Growth and Development-Dunphy
5. Beginning at about age 55, most people can expect which of the following changes? A. a 1 to 2 inch decline in height B. stable body weight C. sharper vision and hearing D. increased strength
A. a 1 to 2 inch decline in height
45. Which tooth is the first to erupt in an infant? A. a lower central incisor B. a lower lateral incisor C. lower canine D. upper lateral incisor
A. a lower central incisor
121. The tasks of middle adulthood include all of the following except A. affiliating with one's age group B. accepting and adjusting to the physical changes of middle age C. reviewing and redirecting career goals D. achieving desired performance in a career
A. affiliating with one's age group
8. The feature(s) of fragile X syndrome that should be evaluated during well child examinations include A. being easily overwhelmed by stimuli and having language delays B. shorter linear growth C. increased frequency of ear infections D. difficulty swallowing
A. being easily overwhelmed by stimuli and having language delays
64. Photosensitivity of the epidermis increases in older adults due to which of the following normal developmental changes of aging skin? A. reduction of Langerhans cells B. decrease in vitamin D synthesis C. decrease in enzymatically active melanocytes D. significant decrease in vascular supply
C. decrease in enzymatically active melanocytes
29. In a game of hide and seek, 3 year old Michael hides his face and believes that no one else can see him. This behavior is an example of A. conservation B. object permanence C. egocentric thought D. concrete operations
C. egocentric thought
120. At what age can a baby usually say two to three words with meaning? A. 8 months B. 10 months C. 12 months D. 24 months
C. 12 months
39. Fine motor coordination improves during the middle childhood years. A person's ability to manipulate objects reaches adult capacity by which age? A. 6 years B. 9 years C. 12 years D. 21 years
C. 12 years
109. Erikson's stage of intimacy vs isolation occurs between what ages? A. 12 and 16 B. 16 and 20 C. 20 and 30 D. 50 and 60
C. 20 and 30
18. The diet of a healthy, nondiabetic older adult female is based on which guidelines? A. energy needs are 2,500 to 3,000 kcal/day B. 5-10% of calories should come from fats, especially monounsaturated fats C. 20-30% of calories should come from protein sources D. calcium requirements decrease after age 70
C. 20-30% of calories should come from protein sources
26. At what age can children use scissors successfully and fasten and unfasten simple buttons? A. 2 year B. 3 years C. 4 years D. 5 years
C. 4 years
123. What is the approximate annual weight gain of a school age child? A. 1-3 lb B. 3-5 lb C. 5-7 lb D. 7-9 lb
C. 5-7 lb
104. Preferring peer group activity over adult activities, conforming to group rules, using secret codes, and desiring acceptance are common at ages A. 2 to 4 B. 4 to 6 C. 6 to 10 D. 12 to 15
C. 6 to 10
111. Most children display a clear tendency for right or left handedness by what age? A. 2 years B. 4 years C. 6 years D. 12 years
C. 6 years
92. At what age does a child usually develop the ability to mentally reverse actions that have been completed? A. 2 years B. 4 years C. 6 years D. 10 years
C. 6 years
47. At what age should a normally developing child be able to use a pincer grasp and pick up small cereal pieces, raisins, and finger foods? A. 2 to 3 months B. 5 to 6 months C. 9 to 10 months D. 12 to 14 months
C. 9 to 10 months
108. While assessing the eyes of Thomas, a newborn, you observe inner canthal folds and Brushfield spots. What do you suspect? A. Trisomies B. Turner's syndrome C. Down syndrome D. Neurofibromatosis
C. Down syndrome
88. When an adolescent girl's breasts and areolae are enlarged and there is no contour separation, which Tanner stage is she in? A. I B. II C. III D. IV
C. III
50. When completing the health history and ROS for a healthy 88 year old woman, you would expect which age-related change to be reported? A. Mildly blurry vision B. Chronically dry and itchy eyes and eyelids C. Increasing presbyopia D. Tearing and photophobia
C. Increasing presbyopia
36. Debbie, age 4, is developing self-assertion, spontaneity, self-sufficiency, direction, and purpose as her mother encourages, reassures, and cheers her on. Which of Erikson's stage of ego development best characterizes Debbie? A. Trust vs mistrust B. Autonomy vs shame and doubt C. Initiative vs guilt D. Industry vs inferiority
C. Initiative vs guilt
52. Johnny, age 3, is at the clinic for his well child visit. He has trouble removing his own shirt as requested. His mother yanks off his shirt after smacking his wrist and saying, "You must do what you're told--quickly." Which action is indicated? A. Ignore the behavior because both Johnny and his mother are probably nervous about being there B. Tell the mother that Johnny's behavior is perfectly normal C. Observe Johnny for signs of child abuse D. Report the mother to CPS
C. Observe Johnny for signs of child abuse
59. According to Piaget, the ability to develop abstract thinking occurs during which stage of life? A. early childhood B. middle school age C. adolescence D. early adulthood
C. adolescence
114. At what age can the healthcare provider stop measuring head circumference in normal full term children whose growth has been normal to this point? A. when head circumference reaches 40 cm B. when the anterior fontanel begins to close C. at 3 years of age D. after 12 months of age
C. at 3 years of age
21. By the end of the first year of life, normal infants demonstrate interest in an object that a caregiver points out. Absence of this behavior is associated with which disorder? A. cerebral palsy B. deafness C. autism D. down syndrome
C. autism
51. Middle-aged persons who still have responsibilities for their children's care and are now caring for their own aging parents are sometimes said to A. have institutional guilt syndrome B. have "full nest" syndrome C. be in the "sandwich" generation D. be members of Generation X
C. be in the "sandwich" generation
100. Miranda is playing with clay and realizes that she can roll a lump of clay into a long snakelike shape and then return that snakelike shape to a lump. She is exhibiting cognitive development typical of which of Piaget stage? A. sensorimotor B. preoperational C. concrete operations D. formal operations
C. concrete operations
17. Hattie, age 6, appears to be masturbating when she rubs herself back and forth against the rug. Her mother asks you for advice because she believes masturbation may cause emotional problems and blindness. What is your best response? A. "Masturbation causes no physical, sexual, or mental problems." B. "Stop her now because she may progress to other sexual behaviors." C. "There is no research to show that masturbation causes blindness." D. "Don't worry; Hattie will be fine."
