Chapter 8 Growth & Nutrition

Question 1

The gonads begin to secrete estrogen and testosterone during
a. infancy.
b. puberty.
c. pregnancy.
d. early adulthood.

Answer 1

ANS: B
At puberty, the gonads secrete testosterone and estrogen. As a result, secondary sex
characteristics (e.g., genitalia growth) begin to appear. Maturation occurs at a mean age of
11.5 years in females and 13.5 years in males.

Question 2

Developmental changes of puberty are caused mainly by the interaction of the pituitary gland,
gonads, and
a. hypothalamus.
b. islet cells.
c. thalamus.
d. thymus.

Answer 2

ANS: A
Under the influence of the hypothalamus, pituitary gland, and gonads, developmental changes
of puberty are established.

Question 3

After 50 years of age, stature
a. becomes fixed.
b. begins a barely perceptible secondary increase.
c. increases at a rate of 0.5 cm/year.
d. declines.

Answer 3

ANS: D
As the individual reaches 50 years of age, the intervertebral disk begins to thin and become
more compressed, which leads to a decline in stature.

Question 4

By 10 to 12 years of age, lymphatic tissues are about
a. 25% of adult size.
b. 50% of adult size.
c. the same as adult size.
d. twice the size of those in the adult.

Answer 4

ANS: D
Lymphatic tissues are small compared with total body size, but they are almost fully
developed at birth. They grow fast and are about twice the adult size by age 10 to 12 years.

Question 5

During adolescence, the head size normally increases as a result of
a. sinus development.
b. brain mass increase.
c. evolution of lymphatic tissue.
d. hypertrophy of myelin.

Answer 5

ANS: A
As the facial sinuses grow, the head size enlarges its surface area to accommodate their
growth.

Question 6

Gender-specific skeletal differences first occur during
a. the second stage of fetal development.
b. late infancy.
c. early childhood.
d. adolescence.

Answer 6

ANS: D
During adolescence, females develop a wider pelvis and males develop broad shoulders;
males transition from a slight increase in body fat to more lean muscle mass in later puberty,
whereas females maintain an increase in adipose tissue throughout adolescence.

Question 7

Mrs. Layton is a 33-year-old patient who is obese. Most adult obesity begins
a. in adolescence.
b. in childhood.
c. after the skeletal growth is completed.
d. once sexual maturation is complete.

Answer 7

ANS: A
Most adult obesity begins in adolescence.

Question 8

The legs are the fastest growing body part during
a. early infancy.
b. late infancy.
c. childhood.
d. early adulthood.

Answer 8

ANS: C
Legs grow the fastest during childhood, whereas the trunk grows fastest in infancy, and the
skeletal muscles and organs grow fastest in early adulthood.

Question 9

Skeletal mass and organ systems double in size during
a. infancy.
b. early childhood.
c. adolescence.
d. early adulthood.

Answer 9

ANS: C
During puberty, sex steroids stimulate secretion of growth hormone, causing the organs and skeletal mass to double in size.

Question 10

Optimal infant birth weight is difficult for pregnant adolescents to obtain because
a. they have not completed their own growth spurt.
b. there are insufficient uterine supporting structures.
c. the amniotic fluid is variable in pregnant adolescents.
d. blood volume has not reached adult proportions.

Answer 10

ANS: A
Pregnant adolescents younger than 16 years, or less than 2 years from menarche, may still be
in their growth spurt. They may require higher weight gains during pregnancy to achieve an
optimal infant birth weight. There are sufficient uterine supporting structures in the pregnant
adolescent. The amnionic fluid is not variable in pregnant adolescents. Blood volume has
reached adult proportions in the pregnant adolescent.

Question 11

How much of the weight gained during a normal pregnancy is accounted for by the fetus?
a. Less than 5 pounds
b. 6 to 8 pounds
c. 9 to 12 pounds
d. 13 to 30 pounds

Answer 11

ANS: B
The growing fetus accounts for only 6 to 8 pounds of the total weight gained. The remainder
results from an increase in maternal tissues (e.g., placenta, amniotic fluid, uterus, blood and fluid volume, breasts, and fat reserves).

Question 12

The rate of weight gain during pregnancy is expected to be
a. greatest in the first trimester.
b. greatest in the second trimester.
c. greatest in the third trimester.
d. about the same in each trimester.

Answer 12

ANS: B
The rate of weight gain is slow during the first trimester, rapid during the second trimester,
and less rapid during the third trimester. Maternal tissue growth accounts for most of the
weight gained in the first and second trimesters, whereas fetal growth accounts for weight
gained during the third trimester.

Question 13

During a preventive healthcare visit, Ms. G, an older patient, states that she is getting shorter.
She says that her son mentioned that her change in stature became noticeable to him during
his last visit with her. Her posture appears straight and aligned. When addressing Ms. G.’s
present concerns, it is most important to inquire about
a. the number of pregnancies.
b. her parents’ heights.
c. a history of scoliosis.
d. her usual height and weight.

