Chapter 13: Caring for the Developing Child

15. Parents of a 2-year-old child are having difficulty with establishing a bedtime routine for sleep. Which observation if noted by the nurse should warrant intervention? A. Reading a bedtime story to the child B. Establishing the bed as a quiet area C. Limit television time prior to sleep D. Placing toys and stuffed animals on the bed

D. Placing toys and stuffed animals on the bed may encourage playtime activities.

4. A nurse observes several preschool-aged children during play and overhears one of them say, "My mommy won't let me do that." What conclusion is the most appropriate by the nurse regarding this child's development? A. The child has developed a superego according to Freud. B. The child has mastered Bandura's concept of self-mastery. C. The child is behind in moral reasoning and development. D. The child is in Erikson's autonomy versus shame and doubt phase.

A. According to Freud, between the ages of 3 and 6, children begin to develop a superego, which serves to regulate behavior. The child who knows there are limits to behavior is demonstrating this development.

20. A nurse is assessing an 18-month-old child at the clinic for a well-child visit. Which findings indicate normal growth and development outcomes for this age range? Select all that apply. A! "Able to walk forward and backwards." B! "Observed playing in the waiting room alongside other children." D. This is incorrect. This age group is prone to having nightmares and while a con- sistent bedtime pattern is recommended, it may not alleviate the occurrence of nightmares. Scannell/Ruggiero Davis Advantage for Maternal-Child Nursing 3e C! "Responds with a couple of words to questions." D! "Waves 'bye' with hand movements." E! "Demonstrates associative play."

A. This is correct. A toddler should be able to walk forward and backwards by this age. B. This is correct. Playing alongside other children is an example of parallel play, which is seen in this age group. C. This is correct. A toddler should have a vocabulary of single word phrases and know at least 15 words by 15 months.

7. A nurse notes that when an infant is startled, she looks at her mother. What conclusion can the nurse make about this infant's development? A. The child is slow to adapt and is distressed over small changes. B. The developmental needs of the child are not being met. C. The infant can develop other relationships because he is secure. D. The infant has an unstable home environment and is insecure.

C. According to John Bowlby's theory of attachment, the infant becomes attached to the mother as a way to survive the vulnerabilities of infancy. When the attachment is secure, the mother is seen as home base. When the child becomes startled or frightened, they will look to the mother for security. Knowing that home base is secure allows the child to go on to develop other relationships.

18. The nurse is preparing to provide information to the parents of a 14-year-old who is within normal limits for growth and development. What information is appropriate for the nurse to include? Select all that apply. A! "Children of this age can anticipate long-term consequences of choices." B! "Growth, although slowed, can still be significant." C! "The child of this age may be able to give informed consent in some situations." D! "The child of this age is not normally worried about sexual identity." E! "Peer group influence is often stronger than family influence."

A. This is correct. Adolescents are in the stage of formal operations and can think ab- stractly. They are able to anticipate long-term consequences of choices. B. This is correct. Growth continues during this period and, although slower than in other stages, can still be significant. C. This is correct. Depending on state law and the teen's age, a teen may be able to give informed consent in situations such as seeking birth control or assistance with substance abuse. E. This is correct. Peers often have more influence over the teen than family.

19. A nurse is reviewing health promotion materials for toddlers to be included in a teaching pamphlet. Which information should be included? Select all that apply. A! "Make sure that all outlets have a protective device." B! "Support body parts to prevent injury." C! "Stimulate appetite by providing finger foods." D! "Bedtime patterns will prevent nightmares." E! "Use of brief time outs can be effective for behavior control."

A. This is correct. Always focus on safety and with toddlers being able to explore new areas, electrical outlets should be protected. C. This is correct. Use of finger foods will help to stimulate appetite, and foster inde- pendence during eating. E. This is correct. Establishing a consistent discipline along with brief time outs is recommended.

