L2-1520-E2 Flashcards
1
Q
The plan of care for a patient newly diagnosed with diabetes includes health promotion with the tertiary
prevention measure of
a. avoiding carcinogens.
b. foot screening techniques.
c. glaucoma screening.
d. seat belt use.
A
b. foot screening techniques.
Foot screening is considered a tertiary prevention measure, one that minimizes the problems with foot
ulcers, an effect of diabetic disease and disability. Avoiding carcinogens is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Glaucoma screening is considered secondary screening—measures designed to
identify individuals in an early state of a disease process so that prompt treatment can be started. Seat
belt use is considered primary prevention—those strategies aimed at optimizing health and disease prevention
in general and not linked to a single disease entity.
2
Q
When teaching a patient with a family history of hypertension about health promotion, the nurse describes
blood pressure screening as _____ prevention.
a. illness
b. primary
c. secondary
d. tertiary
A
c. secondary
Blood pressure screening is considered secondary prevention. It is a measure designed to identify individuals
in an early state of a disease process so that prompt treatment can be started. Illness prevention is
considered primary prevention. Primary prevention measures are those strategies aimed at optimizing
health and disease prevention in general and not linked to a single disease entity. Tertiary prevention
measures are those that minimize the effects of disease and disability.
3
Q
The primary health care nurse would recommend screening based on known risk factors, because they
can
a. eliminate the possibility of developing a condition.
b. identify appropriate treatment guidelines.
c. initiate treatment of a condition or disease.
d. make a substantial difference in morbidity and mortality.
A
d. make a substantial difference in morbidity and mortality.
Screenings are typically indicated and recommended if the effort makes a substantial difference in morbidity
and/or mortality of conditions, and they are safe, cost effective, and accurate. Ideally a screening
measure will accurately differentiate individuals who have a condition from those who do not have a
condition 100% of the time; however, there may be a false-negative result, or the patient may develop a
condition after the screening was conducted. A screening does not specify treatment guidelines; the
screen provides results, and the health care provider identifies the treatment. The goal of screening is to
identify individuals in an early state of a disease so that prompt treatment can be initiated. The screening
results are used for this purpose.
4
Q
At the well-child clinic, the nurse teaching a mother about health promotion activities describes immunizations
as
a. unique for children.
b. primary prevention.
c. secondary prevention.
d. tertiary prevention.
A
b. primary prevention.
Immunizations/vaccinations are considered primary prevention measures, those strategies aimed at optimizing
health and disease prevention in general. Immunizations/vaccinations are primary prevention
measures for individuals across the life span, not just children. Secondary prevention measures are those
designed to identify individuals in an early state of a disease process so that prompt treatment can be
started. Tertiary prevention measures are those that minimize the effects of disease and disability.
5
Q
The nurse in a newly opened community health clinic is developing a program for the individuals considered
at greatest risk for poor health outcomes. The group is considered the
a. global community.
b. sedentary society.
c. unmotivated population.
d. vulnerable populations.
A
d. vulnerable populations.
Vulnerable populations refers to groups of individuals who are at greatest risk for poor health outcomes.
The entire world is the global community. Sedentary refers to the lifestyles of people worldwide who
have epidemic rates of obesity and many other related chronic diseases. Unmotivated population refers
to the individuals who have not demonstrated interest in changing.
6
Q
When there is evidence that supports a screening for an individual patient but not for the general population,
the nurse would expect the United States Preventive Services Task Force Grading to be what?
a. No recommendation for or against
b. Recommends
c. Recommends against
d. Strongly recommends
A
a. No recommendation for or against
The United States Preventive Services Task Force Grading is an example of how evidence is used to
make guidelines and determine priority. When there is evidence that supports a screening for an individual
patient but not for the general population, there is no recommendation for or against screening the
general population. Recommends is the grading when there is high certainty that the net benefit is moderate
or there is moderate certainty that the net benefit is moderate to substantial. Recommends against is
the grading when there is moderate or high certainty that the intervention has no net benefit or that the
harms outweigh the benefits. Strongly recommends is the grading when there is high certainty that the
net benefit is substantial.
7
Q
Interrelated concepts to professional nursing a nurse manager would consider when addressing concerns
about the quality of health promotion include
a. culture.
b. development.
c. evidence.
d. nutrition.
A
c. evidence.
The interrelated concepts to professional nursing include evidence, health care economics, health policy,
and patient education. Culture is a patient attribute concept. Development is a patient attribute concept.
Nutrition is a health and illness concept.
8
Q
The nurse manager of a pediatric clinic could confirm that the new nurse recognized the purpose of the
HEADSS Adolescent Risk Profile when the new nurse responds that it is used to assess for needs related
to
a. anticipatory guidance.
b. low-risk adolescents.
c. physical development.
d. sexual development.
A
a. anticipatory guidance
The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which assesses
home, education, activities, drugs, sex, and suicide for the purpose of identifying high-risk adolescents
and the need for anticipatory guidance. It is used to identify high-risk, not low-risk, adolescents. Physical
development is assessed with anthropometric data. Sexual development is assessed using physical
examination.
9
Q
The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, the expected
stage of development for a preschooler is
a. concrete operational.
b. formal operational.
c. preoperational.
d. sensorimotor.
A
c. preoperational.
The expected stage of development for a preschooler (3 to 4 years old) is preoperational. Concrete operational
describes the thinking of a school-age child (7 to 11 years old). Formal operational describes the
thinking of an individual after about 11 years of age. Sensorimotor describes the earliest pattern of thinking
from birth to 2 years old.
10
Q
The school nurse talking with a high school class about the difference between growth and development would best describe growth as
a. processes by which early cells specialize.
b. psychosocial and cognitive changes.
c. qualitative changes associated with aging.
d. quantitative changes in size or weight.
A
d. quantitative changes in size or weight.
Growth is a quantitative change in which an increase in cell number and size results in an increase in
overall size or weight of the body or any of its parts. The processes by which early cells specialize are
referred to as differentiation. Psychosocial and cognitive changes are referred to as development. Qualitative
changes associated with aging are referred to as maturation.
11
Q
The most appropriate response of the nurse when a mother asks what the Denver II does is that it
a. can diagnose developmental disabilities.
b. identifies a need for physical therapy.
c. is a developmental screening tool.
d. provides a framework for health teaching.
A
c. is a developmental screening tool.
The Denver II is the most commonly used measure of developmental status used by health care professionals;
it is a screening tool. Screening tools do not provide a diagnosis. Diagnosis requires a thorough
neurodevelopment history and physical examination. Developmental delay, which is suggested by
screening, is a symptom, not a diagnosis. The need for any therapy would be identified with a comprehensive
evaluation, not a screening tool. Some providers use the Denver II as a framework for teaching
about expected development, but this is not the primary purpose of the tool.
12
Q
To plan early intervention and care for an infant with Down syndrome, the nurse considers knowledge
of other physical development exemplars such as
a. cerebral palsy.
b. failure to thrive.
c. fetal alcohol syndrome.
d. hydrocephaly.
A
d. hydrocephaly.
Hydrocephaly is also a physical development exemplar. Cerebral palsy is an exemplar of adaptive developmental
delay. Failure to thrive is an exemplar of social/emotional developmental delay. Fetal alcohol
syndrome is an exemplar of cognitive developmental delay.
13
Q
To plan early intervention and care for a child with a developmental delay, the nurse would consider
knowledge of the concepts most significantly impacted by development, including
a. culture.
b. environment.
c. functional status.
d. nutrition.
A
c. functional status.
Function is one of the concepts most significantly impacted by development. Others include sensory-perceptual,
cognition, mobility, reproduction, and sexuality. Knowledge of these concepts can help the
nurse anticipate areas that need to be addressed. Culture is a concept that is considered to significantly
affect development; the difference is the concepts that affect development are those that represent major
influencing factors (causes), hence determination of development and would be the focus of preventive
interventions. Environment is considered to significantly affect development. Nutrition is considered to
significantly affect development.
14
Q
A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to her
toys and makes up stories. The mother wants her child to have a psychologic evaluation. The nurse’s
best initial response is to
a. refer the child to a psychologist.
b. explain that playing make believe with dolls and people is normal at this age.
c. complete a developmental screening.
d. separate the child from the mother to get more information.
A
b. explain that playing make believe with dolls and people is normal at this age.
By the end of the fourth year, it is expected that a child will engage in fantasy, so this is normal at this
age. A referral to a psychologist would be premature based only on the complaint of the mother. Completing
a developmental screening would be very appropriate but not the initial response. The nurse
would certainly want to get more information, but separating the child from the mother is not necessary
at this time.
15
Q
A 17-year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so needy
and acting like a child. The best response of the nurse is that in the hospital, adolescents
a. have separation anxiety.
b. rebel against rules.
c. regress because of stress.
d. want to know everything.
A
c. regress because of stress.
Regression to an earlier stage of development is a common response to stress. Separation anxiety is most
common in infants and toddlers. Rebellion against hospital rules is usually not an issue if the adolescent
understands the rules and would not create childlike behaviors. An adolescent may want to “know everything” with their logical thinking and deductive reasoning, but that would not explain why they
would act like a child.
16
Q
Which milestone is developmentally appropriate for a 2-month-old infant?
a. Pulled to a sitting position, head lag is absent.
b. Pulled to a sitting position, the infant is able to support the head when the trunk is lifted.
c. The infant can lift his or her head from the prone position and briefly hold the head erect.
d. In the prone position, the infant is fully able to support and hold the head in a straight line.
A
c. The infant can lift his or her head from the prone position and briefly hold the head erect.
A 2-month-old infant is able to briefly hold the head erect when in a prone position. If a parent were holding the infant against the parent’s shoulder, the infant would be able to lift his or her head
briefly.
-head lag is
present when pulled to a sitting position.
-4 months-infant can easily lift his or her head and hold it steadily erect
when in prone position.
17
Q
Approximately how much would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year
of age?
a. 14 3/4 lb
b. 22 1/8 lb
c. 29 1/2 lb
d. Unable to estimate weigh at 1 year
A
b. 22 1/8 lb
An infant triples birth weight by 1 year of age.
An infant doubles birth weight by 6 months of age.
An infant quadruples birth weight by 2 years of age.
Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight.
18
Q
Which statement made by a mother is consistent with a developmental delay?
a. “I have noticed that my 9-month-old infant responds consistently to the sound of his name.”
b. “I have noticed that my 12-month-old child does not get herself to a sitting position or pull to
stand. ”
c. “I am so happy when my 1 1/2-month-old infant smiles at me.”
d. “My 5-month-old infant is not rolling over in both directions yet.”
A
b. “I have noticed that my 12-month-old child does not get herself to a sitting position or pull to
stand. ”
Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old
child does not perform these activities, it may be indicative of a developmental delay.
- 9 months- responds to name (can hear and interpret sound)
- A social smile is present by 2 months.
- Rolling in both directions not critical milestone until 6 months.
19
Q
The nurse is performing a routine assessment on a 14-month-old infant and notes that the anterior
fontanel is closed. This should be interpreted as a(n)
a. Normal finding
b. Questionable finding—infant should be rechecked in 1 month
c. Abnormal finding—indicates need for immediate referral to practitioner
d. Abnormal finding—indicates need for developmental assessment
A
a. Normal finding
This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. The posterior
fontanel closes between 2 and 3 months of age.
20
Q
The nurse advises the mother of a 3-month-old exclusively breastfed infant to
a. Start giving the infant a vitamin D supplement.
b. Start using an infant feeder and add rice cereal to the formula.
c. Start feeding the infant rice cereal with a spoon at the evening feeding.
d. Continue breastfeeding without any supplements.
A
a. Start giving the infant a vitamin D supplement.
Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively
breastfed need vitamin D supplements to prevent rickets.
-Breast milk also lacks fluoride, which should also be supplemented.
Solid foods not typical until 4-6 months of age
21
Q
At what age is an infant first expected to locate an object hidden from view?
a. 4 months of age
b. 6 months of age
c. 9 months of age
d. 20 months of age
A
c. 9 months of age
By 9 months of age, an infant will actively search for an object that is out of sight.
22
Q
The parents of a newborn infant state, “We will probably not have our baby immunized because we
are concerned about the risk of our child being injured.” What is the nurse’s best response?
a. “It is your decision.”
b. “Have you talked with your parents about this? They can probably help you think about this
decision. ”
c. “The risks of not immunizing your baby are greater than the risks from the immunizations.”
d. “You are making a mistake.”
A
c. “The risks of not immunizing your baby are greater than the risks from the immunizations.”
Although immunizations have been documented to have a negative effect in a small number of
cases, an unimmunized infant is at greater risk for development of complications from childhood
diseases than from the vaccines.
Although it’s the parent’s decision, the nurse has a responsibility to inform
parents about the risks to infants who are not immunized.
23
Q
The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown
shopper at the grocery store. What is the best response for the nurse to make to the mother?
a. “You could consider leaving the infant more often with other people so he can adjust.”
b. “You might consider taking him to the doctor because he may be ill.”
c. “Have you noticed whether the baby is teething?”
d. “This is a sign of stranger anxiety and demonstrates healthy attachment.”
A
d. “This is a sign of stranger anxiety and demonstrates healthy attachment.”
The nurse can reassure parents that healthy attachment is manifested by stranger anxiety in late
infancy.
24
Q
Which statement concerning physiologic factors is true?
a. The infant has a slower metabolic rate than an adult.
b. An infant has an inability to digest protein and lactase.
c. Infants have a slower circulatory response than adults do.
d. The kidneys of an infant are less efficient in concentrating urine than an adult’s kidneys.
A
d. The kidneys of an infant are less efficient in concentrating urine than an adult’s kidneys.
The infant’s kidneys are not as effective at concentrating urine compared with an adult’s because
of immaturity of the renal system and slower glomerular filtration rates. This puts the infant at greater risk for fluid and electrolyte imbalance.
25
Which is a priority in counseling parents of a 6-month-old infant?
a. Increased appetite from secondary growth spurt
b. Encouraging the infant to smile
c. Securing a developmentally safe environment for the infant
d. Strategies to teach infants to sit up
c. Securing a developmentally safe environment for the infant
Safety is a primary concern as an infant becomes increasingly mobile.
26
A mother of a 2-month-old infant tells the nurse, “My child doesn’t sleep as much as his older brother
did at the same age.” What is the best response for the nurse?
a. “Have you tried to feed the baby more often?”
b. “Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.”
c. “It is helpful to keep a record of your baby’s eating, waking, sleeping, and elimination patterns and
to come back in a week to discuss them.”
d. “This infant is difficult. It is important for you to identify what is bothering the baby.”
b. “Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.”
Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with
some infants sleeping only 2 to 3 hours at a time.
27
The mother of a 10-month-old infant tells the nurse that her infant “really likes cow’s milk.” What is
the nurse’s best response to this mother?
a. “Milk is good for him.”
b. “It is best to wait until he is a year old before giving him cow’s milk.”
c. “Limit cow’s milk to his bedtime bottle.”
d. “Mix his cereal with cow’s milk and give him formula in a bottle.”
b. “It is best to wait until he is a year old before giving him cow’s milk.”
It is best to wait until the infant is at least 1 year old before giving him cow’s milk because of the
risk of allergies and intestinal problems. Cow’s milk protein intolerance is the most common food
allergy during infancy.
28
The mother of a 10-month-old infant asks the nurse about beginning to wean her child from his bottle.
Which statement by the mother suggests that the child is not ready to be weaned?
a. “My son is frequently throwing his bottle down.”
b. “The baby takes a few ounces of formula from the bottle.”
c. “He is constantly chewing on the nipple. It concerns me.”
d. “He consistently is sucking.”
d. “He consistently is sucking.”
Consistent sucking is a sign that the child is not ready to be weaned.
29
Which is appropriate play for a 6-month-old infant?
a. Pat-a-cake, peek-a-boo
b. Ball rolling, hide-and-seek game
c. Bright rattles and tactile toys
d. Push and pull toys
a. Pat-a-cake, peek-a-boo
Six-month-old children enjoy playing pat-a-cake and peek-a-boo.
9 months: rolling a ball and playing hide-and-seek
4 months: bright rattles and tactile toys
12 months: push and pull toys
30
Which statement by a mother indicates that her 5-month-old infant is ready for solid food?
a. “When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow.”
b. “She has just started to sit up without any support.”
c. “I am surprised that she weighs only 11 pounds. I expected her to have gained some weight.”
d. “I find that she really has to be encouraged to eat.”
b. “She has just started to sit up without any support.”
Sitting is a sign that the child is ready to begin with solid foods.
Should not start solid foods if:
- cannot get food to back of mouth to swallow
- infant weights <13 lbs and has lack of interest in eating
- difficult feeders
31
A mother asks the nurse, “When should I begin to clean my baby’s teeth?” What is the best response
for the nurse to make?
a. “You can begin when all her baby teeth are in.”
b. “You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth.”
c. “I don’t think you have to worry about that until she can handle a toothbrush.”
d. “You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary.”
d. “You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary.”
An infant’s teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or
a face cloth is appropriate.
32
A 3-month-old infant born at 38 weeks of gestation will hold a rattle if it is put in her hands, but she
will not voluntarily grasp it. The nurse should interpret this as
a. Normal development
b. Significant developmental lag
c. Slightly delayed development as a result of prematurity
d. Suggestive of a neurologic disorder such as cerebral palsy
a. Normal development
This is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months
and then gradually becomes voluntary.
33
In terms of fine motor development, what should the 7-month-old infant be able to do?
a. Transfer objects from one hand to the other.
b. Use thumb and index finger in crude pincer grasp.
c. Hold crayon and make a mark on paper.
d. Release cubes into a cup.
a. Transfer objects from one hand to the other.
By age 7 months, infants can transfer objects from one hand to the other, crossing the midline.
34
In terms of gross motor development, what would the nurse expect a 5-month-old infant to do?
a. Roll from abdomen to back.
b. Roll from back to abdomen.
c. Sit erect without support.
d. Move from prone to sitting position.
a. Roll from abdomen to back.
Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant.
35
According to Piaget, the 6-month-old infant is in what stage of the sensorimotor phase?
a. Use of reflexes
b. Primary circular reactions
c. Secondary circular reactions
d. Coordination of secondary schemata
c. Secondary circular reactions
Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This
stage is characterized by a continuation of the primary circular reaction because of the response
that results. Shaking is performed to hear the noise of the rattle, not just for shaking.
36
A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse
should recommend that the infant be given
a. Skim milk
b. Whole cow’s milk
c. Commercial iron-fortified formula
d. Commercial formula without iron
c. Commercial iron-fortified formula
For children younger than 1 year, the American Academy of Pediatrics recommends the use of
breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should
be used.
37
he parent of 2-week-old Sarah asks the nurse whether Sarah needs fluoride supplements, because
she is exclusively breastfed. The nurse’s best response is
a. “She needs to begin taking them now."
b. “They are not needed if you drink fluoridated water.”
c. “She may need to begin taking them at age 6 months.”
d. “She can have infant cereal mixed with fluoridated water instead of supplements.”
c. “She may need to begin taking them at age 6 months.”
Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at
age 6 months if the child is not drinking adequate amounts of fluoridated water.
38
A nurse has completed a teaching session for parents about “baby-proofing” the home. Which statements
made by the parents indicate an understanding of the teaching? Select all that apply.
a. “We will put plastic fillers in all electrical plugs.”
b. “We will place poisonous substances in a high cupboard.”
c. “We will place a gate at the top and bottom of stairways.”
d. “We will keep our household hot water heater at 130 degrees.”
e. “We will remove front knobs from the stove.”
a. “We will put plastic fillers in all electrical plugs.”
c. “We will place a gate at the top and bottom of stairways.”
e. “We will remove front knobs from the stove.”
Correct: By the time babies reach 6 months of age, they begin to become much more active, curious,
and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical
shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front
knobs form the stove can prevent burns.
Incorrect: Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to
120 degrees or less.
39
Hearing seems to be relatively acute, even at birth, as shown by reflexive generalized reaction to
noise. All newborns should undergo hearing screening at birth, before hospital discharge. In addition,
assessment for hearing deficits should take place at every well-baby visit. Risk factors for hearing loss
include (select all that apply)
a. Structural abnormalities of the ear
b. Family history of hearing loss
c. Alcohol or drug use by the mother during pregnancy
d. Gestational diabetes
e. Trauma
a. Structural abnormalities of the ear
b. Family history of hearing loss
e. Trauma
Correct: Structural abnormalities of the ear, a family history of hearing loss, and trauma are risk factors
for hearing loss. Other risk factors include persistent otitis media and developmental
delay. The American Academy of Pediatrics suggests that infants who demonstrate hearing loss be eligible for early intervention and specialized hearing and language services.
Incorrect Prenatal alcohol or drug intake and gestational diabetes are not risk factors for hearing loss in the infant.
40
# Fill in the Blank:
The nurse has just assisted in the delivery of a female infant to first-time parents.
The infant is suctioned, dried, and placed skin-to-skin on her mother’s chest. This allows for significant
interaction between mother and baby and is known as _____________.
attachment
Parent-infant attachment is one of the most important aspects of infant psychosocial development. Initiated
immediately after birth, attachment is strengthened by many mutually satisfying interactions between
parents and their infant during the first few months of life. Attachment is a sense of belonging or
connection with each other.
41
True or False:
The rate of Sudden Infant Death Syndrome (SIDS), now the third leading cause of death in infants, has
increased despite international efforts and the Back to Sleep campaign. Is this statement true or false?
False
This statement is incorrect. SIDS, which for a long time was the second leading cause of infant deaths,
has decreased in part because of the Back to Sleep program. It is important for both hospital and clinic
nurses to educate parents on safe sleep strategies for their infant.
42
Public health nursing differs from community health nursing in that public health nursing
a. Focuses on individuals and families.
b. Understands the needs of a population.
c. Ignores political processes.
d. Considers the individual as one member of a group.
b. Understands the needs of a population.
Public health nursing requires understanding the needs of a population. A public health nurse understands
factors that influence the political processes used to affect public policy. The primary focus of
community health nursing is the care of individuals, families, and groups in the community. By focusing
on subpopulations, the community health nurse cares for the community as a whole and considers the individual or family as only one member of a group at risk.
43
A specialist in public health nursing requires
a. The same level of education as the community health nurse.
b. Preparation at the basic entry level.
c. An advanced degree regardless of public health experience.
d. A graduate level education with a focus in public health science.
d. A graduate level education with a focus in public health science.
A specialist in public health has a graduate level education with a focus in public health science. Public
health nursing requires preparation at the basic entry level and sometimes requires a baccalaureate degree
in nursing. Not all hiring agencies require an advanced degree in community health nursing. However,
nurses with a graduate degree in nursing who practice in community settings are considered community
health nurse specialists, regardless of their public health experience.
44
The community health nurse differs from the community-based nurse in that the community health nurse
a. Understands the needs of the population.
b. Focuses on the needs of the individual.
c. Is the first level of contact in the health care system.
d. Involves the family in decision making.
a. Understands the needs of the population.
