NCLEX Practice Exam for Growth and Development

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1. The nurse is caring for the mother of a newborn. The nurse recognizes that the mother needs more teaching regarding cord care because she

  1. keeps the cord exposed to the air.
  2. washes her hands before sponge bathing her baby.
  3. washes the cord and surrounding area well with water at each diaper change.
  4. checks it daily for bleeding and drainage.

2. A client telephones the clinic to ask about a home pregnancy test she used this morning. The nurse understands that the presence of which hormone strongly suggests a woman is pregnant?

  1. Estrogen
  2. HCG
  3. Alpha-fetoprotein
  4. Progesterone

3. The nurse is assessing a six-month-old child. Which developmental skills are normal and should be expected?

  1. Speaks in short sentences.
  2. Sits alone.
  3. Can feed self with a spoon.
  4. Pulling up to a standing position.

4. While teaching a 10 year-old child about their impending heart surgery, the nurse should

  1. Provide a verbal explanation just prior to the surgery
  2. Provide the child with a booklet to read about the surgery
  3. Introduce the child to another child who had heart surgery three days ago
  4. Explain the surgery using a model of the heart

5. When caring for an elderly client it is important to keep in mind the changes in color vision that may occur. What colors are apt to be most difficult for the elderly to distinguish?

  1. Red and blue.
  2. Blue and gold.
  3. Red and green.
  4. Blue and green.

6. While giving nursing care to a hospitalized adolescent, the nurse should be aware that the MAJOR threat felt by the hospitalized adolescent is

  1. Pain management
  2. Restricted physical activity
  3. Altered body image
  4. Separation from family

7. A woman who is 32 years old and 35 weeks pregnant has had rupture of membranes for eight hours and is 4 cm dilated. Since she is a candidate for infection, the nurse should include which of the following in the care plan?

  1. Universal precautions.
  2. Oxytocin administration.
  3. Frequent temperature monitoring.
  4. More frequent vaginal examinations.

8. The nurse prepares for a Denver Screening test with a 3 year-old child in the clinic. The mother asks the nurse to explain the purpose of the test. The BEST response is to tell her that the test

  1. Measures potential intelligence
  2. Assesses a child’s development
  3. Evaluates psychological responses
  4. Diagnoses specific problems

9. A 27-year-old woman has Type I diabetes mellitus. She and her husband want to have a child so they consulted her diabetologist, who gave her information on pregnancy and diabetes. Of primary importance for the diabetic woman who is considering pregnancy should be

  1. a review of the dietary modifications that will be necessary.
  2. early prenatal medical care.
  3. adoption instead of conception.
  4. understanding that this is a major health risk to the mother.

10. The nurse is planning care for an 18 month-old child. Which of the following should be included the in the child’s care?

  1. Hold and cuddle the child often
  2. Encourage the child to feed himself finger food
  3. Allow the child to walk independently on the nursing unit
  4. Engage the child in games with other children

11. The nurse in an infertility clinic is discussing the treatment routine. The nurse advises the couple that the major stressor for couples being treated for infertility is usually

  1. having to tell their families.
  2. the cost of the interventions.
  3. the inconvenience of multiple tests.
  4. the right scheduling of sexual intercourse.

12. The nurse is assessing a four month-old infant. The nurse would anticipate finding that the infant would be able to

  1. Hold a rattle
  2. Bang two blocks
  3. Drink from a cup
  4. Wave “bye-bye”

13. The nurse is evaluating a new mother feeding her newborn. Which observation indicates the mother understands proper feeding methods for her newborn?

  1. Holding the bottle so the nipple is always filled with formula.
  2. Allowing her seven – pound baby to sleep after taking 1 ½ ounces from the bottle.
  3. Burping the baby every ten minutes during the feeding.
  4. Warming the formula bottle in the microwave for 15 seconds and giving it directly to the baby.

14. The nurse is caring for a pregnant client. The client asks how the doctor could tell she was pregnant ‘just by looking inside.’ The nurse tells her the most likely explanation is that she had a positive Chadwick’s sign, which is a

  1. Bluish coloration of the cervix and vaginal walls
  2. Pronounced softening of the cervix
  3. Clot of very thick mucous that obstructs the cervical canal
  4. Slight rotation of the uterus to the right

15. When caring for an elderly client it is important to keep in mind the changes in color vision that may occur. What colors are apt to be most difficult for the elderly to distinguish?

