Chapter 13 The Developing Child Maternal-Child Nursing care 3rd Edition

A caregiver brings their 6-month-old infant to the clinic for a checkup. At birth, the infant weighs 7 lbs, 2 oz. If the infant followed normal expected patterns for growth, the nurse anticipates the child will weigh __________lbs, __________oz at the 6-month visit.

ANS: 14 lbs, 4 oz. Rationale: Infants are expected to double their birth weight at 6 months and triple their birth weight at 1 year. Therefore, 7 lbs doubled is 14 lbs, and 2 oz. doubled is 4 oz for a total of 14 lbs, 4 oz. as an estimated 6-month weight based on birth weight.

When working with a child who is highly interpersonal, which of the following would be the best way for the child to learn? Select all that apply. A. Group activities B. Social events C. Doodling D. Reflecting E. Listening

ANS: A, B A. Group activities Rationale: This would be best for a child who is highly interpersonal B. Social events Rationale: This would be best for a child who is highly interpersonal

When caring for an infant with normal psychosocial development, the nurse expects to see which of the following? Select all that apply. A. The infant responds to their mother more than the nurse. B. The infant smiles when content. C. The infant tracks their mother when she moves across the room. D. An infant knows a block is still there when covered by a blanket. E. The infant babbles saying "da" for daddy.

ANS: A, B, C A. The infant responds to their mother more than the nurse. Rationale: According to Ainsworth's second stage (8-12 weeks), the infant begins to respond more to the mother than to anyone else, but the infant continues to respond indiscriminately to others. B. The infant smiles when content. Rationale: By the time the baby is 2 weeks of age, smiles begin to signify contentment. C. The infant tracks their mother when she moves across the room. Rationale: The infant becomes more aware of others by responding with a social smile and tracking their parents' or others' faces.

A nurse assessing a 2-month-old expects to find which of the following? Select all that apply. A. Bats at a mobile hanging on the car seat B. Holds hands open at times C. Lifts head side to side when prone D. Coos E. Double the birth weight

ANS: A, B, C, D A. Bats at a mobile hanging on the car seat Rationale: This is normal fine motor skills for a 1- to 2-month-old. B. Holds hands open at times Rationale: This is normal for a 1- to 2-month-old. C. Lifts head side to side when prone Rationale: This is a normal gross motor skill for a 1- to 2-month-old. D. Coos Rationale: This is normal language development for a 1-to 2-month-old.

A nurse learning about pediatric development knows which of the following is correct? Select all that apply. A. Development occurs in an orderly sequence. B. It is cephalocaudal. C. A child's torso develops before the arms and legs. D. Gross motor skills precede fine motor skills. E. It is individualized.

ANS: A, B, C, D, E A. Development occurs in an orderly sequence. Rationale: Development occurs in an orderly sequence, and each child should progress through predictable stages within a certain time frame B. It is cephalocaudal. Rationale: Development proceeds in a cephalocaudal, from head to toe, direction. C. A child's torso develops before the arms and legs. Rationale Development proceeds proximodistally. This means children develop from near to far and midline to periphery D. Gross motor skills precede fine motor skills. Rationale: Development proceeds from gross motor skills to fine motor skills E. It is individualized. Rationale: Growth and development is an individualized and unique process for each child, and variability in ages of achievement of milestones may exist from child to child.

According to Bronfenbrenner, when assessing a child's microsystem, which should be evaluated? Select all that apply. A. Peer group B. School C. Parent's work D. Sibling's peer group E. Family

ANS: A, B, E A. Peer group Rationale: The microsystem refers to the systems in which the child is actively involved. Typically, in a child's life the microsystem would be family, school, and peer group. B. School Rationale. The microsystem refers to the systems in which the child is actively involved. Typically, in a child's life, the microsystem would be family, school, and peer group. E. Family Rationale. The microsystem refers to the systems in which the child is actively involved. Typically, in a child's life, the microsystem would be family, school, and peer group.)

