Fundamentals of Nursing, Adult Lifespan
The nurse working in a nursing home is providing care to a group of older adults. The decline in which system in the older adult most often influences the ability to maintain safety? 1. Sensory 2. Respiratory 3. Integumentary 4. Cardiovascular
Correct Answer: 1 1. A decline in vision, hearing, tactile sensation to pain and pressure, and a slower response time have the greatest impact on an older adult's ability to maintain safety over all of the systems offered in the other options.
When planning nursing care, the nurse needs to remember that energy expenditure and nutrient requirements are higher during the: 1. First year of life 2. Early adult years 3. Middle adult years 4. End of the life cycle
Correct Answer: 1 1. 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.
The nurse identifies which word as being unrelated to principles of growth and development? 1. Unpredictable 2. Sequential 3. Integrated 4. Complex
Correct Answer: 1 1. Growth and development is 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.
When the nurse assesses an adult, which 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
Correct Answer: 1 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.
A 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 understand when planning 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
Correct Answer: 1 1. Sedatives are not well tolerated by older adults because a decrease in the absorption, metabolism, and excretion of the drug can result in toxicity. In addition, they may experience idiosyncratic (unexpected or opposite) effects.
The nurse identifies that an individual who nurtures, teaches, and gives to others reflects which stage of Erikson's Stages of Development? 1. Generativity versus Stagnation 2. Ego Integrity versus Despair 3. Industry versus Inferiority 4. Initiative versus Guilt
Correct Answer: 1 1. The 25- to 45-year-old adult (Generativity versus Stagnation) strives to fulfill life goals associated with family, career, and society as well as being able to give to and care for others. A positive resolution of the conflict associated with this age group is often displayed in teaching, counseling, and community volunteer work.
The nurse identifies that a patient in middle adulthood is experiencing a developmental crisis when there is an inability to: 1. Achieve a feeling of success 2. Develop peer relationships 3. Delay satisfaction 4. Face death
Correct Answer: 1 1. The 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.
The 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
Correct Answer: 1 1. This is a serious concern because of a decrease in efficiency of hepatic metabolism and renal excretion of drugs in the older adult.
Which comment best demonstrates agism? "He is 75 years old and: 1. Has outlived his usefulness." 2. Reads the newspaper with difficulty." 3. Reminisces about his past work experience." 4. Is most happy when working in his home workshop."
Correct Answer: 1 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, boring, etc.
To what is a person referring 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. There is a role reversal between parents and self 3. Assists own parents and spouse's parents 4. Has both older and younger siblings
Correct Answer: 1 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.
When the nurse cares for individuals across the life span, which age group generally demonstrates an inefficiency of adaptation? 1. 60 plus years 2. 40 to 60 years 3. 12 to 19 years 4. 3 to 11 years
Correct Answer: 1 1.When a person reaches 60 years of age and older, all physiologic systems are less efficient, which reduces compensatory reserve.
For which common physiologic changes associated with aging should the nurse assess for in an older adult? Check 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
Correct Answer: 1 & 4 1. Although sebaceous glands increase in size with age, the amount of sebum produced decreases, hastening the evaporation of water from the stratum corneum resulting in cracked, dry skin. 4. Hearing acuity decreases, particularly in relation to high-pitched sounds, because of atrophy in the organ of Corti and cochlear neurons, loss of the sensory hair cells, and degeneration of the stria vascularis.
The nurse is caring for children with a variety of ages. At what age do children first recognize that death is irreversible, universal, and natural? 1. 6 2. 9 3. 12 4. 15
Correct Answer: 2 2. 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/her own mortality and may fear death.
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 baby
Correct Answer: 2 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.
The nurse understands that the stage of development that is most unstable and challenging with regard to the development of a personal identity is: 1. Toddlerhood 2. Adolescence 3. Childhood 4. Infancy
Correct Answer: 2 2. Adolescents (12 to 20 years—Identity versus Role Confusion) have 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.
An older adult is admitted to the intensive care unit. For which common behavioral adaptation to sensory overload should the nurse monitor the patient? 1. Dementia 2. Confusion 3. Drowsiness 4. Bradycardia
Correct Answer: 2 2. 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.
A 2-year-old child is trying to eat with a spoon and is making a mess. The nurse should: 1. Provide finger foods until the child is older 2. Offer praise and encouragement as the child eats 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
Correct Answer: 2 2. From 18 months to 3 years of age (Autonomy versus Shame and Doubt) the child strives for independence. Attempts to feed oneself should be encouraged and enthusiastically praised even though the child may make a mess. It allows the child to practice and perfect new skills, helps to develop fine motor skills, and supports control of the self and the environment.
