CONCEPTS FOR NURSING
PRACTICE
4TH EDITION
• AUTHOR(S)JEAN FORET
GIDDENS
TEST BANK
Question 1
Reference:
Ch. 1 — Development — Assessment & Health Promotion
Stem:
A nurse is performing a routine well-child visit for a 4-month-
old infant. The parent reports the infant smiles spontaneously
at family members, holds a rattle briefly when placed in the
hand, and turns their head toward a ringing bell. The infant
,does not yet roll over. Which statement by the nurse is most
appropriate?
Options:
A. "Your baby is slightly behind in social development; we
should discuss strategies to increase smiling."
B. "These are expected findings for a 4-month-old. Let's talk
about the milestone to look for next, like rolling over."
C. "The inability to roll over is a developmental red flag
requiring an immediate specialist referral."
D. "Holding a rattle is an advanced skill; your baby's fine motor
development is ahead of schedule."
Correct Answer:
B
Rationales:
Correct (B): The described behaviors (social smile, grasping
reflex, turning to sound) are all expected developmental
milestones for a 4-month-old. The absence of rolling over at this
age is not a concern, as this skill typically emerges between 4-6
months. The nurse uses this as an opportunity for anticipatory
guidance, reinforcing normal development and educating the
parent about the next expected milestone.
Incorrect (A): A social smile is expected by 2 months, so the
infant is demonstrating appropriate social development. This
statement incorrectly identifies a problem where none exists.
Incorrect (C): Failure to roll over is not a red flag at 4 months.
An immediate referral is not indicated based solely on this
,finding, demonstrating a lack of understanding of typical
developmental windows.
Incorrect (D): The palmar grasp reflex is present at birth and
begins to fade around 4-6 months. Holding a rattle briefly is an
expected primitive reflex, not an advanced fine motor skill.
Teaching Point:
Use validated developmental milestones and windows to
differentiate normal variation from true delays, providing
accurate education and reassurance.
Citation:
Giddens, J. F. (2025). Concepts for Nursing Practice (4th ed.).
Chapter 1.
Question 2
Reference:
Ch. 1 — Development — Safety & Injury Prevention
Stem:
A nurse is providing education to the parents of a 9-month-old
infant during a well-child visit. The infant is crawling and pulling
to a stand. Which safety instruction is the priority for the nurse
to emphasize based on the infant's developmental stage?
Options:
A. "Ensure your car seat is rear-facing in the back seat."
B. "Place safety gates at the top and bottom of stairways."
, C. "Keep all small objects and latex balloons out of reach."
D. "Set your water heater temperature to 120°F (49°C)."
Correct Answer:
B
Rationales:
Correct (B): The greatest safety threat to a mobile infant who is
pulling to stand is injury from falls. Stairs pose a significant risk.
Prioritizing interventions that mitigate the hazards posed by the
child's newly acquired motor skills aligns with injury prevention
principles and developmental theory.
Incorrect (A): While car seat safety is always important, it is not
a new risk directly tied to the developmental achievements of
crawling and pulling to stand.
Incorrect (C): Preventing choking is crucial, but it is a constant
vigilance from infancy through toddlerhood. The scenario
highlights new mobility, making fall prevention the immediate
priority.
Incorrect (D): Scald prevention is important, but not the most
direct response to the infant's new ability to crawl and pull up,
which increases fall risk.
Teaching Point:
Safety teaching must be anticipatory and tailored to the child's
current and emerging developmental abilities.
PRACTICE
4TH EDITION
• AUTHOR(S)JEAN FORET
GIDDENS
TEST BANK
Question 1
Reference:
Ch. 1 — Development — Assessment & Health Promotion
Stem:
A nurse is performing a routine well-child visit for a 4-month-
old infant. The parent reports the infant smiles spontaneously
at family members, holds a rattle briefly when placed in the
hand, and turns their head toward a ringing bell. The infant
,does not yet roll over. Which statement by the nurse is most
appropriate?
Options:
A. "Your baby is slightly behind in social development; we
should discuss strategies to increase smiling."
B. "These are expected findings for a 4-month-old. Let's talk
about the milestone to look for next, like rolling over."
C. "The inability to roll over is a developmental red flag
requiring an immediate specialist referral."
D. "Holding a rattle is an advanced skill; your baby's fine motor
development is ahead of schedule."
Correct Answer:
B
Rationales:
Correct (B): The described behaviors (social smile, grasping
reflex, turning to sound) are all expected developmental
milestones for a 4-month-old. The absence of rolling over at this
age is not a concern, as this skill typically emerges between 4-6
months. The nurse uses this as an opportunity for anticipatory
guidance, reinforcing normal development and educating the
parent about the next expected milestone.
Incorrect (A): A social smile is expected by 2 months, so the
infant is demonstrating appropriate social development. This
statement incorrectly identifies a problem where none exists.
Incorrect (C): Failure to roll over is not a red flag at 4 months.
An immediate referral is not indicated based solely on this
,finding, demonstrating a lack of understanding of typical
developmental windows.
Incorrect (D): The palmar grasp reflex is present at birth and
begins to fade around 4-6 months. Holding a rattle briefly is an
expected primitive reflex, not an advanced fine motor skill.
Teaching Point:
Use validated developmental milestones and windows to
differentiate normal variation from true delays, providing
accurate education and reassurance.
Citation:
Giddens, J. F. (2025). Concepts for Nursing Practice (4th ed.).
Chapter 1.
Question 2
Reference:
Ch. 1 — Development — Safety & Injury Prevention
Stem:
A nurse is providing education to the parents of a 9-month-old
infant during a well-child visit. The infant is crawling and pulling
to a stand. Which safety instruction is the priority for the nurse
to emphasize based on the infant's developmental stage?
Options:
A. "Ensure your car seat is rear-facing in the back seat."
B. "Place safety gates at the top and bottom of stairways."
, C. "Keep all small objects and latex balloons out of reach."
D. "Set your water heater temperature to 120°F (49°C)."
Correct Answer:
B
Rationales:
Correct (B): The greatest safety threat to a mobile infant who is
pulling to stand is injury from falls. Stairs pose a significant risk.
Prioritizing interventions that mitigate the hazards posed by the
child's newly acquired motor skills aligns with injury prevention
principles and developmental theory.
Incorrect (A): While car seat safety is always important, it is not
a new risk directly tied to the developmental achievements of
crawling and pulling to stand.
Incorrect (C): Preventing choking is crucial, but it is a constant
vigilance from infancy through toddlerhood. The scenario
highlights new mobility, making fall prevention the immediate
priority.
Incorrect (D): Scald prevention is important, but not the most
direct response to the infant's new ability to crawl and pull up,
which increases fall risk.
Teaching Point:
Safety teaching must be anticipatory and tailored to the child's
current and emerging developmental abilities.
