Chapter 22: Developmental Concepts
A nurse is providing anticipatory guidance to the parents of a 2 1/2-year-old girl. To foster the development of autonomy, which instruction would the nurse include?
"Encourage the child to dress herself." Explanation: As motor and language skills develop, the toddler (ages 1 to 3 years) learns from the environment and gains independence through encouragement from caregivers to feed, dress, and toilet self. If the caregivers are overprotective or have expectations that are too high, shame and doubt, as well as feelings of inadequacy, may develop in the child. Confidence gained as a toddler allows the preschooler (ages 4 to 6 years) to take the initiative in learning so that the child actively seeks out new experiences and explores the how and why of activities. If the child experiences restrictions or reprimands for seeking new experiences and learning, guilt results, and the child hesitates to attempt more challenging skills in motor or language development.
According to Piaget, the individual assimilates and accommodates new information during this period.
Adaptation Explanation: Adaptation means the process of assimilating and accommodating new information.
Which developmental theorist created the psychosocial theory of development?
Erikson Explanation: Erikson's psychosocial theory of development encompassed social and cultural influences.
What are the two factors that drive growth and development?
Genetics and environment Explanation: Two primary factors drive growth and development: genetics and environment.
According to Kohlberg, which of the following considerations is central to human development?
Morality Explanation: Kohlberg's theory of development focuses specifically on the changes in morality that occur over time. Kohlberg's Theory of Moral Development includes three levels: preconventional morality, conventional morality, and post-conventional morality.
A nurse is presenting a workshop for a group of young women. Part of the workshop focuses on the moral development of women. The nurse integrates information about Gilligan's theory into the presentation, describing the various levels that a woman goes through as morality develops. When describing level 1, the nurse would focus on which area?
Woman's own needs Explanation: In level 1, the focus is on the girl's or woman's own needs. Should and would are the same. The transition that follows this level is characterized by the move from selfishness to responsibility—a move that integrates the responsibility to care for oneself with the desire to care for others. In level 2, moral judgment is based on shared norms and expectations, and societal values are adopted. Acceptance by others becomes critical, and the ability to protect and care for others becomes the defining characteristic of female goodness.
According to Havighurst, learning behaviors are based upon developmental tasks. In assessing an adult client, the nurse is aware that a common developmental task of middle adulthood includes:
assisting children to become responsible adults. Explanation: Assisting children to become responsible adults is a developmental task of middle adulthood. Preparing for a career is a task of adolescence. Learning to live with a marriage partner is a developmental task of young adulthood. Adjusting to retirement and reduced income is a developmental task of later maturity.
The nurse is assessing a 15-year-old who was involved in a fight at school. Which client statements would the nurse see as evidence that this child is delayed in Erickson's developmental stages? Select all that apply.
"I do not trust anyone." "I am not good at anything." "I really don't have many friends, nobody likes me." Explanation: Learning to trust occurs in infanthood. Ability to trust should be established by adolescence. Learning to feel adequate is a task of toddlerhood. Feeling of adequacy should be addressed in the school-age child. In adolescence the child tries on new roles (protector in this case) and decides what direction to take in life.
A client says, "I thought my period was late because I was drinking heavily and did cocaine a couple of times lately. But my pregnancy test is positive and I am scared about what I may have done to the infant." What information should the nurse provide about the possible effects of substance use on the infant? Select all that apply.
"There is a risk for birth defects in the infant." "There is a risk the infant will be born with a low birth weight." "Your infant may be born prematurely." Explanation: Substance use increases the risk for congenital anomalies, low birth weight, and prematurity. Good nutrition will not protect the infant from these effects. Medical care cannot reverse damage already done, but may help prevent further damage.
A nurse is reviewing the medical records of several children who come to the health center for care. When applying Piaget's theory, which child would the nurse anticipate as being able to think abstractly and use deductive reasoning?
13-year-old Explanation: During Piaget's formal operational stage (age 11 or 12 to 14 or 15 years), the individual is able to use abstract thinking and deductive reasoning. Logical thinking is beginning to develop during the concrete operational stage (ages 6 or 7 to 11 or 12 years). A 2 1/2-year-old and a 5-year-old are in the pre-operational stage. This stage is characterized by the beginning use of symbols, through increased language skills and pictures, to represent the preschooler's world.