When assessing the ability to age successfully, the nurse understands that this is basedon a person's ability to: 1. Cope with social isolation 2. Adjust to the change in social roles 3. Associate with members of every age groups 4. Increase the number of meaningful relationships
Correct Answer: 2 2. 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.
When the nurse assesses patients in the following age groups, the nurse understands that the age group that has the greatest potential to demonstrate regression when ill is: 1. Infants 2. Toddlers 3. Adolescents 4. Young adults
Correct Answer: 2 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.
When meeting the sleep needs of patients, the nurse identifies that the group that has the most problems as a result of multiple, complex developmental factors is: 1. Infants 2. Toddlers 3. Adolescents 4. Preschoolers
Correct Answer: 3 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 concept should the nurse understand is reflective of Erikson's Theory of Personality Development? 1. Defense mechanisms help 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
Correct Answer: 3 3. Erikson expanded on Freud's Theory of Personality Development by giving equal emphasis to the influence of a person's social and cultural environment. Erikson 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.
The nurse identifies that the age group that is at the greatest risk for constipation is: 1. Inactive school-aged children 2. Middle-aged adults 3. Older-aged adults 4. Bottle-fed infants
Correct Answer: 3 3. Older adults are at the greatest risk for constipation because of decreases in: activity levels, intake of high-fiber foods, peristalsis, digestive enzymes, and fluid intake.
Which age group should the nurse identify is 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
Correct Answer: 3 3. Older adults still need 7 to 9 hours of sleep daily but often receive less due to 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 pychological problems.
The nurse is providing dietary teaching to a group of adolescents recently diagnosed with diabetes mellitus. The nurse understands that many foods are ingested by the adolescent because of: 1. Taste 2. Routine 3. Pressure 4. Preference
Correct Answer: 3 3. Peers often dictate the dietary choices of adolescents. Fad dieting and demands of socialization that generally involve fast food are commonly seen among adolescents.
The nurse identifies that the person at greatest risk for problems with regulating body temperature is the: 1. Toddler 2. Teenager 3. Older adult 4. School-aged child
Correct Answer: 3 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 is inefficient vasoconstriction in response to cold and inefficient vasodilation in response to heat; and there is a diminished ability to shiver, which increases body temperature.
The nurse understands that, according to Erikson, the person who becomes selfabsorbed and obsessed with one's own needs is having difficulty resolving which stage of psychosocial development? 1. Industry versus Inferiority 2. Ego Integrity versus Despair 3. Generativity versus Stagnation 4. Identity versus Role Confusion
Correct Answer: 3 3. The 25- to 65-year-old adult who is unable to successfully resolve the conflict of Generativity versus Stagnation becomes egocentric, disinterested in others, and self-absorbed. Successful resolution results in the ability to give to and care for others.
The nurse is planning a teaching session for an older adult about a prescribed medication regimen. An issue of major concern for the nurse is that older adults: 1. Experience an increase in absorption of drugs from the gastrointestinal tract 2. Often use alcohol to cope with the multiple stressors of aging 3. Are less motivated to follow a prescribed drug regimen 4. Have a decreased risk for adverse reactions to drugs
Correct Answer: 3 3. The literature documents that 75% of older adults are to some degree intentionally noncompliant with drug therapy because of inconvenience, side effects, and/or perceived ineffectiveness of the drugs.
One of the participants attending a parenting class asks the teacher, "What is the leading cause of death during the first year of life?" Besides exploring the person's concerns, the nurse should respond: 1. Sudden infant death syndrome 2. Unintentional injuries 3. Congenital anomalies 4. Preterm birth
Correct Answer: 3 3. The most recent CDC statistics available at the time of this book's publication indicate that 20.1% of all infant deaths are caused by congenital anomalies.
The nurse understands that according to Erikson, establishing relationships based on commitment mainly occurs in which stage of psychosocial development? 1. Generativity versus Stagnation 2. Identity versus Role Confusion 3. Intimacy versus Isolation 4. Trust versus Mistrust
Correct Answer: 3 3. 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.
The nurse understands that a word that describes the process of growth and development is: 1. Fast 2. Simple 3. Limiting 4. Individual
Correct Answer: 4 4. Although people follow a general pattern, they do not grow and develop at exactly the same rate or extent.
