NURSING CARE ACROSS THE LIFE SPAN: QUESTIONS Fundamentals of success questions

A nurse is facilitating a mothers' class, and the women begin discussing experiences that reflect the intellectual development of their children. Each woman describes a situation that reflects one of the stages of Jean Piaget's theory about logical thinking. Place the situations described in order beginning with the sensorimotor stage and ending with formal operations. 1. "My son touched the radiator and got burned. He'll never do that again." 2. "My son is learning math and is getting 100s on his tests. He is so smart." 3. "My daughter is on the debating team in school. We go to interschool meets." 4. "My daughter asked an obese lady if she had a baby in her stomach. I was so embarrassed."

1. "My son touched the radiator and got burned. He'll never do that again." 4. "My daughter asked an obese lady if she had a baby in her stomach. I was so embarrassed." 2. "My son is learning math and is getting 100s on his tests. He is so smart." 3. "My daughter is on the debating team in school. We go to interschool meets."

A school nurse is assessing several school-aged children between the ages of 6 and 12 years. Which assessment of a child requires a further assessment? 1. 7-year-old boy 2. 9-year-old girl 3. 11-year-old boy 4. 12-year-old girl

1. 7-year-old boy 1. During the school-aged years, children usually grow approximately 2 inches a year and gain 4.5 to 6 lb a year. This child should be assessed further because of the potential for obesity. Obesity in children is increasing in the United States.

A hospice nurse is providing emotional support for eight young children of a dying mother. At which age do children first recognize that death is irreversible, universal, and natural? 1. 9 years of age 2. 6 years of age 3. 15 years of age 4. 12 years of age

1. 9 years of age 1. A 9-year-old child has a more realistic understanding of death than a younger child and recognizes that death is universal, irreversible, and natural. A 9-year-old child has a beginning knowledge of his or her own mortality and may fear death.

When the nurse assesses an adult patient, which patient behavior may indicate an unresolved developmental task of infancy? 1. Avoiding assistance from others 2. Rationalizing unacceptable behaviors 3. Being overly concerned about cleanliness 4. Apologizing constantly for small mistakes

1. Avoiding assistance from others 1. People who avoid help from others and who would rather do things themselves generally have not completely resolved the developmental task of Trust versus Mistrust during infancy.

Which is a person referring to when during an interview the person says, "I am a member of the sandwich generation"? 1. Cares for children and aging parents at the same time 2. Has reversed roles between parents and self 3. Assists own parents and spouse's parents 4. Has both older and younger siblings

1. Cares for children and aging parents at the same time 1. When middle-aged adults are caring for their children and their aging, dependent parents at the same time, they are referred to as the sandwich generation. Their parents and children represent the bread, and they are the meat in between.

A parent tells the nurse in the well-child clinic that the 2-year-old is trying to eat with a spoon and is making a mess. Which should the nurse encourage the parent to do? 1. Praise and encourage the child while eating. 2. Provide finger foods until the child is older. 3. Feed the child along with the child's attempts at eating. 4. Take the spoon and feed the child until the child is more capable.

1. Praise and encourage the child while eating. 1. From 18 months to 3 years of age (Autonomy versus Shame and Doubt), the child strives for independence. Attempts to self-feed should be encouraged and enthusiastically praised even though the child may make a mess. They allow the child to practice and perfect new skills, help to develop fine motor skills, and support control of the self and the environment.

A 70-year-old patient tells the nurse about experiencing problems with sleep and requests sleeping medication. Which concept associated with drug therapy and quality of sleep is important for the nurse to explain when providing nursing care for this patient? 1. Sedatives are not well tolerated by older adults. 2. Antianxiety drugs are the least helpful to support sleep. 3. Effectiveness of hypnotics increases with prolonged use. 4. Melatonin is the drug of choice for long-term use in sleep disorders.

1. Sedatives are not well tolerated by older adults. 1. Sedatives are not well tolerated by older adults because a decrease in the metabolism and excretion of the drug can result in toxicity. In addition, older adults may experience idiosyncratic (e.g., unexpected or opposite) effects.

