ATI Pediatric Growth and Development

identity vs. role confusion

Adolescent, 12-18 years Erikson's stage during which teenagers and young adults search for and become their true selves

Correct order of Erikson's developmental theory

1) Trust vs mistrust 2) Autonomy vs shame and doubt 3) Initiative vs guilt 4) Industry vs inferiority 5) Identity vs role confusion

A nurse is caring for a 2-year-old who is hospitalized and throws a tantrum when his parents leave. Which of the following toys should the nurse provide to alleviate the child's stress? a) Set of building blocks b) Toy hammer and pounding board c) Picture book about hospitals d) stuffed animal

B) Toy hammer and pounding board. All toys are age appropriate, but a toy hammer and pounding board helps the child to express the anger and frustration he feels about the parent leaving but lacks the verbal ability to express.

trust vs mistrust stage

Born - 1 year Erikson's stage in which infants decide whether the world is friendly or hostile. They decide depending on whether they can trust that their basic needs will be met. If successful, the result is trust and hopefulness.

How do we administer ear drops to children younger than 3 years old?

Pinna pulled down and back

Initiative vs. Guilt

Preschooler, 3-6 years Erikson's third stage in which the child finds independence in planning, playing and other activities

Industry vs. Inferiority

School age, 6-12 years Erikson's stage when the child learns to be productive

Autonomy vs. Shame and Doubt

Toddler, 1-3 years Erikson's stage in which a toddler learns to exercise will and to do things independently; failure to do so causes shame and doubt

Nurse is caring for a 4-year-old child who has croup and wet the bed overnight. When the parents visit the next day, the nurse explains the situation and one of the parents says, "she never wets the bed at home. I am so embarrassed." Which of the following responses should the nurse make? a) "It is expected for children who are hospitalized to regress. The toileting skills will return when your child is feeling better." b) "I know this can really be embarrassing. I have kids myself, so I understand, and it doesn't bother me." c) "Your child did not seem upset, so I wouldn't worry about it if I were you." d) "Why does it bother you that your child has wet the bed?"

a) "It is expected for children who are hospitalized to regress. The toileting skills will return when your child is feeling better." A recently learned skill, such as toilet training, is often temporarily lost due to the stress of hospitalization. The nurse should reassure the parents that regression is an expected behavior in children who are hospitalized and that her child will regain bladder control when she is feeling better. (other answers minimize the parents' concerns, never ask "why?")

A nurse is collecting data from a child who is descending stairs by placing both feet on each step and holding on to the railing. The nurse should understand that these actions are developmentally appropriate at which of the following ages? a) 3 years b) 4 years c) 5 years d) 6 years

a) 3 years At age 3, children can typically ascend stairs using alternating feet but still descend by placing both feet on each step. (By age 4, children can descend stairs using alternating feet and holding the railing; By age 5, children's balance improves, but continue hold the railing when ascending and descending stairs; At age 6, balance improves so that children are proficient at ascending and descending stairs)

Nurse is planning care for a 10-year-old who will be hospitalized for an extended period of time. Which of the following actions should the nurse include in the plan of care to meet client's psychosocial needs according to Erikson? a) Arrange for a teacher to provide lesson plans. b) Allow the client to select his own food from the menu. c) Discourage visits from the client's friends. d) Provide a daily session with a play therapist.

a) Arrange for a teacher to provide lesson plans. Erikson's stage for a 10-year-old is industry vs. inferiority. By providing school-age children the opportunity to keep up with their school work, they can continue to develop skills and knowledge and maintain a sense of accomplishment. (Providing appropriate choices can help the school-age child adjust emotionally to the stress but allowing decision making is more appropriate for the psychosocial development of a preschooler; play therapist would help but not specifically in terms of Erikson's psychosocial needs)

A nurse is assessing a 6-month-old infant at a well-child visit. Which of the following findings should the nurse expect? a) Closed posterior fontanel b) Uses thumb and index fingers in a pincer grasp c) Lateral incisors d) Sitting steadily without support

a) Closed posterior fontanel posterior fontanel should close by about 8 weeks of age. (A 9-month-old infant should be able to use his thumb and index fingers in a crude pincer grasp; develop upper lateral incisors between 9 and 13 months of age and lower lateral incisors at 10 to 16 months; 8-month-old infant should be able to sit without support)

