Capter 8
In what years of life does Jean Piaget's second stage, preoperational, take place?
2 to 7 years The second stage of Jean Piaget's cognitive model is preoperational, which lasts from approximately ages 2 to 7 years.
A nursing instructor realizes that a student needs further teaching concerning growth and development when the student states the following:
"Erikson's theory states a person cannot advance to the next stage if the previous task is not completed." Erikson's theory covers the lifespan and is divided into eight stages. Piaget's theory deals with cognitive development. In Erikson's theory, a person can advance to the next stage even if the previous task has not been completed. (less)
The mother of a 7 month old attempts to scoop cereal with his palm and reach his mouth, but drops several pieces of cereal on the floor. His mother asks if this feeding behavior is normal. What is the nurse's best response?
"Fine grasp is just now starting to develop at this age." At age 7-13 months, an infant uses pincer grasp to pick up objects. A child is not expected to feed himself with a spoon and cup until age 10-14 months.
The nursing instructor is teaching students about growth and development during a pediatric clinical rotation. The instructor knows that one of the students needs more information when the student states:
"Growth and development is a simple process." Growth and development is a complex process with many contributing variables, including culture, genetics, environment, and health. Developmental changes are not easily measured with universal tools. (less)
The nurse is assessing an adult client for the presence of Piaget's formal operations stage of development. What assessment question should the nurse ask the client?
"How do you usually go about making difficult decisions?" Piaget's concept of formal operations focuses primarily on thinking patterns and decision making. Intelligence and relationships are not central focuses.
The nursing student is applying Erikson's theory to the young adult patient she is caring for on the medical unit. The instructor knows that the student needs further instruction when she states:
"My patient is not in a sexual relationship; therefore, she has not accomplished Erikson's task of intimacy." In his theory, Erikson did not indicate that intimacy is achieved only through a sexual union but also through close friendships and physcal expressions. The young adult would have achieved trust during her infant years and would have become autonomous when she was a toddler learning how to make choices. (less)
Susan, a 6-month-old, is hospitalized for a respiratory illness. Which activity would be appropriate for the nurse to provide for Susan?
A mobile A mobile would be most appropriate for a 6-month-old child. This child would not be walking but would experiment with kicking a mobile to see it move. Pull toys are appropriate for toddlers (12- to 18-month-olds). The child 12- to 18-months-old would be capable of staking cubes or blocks. A coloring book and crayons would be appropriate for an older child, 4 years and older. (less)
A nurse is assessing a 73-year-old client in terms of her psychosexual development. Which of the following would the nurse most likely identify as an abnormal finding in this client?
Avoidance of relationships Sexual intimacy; occasional forgetting or misplacement of things; and effective use of previous experiences, self, and others to grieve loss are all normal characteristics of older adults, according to Freud. Avoiding relationships, on the other hand, is an abnormal finding of psychosexual development. (less)
In what stage of Erik Erikson's model of development does the older adult come to terms with his or her life choices?
Ego integrity vs. despair Erik Erikson's eighth and last stage applies to late adulthood. The task for the older adult is ego integrity vs. despair. The older adult with ego integrity has come to terms with his or her life choices. He or she comes to recognize that the life that has been lived was the only possible one and that it had dignity, which the person is ready to defend against physical or economic threats. Generativity vs. stagnation is used to describe the middle adult stage. Intimacy vs. isolation is used to describe the early adult stage. Identity vs. role confusion is used to describe the adolescence stage. (less)
A school nurse who provides care in a middle school works exclusively with adolescents. According to Erikson's theory of psychosocial development, what task will underlie much of the students' behavior?
Establishing a personal identity During adolescence, Erikson prioritized the crisis of identity versus role confusion. Erikson emphasized this over the importance of exerting influence, appraising religious beliefs, or evaluating their parents' beliefs. (less)
An adolescent patient is very quiet and withdrawn. The nurse notices that the mother and patient appear to converse and have a good relationship, but the patient begins to be more energetic and talkative when school friends come to visit. The nurse realizes that this patient is in which of Erikson's stages?
