Chapter 1 . Advanced Practice Nursing: Doing What Has to Be Done-Radicals,
Renegades, and Rebels
MULTIPLE CHOICE
1. 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.
ANS: A
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.
REF: 6 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
2. 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.
[Type text]
, b. formal operational.
c. preoperational.
d. sensorimotor.
ANS: C
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.
REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
3. 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.
ANS: D
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 asdifferentiation.
Psychosocial and cognitive changes are referred to as development. Qualitative
changes associated with aging are referred to as maturation.
REF: 2 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
4. 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.
ANS: C
[Type text]
, 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.
REF: 4 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
5. 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.
ANS: D
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.
REF: 9 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
6. 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.
ANS: C
Function is one of the concepts most significantly impacted by development.
Others include sensory-perceptual, cognition, mobility, reproduction, and
[Type text]
, 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.
REF: 1 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
7. 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 nurses 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.
ANS: B
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.
REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
8. 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.
ANS: C
[Type text]
Renegades, and Rebels
MULTIPLE CHOICE
1. 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.
ANS: A
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.
REF: 6 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
2. 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.
[Type text]
, b. formal operational.
c. preoperational.
d. sensorimotor.
ANS: C
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.
REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
3. 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.
ANS: D
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 asdifferentiation.
Psychosocial and cognitive changes are referred to as development. Qualitative
changes associated with aging are referred to as maturation.
REF: 2 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
4. 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.
ANS: C
[Type text]
, 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.
REF: 4 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
5. 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.
ANS: D
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.
REF: 9 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
6. 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.
ANS: C
Function is one of the concepts most significantly impacted by development.
Others include sensory-perceptual, cognition, mobility, reproduction, and
[Type text]
, 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.
REF: 1 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
7. 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 nurses 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.
ANS: B
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.
REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
8. 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.
ANS: C
[Type text]
