L2-1520-E2 Flashcards
The plan of care for a patient newly diagnosed with diabetes includes health promotion with the tertiary
prevention measure of
a. avoiding carcinogens.
b. foot screening techniques.
c. glaucoma screening.
d. seat belt use.
b. foot screening techniques.
Foot screening is considered a tertiary prevention measure, one that minimizes the problems with foot
ulcers, an effect of diabetic disease and disability. Avoiding carcinogens is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Glaucoma screening is considered secondary screening—measures designed to
identify individuals in an early state of a disease process so that prompt treatment can be started. Seat
belt use is considered primary prevention—those strategies aimed at optimizing health and disease prevention
in general and not linked to a single disease entity.
When teaching a patient with a family history of hypertension about health promotion, the nurse describes
blood pressure screening as _____ prevention.
a. illness
b. primary
c. secondary
d. tertiary
c. secondary
Blood pressure screening is considered secondary prevention. It is a measure designed to identify individuals
in an early state of a disease process so that prompt treatment can be started. Illness prevention is
considered primary prevention. Primary prevention measures are those strategies aimed at optimizing
health and disease prevention in general and not linked to a single disease entity. Tertiary prevention
measures are those that minimize the effects of disease and disability.
The primary health care nurse would recommend screening based on known risk factors, because they
can
a. eliminate the possibility of developing a condition.
b. identify appropriate treatment guidelines.
c. initiate treatment of a condition or disease.
d. make a substantial difference in morbidity and mortality.
d. make a substantial difference in morbidity and mortality.
Screenings are typically indicated and recommended if the effort makes a substantial difference in morbidity
and/or mortality of conditions, and they are safe, cost effective, and accurate. Ideally a screening
measure will accurately differentiate individuals who have a condition from those who do not have a
condition 100% of the time; however, there may be a false-negative result, or the patient may develop a
condition after the screening was conducted. A screening does not specify treatment guidelines; the
screen provides results, and the health care provider identifies the treatment. The goal of screening is to
identify individuals in an early state of a disease so that prompt treatment can be initiated. The screening
results are used for this purpose.
At the well-child clinic, the nurse teaching a mother about health promotion activities describes immunizations
as
a. unique for children.
b. primary prevention.
c. secondary prevention.
d. tertiary prevention.
b. primary prevention.
Immunizations/vaccinations are considered primary prevention measures, those strategies aimed at optimizing
health and disease prevention in general. Immunizations/vaccinations are primary prevention
measures for individuals across the life span, not just children. Secondary prevention measures are those
designed to identify individuals in an early state of a disease process so that prompt treatment can be
started. Tertiary prevention measures are those that minimize the effects of disease and disability.
The nurse in a newly opened community health clinic is developing a program for the individuals considered
at greatest risk for poor health outcomes. The group is considered the
a. global community.
b. sedentary society.
c. unmotivated population.
d. vulnerable populations.
d. vulnerable populations.
Vulnerable populations refers to groups of individuals who are at greatest risk for poor health outcomes.
The entire world is the global community. Sedentary refers to the lifestyles of people worldwide who
have epidemic rates of obesity and many other related chronic diseases. Unmotivated population refers
to the individuals who have not demonstrated interest in changing.
When there is evidence that supports a screening for an individual patient but not for the general population,
the nurse would expect the United States Preventive Services Task Force Grading to be what?
a. No recommendation for or against
b. Recommends
c. Recommends against
d. Strongly recommends
a. No recommendation for or against
The United States Preventive Services Task Force Grading is an example of how evidence is used to
make guidelines and determine priority. When there is evidence that supports a screening for an individual
patient but not for the general population, there is no recommendation for or against screening the
general population. Recommends is the grading when there is high certainty that the net benefit is moderate
or there is moderate certainty that the net benefit is moderate to substantial. Recommends against is
the grading when there is moderate or high certainty that the intervention has no net benefit or that the
harms outweigh the benefits. Strongly recommends is the grading when there is high certainty that the
net benefit is substantial.
Interrelated concepts to professional nursing a nurse manager would consider when addressing concerns
about the quality of health promotion include
a. culture.
b. development.
c. evidence.
d. nutrition.
c. evidence.
The interrelated concepts to professional nursing include evidence, health care economics, health policy,
and patient education. Culture is a patient attribute concept. Development is a patient attribute concept.
Nutrition is a health and illness concept.
The nurse manager of a pediatric clinic could confirm that the new nurse recognized the purpose of the
HEADSS Adolescent Risk Profile when the new nurse responds that it is used to assess for needs related
to
a. anticipatory guidance.
b. low-risk adolescents.
c. physical development.
d. sexual development.
a. anticipatory guidance
The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which assesses
home, education, activities, drugs, sex, and suicide for the purpose of identifying high-risk adolescents
and the need for anticipatory guidance. It is used to identify high-risk, not low-risk, adolescents. Physical
development is assessed with anthropometric data. Sexual development is assessed using physical
examination.
The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, the expected
stage of development for a preschooler is
a. concrete operational.
b. formal operational.
c. preoperational.
d. sensorimotor.
c. preoperational.
The expected stage of development for a preschooler (3 to 4 years old) is preoperational. Concrete operational
describes the thinking of a school-age child (7 to 11 years old). Formal operational describes the
thinking of an individual after about 11 years of age. Sensorimotor describes the earliest pattern of thinking
from birth to 2 years old.
The school nurse talking with a high school class about the difference between growth and development would best describe growth as
a. processes by which early cells specialize.
b. psychosocial and cognitive changes.
c. qualitative changes associated with aging.
d. quantitative changes in size or weight.
d. quantitative changes in size or weight.
Growth is a quantitative change in which an increase in cell number and size results in an increase in
overall size or weight of the body or any of its parts. The processes by which early cells specialize are
referred to as differentiation. Psychosocial and cognitive changes are referred to as development. Qualitative
changes associated with aging are referred to as maturation.
The most appropriate response of the nurse when a mother asks what the Denver II does is that it
a. can diagnose developmental disabilities.
b. identifies a need for physical therapy.
c. is a developmental screening tool.
d. provides a framework for health teaching.
c. is a developmental screening tool.
The Denver II is the most commonly used measure of developmental status used by health care professionals;
it is a screening tool. Screening tools do not provide a diagnosis. Diagnosis requires a thorough
neurodevelopment history and physical examination. Developmental delay, which is suggested by
screening, is a symptom, not a diagnosis. The need for any therapy would be identified with a comprehensive
evaluation, not a screening tool. Some providers use the Denver II as a framework for teaching
about expected development, but this is not the primary purpose of the tool.
To plan early intervention and care for an infant with Down syndrome, the nurse considers knowledge
of other physical development exemplars such as
a. cerebral palsy.
b. failure to thrive.
c. fetal alcohol syndrome.
d. hydrocephaly.
d. hydrocephaly.
Hydrocephaly is also a physical development exemplar. Cerebral palsy is an exemplar of adaptive developmental
delay. Failure to thrive is an exemplar of social/emotional developmental delay. Fetal alcohol
syndrome is an exemplar of cognitive developmental delay.
To plan early intervention and care for a child with a developmental delay, the nurse would consider
knowledge of the concepts most significantly impacted by development, including
a. culture.
b. environment.
c. functional status.
d. nutrition.
c. functional status.
Function is one of the concepts most significantly impacted by development. Others include sensory-perceptual,
cognition, mobility, reproduction, and sexuality. Knowledge of these concepts can help the
nurse anticipate areas that need to be addressed. Culture is a concept that is considered to significantly
affect development; the difference is the concepts that affect development are those that represent major
influencing factors (causes), hence determination of development and would be the focus of preventive
interventions. Environment is considered to significantly affect development. Nutrition is considered to
significantly affect development.
A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to her
toys and makes up stories. The mother wants her child to have a psychologic evaluation. The nurse’s
best initial response is to
a. refer the child to a psychologist.
b. explain that playing make believe with dolls and people is normal at this age.
c. complete a developmental screening.
d. separate the child from the mother to get more information.
b. explain that playing make believe with dolls and people is normal at this age.
By the end of the fourth year, it is expected that a child will engage in fantasy, so this is normal at this
age. A referral to a psychologist would be premature based only on the complaint of the mother. Completing
a developmental screening would be very appropriate but not the initial response. The nurse
would certainly want to get more information, but separating the child from the mother is not necessary
at this time.
A 17-year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so needy
and acting like a child. The best response of the nurse is that in the hospital, adolescents
a. have separation anxiety.
b. rebel against rules.
c. regress because of stress.
d. want to know everything.
c. regress because of stress.
Regression to an earlier stage of development is a common response to stress. Separation anxiety is most
common in infants and toddlers. Rebellion against hospital rules is usually not an issue if the adolescent
understands the rules and would not create childlike behaviors. An adolescent may want to “know everything” with their logical thinking and deductive reasoning, but that would not explain why they
would act like a child.
Which milestone is developmentally appropriate for a 2-month-old infant?
a. Pulled to a sitting position, head lag is absent.
b. Pulled to a sitting position, the infant is able to support the head when the trunk is lifted.
c. The infant can lift his or her head from the prone position and briefly hold the head erect.
d. In the prone position, the infant is fully able to support and hold the head in a straight line.
c. The infant can lift his or her head from the prone position and briefly hold the head erect.