A nurse is assessing the psychosocial development of children in a day care center. Which child would the nurse expect to be experiencing the most intense period of speech development?
A 4-year-old Explanation: The most intense period of speech development is in the area of 4 years old. Piaget called this stage the preoperational stage, from ages 2 to 7 years old. This stage is characterized by the beginning use of symbols, through increased language skills and pictures, to represent the preschooler's world. A 2-year-old, although within the preoperational stage, does not experience the most intense period of speech development.
A nurse is caring for a client in a clinical setting. According to Havighurst, which of the following developmental tasks are for middle adulthood? (Select all that apply.)
Accepting and adjusting to physical changes Relating to one's spouse as a person Assisting children to become responsible adults Explanation: Havighurst's developmental tasks for middle adulthood include: Accepting and adjusting to physical changes, relating to one's spouse as a person, and assisting children to become responsible adults. Adjusting and adapting social roles in a flexible way is found in the later maturity stage. Managing a home falls under young adulthood.
A nurse is working in a pediatric clinic. The parent has brought in the 2-year-old toddler for a well-child checkup. The parent asks what the common health problems are common for this age. The nurse's correct reply includes which of the following?
Accidents Explanation: Accidents are a major health concern for toddlers due to their mobility and exploration of their environment. Food allergies are a common health concern during infancy. Scoliosis and lice infestation are more commonly seen in school-age children.
A child who learns that he must sit quietly during story hour in kindergarten, thereby integrating this new experience into his existing schemata, is applying the process of:
Assimilation Explanation: The child is applying the process of assimilation. Piaget introduced the terms assimilation and accommodation. Assimilation is the process of integrating new experiences into existing schemata, or designs. Accommodation is an alteration of existing thought processes to manage more complex information. Dissemination means distribution, and is not related to cognitive development.
A 25-year-old client is a college graduate and is married with one child. During a wellness visit, the client confides, "I just feel like something is missing from my life. Maybe I need to make a career change." How would the nurse familiar with Levenson and associates' theory of development interpret this statement?
As a normal finding for a client at this stage of development. Explanation: Levinson and associates' stage of "entering the adult world" occurs around ages 22 to 28. People are building on past decision and choices but may feel something is "missing" from their lives. Decisions are made to either find a new direction in life or to make a stronger commitment to previous choices. There is no indication that this transformation will be damaging.
A pediatric nurse practitioner is assessing the development of a child. The nurse's assessment of development will focus on which of the following?
Changes in thoughts, feelings, and behaviors Explanation: Development is an orderly pattern of change in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning. Development is a dynamic and continuous process as one proceeds through life, characterized by a series of ascents, plateaus, and declines. Growth, on the other hand, is an increase in body size, or changes in body cell structure, function, and complexity.
A nurse is caring for a child who states: "I don't like the taste of this medicine, but my parents told me it will help me get better, so I'll take it." This example best exemplifies which stage of Piaget's cognitive development theory?
Concrete operational stage Explanation: The child is in the concrete operational stage of development. This stage, from 7 to 11 years of age, is when logical thinking is developing. Sensorimotor stage is from birth to 24 months, where the child moves through a series of developmental tasks. Preoperational stage is from 2 to 7 years of age and when the child is beginning to use symbols and language to represent the his or her world. Formal operational stage is 11 years old and older. This is when the child begins to use abstract thinking and deductive reasoning.
What is considered to be a time when specific environmental or biologic events must occur for development to proceed normally?
Critical period Explanation: A critical period is a time during which specific environmental or biologic events must occur for development to proceed normally.
A student nurse is assisting the school nurse with a health fair at a middle school. The student nurse assesses the students' heights and weights as they file through the station, observing that there is a large variation in physical size and emotional maturity. Which of the following factors may affect emotional growth of children? Choose all that apply.
Development of trust Praise for doing well Loving caregivers Explanation: A child's growth and development might be facilitated or delayed by genetic heredity; prenatal, individual, and caregiver factors; and environment and nutrition. Erikson's early theories indicate that achieving trust and a sense of initiative and industry will allow for better emotional development. Loving caregivers, praise for doing well, and development of trust are critical elements for the emotional growth of school age children. Colorful toys and books may or may not add to emotional development, depending on the environment.
A nurse is preparing to assess an adult client's growth and development. When conducting this assessment, which information would be most important for the nurse to integrate? Select all that apply.