The nurse is preparing a school-age child for a procedure. Which of the following interventions are appropriate for this stage of growth and development? Select all that apply. A. Use a doll to help show the child what will happen during the procedure. B. Allow the child to cry and scream. C. Have the child read a pamphlet about the procedure. D. Remove the parent from the procedure area so the child does not correlate the procedure with their parent. E. Allow the child to pick the gown they will wear during the procedure.

ANS: A, B, E A. Use a doll to help show the child what will happen during the procedure. Rationale. This will help the child better understand and cope with the procedure and allow time for questions. B. Allow the child to cry and scream. Rationale: Children should not be afraid to show emotions and should be able to express feelings and concerns without guilt. E. Allow the child to pick the gown they will wear during the procedure. Rationale: This will give the child some control over the situation.

A nurse assessing a toddler would expect the child of normal development to be able to perform which of the following gross motor skills? Select all that apply. A. Walks down steps with alternating feet B. Stands on one foot C. Skips D. Uses scissors to cut outline of an object E. Walks backward

ANS: A, B, E A. Walks down steps with alternating feet Rationale: This is accomplished during the toddler age (1-3 years). B. Stands on one foot Rationale: This is accomplished during the toddler age (1-3 years). E. Walks backward Rationale: This is accomplished during the toddler age (1-3 years)

A nurse at an outpatient clinic is providing anticipatory guidance to a caregiver of an 8-year-old at a well-child checkup. Which should the nurse include? Select all that apply. A. Rules for being home alone B. 12 hours of sleep is necessary in this age group C. Implementation of chore chart D. Immunization schedule E. Car seat usage

ANS: A, C A. Rules for being home alone Rationale: Since anticipatory guidance should be given in advance of the occurrence, rules for being home alone should be discussed C. Implementation of chore chart Rationale: School-age children need and seek praise and also seek to achieve industry. Performing the prescribed tasks at school home also shows industry.

An example of Piaget's third substage of the sensorimotor stage is when a 4- to 8-month-old infant: A.Shakes a rattle. B. Puts down a block to pick up a Cheerio. C. Plays peek-a-boo. D. Sucks their thumb.

ANS: A.Shakes a rattle. Rationale: The third substage is secondary circular reactions in which the infant recognizes cause and effect. For example, when an infant shakes a rattle, it makes a noise so the action the infant can perform independently begins to capture their own attention.

A nursing instructor teaching pediatric nursing students about Freud's developmental stages should include which of the following? Select all that apply. A. Development is most influenced by biological instincts. B. The ego is the emotional part of the personality C. 4-year-old child picking up their toys is an example of the superego. D. A 16-year-old who refuses to drink alcohol with friends has a balanced ego. E. The id relies solely on instinct.

ANS: A, C, D, E A. Development is most influenced by biological instincts. Rationale: Freud believed that development is most influenced by biological instincts, and these instincts are psychosexual in nature. C. 4-year-old child picking up their toys is an example of the superego. Rationale: The superego functions as not only a center for conscience but as a sense of what and how the child perceives self. The child knows that a "good" person obeys their parents. D. A 16-year-old who refuses to drink alcohol with friends has a balanced ego. Rationale: During adolescence, the ego again provides a balance, this time between the id and the superego. When the adolescent refuses to drink alcohol with friends because it is against their conscience and the law. the ego has prevailed. E. The id relies solely on instinct. Rationale: The id is present at birth and is predominantly unregulated. It is the part of the personality that relies solely on instinct.

The nurse correctly provides which anticipatory guidance information to the caregivers of a 4-month-old infant? Select all that apply. A. The next checkup will be at 6 months old. B. Introduction of whole milk with formula or breast milk. C. "Tummy time". D. Time-out as an effective discipline strategy E. The infant needs 12 to 16 hours of sleep,

ANS: A, C, E A. The next checkup will be at 6 months old. Rationale: In the first year, infants see a health-care provider at regular intervals for physical assessment and immunizations, so the nurse should inform the caregiver when the next appointment is expected C. "Tummy time". Rationale: Supervised "tummy time" to increase neck, arm, and torso strength is important E. The infant needs 12 to 16 hours of sleep, Rationale: A 6-month-old child needs approximately 12 to 16 hours of sleep in a 24-hour period.

