TEST BANK for Growth & Development Across the Lifespan;A Health Promotion Focus 3E by Leifer & Fleck

TEST BANK

TEST BANK

Chapter: 1. Healthy People 2030 Chapter: 2. Government Influences on Health Care Chapter: 3. Cultural Considerations Across the Lifespan and in Health and Illness Chapter: 4. The Influence of Family on Developing a Lifestyle Chapter: 5. Theories of Development Chapter: 6. Prenatal Influences on Healthy Development Chapter: 7. The Infant Chapter: 8. Early Childhood Chapter: 9. Middle Childhood Chapter: 10. Adolescence Chapter: 11. Young Adulthood Chapter: 12. Middle Adulthood Chapter: 13. Late Adulthood Chapter: 14. Advanced Old-Age and Geriatrics Chapter: 15. Planning for the End of Life Chapter: 16. Loss, Grief, and Bereavement

Chapter 1: Healthy People 2030 Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE 1. The purpose of Healthy People 2030 is to: a. examine world health needs. b. evaluate accomplishments for years 2020–2030. c. focus primarily on infant health and mortality. d. examine funding issues for health care.

ANS: B

Healthy People 2030 is an evidence-based 10-year report card describing health-care accomplishments in the United States between the years of 2020 and 2030.

DIF: Cognitive Level: Comprehension REF: p. 1 OBJ: 1 TOP: Healthy People 2030 KEY: Nursing Process Step: Intervention MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease 2. A health-care worker planning a research project related to teenage pregnancy in his

community would include in the initial assessment the health status of the target population.

Health status could be best evaluated by the examination of the: a. birth rate, disease morbidity, and life expectancy. b. birth rate, access to health care, and death rate. c. disease morbidity, life expectancy, and health insurance coverage. d. health insurance coverage, death rate, and access to health care.

ANS: B

Birth rate statistics identify age of mother; death rates include infant mortality and age of mother; access to health care may affect a teenager’s ability to obtain adequate prenatal care.

DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 3 TOP: Health status KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease 3. The health-care worker teaches a group of new parents about the “back to sleep” program,

which is directed toward the reduction of sudden infant death syndrome (SIDS) by: a. positioning the baby on a small flat pillow. b. placing the baby on its back in the crib. c. gently rocking the baby before returning it to bed. d. tucking infant snuggly in the crib with a light blanket.

ANS: B

The back to sleep program helps reduce the incidence of SIDS by placing the infant on its back rather than on its stomach.

DIF: Cognitive Level: Application REF: p. 8 OBJ: 5 TOP: Back to sleep program KEY: Nursing Process Step: Intervention MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

4. Healthy People 2030 endorses the completion of a high school education primarily to enable a

person to: a. secure a better job. b. increase the quality of life. c. make healthy lifestyle choices. d. maintain the family unit.

ANS: C

One of the goals of Healthy People 2030 is to increase the number of persons graduating from high school so that they have a better education basis on which to make healthy lifestyle choices.

DIF: Cognitive Level: Comprehension TOP: Health indicators MSC: NCLEX: NA

REF: p. 10 OBJ: 4 KEY: Nursing Process Step: NA

5. Healthy People 2030 is published by the: a. Centers for Disease Control and Prevention. b. Department of the Interior. c. World Health Organization. d. Department of Health and Human Services.

ANS: D

Healthy People 2030 is published by the U.S. Department of Health and Human Services.

DIF: Cognitive Level: Knowledge TOP: Healthy People 2030 MSC: NCLEX: NA

REF: p. 2 OBJ: 1 KEY: Nursing Process Step: NA

6. Infant mortality rates are based on infant deaths that occur: a. at birth, per 1000 deliveries. b. before one year of age, per 1000 live births. c. from infection and congenital disorders, per 1000 live births. d. from unexplained causes, per 1000 live births.

ANS: B

Infant mortality is reported on deaths occurring before the age of one year per 1000 live births.

DIF: Cognitive Level: Knowledge REF: p. 9 OBJ: 4 TOP: Infant mortality KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development 7. Although the life expectancy has increased, Healthy People 2030 will focus on the older

adult’s need for: a. better pharmacy insurance coverage. b. improved extended care facilities. c. increased compliance to medical protocols. d. maintenance of independent lifestyles.

ANS: D

The maintenance of independent lifestyles is an ongoing problem for the older adult.

DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 4 TOP: Older adults KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease 8. Information about morbidity and mortality gives the health-care worker data to identify: a. lifespan statistics. b. high-risk age groups for certain diseases or hazards. c. effectiveness of treatment. d. cost-effective treatment for the general population.

ANS: B

Evaluating specific details of the determinants of health help health-care workers develop an understanding of the health status of the population. Morbidity and mortality statistics can identify risks for disease or health hazard by age group.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 3 TOP: Morbidity KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease 9. A major cause of death for children under the age of 1 year is: a. congenital abnormalities. b. infection. c. cancer. d. injuries.

ANS: A

The Centers for Disease Control and Prevention has identified congenital abnormalities as a leading cause of death for children under the age of 1 year.

DIF: Cognitive Level: Knowledge REF: p. 7, Box 1-1 OBJ: 1 TOP: Health status KEY: Nursing Process Step: Intervention MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease 10. The health-care worker advises a young woman who is 7 weeks pregnant to include folic acid

supplements in her diet in order to: a. strengthen muscles in preparation for effective labor. b. help control excessive weight gain during pregnancy. c. reduce incidence of congenital malformations. d. enhance the probability of carrying the pregnancy to full term.

ANS: C

One of the goals of Healthy People 2030 is to promote use of folic acid supplements early in pregnancy. Ideally, folic acid supplements, or adequate dietary folic acid, should be recommended early in the pregnancy to help prevent congenital malformations, especially spina bifida.

DIF: Cognitive Level: Application REF: p. 10 OBJ: 4 TOP: Folic acid KEY: Nursing Process Step: Intervention MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

11. Guidelines for “baby-friendly” hospitals include: a. information about immunizations. b. active support of parent–baby bonding. c. control of peri-delivery infection. d. encouragement to breastfeed for the first year of life.

ANS: D

Baby-friendly hospitals encourage breastfeeding during the first year of life.

DIF: Cognitive Level: Comprehension REF: p. 10 OBJ: 4 TOP: Baby-friendly hospitals KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development 12. The statistic widely used to compare the health status of different populations is: a. incidence of specific infections such as AIDS or smallpox. b. maternal mortality rate. c. infant mortality rate. d. health insurance coverage.

ANS: C

Infant mortality rates are used worldwide as an indicator of the health of a nation.

DIF: Cognitive Level: Knowledge REF: p. 12 OBJ: 3 TOP: Healthy People progress KEY: Nursing Process Step: Intervention MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease 13. A health-care worker who is planning a health education program for geriatric adults based on

the goals of Healthy People 2030 would include: a. smoking cessation. b. drug and alcohol abuse. c. education about medications. d. fall prevention.

ANS: D

Reducing falls will reduce the incidence of hip fracture, which continues to be a problem, especially among elderly females.

DIF: Cognitive Level: Application REF: p. 11 OBJ: 4 TOP: Health education KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease 14. The role of the professional nurse has evolved to include: a. providing direct care to patients at the bedside. b. managing care to cure health problems once they have occurred. c. planning patient care to cover longer hospital stays. d. forming legislation for policies and practices related to health care.

ANS: D

Nurses are no longer simply providing bedside care. Their role now includes policymaking, global health education planning, working as change agents for traditional health-care systems, and so on.

DIF: Cognitive Level: Comprehension TOP: World health MSC: NCLEX: NA

REF: p. 12 OBJ: 5 KEY: Nursing Process Step: NA

15. Adults over the age of 65 can significantly reduce their health risk by: a. using herbal remedies. b. getting annual vaccines for influenza and pneumonia. c. engaging in a mild exercise regimen. d. eating three large, well-balanced meals a day.

ANS: B

Annual immunizations against pneumonia and influenza significantly reduce morbidity from these diseases.

DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 4 TOP: Issues and goals related to phases of the life cycle KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease MULTIPLE RESPONSE 1. The new topic areas in the Healthy People guidelines established in 2017 for consideration for

Healthy People 2030 include: (Select all that apply.) a. remove obstacles to health. b. address structural and systemic prejudice and discrimination.. c. develop policies and practices that promote health equity including preventative care. d. create healthy physical, social and economic environments. e. teen pregnancies.

ANS: A, B, C, D

The new topics initiated by the Healthy People 2030 guidelines in 2017 include removal of obstacles to health, addressing structural and systemic prejudice and discrimination, develop policies and practices that promote health equity including preventative care, create healthy physical, social and economic environments and give children and youth opportunities to allow attainment of highest level of health and well-being throughout their lifespan.

DIF: Cognitive Level: Comprehension TOP: New Healthy People topics MSC: NCLEX: NA

REF: p. 2 OBJ: 1 KEY: Nursing Process Step: NA

COMPLETION 1. Criteria used to measure health-related concepts are referred to as ________ ____________.

ANS:

Health indicators Health indicators are measurements of health-related concepts such as increased availability to health care and changing level of tobacco use.

DIF: Cognitive Level: Knowledge

REF: p. 2

OBJ: 3

TOP: Health indicators MSC: NCLEX: NA

KEY: Nursing Process Step: NA

2. The life expectancy at birth in the United States is above ______ years.

ANS:

80 eighty The life expectancy at birth in the United States is 80.3 years.

DIF: Cognitive Level: Knowledge REF: p. 7, Table 1-2 OBJ: 3 TOP: Life expectancy in the United States KEY: Nursing Process Step: Intervention MSC: NCLEX: Health Promotion and Maintenance: growth and development 3. In addition to injuries, the leading causes of death in adolescents and young adults aged 15

through 24 years are ________ and __________.

ANS:

unintentional injuries, suicide homicide, suicide According to the Healthy People review, unintentional injuries and suicide are among the leading causes of death in this age-group.

DIF: Cognitive Level: Knowledge REF: p. 7, Box 1-1 OBJ: 4 TOP: Issues and goals related to phases of the life cycle (adolescent and young adult) KEY: Nursing Process Step: NA MSC: NCLEX: NA

Chapter 2: Government Influences on Health Care Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition

MULTIPLE CHOICE

1. Changes in health-care delivery systems have been influenced primarily by: a. institution of various systems to provide cost-effective health care. b. governmental regulation of the cost of all health-care services. c. the need to meet the health-care needs of an aging population. d. development of medical technology that has reduced the incidence of illness.

ANS: A

Increasing health-care costs have led to initiation of health-care delivery systems to contain cost while providing care. Cost control addressing national health goals, entitlements, use of available sources, and identification of changing health-care needs is the basic goal of these systems.

DIF: Cognitive Level: Analysis TOP: Health-care reform MSC: NCLEX: NA

REF: p. 23 OBJ: 3 KEY: Nursing Process Step: NA

2. The purpose of the state/national government program of Medicaid is to provide: a. immunizations for preschool children. b. prescription drugs at a lower cost. c. medical care on the basis of need or poverty. d. community clinics for wom e n an d c hi ld re n .

ANS: C

Medicaid is similar to a welfare program in which benefits are provided on the basis of need or poverty.

DIF: Cognitive Level: Comprehension OBJ: 3 TOP: Medicaid MSC: NCLEX: NA

REF: p. 19, Box 2-3 KEY: Nursing Process Step: NA

3. A student is preparing a report on the history of the Women, Infants, and Children (WIC) program would acquire the most useful information from: a. Health, United States. b. the Department of Health and Human Services. c. the Federal Register. d. the Centers for Disease Control and Prevention.

ANS: C

Federal legislation related to health care is recorded and published in the Federal Register.

DIF: Cognitive Level: Comprehension REF: p. 20 TOP: Department of Health and Human Services MSC: NCLEX: NA

OBJ: 1 KEY: Nursing Process Step: NA

4. The Human Genome Project has the potential to reduce health-care costs by assisting health-care providers to:

a. detect illnesses before they become chronic. b. prevent chromosomal related illnesses. c. identify the most effective drugs for specific diseases. d. design low cost complementary and alternative medicine (CAM) remedies.

ANS: A

The Human Genome Project gives health-care providers the potential to detect illnesses before they become chronic.

DIF: Cognitive Level: Application TOP: Human Genome Project MSC: NCLEX: NA

REF: p. 23 OBJ: 6 KEY: Nursing Process Step: NA

5. The Tax Equity Fiscal Responsibility Act of 1982 (TEFRA) established the development of: a. diagnosis-related groups (DRGs). b. Medicaid access for the poor. c. aid to families with dependent children. d. maternal and child health services block grants.

ANS: A

TEFRA amended the Social Security Act to establish the development of DRGs in 1982.

DIF: Cognitive Level: Knowledge REF: p. 21, Table 2-1 OBJ: 2 TOP: Diagnosis-related groups KEY: Nursing Process Step: NA MSC: NCLEX: NA

6. The scope of practice for nursing is stipulated by the: a. American Nurses AssociatiN onU. b. Board of Nurse Examiners. c. Nursing Licensure Pact. d. Nurse practice act.

ANS: D

Nurse practice acts of each state establish the scope of practice for nursing in that state.

DIF: Cognitive Level: Comprehension TOP: Nurse Practice Acts MSC: NCLEX: NA

REF: p. 15 OBJ: 4 KEY: Nursing Process Step: NA

7. The roles of the nurse have changed as a result of the national health-care focus on: a. illness prevention and health maintenance. b. increased accountability to professional codes and international standards of care. c. treatment of disease or disability. d. planning for nationalized health care.

ANS: A

Prevention and early intervention appear to be critical to reducing health-care costs and are at the heart of the objectives of Healthy People 2020.

DIF: Cognitive Level: Application TOP: Illness prevention MSC: NCLEX: NA

REF: p. 24 OBJ: 6 KEY: Nursing Process Step: NA

8. An informed consent form requires that: a. the patient is informed of all adverse problems of a procedure. b. the nurse signs as a witness that the patient received the necessary information. c. the nurse questions the patient to confirm that all aspects of treatment are understood. d. the nurse documents that the consent has been signed.

ANS: B

The nurse is required to sign the informed consent form as witness that the patient received pertinent information. Extra documentation is not required.

DIF: Cognitive Level: Application TOP: Informed consent MSC: NCLEX: NA

REF: p. 16 OBJ: 2 KEY: Nursing Process Step: NA

9. A diagnosis-related group (DRG) is: a. a standard used by health-care facilities to determine charges for health-care services. b. a medical condition classification system that determines what Medicare will pay for health-care services. c. the method that health-care agencies use to decide what health-care services are needed for patients. d. a system used by all insurance companies to determine what health-care services will be covered.

ANS: B

DRGs are a government-mandated program that radically changed the face of health care by establishing strict rules for reimNbUuRrsSemIeNnGt.TB.COM DIF: Cognitive Level: Comprehension REF: p. 21, Table 2-1 OBJ: 2 TOP: Policy setting KEY: Nursing Process Step: NA MSC: NCLEX: NA

10. Prospective payment systems for health-care services: a. reimburse only preapproved treatments. b. pay only health-care providers under contract with the system to provide the lowest-priced services. c. require that health care be provided by preapproved health professionals. d. provide payment based on flat predetermined rates regardless of actual cost.

ANS: D

Prospective payment systems are part of the efforts of managed care organizations to standardize and control costs of health care.

DIF: Cognitive Level: Comprehension TOP: Delivery of health care MSC: NCLEX: NA

REF: p. 23 OBJ: 5 KEY: Nursing Process Step: NA

11. To conform to the national trend in health care, health-care agencies of the future may need to depend on: a. accountants to implement cost-saving measures. b. legislators to set limits on health-care funding.

c. nurses to plan and implement self-care education programs. d. insurance companies to provide more coverage for high-technology procedures.

ANS: C

The focus of health care has changed from treatment to prevention. Health-care agencies may depend on self-care education to promote health and prevent disease as an effective cost-containment strategy. Nurses are ideally suited through education and experience to develop and implement these programs.

DIF: Cognitive Level: Application REF: p. 24 TOP: Self-care KEY: Nursing Process Step: NA

OBJ: 6 MSC: NCLEX: NA

12. Standards of practice are the foundations for: a. plans of care. b. insurance reimbursement. c. licensure. d. consumer protection laws.

ANS: D

Standards of practice, which have evolved over the years, have been used as the foundation of laws relative to consumer protection.

DIF: Cognitive Level: Comprehension TOP: Standards of care MSC: NCLEX: NA

REF: p. 14 OBJ: 2 KEY: Nursing Process Step: NA

13. The Health Insurance Portability and Accountability Act (HIPAA) provides for: a. health insurance for emergeN nU cyR t Sre Ia Nt m Ge T nt .B b. confidentiality of medical information. c. payment for home health care. d. medical care for single mothers and their children.

ANS: B

HIPAA provides for portability of health insurance, confidentiality of medical information, and coverage for preexisting conditions DIF: Cognitive Level: Comprehension REF: p. 23, Table 2-1 OBJ: 3 TOP: Health Insurance Portability and Accountability Act (HIPAA) KEY: Nursing Process Step: NA MSC: NCLEX: NA

14. The Patient Protection and Affordable Care Act of 2010 caused controversy because it mandated: a. limited treatment for specified illnesses. b. all recipients must have a picture identification card. c. strict confidentiality of all medical records and medical communications. d. health-care coverage for 32 million uninsured persons.

ANS: D

The Patient Protection and Affordable Care Act of 2010 mandated care to 32 million uninsured persons, which would be financed from Medicare payroll taxes.

DIF:

Cognitive Level: Knowledge

REF: p. 22, Table 2-1

OBJ: 3 TOP: The Patient Protection and Affordable Care Act of 2010 KEY: Nursing Process Step: NA MSC: NCLEX: NA MULTIPLE RESPONSE

15. The Omnibus Budget Reconciliation Act of 1981 provided money for the development of: (Select all that apply.) a. treatment centers for drug dependency. b. skilled nursing facilities. c. nursing schools. d. home health agencies. e. day care centers.

ANS: B, D

The Omnibus Budget Reconciliation Act of 1981 provided money for the development of various health-care projects such as nursing homes, skilled nursing facilities, and home health agencies.

DIF: Cognitive Level: Comprehension REF: p. 21, Table 21 OBJ: 1 TOP: Omnibus Budget Reconciliation Act KEY: Nursing Process Step: NA MSC: NCLEX: NA

16. The Patient Bill of Rights ensures that all patients may: (Select all that apply.) a. select their health-care provider. b. be assured of having a private room. c. take part in treatment decisions. d. expect confidentiality. e. utilize channels for complaint.

ANS: A, C, D, E

The Consumer Patient Bill of Rights assures patients that they may select their provider, take part in treatment decisions, expect confidentiality, use resources for complaint and appeal, be free from discrimination, and have access to emergency services.

DIF: Cognitive Level: Application TOP: Patient Bill of Rights MSC: NCLEX: NA

REF: p. 15-16 OBJ: 2 KEY: Nursing Process Step: NA

17. Political action committees (PACs) can influence legislation by: (Select all that apply.) a. providing lobbying. b. selecting candidates to run for office. c. creating an awareness of the need for new legislation. d. introducing legislation themselves. e. contributing money to legislators.

ANS: A, C, E

PACs can influence legislation by contributing money to legislators and by providing lobbying services to create an awareness of the need for legislation.

DIF: Cognitive Level: Comprehension TOP: Political action committees (PACs) MSC: NCLEX: NA

REF: p. 25

OBJ: 1 KEY: Nursing Process Step: NA

COMPLETION

18. The nursing theorist that proposed a holistic view of health care in the 1960s was .

ANS:

Martha Rogers In the 1960s, Martha Rogers proposed a theory of holistic health care.

DIF: Cognitive Level: Knowledge REF: p.

24 OBJ: 6 TOP: Holistic health care KEY: Nursing Process Step: NA MSC: NCLEX: NA

19. The plan of care is the tool that directs patient care for a health care delivered by a team.

ANS:

multidisciplinary The plan of care allows for the communication among the various team members to meet the individual patient’s health-care needs.

DIF: Cognitive Level: Comprehension REF: p. 15 TOP: Plan of care KEY: Nursing Process Step: NA

OBJ: 4 MSC: NCLEX: NA

Chapter 2: Government Influences on Health Care Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. Changes in health-care delivery systems have been influenced primarily by: a. institution of various systems to provide cost-effective health care. b. governmental regulation of the cost of all health-care services. c. the need to meet the health-care needs of an aging population. d. development of medical technology that has reduced the incidence of illness.

ANS: A

Increasing health-care costs have led to initiation of health-care delivery systems to contain cost while providing care. Cost control addressing national health goals, entitlements, use of available sources, and identification of changing health-care needs is the basic goal of these systems.

DIF: Cognitive Level: Analysis TOP: Health-care reform MSC: NCLEX: NA

REF: p. 23 OBJ: 3 KEY: Nursing Process Step: NA

2. The purpose of the state/national government program of Medicaid is to provide: a. immunizations for preschool children. b. prescription drugs at a lower cost. c. medical care on the basis of need or poverty. d. community clinics for wom e n an d c hi ld re n .

ANS: C

N U R S I N G T B . COM

Medicaid is similar to a welfare program in which benefits are provided on the basis of need or poverty.

DIF: Cognitive Level: Comprehension OBJ: 3 TOP: Medicaid MSC: NCLEX: NA

REF: p. 19, Box 2-3 KEY: Nursing Process Step: NA

3. A student is preparing a report on the history of the Women, Infants, and Children (WIC) program would acquire the most useful information from: a. Health, United States. b. the Department of Health and Human Services. c. the Federal Register. d. the Centers for Disease Control and Prevention.

ANS: C

Federal legislation related to health care is recorded and published in the Federal Register.

DIF: Cognitive Level: Comprehension REF: p. 20 TOP: Department of Health and Human Services MSC: NCLEX: NA

OBJ: 1 KEY: Nursing Process Step: NA

4. The Human Genome Project has the potential to reduce health-care costs by assisting health-care providers to:

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a. detect illnesses before they become chronic. b. prevent chromosomal related illnesses. c. identify the most effective drugs for specific diseases. d. design low cost complementary and alternative medicine (CAM) remedies.

ANS: A

The Human Genome Project gives health-care providers the potential to detect illnesses before they become chronic.

DIF: Cognitive Level: Application TOP: Human Genome Project MSC: NCLEX: NA

REF: p. 23 OBJ: 6 KEY: Nursing Process Step: NA

5. The Tax Equity Fiscal Responsibility Act of 1982 (TEFRA) established the development of: a. diagnosis-related groups (DRGs). b. Medicaid access for the poor. c. aid to families with dependent children. d. maternal and child health services block grants.

ANS: A

TEFRA amended the Social Security Act to establish the development of DRGs in 1982.

DIF: Cognitive Level: Knowledge REF: p. 21, Table 2-1 OBJ: 2 TOP: Diagnosis-related groups KEY: Nursing Process Step: NA MSC: NCLEX: NA

6. The scope of practice for nursing is stipulated by the: a. American Nurses AssociatiNon U. RSINGTB.COM b. Board of Nurse Examiners. c. Nursing Licensure Pact. d. Nurse practice act.

ANS: D

Nurse practice acts of each state establish the scope of practice for nursing in that state.

DIF: Cognitive Level: Comprehension TOP: Nurse Practice Acts MSC: NCLEX: NA

REF: p. 15 OBJ: 4 KEY: Nursing Process Step: NA

7. The roles of the nurse have changed as a result of the national health-care focus on: a. illness prevention and health maintenance. b. increased accountability to professional codes and international standards of care. c. treatment of disease or disability. d. planning for nationalized health care.

ANS: A

Prevention and early intervention appear to be critical to reducing health-care costs and are at the heart of the objectives of Healthy People 2020.

DIF: Cognitive Level: Application TOP: Illness prevention MSC: NCLEX: NA

REF: p. 24 OBJ: 6 KEY: Nursing Process Step: NA

8. An informed consent form requires that: a. the patient is informed of all adverse problems of a procedure. b. the nurse signs as a witness that the patient received the necessary information. c. the nurse questions the patient to confirm that all aspects of treatment are understood. d. the nurse documents that the consent has been signed.

ANS: B

The nurse is required to sign the informed consent form as witness that the patient received pertinent information. Extra documentation is not required.

DIF: Cognitive Level: Application TOP: Informed consent MSC: NCLEX: NA

REF: p. 16 OBJ: 2 KEY: Nursing Process Step: NA

9. A diagnosis-related group (DRG) is: a. a standard used by health-care facilities to determine charges for health-care services. b. a medical condition classification system that determines what Medicare will pay for health-care services. c. the method that health-care agencies use to decide what health-care services are needed for patients. d. a system used by all insurance companies to determine what health-care services will be covered.

ANS: B

DRGs are a government-mandated program that radically changed the face of health care by establishing strict rules for reimNbUuRrsSemIeNnGt.TB.COM DIF: Cognitive Level: Comprehension REF: p. 21, Table 2-1 OBJ: 2 TOP: Policy setting KEY: Nursing Process Step: NA MSC: NCLEX: NA

10. Prospective payment systems for health-care services: a. reimburse only preapproved treatments. b. pay only health-care providers under contract with the system to provide the lowest-priced services. c. require that health care be provided by preapproved health professionals. d. provide payment based on flat predetermined rates regardless of actual cost.

ANS: D

Prospective payment systems are part of the efforts of managed care organizations to standardize and control costs of health care.

DIF: Cognitive Level: Comprehension TOP: Delivery of health care MSC: NCLEX: NA

REF: p. 23 OBJ: 5 KEY: Nursing Process Step: NA

11. To conform to the national trend in health care, health-care agencies of the future may need to depend on: a. accountants to implement cost-saving measures. b. legislators to set limits on health-care funding.

c. nurses to plan and implement self-care education programs. d. insurance companies to provide more coverage for high-technology procedures.

ANS: C

The focus of health care has changed from treatment to prevention. Health-care agencies may depend on self-care education to promote health and prevent disease as an effective cost-containment strategy. Nurses are ideally suited through education and experience to develop and implement these programs.

DIF: Cognitive Level: Application REF: p. 24 TOP: Self-care KEY: Nursing Process Step: NA

OBJ: 6 MSC: NCLEX: NA

12. Standards of practice are the foundations for: a. plans of care. b. insurance reimbursement. c. licensure. d. consumer protection laws.

ANS: D

Standards of practice, which have evolved over the years, have been used as the foundation of laws relative to consumer protection.

DIF: Cognitive Level: Comprehension TOP: Standards of care MSC: NCLEX: NA

REF: p. 14 OBJ: 2 KEY: Nursing Process Step: NA

13. The Health Insurance Portability and Accountability Act (HIPAA) provides for: a. health insurance for emergeNn Ucy Rt Sre Ia Ntm Ge Tnt B. .COM b. confidentiality of medical information. c. payment for home health care. d. medical care for single mothers and their children.

ANS: B

HIPAA provides for portability of health insurance, confidentiality of medical information, and coverage for preexisting conditions DIF: Cognitive Level: Comprehension REF: p. 23, Table 2-1 OBJ: 3 TOP: Health Insurance Portability and Accountability Act (HIPAA) KEY: Nursing Process Step: NA MSC: NCLEX: NA

14. The Patient Protection and Affordable Care Act of 2010 caused controversy because it mandated: a. limited treatment for specified illnesses. b. all recipients must have a picture identification card. c. strict confidentiality of all medical records and medical communications. d. health-care coverage for 32 million uninsured persons.

ANS: D

The Patient Protection and Affordable Care Act of 2010 mandated care to 32 million uninsured persons, which would be financed from Medicare payroll taxes.

DIF:

Cognitive Level: Knowledge

REF: p. 22, Table 2-1

OBJ: 3 TOP: The Patient Protection and Affordable Care Act of 2010 KEY: Nursing Process Step: NA MSC: NCLEX: NA MULTIPLE RESPONSE

15. The Omnibus Budget Reconciliation Act of 1981 provided money for the development of: (Select all that apply.) a. treatment centers for drug dependency. b. skilled nursing facilities. c. nursing schools. d. home health agencies. e. day care centers.

ANS: B, D

The Omnibus Budget Reconciliation Act of 1981 provided money for the development of various health-care projects such as nursing homes, skilled nursing facilities, and home health agencies.

DIF: Cognitive Level: Comprehension REF: p. 21, Table 2-1 OBJ: 1 TOP: Omnibus Budget Reconciliation Act KEY: Nursing Process Step: NA MSC: NCLEX: NA

16. The Patient Bill of Rights ensures that all patients may: (Select all that apply.) a. select their health-care provider. b. be assured of having a private room. c. take part in treatment decisions. d. expect confidentiality. e. utilize channels for complaint.

ANS: A, C, D, E

The Consumer Patient Bill of Rights assures patients that they may select their provider, take part in treatment decisions, expect confidentiality, use resources for complaint and appeal, be free from discrimination, and have access to emergency services.

DIF: Cognitive Level: Application TOP: Patient Bill of Rights MSC: NCLEX: NA

REF: p. 15-16 OBJ: 2 KEY: Nursing Process Step: NA

17. Political action committees (PACs) can influence legislation by: (Select all that apply.) a. providing lobbying. b. selecting candidates to run for office. c. creating an awareness of the need for new legislation. d. introducing legislation themselves. e. contributing money to legislators.

ANS: A, C, E

PACs can influence legislation by contributing money to legislators and by providing lobbying services to create an awareness of the need for legislation.

DIF: Cognitive Level: Comprehension REF: p. 25 TOP: Political action committees (PACs) MSC: NCLEX: NA

OBJ: 1 KEY: Nursing Process Step: NA

COMPLETION

18. The nursing theorist that proposed a holistic view of health care in the 1960s was .

ANS:

Martha Rogers In the 1960s, Martha Rogers proposed a theory of holistic health care.

DIF: Cognitive Level: Knowledge TOP: Holistic health care MSC: NCLEX: NA

REF: p. 24 OBJ: 6 KEY: Nursing Process Step: NA

19. The plan of care is the tool that directs patient care for a health care delivered by a team.

ANS:

multidisciplinary The plan of care allows for the communication among the various team members to meet the individual patient’s health-care needs.

DIF: Cognitive Level: Comprehension REF: p. 15 TOP: Plan of care KEY: Nursing Process Step: NA

OBJ: 4 MSC: NCLEX: NA

Chapter 3: Cultural Considerations Across the Lifespan and in Health and Illness Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. Cultural competence in health care is demonstrated by: a. sensitivity to cultural differences. b. discussing cultural differences. c. being able to differentiate between cultures. d. adapting care to meet cultural needs.

ANS: D

Cultural competence is the ability to adapt care so that it does not violate the culture of the patient. Being aware and sensitive to cultural differences is not the same thing as incorporating those skills into care.

DIF: Cognitive Level: Analysis REF: p. 27 OBJ: 1 TOP: Cultural competence KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

2. The home health-care worker is aware that the development of initiative may be delayed in a German family that practices a(n) parenting style. a. laissez-faire b. permissive c. authoritarian d. democratic ANS: C

The authoritarian parenting style stresses obedience and conformity and may delay the development of initiative in the school-age child.

DIF: Cognitive Level: Application REF: p. 30 TOP: Child rearing influence on development KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 4

3. When caring for an 8-hour postpartum Chinese patient who adheres to the cultural philosophy that pregnancy is a “cold” condition, the health-care worker will remember to: a. offer no fluids at all. b. thoroughly chill all food and drink. c. turn up the thermostat. d. restrict all spicy foods from the diet.

ANS: C

The Chinese belief in “hot” and “cold” physical conditions requires that the treatment modes offer the opposite in terms of intake. The “cold” pregnancy and postpartum period will require a warmer room and warm food and drink.

DIF: Cognitive Level: Analysis REF: p. 30 OBJ: 3 TOP: Chinese culture KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

4. The culturally competent health-care worker helping a Hmong family dress the recently deceased family member will be careful to: a. avoid looking at the deceased. b. keep the deceased covered. c. prevent metal from touching the deceased. d. arrange bowls of food near the body.

ANS: C

The Hmong culture dresses the deceased but does not allow metal to touch the body.

DIF: Cognitive Level: Application REF: p. 32 TOP: Care of the deceased in Hmong culture KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 3

5. The health-care worker caring for a 3-month-old Korean child hospitalized for dehydration would ask the parents’ permission prior to: a. exposing the child’s genitals. b. assessing the fontanel. c. hanging an IV medication. d. offering the child a milk-based formula.

ANS: B

Asians believe the head is sacred and should not be touched or patted unless required by medical protocol.

DIF: Cognitive Level: ApplicatiNonURSINRGETFB: .pC. 3O3M

OBJ: 3

TOP: Asian culture KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

6. In planning the information sent to the diet kitchen for a Hindu patient, the health-care worker would make a note to prohibit: a. the serving of milk and fruit together. b. all meat dishes. c. cheese in any form. d. tea or coffee.

ANS: B

Hindus avoid all meat in their diet.

DIF: Cognitive Level: Application REF: p. 33-34 OBJ: 3 TOP: Hindu culture KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

7. The Agency for Healthcare Research and Quality (AHRQ) promotes: a. increased availability of interpreters in general hospitals. b. culturally competent health care. c. consistency in folk cures and alternative medical remedies. d. a culturally diverse health staff.

ANS: B

The AHRQ promotes cultural competence in health care.

DIF: Cognitive Level: Knowledge REF: p. 34 TOP: AHRQ KEY: Nursing Process Step: NA

OBJ: 7 MSC: NCLEX: NA

8. The health-care worker assesses a new patient for the use of alternative therapies.

Such remedies have become widely used because these protocols: a. are recognized as being superior to traditional remedies. b. require a large number of unusual prescription drugs. c. have become very popular as they focus on health promotion. d. must all be terminated when traditional medicine is used.

ANS: C

The desire to promote health and take control of one’s own body and health-care decisions has been at the root of the popularity of CAM remedies. CAM can be used alone or in conjunction with traditional medicine.

DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 6 TOP: CAM KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

9. The young, female health-care worker who is giving admission information to an elderly Muslim man feels he is ignoring her because he: a. does not value women. b. looks at the floor rather than at her. c. resists instruction from a younger person. d. prefers to be instructed by a man.

ANS: B

Muslims feel eye contact is disrespectful and will look at the floor rather than eye-to-eye. This cultural trait is frequently mistaken for a lack of attention.

DIF: Cognitive Level: Application REF: p. 33 OBJ: 5 TOP: Culturally sensitive instruction KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

10. The culturally competent health-care worker will inquire if the Native American patient would like to call his own folk healer, which is the: a. spiritualist. b. root doctor. c. yerbo. d. shaman.

ANS: D

Native Americans value the integration of their health care with the natural elements. The shaman is the spiritual counselor of the Native American.

DIF: Cognitive Level: Comprehension REF: p. 29, Table 3-1 OBJ: 5 TOP: Native American KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

11. The use of silence in conversation can mean different things depending on the culture. Silence indicates agreement in the culture. a. Native American b. Chinese c. Japanese d. Russian ANS: D

Silence connotes agreement in the Russian culture, whereas silence connotes a symbol of respect in the Native American, Chinese, and Japanese cultures.

DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 4 TOP: Significance of silence KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation MULTIPLE RESPONSE

12. Culture affects broad areas of: (Select all that apply.) a. food preferences. b. socioeconomic status. c. parenting styles. d. health treatment. e. discipline measures.

ANS: A, C, D, E

Culture influences food, parenting, discipline techniques, and health measures.

Socioeconomic status does not affect basic culture. A poverty-stricken Muslim has the same INGTB.COM cultural values as a wealthy N U RS Mu s lim .

DIF: Cognitive Level: Analysis REF: p. 27 TOP: Culture KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

OBJ: 1

13. Complementary and alternative medicine (CAM) modalities include: (Select all that apply.) a. acupuncture. b. energy healing. c. intravenous therapies. d. physical therapy. e. guided imagery.

ANS: A, B, E

CAM therapies include acupuncture, acupressure, energy healing, guided imagery, aromatherapy, massage, biofeedback, and others.

DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 6 TOP: CAM modalities KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation COMPLETION

14. Deep feelings a person has about what is morally right are

.

ANS:

values Values are deep feelings a person holds about what is morally right or wrong, good or bad.

DIF: Cognitive Level: Comprehension REF: p. 28 OBJ: 2 TOP: Values KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

15. To believe that all members of a culture behave in the same way is to practice .

ANS:

cultural stereotyping To treat all members of a particular culture as if they were identical is cultural stereotyping.

DIF: Cognitive Level: Comprehension REF: p. 28 TOP: Stereotyping KEY: Nursing Process Step: NA

OBJ: 1 MSC: NCLEX: NA

16. Typically in the United States, the comfortable personal space is from 1.5 feet to ANS:

4 four The size of the personal space changes from culture to culture. In the United States, the comfortable personal space is from 1.5 feet to 4 feet.

DIF: Cognitive Level: ComprehNenUsiRoSn INRGETFB: .pC. 2O8M

OBJ: 1

TOP: Personal space KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

feet.

Chapter 4: The Influence of Family on Developing a Lifestyle Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The family can be defined as: a. the coexistence of two or more humans. b. a basic human social system. c. a hierarchal partnership. d. a group of persons who are related by blood.

ANS: B

The family has been defined as a basic human social system that involves commitment and interaction among its members.

DIF: Cognitive Level: Application REF: p. 37 OBJ: 3 TOP: Family KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. The health-care worker assesses ethnocentrism in a patient when the patient says: a. “There is no culture that can claim superiority to any other.” b. “A person’s culture is central to his adjustment to reality.” c. “All cultures have something to teach us.” d. “White Anglo-Saxons will always set the civilization standard.”

ANS: D

Ethnocentrism is the belief thatNoUnRe’Ss IowNnGcTuBlt.urCe OisMthe standard of behavior and is superior to other cultures.

DIF: Cognitive Level: Application REF: p. 49 OBJ: 8 TOP: Ethnocentrism KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

3. A Spanish-speaking 6-year-old who has started first grade in an English-speaking school spends most of her time alone and seems helpless and unable to function in this new environment. This situation as an indication of: a. inadequate preparation for attending school. b. school phobia. c. culture shock. d. discrimination.

ANS: C

Culture shock occurs when persons who are exposed to a sudden, drastic change of cultural environment are unable to cope with the new situation.

DIF: Cognitive Level: Comprehension REF: p. 49 OBJ: 8 TOP: Culture shock KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

4. The family systems theory proposes that: a. family functions are interconnected, so what happens to one family member affects

the entire family. b. family is viewed as the sum of its individual members. c. change in one family member cannot create a change in other family members. d. individual family members are readily identifiable as the source of a problem.

ANS: A

Family systems theory is based on family interconnectedness, with the understanding that what happens to one family member affects the entire family. Everything is viewed in the context of family interactions.

DIF: Cognitive Level: Comprehension TOP: Family systems theory MSC: NCLEX: NA

5.

REF: p. 43 OBJ: 3 KEY: Nursing Process Step: Implementation

An example of a blended family is one made up of: a. three unmarried couples and six minor children. b. a paternal grandmother, parents, three minor children. c. a husband, wife, one biological child, one adopted child. d. a mother, her children, stepfather.

ANS: D

An example of a blended family is a mother or father, stepparent, children.

DIF: Cognitive Level: Application REF: p. 39, Table 4-1 OBJ: 1 TOP: Family structures KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

NU RS I N G T B . C O M

r t6. W s hheniasn W Asiaen dsinneer gnuehst sotas t t r by belching loudly to show appreciation of the meal, this behavior is an example of: a. cultural assimilation. b. cultural sensitivity. c. culture shock. d. cultural relativism.

le

ANS: D

Cultural relativism is the concept that what is normal in one culture may not be considered normal in another culture.

DIF: Cognitive Level: Application TOP: Cultural relativism MSC: NCLEX: NA

REF: p. 49 OBJ: 1 KEY: Nursing Process Step: NA

7. The health-care worker would advise parents who are in the process of divorce to support their adolescent children by: a. delegating more home responsibility to them. b. discouraging discussion with a neutral party. c. encouraging pursuit of own interests. d. using adolescent as a confidant.

ANS: C

Adolescents need to be encouraged to pursue their own interests and not be burdened with extra home responsibility. Discussion with a neutral party is helpful to the adolescent. Parents should avoid using the adolescent as a confidant.

DIF: Cognitive Level: Application REF: p. 41, Table 4-2 OBJ: 4 TOP: Divorce KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

8. A mother with a 6-month-old infant says, “I want to go back to work, but I don’t want there to be a problem since I’ll have less time to spend with the baby.” The best response should be: a. “I’m sure the baby will be fine if you get a good babysitter.” b. “Let’s talk about child-care options that will be best for the baby.” c. “You should stay home until the baby starts school.” d. “You should go back to work so the baby will get used to being with others.”

ANS: B

Adequate child-care arrangements should be established prior to employment.

DIF: Cognitive Level: Application REF: p. 38, Box 4-1 OBJ: 5 TOP: Child-care services KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. The home health-care worker assesses cultural assimilation when: a. a Native American child living in Florida learns to cook traditional dishes. b. a Muslim man living in Illinois performs ritual prayers daily at his workplace. c. an Asian woman living in Texas wears blue jeans and boots. d. a young Hindu woman livinNgUiRn SAIrkNaGnsTasBa.gCreOesMto marry a man chosen by her father.

ANS: C

Cultural assimilation occurs when a person of one culture adopts the practices of another.

DIF: Cognitive Level: Application REF: p. 49 OBJ: 8 TOP: Cultural assimilation KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. Because age differences between siblings may affect family dynamics, there is more affection and less rivalry and hostility between siblings whose ages differ by: a. 5 or more years. b. 4 years. c. 3 years. d. 2 or fewer years.

ANS: A

Children older than 4 years of age may feel protective of the newborn and feel less competition for parental affection and approval.

DIF: Cognitive Level: Comprehension REF: p. 40 OBJ: 5 TOP: Spacing of siblings KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. The laissez-faire parenting style: a. allows children to regulate their own activity; sees parenting role as resource rather than role model. b. establishes rules, regulations, and standards of conduct for children that are to be followed without question. c. respects each child’s individuality; directs child’s behavior by emphasizing the reasons for the rules. d. employs only one-way communication with the children.

ANS: A

The laissez-faire style offers complete freedom for all members, with no rules, minimal discipline (if any), and no effort at impulse control.

DIF: Cognitive Level: Application REF: p. 48 OBJ: 6 TOP: Childrearing styles KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. The health-care worker designing culturally competent care will employ interventions that: a. go beyond the awareness of similarities and differences to implementing care that is sensitive. b. recognize awareness of cultural similarities and differences. c. will judge behavior first in relation to the context of the culture in which it occurs. d. teach health beliefs of the dominant culture.

ANS: A

Culturally competent care shows respect and acceptance of another culture and does not violate the culture of the patient.

DIF: Cognitive Level: Application REF: p. 49 OBJ: 8 TOP: Cultural competence KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

13. Studies suggest that viewing violent television programs or playing violent video games may cause: a. visual disorders in preschool-age children. b. sleep disorders in school-age children. c. mental fatigue and irritability. d. release of dopamine, which affects attention and learning.

ANS: D

Violent TV and video games may cause the release of dopamine, which has a negative effect on attention and learning.

DIF: Cognitive Level: Application REF: p. 50 OBJ: 10 TOP: Electronic media KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. In the launching stage of the growth and development of a family unit, the focus of the family will be on: a. maintaining a stable home base as children mature. b. establishing financial independence. c. negotiating tasks related to childrearing and household maintenance.

d. maintaining own and/or couple functioning and interests in the face of physiologic decline.

ANS: A

As children begin to mature, they need a stable home base as they begin to form an adult relationship with their parents.

DIF: Cognitive Level: Application REF: p. 48, Table 4-5 OBJ: 2 TOP: Developmental tasks of the family life cycle KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. Parents tell the school nurse that their second-grade child watches television about 4 hours a day. When discussing this issue with the parents, the nurse would best advise the parent that: a. if the programs are educational, the length of time spent watching television is not important. b. if the child is doing well in school, the length of time spent watching television is not important. c. parents need to supervise the amount and type of television programs their children watch. d. most children watch this much or more television without negative effects.

ANS: C

The best television viewing is family viewing, with parents selecting the programs and sharing thoughts with the child about what they are watching. Parents can point out the purpose of the program (entertainment, education), distinguish between what is real and unreal, correlate consequences with actions, and so on.

DIF: Cognitive Level: Application REF: p. 60 OBJ: 11 TOP: Electronic media and technology KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. The culturally competent health-care worker is aware that when caring for members of a culturally diverse population, care must focus on: a. overcoming their own cultural barriers to avoid stereotyping. b. the tendency to develop ethnocentricity. c. unconsciously imposing one’s own culture on others. d. confusing the values and beliefs of one culture with another.

ANS: A

Knowledge of cultural beliefs and behaviors can be used to determine the degree to which a family or person shares commonalities with a particular culture, but care must be taken not to assume that all members of a specific culture are alike and share the same values and beliefs.

DIF: Cognitive Level: Application REF: p. 49 OBJ: 8 TOP: Cultural competency KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. A distressed mother of a 2-year-old is at her “wit’s end” with the toddler’s desire to do activities that may be dangerous. The health-care worker counsels the parent that to assist the child with the development of autonomy, the parent should: a. be vigilant and protective and remind the child to be careful.

b. discourage the child’s independence at this early age. c. direct the child in quiet pursuits with close supervision. d. allow independent activity in a safe environment.

ANS: D

The task of developing autonomy should be encouraged and allowed in a safe environment.

For instance, let the child climb on the slide, but be available without constant caution to “be careful.”

DIF: Cognitive Level: Comprehension REF: p. 47, Table 4-4 OBJ: 7 TOP: Supporting autonomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. A child who has a brother or a sister in the family unit will have the support to develop: a. a sense of autonomy. b. a sense of self. c. concepts of social interaction. d. a greater attention span.

ANS: C

The presence of a sibling provides support and gives early experience with the development of social interaction. Siblings do not necessarily improve sense of self, attention span, or autonomy.

DIF: Cognitive Level: Application REF: p. 40 OBJ: 5 TOP: Siblings KEY: Nursing Process Step: Assessment MSC: NCLEX: Health PromotionNaUnRd SMIaiNntGenTaBnc.e:CgOroMwth and development

19. Using family development theory of Duvall as a basis, the health-care worker counsels a couple expecting their first baby that in addition to integrating the child into the family unit, the couple should examine: a. reestablishing their relationship with their best friends. b. how they will help each other with household chores. c. finding reliable child care. d. developing hobbies for both the parents.

ANS: B

Families with new infants must integrate the newborn into the family unit and expand roles and responsibilities as they remold their family unit.

DIF: Cognitive Level: Application REF: p. 45, Table 4-5 OBJ: 2 TOP: Developmental tasks of the family life cycle KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. The Family Apgar scoring system to assess family function was created by: a. Erik Erikson. b. Robert Havighurst. c. Gabriel Smilkstein. d. Betty Neuman.

ANS: C

Gabriel Smilkstein created the Family Apgar scoring system in 1978 to help assess a family’s ability to adapt and resolve issues.

DIF: Cognitive Level: Knowledge TOP: Family Apgar MSC: NCLEX: NA

REF: p. 43 OBJ: 2 KEY: Nursing Process Step: NA

21. Altered sleep patterns, disorganized eating patterns, and social isolation in a 13-year-old who is very involved in social networking could be symptoms of: a. regression. b. Facebook depression. c. anorexia nervosa. d. loss of autonomy.

ANS: B

Facebook depression occurs in young persons who spend inordinate amounts of time involved with social media and, as a result, exhibit typical signs of depression.

DIF: Cognitive Level: Application REF: p. 52 OBJ: 10 TOP: Facebook depression KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

22. The Children’s Television Act of 1991 mandated that television networks: a. provide at least 2 hours of educational programs each afternoon. b. depict multiethnic characters in programs designed for young children. c. censor the content of programs being aired during prime time. d. avoid any religious referencNeUs RinSthIeNirGpTroBg.raCmOmMing.

ANS: C

The Children’s Television Act of 1991 mandated that the content of programs shown during prime time be appropriate for young viewers.

DIF: Cognitive Level: Comprehension TOP: Children’s Television Act of 1991 MSC: NCLEX: NA

REF: p. 50 OBJ: 10 KEY: Nursing Process Step: NA

23. Robert Havighurst designed a developmental theory for the learning of developmental tasks for persons of: a. preschool age. b. school age. c. adolescent age. d. late adulthood age.

ANS: D

Robert Havighurst described a sequence for learning developmental tasks for the period of late adulthood.

DIF: Cognitive Level: Knowledge TOP: Developmental theories MSC: NCLEX: NA

REF: p. 45 OBJ: 7 KEY: Nursing Process Step: NA

24. While talking with the upset and tearful family of a patient newly diagnosed with a chronic illness, the health-care worker asks, “When something is bothering you, what do you do?” This should be interpreted as: a. part of assessing the family’s coping skills. b. inappropriate, because the family is so upset. c. a way to stop the family from crying. d. comparing this crisis to similar situations with which the family has dealt.

ANS: A

The health-care worker needs to identify family strengths and coping skills so a comprehensive plan of care can be developed and implemented by the health-care team.

DIF: Cognitive Level: Application REF: p. 42 OBJ: 5 TOP: Chronic illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

25. The health-care worker is alert for signs of involved in a flood that swept their house away. a. social isolation b. posttraumatic stress c. aggressive behavior d. regression

after the entire family was

ANS: B

Families who have been involved in a disaster can suffer from posttraumatic stress syndrome.

Their reaction should not be minimized, but carefully assessed.

DIF: Cognitive Level: ComprehNenUsiRoSn INRGETFB: .pC. 5O3M

OBJ: 11

TOP: Effects of disaster KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

26. After the death of a child, what might the parents exhibit toward the surviving children? a. Increased anxiety b. Insistence on greater self-reliance c. Overprotectiveness d. Indifference ANS: C

Family members may exhibit overprotectiveness toward the surviving children, depriving them of normal interaction with their peers.

