Free NCLEX-RN practice
Free NCLEX-RN Health Promotion & Maintenance Questions
Free NCLEX-RN health promotion and maintenance practice questions with rationales — growth and development, screening, and prevention.
8 health promotion & maintenance practice questions with rationales
An 18-year-old repeatedly changes major, friend group, and style of dress and cannot yet commit to personal beliefs or long-term goals. Which nursing approach best supports this adolescent's psychosocial development?
Correct answer: A
Adolescence centers on identity versus role confusion, and the task is supported by letting the young person explore different roles, interests, and values without pressure so they can build a self-chosen identity. Pushing premature commitment can foreclose identity development, focusing on a committed partnership belongs to the next stage (intimacy versus isolation), and framing normal exploration as a failure of trust (an infancy task) misreads the behavior.
Why the other options are wrong
- B. Adolescent identity formation requires role experimentation. Pressuring the client to commit to a career and friend group now can lead to identity foreclosure or role confusion because it cuts off necessary self-exploration. Key distinction: Forcing a choice halts the developmental process of self-exploration.
- C. Intimacy versus isolation is the task of young adulthood. Directing teaching toward forming a romantic partnership introduces this task too early, as a stable identity is a prerequisite for healthy intimacy. Key distinction: An individual must establish a firm sense of identity in adolescence before they can successfully form deep, committed relationships in young adulthood.
- D. Trust versus mistrust is the developmental task of infancy. Telling parents that this behavior represents a failure of trust is incorrect because role exploration is normal adolescent behavior, not a regression to infancy. Key distinction: Trust is established in infancy, whereas role exploration is a hallmark of adolescent identity development.
Key takeaway
Support adolescent identity by encouraging exploration of roles and values, not by forcing a fixed choice.
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An 8-year-old is hospitalized for 2 weeks. Which nursing action best supports the psychosocial task of the school-age child?
Correct answer: A
The psychosocial task of the school-age child is industry versus inferiority: the child builds a sense of competence by producing and completing real work. Helping the hospitalized child keep up with schoolwork and finish achievable tasks protects that developing sense of accomplishment. Consistent caregiving supports the infant's trust, offering choices supports the toddler's autonomy, and child-led pretend play supports the preschooler's initiative: all valuable, but each fits a different stage.
Why the other options are wrong
- B. Trust versus mistrust is the primary task of infancy. Providing a consistent nurse to build trust targets this infant need rather than the school-age child's need for competence. Key distinction: Infants require emotional security and predictability, whereas school-age children require task achievement and cognitive stimulation.
- C. Autonomy versus shame and doubt is the primary task of toddlerhood. Offering choices supports a toddler's desire for physical control, whereas school-age children seek intellectual and task-oriented accomplishments. Key distinction: Toddlers seek physical control over their environment, while school-age children seek competence through real, structured work.
- D. Initiative versus guilt is the primary task of the preschool years. Pretend-play scenarios support the preschooler's imaginative exploration, whereas school-age children prefer structured, rule-bound activities with a concrete outcome. Key distinction: Preschoolers use imaginative play to explore roles, whereas school-age children seek competence through completing real work.
Key takeaway
The school-age child's task is industry versus inferiority; support it by helping the child complete real, achievable work.
A nurse is teaching a 15-year-old newly diagnosed with type 1 diabetes. Given the cognitive stage now emerging at this age, which teaching approach is most appropriate?
Correct answer: B
By adolescence, formal operational thinking is emerging, so the teen can reason abstractly and think through hypothetical 'what if' consequences over time. Teaching that connects today's choices to long-term outcomes and explores hypothetical scenarios matches this new ability. Concrete, tangible, step-by-step and repetition-with-reward methods suit the concrete operational school-age child, who reasons best about what is real and present rather than abstract or future possibilities.
Why the other options are wrong
- A. Concrete operational thinking relies on tangible, physical steps. Breaking skills into concrete, hands-on steps is ideal for school-age children but underutilizes the adolescent's ability to grasp the abstract rationale behind their treatment. Key distinction: Concrete thinkers reason about visible actions, whereas formal operational teens can reason about abstract physiological processes.
- C. Concrete operational thinkers cannot reason effectively about abstract future states. Limiting teaching to visible objects and avoiding hypotheticals fits concrete operational thinking, not the emerging formal operational stage of the teen. Key distinction: Concrete operational thinkers require physical presence, while formal operational teens can handle hypothetical outcomes.
- D. Concrete operational learning is supported by simple lists without complex explanations. Using a daily checklist without explaining the reasons behind the tasks treats the client like a school-age child and underuses the adolescent's emerging ability to think through consequences. Key distinction: Adolescents require logical explanations of cause and effect to promote treatment adherence.
Key takeaway
As formal operational thinking emerges in adolescence, teach with abstract reasoning and hypothetical 'what if' consequences.
A 4-year-old is admitted to the pediatric unit. Which nursing approach best supports the psychosocial task of the preschool years?
Correct answer: D
The preschooler's task is initiative versus guilt: the child thrives by imagining, planning, and starting activities of their own. Encouraging the child to lead pretend play and try out their own ideas nurtures initiative. Keeping a caregiver near and responding to distress supports the infant's trust; offering acceptable choices supports the toddler's autonomy; and giving achievable tasks with praise supports the school-age child's industry.
Why the other options are wrong
- A. Trust versus mistrust is the primary task of infancy. Keeping the caregiver near and responding to distress supports the infant's need for security, but does not actively nurture the preschooler's need to initiate and direct activities. Key distinction: Trust focuses on emotional security, while initiative focuses on active planning and goal-seeking.
