NR222 Final example questions

19. 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.

13. 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. Nonexploratory 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.

6. When utilizing Freuds 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 Eriksons theory differed from Freuds in that it focused on psychosocial stages rather than psychosexual stages. Freuds 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.

7. Fats are composed of triglycerides and fatty acids. Triglycerides a. Are made up of three fatty acids. b. Can be saturated. c. Can be monounsaturated. d. Can be polyunsaturated.

a. Are made up of three fatty acids.

1. The energy needed to maintain life-sustaining activities for a specific period of time at rest is known as a. BMR. b. REE. c. Nutrients. d. Nutrient density.

a. BMR.

8. 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.

2. 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 patients 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 patients 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.

2. 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. Childrens books c. 500-piece puzzle d. Building blocks e. Magazines and newspapers

a. Crayons and paper b. Childrens books d. Building blocks A school-aged child thrives on feelings of accomplishment. Drawing pictures, looking at childrens 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.

13. During assessment of an older adults 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

10. 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.

1. 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 nurses 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

1. 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 newborns 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 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.

15. 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.

8. Jean Piagets 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 Piagets theory includes four stages in sequential order: sensorimotor, preoperational, concrete operations, and formal operations. Intimacy versus isolation is part of Erik Eriksons psychosocial theory of development. Latency is stage 4 of Freuds five-stage psychosexual theory of development. The postconventional level of reasoning is part of Kohlbergs theory of moral development.

9. 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.

7. 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.

16. 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 patients manifestations of standard symptoms. c. Assist patient with all ADLs. d. Isolate patients to protect others.

a. Maintain physical health.

4. 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. Thats 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. Thats why we care for so many of them in the hospital.

21. 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 patients 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 patients list of medications.

3. 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

20. 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.

16. 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.

1. 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 patients 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.

21. 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 childrens 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.

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.

5. 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).

22. An older adult patient has developed acute confusion. The patient has been on tranquilizers for the past week. The patients 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.

3. 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.

2. 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.

18. 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.

7. 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.

4. 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.

6. 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.

1. 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 individuals patterns of growth and development. c. Compare the individuals 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 individuals patterns of growth and development. c. Compare the individuals 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. Todays nurses need to be knowledgeable about several theoretical perspectives when working with patients. These theories form the basis for meaningful observation of an individuals 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.

14. The parents of a 14-year-old boy express concern over their childs 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. Childs behavior is normal because the adolescent is trying to adjust to his emerging identity. c. Childs behavior is a matter of concern because he is likely conflicted about establishing companionship with a partner. d. Childs behavior is expected because he is expressing his need to support future generations.

b. Childs 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.

23. 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

1. 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.

2. 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 mothers 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.

20. 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. Ill leave my throw rugs in place so that my feet wont touch the cold tile. b. Ill 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 eye

b. Ill take my time getting up from the bed or chair.

5. 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.

2. 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 patients 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 patients 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.

17. 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 nurses 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 providers 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 patients 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.

12. 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 cant be COPD. He argues, Its just these colds Ive been getting. Theyre 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 patients 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.

5. Knowing that protein is required for tissue growth, maintenance, and repair, the nurse must understand that for optimal tissue healing to occur, the patient must be in a. Negative nitrogen balance. b. Positive nitrogen balance. c. Total dependence on protein for kcal production. d. Neutral nitrogen balance.

b. Positive nitrogen balance.

6. In providing diet education for a patient on a low-fat diet, it is important for the nurse to understand that with few exceptions a. Saturated fats are found mostly in vegetable sources. b. Saturated fats are found mostly in animal sources. c. Unsaturated fats are found mostly in animal sources. d. Linoleic acid is a saturated fatty acid.

b. Saturated fats are found mostly in animal sources.

15. 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.

11. 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.

15. 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

17. The parents of a 15-month-old child express concern to the nurse about their childs thumb-sucking habit. Which of these explanations related to the childs 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 preoperational period. Thumb sucking does not indicate transition away from egocentric thinking. No statements have supported thumb sucking as enhancing language development.

10. According to Piagets 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.

8. 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.

10. 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.

16. A mother expresses concern because her 5-year-old child frequently talks about friends who dont exist. What is the nurses best response to this mothers concern? a.Have you considered a child psychological evaluation? b.Its 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.Its 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 childs total play activities.

8. 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 patients 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

11. 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.

13. 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. Eriksons 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 patients 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.

5. 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.

11. 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 nurses 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.

16. 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 individuals 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.

4. The nurse knows that the young adult patient understands the health risks that affect his/her age group when the patient states a. Its probably safe for me to start smoking. At my age, theres 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. Its genetic. c. Controlling the amount of stress in my life may decrease the risk of illness. d. I dont 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 members 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.

