Pediatrics: Growth and Development

Which fine motor skill would the nurse expect when assessing the development of an infant between 10 and 12 months of age? 1. Holds a crayon 2. Walks with assistance 3. Stands independently 4. Sits from a standing position

1. The ability to hold a crayon is a fine motor skill that the nurse would expect when conducting a developmental assessment for an infant between 10 to 12 months of age. Walking with assistance, standing alone, and sitting from a standing position are all gross motor skills the nurse would anticipate for this infant.

According to the Piaget's theory, which behavior does a 9-year-old child show? 1. Logical reasoning 2. Concrete thinking 3. Object permanence 4. Imaginary audience

2. A child of 9 years of age will exhibit concrete thinking. Logical reasoning is observed in individuals starting from the age of 11 years. Object permanence is observed in children between birth and 2 years old. The idea of being constantly observed by an imaginary audience is observed in individuals starting from the age of 11 years.

The nurse assesses and reports a disproportionate head-to-chest ratio for a 6-month-old infant. Which information would the nurse prepare to share with the infant's parents as the most likely cause of this assessment data? 1. "Your infant most likely has an altered chest shape." 2. "Your infant is likely experiencing abnormal head growth." 3. "Your infant will most likely be diagnosed with brain cancer." 4. "Your infant most likely had inaccurate measurements during the last visit."

2. A disproportionate head-to-chest ratio during infancy is most likely caused by abnormal head growth. Although an altered chest shape may cause the disproportionate measurements, this is not the most likely cause. Telling the parents that their infant will most likely be diagnosed with brain cancer is inaccurate and not therapeutic. The data obtained to determine the disproportionate measures were obtained during the current visit; previous measurements will not be taken into account in this circumstance.

Which would the nurse anticipate when assessing a preschool-age child, according to Erikson's developmental stages? 1. Being engaged in tasks 2. Questioning sexual identity 3. Having highly imaginative thoughts 4. Wanting to participate in organized activities

3. The nurse would anticipate that a preschool-age child would have highly imaginative thoughts, according to Erikson. Being engaged in tasks and wanting to participate in organized activities is expected for the school-age child. Questioning sexual identity is expected for the adolescent.

Which would the nurse anticipate when assessing a school-age child according to Erikson's theory of development? Select all that apply. 1. Being engaged in tasks 2. Questioning sexual identity 3. Having highly imaginative thoughts 4. Wanting to participate in organized activities 5. Struggling with self-control and independence

1 & 4 The nurse would anticipate that the school-age child would want to be engaged in tasks and participate in organized activities. Questioning sexual identity is expected for the adolescent.The nurse would anticipate that a preschool-age child would have highly imaginative thoughts, according to Erikson. Struggling with self-control and independence is expected for the toddler-age child.

n which settings would the nurse prepare to administer developmental assessment for pediatric clients? Select all that apply. 1. Home 2. School 3. Hospital 4. Daycare center 5. Assisted living center

1, 2, 3, 4 Pediatric developmental assessments are performed in many settings, including the home, school, hospital, and daycare center environments. It is unlikely that a pediatric developmental assessment would be performed in an assisted living center.

The nurse notes that the peak height velocity (PHV) for an 11-year-old female has occurred since the last health maintenance visit. Which assessment question would the nurse ask the adolescent based on this data? 1. "Have you begun to menstruate?" 2. "How tall do you think you will get?" 3. "What do you typically eat in a normal day?" 4. "Are you taller than most of the other girls in your class?"

1. An accelerated rate of linear growth is referred to as PHV. When this occurs for a school-age or adolescent female client, it is a predictor for menarche; therefore, asking the client if she has begun to menstruate is an appropriate assessment question. Typically, menarche begins 6 to 12 months after PHV. The other questions about height and nutrition are not inappropriate, but they are not assessment questions that should be asked based on the current client data.

Which is the first action of the nurse when a parent expresses concern about a child's diet? 1. Perform a nutritional assessment. 2. Provide a referral for a nutritionist. 3. Encourage the parent to decrease juice intake. 4. Speak to the physician about ordering blood testing.

1. Before taking any action, the nurse first performs a nutritional assessment, including a dietary history. The child may need blood testing, but the nutritional assessment should be performed first. Once the nurse has the appropriate data, nursing diagnoses can be identified and a plan established. Providing a referral for a nutritionist or encouraging the decreased intake of juice are potential interventions, depending on the outcome of the assessment.

