138: Development
A student nurse compares the sources of stress in both 7-year-olds and 12-year-olds. Which source of stress is prevalent in children of both these age groups? 1 Idols 2 Health 3 Money 4 Confusion
1 Idols are a source of stress for both 7-year-old and 12-year-old children. The 7-year-old has a desire to be more like an admired idol. The 12-year-old continues hero worshipping. Health is a source of stress for 12 year olds and some may become hypochondriacs during this period of development. Health is not a source of stress for 7 year olds. Money can be a source of stress for the 12 year old. This child is anxious to earn and handle money but often uses poor judgment. Money is not yet a matter of concern for the 7 year old. Too much freedom can create confusion in a 12-year-old and can cause the child to flounder. A 7-year-old does not usually have much freedom and, thereby, does not experience the accompanying stress.
The nurse is teaching the parents of a toddler-age client about food safety related to choking. Which parental statement indicates the need for further education? 1 "Hot dogs are safe and do not present a choking hazard for my child." 2 "Ice cream is safe and does not present a choking hazard for my child." 3 "Chicken nuggets are safe and do not present a choking hazard for my child." 4 "Mashed potatoes are safe and do not present a choking hazard for my child."
1 Large round foods, such as hot dogs, should be avoided until the toddler is able to chew effectively due to the risk for choking. Ice cream, chicken nuggets, and mashed potatoes are not identified as choking hazards for the toddler-age client.
Which drug should be excluded from the prescription of a lactating mother being treated for heart problems? 1 Tenormin 2 Labetalol 3 Metoprolol 4 Propranolol
1 Tenormin is contraindicated for lactating mothers because this drug highly concentrates in breast milk. Labetalol, metoprolol, and propranolol are safe to prescribe to lactating mothers
A day after an explanation of the effects of surgery to create an ileostomy, a 68-year-old client remarks to the nurse, "It will be difficult for my wife to care for a helpless old man." This comment by the client regarding himself is an example of Erikson's conflict of what? 1 Initiative versus guilt 2 Integrity versus despair 3 Industry versus inferiority 4 Generativity versus stagnation
2 According to Erikson, poor self-concept and feelings of despair are conflicts manifested in those who are older than 65 years of age. The initiative versus guilt conflict is manifested in early childhood between 3 and 6 years of age. The industry versus inferiority conflict is manifested during the ages from 6 to 11 years. The generativity versus stagnation conflict is manifested during middle adulthood, 45 to 65 years of age.
A nurse is teaching parents about growth and development in preadolescent girls, and a mother asks at what age her daughter will have her first period. What is the most accurate response by the nurse? 1 Before the pubic hair appears 2 At the end of the growth spurt 3 Near the age when their mothers did 4 Around the time when the breasts develop
2 Menarche occurs when the prepubertal growth spurt is almost completed and after the primary and secondary sexual characteristics are almost fully developed. Pubic hair is seen about 6 months after the breast buds appear; the buds appear earlier than menarche. Although there may be a familial tendency to reach menarche at the same age as the mother, there are too many variables for this to be used as a guideline. The breast buds become noticeable about 2 years before menarche; they are the first secondary sexual characteristic to appear.
A nurse is teaching a group of assistants in a daycare center about toddlers' developmental milestones. What behavior should indicate to the assistants that one of the milestones has been achieved? 1 Trusting others 2 Accepting external limits 3 Initiating superego control 4 Distinguishing roles in society
2 One task of toddlers is to accept limit setting and discipline, which are necessary for them to develop self-control while learning the boundaries of their abilities. An infant must learn to trust before moving on to other developmental goals. Superego control begins in the preschooler. Roles within society are learned by the school-aged child.
Which ages are the most critical for language development during the preschool stage of development? Select all that apply. 1 2 years 2 3 years 3 4 years 4 5 years 5 6 years
2,3 The most critical ages for speech development for the preschool-age client are 3 and 4 years of age. While critical speech development occurs at the age of 2, this is the toddler, not preschool, stage of development. The ages of 5 and 6 years are not considered critical ages for speech development for the preschool-age client.