DIF: Cognitive Level: Comprehension REF: p. 42 OBJ: 5 TOP: Death of a sibling KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. The health-care worker points out to the family of a hospitalized child evidence that the facility supports family-centered health care by such practices as: a. presenting the family with the completed plan of care. b. nursing staff performing all care of the child. c. rigid times for meal service. d. expanded or totally open visiting hours.

ANS: D

Expanded or totally open visiting hours allow time for a family to be with their child.

Designing the plan of care without family input does not support family-centered health care, nor does assuming every aspect of care.

DIF: Cognitive Level: Comprehension REF: p. 55 OBJ: 8 TOP: Family-centered health care KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

28. Selected video games with a flickering frequency on the screen can trigger: a. seizures. b. loss of visual acuity. c. retinal damage. d. eye strain.

ANS: A

A flickering frequency can trigger a seizure in a child who has photosensitivity epilepsy.

DIF: Cognitive Level: Application REF: p. 51 OBJ: 10 TOP: Negative effects of video KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

29. The parents of two children, ages 7 and 2, are concerned about the language development of their 2-year-old. They tell the health-care worker that their older child began talking in two- or three-word phrases by age 2, but their younger child is still using mostly one-word sentences.

The best response by the health-care worker is: a. “Your child should be evaluated as soon as possible for a language disorder.” b. “First-born children generaNllyUhRaSvIe Na GlaTrgBer.vCoOcaMbulary and better conversational skills at an earlier age.” c. “Your child will not begin to develop better language skills until she enters preschool.” d. “Make arrangements for your child to attend a day care center to improve language skills.”

ANS: B

Older siblings may help younger children grasp language skills, but first-born children may have longer, more intense verbal interaction with parents, resulting in a wider vocabulary and better conversational skills at an earlier age.

DIF: Cognitive Level: Application REF: p. 40 OBJ: 5 TOP: Effect of family on growth and development of the child KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

30. The changes that have occurred to the traditional nuclear family over the past 40 years include: (Select all that apply.) a. decreased daily availability of the father. b. dual-career parents. c. larger families with young children.

d. increase in number of single-parent families. e. expectation that children be more independent.

ANS: A, B, D, E

More families are dual-career families or single-parent families, which requires the child to be more independent at an earlier age. There is often decreased daily time with the father due to demands of the workplace. Families are smaller with fewer young children.

DIF: Cognitive Level: Application REF: p. 38 OBJ: 5 TOP: Changes in family life KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

31. To make an effective cultural assessment of a family that is dealing with a child with a terminal illness, the health-care worker must consider: (Select all that apply.) a. socioeconomic status. b. availability of other family members. c. religious practices. d. health beliefs. e. significance of the disease.

ANS: A, C, D, E

The cultural assessment should include values, socioeconomic status, religious practices, and health beliefs.

DIF: Cognitive Level: Comprehension REF: p. 49 OBJ: 8 TOP: Cultural Assessment KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

32. The health-care worker uses as a basis for interventions for children the developmental theory of the theorist that is based on the mastery of developmental tasks at specific ages.

ANS:

Erik Erikson Erik Erikson developed the growth and development theory in which particular life skills are mastered at a particular age.

DIF: Cognitive Level: Comprehension REF: p. 46-47, Table 4-4 OBJ: 7 TOP: Developmental theory: Erikson KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

33. Families who have poor communication among members, who tend to be isolated from the community, and who have inconsistent rules are labeled as .

ANS:

dysfunctional

Dysfunctional family styles often result in antisocial behaviors of family members, where behavior of individuals may violate the rights of others. Even families labeled as dysfunctional have certain strengths, so the role of health-care providers are to refer the family to appropriate community resources to help family members regain self-esteem and break the cycle of dysfunction in future generations.

DIF: Cognitive Level: Knowledge REF: p. 48-49 OBJ: 10 TOP: Childrearing styles KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

Chapter 5: Theories of Development Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The theorist who proposed a psychosocial theory that human development occurs as a result of interactions among the environment, culture, and the individual was: a. Erik Erikson. b. Daniel Levinson. c. Carl Jung. d. Robert Keegan.

ANS: B

Daniel Levinson proposed that a person’s interactions with the environment and culture form the “fabric of life.”

DIF: Cognitive Level: Comprehension TOP: Daniel Levinson MSC: NCLEX: NA

REF: p. 62 OBJ: 3 KEY: Nursing Process Step: NA

2. The characteristic common to all developmental models is that: a. chronological age is the most important factor. b. development is a continuous process throughout the lifespan. c. development depends on physical growth. d. developmental progress continues regardless of environment.

ANS: B

The study of growth and development begins with conception and continues throughout the lifespan. Developmental theories are designed to explain the occurrence of specific behaviors and to suggest relationships of behavior to other developing skills.

DIF: Cognitive Level: Comprehension REF: p. 58 OBJ: 7 TOP: Developmental theories KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. When the health-care worker praises a child for eating all of the meal and expresses disappointment when the child does not eat, the health-care worker is following the behavioral theory of: a. Skinner. b. Erikson. c. Freud. d. Havighurst.

ANS: A

Skinner attributed learning to operant conditioning, which involves the use of rewards or punishment for certain behaviors. Reinforcing positive behavior with a reward will eventually lead to regular practice of that behavior.

DIF: Cognitive Level: Application REF: p. 66 TOP: Selected theories of development (Skinner) KEY: Nursing Process Step: Implementation

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OBJ: 2

MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. The function of Freud’s defense mechanism is to: a. foster learning, growth, and adaptation. b. inflate the self-image. c. resolve interpersonal conflicts. d. relieve anxiety.

ANS: D

Freud described defense mechanisms that protect the ego by hiding unpleasant feelings or memories from a person’s awareness and serve as a defense against anxiety. Defense mechanisms may provide time for the person to develop or mobilize coping strategies to deal with the situation.

DIF: Cognitive Level: Comprehension REF: p. 59 OBJ: 1 TOP: Defense mechanisms KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. A school-age child who is helping his father wash the car is told by his father that he is leaving “streaks all over the windows.” The child feels his father thinks he’s stupid for not being able to wash windows correctly. This incorporation of “being stupid” into the child’s self-concept illustrates an example of: a. moral reasoning (Kohlberg). b. information processing (Piaget). c. looking-glass self (Cooley and Mead). d. imitation of behavior (Bandura and Mischel).

ANS: C

Cooley and Mead’s theory of development of self-image includes a combination of imagining how we portray ourselves to others and imagining how others evaluate us to form a self concept.

DIF: Cognitive Level: Analysis TOP: Looking-glass self MSC: NCLEX: NA

REF: p. 67 OBJ: 2 KEY: Nursing Process Step: NA

6. A 73-year-old man scheduled for surgery tells the health-care worker that if things do not go well during surgery, he has lived a full life and has no regrets. The health-care worker recognizes that this statement is consistent with: a. the changes and redirected goals characteristic of Levinson’s theory of late adulthood. b. achievement of the developmental task of integrity described by Erikson. c. the wisdom and judgment that maintains self-esteem in Peck’s theory of development. d. unsuccessful achievement of earlier developmental tasks described by Havighurst.

ANS: B

A sense of a life well lived and an acceptance of death are characteristic of Erikson’s task of ego-integrity.

DIF: Cognitive Level: Analysis TOP: Ego-integrity

REF: p. 60 OBJ: 3 KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. When the driver who is stopped for speeding tells the officer that he was rushing to an important appointment, this is an example of the defense mechanism of: a. identification. b. rationalization. c. sublimation. d. repression.

ANS: B

Developing a plausible excuse to explain problematic behavior is considered rationalization.

DIF: Cognitive Level: Application REF: p. 59, Box 5-1 OBJ: 7 TOP: Defense mechanism KEY: Nursing Process Step: NA MSC: NCLEX: NA

8. To promote a sense of industry in a hospitalized school-age child, the health-care worker should: a. encourage the child to read a book. b. ask the parents of the child to bring a favorite toy from home. c. encourage the child to telephone friends and family members. d. ask the child to help pick up all the stuffed toys in the playroom.

ANS: D

Erikson’s stage of industry in the school-age child involves developing a sense of achievement.

DIF: Cognitive Level: Application REF: p. 61, Table 5-2 OBJ: 7 TOP: Erikson’s stages KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. According to the theory of Lawrence Kohlberg, the health-care worker can anticipate that the moral development of a 2-year-old will follow the preconventional pattern by: a. obeying rules to avoid punishment. b. conforming to rules to gain reward. c. following rules to be thought of as “good.” d. desiring to do the “right” thing.

ANS: A

Rationale The preconventional pattern of behavior would lead the toddler to obey rules to avoid punishment.

DIF: Cognitive Level: Comprehension REF: p. 67, Table 5-7 OBJ: 7 TOP: Moral development KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. The behavior most characteristic of the concrete operations stage of cognitive development is: a. progression from reflex activity to imitative behavior. b. inability to put oneself in another’s place. c. thought processes become increasingly logical and coherent.

d. ability to think in abstract terms and draw logical conclusions.

ANS: C

According to Piaget, during the concrete operations stage of development, there is understanding of more than one piece of information at a time. There is a realistic understanding of the world, and thought processes become more logical.

DIF: Cognitive Level: Comprehension REF: p. 62, Table 5-4 OBJ: 5 TOP: Concrete operations KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. Behavior modification is basically designed to: a. probe the unconscious motives of behavior. b. alter current behavior patterns. c. produce basic changes in personality. d. relieve conflicts in behavior.

ANS: B

Behavior modification is based on Skinner’s operant conditioning method of learning.

Reinforcing positive behavior with a reward will eventually lead to regular practice of that behavior.

DIF: Cognitive Level: Comprehension TOP: Behavior modification MSC: NCLEX: NA

REF: p. 66 OBJ: 2 KEY: Nursing Process Step: NA

12. According to the language/culture developmental theory of Lev Vygotsky, preschoolage children guide their own behavior by the use of: a. avoidance of punishment. b. imitating older children. c. relying on their autonomy. d. inner language.

ANS: D

The theory of Vygotsky proposes that children as young as 4 years old can guide their own behavior by heeding an inner language.

DIF: Cognitive Level: Comprehension REF: p. 64, Table 5-5 OBJ: 2 TOP: Inner language KEY: Nursing Process Step: NA MSC: NCLEX: NA

13. A woman whose husband retired 6 months ago says that he is “driving me crazy” and is “underfoot all the time.” These complaints indicate that the wife is in the retirement developmental stage of: a. honeymoon. b. terminal. c. disenchantment. d. freedom.

ANS: C

Robert Atchley described the disenchantment stage of retirement as a time when new priorities are developed as a result of boredom.

DIF: Cognitive Level: Application REF: p. 69, Table 5-8 OBJ: 9 TOP: Disenchantment stage KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. The best advice to parents who want to encourage autonomy in their toddler would be to: a. provide opportunities for the toddler to play with other children. b. help the toddler learn right from wrong. c. help the toddler to complete tasks. d. encourage the toddler to do things for himself.

ANS: D

This is the “me do” stage of development. Encouraging independence in the toddler will foster a sense of confidence, autonomy, and well-being.

DIF: Cognitive Level: Application REF: p. 61, Table 5-2 OBJ: 3 TOP: Supporting autonomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. Maslow’s hierarchy of needs states that basic physiological needs must be met before the individual can reach full potential. An example of a physiological need being met is: a. the need to be well thought of by oneself as well as by others. b. obtaining prenatal care early in pregnancy. c. drinking eight glasses of water a day and following a well-balanced diet. d. building an extra room for an elder onto a small house.

ANS: C

Examples of Maslow’s basic physiological needs are air, water, food, elimination, and rest.

DIF: Cognitive Level: Comprehension REF: p. 65 OBJ: 8 TOP: Theories of development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. According to Kohlberg, children develop moral reasoning as they mature. Which action is most characteristic of a school-age child’s stage of moral development? a. Rules are obeyed to avoid punishment. b. Rules are followed to gain recognition. c. Behavior that pleases others is considered good. d. Showing respect for authority is important behavior.

ANS: B

During the school childhood stage of development, the child seeks to conform to rules to gain recognition.

DIF: Cognitive Level: Comprehension REF: p. 67, Table 5-7 OBJ: 2 TOP: School-age moral development (Kohlberg) KEY: Nursing Process Step: NA MSC: NCLEX: NA

17. When the father of a 12-year-old says, “I must find some way to get my son to become serious about school. He just seems to want to play all the time.” The parent is in the stage of parenting behaviors described by Erik Erikson. a. parental image b. authority c. integrative d. independent ANS: C

The need a parent feels to motivate the child who is experiencing early independence is part of Erik Erikson’s stages of parenting, Stage 3: Integrative.

DIF: Cognitive Level: Application REF: p. 61, Table 5-3 OBJ: 9 TOP: Integrative stage of parenting KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. A 10-year-old child has demonstrated exceptional spelling ability in several school and community contests and is recognized in his school by teachers and peers for his ability. He believes he can win the state championship. This situation is representative of the concept of: a. latency; achievement of skills (Freud). b. mastery of environment; match between ideal and actual self (Rogers). c. initiative; following rules (Erikson). d. academic recognition; value of the less aggressive child (Bronfenbrenner).

ANS: B

Rogers believed that mastery of environment helped form the self concept and that a person has an idea of the type of person he or she would like to be. If the ideal self shares much in common with the actual self, that person will achieve full potential.

DIF: Cognitive Level: Analysis REF: p. 65 OBJ: 4 TOP: Mastery (Rogers) KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

19. Psychodynamic developmental theories focus on resolution or development of: (Select all that apply.) a. thinking/reasoning skills. b. love/attachment. c. personality traits. d. cultural adjustment. e. psychological challenges.

ANS: C, E

Psychodynamic theories focus on the development of personality traits and the resolution of psychological challenges.

DIF: Cognitive Level: Comprehension REF: p. 57 OBJ: 3 TOP: Psychodynamic theories KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. What are major characteristic(s) of a self-actualized person? (Select all that apply.) a. Understands reality b. Makes judgments based on evidence c. Is reliant on significant others d. Is creative e. Has values that are constantly changing ANS: A, B, D

The self-actualized person understands reality, uses evidence for judgments, is self-reliant and creative, and has a sound set of values.

DIF: Cognitive Level: Application REF: p. 65 OBJ: 9 TOP: Self actualization KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

21. The school nurse recognizes the defense mechanism of when the 7-year-old first grader throws his crayons on the floor after he has been reprimanded by the teacher for boisterous behavior.

ANS:

displacement Displacement is the defense mechanism in which an individual expresses feelings (usually anger) he has about one person again another person or object.

DIF: Cognitive Level: Application REF: p. 59, Box 5-1 OBJ: 7 TOP: Defense mechanism: Displacement KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

22. According to Piaget, children typically solve problems by trial and error during the stage of development.

ANS:

sensorimotor Piaget’s theory involves sensory and motor interactions with the environment, leading to information processing. This information processing is believed to be the basis of problemsolving and critical thinking skills.

DIF: Cognitive Level: Application REF: p. 62, Table 5-4 OBJ: 5 TOP: Cognitive theories KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 6: Prenatal Influences on Healthy Development Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The Human Genome Project is credited with the development of significant research on the subject of: a. analysis of chemicals that make up RNA. b. prevention of birth defects. c. ethical use of stem cells. d. gene mapping.

ANS: D

The Human Genome Project was involved in gene mapping, which determined the make-up of all human genes.

DIF: Cognitive Level: Comprehension TOP: The Genome Project MSC: NCLEX: NA

REF: p. 72 OBJ: 1 KEY: Nursing Process Step: Implementation

2. The ELSI program has been developed for the purpose of: a. promoting fund raising for the study of gene therapy. b. publishing up-to-date information on the progress of gene therapy. c. evaluating the ethical, legal, and social implications of gene therapy. d. educating the general public about the benefits of gene therapy.

ANS: C

The ELSI program’s purpose is to evaluate the ethical, legal, and social implications of gene therapy.

DIF: Cognitive Level: Application TOP: ELSI program MSC: NCLEX: NA

REF: p. 75 OBJ: 1 KEY: Nursing Process Step: NA

3. The newlywed couple most appropriately referred to genetic counseling would be the: a. Jewish couple who feel they must have a male child. b. Caucasian couple who both have family histories of schizophrenia. c. mixed cultural couple of a Japanese wife and American husband. d. African Americans, one of whom has sickle cell trait.

ANS: D

Counseling is a significant consideration for persons with sickle cell trait who need information about the probability of passing the disease on to the next generation.

DIF: Cognitive Level: Analysis REF: p. 75 OBJ: 1 TOP: Genetic counseling KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

4. A woman who is 14 weeks pregnant says that she has abstained from alcohol during her first trimester and would like to know if it is now safe to have a drink with dinner. The healthcare worker’s best response would be:

a. “As you are in your second trimester, there is no problem with having one drink with dinner.” b. “One drink every night is too much. One drink three times a week should be fine.” c. “Because no one knows how much or how little alcohol it takes to cause fetal problems, it is recommended that you abstain throughout your pregnancy.” d. “Because you are in your second trimester, you can drink as much as you like.”

ANS: C

Maternal ingestion of substances such as alcohol can interfere with cell growth in the developing fetus.

DIF: Cognitive Level: Analysis REF: p. 80 OBJ: 3 TOP: Teratogens KEY: Nursing Process Step: Intervention MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

5. The home health-care worker visiting a pregnant woman in her second trimester observes the patient doing chores and performing errands. Because of a threat to the fetus, the woman should refrain from: a. walking a mile to the grocery store. b. sweeping the floor with a broom. c. using bleach when doing the wash. d. emptying and cleaning the cat box.

ANS: D

Contact with cat litter boxes poses a threat of contracting toxoplasmosis.

DIF: Cognitive Level: Application REF: p. 81 OBJ: 3 TOP: Toxoplasmosis KEY: Nursing Process Step: Intervention MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

6. According to parental role development theory, the reality of the pregnancy occurs for the couple when: a. the mother is aware that she has missed her period. b. the pregnancy is confirmed in the first trimester. c. movement is felt in the second trimester. d. actual plans for the birth are made in the third trimester.

ANS: C

According to the parental role development theory, the reality of the pregnancy and the introduction of a new baby into a family unit usually occurs in the second trimester when movement is felt and ultrasound pictures are taken.

DIF: Cognitive Level: Comprehension TOP: Parental role development MSC: NCLEX: NA

REF: p. 82 OBJ: 8 KEY: Nursing Process Step: NA

7. The difference between a nurse midwife and a doula is that a doula is a: a. registered nurse with advanced training in labor and delivery. b. registered nurse with advanced practice education. c. specially trained coach that stays with the mother during labor and delivery. d. medical doctor with advanced education in women’s health.

ANS: C

A doula is a person who will act as a coach during labor and delivery. This person is not necessarily a nurse.

DIF: Cognitive Level: Comprehension REF: p. 83 TOP: Doula KEY: Nursing Process Step: NA

OBJ: 8 MSC: NCLEX: NA

8. A new mother of a baby girl who has a 2 1/2-year-old son at home says, “I don’t know how I’ll ever manage both children when I get home.” The most informative response would be: a. “Your son is a big brother now and will love his new sister.” b. “You might consider letting your son stay with his grandparents for several weeks to allow him to adjust to the new baby.” c. “Make sure your husband bonds with your son while you are busy with your new daughter.” d. “You may see babyish behavior in your son, which is a typical reaction.”

ANS: D

Sibling rivalry is the competition between siblings for parental love and attention. Toddlers may regress and be angry at the birth of a new sister or brother.

DIF: Cognitive Level: Application REF: p. 86 OBJ: 10 TOP: Regression KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. The health-care worker observes several interactions between a postpartum woman and her newborn. The behavior that would be assessed as maladaptive is: a. seldom making eye contact with the baby. b. reading a magazine while the baby sleeps. c. cuddling the baby close to her chest. d. telling visitors how well the baby is feeding.

ANS: A

Bonding is the term often used to describe the emotional relationship that begins to develop between parent and newborn in the first few hours or days after birth. Touch and visual interaction are critical factors in facilitating this process.

DIF: Cognitive Level: Comprehension REF: p. 87 OBJ: 8 TOP: Bonding KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. A 15-year-old mother seems to ignore her newborn. A strategy that the health-care worker can use to facilitate mother–infant attachment in this mother is to: a. tell the mother that she must pay attention to her baby. b. show the mother how the baby initiates interaction in face-to-face encounters. c. demonstrate for the mother different positions for holding her baby while feeding. d. arrange for the mother to watch a video on parent–infant interaction.

ANS: B

Facilitating the mother’s appreciation of the newborn’s reaction to her in a face-to-face encounter can stimulate bonding.

DIF:

Cognitive Level: Application

REF: p. 89

OBJ: 8

TOP: Stimulation of bonding KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

11. “Taking hold” is occurring when the new mother: a. requests help with ambulation and perineal care. b. shows interest in learning more about infant care. c. sleeps most of the time when the baby is not present. d. is very excited and talkative about the birth experience.

ANS: B

According to Reva Rubin, the “taking hold” phase is introduced when the mother begins to initiate care of the newborn and is most receptive to teaching at this stage.

DIF: Cognitive Level: Comprehension REF: p. 85, Table 6-2 OBJ: 8 TOP: Transition to motherhood KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. During a telephone follow-up conversation 5 days postpartum, the woman tells the health-care worker, “I don’t know what’s wrong with me. I love my baby, but I seem to be crying all the time!” The woman is most likely experiencing: a. taking-in. b. letting go. c. postpartum blues. d. attachment.

ANS: C

During the transition to motherhood, mood swings are common. Conflicting feelings of happiness and depression are called postpartum blues, and the symptoms are generally selflimiting.

DIF: Cognitive Level: Application REF: p. 85 OBJ: 8 TOP: Postpartum blues KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

13. The home health-care worker can help a father in his transition to parenthood by: a. pointing out that the infant recognizes his voice. b. asking him what child care arrangements have been made. c. teaching him to tape the baby’s diaper a different way. d. reminding him that he must be ready to help with household chores.

ANS: A

Fathers develop an intense focus on the newborn, called engrossment. An outstanding response to this is one of strong attraction to the newborn, leading to the development of strong bonds with the infant over time. Subsequently, fathers often reevaluate their relationship with their own parents.

DIF: Cognitive Level: Application REF: p. 85 OBJ: 10 TOP: Fathers or significant others KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. The mother asks how much her baby will sleep every day. The best response is:

a. “He will only wake up to be fed, and you should not bother him between feedings.” b. “A newborn sleeps about 17 hours a day with periods of wakefulness gradually increasing.” c. “He will probably follow your same sleep and wake patterns, so you can expect him to be awake soon.” d. “You should try to limit day sleep to about 3 hours so he will sleep through the night.”

ANS: B

Neonates sleep 15 to 20 hours a day in the first 3 to 4 weeks of life. By 4 weeks, some infants stay awake from one feeding to the next.

DIF: Cognitive Level: Comprehension REF: p. 88 OBJ: 8 TOP: Neonatal sleep patterns KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. Parents of a newborn ask about the baby’s vision and specifically want to know what visual stimuli they should provide for the newborn. The most appropriate response is: a. “Babies can see very little until about age 3 months.” b. “It is important to shield the baby’s eyes. You should ask your physician what visual stimulation to offer your child.” c. “The baby’s eyes are immature and must be protected. Any visual stimuli should not contain bright or strong colors.” d. “Newborns have good near vision. A brightly colored mobile to hang over the crib is a good choice for your baby.”

ANS: D

The newborn can both see and hear. A musical mobile would capture the baby’s attention via hearing and vision.

DIF: Cognitive Level: Application REF: p. 91 OBJ: 12 TOP: Visual stimuli KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. Characteristics of dizygotic twins include their being: a. of the same sex. b. formed from the same single ovum and sperm. c. always carried to full term. d. similar to each other as any sibling.

ANS: D

Dizygotic twins (fraternal) occur when two ova are released and both ova are fertilized by two different sperm. The two embryos are not necessarily of the same sex and will resemble each other no more than any other siblings. Many twins are born prematurely as the uterus becomes overdistended.

DIF: Cognitive Level: Application REF: p. 79 OBJ: 6 TOP: Dizygotic twins KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. A young, newly pregnant woman who led a sedentary life prior to pregnancy asks what sort of exercise would be beneficial. Helpful suggestions would be to engage in regular: a. aggressive exercise at a gym. b. jogging. c. lifting free weights. d. swimming.

ANS: D

Swimming is a good light exercise program to recommend to a previously sedentary pregnant woman.

DIF: Cognitive Level: Application REF: p. 80 OBJ: 5 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

18. Warnings that are appropriate to an exercising pregnant woman in her second trimester of pregnancy would include: a. limiting water while exercising to prevent hypertension. b. avoiding exercises that require the supine position. c. performing exaggerated range-of-motion exercises. d. exercising strenuously to supply extra heat and blood to the placenta.

ANS: B

Exercising should be moderated so that no supine positions are assumed after the second trimester to avoid cord compression. While exercising, adequate hydration should be maintained. Excessive heat increases the oxygen needs of the fetus and should be avoided.

DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 5 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk

19. The pH of the female reproductive tract and estrogen level have an effect on fertilization in that they: a. soften the ovum to enhance fertilization. b. can trap defective sperm. c. determine the sex of the fetus. d. affect the speed of the ova and sperm entering the fallopian tube.

ANS: D

Vaginal pH and the estrogen level of the female enhance the speed of the movement of the sperm and the ova into the fallopian tube where fertilization occurs.

DIF: Cognitive Level: Comprehension REF: p. 75 OBJ: 4 TOP: Fetal development KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. The young pregnant woman with type 2 diabetes mellitus should get at least exercise a day to control weight and blood glucose. a. 10 b. 15 c. 30 d. 60

minutes of

ANS: C

Thirty minutes per day of light exercise will help control weight and control glucose levels.

DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 3 TOP: Exercise during pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

21. Development of neural tube defects seems to be more common in the fetuses of pregnant women whose diet is low in: a. iron. b. vitamin D. c. folic acid. d. essential amino acids.

ANS: C

Research has shown a higher incidence of neural tube defects in fetuses of women with folic acid deficiency. In 1992 the U.S. Public Health Service recommended that all women of childbearing years consume 0.4 mg of folic acid daily.

DIF: Cognitive Level: Comprehension REF: p. 78 TOP: Folic acid KEY: Nursing Process Step: NA

22. The term fetus refers to an embryo that is a. 2 b. 3 c. 6 d. 9

OBJ: 3 MSC: NCLEX: NA

weeks old.

ANS: D

From the 9th week of life, the embryo is called a fetus.

DIF: Cognitive Level: Comprehension REF: p. 75 TOP: Fetus KEY: Nursing Process Step: NA

OBJ: 3 MSC: NCLEX: NA

23. The Moro (startle) reflex, which is present at birth, disappears normally at the age of: a. 3 months. b. 4 months. c. 5 months. d. 6 months.

ANS: A

The Moro (startle) reflex disappears 1 to 3 months after birth.

DIF: Cognitive Level: Comprehension OBJ: NA TOP: Reflexes MSC: NCLEX: NA

REF: p. 90, Table 6-3 KEY: Nursing Process Step: NA

24. Good prenatal nutrition is stressed to an expectant mother because poor nutrition could increase the baby’s risk of in later life. a. diabetes b. kidney failure c. respiratory disorders

d. coronary artery disease ANS: D

Inadequate prenatal nutrition can alter the structure of the baby’s body and lead to coronary artery disease or stroke.

DIF: Cognitive Level: Application REF: p. 79 OBJ: 7 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

25. The prenatal intervention that would be most helpful to a prospective father about his new role would be to: a. explain the physiological and psychological changes he can expect in the mother. b. demonstrate diapering and bathing techniques. c. let him verbalize his feelings about the pregnancy and fatherhood. d. encourage him to think about his role in the pregnancy.

ANS: C

Future changes in sleep patterns, household responsibility, and financial concerns are stressful to the father and may need to be verbalized.

DIF: Cognitive Level: Application REF: p. 86 TOP: Paternal adaptations during the prenatal phase KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 9

26. The single most important influence on appropriate growth and disease prevention at all stages of development is: a. nutrition. b. heredity. c. culture. d. environment.

ANS: A

Lack of proper nutrition during critical periods of fetal development can cause maldevelopment or malfunction of a specific organ or system that may not be manifested until adulthood. One of the goals of Health People 2020 is to prevent disease in the next generation by improving the nutrition of mothers and babies.

DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 7 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. The most effective time for interaction between parents and the new baby is when the baby is in the state of: a. active alert. b. crying. c. drowsiness. d. quiet alert.

ANS: D

During the quiet alert state, the infant responds to the environment by staring at close-range objects and people. This is a good time for visual contact and conversation by the sibling.

DIF: Cognitive Level: Comprehension REF: p. 88 OBJ: 10 TOP: Developmental tasks and responses KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

28. A woman delivered a baby 1 hour ago. The nurse is ready to assist her with breastfeeding.

The woman states she cannot breastfeed until her “good” milk comes in. She says she is afraid the “thin” milk will harm the baby. The nurse’s best response is: a. “You should begin breastfeeding now or your milk will never come in.” b. “I understand that you believe this colostrum is unhealthy for the baby. Let’s talk about feeding alternatives until your milk comes in.” c. “If you don’t provide your baby with the benefits of colostrum, he will have more childhood illnesses than normal.” d. “Your baby will not learn to suck correctly if you don’t start breastfeeding now.”

ANS: B

In the provision of culturally competent care, the nurse needs to understand and respect the beliefs and practices of the families in his or her care.

DIF: Cognitive Level: Application REF: p. 88 OBJ: 7 TOP: Culturally competent care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

29. After the delivery of the newborn, the major focus for its well-being is to: a. initiate hydration. b. provide nutrition. c. prevent heat loss. d. stimulate bonding.

ANS: C

After delivery, the newborn is dried, placed in a prewarmed bed, and the head is covered to minimize heat loss.

DIF: Cognitive Level: Application REF: p. 83 TOP: Heat loss KEY: Nursing Process Step: NA

OBJ: NA MSC: NCLEX: NA

30. After delivery, the new father is staring intently at his newborn and lightly running his fingertips over the baby’s face. The father is beginning: a. parenting. b. engrossment. c. development. d. identification.

ANS: B

Fathers or significant others develop an intense focus on the newborn, called engrossment.

Characteristics of engrossment include touch and eye-to-eye contact as the father seeks to identify features both unique to the newborn and similar to himself. An outstanding response is one of strong attachment to the infant and a sense of increased self-esteem.

DIF: Cognitive Level: Knowledge REF: p. 85 OBJ: 8 TOP: Fathers or significant others KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

31. A Chinese woman rejects the plan for her to bring the newborn to the health clinic before the seventh day of life to repeat the test for phenylketonuria (PKU) stating that it is too early for her to come. The culturally competent health-care worker would ask: a. “Do you lack transportation to the clinic?” b. “Isn’t your baby’s health important enough to come to the clinic?” c. “Do you realize that the state requires this test to be done?” d. “Do you need more time to heal after your delivery?”

ANS: D

To provide culturally competent care, the health-care worker must understand that in some cultures the postpartum period may last 30 days or longer, with the woman forbidden from leaving the home.

DIF: Cognitive Level: Analysis REF: p. 88 OBJ: 9 TOP: Culturally competent care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation MULTIPLE RESPONSE

32. Methods of holding a neonate that are comforting and consoling to the baby and reinforce bonding include: (Select all that apply.) a. holding baby upright on parent’s knee. b. placing the nude baby on the naked chest of the parent. c. swaddling the baby. d. cuddling the baby. e. the football hold supporting baby with one arm.

ANS: B, C, D

Close, warm positions quiet and soothe a baby and encourage bonding.

DIF: Cognitive Level: Comprehension REF: p. 89 OBJ: 10 TOP: Comfort and bonding KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

33. In speaking with a group of parents, the health-care worker informs them that in the case of a premature delivery, the fetus of 25 weeks gestation has many attributes that would help support extrauterine life. These include: (Select all that apply.) a. surfactant in the lungs. b. respiratory movements. c. a functioning central nervous system (CNS). d. smooth skin. e. subcutaneous fat.

ANS: A, B

The 2-week-old fetus is viable and has surfactant in the lungs and has begun respiratory movements, but the CNS is not fully functional. There is no subcutaneous fat; therefore, the skin is wrinkled.

DIF: Cognitive Level: Analysis REF: p. 76, Table 6-1 OBJ: 3 TOP: Viability KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

34. A complete set of DNA contained in all human cells is referred to as a(n)

.

ANS:

genome A genome is a complete set of DNA that is contained in all cells.

DIF: Cognitive Level: Comprehension REF: p. 73 TOP: Genome KEY: Nursing Process Step: NA

35. A gene to replace it.

OBJ: 1 MSC: NCLEX: NA

can now be programmed to destroy a defective gene, allowing a pure

ANS:

suicide gene Suicide genes are therapeutic genes that destroy defective genes allowing for a pure gene to replace it.

DIF: Cognitive Level: Comprehension REF: p. 74 TOP: Suicide gene KEY: Nursing Process Step: NA

OBJ: 1 MSC: NCLEX: NA

Chapter 7: The Infant Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The 5-month-old should demonstrate: a. hand-to-mouth coordination. b. neat pincer grasp. c. building a tower of two cubes. d. ability to grasp an object voluntarily.

ANS: D

By 5 months, newborn reflexes have disappeared and the infant is able to shape the hand to voluntarily grasp an object.

DIF: Cognitive Level: Knowledge REF: p. 102, Table 7-2 OBJ: 4 TOP: Motor development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. According to Erikson, infancy is concerned with acquiring a sense of: a. trust. b. industry. c. initiative. d. autonomy.

ANS: A

Trust develops when infants learn their basic needs will be met, providing the foundation for all succeeding phases of development. Trust assists infants in experiencing unknown or unfamiliar situations with minimal fear.

DIF: Cognitive Level: Knowledge REF: p. 96 OBJ: 7 TOP: Trust versus mistrust KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. Object permanence is: a. recognizing a familiar face, such as mother. b. recognizing a familiar object, such as bottle. c. actively searching for a hidden object. d. securing objects by pulling on a string.

ANS: C

By 9-10 months, infants have achieved the concept of object permanence, or the realization that objects that leave the visual field can still exist.

DIF: Cognitive Level: Comprehension REF: p. 96 OBJ: 2 TOP: Object performance KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. A parent of an 8-month-old infant says that the baby cries and screams whenever she is left with her grandparents. The reply should be based on the fact that the:

a. b. c. d.

infant is most likely spoiled. infant is experiencing separation anxiety. infant should be left with another caretaker. grandparents’ home may be a frightening environment.

ANS: B

At around 6 months of age, the infant begins to have an awareness of self and parent as separate beings. This, coupled with the development of object permanence, causes the infant to become distressed at the absence of the parent.

DIF: Cognitive Level: Application REF: p. 98 OBJ: 7 TOP: Separation anxiety KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries. The most informative response would be: a. “Allow him to cry for no longer than 15 minutes, then pick him up.” b. “Babies need comforting and cuddling. Meeting these needs will not spoil him.” c. “Babies this young cry when they are hungry. Try feeding him when he cries.” d. “If he isn’t soiled or wet, leave him and he’ll cry himself to sleep.”

ANS: B

Prompt attention to an infant’s crying promotes attachment and development of trust.

DIF: Cognitive Level: Application REF: p. 97 OBJ: 9 TOP: Attachment KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. The parents of a 6-month-old infant say that they are worried about their baby’s thumb-sucking. The reply that is most informative would be: a. “A pacifier should be substituted for the thumb.” b. “Nonnutritive sucking may indicate unsatisfied hunger.” c. “Sucking should be interrupted by diverting the baby’s attention.” d. “Nonnutritive sucking during infancy is normal.”

ANS: D

Nonnutritive sucking in infancy is of benefit by providing a self-regulating source of comfort.

DIF: Cognitive Level: Application REF: p. 106 OBJ: 3 TOP: Sucking KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. The health-care worker instructs the parents of an infant that they can expect the first tooth eruption at the age of: a. 2 months. b. 6 months. c. 8 months. d. 10 months.

ANS: B

Normal tooth eruption occurs between 5 to 7 months with the appearance of the central incisors.

DIF: Cognitive Level: Comprehension REF: p. 108 OBJ: 2 TOP: Tooth eruption KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. The parent of a 12-month-old says, “He pushes the spoon right out of my hand and screams when I feed him. I can’t let him feed himself, he makes too much of a mess.” The best response is: a. “It’s important not to give in to this kind of temper tantrum at this age.” b. “Maybe you need to try a different type of spoon, one designed for children.” c. “He is old enough to try to feed himself. Let’s think of ways to limit the mess.” d. “You should continue to feed him. Self-feeding may interfere with adequate nutrition.”

ANS: C

Self-feeding is a developmental task that is part of the first year of life and the infant’s growing need for independence.

DIF: Cognitive Level: Application REF: p. 96 OBJ: 2 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. A 4-month-old infant is brought to the clinic by her parents for a well-baby checkup.

Because 4-month-old infants are developing very fast, the health-care worker reminds parents that they can help prevent an accident by: a. using a tray on highchair as restraint rather than the restraining strap. b. placing adjustable gates at the head of the stairs. c. placing the child on the stomach to sleep at night or at nap time. d. supporting child firmly during bath time.

ANS: D

Good support and never leaving child unattended at the bath time can prevent an accident.

Straps should be used as restraints in highchairs. Gates are not yet needed for a 4-monthold.

DIF: Cognitive Level: Application REF: p. 109 OBJ: 12 TOP: Accident prevention KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. Regarding the introduction of solid foods during infancy, the nurse would advise: a. solid foods should not be introduced until 8 to 10 months of age when the extrusion reflex begins to disappear. b. foods should be introduced one at a time, at intervals of 4 to 7 days. c. solid foods should be mixed in a bottle to make the transition easier for the infant. d. fruits and vegetables should be introduced into the diet first.

ANS: B

Solid foods are introduced one at a time to help parents identify a food allergy response.

DIF: Cognitive Level: Application REF: p. 107 OBJ: 9 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. The health-care worker ensures doting parents that they will hear the first meaningful words from their infant when the baby is about months old. a. 6 b. 8 c. 10 d. 12 ANS: C

Although infants vocalize as early as 5 to 6 weeks, it is not until they are about 10 months old that cognitive and motor development enables them to use meaningful words.

DIF: Cognitive Level: Comprehension REF: p. 100 OBJ: 6 TOP: Language development KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. The parents of a 6-month-old infant say, “She cries sometimes after we have put her down after we have played with her. We know she is dry and has recently been fed.” The most appropriate intervention is to suggest that the baby: a. is learning elementary language skills. b. may still be hungry. c. is uncomfortable. d. still wants parental stimulation.

ANS: D

If the adult turns away before the infant is ready, the infant will lean forward and attempt to get the adult’s attention with sound and movement and will eventually cry with frustration.

DIF: Cognitive Level: Application TOP: Language development MSC: NCLEX: NA

REF: p. 97 OBJ: 5 KEY: Nursing Process Step: Implementation

13. Even infants can develop coping skills, which allow the infant to: a. enhance speech development. b. manage a stressful situation. c. manipulate his environment. d. increase parental bonding.

ANS: B

Infants are capable of dealing with a stressful situation by developing a coping skill. They may climb out of an infant seat to reach a toy or move self around in the crib to see into another room.

DIF: Cognitive Level: Application REF: p. 95 OBJ: 2 TOP: Development of coping skills KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

14. The parents of a 3-month-old complain that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. The best suggestion would be to: a. put her in parents’ bed to cuddle. b. give the baby a pacifier while the child is in a semi-awake state. c. let her cry herself back to sleep.

d. give her a bottle of formula instead of breastfeeding her so often at night.

ANS: B

Giving a pacifier in the semi-awake state often will help the baby return to sleep and begin to develop self-regulatory habits.

DIF: Cognitive Level: Application REF: p. 105 OBJ: 2 TOP: Sleep patterns KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. A mother is concerned that her 12-month-old is “getting fat.” She plans to switch the infant from formula to 2% low-fat milk. Based on knowledge of infant nutrition, the best response should be: a. “That’s an excellent idea. Preventing childhood obesity is a goal of Healthy People 2020.” b. “You should give your child low-calorie juices instead of milk to prevent excessive weight gain.” c. “Formula is necessary for 2 full years to ensure proper growth.” d. “Your child needs whole milk instead of low-fat milk to promote proper growth and development.”

ANS: D

Fats are necessary in children under age 2 to promote development of the nervous system.

DIF: Cognitive Level: Comprehension REF: p. 107 OBJ: 10 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. When the parents of a 6-month-old say that they see no reason to spend money for a car seat because the baby is happier sitting in someone’s lap. The best response is: a. “As long as the baby is being held securely by an adult there is no need for a car seat.” b. “The air bag will protect both adult and baby in the event of an accident.” c. “A rear-facing car seat placed in the back seat is the safest place for your baby.” d. “A front-facing car seat placed next to the driver should keep your baby safe and happy.”

ANS: C

A rear-facing car seat provides the best protection for the infant’s head and neck. The back seat is preferable to help protect the infant from being ejected from the car and from injury from a front seat air bag.

DIF: Cognitive Level: Comprehension REF: p. 109 OBJ: 12 TOP: Car seats KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. The usual initial age at which infants begin to demonstrate meaningful social smiles in response to parental interaction is at: a. 2 months. b. 3 months. c. 5 months. d. 6 months.

ANS: A

Positive infant responses to parents’ interaction efforts strengthen parent–infant attachment and usually are seen at the age of 2 months.

DIF: Cognitive Level: Comprehension REF: p. 96 OBJ: 8 TOP: Attachment KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. An appropriate play activity to encourage sensorimotor stimulation in a 7-month-old would be: a. reading a story. b. playing peek-a-boo. c. showing how to clap hands. d. imitating animal sounds.

ANS: B

By 6 months to 1 year, play involves sensorimotor skills as described by Piaget. Infants need to be played with. A game of peek-a-boo provides visual stimulation and interaction with the parent.

DIF: Cognitive Level: Comprehension REF: p. 96 OBJ: 6 TOP: Sensorimotor stimulating play KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. To support the development of language skills in their child, the parents should: a. talk to the infant in their native language. b. introduce common slang words. c. employ “baby talk” to get the infant’s attention. d. speak loudly.

ANS: A

Parents should talk to the infant in the native language. Use of slang or baby talk may confuse or delay language development. Loud speech is not necessary to the development of language.

DIF: Cognitive Level: Application REF: p. 106 OBJ: 6 TOP: Language development KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. If parents are concerned about the fact that their 14-month-old infant is not walking, the health-care worker should particularly evaluate whether the infant: a. pulls up on the furniture. b. uses a pincer grasp. c. transfers objects. d. has developed object permanence.

ANS: A

Infants generally start to walk about 4 to 5 months after they are able to pull themselves up to a standing position.

DIF: Cognitive Level: Application REF: p. 109, Table 7-2 OBJ: 4 TOP: Motor development KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: growth and development

21. According to Freud’s theory of development, the best toy for an infant would be a: a. colorful mobile. b. rattle. c. teething ring. d. baby swing.

ANS: C

A teething ring satisfies the need to examine the world through the mouth, which is a characteristic of Freud’s oral stage.

DIF: Cognitive Level: Comprehension REF: p. 106 OBJ: 7 TOP: Oral stage KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

22. The information that should be given to the parents of a 12-month-old regarding appropriate play activities would include which of the following? a. Provide a stick horse to develop gross motor coordination. b. Give large push-pull toys for kinetic stimulation. c. Place cradle gym across the crib to facilitate fine motor skills. d. Provide finger paints to enhance fine motor skills.

ANS: B

Push-pull toys foster newly mastered walking skills.

DIF: Cognitive Level: Application REF: p. 106 OBJ: 4 TOP: Role of play KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

23. A child who weighed 6 pounds at birth will weigh approximately 12 months. a. 15 b. 18 c. 21 d. 24

pounds at the age of

ANS: B

Growth is an increase in size, measured by pounds and inches. By 1 year, birth weight is generally tripled.

DIF: Cognitive Level: Knowledge REF: p. 95 OBJ: 3 TOP: Growth KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

24. A 2-month-old uses the preverbal speech technique of: a. nonnutritive sucking. b. grunting. c. pointing. d. smiling.

ANS: D

Crying and smiling are the preverbal options for a 2-month-old.

DIF: Cognitive Level: Application REF: p. 100 OBJ: 6 TOP: Preverbal speech KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

25. A hospitalized 11-month-old is crying and clinging to the parents as they attempt to leave the room at the termination of visiting hours. An appropriate intervention would be to: a. encourage the parents to leave right away to minimize the child’s distress. b. provide privacy until the infant has calmed down. c. arrange for a parent to room in with the infant. d. distract the infant with toys so the parents can leave unnoticed.

ANS: C

Because hospitalization is a unique experience of separation filled with strangers, pain, and fear of the unknown, it is strongly recommended that a parent room in with the child.

DIF: Cognitive Level: Application REF: p. 98 OBJ: 7 TOP: Attachment KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

26. At what age would the health-care worker expect an infant to be able to say “mama” and “dada” with meaning? a. 4-5 months b. 5-6 months c. 9-10 months d. 12-14 months ANS: C

By 7 or 8 months, syllables using the M and D sounds appear, and by 9 to 10 months, specific meaningful sounds are used to refer to objects or events.

DIF: Cognitive Level: Comprehension REF: p. 100 OBJ: 6 TOP: Language development KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. Interactive physical activity between parents and their baby should be focused on: a. exploring developmental movement and the environment. b. ensuring that activity times do not interfere with sleep or nutrition. c. exposure to outdoors. d. interaction with other infants.

ANS: A

Interactive physical activity with an infant should be focused on exploring movement and the environment.

DIF: Cognitive Level: Application REF: p. 106, Box 7-1 OBJ: 5 TOP: Physical activity KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

28. What is a possible indication of child abuse on an 11-month-old?

a. b. c. d.

Excessive drooling Cooing and reaching for the parent Hyperactivity during physical assessment Bruises in various stages of healing

ANS: D

The appearance of bruises in various stages of healing should alert a caregiver to possible child abuse.

DIF: Cognitive Level: Application REF: p. 100, Figure 7-1 OBJ: 12 TOP: Child abuse KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

29. Which age-appropriate toy(s) for a 3-month-old infant should be recommended? (Select all that apply.) a. Crib mobile b. Squeeze toys c. Teething toys d. Soft or furry quilt e. Stuffed animals f. Strings of big beads ANS: A, D, E

These toys assist the 3-month-old in the development of visual and tactile senses, as well as in the beginning of fine motor development.

DIF: Cognitive Level: Application REF: p. 106 OBJ: 2 TOP: Role of play in growth and development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

30. The parents of a 2-month-old bring their infant to the well-child clinic for a checkup and immunizations. Based on knowledge of immunization schedules, the health-care worker instructs the parents that the infant should receive which vaccine(s)? (Select all that apply.) a. Polio b. HepB c. MMR d. Varicella e. DTaP f. Tetanus ANS: A, B, E

At 2 months, the recommended immunizations for infants are HepB, DTaP, and IPV. Although many of the immunizations can be given at any age, the recommended primary schedule begins in infancy and is completed during early childhood. This practice has contributed to the decline of preventable infectious diseases.

DIF: Cognitive Level: Application TOP: Immunizations

REF: Appendix A OBJ: 10 KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

31. To assist parents in understanding normal growth and development during various stages of infancy, the health-care worker must understand age-appropriate motor development. Which gross and fine motor skill(s) would be appropriate for a 9-month-old? (Select all that apply.) a. Walks with one hand held b. Uses thumb and forefinger in crude pincer grasp c. Can turn pages in a book d. Can sit down from standing position without help e. Creeps on hands and knees f. Sits steadily on floor for prolonged time ANS: B, E, F

A 9-month-old has a crude pincer grasp, creeps, and can sit alone.

DIF: Cognitive Level: Comprehension REF: p. 103, Table 7-2 OBJ: 4 TOP: Motor development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

32. Although the child protests when the parent leaves the room, the child will develop when the parent consistently returns.

ANS:

trust Children learn that their parents return after a separation. This learning builds the developmental task of trust.

DIF: Cognitive Level: Comprehension REF: p. 98 OBJ: 2 TOP: Trust KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 8: Early Childhood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. A 2-year-old should be able to: a. ride a tricycle. b. climb stairs reciprocally. c. run. d. hop on two feet.

ANS: C

The 2-year-old is able to run, but cannot climb stairs reciprocally, hop, or ride a tricycle.

DIF: Cognitive Level: Comprehension REF: p. 112 OBJ: 2 TOP: Developmental tasks KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. Erik Erikson describes the major developmental task of the toddler to be: a. trust. b. initiative. c. autonomy. d. intimacy.

ANS: C

According to Erikson, the toddler, between 2 and 4 years of age, is in the stage of autonomy versus shame or doubt.

DIF: Cognitive Level: Comprehension REF: p. 111 TOP: Erikson’s developmental tasks of early childhood MSC: NCLEX: NA

OBJ: 4 KEY: Nursing Process Step: NA

3. A parent of a 24-month-old boy say that the child has frequent tantrums and that “no” is becoming his favorite word. This behavior: a. is a response to frustration in gaining autonomy. b. is an indication of regression. c. is a signal that he is not effectively coping with stress. d. shows that he needs more attention.

ANS: A

Negativism is typical of toddlers in their quest for autonomy. As toddlers attempt to express their will, they may become angry in their frustration. This frustration then leads to a desire to be loved and comforted by a parent.