The nurse observes that a school-age child does not have proper oral hygiene and is at an increased risk for oral problems. The parents tell the nurse that the child brushes the teeth independently. Which would the nurse suggest to the parents? 1. "Help the child with brushing and flossing." 2. "Ask the child to use a brush with hard bristles." 3. "Dictate that the child brush every hour for a few days." 4. "Avoid fruit juice and sugary beverages in the child's diet."

1. Brushing and flossing conscientiously helps prevent oral problems. In this case the child may not be able to brush the teeth effectively without parental assistance, which may have caused the oral problems. The nurse would instruct the parents to help the child with brushing and flossing. Hard bristles may hurt the gums, so the nurse would advise the parents to use a brush with soft nylon bristles. It is not necessary to brush every hour, but teeth should be brushed after meals and snacks and before bedtime. It is not a requirement to avoid fruit juice, but fruit juice and other sugary drinks should be limited to prevent the risk for dental caries.

The nurse is teaching a group of young adults about the calendar method of contraception. Which statement made by an adolescent indicates effective learning? 1. "This type of contraception requires a regular menstrual cycle." 2. "This contraceptive method is 100% effective to prevent pregnancy." 3. "This contraception may decrease sensation and reduce spontaneity." 4. "This type of contraception is simple, must fit correctly, and is reusable."

1. The calendar method of contraception is refraining from sexual intercourse during the fertile period. A client who has an irregular menstrual cycle will not be able to calculate her fertile period, which results in failure of contraception. Lea's shield, not the calendar method, is a simple-fitting and reusable method of contraception. Abstinence is refraining from sexual intercourse, which makes it a 100% effective method to prevent pregnancy. Condoms are the most widely used method of contraception. However, the use of a condom may reduce sensation and spontaneity.

A student is learning about the maturation of systems in a school-age child. Which statement made by the nurse indicates effective learning? 1. "The heart grows slower in the school-age child than at any other period of life." 2. "Physical maturity in the school-age child correlates with emotional and social maturity." 3. "The school-age child has less efficient maintenance of blood sugar levels than a preschooler." 4. "Facial proportions change in the school-age child because the face grows slower in relation to the remainder of the cranium."

1. The heart grows more slowly during the middle childhood years and is smaller in relation to the rest of the body than at any other period of life. Physical maturity in the school-age child is not necessarily correlated with emotional and social maturity. Children will generally have the emotional and social maturity that corresponds to their age. Because the gastrointestinal system in a school-age child is more mature than that in a preschooler, the school-age child has better maintenance of blood sugar levels than preschoolers. In the school-age child, facial proportions change as the face grows faster in relation to the remainder of the cranium. The skull and brain grow very slowly during this period and increase little in size thereafter.

How many hours of sleep would the nurse recommend for the 11-year-old client?

9 hours A school-age client who is 11 years of age would require 9 hours of sleep each night. Ten hours of sleep is not recommended for the school-age client. A 5-year-old school-age client requires 11.5 hours of sleep per night; however, 11 and 12 hours of sleep is not recommended for an 11-year-old school-age client.

Which activities would the nurse suggest to the parents of a latchkey school-age client to decrease loneliness? Select all that apply. 1. Reinforcing bicycle safety with the child 2. Suggesting that the parents get the child a pet 3. Discussing appropriate activities while home alone 4. Calling the child if the parent will be late coming home 5. Helping the child talk about his or her feelings about being alone after school

2, 4, 5 Suggestions that are appropriate for a latchkey school-age client who is lonely include suggesting getting a dog to keep the child company, calling the child if the parent will be home later than anticipated, and helping the child talk about his or her feelings. Reinforcing bicycle safety is an important topic to address regarding the latchkey child's safety, but is not appropriate for a child who is struggling with loneliness. Discussing appropriate after-school activities for the child does not address the child's loneliness.

Which assessment findings of a child would indicate a need for genetic consultation? Select all that apply. One, some, or all responses may be correct. 1. Fetal alcohol syndrome 2. Visual or hearing problems 3. Family history of hypertension 4. Development and speech delays 5. Excessive bleeding or excessive clotting

2, 4, 5 Visual or hearing problems may indicate a genetic disorder and should be assessed thoroughly. A family history of any mental illness indicates a need for genetic consultation so that preventive measures and treatment can be initiated. Development and speech delays may indicate a genetic disorder, like autism or another behavioral disorder. Bleeding disorders like sickle cell anemia are also inherited and need genetic consultation. Fetal alcohol syndrome is not inherited but caused by maternal consumption of alcohol during pregnancy. Although hypertension is thought to be linked to genetics, the exact cause of primary hypertension is unknown.

