Concept 01: Development
x$ x$
,Giddens: Concepts for Nursing Practice, 3rd Edition
x$ x$ x$ x$ x$ x$
MULTIPLE CHOICE x$
1. The nurse manager of a pediatric clinic could confirm that the new nurse recognized t
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
he purpose of the HEADSS Adolescent Risk Profile when the new nurse responds th
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
at it is used to assess for needs related to
x$ x$ x$ x$ x$ x$ x$ x$ x$
a. anticipatory guidance. x$
b. low-risk adolescents. x$
c. physical development. x$
d. sexual development. x$
ANS: A x $
The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
assesses home, education, activities, drugs, sex, and suicide for the purpose of identifyin
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
g high-risk adolescents and the need for anticipatory guidance. It is used to identify high-
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
risk, not low- x$ x$
risk, adolescents. Physical development is assessed with anthropometric data.
x$ x$ x$ x$ x$ x$ x$ x$
Sexual development is assessed using physical examination.
x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
2. The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, t
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
he expected stage of development for a preschooler is
x$ x$ x$ x$ x$ x$ x$ x$
a. concrete operational. x$
b. formal operational. N x$
c. preoperational.
d. sensorimotor.
ANS: C x $
The expected stage of development for a preschooler (3–4 years old) is pre-
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
operational. Concrete operational describes the thinking of a school-age child (7–
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
11 years old). Formal operational describes the thinking of an individual after about 11 ye
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ars of age. Sensorimotor describes the earliest pattern of thinking from birth to 2 years old
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
.
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
3. The school nurse talking with a high school class about the difference between growth a
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
nd development would best describe growth as
x$ x$ x$ x$ x$ x$
a. processes by which early cells specialize. x$ x$ x$ x$ x$
b. psychosocial and cognitive changes. x$ x$ x$
c. qualitative changes associated with aging. x$ x$ x$ x$
d. quantitative changes in size or weight x$ x$ x$ x$ x$
. ANS: D
x$ x $
, Growth is a quantitative change in which an increase in cell number and size results in a
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
n increase in overall size or weight of the body or any of its parts. The processes by whi
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ch early cells specialize are referred to as differentiation. Psychosocial and cognitive cha
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
nges are referred to as development. Qualitative changes associated with aging are referre
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
d to as maturation.
x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
4. The most appropriate response of the nurse when a mother asks what the Denver II does
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
is that it
x$ x$ x$
a. can diagnose developmental disabilities.
x$ x$ x$
b. identifies a need for physical therapy. x$ x$ x$ x$ x$
c. is a developmental screening tool.
x$ x$ x$ x$
d. provides a framework for health teaching. x$ x$ x$ x$ x$
ANS: C x $
The Denver II is the most commonly used measure of developmental status used by healt
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
hcare professionals; it is a screening tool. Screening tools do not provide a diagnosis. Diag
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
nosis requires a thorough neurodevelopment history and physical examination.
x$ x$ x$ x$ x$ x$ x$ x$
Developmental delay, which is suggested by screening, is a symptom, not a diagnosis. The
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x
need for any therapy would be identified with a comprehensive evaluation, not a screening
$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
tool. Some providers use the Denver II as a framework for teaching about expected devel
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
opment, but this is not the primary purpose of the tool.
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
5. To plan early intervention a n Nd care for an infant with Down syndrome, the nurse consider
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
s knowledge of other physical development exemplars such as
x$ x$ x$ x$ x$ x$ x$ x$
a. cerebral palsy. x$
b. autism.
c. attention-deficit/hyperactivity disorder (ADHD). x$ x$
d. failure to thrive. x$ x$
ANS: D x $
Failure to thrive is also a physical development exemplar. Cerebral palsy is an exemplar
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
of motor/developmental delay. Autism is an exemplar of social/emotional developmental
x$ x$ x$ x$ x$ x$ x$ x$ x$ x
delay. ADHD is an exemplar of a cognitive disorder.
