Chapter 22 - Conception through Young Adult

Adolescent sexual development occurs in tree stages: prepubescence, pubescence, and post pubescence. Characteristics common to the phase of pubescence include which of the following? a- increase in the amount, pigmentation, and curling of public hair, and growth spurt in height and weight b- completion of sexual growth and development, as well as fertility c- appearance of breast buds in females and increase in length and circumference of penis in males d- slight enlargement of sex organs and appearance of downy pubic hair

a- increase in the amount, pigmentation, and curling of public hair, and growth spurt in height and weight. Characteristics common to the pubescence phase include as increase in the amount, pigmentation, and curling of public hair, and a growth spurt in height and weight. Axillary hair appears and no longer has a downy appearance. Sex organs continue to enlarge, and ovulation and spermatogenesis begins. Completion of sexual growth and development, as well as fertility, occur during the postpubescence phase. Appearance of breast buds in females, increase in length and circumference of penis, progressive enlargement of sex organs, and appearance of downy pubic hair occur during the prepubescence phase.

A school-aged child is attentive to following the rules at school, respects his teachers, and views justice as a means of fair play. These are characteristics of which type of development typical of this age group? a- moral development b- psychosocial development c- physiologic development d- spiritual development

a- moral development Following the rules at school, respecting teachers, and viewing justice as a means of fair play are important moral development characteristics. Spiritual development involves religious faith and spiritual beliefs. Psychosocial development includes therories by Freud, Erikson, and Havighurst. Physiologic development during the school-aged period focuses on growth and motor development.

Which of the following topics for the client education of a pregnant woman should the nurse prioritize in an effort to promote healthy fetal development? a- nutrition b- infection prevention c- stress management d- physical activity

a- nutrition During pregnancy, adequate maternal nutrition is essential for normal growth and development of the fetus. While infection, exercise, and stress management are all valid and relevant of the mother and usually does not affect the growth of the fetus. Physical activity affects the maternal component of reducing excessive weight gain.

The nurse is conducting a preoperative assessment of a girl 5 years of age who is scheduled for surgery later that day. The nurse should be aware that the client's imminent surgery is likely to cause what? a- separation anxiety and fear of pain b- risk for shame and guilt c- mistrust or authority d- impaired psychosocial development

a- separation anxiety and fear of pain. When caring for a preschool-aged child who is scheduled for surgery or requires hospitalization, nurses must recognize the importance of the child's fear of pain as well as separation anxiety. However, the experience is unlikely to impair her overall development. There is unlikely to be a significant risk for shame, guilt, or mistrust associated with the procedure.

The nurse is assessing a preschooler who has just turned 6 years of age. The nurse expects which of the following as typical development for a child in this developmental phase. a- the head is close to adult size by age 6 years b- the child begins to draw by drawing stick figures c- play is related to fantasy instead of real-life events d- egocentrism increases as socialization increases

a- the head is close to adult size by age 6 years Preschool development includes a head that is close to adult size by the age of 6 years. Egocentrism decreases as socialization with peers increases. The child begins to draw stick figures in the toddler years, not the preschool years. Play during the preschool years is more related to real-life events rather than fantasy.

Which of the following characteristics of a neonate would be reflected in her Apgar score? a- the infant's hands and feet appear blue b- the infant does not open her eyes to verbal stimulus c- the infant is hypersensitive to noise d- the infant coughs up mucus shortly after delivery

a- the infant's hands and feet appear blue The assessment domains of an Apgar score are heart rate, respiratory effort, muscle tone, reflex irritability, and color. Blue-tinged extremities are thus reflected in the score, while response to stimulus and the presence of oral mucus are not.

The nurse is caring for Michelle, a 15 year old female, who was admitted for a concussion suffered while playing hockey. Her parents are at her bedside and appear very concerned about her. She ignores them for the most part and spends her time texting her hockey friends. Which of the following describes how her behavior is related to Erik Erikson's theory of growth and development? a- the peer group acts as the greatest influence b- she is learning about gender social roles c- this stage is about learning useful skills d- abstract concepts are being utilized

a- the peer group acts as the greatest influence. According to Erikson's theory, the peer group acts as the greatest influence on the adolescent. Erikson's theory indicates that learning useful skills is a task for school-age children. Learning gender social roles is a task for school-age children according to Havighurst's theory. Abstract concepts are part of Piaget's theory for the adolescent.