The nurse is assessing a 4 -year-old at their well-child checkup. Which of the following findings is consistent with expected growth and development at this age? Select all that apply. A. This child can ride a tricycle on their own. B. The child has a vocabulary of about 100 words C. The child has developed object permanence. D. The child grew 2½ inches since their well-child visit last year. E. The mother states the child is right-handed.

ANS: A, D, E A. This child can ride a tricycle on their own. Rationale: This is a normal finding as a toddler this age acquires more gross motor skills with ease and can typically pedal with both feet. D. The child grew 2½ inches since their well-child visit last year. Rationale: Average growth for this age is 2½-3 inches per year. E. The mother states the child is right-handed. Rationale: Hand dominance begins to develop around the age of 3 when the preschooler may show a preference in using one hand over the other and is typically established by age 4.

A nurse caring for a 6-month-old expects to see all of the following on assessment except: A. Tripled birth weight B. Sits in tripod position C. Palmer grasp D. Head lag when pulled to sitting position E. Head circumference is 14 inches

ANS: A, D, E A. Tripled birth weight Rationale. At 12 months, birth weight is tripled. At 6 months, birth weight is doubled D. Head lag when pulled to sitting position Rationale By 6 months, there should not be head lag E. Head circumference is 14 inches Rationale Head circumference at birth should be 13-14 inches and then increase 0.5 inches per month, so 14 inches is small for 6 months.

A nurse is providing care for a 17-year-old about to graduate from high school. Which of the following behaviors does the nurse identify as successful progression through the stages of Erikson's theory of development? A. A strong understanding of their own internal identity B. A strong moral code they follow C. The ability to critically think and handle problems on their own. D. A strong sense of accomplishment and purpose

ANS: A. A strong understanding of their own internal identity Rationale: A sense of identity is consistent with Erikson's theory of development for this age.

When a nurse provides proactive education to a caregiver about age-appropriate toys, nutrition, sleep, and safety concerns for their child's stage of development, it is known as: A. Anticipatory guidance B. Guidance counseling C. Nursing care plan D. Developmental theory

ANS: A. Anticipatory guidance Rationale: Anticipatory guidance is defined as proactive counseling that addresses the significant physical, emotional psychological, and developmental changes that will occur in children during the interval between health supervision visits

A 15-year-old boy is hospitalized due to a new diagnosis of Crohn's disease. What is the best way for the nurse to help influence him to make proper dietary changes and choices needed to manage the new diagnosis? A. Have him talk to another willing teenager on the unit who has the same diagnosis. B. Show him videos on the hospital television channel that explain the diagnosis and possible treatment options. C. Allow his parents to make his dietary choices until he is able. D. Use drawings and puppets to explain the diagnosis and treatments to him.

ANS: A. Have him talk to another willing teenager on the unit who has the same diagnosis. Rationale: Teens at this age are heavily influenced by peers and seek acceptance and information from the peer group

According to Freud, the nurse would expect an 11-year-old boy to: A. Have little interest in issues of sexuality. B. Develop romantic feelings for someone else. C. Explore, learn, and assert boundaries. D. Develop curiosity and compare male and female bodies.

ANS: A. Have little interest in issues of sexuality. Rationale: Boys ages 6 to 12 years are in the latency stage. Freud believed that the child "takes a break" psychosexually during this period of development allowing more focus on other aspects of growth and learning.

A 10-year-old child is awaiting a procedure for central line placement to start chemotherapy treatment. The child is nervous about the procedure. What activity would be best for the nurse to suggest to distract the child from thinking about the upcoming procedure? A. Video games with others online B. Reading a pamphlet about the procedure C. Calling a friend to talk on the phone D. Watching a movie

ANS: A. Video games with others online Rationale: This is the best option because it will distract the child and provide a challenge while giving them a sense of accomplishment at playing the game.

