chapter 19, 20, 21
A client reports feelings of spiritual anguish and depression as a result of experiencing numerous somatic complaints that make the client feel like everything is out of order. Which nursing diagnosis should the nurse identify for this client? 1. Energy-field disturbance 2. Powerlessness 3. Hopelessness 4. Anxiety
1
A client undergoing chemotherapy becomes very anxious and stressed just before the treatments. Which would be an appropriate therapy for this person to learn? 1. Meditation 2. Aromatherapy 3. Homeopathy 4. Yoga
1
A client visits a clinic that integrates Western medicine with complementary therapies. Which therapies might the client utilize and believe to keep the flow of qi at a therapeutic level? 1. Acupressure and reflexology 2. Therapeutic touch and Reiki 3. Aromatherapy and naturopathic remedies 4. Chiropractic and massage therapy
1
A client was in a motor vehicle crash where he sustained injury to his spinal cord that has resulted in difficulty with balance and holding his posture. Which should the nurse suggest the client consider? 1. Animalassisted therapy 2. Hypnotherapy 3. Chelation therapy 4. Detoxification
1
A kindergarten class is being screened by a group of nursing students using a Snellen E chart. Few of the children have 20/20 vision. Most have 20/30, and some have 20/40. What should the nursing students report to the instructor about these childrens vision? 1. These children have normal vision abilities. 2. We should check into the health of these children. Maybe their diets are lacking in essential vitamins because they all have poor eyesight. 3. These kids will all be wearing glasses when we come back next year. 4. We should use a different eye chart. Maybe the kids would understand it better.
1
A nurse is working with a school-age client who is learning how to use a peak flow meter to monitor his asthma. The child has been frustrated at first, but now is able to give the reason to use the meter on a daily basis. Remembering the growth and development characteristics of the adolescent, how should the nurse respond to this client? 1. You should feel very proud for understanding and using your meter. 2. Think of using the meter as one of your daily chores. 3. Maybe you could make a game out of the daily use of your meter. 4. Its too bad if you dont want to use the meter, its just something youll have to do.
1
A parent brings her baby in for a well-child checkup. Which action of the child should the nurse identify as an indicator of positive resolution of the central task of this age? 1. The child does not cry when the parent allows the nurse to hold the child. 2. The child shows mistrust when strangers approach. 3. The child becomes willful when disciplined. 4. The child does not play with other children.
1
A school health nurse is working on education programs for high school students. As part of the plan, the nurse wants to address health concern topics besides the dangers of unprotected sex or drug and alcohol abuse. Which class topic should the nurse present to these students? 1. Warning signs of depression for peers to identify among their classmates 2. Injury prevention 3. Early signs of cancer and heart disease 4. Normal physiological changes of this age group
1
New parents ask if their 8monthold baby is performing activities that are expected at this age. What should the nurse suggest to screen this babys developmental level? 1. The Denver Developmental Screening Test (DDST-II) 2. Growth and development charts from the Centers for Disease Control and Prevention (CDC) 3. Assessment tools utilized by the state education department 4. The Apgar scoring system Correct Answer: 1
1
The nurse is assessing a childs growth and development. What questions should the nurse ask the parents that demonstrate an understanding of the factors that affect growth and development processes? Standard Text: Select all that apply. 1. How tall the parents are 2. Whether noises seem to bother their child 3. How many ounces of formula their child drinks daily 4. What their yearly income is 5. Whether their child will receive daycare services
1,2,3
The school nurse determines that a 14yearold student has reached an expected level of cognitive development. What did the nurse assess to come to this conclusion? Standard Text: Select all that apply. 1. Thinks logically 2. Thinks about the future 3. Makes rational statements 4. Uses a trialanderror process 5. States things as they could be
1,2,3,5
The nurse is confident that a client has met the developmental guidelines for a preschooler. What did the nurse assess to make this clinical decision? Standard Text: Select all that apply. 1. Can print her own name. 2. Proudly announces, I put my own toys away. 3. Shares that, I know I shouldnt hit, even when Im mad. 4. Effectively brushes her own teeth. 5. Washes her hands after toileting without prompting.
