Test 3 Health N Wellness

Chapter 24: Older Adult
Edelman: Health Promotion Throughout the Life Span, 8th Edition

MULTIPLE CHOICE
1. A nurse is planning to write a grant for a health promotion project in the community. Which of
considerations should the nurse make when determining the appropriate population for this
project?
a. The fastest growing population is children under the age of 12.
b. The fastest growing population is young Black American adults.
c. The fastest growing population is White middle-age adults.
d. The fastest growing population is non-White older adults age 65 and older.
ANS: D
Adults age 85 and older are the fastest growing population in the United States, and the
percentage of White Americans greater than age of 65 is decreasing compared with other ethnic
groups.
DIF: Cognitive Level: Apply (Application)
REF: p. 592
2. Which of the following statements made by a client best identifies someone who would benefit
from health promotion interventions?

a. I have a new grandchild and want to be part of her life.
b. My mother lived until she was 90, so a long life is in my genes.
c. Some chronic illness is just a part of aging.
d. I hope Ill live a lot longer, but one never knows.
ANS: A
Motivation to adopt a healthy lifestyle is a primary predictor of successful interventions. Feeling

that illness is just part of aging or leaving health up to chance will not help the person make
necessary lifestyle changes.
DIF: Cognitive Level: Analyze (Analysis)
REF: p. 595
3. Which of the following statements concerning nutrition and older adults is true?
a. Older adults who live in their own homes are more likely to be malnourished than
older adults living in a nursing home.

b. Older adults lose their desire for high-fat, salty foods.
c. Meals served in long-term care institutions are usually more well-balanced than
foods eaten by older adults living at home.

d. Many older adults are not aware of food assistance programs.
ANS: D
Barriers that may interfere with the ability of independent seniors to obtain adequate nutritional
food include limited transportation, income, and social support resources. Many older persons
are unaware that they are eligible to participate in SNAP. The percent of older adults who live in
their own homes and are malnourished is lower than that of older adults who live in a nursing
home. Older adults do not lose their desire for high-fat, high-cholesterol, high-sodium foods.
Fresh fruits and vegetables are not always available for older adults living in nursing homes.
DIF: Cognitive Level: Understand (Comprehension)
REF: pp. 596-597
4. Which of the following statements concerning urinary incontinence is correct?

a. Urge incontinence occurs when one has the urge to void but is unable.
b. Stress incontinence is associated with emotional turmoil.
c. Functional incontinence occurs is associated with environmental barriers.
d. Incontinence with high post-void residual occurs when someone laughs or sneezes.
ANS: C
Functional incontinence is associated with environmental barriers, physical limitations, or

cognitive impairment in which the client is unable to reach the toilet. Stress incontinence occurs
when someone coughs or sneezes. Urge incontinence occurs when someone cannot wait to void
once the urge to void is felt. Urge, mixed, or stress incontinence with high post-void residual is
caused by physiological changes that affect voiding, such as an enlarged prostate gland.
REF: p. 597
5. Which of the following nursing diagnoses is a priority related to the problem of urinary
incontinence?
a. Risk for social isolation
b. Risk for impaired skin integrity
c. Risk for inadequate fluid intake
d. Risk for impaired coping
ANS: B
Although social isolation and decreased fluid intake may occur because of urinary incontinence,
impaired skin integrity is a major concern because of its impact on physical and psychological
health.
REF: p. 597
6. A 75-year-old man tells the nurse that he has difficulty staying asleep during the night. Which of
the following responses should be made by the nurse?

a. Older adults need as much sleep as middle-age and younger adults. Lets talk
about your sleep patterns.
b. Ill ask the nurse practitioner to prescribe a sleeping pill for you.
c. Taking naps during the day can help relieve excessive fatigue and will help you
sleep better.
d. Lets talk about your sleep schedule and things that may prevent you from getting
a restful nights sleep.
ANS: D
Nurses should assist older adults in achieving a good nights sleep through assessment that might
reveal possible causes of sleep disturbances. Older adults need less sleep than younger adults.
Daytime naps may prevent sleeping adequately at night. Medications to assist in sleeping are not
the initial therapy choice because of side effects.
REF: pp. 599-560
7. A nurse is conducting a community education program about cognition in older adults. Which of
the following information should be included?

a. Some form of mild dementia is a normal part of aging.
b. All forms of dementia have the same symptoms, but progress at different rates.
c. Assessment for dementia should be part of routine physical exams.
d. Elders who score below 27 points on the Mini-Mental State Exam (MMSE) are not
likely to have a cognition problem.
ANS: C
Cognitive alterations are key symptoms that indicate changes in physiological function among
older persons. Thus, assessment of cognition is an important part of routine assessments.
Dementia is not a normal part of aging. Dementia symptoms vary according to the specific type
of dementia. A score of 23 or lower on the MMSE indicates a problem with cognition.
REF: pp. 600-601
8. A nurse has recently accepted the position of unit nurse manager on a long-term care unit. Which
of the following directives should the nurse give to the staff nurses?
a. Encourage residents to participate in unit activities such as Scrabble and bingo.
b. Demonstrate the caring aspect of nursing by dressing residents before breakfast.
c. Fill in missing words during conversation with the residents to avoid
embarrassment.
d. Instruct the aides to get residents ready for breakfast as quickly as possible to make
sure they are ready to eat.
ANS: A
To encourage cognitive health nurses should inspire older individuals to take classes, read,
engage in stimulating conversation and entertainment, keep their minds active, and continue
learning throughout their lives. They are encouraged to continue with self-care activities rather
than relinquish them to caregivers. Residents should be encouraged to perform self-care
activities themselves. When help is required, it should be provided in an unhurried manner.
Filling in missing words makes the resident dependent on the staff and reduces motivation to
communicate, and the words supplied may not be the intended words.
REF: p. 602
9. A nurse is assisting with development of menu items at a long-term care facility. Which of the
following menus would the nurse most likely recommend?

a. One egg over easy, one slice of whole wheat toast with sugar-free jam, 4 oz orange
juice
b. 5-oz cheeseburger cooked medium well with lettuce and tomato, 10 baked potato
chips, and 1 cup of decaf coffee with low-fat milk and artificial sweetener
c. Chef salad with 2 oz each ham and turkey, lettuce, tomato, bean sprouts, onion,
green pepper with low-fat dressing, and one small roll with low-fat spread
d. Turkey bacon, lettuce, and tomato sandwich on whole wheat bread with two
teaspoons of low-fat mayonnaise, 10 vegetable chips, and ice tea with artificial
sweetener
ANS: D
The United States Department of Agriculture recommends that infants and young children,
pregnant women, older adults, and those who are immune compromised should not consume raw
(unpasteurized) milk or any products from unpasteurized milk, raw or partially cooked eggs or
foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or
shellfish, unpasteurized juices, or raw sprouts.
REF: p. 603
10. Which of the following individuals would be at greatest risk of injury?

a. 80-year-old who does not have air conditioning or a fan
b. 70-year-old who has new dentures
c. 68-year-old who has difficulty tasting salt in food
d. 84-year-old who needs hearing aids
ANS: A
Sweating decreases in older adults, predisposing them to heat stroke.

REF: p. 603
11. According to Eriksons theory of development, which of the following older adults has
successfully navigated the stage of ego integrity versus despair?

a. 72-year-old man who is reluctant to retire because work is everything to me
b. 78-year-old woman who has scheduled her third face lift
c. 80-year-old man who has informed his children that he has made his funeral
arrangements
d. 67-year-old woman who is depressed because she has not been promoted at work
for the past 10 years
ANS: C
Successfully navigating the stage of ego integrity versus despair requires that the individual
accept normal bodily changes associated with aging, find meaning in life apart from work,
accepts the inevitability of death, and is at peace with his or her life.
REF: p. 604
12. A couple in their sixties has assumed responsibility for raising their two grandchildren ages 9 and
12 because the childrens parents died in a car accident. Which of the following are priority
nursing interventions that the nurse can implement to help the grandparents cope with the
responsibility of raising their grandchildren?
a. Connecting them with the Grandparents Raising Grandchildren support group
b. Encouraging them by reinforcing how they successfully raised their own children
c. Volunteering to provide respite time for them as needed

d. Assuring them that their stress level will lessen as they gain confidence
ANS: A
Stress experienced by grandparents who must raise grandchildren can be lessened by counseling
and participation in support groups.
REF: pp. 604-605
13. A nurse is conducting a staff development program about human sexuality for nurses who work
in a long-term care facility. Which of the following statements would most likely be made by the
nurse?
a. The desire for sexual intimacy declines rapidly with age.
b. Older adults are very well-informed about sexuality.
c. Older adults need to practice safe sex.
d. The danger of contracting STDs during sexual intimacy is extremely low in older
adults.
ANS: C
The desire for sexual intimacy remains a primary force throughout life. Older adults need
teaching related to safe sexual practices, STD transmission, and so on. HIV infection is a concern
in all age groups.
REF: p. 606
14. The clinic nurse has seen the following four people today. Which of the following people is
demonstrating a healthy coping pattern?

a. Discusses very little except the loss of her husband 3 years ago
b. Talks about the good times she and her husband had before his illness and death
1 year ago
c. States that life is not worth living without her husband, who died 2 years ago
d. Blames herself for her husbands death because she did not make him go to the
doctor
ANS: B
Research has demonstrated that rumination, self-blame, and catastrophizing have negative effects
on coping, whereas positive reappraisal has a positive effect.
REF: p. 606
15. A nurse is assigned to provide care for a 96-year-old bedridden man who experiences severe pain
from a chronic neurological disease. The man asks the nurse to please help him leave this world
so that his suffering ends. Which of the following actions would be most appropriate for the
nurse to take?
a. Assist the doctor with the mans request
b. Refuse to care for the man
c. Contact the pain care specialist
d. Provide the man with names of doctors who participate in assisted suicide
ANS: C
Nurses caring for chronically ill older adults have the added responsibility of determining who is
at risk for wanting physician-assisted suicide and helping them to be as comfortable as possible
and free of pain through the use of pharmacological and nonpharmacological interventions.
Refusing to care for the man could be construed as abandonment and is not necessary.
Consulting a pain care specialist is the correct action.
REF: p. 607
16. A nurse is conducting a home visit for an older adult in the summer. Which of the following
items should the nurse should locate in the home?

a. Fan
b. Porch chair
c. Synthetic blend clothing
d. Thermometer
ANS: A
Older adults are susceptible to heat stroke. The availability of a fan will help cool the ambient air.
Light-weight cotton clothing breathes and facilitates cooling, whereas synthetic material
retains heat.
REF: p. 609
17. The community health nurse has obtained a grant to offer a Safe Driving series for older
adults. Which of the following information should the nurse stress during the series?
a. Traffic fatalities involving older adults occur mainly at dusk.
b. The cause of two-vehicle accidents is frequently an older driver striking another
car.
c. The average blood alcohol level in older adults involved in accidents is higher than
the blood alcohol level of younger drivers involved in accidents.
d. Relearning the art of defensive driving can help reduce the likelihood that an older
driver will be involved in a motor vehicle accident.
ANS: D
Traffic fatalities involving older adults occur mainly during the daytime. The cause of two
vehicle accidents is frequently a younger driver striking the car driven by an older adult. The
average blood alcohol level in older adults involved in accidents is lower than the blood alcohol
level of younger drivers involved in accidents.
REF: p. 609
18. As part of a community-wide flu vaccination program for older adults, the nurse is assisting at a
vaccination clinic. Which of the following questions should the nurse ask before administering
the vaccine?
a. Do you have any food allergies?
b. Have you had the pneumococcal vaccine?
c. Have you had the flu in the past 5 years?
d. Do you have Medicare?
ANS: A
An allergy to eggs is a contraindication to receiving flu vaccine grown in chick embryo cells.
REF: p. 610
19. A man tells a nurse that he is concerned about his risk of developing cancer. Which of the
following behaviors would place the man at higher risk of developing cancer?
a. Smoking a half of a pack of cigarettes a day
b. Exercising three times a week
c. Consuming green, leafy vegetables several times a week
d. Visiting a chiropractor every week
ANS: A
Habits that place older adults at a high risk for developing cancer: not following nutritional
guidelines, high stress levels, not engaging in a regular exercise program, and smoking cigarettes
and using other tobacco products.
REF: p. 611
20. Which of the following statements is the best definition of polypharmacy?