A. "Masturbation causes no physical, sexual, or mental problems."
79. You are examining 14 year old Bobby. He tells you he is embarrassed to undress in the school locker room because his "chest is swollen." You observe very slight breast enlargement and palpate small subareolar disks of soft, slightly tender tissue bilaterally. There are no other significant findings. His BMI is between the 75th and 85th percentile for his age. He takes no medications, supplements, or other substances. Which response to Bobby's concern is indicated? A. "This is called gynecomastia. It is normal, and many boys develop it during early adolescence. It usually resolves on its own within a year or so." B. "You do have some excess tissue on your chest. It's because of your weight. Once you lose some weight, the swelling will go away." C. "It's due to a condition called precocious puberty and means puberty is a bit too early. It will be important to do some blood tests to check your hormones." D. "Swollen breasts in boys need further evaluation to make sure there's nothing wrong. You will need to have some x-rays, imaging, and blood tests."
A. "This is called gynecomastia. It is normal, and many boys develop it during early adolescence. It usually resolves on its own within a year or so."
116. Jason is in first grade. His mother expresses concern because he pronounces the th sound as f. For instance, he stays "free" for "three." You respond to his mother A. "This is normal at his age." B. "He may have a hearing problem and does not know how it should sound." C. "You should correct him when he does this, or he will not learn the proper way to say it." D. "He should be referred to a speech therapist for evaluation."
A. "This is normal at his age."
38. David, a new father, expresses his concerns that his newborn son does not smile at hime when he talks to him. What do you tell him? A. "True social smiles usually do not emerge until 4-9 weeks of age." B. "Continue to watch his response so we can be certain that he is seeing." C. "Babies usually have a preference for the mother's face. That's probably why he doesn't smile at you." D. "This may just be his personality."
A. "True social smiles usually do not emerge until 4-9 weeks of age."
71. According to the American Academy of Pediatrics, what is the earliest age that visual acuity screening in primary care practice should be included in the overall well child assessment? A. 3 years B. 4 years C. 5 years D. visual acuity screening is valid only if performed by an optometrist
A. 3 years
35. Which one of the following is a normal physiological change of aging? A. A decrease in strength and speed of muscle contraction in the extremities B. Degenerative arthritis C. Rheumatoid arthritis D. Bulging intervertebral discs
A. A decrease in strength and speed of muscle contraction in the extremities
6. 9 year old Mark is a highly active child with limited self control. He is easily distracted and has difficulty staying on task and working toward a goal. You determine that he should have a neurodevelopmental evaluation because he is showing signs of A. ADHD B. dyslexia C. autism D. impaired hearing
A. ADHD
70. Justin, age 18 months, crosses his legs when lifted from behind rather than pulling them up. His legs are also hard to separate, making diaper changes difficult. He persistently uses only one hand. What condition do you suspect? A. Cerebral palsy B. Mild hydrocephalus C. Mild spinal cord defect (spina bifida occulta) D. Fetal alcohol syndrome
A. Cerebral palsy
31. Which of these musculoskeletal changes accompany older adulthood? A. Change in stature B. Increased stride length C. Improved fine motor skill D. Stretching of muscle fibers
A. Change in stature
56. A 2 year old is brought to the clinic for his annual exam. His mother tells you that he can speak 5 to 10 single words but that she can understand what the child is saying only 25% of the time. To make his needs known, he typically resorts to gesturing rather than trying to use words. He appears to understand half of her commands. The child does not live in a bilingual household. Which steps are indicated? A. Conduct an ear examination with pneumatic otoscopy and refer to audiology/speech clinic for evaluation B. After a normal ear examination with a pneumatic otoscopy, reevaluate the child in 6 months C. Treat with an antibiotic for presumptive chronic otitis media with effusion D. Give the child an articulation screening examination
A. Conduct an ear examination with pneumatic otoscopy and refer to audiology/speech clinic for evaluation
30. What is the major determinant of sexual activity in older adults? A. Physical and mental health B. Social sanctions C. Religious beliefs D. Age
A. Physical and mental health
63. Which cardiac finding can be normal in children and young adults? A. S3 B. S4 C. ejection click D. diastolic murmur
A. S3
55. Susie is 18 months old and does not seem the least bit interested in being toilet trained. What do you tell her mother? A. Susie's behavior is typical because most children are not ready for toilet training until age 2 B. The majority of children Susie's age have started showing readiness behaviors related to toilet training by this age C. She can use reinforcement conditioning to discipline Susie whenever she soils her diapers and reward her when she stays dry D. She should have Susie spend time around other toddlers who are toilet trained so that she can learn from them
