Module 25: Development
The nurse is teaching a school-aged client how to use a peak flow meter to monitor asthma. Which approach by the nurse is most likely to result in the desired outcome? A) Providing positive reinforcement after every attempt B) Explaining that asthma can be fatal if not monitored and treated C) Telling the client he cannot play until he learns to use the meter correctly D) Using colloquialisms and slang when describing how to use the meter
Answer: A Explanation: A) A sense of achievement is very important to school-aged children, and rewarding and reinforcing behavior is most effective. Scare tactics and negative reinforcement are not appropriate. Nurses should use clear, concrete language to enhance understanding.
A nurse is caring for a 76-year-old client. The nurse suspects that the client may be minimizing her pain. Which should the nurse recognize as a common reason for this behavior in older adults? A) Older adults see pain as a natural progression of aging, causing them to downplay the extent of their pain. B) Older adults fear that admitting the extent of pain will result in administration of potentially addictive pain killers. C) Older adults think that admitting the extent of their pain increases the likelihood they will be sent to a rehabilitation hospital prior to returning home. D) Older adults have usually lost some degree of sensation in their appendages which makes it difficult for them to sense the full extent of their pain.
Answer: A Explanation: A) Older adults see pain as a natural progression of aging. As such, many elderly patients tend to downplay the extent of their pain, which leads to undertreatment of pain. The nurse should be aware when assessing for pain that the older adult may not rate his or her pain realistically. Fear of addictive pain killers, admission to a rehabilitation hospital, and loss of sensation are unlikely to contribute to the older adult downplaying pain.
What activity should the nurse implement for a 6-month-old client with gross motor delays? A) Pull the child to a sitting position and prop the child in that position. B) Encourage the child to hold a rattle or play patty-cake. C) Talk to the child and play music. D) Encourage the child to pull up to a standing position.
Answer: A Explanation: A) The infant at 6 months should have head control and is working on sitting without support. Pulling the child to a sitting position allows the neck muscles to support the head. Propping the child in a sitting position helps to develop self-righting behaviors. It is too early to worry about standing. Talking to the child promotes language development, not gross motor development. Handling a rattle is a fine motor behavior, not a gross motor behavior.
A 6-month-old is in the clinic for a well-child visit. As part of the visit, the nurse will assess his development using the Ages and Stages Questionnaire (ASQ). Which will the nurse rely on to make her assessment? A) Observation of the child's skills in a variety of areas B) Parent reports of communication and motor skills, social skills, and problem-solving ability C) Parental reports and observation of the child's skills in a variety of areas D) Childcare provider reports of communication and motor skills, social skills, and problem-solving ability
Answer: B Explanation: A) The ASQ relies on parental reports to assess the child's communication and motor skills, social skills, and problem-solving ability. The Battelle Developmental Inventory Screening Test (BTDIST) uses both observation and parental reports to assess a variety of areas. Tests specifically described in this chapter do not include those based solely on observation or childcare provider reports.
The school nurse cares for students with physical challenges and suspects that the needs for physical safety are not being adequately met for several students in the home environment. Which of the following assessment findings support the nurse's concern? Select all that apply. A) Wearing the same clothes to school several days of the week B) Limited arm range of motion C) Scrapes on knees caused by falling from a bicycle D) Hand burn from touching a hot stove E) Lunch contains leftovers from previous evening dinner
Answer: B, C, D Explanation: A) Wearing the same clothes to school several days of the week and eating leftovers for lunch could be an indication of the family's financial status. Evidence that physical safety needs are not being adequately met would include the formation of contractures, which limits arm range of motion; scrapes on knees after falling from a bicycle, indicating the lack of safety or protective equipment for the head and extremities; and hand burns obtained from touching a hot stove, which could mean the child was not attended in the kitchen at home.
The nurse notes that an infant does not seem to respond to noises in the environment and has difficulty following the movement of toys. Which diagnostic tools does the nurse anticipate will be used to further assess this client? Select all that apply. A) CT scan of the brain B) Vision test C) Abdominal x-rays D) Nerve conduction studies E) Audiology testing
Answer: B, E Explanation: A) The child is not responding to environmental noise and is having difficulty tracking the movement of toys. The two tests that should be considered for this child are vision and hearing testing. There is not enough evidence to support that the child would need a CT scan of the brain, abdominal x-rays, or nerve conduction studies.
According to Bandura's social learning theory, which of the following should the nurse advise the parent of a preschool-aged child to do in order to help the child become independent in activities of daily living? A) Punish the child if he does not complete the personal care tasks independently. B) Refuse to help the child with the tasks and insist he do them on his own. C) Model the tasks and positively reinforce the child for completing the tasks independently. D) Wait until the child reaches the concrete operational phase before asking him to complete the tasks.
Answer: C Explanation: A) According to Bandura, children imitate the behavior they see; if the behavior is positively reinforced they tend to repeat it. Negative reinforcement like punishment is not part of Bandura's theory; it is more closely aligned with Skinner's behaviorist theory. Refusing assistance to the child does not align with Bandura's belief in the need for modeling. The concrete operational phase is part of Piaget's theory and not Bandura's.