a. The use of more than five medications prescribed by different physicians
b. The use of multiple medications for the same or different health problems
c. The use of multiple pharmacies and self-management of medications
d. The use of multiple medications and supplements simultaneously
ANS: B
Polypharmacy is the use of multiple medications for the same or different health problems. It is a
major concern for elderly people, with the rate of polypharmacy in this population being between
9% and 39%.
REF: p. 611
21. A person is preparing to return home following a 2-week hospital stay for congestive heart
failure and pneumonia. Which of the following referrals would be most beneficial for the person?
a. Transportation assistance
b. Home-delivered meals
c. Adult day care
d. Home health nursing
ANS: D
Home care nurses provide health care information and services to individuals and families. The
resources available to community health nurses frequently are rich and enable the nurses to draw
on a variety of sources to assist in promoting the health of community-dwelling older adults.
Although all of the referrals listed may be of benefit to the person, the home health nurse will
provide the most comprehensive services and be able to connect the person to necessary
community resources.
REF: p. 614
22. The son of a 70-year-old man dying of cancer asks the nurse to tell him about the hospice
program, so he can help his father decide if the program would be of benefit to him. Which of the
following responses should be given by the nurse?
a. At hospice, your father will be heavily medicated, so he will not have pain.
b. All of your fathers care will be provided by nurses at hospice.
c. Hospice care can take place either at home or in a hospice facility.
d. Visiting hours are about the same at hospice as they are here in the hospital.
ANS: C
Once the person is placed in hospice care, treatment to relieve pain and other symptoms is
continued by the physician after they have decided to end all curative treatment. Hospice care
can occur in the home, a hospice inpatient facility, nursing home, and acute care hospital. The
focus of hospice care is to help the person remain alert but free of pain. Families are encouraged
to participate in care giving. There are no restrictions to visiting hours.
REF: p. 614
23. A community health nurse is working with a diverse population of older adults within the
community. Based on the data from the National Health Interview Survey, which of the
following assumptions should be made by the nurse when working with this diverse population?
a. White Non-Hispanic older adults tend to require more assistance with their
activities of daily living.
b. Hispanic older adults tend to rate their health as poorer than other ethnic groups.
c. Older adults who tend to rate their health as fair or poor are also financially poor.
d. Older adults tend to require more assistance with activities of daily living than with
meeting their routine needs.
ANS: C
The National Health Interview Survey conducted by the Centers for Disease Control and
Prevention in 2010 provides interesting information about the perceptions of a variety of ethnic
groups regarding their health status, their perceived need for assistance with routine needs, and
the need for assistance with activities of daily living. In all groups, those who described their
health as fair or poor were also more likely to be financially poor.
REF: p. 594 (Box 24-2)
24. A woman who is being discharged from the hospital is oriented to person, place, and time, and
her memory is intact. She has occasional forgetfulness without a consistent pattern of memory
loss. Which of the following housing options would be most appropriate for this woman?
a. Independent living
b. Retirement community
c. Assisted living
d. Nursing facility
ANS: B
Retirement community living is suited for a person who is oriented to person, place, and time
and has a memory that is intact, but has occasional forgetfulness without a consistent pattern of
memory loss. Independent living may be appropriate for the person if she had a consistent
pattern of memory loss. Assisted living or nursing facility living may be appropriate if the
woman has difficulty with orientation to person, place, or time or has difficulty with confusion
that results in anxiety, social withdrawal, or depression.
REF: p. 612 (Table 24-4)
MULTIPLE RESPONSE
1. Which of the following interventions will have the greatest impact on reducing constipation in
older adults? (select all that apply)

a. Offering pureed foods that are easy to digest
b. Encouraging fluids between meals
c. Administering laxatives on a daily basis
d. Assisting with ambulation
ANS: B, D
Nurses can help reduce the incidence of constipation by encouraging older adults to exercise and
increase their fluid and dietary intake. Dietary modifications, such as increasing fiber and fluid
intake, can stimulate the colon and resolve constipation. Pureed foods do not contain adequate
fiber. Increased fluid intake and exercise should be implemented before relying on medication to
relieve constipation.
REF: p. 597
2. A nurse has accepted a position as director of health services in a retirement community. Which
of the following statements about retirees is important for the nurse to consider as she plans
programs? (select all that apply)
a. Depressed and inactive.
b. Left their job to spend more time with family.
c. Left their job because of ill health.
d. Happy and well-adjusted to retirement.
ANS: B, D
Research has demonstrated that the majority of retirees are in good health and happy with their
decision to leave work so as to spend more time with their families.
REF: pp. 604-605
3. The nurse working in a retirement community for older adults is conducting a psychosocial
assessment of all residents. Which of the following questions should the nurse ask during the
assessment process? (select all that apply)
a. Have you thought about harming yourself?
b. Are you still playing bridge every Thursday?
c. How does your congestive heart failure affect your life?
d. Has your financial situation changed since last year?
ANS: A, B, C
Suicide ideation, loss of interest in activities, and chronic illness are signs of, or may lead to,
depression. Economic difficulty is not a predictor of suicide in older adults.
REF: p. 607
4. Which of the following nursing interventions implies respect for a persons spirituality? (select
all that apply)

a. Changing the position of the bed in a Muslim clients room so that it faces east
b. Contacting the chaplain to assess the clients spiritual needs
c. Saying a silent prayer with a client at the clients request
d. Praying out loud in the room of a dying client
ANS: A, C
Because of the highly personal quality of spirituality, an unobtrusive and sensitive presence by
the nurse is needed to allow the person in any setting to achieve spiritual health. The nurse can
provide an environment that is supportive to the practice of the persons spirituality. Praying out
loud does not demonstrate respect for a persons spirituality but imposes the nurses belief
system on the person. Nurses should be able to assess the persons spirituality initially and
determine if it is necessary to further consult the chaplain.
REF: p. 607
5. A nurse is conducting a community health education program about osteoporosis with a group of
older adults. Which of the following individuals in attendance is at greatest risk for developing
osteoporosis? (select all that apply)
a. 65-year-old Asian woman who smokes one pack of cigarettes per week
b. 80-year-old White man who has three glasses of wine per day
c. 74-year-old White woman on daily oral prednisone for emphysema
d. 68-year-old Black man who has a sedentary lifestyle
ANS: A, B, C
Osteoporosis is a disease of bone loss common to women age 70 and older and men age 80 and
older. The disease occurs six times more frequently in women than it does in men. Risk factors
include a small, thin frame; White or Asian ancestry; family history; excessive thyroid
medication or high doses of cortisone-like drugs for asthma, arthritis, or cancer; a diet low in
dairy products and other sources of calcium; physical inactivity; smoking cigarettes; and
drinking alcohol.
REF: pp. 607-608
6. An 80-year-old person is admitted to the hospital. During the health assessment process, which
of the following conditions should the person be screened for by the nurse? (select all that apply)
a. Polypharmacy
b. Kidney failure
c. Illegal drug use
d. Alcoholism
ANS: A, B, C, D
Alcoholism and illegal drug use are often overlooked by health care professionals because of a
persons age. Many older adults take multiple over-the-counter and prescription medications and
are at risk for drug interactions.
DIF:
Cognitive Level: Ap
Chapter 23: Middle-Age Adult

MULTIPLE CHOICE
1. A 35-year-old person asks the nurse working in a dermatology clinic what causes skin to wrinkle.
Which of the following statements would be most appropriate way for the nurse to reply?
a. There is really nothing you can do to prevent a lot of wrinkles. It is part of aging.
b. As we age, we lose fat beneath the skin so wrinkles appear. There is nothing we
can do to prevent it.
c. Wrinkles appear for a number of reasons, including loss of fat beneath your skin
and too much sun exposure.
d. Wrinkles are caused by genetic factors.
ANS: C
Loss of subcutaneous fat and collagen damage related to sun exposure cause wrinkles.
REF: p. 563
2. A 45-year-old client who has experienced a ten pound weight gain during the past year asks the
nurse if she thinks iron supplements would help increase her energy. Which of the following
would be the most appropriate action for the nurse to take?
a. Ask the client to describe her daily activity and diet
b. Leave a note requesting an iron supplement on the clients chart for the doctor
c. Provide the client with information related to aerobic exercise classes
d. Ask the client if she is still menstruating
ANS: A
A lack of routine exercise and activity plus a diet high in calories contributes to weight gain and
a lack of energy. The priority action by the nurse is assessment, which will reveal the reason for a
lack of energy.
REF: p. 563
3. Which of the following is a normal physiological change that occurs during middle age?
a. Increase in gastric emptying resulting in acid reflux
b. Reduction in height caused by kyphosis
c. Reduction of glomerular filtration by 50%
d. Increase in the amount of estrogen produced in both genders
ANS: C
Gastric emptying is decreased, kyphosis is not an expected part of aging, and estrogen levels
decrease in women and increase in men as male testosterone levels decrease.
REF: p. 564
4. A nurse is conducting a community education program. Which of the following should be
stressed as the leading cause of death in middle-age adults?

a. Automobile accidents
b. Malignant disease
c. Homicide
d. Suicide
ANS: B
The leading causes of death during middle adulthood are heart disease, cancer, and accidents.
Accidents are the major cause of death for children and young adults. Homicide and suicide are
major causes of death for young adults.
REF: p. 564 | p. 564 (Box 23-1)
5. A nurse formed a political action committee to advocate for health insurance for the uninsured.
On which of the following populations would the nurse focus the groups efforts?
a. Asian Americans
b. Blacks
c. Hispanic Americans
d. Working-poor White Americans
ANS: C
Hispanic Americans are the largest minority group in the United States and have the highest
uninsured rate.
REF: p. 567
6. A nurse has been asked to develop a visit plan for a mobile mammogram van. Which of the
following considerations would be made by the nurse when deciding which neighborhoods to
visit?
a. Hispanic women have the highest rate of breast cancer of all minority groups in the
United States.
b. The death rate from breast cancer is higher in Hispanic women than for women in
other ethnic groups.
c. The death rate from breast cancer in Hispanic women has risen in the past 10
years.
d. Breast cancer in Hispanic women is usually diagnosed at an early stage.
ANS: B
Even though Hispanic women have a breast cancer rate approximately 40% lower than nonHispanic White women, their death rate is higher and the cancer is diagnosed at a later stage.
REF: p. 567
7. A nurse has received a grant to provide a community-based education series for middle-age
adults. Which of the following topics would allow the nurse to have the greatest impact on the
health of members of this age group?
a. Diet and exercise
b. Seat belt use
c. Depression screening
d. Cancer prevention
ANS: A
Obesity is a major risk factor for heart disease, metabolic syndrome, and Type 2 diabetes
mellitus. An educational series devoted to discussing diet and exercise will have the greatest
impact on health.
REF: pp. 568-569
8. The nurse collects the following assessment data from a woman: Hispanic ethnicity, BMI 29
kg/m2, age 41. Which of the following actions should be taken by the nurse?
a. Encourage the client to continue her dietary and exercise patterns.
b. Discuss her current dietary and exercise lifestyle habits.
c. Counsel the client that she will face chronic health problems because of her
weight.
d. Encourage the client to adopt a low-calorie diet to help control her weight.
ANS: B
Obesity is defined as a BMI of 30 kg/m2. The client is at risk for obesity. Further data should be
gathered related to her dietary and exercise patterns so as to plan appropriate interventions.
Adoption of a low-calorie diet may not be an appropriate intervention depending on what
additional data collection reveals. Also, dietary changes should be accompanied by regular
aerobic exercise.
REF: p. 568
9. A nurse working in a rural location is interested in starting a weight management group for
clients in the area. Which of the following interventions is most likely to ensure success?
a. Using a pre-set list of topics for discussion
b. Relying on printed material to relay information to the group
c. Asking for a list of topics that interest the group
d. Beginning each session with a 2-mile walk
ANS: C
When participants plan the topics of discussion, interest is maintained. A pre-set list of topics
may not meet the learning needs of this particular group. A 2-mile walk may not be realistic for
participants.
REF: p. 568
10. A 52-year-old postmenopausal woman tells the nurse that she is afraid she will develop
osteoporosis like her mother did. Which of the following statements is the most appropriate
response by the nurse?
a. The American diet is much better now than when your mother was your age, so
you have enough calcium in your diet to keep your bones strong.
b. You have a strong genetic risk factor. There is not much we can do to stop the
process.
c. You need about 1000 mg of calcium a day to keep your bones strong. Lets talk
about your diet.
d. Tell me about your diet, how much walking you do each day, and what
medications you take.
ANS: D
The postmenopausal woman needs 1500 mg of calcium a day if she is not taking estrogen.
Dietary calcium and vitamin D intake, and walking, can help prevent osteoporosis.
REF: p. 569
11. Which of the following statements about alcohol intake is correct?

a. Women have a higher death rate related to alcoholism than men.
b. A woman who drinks two glasses of wine per day with her evening meal is
considered a moderate drinker.

c. More women than men are considered problem drinkers.
d. Women who experience fewer cognitive effects from drinking are less likely to
drink heavily than do women who get a buzz from drinking.

