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Performance
Exit
Week 1 - Growth and Development
Adaptive Quizzing
Due Oct 19, 2022 by 11:59 pm
Passed
145 out of 149 questions answered correctly
Completed on Oct 18, 2022 11:23 am
Incorrect (4)
Which stage is a part of postconventional reasoning?
Social contract orientation
Society-maintaining orientation
Instrumental relativist orientation
Punishment and obedience orientation
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Rationale
The social contract orientation stage is a part of postconventional reasoning. Societymaintaining orientation is part of the conventional/role conformity reasoning level.
The instrumental relativist orientation stage and the punishment and obedience
orientation stage are parts of the preconventional reasoning level.
Test-Taking Tip: Have confidence in your initial response to an item because it more
than likely is the correct answer.
At which age should the anterior fontanel of an infant close?
At 4 to 10 months
At 8 to 12 months
At 12 to 18 months
At 18 to 26 months
Rationale
The anterior fontanel usually closes between 12 and 18 months.
Test-Taking Tip: Multiple-choice questions can be challenging because students think
that they will recognize the right answer when they see it or that the right answer will
somehow stand out from the other choices. This is a dangerous misconception. The
more carefully the question is constructed, the more each of the choices will seem like
the correct response.
Which growth and developmental assessments would the nurse include
when conducting a health maintenance visit for a 15-month-old
toddler? Select all that apply. One, some, or all responses may be
correct.
Some correct answers were not selected
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Length
Weight
Body mass index
Head circumference
Developmental screening
Rationale
Growth and developmental assessments that the nurse would perform for a 15month-old toddler include length, weight, and head circumference. Body mass index
is not assessed until 24 months of age. A developmental surveillance, not screening, is
appropriate for a 15-month-old toddler.
According to Piaget’s theory, which of these statements would be
provided regarding a 4-year-old child? Select all that apply. One, some,
or all responses may be correct.
'The child will only be able to consider his or her own point of view.'
'The child will consider that inanimate objects may be alive.'
'The child will think about an action before performing it.'
'The child will believe that his or her actions are scrutinized.'
'The child will be able to order things according to length.'
Rationale
According to Piaget’s theory, a 4-year-old child will see others only from his or her
point of view. In addition, the child will consider inanimate objects as living. Between
the ages of 4 and 11 years, the child thinks about an action before performing it
physically. From the age of 11 years to adulthood, a child believes that his or her
actions and appearance are constantly scrutinized. The child has an 'imaginary
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audience.' This is the period of formal operations. Between the ages of 4 and 11 years,
a child is able to correctly order or sort objects by length or weight.
Correct (145)
At which stage of Kohlberg’s theory does an individual want to fulfill the
expectations of one’s immediate group?
Good boy–nice girl orientation
Society-maintaining orientation
Instrumental relativist orientation
Universal ethical principle orientation
Rationale
The good boy–good girl orientation stage involves an individual who wants to win the
approval and maintain the expectations of one’s immediate group. During the societymaintaining orientation stage, an individual expands focus from a relationship with
others to societal concerns. The instrumental relativist orientation stage involves a
child who wants to follow his or her parent’s rules. The universal ethical principle
orientation stage defines 'right' by the decision of conscience according to self-chosen
ethical principles.
In which settings would the nurse prepare to administer developmental
assessment for pediatric clients? Select all that apply. One, some, or all
responses may be correct.
Home
School
Hospital
Daycare center
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Assisted living center
Rationale
Pediatric developmental assessments are performed in many settings, including the
home, school, hospital, and daycare center environments. It is unlikely that a pediatric
developmental assessment would be performed in an assisted living center.
To which client would the nurse provide education regarding the
pubertal growth spurt?
An 8-year-old school-age male client
A 16-year-old adolescent male client
A 12-year-old school-age female client
An 18-year-old adolescent female client
Rationale
The pubertal growth spurt reaches a peak for female clients at 12 years of age;
therefore the nurse would provide education to this client regarding expected growth
during this time period. The 8-year-old male client would not be expected to
experience the pubertal growth spurt until the age of 14 years. The 16-year-old and the
18-year-old adolescent clients would have already experienced the pubertal growth
spurt.
How many hours of sleep would the nurse recommend for the 11-yearold client?
8
9
11
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12
Rationale
A school-age client who is 11 years of age would require 9 hours of sleep each night.
Ten hours of sleep is not recommended for the school-age client. A 5-year-old schoolage client requires 11.5 hours of sleep per night; however, 11 and 12 hours of sleep is
not recommended for an 11-year-old school-age client.
Which client may have concerns related to sexuality when hospitalized
with a chronic illness?
An 8 year old
A 10 year old
A 12 year old
An 18 year old
Rationale
An 18-year-old client is an adolescent, which is the stage of development where
concerns about sexuality may occur when the client is hospitalized with a chronic
illness. The other clients are not developmentally characterized as adolescents;
therefore, the nurse would not anticipate an 8-year-old, 10-year-old, or 12-year-old
child to have this concern.
Which stage of development classifies boys and girls as differing very
little in terms of size?
Toddler
Preschool
School-age
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Adolescence
Rationale
During the school-age stage of development, boys and girl differ very little in terms of
size. During the toddler, preschool, and adolescence stages of development boys are
often larger than girls.
Arrange in order of occurrence the steps involved in the changes during
puberty.
1.
Triggering of GnRH by the hypothalamus
2.
Movement of GnRH through a network of capillaries to the anterior pituitary gland
3.
Stimulation of production and secretion of FSH and LH
4.
Stimulation of the gonadal response
Rationale
Some events trigger the production of gonadotropin-releasing hormone (GnRH) by
the hypothalamus. GnRH travels through a network of capillaries to the anterior
pituitary gland and stimulates the production and secretion of follicle-stimulating
hormone (FSH) and luteinizing hormone (LH). When the levels of these hormones
increase, they in turn stimulate the gonadal response.
Test-Taking Tip: In this question type, you are asked to prioritize (put in order) the
options presented. For example, you might be asked the steps of performing an action
or skill such as those involved in medication administration.
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According to the Erikson’s theory, which stage in a young adult
describes the development of the sense of caring for others?
Initiative versus guilt
Integrity versus despair
Intimacy versus isolation
Identity versus role confusion
Rationale
The development of a sense of caring for others in a young adult occurs at the stage of
intimacy versus isolation. During the initiative versus guilt stage, a child likes to
pretend and try out new roles. At the integrity versus despair stage, many older adults
view their lives with a sense of satisfaction. During the identity versus role confusion
stage, a child’s identity development begins with the goal of achieving some
perspective or direction.
Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end
of an exam may trigger your mind with the answer or provide an important clue to an
earlier question.
Which period of Piaget’s theory describes the idea of object
permanence?
Sensorimotor period
Preoperational period
Formal operations period
Concrete operations period
Rationale
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There are four periods of Piaget’s theory of cognitive development. The first period is
the sensorimotor period; this period describes object permanence. During the ages of
birth to 2 years, the child understands that objects continue to exist even when they
are not visible. The second period is the preoperational period, which is observed in
children between the ages of 2 and 7 years. During this time, children learn to think
about the use of symbols and have mental images. The third period is the concrete
operations period, which is observed between the ages of 7 and 11 years. During this
period, the child thinks about an action before performing it. The formal operations
period is the fourth period, which is observed in children from the ages of 11 years old
throughout adulthood. During this period, there is a prevalence of egocentric thought.
Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times
when four or five consecutive questions have the same letter or number for the correct
answer.
Which is true about the preoperational period of Piaget’s theory?
The child develops a scheme for dealing with the environment.
The child is able to describe a process without actually doing it.
The child has the capacity to reason with respect to possibilities.
The child believes that everyone experiences the world exactly as he or she
does.
Rationale
According to Piaget’s theory, children believe that everyone experiences the world
exactly as they do during the preoperational period. Children develop a scheme for
dealing with the environment during the sensorimotor period. Children are able to
describe a process without actually doing it during the concrete operations period.
Children have the capacity to reason with respect to possibilities during the formal
operations period.
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If hearing loss is detected early, proper intervention can help a child
achieve normal language development. Which should be the latest age
that hearing loss should be detected to ensure that a child achieves
normal language development? Record your answer using a whole
number.
3
months
Rationale
If a health care provider detects hearing loss before the child is 3 months old and an
intervention is initiated within 6 months, the child can achieve normal language
development.
According to Piaget, which statement describes the concrete operation
stage?
During this stage, children have egocentric thoughts.
During this stage, children are able to perform mental operations.
During this stage, children learn to think with the use of symbols and mental
images.
During this stage, children develop an action pattern for dealing with the
environment.
Rationale
During the concrete operation stage, children are able to perform mental operations.
During the formal operations stage, there is prevalence of egocentric thoughts. During
the preoperational stage, children learn to think with the use of symbols and mental
images. During the sensorimotor stage, children develop an action pattern for dealing
with the environment.
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Which is a similarity between Havighurst’s stage-crisis and Erikson’s
psychosocial development theories?
Both theories are based on developmental tasks.
Both theories incorporate eight stages of development.
Both theories are based on psychosexual development.
Both theories emphasize that a child’s growth is directed by gene activity.
Rationale
Both stage-crisis theory and psychosocial development theory are based on
developmental tasks. Both theories teach that the successful resolution of a
developmental task is essential for a successful progression through life. The stagecrisis theory has six stages whereas the psychosocial development theory has eight
stages of development. Freud’s theory is based on psychosexual development. Gesell’s
theory of development suggests that development of child is directed by gene activity.
According to Piaget’s theory, which period describes a child’s stage of
egocentrism?
Sensorimotor
Preoperational
Formal operations
Concrete operations
Rationale
During the preoperational period, children learn to think with the use of symbols and
mental images. They exhibit egocentrism where they see all objects and persons as
their own. The sensorimotor period occurs between birth and 2 years of age. During
this period, infants develop an action pattern for dealing with the environment. The
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formal operations period lasts from 11 years of age into adulthood. During this period,
the person is self-conscious and thinks he or she is invulnerable and tends to show
risk-taking behaviors. The concrete operations period occurs between 7 to 11 years of
age. During this period, children are able to perform mental operations.
Test-Taking Tip: Identify option components as correct or incorrect. This may help you
identify a wrong answer.
Which of these statements about the transition from intrauterine to
extrauterine life is true?
Hyperthermia is observed in the newborn.
Newborns are susceptible to heat loss and cold stress.
Apgar assessments are conducted 5 and 10 minutes after birth.
Physiological changes in the newborn occur during the first 12 hours of life.
Rationale
During the transition from intrauterine to extrauterine life, newborns are susceptible
to heat loss and cold stress. Newborns are susceptible to hypothermia, not
hyperthermia. Apgar assessments are generally conducted between 1 and 5 minutes
after birth. Physiological changes in the newborn are seen during the first 24 hours of
life.
Test-Taking Tip: Read the question carefully before looking at the answers: (1)
Determine what the question is really asking, looking for key words; (2) Read each
answer thoroughly and see whether it completely covers the material asked by the
question; and (3) Narrow the choices by immediately eliminating answers that you
know are incorrect.
According to Kohlberg’s theory of moral development, which statement
about conventional reasoning is true?
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A person wants to fulfill family expectations.
A child’s thinking is mostly based on likes and pleasures.
A child recognizes that there is more than one correct view.
An individual moves away from moral decisions based on authority.
Rationale
During the 'convention reasoning' level, a person wants to fulfill the expectations of his
or her family, group, or nation. During the 'preconventional reasoning' level, a child’s
thinking is mostly based on likes and pleasures. During this stage, the child also
recognizes that there is more than one correct view. During the 'postconventional
stage,' individuals move away from moral decisions based on authority or conformity
to groups to define their own moral values and principles.
According to Kohlberg’s theory, which stage comes before the societymaintaining orientation stage?