The community health nurse understands the needs of a population or community through experience
with individual families in working through their social and health care issues. The community-based
nurse focuses on the needs of the individual or family. Community-based nursing centers function as the
first level of contact between members of a community and the health care system. The community based
nurse learns to partner with patients and families so that ultimately the patient and the family become
involved in planning, decision making, implementation, and evaluation of health care approaches.
45
The type of nursing that focuses on acute and chronic care of individuals and families while enhancing
patient autonomy is known as _____ nursing.
a. Public health
b. Community health
c. Community-based
d. Community-focused
c. Community-based
Community-based nursing involves acute and chronic care of individuals and families and enhances
their capacity for self-care while promoting autonomy in decision making. Public health nursing focuses
on the needs of a population. Community health nursing cares for the community as a whole and considers
the individual or the family as only one member of a group at risk. Community-focused nursing understands
the needs of a population or community.
46
The community health nurse is administering flu shots to children at a local playground. In doing so,
the nurse’s focus is on
a. Preventing individual illness.
b. Preventing community outbreak of illness.
c. Preventing outbreak of illness in the family.
d. The needs of the individual or family.
b. Preventing community outbreak of illness.
By focusing on subpopulations, the community health nurse cares for the community as a whole and
considers the individual or the family as only one member of a group at risk. Community-based nursing,
as opposed to community health nursing, focuses on the needs of the individual or family.
47
The community health nurse is providing counseling to a group of teenage girls related to birth control
and disease prevention. The nurse does this because
a. Focusing on subpopulations leads to community health.
b. Community health nursing focuses on individuals only.
c. Community health nursing excludes direct care to subpopulations.
d. The focus is on preventing illness and unwanted pregnancy.
a. Focusing on subpopulations leads to community health.
By focusing on subpopulations, the community health nurse cares for the community as a whole and
considers the individual or the family as only one member of a group at risk. Community health nursing
is a nursing practice in the community, with the primary focus on the health care of individuals, families,
and groups in a community. Subpopulations are often a clinical focus. The goal is to protect, promote, or maintain health, not to prevent illness.
48
Community-based nursing care takes place in community settings such as the home or a clinic. Ideally,
this is done to
a. Exert greater control over individual or family decisions.
b. Provide services close to where patients live.
c. Isolate patients and prevent the spread of disease.
d. Reduce the need for self-care.
b. Provide services close to where patients live.
The ideal is to provide health care services close to where patients live. This lessens the cost of care as
well as the stress associated with the financial burdens of care. The focus is on the needs of the individual
or family. The nurse learns to partner with patients and families so they assume responsibility for
their health care decisions.
49
The community-based nurse is caring for a patient who is home bound by arthritis and chronic lung problems. The patient, however, receives many visitors from the neighborhood and from former coworkers,
as well as frequent phone calls from extended family. When concerned about how the large number
of visitors may be fatiguing the patient, the nurse should
a. Restrict the number of visitors for the patient’s welfare.
b. Voice concerns to the patient and proceed according to the patient’s wishes.
c. Allow visitors to come and go freely as they have been.
d. Create visiting hours when the patient may see non–family members.
b. Voice concerns to the patient and proceed according to the patient’s wishes.
With the individual and the family as patients, the context of community-based nursing is family-centered
care within the community. This focus requires a strong knowledge base in family theory, principles
of communication, group dynamics, and cultural diversity. The nurse learns to partner with patients
and families, so ultimately the patient and the family assume responsibility for their health care
decisions.
50
The student nurse is trying to determine what type of nurse she wants to be after graduation. In class, she states that community health nursing is probably not for her because community nursing focuses only on community issues such as preventing epidemics. The instructor’s most appropriate response
would be that community health nursing
a. Focuses on the health care of individuals, families, and groups in a community.
b. Focuses only on the health of a specific subgroup in a community.
c. Requires an advanced nursing degree, so the student need not worry.
d. Focuses only on maintaining the health of the community.
a. Focuses on the health care of individuals, families, and groups in a community.
Community health nursing is a nursing practice with the primary focus on the health care of individuals,
families, and groups in a community. The goal is to preserve, protect, promote, or maintain health. Not
all hiring agencies require an advanced degree.
51
Vulnerable populations include those patients who are more likely to develop health problems as a
result of
a. Pregnancy.
b. Nontraditional healing practices.
c. Excessive risk.
d. Unlimited access to health care.
c. Excessive risk.
Vulnerable populations are those patients who are more likely to develop health problems as a result of
excess risks or limits in access to health care services, or who are dependent on others for care. Pregnancy
is not a cause of vulnerability, except in cases where the mother is an adolescent, is addicted to drugs,
or is at high risk for other reasons. Frequently, the immigrant population practices nontraditional healing
practices. Many of these healing practices are effective and complement traditional therapies.
52
The instructor is teaching student nurses about identifying members of vulnerable populations when
the nursing student asks, “Why is it that not all poor people are considered members of vulnerable populations?”
The instructor’s best answer would be
a. “All poor people are members of a vulnerable population.”
b. “Poor people are members of a vulnerable population only if they take drugs.”
c. “Poor people are members of a vulnerable population only if they are homeless.”
d. “Members of vulnerable groups frequently have a combination of risk factors.”
d. “Members of vulnerable groups frequently have a combination of risk factors.”
Members of vulnerable groups frequently have many risks or a combination of risk factors that make
them more sensitive to the negative effects of individual risk factors. Individual risk factors are not always
overwhelming, depending on the patient’s beliefs and values and sources of social support.
53
The nurse is making a home visit to a Korean family whose daughter gave birth 6 weeks earlier. She
finds the daughter in bed with a severe headache. The daughter’s father is holding her hand and is pressing
different parts of the hand and lower arm. The mother explains that the father is trying to cure the
headache by using pressure points. The nurse’s best response would be to
a. Tell the father to stop and give the daughter Tylenol.
b. Ask the mother and/or father to explain the procedure.
c. Explain to the father that what he is doing will not work.
d. Let the father finish and then give the daughter Tylenol.
b. Ask the mother and/or father to explain the procedure.
The nurse should not judge the patient’s/family’s beliefs and values about health. The nurse needs to create
a comfortable, nonthreatening environment and to learn as much as possible about the patient’s culture
and values that influence his or her health care practices. Tylenol may not be an acceptable alternative
for this family. Criticizing the family’s beliefs and practices will only create a barrier to care.
54
The nurse is working in a community clinic when a man and woman bring a 12 year-old boy in, stating
that the child fell down a flight of stairs and hurt his arm. The nurse notices several other bruises on
the child’s body at varying stages of healing. The boy is placed on the stretcher. When asked how he
hurt himself, he states that he does not remember. However, the nurse notices that the boy continuously
avoids looking at the man, while the man stares at him constantly. The nurse should
a. Ask the boy if the man hurt him.
b. Confront the man directly.
c. Ask the man and woman to step out.
d. Ask the woman if the man hurt the boy.
c. Ask the man and woman to step out.
Ask the man and woman to step out. When dealing with patients at risk for or who have suffered abuse,
it is important to provide protection and to interview the patient at a time when he or she has privacy,
and the individual suspected of being the abuser is not present. The boy may be less likely to be forthcoming
with his attacker in the room. Confronting the man directly may lead to violence. The woman
may also be a victim of abuse and may fear retribution if she discusses their problems with health care providers.
55
The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs an abortion.
The nurse provides the patient with information on alternatives to abortion, but after several sessions,
the patient still insists on having the abortion. The competency of the counselor requires the nurse
to
a. Insist that the patient speak with a “Right-to-Life” advocate.
b. Provide a referral to an abortion service.
c. Refuse to provide referral to an abortion service.
d. Delay referral to an abortion service.
b. Provide a referral to an abortion service.
As a counselor, the nurse is responsible for providing information, listening objectively, and being supportive,
caring, and trustworthy. The nurse does not make decisions but rather helps the patient reach decisions
that are best for him or her. To refuse to provide a referral or to delay referral would not be supportive
of the patient’s decision. Counselors usually suggest and rarely insist.
56
The patient is in the hospital with the diagnosis of early-onset Alzheimer’s disease. Before the patient
is discharged, the community-based nurse is making a visit to the patient’s home, where he lives with his
daughter and her family. A major focus of this visit will be to
a. Demonstrate caregiver techniques for providing care.
b. Stress to the family how difficult it will be to provide care at home.
c. Encourage the family to send the patient to an extended care facility.
d. Teach the family how to have the patient declared incompetent.
a. Demonstrate caregiver techniques for providing care.
The role of the community health nurse, when dealing with patients with Alzheimer’s disease, is to
maintain the best possible functioning, protection, and safety for the patient. The nurse should demonstrate
to the primary family caregiver techniques for dressing, feeding, and toileting the patient while
providing encouragement and emotional support to the caregiver. The nurse should protect the patient’s
rights and maintain family stability.
57
The community has three components: structure or locale, the people, and the social systems. While
doing a community assessment, the nurse seeks data on the average household income and the number
of residents on public assistance. In doing so, the nurse is evaluating which of the following?
a. Structure
b. Population
c. Welfare system
d. Social system
a. Structure
Economic status is part of the community structure. Population would involve age and gender distribution,
growth trends, density, education level, and ethnic or religious groups. The welfare system is part
of the social system that also includes the education, government, communication and health systems.
58
The patient is being readmitted to an inner city hospital for chest pain after being discharged 3
months earlier after having a heart attack. The patient was referred to the hospital’s cardiac rehabilitation
program after her previous admission. The patient states that she began going to cardiac rehabilitation
and liked it but stopped. When asked why, she states that, at the beginning, the classes were at 9 AM, but
then got switched to 7 PM, when it’s dark. The cardiac rehabilitation program was within walking distance
of the patient’s home. What is the most likely cause of the patient’s unwillingness to go to cardiac
rehabilitation?
a. Lack of transportation
b. Fear of walking at night
c. Reimbursement issues
d. Noncompliance
b. Fear of walking at night
A community assessment should be done to determine the level of community violence at night in the
patient’s neighborhood. She claimed that she liked the program when it was at 9 AM. She did not mention
finances as a reason for not going, and the program was within walking distance to her house. Noncompliance
is a label given unfairly to patients. Most “noncompliance” is caused. The cause should be
identified and dealt with, so the therapy will be successful.
59
Community-based nursing requires a strong knowledge base in which of the following? (Select all that
apply.)
a. Family theory
b. Communication
c. Group dynamics
d. Focus on the individual
e. Cultural diversity
a. Family theory
b. Communication
c. Group dynamics
e. Cultural diversity
With the individual and family as the patients, the context of community-based nursing is family-centered
care within the community. This focus requires a strong knowledge base in family theory, principles
of communication, group dynamics, and cultural diversity. The nurse leans to partner with patients
and families, not just with individuals.
60
Community-based nursing centers function as the first level of contact between members of a community
and the health care delivery system. Ideally, health care services (Select all that apply.)
a. Are provided where patients live.
b. Reduce the cost of health care for the patient.
c. Provide direct access to nurses.
d. Exclude interference from family or friends.
a. Are provided where patients live.
b. Reduce the cost of health care for the patient.
c. Provide direct access to nurses.
Community-based nursing centers function as the first level of contact between members of a community
and the health care delivery system. Ideally, health care services are provided near where patients live.
This approach helps to reduce the cost of health care for the patient and the stress associated with the financial
burdens of care. In addition, these centers offer direct access to nurses and patient-centered
health services and readily incorporate the patient and the patient’s family or friends into a plan of care.
61
Of the following list of patients, which would be considered at high risk to be members of a vulnerable
population? (Select all that apply.)
a. An immigrant who speaks only Chinese
b. An Hispanic truck driver who speaks limited English
c. A 22-year-old pregnant woman
d. A 15-year-old rape victim
e. A 40-year-old schizophrenic
a. An immigrant who speaks only Chinese
b. An Hispanic truck driver who speaks limited English
d. A 15-year-old rape victim
e. A 40-year-old schizophrenic
For some immigrants, access to health care is limited because of language barriers and lack of benefits,
resources, and transportation. Immigrant populations face multiple diverse health issues that cities, counties,
and states need to address. These health care needs pose significant legal and policy issues. For some immigrants, access to health care is limited because of language barriers and lack of benefits, resources,
and transportation. Low-risk mothers and babies usually are not considered vulnerable populations
unless other factors are noted. Physical, emotional, and sexual abuse (such as rape), as well as neglect,
is a major public health problem affecting older adults, women, and children. When a patient has a
severe mental illness such as schizophrenia, multiple health and socioeconomic problems will need to be
explored.
62
When caring for a middle-aged adult exhibiting maladaptive coping skills, the nurse is trying to determine
the cause of the patient’s behavior. From a growth and development perspective, what should the
nurse recall?
a. Individuals have uniform patterns of growth and development.
b. Health is promoted based on how many developmental failures a patient experiences.
c. Culture usually has no effect on predictable patterns of growth and development.
d. When individuals experience repeated developmental failures, inadequacies sometimes result.
d. When individuals experience repeated developmental failures, inadequacies sometimes result.
“If individuals experience repeated developmental failures, inadequacies sometimes result” is a true
statement. Developmental failures could manifest with ineffective coping skills. However, when an individual
experiences successes, health is promoted. Patients have unique patterns of growth and development that are not uniform. Nurses must consider the influence of culture and context on growth and
development.
63
The nursing instructor will need to provide further instruction to the student who states
a. “Intellectual development is affected by cognitive processes.”
b. “Socioemotional processes can influence an individual’s growth and development.”
c. “Breast development is an example of a change resulting from biological processes.”
d. “An individual’s biological processes determine physical characteristics and do not affect growth
and development.”
d. “An individual’s biological processes determine physical characteristics and do not affect growth
and development.”
Human growth and development is a complex pattern of movement that involves changes in biological,
cognitive, and socioemotional processes. Cognitive processes comprise changes in intelligence, use of
language, and development of thinking. Socioemotional processes consist of variations in personality,
emotions, and relationships with others. Height and weight, development of gross and fine motor skills,
and sexual maturation resulting from hormonal changes during puberty are examples of changes resulting
from biological processes.
64
Which of these statements would be most appropriate for a nurse to state when assessing an adult patient
for growth and developmental delays?
a. “How many times per week do you exercise?”
b. “Are you able to stand on one foot for 5 seconds?”
c. “Would you please describe your usual activities during the day?”
d. “How many hours a day do you spend watching television or sitting in front of a computer?”
c. “Would you please describe your usual activities during the day?”
Understanding normal growth and development helps nurses predict, prevent, and detect deviations from patients’ own expected patterns. The nurse can then compare expected patterns of activity based on age
with the patient’s stated activity patterns to determine deviations from the patient’s own expected patterns.
Asking the patient to describe his/her usual daily activities will provide the nurse with useful information
about the patient’s own expected patterns. How many hours are spent watching television or
in front of a computer and how many times the patient exercises in a week are closed-ended questions.
These questions would not provide the nurse with as much information about the patient’s expected patterns
when his/her stated patterns are compared with expected patterns for the patient’s age group to detect
delays.
65
The nurse knows that a priority reason for being knowledgeable about biophysical developmental theories
is to
a. Understand how the physical body grows.
b. Predict definite patterns of cognitive development.
c. Anticipate how patients’ social behaviors develop.
d. Describe the process of psychological development.
a. Understand how the physical body grows.
Biophysical development refers to how our physical bodies grow and change. Nurses and other health
care providers are able to quantify and compare the changes that occur as a newborn infant grows into adulthood against established norms to detect abnormalities. Biophysical development refers to physical growth, not cognitive development, social behaviors, or psychological development.
66
While assessing an 18-month-old toddler, the nurse distinguishes normal from abnormal findings by
remembering that Gesell’s theory of development states
a. “The developmental stage of the toddler is affected solely by environmental influence.”
b. “Developmental patterns are not affected by gene activity.”
c. “Skill development should be identical to that of other toddlers in the playroom.”
d. “Environmental influence does not affect the sequence of development.”
d. “Environmental influence does not affect the sequence of development.”
Gesell’s theory of development states that environment plays a part in child development, but it does not
have any part in the sequence of development. Other factors influencing growth and development include
biological, cognitive, and socioemotional processes. Environmental factors support, change, and
modify the pattern of development, but they do not generate progressions of development. Each child’s
pattern of growth and development is unique and is directed by gene activity. Not every child develops
certain skills at the same time. Children grow according to their own genetic blueprint.
67
When utilizing Freud’s psychoanalytical/psychosocial theory, the nurse recalls that
a. Adult personality is the result of resolved conflicts between sources of sexual pleasure and the mandates of reality.
b. Development occurs throughout the life span and focuses on psychosocial stages.
c. The genital stage precedes the phallic stage of development.
d. Problems evident in adult life are due to early successes and resolution of earlier developmental
stages.
a. Adult personality is the result of resolved conflicts between sources of sexual pleasure and the mandates of reality.
Freud believed that adult personality is the result of how an individual resolved conflicts between
sources of sexual pleasure and the mandates of reality. Freud had a strong influence on Erik Erikson, but Erikson’s theory differed from Freud’s in that it focused on psychosocial stages rather than psychosexual
stages. Freud’s five stages of psychoanalytical development in sequential order include oral, anal, phallic,
latency, and genital. The phallic stage precedes the genital stage. In theory, problems in adult life would be due to unresolved conflicts and failures.
68
The nurse is teaching a young adult couple about promoting the health of their 8-year-old child. The nurse knows that the parents understand the developmental stage their child is in according to Erikson when they state, “We should
a. Provide proper support for learning new skills.”
b. Encourage devoted relationships with others.”
c. Limit choices and provide harsh punishment for mistakes.”
d. Not leave our child at school for longer than 3 hours at a time.”
a. Provide proper support for learning new skills.”
An 8-year-child would be in the industry versus inferiority stage of development. During this stage, the child needs to be praised for accomplishments such as learning new skills. Developing devoted relationships
is part of the identity versus role confusion stage, usually occurring during puberty. During the autonomy
versus shame and doubt stage, limiting choices and harsh punishment lead to feelings of shame
and doubt. Separation anxiety is usually a part of the trust versus mistrust stage.
69
Jean Piaget’s cognitive developmental theory focuses on four stages of development, including
a. Formal operations.
b. Intimacy versus isolation.
c. Latency.
d. The postconventional level.
a. Formal operations.
Jean Piaget’s theory includes four stages in sequential order: sensorimotor, preoperational, concrete operations,
and formal operations. Intimacy versus isolation is part of Erik Erikson’s psychosocial theory
of development. Latency is stage 4 of Freud’s five-stage psychosexual theory of development. The postconventional
level of reasoning is part of Kohlberg’s theory of moral development.
70
According to Piaget’s formal operations level, a 13-year-old adolescent will likely
a. Hit other students to deal with environmental change.
b. Use play to understand her surroundings.
c. Question her parents about an upcoming presidential election.
d. Question where the ice is hiding when ice has melted in her drink.
c. Question her parents about an upcoming presidential election.
In the formal operations period, adolescents and young adults begin to think about such subjects as
achieving world peace, finding justice, and seeking meaning in life. Asking about a presidential election
demonstrates that the adolescent is concerned about political issues that affect others besides her. Hitting would be a common schema during the sensorimotor stage of development. Using play to learn about
the environment is indicative of the preoperational stage. During the concrete operations stage (ages 6 to
12 years), children are able to coordinate two concrete perspectives in social and scientific thinking,
such as understanding the difference between “hiding” and “melting.”
71
According to Piaget’s theory of cognitive development, the nurse should allow a hospitalized 4-year-old patient to safely play with
a. The pump administering intravenous fluids.
b. The blood pressure cuff.
c. A baseball bat.
d. A book to read alone in a quiet place.
b. The blood pressure cuff.
A 4-year-old child would be in the preoperational period. Children at this stage are still egocentric. Play
is very important to foster cognitive development. Children should be allowed to play with any equipment
that is safe and should be allowed to communicate feelings about their health care. The IV pump is
not a safe piece of equipment for a 4-year-old child to play with. A baseball bat typically is not found in
a hospital setting and is a potentially dangerous toy to play with in the hospital. The blood pressure cuff
is a safer option. A 4-year-old child is of preschool age and more than likely is not able to read yet. Also,
the book does not allow for any human interaction and communication if read alone.
72
Which of these manifestations, if identified in a 6-year-old patient, should the nurse associate with a
possible developmental delay based on Piaget’s theory?
a. The child speaks in complete sentences but often talks only about himself.
b. The child still plays with a favorite doll that he has had since he was a toddler.
c. The child continues to suck his thumb.
d. The child describes an event from his own perspective, even though the entire family was present.
c. The child continues to suck his thumb.
This is a characteristic of the sensorimotor stage (birth to 2 years), where schemas become self-initiated
activities. For example, the infant who learns that sucking achieves a pleasing result generalizes the action
to suck fingers, blanket, or clothing. Successful achievement leads to greater exploration. By age 6,
the child is in the preoperational stage of development. The child is expected to be egocentric, even
though language ability is progressing. Play becomes a primary means by which children foster their
cognitive development; therefore playing with a doll is considered normal at this age. Children see objects
and persons from only one point of view—their own—at this stage.
73
An 18-month-old patient is brought into the clinic for evaluation because the mother is concerned.
The 18-month-old child hits her siblings and says only “No” when communicating verbally. According
to Piaget’s theory, what recommendation should the nurse make a priority?
a. Consult the social worker because the child is hitting other children.
b. Reassure the mother that the child is developmentally within specified norms.
c. Encourage the mother to seek psychological counseling for the child.
d. Remove all toys from the child’s room until this behavior ceases.
c. Encourage the mother to seek psychological counseling for the child.
At 18 months, the child is in the sensorimotor period of development. Piaget describes hitting, looking,
grasping, and kicking as normal schemas to deal with the environment. The social worker does not need
to be consulted in this case, nor is psychological counseling warranted, because the child is exhibiting
normal behaviors. Play is an important part of all children’s development. Removing the toys is not necessary
because this child is exhibiting normal behaviors. Removing toys and the opportunity to play with
them may actually hinder the child’s development.
74
A formerly independent and active older adult becomes severely withdrawn upon admission to a
nursing home. When approaching this patient, which intervention should the nurse plan first?
a. Offer a reward for participation in all events.
b. Encourage the patient to attend all social events scheduled for the patients.
c. Allow the patient to incorporate personal belongings into her room.
d. Advise the patient of the importance of attending mandatory activities.
c. Allow the patient to incorporate personal belongings into her room.
The older adult is in the mature thinking stages of development according to Piaget and Kohlberg. According
to Gould, the older adult needs help in realistically appreciating his/her accomplishments and in
fostering continued development. Erikson’s theory proposes that the older adult faces integrity versus
despair. To avoid despair, the nurse should allow the patient to actively participate in an independent activity,
such as preparing his/her own room with personal belongings. Offering a reward does not address
the need for continued independence. Encouraging participation in social events again does not address independence, and the question is asking for the best first intervention. Advising the patient to attend all
mandatory activities as the first intervention does not allow for the patient’s independence. Some activities
may be mandatory, but by first allowing the patient to decorate her room, the nurse is fostering independence
and is helping the patient feel welcome and more at home.