ANS: A
The death rate for female alcoholics is 50% to 100% higher than for male alcoholics. More men
than women are considered problem drinkers. Moderate drinking for women is defined as one
alcohol-containing drink a day. Women who are able to hold their liquor are more likely to
drink excessively than those who cannot hold their liquor.
REF: pp. 569-570
12. The occupational health nurse is planning a health fair for employees. Which of the following
information about dental health should be included?

a. Drinking bottled water helps prevent tooth decay.
b. Gingivitis results in bone destruction and can be eliminated by flossing daily.
c. Preventive dental care requires a visit to the dentist every 4 months.
d. In addition to screening for tooth decay, dentists screen for mouth cancer.
ANS: D
Dental health is essential to overall health. Dental professionals may be the first to detect a
symptom or irregularity that points to a potentially dangerous condition, such as cancer of the
mouth and esophageal cancer. Bottled water does not contain fluoride. Periodontitis is oral bone
destruction. An annual dental check-up is recommended for the average person, not a check-up
every 4 months.
REF: p. 570
13. Which of the following people has exceeded the recommended guidelines for activity?
a. A 36-year-old man who engages in bike riding and has a pulse rate of 137 during
activity
b. A 45-year-old woman who swims and has a pulse rate of 145 during activity
c. A 50-year-old man who jogs and has a pulse rate of 120 during activity
d. A 60-year-old woman who walks briskly and has a pulse rate of 125 during activity
ANS: D
During activity, the persons pulse rate should not exceed 220 minus the age times 0.75. Thus the
woman who is 60 years old would subtract (220 60 = 180); then multiply 180 by 0.75 to give
120 for the optimal heart rate for this client. A pulse rate of 125 exceeds the recommended
optimal rate of 120.
REF: p. 572
14. A 63-year-old woman complains to the nurse that she has insomnia and sleeps only 6 hours a
night. Which of the following responses should be made by the nurse?

a. Do you want a sleeping pill?
b. Make sure that you do not nap during the day even if you are tired.
c. Do you feel excessively tired during the day?
d. The nurse practitioner may want to run some simple tests to find out why you are
having trouble sleeping.
ANS: C
It is important to assess the quality of sleep as well as the effects that the limited sleep has on this
individuals daily activities. Medication should not be the first intervention used to help someone
attain restful sleep. People should nap when tired, if they are able to do so, rather than forcing
themselves to stay awake.
REF: p. 572
15. A nurse conducted a 5-week education series about health maintenance. Which of the following
statements by a participant indicates the analysis stage of cognition as defined by Blooms

taxonomy?
a. If I eat too much food and do not exercise, I will gain weight.
b. Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not
do moderate exercise at least 5 days a week, I will gain weight.
c. I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy
weight.
d. I can eat more if I exercise more.
ANS: B
During the analysis stage of cognition, all aspects of learning come together in thought and the
individual is cognizant of the relationships and interactions of all the parts. If I eat too much
food and do not exercise, I will gain weight indicates knowledge (recall of facts). I will walk
briskly at least a mile a day, 6 days a week, to maintain a healthy weight indicates application.
I can eat more if I exercise more indicates comprehension.
REF: p. 573
16. A 62-year-old person states to the nurse, I have trouble with my peripheral vision. Sometimes, I
do not notice objects unless they are in front of me. Which of the following disorders is the
client likely experiencing?
a. Presbyopia
b. Glaucoma
c. Cataracts
d. Diabetic retinopathy
ANS: B
Glaucoma occurs as a result of increased intraocular pressure, which can damage the optic nerve.
Damage to the optic nerve is irreversible, but visual loss can be prevented if damage is identified
early and treatment is initiated. Peripheral vision is affected in glaucoma. Presbyopia is
farsightedness. Cataracts cause cloudy vision.
REF: p. 573
17. Which of the following middle-age adults has successfully transitioned to Eriksons generativity-
versus-stagnation stage of development?

a. A 60-year-old woman who retired last year and volunteers at a homeless shelter 2
days a week
b. A 63-year-old man who regrets his career choice and feels he cannot change
careers
c. A 45-year-old woman who resents having to care for her aging mother-in-law
d. A 50-year-old man who has not saved for retirement but spends his discretionary
income on vacations he takes by himself
ANS: A
Generativity according to Eriksons theory involves a sense of productivity, creativity, and the
desire to help others, whereas stagnation involves a sense of isolation and focus on oneself.
REF: p. 574
18. A 52-year-old woman going through menopause tells the nurse working in the womens health
center that she is interested in slowing down the aging process and asks if she should take
estrogen. Which of the following statements would be the best response by the nurse?
a. The latest research has shown that estrogen is safe to take and will help keep you
healthy. Ill tell the nurse practitioner that you are interested in estrogen therapy.
b. Estrogen is safe to take for about 10 years. Ill get you some information on
estrogen therapy that you can take home and read.
c. The safety of long-term estrogen therapy is inconclusive. It is primarily used
short-term to relieve hot flashes.
d. You can get the same effects from natural products in a health food store, and
each product is backed up by research showing that it is effective.
ANS: C
Research about the safety of estrogen therapy is mixed, therefore it is only recommended for
short-term use (1 to 3 years) and only to relieve hot flashes. Natural products do not need
research to back up their claims of safety or efficacy.
REF: pp. 574-575
19. The occupational health nurse is asked to develop a plan to reduce work-related injuries. Which
of the following recommendations would the nurse stress as the most effective way to reduce
work-related injuries?
a. Make the work environment smoke-free.
b. Reduce environmental noise levels.
c. Conduct regular walk-through assessments at the worksite.
d. Increase paid personal days from one to three.
ANS: A
Accidents are twice as high among smokers than nonsmokers. Possible explanations include the
loss of attention, the use of one hand for smoking, and irritation of the eyes. Because smoking
has such an impact on accident rates, this would have the largest effect on reduction of workrelated injuries.
REF: p. 576
20. Which of the following effects of divorce on middle-age adults and children has been
documented by research?
a. Children adapt to divorce more rapidly than do adults.
b. Emotional healing after a divorce takes approximately 24 months in adults.
c. Children of divorced parents may have life-long difficulty forming relationships.
d. Children of divorced parents undergo similar emotional turmoil as their parents.
ANS: C
Although research is continuing, longitudinal studies by Wallerstein and her colleagues

beginning in the early 1970s indicate that children bear the emotional scars of a divorce for a
lifetime. The emotional response to divorce is different for children and parents, with most
parents adjusting to the divorce within 3 years after the event.
REF: p. 578
21. A nurse is discussing sexuality with middle-age men and women. Which of the following
information should be stressed by the nurse?

a. Contraception usage should be decreased as a woman nears menopause.
b. Difficulty with sexual performance among men happens near age 60.
c. HIV infection after age 50 is rare.
d. The majority of new HIV/AIDS cases occur among middle-age adults.
ANS: D
Adults in middle age represent 71% of all new cases of HIV/AIDS. Unintended pregnancy
occurs most often in middle-age women. Male sexual performance issues begin between the ages
of 40 to 50. HIV infection is not rare among middle-age adults.
REF: p. 579
22. An occupational health nurse is planning injury-prevention educational sessions. Which of the
following considerations should be made by the nurse?

a. Education should be focused on workers with the least experience.
b. All workers need continued education related to safety issues.
c. OSHA rules apply to all companies with more than 25 employees.
d. Middle-age workers have the lowest rate of injury of any age group.
ANS: B
The role of the occupational health nurse is focused on keeping the worksite safe for employees.
Experienced workers may not know how to prevent injury. OSHA applies to all companies.
There are no data to support that middle-age workers have the lowest rate of injury. Physical and
cognitive changes, which are part of middle age, may predispose workers to injury (i.e., decline
in vision/hearing).
REF: p. 584
23. Taking into account all of the agents that affect middle-age adults, the nurse plans a health
education workshop focused on developing an individualized lifestyle change program for each
participant. Which of the following actions should the nurse stress that individuals take first?
a. Limiting unprotected exposure to sun
b. Starting a smoking cessation program
c. Exercising at least three times a week
d. Scheduling a complete physical and dental exam
ANS: D
Although limited unprotected exposure to the sun, starting a smoking cessation program, and
regular exercise are important to overall health, assessment data must first be collected to create
an effective lifestyle change program. Health care needs and issues vary according to race and
ethnicity, socioeconomic status, marital status, and so on. Approaches to health care/education
must be individualized.
REF: pp. 585-586
24. Which of the following medications is generally recommended to help preserve cardiovascular
health in middle-age women?

a. Aspirin
b. Folic acid
c. Estrogen
d. Estrogen receptor modulator
ANS: A
Only aspirin is recommended to help maintain cardiovascular health by lowering the risk of clot
formation.
REF: p. 577 (Box 23-7)
MULTIPLE RESPONSE
1. Which of the following individuals is at risk for developing osteoporosis? (select all that apply)
a. A 55-year-old man who is on a low dose of oral prednisone every day because of
rheumatoid arthritis
b. A 40-year-old woman who works as a secretary
c. A 60-year-old woman who walks three miles a day
d. A 50-year-old man who works as a mason
ANS: A, B
Osteoporosis occurs most frequently in postmenopausal women who have fair complexions and
are small, sedentary individuals, and people on long-term steroid use. It increases with age.
REF: p. 563
2. Blacks are more likely than non-Hispanic White Americans to be diagnosed with cancer at a later
stage and have a less optimal outcome after the diagnosis is made. Which of the following
reasons help explain this difference? (select all that apply)
a. Lack of access to, or utilization of, cancer screening
b. Lack of health insurance
c. Genetic variations
d. Lack of resiliency against disease
ANS: A, B, C
Although poverty and lack of access may account for lack of screening and early diagnosis,
genetic variations in tumor growth and response to medication along with other major health
problems also affect outcomes.
REF: p. 566
3. A community health nurse is caring for a variety of different people in the community. Which of
the following individuals would the nurse recognize as being at risk to experience increased
stress related to family dynamics? (select all that apply)
a. A 54-year-old couple whose young adult daughter and grandson move back into
their home
b. A 44-year-old single mother raising three adolescent children without child support
c. A 60-year-old couple whose children have established successful careers in another
state
d. A 36-year-old couple whose child plays competitive tennis
ANS: A, B, D
Stressors of middle age include adult children moving back home, heading a single parent
household, and parents whose child plays competitive sports with an emphasis on winning. The
couple who has children living out of state who have established successful careers are at the
least risk to have stress related to family dynamics.
REF: pp. 575-576
4. The occupational health nurse working for a large corporation is a member of a task force to
improve the work environment. Which of the following suggestions by the nurse would help to
improve work conditions? (select all that apply)
a. On-site walking paths
b. On-site food vendors
c. On-site counseling services
d. On-site meetings of support groups such as Alcoholics Anonymous
ANS: A, C, D
On-site facilities that improve health (walking paths) and psychological well-being (support
groups, counseling) will help to create a positive work environment. Depending on the food
vendor who is on-site, the healthy food options may not be beneficial to the employees.
DIF:
Cognitive Level: Apply (Application)
Chapter 22: Young Adult

