Growth & Development

A nursing student is learning about the maturation of systems in a school-age child. Which statement made by the student indicates effective learning?

"The heart grows slower in the school-age child than at any other period of life." The heart grows more slowly during the middle childhood years and is smaller in relation to the rest of the body than at any other period of life. Physical maturity in the school-age child is not necessarily correlated with emotional and social maturity. Children will generally have the emotional and social maturity that corresponds to their age. As the gastrointestinal system in a school-age child is more mature than that in a preschooler, school-age children have better maintenance of blood sugar levels than preschoolers. In the school-age child, facial proportions change as the face grows faster in relation to the remainder of the cranium. The skull and brain grow very slowly during this period and increase little in size thereafter.

A single mother of three children, brings her 9-month-old daughter to the pediatric clinic. The infant is found to have nonorganic failure to thrive and is admitted to the hospital. What infant behavior does the nurse anticipate as the mother leaves to return home to care for her other children?

Allowing the nurse to take her but remaining stiff while being held Going to a stranger without protest usually indicates the lack of a meaningful relationship with the mother. Clinging to the mother is a healthy reaction to strangers that is uncommon in children with nonorganic failure to thrive syndrome. Crying at first is a healthy reaction to strangers that is uncommon in children with nonorganic failure to thrive syndrome. Children with nonorganic failure to thrive avoid eye contact with their mothers and do not prefer them over others.

Which condition causes failure to thrive in infants due to an increased metabolism?

Congenital heart disease Congenital heart disease causes increased metabolism in infants, resulting in failure to thrive. Biliary atresia and hepatic disease may cause failure to thrive due to inadequate intestinal absorption of nutrients. Metabolic storage disease can cause defective use of energy and leads to failure to thrive in infants.

Which is the cognitive developmental stage of adolescents according to Piaget?

Formal operations stage According to Piaget, the cognitive development stage of adolescents is called the formal operations stage. This stage involves the logical use of symbols related to concepts that are abstract. The sensorimotor stage is observed in infants. The preoperational stage of cognitive development is observed in preschoolers. The concrete operational stage is observed in school-age children.

An older retired client is visiting the clinic for a regularly scheduled checkup. The client tells the nurse about the great life he has lived and the activities that he enjoys at the senior center. According to Erikson, what developmental conflict has been resolved by this client?

Integrity versus despair The tasks of older individuals are ego integrity, satisfaction with life, and acceptance of the future versus despair, remorse, and fear of the future. Trust versus mistrust is the conflict associated with infancy. Generativity versus self-absorption is the conflict associated with later adulthood. Autonomy versus shame and doubt is the conflict associated with early childhood.

Which is a characteristic of the developmental theory?

It provides a dynamic, rather than a static, view of the family. According to the developmental theory, families develop and change over time in similar and consistent ways. Therefore, it provides a dynamic, rather than static, view of the family. The family system theory is useful for families of varying structure. The family stressor theory explains and predicts family behaviors in response to stressors and focuses on the positive contribution of resources, coping, and social support.

A nurse is helping a client who observes the traditional Jewish dietary laws to prepare a dietary menu. What considerations should the nurse make?

Meat and milk at the same meal are forbidden Jewish dietary laws prohibit any combination of milk and meat at the same meal. The Hindu, not Jewish, religion prohibits the ingestion of beef and veal; many Hindus believe that the cow is sacred. Fish that have scales and fins are considered clean, and therefore allowed in the diet. Seventh Day Adventists, Baptists, Mormons, and Muslims prohibit some or all of the beverages alcohol, coffee, and tea.

A nurse manager works on a unit where the nursing staff members are uncomfortable taking care of clients from cultures that are different from their own. How should the nurse manager address this situation?

Plan a workshop that offers opportunities to learn about the cultures they might encounter while at work A workshop provides an opportunity to discuss cultural diversity; this should include identification of one's own feelings, Also, it provides an opportunity for participants to ask questions. Although articles provide information, they do not promote a discussion about the topic. Relocation is not feasible or desirable; clients from other cultures are found in all settings. Rotating the nurses' assignments probably will increase tension on the unit.

