AQ Peds Growth and Development

The nurse observes that a school-age child does not have proper oral hygiene and therefore is at an increased risk for oral problems. The parents tell the nurse that the child brushes the teeth independently. What does the nurse suggest to the parents? 1. "Help the child with brushing and flossing." 2. "Ask the child to use a brush with hard bristles." 3. "Ask the child to brush every hour for a few days." 4. "Avoid fruit juice and sugary beverages in the child's diet.

1. "Help the child with brushing and flossing." Brushing and flossing conscientiously helps prevent oral problems. In this case, the child may not be able to brush the teeth effectively without parental assistance, which may have caused the oral problems. Therefore the nurse should instruct the parents to help the child with brushing and flossing. Hard bristles may hurt the gums, so the nurse should advise the parents to use a brush with soft nylon bristles. It is not necessary to brush every hour, but teeth should be brushed after meals and snacks and before bedtime. It is not a requirement to avoid fruit juice, but fruit juice and other sugary drinks should be limited to prevent the risk for dental caries.

The parents inform the nurse that their school-age child frequently plays in hazardous places. However, the parents find it difficult to restrain the child from engaging in such activities. Which instruction is a priority in this case? 1. "Always accompany the child everywhere." 2. "Avoid giving any sports equipment to the child." 3. "Ensure the child has eye, ear, or mouth protection." 4. "Avoid outdoor games and invite the child's friends to your home."

3. "Ensure the child has eye, ear, or mouth protection." School-age children have well-developed motor functions, so they engage in hazardous activities. Therefore it is important to ensure that the child has eye, ear, or mouth protection to prevent injuries and accidents. It may not be feasible to accompany the child everywhere. The child is not at risk for injury from sports equipment alone, but also from reckless physical activities like running or jumping. Avoiding outdoor games is restricting the child's developmental needs.

The nurse examines a child for the appearance of the neurologic reflex that is a protective response during a fall. The nurse is aware that this reflex appears during the first year of life, and persists indefinitely. What is the likely age of the infant? 1. 2 months 2. 3 months 3. 6 months 4. 7 months

4. 7 months The neurologic reflex that develops as a protective response during a fall is called the parachute reflex. When an infant is suspended in a horizontal prone position and is suddenly thrust downward, the infant demonstrates the parachute reflex by extending the hands and fingers forward as if to protect against falling. This reflex appears at 7 to 9 months, and persists indefinitely. So the infant in this scenario is likely to be 7 months old. Labyrinth righting appears at 2 months, neck righting at 3 months, and body righting at 6 months. None of these three reflexes act as a protective response during a fall, nor do they persist indefinitely.

A nurse counsels the parents of a five-year-old child. Which of these concepts would the nurse include in the discussion? Select all that apply. 1. Animism 2. Egocentrism 3. Logical reasoning 4. Concrete thinking 5. Object permanence

1. Animism and 2. Egocentrism The nurse will explain the concepts of egocentrism and animism to the parents of a five-year-old child. Logical reasoning is associated with individuals who are 11 years and older. Concrete thinking is associated with children from the ages of 7 to 11 years old. Object permanence is observed in children between birth and two years old.

Which are general growth parameters for an adolescent client that the nurse will monitor during a growth and development assessment during a health maintenance visit? Select all that apply. 1. Height 2. Weight 3. Body mass 4. Blood pressure 5. Head circumference

1. Height 2. Weight 3. Body mass Growth parameters that the nurse includes in the growth and developmental assessment for an adolescent client includes height, weight, and body mass. Blood pressure is a vital sign, not a growth parameter. Head circumference is assessed until 36 months of age; therefore, this is not an appropriate growth parameter for the nurse to include in the growth and developmental assessment.

Which type of prehension is exhibited by a 5-month-old infant? 1. The grasp is palmar. 2. Hands are mostly open. 3. The grasp is a crude pincer. 4. Hands are predominantly closed.

1. The grasp is palmar. A 5-month-old infant is able to voluntarily grasp an object using the whole hand; this is called a palmar grasp. At 3 months of age, the hands are mostly open. By 8 to 9 months of age the infant uses a crude pincer grasp, using the thumb and index finger. At 1 month of age the hands are predominantly closed.

Which data collected during the nursing assessment for a 24-month-old client indicates the need for further evaluation for delayed language? Select all that apply. 1. The child uses two-word sentences. 2. The child cries and points at an object he wants. 3. The child states, "Me do it" when asked to stack blocks. 4. The child understands the meaning of as many as 50 words. 5. The child asks, "What's that?" when the nurse uses the stethoscope to assess lung sounds.

2. The child cries and points at an object he wants. 4. The child understands the meaning of as many as 50 words Observations made during the nursing assessment for a 24-month-old client that would require further evaluation for a language delay include: the child crying and pointing at an object that is wanted and the child who understands the meaning of only 50 words (300 is expected by this stage of development). The use of two-word sentences, "Me do it," and asking "What's that?" are all expected findings for the 24-month-old client in regards to language development.