A 2-month-old infant is able to briefly hold the head erect when in a prone position. If a parent were holding the infant against the parent’s shoulder, the infant would be able to lift his or her head
briefly.
-head lag is
present when pulled to a sitting position.
-4 months-infant can easily lift his or her head and hold it steadily erect
when in prone position.
Approximately how much would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year
of age?
a. 14 3/4 lb
b. 22 1/8 lb
c. 29 1/2 lb
d. Unable to estimate weigh at 1 year
b. 22 1/8 lb
An infant triples birth weight by 1 year of age.
An infant doubles birth weight by 6 months of age.
An infant quadruples birth weight by 2 years of age.
Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight.
Which statement made by a mother is consistent with a developmental delay?
a. “I have noticed that my 9-month-old infant responds consistently to the sound of his name.”
b. “I have noticed that my 12-month-old child does not get herself to a sitting position or pull to
stand. ”
c. “I am so happy when my 1 1/2-month-old infant smiles at me.”
d. “My 5-month-old infant is not rolling over in both directions yet.”
b. “I have noticed that my 12-month-old child does not get herself to a sitting position or pull to
stand. ”
Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old
child does not perform these activities, it may be indicative of a developmental delay.
- 9 months- responds to name (can hear and interpret sound)
- A social smile is present by 2 months.
- Rolling in both directions not critical milestone until 6 months.
The nurse is performing a routine assessment on a 14-month-old infant and notes that the anterior
fontanel is closed. This should be interpreted as a(n)
a. Normal finding
b. Questionable finding—infant should be rechecked in 1 month
c. Abnormal finding—indicates need for immediate referral to practitioner
d. Abnormal finding—indicates need for developmental assessment
a. Normal finding
This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. The posterior
fontanel closes between 2 and 3 months of age.
The nurse advises the mother of a 3-month-old exclusively breastfed infant to
a. Start giving the infant a vitamin D supplement.
b. Start using an infant feeder and add rice cereal to the formula.
c. Start feeding the infant rice cereal with a spoon at the evening feeding.
d. Continue breastfeeding without any supplements.
a. Start giving the infant a vitamin D supplement.
Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively
breastfed need vitamin D supplements to prevent rickets.
-Breast milk also lacks fluoride, which should also be supplemented.
Solid foods not typical until 4-6 months of age
At what age is an infant first expected to locate an object hidden from view?
a. 4 months of age
b. 6 months of age
c. 9 months of age
d. 20 months of age
c. 9 months of age
By 9 months of age, an infant will actively search for an object that is out of sight.
The parents of a newborn infant state, “We will probably not have our baby immunized because we
are concerned about the risk of our child being injured.” What is the nurse’s best response?
a. “It is your decision.”
b. “Have you talked with your parents about this? They can probably help you think about this
decision. ”
c. “The risks of not immunizing your baby are greater than the risks from the immunizations.”
d. “You are making a mistake.”
c. “The risks of not immunizing your baby are greater than the risks from the immunizations.”
Although immunizations have been documented to have a negative effect in a small number of
cases, an unimmunized infant is at greater risk for development of complications from childhood
diseases than from the vaccines.
Although it’s the parent’s decision, the nurse has a responsibility to inform
parents about the risks to infants who are not immunized.
The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown
shopper at the grocery store. What is the best response for the nurse to make to the mother?
a. “You could consider leaving the infant more often with other people so he can adjust.”
b. “You might consider taking him to the doctor because he may be ill.”
c. “Have you noticed whether the baby is teething?”
d. “This is a sign of stranger anxiety and demonstrates healthy attachment.”
d. “This is a sign of stranger anxiety and demonstrates healthy attachment.”
The nurse can reassure parents that healthy attachment is manifested by stranger anxiety in late
infancy.
Which statement concerning physiologic factors is true?
a. The infant has a slower metabolic rate than an adult.
b. An infant has an inability to digest protein and lactase.
c. Infants have a slower circulatory response than adults do.
d. The kidneys of an infant are less efficient in concentrating urine than an adult’s kidneys.
d. The kidneys of an infant are less efficient in concentrating urine than an adult’s kidneys.
The infant’s kidneys are not as effective at concentrating urine compared with an adult’s because
of immaturity of the renal system and slower glomerular filtration rates. This puts the infant at greater risk for fluid and electrolyte imbalance.
Which is a priority in counseling parents of a 6-month-old infant?
a. Increased appetite from secondary growth spurt
b. Encouraging the infant to smile
c. Securing a developmentally safe environment for the infant
d. Strategies to teach infants to sit up
c. Securing a developmentally safe environment for the infant
Safety is a primary concern as an infant becomes increasingly mobile.
A mother of a 2-month-old infant tells the nurse, “My child doesn’t sleep as much as his older brother
did at the same age.” What is the best response for the nurse?
a. “Have you tried to feed the baby more often?”
b. “Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.”
c. “It is helpful to keep a record of your baby’s eating, waking, sleeping, and elimination patterns and
to come back in a week to discuss them.”
d. “This infant is difficult. It is important for you to identify what is bothering the baby.”
b. “Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.”
Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with
some infants sleeping only 2 to 3 hours at a time.
The mother of a 10-month-old infant tells the nurse that her infant “really likes cow’s milk.” What is
the nurse’s best response to this mother?
a. “Milk is good for him.”
b. “It is best to wait until he is a year old before giving him cow’s milk.”
c. “Limit cow’s milk to his bedtime bottle.”
d. “Mix his cereal with cow’s milk and give him formula in a bottle.”
b. “It is best to wait until he is a year old before giving him cow’s milk.”
It is best to wait until the infant is at least 1 year old before giving him cow’s milk because of the
risk of allergies and intestinal problems. Cow’s milk protein intolerance is the most common food
allergy during infancy.
The mother of a 10-month-old infant asks the nurse about beginning to wean her child from his bottle.
Which statement by the mother suggests that the child is not ready to be weaned?
a. “My son is frequently throwing his bottle down.”
b. “The baby takes a few ounces of formula from the bottle.”
c. “He is constantly chewing on the nipple. It concerns me.”
d. “He consistently is sucking.”
d. “He consistently is sucking.”
Consistent sucking is a sign that the child is not ready to be weaned.
Which is appropriate play for a 6-month-old infant?
a. Pat-a-cake, peek-a-boo
b. Ball rolling, hide-and-seek game
c. Bright rattles and tactile toys
d. Push and pull toys
a. Pat-a-cake, peek-a-boo
Six-month-old children enjoy playing pat-a-cake and peek-a-boo.
9 months: rolling a ball and playing hide-and-seek
4 months: bright rattles and tactile toys
12 months: push and pull toys
Which statement by a mother indicates that her 5-month-old infant is ready for solid food?
a. “When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow.”
b. “She has just started to sit up without any support.”
c. “I am surprised that she weighs only 11 pounds. I expected her to have gained some weight.”
d. “I find that she really has to be encouraged to eat.”
b. “She has just started to sit up without any support.”
Sitting is a sign that the child is ready to begin with solid foods.
Should not start solid foods if:
- cannot get food to back of mouth to swallow
- infant weights <13 lbs and has lack of interest in eating
- difficult feeders
A mother asks the nurse, “When should I begin to clean my baby’s teeth?” What is the best response
for the nurse to make?
a. “You can begin when all her baby teeth are in.”
b. “You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth.”
c. “I don’t think you have to worry about that until she can handle a toothbrush.”
d. “You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary.”
d. “You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary.”
An infant’s teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or
a face cloth is appropriate.
A 3-month-old infant born at 38 weeks of gestation will hold a rattle if it is put in her hands, but she
will not voluntarily grasp it. The nurse should interpret this as
a. Normal development
b. Significant developmental lag
c. Slightly delayed development as a result of prematurity
d. Suggestive of a neurologic disorder such as cerebral palsy
a. Normal development
This is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months
and then gradually becomes voluntary.
In terms of fine motor development, what should the 7-month-old infant be able to do?
a. Transfer objects from one hand to the other.
b. Use thumb and index finger in crude pincer grasp.
c. Hold crayon and make a mark on paper.
d. Release cubes into a cup.
a. Transfer objects from one hand to the other.
By age 7 months, infants can transfer objects from one hand to the other, crossing the midline.
In terms of gross motor development, what would the nurse expect a 5-month-old infant to do?
a. Roll from abdomen to back.
b. Roll from back to abdomen.
c. Sit erect without support.
d. Move from prone to sitting position.
a. Roll from abdomen to back.
Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant.
According to Piaget, the 6-month-old infant is in what stage of the sensorimotor phase?
a. Use of reflexes
b. Primary circular reactions
c. Secondary circular reactions
d. Coordination of secondary schemata
c. Secondary circular reactions
Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This
stage is characterized by a continuation of the primary circular reaction because of the response
that results. Shaking is performed to hear the noise of the rattle, not just for shaking.