Answer 13

ANS: D
Stature declines after 50 years of age because of progressive thinning of the intervertebral
disks, so it is important to determine the patient’s height and weight at this age as a baseline for future trending.

Question 14

Over the past 2 decades, there has been a trend toward
a. increased osteoporosis.
b. preservation of height.
c. obesity in older adults.
d. preservation of muscle mass.

Answer 14

ANS: C
An increase in overweight and obese older adults has been documented over the past 15 to 20
years. A decrease in weight for height and body mass index has been found with increasing
age in patients between 70 and 89 years of age

Question 15

Milestone achievements are data most likely to appear in the history of
a. adolescents.
b. infants.
c. school-age children.
d. young adults.

Answer 15

ANS: B
As part of developmental assessment in infants, milestone achievements at certain ages, such
as crawling, laughing, picking up their head, and turning over, are recorded.

Question 16

To estimate an individual’s frame size, the examiner should measure
a. skull circumference.
b. the length from the olecranon process to the acromion process.
c. elbow breadth.
d. hip circumference.

Answer 16

ANS: C
With the patient’s right arm extended and the elbow flexed to 90 degrees, measure the elbow
breadth using a measuring device or skinfold calipers, held on the same plane as the upper
arm, on the two most prominent bones of the elbow.

Question 17

Healthy term babies generally double their birth weight by what age?
a. 3 months
b. 5 months
c. 9 months
d. 12 months

Answer 17

ANS: B
In general, healthy infants double their birth weight by 4 to 5 months of age and triple their
birth weight by 12 months of age. Formula-fed infants are heavier after the first 6 months of
life than breast-fed infants; they grow faster in the first 6 months of life and experience slower
growth in the second 6 months of the first year.

Question 18

Infants born to the same parents are normally within which range of weight of each other?
a. 6 ounces
b. 12 ounces
c. 1 pound
d. 2 pounds

Answer 18

ANS: A
Siblings born at term to the same parents usually weigh within 6 ounces of each other.

Question 19

To measure head circumference, the tape is wrapped snugly around the child’s head at the
occipital protuberance and the
a. supraorbital prominence.
b. brow line.
c. nasal bridge.
d. chin.

Answer 19

ANS: A
The measuring tape should be snugly wrapped around the child’s head at the occipital
protuberance and supraorbital prominence, thereby documenting the largest circumference.
Care should be taken to ensure that the tape does not cut the skin. Make the reading to the
nearest 0.5 cm or inch, and remember to remeasure the head circumference at least once to
check the accuracy of your measurement.

Question 20

Between 5 and 24 months of life, the infant’s chest circumference is normally
a. about equal to the head circumference.
b. greater than head circumference by 2 inches.
c. smaller than head circumference by about 4 inches.
d. at least 2 inches smaller than head circumference.

Answer 20

ANS: A
Between the ages of 5 months and 2 years, the infant’s chest circumference should closely
approximate the head circumference; the ratio should be monitored so that possible
microcephaly can be identified.

Question 21

In clinical practice, the Ballard Assessment Tool is used to assess a newborn’s
a. length.
b. weight.
c. lung maturity.
d. gestational age.

Answer 21

ANS: D
The Ballard Assessment Tool assesses six physical and six neuromuscular characteristics and
is administered within 36 hours of birth to confirm the newborn’s gestational age.

Question 22

Which situation poses the most concern?
a. The child whose weight and height ratios have remained at the 50th percentile
b. The child whose weight and height ratios have stayed between the 90th and 95th
percentiles
c. The child whose weight and height ratios have never been above the 50th
percentile
d. The child whose weight and height ratios have dropped 15 percentiles since the last visit

Answer 22

ANS: D
Over time, interval measurements should demonstrate that the child has established a growth
pattern, indicated by consistently following a percentile curve on the growth chart. Greatest
concern is for the child who is trending down in a more dramatic fashion. Children who
suddenly fall below or rise above their established percentile growth curve should be
examined more closely to determine the cause.

Question 23

The upper-to-lower segment ratio should be calculated
a. bimonthly for the first year of life.
b. annually for the first 5 years.
c. only when a child is suspected of having a growth problem or unusual body
proportions.
d. in children of first-generation immigrants.

Answer 23

ANS: C
The upper-to-lower segment ratio is calculated when a child is suspected of having a growth
problem or unusual body proportions.

Question 24

Which statement regarding female pubertal changes is true?
a. Most adolescent girls will develop breasts before they develop pubic hair.
b. Peak height velocity should occur after menarche.
c. Breast asymmetry is an abnormal finding.
d. Menarche should occur by Tanner breast stage 2.

