2 Transitions

Which characteristic change is observed during late adolescence stage? a) Changes in puberty b) Changes in dressing c) Dominant peer orientation d) Develops adult relationships

D

A community health nurse is educating a client who is interested in discontinuing cigarette smoking. What should the teaching plan include? a) Helping the client set a date to stop smoking b) Referring the client to the American Red Cross (Canada: Canadian Red Cross) c) Encouraging the client to eat when the desire to smoke occurs d) Telephoning the client several weeks after the preset target date

A

The parents of a 15-year-old adolescent who is being treated for allergies privately tell a nurse that they suspect that their child is a hypochondriac. What is the most therapeutic response by the nurse? a) Discussing developmental behaviors of adolescents b) Explaining potentially serious complications of allergies c) Discussing some of the underlying causes of hypochondriasis d) Explaining that the parents may be transferring their fears to their adolescent

A Adolescents are very aware of their changing bodies and become especially concerned with any alteration resulting from illness or injury. Explaining the complications of allergies does not address concepts related to growth and development of the adolescent and may cause unnecessary concern about the child's physical condition. A discussion about hypochondriasis may reinforce the parents' concern. Indicating that the parents may be engaging in transference is accusatory and is not supported by adequate data; this response may precipitate such feelings as anger and guilt.

An IV catheter is to be inserted into a 3-year-old toddler's peripheral vein. As local topical anesthetic is applied, the toddler starts to cry and asks whether the insertion is going to hurt. How should the nurse respond? a) "Yes, it will hurt, but not for very long." b) "Maybe it will hurt, but remember that big kids don't cry." c) "Yes, it may hurt, but if you hold still it won't hurt too much." d) "It will hurt a little, but I'm good at getting the needle into your arm.

A Although the local anesthetic will help minimize the discomfort, the needle insertion may still hurt. Telling the child that the insertion will hurt but not for very long is an honest, simple answer that is appropriate for a 3-year-old child. Telling the child that big kids don't cry is a judgmental response that is inappropriate for a 3-year-old child; children sometimes need to cry to express their feelings. Although the child should hold still, there is no guarantee that doing this will cause the insertion to hurt less. Saying, "Maybe it will hurt" or "It may hurt" constitutes false reassurance. Saying that the insertion will hurt just a little because the nurse is skilled is also false reassurance; there is no guarantee of success, despite the nurse's self-proclaimed expertise.

To help prevent a cycle of recurring urinary tract infections in a female client, which instruction should the nurse share? a) "Urinate as soon as possible after intercourse." b) "Increase your daily intake of citrus juice." c) "Douche regularly with alkaline agents." d) "Take bubble baths regularly."

A Intercourse may cause urethral inflammation, increasing the risk of infection; voiding clears the urinary meatus and urethra of microorganisms. Most fruit juices, with the exception of cranberry juice, cause alkaline urine, which promotes bacterial growth. Douching is no longer recommended because it alters the vaginal flora. Bubble baths can promote urinary tract infections.

Three days after birth, a breast-feeding newborn becomes jaundiced. The parents bring the infant to the clinic, and blood is drawn for an indirect serum bilirubin determination, which reveals a concentration of 12 mg/dL (100 mcmol/L). The nurse explains that the infant has physiologic jaundice. What is the cause of this benign condition? a) Immature liver function b) An inability to synthesize bile c) An increased maternal hemoglobin level d) A high hemoglobin and low hematocrit level

A Jaundice occurs because of the expected physiologic breakdown of fetal red blood cells and the inability of the newborn's immature liver to conjugate the resulting bilirubin. Breast-fed neonates are more prone to physiologic jaundice because of diminished calorie and fluid intake in the 3 days before milk production reaches normal volume. Conjugation and excretion, not synthesis of bile, are compromised because of the immature liver. The mother's hemoglobin level is unrelated to the newborn's; the mother and the fetus had separate circulations. Newborns usually have high hemoglobin and high hematocrit levels.

Which statement would the nurse state is true for toddlers? a) The incidence of poisoning is very common in toddlers. b) An 18-month-old child uses approximately up to 300 words. c) The average toddler gains 2 to 3 pounds (0.9 to 1.4 kg) each year. d) Toddlers prefer to engage in parallel play rather than in solitary play

A Poisonings occur frequently because children of around 2 years of age place objects or substances in their mouths to learn about them. The 18-month-old child uses approximately 10 words. A toddler gains approximately 5 to 7 pounds (2.3 to 3.2 kg) each year. The toddler begins to engage in parallel play during toddlerhood but also engages in solitary play.

A client tells the nurse, "I keep reverting to my old habit of drinking soda, although I have stopped drinking as much." What stage of health behavior change has the client reached? a) Action stage b) Preparation stage c) Maintenance stage d) Contemplation stage

A The client in this situation has reached the action stage of health behavior change. In this stage, old habits may get in the way of new behaviors. In the preparation stage, the client understands that the advantages of the health behavior change outweigh its disadvantages. In this situation, the client has already made changes in health behavior. In the maintenance stage, the client continues the health behavior change indefinitely. In the contemplation stage, the client may be ambivalent but is more ready to accept information regarding health behavior change.