DIF: Cognitive Level: Application REF: p. 116 OBJ: 4 TOP: Developmental tasks of early childhood KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. According to Piaget, magical thinking is the belief that: a. events have cause and effect.

b. God is like an imaginary friend. c. if the skin is broken, the insides will come out. d. dolls are real people.

ANS: D

Because of their egocentrism, preschoolers believe that inanimate objects have real life qualities.

DIF: Cognitive Level: Comprehension TOP: Cognitive development MSC: NCLEX: NA

REF: p. 115 OBJ: 3 KEY: Nursing Process Step: NA

5. Most children use sentences of five words by the age of a. 2 b. 3 c. 4 d. 5

years.

ANS: D

In a preschool child, the number of words in a typical sentence is about equal to the child’s age.

DIF: Cognitive Level: Comprehension REF: p. 115 OBJ: 4 TOP: Language development and communication skills KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. When preparing parents to teach their children about sexuality, the health-care worker should emphasize that they should: a. treat bodily functions as secret. b. expect some masturbatory behavior. c. correct all behavior that involves nudity. d. limit parental displays of hugging or kissing.

ANS: B

Children in early childhood engage in normal masturbatory behavior. Young children enjoy nudity.

DIF: Cognitive Level: Comprehension REF: p. 120 OBJ: 3 TOP: Sexuality in early childhood KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. Although a 14-month-old girl received a shock from an electrical outlet recently, her mother finds her about to place a paper clip in another outlet. The repeated behavior is due to: a. cognitive development is delayed. b. memory deficit. c. inability to understand cause and effect. d. desire for attention.

ANS: C

Reasoning skills are still quite underdeveloped and children at this age do not understand cause and effect.

DIF: Cognitive Level: Application REF: p. 125, Table 8-5 OBJ: 2 TOP: Cognitive development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. When a toddler snatches a toy from another toddler, this behavior is: a. representative of the aggressive nature of toddlers. b. typical behavior because toddlers are egocentric. c. a primitive attempt at sharing. d. a deliberate behavior the toddler knows to be wrong.

ANS: B

Toddlers see, experience, and live every event in relation to themselves. They are unable to envision situations from perspectives other than their own. They feel their point of view is the same as everyone else’s.

DIF: Cognitive Level: Application REF: p. 115 OBJ: 2 TOP: Cognitive development KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. When a 3-year-old spills his milk at the dinner table, he can be expected to: a. clean the spill up immediately. b. cry because he expects punishment. c. play in the spilled milk. d. blame his sibling for the accident.

ANS: D

Children of the age of 3 can differentiate an accident from an intentional act but are quick to assign blame.

DIF: Cognitive Level: Application TOP: Moral development MSC: NCLEX: NA

REF: p. 118 OBJ: 3 KEY: Nursing Process Step: NA

10. The Portion Plate for Kids placemat can be used as an aid to nutrition because it: a. introduces a variety of foods. b. acts as a guide for food intake. c. is colorful and teaches basic food groups. d. likens portion sizes to a baseball.

ANS: B

The Portion Plate for Kids placemat serves as a guide for portion amounts and is an aid to prevent “supersizing.” Portion amounts are likened to the size of a tennis ball.

DIF: Cognitive Level: Knowledge REF: p. 114, Figure 8-2 OBJ: NA TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. According to Kohlberg, the moral task of childhood is learning to: a. take responsibility. b. share with others.

c. cooperate with others. d. recognize religion.

ANS: B

According to Kohlberg, the moral task of childhood is learning to share.

DIF: Cognitive Level: Comprehension TOP: Moral development MSC: NCLEX: NA

REF: p. 116 OBJ: 4 KEY: Nursing Process Step: NA

12. When a toddler acquires receptive language skills, the child is able to: a. understand abstract information. b. understand simple messages. c. converse at length. d. respond with appropriate language.

ANS: B

The mastery of receptive language allows the toddler to understand simple messages but not abstractions. Appropriate response and lengthy conversations would indicate mastery of expressive language.

DIF: Cognitive Level: Analysis REF: p. 111 OBJ: 4 TOP: Receptive language KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

13. In the clinic waiting room, a parent is showing an 18-month-old how to build a tower out of blocks. Toddlers: a. use blocks at this age primarily for throwing. b. are too young to imitate the behavior of others. c. are capable of building a tower of blocks. d. are unable to concentrate long enough to build a tower.

ANS: C

During toddlerhood, imitation is one of the most distinguishing characteristics of play. By this age, toddlers have a well-developed reach, grasp, and release and are able to build a tower of three to four blocks.

DIF: Cognitive Level: Application REF: p. 121 OBJ: 2 TOP: Play KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. In the instruction about considerations relative to the use of car seats, the health-care worker lists that before a child should be allowed to sit in the front seat of a car, the child should be at least years of age. a. 8 b. 10 c. 12 d. 13 ANS: D

The American Academy of Pediatrics (AAP) recommends that children under the age of 13 should not ride in the front seat of a vehicle.

DIF: Cognitive Level: Knowledge REF: p. 124 OBJ: 9 TOP: Day care KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk

15. A “time-out” for unacceptable behavior may be effective discipline for children between 1 and 6 years of age if the time-out period is no more than minute(s) per year of child’s age. a. 1 b. 2 c. 3 d. 4 ANS: A

Time-outs of 1 minute per each year of the child’s age place a child in a safe place with time to regain self-control. Short lengths of time are more appropriate than longer periods of time because of the short attention spans of children in this age-group.

DIF: Cognitive Level: Comprehension REF: p. 119 TOP: Discipline KEY: Nursing Process Step: NA

OBJ: 10 MSC: NCLEX: NA

16. A 5-year-old boy has been having increasingly more frequent angry outbursts in preschool.

For the past 8 to 10 weeks, he had seven episodes of aggressiveness toward the other children and the teachers. The best advice would be to: a. encourage the parent to try more consistent and firm discipline. b. explain that this is normal in preschoolers, especially boys. c. take the child for a professional psychosocial assessment. d. deprive him of some special treat each time he is aggressive at school.

ANS: C

By age 4, impulse control is usually achieved with minor relapses in times of stress.

Generally, the difference between “normal” and “problematic” behavior is not the behavior itself but the number of occurrences, severity, onset (especially a sudden change in behavior), and duration (at least 4 weeks).

DIF: Cognitive Level: Application REF: p. 116 OBJ: 3 TOP: Cognitive development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. An example of parallel play is a toddler: a. sitting by himself playing with blocks. b. sharing a box of crayons with another toddler as they color in the same book. c. sitting with another toddler playing with toys without interaction. d. sitting in a circle of other toddlers passing a ball from one to another.

ANS: C DIF: Cognitive Level: Comprehension REF: p. 121 OBJ: 8 TOP: Parallel play KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. Dental evaluations should start at the age of a. 12 b. 18

months.

c. 24 d. 30 ANS: A

The American Academy of Pediatric Dentistry (AAPD) recommends that children aged 1 year be introduced to the dentist.

DIF: Cognitive Level: Knowledge REF: p. 123 OBJ: NA TOP: Dental care KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

19. Toilet training is dependent on: a. developing sphincter control. b. child’s desire to stay dry. c. being rewarded for using the toilet. d. children using the family toilet when first learning.

ANS: A

Toilet training occurs as sphincter control develops and the child masters some form of communication to indicate the need to use the toilet. The process cannot be hurried and may not be complete before 3 years of age. Using the family toilet may be frightening, as child may feel like he will fall in or be flushed away.

DIF: Cognitive Level: Application REF: p. 113 OBJ: 4 TOP: Toilet training KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. During the preschool period, the emphasis of injury prevention should be placed on: a. constant vigilance and protection. b. punishment for unsafe behaviors. c. education for safety and potential hazards. d. limitation of physical activities.

ANS: C

Children as young as 3 years can be taught safety measures regarding potential hazards.

Accident prevention techniques should be discussed with parents.

DIF: Cognitive Level: Comprehension TOP: Safety and accident prevention MSC: NCLEX: NA

REF: p. 123 OBJ: 9 KEY: Nursing Process Step: NA

21. The toddler is vulnerable to ear infections because: a. respirations are abdominal. b. pulse and respiratory rates are slower than in infancy. c. defense mechanisms are less efficient than during infancy. d. there is a short, straight internal ear canal leading to the oropharynx.

ANS: D

The internal structures of the ear and throat are short and straight, and lymphoid tissue of the tonsils and adenoids continues to be large. As a result, ear, throat, and upper respiratory infections are common.

DIF: Cognitive Level: Comprehension REF: p. 113 OBJ: 2 TOP: Ear infections KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

22. The preschool child learns socially acceptable behavior through the use of: a. punishment. b. positive reinforcement. c. restricting privileges. d. comparing child to role model.

ANS: B

Rewarding good behavior is the positive and most effective technique of discipline as well as consistency in parental response.

DIF: Cognitive Level: Application REF: p. 119, Table 8-3 OBJ: 10 TOP: Discipline KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

23. Age-appropriate literacy skills for a 24-month-old include the child taking a book and: a. holding it. b. looking at pictures. c. carrying it around the house. d. pointing at pictures with one finger.

ANS: C

The 24-month-old should carry the book around the house and turn one page at a time.

DIF: Cognitive Level: Application REF: p. 116, Table 8-1 OBJ: 2 TOP: Literacy milestone KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

24. A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate the need for more instruction regarding child safety? a. “We locked all the medicines in the bathroom cabinet.” b. “We turned the thermostat down on our hot water heater.” c. “We placed gates at the top and bottom of our stairs.” d. “We’re using the car seat belt instead of the car seat now that the baby is older.”

ANS: D

Children should use specially designed car restraints until they weigh at least 60 pounds or are 8 years old.

DIF: Cognitive Level: Application REF: p. 124, Figure 8-8 OBJ: 9 TOP: Safety and accident prevention KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe Effective Care Environment: safety and infection control

25. The parents of a 30-month-old say that their daughter is not talking in short sentences. The most appropriate response is: a. “Let’s make an appointment with your pediatrician for an evaluation.” b. “Children of that age are too young to use short sentences.”

c. “You don’t need to worry until your child is at least 48 months old.” d. “Your child should have started talking in short sentences by 18 months old.”

ANS: A

Language milestones can be used to assess a child’s development. By 30 months, a child should be talking in short sentences.

DIF: Cognitive Level: Application REF: p. 116, Table 8-1 OBJ: 2 TOP: Language development and communication skills KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

26. Complete myelinization of the brain does not occur until the age of: a. 5 years. b. 7 years. c. 10 years. d. 12 years.

ANS: B

Compete myelinization of the brain does not occur until the age of 7 years.

DIF: Cognitive Level: Knowledge REF: p. 112 OBJ: 3 TOP: Myelinization of the brain KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

27.

The child is involved in fantasy play when the child: a. puts a string on a toy dog and takes it for a walk. b. looks at the pictures in a book over and over. c. uses the sandbox as a sailboat. d. colors the picture of an apple purple.

ANS: C

Fantasy play is seen in early childhood as one object becomes another.

DIF: Cognitive Level: Application REF: p. 116 OBJ: 8 TOP: Fantasy play KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

28. Children learn to cope by: a. imitating others. b. experiencing new situations. c. asking for help. d. following parental direction.

ANS: B

Through experience, toddlers and preschoolers learn how to problem-solve, which provides them with a sense of mastery over their own lives and reinforces the fact that they have the ability to handle whatever comes their way. If parents solve all of their problems, this mastery will not be learned and may leave them with feelings of insecurity and stress at their inability to cope.

DIF: Cognitive Level: Comprehension TOP: Cognitive development

REF: p. 116 OBJ: 4 KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: growth and development

29. To prepare a preschooler for better human interaction, the parents should help the child learn to: a. be autonomous. b. express feelings verbally rather than acting out. c. avoid conflict. d. rely on others.

ANS: B

Helping a child to learn to express his feelings rather than acting out is important for success in school and later life.

DIF: Cognitive Level: Analysis REF: p. 123 OBJ: 4 TOP: Developmental tasks KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

30. The activity that is most appropriate for a hospitalized 5-year-old who is allowed to go to the playroom is: a. joining a group of boys and girls who are playing house. b. looking at a coin collection that belongs to an 8-year-old. c. playing alone with a racing car. d. building a block tower next to another child who is also playing with blocks.

ANS: A

Children in the preschool years engage most often in creative or dramatic play with others.

DIF: Cognitive Level: Application REF: p. 116 OBJ: 7 TOP: Play KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

31. The home health-care worker would assess the indication of sexual abuse in a preschool child if assessments were made of the child’s: (Select all that apply.) a. positioning dolls in sexual positions. b. excessive sexual curiosity. c. removing clothes to play nude. d. playing “doctor.” e. drawing genitals on dolls.

ANS: A, B, E

Recreating sexual positions with dolls or in play, demonstrating excessive sexual curiosity, and drawing genitals on dolls or other images suggest sexual abuse.

DIF: Cognitive Level: Application REF: p. 120, Table 8-4 OBJ: 4 TOP: Sexual abuse KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

32. The health-care worker guiding parents in selecting a day care facility for their child would emphasize the importance of: (Select all that apply.)

a. b. c. d. e.

licensure. location. student-to-staff ratio. discipline techniques. staff education.

ANS: A, C, D, E

Characteristics of a day care center are important to ensure well-being and continued support of growth and development.

DIF: Cognitive Level: Comprehension REF: p. 122 OBJ: 6 TOP: Day care centers KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

33. Preschool children need a minimum of

minutes a day of age-appropriate active play.

ANS:

60 Children should be physically active for a minimum of 60 minutes a day in age-appropriate activities such as running, jumping, and climbing.

DIF: Cognitive Level: Comprehension REF: p. 121 OBJ: 7 TOP: Play KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 9: Middle Childhood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. In middle childhood, the child’s developing cognition is more focused on: a. fantasy. b. fun. c. family. d. fact.

ANS: D

During the middle childhood years (6-12 years), the child becomes more focused on fact than fantasy as the cognition develops.

DIF: Cognitive Level: Application REF: p. 131 OBJ: 3 TOP: Changing focus of middle childhood KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. The concerned parent of a 9-year-old confides in the health-care worker that her child will only wear the athletic jersey with the number of his favorite professional quarterback and insists on being called by the quarterback’s name rather than his own. The health-care worker bases her response on Erikson’s theory that 9-year-olds: a. should have given up such fantasy play. b. enjoy such dress-up play. c. fashion their behavior after role models. d. need to find their own identity.

ANS: C

Erikson refers to school age as the stage of industry, when the child has a thirst for knowledge, a desire to master skills, and the wish to emulate role models or “heroes.”

DIF: Cognitive Level: Comprehension REF: p. 141 OBJ: 5 TOP: Role models KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. The question or statement made by a parent of an 11-year-old that indicates a need for better understanding of middle childhood development is: a. “What kind of birds will want to live in your bright red birdhouse?” b. “Where do you propose to put this little birdhouse you made?” c. “This bird house needs to be put in a safe place.” d. “Let me help you to repaint the little birdhouse white so birds will come to it.”

ANS: D

The goal of the sense of industry, or stage of accomplishment, is to achieve a sense of personal and interpersonal competence through acquisition of technological and social skills.

Failure to develop this sense of accomplishment results in feelings of inferiority, which may come from the children themselves or from the social environment.

DIF:

Cognitive Level: Analysis

REF: p. 141

OBJ: 4

TOP: Psychosocial development KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. Middle childhood–age children will grow on the average of a. 1 inch b. 1 1/2 inches c. 2 inches d. 2 1/2 inches

per year.

ANS: C

During middle childhood, the average weight gain is 5 to 7 pounds and 2 inches per year.

DIF: Cognitive Level: Knowledge REF: p. 132 OBJ: 2 TOP: Average growth increase KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. The parents of 9-year-old twins say, “They have filled up their bedroom with collections of rocks, shells, dolls, and baseball cards.” This is indicative of: a. giftedness. b. typical “twin” competition. c. concrete cognitive behavior. d. unidentified stress.

ANS: C

School-age children are acquiring classification skills, which involve the ability to group objects according to common attributes. It is characteristic of middle childhood that children derive enjoyment from classifying and ordering their environment.

DIF: Cognitive Level: Application REF: p. 134, Table 9-1 OBJ: 8 TOP: Play KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. Parents planning a birthday party for their 6-year-old son would best plan to invite: a. a large group of children to watch a collection of cartoons. b. a group of boys from his class to play active games. c. an equal number of boys and girls to play competitive board games. d. children of different ages to play competitive games.

ANS: B

Interaction among peers leads to formation of close friendships between same-sex peers. A group of boys playing active games would have the most positive outcome.

DIF: Cognitive Level: Comprehension REF: p. 134, Table 9-1 OBJ: 10 TOP: Peer relationships KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. A group of boys ages 9 and 10 forming a “boys-only” club that is open to neighborhood and school friends who have bicycles is: a. behavior that encourages bullying and sexism. b. behavior that reinforces poor peer relationships. c. characteristic of social development at this age. d. characteristic of children who are at risk for gang membership.

ANS: C

At this age there is a strong preference for same-sex clubs with an exclusiveness in the selection of persons who may belong to the group.

DIF: Cognitive Level: Comprehension REF: p. 134, Table 9-1 OBJ: 10 TOP: Peer relationships KEY: Nursing Process Step: Health Promotion and Maintenance: growth and development MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. A 12-year-old girl is frequently teased about being taller than anyone else in the class. This teasing: a. can damage the girl’s self concept. b. is an indication that the girl is well liked. c. is a positive aspect of a peer relationship. d. is usually ignored by the person being teased.

ANS: A

School-age children have a strong desire not to be considered different. Those children who dress differently, have less spending money than their peers, or who look different are often the target of criticism or ridicule by their peers, leading to threats to self-esteem and self concept.

DIF: Cognitive Level: Comprehension REF: p. 132 OBJ: 4 TOP: Psychosocial development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. The school nurse is to begin teaching sex education to children in the fifth grade. The nurse should plan to: a. use non-anatomical terminology. b. limit depth of questions asked by the students. c. separate class and teach girls and boys separately. d. present sex as a normal part of growth and development.

ANS: D

Sex education is a lifelong process and should be introduced in the context of normal anatomy and physiology. Information should be age-appropriate, culturally relevant, and treat sexuality as a healthy part of life.

DIF: Cognitive Level: Comprehension REF: p. 144 OBJ: 11 TOP: Sexuality KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. Eight-year-olds enjoy play that employs: a. competitive team play. b. solitary play to develop self expression. c. quiet, low-activity games. d. easy ways to win.

ANS: A

Understanding rules for competitive highly active games allows for 8-year-olds to follow rules and develop teamwork as well as answer the developmental need for industry. Stress for high competition and the need to win are not helpful to development.

DIF: Cognitive Level: Application REF: p. 133 OBJ: 8 TOP: Play KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. The behavior that alerts the school nurse to a possible cognitive deficit in a 7-year-old child would be: a. playing only with “best friend.” b. confusing letters b, d, and g. c. boisterous and “know it all.” d. unable to complete complex tasks.

ANS: B

The inability to consistently differentiate the letters b, d, and g may indicate a cognitive problem. Boisterous behavior, preference for the best friend, and inability to complete complex tasks are not unusual in the 7-year-old.

DIF: Cognitive Level: Application REF: p. 141, Table 9-3 OBJ: 3 TOP: Cognitive development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. A 7-year-old is caught taking a playmate’s toy. Which of the following reflects the development of this 7-year-old? a. If punished, this child will not to do it again. b. A child’s sense of property rights is limited until that concept is modeled for him. c. This stealing act indicates that something is seriously lacking in this child’s life. d. The child will learn the importance of respecting the property of others if the parents unexpectedly give away an item of his.

ANS: B

As with other ethically related behaviors, stealing is not an unexpected event in a younger child. Between the ages of 5 and 8 years, children have a limited sense of property rights of others.

DIF: Cognitive Level: Comprehension REF: p. 142 OBJ: 6 TOP: Cognitive development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

13. The parents of an 8-year-old girl say that their daughter wants to join a softball team.

Instruction regarding participation in sports at this age should include which of the following? a. Organized sports, such as softball, are not appropriate at this age. b. Competition is harmful to the establishment of a positive self-image. c. Sports participation is encouraged if the type of sport is appropriate to the child’s abilities. d. Girls should compete only against girls because at this age boys are larger and have more muscle mass.

ANS: C

By age 8, children are able to engage in competitive sports and use coping strategies to deal with team cooperation, conflict, losing, and winning. Participation in organized sports can develop teamwork and physical fitness, but the focus should be on mastery of skills and enjoyment rather than on winning only.

DIF: Cognitive Level: Application REF: p. 133 OBJ: 8 TOP: Play KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. Interventions to promote health during middle childhood should include: a. educating parents on the need for good dental hygiene for the erupting teeth. b. stressing the need for increased caloric intake to meet increased physiological demands. c. instructing parents to limit questions about sex until the child reaches adolescence. d. advising parents to reduce child’s rest and encourage active exercise.

ANS: A

Regular dental checkups should be a part of routine health care to screen for dental problems and have the teeth cleaned. Daily dental care and consumption of healthy snacks should be encouraged.

DIF: Cognitive Level: Comprehension REF: p. 147 OBJ: 13 TOP: Physiological changes KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. Frequent spankings as a discipline technique can: a. be an effective deterrent over the long term. b. establish the parent as an effective authoritarian. c. shock the child into a permanently modified behavior. d. teach violent behavior.

ANS: D

Frequent spankings as a means of discipline is not a long-term deterrent and can cause loss of self-esteem and depression. Spankings do not elevate the parent’s role as an authoritarian but rather as a punisher.

DIF: Cognitive Level: Application REF: p. 148 OBJ: 7 TOP: Corporal punishment KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. When teaching injury prevention during the school-age years, the health-care worker should: a. teach the need to fear and distrust strangers. b. teach basic rules of water safety. c. avoid letting the child cook in a microwave oven. d. caution the child against engaging in competitive sports.

ANS: B

As a rule, school-age children enjoy swimming and water-related activities. Because they are adventuresome and eager to try new things, rules of water safety need to be stressed to prevent accidents.

DIF: Cognitive Level: Application

REF: p. 137, Table 9-1

OBJ: 13 TOP: Health and safety needs of the school-age child KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. An important consideration for the school nurse to stress in a class on bicycle safety would be that: a. most bicycle injuries involve collision with an automobile. b. children should wear a bicycle helmet if they ride on paved streets. c. head injuries are the major causes of bicycle-related fatalities. d. children should not ride double unless the bicycle has an extra-large seat.

ANS: C

Although most bicycle injuries are not automobile-related, most bicycle fatalities are head injuries as a result of an automobile–bicycle collision. The most important aspect of bicycle safety is to encourage the use of protective headgear at all times when riding a bicycle.

DIF: Cognitive Level: Application REF: p. 139, Table 9-1 OBJ: 13 TOP: Health and safety needs of the school-age child KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: reduction of risk

18. The child experiencing middle childhood forms a positive self-esteem from: a. praise from elders. b. refinement of motor skills. c. developing internal sources. d. identifying moral reasoning.

ANS: C

One of the tasks of middle childhood is to develop inner sources that will be the foundation of a positive self-image.

DIF: Cognitive Level: Comprehension REF: p. 131 OBJ: 4 TOP: Developing self-esteem KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. When a 9-year-old boy feels bad about having cheated on a test, the child is exhibiting the moral behavior phase of: a. logic. b. reaction. c. emotion. d. guilt ANS: C

Moral behavior includes three phases: knowledge (knowing what is right), emotion (feeling good or bad about what is right), and action (behaving according to the rule of what is right).

DIF: Cognitive Level: Application REF: p. 142, Box 9-1 OBJ: 6 TOP: Moral behavior KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. The school nurse discussing dental health with some first-grade children would emphasize: a. how to floss teeth properly.

b. use of a toothbrush with hard nylon bristles. c. the importance of brushing before bedtime. d. use of non-fluoridated toothpaste.

ANS: C

Children should be taught to carry out their own dental care under the guidance and supervision of parents after each meal and before bedtime. The majority of children do not possess the fine motor skills needed to brush their teeth properly until approximately second grade. Children under age 10 may need parental assistance to brush back teeth. Because most children do not have the manual dexterity necessary to use dental floss properly until about age 8 or 9, flossing should be done by parents.

DIF: Cognitive Level: Application REF: p. 132 OBJ: 13 TOP: Dental hygiene KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

21. According to Freud, the child is in a period of latency during middle childhood, which is characterized by: a. intense desire for gender specific toys. b. frequent masturbatory activity. c. a return to a more immature behavior pattern. d. identification with the parent of the same sex.

ANS: D

During the latency period, children expand on previously acquired traits and skills.

Identification is with the same-sex parent.

DIF: Cognitive Level: Comprehension REF: p. 144 OBJ: 11 TOP: Sexuality KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

22. A parent says, “I am worried about my 13-year-old son. He hasn’t started puberty, and my daughter did when she was 11 years old.” The health-care worker should explain to this parent that this is: a. unusual and requires further evaluation. b. unusual because the onset of puberty is usually the same in siblings. c. normal because the onset of puberty is usually earlier in girls than in boys. d. abnormal because the onset of puberty is usually earlier in boys than in girls.

ANS: C

Toward the end of middle childhood, the discrepancies in growth and maturation between boys and girls begin to be apparent. On average, there is a difference of approximately 2 years between girls and boys in which observable signs of puberty appear.

DIF: Cognitive Level: Application REF: p. 137, Table 9-1 OBJ: 11 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

23. According to Kohlberg, the development of occurs as cognitive function matures and the school-age child learns to understand rules and to determine if an action is right or wrong. a. cognitive style

b. social cognition c. cultural adjustment d. moral reasoning ANS: D

Moral reasoning is the development of the child’s understanding of what actions would be considered right or wrong.

DIF: Cognitive Level: Analysis TOP: Cognitive development MSC: NCLEX: NA

REF: p. 141 OBJ: 6 KEY: Nursing Process Step: NA

24. The Wechsler Primary Scale of Intelligence has been administered to a group of 7-year-olds.

The parents of one of the children ask why this test is being administered to these children.

The best response is: a. “This test determines a child’s overall intelligence.” b. “This test determines which children should be placed in a gifted program.” c. “This test determines which children should be placed in a remedial program.” d. “This test can be used to predict school ability and future performance.”

ANS: D

Intelligence tests are not designed to determine general intelligence but to help predict school performance and to help identify children who may need additional help or challenges.

DIF: Cognitive Level: Comprehension REF: p. 143 OBJ: 9 TOP: Intelligence tests KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

25. Anticipatory guidance for the family of an 11-year-old girl should include that they should expect their daughter to exhibit: a. decreased modesty. b. desire for privacy. c. disinterest in boys. d. selection of career choice.

ANS: B

The 11-year-old appreciates privacy and may become embarrassed to show her maturing body.

DIF: Cognitive Level: Application REF: p. 144 OBJ: 4 TOP: Desire for privacy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

26. The health-care worker assesses a decrease in egocentrism in a 7-year-old when the child demonstrates: a. less interpersonal cooperation. b. inability to see how his behavior affects others. c. recognition of opinions of others. d. abandonment of the relationship of an imaginary friend.

ANS: C

A reduction in egocentrism allows the child to consider the opinions of others, to become more cooperative, and to see how his behavior affects others.

DIF: Cognitive Level: Application REF: p. 141 OBJ: 2 TOP: Health and safety needs of the school-age child KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. The description of behaviors of the school-age child that is most closely linked to Erikson’s theory is that during this time, school-age children: a. experience relationships with same-sex peers. b. with greater independence can carry tasks through to completion. c. continue to use infantile traits to influence their behavior. d. have an overlapping of developmental characteristics between childhood and adolescence.

ANS: B

According to Erikson, the primary task for school-age children is to achieve a sense of industry. As children progress through middle childhood, they develop the independence and ability to carry through tasks to completion and to work for delayed rewards.

DIF: Cognitive Level: Knowledge TOP: Task of industry MSC: NCLEX: NA

REF: p. 143 OBJ: 5 KEY: Nursing Process Step: NA

28. School-age children are at risk for disturbances in nutrition related to: a. unsatisfied hunger and large appetite. b. loss of deciduous teeth. c. excessive intake of milk. d. tendency to neglect breakfast in a rush to get to school.

ANS: D

School-age children may neglect breakfast in a rush to get to school. Frequently they skip a meal because they are too busy to eat and may incur deficiencies in iron, calcium, and vitamins.

DIF: Cognitive Level: Application REF: p. 135, Table 9-1 OBJ: 2 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

29. The health-care worker giving parents guidelines about discipline for their school-age children would include which of the following guidelines? a. Discipline for inappropriate behavior may be deferred until both parents are available. b. Discipline should combine reward and punishment, based on age-appropriate behavior expectation. c. Time-outs are appropriate forms of discipline for the school-age child. d. At this age, spanking is the best long-term form of discipline.

ANS: B

Punishment should be prompt, consistent, and fair. It should not be used to demand behavior that is beyond a child’s capability. Positive reinforcement is critical to development of good behavior.

DIF: Cognitive Level: Application REF: p. 142 OBJ: 7 TOP: Discipline KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

30. A parent asks how to prevent her 10-year-old son from becoming involved in gang violence.

The best response should be: a. “Become aware of any gang-related activity in your neighborhood.” b. “Try to become more of a ‘pal’ to your son so that he won’t look for outside approval.” c. “Don’t place too many restrictions on your son. He needs to increase his independence and this will show that you trust him.” d. “Don’t allow him to join ‘boys-only’ groups.”

ANS: A

Parents can be encouraged to become aware of gang-related activity in their community or neighborhood by calling or visiting the local police station. In addition, gang members often have characteristics that parents can identify, such as a particular clothing style, tattoos, hand signals, or graffiti.

DIF: Cognitive Level: Application REF: p. 144 OBJ: 10 TOP: Peer relationships KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

31. The major health teaching need(s) of middle childhood include: (Select all that apply.) a. injury prevention. b. ethical behavior. c. scoliosis screening. d. driving safety. e. need for immunizations.

ANS: A, C, E

Children in middle childhood (ages 6-12 years) need to be reminded of injury prevention and screened for scoliosis, sensory deficits, nutritional deficits, dental care, and immunizations.

Although traffic safety is a concern, driving safety is not. Ethics is not a concept that children in middle childhood understand.

DIF: Cognitive Level: Application REF: p. 147 OBJ: 13 TOP: Health and safety needs of the school-age child KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

32. When giving parents guidelines about supporting their children to learn in school, the health-care worker includes that parents should: (Select all that apply.) a. give praise for the child’s application to the learning process. b. correct all incorrect responses.

c. encourage the child to accept responsibility for learning. d. reinforce teaching frequently. e. give occasional rewards.

ANS: A, C, D, E

Praise, reinforcement, and encouraging responsibility for the learning support the child’s approach to learning.

DIF: Cognitive Level: Comprehension REF: p. 146 OBJ: 3 TOP: Supporting learning KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

33. Parents of latchkey children can help ensure their safety by instructing the child to: (Select all that apply.) a. watch TV until an adult comes home. b. walk to and from school with friends. c. call a work number if necessary. d. inform callers that parents are out. e. practice route of escape in case of fire.

ANS: B, C, E

Walking with friends or with a group increases the safety of a latchkey child. The child should know the work number of the parents and a responsible adult with whom to make contact if needed. Callers should be told that the parents are busy, not out. Knowing the escape route in case of fire enhances the child’s safety.

DIF: Cognitive Level: Comprehension REF: p. 145, Box 9-2 OBJ: 13 TOP: Latchkey kids KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk COMPLETION

34. According to Piaget, school-age children are concrete thinkers, and retained best.

_-

learning is

ANS:

hands, on hands-on School-age children think logically and understand rules, although they learn best when they can see and handle objects.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 3 TOP: Cognitive development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

35. The health-care worker designing a class on maintenance of good nutrition for middle childhood children would ensure each class lasted no more than minutes.

ANS:

45

The attention span of children in middle childhood is no more than 45 minutes.

DIF: Cognitive Level: Knowledge REF: p. 146 OBJ: 3 TOP: Attention span KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 10: Adolescence Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. During puberty, girls experience an increase in weight and redistribution of fat. Health-care considerations related to this include: a. providing reassurance that these changes are normal. b. suggesting dietary measures to control weight gain. c. recommending an exercise program to control weight gain. d. encouraging a low-fat diet to prevent excess deposition of fat.

ANS: A

A common response to changes in body shape in teenage girls is to begin dieting at a time when nutritional requirements are at a peak. For some, the focus on slim figures and dieting may trigger an eating disorder.

DIF: Cognitive Level: Application REF: p. 155 OBJ: 4 TOP: Physiological changes KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. According to Erikson, the psychosocial task of adolescence is developing a sense of . a. initiative b. identity c. independence d. autonomy ANS: B

According to Erikson, a major developmental task of adolescence is establishing a stable self-identity.

DIF: Cognitive Level: Knowledge TOP: Psychosocial development MSC: NCLEX: NA

REF: p. 159 OBJ: 6 KEY: Nursing Process Step: NA

3. The health-care worker advising parents of an adolescent as to how to avoid conflict and rebellion as they instruct their child in healthy behaviors would suggest the approach of: a. giving clear, strict guidelines for the adolescent’s expected behavior. b. allowing adolescent to direct his or her own health-seeking behavior to support independence. c. pointing out behaviors that are not healthy to help channel better decision making. d. discussing expected guidelines in respectful manner with the adolescent.

ANS: D

As the adolescent moves toward becoming a self-governing adult, respectful trusting communication will reduce friction and lower defenses.

DIF: Cognitive Level: Comprehension REF: p. 163 OBJ: 5 TOP: Psychosocial development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. The school nurse would inform parents who are seeking information regarding adolescent masturbation that: a. masturbation at an early age is associated with sexual intercourse at an earlier age. b. the practice of masturbation encourages homosexuality. c. masturbation is normal in adolescents and is more common among boys. d. development of intimate relationships may be delayed when masturbation is regularly practiced.

ANS: C

Developing a sexual identity is part of the adolescent’s sense of self. Masturbation is one way to explore and learn about one’s body.

DIF: Cognitive Level: Application REF: p. 162 OBJ: 5 TOP: Masturbation KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. The school nurse tells adolescents that privacy and confidentiality will be maintained unless a life-threatening situation arises. This practice is: a. not appropriate in a school setting. b. never appropriate because adolescents are minors. c. important in establishing trusting relationships. d. indicative that the nurse is meeting his or her own needs.

ANS: C

Establishing a trusting relationship is the first step in effective teaching of adolescents.

Providing privacy and confidentiality is an important step in developing this trust.

DIF: Cognitive Level: Analysis REF: p. 160 OBJ: 13 TOP: Teaching techniques for the adolescent KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. A 14-year-old girl tells the school nurse that she has not started to menstruate and that all of her friends have. The nurse’s best response to the girl would be to: a. explain that this is not unusual as sexual maturing can occur as late as 15 years of age. b. suggest the girl seek medical evaluation. c. call the girl’s parents in for a conference about this situation. d. recommend that she stop all strenuous exercising until her periods begin.

ANS: A

Sexual maturity can occur in girls between the ages of 10 and 15 years of age.

DIF: Cognitive Level: Application REF: p. 154 OBJ: 4 TOP: Puberty KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. A 15-year-old athlete is concerned that the darkening pigment on his scrotum is related to his frequent masturbation. The best response would be based on the knowledge that the color change is: a. most probably “jock itch.”

b. related to frequent nocturnal emissions. c. the result of increase in androgens. d. possible bruising from a sports injury.

ANS: C

The increase of androgens in the adolescent male causes the appearance of secondary sex characteristics among which is the darkening of the skin of the scrotum.

DIF: Cognitive Level: Application REF: p. 154 OBJ: 13 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. According to Piaget, the cognitive development of the adolescent progresses to the stage by middle adolescence. a. preoperational b. formal c. concrete d. sensorimotor ANS: B

Early adolescents are in the concrete phase of thinking, where they interpret words and concepts literally. By middle adolescence they have moved into the formal operation stage, where thinking is more abstract.

DIF: Cognitive Level: Comprehension REF: p. 158 OBJ: 6 TOP: Cognitive development KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. The health-care worker reminds a group of parents of adolescents that as they find their own identity, adolescents will demonstrate: a. increased independence from peers and friends. b. increased need for parental approval. c. imitation of parental values and ideals. d. less emotional dependence on parents.

ANS: D

To achieve a sense of self-identity, adolescents must see themselves as separate from their role of child in the family. Parents can help adolescents achieve this identity by offering support and guidance and by giving adolescents freedom to discover their own interests, which differ from those of their parents.

DIF: Cognitive Level: Analysis REF: p. 159 OBJ: 5 TOP: Psychosocial development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. The initiation of puberty is controlled by the secretions from the: a. gonads b. hypothalamus. c. anterior pituitary d. posterior pituitary ANS: B

The hypothalamus initiates the process as it stimulates the anterior pituitary to stimulate the gonads, which cause the physical changes associated with puberty.

DIF: Cognitive Level: Comprehension REF: p. 154 OBJ: 3 TOP: Hypothalamus KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. When a 16-year-old student tells her mother that she is going to go to work for 30 hours a week to earn money to buy a car, the most therapeutic response would be: a. “You are healthy and doing well in school. Go for it!” b. “A car will give you a lot of freedom and will enhance your maturity.” c. “What is the hourly wage?” d. “Will working 30 hours a week interfere with school?”

ANS: D

Adolescents need to be responsible for making decisions. The parental role is to guide the adolescent to see more realistic options rather than to mandate behavior.

DIF: Cognitive Level: Application REF: p. 161 OBJ: 12 TOP: Development of responsibility KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. In planning sex education and contraceptive teaching for adolescents, the health-care worker should recognize that: a. most adolescents today are knowledgeable about reproductive anatomy and physiology. b. adolescents frequently do not have a basic understanding of fertility. c. both contraception and sexual activity require planning. d. most adolescents who become pregnant do so as an act of defiance against their parents.

ANS: B

Although most adolescents know that once a girl has begun menstruating she can become pregnant, most have no concept of fertility and the process of reproduction. Many believe that pregnancy cannot occur with the first experience of intercourse.

DIF: Cognitive Level: Application REF: p. 157 OBJ: 7 TOP: Puberty KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

13. The appropriate term for the initial menstrual period is: a. ovulation. b. puberty. c. menarche. d. luteinization.

ANS: C

Menarche is the term for the initial menstrual period.

DIF: Cognitive Level: Knowledge REF: p. 155 OBJ: 3 TOP: Menarche KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. When providing health teaching for middle adolescents, the health-care worker should recognize that middle adolescents: a. have adequate opportunities to make decisions based on past experiences. b. develop the ability to demonstrate deductive reasoning. c. accept parents’ beliefs as their own. d. have beliefs that become more concrete and founded in observing religious customs.

ANS: B

Although the early adolescent needs to conform and please others, during later adolescence moral principles are based on one’s individual thinking and beliefs. Middle adolescents are able to perform inductive and deductive reasoning.

DIF: Cognitive Level: Analysis REF: p. 153, Table 10-1 OBJ: 2 TOP: Cognitive development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. The health-care worker is sensitive to the fact that health concerns consistent with middle adolescence are focused on: a. school performance. b. emotional health issues. c. physical appearance. d. future career or employment.

ANS: C

During middle adolescence, teenagers are more concerned with their physical appearance than with school performance, emotional health, or future careers.

DIF: Cognitive Level: Comprehension REF: p. 157 OBJ: 2 TOP: Developmental tasks KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. The leading cause of teenage deaths is related to: a. motor vehicle accidents. b. drowning. c. suicides d. drug overdoses.

ANS: A

Because adolescents often feel invincible and have an “It can’t happen to me” attitude, they may involve themselves in risk-taking behavior, particularly related to motor vehicles and driving.

DIF: Cognitive Level: Comprehension REF: p. 163 OBJ: 13 TOP: Teaching techniques for the adolescent KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. When an adolescent boy tells the health-care worker that he has recently had a homosexual encounter with his best friend, the response should be based on knowledge that this event suggests that the adolescent: a. is homosexual. b. will become homosexual as an adult. c. should be referred for psychotherapy. d. should be encouraged to discuss this event.

ANS: D

Sexual fantasy and experimentation is a normal part of sexual maturation. Experimentation with homosexual behavior may have a relationship to future sexual identification but may also simply be part of an exploration of lifestyle options and identity.

DIF: Cognitive Level: Application REF: p. 162 OBJ: 5 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. Early adolescence is considered to begin at the age of: a. 9 years. b. 10 years. c. 13 years. d. 14 years.

ANS: B

Early adolescence is considered to be the period between the ages of 10 years and 13 years.

DIF: Cognitive Level: Knowledge TOP: Developmental tasks MSC: NCLEX: NA

REF: p. 152 OBJ: 2 KEY: Nursing Process Step: NA

19. The high school nurse is intending to present a class on potential health problems associated with body piercing and tattooing. What piece of information is critical to planning the class? a. Culture affects health-care practices and forms of communication. b. Adolescents are eager to be told what to do regarding health-care practices. c. Physical maturity and cognitive maturity occur at the same rate. d. Peer-group practices need not be a consideration when planning a class on potential health problems.

ANS: A

An adolescent’s culture affects how he/she thinks and interacts. Focus that is on cultural values and individual strengths will help achieve positive health teaching outcomes.

DIF: Cognitive Level: Application REF: p. 160 OBJ: 9 TOP: Culture and the adolescent KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

20. The school nurse plans to include information about oral sex in a sex-education class for 15-year-olds. The most significant reason to include this information is that: a. the information introduces a non-intercourse method of sexual expression. b. a sex-education class would be incomplete without the information. c. middle adolescents may not consider oral sex a sexual act or a risk for sexually transmitted diseases (STDs).

d. exposure to sexual expression through TV and movies make the information necessary.

ANS: C

Instruction on oral sex informs the adolescent that the act is a sexual one and exposes the practitioners to STDs. Although the other options are appropriate, the most significant is that of the recognition of the threat of STDs. DIF: Cognitive Level: Analysis REF: p. 162 OBJ: 14 TOP: Physiological changes KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment: safety and infection control

21. The school nurse presenting a sex-education class to a group of 14-year-olds would stress that the birth control method that can prevent STDs, if used correctly, is the: a. vaginal ring. b. spermicidal foams. c. cervical cap. d. condom.

ANS: D

If used correctly and used only once, the condom can be effective in the prevention of contracting a STD. DIF: Cognitive Level: Comprehension REF: p. 156, Table 10-2 OBJ: 13 TOP: Birth control methods that prevent STDs KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

22. The school nurse is discussing testicular self-examination with adolescent boys. This is important because: a. inflammation of the testes is common during adolescence. b. asymptomatic STDs may be present. c. adolescence is the best time to teach preventative health measures. d. testicular tumors are common during adolescence.

ANS: C

Developing the habit of self-examination during adolescence should support the likelihood that the behavior will continue into adulthood, when the risk for testicular tumors becomes greater.

DIF: Cognitive Level: Comprehension REF: p. 155 OBJ: 3 TOP: Testicular self-examination KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

23. An adolescent tells the school nurse that she is about 4 months pregnant. She has had no medical care and states that although she smokes, she doesn’t use any drugs. The priority nursing action is to: a. notify her parents. b. refer her for prenatal care. c. discuss nutritional needs for herself and the growing fetus. d. explain the importance of not smoking.

ANS: B

Pregnant teens must cope with their own developmental tasks as well as those of parenthood.

Counseling and close medical supervision are essential for a positive outcome in a teen pregnancy.

DIF: Cognitive Level: Application REF: p. 157 OBJ: 14 TOP: Teen pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk

24. The factor that has the greatest impact on the likelihood that an adolescent will begin drinking alcohol is: a. friends drink alcohol. b. parents drink alcohol. c. availability of alcohol. d. enjoyable effects of alcohol.

ANS: A

Belonging to a social group is of utmost importance to an adolescent. Failure to connect in a peer group, or association with a group that indulges in risky behavior, may leave the adolescent vulnerable to use of illegal substances or alcohol.

DIF: Cognitive Level: Comprehension REF: p. 161 OBJ: 10 TOP: Peer relationships KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

25. A school nurse is conducting a sex-education class for early adolescent girls. One girl asks how to tell when she could become pregnant. The nurse explains that: a. ovulation, and the most fertile period, occurs immediately after menstruation stops. b. ovulation, and the most fertile period, occurs just before the start of menstruation. c. ovulation, and the most fertile period, occurs about 14 days before menstruation begins. d. if you have irregular menses, there is no way to determine the fertile period.

ANS: C

Ovulation occurs about 14 days before the onset of menses, when pregnancy can occur if sperm are present. Teaching adolescents about contraception may prevent an unwanted pregnancy.

DIF: Cognitive Level: Comprehension REF: p. 155 OBJ: 7 TOP: Puberty KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

26. According to Kohlberg’s moral development, the 15-year-old adolescent is motivated by: a. what seems most pleasurable. b. associated rewards for appropriate behavior. c. the desire to demonstrate responsible behavior. d. the need to conform and please others.

ANS: D

The 15-year-old is motivated by the need to conform and please others.

DIF:

Cognitive Level: Application

REF: p. 158, Tables 10-1 and 10-6

OBJ: 5 TOP: Teaching techniques for the adolescent KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. Adolescents are more likely to participate in health-care services when they: a. understand the potentially negative results of their health behavior. b. see the health-care provider as caring and respectful. c. view their health problems as not physical in nature. d. are allowed to consistently make their own decisions about seeking health care.

ANS: B

Communication with adolescents must be supportive and not threaten their sense of autonomy. If health-care providers and parents show respect for the adolescent and demonstrate a caring attitude, the adolescent is more likely to use information about healthy behaviors wisely.

DIF: Cognitive Level: Comprehension REF: p. 163 OBJ: 12 TOP: Teaching techniques for the adolescent KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

28. When considering the effect of culture on an adolescent, the health-care worker recognizes that culture: a. is synonymous with race. b. refers to a group of people with similar physical attributes. c. refers to the universal sequence of growth and development. d. affects the development of health beliefs and health-care practices.

ANS: D

Culture plays a role in how an adolescent thinks and acts and can affect health beliefs and practices. Health-care providers must recognize and respect values and practices of other cultures in order to achieve positive health teaching outcomes.

DIF: Cognitive Level: Analysis REF: p. 160 OBJ: 9 TOP: Culture and the adolescent KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

29. The parents of an adolescent are concerned about the amount of time their adolescent spends daydreaming and “doing nothing.” The health-care worker recognizes that: a. daydreams help the adolescent think through responses to various situations and can be a safe outlet for strong emotions. b. daydreaming is a sign of early depression and the child needs medical evaluation. c. daydreams are time-wasting and the adolescent needs to be involved in more outside activities. d. daydreaming is always an adolescent’s substitute for doing homework and household chores.

ANS: A

Daydreaming is a healthy way for adolescents to vent strong emotions and devise responses to various situations. Daydreams are harmless unless they interfere with school or relationship functioning.

DIF: Cognitive Level: Analysis REF: p. 158 OBJ: 5 TOP: Cognitive development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

30. A group of parents are concerned about their adolescent children and dating. The health-care worker points out that: a. early adolescence is not the proper time for dating or mixed-sex group activities. b. dating can have a positive impact on developing problem-solving and social skills. c. adolescents should be allowed to make their own decisions about when to start dating. d. parents should set strict guidelines for dating and expect the adolescent to conform to the rules.

ANS: B

An adolescent utilizes problem-solving skills in the task of establishing a dating relationship.

Social skills and cognitive reasoning are further enhanced in later adolescence as relationships become longer-lasting and less experimental.

DIF: Cognitive Level: Analysis REF: p. 159 OBJ: 11 TOP: Psychosocial development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

31. According to the definition of vigorous exercise published by the Centers for Disease Control and Prevention (CDC) in 2006, the exercise should: (Select all that apply.) a. be at least 30 minutes in duration. b. produce sweat. c. be performed before meals. d. increase respiration. e. be practiced every day.

ANS: B, D

The CDC defined vigorous exercise as an activity that will produce sweat and increased respiration and be at least 20 minutes in duration. This exercise is to be practiced 3 days a week in addition to the recommended 50 minutes of physical activity a day.

DIF: Cognitive Level: Application TOP: Vigorous exercise MSC: NCLEX: NA

REF: p. 152 OBJ: 13 KEY: Nursing Process Step: NA

32. The peer group serves as: (Select all that apply.) a. a major step in separation from family dependence. b. a practice area for forming relationships. c. a source of social interaction. d. the only source for role modeling. e. a status symbol of membership.

ANS: A, B, C, E

The peer group is a place to share thoughts and feelings apart from family. It serves as a source to form relationships. It is not the only source for role modeling.

DIF: Cognitive Level: Application REF: p. 162 OBJ: 10 TOP: Peer groups KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

33. The term

refers to the functional ability to reproduce.

ANS:

puberty Puberty is the functional ability to reproduce, or sexual maturity.

DIF: Cognitive Level: Knowledge REF: p. 154 OBJ: 4 TOP: Puberty KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

34. The birth control option that requires a subdermal insertion and lasts up to 3 years is .

ANS:

Implanon Implanon is placed under the skin of the arm and provides up to 3 years of contraception.

DIF: Cognitive Level: Comprehension REF: p. 156, Table 10-2 OBJ: 7 TOP: Implanon KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: pharmacological therapies

Chapter 11: Young Adulthood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The school nurse plans a class in men’s health needs in order to: a. balance the amount of information about female health needs. b. encourage the organization of gender-specific health-care providers. c. interest insurance carriers in supporting preventative health measures for men. d. sensitize males to health concerns.

ANS: D

Men need to be aware of their health-care needs and methods to prevent illness. Men do not seek health care as often as females do. Men rarely seek medical assistance until a specific problem arises.