1,2,4
The nurse is preparing a teaching session for pregnant clients that reviews the fetal growth and development that occurs in the first 3 weeks post-conception. What should the nurse include in this teaching? Standard Text: Select all that apply. 1. How the embryo has attached to the wall of the uterus 2. Development of the fetal membranes and the amniotic sac 3. How the embryo will be covered with a protective substance called vernix caseosa 4. How development of the fetal placenta has begun 5. How the embryo is covered with a soft, downy hair
1,2,4
The nurse is preparing a teaching session for a group of parents with newborn children. What should the nurse include about Bowlbys attachment theory during this presentation? Standard Text: Select all that apply. 1. Use the attachment figure as security 2. Desire to be near the attachment figure 3. Plan to separate from the attachment figure 4. Return to the attachment figure when threatened 5. Express anxiety when the attachment figure is absent
1,2,4,5
The nurse concludes that a young adult client is completing developmental tasks within Havighursts early adulthood age period. What did the nurse assess to come to this conclusion? Standard Text: Select all that apply. 1. Taking on civic responsibility 2. Developing adult leisure-time activities 3. Getting started in an occupation 4. Relating oneself to ones spouse as a person 5. Managing a home
1,3
An expectant parent asks the nurse about health problems of newborns. On what should the nurse provide information to this client? Standard Text: Select all that apply. 1. Infant colic 2. Respiratory tract infections 3. Failure to thrive 4. Injuries 5. SIDS
1,3,5
The nurse is discussing human growth and development with the parents of a newborn. What should the nurse include in this discussion? Standard Text: Select all that apply. 1. Growth involves physical change and increase in size. 2. Skills and function increase with growth. 3. Most humans experience a similar pattern of growth. 4. Being able to adapt to ones environment is an indicator of growth. 5. Childrens growth is monitored by height, weight, bone size, and dentition.
1,3,5
A client comes to the clinic with a chief complaint of feeling dirty inside and asks the nurse how colonics would work to improve the clients overall well-being. What should the nurse respond to this client? 1. Colonics is a dangerous and not useful technique that no one should try. 2. There is much controversy about colonics. What do you know about it? 3. This is a good way to get rid of toxins in your system. 4. Youd better ask your doctor about this.
2
A client living in a long-term care center has been withdrawn and subdued, and does not eat in the dining room because of embarrassment about her physical decline. What might the nurse suggest that provides opportunities for unconditional love, achievement of trust, responsibility, and empathy toward others? 1. Chelation therapy 2. Animal-assisted therapy 3. Meditation 4. Pilates
2
A client who has a terminal diagnosis has been using her time to help family members deal with her impending death. Among her activities, she collected pictures for a scrapbook and wrote a journal of favorite memories for family members to read after the client dies. According to Peck, the nurse realizes that this client is working through which developmental task? 1. Body transcendence versus body preoccupation 2. Ego transcendence versus ego preoccupation 3. Ego differentiation versus work-role preoccupation 4. Integrity versus despair
2
A client with an acute, serious illness has been hospitalized. Upon entering the room, the nurse observes the client praying. The client states to the nurse: I dont know how people manage to get through difficult times without their faith. Its where I get my strength. With which theorist should the nurse associate this clients belief? 1. Fowler 2. Westerhoff 3. Gilligan 4. Kohlberg
2
A nurse working on an Alzheimers unit notes that just before the supper hour, many of the residents become more anxious and confusedexhibiting typical sundowners syndromemaking the evening meal an unpleasant ordeal. As a method to try to decrease their turmoil during this time, which therapy should the nurse introduce into the daily routine? 1. Biofeedback 2. Music therapy 3. Pilates 4. Spiritual therapy
2
A toilet trained 4-year-old hospitalized for several days with an acute illness has been wetting the bed at night and is having incontinent accidents during the day. How should the nurse address the parents concern about this behavior? 1. Maybe your child should be seen by a specialist, just to make sure there are no physical problems. 2. It is normal for some children to go through a stage of regression after separation from their family or after an acute illness. Try not to be too discouraged. 3. Youll have to be very strict with discipline, so your child knows this behavior is not acceptable. 4. Id be upset too. It must be hard to go back to using diapers.