A. Susie's behavior is typical because most children are not ready for toilet training until age 2
41. What is the first male secondary sexual characteristic to emerge? A. Testicular enlargement B. Growth of axillary and pubic hair C. Growth of facial and chest hair D. Deepening of the voice
A. Testicular enlargement
40. You are examining a 58 year old man who complains of recent onset of erectile dysfunction (ED). The approach to his concern should be guided by which principle? A. There are multiple physical conditions associated with the development of ED B. Almost all men will develop ED by the time they reach their 60s C. Most ED is caused by hormonal imbalance D. ED is correlated with the development of benign prostatic enlargement
A. There are multiple physical conditions associated with the development of ED
122. Jonathan, 2.5 years of age, has come to see you because his mother says that he has been very fussy and irritable. When you examine his ears, you note that the tympanic membrane is red and bulging. He has a fever at 102.2. You look at his record and notice he has had three episodes of AOM within the past 6 months. You are concerned about this because A. children <3 years of age with recurrent otitis media are at increased risk for impaired speech and language development B. children with opaque TMs are probably deaf C. the infection is highly likely to spread to the meninges D. he will not be able to be immunized for at least 6 months
A. children <3 years of age with recurrent otitis media are at increased risk for impaired speech and language development
98. When performing a mental status exam, you should keep in mind the ABCTs. What does the C stand for? A. cognition B. consciousness C. capabilities D. conscience
A. cognition
83. The diagnosis of ADHD in a child is made using which of these? A. comparison of child's characteristics with criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) B. blood assays demonstrating elevated lead levels C. identification of EEG abnormalities D. Scores on the Conners Comprehensive Behavior Rating Scales
A. comparison of child's characteristics with criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)
106. Four year old Jamie believes that there is more juice in a tall,thin glass than in a short, wide one. Jamie has not yet achieved which of the principles of Piaget? A. conservation B. object permanence C. formal operations D. abstract reasoning
A. conservation
4. A 14 year old girl's BMI is plotted between the 85th and 95th percentiles. Based on developmental characteristics, which strategy is best to use when educating her about self-care changes that are needed? A. emphasize the benefits of diet and activity changes that she identifies as most important B. describe the relationship between current health choices and later health risks C. encourage her parents to share their recent experiences with weight management D. tell her frankly that her weight is too high, she she must make changes to decrease risks for developing chronic illness like diabetes
A. emphasize the benefits of diet and activity changes that she identifies as most important
93. You are examining a previously healthy 6 month old who was delivered by cesarean section at 32 weeks gestation. Exam reveals the presence of Moro, Babinski, and Landau reflexes. Which interpretation of findings is accurate? A. findings are normal B. findings suggest developmental delay C. findings indicate persistence of primitive reflexes often associated with neurological dysfunction D. findings are imprecise due to the infant's age
A. findings are normal
42. Adolescent thinking is egocentric, and adolescents sometimes perceive that they are the focus of everyone else's attention. A term that captures this is A. imaginary audience B. narcissism C. selfishness D. ego ideal
A. imaginary audience
82. The parent of a newborn asks you about the relationship between the infant's development and early experiences. Which theory guides your response? A. neurons and the connections among them continue to develop throughout early childhood B. the immature nervous system and brain imprint on early, repeated experiences in early childhood C. inborn temperamental patterns have the largest influence on infant and early childhood development D. all the sensory and perceptual capabilities are well developed at birth, priming newborns for multiple types of early childhood experiences
A. neurons and the connections among them continue to develop throughout early childhood
13. You are watching baby Jane play with a toy in the examining room. You move the toy and cover it with a cloth. The baby removes the cloth and reclaims the toy. This is an indication that the baby has achieved which of the following? A. object permanence B. conservation C. basic trust D. initiative
A. object permanence
68. Some psychologists have suggested that at the end of adolescence, a kind of thinking emerges that goes beyond logic to encompass interpretive and subjective thinking. What is this called? A. postformal thought B. mature thinking C. adult cognition D. ephemeral perception
A. postformal thought
97. Cydny is 5 years old and cannot understand how the half-cup of vegetables on her plate is the same amount as the half-cup of vegetables in the saucepan. According to Piaget, she is at which stage of cognitive development? A. preoperational B. sensorimotor C. formal operations D. concrete operations
A. preoperational