A preschooler recently admitted to school shows aggressive behavior toward the teacher. The child resists playing and interacting with other children. Which temperament is the child exhibiting, according to Stella Chess and Alexander Thomas's longitudinal study? 1. The easy child 2. The difficult child 3. The hyperactive child 4. The slow-to-warm-up child

2. A difficult child adapts slowly to new routines, people, or situations. They tend to display aggressive behavior and resist interacting with other children. An easy child is open and adaptable to change and displays a mild-to-moderately intense mood that is typically positive. A hyperactive child usually has problems concentrating and paying attention. A slow-to-warm-up child adapts slowly with repeated contact unless pressured and responds with mild but passive resistance to novelty or changes in routine.

The nurse is teaching health promotion tips to the mother of a 2-year-old child. During the follow-up visit, the nurse observes that the child has diarrhea and dental caries. Which action is responsible for this condition? 1., "I give my child 1 cup of fruit daily." 2. "I give my child 8 oz of fruit juice daily." 3. "I give my child vitamin C-rich foods daily." 4. "I do not rinse my child's mouth after brushing with fluoridated gels."

2. Providing 4 to 6 oz of 100% fruit juice per day is recommended for toddlers. Consumption of high amounts of fruit juice can contribute to diarrhea, overnutrition, and dental caries. One cup of fruit is sufficient for good health in toddlers. Vitamin C enhances iron absorption in the body. The mother should not rinse the child's mouth after brushing with fluoridated pastes and gels to maximize the action of the fluoridated gels.

Which statement made by the parent of a 6-month-old infant would warrant further assessment regarding the infant's fine motor skills? 1. "My child loves to bang toys on the tray of the highchair." 2. "My child seems lazier than my other kids because I still hold the bottle." 3. "My child has discovered feet and is constantly trying to put them in her mouth." 4. "My child loves to drop things and then pick them up again so that we will clap."

2. The nurse would further assess fine motor development for a 6-month-old infant who is not independently holding his or her own bottle. Banging toys together or on another surface, placing feet into the mouth, and dropping things so that he or she can pick them back up are fine motor skill expectations for the 6-month-old infant.

At which age would the nurse assess the school-age client for mastery of the concept of conservation of volume?

9 years. Mastery of the concept of conservation of volume occurs between the ages of 9 and 12 years; therefore the nurse would include this in the assessment for the 9-year-old school-age client. Volume conservation is not assessed for the 6-, 7-, or 8-year-old school-age child.

While interacting with a 4-year-old child, the nurse observes that the child exhibits which behavior that is congruent with Piaget's cognitive developmental theory? 1. The child is beginning to use language to communicate. 2. The child uses abstract symbols and draws conclusions. 3. The child is unable to see things from others' perspectives. 4. The child is able to classify and sort facts to solve problems.

3. A 4-year-old child has his or her own perspective and expects that others also think the same way. This behavior is seen in the preoperational stage of Piaget's development. A 1- to 2-year-old child who is in the sensorimotor stage, according to Piaget's developmental theory, will begin to use language. An adolescent who is in the formal operations stage of Piaget's developmental theory will use abstract symbols and draw conclusions. The ability to draw conclusions from abstract symbols is not a finding in a 4-year-old. The ability to classify and sort problems is developed between the ages of 7 and 11 years. A child who is in the concrete operation stage of Piaget's development will exhibit the ability to classify and sort facts to solve problems.

Which auditory test is appropriate for infants? 1. Play audiometry 2. Pure tone audiometry 3. Behavioral audiometry 4. Auditory brainstem response (ABR)

3. Behavioral audiometry is used for infants. Play audiometry is used for toddlers. Pure tone audiometry is used for children and adolescents. ABR is used for newborns.

The nurse finds that a 2-year-old child has impaired fine motor skills. The nurse recommends toys that will be beneficial for the child. Which statement by the child's parents needs correction? 1. "I should provide musical toys." 2. "I should provide straddle trucks." 3. "I should provide battery-operated cars." 4. "I should provide thick crayons and finger paints."

3. Passive toys such as battery-operated cars should not be provided because they do not stimulate musculoskeletal development. Musical toys can improve coordination. Straddle trucks improve locomotive skills. Thick crayons and finger paints improve fine motor skills.