A nurse is administering medication to an older adult. For which response to medication that occurs most frequently in older adults should the nurse assess the patient? 1. Toxicity 2. Side effects 3. Hypersensitivity 4. Idiosyncratic effects

1. Toxicity 1. This is a serious concern because of a decrease in efficiency of hepatic metabolism and renal excretion of drugs in older adults; as a result, accumulation of the drug occurs, resulting in toxicity.

Which family members comments about an older adult member of the family demonstrates agism? Select all that apply. 1. _____"She has outlived her usefulness." 2. _____"She is elderly but she is so cute." 3. _____"She reads the newspaper with difficulty." 4. _____"He reminisces about his past work experience." 5. _____"He is most happy when working in his home workshop."

1. _____"She has outlived her usefulness." 2. _____"She is elderly but she is so cute." 1. This statement is a clear example of agism whereby older adults are systematically stereotyped and discriminated against because they are old. This is a form of prejudice, an unfavorable opinion without concrete information about the individual. Agism is based on the misconceptions that older adults are no longer productive, are narrow minded, are unable to learn, are dependent, experience memory loss, live in a nursing home, are ill, are boring, and so on. 2. The word elderly has a negative connotation. It implies that the person is different from other human beings and is frail, weak, or disabled. To call an adult cute is demeaning because it may imply that the person is childlike.

A nurse is assessing a 4-year-old child's growth and development. Which activities should the nurse expect the child to be capable of performing? Select all that apply. 1. _____Dresses self 2. _____Uses toy tools 3. _____Hops on one foot 4. _____Rides a two-wheel bicycle 5. _____Swims using the freestyle stroke

1. _____Dresses self 2. _____Uses toy tools 3. _____Hops on one foot 1. Preschool-aged children have the fine motor skills to open and close zippers and buttons. 2. Preschool-aged children have the motor skills necessary to manipulate a toy tool such as a hammer. 3. Preschool-aged children have the gross motor skills and balance to be able to hop and skip on one foot, balance on one foot, and perform a broad jump.

A nurse is caring for a variety of individuals across the life span. Which age groups generally demonstrate an inefficiency of adaptation? Select all that apply. 1. _____More than 60 years 2. _____40 to 60 years 3. _____12 to 19 years 4. _____3 to 11 years 5. _____0 to 1 year

1. _____More than 60 years 5. _____0 to 1 year 1. When a person reaches 60 years of age and older, all physiological systems are less efficient, which reduces compensatory reserve. 5. Infants have immature immune systems and body systems that are still developing. Also, their body's physiological processes have a limited experiential background on which to draw responses to new stressors. These issues result in an inefficiency of adaptation.

An older adult is admitted to the intensive care unit. For which common adaptations to sensory overload should the nurse monitor the patient? Select all that apply. 1. _____Tachycardia 2. _____Drowsiness 3. _____Confusion 4. _____Irritability 5. _____Dementia

1. _____Tachycardia 3. _____Confusion 4. _____Irritability 1. If sensory overload precipitates anxiety and the autonomic nervous system is stimulated by the fight or flight mechanism, tachycardia will occur. 3. Confusion is a common response to sensory overload. Because of excessive sensory stimulation, a person is unable to perceive the environment accurately or respond appropriately. 4. Excessive sensory stimulation from the environment can overwhelm an individual's nervous system resulting in irritability.

A nurse identifies that a patient in middle adulthood is experiencing a developmental crisis. Which of the person's behaviors support this conclusion? Select all that apply. 1. _____Unable to mentor children in the next generation 2. _____Difficulty in developing peer relationships 3. _____Inability to achieve feelings of success 4. _____Incapable of delaying satisfaction 5. _____Failure to face eventual death

1. _____Unable to mentor children in the next generation 3. _____Inability to achieve feelings of success 1. A task associated with middle adulthood is sharing of self and performing activities that promote the growth of others, particularly those in the next generation. 3. A major task of middle adulthood is successfully fulfilling lifelong goals that involve family, career, and society. If these goals are not achieved, a crisis is often precipitated.