Which auditory test is appropriate for infants? 1 Play audiometry 2 Pure tone audiometry 3 Behavioral audiometry 4 Auditory brainstem response (ABR)
3 Behavioral audiometry is used for infants. Play audiometry is used for toddlers. Pure tone audiometry is used for children and adolescents. ABR is used for newborns.
Which nutrient deficiency in the pregnant adolescent may result in decreased birth weight as a consequence of low bone mineral density in the fetus? 1 Zinc 2 Iron 3 Calcium 4 Folic acid
3 Calcium and vitamin deficiency may result in decreased birth weight as a consequence of low bone mineral density. Zinc deficiency may not lead to a decrease in bone mineral density. Iron deficiency may lead to anemia. Folic acid deficiency may result in neural tube defects.
A nurse finds it difficult to obtain intravenous (IV) access to administer electrolytes to a 2-year-old child suffering from severe diarrhea. Which other route of administration should the nurse try? 1 Intrathecal 2 Intrapleural 3 Intraosseous 4 Intraperitoneal
3 The nurse should use the intraosseous route to administer electrolytes to infants and toddlers. This route is most commonly used in infants and toddlers when an emergency arises and IV access is impossible. This method involves the infusion of medication directly into the bone marrow. Intrathecal administration is often associated with long-term medication administration through surgically implanted catheters. Chemotherapeutic agents are the most common medications administered via the intrapleural method. Chemotherapeutic agents, insulin, and antibiotics are administered through the intraperitoneal route.
During which stage of development should the nurse anticipate sibling relationships that fluctuate between open bickering and supportive relationships? 1 Preschool 2 Early school-age 3 Late adolescence 4 Middle school-age
4 During middle school-age the nurse would anticipate that the sibling relationship will fluctuate between open bickering and a supportive relationship. This behavior is not anticipated during the preschool, early school-age, or late adolescent stages of development.
Which stage of Kohlberg's theory is an individual in if he or she wants to modify a law if it is not fair to a particular group? 1 Social contract orientation 2 Society-maintaining orientation 3 Instrument relativist orientation 4 Universal ethical principle orientation
4 The universal ethical principle orientation stage is associated with a person who wants to modify a law if it does not seem just. According to the social contract orientation stage, a person tends to follow a law even if it is not fair. During the society-maintaining stage, an individual shows concerns for his or her society and makes decisions in accordance to his or her society. During the instrument relativist orientation stage, a child recognizes that there is more than one correct view.
Which opposing conflict does a young adult face according to Erikson's theory of psychosocial development? 1 Intimacy versus Isolation 2 Identity versus Role Confusion 3 Autonomy versus Sense of Shame and Doubt 4 Generativity versus Self-Absorption and Stagnation
1 According to Erikson's theory of psychosocial development, a young adult is likely to face Intimacy versus Isolation. An adolescent is likely to face Identity versus Role confusion. A toddler age 1 to 3 years of age is likely to face Autonomy versus Sense of Shame and Doubt. A middle-aged adult is likely to face Generativity versus Self-Absorption and Stagnation.
After assessing a neonate immediately after birth who was delivered using forceps, the nurse confirms facial paralysis. Which information does the nurse provide to the mother? 1 Don't panic; it will resolve within a few days. 2 Take the newborn to a neurologist immediately. 3 The infant requires phototherapy for a few minutes. 4 Refrain from breast-feeding the infant for a few days
1 Facial paralysis may occur in a neonate because of a forceps delivery. This facial paralysis generally disappears within a few hours or days, so no medical intervention is required. Phototherapy does not affect facial paralysis in a neonate. Facial paralysis in a neonate generally does not reflect brain damage, so there is no immediate need to consult a neurologist. Breastfeeding is not contraindicated in neonates with facial paralysis.
