Test Bank

Multiple Choice

1. The nurse leading parent education classes bases instruction on Erikson‟s developmental stages. It follows that the nurse will plan to instruct the parents that a helpful strategy to foster a child‟s initiative would be to: a. Offer several different options for dressing and encourage the child to select one of them. b. Allow the child to help wash the unbreakable dishes used to serve breakfast. c. Provide one-on-one parent–child time each evening before bed. d. Enroll the child in a weekend, age-appropriate sports program.

ANS: B

This strategy will allow the child to demonstrate initiative by washing dishes without worrying about breakage. Making clothes selections is a strategy related to development of autonomy. Providing one-on-one time promotes trust. Age appropriate sports program is related to competence.

DIF: Cognitive Level: Application REF: Page 117 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance a. “You are never allowed to steal.” b. “You go to jail is you steal someone else‟s things.” c. “My parents would punish me if I was caught stealing.” d. “Stealing food when you don‟t have anything to eat is alright.”

2. Which of the following responses would the nurse expect from a 12-year-old regarding stealing?

ANS: D

Before the ages of 10 or 11 years, children consider moral dilemmas differently from older children. For younger children, rules are absolute and come from an authority figure. Older children learn that rules are changeable in certain situations. According to Piaget, younger children base moral judgment on consequences, whereas older children base judgment on motives.

DIF: Cognitive Level: Application REF: Page 121

TOP: Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance, Health Promotion and Maintenance

3. A nursing diagnosis of hopelessness would be considered for an individual who: a. Was consistently overprotected by family members b. Was raised by parents who were strict disciplinarians c. Had inconsistent, unpredictable physical care as an infant d. As a teenager always felt unaccepted by his social peers

ANS: C

A sense of hope is the outcome of Erikson‟s stage of trust versus mistrust. Inconsistent, unpredictable, and discontinuous care would lead to hopelessness and to a mistrust of self and the world. No data are given to support any of the other diagnoses.

DIF: Cognitive Level: Application REF: Page 117

TOP: Nursing Process: Nursing Diagnosis

MSC: NCLEX: Health Promotion and Maintenance, Psychosocial Integrity a. “It‟s too hard to get good grades.” b. “I‟ll never be able to get into a good college.” c. “My parents are disappointed that I do so poorly in school.” d. “I don‟t want people to know I can barely read or write.”

4. An adolescent has been a consistently, poor academic student due to a learning disorder. Which statement overheard by the nurse would support the possibility of a problem with the developmental stage competence versus inferiority?

ANS: B

According to Erikson and the stage of competence versus inferiority, during school years (6 to 12 years of age), children gain new knowledge, learn new skills, and grow more competent. If they lack successes in learning or productivity, children may develop a sense of inferiority. The other options reflect problems with autonomy and guilt.

DIF: Cognitive Level: Application REF: Page 117

TOP: Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance, Psychosocial Integrity

5. A parent is concerned with the interpersonal skills of her 12-year-old son. Based on interpersonal theory, the nurse asks: a. “Does your son belong to team or club with friends or classmates?” b. “Does he feel bad when he does something he knows he shouldn‟t do?” c. “How does he tend to act when he doesn‟t get exactly what he wants?” d. “How confident is he in situations that are generally unfamiliar for him?”

ANS: A

According to Sullivan, the expected development of the preadolescent permits him or her to work with peers toward a common goal and to develop a sense of “oneness.” Development of a social conscience is not related to interpersonal skill development. Coping with frustration develops in late adolescence. Confidence is suggested as a developmental issue of 12- to 18year-olds in Erikson‟s model.

DIF: Cognitive Level: Application REF: Page 118

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Health Promotion and Maintenance a. The use of drawing and illustrations b. Comparing the child‟s experiences to the new material c. Encouraging the child to talk about this new information d. Asking the child to give a reason for how they feel about new information

6. The parents of an 8-year-old are attempting to help their child comprehend new information. Which intervention suggested by the nurse shows an understanding of the cognitive development theory for this age group?

ANS: B

Comparing a known to an unknown will help this age group understand new information. Drawings and illustration as well as talking about new information are effective methods for the younger aged child. Providing rationales is too advanced for this age group.

DIF: Cognitive Level: Application REF: Page 119 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance a. Playing with an “imaginary friend” b. Talking about their “best friend” c. Enjoying putting puzzles together d. Knowing its wrong to tell a lie

7. According to Piaget, which of the following would the nurse consider normal when assessing a 6-year-old?

ANS: A

Preoperational stage (2-7 years) children begin to exhibit pretend play. The need to make friends and the development of a conscious are observed in the concrete operations stage (7-11 years). The ability to problem solve is seen in the formal operations stage (11-16 years).

