TEST BANK CONCEPTS FOR NURSING PRACTICE 3RD EDITION BY JEAN
FORET GIDDENS | ACTUAL QUESTIONS AND ANSWERS
,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.
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.
b. formal operational.
c. preoperational.
d. sensorimotor.
ANS: C
The expected stage of development for a preschooler (3–4 years old) is pre-operational.
Concrete operational describes the thinking of a school-age child (7–11 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.
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 as differentiation. Psychosocial and cognitive changes
are referred to as development. Qualitative changes associated with aging are referred to as
maturation.
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
The Denver II is the most commonly used measure of developmental status used by
healthcare 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.
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
5. To plan early intervention a n d care for an infant with Down syndrome, the nurse considers
knowledge of other physical development exemplars such as
a. cerebral palsy.
b. autism.
c. attention-deficit/hyperactivity disorder (ADHD).
d. failure to thrive.
ANS: D
Failure to thrive is also a physical development exemplar. Cerebral palsy is an exemplar of
motor/developmental delay. Autism is an exemplar of social/emotional developmental
delay. ADHD is an exemplar of a cognitive disorder.
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.
nutrition.
d.
e. ANS: a C
, Function ais aone aof athe aconcepts amost asignificantly aimpacted aby adevelopment. aOthers
ainclude asensory-perceptual, acognition, amobility, areproduction, aand asexuality. aKnowledge
aof athese aconcepts acan ahelp athe anurse aanticipate aareas athat aneed ato abe aaddressed. aCulture ais
aa aconcept athat ais aconsidered ato asignificantly aaffect adevelopment; athe adifference ais athe
aconcepts athat aaffect adevelopment aare athose athat arepresent amajor ainfluencing afactors
a(causes); ahence adetermination aof adevelopment awould abe athe afocus aof apreventive
ainterventions. aEnvironment ais aconsidered ato asignificantly aaffect adevelopment. aNutrition ais
aconsidered ato asignificantly aaffect adevelopment.
OBJ: NCLEX aClient aNeeds aCategory: aHealth aPromotion aand aMaintenance
7. A amother acomplains ato athe anurse aat athe apediatric aclinic athat aher a4-year-old achild aalways
atalks ato aher atoys aand amakes aup astories. aThe amother awants aher achild ato ahave aa
apsychological aevaluation. aThe anurse‘s abest ainitial aresponse ais ato
a. refer athe achild ato aa apsychologist aimmediately.
b. explain athat aplaying amake abelieve ais anormal aat athis aage.
c. complete aa adevelopmental ascreening ausing aa avalidated atool.
d. separate athe achild afrom athe amother ato aget amore ainformation.
ANS: a B
By athe aend aof athe afourth ayear, ait ais aexpected athat aa achild awill aengage ain afantasy, aso athis ais
anormal aat athis aage. aA areferral ato aa apsychologist awould abe apremature abased aonly aon athe
acomplaint aof athe amother. aCompleting aa adevelopmental ascreening awould abe avery
aappropriate abut anot athe ainitial aresponse. aThe anurse awould acertainly awant ato aget amore
ainformation, abut aseparating athe achild afrom athe amother ais anot anecessary aat athis atime.
OBJ: NCLEX aClient aNeeds aCategory: aHealth aPromotion aand aMaintenance
8. A a17-year-old agirl ais ahospitalized afor aappendicitis, aand aher amother aasks athe anurse awhy ashe
ais aso aneedy aand aacting alike aa achild. aThe abest aresponse aof athe anurse ais athat ain athe ahospital,
aadolescents
a. have aseparation aanxiety.
b. rebel aagainst arules.
c. regress abecause aof astress.
d. want ato aknow aeverything.
ANS: a C
Regression ato aan aearlier astage aof adevelopment ais aa acommon aresponse ato astress. aSeparation
aanxiety ais amost acommon ain ainfants aand atoddlers. aRebellion aagainst ahospital arules ais ausually
anot aan aissue aif athe aadolescent aunderstands athe arules aand awould anot acreate achildlike
abehaviors. aAn aadolescent amay awant ato a―know aeverything‖ awith atheir alogical athinking aand
adeductive areasoning, abut athat awould anot aexplain awhy athey awould aact alike aa achild.