A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse
should recommend that the infant be given
a. Skim milk
b. Whole cow’s milk
c. Commercial iron-fortified formula
d. Commercial formula without iron
c. Commercial iron-fortified formula
For children younger than 1 year, the American Academy of Pediatrics recommends the use of
breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should
be used.
he parent of 2-week-old Sarah asks the nurse whether Sarah needs fluoride supplements, because
she is exclusively breastfed. The nurse’s best response is
a. “She needs to begin taking them now.”
b. “They are not needed if you drink fluoridated water.”
c. “She may need to begin taking them at age 6 months.”
d. “She can have infant cereal mixed with fluoridated water instead of supplements.”
c. “She may need to begin taking them at age 6 months.”
Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at
age 6 months if the child is not drinking adequate amounts of fluoridated water.
A nurse has completed a teaching session for parents about “baby-proofing” the home. Which statements
made by the parents indicate an understanding of the teaching? Select all that apply.
a. “We will put plastic fillers in all electrical plugs.”
b. “We will place poisonous substances in a high cupboard.”
c. “We will place a gate at the top and bottom of stairways.”
d. “We will keep our household hot water heater at 130 degrees.”
e. “We will remove front knobs from the stove.”
a. “We will put plastic fillers in all electrical plugs.”
c. “We will place a gate at the top and bottom of stairways.”
e. “We will remove front knobs from the stove.”
Correct: By the time babies reach 6 months of age, they begin to become much more active, curious,
and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical
shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front
knobs form the stove can prevent burns.
Incorrect: Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to
120 degrees or less.
Hearing seems to be relatively acute, even at birth, as shown by reflexive generalized reaction to
noise. All newborns should undergo hearing screening at birth, before hospital discharge. In addition,
assessment for hearing deficits should take place at every well-baby visit. Risk factors for hearing loss
include (select all that apply)
a. Structural abnormalities of the ear
b. Family history of hearing loss
c. Alcohol or drug use by the mother during pregnancy
d. Gestational diabetes
e. Trauma
a. Structural abnormalities of the ear
b. Family history of hearing loss
e. Trauma
Correct: Structural abnormalities of the ear, a family history of hearing loss, and trauma are risk factors
for hearing loss. Other risk factors include persistent otitis media and developmental
delay. The American Academy of Pediatrics suggests that infants who demonstrate hearing loss be eligible for early intervention and specialized hearing and language services.
Incorrect Prenatal alcohol or drug intake and gestational diabetes are not risk factors for hearing loss in the infant.
Fill in the Blank:
The nurse has just assisted in the delivery of a female infant to first-time parents.
The infant is suctioned, dried, and placed skin-to-skin on her mother’s chest. This allows for significant
interaction between mother and baby and is known as _____________.
attachment
Parent-infant attachment is one of the most important aspects of infant psychosocial development. Initiated
immediately after birth, attachment is strengthened by many mutually satisfying interactions between
parents and their infant during the first few months of life. Attachment is a sense of belonging or
connection with each other.
True or False:
The rate of Sudden Infant Death Syndrome (SIDS), now the third leading cause of death in infants, has
increased despite international efforts and the Back to Sleep campaign. Is this statement true or false?
False
This statement is incorrect. SIDS, which for a long time was the second leading cause of infant deaths,
has decreased in part because of the Back to Sleep program. It is important for both hospital and clinic
nurses to educate parents on safe sleep strategies for their infant.
Public health nursing differs from community health nursing in that public health nursing
a. Focuses on individuals and families.
b. Understands the needs of a population.
c. Ignores political processes.
d. Considers the individual as one member of a group.
b. Understands the needs of a population.
Public health nursing requires understanding the needs of a population. A public health nurse understands
factors that influence the political processes used to affect public policy. The primary focus of
community health nursing is the care of individuals, families, and groups in the community. By focusing
on subpopulations, the community health nurse cares for the community as a whole and considers the individual or family as only one member of a group at risk.
A specialist in public health nursing requires
a. The same level of education as the community health nurse.
b. Preparation at the basic entry level.
c. An advanced degree regardless of public health experience.
d. A graduate level education with a focus in public health science.
d. A graduate level education with a focus in public health science.
A specialist in public health has a graduate level education with a focus in public health science. Public
health nursing requires preparation at the basic entry level and sometimes requires a baccalaureate degree
in nursing. Not all hiring agencies require an advanced degree in community health nursing. However,
nurses with a graduate degree in nursing who practice in community settings are considered community
health nurse specialists, regardless of their public health experience.
The community health nurse differs from the community-based nurse in that the community health nurse
a. Understands the needs of the population.
b. Focuses on the needs of the individual.
c. Is the first level of contact in the health care system.
d. Involves the family in decision making.
a. Understands the needs of the population.
The community health nurse understands the needs of a population or community through experience
with individual families in working through their social and health care issues. The community-based
nurse focuses on the needs of the individual or family. Community-based nursing centers function as the
first level of contact between members of a community and the health care system. The community based
nurse learns to partner with patients and families so that ultimately the patient and the family become
involved in planning, decision making, implementation, and evaluation of health care approaches.
The type of nursing that focuses on acute and chronic care of individuals and families while enhancing
patient autonomy is known as _____ nursing.
a. Public health
b. Community health
c. Community-based
d. Community-focused
c. Community-based
Community-based nursing involves acute and chronic care of individuals and families and enhances
their capacity for self-care while promoting autonomy in decision making. Public health nursing focuses
on the needs of a population. Community health nursing cares for the community as a whole and considers
the individual or the family as only one member of a group at risk. Community-focused nursing understands
the needs of a population or community.
The community health nurse is administering flu shots to children at a local playground. In doing so,
the nurse’s focus is on
a. Preventing individual illness.
b. Preventing community outbreak of illness.
c. Preventing outbreak of illness in the family.
d. The needs of the individual or family.
b. Preventing community outbreak of illness.
By focusing on subpopulations, the community health nurse cares for the community as a whole and
considers the individual or the family as only one member of a group at risk. Community-based nursing,
as opposed to community health nursing, focuses on the needs of the individual or family.
The community health nurse is providing counseling to a group of teenage girls related to birth control
and disease prevention. The nurse does this because
a. Focusing on subpopulations leads to community health.
b. Community health nursing focuses on individuals only.
c. Community health nursing excludes direct care to subpopulations.
d. The focus is on preventing illness and unwanted pregnancy.
a. Focusing on subpopulations leads to community health.
By focusing on subpopulations, the community health nurse cares for the community as a whole and
considers the individual or the family as only one member of a group at risk. Community health nursing
is a nursing practice in the community, with the primary focus on the health care of individuals, families,
and groups in a community. Subpopulations are often a clinical focus. The goal is to protect, promote, or maintain health, not to prevent illness.
Community-based nursing care takes place in community settings such as the home or a clinic. Ideally,
this is done to
a. Exert greater control over individual or family decisions.
b. Provide services close to where patients live.
c. Isolate patients and prevent the spread of disease.
d. Reduce the need for self-care.
b. Provide services close to where patients live.
The ideal is to provide health care services close to where patients live. This lessens the cost of care as
well as the stress associated with the financial burdens of care. The focus is on the needs of the individual
or family. The nurse learns to partner with patients and families so they assume responsibility for
their health care decisions.
The community-based nurse is caring for a patient who is home bound by arthritis and chronic lung problems. The patient, however, receives many visitors from the neighborhood and from former coworkers,
as well as frequent phone calls from extended family. When concerned about how the large number
of visitors may be fatiguing the patient, the nurse should
a. Restrict the number of visitors for the patient’s welfare.
b. Voice concerns to the patient and proceed according to the patient’s wishes.
c. Allow visitors to come and go freely as they have been.
d. Create visiting hours when the patient may see non–family members.
b. Voice concerns to the patient and proceed according to the patient’s wishes.
With the individual and the family as patients, the context of community-based nursing is family-centered
care within the community. This focus requires a strong knowledge base in family theory, principles
of communication, group dynamics, and cultural diversity. The nurse learns to partner with patients
and families, so ultimately the patient and the family assume responsibility for their health care
decisions.
The student nurse is trying to determine what type of nurse she wants to be after graduation. In class, she states that community health nursing is probably not for her because community nursing focuses only on community issues such as preventing epidemics. The instructor’s most appropriate response
would be that community health nursing
a. Focuses on the health care of individuals, families, and groups in a community.
b. Focuses only on the health of a specific subgroup in a community.
c. Requires an advanced nursing degree, so the student need not worry.
d. Focuses only on maintaining the health of the community.
a. Focuses on the health care of individuals, families, and groups in a community.
Community health nursing is a nursing practice with the primary focus on the health care of individuals,
families, and groups in a community. The goal is to preserve, protect, promote, or maintain health. Not
all hiring agencies require an advanced degree.
Vulnerable populations include those patients who are more likely to develop health problems as a
result of
a. Pregnancy.
b. Nontraditional healing practices.
c. Excessive risk.
d. Unlimited access to health care.
c. Excessive risk.
Vulnerable populations are those patients who are more likely to develop health problems as a result of
excess risks or limits in access to health care services, or who are dependent on others for care. Pregnancy
is not a cause of vulnerability, except in cases where the mother is an adolescent, is addicted to drugs,
or is at high risk for other reasons. Frequently, the immigrant population practices nontraditional healing
practices. Many of these healing practices are effective and complement traditional therapies.