Social contract orientation
Good boy–nice girl orientation
Instrumental relativist orientation
Punishment and obedience orientation
Rationale
According to Kohlberg’s theory, the good boy–nice girl orientation phase (stage 3)
occurs before the society-maintaining orientation phase (stage 4). Social contract
orientation is the fifth stage. Instrumental relativist orientation is the second stage.
According to Piaget’s theory, which of these statements about the period
of concrete operations is true?
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A child develops a scheme for dealing with the environment.
A child is able to describe a process without actually doing it.
A child has the capacity to reason with respect to possibilities.
A child believes that everyone experiences the world exactly as he or she does.
Rationale
According to Piaget’s theory, a child is able to describe a process without actually
carrying it out in the concrete operations period. A child develops a scheme for dealing
with the environment during the sensorimotor period. A child gains the capacity to
reason with respect to possibilities during the formal operations period. A child
believes that everyone experiences the world exactly as he or she does during the
preoperational period.
In which stage of Piaget’s theory of growth and development does an
infant develop an action pattern to deal with the environment?
Sensorimotor
Preoperational
Formal operations
Concrete operations
Rationale
In Piaget’s theory, child development is divided into four periods. During the
sensorimotor period, an infant develops a schema or action pattern for dealing with
the environment. During the preoperational period, children learn to think with the
use of symbols and mental images. During the formal operations period, egocentric
thought prevails. During the concrete operations period, the child thinks about a
recently performed physical action.
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According to the Piaget’s theory, which behavior does a 9-year-old child
show?
Logical reasoning
Concrete thinking
Object permanence
Imaginary audience
Rationale
A child of 9 years of age will exhibit concrete thinking. Logical reasoning is observed in
individuals starting from the age of 11 years. Object permanence is observed in
children between birth and 2 years old. The idea of being constantly observed by an
imaginary audience is observed in individuals starting from the age of 11 years.
According to Freud’s theory, in what order do the stages of child
development occur?
1.
Oral
2.
Anal
3.
Oedipal
4.
Latency
5.
Genital
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Rationale
Freud’s theory sets forth five stages of child development. The oral stage (stage 1)
spans the period from birth to 12 to 18 months. The anal stage (stage 2) occurs
between the ages of 18 months and 3 years. The Oedipal stage (stage 3) occurs
between 3 and 6 years of age. The latency stage (stage 4) occurs between the ages of 6
and 12 years. Finally, the genital stage (stage 5) lasts from puberty through adulthood.
Test-Taking Tip: In this question type, you are asked to prioritize (put in order) the
options presented. For example, you might be asked the steps of performing an action
or skill such as those involved in medication administration.
Which stage describes the Oedipus complex, according to Freud’s
theory?
Stage 2
Stage 3
Stage 4
Stage 5
Rationale
According to Freud’s theory, there are five stages in a child’s development. Stage 3 is
the Oedipal stage, which is also known as the phallic stage. Stage 2 is the anal stage.
Stage 4 is the latency stage. Stage 5 is the genital stage.
Which psychosocial change does a toddler exhibit?
Achieves full independence
Engages in temper tantrums
Exhibits weak determination
Performs very few muscular activities
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Rationale
A 2-year-old child engages in temper tantrums when parents start restricting certain
activities to prevent harm. At 2 years of age, a child has a strong will and
determination, which may result in negative behavior. The child strives for
independence by using the developing muscles to do everything for himself or herself.
Test-Taking Tip: Identify option components as correct or incorrect. This may help you
identify a wrong answer.
According to Kohlberg’s theory of moral development, which stage is a
part of conventional reasoning?
Social contract orientation
Society-maintaining orientation
Instrument relativist orientation
Universal ethical principle orientation
Rationale
In Kohlberg’s theory, the society-maintaining orientation is stage 4 of conventional
reasoning. Social contract orientation is stage 5 of postconventional reasoning.
Instrument relativist orientation is stage 2 of preconventional reasoning. Universal
ethical principle orientation is stage 6 of postconventional reasoning.
Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end
of an exam may trigger your mind with the answer or provide an important clue to an
earlier question.
Which theory states that a child’s growth pattern is related to gene
activity?
Gesell’s theory
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Piaget’s theory
Erikson’s theory
Havighurst’s theory
Rationale
Gesell’s theory of development states that each child’s pattern of growth is unique and
that this pattern is directed by gene activity. Piaget’s theory of cognitive development
comprises four periods related to age: sensorimotor, preoperational, concrete
operations, and formal operations. Erikson’s theory of psychosocial development states
that an individual needs to accomplish a particular task before mastering the stage and
progressing to the next one. Havighurst’s theory of stage crisis is based on
developmental tasks. This theory incorporates three primary sources for developmental
tasks: tasks that surface because of physical maturation, tasks that evolve from
personal values, and tasks that are a result of pressures from society.
The nurse is preparing to assess several clients at a pediatric clinic.
Which client would require a developmental screening versus
developmental surveillance during a scheduled health maintenance
visit?
A 9-month-old infant
A 2-week-old newborn
A 15-month-old toddler
A 4-year-old preschooler
Rationale
The nurse would conduct a developmental screening for the 9-month-old infant
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old toddler, and the 4-year-old preschooler would all require developmental
surveillance during a health maintenance visit.
Which statement is true regarding the physical development of a
preschooler?
Children gain about 3 lbs (1.36 kg) per year.
Preschoolers grow 6.2 to 7.5 cm per year.
Preschoolers grow three times their length at around 4 years.
The average weight of the child at 4 years is 32 lbs (14.51 kg).
Rationale
Preschoolers grow 6.2 to 7.5 cm per year. Preschoolers gain about 5 lbs (2.26 kg) per
year. They also grow double their length at around 4 years old. The average weight of a
4-year-old child is 37 lbs (16.78 kg).
Which statement correctly describes the initiative versus guilt stage?
Individuals like to pretend and try out new roles.
Individuals are more accomplished in some basic self-care activities.
Individuals show marked preoccupation with appearance and body image.
Individuals are eager to apply themselves to learning socially productive skills
and tools.
Rationale
During the initiative versus guilt stage, a child likes to pretend and try out new roles. A
child is more accomplished in some basic self-care activities during the autonomy
versus sense of shame and doubt stage. During the identity versus role confusion
stage, an individual shows marked preoccupation with appearance and body image.
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During the industry versus inferiority stage, a child is eager to apply himself or herself
to learning socially productive skills and tools.
Which gross motor skill is found in children between 2 to 4 months of
age?
The child can creep on its hands and knees.
The child has predominant inborn reflexes.
The child can sit alone without any kind of support.
The child can bear weight on forearms when prone.
Rationale
A child between 2 and 4 months of age is able to bear his or her weight on the
forearms when in the prone position. A child between 8 and 10 months of age can
creep on his or her hands and knees. A child between birth and 1 month has
predominant inborn reflexes. A child between 6 and 8 months of age can sit alone
without support.
According to Freud, which must occur before an individual is able to
have a mature adult sexual relationship?
Puberty
Conflict resolution
Acquisition of new skills
Loss of self in another person
Rationale
According to Freud, an individual must resolve conflict before having a mature adult
sexual relationship. Puberty is required for sexual function but not a mature adult
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sexual relationship. The acquisition of new skills and losing self in another person are
characteristics of Erikson’s theory of psychosocial development.
From which client would the nurse expect dramatic physical growth and
marked development?
9-month-old infant
24-month-old toddler
4-year-old preschool-age child
10-year-old school-age child
Rationale
The nurse can anticipate the infant to have both dramatic physical growth and marked
development. The toddler, preschool-age, and school-age children will all continue to
experience physical growth and development; however, these age groups do not
experience growth and development as rapid as that of the infant.
Which fine motor skill would the nurse expect when assessing the
development of an infant between 10 and 12 months of age?
Holds a crayon
Walks with assistance
Stands independently
Sits from a standing position
Rationale
The ability to hold a crayon is a fine motor skill that the nurse would expect when
conducting a developmental assessment for an infant between 10 to 12 months of age.
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Walking with assistance, standing alone, and sitting from a standing position are all
gross motor skills the nurse would anticipate for this infant.
During which week of pregnancy does placental development occur?
First
Third
Fifth
Seventh
Rationale
Placental development begins during the third week of pregnancy. The other answer
options, first, fifth, and seventh, are not when placental development occurs.
The nurse is learning about the shift in total body fluid that occurs from
infancy to adulthood. Which percentage of body weight is the weight of
extracellular fluid (ECF) in an infant at term?
10%
20%
44%
78%
Rationale
The amount of ECF is 44% of the body weight at term. The initial birth weight of a
term newborn can decrease by 10% in the first 5 days of life due to ECF compartment
contraction, enhanced renal tubular function, and rapidly increasing glomerular
filtration rate. The amount of ECF is 20% in adulthood. At birth, 78% of the infant’s
body weight is water—ECF occupies a significant part of it.
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Which type of prehension is exhibited by a 5-month-old infant?
The grasp is palmar.
Hands are mostly open.
The grasp is a crude pincer.
Hands are predominantly closed.
Rationale
A 5-month-old infant is able to voluntarily grasp an object using the whole hand; this
is called a palmar grasp. At 3 months of age, the hands are mostly open. By 8 to 9
months of age the infant uses a crude pincer grasp, using the thumb and index finger.
At 1 month of age the hands are predominantly closed.
Which age should an infant develop binocularity?
8 to 9 weeks
3 to 4 months
7 to 8 months
9 to 12 months
Rationale
Children develop binocularity (the ability to fixate on one visual field with both eyes
simultaneously) by 3 to 4 months. Children are not able to fixate on one visual field
with both eyes simultaneously as early as 8 to 9 weeks. Children learn to fixate on one
visual field with both eyes simultaneously earlier than 7 to 8 months or 9 to 12
months.
Test-Taking Tip: You have at least a 25% chance of selecting the correct response in
multiple-choice items. If you are uncertain about a question, eliminate the choices that
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you believe are wrong and then call on your knowledge, skills, and abilities to choose
from the remaining responses.
Which is a goal for organized athletics for school-age children?
A lifelong enjoyment of fitness
A physical examination every 2 years
The use of appropriate safety equipment
Participation in warmup exercises before physical activity
Rationale
A goal for organized athletics for school-age children is a lifelong enjoyment of fitness.
A physical examination every 2 years, the use of appropriate safety equipment, and
participating in warmup exercises before physical activity are all safeguards for athletic
programs.
At which stage of development would the nurse anticipate that pediatric
clients will begin to show differences in play activities that are related to
gender?
Preschool
Adolescence
Late school-age
Early school-age
Rationale
During the late school-age years, the nurse would anticipate that pediatric clients will
begin to show differences in play activities that are related to gender. There will be very
few differences in play activities related to gender during the preschool stage of
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development. Adolescence involves different social, not play, activities related to
gender. The early school-age client will exhibit the same types of play activities related
to gender as the preschool-age child.
Which type of play would the nurse encourage when providing ageappropriate care to a preschool-age child who is hospitalized?
Team
Parallel
Solitary
Associative
Rationale
The nurse would encourage the hospitalized preschool-age client to participate in
associative play. Team play is appropriate for the school-age child. Parallel play is
appropriate for the toddler-age client. Solitary play is appropriate for the infant.
Which stage of the development would the nurse document for an
infant when using Freud’s theory of psychosocial development?
Oral
Anal
Phallic
Latent
Rationale
According to Freud, an infant is in the oral stage of development. The toddler is in the
anal stage of development. The preschool-age child is in the phallic stage of
development. The middle childhood client is in the latent stage of development.
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According to Erikson, which would the nurse anticipate when assessing
an adolescent?
Being engaged in tasks
Questioning sexual identity
Having highly imaginative thoughts
Wanting to participate in organized activities
Rationale
The nurse would anticipate the adolescent to question sexual identity, according to
Erikson. Being engaged in tasks and wanting to participate in organized activities is
expected for the school-age child. The nurse would anticipate that a preschool-age
child would have highly imaginative thoughts.
