Chapter 22: Conception Through Young Adult

The nurse is caring for a 19 year old male client who has suffered multiple fractures related to a motor vehicle accident. His father is at his bedside and while the client is away for radiology tests hist father talks about his sons injury and age group in general. The father asks what the major cause of death is in his sons age group. The nurses best reply is which of the following? A. injuries related to car accidents B. suicide related to job stress C. swimming and boating accidents D. cancer and chronic illnesses

A

Piaget's cognitive stage in the adolescent

formal operations; all reasoning is possible, abstract concepts can be used, long term goals can be set, and concepts of time, its passage, and future become real

A high school nurse is counseling parents of teenagers who are beginning high school. Which issues would be priority topics of discussion for this age group? Select all that apply. a. The influence of peer groups b. Bullying c. Water safety d. Eating disorders e. Risk taking behavior f. Immunizations

A, B, D, and E

A mother tells the nurse that she is worried about her 4-year- old daughter because she is "overly attached to her father and won't listen to anything I tell her to do." What would be the nurse's best response to this parental concern?A. Tell the mother that this is normal behavior for a preschooler. B. Tell the mother that she and her family should see a counselor. C. Tell the mother that she should try to spend more time with her daughter. D. Tell the mother that her child should be tested for autism.

A.

The nurse is caring for Michelle, a 15-year-old female, who was admitted for a concussion suffered while playing hockey. Her parents are at her bedside and appear very concerned about her. She ignores them for the most part and spends her time texting her hockey friends. Which of the following describes how her behavior is related to Erik Erikson's theory of growth and development? A. the peer group acts as the greater influence B. this stage is about learning useful skills C. she is learning about gender social roles D. abstract concepts are being utilized

A.

A nurse is teaching new mothers about infant care and safety. What would the nurse include as a teaching point? A. keep infants younger than 6 months out of direct sunlight B. use honey instead of sugar in home made baby food C. place them on their stomach for sleeping D. keep crib rails down at all times

A. Rationale: mothers should not add honey to their child's food, or place the baby on their stomach they should be on their back. Also the crib rails should be up at all times to prevent falls

The nurse is educating the mother of an infant age 4 months on safety concepts in child rearing. Which of the following statements by the mother suggests that she may require some repetition and reinforcement of the information? A. The baby can sleep on her stomach during naps. B. The baby will sleep in her crib, not with me and my husband. C. I must keep appointments for the baby's immunizations. D. I must keep small objects out of the baby's reach.

A. Rationale: sleeping habits can cause SIDS so the baby should sleep on its back

A school-aged child is attentive to following the rules at school, respects his teachers, and views justice as a means of fair play. These are characteristics of which type of development typical of this age group? A. moral development B. psychosocial development C. physiologic development D. spiritual development

A. moral development

A nurse working with adolescents in a group home discusses the developmental tasks appropriate for adolescents with the staff. What is an example of a primary developmental task of the adolescent? A. Working hard to succeed in school B. Spending time developing relationships with peers C. Developing athletic activities and skills D. Accepting the decisions of parents

B.

Sleep habits have been implicated in cases of sudden infant death syndrome (SIDS). What instructions will the nurse provide to new parents related to positioning their infant for sleeping? A. healthy infants up to age 6 months should be positioned on their backs on a soft surface B. healthy infants up to age 6 months should be positioned on their backs on a firm surface C. healthy infants up to age 6 months should be positioned on their stomachs on a soft surface D. healthy infants up to age 6 months should be positioned on their stomachs on a firm surface

B.

Which of the following points should the nurse prioritize when educating school aged children about nutrition? A. sources of iron and folate B. sources of calcium and vitamin D C. limiting complex carbohydrate intake D. the importance of organic food

B. Rationale: school aged children are undergoing rapid growth and requires high intake of vitamin D and calcium which is more important than iron and folate.

The mother of a girl 6 years of age is exasperated at her daughter's persistent enuresis. How can the nurse best respond to this mother's concern? A. This is especially common among girls and is very normal. B. Most children outgrow their bedwetting at around your daughters age or shortly after. C. Does your daughter ever complain of pain or burning when she urinates? D. Have you spoken to your PCP about a referral to a specialist?

B. Rationale: enuresis typically ends between the ages of 6 and 8. it is not noted to be more common in girls than boys

Mrs. Karlilse brings her 1-month-old son to the clinic for a well-baby checkup. She reports to the nurse that the baby cries every day from 4 PM until about midnight. The baby draws his legs up to his abdomen and cries hard continually during this time. The nurse talks to the mother about which of the following conditions? A. failure to thrive B. infant colic C. danger of suffocation D. SIDS

B. infant colic

When providing nursing care and education to an adolescent, the nurse recognizes that which of the following groups has the greatest influence during this stage of development? A. immediate family B. peer group C. extended family D. teachers and coaches

B. peer group

The nurse encourages parents of hospitalized infants and toddlers to stay with their child to help decrease what potential problem? A. problems with attachment B. separation anxiety C. risk for injury D. failure to thrive