Which period of Piaget's theory covers the prevalence of egocentrism in adolescents? 1. Sensorimotor 2. Preoperational 3. Formal operations 4. Concrete operations

3. Formal operations Formal operations is the fourth period of Piaget's theory. During this period, there is a prevalence of egocentric thought. This egocentricity leads adolescents to demonstrate feelings and behaviors characterized by self-consciousness. The sensorimotor period is the first period of Piaget's theory. In this period, infants develop a schema or action pattern for dealing with the environment. The preoperational period is the second period. During this time, children learn to think with the use of symbols and mental images. Concrete operations is the third period of Piaget's theory. During this period, children are able to coordinate two concrete perspectives in social and scientific thinking.

How is stage 2 of Kohlberg's theory different from stage 1? 1. Stage 2 is a premoral stage. 2. Stage 2 is focused on avoiding punishments. 3. Stage 2 is based on a child obeying his or her parent's rules. 4. Stage 2 is about recognizing another's point of view.

4. Stage 2 is about recognizing another's point of view. During stage 2 of Kohlberg's theory, a child learns that there can be more than one point of view. Both stages 1 and 2 are premoral stages that are associated with limited cognitive thinking. Both stages involve a child wanting to avoid punishment and showing obedience to a parent's rules.

The nurse notes that the peak height velocity (PHV) for an 11-year-old female has occurred since the last health maintenance visit. Which assessment question should the nurse ask the adolescent based on this data? 1. "Have you begun to menstruate?" 2. "How tall do you think you will get?" 3. "What do you typically eat in a normal day?" 4. "Are you taller than most of the other girls in your class?"

Correct 1. "Have you begun to menstruate?" An accelerated rate of linear growth is referred to as PHV. When this occurs for a school-age or adolescent female client, it is a predictor for menarche; therefore, asking the client if she has begun to menstruate is an appropriate assessment question. Typically, menarche begins 6 to 12 months after PHV. The other questions are not inappropriate, but they are not assessment questions that should be asked based on the current client data.

The nurse is caring for a child who has attention deficit-hyperactivity disorder (ADHD). Which changes in the child's classroom will be beneficial? Select all that apply. 1. Providing breaks frequently at regular intervals 2. Writing instructions on the blackboard after verbalization 3. Increasing the number of classroom assignments and homework 4. Improving the writing skills of the child compared with computer skills 5. Scheduling academic subjects for times when the child is under the effect of medication

Correct 1. Providing breaks frequently at regular intervals Correct 2. Writing instructions on the blackboard after verbalization Correct 5. Scheduling academic subjects for times when the child is under the effect of medication A child with ADHD will not be able to concentrate properly and experiences difficulty sitting in one place for a prolonged time. Therefore frequent breaks are helpful to improve the child's concentration. Visual representations also help attract attention and improve concentration. Therefore it is appropriate to write instructions after saying them. The child will have increased concentration under the effect of medication, which is generally in the morning. Therefore academic subjects should be scheduled for the morning. A child with ADHD will have dysgraphia, or poor handwriting. Therefore it is appropriate to concentrate on improving the child's computer skills, instead of improving handwriting. It is appropriate to allot more time to take tests and help the child complete tasks rather than giving homework and assignments.

A student nurse compares the sources of stress in both 7-year-olds and 12-year-olds. Which source of stress is prevalent in children of both these age groups? 1. Idols 2. Health 3. Money 4. Confusion

Correct 1.Idols Idols are a source of stress for both 7-year-old and 12-year-old children. The 7-year-old has a desire to be more like an admired idol. The 12-year-old continues hero worshipping. Health is a source of stress for 12-year-olds and some may become hypochondriacs during this period of development. Health is not a source of stress for 7-year-olds. Money can be a source of stress for the 12-year-old. This child is anxious to earn and handle money but often uses poor judgment. Money is not yet a matter of concern for the 7-year-old. Too much freedom can create confusion in a 12-year-old and can cause the child to flounder. A 7-year-old does not usually have much freedom and, thereby, does not experience the accompanying stress.

Which type of relationship is most important to the school-age child? 1. Same-sex peer relationships 2. Opposite-sex peer relationship 3. Same-sex parental relationship 4. Opposite-sex parental relationship

Correct 1.Same-sex peer relationships Same-sex peer relationships are important to the school-age child. Opposite-sex peer relationships become important during adolescence. Parental relationships vary during this stage of development.

The nurse is assessing head growth in an 8-month-old infant. The nurse observes that the rate of the growth has been 0.5 cm per month since the 6-month check-up. What does the nurse tell the parents about the child's development? 1. "The child needs to be screened." 2. "The child's head growth is normal." 3. "The child's posterior fontanel is not fused." 4. "There may be some developmental issues."

Correct 2 "The child's head growth is normal." After the sixth month, the infant's head grows at 0.5 cm every month. Therefore, the nurse informs the parents that the head growth rate is normal for the child. There is no need for screening, because the child has not received any head injuries. There may be developmental issues if the head growth is not normal. The posterior fontanel is fused at 6 to 8 weeks of age, so this is not a plausible finding at the 8-month mark.