2
An adolescent comes to the school nurses office seeking advice about his friends and feeling pressure to participate in activities with which he isnt comfortable, such as drinking parties and sexual explorations. What should the nurse do? 1. Tell the adolescent to stay away from friends like that. 2. Be open to the concerns and provide accurate information about any questions. 3. Encourage the adolescent to accept psychosocial counseling. 4. Give the adolescent pamphlets on sexually transmitted diseases.
2
During an auditory screening of third graders, the school nurse identifies a hearing deficit for one of the students. When the parents ask the nurse about the findings, how should the nurse respond? 1. Hearing acuity is not fully developed in your child. Lets recheck next year. 2. Id like to recheck at the clinic. Then we may need to have your child be seen by an auditory specialist. 3. It was too noisy when we were testing, so I wouldnt be concerned if I were you. 4. Your child will probably need a hearing aid.
2
Parents of a newborn ask the nurse why their newborns head seems lopsided and not round, as they thought it should be. How should the nurse respond to these parents? 1. I dont think it looks unusual; actually the head is beautifully shaped. 2. Your babys head had to shape itself to the birth canal. It will look round in a few days. 3. Youre right. Well make sure your doctor checks this out. 4. Babies heads always look funny. Once his hair grows out, youll hardly notice it.
2
The nurse is completing a health history with a client who is 10 weeks pregnant. Which factor should the nurse identify as increasing this clients risk for a spontaneous abortion? 1. Having taken a medication that is a known teratogen 2. Smoking 3. Having low levels of folic acid 4. Genetic history
2
The nurse is working with a client who, during her interview, expresses feelings of groundedness. The nurse interprets this to mean that the client 1. is full of energy. 2. feels connected to her reality. 3. is focused on her center of energy. 4. feels down in the dumps.
2
The nurse notes that a 20-month-old child is lagging in stage 6 of Piagets phases of cognitive development. Which activity did the nurse observe that indicates that this child is struggling at this stage? 1. The child wants the same toy to sleep with during naptime and bedtime. 2. The child merely watches as the other children pretend-play. 3. The child cries when the parents leave the unit. 4. The child does not cooperate with some of the treatments.
2
The parents of a baby born prematurely during the sixth month of pregnancy question the nurse about the hair all over their baby. What is the nurses best response? 1. All babies are hairy. It is more noticeable on preemies. 2. Fine downy hair helps keep the baby insulated in utero. 3. You should be more concerned with the babys respiratory function. 4. Dont worry about how the baby looks. All preemies look funny.
2
A client has been undergoing therapy as a victim of severe emotional abuse. The goal of the clients therapy is to gain self-control of the situation, improve self-esteem, and become self-sufficient. Which application should the nurse suggest become a part of the clients therapy sessions? 1. Yoga 2. Meditation 3. Hypnotherapy 4. Guided imagery
3
A client who resides in a long-term care facility has no family or visitors. Her only social contacts are with the staff. The client is confined to bed and is not able to communicate verbally. As part of the clients care plan, the nurses provide massage therapy three times a week. What is the main benefit of this intervention for this client? 1. Stretch and loosen the muscles 2. Speed the removal of metabolic waste products 3. Help satisfy the need for caring and nurturing touch 4. Relieve pain
3
A nurse educator believes that teaching students without caring about them is an exercise in futility. This educator also believes that in meeting the students needs, educators must also work to take care of themselves and care for their own needs. From which stage of Gilligans theory is the educator approaching the teaching of students? 1. Stage 1 2. Stage 2 3. Stage 3 4. Stage 4
3
A nurse is helping a hospice client who has had difficulty with making end-of-life decisions. The nurse has encouraged the client to focus on her self-worth, her accomplishments, and having positive self-esteem in order to process through some of these decisions. The nurse is helping the client to achieve balance in which component? 1. Environmental 2. Physical 3. Mental 4. Spiritual
3
A nurse is teaching a class to new parents on how to handle some of the behaviors that could be demonstrated by toddlers. One of the parents asks what to do when her child throws a temper tantrum. How should the nurse respond to this parent? 1. Try to be more attentive to the behaviors that lead into a tantrum. Then you can avoid them. 2. Put the child in a room alone and ignore the tantrum. 3. Make sure the child is safe, then walk away. 4. Hold the child tightly until he stops crying.