The instructor is teaching student nurses about identifying members of vulnerable populations when
the nursing student asks, “Why is it that not all poor people are considered members of vulnerable populations?”
The instructor’s best answer would be
a. “All poor people are members of a vulnerable population.”
b. “Poor people are members of a vulnerable population only if they take drugs.”
c. “Poor people are members of a vulnerable population only if they are homeless.”
d. “Members of vulnerable groups frequently have a combination of risk factors.”
d. “Members of vulnerable groups frequently have a combination of risk factors.”
Members of vulnerable groups frequently have many risks or a combination of risk factors that make
them more sensitive to the negative effects of individual risk factors. Individual risk factors are not always
overwhelming, depending on the patient’s beliefs and values and sources of social support.
The nurse is making a home visit to a Korean family whose daughter gave birth 6 weeks earlier. She
finds the daughter in bed with a severe headache. The daughter’s father is holding her hand and is pressing
different parts of the hand and lower arm. The mother explains that the father is trying to cure the
headache by using pressure points. The nurse’s best response would be to
a. Tell the father to stop and give the daughter Tylenol.
b. Ask the mother and/or father to explain the procedure.
c. Explain to the father that what he is doing will not work.
d. Let the father finish and then give the daughter Tylenol.
b. Ask the mother and/or father to explain the procedure.
The nurse should not judge the patient’s/family’s beliefs and values about health. The nurse needs to create
a comfortable, nonthreatening environment and to learn as much as possible about the patient’s culture
and values that influence his or her health care practices. Tylenol may not be an acceptable alternative
for this family. Criticizing the family’s beliefs and practices will only create a barrier to care.
The nurse is working in a community clinic when a man and woman bring a 12 year-old boy in, stating
that the child fell down a flight of stairs and hurt his arm. The nurse notices several other bruises on
the child’s body at varying stages of healing. The boy is placed on the stretcher. When asked how he
hurt himself, he states that he does not remember. However, the nurse notices that the boy continuously
avoids looking at the man, while the man stares at him constantly. The nurse should
a. Ask the boy if the man hurt him.
b. Confront the man directly.
c. Ask the man and woman to step out.
d. Ask the woman if the man hurt the boy.
c. Ask the man and woman to step out.
Ask the man and woman to step out. When dealing with patients at risk for or who have suffered abuse,
it is important to provide protection and to interview the patient at a time when he or she has privacy,
and the individual suspected of being the abuser is not present. The boy may be less likely to be forthcoming
with his attacker in the room. Confronting the man directly may lead to violence. The woman
may also be a victim of abuse and may fear retribution if she discusses their problems with health care providers.
The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs an abortion.
The nurse provides the patient with information on alternatives to abortion, but after several sessions,
the patient still insists on having the abortion. The competency of the counselor requires the nurse
to
a. Insist that the patient speak with a “Right-to-Life” advocate.
b. Provide a referral to an abortion service.
c. Refuse to provide referral to an abortion service.
d. Delay referral to an abortion service.
b. Provide a referral to an abortion service.
As a counselor, the nurse is responsible for providing information, listening objectively, and being supportive,
caring, and trustworthy. The nurse does not make decisions but rather helps the patient reach decisions
that are best for him or her. To refuse to provide a referral or to delay referral would not be supportive
of the patient’s decision. Counselors usually suggest and rarely insist.
The patient is in the hospital with the diagnosis of early-onset Alzheimer’s disease. Before the patient
is discharged, the community-based nurse is making a visit to the patient’s home, where he lives with his
daughter and her family. A major focus of this visit will be to
a. Demonstrate caregiver techniques for providing care.
b. Stress to the family how difficult it will be to provide care at home.
c. Encourage the family to send the patient to an extended care facility.
d. Teach the family how to have the patient declared incompetent.
a. Demonstrate caregiver techniques for providing care.
The role of the community health nurse, when dealing with patients with Alzheimer’s disease, is to
maintain the best possible functioning, protection, and safety for the patient. The nurse should demonstrate
to the primary family caregiver techniques for dressing, feeding, and toileting the patient while
providing encouragement and emotional support to the caregiver. The nurse should protect the patient’s
rights and maintain family stability.
The community has three components: structure or locale, the people, and the social systems. While
doing a community assessment, the nurse seeks data on the average household income and the number
of residents on public assistance. In doing so, the nurse is evaluating which of the following?
a. Structure
b. Population
c. Welfare system
d. Social system
a. Structure
Economic status is part of the community structure. Population would involve age and gender distribution,
growth trends, density, education level, and ethnic or religious groups. The welfare system is part
of the social system that also includes the education, government, communication and health systems.
The patient is being readmitted to an inner city hospital for chest pain after being discharged 3
months earlier after having a heart attack. The patient was referred to the hospital’s cardiac rehabilitation
program after her previous admission. The patient states that she began going to cardiac rehabilitation
and liked it but stopped. When asked why, she states that, at the beginning, the classes were at 9 AM, but
then got switched to 7 PM, when it’s dark. The cardiac rehabilitation program was within walking distance
of the patient’s home. What is the most likely cause of the patient’s unwillingness to go to cardiac
rehabilitation?
a. Lack of transportation
b. Fear of walking at night
c. Reimbursement issues
d. Noncompliance
b. Fear of walking at night
A community assessment should be done to determine the level of community violence at night in the
patient’s neighborhood. She claimed that she liked the program when it was at 9 AM. She did not mention
finances as a reason for not going, and the program was within walking distance to her house. Noncompliance
is a label given unfairly to patients. Most “noncompliance” is caused. The cause should be
identified and dealt with, so the therapy will be successful.
Community-based nursing requires a strong knowledge base in which of the following? (Select all that
apply.)
a. Family theory
b. Communication
c. Group dynamics
d. Focus on the individual
e. Cultural diversity
a. Family theory
b. Communication
c. Group dynamics
e. Cultural diversity
With the individual and family as the patients, the context of community-based nursing is family-centered
care within the community. This focus requires a strong knowledge base in family theory, principles
of communication, group dynamics, and cultural diversity. The nurse leans to partner with patients
and families, not just with individuals.
Community-based nursing centers function as the first level of contact between members of a community
and the health care delivery system. Ideally, health care services (Select all that apply.)
a. Are provided where patients live.
b. Reduce the cost of health care for the patient.
c. Provide direct access to nurses.
d. Exclude interference from family or friends.
a. Are provided where patients live.
b. Reduce the cost of health care for the patient.
c. Provide direct access to nurses.
Community-based nursing centers function as the first level of contact between members of a community
and the health care delivery system. Ideally, health care services are provided near where patients live.
This approach helps to reduce the cost of health care for the patient and the stress associated with the financial
burdens of care. In addition, these centers offer direct access to nurses and patient-centered
health services and readily incorporate the patient and the patient’s family or friends into a plan of care.
Of the following list of patients, which would be considered at high risk to be members of a vulnerable
population? (Select all that apply.)
a. An immigrant who speaks only Chinese
b. An Hispanic truck driver who speaks limited English
c. A 22-year-old pregnant woman
d. A 15-year-old rape victim
e. A 40-year-old schizophrenic
a. An immigrant who speaks only Chinese
b. An Hispanic truck driver who speaks limited English
d. A 15-year-old rape victim
e. A 40-year-old schizophrenic
For some immigrants, access to health care is limited because of language barriers and lack of benefits,
resources, and transportation. Immigrant populations face multiple diverse health issues that cities, counties,
and states need to address. These health care needs pose significant legal and policy issues. For some immigrants, access to health care is limited because of language barriers and lack of benefits, resources,
and transportation. Low-risk mothers and babies usually are not considered vulnerable populations
unless other factors are noted. Physical, emotional, and sexual abuse (such as rape), as well as neglect,
is a major public health problem affecting older adults, women, and children. When a patient has a
severe mental illness such as schizophrenia, multiple health and socioeconomic problems will need to be
explored.
When caring for a middle-aged adult exhibiting maladaptive coping skills, the nurse is trying to determine
the cause of the patient’s behavior. From a growth and development perspective, what should the
nurse recall?
a. Individuals have uniform patterns of growth and development.
b. Health is promoted based on how many developmental failures a patient experiences.
c. Culture usually has no effect on predictable patterns of growth and development.
d. When individuals experience repeated developmental failures, inadequacies sometimes result.
d. When individuals experience repeated developmental failures, inadequacies sometimes result.
“If individuals experience repeated developmental failures, inadequacies sometimes result” is a true
statement. Developmental failures could manifest with ineffective coping skills. However, when an individual
experiences successes, health is promoted. Patients have unique patterns of growth and development that are not uniform. Nurses must consider the influence of culture and context on growth and
development.
The nursing instructor will need to provide further instruction to the student who states
a. “Intellectual development is affected by cognitive processes.”
b. “Socioemotional processes can influence an individual’s growth and development.”
c. “Breast development is an example of a change resulting from biological processes.”
d. “An individual’s biological processes determine physical characteristics and do not affect growth
and development.”
d. “An individual’s biological processes determine physical characteristics and do not affect growth
and development.”