A nurse is assessing a 3-month-old infant. Which of the following findings should the nurse report to the provider? a) Inability to raise head when in prone position b) Inability to sit without support c) Inability to pick up an object with her fingers d) Inability to bring an object to her mouth

a) Inability to raise head when in prone position A 3-month-old infant should be able to raise her head and shoulders from prone position. (should be able to sit without support at 8 months; should be able to grasp objects w fingers at 6 months; should be able to bring objects to her mouth at 4 months)

Nurse is caring for a 12-month-old toddler who is hospitalized and confined to a room with contact precautions. Which of the following toys should the nurse recommend in order to meet the developmental needs of the client? a) Large building blocks b) Hanging crib toys c) Modeling clay d) crayons and coloring book

a) Large building blocks Large building blocks are age-appropriate for a 12-month-old, others are not

A nurse is planning care for a 4-year-old child who requires airborne precautions. Which of the following activities should the nurse plan for the child? a) Putting a large-piece puzzle together b) Watching a video game in the playroom c) Pulling a wagon with toys in the hallway d) Constructing a model airplane

a) Putting a large-piece puzzle together A child who requires airborne precautions must remain in her room. Appropriate activities for a 4-year old child include putting together large-piece puzzles, using paints and crayons, playing ball, riding tricycles, playing pretend and dress up, sewing cards and beads, and reading books. (child w/ airborne precautions can't be in common areas; 4-year old is developing fine motor skills, such as using scissors to cut out a picture, copying squares, and tracing crosses and diamonds, but doesn't have cognitive ability to read directions nor the fine motor skills to put a model together)

Nurse is preparing to assist with applying a cast to a preschooler's arm. Which of the following actions should the nurse take? a) Wrap the arm of the child's doll or toy prior to the procedure. b) Tell the child, "This will make your arm feel better." c) Place a heated fan at the bedside to facilitate drying. d) Support the casted arm with a firm grasp.

a) Wrap the arm of the child's doll or toy prior to the procedure. consider the developmental age before the cast is applied. A preschooler might fear bodily harm and fantasize about the loss of an extremity. Using a doll helps to explain. During this stage, child is a "magical thinker" and might believe dolls are alive. This action shows that it doesn't hurt doll, and will not hurt child. (preschooler wouldn't be comforted by "this will make you feel better." child in this age group isn't able to associate "cause and effect" and has a limited understanding of the cause, but knows what it feels like; Heated fans or dryers should not be used, bc promotes drying from the outside -> inside and could also cause a burn. The cast should remain uncovered and allowed to dry from the inside out; don't use firm touch)

A nurse is caring for a toddler. Which of the following statements should the nurse use when preparing to obtain the child's vital signs? a) "Can I listen to your lungs?" b) "I am going to listen to your heart." c) "I am going to take your blood pressure now." d) "Can you stand very still while I feel how warm you are?"

b) "I am going to listen to your heart." inform the toddler of the procedure prior (don't ask yes/no questions. Negativism is a way for toddlers to assert self-control & gain independence. Therefore, toddlers tend to answer questions with a negative response and are likely to initially resist. If the nurse asks, the toddler responds "no," the nurse proceeds anyway, creates an environment of mistrust; avoid using the word "take" when measuring bc toddler might interpret the words literally)

The parent of a 4-year-old child tells a nurse that the child believes there are monsters hiding in the closet at bedtime. Which one of the following statements should the nurse make? a) "Let your child sleep in your bed with you." b) "Keep a night light on in your child's room." c) "Tell your child that monsters are not real." d) "Stay with your child until the child is asleep."