117. Developmental tasks of early adulthood (ages 20-45) include which of the following? A. psychological separation from parents and developing a capacity for intimacy with a partner B. starting a family C. achieving desired performance in career D. graduating from college or a vocational school
A. psychological separation from parents and developing a capacity for intimacy with a partner
128. Developmental tasks of adolescence include which of the following? A. searching for one's identity and growing independent from parents B. graduating from high school C. learning to establish meaningful relationships with siblings D. engaging in community service projects to assist acceptance into college
A. searching for one's identity and growing independent from parents
11. Male reproductive system changes during middle and later adulthood result in which manifestation? A. slight decrease in sperm production B. testicular enlargement C. decrease in estrogen-like hormone production D. stable levels of testosterone
A. slight decrease in sperm production
7. Jon, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some hair texture alteration, but his penis is not enlarged. He is in Tanner stage A. I B. II C. III D. IV
B. II
89. While examining a 12 month old boy whose family recently immigrated to the US from Mexico, you notice that his weight is in the 95th percentile and his height is in the 50th percentile. You begin to discuss the implications of maintaining a healthy weight, and the mother tells you that she is very proud of her son's size. Your response to her is guided by your understanding that A. some cultures believe that a fat baby is a healthy baby B. she is probably overfeeding the baby to stop his crying C. she does not understand the nutritional value of foods D. the relationship of obesity to childhood health risks has not been explained to her
A. some cultures believe that a fat baby is a healthy baby
53. A 6 year old would most likely view a friend as A. someone to share enjoyable activities with B. someone who has the traits that satisfy the child's needs and wants C. someone to share loyalty with D. someone to be intimate with
A. someone to share enjoyable activities with
118. Cross-cultural studies of Piaget's theory of cognitive development provide which of the following conclusions? A. the stages and sequence of cognitive development are universal B. the rate of physical growth has a positive influence on cognitive development C. some cultural groups achieve the task of conservation earlier than American and European children D. Piaget's theory was concerned with the prediction of psychological rather than cognitive development
A. the stages and sequence of cognitive development are universal
107. Why is Alzheimer's disease considered a specific disease, distinct from the normal changes of aging? A. there are types of AD that are inherited and present before age 60 B. there are changes in biological processes that occur with normal aging C. there is a notable decline in cognitive functioning as people age D. there are multiple changes in organ functioning, especially in the brain
A. there are types of AD that are inherited and present before age 60
73. When assessing children's growth and development from a cross-cultural perspective, healthcare providers need to be aware that A. there may be differences in normal growth curves B. children with immigrant parents have a difficult time developing social relationships in their age groups C. cognitive development may be delayed if children live in a bilingual household D. children from Asian households have higher IQs than Caucasian/white children
A. there may be differences in normal growth curves
12. The parent of Jorge, a 27 month old, is concerned because Jorge insists on going through the same sequence of washing his hands and face, sitting at the table, and using the same cup at every meal and snack, even at the mall's food court. He cries or has a tantrum when it's not possible. Your response to his parent should be based on which rationale? A. these are normal and expected behaviors for the age B. behavior modification techniques can help quickly extinguish these behaviors C. a child should be able to be more adaptable at this developmental stage D. these behaviors suggest the child is having difficulty coping with change
A. these are normal and expected behaviors for the age
115. Physiological changes of aging can affect functional mobility. Screening for functional mobility of older adults involves which screening tool? A. Katz Index B. Get Up and Go Test C. Functional Independence Measure D. Mini Mental State Exam
B. Get Up and Go Test
102. Donna is exclusively breastfeeding her 3 month old infant. She expresses concern to you that the baby's growth seems to be slowing down, and she wonders if she should supplement the diet with other foods. What would be your response? A. "You are probably not producing enough milk. Try introducing several tablespoons of rice cereal, in addition to breastfeeding, once each day." B. "As long as you are well nourished, the baby will get what she needs. Her growth pattern is normal for an exclusively breastfed baby." C. "Other foods are not needed now, but supplement breastfeeding by offering about eight ounces of formula each day." D. "This indicates it is time to begin weaning from breast to bottle and to begin to introduce solid foods."
B. "As long as you are well nourished, the baby will get what she needs. Her growth pattern is normal for an exclusively breastfed baby."