Human growth and development is a complex pattern of movement that involves changes in biological,
cognitive, and socioemotional processes. Cognitive processes comprise changes in intelligence, use of
language, and development of thinking. Socioemotional processes consist of variations in personality,
emotions, and relationships with others. Height and weight, development of gross and fine motor skills,
and sexual maturation resulting from hormonal changes during puberty are examples of changes resulting
from biological processes.
Which of these statements would be most appropriate for a nurse to state when assessing an adult patient
for growth and developmental delays?
a. “How many times per week do you exercise?”
b. “Are you able to stand on one foot for 5 seconds?”
c. “Would you please describe your usual activities during the day?”
d. “How many hours a day do you spend watching television or sitting in front of a computer?”
c. “Would you please describe your usual activities during the day?”
Understanding normal growth and development helps nurses predict, prevent, and detect deviations from patients’ own expected patterns. The nurse can then compare expected patterns of activity based on age
with the patient’s stated activity patterns to determine deviations from the patient’s own expected patterns.
Asking the patient to describe his/her usual daily activities will provide the nurse with useful information
about the patient’s own expected patterns. How many hours are spent watching television or
in front of a computer and how many times the patient exercises in a week are closed-ended questions.
These questions would not provide the nurse with as much information about the patient’s expected patterns
when his/her stated patterns are compared with expected patterns for the patient’s age group to detect
delays.
The nurse knows that a priority reason for being knowledgeable about biophysical developmental theories
is to
a. Understand how the physical body grows.
b. Predict definite patterns of cognitive development.
c. Anticipate how patients’ social behaviors develop.
d. Describe the process of psychological development.
a. Understand how the physical body grows.
Biophysical development refers to how our physical bodies grow and change. Nurses and other health
care providers are able to quantify and compare the changes that occur as a newborn infant grows into adulthood against established norms to detect abnormalities. Biophysical development refers to physical growth, not cognitive development, social behaviors, or psychological development.
While assessing an 18-month-old toddler, the nurse distinguishes normal from abnormal findings by
remembering that Gesell’s theory of development states
a. “The developmental stage of the toddler is affected solely by environmental influence.”
b. “Developmental patterns are not affected by gene activity.”
c. “Skill development should be identical to that of other toddlers in the playroom.”
d. “Environmental influence does not affect the sequence of development.”
d. “Environmental influence does not affect the sequence of development.”
Gesell’s theory of development states that environment plays a part in child development, but it does not
have any part in the sequence of development. Other factors influencing growth and development include
biological, cognitive, and socioemotional processes. Environmental factors support, change, and
modify the pattern of development, but they do not generate progressions of development. Each child’s
pattern of growth and development is unique and is directed by gene activity. Not every child develops
certain skills at the same time. Children grow according to their own genetic blueprint.
When utilizing Freud’s psychoanalytical/psychosocial theory, the nurse recalls that
a. Adult personality is the result of resolved conflicts between sources of sexual pleasure and the mandates of reality.
b. Development occurs throughout the life span and focuses on psychosocial stages.
c. The genital stage precedes the phallic stage of development.
d. Problems evident in adult life are due to early successes and resolution of earlier developmental
stages.
a. Adult personality is the result of resolved conflicts between sources of sexual pleasure and the mandates of reality.
Freud believed that adult personality is the result of how an individual resolved conflicts between
sources of sexual pleasure and the mandates of reality. Freud had a strong influence on Erik Erikson, but Erikson’s theory differed from Freud’s in that it focused on psychosocial stages rather than psychosexual
stages. Freud’s five stages of psychoanalytical development in sequential order include oral, anal, phallic,
latency, and genital. The phallic stage precedes the genital stage. In theory, problems in adult life would be due to unresolved conflicts and failures.
The nurse is teaching a young adult couple about promoting the health of their 8-year-old child. The nurse knows that the parents understand the developmental stage their child is in according to Erikson when they state, “We should
a. Provide proper support for learning new skills.”
b. Encourage devoted relationships with others.”
c. Limit choices and provide harsh punishment for mistakes.”
d. Not leave our child at school for longer than 3 hours at a time.”
a. Provide proper support for learning new skills.”
An 8-year-child would be in the industry versus inferiority stage of development. During this stage, the child needs to be praised for accomplishments such as learning new skills. Developing devoted relationships
is part of the identity versus role confusion stage, usually occurring during puberty. During the autonomy
versus shame and doubt stage, limiting choices and harsh punishment lead to feelings of shame
and doubt. Separation anxiety is usually a part of the trust versus mistrust stage.
Jean Piaget’s cognitive developmental theory focuses on four stages of development, including
a. Formal operations.
b. Intimacy versus isolation.
c. Latency.
d. The postconventional level.
a. Formal operations.
Jean Piaget’s theory includes four stages in sequential order: sensorimotor, preoperational, concrete operations,
and formal operations. Intimacy versus isolation is part of Erik Erikson’s psychosocial theory
of development. Latency is stage 4 of Freud’s five-stage psychosexual theory of development. The postconventional
level of reasoning is part of Kohlberg’s theory of moral development.
According to Piaget’s formal operations level, a 13-year-old adolescent will likely
a. Hit other students to deal with environmental change.
b. Use play to understand her surroundings.
c. Question her parents about an upcoming presidential election.
d. Question where the ice is hiding when ice has melted in her drink.
c. Question her parents about an upcoming presidential election.
In the formal operations period, adolescents and young adults begin to think about such subjects as
achieving world peace, finding justice, and seeking meaning in life. Asking about a presidential election
demonstrates that the adolescent is concerned about political issues that affect others besides her. Hitting would be a common schema during the sensorimotor stage of development. Using play to learn about
the environment is indicative of the preoperational stage. During the concrete operations stage (ages 6 to
12 years), children are able to coordinate two concrete perspectives in social and scientific thinking,
such as understanding the difference between “hiding” and “melting.”
According to Piaget’s theory of cognitive development, the nurse should allow a hospitalized 4-year-old patient to safely play with
a. The pump administering intravenous fluids.
b. The blood pressure cuff.
c. A baseball bat.
d. A book to read alone in a quiet place.
b. The blood pressure cuff.
A 4-year-old child would be in the preoperational period. Children at this stage are still egocentric. Play
is very important to foster cognitive development. Children should be allowed to play with any equipment
that is safe and should be allowed to communicate feelings about their health care. The IV pump is
not a safe piece of equipment for a 4-year-old child to play with. A baseball bat typically is not found in
a hospital setting and is a potentially dangerous toy to play with in the hospital. The blood pressure cuff
is a safer option. A 4-year-old child is of preschool age and more than likely is not able to read yet. Also,
the book does not allow for any human interaction and communication if read alone.
Which of these manifestations, if identified in a 6-year-old patient, should the nurse associate with a
possible developmental delay based on Piaget’s theory?
a. The child speaks in complete sentences but often talks only about himself.
b. The child still plays with a favorite doll that he has had since he was a toddler.
c. The child continues to suck his thumb.
d. The child describes an event from his own perspective, even though the entire family was present.
c. The child continues to suck his thumb.
This is a characteristic of the sensorimotor stage (birth to 2 years), where schemas become self-initiated
activities. For example, the infant who learns that sucking achieves a pleasing result generalizes the action
to suck fingers, blanket, or clothing. Successful achievement leads to greater exploration. By age 6,
the child is in the preoperational stage of development. The child is expected to be egocentric, even
though language ability is progressing. Play becomes a primary means by which children foster their
cognitive development; therefore playing with a doll is considered normal at this age. Children see objects
and persons from only one point of view—their own—at this stage.
An 18-month-old patient is brought into the clinic for evaluation because the mother is concerned.
The 18-month-old child hits her siblings and says only “No” when communicating verbally. According
to Piaget’s theory, what recommendation should the nurse make a priority?
a. Consult the social worker because the child is hitting other children.
b. Reassure the mother that the child is developmentally within specified norms.
c. Encourage the mother to seek psychological counseling for the child.
d. Remove all toys from the child’s room until this behavior ceases.
c. Encourage the mother to seek psychological counseling for the child.
At 18 months, the child is in the sensorimotor period of development. Piaget describes hitting, looking,
grasping, and kicking as normal schemas to deal with the environment. The social worker does not need
to be consulted in this case, nor is psychological counseling warranted, because the child is exhibiting
normal behaviors. Play is an important part of all children’s development. Removing the toys is not necessary
because this child is exhibiting normal behaviors. Removing toys and the opportunity to play with
them may actually hinder the child’s development.
A formerly independent and active older adult becomes severely withdrawn upon admission to a
nursing home. When approaching this patient, which intervention should the nurse plan first?
a. Offer a reward for participation in all events.
b. Encourage the patient to attend all social events scheduled for the patients.
c. Allow the patient to incorporate personal belongings into her room.
d. Advise the patient of the importance of attending mandatory activities.
c. Allow the patient to incorporate personal belongings into her room.
The older adult is in the mature thinking stages of development according to Piaget and Kohlberg. According
to Gould, the older adult needs help in realistically appreciating his/her accomplishments and in
fostering continued development. Erikson’s theory proposes that the older adult faces integrity versus
despair. To avoid despair, the nurse should allow the patient to actively participate in an independent activity,
such as preparing his/her own room with personal belongings. Offering a reward does not address
the need for continued independence. Encouraging participation in social events again does not address independence, and the question is asking for the best first intervention. Advising the patient to attend all
mandatory activities as the first intervention does not allow for the patient’s independence. Some activities
may be mandatory, but by first allowing the patient to decorate her room, the nurse is fostering independence
and is helping the patient feel welcome and more at home.