A nurse caring for a hospitalized 2-year-old knows which of the following contribute to the child's stress due to the hospitalization? Select all that apply. A. Isolation from friends B. Abnormal routine C. Separation from parents D. Sleep interruptions E. Self-esteem disturbances

ANS: B, C, D B. Abnormal routine Rationale: A toddler is stressed by disruption in routine. C. Separation from parents Rationale: Toddlers may be stressed when separated from parents, and parents are encouraged to stay with children D. Sleep interruptions Rationale: Sleep disturbances cause stress to the growing toddler and disruption to their routine.

A nurse is talking to an adolescent about some unhealthy decisions they have been making. Which of the following would be successful when influencing this age to make good decisions? Select all that apply. A. Model correct behavior they want to see in the adolescent B. Share a personal understanding of various perspectives about the decisions. C. Tell the adolescent you are obligated to tell their parents about the unhealthy decisions they are making. D. Ask the adolescent what other options they could make instead. E. Be truthful with the adolescent about their decisions and how poor they are.

ANS: B, D B. Share a personal understanding of various perspectives about the decisions. Rationale: The nurse can share a personal understanding of the issues and various perspectives while respecting those of the adolescent. D. Ask the adolescent what other options they could make instead. Rationale: Allowing the adolescent to explore and further develop options encourages critical thinking, which is important in adolescent development.

Parents of a 9-year-old child express concerns that the teacher mentioned the child is cheating on classwork assignments. What is the best statement toward the parents? A. "It is typical for children to feel pressured to earn good grades." B. "Be sure to mimic exemplary behavior around your child to be clear in expectations." C. "There should be strong and immediate punishment every time this occurs." D. "Ask the teacher to confront the child in the act the next time they cheat"

ANS: B. "Be sure to mimic exemplary behavior around your child to be clear in expectations." Rationale: Children mimic role models, so behaviors that are wanted should be role modeled. Also, a child unintentionally feel pressure from parents when expectations are unclear.

A theoretical approach to understanding growth and development is different than a developmental domain, because a theoretical approach: A. Takes into consideration a child's mind, body, and spirit. B. Predicts the various aspects of growth and development. C. Contributes to a broader understanding about the child. D. Includes cognitive development

ANS: B. Predicts the various aspects of growth and development. Rationale. A theoretical approach explains describes, and predicts the various aspects of growth and development

A nurse is teaching a parenting class to parents of school-age children, all of the following should be included except: Select all that apply. A. Children this age are likely to be very self-conscious B. This age asks a lot of 'why' questions. C. Offering plenty of praise to this age is important for developing self-esteem. D. If a child becomes ill, they may feel it is a consequence of their bad behavior. E. Children this age are generally rule-oriented and seek to have order.

ANS: B. This age asks a lot of 'why' questions. Rationale The preschool age child asks 'why' questions, whereas the school-age child asks 'how' questions.

The aunt of an 18-month-old asks a nurse about appropriate toys to buy for a birthday present. Based on normal growth and development, which items should the nurse suggest? Select all that apply. A. A tricycle B. A mobile C. A board book D. A walk-behind push toy E. A DVD set of cartoon movies

ANS: C, D C. A board book Rationale: A board book is an appropriate quiet activity for the toddler age. D. A walk-behind push toy Rationale: The toddler age enjoys toys that incorporate movement, and this would allow for independent movement.

A pediatric nurse knows which of the following is true regarding developmental disabilities? Select all that apply. A. Special education services can be used for children with identified delays starting at birth. B. The Denver Developmental Screening tool is used to examine children over age 6 C. Early identification of developmental disabilities is associated with better outcomes. D. Identification of a developmental delay can lead to identification of a medical condition. E. Developmental screening consists solely of observations.

ANS: C, D C. Early identification of developmental disabilities is associated with better outcomes. Rationale Early identification leads to early intervention and better outcomes. D. Identification of a developmental delay can lead to identification of a medical condition. Rationale: Early identification of developmental delays helps identify associated medical conditions or other needs of the child and family.