75
The parents of a 14-year-old boy express concern over their child’s rebellious behavior. The nurse
should plan to respond to the parents’ concern by informing them that their
a. Child should be referred to a juvenile correctional facility.
b. Child’s behavior is normal because the adolescent is trying to adjust to his emerging identity.
c. Child’s behavior is a matter of concern because he is likely conflicted about establishing companionship
with a partner.
d. Child’s behavior is expected because he is expressing his need to support future generations.
b. Child’s behavior is normal because the adolescent is trying to adjust to his emerging identity.
According to Erikson, a 14-year-old adolescent is developing his identity versus role confusion. A
teenager is very concerned with self and is often preoccupied with body image. Frequently, teenagers
express themselves rebelliously as they struggle to discover their own identities. Rebellious behavior is
very common and normal at this stage of development. A juvenile correctional facility usually is not
necessary. Establishing companionship occurs in the young adult age group. Feeling the need to support
future generations is usually experienced by the middle-aged adult.
76
The teaching plan for a 3-year-old child who is at risk for developmental delay should include which
of these instructions for the parents?
a. Encourage play as your child is exploring his or her surroundings.
b. Insist that your child discuss various points of view, not just his or her own.
c. Discuss world events with your child to foster language development.
d. Actively encourage your child to read lengthy books to expedite reading and writing abilities.
a. Encourage play as your child is exploring his or her surroundings.
A 3-year-old child is going to use play to learn and discover the surrounding environment. Children at
this age are egocentric and often are unable to see the world from any perspective other than their own.
Very young children are not able to understand and comment on world events because their thinking has
not advanced to abstract reasoning yet. A 3-year-old child is likely unable to read. Asking a child to perform
an activity that is beyond his or her developmental abilities will likely result in frustration at not
being able to complete the task.
77
A nurse should instruct the parents of a 10-year-old child to keep which of the following theoretical principles in mind when dealing with a behavioral problem at home?
a. Strategies that worked well with the first child will be equally as effective for the second child.
b. Encourage the child to volunteer some time at a local hospital to instill a sense of fulfillment.
c. Bargaining about chores in exchange for privileges may be an effective method of encouraging
helpful activities.
d. Do not offer praise for accomplishments and punishment for behavioral issues.
c. Bargaining about chores in exchange for privileges may be an effective method of encouraging
helpful activities.
In the concrete operations period, children begin to cooperate and share new information about the acts
they perform. Parents will be able to adjust their approaches to guide the child into helpful activities
within the home, such as bargaining about chores in exchange for privileges. With the birth of a second
child, most parents find that the strategies that worked well with the first child no longer work at all. After
birth, children grow according to their genetic blueprint and gain skills in an orderly fashion, but at
each individual’s own pace. The need for a sense of fulfillment is usually experienced by middle-aged adults, not children. School-aged children need praise to discourage a sense of inferiority; providing
praise is the best choice for encouraging positive behaviors while nurturing growth and development.
78
The parents of a 15-month-old child express concern to the nurse about their child’s thumb-sucking
habit. Which of these explanations related to the child’s age and developmental level would be most appropriate for the nurse to give the parents?
a. Thumb sucking at this age indicates a developmental delay and should be further assessed.
b. Sucking achieves a pleasing result for infants, and generalizing that action by thumb sucking is
normal.
c. Thumb sucking at this age demonstrates a transition away from egocentric thinking.
d. At this age, thumb sucking will enhance language development.
b. Sucking achieves a pleasing result for infants, and generalizing that action by thumb sucking is
normal.
Action patterns are used by infants and toddlers to deal with the environment. For example, the infant
who learns that sucking achieves a pleasing result generalizes that action to suck fingers, blankets, or
clothing. Children remain egocentric into the pre-operational period. Thumb sucking does not indicate
transition away from egocentric thinking. No statements have supported thumb sucking as enhancing
language development.
79
Which of these approaches would be most appropriate for the nurse to use when teaching a 4-year-old
patient about a scheduled surgery?
a. Give the parents a book to read about the procedure and do not discuss the procedure with the child
to decrease anxiety.
b. Set boundaries before teaching by telling the child that she can ask only three questions because
time is limited.
c. Insist that the parents wait outside the room to ensure privacy of the child.
d. Allow the child to touch and hold medical equipment such as thermometers and syringes.
d. Allow the child to touch and hold medical equipment such as thermometers and syringes.
Nursing interventions during the pre-operational period (age 2 to 7 years) should recognize the use of
play (such as handling equipment) to help the child understand the events taking place. Giving the parents
a book and not involving the child is not the best option, because the nurse should explain all procedures
to children and their parents. Children tend to ask a lot of questions; therefore limiting questions
may increase anxiety. Parents and the child all should be involved in preoperative teaching because the
parents will be the primary caregivers upon discharge.
80
When developing a plan of care concerning growth and development for a hospitalized adolescent,
what should the nurse do? (Select all that apply.)
a. Stick with one developmental theory for consistency.
b. Apply developmental theories when making observations of the individual’s patterns of growth and
development.
c. Compare the individual’s assessment findings versus established normal findings.
d. Recognize his/her own moral developmental level.
e. Apply a unidimensional life span perspective.
b. Apply developmental theories when making observations of the individual’s patterns of growth and
development.
c. Compare the individual’s assessment findings versus established normal findings.
d. Recognize his/her own moral developmental level.
No one theory successfully describes all the intricacies of human growth and development. Today’s
nurses need to be knowledgeable about several theoretical perspectives when working with patients.
These theories form the basis for meaningful observation of an individual’s pattern of growth and development.
They provide important guidelines for an understanding of important human processes that allows
the nurse to begin to predict human responses, not medical diagnoses, and to recognize deviations
from the norm. Recognizing your own moral developmental level is essential in separating your own beliefs from those of others when helping patients with their moral decision-making process. Growth and
development, as supported by a life span perspective, is multidimensional.
81
The nurse is planning playroom activities for a hospitalized 6-year-old patient. Which of the following
age appropriate items that the nurse should ensure are available? (Select all that apply.)
a. Crayons and paper
b. Children’s books
c. 500-piece puzzle
d. Building blocks
e. Magazines and newspapers
a. Crayons and paper
b. Children’s books
d. Building blocks
A school-aged child thrives on feelings of accomplishment. Drawing pictures, looking at children’s books, and building blocks are all ways that a child this age could play while developing a sense of accomplishment.
A 500-piece puzzle would be too difficult for a 6-year-old child to complete without the
possibility of getting frustrated. Magazines and newspapers would be written at too high a reading level
for a 6-year-old child. If play items offered to the child are too difficult, the child may become frustrated
and may experience a feeling of inferiority.
82
To promote parent-child attachment with a healthy newborn, what should the nurse do?
a. Encourage close physical contact as soon as possible after birth.
b. Do not allow the newborn to remain with parents until the second hour after delivery.
c. Never leave the newborn alone with the mother during the first 8 hours after delivery.
d. Isolate the newborn in the nursery during the first hour after delivery.
a. Encourage close physical contact as soon as possible after birth.
After immediate physical evaluation and application of identification bracelets, the nurse promotes the
parents’ and newborn’s need for close physical contact. Early parent-child interaction encourages parentchild
attachment. Most healthy newborns are awake and alert for the first half-hour after birth. This is a
good time for parent-child interaction to begin. No evidence in the question stem suggests that the baby
cannot be left alone with the parents during the first 8 hours, or that the baby should remain in the nursery during the first hour.
83
The nurse knows that the mother of a newborn understands associated health risks to her baby when she states
a. “I need to moisten the umbilical cord every hour during the day until the cord falls off.”
b. “I need to remind anyone who wants to hold the baby to wash their hands.”
c. “I need to leave the blankets off the baby to prevent smothering.”
d. “I can throw away the bulb syringe now because my baby is breathing on her own.”
b. “I need to remind anyone who wants to hold the baby to wash their hands.”
Prevention of infection is a major concern in the care of the newborn. Good handwashing technique is
the most important factor in protecting the newborn from infection. The umbilical stump should be kept
clean and dry. Newborns are susceptible to heat loss and cold stress. Place the new born directly on the
mother’s abdomen, and cover him or her in warm blankets, making sure to keep the head well covered,
or placed unclothed in an infant warmer with a temperature probe in place. Removal of nasopharyngeal
and oropharyngeal secretions remains a priority of care to maintain a patent airway.
84
The priority assessment immediately after birth is to
a. Assess infant-parent interactions.
b. Promote parent-newborn physical contact.
c. Open the airway.
d. Assess gestational age.
c. Open the airway.
The most extreme physiologic change occurs when the newborn leaves the in utero circulation and develops
independent respiratory functioning. Direct nursing care includes maintaining an open airway,
stabilizing and maintaining body temperature, and protecting the newborn from infection. After immediate
physical evaluation and application of identification bracelets, the nurse promotes the parents’ and
newborn’s need for close physical contact. Following a comprehensive physical assessment, the nurse
assesses gestational age and interactions between infant and parents.
85
Immediate intervention is needed when the newborn exhibits
a. A soft, protuberant abdomen.
b. Molding.
c. Lack of reflexes.
d. Cyanotic hands and feet.
c. Lack of reflexes.
Normal reflexes include blinking in response to bright lights, startling in response to sudden loud noises,
and sucking, rooting, grasping, yawning, coughing, sneezing, and hiccoughing. Assessment of these reflexes
is vital because the newborn depends largely on reflexes for survival and in response to its environment.
Normal physical characteristics include the continued presence of lanugo on the skin of the
back; cyanosis of the hands and feet for the first 24 hours; and a soft, protuberant abdomen. Molding, or
overlapping of the soft skull bones, allows the fetal head to adjust to various diameters of the maternal
pelvis and is a common occurrence with vaginal births.
86
Normal physical findings in a healthy newborn include
a. Sporadic motor movements.
b. Cyanosis of the feet and hands for the first 48 hours.
c. Triangle-shaped anterior fontanel.
d. Weight of 4800 grams.
a. Sporadic motor movements.
Movements in the newborn are generally sporadic, but they are symmetric and involve all four extremities.
Cyanosis of the hands and feet is normal for the first 24 hours, not 48 hours. The diamond shape of
the anterior fontanel and the triangular shape of the posterior fontanel are found between the unfused
bones of the skull. The expected, normal weight of a healthy newborn is between 2700 and 4000 grams
(6 to 9 pounds).
87
The nursing instructor will need to provide further instruction to the student who states, “Development
proceeds
a. In a proximal-distal pattern.”
b. In a cephalocaudal pattern.”
c. At a slower rate during the embryonic stage.”
d. At a predictive rate from the moment of conception.”
c. At a slower rate during the embryonic stage.”
From the moment of conception, human development proceeds at a predictive and rapid rate. During
gestation or the prenatal period, the embryo grows from a single cell to a complex physiologic being.
Development proceeds in a cephalocaudal and proximal-distal pattern.
88
When comparing physical growth patterns between school-aged children and adolescents, the nurse
notes that
a. Physical growth usually slows during the adolescent period.
b. Boys usually exceed girls in height and weight by the end of the school years.
c. Secondary sex characteristics usually develop during the adolescent years.
d. The distribution of muscle and fat remains constant during the adolescent years.
c. Secondary sex characteristics usually develop during the adolescent years.
Hormonal changes during adolescence contribute to the development of secondary sex characteristics
such as hair growth and voice changes. Physical growth usually slows during the school-aged period, and then a growth spurt occurs during adolescence. Girls usually exceed boys in height and weight by
the end of the school
89
A mother brings her child to the clinic for a 12-month well visit. The child weighed 6 pounds 2 ounces
and was 21 inches long at birth. What finding indicates that the child needs further assessment?
a. Height of 30 inches
b. Weight of 16 pounds
c. The infant is not yet potty-trained.
d. The infant is not yet walking up stairs.
b. Weight of 16 pounds
Size increases rapidly during the first year of life. Birth weight doubles in approximately 5 months and
triples by 12 months. This infant should weigh at least 18 pounds by this calculation. This child needs further assessment.
Height increases an average of 1 inch during each of the first 6 months and about 1/2
inch each month until 12 months: 21 + 6 + 3 = 30 (30 inches is the predicted height). Patterns of body
function are just now starting to stabilize. It is quite normal for a 12-month-old child to not be potty trained or walking up stairs yet. These milestones usually occur in the toddler period of development (12
to 36 months).
In the toddler stage, rapid development of motor skills allows the child to participate in self-care activities such as feeding, dressing, and toileting. Soon the child begins to navigate stairs, using a rail or the wall to maintain balance.
90
Which of the following is characteristic of the cognitive changes in a preschooler?
a. The ability to think in a logical manner about the here and now
b. The ability to think abstractly and deal effectively with hypothetical problems
c. The inability to assume the view of another person and to use symbols to represent others
d. The ability to classify objects by size or color
d. The ability to classify objects by size or color
Preschoolers demonstrate their ability to think more complexly by classifying objects according to size
or color. Cognitive changes that provide the ability to think in a logical manner about the here and now
and to understand the relationships between things and ideas occur during the school-aged years. It is
during the teenaged years when the individual thinks abstractly and deals effectively with hypothetical
problems. The toddler is unable to assume the view of another. Toddlers also use symbols to represent
objects, places, and persons.
91
The nursing instructor will need to provide further instruction to the student who uses which of these
statements when describing the differences between cognitive and psychosocial development in
children?
a. “The preschooler develops the ability to play in small groups.”
b. “The toddler may participate in parallel play.”
c. “The school-aged child still requires total assistance in all activities for safety.”
d. “The toddler period is a time of potential frustration manifested by temper tantrums.”
c. “The school-aged child still requires total assistance in all activities for safety.”
The care provider should promote independence within safe limits for the school-aged child. The
school-aged child, according to Erikson, is in the industry versus inferiority stage of development. The
school-aged child likes to perform tasks by himself when possible and needs to be praised for those
tasks. The child continues to engage in solitary play during toddlerhood but also begins to participate in
parallel play, which is playing beside rather than with another child. The toddler’s strong will is frequently
exhibited in negative behavior when caregivers attempt to direct his actions. Temper tantrums
result when parental restrictions frustrate toddlers.
92
The nurse is observing his 2-year-old hospitalized patient in the playroom. The nurse is most likely to
observe the child
a. Participating as the leader of a small group activity.
b. Sitting beside another child while playing with blocks.
c. Separating building blocks into groups by size and color.
d. Seeking out same sex children to play with.
b. Sitting beside another child while playing with blocks.
The child beside another child and playing is exhibiting parallel play, characteristic of a toddler. Participating
as a group leader does not usually occur until around age 5. Preschoolers (ages 3 to 5) demonstrate
their ability to think more complexly by classifying objects according to size or color. A 2-year-old
child does not have this ability yet. The play of preschool children becomes more social after the third
birthday as it shifts from parallel to associative play. However, gender does not become a factor until the
child reaches school age, when she prefers same sex peers to opposite sex peers.
93
When communicating with a newly admitted teenaged patient, the nurse should
a. Avoid questioning the patient about cigarette use when she observes a cigarette lighter lying on the
bedside table.
b. Complete the admission database as quickly as possible by asking yes and no questions.
c. Ignore the patient’s withdrawn behavior.
d. Observe for congruency between the patient’s facial expressions and verbal responses.
d. Observe for congruency between the patient’s facial expressions and verbal responses.
Good communication skills are critical for adolescents. Following are some hints for communicating
with adolescents: Do not avoid discussing sensitive issues. Asking questions about sex, drugs, and
school opens the channels for further discussion. Ask open-ended questions. Yes and no questions are
closed-ended questions. Look for meaning behind their words and actions. The nurse should inquire
about a patient’s withdrawn behavior to seek out the meaning of such behaviors. Be alert to clues to their
emotional state. The nurse should observe that the patient’s statements are congruent with his/her facial
expressions of emotion.
94
During infant/child development, play is best recognized as
a. A means to interact with the environment and relate to others.
b. Independent of cognitive and social development.
c. Non-exploratory and simply play.
d. Too soon to achieve milestones.
a. A means to interact with the environment and relate to others.
During infancy, play is a meaningful set of activities through which the child interacts with the environment
and relates to others. Play provides opportunities for development of cognitive, social, and motor
skills. Much of infant play is exploratory as infants use their senses to observe and examine their own
bodies and objects of interest in their surroundings. Adults facilitate infant learning by planning activities
that promote the development of milestones and by providing toys that are safe for the infant to explore
with the mouth and manipulate with the hands.
95
Which statement by the nurse best explains the importance of play during the toddler stage of
development?
a. “Exploration can suppress the toddler’s curiosity to promote safety.”
b. “Parental control during play will eliminate the frustration of learning self-control.”
c. “Play can enhance cognitive and psychosocial development.”
d. “Play will enhance the toddler’s ability to explore the environment safely without supervision.”
c. “Play can enhance cognitive and psychosocial development.”
Play can enhance cognitive and psychosocial development. The toddler’s curiosity is evident in his or
her exploration of the environment. Children strive for independence. Their strong wills are frequently
exhibited in negative behavior when caregivers attempt to direct their actions. Temper tantrums result when parental restrictions frustrate toddlers. Parents need to provide toddlers with graded independence,
allowing them to do things that do not result in harm to themselves or others.
96
After comparing appropriate play activities for infants and preschool children, the nurse should appropriately
offer which of the following activities to an infant?
a. Set of cards to organize and separate into groups
b. Set of plastic stacking rings
c. Paperback book
d. Set of sock puppets with movable eyes
b. Set of plastic stacking rings
Play becomes manipulative as the child learns control of the hands. Adults facilitate infant learning by
planning activities that promote the development of milestones, and by providing toys that are safe for
the infant to explore with the mouth and manipulate with the hands, such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Preschoolers demonstrate their ability to
think more complexly by classifying objects according to size or color, making the cards more appropriate
for them. Neither group is ready for paperback books. The sock puppet with movable eyes could create
a choking hazard if one of the eyes comes off.
97
A mother expresses concern because her 5-year-old child frequently talks about friends who don’t exist.
What is the nurse’s best response to this mother’s concern?
a. “Have you considered a child psychological evaluation?”
b. “It’s very normal for a 5-year-old child to have imaginary playmates.”
c. “You should stop your child from playing electronic games.”
d. “Pretend play is a sign your child watches too much television.”
b. “It’s very normal for a 5-year-old child to have imaginary playmates.”
At age 5, some children have imaginary playmates. Imaginary playmates are a sign of health and allow
the child to distinguish between reality and fantasy. The child does not need a psychological evaluation
based on this information. Television, videos, electronic games, and computer programs help support development
and the learning of basic skills. However, these should be only one part of the child’s total
play activities.
98
Encouraging children to play a game of kickball would be best suited for which age group?
a. Infant
b. Toddler
c. Preschool
d. School-aged
d. School-aged
A game of kickball would be best suited for school-aged children because in this age group, play involves
peers and the pursuit of group goals. Although solitary activities are not eliminated, group play
overshadows them. Younger children typically are not able to participate cooperatively in groups yet.
Infants begin to play simple social games such as patty-cake and peek-a-boo. Toddlers engage in solitary
play but also begin to participate in parallel play. Preschoolers playing together engage in similar if not
identical activities; however, no division of labor nor rigid organization nor rules are observed. By the
age of 5, the group has a temporary leader for each activity.
99
Which of these manifestations, if identified in a school-aged child during a routine assessment,
should a nurse associate with a possible developmental delay or problem?
a. Withdrawn demeanor and verbalizes that he has no friends
b. Absence of secondary sex characteristics
c. Lack of peer relationships
d. Curiosity about his or her sexuality
a. Withdrawn demeanor and verbalizes that he has no friends
School-aged children should begin to develop friendships and to socialize with others. Interaction with
peers allows them to define their own accomplishments in relation to others as they work to develop a
positive self-image. The absence of secondary sex characteristics is a major concern of adolescents, not
school-aged children, because physical evidence of maturity encourages the development of masculine
and feminine behaviors in the adolescent. Lack of peer relationships is also a concern of adolescents, not
of school-aged children, because adolescents seek a group identity to fulfill their esteem and acceptance
needs. Today many researchers believe that school-aged children have a great deal of curiosity about
their sexuality. Some experiment, but this play is usually transitory.
100
The nurse who is teaching a parent about developmental needs of the infant knows that the parent has
verbalized understanding of a infant’s developmental needs when he states
a. “My child is too young to understand words.”
b. “My child will begin to speak in sentences by 1 year of age.”
c. “My child will probably enjoy playing peek-a-boo.”
d. “While my child is in the hospital, I should let the nurses provide most of the care.”
c. “My child will probably enjoy playing peek-a-boo.”
By 9 months, infants play simple social games such as patty-cake and peek-a-boo. By 1 year, infants not
only recognize their own names but are able to say three to five words and understand almost 100
words. Extended separations from parents complicate the attachment process and increase the number of
caregivers with whom they must interact. Ideally, the parents provide most of the care during
hospitalizations.
101
During hospitalization, the nurse should encourage the parents of an 8-month-old infant to
a. Provide as much care as possible.
b. Not worry about attachments because the infant is too young to develop them.
c. Remember that infants cannot differentiate a stranger from a familiar person.
d. Relax and allow nursing staff to care for the child at all times.
a. Provide as much care as possible.
Extended separations from parents complicate the attachment process and increase the number of caregivers
with whom the infant must interact. Ideally, the parents provide most of the care during hospitalizations.
Close attachment to the primary caregivers, most often parents, usually occurs by this age. Infants
seek out these persons for support and comfort during times of stress. By 8 months, most infants
are able to differentiate a stranger from a familiar person and respond differently to the two.
102
The nursing student correctly explains health promotion teaching points for parents of toddlers when
she states
a. “Setting consistent, firm limits will help the child cope with the frustration of learning self-control.”
b. “Slower development of motor skills prevents the child from participating in self-care activities.”
c. “Toddlers have a natural sense of right and wrong and know when they do something wrong.”
d. “Temper tantrums should never be tolerated, and toddlers need to do what they are told.”
a. “Setting consistent, firm limits will help the child cope with the frustration of learning self-control.”
Firm consistent limits, patience, and support allow toddlers to develop socially acceptable behaviors and
to cope with the frustration of learning self-control. Rapid development of motor skills allows the child
to participate in self-care activities such as feeding, dressing, and toileting. Because children’s moral development
is closely associated with their cognitive abilities, the moral development of toddlers is only
beginning. Toddlers do not understand concepts of right and wrong. Temper tantrums result when
parental restrictions frustrate toddlers. Parents need to provide toddlers with graded independence, allowing
them to do things that do not result in harm to themselves or others.
103
The nursing student is preparing a teaching project for parents of school-aged children. Which statement
correctly identifies health risks in this age group?
a. “School-aged children are more likely to suffer from unintentional injury.”
b. “The risk for infection is not a major concern of this age group as immunity develops.”
c. “Mental retardation, learning disorders, and malnutrition are prevalent across all socioeconomic
categories. ”
d. “Poor nutrition and lack of immunizations continue to be health concerns for children of the poor.”
d. “Poor nutrition and lack of immunizations continue to be health concerns for children of the poor.”