Each client is a unique individual. Regression may occur during a crisis period. A time of transition typically occurs with each stage. Explanation: Nurses need to maintain flexibility in assessing clients, and respect the uniqueness of each person. Although the literature describes development typical of a particular age, not everyone fits into an exact mold. Regression is possible during difficult periods or times of crisis. Within each stage of development, a person may retain some behaviors of a previous stage, attain goals of the current stage, and begin to exhibit behaviors of the next stage. There is a time of transition to the next stage with no definite beginning or ending to the particular stage of development. Environmental and cultural influences have a strong effect on development.
A nurse is caring for an older adult client in a long term care facility. The resident is reminiscing about his life and his achievements. The nurse understands the client is in which of the following stages of Erik Erikson's Psychosocial Development theory?
Ego Integrity Explanation: Erik Erikson's Ego Integrity stage includes older adults discussing their life and life achievements. Identity stage is the time when adolescences are trying different roles and undergoing puberty. Intimacy stage is seen in young adulthood when a sense of self identity emerges. Generativity is from middle adulthood when this age group begins to become concerned for the next generation.
An older adult has come to the clinic for a follow up visit. During the visit, the client tells the nurse, "I've really had a good life. I've been successful in my work and I have a wonderful family. My grandchildren bring me so much joy." The nurse interprets this statement as indicating achievement of which developmental task?
Ego integrity Explanation: As a person enters the older years, reminiscence about life events provides a sense of fulfillment and purpose, indicating the achievement of ego integrity. Generativity is the developmental task associated with middle adulthood, characterized by involvement with family, friends, and the community, with a concern for the next generation. Despair would be evident in the older adult by statements related to the person's life being a series of failures or missed directions. Intimacy is the developmental task associated with young adulthood.
The nurse is caring for a man 79 years of age who was admitted for a hip replacement. He visits with the nurse every chance he gets; he seems lonely. He tells the nurse his wife died two years ago. He has children in nearby cities and has nine grandchildren. He says his life has been good and he is content, even though he misses his wife. The nurse assesses him for developmental issues and knows that he fits well into which of Erikson's stages of development?
Ego integrity versus despair Explanation: Later adulthood brings either ego integrity or despair, according to Erikson. As one enters the older years, reminiscence about life events provides a sense of fulfillment and purpose. If one believes that one's life has been a series of failures or missed directions, a sense of despair might prevail. Generativity versus stagnation involves the middle years and intimacy versus isolation is about young adulthood. Mental health versus instability is not part of Erikson's theory.
A nurse is observing interactions between a new mother and her newborn. The nurse observes the mother not responding to her newborn's cries. Which of the following growth and development theories does the nurse understand this observation addresses?
Erik Erikson's Trust vs Mistrust stage Explanation: Erikson's Trust vs Mistrust stage is when the infant learns to rely on basic needs, such as warmth, food, and comfort. The mother in this scenario is not meeting these basic needs. Gillian's Selfishness level involves focusing on the mother's needs and wants. Kohlberg's theory is based on moral development. This is when the child learns to conform to rules by authority figures. Piaget's Sensorimotor stage is progression through a series of sensory and motor stages, such as sucking, manipulation of objects, and object permanence.
A nurse is reviewing developmental theories for class discussion. The nurse knows that Freud's theory emphasizes the effect of instinctual human drives on behavior. He identified the underlying stimulus for human behavior as sexuality, which he called libido. Freud defined libido as which of the following?
General pleasure-seeking instincts Explanation: Freud's theory emphasizes the effect of instinctual human drives on behavior. Freud identified the underlying stimulus for human behavior as sexuality, which he called libido. Libido is defined as general pleasure-seeking instincts rather than purely genital gratification.
A nurse observes individuals who are volunteering in a community free health clinic. Which of the following stages of Erikson's Psychosocial Development theory describes these individuals?
Generativity vs stagnation Explanation: With Erikson's Generativity vs Stagnation the individual desires to make a difference in his or her community. Volunteering at the community free health clinic is an example of this. Ego Integrity vs despair is a time of reminiscence of their life. Intimacy vs isolation is seen in young adults who are meshing their identities with those of their friends and making commitments. Identity vs role confusion is the transition from childhood to adulthood.