Identity vs. role confusion The nurse understands that the teenage patient is experiencing the stage of identity vs. role confusion. She is trying to gain independence and establish her own identity and self-concept. Trust vs. mistrust is during the infancy stage; initiative vs. guilt is during the preschool ages of 3 to 5 years; industry vs. inferiority is during the school years (6 to 12 years old). (less)
What statement by a middle-aged adult would most clearly suggest successful achievement of Erikson's central task during this stage of development?
"I'm doing a lot of volunteering in order to give back to the community." Erikson identified the main task of middle adulthood as generativity versus stagnation. "Giving back" is a tangible indicator of generativity. Each of the other listed statements is positive, but none directly exemplifies this developmental task. (less)
The nurse manager should provide further teaching to a new staff nurse on the pediatric unit when the staff nurse makes which statement?
"Physical growth in children takes place in an expected, steady pace." Physical growth takes place in an expected pattern, but at a variable pace. Cognitive development includes sensorimotor, preoperational, concrete operational, and formal operational stages. Development refers to changes in motor, language, psychosocial, and cognitive developments. Motor development follows a pattern, but individuals develop at variable rates. (less)
A mother brings her 3 year old to the clinic, concerned about her daughter's growth and development. She tells the nurse that her daughter can climb stairs, dress herself, and feed herself, but she cannot draw circles or rectangles like her 5-year-old brother. What should the nurse tell this mother?
"This is normal for this age, because children do not master the fine motor skill of drawing until age 5 years." The patient is right on target for her fine and gross motor skills. Climbing stairs, feeding herself, and dressing herself are normal skills for this age group. Drawing circles and rectangles are fine motor skills that are not accomplished until age 5 years. (less)
The nurse is assessing an adult client's self-image during the health history interview. What assessment question is most likely to elicit meaningful data?
"What would you describe as your main strengths and weaknesses?" Asking a client about his or her strengths and weaknesses can elicit insights into self-concept or self-image. Asking about religion or self-improvement is unlikely to elicit these data. A person may give insights into his or her self-image when asked about meaningful activities, but this is less direct than asking about strengths and weaknesses. (less)
A 90-year-old patient is crying and states to the nurse, "I've had such a wasted life." The most appropriate response from the nurse will be
"You are feeling like you have had a wasted life...?" The central task for the older adult is ego integrity vs. despair. Unsuccessfully completing this task can lead to regret, discontent, and pessimism.
Which child would the nurse expect to draw a circle and triangle?
5-year-old Brian The nurse would expect 5-year-old Brian to draw a circle and triangle.
A nurse is caring for a 22-year-old man and a 75-year-old man. If the nurse gave both patients the same simple comparison task, how much faster would the nurse expect the 22-year-old to finish it than the 75-year-old?
50% Numerous studies have examined the speed of cognition in older adults, and the results have shown that older adults take about 50% longer than younger adults to do a simple comparison task. (less)
Parents of 13-year-old Kara express concern about whether Kara will always be short. Her mother is 5 feet, 2 inches and her father is 5 feet, 8 inches. In inches, what would be an accurate estimate of potential adult height for Kara?
62.5 Kara's estimated adult height would be 62.5 inches. (68 + 62 - 5 inches)/2
The nurse is caring for 6-year-old Abigail. Which activity would the nurse expect Abigail to perform?
Abigail draws a picture of her family. Abigail is in Erikson's stage of industry versus inferiority. She would be expected to plan and complete an activity, such as drawing a picture of her family. As an infant in the stage of trust versus mistrust, Abigail would learn to calm herself by sucking her thumb. Adolescents achieve identity (versus role confusion) by establishing their own opinions, views, and ideas separate from parent, peers, and others. Middle-aged adults demonstrate generativity (versus stagnation) by sharing their knowledge with younger generations. (less)
A mother brings her baby to the pediatric clinic for a 1-year-old wellness check. At birth the baby measured 22 inches and weighed 8 lbs. The nurse would expect to find which of the following when assessing the baby?
Baby measures 33 inches and weighs 24 lbs. When assessing normal growth and development, the pattern expected for the infant to 1 year old is to increase the height by one and one-half times the birth length and to triple the birth weight by age 1 year. Therefore, the nurse would expect this child to be 33 inches and weigh 24 lbs. (less)
The nurse's assessment suggests that a 10-year-old has failed to achieve Erikson's central task of this stage of development. What nursing diagnosis should most likely be included in the child's plan of care?