MULTIPLE CHOICE
1. A nurse is planning a community health education program for young adults. Which of the
following considerations should be made by the nurse?

a. The age span encompassing young adulthood is between 20 to 30 years of age.
b. The number one cause of death for young adults is injury.
c. The number of young adults in the United States is increasing.
d. The maternal mortality rate is at its lowest point since 1980.
ANS: B
Young adulthood spans the years between ages 18 to 35. The number of young adults in the
United States is declining, and the maternal mortality rate is at its highest level since 1980.
REF: p. 536
2. A nurse is completing a health counseling session with a 25-year-old woman. Which of the
following statements should be made by the nurse during this session?

a. A yearly Pap test is recommended for detection of ovarian cancer.
b. Research supports that breast self-exams reduce breast cancer mortality.
c. The incidence of cervical cancer is very low in your age group.
d. Daily physical activity and weight control is one way to stay healthy.
ANS: D
Screening is strongly recommended for cervical cancer in women who have been sexually active
(Papanicolaou [Pap] smears). The incidence of carcinoma in situ is high in young adults. The US
Preventative Services Task Force recommends against teaching breast self-examination and
concludes that the current evidence is insufficient to assess the additional benefits and harm of
clinical breast examination beyond screening mammography for women 40 and older. After age
25, the preventive emphasis is on modifying coronary disease risk factors, which would be
accomplished by discussing activity and weight control.
REF: pp. 538-539
3. A 26-year-old client has a total cholesterol of 206 mg/dL and an LDL of 110. Which of the
following conclusions can be drawn by the nurse?

a. The client has achieved the target levels for cholesterol in young adults.
b. The client has a very low risk of developing heart disease.
c. The client requires counseling about cardiac disease risk factors.
d. The client has early-onset cardiac disease.
ANS: C
Cardiovascular assessment of the young adult includes determining the presences of

hyperlipemia, hypertension, diabetes, chest pain, or heart disease. This client has an elevated
cholesterol levels and requires additional education about risk factors that may lead to cardiac
disease. The Healthy People 2020 target is to reduce the mean total blood cholesterol levels
among adults to 177.9 mg/dL. A diagnosis of heart disease cannot be made on the basis of these
lab values.
REF: pp. 538-539
4. The public health nurse is conducting a screening of young adults for metabolic syndrome. When
asked about the syndrome, which of the following responses should be made by the nurse?
a. Anyone who has low blood sugar, high cholesterol, and high blood pressure has
this syndrome and is at risk for cardiac disease.
b. This syndrome helps predict heart disease. Once it is diagnosed, the correct
medication can be prescribed and heart disease avoided.
c. This syndrome is a warning sign that the person could develop heart disease.
When someone has metabolic syndrome, dietary and activity level changes are
recommended.
d. Anyone who has high cholesterol, high blood pressure, and high blood sugar has
coronary artery disease. Once we make the diagnosis, we can begin to treat the
disease.
ANS: C
Metabolic syndrome is diagnosed when a person has high cholesterol, high blood pressure, and
high blood sugar. A person with this syndrome is at risk for coronary artery disease. Lifestyle
changes are tried before medication is used.
REF: p. 541
5. The university health services nurse is preparing a disease prevention program for college
students. Which of the following information should the nurse include in the program?
a. Living in the dorm increases ones risk of developing meningococcal disease.
b. The mortality rate from meningococcal disease is very low.
c. There are no antiviral medications that can treat meningococcal outbreaks.
d. A vaccine for meningococcal disease has not been developed.
ANS: A
Although most outbreaks of meningococcal disease are sporadic, young adults living in
dormitories or crowded conditions may be more susceptible than young adults not living in close
settings. Meningococcal disease has a high mortality rate. It is caused by a bacterium, not a virus,
and antibiotics to treat the disease are readily available. A preventive vaccine is available.
REF: p. 543
6. A 30-year-old woman with a BMI of 36 is counseled by the nurse regarding interventions to
assist with weight reduction. In which order would the nurse discuss the implementation of these
interventions?
1. Gastric stapling
2. Medication to reduce appetite
3. Nutrition and exercise education
4. Assessment of lipid profile and blood pressure
a. 4, 3, 2, 1
b. 4, 2, 3, 1
c. 3, 4, 2, 1
d. 3, 2, 1, 4
ANS: A
Assessment data must be complete before intervention. Diet and exercise are used first, and then
pharmaceutical agents to reduce appetite. Bariatric surgery is used when all other options have
failed.
REF: p. 544
7. A nurse is discussing optimal activity for young adults. Which of the following information
should be stressed?
a. Forty-five minutes of moderate exercise per day are required to maximize health
benefits.
b. An increase in heart rate from 70 to 200 beats/min during exercise is optimal.
c. Moderately brisk walking is an appropriate aerobic exercise.
d. Sixty minutes of exercise three times a week is recommended.
ANS: C
The Healthy People 2020 goal is to increase the proportion of adults who engage in moderate
physical activity for 150 minutes a week (30 minutes five times per week) to 47.9% from 43.5%.
Aerobic conditioning achieves cardiovascular fitness through five periods of moderately intense
exercise weekly for about 30 minutes or more at a heart rate of approximately 220 minus the age
of the person multiplied by 65% to 85%. Young adults are encouraged to engage in fitness
activities that increase the heart rate to approximately 150 beats or more per minute. Moderately
brisk walking that increases the heart rate is an appropriate aerobic exercise.
REF: p. 545
8. The nurse working in the college health center is asked about a safe way to obtain a tan. Which
of the following would be the best response by the nurse?

a. There is no safe way. Be sure to stay out of the sun as much as possible.
b. Tanning beds are much safer than exposure to actual sunlight.
c. Be sure to use sunblock agents and do not sunbathe between 10 AM and 2 PM.
d. Once you apply sunblock, you are protected all day, so be sure to use it before any
outdoor activity.
ANS: C
Young adults should avoid sunbathing during the 2-hour period before and after noon because
two-thirds of the days ultraviolet light comes through the earths atmosphere during this time.
There is no need to stay completely out of the sun. Tanning beds are not a safe way to tan.
Sunblock should be reapplied if certain outdoor activities are part of the day, such as swimming.
REF: p. 545
9. A nurse is working in the community to prevent bicycle and motorcycle fatalities. Which of the
following measures would be most effective for the nurse to promote?

a. Use of helmets
b. Increasing the minimum age for motorcycle licensure
c. Construction of bike paths along busy roads
d. Right-of-way laws for bicyclists
ANS: A
Head injury is the major cause of death related to bicycle or motorcycle accidents. Bicycle
helmets are believed to be the single most effective preventive measure available to decrease the
incidence of brain and head injury.
REF: p. 545
10. Which of the following reflects Piagets theory as applied to young adults?
a. Voting for a candidate based on popularity
b. Voting for a candidate based on media advertisements
c. Voting for a candidate based on support of the candidate by peers
d. Voting for a candidate based on analysis of views about various issues
ANS: D
Young adults are in Piagets formal operational thinking stage during which they analyze issues
objectively and insightfully.
REF: p. 546
11. Which of the following adults has transitioned to Eriksons intimacy versus isolation and
loneliness stage of development?

a. A 21-year-old man who has a part-time job, spends most of his leisure time with
his buddies, and has numerous short-term intimate relationships
b. A 25-year-old woman who is very concerned with how she is perceived by her
coworkers and friends
c. A 30-year-old man who just graduated with a PhD and is looking for his first fulltime job
d. A 26-year-old woman who has a long-term relationship with a female companion
ANS: D
Eriksons intimacy versus isolation and loneliness stage of development involves reciprocal
expressions of affection and trust. Promiscuous behavior is not characteristic of this stage of
development. Reliance on a positive perception by friends and coworkers for self-esteem is not
characteristic of this stage of development.
REF: p. 546
12. Which of the following young adults exemplifies Kohlbergs postconventional level of moral
reasoning?
a. 28-year-old person who calls in sick so as to help a friend move to a new location
b. 22-year-old man who uses marijuana on the weekends with friends
c. 30-year-old woman who volunteers at a soup kitchen one day a month
d. 35-year-old who works long hours so as to be considered for a promotion
ANS: C
Someone in Kohlbergs postconventional level of moral reasoning is able to do what is beneficial

or right regardless of peer pressure to take another course of action.
REF: p. 546
13. Which of the following statements should be considered by a nurse working in occupational
health who organizes a stress reduction workshop?

a. Women generally experience less workplace stress than do men.
b. Ones first job is exciting and leads to numerous opportunities, and therefore
causes little stress.
c. Young adults adapt easily to changing job demands such as telecommuting and
long work hours.
d. Work is of primary importance to young adults and helps form their self-image.
ANS: D
Employment is more than a source of income to young adults; it provides self-esteem and social
interaction. Women experience as much, and sometimes more, stress than do men because of
child care issues. The demands of work are stressful and sometimes lead to unhealthy behavior.
REF: p. 547
14. The parents of a young adult female have recently divorced. Which of the following is the young
adult most likely to experience?

a. Relief
b. Depression
c. Unemployment
d. Inability to sustain own relationships
ANS: B
Although dissatisfaction and unhappiness are frequent precursors to separation and divorce, the
decision to dissolve a marriage is not easy. Divorced young adults frequently suffer severe
emotional strain and depression. Some young adults are unable to adjust to role and status
changes and to threats of self-concept. Young adults whose parents divorce have an increased
rate of divorce, but that does not mean that they are unable to sustain their own relationships.
REF: p. 548
15. A 19-year-old college student is seen by the health services nurse. The young woman is
distraught that she had unprotected sex 4 days ago and is afraid she may have become pregnant.
Which of the following statements should be made by the nurse?
a. Lets talk about your options because you must be 21 years of age to purchase
emergency contraception.
b. Dont worry; you can purchase Plan B, an emergency contraception drug, without
a prescription and it will terminate the pregnancy.
c. I know you are upset, but we are in one of the 40 states that allow drugstores to
carry Plan B, an emergency contraception drug. Lets talk about how to use the
medication.
d. You have several options. Lets discuss what would be the best thing for you to do
next.
ANS: D
Emergency contraception can reduce the number of unintended pregnancies. There is a generic
two-dose form Next Choice, and a one-dose form, Plan B One-Step. Both require a prescription
for girls under 17. Emergency contraception must be used within three days of unprotected sex.
It works by either altering tubal transport of either sperm or ova, inhibiting implantation. It will
not terminate an existing pregnancy and does not provide protection against sexually transmitted
diseases.
REF: pp. 550-551
16. The nurse working in the college health center is planning a program about sexually transmitted
diseases (STDs). Which of the following information should the nurse include in the program?
a. STDs are the third most common infection in young adults.
b. STDs can be transmitted by any intimate contact, not just sexual intercourse.
c. STDs usually occur as a single infection.
d. STDs are the most common reason for a visit to the health center.
ANS: B
STDs can be transmitted from oral and anal sex, not just vaginal intercourse, and many young
adults do not understand this. STDs are the most common infection in persons age 15 to 24. A
person may have multiple STDs. STDs are generally unreported and not treated.
REF: pp. 551-552
17. A 32-year-old woman visits the occupational health nurse because of malaise. Which of the
following assessment data indicates that the client may be experiencing achievement-oriented
stress?
a. Sleeping 10 hours per day
b. Unintentional loss of 10 pounds in the past 3 weeks
c. Expressed fear of company layoffs
d. Calling in sick once every 2 weeks for the past month
ANS: B
Achievement-oriented stress is characterized by lack of sleep, skipping meals, and workaholic

