G&D Infancy through Preschool Age
Nursing students are reviewing developmental milestones for toddlers. They demonstrate understanding of these milestones when they put them in the proper sequence. Place the milestones in their proper sequence from earliest to latest. Name one body part Name one color Creep up stairs Engage in parallel play Run and jump in place
Creep up stairs Run and jump in place Name one body part Engage in parallel play Name one color Explanation: A 15-month-old can creep upstairs. An 18-month-old can run and jump in place and name one body part. A 24-month-old engages in parallel play; a 30-month-old can name one color.
Nursing students are reviewing information about the emotional development of the preschooler. They demonstrate understanding of the information when they identify what task as the task of the preschooler? a) Initiative b) Industry c) Autonomy d) Trust
Initiative Explanation: The developmental task of the preschool period is initiative versus guilt. Industry is the developmental task of the school-aged child. Trust is the developmental task of infancy. Autonomy is the developmental task of toddlerhood.
Place these primitive protective reflexes of infancy in the order in which they will disappear as the child matures. Moro, Step, Babinski, Root and Plantar
Step Root Moro Plantar Babinski
The nurse is discussing proper discipline with the mother of a 15-month-old boy. Which statement is most important? a) Never spank the child for any reason. b) Rules and limits should be simple and few c) Use praise when the child is doing something right. d) Toddlers are unable to learn rules easily.
a) Never spank the child for any reason. Explanation: Toddlers younger than 18 months of age should not be spanked due to the possibility of injury. All the other statements describe toddler characteristics accurately and are basic to good discipline but are not the most important for this young toddler.
The nurse is observing a 6-month-old boy for developmental progress. For which typical milestone should the nurse look? a) Puts down a little ball to pick up a stuffed toy b) Enjoys hitting a plastic bowl with a large spoon c) Shifts a toy to his left hand and reaches for another d) Picks up an object using his thumb and finger tips
a) Puts down a little ball to pick up a stuffed toy Explanation: At 6 months of age, the child is able to put down one toy to pick up another. He will be able to shift a toy to his left hand to reach for another with his right hand by 7 months. He will pick up an object with his thumb and fingertips at 8 months, and he will enjoy hitting a plastic bowl with a large spoon at 9 months.
A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage? a) Giving the child opportunity to speak and finish her ideas b) Asking the girl to slow down and to think before she talks c) Looking at the child while she is speaking d) Enunciating clearly and slowing down parental speech
b) Asking the girl to slow down and to think before she talks Explanation: Many preschoolers stutter as thinking races ahead of their ability to articulate ideas. Most of this stuttering, when not made an issue, will resolve on its own. Calling attention to the dysfluency often exacerbates it. All the other practices are helpful.
The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which task would the nurse expect the toddler to be able to perform? a) Winding up a mechanical toy b) Knowing which are his or her toys c) Completing puzzles with four pieces d) Playing make-believe with dolls
b) Knowing which are his or her toys Explanation: The toddler in Piaget's sensorimotor stage of cognitive development (18 to 24 months) understands requests, is capable of following simple directions, and has a sense of ownership (knowing which toys are his). The other tasks are accomplished by the child in the preoperational stage (2 to 7 years).
The nurse is choosing foods for a toddler's diet that are high in vitamin A. What foods could be added to the menu? Select all that apply. a) Avocados b) Spinach c) Broccoli d) Carrots e) Applesauce f) Sweet potatoes
b) Spinach e) Carrots f) Sweet potatoes Explanation: Foods that are high in vitamin A include apricots, cantaloupe, carrots, mangos, spinach and dark greens, and sweet potatoes. Applesauce is high in fiber, and avocados and broccoli are high in folate.
Language development is rapid in the preschool years. At the age of 2 most children use about 50 to 100 words. By the time the child is 5 years of age, how many additional words do most children use? a) 3,000 words b) 1,000 words c) 2,000 words d) 1,500 words
c) 2,000 words Explanation: By the end of the fifth year, preschoolers use sentences that are adult-like in structure and know about 2,000 words.
