NRSG 1520 Exam 2

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 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).

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

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

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 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.

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. anti ipatory guidance. b. low-risk adolescents. c. physical development. d. sexual development.

A 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.

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 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.

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 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.

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.

c 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.

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 n 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 "meltin

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 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.

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

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 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 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.

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 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 noninstitutionalized 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 noninstitutional settings with family members or alone.

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 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.

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 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

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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

ABCD

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

ABD

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.

ACD

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

ANS: A 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.

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.

ANS: A 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.

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

ANS: A 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.

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.

ANS: A 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.

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.

ANS: A 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.

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.

ANS: A 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.

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.

ANS: A 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.

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.

ANS: A 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.

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

ANS: A, B, C, E 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.

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

ANS: B 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.

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.

ANS: B 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.

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."

ANS: B 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.

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.

ANS: B 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

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.

ANS: B 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.

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

ANS: B 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.

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

ANS: C 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.

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.

ANS: C 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.

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.

ANS: C 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.

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.

ANS: D 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.

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.

ANS: D 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.

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."

ANS: D 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.

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.

ANS: D 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.

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

ANS: D 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.

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

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 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.

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 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.

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 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.

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 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.

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 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.

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.

B 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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.

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.

BCD

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

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 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.

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 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.

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 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.

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 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

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 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.

BA 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

C 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.

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 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.

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 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.

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 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.

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. 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.

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. ave separation anxiety. b. rebel against rules. c. regress because of stress. d. want to know everything.

C 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.

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 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.

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 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.

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 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.

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.

C 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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.

D 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 asdifferentiation. Psychosocial and cognitive changes are referred to as development. Qualitative changes associated with aging are referred to as maturation.

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 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.

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. etal alcohol syndrome. d. hydrocephaly.

D 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.

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 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.