3
A nurse who works in a busy neonatal intensive care unit has been having difficulty with concentration after a long days work. Which therapy should the nurse consider doing to help with this problem? 1. Guided imagery 2. Hypnotherapy 3. Qigong 4. Aromatherapy
3
A toddler shows fear and begins to cry when her parent leaves her at day care. According to Havighurst, which developmental task should the nurse recognize this child is exhibiting? 1. Building wholesome attitudes toward oneself 2. Learning to get along with age-mates 3. Learning to relate emotionally 4. Achieving personal independence
3
A young adult has never lived away from his parents and feels unable to make decisions on his own. According to Freuds theory of development, the nurse should suspect that this person would be fixated at which stage of development? 1. Phallic 2. Latency 3. Genital 4. Anal
3
The nurse is exploring the behavior of children and how they interpret right from wrong or bad from good. Which theorist should the nurse study to learn this information? 1. Vygotsky 2. Skinner 3. Kohlberg 4. Piaget
3
The nurse is plotting the height and weight of children during a school assessment clinic. Which aspect of the childrens health is the nurse assessing? 1. Development 2. Health 3. Growth 4. Bone size
3
The nurse is preparing to assess a group of assigned clients with chronic illnesses who use essential oils. For which health problem should the nurse particularly assess the clients? 1. Hypertension 2. Cardiac problems 3. Asthma 4. Cancer
3
The nurse is preparing to instruct a client about nutritional needs before and during pregnancy. What should the nurse encourage the patient to consume in order to meet the requirements for folic acid? 1. Meats, fish, and poultry 2. A mix of vegetables and fiber 3. Oranges and green leafy vegetables 4. Lowfat and highprotein foods
3
The parents of a newborn ask what their baby can see. What should the nurse respond to these parents? 1. Babies arent able to see until they are around 4 months old. 2. Babies wont track moving objects until about 5 months. 3. Newborns blink in response to bright lights and sound and will follow large objects. 4. Newborns arent able to focus, so everything looks blurry to them.
3
The parents of a toddler are concerned that their child is so messy during eating, so they feed him instead of allowing him to feed himself. What should the nurse respond to the parents? 1. Thats probably best. Im sure it makes your mealtime more pleasant. 2. At least youre sharing meals as a family. Thats the most important. 3. Motor skills keep improving with age. Try not to get frustrated with the mess. 4. Your child will never learn if you dont let him experience.
3
While the nurse is teaching a group of parents and their teenage sons about puberty and sexual growth, a parent asks if fertility coincides with ejaculation. What should the nurse respond to this question? 1. Yes, if your son is ejaculating, he also possesses fertility. 2. Sexual maturity does not occur until age 18, so dont worry about anything until then. 3. Fertility follows several months after the first ejaculation. 4. Youll have to ask your physician about this because it is a sensitive subject.
3
A client asks the nurse about chiropractic medicine. What should the nurse explain as being among the goals of this type of health intervention? Standard Text: Select all that apply. 1. Improvement of blood and lymph flow through the body 2. Stimulation of specific points to help with pain relief, cures certain illnesses, and promote wellness 3. Reduce or eliminate pain 4. Correct spinal dysfunction 5. Preventive maintenance
3,4,5
The nurse suspects that an adolescent is working through the stages of spiritual development. What observations did the nurse make to come to this conclusion? Standard Text: Select all that apply. 1. Imitated behavior demonstrated by parents 2. Conceptualized angels and devils with the use of imagination 3. Compartmentalized differences between spiritual beliefs with friends 4. Determined differences between spiritual beliefs as being right or wrong 5. Met with the church priest to talk about the differences in spiritual beliefs
3,4,5
A client comes to the family planning clinic for follow-up and is currently taking an oral contraceptive. During the interview assessment, the client states she has been using some natural medicines. Which herbal preparation should alert the nurse to a possible interaction with oral contraceptives? 1. Valerian 2. Echinacea 3. Garlic 4. Milk thistle
4
A client comes to the womens clinic, stating she has had a positive home pregnancy test. The client states that her last menstrual cycle was 2 months ago. According to this time frame, the nurse determines that the client is in which stage of pregnancy? 1. Fetal phase 2. Second trimester 3. Third trimester 4. Embryonic phase