The nurse is teaching the mother of a 2-year-old boy about age-appropriate toys. Which would be of most interest plus stimulating to the growth and development of this child? a) Giving the child a toy vacuum cleaner b) Providing a brightly colored plastic bucket and shovel c) Giving the child bowls, pot, pans, and large spoons d) Offering the child a variety of large stuffed toys
c) Giving the child bowls, pot, pans, and large spoons Explanation: The kitchen items are usually of most interest since they give opportunity to copy observed parental actions. Also, these items can be used not only to role model but also to stack, nest, make noise, and rearrange in many configurations. They are also inexpensive. However, all the other toys are appropriate and safe for toddlers.
The nurse is assessing a 4-month-old boy during a scheduled visit. Which findings might suggest a developmental problem? a) The child never squeals or yells. b) The child does not babble. c) The child does not vocally respond to voices. d) The child does not say dada or mama.
c) The child does not vocally respond to voices. Explanation: The fact that the child does not vocally respond to voices might suggest a developmental problem. At 4 to 5 months of age most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child is too young to babble, squeal, yell, or say dada or mama.
The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by the caregivers best indicates a common aspect of the diet and nutrition of the preschool child? a)"My 4-year-old eats as much as my adolescent does every day." b)"My husband is insistent that our 5-year-old not eat any snacks so he will eat he all of his meals at mealtime." c)"Our child gets into food jags where she will only eat one food all day long." d)"My child is so picky and eats the same thing every day for days on end!"
d) "My child is so picky and eats the same thing every day for days on end!" Explanation: The preschooler's appetite is erratic; at one sitting the preschooler may devour everything on the plate, and at the next meal he or she may be satisfied with just a few bites. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks.
By what age should the child know his/her own gender? a) 1 b) 4 c) 2 d) 3
d) 3 Explanation: By the age of three, the child should know his or her own gender. The other age ranges are incorrect.
Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order. You selected: Remove the preschooler to a boring spot. Set a timer for no more than 4 minutes. Parent knows the misbehavior was intentional. If the child gets up, replace the child and restart the time. Warn the child there will be a time-out if the behavior does not stop.
Parent knows the misbehavior was intentional. Warn the child there will be a time-out if the behavior does not stop. Remove the preschooler to a boring spot. Set a timer for no more than 4 minutes. If the child gets up, replace the child and restart the time. Explanation: Time-out is an extinction method of discipline that avoids reinforcing the unacceptable behavior with attention. One minute per year of age is the appropriate length of a time-out. Five minutes is the recommended maximum length.
The nurse is teaching a first-time mother with a 14-month-old boy about child safety. Which is the most effective overall safety information to provide guidance for the mother? a) "Never let him out of your sight when outdoors." b) "Place a gate at the top of each stairway." c) "Put chemicals in a locked cabinet." d) "Don't smoke in the house or car."
a) "Never let him out of your sight when outdoors." Explanation: Because they are curious and mobile, toddlers require direct observation and cannot be trusted to be left alone, especially when outdoors. The priority guidance is to never let the child be out of sight. Gating stairways, locking up chemicals, and not smoking around the child are excellent, but specific, safety interventions.
The nurse observes an infant interacting with his parents. What are normal social behavioral developments for this age group? Select all that apply. a)Around 2 months the infant exhibits a first real smile. b)Separation anxiety may also start in the last few months of infancy. c) Around 3 months the infant smiles widely and gurgles when interacting with the caregiver. d)Around 5 months the infant may develop stranger anxiety. e)Around 3 months the infant will mimic the parent's facial movements, such as sticking out the tongue. f)Around 3 to 6 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo.
a) Around 2 months the infant exhibits a first real smile. b) Separation anxiety may also start in the last few months of infancy. c) Around 3 months the infant smiles widely and gurgles when interacting with the caregiver. e) Around 3 months the infant will mimic the parent's facial movements, such as sticking out the tongue. Explanation: The infant exhibits a first real smile at age 2 months. By about 3 months of age the infant will start an interaction with a caregiver by smiling widely and possibly gurgling. The 3- to 4-month-old will also mimic the parent's facial movements, such as widening the eyes and sticking out the tongue. Separation anxiety may also start in the last few months of infancy. Around the age of 8 months the infant may develop stranger anxiety. At 6 to 8 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo.