$ x$ x$ x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
6. To plan early intervention and care for a child with a developmental delay, the nurse wo
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
uld consider knowledge of the concepts most significantly impacted by development, incl
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
uding
a. culture.
b. environment.
c. functional status. x$
d. nutrition.
x$ ANS: C x $
, Function is one of the concepts most significantly impacted by development. Others inclu
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
de sensory-
x$
perceptual, cognition, mobility, reproduction, and sexuality. Knowledge of these concepts
x$ x$ x$ x$ x$ x$ x$ x$ x$
can help the nurse anticipate areas that need to be addressed. Culture is a concept that is
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
considered to significantly affect development; the difference is the concepts that affect
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
development are those that represent major influencing factors (causes); hence determinat
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ion of development would be the focus of preventive interventions. Environment is consi
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
dered to significantly affect development. Nutrition is considered to significantly affect d
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
evelopment.
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
7. A mother complains to the nurse at the pediatric clinic that her 4-year-
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
old child always talks to her toys and makes up stories. The mother wants her child to ha
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ve a psychological evaluation. The nurse‘s best initial response is to
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
a. refer the child to a psychologist immediately.
x$ x$ x$ x$ x$ x$
b. explain that playing make believe is normal at this age.
x$ x$ x$ x$ x$ x$ x$ x$ x$
c. complete a developmental screening using a validated tool. x$ x$ x$ x$ x$ x$ x$
d. separate the child from the mother to get more information.
x$ x$ x$ x$ x$ x$ x$ x$ x$
ANS: B x $
By the end of the fourth year, it is expected that a child will engage in fantasy, so this is
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
normal at this age. A referral to a psychologist would be premature based only on the co
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
mplaint of the mother. Completing a developmental screening would be very appropriate b
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ut not the initial response. The nurse would certainly want to get more information, but se
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
parating the child from the mother is not necessary at this time.
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client NeedsNCategory: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$
8. A 17-year-
x$
old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so need
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
y and acting like a child. The best response of the nurse is that in the hospital, adolescen
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ts
a. have separation anxiety. x$ x$
b. rebel against rules. x$ x$
c. regress because of stress. x$ x$ x$
d. want to know everything. x$ x$ x$
ANS: C x $
Regression to an earlier stage of development is a common response to stress. Separation
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
anxiety is most common in infants and toddlers. Rebellion against hospital rules is usuall
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
y not an issue if the adolescent understands the rules and would not create childlike behav
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
iors. An adolescent may want to ―know everything‖ with their logical thinking and deduc
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
tive reasoning, but that would not explain why they would act like a child.
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
x$ x$
,Giddens: Concepts for Nursing Practice, 3rd Edition
x$ x$ x$ x$ x$ x$
MULTIPLE CHOICE x$
1. The nurse manager of a pediatric clinic could confirm that the new nurse recognized t
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
he purpose of the HEADSS Adolescent Risk Profile when the new nurse responds th
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
at it is used to assess for needs related to
x$ x$ x$ x$ x$ x$ x$ x$ x$
a. anticipatory guidance. x$
b. low-risk adolescents. x$
c. physical development. x$
d. sexual development. x$
ANS: A x $
The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
assesses home, education, activities, drugs, sex, and suicide for the purpose of identifyin
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
g high-risk adolescents and the need for anticipatory guidance. It is used to identify high-
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
risk, not low- x$ x$
risk, adolescents. Physical development is assessed with anthropometric data.
x$ x$ x$ x$ x$ x$ x$ x$
Sexual development is assessed using physical examination.
x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
2. The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, t
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
he expected stage of development for a preschooler is
x$ x$ x$ x$ x$ x$ x$ x$
a. concrete operational. x$
b. formal operational. N x$
c. preoperational.
d. sensorimotor.
ANS: C x $
The expected stage of development for a preschooler (3–4 years old) is pre-
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
operational. Concrete operational describes the thinking of a school-age child (7–
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
11 years old). Formal operational describes the thinking of an individual after about 11 ye
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ars of age. Sensorimotor describes the earliest pattern of thinking from birth to 2 years old
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
.
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
3. The school nurse talking with a high school class about the difference between growth a
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
nd development would best describe growth as
x$ x$ x$ x$ x$ x$
a. processes by which early cells specialize. x$ x$ x$ x$ x$
b. psychosocial and cognitive changes. x$ x$ x$
c. qualitative changes associated with aging. x$ x$ x$ x$
d. quantitative changes in size or weight x$ x$ x$ x$ x$
. ANS: D
x$ x $
, Growth is a quantitative change in which an increase in cell number and size results in a
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
n increase in overall size or weight of the body or any of its parts. The processes by whi
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ch early cells specialize are referred to as differentiation. Psychosocial and cognitive cha
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
nges are referred to as development. Qualitative changes associated with aging are referre
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
d to as maturation.
