ESI MODEL MCQ 1

1. Using the principles of standard precautions, the nurse would wear gloves in what nursing interventions?

A. Providing a back massage
B. Feeding a client
C. Providing hair care
D. Providing oral hygiene

2. The nurse is preparing to take vital sign in an alert client admitted to the hospital with dehydration secondary to vomiting and diarrhea. What is the best method used to assess the client’s temperature?

A. Oral
B. Axillary
C. Radial
D. Heat sensitive tape

3. A nurse obtained a client’s pulse and found the rate to be above normal. The nurse document this findings as:

A. Tachypnea
B. Hyperpyrexia
C. Arrhythmia
D. Tachycardia

4. Which of the following actions should the nurse take to use a wide base support when assisting a client to get up in a chair?

A. Bend at the waist and place arms under the client’s arms and lift
B. Face the client, bend knees and place hands on client’s forearm and lift
C. Spread his or her feet apart
D. Tighten his or her pelvic muscles

5. A client had oral surgery following a motor vehicle accident. The nurse assessing the client finds the skin flushed and warm. Which of the following would be the best method to take the client’s body temperature?

A. Oral
B. Axillary
C. Arterial line
D. Rectal

6. A client who is unconscious needs frequent mouth care. When performing a mouth care, the best position of a client is:

A. Fowler’s position
B. Side lying
C. Supine
D. Trendelenburg

7. A client is hospitalized for the first time, which of the following actions ensure the safety of the client?

A. Keep unnecessary furniture out of the way
B. Keep the lights on at all time
C. Keep side rails up at all time
D. Keep all equipment out of view

8. A walk-in client enters into the clinic with a chief complaint of abdominal pain and diarrhea. The nurse takes the client’s vital sign hereafter. What phrase of nursing process is being implemented here by the nurse?

A. Assessment
B. Diagnosis
C. Planning
D. Implementation

9. It is best describe as a systematic, rational method of planning and providing nursing care for individual, families, group and community

A. Assessment
B. Nursing Process
C. Diagnosis
D. Implementation

10. Exchange of gases takes place in which of the following organ?

A. Kidney
B. Lungs
C. Liver
D. Heart

11. The chamber of the heart that receives oxygenated blood from the lungs is the:

A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventricle

12. A muscular enlarges pouch or sac that lies slightly to the left which is used for temporary storage of food…

A. Gallbladder
B. Urinary bladder
C. Stomach
D. Lungs

13. The ability of the body to defend itself against scientific invading agent such as bacteria, toxin, viruses and foreign body

A. Hormones
B. Secretion
C. Immunity
D. Glands

14. Hormones secreted by Islets of Langerhans

A. Progesterone
B. Testosterone
C. Insulin
D. Hemoglobin

15. It is a transparent membrane that focuses the light that enters the eyes to the retina.

A. Lens
B. Sclera
C. Cornea
D. Pupils

16. Which of the following is included in Orem’s theory?

A. Maintenance of a sufficient intake of air
B. Self perception
C. Love and belongingness
D. Physiologic needs

17. Which of the following cluster of data belong to Maslow’s hierarchy of needs

A. Love and belonging
B. Physiologic needs
C. Self actualization
D. All of the above

18. This is characterized by severe symptoms relatively of short duration.

A. Chronic Illness
B. Acute Illness
C. Pain
D. Syndrome

19. Which of the following is the nurse’s role in the health promotion

A. Health risk appraisal
B. Teach client to be effective health consumer
C. Worksite wellness
D. None of the above

20. It is describe as a collection of people who share some attributes of their lives.

A. Family
B. Illness
C. Community
D. Nursing

21. Five teaspoon is equivalent to how many milliliters (ml)?

A. 30 ml
B. 25 ml
C. 12 ml
D. 22 ml

22. 1800 ml is equal to how many liters?

A. 1.8
B. 18000
C. 180
D. 2800

23. Which of the following is the abbreviation of drops?

A. Gtt.
B. Gtts.
C. Dp.
D. Dr.

24. The abbreviation for micro drop is…

A. µgtt
B. gtt
C. mdr
D. mgts

25. Which of the following is the meaning of PRN?

A. When advice
B. Immediately
C. When necessary
D. Now

26. Which of the following is the appropriate meaning of CBR?

A. Cardiac Board Room
B. Complete Bathroom
C. Complete Bed Rest
D. Complete Board Room

27. One (1) tsp is equals to how many drops?

A. 15
B. 60
C. 10
D. 30

28. 20 cc is equal to how many ml?