Which is an inborn error of metabolism that affects growth and
development?
Cystic fibrosis
Achondroplasia
Turner syndrome
Hunter syndrome
Rationale
Hunter syndrome is an inborn error of metabolism that hinders development and
results in altered physical appearance and impaired mental development. Cystic
fibrosis is a genetic disorder that results in accumulation of mucus in the lungs and
pancreas. Achondroplasia is a congenital disorder that is a common cause for the
structural defect called dwarfism. Turner syndrome is a chromosomal abnormality
associated with webbed neck and low-set ears.
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The mother of a 2-year-old girl expresses concern that her daughter’s
growth rate has slowed. Which explanation would the nurse give
regarding the growth rate of a toddler?
'This growth pattern is typical at this age.'
'Toddlers are too busy exploring their world to eat.'
'Growth patterns can’t be interpreted for another year.'
'Toddlers usually lose their taste for foods they liked when younger.'
Rationale
As the child gets older, growth slows. Toddlers develop physiologic anorexia because
their appetite decreases along with their growth rate. Although the toddler may be too
busy to eat, this is not why the growth rate slows. This growth pattern may be
interpreted now. Although a toddler may lose his or her taste for a particular food, it is
not common in this age group.
STUDY TIP: Record the information you find to be most difficult to remember on 3' ×
5' cards and carry them with you in your pocket or purse. When you are waiting in
traffic or for an appointment, just pull out the cards and review again. This 'found' time
may add points to your test scores that you have lost in the past.
Which action related to gender is often expected in regards to
socialization for school-age girls within the community setting?
Expressing feelings openly
Being insensitive to others
Trying out for the football team at school
Taking the most challenging classes in school
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Rationale
Health professionals have long been aware that boys and girls are socialized differently
by parents and teachers. Girls are encouraged to express their emotions openly. Girls
are also expected to be sensitive and responsive to others. Girls are often ostracized if
they want to play a sport that is historically associated with the male gender, such as
football. Taking the most challenging classes in school is an expectation for males, not
females.
Which school-age client would the nurse anticipate will experience
sibling rivalry as a source of stress?
A 9-year-old male
A 7-year-old male
A 6-year-old female
An 8-year-old female
Rationale
A 6-year-old school-age client is most likely to experience sibling rivalry as a source of
stress. The 9-year-old, 7-year-old, and 8-year-old are not as likely to experience sibling
rivalry as a source of stress.
During testing of the neurological reflexes of an infant, which reflex
would the nurse expect to appear at 3 months and persist until 24 to 36
months of age?
Neck righting
Body righting
Otolith righting
Labyrinth righting
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Rationale
While the infant is supine, if the head is turned to one side, the shoulder, trunk, and
finally the pelvis will turn toward that side. This reflex appears at 3 months, and
persists until 24 to 36 months of age. Body righting is a modification of the neckrighting reflex in which turning hips and shoulders to one side causes all other body
parts to follow; it appears at 6 months and persists until 24 to 36 months of age. When
the body of an erect infant is tilted, the head is returned to an upright, erect position;
this is known as otolith righting, which appears at 7 to 12 months of age, and persists
indefinitely. When an infant in prone or supine position is able to raise his or her head,
it is known as labyrinth righting. It appears at 2 months and is strongest at 10 months
of age.
The nurse is discussing the neurological reflexes seen in an infant with
the parents. Which reflex would the nurse state as being present
indefinitely?
Landau
Parachute
Body righting
Neck righting
Rationale
The parachute reflex appears at 7 to 9 months and persists indefinitely. The Landau
reflex appears at 6 to 8 months and lasts until 12 to 24 months. Body righting appears
at 6 months and lasts until 24 to 36 months. Neck righting appears at 3 months and
lasts until 24 to 36 months.
STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes
you laugh, reading something funny, or sharing humor with friends helps decrease
stress.
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Which type of relationship is most important to the school-age child?
Same-sex peer relationships
Opposite-sex peer relationship
Same-sex parental relationship
Opposite-sex parental relationship
Rationale
Same-sex peer relationships are important to the school-age child. Opposite-sex peer
relationships become important during adolescence. Parental relationships vary during
this stage of development.
Which age would the nurse teach the parents of a school-age client to
expect mandibular second molars to erupt?
7 to 8 years
9 to 10 years
10 to 12 years
11 to 13 years
Rationale
Mandibular second molars often erupt between 11 and 13 years of age. The maxillary
central incisor is expected to erupt between 7 and 8 years of age. The mandibular
cuspids are expected to erupt between 9 and 10 years of age. The mandibular second
bicuspids are expected to erupt between 11 to 12 years of age.
Which of these skills should be present in a 6- to 8-month-old child?
The child pulls himself or herself up to stand or sit.
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The child is able to pick up small objects.
The child can sit alone without support.
The child can place objects into containers.
Rationale
A child of 6 to 8 months of age should be able to sit alone without support. A child
after 8 months of age should be able to pick up small objects, place objects in
containers, and pull himself or herself up to stand or sit.
Which developmental skills should a preschooler exhibit? Select all that
apply. One, some, or all responses may be correct.
Personal identity
Specific reasoning
Increased curiosity
Magical thinking
Understanding of others
Rationale
Preschoolers begin to engage in specific and become curious. Preschoolers’ thinking is
often described as magical thinking. Between the ages of 12 and 36 months, toddlers
start thinking of the self as separate from the mother. School-age children around the
age of 12 years start concentrating on more than 1 aspect of a situation. They also start
understanding different points of view.
Which period of Piaget’s theory explains animism in a child?
Period I
Period II
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Period III
Period IV
Rationale
During period II of Piaget’s theory, children demonstrate animism, in which they
personify objects. During period I, infants develop a schema or action pattern for
dealing with the environment. During period III, a child is able to think about an
action that previously was performed physically. During period IV, adolescents
demonstrate feelings and behaviors characterized by self-consciousness.
Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly
because there is usually no pattern to the answers.
According to Erikson’s stages of life, which is the stage of development
when a child begins walking, feeding, and using the toilet?
Trust versus mistrust
Initiative versus guilt
Identity versus role confusion
Autonomy versus sense of shame and doubt
Rationale
At 1 to 3 years of age, the child starts walking, feeding, and using the toilet on his or
her own. This stage is one of autonomy versus sense of shame and doubt. The stage
from birth to 1 year when the infant develops trust toward parents or the caregiver is
known as the trust versus mistrust stage. The initiative versus guilt stage is marked by
the child’s fantasies and imaginations motivating the child to explore the environment.
The identity versus role confusion stage begins after adolescence. During this stage, an
individual tries to find out his or her own identity.
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Test-Taking Tip: You have at least a 25% chance of selecting the correct response in
multiple-choice items. If you are uncertain about a question, eliminate the choices that
you believe are wrong and then call on your knowledge, skills, and abilities to choose
from the remaining responses.
Which statement is true about the instrumental relativist orientation
stage?
An individual recognizes that there is more than 1 correct point of view.
An individual finds a balance between societal rules and basic human rights
and obligations.
An individual response to a moral dilemma is in terms of absolute obedience
to authority and rules.
An individual sees moral reasoning based on his or her own personal
internalization of societal and other’s expectations.
Rationale
During the instrumental relativist orientation stage, an individual finds that there is
more than 1 correct point of view. During the postconventional reasoning stage, a
person finds a balance between societal rules and basic human rights and obligations.
During the punishment and obedience orientation stage, a child’s response to a moral
dilemma is in terms of absolute obedience to authority and rules. During the
conventional reasoning stage, the person sees moral reasoning based on his or her
own personal internalization of societal and other's expectations.
Determine how an adolescent can establish group identity during
psychosocial development?
By evaluating his or her own health with a feeling of well-being
By fostering his or her independence with balanced family structure
By building close peer relationships to achieve acceptance in the society
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By achieving marked physical changes with masculine and feminine behaviors
Rationale
By building close peer relationships, adolescents develop a sense of belonging,
approval, and the opportunity to learn acceptable behavior. This behavior establishes
the group identity. By evaluating his or her own health with a feeling of well-being, an
adolescent establishes health identity. An individual establishes family identity by
fostering his or her independence with balanced family structure. The sound and
healthy growth of an adolescent with marked physical changes helps build sexual
identity.
Test-Taking Tip: Identify option components as correct or incorrect. This may help you
identify a wrong answer.
Which statement describes the latency stage of Freud’s psychoanalytic
model of personality development?
During this stage, genital organs are the focus of pleasure.
During this stage, sexual urges are repressed and channeled into productive
activities.
During this stage, an infant begins to think that his or her parent is separate
from the self.
During this stage, sexual urges reawaken and are directed to an individual
outside the family circle.
Rationale
During the latency stage, Freud believed that sexual urges from the earlier Oedipal
stage are repressed and channeled into productive activities that are socially
acceptable. During the phallic stage, the genital organs are the focus of pleasure.
During the oral stage, infants begin to think that the parent is something separate
from the self. During the genital stage, sexual urges reawaken and are directed to an
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individual outside the family circle.
Test-Taking Tip: Identify option components as correct or incorrect. This may help you
identify a wrong answer.
At which stage of Kohlberg’s theory would a child exhibit fear of
punishment?
Stage 1
Stage 2
Stage 3
Stage 4
Rationale
According to Kohlberg’s theory of moral development, at stage 1 a child is afraid of
punishment. At stage 2, the child recognizes that there is more than 1 correct
viewpoint. At stage 3, an individual seeks the approval of and maintains the
expectations of one’s immediate group. At stage 4, an individual expands focus from a
relationship with others to societal concerns.
Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly
because there usually is no pattern to the answers.
The nurse is providing care to the family of a preschool-age child who is
diagnosed with sickle cell disease. Which statement made by the sibling
would initiate a teaching session with the parents regarding discipline?
'I really wish my brother wasn’t sick all the time.'
'I am afraid that I caused my brother to get sick again because I was mad at
him.'
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'When I lied to my parents, I was punished for a week and my brother never
gets punished.'
'I never get to go over to my friends’ houses because we are always taking my
brother to the doctor.'
Rationale
A critical component of any child’s development is discipline. Applying appropriate
discipline to the child who is chronically ill or disabled can also limit the resentment
and hostility that can develop among siblings if parents apply different standards to
each child. The nurse’s responsibility is to help parents learn successful methods of
guiding the child. The statements regarding wishing that the brother wasn’t sick, fears
of having caused the illness, and missing play dates may require further assessment
and family teaching, but the teaching would not be related to discipline.
The nurse performs a gross motor skills assessment on an infant. Which
age should the infant obtain the ability to crawl?
3 months
5 months
7 months
9 months
Rationale
At the age of 9 months, a child starts to crawl along the floor and can pull himself or
herself to a standing or sitting position. At the age of 3 months, a child can lift his or
her head and chest and is able to sit erect with support. At the age of 5 months, a child
can support much of his or her own weight when pulled to stand. At the age of 7
months, a child can sit alone without support, can bear his or her full weight on his or
her feet, and can hold on to furniture.
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Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end
of an exam can trigger the answer or provide an important clue to an earlier question.
Which is a similarity between the preoperational period and the formal
operations period?
Both periods reflect egocentrism in the individual.
Both periods demonstrate animism in the individual.
Both stages outline play as a means for fostering development.
Both periods are characterized by an individual’s capacity to reason with
respect to all possibilities.
Rationale
Both the preoperational and the formal operations period show that there is a
prevalence of egocentric thought in the individual. The preoperational period
demonstrates animism in an individual. The preoperational period also demonstrates
play as a means of fostering development in the child. During formal operation period,
the individual has the capacity to reason with respect to possibilities.
Test-Taking Tip: Do not spend too much time on one question because it can
compromise your overall performance. There is no deduction for incorrect answers, so
you are not penalized for guessing. You cannot leave an answer blank; therefore,
guess. Go for it! Remember: You do not have to get all the questions correct to pass.