4
A client diagnosed with hypertension has had well-controlled follow-up of her blood pressure for the past 6 months. At todays clinic appointment, the clients blood pressure is 98/58. The client insists she has been taking her prescribed antihypertensive medication as prescribed, but also added an herbal tablet because she heard it was supposed to be good for her. Which is most likely interfering with the clients antihypertensive? 1. Valerian 2. Milk thistle 3. Ginseng 4. Garlic
4
A client is being seen in the mental health clinic for antisocial behavior. According to Eriksons stages of development, the nurse realizes that this client is dealing with which task of development? 1. Initiative versus guilt 2. Industry versus inferiority 3. Intimacy versus isolation 4. Identity versus role confusion
4
A client who has a long-standing history of depression has been on a prescribed antidepressant for several months and states that hehas also been trying St. Johns wort. Which vital sign should the nurse assess for possible adverse effects? 1. Temperature 2. Respiratory rate 3. Oxygen saturation 4. Pulse rate
4
A home health nurse is working with a client who has had to quit his job after a serious injury and whose future employability is uncertain. The client states that his life has no meaning or purpose anymore and that he feels lonely and abandoned. What is an appropriate nursing diagnosis for this client? 1. Body Image Disturbance 2. Health-Seeking Behavior 3. Altered Family Processes 4. Spiritual Distress
4
A nurse educator is working with students and assisting them in addressing their clients spiritual needs. The educator understands that most traditional, second-year college students are aware of their own spiritual development or working to develop their own system of spirituality. The educator realizes that the students are in which stage of Fowlers developmental theory? 1. Mythic-lyrical 2. Intuitive-projective 3. Universalizing 4. Individuating-reflexive
4
A parent is concerned that her 5-year-old is beginning to masturbate. How should the nurse, familiar with Freuds stages of development, respond? 1. All children are curious, but make sure the child knows that this behavior might be offensive to others. 2. You should probably consult a child psychologist if youre this concerned. 3. Lets make sure to ask your physician at the next appointment. 4. This behavior is a normal part of your childs development.
4
A parent is concerned that her child is unable to sit alone. The nurse explains that development is based on in-born timetables and the child will be most likely able to meet this milestone at a specific time. Upon which theory did the nurse base the response to the client? 1. Havighursts theory 2. Task theory 3. Psychosocial theory 4. Maturational theory
4
A school nurse is implementing a program to promote psychosocial development among adolescent teens at a high school. Which activity should the nurse include? 1. Career planning 2. Establishing peer groups 3. Playing musical instruments 4. Determining a value system
4
A school nurse is working with teachers in helping them address the developmental needs of grade school students, according to Eriksons theory of industry versus inferiority. Which activities should the nurse suggest? 1. Providing time for running and playing sports, such as basketball, to increase gross motor skills 2. Allowing pretend time during their classes, such as for dress-up or role-playing activities 3. Presenting diversity in culture and practices as part of classroom study 4. Helping them develop skills needed in the adult world, such as allowance budgeting
4
After having a difficult time saying no when asked to work yet another overtime shift, the nurse begins to feel overwhelmed and irritable. As a method to most effectively promote self-healing, what should this nurse do? 1. Clarify values and beliefs. 2. Set realistic goals. 3. Learn to manage stress. 4. Challenge the belief that others always come first.
4
At birth a baby weighed 8 lb. What should the nurse expect this baby to weight at the age of 1? 1. 32 lb 2. 16 lb 3. 20 lb 4. 24 lb
4
The parents of a newborn male ask the nurse about pain during circumcision. What should the nurse respond to these parents? 1. Newborns cant feel pain, so dont worry about it. 2. Well make sure to bring your baby to you right after the procedure, so you can comfort him. 3. Ill have the pediatrician speak to you about it. 4. Newborns pain experience is real. Well use some medication to help your baby feel more comfortable.
