeks as a result of poor adult supervision. Deaths for children from motor vehicle injuries is the greatest between the ages of 5 to 14. PTS: 1 REF: p. 13 - Child Mortality OBJ: Cognitive Level: Knowledge 18. The leading cause of injury -related deaths in adolescents aged 14 to 19 is by: a. drowning c. suicide b. motor vehicle occupant injuries d. homicide ANS: B Feedback A Incorrect. Adolescents are far less likely to drown than younger children. B Correct. Adolescent inexperience driving and other risky behaviors take a heavy toll, as motor vehicle occupant injuries become the number one cause of unintentional injury deaths from age 14 to 19. C Incorrect. Although suicide becomes more prevalent in this age grouping, it remains a smaller percentage cause for death. Med C D Incorrect. Although homicide becomes a larger percentage cause for injury -related deaths among this age group, it remains dramatically overshadowed by motor vehicle occupant injuries. PTS: 1 REF: p. 13 - Child Mortality OBJ: Cognitive Level: Knowledge 19. In the United States, which of the following occupations is the most hazardous? a. agriculture c. construction b. mining d. medical ANS: A Feedback A Correct. Farming and ranching remains a major family enterprise in America, and represents the most hazardous occupation. Heavy machinery, livestock, physical labor involving heavy lifting, pesticide and herbicide exposure, exposure to viral, bacterial and fungal infections are on the short list of hazards. Children are more vulnerable to all these risks than are adults. B Incorrect. Agriculture surpassess mining and construction as the most hazardous occupation in the United States. C Incorrect. Agriculture as more hazardous than construction in the United States. D Incorrect. Medical occupations are among the safest in the United States. PTS: 1 REF: p. 9 - Migrant Farm Workers OBJ: Cognitive Level: Knowledge 20. In 1987, the Association for the Care of Children's Health (ACCH) stated that paramount in the concept of family -centered care is meeting the ever-changing needs of: a. the individual child c. the community b. all family members d. the society ANS: B Feedback A Incorrect. Family -centered care describes a philosophy of care that recognizes the centrality of the family in the child’s life, the family in its entirety, not the individual members. B Correct. Meeting the ever-changing needs of all family members, not just those of the child, is paramount to the concept of family -centered care. C Incorrect. The community is a support to the family, and is not critical to the concept of family -centered care. D Incorrect. The society is the broader context to which the family belongs, but it is not paramount to the concept of family -centered care. PTS: 1 REF: p. 15 - Family -Centered Care OBJ: Cognitive Level: Comprehension 21. One of the eight key elements of family -centered care states that the constant in a child's life is the: a. church c. neighborhood b. school d. family ANS: D . Feedback A Incorrect. The more central constant in any child’s life using family -centered care is the Med C family, not the church. B Incorrect. The most central constant in any child’s life using family -centered care is the family, not the school. C Incorrect. The most central constant in any child’s life using family -centered care is the family, not the neighborhood. D Correct. Family -centered care assumes the first constant in a child’s life is the family. PTS: 1 REF: p. 16 - Box 1 -3 OBJ: Cognitive Level: Comprehension 22. Which of the following describes the exchange of information between families and professionals in family -centered care? a. Only medical information needs to be exchanged between professionals and the family when necessary. b. Complete and unbiased information must be exchanged between professionals and family in a supportive manner at all times. c. The family will decide what information they are comfortable with giving the professionals. d. Professionals will set the parameters for information in the first interview with the family and will contact the family for information as needed. ANS: B Feedback A Incorrect. In family -centered care, a central tenet is the promotion of greater family self-determination, decision -making capabilities, control and self-efficacy. The information exchange must be unguarded and complete between healthcare providers and the family members. B Correct. Exchanging complete and unbiased information in a supportive manner at all times between the family members and the healthcare professionals is required. C Incorrect. The family must exchange complete and unbiased information in a timely manner to the healthcare professionals, or the care provided will be compromised. D Incorrect. Family -centered care is a process, with a beginning and an end, but information exchange must be ongoing, complete and unbiased. PTS: 1 REF: p. 15 - Family -Centered Care OBJ: Cognitive Level: Comprehension 23. The medical model directs health care professionals to follow the roles of: a. advocate and advisor c. evaluator and controller b. teacher and director d. manager and mentor ANS: C Feedback A Incorrect. The medical model directs health care professionals to assume the roles of evaluator and controller of treatment interventions. This role is in conflict with advocate and advisor. B Incorrect. The medical model directs health care professionals to assume the roles of evaluator and controller of treatment interventions. C Correct. The medical model directs health care professionals to assume the roles of evaluator and controller of treatment interventions. D Incorrect. The medical model directs health care professionals to assume the roles of Med C evaluator and controller of treatment interventions. This position is in direct conflict with conditions necessary for more active involvement of caregivers in the child’s care. PTS: 1 REF: p. 1 - Family -Centered Care OBJ: Cognitive Level: Knowledge 24. To empower caregivers of children to make decisions about their child's care, the health care provider most needs to: a. assess family decision making in the past b. provide needed education and knowledge for the family c. tell the family they are in charge of decisions d. initially make difficult decisions and let the family make easier ones ANS: B Feedback A Incorrect. Assessing previous or past family decision making may determine the effectiveness of the family in making choices, but it cannot inform them about choices they may face now or in the future. B Correct. For a family or caregivers to be informed about decisions they face currently about their