A nurse places a newly admitted client with worsening preeclampsia in a private room. Why is it important for this client to be in a nonstimulating environment?

The probability of tonic-clonic seizures is reduced. Even minimal sensory stimuli can trigger an exaggerated cerebral response such as seizures; therefore a nonstimulating environment is most therapeutic. Women with preeclampsia do not have respiratory problems. Although respiration may become depressed with magnesium sulfate therapy, a quiet environment will have no effect on respiration. A nonstimulating environment does not reduce the severity of headaches resulting from hypertension and has no relationship to the effects of antihypertensive drugs.

The nurse is planning a teaching session for the parents of a toddler. Which statement regarding toddler behavior indicative of centration should the nurse include in the session?

"Your child may not want to eat certain foods due to the color." Not wanting to eat food due to the color is an example of centration. Yelling at the chair for causing a fall is an example of animism. Refusal to sleep in a bedroom because the bed has been moved to another location is an example of global organization. Egocentrism causes the toddler-age client to be unable to understand a different perspective.

A neonate has irregular, slow, weak cry; well-flexed extremities; heart rate of 102 beats/min; no response to reflex irritability; and the color of the body is completely pink. What would be the Apgar score in this neonate? Record your answer using a whole number.______

7 Irregular, slow, weak cry = 1, well-flexed extremities = 2, heart rate of 102 beats/min = 2, no response to reflex irritability = 0, color is completely pink = 2. Therefore, the Apgar score is 7.

The nurse is preparing to assess several clients at a pediatric clinic. Which client would require a developmental screening versus developmental surveillance during a scheduled health maintenance visit?

A 9-month-old infant The nurse would conduct a developmental screening for the 9-month-old infant during a scheduled health maintenance visit. The 2-week-old newborn, the 15-month-old toddler, and the 4-year-old preschooler would all require developmental surveillance during a health maintenance visit.

A father asks his family members to express their opinions about a plan to rearrange the furniture in their home. The father says, "I like the plan, but I cannot help you with rearranging because I have severe knee pain." All the family members agree with the individual opinions. Which type of family pattern is reflected in this situation?

Democratic family patter A democratic family pattern respects every family member's opinion; the children are treated with respect and recognized as individuals. This style encourages joint decision-making. An autocratic family pattern is unequal because the parents attempt to control the children with strict, rigid rules and expectations. A patriarchal family pattern involves a male adult who is responsible for control of the finances and family decision. A matriarchal family pattern includes a dominant adult female who makes decisions involving child care, homemaking, and financial decision-making.

Why is it important for a nurse in the prenatal clinic to provide nutritional counseling to all newly pregnant women?

Different cultural groups favor different essential nutrients. The nurse should become informed regarding the cultural eating patterns of clients so that foods containing the essential nutrients that are part of these dietary patterns may be included in the diet. Fluid retention is only one component of weight gain; growth of the fetus, placenta, breasts, and uterus also contributes to weight gain. The need for calories and nutrients increases during pregnancy. Pregnancy diets are not specific; they are composed of the essential nutrients.

Which two groups of American women have the highest breast and cervical cancer mortality rates?

Hispanic and African American Hispanic and African American women have the highest breast and cervical cancer mortality rates. The breast and cervical cancer mortality rates for Native American and Asian American women are lower.

A nurse is assessing the growth and development of a 6-month-old infant. What behavior indicates that the infant has reached the expected level of development?

Holds a bottle without help A 6-month-old infant is capable of holding a bottle in his or her hands. Holding a bottle is a basic gross motor skill that develops early during infancy. Saying words is a skill of older infants. Language development requires expressive (ability to make thoughts, ideas, and desires known to others) and receptive (ability to understand words being spoken) skills. Crawling is a skill of older infants. As the neurological system begins to mature, the strong flexor tone of the lower extremities subsides, permitting independent limb movement. Turning pages in a book is a skill of older infants; it requires fine motor skills and hand-eye coordination.

