Theories. Health Promotion

A nurse is caring for a 4-year-old child who is terminally ill. The 4-year-old child's concept of death is based on a sense of causality. In what stage of Piaget's cognitive development is this child?

Preoperational thought Rationale: Piaget describes preoperational thought as the preschooler's thought processes. A 4-year-old child is a preschooler. Piaget describes formal operations as the adolescent's thought processes. Piaget describes sensorimotor operations as the infant's thought processes. Piaget describes concrete operational thought as the school-age child's thought processes.

At what age is a client in Freud's phallic stage of psychosexual development and Erikson's psychosocial phase of initiative versus guilt?

3 to 5 years Rationale: Three to 5 years is Freud's phallic stage and Erikson's stage of initiative versus guilt. Adolescence is Freud's genital stage and Erikson's stage of identity versus role confusion. Six to 12 years is Freud's latency stage and Erikson's stage of industry versus inferiority. Birth to 1 year is Freud's oral stage and Erikson's stage of trust versus mistrust.

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?

Autonomy versus shame and doubt Rationale: 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 him- 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 of 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 where the child will perform tasks to attain real achievements, not 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.

According to Piaget's theory of cognitive development, what should the nurse expect a 6-month-old infant to demonstrate?

Beginning of object permanence Rationale: The concept of object permanence begins to develop around 6 months of age. Early traces of memory and beginning sense of time occur at between 13 and 24 months. Repetitious reflex responses occur during the first several months of life. These diminish as the newborn grows.

A 9-month-old infant who appears well nourished, alert, and happy is brought to the well-baby clinic for a routine physical examination. Using Freud's psychosocial theory of development, the nurse determines that the infant is in the:

Oral-sensory stage Rationale: According to Freud's psychosocial theory, the oral-sensory stage extends from birth to 18 months. The genital stage runs from 12 years to early adulthood. The latency stage is between 6 and 12 years of age. The anal-urethral stage extends from 1½ to 3 years of age.

A 2-year-old boy who has fallen from a tree tells his parents and the nurse, "Bad, bad tree." The nurse concludes that the child is within the cognitive developmental norm of Piaget's:

Preconceptual operations Rationale: Attributing lifelike qualities to inanimate objects (animism) is associated with preconceptual thought. Concrete operational thought is achieved in school-age children. Concept of reversibility is a phase of concrete operations achieved by school-age children. Sensorimotor development is related to infants.

What are the different stages of cognitive development in an infant as described by Piaget? Select all that apply.

Separation, Using symbols, Object permanence The first stage of cognitive development is separation, in which infants learn that they are separate from the objects in their environment. Using symbols or mental representation to think of an object without actually experiencing it is the last stage of intellectual development and occurs at 12 months of age. In the object permanence stage the infant understands that the objects exist even after they are outside the visual field. Narcissism refers to total control for oneself, which is seen in infants at the first stage of psychosocial development. Attachment is a development of the social aspects in a child, and is not a stage of cognitive development.

While interacting with a 4-year-old child, the nurse observes that the child exhibits which behavior congruent with Piaget's cognitive development theory?

The child is unable to see things from others' perspectives. Rationale: A 4-year-old child has his or her own perspective and expects that others also think the same way. This behavior is seen in the preoperational stage of Piaget's development theory. A 1- to 2-year-old child who is in the sensorimotor stage, according to Piaget's theory, will begin to use language. An adolescent who is in the formal operations stage of Piaget's developmental theory will use abstract symbols and draw conclusions. The ability to draw conclusions from abstract symbols is not a finding in a 4-year-old. The ability to classify and sort problems is developed between the ages of 7 and 11 years. A child who is in the concrete operations stage of Piaget's development theory will exhibit the ability to classify and sort facts to solve problems.

A child is born to a mother whose hepatitis B status is negative. While assessing the newborn, the nurse finds that the birth weight is 1.8 kg. Which action by the nurse is appropriate in this situation?

Administer HepB vaccine to the newborn 1 month after birth. Rationale: The immune response to the HepB vaccine is not optimum in newborns weighing less than 2 kg. As the mother's hepatitis B status is negative, the first dose of HepB vaccine should be administered 1 month after birth. There is no need to administer 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth, as the mother's hepatitis B status is negative. Monovalent HepB vaccine is administered during discharge to newborns whose birth weight is more than 2 kg. If the infant were born to a hepatitis-positive mother, HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) would be administered within 12 hours of birth.

Which stage of Freud's psychosexual development theory does the nurse observe in a 3-year-old child?

Anal stage Rationale: The anal stage of development is seen in a child at 1 to 3 years of age, during the time the child is being toilet trained. The period from birth to 1 year of age, when the child likes sucking, biting, and chewing, is said to be the oral stage. A child is in the phallic stage of development from 3 to 6 years of age. During the phallic stage, the child develops interest in sensitive areas of the body like the genitals. The latency stage of development is seen from 6 to 12 years of age, when the child channels all energy to gain knowledge and play.

A nurse is assessing a 2½-year-old child who has fallen from a tree. The child tells the parents, "Bad, bad tree." According to Piaget, what cognitive level does this conversation reflect?

Preconceptual operations Rationale: Attributing lifelike qualities to inanimate objects (animism) is associated with preconceptual thought, which is typical of toddlers. Concrete operations are associated with school-age children. The concept of reversibility is a phase of concrete operations associated with school-age children. Sensorimotor development is associated with infants.

A nurse must consider a child's cognitive level of development when providing preoperative teaching. At which stage of Piaget's cognitive theory should the nurse anticipate that a child will experience the greatest fear of surgery?

Preoperational Rationale: Children ages 2 to 7 years have difficulty distinguishing reality from fantasy, which may increase fears. Children between birth and 1 year of age focus on "in the moment" thinking; preoperative preparation most likely will not be recalled. Children 12 to 16 years of age can think in the abstract and have the ability to solve complex problems; children in this stage usually do not pose difficulties in preoperative teaching. Children 7 to 11 years of age have the ability to comprehend and visualize a series of events and can think about the past and present; this stage provides less of a challenge to absorb preoperative teachings.