DIF: Cognitive Level: Analysis REF: p. 175 OBJ: 6 TOP: Men’s health care KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

2. High schools and junior high schools are now offering classes in money management and parenting for the purpose of: a. keeping adolescents interested in school. b. giving minority populations increased insight to finances. c. helping adolescents transition more easily to adulthood. d. discouraging teen pregnancy.

ANS: C

Schools are offering classes in money management, family life classes, and parenting classes to help adolescents move into adulthood.

DIF: Cognitive Level: Application TOP: School classes MSC: NCLEX: NA

REF: p. 176 OBJ: 8 KEY: Nursing Process Step: NA

3. Women’s health care should include safe-sex practices. The purpose of this is to: a. make sure no unwanted pregnancies occur. b. identify persons who are not using safe-sex practices. c. encourage healthy lifestyles to prevent sexually transmitted diseases (STDs). d. reduce teen pregnancies.

ANS: C

The consistent practice of safe sex reduces the incidence of STDs, which, untreated, can lead to women’s health problems such as pelvic inflammatory disease, acute illness, and ectopic pregnancies.

DIF: Cognitive Level: Application REF: p. 173 OBJ: 4 TOP: Safe-sex practices KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

4. The health-care worker suspecting a woman who comes to the clinic is in an abusive relationship teaches the woman about partner abuse because the health-care worker knows that all women should be informed: a. about the health-care worker’s ethical responsibility to protect women. b. that women’s legal rights cannot be controlled by men. c. about the submissive nature of women who stay in abusive relationships. d. about the cycle of violence that indicates once violence begins, it continues and escalates over time.

ANS: D

Intimate partner violence is an epidemic and contributes to the mortality and morbidity statistics of young adult women. Once begun, the cycles of violence have fewer “honeymoon” phases and the tension and battering phases last longer, increasing the risk of lasting harm to the woman.

DIF: Cognitive Level: Application REF: p. 175, Fig. 11-5 OBJ: 4 TOP: Women’s health issues KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

5. The college health-care worker planning a health promotion class plans to support the goals of Health People 2020 and focus on: a. nutrition, family planning, and physical fitness. b. vaccine-preventable disease and osteoporosis prevention. c. periodontal disease and chronic lung disease. d. breastfeeding and sudden infant death syndrome (SIDS) prevention.

ANS: A

Healthy People 2020 has identified several priority areas for health promotion during young adulthood, including maintaining physical activity, nutrition, family planning, and reducing the use of tobacco and alcohol.

DIF: Cognitive Level: Application REF: p. 171 OBJ: 4 TOP: Health Promotion KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

6. The health-care worker planning a men’s health clinic at a local college plans to give a priority focus on a booth that will provide information about: a. career counseling. b. family planning. c. immunizations. d. testicular self-examination.

ANS: D

The highest rate of testicular cancer is between the ages of 17 and 35 years, so early teaching programs in this clinic should include testicular self-examination.

DIF: Cognitive Level: Application REF: p. 176 OBJ: 6 | 7 TOP: Testicular cancer KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

7. Using Erikson’s developmental stages as a guide, the home health-care worker identifies the person at risk for delayed development as the: a. 22-year-old man finishing his degree at night school so he can work in the daytime to support his wife and child. b. 23-year-old divorced woman in a committed lesbian relationship who works as a medical assistant in a busy physician’s office. c. 24-year-old woman who is still living at home and spends most of her time involved in computer social media. d. 25-year-old man living in the garage apartment behind his parent’s house as he and his wife work and go to school to finish their advanced degrees.

ANS: C

The developmental tasks according to Erikson are to become independently self-supporting and develop an intimate relationship and a stable lifestyle.

DIF: Cognitive Level: Analysis REF: p. 167 OBJ: 2 TOP: Developmental tasks of the young adult KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

8. At a routine yearly physical, an 18-year-old woman states, “I never check my breasts. I think I am too young to worry about that.” The most helpful response would be: a. “There is no need to check your breasts at your age.” b. “Most women would be interested in their own health.” c. “You should practice checking your breasts the first day of your monthly period.” d. “All women should check their breasts every month.”

ANS: D

The health-care worker should encourage the woman to perform monthly breast selfexamination.

The exam is usually done 1 week after the cessation of their monthly period.

DIF: Cognitive Level: Application REF: p. 173 OBJ: 7 TOP: Breast self-exam KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

9. An occupational health-care worker is teaching a class of health-promoting behaviors to a group of young adults when a member of the group asks why this class is necessary, since they are all healthy young adults. The health-care worker’s best response is: a. “Major health changes occur from young adulthood to middle age, so it is necessary to learn health behaviors to cope with these changes.” b. “Because you all will face chronic illness as older adults, you need to learn coping strategies now.” c. “Good health habits formed as young adults show striking effects on the prevention of illness and disease as you grow older.” d. “In order to maintain your company health insurance, it is necessary for you to attend this class.”

ANS: C

Positive health behaviors practiced in young adulthood may significantly reduce the development of chronic illness and serious disease in older adulthood.

DIF: Cognitive Level: Comprehension REF: p. 171 OBJ: 14 TOP: Teaching techniques for the young adult KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

10. The college health-care worker cautions the 20-year-old male about an adverse effect of overtraining, which is: a. excessive secretion of testosterone. b. loss of strength. c. uncontrolled rise in blood glucose. d. reduced libido.

ANS: B

Overtraining can result in loss of strength, dehydration, and muscle and joint injury.

DIF: Cognitive Level: Comprehension REF: p. 176 OBJ: 4 TOP: Overtraining KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk

11. A health-care worker preparing a class on nutrition for a group of young adults explains that MyPlate is a nutritional guide that: a. spells out food exchanges. b. recommends that 30% of a plate be fruits and vegetables. c. directs nutritional intake to be 50% protein. d. helps limit portion size.

ANS: D

By following this guide, the young adult can use this visual guide to select meals that are 50% fruits and vegetables and maintain optimum nutrition. The colored-coded guide is a reminder to limit portion size.

DIF: Cognitive Level: Knowledge REF: p. 168, Figure 11-3A OBJ: 14 TOP: MyPlate KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. Health maintenance instruction during young adulthood should be directed toward: a. preparing for the inevitable physical decline. b. halting age-related physiological changes. c. teaching how to cope with chronic illness. d. preventing illnesses caused by lifestyle choices.

ANS: D

Teaching the young adult about lifestyle changes to prevent illness and promote health may contribute to better health as an older adult. It is easier to develop good health habits at a younger age than to change or compensate for bad habits later in life.

DIF: Cognitive Level: Application REF: p. 169 OBJ: 14 TOP: Teaching techniques for the young adult KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

13. A new mother tells the home health-care worker that she feels “really stupid” about caring for her newborn, as her mother-in-law does everything for the baby. The best approach to facilitate instruction would be: a. “Let’s talk about what you already know about infant care, then we can plan from there.” b. “Tell your mother-in-law that she has to teach you everything she knows.” c. “You and your husband should sign up for child-care classes at the YMCA.” d. “You and your husband should read up on infant care.”

ANS: A

Successful adult teaching relates information to the appropriate developmental tasks they are experiencing and should build on previous knowledge and skills. In addition, in-laws should understand that while assistance at this time is appreciated, most of the infant care is the responsibility of the new parents.

DIF: Cognitive Level: Application REF: p. 181 OBJ: 13 TOP: Parenting KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

14. Young adulthood, or early adulthood, is most often defined as the time of age 20 years to years. a. 25 b. 30 c. 35 d. 40 ANS: D

Young adulthood is defined as the young adult phase from 20 to 40 years of age.

DIF: Cognitive Level: Knowledge REF: p. 166 TOP: Definition KEY: Nursing Process Step: NA

OBJ: 1 MSC: NCLEX: NA

15. The goal of intimacy for the young adult means that the young adult has achieved: a. a satisfying sexual relationship. b. an open and trusting relationship with another person. c. a casual relationship with several close friends. d. a clear sense of identity.

ANS: B

Intimacy allows the person to share thoughts and feeling in an open and trusting relationship.

The intimacy is not merely sexual.

DIF: Cognitive Level: Comprehension REF: p. 177 OBJ: 2 TOP: Intimacy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. The signs of a mid-life crisis” in a 39-year-old man suggest that he may be experiencing the negative influence of Levinson’s stage of: a. structure period. b. concrete period. c. operational phase. d. transitional phase.

ANS: D

In Levinson’s transitional phase, the person looks at decisions made in the structure period and evaluates them. Many become unhappy and feel they have missed opportunities.

DIF: Cognitive Level: Application REF: p. 177 OBJ: 2 TOP: Levinson’s theory KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. According to Piaget, the stage of development that is necessary for effective problemsolving skills in adulthood is the stage. a. integrative b. preoperational c. concrete operational d. post-formal operational ANS: D

Development of the formal operational method of thinking begins in adolescence and extends into young adulthood. This type of thinking is necessary in the use of effective problemsolving techniques in the post-formal operational period.

DIF: Cognitive Level: Knowledge TOP: Cognitive ability MSC: NCLEX: NA

REF: p. 177 OBJ: 10 KEY: Nursing Process Step: NA

18. According to Kohlberg, young adults should develop moral reasoning as they mature; this moral reasoning is characterized by: a. conforming to rules to gain recognition or reward. b. taking responsibility for care of others. c. obeying rules to avoid punishment. d. maintaining a sense of life achievement.

ANS: B

Taking responsibility for care of others, dealing with differing points of view, and understanding how their behavior affects others all contribute to the development of mature moral reasoning.

DIF: Cognitive Level: Comprehension TOP: Moral reasoning MSC: NCLEX: NA

REF: p. 177 OBJ: 11 KEY: Nursing Process Step: NA

19. A young woman pregnant with her first child is in the second trimester. The health-care worker will direct instruction toward: a. detailed information about the birth process. b. possible abnormalities of the fetus. c. preparations about the physical environment for the expected infant. d. birth-control measures after delivery.

ANS: C

In the second trimester, the family should be directed and supported as they prepare the physical environment for the baby. Instruction about care of the newborn is appropriate at this time.

DIF: Cognitive Level: Application REF: p. 179, Table 11-2 OBJ: 13 TOP: Second trimester KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. A woman in the third trimester of pregnancy expresses fear about her impending labor and how she will manage. The best response would be: a. “Don’t worry about it, you’ll do fine.” b. “Labor is scary to think about, but the actual experience isn’t.” c. “You can have an epidural. You won’t feel anything.” d. “It’s normal to be anxious. Let’s go over what happens after you are admitted.”

ANS: D

The third trimester of pregnancy is the time that information should be given to parents concerning labor, the birth process, preparation for birth, and so on. Successful adult learning involves relating the information to the appropriate developmental tasks they are experiencing.

DIF: Cognitive Level: Application REF: p. 179, Table 11-2 OBJ: 13 TOP: Parenting KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

21. A young adult man says that his 3-year-old son wants to do many things the parent thinks is dangerous. The most helpful suggesting the health-care worker could give about this toddler’s behavior is: a. “Let him do what he wants. He won’t break.” b. “Allow him his independence, but keep an eye out for safety.” c. “Your child should be limited in his explorations as his judgment is immature.” d. “Parents of toddlers need to continue to do things for their children.”

ANS: B

Toddlers need to be allowed to develop autonomy by seeking new boundaries, but these children still need to be protected from injury.

DIF: Cognitive Level: Application REF: p. 179, Table 11-2 OBJ: 13 TOP: Parental development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

22. Teaching to increase self care is effective when the adult learner makes which statement? a. “I’ll do whatever you say; you’re the professional.” b. “I don’t think I can quit smoking.” c. “I exercise for 30 minutes 5 times a week.” d. “What do you think I should do?”

ANS: C

Concepts presented to young adults should build on previous knowledge and skills. Teaching goals should be clear and should identify how the new knowledge can be used and how it will benefit their current life roles.

DIF: Cognitive Level: Application

REF: p. 181

OBJ: 14

TOP: Teaching techniques for the young adult KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

23. In the United States, at age 18, young adults are able to: (Select all that apply.) a. vote. b. purchase a license for a shotgun. c. marry without parental consent. d. purchase alcohol. e. be drafted into military.

ANS: A, B, C, E

In the United States, persons who are 18 may vote, marry without parental consent, be drafted into the military, and purchase a license for a shotgun. To purchase alcohol or obtain a license for a pistol, persons must be 21.

DIF: Cognitive Level: Comprehension REF: p. 166 OBJ: 1 TOP: Rights of young adulthood KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

24. Signs of intimate partner violence include: (Select all that apply.) a. absolute financial control by partner. b. erratic prenatal care. c. self-blame for marital problems. d. cycle of violence in partner. e. substance abuse in partner.

ANS: B, C, D, E

The Centers for Disease Control (CDC) lists signals of Intimate Partner Violence (IPV) as erratic prenatal care and child health care, history of substance abuse, abuse as a child, history of minor battering incidents, evidence of bruises and lacerations in various stages of healing, and the victim’s accepting blame for marital problems.

DIF: Cognitive Level: Comprehension REF: p. 175, Box 11-2, Figure 11-2 OBJ: 4 TOP: IPV KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

25. The health-care worker recommends that the young adult take up weight training for fitness and counsels that such activity should be: (Select all that apply.) a. moderate to high intensity. b. performed 2 or more days a week. c. intense enough to involve all major muscle groups. d. supervised and directed by a trainer. e. prescribed by a physician.

ANS: A, B, C

Weight training should be of moderate to high intensity, performed two or more times a week and intense enough to involve all major muscle groups. It need not be supervised or prescribed by a physician.

DIF: Cognitive Level: Comprehension REF: p. 168 OBJ: 6 TOP: Weight training KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease COMPLETION

26. Most young adults have ceased to grow when the

of the long bones fuse.

ANS:

epiphyses The epiphyses fuse during the young adult years by the excretion of gonadal steroids, which stops growth.

DIF: Cognitive Level: Knowledge REF: p. 167 OBJ: 3 TOP: Growth KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. The health-care worker cautions the 30-year-old woman that at her age there is an increased risk for injuries due to muscle mass being replaced by .

ANS:

fat fatty tissue Around the age of 30, there is a natural decrease in muscle mass, which is replaced by fatty tissue. The reduced strength can lean to vulnerability to injury.

DIF: Cognitive Level: Comprehension REF: p. 167 OBJ: 3 TOP: Loss of muscle mass KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 12: Middle Adulthood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. Health maintenance during middle adulthood should be directed toward: a. preventing illnesses due to lifestyle and physiological changes. b. stopping the physiological aging process. c. preparing for inevitable physical decline. d. maintaining strength and endurance at the young adult level.

ANS: A

Metabolic needs decrease during middle adulthood. Diet and exercise must be part of the lifestyle of the middle-aged adult. Diet, smoking, and lack of exercise influence cardiovascular change.

DIF: Cognitive Level: Application REF: p. 184 OBJ: 8 TOP: Health maintenance KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

2. According to Erikson, the primary task of middle adulthood is contributing positively to family and community, also known as . Failure to achieve this task may result in stagnation. a. intimacy b. integrated c. generativity d. ego integrity ANS: C

Generativity enhances self-image and promotes a feeling of well-being. Adults who do not achieve a sense of generativity may become self-preoccupied and overly concerned with physical and psychological health needs.

DIF: Cognitive Level: Comprehension TOP: Erikson’s developmental tasks MSC: NCLEX: NA

REF: p. 184 OBJ: 3 KEY: Nursing Process Step: NA

3. A 50-year-old woman visits the women’s health clinic stating her last menstrual period was 6 months ago. Since that time, she has been experiencing palpitations and hot flashes. The health-care worker should suspect that her symptoms are related to: a. pregnancy. b. menopause. c. a cardiac disorder. d. neurosis.

ANS: B

Hot flashes and palpitations often accompany menopause and are very distracting and uncomfortable for the woman. Hormone replacement may be prescribed, or complementary and alternative medicine therapy may be recommended.

DIF:

Cognitive Level: Knowledge

REF: p. 187

Downloaded by: BestRates | maytheblessed@gmail.com

OBJ: 4

Distribution of this document is illegal

TOP: Women’s health KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: physiological adaptation

4. Many middle-aged adults desire to return to school to continue an education interrupted by career, family, and childrearing. When counseling these adults, an important factor to consider is that: a. intelligence declines after age 30, so it may be too difficult to resume schooling at this age. b. it may take more time to learn and assimilate new material, but once learned, the content is remembered with greater accuracy. c. without family responsibilities or pressures, learning capability will quickly return to young adult levels. d. there should be no difficulty in keeping up with the younger students in the class.

ANS: B

Speed in mental functioning may be a problem as adults grow older, but when time is not a factor there is little difference in performance when compared to young adults.

DIF: Cognitive Level: Application REF: p. 194-195 OBJ: 3 TOP: Challenges KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. When assessing a middle-aged person, the health-care worker should be sensitive to the fact that these persons are uniquely challenged by: a. metabolic changes in their aging bodies. b. attempting to meet the needs of both their children and their parents. c. inadequate income and job insecurity in an unstable economy. d. the need to find their place NinUtRheSirIcNomGTmBun.iCtyO. M ANS: B

These adults may have to handle increased financial and emotional responsibilities related to the needs of their children and the needs of their aging, and perhaps dependent, parents.

Middle-aged persons usually have a stable income and job security and usually have established themselves in a community.

DIF: Cognitive Level: Application REF: p. 185 OBJ: 9 TOP: The sandwich generation KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. While discussing health promotion and maintenance to a group of middle-aged men, the health-care worker advises that men should make as a priority to have an annual: a. screen for prostate cancer. b. sperm count for infertility. c. skin assessment for cancer. d. assessment for testosterone level.

ANS: A

Because of the prevalence of cancer of the prostate as the most common cancer in men, annual screening for prostate cancer is recommended. New screening procedures are available which can diagnose prostate cancer much earlier and often before symptoms occur.

DIF:

Cognitive Level: Application

REF: p. 189

OBJ: 8

TOP: Prostate screening KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

7. To enhance success for health teaching to middle-aged adults, the health-care worker should: a. provide information related to health concerns and stressors common to the age-group. b. begin with concepts about teaching and learning techniques. c. incorporate structured learning activities that keep all group members learning at the same rate. d. direct members to seek independent learning without formal instruction.

ANS: A

Successful teaching of middle-aged adults depends on having an understanding of their concerns and potential sources of stress. Teaching strategies should incorporate the independence and competencies of adult learners and provide information relevant to the age-group. Directing these adults to independent learning without providing guidelines or initial direction may doom the opportunity to learn.

DIF: Cognitive Level: Application REF: p. 190 OBJ: 11 TOP: Teaching strategies for the middle-aged adult KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. A middle-aged man says that he is taking up a strenuous exercise program to increase his testosterone level and his libido. The best response to this information would be: a. “That is great! You will begin to feel better and enjoy an increased libido.” b. “While exercising, you should wear tight fitting underwear and an athletic support.” c. “To get the result you want, you will have to exercise every day.” d. “Excessive exercise may actually decrease your testosterone level.”

ANS: D

Excessive exercise may decrease the level of testosterone. The effect can last for several months. Wearing of tight undergarments also decreases the sperm count as the gonads get too hot.

DIF: Cognitive Level: Comprehension REF: p. 188 OBJ: 3 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

9. The term climacteric refers to a time in life in which: a. women have erratic menstrual cycles. b. men have a decrease in libido. c. women have completed menopause. d. men become permanently impotent.

ANS: B

The climacteric refers to a period in a person’s life when there is a slowing and a cessation of the reproductive ability of the female and a decrease in the sexual activity of the male.

DIF: Cognitive Level: Knowledge TOP: Reproductive health

REF: p. 187 OBJ: 5 KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. A 52-year-old woman who is recently divorced and has just sent her last child to college says she just does not understand why she is feeling so “low and alone.” She states she is not sleeping well and has no energy for anything. These most likely are symptoms of: a. worsening depression related to early menopause. b. pathologic depression related to the divorce. c. the “empty nest” syndrome related to the children being gone from home and stress from the recent divorce. d. indicative of her need to go out and get a job.

ANS: C

Women at midlife are at higher risk for the “empty nest” syndrome when the last child leaves home. Feelings of depression and isolation may be exacerbated by divorce or widowhood.

DIF: Cognitive Level: Application REF: p. 185 TOP: Empty nest KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

OBJ: 3

11. A middle-aged man is considering testosterone replacement therapy to increase his strength and sense of well-being. A deficit of testosterone therapy is that the therapy: a. is very expensive. b. does not correct erectile dysfunction. c. increases accumulation of body fat. d. may cause hypertension.

ANS: B

Testosterone replacement theraNpyURdoSeIs NreGstTorBe.stCreOnMgth, decrease fat accumulation, restore libido, and increase a sense of well-being, but it does not correct erectile dysfunction.

DIF: Cognitive Level: Application REF: p. 188 OBJ: 7 TOP: Testosterone replacement therapy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: pharmacological therapies

12. A 55-year-old man has recently purchased a sports car, had a hair transplant, and taken up skydiving as a hobby. The term for this behavior as an attempt to challenge the inevitability of the future is known as: a. generativity. b. identity accommodation. c. male climacteric. d. midlife crisis.

ANS: D

Midlife crisis is a time when adults may fear the inevitability of their own mortality and attempt to make up for lost opportunities or challenge the future by engaging in atypical behaviors.

DIF: Cognitive Level: Comprehension TOP: Midlife crisis MSC: NCLEX: NA

REF: p. 185 OBJ: 6 KEY: Nursing Process Step: NA

13. Middle adulthood is considered the period of development after young adulthood but before retirement and is categorized as age 40 to years. a. 50 b. 55 c. 60 d. 65 ANS: C

Definition of middle adulthood is the life period between the ages of 40 and 60 years of age DIF: Cognitive Level: Knowledge REF: p. 183 OBJ: 1 TOP: Definition of middle adulthood KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. The health-care worker clarifies that the concept of generativity means that the middle adult: a. provides care for elderly parents. b. has generated the next generation. c. contributes positively to family and community. d. expresses total concern for his well-being.

ANS: C

Generativity is the concept of the middle adult contributing in a positive way to the community and family through personal activity and achievements that go beyond the self.

DIF: Cognitive Level: Comprehension REF: p. 184 OBJ: 3 TOP: Generativity KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development 15. 1

5 .

As adults move from middle adulthood into older and late adulthood, a productive level of functioning is more likely to be maintained if the person feels: a. useful and loved. b. dependent and closely watched. c. wanted and dependent. d. financially secure and physically active.

ANS: A

An important aspect of all stages of development is the need for feeling useful and loved, as well as maintaining a positive self-image. According to Kegan (see Chapter 5), individuals need to be included in reciprocal relationships with others and to maintain independence.

DIF: Cognitive Level: Analysis REF: p. 184 OBJ: 3 TOP: Developmental tasks KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. A middle-aged woman says that her husband does not seem to want to make love to her anymore. She says he makes excuses every night and she is afraid he no longer loves her. The health-care worker recognizes that most likely: a. he may be having an affair and is too tired for his wife. b. the physiological changes occurring in his wife’s body have made her unattractive to him. c. he is working too hard and is too tired at night for anything but sleep. d. he is concerned about his sexual performance and is afraid to try for fear of failure.

ANS: D

Middle-aged men often have sexual concerns related to decreased physical fitness and performance anxiety. As well, the male climacteric, with its decrease in hormones, may lead to a decrease in sex drive.

DIF: Cognitive Level: Analysis REF: p. 188 OBJ: 7 TOP: Men’s health KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation MULTIPLE RESPONSE

17. The health-care worker assesses for the physiological changes in the middle-aged person, which include: (Select all that apply.) a. redistribution of fat. b. increased muscle tone. c. loss of skin elasticity. d. thinning hair. e. increasing energy.

ANS: A, C, D

At middle age, the muscles and skin lose their tone and elasticity. Fat is redistributed around the hips, and hair becomes thin, gray, or absent. Visual changes usually require the use of glasses, contacts, or surgery.

DIF: Cognitive Level: Knowledge REF: p. 184 OBJ: 2 TOP: Physiological changes in middle age KEY: Nursing Process Step: AssNesUsmReSntINGTB.COM MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. In addition to the Eriksonian crisis, middle-aged persons have other developmental tasks, which include: (Select all that apply.) a. managing finances. b. nurturing their marriage. c. maintaining social relationships. d. managing the household. e. developing an ego ideal.

ANS: A, B, C, D

The middle adult must manage finances and households and maintain family and social relationships. The development of an ego ideal is part of the adolescent identity task.

DIF: Cognitive Level: Comprehension REF: p. 184 OBJ: 3 TOP: Developmental tasks of middle adults KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. The health-care worker reminds a group of middle-aged men that they should take preventative measures to reduce the risk of cardiovascular disorders resultant from their lifestyle, which includes which factor(s)? (Select all that apply.) a. Sandwich generation stress b. Lack of intimacy

c. Smoking d. Inadequate exercise e. Hormonal changes ANS: A, C, D, E

Middle-aged adult males are at risk for cardiovascular disorders due to inappropriate diet, inadequate exercise, stress, and smoking. Lack of intimacy is not a cardiovascular threat.

DIF: Cognitive Level: Application REF: p. 184 OBJ: 8 TOP: Risk factors KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease COMPLETION

20. The health-care worker reminds the 55-year-old executive that, although he is busy, he should find time to engage in the recommended hours of moderate exercise a week.

ANS:

2.5 As in younger years, the recommendation for moderate exercise is 2.5 hour per week, DIF: Cognitive Level: Knowledge REF: p. 189 OBJ: 10 TOP: Moderate exercise recommendation KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

21.

is a part of every phase of life and involves beliefs and behaviors that surround physiological responsNesU, RemSoItNioGnsT, Ban.dCcOulMtural values.

ANS:

Sexuality Sexuality is not limited to the sex act. Sexuality is a part of every phase of life and involves beliefs and behaviors that surround physiological responses, emotions, and cultural values.

DIF: Cognitive Level: Comprehension REF: p. 186 TOP: Sexuality KEY: Nursing Process Step: NA

OBJ: 7 MSC: NCLEX: NA

Chapter 13: Late Adulthood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. To help the older adult maintain independence, Healthy People 2020 advocates the promotion of services that provide: a. prescription drug delivery. b. food banks for the older adult. c. transportation. d. day care for persons suffering from dementia.

ANS: C

Healthy People 2020 supports services that aid in the maintenance of independence for the elderly, which include transportation to health-care facilities, housing, and an increasing number of certified specialists to care for the elderly.

DIF: Cognitive Level: Comprehension TOP: Maintenance of independence MSC: NCLEX: NA

REF: p. 196 OBJ: 1 KEY: Nursing Process Step: NA

2. The home health-care worker recognizes that memory loss related to depression as compared to normal age–related memory loss is that depression-related memory loss: a. progresses slowly. b. has a rapid onset. c. affects all areas of memory. d. usually becomes permanent.

ANS: B

Depression-related memory loss has a rapid onset as opposed to age-related memory loss, which has a slow progression and usually affects memory of dates and names. When the depression is resolved, the memory improves.

DIF: Cognitive Level: Application REF: p. 206, Table 13-2 OBJ: 2 TOP: Memory loss KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. The home health care worker suggests a lifestyle change that would be supportive to memory retention such as: a. completing a crossword puzzle. b. listening to “oldies” music. c. subscribing to a travel magazine. d. working on a jigsaw puzzle.

ANS: A

A lifestyle component that exercises memory skills, such as doing crossword puzzles, is thought to help maintain memory function.

DIF: Cognitive Level: Application REF: p. 206 TOP: Lifestyle changes to promote memory

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OBJ: 4

KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. The most effective nursing intervention for health promotion in the older adult is primarily focused on: a. managing disease. b. providing a sense of control over health problems. c. controlling symptoms of illness. d. teaching positive health behaviors.

ANS: D

Important goals in managing the aging process include preventing illness and disability, maintaining cognitive functioning, and promoting an active and healthy lifestyle.

DIF: Cognitive Level: Application REF: p. 196 OBJ: 2 TOP: Teaching techniques and goals for the older adult KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

5. The health-care worker is taking the health history of an older adult with the assistance of the patient’s daughter, who is the caregiver. The assessment that would suggest that the patient may be abused is the: a. patient is disoriented. b. daughter has little knowledge of the patient’s medical condition. c. daughter handles the patient’s finances. d. daughter is involved in many community activities.

ANS: B

Lack of interest by the daughter in the condition or needs of an older adult may indicate a lack of commitment to meeting the individual’s needs.

DIF: Cognitive Level: Application REF: p. 201 OBJ: 5 TOP: Elder or dependent abuse KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: reduction of risk

6. The health-care worker identifies age-related memory impairment in the older adult who says: a. “I just can’t remember my telephone number.” b. “I forgot I went to the store this morning and didn’t realize it until I went again this afternoon.” c. “I forget the names of movie stars more often now, but I can remember them later.” d. “I simply cannot remember how to set my alarm clock anymore.”

ANS: C

Age-associated memory loss is characterized by a temporary memory loss or benign forgetfulness. The other examples indicate abnormal cognitive functioning.

DIF: Cognitive Level: Application REF: p. 206, Table 13-2 | p. 205, Box 13-2 OBJ: 2 TOP: Memory loss KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. When access to health care is blocked, the major negative impact is that: a. communities will not develop broader health services. b. minorities will be the most neglected. c. insurance payments will be impacted. d. preventative health-care measures are neglected.

ANS: D

When access to health care is blocked either by lack of knowledge or lack of transportation, basic preventative health care is neglected. This deficit affects all ages and ethnic groups.

DIF: Cognitive Level: Analysis REF: p. 200 OBJ: 2 TOP: Effect of blocked access to health care KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

8. When teaching an older adult, the health-care worker promotes learning by providing: a. detailed verbal explanations. b. information that relates to the person’s actual experiences. c. a review of basic concepts, because long-term memory is impaired. d. numerous repetitive presentations to promote memory retention.

ANS: B

Relating information to the older adult’s experience is much more effective than reviewing basic concepts, particularly if the material is already known. Repetition may be helpful but should not be excessive to the point of demeaning the person.

DIF: Cognitive Level: Application REF: p. 209 OBJ: 8 TOP: Teaching techniques and goals for the older adult KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. A 65-year-old woman who recently lost her husband comes to the clinic for her first examination in 5 years. To facilitate a positive health-care experience, the health-care worker should: a. remind the woman that she is long overdue for an examination. b. reassure this woman that her examination should be normal as she has no symptoms. c. listen carefully and allow for extra time for her health history interview. d. encourage the woman to talk about the death of her husband.

ANS: C

Taking a careful health history and taking time to listen will enable the health-care worker to determine risk factors related to age and stress. Allowing extra time for the processing of thoughts will facilitate the health interview.

DIF: Cognitive Level: Application REF: p. 206 OBJ: 7 TOP: Health history KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. To prevent or decrease age-related postmenopausal osteoporosis, the health-care worker recommends that the 66-year-old woman include in her lifestyle: a. taking vitamins E and B-complex supplements.

b. increasing intake foods rich in iron. c. maintaining annual health assessments. d. performing regular aerobic, weight-bearing exercise.

ANS: D

Preventive measures for postmenopausal bone loss and osteoporosis are increased calcium intake, vitamin D, and regular weight-bearing exercise.

DIF: Cognitive Level: Application REF: p. 204 OBJ: 2 TOP: Health screenings KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

11. The health-care worker recommends cardiovascular screening for the 60-year-old man who: a. smokes a cigar after Sunday dinner. b. has a high low-density lipid level. c. has a blood pressure of 136/78. d. exercises strenuously every day.

ANS: B

Cardiovascular screening is recommended for persons who smoke daily, have high lipid levels, or have hypertension.

DIF: Cognitive Level: Knowledge REF: p. 204 OBJ: 2 TOP: Cardiovascular risk factors KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

12. When a 66-year-old woman comes into the health clinic complaining of dyspareunia, the sensitive health-care worker would: a. say, “I believe you can get relief from the use of lubricating creams.” b. ask, “Has this affected your sexual activity?” c. ask, “Have you considered hormone replacement therapy?” d. inform her, “There are many CAM therapies that can help.”

ANS: B

The main obstacle to a healthy sexual lifestyle is the reluctance to talk about it because of embarrassment. It is the health-care worker’s responsibility to assess the sexual function of the older adult.

DIF: Cognitive Level: Analysis REF: p. 206 OBJ: 6 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

13. In cultures in which respect and inclusion of the older adult in family life is the norm, the older adult demonstrates greater: a. authoritarian dominance. b. fiscal responsibility. c. emotional competency. d. life expectancy.

ANS: C

In a culture that respects and includes the older adult in family life, there is greater emotional competency and less disengagement.

DIF: Cognitive Level: Knowledge REF: p. 206 OBJ: 4 TOP: Disengagement KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

14. The health-care worker plans to use the CAGE alcohol use assessment tool to assess the older adult. This tool is a questionnaire consisting of questions. a. 4 b. 5 c. 8 d. 10 ANS: A

The CAGE alcohol assessment tool is a questionnaire of four items. If there are as few as two affirmative answers, the older adult should be further assessed or referred for evaluation.

DIF: Cognitive Level: Knowledge REF: p. 204 OBJ: 2 TOP: CAGE KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

15. A 70-year-old woman has been newly diagnosed with cancer. She says that if the treatment is not successful, she has had a productive life and will have no regrets. This is: a. denial of the severity of her disease. b. an example of repression. c. lack of faith in the effectiveness of treatment. d. indication of a satisfactory and fulfilling life.

ANS: D

A sense of fulfillment and a recognition of the meaning of one’s life is indication of a positive psychosocial development.

DIF: Cognitive Level: Application REF: p. 201 OBJ: 3 TOP: Psychosocial development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. A provision of the controversial Health Care Affordability Act of 2010 was to: a. ration health care to the elderly. b. provide wider health-care coverage. c. limit hospital stays. d. set up more community health clinics.

ANS: B

The controversial Health Care Affordability Act of 2010 offered wider health-care coverage.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 2 TOP: Health concerns of late adulthood KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

17. When discussing the basic needs for the older adult, the health-care worker uses the term to indicate effective interactions. a. autonomy b. disengagement

c. competence d. relatedness ANS: C

Competence is the term used to describe the older adult’s ability to engage in effective interactions.

DIF: Cognitive Level: Application REF: p. 201 OBJ: 3 TOP: Competence KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. When planning health promotion classes for people in late adulthood, the health-care worker should include information about: a. motor vehicle accidents. b. stress management. c. sexually transmitted diseases. d. vitamin supplements.

ANS: B

Helping the older adult to decrease stress can help prevent development of depression and clinical disease.

DIF: Cognitive Level: Application REF: p. 210 OBJ: 7 TOP: Stress reduction KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

19. When a 65-year-old woman comes to the health clinic with postmenopausal symptoms, the health-care worker will encourage a high dietary intake of: a. potassium. b. sodium. c. calcium. d. vitamin C. ANS: C

Measures such as increased calcium and vitamin D are recommended to help prevent postmenopausal bone loss and osteoporosis.

DIF: Cognitive Level: Application REF: p. 204 OBJ: 6 TOP: Menopausal concerns KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

20. The home health care worker will make a point to make frequent blood pressure assessments on a 67-year-old man who has been put on a new hypertensive drug because the older adult: a. will be curious about the effectiveness of the drug. b. has sudden changes in blood pressure. c. may reject a medication change. d. has decreased liver and kidney function.

ANS: D

The older adult has decreased ability to excrete drugs from the body because of decreased liver and kidney function.

DIF: Cognitive Level: Application REF: p. 200 OBJ: 2 TOP: Altered kidney and liver function KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: pharmacological therapies MULTIPLE RESPONSE

21. Health goals established for older adults by Healthy People 2020 include: (Select all that apply.) a. eradication of dementia. b. reduction of morbidity from flu and pneumonia. c. disease prevention. d. reduction of occurrence of hip fractures. e. food banks for the needy.

ANS: B, C, D

Healthy People 2020 established health goals for the older adult, which include prevention of vaccine-preventable illnesses (flu and pneumonia), reduction of occurrences of hip fractures, disease prevention focus on healthy lifestyles, and early diagnosis and treatment (not prevention) of dementia.

DIF: Cognitive Level: Application REF: p. 196 OBJ: 1 TOP: Goals of Healthy People 2020 KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

22. When designing a plan of care for the older adult, the health-care worker should consider the older adult’s: (Select all that apply.) a. income. b. previous employment. c. educational level. d. date of retirement. e. living arrangements.

ANS: A, C

The plan of care should be based on the living arrangements, support systems, income, and educational level of the older adult.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 2 TOP: Basis for plan of care KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease COMPLETION

23. The health-care worker recommends the practice of Tai Chi to an older adult to enhance strength.

ANS:

muscle Tai Chi can enhance muscle strength.

DIF: Cognitive Level: Comprehension REF: p. 208 OBJ: 2 TOP: Tai Chi KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

24. The baseline goal for moderate to vigorous physical activity is

hours a week.

ANS:

2 1/2 two and one half 2.5 The recommendation of 2 1/2 hours a week of moderate to vigorous activity is the baseline goal for the older adult.

DIF: Cognitive Level: Comprehension REF: p. 208 OBJ: 5 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

Chapter 14: Advanced Old-Age and Geriatrics Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The term geriatrics refers to the study of: a. the elderly. b. care of aging persons. c. human adaptation to aging. d. biological, psychological, physiological, and sociological aspects of aging.

ANS: D

Geriatrics refers to the study of the biological, psychological, physiological, and sociological aspects of aging.

DIF: Cognitive Level: Application REF: p. 213 OBJ: 1 TOP: Geriatrics KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. The theory of aging that attributes the age-related cellular changes to an unpaired ion is the theory of: a. wear and tear. b. free radical. c. immune. d. apoptosis.

ANS: B

The free radical theory proposes that the unpaired ion, or free radical, attacks the body, which results in cell damage that cannot be repaired.

DIF: Cognitive Level: Application REF: p. 214 OBJ: 1 TOP: Free radical KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. Columbia University developed an assessment tool for persons with Alzheimer’s that: a. aids in the planning of care for the person with Alzheimer’s disease. b. sets a drug protocol for the treatment of Alzheimer’s. c. lists specific effective interventions for care of a person with Alzheimer’s. d. measures the deterioration of the cerebral cortex.

ANS: A

Columbia University’s tool uses age of onset, presenting signs, gender, and results of a mini mental test to predict the progress of the disease and is an aid in planning care for the person with Alzheimer’s disease.

DIF: Cognitive Level: Comprehension REF: p. 221 TOP: Columbia University’s Alzheimer’s prediction tool MSC: NCLEX: NA

4. In cultures where ageism prevails, the elderly are: a. respected and are valued for their contribution to society.

OBJ: 11 KEY: Nursing Process Step: NA

b. used as role models for the younger generation. c. avoided and made to feel useless. d. disallowed to take part in community and civic organizations.

ANS: C

Ageism is avoidance of and negative attitudes toward the elderly based on age.

DIF: Cognitive Level: Comprehension REF: p. 220 OBJ: 1 TOP: Ageism KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. The White House Conference of 2005 stimulated the: a. broadening of the definition of elder abuse. b. increase in the number of assisted living facilities. c. development of training programs for caregivers. d. passing of the Older American Act, which supported long-term care strategies.

ANS: D

The White House Conference of 2005 made recommendations to Congress about the aging population, which resulted in the passing of the Older Americans Act in 2008 supporting longterm care strategies for the United States.

DIF: Cognitive Level: Knowledge TOP: White House Conference of 2005 MSC: NCLEX: NA

REF: p. 221 OBJ: 2 KEY: Nursing Process Step: NA

6. A woman tells the health-care worker that her 85-year-old father is frequently confused about medication doses and frequently forgets to take his medicines. He usually eats crackers for dinner and sweet snacks for lunch. The daughter lives in a two-bedroom apartment with her two children and works full time. The health-care worker suggests that the most appropriate placement for him would be in: a. the daughter’s home. b. a nursing home. c. an assisted-living home. d. a retirement center.

ANS: C

The assisted living home provides care for persons with minimal supervision and care.

DIF: Cognitive Level: Comprehension REF: p. 224 OBJ: 11 TOP: Placement alternatives KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

7. The health-care worker recommends the utilization of a senior center for a 79-year-old widow because in addition to a meal, a senior center can provide: a. transportation to and from the center. b. prescription drugs. c. a venue for socialization. d. a nurse counselor.

ANS: C

Senior centers offer a venue for socialization and frequently have activities such as crafts, line dancing, and board games. Many centers offer other services, such as health screening or counseling. Transportation is not part of most senior centers’ services.

DIF: Cognitive Level: Knowledge REF: p. 222 OBJ: 2 TOP: Senior centers KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

8. A health-care worker passing an open door sees a nursing home resident having sexual intercourse with another resident. The most appropriate response is to say: a. “What are you doing? Please remember where you are!” b. “Let me shut the door to give you more privacy.” c. “I need to notify your physician. Remember your heart condition.” d. “You should wait until all the other residents are in their rooms.”

ANS: B

The elder adult may continue to have sexual feelings well into advanced old age. Health-care workers must consider that the geriatric adult has the right to express these feelings without shame or guilt, in the privacy of their home setting.

DIF: Cognitive Level: Application REF: p. 219 OBJ: 9 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

9. A 70-year-old man retired 6 months ago after a long career as a newsman. His wife tells the health-care worker that she is concerned because her husband has stopped going to church, turned over the bill-paying duties to her, and spends most of the time listening to the radio.

The health-care worker recognizes this as: a. normal in the newly retired. b. necessary for adjustment to retirement. c. signs of disengagement and possible early depression. d. preparation for transition to advanced old age.

ANS: C

A major developmental task of old age is adjustment to retirement. If the self-worth of the retiree is dependent upon his or her previous occupation, this loss may lead to disengagement or depression.

DIF: Cognitive Level: Application REF: p. 220 OBJ: 4 TOP: Disengagement KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. Among the goals for the aged from Healthy People 2020 is an increased access for the elderly to acquire: a. comprehensive dental care. b. preventative health-care services. c. spiritual counseling. d. legal assistance.

ANS: B

Healthy People 2020 developed goals to increase access to preventative health care.

DIF: Cognitive Level: Knowledge REF: p. 213, Box 14-1 OBJ: 2 TOP: Goals of Healthy People 2020 KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

11. An appropriate strategy when teaching geriatric adults is to: a. ask them to repeat what they heard because of possible hearing deficits. b. use many videos and charts to keep their interest. c. present all the material in one long session rather than two short ones. d. speed up the presentation because of the short attention span.

ANS: A

Asking the geriatric learner to repeat what was heard will assess comprehension as well as the ability to hear accurately. Excess videos may be confusing. Speeding up the presentation is not helpful to the geriatric learner. Offering the information in smaller sessions is helpful to the geriatric person.

DIF: Cognitive Level: Application REF: p. 216 OBJ: 15 TOP: Teaching strategies KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. An appropriate nursing action helpful to older adults with insulin-dependent diabetes mellitus is to: a. avoid discussing future lifestyle changes. b. assure the elder that the condition is stable. c. encourage confidence in the elder as a competent manager of the disease. d. assign the responsibility for insulin injections and blood testing to a home healthcare worker.

ANS: C

Treating geriatric adults as capable of dealing with the illness often calls forth strengths and coping strategies that give them the ability to manage a chronic illness. The health-care worker can provide education and guidance in meeting the needs of the elder in dealing with the illness.

DIF: Cognitive Level: Application REF: p. 225, Box 14-5 OBJ: 14 TOP: Role of the health-care worker KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

13. An elder who lives alone at home says to the home health care worker, “My children haven’t visited me in weeks, and I’ve had no phone calls either. I don’t even have any news about my new granddaughter. I think they have forgotten me.” Which response would be most helpful at this time? a. “I’m sure they didn’t forget you. They must be very busy with your new granddaughter.” b. “Why don’t you give them a call and find out what’s happening?” c. “It sounds as if you are feeling a little neglected at this time.” d. “Well, let’s see what your blood pressure is doing. I bet it is low.”

ANS: C

Social isolation may bring on a sense of low self-esteem.

DIF: Cognitive Level: Application REF: p. 222-223 TOP: Psychological changes in the aging process KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 14

14. When developing a teaching plan for elders, the health-care worker may include family members and significant others because: a. family support affects the elder’s sense of well-being. b. family members are responsible for care of the elder. c. the family members may have conflicting views regarding health teaching topics. d. families need to know how to foster dependence in the elder to prevent serious injury.

ANS: A

The well-being of the elder depends in part on family support system, which contributes to a sense of ego-strength and competence.

DIF: Cognitive Level: Application REF: p. 225, Box 14-5 OBJ: 15 TOP: Teaching strategies KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. An important consideration in the rehabilitation of a geriatric patient to prevent loss of function from inactivity and immobility is: a. using assistive devices such as walkers and canes. b. teaching good nutrition to prevent loss of muscle mass. c. performing active exercises daily. d. assessing for safe environment.

ANS: C

Exercise for all elders is important to prevent functional decline from many different causes.

Assistive devices decrease mobility if they are too difficult for the elder to use. Nutrition is important for muscles, but muscle strength is dependent primarily on use.

DIF: Cognitive Level: Application REF: p. 222 OBJ: 8 TOP: Exercise KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

16. The health-care worker is planning a discussion about sexual responses in the aging population. The health-care worker would make a point to include information relative to that fact that: a. menopause decreases the sexual response in females. b. erotic response of the nipple and clitoris decrease. c. sperm motility is not affected by reduced testosterone. d. males retain their fertility into the eighth decade of life.

ANS: D

Males retain their fertility into their 80s. Menopause does not affect the sexual response or the nipple/clitoris sensitivity. Sperm motility is slowed with the reduction of testosterone.

DIF:

Cognitive Level: Application

REF: p. 218

OBJ: 9

TOP: Sexuality KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. Because of changes in the blood vessels, which become narrow with fatty deposits, the geriatric elder is at risk for: a. hypotension. b. stroke. c. increased heart muscle tone. d. rapid response to anxiety.

ANS: B

The narrowed lumen of the vessels lead to hypertension that puts the geriatric elder at risk for stroke. The heart muscle loses tone and therefore delays the response to anxiety.

DIF: Cognitive Level: Application TOP: Blood vessel changes MSC: NCLEX: NA

REF: p. 215 OBJ: 3 KEY: Nursing Process Step: NA

18. The immune theory of aging proposes that: a. the aging body becomes immune to the restorative properties of nutritious food, adequate sleep, and exercise. b. as body parts begin to age and become dysfunctional, they become immune to the body’s attempt to repair them. c. the aging person’s immune system cannot differentiate between healthy and defective cells and destroys both kinds. d. the geriatric elder becomes immune to many therapeutic remedies and can receive no protection from infection from them.

ANS: C

The immune theory proposes that the aging person’s immune system cannot differentiate between healthy and defective cells and destroys both kinds, leaving the elder at risk for infections and a variety of illnesses.

DIF: Cognitive Level: Knowledge REF: p. 214 OBJ: 1 TOP: Immune theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. The term old-old senescence is categorized as a person who is: a. 65 to 75 years of age. b. 76 to 84 years of age. c. 85 to 99 years of age. d. over 100 years of age.

ANS: C

The “old-old” group in senescence terminology are those people in the age range of 85 to 99 years.

DIF: Cognitive Level: Knowledge REF: p. 213 OBJ: 1 TOP: Senescence: old-old KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. During an assessment, an 80-year-old man says that his wife died a year ago, his only child moved to another city, and he recently moved into an apartment in a new neighborhood so he stays indoors most of the time and watches TV. This man: a. has an opportunity for new social contacts. b. may be at risk for suicide. c. should go live with his child. d. needs the services of Meals on Wheels.

ANS: B

Depression is the most common mental health problem in geriatric elders and often is a result of loss of loved ones, isolation from social contacts, and change in environment, all of which make suicide a common problem in this age-group.

DIF: Cognitive Level: Analysis REF: p. 222 OBJ: 6 TOP: Suicide KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

21. When planning health-promotion classes for geriatric adults, the health-care worker should include information pertinent to: a. vitamin supplements, folic acid. b. hormone replacement therapy, contraception. c. homicide, motor vehicle accidents. d. safe home environment, immunizations.

ANS: D

Control of the environment reduces the risk for falls and fractures, while influenza and pneumonia vaccines decrease the risk for these diseases.

DIF: Cognitive Level: Application REF: p. 223 OBJ: 7 TOP: Health maintenance KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

22.

Regarding cataracts, the most important point is that they: a. are rare and are symptoms of other medical conditions. b. block some of the light to the eye but do not cause blindness. c. are a normal part of aging; most older people have cataracts in both eyes. d. occur in both eyes and vision deteriorates at the same rate.

ANS: C

Cataracts are a normal part of aging. One eye may be worse than the other because cataracts develop at different rates.

DIF: Cognitive Level: Application REF: p. 216 OBJ: 3 TOP: Cataracts KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

23. An 83-year-old senior in a nursing home spends a great deal of time telling stories about past accomplishments and life experiences. The health-care worker recognizes that: a. reminiscing about positive life experiences is therapeutic and helps bring a feeling of achievement and satisfaction to the elder adult. b. this may be early senility, as the elder cannot remember from one time to the next what stories have been told.

c. this story-telling needs to be curtailed to allow others to participate. d. the reminiscences should not be encouraged, to prevent feelings of bitterness or anxiety.

ANS: A

Reflecting on their own accomplishments and life legacy brings a sense of ego integrity and satisfaction to geriatric adults. This reflects successful mastery of the developmental tasks across the lifespan.

DIF: Cognitive Level: Application REF: p. 221 OBJ: 2 TOP: Developmental tasks of the aged KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

24. Interventions to promote health in the geriatric elder that follow the goals of Healthy People 2020 are primarily focused on: a. providing a sense of mastery over health problems. b. managing disease and disability. c. teaching positive health behaviors. d. controlling symptoms of illness.

