developmental milestones should the nurse expect at this age?
a. Sits without support
b. Follows objects with eyes
c. Pulls up to stand
d. Says "mama" and "dada"
Answer: b. Follows objects with eyes
Rationale: At 2 months, infants are expected to begin tracking objects with their eyes. Sitting
without support occurs closer to 6 months, pulling to stand closer to 9 months, and saying
"mama" or "dada" typically develops after 9-12 months.
2. The nurse is teaching a group of parents about injury prevention in toddlers.
Which statement by a parent indicates the need for further teaching?
a. "I should keep poisonous substances locked away."
b. "I should make sure my child wears a helmet when biking."
c. "I can leave my toddler in the bathtub as long as I’m in the next room."
d. "I will ensure my toddler's car seat is rear-facing."
Answer: c. "I can leave my toddler in the bathtub as long as I’m in the next room."
Rationale: Toddlers should never be left unattended in the bathtub due to the risk of drowning.
Helmets and rear-facing car seats are important safety measures, and keeping poisonous
substances out of reach prevents accidental ingestion.
3. A 4-year-old child is in the hospital. The nurse expects which behavior
according to Piaget’s stages of development?
a. The child has abstract reasoning skills
b. The child engages in pretend play
c. The child understands conservation
d. The child solves hypothetical problems
Answer: b. The child engages in pretend play
Rationale: According to Piaget, a 4-year-old is in the preoperational stage (2-7 years),
characterized by symbolic play and egocentric thinking. Abstract reasoning and understanding of
conservation come in later stages of cognitive development.
,4. The nurse is planning care for a school-aged child who is recovering from
surgery. Which intervention best addresses the child's developmental needs?
a. Encourage participation in group activities
b. Allow the child to have frequent rest periods
c. Provide age-appropriate books and puzzles
d. Engage the child in pretend play
Answer: c. Provide age-appropriate books and puzzles
Rationale: School-aged children (6-12 years) are in Erikson's stage of Industry vs. Inferiority,
where they develop competence through activities that challenge their intellect. Puzzles and
books are appropriate for cognitive development.
5. Which of the following is the most appropriate intervention when assessing an
adolescent client?
a. Talk to the parents first
b. Focus on developmental delays
c. Respect the client’s need for privacy
d. Use medical jargon
Answer: c. Respect the client’s need for privacy
Rationale: Adolescents are developing a sense of identity and value privacy. It’s important to
build trust by maintaining confidentiality and addressing the client directly rather than focusing
solely on parental input or delays.
6. The nurse is assessing a 45-year-old client who reports difficulty managing
stress. Which of the following approaches would be most appropriate for this age
group?
a. Discuss retirement planning
b. Offer information on stress management techniques
c. Recommend a complete diet change
d. Suggest the client reduce social activities
Answer: b. Offer information on stress management techniques
Rationale: At this stage (middle adulthood), clients are often balancing work, family, and
personal health. Stress management techniques are useful interventions to promote coping and
prevent health issues.
, 7. A 72-year-old client expresses concern about memory loss. Which assessment
finding is most consistent with normal aging?
a. Forgetting to pay bills regularly
b. Inability to recall recent events
c. Forgetting the names of close family members
d. Occasionally forgetting where the keys are placed
Answer: d. Occasionally forgetting where the keys are placed
Rationale: Mild forgetfulness, such as occasionally misplacing items, is a normal part of aging.
Forgetting recent events or family members may indicate a more serious condition like dementia.
8. A nurse is caring for a client with Alzheimer’s disease. Which intervention is
most appropriate for promoting communication?
a. Ask the client open-ended questions
b. Use simple, direct statements
c. Encourage the client to write responses
d. Avoid repeating instructions
Answer: b. Use simple, direct statements
Rationale: Clients with Alzheimer’s disease benefit from clear, simple communication as their
cognitive function declines. Open-ended questions may be too difficult for them to process.
9. The nurse is teaching an older adult client about nutrition. Which of the
following dietary changes is most important for this age group?
a. Increase carbohydrate intake
b. Limit protein intake
c. Increase calcium and vitamin D
d. Reduce fiber consumption
Answer: c. Increase calcium and vitamin D
Rationale: Older adults need additional calcium and vitamin D to maintain bone health and
prevent osteoporosis. Fiber is also important to prevent constipation, while carbohydrate and
protein intake should be balanced.
10. When teaching an older adult client about health promotion, which of the
following topics is most relevant to include?