A school-aged child scores between 55 and 68 on a standardized intelligent quotient (IQ) assessment test. What degree of intellectual impairment should the nurse consider this to represent? 1 Mild 2 Severe 3 Profound 4 Moderate
1 IQs between 50 to 55 and 70 are considered to represent mild intellectual impairment. An IQ between 20 to 25 and 35 to 40 indicates severe intellectual impairment. An IQ below 20 to 25 indicates profound intellectual impairment. An IQ between 35 to 40 and 50 to 55 indicates moderate intellectual impairment.
A nurse is evaluating different situations on the basis of the components of human personality as mentioned by Sigmund Freud. Which situations represent the id component? Select all that apply. 1 A client experiencing pain takes pain medication prescribed to a family member. 2 A client feels nauseous; therefore, he or she leaves work midway to go to a healthcare facility. 3 A client wishes to go home and therefore slips out of the healthcare facility quietly without anyone noticing. 4 A client feeling hungry notices a food tray at the next bed, but does not grab the food because a nurse is watching. 5 A client feeling thirsty waits for the nurse to bring him or her water instead of taking it from the next client because he or she knows that it is wrong.
1,2,3 According to Sigmund Freud, the components of human personality develop in stages and affect behavior. The three components are the id, the ego and the superego. The id represents basic human instincts and impulses that are driven to achieve pleasure. In the given situation, the client feels the need to reduce the pain and therefore takes a medication prescribed for a different person. This is an example of id. A client who leaves work midway to go to the healthcare facility because of nausea is also exhibiting id behavior. Another example of id behavior is a situation where a client who wishes to go home slips out of the healthcare facility instead of following proper protocol. A client who is hungry is tempted by the food tray beside the next bed but controls himself or herself because the nurse is watching exhibits ego behavior. A client who feels thirsty understands that it is wrong to take water given to another client and instead waits for the nurse to bring some water exhibits superego behavior.
The nurse who works in a birthing unit understands that newborns may have impaired thermoregulation. Which nursing interventions may help prevent heat loss in the newborns? Select all that apply. 1 The nurse keeps the newborn covered in warm blankets. 2 The nurse keeps the newborn under the radiant warmer. 3 The nurse places the newborn on the mother's abdomen. 4 The nurse measures the newborn's temperature regularly. 5 The nurse encourages the mother to feed the newborn well to maintain the fluid balance
1,2,3 Newborns have impaired thermoregulation due to immaturity of the body systems. Therefore, the nurse performs interventions to prevent heat loss in the newborn. Covering the newborn with warm blankets helps to prevent heat loss. The nurse keeps the newborn under the radiant warmer to help maintain the body temperature. Placing the newborn on the mother's abdomen helps to promote warmth through skin-to-skin contact. Regular measurement of temperature may help in assessing any significant change; however, it may not help prevent heat loss. Ensuring that the newborn is fed well does not help to prevent heat loss.
In which settings should the nurse prepare to administer developmental assessment for pediatric clients? Select all that apply. 1 Home 2 School 3 Hospital 4 Daycare center 5 Assisted living center
1,2,3,4 Pediatric developmental assessments are performed in many settings, including the home, school, hospital, and daycare center environments. It is unlikely that a pediatric developmental assessment would be performed in an assisted living center.
Which activities should the nurse expect to see exhibited by a healthy 6-month-old infant during an evaluation of the infant's growth and development? Select all that apply. 1 Playing peek-a-boo 2 Turning completely over 3 Reaching to be picked up 4 Pulling up to a standing position 5 Sitting for a short time without support
1,2,3,5 Peek-a-boo is enjoyed by 6-month-old infants because they do not understand the concept of object permanence. Infants turn from abdomen to back by 5 months of age and from back to abdomen by 6 months of age. Reaching to be picked up is age appropriate for a 6-month-old infant; at 6 months infants differentiate between familiar and strange faces and have developed trust in primary caregivers. Sitting for a short time without support is age appropriate for a 6-month-old infant; infants of this age can sit for short periods, especially when placed in a tripod position with legs abducted. Pulling up to a standing position is usually performed by 10 months of age; torso and extremity strength have increased enough for a child of this age to perform this skill.