  1. Red and blue.
  2. Blue and gold.
  3. Red and green.
  4. Blue and green.

16. The nurse’s FIRST step in nutritional counseling/teaching for a pregnant woman is to

  1. Teach her how to meet the needs of self and her family
  2. Explain the changes in diet necessary for pregnant women
  3. Question her understanding and use of the food pyramid
  4. Conduct a diet history to determine her normal eating routines

17. A woman who is six months pregnant is seen in antepartal clinic. She states she is having trouble with constipation. To minimize this condition, the nurse should instruct her to

  1. increase her fluid intake to three liters/day.
  2. request a prescription for a laxative from her physician.
  3. stop taking iron supplements.
  4. take two tablespoons of mineral oil daily.

18. The nurse is observing children playing in the hospital playroom. She would expect to see 4 year-old children playing

  1. Competitive board games with older children
  2. With their own toys along side with other children
  3. Alone with hand held computer games
  4. Cooperatively with other preschoolers

19. The nurse is caring for residents in a long term care setting for the elderly. Which of the following activities will be MOST effective in meeting the growth and development needs for persons in this age group?

  1. Aerobic exercise classes
  2. Transportation for shopping trips
  3. Reminiscence groups
  4. Regularly scheduled social activities

20. A pregnant woman is advised to alter her diet during pregnancy by increasing her protein and Vitamin C to meet the needs of the growing fetus. Which diet BEST meets the client’s needs?

  1. Scrambled egg, hash browned potatoes, half-glass of buttermilk, large nectarine
  2. 3oz. chicken, ½ C. corn, lettuce salad, small banana
  3. 1 C. macaroni, ¾ C. peas, glass whole milk, medium pear
  4. Beef, ½ C. lima beans, glass of skim milk, ¾ C. strawberries

21. Which age group has the greatest potential to demonstrate regression when they are sick?

  1. Adolescent
  2. Young Adult
  3. Toddler
  4. Infant

22. Which is a major concern when providing drug therapy for older adults?

  1. Alcohol is used by older adults to cope with the multiple problems of aging
  2. Hepatic clearance is reduced in older adults
  3. Older adults have difficulty in swallowing large tablets
  4. Older adults may chew on tablets instead of swallowing them.

23. One of the participants attending a parenting class asks the teacher “what is the leading cause of death during the first month of life?

  1. Congenital Abnormalities
  2. Low birth weight
  3. SIDS
  4. Infection

24. Which stage of development is most unstable and challenging regarding development of personal identity?

  1. Adolescence
  2. Toddler hood
  3. Childhood
  4. Infancy

25. Which age group would have a tendency towards eating disorders?

  1. Adolescence
  2. Toddler hood
  3. Childhood
  4. Infancy

26. When assessing an older adult. The nurse may expect an increase in:

  1. Nail growth
  2. Skin turgor
  3. Urine residual
  4. Nerve conduction

27. A maternity nurse is providing instruction to a new mother regarding the psychosocial development of the newborn infant.  Using Erikson’s psychosocial development theory, the nurse would instruct the mother to

  1. Allow the newborn infant to signal a need
  2. Anticipate all of the needs of the newborn infant
  3. Avoid the newborn infant during the first 10 minutes of crying
  4. Attend to the newborn infant immediately when crying

28. A mother of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums.  The nurse most appropriately tells the mother to:

  1. Punish the child every time the child says “no”, to change the  behavior
  2. Allow the behavior because this is normal at this age period
  3. Set limits on the child’s behavior
  4. Ignore the child when this behavior occurs

29. The parents of a 2-year-old arrive at a hospital to visit their child.  The child is in the playroom when the parents arrive.  When the parents enter the playroom, the child does not readily approach the parents.  The nurse interprets this behavior as indicating that:

  1. The child is withdrawn
  2. The child is self-centered
  3. The child has adjusted to the hospitalized setting
  4. This is a normal pattern

30. The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime.  Which of the following is the most appropriate suggestion to the mother?

  1. Do not allow the child to have the bottle
  2. Allow the bottle during naps but not at bedtime
  3. Allow the bottle if it contains juice
  4. Allow the bottle if it contains water

31. A nurse is evaluating the developmental level of a 2-year-old.  Which of the following does the nurse expect to observe in this child?