A nurse identifies which words as being unrelated to principles of growth and development? Select all that apply. 1. _____Unpredictable 2. _____Sequential 3. _____Integrated 4. _____Simple 5. _____Static

1. _____Unpredictable 4. _____Simple 5. _____Static 1. Growth and development comprise an orderly process that follows a predictable, not unpredictable, path. There are three predictable patterns: cephalocaudal—proceeding from head to toe; proximodistal—progressing from gross motor to fine motor movements; and symmetrical—both sides developing equally. Growth is marked by measurable changes in the physical aspects of the life cycle, and development is marked by behavioral changes that occur because of achievement of developmental tasks and their resulting functional abilities and skills. 4. Growth and development comprise a complex, not simple, process that involves multiple influencing variables, such as genetics, experience, health, culture, and environment. 5. The word static means stationary, stagnant, or fixed. Growth and development are dynamic and progressive.

A nurse is caring for several children on a pediatric unit. Children in which age group should the nurse expect will be most unstable and challenging with regard to the development of a personal identity? 1. Toddlerhood 2. Adolescence 3. Childhood 4. Infancy

2. Adolescence 2. Adolescents (12 to 20 years—Identity versus Role Confusion) have more multiple and complex physiological (e.g., puberty), psychological (e.g., self-identity and independence), and social (e.g., peer pressure, altered roles, and maturing relationships) milestones than any other stage of development. The multiplicity of these stressors can have a major impact on the development of the adolescent's personal identity and sense of self.

One of the participants attending a parenting seminar asks the nurse teaching the class, "What is the leading cause of death during the first year of life?" Besides exploring the person's concerns, what should the nurse respond? 1. Sudden infant death syndrome 2. Congenital malformations 3. Unintentional injuries 4. Short gestation

2. Congenital malformations 2. The most recent statistics from the National Center for Health Statistics indicate that congenital malformations are ranked first as the leading cause of all infant deaths.

Which patient should the nurse identify is at the greatest risk when taking a drug that has a high teratogenic potential? 1. Older adult man 2. Pregnant woman 3. Four-year-old child 4. One-month-old infant

2. Pregnant woman 2. A pregnant woman is at risk. Teratogenic refers to a substance that can cross the placental barrier and interfere with growth and development of the fetus.

A nurse is planning a teaching session for an older adult about a prescribed medication regimen. Which is a major concern about older adults that the nurse should consider? 1. They experience an increase in absorption of drugs from the gastrointestinal tract. 2. They are less motivated to follow a prescribed drug regimen. 3. They often use alcohol to cope with the stressors of aging. 4. They have a decreased risk for adverse reactions to drugs.

2. They are less motivated to follow a prescribed drug regimen. 2. The literature documents that older adults are at high risk for nonadherence to a medication regimen because of its complexity. The larger the number of medications and the larger the number of doses per day, the higher the risk of nonadherence. One study indicated that the adherence rate was 87% for daily dosing, 81% for doses twice a day, 77% for doses three times a day, and 39% for doses four times a day. Other reasons for not fully adhering to a drug regimen include inconvenience, side effects, financial limitations, and/or perceived ineffectiveness of the drugs.

A nurse in a clinic is caring for patients in a variety of age groups. Which age group should the nurse anticipate will have the greatest potential to demonstrate regression when ill? 1. Infants 2. Toddlers 3. Adolescents 4. Young adults

2. Toddlers 2. Toddlers are less able to understand and interpret what is happening to them when ill; therefore, they commonly regress to a previous level of development in an attempt to reduce anxiety.

A nurse determines that according to Erikson, establishing relationships based on commitment mainly occurs in which stage of psychosocial development? 1. Middle-aged adulthood 2. Young adulthood 3. Adolescence 4. Infancy

2. Young adulthood 2. Young adults (18 to 25 years—Intimacy versus Isolation) strive to establish mature relationships, commit to suitable partners, and develop social and work roles acceptable to society. Unsuccessful resolution results in self-absorption, egocentricity, and emotional isolation.

