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Edition by Jean Foret Giddens 9780323581936
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Chapter 1-57 Complete
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,Concept 1: Development
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Test Bank
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MULTIPLE CHOICE v
1. The nurse manager of a pediatric clinic could confirm that the new nurse recognized the
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vpurpose of the HEADSS Adolescent Risk Profile when the new nurse responds that it is used
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vto assess for needs related to
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a. anticipatory guidance. v
b. low-risk adolescents. v
c. physical development. v
d. sexual development. v
ANS: A v
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
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high-risk adolescents and the need for anticipatory guidance. It is used to identify high-risk,
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not low-risk, adolescents. Physical development is assessed with anthropometric data.
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Sexual development is assessed using physical examination.
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REF: v v 6 OBJ: NCLEX® Client Needs Category: Health Promotion and Maintenance
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2. The nurse preparing a teaching plan for a preschooler knows that, according to Piaget,
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vthe expected stage of development for a preschooler is
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a. concrete operational. v
b. formal operational. v
c. preoperational.
d. sensorimotor.
ANS: C v
The expected stage of development for a preschooler (3 to 4 years old) is preoperational.
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Concrete operational describes the thinking of a school-age child (7 to 11 years old). Formal
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operational describes the thinking of an individual after about 11 years of age. Sensorimotor
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describes the earliest pattern of thinking from birth to 2 years old.
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REF: v v 5 OBJ: NCLEX® Client Needs Category: Health Promotion and Maintenance
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3. The school nurse talking with a high school class about the difference between growth
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and development would best describe growth as
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a.processes by which early cells specialize. v v v v v
b.psychosocial and cognitive changes. v v v
c.qualitative changes associated with aging. v v v v
d.quantitative changes in size or weight. v v v v v
ANS: D v
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.
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, REF: v v 2 OBJ: NCLEX® Client Needs Category: Health Promotion and Maintenance
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4. The most appropriate response of the nurse when a mother asks what the Denver II does
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vis that it
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a. can diagnose developmental disabilities.
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b. identifies a need for physical therapy. v v v v v
c. is a developmental screening tool.
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d. provides a framework for health teaching. v v v v v
ANS: C v
The Denver II is the most commonly used measure of developmental status used by health
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care professionals; it is a screening tool. Screening tools do not provide a diagnosis. Diagnosis
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requires a thorough neurodevelopment history and physical examination. Developmental
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delay, which is suggested by screening, is a symptom, not a diagnosis. The need for any
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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
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this is not the primary purpose of the tool.
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REF: v v 4 OBJ: NCLEX® Client Needs Category: Health Promotion and Maintenance
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5. To plan early intervention and care for an infant with Down syndrome, the nurse considers
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v knowledge of other physical development exemplars such as
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a. cerebral palsy. v
b. failure to thrive. v v
c. fetal alcohol syndrome. v v
d. hydrocephaly.
ANS: D v
Hydrocephaly is also a physical development exemplar. Cerebral palsy is an exemplar of
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adaptive developmental delay. Failure to thrive is an exemplar of social/emotional
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developmental delay. Fetal alcohol syndrome is an exemplar of cognitive developmental
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delay.
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REF: v v 9 OBJ: NCLEX® Client Needs Category: Health Promotion and Maintenance
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6. To plan early intervention and care for a child with a developmental delay, the nurse
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vwould consider knowledge of the concepts most significantly impacted by development,
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vincluding
a. culture.
b. environment.
c. functional status. v
d. nutrition.
ANS: C v
, 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
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concept that is considered to significantly affect development; the difference is the concepts
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that affect development are those that represent major influencing factors (causes), hence
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determination of development and would be the focus of preventive interventions.
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Environment is considered to significantly affect development. Nutrition is considered to
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significantly affect development.
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REF: v v 1 OBJ: NCLEX® Client Needs Category: Health Promotion and Maintenance
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7. A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to
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vher toys and makes up stories. The mother wants her child to have a psychologic evaluation.
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The nurse’s best initial response is to
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a. refer the child to a psychologist.
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b. explain that playing make believe with dolls and people is normal at this age.
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c. complete a developmental screening. v v v
d. separate the child from the mother to get more information.v v v v v v v v v
ANS: B v
By the end of the fourth year, it is expected that a child will engage in fantasy, so this is
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normal at this age. A referral to a psychologist would be premature based only on the
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complaint of the mother. Completing a developmental screening would be very appropriate
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but not the initial response. The nurse would certainly want to get more information, but
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separating the child from the mother is not necessary at this time.
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REF: v v 5 OBJ: NCLEX® Client Needs Category: Health Promotion and Maintenance
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8. A 17-year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so
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vneedy and acting like a child. The best response of the nurse is that in the hospital,
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vadolescents
a. have separation anxiety. v v
b. rebel against rules. v v
c. regress because of stress. v v v
d. want to know everything. v v v
ANS: C v
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
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an issue if the adolescent understands the rules and would not create childlike behaviors.
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An adolescent may want to “know everything” with their logical thinking and deductive
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reasoning, but that would not explain why they would act like a child.
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REF: v v 4 OBJ: NCLEX® Client Needs Category: Health Promotion and Maintenance
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