8. The patient has been diagnosed with cardiovascular disease and placed on a low-fat diet. The patient asks the nurse, How much fat should I have? I guess the less fat, the better. The nurse needs to explain that a. Fats have no significance in health and the incidence of disease. b. All fats come from external sources so can be easily controlled. c. Deficiencies occur when fat intake falls below 10% of daily nutrition. d. Vegetable fats are the major source of saturated fats and should be avoided.

c. Deficiencies occur when fat intake falls below 10% of daily nutrition.

9. 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.

23. 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 hes 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 lifes 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.

4. 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.

19. The nurse who is teaching a parent about developmental needs of the infant knows that the parent has verbalized understanding of a infants 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.

3. 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 newborns need for close physical contact. Following a comprehensive physical assessment, the nurse assesses gestational age and interactions between infant and parents.

14. Which statement by the nurse best explains the importance of play during the toddler stage of development? a. Exploration can suppress the toddlers 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 toddlers ability to explore the environment safely without supervision.

c. Play can enhance cognitive and psychosocial development. Play can enhance cognitive and psychosocial development. The toddlers 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.

9. According to Piagets 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.

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 years. As height and weight increase during adolescence, the distribution of muscle and fat changes.

18. A male older adult patient expresses his concern and anxiety about decreased penile firmness during erection. What is the nurses 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.

11. Which of these manifestations, if identified in a 6-year-old patient, should the nurse associate with a possible developmental delay based on Piagets 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 viewtheir ownat this stage.

12. 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 patients age and symptoms point toward normal menopause. d. The patient should stop regular exercise because that is probably causing her symptoms.

c. The patients 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.

10. 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 toddlers strong will is frequently exhibited in negative behavior when caregivers attempt to direct his actions. Temper tantrums result when parental restrictions frustrate toddlers.

2. In general, when energy requirements are completely met by kilocalorie (kcal) intake in food a. Weight increases. b. Weight decreases. c. Weight does not change. d. Kilocalories are not a factor.

c. Weight does not change.

13. 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.

12. 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 Piagets 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 childs 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 childrens 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 childs development.

3. 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 patients stated activity patterns to determine deviations from the patients own expected patterns. Asking the patient to describe his/her usual daily activities will provide the nurse with useful information about the 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 are closed-ended questions. These questions would not provide the nurse with as much information about the patients expected patterns when his/her stated patterns are compared with expected patterns for the patients age group to detect delays.

3. In determining kcal expenditure, the nurse knows that carbohydrates and proteins provide 4 kcal of energy per gram ingested. The nurse also knows that fats provide _____ kcal per gram. a. 3 b. 4 c. 6 d. 9

d. 9

18. 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 preoperational 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.

2. 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 individuals growth and development. c. Breast development is an example of a change resulting from biological processes. d. An individuals biological processes determine physical characteristics and do not affect growth and development.

d. An individuals 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.

6. 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.

5. While assessing an 18-month-old toddler, the nurse distinguishes normal from abnormal findings by remembering that Gesells 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. Gesells 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 childs 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.

7. 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.

14. An older adult patient in no acute distress reports being less able to taste and smell. What is the nurses 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.

24. 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. Im up to date on my immunizations, but at my age, I dont 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.

4. Some proteins are manufactured in the body, but others are not. Those that must be obtained through diet are known as a. Amino acids. b. Dispensable amino acids. c. Triglycerides. d. Indispensable amino acids.

d. Indispensable amino acids.

14. 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. Ill 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. Ill call my family doctor for an appointment to get it checked. d. Ive had this mole my whole life. So what if it changed color? My skin is fine.

d. Ive 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.

12. 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 patients withdrawn behavior. d. Observe for congruency between the patients facial expressions and verbal responses.

d. Observe for congruency between the patients 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 patients withdrawn behavior to seek out the meaning of such behaviors. Be alert to clues to their emotional state. The nurse should observe that the patients statements are congruent with his/her facial expressions of emotion.

17. 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.

24. 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.

22. 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.

6. An older patient has fallen and broken his hip. As a consequence, the patients 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.

15. 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.

17. 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.

25. 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

9. 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.

9. The ChooseMyPlate program was developed to replace MyFoodPyramid as a basic guide for buying food and meal preparations. This system was developed by the a. Food and Drug Administration. b. 1990 Nutrition Labeling and Education Act. c. Referenced daily intakes (RDIs). d. U.S. Department of Agriculture.

d. U.S. Department of Agriculture.

When caring for a middle-aged adult exhibiting maladaptive coping skills, the nurse is trying to determine the cause of the patients 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.

3. 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.

1. 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 todays 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 todays society. Today, many women pursue careers and contribute significantly to their familys inc