B. separation anxiety

A school nurse is preparing to talk on safety issues for school aged children to present at a parent teacher meeting. Which topics should the nurse include based on the age of the children? (select all that apply) A. child proofing the home B. choosing a car seat C. teaching pedestrian traffic safety D. providing swimming lessons and water safety rules E. discussing alcohol and drug consumption related to motor vehicle safety F. teaching the child how to stop, drop, and roll

C, D and F Rationale: A and B would be appropriate for parents of an infant or toddler, and E would be for parents of an adolescent

Today the pediatric clinic nurse gets Mrs. Johnson and her 20-month-old son, Jackson, settled in an exam room. Mrs. Johnson tells the nurse that the biggest problem she faces now is Jackson's refusal to let her out of his sight. "He screams and cries if he thinks I am gone". She asks if she should be concerned about this. Your best reply is which of the following? A. Only leave him with a trusted persons. B. Has he been frightened by something when alone? C. Separation anxiety is normal at 18-24 months. D. :eave him for short periods of 10 minutes.

C.

The parents of a 4 month old cannot visit at the hospital except on weekend. Which of the following actions by the nurse indicates an understanding of the emotional needs of a young infant? A. have different nurses provide care for varied contact B. tell parents infrequent visiting isn't necessary C. assign the same nurse as much as possible D. place the infant in a room away from other clients

C. Rationale: According to Erikson, trust develops if the caregiver can be counted on to provide food when the infant is hungry or is in need of warmth and comforting

The nurse is assessing a preschooler who has just turned 6 years old. The nurse expects which of the following as typical development for a child in this developmental phase. A. the child begins by drawing stick figures B. egocentrism increases as socialization increases C. the head is close to adult size by 6 years D. play is related to fantasy instead of real life events

C. Rationale: children begin drawing stick figures in the toddler years, and play during preschool years is related to fantasy and not real life events. Egocentrism decreases as socialization increases

A father is concerned because his 3-year-old daughter has been using the bathroom independently for the past 6 months but has had a few "accidents" since her hospitalization. Which of the following is the nurse's best response? A. You need to take your daughter to the bathroom more often. B. Reward her for every time she goes to the bathroom. C. Her regressive behaviors are a reaction to being hospitalized. D. Her accidents may indicate the need for additional potty training.

C. Rationale: this is a normal finding and will disappear after being discharged

The nurse is caring for a female client 15 years of age who is hospitalized with a fractured ankle. Her father tells the nurse that this happened during a gymnastics lesson. He goes on to explain that every six or eight months it seems his daughter is trying something different; right now it is gymnastics. You know that this behavior fits with which of the following theorist's developmental tasks for adolescents? A. Havinghurst B. Piaget C. Erikson D. Freud

C. Erikson Rationale: based on Erikson's theory, the adolescent tries out different roles, personal choices, and beliefs in the stage called identity vs role confusion.

A school nurse is aware of the importance of creating and carrying out interventions that resonate with the developmental tasks of the adolescent population. Such interventions should appeal to adolescents' prioritization of their what? A. skepticism B. goals C. identity D. vulnerability

C. identity Rationale: one of the key developmental tasks in adolescence is the creation and maintenance of an independent identity.

When providing education to a young adult during an annual health exam, the nurse discusses health problems common during this stage of development. What is the most common cause of mortality during this stage? A. eating disorders B. suicide C. motor vehicle crashes D. drug overdose

C. motor vehicle crashes

Which of the following topics for the client education of a pregnant woman should the nurse prioritize in an effort to promote healthy fetal development? A. infection prevention B. physical activity C. nutrition D. stress management

C. nutrition

A nurse is teaching parents of toddlers how to spend quality time with their children. Which activity would be developmentally appropriate for this age group? A. playing video games B. playing peek-a-boo C. playing in a sand box D. playing board games

C. playing in a sand box

Today you are caring for Jerry, a 3-year-old boy, who is admitted with a respiratory infection. His mother, Mrs. Baker, is a single parent and works. She can only be with Jerry during the late afternoon and evening. Today she tells you that Jerry has been toilet trained for a year and she is very surprised and disappointed that he is wetting and soiling his bed now. Your best reply would be which of the following? A. We can start working on retraining him here. B. It's his way of saying he's angry at you. C. We can remind him to use the toilet once in a while. D. His regression is normal and related to stress.

D.

Of the following components of psychosocial development in the neonate and infant, which one facilitates emotional linkage between a baby and a caregiver? A. temperament B. attachment C. play D. bonding

D. bonding Rationale: bonding is considered the emotional linkage and is necessary for later attachment. Attachment is an active reciprocal relationship different than bonding.

Following assessment of an obese adolescent, a nurse considers nursing diagnoses for the pt. Which diagnosis would be the most appropriate? A. risk for injury B. risk for delayed development C. social isolation D. disturbed body image

D. disturbed body image

A toddler's mother exits the room to talk to the physician in the hallway. The nurse caring for the toddler notes that the child starts to cry when he no longer sees his mother in the room. He soon stops crying and appears saddened and depressed. The nurse recognizes this behavior as which of the following? A. negativism B. regression C. fantasizing D. separation anxiety

D. separation anxiety

Which healthcare issue for the infant is most serious?