The parents of a 14-year-old boy express concern over their child’s rebellious behavior. The nurse
should plan to respond to the parents’ concern by informing them that their
a. Child should be referred to a juvenile correctional facility.
b. Child’s behavior is normal because the adolescent is trying to adjust to his emerging identity.
c. Child’s behavior is a matter of concern because he is likely conflicted about establishing companionship
with a partner.
d. Child’s behavior is expected because he is expressing his need to support future generations.
b. Child’s behavior is normal because the adolescent is trying to adjust to his emerging identity.
According to Erikson, a 14-year-old adolescent is developing his identity versus role confusion. A
teenager is very concerned with self and is often preoccupied with body image. Frequently, teenagers
express themselves rebelliously as they struggle to discover their own identities. Rebellious behavior is
very common and normal at this stage of development. A juvenile correctional facility usually is not
necessary. Establishing companionship occurs in the young adult age group. Feeling the need to support
future generations is usually experienced by the middle-aged adult.
The teaching plan for a 3-year-old child who is at risk for developmental delay should include which
of these instructions for the parents?
a. Encourage play as your child is exploring his or her surroundings.
b. Insist that your child discuss various points of view, not just his or her own.
c. Discuss world events with your child to foster language development.
d. Actively encourage your child to read lengthy books to expedite reading and writing abilities.
a. Encourage play as your child is exploring his or her surroundings.
A 3-year-old child is going to use play to learn and discover the surrounding environment. Children at
this age are egocentric and often are unable to see the world from any perspective other than their own.
Very young children are not able to understand and comment on world events because their thinking has
not advanced to abstract reasoning yet. A 3-year-old child is likely unable to read. Asking a child to perform
an activity that is beyond his or her developmental abilities will likely result in frustration at not
being able to complete the task.
A nurse should instruct the parents of a 10-year-old child to keep which of the following theoretical principles in mind when dealing with a behavioral problem at home?
a. Strategies that worked well with the first child will be equally as effective for the second child.
b. Encourage the child to volunteer some time at a local hospital to instill a sense of fulfillment.
c. Bargaining about chores in exchange for privileges may be an effective method of encouraging
helpful activities.
d. Do not offer praise for accomplishments and punishment for behavioral issues.
c. Bargaining about chores in exchange for privileges may be an effective method of encouraging
helpful activities.
In the concrete operations period, children begin to cooperate and share new information about the acts
they perform. Parents will be able to adjust their approaches to guide the child into helpful activities
within the home, such as bargaining about chores in exchange for privileges. With the birth of a second
child, most parents find that the strategies that worked well with the first child no longer work at all. After
birth, children grow according to their genetic blueprint and gain skills in an orderly fashion, but at
each individual’s own pace. The need for a sense of fulfillment is usually experienced by middle-aged adults, not children. School-aged children need praise to discourage a sense of inferiority; providing
praise is the best choice for encouraging positive behaviors while nurturing growth and development.
The parents of a 15-month-old child express concern to the nurse about their child’s thumb-sucking
habit. Which of these explanations related to the child’s age and developmental level would be most appropriate for the nurse to give the parents?
a. Thumb sucking at this age indicates a developmental delay and should be further assessed.
b. Sucking achieves a pleasing result for infants, and generalizing that action by thumb sucking is
normal.
c. Thumb sucking at this age demonstrates a transition away from egocentric thinking.
d. At this age, thumb sucking will enhance language development.
b. Sucking achieves a pleasing result for infants, and generalizing that action by thumb sucking is
normal.
Action patterns are used by infants and toddlers to deal with the environment. For example, the infant
who learns that sucking achieves a pleasing result generalizes that action to suck fingers, blankets, or
clothing. Children remain egocentric into the pre-operational period. Thumb sucking does not indicate
transition away from egocentric thinking. No statements have supported thumb sucking as enhancing
language development.
Which of these approaches would be most appropriate for the nurse to use when teaching a 4-year-old
patient about a scheduled surgery?
a. Give the parents a book to read about the procedure and do not discuss the procedure with the child
to decrease anxiety.
b. Set boundaries before teaching by telling the child that she can ask only three questions because
time is limited.
c. Insist that the parents wait outside the room to ensure privacy of the child.
d. Allow the child to touch and hold medical equipment such as thermometers and syringes.
d. Allow the child to touch and hold medical equipment such as thermometers and syringes.
Nursing interventions during the pre-operational period (age 2 to 7 years) should recognize the use of
play (such as handling equipment) to help the child understand the events taking place. Giving the parents
a book and not involving the child is not the best option, because the nurse should explain all procedures
to children and their parents. Children tend to ask a lot of questions; therefore limiting questions
may increase anxiety. Parents and the child all should be involved in preoperative teaching because the
parents will be the primary caregivers upon discharge.
When developing a plan of care concerning growth and development for a hospitalized adolescent,
what should the nurse do? (Select all that apply.)
a. Stick with one developmental theory for consistency.
b. Apply developmental theories when making observations of the individual’s patterns of growth and
development.
c. Compare the individual’s assessment findings versus established normal findings.
d. Recognize his/her own moral developmental level.
e. Apply a unidimensional life span perspective.
b. Apply developmental theories when making observations of the individual’s patterns of growth and
development.
c. Compare the individual’s assessment findings versus established normal findings.
d. Recognize his/her own moral developmental level.
No one theory successfully describes all the intricacies of human growth and development. Today’s
nurses need to be knowledgeable about several theoretical perspectives when working with patients.
These theories form the basis for meaningful observation of an individual’s pattern of growth and development.
They provide important guidelines for an understanding of important human processes that allows
the nurse to begin to predict human responses, not medical diagnoses, and to recognize deviations
from the norm. Recognizing your own moral developmental level is essential in separating your own beliefs from those of others when helping patients with their moral decision-making process. Growth and
development, as supported by a life span perspective, is multidimensional.
The nurse is planning playroom activities for a hospitalized 6-year-old patient. Which of the following
age appropriate items that the nurse should ensure are available? (Select all that apply.)
a. Crayons and paper
b. Children’s books
c. 500-piece puzzle
d. Building blocks
e. Magazines and newspapers
a. Crayons and paper
b. Children’s books
d. Building blocks
A school-aged child thrives on feelings of accomplishment. Drawing pictures, looking at children’s books, and building blocks are all ways that a child this age could play while developing a sense of accomplishment.
A 500-piece puzzle would be too difficult for a 6-year-old child to complete without the
possibility of getting frustrated. Magazines and newspapers would be written at too high a reading level
for a 6-year-old child. If play items offered to the child are too difficult, the child may become frustrated
and may experience a feeling of inferiority.
To promote parent-child attachment with a healthy newborn, what should the nurse do?
a. Encourage close physical contact as soon as possible after birth.
b. Do not allow the newborn to remain with parents until the second hour after delivery.
c. Never leave the newborn alone with the mother during the first 8 hours after delivery.
d. Isolate the newborn in the nursery during the first hour after delivery.
a. Encourage close physical contact as soon as possible after birth.
After immediate physical evaluation and application of identification bracelets, the nurse promotes the
parents’ and newborn’s need for close physical contact. Early parent-child interaction encourages parentchild
attachment. Most healthy newborns are awake and alert for the first half-hour after birth. This is a
good time for parent-child interaction to begin. No evidence in the question stem suggests that the baby
cannot be left alone with the parents during the first 8 hours, or that the baby should remain in the nursery during the first hour.
The nurse knows that the mother of a newborn understands associated health risks to her baby when she states
a. “I need to moisten the umbilical cord every hour during the day until the cord falls off.”
b. “I need to remind anyone who wants to hold the baby to wash their hands.”
c. “I need to leave the blankets off the baby to prevent smothering.”
d. “I can throw away the bulb syringe now because my baby is breathing on her own.”
b. “I need to remind anyone who wants to hold the baby to wash their hands.”
Prevention of infection is a major concern in the care of the newborn. Good handwashing technique is
the most important factor in protecting the newborn from infection. The umbilical stump should be kept
clean and dry. Newborns are susceptible to heat loss and cold stress. Place the new born directly on the
mother’s abdomen, and cover him or her in warm blankets, making sure to keep the head well covered,
or placed unclothed in an infant warmer with a temperature probe in place. Removal of nasopharyngeal
and oropharyngeal secretions remains a priority of care to maintain a patent airway.
The priority assessment immediately after birth is to
a. Assess infant-parent interactions.
b. Promote parent-newborn physical contact.
c. Open the airway.
d. Assess gestational age.
c. Open the airway.
The most extreme physiologic change occurs when the newborn leaves the in utero circulation and develops
independent respiratory functioning. Direct nursing care includes maintaining an open airway,
stabilizing and maintaining body temperature, and protecting the newborn from infection. After immediate
physical evaluation and application of identification bracelets, the nurse promotes the parents’ and
newborn’s need for close physical contact. Following a comprehensive physical assessment, the nurse
assesses gestational age and interactions between infant and parents.