habits. It differs from situational stress, which would be caused by changes in job function for
example.
REF: p. 553
18. A nurse volunteered to work at a natural disaster site. Which of the following questions should
the nurse ask to determine if the 26-year-old individual being screened is depressed or has
suicide ideation?
a. Tell me about your pets.
b. What do you do for work? How has your work been affected by this disaster?
c. Have you thought of harming yourself?
d. Have you seen your friends since the disaster?
ANS: C
Direct questioning about the intent to harm oneself is appropriate for the nurse to ask during
screening/counseling sessions.
REF: pp. 553-554
19. A nurse is planning health care for young adults. Which of the following factors about the
interventions should be recognized by the nurse as having the greatest impact on whether they
are effective?
a. Culturally sensitive
b. Match the persons health care beliefs
c. Cost effective
d. Gender neutral
ANS: A
Unless the interventions are culturally sensitive, they are not likely to be successful. Although the
other factors are important, the priority consideration is cultural sensitivity.
REF: pp. 554-555
20. Which of the following circumstances accounts for one of the leading cause of death in young
adults?
a. Tobacco use
b. Binge drinking and driving
c. Illegal drug use
d. HIV infection
ANS: B
Alcohol-related accidents among individuals ages 15 to 24 continue to be a leading cause of

preventable morbidity, disability, and death.
REF: p. 556
21. A nurse is counseling a 23-year-old woman about oral, transdermal, injectable, vaginal ring, and
implant contraceptive methods. Which of the following risks of using these methods should be
stressed by the nurse?
a. Toxic shock syndrome
b. Nausea
c. Blood clots
d. Ectopic pregnancy
ANS: C
Blood clots are a potential risk with using all of these contraceptive methods. Ectopic pregnancy
is a possible complication of IUDs. Nausea may occur with the use of Plan B, and toxic shock
syndrome may occur with use of a diaphragm.
REF: p. 551 (Table 22-2)
22. Which of the following interventions are appropriate relative to the nursing diagnosis: Health-
Seeking Behaviors Related to Preconceptual Assessment and Preparation for Childbearing?

a. Encouraging the consumption of a moderate-fat diet to prepare for pregnancy
b. Referral to genetic counseling based on family history
c. Counseling to avoid hard liquor
d. Substituting a nutritional supplement for a meal so as to assure adequate vitamin
intake
ANS: B
Assessment of biophysical risk factor is an important intervention, which includes review of

genetic disorders, nutrition problems, and current medical problems. Before and during
pregnancy, the diet should be well-balanced, low in fat and sodium, and high in calcium and iron.
Nutritional supplements are not required unless the woman is malnourished. Alcohol in all forms
including beer and wine should be avoided.
MULTIPLE RESPONSE
REF: p. 559 (Care Plan)
1. An occupational health nurse is conducting a blood pressure screening. Which of the following
clients is at greatest risk of mortality from cardiac disease? (select all that apply)
a. Black man with a blood pressure of 130/80
b. Mexican American man with a blood pressure of 110/60
c. White woman with a bold pressure of 120/80
d. Black woman with a blood pressure of 128/78
ANS: A, D
According to the JNC VII, the risk for cardiovascular events rises when blood pressure is greater
than 115/75. Blacks have a higher death rate from heart disease than do Whites. Mexican
Americans have the lowest rate of hypertension.
REF: pp. 538-539
2. A public health nurse is interested in writing a grant to improve vaccination rates of young
adults. His focus should be on trying to obtain funding to support which of the following
vaccination initiatives? (select all that apply)
a. Rubella prevention
b. Lyme disease prevention
c. Hepatitis B prevention
d. Human papilloma virus (HPV) prevention
ANS: C, D
Rubella in young adults is generally a minor disease; the population at risk is women of
childbearing age. There is not a vaccine available for Lyme disease. Hepatitis B and HPV can
both be prevented through immunization and young adults are at high risk for contracting these
diseases.
REF: p. 543
3. A nurse is conducting a community health education program for Hispanic women ages 18 to 35.
Which of the following items should the nurse recommend that they increase in their diet on a
daily basis? (select all that apply)
a. Calcium
b. Folic acid
c. Iron
d. Sodium
ANS: A, B, C
Women of childbearing age frequently consume a diet deficient in calcium, iron, and folic acid.
REF: p. 544
4. A community health nurse has received a grant to present a program about violence prevention.
Which of the following individuals has a higher than average risk of homicide? (select all that
apply)
a. 33-year-old woman who served 5 years in prison
b. 20-year-old homeless man
c. 28-year-old man with a history of bipolar disorder
d. 24-year-old woman who has a female partner

ANS: A, B, C
Homicide is closely associated with alcohol and drug abuse and frequently is related to other
violent acts, such as robbery. Other risk factors for homicide include a history of loss of
employment, detention or prison experience, access to firearms, abuse in the home, mental
illness, social isolation, and homelessness.
REF: p. 549
5. A nurse is working in a domestic violence shelter. Which of the following individuals would the
nurse expect to encounter? (select all that apply)

a. 34-year-old White woman who is vice president of a communications company
b. 26-year-old Black woman who has a live-in boyfriend
c. 29-year-old Hispanic man who has been married for 2 years
d. 21-year-old unemployed White woman who has been with her boyfriend for 3
years
ANS: A, B, C, D
Abusive behavior victims come from all racial, ethnic, and socioeconomic levels.
REF: p. 549
6. A nurse is planning community health programming for young adults. Based on the objectives
for Healthy People 2020, which of the following topics would be priority areas for
programming? (select all that apply)
a. Prenatal care
b. Physical activity
c. HIV
d. Suicide
ANS: A, B
Healthy People 2020 objectives targeted for the young adult include increasing the proportion of
adults who engage in regular aerobic activity of moderate intensity and increasing the proportion
of women who receive early and adequate prenatal care. HIV and suicide rates are not mentioned
in the target areas for young adults.
DIF: Cognitive Level: AFChapter 21: Adolescent

MULTIPLE CHOICE
1. When do females usually begin puberty?
a. 1 year before males
b. 1 year after males
c. 2 years before males
d. 2 years after males
ANS: C
Females usually begin puberty 2 years before males and experience their growth spurts earlier.
DIF: Cognitive Level: Remember (Knowledge)
REF: p. 515
2. A teenager has been using acne medications for the last 14 days. Her acne is no better, and in
fact, it is a little worse. What information should the nurse offer this girl?
a. Wash your face at least four times a day, making sure to scrub well.
b. The medications can make acne appear worse at first; try to give it a few more
weeks.
c. Avoid all chocolate products.
d. Because it is summertime, it would be good for your skin if you lie out in the sun
for a few hours each day.
ANS: B
Acne is common in adolescents. Evidence indicates that dietary restrictions for acne are
unnecessary. Although washing with soap and water is the best way to remove dirt, vigorous
scrubbing should be discouraged. Furthermore, although sunlight can have a beneficial effect on
acne, prolonged exposure should be avoided. Topical acne products make acne appear worse
initially, and improvement occurs slowly over several months. Nurses should provide this
information to teenagers planning to use acne products, so they are not discouraged early in
therapy.
REF: p. 517
3. The mother of a 13-year-old girl is concerned because her daughter has not started menstruating
yet. The girl developed breast buds and started her height spurt at 12 years of age. Which of the
following statements would be the most appropriate response from the nurse?
a. Usually, girls start menstruating when they develop breast buds; an endocrine
evaluation might be warranted.
b. Everyone is different; it will happen when it happens.
c. Based on when the breast buds first appeared, she should starting menstruating
around the age of 14.
d. She will not start menstruating until her breasts are of adult size and contour.
ANS: C
The first sign of puberty in females is the appearance of breast buds, followed by a growth spurt.
The onset of menstruation occurs approximately 2 years after the appearance of breast buds and
near the end of the growth spurt. Thus, based on the age of breast bud appearance, the girl should
start menstruating around age 14.
REF: p. 518
4. Which female disorder is characterized by only one X chromosome present instead of two?
a. Gynecomastia
b. Menstruation
c. Turner syndrome
d. Klinefelter syndrome
ANS: C
A female disorder in which only one X chromosome is present instead of two is known as Turner
syndrome.
REF: p. 518
5. Which of the following disorders is characterized by males having an extra chromosome,
typically being tall and initially thin, and not developing secondary sex characteristics?
a. Gynecomastia
b. Menstruation
c. Turner syndrome
d. Klinefelter syndrome
ANS: D
A disorder in which males have an extra chromosome and typically are tall and initially thin, and
do not develop secondary sex characteristics is known as Klinefelter syndrome.
REF: pp. 518-519
6. Parents recently discovered that their teenage daughter has been consuming alcohol on a regular
basis. They ask the nurse for advice on how to best help their daughter. Which of the following
recommendations should the nurse give to the parents?
a. Talk to their daughter at length regarding the dangers associated with drinking.
b. Tell their daughter she will not be allowed to use her cell phone if this continues.
c. Enroll their daughter in a peer support group focused on teenage drinking.
d. Provide their daughter with literature regarding the dangers of drinking.
ANS: C
Teens do not always consider health risks associated with their risky behaviors. Additionally,
peer influence is primary and parental input is often rejected. In this case, the teenager may risk
losing her cell phone and privileges by continuing with her risky behavior, but because peer
influence is primary, the parents should enroll her in a peer support group focused on teenage
drinking.
REF: p. 519
7. Which of the following behaviors is most reflective of a teenager?

a. Riding an ATV without a helmet
b. Not skiing for fear of falling and getting hurt
c. Obeying a new parental rule without a challenge
d. Walking away from a group of friends who are smoking cigarettes
ANS: A
Teenagers are known for their risk-taking behaviors. They do not always consider the health risks
associated with their behaviors. In addition, they often do things because their friends do it.
Therefore, riding an ATV without a helmet and risking a head injury is most reflective of a
teenagers behavior.
REF: p. 519
8. What percentage of adolescent females suffer from an eating disorder in the United States?
a. 5%
b. 10%
c. 15%
d. 20%
ANS: B
Ten percent of adolescent females suffer from an eating disorder in the United States.
REF: pp. 519-520
9. During a physical exam, a teenager asks the nurse if she can have a stronger medication for her
constipation because the laxatives she has been taking are not helping. During the physical exam,
the nurse observes mild to moderate erosion of the tooth enamel. Which of the following
disorders is the client most likely experiencing?
a. Bulimia nervosa
b. Binge eating disorder
c. Idiopathic constipation
d. Irritable bowel syndrome
ANS: A
Bulimia nervosa is characterized by binge eating and then purging by self-induced vomiting
and/or laxatives. Purging can also lead to erosion of the tooth enamel. Bulimia nervosa occurs
more commonly in females. A teenage girl asking for stronger laxatives with tooth enamel
erosion should cause any health care provider to consider the possibility of bulimia nervosa.
REF: p. 520
10. A teenager has a family history of Type 2 diabetes mellitus. He asks the nurse what he can do to
try to prevent developing it himself. Which of the following instructions should the nurse give
this client?
a. Tell him to avoid any and all sweets.
b. Tell him to be active and eat a balanced diet.
c. Tell him he should talk to his physician about genetic testing.
d. Tell him that very little can be done to avoid developing this disorder.
ANS: B
Obesity is making Type 2 diabetes mellitus common among teens and young adults. Being
overweight and inactive increases the risk. Therefore, encouraging activity and a balanced diet is
the best information the nurse can give to the client. Telling him to avoid all sweets would be an
impossible request, and genetic testing does not detect the development of this disorder.
REF: p. 521
11. Which of the following teenage behaviors is cause for concern?

