h h
Giddens: Concepts for Nursing Practice, 4th Edition
h h h h h h
MULTIPLE h CHOICE
1. The h nurse h manager h of h a h pediatric h clinic h could h confirm h that h the h new h nurse
hrecognized h the h purpose h of h the h HEADSS h Adolescent h Risk h Profile h when h the
h new hnurse h responds h that h it h is h used h to h assess h for h needs h related h to
a. anticipatory h guidance.
b. low-risk h adolescents.
c. physical h development.
d. sexual h development.
ANS: A
The h HEADSS h Adolescent h Risk h Profile h is h a h psychosocial h assessment h screening
h tool hwhich h assesses h home, h education, h activities, h drugs, h sex, h and h suicide h for
h the h purpose h of h identifying h high-risk h adolescents h and h the h need h for h anticipatory
h guidance. h It h is h used h to h identify h high-risk, h not h low-risk, h adolescents. h Physical
h development h is hassessed h with h anthropometric h data.
Sexual h development h is h assessed h using h physical h examination.
OBJ: NCLEX h Client h Needs h Category: h Health h Promotion h and h Maintenance
2. The h nurse h preparing h a h teaching h plan h for h a h preschooler h knows h that,
h according h to hPiaget, h the h expected h stage h of h development h for h a h preschooler
h is
a. concrete h operational.
b. formal h operational. N
c. preoperational.
d. sensorimotor.
ANS: C
The h expected h stage h of h development h for h a h preschooler h (3–4 h years h old) h is h pre-
h operational. h Concrete h operational h describes h the h thinking h of h a h school-age h child
h (7–11 h years h old). h Formal h operational h describes h the h thinking h of h an h individual
h after h about h 11 h years h of h age. h Sensorimotor h describes h the h earliest h pattern h of
h thinking h from h birth h to h 2 h years h old.
OBJ: NCLEX h Client h Needs h Category: h Health h Promotion h and h Maintenance
3. The h school h nurse h talking h with h a h high h school h class h about h the h difference
h between hgrowth h and h development h would h best h describe h growth h as
a. processes h by h which h early h cells h specialize.
b. psychosocial h and h cognitive h changes.
c. qualitative h changes h associated h with h aging.
d. quantitative h changes h in h size
h or hweight. h ANS: D
WWW.NURSYLAB.COM
, Growth h is h a h quantitative h change h in h which h an h increase h in h cell h number h and h size
results h in h an h increase h in h overall h size h or h weight h of h the h body h or h any h of h its
h parts. h The hprocesses h by h which h early h cells h specialize h are h referred h to h as
h differentiation.
Psychosocial h and h cognitive h changes h are h referred h to h as h development. h Qualitative
hchanges h associated h with h aging h are h referred h to h as h maturation.
OBJ: NCLEX h Client h Needs h Category: h Health h Promotion h and h Maintenance
4. The h most h appropriate h response h of h the h nurse h when h a h mother h asks h what h the
h Denver h II h does h is h that h it
a. can h diagnose h developmental h disabilities.
b. identifies h a h need h for h physical h therapy.
c. is h a h developmental h screening h tool.
d. provides h a h framework h for h health h teaching.
ANS: C
The h Denver h II h is h the h most h commonly h used h measure h of h developmental
h status h used hby h healthcare h professionals; h it h is h a h screening h tool. h Screening h tools
h do h not h provide h a hdiagnosis. h Diagnosis h requires h a h thorough h neurodevelopment
h history h and h physical hexamination.
Developmental h delay, h which h is h suggested h by h screening, h is h a h symptom, h not h a
h diagnosis. hThe hneed hfor hany htherapy hwould hbe hidentified hwith ha hcomprehensive
hevaluation, hnot ha hscreening htool. hSome hproviders huse hthe hDenver hII has ha hframework hfor
hteaching habout hexpected h development, h but h this h is h not h the h primary h purpose h of
h the h tool.