A common stressor identified by the nurse that is associated with the developmental stage of early childhood (1-3 years) is: 1. Accepting limited dietary choices 2. Adjusting to a change in physique 3. Responding to life-threatening illness 4. Resolving conflicts associated with independence
Correct Answer: 4 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.
Which psychodynamic theorist believed that 10-year-old children gain pleasure from accomplishments? 1. Lawrence Kohlberg 2. Berry Brazelton 3. Sigmund Freud 4. Erik Erikson
Correct Answer: 4 4. Erik Erikson believed that 6- to 12- year-old children are in conflict over the developmental task of Industry versus Inferiority. Ten-year-old children strive to work or produce, compete and cooperate, and be competent.
The nurse in the operating room cares for patients with a variety of ages. The nurse understands that the individual at the greatest risk for complications during surgery is the: 1. Middle-aged adult 2. Pregnant woman 3. Adolescent 4. Infant
Correct Answer: 4 4. Infants are at risk for 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.
The nurse in the emergency department is assessing patients of various ages. The nurse understands that the age group that has the greatest individual differences in appearance and behavior is: 1. Children 2. Adolescents 3. Older adults 4. Middle-aged adults
Correct Answer: 4 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 resident in a nursing home reminisces about past-life events. The nurse identifies that according to Erikson, the patient is in which stage of psychosocial development? 1. Autonomy versus Shame and Doubt 2. Identity versus Role Confusion 3. Generativity versus Stagnation 4. Ego Integrity versus Despair
Correct Answer: 4 4. The adult 65 years and older (Ego Integrity versus Despair) conducts a review of life events and seeks to come to terms with and accept responsibility for one's own life, including what it was in light of what one had hoped it would be.
The nurse identifies that the behavior in an adult that indicates an unresolved developmental conflict associated with adolescence is: 1. Being overly concerned about following daily routines 2. Requiring excessive attention from others 3. Relying on oneself rather than others 4. Failing to set goals in life
Correct Answer: 4 4. The 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 or who is unable to make a commitment to others indicates an unresolved conflict of Identity versus Role Confusion.
The nurse is assessing the skin of an older adult. Which change in the patient's skin should the nurse anticipate? 1. Increased tone 2. Decreased dryness 3. Increased elasticity 4. Decreased thickness
Correct Answer: 4 4. The skin of the older adult decreases in thickness because of loss of dermal and subcutaneous mass. This occurs in response to a flattening of the dermalepidermal junction, reduced thickness and vascularity of the dermis, and slowing of epidermal proliferation.
The nurse in the clinic is monitoring patients for iron deficiency anemia. Which group of individuals is considered to be at the greatest risk? 1. Postmenopausal women 2. Older adults 3. Teenagers 4. Infants
Correct Answer: 4 4. This age group is 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.
The nurse understands that an individual who is preoccupied with work and the drive to succeed at the expense of emotionally committing to others reflects a negative resolution of which stage of Erikson's Stages of Development? 1. Autonomy versus Shame and Doubt 2. Identify versus Role Confusion 3. Ego Integrity versus Despair 4. Intimacy versus Isolation
Correct Answer: 4 4. Young adults 18 to 25 years of age who are self-absorbed, egocentric, and emotionally isolated reflect a negative resolution of the conflict of Intimacy versus Isolation. Successful resolution results in the ability to establish mature relationships, commit to a suitable partner, and develop social and work roles acceptable to society.
The 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." Answer: _______________
Correct Answer:1, 4, 2, 3 1. The sensorimotor stage (birth to 2 years) is governed by sensations in which simple learning takes place. It progresses from reflex activity, through repetitive behaviors, to imitative behavior. They are curious, experiment, and learn primarily through trial and error. 4. The preoperational stage (2 to 7 years) involves thinking that is concrete and tangible; they cannot reason beyond the observable. Also, their thinking is transductive; that is, knowledge of one characteristic is transferred to another. 2. The concrete-operational stage (7 to 11 years) reflects an increasing ability to use symbols and understand relationships between things and ideas. Judgments are made based on what they reason (conceptual thinking) rather than just what they see (preoperational thinking). Also, they develop the concept of conservation; that is, physical factors (e.g., volume, weight, and number) remain the same even though outward appearances may change. 3. The formal operational stage (11 to 15 years) involves thinking that is abstract, theoretical, philosophical, and hypothetical. Thinking is characterized by flexibility, adaptability, and drawing logical conclusions.