The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which statements accurately describe the typical infant's achievement of these milestones? Select all that apply. a)At 7 months the infant sits alone with some use of hands for support. b)At 1 month the infant lifts and turns the head to the side in the prone position. c)At 2 months the infant rolls from supine to prone to back again. d)At 12 months the infant walks independently. e)At 9 months the infant crawls with the abdomen off the floor. f)At 6 months the infant pulls to stand up.
a) At 7 months the infant sits alone with some use of hands for support. b) At 1 month the infant lifts and turns the head to the side in the prone position. d) At 12 months the infant walks independently. e) At 9 months the infant crawls with the abdomen off the floor. Explanation: At 1 month the infant lifts and turns the head to the side in the prone position. At 7 months the infant sits alone with some use of hands for support. At 9 months the infant crawls with the abdomen off the floor. At 12 months the infant walks independently. At 4 months the infant lifts the head and looks around. At 10 months the infant pulls to stand up.
Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of these actions? Select all that apply. a)Books and stories can help preschoolers master proper behavior. b)A time-out of about 8 minutes would be appropriate for intentional misbehavior. c)Spank with an open hand only and never with an object. d)Anticipate situations likely to cause misbehavior and redirect the child to another activity. e)When discussing improper behavior, call the behavior "bad" or "naughty," not the child.
a) Books and stories can help preschoolers master proper behavior. d) Anticipate situations likely to cause misbehavior and redirect the child to another activity. e) When discussing improper behavior, call the behavior "bad" or "naughty," not the child. Explanation: Spanking is the least effective discipline and discouraged by pediatric professionals. If chosen by parents, it should be infrequent and done only with an open hand. Labeling behavior and not the child supports self-esteem. One minute per year of age is an appropriate length for time-outs. Redirecting from events that tend to lead to misbehavior is wise and reduces conflict. Preschoolers can learn much from stories and books including appropriate behavior.
The nurse is assessing the psychosocial development of a preschooler. What are normal activities characteristic of the preschooler? Select all that apply. a) Initiates activities with others b) Engages in parallel play with peers c) Plans activities and makes up games d) Acts out roles of other people e) Classifies or groups objects by their common elements f) Understands relationships among objects
a) Initiates activities with others c) Plans activities and makes up games d) Acts out roles of other people Explanation: The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.
The best activity that a preschooler's parents could use to help her achieve the developmental task of the preschool period is to: a) teach her street-crossing safety. b) help her learn how to follow rules. c) provide her with clothes that snap rather than button. d) allow her to experiment with Play-Doh.
d) allow her to experiment with Play-Doh. Explanation: Preschoolers enjoy toys or material that they can manipulate (free-form play) because this helps them learn how things work.
Johnny exhibits the following growth pattern. How should the nurse interpret or manage this data? Select all that apply. 3 yrs: Ht. 37 inches Wt. 32 pounds 4 yrs: Ht. 39 inches Wt. 39 pounds 5 yrs: Ht. 40 inches Wt. 46 pounds a) Johnny's height and weight should be plotted on a growth chart. b) Johnny is growing slowly in height but rapidly in weight. c) Johnny is following a normal pattern of growth for the preschool years. d) Johnny may be at risk for overweight or obesity.
a) Johnny's height and weight should be plotted on a growth chart. b) Johnny is growing slowly in height but rapidly in weight. d) Johnny may be at risk for overweight or obesity. Explanation: The preschool child's growth is fairly even. The child should grow about 2½ to 3 inches and gain around 5 pounds yearly. Johnny is not following this pattern. Plotting the child's height and weight on a growth chart would make it visually easy to follow his growth pattern and compare it to the norms.