ANS: C

By teaching about or providing appropriate age-related health promotion activities, the healthcare worker can assist in the promotion of health in the geriatric elder.

DIF: Cognitive Level: Application REF: p. 213, Box 14-1 OBJ: 14 TOP: Role of the health-care worker KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease MULTIPLE RESPONSE

25. The health-care worker encourages the 84-year-old to engage in some physical activity for at least 30 minutes a day. Such natural activities appropriate for the able geriatric person include: (Select all that apply.) a. weight training. b. dancing. c. swimming. d. walking. e. jogging.

ANS: B, C, D, E

Activities such as dancing, walking, swimming, and jogging are appropriate natural exercises for the geriatric person.

DIF: Cognitive Level: Comprehension REF: p. 222 OBJ: 7 TOP: Physical exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

26. The health-care worker assessing an 85-year-old man for his ability to manage the activities of daily living (ADLs) would assess his ability to: (Select all that apply.) a. feed himself.

b. c. d. e.

manage his own finances. cook a simple meal. shop for himself. manage some form of transportation.

ANS: A, C, D

The ADLs that are believed to be essential to independent living are the ability to manage one’s own eating, toileting, bathing, grooming, cooking, shopping, and taking medications.

DIF: Cognitive Level: Application REF: p. 224, Box 14-3 OBJ: 13 TOP: ADLs KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: physiological adaptation COMPLETION

27. According to Sanderson (2008), gerontologists list old age as when the prospects of living another years is not realistic.

ANS:

15 Gerontologists now list old age as when the prospects of living greater than 15 more years is not realistic.

DIF: Cognitive Level: Knowledge TOP: Definition of old age MSC: NCLEX: NA

REF: p. 213 OBJ: 1 KEY: Nursing Process Step: NA

28. According to the theory, a recently retired person who finds satisfaction in hobbies, travel, or volunteering is adjusting to life after retirement.

ANS:

activity The activity theory proposes that a recently retired person finds self-worth and fulfillment in activities such as volunteering, traveling, or pursuing a hobby.

DIF: Cognitive Level: Comprehension REF: p. 222 OBJ: 5 TOP: Activity theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 15: Planning for the End-of-Life Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The sensitive health-care worker can demonstrate therapeutic presence by: a. keeping family informed about patient’s condition every hour. b. remaining near the patient and family. c. calling the chaplain to administer to the family. d. giving pain medication every 4 hours.

ANS: B

Therapeutic presence can be accomplished by simply being near the patient and available.

DIF: Cognitive Level: Knowledge REF: p. 228 OBJ: 9 TOP: Therapeutic presence KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: basic care and comfort

2. The statement that best depicts the preschooler’s understanding of death is: a. “My brother is in a better place now and isn’t sick now.” b. “It will seem funny not to play with my brother anymore.” c. “My mom and dad won’t have two children since my brother died.” d. “I know that my brother got taken because I had a fight with him.”

ANS: D

Preschoolers engage in magical thinking and think that death is reversible. They frequently believe their own behavior caused the illness or death of a sibling.

DIF: Cognitive Level: Analysis REF: p. 238 OBJ: 5 TOP: Family behaviors related to the dying process KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. A 90-year-old West Indian man is dying, and 20 family members fill the hall as they try to crowd into the room. The culturally competent health-care worker will: a. inform the family that only 3 or 4 at a time should try to be at the bedside. b. move out unnecessary furniture to make room for the family. c. direct the family to the waiting room so they will have more space. d. call the chaplain to pray with the family.

ANS: B

Making room for the family at bedside is comforting to West Indian families as they prefer to be at bedside at time of death to pray for their loved one.

DIF: Cognitive Level: Application REF: p. 233, Table 15-3 OBJ: 10 TOP: West Indian rituals KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

4. The health-care worker can support grieving families at the time of death by: a. allowing the family time to stay with the loved one after the death.

b. calling the funeral home to collect the body. c. uttering consoling phrases such as “I know how you feel.” d. emphasizing that the painful grieving should last less than a year.

ANS: A

One of the roles of the health-care worker at the time of death is to provide support to grieving families. Providing privacy and time with the loved one after death allows family members an opportunity to see and touch the deceased, often for the last time.

DIF: Cognitive Level: Application REF: p. 238 TOP: Nursing responsibilities when death occurs KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 9

5. When parents ask if their school-age child should attend the funeral of their grandmother, the health-care worker would base a response on the understanding that attendance will: a. provide an closure for the child. b. be a frightening experience. c. be a deeply religious experience. d. be parents’ responsibility is to protect the child from distressing events.

ANS: A

Attendance at funerals helps the school-age child to realize that death is permanent and provides closure. Sharing this moment of deep significance with parents helps children deal with their own feelings of sorrow and grief.

DIF: Cognitive Level: Application REF: p. 238 TOP: Developmental concepts of death and dying KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 11

6. The primary goal of end-of-life care is: a. comfort and care to promote death with dignity. b. protecting the dying person from needless grieving. c. implementing measures to maintain physiological functioning. d. facilitating the patient’s progress through all stages of grieving.

ANS: A

When modern technology and pharmacology can no longer keep someone alive, the dying person’s bill of rights states that he or she has the right to die in comfort and with peace and dignity.

DIF: Cognitive Level: Application REF: p. 234 OBJ: 6 TOP: Options for end-of-life care KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: basic care and comfort

7. A terminally ill patient is unresponsive and having periods of apnea. The patient’s family is arguing at the bedside about where the funeral should be held. The health-care worker should: a. remind the family that this should be the patient’s decision. b. ask the family members to leave the room. c. take the family members aside and explain that the patient may be able to hear them.

d. tell the family members that such decisions are premature.

ANS: C

Although the dying person may appear to be in a coma, hearing is the last sense to be lost.

Asking the family to leave the room without an explanation is inappropriate.

DIF: Cognitive Level: Application REF: p. 229, Box 15-1 OBJ: 13 TOP: Signs of impending death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

8. The document naming the person or persons who should make health-care decisions if a patient cannot make informed decisions for him- or herself is the: a. personal will. b. living will. c. durable power of attorney. d. do not resuscitate (DNR) order.

ANS: C

The durable power of attorney for health care names the person who is to make medical decisions for the patient if the patient is unable to do so.

DIF: Cognitive Level: Knowledge REF: p. 238 OBJ: 8 TOP: Ethical and legal issues KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe Effective Care Environment: coordinated care

9. The grieving mother whose adolescent son died last week tells the home health-care worker that her 5-year-old has begun to wet the bed. The health-care worker’s most helpful response would be: a. “Your preschooler should probably be evaluated by a urologist.” b. “Your son is showing a rather severe grief reaction.” c. “Regression to less mature forms of behavior are not unusual after a death.” d. “Don’t worry about it. Bedwetting is no big deal.”

ANS: C

Regression is to be expected in the preschooler after a traumatic event such as death.

DIF: Cognitive Level: Application REF: p. 239, Table 15-4 OBJ: 10 TOP: Preschooler reaction to death KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. The health-care worker caring for a dying 78-year-old Hispanic woman understands that in Hispanic families when death is near, the family will: a. seek the spouse’s advice on medical decisions. b. confirm the DNR order. c. call for the shaman to perform religious rites. d. prohibit pregnant women and children from the bedside.

ANS: D

In the Hispanic culture, pregnant women and children are prohibited to be in contact with the dying person. The shaman is the holy man revered by the Native Americans. Hispanics feel DNR orders are not acceptable, and the eldest child is usually responsible for health-care decisions.

DIF: Cognitive Level: Application REF: p. 233, Table 15-3 OBJ: 10 TOP: Hispanic culture KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

11. As a Native American elder is dying, a young health-care worker complains to her supervisor that the eldest son is not at his father’s bedside and is nowhere to be found. The culturally competent health-care worker responds: a. “He is probably making arrangements with the funeral home.” b. “Because he believes it is dishonorable to watch a person die, he is not here.” c. “He has gone to get the ceremonial robes for his father to wear after death.” d. “He is observing his own private grieving away from his dying father.”

ANS: D

Native Americans avoid contact with the dying person and grieve in private, away from the person who is dying.

DIF: Cognitive Level: Application REF: p. 232, Table 15-3 OBJ: 10 TOP: Native American grief KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

12. When the treatment for a 12-year-old child with terminal cancer needs to shift from cure to palliation, the health-care worker reminds the family it is important that they should: a. tell the child that he will not have to take any more treatments. b. explain this new approach in age-appropriate terms. c. the family must understand that palliative care takes place at home. d. withhold this information from the child as it will contribute to a sense of hopelessness.

ANS: B

Truthfulness and explanations in age-appropriate terms will help the child to better communicate his needs and feelings.

DIF: Cognitive Level: Application REF: p. 237 OBJ: 12 TOP: End of life for a child KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

13. When a terminally ill patient says, “I feel that death is just around the corner,” the most appropriate response would be: a. “Don’t talk like that. You sound as if you are giving up hope.” b. “We are all going to die. No one knows when.” c. “Is this feeling something you would like to talk about?” d. “Let’s not talk about dying. Let’s talk about living. “ ANS: C

Health-care professionals need to provide an atmosphere in which the patient is able to freely verbalize feelings about death.

DIF: Cognitive Level: Application REF: p. 231, Table 15-2 OBJ: 2 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Physiological Integrity: basic care and comfort MSC: NCLEX: Psychosocial Integrity: coping and adaptation

14. A dying patient becomes withdrawn and verbally uncommunicative. Relatives try to cheer him up, which is most indicative of: a. hopefulness. b. anticipatory grief. c. very strong support toward the patient’s feelings. d. failure to recognize the patient’s need to openly express his grief.

ANS: D

Most dying persons are aware of the reality of their conditions. Open acknowledgment and open communication provide support during this difficult time not only to the patient, but to family, friends, and caregivers.

DIF: Cognitive Level: Application REF: p. 231 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 1

15. The health-care worker assesses a normal response in a dying 8-year-old boy who says: a. “I am too young to die. God is being cruel to make me die!” b. “I cry because my mom cries a lot.” c. “I will miss my mom and dad, but my grandmother in heaven will take care of me.” d. “After I am dead, I can come back and be with my mom and dad again.”

ANS: C

The school-age child may fear separation from family but envision continuation of life in another form.

DIF: Cognitive Level: Comprehension REF: p. 239, Table 15-4 OBJ: 11 TOP: End-of-life concepts of the school-age child KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. When caring for a terminally ill patient, health-care workers are permitted to provide interventions that: a. present the family with the means to end the dying person’s life. b. actively aim to end a suffering person’s life. c. relieve symptoms only if there is low risk for hastening death. d. offer pain relief to the dying person even if there is a risk death will occur.

ANS: D

Analgesics, particularly opioids, should be administered around the clock to prevent pain, with dosage and schedule adjustments made as needed to maintain maximum comfort. This often requires very large doses of medication given at more frequent intervals, in accordance with the patient’s wishes.

DIF: Cognitive Level: Analysis REF: p. 236 TOP: Role of the health-care worker in end-of-life care KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: basic care and comfort

OBJ: 9

17. The school-age siblings of a dying child should be: a. involved in the plan of care for their sibling. b. allowed to remember the dying child as he or she was before death. c. allowed to contact their sibling only by phone. d. protected from death rituals and end-of-life care.

ANS: A

Siblings should be included as much as possible in the plan of care for the dying child, so they do not feel abandoned or punished or develop a sense of sibling rivalry and, later, guilt feelings.

DIF: Cognitive Level: Application REF: p. 238 OBJ: 7 TOP: Death of a child KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

18. The best practice in promoting quality of life for a terminally ill 10-year-old child would be: a. focused on the child’s chronological age. b. allowing the child to return to his or her regular classroom. c. having the child cared for only by health-care providers, who are more objective than families. d. placing the child in a health-care facility for treatment and care.

ANS: B

An important understanding about quality of life for a child with a terminal illness is that they can participate in age-appropriate activities as normal, healthy children do. Attending school, even if it must be part time, helps the child and family cope with the illness.

DIF: Cognitive Level: Analysis REF: p. 239, Table 15-4 OBJ: 5 TOP: Developmental concepts of death and dying KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. Denial is a common reaction to the diagnosis of a terminal illness, because the use of this defense mechanism: a. is a maladaptive response. b. is helpful to adaptation. c. prevents a sense of hope. d. prevents the development of problem-solving behavior.

ANS: B

Denial may allow the patient to function adaptively and productively through the grief process. It is helpful for gradual adaptation and does not interfere with problem-solving behavior.

DIF: Cognitive Level: Comprehension REF: p. 230 TOP: Denial KEY: Nursing Process Step: Planning

OBJ: 2

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

20. Patients and families progress through various stages of reactions when a diagnosis of a terminal illness is made. After the helplessness phase, a period of adjustment usually follows. This phase is characterized by: a. social reintegration. b. denial. c. guilt. d. acceptance.

ANS: C

Although some patients and families never progress beyond the shock and denial stage, most go through stages of the grieving process. Anger and guilt usually follow denial, and some patients will regress to anger from time to time even though they may have reached a level of acceptance of the diagnosis.

DIF: Cognitive Level: Comprehension REF: p. 230 OBJ: 7 TOP: Grief reaction KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

21. An 8-year-old child with a terminal illness is returning to school after having received treatment that has caused hair and weight loss. The most appropriate action by the school nurse would be to: a. recommend that the child’s parents attend school at first to prevent teasing. b. refer the child to a home school program. c. discuss with the child and the parents that the child’s classmates will not accept him or her as before. d. prepare the child’s classmates and teachers for changes they can expect.

ANS: D

Peer contact and regular school attendance should be encouraged to promote quality of life for the child with terminal illness. Classmates and teachers can be very supportive when they understand the changes they will see in the child.

DIF: Cognitive Level: Application REF: p. 239, Table 15-4 OBJ: 5 TOP: Developmental concepts of death and dying KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

22. A young Cambodian man has just arrived at the hospital from the airport to find that his father has already died. His family members are all praying at the bedside. The culturally competent health-care worker would offer the young man a(n): a. white hospital gown to wear. b. small basin with soap so that he may wash his hands before praying. c. surgical cap so he may cover his head. d. opportunity to pray with the hospital chaplain.

ANS: A

Cambodians wear white during their grief rituals.

DIF: Cognitive Level: Comprehension REF: p. 232, Table 15-3 OBJ: 10 TOP: Culture and dying

KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

23. A terminally ill patient in hospice care says that she plans to attend her grandson’s college graduation 5 months from now. This patient: a. is in denial about her condition. b. has unrealistic expectations about the length of time she has left. c. will probably live to attend the graduation. d. is only offering her family false hope and should stop planning an event so far in the future.

ANS: C

Patients with a strong desire to be present at an important family event often prolong their lives until that event, then die soon afterwards.

DIF: Cognitive Level: Application REF: p. 229, Table 15-1 OBJ: 3 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

24. A terminally ill man tells the health-care worker, “I have never believed in God or in an afterlife, but now it really doesn’t seem so bad.” The health-care worker assesses that this man has reached the dying state of: a. denial. b. bargaining. c. depression. d. acceptance.

ANS: D

The Kübler-Ross stages of dying describe acceptance as a sense of “My time has come.”

DIF: Cognitive Level: Comprehension REF: p. 229, Table 15-1 OBJ: 2 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

25. A school-age child is diagnosed with a terminal illness. The parents want to protect their child from knowing the seriousness of the illness. The health-care worker should explain that: a. denial will help the child cope more effectively. b. this attitude is helpful in order to give the parents more time to cope. c. terminally ill children usually do not wish to discuss the seriousness of their illness. d. truthfulness in understandable terms is the most supportive approach.

ANS: D

Children who have a terminal illness are often more aware of their condition than parents realize. Therefore, truthfulness, explained in age-appropriate terms in a supportive manner, is the best approach when providing care to a terminally ill child.

DIF: Cognitive Level: Application REF: p. 237 OBJ: 11 TOP: Death of a child KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

26. A psychological death occurs begins when the: a. dying person begins to discuss end-of-life rituals. b. person is informed of a terminal illness. c. terminally ill person gives up hope. d. person loses confidence in his curative protocols.

ANS: B

The phenomenon of psychological death begins when the person is informed of his terminal illness and the body processes decline in function.

DIF: Cognitive Level: Application REF: p. 228 OBJ: 3 TOP: Psychological death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

27. The health-care worker enters the room of a patient who has just been diagnosed with a terminal illness. The son is highly agitated and tearfully screams, “I am taking my dad out of this place and take him somewhere where people actually care what happens to him!”

The most helpful response would be: a. “Why don’t you tell me what is really wrong?” b. “I can understand your angry feelings.” c. “I’ll be back when you calm down.” d. “Yelling at me will not change the diagnosis.”

ANS: B

Therapeutic communication involves not only accepting a patient’s anger and emotional outbursts but those of the family as well.

DIF: Cognitive Level: Application REF: p. 229, Table 15-1 OBJ: 2 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

28. The best description of therapeutic communication related to terminally ill patients and their families would be that it is a(n): a. goal-directed interaction that brings about the patient’s insight. b. purposeful interaction that is highly structured. c. interaction guided by the needs of the patient and the health-care worker. d. interaction that involves accepting the patient’s emotional responses.

ANS: D

Therapeutic communication with terminally ill patients and families involves acceptance of emotional outbursts and expressions of anger and encourages venting and verbalization.

DIF: Cognitive Level: Comprehension REF: p. 228 TOP: Psychological responses of the dying patient MSC: NCLEX: NA

OBJ: 7 KEY: Nursing Process Step: NA

29. A terminally ill person has elected to stop receiving curative treatment and has requested no cardiopulmonary resuscitation. The family is very upset by this decision and wants to override the patient’s decision. The best response to the family is: a. “I will discuss your concerns with the doctor and ask her to reinstitute treatment.” b. “I will discuss your concerns with your family member and try to get him to change

his mind.” c. “According to the dying person’s bill of rights, your relative has the right to make this decision.” d. “I will get the chaplain to help you accept this decision.”

ANS: C

According to the dying person’s bill of rights, the patient has the right to participate in decisions concerning care and the right to not be judged for his or her decisions, which may be contrary to the wishes or beliefs of others.

DIF: Cognitive Level: Application REF: p. 234 , Box 15-2 OBJ: 6 TOP: Dying person’s bill of rights KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

30. The family of a terminally ill Hindu patient requests that all life support equipment be removed, as per the wishes of the patient, and the loved one discharged to their care at home. The health-care worker points out that: a. “This is an unrealistic request. Your family member is in no shape to go home.” b. “I’m sorry, that request is against hospital policy.” c. “The grief counselor can speak to you about this decision.” d. “I know that you and your loved one will be more comfortable at home; I will do what I can to expedite the process.”

ANS: D

Hindus prefer death to occur in the privacy of their own home, where family and friends can conduct religious ceremonies without interruption. Health-care providers must demonstrate cultural competence when providing end-of-life care.

DIF: Cognitive Level: Analysis REF: p. 232, Table 15-3 OBJ: 10 TOP: Culture and dying KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation MULTIPLE RESPONSE

31. The impending signs of death include: (Select all that apply.) a. thirst. b. anorexia. c. pulmonary congestion. d. flushed face. e. mottled extremities.

ANS: B, C, E

Among the signs of impending death are weakness, weight loss, decreased appetite (anorexia), sweating, pulmonary congestion, altered breathing patterns, decreased urine output slowed pulse, relaxed jaw, and mottled, cold extremities.

DIF: Cognitive Level: Application REF: p. 229, Box 15-1 OBJ: 13 TOP: Signs of impending death KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: physiological adaptation

32. The health-care worker clarifies to the family of a dying patient that palliative care includes: (Select all that apply.) a. patient-centered care b. analgesics c. oxygen therapy d. curative therapy e. laxatives ANS: A, B, C, E

Palliative care is an active total care of patients whose disorder does not respond to curative therapy, and aggressive curative efforts are not pursued. The patients are provided with comfort measures such as pain and anxiety relief, oxygen therapy, laxatives, and antinausea drugs.

DIF: Cognitive Level: Application REF: p. 235 OBJ: 4 TOP: Palliative care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation COMPLETION

33. The health-care worker recommends the services of , a community healthcare organization specializing in the care of dying patients and their families.

ANS:

hospice Hospice services are provided to patients and families through the death and bereavement process. The service addresses the physical, psychological, spiritual, and social needs of the dying patient. This service is available to patients in the hospital, nursing home, and in their own home.

DIF: Cognitive Level: Comprehension REF: p. 239 OBJ: 4 TOP: Hospice care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychological Integrity: coping and adaptation

34. The Act of 1990 is a federal law stating that acute care or long-term care facilities must provide written information to patients concerning their rights to accept or refuse treatment and make advance directives.

ANS:

Omnibus Reconciliation The Omnibus Reconciliation Act of 1990 and the Patient Self-Determination Act mandates that all patients, at the time of admission, should be given written information relative to their right to refuse treatment and should be encouraged to make advance directives.

DIF: Cognitive Level: Comprehension REF: p. 235 OBJ: 8 TOP: Omnibus Reconciliation Act of 1990 KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment: coordinated care

Chapter 16: Bereavement Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. A grief reaction that interferes with life’s functions is: a. mourning. b. anticipatory grief. c. bereavement. d. dysfunctional grief.

ANS: D

Dysfunctional grief is the continued expression of unresolved issues and symptoms that interfere with life’s functions.

DIF: Cognitive Level: Comprehension REF: p. 247-248 OBJ: 3 TOP: Dysfunctional grief KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

2. After giving birth to a stillborn baby, the woman says, “I just painted the baby’s room. Do you think that had an influence on my baby’s death?” The best response to this woman is: a. “No, that’s an old wives’ tale.” b. “Maybe. The excessive exertion may have caused the loss of the baby.” c. “Looking for answers to questions like that will prolong your grief.” d. “I can understand your need to find an answer to what caused this.”

ANS: D

Clear information should be provided about the cause of death. Part of the grief process for bereaved parents is figuring out what happened, their role in the loss, why it happened to them, and why it happened to their baby. The health-care worker needs to recognize that these questions must be answered by the bereaved themselves as part of their healing.

DIF: Cognitive Level: Application REF: p. 251 OBJ: 8 TOP: Pregnancy and grief KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

3. The statement that would be least therapeutic to say to the bereaved mother at the death of her infant son would be: a. “I have called your husband. He will be here soon.” b. “You can stay with him and hold him if you wish.” c. “He was a very special little boy to me.” d. “Fortunately he is not suffering anymore.”

ANS: D

Health-care workers can facilitate the grief process by having a basic understanding of the process, by talking with family members, and by supporting the family’s efforts to cope, adapt, and grieve. A comment such as “be glad he is not suffering” is nontherapeutic. Sharing their own feelings of loss is supportive.

DIF: Cognitive Level: Application REF: p. 249, Table 16-4 OBJ: 10 TOP: Role of the health-care worker

KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

4. After the death of an 80-year-old Jewish man, the health-care worker is aware that while the family is waiting for the funeral home to come for the body, the deceased is: a. covered by a ceremonial cloth. b. prepared for burial on the next Saturday. c. blessed by placing a basil leaf on his tongue. d. never left alone.

ANS: D

The Jewish religion requires that the body be buried within 24 hours of death, not be left alone, and not be moved on a Saturday.

DIF: Cognitive Level: Comprehension REF: p. 247, Table 16-2 OBJ: 4 TOP: Jewish death rituals KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

5. At the time of a child’s death, a “memory kit” is made for the parents. The most appropriate items in such a kit would be: a. the hospital identification bracelet. b. a curl of the baby’s hair. c. the pacifier used to quiet the baby. d. the small hospital blanket used to cover the baby.

ANS: B

The recognition of the child as Na sU e p Rar Sat I e pNerG soT nBis . h eClpf O ul . MThe preservation of a “memory kit” made up of carefully selected photos or a curl of hair is thoughtful.

DIF: Cognitive Level: Comprehension REF: p. 250 OBJ: 10 TOP: Helping the grieving survivors KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

6. The health-care worker can provide the best support to a family experiencing anticipatory grief related to the imminent death of a loved one by: a. discouraging premature expressions of grief. b. suggesting activities to cheer up the family. c. attempting to “lighten the mood.” d. being available to the family.

ANS: D

Health-care workers need to be available to the family to discuss the grieving process and provide opportunities for the family to express emotions.

DIF: Cognitive Level: Application REF: p. 247 OBJ: 10 TOP: Grief process KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

7. A man whose wife died 6 months ago says that he sometimes still “hears” his wife’s voice and has trouble sleeping and does not feel like socializing. The health-care worker recognizes that: a. these complaints are part of a normal grief response.

b. the pain of the loss should be less by this time. c. these responses are more typical immediately after the death. d. this grieving is excessive and should be evaluated.

ANS: A

These responses are typical of early grief. As family members move through the bereavement process, they will exhibit physical signs of weight loss and insomnia, confusion, and inability to concentrate and social withdrawal.

DIF: Cognitive Level: Application REF: p. 244 OBJ: 5 TOP: Normal grief responses KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

8. Several health-care workers have requested to attend the funeral of a patient for whom they felt especially close. The supervisor recognizes that attending the funeral is: a. appropriate, because families always expect this expression of concern. b. appropriate, because it can assist in the resolution of personal grief. c. inappropriate, because it is unprofessional. d. inappropriate, because it increases the potential for burnout.

ANS: B

Attending the funeral can be a supportive act for both the health-care worker and family members and is in no way unprofessional. For the family, it conveys a sense of support and caring. For the health-care worker, it can provide a sense of “closure” and assist in resolution of personal grief.

DIF: Cognitive Level: Application REF: p. 254 OBJ: 10 TOP: Offering condolence Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

9. While doing final preparations for a Hindu woman to be picked up by the funeral home, the health-care worker observes a thread tied around the corpse’s wrist and a basil leaf in her mouth. These items: a. are to be removed only by the next of kin. b. may be removed by the sadhu, the Hindu holy man. c. should be left in place. d. should be collected and given to the eldest son.

ANS: C

Hindus tie a string around the wrist of the dying person and also place a basil leaf on their tongue. These should not be removed after death.

DIF: Cognitive Level: Application REF: p. 247, Table 16-2 OBJ: 6 TOP: Hindu religious rights KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: basic care and comfort

10. When a dying 90-year-old woman gives her rosary to her granddaughter, this gift should be viewed as a: a. religious ceremony. b. legacy. c. sign of favoritism.

d. directive for greater spiritualism.

ANS: B

A legacy is something that the dying person leaves to the world that provides some small assurance of immortality.

DIF: Cognitive Level: Knowledge REF: p. 243 TOP: Legacy KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 1

11. When the shocked father of a 17-year-old who committed suicide says, “We should have seen this coming. I feel so guilty.” The most therapeutic response would be: a. “This must be awful for you. Tell me about your son.” b. “I know how you must feel.” c. “Don’t feel guilty. It was his decision.” d. “Tell me what happened.”

ANS: A

Survivors feel the death could have been prevented. The most therapeutic intervention is to listen. The request to be told what happened will seem like a police inquiry and is not therapeutic.

DIF: Cognitive Level: Comprehension REF: p. 249, Table 16-4 OBJ: 10 TOP: Support after a suicide KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

12. The parents of a 7-year-old are concerned because their child, upon being informed about the NURSINGTB.CO death of his grandmother, said, “Nana is mean. I don’t love her anymore!” This behavior is: a. maladaptive. b. an inability to have a concept of death. c. anxiety about their own death. d. a normal reaction.

ANS: D

Young children react to death in ways that reflect their developmental stage. By this age, children realize death is irreversible and often may show anger toward the one who left them.

DIF: Cognitive Level: Application REF: p. 251 OBJ: 8 TOP: Grief early in the life cycle KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

13. The most therapeutic communication to use with a bereaved family should reflect: a. reassurance of reduction of grief. b. acknowledgment of the loss. c. interpretation of depth of grief. d. cheerfulness.

ANS: B

Acknowledging the loss validates the loss and grief the family feels at this time and offers understanding as the family begins the process of grieving.

DIF:

Cognitive Level: Comprehension

REF: p. 253

OBJ: 10

TOP: Expressing condolence MSC: NCLEX: NA

KEY: Nursing Process Step: NA

14. A widow of 10 months says that she has started sleeping better, is going out more with friends, and can talk about her husband without feeling so lost and angry. The health-care worker recognizes that this represents: a. the beginning of the “letting-go” process. b. an inability to accept the reality of her husband’s death. c. her true feelings of relief that her husband has died. d. recognition that she is now ready to make changes in her life, such as selling her house or moving to a new city.

ANS: A

Letting go of the past begins when the survivor can begin to speak of the loved one without deep pain, move away from a feeling of isolation, and feel less intense grief from the loss.

DIF: Cognitive Level: Analysis REF: p. 253 TOP: Mastering tasks toward grief healing KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 9

15. After the death of their child in the emergency room following a hit-and-run automobile accident, the mother says, “God is dead for me. God is as dead as my child. I will not worship a dead god!” The most helpful response would be: a. “I am sorry for your loss.” b. “Let me get the hospital chaplain for you!” c. “God feels your pain and he is still there for you. d. “I can understand why youNfeUeRl aSnIgrNyGwTitBh.GCoOd Mand everyone else right now.”

ANS: D

Validating the mother’s feelings of anguish is therapeutic. The option “I am sorry for your loss” is too bland and impersonal for this situation.

DIF: Cognitive Level: Comprehension REF: p. 249, Table 16-4 OBJ: 10 TOP: Role of the health-care worker KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

16. The family of a young girl killed in an automobile accident arrives at the hospital shortly after her death and requests to see her body. Since she is disfigured from the accident, the most appropriate action is to: a. explain that their daughter is disfigured and that it would be too upsetting for them to see her. b. contact a grief counselor to discuss this problem with them. c. encourage them to wait to see her until the funeral home has prepared her body. d. inform them of what to expect and then let them see the body.

ANS: D

Although memory of a loved one’s disfigurement can be upsetting, seeing the loved one is the first step in accepting the loss.

DIF:

Cognitive Level: Application

REF: p. 244

OBJ: 4

TOP: Grief KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

17. A health-care worker is preparing the body of an Arab American patient who just died for transfer to the morgue. Family members insist on washing and cleansing the body before it is taken away. The health-care worker’s best response is: a. “No, I’m sorry, only hospital personnel are allowed to do this.” b. “I think it would be better if you left the room while I make him ready.” c. “Yes, of course you may. Do you need any special cloths or towels?” d. “I’m afraid it will just make you more distressed if you touch him again.”

ANS: C

In Arab culture, family members wish to take part in washing and preparing the body or have special bathing done by a member of their clergy. Health-care workers need to be especially sensitive to cultural practices at this difficult time.

DIF: Cognitive Level: Application REF: p. 245, Table 16-1 OBJ: 6 TOP: Culture, religion, and death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

18. Seven months ago, a 30-year-old man lost his wife in an automobile accident. His coworkers have become concerned about his mood swings from rage to uncontrolled crying. The health-care worker recognizes that this is: a. normal grief due to the unexpectedness of his loss. b. abnormal grief that may require psychological counseling. c. a manifestation of a personality disorder. d. outward expressions of grief that are considered normal.

ANS: B

Although some signs and symptoms of abnormal grieving are similar to those of normal grieving, extreme emotional lability after this length of time most likely represents a major depressive episode and dysfunctional grieving, requiring medical or psychological attention.

DIF: Cognitive Level: Comprehension REF: p. 248 OBJ: 7 TOP: Abnormal grieving KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

19. The manner in which persons adjust to losses in their life will determine: a. family relationships. b. depth of religious views. c. quality of life. d. maturity.

ANS: C

Positive adaptation to the losses in life, such as deaths, changes due to old age, and economic losses, often determines the quality of life that is maintained.

DIF: Cognitive Level: Comprehension REF: p. 243 OBJ: 5 TOP: Loss adaptation KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

20. A newborn in the neonatal intensive care unit is dying, and the neonatologist has shared with the parents their baby’s prognosis. When the father sees his son, he says, “He looks just fine to me. I can’t understand what all this is about.” The health-care worker recognizes that the father is: a. in denial or disbelief. b. attempting to shield the truth from his wife. c. in the shock and numbness phase of mourning. d. beginning anticipatory grieving.

ANS: A

When parents are first told of the impending death of a child, the initial response from some is disbelief and denial. Some denial is important for parents; it protects them from the overwhelming reality of the death. Shock and numbness usually predominate during the first 2 weeks after a loss, and normal functioning is impeded.

DIF: Cognitive Level: Analysis REF: p. 244 OBJ: 5 TOP: Grief early in the life cycle KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

21. The event most likely to make a grief reaction complicated and pathological would be: a. identification with the lost person. b. death by suicide. c. fantasizing about one’s own death. d. intense anticipatory grieving.

ANS: B

Death of a loved one by suicide affects the grieving process and may contribute to pathological grieving.

DIF: Cognitive Level: Comprehension REF: p. 248 OBJ: 7 TOP: Abnormal grieving KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

22. A common anxiety about suicide is reflected when the twin brother of a suicide victim asks: a. “Although he is dead, am I still a twin?” b. “Do you think I will be tempted to commit suicide like he did?” c. “Do you think my parents will ever get over this?” d. “Have you ever had suicidal thoughts?”

ANS: B

Death of a loved one by suicide may leave the survivors feeling that there may be an inherited predisposition for suicide.

DIF: Cognitive Level: Analysis REF: p. 249, Box 16-2 OBJ: 8 TOP: Reaction to suicide KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

23. Persons experiencing bereavement should postpone making drastic changes in their lives for at least: a. 1 month. b. 6 months.

c. 1 year. d. 2 years.

ANS: C

Postponing making changes in lifestyle for at least 1 year to allow careful thought for the considered changes is recommended for bereaved persons.

DIF: Cognitive Level: Application REF: p. 253 OBJ: 9 TOP: Decisions during bereavement KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

24. A bereaved person is in special need of condolence and support: a. on the deceased’s birthday. b. at the first of the year. c. on the anniversary date of the death. d. on the weekends.

ANS: C

Reinforcing support is especially important on the anniversary of the death.

DIF: Cognitive Level: Knowledge REF: p. 253-254 OBJ: 1 TOP: Condolence KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation MULTIPLE RESPONSE

25. The process of bereavement includes the survivors’: (Select all that apply.) a. reaction to the loss. b. c. d. e.

refusal to integrate the loss. portrayal of the deceased as perfect. adjustment to the loss. reorganization of the fabric of life.

ANS: A, D, E

Bereavement is the three-step process of reacting to the loss, adjusting to the loss, and moving on with the reorganization of the fabric of life.

DIF: Cognitive Level: Comprehension REF: p. 244 OBJ: 3 TOP: Bereavement KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

26. The death rituals observed by the East Indian community include which aspect(s)? (Select all that apply.) a. Family members wash and prepare the body. b. Family allows only the heart to be donated. c. The naked body is wrapped in a white sheet. d. Official mourning will last for 40 days. e. The body is buried within 24 hours of death.

ANS: A, D

East Indian family members wash, dress the body in new clothes, and prepare the body for cremation. East Indians do not allow organ donation, and the mourning lasts for 40 days.

DIF: Cognitive Level: Knowledge REF: p. 248, Table 16-1 OBJ: 6 TOP: East Indian death rituals KEY: Nursing Process Step: NA MSC: NCLEX: Psychosocial Integrity: coping and adaptation COMPLETION

27.

is the outward expression of grief.

ANS:

Mourning Mourning is the outward expression of grief, often based on cultural practices and traditions.

DIF: Cognitive Level: Comprehension REF: p. 244 OBJ: 3 TOP: Mourning KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

28. Saying goodbye to the pain of loss, the feeling of isolation, and the nearness of the loved one is known as .

ANS:

letting, go letting go Letting go does not mean forgetting the loved one. It means saying goodbye to the deep anguish of loss, expressing positive and negative memories of the deceased, and moving on.

DIF: Cognitive Level: Knowledge REF: p. 253 NURSINGTB.CO TOP: Mastering tasks toward grief healing KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 9

a. “He will only wake up to be fed, and you should not bother him between feedings.” b. “A newborn sleeps about 17 hours a day with periods of wakefulness gradually increasing.” c. “He will probably follow your same sleep and wake patterns, so you can expect him to be awake soon.” d. “You should try to limit day sleep to about 3 hours so he will sleep through the night.”

ANS: B

Neonates sleep 15 to 20 hours a day in the first 3 to 4 weeks of life. By 4 weeks, some infants stay awake from one feeding to the next.

DIF: Cognitive Level: Comprehension REF: p. 88 OBJ: 8 TOP: Neonatal sleep patterns KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. Parents of a newborn ask about the baby’s vision and specifically want to know what visual stimuli they should provide for the newborn. The most appropriate response is: a. “Babies can see very little until about age 3 months.” b. “It is important to shield the baby’s eyes. You should ask your physician what visual stimulation to offer your child.” c. “The baby’s eyes are immature and must be protected. Any visual stimuli should not contain bright or strong colors.” d. “Newborns have good near vision. A brightly colored mobile to hang over the crib is a good choice for your baby.”

ANS: D

The newborn can both see and hear. A musical mobile would capture the baby’s attention via hearing and vision.

DIF: Cognitive Level: Application REF: p. 91 OBJ: 12 TOP: Visual stimuli KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. Characteristics of dizygotic twins include their being: a. of the same sex. b. formed from the same single ovum and sperm. c. always carried to full term. d. similar to each other as any sibling.

ANS: D

Dizygotic twins (fraternal) occur when two ova are released and both ova are fertilized by two different sperm. The two embryos are not necessarily of the same sex and will resemble each other no more than any other siblings. Many twins are born prematurely as the uterus becomes overdistended.

DIF: Cognitive Level: Application REF: p. 79 OBJ: 6 TOP: Dizygotic twins KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. A young, newly pregnant woman who led a sedentary life prior to pregnancy asks what sort of exercise would be beneficial. Helpful suggestions would be to engage in regular: a. aggressive exercise at a gym. b. jogging. c. lifting free weights. d. swimming.

ANS: D

Swimming is a good light exercise program to recommend to a previously sedentary pregnant woman.

DIF: Cognitive Level: Application REF: p. 80 OBJ: 5 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

18. Warnings that are appropriate to an exercising pregnant woman in her second trimester of pregnancy would include: a. limiting water while exercising to prevent hypertension. b. avoiding exercises that require the supine position. c. performing exaggerated range-of-motion exercises. d. exercising strenuously to supply extra heat and blood to the placenta.

ANS: B

Exercising should be moderated so that no supine positions are assumed after the second trimester to avoid cord compression. While exercising, adequate hydration should be maintained. Excessive heat increases the oxygen needs of the fetus and should be avoided.

DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 5 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk

19. The pH of the female reproductive tract and estrogen level have an effect on fertilization in that they: a. soften the ovum to enhance fertilization. b. can trap defective sperm. c. determine the sex of the fetus. d. affect the speed of the ova and sperm entering the fallopian tube.

ANS: D

Vaginal pH and the estrogen level of the female enhance the speed of the movement of the sperm and the ova into the fallopian tube where fertilization occurs.

DIF: Cognitive Level: Comprehension REF: p. 75 OBJ: 4 TOP: Fetal development KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. The young pregnant woman with type 2 diabetes mellitus should get at least exercise a day to control weight and blood glucose. a. 10 b. 15 c. 30 d. 60

minutes of

ANS: C

Thirty minutes per day of light exercise will help control weight and control glucose levels.

DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 3 TOP: Exercise during pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

21. Development of neural tube defects seems to be more common in the fetuses of pregnant women whose diet is low in: a. iron. b. vitamin D. c. folic acid. d. essential amino acids.

ANS: C

Research has shown a higher incidence of neural tube defects in fetuses of women with folic acid deficiency. In 1992 the U.S. Public Health Service recommended that all women of childbearing years consume 0.4 mg of folic acid daily.

DIF: Cognitive Level: Comprehension REF: p. 78 TOP: Folic acid KEY: Nursing Process Step: NA

22. The term fetus refers to an embryo that is a. 2 b. 3 c. 6 d. 9

OBJ: 3 MSC: NCLEX: NA

weeks old.

ANS: D

From the 9th week of life, the embryo is called a fetus.

DIF: Cognitive Level: Comprehension REF: p. 75 TOP: Fetus KEY: Nursing Process Step: NA

OBJ: 3 MSC: NCLEX: NA

23. The Moro (startle) reflex, which is present at birth, disappears normally at the age of: a. 3 months. b. 4 months. c. 5 months. d. 6 months.

ANS: A

The Moro (startle) reflex disappears 1 to 3 months after birth.

DIF: Cognitive Level: Comprehension OBJ: NA TOP: Reflexes MSC: NCLEX: NA

REF: p. 90, Table 6-3 KEY: Nursing Process Step: NA

24. Good prenatal nutrition is stressed to an expectant mother because poor nutrition could increase the baby’s risk of in later life. a. diabetes b. kidney failure c. respiratory disorders

d. coronary artery disease ANS: D

Inadequate prenatal nutrition can alter the structure of the baby’s body and lead to coronary artery disease or stroke.

DIF: Cognitive Level: Application REF: p. 79 OBJ: 7 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

25. The prenatal intervention that would be most helpful to a prospective father about his new role would be to: a. explain the physiological and psychological changes he can expect in the mother. b. demonstrate diapering and bathing techniques. c. let him verbalize his feelings about the pregnancy and fatherhood. d. encourage him to think about his role in the pregnancy.

ANS: C

Future changes in sleep patterns, household responsibility, and financial concerns are stressful to the father and may need to be verbalized.

DIF: Cognitive Level: Application REF: p. 86 TOP: Paternal adaptations during the prenatal phase KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 9

26. The single most important influence on appropriate growth and disease prevention at all stages of development is: a. nutrition. b. heredity. c. culture. d. environment.

ANS: A

Lack of proper nutrition during critical periods of fetal development can cause maldevelopment or malfunction of a specific organ or system that may not be manifested until adulthood. One of the goals of Health People 2020 is to prevent disease in the next generation by improving the nutrition of mothers and babies.

DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 7 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. The most effective time for interaction between parents and the new baby is when the baby is in the state of: a. active alert. b. crying. c. drowsiness. d. quiet alert.

ANS: D

During the quiet alert state, the infant responds to the environment by staring at close-range objects and people. This is a good time for visual contact and conversation by the sibling.

DIF: Cognitive Level: Comprehension REF: p. 88 OBJ: 10 TOP: Developmental tasks and responses KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

28. A woman delivered a baby 1 hour ago. The nurse is ready to assist her with breastfeeding.

The woman states she cannot breastfeed until her “good” milk comes in. She says she is afraid the “thin” milk will harm the baby. The nurse’s best response is: a. “You should begin breastfeeding now or your milk will never come in.” b. “I understand that you believe this colostrum is unhealthy for the baby. Let’s talk about feeding alternatives until your milk comes in.” c. “If you don’t provide your baby with the benefits of colostrum, he will have more childhood illnesses than normal.” d. “Your baby will not learn to suck correctly if you don’t start breastfeeding now.”

ANS: B

In the provision of culturally competent care, the nurse needs to understand and respect the beliefs and practices of the families in his or her care.

DIF: Cognitive Level: Application REF: p. 88 OBJ: 7 TOP: Culturally competent care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

29. After the delivery of the newborn, the major focus for its well-being is to: a. initiate hydration. b. provide nutrition. c. prevent heat loss. d. stimulate bonding.

ANS: C

After delivery, the newborn is dried, placed in a prewarmed bed, and the head is covered to minimize heat loss.

DIF: Cognitive Level: Application REF: p. 83 TOP: Heat loss KEY: Nursing Process Step: NA

OBJ: NA MSC: NCLEX: NA

30. After delivery, the new father is staring intently at his newborn and lightly running his fingertips over the baby’s face. The father is beginning: a. parenting. b. engrossment. c. development. d. identification.

ANS: B

Fathers or significant others develop an intense focus on the newborn, called engrossment.

Characteristics of engrossment include touch and eye-to-eye contact as the father seeks to identify features both unique to the newborn and similar to himself. An outstanding response is one of strong attachment to the infant and a sense of increased self-esteem.

DIF: Cognitive Level: Knowledge REF: p. 85 OBJ: 8 TOP: Fathers or significant others KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

31. A Chinese woman rejects the plan for her to bring the newborn to the health clinic before the seventh day of life to repeat the test for phenylketonuria (PKU) stating that it is too early for her to come. The culturally competent health-care worker would ask: a. “Do you lack transportation to the clinic?” b. “Isn’t your baby’s health important enough to come to the clinic?” c. “Do you realize that the state requires this test to be done?” d. “Do you need more time to heal after your delivery?”

ANS: D

To provide culturally competent care, the health-care worker must understand that in some cultures the postpartum period may last 30 days or longer, with the woman forbidden from leaving the home.

DIF: Cognitive Level: Analysis REF: p. 88 OBJ: 9 TOP: Culturally competent care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation MULTIPLE RESPONSE

32. Methods of holding a neonate that are comforting and consoling to the baby and reinforce bonding include: (Select all that apply.) a. holding baby upright on parent’s knee. b. placing the nude baby on the naked chest of the parent. c. swaddling the baby. d. cuddling the baby. e. the football hold supporting baby with one arm.

ANS: B, C, D

Close, warm positions quiet and soothe a baby and encourage bonding.

DIF: Cognitive Level: Comprehension REF: p. 89 OBJ: 10 TOP: Comfort and bonding KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

33. In speaking with a group of parents, the health-care worker informs them that in the case of a premature delivery, the fetus of 25 weeks gestation has many attributes that would help support extrauterine life. These include: (Select all that apply.) a. surfactant in the lungs. b. respiratory movements. c. a functioning central nervous system (CNS). d. smooth skin. e. subcutaneous fat.

ANS: A, B

The 2-week-old fetus is viable and has surfactant in the lungs and has begun respiratory movements, but the CNS is not fully functional. There is no subcutaneous fat; therefore, the skin is wrinkled.

DIF: Cognitive Level: Analysis REF: p. 76, Table 6-1 OBJ: 3 TOP: Viability KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

34. A complete set of DNA contained in all human cells is referred to as a(n)

.

ANS:

genome A genome is a complete set of DNA that is contained in all cells.

DIF: Cognitive Level: Comprehension REF: p. 73 TOP: Genome KEY: Nursing Process Step: NA

35. A gene to replace it.

OBJ: 1 MSC: NCLEX: NA

can now be programmed to destroy a defective gene, allowing a pure

ANS:

suicide gene Suicide genes are therapeutic genes that destroy defective genes allowing for a pure gene to replace it.

DIF: Cognitive Level: Comprehension REF: p. 74 TOP: Suicide gene KEY: Nursing Process Step: NA

OBJ: 1 MSC: NCLEX: NA

Chapter 7: The Infant Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The 5-month-old should demonstrate: a. hand-to-mouth coordination. b. neat pincer grasp. c. building a tower of two cubes. d. ability to grasp an object voluntarily.

ANS: D

By 5 months, newborn reflexes have disappeared and the infant is able to shape the hand to voluntarily grasp an object.

DIF: Cognitive Level: Knowledge REF: p. 102, Table 7-2 OBJ: 4 TOP: Motor development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. According to Erikson, infancy is concerned with acquiring a sense of: a. trust. b. industry. c. initiative. d. autonomy.

ANS: A

Trust develops when infants learn their basic needs will be met, providing the foundation for all succeeding phases of development. Trust assists infants in experiencing unknown or unfamiliar situations with minimal fear.

DIF: Cognitive Level: Knowledge REF: p. 96 OBJ: 7 TOP: Trust versus mistrust KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. Object permanence is: a. recognizing a familiar face, such as mother. b. recognizing a familiar object, such as bottle. c. actively searching for a hidden object. d. securing objects by pulling on a string.

ANS: C

By 9-10 months, infants have achieved the concept of object permanence, or the realization that objects that leave the visual field can still exist.

DIF: Cognitive Level: Comprehension REF: p. 96 OBJ: 2 TOP: Object performance KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. A parent of an 8-month-old infant says that the baby cries and screams whenever she is left with her grandparents. The reply should be based on the fact that the:

a. b. c. d.

infant is most likely spoiled. infant is experiencing separation anxiety. infant should be left with another caretaker. grandparents’ home may be a frightening environment.

ANS: B

At around 6 months of age, the infant begins to have an awareness of self and parent as separate beings. This, coupled with the development of object permanence, causes the infant to become distressed at the absence of the parent.

DIF: Cognitive Level: Application REF: p. 98 OBJ: 7 TOP: Separation anxiety KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries. The most informative response would be: a. “Allow him to cry for no longer than 15 minutes, then pick him up.” b. “Babies need comforting and cuddling. Meeting these needs will not spoil him.” c. “Babies this young cry when they are hungry. Try feeding him when he cries.” d. “If he isn’t soiled or wet, leave him and he’ll cry himself to sleep.”

ANS: B

Prompt attention to an infant’s crying promotes attachment and development of trust.

DIF: Cognitive Level: Application REF: p. 97 OBJ: 9 TOP: Attachment KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. The parents of a 6-month-old infant say that they are worried about their baby’s thumb-sucking. The reply that is most informative would be: a. “A pacifier should be substituted for the thumb.” b. “Nonnutritive sucking may indicate unsatisfied hunger.” c. “Sucking should be interrupted by diverting the baby’s attention.” d. “Nonnutritive sucking during infancy is normal.”

ANS: D

Nonnutritive sucking in infancy is of benefit by providing a self-regulating source of comfort.

DIF: Cognitive Level: Application REF: p. 106 OBJ: 3 TOP: Sucking KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. The health-care worker instructs the parents of an infant that they can expect the first tooth eruption at the age of: a. 2 months. b. 6 months. c. 8 months. d. 10 months.

ANS: B

Normal tooth eruption occurs between 5 to 7 months with the appearance of the central incisors.