17. A nurse is providing anticipatory guidance to the parents of a 5-month-old baby. Which nursing statements are most appropriate by the nurse to these parents? Select all that apply. A! "Do not leave the child alone on the changing table." B! "Until the age of 3, falls are common due to large head size." C! "Peak-a-boo is an appropriate game for this age." D! "Wrap up mini-blind ties so the child can't reach them." E! "You need to childproof all your cabinets now."

A. This is correct. An infant begins to roll over by the age of 6 months and could eas- ily fall off a changing table with this newfound skill. C. This is correct. Infants respond strongly to peek-a-boo games due to the develop- ment of object permanence.

5. A 10-year-old child who has been hospitalized frequently and for long periods of time has the nursing diagnosis of delayed growth and development. Which action by the child would demonstrate that outcomes for this diagnosis have been met? A. Able to play harmoniously with peers B. Does own homework independently C. Seeks out parental approval for activities D. Learns the rules of simple games

B. A 10-year-old child is in the Erikson stage of industry versus inferiority. Mastery of tasks leads to self-confidence. Industry is apparent when the child feels capable of doing homework or other assigned tasks independently. This shows resolution of the nursing diagnosis, as appropriate developmental tasks have been accomplished.

11. A couple brings their child to the well-child clinic for guidance in improving the child's school performance. The nurse assesses the child and finds that favorite activities are running, playing basketball, and building models. Which conclusion is most appropriate for the nurse to make based on the assessment findings? A. Hyperactive and may need medication B. Learns best through bodily activity C. Needs firm structure for completing schoolwork D. Normal activity: school performance will improve with time

B. According to Howard Gardner, there are eight forms of intelligence: bodily-kinesthetic, interpersonal, intrapersonal, linguistic, logical-mathematical, musical, naturalistic, and spatial. Although children possess all eight forms, they typically develop one to a greater degree. Using this form of intelligence is best to help the child learn. By assessing the child's hobbies and interests, the nurse gains insight into which form a child uses. This child prefers the bodily-kinesthetic form of intelligence and using bodily motion in learning activities will improve learning.

9. A nurse has assessed a 14-year-old hospitalized patient over several days and notes that the child has difficulty with abstract concepts and is unable to appreciate diverse points of view. According to Piaget, how would the nurse categorize this child's development? A. Ahead in development B. Behind in development C. Development is normal D. Not applicable to development

B. According to Piaget, children aged 11 to 15 should be in the formal operational stage, in which they are able to use abstract reasoning and can consider both sides of an issue. Since the child is unable to perform these tasks, the child is behind in development.

10. A mother brings her child to the well-child clinic. She is distraught because the child tested well below normal on a school-administered intelligence (IQ) test. Which action by the nurse is the most appropriate? A. Advise the mother to have the test repeated next year. B. Assess cultural background and economic status. C. Facilitate a referral to a developmental specialist. D. Reassure the mother that IQ tests are often wrong.

B. Many IQ tests have been criticized for not considering the impact of culture or socioeconomic status. The nurse should assess these factors before proceeding further.

1. A pediatric nurse examines a 7-year-old at a well-child visit. Based on developmental milestones, what observation should the nurse anticipate should be present? A. Ability to follow a complicated series of instructions B. Eager to participate in the conversation C. Increase in height of 4 inches since last year's check-up D. Asks "why" questions repeatedly through the conversation

B. A developmental milestone for a school-aged child include a child who is eager to participate in a lengthy conversation.

12. A father is frustrated that his child frequently disobeys well-established rules and then attempts to excuse the action by stating "Well I just thought . . .." The father asks for guidance with discipline. What information is most appropriate for the nurse to provide? A. Ensure the child knows the rules. B. Habitual rule breaking is problematic. C. This is a normal developmental stage. D. Time-outs are ineffective for lying.

C. According to Kohlberg, a child passes through three stages when learning to make moral decisions. In the first (preconventional) stage, a child may not see an action as wrong if they can justify the action in their mind. The best response by the nurse would be to explain this to the father and help him develop strategies to work with this.