a. Has difficulty waking up in the morning and naps during the day
b. Goes to bed late and naps during the day
c. Takes frequent naps and states it is because he is bored
d. Participates in after school activities and has difficulty waking up

ANS: C
Adolescents need at least 8 hours of sleep per night. Often, they stay up late and wake up for
school before their sleep cycles have finished; therefore, napping is common. However, those
with a decreased energy level who use words such as bored or sad should be further
evaluated for suspected depression. Therefore, a teenager who takes frequent naps and states it is
because he is bored is cause for concern because this behavior might indicate depression.
REF: p. 522 | p. 525
12. A mother is concerned because her daughter has been taking a nap every day after school. Which
of the following statements would be the best response by the nurse?

a. Dont worry; all teenagers do that.
b. Tell me about your daughters schedule.
c. Lets bring her in for some blood work.
d. Have you addressed the topic of drugs with you daughter?
ANS: B
Many teenagers take naps, although this does not address the mothers concern. Although the nap
can be a symptom of a health problem or drug use, additional information is necessary to make
that determination. Asking the mother to tell you about her daughters schedule provides
information to determine whether the behavior is normal or whether it requires further
investigation.
REF: p. 522
13. Which of the following teenagers is at risk for not meeting his developmental task?
a. Arrested for petty theft
b. Decided he wants to major in accounting
c. Has recently broke up with his girlfriend
d. Is a member of the varsity basketball team
ANS: A
The central task of adolescence according to Erikson is the establishment of identity, with the
primary risk being role confusion. As the adolescent searches for direction, he makes choices in
social, recreational, volunteer, academic, familial, and occupational activities. When the threat of
confusion is exceedingly great, delinquent behavior and alterations in mental health can occur.
Thus, a teenager arrested for petty theft is displaying delinquent behavior that may place him at
risk for not meeting his developmental task of identity.
REF: p. 522
14. Which of the following actions should parents take to help their teenager meet his developmental
task?
a. Set strict rules to prevent the teenager from getting into any trouble.
b. Maintain an ongoing dialogue about important issues and upcoming challenges.
c. Maintain a friendship with the teenager, so he views parents as peers.
d. Be very lenient with the teenager so that he can figure out who he is as a person.
ANS: B
Imposing strict limits and eliminating all rules are not helpful to teenagers. Families in which
parents maintain a willingness to listen, demonstrate an ongoing affection for and acceptance of
their adolescent, yet still maintain some consistent limits, experience more constructive, positive
outcomes during adolescence. Thus, maintaining an ongoing dialogue about important issues and
upcoming challenges demonstrates the parents willingness to listen and their concern.
REF: pp. 523-524
15. Which of the following teenagers is at increased risk for acquiring a sexually transmitted disease
and should be provided with anticipatory guidance?

a. Asks the nurse for information about condoms
b. Feels her friends and family do not care about her
c. Has multiple friends and feels good about herself
d. Talks to her boyfriend on the phone for hours
ANS: B
Adolescents often talk on the phone for hours, providing a safe way for them to interact with
members of the opposite sex. However, adolescence is a time when teenagers fantasize about
relationships and sex. Teenagers decide to become sexually active for a number of reasons,
including affection. This can put them at increased risk for sexually transmitted diseases;
therefore, anticipatory guidance regarding protection from sexually transmitted diseases needs to
be provided before the adolescent is in a situation that can place him or her at risk.
REF: p. 524
16. A mother is concerned because her 13-year-old daughter comes home happy one day and sad the
next. The girl also argues with her younger sister more than she did in the past, and does not like
participating in family activities anymore. Which of the following is the best initial response
from the nurse?
a. The changes during adolescence can be stressful as they struggle to come to terms
with who they are. What other types of behaviors has she been displaying?
b. Changes in affect can be a warning sign for suicide. Has she had any increase in
risk-taking behaviors or physical violence?
c. Is there any history of psychological disorders in your family?
d. Withdrawal can be a sign of substance abuse. Has she given you any indication
she might be using illicit drugs?
ANS: A
Although dramatic swings in affect can be a warning sign for suicide, and withdrawal can be a
sign of substance abuse, additional information is required before suggesting a diagnosis. Often,
mood swings and spending more time with peers and less time with the family is normal
adolescent behavior during this period of rapid change in physical, psychosocial, spiritual, moral,
and cognitive growth. Parents and teenagers should be aware of and prepared for these changes.
REF: pp. 525-526
17. Which of the following is the third leading cause of death in adolescents between 10 and 24
years of age?
a. Accidents
b. Suicide
c. Cancer
d. Sport injuries
ANS: B
The third leading cause of death in adolescents between 10 and 24 years of age is suicide.
REF: p. 526
18. After offering a teenager the HPV vaccine, the teenager responds by saying, I cant have the
vaccine because I have already been sexually active. Which of the following statements is the
best response by the nurse?
a. You can still benefit from the vaccine, but there is a chance it will not be as
effective.
b. The best way to protect yourself now is to make sure all your future sexual
partners have received the vaccine.
c. You are correct, the vaccine is only indicated for females who have never been
sexually active.
d. It depends on the number of partners you have had. If you have had less than five
partners, you are still eligible for the vaccine.
ANS: A
The HPV vaccine is recommended for 11- to 12-year-old girls and for 13- to 26-year olds who
have not yet received or completed the vaccine series. Ideally, females should receive the vaccine
before they are sexually active because girls who have not been infected with any of the four
HPV types covered by the vaccine will receive the full benefits of the vaccine. Females who are
sexually active may also benefit but to a lesser degree. It is not known if the vaccine is effective
in boys or men. Thus, the best response is, You can still benefit from the vaccine, but there is a
chance it will not be as effective.
REF: p. 530
19. A nurse is initiating a discussion about alcohol consumption during a physical exam with a
teenager. Which of the following questions would be most appropriate for the nurse to ask?
a. So, what do you and your friends do for fun and excitement?
b. Do you have access to alcohol?
c. Do any of your friends drink?
d. Do you want to talk about alcohol or drinking?
ANS: C
Anticipatory guidance during a physical exam is important. This includes asking about substance
use. Questions should not be vague because they may be misinterpreted. Direct questions are
useful when discussing sensitive topics. However, asking first about friends and the adolescents
feelings about them is a good lead-in approach to a discussion about substance use.
REF: p. 532
20. The school nurse is working on a campaign in the school to prevent adolescent pregnancies.
Which of the following interventions should the nurse implement?

a. Talk to teenagers about sex, including abstinence, contraception, and sexually
transmitted diseases.
b. Tell the teenagers they should abstain from sex until they are old enough to cope
with the potential consequences such as an unwanted pregnancy.
c. Encourage parents of all teenage girls to make sure their daughters start oral
contraceptives early.
d. Offer all teenagers free condoms when they come in for physical exams.
ANS: A
The emergence of secondary sexual characteristics increases adolescents awareness of

themselves as sexual human beings leading to experimentation. Primary prevention is necessary
to help prevent adolescent pregnancies. Parents, teachers, and health care providers will be more
successful in assisting teens to manage their health needs if they treat them as joint partners.
Talking to teenagers about sex, contraceptive options, and sexually transmitted diseases gives
them the information and anticipatory guidance they need to help them make a decision.
REF: p. 524 | p. 520 (Box 21-3)
21. A teenager asks the school nurse for advice before getting a tattoo. Which of the following
responses would be most appropriate for the nurse?

a. You should not get a tattoo.
b. It is okay to get a tattoo if you go to a licensed artist.
c. Tattoos are popular; however, they can lead to infection and/or bleeding.
d. A body piercing would be safer and less permanent.
ANS: C
Tattoos and piercings carry similar risks, which include localized infection, bleeding, and
dermatitis. In addition, tattoos carry a heightened concern for blood-borne disease such as
hepatitis and HIV. When providing anticipatory guidance, nurses should treat teenagers as
partners and give them the information they need to make an informed decision. Therefore,
informing the teenager about the risk of infection is the best response.
REF: p. 523 (Box 21-5)
22. A teenager is expecting her menstrual period on May 14. On which of the following dates would
the nurse recommend that she perform a self-breast exam?

a. May 11
b. May 14
c. May 17
d. May 23
ANS: D
The best day to perform a self-breast exam is 2 to 3 days after ones period when breasts are least
likely to be tender or swollen. A typical period lasts about 6 days. Thus, a teenager who starts her
period on May 14 should perform a breast self-exam on May 23 (14 + 6 = 20 + 3 = 23).
REF: p. 525 (Box 21-6)
23. Which of the following teenagers is exhibiting a behavior that cause for concern and requires
further evaluation?
a. Is always very happy
b. Is agitated and has trouble sleeping
c. Has a lot of homework and stays up late to finish it
d. Values his friends opinion more than his parents opinion
ANS: B
Nurses should be aware that the problem of substance abuse exists. They should also be aware of
what the signs and symptoms are. Agitation and insomnia are signs of substance abuse and
should therefore be evaluated further.
REF: p. 529 (Box 21-10)
24. Which stage of male genital development is characterized by initial enlargement of the penis,
mainly in length along with further growth of the testes and scrotum?
a. 1
b. 2
c. 3
d. 4
ANS: C
In stage 3, male genital development is characterized by initial enlargement of the penis, mainly
in length along with further growth of the testes and scrotum.
REF: p. 516 (Table 21-1)
25. Which stage of female breast development is characterized by enlargement of the areolar
diameter along with a small area of elevation around the papillae?

a. 1
b. 2
c. 3
d. 4
ANS: B
In stage 2, female breast development is characterized by enlargement of the areolar diameter

along with a small area of elevation around the papillae.
REF: p. 516 (Table 21-1)
26. A 14-year-old female is in for a physical exam. Which finding requires further investigation?
a. A height spurt since her last visit
b. Facial acne
c. The lack of breast buds
d. Noticeable sweating and body odor with activity
ANS: C
The onset of puberty usually begins around 11 to 13 years of age. Stage 2 is the usual time of
peak height velocity for girls. Additionally, both sweat and sebaceous glands become more active
during adolescence leading to sweat, body odor, and acne. Breast buds also usually appear during
stage 2 of puberty. Females who have not begun pubertal development by age 14 should have an
endocrine evaluation. Thus, the finding of lack of breast buds on this 14-year-old girl requires
further investigation.
REF: p. 516 (Table 21-1) | p. 518 (Figure 21-3)
MULTIPLE RESPONSE
1. Which of the following are symptoms or warning signs of anorexia nervosa? (select all that
apply)
a. Lack of menstruation in females
b. Preoccupation with food
c. Eating only small amounts of certain foods
d. Dramatic weight fluctuations
ANS: A, B, C, D
Symptoms or warning signs of anorexia nervosa include the relentless pursuit of thinness, selfstarving with significant weight loss, lack of menstruation in females, decreased sexual interests
in males, compulsive physical activity, preoccupation with food, portioning food carefully, eating
only small amounts of only certain foods, and a distorted body image. Dramatic weight
fluctuations are seen with bulimia nervosa.
REF: p. 520
2. A nurse is discussing being a safe driver as part of a drivers education course. Which of the
following recommendations would the nurse include in this presentation? (select all that apply)
a. Carpooling with friends
b. Avoiding talking on cell phones
c. Driving during daytime hours
d. Wearing safety belt
ANS: B, C, D
The risk of motor vehicle crashes is four times higher among 16- to 19-year-old adolescents than
among any other age group. Research suggests that distractions, such as talking or texting on cell
phones, eating, or playing with the radio, increase teen drivers risk of being involved in a crash.
Nurses should talk to teens about these distractions, which can also include riding with a car full
of other teens. Teens have a much higher nighttime crash fatality rate as well.
DIF:
Cognitive Level: Apply (Application)
Chapter 04: The Therapeutic Relationship