If there is a shortage of health care providers in the vicinity, members of which group may visit shamans for treatment?

Native American A shortage of health care providers in certain geographic areas may make it difficult for people in those areas to seek health care. Native Americans may visit shamans for treatment. Hispanic people may visit curanderos for treatment. Asian Americans may visit Chinese herbal therapists for treatment. African Americans may visit hougans for treatment.

A 10-year-old child has sustained an injury resulting in avulsion of a permanent tooth. Which interventions should the nurse implement to keep the tooth alive and suitable for reimplantation? Select all that apply.

Rinse the tooth with saline, if dirty Insert the tooth back into the socket Transport child to the dentist immediately An avulsed permanent tooth can be reimplanted if it is done in time. The nurse should rinse the tooth to remove the dirt, if any, and the tooth should be placed into its socket to help restore the blood circulation. The child should be transported to the dentist immediately to reimplant the avulsed tooth. The nurse should hold the tooth by its crown; holding the tooth by its root may hamper the blood circulation of the tooth. The child should bite gently on the tooth with gauze in between to prevent excess pressure on the tooth.

A client delivered a 7-lb 6-oz (3345 g) female infant at 11 pm yesterday after a labor of 14 hours. After breakfast the nursery staff brings the baby to the new mother. The mother smiles at the baby, then asks that the nurse take the baby back to the nursery because she has not had a shower yet. One hour later the nurse returns with the infant. Again the mother smiles at the baby; then she holds her, kisses her, and feeds her a bottle. Immediately after feeding the baby, the mother calls the nursery and asks if the baby be picked up so she can take a nap. Which behavior is the new mother demonstrating?

Taking in During the taking-in period the mother focuses on her needs rather than the baby's. During this period the mother needs to be "mothered" so she can assume the role of mother. The letting-go period is when the mother wants to take control and "mother" the infant. The taking-hold period is when the mother is anxious to learn about the infant and how to care for it. This mother shows positive behaviors, including smiling, kissing, and holding. There is no evidence of a failure to bond.

The gravida 1 now para 1 woman delivered a 7-lb 6 oz female infant at 11 pm yesterday after a labor of 14 hours. After breakfast the nursery staff brings the baby to the new mother. The mother smiles at the baby, then asks that the nurse take the baby back to the nursery because she has not had a shower yet. One hour later the nurse returns with the infant. Again the mother smiles at the baby; then she holds her, kisses her, and feeds her a bottle. Immediately after feeding the baby, the mother calls the nursery and asks that the baby be picked up so she can take a nap. What behavior is the new mother demonstrating?

Taking-in During the taking-in period the mother focuses on her needs rather than the baby's. During this period the mother needs to be "mothered" so she can assume the role of mother. The letting-go period is when the mother wants to take control and "mother" the infant. The taking-hold period is when the mother is anxious to learn about the infant and how to care for it. This mother shows positive behaviors, including smiling, kissing, and holding. There is no evidence of a failure to bond.

During a home visit, the nurse observes the children and concludes that the family is democratic. Which behavior of the family would lead to this conclusion?

The child is respected as an individual In a democratic family, all members have an equal function. In this type of family pattern, the children are recognized as individuals and treated with respect. If the female relatives take care of the children while the mother is at work, this action indicates a matriarchal family. If the father has all the authority in the decision-making, this action represents a patriarchal family. If the child is bound to strict rules and expectations by parents, this observation indicates an autocratic family.

A 16-year-old adolescent visits the prenatal clinic because she has missed three menstrual periods. Before her physical examination she says, "I don't know what the problem is, but I just can't be pregnant." What is the nurse's most therapeutic response?

"Why did you decide to come to the prenatal clinic?" Asking the client why she came to the prenatal clinic points out reality and allows the client to elaborate. Although it is true that many young women's periods are irregular, stating this does not encourage further communication. Telling the client that she is probably pregnant implies that the nurse does not believe the client and will probably cut off further communication. Asking whether the nurse should have the primary healthcare provider talk to the client abdicates the nurse's responsibility; also, it may cut off further communication.