Infant mortality, dental problems, poor nutrition, and lack of immunizations continue to be major health
concerns for uninsured or impoverished families. Accidents and injuries are major health problems affecting school-aged children. They now have more exposure to various environments and less supervision,
but their developed cognitive and motor skills make them less likely to suffer from unintentional
injury. Infections account for most childhood illnesses. Mental retardation, learning disorders, and malnutrition
are far more prevalent among children living in poverty.
104
Which of these statements, if made by a parent, would require further instruction?
a. “I should not be surprised that my teenager has so many friends.”
b. “I get worried because my teenager thinks he’s indestructible. He takes a lot of risks.”
c. “I should cover for my school-aged child when he makes a mistake until he learns the ropes.”
d. “My 10-year-old child is always hungry right after school, so I usually fix him a nutritious snack.”
c. “I should cover for my school-aged child when he makes a mistake until he learns the ropes.”
School and home influence growth and development, requiring adjustment by parents and by the child.
The child learns to cope with rules and expectations presented by the school and by peers. Parents have
to learn to allow their child to make decisions, accept responsibility, and learn from life’s experiences.
Teenagers typically are very social and have many friends. Adolescents seek a group identity because
they need esteem and acceptance. By midadolescence, adolescents believe that they are unique and the
exception, giving rise to their risk-taking behaviors. Obesity occurs because children often rush into the
home after school or play and eat the most easily obtainable and appealing foods. Providing nutritious snacks is often the best way to ensure good nutritional intake.
105
Which of these toys, if selected by the parent of a 10-month-old child, would indicate that the parent
has a correct understanding of infant growth and development?
a. A game requiring two to four players
b. Electronic games
c. Small, plastic alphabet letters and magnets
d. Plastic stacking rings
d. Plastic stacking rings
Adults facilitate infant learning by planning activities that promote the development of milestones and by providing toys that are safe for the infant to explore with the mouth and manipulate with the hands,
such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Infants
are not capable of participating in small group activities. By age 4, children play in groups of two
or three. For the toddler (not the infant), television, videos, electronic games, and computer programs
help support development and learning of basic skills. Adults should provide toys that are safe for the
infant to explore with the mouth. Small, plastic letters and magnets could be choking hazards for an
infant.
106
The nurse should instruct the parents of an adolescent about which of the following health concerns?
(Select all that apply.)
a. Signs of substance abuse
b. Suicide prevention
c. Safe sex practices
d. Pregnancy
e. Gonadotropic hormone stimulation
f. Voice changes
a. Signs of substance abuse
b. Suicide prevention
c. Safe sex practices
d. Pregnancy
All adolescents are at risk for experimental or recreational substance use because some believe that substance
use makes them more mature. Suicide is the third leading cause of death in adolescents. Sexually
transmitted diseases annually affect 3 million sexually active adolescents. Adolescent pregnancy continues
to be a major social challenge for our nation. Gonadotropic hormones stimulate ovarian cells to produce
estrogen and testicular cells to produce testosterone. These hormones are normally occurring and contribute to the development of secondary sex characteristics, such as hair growth and voice changes,
and play an essential role in reproduction.
107
According to some developmental theorists, intellectual development and moral development differ
between men and women. What did Gilligan propose?
a. As women progress toward adulthood, concepts, morals, and responsibility remain unchanged.
b. Providing and protecting remain the sole responsibilities of men in today’s society.
c. Women continue to play a minor role in the financial well-being of their families.
d. Women struggle with issues of care and responsibility.
d. Women struggle with issues of care and responsibility.
According to Gilligan, women struggle with issues of care and responsibility, and in turn, their relationships
progress toward a maturity of interdependence. As women progress toward adulthood, the moral
dilemma changes from how to exercise their rights without interfering with the rights of others to “how
to lead a moral life,” which includes obligations to themselves and their families and people in general.
Traditional masculine roles include providing and protecting. Recently, however, men have been moving
into greater disequilibrium. Both men and women are assuming different roles in today’s society. Today,
many women pursue careers and contribute significantly to their family’s income.
108
The nurse is caring for a hospitalized young adult male who is uninsured even though he works as a
dishwasher at a local restaurant. He states that he would like to get a better job, but he has no education.
How can the nurse best assist this patient psychosocially?
a. By providing information and referrals
b. By telling the patient that he needs to go back to school
c. By focusing on the patient’s medical diagnoses
d. By expecting the patient to be flexible in his decision making
a. By providing information and referrals
Support from the nurse, access to information, and appropriate referrals provide opportunities for
achievement of a patient’s potential. Many young adults lack the necessary resources or support systems
to facilitate further education or development of skills necessary for many positions in the workplace. As
a result, some young adults have limited occupational choices. Health is not merely the absence of disease
but involves wellness in all human dimensions. Insecure persons tend to be more rigid in making
decisions.
109
A nursing student is asked to compare major life events of young adult, middle adult, and childbearing
families. Which statement by the student demonstrates understanding?
a. “Young adults have gained sexual experience and do not need sexual education.”
b. “Once a woman has her baby, stress levels decrease, as does health risk.”
c. “The social pressure to get married is greater now than it ever was.”
d. “When married people both work, income is increased, but so is stress.”
d. “When married people both work, income is increased, but so is stress.”
The two-career family has benefits and liabilities. Stressors result from transfer to a new city; increased
expenditures of physical, mental, or emotional energy; child care demands; or household needs. To
avoid stress, partners should share all responsibilities. Young adults are at risk for sexually transmitted
diseases. Consequently, there is an increased need for education regarding mode of transmission, prevention,
and symptom recognition and management for sexually transmitted diseases. The stress that
many women experience after childbirth has a significant impact on the health of postpartum women.
Social pressure to get married is not as great as it once was, and many young adults do not marry until
their late 20s or early 30s, or not at all.
110
The nurse knows that the young adult patient understands the health risks that affect his/her age group
when the patient states
a. “It’s probably safe for me to start smoking. At my age, there’s not enough time for cancer to
develop. ”
b. “I am sure that I am going to get emphysema. Both my mother and my aunt had it. It’s genetic.”
c. “Controlling the amount of stress in my life may decrease the risk of illness.”
d. “I don’t do drugs. I do drink coffee, but caffeine is not a drug. It is perfectly safe and has no side
effects. ”
c. “Controlling the amount of stress in my life may decrease the risk of illness.”
Lifestyle habits that activate the stress response increase the risk of illness. Smoking is a well-documented
risk factor for pulmonary, cardiac, and vascular disease in smokers and in individuals who receive secondhand smoke. The presence of certain chronic illnesses in the family increases the family member’s risk of developing a disease. Family risk is distinct from hereditary disease. Caffeine is a naturally
occurring legal stimulant that is readily available. Caffeine stimulates catecholamine release, which, in
turn, stimulates the central nervous system; it also increases gastric acid secretion, heart rate, and basal
metabolic rate.
111
When choosing an appropriate topic for a young adult health fair, the nurse ranks which topic as least
relevant?
a. Unplanned pregnancies
b. Menopause and climacteric factors
c. Smoking cessation
d. Alcohol and drug use
b. Menopause and climacteric factors
The onset of menopause and the climacteric affect the sexual health of the middle adult, not the young
adult. Unplanned pregnancies are a continued source of stress that can result in adverse health outcomes
for the mother (young adult), infant, and family. Smoking is a well-documented risk factor for pulmonary,
cardiac, and vascular diseases in smokers and in individuals who receive secondhand smoke
and constitutes a health risk for the young adult. Substance abuse directly or indirectly contributes to
mortality and morbidity in young adults.
112
During middle adulthood, the 50-year-old patient is likely to adapt favorably to a changing body image
if he or she
a. Decreases the amount of physical exercise.
b. Eats a diet composed of 40% fat.
c. Gets less than 5 hours of sleep per night.
d. Engages in good hygiene practices.
d. Engages in good hygiene practices.
High self-esteem, a favorable body image, and a positive attitude toward physiological changes occur
when adults engage in physical exercise, balanced diets, adequate sleep, and good hygiene practices that
promote vigorous, healthy bodies.
113
A patient states that she is pregnant and concerned because she does not know what to expect, and she
wants her husband to play an active part in the birthing process. What should the nurse tell the patient?
a. Lamaze classes can prepare pregnant women and their partners for what is coming.
b. The frequency of sexual intercourse is key to helping the husband feel valued.
c. After the birth, the stress of pregnancy will disappear and will be replaced by relief.
d. After the baby is born, the wife should accept the extra responsibilities of motherhood.
a. Lamaze classes can prepare pregnant women and their partners for what is coming.
Education such as Lamaze classes can prepare pregnant women, their partners, and other support persons to participate in the birthing process. The psychodynamic aspect of sexual activity is as important
as the type or frequency of sexual intercourse to young adults. The stress that many women experience
after childbirth has a significant impact on the health of postpartum women. To avoid stress in a two-career family, partners should share all responsibilities.
114
What do changing norms and values about family life in the United States reveal?
a. Basic shifts in attitudes in our society
b. Greater resistance to cohabitation without marriage
c. Decreased numbers of infants born to unmarried women
d. Greater support and acceptance from the health care system
a. Basic shifts in attitudes in our society
Changing norms and values about family life in the United States reveal basic shifts in attitudes in our
society. The trend toward greater acceptance of cohabitation without marriage is a factor in the greater
numbers of infants being born to unmarried women. Many times, parents from alternative family structures
feel lack of support and even bias from the health care system.
115
When describing relevant family psychosocial factors in middle adulthood that cause stress, the nurse
would not include
a. Singlehood and feeling isolated.
b. Choices stemming from marital changes.
c. Financial security and certainty.
d. Planning for the future when children leave home.
c. Financial security and certainty.
In the middle adult years, as children depart from the household, the family enters the postparental family
stage. Time and financial demands on parents decrease, and the couple faces the task of redefining
their own relationship. Psychosocial factors involving the family include the stresses of singlehood, marital changes, transition of the family as children leave home, and the care of aging parents.
116
What should the nurse recognize when comparing the physical changes in young and middle
adulthood?
a. Fertility issues do not occur in young adulthood.
b. Young adults are quite active but are at risk for illness in later years.
c. Young adults tend to suffer more from severe illness.
d. Exercise is less important in young adulthood than in middle adulthood.
b. Young adults are quite active but are at risk for illness in later years.
Young adults are generally active and have a minimum of major health problems. However, their
lifestyles put them at risk for illnesses or disabilities during their middle or older adult years. An estimated
10% to 15% of reproductive couples are infertile, and many are young adults. Exercise in young
adulthood is increasingly important to prevent or decrease the development of chronic health conditions
such as high blood pressure, obesity, and diabetes that develop later in life.
117
During a routine physical assessment, the nurse obtaining a health history notes that a 50-year-old female
patient reports pain and redness in the right breast. What is the nurse’s best action in response to
this finding?
a. Explain to the patient that breast tenderness is normal at her age.
b. Tell the patient that redness is not a cause for concern and is quite common.
c. Assess the patient as thoroughly as possible.
d. Inform her that redness is the precursor to normal unilateral breast enlargement.
c. Assess the patient as thoroughly as possible.
A comprehensive assessment offers direction for health promotion recommendations, as well as for
planning and implementing any acutely needed intervention. Redness or painful breasts are abnormal
physical assessment findings in the middle adult. Increased size of one breast is an abnormal physical
assessment finding in the middle adult.
118
A 55-year-old female presents to the outpatient clinic describing irregular menstrual periods and hot
flashes. What should the nurse explain?
a. Those symptoms are normal when a woman undergoes the climacteric.
b. An assessment is not really needed because these problems are normal for older women.
c. The patient’s age and symptoms point toward normal menopause.
d. The patient should stop regular exercise because that is probably causing her symptoms.
c. The patient’s age and symptoms point toward normal menopause.
The most significant physiological changes during middle age are menopause in women and the climacteric
in men. The nurse should continue with the examination because a comprehensive assessment offers
direction for health promotion recommendations, as well as for planning and implementing any acutely needed interventions. High self-esteem, a favorable body image, and a positive attitude toward physiological changes occur when adults engage in physical exercise, balanced diets, adequate sleep,
and good hygiene practices that promote vigorous, healthy bodies.
119
```
The nurse is teaching a class to pregnant women about common physiological changes during pregnancy.
Which statement by the nurse accurately describes these changes?
```
a. “Pregnancy enhances your ability to cope with stress.”
b. “Being nauseated and feeling tired will not affect your physical body image.”
c. “You and your partner may experience feelings of uncertainty about assuming the roles of parents.”
d. “Returning home after delivery will rejuvenate you and foster independence.”
c. “You and your partner may experience feelings of uncertainty about assuming the roles of parents.”
Both partners think about and have feelings of uncertainty about impending role changes. Parents need
reassurance that childbirth and childrearing are natural and positive experiences but are also stressful.
Parents often are unable to cope with particular stressors. Morning sickness and fatigue contribute to
poor body image. New mothers often return home from the hospital fatigued and unfamiliar with infant
care.
120
A nurse discusses the risks of repeated sun exposure with a young adult patient. Which of these patient
responses would be most expected from this patient?
a. “I’ll make an appointment with my doctor right away for a full skin check.”
b. “I should consider participating in a health fair about safe sun practices.”
c. “I have a mole that has been bothering me. I’ll call my family doctor for an appointment to get it
checked. ”
d. “I’ve had this mole my whole life. So what if it changed color? My skin is fine.”
d. “I’ve had this mole my whole life. So what if it changed color? My skin is fine.”
Young adults often ignore physical symptoms and often postpone seeking health care. Making an appointment
right away with the doctor and participating in health fairs are not typical behaviors of young adults for the same reason.
121
When performing a thorough psychosocial assessment on a young adult, what must the nurse realize?
a. Having a job is the best way to relieve stress.
b. Although psychologically disturbing, stress does not lead to physical illness.
c. Change is inevitable and is not a factor in stress-related illness.
d. Psychosocial health is often related to job and family stress.
d. Psychosocial health is often related to job and family stress.
The psychosocial health concerns of the young adult are often related to job and family stressors. If
stress is prolonged and the patient is unable to adapt to the stressor, health problems will develop. Job
assessment also includes conditions and hours, duration of employment, changes in sleep or eating
habits, and evidence of increased irritability or nervousness. When a patient seeks health care and
presents stress-related symptoms, the nurse needs to assess for the occurrence of a life change event.
122
A 25-year-old patient is brought to the hospital by police after crashing his car in a high-speed chase
when trying to avoid arrest for spousal abuse. What should the nurse do?
a. Question the patient about drug use.
b. Offer the patient a cup of coffee to calm his nerves.
c. Be aware that substance abuse is usually obvious.
d. Deal with the issue at hand, and put off asking about previous illnesses.
a. Question the patient about drug use.
Reports of arrests because of driving while intoxicated, wife or child abuse, or disorderly conduct are
reasons for the nurse to investigate the possibility of drug abuse more carefully. Caffeine is a naturally
occurring legal stimulant that stimulates the central nervous system and is not the choice for calming
nerves. Substance abuse is not always diagnosable, particularly in its early stages. The nurse may obtain
important information by making specific inquiries about past medical problems, changes in food intake
or sleep patterns, and problems of emotional lability.
123
A 61-year-old obese patient is diagnosed with type 2 diabetes and high blood pressure. The patient
states that he is upset about the diet restrictions imposed by the treatment regimen. What is the nurse’s
best approach?
a. Tell the patient that he must do what the doctor tells him.
b. Offer counseling on nutrition and exercise.
c. Tell the patient about what happened to other patients who did not change their lifestyle.
d. Explain that he needs to accept the care provider’s advice without question if he wants to get better.
b. Offer counseling on nutrition and exercise.
Counseling related to physical activity and nutrition is an important component of the plan of care for
overweight and obese patients. To help the patients develop positive health habits, the nurse becomes a
teacher and a facilitator, providing information and positive reinforcement. Ultimately, however, the patient decides which behaviors will become habits of daily living. Scare tactics do not usually work. By providing information about how the body works and how patients form and change habits, the nurse raises the patient’s level of knowledge regarding the potential impact of behavior on health. The nurse
should encourage patients to express their feelings to promote problem solving and recognition of risk
factors by patients themselves.
124
What are the most common life events that occur during young adulthood? (Select all that apply.)
a. Refining self-perception and ability for intimacy
b. Achievement and mastery of the surrounding world
c. Examination of life goals and relationships
d. Rejection of culture-bound definitions of health and illness
e. Women surrendering careers to raise families
a. Refining self-perception and ability for intimacy
b. Achievement and mastery of the surrounding world
c. Examination of life goals and relationships
Between the ages of 23 and 28, the person refines self-perception and ability for intimacy. From 29 to
34, the person directs enormous energy toward achievement and mastery of the surrounding world. The
years from 35 to 43 are a time of vigorous examination of life goals and relationships. Often the stresses
of this re-examination result in a “midlife crisis.” Each person holds culture-bound definitions of health
and illness. Knowing too little about the patient’s self-perception or beliefs regarding health and illness
creates conflict between the nurse and the patient. Women often continue to work during the childrearing
years, and many women struggle with the enormity of balancing three careers: wife, mother, and
employee.
125
Nurses need to provide competent care to young and middle adult patients. Why must nurses be
knowledgeable about developmental theories to care for this group? (Select all that apply.)
a. These theories provide nurses with a basis for understanding the life events and developmental
tasks of young and middle adults.
b. It is important to understand societal structures and roles because they have not changed in the past 20 or 30 years.
c. Patients present challenges to nurses, who themselves are often young or middle adults coping with
the demands of their respective developmental period.
d. Nurses need to recognize the needs of their patients even if they are not experiencing the same
challenges and events.
a. These theories provide nurses with a basis for understanding the life events and developmental
tasks of young and middle adults.
c. Patients present challenges to nurses, who themselves are often young or middle adults coping with
the demands of their respective developmental period.
d. Nurses need to recognize the needs of their patients even if they are not experiencing the same
challenges and events.
Developmental theories provide nurses with a basis for understanding the life events and developmental
tasks of young and middle adults. Patients present challenges to nurses who themselves are often young
or middle adults coping with the demands of their respective developmental period. Nurses need to recognize
the needs of their patients even if they are not experiencing the same challenges and events.
Faced with a societal structure that differs greatly from the norms of 20 or 30 years ago, both men and
women are assuming different roles in today’s society.
126
When providing prenatal care, what information does the nurse expect to provide? (Select all that
apply.)
a. Protecting against urinary infection
b. No longer needing condoms
c. Exercise patterns
d. Proper diet
e. Physical assessments only during the last trimester
a. Protecting against urinary infection
c. Exercise patterns
d. Proper diet
Prenatal care includes a thorough physical assessment of the pregnant woman during regularly scheduled
intervals (not just the last trimester). Information regarding STIs and other vaginal infections and
urinary infections that will adversely affect the fetus and counseling about exercise patterns, diet, and
child care are important for a pregnant woman.
127
As the aging population in the United States increases, the nurse knows that the
a. Baby boomer generation accounts for a very small percentage of this group.
b. Extension of the average life span has also increased.
c. Population segment over age 85 is decreasing.
d. Diversity of this age group will certainly decrease.
b. Extension of the average life span has also increased.
According to estimates, the number of older adults will increase to 72.1 million by 2030. Part of that increase
is due to extension of the average life span. Two other factors that contribute to the projected increase
in the number of older adults are the aging of the baby boom generation and the growth of the
population segment over age 85. The baby boomers are the large group of adults born between 1946 and
1964.The diversity of the group over age 65 will also possibly increase.
128
As a patient ages, the nursing plan of care
a. Should be standardized because all geriatric patients have the same needs.
b. Needs to be individualized to the patient’s unique needs.
c. Should be based on chronological age alone.
d. Focuses on the disabilities that all aging persons face.
b. Needs to be individualized to the patient’s unique needs.
Every older adult is unique, and the nurse needs to approach each one as a unique individual. The nursing care of older adults poses special challenges because of great variation in their physiological, cognitive,
and psychosocial health. Nurses need to take into account the cultural, ethnic, and racial diversity
represented by these numbers (not just age) as they care for older adults from these groups. Aging does
not inevitably lead to disability and dependence.
129
Which of these findings, if identified in a patient on a gerontological unit, would be most surprising to a culturally sensitive nurse?
a. The older person not being functionally independent
b. Preferences in food, music, and religion
c. Use of conventions of the handshake, silence, and eye contact
d. Personal health practices and spiritual resources
a. The older person not being functionally independent
Most older people remain functionally independent despite the increasing prevalence of chronic disease.
Examples of culturally competent nursing approaches to older adults include respect for preferences in
food, music, and religion; appropriate use of conventions of the handshake, silence, and eye contact; use
of interpreters; use of physical assessment norms appropriate for the ethnic group; and asking about personal
health practices, family customs, lifestyle preferences, and spiritual resources.
130
Which of the following statements by a new graduate nurse should be corrected by an experienced
nurse?
a. “Most older patients are ill and disabled. That’s why we care for so many of them in the hospital.”
b. “Older adults are many times still interested in sexual relations.”
c. “Patients over age 65 are still lifelong learners.”
d. “Many older adult patients remain independent enough to live alone.”
a. “Most older patients are ill and disabled. That’s why we care for so many of them in the hospital.”
Although many experience chronic conditions or have at least one disability that limits their performance
of activities of daily living, in 2004, 37.4% of non-institutionalized older adults assessed their
health as excellent or very good. Older adults do report continued enjoyment of sexual relationships. Although
changes in vision or hearing and reduced energy and endurance sometimes affect the process of
learning, older adults are lifelong learners. Most older adults live in non-institutional settings with family
members or alone.
131
Which teaching strategy is best to utilize with older adult patients?
a. Provide several topics of discussion at once to promote independence and making choices.
b. Avoid uncomfortable silences after questions by helping patients complete their statements.
c. Ask patients to recall past experiences that correspond with their interests.
d. Speak in a high pitch to help patients hear better.
c. Ask patients to recall past experiences that correspond with their interests.
Teaching strategies include the use of past experiences to connect new learning with previous knowledge,
focusing on a single topic to help the patient concentrate, giving the patient enough time in which
to respond because older adults’ reaction times are longer than those of younger persons, and keeping
the tone of voice low; older adults are able to hear low sounds better than high-frequency sounds.
132
An older patient has fallen and broken his hip. As a consequence, the patient’s family is concerned
about his ability to care for himself, especially during his convalescence. What should the nurse do?
a. Stress that older patients usually ask for help when needed.
b. Inform the family that placement in a nursing center is a permanent solution.
c. Tell the family to enroll the patient in a ceramics class to maintain his quality of life.
d. Provide information and answer questions as family members make choices among care options.
d. Provide information and answer questions as family members make choices among care options.
Nurses assist older adults and their families by providing information and answering questions as they
make choices among care options. Some older adults deny functional declines and refuse to ask for assistance with tasks that place their safety at great risk. The decision to enter a nursing center is never final, and a nursing center resident sometimes is discharged to home or to another less-acute residence.