MULTIPLE CHOICE
1. Which of the following statements about values is true?
a. It is impossible for someone to understand his or her values.
b. Values evolve over time; they are not static.
c. Values assimilated in childhood are those held for a lifetime.
d. Values clarification tells a person how to act.
ANS: B
Values take time to develop, and they may change with education, experience, exposure, or a
combination of these.
REF: p. 83
2. A nurse is providing education about improving self-awareness to a small group of women who
have been victims of domestic violence. Which of the following should the nurse recommend the
clients do first to improve their self-awareness?
a. Use self-disclosure to share aspects of self.
b. Listen to and learn from others.
c. Listen to oneself and pay attention to emotions, thoughts, and reactions.
d. Use others to bounce back your own thoughts and recollections.
ANS: C
To achieve a high self-awareness, three steps must be taken. The first step is listening to oneself
and paying attention to emotions, thoughts, memories, reactions, and impulses. The second step
is listening to and learning from others. The third step is using self-disclosure to share aspects of
self.
REF: p. 84
3. The nurse shares with her client the news that she, the nurse, is going to be married soon and
tells the client about her wedding plans. Which of the following best describes the nurses
actions?
a. The nurse is sharing inappropriate personal information with her client.
b. The nurse is exhibiting a communication technique called self-disclosure.
c. The nurse is attempting to show empathy with her client.
d. The nurse is violating client confidentiality rights of the Health Insurance
Portability and Accountability Act (HIPAA).
ANS: B
Sharing aspects of the self enriches interpersonal life and is a use of the technique labeled selfdisclosure.
REF: pp. 84-85
4. A nurse has started admitting a new person on home care and is beginning to establish a
relationship. Which of the following would be the most important thing for the nurse to do?
a.
b.
c.
d.
Complete the paperwork in a timely fashion

Establish open communication
Conduct a complete physical health assessment
Provide feedback to the persons questions
ANS: B
Communication is the foundation for any professional relationship. It is the cornerstone of a

positive nurse-person relationship. It refers to a set of strategies and actions to enhance
reciprocity, mutual understanding, and decision making.
REF: p. 85 | p. 87
5. Which of the following best describes person-centered communication?

a. The nurse says to the person seeking care, Why do you continue to drink when
you know it is not good for you?

b. The nurse responds to person seeking cares request for pain medicine by saying,
It is not time for your pain medicine. You had it

hours ago.
c. The client says to the nurse, I think my husband is cheating on me. The nurse
responds by saying, You think your husband is cheating on you?
d. The client says to the nurse, I cant believe I have cancer. The nurse responds by
saying, One of my closest friends had cancer and had to have chemotherapy.
ANS: C
The nurse recognizes that the person seeking care has some concerns that she would like to
discuss and paraphrases her statement to give the person an opportunity to elaborate on thoughts
that are important to him or her.
REF: p. 87
6. A nurse is counseling someone who has recently been diagnosed with diabetes. The nurse says,
Tell me more about how this diagnosis has affected your daily activities. Which of the
following best describes the type of communication the nurse is using?
a. Verbal communication
b. Nonverbal communication
c. Metacommunication
d. Functional communication
ANS: A
Verbal communication is the transmission of messages using words, spoken or written.

Nonverbal communication encompasses all messages that are not spoken or written.
Metacommunication refers to a message about the message, the relationship aspect of
communication.
REF: p. 88
7. Which of the following statements about nonverbal communication is true?

a. Nonverbal behavior is not usually contextual.
b. Nonverbal behavior is culturally and situationally bound.
c. Nonverbal communication is the most important type of communication.

d. Nonverbal communication is easy to interpret.
ANS: B
Cultural exposure and situational impact are essential components of interpreting nonverbal
communication and must be taken into consideration in attempts to interpret nonverbal
communication.
REF: p. 89
8. Which of the following scenarios best describes a nurse using metacommunication?

a. Using both touch and silence when counseling an individual
b. Practicing reflection when interaction with an individual
c. Discussing with an individual how to solve a problem
d. Understanding that an individual needs a break before proceeding
ANS: D
Metacommunication refers to a message about the message. It is the relationship aspect of

communication. In a sense, it involves reading between the lines or going past the surface
content of the message to glean nuances of meaning.
REF: p. 89
9. Which of the following statements can be identified as a method for clarifying a message?
a. I get very upset when you talk to me in that tone.
b. You make me very angry when you drink alcohol.
c. I can make you happy. I know I can.
d. What I want from you is to be left alone!
ANS: A
Use of I statements is one technique that can be used for clarifying and qualifying messages.
REF: p. 90
10. A nurse and a man are involved in a conversation. When the person folds his arms across his
chest, the nurse almost simultaneously folds her arms across her chest. This behavior is
recognized as:
a. empathy.
b. reciprocity.
c. flexibility.
d. spacing.
ANS: B
The patterning of similar activities within the same interval by two people can facilitate
communication. This patterning is known as reciprocity.
REF: pp. 90-91
11. A nurse and her client are engaged in meaningful conversation when suddenly there is silence
between the two. To facilitate effective client-centered communication, the nurse should:
a. ask the person what he is thinking, so they can understand each other.
b. restate what the person said before silence ensued, to get clarification.
c. change the subject to one that is more pleasant for the person to discuss.
d. wait quietly to give the person time to reflect where he wants to lead the
conversation.
ANS: D
Silence allows the person to reflect on what is being discussed or experienced and lets him or her
know that the nurse is willing to wait until he or she is ready to say more.
REF: p. 91
12. A person has just been admitted to the hospital. In talking with the person, the nurse is able to
elicit from her that the reason for her hospitalization is that her husband beat her up. Which
characteristic of the therapeutic relationship is being demonstrated?
a. Empathy
b. Trust
c. Rapport
d. Purposeful communication
ANS: D
The nurse focuses communication for a particular aim: to obtain information to be used in care of
the person.
REF: p. 93
13. An individual reveals to the nurse that he is having an affair with his wifes best friend. Which of
the following statements will enhance effective therapeutic communication between him and the
nurse?
a. You know that what you are doing is wrong.
b. Why would you want do something like that?
c. How could you do that to your wife and children?
d. This affair seems to be troubling you.
ANS: D
The nurse is seeking to determine the clients own feelings about his affair. By seeking feedback,
the nurse helps explain the meaning further. The nurse suspends judgment and responds in such a
way as to encourage him to keep talking rather than make judgments about his behavior, which
would shut down communication.
REF: p. 95
14. A nurse is working with a person to increase his daily exercise and activity. Which of the
following statements by the nurse best demonstrates the use of reflection?

a. I have also struggled with finding time to exercise on a regular basis.
b. Regular exercise plays an important role in preventing many health problems.
c. You said that you have difficulty making time in your day for exercise.
d. It may be helpful if we developed a goal related to daily exercise.

ANS: C
Reflection is the restatement of what the individual has said in the same or different words. This
technique can involve paraphrasing or summarizing the persons main point to indicate interest
and to focus the discussion. It is the selective paraphrasing or literal repetition of the persons
words to underscore the importance of what has been said, summarize a main concern or theme,
or elicit elaborated information.
REF: p. 95
15. A woman tells the nurse that she is very nervous about their meeting today. Which of the
following relationship stages are the nurse and woman most likely experiencing?
a. Orientation phase
b. Working phase
c. Therapeutic phase
d. Termination phase
ANS: A
The orientation phase begins when the nurse and individual meet. This meeting typically
involves some feeling of anxiety because neither party knows what to expect.
REF: p. 98
16. Which of the following is the first step in the valuing process?
a. Acting out the choice
b. Selecting from alternatives
c. Being happy with personal beliefs and actions
d. Choosing freely
ANS: D
The seven-step valuing process involves (1) choosing freely, (2) choosing from alternatives, (3)
choosing after careful consideration of potential outcomes of each alternative, (4) cherishing and
being happy with personal beliefs and actions, (5) affirming the choice in public, when
appropriate, (6) acting out the choice, and (7) repeatedly acting in some type of pattern.
REF: p. 83 (Box 4-2)
17. The nurse makes sure that the distance between himself and the client is at least 6 feet before he
begins to ask questions related to the clients health history. Which of the following statements is
true?
a. This is the ideal space for intimate communication.
b. This distance is too far for the nurse to build a therapeutic relationship while
obtaining the information.
c. This is the recommended distance between client and nurse for effective
therapeutic communication.
d. The nurse should position himself an additional foot away to facilitate the
conversation.
ANS: B
Personal space of 18 inches to 4 feet is appropriate for close relationships in which touching may
be involved and good visualization is desired.
REF: p. 91 (Box 4-8)
MULTIPLE RESPONSE
1. A nurse is working on values clarification with a person who has chosen to smoke during her
pregnancy. Which of the following statements would be the most appropriate for the nurse to
assist in this process? (select all that apply)
a. Why do you smoke cigarettes?
b. What do you value most in life?
c. Who has influenced your decision to smoke?
d. Is your decision to smoke consistent with your values?
ANS: B, D
Techniques to clarify values include assisting the person to identify her own values (What is
important to you?), identify values conflicts or conflicts between values and actions (Are your
actions consistent with your values?), and using reflection to restate the value and make it
explicit.
REF: p. 83 (Box 4-3)
2. A nurse is in the process of establishing a therapeutic relationship with a person. Which of the
following techniques should be used by the nurse? (select all that apply)
a. Learn about the persons interests.
b. Sit close to the person.
c. Show interest in the persons concerns.
d. Define the parameters of the relationship with the person.
ANS: C, D
Purposeful communication should be an aim of the therapeutic relationship. Social chitchat,

communication without a goal, should not make up the bulk of the therapeutic interaction. The
amount of space between communicators varies from culture to culture, so sitting close to the
person may not be culturally appropriate. Building rapport by showing the person that his or her
concerns interest the nurse is important. Also, trust can be built with the person by clearly
defining the relationship parameters and expectations.
REF: p. 93
3. Which of the following is an essential question that nurses should encourage individuals to ask at
every health visit? (select all that apply)

a. What is my main problem?
b. What health information do I not understand?
c. What do I need to do?
d. What is the plan for the next visit?
ANS: A, C
Health literacy is the capacity to read, comprehend, and follow through on health information; it
is a critical component of health promotion. To combat low health literacy, nurses can encourage
individuals to ask three essential questions at every health visit: What is my main problem?
What do I need to do? Why is it important for me to do this?
REF: p. 100
Chapter 15: Overview of Growth and Development Framework

MULTIPLE CHOICE
1. The nurse is explaining the concept of growth to a parent. Which of the following statements
should be made by the nurse?

a. Growth means adding height and weight to your body.
b. We continue to grow in various ways throughout life.
c. How much we grow is based on gender.
d. Growth stops when we are young adults.
ANS: B
Growth, in some form, continues throughout life, not just during puberty. Not all growth is based
on gender. Growth indicates more than a change in height and weight.
REF: p. 336
2. Which of the following statements is correct related to the concept of growth

a. Growth occurs mainly during early childhood.
b. Older adults do not experience growth-related changes..
c. Growth refers only to the increase in the size of specific organs and systems.
d. Growth occurs throughout the life cycle.
ANS: D
People experience developmental transitions throughout life, not just during times of rapid
physical growth. Growth changes that take place in young, middle-aged, and older adults should
be noted. People who think of growth only as it applies to infants, children and adolescents are
missing important changes from conception throughout adulthood.
REF: p. 336
3. The nurse at a well-baby clinic is assessing a 12-month-old child. At birth, the child weighed 7
lb. 3 oz. During this visit, the child weighs 21 lb. 10 oz. Which of the following conclusions
would the nurse make about the childs weight?
a. The infant is gaining weight faster than anticipated.
b. The infant is malnourished.
c. The infant is at the expected weight for his or her age.

d. The infant is having a growth spurt.
ANS: C
A 1-year-old infant is expected to have at least doubled his or her weight by 12 months of age.
REF: p. 343
4. The school nurse has been asked to order growth charts. Which of the following growth charts
should be selected to assessing children in first through fifth grades?