child’s care, they must be informed and educated about the choices and the projected outcomes. C Incorrect. Being in charge of decisions without knowing the options and choices does not inform the caregivers, only gives them the accountability. D Incorrect. Empowering caregivers to make decisions includes all choices, both difficult and easy. PTS: 1 REF: p. 17 - Advocate OBJ: Cognitive Level: Comprehension 25. Placing no limits on the ages or numbers of visitors and providing sleeping facilities for the caregivers in a child's room in a health care facility will most likely bring which of the following results? a. The child will be more dependent on the family. b. There will be loss of rest by the child. c. Family -centered care will be enhanced. d. Nurses will find procedures less difficult to carry out. ANS: C Feedback A Incorrect. A central concept of family -centered care is to allow the family to be more in control of who can come and go, who can stay, making the child less dependent on the family, as friends and neighbors can be more involved. B Incorrect. Loss of rest by the child is not a reason to restrict who can come and go and who can stay. C Correct. Other strategies that enhance family -centered care include no limits on the ages or number of visitors (unless directed otherwise by the family), and adequate sleeping facilities for the caregivers in the child’s room. D Incorrect. In fact, nurses may find procedures are more difficult to carry out with family and friends in the room. PTS: 1 REF: p. 15 - Family -Centered Care OBJ: Cognitive Level: Comprehension Med C 26. Professional pediatric nurses practice in a wide variety of settings. In each setting the primary roles of the pediatric nurse will: a. be universal or be the same c. be slightly similar b. vary slightly d. vary widely ANS: A Feedback A Correct. Although each setting may have separate roles and responsibilities, the roles that nurses take are universal. B Incorrect. The primary roles of the professional pediatric nurse are universal, and include the primary roles of caregiver, advocate, educator, researcher, manager, or leader. These do not change. C Incorrect. Similar is not the same. D Incorrect. The primary roles do not change. PTS: 1 REF: p. 16 - Roles of the Pediatric Nurse OBJ: Cognitive Level: Comprehension 27. Atraumatic care refers to: a. care of children without wounds or assaults b. care that avoids any harm to the child or the family c. a philosophy of providing health care that minimizes or eliminates physical or psychological distress for children and their families d. any care by the nurse, or other members of the health care team, that does not involve an invasive procedure to the child ANS: C Feedback A Incorrect. Atraumatic care does not refer to caring for children without wounds or assaults. B Incorrect. Atraumatic care does intend to minimize or eliminate physical and psychological distress for children and their families, especially the avoidance of any harm to the child or family. C Correct. Three principles provide the basis for atraumatic are: 1) identification of stressors for the child and family; 2) minimizing separation; and, 3) minimizing or preventing pain. The minimization or elimination of physical and psychological distress has been proven to assist the caregiver and the health care professional, and improve the entire experience for all involved. D Incorrect. Atraumatic care involves all medical procedures, invasive or noninvasive. PTS: 1 REF: p. 16 - A traumatic Care OBJ: Cognitive Level: Comprehension 28. Which of the following actions by the nurse best exemplifies atraumatic care? a. using a eutectic mixture of local anesthetics (EMLA) cream 1 hour before blood draws or the use of any needle b. requesting assignment to a general medical unit rather than the intensive care unit c. handwashing when entering the room and before leaving the room d. reverse isolation for the child who is immunologically compromised ANS: A Med C Feedback A Correct. Examples of atraumatic care include: 1) age -appropriate explanations before any and every procedure; 2) prior to surgery, helping the child to become familiar with the hospital, equipment, dress, etc.; 3) pain control; and, 4) local anesthetics prior to blood samples, IVs, and injections. B Incorrect. Atraumatic is the avoidance of physical or psychological distress, and has nothing to do with the trauma unit, the ER, the ICU, etc. C Incorrect. Handwashing is general hygeine, and has no impact upon lowering or eliminating the physical or psychological distress of the child patient. D Incorrect. Reverse isolation violates the philosophy of atraumatic care. PTS: 1 REF: p. 16 - A traumatic Care OBJ: Cognitive Level: Comprehension 29. Which of the following best describes differentiated practice? a. having a practice that is different from the usual practices of nurses b. an area of nursing that is highly specialized c. delineating a nurse's role and functions according to experience, competence, and educati on d. separating different nursing roles in a hospital and using competency testing to determine who can fill these roles ANS: C a. Feedback A Incorrect. Although the word different distinguishes between “a practice” and “usual practices” of nurses, the primary roles and even the secondary roles of a nurse are universal and the same. B Incorrect. Specialization is described by expanded roles, such as pediatric nurse practitioners, clinical nurse specialists and case managers. C Correct. Other roles seen in the acute care setting involve differentiated practice (a philosophy that delineates a nurse’s role and functions according to experience, competence, and education) and include the clinical care coordinator, care manager, and clinical nurse. D Incorrect. Differentiated practice involves experience and education in addition to competencies. PTS: 1 REF: p. 20 - Differentiated Practice Roles OBJ: Cognitive Level: Knowledge 30. Which of the following roles best exemplifies the expanded role of the nurse? a. medication nurse c. obstetrical nurse b. pediatric nurse practitioner d. circulating nurse in surgery ANS: B Feedback A Incorrect. All nurses are trained in giving medications, hence, this is not an expanded role. B Correct. The pediatric nurse practitioner provides routine health maintenance and preventive services in ambulatory settings, clinics, or acute care settings. The PNP role is expanded to include performing assessments and physical exams, counseling, ordering lab studies, and in many states, prescriptive authority. C Incorrect. The obstetrical nurse does not have an expanded role.