Which common physiological changes associated with aging should the nurse assess for in an older adult? Select all that apply. 1. _____Increase in sebaceous gland activity 2. _____Deterioration of joint cartilage 3. _____Loss of social support system 4. _____Decreased hearing acuity 5. _____Increased need for sleep

2. _____Deterioration of joint cartilage 4. _____Decreased hearing acuity 2. Older adults generally experience a deterioration of the hyaline cartilage surface of joints, which tears, allowing bones to be in direct contact with each other. Often this results in the formation of spurs or projecting points that limit joint motion. 4. Hearing acuity decreases, particularly in relation to high-pitched sounds, because of atrophy in the organ of Corti and cochlear neurons, loss of sensory hair cells, and degeneration of the stria vascularis.

A nurse identifies that an older adult has successfully resolved the developmental conflict associated with aging. Which of the person's abilities most support this conclusion? Select all that apply. 1. _____Accepting social isolation 2. _____Reminiscing about past life events 3. _____Managing the change in social roles 4. _____Associating with members of every age group 5. _____Increasing the number of meaningful relationships

2. _____Reminiscing about past life events 3. _____Managing the change in social roles 2. Older adults review life experiences and put them all in perspective. With a successful life review, the individual views life as meaningful, respects the self, and feels respect from others. 3. The older adult needs to adjust to multiple changes in social roles to emerge emotionally integrated with an intact ego and sense of wholeness. Changes in social roles are often dramatic as the result of retirement, death of significant others, changing responsibilities within the extended family structure, moving to different living quarters, and decreasing finances.

Which concept is reflective of Erik Erikson's Theory of Personality Development? 1. Defense mechanisms help people to cope with anxiety. 2. Moral maturity is a central theme in all stages of development. 3. Achievement of developmental goals is affected by the social environment. 4. Two continual processes, assimilation and accommodation, stimulate intellectual growth.

3. Achievement of developmental goals is affected by the social environment. 3. Erik Erikson expanded on Freud's Theory of Personality Development by giving equal emphasis to the influence of a person's social and cultural environment. He stressed that psychosocial development depends on an interactive process between the physical and emotional variables during a person's life at eight distinct stages. Each stage requires resolution of a developmental conflict that has opposite outcomes and that requires interaction within the self and with others in the environment.

A pediatric nurse is caring for children of a variety of ages. Which group should the nurse anticipate will have the most problems sleeping as a result of multiple complex developmental factors? 1. Infants 2. Toddlers 3. Adolescents 4. Preschoolers

3. Adolescents 3. Adolescents (12 to 20 years) have more multiple and complex physiological (e.g., puberty), psychological (e.g., self-identity and independence issues), and social (e.g., peer pressure, altered roles, and maturing relationships) milestones than any other stage of development. Anxiety associated with all of these stressors contributes to altered sleep patterns and sleep deprivation. Adolescents generally need 8 to 10 hours of sleep a day; however, adolescents' sleep needs vary widely.

Which individual does the nurse anticipate has the greatest risk for problems with regulating body temperature? 1. Toddler 2. Teenager 3. Older adult 4. School-aged child

3. Older adult 3. Regulation of body temperature depends on the ability to dilate or constrict blood vessels and control the activity of sweat glands. In the older adult, the production of sweat glands decreases, reducing a person's ability to perspire and resulting in risk for heat exhaustion; there are decreased amounts of muscle mass and subcutaneous fat, which lead to increased susceptibility to cold; there are inefficient vasoconstriction in response to cold and inefficient vasodilation in response to heat; and there is a diminished ability to shiver.

Which group of individuals should the nurse anticipate is at the greatest risk for constipation? 1. Inactive school-aged children 2. Middle-aged adults 3. Older-aged adults 4. Bottle-fed infants

3. Older-aged adults 3. Older adults are at the greatest risk for constipation because of decreases in activity levels, in intake of high-fiber foods, in peristalsis, in digestive enzymes, and in fluid intake.

A nurse is providing dietary teaching to a group of adolescents recently diagnosed with diabetes mellitus. Which factor should the nurse consider that frequently influences food choices by adolescents? 1. Taste 2. Routine 3. Pressure 4. Preference

3. Pressure 3. Peers often dictate the dietary choices of adolescents. Fad dieting and demands of socialization that generally involve fast food are common among adolescents.