x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
4. The most appropriate response of the nurse when a mother asks what the Denver II does
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
is that it
x$ x$ x$
a. can diagnose developmental disabilities.
x$ x$ x$
b. identifies a need for physical therapy. x$ x$ x$ x$ x$
c. is a developmental screening tool.
x$ x$ x$ x$
d. provides a framework for health teaching. x$ x$ x$ x$ x$
ANS: C x $
The Denver II is the most commonly used measure of developmental status used by healt
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
hcare professionals; it is a screening tool. Screening tools do not provide a diagnosis. Diag
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
nosis requires a thorough neurodevelopment history and physical examination.
x$ x$ x$ x$ x$ x$ x$ x$
Developmental delay, which is suggested by screening, is a symptom, not a diagnosis. The
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x
need for any therapy would be identified with a comprehensive evaluation, not a screening
$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
tool. Some providers use the Denver II as a framework for teaching about expected devel
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
opment, but this is not the primary purpose of the tool.
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
5. To plan early intervention a n Nd care for an infant with Down syndrome, the nurse consider
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
s knowledge of other physical development exemplars such as
x$ x$ x$ x$ x$ x$ x$ x$
a. cerebral palsy. x$
b. autism.
c. attention-deficit/hyperactivity disorder (ADHD). x$ x$
d. failure to thrive. x$ x$
ANS: D x $
Failure to thrive is also a physical development exemplar. Cerebral palsy is an exemplar
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
of motor/developmental delay. Autism is an exemplar of social/emotional developmental
x$ x$ x$ x$ x$ x$ x$ x$ x$ x
delay. ADHD is an exemplar of a cognitive disorder.
$ x$ x$ x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
6. To plan early intervention and care for a child with a developmental delay, the nurse wo
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
uld consider knowledge of the concepts most significantly impacted by development, incl
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
uding
a. culture.
b. environment.
c. functional status. x$
d. nutrition.
x$ ANS: C x $
, Function is one of the concepts most significantly impacted by development. Others inclu
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
de sensory-
x$
perceptual, cognition, mobility, reproduction, and sexuality. Knowledge of these concepts
x$ x$ x$ x$ x$ x$ x$ x$ x$
can help the nurse anticipate areas that need to be addressed. Culture is a concept that is
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
considered to significantly affect development; the difference is the concepts that affect
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
development are those that represent major influencing factors (causes); hence determinat
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ion of development would be the focus of preventive interventions. Environment is consi
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
dered to significantly affect development. Nutrition is considered to significantly affect d
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
evelopment.
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
7. A mother complains to the nurse at the pediatric clinic that her 4-year-
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
old child always talks to her toys and makes up stories. The mother wants her child to ha
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ve a psychological evaluation. The nurse‘s best initial response is to
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
a. refer the child to a psychologist immediately.
x$ x$ x$ x$ x$ x$
b. explain that playing make believe is normal at this age.
x$ x$ x$ x$ x$ x$ x$ x$ x$
c. complete a developmental screening using a validated tool. x$ x$ x$ x$ x$ x$ x$
d. separate the child from the mother to get more information.
x$ x$ x$ x$ x$ x$ x$ x$ x$
ANS: B x $
By the end of the fourth year, it is expected that a child will engage in fantasy, so this is
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
normal at this age. A referral to a psychologist would be premature based only on the co
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
mplaint of the mother. Completing a developmental screening would be very appropriate b
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ut not the initial response. The nurse would certainly want to get more information, but se
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
parating the child from the mother is not necessary at this time.
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client NeedsNCategory: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$
8. A 17-year-
x$
old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so need
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
y and acting like a child. The best response of the nurse is that in the hospital, adolescen
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
ts
a. have separation anxiety. x$ x$
b. rebel against rules. x$ x$
c. regress because of stress. x$ x$ x$
d. want to know everything. x$ x$ x$
ANS: C x $
Regression to an earlier stage of development is a common response to stress. Separation
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
anxiety is most common in infants and toddlers. Rebellion against hospital rules is usuall
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
y not an issue if the adolescent understands the rules and would not create childlike behav
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
iors. An adolescent may want to ―know everything‖ with their logical thinking and deduc
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
tive reasoning, but that would not explain why they would act like a child.
x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$ x$
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
x$ x$ x$ x$ x$ x$ x$