A caregiver brings an 11-year-old daughter to the clinic for a well child checkup. The nurse uses Tanner staging for all of the following except: Select all that apply. A. To document pubertal development B. To assess for sexual abuse. C. To diagnose precocious puberty. D. To determine is menarche has begun. E. To determine approximate height the child will reach.

ANS: C, D, E C. To diagnose precocious puberty. Rationale. Tanner staging is done to detect signs of precocious puberty but does not diagnose it D. To determine is menarche has begun. Rationale: The nurse would ask if menarche has begun. Tanner staging does not give information about whether menarche has occurred or not. E. To determine approximate height the child will reach. Rationale: Tanner staging evaluates development of secondary sexual characteristics and does not give information about final height or weight of a child.

A student nurse learning about infant reflexes needs further teaching when they state which of the following? A. "Infant reflexes are typically present at birth and disappear by 9 months." B. "Failure of a reflex to disappear may indicate delayed neurologic development." C. "The Babinski is a turning out of the foot with the toes curling in toward the sole when the bottom of the foot is stroked." D. "When the Moro reflex is elicited, a startle causes arms to abduct and move upward."

ANS: C. "The Babinski is a turning out of the foot with the toes curling in toward the sole when the bottom of the foot is stroked." Rationale: Babinski is the turning in of the foot and fanning out of the toes when the sole of the foot is stroked.

When caring for a hospitalized 8-year-old, what activity would most encourage the child's development of sense of industry? A. Allow the child to decide when they want to take a bath B. Allow the child to get themselves dressed C. Allow the child time to complete their online schoolwork. D. Allow the child to choose the color of cast to be applied.

ANS: C. Allow the child time to complete their online schoolwork. Rationale: The school-age child is focused on academic performance and allowing time to complete work gives a sense of industry or achievement while staying on target with their peers/classmates.

A 4-year-old is hospitalized for surgical repair of a broken arm. The nurse knows which action will help foster the child's sense of initiative? A. Allow the child to administer their own dose of oral pain medication prepared by the nurse. B. Allow the child to choose when to start the chemotherapy infusion. C. Allow the child to tell a joke they just learned before starting the chemotherapy infusion. D. Provide directed activities for the child to do while in their room.

ANS: C. Allow the child to tell a joke they just learned before starting the chemotherapy infusion. Rationale: Taking initiative is allowing the child to assert their power and control over the world through directing play and other social interaction. Allowing a minute for the child to tell a joke on their own will foster their initiative in social interaction.

An 18-month-old notices their mother getting ready to leave the house for work. The child starts to cry and tries to get the mother to pick them up. When the mother returns from work, the child wants to be picked up by the mother but when is picked up, pushes the mom away. This is an example of what type of attachment? A. Secure attachment B. Avoidant attachment C. Ambivalent attachment D. Disorganized attachment

ANS: C. Ambivalent attachment Rationale: With ambivalent attachment, the baby becomes anxious prior to the mother leaving, is very upset when the mother leaves, and seeks contact with her while pushing her away on return.

A school-age child understands that a piece of clay rolled in a round ball can be the same amount of clay that is rolled in a long skinny rope. This is an example of: A. Object permanence B. Concrete operation C. Conservation D. Abstract thinking

ANS: C. Conservation Rationale: Understanding of conservation is achieved during school age and is the understanding that certain properties of objects do not change simply because the form or appearance has changed.

A student nurse is learning about the stages of development. While observing children in a daycare center, the student nurse would expect children in the 3-year-old classroom to play: A. Individually along-side other children in the classroom. B. Competitive board games with others in the class. C. In small groups cooperating with others. D. An individual video game.

ANS: C. In small groups cooperating with others. Rationale: Associative play helps the preschool-age child learn how to share, play in small groups, and learn simple games with rules.

When assessing for possible lead exposure, the nurse knows blood lead level tests are: A. Recommended yearly through the age of 6 years B. Recommended at well-child visits until 6 years of age. C. Not recommended unless the child is in a high-risk area. D. Recommended only if the child lives in a house built before 1978.