The nurse is assessing a 20-month-old and learns that he is unable to stand alone. Which aspect of development does the nurse identify as altered? A) Behavior B) Height C) Motor D) Growth
Answer: C Explanation: A) Development is an increase in the complexity of function and skill progression, the capacity of an individual to adapt to the environment. It includes changes in a person's cognitive, psychosocial, and gross and fine motor skills. In this case, the child's inability to stand is indicative of a delay in motor development. Growth refers to physical change and increase in size; it does not entail changes in skills and abilities. Height is one indicator of growth. Behavior is a component of each developmental stage and can sometimes indicate that development has taken place, but its absence does not mean that development has not occurred.
Which activities should the nurse emphasize when teaching parents about how to foster development in preschool-aged children? A) Providing time for playing sports, such as basketball, to increase gross motor skills B) Helping them develop skills needed in the adult world, such as allowance budgeting C) Allowing "pretend" time, such as dress-up or role-playing activities D) Presenting diversity in culture and practices as part of home-based study
Answer: C Explanation: A) Preschool-aged children should be given activities that focus on make-believe and pretend opportunities. Gross motor activities are also important, but children this age prefer activities such as swinging, riding a tricycle, and throwing a ball to organized sports. School-age children are motivated by activities that provide a sense of worth. They concentrate on mastering skills that will help them function in the adult world. Understanding diversity, role preference, and performance is the task of the adolescent.
The nurse is assessing a child who was last seen in the clinic 2 years earlier. Which of the following should the nurse anticipate as having remained relatively stable over time? A) The child's behavior B) The child's physical characteristics C) The child's temperament D) The child's home environment
Answer: C Explanation: A) Temperament refers to innate characteristics that do not change over time. Each individual brings these characteristics to the events of daily life, and they set the stage for the interactive dynamics of growth and development. Physical characteristics include eye color and height; although some physical characteristics remain constant as a child grows, others do not. A person's temperament shapes his or her behaviors; however, regardless of temperament, a child's behaviors should be expected to change over time as a normal part of development. Finally, a child's home environment may change at any time due to any number of factors.
The nurse is performing developmental assessments on several children in a pediatric clinic setting. The nurse should recognize that which child is exhibiting a delay in meeting the expected developmental milestones? Select all that apply. A) A 2-year-old who is unable to cut with scissors B) A 2-year-old who cannot recite her phone number C) A 3-year-old who is unable to speak in sentences D) A 5-year-old who is unable to button his shirt E) A 6-year-old who is unable to sit still for a short story
Answer: C, D, E Explanation: A) A 5-year-old should be able to button his shirt. A 6-year-old should be able to sit still for a short story; this is a task that children between 3 and 5 years old are typically able to do. A child who cannot cut with scissors by kindergarten age is considered developmentally delayed, but a 2-year-old is not expected to be able to do this. A 2-year-old is not expected to be able to recite a phone number. A 3-year-old is usually able to speak in sentences.
The nurse is conducting a psychoeducation group with male and female clients. The nurse observes what appear to be differences in moral perspectives between the men and women. Which observation is most consistent with Gilligan's theory of moral development? A) The men are focused on human-made rules governing morality. B) The women have difficulty looking at moral issues objectively. C) The men believe that morality is tied to relationships and caring. D) The women believe that it is most important not to inflict harm.
Answer: D Explanation: A) According to Gilligan, men tend to consider what is right to be what is just, whereas for women what is right is taking responsibility for others as a self-chosen decision. The ethic of justice, or fairness, is based on the idea of equality: Everyone should receive the same treatment. This is the development path usually followed by men and widely accepted by moral theorists. By contrast, the ethic of care is based on the premise of nonviolence: No one should be harmed. This is the path typically followed by women.
A community nurse is planning an educational program supports the developmental tasks of adults ages 50 to 60. According to Gould's theory, which task should be emphasized? A) Engaging in self-reflection B) Viewing personality as set C) Adjusting to decreasing physical capacities D) Undergoing a period of transformation
Answer: D Explanation: A) According to Gould, the seventh stage of adult development is experienced by individuals ages 50-60 and is a period of transformation. Gould's theory states that personalities are set at ages 43-50, in stage 6. Adjusting to decreasing physical capacities is a part of Peck's theory, and self-reflection occurs in stage 5 of Gould's theory, during the ages 35-43.
The nurse is caring for an adolescent with a chronic illness who suddenly becomes noncompliant with the medication regimen. Which intervention should the nurse choose to help improve medication compliance for this client? A) Give the client a computer-animated game that presents information on the management of the condition. B) Recommend to the client's parents that certain privileges should be taken away, such as cell phone use and texting, if compliance fails to improve. C) Arrange for the physician to discuss the risks related to noncompliance with medications to the client. D) Set up a meeting with some older teens with the same condition who have been managing their disease effectively.
Answer: D Explanation: A) Providing the adolescent with positive role models from his or her peer group is the intervention most likely to improve compliance. Interest in games might begin to wane at this age. Adult opinions, even from a physician, could be viewed negatively and challenged. Threatening punishment could further incite rebellion.