DIF: Cognitive Level: Comprehension REF: p. 108 OBJ: 2 TOP: Tooth eruption KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. The parent of a 12-month-old says, “He pushes the spoon right out of my hand and screams when I feed him. I can’t let him feed himself, he makes too much of a mess.” The best response is: a. “It’s important not to give in to this kind of temper tantrum at this age.” b. “Maybe you need to try a different type of spoon, one designed for children.” c. “He is old enough to try to feed himself. Let’s think of ways to limit the mess.” d. “You should continue to feed him. Self-feeding may interfere with adequate nutrition.”

ANS: C

Self-feeding is a developmental task that is part of the first year of life and the infant’s growing need for independence.

DIF: Cognitive Level: Application REF: p. 96 OBJ: 2 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. A 4-month-old infant is brought to the clinic by her parents for a well-baby checkup.

Because 4-month-old infants are developing very fast, the health-care worker reminds parents that they can help prevent an accident by: a. using a tray on highchair as restraint rather than the restraining strap. b. placing adjustable gates at the head of the stairs. c. placing the child on the stomach to sleep at night or at nap time. d. supporting child firmly during bath time.

ANS: D

Good support and never leaving child unattended at the bath time can prevent an accident.

Straps should be used as restraints in highchairs. Gates are not yet needed for a 4-monthold.

DIF: Cognitive Level: Application REF: p. 109 OBJ: 12 TOP: Accident prevention KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. Regarding the introduction of solid foods during infancy, the nurse would advise: a. solid foods should not be introduced until 8 to 10 months of age when the extrusion reflex begins to disappear. b. foods should be introduced one at a time, at intervals of 4 to 7 days. c. solid foods should be mixed in a bottle to make the transition easier for the infant. d. fruits and vegetables should be introduced into the diet first.

ANS: B

Solid foods are introduced one at a time to help parents identify a food allergy response.

DIF: Cognitive Level: Application REF: p. 107 OBJ: 9 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. The health-care worker ensures doting parents that they will hear the first meaningful words from their infant when the baby is about months old. a. 6 b. 8 c. 10 d. 12 ANS: C

Although infants vocalize as early as 5 to 6 weeks, it is not until they are about 10 months old that cognitive and motor development enables them to use meaningful words.

DIF: Cognitive Level: Comprehension REF: p. 100 OBJ: 6 TOP: Language development KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. The parents of a 6-month-old infant say, “She cries sometimes after we have put her down after we have played with her. We know she is dry and has recently been fed.” The most appropriate intervention is to suggest that the baby: a. is learning elementary language skills. b. may still be hungry. c. is uncomfortable. d. still wants parental stimulation.

ANS: D

If the adult turns away before the infant is ready, the infant will lean forward and attempt to get the adult’s attention with sound and movement and will eventually cry with frustration.

DIF: Cognitive Level: Application TOP: Language development MSC: NCLEX: NA

REF: p. 97 OBJ: 5 KEY: Nursing Process Step: Implementation

13. Even infants can develop coping skills, which allow the infant to: a. enhance speech development. b. manage a stressful situation. c. manipulate his environment. d. increase parental bonding.

ANS: B

Infants are capable of dealing with a stressful situation by developing a coping skill. They may climb out of an infant seat to reach a toy or move self around in the crib to see into another room.

DIF: Cognitive Level: Application REF: p. 95 OBJ: 2 TOP: Development of coping skills KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

14. The parents of a 3-month-old complain that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. The best suggestion would be to: a. put her in parents’ bed to cuddle. b. give the baby a pacifier while the child is in a semi-awake state. c. let her cry herself back to sleep.

d. give her a bottle of formula instead of breastfeeding her so often at night.

ANS: B

Giving a pacifier in the semi-awake state often will help the baby return to sleep and begin to develop self-regulatory habits.

DIF: Cognitive Level: Application REF: p. 105 OBJ: 2 TOP: Sleep patterns KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. A mother is concerned that her 12-month-old is “getting fat.” She plans to switch the infant from formula to 2% low-fat milk. Based on knowledge of infant nutrition, the best response should be: a. “That’s an excellent idea. Preventing childhood obesity is a goal of Healthy People 2020.” b. “You should give your child low-calorie juices instead of milk to prevent excessive weight gain.” c. “Formula is necessary for 2 full years to ensure proper growth.” d. “Your child needs whole milk instead of low-fat milk to promote proper growth and development.”

ANS: D

Fats are necessary in children under age 2 to promote development of the nervous system.

DIF: Cognitive Level: Comprehension REF: p. 107 OBJ: 10 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. When the parents of a 6-month-old say that they see no reason to spend money for a car seat because the baby is happier sitting in someone’s lap. The best response is: a. “As long as the baby is being held securely by an adult there is no need for a car seat.” b. “The air bag will protect both adult and baby in the event of an accident.” c. “A rear-facing car seat placed in the back seat is the safest place for your baby.” d. “A front-facing car seat placed next to the driver should keep your baby safe and happy.”

ANS: C

A rear-facing car seat provides the best protection for the infant’s head and neck. The back seat is preferable to help protect the infant from being ejected from the car and from injury from a front seat air bag.

DIF: Cognitive Level: Comprehension REF: p. 109 OBJ: 12 TOP: Car seats KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. The usual initial age at which infants begin to demonstrate meaningful social smiles in response to parental interaction is at: a. 2 months. b. 3 months. c. 5 months. d. 6 months.

ANS: A

Positive infant responses to parents’ interaction efforts strengthen parent–infant attachment and usually are seen at the age of 2 months.

DIF: Cognitive Level: Comprehension REF: p. 96 OBJ: 8 TOP: Attachment KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. An appropriate play activity to encourage sensorimotor stimulation in a 7-month-old would be: a. reading a story. b. playing peek-a-boo. c. showing how to clap hands. d. imitating animal sounds.

ANS: B

By 6 months to 1 year, play involves sensorimotor skills as described by Piaget. Infants need to be played with. A game of peek-a-boo provides visual stimulation and interaction with the parent.

DIF: Cognitive Level: Comprehension REF: p. 96 OBJ: 6 TOP: Sensorimotor stimulating play KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. To support the development of language skills in their child, the parents should: a. talk to the infant in their native language. b. introduce common slang words. c. employ “baby talk” to get the infant’s attention. d. speak loudly.

ANS: A

Parents should talk to the infant in the native language. Use of slang or baby talk may confuse or delay language development. Loud speech is not necessary to the development of language.

DIF: Cognitive Level: Application REF: p. 106 OBJ: 6 TOP: Language development KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. If parents are concerned about the fact that their 14-month-old infant is not walking, the health-care worker should particularly evaluate whether the infant: a. pulls up on the furniture. b. uses a pincer grasp. c. transfers objects. d. has developed object permanence.

ANS: A

Infants generally start to walk about 4 to 5 months after they are able to pull themselves up to a standing position.

DIF: Cognitive Level: Application REF: p. 109, Table 7-2 OBJ: 4 TOP: Motor development KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: growth and development

21. According to Freud’s theory of development, the best toy for an infant would be a: a. colorful mobile. b. rattle. c. teething ring. d. baby swing.

ANS: C

A teething ring satisfies the need to examine the world through the mouth, which is a characteristic of Freud’s oral stage.

DIF: Cognitive Level: Comprehension REF: p. 106 OBJ: 7 TOP: Oral stage KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

22. The information that should be given to the parents of a 12-month-old regarding appropriate play activities would include which of the following? a. Provide a stick horse to develop gross motor coordination. b. Give large push-pull toys for kinetic stimulation. c. Place cradle gym across the crib to facilitate fine motor skills. d. Provide finger paints to enhance fine motor skills.

ANS: B

Push-pull toys foster newly mastered walking skills.

DIF: Cognitive Level: Application REF: p. 106 OBJ: 4 TOP: Role of play KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

23. A child who weighed 6 pounds at birth will weigh approximately 12 months. a. 15 b. 18 c. 21 d. 24

pounds at the age of

ANS: B

Growth is an increase in size, measured by pounds and inches. By 1 year, birth weight is generally tripled.

DIF: Cognitive Level: Knowledge REF: p. 95 OBJ: 3 TOP: Growth KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

24. A 2-month-old uses the preverbal speech technique of: a. nonnutritive sucking. b. grunting. c. pointing. d. smiling.

ANS: D

Crying and smiling are the preverbal options for a 2-month-old.

DIF: Cognitive Level: Application REF: p. 100 OBJ: 6 TOP: Preverbal speech KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

25. A hospitalized 11-month-old is crying and clinging to the parents as they attempt to leave the room at the termination of visiting hours. An appropriate intervention would be to: a. encourage the parents to leave right away to minimize the child’s distress. b. provide privacy until the infant has calmed down. c. arrange for a parent to room in with the infant. d. distract the infant with toys so the parents can leave unnoticed.

ANS: C

Because hospitalization is a unique experience of separation filled with strangers, pain, and fear of the unknown, it is strongly recommended that a parent room in with the child.

DIF: Cognitive Level: Application REF: p. 98 OBJ: 7 TOP: Attachment KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

26. At what age would the health-care worker expect an infant to be able to say “mama” and “dada” with meaning? a. 4-5 months b. 5-6 months c. 9-10 months d. 12-14 months ANS: C

By 7 or 8 months, syllables using the M and D sounds appear, and by 9 to 10 months, specific meaningful sounds are used to refer to objects or events.

DIF: Cognitive Level: Comprehension REF: p. 100 OBJ: 6 TOP: Language development KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. Interactive physical activity between parents and their baby should be focused on: a. exploring developmental movement and the environment. b. ensuring that activity times do not interfere with sleep or nutrition. c. exposure to outdoors. d. interaction with other infants.

ANS: A

Interactive physical activity with an infant should be focused on exploring movement and the environment.

DIF: Cognitive Level: Application REF: p. 106, Box 7-1 OBJ: 5 TOP: Physical activity KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

28. What is a possible indication of child abuse on an 11-month-old?

a. b. c. d.

Excessive drooling Cooing and reaching for the parent Hyperactivity during physical assessment Bruises in various stages of healing

ANS: D

The appearance of bruises in various stages of healing should alert a caregiver to possible child abuse.

DIF: Cognitive Level: Application REF: p. 100, Figure 7-1 OBJ: 12 TOP: Child abuse KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

29. Which age-appropriate toy(s) for a 3-month-old infant should be recommended? (Select all that apply.) a. Crib mobile b. Squeeze toys c. Teething toys d. Soft or furry quilt e. Stuffed animals f. Strings of big beads ANS: A, D, E

These toys assist the 3-month-old in the development of visual and tactile senses, as well as in the beginning of fine motor development.

DIF: Cognitive Level: Application REF: p. 106 OBJ: 2 TOP: Role of play in growth and development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

30. The parents of a 2-month-old bring their infant to the well-child clinic for a checkup and immunizations. Based on knowledge of immunization schedules, the health-care worker instructs the parents that the infant should receive which vaccine(s)? (Select all that apply.) a. Polio b. HepB c. MMR d. Varicella e. DTaP f. Tetanus ANS: A, B, E

At 2 months, the recommended immunizations for infants are HepB, DTaP, and IPV. Although many of the immunizations can be given at any age, the recommended primary schedule begins in infancy and is completed during early childhood. This practice has contributed to the decline of preventable infectious diseases.

DIF: Cognitive Level: Application TOP: Immunizations

REF: Appendix A OBJ: 10 KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

31. To assist parents in understanding normal growth and development during various stages of infancy, the health-care worker must understand age-appropriate motor development. Which gross and fine motor skill(s) would be appropriate for a 9-month-old? (Select all that apply.) a. Walks with one hand held b. Uses thumb and forefinger in crude pincer grasp c. Can turn pages in a book d. Can sit down from standing position without help e. Creeps on hands and knees f. Sits steadily on floor for prolonged time ANS: B, E, F

A 9-month-old has a crude pincer grasp, creeps, and can sit alone.

DIF: Cognitive Level: Comprehension REF: p. 103, Table 7-2 OBJ: 4 TOP: Motor development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

32. Although the child protests when the parent leaves the room, the child will develop when the parent consistently returns.

ANS:

trust Children learn that their parents return after a separation. This learning builds the developmental task of trust.

DIF: Cognitive Level: Comprehension REF: p. 98 OBJ: 2 TOP: Trust KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 8: Early Childhood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. A 2-year-old should be able to: a. ride a tricycle. b. climb stairs reciprocally. c. run. d. hop on two feet.

ANS: C

The 2-year-old is able to run, but cannot climb stairs reciprocally, hop, or ride a tricycle.

DIF: Cognitive Level: Comprehension REF: p. 112 OBJ: 2 TOP: Developmental tasks KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. Erik Erikson describes the major developmental task of the toddler to be: a. trust. b. initiative. c. autonomy. d. intimacy.

ANS: C

According to Erikson, the toddler, between 2 and 4 years of age, is in the stage of autonomy versus shame or doubt.

DIF: Cognitive Level: Comprehension REF: p. 111 TOP: Erikson’s developmental tasks of early childhood MSC: NCLEX: NA

OBJ: 4 KEY: Nursing Process Step: NA

3. A parent of a 24-month-old boy say that the child has frequent tantrums and that “no” is becoming his favorite word. This behavior: a. is a response to frustration in gaining autonomy. b. is an indication of regression. c. is a signal that he is not effectively coping with stress. d. shows that he needs more attention.

ANS: A

Negativism is typical of toddlers in their quest for autonomy. As toddlers attempt to express their will, they may become angry in their frustration. This frustration then leads to a desire to be loved and comforted by a parent.

DIF: Cognitive Level: Application REF: p. 116 OBJ: 4 TOP: Developmental tasks of early childhood KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. According to Piaget, magical thinking is the belief that: a. events have cause and effect.

b. God is like an imaginary friend. c. if the skin is broken, the insides will come out. d. dolls are real people.

ANS: D

Because of their egocentrism, preschoolers believe that inanimate objects have real life qualities.

DIF: Cognitive Level: Comprehension TOP: Cognitive development MSC: NCLEX: NA

REF: p. 115 OBJ: 3 KEY: Nursing Process Step: NA

5. Most children use sentences of five words by the age of a. 2 b. 3 c. 4 d. 5

years.

ANS: D

In a preschool child, the number of words in a typical sentence is about equal to the child’s age.

DIF: Cognitive Level: Comprehension REF: p. 115 OBJ: 4 TOP: Language development and communication skills KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. When preparing parents to teach their children about sexuality, the health-care worker should emphasize that they should: a. treat bodily functions as secret. b. expect some masturbatory behavior. c. correct all behavior that involves nudity. d. limit parental displays of hugging or kissing.

ANS: B

Children in early childhood engage in normal masturbatory behavior. Young children enjoy nudity.

DIF: Cognitive Level: Comprehension REF: p. 120 OBJ: 3 TOP: Sexuality in early childhood KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. Although a 14-month-old girl received a shock from an electrical outlet recently, her mother finds her about to place a paper clip in another outlet. The repeated behavior is due to: a. cognitive development is delayed. b. memory deficit. c. inability to understand cause and effect. d. desire for attention.

ANS: C

Reasoning skills are still quite underdeveloped and children at this age do not understand cause and effect.

DIF: Cognitive Level: Application REF: p. 125, Table 8-5 OBJ: 2 TOP: Cognitive development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. When a toddler snatches a toy from another toddler, this behavior is: a. representative of the aggressive nature of toddlers. b. typical behavior because toddlers are egocentric. c. a primitive attempt at sharing. d. a deliberate behavior the toddler knows to be wrong.

ANS: B

Toddlers see, experience, and live every event in relation to themselves. They are unable to envision situations from perspectives other than their own. They feel their point of view is the same as everyone else’s.

DIF: Cognitive Level: Application REF: p. 115 OBJ: 2 TOP: Cognitive development KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. When a 3-year-old spills his milk at the dinner table, he can be expected to: a. clean the spill up immediately. b. cry because he expects punishment. c. play in the spilled milk. d. blame his sibling for the accident.

ANS: D

Children of the age of 3 can differentiate an accident from an intentional act but are quick to assign blame.

DIF: Cognitive Level: Application TOP: Moral development MSC: NCLEX: NA

REF: p. 118 OBJ: 3 KEY: Nursing Process Step: NA

10. The Portion Plate for Kids placemat can be used as an aid to nutrition because it: a. introduces a variety of foods. b. acts as a guide for food intake. c. is colorful and teaches basic food groups. d. likens portion sizes to a baseball.

ANS: B

The Portion Plate for Kids placemat serves as a guide for portion amounts and is an aid to prevent “supersizing.” Portion amounts are likened to the size of a tennis ball.

DIF: Cognitive Level: Knowledge REF: p. 114, Figure 8-2 OBJ: NA TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. According to Kohlberg, the moral task of childhood is learning to: a. take responsibility. b. share with others.

c. cooperate with others. d. recognize religion.

ANS: B

According to Kohlberg, the moral task of childhood is learning to share.

DIF: Cognitive Level: Comprehension TOP: Moral development MSC: NCLEX: NA

REF: p. 116 OBJ: 4 KEY: Nursing Process Step: NA

12. When a toddler acquires receptive language skills, the child is able to: a. understand abstract information. b. understand simple messages. c. converse at length. d. respond with appropriate language.

ANS: B

The mastery of receptive language allows the toddler to understand simple messages but not abstractions. Appropriate response and lengthy conversations would indicate mastery of expressive language.

DIF: Cognitive Level: Analysis REF: p. 111 OBJ: 4 TOP: Receptive language KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

13. In the clinic waiting room, a parent is showing an 18-month-old how to build a tower out of blocks. Toddlers: a. use blocks at this age primarily for throwing. b. are too young to imitate the behavior of others. c. are capable of building a tower of blocks. d. are unable to concentrate long enough to build a tower.

ANS: C

During toddlerhood, imitation is one of the most distinguishing characteristics of play. By this age, toddlers have a well-developed reach, grasp, and release and are able to build a tower of three to four blocks.

DIF: Cognitive Level: Application REF: p. 121 OBJ: 2 TOP: Play KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. In the instruction about considerations relative to the use of car seats, the health-care worker lists that before a child should be allowed to sit in the front seat of a car, the child should be at least years of age. a. 8 b. 10 c. 12 d. 13 ANS: D

The American Academy of Pediatrics (AAP) recommends that children under the age of 13 should not ride in the front seat of a vehicle.

DIF: Cognitive Level: Knowledge REF: p. 124 OBJ: 9 TOP: Day care KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk

15. A “time-out” for unacceptable behavior may be effective discipline for children between 1 and 6 years of age if the time-out period is no more than minute(s) per year of child’s age. a. 1 b. 2 c. 3 d. 4 ANS: A

Time-outs of 1 minute per each year of the child’s age place a child in a safe place with time to regain self-control. Short lengths of time are more appropriate than longer periods of time because of the short attention spans of children in this age-group.

DIF: Cognitive Level: Comprehension REF: p. 119 TOP: Discipline KEY: Nursing Process Step: NA

OBJ: 10 MSC: NCLEX: NA

16. A 5-year-old boy has been having increasingly more frequent angry outbursts in preschool.

For the past 8 to 10 weeks, he had seven episodes of aggressiveness toward the other children and the teachers. The best advice would be to: a. encourage the parent to try more consistent and firm discipline. b. explain that this is normal in preschoolers, especially boys. c. take the child for a professional psychosocial assessment. d. deprive him of some special treat each time he is aggressive at school.

ANS: C

By age 4, impulse control is usually achieved with minor relapses in times of stress.

Generally, the difference between “normal” and “problematic” behavior is not the behavior itself but the number of occurrences, severity, onset (especially a sudden change in behavior), and duration (at least 4 weeks).

DIF: Cognitive Level: Application REF: p. 116 OBJ: 3 TOP: Cognitive development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. An example of parallel play is a toddler: a. sitting by himself playing with blocks. b. sharing a box of crayons with another toddler as they color in the same book. c. sitting with another toddler playing with toys without interaction. d. sitting in a circle of other toddlers passing a ball from one to another.

ANS: C DIF: Cognitive Level: Comprehension REF: p. 121 OBJ: 8 TOP: Parallel play KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. Dental evaluations should start at the age of a. 12 b. 18

months.

c. 24 d. 30 ANS: A

The American Academy of Pediatric Dentistry (AAPD) recommends that children aged 1 year be introduced to the dentist.

DIF: Cognitive Level: Knowledge REF: p. 123 OBJ: NA TOP: Dental care KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

19. Toilet training is dependent on: a. developing sphincter control. b. child’s desire to stay dry. c. being rewarded for using the toilet. d. children using the family toilet when first learning.

ANS: A

Toilet training occurs as sphincter control develops and the child masters some form of communication to indicate the need to use the toilet. The process cannot be hurried and may not be complete before 3 years of age. Using the family toilet may be frightening, as child may feel like he will fall in or be flushed away.

DIF: Cognitive Level: Application REF: p. 113 OBJ: 4 TOP: Toilet training KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. During the preschool period, the emphasis of injury prevention should be placed on: a. constant vigilance and protection. b. punishment for unsafe behaviors. c. education for safety and potential hazards. d. limitation of physical activities.

ANS: C

Children as young as 3 years can be taught safety measures regarding potential hazards.

Accident prevention techniques should be discussed with parents.

DIF: Cognitive Level: Comprehension TOP: Safety and accident prevention MSC: NCLEX: NA

REF: p. 123 OBJ: 9 KEY: Nursing Process Step: NA

21. The toddler is vulnerable to ear infections because: a. respirations are abdominal. b. pulse and respiratory rates are slower than in infancy. c. defense mechanisms are less efficient than during infancy. d. there is a short, straight internal ear canal leading to the oropharynx.

ANS: D

The internal structures of the ear and throat are short and straight, and lymphoid tissue of the tonsils and adenoids continues to be large. As a result, ear, throat, and upper respiratory infections are common.

DIF: Cognitive Level: Comprehension REF: p. 113 OBJ: 2 TOP: Ear infections KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

22. The preschool child learns socially acceptable behavior through the use of: a. punishment. b. positive reinforcement. c. restricting privileges. d. comparing child to role model.

ANS: B

Rewarding good behavior is the positive and most effective technique of discipline as well as consistency in parental response.

DIF: Cognitive Level: Application REF: p. 119, Table 8-3 OBJ: 10 TOP: Discipline KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

23. Age-appropriate literacy skills for a 24-month-old include the child taking a book and: a. holding it. b. looking at pictures. c. carrying it around the house. d. pointing at pictures with one finger.

ANS: C

The 24-month-old should carry the book around the house and turn one page at a time.

DIF: Cognitive Level: Application REF: p. 116, Table 8-1 OBJ: 2 TOP: Literacy milestone KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

24. A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate the need for more instruction regarding child safety? a. “We locked all the medicines in the bathroom cabinet.” b. “We turned the thermostat down on our hot water heater.” c. “We placed gates at the top and bottom of our stairs.” d. “We’re using the car seat belt instead of the car seat now that the baby is older.”

ANS: D

Children should use specially designed car restraints until they weigh at least 60 pounds or are 8 years old.

DIF: Cognitive Level: Application REF: p. 124, Figure 8-8 OBJ: 9 TOP: Safety and accident prevention KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe Effective Care Environment: safety and infection control

25. The parents of a 30-month-old say that their daughter is not talking in short sentences. The most appropriate response is: a. “Let’s make an appointment with your pediatrician for an evaluation.” b. “Children of that age are too young to use short sentences.”

c. “You don’t need to worry until your child is at least 48 months old.” d. “Your child should have started talking in short sentences by 18 months old.”

ANS: A

Language milestones can be used to assess a child’s development. By 30 months, a child should be talking in short sentences.

DIF: Cognitive Level: Application REF: p. 116, Table 8-1 OBJ: 2 TOP: Language development and communication skills KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

26. Complete myelinization of the brain does not occur until the age of: a. 5 years. b. 7 years. c. 10 years. d. 12 years.

ANS: B

Compete myelinization of the brain does not occur until the age of 7 years.

DIF: Cognitive Level: Knowledge REF: p. 112 OBJ: 3 TOP: Myelinization of the brain KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

27.

The child is involved in fantasy play when the child: a. puts a string on a toy dog and takes it for a walk. b. looks at the pictures in a book over and over. c. uses the sandbox as a sailboat. d. colors the picture of an apple purple.

ANS: C

Fantasy play is seen in early childhood as one object becomes another.

DIF: Cognitive Level: Application REF: p. 116 OBJ: 8 TOP: Fantasy play KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

28. Children learn to cope by: a. imitating others. b. experiencing new situations. c. asking for help. d. following parental direction.

ANS: B

Through experience, toddlers and preschoolers learn how to problem-solve, which provides them with a sense of mastery over their own lives and reinforces the fact that they have the ability to handle whatever comes their way. If parents solve all of their problems, this mastery will not be learned and may leave them with feelings of insecurity and stress at their inability to cope.

DIF: Cognitive Level: Comprehension TOP: Cognitive development

REF: p. 116 OBJ: 4 KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: growth and development

29. To prepare a preschooler for better human interaction, the parents should help the child learn to: a. be autonomous. b. express feelings verbally rather than acting out. c. avoid conflict. d. rely on others.

ANS: B

Helping a child to learn to express his feelings rather than acting out is important for success in school and later life.

DIF: Cognitive Level: Analysis REF: p. 123 OBJ: 4 TOP: Developmental tasks KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

30. The activity that is most appropriate for a hospitalized 5-year-old who is allowed to go to the playroom is: a. joining a group of boys and girls who are playing house. b. looking at a coin collection that belongs to an 8-year-old. c. playing alone with a racing car. d. building a block tower next to another child who is also playing with blocks.

ANS: A

Children in the preschool years engage most often in creative or dramatic play with others.

DIF: Cognitive Level: Application REF: p. 116 OBJ: 7 TOP: Play KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

31. The home health-care worker would assess the indication of sexual abuse in a preschool child if assessments were made of the child’s: (Select all that apply.) a. positioning dolls in sexual positions. b. excessive sexual curiosity. c. removing clothes to play nude. d. playing “doctor.” e. drawing genitals on dolls.

ANS: A, B, E

Recreating sexual positions with dolls or in play, demonstrating excessive sexual curiosity, and drawing genitals on dolls or other images suggest sexual abuse.

DIF: Cognitive Level: Application REF: p. 120, Table 8-4 OBJ: 4 TOP: Sexual abuse KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

32. The health-care worker guiding parents in selecting a day care facility for their child would emphasize the importance of: (Select all that apply.)

a. b. c. d. e.

licensure. location. student-to-staff ratio. discipline techniques. staff education.

ANS: A, C, D, E

Characteristics of a day care center are important to ensure well-being and continued support of growth and development.

DIF: Cognitive Level: Comprehension REF: p. 122 OBJ: 6 TOP: Day care centers KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

33. Preschool children need a minimum of

minutes a day of age-appropriate active play.

ANS:

60 Children should be physically active for a minimum of 60 minutes a day in age-appropriate activities such as running, jumping, and climbing.

DIF: Cognitive Level: Comprehension REF: p. 121 OBJ: 7 TOP: Play KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 9: Middle Childhood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. In middle childhood, the child’s developing cognition is more focused on: a. fantasy. b. fun. c. family. d. fact.

ANS: D

During the middle childhood years (6-12 years), the child becomes more focused on fact than fantasy as the cognition develops.

DIF: Cognitive Level: Application REF: p. 131 OBJ: 3 TOP: Changing focus of middle childhood KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. The concerned parent of a 9-year-old confides in the health-care worker that her child will only wear the athletic jersey with the number of his favorite professional quarterback and insists on being called by the quarterback’s name rather than his own. The health-care worker bases her response on Erikson’s theory that 9-year-olds: a. should have given up such fantasy play. b. enjoy such dress-up play. c. fashion their behavior after role models. d. need to find their own identity.

ANS: C

Erikson refers to school age as the stage of industry, when the child has a thirst for knowledge, a desire to master skills, and the wish to emulate role models or “heroes.”

DIF: Cognitive Level: Comprehension REF: p. 141 OBJ: 5 TOP: Role models KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. The question or statement made by a parent of an 11-year-old that indicates a need for better understanding of middle childhood development is: a. “What kind of birds will want to live in your bright red birdhouse?” b. “Where do you propose to put this little birdhouse you made?” c. “This bird house needs to be put in a safe place.” d. “Let me help you to repaint the little birdhouse white so birds will come to it.”

ANS: D

The goal of the sense of industry, or stage of accomplishment, is to achieve a sense of personal and interpersonal competence through acquisition of technological and social skills.

Failure to develop this sense of accomplishment results in feelings of inferiority, which may come from the children themselves or from the social environment.

DIF:

Cognitive Level: Analysis

REF: p. 141

OBJ: 4

TOP: Psychosocial development KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. Middle childhood–age children will grow on the average of a. 1 inch b. 1 1/2 inches c. 2 inches d. 2 1/2 inches

per year.

ANS: C

During middle childhood, the average weight gain is 5 to 7 pounds and 2 inches per year.

DIF: Cognitive Level: Knowledge REF: p. 132 OBJ: 2 TOP: Average growth increase KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. The parents of 9-year-old twins say, “They have filled up their bedroom with collections of rocks, shells, dolls, and baseball cards.” This is indicative of: a. giftedness. b. typical “twin” competition. c. concrete cognitive behavior. d. unidentified stress.

ANS: C

School-age children are acquiring classification skills, which involve the ability to group objects according to common attributes. It is characteristic of middle childhood that children derive enjoyment from classifying and ordering their environment.

DIF: Cognitive Level: Application REF: p. 134, Table 9-1 OBJ: 8 TOP: Play KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. Parents planning a birthday party for their 6-year-old son would best plan to invite: a. a large group of children to watch a collection of cartoons. b. a group of boys from his class to play active games. c. an equal number of boys and girls to play competitive board games. d. children of different ages to play competitive games.

ANS: B

Interaction among peers leads to formation of close friendships between same-sex peers. A group of boys playing active games would have the most positive outcome.

DIF: Cognitive Level: Comprehension REF: p. 134, Table 9-1 OBJ: 10 TOP: Peer relationships KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. A group of boys ages 9 and 10 forming a “boys-only” club that is open to neighborhood and school friends who have bicycles is: a. behavior that encourages bullying and sexism. b. behavior that reinforces poor peer relationships. c. characteristic of social development at this age. d. characteristic of children who are at risk for gang membership.

ANS: C

At this age there is a strong preference for same-sex clubs with an exclusiveness in the selection of persons who may belong to the group.

DIF: Cognitive Level: Comprehension REF: p. 134, Table 9-1 OBJ: 10 TOP: Peer relationships KEY: Nursing Process Step: Health Promotion and Maintenance: growth and development MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. A 12-year-old girl is frequently teased about being taller than anyone else in the class. This teasing: a. can damage the girl’s self concept. b. is an indication that the girl is well liked. c. is a positive aspect of a peer relationship. d. is usually ignored by the person being teased.

ANS: A

School-age children have a strong desire not to be considered different. Those children who dress differently, have less spending money than their peers, or who look different are often the target of criticism or ridicule by their peers, leading to threats to self-esteem and self concept.

DIF: Cognitive Level: Comprehension REF: p. 132 OBJ: 4 TOP: Psychosocial development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. The school nurse is to begin teaching sex education to children in the fifth grade. The nurse should plan to: a. use non-anatomical terminology. b. limit depth of questions asked by the students. c. separate class and teach girls and boys separately. d. present sex as a normal part of growth and development.

ANS: D

Sex education is a lifelong process and should be introduced in the context of normal anatomy and physiology. Information should be age-appropriate, culturally relevant, and treat sexuality as a healthy part of life.

DIF: Cognitive Level: Comprehension REF: p. 144 OBJ: 11 TOP: Sexuality KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. Eight-year-olds enjoy play that employs: a. competitive team play. b. solitary play to develop self expression. c. quiet, low-activity games. d. easy ways to win.

ANS: A

Understanding rules for competitive highly active games allows for 8-year-olds to follow rules and develop teamwork as well as answer the developmental need for industry. Stress for high competition and the need to win are not helpful to development.

DIF: Cognitive Level: Application REF: p. 133 OBJ: 8 TOP: Play KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. The behavior that alerts the school nurse to a possible cognitive deficit in a 7-year-old child would be: a. playing only with “best friend.” b. confusing letters b, d, and g. c. boisterous and “know it all.” d. unable to complete complex tasks.

ANS: B

The inability to consistently differentiate the letters b, d, and g may indicate a cognitive problem. Boisterous behavior, preference for the best friend, and inability to complete complex tasks are not unusual in the 7-year-old.

DIF: Cognitive Level: Application REF: p. 141, Table 9-3 OBJ: 3 TOP: Cognitive development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. A 7-year-old is caught taking a playmate’s toy. Which of the following reflects the development of this 7-year-old? a. If punished, this child will not to do it again. b. A child’s sense of property rights is limited until that concept is modeled for him. c. This stealing act indicates that something is seriously lacking in this child’s life. d. The child will learn the importance of respecting the property of others if the parents unexpectedly give away an item of his.

ANS: B

As with other ethically related behaviors, stealing is not an unexpected event in a younger child. Between the ages of 5 and 8 years, children have a limited sense of property rights of others.

DIF: Cognitive Level: Comprehension REF: p. 142 OBJ: 6 TOP: Cognitive development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

13. The parents of an 8-year-old girl say that their daughter wants to join a softball team.

Instruction regarding participation in sports at this age should include which of the following? a. Organized sports, such as softball, are not appropriate at this age. b. Competition is harmful to the establishment of a positive self-image. c. Sports participation is encouraged if the type of sport is appropriate to the child’s abilities. d. Girls should compete only against girls because at this age boys are larger and have more muscle mass.

ANS: C

By age 8, children are able to engage in competitive sports and use coping strategies to deal with team cooperation, conflict, losing, and winning. Participation in organized sports can develop teamwork and physical fitness, but the focus should be on mastery of skills and enjoyment rather than on winning only.

DIF: Cognitive Level: Application REF: p. 133 OBJ: 8 TOP: Play KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. Interventions to promote health during middle childhood should include: a. educating parents on the need for good dental hygiene for the erupting teeth. b. stressing the need for increased caloric intake to meet increased physiological demands. c. instructing parents to limit questions about sex until the child reaches adolescence. d. advising parents to reduce child’s rest and encourage active exercise.

ANS: A

Regular dental checkups should be a part of routine health care to screen for dental problems and have the teeth cleaned. Daily dental care and consumption of healthy snacks should be encouraged.

DIF: Cognitive Level: Comprehension REF: p. 147 OBJ: 13 TOP: Physiological changes KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. Frequent spankings as a discipline technique can: a. be an effective deterrent over the long term. b. establish the parent as an effective authoritarian. c. shock the child into a permanently modified behavior. d. teach violent behavior.

ANS: D

Frequent spankings as a means of discipline is not a long-term deterrent and can cause loss of self-esteem and depression. Spankings do not elevate the parent’s role as an authoritarian but rather as a punisher.

DIF: Cognitive Level: Application REF: p. 148 OBJ: 7 TOP: Corporal punishment KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. When teaching injury prevention during the school-age years, the health-care worker should: a. teach the need to fear and distrust strangers. b. teach basic rules of water safety. c. avoid letting the child cook in a microwave oven. d. caution the child against engaging in competitive sports.

ANS: B

As a rule, school-age children enjoy swimming and water-related activities. Because they are adventuresome and eager to try new things, rules of water safety need to be stressed to prevent accidents.

DIF: Cognitive Level: Application

REF: p. 137, Table 9-1

OBJ: 13 TOP: Health and safety needs of the school-age child KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. An important consideration for the school nurse to stress in a class on bicycle safety would be that: a. most bicycle injuries involve collision with an automobile. b. children should wear a bicycle helmet if they ride on paved streets. c. head injuries are the major causes of bicycle-related fatalities. d. children should not ride double unless the bicycle has an extra-large seat.

ANS: C

Although most bicycle injuries are not automobile-related, most bicycle fatalities are head injuries as a result of an automobile–bicycle collision. The most important aspect of bicycle safety is to encourage the use of protective headgear at all times when riding a bicycle.

DIF: Cognitive Level: Application REF: p. 139, Table 9-1 OBJ: 13 TOP: Health and safety needs of the school-age child KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: reduction of risk

18. The child experiencing middle childhood forms a positive self-esteem from: a. praise from elders. b. refinement of motor skills. c. developing internal sources. d. identifying moral reasoning.

ANS: C

One of the tasks of middle childhood is to develop inner sources that will be the foundation of a positive self-image.

DIF: Cognitive Level: Comprehension REF: p. 131 OBJ: 4 TOP: Developing self-esteem KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. When a 9-year-old boy feels bad about having cheated on a test, the child is exhibiting the moral behavior phase of: a. logic. b. reaction. c. emotion. d. guilt ANS: C

Moral behavior includes three phases: knowledge (knowing what is right), emotion (feeling good or bad about what is right), and action (behaving according to the rule of what is right).

DIF: Cognitive Level: Application REF: p. 142, Box 9-1 OBJ: 6 TOP: Moral behavior KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. The school nurse discussing dental health with some first-grade children would emphasize: a. how to floss teeth properly.

b. use of a toothbrush with hard nylon bristles. c. the importance of brushing before bedtime. d. use of non-fluoridated toothpaste.

ANS: C

Children should be taught to carry out their own dental care under the guidance and supervision of parents after each meal and before bedtime. The majority of children do not possess the fine motor skills needed to brush their teeth properly until approximately second grade. Children under age 10 may need parental assistance to brush back teeth. Because most children do not have the manual dexterity necessary to use dental floss properly until about age 8 or 9, flossing should be done by parents.

DIF: Cognitive Level: Application REF: p. 132 OBJ: 13 TOP: Dental hygiene KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

21. According to Freud, the child is in a period of latency during middle childhood, which is characterized by: a. intense desire for gender specific toys. b. frequent masturbatory activity. c. a return to a more immature behavior pattern. d. identification with the parent of the same sex.

ANS: D

During the latency period, children expand on previously acquired traits and skills.

Identification is with the same-sex parent.

DIF: Cognitive Level: Comprehension REF: p. 144 OBJ: 11 TOP: Sexuality KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

22. A parent says, “I am worried about my 13-year-old son. He hasn’t started puberty, and my daughter did when she was 11 years old.” The health-care worker should explain to this parent that this is: a. unusual and requires further evaluation. b. unusual because the onset of puberty is usually the same in siblings. c. normal because the onset of puberty is usually earlier in girls than in boys. d. abnormal because the onset of puberty is usually earlier in boys than in girls.

ANS: C

Toward the end of middle childhood, the discrepancies in growth and maturation between boys and girls begin to be apparent. On average, there is a difference of approximately 2 years between girls and boys in which observable signs of puberty appear.

DIF: Cognitive Level: Application REF: p. 137, Table 9-1 OBJ: 11 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

23. According to Kohlberg, the development of occurs as cognitive function matures and the school-age child learns to understand rules and to determine if an action is right or wrong. a. cognitive style

b. social cognition c. cultural adjustment d. moral reasoning ANS: D

Moral reasoning is the development of the child’s understanding of what actions would be considered right or wrong.

DIF: Cognitive Level: Analysis TOP: Cognitive development MSC: NCLEX: NA

REF: p. 141 OBJ: 6 KEY: Nursing Process Step: NA

24. The Wechsler Primary Scale of Intelligence has been administered to a group of 7-year-olds.

The parents of one of the children ask why this test is being administered to these children.

The best response is: a. “This test determines a child’s overall intelligence.” b. “This test determines which children should be placed in a gifted program.” c. “This test determines which children should be placed in a remedial program.” d. “This test can be used to predict school ability and future performance.”

ANS: D

Intelligence tests are not designed to determine general intelligence but to help predict school performance and to help identify children who may need additional help or challenges.

DIF: Cognitive Level: Comprehension REF: p. 143 OBJ: 9 TOP: Intelligence tests KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

25. Anticipatory guidance for the family of an 11-year-old girl should include that they should expect their daughter to exhibit: a. decreased modesty. b. desire for privacy. c. disinterest in boys. d. selection of career choice.

ANS: B

The 11-year-old appreciates privacy and may become embarrassed to show her maturing body.

DIF: Cognitive Level: Application REF: p. 144 OBJ: 4 TOP: Desire for privacy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

26. The health-care worker assesses a decrease in egocentrism in a 7-year-old when the child demonstrates: a. less interpersonal cooperation. b. inability to see how his behavior affects others. c. recognition of opinions of others. d. abandonment of the relationship of an imaginary friend.

ANS: C

A reduction in egocentrism allows the child to consider the opinions of others, to become more cooperative, and to see how his behavior affects others.

DIF: Cognitive Level: Application REF: p. 141 OBJ: 2 TOP: Health and safety needs of the school-age child KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. The description of behaviors of the school-age child that is most closely linked to Erikson’s theory is that during this time, school-age children: a. experience relationships with same-sex peers. b. with greater independence can carry tasks through to completion. c. continue to use infantile traits to influence their behavior. d. have an overlapping of developmental characteristics between childhood and adolescence.

ANS: B

According to Erikson, the primary task for school-age children is to achieve a sense of industry. As children progress through middle childhood, they develop the independence and ability to carry through tasks to completion and to work for delayed rewards.

DIF: Cognitive Level: Knowledge TOP: Task of industry MSC: NCLEX: NA

REF: p. 143 OBJ: 5 KEY: Nursing Process Step: NA

28. School-age children are at risk for disturbances in nutrition related to: a. unsatisfied hunger and large appetite. b. loss of deciduous teeth. c. excessive intake of milk. d. tendency to neglect breakfast in a rush to get to school.

ANS: D

School-age children may neglect breakfast in a rush to get to school. Frequently they skip a meal because they are too busy to eat and may incur deficiencies in iron, calcium, and vitamins.

DIF: Cognitive Level: Application REF: p. 135, Table 9-1 OBJ: 2 TOP: Nutrition KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

29. The health-care worker giving parents guidelines about discipline for their school-age children would include which of the following guidelines? a. Discipline for inappropriate behavior may be deferred until both parents are available. b. Discipline should combine reward and punishment, based on age-appropriate behavior expectation. c. Time-outs are appropriate forms of discipline for the school-age child. d. At this age, spanking is the best long-term form of discipline.

ANS: B

Punishment should be prompt, consistent, and fair. It should not be used to demand behavior that is beyond a child’s capability. Positive reinforcement is critical to development of good behavior.

DIF: Cognitive Level: Application REF: p. 142 OBJ: 7 TOP: Discipline KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

30. A parent asks how to prevent her 10-year-old son from becoming involved in gang violence.

The best response should be: a. “Become aware of any gang-related activity in your neighborhood.” b. “Try to become more of a ‘pal’ to your son so that he won’t look for outside approval.” c. “Don’t place too many restrictions on your son. He needs to increase his independence and this will show that you trust him.” d. “Don’t allow him to join ‘boys-only’ groups.”

ANS: A

Parents can be encouraged to become aware of gang-related activity in their community or neighborhood by calling or visiting the local police station. In addition, gang members often have characteristics that parents can identify, such as a particular clothing style, tattoos, hand signals, or graffiti.

DIF: Cognitive Level: Application REF: p. 144 OBJ: 10 TOP: Peer relationships KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

31. The major health teaching need(s) of middle childhood include: (Select all that apply.) a. injury prevention. b. ethical behavior. c. scoliosis screening. d. driving safety. e. need for immunizations.

ANS: A, C, E

Children in middle childhood (ages 6-12 years) need to be reminded of injury prevention and screened for scoliosis, sensory deficits, nutritional deficits, dental care, and immunizations.

Although traffic safety is a concern, driving safety is not. Ethics is not a concept that children in middle childhood understand.

DIF: Cognitive Level: Application REF: p. 147 OBJ: 13 TOP: Health and safety needs of the school-age child KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

32. When giving parents guidelines about supporting their children to learn in school, the health-care worker includes that parents should: (Select all that apply.) a. give praise for the child’s application to the learning process. b. correct all incorrect responses.

c. encourage the child to accept responsibility for learning. d. reinforce teaching frequently. e. give occasional rewards.

ANS: A, C, D, E

Praise, reinforcement, and encouraging responsibility for the learning support the child’s approach to learning.

DIF: Cognitive Level: Comprehension REF: p. 146 OBJ: 3 TOP: Supporting learning KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

33. Parents of latchkey children can help ensure their safety by instructing the child to: (Select all that apply.) a. watch TV until an adult comes home. b. walk to and from school with friends. c. call a work number if necessary. d. inform callers that parents are out. e. practice route of escape in case of fire.

ANS: B, C, E

Walking with friends or with a group increases the safety of a latchkey child. The child should know the work number of the parents and a responsible adult with whom to make contact if needed. Callers should be told that the parents are busy, not out. Knowing the escape route in case of fire enhances the child’s safety.

DIF: Cognitive Level: Comprehension REF: p. 145, Box 9-2 OBJ: 13 TOP: Latchkey kids KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk COMPLETION

34. According to Piaget, school-age children are concrete thinkers, and retained best.

_-

learning is

ANS:

hands, on hands-on School-age children think logically and understand rules, although they learn best when they can see and handle objects.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 3 TOP: Cognitive development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

35. The health-care worker designing a class on maintenance of good nutrition for middle childhood children would ensure each class lasted no more than minutes.

ANS:

45

The attention span of children in middle childhood is no more than 45 minutes.

DIF: Cognitive Level: Knowledge REF: p. 146 OBJ: 3 TOP: Attention span KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 10: Adolescence Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. During puberty, girls experience an increase in weight and redistribution of fat. Health-care considerations related to this include: a. providing reassurance that these changes are normal. b. suggesting dietary measures to control weight gain. c. recommending an exercise program to control weight gain. d. encouraging a low-fat diet to prevent excess deposition of fat.

ANS: A

A common response to changes in body shape in teenage girls is to begin dieting at a time when nutritional requirements are at a peak. For some, the focus on slim figures and dieting may trigger an eating disorder.

DIF: Cognitive Level: Application REF: p. 155 OBJ: 4 TOP: Physiological changes KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. According to Erikson, the psychosocial task of adolescence is developing a sense of . a. initiative b. identity c. independence d. autonomy ANS: B

According to Erikson, a major developmental task of adolescence is establishing a stable self-identity.

DIF: Cognitive Level: Knowledge TOP: Psychosocial development MSC: NCLEX: NA

REF: p. 159 OBJ: 6 KEY: Nursing Process Step: NA

3. The health-care worker advising parents of an adolescent as to how to avoid conflict and rebellion as they instruct their child in healthy behaviors would suggest the approach of: a. giving clear, strict guidelines for the adolescent’s expected behavior. b. allowing adolescent to direct his or her own health-seeking behavior to support independence. c. pointing out behaviors that are not healthy to help channel better decision making. d. discussing expected guidelines in respectful manner with the adolescent.

ANS: D

As the adolescent moves toward becoming a self-governing adult, respectful trusting communication will reduce friction and lower defenses.

DIF: Cognitive Level: Comprehension REF: p. 163 OBJ: 5 TOP: Psychosocial development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. The school nurse would inform parents who are seeking information regarding adolescent masturbation that: a. masturbation at an early age is associated with sexual intercourse at an earlier age. b. the practice of masturbation encourages homosexuality. c. masturbation is normal in adolescents and is more common among boys. d. development of intimate relationships may be delayed when masturbation is regularly practiced.

ANS: C

Developing a sexual identity is part of the adolescent’s sense of self. Masturbation is one way to explore and learn about one’s body.

DIF: Cognitive Level: Application REF: p. 162 OBJ: 5 TOP: Masturbation KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. The school nurse tells adolescents that privacy and confidentiality will be maintained unless a life-threatening situation arises. This practice is: a. not appropriate in a school setting. b. never appropriate because adolescents are minors. c. important in establishing trusting relationships. d. indicative that the nurse is meeting his or her own needs.

ANS: C

Establishing a trusting relationship is the first step in effective teaching of adolescents.

Providing privacy and confidentiality is an important step in developing this trust.

DIF: Cognitive Level: Analysis REF: p. 160 OBJ: 13 TOP: Teaching techniques for the adolescent KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. A 14-year-old girl tells the school nurse that she has not started to menstruate and that all of her friends have. The nurse’s best response to the girl would be to: a. explain that this is not unusual as sexual maturing can occur as late as 15 years of age. b. suggest the girl seek medical evaluation. c. call the girl’s parents in for a conference about this situation. d. recommend that she stop all strenuous exercising until her periods begin.

ANS: A

Sexual maturity can occur in girls between the ages of 10 and 15 years of age.

DIF: Cognitive Level: Application REF: p. 154 OBJ: 4 TOP: Puberty KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. A 15-year-old athlete is concerned that the darkening pigment on his scrotum is related to his frequent masturbation. The best response would be based on the knowledge that the color change is: a. most probably “jock itch.”

b. related to frequent nocturnal emissions. c. the result of increase in androgens. d. possible bruising from a sports injury.

ANS: C

The increase of androgens in the adolescent male causes the appearance of secondary sex characteristics among which is the darkening of the skin of the scrotum.

DIF: Cognitive Level: Application REF: p. 154 OBJ: 13 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. According to Piaget, the cognitive development of the adolescent progresses to the stage by middle adolescence. a. preoperational b. formal c. concrete d. sensorimotor ANS: B

Early adolescents are in the concrete phase of thinking, where they interpret words and concepts literally. By middle adolescence they have moved into the formal operation stage, where thinking is more abstract.

DIF: Cognitive Level: Comprehension REF: p. 158 OBJ: 6 TOP: Cognitive development KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. The health-care worker reminds a group of parents of adolescents that as they find their own identity, adolescents will demonstrate: a. increased independence from peers and friends. b. increased need for parental approval. c. imitation of parental values and ideals. d. less emotional dependence on parents.

ANS: D

To achieve a sense of self-identity, adolescents must see themselves as separate from their role of child in the family. Parents can help adolescents achieve this identity by offering support and guidance and by giving adolescents freedom to discover their own interests, which differ from those of their parents.