SIDS

Health care issues for the infant

accidental injury, colic, SIDS, failure to thrive, and child maltreatment or abuse

What is the major cause of death in toddlers?

accidents

Special considerations for an infant

attachment and bonding, play, and temperament

Erikson's stage for the toddler

autonomy vs. shame and doubt

Accidental injury during infancy

babies can aspirate and choke because the swallowing reflex isn't fully developed; as they become mobile they are at risk for falls and be careful of cords in the floor

Child maltreatment

child abuse and neglect

Erikson's autonomy vs shame and doubt for the toddler

child learns about the environment and gains independence; if they don't they have a sense of inadequacy and self-doubt

Healthcare issues with preschoolers

communicable diseases and respiratory tract infections, accidents, and obesity

Piaget's stage of moral development for school aged children

concrete operational; the child learns by manipulating concrete or tangible objects and can classify articles

Failure to thrive

condition where there is inadequate growth in height and weight and results from the infants inability to obtain or use calories needed for growth (seen from neglect or physiologically)

Role of nursing in preschool

continue to teach the parents identify risk for obesity, looking at vulnerable populations, and activity levels (lack of activity due to electronics)

Levinson's theory of development in the adolescent/young adult

early adult transition; making initial career choices, establishing personal relationships, and selecting personal values and lifestyles

Freud's stages of psychosexual development of the adolescent/young adult

genital stage; their libido returns and the person is capable of full sexual function. creativity and pleasure are found in love and work

Role of the nurse promoting health and preventing in adolescents and young adults

helping them understand reproductive functioning, facilitate family relationships, be their advocate because they are the primary patient

Erikson's Psychosocial Theory of adolescent/young adult

identity vs role confusion; self concept is stabilized and the peer group has the most influence on actions; they struggle with their sexual identity

Cognitive development of the toddler

in Piaget's last two stages of sensorimotor development. they begin to understand object permeance and self as separate from others, being perceiving body image, get a sense of gender identity and language beings at 2 years.

Colic

inconsolable crying or fussing that lasts more than 3 hours and occurs more than 3 days a week and lasts for more than 3 months; parents can't soothe the baby

Erikson's stage for school aged children

industry vs inferiority; the child is focused on learning useful skills and a positive self esteem

Erikson's stage for the preschool child

initiative vs guilt; inner turmoil occurs when natural curiosity is pitted against conscience and they assert themselves more frequently. if this isn't met guilt can occur

Health issues for the adolescent/young adult

injuries, substance abuse, suicide and self harm, pregnancy, nutritional problems, STI's, and developmental and situational stressors

The body of a preschooler is more...

lean and coordinated

Havinghurst's tasks for preschool children

learn sex differences and modesty, describe social and physical reality in language and concept, get ready to read, and distinguish right from wrong

Havinghurts's tasks for the toddler

learn to control elimination processes, sex differences, form concepts, learn language, and distinguish right from wrong

Havinghurst's tasks for school aged children

learning game skills, appropriate social roles, developing skills in reading, writing and calculating, developing morality and a scale of values, and achieving personal independence

Havinghurst's Developmental Tasks for the adolescent/young adult

masculine or feminine social role develops, set of values and ethical system is internalized

Leading cause of death in adolescents and young adults

motor vehicle crashes

Erikson's theory with toddlers

negativism which is when they say no constantly and they have temper outburst; we see it as a way for them to control their environment (can see regression here)

Health issues for the school aged child

obesity, accidents, communicable diseases, ADHD, learning disabilities, beginnings of chronic illnesses, and bed wetting (enuresis)

Freud's stage for preschoolers

phallic stage where the biologic focus is genital; the child has sexual desire for the opposite sex parent for means of defense and they identify with them

Kohlberg's stage for preschoolers

preconventional stage; the focus is to avoid punishment or receive a reward

What's one of the biggest things we will see with toddler's in the hospital?

separation anxiety because they are not used to being separated from their parents

Developmental and situational stressors for adolescents/young adults

stressors related to sexual orientation and family; peers become important and they struggle with their sexual identities; families can go through a divorce or the child can become pregnant

SIDS

sudden infant death syndrome; unexpected death of the infant under the age of 1 (any other cause of death is looked for and if they can't find one its usually SIDS) (recommended to place infants on their back when sleeping)

Promoting health in the school aged child

teach the family and incorporate the child into the teaching; we need to make sure they are developed enough to understand the information

Freud's stage for school aged children

the latency stage where they are identifying with their own biological sex and oriented creative activities; body image and peer related uses become important

Freud's stage for the toddler

they move into the anal stage and toilet training is a major focus

Adolescents are prone to injury because they...

think they are invincible and get into risk taking behavior

What do we as nurses want to teach the parents about their toddler?

to support their toddler's independence