A. 2
B. 20
C. 2000
D. 20000

29. 1 cup is equals to how many ounces?

A. 8
B. 80
C. 800
D. 8000

30. The nurse must verify the client’s identity before administration of medication. Which of the following is the safest way to identify the client?

A. Ask the client his name
B. Check the client’s identification band
C. State the client’s name aloud and have the client repeat it
D. Check the room number

31. The nurse prepares to administer buccal medication. The medicine should be placed…

A. On the client’s skin
B. Between the client’s cheeks and gums
C. Under the client’s tongue
D. On the client’s conjunctiva

32. The nurse administers cleansing enema. The common position for this procedure is…

A. Sims left lateral
B. Dorsal Recumbent
C. Supine
D. Prone

33. A client complains of difficulty of swallowing, when the nurse try to administer capsule medication. Which of the following measures the nurse should do?

A. Dissolve the capsule in a glass of water
B. Break the capsule and give the content with an applesauce
C. Check the availability of a liquid preparation
D. Crash the capsule and place it under the tongue

34. Which of the following is the appropriate route of administration for insulin?

A. Intramuscular
B. Intradermal
C. Subcutaneous
D. Intravenous

35. The nurse is ordered to administer ampicillin capsule TID p.o. The nurse should give the medication…

A. Three times a day orally
B. Three times a day after meals
C. Two time a day by mouth
D. Two times a day before meals

36. Back Care is best described as:

A. Caring for the back by means of massage
B. Washing of the back
C. Application of cold compress at the back
D. Application of hot compress at the back

37. It refers to the preparation of the bed with a new set of linens

A. Bed bath
B. Bed making
C. Bed shampoo
D. Bed lining

38. Which of the following is the most important purpose of handwashing

A. To promote hand circulation
B. To prevent the transfer of microorganism
C. To avoid touching the client with a dirty hand
D. To provide comfort

39. What should be done in order to prevent contaminating of the environment in bed making?

A. Avoid fanning soiled linens
B. Strip all linens at the same time
C. Finished both sides at the time
D. Embrace soiled linen

40. The most important purpose of cleansing bed bath is:

A. To cleanse, refresh and give comfort to the client who must remain in bed
B. To expose the necessary parts of the body
C. To develop skills in bed bath
D. To check the body temperature of the client in bed

41. Which of the following technique involves the sense of sight?

A. Inspection
B. Palpation
C. Percussion
D. Auscultation

42. The first techniques used examining the abdomen of a client is:

A. Palpation
B. Auscultation
C. Percussion
D. Inspection

43. A technique in physical examination that is use to assess the movement of air through the tracheobronchial tree:

A. Palpation
B. Auscultation
C. Inspection
D. Percussion

44. An instrument used for auscultation is:

A. Percussion-hammer
B. Audiometer
C. Stethoscope
D. Sphygmomanometer

45. Resonance is best describe as:

A. Sounds created by air filled lungs
B. Short, high pitch and thudding
C. Moderately loud with musical quality
D. Drum-like

46. The best position for examining the rectum is:

A. Prone
B. Sim’s
C. Knee-chest
D. Lithotomy

47. It refers to the manner of walking

A. Gait
B. Range of motion
C. Flexion and extension
D. Hopping

48. The nurse asked the client to read the Snellen chart. Which of the following is tested:

A. Optic
B. Olfactory
C. Oculomotor
D. Trochlear

49. Another name for knee-chest position is:

A. Genu-dorsal
B. Genu-pectoral
C. Lithotomy
D. Sim’s

50. The nurse prepare IM injection that is irritating to the subcutaneous tissue. Which of the following is the best action in order to prevent tracking of the medication

A. Use a small gauge needle
B. Apply ice on the injection site
C. Administer at a 45° angle
D. Use the Z-track technique

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Answers and Rationale

1. Answer: D. Providing oral hygiene

Doing oral care requires the nurse to wear gloves.

2. Answer: B. Axillary

Axilla is the most accessible body part in this situation.