Immediate intervention is needed when the newborn exhibits
a. A soft, protuberant abdomen.
b. Molding.
c. Lack of reflexes.
d. Cyanotic hands and feet.
c. Lack of reflexes.
Normal reflexes include blinking in response to bright lights, startling in response to sudden loud noises,
and sucking, rooting, grasping, yawning, coughing, sneezing, and hiccoughing. Assessment of these reflexes
is vital because the newborn depends largely on reflexes for survival and in response to its environment.
Normal physical characteristics include the continued presence of lanugo on the skin of the
back; cyanosis of the hands and feet for the first 24 hours; and a soft, protuberant abdomen. Molding, or
overlapping of the soft skull bones, allows the fetal head to adjust to various diameters of the maternal
pelvis and is a common occurrence with vaginal births.
Normal physical findings in a healthy newborn include
a. Sporadic motor movements.
b. Cyanosis of the feet and hands for the first 48 hours.
c. Triangle-shaped anterior fontanel.
d. Weight of 4800 grams.
a. Sporadic motor movements.
Movements in the newborn are generally sporadic, but they are symmetric and involve all four extremities.
Cyanosis of the hands and feet is normal for the first 24 hours, not 48 hours. The diamond shape of
the anterior fontanel and the triangular shape of the posterior fontanel are found between the unfused
bones of the skull. The expected, normal weight of a healthy newborn is between 2700 and 4000 grams
(6 to 9 pounds).
The nursing instructor will need to provide further instruction to the student who states, “Development
proceeds
a. In a proximal-distal pattern.”
b. In a cephalocaudal pattern.”
c. At a slower rate during the embryonic stage.”
d. At a predictive rate from the moment of conception.”
c. At a slower rate during the embryonic stage.”
From the moment of conception, human development proceeds at a predictive and rapid rate. During
gestation or the prenatal period, the embryo grows from a single cell to a complex physiologic being.
Development proceeds in a cephalocaudal and proximal-distal pattern.
When comparing physical growth patterns between school-aged children and adolescents, the nurse
notes that
a. Physical growth usually slows during the adolescent period.
b. Boys usually exceed girls in height and weight by the end of the school years.
c. Secondary sex characteristics usually develop during the adolescent years.
d. The distribution of muscle and fat remains constant during the adolescent years.
c. Secondary sex characteristics usually develop during the adolescent years.
Hormonal changes during adolescence contribute to the development of secondary sex characteristics
such as hair growth and voice changes. Physical growth usually slows during the school-aged period, and then a growth spurt occurs during adolescence. Girls usually exceed boys in height and weight by
the end of the school
A mother brings her child to the clinic for a 12-month well visit. The child weighed 6 pounds 2 ounces
and was 21 inches long at birth. What finding indicates that the child needs further assessment?
a. Height of 30 inches
b. Weight of 16 pounds
c. The infant is not yet potty-trained.
d. The infant is not yet walking up stairs.
b. Weight of 16 pounds
Size increases rapidly during the first year of life. Birth weight doubles in approximately 5 months and
triples by 12 months. This infant should weigh at least 18 pounds by this calculation. This child needs further assessment.
Height increases an average of 1 inch during each of the first 6 months and about 1/2
inch each month until 12 months: 21 + 6 + 3 = 30 (30 inches is the predicted height). Patterns of body
function are just now starting to stabilize. It is quite normal for a 12-month-old child to not be potty trained or walking up stairs yet. These milestones usually occur in the toddler period of development (12
to 36 months).
In the toddler stage, rapid development of motor skills allows the child to participate in self-care activities such as feeding, dressing, and toileting. Soon the child begins to navigate stairs, using a rail or the wall to maintain balance.
Which of the following is characteristic of the cognitive changes in a preschooler?
a. The ability to think in a logical manner about the here and now
b. The ability to think abstractly and deal effectively with hypothetical problems
c. The inability to assume the view of another person and to use symbols to represent others
d. The ability to classify objects by size or color
d. The ability to classify objects by size or color
Preschoolers demonstrate their ability to think more complexly by classifying objects according to size
or color. Cognitive changes that provide the ability to think in a logical manner about the here and now
and to understand the relationships between things and ideas occur during the school-aged years. It is
during the teenaged years when the individual thinks abstractly and deals effectively with hypothetical
problems. The toddler is unable to assume the view of another. Toddlers also use symbols to represent
objects, places, and persons.
The nursing instructor will need to provide further instruction to the student who uses which of these
statements when describing the differences between cognitive and psychosocial development in
children?
a. “The preschooler develops the ability to play in small groups.”
b. “The toddler may participate in parallel play.”
c. “The school-aged child still requires total assistance in all activities for safety.”
d. “The toddler period is a time of potential frustration manifested by temper tantrums.”
c. “The school-aged child still requires total assistance in all activities for safety.”
The care provider should promote independence within safe limits for the school-aged child. The
school-aged child, according to Erikson, is in the industry versus inferiority stage of development. The
school-aged child likes to perform tasks by himself when possible and needs to be praised for those
tasks. The child continues to engage in solitary play during toddlerhood but also begins to participate in
parallel play, which is playing beside rather than with another child. The toddler’s strong will is frequently
exhibited in negative behavior when caregivers attempt to direct his actions. Temper tantrums
result when parental restrictions frustrate toddlers.
The nurse is observing his 2-year-old hospitalized patient in the playroom. The nurse is most likely to
observe the child
a. Participating as the leader of a small group activity.
b. Sitting beside another child while playing with blocks.
c. Separating building blocks into groups by size and color.
d. Seeking out same sex children to play with.
b. Sitting beside another child while playing with blocks.
The child beside another child and playing is exhibiting parallel play, characteristic of a toddler. Participating
as a group leader does not usually occur until around age 5. Preschoolers (ages 3 to 5) demonstrate
their ability to think more complexly by classifying objects according to size or color. A 2-year-old
child does not have this ability yet. The play of preschool children becomes more social after the third
birthday as it shifts from parallel to associative play. However, gender does not become a factor until the
child reaches school age, when she prefers same sex peers to opposite sex peers.
When communicating with a newly admitted teenaged patient, the nurse should
a. Avoid questioning the patient about cigarette use when she observes a cigarette lighter lying on the
bedside table.
b. Complete the admission database as quickly as possible by asking yes and no questions.
c. Ignore the patient’s withdrawn behavior.
d. Observe for congruency between the patient’s facial expressions and verbal responses.
d. Observe for congruency between the patient’s facial expressions and verbal responses.
Good communication skills are critical for adolescents. Following are some hints for communicating
with adolescents: Do not avoid discussing sensitive issues. Asking questions about sex, drugs, and
school opens the channels for further discussion. Ask open-ended questions. Yes and no questions are
closed-ended questions. Look for meaning behind their words and actions. The nurse should inquire
about a patient’s withdrawn behavior to seek out the meaning of such behaviors. Be alert to clues to their
emotional state. The nurse should observe that the patient’s statements are congruent with his/her facial
expressions of emotion.
During infant/child development, play is best recognized as
a. A means to interact with the environment and relate to others.
b. Independent of cognitive and social development.
c. Non-exploratory and simply play.
d. Too soon to achieve milestones.
a. A means to interact with the environment and relate to others.
During infancy, play is a meaningful set of activities through which the child interacts with the environment
and relates to others. Play provides opportunities for development of cognitive, social, and motor
skills. Much of infant play is exploratory as infants use their senses to observe and examine their own
bodies and objects of interest in their surroundings. Adults facilitate infant learning by planning activities
that promote the development of milestones and by providing toys that are safe for the infant to explore
with the mouth and manipulate with the hands.
Which statement by the nurse best explains the importance of play during the toddler stage of
development?
a. “Exploration can suppress the toddler’s curiosity to promote safety.”
b. “Parental control during play will eliminate the frustration of learning self-control.”
c. “Play can enhance cognitive and psychosocial development.”
d. “Play will enhance the toddler’s ability to explore the environment safely without supervision.”
c. “Play can enhance cognitive and psychosocial development.”
Play can enhance cognitive and psychosocial development. The toddler’s curiosity is evident in his or
her exploration of the environment. Children strive for independence. Their strong wills are frequently
exhibited in negative behavior when caregivers attempt to direct their actions. Temper tantrums result when parental restrictions frustrate toddlers. Parents need to provide toddlers with graded independence,
allowing them to do things that do not result in harm to themselves or others.
After comparing appropriate play activities for infants and preschool children, the nurse should appropriately
offer which of the following activities to an infant?
a. Set of cards to organize and separate into groups
b. Set of plastic stacking rings
c. Paperback book
d. Set of sock puppets with movable eyes
b. Set of plastic stacking rings
Play becomes manipulative as the child learns control of the hands. Adults facilitate infant learning by
planning activities that promote the development of milestones, and by providing toys that are safe for
the infant to explore with the mouth and manipulate with the hands, such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Preschoolers demonstrate their ability to
think more complexly by classifying objects according to size or color, making the cards more appropriate
for them. Neither group is ready for paperback books. The sock puppet with movable eyes could create
a choking hazard if one of the eyes comes off.
A mother expresses concern because her 5-year-old child frequently talks about friends who don’t exist.
