Nokea
The nurse correctly explains that this is normal behavior for toddlers who are developing which psychosocial characteristic?
- A. Integrity
- B. Identity
- C. Autonomy
- D. Generativity
Correct Answer: C
Rationale: The 'no' phase reflects toddlers asserting autonomy, per Erikson's stages.
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If ruminations about suicide are present, which observation by the nurse is most significant?
- A. The teen is not attending school regularly.
- B. The teen is hoarding sharp objects in the bedroom.
- C. The teen is not completing homework assignments.
- D. The teen is not participating in extracurricular activities.
Correct Answer: B
Rationale: Hoarding sharp objects indicates a high risk for self-harm.
When discussing the home environment with the parents, the nurse should explain that which one of the following is the most appropriate environment for an autistic child?
- A. Stimulating, with a variety of sensory experiences
- B. Consistent, with a minimum of physical change
- C. Flexible, with the freedom to initiate activity
- D. Strict, with narrow limits for acceptable behavior
Correct Answer: B
Rationale: Consistency minimizes anxiety and supports routine.
Which nursing action best conveys an interest in this client and her situation?
- A. Making frequent eye contact with her
- B. Reviewing birth control clinic literature
- C. Writing down information the client provides
- D. Avoiding long pauses between questions
Correct Answer: C
Rationale: Writing down information shows attentiveness and validates the client's concerns.
Which response by the nurse provides the best explanation of the child's behavior?
- A. Thumb sucking is a primitive form of self-stimulation and security.
- B. Thumb sucking is a regressive behavior with a comforting effect.
- C. Thumb sucking substitutes for the missing fluids due to postoperative restriction of fluids.
- D. Thumb sucking satisfies the child's increased need for a familiar touch.
Correct Answer: B
Rationale: Thumb sucking is a regressive behavior triggered by stress, offering comfort.
Which area of the adolescent's social history is most appropriate for the clinic nurse to assess?
- A. Peer relationships
- B. School performance
- C. Church attendance
- D. Employment records
Correct Answer: A
Rationale: Peer relationships strongly influence gang involvement and antisocial behavior.