Chapter 20: Growth, Development, and Stages of Life

Upon palpation of the fontanel of a 3-month-old newborn, the nurse notes that the anterior fontanel has not closed and is soft and flat. Which action would the nurse take? 1. Increase oral fluids. 2. Document the findings. 3. Notify the registered nurse. 4. Elevate the head of the bed to 90 degrees.

2 Rationale: The anterior fontanel is diamond shaped and located on the top of the head. It needs to be soft and flat in a normal infant, and it normally closes by 12 to 18 months of age. The posterior fontanel closes by 2 to 3 months of age. Therefore, because the findings are normal, the nurse must document the findings. Test-Taking Strategy: Note the subject, findings for an infant's fontanelles. Because they are "soft and flat," this would provide you with the clue that this is a normal finding. A bulging or tense fontanel may result from crying or increased intracranial pressure

When caring for a 3-year-old child, the nurse would provide which toy for the child? 1. A puzzle 2. A wagon 3. A golf set 4. A miniature farm set

2 Rationale: Toys for the toddler must be strong, safe, and too large to swallow or place in the ear or nose. Toddlers need supervision at all times. Push-pull toys, large balls, large crayons, trucks, and dolls are some appropriate toys. A puzzle, with large pieces only, may be appropriate. A miniature farm set and a golf set may contain items that the child could swallow. Test-Taking Strategy: Focus on the subject, appropriate toys for a 3-year-old. A golf set and a miniature farm set can be easily eliminated because they contain items that could be swallowed by the child. From the remaining options, the appropriate toy is a wagon. Remember that large and strong toys are safest for the toddler.

The parent of a 4-year-old child expresses concern because her hospitalized child has started sucking his thumb. The mother states that this behavior began 2 days after hospital admission. Which is the appropriate nursing response? 1. "Your child is acting like a baby." 2. "The doctor will need to be notified." 3. "This is common during hospitalization." 4. "A 4-year-old is too old for this type of behavior."

3 Rationale: In the hospitalized preschooler, it is best to accept regression, such as thumb sucking if it occurs, because it is most often caused by the stress of the hospitalization. Parents may be overly concerned about regression and would be told that their child may continue the behavior at home. There is no need to call the health care provider. Telling the parents the child is acting like a baby or being too old to act this way is inappropriate. Test-Taking Strategy: Focus on the subject, regression because of hospitalization. The incorrect options will cause additional stress and concern for the parent.

The nurse is reinforcing discharge instructions to the parents of a 2-year-old child who sustained accidental burns from a hot cup of coffee. The nurse determines that the parents have correctly understood the teaching when they make which statement? 1. "We will be sure not to leave hot liquids unattended." 2. "I guess my child needs to understand what the word 'hot' means." 3. "We will be sure that our child stays in his room when we work in the kitchen." 4. "We will install a safety gate as soon as we get home so that our child can't get into the kitchen."

1 Rationale: Toddlers, with their increased mobility and developing motor skills, can reach hot water, open fires, or hot objects placed on counters and stoves above their eye level. Parents would be encouraged to remain in the kitchen when preparing a meal and reminded to use the back burners of the stove. Pot handles must be turned inward and toward the middle of the stove. Hot liquids must never be left unattended, and the toddler must always be supervised. The other options do not reflect an adequate understanding of the principles of safety. Test-Taking Strategy: The option about the child understanding the word "hot" can be easily eliminated considering the development level of a 2-year-old. Next eliminate options 3 and 4 because they are comparable or alike in that they isolate the child from the environment.

Which interventions are appropriate for the care of an infant? Select all that apply. 1. Provide swaddling. 2. Talk in a loud voice. 3. Provide the infant with a bottle of juice at naptime. 4. Hang mobiles with black-and-white contrast designs. 5. Caress the infant while bathing or during diaper changes. 6. Allow the infant to cry for at least 10 minutes before responding.

1, 4, 5 Rationale: Holding, caressing, and swaddling provide warmth and tactile stimulation for the infant. To provide auditory stimulation, the nurse would talk to the infant in a soft voice and would instruct the mother to also do so. Additional interventions include playing a music box, radio, or television or having a ticking clock or metronome nearby. Hanging a bright, shiny object within 20 cm to 25 cm of the infant's face in the midline and hanging mobiles with contrasting colors (e.g., black and white) provide visual stimulation. Crying is an infant's way of communicating; therefore, the nurse would respond to the infant's crying. The mother is taught to do so also. An infant or child must never be allowed to fall asleep with a bottle containing milk, juice, soda, or sweetened water because of the risk of nursing (bottle-mouth) caries. Test-Taking Strategy: Focus on the subject, the care of the infant. Noting the word loud in option 2 and the words at least 10 minutes before responding in option 6 will assist you with eliminating these interventions. Recalling the concerns related to dental caries will assist you with eliminating option 3.