What defines quality of life varies from person to person. Nurses must listen to what the older adult considers
to be most important rather than making assumptions about the individual’s priorities.
133
What is the best suggestion a nurse could make to a family requesting help in selecting a local nursing
center?
a. Suggest choosing a nursing center that is as sanitary as possible. The closer the center is to hospital
standards, the better.
b. Have family members evaluate nursing home staff according to their ability to get tasks done
efficiently.
c. Make sure that nursing home staff members get patients out of bed every day for the entire day.
d. Explain that it is probably best for the family to visit the center and inspect it personally.
d. Explain that it is probably best for the family to visit the center and inspect it personally.
An important step in the process of selecting a nursing home is to visit the nursing home. The nursing
home should not feel like a hospital. It is a home, a place where people live. Members of the nursing home staff should focus on the person, not the task. Residents should be out of bed and dressed according
to their preferences, not staff preferences.
134
A 70-year-old patient who suffers from worsening dementia is no longer able to live alone. When discussing
health care services and possible long-term living arrangements with the patient’s only son, what
should the nurse suggest?
a. An apartment setting with neighbors close by
b. Having the patient utilize weekly home health visits
c. A nursing center because home care is no longer safe
d. That placement is irrelevant because the patient is retreating to a place of inactivity
c. A nursing center because home care is no longer safe
Some family caregivers consider nursing center placement when in-home care becomes increasingly difficult,
or when convalescence from hospitalization requires more assistance than the family is able to provide. An apartment setting and the use of home health visits are not appropriate because some older adults deny functional decline and refuse to ask for assistance with tasks that place their safety at great risk. Others avoid activities designed to benefit older adults such as senior health promotion activities
(such as some health visits), and thus do not receive the benefits that these programs offer. Acceptance of personal aging does not mean a retreat into inactivity, but it does require a realistic review of strengths and limitations.
135
Several theories on aging have been put forth, and the nurse should use these theories to
a. Guide nursing care.
b. Explain the stochastic view of genetically programmed physiological changes.
c. Select one theory to guide nursing care for all geriatric patients.
d. Understand the nonstochastic views of aging as the result of cellular damage.
a. Guide nursing care.
Although theories on aging are in various stages of development and have limitations, the nurse should
use them to increase understanding of the phenomena affecting the health and well-being of older adults
and to guide nursing care. Stochastic theories view aging as the result of random cellular damage occurring
over time. No one single universally accepted theory predicts and explains the complexities of the
aging process. Nonstochastic theories view aging as the result of genetically programmed physiological
mechanisms within the body.
136
The nurse correctly describes psychosocial theories on aging as theories that
a. Describe role changes in behaviors in older adults.
b. Emphasize that all adults age in similar ways.
c. Stress the need for the aging to discontinue activities as they age.
d. Describe behavior patterns for all aging adults as unpredictable.
a. Describe role changes in behaviors in older adults.
Psychosocial theories of aging explain changes in behaviors, roles, and relationships that come with aging.
Although some theories generalize about aging, biologically and psychosocially each individual ages uniquely. The activity theory considers the continuation of activities performed during middle age
as necessary for successful aging. The continuity theory states that personality remains the same and behavior becomes more predictable as people age.
137
When comparing developmental tasks of middle-aged persons versus older adults, what should the
nurse infer?
a. Learning to cope with loss is most common during the middle adult years.
b. After age 65, most older adults age both biologically and psychologically the same way.
c. All older adults will need nursing assistance to deal with loss.
d. Older adults fear and resent retirement as a disruption of their lifestyle.
c. All older adults will need nursing assistance to deal with loss.
Some older adults deny their own aging in ways that are potentially problematic. For example, some
older adults deny functional declines and refuse to ask for assistance with tasks that place their safety at
great risk. The need to cope with loss is much greater in the older adult population. Most older adults
cope with the death of a spouse. Some must cope with the death of adult children and grandchildren. All experience the death of friends. The ways that older adults adjust to the changes of aging are highly individualized.
Many older adults welcome retirement as a time to pursue new interests and hobbies, participate
in volunteer activities, continue their education, or start a new business career.
138
An 80-year-old male is brought to the emergency department with an exacerbation of chronic obstructive
pulmonary disease (COPD). He states that he quit smoking 30 years ago, so it can’t be COPD.
He argues, “It’s just these colds I’ve been getting. They’re just getting worse and worse.” The nurse understands
that
a. These symptoms are more associated with normal aging than with disease.
b. Older adults do not have to alter physical activity because of physical changes.
c. The patient’s age will require adjustment of lifestyle to one of inactivity.
d. Older adults usually are aware and accepting of the aging process.
b. Older adults do not have to alter physical activity because of physical changes.
Older adults face the necessity of adjustment to the physical changes that accompany aging. As body
systems age, changes in appearance and functioning occur. These changes are not associated with a disease
but are normal changes. The presence of disease sometimes alters the timing of the changes or their
impact on daily life. Acceptance of personal aging does not mean retreat into inactivity, but it does require
a realistic review of strengths and limitations. Some older adults find it difficult to accept that they
are aging.
139
During assessment of an older adult’s skin integrity, expected findings include which of the
following?
a. Decreased elasticity
b. Oily skin
c. Increased facial hair in men
d. Faster nail growth
a. Decreased elasticity
Loss of skin elasticity is a common finding in the older adult. Other common findings include pigmentation
changes, glandular atrophy (oil, moisture, sweat glands), thinning hair (facial hair: decreased in
men, increased in women), slower nail growth, and atrophy of epidermal arterioles.
140
An older adult patient in no acute distress reports being less able to taste and smell. What is the
nurse’s best response to this information?
a. Notify the physician immediately to rule out cranial nerve damage.
b. Perform testing on the vestibulocochlear nerve and a hearing test.
c. Schedule the patient for an appointment at a smell and taste disorders clinic.
d. Explain to the patient that diminished senses are normal findings.
d. Explain to the patient that diminished senses are normal findings.
Diminished taste and smell senses are common findings in older adults. Scheduling an appointment at a
smell and taste disorders clinic, testing the vestibulocochlear nerve, or an attempt to rule out cranial
nerve damage is unnecessary at this time per the information provided.
141
Which symptom is an expected cognitive change in the older adult patient?
a. Disorientation
b. Slower reaction time
c. Poor judgment
d. Loss of language skills
b. Slower reaction time
Slower reaction time is a common change in the older adult owing to degeneration of nerve cells, decreased
neurotransmitters, and decreased rate of conduction of impulses. Symptoms of cognitive impairment,
such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgment
are not normal aging changes and require further investigation of underlying causes.
142
A patient with gradual, progressive cognitive impairment (dementia) is admitted to the nursing unit
after hip replacement surgery. Which of the following is a nursing care principle for care of cognitively
impaired older adults?
a. Maintain physical health.
b. Evaluate the patient’s manifestations of standard symptoms.
c. Assist patient with all ADLs.
d. Isolate patients to protect others.
a. Maintain physical health.
The nurse works to monitor and maintain physical health. The nurse should also assess the person’s
unique manifestations of the disease as it progresses while facilitating independent performance of activities
of daily living (ADLs). Social interaction based on the patient’s abilities is to be promoted.
143
To promote physical well-being and socialization in an older adult, what should the nurse realize?
a. Social isolationism is always a chosen behavior.
b. Body image plays no role in decision making by the older adult.
c. No community resources are focused on the older adult.
d. Older adults may have a functional purpose in social arenas.
d. Older adults may have a functional purpose in social arenas.
Social service agencies in most communities welcome older adults as volunteers and provide the opportunity
for older adults to serve while meeting their socialization or other needs. Although some older adults choose isolation or a lifelong pattern of reduced interaction with others, other older adults do not choose isolation but are vulnerable to its consequences. Some older adults withdraw from social interaction because of feelings of rejection. These older adults see themselves as unattractive and rejected because of changes in their personal appearance due to normal aging changes or because of body image
changes. Many communities have outreach programs designed to make contact with isolated older
adults.
144
A male older adult patient expresses his concern and anxiety about decreased penile firmness during
erection. What is the nurse’s best response?
a. Explain that over time, his libido will decrease, as will the frequency of sexual activity.
b. Tell the patient to double his antidepressant medication to increase his libido.
c. Tell the patient that this change is expected in aging adults.
d. Tell the patient that touching should be avoided unless intercourse is planned.
c. Tell the patient that this change is expected in aging adults.
Decreased firmness during erection is an expected change in aging adults. Libido does not necessarily
decrease as one ages. Many older adults use prescription medications that depress sexual activity such as
antihypertensives, antidepressants, sedatives, or hypnotics. Touch complements traditional sexual methods or serves as an alternative sexual expression when physical intercourse is not desired or possible.
145
A patient asks the nurse what the term polypharmacy means. The nurse defines this term as
a. Multiple side effects experienced when taking a medication.
b. The concurrent use of many medications.
c. The many adverse drug effects reported to the pharmacy.
d. The risks of medication effects due to aging.
b. The concurrent use of many medications.
Polypharmacy refers to the concurrent use of many medications. It does not have anything to do with
side effects, adverse drug effects, or risks of medication use due to aging.
146
An outcome for an older adult patient living alone is to be free from falls. Which of these statements
by a patient indicates that teaching on safety concerns has been effective?
a. “I’ll leave my throw rugs in place so that my feet won’t touch the cold tile.”
b. “I’ll take my time getting up from the bed or chair.”
c. “I should wear my favorite smooth bottom socks to protect my feet when walking around.”
d. “I will have my son dim the lighting outside to decrease the glare in my eyes.”
b. “I’ll take my time getting up from the bed or chair.”
Older adults taking medications with adverse effects such as postural hypotension, dizziness, or sedation need to be aware of these potential effects and to take precautions such as changing position slowly or
ambulating with assistance if unsteady. Household items that are easy to trip over, such as throw rugs,
are a risk factor for falls. Other risk factors include wearing shoes in poor repair or slippery soles. Impaired
vision and poor lighting are other risk factors.
147
One of the greatest challenges for the nurse caring for older adults is ensuring safe medication use.
One way to reduce the risks associated with medication usage is to
a. Periodically review the patient’s list of medications.
b. Inform the patient that polypharmacy is to be avoided at all cost.
c. Be aware that medication is absorbed the same way regardless of patient age.
d. Focus only on prescribed medications.
a. Periodically review the patient’s list of medications.
Periodic and thorough review of all medications is important to restrict the number of medications used
to the fewest necessary to ensure the greatest therapeutic benefit with the least amount of harm. Although
polypharmacy reflects inappropriate prescribing, the concurrent use of multiple medications is
necessary in situations where an older adult has multiple acute and chronic conditions. Older adults are
at risk for adverse drug effects because of age-related changes in the absorption, distribution, metabolism,
and excretion of drugs. Work collaboratively with the older adult to ensure safe and appropriate
use of all medications—both prescribed medications and over-the-counter medications.
148
An older adult patient has developed acute confusion. The patient has been on tranquilizers for the
past week. The patient’s vital signs are normal. What should the nurse do?
a. Take into account age-related changes in body systems that affect pharmacokinetic activity.
b. Increase the dose of tranquilizer if the cause of the confusion is an infection.
c. Note when the confusion occurs and medicate before that time.
d. Restrict telephone usage to prevent further confusion.
a. Take into account age-related changes in body systems that affect pharmacokinetic activity.
Sedatives and tranquilizers sometimes prescribed for acutely confused older adults sometimes cause or
exacerbate confusion. Carefully administer drugs used to manage confused behaviors, taking into account
age-related changes in body systems that affect pharmacokinetic activity. When confusion has a
physiological cause (such as an infection), specifically treat that cause, rather than the confused behavior.
When confusion varies by time of day or is related to environmental factors, nonpharmacological
measures such as making the environment more meaningful, providing adequate light, etc., should be
used. Making telephone calls to friends or family members allows older adults to hear reassuring voices,
which may be beneficial.
149
Which of these assessments of an older adult, who has a urinary tract infection, requires an immediate
nursing intervention?
a. Presbycusis
b. Confusion
c. Death of a spouse 3 months ago
d. Temperature of 97.6° F
b. Confusion
Confusion is a common manifestation in older adults with urinary tract infection; however, the cause requires
further assessment. There may be another reason for the confusion. Confusion is not a normal
finding in the older adult, even though it is commonly seen with concurrent infections. Difficulty hearing,
presbycusis, is an expected finding in an older adult. Coping with the death of a spouse is a psychosocial concern to be addressed after the acute physiological concern in this case. Older adults tent to
have lower temperatures, so the nurse needs to assess for slight elevations. A temperature of 97.6° F is
within normal limits.
150
Which of these patient statements is the most reliable indicator that an older adult has the correct understanding
of health promotion activities?
a. “I need to increase my fat intake and limit protein.”
b. “I should discontinue my fitness club membership for safety reasons.”
c. “I’m up to date on my immunizations, but at my age, I don’t need the tetanus vaccine.”
d. “I still keep my dentist appointments even though I have partials now.”
d. “I still keep my dentist appointments even though I have partials now.”
General preventive measures for the nurse to recommend to older adults include keeping periodic dental appointments to promote good oral hygiene, eating a low-fat, well-balanced diet, exercising regularly, and maintaining immunizations for influenza, pneumococcal pneumonia, and tetanus.
151
A 72-year-old woman was recently widowed. She worked as a teller at a bank for 40 years and has been retired for the past 5 years. She never learned how to drive. She lives in a rural area that does not
have public transportation. Which of the following psychosocial changes does the nurse focus on as a
priority?
a. Sexuality
b. Housing and environment
c. Retirement
d. Social isolation
d. Social isolation
The highest priority at this time is the potential for social isolation. This woman does not know how to
drive and lives in a rural community that does not have public transportation. All of these factors contribute
to her social isolation. Other possible changes she may be going through right now include sexuality
related to her advanced age and recent death of her spouse; however, this is not the priority at this
time. She has been retired for 5 years, so this is also not an immediate need. She may eventually experience
needs related to housing and environment, but the data do not support this as an issue at this time.
152
A recently widowed 80-year-old male is dehydrated and is admitted to the hospital for intravenous fluid replacement. During the evening shift, the patient becomes acutely confused. The nurse’s best action is to assess the patient for which of the following reversible causes? (Select all that apply.)
a. Electrolyte imbalance
b. Hypoglycemia
c. Drug effects
d. Dementia
e. Cerebral anoxia
a. Electrolyte imbalance
b. Hypoglycemia
c. Drug effects
e. Cerebral anoxia
Delirium, or acute confusional state, is a potentially reversible cognitive impairment that is often due to a physiological event. Physiological causes of delirium can include electrolyte imbalances, cerebral anoxia, hypoglycemia, medications, drug effects, tumors, subdural hematomas, and cerebrovascular infection, infarction, or hemorrhage. Unlike delirium, dementia is a gradual, progressive, irreversible cerebral
dysfunction.
153
A nurse is working as a public health nurse. What will be the nurse’s primary focus?
a. The individual as one member of a group
b. Individuals and families
c. Needs of a population
d. Health promotion
c. Needs of a population
Public health nursing primary focus is understanding the needs of a population. Community-based care focuses on health promotion. Community health nursing focuses on health care of individuals, families, and groups within the community.
154
A nurse wants to become a specialist in public health nursing. Which educational requirement will the nurse
have to obtain?
a. A baccalaureate degree in nursing
b. Preparation at the basic entry level
c. The same level of education as the community health nurse
d. A graduate level education with a focus in public health science
d. A graduate level education with a focus in public health science
A specialist in public health has a graduate level education with a focus in public health science. Public health
nursing requires preparation at the basic entry level and sometimes requires a baccalaureate degree in nursing.
A community health nurse is not the same thing as a public health nursing specialist.
155
A nurse is working as a community health nurse. Which action is a priority for this nurse?
a. Provide direct care to subpopulations.
b. Focus on the needs of the ill individual.
c. Provide first level of contact to health care systems.
d. Focus on providing care in various community settings.
a. Provide direct care to subpopulations.
Community health nursing is nursing practice in the community, with the primary focus on the health care of
individuals, families, and groups within the community. In addition, the community health nurse provides direct
care services to subpopulations within a community. Community-based nursing centers function as the
first level of contact between members of a community and the health care system. Community-based nursing
focuses on providing care in various community settings, such as the home or a clinic and involves acute and
chronic care.
156
A nurse is focusing on acute and chronic care of individuals and families within a community while enhancing
patient autonomy. Which type of nursing care is the nurse providing?
a. Public health
b. Community health
c. Community-based
d. Community assessment
c. Community-based
Community-based nursing involves acute and chronic care of individuals and families and enhances their capacity
for self-care while promoting autonomy in decision making. Public health nursing focuses on the needs
of a population. Community health nursing cares for the community as a whole and considers the individual or
the family as only one member of a group at risk. Community assessment is the systematic data collection on
the population, monitoring the health status of the population, and making information available about the health of the community.
157
The community health nurse is administering flu shots to children at a local playground. What is the rationale
for this nurse’s action?
a. To prevent individual illness
b. To prevent community outbreak of illness
c. To prevent outbreak of illness in the family
d. To prevent needs of the local population groups
b. To prevent community outbreak of illness
The nurse is trying to prevent a community outbreak of illness. By focusing on subpopulations (children), the
community health nurse cares for the community as a whole and considers the individual or the family as only
one member of a group at risk. Community-based nursing, as opposed to community health nursing, focuses
on the needs of the individual or family. Public health nursing focuses on meeting the population groups’
needs.
158
A nurse attended a seminar on community-based health care. Which information indicates the nurse has a
good understanding of community-based health care?
a. It occurs in hospitals.
b. Its focus is on ill individuals.
c. Its priority is health promotion.
d. It provides services primarily to the poor.
c. Its priority is health promotion.
Community-based health care is a model of care that reaches everyone in the community (including the poor
and underinsured), focuses on primary rather than institutional or acute care, and provides knowledge about
health and health promotion and models of care to the community. Community-based health care occurs outside
traditional health care institutions such as hospitals.
159
A nurse is using the Healthy People 2020 to establish goals for the community. Which goal is priority?
a. Reduce health care costs.
b. Increase life expectancy.
c. Provide services close to where patients live.
d. Isolate patients to prevent the spread of disease.
b. Increase life expectancy.
The overall goals of Healthy People 2020 are to increase life expectancy and quality of life and eliminate health
disparities through an improved delivery of health care services. It does not focus on reducing health care
costs, providing services close to where patients live, or isolating patients to prevent the spread of disease.
160
A nurse is working in community-based nursing. Which competency is priority for this nurse?
a. Caregiver
b. Collaborator
c. Change agent
d. Case manager
a. Caregiver
First and foremost is the role of caregiver. While collaborator, change agent, and case manager are important, they are not the priority.
161
A nurse observes an outbreak of lice in a certain school district. The nurse collects data and identifies a common
practice of sharing lockers, caps, and hair brushes. The nurse shares the information with the school.
Which community-based nursing competency did the nurse use?
a. Educator
b. Caregiver
c. Case manager
d. Epidemiologist
d. Epidemiologist
As an epidemiologist, you are involved in case finding, health teaching, and tracking incident rates of an illness
(outbreak of lice). The nurse did not teach the students about lice. The nurse did not provide care for the lice.
The nurse did not coordinate needed resources and services for a group of patient’s well-being (case manager).
162
A nurse is providing screening at a health fair. Which finding indicates the person may be a vulnerable patient
who is most likely to develop health problems?
a. One who is pregnant
b. One who has excessive risks
c. One who has unlimited access to health care
d. One who uses nontraditional healing practices
b. One who has excessive risks
Vulnerable populations are the patients who are more likely to develop health problems as a result of excess
risks or limits in access to health care services or who are dependent on others for care. Pregnancy is not a
cause of vulnerability, except in cases where the mother is an adolescent, is addicted to drugs, or is at high risk
for other reasons. A person who has unlimited access to health care is not vulnerable. Frequently, the immigrant
population practices nontraditional healing practices. Many of these healing practices are effective and
complement traditional therapies.
163
The instructor is teaching student nurses about identifying members of vulnerable populations when the
nursing student asks, “Why is it that not all poor people are considered members of vulnerable populations?”
How should the nurse respond?
a. “All poor people are members of a vulnerable population.”
b. “Poor people are members of a vulnerable population only if they take drugs.”
c. “Poor people are members of a vulnerable population only if they are homeless.”
d. “Members of vulnerable groups frequently have a combination of risk factors.”
d. “Members of vulnerable groups frequently have a combination of risk factors.”
Members of vulnerable groups frequently have many risks or a combination of risk factors that make them
more sensitive to the negative effects of individual risk factors. Individual risk factors are not always overwhelming,
depending on the patient’s beliefs and values and sources of social support.
164
The nurse is making a home visit to a Korean mother after the birth of girl. The spouse is pressing different
parts of the patient’s hand and lower arm to relieve a headache. What is the nurse’s next action?
a. Tell the spouse to stop and give the mother acetaminophen.
b. Let the spouse finish and then give the mother medication.
c. Ask the mother and/or spouse to explain the procedure.
d. Explain to the spouse that it will not work.
c. Ask the mother and/or spouse to explain the procedure.
The nurse should not judge the patient’s/family’s beliefs and values about health. The nurse needs to understand
cultural beliefs, values, and practices to determine their specific needs. Acetaminophen may not be an acceptable alternative for this family. Criticizing the family’s beliefs and practices or saying they will not work
may only create a barrier to care.
165
A nurse is assessing the social system of a community. Which area should the nurse assess?
a. Housing
b. Economic status
c. Volunteer programs
d. Predominant ethnic groups
c. Volunteer programs
Social systems include volunteer programs, education system, government, and health systems. Housing and
economic status are included in the structure assessment. Predominant ethnic groups are a component of the
population assessment.
166
The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs an abortion.
The nurse, acting as a counselor, provides the patient with information on alternatives to abortion, but after
several sessions, the patient still insists on having the abortion. What should the nurse, in the counselor role,
do next?
a. Encourage the patient to speak with a “Right-to-Life” advocate.
b. Refuse to provide a referral to an abortion service.
c. Provide referral to an abortion service.
d. Delay referral to an abortion service.
c. Provide referral to an abortion service.
As a counselor, the nurse is responsible for providing information, listening objectively, and being supportive,
caring, and trustworthy and providing a referral to an abortion service. The nurse does not make decisions, like going to a “Right-to-Life” advocate, but rather helps the patient reach decisions that are best for him or her. To refuse to provide a referral or to delay referral would not be supportive of the patient’s decision.
167
Before a patient with beginning stage of Alzheimer’s disease is discharged, the community-based nurse is
making a visit to the patient’s home. The patient’s daughter and family live in the home with the patient. What
is the major focus of this visit?
a. Teach the family how to monitor blood pressure.
b. Demonstrate techniques for providing care.
c. Stress to the family how difficult it will be to provide care at home.
d. Encourage the family to send the patient to an extended care facility.
b. Demonstrate techniques for providing care.