6. A hospitalized 11-year-old child turns down opportunities to play or engage in diversionary activities. When questioned, the child states, "I'm bad at that" or "I can't do anything." What action by the nurse is best? A. Arrange a pediatric psychology consultation. B. Assess the child for emotional abuse at home. C. Consult the child developmental specialist. D. Document the statements in the child's chart.

C. This 11-year-old child is in the Erikson stage of industry versus inferiority, and it seems they have not mastered tasks and developed a sense of self-confidence. Illness can frequently disrupt growth and behavior, and the child developmental specialist is a vital resource in meeting the developmental needs of the hospitalized child.

14. A mother brings her 1-year-old child to the pediatric clinic and appears frustrated and stressed. During the assessment, the mother states she tries to give her child exposure to new situations and people several times a week, but the outings always end with the child screaming and crying. Which response by the nurse is the most appropriate? A. "Keep trying; new situations are so stimulating for children." B. "Stop taking your child to new places and meeting new people." C. "Use an established routine and add new experiences slowly." D. "Your child will soon become used to such daily activity."

C. This child displays difficulty with adapting to new situations. The mother's attempts to provide new experiences are antagonizing the child's natural temperament. According to the temperament theory of Thomas, Chess, and Birch, the mother should provide structure with limited variation in this slow-to-adapt child's daily activities.

13. A nurse is working at a community health-screening event. A woman tells the nurse that her oldest child is leaving home in a month and that this change is making her feel stressed and unneeded. What response by the nurse is the most appropriate? A. "At your age you need to start coping with losses." B. "Lucky you; I can't wait 'til my kids leave home!" C. "This is a great time to refocus on your marriage." D. "Your other children will need help with separating."

C. According to Duvall's theory of family development, the activities of the oldest child in a family are the marker for family transition. As the oldest child prepares to

3. The pediatric nurse is examining a newborn infant and notes a turning in of the foot and turning out of the toes when the sole of the foot is stroked. Which action by the nurse is most appropriate? A. Arrange a consultation with a developmental specialist. B. Assess the parents' family histories for genetic defects. C. Document the findings in the patient's chart. D. Instruct the parents on required follow-up care.

C. The newborn is exhibiting the Babinski reflex, one of the normal primitive reflexes that should disappear by 9 months of age. Documentation is all that is required.

2. A young couple brings their 20-month-old daughter to the pediatrician's office for immunizations. The mother tells the nurse that she is going back to work and is looking for a day-care center in the vicinity of the clinic. What priority assessment should the nurse perform prior to recommending a day-care center? A. Available financial assets B. Available support people C. Potty-training status D. The child's temperament

D. During a normal daily routine, the child may be exposed to a variety of settings and to several people in a day-care center or while visiting extended family, visiting a physician's office, or in public places in the community. Understanding an infant's temperament is essential in the care of the child to help both the parent and child adapt to these experiences.

16. A nurse is assessing several children during a shift at the well-child clinic. Which child demonstrates the most successful resolution of the Erikson stage of autonomy versus shame and doubt? A. A 15-month-old playing on the floor with supervision B. An 18-month-old being consistently consoled by her father C. A 20-month-old using building blocks with her grandfather D. A 24-month-old being allowed to independently dress himself

D. The Erikson stage of autonomy versus shame and doubt occurs during the ages of 1 to 3. During this stage, the child develops a "can-do" attitude and wishes to be independent. A child who does not successfully meet the tasks of this stage will suffer from self-doubt later on. The most independent child in the options is the 24-month-old dressing independently. This child is mastering the tasks of this developmental stage.

8. A nurse is working with a child at a nutrition site. The father is not in the child's life, and the mother has been in and out of jail, resulting in a series of caregivers for the child, who appears malnourished. Using Bandura's theory of growth and development, what should the nurse assess as a priority? A. Bonding B. Industry C. School success D. Self-esteem

D. According to Bandura, lack of positive modeling leads to poor self-esteem, and the