Which would be the nurse’s first step in efficiently addressing a situation
of moral dilemma?
Helping the client make a moral decision
Recognizing one’s own moral development level
Abiding by the decision of the hospital authority
Having one’s own opinion that differs from the health care team
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Rationale
If a nurse first recognizes his or her own moral developmental level, the nurse can
efficiently tackle a situation of moral dilemma. A nurse can help clients making moral
decisions only after the nurse figures out his or her own moral reasoning level. If a
nurse thinks that a particular action is not appropriate for a client, the nurse may form
an opinion and present his or her own view and question the action of the hospital
authority. Note that the entire health care team should be in agreement about the
decision.
How do adolescents establish health identity during psychosocial
development?
By evaluating their own health with feelings of well-being
By fostering their independence with a balanced family structure
By building close peer relationships to achieve societal acceptance
By achieving marked physical changes with masculine and feminine behaviors
Rationale
Adolescents establish health identity by evaluating their own health with feelings of
well-being. An individual establishes family identity by fostering their independence
with a balanced family structure. By building close peer relationships, adolescents
establish a group identity. The healthy growth of an adolescent, with marked physical
and behavioral changes, helps build sexual identity.
Which nursing action is appropriate when assessing a pediatric client’s
arm circumference?
Using specialized calipers for the measurements
Having cloth tape available to measure the midpoint
Recording the average of 1 measurement using 2 sites
Measuring vertically along the posterior aspect of the upper arm
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Rationale
Arm circumference is an indirect measurement of muscle mass. The appropriate
nursing action is to measure vertically along the posterior aspect of the upper arm to
the acromial process and to the olecranon process. Specialized calipers are used to
assess skinfold measurements. The nurse would record the average of at least 2
measurements at the same site.
The nurse is performing physical assessments for children in a daycare
center. Which children should require a head circumference
measurement to monitor growth patterns? Select all that apply. One,
some, or all responses may be correct.
A 6-month-old infant who is breast-fed
A 15-month-old toddler who has asthma
A 3-year-old child whose birthday was the day prior
A 5-year-old who will attend kindergarten in the fall
An 8-year-old child who will begin playing soccer next week
Rationale
The nurse includes a head circumference in the physical assessment from birth to 36
months of age; therefore the 6-month-old infant, the 15-month-old toddler, and the
3-year-old child whose birthday was the day prior will all have their head
circumferences measured during the assessment. The 5-year-old and the 8-year-old
will not have their head circumferences measured during the assessment process.
Which assessment question is appropriate when collecting a
developmental history for an adolescent who is new to the pediatric
practice?
'What grades do you get in school?'
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'Have your wisdom teeth erupted yet?'
'What was your approximate height at 4 years of age?'
'What was your approximate weight at 5 years of age?'
Rationale
Although all of these assessment questions are appropriate, only the question
regarding scholastic performance (grades in school) is a question that is appropriate
for a developmental history. Asking questions regarding wisdom tooth eruption and
approximate height and weight at 4 and 5 years of age respectively is more appropriate
when collecting a growth history.
Which growth and developmental assessments would the nurse include
when conducting a health maintenance visit for a 15-month-old
toddler? Select all that apply. One, some, or all responses may be
correct.
Weight
Heart rate
Blood pressure
Head circumference
Developmental screening
Rationale
Growth and developmental assessments that the nurse would perform for a 15month-old toddler include weight and head circumference. Data related to heart rate
and blood pressure are vital signs and not growth and developmental assessments. A
developmental surveillance, not screening, is appropriate for a 15-month-old toddler.
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Which nursing action promotes psychosocial development for a
newborn?
Washing hands before holding the newborn
Measuring the newborn using an approved length board
Weighing the newborn on the same scale during hospitalization
Placing the newborn in the mother’s arms during the first hour of life
Rationale
Placing a newborn in the mother’s arms for the first hour of life is a nursing action that
promotes psychosocial development in the form of bonding with his or her mother.
Washing hands before holding the newborn is hospital policy and promotes infection
prevention and control. Measuring the newborn’s length using an approved length
board and weighing the newborn on the same scale each day during hospitalization
allow the nurse to assess newborn growth.
Which client situation may benefit from the nurse issuing a contract
regarding the plan of care?
An infant’s parents before hospital discharge
A preschool-age child requiring immunizations
A school-age child who is active in afterschool sports
An adolescent who is seeking information regarding birth control
Rationale
Adolescent clients are seeking independence; therefore, this client may benefit from
the nurse issuing a contract regarding the plan of care and its implementation.
Although all clients should be involved with their plans of care, the nurse would not
issue a contract to the other clients.
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The nurse is assessing a newborn whose parents are Asian. The nurse
finds that the child has irregular, deep-blue pigmentation on the gluteal
regions. How would the nurse interpret the examination findings?
The skin demonstrates milia.
The observations are consistent with Mongolian spots.
The child has erythema toxicum.
There is a harlequin color change.
Rationale
Mongolian spots are a medical condition characterized by the appearance of irregular,
deep-blue pigmented spots on the gluteal regions. This skin abnormality is a common
finding in newborns of Asian descent. Milia are distended sebaceous glands, which
manifest as tiny white papules on cheeks, chin, and nose. Erythema toxicum manifests
as a pink papular rash on the thorax, back, and buttocks. Harlequin color change is a
clear line through the body caused by lying on one side. The side on which the baby
sleeps turns pink.
Which reflex would the nurse assess in a newborn to determine auditory
ability?
Startle reflex
Rooting reflex
Glabellar reflex
Extrusion reflex
Rationale
To assess auditory ability in a newborn, the nurse makes a sudden loud sound, which
causes the newborn’s arms to abduct. This is called the startle reflex. When assessing
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the rooting reflex, the nurse strokes the child’s cheek, and the child’s head turns to the
same side in response. When assessing the glabellar reflex, the nurse taps the tip of
the child’s nose, and the child’s eyes close in response. When assessing the extrusion
reflex, the nurse touches the child’s tongue, and the child forces it out in response. The
rooting reflex, glabellar reflex, and extrusion reflex do not help determine auditory
ability.
Which parental statement indicates accurate understanding of bicycle
safety for the school-age client?
'My child should ride opposite of traffic.'
'My child should ride the bicycle through crosswalks.'
'My child should avoid hand signals in advance of stopping.'
'My child should keep as close to the curb as possible when in the street.'
Rationale
The parental statement indicating the school-age child should ride as close to the curb
as possible when riding a bicycle in the street indicates accurate understanding of
bicycle safety. The child should ride with the traffic, not opposite of traffic. The child
should walk, not ride, the bicycle through crosswalks. The child should be taught to
use, not avoid, hand signals in advance of stopping.
Which common source of stress for a 6-year-old client would the nurse
include in the teaching session during a scheduled health maintenance
visit?
Wanting to be first
Demanding privacy
Having a desire to be like an idol
Being more selective with playmates
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Rationale
A common source of stress for a 6-year-old school-age client is competition such as
wanting to be first or the best (winning); therefore, the nurse would include this in the
teaching session during the health maintenance visit. Demanding privacy, the desire
to be like an idol, and becoming more selective with playmates is anticipated for the 7year-old client, not 6-year-old client.
Which growth characteristics would the nurse anticipate for a 16-yearold female client? Select all that apply. One, some, or all responses
may be correct.
Physically mature
Reaching peak velocity
Decreasing rate of growth
Reaching 95% of adult height
Having well-advanced secondary sexual characteristics
Rationale
The nurse would expect a 16-year-old female client to have a decreasing rate of
growth, to have reached 95% of adult height, and to have well-advanced secondary
sexual characteristics. The nurse would not anticipate a 16-year-old adolescent being
physically mature, because this does not occur until late adolescence. The nurse would
anticipate the client having reached peak velocity during early adolescence.
Which clients would the nurse measure head circumference during the
growth and development assessment? Select all that apply. One, some,
or all responses may be correct.
A 2-month-old infant
A 3-year-old preschooler
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A 14-year-old adolescent
An 18-month-old toddler
A 6-year-old school-age child
Rationale
The nurse measures head circumference during the growth and development
assessment until 36 months of age. The 2-month-old infant, the 3-year-old
preschooler, and the 18-month-old toddler would all require a head circumference
measurement to assess growth. The adolescent and school-age child would not
require a head circumference measurement to assess growth.
Which would the nurse teach to a preschool-age client to avoid the risk
of altered growth and development?
Trust
Empathy
Impulse control
Problem-solving
Rationale
Teaching a preschool-age child, and his or her parents, the importance of impulse
control is necessary to avoid the risk for altered growth and development. Trust is an
important teaching point during infancy. Empathic guidance is important to provide to
the parents of a toddler-age client. Problem-solving is an important teaching point for
the school-age child.
According to Erikson’s theory of psychosocial development, which would
the nurse include in the plan of care for a young adult client who is
hospitalized?
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The importance of having support from the client’s peers
The importance of having support from the client’s siblings
The importance of having support from the client’s parents
The importance of having support from the client’s significant other
Rationale
A young adult is experiencing intimacy versus isolation; therefore, having support from
a significant other is important. Peers are important to adolescent clients. Siblings and
parents are important to infants, toddlers, and school-age children.
Which birth weight in a neonate indicates very low birth weight infant?
900 g
1300 g
1700 g
2000 g
Rationale
Infants whose birth weight is less than 1500 g are known as very low birth weight.
Infants whose birth weight is less than 1000 g are known as extremely low birth weight
infants. Infants whose birth weight is less than 2500 g are known as low birth weight
infants.
A toddler wearing a diaper is impatient with the wet diaper and shows a
desire to have it changed. Which toilet training readiness does this
behavior indicate?
Mental readiness
Physical readiness
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Parental readiness
Psychological readiness
Rationale
The toddler’s impatience with the wet diaper and desire for a change indicates
psychological readiness for toilet training. Mental readiness is indicated when the
toddler recognizes the urge to urinate. Physical readiness is indicated when the toddler
is voluntarily able to control the sphincter and wakes up dry after a nap. Parental
readiness is indicated when the parent is willing to invest the time required for toilet
training.
A nurse is supportive of a child receiving long-term rehabilitation in the
home rather than in a health care facility. Why is living with the family
so important to a child’s emotional development?
It provides rewards and punishment.
The child’s development is supported.
It reflects the norms of a larger society.
It is where child’s identity and roles are learned.
Rationale
Socialization, values, and role definition are learned within the family and help develop
a sense of self. Once established in the family, the child can move more easily into
society. Although important, providing rewards and punishments, supporting the
child’s development, and reflecting the norms of society are just one aspect of the
family’s influence and are not as important as identity and roles in relation to
emotional development.
Which psychosocial attribute plays an important role in the development
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of a healthy personality from birth to 1 year of age?
Initiative versus guilt
Trust versus mistrust
Autonomy versus shame
Industry versus inferiority
Rationale
According to Erikson’s theory of psychosocial development, the first attribute that
helps develop a healthy personality after birth is trust. Mistrust develops if the care
provided to the infant is inconsistent. Initiative versus guilt is seen at 3 to 6 years of
age, when children explore their surroundings with their senses and power. If the child
does something that contradicts the parents’ desires, then there are feelings of guilt.
The need for autonomy and feelings of shame develop between 1 and 3 years of age,
when the child acquires motor skills and learns new activities. If the child is made to
feel self-conscious, then the child struggles with feelings of shame. Industry versus
inferiority is seen in a child 6 to 12 years of age. In this stage children engage in
activities that they can complete successfully. If too much is expected out of them, then
there are feelings of inferiority.
The parents tell the nurse that their preschooler often awakes from sleep
screaming in the middle of the night. The preschooler is not easily
comforted and screams if the parents try to restrain the child. Which
would the nurse instruct the parents?
'Always read a story to the child before bedtime.'
'Intervene only if necessary to protect the child from injury.'
'Discuss counseling options with the primary health care provider.'
'Try to wake the child and ask the child to describe the dream.'