CHRONIC LOW SELF-ESTEEM The major task of the school-aged child is industry versus inferiority. Failure to achieve this task can cause a sense of failure and consequent low self-esteem. There is not likely an accompanying risk for injury, disturbance in thinking, or sense of fear. (less)
The student nurse walks into her 8-year-old patient's room and finds him looking at a collection of baseball cards. He has spread the cards out all over the bed and arranged them into different piles of teams and positions. This young patient is showing signs of being in which of the following stages of Piaget?
Concrete operational Piaget divides the preoperational stage into two substages: symbolic and intuitive thought. These substages last from 2 to 7 years of age. The concrete operational stage begins at 7 years of age and lasts until 11 years of age. Concrete operational means executing operations that are reversible mental actions. Collecting baseball cards and carefully organizing them into teams and positions are two examples of concrete thinking. (less)
A nurse is talking to an 8-year-old boy who is proud of himself for washing his hands before every meal this past week. The nurse recognizes that this client is eager to please the nurse and his own parents. The nurse realizes that this boy is most likely in which level of moral development, according to Kohlberg?
Conventional This boy appears to be in the conventional level of moral development according to Kohlberg, in which one maintains external expectations of others. This stage typically begins at school age and extends into adulthood. The preconventional level, which typically occurs from preschool through late school age, is characterized by actions being guided by desire to avoid punishment or receive reward. The postconventional level, which typically begins in middlescence and extends through older adulthood (only 10%-20% of the dominant American culture attain this stage), is characterized by maintaining internal principles of self. The latent phase is a concept of Freud, not Kohlberg. (less)
The nurse has identified abnormal findings when reviewing a young adult client's health history. Within Kohlberg's theory of psychosocial development, what behavioral characteristic is the nurse most likely to observe?
The client makes decisions without considering the impact on others. Within Kohlberg's framework, the young adult who continues to make decisions and behave for sole satisfaction has not attained the conventional level of development. Kohlberg emphasizes moral behavior, and this is a more central focus than trust, being manipulated, or having difficulty with decision making. (less)
The school nurse has learned that a 14-year-old student is having social difficulties. According to Erikson, what is the most likely source of this child's stress?
The student is having difficulty creating an identity. During adolescence, Erikson emphasized the need to establish an identity. He did not prioritize the role of sexuality, empathy, or moral behavior at this stage of development.
The nurse is assessing a toddler and observes the toddler removing clothing and partially dressing himself. What is the nurse's best action based on this finding?
Document the finding. A toddler may be able to remove clothing and partially dress himself. However, the nurse should not expect the toddler to completely dress himself without help. The nurse should document the expected finding. The child is not exhibiting a developmental delay. Tying shoes should not be expected of a toddler; this activity is more appropriate for an older child. (less)
The nurse is assessing the cognitive function of an older adult. During the interaction, the patient accurately describes the first date with his spouse of 50 years. Which type of memory has the patient demonstrated?
Episodic long-term memory Episodic long-term memory involves the recall of past events and personally relevant information, validated by the older adult's accurate description of the first date with his spouse. Short-term memory represents things the person is presently and actively thinking about, whereas sensory memory is retention of a sensory image for a very brief period of time. Semantic long-term memory involves the retrieval of facts, vocabulary, and general knowledge. (less)
The nurse is working with an older adult client and is attempting to determine whether the client deems her life to have been meaningful and valuable. As well, the nurse has addressed the client's acceptance of the inevitability of death. This nurse's actions are best understood within the ideas of which theorist?
Erikson Erikson emphasized the conflict between ego integrity and despair in late adulthood. Central tasks involved accepting death and appraising the value and worth of the life one lived. (less)
The nurse is working with an older adult client and is attempting to determine whether the client deems her life to have been meaningful and valuable. As well, the nurse has addressed the client's acceptance of the inevitability of death. This nurse's actions are best understood within the ideas of which theorist?