ANS: C. Not recommended unless the child is in a high-risk area. Rationale: According to the AAP and the U.S. Centers for Disease Control and Prevention (CDC), universal screening or blood lead level tests are no longer recommended except for children in high-risk areas with increased risk factors.

A nurse caring for a 6-year-old admitted to the hospital would be most concerned about which developmental finding on assessment? A. The child plays Chutes and Ladders with their sibling B. The child wets the bed the first night of admission. C. The child uses simple phrases like 'I want' to express wants and needs. D. The child gets dressed by themselves Rationale: This is a typical expected finding of this age

ANS: C. The child uses simple phrases like 'I want' to express wants and needs. Rationale: Vocabulary at 6-years-old should be 1,500-2,000 words and speaking in complete sentences with increasing fluency, therefore only using simple phrases indicates a possible delay.

According to Erikson, a nurse teaching a first-time new mother how to care for the newborn should include which of the following? A. Allow the newborn to 'cry it out' so they do not get spoiled B. Feed and change the infant just before it is anticipated to be needed. C. When the newborn cries, respond to the signal of need. Rationale: Allowing the infant to signal a need lets them control their environment and thus communicate more deliberately, while responding to the need develops trust. D. Allow the father figure to participate in care when the infant signals.

ANS: C. When the newborn cries, respond to the signal of need. Rationale: Allowing the infant to signal a need lets them control their environment and thus communicate more deliberately, while responding to the need develops trust.

A hospitalized 4-year-old child is crying and asking their mother to put a diaper on them. The mother expresses concern because the child has been potty-trained without accidents for the last year. The nurse explains that A. hospitalization can induce irritability in children. B. temper-tantrums are normal for this age. C. regressing to an earlier behavior may occur as a way to cope with stress and anxiety. D. the child will need to be retrained when out of the hospital.

ANS: C. regressing to an earlier behavior may occur as a way to cope with stress and anxiety. Rationale: The child has likely regressed due to the stress and anxiety associated with illness and hospitalization. This is a normal coping mechanism at this age

The parent of 13-year-old fraternal twins tells the nurse they are concerned because their daughter has gained more weight and is much taller than their son. The parent is concerned the son has a hormonal issue delaying his growth. The best response to this concern is: A. "I will get the supplies to draw the proper labs for hormonal and growth factors." B. "Your son may be failure to thrive or may have an undiagnosed illness." C. "Give it time. Your son will catch up and surpass his sister in time" D. "It is normal for girls at this age to grow more in weight and height in comparison to boys."

ANS: D. "It is normal for girls at this age to grow more in weight and height in comparison to boys." Rationale: This is an appropriate answer explaining the normal growth pattern at this age that is expected.

According to Piaget's cognitive theory of development, when teaching a 15-year-old about their new scoliosis diagnosis and the necessary impending surgery, the nurse should: A. Keep explanations and instructions simple and straight-forward. B.Use illustrations and diagrams to illustrate the steps when discussing the procedure. C. Use a model of the spine to explain the procedure. D. Provide the child a book about scoliosis and the procedure.

ANS: D. Provide the child a book about scoliosis and the procedure. Rationale: A child aged 11 and up is in the formal operational stage of cognitive development. In this stage, the child has the ability to think logically and understand abstract concepts. The nurse can use a book or provide a verbal explanation about the diagnosis and procedure.

When disciplining an 11-month-old for repeatedly throwing food off their high-chair tray onto the floor while the rest of the family finishes eating dinner, which of the following is an inappropriate suggestion to make to the caregiver? A. "Provide a toy to the infant while still seated at the high-chair" B. "Withhold the child's favorite food of the meal until they stop throwing food." C. "Tell them 'bad boy' while holding the child's hand for a few seconds to keep them from throwing food." D. "Move the infant to another location away from the table

C. "Tell them 'bad boy' while holding the child's hand for a few seconds to keep them from throwing food." Rationale: The nurse should advise to give spoken warnings or disapprovals but without berating the child or judging the child as 'bad', and the caregiver should not practice corporal punishment such as spanking, grabbing, swatting.