Which of the following are congenital anomalies or birth defects seen in children? Select all that apply. 1 Dysplasias 2 Disruptions 3 Teratogens 4 Deformations 5 Malformations
1,2,4,5 Dysplasias are caused by abnormal organization of cells into a particular tissue type. Disruptions are sometimes seen in a child from the breakdown of previously normal tissue. Deformations may be seen in a child at birth and are caused by extrinsic mechanical forces on normally developing tissue. Malformations are abnormal body parts caused by an abnormal developmental process. Teratogens are agents such as drugs, warfarin, alcohol, or bacteria that cause birth defects in a child.
A registered nurse is teaching a nursing student about various developmental theories. What points mentioned by the registered nurse are accurate? Select all that apply. 1 Moral development theory attempts to define how moral reasoning matures in an individual. 2 Developmental theory provides a basis for nurses to assess and understand a client's responses. 3 Biophysical development theory describes human development from the perspectives of personality, thinking, and behavior. 4 Psychosocial theories explore theories of why individuals age from a biological standpoint and why development follows a predictable sequence. 5 Cognitive development focuses on rational thinking processes that include changes in children, adolescents, and adults to perform intellectual operations
1,2,5 Moral development theory attempts to define how moral reasoning matures in an individual. Developmental theory provides a basis for nurses to assess and understand a client's responses. Cognitive development focuses on rational thinking processes that include the changes in children, adolescents, and adults to perform intellectual operations. Biophysical development explores theories of why individuals age from a biological standpoint as well as why development follows a predictable sequence. Psychosocial theories describe human development from the perspectives of personality, thinking, and behavior.
The student nurse is learning about the developmental characteristics of vision. Which major developmental characteristics does an infant start exhibiting around age 6 weeks? Select all that apply. 1 Having binocular vision 2 Having doll's eye reflex 3 Having visual acuity 20/40 to 20/60 4 Having peripheral vision to 180 degree 5 Having strabismus if binocular vision is absent
1,4 Beginning at age 6 weeks, the infant has binocular vision, which becomes well established by age 4 months. Within 6 to 12 weeks, the infant has peripheral vision to 180 degrees. An infant has doll's eye reflex at birth, and it disappears within age 6 to 12 weeks. Visual acuity of 20/40 to 20/60 does not develop until age 44 to 52 weeks. Lack of binocular vision indicates strabismus at age 28 to 44 weeks. While binocular vision generally develops by age 6 weeks, a lack of this development at this age is not indicative of strabismus.
What are the greatest risks for injury among adolescents? Select all that apply. 1 Suicide 2 Poisoning 3 Child abduction 4 Home accidents 5 Substance abuse 6 Automobile accidents
1,5,6 Adolescents are at greater risk of suicide, substance abuse, and automobile accidents. Preschoolers are at a greater risk of poisoning and abduction. Children younger than 5 years are at greatest risk for home accidents that result in severe injury and death.
A nursing student is learning about Erikson's theory of psychosocial development. Which statement made by the client indicates the Identity versus Role Confusion stage? Select all that apply. 1 "I fear that this relationship will not last, just like the previous one." 2 "I like to dress like a boy even though my parents want me to dress like a girl." 3 "When I look back at my life, I feel that I have not been able to be a good mother." 4 "I want to get a clear skin like my best friend, so I am visiting the skin specialist today." 5 "I do not want to become an engineer like my parents want me to be; I dream of becoming a pilot."
2,4,5 According to Erikson's theory of psychosocial development, in the Identity versus Role Confusion stage, an individual may pass through dramatic physiological changes. A client who says that she likes to dress like a boy but her parents want her to dress like a girl is in the Identity versus Role Confusion stage. A client who wants clear skin like his or her best friend is also in this stage. A client who wants to become a pilot instead of an engineer is also in the Identity versus Role Confusion stage. A client who fears that his or her relationship will not last like his or her previous one is in the Intimacy versus Isolation stage. An older adult who feels that she has not been able to be a good mother is in the Integrity versus Despair stage.