A nursing student is learning about cultural competence. Which statement by the nurse reflects ethnocentrism?

"I sincerely believe that the beliefs and practices of the culture I was born into are the best." Ethnocentrism is the belief by an individual that that the beliefs and practices of his or her particular culture are best. An individual who learns to value the beliefs of others and realizes that practices of other cultures can be valuable in health care is not ethnocentric. Cultural influences vary with the individual; the belief that all members of an ethnic group act or think the same way is called ethnic stereotyping. The awareness of one's own cultural beliefs and practices and their relation to differing cultural beliefs is known as cultural competence.

Which statement by a mother indicates the need for additional teaching about safety guidelines for infants and toddlers?

"I will give my child hard candies for chewing." Hard candies should not be given to infants and toddlers because they can be easily aspirated, which will result in choking. Therefore, the nurse should suggest that the mother avoid giving hard candies to young children. The nurse should suggest that the mother use plastic eating and drinking utensils for young children because glass and ceramic utensils may break and lead to injury. Old furniture may contain lead paints, which are toxic. Therefore, children should not be allowed to chew on them. Some children, out of curiosity, may grab pot handles, which can cause burns. Therefore, the nurse should advise the mother to turn pot handles toward the back of the stove for the safety of young children.

While communicating with a child in a hospital setting, the nurse understands that the child's family pattern is patriarchal. Which statement of the child would lead to this conclusion?

"My father makes all decisions regarding my education." In a patriarchal family pattern, the adult male or father makes all decisions and controls the finances. If the child says that his or her father makes all decisions regarding education, the nurse may interpret that the child belongs to a patriarchal-pattern family. In a matriarchal family pattern, the elder female in the family, such as the grandmother or mother, provides child care and makes decisions involving such events as days when the child can play. In a democratic-family pattern, each member of the family, including the children, is treated with respect and recognized for his uniqueness. A father who considers his child's wishes would be part of a democratic family.

Which disorder is the most common congenital chromosomal abnormality?

Down syndrome Down syndrome is the most common congenital chromosomal abnormality. Autism, cognitive impairment, and hyperactivity disorder are not congenital chromosomal abnormalities. Autism is a developmental disorder of brain functioning. Cognitive impairment is the most common developmental disability. Hyperactivity disorder is the most prevalent behavioral disorder.

While caring for a child, the nurse observes that the child turns onto the side, flexes the knees to assume a kneeling position, and then pushes the torso upright by walking the hands up the legs. Which condition does the nurse suspect in this patient?

Duchenne muscular dystrophy This observation refers to Gower sign, which is seen in Duchenne muscular dystrophy due to the lack of thigh and hip muscle strength. Werdnig-Hoffmann disease is a type 1 spinal muscular dystrophy. Clinical manifestations within the first few weeks or months of life are lying in a frog-leg position with the legs externally rotated, abducted, and flexed at the knees; generalized weakness; and an absence of deep tendon reflexes. Kugelberg-Welander disease is a type 3 spinal muscular atrophy characterized by scoliosis and an inability to walk. Limb-girdle muscular dystrophy is characterized by weakness of the proximal muscles of the pelvic and shoulder girdles

Which of these diseases would the nurse explain is most common in toddlers?

Influenza Toddlers are very prone to developing upper respiratory tract infections; hence, influenza is seen most frequently among toddlers. Lung cancer is seen commonly in younger or middle-aged adults from smoking. Hypertension is commonly seen in middle age due to an unhealthy diet, lack of exercise, and stress. Angina is common in young and middle-aged adults.

A Jewish client who keeps kosher underwent abdominal surgery and requires a high-protein diet for healing. Which of the following actions of the home-care nurse is in accordance with the client's dietary rules?