The parent of a child client says to the nurse, "Our 10 year old wants to get a puppy. Do you think it's a good idea?" Which response by the nurse is developmentally appropriate? 1. "Your child is not old enough to help take care of a pet." 2. "A pet may have a negative influence on your child's emotional health." 3. "Many children learn empathy and responsibility when helping take care of a pet." 4. "Pets are costly and should not be considered until your child is able to help financially."

3. Pets influence a child's self-esteem and self-confidence. Pets can teach children about empathy and responsibility. A school-age child is developmentally able to help take care of a family pet. Pets have a positive, not negative, effect on physical and emotional health. Although pets may be costly, this is not a developmentally appropriate response from the nurse.

Which statement provides the similarity between stages 5 and 6 of Kohlberg's theory? 1. Both stages explain the basic rights of an individual. 2. Both stages emphasize the democratic process. 3. Both stages are associated with postconventional reasoning. 4. Both stages stress the importance of following laws without question.

3. Postconventional reasoning is associated with stages 5 and 6 of Kohlberg's theory. Stage 5 explains the basic rights of an individual, whereas stage 6 defines "right" by the decision of conscience in accordance with self-chosen ethical principles. Stage 5 emphasizes the democratic process, whereas stage 6 does not. Stage 5 stresses the importance of following laws without question, whereas an individual in stage 6 may not follow a law if it seems unjust.

A worried mother reports that her teenage child wears unusual clothes and makeup and refuses to wear the clothes the mother buys. Which would the nurse suspect as the cause for this behavior? 1. The child is establishing self-image in relation to others. 2. The child is establishing gender role identification with the mother. 3. The child is displaying group identity to develop a personal identity. 4. The child is identifying himself or herself as a separate entity from the mother.

3. The child is seeking to establish a group identity by dressing and wearing makeup in a way that confirms this identity to other members of the group. The child establishes a self-image in relation to others during the latter part of childhood. In early childhood, the child attempts to establish gender role identification with the same-sex parent. During infancy, the child identifies himself or herself as a separate entity from the mother.

According to the Erikson's theory, which stage in a young adult describes the development of the sense of caring for others? 1. Initiative versus guilt 2. Integrity versus despair 3. Intimacy versus isolation 4. Identity versus role confusion

3. The development of a sense of caring for others in a young adult occurs at the stage of intimacy versus isolation. During the initiative versus guilt stage, a child likes to pretend and try out new roles. At the integrity versus despair stage, many older adults view their lives with a sense of satisfaction. During the identity versus role confusion stage, a child's identity development begins with the goal of achieving some perspective or direction.

The parents of a child often try to persuade their preschooler to touch their pet dog because they want to reduce the child's fear of dogs. Instead, the child's fears and anxiety increase. Which advice would the nurse suggest to help overcome their child's fear? 1. "Ask the child to touch the dog's back gently." 2. "Keep the child away from dogs for a few years." 3. "Let the child watch other children playing with dogs." 4. "Bring in a pet cat to familiarize the child with animals."

3. The parents should allow the child to become comfortable with animals at a gradual pace, while maintaining the child's feeling of well-being. One way to do this is to encourage the child to watch as other children play with dogs. Encouraging the child to touch the dog's back gently is not effective for overcoming the child's fear, because the child should not be forced to touch the animal until he or she is comfortable. Trying to keep the child away from dogs will not be effective in reducing fear and may not be practical. Introducing the child to other animals, such as cats, may be ineffective, because the child's fear may be specific to dogs.

While interacting with parents of children ranging in ages from 6 to 12 years, the nurse suggests that the parents avoid imposing too many expectations on their children. Which statement provides the rationale for this suggestion? 1. To prevent role confusion in the children 2. To reduce the feelings of guilt in the children 3. To prevent inferiority complexes in the children 4. To improve the decision-making abilities of the children

3. To prevent inferiority complexes Erikson's lifespan approach in the development of children is categorized into eight stages relating to childhood. In the stage of industry versus inferiority, development is attained by children between 6 and 12 years of age. Children at this stage act as workers and producers; they initiate and complete work aiming at real achievement. The child may feel inferior if parents impose many expectations on him or her. Identity versus role confusion is seen in children between 12 and 18 years of age and is the stage in which rapid and marked physical changes occur. Adolescents struggle to fit the roles they have played and those they expect to play. When the ability to solve these conflicts fails, it leads to role confusion. Initiative versus guilt is seen in children between 3 and 6 years old; children in this stage explore the physical world with all their senses and powers and may feel guilty when parents make them feel as though their behaviors are bad. Children in the age group of 1 to 3 years are in the stage of autonomy versus shame and doubt. Children in this stage increase their ability to develop, control their bodies and their environment, and use their mental powers for decision-making. However, avoiding imposing too many expectations does not prevent role confusion or guilt and does not improve the children's decision-making abilities.