The role of the community health nurse, when dealing with patients with Alzheimer’s disease, is to maintain
the best possible functioning, protection, and safety for the patient. The nurse should demonstrate to the primary
family caregiver techniques for dressing, feeding, and toileting the patient while providing encouragement
and emotional support to the caregiver. Monitoring blood pressure is not necessary for an Alzheimer’s
patient; blood pressure would be for a patient with hypertension. The nurse should protect the patient’s rights
and maintain family stability, not encourage placement in an extended care facility.
168
While conducting a community assessment, the nurse seeks data on the average household income and the number of residents on public assistance. In doing so, the nurse is evaluating which component of a community
assessment?
a. Structure
b. Population
c. Social system
d. Welfare system
a. Structure
Economic status is part of the community structure. Population would involve age and gender distribution,
growth trends, density, education level, and ethnic or religious groups. The welfare system is part of the social
system that also includes the education, government, communication, and health systems.
169
The nurse uses statistics on increased incidence of communicable disease to influence legislatures to pass
a bill for mandatory vaccinations to enroll in school. Which type of nursing will the nurse use in this process?
a. Public health nursing
b. Community-based nursing
c. Community health nursing
d. Vulnerable population nursing
a. Public health nursing
A public health nurse understands factors that influence health promotion and health maintenance, the trends and patterns influencing the incidence of disease within populations, environmental factors contributing to
health and illness, and the political processes used to affect public policy. Community health nursing is nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within the community. Community-based nursing care takes place in community settings such as the home or a clinic,
where the focus is on the needs of the individual or family. While there is no specific vulnerable population nursing, all types of nursing should care for these populations.
170
A community-based nursing is working with a family. For which key areas will the nurse need a strong knowledge
base? (Select all that apply.)
a. Family theory
b. Communication
c. Group dynamics
d. Cultural diversity
e. Individual-centered care
a. Family theory
b. Communication
c. Group dynamics
d. Cultural diversity
With the individual and family as the patients, the context of community-based nursing is family-centered care
(not individual-centered care) within the community. This focus requires a strong knowledge base in family theory, principles of communication, group dynamics, and cultural diversity. The nurse leans to partner with patients
and families, not just with individuals.
171
Which community-based nursing activities indicate the nurse is working in the role of educator? (Select all
that apply.)
a. Offers prenatal classes
b. Offers a child safety program
c. Offers to defend patients’ decisions
d. Offers creative solutions to local problems
e. Offers coordinate resources after discharge
a. Offers prenatal classes
b. Offers a child safety program
Prenatal classes, infant care, child safety, and cancer screening are just some of the health education programs provided in a community practice setting. Offers to defend patients’ decisions is the role of patient advocate.
Offers creative solutions to local problems indicates a change agent. Collaborator will offer to coordinate resources after discharge.
172
A nurse is caring for vulnerable populations in a local community. Which patients will the nurse care for in this community? (Select all that apply.)
a. A 47-year-old immigrant who speaks only Spanish
b. A 35-year-old living in own home
c. A 22-year-old pregnant woman
d. A 40-year-old schizophrenic
e. A 15-year-old rape victim
a. A 47-year-old immigrant who speaks only Spanish
d. A 40-year-old schizophrenic
e. A 15-year-old rape victim
Individuals living in poverty, older adults, people who are homeless, immigrant populations, individuals in abusive relationships (rape), substance abusers, and people with severe mental illnesses (schizophrenic) are examples of vulnerable populations. Middle-aged people living in their own home are not an example of a vulnerable population. Pregnancy is not an example of a vulnerable population.
173
Matching:
A nurse is assessing a community. Match each community element the nurse will assess with the correct example.
a. Education level
b. Housing
c. Government
a. Education level- Population
b. Housing- Structure
c. Government- Social System
174
A mother has delivered a healthy newborn. Which action is priority?
a. Encourage close physical contact as soon as possible after birth.
b. Isolate the newborn in the nursery during the first hour after delivery.
c. Never leave the newborn alone with the mother during the first 8 hours after delivery.
d. Do not allow the newborn to remain with parents until the second hour after delivery.
a. Encourage close physical contact as soon as possible after birth.
After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents’
and newborn’s need for close physical contact. Early parent-child interaction encourages parent-child attachment.
Most healthy newborns are awake and alert for the first half-hour after birth. This is a good time for
parent-child interaction to begin. No evidence in the scenario suggests that the baby cannot be left alone with the parents during the first 8 hours or that the baby should remain in the nursery during the first hour.
175
A nurse teaches a new mother about the associated health risks to the infant. Which statement by the mother
indicates a correct understanding of the teaching?
a. “I will feed my baby every 4 hours around-the-clock.”
b. “I need to leave the blankets off my baby to prevent smothering.”
c. “I need to remind friends who want to hold my baby to wash their hands.”
d. “I will throw away the bulb syringe now because my baby is breathing fine.”
c. “I need to remind friends who want to hold my baby to wash their hands.”
Good handwashing technique is the most important factor in protecting the newborn from infection. You can
help prevent infection by instructing parents and visitors to wash their hands before touching the infant. The nurse can help parents identify ways to meet needs by counseling them to feed their baby on demand rather
than on a rigid schedule.
Newborns are susceptible to heat loss and cold stress. Place the healthy newborn directly on the mother’s abdomen, covering with warm blankets. Removal of nasopharyngeal and oropharyngeal secretions remains a priority
of care to maintain a patent airway; keeping the bulb syringe is important.
176
A nurse is working in the delivery room. Which action is priority immediately after birth?
a. Open the airway.
b. Determine gestational age.
c. Monitor infant-parent interactions.
d. Promote parent-newborn physical contact.
a. Open the airway.
Opening the airway is the priority. The most extreme physiological change occurs when the newborn leaves the
utero circulation and develops independent respiratory functioning. Direct nursing care includes maintaining an open airway, stabilizing and maintaining body temperature, and protecting the newborn from infection. After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents’ and newborn’s need for close physical contact. Following a comprehensive physical assessment, the nurse assesses gestational age and interactions between infant and parents.
177
A nurse is assessing a newborn that was just born. Which newborn finding will cause the nurse to intervene
immediately?
a. Molding
b. A lack of reflexes
c. Cyanotic hands and feet
d. A soft, protuberant abdomen
b. A lack of reflexes
A lack of reflexes must be addressed quickly. Assessment of these reflexes is vital because the newborn depends largely on reflexes for survival and in response to its environment. Molding, or overlapping of the soft
skull bones, allows the fetal head to adjust to various diameters of the maternal pelvis and is a common occurrence with vaginal births. Normal physical characteristics include the continued presence of lanugo on the skin
of the back; cyanosis of the hands and feet for the first 24 hours; and a soft, protuberant abdomen.
178
A nurse performs an assessment on a healthy newborn. Which assessment finding will the nurse document
as normal?
a. Cyanosis of the feet and hands for the first 48 hours
b. Triangle-shaped anterior fontanel
c. Sporadic motor movements
d. Weight of 4800 grams
c. Sporadic motor movements
Movements in the newborn are generally sporadic, but they are symmetric and involve all four extremities.
Cyanosis of the hands and feet is normal for the first 24 hours, not 48 hours. The diamond shape of the anterior fontanel and the triangular shape of the posterior fontanel are found between the unfused bones of the skull. The average newborn is 2700 to 4000 grams (6 to 9 pounds), not 4800 grams.
179
A nurse is teaching the staff about development. Which information indicates the nurse needs to follow up?
a. “Development proceeds in a cephalocaudal pattern.”
b. “Development proceeds in a proximal-distal pattern.”
c. “Development proceeds at a slower rate during the embryonic stage.”
d. “Development proceeds at a predictive rate from the moment of conception.”
c. “Development proceeds at a slower rate during the embryonic stage.”
Development proceeds at a slower rate during embryonic stage indicates the nurse needs to follow up to correct
the misconception. From the moment of conception until birth, human development proceeds at a predictive
and rapid rate. All the rest of the information is correct and does not need follow-up. Development proceeds
in a cephalocaudal and proximal-distal pattern.
180
A nurse is comparing physical growth patterns between school-aged children and adolescents. Which principle
should the nurse consider?
a. Physical growth usually slows during the adolescent period.
b. Secondary sex characteristics usually develop during the adolescent years.
c. Boys usually exceed girls in height and weight by the end of the school years.
d. The distribution of muscle and fat remains constant during the adolescent years.
b. Secondary sex characteristics usually develop during the adolescent years.
Sexual maturation in adolescence occurs with the development of primary and secondary sexual characteristics.
Physical growth usually slows during the school-aged period, and then a growth spurt occurs during adolescence.
Girls usually exceed boys in height and weight by the end of the school years. As height and weight increase during adolescence, the distribution of muscle and fat changes.
181
The parent brings a child to the clinic for a 12-month well visit. The child weighed 6 pounds 2 ounces and
was 21 inches long at birth. Which finding will cause the nurse to intervene?
a. Height of 30 inches
b. Weight of 16 pounds
c. Is not yet potty-trained
d. Is not yet walking up stairs
b. Weight of 16 pounds
Size increases rapidly during the first year of life. Birth weight doubles in approximately 5 months and triples by 12 months. This infant should weigh at least 18 (6 × 3) pounds by this calculation. This child needs the nurse to intervene for further assessment. Height increases an average of 1 inch during each of the first 6 months and about 1/2 inch each month until 12 months: 21 + 6 + 3 = 30 (30 inches is the predicted height). Patterns of body function are just now starting to stabilize. It is quite normal for a 12-month-old child to not be potty-trained or walking up stairs yet. These milestones usually occur in the toddler period of development (12 to 36 months).
182
A nurse is assessing the cognitive changes in a preschooler. Which standard will the nurse use to determine
normal?
a. The ability to think abstractly and deal effectively with hypothetical problems
b. The ability to think in a logical manner about the here and now
c. The ability to assume the view of another person
d. The ability to classify objects by size or color
d. The ability to classify objects by size or color
Preschoolers demonstrate their ability to think more complexly by classifying objects according to size or color.
Cognitive changes that provide the ability to think in a logical manner about the here and now occur during the school-aged years. It is during the teenaged years when the individual thinks abstractly and deals effectively with hypothetical problems. The toddler is unable to assume the view of another.
183
The nurse is teaching a parenting class. One of the topics is development. Which statement from a parent
indicates more teaching is needed?
a. “The toddler may use parallel play.”
b. “The preschooler has the ability to play in small groups.”
c. “The school-aged child still needs total assistance in all safety activities.”
d. “The toddler may have temper tantrums from parent’s acting on safety rules.”
c. “The school-aged child still needs total assistance in all safety activities.”
The toddler continues to engage in solitary play but also begins to participate in parallel play, which is playing
beside rather than with another child. The play of preschool children becomes more social after the third birthday as it shifts from parallel to associative play with others in small groups. The toddler’s strong will is frequently exhibited in negative behavior when caregivers attempt to direct actions. Temper tantrums result when parental restrictions frustrate toddlers.
184
The nurse is observing a 2-year-old hospitalized patient in the playroom. Which activity will the nurse most
likely observe?
a. Seeking out same sex children to play with
b. Participating as the leader of a small group activity
c. Sitting beside another child while playing with blocks
d. Separating building blocks into groups by size and color
c. Sitting beside another child while playing with blocks
The child beside another child and playing is exhibiting parallel play, characteristic of a toddler. Participating as
a group leader does not usually occur until around age 5. Preschoolers (ages 3 to 5) demonstrate their ability to think more complexly by classifying objects according to size or color. A 2-year-old child does not have this ability yet. Gender does not become a factor until the child reaches school-age when the child prefers same sex peers to opposite sex peers.
185
A nurse is communicating with a newly admitted teenaged patient. Which action should the nurse take?
a. Avoid questioning the patient about cigarette use when the nurse observes a cigarette lighter lying on the bedside
table.
b. Complete the admission database as quickly as possible by asking yes and no questions.
c. Look for meaning behind the patient’s words and actions.
d. Ignore the patient’s withdrawn behavior.
c. Look for meaning behind the patient’s words and actions.
Good communication skills are critical for adolescents. Look for meaning behind the adolescent’s words and
actions. Following are some hints for communicating with adolescents: Do not avoid discussing sensitive issues.
Asking questions about sex, drugs, and school opens the channels for further discussion. Ask open-ended
questions. (Yes and no questions are closed-ended questions.) The nurse should inquire about a patient’s
withdrawn behavior to seek out the meaning of such behaviors. Be alert to clues about adolescents’ emotional
states.
186
A nurse is caring for a preschooler. Which fear should the nurse most plan to minimize?
a. Fear of bodily harm
b. Fear of weight gain
c. Fear of separation
d. Fear of strangers
a. Fear of bodily harm
The greatest fear of preschoolers appears to be that of bodily harm; this is evident in children’s fear of the dark, animals, thunderstorms, and medical personnel. Toddlers who become ill and require hospitalization are
most stressed by the separation from their parents. Persons with anorexia nervosa have an intense fear of gaining weight. By 8 months, most infants are able to differentiate a stranger from a familiar person and respond
differently to the two.
187
A nurse is teaching a class about the effects of nutrition on fetal growth and development. A pregnant patient
asks the nurse how much weight should normally be gained over the pregnancy. Which information
should the nurse share with the patient?
a. About 10 to 20 pounds
b. About 15 to 25 pounds
c. About 20 to 30 pounds
d. About 25 to 35 pounds
d. About 25 to 35 pounds
The diet of a woman both before and during pregnancy has a significant effect on fetal development. For
women who are at normal weight for height, the recommended weight gain is 25 to 35 pounds over three
trimesters. Weight gains of 10 to 20, 15 to 25, and 20 to 30 pounds are too low.
188
The nurse is caring for an infant. Which activity is most appropriate for the nurse to offer to the infant?
a. Set of cards to organize and separate into groups
b. Set of sock puppets with movable eyes
c. Set of plastic stacking rings
d. Set of paperback book
c. Set of plastic stacking rings
Adults and nurses facilitate infant learning by planning activities that promote the development of milestones
and providing toys that are safe for the infant to explore with the mouth and manipulate with the hands such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Preschoolers demonstrate their ability to think more complexly by classifying objects according to size or color, making the
cards more appropriate for them. Neither group is ready for paperback books. The sock puppet with movable
eyes could create a choking hazard if one of the eyes comes off.
189
A mother expresses concern because her 5-year-old child frequently talks about friends who don’t exist.
What is the nurse’s best response to this mother’s concern?
a. “Have you considered a child psychological evaluation?”
b. “You should stop your child from playing electronic games.”
c. “Pretend play is a sign your child watches too much television.”
d. “It’s very normal for a child this age to have imaginary playmates.”
d. “It’s very normal for a child this age to have imaginary playmates.”
At age 5, some children have imaginary playmates. Imaginary playmates are a sign of health and allow the child
to distinguish between reality and fantasy. The child does not need a psychological evaluation because this is
normal behavior. Television, videos, electronic games, and computer programs help support development and
the learning of basic skills. However, these should be only one part of the child’s total play activities. Pretend
play is not a sign of watching too much television.
190
A school nurse is encouraging children to play a game of kickball. Which group of children is the nurse
most likely addressing?
a. Infant
b. Toddler
c. Preschool
d. School-aged
d. School-aged
A game of kickball would be best suited for school-aged children because in this age group, play involves peers
and the pursuit of group goals. Although solitary activities are not eliminated, group play overshadows them.
Younger children typically are not able to participate cooperatively in groups yet. Infants begin to play simple
social games such as patty-cake and peek-a-boo. Toddlers engage in solitary play but also begin to participate in parallel play. Preschoolers playing together engage in similar if not identical activities; however, no division
of labor or rigid organization or rules are observed. By the age of 5, the group has a temporary leader for each
activity.
191
Which assessment finding of a school-aged patient should alert the nurse to a possible developmental
delay?
a. Verbalization of “I have no friends”
b. Absence of secondary sex characteristics
c. Curiosity about sexuality
d. Lack of group identity
a. Verbalization of “I have no friends”
School-aged children should begin to develop friendships and to socialize with others. Interaction with peers
allows them to define their own accomplishments in relation to others as they work to develop a positive self image.
The absence of secondary sex characteristics is a major concern of adolescents, not school-aged children,
because physical evidence of maturity encourages the development of masculine and feminine behaviors
in the adolescent. Lack of group relationships is also a concern of adolescents, not of school-aged children, because adolescents seek a group identity to fulfill their esteem and acceptance needs. Today many researchers believe that school-aged children have a great deal of curiosity about their sexuality. Some experiment, but this
is usually transitory.
192
The nurse is teaching a parent about developmental needs of a 9-month-old infant. Which statement from
the parent indicates a correct understanding of the teaching?
a. “My child will begin to speak in sentences by 1 year of age.”
b. “My child will probably enjoy playing peek-a-boo.”
c. “My child will sleep about 7 to 8 hours a night.”
d. “My child will be ready to try low-fat milk.”
b. “My child will probably enjoy playing peek-a-boo.”
By 9 months, infants play simple social games such as patty-cake and peek-a-boo. By 1 year, infants not only
recognize their own names but are also able to say three to five words and understand almost 100 words; a 2
year old is generally able to speak in two-word sentences. The use of whole cow’s milk, 2% cow’s milk, or alternate
milk products before the age of 12 months is not recommended. By 6 months, most infants are nocturnal
and sleep between 9 and 11 hours at night. Total daily sleep averages 15 hours.
193
A nurse is teaching the parents of a school-aged child about accidents most common in this age group.
Which topic should the nurse address?
a. Falls
b. Fires
c. Drownings
d. Poisonings
b. Fires
Because accidents such as fires and car and bicycle crashes are the leading cause of death and injury in the
school-age period, safety is a priority health teaching consideration. Falls, drownings, and poisonings are priority
for toddlers.
194
Which information from the parent of an 8-month-old infant will cause the nurse to intervene?
a. My baby rides in the front-facing car seat when I go to the grocery store.
b. I made sure the slats on the crib were less than 2 inches apart.
c. I removed the mobile after my baby could reach it.
d. My baby cries every time he sees a new person.
a. My baby rides in the front-facing car seat when I go to the grocery store.
The nurse should intervene when parents let infants and toddlers ride in a front-facing car seat. All infants and
toddlers should ride in a rear-facing car safety seat until they are 2 years of age or until they reach the highest
weight or height allowed by the manufacturer or their car safety seat. Parents also need to inspect an older
crib to make sure the slats are no more than 6 cm (2.4 inches) apart. Instruct parents to remove mobiles as
soon as the infant is able to reach them. By 8 months, most infants are able to differentiate a stranger from a
familiar person and respond differently to the two; this is a normal finding.
195
The nurse is preparing to teach a group of parents with infants about growth and development. Which information
should the nurse include in the teaching session?
a. 3-month-old infants will be able to bang objects together.
b. 4-month-old infants will be able to sit alone with support.
c. 5-month-old infants will be able to creep on hands and knees.
d. 6-month-old infants will be able to turn from back to abdomen.
d. 6-month-old infants will be able to turn from back to abdomen.
6-month-old infants will be able to turn from back to abdomen. 6 to 8 month olds can sit alone without support
and bang objects together. 8 to 10 month olds can creep on hands and knees.
196
Which statement, if made by a parent, will require further instruction from the nurse?
a. “I should not be surprised that my teenage son has so many friends.”
b. “I get worried because my teenage son thinks he’s indestructible.”
c. “I should cover for my 10-year-old son when he makes mistakes until he learns the ropes.”
d. “I usually have nutritious snacks available because my 10-year-old son is always hungry right after school.”
c. “I should cover for my 10-year-old son when he makes mistakes until he learns the ropes.”
The nurse will need to teach the parent of a school-aged child covering for the child’s mistakes; this is a misconception
that needs to be corrected. Parents have to learn to allow their school-aged child (6 to 12 years old) to
make decisions, accept responsibility, and learn from life’s experiences. All the other statements are normal
and do not need further teaching. Teenagers typically are very social and have many friends. Adolescents seek a group identity because they need esteem and acceptance. Adolescents feel they are indestructible, which
leads to risk-taking behaviors. School-age children are developing eating patterns that are independent of
parental supervision. Having nutritious snacks available is a healthy option.
197
A nurse is teaching parents about appropriate activities for different age groups. Which toy, if selected by
the parent of a 12-month-old infant, will indicate a correct understanding of the teaching?
a. Busy box
b. Electronic games
c. Game requiring two to four people
d. Small, plastic alphabet letters and magnets
a. Busy box
Adults facilitate infant learning by planning activities that promote the development of milestones and by providing
toys that are safe for the infant to explore with the mouth and manipulate with the hands, such as rattles,
wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. For the toddler (not the infant), television, videos, electronic games, and computer programs help support development and learning of basic skills. Infants are not capable of participating in small group activities. By age 4, children play in groups of
two or three. Adults should provide toys that are safe for the infant to explore with the mouth. Small, plastic
letters and magnets could be choking hazards for an infant.
198
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A nurse is teaching a parenting class for families with adolescents. Which health concerns will the nurse include
in the teaching session? (Select all that apply.)
```
a. Suicide
b. Eating disorders
c. Violence/Homicide
d. Sexually transmitted infections
e. Gonadotropic hormone stimulation
a. Suicide
b. Eating disorders
c. Violence/Homicide
d. Sexually transmitted infections
Suicide is a major leading cause of death in adolescents 15 to 24 years of age. Adolescent overweight and obesity
are current concerns in the United States, and most teens try dieting at some time to control weight. Unfortunately
the number of eating disorders is on the rise in adolescent girls. Homicide is the second leading cause
of death in the 15- to 24-year-old age-group, and for African-American teenagers it is the most likely cause of
death. Sexually transmitted diseases annually affect three million sexually active adolescents. Gonadotropic
hormones stimulate ovarian cells to produce estrogen and testicular cells to produce testosterone. These hormones are normally occurring and contribute to the development of secondary sex characteristics, such as hair
growth and voice changes, and play an essential role in reproduction. It is not a health concern.
199
Matching:
A nurse is teaching parents about the fine motor skills of infants to help parents understand development growth and
needs. Match the information to the correct age that the nurse should include in the teaching session.
a. Can place objects into containers
b. Pulls a string to obtain an object
c. Can hold a baby bottle
d. Holds rattle for short periods
a. Can place objects into containers (10-12 months)
b. Pulls a string to obtain an object (6-8 months)
c. Can hold a baby bottle (4-6 months)
d. Holds rattle for short periods (2-4 months)
200
A nurse is caring for a young adult. Which goal is priority?
a. Maintain peer relationships.
b. Maintain family relationships.
c. Maintain parenteral relationships.
d. Maintain recreational relationships.
b. Maintain family relationships.
Family is important during young adulthood. Challenges may include the demands of working and raising families.
Peer is more important in the adolescent years. Young adults are much freer from parental control. While
recreation is important, the family and work are the priorities in young adults.