a. Generic body mass index chart
b. Height and weight chart
c. Revised CDC growth chart
d. WHO international growth chart
ANS: C
The CDC recommends the revised 2000 CDC growth charts (including the BMI and the 3rd and
97th percentile) be used for children aged 2 to 20 years.
REF: p. 343
5. A school nurse is obtaining the height and weight of a 9-year-old child. Which of the following is
the best method to assess the childs growth?

a. Use serial measurements over time.
b. Use this measurement.
c. Use this measurement and compare it with the childs peers.
d. Use the WHO growth chart to assess this childs measurements.
ANS: A
When assessing growth data for use in growth charts, it is important to remember that a single
measurement taken at one point in time, although helpful in providing a baseline, does not allow
for the best assessment of a childs growth. Serial measurements, plotted on a growth chart over
time, best reflect a childs pattern of growth.
REF: p. 344
6. A mother comes to the pediatric clinic and says to the nurse, I am worried about my 11-month-
old baby because he is not crawling yet and his brother crawled when he was 11 months old. Is
something wrong? Which of the following statements should the nurse make?
a. It is highly unusual for siblings not to reach developmental milestones at the same
time. Ill ask the doctor to assess him.
b. All babies reach developmental milestones at different rates.
c. This may be something to worry about. Ill have the doctor examine him.
d. Dont worry; hell crawl soon enough.
ANS: B
Although developmental milestones follow a predictable pattern, each child develops at his or
her own rate. Telling the mother not to worry is not answering her question.
REF: pp. 344-345
7. Which of the following statements describes Eriksons theory of development?

a. A healthy personality is defined by the lack of pathology.
b. Stages of development advance based on psychosocial factors.
c. The main premise of the theory is that individuals are interdependent beings and
rely on each other in order to develop successfully.

d. An individual must successfully accomplish the developmental stage before
proceeding to the next stage.
ANS: D
Eriksons theory of development is based on the need of each person to develop a sense of trust
in self and others and a sense of personal worth. Each stage depends on the preceding stage,
which must be accomplished successfully for the person to proceed. Although the environment
and others may influence development, it is primarily an individual task. A person may regress to
an earlier stage during times of stress.
REF: pp. 345-346
8. According to Piagets theory of cognitive development, which of the following statements is
correct?
a. Cognitive function continues to become refined throughout life.
b. A childs greatest task is to make sense of the world around him or her.
c. Culture plays a major role in cognitive development.
d. Learning precedes development.
ANS: B
Piaget theorized that cognitive development was complete by about age 15. He did not factor the
effects of culture into his theory and felt that learning followed cognitive development.
REF: p. 346
9. Which of the following statements summarizes Vygotskys theory of development?

a. All children develop cognitively at the same rate.
b. Social and cultural influences are not major factors in cognitive development.
c. Learning is an individual activity.
d. Experience creates learning.
ANS: D
Vygotskys theory of development stresses that social and cultural influences can have a major
impact on learning. He felt that cognitive development was dependent on exposure to many life
experiences, was influenced by interaction with others, and did not proceed according to
predetermined stages.
10. Kohlbergs theory of moral development is based on:
a. Eriksons theory of psychosocial development
b. Piagets theory of cognitive development
REF: pp. 346-347
c. Vygotskys theory of cognitive development

d. Gilligans theory of moral development
ANS: B
Kohlbergs theory of moral development is based on Piagets theory of cognitive development.

REF: pp. 347-348
11. Which of the following statements about Gilligans theory of moral development is accurate?
a. This theory is based on a sense of absolute right and wrong.
b. This theory is gender specific.
c. This theory is dependent on ones stage of cognitive development.
d. This theory is based on the premise that women view situations in terms of rules.
ANS: B
Gilligans theoretical work is based on womens moral development. Kohlberg postulated that
men view situations in terms of justice and rules, and that moral development depends on
cognitive development.
REF: p. 348
12. A nurse is caring for a person with the nursing diagnosis of chronic sorrow related to missed
opportunities. Which of the following nursing interventions would be appropriate for this
person?
a. Sharing a personal story with the person to demonstrate empathy
b. Assuring the person that he or she will be able to cope with the illness
c. Encouraging the person to discuss his or her fears
d. Contacting a support group representative for the person
ANS: C
It is not appropriate to discuss personal issues with an individual. Assuring the individual what
he or she will be able to cope with is not appropriate because it does not encourage the person to
talk about his or her fears. It is not appropriate to contact a support group without the persons
permission. The person may not be ready to discuss the issue with strangers. The correct
response is part of grief work facilitation: helping another cope with painful feelings of actual or
perceived responsibility.
REF: pp. 348-349 (Care Plan)
13. A nurse is teaching parents of a toddler about nutrition. Which of the following statements
should be made by the nurse?

a. Raisins are a good finger food because they provide fiber.
b. Grapes are a good snack choice because they help toddlers meet their daily fruit
requirements.
c. Hot dogs are not a safe food choice because they may cause choking.
d. A small piece of chewing gum will help strengthen jaw muscle; just be sure he or
she does not swallow it.
ANS: C
Raisins, grapes, and chewing gum all pose a choking hazard and should not be given to toddlers.
REF: p. 345 (Box 15-3)
14. A nurse who is conducting a parenting class is asked how to select a good day care center for an
18-month-old child. Which of the following responses should be made by the nurse?
a. Day care centers that schedule age-appropriate educational videos increase verbal
ability.
b. Human interaction increases a toddlers verbal skills, so select a day care center
that values adult-to-toddler interaction.
c. Learning to understand the meaning of words is increased when toddlers are
exposed to educational DVDs, so select a day care center that has an extensive
library of age-appropriate, educational DVDs.
d. There really is no difference in the quality of day care centers based on whether
or not videos or DVDs are used for educational purposes.
ANS: B
Research has demonstrated that toddlers who are exposed to videos and DVDs have a more
limited vocabulary than toddlers who interact with caregivers.
REF: p. 347 (Box 15-4)
15. A high school sophomore engages in risky behavior to fit in with his peers. According to
Eriksons theory of human development, which of the following developmental conflicts is this
student facing?
a. Initiative versus guilt
b. Industry versus inferiority
c. Identity versus role confusion
d. Intimacy versus isolation
ANS: C
According to Erikson, a preschool child has a developmental conflict between initiative and
guilt, a school-age child has a developmental conflict between industry and inferiority, and a
young adult has a developmental conflict between intimacy and isolation. An adolescent has a
developmental conflict between identity and role confusion.
REF: p. 346 (Table 15-3)
16. A child is focused on peer approval and avoidance of not fitting in. According to Kohlberg,
this child is experiencing which of the following stages of moral development?

a. Preconventional
b. Conventional
c. Postconventional
d. Preoperational
ANS: B
The goal of the conventional stage is gaining approval and avoiding disapproval. The goal of the
preconventional stage is avoiding punishment and gaining reward, while the goal of the
postconventional stage is agreeing upon rights, establishing personal moral standards, and
achieving justice.
REF: p. 348 (Table 15-5)
17. The nurse is caring for a person who donated a kidney to a stranger in need. According to
Gilligans stages of moral development, the person who donated the kidney is in which of the
following stages?
a. Preconventional
b. Conventional
c. Postconventional
d. Midconventional
ANS: B
Characteristics of the conventional stage of Gilligans stages of moral development include

sacrifice to fulfill the needs of others.
REF: p. 348 (Table 15-6)
MULTIPLE RESPONSE
1. A nurse is attending a continuing education program about growth and development. Why is it
necessary that nurses are well educated about this content? (select all that apply)
a. Have a better understanding of genetics and genomics
b. Can meet the requirements of Healthy People 2010
c. Can provide more effective health education
d. Can deliver anticipatory guidance to families
ANS: A, C, D
Genetics and genomics is an important part of our age of technology; understanding growth and
development aids in the understanding of these topics as well. Health education is more effective
when the nurse acknowledges and incorporates growth and developmental needs as well as the
individuals prior understanding of beliefs about health and health-related concepts. Health
promotion is an important part of Healthy People 2010, but there are no requirements within this
document that nurses need to be educated about growth and development.
REF: p. 336 | p. 346 (Box 15-3)
2. A nurse is educating new parents about normal growth and development for their child. Which of
the following items would the nurse include in this discussion? (select all that apply)
a. Trends in childhood obesity
b. Availability of a well-balanced diet
c. Exposure to lead-based pain
d. Height/weight of relatives
ANS: B, C, D
A well-balanced diet will help assure that the child reaches his or her growth potential. Lead
poisoning, an environmental exposure, remains a significant threat to todays children. Genetic
factors greatly influence growth and development.
REF: p. 336
3. The school nurse is conducting an in-service program for teachers that discusses the
development of elementary school children. According to Piagets theory of cognitive

development, which of the following information would the nurse include? (select all that apply)
a. Use abstract thought to discuss a story.
b. Make moral decisions concerning right and wrong actions.
c. Listen to a peers point of view about a playground situation.
d. Be influenced by his or her friends.
ANS: C, D
Children age 7 to 11 are in the concrete operations stage of development according to Piaget.
They are influenced by friends and can listen to and think about a peers point of view. Moral
decision making and use of abstract thought occur during the formal operations stage of
development, usually between the ages of 11 and 15 years.

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Chapter 24: Older Adult

Edelman: Health Promotion Throughout the Life Span, 8th Edition

from health promotion interventions?

Motivation to adopt a healthy lifestyle is a primary predictor of successful interventions. Feeling

older adults living in a nursing home.

foods eaten by older adults living at home.

REF: pp. 596-597

4. Which of the following statements concerning urinary incontinence is correct?

Functional incontinence is associated with environmental barriers, physical limitations, or

the following responses should be made by the nurse?

REF: pp. 599-560

the following information should be included?

REF: pp. 600-601

following menus would the nurse most likely recommend?

10. Which of the following individuals would be at greatest risk of injury?

Sweating decreases in older adults, predisposing them to heat stroke.

successfully navigated the stage of ego integrity versus despair?

c. Volunteering to provide respite time for them as needed

REF: pp. 604-605

demonstrating a healthy coping pattern?

items should the nurse should locate in the home?

20. Which of the following statements is the best definition of polypharmacy?

REF: p. 594 (Box 24-2)

REF: p. 612 (Table 24-4)

older adults? (select all that apply)

REF: pp. 604-605

all that apply)

REF: pp. 607-608

Chapter 23: Middle-Age Adult

4. A nurse is conducting a community education program. Which of the following should be

stressed as the leading cause of death in middle-age adults?

REF: p. 564 | p. 564 (Box 23-1)

DIF: Cognitive Level: Apply (Application)

REF: pp. 568-569

11. Which of the following statements about alcohol intake is correct?

considered a moderate drinker.

drink heavily than do women who get a buzz from drinking.

REF: pp. 569-570

information about dental health should be included?

night. Which of the following responses should be made by the nurse?

statements by a participant indicates the analysis stage of cognition as defined by Blooms

DIF: Cognitive Level: Apply (Application)

versus-stagnation stage of development?

REF: pp. 574-575

Although research is continuing, longitudinal studies by Wallerstein and her colleagues

information should be stressed by the nurse?

DIF: Cognitive Level: Apply (Application)

following considerations should be made by the nurse?

REF: pp. 585-586

health in middle-age women?

REF: p. 577 (Box 23-7)

REF: pp. 575-576

Cognitive Level: Apply (Application)

Chapter 22: Young Adult

following considerations should be made by the nurse?

following statements should be made by the nurse during this session?

REF: pp. 538-539

following conclusions can be drawn by the nurse?

Cardiovascular assessment of the young adult includes determining the presences of

REF: pp. 538-539

6. A 30-year-old woman with a BMI of 36 is counseled by the nurse regarding interventions to

of the following would be the best response by the nurse?

following measures would be most effective for the nurse to promote?