What is the nurse’s best response to this mother’s concern?
a. “Have you considered a child psychological evaluation?”
b. “It’s very normal for a 5-year-old child to have imaginary playmates.”
c. “You should stop your child from playing electronic games.”
d. “Pretend play is a sign your child watches too much television.”
b. “It’s very normal for a 5-year-old child to have imaginary playmates.”
At age 5, some children have imaginary playmates. Imaginary playmates are a sign of health and allow
the child to distinguish between reality and fantasy. The child does not need a psychological evaluation
based on this information. Television, videos, electronic games, and computer programs help support development
and the learning of basic skills. However, these should be only one part of the child’s total
play activities.
Encouraging children to play a game of kickball would be best suited for which age group?
a. Infant
b. Toddler
c. Preschool
d. School-aged
d. School-aged
A game of kickball would be best suited for school-aged children because in this age group, play involves
peers and the pursuit of group goals. Although solitary activities are not eliminated, group play
overshadows them. Younger children typically are not able to participate cooperatively in groups yet.
Infants begin to play simple social games such as patty-cake and peek-a-boo. Toddlers engage in solitary
play but also begin to participate in parallel play. Preschoolers playing together engage in similar if not
identical activities; however, no division of labor nor rigid organization nor rules are observed. By the
age of 5, the group has a temporary leader for each activity.
Which of these manifestations, if identified in a school-aged child during a routine assessment,
should a nurse associate with a possible developmental delay or problem?
a. Withdrawn demeanor and verbalizes that he has no friends
b. Absence of secondary sex characteristics
c. Lack of peer relationships
d. Curiosity about his or her sexuality
a. Withdrawn demeanor and verbalizes that he has no friends
School-aged children should begin to develop friendships and to socialize with others. Interaction with
peers allows them to define their own accomplishments in relation to others as they work to develop a
positive self-image. The absence of secondary sex characteristics is a major concern of adolescents, not
school-aged children, because physical evidence of maturity encourages the development of masculine
and feminine behaviors in the adolescent. Lack of peer relationships is also a concern of adolescents, not
of school-aged children, because adolescents seek a group identity to fulfill their esteem and acceptance
needs. Today many researchers believe that school-aged children have a great deal of curiosity about
their sexuality. Some experiment, but this play is usually transitory.
The nurse who is teaching a parent about developmental needs of the infant knows that the parent has
verbalized understanding of a infant’s developmental needs when he states
a. “My child is too young to understand words.”
b. “My child will begin to speak in sentences by 1 year of age.”
c. “My child will probably enjoy playing peek-a-boo.”
d. “While my child is in the hospital, I should let the nurses provide most of the care.”
c. “My child will probably enjoy playing peek-a-boo.”
By 9 months, infants play simple social games such as patty-cake and peek-a-boo. By 1 year, infants not
only recognize their own names but are able to say three to five words and understand almost 100
words. Extended separations from parents complicate the attachment process and increase the number of
caregivers with whom they must interact. Ideally, the parents provide most of the care during
hospitalizations.
During hospitalization, the nurse should encourage the parents of an 8-month-old infant to
a. Provide as much care as possible.
b. Not worry about attachments because the infant is too young to develop them.
c. Remember that infants cannot differentiate a stranger from a familiar person.
d. Relax and allow nursing staff to care for the child at all times.
a. Provide as much care as possible.
Extended separations from parents complicate the attachment process and increase the number of caregivers
with whom the infant must interact. Ideally, the parents provide most of the care during hospitalizations.
Close attachment to the primary caregivers, most often parents, usually occurs by this age. Infants
seek out these persons for support and comfort during times of stress. By 8 months, most infants
are able to differentiate a stranger from a familiar person and respond differently to the two.
The nursing student correctly explains health promotion teaching points for parents of toddlers when
she states
a. “Setting consistent, firm limits will help the child cope with the frustration of learning self-control.”
b. “Slower development of motor skills prevents the child from participating in self-care activities.”
c. “Toddlers have a natural sense of right and wrong and know when they do something wrong.”
d. “Temper tantrums should never be tolerated, and toddlers need to do what they are told.”
a. “Setting consistent, firm limits will help the child cope with the frustration of learning self-control.”
Firm consistent limits, patience, and support allow toddlers to develop socially acceptable behaviors and
to cope with the frustration of learning self-control. Rapid development of motor skills allows the child
to participate in self-care activities such as feeding, dressing, and toileting. Because children’s moral development
is closely associated with their cognitive abilities, the moral development of toddlers is only
beginning. Toddlers do not understand concepts of right and wrong. Temper tantrums result when
parental restrictions frustrate toddlers. Parents need to provide toddlers with graded independence, allowing
them to do things that do not result in harm to themselves or others.
The nursing student is preparing a teaching project for parents of school-aged children. Which statement
correctly identifies health risks in this age group?
a. “School-aged children are more likely to suffer from unintentional injury.”
b. “The risk for infection is not a major concern of this age group as immunity develops.”
c. “Mental retardation, learning disorders, and malnutrition are prevalent across all socioeconomic
categories. ”
d. “Poor nutrition and lack of immunizations continue to be health concerns for children of the poor.”
d. “Poor nutrition and lack of immunizations continue to be health concerns for children of the poor.”
Infant mortality, dental problems, poor nutrition, and lack of immunizations continue to be major health
concerns for uninsured or impoverished families. Accidents and injuries are major health problems affecting school-aged children. They now have more exposure to various environments and less supervision,
but their developed cognitive and motor skills make them less likely to suffer from unintentional
injury. Infections account for most childhood illnesses. Mental retardation, learning disorders, and malnutrition
are far more prevalent among children living in poverty.
Which of these statements, if made by a parent, would require further instruction?
a. “I should not be surprised that my teenager has so many friends.”
b. “I get worried because my teenager thinks he’s indestructible. He takes a lot of risks.”
c. “I should cover for my school-aged child when he makes a mistake until he learns the ropes.”
d. “My 10-year-old child is always hungry right after school, so I usually fix him a nutritious snack.”
c. “I should cover for my school-aged child when he makes a mistake until he learns the ropes.”
School and home influence growth and development, requiring adjustment by parents and by the child.
The child learns to cope with rules and expectations presented by the school and by peers. Parents have
to learn to allow their child to make decisions, accept responsibility, and learn from life’s experiences.
Teenagers typically are very social and have many friends. Adolescents seek a group identity because
they need esteem and acceptance. By midadolescence, adolescents believe that they are unique and the
exception, giving rise to their risk-taking behaviors. Obesity occurs because children often rush into the
home after school or play and eat the most easily obtainable and appealing foods. Providing nutritious snacks is often the best way to ensure good nutritional intake.
Which of these toys, if selected by the parent of a 10-month-old child, would indicate that the parent
has a correct understanding of infant growth and development?
a. A game requiring two to four players
b. Electronic games
c. Small, plastic alphabet letters and magnets
d. Plastic stacking rings
d. Plastic stacking rings
Adults facilitate infant learning by planning activities that promote the development of milestones and by providing toys that are safe for the infant to explore with the mouth and manipulate with the hands,
such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Infants
are not capable of participating in small group activities. By age 4, children play in groups of two
or three. For the toddler (not the infant), television, videos, electronic games, and computer programs
help support development and learning of basic skills. Adults should provide toys that are safe for the
infant to explore with the mouth. Small, plastic letters and magnets could be choking hazards for an
infant.
The nurse should instruct the parents of an adolescent about which of the following health concerns?
(Select all that apply.)
a. Signs of substance abuse
b. Suicide prevention
c. Safe sex practices
d. Pregnancy
e. Gonadotropic hormone stimulation
f. Voice changes
a. Signs of substance abuse
b. Suicide prevention
c. Safe sex practices
d. Pregnancy
All adolescents are at risk for experimental or recreational substance use because some believe that substance
use makes them more mature. Suicide is the third leading cause of death in adolescents. Sexually
transmitted diseases annually affect 3 million sexually active adolescents. Adolescent pregnancy continues
to be a major social challenge for our nation. Gonadotropic hormones stimulate ovarian cells to produce
estrogen and testicular cells to produce testosterone. These hormones are normally occurring and contribute to the development of secondary sex characteristics, such as hair growth and voice changes,
and play an essential role in reproduction.
According to some developmental theorists, intellectual development and moral development differ
between men and women. What did Gilligan propose?
a. As women progress toward adulthood, concepts, morals, and responsibility remain unchanged.
b. Providing and protecting remain the sole responsibilities of men in today’s society.
c. Women continue to play a minor role in the financial well-being of their families.
d. Women struggle with issues of care and responsibility.
d. Women struggle with issues of care and responsibility.
According to Gilligan, women struggle with issues of care and responsibility, and in turn, their relationships
progress toward a maturity of interdependence. As women progress toward adulthood, the moral
dilemma changes from how to exercise their rights without interfering with the rights of others to “how
to lead a moral life,” which includes obligations to themselves and their families and people in general.
Traditional masculine roles include providing and protecting. Recently, however, men have been moving
into greater disequilibrium. Both men and women are assuming different roles in today’s society. Today,
many women pursue careers and contribute significantly to their family’s income.