3. Answer: D. Tachycardia

Tachycardia means rapid heart rate. Tachypnea (Option A) refers to rapid respiratory rate. Hyperpyrexia (Option B) means increase in temperature. Arrhythmia (Option C) means irregular heart rate.

4. Answer: B. Face the client, bend knees and place hands on client’s forearm and lift

This is the proper way on supporting the client to get up in a chair that conforms to safety and proper body mechanics.

5. Answer: B. Axillary

Taking the temperature via the oral route is incorrect since the client had oral surgery. Choice C and D are unnecessary. Taking the temperature via the axilla is the most appropriate route.

6. Answer: B. Side lying

An unconscious client is best placed on his side when doing oral care to prevent aspiration.

7. Answer: C. Keep side rails up at all time

Although the other choices seem correct, they are not the best answer.

8. Answer: A. Assessment

Assessment is the first phase of the nursing process where a nurse collects information about the client. Diagnosis is the formulation of the nursing diagnosis from the information collected during the assessment. In Planning, the nurse sets achievable and measurable short and long term goals. Implementation is where nursing care is given.

9. Answer: B. Nursing Process

The statement describes the Nursing Process. The Nursing Process is the essential core of practice for the registered nurse to deliver holistic, patient-focused care.

10. Answer: B. Lungs

11. Answer: A. Left atrium

The left atrium receives oxygenated blood from the lungs and pumps it to the left ventricle. The right atrium receives blood from the veins and pumps it to the right ventricle. The right ventricle receives blood from the right atrium and pumps it to the lungs, where it is loaded with oxygen. The left ventricle (the strongest chamber) pumps oxygen-rich blood to the rest of the body, its vigorous contractions create the blood pressure.

12. Answer: C. Stomach

13. Answer: C. Immunity

14. Answer: C. Insulin

The Islets of Langerhans are the regions of the pancreas that contain its endocrine cells. Progesterone (Choice A) is produced by the ovaries. Testosterone (Choice B) is secreted by the testicles of males and ovaries of females. Hemoglobin (Choice D) is a protein molecule in the red blood cells that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide.

15. Answer: C. Cornea

The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. The cornea is like the crystal of a watch.

16. Answer: A. Maintenance of a sufficient intake of air

Dorothea Orem’s Self-Care Theory defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness.” Choices B, C, and D are from Abraham Maslow’s Hierarchy of Needs.

17. Answer: D. All of the above

All of the choices are part of Maslow’s Hierarchy of Needs.

18. Answer: B. Acute Illness

Chronic Illness (Choice A) are illnesses that are persistent or long-term.

19. Answer: B. Teach client to be effective health consumer

20. Answer: C. Community

Family is defined as a group consisting typically of parents and children living together in a household.

21. Answer: B. 25 ml

One teaspoon is equal to 5ml.

22. Answer: A. 1.8

23. Answer: B. Gtts.

Gtt (Choice A) is an abbreviation for drop. Dp and Dr are not recognized abbreviation for measurement.

24. Answer: A. µgtt

25. Answer: C. When necessary

PRN comes from the Latin “pro re nata” meaning, for an occasion that has arisen or as circumstances require.

26. Answer: C. Complete Bed Rest

CBR means complete bed rest. For more abbreviations, please see this post.

27. Answer: B. 60

One teaspoon (tsp) is equal to 60 drops (gtts).

28. Answer: B. 20

One cubic centimeter is equal to one milliliter.

29. Answer: A. 8

One cup is equal to 8 ounces.

30. Answer: B. Check the client’s identification band

The identification band is the safest way to know the identity of a patient whether he is conscious or unconscious. Ask the client his name only after you have checked his ID band.

31. Answer: B. Between the client’s cheeks and gums

32. Answer: A. Sims left lateral

This position provides comfort to the patient and an easy access to the natural curvature of the rectum.

33. Answer: C. Check the availability of a liquid preparation

The nurse should check first if the medication is available in liquid form before doing Choice A. Placing it under the tongue is not the intended way of administering an oral medication.

34. Answer: C. Subcutaneous

The subcutaneous tissue of the abdomen is preferred because absorption of the insulin is more consistent from this location than subcutaneous tissues in other locations.

35. Answer: A. Three times a day orally

TID is the Latin for “ter in die” which means three times a day. P.O. means per orem or through mouth.