b) "Keep a night light on in your child's room." Fears of the dark and "monsters" are common in preschool-age children who are imaginative thinkers and have difficulty distinguishing between real and make-believe. After the parent reassures the child that there are no monsters, the night light provides enough illumination for the child to see that there is nothing hiding in the closet. (co-sleeping & staying tild child asleep can develop into a hard-to-break-habit; telling the child monsters aren't real is not an appropriate suggestion for a preschool-age child who has difficulty distinguishing between real and make-believe)

A nurse is teaching the parents of a toddler about temper tantrums. Which of the following statements should the nurse include in the teaching? a) "You should leave the room while the tantrum is happening." b) "Temper tantrums are the toddler's attempt to gain control of a situation." c) "You should get a psychological consult for the temper tantrums." d) "Temper tantrums are a type of learning disability."

b) "Temper tantrums are the toddler's attempt to gain control of a situation." tantrums = result of toddler's frustration over his inability to control his environment, occur because toddlers haven't learned to control their emotions. (Although parents should ignore the behavior, it's important for them to remain present to provide the toddler with a feeling of security; they are expected for toddlers, nothing wrong)

A nurse is collecting data from an infant at a well-child visit. The nurse should understand that birth weight typically doubles by what age? a) 3 months b) 6 months c) 9 months d) 12 months

b) 6 months (triples by 12 months)

A parent of a toddler asks a nurse how the child's frequent temper tantrums can best be handled. Which of the following actions should the nurse suggest to the parent? a) Restrain the child physically. b) Ignore the temper tantrums. c) Tell the child that temper tantrums are not acceptable. d) Distract the child by offering to play a game.

b) Ignore the temper tantrums. Ignoring a negative behavior is a basic concept in behavior modification. The parent should be instructed to make sure that the child is safe, and then appear to ignore the child or walk away. Without an audience, the behavior is more likely to extinguish itself quickly. (restraints can cause behavior to intensify; not developmentally appropriate to tell the child it's not acceptable. Temper tantrums occur due to an age-appropriate lack of self-control, which is gradually gained as the child matures; Offering the opportunity to play a game provides positive reinforcement for an unacceptable behavior)

A nurse is assessing a 10-month-old infant. Which of the following findings should the nurse report to the provider? a) The infant is unable to imitate animal sounds. b) The infant does not sit steadily without support. c) The infant cannot turn pages in a book. d) The infant cannot build a tower of three or four cubes.

b) The infant does not sit steadily without support. An 8-month-old infant should be able to sit steadily without support. A 10-month-old infant should be able to change from a prone to sitting position, stand while holding onto furniture, and lift one foot while standing. (A 10-month-old infant should be able to "Dada," "Mama," and to comprehend "Bye-bye." A 12-month-old infant should be able to imitate animal sounds; can look @ and follow along w pictures in book by 12 months; can build tower of blocks by 18 months)

A nurse is assessing a 15-month-old toddler. Which of the following findings should the nurse report to the provider? a) The toddler cannot build a tower of six to seven cubes. b) The toddler cannot stand upright without support. c) The toddler cannot jump with both feet. d) The toddler cannot turn a doorknob.

b) The toddler cannot stand upright without support. expect a 15-month-old toddler to be able to stand w/o support. Finding can indicate a developmental delay. (build a tower of 6-7 cubes at 24 months; jump with both feet at 30 months; turn a doorknob at 24 months)

Nurse is preparing to administer a vaccine into deltoid muscle of a preschooler. Which of the following actions should the nurse take? a) Use a 20-gauge needle. b) Use a 1.8 mm (0.5 in) needle. c) Insert the needle just below the acromion process. d) Insert the needle at a 15° angle.

b) Use a 1.8 mm (0.5 in) needle. use the smallest size needle that will allow the med to pass through the SubQ tissue and enter the muscle. For a preschooler, a 1.8 mm (0.5 in) needle is adequate in length. (should use 22-25 gauge needle; should use the upper 1/3 of the muscle, which is approximately two fingers below the acromion process, to avoid the radial and axillary nerve; insert the needle at a 90° angle, pointing the needle slightly toward the shoulder)