The nurse is caring for Jerry, a 3 year old boy, who is admitted with a respiratory infection. His mother, Mrs. Maker, is a single parent and works. She can only be with Jerry during the late afternoon and evening. Today she tells the nurse that Jerry has been toilet trained for a year and she is very surprised and disappointed that he is wetting and soiling his bed now. What is the nurse's best response? a- we can start working on retraining him here. b- his regression is normal and is related to stress. c- we can remind him to use the toilet once in awhile. d- it's his way of saying he is angry at you.

b- his regression is normal and is related to stress. Toddlers who require care in the hospital setting experience stress and separation anxiety when parents are not present. When ill or in pain, toddlers often regress to earlier behaviors. Working on toilet training while he is hospitalized would only increase his stress. Mr. Baker probably already feels guilty for not being able to spend more time with Jerry; telling her he is angry will only make it harder for her.

Mrs. Karlilse brings her 1 month old son to the clinic for a well-baby checkup. She reports to the nurse that the baby cries every day from 4 PM until about midnight. The nurse talks to the mother about which of the following conditions? a- danger of suffocation b- infant colic c- sudden infant death syndrome (SIDS) d- failure to thrive (FTT)

b- infant colic. Colic is uncontrollable, extended crying in an otherwise healthy and well-fed baby. Colic generally occurs during the first 3 months of life and has been referred to as the "100-day syndrome". This continuous crying can occur at any time but usually worsens in the evening. The infant cries loudly and draws the legs up to the abdomen. FTT is a condition of inadequate growth in height and weight resulting from the infant's inability to obtain or use calories needed for growth. SIDS is the sudden death of an infant under the age of 1 year, unexpected in light of the infant's history, in which a postmortem examination fails to reveal a cause of death. Death rates for infants due to strangulation and suffocation have increasaed dramatically since the 1980s. THese accidental deaths occur most commonly when infants share a bed with parents (co-sleeping) and are inadvertently wedged beneath another person, trapped in a dangerous position, such as between the bed and the wall, or suffocated by bedding.

The nurse is caring for a 19 year old male client who has suffered multiple fractures related to a motor vehicle accident. His father is at his bedside and, while the client is away for radiology tests, his father talks about his son's injuries and age group in general. The father asks what the major cause of death is in his son's age group. The nurse's best reply is which of the following? a- suicide related to job stress b- injuries related to car accidents c- cancer and chronic illnesses d- swimming and boating accidents

b- injuries related to car accidents. Injuries are the leading cause of death for adolescents and young adults. Motor vehicle crashes are the most common cause of mortality. Suicide is not associated with any age group. Cancer and chronic illness is associated with adulthood. Swimming and boating accidents are included in injuries with the age group but is dependent on water access.

When providing nursing care and education to an adolescent, the nurse recognizes that which of the following groups has the greatest influence during this period of development? a- immediate family b- peer group c- extended family d- teachers and coaches

b- peer group The adolescent is primarily influenced by his or her peer group. Yet, a nursing activity for individuals in this stage is facilitating healthy family relationships, and this is a task common to many stages of development. The family, whether it is immediate or extended, as a primary social unit provides the environment and relationships necessary for members to meet their basic human needs. Teacher and coaches impact school age and older children.

A toddler's mother exits the room to talk to the physician in the hallway. The nurse caring for the toddler notes that the child starts to cry when he no longer sees his mother in the room. He soon stops crying and appears saddened and depressed. The nurse recognizes this behavior as which of the following? a- negativism b- separation anxiety c- fantasizing d- regression

b- separation anxiety. Separation anxiety occurs whena child is afraid to be separated from loved ones who offer security. The child might initially cry and scream, but when the crying stops, he appears depressed. Regression is a behavior that is more characterisitic of a younger age and can occur at any time in response to stressful circumstances. Negativism is characterized by a toddler's expression of "no" and outbursts of temper in efforts to control the environment. Preschoolers have a fertile imagination and the ability to fantasize.

The nurse is providing prenatal education to a group of pregnant teenagers. One of the group members asks what the baby can do physically right after birth. Which is an accurate statement about neonatal ability following birth? a- The neonatal period lasts from birth to six months b- the newborn can suck, swallow, sneeze, and yawn c- the elimination of stool and urine has not yet begun d- the Braden scale is used to assess newborns

b- the newborn can suck, swallow, sneeze, and yawn. The neonate is assessed immediately after birth at one and five minutes using the Apgar scale. The neonatal period lasts from birth to 28 days. The physical characteristics and behaviors of normal neonates include active reflexes (moro, stepping, and grasp), hand to mouth activity, sucking, swallowing, blinking, sneezing, and yawning. Stool and urine are eliminated by the newborn. The Braden scale is a scale used to predict pressure sore risk in hospitalized clients. It is not usually used in hospitalized clients. It is not usually used in neonates.

The nurse is providing prenatal education to a group of pregnant teenagers. One of the group members asks about the advantages of breastfeeding. An accurate statement from you about breastfeeding would be which of the following? a- high lactose content contributes to infections b- transient immunity is provided by breast milk c- acid environment allows bacterial growth d- high protein content helps with healing

b- transient immunity is provided by breast milk. Breasatfeeding provides further protection against bacterial and viral infections through antibodies, immunoglobulins, and leukocytes in breast milk. The high lactose content in breast milk, combined with limited protein, promotes an acid environment that is unsuitable for bacterial growth.