The nurse is preparing to assess several clients at a pediatric clinic. Which client would require a developmental screening versus developmental surveillance during a scheduled health maintenance visit? a) A 9-month-old infant b) A 2-week-old newborn c) A 15-month-old toddler d) A 4-year-old preschooler

A The nurse would conduct a developmental screening for the 9-month-old infant during a scheduled health maintenance visit. The 2-week-old newborn, the 15-month-old toddler, and the 4-year-old preschooler would all require developmental surveillance during a health maintenance visit.

A 2-year-old child who has been restricted to bed rest because of a diagnosis of meningitis is now allowed out of bed. The nurse suggests going to the playroom. The child responds by shaking the head vigorously from side to side, screaming, "No! Won't!" However, the child is trying to climb out of the crib at the same time. In light of these behaviors, what is the most likely conclusion by the nurse? a) The child is trying to assert independence. b) The child is eager to resume regular play activities. c) The child is unsure of the difference between yes and no. d) The child is confused as a result of increased intracranial pressure

A The toddler is exhibiting typical behavior for this developmental level; most toddlers will say no as a means of asserting their independence. Although the child may be eager to resume playing, the behavior described is related to the child's assertion of autonomy. Although toddlers who are attempting to assert independence will say no even when they mean yes, they do understand the difference. This child's behavior does not indicate confusion; it is typical of 2-year-old children, who will say no to most things as a means of asserting their independence.

Which are barrier methods of contraception? Select all that apply. a) Condom b) Lea's shield c) Diaphragm d) Spermicidal foam e) Coitus interruptus

A, B, C

The nurse is teaching campfire safety to a group of community members and includes information about what to do if a person catches on fire. The nurse teaches the most effective method for putting out the flames. Which information from the group members indicates successful learning? a) Wrap hand with towel and slap at the flames. b) Instruct the victim to roll on the ground. c) Pour cold liquid over the flames. d) Remove the victim's burning clothes

B

According to Erikson's theory of psychosocial development, which opposing conflicts is an older adult likely to face? a) Trust versus Mistrust b) Integrity versus Despair c) Intimacy versus Isolation d) Industry versus Inferiority

B According to Erikson's theory of psychosocial development, an older adult is likely to face the opposing conflict of Integrity versus Despair. An infant in the age group between birth and one year old is likely to face the opposing conflicts Trust versus Mistrust. A young adult is likely to face the opposing conflicts Intimacy versus Isolation. School-aged children between the ages of 6 and 11 years are likely to face the opposing conflicts Industry versus Inferiority.

Which structure is removed during circumcision of an infant? a) Glans b) Prepuce c) Epididymis d) Vas deferens

B Circumcision involves removal of the prepuce, which is a skin folding over the glans. The glans is the tip of the penis. The epididymis is the internal structure that helps in the transportation and maturation of sperm. The vas deferens carries sperm from the epididymis to the ejaculatory duct.

A client tells the nurse that the first day of her last menstrual period was July 22. What is the estimated date of birth (EDB)? a) May 7 b) April 29 c) April 22 d) March 6

B Her EDB is April 29. The Nägele rule is an indirect, noninvasive method for estimating the date of birth: EDB = last menstrual period + 1 year - 3 months + 7 days. May 7 is beyond the expected date of birth. April 22 and March 6 are both before the EDB.

A nurse who is assessing a full-term newborn elicits the Moro reflex. Which method would the nurse utilize to best elicit this reflex? a) Touching the infant's cheek b) Striking the surface of the infant's crib suddenly c) Allowing the infant's feet to touch the surface of the crib d) Stroking the sole of the foot along the outer edge from the heel to the toe

B Jarring the crib produces a startle response (Moro reflex); the legs and arms extend, and the fingers fan out, while the thumb and forefinger form a C. When the cheek is touched, the head turns toward the side that was touched; this is the rooting reflex. When the feet touch the crib surface the stepping reflex is elicited; one foot is placed before the other in a simulated walk with the weight on the toes. When the bottom of the foot is stroked along the outer edge of the sole from the heel to the toe, the toes flare out. This is the Babinski reflex, which is expected because of the newborn's immature nervous system. In an adult, this reflex is a sign of neurological damage.

Which statement made by a pregnant client to a nurse indicates that the client does not understand the teaching regarding fetal growth and development? a) "The baby is smaller if the mother smokes." b) "The baby gets food from the amniotic fluid." c) "The baby's oxygen is provided by the mother." d) "The baby's umbilical cord has two arteries and one vein."

B The amniotic fluid serves as a protective environment; the fetus depends on the placenta, along with the umbilical blood vessels, for nutrients and oxygen. "The baby is smaller if the mother smokes," "The baby's oxygen is provided by the mother," and "The baby's umbilical cord has two arteries and one vein" are all true statements, and further teaching would not be required.