Erikson Erikson emphasized the conflict between ego integrity and despair in late adulthood. Central tasks involved accepting death and appraising the value and worth of the life one lived. (less)
What action on the part of a middle-aged client would best exemplify Erikson's concept of generativity?
Guiding and mentoring individuals who are younger Generativity implies mentoring and giving to future generations. It is a broad concept, but it does not necessarily involve increasing one's income or emphasizing one's own knowledge and ideas over those of others. (less)
The nurse has just finished assessing a 48-year-old female client who is morbidly obese. The client claims that she overeats as a way to cope with stress. The client underwent a divorce 3 years ago and is currently single. She works 50 hours a week and cares for both her teenaged daughter and her elderly mother. When the nurse suggests changes to her nutrition, the client is resistant. Which of the following nursing diagnoses would be most appropriate for this client?
Imbalanced nutrition: more than body requirements This client clearly demonstrates an imbalanced nutrition, more than body requirements, related to overeating as a coping mechanism for stress. She is not ready for enhanced self-health management. There is no indication that she is at risk for suicide, despite her many stressors. Also, despite her divorce, she is not socially isolated, as she frequently interacts with her daughter and mother. (less)
A mother brings her 6-month-old to the clinic for a well-baby checkup. She tells the nurse that she is concerned that her baby is not crawling yet. What would be important for the nurse to explain to this mother?
Individuals develop at different rates. Motor development also follows a pattern, but individuals develop at variable rates.
A young nurse is reviewing growth and development to improve assessment skills. When reviewing culture, the nurse remembers that various cultures consider children differently. For instance, some cultures have rites of passage that mark the transition from childhood to adulthood. Which of the following is the best example of a rite of passage:
Jewish Bar Mitzvah In some cultures, rites of passage mark the transition from childhood to adulthood. One of these is the Jewish ritual of Bar Mitzvah for boys. Catholics recognize confirmation, not first communion, as a rite of passage. Christian baptism frequently occurs at an early age and is not usually a rite of passage from childhood to adulthood. Graduation from grade school occurs at an early age and also is not considered a rite of passage by society. (less)
The nurse is caring for a Jewish adolescent who is anxious to enter adulthood. The nurse suggests which activity to achieve adulthood status?
Living independently In the United States, living independently and becoming economically independent are two determinants of adulthood. Defining adulthood may differ in various cultures. A bar mitzvah, confirmation ceremony, and graduation do not necessarily ensure independence. (less)
In Jean Piaget's formal operations stage, what does the adolescent use for the first time to allow the adolescent to "think about thinking?"
Metacognition For the first time, those in the formal operations stage can use metacognition or the ability to "think about thinking." The other words are not terms used in the area of developmental psychology. (less)
The nurse is teaching parents of children, and states that children in this stage believe inanimate objects have life-like qualities. Which stage of Piaget's theory of cognitive development is the nurse describing?
Preoperational The child in Piaget's preoperational stage believes inanimate objects have life-like qualities. Piaget's concrete operation stage refers to cognitive development of school-age children. Adolescence is the beginning of formal operations. Cognitive expertise is developed in middle adults. (less)
The nurse recognizes that a child is most likely in Piaget's preoperational stage of development when observing which activity?
Pretend play Using language and pretend play are characteristics of the preoperational stage. Seriation refers to the ability to arrange objects by quantitative dimensions, characteristic of the concrete operational stage. Formal operations also include verbal problem-solving skills. The adolescent who uses formal operations can be presented verbally with "A = B, B = C, A ? C" and substitute the "=" for the question mark without having to see the written problem. The amygdala (that part of the brain involved in processing emotional information) matures sooner than the prefrontal cortex (Santrock, 2012). This finding may partially explain why teens frequently react emotionally before weighing the consequences of such behavior and why they may do things and not realize beforehand what the consequences might be- formal operations stage. (less)
The nurse is conducting a health interview and is addressing the client's current stressors. What is the primary rationale for including stress as a focus of psychosocial assessment?
Psychosocial stress has a major influence on health in many domains. Stress can have physical, emotional, social, cognitive, and/or spiritual consequences on a person. Stress does not necessarily preclude development, however, nor does it always drive the process of development. Stress influences the character and content of the health interview, but it does not necessarily "distort" the data obtained. (less)
The nurse is aware the when assessing a patient's language development, it is important to include which of the following?