36. Answer: A. Caring for the back by means of massage

37. Answer: B. Bed making

38. Answer: B. To prevent the transfer of microorganism

Hand washing is the single most effective infection control measure.

38. Answer: A. Avoid fanning soiled linens

Fanning soiled linens would scatter the lodged microorganisms and dead skin cells on the linens.

40. Answer: A. To cleanse, refresh and give comfort to the client who must remain in bed

41. Answer: A. Inspection

Palpation is a method of feeling with the fingers or hands during a physical examination. Percussion is a method of tapping on a surface to determine the underlying structure, and is used in clinical examinations to assess the condition of the thorax or abdomen. Auscultation (based on the Latin verb auscultare “to listen”) is listening to the internal sounds of the body, usually using a stethoscope.

42. Answer: D. Inspection

For abdominal exam, auscultation is performed before palpation because the act of palpation could change what was auscultated. Remember the mnemonic “I-A-Per-Pal”.

43. Answer: B. Auscultation

44. Answer: C. Stethoscope

45. Answer: A. Sounds created by air filled lungs

46. Answer: C. Knee-chest

To assume the genupectoral position the person kneels so that the weight of the body is supported by the knees and chest, with the buttocks raised. The head is turned to one side and the arms are flexed so that the upper part of the body can be supported in part by the elbows.

47. Answer: A. Gait

48. Answer: A. Optic

Cranial Nerve II or the optic nerve is tested through the use of the Snellen chart.

49. Answer: B. Genu-pectoral

50. Answer: D. Use the Z-track technique

During the procedure, skin and tissue are pulled and held firmly while a long needle is inserted into the muscle. After the medication is injected, the skin and tissue are released. The needle track that forms during this procedure takes the shape of the letter “Z,” which gives the procedure its name. This zigzag track line is what prevents medication from leaking from the muscle into surrounding tissue.

FUNDAMENTAL NURSING BULLETS - 9

Ø  When answering a question on the NCLEX examination, the student should consider the cue (the stimulus for a thought) and the inference (the thought) to determine whether the inference is correct. When in doubt, the nurse should select an answer that indicates the need for further information to eliminate ambiguity. For example, the patient complains of chest pain (the stimulus for the thought) and the nurse infers that the patient is having cardiac pain (the thought). In this case, the nurse hasn’t confirmed whether the pain is cardiac. It would be more appropriate to make further assessments.

Ø  Veracity is truth and is an essential component of a therapeutic relationship between a health care provider and his patient.

Ø  Beneficence is the duty to do no harm and the duty to do good. There’s an obligation in patient care to do no harm and an equal obligation to assist the patient.

Ø  Nonmaleficence is the duty to do no harm.

Ø  Frye’s ABCDE cascade provides a framework for prioritizing care by identifying the most important treatment concerns.

A = Airway. This category includes everything that affects a patent airway, including a foreign object, fluid from an upper respiratory infection, and edema from trauma or an allergic reaction.

B = Breathing. This category includes everything that affects the breathing pattern, including hyperventilation or hypoventilation and abnormal breathing patterns, such as Korsakoff’s, Biot’s, or Cheyne-Stokes respiration.

C = Circulation. This category includes everything that affects the circulation, including fluid and electrolyte disturbances and disease processes that affect cardiac output.

D = Disease processes. If the patient has no problem with the airway, breathing, or circulation, then the nurse should evaluate the disease processes, giving priority to the disease process that poses the greatest immediate risk. For example, if a patient has terminal cancer and hypoglycemia, hypoglycemia is a more immediate concern.

 E = Everything else. This category includes such issues as writing an incident report and completing the patient chart. When evaluating needs, this category is never the highest priority.

Ø  When answering a question on an NCLEX examination, the basic rule is “assess before action.” The student should evaluate each possible answer carefully. Usually, several answers reflect the implementation phase of nursing and one or two reflect the assessment phase. In this case, the best choice is an assessment response unless a specific course of action is clearly indicated.

Ø  Rule utilitarianism is known as the “greatest good for the greatest number of people” theory.

Ø  Egalitarian theory emphasizes that equal access to goods and services must be provided to the less fortunate by an affluent society.

Ø  Active euthanasia is actively helping a person to die.

Ø  Brain death is irreversible cessation of all brain function.

