Test Bank for Concepts for Nursing Practice, 3rd Edition by Jean Foret Giddens – Complete Guide

,Concept 01: Development
b b




Giddens: Concepts for Nursing Practice, 3rd Edition
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MULTIPLE CHOICE b




1. The nurse manager of a pediatric clinic could confirm that the new nurse recognized the
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purpose of the HEADSS Adolescent Risk Profile when the new nurse responds that it is
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used to assess for needs related to
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a. anticipatory guidance. b




b. low-risk adolescents. b




c. physical development. b




d. sexual development. b




ANS: A b




The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which
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assesses home, education, activities, drugs, sex, and suicide for the purpose of identifying high-
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risk adolescents and the need for anticipatory guidance. It is used to identify high-risk, not low-
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risk, adolescents. Physical development is assessed with anthropometric data.
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Sexual development is assessed using physical examination.
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OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance b b b b b b b




2. The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, the
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expected stage of development for a preschooler is
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a. concrete operational. b




b. formal operational. N b




c. preoperational.
d. sensorimotor.
ANS: C b




The expected stage of development for a preschooler (3–4 years old) is pre-operational. Concrete
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operational describes the thinking of a school-age child (7–11 years old). Formal operational
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describes the thinking of an individual after about 11 years of age. Sensorimotor describes the
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earliest pattern of thinking from birth to 2 years old.
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OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance b b b b b b b




3. The school nurse talking with a high school class about the difference between growth and
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development would best describe growth as
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a. processes by which early cells specialize. b b b b b




b. psychosocial and cognitive changes. b b b




c. qualitative changes associated with aging. b b b b




d. quantitative changes in size or weight. b b b b b




b ANS: D b




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, Growth is a quantitative change in which an increase in cell number and size results in an
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increase in overall size or weight of the body or any of its parts. The processes by which early
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cells specialize are referred to as differentiation. Psychosocial and cognitive changes are
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referred to as development. Qualitative changes associated with aging are referred to as
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maturation.
b




OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance b b b b b b b




4. The most appropriate response of the nurse when a mother asks what the Denver II does is that it
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a. can diagnose developmental disabilities.
b b b




b. identifies a need for physical therapy. b b b b b




c. is a developmental screening tool.
b b b b




d. provides a framework for health teaching. b b b b b




ANS: C b




The Denver II is the most commonly used measure of developmental status used by healthcare
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professionals; it is a screening tool. Screening tools do not provide a diagnosis. Diagnosis requires
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a thorough neurodevelopment history and physical examination.
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Developmental delay, which is suggested by screening, is a symptom, not a diagnosis. The need b b b b b b b b b b b b b b




for any therapy would be identified with a comprehensive evaluation, not a screening tool. Some
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providers use the Denver II as a framework for teaching about expected development, but this is
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not the primary purpose of the tool.
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OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance b b b b b b b




5. Toplanearly interventiona n Nd careforan infantwithDown syndrome, thenurseconsiders
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knowledge of other physical development exemplars such as
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a. cerebral palsy. b




b. autism.
c. attention-deficit/hyperactivity disorder (ADHD). b b




d. failure to thrive. b b




ANS: D b




Failure to thrive is also a physical development exemplar. Cerebral palsy is an exemplar of
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motor/developmental delay. Autism is an exemplar of social/emotional developmental delay.
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ADHD is an exemplar of a cognitive disorder.
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OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance b b b b b b b




6. To plan early intervention and care for a child with a developmental delay, the nurse would
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consider knowledge of the concepts most significantly impacted by development, including
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a. culture.
b. environment.
c. functional status. b




d. nutrition.
bANS: C b

, Function is one of the concepts most significantly impacted by development. Others include
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sensory-perceptual, cognition, mobility, reproduction, and sexuality. Knowledge of these
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concepts can help the nurse anticipate areas that need to be addressed. Culture is a concept that is
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considered to significantly affect development; the difference is the concepts that affect
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development are those that represent major influencing factors (causes); hence determination
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of development would be the focus of preventive interventions. Environment is considered to
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significantly affect development. Nutrition is considered to significantly affect development.
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OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance b b b b b b b




7. A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to
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her toys and makes up stories. The mother wants her child to have a psychological evaluation.
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The nurse’s best initial response is to
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a. refer the child to a psychologist immediately.b b b b b b




b. explain that playing make believe is normal at this age. b b b b b b b b b




c. complete a developmental screening using a validated tool. b b b b b b b




d. separate the child from the mother to get more information. b b b b b b b b b




ANS: B b




By the end of the fourth year, it is expected that a child will engage in fantasy, so this is normal at
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this age. A referral to a psychologist would be premature based only on the complaint of the
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mother. Completing a developmental screening would be very appropriate but not the initial
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response. The nurse would certainly want to get more information, but separating the child from
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the mother is not necessary at this time.
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OBJ: NCLEX Client NeedsNCategory: Health Promotion and Maintenance b b b b b b




8. A 17-year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so
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needy and acting like a child. The best response of the nurse is that in the hospital, adolescents
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a. have separation anxiety. b b




b. rebel against rules. b b




c. regress because of stress. b b b




d. want to know everything. b b b




ANS: C b




Regression to an earlier stage of development is a common response to stress. Separation
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anxiety is most common in infants and toddlers. Rebellion against hospital rules is usually not an
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issue if the adolescent understands the rules and would not create childlike behaviors. An
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adolescent may want to “know everything” with their logical thinking and deductive reasoning,
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but that would not explain why they would act like a child.
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OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance b b b b b b b




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