A mother brings her 4-year-old son in for a check-up. Which of the following findings should the nurse be concerned about? a) Resting pulse rate of 120 b) Ectomorphic body type c) Weight gain of 5 lb in the past year d) No increase in appetite compared with that in toddler years
a) Resting pulse rate of 120 Explanation: Pulse rate in preschool children decreases to about 85 bpm typically, so the nurse should be concerned about a pulse rate of 120 in a 4-year-old. Contour changes in preschool children are so definite that future body type—ectomorphic (slim body build) or endomorphic (large body build)—becomes apparent. Neither of these body types is a reason for concern. During these years, appetite remains the same as it was during the toddler years, a level perhaps considerably less than some parents would like or expect. Weight gain is slight during the preschool years as the average child gains only about 4.5 lb (2 kg) a year. (less)
The nurse is assessing the development of a 15-month-old girl during a well-child visit. Which skill would the nurse expect to see? a) Stands alone b) Runs to her mother c) Points to her nose and mouth d) Feeds herself with a spoon
a) Stands alone Explanation: At 15 months, toddlers have mastered standing and walking alone. The child has yet to develop the ability to feed herself with a spoon, point to her nose and mouth, or run to her mother.
Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium? a) White beans b) Spinach c) Fortified cereal d) Enriched bread
a) White beans Explanation: To ensure an adequate intake of calcium, the nurse should suggest white beans, because 1 ounce of dried white beans when cooked provides 160 mg of calcium. Spinach, enriched bread, and fortified cereal are good sources of iron.
A toddler's parents want to begin toilet training him. As a rule, the best instruction you could give them is: a) bowel training is easier than urine training. b) all children should be toilet trained by age 2 years. c) toilet training is a 12-month process. d) children can remain dry during the night before they can do so during the day.
a) bowel training is easier than urine training. Explanation: Bowel training is often easier than urine training because the substance to be evacuated is so much more tangible.
The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer to prevent confrontations? a) "Respond in a calm but firm manner." b) "You need to adhere to various routines." c) "Put her in time-out when she misbehaves." d) "It's important to toddler-proof your home."
b) "You need to adhere to various routines." Explanation: Making expectations known through everyday routines helps to avoid confrontations. This helps the child know what to expect and how to behave. It is the best guidance to give these parents. Calm response and time-out are effective ways to discipline, but do not help to prevent confrontations. Toddler-proofing the house doesn't eliminate all the opportunities for confrontation.
When weighing and measuring a child at her 1-year well-baby checkup, the nurse would expect to see that over the previous 6 months a baby who weighed 8 pounds and was 20 inches long at birth would have gained about a) 16 pounds and grown 4-6 inches. b) 8 pounds and grown 4-6 inches. c) 8 pounds and grown 2-3 inches. d) 16 pounds and grown 2-3 inches.
b) 8 pounds and grown 4-6 inches. Explanation: During the first 6 months, an infant's birth weight doubles and his or her height increases by about 6 inches. Growth slows slightly during the second 6 months but is still rapid. By 1 year of age, the infant has tripled his or her birth weight and has grown 10 to 12 inches.
The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's "negativism." Based on Erickson's theory of development, what would be an appropriate intervention for this child? a) Encourage the child to take turns when playing games. b) Encourage the child to pick out his own clothes. c) Use "time-outs" whenever the child says "no" inappropriately. d) Discourage solitary play; encourage playing with other children.
b) Encourage the child to pick out his own clothes. Explanation: Erikson defines the toddler period as a time of autonomy versus shame and doubt. It is a time of exerting independence. Allowing the child to choose his own clothes helps him to assert his independence. Negativism—always saying "no"—is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. It should not be punished with "time-outs." The toddler should be encouraged to play alone and with other children. Toddlers cannot take turns in games until age 3.