Preparing either dairy or meat meals, but not a combination A Jewish client who keeps kosher will not consume meals that include both dairy and meat unless medically necessary. Therefore, if the nurse prepares either dairy or meat meals, but not combination ones, this is in accordance with the client's religious dietary rules. Using the same utensils for dairy and meat violates this rule. Kosher laws require that an animal killed for meat is done humanely; meat products that meet this requirement are explicitly certified as such on the packaging. Including pig products like ham also violates kosher dietary rules.

The parent of a child says, "My child is repeatedly banging the table to make loud sounds." Which sensorimotor stage of cognitive development best explains this behavior of the child?

Secondary circular reactions The third stage of Piaget's sensorimotor phase involves secondary circular reactions, in which the child intentionally repeats an action in order to trigger a response. The first stage of sensorimotor phase comprises of reflexes, in which the infant will exhibit involuntary responses to stimuli, such as sucking, rooting, grasping, and crying. Replacement of reflexive behavior with voluntary acts is seen in primary circular reactions, which is the second stage of sensorimotor phase. The fourth stage is coordination of secondary schemas, in which the child starts showing intentional actions and uses previous behavioral achievements, primarily as the foundation for new intellectual skills.

While collecting data on a 7-year-old child, the nurse suspects that the child has impaired cognitive development. Which behavior supports the nurse's conclusion?

The child is unable to copy a diamond shape Concrete operations are well developed in a 7-year-old child. The child has the ability to copy a diamond, repeat three numbers backward, and perform mechanical reading. Therefore, an inability to copy a diamond indicates that the child has impaired cognitive development. The child develops the ability to write a brief story about a butterfly at 10 to 12 years of age. An 8 to 9-year-old child has the ability to repeat the days of the week in order and count backwards from 10 to 1.

Which finding indicates an 8-year-old is a latchkey child?

The child is unsupervised at home after school Latchkey children are those who remain unsupervised after school hours. Staying with a single parent does not mean that the child is a latchkey child; a single parent may also be available to supervise the child. Latchkey children may not have many friends, as activities outside the home may be curtailed. All children, and not just the latchkey children, are dependent on adults to an extent for their needs.

A licensed practical nurse cares for a client of Italian descent after the client has given birth. The nurse is aware of the significance of touch in the client's culture. What does the nurse anticipate to be true of the client's preferences regarding touch?

The client would be comforted if the nurse pats her shoulder during their conversation. Some cultural groups are more comfortable than others with touching or maintaining eye contact. People of Italian descent are likely to be comfortable with touching other people during conversation and with being touched. Patting the client's shoulder while talking with her might be comforting for a client of this cultural group. In Observant Judaism, a woman is considered to be in a ritual state of impurity whenever blood is coming from her uterus, such as after the birth of a child. During this time, her husband would not make physical contact with her and would not be able to assist her in moving in the bed. Many Native Americans would see a firm handshake as a sign of aggression. Because people of Italian descent are comfortable touching one other, the nurse may touch the client's hand.

A nurse is caring for an adult client who immigrated to this country 5 years ago. What does the nurse know about the past experiences of clients who have immigrated to this country?

They are important in assessment of their values. Past experiences are important and must be recognized because they set the parameters for the individual's enduring values throughout life. Past experiences do not affect inherited traits. Past experiences play an important role in an individual's life. Nothing establishes how an individual responds over a lifetime; new experiences continue to influence future responses.

A registered nurse advises parents to assist their child with stretching exercises. The child has impaired physical mobility due to neuromuscular impairment. What is the rationale for performing stretching exercises?

To prevent contractures A contracture deformity is the result of stiffness or constriction in the muscles. A contracture would adversely affect a child's development, depending upon location and severity. For example, if an infant developed a contracted Achilles tendon, the infant would not be able to physically develop the ability to walk. Administering pain medications helps decrease the pain. To promote the achievement of developmental milestones, the nurse encourages play exercises that involve joint movement and enhance fine and gross motor skill acquisition. The nurse places the child in the semi-upright position during feedings to facilitate the mobilization of food and fluids through the esophagus.