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Rationale
Waking up screaming from sleep at night indicates sleep terrors. The nurse would
advise the parents to observe the child and intervene only if there is a risk for injury.
Reading a story before bedtime helps calm the child before sleeping, but it does not
ensure that the child will not have a sleep terror. There is no need for professional
counseling, because sleep terrors are a common phenomenon in preschool-age
children. The child is not aware of anybody’s presence during a sleep terror, so it is not
appropriate to wake up the child; this may cause the child to scream and thrash more.
A young adult client sustains a spinal injury at the level of T5. Which
developmental task will be most difficult for this client to achieve?
Mastering his environment
Identifying with the male role
Developing meaningful relationships
Differentiating himself from the environment
Rationale
Developing meaningful relationships is the young adult’s developmental task
associated with intimacy versus isolation. Mastering his environment is a school-age
child’s developmental task associated with initiative versus guilt. Identifying with the
male role is a toddler’s developmental task associated with autonomy versus shame
and doubt. Differentiating himself from the environment is a toddler’s developmental
task associated with autonomy versus shame and doubt.
A child is frightened and refuses to use the toilet after watching a
television commercial that shows the toilet bowl turning into a monster
and swallowing the person using it. Which behavior would the child
exhibit?
Animism
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Modeling
Aggression
Desensitization
Rationale
Relating lifelike qualities to nonliving things is called animism. When a child believes
that the toilet bowl turns into a monster and swallows a person, he or she exhibits
animism. Aggression is characterized by an attempt to hurt a person or damage
property. Modeling is associated with imitation of others’ behavior. Desensitization is a
therapeutic technique that involves exposing the child to the feared object in a safe
situation.
Test-Taking Tip: Look for answers that focus on the client or are directed toward
feelings.
Why would the nurse recommend that parents give their child food rich
in vitamin A?
To help the child improve visual acuity
To help the child improve language skills
To help the child develop gross motor skills
To help the child improve concentration levels
Rationale
Eating vitamin A–rich food improves the child’s vision. Engaging the child in
conversation will help improve language skills. Activities like jumping, running, and
climbing will promote physical growth and improve gross motor skills. Vitamin A is
not associated with concentration levels.
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Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable
under ordinary circumstances and that the action can be carried out in the given
situation.
The parents of a child often try to persuade their preschooler to touch
their pet dog because they want to reduce the child’s fear of dogs.
Instead, the child’s fears and anxiety increase. Which advice would the
nurse suggest to help overcome their child’s fear?
'Ask the child to touch the dog’s back gently.'
'Keep the child away from dogs for a few years.'
'Let the child watch other children playing with dogs.'
'Bring in a pet cat to familiarize the child with animals.'
Rationale
The parents should allow the child to become comfortable with animals at a gradual
pace, while maintaining the child’s feeling of well-being. One way to do this is to
encourage the child to watch as other children play with dogs. Encouraging the child
to touch the dog’s back gently is not effective for overcoming the child’s fear, because
the child should not be forced to touch the animal until he or she is comfortable.
Trying to keep the child away from dogs will not be effective in reducing fear and may
not be practical. Introducing the child to other animals, such as cats, may be
ineffective, because the child’s fear may be specific to dogs.
The nurse finds that a child has developed the qualities of
independence, self-control, and self-governance. Which type of
development would the nurse anticipate in the toddler?
Social development
Spiritual development
Biological development
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Psychosocial development
Rationale
Psychosocial development is indicated by the child’s awareness of the relationship
between himself or herself and his or her environment. When the child develops
independence, self-control, and self-governance, it indicates that the child has
acquired a sense of autonomy, which is a component of psychosocial development.
Social development is the ability to establish and maintain rewarding relationships
with others. Spiritual development in children is heavily influenced by family members
and others close to them; it is not specifically associated with the development of
autonomy. Biological development is the series of changes that occur at different
stages of growth.
Which type of play will help develop a leader-follower type of
relationship?
Solitary play
Parallel play
Associative play
Cooperative play
Rationale
Children who are involved in cooperative play discuss and plan activities. A leaderfollower type of relationship will develop among the children. During solitary play, the
child plays with toys alone. During parallel play, children play side by side but
individually with different toys. During associative play, the children borrow or lend
play materials but do not control each other’s activities and do not develop a leaderfollower type of relationship.
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Test-Taking Tip: Have confidence in your initial response to an item, because it more
than likely is the correct answer.
Which characteristics would the nurse observe in a client who has
secondary amenorrhea?
No uterine bleeding for 4 years after breast development
Absence of menstrual bleeding for 3 cycles after menarche
Absence of uterine bleeding and secondary sex characteristics at age 16 years
No uterine bleeding for 1 year after attaining a sexual maturity rating of 5 on
the Tanner scale
Rationale
The client’s menstrual cycle is absent 3 successive times after menarche. This is an
indication of secondary amenorrhea. The absence of uterine bleeding 4 years after
breast development, the absence of uterine bleeding and secondary sex characteristics
at age 16 years, or no uterine bleeding for 1 year after attaining a sexual maturity
rating of 5 on the Tanner scale are indicative of primary amenorrhea.
During a clinical assessment, which secondary sex characteristics would
the nurse observe in a teenage client? Select all that apply. One, some,
or all responses may be correct.
Change in voice
Enlargement of breasts
Development of facial hair
Beginning of menstruation
Completion of skeletal growth
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Rationale
Secondary sex characteristics are the changes observed in various parts of the body
from hormonal alterations. Voice change occurs as a result of changes in the larynx,
and facial hair develops on the face and neck regions. Primary sex characteristics are
the changes that occur in the internal and external organs involved in reproductive
functions. Enlargement of breasts and beginning of menstruation are regarded as
primary sex characteristics. The completion of skeletal growth is seen in
postpubescence and is not a secondary sex characteristic.
Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as
behavioral changes or clinical changes (or both) within a certain time period, can
provide a clue to the most appropriate response or, in some cases, responses.
Which is the most accurate response to a mother who asks at which age
her daughter will have her first period?
Before the pubic hair appears
At the end of the growth spurt
Near the age when their mothers did
Around the time when the breasts develop
Rationale
Menarche occurs when the prepubertal growth spurt is almost completed and after the
primary and secondary sexual characteristics are almost fully developed. Pubic hair is
seen about 6 months after the breast buds appear; the buds appear earlier than
menarche. Although there may be a familial tendency to reach menarche at the same
age as the mother, there are too many variables for this to be used as a guideline. The
breast buds become noticeable about 2 years before menarche; they are the first
secondary sexual characteristic to appear.
While assessing the development of an 8-month-old infant, the nurse
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finds that the infant is interested in playing with food, water, and sand.
Which type of content play interests the child?
Skill play
Dramatic play
Sense-pleasure
Imitative games
Rationale
The child derives pleasure by playing with raw materials like food, sand, and water,
indicating interest in sense-pleasure play. The child who has developed the ability to
grasp and manipulate will be interested in skill play. A 1-year-old child derives pleasure
from dramatic play, because children this age tend to fantasize about everything.
Young children enjoy imitative games like peek-a-boo and pat-a-cake. However, the
imitative games do not include playing with sand and food.
Test-Taking Tip: After you have eliminated one or more choices, you may discover that
two of the options are very similar. This can be very helpful, because it may mean that
one of these lookalike answers is the best choice and the other is a very good
distractor. Test both of these options against the stem. Ask yourself which one
completes the incomplete statement grammatically and which one answers the
question more fully and completely. The option that best completes or answers the
stem is the one you should choose. Here, too, pause for a few seconds, give your brain
time to reflect, and recall may occur.
Which would be included in the assessment of a school health
promotional program for adolescents? Select all that apply. One, some,
or all responses may be correct.
Perform a school violence assessment.
Assess the sleep pattern of the students.
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Identify individuals at risk for drug abuse.
Explain the need for fluoride supplements to prevent dental caries.
Instruct the students about principles of gun safety.
Rationale
During a school educational health promotional program for adolescents, the nurse
would perform a school violence assessment. The nurse would try to identify
individuals with substance abuse problems and counsel them. The presence of a gun
at home may predispose adolescents to a greater incidence of homicide. The nurse
would teach about gun safety. The assessment of sleep patterns is done in infants
because they have fluctuating sleep patterns. Fluoride supplements for the prevention
of dental caries is an important infant issue.
A mother complains to the nurse that her 3-year-old child refuses to go
to preschool. The child rarely interacts and avoids playing with other
children. Which statement would the nurse provide?
'Do not be concerned because all toddlers behave this way.'
'Ask the teacher to push the child to speak up and open up to the other kids.'
'Set boundaries and supervise the child closely.'
'Give your child time to get acquainted and warm up to the new environment.'
Rationale
According to the mother’s description, the child is a slow-to-warm-up child. These
children are uneasy in new situations or with unfamiliar people. The nurse would
educate the mother to give the child time to be more familiar with the new
environment. All toddlers do not behave in the same manner. A slow to warm-up child
should not be pressured to do anything against his or her wishes. A difficult child
needs supervision and a more structured environment.
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Which stage of Erikson’s theory focuses on the needs of an infant?
Trust versus mistrust
Intimacy versus isolation
Autonomy versus sense of shame and doubt
Generativity versus self-absorption and stagnation
Rationale
The trust versus mistrust stage of Erikson’s theory is focused on infants from birth
until 1 year of age. The stage of intimacy versus isolation is focused on young adults.
The autonomy versus sense of shame and doubt stage focuses on toddlers between 1
and 3 years of age. The generativity versus self-absorption and stagnation stage is
focused on middle-aged adults.
Which chart would the nurse use to plot an infant’s physical growth
during a scheduled health maintenance visit?
Centers for Disease Control (CDC)
World Health Organization (WHO)
American Academy of Pediatrics (AAP)
National Association of Pediatric Nurses (NAPN)
Rationale
WHO growth charts should be used to plot physical growth for newborns and infants.
The CDC growth charts should be used for children 2 years of age and older. The AAP
and the NAPN do not have specific growth charts to plot physical growth; however,
they both support the use of the WHO growth charts for newborns and infants.
The nurse examines a class of 7-year-old students during a school
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health program. According to Erikson’s theory, which behavior would
the students display?
Students want to know 'Who am I?'
Students exhibit a sense of care for others.
Students show an eagerness to learn social skills.
Students like to pretend and try out new roles.
Rationale
The nurse will likely notice that 7-year-old students show an eagerness to learn social
skills. This stage is identified as the industry versus inferiority stage according to
Erikson’s theory. During puberty, students want the answer of 'Who am I?' This is
indicative of the identity versus role confusion stage. Young adults exhibit a sense of
caring for others at the intimacy versus isolation stage. Children like to pretend and try
out new roles at the stage of initiative versus guilt. This is seen at the age of 3 to 6
years.
Which action would the nurse provide to a hospitalized individual
according to the industry versus inferiority stage?
Choose creative ways to promote social participation.
Provide a client with information about his or her treatment plan.
Involve a client’s partners or family members in the caring process.
Help the client actively participate in the treatment procedure.
Rationale
According to Erikson, the industry versus inferiority stage occurs between 7 and 11
years of age. During this stage, the child is eager to learn socially productive skills and
tools. During hospitalization, the nurse would have the child actively participate in his
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or her treatment. This action will help the child understand the importance of keeping
good health. A client in the generativity versus self-absorption and stagnation stage
should be encouraged to socialize to find a sense of fulfillment. If a client under the
intimacy versus isolation stage is admitted to the hospital, the nurse would try
involving the client’s partners or family members in the caring process. During the
identity versus role confusion or puberty stage, the nurses would help hospitalized
adolescents deal with their illness by giving them enough information to allow them to
make decisions about their treatment plan.
Test-Taking Tip: Multiple-choice questions can be challenging because students think
that they will recognize the right answer when they see it or that the right answer will
somehow stand out from the other choices. This is a dangerous misconception. The
more carefully the question is constructed, the more each of the choices will seem like
the correct response.