DIF: Cognitive Level: Analysis REF: p. 159 OBJ: 5 TOP: Psychosocial development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. The initiation of puberty is controlled by the secretions from the: a. gonads b. hypothalamus. c. anterior pituitary d. posterior pituitary ANS: B

The hypothalamus initiates the process as it stimulates the anterior pituitary to stimulate the gonads, which cause the physical changes associated with puberty.

DIF: Cognitive Level: Comprehension REF: p. 154 OBJ: 3 TOP: Hypothalamus KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

11. When a 16-year-old student tells her mother that she is going to go to work for 30 hours a week to earn money to buy a car, the most therapeutic response would be: a. “You are healthy and doing well in school. Go for it!” b. “A car will give you a lot of freedom and will enhance your maturity.” c. “What is the hourly wage?” d. “Will working 30 hours a week interfere with school?”

ANS: D

Adolescents need to be responsible for making decisions. The parental role is to guide the adolescent to see more realistic options rather than to mandate behavior.

DIF: Cognitive Level: Application REF: p. 161 OBJ: 12 TOP: Development of responsibility KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. In planning sex education and contraceptive teaching for adolescents, the health-care worker should recognize that: a. most adolescents today are knowledgeable about reproductive anatomy and physiology. b. adolescents frequently do not have a basic understanding of fertility. c. both contraception and sexual activity require planning. d. most adolescents who become pregnant do so as an act of defiance against their parents.

ANS: B

Although most adolescents know that once a girl has begun menstruating she can become pregnant, most have no concept of fertility and the process of reproduction. Many believe that pregnancy cannot occur with the first experience of intercourse.

DIF: Cognitive Level: Application REF: p. 157 OBJ: 7 TOP: Puberty KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

13. The appropriate term for the initial menstrual period is: a. ovulation. b. puberty. c. menarche. d. luteinization.

ANS: C

Menarche is the term for the initial menstrual period.

DIF: Cognitive Level: Knowledge REF: p. 155 OBJ: 3 TOP: Menarche KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. When providing health teaching for middle adolescents, the health-care worker should recognize that middle adolescents: a. have adequate opportunities to make decisions based on past experiences. b. develop the ability to demonstrate deductive reasoning. c. accept parents’ beliefs as their own. d. have beliefs that become more concrete and founded in observing religious customs.

ANS: B

Although the early adolescent needs to conform and please others, during later adolescence moral principles are based on one’s individual thinking and beliefs. Middle adolescents are able to perform inductive and deductive reasoning.

DIF: Cognitive Level: Analysis REF: p. 153, Table 10-1 OBJ: 2 TOP: Cognitive development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. The health-care worker is sensitive to the fact that health concerns consistent with middle adolescence are focused on: a. school performance. b. emotional health issues. c. physical appearance. d. future career or employment.

ANS: C

During middle adolescence, teenagers are more concerned with their physical appearance than with school performance, emotional health, or future careers.

DIF: Cognitive Level: Comprehension REF: p. 157 OBJ: 2 TOP: Developmental tasks KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. The leading cause of teenage deaths is related to: a. motor vehicle accidents. b. drowning. c. suicides d. drug overdoses.

ANS: A

Because adolescents often feel invincible and have an “It can’t happen to me” attitude, they may involve themselves in risk-taking behavior, particularly related to motor vehicles and driving.

DIF: Cognitive Level: Comprehension REF: p. 163 OBJ: 13 TOP: Teaching techniques for the adolescent KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. When an adolescent boy tells the health-care worker that he has recently had a homosexual encounter with his best friend, the response should be based on knowledge that this event suggests that the adolescent: a. is homosexual. b. will become homosexual as an adult. c. should be referred for psychotherapy. d. should be encouraged to discuss this event.

ANS: D

Sexual fantasy and experimentation is a normal part of sexual maturation. Experimentation with homosexual behavior may have a relationship to future sexual identification but may also simply be part of an exploration of lifestyle options and identity.

DIF: Cognitive Level: Application REF: p. 162 OBJ: 5 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. Early adolescence is considered to begin at the age of: a. 9 years. b. 10 years. c. 13 years. d. 14 years.

ANS: B

Early adolescence is considered to be the period between the ages of 10 years and 13 years.

DIF: Cognitive Level: Knowledge TOP: Developmental tasks MSC: NCLEX: NA

REF: p. 152 OBJ: 2 KEY: Nursing Process Step: NA

19. The high school nurse is intending to present a class on potential health problems associated with body piercing and tattooing. What piece of information is critical to planning the class? a. Culture affects health-care practices and forms of communication. b. Adolescents are eager to be told what to do regarding health-care practices. c. Physical maturity and cognitive maturity occur at the same rate. d. Peer-group practices need not be a consideration when planning a class on potential health problems.

ANS: A

An adolescent’s culture affects how he/she thinks and interacts. Focus that is on cultural values and individual strengths will help achieve positive health teaching outcomes.

DIF: Cognitive Level: Application REF: p. 160 OBJ: 9 TOP: Culture and the adolescent KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

20. The school nurse plans to include information about oral sex in a sex-education class for 15-year-olds. The most significant reason to include this information is that: a. the information introduces a non-intercourse method of sexual expression. b. a sex-education class would be incomplete without the information. c. middle adolescents may not consider oral sex a sexual act or a risk for sexually transmitted diseases (STDs).

d. exposure to sexual expression through TV and movies make the information necessary.

ANS: C

Instruction on oral sex informs the adolescent that the act is a sexual one and exposes the practitioners to STDs. Although the other options are appropriate, the most significant is that of the recognition of the threat of STDs. DIF: Cognitive Level: Analysis REF: p. 162 OBJ: 14 TOP: Physiological changes KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment: safety and infection control

21. The school nurse presenting a sex-education class to a group of 14-year-olds would stress that the birth control method that can prevent STDs, if used correctly, is the: a. vaginal ring. b. spermicidal foams. c. cervical cap. d. condom.

ANS: D

If used correctly and used only once, the condom can be effective in the prevention of contracting a STD. DIF: Cognitive Level: Comprehension REF: p. 156, Table 10-2 OBJ: 13 TOP: Birth control methods that prevent STDs KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

22. The school nurse is discussing testicular self-examination with adolescent boys. This is important because: a. inflammation of the testes is common during adolescence. b. asymptomatic STDs may be present. c. adolescence is the best time to teach preventative health measures. d. testicular tumors are common during adolescence.

ANS: C

Developing the habit of self-examination during adolescence should support the likelihood that the behavior will continue into adulthood, when the risk for testicular tumors becomes greater.

DIF: Cognitive Level: Comprehension REF: p. 155 OBJ: 3 TOP: Testicular self-examination KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

23. An adolescent tells the school nurse that she is about 4 months pregnant. She has had no medical care and states that although she smokes, she doesn’t use any drugs. The priority nursing action is to: a. notify her parents. b. refer her for prenatal care. c. discuss nutritional needs for herself and the growing fetus. d. explain the importance of not smoking.

ANS: B

Pregnant teens must cope with their own developmental tasks as well as those of parenthood.

Counseling and close medical supervision are essential for a positive outcome in a teen pregnancy.

DIF: Cognitive Level: Application REF: p. 157 OBJ: 14 TOP: Teen pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk

24. The factor that has the greatest impact on the likelihood that an adolescent will begin drinking alcohol is: a. friends drink alcohol. b. parents drink alcohol. c. availability of alcohol. d. enjoyable effects of alcohol.

ANS: A

Belonging to a social group is of utmost importance to an adolescent. Failure to connect in a peer group, or association with a group that indulges in risky behavior, may leave the adolescent vulnerable to use of illegal substances or alcohol.

DIF: Cognitive Level: Comprehension REF: p. 161 OBJ: 10 TOP: Peer relationships KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

25. A school nurse is conducting a sex-education class for early adolescent girls. One girl asks how to tell when she could become pregnant. The nurse explains that: a. ovulation, and the most fertile period, occurs immediately after menstruation stops. b. ovulation, and the most fertile period, occurs just before the start of menstruation. c. ovulation, and the most fertile period, occurs about 14 days before menstruation begins. d. if you have irregular menses, there is no way to determine the fertile period.

ANS: C

Ovulation occurs about 14 days before the onset of menses, when pregnancy can occur if sperm are present. Teaching adolescents about contraception may prevent an unwanted pregnancy.

DIF: Cognitive Level: Comprehension REF: p. 155 OBJ: 7 TOP: Puberty KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

26. According to Kohlberg’s moral development, the 15-year-old adolescent is motivated by: a. what seems most pleasurable. b. associated rewards for appropriate behavior. c. the desire to demonstrate responsible behavior. d. the need to conform and please others.

ANS: D

The 15-year-old is motivated by the need to conform and please others.

DIF:

Cognitive Level: Application

REF: p. 158, Tables 10-1 and 10-6

OBJ: 5 TOP: Teaching techniques for the adolescent KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. Adolescents are more likely to participate in health-care services when they: a. understand the potentially negative results of their health behavior. b. see the health-care provider as caring and respectful. c. view their health problems as not physical in nature. d. are allowed to consistently make their own decisions about seeking health care.

ANS: B

Communication with adolescents must be supportive and not threaten their sense of autonomy. If health-care providers and parents show respect for the adolescent and demonstrate a caring attitude, the adolescent is more likely to use information about healthy behaviors wisely.

DIF: Cognitive Level: Comprehension REF: p. 163 OBJ: 12 TOP: Teaching techniques for the adolescent KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

28. When considering the effect of culture on an adolescent, the health-care worker recognizes that culture: a. is synonymous with race. b. refers to a group of people with similar physical attributes. c. refers to the universal sequence of growth and development. d. affects the development of health beliefs and health-care practices.

ANS: D

Culture plays a role in how an adolescent thinks and acts and can affect health beliefs and practices. Health-care providers must recognize and respect values and practices of other cultures in order to achieve positive health teaching outcomes.

DIF: Cognitive Level: Analysis REF: p. 160 OBJ: 9 TOP: Culture and the adolescent KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

29. The parents of an adolescent are concerned about the amount of time their adolescent spends daydreaming and “doing nothing.” The health-care worker recognizes that: a. daydreams help the adolescent think through responses to various situations and can be a safe outlet for strong emotions. b. daydreaming is a sign of early depression and the child needs medical evaluation. c. daydreams are time-wasting and the adolescent needs to be involved in more outside activities. d. daydreaming is always an adolescent’s substitute for doing homework and household chores.

ANS: A

Daydreaming is a healthy way for adolescents to vent strong emotions and devise responses to various situations. Daydreams are harmless unless they interfere with school or relationship functioning.

DIF: Cognitive Level: Analysis REF: p. 158 OBJ: 5 TOP: Cognitive development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

30. A group of parents are concerned about their adolescent children and dating. The health-care worker points out that: a. early adolescence is not the proper time for dating or mixed-sex group activities. b. dating can have a positive impact on developing problem-solving and social skills. c. adolescents should be allowed to make their own decisions about when to start dating. d. parents should set strict guidelines for dating and expect the adolescent to conform to the rules.

ANS: B

An adolescent utilizes problem-solving skills in the task of establishing a dating relationship.

Social skills and cognitive reasoning are further enhanced in later adolescence as relationships become longer-lasting and less experimental.

DIF: Cognitive Level: Analysis REF: p. 159 OBJ: 11 TOP: Psychosocial development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

31. According to the definition of vigorous exercise published by the Centers for Disease Control and Prevention (CDC) in 2006, the exercise should: (Select all that apply.) a. be at least 30 minutes in duration. b. produce sweat. c. be performed before meals. d. increase respiration. e. be practiced every day.

ANS: B, D

The CDC defined vigorous exercise as an activity that will produce sweat and increased respiration and be at least 20 minutes in duration. This exercise is to be practiced 3 days a week in addition to the recommended 50 minutes of physical activity a day.

DIF: Cognitive Level: Application TOP: Vigorous exercise MSC: NCLEX: NA

REF: p. 152 OBJ: 13 KEY: Nursing Process Step: NA

32. The peer group serves as: (Select all that apply.) a. a major step in separation from family dependence. b. a practice area for forming relationships. c. a source of social interaction. d. the only source for role modeling. e. a status symbol of membership.

ANS: A, B, C, E

The peer group is a place to share thoughts and feelings apart from family. It serves as a source to form relationships. It is not the only source for role modeling.

DIF: Cognitive Level: Application REF: p. 162 OBJ: 10 TOP: Peer groups KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development COMPLETION

33. The term

refers to the functional ability to reproduce.

ANS:

puberty Puberty is the functional ability to reproduce, or sexual maturity.

DIF: Cognitive Level: Knowledge REF: p. 154 OBJ: 4 TOP: Puberty KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

34. The birth control option that requires a subdermal insertion and lasts up to 3 years is .

ANS:

Implanon Implanon is placed under the skin of the arm and provides up to 3 years of contraception.

DIF: Cognitive Level: Comprehension REF: p. 156, Table 10-2 OBJ: 7 TOP: Implanon KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: pharmacological therapies

Chapter 11: Young Adulthood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The school nurse plans a class in men’s health needs in order to: a. balance the amount of information about female health needs. b. encourage the organization of gender-specific health-care providers. c. interest insurance carriers in supporting preventative health measures for men. d. sensitize males to health concerns.

ANS: D

Men need to be aware of their health-care needs and methods to prevent illness. Men do not seek health care as often as females do. Men rarely seek medical assistance until a specific problem arises.

DIF: Cognitive Level: Analysis REF: p. 175 OBJ: 6 TOP: Men’s health care KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

2. High schools and junior high schools are now offering classes in money management and parenting for the purpose of: a. keeping adolescents interested in school. b. giving minority populations increased insight to finances. c. helping adolescents transition more easily to adulthood. d. discouraging teen pregnancy.

ANS: C

Schools are offering classes in money management, family life classes, and parenting classes to help adolescents move into adulthood.

DIF: Cognitive Level: Application TOP: School classes MSC: NCLEX: NA

REF: p. 176 OBJ: 8 KEY: Nursing Process Step: NA

3. Women’s health care should include safe-sex practices. The purpose of this is to: a. make sure no unwanted pregnancies occur. b. identify persons who are not using safe-sex practices. c. encourage healthy lifestyles to prevent sexually transmitted diseases (STDs). d. reduce teen pregnancies.

ANS: C

The consistent practice of safe sex reduces the incidence of STDs, which, untreated, can lead to women’s health problems such as pelvic inflammatory disease, acute illness, and ectopic pregnancies.

DIF: Cognitive Level: Application REF: p. 173 OBJ: 4 TOP: Safe-sex practices KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

4. The health-care worker suspecting a woman who comes to the clinic is in an abusive relationship teaches the woman about partner abuse because the health-care worker knows that all women should be informed: a. about the health-care worker’s ethical responsibility to protect women. b. that women’s legal rights cannot be controlled by men. c. about the submissive nature of women who stay in abusive relationships. d. about the cycle of violence that indicates once violence begins, it continues and escalates over time.

ANS: D

Intimate partner violence is an epidemic and contributes to the mortality and morbidity statistics of young adult women. Once begun, the cycles of violence have fewer “honeymoon” phases and the tension and battering phases last longer, increasing the risk of lasting harm to the woman.

DIF: Cognitive Level: Application REF: p. 175, Fig. 11-5 OBJ: 4 TOP: Women’s health issues KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

5. The college health-care worker planning a health promotion class plans to support the goals of Health People 2020 and focus on: a. nutrition, family planning, and physical fitness. b. vaccine-preventable disease and osteoporosis prevention. c. periodontal disease and chronic lung disease. d. breastfeeding and sudden infant death syndrome (SIDS) prevention.

ANS: A

Healthy People 2020 has identified several priority areas for health promotion during young adulthood, including maintaining physical activity, nutrition, family planning, and reducing the use of tobacco and alcohol.

DIF: Cognitive Level: Application REF: p. 171 OBJ: 4 TOP: Health Promotion KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

6. The health-care worker planning a men’s health clinic at a local college plans to give a priority focus on a booth that will provide information about: a. career counseling. b. family planning. c. immunizations. d. testicular self-examination.

ANS: D

The highest rate of testicular cancer is between the ages of 17 and 35 years, so early teaching programs in this clinic should include testicular self-examination.

DIF: Cognitive Level: Application REF: p. 176 OBJ: 6 | 7 TOP: Testicular cancer KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

7. Using Erikson’s developmental stages as a guide, the home health-care worker identifies the person at risk for delayed development as the: a. 22-year-old man finishing his degree at night school so he can work in the daytime to support his wife and child. b. 23-year-old divorced woman in a committed lesbian relationship who works as a medical assistant in a busy physician’s office. c. 24-year-old woman who is still living at home and spends most of her time involved in computer social media. d. 25-year-old man living in the garage apartment behind his parent’s house as he and his wife work and go to school to finish their advanced degrees.

ANS: C

The developmental tasks according to Erikson are to become independently self-supporting and develop an intimate relationship and a stable lifestyle.

DIF: Cognitive Level: Analysis REF: p. 167 OBJ: 2 TOP: Developmental tasks of the young adult KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

8. At a routine yearly physical, an 18-year-old woman states, “I never check my breasts. I think I am too young to worry about that.” The most helpful response would be: a. “There is no need to check your breasts at your age.” b. “Most women would be interested in their own health.” c. “You should practice checking your breasts the first day of your monthly period.” d. “All women should check their breasts every month.”

ANS: D

The health-care worker should encourage the woman to perform monthly breast selfexamination.

The exam is usually done 1 week after the cessation of their monthly period.

DIF: Cognitive Level: Application REF: p. 173 OBJ: 7 TOP: Breast self-exam KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

9. An occupational health-care worker is teaching a class of health-promoting behaviors to a group of young adults when a member of the group asks why this class is necessary, since they are all healthy young adults. The health-care worker’s best response is: a. “Major health changes occur from young adulthood to middle age, so it is necessary to learn health behaviors to cope with these changes.” b. “Because you all will face chronic illness as older adults, you need to learn coping strategies now.” c. “Good health habits formed as young adults show striking effects on the prevention of illness and disease as you grow older.” d. “In order to maintain your company health insurance, it is necessary for you to attend this class.”

ANS: C

Positive health behaviors practiced in young adulthood may significantly reduce the development of chronic illness and serious disease in older adulthood.

DIF: Cognitive Level: Comprehension REF: p. 171 OBJ: 14 TOP: Teaching techniques for the young adult KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

10. The college health-care worker cautions the 20-year-old male about an adverse effect of overtraining, which is: a. excessive secretion of testosterone. b. loss of strength. c. uncontrolled rise in blood glucose. d. reduced libido.

ANS: B

Overtraining can result in loss of strength, dehydration, and muscle and joint injury.

DIF: Cognitive Level: Comprehension REF: p. 176 OBJ: 4 TOP: Overtraining KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: reduction of risk

11. A health-care worker preparing a class on nutrition for a group of young adults explains that MyPlate is a nutritional guide that: a. spells out food exchanges. b. recommends that 30% of a plate be fruits and vegetables. c. directs nutritional intake to be 50% protein. d. helps limit portion size.

ANS: D

By following this guide, the young adult can use this visual guide to select meals that are 50% fruits and vegetables and maintain optimum nutrition. The colored-coded guide is a reminder to limit portion size.

DIF: Cognitive Level: Knowledge REF: p. 168, Figure 11-3A OBJ: 14 TOP: MyPlate KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. Health maintenance instruction during young adulthood should be directed toward: a. preparing for the inevitable physical decline. b. halting age-related physiological changes. c. teaching how to cope with chronic illness. d. preventing illnesses caused by lifestyle choices.

ANS: D

Teaching the young adult about lifestyle changes to prevent illness and promote health may contribute to better health as an older adult. It is easier to develop good health habits at a younger age than to change or compensate for bad habits later in life.

DIF: Cognitive Level: Application REF: p. 169 OBJ: 14 TOP: Teaching techniques for the young adult KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

13. A new mother tells the home health-care worker that she feels “really stupid” about caring for her newborn, as her mother-in-law does everything for the baby. The best approach to facilitate instruction would be: a. “Let’s talk about what you already know about infant care, then we can plan from there.” b. “Tell your mother-in-law that she has to teach you everything she knows.” c. “You and your husband should sign up for child-care classes at the YMCA.” d. “You and your husband should read up on infant care.”

ANS: A

Successful adult teaching relates information to the appropriate developmental tasks they are experiencing and should build on previous knowledge and skills. In addition, in-laws should understand that while assistance at this time is appreciated, most of the infant care is the responsibility of the new parents.

DIF: Cognitive Level: Application REF: p. 181 OBJ: 13 TOP: Parenting KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

14. Young adulthood, or early adulthood, is most often defined as the time of age 20 years to years. a. 25 b. 30 c. 35 d. 40 ANS: D

Young adulthood is defined as the young adult phase from 20 to 40 years of age.

DIF: Cognitive Level: Knowledge REF: p. 166 TOP: Definition KEY: Nursing Process Step: NA

OBJ: 1 MSC: NCLEX: NA

15. The goal of intimacy for the young adult means that the young adult has achieved: a. a satisfying sexual relationship. b. an open and trusting relationship with another person. c. a casual relationship with several close friends. d. a clear sense of identity.

ANS: B

Intimacy allows the person to share thoughts and feeling in an open and trusting relationship.

The intimacy is not merely sexual.

DIF: Cognitive Level: Comprehension REF: p. 177 OBJ: 2 TOP: Intimacy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. The signs of a mid-life crisis” in a 39-year-old man suggest that he may be experiencing the negative influence of Levinson’s stage of: a. structure period. b. concrete period. c. operational phase. d. transitional phase.

ANS: D

In Levinson’s transitional phase, the person looks at decisions made in the structure period and evaluates them. Many become unhappy and feel they have missed opportunities.

DIF: Cognitive Level: Application REF: p. 177 OBJ: 2 TOP: Levinson’s theory KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. According to Piaget, the stage of development that is necessary for effective problemsolving skills in adulthood is the stage. a. integrative b. preoperational c. concrete operational d. post-formal operational ANS: D

Development of the formal operational method of thinking begins in adolescence and extends into young adulthood. This type of thinking is necessary in the use of effective problemsolving techniques in the post-formal operational period.

DIF: Cognitive Level: Knowledge TOP: Cognitive ability MSC: NCLEX: NA

REF: p. 177 OBJ: 10 KEY: Nursing Process Step: NA

18. According to Kohlberg, young adults should develop moral reasoning as they mature; this moral reasoning is characterized by: a. conforming to rules to gain recognition or reward. b. taking responsibility for care of others. c. obeying rules to avoid punishment. d. maintaining a sense of life achievement.

ANS: B

Taking responsibility for care of others, dealing with differing points of view, and understanding how their behavior affects others all contribute to the development of mature moral reasoning.

DIF: Cognitive Level: Comprehension TOP: Moral reasoning MSC: NCLEX: NA

REF: p. 177 OBJ: 11 KEY: Nursing Process Step: NA

19. A young woman pregnant with her first child is in the second trimester. The health-care worker will direct instruction toward: a. detailed information about the birth process. b. possible abnormalities of the fetus. c. preparations about the physical environment for the expected infant. d. birth-control measures after delivery.

ANS: C

In the second trimester, the family should be directed and supported as they prepare the physical environment for the baby. Instruction about care of the newborn is appropriate at this time.

DIF: Cognitive Level: Application REF: p. 179, Table 11-2 OBJ: 13 TOP: Second trimester KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. A woman in the third trimester of pregnancy expresses fear about her impending labor and how she will manage. The best response would be: a. “Don’t worry about it, you’ll do fine.” b. “Labor is scary to think about, but the actual experience isn’t.” c. “You can have an epidural. You won’t feel anything.” d. “It’s normal to be anxious. Let’s go over what happens after you are admitted.”

ANS: D

The third trimester of pregnancy is the time that information should be given to parents concerning labor, the birth process, preparation for birth, and so on. Successful adult learning involves relating the information to the appropriate developmental tasks they are experiencing.

DIF: Cognitive Level: Application REF: p. 179, Table 11-2 OBJ: 13 TOP: Parenting KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

21. A young adult man says that his 3-year-old son wants to do many things the parent thinks is dangerous. The most helpful suggesting the health-care worker could give about this toddler’s behavior is: a. “Let him do what he wants. He won’t break.” b. “Allow him his independence, but keep an eye out for safety.” c. “Your child should be limited in his explorations as his judgment is immature.” d. “Parents of toddlers need to continue to do things for their children.”

ANS: B

Toddlers need to be allowed to develop autonomy by seeking new boundaries, but these children still need to be protected from injury.

DIF: Cognitive Level: Application REF: p. 179, Table 11-2 OBJ: 13 TOP: Parental development KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

22. Teaching to increase self care is effective when the adult learner makes which statement? a. “I’ll do whatever you say; you’re the professional.” b. “I don’t think I can quit smoking.” c. “I exercise for 30 minutes 5 times a week.” d. “What do you think I should do?”

ANS: C

Concepts presented to young adults should build on previous knowledge and skills. Teaching goals should be clear and should identify how the new knowledge can be used and how it will benefit their current life roles.

DIF: Cognitive Level: Application

REF: p. 181

OBJ: 14

TOP: Teaching techniques for the young adult KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: growth and development MULTIPLE RESPONSE

23. In the United States, at age 18, young adults are able to: (Select all that apply.) a. vote. b. purchase a license for a shotgun. c. marry without parental consent. d. purchase alcohol. e. be drafted into military.

ANS: A, B, C, E

In the United States, persons who are 18 may vote, marry without parental consent, be drafted into the military, and purchase a license for a shotgun. To purchase alcohol or obtain a license for a pistol, persons must be 21.

DIF: Cognitive Level: Comprehension REF: p. 166 OBJ: 1 TOP: Rights of young adulthood KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

24. Signs of intimate partner violence include: (Select all that apply.) a. absolute financial control by partner. b. erratic prenatal care. c. self-blame for marital problems. d. cycle of violence in partner. e. substance abuse in partner.

ANS: B, C, D, E

The Centers for Disease Control (CDC) lists signals of Intimate Partner Violence (IPV) as erratic prenatal care and child health care, history of substance abuse, abuse as a child, history of minor battering incidents, evidence of bruises and lacerations in various stages of healing, and the victim’s accepting blame for marital problems.

DIF: Cognitive Level: Comprehension REF: p. 175, Box 11-2, Figure 11-2 OBJ: 4 TOP: IPV KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

25. The health-care worker recommends that the young adult take up weight training for fitness and counsels that such activity should be: (Select all that apply.) a. moderate to high intensity. b. performed 2 or more days a week. c. intense enough to involve all major muscle groups. d. supervised and directed by a trainer. e. prescribed by a physician.

ANS: A, B, C

Weight training should be of moderate to high intensity, performed two or more times a week and intense enough to involve all major muscle groups. It need not be supervised or prescribed by a physician.

DIF: Cognitive Level: Comprehension REF: p. 168 OBJ: 6 TOP: Weight training KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease COMPLETION

26. Most young adults have ceased to grow when the

of the long bones fuse.

ANS:

epiphyses The epiphyses fuse during the young adult years by the excretion of gonadal steroids, which stops growth.

DIF: Cognitive Level: Knowledge REF: p. 167 OBJ: 3 TOP: Growth KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

27. The health-care worker cautions the 30-year-old woman that at her age there is an increased risk for injuries due to muscle mass being replaced by .

ANS:

fat fatty tissue Around the age of 30, there is a natural decrease in muscle mass, which is replaced by fatty tissue. The reduced strength can lean to vulnerability to injury.

DIF: Cognitive Level: Comprehension REF: p. 167 OBJ: 3 TOP: Loss of muscle mass KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 12: Middle Adulthood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. Health maintenance during middle adulthood should be directed toward: a. preventing illnesses due to lifestyle and physiological changes. b. stopping the physiological aging process. c. preparing for inevitable physical decline. d. maintaining strength and endurance at the young adult level.

ANS: A

Metabolic needs decrease during middle adulthood. Diet and exercise must be part of the lifestyle of the middle-aged adult. Diet, smoking, and lack of exercise influence cardiovascular change.

DIF: Cognitive Level: Application REF: p. 184 OBJ: 8 TOP: Health maintenance KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

2. According to Erikson, the primary task of middle adulthood is contributing positively to family and community, also known as . Failure to achieve this task may result in stagnation. a. intimacy b. integrated c. generativity d. ego integrity ANS: C

Generativity enhances self-image and promotes a feeling of well-being. Adults who do not achieve a sense of generativity may become self-preoccupied and overly concerned with physical and psychological health needs.

DIF: Cognitive Level: Comprehension TOP: Erikson’s developmental tasks MSC: NCLEX: NA

REF: p. 184 OBJ: 3 KEY: Nursing Process Step: NA

3. A 50-year-old woman visits the women’s health clinic stating her last menstrual period was 6 months ago. Since that time, she has been experiencing palpitations and hot flashes. The health-care worker should suspect that her symptoms are related to: a. pregnancy. b. menopause. c. a cardiac disorder. d. neurosis.

ANS: B

Hot flashes and palpitations often accompany menopause and are very distracting and uncomfortable for the woman. Hormone replacement may be prescribed, or complementary and alternative medicine therapy may be recommended.

DIF:

Cognitive Level: Knowledge

REF: p. 187

Downloaded by: BestRates | maytheblessed@gmail.com

OBJ: 4

Distribution of this document is illegal

TOP: Women’s health KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: physiological adaptation

4. Many middle-aged adults desire to return to school to continue an education interrupted by career, family, and childrearing. When counseling these adults, an important factor to consider is that: a. intelligence declines after age 30, so it may be too difficult to resume schooling at this age. b. it may take more time to learn and assimilate new material, but once learned, the content is remembered with greater accuracy. c. without family responsibilities or pressures, learning capability will quickly return to young adult levels. d. there should be no difficulty in keeping up with the younger students in the class.

ANS: B

Speed in mental functioning may be a problem as adults grow older, but when time is not a factor there is little difference in performance when compared to young adults.

DIF: Cognitive Level: Application REF: p. 194-195 OBJ: 3 TOP: Challenges KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. When assessing a middle-aged person, the health-care worker should be sensitive to the fact that these persons are uniquely challenged by: a. metabolic changes in their aging bodies. b. attempting to meet the needs of both their children and their parents. c. inadequate income and job insecurity in an unstable economy. d. the need to find their place NinUtRheSirIcNomGTmBun.iCtyO. M ANS: B

These adults may have to handle increased financial and emotional responsibilities related to the needs of their children and the needs of their aging, and perhaps dependent, parents.

Middle-aged persons usually have a stable income and job security and usually have established themselves in a community.

DIF: Cognitive Level: Application REF: p. 185 OBJ: 9 TOP: The sandwich generation KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

6. While discussing health promotion and maintenance to a group of middle-aged men, the health-care worker advises that men should make as a priority to have an annual: a. screen for prostate cancer. b. sperm count for infertility. c. skin assessment for cancer. d. assessment for testosterone level.

ANS: A

Because of the prevalence of cancer of the prostate as the most common cancer in men, annual screening for prostate cancer is recommended. New screening procedures are available which can diagnose prostate cancer much earlier and often before symptoms occur.

DIF:

Cognitive Level: Application

REF: p. 189

OBJ: 8

TOP: Prostate screening KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

7. To enhance success for health teaching to middle-aged adults, the health-care worker should: a. provide information related to health concerns and stressors common to the age-group. b. begin with concepts about teaching and learning techniques. c. incorporate structured learning activities that keep all group members learning at the same rate. d. direct members to seek independent learning without formal instruction.

ANS: A

Successful teaching of middle-aged adults depends on having an understanding of their concerns and potential sources of stress. Teaching strategies should incorporate the independence and competencies of adult learners and provide information relevant to the age-group. Directing these adults to independent learning without providing guidelines or initial direction may doom the opportunity to learn.

DIF: Cognitive Level: Application REF: p. 190 OBJ: 11 TOP: Teaching strategies for the middle-aged adult KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

8. A middle-aged man says that he is taking up a strenuous exercise program to increase his testosterone level and his libido. The best response to this information would be: a. “That is great! You will begin to feel better and enjoy an increased libido.” b. “While exercising, you should wear tight fitting underwear and an athletic support.” c. “To get the result you want, you will have to exercise every day.” d. “Excessive exercise may actually decrease your testosterone level.”

ANS: D

Excessive exercise may decrease the level of testosterone. The effect can last for several months. Wearing of tight undergarments also decreases the sperm count as the gonads get too hot.

DIF: Cognitive Level: Comprehension REF: p. 188 OBJ: 3 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

9. The term climacteric refers to a time in life in which: a. women have erratic menstrual cycles. b. men have a decrease in libido. c. women have completed menopause. d. men become permanently impotent.

ANS: B

The climacteric refers to a period in a person’s life when there is a slowing and a cessation of the reproductive ability of the female and a decrease in the sexual activity of the male.

DIF: Cognitive Level: Knowledge TOP: Reproductive health

REF: p. 187 OBJ: 5 KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. A 52-year-old woman who is recently divorced and has just sent her last child to college says she just does not understand why she is feeling so “low and alone.” She states she is not sleeping well and has no energy for anything. These most likely are symptoms of: a. worsening depression related to early menopause. b. pathologic depression related to the divorce. c. the “empty nest” syndrome related to the children being gone from home and stress from the recent divorce. d. indicative of her need to go out and get a job.

ANS: C

Women at midlife are at higher risk for the “empty nest” syndrome when the last child leaves home. Feelings of depression and isolation may be exacerbated by divorce or widowhood.

DIF: Cognitive Level: Application REF: p. 185 TOP: Empty nest KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

OBJ: 3

11. A middle-aged man is considering testosterone replacement therapy to increase his strength and sense of well-being. A deficit of testosterone therapy is that the therapy: a. is very expensive. b. does not correct erectile dysfunction. c. increases accumulation of body fat. d. may cause hypertension.

ANS: B

Testosterone replacement theraNpyURdoSeIs NreGstTorBe.stCreOnMgth, decrease fat accumulation, restore libido, and increase a sense of well-being, but it does not correct erectile dysfunction.

DIF: Cognitive Level: Application REF: p. 188 OBJ: 7 TOP: Testosterone replacement therapy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: pharmacological therapies

12. A 55-year-old man has recently purchased a sports car, had a hair transplant, and taken up skydiving as a hobby. The term for this behavior as an attempt to challenge the inevitability of the future is known as: a. generativity. b. identity accommodation. c. male climacteric. d. midlife crisis.

ANS: D

Midlife crisis is a time when adults may fear the inevitability of their own mortality and attempt to make up for lost opportunities or challenge the future by engaging in atypical behaviors.

DIF: Cognitive Level: Comprehension TOP: Midlife crisis MSC: NCLEX: NA

REF: p. 185 OBJ: 6 KEY: Nursing Process Step: NA

13. Middle adulthood is considered the period of development after young adulthood but before retirement and is categorized as age 40 to years. a. 50 b. 55 c. 60 d. 65 ANS: C

Definition of middle adulthood is the life period between the ages of 40 and 60 years of age DIF: Cognitive Level: Knowledge REF: p. 183 OBJ: 1 TOP: Definition of middle adulthood KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

14. The health-care worker clarifies that the concept of generativity means that the middle adult: a. provides care for elderly parents. b. has generated the next generation. c. contributes positively to family and community. d. expresses total concern for his well-being.

ANS: C

Generativity is the concept of the middle adult contributing in a positive way to the community and family through personal activity and achievements that go beyond the self.

DIF: Cognitive Level: Comprehension REF: p. 184 OBJ: 3 TOP: Generativity KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development 15. 1

5 .

As adults move from middle adulthood into older and late adulthood, a productive level of functioning is more likely to be maintained if the person feels: a. useful and loved. b. dependent and closely watched. c. wanted and dependent. d. financially secure and physically active.

ANS: A

An important aspect of all stages of development is the need for feeling useful and loved, as well as maintaining a positive self-image. According to Kegan (see Chapter 5), individuals need to be included in reciprocal relationships with others and to maintain independence.

DIF: Cognitive Level: Analysis REF: p. 184 OBJ: 3 TOP: Developmental tasks KEY: Nursing Process Step: NA MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. A middle-aged woman says that her husband does not seem to want to make love to her anymore. She says he makes excuses every night and she is afraid he no longer loves her. The health-care worker recognizes that most likely: a. he may be having an affair and is too tired for his wife. b. the physiological changes occurring in his wife’s body have made her unattractive to him. c. he is working too hard and is too tired at night for anything but sleep. d. he is concerned about his sexual performance and is afraid to try for fear of failure.

ANS: D

Middle-aged men often have sexual concerns related to decreased physical fitness and performance anxiety. As well, the male climacteric, with its decrease in hormones, may lead to a decrease in sex drive.

DIF: Cognitive Level: Analysis REF: p. 188 OBJ: 7 TOP: Men’s health KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation MULTIPLE RESPONSE

17. The health-care worker assesses for the physiological changes in the middle-aged person, which include: (Select all that apply.) a. redistribution of fat. b. increased muscle tone. c. loss of skin elasticity. d. thinning hair. e. increasing energy.

ANS: A, C, D

At middle age, the muscles and skin lose their tone and elasticity. Fat is redistributed around the hips, and hair becomes thin, gray, or absent. Visual changes usually require the use of glasses, contacts, or surgery.

DIF: Cognitive Level: Knowledge REF: p. 184 OBJ: 2 TOP: Physiological changes in middle age KEY: Nursing Process Step: AssNesUsmReSntINGTB.COM MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. In addition to the Eriksonian crisis, middle-aged persons have other developmental tasks, which include: (Select all that apply.) a. managing finances. b. nurturing their marriage. c. maintaining social relationships. d. managing the household. e. developing an ego ideal.

ANS: A, B, C, D

The middle adult must manage finances and households and maintain family and social relationships. The development of an ego ideal is part of the adolescent identity task.

DIF: Cognitive Level: Comprehension REF: p. 184 OBJ: 3 TOP: Developmental tasks of middle adults KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. The health-care worker reminds a group of middle-aged men that they should take preventative measures to reduce the risk of cardiovascular disorders resultant from their lifestyle, which includes which factor(s)? (Select all that apply.) a. Sandwich generation stress b. Lack of intimacy

c. Smoking d. Inadequate exercise e. Hormonal changes ANS: A, C, D, E

Middle-aged adult males are at risk for cardiovascular disorders due to inappropriate diet, inadequate exercise, stress, and smoking. Lack of intimacy is not a cardiovascular threat.

DIF: Cognitive Level: Application REF: p. 184 OBJ: 8 TOP: Risk factors KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease COMPLETION

20. The health-care worker reminds the 55-year-old executive that, although he is busy, he should find time to engage in the recommended hours of moderate exercise a week.

ANS:

2.5 As in younger years, the recommendation for moderate exercise is 2.5 hour per week, DIF: Cognitive Level: Knowledge REF: p. 189 OBJ: 10 TOP: Moderate exercise recommendation KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

21.

is a part of every phase of life and involves beliefs and behaviors that surround physiological responsNesU, RemSoItNioGnsT, Ban.dCcOulMtural values.

ANS:

Sexuality Sexuality is not limited to the sex act. Sexuality is a part of every phase of life and involves beliefs and behaviors that surround physiological responses, emotions, and cultural values.

DIF: Cognitive Level: Comprehension REF: p. 186 TOP: Sexuality KEY: Nursing Process Step: NA

OBJ: 7 MSC: NCLEX: NA

Chapter 13: Late Adulthood Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. To help the older adult maintain independence, Healthy People 2020 advocates the promotion of services that provide: a. prescription drug delivery. b. food banks for the older adult. c. transportation. d. day care for persons suffering from dementia.

ANS: C

Healthy People 2020 supports services that aid in the maintenance of independence for the elderly, which include transportation to health-care facilities, housing, and an increasing number of certified specialists to care for the elderly.

DIF: Cognitive Level: Comprehension TOP: Maintenance of independence MSC: NCLEX: NA

REF: p. 196 OBJ: 1 KEY: Nursing Process Step: NA

2. The home health-care worker recognizes that memory loss related to depression as compared to normal age–related memory loss is that depression-related memory loss: a. progresses slowly. b. has a rapid onset. c. affects all areas of memory. d. usually becomes permanent.

ANS: B

Depression-related memory loss has a rapid onset as opposed to age-related memory loss, which has a slow progression and usually affects memory of dates and names. When the depression is resolved, the memory improves.

DIF: Cognitive Level: Application REF: p. 206, Table 13-2 OBJ: 2 TOP: Memory loss KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. The home health care worker suggests a lifestyle change that would be supportive to memory retention such as: a. completing a crossword puzzle. b. listening to “oldies” music. c. subscribing to a travel magazine. d. working on a jigsaw puzzle.

ANS: A

A lifestyle component that exercises memory skills, such as doing crossword puzzles, is thought to help maintain memory function.

DIF: Cognitive Level: Application REF: p. 206 TOP: Lifestyle changes to promote memory

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OBJ: 4

KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

4. The most effective nursing intervention for health promotion in the older adult is primarily focused on: a. managing disease. b. providing a sense of control over health problems. c. controlling symptoms of illness. d. teaching positive health behaviors.

ANS: D

Important goals in managing the aging process include preventing illness and disability, maintaining cognitive functioning, and promoting an active and healthy lifestyle.

DIF: Cognitive Level: Application REF: p. 196 OBJ: 2 TOP: Teaching techniques and goals for the older adult KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

5. The health-care worker is taking the health history of an older adult with the assistance of the patient’s daughter, who is the caregiver. The assessment that would suggest that the patient may be abused is the: a. patient is disoriented. b. daughter has little knowledge of the patient’s medical condition. c. daughter handles the patient’s finances. d. daughter is involved in many community activities.

ANS: B

Lack of interest by the daughter in the condition or needs of an older adult may indicate a lack of commitment to meeting the individual’s needs.

DIF: Cognitive Level: Application REF: p. 201 OBJ: 5 TOP: Elder or dependent abuse KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: reduction of risk

6. The health-care worker identifies age-related memory impairment in the older adult who says: a. “I just can’t remember my telephone number.” b. “I forgot I went to the store this morning and didn’t realize it until I went again this afternoon.” c. “I forget the names of movie stars more often now, but I can remember them later.” d. “I simply cannot remember how to set my alarm clock anymore.”

ANS: C

Age-associated memory loss is characterized by a temporary memory loss or benign forgetfulness. The other examples indicate abnormal cognitive functioning.

DIF: Cognitive Level: Application REF: p. 206, Table 13-2 | p. 205, Box 13-2 OBJ: 2 TOP: Memory loss KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

7. When access to health care is blocked, the major negative impact is that: a. communities will not develop broader health services. b. minorities will be the most neglected. c. insurance payments will be impacted. d. preventative health-care measures are neglected.

ANS: D

When access to health care is blocked either by lack of knowledge or lack of transportation, basic preventative health care is neglected. This deficit affects all ages and ethnic groups.

DIF: Cognitive Level: Analysis REF: p. 200 OBJ: 2 TOP: Effect of blocked access to health care KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

8. When teaching an older adult, the health-care worker promotes learning by providing: a. detailed verbal explanations. b. information that relates to the person’s actual experiences. c. a review of basic concepts, because long-term memory is impaired. d. numerous repetitive presentations to promote memory retention.

ANS: B

Relating information to the older adult’s experience is much more effective than reviewing basic concepts, particularly if the material is already known. Repetition may be helpful but should not be excessive to the point of demeaning the person.

DIF: Cognitive Level: Application REF: p. 209 OBJ: 8 TOP: Teaching techniques and goals for the older adult KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

9. A 65-year-old woman who recently lost her husband comes to the clinic for her first examination in 5 years. To facilitate a positive health-care experience, the health-care worker should: a. remind the woman that she is long overdue for an examination. b. reassure this woman that her examination should be normal as she has no symptoms. c. listen carefully and allow for extra time for her health history interview. d. encourage the woman to talk about the death of her husband.

ANS: C

Taking a careful health history and taking time to listen will enable the health-care worker to determine risk factors related to age and stress. Allowing extra time for the processing of thoughts will facilitate the health interview.

DIF: Cognitive Level: Application REF: p. 206 OBJ: 7 TOP: Health history KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. To prevent or decrease age-related postmenopausal osteoporosis, the health-care worker recommends that the 66-year-old woman include in her lifestyle: a. taking vitamins E and B-complex supplements.

b. increasing intake foods rich in iron. c. maintaining annual health assessments. d. performing regular aerobic, weight-bearing exercise.

ANS: D

Preventive measures for postmenopausal bone loss and osteoporosis are increased calcium intake, vitamin D, and regular weight-bearing exercise.

DIF: Cognitive Level: Application REF: p. 204 OBJ: 2 TOP: Health screenings KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

11. The health-care worker recommends cardiovascular screening for the 60-year-old man who: a. smokes a cigar after Sunday dinner. b. has a high low-density lipid level. c. has a blood pressure of 136/78. d. exercises strenuously every day.

ANS: B

Cardiovascular screening is recommended for persons who smoke daily, have high lipid levels, or have hypertension.

DIF: Cognitive Level: Knowledge REF: p. 204 OBJ: 2 TOP: Cardiovascular risk factors KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

12. When a 66-year-old woman comes into the health clinic complaining of dyspareunia, the sensitive health-care worker would: a. say, “I believe you can get relief from the use of lubricating creams.” b. ask, “Has this affected your sexual activity?” c. ask, “Have you considered hormone replacement therapy?” d. inform her, “There are many CAM therapies that can help.”

ANS: B

The main obstacle to a healthy sexual lifestyle is the reluctance to talk about it because of embarrassment. It is the health-care worker’s responsibility to assess the sexual function of the older adult.

DIF: Cognitive Level: Analysis REF: p. 206 OBJ: 6 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

13. In cultures in which respect and inclusion of the older adult in family life is the norm, the older adult demonstrates greater: a. authoritarian dominance. b. fiscal responsibility. c. emotional competency. d. life expectancy.

ANS: C

In a culture that respects and includes the older adult in family life, there is greater emotional competency and less disengagement.

DIF: Cognitive Level: Knowledge REF: p. 206 OBJ: 4 TOP: Disengagement KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

14. The health-care worker plans to use the CAGE alcohol use assessment tool to assess the older adult. This tool is a questionnaire consisting of questions. a. 4 b. 5 c. 8 d. 10 ANS: A

The CAGE alcohol assessment tool is a questionnaire of four items. If there are as few as two affirmative answers, the older adult should be further assessed or referred for evaluation.

DIF: Cognitive Level: Knowledge REF: p. 204 OBJ: 2 TOP: CAGE KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

15. A 70-year-old woman has been newly diagnosed with cancer. She says that if the treatment is not successful, she has had a productive life and will have no regrets. This is: a. denial of the severity of her disease. b. an example of repression. c. lack of faith in the effectiveness of treatment. d. indication of a satisfactory and fulfilling life.

ANS: D

A sense of fulfillment and a recognition of the meaning of one’s life is indication of a positive psychosocial development.

DIF: Cognitive Level: Application REF: p. 201 OBJ: 3 TOP: Psychosocial development KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. A provision of the controversial Health Care Affordability Act of 2010 was to: a. ration health care to the elderly. b. provide wider health-care coverage. c. limit hospital stays. d. set up more community health clinics.

ANS: B

The controversial Health Care Affordability Act of 2010 offered wider health-care coverage.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 2 TOP: Health concerns of late adulthood KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

17. When discussing the basic needs for the older adult, the health-care worker uses the term to indicate effective interactions. a. autonomy b. disengagement

c. competence d. relatedness ANS: C

Competence is the term used to describe the older adult’s ability to engage in effective interactions.

DIF: Cognitive Level: Application REF: p. 201 OBJ: 3 TOP: Competence KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

18. When planning health promotion classes for people in late adulthood, the health-care worker should include information about: a. motor vehicle accidents. b. stress management. c. sexually transmitted diseases. d. vitamin supplements.

ANS: B

Helping the older adult to decrease stress can help prevent development of depression and clinical disease.

DIF: Cognitive Level: Application REF: p. 210 OBJ: 7 TOP: Stress reduction KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

19. When a 65-year-old woman comes to the health clinic with postmenopausal symptoms, the health-care worker will encourage a high dietary intake of: a. potassium. b. sodium. c. calcium. d. vitamin C. ANS: C

Measures such as increased calcium and vitamin D are recommended to help prevent postmenopausal bone loss and osteoporosis.

DIF: Cognitive Level: Application REF: p. 204 OBJ: 6 TOP: Menopausal concerns KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

20. The home health care worker will make a point to make frequent blood pressure assessments on a 67-year-old man who has been put on a new hypertensive drug because the older adult: a. will be curious about the effectiveness of the drug. b. has sudden changes in blood pressure. c. may reject a medication change. d. has decreased liver and kidney function.

ANS: D

The older adult has decreased ability to excrete drugs from the body because of decreased liver and kidney function.

DIF: Cognitive Level: Application REF: p. 200 OBJ: 2 TOP: Altered kidney and liver function KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: pharmacological therapies MULTIPLE RESPONSE

21. Health goals established for older adults by Healthy People 2020 include: (Select all that apply.) a. eradication of dementia. b. reduction of morbidity from flu and pneumonia. c. disease prevention. d. reduction of occurrence of hip fractures. e. food banks for the needy.

ANS: B, C, D

Healthy People 2020 established health goals for the older adult, which include prevention of vaccine-preventable illnesses (flu and pneumonia), reduction of occurrences of hip fractures, disease prevention focus on healthy lifestyles, and early diagnosis and treatment (not prevention) of dementia.

DIF: Cognitive Level: Application REF: p. 196 OBJ: 1 TOP: Goals of Healthy People 2020 KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

22. When designing a plan of care for the older adult, the health-care worker should consider the older adult’s: (Select all that apply.) a. income. b. previous employment. c. educational level. d. date of retirement. e. living arrangements.