201
The nurse is caring for a hospitalized young-adult male who works as a dishwasher at a local restaurant. He
states that he would like to get a better job but has no education. How can the nurse best assist this patient
psychosocially?
a. By providing information and referrals
b. By focusing on the patient’s medical diagnoses
c. By telling the patient that he needs to go back to school
d. By expecting the patient to be flexible in decision making
a. By providing information and referrals
Support from the nurse, access to information, and appropriate referrals provide opportunities for achievement
of a patient’s potential. Health is not merely the absence of disease (focusing on medical diagnoses) but
involves wellness in all human dimensions. Telling a patient what to do (go back to school) is inappropriate.
Each person (not the nurse) needs to make these decisions based on individual factors. Insecure persons tend
to be more rigid in making decisions.
202
Which goal is priority when the nurse is caring for a middle-aged adult?
a. Maintain immediate family relationships.
b. Maintain future generation relationships.
c. Maintain personal career
relationships.
d. Maintain work relationships.
b. Maintain future generation relationships.
Many middle-aged adults find particular joy in helping their children and other young people become productive
and responsible adults. While immediate family is important, this goal is priority in young adults, not as important
in middle-aged adults. During this period, personal and career achievements have often already been
experienced; therefore, these goals are not priority.
203
A nurse is teaching young adults about health risks. Which statement from a young adult indicates a correct
understanding of the teaching?
a. “It’s probably safe for me to start smoking. At my age, there’s not enough time for cancer to develop.”
b. “My mother had appendicitis so this increases my chance for developing appendicitis.”
c. “Controlling the amount of stress in my life may decrease the risk of illness.”
d. “I don’t do drugs. I do drink coffee, but caffeine is not a drug.”
c. “Controlling the amount of stress in my life may decrease the risk of illness.”
Lifestyle habits that activate the stress response increase the risk of illness; so, controlling this will decrease
risk. Smoking is a well-documented risk factor for pulmonary, cardiac, and vascular disease as well as cancer in smokers and in individuals who receive secondhand smoke. The presence of certain chronic illnesses (not acute illnesses—appendicitis) in the family increases the family member’s risk of developing a disease. Caffeine
is a naturally occurring legal stimulant that is readily available. Caffeine stimulates catecholamine release,
which, in turn, stimulates the central nervous system; it also increases gastric acid secretion, heart rate, and
basal metabolic rate.
204
A nurse is choosing an appropriate topic for a young-adult health fair. Which topic should the nurse include?
a. Retirement
b. Menopause
c. Climacteric factors
d. Unplanned pregnancies
d. Unplanned pregnancies
Unplanned pregnancies are a continued source of stress that can result in adverse health outcomes for the
mother (young adult), infant, and family. Retirement is an issue for middle-aged, not young adults. The onset of
menopause and the climacteric affect the sexual health of the middle-aged adult, not the young adult.
205
A nurse is assessing the risk of intimate partner violence (IPV) for patients. Which population should the
nurse focus on most for IVP?
a. White males
b. Pregnant females
c. Middle-aged adults
d. Nonsubstance abusers
b. Pregnant females
The greatest risk of violence occurs during the reproductive years. A pregnant woman has a 35.6% greater risk
of being a victim of IPV than a nonpregnant woman. White males, middle-aged adults, and nonsubstance
abusers are not as high risk as pregnant women.
206
A patient states that she is pregnant and concerned because she does not know what to expect, and she
wants her husband to play an active part in the birthing process. Which information should the nurse share
with the patient?
a. Lamaze classes can prepare pregnant women and their partners for what is coming.
b. The frequency of sexual intercourse is key to helping the husband feel valued.
c. After the birth, the stress of pregnancy will disappear and will be replaced by relief.
d. After the baby is born, the wife should accept the extra responsibilities of motherhood.
a. Lamaze classes can prepare pregnant women and their partners for what is coming.
Childbirth education classes (like Lamaze) can prepare pregnant women, their partners, and other support persons
to participate in the birthing process. The psychodynamic aspect of sexual activity is as important as the
type or frequency of sexual intercourse to young adults; however, this does not relate to the issue the patient
reports (lack of knowledge and participation). The stress that many women experience after childbirth has a
significant impact on the health of postpartum women. Ideally partners should share all responsibilities; however,
this does not relate to the patient’s concerns.
207
Which information from the nurse indicates a correct understanding of emerging adulthood?
a. It is a type of young adulthood.
b. It is a type of extended adolescence.
c. It is a type of independent exploration.
d. It is a type of marriage and parenthood.
c. It is a type of independent exploration.
This newly identified stage of development from age 18 to 25 (emerging adulthood) has been described as neither an extended adolescence, as it is much freer from parental control and is much more a period of independent
exploration, nor young adulthood, as most young people in their twenties have not made the transitions
historically associated with adult status, especially marriage and parenthood.
208
A nurse is planning care for a 30 year old. Which goal is priority?
a. Refine self-perception.
b. Master career plans.
c. Examine life goals.
d. Achieve intimacy.
b. Master career plans.
From 29 to 34, the person directs enormous energy toward achievement and mastery of the surrounding
world. The years from 35 to 43 are a time of vigorous examination of life goals and relationships. Between the
ages of 23 and 28, the person refines self-perception and ability for intimacy.
209
A nurse is planning care for young-adult patients. Which information should the nurse consider when planning
care?
a. Fertility issues do not occur in young adulthood.
b. Young adults tend to suffer more from severe illness.
c. Substance abuse is easy to observe in young-adult patients.
d. Young adults are quite active but are at risk for illness in later years.
d. Young adults are quite active but are at risk for illness in later years.
Young adults are generally active and experience severe illnesses less frequently. However, their lifestyles may
put them at risk for illnesses or disabilities during their middle or older-adult years. An estimated 10% to 15%
of reproductive couples are infertile, and many are young adults. Substance abuse is not always diagnosable,
particularly in its early stages.
210
During a routine physical assessment, the nurse obtaining a health history notes that a 50-year-old female
patient reports pain and redness in the right breast. Which action is best for the nurse to take in response to
this finding?
a. Assess the patient as thoroughly as possible.
b. Explain to the patient that breast tenderness is normal at her age.
c. Tell the patient that redness is not a cause for concern and is quite common.
d. Inform her that redness is the precursor to normal unilateral breast enlargement.
a. Assess the patient as thoroughly as possible.
A comprehensive assessment offers direction for health promotion recommendations, as well as for planning
and implementing any acutely needed intervention. Redness or painful breasts are abnormal physical assessment
findings in the middle-aged adult. Increased size of one breast is an abnormal physical assessment finding
in the middle-aged adult.
211
A 55-year-old female presents to the outpatient clinic describing irregular menstrual periods and hot flashes.
Which information should the nurse share with the patient?
a. The patient’s assessment points toward normal menopause.
b. Those symptoms are normal when a woman undergoes the climacteric.
c. An assessment is not really needed because these problems are normal for older women.
d. The patient should stop regular exercise because that is probably causing these symptoms.
a. The patient’s assessment points toward normal menopause.
The most significant physiological changes during middle age are menopause in women and the climacteric in
men. Menopause typically occurs between 45 and 60 years of age. The nurse should continue with the examination
because a comprehensive assessment offers direction for health promotion recommendations, as well
as for planning and implementing any acutely needed interventions. Exercise should not be stopped, especially
in middle-aged adults.
212
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The nurse is teaching a class to pregnant women about common physiological changes during pregnancy.
Which information should the nurse include in the teaching session?
```
a. Pregnancy is not a time to be having sexual activity.
b. Urinary frequency will occur early in the pregnancy.
c. Breast tenderness should be reported as soon as possible.
d. Late in the pregnancy Braxton Hicks contraction may occur.
d. Late in the pregnancy Braxton Hicks contraction may occur.
During the third trimester (late pregnancy), increases in Braxton Hicks contractions (irregular, short contractions),
fatigue, and urinary frequency (not early) occur. Normally, women commonly have morning sickness,
breast enlargement and tenderness, and fatigue. Women need to be reassured that sexual activity will not
harm the fetus.
213
A nurse discusses the risks of repeated sun exposure with a young-adult patient. Which response will the
nurse most expect from this patient?
a. “I should consider participating in a health fair about safe sun practices.”
b. “I’ll make an appointment with my doctor right away for a full skin check.”
c. “I’ve had this mole my whole life. So what if it changed color? My skin is fine.”
d. “I have a mole that has been bothering me. I’ll call my family doctor for an appointment to get it checked.”
c. “I’ve had this mole my whole life. So what if it changed color? My skin is fine.”
Most typically young adults would say that their skin is fine. Young adults often ignore physical symptoms and often postpone seeking health care. Making an appointment right away with the doctor and participating in health fairs are not typical behaviors of young adults for the same reason.
214
Upon assessment of a middle-aged adult, the nurse observes uneven weight bearing and decreased range
of joint motion. Which area is priority?
a. Abuse potential
b. Fall precautions
c. Stroke prevention
d. Self-esteem issues
b. Fall precautions
With uneven weight bearing and decreased range of joint motion, falling is a priority. Abuse potential would indicate other findings such as bruising or unkept appearance. While stroke prevention is important in a middle-aged
adult, these are not the signs of stroke. While self-esteem issues may arise from physical changes, safety
is a priority over self-esteem issues.
215
A young-adult patient is brought to the hospital by police after crashing the car in a high-speed chase when
trying to avoid arrest for spousal abuse. Which action should the nurse take?
a. Question the patient about drug use.
b. Offer the patient a cup of coffee to calm nerves.
c. Discretely assess the patient for sexually transmitted infections.
d. Deal with the issue at hand, not asking about previous illnesses.
a. Question the patient about drug use.
Reports of arrests because of driving while intoxicated, wife or child abuse, or disorderly conduct are reasons
for the nurse to investigate the possibility of drug abuse more carefully. Caffeine is a naturally occurring legal
stimulant that stimulates the central nervous system and is not the choice for calming nerves. Although sexually
transmitted infections occur in the young adult, this is not an action a nurse should take in this situation. The
nurse may obtain important information by making specific inquiries about past medical problems, changes in
food intake or sleep patterns, and problems of emotional lability.
216
A nurse determines that a middle-aged patient is a typical example of the “sandwich generation.” What did
the nurse discover the patient is caught between?
a. Job responsibilities or family responsibilities
b. Stopping old habits and starting new ones
c. Caring for children and aging parents
d. Advancing in career or retiring
c. Caring for children and aging parents
Middle-aged adults also begin to help aging parents while being responsible for their own children, placing
them in the sandwich generation. It does not include job and family responsibilities; old habits and new ones;
or career and retiring.
217
A nurse is assessing a middle-aged patient’s barriers to change in eating habits. Which areas will the nurse
assess that are external barriers? (Select all that apply.)
a. Lack of facilities
b. Lack of materials
c. Lack of knowledge
d. Lack of social supports
e. Lack of short- and long-term goals
a. Lack of facilities
b. Lack of materials
d. Lack of social supports
External barriers to change include lack of facilities, materials, and social supports. Internal barriers are lack of knowledge, insufficient skills, and undefined short- and long-term goals.
218
A home health nurse is providing care to a middle-aged couple with children at home. The patient has a debilitating chronic illness. Which areas will the nurse need to assess? (Select all that apply.)
a. Adherence to treatment and rehabilitation regimens
b. Coping mechanisms of patient and family
c. Need for community services or referrals
d. Knowledge base of patient only
e. Use of a doula for care
a. Adherence to treatment and rehabilitation regimens
b. Coping mechanisms of patient and family
c. Need for community services or referrals
Along with the current health status of the chronically ill middle-aged adult, you need to assess the knowledge
base of both the patient and family. In addition, you must determine the coping mechanisms of the patient
and family; adherence to treatment and rehabilitation regimens; and the need for community and social services,
along with appropriate referrals. A doula is a support person to be present during labor to assist women
who have no other source of support.
219
A nurse is providing prenatal care to a first-time mother. Which information will the nurse share with the patient?
(Select all that apply.)
a. Regular trend for postpartum depression
b. Protection against urinary infection
c. Strategies for empty nest syndrome
d. Exercise patterns
e. Proper diet
b. Protection against urinary infection
d. Exercise patterns
e. Proper diet
Prenatal care includes a thorough physical assessment of the pregnant woman during regularly scheduled intervals.
Information regarding STIs and other vaginal infections and urinary infections that will adversely affect
the fetus and counseling about exercise patterns, diet, and child care are important for a pregnant woman.
Empty nest syndrome occurs as children leave the home. Postpartum depression is rare.
220
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Matching:
A nurse is assessing young and middle-aged adults for work-related conditions. Match the job to the work-related conditions that the nurse is assessing.
a. Liver disease
b. Carpal tunnel syndrome
c. Asbestosis
d. Farmer’s lung
e. Bladder cancer
```
a. Liver disease- Dry Cleaners
b. Carpal tunnel syndrome- Office Computer Workers
c. Asbestosis- Insulators
d. Farmer’s lung- Agricultural Workers
e. Bladder cancer- Dye Workers
221
A nurse is obtaining a history on an older adult. Which finding will the nurse most typically find?
a. Lives in a nursing home
b. Lives with a spouse
c. Lives divorced
d. Lives alone
b. Lives with a spouse
In 2012, 57% of older adults in non-institutional settings lived with a spouse (45% of older women, 71% of older
men); 28% lived alone (35% of older women, 19% of older men); and only 3.5% of all older adults resided in institutions
such as nursing homes or centers. Most older adults have lost a spouse due to death rather than
divorce.
222
A nurse is developing a plan of care for an older adult. Which information will the nurse consider?
a. Should be standardized because most geriatric patients have the same needs
b. Needs to be individualized to the patient’s unique needs
c. Focuses on the disabilities that all aging persons face
d. Must be based on chronological age alone
b. Needs to be individualized to the patient’s unique needs
Every older adult is unique, and the nurse needs to approach each one as a unique individual. The nursing care of older adults poses special challenges because of great variation in their physiological, cognitive, and psychosocial health. Aging does not automatically lead to disability and dependence. Chronological age often has
little relation to the reality of aging for an older adult.
223
Which information from a co-worker on a gerontological unit will cause the nurse to intervene?
a. Most older people have dependent functioning.
b. Most older people have strengths we should focus on.
c. Most older people should be involved in care decision.
d. Most older people should be encouraged to have independence.
a. Most older people have dependent functioning.
Most older people remain functionally independent despite the increasing prevalence of chronic disease; therefore, this misconception should be addressed. It is critical for you to respect older adults and actively involve them in care decisions and activities. You also need to identify an older adult’s strengths and abilities during the assessment and encourage independence as an integral part of your plan of care.
224
A nurse suspects an older-adult patient is experiencing caregiver neglect. Which assessment findings are
consistent with the nurse’s suspicions?
a. Flea bites and lice infestation
b. Left at a grocery store
c. Refuses to take a bath
d. Cuts and bruises
a. Flea bites and lice infestation
Caregiver neglect includes unsafe and unclean living conditions, soiled bedding, and animal or insect infestation.
Abandonment includes desertion at a hospital, nursing facility, or public location such as a shopping center.
Self-neglect includes refusal or failure to provide oneself with basic necessities such as food, water, clothing,
shelter, personal hygiene, medication, and safety. Physical abuse includes hitting, beating, pushing, slapping,
kicking, physical restraint, inappropriate use of drugs, fractures, lacerations, rope burns, and untreated
injuries.
225
A nurse is teaching a group of older-adult patients. Which teaching strategy is best for the nurse to use?
a. Provide several topics of discussion at once to promote independence and making choices.
b. Avoid uncomfortable silences after questions by helping patients complete their statements.
c. Ask patients to recall past experiences that correspond with their interests.
d. Speak in a high pitch to help patients hear better.
c. Ask patients to recall past experiences that correspond with their interests.
Teaching strategies include the use of past experiences to connect new learning with previous knowledge, focusing on a single topic to help the patient concentrate, giving the patient enough time in which to respond because older adults’ reaction times are longer than those of younger persons, and keeping the tone of voice low;
older adults are able to hear low sounds better than high-frequency sounds.
226
An older patient has fallen and suffered a hip fracture. As a consequence, the patient’s family is concerned
about the patient’s ability to care for self, especially during this convalescence. What should the nurse do?
a. Stress that older patients usually ask for help when needed.
b. Inform the family that placement in a nursing center is a permanent solution.
c. Tell the family to enroll the patient in a ceramics class to maintain quality of life.
d. Provide information and answer questions as family members make choices among care options.
d. Provide information and answer questions as family members make choices among care options.
Nurses help older adults and their families by providing information and answering questions as they make choices among care options. Some older adults deny functional declines and refuse to ask for assistance with tasks that place their safety at great risk. The decision to enter a nursing center is never final, and a nursing center resident sometimes is discharged to home or to another less-acute residence. What defines quality of
life varies and is unique for each person.
227
What is the best suggestion a nurse could make to a family requesting help in selecting a local nursing
center?
a. Have the family members evaluate nursing home staff according to their ability to get tasks done efficiently and
safely.
b. Make sure that nursing home staff members get patients out of bed and dressed according to staff’s preferences.
c. Explain that it is important for the family to visit the center and inspect it personally.
d. Suggest a nursing center that has standards as close to hospital standards as possible.
c. Explain that it is important for the family to visit the center and inspect it personally.
An important step in the process of selecting a nursing home is to visit the nursing home. The nursing home should not feel like a hospital. It is a home, a place where people live. Members of the nursing home staff
should focus on the person, not the task. Residents should be out of bed and dressed according to their preferences, not staff preferences.
228
A 70-year-old patient who suffers from worsening dementia is no longer able to live alone. The nurse is discussing health care services and possible long-term living arrangements with the patient’s only son. What will the nurse suggest?
a. An apartment setting with neighbors close by
b. Having the patient utilize weekly home health visits
c. A nursing center because home care is no longer safe
d. That placement is irrelevant because the patient is retreating to a place of inactivity
c. A nursing center because home care is no longer safe
Some family caregivers consider nursing center placement when in-home care becomes increasingly difficult or when convalescence from hospitalization requires more assistance than the family is able to provide. An apartment setting and the use of home health visits are not appropriate because living at home is unsafe. Dementia
is not a time of inactivity but an impairment of intellectual functioning.
229
A nurse is caring for an older adult. Which goal is priority?
a. Adjusting to career
b. Adjusting to divorce
c. Adjusting to retirement
d. Adjusting to grandchildren
c. Adjusting to retirement
Adjusting to retirement is one of the developmental tasks for an older person. A young or middle-aged adult
has to adjust to career and/or divorce. A middle-aged adult has to adjust to grandchildren.
230
A nurse is observing for the universal loss in an older-adult patient. What is the nurse assessing?
a. Loss of finances through changes in income
b. Loss of relationships through death
c. Loss of career through retirement
d. Loss of home through relocation
b. Loss of relationships through death
The universal loss for older adults usually revolves around the loss of relationships through death. Life transitions,
of which loss is a major component, include retirement and the associated financial changes, changes in
roles and relationships, alterations in health and functional ability, changes in one’s social network, and relocation.
However, these are not the universal loss.
231
A nurse is discussing sexuality with an older adult. Which action will the nurse take?
a. Ask closed-ended questions about specific symptoms the patient may experience.
b. Provide information about the prevention of sexually transmitted infections.
c. Discuss the issues of sexuality in a group in a private room.
d. Explain that sexuality is not necessary as one ages.
b. Provide information about the prevention of sexually transmitted infections.
Include information about the prevention of sexually transmitted infections when appropriate. Open-ended
questions inviting an older adult to explain sexual activities or concerns elicit more information than a list of
closed-ended questions about specific activities or symptoms. You need to provide privacy for any discussion
of sexuality and maintain a nonjudgmental attitude. Sexuality and the need to express sexual feelings remain
throughout the human life span.
232
```
A nurse is teaching a health promotion class for older adults. In which order will the nurse list the most
common to least common conditions that can lead to death in older adults?
```
1. Chronic obstructive lung disease
2. Cerebrovascular accidents
3. Heart disease
4. Cancer
a. 4, 1, 2, 3
b. 3, 4, 1, 2
c. 2, 3, 4, 1
d. 1, 2, 3, 4
b. 3, 4, 1, 2
Heart disease is the leading cause of death in older adults followed by cancer, chronic lung disease, and stroke
(cerebrovascular accidents).
233
A nurse is observing skin integrity of an older adult. Which finding will the nurse document as a normal
finding?
a. Oily skin
b. Faster nail growth
c. Decreased elasticity
d. Increased facial hair in men
c. Decreased elasticity
Loss of skin elasticity is a common finding in the older adult. Other common findings include pigmentation
changes, glandular atrophy (oil, moisture, and sweat glands), thinning hair (facial hair: decreased in men, increased
in women), slower nail growth, and atrophy of epidermal arterioles.
234
An older-adult patient in no acute distress reports being less able to taste and smell. What is the nurse’s
best response to this information?
a. Notify the health care provider immediately to rule out cranial nerve damage.
b. Schedule the patient for an appointment at a smell and taste disorders clinic.
c. Perform testing on the vestibulocochlear nerve and a hearing test.
d. Explain to the patient that diminished senses are normal findings.
d. Explain to the patient that diminished senses are normal findings.
Diminished taste and smell senses are common findings in older adults. Scheduling an appointment at a smell
and taste disorders clinic, testing the vestibulocochlear nerve, or an attempt to rule out cranial nerve damage
is unnecessary at this time as per the information provided.
235
A nurse is assessing an older adult for cognitive changes. Which symptom will the nurse report as normal?
a. Disorientation
b. Poor judgment
c. Slower reaction time
d. Loss of language skills
c. Slower reaction time
Slower reaction time is a common change in the older adult. Symptoms of cognitive impairment, such as disorientation,
loss of language skills, loss of the ability to calculate, and poor judgment are not normal aging
changes and require further investigation of underlying causes.
236
An older patient with dementia and confusion is admitted to the nursing unit after hip replacement
surgery. Which action will the nurse include in the plan of care?
a. Keep a routine.
b. Continue to reorient.
c. Allow several choices.
d. Socially isolate patient.
a. Keep a routine.
Patients with dementia need a routine. Continuing to reorient a patient with dementia is nonproductive and not advised. Patients with dementia need limited choices. Social interaction based on the patient’s abilities is to be promoted.
237
A nurse is helping an older-adult patient with instrumental activities of daily living. The nurse will be assisting
the patient with which activity?
a. Taking a bath
b. Getting dressed
c. Making a phone call
d. Going to the bathroom
c. Making a phone call
Instrumental activities of daily living or IADLs (such as the ability to write a check, shop, prepare meals, or make
phone calls) and activities of daily living or ADLs (such as bathing, dressing, and toileting) are essential to independent
living.
238
A male older-adult patient expresses concern and anxiety about decreased penile firmness during an erection.
What is the nurse’s best response?
a. Tell the patient that libido will always decrease, as well as the sexual desires.
b. Tell the patient that touching should be avoided unless intercourse is planned.
c. Tell the patient that heterosexuality will help maintain stronger libido.
d. Tell the patient that this change is expected in aging adults.
d. Tell the patient that this change is expected in aging adults.