1. Sally Ann is concerned that she cannot afford special walking shoes for her baby, who is beginning to pull himself up to his feet. What do you tell her? A. "High-top shoes are necessary to prevent ankle injuries when your baby falls." B. "Don't worry. Special shoes are not necessary. The more flexible the shoe, the better." C. "Try to keep him off uncarpeted floors until you can obtain shoes." D. "The sock-type booties you have are fine."
B. "Don't worry. Special shoes are not necessary. The more flexible the shoe, the better."
23. Jane, age 45, is having her annual physical. She wants to know when she can expect to go through menopause. Your response to her would be A. "You should not have any more periods after the age of 50" B. "Most women begin having irregular periods in their late 40s, but menopause can occur any time from age 40 to 60" C. "It is typical to complete the process of menopause at your age. I'm surprised you haven't gone through it yet" D. "You should think about hormone replacement therapy now"
B. "Most women begin having irregular periods in their late 40s, but menopause can occur any time from age 40 to 60"
99. Marta, age 16, is not happy with the size of her breasts. She asks if her breasts will continue to enlarge. How do you respond? A. "Full breast growth occurs around age 15." B. "No, this is probably the size your breasts will remain." C. "Your breasts will continue to develop until about age 18." D. "Your breasts will continue to develop until about age 20."
B. "No, this is probably the size your breasts will remain."
81. A 6 year old has just been diagnosed with ADHD. His parents report that he is doing poorly in school and is often disruptive in the classroom. They ask what they can do. Your best response is A. "Children usually outgrow a high activity level." B. "Use a consistent approach with behavioral cues both at home and at school." C. "Medications are the only interventions that can help with ADHD." D. "You should have him tested for food and environmental allergies."
B. "Use a consistent approach with behavioral cues both at home and at school."
48. During the school-age years (6-11), children usually grow how much annually? A. 1 in B. 3 in C. 5 in D. 6-8 in
B. 3 in
43. Children begin to develop real friendships at the age of A. 18 months B. 3 years C. 6 years D. 10 years
B. 3 years
76. Sue takes her young son, Michael, to day care every day. He has begun to cry loudly and cling to her when she leaves. Michael is likely at what age? A. 4-5 months B. 8-9 months C. 12-15 months D. 15-18 months
B. 8-9 months
74. Self-actualization is the goal of personality development for which of the following theories? A. Peck's expansion of Erikson's theory B. Maslow's hierarchy of human needs C. Jung's theory of individualism D. Erikson's eight stages of life
B. Maslow's hierarchy of human needs
34. While assessing the skin of a newborn, you note cafe-au-lait spots. Which disease should be ruled out? A. Tuberous sclerosis B. Neurofibromatosis C. Sturge-Weber syndrome D. Fetal alcohol syndrome
B. Neurofibromatosis
49. The benefits of exercise during middle adulthood include which of the following? A. Less need for an increase in dietary calcium B. Slower decline in CNS processing C. A delay in the onset of menopause in women D. A delay in the development of vision problems
B. Slower decline in CNS processing
32. Byron is 36 months old. His mother asks you what toys she should have for him to play with at home? Your suggestions to her could include A. blocks and simple shape puzzles with few pieces B. a tricycle and a Wiffle ball and bat C. pop beads and Matchbox cars D. a mobile and cloth book
B. a tricycle and a Wiffle ball and bat
126. You suspect autism in the young child of a client of yours, but the client says the child is just shy. For a diagnosis of autism, you know the DSM-5 requires that three criteria be present. Which of these behaviors would lead the NP to suspect autism in a young child? A. receiving immunizations that use thimerosal as adjuvants B. abnormal verbal and nonverbal communication C. reliance of an imaginary friend for all interactions by a preschooler D. inability of a newborn to track mother's face from left to right
B. abnormal verbal and nonverbal communication
15. To determine your client's emotional and cognitive level of functioning when you are performing a mental status exam, you assess several individual behaviors. What is the term used when one ponders a deeper meaning beyond concrete and literal? A. thought process B. abstract reasoning C. consciousness D. perception
B. abstract reasoning
90. When does the onset of menses usually occur? A. between ages 10 and 11 B. between ages 12 and 13 C. between ages 14 and 15 D. between ages 16 and 17
B. between ages 12 and 13
66. You are performing a physical exam on a 3 year old who is new to your clinic. Which finding requires immediate further evaluation? A. child's heart rate increases during inspiration and decreases during expiration B. child has an equal A-P and transverse chest diameter C. child can stand briefly on one foot but cannot skip and hop D. child's weight plots in the 50th percentile, while the height plots at the 75th percentile
B. child has an equal A-P and transverse chest diameter
27. As people age, they try to maintain previous lifestyles that have contributed to their personalities. This is an example of A. activity theory B. continuity theory C. disengagement theory D. age stratification theory
B. continuity theory
103. Davy, age 4, is here for a well child visit. To assess for age appropriate fine motor skills, what activity would you ask him to perform? A. copy a circle B. cut on a line with scissors C. string beads D. copy a square
B. cut on a line with scissors
124. The body and the senses typically reach their peak during which stage of life? A. adolescence B. early adulthood C. middle adulthood D. late adulthood
B. early adulthood
112. Your 66 year old patient is able to correctly interpret the meaning of the proverb "A penny saved is a penny earned." This helps to establish the patient's expected ability to A. access long-term memory B. engage in abstract reasoning C. execute concrete operations D. follow complex instructions