Ø  Passive euthanasia is stopping the therapy that’s sustaining life.

Ø  A third-party payer is an insurance company.

Ø  Utilization review is performed to determine whether the care provided to a patient was appropriate and cost-effective.

Ø  A value cohort is a group of people who experienced an out-of-the-ordinary event that shaped their values.

Ø  Voluntary euthanasia is actively helping a patient to die at the patient’s request.

Ø  Bananas, citrus fruits, and potatoes are good sources of potassium.

Ø  Good sources of magnesium include fish, nuts, and grains.

Ø  Beef, oysters, shrimp, scallops, spinach, beets, and greens are good sources of iron.

Ø  Intrathecal injection is administering a drug through the spine.

Ø  When a patient asks a question or makes a statement that’s emotionally charged, the nurse should respond to the emotion behind the statement or question rather than to what’s being said or asked.

Ø  The steps of the trajectory-nursing model are as follows:
      Step 1: Identifying the trajectory phase
      Step 2: Identifying the problems and establishing goals
      Step 3: Establishing a plan to meet the goals
      Step 4: Identifying factors that facilitate or hinder attainment of the goals
      Step 5: Implementing interventions
      Step 6: Evaluating the effectiveness of the interventions

Ø  A Hindu patient is likely to request a vegetarian diet.

Ø  Pain threshold, or pain sensation, is the initial point at which a patient feels pain.

Ø  The difference between acute pain and chronic pain is its duration.

Ø  Referred pain is pain that’s felt at a site other than its origin.

Ø  Alleviating pain by performing a back massage is consistent with the gate control theory.

Ø  Romberg’s test is a test for balance or gait.

Ø  Pain seems more intense at night because the patient isn’t distracted by daily activities.

Ø  Older patients commonly don’t report pain because of fear of treatment, lifestyle changes, or dependency.

Ø  No pork or pork products are allowed in a Muslim diet.

Ø  Two goals of Healthy People 2010 are:
    1. Help individuals of all ages to increase the quality of life and the number of years of optimal health
    2. Eliminate health disparities among different segments of the population.

Ø  A community nurse is serving as a patient’s advocate if she tells a malnourished patient to go to a meal program at a local park.

Ø  If a patient isn’t following his treatment plan, the nurse should first ask why.

Ø  Falls are the leading cause of injury in elderly people.

Ø  Primary prevention is true prevention. Examples are immunizations, weight control, and smoking cessation.

Ø  Secondary prevention is early detection. Examples include purified protein derivative (PPD), breast self-examination, testicular self-examination, and chest X-ray.

         Ø  Tertiary prevention is treatment to prevent long-term complications

FUNDAMENTAL NURSING BULLETS -8

Ø  The two nursing diagnoses that have the highest priority that the nurse can assign are Ineffective airway clearance and Ineffective breathing pattern.

Ø  A subjective sign that a sitz bath has been effective is the patient’s expression of decreased pain or discomfort.

Ø  For the nursing diagnosis Deficient diversional activity to be valid, the patient must state that he’s “bored,” that he has “nothing to do,” or words to that effect.

Ø   The most appropriate nursing diagnosis for an individual who doesn’t speak English is Impaired verbal communication related to inability to speak dominant language (English).

Ø  The family of a patient who has been diagnosed as hearing impaired should be instructed to face the individual when they speak to him.

Ø  Before instilling medication into the ear of a patient who is up to age 3, the nurse should pull the pinna down and back to straighten the eustachian tube.

Ø   To prevent injury to the cornea when administering eyedrops, the nurse should waste the first drop and instill the drug in the lower conjunctival sac.

Ø   After administering eye ointment, the nurse should twist the medication tube to detach the ointment.

Ø   When the nurse removes gloves and a mask, she should remove the gloves first. They are soiled and are likely to contain pathogens.

Ø   Crutches should be placed 6″ (15.2 cm) in front of the patient and 6″ to the side to form a tripod arrangement.

Ø  Listening is the most effective communication technique.

Ø   Before teaching any procedure to a patient, the nurse must assess the patient’s current knowledge and willingness to learn.

Ø   Process recording is a method of evaluating one’s communication effectiveness.

Ø  When feeding an elderly patient, the nurse should limit high-carbohydrate foods because of the risk of glucose intolerance.