Which age group should the nurse identify as being reflected in the following statement? "More time is spent in bed but less time is spent asleep." 1. Two-year-olds 2. Forty-year-olds 3. Seventy-year-olds 4. Fourteen-year-olds

3. Seventy-year-olds 3. Older adults still need 7 to 9 hours of sleep daily but often receive less because of difficulty falling asleep and more frequent awakening. They often go to bed earlier in an effort to get more sleep and end up spending more time in bed awake. Sleeping difficulties are attributed to a decrease in melatonin, less deep sleep, a decrease in exercise, more naps, movement disorders, sleep apnea, and medical and psychological problems.

A school nurse is teaching a class of adolescents about nutrition. Which age group should the nurse identify as having the highest energy expenditure and nutrient requirements? 1. End of the life cycle 2. Middle adult years 3. Early adult years 4. First year of life

4. First year of life 4. During the first year of life, nutritional needs per unit of body weight are the greatest in comparison to any other time during the life span. Birth weight generally doubles in 4 to 6 months and triples by the end of the first year.

Which word describes the process of growth and development? 1. Fast 2. Simple 3. Limiting 4. Individual

4. Individual 4. Although people follow a general pattern, they do not grow and develop at exactly the same rate or extent.

A nurse in the operating room cares for patients of a variety of ages. Which individual should the nurse anticipate will have the greatest risk for complications during surgery? 1. Middle-aged adult 2. Pregnant woman 3. Adolescent 4. Infant

4. Infant 4. Infants are at risk for fluid volume depletion because of a small blood volume and limited fluid reserves. In addition, immature liver and kidneys affect the ability to metabolize and eliminate drugs, an undeveloped immune system increases the risk of infection, and immature temperature regulating mechanisms increase the risk of hyperthermia and hypothermia.

A nurse in the clinic is monitoring patients for iron deficiency anemia. Which group of individuals should the nurse anticipate to be at the greatest risk? 1. Postmenopausal women 2. Older adults 3. Teenagers 4. Infants

4. Infants 4. Infants are at the highest risk for iron deficiency anemia because of the increased physiological demand for blood production during growth, inadequate solid food intake after 6 months of age, and formula not fortified with iron. In addition, premature or multiple-birth infants are at special risk because of inadequate stores of iron during the end of fetal development.

A nurse in the emergency department is assessing patients of various ages. Which age group should the nurse anticipate will have the greatest individual differences in appearance and behavior? 1. Children 2. Adolescents 3. Older adults 4. Middle-aged adults

4. Middle-aged adults 4. Middle-aged adults (40 to 60 years) are in a time of transition between young adulthood and older adulthood. Therefore, individuals in this group, more so than in any other age group, have the greatest individual differences in appearance and behavior as they span the norms seen in young adulthood, middle adulthood, and older adulthood.

A nurse is teaching a parenting class at a local community health center. Which common stressor associated with the developmental stage of early childhood (1 to 3 years) should the nurse include? 1. Accepting limited dietary choices 2. Adjusting to a change in physique 3. Responding to life-threatening illness 4. Resolving conflicts associated with independence

4. Resolving conflicts associated with independence 4. During early childhood, the child gains independence through learning right from wrong. Independence occurs with guidance from parents as the child learns self-control without feeling shame and doubt. When parents are overly protective or critical, feelings of inferiority will develop.

A nurse identifies that an adult has an unresolved developmental conflict associated with adolescence. Which behaviors support this conclusion? Select all that apply. 1. _____Being overly concerned about following daily routines 2. _____Requiring excessive attention from others 3. _____Relying on oneself rather than others 4. _____Failing to verbalize a sense of self 5. _____Lacking goals in life

4. _____Failing to verbalize a sense of self 5. _____Lacking goals in life 4. A main developmental task of adolescence is being capable of determining "who you are." An inability to verbalize a sense of self later in life reflects an unresolved conflict of Identity versus Role Confusion. 5. A main developmental task of adolescence is forming a sense of personal identity as a foundation for the tasks of young adulthood, making decisions regarding career choices, and selecting a mate. An adult who has difficulty setting goals in life indicates an unresolved conflict of Identity versus Role Confusion.