Donald, a newly graduated nurse, is working in a pediatric clinic. Today he sees Karen, a 1-month-old infant, and her single mother. The mother is estranged from Karen's father but is marrying her high school sweetheart next week. Donald remembers from nursing school that which of the following will affect an infant's growth and development? Choose all that apply.
Genetics of mother Environment of infant Mother's prenatal nutrition Explanation: Growth and development might be facilitated or delayed by genetic heredity; prenatal, individual, and caregiver factors; and environment and nutrition. Gender identity is the inner sense a person has of being male or female and should not effect growth and development of an infant.
A nurse is searching the Internet for information about theorists associated with moral development. The search reveals several theorists. Which result would the nurse identify as being associated with women and morality?
Gilligan Explanation: Gilligan (1977; 1982) originally worked with Kohlberg. As she listened to women discuss their own real-life moral conflicts, she recognized that there was a conception of morality from the female viewpoint that was not represented in Kohlberg's work. Gilligan's theory views girls and women as developing a morality of response and care, and boys and men as developing a morality of justice. Piaget developed a theory of cognitive development. Fowler postulated a developmental theory of the spiritual identity of humans.
The nurse is seeing 6-year-old Patrick in the clinic. As the nurse is measuring height and weight for Patrick, his mother comments on how much he has grown since his last checkup. The nurse knows that this increase in size is which of the following?
Growth Explanation: Growth is an increase in body size, or changes in body cell structure, function, and complexity. Development is an orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning. Cephalocaudal means proceeding from head to tail. Pubescence is the time when secondary sex characteristics continue to develop, and ova and sperm begin to be produced by the reproductive organs.
A student nurse is assisting the school nurse with a health fair at a middle school. The student nurse assesses the students' height and weight as they file through her station, where she observes that there is a large variation in physical size and emotional maturity. Which of the following factors may affect physical growth of children? Choose all that apply.
Heredity Prenatal nutrition Physical activity Explanation: Many different factors influence both growth and development. Growth and development might be facilitated or delayed by genetic heredity; prenatal, individual, and caregiver factors; and environment and nutrition. Colorful toys and books help create a stimulating environment, but probably do not contribute to physical growth.
A 10-year-old girl is excited when she receives the "most improved player" award on her softball team. Although she was not the strongest player on the team, she always tried to perform at her best level and never gave up on practicing her skills. What stage of psychosocial development according to Erik Erikson is this child demonstrating?
Industry versus inferiority Explanation: Industry versus inferiority focuses on end results of achievements, and the school-aged child gains pleasure from finishing projects and receiving recognition for accomplishments. Autonomy versus shame and doubt occurs during toddlerhood, as the child learns about the environment and gains independence. Initiative versus guilt occurs during the preschool years and is characterized by confidence gained as the child takes the initiative in learning. Identity versus role confusion occurs during adolescence as physical changes occur. The individual also works to acquire a sense of self and the direction in life to follow.
The parents of a 4-year-old girl bring the child to the clinic for the first time. During the assessment, the nurse asks the parents about any religious beliefs. The parents tell the nurse that they are Christian. The mother says, "We take her to church with us. She's really well-behaved. She even tries to imitate what we do, standing, kneeling, folding her hands, and such." The nurse interprets this behavior as reflecting which stage of faith development?
Intuitive-projective faith Explanation: Intuitive-projective faith is most typical of the 3- to 7-year-old child. Children imitate religious gestures and behaviors of others, primarily their parents. During the prestage (undifferentiated faith), trust, courage, hope, and love compete with threats of abandonment and inconsistencies in the infant's environment. The strength of faith in this stage is based on the infant's relationship with the primary caregiver. Mythical-literal faith predominates in the school-aged child, who is having more social interaction. Stories represent religious and moral beliefs, and the child accepts the existence of a deity. Synthetic-conventional faith is the characteristic stage of many adolescents.
The school nurse is teaching growth and development in a health class. What should the nurse teach the students about development?
It is the process of ongoing change Explanation: Development is the process of ongoing change, reorganization, and integration that occurs throughout life. Growth centers around the physical attainment such as body size and genetically predisposed alterations as well as development which focuses on the psycho social elements including intellectual growth.
A boy 8 years of age is looking at his father's razor and shaving cream in the bathroom medicine cabinet. He watches his father shave daily and asks his father when he will need to start shaving. This child is demonstrating characteristics common during which of Freud's psychoanalytic developmental stages?