The nurse is preparing to care for a dying client and several family members are at the client's bedside. Which therapeutic techniques would the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing. 2. Make the decisions for the family. 3. Encourage expression of feelings, concerns, and fears. 4. Explain everything that is happening to all family members. 5. Touch and hold the client's or family member's hand if appropriate. 6. Be honest and let the client and family know that they will not be abandoned by the nurse.

3, 5, 6 Rationale: The nurse must determine whether there is a spokesperson for the family and how much the client and family want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse would encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know that they will not be abandoned. The nurse would touch and hold the client's or family member's hand, if appropriate. Test-Taking Strategy: Use therapeutic communication techniques, and recall client and family rights to assist in directing you to the correct options.

A 16-year-old child is admitted to the hospital for acute appendicitis, and an appendectomy is performed. Which intervention is most appropriate to facilitate normal growth and development? 1. Encourage the child to rest and read. 2. Encourage the parents to room-in with the child. 3. Allow the family to bring in favorite computer games. 4. Allow the child to participate in activities with other individuals in the same age group when the condition permits.

4 Rationale: Adolescents are not often sure they want their parents with them when they are hospitalized. Because of the importance of the peer group, separation from friends is a source of anxiety. Ideally, the peer group will support the ill friend. The other options isolate the child from the peer group. Test-Taking Strategy: Note the strategic words, most appropriate. Consider the psychosocial needs of the adolescent when answering the question. The other options are comparable or alike in that they isolate the child from their own peer group.

The parents of a 2-year-old arrive at the hospital to visit their child. The child is in the play room and ignores the parents during the visit. The nurse tells the parents that this behavior in a 2-year-old child indicates which characteristic about the child? 1. The child is withdrawn. 2. The child is upset with the parents. 3. The child is exhibiting a normal pattern. 4. The child has adjusted to the hospitalized setting.

3 Rationale: The toddler is particularly vulnerable to separation. A toddler often shows anger at being left by ignoring the parent or pretending to be more interested in play than in going home. The parents of hospitalized toddlers are frequently distressed by such behavior. The toddler normally engages in parallel play and plays alongside (but not with) other children. Options 1, 2, and 4 are incorrect. Test-Taking Strategy: Focus on the subject, separation anxiety, and use the concepts of growth and development. The option mentioning adjustment can be easily eliminated first, because there is no indication that the child has adjusted. There is no information in the question to support the option that the child is withdrawn, so eliminate this option. From the remaining options, knowledge regarding separation anxiety in the toddler will direct you to the correct option.

The parents of a 16-year-old child tell the nurse that they are concerned because the child sleeps until noon every weekend. Which is the most appropriate nursing response? 1. "Adolescents love to sleep late in the morning." 2. "The child shouldn't be staying up so late at night." 3. "If the child eats properly, that shouldn't be happening." 4. "The child needs to have a blood test to check for anemia."

1 Rationale: The sleep patterns of the adolescent vary some according to individual needs. However, in general, adolescents love to sleep late in the morning, but they would be encouraged to be responsible for waking themselves, particularly in time to get ready for school. Options 2, 3, and 4 are incorrect. Test-Taking Strategy: Note the strategic words, most appropriate. The options that suggest comments about the child's sleeping and eating habits can be eliminated first, because they are inappropriate responses and are not helpful or therapeutic. From the remaining options, there is no indication that a physiological alteration is present; therefore, the sleeping late option is most appropriate.

The nurse is caring for a 5-year-old child who has been placed in traction after a fracture of the femur. Which is the most appropriate activity for this child? 1. Blocks 2. A music video 3. A 10-piece puzzle 4. Large picture books

3 Rationale: In the preschooler, play is simple and imaginative, and it includes activities such as dressing up, paints, crayons, and simple board and card games. Ten-piece puzzles are also appropriate and aid with fine motor development. Blocks are most appropriate for the toddler. A music video is most appropriate for the adolescent. Large picture books are most appropriate for the infant. Test-Taking Strategy: Note the strategic words, most appropriate. Also note the subject, play activity and the age of the child, and then think about the age-related activity that would be appropriate. Eliminate the music video, knowing that it is most appropriate for the adolescent. From the remaining options, the words blocks and large in the remaining option would provide you with the clue that these activities would be more appropriate for a child who is less than 5 years old.