Advanced Practice
Nursing
Essentials For Role Development
4th Edition
,Chapter 1 . Advanced Practice Nursing: Doing What Has to Be Done-Radicals, Renegades, and
Rebels
MULTIPLE CHOICE
1. The nurse manager of a pediatric clinic could confirm that the new nurse recognized the
purpose of the HEADSS Adolescent Risk Profile when the new nurse responds that it is used to
assess for needs related to
a. anticipatory guidance.
b. low-risk adolescents.
c. physical development.
d. sexual development.
ANS: A
The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which assesses
home, education, activities, drugs, sex, and suicide for the purpose of identifying high-risk
adolescents and the need for anticipatory guidance. It is used to identify high-risk, not low-risk,
adolescents. Physical development is assessed with anthropometric data. Sexual development
is assessed using physical examination.
REF: 6 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
2. The nurse preparing a teaching plan for a preschooler knows that, according to Piaget,
the expected stage of development for a preschooler is
a. concrete operational.
b. formal operational.
,c. preoperational.
d. sensorimotor.
ANS: C
The expected stage of development for a preschooler (3 to 4 years old) is preoperational.
Concrete operational describes the thinking of a school-age child (7 to 11 years old). Formal
operational
describes the thinking of an individual after about 11 years of age. Sensorimotor describes the
earliest pattern of thinking from birth to 2 years old.
REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
3. The school nurse talking with a high school class about the difference between growth
and development would best describe growth as
a. processes by which early cells specialize.
b. psychosocial and cognitive changes.
c. qualitative changes associated with aging.
d. quantitative changes in size or weight.
ANS: D
Growth is a quantitative change in which an increase in cell number and size results in an
increase in overall size or weight of the body or any of its parts. The processes by which early
cells specialize are referred to asdifferentiation. Psychosocial and cognitive changes are
referred to as development. Qualitative changes associated with aging are referred to as
maturation.
, REF: 2 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
4. The most appropriate response of the nurse when a mother asks what the Denver II
does is that it
a. can diagnose developmental disabilities.
b. identifies a need for physical therapy.
c. is a developmental screening tool.
d. provides a framework for health teaching.
ANS: C
The Denver II is the most commonly used measure of developmental status used by health care
professionals; it is a screening tool. Screening tools do not provide a diagnosis. Diagnosis
requires a thorough neurodevelopment history and physical examination. Developmental
delay, which is suggested by screening, is a symptom, not a diagnosis. The need for any therapy
would be identified with a comprehensive evaluation, not a screening tool. Some providers use
the Denver II as a framework for teaching about expected development, but this is not the
primary purpose of the tool.
REF: 4 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
5. To plan early intervention and care for an infant with Down syndrome, the nurse
considers knowledge of other physical development exemplars such as
a. cerebral palsy.
b. failure to thrive.
c. fetal alcohol syndrome.
d. hydrocephaly.