Answer 24

ANS: A

In two-thirds of the population of girls, breasts begin to develop before pubic hair. Peak height
velocity actually occurs about 1 year before menarche, breast asymmetry is common, and
menarche occurs after Tanner breast stage 2. Peak height velocity will not occur after
menarche. Breast asymmetry is not an abnormal finding. Menarche does not generally occur
by Tanner breast stage 2.

Question 25

What is the youngest age at which pubic hair growth in the male may be considered normal?
a. 7 years
b. 8 years
c. 9 years
d. 10 years

Answer 25

ANS: C
In males, sexual development before 9 years of age is precocious puberty and is considered an
abnormal finding; sexual development after 9 years of age is considered normal puberty.

Question 26

A pregnant woman of normal prepregnancy weight should be expected to gain how much
weight per week during the second and third trimesters of pregnancy?
a. 1 pound
b. 3 pounds
c. 2 pounds
d. 4 pounds

Answer 26

ANS: A
Expected weight gain in the first trimester is variable, between 1 and 2 kg (2 to 4 pounds);
however, in the second and third trimesters, weekly weight gain should be around 0.45 kg (1
pound) per week.

Question 27

A prominent forehead, large nose, large jaw, and elongation of the facial bones and
extremities are signs of
a. infantile hydrocephalus.
b. acromegaly.
c. Cushing syndrome.
d. achondroplasia.

Answer 27

ANS: B
A prominent forehead, large nose, large jaw, and elongation of the facial bones and
extremities are all prominent characteristics of acromegaly; a prominent forehead can also
occur with achondroplasia, but hypoplasia of the midface differentiates the two.

Question 28

Round face, preauricular fat, hyperpigmentation, and ―buffalo hump‖ in the posterior cervical
area are associated with
a. infantile hydrocephalus.
b. acromegaly.
c. Cushing syndrome.
d. achondroplasia.

Answer 28

ANS: C
Round face, preauricular fat, hyperpigmentation, and a buffalo hump in the posterior cervical
area are all commonly associated with Cushing syndrome; the buffalo hump distinguishes
Cushing syndrome from the other choices.

Question 29

Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her
current weight. In your patient teaching with her, you explain the importance of
macronutrients. Which of the following is a macronutrient?
a. Iron
b. Thiamin
c. Calcium
d. Fat

Answer 29

ANS: D
Carbohydrates, protein, and fat are referred to as macronutrients because they are required in
large amounts. Iron, thiamin, and calcium are minerals.

Question 30

Which is the most vital nutrient?
a. Protein
b. Carbohydrate
c. Fat
d. Water

Answer 30

ANS: D
Water is the most vital nutrient. A person can exist without food for several weeks but without
water for only a few days.

Question 31

Which of the following is the most accurate reflection of an individual’s food intake?
a. 24-hour diet recall
b. Food diary
c. Computerized nutrient analysis
d. Serum protein assay

Answer 31

ANS: B
The food diary is a record of intake as it happens, making this method the most accurate
reflection of an individual’s food intake.

Question 32

Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because
she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet?
a. Ascorbic acid
b. Vitamin B12
c. Folate
d. Fiber

Answer 32

ANS: B
The nutrients that may be deficient in a vegetarian diet, if not carefully planned, include
proteins, calcium, iron, vitamin B12, and vitamin D.

Question 33

Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which
medication is frequently associated with weight gain?
a. Diuretics
b. Oral hypoglycemics
c. Laxatives
d. Steroids

Answer 33

ANS: D
Medications that contribute to weight gain include steroids, oral contraceptives,
antidepressants, and insulin.

Question 34

Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would
be
a. normal body weight.
b. overweight.
c. obese.
d. extremely obese.

Answer 34

ANS: C
An obese BMI is 30 to 39.9. A normal BMI is less than 24. An overweight BMI is 25 to 29.9.
An extremely obese BMI is greater than 40.

Question 35

A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings
reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears
healthy otherwise. You should ask her if she
a. binges and vomits.
b. has regular menstrual periods.
c. has constipation frequently.
d. is cold intolerant.

Answer 35

ANS: A
In young adults, usually female, bradycardia, knuckle scars, and tooth decay are signs of
chronic, self-induced vomiting characteristic of bulimia. Amenorrhea can occur from
increased physical activity or anorexia. Constipation and cold intolerance are usually
symptoms of anorexia nervosa.

Question 36

Which are signs and symptoms of hydrocephalus? (Select all that apply.)
a. Early closed suture lines
b. Hyperreflexia Y
c. Irritable, poor feeding Y
d. Does not meet expected height and weight
e. Difficulty holding head up Y
f. Rapidly increasing head circumference Y

Answer 36

ANS: B, C, E, F
Signs and symptoms of hydrocephalus include hyperreflexia, difficulty holding head up,
irritability, lack of energy, rapidly increasing head circumference, and poor feeding. Early closed suture lines and inability to meet expected height and weight do not indicate
hydrocephalus.