A neonate has a heartbeat of 92 beats/minute, good respiratory effort, active motion, a vigorous cry, a pink body, and blue extremities. Based upon these findings, what Apgar score will this neonate receive? a- 10 b- 9 c- 8 d- 7

c- 8. The neonate will receive a score of 8. The score calculation is as follows: 1 = slow heart rate (less than 100 beats/minute), 2 = good respiratory effort and crying (respiratory effort), 2 = active motion (muscle tone), 2 = vigorous cry (reflex/irritability), 1 = pink body and blue extremities (color), for a total score of 8.

The parents of a 4 month old cannot visit at the hospital except on weekends. Which of the following actions by the nurse indicates an understanding of the emotional needs of a young infant? a- place infant in a room away from other clients b- tell parents infrequent visiting is not necessary c- assign the same nurse as much as possible d- have different nurses provide care for varied contact

c- assign the same nurse as much as possible. according to Erikson, trust develops if the caregiver can be counted on to provide food when the infant is hungry or is need of warmth and comforting. Trust is important for attachement which is an active, affectionate, reciprocal relationship between 2 people, in this case the infant and the same nurse as much as possible, as the parents cannot be there daily. Placing the infant in a room away from other clients is not necessary. Telling the parents infrequent visiting is not therapeutic for the parents nfrequent visiting is not necessary. Telling the parents infrequent visiting is not therapeutic for the parents or the infant. Having different nurses does not aid in the development of trust and attachment necessary for the infant.

The nurse is caring for a female client 15 years of age who is hospitalized with a fractured ankle. Her father tells the nurse that this happened during a gymnastics lesson. He goes on to explain that every six or eight months it seems his daughter is trying something diffrent; right now it is gymnastics. You know that this behavior fits with which of the following theorist's developmental tasks for adolescents? a- havighurst b- piaget c- erikson d- freud

c- erikson Based on Erikson's theory, the adolescent tries out differnt roles, personal choices, and beliefs in the stage called "identity versus role confusion"

A father is concerned because his 3 year old daughter has been using the bathroom independently for the past 6 months, but has had a few "accidents" since her hospitalization. Which of the following is the nurse's best response? a- reward her for every time she goes to the bathroom b- her 'accidents' may indicate the need for additional potty training c- her regressive behaviors are a reaction to being hospitalized d- you need to take our daughter to the bathroom more often

c- her regressive behaviors are a reaction to being hospitalized. Regression in toilet training is a normal reaction for a 3 year old child who is hospitalized. The father should be reassured this is a normal reaction, and will disappear after being discharged. Taking her to the bathroom more often or rewarding her may not stop the regression.

A school nurse is aware of the importance of creating and carrying out interventions that resonate with the developmental tasks of the adolescent population. Such interventions should appeal to adolescents' prioritization of their what? a- vulnerability b- goals c- identity d- skepticism

c- identity. One of the key developmental tasks in adolescence is the creation and maintenance of an independent identity. This consideration frequently trumps goal orientation. While adolescents may often be skeptical and vulnerable, the role of identity is central to this population.

The clinic nurse is seeing a female client 18 years of age who needs to renew her asthma prescription. The client tells the nurse that she is going to another province in a few weeks to attend college and will be living in a dorm. The nurse recommends which of the following while the client is being seen in the clinic? a- polio booster b- hep b series c- meningococcal vaccine d- TB skin test (PPD)

c- meningococcal vaccine. College freshman living in formitories are at risk for meningococcal disease and require the vaccine for protection from it. A TB skin test is usually done if the client has been exposed to TB. Polio boosters are not given to this age group. Hep B is not completed in a single visit.

Which of the following points should the nurse prioritize when educating school-aged children about nutrition? a- sources of iron and folate b- the importance of organic food c- sources of calcium and vitamin D d- limiting complex carbohydrate intake

c- sources of calcium and vitamin D School-aged children are undergoing rapid growth, a process that requires consistently high intake of vitamin D and calcium. This is more significant than iron and folate intake for children. The specific benefits of organic food are still debated, and it would be simplistic to teach children to reduce their intake of complex carbohydrates, since these are necessary for growth. Rather, the benefits of a balanced diet should be emphasized.

Of the following components of psychosocial development in the neonate and infant, which one facilitates emotional linkage between a baby and caregiver? a- play b- attachment c- temperament d- bonding

d- bonding Bonding is considered the emotional linkage between two people and is necessary for later attachment. It usually occurs during the first few hours after birth, although it may occur later in the first few months of life. Attachment is an active, affectionate, reciprocal relationship that is different than bonding. Play is used by children to discover and control their environment. Temperament of an infant is primarily inborn and relates to behavioral style.

