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Nurse is collecting data from mother of 1 yo. Client states her child is old enough for toilet training. Following teaching by nurse, client now states her earlier ideas have changed. She's now willing to postpone toilet training until child is older. Learning has occurred in which of following domains?
- A. Cognitive
- B. Affective
- C. Psychomotor
- D. Kinesthetic
Correct Answer: B
Rationale: The correct answer is B: Affective. Affective domain involves emotions, attitudes, and feelings. In this scenario, the mother's change in willingness to postpone toilet training shows a shift in her emotional response and attitude towards the situation. This indicates a change in the affective domain, as the mother's feelings and attitudes have been influenced by the nurse's teaching.
Choices A, C, and D are incorrect:
A: Cognitive domain involves knowledge, understanding, and thinking skills. While there may be some cognitive processing involved in the mother's decision-making, the primary change observed is in her emotions and attitudes.
C: Psychomotor domain relates to physical skills and movements, which are not the focus of the scenario.
D: Kinesthetic refers to the sense of body position and movement, which is not relevant to the mother's change in willingness to postpone toilet training.
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Nursing instructor is explaining various stages of lifespan to students. Nurse should offer which of following behaviors by young adult as example of accomplishing Erikson's tasks for psychosocial development during middle adulthood?
- A. Client evaluates his behavior after social interaction
- B. Client states he is learning to trust others
- C. Client wishes to find meaningful relationships
- D. Client expresses concerns about next generation
Correct Answer: D
Rationale: The correct answer is D: Client expresses concerns about the next generation. This behavior aligns with Erikson's task of generativity vs. stagnation in middle adulthood. This stage involves contributing to future generations through mentoring, guiding, and caring for others. Expressing concerns about the next generation demonstrates a sense of responsibility and investment in the well-being of future individuals.
A: Evaluating behavior after social interaction pertains more to self-reflection and self-awareness, not specifically related to generativity.
B: Learning to trust others is more aligned with Erikson's earlier stage of trust vs. mistrust in infancy.
C: Wishing to find meaningful relationships is associated with Erikson's intimacy vs. isolation stage in young adulthood, not middle adulthood.
Nurse is talking with 45 yo client with no specific family hx of cancer or DM, about planning routine screenings. Which client statement indicates client understands how to proceed?
- A. So I don't need colon cancer procedure for another 2-3 yrs
- B. For now, I should continue to have mammogram each year
- C. B/c doctor just did pap smear, I'll come back next year for another
- D. I had my blood glucose test last year so I won't need it again till next year
Correct Answer: B
Rationale: The correct answer is B. The client's statement indicates an understanding of the recommended screening guideline for mammograms for a 45-year-old individual with no specific family history of cancer. Yearly mammograms are typically recommended starting at age 40 for early detection of breast cancer. Choice A is incorrect as colon cancer screening is recommended starting at age 45-50, not in 2-3 years. Choice C is incorrect as Pap smears are typically recommended every 3-5 years, not yearly. Choice D is incorrect as blood glucose testing is usually recommended annually for individuals at risk for diabetes.
Nurse talking with parents of 6 mo infant about gross motor development. Which gross motor skills are expected in next 3 mo? (Select all that apply.)
- A. Rolls from back to front
- B. Bears weight on legs
- C. Walks holding onto furniture
- D. Sits unsupported
- E. Sits down from standing position
Correct Answer: A,B,D
Rationale: The correct answers are A, B, and D. In the next 3 months, the infant is expected to roll from back to front (A), bear weight on legs (B), and sit unsupported (D). Rolling develops around 4-6 months, weight-bearing on legs around 6-9 months, and sitting unsupported around 6-8 months. Choice C, walking holding onto furniture, is more characteristic of the 9-12 month age range. Choice E, sitting down from a standing position, typically occurs after the infant has mastered standing independently, which is beyond the 9-month mark.
A nurse on a med-surg unit has received change-of-shift report & will care for 4 clients. Which of the following client's needs may the nurse assign to an AP?
- A. Feeding client admitted 24h ago with aspiration pneumonia
- B. Reinforcing teaching with client learning to walk using a quad cane
- C. Reapplying a condom catheter for a client with urinary incontinence
- D. Applying sterile dressing to a pressure ulcer
Correct Answer: C
Rationale: The correct answer is C: Reapplying a condom catheter for a client with urinary incontinence. This task involves non-invasive, routine care that can be safely delegated to an assistive personnel (AP). The nurse should ensure that the AP is trained and competent in performing this procedure.
Choice A: Feeding a client with aspiration pneumonia requires assessment and monitoring for signs of aspiration, which should be done by a licensed nurse due to the risk of complications.
Choice B: Reinforcing teaching with a client using a quad cane involves critical thinking, assessment of the client's understanding, and ensuring safety, which should be done by a licensed nurse.
Choice D: Applying a sterile dressing to a pressure ulcer requires sterile technique, assessment of wound status, and potential need for wound care interventions, which should be performed by a licensed nurse.
Nurse planning diversionary activities for children on an inpatient unit. Which should nurse incorporate as appropriate play activities for toddler? (Select all that apply.)
- A. Building simple models
- B. Working with clay
- C. Filling & emptying containers
- D. Playing with blocks
- E. Looking at books
Correct Answer: C,D,E
Rationale: The correct activities for toddlers should focus on their developmental needs. Filling & emptying containers (C) helps with sensory exploration and fine motor skills. Playing with blocks (D) enhances problem-solving and hand-eye coordination. Looking at books (E) promotes language development and cognitive skills. Building simple models (A) and working with clay (B) may not be suitable for toddlers due to potential choking hazards and fine motor skill requirements.