4
A client with degenerative joint disease comes to the clinic and states that he has been reading a lot about essential oils that are helpful for stomach problems. The nurse should offer the client information about the use of which oil? 1. Chamomile 2. Eucalyptus 3. Lavender 4. Tea tree
1
A college-age client shares that he is struggling with feelings of both independence and dependence regarding his family. The nurse recognizes this as which stage of development, according to Roger Gould? 1. Stage 2 2. Stage 3 3. Stage 4 4. Stage 5
1
During a clinic appointment, a client prescribed medication for glaucoma reports vision problems. When taking a medication history, which herbal preparation should the nurse identify as being problematic for this client? 1. Ginseng 2. Echinacea 3. Valerian 4. St. Johns wort
1
During an interview assessment, the client states a belief in nutritional lifestyle counseling and that the bodys vital energy circulates through the body, which can be manipulated through specific anatomical points. Which type of healing practice should the nurse identify that this patient is following? 1. Traditional Chinese medicine 2. Native American healing 3. Ayurveda 4. Curanderismo
1
After analyzing behavior, the nurse determines that a client is demonstrating defense mechanisms. According to Freud, what should the nurse realize as being the cause of this behavior? Standard Text: Select all that apply. 1. Anxiety created by conflicts 2. Activation of the conscience 3. Conflict between the ids impulses 4. Immediate pleasure and gratification 5. Underlying motivation for development
1,3
The parents of a school age child are concerned about the child learning right from wrong. In which order should the nurse instruct the parents of a school-age child that moral development will develop in their child? Select all that apply: 1. Punishment and obedience 2. Law-and-order orientation 3. Instrumental-relativist orientation 4. Good boynice girl stage
1,4,2,3
A nurse is working with the residents of an assisted living complex. When planning care for the old-old stage, the nurse realizes that what action will be important? 1. Provide as much care to the residents as possible. 2. Allow as much independence for the residents as possible. 3. Make sure to provide safety measures as needed. 4. Make sure the residents maintain peer interactions and social groups.
2
A parent brings a 16-month-old child to the clinic for a well-child checkup. During the assessment, the nurse finds that the child cannot stand next to furniture and does not try to pull himself up from a sitting position. In which process should the nurse identify that this child is lagging? 1. Growth 2. Development 3. Height 4. Behavior
2
A parent reports to the nurse that his child is learning new words faster than he can write them in the baby book. According to Piaget, the nurse realizes that this child is in which phase? 1. Intuitive thought phase 2. Preconceptual phase 3. Concrete operations phase 4. Formal operations phase
2
A parent tells the nurse that his child is quite creative and learning how to pretend with almost anything in the house. According to Piaget, the nurse realizes this child is demonstrating which stage/phase? 1. Tertiary circular reaction: stage 5 2. Inventions of new means: stage 6 3. Preconceptual phase 4. Concrete operations phase
2
A teenage girl spends most of her free time with friends.In sharing their concerns about this behavior with the school nurse, the parents are worried about their child seeming to draw away from them. What should the nurse respond to the parents? 1. You should really keep better track of your child. Its hard to tell what kinds of troubleshe may be getting into. 2. Independence is really important for this age group. Try to be extra attentive when your child does spend time at home. 3. Use stricter guidelines for curfew and punishment if curfew is broken. 4. Is it possible that your child might be taking drugs?
2
The client asks whether herbal medicines are a good idea. What should the nurse respond? 1. Things found in nature are always healthy. 2. If your doctor didnt prescribe it, dont take it. 3. Are there specific ones youre wondering about?
3
A community health nurse is planning adult health education classes. According to Eriksons stages of development, the nurse should address which task with this age group? 1. Industry versus inferiority 2. Identity versus role confusion 3. Intimacy versus isolation 4. Generativity versus stagnation
4
A baby was born with flaccid muscle tone, regular respirations with crying, a heart rate of 85, and blue extremities. What would the Apgar score be? 1. 6 2. 7 3. 5 4. 8
1
A child is starting school and is being screened for certain developmental milestones. What is the nurse assessing when determining how the child interacts with other children? 1. Temperament 2. Physical characteristics 3. Environment 4. Culture
1
A client has been diagnosed with post-traumatic stress syndrome and has difficulty sleeping because of recurrent nightmares. In working with this client to overcome the problem, what should the nurse implement as part of therapy? 1. Guided imagery 2. Hypnotherapy 3. Yoga 4. Meditation
1