The nurse is educating the parents of a preschooler about the
importance of play in the development of their child. Which statements
would the nurse include for adequate teaching? Select all that apply.
One, some, or all responses may be correct.
'Playing helps the child socialize with others.'
'Pretend play allows children to learn to understand others.'
'Playing helps the child release frustration.'
'If the child fantasizes about imaginary playmates, introduce him or her to
reality.'
'The child should completely avoid television, video games, and computer
programs.'
Rationale
A child should be encouraged to play because this activity helps the child socialize with
others, learn to understand other points of view, develop skills in solving social
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problems, and release frustration. Imaginary playmates are a sign of health and allow
the child to distinguish between reality and fantasy; this type of play should not be
discouraged. Television, video games, and computer programs also support
development and the learning of basic skills.
Test-Taking Tip: Be alert for details about what you are being asked to do. In this
question type, you are asked to select all options that apply to a given situation or
client. All options likely relate to the situation, but only some of the options may relate
directly to the situation.
A toddler is raised in a controlled environment. The parents keep
imposing restrictions on the child’s desire for autonomy. Which is a
possible consequence?
Guilt
Mistrust
Isolation
Sense of shame and doubt
Rationale
A toddler develops his or her autonomy by making choices. Limiting a child’s choices
can instill a sense of shame and doubt. Preschoolers can often develop a feeling of
guilt if the caregiver’s response is too harsh. If parents fail to establish a sense of trust
with an infant, then the child may develop a feeling of mistrust. If a young adult is not
able to establish companionship and intimacy, feelings of isolation may result.
Test-Taking Tip: Answer the question that is asked. Read the situation and the
question carefully, looking for key words or phrases. Do not read anything into the
question or apply what you did in a similar situation during one of your clinical
experiences. Think of each question as being an ideal, yet realistic, situation.
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Which adolescent’s thought corresponds to the good boy–nice girl
orientation stage?
'I should avoid parties where alcohol is served.'
'I should follow the rules or else the teacher will punish me.'
'I should follow all the laws formulated by the government.'
'I should complete my homework on time so that the teacher will reward me.'
Rationale
When an individual thinks that completing the homework will help win a reward, this
thought corresponds to good boy–nice girl orientation stage. Individuals in this stage
seek the approval of and want to maintain the expectations of their immediate group.
When an individual thinks of avoiding parties where alcohol is served, this thought
corresponds to the society-maintaining orientation stage. When an individual thinks
that breaking a rule will lead to physical punishment, this thought corresponds to the
punishment and obedience orientation stage. When an individual feels that he or she
should follow all the laws formulated by the government, this thought corresponds to
the universal ethical principle orientation.
The nurse is explaining to a parent about Freud’s theory of child
development. Which stages would the nurse include in the discussions?
Select all that apply. One, some, or all responses may be correct.
Phallic stage
Latency stage
Sensorimotor stage
Formal operation stage
Punishment orientation stage
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Rationale
Freud’s psychoanalytic model of personality development involves the phallic and
latency stage. The sensorimotor stage and formal operation stage are explained under
Piaget’s theory. The punishment orientation stage is explained under preconventional
reasoning in Kohlberg’s theory of moral development.
A nurse counsels the parents of a 5-year-old child. Which of these
concepts would the nurse include in the discussion? Select all that
apply. One, some, or all responses may be correct.
Animism
Egocentrism
Logical reasoning
Concrete thinking
Object permanence
Rationale
The nurse will explain the concepts of egocentrism and animism to the parents of a 5year-old child. Logical reasoning is associated with individuals who are 11 years and
older. Concrete thinking is associated with children from the ages of 7 to 11 years old.
Object permanence is observed in children between birth and 2 years old.
Test-Taking Tip: Be alert for details about what you are being asked to do. In this
question type, you are asked to select all options that apply to a given situation or
client. All options likely relate to the situation, but only some of the options may relate
directly to the situation.
Which stages would a nurse include under the first level of the theory of
Kohlberg’s theory? Select all that apply. One, some, or all responses
may be correct.
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Good boy–nice girl orientation
Society-maintaining orientation
Instrument relativist orientation
Universal ethical principle orientation
Punishment and obedience orientation
Rationale
The first level of Kohlberg’s theory is preconventional reasoning, which includes the
instrument relativist orientation stage and punishment and obedience orientation
stage in the first level. Good boy–nice girl orientation stage and society-maintaining
orientation stage are covered under the conventional reasoning level. The universal
ethical principle orientation stage is a part of postconventional reasoning.
Test-Taking Tip: Be alert for details about what you are being asked to do. In this
question type, you are asked to select all options that apply to a given situation or
client. All options likely relate to the situation, but only some of the options may relate
directly to the situation.
A nurse educates a parent about Erikson’s theory of child development.
At which age would the nurse advise the parent to begin instilling a
sense of trust in the child?
Birth to 1 year
1 to 3 years
3 to 6 years
6 to 11 years
Rationale
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According to Erikson’s theory, the period between birth and 1 year is the most
appropriate period for instilling a sense of trust in a child. The period between 1 and 3
years is the stage during which a child develops self-control and willpower.
Establishing a basic sense of trust is essential for the development of a healthy
personality. The period between 3 and 6 years is the best time for a child to achieve
self-control and willpower. Between 6 and 11 years, a child is eager to learn socially
productive skills and tools.
Test-Taking Tip: Read the question carefully before looking at the answers: (1)
Determine what the question is really asking; looking for key words; (2) Read each
answer thoroughly and see whether it completely covers the material asked by the
question; and (3) Narrow the choices by immediately eliminating answers that you
know are incorrect.
The nurse assesses and reports a disproportionate head-to-chest ratio
for a 6-month-old infant. Which information would the nurse prepare to
share with the infant’s parents as the most likely cause of this
assessment data?
'Your infant most likely has an altered chest shape.'
'Your infant is likely experiencing abnormal head growth.'
'Your infant will most likely be diagnosed with brain cancer.'
'Your infant most likely had inaccurate measurements during the last visit.'
Rationale
A disproportionate head-to-chest ratio during infancy is most likely caused by
abnormal head growth. Although an altered chest shape may cause the
disproportionate measurements, this is not the most likely cause. Telling the parents
that their infant will most likely be diagnosed with brain cancer is inaccurate and not
therapeutic. The data obtained to determine the disproportionate measures were
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obtained during the current visit; previous measurements will not be taken into
account in this circumstance.
The nurse is preparing to assess height, length/height, and head
circumference for several pediatric clients who are scheduled for health
maintenance visits at a pediatric clinic. For which client would the nurse
plot growth using the World Health Organization’s (WHO’s) growth
chart?
A 15-month-old infant who was bottle-fed
A 30-month-old toddler who was breast-fed
A 4-year-old preschooler who was bottle-fed
A 6-year-old school-age child who was breast-fed
Rationale
The WHO’s growth charts are used for all children who are breast-fed or bottle-fed for
the first 2 years of life; therefore the 15-month-old infant’s growth will be plotted on
this chart. The other clients (30-month-old toddler, 4-year-old preschooler, and 6year-old school-age child) should have their growth plotted using the Centers for
Disease Prevention and Control growth charts.
The nurse is providing care to a 6-week-old infant who is hospitalized
for poor growth. The infant is currently being breast-fed and is
diagnosed with failure to thrive (FTT). Which is the priority nursing
assessment for this infant?
Family financial difficulties
Uncoordinated suck and swallow
Neglect and abuse by the parents
Knowledge deficit related to nutritional intake
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Rationale
Most cases of poor growth and FTT in the first 2 months of life occur because of an
uncoordinated suck and swallow during feedings (formula or breast); therefore, this is
the priority nursing assessment. Assessing for financial difficulties, neglect and abuse,
and a knowledge deficit are appropriate but not the priority in this situation.
The nurse is providing care to an infant diagnosed with Down
syndrome. Which parental statement related to the infant’s growth
indicates the need for further education?
'My baby will have growth deficiencies during infancy.'
'My child will have accelerated growth during adolescence.'
'My child will most likely be overweight by 3 years of age.'
'My baby will have reduced growth in both height and weight.'
Rationale
Children diagnosed with Down syndrome will often have growth deficiencies. These
deficiencies are most pronounced during adolescence and infancy. Because weight
gain is more rapid than growth in stature, many children with Down syndrome are
overweight by 3 years of age. Overall reduced growth is noted for both height and
weight.
The nurse is providing anticipatory guidance to the parents of a child
who has a difficult temperament. Which statement would the nurse
include in the teaching session with these parents regarding their child’s
temperament? Select all that apply. One, some, or all responses may
be correct.
'Your child will develop predictable habits.'
'Your child will benefit from a bedtime routine.'
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'Your child is open to change and adapts easily.'
'Your child is likely to adapt slowly to the new daycare setting.'
'Your child will display intense emotions, including those associated with
happiness.'
Rationale
Children who are classified as having a difficult temperament will benefit from a
bedtime routine, will likely adapt slowly to a new daycare setting, and will display
intense emotions, including those associated with happiness. The child who is
classified as easy will develop predictable habits and will be open to change and adapt
easily.
Which parental action would require the nurse to provide additional
education related to the toddler-age client’s achievement of autonomy
versus shame and doubt?
Providing the child with a choice between 2 snacks each day
Implementing a time-out equal in minutes to the child’s age in years
Allowing the child to choose the lollipop flavor after receiving an injection
Yelling at the child for having a bathroom-related accident in the waiting room
Rationale
Limiting choices and/or enacting harsh punishment leads to feelings of shame and
doubt for the toddler-age client. The nurse would provide more education to the
parents regarding appropriate punishment for yelling at the child in the waiting room
for having a bathroom-related accident because this can lead to the development of
shame and doubt. Allowing the child to choose between 2 snacks, implementing a
time-out that is equal to the child’s age in years, and allowing the child to choose a
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lollipop flavor after receiving an injection are all parental actions that will facilitate the
achievement of autonomy, so these do not require additional education.
Which parental statement indicates the need for further education
regarding the psychosocial development that occurs during infancy?
'My older kids are so excited that our 10-month-old can play hide-and-seek
with them.'
'Peek-a-boo is an appropriate activity to initiate with my baby around 9
months of age.'
'I just bought my 6-month-old some new rattles to play with because they are
easy to grasp.'
'It is important that my baby develops trust so we always respond when he
cries for us at night.'
Rationale
Play is an important aspect of an infant’s psychosocial development. Although more
complex interactive games, such as hide-and-seek involving objects is expected by 1
year of age, this statement would require additional education regarding ageappropriate play for the infant. Peek-a-boo and rattles are both appropriate play for the
infant. Responding promptly to an infant’s cry will establish trust.
Which statement made by the parent of a 6-month-old infant would
warrant further assessment regarding the infant’s fine motor skills?
'My child loves to bang toys on the tray of the highchair.'
'My child seems lazier than my other kids because I still hold the bottle.'
'My child has discovered feet and is constantly trying to put them in her
mouth.'
'My child loves to drop things and then pick them up again so that we will
clap.'
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Rationale
The nurse would further assess fine motor development for a 6-month-old infant who
is not independently holding his or her own bottle. Banging toys together or on
another surface, placing feet into the mouth, and dropping things so that he or she
can pick them back up are fine motor skill expectations for the 6-month-old infant.
Which question would the nurse ask the parent of a 7-month-old infant
to assess fine motor skill development?
'Is your baby showing a hand preference?'
'Is your baby able to pick up small objects?'
'Does your baby use the pincer grasp when eating?'
'Does your baby transfer a rattle from one hand to the other?'
Rationale
An expected fine motor skill for an infant between the ages of 6 and 8 months is to
transfer a toy from one hand to the other. The other fine motor skills such as hand
preference, picking up small objects, and using a pincer grasp when eating are fine
motor skills assessed between the ages of 8 to 10 months.