Aging men typically experience an erection that is less firm and shorter acting and have a less forceful ejaculation.
Testosterone lessens with age and sometimes (not always) leads to a loss of libido. However, for both men
and women sexual desires, thoughts, and actions continue throughout all decades of life. Sexuality involves
love, warmth, sharing, and touching, not just the act of intercourse. Touch complements traditional sexual
methods or serves as an alternative sexual expression when physical intercourse is not desired or possible.
Clearly not all older adults are heterosexual, and there is emerging research on older adult, lesbian, gay, bisexual,
and transgender individuals and their health care needs.
239
A patient asks the nurse what the term polypharmacy means. Which information should the nurse share
with the patient?
a. This is multiple side effects experienced when taking medications.
b. This is many adverse drug effects reported to the pharmacy.
c. This is the multiple risks of medication effects due to aging.
d. This is concurrent use of many medications.
d. This is concurrent use of many medications.
Polypharmacy refers to the concurrent use of many medications. It does not have anything to do with side effects,
adverse drug effects, or risks of medication use due to aging.
240
An outcome for an older-adult patient living alone is to be free from falls. Which statement indicates the patient
correctly understands the teaching on safety concerns?
a. “I’ll take my time getting up from the bed or chair.”
b. “I should dim the lighting outside to decrease the glare in my eyes.”
c. “I’ll leave my throw rugs in place so that my feet won’t touch the cold tile.”
d. “I should wear my favorite smooth bottom socks to protect my feet when walking around.”
a. “I’ll take my time getting up from the bed or chair.”
Postural hypotension is an intrinsic factor that can cause falls. Changing positions slowly indicates a correct understanding
of this concept. Environmental hazards outside and within the home such as poor lighting, slippery
or wet flooring, and items on floor that are easy to trip over such as throw rugs are other factors that can lead to falls. Impaired vision and poor lighting are other risk factors for falls and should be avoided (dim lighting).
Inappropriate footwear such as smooth bottom socks also contributes to falls.
241
A nurse’s goal for an older adult is to reduce the risk of adverse medication effects. Which action will the
nurse take?
a. Review the patient’s list of medications at each visit.
b. Teach that polypharmacy is to be avoided at all cost.
c. Avoid information about adverse effects.
d. Focus only on prescribed medications.
a. Review the patient’s list of medications at each visit.
Strategies for reducing the risk for adverse medication effects include reviewing the medications with older
adults at each visit; examining for potential interactions with food or other medications; simplifying and individualizing
medication regimens; taking every opportunity to inform older adults and their families about all aspects
of medication use; and encouraging older adults to question their health care providers about all prescribed
and over-the-counter medications. Although polypharmacy often reflects inappropriate prescribing,
the concurrent use of multiple medications is often necessary when an older adult has multiple acute and
chronic conditions. Older adults are at risk for adverse drug effects because of age-related changes in the absorption,
distribution, metabolism, and excretion of drugs. Work collaboratively with the older adult to ensure
safe and appropriate use of all medications—both prescribed medications and over-the-counter medications
and herbal options.
242
An older-adult patient has developed acute confusion. The patient has been on tranquilizers for the past
week. The patient’s vital signs are normal. What should the nurse do?
a. Take into account age-related changes in body systems that affect pharmacokinetic activity.
b. Increase the dose of tranquilizer if the cause of the confusion is an infection.
c. Note when the confusion occurs and medicate before that time.
d. Restrict phone calls to prevent further confusion.
a. Take into account age-related changes in body systems that affect pharmacokinetic activity.
Some sedatives and tranquilizers prescribed for acutely confused older adults sometimes cause or exacerbate
confusion. Carefully administer drugs used to manage confused behaviors, taking into account age-related
changes in body systems that affect pharmacokinetic activity. When confusion has a physiological cause (such
as an infection), specifically treat that cause, rather than the confused behavior. When confusion varies by time
of day or is related to environmental factors, nonpharmacological measures such as making the environment
more meaningful, providing adequate light, etc., should be used. Making phone calls to friends or family members
allows older adults to hear reassuring voices, which may be beneficial.
243
Which assessment finding of an older adult, who has a urinary tract infection, requires an immediate nursing
intervention?
a. Confusion
b. Presbycusis
c. Temperature of 97.9° F
d. Death of a spouse 2 months ago
a. Confusion
Confusion is a common manifestation in older adults with urinary tract infection; however, the cause requires further assessment. There may be another reason for the confusion. Confusion is not a normal finding in the
older adult, even though it is commonly seen with concurrent infections. Difficulty hearing, presbycusis, is an
expected finding in an older adult. Older adults tend to have lower core temperatures. Coping with the death
of a spouse is a psychosocial concern to be addressed after the acute physiological concern in this case.
244
Which patient statement is the most reliable indicator that an older adult has the correct understanding of
health promotion activities?
a. “I need to increase my fat intake and limit protein.”
b. “I still keep my dentist appointments even though I have partials now.”
c. “I should discontinue my fitness club membership for safety reasons.”
d. “I’m up-to-date on my immunizations, but at my age, I don’t need the influenza vaccine.”
b. “I still keep my dentist appointments even though I have partials now.”
General preventive measures for the nurse to recommend to older adults include keeping regular dental appointments
to promote good oral hygiene, eating a low-fat, well-balanced diet, exercising regularly, and maintaining
immunizations for seasonal influenza, tetanus, diphtheria and pertussis, shingles, and pneumococcal
disease.
245
A 72-year-old woman was recently widowed. She worked as a teller at a bank for 40 years and has been retired for the past 5 years. She never learned how to drive. She lives in a rural area that does not have public
transportation. Which psychosocial change does the nurse focus on as a priority?
a. Sexuality
b. Retirement
c. Environment
d. Social isolation
d. Social isolation
The highest priority at this time is the potential for social isolation. This woman does not know how to drive
and lives in a rural community that does not have public transportation. All of these factors contribute to her
social isolation. Other possible changes she may be going through right now include sexuality related to her
advanced age and recent death of her spouse; however, this is not the priority at this time. She has been retired
for 5 years, so this is also not an immediate need. She may eventually experience needs related to environment,
but the data do not support this as an issue at this time.
246
A recently widowed older-adult patient is dehydrated and is admitted to the hospital for intravenous fluid replacement.
During the evening shift, the patient becomes acutely confused. Which possible reversible causes
will the nurse consider when assessing this patient? (Select all that apply.)
a. Electrolyte imbalance
b. Sensory deprivation
c. Hypoglycemia
d. Drug effects
e. Dementia
a. Electrolyte imbalance
b. Sensory deprivation
c. Hypoglycemia
d. Drug effects
Delirium, or acute confusional state, is a potentially reversible cognitive impairment that is often due to a physiological
event. Physiological causes include electrolyte imbalances, untreated pain, infection, cerebral anoxia,
hypoglycemia, medication effects, tumors, subdural hematomas, and cerebrovascular infarction or hemorrhage.
Sometimes it is also caused by environmental factors such as sensory deprivation or overstimulation,
unfamiliar surroundings, or sleep deprivation or psychosocial factors such as emotional distress. Dementia is a
gradual, progressive, and irreversible cerebral dysfunction.
247
Matching:
A nurse is using different strategies to meet older patients’ psychosocial needs. Match the strategy the nurse is using to its description.
a. Respecting the older adult’s uniqueness
b. Improving level of awareness
c. Listening to the patient’s past recollections
d. Accepting describing of patient’s perspective
e. Offering help with grooming and hygiene
a. Respecting the older adult’s uniqueness-
Therapeutic Communication
b. Improving level of awareness- Reality Orientation
c. Listening to the patient’s past recollections- Reminiscence
d. Accepting describing of patient’s perspective- Validation Therapy
e. Offering help with grooming and hygiene- Body Image Interventions
248
When caring for a middle-aged adult exhibiting maladaptive coping skills, the nurse is trying to determine
the cause of the patient’s behavior. Which information from a growth and development perspective should the
nurse consider when planning care?
a. Individuals have uniform patterns of growth and development.
b. Culture usually has no effect on predictable patterns of growth and development.
c. Health is promoted based on how many developmental failures a patient experiences.
d. When individuals experience repeated developmental failures, inadequacies sometimes result.
d. When individuals experience repeated developmental failures, inadequacies sometimes result.
If individuals have repeated development failures, inadequacies sometimes result should be considered. Developmental
failures could manifest with ineffective coping skills. However, when an individual experiences successes,
health is promoted. Patients have unique patterns of growth and development that are not uniform.
Nurses must consider the influence of culture and context on growth and development.
249
A nurse is measuring an infant’s head circumference and height. Which area is the nurse assessing?
a. Moral development
b. Cognitive development
c. Biophysical development
d. Psychosocial development
c. Biophysical development
Biophysical development is how our physical bodies grow and change. Moral development is the difference between
right and wrong. Cognitive development comprises changes in intelligence, use of language, and development
of thinking. Psychosocial development consists of variations in emotions and relationships with others.
250
Which question will be most appropriate for a nurse to ask when assessing an adult patient for growth and
developmental delays?
a. “How many times per week do you exercise?”
b. “Are you able to stand on one foot for 5 seconds?”
c. “Would you please describe your usual activities during the day?”
d. “How many hours a day do you spend watching television or sitting in front of a computer?”
c. “Would you please describe your usual activities during the day?”
Asking the patient to describe usual daily activities will provide the nurse with useful information about the patient’s current patterns. Understanding normal growth and development helps nurses predict, prevent, and detect
deviations from patients’ own expected patterns. How many hours are spent watching television or in front of a computer and how many times the patient exercises in a week would not provide the nurse with as much
information about the patient’s expected patterns when stated patterns are compared with expected patterns for the patient’s age group to detect delays. The question about standing on one foot is for a child, not an
adult.
251
A nurse is using the proximodistal pattern to assess an infant’s growth and development as normal. Which assessment finding will the nurse determine as normal?
a. Bangs objects before turns
b. Lifts head before grasps
c. Walks before crawls
d. Laughs before coos
b. Lifts head before grasps
Lifting the head before grasping is a normal finding according to proximodistal growth. The proximodistal
growth pattern starts at the center of the body and moves toward the extremities (e.g., organ systems in the
trunk of the body develop before arms and legs). The infant should turn before banging objects and crawl before walking according to the proximodistal pattern of growth. The infant should coo before laughing, but this
is not an example of proximodistal; this is an example of language development.
252
A nurse is assessing an 18-month-old toddler. The nurse distinguishes normal from abnormal findings by remembering
Gesell’s theory of development. Which information will the nurse consider?
a. Growth in humans is determined solely by heredity.
b. Environmental influence does not influence development.
c. The cephalocaudal pattern describes the sequence in which growth is fastest at the top.
d. Gene activity influences development but does not affect the sequence of development
c. The cephalocaudal pattern describes the sequence in which growth is fastest at the top.
Gesell’s theory of development states that the cephalocaudal pattern describes the sequence in which growth is fastest at the top (e.g., head/brain develop faster than arm and leg coordination). Growth in humans is determined
by heredity, genes, and environment. Environment does influence development. Gesell’s theory states
that genes direct the sequence of development, but environmental factors also influence development, resulting in developmental changes.
253
A nurse is working with a patient who wants needs to be met and is impatient and demanding when these
needs are not met immediately. How should the nurse interpret this finding according to Freud?
a. The id is functioning.
b. The ego is functioning.
c. The superego is functioning.
d. The Oedipus complex is functioning.
a. The id is functioning.
The id is functioning. The id (i.e., basic instinctual impulses driven to achieve pleasure) is the most primitive part of the personality and originates in the infant. The infant, in this case the patient, cannot tolerate delay and must have needs met immediately. The ego represents the reality component, mediating conflicts between the environment and the forces of the id. The ego helps people judge reality accurately, regulate impulses, and make good decisions. The third component, the superego, performs regulating, restraining, and prohibiting
actions. Often referred to as the conscience, the superego is influenced by the standards of outside social forces (e.g., parent or teacher). The child fantasizes about the parent of the opposite sex as his or her first love interest, known as the Oedipus or Electra complex. By the end of this stage, the child attempts to reduce this conflict by identifying with the parent of the same sex as a way to win recognition and acceptance.
254
The nurse is teaching a young-adult couple about promoting the health and psychosocial development of
their 8-year-old child. Which information from the parent indicates a correct understanding of the teaching?
a. “We will provide consistent, devoted relationships to meet needs.”
b. “We will limit choices and provide punishment for mistakes.”
c. “We will provide proper support for learning new skills.”
d. “We will instill a strong identity of who our child is.”
c. “We will provide proper support for learning new skills.”
An 8-year-child would be in the industry versus inferiority stage of development. During this stage, the child
needs to be praised (proper support) for accomplishments such as learning new skills. Developing a strong
identity is part of the identity versus role confusion stage, usually occurring during puberty. During the autonomy
versus shame and doubt stage, limiting choices and harsh punishment lead to feelings of shame and
doubt. Providing consistent, devoted relationship to meet needs is usually a part of the trust versus mistrust
stage.
255
A nurse is using Jean Piaget’s developmental theory to focus on cognitive development. Which area will the
nurse assess in this patient?
a. Latency
b. Formal operations
c. Intimacy versus isolation
d. The postconventional level
b. Formal operations
Jean Piaget’s theory includes four stages in sequential order: sensorimotor, preoperational, concrete operations,
and formal operations. Intimacy versus isolation is part of Erik Erikson’s psychosocial theory of development.
Latency is stage 4 of Freud’s five-stage psychosexual theory of development. The postconventional level
of reasoning is part of Kohlberg’s theory of moral development.
256
A nurse is assessing a 17-year-old adolescent’s cognitive development. Which behavior indicates the adolescent
has reached formal operations?
a. Uses play to understand surroundings
b. Discusses the topic of justice in society
c. Hits other students to deal with environmental change
d. Questions where the ice is hiding when ice has melted in a drink
b. Discusses the topic of justice in society
Discussing the topic of justice demonstrates that the adolescent is concerned about issues that affect others besides self. In the formal operations period, as adolescents mature, their thinking moves to abstract and theoretical subjects. They have the capacity to reason with respect to possibilities. Hitting would be a common schema during the sensorimotor stage of development. Using play to learn about the environment is indicative of the preoperational stage. During the concrete operations stage (ages 6 to 12 years), children are able to coordinate two concrete perspectives in social and scientific thinking, such as understanding the difference between “hiding” and “melting.”
257
A nurse is caring for a 4-year-old patient. Which object will the nurse allow the child to play with safely to foster cognitive development?
a. The pump administering intravenous fluids
b. A book to read alone in a quiet place
c. The blood pressure cuff
d. A baseball bat
c. The blood pressure cuff
Children should be allowed to play with any equipment that is safe, like a blood pressure cuff. A 4-year-old
child would be in the preoperational period of cognitive development. Children at this stage are still egocentric.
Play is very important to foster cognitive development. The IV pump and bat are not safe pieces of equipment for a 4-year-old child to play with. A 4-year-old child is of preschool age and more than likely is not able to read yet. Also, the book does not allow for any human interaction and communication if he or she reads alone.
258
A patient follows all the instructions a nurse provides because the patient wants to be perceived as a “good”
patient. How should the nurse interpret this information according to moral development?
a. The patient is in postformal thought reasoning.
b. The patient is in postconventional reasoning.
c. The patient is in preconventional reasoning.
d. The patient is in conventional reasoning.
d. The patient is in conventional reasoning.
The patient is in conventional reasoning, specifically stage 3: Good Boy-Nice Girl Orientation. The patient wants to win approval from the nurse by “being good.” Developmentalists proposed a fifth stage of cognitive (not
moral) development termed postformal thought. Within this stage, adults demonstrate the ability to recognize that answers vary from situation to situation and that solutions need to be sensible. The person finds a balance between basic human rights and obligations and societal rules and regulations in the level of postconventional
reasoning. Individuals move away from moral decisions based on authority or conformity to groups to
define their own moral values and principles. Preconventional reasoning is the premoral level, in which there is limited cognitive thinking and the individual’s thinking is primarily egocentric. At this stage, thinking is mostly
based on likes and pleasures.
259
An 18-month-old patient is brought into the clinic for evaluation because the parent is concerned. The 18-
month-old child hits siblings and says only “No” when communicating verbally. Which recommendation by the
nurse will be best for this situation?
a. Assure the mother that the child is developmentally within specified norms.
b. Encourage the mother to seek psychological counseling for the child.
c. Consult the social worker because the child is hitting other children.
d. Remove all toys from the child’s room until this behavior ceases.
a. Assure the mother that the child is developmentally within specified norms.
Assure the mother that the child is displaying normal behavior. At 18 months, the child is in the sensorimotor
period of development. Piaget describes hitting, looking, grasping, and kicking as normal schemas to deal with the environment. The social worker does not need to be consulted in this case nor is psychological counseling warranted, because the child is exhibiting normal behaviors. Play is an important part of all children’s development.
Removing toys and the opportunity to play with them may actually hinder the child’s development.
260
A formerly independent older adult becomes severely withdrawn upon admission to
a nursing home.
Which action should the nurse take first?
a. Offer a reward to the patient for participation in all events.
b. Encourage the patient to eat meals in the dining room with others.
c. Allow the patient to incorporate personal belongings into the room.
d. Advise the patient of the importance of attending mandatory activities.
c. Allow the patient to incorporate personal belongings into the room.
The nurse should first allow the patient to actively participate in an independent activity (the patient was formerly independent), such as preparing the room with personal belongings. Erikson’s theory proposes that the older adult faces integrity versus despair. Offering a reward does not address the need for continued independence.
Encouraging eating in the dining room would be a step after fixing the room since it does not address
independence, and the question is asking for the first action. Advising the patient to attend all mandatory activities
as the first intervention does not allow for the patient’s independence. Some activities may be mandatory,
but by first allowing the patient to decorate room, the nurse is fostering independence and is helping the patient feel welcome and more at home, fostering integrity.
261
The nurse is caring for a 14-year-old patient in the hospital. Which goal will be priority?
a. Maintain industry
b. Maintain identity
c. Maintain intimacy
d. Maintain initiative
b. Maintain identity
According to Erikson, a 14-year-old adolescent is developing an identity versus role confusion. Maintaining initiative is for 3 to 6 year olds. Maintaining industry is for 6 to 11 year olds. Maintaining intimacy is for young
adults.
262
The nurse is teaching the parents of a 3-year-old child who is at risk for developmental delays. Which instruction
will the nurse include in the teaching plan?
a. Insist that your child discuss various points of view.
b. Encourage play as your child is exploring the surroundings.
c. Discuss world events with your child to foster language development.
d. Actively encourage your child to read lengthy books to foster reading abilities.
b. Encourage play as your child is exploring the surroundings.
A 3-year-old child is going to use play to learn and discover the surrounding environment. Children at this age are egocentric and often are unable to see the world from any perspective other than their own. Very young
children are not able to understand and comment on world events because their thinking has not advanced to
abstract reasoning yet. A 3-year-old child is likely unable to read; lengthy is not appropriate.
263
A nurse is caring for a young adult after surgery. Which action by the nurse will be priority?
a. Allow involvement of peers
b. Allow involvement of partner
c. Allow involvement of volunteer activities
d. Allow involvement of consistent schedule
b. Allow involvement of partner
Nurses must understand that during hospitalization, a young adult’s need for intimacy remains present; thus young adults benefit from the support of their partner or significant other during this time. Involvement of peers is priority for adolescents. Volunteer activities are priority for middle-aged adults. Consistent schedule is
priority for infants and toddlers.
264
A nurse takes the history of a middle-aged patient in a health clinic. Which information indicates the patient has achieved generativity?
a. Married for 30 years
b. Teaches preschoolers
c. Has no regrets with life choices
d. Cares for aging parents after work
b. Teaches preschoolers
Teaching preschoolers indicates generativity. Middle-aged adults achieve success (generativity) in this stage by contributing to future generations through parenthood, teaching, mentoring, and community involvement.
Married for 30 years indicates achievement of intimacy. Has no regrets is ego integrity. Caring for aging parents
is admirable but it does not indicate development of the next generation (generativity).
265
Which action should the nurse take when teaching a 5-year-old patient about a scheduled surgery?
a. Do not discuss the procedure with the child to decrease anxiety.
b. Let the child know the surgery will be at 9:00 AM in the morning.
c. Insist that the parents wait outside the room to ensure privacy of the child.
d. Allow the child to touch and hold medical equipment such as thermometers.
d. Allow the child to touch and hold medical equipment such as thermometers.
Nursing interventions during the preoperational period (ages 2 to 7 years) should recognize the use of play
(such as handling equipment) to help the child understand the events taking place. The nurse should talk to
the child about the procedure in terms the child can understand. Children at this stage have difficulty conceptualizing
time; telling the child surgery is at 9:00 AM in the morning is inappropriate. Parents should be allowed
in the room.
266
A nurse works on a pediatric unit and is using a psychosocial developmental approach to child care. In
which order from the first to the last will the nurse place the developmental stages?
1. Initiative versus guilt
2. Trust versus mistrust
3. Industry versus inferiority
4. Identity versus role confusion
5. Autonomy versus shame and doubt
a. 2, 5, 3, 1, 4
b. 2, 1, 3, 5, 4
c. 2, 3, 1, 5, 4
d. 2, 5, 1, 3, 4
d. 2, 5, 1, 3, 4
Erikson uses a psychosocial approach to development. The stages are as follows: trust versus mistrust; autonomy versus shame and doubt; initiative versus guilt; industry versus inferiority; and identity versus role
confusion.
267
A nurse is developing a plan of care concerning growth and development for a hospitalized adolescent. What should the nurse do? (Select all that apply.)
a. Apply developmental theories when making observations of the adolescent’s patterns of growth and development.
b. Compare the adolescent’s assessment findings versus normal findings.
c. Recognize her own (the nurse’s) moral developmental level.
d. Stick with one developmental theory for consistency.
e. Apply a unidimensional life span perspective.
a. Apply developmental theories when making observations of the adolescent’s patterns of growth and development.
b. Compare the adolescent’s assessment findings versus normal findings.
c. Recognize her own (the nurse’s) moral developmental level.
Today’s nurses need to be knowledgeable about several theoretical perspectives when working with patients.
These theories form the basis for meaningful observation of an individual’s pattern of growth and development.
They provide important guidelines for nurses to recognize deviations from the norm. Recognizing your
own moral developmental level is essential in separating your own beliefs from those of others when helping
patients with their moral decision-making process. No one theory successfully describes all the intricacies of
human growth and development. Growth and development, as supported by a life span perspective, is multidimensional,
not unidimensional.
268
A nurse is assessing temperaments of children. Which terms should the nurse use to describe findings? (Select
all that apply.)
a. The easy child
b. The defiant child
c. The difficult child
d. The slow-to-warm up child
e. The momma’s boy or daddy’s girl
a. The easy child
c. The difficult child
d. The slow-to-warm up child
Psychiatrists identified three basic classes of temperament: the easy child; the difficult child; and the slow-to-warm up child. There is no momma’s boy or daddy’s girl or defiant child.