B. engage in abstract reasoning
87. Why are younger children more predisposed to AOM than older children? A. more susceptible to the new bacteria they encounter B. eustachian tubes are more flaccid and more horizontal than those of older children C. have more viral infections, which precipitate otitis infections D. have more allergies, which are a frequent cause of serous otitis media
B. eustachian tubes are more flaccid and more horizontal than those of older children
25. Which of these infant characteristics is associated with readiness for the introduction of solid foods into an infant's diet? A. at least one tooth has emerged B. extrusion reflex has faded C. infant is at least 3 months of age D. infant wants to nurse every 3 to 4 hours
B. extrusion reflex has faded
69. What is the most common inherited cause of intellectual disability in children? A. down syndrome B. fragile X C. Tay-Sachs D. Huntington's
B. fragile X
37. Evaluating an older adult client according to the successful aging paradigm involves assessment of A. cognition, problem-solving, physical skills, and memory B. health, social engagement, mental activity, and life satisfaction C. vision, hearing, balance, strength D. coping, social support, financial resources, and living arrangement
B. health, social engagement, mental activity, and life satisfaction
85. Older adults face greater risks for fluid imbalance than young adults and middle adults due to which age-related factor? A. increased amounts of intracellular fluid and total body water B. higher proportion of fat to muscle cells C. faster speed of metabolism D. increased intestinal motility
B. higher proportion of fat to muscle cells
119. Which of the following is a result of changes in the cell-mediated immune function that occur from aging? A. fewer neutrophils, so older adults do not respond to local infections quickly B. increases in autoantibodies as a result of altered immune function C. fewer thrombocytes D. the pancytopenia of aging
B. increases in autoantibodies as a result of altered immune function
91. At birth, a baby's head circumference should A. range from 40 to 42 cm B. measure about 2 cm greater than the chest circumference C. be 25% larger than the height and weight percentiles D. measure 25% smaller than the height and weight percentiles
B. measure about 2 cm greater than the chest circumference
113. Common medications for treating ADHD include A. aminophylline and antihistamines B. methylphenidate, amphetamine, and their derivatives C. amphetamines and isotretinoin (Accutane) D. codeine and diazepam
B. methylphenidate, amphetamine, and their derivatives
62. Your 49 year old female client reports that she has not had a menstrual period in 3 months. She uses contraception. She is experiencing occasional poor sleep, sweating, and flushing. She believes she is entering menopause. Which step is appropriate to take next? A. initiate calcium supplementation B. obtain pregnancy test results C. send blood samples for FSH and estradiol levels D. refer her for a bone density test
B. obtain pregnancy test results
95. Because children are curious about sexual feelings and developmental changes in their bodies from the preschool years onward, education about these feelings and changes should begin during A. first year of life B. preschool years C. school age years D. adolescence
B. preschool years
78. After conducting the Tumbling E Snellen eye test on a verbal 4.5 year old boy, you determine that his vision is 20/30 in both eyes. Your next step is to A. refer to a pediatric ophthalmology clinic to be evaluated for glasses B. recheck vision at the next well child exam C. notify the preschool he will be attending in the fall that he needs to be seated in the front of the classroom D. reevaluate the child's vision in 3 months
B. recheck vision at the next well child exam
65. Josephine, age 6, is just learning to hop on one foot. You know that A. she should have been able to do this at age 3 B. she should have been able to do this at age 4 C. she should have been able to do this at age 5 D. this is a normal age-related activity for her
B. she should have been able to do this at age 4
61. Which cognitive change is expected in healthy older adults aged 65 and older? A. decrease in IQ B. slower information processing C. low capacity for learning D. decreased attentional focus
B. slower information processing
129. Kay reports that Kelly, her preschooler, sleeps a good deal of the time. She is concerned that Kelly is "not active enough." She also reports that Kelly is "abnormally fearful" about going to bed at night. You A. ask Kay to keep a record of how many hours each day and night Kelly sleeps and call you in 1 week to review B. tell Kay that this is normal C. evaluate Kelly for childhood anxiety and depression D. inquire about other patterns of behavior such as playing with others
B. tell Kay that this is normal
9. Victoria's mother brings her daughter for her 1 year checkup. As you are weighing her, you remember that at 1 year, her weight should be A. twice her birth weight B. triple her birth weight C. four times her birth weight D. at least 25 pounds
B. triple her birth weight
2. Shannon, age 4 months, is waiting in the exam room with her mother. When you walk into the room, you expect Shannon to A. begin crying B. turn her head toward the sound of the door or your voice C. not notice you D. smile at you
B. turn her head toward the sound of the door or your voice
105. Daisy, age 2, has a "blankie" that she carries with her at all times. Her mother is concerned that if she does not get rid of it, Daisy will remain attached to this blanket forever. What do you tell her? A. "Yes it is important to eliminate dependence on the blanket. Her attachment to it is also probably related to her thumb sucking." B. "Children should be weaned from their favorite toy or blanket gradually so that going without it is not so traumatic." C. "Don't worry. This normal attachment may last throughout the preschool years." D. "Try to reason with Daisy that this habit needs to be broken."