Receptive and productive language All human societies use language as a means to communicate. Language development consists of two parts. Receptive language is the understanding of spoken or written words. Productive language is the use of spoken or written words. Subjective and objective are terms nurses use when describing assessment data, while negative and positive are values that can be assigned to many different events. Motor and sensory are diffferent areas of a person's growth and development, not related to language
In some cultures, "the avenue through which adolescents gain access to sacred adult practices, to knowledge, and to sexuality" is commonly referred to as what?
Rite of passage Rites of passage mark the transition from childhood to adulthood. Examples include the Jewish ritual of bar mitzvah for boys and bat mitzvah for girls, Catholic confirmation, and the Hispanic girl's quinceanera. The Bar Mitzvah is a specific rite of passage, but the question does not give information regarding the specifics of this event. In the United States, these rites do not necessarily give adolescents status as adults in the community outside their faith or ethnic communities. Graduation from high school may or may not lead to adulthood; the graduate may go on to a vocational school, college, or the world of work but may continue to live with or be economically dependent on parents for some years after. (less)
A nurse is assessing a 24-year-old client in terms of her psychosocial development, following Erikson's approach. Which of the following would the nurse most likely identify as an abnormal finding in this client?
Sexual promiscuity Although this stage focuses on the desire for a special and permanent love relationship, it also includes the ability to have close, caring relationships with friends of both genders and a variety of ages. Having established an identity apart from the childhood family, the young adult is now able to form adult friendships with parents and siblings. However, the young adult will always be a son or daughter. If the young adult cannot express emotion and trust enough to open up to others, social and emotional isolation may occur. Loneliness may cause the young adult to turn to addictive behaviors such as alcoholism, drug abuse, or sexual promiscuity. (less)
The nurse is assessing an older adult with the Mini-Cog. The older adult is unable to recall the three unrelated words. Which type of memory is the nurse assessing?
Short-term memory One aspect of the Mini-Cog is to assess the individual's ability to recall three unrelated words after completing a task. This assesses short-term memory; things the person is presently and actively thinking about. Sensory memory is retention of a sensory image for a very brief period of time. Episodic long-term memory involves the recall of past events and personally relevant information, whereas semantic long-term memory involves the retrieval of facts, vocabulary, and general knowledge. (less)
The nursing student is studying Erikson's eight stages and understands that generativity is related to which of the following?
Showing a concern for establishing and guiding the next generation Generativity vs. stagnation occurs during the middle-adult ages and includes productivity and creativity. Generativity is primarily the concern with establishing and guiding the next generation. Coming to terms with one's life choices is done during the integrity vs. despair stage of late adulthood. During this time, older adults express feelings that time is short. Separating oneself from others to prevent commitment is during the early adult stage of intimacy vs. isolation, and this occurs when a person is unsuccesssful in establishng intimacy. (less)
Assessment reveals that a young adult has failed to achieve Erikson's central task of his current stage of development. What nursing diagnosis would the nurse associate most closely with this finding?
Social isolation The central task of young adulthood in Erikson's framework is intimacy versus isolation. Failure to achieve this task results in isolation. The other listed diagnoses may or may not accompany this developmental deficit. (less)
A client explains that she has been feeling stress at work lately because her boss has been asking her to perform accounting measures that went against her conscience. According to Freud, which component of the personality is associated with the conscience?
Superego Freud's theory includes three basic structures in the anatomy of the personality: the id, ego, and superego. The id is completely unconscious and is an inherited system. Containing the basic motivational drives for such entities as air, water, warmth, and sex, it seeks instant gratification and supplies the psychic energy for the ego and the superego. The ego emerges to initially act as an intermediary between the id and the external world, or reality. It includes many processes such as learning, perceptions, memory, problem solving and decision making. The superego, often referred to as the moral component of personality (or in lay terms, one's "conscience"), provides feedback to the person regarding how closely the person's behavior conforms to the external value system. There is no "super id." (less)
The nurse is assessing a young adult client in light of Erikson's theory of psychosocial development. During this life stage, what assessment finding would most clearly suggest a lack of successful development?