How many words should the nurse expect the 3-year-old child to acquire each day? a) 2 to 3 b) 5 to 6 c) 8 to 10 d) 11 to 13

B The nurse would expect the 3-year-old toddler-age child to acquire 5 to 6 new words each day. Two to 3 new words, 8 to 10 new words, and 11 to 13 new words are not expected parameters for language development. Topics

The mother of an adolescent asks the nurse, "What's the best way to remove a tick from the skin?" What is the best response by the nurse? a) "Touch the tick with a lit cigarette." b) "Remove the tick carefully with tweezers." c) "Pour ammonia over the tick, and it will shrivel up." d) "Spray the tick with insect repellent, and it will fall off."

B The tick must be carefully removed with tweezers or forceps so the body and head are both removed; this technique prevents further inoculation of the individual. Using a lit cigarette, ammonia, or insect repellent is unsafe; the tick may further inoculate the child, and the method may hurt the child.

Which statements regarding acne are correct? Select all that apply. A) Acne is a hormonal disease. B) Acne may be caused by stress. C) Family history could be a reason for it. D) Propionibacterium acnes causes acne. E) Acne is commonly found on the face, chest, upper back, and neck

B, C, D, E Stress and family history may cause acne formation. The causative organism is Propionibacterium acnes. Acne is not a hormonal disease; rather, it is a skin disease due to hormonal imbalance. Acne is commonly found on the face, chest, upper back, and neck where there are a higher number of sebaceous glands.

At which age should the nurse anticipate that the preschool-age client will begin to participate in the social side of eating? a) 3 years b) 4 years c) 5 years d) 6 years

C

The student nurse is learning about cognitive development in preschoolers. Which is characteristic of cognition in 4-year-olds? a) Beginning to question what parents think b) Egocentricity in thought and behavior c) Phase of intuitive thought d) Beginning ability to view concepts from another perspective

C A 4-year-old child is in the phase of intuitive thought. A 3-year-old child is egocentric in thought and behavior. A 5-year-old child begins to question what parents think by comparing them with age-mates and other adults. A 3-year-old has beginning ability to view concepts from another perspective.

A nurse is planning to provide self-care health information to several clients. Which client should the nurse anticipate will be most motivated to learn? a) A 55-year-old client who had a mastectomy and is very anxious about her body image b) An 18-year-old client who smokes cigarettes and is in denial about the dangers of smoking c) A 56-year-old client who had a heart attack last week and is requesting information about exercise d) A 47-year-old client who has a long-leg cast after sustaining a broken leg and is still experiencing severe pain

C A client who is requesting information is indicating a readiness to learn. When a nurse is caring for a person who is coping with the diagnosis of cancer and a change in body image, the nurse should encourage the expression of feelings, not engage in teaching. People in denial are not ready to learn because they do not admit they have a problem. In addition, many adolescents believe that they are invincible. A person who is in pain is attempting to cope with a physiological need. This client is not a candidate for teaching until the pain can be lessened; pain can preoccupy the client and prevent focusing on the information being presented.

A 24-year-old client is admitted at 40 weeks' gestation. The cervix is dilated 5 cm and is 100% effaced, and the presenting part is at station 0. The nurse assesses that the fetal heart tones are just above the umbilicus. Which fetal presentation does the nurse document? a) Face b) Brow c) Breech d) Shoulder

C In the breech presentation, the fetal head is in the fundal portion of the uterus; the chest or back is at or above the umbilicus, where fetal heart tones can be heard. In the vertex presentation the head is the presenting part; the chest and back are in lower quadrants, where the fetal heart is heard. The brow presentation is a type of cephalic presentation in which the fetal head is partially extended; the fetal heart is heard in the lower abdomen, not above the umbilicus. In the shoulder presentation the fetal heart usually is heard in the midabdominal region.

A mother is inspecting her newborn girl for the first time. The infant's breasts are edematous, and she has a pink vaginal discharge. How should the nurse respond when the mother asks what is wrong? a) "You seem very concerned. I don't see anything unusual." b) "Your baby appears to have a problem. I'll notify the pediatrician." c) "The swelling and discharge will go away. It's nothing to worry about." d) "The swelling and discharge are expected. They're a response to your hormones."

D

The parents of a 5-month-old infant tell the nurse that they have started to feed the baby fortified cereal mixed with formula. They ask in which order they should introduce new foods. What foods should be selected first? a) Meats and fish b) Eggs and cheeses c) Citrus fruits and bread d) Vegetables and noncitrus fruits

D

The nurse recognizes that which is the mental process most sensitive to deterioration with aging? a) Judgment b) Intelligence c) Creative thinking d) Short-term memory

D During the aging process there is a progressive atrophy of the convolutions of the brain with a decrease in its blood supply, which may produce a tendency to become forgetful, a reduction in short-term memory, and susceptibility to personality changes. There should be little or no change in judgment. There is little or no intellectual deterioration; intelligence scores show no decline. Creativity is not affected by aging; many people remain creative until very late in life.

Which age should the nurse teach the parents of a school-age client to expect mandibular second molars to erupt? a) 7 to 8 years b) 9 to 10 years c) 10 to 12 years d) 11 to 13 years

D Mandibular second molars often erupt between 11 and 13 years of age. The maxillary central incisor is expected to erupt between 7 and 8 years of age. The mandibular cuspids are expected to erupt between 9 and 10 years of age. The mandibular second bicuspids are expected to erupt between 11 to 12 years of age.