A nurse is observing a 3-year-old preschooler engaged in play. What behavior would the nurse most likely expect to observe? a) Solitary play b) Imitative play c) Parallel play d) Group play
b) Imitative play Explanation: Preschoolers enjoy games that use imitation such as pretending to be teachers, cowboys, firefighters, and store clerks. They imitate exactly what they see their parents doing. Parallel play is characteristic of toddlers. Preschoolers are capable of sharing and play with other children as a means for socialization. Older preschoolers are interested in group games.
The nurse is assessing the respiratory system of a newborn. Which anatomic differences place the infant at risk for respiratory compromise? Select all that apply. a) The trachea and chest wall are less compliant. b) The nasal passages are narrower. c) The tongue is smaller. d) There are significantly fewer alveoli. e) The larynx is more funnel shaped. f) The bronchi and bronchioles are shorter and wider.
b) The nasal passages are narrower. d) There are significantly fewer alveoli. e) The larynx is more funnel shaped. Explanation: In comparison with the adult, in the infant, the nasal passages are narrower, the trachea and chest wall are more compliant, the bronchi and bronchioles are shorter and narrower, the larynx is more funnel shaped, the tongue is larger, and there are significantly fewer alveoli. These anatomic differences place the infant at higher risk for respiratory compromise. The respiratory system does not reach adult levels of maturity until about 7 years of age.
The nurse is assessing speech development in the 2-year-old whose family uses both Spanish and English in the home. What finding is of concern? a)The parents understand the child much of the time. b)The toddler speaks 15 words between the two languages. c)The child mixes words from the two languages within a sentence. d)Some words the toddler speaks are a blend of English and Spanish.
b) The toddler speaks 15 words between the two languages. Explanation: Of concern is speaking only 15 words between Spanish and English. At 20 months, the bilingual child should use 20 words. The other findings fit the norms for a bilingual child.
The nurse is discussing the activities of a 20-month-old child with his mother. The mother reports the children of her friends seem to have more advanced speech abilities than her child. After assessing the child, which finding is cause for follow up? a) Points to pictures in books when asked b) Understands approximately 200 words c) Inability to point to named body parts d) Inability to talk with the nurse about something that happened a few days ago
b) Understands approximately 200 words Explanation: The 20-month-old toddler should have a vocabulary greater than 40 to 50 words and should comprehend approximately 200 words. The ability to point to named body points, discuss past events, and point to pictures in a book when asked are communication skills associated with an older child.
A mother is concerned because her 2-year-old daughter is not speaking much. What should the nurse suggest to the mother? Select all that apply. a) Use pronouns when speaking to her. b) Use baby talk when speaking to her. c) Always answer her questions. d) Name aloud the objects that she is playing with. e) Read books aloud to her. f) Have her watch educational television.
c) Always answer her questions. d) Name aloud the objects that she is playing with. e) Read books aloud to her. Explanation: Reading aloud is an effective way to strengthen vocabulary. Also, urge parents to encourage language development by naming objects as they play with their child or when they give their toddler something. This helps children grasp the fact words are not meaningless sounds; they apply to people and objects and have uses. Always answering a child's questions is another good way to do this. Watching television promotes little learning as the activity is passive and it is difficult to discern how language caused the action. The American Academy of Pediatrics recommends television viewing should be severely limited until at least 2 years of age. Because children learn language from imitating what they hear, if they are spoken to in baby talk, their enunciation of words can be poor; if they hear examples of bad grammar, they will not use good grammar. Remind parents pronouns are difficult for children to use correctly; many children are 3½ or 4 years of age before they can separate the different uses of "I," "me," "him," and "her."
Which suggestion by the nurse meant to promote good dental health in the 15-month-old is inappropriate? a) Avoid grazing (continual snacking) throughout the day. b) Wean the child from the bottle. c) Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. d) Arrange for your child's first dental visit as soon as possible.
c) Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. Explanation: Using fluoride toothpaste prior to age 2 years promotes development of fluorosis. The first dental visit should be made at 1 year. This check-up is overdue. Continual snacking and bottle drinking keep the teeth in contact with cariogenic substances for extended periods.