C. "Don't worry. This normal attachment may last throughout the preschool years."
24. Sally, age 12, asks you when you think her periods will start. What do you tell her? A. "They should have started by now" B. "They will probably start any day now" C. "There is a range of normal for girls from 11 to 16" D. "It might not happen until you're 15"
C. "There is a range of normal for girls from 11 to 16"
44. Jake, 8 years old, is brought in by his mother for evaluation of school problems. When he was 4 years old, his preschool teacher had expressed concern regarding his high activity level interfering with play with other children. Now, in third grade, he is underachieving in both math and reading. HIs teacher says that he constantly fidgets and bothers the other children. The school counselor has recommended that he be evaluated for ADHD. Which question would provide important additional information regarding the possible diagnosis of ADHD? A. "How do you think his behavior compares to the other 8 year olds you know?" B. "How does his teacher handle his behavior in school?" C. "What is he like at home?" D. "Has anyone in your extended family had a diagnosis of ADHD?"
C. "What is he like at home?"
16. Mrs. Groome calls the clinic to say she is distressed that her 3 month old baby is still not sleeping through the night. Your best response would be A. "at this age, infants are typically sleeping at least 10 hours a night without waking." B. "It may be helpful to give some rice cereal right before bedtime because she probably is waking up at night due to hunger." C. "the length of sleep for young babies is variable, but most sleep through the night by the end of the first year." D. "babies never sleep through the night until they are at least 6 months old."
C. "the length of sleep for young babies is variable, but most sleep through the night by the end of the first year."
77. What is the term used when the last child leaves home, either for school or to move out on his or her own? A. longed-for freedom B. silent guilt C. empty nest D. abandonment
C. empty nest
80. You are seeing Minnie, a 15 year old girl. You suspect that Minnie is suffering from bulimia, based on your physical exam. When assessing Minnie you observe the following A. an absence of bowel sounds, epigastric rumbling, and halitosis B. hyperactive bowel sounds, enlarged thyroid, and tachycardia C. erosion on the inside of the teeth, enlarged parotid glands, and a scar on the dorsal surface of a finger D. clear evidence of dehydration, sore gums, and subjective complaints of stomach pain
C. erosion on the inside of the teeth, enlarged parotid glands, and a scar on the dorsal surface of a finger
94. The mother of your 3 year old client is concerned because the child stutters. What should your approach be? A. refer to a speech clinic for a full evaluation B. refer to a pediatric neurologist C. explain that this can be normal until 4 or 5 years of age D. perform an articulation test on the child
C. explain that this can be normal until 4 or 5 years of age
57. Sleep in older adults is characterized by which pattern? A. increased time spent in REM sleep B. increased overall sleep time C. increased sleep latency D. increased proportion of deep sleep
C. increased sleep latency
14. Fragile X syndrome is usually diagnosed when a child A. is a newborn B. begins to walk C. is past the toddler stage D. begins puberty
C. is past the toddler stage
101. To best help parents foster social-emotional development in their preschooler, age 4, you advise them to A. give instructions rather than choices to the child B. set strict limits for behavior and quickly discipline for misbehavior C. provide frequent opportunities to interact with other children D. ask questions that direct the child to think about how others are feeling
C. provide frequent opportunities to interact with other children
127. Assessment of an adolescent using the HEADSS framework involves asking the teen about A. habits B. exercise C. school D. disabilities
C. school
75. At what stage of sexual development should a boy expect to begin to have nocturnal emissions? A. when he starts to get facial hair B. when his scrotal sac begins to darken in color C. six to twelve months after his penis begins to enlarge D. at 15 years of age regardless of his sexual development
C. six to twelve months after his penis begins to enlarge
20. A 75 year old man comes to your office with concerns about memory loss. He is worried that he has Alzheimer's disease. Which finding in the patient would be cause for concern? A. often misplaces his car and house keys B. has difficulty remembering some of the names of people he has recently met C. sometimes forgets the names of his children D. recalls the names of only seven of the nine medications he is currently taking
C. sometimes forgets the names of his children
22. Amanda states that her baby Jill, age 18 months, will not go to bed without her bottle. You tell her that if the baby must have a bottle at night, it should be a bottle containing A. formula B. breast milk C. diluted juice D. plain water
D. plain water
19. Suzanne's 8 year old daughter, Natasha, has ADHD. She asks if Natasha will "outgrow" her ADHD. You respond A. "Yes. When they become young adults, most children outgrow the problem." B. "No. Unfortunately, Natasha will have this for the rest of her life." C. "No, but there are many treatments available that we need to start now." D. "About 50% or more of affected children will continue to have some difficulty as adolescents and adults."