Latency stage Explanation: The latency stage (ages 7 to 12 years) makes the transition to the genital stage during adolescence and is characterized by increasing sex-role identification with the parent of the same sex. This stage prepares the child for adult roles and relationships. The anal stage (ages 8 months to 4 years) begins with the development of neuromuscular control to allow control of the anal sphincter. The phallic stage occurs between the ages of 3 and 7 years and the child demonstrates an increased interest in gender differences and his or her own gender. The genital stage (ages 12 to 20 years) is characterized by sexual interest that can be expressed in overt sexual relationships.
A nurse is working with young adults and assessing their moral development. The nurse relates which of the following theorists who developed the Theory of Moral Development?
Lawrence Kohlberg Explanation: Lawrence Kohlberg developed the Theory of Moral Development. Erik Erikson developed the Theory of Psychosocial Development. Robert Havighurst described learned behaviors as developmental tasks that occur through various times in a human's life. Sigmund Freud developed the theory of Psychoanalytic Development.
A nurse is describing the developmental phases identified by Roger Gould. Place the phases listed below in the proper order (from first to last) as to how the nurse would describe them.
Leaving the parents' world Getting into the adult world Questioning and reexamination Mid-life decade Reconciliation and mellowing Stability and acceptance Explanation: According to Gould, development occurs as follows: ages 18 to 22—leaving the parents' world; ages 22 to 28—getting into the adult world; ages 29 to 34— questioning and reexamination; ages 35 to 43—midlife decade; ages 43 to 50—reconciliation and mellowing; ages 50 and over—stability and acceptance.
The nurse is counseling a woman who states: "I'm never going to find a husband; every time I start dating I end up getting hurt. I'm not even going to try anymore." This woman is in what stage of Carol Gilligan's theory of moral development?
Level 1—selfishness Explanation: This woman is in Level 1 of Gilligan's theory of moral development. In Level 1, the focus is on one's own needs. In Level 2, moral judgment is based on shared norms and expectations, and societal values are adopted. In Level 3, a changed understanding of self and a redefinition of morality allow reconciliation of selfishness and responsibility. Nonviolence (the injunction against hurting) governs all moral judgments and actions.
The nurse is providing prenatal education for a group of pregnant adolescents. The nurse talks about substance use during pregnancy and relates that use to which possible newborn consequences? Select all that apply.
Low birth weight Premature birth Congenital anomalies Explanation: Substance use by a pregnant woman increases the risk for congenital anomalies, low birth weight, and prematurity in the developing fetus. Poor development of superego and development of mistrust may occur after birth, but are not caused by substance use during pregnancy. If developed, these may occur during the emotional growth stage.
As a nursing student is visiting a day care to observe growth and development in action. The nursing student completes assessments on infants and toddlers who are learning to walk, talk, and control elimination. According to Freud, in what developmental stage are they?
Oral; anal Explanation: During the oral stage, Freud indicates that the infant uses his or her mouth as the major source of gratification and exploration. Pleasure is experienced from eating, biting, chewing, and sucking. Freud goes on to say that toilet training is a crucial issue, requiring delayed gratification as the child compromises between enjoyment of bowel function and limits set by social expectations. Trust versus mistrust is Erikson's theory. The Phallic stage is Freud's preschool theory. The relationships and events theory belongs to Piaget.
A student nurse is enrolled in a growth and development class. Which of the following Freudian stages should the student nurse recognize in a child with an increase in gender difference awareness?
Phallic Stage Explanation: The Phallic Stage is the stage in which a child develops an increased awareness of gender differences. The Oral Stage is when the infant uses his or her mouth as a major source of satisfaction. The Anal Stage is when toilet training is taking place with the child. The Latency Stage involves identification with the same sex parent.
A mother, 13 years of age, delivers a low-birth-weight neonate. The neonate is transferred to the neonatal intensive care unit. The mother reports receiving occasional prenatal care and has a history of excessive alcohol consumption. The growth and development of this neonate has been influenced by which of the following?