DIF: Cognitive Level: Application REF: Page 118

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance a. Preoperational b. Concrete operational c. Formal operational d. Postoperational

8. Which developmental level would be characterized by a child being able to focus, to coordinate, and to imagine a series of events?

ANS: B

In the concrete operational level, the child can focus and coordinate and imagine a series of events. In the preoperational stage, the child is unable to relate two classifications at one time and is present-oriented. At the formal operations level, the child can think abstractly and in future orientation. Postoperational is not a stage of cognitive development.

DIF: Cognitive Level: Application REF: Page 118

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance a. Periodically asking the child to attempt to solve increasingly difficult puzzles b. Consistently offering praise when the child puts his dirty clothes in the hamper c. Expecting the child to rinse and to place his dirty dishes in the sink d. Conditioning the child to expect punishment when he misbehaves

9. Which strategy will the nurse include in the plan of care for a 6-year-old child for whom operant conditioning has been recommended?

ANS: B

A 6-year-old can learn to comply with requests when adults reinforce compliance with positive reinforcement. The remaining options do not reinforce compliance but rather state expectations.

DIF: Cognitive Level: Application REF: Page 120 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance, Psychosocial Integrity a. The child views the abuse to be more desirable than the parent leaving. b. The parent has fostered a fear in the child that increases when they are apart. c. The child believes that he is responsible for the parent now being punished. d. The parent has likely told the child that he deserved the abuse as a punishment.

10. A child who has been physically abused becomes emotionally distorted when told that the parent will no longer be allowed to visit. Which principle of social learning theory is most likely for the child‟s response?

ANS: A

Social theory states that reinforcement value is subjective and influenced by past experiences. For most children, parental punishment is a negative outcome with low reinforcement value. However, for some children who suffer from parental abuse, the abuse has a high reinforcement value, because it is more desirable than abandonment. The remaining options are not supported by the social theory.

DIF: Cognitive Level: Application REF: Page 120

TOP: Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance, Psychosocial Integrity a. Applying an elastin sustaining moisturizer to an adult patient‟s skin b. Assessing a patient‟s family history for genetic diseases and disorders c. Questioning a patient regarding long-term exposure to environmental toxins d. Assisting an adult patient is selecting foods that are high in vitamins A, C, and E

11. Which nursing intervention supports the principles on which the cross-links theory of aging is based?

ANS: A

Cross-links form in elastin in connective tissue. Elastin is similar to collagen in that it maintains tissue flexibility and permeability. The effects of cross-linking in elastin fibers are most pronounced in the changes that occur in facial skin with aging. Skin becomes brittle, dry, and saggy, and it appears translucent. Applying appropriate moisturizes helps minimize the effects. Genetic history is relevant to the genetic theory of aging. Exposure to environmental toxics applies to the biological theory of aging. Vitamin A, C, and E consumption related to the freeradical theory of aging.

DIF: Cognitive Level: Application REF: Page 128 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity, Health Promotion and Maintenance a. Inability to remember how to operate a common kitchen appliance b. Difficulty remembering the name of a place visited 20 years ago c. Being unsuccessful at retaining new information d. Forgetting the ingredients of a favorite recipe

12. The nurse determines that a patient is showing a decline in explicit memory. Which characterizes such a deficiency?

ANS: B

Explicit memory, which is the ability to recall a specific name or place, tends to decline with aging. Working memory, which is the type of memory that is needed to perform daily activities, does not show an aging decline.

DIF: Cognitive Level: Analysis REF: Page 133

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity a. “I won‟t give up on my dream to be rich.” b. “Being rich doesn‟t necessarily make a person happy.” c. “I‟ll never be rich but I can save enough to live comfortably.” d. “I wasn‟t being realistic when I set being rich as my life‟s goal.”

13. A patient is experiencing distress with midlife transition. Which statement provides support that the patient is successfully managing this stressor?

ANS: C

The midlife transition occurs between the ages of 40 and 45 years. Individuals face the realization that the failure to accomplish all of life‟s goals leads first to disappointment and then to the reformulation of earlier goals. The remaining options do not show a reforming of original goals.