Which gross motor developmental milestone is least likely for a 2 year old? a) Jumps in place b) Climbs c) Rides a tricycle d) Stands on one foot with help
c) Rides a tricycle Explanation: A gross motor developmental milestone for a 2- to 3-year-old includes jumping in place. Riding a tricycle occurs at 3 to 4 years of age. Climbing occurs at occurs at 18 months to 2 years. At 12 to 18 months, the child can stand on one foot with help.
The nurse is caring for a 7-month-old girl during a well-child visit. Which intervention is most appropriate for this child? a) Explaining how to prepare table meats b) Advising about increased caloric needs c) Describing the tongue extrusion reflex d) Discussing the type of sippy cup to use
d) Discussing the type of sippy cup to use Explanation: The cup may be introduced at 6 to 8 months of age. Old-fashioned sippy cups are preferred compared to the new style. The nurse would not advise about increased caloric needs as caloric needs drop at this age. Transition to table meat will not take place until age 10 to 12 months. Tongue extrusion reflex has disappeared at age 4 to 6 months
The nurse is working with the caregivers of an infant. The caregivers tell the nurse their child cries when her mother leaves for even a short amount of time. What might the nurse suggest as a way to console the infant and help the child develop a sense of security when the child's primary caregiver is out of sight? a)Slowly increase the amount of time she is allowed to cry before being picked up. b)Pick the child up as soon as she begins to cry. c)Give her dolls and stuffed animals so she learns to distract herself. d)Play "peek-a-boo" with the child when she is happy.
d) Play "peek-a-boo" with the child when she is happy. Explanation: For the infant, self-assurance is necessary to confirm that objects and people do not cease to exist when out of sight. This is a learning experience on which the infant's entire attitude toward life depends. The ancient game of "peek-a-boo" is a universal example of this learning technique. It is also one of the joys of infancy as the child affirms the ability to control the disappearance and reappearance of self. In the same manner by which the infant affirms self-existence, she learns to confirm the existence of others, even when they are temporarily out of sight
A 5-year-old boy's father was recently injured in a motorcycle accident, but has fully recovered. The father confides to the school nurse that he is concerned about the child not acting the way he did before the accident. The boy is not testing boundaries as he was before the accident. Which situation best describes the reason for the behavior Jack's father is seeing? a) Everyone in the family is being nicer to each other and the boy is imitating the adults' behavior. b) The thought of losing his father was scary, and the child is trying to show his father how much he loves him. c) The child is afraid of being hurt himself and thinks being especially good will protect him from accidents. d) The boy wanted to go with his father on the motorcycle ride. When he was told he couldn't go he told his father he hoped he would crash, so he believes he caused the accident.
d) The boy wanted to go with his father on the motorcycle ride. When he was told he couldn't go he told his father he hoped he would crash, so he believes he caused the accident. Explanation: Preschoolers have learned to think about something without actually seeing it: to visualize or imagine. This normal development, sometimes called magical thinking, makes it difficult for them to separate fantasy from reality. Preschoolers believe that words or thoughts can make things real, and this belief can have either positive or negative results. The child needs reassurance that this is not so.
The nurse is discussing development of fine motor skills in the preschool-age group with a group of nursing students. Which statement is most accurate regarding the fine motor skills of a 3-year-old? a) The child can use scissors. b) The child can print a few letters. c) The child can tie his shoelaces. d) The child can button his clothes.
d) The child can button his clothes. Explanation: The 3-year-old is able to button their clothes and use a pencil or crayon. By the age of 4 to 5, the child can use scissors, tie shoelaces, and print his first name.
The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? a) The mother is suffering from depression. b) The mother describes an inadequate diet. c) The child is unperturbed by a loud noise. d) The child is homeless and has no toys.
d) The child is homeless and has no toys. Explanation: Children develop through play, so a child without any toys may have trouble developing the motor skills appropriate to his age. Maternal depression is a risk factor for poor cognitive development. Inadequate diet will cause growth deficiencies. A child who does not respond to a loud noise probably has hearing loss, which will lead to a language deficit.