- B. Autonomy versus shame and doubt is the primary task of toddlerhood. Offering two acceptable choices supports a toddler's need for physical control, whereas initiative involves active planning, goal-seeking, and creative imagination. Key distinction: Autonomy focuses on developing willpower and self-control, while initiative focuses on purposeful, creative actions.
- C. Industry versus inferiority is the primary task of school-age children. Giving achievable tasks and praising finished work supports the school-age child's need for competence, whereas preschoolers focus on creative play and the process of exploration. Key distinction: School-age children seek competence through real, structured work and peer-matched standards, whereas preschoolers focus on imaginative play.
Key takeaway
Letting a preschooler imagine, plan, and lead play supports Erikson's initiative versus guilt.
A client asks the nurse which situation makes her a candidate for a trial of labor after a previous cesarean (VBAC). Which statement by the nurse is correct?
Correct answer: C
A trial of labor after cesarean is generally considered when the prior incision was a single low transverse uterine incision, which carries the lowest risk of rupture. A classic (vertical) scar is a contraindication because of its high rupture risk; two or more prior low transverse cesareans do not automatically exclude a trial of labor, so an absolute 'always rules out' statement is overstated; and a VBAC must occur where an emergency cesarean can be performed immediately, not at a birth center without surgical backup.
Why the other options are wrong
- A. A classic vertical uterine incision extends into the active muscular segment of the uterus. Key distinction: The scar tissue in this area is weaker and under intense tension during contractions, making a trial of labor an absolute contraindication due to the high risk of rupture.
- B. Having two prior low transverse cesarean deliveries does not automatically exclude a client from attempting a VBAC. Key distinction: Clinical guidelines state that a trial of labor may be considered for clients with two prior low transverse incisions, depending on their overall obstetric risk profile, so it is not an absolute exclusion.
- D. A trial of labor after cesarean carries a risk of sudden uterine rupture, which is a life-threatening emergency. Key distinction: TOLAC must be conducted in a hospital with a surgical team, obstetrician, and anesthesiologist immediately available to perform an emergency cesarean, making birth centers without these capabilities unsafe.
Key takeaway
VBAC is generally considered with a prior low transverse incision and must occur where emergency cesarean is available.
The nurse teaches parents how to feed an infant born with a cleft lip and palate before surgical repair. Which techniques should the nurse include? Select all that apply.
Correct answers: o1, o2, o3, o6
An infant with a cleft cannot form a normal seal, so feeding is done upright to reduce choking and nasal reflux, with a wide or special nipple to deliver milk, frequent burping because these infants swallow extra air, and attention to reducing that swallowed air. Feeding the infant semi-reclined raises the risk of aspiration and nasal reflux, and pushing a single feeding until the whole bottle is gone tires the infant instead of helping; feeds are kept to about 30 minutes.
Why the other options are wrong
- o4. A cleft infant is fed upright, not semi-reclined; reclining raises the risk of choking and milk coming out the nose even at a slow pace.
- o5. Cleft feeds are limited to roughly 30 minutes; pushing a single feeding until the whole bottle is gone tires the infant and raises the risk of aspiration.
Key takeaway
Cleft lip and palate feeding: upright position, wide or special nipple, frequent burping, and reduce swallowed air.
The nurse teaches the parents of an infant with gastroesophageal reflux about home care. Which instructions are appropriate? Select all that apply.
Correct answers: o1, o2, o3, o5
Reflux is eased by keeping the infant upright after feeds so gravity keeps milk down, thickening feeds as ordered, giving smaller and more frequent feeds to avoid overfilling the stomach, and burping to release swallowed air. Slumped seated positioning in a car seat raises intra-abdominal pressure and worsens reflux, and giving extra water is unsafe for young infants and does not treat reflux.
Why the other options are wrong
- o4. Slumped seated positioning in a car seat or infant seat bends the infant forward and raises intra-abdominal pressure, which can worsen reflux; hold the infant upright instead.
- o6. Extra water between feeds can be unsafe for a young infant, risking water intoxication and hyponatremia, and it does not reduce reflux.
Key takeaway
Infant reflux care: upright after feeds, thickened feeds as ordered, smaller frequent feeds, and burping.
The nurse watches a 7-month-old lose all interest in a rattle the instant it is covered with a cloth, acting as if the rattle no longer exists. Which nursing action best supports the cognitive skill this infant is just beginning to develop?
Correct answer: A
Object permanence (knowing an object exists even when out of sight) is the sensorimotor achievement that emerges around 8 to 12 months, and at 7 months it is just appearing. Peek-a-boo and hide-and-find games let the infant practice searching for something that has disappeared, so they directly support this developing skill. The other activities are appropriate infant stimulation but target sensory exploration, language, or social awareness rather than object permanence.
Why the other options are wrong
- B. Sensory-motor exploration focuses on physical interaction with the immediate environment. Grasping and mouthing rattles fits this exploration, which does not require or build the concept that hidden objects still exist. Key distinction: Tactile toys promote motor skills, whereas object permanence requires maintaining a mental image of an unseen object.
- C. Early language stimulation uses verbal interaction to promote speech. Talking and singing to encourage babbling fits language development but does not teach the concept that physical objects persist when hidden. Key distinction: Auditory stimulation builds communication skills, while object permanence is a cognitive understanding of physical object persistence.
- D. Self-recognition and physical positioning are promoted by tummy time with mirrors. Using a mirror nearby supports self-identity and physical neck strength, not the searching behavior needed to find hidden items. Key distinction: Mirrors reinforce visual self-awareness, whereas object permanence is practiced by finding objects that have vanished from view.
Key takeaway
Peek-a-boo and hide-and-find games support object permanence, the sensorimotor skill of knowing hidden objects still exist.