Prenatal factors Explanation: Fetal development can be altered by prenatal factors such as maternal age (with risk greater in those under age 15 and over age 35), maternal substance use, inadequate prenatal care, and inadequate maternal nutrition. Individual factors might result in altered development from birth through adolescence and may include congenital or genetic disorders, brain damage from accidents, or abuse, sensory impairments, and substance use. Caregiver factors that negatively affect development are neglect and abuse, mental illness, intellectual disability, or a severe learning disability. Spiritual factors, such as religious beliefs, are not a factor in this situation.
A nursing student is visiting a day care to observe growth and development in action. The nursing student completes screening assessments on preschoolers who are learning to feed, dress, and toilet themselves, as well as expanding their motor and verbal abilities. According to Piaget, in what development stage are they?
Preoperational Explanation: Piaget's preoperational stage is characterized by the beginning use of symbols, through increased language skills and pictures, to represent the preschooler's world. Sensorimotor is Piaget's birth to 24-month stage. Concrete operational is Piaget's 7- to 11-year-old stage. Autonomy versus shame and doubt is Erikson's theory.
Genomic information can identify gene mutations and environmental influences that can impact a pregnancy. What are the implications for nursing practice related to this advancement?
Provision of appropriate health teaching Explanation: Regarding the ongoing genomic research, nurses need the knowledge base to be able to answer questions, provide appropriate health teaching, and counsel or direct clients at risk to available resources. The other choices are all good prevention interventions for nurses to teach pregnant clients, but not necessarily related to genomic research.
A nurse is caring for a 6-year-old boy who is hospitalized for observation following a motor vehicle accident. Based on Havighurst's developmental tasks, what would be the best choice for a diversional activity for this client?
Reading a storybook Explanation: Havighurst (1972) believed that living and growing are based on learning, and that a person must continuously learn to adjust to changing conditions. He described learned behaviors as developmental tasks that occur at certain periods in life. Development tasks of early childhood would include developing fundamental skills in reading and achieving personal independence, to name a few. The best answer above would be reading a story book. The other diversional activities would be appropriate for the adolescent.
The nurse is seeing a male client 6 years of age in the clinic. As the nurse is measuring height and weight for the client, his mother comments on how coordinated he is becoming. The nurse knows that this increase in coordination is which of the following?
Related to development Explanation: Growth is an increase in body size, or changes in body cell structure, function, and complexity. Development is an orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning. Pubescence is the time when secondary sex characteristics continue to develop, and ova and sperm begin to be produced by the reproductive organs. Developing coordination is not a reflex.
Newborns are capable of activities such as grasping objects and displaying basic reflexes. To which of the following of Piaget's cognitive developmental stages do the newborns belong?
Sensorimotor Explanation: Newborns belong to the sensorimotor stage of cognitive development, characterized by activities such as grasping and displaying basic reflexes. The preoperational stage is characterized by assigning meaning or identity to an object governed by own perceptions. The concrete operational stage is characterized by concrete thinking and using more logic. The formal operational stage emerges around 12 years of age and is characterized by the ability to think abstractly.
A nurse is observing a child pick up a rattler and shake it to hear a sound. The nurse understands that the child is considered to be in which of the following of Piaget's Cognitive Development stages?
Sensorimotor stage Explanation: A child who picks up a rattler to shake it is considered to be in Piaget's Sensorimotor stage. This shows the child relating his or her own behavior to the environment. In the Preoperational stage the child uses symbols and pictures to represent themselves. In the Concrete Operational stage the child can manipulate objects. With formal Operational stage the child uses abstract thinking.
According to Freud, which of the following influences is the primary force that drives an individual's development?
Sexuality Explanation: According to Sigmund Freud, the stages of development are based on sexual motivation. Sexuality supersedes security and autonomy, though both are highly significant and are influenced by sexual motivation. Faith is not a central construct in Freud's theory of development.
As the nurse is preparing an immunization for a male client 2 years of age, his mother discovers that he has soiled his underpants. She scolds him and calls him a "bad boy" because he "dirtied" his underwear. The nurse gives the immunization and provides some education to the mother about appropriate expectations for this age group. The nurse knows that according to Erikson's theory for this client's age group, he is at risk to develop which of the following?