DIF: Cognitive Level: Application REF: Page 124 TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance, Psychosocial Integrity

14. According to Maslow‟s hierarchy of needs, the nursing strategies a psychiatric nurse would use to assist in meeting self-esteem needs of elderly patients would include: a. Providing privacy when spouses are visiting b. Arranging for the spouses to dine with the patients when visiting c. Including both the patients and spouses in all educational sessions d. Attending to patient hygiene and dress in preparation for spousal visits

ANS: D

Promoting an attractive physical appearance will assist patients in meeting the need for selfesteem. Patients receive positive feedback when appearance is attractive. The remaining options are not directly focused on self-esteem but rather belonging and safety.

DIF: Cognitive Level: Application REF: Page 124

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance a. Limiting the act of smoking to certain times of the day b. Keeping a behavioral diary that tracks when the patient smokes c. Identifying the factors that initially encouraged the patient to start smoking d. Making plans that involve spending the money saved when the smoking stops

15. A patient is involved in a smoking cessation program that encourages self-control therapy interventions. Which intervention would the nurse suggest to this patient?

ANS: B

Self-control therapy is based on self-regulation concepts, for example, keeping track of one‟s smoking behaviors with the use of a behavioral diary helps to identify cues associated with the habit. Taking steps to then remove or avoid some of the cues is a way to alter the environment. The remaining options are more reflective of behavior modification therapy.

DIF: Cognitive Level: Application REF: Page 121 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance, Psychosocial Integrity

16. A 70-year-old male has the nursing diagnosis situational low self-esteem related to forced retirement. Using Maslow‟s hierarchy of human needs, the nurse is confident the patient is meeting the outcome of experiencing self-worth when the patient: a. Moves to a secure apartment building b. Exercises regularly with friends at the gym c. Attends his grandchildren‟s school functions d. Volunteers at the local homeless shelter each week

ANS: C

Feelings of worth, self-confidence, and adequacy are desired outcomes for a patient with low self-esteem. Security is associated with Maslow‟s need for safety and security and would be an appropriate outcome for a patient experiencing fear. Self-fulfillment is related to selfactualization needs and might be associated with a wellness diagnosis. Acceptance is related to love and belonging needs and could be associated with a social isolation diagnosis.

DIF: Cognitive Level: Application REF: Page 124 TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance, Psychosocial Integrity

17. The spouse of a patient recently diagnosed with early stage Alzheimer‟s disease asks, “ a. Minimize contact with the public during cold and flu season. b. Enroll the patient in an exercise program that meets regularly. c. Provide supplements to enhance the patient‟s immune system. d. Identify creative ways to keep the patient mentally challenged.

Is there anything I can do to help delay the progression of this disease?” Which strategy has the greatest potential for preserving the protective abilities of immune cells related to the disease?

ANS: D

Research has demonstrated links between creative activities and the consequential positive feelings with the increased production of protective immune cells. Creativity is also possibly linked to delaying the onset of Alzheimer‟s disease. Continually challenging oneself mentally is a way to build up reserves of neurologic structures and connections. The remaining options, although related to the immune system, are more directly focused on the physical affects rather than the cognitive ones.

DIF: Cognitive Level: Application REF: Page 138 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance, Psychosocial Integrity

MULTIPLE RESPONSE a. Becomes sad when the family pet dies b. Plans a trip to attend a basketball game c. Identifies two different bowls that hold 1 cup d. Selects the appropriate clothing for a ski trip e. Enjoys solving “what if” types of word problems

1. A nurse is using Piaget‟s model to assess a child‟s developmental stage. Which behaviors would determine that a child is successfully achieving the skills required of the formal operations level of development? Select all that apply.

ANS: B, D, E

The formal operations level includes the ability for future thinking and for problem-solving complex issues. The remaining options reflect concrete operations level abilities.

DIF: Cognitive Level: Analysis REF: Page 119 TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance a. “If I pick up my toys, can I get an ice cream cone?” b. “I can‟t watch cartoons when I don‟t pick up my toys.” c. “I always pick up my toys because mommy needs my help.” d. “When I pick up all of my toys I make mommy very happy.” e. “If I don‟t pick up my toys, mommy could trip on them and fall.”

2. The nurse is assessing a child according to Kohlberg‟s developmental theory. Which statement would support the belief the child is showing appropriate behaviors of the preconventional state? Select all that apply.

ANS: A, B, E

The pre-conventional stage (4-10 years) involves a punishment-obedience orientation as well as an instrumental relativist orientation. The remaining options are reflective of a higher level of development.