Ø   When feeding an elderly patient, essential foods should be given first.

Ø   Passive range of motion maintains joint mobility. Resistive exercises increase muscle mass.

Ø   Isometric exercises are performed on an extremity that’s in a cast.

Ø  A back rub is an example of the gate-control theory of pain.

Ø   Anything that’s located below the waist is considered unsterile; a sterile field becomes unsterile when it comes in contact with any unsterile item; a sterile field must be monitored continuously; and a border of 1″ (2.5 cm) around a sterile field is considered unsterile.

Ø  A “shift to the left” is evident when the number of immature cells (bands) in the blood increases to fight an infection.

Ø  A “shift to the right” is evident when the number of mature cells in the blood increases, as seen in advanced liver disease and pernicious anemia.

Ø   Before administering preoperative medication, the nurse should ensure that an informed consent form has been signed and attached to the patient’s record.

Ø  A nurse should spend no more than 30 minutes per 8-hour shift providing care to a patient who has a radiation implant.

Ø  A nurse shouldn’t be assigned to care for more than one patient who has a radiation implant.

Ø  Long-handled forceps and a lead-lined container should be available in the room of a patient who has a radiation implant.

Ø  Usually, patients who have the same infection and are in strict isolation can share a room.

Ø  Diseases that require strict isolation include chickenpox, diphtheria, and viral hemorrhagic fevers such as Marburg disease.

Ø  For the patient who abides by Jewish custom, milk and meat shouldn’t be served at the same meal.

Ø  Whether the patient can perform a procedure (psychomotor domain of learning) is a better indicator of the effectiveness of patient teaching than whether the patient can simply state the steps involved in the procedure (cognitive domain of learning).

Ø  According to Erik Erikson, developmental stages are trust versus mistrust (birth to 18 months), autonomy versus shame and doubt (18 months to age 3), initiative versus guilt (ages 3 to 5), industry versus inferiority (ages 5 to 12), identity versus identity diffusion (ages 12 to 18), intimacy versus isolation (ages 18 to 25), generativity versus stagnation (ages 25 to 60), and ego integrity versus despair (older than age 60).

Ø  When communicating with a hearing impaired patient, the nurse should face him.

Ø  An appropriate nursing intervention for the spouse of a patient who has a serious incapacitating disease is to help him to mobilize a support system.

Ø  Hyperpyrexia is extreme elevation in temperature above 106° F (41.1° C).

Ø  Milk is high in sodium and low in iron.

Ø  When a patient expresses concern about a health-related issue, before addressing the concern, the nurse should assess the patient’s level of knowledge.

Ø  The most effective way to reduce a fever is to administer an antipyretic, which lowers the temperature set point.

Ø  When a patient is ill, it’s essential for the members of his family to maintain communication about his health needs.

Ø  Ethnocentrism is the universal belief that one’s way of life is superior to others.

Ø  When a nurse is communicating with a patient through an interpreter, the nurse should speak to the patient and the interpreter.

Ø  In accordance with the “hot-cold” system used by some Mexicans, Puerto Ricans, and other Hispanic and Latino groups, most foods, beverages, herbs, and drugs are described as “cold.”

Ø  Prejudice is a hostile attitude toward individuals of a particular group.

Ø  Discrimination is preferential treatment of individuals of a particular group. It’s usually discussed in a negative sense.

Ø  Increased gastric motility interferes with the absorption of oral drugs.

Ø  The three phases of the therapeutic relationship are orientation, working, and termination.

Ø  Patients often exhibit resistive and challenging behaviors in the orientation phase of the therapeutic relationship.

Ø  Abdominal assessment is performed in the following order: inspection, auscultation, percussion & palpation.

Ø  When measuring blood pressure in a neonate, the nurse should select a cuff that’s no less than one-half and no more than two-thirds the length of the extremity that’s used.

Ø  When administering a drug by Z-track, the nurse shouldn’t use the same needle that was used to draw the drug into the syringe because doing so could stain the skin.

Ø  Sites for intradermal injection include the inner arm, the upper chest, and on the back, under the scapula.

     Ø  When evaluating whether an answer on an examination is correct, the nurse                 should consider whether the action that’s described promotes autonomy                       (independence), safety, self-esteem, and a sense of belonging