The nurse reviews the history to find an adolescent has a tattoo on the neck and piercings on the ear and eyebrow. During the next visit, the nurse finds a new tattoo on the right upper arm and another piercing on the nose. Which would be priority nursing interventions in this situation? Select all that apply. 1. Prepare a proper diet plan for the adolescent. 2. Instruct the adolescent to get an electrocardiogram. 3. Instruct the adolescent to perform regular exercises. 4. Screen the adolescent for human immunodeficiency virus (HIV). 5. Schedule an appointment for administering the hepatitis vaccine.

4 & 5 Infection-causing viruses such as human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus can be transmitted through body art needles from one person to another. The nurse would have the client tested for HIV and schedule an appointment for administering the hepatitis vaccine to ensure safety and reduce the risk of infection. Safety is the priority intervention over health promotion activities such as a proper diet plan, screening electrocardiogram, and exercise.

The nurse notices an infant has developed a color preference for red and yellow. Which should be the likely age of the infant? 1. 4 weeks 2. 8 weeks 3. 15 weeks 4. 20 weeks

4. An infant develops a color preference for yellow and red between 20 to 28 weeks of age. At 4 weeks, the infant can follow a range of 90 degrees. Between 6 to 12 weeks of age, the infant develops peripheral vision to 180 degrees. Between 12 to 20 weeks of age, the infant is able to accommodate to near objects.

The nurse examines an infant for the parachute reflex. Which age correlates with the initial presentation of this reflex? 1. 2 months 2. 3 months 3. 6 months 4. 7 months

4. The neurological reflex that develops as a protective response during a fall is called the parachute reflex. When an infant is suspended in a horizontal prone position and is suddenly thrust downward, the infant demonstrates the parachute reflex by extending the hands and fingers forward as if to protect against falling. This reflex appears at 7 to 9 months, and persists indefinitely. So the infant in this scenario is likely to be 7 months old. Labyrinth righting appears at 2 months, neck righting at 3 months, and body righting at 6 months. None of these 3 reflexes act as a protective response during a fall, nor do they persist indefinitely.

The nurse is teaching safe transportation techniques to new parents who have a low economic background. Which advice given by the nurse is appropriate? 1. "You should borrow or buy a second-hand car seat." 2. "You should place padding in the car seat behind the baby." 3. "You should buy an infant-only model and an infant-toddler convertible car seat." 4. "You should place the baby's car seat in the rear-facing position in the backseat."

4. The nurse instructs the parents to place the baby's car seat in the rear-facing position in the backseat, because it prevents injury to the infant from the air bag in case of a crash. It is dangerous to borrow or buy second-hand car seats. Placing padding behind the baby will create slack in the harness, which may result in the baby being ejected from the seat in the event of a crash. It is not a safe intervention. The parents of the baby are from a low economic background. Convertible-type car seats are preferable. Though convertible-type seats cost more initially, they work out to be less expensive than buying both an infant-only model and an infant-toddler convertible model.

Which task would be considered developmentally appropriate for a 2-year-old to complete? Select all that apply. . 1. Putting socks on feet 2. Washing and drying hands 3. Using fingers to eat food 4. Building a tower of four cubes 5. Identifying facial body parts

All the above. The Denver Developmental Screening Test is used to determine if a child is meeting appropriate developmental milestones. It incorporates sensorimotor and preoperational phases of growth and development. According to these phases, a 2-year-old child should be able to put socks on feet, wash and dry hands, use fingers to eat food, build a tower of four cubes, and identify facial body parts.

Which stage of development classifies boys and girls as differing very little in terms of size?

During the school-age stage of development, boys and girl differ very little in terms of size. During the toddler, preschool, and adolescence stages of development boys are often larger than girls.

Which stage of Kohlberg's theory of moral development would the nurse anticipate in a client who exhibits absolute obedience to authority and rules?

Stage 1 Level I, preconventional reasoning, includes stage 1, punishment and obedience training. It is during this stage the nurse would anticipate absolute obedience to authority and rules. Stage 2, also in level I, is when the nurse anticipates that the child will realize there is more than one right view. In stage 3, level II, the child wants to win approval and maintain expectations of his or her immediate group. In stage 4, also in level II, the client expands focus from the relationship with others to societal concerns.