The client describes herself as lonely and isolated. According to Erikson, the young adult should have achieved self-efficacy during adolescence and is now ready to open up and become intimate with others. Loneliness and isolation suggest a failure to achieve this task. Erikson did not emphasize employment, psychiatric illness, or childbearing as central focuses of young adult development. (less)
A nurse is interviewing a 15-year-old girl who is morbidly obese. The client explains that she eats because it brings her comfort. According to Freud, which of the following would explain this client's eating habits?
The client has an oral fixation. Freud proclaimed that people who overeat are orally fixated and that those who deny themselves food are using oral zone control. Behavior being guided by punishment and reward is characteristic of the preconventional level of Kohlberg. Establishing identity versus role confusion is the primary task of adolescence, according to Erikson. Piaget stated that during the attainment of concrete operations, a person develops the ability to conserve (realize that certain properties still exist in spite of transformations) weight. (less)
All the following are characteristics of wisdom except?
The level of knowledge, judgment, and advice reflected in wisdom is inferior Wisdom, an expert knowledge system, focuses on important and difficult matters often associated with the meaning of life and the human condition. The level of knowledge, judgment, and advice reflected in wisdom is superior. The knowledge associated with wisdom has extraordinary scope, depth, and balance and is applicable to specific situations. Wisdom combines mind and virtue (character) and is employed for personal well-being, as well as for the benefit of humankind. (less)
A nurse is assessing an 82-year-old client in terms of his psychosocial development, following Piaget's approach. Which of the following would the nurse most likely identify as an abnormal finding in this client?
The need for assistance in correctly taking daily medication Normally, the older adult, who has seen much change, can demonstrate flexibility. This person is capable of making realistic decisions regarding pacing of activities, planning self-care, making living arrangements, providing for transportation, adhering to medical regimen, and managing finances. Older adults are capable of gradually transferring social/civic responsibilities to others. The older adult who does not possess formal operational thinking (an abnormal finding), however, eventually profits from assistance from others, especially in obtaining help with activities of daily living, correctly taking medication, and maintaining one's highest level of wellness. (less)
Why are middle-aged adults usually more adept at solving practical problems than younger people?
They have more experience with such problems Middle-aged adults are usually more adept at solving practical problems than younger age groups because of their years of experience in doing so. They have encountered everyday problems dozens of time. While these problems remain irritating, a person in his or her 40s or 50s knows that they are solvable, what strategies to use to handle them, and how to survive them. (less)
Which of the following statements is true regarding Piaget's concept of transductive thinking?
Transductive thinking can be used by formal operational thinkers. In transductive reasoning, thinking occurs from specific to specific; if two things are alike in one aspect, the child thinks they are alike in all aspects.
How does Urie Bronfenbrenner describe development in his systems model of development? Select all that apply.
• Development is important at all ages • Development is continuous • Development is an active rather than a passive process Urie Bronfenbrenner proposed a systems model of development, which describes the individual's development in interaction with the immediate environment. In this approach, development is continuous, important at all ages, and active rather than passive
The nurse when caring for patients of a culture different from the nurse's should be respectful of different viewpoints and aware that culture can affect the following areas of growth and development: (Check all that apply.)
• Independence/dependence • Self-motivation/interdependence • Intimate relationships/family relationships Culture profoundly affects the individual development of all patients. Depending on Eastern or Western viewpoints, culture can affect a person's independence/dependence as well as self-motivation and interdependence. Culture also influences intimate and family relationships. The rate of physical growth and motor development are not influenced by a patient's culture. (less)
The nursing instructor informs students that Healthy People contains several goals associated with growth and development. Some of these include which of the following? (Check all that apply.)
• Reduce the indigenous cases of vaccine-preventable diseases. • Reduce the occurrence of spina bifida and other neural tube defects. • Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women. Healthy People has some goals associated with growth and development, including reducing indigenous cases of vaccine-preventable diseases, reducing spina bifida and other defects, and increasing abstinence from alcohol, drugs, and cigarettes among pregnant women. Nurses would be focused on optimizing activity in the eldery. Reducing the number of hours worked in young adults is not a goal of Healthy People. (less)