Which finding related to a school-age client's vital signs should the nurse anticipate during the assessment process? 1. Increased heart rate 2. Increased blood pressure 3. Increased respiratory rate 4. Increased body temperature

Correct 2.Increased blood pressure During the school-age stage of development, the nurse anticipates an increase in blood pressure. Other findings the nurse anticipates include a decreased heart rate and respiratory rate; neither of these values are increased during the school-age stage of development. Body temperature does not change.

While assessing the development of a child, the nurse finds that the child is imitating the actions of her elders. Which stage, according to Erickson's developmental theory, does the nurse expect the child is in? 1. Initiative versus guilt 2. Industry versus inferiority 3. Identity versus role confusion 4. Autonomy versus shame and doubt

Correct 4. Autonomy versus shame and doubt According to Erickson's developmental theory, a child who is 1 to 3 years old is in the autonomy versus shame and doubt stage. The child will have control over his or her body and environment. Therefore, the child starts imitating elders in an attempt to learn and do things for himself or herself. A 3- to 6-year-old child is in the initiative versus guilt stage according to Erickson's theory of development. The child who is in the initiative versus guilt stage will try to explore things with all the senses. A 6- to 12-year-old child is in the industry versus inferiority stage according to Erickson's theory of development. Industry versus inferiority is a higher stage of development in which the child will perform tasks to attain real achievements and not as mere imitation. A child who is 12 to 18 years old is in the identity versus role confusion stage of Erickson's developmental theory. In this stage, the child becomes preoccupied with personal appearance.

A parent of a school-age child reports to the nurse that the child wets the bed at night. Upon interaction with the child, the nurse learns that the child is afraid of the dark. What does the nurse recommend to the parent? Select all that apply. 1. "Take your child for a walk before going to bed." 2. "Provide nutritious food to your child at dinner." 3. "Give your child a glass of milk before bedtime." 4. "Allow your child to keep a light on in the bedroom at night." 5. "Encourage your child to use the toilet before going to bed."

Correct 4."Allow your child to keep a light on in the bedroom at night." Correct 5."Encourage your child to use the toilet before going to bed." Keeping a light on at night will help comfort a child who is afraid of the dark. Encouraging the child to use the toilet to empty the bladder before going to bed promotes uninterrupted sleep and reduces the child's risk of bed wetting. Taking the child for a walk before going to bed may promote sleep but does not reduce fear of darkness. Providing nutritious food to the child will be beneficial to improve overall growth and development. Providing milk before bed promotes sleep but does not address the fear of darkness.

The parents of a preschooler are worried, because the child is often seen talking to imaginary friends. The parents admit that they often scold the child for such behavior. Of what does the nurse inform the parents? 1. "The child may develop severe psychological problems." 2. "You must involve the child in some spiritual activities." 3. "There may be some neurologic or developmental issue." 4. "The behavior is normal at this age and it will help counter loneliness."

Correct 4."The behavior is normal at this age and it will help counter loneliness." Sometimes children create imaginary friends to help counter the feelings of loneliness. Therefore the nurse should tell the parents that it is a normal behavior. Speaking to imaginary friends is a habit that children overcome later in life and, therefore, there is no risk for developing any psychological problems. It is not necessary to involve the child in any spiritual activity if the parents do not desire to do so. A neurologic problem is suspected if the child exhibits jerking movements or experiences fainting spells.

A father expresses concern that his 2-year-old daughter has become a "finicky eater" and is eating less. How should the nurse respond? 1 "Your daughter has become manipulative." 2 "She's probably experiencing the stress of a typical 2-year-old." 3 "She may have an eating problem that requires a referral to a specialist." Correct4 "Your daughter's behavior is expected in response to her slower growth."

Correct 4."Your daughter's behavior is expected in response to her slower growth." Growth slows during the toddler years, and these children generally do not eat as much as they do during infancy; this is called physiologic anorexia, which is typical of this age group. Toddlers may try to manipulate as they assert their autonomy, but usually not through eating behaviors unless the parents express anxiety and concern over their food intake. Although toddlers have difficulty withstanding frustration and are prone to temper tantrums, these eating behaviors are within the norm for toddlers. Eating disorders usually do not occur in children this young; these behaviors are typical of healthy toddlers.

The nurse observes an infant using his thumb and index finger to hold an object. What does the nurse infer from this? 1. The infant is exhibiting Moro reflex. 2. The infant is showing tonic neck reflex. 3. The infant is exhibiting parachute reflex. 4. The infant is showing crude pincer grasp reflex.

Correct 4.The infant is showing crude pincer grasp reflex. An infant using his thumb and index finger to hold an object would indicate that the infant has crude pincer grasp reflex. The infant is not startled, so the nurse does not conclude that the infant is showing Moro reflex. If the infant extends his or her arm and leg to the side where the infant's head is turned, it indicates that the infant has tonic neck reflex. The infant is not showing protective response toward falling; therefore the infant does not show parachute reflex.