  1. Uses a fork to eat
  2. Uses a cup to drink
  3. Uses a knife for cutting food
  4. Pours own milk into a cup

32.   The nurse is providing an educational session to new employees, and the topic is abuse to the older client.  The nurse tells the employees that which client is most characteristic of a victim of abuse

  1. A 90-year-old woman with advanced Parkinson’s disease
  2. A 68-year-old man with newly diagnosed cataracts
  3. A 70-year-old woman with early diagnosed Lyme’s disease
  4. A 74-year-old man with moderate hypertension

33. The home care nurse is visiting an older female client whose husband died 6 months ago.  Which behavior, by the client, indicates ineffective coping?

  1. Visiting her husband’s grave once a month
  2. Participating in a senior citizens program
  3. Looking at old snapshots of her family
  4. Neglecting her personal grooming

34. A clinic nurse assesses the communication patterns of a 5-month-old infant.  The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant:

  1. Uses simple words such as “mama”
  2. Uses monosyllabic babbling
  3. Links syllables together
  4. Coos when comforted

35. A nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur.  The nurse plans care, knowing that which of the following is the most appropriate activity for this child?

  1. Large picture books
  2. A radio
  3. Crayons and coloring book
  4. A sports video

36.  A 16-year-old is admitted to the hospital for acute appendicitis, and an appendectomy is performed.  Which of the following nursing interventions is most appropriate to facilitate normal growth and development?

  1. Allow the family to bring in the child’s favorite computer games
  2. Encourage the parents to room-in with the child
  3. Encourage the child to rest and read
  4. Allow the child to participate in activities with other individuals in the same age group when the condition permits

37. The mother of a toddler asks a nurse when it is safe to place the car safety seat in a face-forward position.  The best nursing response is which of the following?

  1. When the toddler weighs 20 lbs
  2. The seat should not be placed in a face-forward position unless there are safety locks in the car
  3. The seat should never be place in a face-forward position because the risk of the child unbuckling the harness
  4. When the weight of the toddler is greater than 40 lbs

38. The nurse is caring for an agitated older client with Alzheimer’s disease.  Which nursing intervention most likely would calm the client?

  1. Playing a radio
  2. Turning the lights out
  3. Putting an arm around the client’s waist
  4. Encouraging group participation

39. The nurse who volunteers at a senior citizens center is planning activities for the members who attend the center.  Which activity would best promote health and maintenance for these senior citizens?

  1. Gardening every day for an hour
  2. Cycling 3 times a week for 20 minutes
  3. Sculpting once a week for 40 minutes
  4. Walking 3 to 5 times a week for 30 minutes