A nurse is providing anticipatory guidance about child development to the parents of a toddler. Which of the following developmental tasks should the nurse include as expected of a toddler? a) Explains the difference between right and wrong b) Prints letters and numbers c) Separates easily from primary care giver for short periods of time d) Cooperates in doing simple chores

c) Separates easily from primary care giver for short periods of time By 3 years, a toddler's psychosocial development should include the ability to accept separating from a primary care giver for short periods of time, should also be able to express likes/dislikes and begin to play with children and others outside the family. (diff btwn right & wrong is school-age, ability to write letters and numbers and simple chores is 5 years)

A nurse is assessing a female child in an area struck by an earthquake. The child, who is crying, walks well, can state her first name, and repeatedly says "All done" and "Go bye-bye now" during the assessment. The child has 24 deciduous teeth and her anterior fontanel is closed. Based on these observations, the nurse should estimate that the child is how many months old? a) 12 b) 18 c) 24 d) 30

d) 30 (the child has completed her primary dentition (24 deciduous teeth), which occurs by 30 months (2 ½ years) of age; the nurse should recognize that the child is at least 18 months of age because the anterior fontanel is closed and should suspect that the child is at least 24 months (2 years) of age because the child speaks in two- and three-word phrases.)

A nurse is caring for a 10-month-old infant who is in a cast for developmental dysplasia of the hip (DDH). Which of the following strategies should the nurse implement to promote the infant's growth and development? a) Tie colorful latex balloons to the side of the crib. b) Provide a small electronic toy. c) Change the infant's diaper as soon as soiling occurs. d) Allow the infant to stand in the crib

d) Allow the infant to stand in the crib Allowing the child to participate in normal developmental activities promotes growth and development. The infant can be held and allowed to walk in a cast or orthotic device. (balloons & small electronic toys are a safety hazard; changing diaper is necessary but doesn't promote growth/devel)

Nurse is assessing a 7-month-old infant. Which of the following indicates a need for further evaluation? a) Uses a unidextrous grasp b) Has a fear of strangers c) Shows preferences towards foods d) Babbles one-syllable sounds

d) Babbles one-syllable sounds A 7-month-old infant should babble in chained syllables such as mama and baba, and babble four distinct vowel sounds; therefore, this finding indicates a need for further evaluation. (all of the other choices are expectations for this age)

A nurse in a pediatric clinic is talking with the mother of a preschool-age child. The mother tells the nurse that her son is a "picky eater." Which of the following instructions should the nurse include in the teaching? a) Have the child remain at the table after meals to increase food intake. b) Add fruit juice to the child's diet to increase vitamin intake. c) Emphasize the quantity, rather than the quality, of food consumed. d) Expect that food consumption might not decrease significantly.

d) Expect that food consumption might not decrease significantly. Food consumption varies and most preschool-age children consume an adequate quantity of food despite their fads and preferences. (Avoid prolonging time at table, promotes overeating& poor nutrition habits; Fruit juice consumption should be limited, associated with dental caries and GI upset; quality is more important than quantity)

A nurse is developing a health program for the parents of school-age boys. Which of the following information about pubescent changes should the nurse include in the program? a) Changes in the voice signal the beginning of puberty. b) Gynecomastia commonly occurs during late puberty. c) Puberty might be delayed if scrotal changes have not occurred by the age of 11 years. d) Growth spurts in height occur toward the end of midpuberty.

d) Growth spurts in height occur toward the end of midpuberty. (Enlargement of the testicles signals the beginning of puberty; Gynecomastia typically occurs during midpuberty; Puberty changes might be delayed if scrotal changes have not occurred by 13½ to 14 years of age)

A nurse is assessing the psychosocial development of a toddler. The nurse should recognize that this stage is characterized by which of the following? a) imaginary playmates b) Erikson's stage of initiative vs guilt c) Demonstrations of sexual curiosity d) negative behaviors characterized by the need for autonomy

d) Negative behaviors characterized by the need for autonomy Assertion of autonomy is seen in toddlers as they begin their language and social development. (imaginary playmates at 4-5 yrs; initiative vs guilt & sexual curiosity is preschool-aged)