ANS: A, C

The plan of care should be based on the living arrangements, support systems, income, and educational level of the older adult.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 2 TOP: Basis for plan of care KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease COMPLETION

23. The health-care worker recommends the practice of Tai Chi to an older adult to enhance strength.

ANS:

muscle Tai Chi can enhance muscle strength.

DIF: Cognitive Level: Comprehension REF: p. 208 OBJ: 2 TOP: Tai Chi KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

24. The baseline goal for moderate to vigorous physical activity is

hours a week.

ANS:

2 1/2 two and one half 2.5 The recommendation of 2 1/2 hours a week of moderate to vigorous activity is the baseline goal for the older adult.

DIF: Cognitive Level: Comprehension REF: p. 208 OBJ: 5 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: physiological adaptation

Chapter 14: Advanced Old-Age and Geriatrics Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The term geriatrics refers to the study of: a. the elderly. b. care of aging persons. c. human adaptation to aging. d. biological, psychological, physiological, and sociological aspects of aging.

ANS: D

Geriatrics refers to the study of the biological, psychological, physiological, and sociological aspects of aging.

DIF: Cognitive Level: Application REF: p. 213 OBJ: 1 TOP: Geriatrics KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

2. The theory of aging that attributes the age-related cellular changes to an unpaired ion is the theory of: a. wear and tear. b. free radical. c. immune. d. apoptosis.

ANS: B

The free radical theory proposes that the unpaired ion, or free radical, attacks the body, which results in cell damage that cannot be repaired.

DIF: Cognitive Level: Application REF: p. 214 OBJ: 1 TOP: Free radical KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. Columbia University developed an assessment tool for persons with Alzheimer’s that: a. aids in the planning of care for the person with Alzheimer’s disease. b. sets a drug protocol for the treatment of Alzheimer’s. c. lists specific effective interventions for care of a person with Alzheimer’s. d. measures the deterioration of the cerebral cortex.

ANS: A

Columbia University’s tool uses age of onset, presenting signs, gender, and results of a mini mental test to predict the progress of the disease and is an aid in planning care for the person with Alzheimer’s disease.

DIF: Cognitive Level: Comprehension REF: p. 221 TOP: Columbia University’s Alzheimer’s prediction tool MSC: NCLEX: NA

4. In cultures where ageism prevails, the elderly are: a. respected and are valued for their contribution to society.

OBJ: 11 KEY: Nursing Process Step: NA

b. used as role models for the younger generation. c. avoided and made to feel useless. d. disallowed to take part in community and civic organizations.

ANS: C

Ageism is avoidance of and negative attitudes toward the elderly based on age.

DIF: Cognitive Level: Comprehension REF: p. 220 OBJ: 1 TOP: Ageism KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

5. The White House Conference of 2005 stimulated the: a. broadening of the definition of elder abuse. b. increase in the number of assisted living facilities. c. development of training programs for caregivers. d. passing of the Older American Act, which supported long-term care strategies.

ANS: D

The White House Conference of 2005 made recommendations to Congress about the aging population, which resulted in the passing of the Older Americans Act in 2008 supporting longterm care strategies for the United States.

DIF: Cognitive Level: Knowledge TOP: White House Conference of 2005 MSC: NCLEX: NA

REF: p. 221 OBJ: 2 KEY: Nursing Process Step: NA

6. A woman tells the health-care worker that her 85-year-old father is frequently confused about medication doses and frequently forgets to take his medicines. He usually eats crackers for dinner and sweet snacks for lunch. The daughter lives in a two-bedroom apartment with her two children and works full time. The health-care worker suggests that the most appropriate placement for him would be in: a. the daughter’s home. b. a nursing home. c. an assisted-living home. d. a retirement center.

ANS: C

The assisted living home provides care for persons with minimal supervision and care.

DIF: Cognitive Level: Comprehension REF: p. 224 OBJ: 11 TOP: Placement alternatives KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

7. The health-care worker recommends the utilization of a senior center for a 79-year-old widow because in addition to a meal, a senior center can provide: a. transportation to and from the center. b. prescription drugs. c. a venue for socialization. d. a nurse counselor.

ANS: C

Senior centers offer a venue for socialization and frequently have activities such as crafts, line dancing, and board games. Many centers offer other services, such as health screening or counseling. Transportation is not part of most senior centers’ services.

DIF: Cognitive Level: Knowledge REF: p. 222 OBJ: 2 TOP: Senior centers KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

8. A health-care worker passing an open door sees a nursing home resident having sexual intercourse with another resident. The most appropriate response is to say: a. “What are you doing? Please remember where you are!” b. “Let me shut the door to give you more privacy.” c. “I need to notify your physician. Remember your heart condition.” d. “You should wait until all the other residents are in their rooms.”

ANS: B

The elder adult may continue to have sexual feelings well into advanced old age. Health-care workers must consider that the geriatric adult has the right to express these feelings without shame or guilt, in the privacy of their home setting.

DIF: Cognitive Level: Application REF: p. 219 OBJ: 9 TOP: Sexuality KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

9. A 70-year-old man retired 6 months ago after a long career as a newsman. His wife tells the health-care worker that she is concerned because her husband has stopped going to church, turned over the bill-paying duties to her, and spends most of the time listening to the radio.

The health-care worker recognizes this as: a. normal in the newly retired. b. necessary for adjustment to retirement. c. signs of disengagement and possible early depression. d. preparation for transition to advanced old age.

ANS: C

A major developmental task of old age is adjustment to retirement. If the self-worth of the retiree is dependent upon his or her previous occupation, this loss may lead to disengagement or depression.

DIF: Cognitive Level: Application REF: p. 220 OBJ: 4 TOP: Disengagement KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. Among the goals for the aged from Healthy People 2020 is an increased access for the elderly to acquire: a. comprehensive dental care. b. preventative health-care services. c. spiritual counseling. d. legal assistance.

ANS: B

Healthy People 2020 developed goals to increase access to preventative health care.

DIF: Cognitive Level: Knowledge REF: p. 213, Box 14-1 OBJ: 2 TOP: Goals of Healthy People 2020 KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

11. An appropriate strategy when teaching geriatric adults is to: a. ask them to repeat what they heard because of possible hearing deficits. b. use many videos and charts to keep their interest. c. present all the material in one long session rather than two short ones. d. speed up the presentation because of the short attention span.

ANS: A

Asking the geriatric learner to repeat what was heard will assess comprehension as well as the ability to hear accurately. Excess videos may be confusing. Speeding up the presentation is not helpful to the geriatric learner. Offering the information in smaller sessions is helpful to the geriatric person.

DIF: Cognitive Level: Application REF: p. 216 OBJ: 15 TOP: Teaching strategies KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

12. An appropriate nursing action helpful to older adults with insulin-dependent diabetes mellitus is to: a. avoid discussing future lifestyle changes. b. assure the elder that the condition is stable. c. encourage confidence in the elder as a competent manager of the disease. d. assign the responsibility for insulin injections and blood testing to a home healthcare worker.

ANS: C

Treating geriatric adults as capable of dealing with the illness often calls forth strengths and coping strategies that give them the ability to manage a chronic illness. The health-care worker can provide education and guidance in meeting the needs of the elder in dealing with the illness.

DIF: Cognitive Level: Application REF: p. 225, Box 14-5 OBJ: 14 TOP: Role of the health-care worker KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

13. An elder who lives alone at home says to the home health care worker, “My children haven’t visited me in weeks, and I’ve had no phone calls either. I don’t even have any news about my new granddaughter. I think they have forgotten me.” Which response would be most helpful at this time? a. “I’m sure they didn’t forget you. They must be very busy with your new granddaughter.” b. “Why don’t you give them a call and find out what’s happening?” c. “It sounds as if you are feeling a little neglected at this time.” d. “Well, let’s see what your blood pressure is doing. I bet it is low.”

ANS: C

Social isolation may bring on a sense of low self-esteem.

DIF: Cognitive Level: Application REF: p. 222-223 TOP: Psychological changes in the aging process KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 14

14. When developing a teaching plan for elders, the health-care worker may include family members and significant others because: a. family support affects the elder’s sense of well-being. b. family members are responsible for care of the elder. c. the family members may have conflicting views regarding health teaching topics. d. families need to know how to foster dependence in the elder to prevent serious injury.

ANS: A

The well-being of the elder depends in part on family support system, which contributes to a sense of ego-strength and competence.

DIF: Cognitive Level: Application REF: p. 225, Box 14-5 OBJ: 15 TOP: Teaching strategies KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

15. An important consideration in the rehabilitation of a geriatric patient to prevent loss of function from inactivity and immobility is: a. using assistive devices such as walkers and canes. b. teaching good nutrition to prevent loss of muscle mass. c. performing active exercises daily. d. assessing for safe environment.

ANS: C

Exercise for all elders is important to prevent functional decline from many different causes.

Assistive devices decrease mobility if they are too difficult for the elder to use. Nutrition is important for muscles, but muscle strength is dependent primarily on use.

DIF: Cognitive Level: Application REF: p. 222 OBJ: 8 TOP: Exercise KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

16. The health-care worker is planning a discussion about sexual responses in the aging population. The health-care worker would make a point to include information relative to that fact that: a. menopause decreases the sexual response in females. b. erotic response of the nipple and clitoris decrease. c. sperm motility is not affected by reduced testosterone. d. males retain their fertility into the eighth decade of life.

ANS: D

Males retain their fertility into their 80s. Menopause does not affect the sexual response or the nipple/clitoris sensitivity. Sperm motility is slowed with the reduction of testosterone.

DIF:

Cognitive Level: Application

REF: p. 218

OBJ: 9

TOP: Sexuality KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

17. Because of changes in the blood vessels, which become narrow with fatty deposits, the geriatric elder is at risk for: a. hypotension. b. stroke. c. increased heart muscle tone. d. rapid response to anxiety.

ANS: B

The narrowed lumen of the vessels lead to hypertension that puts the geriatric elder at risk for stroke. The heart muscle loses tone and therefore delays the response to anxiety.

DIF: Cognitive Level: Application TOP: Blood vessel changes MSC: NCLEX: NA

REF: p. 215 OBJ: 3 KEY: Nursing Process Step: NA

18. The immune theory of aging proposes that: a. the aging body becomes immune to the restorative properties of nutritious food, adequate sleep, and exercise. b. as body parts begin to age and become dysfunctional, they become immune to the body’s attempt to repair them. c. the aging person’s immune system cannot differentiate between healthy and defective cells and destroys both kinds. d. the geriatric elder becomes immune to many therapeutic remedies and can receive no protection from infection from them.

ANS: C

The immune theory proposes that the aging person’s immune system cannot differentiate between healthy and defective cells and destroys both kinds, leaving the elder at risk for infections and a variety of illnesses.

DIF: Cognitive Level: Knowledge REF: p. 214 OBJ: 1 TOP: Immune theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. The term old-old senescence is categorized as a person who is: a. 65 to 75 years of age. b. 76 to 84 years of age. c. 85 to 99 years of age. d. over 100 years of age.

ANS: C

The “old-old” group in senescence terminology are those people in the age range of 85 to 99 years.

DIF: Cognitive Level: Knowledge REF: p. 213 OBJ: 1 TOP: Senescence: old-old KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

20. During an assessment, an 80-year-old man says that his wife died a year ago, his only child moved to another city, and he recently moved into an apartment in a new neighborhood so he stays indoors most of the time and watches TV. This man: a. has an opportunity for new social contacts. b. may be at risk for suicide. c. should go live with his child. d. needs the services of Meals on Wheels.

ANS: B

Depression is the most common mental health problem in geriatric elders and often is a result of loss of loved ones, isolation from social contacts, and change in environment, all of which make suicide a common problem in this age-group.

DIF: Cognitive Level: Analysis REF: p. 222 OBJ: 6 TOP: Suicide KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

21. When planning health-promotion classes for geriatric adults, the health-care worker should include information pertinent to: a. vitamin supplements, folic acid. b. hormone replacement therapy, contraception. c. homicide, motor vehicle accidents. d. safe home environment, immunizations.

ANS: D

Control of the environment reduces the risk for falls and fractures, while influenza and pneumonia vaccines decrease the risk for these diseases.

DIF: Cognitive Level: Application REF: p. 223 OBJ: 7 TOP: Health maintenance KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

22.

Regarding cataracts, the most important point is that they: a. are rare and are symptoms of other medical conditions. b. block some of the light to the eye but do not cause blindness. c. are a normal part of aging; most older people have cataracts in both eyes. d. occur in both eyes and vision deteriorates at the same rate.

ANS: C

Cataracts are a normal part of aging. One eye may be worse than the other because cataracts develop at different rates.

DIF: Cognitive Level: Application REF: p. 216 OBJ: 3 TOP: Cataracts KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

23. An 83-year-old senior in a nursing home spends a great deal of time telling stories about past accomplishments and life experiences. The health-care worker recognizes that: a. reminiscing about positive life experiences is therapeutic and helps bring a feeling of achievement and satisfaction to the elder adult. b. this may be early senility, as the elder cannot remember from one time to the next what stories have been told.

c. this story-telling needs to be curtailed to allow others to participate. d. the reminiscences should not be encouraged, to prevent feelings of bitterness or anxiety.

ANS: A

Reflecting on their own accomplishments and life legacy brings a sense of ego integrity and satisfaction to geriatric adults. This reflects successful mastery of the developmental tasks across the lifespan.

DIF: Cognitive Level: Application REF: p. 221 OBJ: 2 TOP: Developmental tasks of the aged KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

24. Interventions to promote health in the geriatric elder that follow the goals of Healthy People 2020 are primarily focused on: a. providing a sense of mastery over health problems. b. managing disease and disability. c. teaching positive health behaviors. d. controlling symptoms of illness.

ANS: C

By teaching about or providing appropriate age-related health promotion activities, the healthcare worker can assist in the promotion of health in the geriatric elder.

DIF: Cognitive Level: Application REF: p. 213, Box 14-1 OBJ: 14 TOP: Role of the health-care worker KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease MULTIPLE RESPONSE

25. The health-care worker encourages the 84-year-old to engage in some physical activity for at least 30 minutes a day. Such natural activities appropriate for the able geriatric person include: (Select all that apply.) a. weight training. b. dancing. c. swimming. d. walking. e. jogging.

ANS: B, C, D, E

Activities such as dancing, walking, swimming, and jogging are appropriate natural exercises for the geriatric person.

DIF: Cognitive Level: Comprehension REF: p. 222 OBJ: 7 TOP: Physical exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

26. The health-care worker assessing an 85-year-old man for his ability to manage the activities of daily living (ADLs) would assess his ability to: (Select all that apply.) a. feed himself.

b. c. d. e.

manage his own finances. cook a simple meal. shop for himself. manage some form of transportation.

ANS: A, C, D

The ADLs that are believed to be essential to independent living are the ability to manage one’s own eating, toileting, bathing, grooming, cooking, shopping, and taking medications.

DIF: Cognitive Level: Application REF: p. 224, Box 14-3 OBJ: 13 TOP: ADLs KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: physiological adaptation COMPLETION

27. According to Sanderson (2008), gerontologists list old age as when the prospects of living another years is not realistic.

ANS:

15 Gerontologists now list old age as when the prospects of living greater than 15 more years is not realistic.

DIF: Cognitive Level: Knowledge TOP: Definition of old age MSC: NCLEX: NA

REF: p. 213 OBJ: 1 KEY: Nursing Process Step: NA

28. According to the theory, a recently retired person who finds satisfaction in hobbies, travel, or volunteering is adjusting to life after retirement.

ANS:

activity The activity theory proposes that a recently retired person finds self-worth and fulfillment in activities such as volunteering, traveling, or pursuing a hobby.

DIF: Cognitive Level: Comprehension REF: p. 222 OBJ: 5 TOP: Activity theory KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

Chapter 15: Planning for the End-of-Life Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. The sensitive health-care worker can demonstrate therapeutic presence by: a. keeping family informed about patient’s condition every hour. b. remaining near the patient and family. c. calling the chaplain to administer to the family. d. giving pain medication every 4 hours.

ANS: B

Therapeutic presence can be accomplished by simply being near the patient and available.

DIF: Cognitive Level: Knowledge REF: p. 228 OBJ: 9 TOP: Therapeutic presence KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: basic care and comfort

2. The statement that best depicts the preschooler’s understanding of death is: a. “My brother is in a better place now and isn’t sick now.” b. “It will seem funny not to play with my brother anymore.” c. “My mom and dad won’t have two children since my brother died.” d. “I know that my brother got taken because I had a fight with him.”

ANS: D

Preschoolers engage in magical thinking and think that death is reversible. They frequently believe their own behavior caused the illness or death of a sibling.

DIF: Cognitive Level: Analysis REF: p. 238 OBJ: 5 TOP: Family behaviors related to the dying process KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

3. A 90-year-old West Indian man is dying, and 20 family members fill the hall as they try to crowd into the room. The culturally competent health-care worker will: a. inform the family that only 3 or 4 at a time should try to be at the bedside. b. move out unnecessary furniture to make room for the family. c. direct the family to the waiting room so they will have more space. d. call the chaplain to pray with the family.

ANS: B

Making room for the family at bedside is comforting to West Indian families as they prefer to be at bedside at time of death to pray for their loved one.

DIF: Cognitive Level: Application REF: p. 233, Table 15-3 OBJ: 10 TOP: West Indian rituals KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

4. The health-care worker can support grieving families at the time of death by: a. allowing the family time to stay with the loved one after the death.

b. calling the funeral home to collect the body. c. uttering consoling phrases such as “I know how you feel.” d. emphasizing that the painful grieving should last less than a year.

ANS: A

One of the roles of the health-care worker at the time of death is to provide support to grieving families. Providing privacy and time with the loved one after death allows family members an opportunity to see and touch the deceased, often for the last time.

DIF: Cognitive Level: Application REF: p. 238 TOP: Nursing responsibilities when death occurs KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 9

5. When parents ask if their school-age child should attend the funeral of their grandmother, the health-care worker would base a response on the understanding that attendance will: a. provide an closure for the child. b. be a frightening experience. c. be a deeply religious experience. d. be parents’ responsibility is to protect the child from distressing events.

ANS: A

Attendance at funerals helps the school-age child to realize that death is permanent and provides closure. Sharing this moment of deep significance with parents helps children deal with their own feelings of sorrow and grief.

DIF: Cognitive Level: Application REF: p. 238 TOP: Developmental concepts of death and dying KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 11

6. The primary goal of end-of-life care is: a. comfort and care to promote death with dignity. b. protecting the dying person from needless grieving. c. implementing measures to maintain physiological functioning. d. facilitating the patient’s progress through all stages of grieving.

ANS: A

When modern technology and pharmacology can no longer keep someone alive, the dying person’s bill of rights states that he or she has the right to die in comfort and with peace and dignity.

DIF: Cognitive Level: Application REF: p. 234 OBJ: 6 TOP: Options for end-of-life care KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: basic care and comfort

7. A terminally ill patient is unresponsive and having periods of apnea. The patient’s family is arguing at the bedside about where the funeral should be held. The health-care worker should: a. remind the family that this should be the patient’s decision. b. ask the family members to leave the room. c. take the family members aside and explain that the patient may be able to hear them.

d. tell the family members that such decisions are premature.

ANS: C

Although the dying person may appear to be in a coma, hearing is the last sense to be lost.

Asking the family to leave the room without an explanation is inappropriate.

DIF: Cognitive Level: Application REF: p. 229, Box 15-1 OBJ: 13 TOP: Signs of impending death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

8. The document naming the person or persons who should make health-care decisions if a patient cannot make informed decisions for him- or herself is the: a. personal will. b. living will. c. durable power of attorney. d. do not resuscitate (DNR) order.

ANS: C

The durable power of attorney for health care names the person who is to make medical decisions for the patient if the patient is unable to do so.

DIF: Cognitive Level: Knowledge REF: p. 238 OBJ: 8 TOP: Ethical and legal issues KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe Effective Care Environment: coordinated care

9. The grieving mother whose adolescent son died last week tells the home health-care worker that her 5-year-old has begun to wet the bed. The health-care worker’s most helpful response would be: a. “Your preschooler should probably be evaluated by a urologist.” b. “Your son is showing a rather severe grief reaction.” c. “Regression to less mature forms of behavior are not unusual after a death.” d. “Don’t worry about it. Bedwetting is no big deal.”

ANS: C

Regression is to be expected in the preschooler after a traumatic event such as death.

DIF: Cognitive Level: Application REF: p. 239, Table 15-4 OBJ: 10 TOP: Preschooler reaction to death KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: growth and development

10. The health-care worker caring for a dying 78-year-old Hispanic woman understands that in Hispanic families when death is near, the family will: a. seek the spouse’s advice on medical decisions. b. confirm the DNR order. c. call for the shaman to perform religious rites. d. prohibit pregnant women and children from the bedside.

ANS: D

In the Hispanic culture, pregnant women and children are prohibited to be in contact with the dying person. The shaman is the holy man revered by the Native Americans. Hispanics feel DNR orders are not acceptable, and the eldest child is usually responsible for health-care decisions.

DIF: Cognitive Level: Application REF: p. 233, Table 15-3 OBJ: 10 TOP: Hispanic culture KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

11. As a Native American elder is dying, a young health-care worker complains to her supervisor that the eldest son is not at his father’s bedside and is nowhere to be found. The culturally competent health-care worker responds: a. “He is probably making arrangements with the funeral home.” b. “Because he believes it is dishonorable to watch a person die, he is not here.” c. “He has gone to get the ceremonial robes for his father to wear after death.” d. “He is observing his own private grieving away from his dying father.”

ANS: D

Native Americans avoid contact with the dying person and grieve in private, away from the person who is dying.

DIF: Cognitive Level: Application REF: p. 232, Table 15-3 OBJ: 10 TOP: Native American grief KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

12. When the treatment for a 12-year-old child with terminal cancer needs to shift from cure to palliation, the health-care worker reminds the family it is important that they should: a. tell the child that he will not have to take any more treatments. b. explain this new approach in age-appropriate terms. c. the family must understand that palliative care takes place at home. d. withhold this information from the child as it will contribute to a sense of hopelessness.

ANS: B

Truthfulness and explanations in age-appropriate terms will help the child to better communicate his needs and feelings.

DIF: Cognitive Level: Application REF: p. 237 OBJ: 12 TOP: End of life for a child KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

13. When a terminally ill patient says, “I feel that death is just around the corner,” the most appropriate response would be: a. “Don’t talk like that. You sound as if you are giving up hope.” b. “We are all going to die. No one knows when.” c. “Is this feeling something you would like to talk about?” d. “Let’s not talk about dying. Let’s talk about living. “ ANS: C

Health-care professionals need to provide an atmosphere in which the patient is able to freely verbalize feelings about death.

DIF: Cognitive Level: Application REF: p. 231, Table 15-2 OBJ: 2 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Physiological Integrity: basic care and comfort MSC: NCLEX: Psychosocial Integrity: coping and adaptation

14. A dying patient becomes withdrawn and verbally uncommunicative. Relatives try to cheer him up, which is most indicative of: a. hopefulness. b. anticipatory grief. c. very strong support toward the patient’s feelings. d. failure to recognize the patient’s need to openly express his grief.

ANS: D

Most dying persons are aware of the reality of their conditions. Open acknowledgment and open communication provide support during this difficult time not only to the patient, but to family, friends, and caregivers.

DIF: Cognitive Level: Application REF: p. 231 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 1

15. The health-care worker assesses a normal response in a dying 8-year-old boy who says: a. “I am too young to die. God is being cruel to make me die!” b. “I cry because my mom cries a lot.” c. “I will miss my mom and dad, but my grandmother in heaven will take care of me.” d. “After I am dead, I can come back and be with my mom and dad again.”

ANS: C

The school-age child may fear separation from family but envision continuation of life in another form.

DIF: Cognitive Level: Comprehension REF: p. 239, Table 15-4 OBJ: 11 TOP: End-of-life concepts of the school-age child KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: growth and development

16. When caring for a terminally ill patient, health-care workers are permitted to provide interventions that: a. present the family with the means to end the dying person’s life. b. actively aim to end a suffering person’s life. c. relieve symptoms only if there is low risk for hastening death. d. offer pain relief to the dying person even if there is a risk death will occur.

ANS: D

Analgesics, particularly opioids, should be administered around the clock to prevent pain, with dosage and schedule adjustments made as needed to maintain maximum comfort. This often requires very large doses of medication given at more frequent intervals, in accordance with the patient’s wishes.

DIF: Cognitive Level: Analysis REF: p. 236 TOP: Role of the health-care worker in end-of-life care KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: basic care and comfort

OBJ: 9

17. The school-age siblings of a dying child should be: a. involved in the plan of care for their sibling. b. allowed to remember the dying child as he or she was before death. c. allowed to contact their sibling only by phone. d. protected from death rituals and end-of-life care.

ANS: A

Siblings should be included as much as possible in the plan of care for the dying child, so they do not feel abandoned or punished or develop a sense of sibling rivalry and, later, guilt feelings.

DIF: Cognitive Level: Application REF: p. 238 OBJ: 7 TOP: Death of a child KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

18. The best practice in promoting quality of life for a terminally ill 10-year-old child would be: a. focused on the child’s chronological age. b. allowing the child to return to his or her regular classroom. c. having the child cared for only by health-care providers, who are more objective than families. d. placing the child in a health-care facility for treatment and care.

ANS: B

An important understanding about quality of life for a child with a terminal illness is that they can participate in age-appropriate activities as normal, healthy children do. Attending school, even if it must be part time, helps the child and family cope with the illness.

DIF: Cognitive Level: Analysis REF: p. 239, Table 15-4 OBJ: 5 TOP: Developmental concepts of death and dying KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: growth and development

19. Denial is a common reaction to the diagnosis of a terminal illness, because the use of this defense mechanism: a. is a maladaptive response. b. is helpful to adaptation. c. prevents a sense of hope. d. prevents the development of problem-solving behavior.

ANS: B

Denial may allow the patient to function adaptively and productively through the grief process. It is helpful for gradual adaptation and does not interfere with problem-solving behavior.

DIF: Cognitive Level: Comprehension REF: p. 230 TOP: Denial KEY: Nursing Process Step: Planning

OBJ: 2

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

20. Patients and families progress through various stages of reactions when a diagnosis of a terminal illness is made. After the helplessness phase, a period of adjustment usually follows. This phase is characterized by: a. social reintegration. b. denial. c. guilt. d. acceptance.

ANS: C

Although some patients and families never progress beyond the shock and denial stage, most go through stages of the grieving process. Anger and guilt usually follow denial, and some patients will regress to anger from time to time even though they may have reached a level of acceptance of the diagnosis.

DIF: Cognitive Level: Comprehension REF: p. 230 OBJ: 7 TOP: Grief reaction KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

21. An 8-year-old child with a terminal illness is returning to school after having received treatment that has caused hair and weight loss. The most appropriate action by the school nurse would be to: a. recommend that the child’s parents attend school at first to prevent teasing. b. refer the child to a home school program. c. discuss with the child and the parents that the child’s classmates will not accept him or her as before. d. prepare the child’s classmates and teachers for changes they can expect.

ANS: D

Peer contact and regular school attendance should be encouraged to promote quality of life for the child with terminal illness. Classmates and teachers can be very supportive when they understand the changes they will see in the child.

DIF: Cognitive Level: Application REF: p. 239, Table 15-4 OBJ: 5 TOP: Developmental concepts of death and dying KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

22. A young Cambodian man has just arrived at the hospital from the airport to find that his father has already died. His family members are all praying at the bedside. The culturally competent health-care worker would offer the young man a(n): a. white hospital gown to wear. b. small basin with soap so that he may wash his hands before praying. c. surgical cap so he may cover his head. d. opportunity to pray with the hospital chaplain.

ANS: A

Cambodians wear white during their grief rituals.

DIF: Cognitive Level: Comprehension REF: p. 232, Table 15-3 OBJ: 10 TOP: Culture and dying

KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

23. A terminally ill patient in hospice care says that she plans to attend her grandson’s college graduation 5 months from now. This patient: a. is in denial about her condition. b. has unrealistic expectations about the length of time she has left. c. will probably live to attend the graduation. d. is only offering her family false hope and should stop planning an event so far in the future.

ANS: C

Patients with a strong desire to be present at an important family event often prolong their lives until that event, then die soon afterwards.

DIF: Cognitive Level: Application REF: p. 229, Table 15-1 OBJ: 3 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

24. A terminally ill man tells the health-care worker, “I have never believed in God or in an afterlife, but now it really doesn’t seem so bad.” The health-care worker assesses that this man has reached the dying state of: a. denial. b. bargaining. c. depression. d. acceptance.

ANS: D

The Kübler-Ross stages of dying describe acceptance as a sense of “My time has come.”

DIF: Cognitive Level: Comprehension REF: p. 229, Table 15-1 OBJ: 2 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

25. A school-age child is diagnosed with a terminal illness. The parents want to protect their child from knowing the seriousness of the illness. The health-care worker should explain that: a. denial will help the child cope more effectively. b. this attitude is helpful in order to give the parents more time to cope. c. terminally ill children usually do not wish to discuss the seriousness of their illness. d. truthfulness in understandable terms is the most supportive approach.

ANS: D

Children who have a terminal illness are often more aware of their condition than parents realize. Therefore, truthfulness, explained in age-appropriate terms in a supportive manner, is the best approach when providing care to a terminally ill child.

DIF: Cognitive Level: Application REF: p. 237 OBJ: 11 TOP: Death of a child KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

26. A psychological death occurs begins when the: a. dying person begins to discuss end-of-life rituals. b. person is informed of a terminal illness. c. terminally ill person gives up hope. d. person loses confidence in his curative protocols.

ANS: B

The phenomenon of psychological death begins when the person is informed of his terminal illness and the body processes decline in function.

DIF: Cognitive Level: Application REF: p. 228 OBJ: 3 TOP: Psychological death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

27. The health-care worker enters the room of a patient who has just been diagnosed with a terminal illness. The son is highly agitated and tearfully screams, “I am taking my dad out of this place and take him somewhere where people actually care what happens to him!”

The most helpful response would be: a. “Why don’t you tell me what is really wrong?” b. “I can understand your angry feelings.” c. “I’ll be back when you calm down.” d. “Yelling at me will not change the diagnosis.”

ANS: B

Therapeutic communication involves not only accepting a patient’s anger and emotional outbursts but those of the family as well.

DIF: Cognitive Level: Application REF: p. 229, Table 15-1 OBJ: 2 TOP: Psychological responses of the dying patient KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

28. The best description of therapeutic communication related to terminally ill patients and their families would be that it is a(n): a. goal-directed interaction that brings about the patient’s insight. b. purposeful interaction that is highly structured. c. interaction guided by the needs of the patient and the health-care worker. d. interaction that involves accepting the patient’s emotional responses.

ANS: D

Therapeutic communication with terminally ill patients and families involves acceptance of emotional outbursts and expressions of anger and encourages venting and verbalization.

DIF: Cognitive Level: Comprehension REF: p. 228 TOP: Psychological responses of the dying patient MSC: NCLEX: NA

OBJ: 7 KEY: Nursing Process Step: NA

29. A terminally ill person has elected to stop receiving curative treatment and has requested no cardiopulmonary resuscitation. The family is very upset by this decision and wants to override the patient’s decision. The best response to the family is: a. “I will discuss your concerns with the doctor and ask her to reinstitute treatment.” b. “I will discuss your concerns with your family member and try to get him to change

his mind.” c. “According to the dying person’s bill of rights, your relative has the right to make this decision.” d. “I will get the chaplain to help you accept this decision.”

ANS: C

According to the dying person’s bill of rights, the patient has the right to participate in decisions concerning care and the right to not be judged for his or her decisions, which may be contrary to the wishes or beliefs of others.

DIF: Cognitive Level: Application REF: p. 234 , Box 15-2 OBJ: 6 TOP: Dying person’s bill of rights KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

30. The family of a terminally ill Hindu patient requests that all life support equipment be removed, as per the wishes of the patient, and the loved one discharged to their care at home. The health-care worker points out that: a. “This is an unrealistic request. Your family member is in no shape to go home.” b. “I’m sorry, that request is against hospital policy.” c. “The grief counselor can speak to you about this decision.” d. “I know that you and your loved one will be more comfortable at home; I will do what I can to expedite the process.”

ANS: D

Hindus prefer death to occur in the privacy of their own home, where family and friends can conduct religious ceremonies without interruption. Health-care providers must demonstrate cultural competence when providing end-of-life care.

DIF: Cognitive Level: Analysis REF: p. 232, Table 15-3 OBJ: 10 TOP: Culture and dying KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation MULTIPLE RESPONSE

31. The impending signs of death include: (Select all that apply.) a. thirst. b. anorexia. c. pulmonary congestion. d. flushed face. e. mottled extremities.

ANS: B, C, E

Among the signs of impending death are weakness, weight loss, decreased appetite (anorexia), sweating, pulmonary congestion, altered breathing patterns, decreased urine output slowed pulse, relaxed jaw, and mottled, cold extremities.

DIF: Cognitive Level: Application REF: p. 229, Box 15-1 OBJ: 13 TOP: Signs of impending death KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: physiological adaptation

32. The health-care worker clarifies to the family of a dying patient that palliative care includes: (Select all that apply.) a. patient-centered care b. analgesics c. oxygen therapy d. curative therapy e. laxatives ANS: A, B, C, E

Palliative care is an active total care of patients whose disorder does not respond to curative therapy, and aggressive curative efforts are not pursued. The patients are provided with comfort measures such as pain and anxiety relief, oxygen therapy, laxatives, and antinausea drugs.

DIF: Cognitive Level: Application REF: p. 235 OBJ: 4 TOP: Palliative care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation COMPLETION

33. The health-care worker recommends the services of , a community healthcare organization specializing in the care of dying patients and their families.

ANS:

hospice Hospice services are provided to patients and families through the death and bereavement process. The service addresses the physical, psychological, spiritual, and social needs of the dying patient. This service is available to patients in the hospital, nursing home, and in their own home.

DIF: Cognitive Level: Comprehension REF: p. 239 OBJ: 4 TOP: Hospice care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychological Integrity: coping and adaptation

34. The Act of 1990 is a federal law stating that acute care or long-term care facilities must provide written information to patients concerning their rights to accept or refuse treatment and make advance directives.

ANS:

Omnibus Reconciliation The Omnibus Reconciliation Act of 1990 and the Patient Self-Determination Act mandates that all patients, at the time of admission, should be given written information relative to their right to refuse treatment and should be encouraged to make advance directives.

DIF: Cognitive Level: Comprehension REF: p. 235 OBJ: 8 TOP: Omnibus Reconciliation Act of 1990 KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment: coordinated care

Chapter 16: Bereavement Test Bank Leifer: Growth and Development Across the Lifespan, 3rd Edition MULTIPLE CHOICE

1. A grief reaction that interferes with life’s functions is: a. mourning. b. anticipatory grief. c. bereavement. d. dysfunctional grief.

ANS: D

Dysfunctional grief is the continued expression of unresolved issues and symptoms that interfere with life’s functions.

DIF: Cognitive Level: Comprehension REF: p. 247-248 OBJ: 3 TOP: Dysfunctional grief KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

2. After giving birth to a stillborn baby, the woman says, “I just painted the baby’s room. Do you think that had an influence on my baby’s death?” The best response to this woman is: a. “No, that’s an old wives’ tale.” b. “Maybe. The excessive exertion may have caused the loss of the baby.” c. “Looking for answers to questions like that will prolong your grief.” d. “I can understand your need to find an answer to what caused this.”

ANS: D

Clear information should be provided about the cause of death. Part of the grief process for bereaved parents is figuring out what happened, their role in the loss, why it happened to them, and why it happened to their baby. The health-care worker needs to recognize that these questions must be answered by the bereaved themselves as part of their healing.

DIF: Cognitive Level: Application REF: p. 251 OBJ: 8 TOP: Pregnancy and grief KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

3. The statement that would be least therapeutic to say to the bereaved mother at the death of her infant son would be: a. “I have called your husband. He will be here soon.” b. “You can stay with him and hold him if you wish.” c. “He was a very special little boy to me.” d. “Fortunately he is not suffering anymore.”

ANS: D

Health-care workers can facilitate the grief process by having a basic understanding of the process, by talking with family members, and by supporting the family’s efforts to cope, adapt, and grieve. A comment such as “be glad he is not suffering” is nontherapeutic. Sharing their own feelings of loss is supportive.

DIF: Cognitive Level: Application REF: p. 249, Table 16-4 OBJ: 10 TOP: Role of the health-care worker

KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

4. After the death of an 80-year-old Jewish man, the health-care worker is aware that while the family is waiting for the funeral home to come for the body, the deceased is: a. covered by a ceremonial cloth. b. prepared for burial on the next Saturday. c. blessed by placing a basil leaf on his tongue. d. never left alone.

ANS: D

The Jewish religion requires that the body be buried within 24 hours of death, not be left alone, and not be moved on a Saturday.

DIF: Cognitive Level: Comprehension REF: p. 247, Table 16-2 OBJ: 4 TOP: Jewish death rituals KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

5. At the time of a child’s death, a “memory kit” is made for the parents. The most appropriate items in such a kit would be: a. the hospital identification bracelet. b. a curl of the baby’s hair. c. the pacifier used to quiet the baby. d. the small hospital blanket used to cover the baby.

ANS: B

The recognition of the child as Na sU e p Rar Sat I e pNerG soT nBis . h eClpf O ul . MThe preservation of a “memory kit” made up of carefully selected photos or a curl of hair is thoughtful.

DIF: Cognitive Level: Comprehension REF: p. 250 OBJ: 10 TOP: Helping the grieving survivors KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

6. The health-care worker can provide the best support to a family experiencing anticipatory grief related to the imminent death of a loved one by: a. discouraging premature expressions of grief. b. suggesting activities to cheer up the family. c. attempting to “lighten the mood.” d. being available to the family.

ANS: D

Health-care workers need to be available to the family to discuss the grieving process and provide opportunities for the family to express emotions.

DIF: Cognitive Level: Application REF: p. 247 OBJ: 10 TOP: Grief process KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

7. A man whose wife died 6 months ago says that he sometimes still “hears” his wife’s voice and has trouble sleeping and does not feel like socializing. The health-care worker recognizes that: a. these complaints are part of a normal grief response.

b. the pain of the loss should be less by this time. c. these responses are more typical immediately after the death. d. this grieving is excessive and should be evaluated.

ANS: A

These responses are typical of early grief. As family members move through the bereavement process, they will exhibit physical signs of weight loss and insomnia, confusion, and inability to concentrate and social withdrawal.

DIF: Cognitive Level: Application REF: p. 244 OBJ: 5 TOP: Normal grief responses KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

8. Several health-care workers have requested to attend the funeral of a patient for whom they felt especially close. The supervisor recognizes that attending the funeral is: a. appropriate, because families always expect this expression of concern. b. appropriate, because it can assist in the resolution of personal grief. c. inappropriate, because it is unprofessional. d. inappropriate, because it increases the potential for burnout.

ANS: B

Attending the funeral can be a supportive act for both the health-care worker and family members and is in no way unprofessional. For the family, it conveys a sense of support and caring. For the health-care worker, it can provide a sense of “closure” and assist in resolution of personal grief.

DIF: Cognitive Level: Application REF: p. 254 OBJ: 10 TOP: Offering condolence Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

9. While doing final preparations for a Hindu woman to be picked up by the funeral home, the health-care worker observes a thread tied around the corpse’s wrist and a basil leaf in her mouth. These items: a. are to be removed only by the next of kin. b. may be removed by the sadhu, the Hindu holy man. c. should be left in place. d. should be collected and given to the eldest son.

ANS: C

Hindus tie a string around the wrist of the dying person and also place a basil leaf on their tongue. These should not be removed after death.

DIF: Cognitive Level: Application REF: p. 247, Table 16-2 OBJ: 6 TOP: Hindu religious rights KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: basic care and comfort

10. When a dying 90-year-old woman gives her rosary to her granddaughter, this gift should be viewed as a: a. religious ceremony. b. legacy. c. sign of favoritism.

d. directive for greater spiritualism.

ANS: B

A legacy is something that the dying person leaves to the world that provides some small assurance of immortality.

DIF: Cognitive Level: Knowledge REF: p. 243 TOP: Legacy KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 1

11. When the shocked father of a 17-year-old who committed suicide says, “We should have seen this coming. I feel so guilty.” The most therapeutic response would be: a. “This must be awful for you. Tell me about your son.” b. “I know how you must feel.” c. “Don’t feel guilty. It was his decision.” d. “Tell me what happened.”

ANS: A

Survivors feel the death could have been prevented. The most therapeutic intervention is to listen. The request to be told what happened will seem like a police inquiry and is not therapeutic.

DIF: Cognitive Level: Comprehension REF: p. 249, Table 16-4 OBJ: 10 TOP: Support after a suicide KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

12. The parents of a 7-year-old are concerned because their child, upon being informed about the NURSINGTB.CO death of his grandmother, said, “Nana is mean. I don’t love her anymore!” This behavior is: a. maladaptive. b. an inability to have a concept of death. c. anxiety about their own death. d. a normal reaction.

ANS: D

Young children react to death in ways that reflect their developmental stage. By this age, children realize death is irreversible and often may show anger toward the one who left them.

DIF: Cognitive Level: Application REF: p. 251 OBJ: 8 TOP: Grief early in the life cycle KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

13. The most therapeutic communication to use with a bereaved family should reflect: a. reassurance of reduction of grief. b. acknowledgment of the loss. c. interpretation of depth of grief. d. cheerfulness.

ANS: B

Acknowledging the loss validates the loss and grief the family feels at this time and offers understanding as the family begins the process of grieving.

DIF:

Cognitive Level: Comprehension

REF: p. 253

OBJ: 10

TOP: Expressing condolence MSC: NCLEX: NA

KEY: Nursing Process Step: NA

14. A widow of 10 months says that she has started sleeping better, is going out more with friends, and can talk about her husband without feeling so lost and angry. The health-care worker recognizes that this represents: a. the beginning of the “letting-go” process. b. an inability to accept the reality of her husband’s death. c. her true feelings of relief that her husband has died. d. recognition that she is now ready to make changes in her life, such as selling her house or moving to a new city.

ANS: A

Letting go of the past begins when the survivor can begin to speak of the loved one without deep pain, move away from a feeling of isolation, and feel less intense grief from the loss.

DIF: Cognitive Level: Analysis REF: p. 253 TOP: Mastering tasks toward grief healing KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 9

15. After the death of their child in the emergency room following a hit-and-run automobile accident, the mother says, “God is dead for me. God is as dead as my child. I will not worship a dead god!” The most helpful response would be: a. “I am sorry for your loss.” b. “Let me get the hospital chaplain for you!” c. “God feels your pain and he is still there for you. d. “I can understand why youNfeUeRl aSnIgrNyGwTitBh.GCoOd Mand everyone else right now.”

ANS: D

Validating the mother’s feelings of anguish is therapeutic. The option “I am sorry for your loss” is too bland and impersonal for this situation.

DIF: Cognitive Level: Comprehension REF: p. 249, Table 16-4 OBJ: 10 TOP: Role of the health-care worker KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

16. The family of a young girl killed in an automobile accident arrives at the hospital shortly after her death and requests to see her body. Since she is disfigured from the accident, the most appropriate action is to: a. explain that their daughter is disfigured and that it would be too upsetting for them to see her. b. contact a grief counselor to discuss this problem with them. c. encourage them to wait to see her until the funeral home has prepared her body. d. inform them of what to expect and then let them see the body.

ANS: D

Although memory of a loved one’s disfigurement can be upsetting, seeing the loved one is the first step in accepting the loss.

DIF:

Cognitive Level: Application

REF: p. 244

OBJ: 4

TOP: Grief KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

17. A health-care worker is preparing the body of an Arab American patient who just died for transfer to the morgue. Family members insist on washing and cleansing the body before it is taken away. The health-care worker’s best response is: a. “No, I’m sorry, only hospital personnel are allowed to do this.” b. “I think it would be better if you left the room while I make him ready.” c. “Yes, of course you may. Do you need any special cloths or towels?” d. “I’m afraid it will just make you more distressed if you touch him again.”

ANS: C

In Arab culture, family members wish to take part in washing and preparing the body or have special bathing done by a member of their clergy. Health-care workers need to be especially sensitive to cultural practices at this difficult time.

DIF: Cognitive Level: Application REF: p. 245, Table 16-1 OBJ: 6 TOP: Culture, religion, and death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

18. Seven months ago, a 30-year-old man lost his wife in an automobile accident. His coworkers have become concerned about his mood swings from rage to uncontrolled crying. The health-care worker recognizes that this is: a. normal grief due to the unexpectedness of his loss. b. abnormal grief that may require psychological counseling. c. a manifestation of a personality disorder. d. outward expressions of grief that are considered normal.

ANS: B

Although some signs and symptoms of abnormal grieving are similar to those of normal grieving, extreme emotional lability after this length of time most likely represents a major depressive episode and dysfunctional grieving, requiring medical or psychological attention.

DIF: Cognitive Level: Comprehension REF: p. 248 OBJ: 7 TOP: Abnormal grieving KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

19. The manner in which persons adjust to losses in their life will determine: a. family relationships. b. depth of religious views. c. quality of life. d. maturity.

ANS: C

Positive adaptation to the losses in life, such as deaths, changes due to old age, and economic losses, often determines the quality of life that is maintained.

DIF: Cognitive Level: Comprehension REF: p. 243 OBJ: 5 TOP: Loss adaptation KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

20. A newborn in the neonatal intensive care unit is dying, and the neonatologist has shared with the parents their baby’s prognosis. When the father sees his son, he says, “He looks just fine to me. I can’t understand what all this is about.” The health-care worker recognizes that the father is: a. in denial or disbelief. b. attempting to shield the truth from his wife. c. in the shock and numbness phase of mourning. d. beginning anticipatory grieving.

ANS: A

When parents are first told of the impending death of a child, the initial response from some is disbelief and denial. Some denial is important for parents; it protects them from the overwhelming reality of the death. Shock and numbness usually predominate during the first 2 weeks after a loss, and normal functioning is impeded.

DIF: Cognitive Level: Analysis REF: p. 244 OBJ: 5 TOP: Grief early in the life cycle KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

21. The event most likely to make a grief reaction complicated and pathological would be: a. identification with the lost person. b. death by suicide. c. fantasizing about one’s own death. d. intense anticipatory grieving.

ANS: B

Death of a loved one by suicide affects the grieving process and may contribute to pathological grieving.

DIF: Cognitive Level: Comprehension REF: p. 248 OBJ: 7 TOP: Abnormal grieving KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

22. A common anxiety about suicide is reflected when the twin brother of a suicide victim asks: a. “Although he is dead, am I still a twin?” b. “Do you think I will be tempted to commit suicide like he did?” c. “Do you think my parents will ever get over this?” d. “Have you ever had suicidal thoughts?”

ANS: B

Death of a loved one by suicide may leave the survivors feeling that there may be an inherited predisposition for suicide.

DIF: Cognitive Level: Analysis REF: p. 249, Box 16-2 OBJ: 8 TOP: Reaction to suicide KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

23. Persons experiencing bereavement should postpone making drastic changes in their lives for at least: a. 1 month. b. 6 months.

c. 1 year. d. 2 years.

ANS: C

Postponing making changes in lifestyle for at least 1 year to allow careful thought for the considered changes is recommended for bereaved persons.

DIF: Cognitive Level: Application REF: p. 253 OBJ: 9 TOP: Decisions during bereavement KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: coping and adaptation

24. A bereaved person is in special need of condolence and support: a. on the deceased’s birthday. b. at the first of the year. c. on the anniversary date of the death. d. on the weekends.

ANS: C

Reinforcing support is especially important on the anniversary of the death.

DIF: Cognitive Level: Knowledge REF: p. 253-254 OBJ: 1 TOP: Condolence KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation MULTIPLE RESPONSE

25. The process of bereavement includes the survivors’: (Select all that apply.) a. reaction to the loss. b. c. d. e.

refusal to integrate the loss. portrayal of the deceased as perfect. adjustment to the loss. reorganization of the fabric of life.

ANS: A, D, E

Bereavement is the three-step process of reacting to the loss, adjusting to the loss, and moving on with the reorganization of the fabric of life.

DIF: Cognitive Level: Comprehension REF: p. 244 OBJ: 3 TOP: Bereavement KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

26. The death rituals observed by the East Indian community include which aspect(s)? (Select all that apply.) a. Family members wash and prepare the body. b. Family allows only the heart to be donated. c. The naked body is wrapped in a white sheet. d. Official mourning will last for 40 days. e. The body is buried within 24 hours of death.

ANS: A, D

East Indian family members wash, dress the body in new clothes, and prepare the body for cremation. East Indians do not allow organ donation, and the mourning lasts for 40 days.

DIF: Cognitive Level: Knowledge REF: p. 248, Table 16-1 OBJ: 6 TOP: East Indian death rituals KEY: Nursing Process Step: NA MSC: NCLEX: Psychosocial Integrity: coping and adaptation COMPLETION

27.

is the outward expression of grief.

ANS:

Mourning Mourning is the outward expression of grief, often based on cultural practices and traditions.

DIF: Cognitive Level: Comprehension REF: p. 244 OBJ: 3 TOP: Mourning KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: coping and adaptation

28. Saying goodbye to the pain of loss, the feeling of isolation, and the nearness of the loved one is known as .

ANS:

letting, go letting go Letting go does not mean forgetting the loved one. It means saying goodbye to the deep anguish of loss, expressing positive and negative memories of the deceased, and moving on.

DIF: Cognitive Level: Knowledge REF: p. 253 NURSINGTB.CO TOP: Mastering tasks toward grief healing KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OBJ: 9