40. A 16 year old child is hospitalized, according to Erik Erikson, what is an appropriate intervention?

  1. tell the friends to visit the child
  2. encourage patient to help child learn lessons missed
  3. call the priest to intervene
  4. tell the child’s girlfriend to visit the child.
Answers and Rationales
  1. Answer C. Exposure to air helps dry the cord. Good hand washing is the prime mechanism for preventing infection. Washing the surrounding area is fine but wetting the cord keeps it moist and predisposes it to infection. It is important to check for complications of bleeding and drainage that might occur.
  2. Answer B. Human chorionic gonadotropin (HCG) is the biologic marker on which pregnancy tests are based. Reliability is about 98%, but the test does not positively confirm pregnancy.
  3. Answer B. The child develops language skills between the ages of one and three. A six-month-old child is learning to sit alone. The child begins to use a spoon at 12-15 months of age. The baby pulls himself to a standing position about ten months of age.
  4. Answer D. According to Piaget, the school age child is in the concrete operations stage of cognitive development. Using something concrete, like a model will help the child understand the explanation of the heart surgery.
  5. Answer D. The elderly are better able to distinguish between red and blue because of the difference in wavelengths. The elderly are better able to distinguish between blue and gold because of the difference in wavelengths. The elderly are better able to distinguish between red and green because of the difference in wavelengths. Red and green color blindness is an inherited disorder that is unrelated to age. The elderly have poor blue-green discrimination. The effects of age are greatest on short wavelengths. These changes are related to the yellowing of the lens with age.
  6. Answer C. The hospitalized adolescent may see each of these as a threat, but the major threat that they feel when hospitalized is the fear of altered body image, because of the emphasis on physical appearance.
  7. Answer C. Universal precautions are necessary for all clients but a specific assessment of the client’s temperature will give an indication the client is becoming infected. Oxytocin may be needed to induce labor if it is not progressing, but it is not done initially.Temperature elevation will indicate beginning infection. This is the most important measure to help assess the client for infections, since the lost mucous plug and the ruptured membranes increase the potential for ascending bacteria from the reproductive tract. This will infect the fetus, membranes, and uterine cavity. More frequent vaginal examinations are not recommended, as frequent vaginal exams can increase chances of infection.
  8. Answer B. The Denver Developmental Test II is a screening test to assess children from birth through 6 years in personal/social, fine motor adaptive, language and gross motor development. A child experiences the fun of play during the test.
  9. Answer B. A review of dietary modifications is important once the woman is pregnant. However, it is not of primary importance when considering pregnancy. Pregnancy makes metabolic control of diabetes more difficult. It is essential that the client start prenatal care early so that potential complications can be controlled or minimized by the efforts of the client and health care team. The alternative of adoption is not necessary just because the client is a diabetic. Many diabetic women have pregnancies with successful outcomes if they receive good care. While there is some risk to the pregnant diabetic woman, it is not considered a major health risk. The greater risk is to the fetus.
  10. Answer B. According to Erikson, the toddler is in the stage of autonomy versus shame and doubt. The nurse should encourage increasingly independent activities of daily living.
  11. Answer D. Having to tell families may also be a factor contributing to stress but is not the major stressor. Cost may also be a contributing factor to stress but is not usually the major factor. The inconvenience of multiple tests may also be a factor contributing to stress but is not usually the major factor. Sexual activity “on demand” is the major cause of stress for most infertile couples.
  12. Answer A. The age at which a baby will develop the skill of grasping a toy with help is 4 to 6 months.
  13. Answer A. Holding the bottle so the nipple is always filled with formula prevents the baby from sucking air. Sucking air can cause gastric distention and intestinal gas pains. A seven-pound baby should be getting 50 calories per pound: 350 calories per day. Standardized formulas have 20 calories per ounce. This seven-pound baby needs 17.5 ounces per day. 17.5 ounces per day divided by 6-8 feedings equals 2-3 ounces per feeding. A normal newborn without feeding problems could be burped halfway through the feeding and again at the end. If burping needs to be at intervals, it should be done by ounces or half ounces, not minutes. Microwaving is not recommended as a method of warming due to the uneven heating of the formula. If used, the formula should be shaken after warming and the temperature then checked with a drop on the wrist. The recommended method of warming is to place the bottle in a pan of hot water to warm, and then check the temperature on the wrist before feeding.
  14. Answer A. Chadwick’s sign is a bluish-purple coloration of the cervix and vaginal walls, occurring at 4 weeks of pregnancy, that is caused by vasocongestion.
  15. Answer D. The elderly are better able to distinguish between red and blue because of the difference in wavelengths. Red and green color blindness is an inherited disorder that is unrelated to age. The elderly have poor blue-green discrimination. The effects of age are greatest on short wavelengths. These changes are related to the yellowing of the lens with age.
  16. Answer D. Assessment is always the first step in planning teaching for any client.