Shame and doubt Explanation: According to Erikson, the toddler's task is to achieve autonomy versus shame and doubt. If the caregivers are overprotective or have expectations that are too high (such as the client's mother), shame and doubt, as well as feelings of inadequacy, might develop in the child. During the initiative versus guilt stage, children begin to assert their power and control over the world through directing play and other social interaction. Industry versus inferiority is the fourth stage of Erik Erikson's theory of psychosocial development. The stage occurs during childhood between the ages of approximately six and eleven. Children are at the stage where they will be learning to read and write, to do sums, to do things on their own. Intimacy versus isolation is the sixth stage of Erik Erikson's theory of psychosocial development. This stage takes place during young adulthood between the ages of approximately 19 and 40. During this period, the major conflict centers on forming intimate, loving relationships with other people.
A nurse assesses the effect of the environment and nutrition on clients visiting a walk-in clinic in a low-income community. Which statements accurately describe these effects? Select all that apply.
Substance use by a pregnant woman increases the risk for congenital anomalies in the developing fetus. Use of alcohol and drugs is more prevalent in adolescents who have poor family relationships. An increased incidence of adolescent pregnancy can be linked to substance use by adolescents. Explanation: Environment and nutrition influence all stages of development. Environmental factors that might alter development include poverty, violence, unsafe living conditions, the presence of lead or mold in the home, and the quality of air and water in the surrounding environment. With this in mind, the following statements accurately describe the effect of the environment and nutrition on clients: substance use is a higher risk with this population; use of alcohol and drugs in adolescents is a higher risk with this population; and an increased incidence of adolescent pregnancy can be linked to substance use by adolescents. Infants who are malnourished in utero do not develop the same amount of brain cells as infants who have had adequate prenatal nutrition. Failure to thrive can be linked to emotional deprivation. Psychosocial development can be affected by child abuse.
A nurse is using Freud's theory of psychoanalytic development to assess the development of children in the phallic stage of this theory. Which developmental milestones would the nurse expect the child to have experienced by this age? Select all that apply.
The child is toilet trained. The child increases interest in gender differences. The child is possessive of the opposite-sex parent. The child is curious about genitals and masturbation. Explanation: The nurse would expect the following milestones to have been reached by children in the phallic stage: toilet training (accomplished in the anal stage), possessive of the opposite-sex parent, increased interest in gender differences, and curious about genitals and increase in masturbation. The child would not yet be preparing for adult roles and relationships or experiencing sexual pressures and conflicts.
A nurse is assessing children using Kohlberg's theory of moral development. What milestones are achieved in the preconventional level of this theory? Select all that apply.
The child learns to follow parents' rules. The child is motivated by punishment for not conforming to rules. The child develops a perception of goodness or badness. Explanation: In Kohlberg's preconventional level, the child learns to follow parents' rules, is motivated by punishment for not conforming to rules, and develops a perception of goodness or badness. The conventional stage would be represented by the child identifying with family members and conforming to their expectations. The conventional stage would also be represented by the child striving for approval in an attempt to be viewed as "good." The postconventional stage is represented by the child developing moral judgment that is rational and internalized into self.
A nurse wants to teach children about the importance of oral health with brushing and flossing. Based on Piaget's theory, to what age group would it be most appropriate to teach this topic?
Third- and fourth-graders Explanation: According to Piaget, children ages 7 to 11 learn by manipulating concrete or tangible objects and are developing logical thinking. This (third and fourth grade) would be an appropriate age to teach oral health.
During a well-child visit, the nurse observes a 3-year-old girl who climbs up into her father's lap and says, "I am going to marry you when I grow up, Daddy." What determination does the nurse make about this observation?
This child is experiencing the Electra complex which is normal at this age. Explanation: The Electra complex is based on feelings of intimate sexual possessiveness for the opposite-sex parent. It is normal during the phallic stage of development and will likely resolve. The latency stage does not begin until much later in childhood (age 7). There is no indication that this child is being sexually abused by the father or has an unhealthy attachment to him.
A nurse is teaching a new mother about the growth and development of her infant. When describing development, the nurse would explain it as encompassing changes in which area? Select all that apply.
Thoughts Behaviors Feelings Explanation: Growth is an increase in body size or changes in body cell structure, function, and complexity. Development is an orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning.
During a health history, a middle-aged man tells the nurse, "I will always take care of my children because my parents took care of me." Based on Kohlberg's theory, what level of moral development is the man demonstrating?
conventional Explanation: The conventional level of moral development in Kohlberg's theory involves identifying with significant others and conforming to their expectations. The person respects the values and ideals of family and friends, regardless of consequences.