DIF: Cognitive Level: Analysis REF: Page 121

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance a. Possessing the ability to prepare nutritious meals independently b. Having the financial resources available to live independently c. Performing regular, simple maintenance on their primary residence d. Effectively toileting themselves for both bowel and bladder elimination e. Safely moving around their residence without an increased risk for falls

3. Which activities should the nurse evaluate in an assessment of an older patient‟s functional status? Select all that apply.

ANS: A, D, E

Functional assessment usually consists of evaluating two areas. The first area, ADLs, includes categories of personal care such as bathing, grooming, toileting, and transferring. The second area, IADLs, addresses activities that are important for the individual to be able to function in the community. IADLs include shopping, preparing meals, and getting around. Financial resources and maintenance skills are not included in such an assessment.

DIF: Cognitive Level: Application REF: Page 131

TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity, Health Promotion and Maintenance a. Has, at age 64, been diagnosed with type 2 diabetes b. Has been treated for multiple sclerosis since age 30 c. Is managing a 36-year history of chronic Graves‟ disease d. Has begun to experience symptoms of rheumatoid arthritis e. Is experiencing a flare up of celiac disease, which was diagnosed at age 26

4. Which older adult patient‟s medical conditions appear to support the hypothesis upon which the immunologic theory of aging is based? Select all that apply.

ANS: A, D

Immune function significantly declines with aging. Rheumatoid arthritis and mature-onset diabetes are two diseases that are commonly experienced during older age that are caused by alterations to the immune system. Although the remaining options reflect disease processes associated with the immune system, they manifested in early adulthood.

DIF: Cognitive Level: Application REF: Page 128

TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity, Health Promotion and Maintenance a. Allowing ample time for completion of patient activities b. Breaking complicated patient activities into single tasks c. Planning patient activities that can be completed rather quickly d. Excluding complex problem-solving patient activities in the daily routine e. Planning for complex patient activities to be introduced early in the day

5. The nurse manages the care for several older adult patients. Which strategies shows an understanding of the effects of aging on cognitive function? Select all that apply.

ANS:

A, B, C

With aging, the ability to maintain the attention span through the completion of complex tasks diminishes. Another segment of attention that shows some decrements with aging is vigilance, which is the ability to sustain attention over longer periods of time. Increased reaction time that results in decreased speed of performance is an obvious change that occurs with normal aging. Problem-solving ability is a higher cognitive function. There is little knowledge regarding normal changes in higher cognitive functioning during aging and so the remaining options are not based on evidenced-based practice.

DIF: Cognitive Level: Analysis

REF: Page 133

TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance, Psychosocial Integrity a. Diagnosis of a chronic genetic disease b. Lack of healthy diet and regular exercise c. Family history of several different cancers d. Occupation that involved working with toxins e. Radiation exposure from numerous diagnostic studies

6. According to most biological theories of aging, predisposing factors create the affects seen in aging. Which behaviors are considered predisposing factors regarding aging? Select all that apply.

ANS: A, C, D, E

One method of classifying biologic theories of aging relates to categorizing predisposing factors as intrinsic or extrinsic to the organism. Intrinsic or genetic theories focus on the process of aging as internal to the organism. Certain genetic diseases, including several types of cancers and high-cholesterol syndromes that lead to heart disease, have a negative impact on life expectancy. Extrinsic or nongenetic theories propose that aging occurs as a result of environmental factors that act on the organism, such as radiation, ozone, drugs, and toxic substances which, researchers have theorized, damage cellular structures, thereby leading to aging and death. Diet and exercise are not considered either intrinsic or extrinsic factors to biological theories of aging.

DIF: Cognitive Level: Application REF: Page 128

TOP: Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance, Physiological Integrity: Physiological Adaptation a. Having warm and caring people in your life b. Engaging in age-appropriate exercise on a regular basis c. Accepting the fact that aging negatively impacts your life d. Seeking help if changes of aging cause depression or anxiety e. Avoiding retirement for as long as possible in order to keep active

7. The nurse is preparing to educate a group of middle-aged adults on longevity strategies. Which behaviors would the nurse stress? Select all that apply.

ANS: A, B, D

A Harvard study identified factors of middle adulthood that promote longevity and include experiencing a warm and caring relationships, having effective adaptive or coping strategies, and getting adequate exercise. Aging does not necessarily affect life negatively and there are numerous ways to remain both physical and mentally active after retirement.

DIF: Cognitive Level: Application REF: Pages 124-125

TOP: Nursing Process: Implementation