  17. Answer A. In pregnancy, constipation results from decreased gastric motility and increased water reabsorption in the colon caused by increased levels of progesterone. Increasing fluid intake to three liters a day will help prevent constipation. The client should increase fluid intake, increase roughage in the diet, and increase exercise as tolerated. Laxatives are not recommended because of the possible development of laxative dependence or abdominal cramping. Iron supplements are necessary during pregnancy, as ordered, and should not be discontinued. The client should increase fluid intake, increase roughage in the diet, and increase exercise as tolerated. Laxatives are not recommended because of the possible development of laxative dependence or abdominal cramping. Mineral oil is especially bad to use as a laxative because it decreases the absorption of fat-soluble vitamins (A, D, E, K) if taken near mealtimes.
  18. Answer D. Cooperative play is typical of the preschool period.
  19. Answer C. According to Erikson”s theory, older adults need to find and accept the meaningfulness of their lives, or they may become depressed, angry, and fear death. Reminiscing contributes to successful adaptation by maintaining self-esteem, reaffirming identity, and working through loss.
  20. Answer D. Beef and beans are an excellent source of protein as is skim milk. Strawberries are a good source of Vitamin C.
  21. Answer C.
  22. Answer B.
  23. Answer C.
  24. Answer A.
  25. Answer A.
  26. Answer C.
  27. Answer A. According to Erikson, the caregiver should not try to anticipate the newborn infant’s needs at all times but must allow the newborn infant to signal needs.  If a newborn is not allowed to signal a need, the newborn will not learn how to control the environment.  Erikson believed that a delayed or prolonged response to a newborn’s signal would inhibit the development of trust and lead to mistrust of others.
  28. Answer C.  According to Erikson, the child focuses on independence between ages 1 and 3 years.  Gaining independence often means that the child has to rebel against the parents’ wishes.  Saying things like “no” or “mine” and having temper tantrums are common during this period of development.  Being consistent and setting limits on the child’s behavior are the necessary elements.
  29. Answer D.  The phases through which young children progress when separated from their parents include protest, despair, and denial or detachment.  In the stage of protest, when the parents return, the child readily goes to them.  In the stage of despair, the child may not approach them readily or may cling to a parent.  In denial or detachment, when the parents return, the child becomes cheerful, interested in the environment and new persons (seemingly unaware of the lost parents), friendly with the staff, and interested in developing superficial relationships.
  30. Answer D.  A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda, or sweetened water because of the risk or nursing caries.  If a bottle is allowed at nap time or bedtime, it should contain only water.
  31. Answer B.  By age 2 years, the child can use a cup and can use a spoon correctly but with some spilling.  By ages 3 to 4, the child begins to use a fork.  By the end of the preschool period, the child should be able to pour milk into a cup and begin to use a knife for cutting.
  32. Answer A.   The typical abuse victim is a woman of advanced age with few social contacts and at least one physical or mental impairment that limits the ability to perform activities of daily living.  In addition, the client usually lives alone or with the abuser and depends on the abuser for care.
  33. Answer D.  Coping mechanisms are behaviors used to decrease stress and anxiety.  In response to a death, ineffective coping is manifested by an extreme behavior that in some instances may be harmful to the individual physically or psychologically.  Option D is indicative of a behavior that indentifies an ineffective coping behavior in the grieving process.
  34. Answer B.  Using monosyllabic babbling occurs between 3 and 6 months of age.  Using simple words such as “mama” occurs between 9 and 12 months.  Linking syllables together when communicating occurs between 6 and 9 months.  Cooing begins at birth and continues until 2 months.
  35. Answer C. In the preschooler, play is simple and imaginative and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh.  Large picture books are most appropriate for the infant.  A radio and a sports video are most appropriate for the adolescent.
  36. Answer D. Adolescents often are not sure whether they want their parents with them when they are hospitalized.  Because of the importance of the peer group, separation from friends is a source of anxiety.  Ideally, the members of the peer group will support their ill friend.  Options a, b, and c isolate the child from the peer group.
  37. Answer A.  The transition point for switching to the forward facing position is defined by the manufacturer of the convertible car safety seat but is generally at a body weight of 9 kg or 20 lb and 1 year of age.  Convertible car safety seats are used until the child weighs at least 40 lb.  Options b, c, and d are incorrect
  38. Answer C. Nursing interventions for the client with Alzheimer’s disease who is angry, frustrated, or hostile include decreasing environmental stimuli, approaching the client calmy and with assurance, not demanding anything from the client, and distracting the client.  For the nurse to reach out, touch, hold a hand, put an arm around the waist, or in some way maintain physical contact is important.  Playing a radio may increase stimuli, and turning the lights out may produce more agitation.  The client with Alzheimer’s disease would not be a candidate for group work if the client is agitated.
  39. Answer D.  Exercise and activity are essential for health promotion and maintenance in the older adult and to achieve an optimal level of functioning.  About half of the physical deterioration of the older client is caused by disuse rather that by the aging process or disease.  One of the best exercises for an older adult is walking, progressing to 30 minutes session 3 to 5 times each week.  Swimming and dancing are also beneficial.
  40. Answer A. The child is 16 years old, In the stage of IDENTITY VS. ROLE CONFUSION. The most significant persons in this group are the PEERS. B refers to children in the school age while C refers to the young adulthood stage of INTIMACY VS. ISOLATION. The child is not dying and the situation did not even talk about the child’s belief therefore, calling the priest is unnecessary.