The school nurse is concerned about nutrition for school-age children. Which meal plan should be selected for a nutritious lunch? a- fried fish sandwich with macaroni and cheese and whole milk b- cheeseburger on a roll with French fries and a cola soda c- spaghetti with tomato sauce and garlic bread with apple juice d- grilled chicken with celery and carrot sticks and apple slices

d- grilled chicken with celery and carrot sticks and apple slices. Grilled chicken with celery and carrot sticks and apple slices adds vegetables and fruit with a protein and fiber to the diet for a nutritious lunch. The cheeseburger, french fries, and cola contain excessive fats and carbohydrates. The spaghetti, garlic bread, and apple juice consist primarily of refined carbohydrates and lacks a balance of fruits and vegetables. The fried fish sandwich, mac and cheese, and whole milk is high in fats and lacks fruits and vegetables leaving this choice void of fiber.

Sleep habits have been implicated in cases of sudden infant death syndrome (SIDS). What instructions will the nurse provide to new parents related to positioning their infant for sleeping? a- healthy infants up to age 6 months should be positioned on their backs on a soft surface b- healthy infants up to age 6 months should be positioned on their stomachs on a soft surface c- healthy infants up to age 6 months should be positioned on their stomachs on a firm surface d- healthy infants to up age 6 months should be positioned on their backs on a firm surface

d- healthy infants to up age 6 months should be positioned on their backs on a firm surface. Becuase sleep habits have been implicated in cases of sudden infant death syndrome (SIDS), it is recommended that healthy infants up to the age of 6 months sleep on their backs on a firm surface. The "back to sleep" campaign has reduced the cases of SIDS

The mother of a girl 6 years of age is exasperated at her daughter's persistent enuresis. How can the nurse best respond to this mother's concern? a- have you spoken to your primary care provider about a referral to a specialist? b- does your daughter ever complain of pain or burning when she urinates? c- this is especially common among girls, and is very normal d- most children outgrow their bed wetting at around your daughter's age or shortly after.

d- most children outgrow their bed wetting at around your daughter's age or shortly after. Enuresis typically ends between 6 and 8. Bed wetting at age 6 does not likely necessitate a referral to a specialist and is unlikely to be related to a pathological process. Enuresis is not noted to be more common among girls than boys.

While providing education to a young adult during an annual health exam, the nurse discusses health problems common during this stage of development. What is the most common cause of mortality during this stage? a- eating disorders b- suicide c- drug overdose d- motor vehicle crashes

d- motor vehicle crashes Injuries are the leading cause of death for adolescents and young adults. Motor vehicle crashes are the most common cause of mortality, often associated with the use of alcohol or other drugs.

Today the pediatric clinic nurse gets Mrs. Johnson and her 20-month-old son, Jackson, settled in an exam room. Mrs. Johnson tells the nurse that the biggest problem she faces now is Jackson's refusal to let her out of his sight. "He screams and cries if he thinks I am gone". She asks if she should be concerned about this. What is the nurse's best reply? a- has he been frightened by something when alone? b- leave him for very short periods, like 10 minutes. c- only leave him with very trusted persons d- separation anxiety is normal at 18 to 24 months

d- separation anxiety is normal at 18 to 24 months. Separation anxiety in response to separation from the mother figure intensifies at about 18 to 24 months, and can be as intense for the toddler as it was for the infant. The child might have feelings of anger, fear, grief, and revenge during this period, but by 24 months, the toddler begins to demonstrate increased independence from the mother. The nurse should instruct the client that over time this will go away but the child should not be left for 10 minutes to experiment with the anxiety or left with very trusted person. The nurse should not ask if the child has been frightened by someone when alone as this is an expected toddler response.

The nurse is educating the mother of an infant age 4 months on safety concepts in child rearing. Which of the following statements by the mother suggests that she may require some repetition and reinforcement of the information? a- the baby will sleep in her crib, not with me and my husband. b- I must keep appointments for the baby's immunizations. c- I mist keep small objects out of the baby's reach. d- the baby can sleep on her stomach during naps.

d- the baby can sleep on her stomach during naps. Because sleep habits have been implicated with SIDS, it is recommended that healthy infants up to the age of 6 months sleep on their back (rather than the stomach) on a firm surface in a safety-approved crib. There is a schedule that includes recommendations for infant immunization Practices. Because infants put small objects i their mouths, choking is a risk. Accidental deaths occur most commonly when infants share a bed with parents (co-sleeping) and are inadvertently wedged beneath another person, trapped in a dangerous position, such as between the bed and the wall, or suffocated by bedding.