Which topics would the nurse include in the teaching session for a
pregnant client regarding maternal discomforts caused by fetal growth
and hormonal changes? Select all that apply. One, some, or all
responses may be correct.
Emesis
Nausea
Diarrhea
Backache
Dyspepsia
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Rationale
Maternal discomforts during pregnancy that are associated with fetal growth and
hormonal changes include emesis (vomiting), nausea, backache, and dyspepsia
(heartburn). Constipation, not diarrhea, is an expected maternal discomfort caused by
fetal growth and hormonal changes.
The student nurse is classifying four infants according to their
gestational age. Which infant’s information requires correction?
Infant 1
Infant 2
Infant 3
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Infant 4
Rationale
Infants who are born between 34 and 36 6/7 weeks of gestation are known as latepreterm infants, not infants who are born at 38 weeks of gestational age. An infant who
is born before completion of 37 weeks of gestational age is known as a preterm infant.
An infant who is born between 38 and 42 weeks of gestational age is known as a fullterm infant. An infant who is born after 42 weeks of gestational age is known as a
postterm infant.
The nurse observes that an infant is extending an arm to the side while
the head is turned. Which reflex is the infant eliciting?
Extrusion reflex
Trunk incurvation
Tonic neck reflex
Ankle clonus reflex
Rationale
An infant extending an arm to the side while the head is turned indicates the tonic
neck reflex. The extrusion reflex occurs when the child pushes the tongue forward
when the nurse touches or depresses it. When assessing trunk incurvation, the nurse
presses the infant’s spine to assess whether the infant’s hips move in response. When
assessing the ankle clonus reflex, the nurse performs dorsiflexion of the infant’s foot
while supporting the knee.
STUDY TIP: Determine whether you are a 'lark' or an 'owl.' Larks, day people, do best
getting up early and studying during daylight hours. Owls, night people, are more
alert after dark and can remain up late at night studying, catching up on needed sleep
during daylight hours. It is better to work with natural biorhythms than to try to
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conform to an arbitrary schedule. You will absorb material more quickly and retain it
better if you use your most alert periods of each day for study. Of course, it is
necessary to work around class and clinical schedules. Owls should attempt to register
in afternoon or evening lectures and clinical sections; larks do better with morning
lectures and day clinical sections.
The parents inform the nurse that their school-age child frequently
participates in hazardous activities. Which instruction is a priority in this
case?
'Always accompany the child everywhere.'
'Refrain from giving any sports equipment to the child.'
'Ensure the child has eye, ear, and mouth protection.'
'Avoid outdoor games and invite the child’s friends to your home.'
Rationale
School-age children have well-developed motor functions, so they engage in
hazardous activities. It is important to ensure that the child has eye, ear, or mouth
protection to prevent injuries and accidents. It may not be feasible to accompany the
child everywhere. The child is not at risk for injury from sports equipment alone, but
also from reckless physical activities like running or jumping. Avoiding outdoor games
is restricting the child’s developmental needs.
The nurse places a child in the prone position and presses a thumb
along the child’s spine from sacrum to neck. The nurse finds that the
child starts crying and urinates while flexing the extremities. Which
reflex did the nurse elicit?
Perez reflex
Babinski reflex
Trunk incurvation
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Ankle clonus reflex
Rationale
To assess the Perez reflex, the nurse places the child in a prone position and presses a
thumb along the child’s spine from sacrum to neck, and the child starts crying. This
indicates that the child has the Perez reflex. To assess the Babinski reflex, the nurse
strokes the child’s foot upward from the heel; in response, the child hyperextends the
toes. To assess trunk incurvation, the nurse strokes the infant’s spine; in response, the
child’s hips move to the stimulated side. To assess the ankle clonus reflex, the nurse
performs dorsiflexion of the child’s foot while ensuring that the knee is flexed. The
child’s foot will make an oscillating movement in response.
Test-Taking Tip: Be certain to answer every question. You must arrive at one correct or
one 'best' answer. If you must, 'guess' between two alternatives or eliminate the two or
three answers you know are wrong first.
The nurse is planning a presentation related to growth and
development for the parents of school-age children. Which topic is
most appropriate related to the topic of sexual maturation?
Methods to prevent pregnancy
Typical questions and learning needs
Safer sex practices to prevent infection
Information relayed by one parent to the child
Rationale
When planning a presentation related to sexual maturation for the parents of schoolage children, the nurse would include information related to typical questions and
learning needs that occur during this stage of development. Methods to prevent
pregnancy and safer sex practices to prevent infection should be addressed if the child
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specifically asks for information related to these topics; however, this is a rare
occurrence during the school-age years. Both parents should be involved when
discussing sexual maturation to the school-age client.
Which activity would the nurse encourage to enhance a toddler’s ability
to learn through sensorimotor experiences?
Play dates
Bottle holding
Finger-painting
Trips to the park
Rationale
Finger-painting is an age-appropriate activity for a toddler to enhance learning
through sensorimotor experiences. Play dates are encouraged for the preschool-age
child. Bottle holding is an age-appropriate activity for an infant to enhance learning
through sensorimotor experiences. Trips to the park are an age appropriate activity for
a preschool-age child.
Which topic would the nurse include in the anticipatory guidance
provided to the parents of a 12-year-old client during a scheduled health
maintenance visit?
Erratic mood changes
An increase in allergies
Strong food preferences
Changes that occur with puberty
Rationale
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It is appropriate for the nurse to provide anticipatory guidance–related changes that
occur with puberty for the parents of a 12-year-old school-age client. Anticipatory
guidance for a 7-year-old client should include an increase in allergies. Erratic mood
changes and strong food preferences occur more often for the 6-year-old client, not
the 12-year-old client.
Which client would the nurse conduct a developmental surveillance on
during a scheduled health maintenance visit?
9-month-old infant
15-month-old toddler
4-year-old preschooler
6-year-old school-age child
Rationale
Developmental surveillance is conducted at 9 months, 18 months, and 30 months of
age. The 9-month-old client would require this assessment during the scheduled
health maintenance visit. The other children do not meet the criteria for a
developmental surveillance assessment.
Which physical growth parameters would the nurse assess during a
scheduled health maintenance visit for a 24-month-old toddler-age
child? Select all that apply. One, some, or all responses may be correct.
Height
Length
Weight
Head circumference
Blood pressure
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Rationale
The physical growth parameters that the nurse will assess during the health
maintenance visit for a 24-month-old toddler-age child include length, weight, and
head circumference. Length is a growth parameter that is assessed through 24 to 36
months of age, then height is assessed. Blood pressure, although assessed during the
health maintenance visit, is not a physical growth parameter; it is a vital sign.
Which finding related to a school-age client’s vital signs would the nurse
anticipate during the assessment process?
Increased heart rate
Increased blood pressure
Increased respiratory rate
Increased body temperature
Rationale
During the school-age stage of development, the nurse anticipates an increase in
blood pressure. Other findings the nurse anticipates include a decreased heart rate
and respiratory rate; neither of these values are increased during the school-age stage
of development. Body temperature does not change.
Which nursing actions are appropriate when assessing a client’s growth?
Select all that apply. One, some, or all responses may be correct.
Assessing weight
Measuring height
Comparing data with norms
Monitoring blood pressure
Documenting actual words in quotes
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Rationale
Nursing actions appropriate when assessing a client’s growth include assessing
weight, measuring height, and comparing data with norms for the age of the client.
Monitoring blood pressure is a nursing action appropriate when assessing vital signs.
Documenting actual words in quotes is appropriate when conducting a developmental
assessment.
Which activities would the nurse recommend to a middle-age adult
client to find a sense of fulfillment, according to Erikson? Select all that
apply. One, some, or all responses may be correct.
Attending church functions
Visiting adult children in their homes
Becoming involved at a local hospital
Volunteering to coach for a grandchild’s soccer team
Allowing independent decision-making when hospitalized
Rationale
According to Erikson, middle-aged persons often find a sense of fulfillment by
volunteering in a local school, hospital, or church; therefore, the nurse would
recommend that the client attend church functions, become involved at a local
hospital, and volunteer to coach a grandchild’s soccer team. All of these suggestions
would allow the client to find a sense of fulfillment. Visiting adult children in their
homes and allowing independent decision-making when hospitalized are not
recommendations that will allow the client to find a sense of fulfillment.
The nurse is teaching growth and development activities to the parents
of a 3-month-old infant. Which statements would the nurse include in
the teaching plan? Select all that apply. One, some, or all responses
may be correct.
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'Your child should be able to show the grasp reflex.'
'Your child should be able to coo, babble, and chuckle.'
'Your child should be able to pull at blankets or clothes.'
'Your child should be able to put the feet into the mouth when supine.'
'Your child’s head can come up to a 45- to 90-degree angle from the table.'
Rationale
Cooing, babbling, and chuckling in a 3-month-old infant indicate normal
development. A 3-month-old infant can pull at blankets or clothes and can raise his or
her head to a 45- to 90-degree angle from the table. The grasp reflex generally
disappears by the age of 3 months. A 3-month-old infant may not able to put his or
her feet in the mouth when lying in the supine position. Generally a 5-month-old
infant can put his or her feet in the mouth when lying in the supine position.
When assessing the cognitive development of a 2-year-old-child, the
nurse finds that the toddler exhibits global organization. Which behavior
supports the nurse’s conclusion?
The child refuses to talk and play with peers of opposite sex.
The child refuses to eat because something previously eaten did not taste
good.
The child refuses to sleep in his or her room because the location of the bed
has changed.
The child refuses to eat a food because of its color even though its taste and
smell are acceptable.
Rationale
Global organization is a characteristic of preoperational thinking in which the child
believes that changing any one part changes the entire thing. The child’s refusal to
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sleep in his or her room because the location of the bed has changed indicates global
organization thinking. Refusal to talk and play with peers of opposite sex indicates
impaired gender identification. Refusal to eat because something previously eaten did
not taste good indicates transductive reasoning. Refusal to eat a food because of its
color even though its taste and smell are acceptable indicates centration.
According to Freud, which aspect of one’s life helps in the development
of personality?
The need for self-knowledge
The need for sensual pleasure
The need for trust and identity
The need for moral development
Rationale
According to Freud, sexual instincts or sensual pleasure is significant in the
development of our personalities. From childhood to later stages of development, a
child obtains pleasure from different parts of the body. Self-knowledge is not a theory,
but an aspect of the personality that develops gradually as an infant learns about
independent existence. Erikson proposed the psychosocial development of personality,
wherein he states that a child tries to master key conflicts, like trust versus mistrust
and identity versus role confusion, at different stages in life. Kohlberg, who explains
that children develop moral reasoning in two stages, describes moral development.
The parents inform the nurse that their child is often seen daydreaming.
Which statement would the nurse provide to the parents?
'The child is engaged in onlooker play.'
'The child needs to play with other children.'
'The child may have some neurological issues.'
'The child is exhibiting normal behavior seen in children.'
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Rationale
Sometimes a child can be found engaging in unoccupied behavior, wherein the child
focuses attention on anything that is of interest, such as daydreaming. The nurse
would inform the parents that it is a normal behavior seen in children. Onlooker play is
different from daydreaming; it is characterized by the child actively observing when
other children are playing. A child may also engage in daydreaming even while playing
with other children. Neurological issues would be suspected if the child exhibited
jerking movements or experienced fainting spells.
Which screening report will help the nurse determine skeletal growth in
a child?
Electroencephalogram reports
Radiographs of the hand and wrist
Magnetic resonance imaging (MRI)
Denver Developmental Screening Test
Rationale
Skeletal growth in a child can be determined from the ossification centers. At 5 to 6
months of age, the capitate and hamate bones in the wrist are the earliest centers.
Radiographs of the hand and wrist will help determine skeletal growth in the child.
Electroencephalogram reports will help assess a child’s brain activity. MRI is used to
scan the internal structures of a client. The Denver Developmental Screening Test is
used to understand developmental issues of a child.