OBJ: h h NCLEX h Client h Needs h Category: h Health h Promotion h and h Maintenance
5. To h plan h early h intervention h ahnhNd h care h for h an h infant h with h Down h syndrome, h the
h nurse hconsiders h knowledge h of h other h physical h development h exemplars h such h as
a. cerebral h palsy.
b. autism.
c. attention-deficit/hyperactivity h disorder h (ADHD).
d. failure h to h thrive.
ANS: h h D
Failure h to h thrive h is h also h a h physical h development h exemplar. h Cerebral h palsy h is
h an hexemplar h of h motor/developmental h delay. h Autism h is h an h exemplar h of
h social/emotional hdevelopmental h delay. h ADHD h is h an h exemplar h of h a h cognitive
h disorder.
OBJ: h h NCLEX h Client h Needs h Category: h Health h Promotion h and h Maintenance
6. To h plan h early h intervention h and h care h for h a h child h with h a h developmental h delay,
h the hnurse hwould hconsider hknowledge hof hthe hconcepts hmost hsignificantly himpacted
hby hdevelopment, h including
a. culture.
b. environment.
c. functional h status.
d. nutrition.
hANS: h C
, Function h is h one h of h the h concepts h most h significantly h impacted h by h development.
h Others hinclude h sensory-perceptual, h cognition, h mobility, h reproduction, h and h sexuality.
Knowledge h of h these h concepts h can h help h the h nurse h anticipate h areas h that h need h to
h be h addressed. h Culture h is h a h concept h that h is h considered h to h significantly h affect
hdevelopment; h the h difference h is h the h concepts h that h affect h development h are h those
h that hrepresent h major h influencing h factors h (causes); h hence h determination h of
h development hwould h be h the h focus h of h preventive h interventions. h Environment h is
h considered h to hsignificantly h affect h development. h Nutrition h is h considered h to
h significantly h affect hdevelopment.
OBJ: NCLEX h Client h Needs h Category: h Health h Promotion h and h Maintenance
7. A h mother h complains h to h the h nurse h at h the h pediatric h clinic h that h her h 4-year-old
h child h always h talks h to h her h toys h and h makes h up h stories. h The h mother h wants
h her h child h to h have ha h psychological h evaluation. h The h nurse‘s h best h initial h response
h is h to
a. refer h the h child h to h a h psychologist h immediately.
b. explain h that h playing h make h believe h is h normal h at h this h age.
c. complete h a h developmental h screening h using h a h validated h tool.
d. separate h the h child h from h the h mother h to h get h more h information.
ANS: B
By h the h end h of h the h fourth h year, h it h is h expected h that h a h child h will h engage h in
h fantasy, h so hthis h is h normal h at h this h age. h A h referral h to h a h psychologist h would h be
h premature h based h only h on h the h complaint h of h the h mother. h Completing h a
h developmental h screening h would hbe h very h appropriate h but h not h the h initial h response.
h The h nurse h would h certainly h want h to h get h more h information, h but h separating h the
h child h from h the h mother h is h not h necessary h at h this h time.
OBJ: NCLEX h Client h NeedsNCategory: h Health h Promotion h and h Maintenance
8. A h 17-year-old h girl h is h hospitalized h for h appendicitis, h and h her h mother h asks h the
h nurse hwhy h she h is h so h needy h and h acting h like h a h child. h The h best h response h of
h the h nurse h is hthat h in h the h hospital, h adolescents
a. have h separation h anxiety.
b. rebel h against h rules.
c. regress h because h of h stress.
d. want h to h know h everything.
ANS: C
Regression h to h an h earlier h stage h of h development h is h a h common h response h to h stress.
h Separation h anxiety h is h most h common h in h infants h and h toddlers. h Rebellion
h against hhospital h rules h is h usually h not h an h issue h if h the h adolescent h understands h the
h rules h and h would h not h create h childlike h behaviors. h An h adolescent h may h want h to
h ―know h everything‖ hwith h their h logical h thinking h and h deductive h reasoning, h but h that
h would h not h explain h why h they h would h act h like h a h child.
OBJ: NCLEX h Client h Needs h Category: h Health h Promotion h and h Maintenance
WWW.NURSYLAB.COM