OBJ: NCLEX aClient aNeeds aCategory: aHealth aPromotion aand aMaintenance
FORET GIDDENS | ACTUAL QUESTIONS AND ANSWERS
,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.
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.
b. formal operational.
c. preoperational.
d. sensorimotor.
ANS: C
The expected stage of development for a preschooler (3–4 years old) is pre-operational.
Concrete operational describes the thinking of a school-age child (7–11 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.
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 as differentiation. Psychosocial and cognitive changes
are referred to as development. Qualitative changes associated with aging are referred to as
maturation.
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
The Denver II is the most commonly used measure of developmental status used by
healthcare 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.
OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
5. To plan early intervention a n d care for an infant with Down syndrome, the nurse considers
knowledge of other physical development exemplars such as
a. cerebral palsy.
b. autism.
c. attention-deficit/hyperactivity disorder (ADHD).
d. failure to thrive.
ANS: D
Failure to thrive is also a physical development exemplar. Cerebral palsy is an exemplar of
motor/developmental delay. Autism is an exemplar of social/emotional developmental
delay. ADHD is an exemplar of a cognitive disorder.
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.
nutrition.
d.
e. ANS: a C
, Function ais aone aof athe aconcepts amost asignificantly aimpacted aby adevelopment. aOthers
ainclude asensory-perceptual, acognition, amobility, areproduction, aand asexuality. aKnowledge
aof athese aconcepts acan ahelp athe anurse aanticipate aareas athat aneed ato abe aaddressed. aCulture ais
aa aconcept athat ais aconsidered ato asignificantly aaffect adevelopment; athe adifference ais athe
aconcepts athat aaffect adevelopment aare athose athat arepresent amajor ainfluencing afactors
a(causes); ahence adetermination aof adevelopment awould abe athe afocus aof apreventive
ainterventions. aEnvironment ais aconsidered ato asignificantly aaffect adevelopment. aNutrition ais
aconsidered ato asignificantly aaffect adevelopment.
OBJ: NCLEX aClient aNeeds aCategory: aHealth aPromotion aand aMaintenance
7. A amother acomplains ato athe anurse aat athe apediatric aclinic athat aher a4-year-old achild aalways
atalks ato aher atoys aand amakes aup astories. aThe amother awants aher achild ato ahave aa
apsychological aevaluation. aThe anurse‘s abest ainitial aresponse ais ato
a. refer athe achild ato aa apsychologist aimmediately.
b. explain athat aplaying amake abelieve ais anormal aat athis aage.
c. complete aa adevelopmental ascreening ausing aa avalidated atool.
d. separate athe achild afrom athe amother ato aget amore ainformation.
ANS: a B
By athe aend aof athe afourth ayear, ait ais aexpected athat aa achild awill aengage ain afantasy, aso athis ais
anormal aat athis aage. aA areferral ato aa apsychologist awould abe apremature abased aonly aon athe
acomplaint aof athe amother. aCompleting aa adevelopmental ascreening awould abe avery
aappropriate abut anot athe ainitial aresponse. aThe anurse awould acertainly awant ato aget amore
ainformation, abut aseparating athe achild afrom athe amother ais anot anecessary aat athis atime.
OBJ: NCLEX aClient aNeeds aCategory: aHealth aPromotion aand aMaintenance
8. A a17-year-old agirl ais ahospitalized afor aappendicitis, aand aher amother aasks athe anurse awhy ashe
ais aso aneedy aand aacting alike aa achild. aThe abest aresponse aof athe anurse ais athat ain athe ahospital,
aadolescents
a. have aseparation aanxiety.
b. rebel aagainst arules.
c. regress abecause aof astress.
d. want ato aknow aeverything.
ANS: a C
Regression ato aan aearlier astage aof adevelopment ais aa acommon aresponse ato astress. aSeparation
aanxiety ais amost acommon ain ainfants aand atoddlers. aRebellion aagainst ahospital arules ais ausually
anot aan aissue aif athe aadolescent aunderstands athe arules aand awould anot acreate achildlike
abehaviors. aAn aadolescent amay awant ato a―know aeverything‖ awith atheir alogical athinking aand
adeductive areasoning, abut athat awould anot aexplain awhy athey awould aact alike aa achild.
OBJ: NCLEX aClient aNeeds aCategory: aHealth aPromotion aand aMaintenance