The parents inform the nurse that their child often engages in 'doctor
play' with other kids, with an aim to learn more about the sexual organs.
The parents have often expressed their disapproval to the child, but it
has no effect on the child’s behavior. Which would the nurse suggest to
the parents?
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'Offer a reward for not engaging in such activities.'
'Encourage the child to engage in some sports activity.'
'Inform the child it is dangerous to engage in such activities.'
'Tell the child to talk with you about any questions related to sexuality.'
Rationale
It is not effective to condemn the child’s curiosity about sexual matters. Instead, the
parents should clarify any question that the child has about sexuality and then
encourage the child to engage in some other activity. Offering a reward for not
engaging in such behaviors will not alleviate the child’s sexual curiosity. Telling the
child that it is dangerous to engage in such activities is reinforcing negative
information that may build up a false image in the child’s mind. As an alternative, the
parents need to be honest about such explanations. Asking the child to engage in
some sports activity will not help reduce the child’s interest in sexual matters if this
curiosity is not addressed promptly.
An adolescent who has had type 1 diabetes for 5 years stops adhering to
the therapeutic regimen. Which would the nurse conclude based on the
client’s developmental level?
Need for attention
Struggle for identity
Denial of the diabetes
Regression related to the illness
Rationale
Striving to attain identity and independence are tasks of the adolescent, and rebellion
against established norms may be exhibited. Nonadherence to a regimen is not a bid
for attention; rather, it is an attempt to establish an identity, which is a developmental
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task of adolescence. Although the adolescent may be using denial, denial is not
developmentally related to adolescence. Noncompliance is not a sign of regression; it
is an attempt to attain identity through rebellion against established norms.
Which behavior of a 3-year-old child indicates delayed development?
Select all that apply. One, some, or all responses may be correct.
The child is unable to feed him- or herself.
The child is unable to climb the stairs.
The child is unable to name the colors.
The child is unable to count when asked.
The child is unable to tie his or her shoes.
Rationale
A 3-year-old child tends to ask many questions, talk for long periods irrespective of
someone listening, is able to climbs stairs, and can eat independently. If the child is
unable to self-feed or climb the stairs, it indicates impaired gross motor skills and
social development. Fine motor skills like tying the shoelaces develop by age 5 years.
Language development like naming the colors develops by age 4 years. Cognitive
function like counting is developed by age 4 years.
Test-Taking Tip: Be alert for details about what you are being asked to do. In this
question type, you are asked to select all options that apply to a given situation or
client. All options likely relate to the situation, but only some of the options may relate
directly to the situation.
The nurse is teaching health promotion techniques to the parents of a
school-aged child. During the follow-up visit, the nurse anticipates that
the child has a risk of muscle injury from overuse. Which statement by
the parent supports the nurse’s conclusion?
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'I make my child exercise 2 hours per day.'
'I advise my child to walk with his back straight.'
'I give my child a glass of whole cow’s milk every day.'
'I encourage my child to sleep 10 to 12 hours per night.'
Rationale
Excessive exercise can cause tissue injury and impair muscular development in a child.
The parent requiring the child to exercise 2 hours per day may be excessive exercise for
this child. Cow’s milk is a rich source of calcium and helps in bone and teeth
formation. The parent should encourage the child to walk with his or her back straight,
because it helps prevent spine problems in the child. Sleeping 10 to 12 hours per night
provides proper rest, which is beneficial for overall growth and development.
Test-Taking Tip: Read the question carefully before looking at the answers: (1)
Determine what the question is really asking; look for key words. (2) Read each answer
thoroughly and see if it completely covers the material asked by the question. (3)
Narrow the choices by immediately eliminating answers you know are incorrect.
While teaching parents about the developmental milestones of a 15month-old child, the nurse informs the parents about various activities
that their child should be able to do. Which statement of the parent
indicates effective learning?
'My child can jump with both feet.'
'My child can walk up stairs with one hand held.'
'My child can creep up stairs and kneel without support.'
'My child goes up and down stairs alone with two feet on each step.'
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Rationale
A 15-month-old child has the ability to creep up stairs and kneel without support
because of the development of gross motor skills. The child starts jumping with both
feet at the age of 30 months. The child will start walking up stairs with one hand held
at the age of 18 months. The calf muscles develop sufficiently for the child to walk up
and down stairs alone at the age of 24 months.
The nurse is examining a teenage client who has an awkward, longlegged appearance. Which is the sequence of growth changes that lead
to this characteristic early adolescent appearance?
1.
Growth of the neck, hands, and legs in length
2.
Increase in the breadth of the hips and chest
3.
Increase in the width of the shoulders
4.
Increase in the length of the trunk
5.
Increase in the depth of the chest
Rationale
There is a characteristic sequence in the growth changes that occur during
adolescence. The lengthwise growth of the neck and extremities occurs first before
growth in other areas of the body. This is followed by an increase in the breadth of the
hips and chest. Months later there is increase in shoulder width. Then the trunk
increases in length, and finally there is an increase in the depth of the chest. This
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sequential growth pattern results in the characteristic gawky, long-legged appearance
of early adolescence.
The nurse asks a client about developmental milestones such as the age
at which thelarche and menarche occurred. The nurse determines that
the client experienced pubertal delay. Which finding in the client’s
history supports this conclusion?
Weight increased by 8 to 12 kg.
Menarche occurred 2 years after thelarche.
Breast development occurred by 15 years of age.
Growth in height stopped 2 years after menarche.
Rationale
When the development of breasts has not occurred by 13 years of age in girls, it is
considered pubertal delay. An increase in weight between 7 and 25 kg is considered
normal during the growth spurt period. The occurrence of menarche within 2 years of
onset of breast development, or thelarche, is a normal finding. Generally, in girls,
growth in height stops 2 to 2.5 years after menarche.
The nurse is preparing to bathe a neonate born at 30 weeks' gestation.
Which practices ensure the infant’s safety? Select all that apply. One,
some, or all responses may be correct.
Gives the neonate a daily warm-water bath
Immerses the neonate fully except the head in the tub
Measures the body temperature within 2 to 4 hours before giving the bath
Removes the vernix completely from the neonate’s skin while giving the bath
Uses cleansing agents with neutral pH and minimal dyes while giving the bath
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Rationale
A neonate born before 32 weeks' gestation is known as a preterm infant. Immersing the
neonate’s head in water during a bath can increase the risk of respiratory depression.
The neonate’s body temperature should be stable 2 to 4 hours before giving the initial
bath. The nurse monitors body temperature before giving a bath. Cleansing agents
with neutral pH and minimal dyes reduce skin irritation, so these are used when
bathing the neonate. The nurse would give a warm-water bath every second or third
day, not daily, to prevent hypothermia. Removing vernix completely during the initial
bath can alter thermoregulation in a neonate.
The nurse observes an infant using his or her thumb and index finger to
hold an object. Which would the nurse infer from this observation?
The infant is exhibiting Moro reflex.
The infant is showing tonic neck reflex.
The infant is exhibiting parachute reflex.
The infant is showing crude pincer grasp reflex.
Rationale
An infant using his or her thumb and index finger to hold an object would indicate
that the infant has crude pincer grasp reflex. The infant is not startled, so the nurse
does not conclude that the infant is showing Moro reflex. If the infant extends his or
her arm and leg to the side where the infant’s head is turned, it indicates that the
infant has tonic neck reflex. The infant is not showing protective response toward
falling; therefore, the infant does not show parachute reflex.
The nurse instructs parents to avoid placing their infant in a prone
position while sleeping. Which risk would be prevented with this
instruction?
Otitis media of the ear
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Conjunctivitis of the eye
Infantile colic or baby colic
Sudden infant death syndrome
Rationale
Infants should be placed on their backs while sleeping to prevent sudden infant death
syndrome. Sleeping in the prone position can cause respiratory depression and death
in infants. Otitis media does not result from sleeping in the prone position. The nurse
instructs the parents about proper eye hygiene to prevent conjunctivitis. Infantile colic
or baby colic is not caused by placing the infant in the prone position.
Upon interacting with the parent of a toddler, the nurse anticipates that
the there is an increased risk of childhood obesity. Which statement
from the parent supports the nurse’s assumption?
'I feed my child cereal.'
'We often eat oatmeal for breakfast.'
'I often give my child potato chips.'
'I provide bananas for snacks.'
Rationale
Foods like potato chips, candy, ice cream, cake, soda pop, and other sweetened drinks
increase cholesterol levels and result in obesity. High-protein cereals do not increase
cholesterol levels in the body and do not contribute to childhood obesity. Bananas do
not increase cholesterol levels in the body and do not contribute to childhood obesity.
Oatmeal reduces the risk of obesity in the child.
Test-Taking Tip: You have at least a 25% chance of selecting the correct response in
multiple-choice items. If you are uncertain about a question, eliminate the choices that
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you believe are wrong and then call on your knowledge, skills, and abilities to choose
from the remaining responses.
While caring for a breast-feeding client, the nurse instructs the client to
begin feeding the infant when the child is quiet and alert. The nurse
observes that the infant begins fussing and crying. Which behavior does
the infant display?
Satiated behavior
Approach behavior
Prefeeding behavior
Consummatory behavior
Rationale
The infant is crying and fussing, which indicates high arousal and hunger. This
behavior is termed prefeeding behavior. To enable the infant to gain a proper grasp of
the mother’s breast, the nurse instructs the mother to begin feeding before the onset
of prefeeding behavior. The infant who is satisfied with the feeding exhibits satiety and
usually becomes calm and falls asleep. Sucking movements and rooting reflex indicate
approach behavior. Consummatory behavior is demonstrated by coordinated sucking
and swallowing.
While assessing a 2-month-old infant, the nurse makes a loud sound
and observes that the child forms a C shape with thumb and index
finger while flexing the extremities. Which would the nurse conclude?
The child is exhibiting the Moro reflex.
The child is exhibiting the rooting reflex.
The child is exhibiting the Babinski reflex.
The child is exhibiting the tonic neck reflex.
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Rationale
The infant forms a C shape with thumb and index finger while flexing the extremities
in response to a jarring sound. This indicates a positive Moro reflex. The rooting reflex
occurs when the nurse strokes the infant’s cheek, and the infant turns toward that side
and makes sucking sounds. The Babinski reflex occurs when the nurse strokes from
the heel upward across the foot and the infant hyperextends the toes in response. The
tonic neck reflex occurs when the nurse turns the infant’s head to one side and, in
response, the infant’s arm and leg extend to the same side as the head, and the
opposite arm and leg are flexed.
Test-Taking Tip: Multiple-choice questions can be challenging, because students think
that they will recognize the right answer when they see it or that the right answer will
somehow stand out from the other choices. This is a dangerous misconception. The
more carefully the question is constructed, the more each of the choices will seem like
the correct response.
The nurse is teaching a group of young adults about the calendar
method of contraception. Which statement made by an adolescent
indicates effective learning?
'This type of contraception requires a regular menstrual cycle.'
'This contraceptive method is 100% effective to prevent pregnancy.'
'This contraception may decrease sensation and reduce spontaneity.'
'This type of contraception is simple, must fit correctly, and is reusable.'
Rationale
The calendar method of contraception is refraining from sexual intercourse during the
fertile period. A client who has an irregular menstrual cycle will not be able to calculate
her fertile period, which results in failure of contraception. Lea’s shield, not the
calendar method, is a simple-fitting and reusable method of contraception. Abstinence
is refraining from sexual intercourse, which makes it a 100% effective method to
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prevent pregnancy. Condoms are the most widely used method of contraception.
However, the use of a condom may reduce sensation and spontaneity.
STUDY TIP: Answer every question. A question without an answer is the same as a
wrong answer. Go ahead and guess. You have studied for the test and you know the
material well. You are not making a random guess based on no information. You are
guessing based on what you have learned and your best assessment of the question.
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Growth and Development
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RN Content Area / Pediatric Nursing
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Intermed.
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