A child in sickle cell crisis is admitted to the pediatric unit. Which actions will the nurse take? Select all that apply. 1 Place on strict isolation 2 Administer hydroxyurea 3 Administer acetylsalicylic acid 4 Apply oxygen via nasal cannula 5 Offer age-appropriate activities 6 Administer intravenous (IV) hydration
2,4,5,6 Hydroxyurea can reduce the number of sickling and pain episodes by stimulating fetal hemoglobin production. Providing oxygen via nasal cannula provides additional oxygen, which is necessary because of decreased hemoglobin, which carries oxygen. Age-appropriate activities can help alleviate boredom as the child begins to feel better. Providing intravenous hydration until the child is able to tolerate adequate by mouth fluids reduces sickle cell clotting. Strict isolation is not necessary. Aspirin should not be given to children because of risk of Reye syndrome.
A registered nurse is teaching a student nurse about Gesell's theory of biophysical development. Which statement by the student nurse indicates the need for further teaching? Select all that apply. 1 "Poor nutrition or chronic disease often affect growth rate." 2 "A child's pattern of growth is unique, and this development is directed by gene activity." 3 "Proximodistal growth describes the sequence in which growth is fastest from the head down." 4 "Genes direct the sequence of development, but environmental factors also influence development." 5 "In the cephalocaudal pattern, growth starts at the center of the body and moves toward the extremities.
3,5 Growth in humans is both cephalocaudal and proximodistal. The cephalocaudal pattern describes the sequence in which growth is fastest at the top (from the head and then down). The proximodistal growth starts at the center of the body and moves toward the extremities. Poor nutrition or chronic disease often affect growth rate and result in smaller stature despite of the genetic blueprint. According to Gesell's theory of development, each child's pattern of growth is unique, and this pattern is directed by gene activity. According to Gesell's theory, genes direct the sequence of development, but environmental factors also influence development and result in developmental changes.
How is stage 2 of Kohlberg's theory different from stage 1? 1 Stage 2 is a premoral stage. 2 Stage 2 is focused on avoiding punishments. 3 Stage 2 is based on a child obeying his or her parent's rules. 4 Stage 2 is about recognizing another's point of view
4 During stage 2 of Kohlberg's theory, a child learns that there can be more than one point of view. Both stages 1 and 2 are premoral stages that are associated with limited cognitive thinking. Both stages involve a child wanting to avoid punishment and showing obedience to a parent's rules.
The nurse is assessing the development of a male child and finds that the child is tall, with deficient secondary sex characteristics and hypogenitalism. Which chromosomal notation is associated with the child's condition? 1 45,XO 2 47,XXX 3 47,XYY 4 48,XXXY
4 The male child is tall, with deficient secondary sex characteristics and hypogenitalism, indicating Klinefelter syndrome. The chromosomal abnormality present in the child is denoted as 48,XXXY. The chromosomal complement 45,XO is seen in children with Turner syndrome. A child with Turner syndrome will have short stature and a webbed neck. The 47,XXX chromosomal complement indicates that the child has triple X, or superfemale, chromosomal abnormality. This condition is associated with impaired language and mental capacity. A child with the chromosomal complement 47,XYY has Jacobs XYY chromosomal abnormality, which is associated with normal sexual development and aggressive sexual tendencies.
The parents of a school-age child tell the nurse that their child is tall, broad, and very active in sports, so they are planning to enroll the child for strenuous competitive athletics. What is the best response from the nurse? 1 "The child may not be interested." 2 "The child requires more rest periods." 3 "The child has a brilliant sports career." 4 "The child is not ready for strenuous activities."
4 The school-age child may look large and strong, but because of the child's age, he or she may not be ready for strenuous sports activities. The child may be interested in the sports activity, but may not be strong enough for strenuous work. The child does not need more rest periods, because the child is growing and will not be too tired to engage in different physical activities. The child may or may not have a sports career depending on the interest and the excellence in the activity, so this is not an appropriate response from the nurse.