D. "About 50% or more of affected children will continue to have some difficulty as adolescents and adults."
28. At what age would a child be expected to remember a string of six numbers and repeat them backward? A. 3 years B. 6 years C. 9 years D. 12 years
D. 12 years
54. Infants born at term are expected to sit well without support by what age? A. 1 to 2 months B. 3 to 4 months C. 5 to 6 months D. 7 to 8 months
D. 7 to 8 months
3. Which of these language behaviors would be cause for concern at a primary care visit? A. 1 year old cannot say more than two words with meaning B. an 18 month old uses unintelligible jargon and has only a few words that are intelligible to family members C. a 2 year old uses only two to three word sentences D. a 3 year old does not use three to five word sentences
D. a 3 year old does not use three to five word sentences
86. Which strategy for care of older adults is inconsistent with an approach supportive of aging in place? A. make changes to the home environment that can accommodate an individual's changing needs B. refer for home care and adult day-care services C. hire assistants to help with activities of daily living D. emphasize the individual's limitations and likely need for long-term care placement
D. emphasize the individual's limitations and likely need for long-term care placement
46. The mother of your 12 year old female client is concerned because all her daughter's friends have started their periods, but her daughter has not. Upon physical exam, you note that the daughter's pubic hair and breast development are both at Tanner stage III. Your next step would be to A. refer to an endocrinologist B. start the girl on birth control pills to encourage her menses to start C. order bone age x-rays D. explain to the mother and child that this appears to be normal for this child
D. explain to the mother and child that this appears to be normal for this child
72. The statement that adults in middle age look beyond themselves and are concerned about more global issues is an example of which stage of Erikson's theory? A. ego integrity vs despair B. ego differentiation vs work role preoccupation C. ego transcendence vs ego preoccupation D. generativity vs self absorption
D. generativity vs self absorption
58. At what age/stage of development would you expect a boy to reach his adult height? A. one year after the enlargement of the testicles B. when his voice changes C. by the time he is 17 D. he may continue to grow past his teenage years
D. he may continue to grow past his teenage years
67. Risks for automobile accidents are increased in older adult drivers due to which normal changes associated with aging? A. decreased ability to understand driving-related dangers B. lack of recognition of their own physical challenges C. magnified physiological response to stressful situations D. increased reaction time
D. increased reaction time
60. Erikson's final ego stage in older adults occurs when successful resolution results in these adults feeling comfortable with their life choices and the knowledge that they would have done everything the same way again. What is this ego stage called? A. generativity vs stagnation B. workaholism vs retirement C. success vs failure D. integrity vs despair
D. integrity vs despair
125. Delayed development can be the result of malnutrition from a deficiency of protein, calories, or both. This is referred to as protein energy malnutrition, kwashiorkor, or A. protein-wasting disease B. hypermetabolic disease C. cachexia D. marasmus
D. marasmus
10. You are seeing Sarah, 24, who is 8 weeks pregnant with her first child. She is concerned because of a family history of cystic fibrosis. You recommend that she A. see a pulmonologist B. undergo chorionic villus sampling C. have a sweat chloride test done D. seek out genetic counseling
D. seek out genetic counseling
96. Which theory of aging focuses on older adults' development of specific strategies to manage losses of function over time? A. disengagement theory B. activity/developmental task theory C. person-environment fit theory D. selective optimization with compensation theory
D. selective optimization with compensation theory
84. Germaine, age 12 years, comes to see you for her checkup. After weighing her, you note that her BMI is at the 96th percentile on the National Center for Health Statistics graph. Your response to this will be guided by the knowledge that A. her size is acceptable for her age, and you will continue to follow up weight during subsequent checkups B. she has been in a phase of rapid growth, and it will slack off within a year C. she is healthy but may be at risk for an eating disorder D. she is obese and at risk for HTN and DM
D. she is obese and at risk for HTN and DM
110. Which age-related changes in the respiratory system make drugs like albuterol and salmeterol less effective in older adults? A. the vital capacity of the lungs decreases B. residual lung volume decreases C. there is a decrease in cellular oxygen uptake in lung tissue D. there is a decrease in the number of beta receptors
D. there is a decrease in the number of beta receptors
33. The mother of a 2 year old is concerned about her toddler's frequent temper tantrums and asks how to decrease their frequency. To address her concern, you advise her to A. firmly tell the child "no" when a tantrum is beginning B. place the child in time out during every tantrum C. talk with the child about appropriate ways to communicate anger or disappointment D. try to avoid situations that tend to provoke tantrums such as hunger, fatigue, and frustration
D. try to avoid situations that tend to provoke tantrums such as hunger, fatigue, and frustration
