Saunders review questions Growth and development

204. The maternity nurse is providing instructions to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse instructs the mother to take which measure? 1. Allow the newborn infant to signal a need. 2. Anticipate all needs of the newborn infant. 3. Attend to the newborn infant immediately when crying. 4. Avoid the newborn infant during the first 10 minutes of crying.

ANS: 1 Rationale: According to Erikson, the caregiver should not try to anticipate the newborn infant's needs at all times but must allow the newborn infant to signal needs. If a newborn infant is not allowed to signal a need, the newborn will not learn how to control the environment. Erikson believed that a delayed or prolonged response to a newborn infant's signal would inhibit the development of trust and lead to mistrust of others. Test-Taking Strategy: Eliminate options 2, 3, and 4 because of the closed-ended words, all, immediately, and avoid, in these options. Review: Erikson's stage of psychosocial development

211. A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? 1. Encourage the child's parents to stay with the child. 2. Encourage play with other children of the same age. 3. Advise the family to visit only during the scheduled visiting hours. 4. Provide a private room, allowing the child to bring favorite toys from home.

ANS: 1 Rationale: Although the preschooler already may be spending some time away from parents at a day care center or preschool, illness adds a stressor that makes separation more difficult. The child may ask repeatedly when parents will be coming for a visit or may constantly want to call the parents. Options 3 and 4 increase stress related to separation anxiety. Option 2 is unrelated to the subject of the question and, in addition, may not be appropriate for a child who may be immunocompromised and at risk for infection. Test-Taking Strategy: Note that the subject relates to the child's fear. Options 3 and 4 will increase anxiety and fear further and should be eliminated. Bearing the subject of the question in mind and considering the child's diagnosis will assist you in eliminating option 2. Review: Measures to alleviate separation anxiety Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Caring Content Area: Developmental Stages—Infancy to Adolescence

217. A 2-year-old child is treated in the emergency department for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement by the parents indicates an understanding of measures to provide safety in the home? 1. "We will be sure not to leave hot liquids unattended." 2. "I guess our children need to understand what the word hot means." 3. "We will be sure that the children stay in their rooms when we work in the kitchen." 4. "We will install a safety gate as soon as we get home so the children cannot get into the kitchen."

ANS: 1 Rationale: Toddlers, with their increased mobility and development of motor skills, can reach hot water or hot objects placed on counters and stoves and can reach open fires or stove burners above their eye level. The nurse should encourage parents to remain in the kitchen when preparing a meal, use the back burners on the stove, and turn pot handles inward and toward the middle of the stove. Hot liquids should never be left unattended or within the child's reach, and the toddler should always be supervised. The statements in options 2, 3, and 4 do not indicate an understanding of the principles of safety. Test-Taking Strategy: Note the words indicates an understanding. Option 2 can be eliminated because it is mandating that the toddler understand what is and is not safe. The toddler is not developmentally able to understand danger. Options 3 and 4 are comparable or alike in that they isolate the child from the environment. The correct option is the only one that reflects an understanding of safety principles by the parents. Review: Safety measures for the toddler Level of Cognitive Ability: Evaluating Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process—Evaluation Content Area: Developmental Stages—Infancy to Adolescence

210. A parent of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. Using Erikson's psychosocial development theory, which instructions should the nurse provide to the parent? Select all that apply. 1. Set limits on the child's behavior. 2. Ignore the child when this behavior occurs. 3. Allow the behavior, because this is normal at this age period. 4. Provide a simple explanation of why the behavior is unacceptable. 5. Punish the child every time the child says "no" to change the behavior.

ANS: 1, 4 Rationale: According to Erikson, the child focuses on gaining some basic control over self and the environment and independence between ages 1 and 3 years. Gaining independence often means that the child has to rebel against the parents' wishes. Saying things like "no" or "mine" and having temper tantrums are common during this period of development. Being consistent and setting limits on the child's behavior are necessary elements. Providing a simple explanation of why certain behaviors are unacceptable is an appropriate action. Options 2 and 3 do not address the child's behavior. Option 5 is likely to produce a negative response during this normal developmental pattern. Test-Taking Strategy: Options 2 and 3 can be eliminated first because they are comparable or alike, indicating that the mother should not address the child's behavior. Next, eliminate option 5 because this action is likely to produce a negative response during this normal developmental pattern. Also, note the closed-ended word every in option 5. Review: Erik Erikson's stages of psychosocial development

222. Which interventions are appropriate for the care of an infant? Select all that apply. 1. Provide swaddling. 2. Talk in a loud voice. 3. Provide the infant with a bottle of juice at nap time. 4. Hang mobiles with black and white contrast designs. 5. Caress the infant while bathing or during diaper changes. 6. Allow the infant to cry for at least 10 minutes before responding.

ANS: 1, 4, 5 Rationale: Holding, caressing, and swaddling provide warmth and tactile stimulation for the infant. To provide auditory stimulation, the nurse should talk to the infant in a soft voice and should instruct the mother to do so also. Additional interventions include playing a music box, radio, or television, or having a ticking clock or metronome nearby. Hanging a bright shiny object in midline within 20 to 25 cm of the infant's face and hanging mobiles with contrasting colors, such as black and white, provide visual stimulation. Crying is an infant's way of communicating; therefore, the nurse would respond to the infant's crying. The mother is taught to do so also. An infant or child should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, sweetened water, or another sweet liquid because of the risk of nursing (bottle-mouth) caries. Test-Taking Strategy: Focus on the subject, care of the infant. Noting the word loud and the words at least 10 minutes before responding will assist in eliminating these interventions. Also, recalling the concerns related to dental caries will assist in eliminating option 3. Review: Care of an infant Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process—Implementation Content Area: Developmental Stages—Infancy to Adolescence

219. The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which is the most appropriate suggestion to the mother? 1. Allow the bottle if it contains juice. 2. Allow the bottle if it contains water. 3. Do not allow the child to have the bottle. 4. Allow the bottle during naps but not at bedtime.

ANS: 2 Rationale: A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, sweetened water, or any other sweet liquid because of the risk of nursing (bottle-mouth) caries. If a bottle is allowed at nap time or bedtime, it should contain only water. Test-Taking Strategy: Note the strategic words, most appropriate. Eliminate options 3 and 4 first because they are comparable or alike statements. From the remaining options, recalling that nursing (bottle-mouth) caries is a concern in a child will assist in directing you to the correct option. Review: Instructions for the child who is bottle-feeding Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Teaching and Learning Content Area: Developmental Stages—Infancy to Adolescence

213. Which car safety device should be used for a child who is 8 years old and 4 feet tall? 1. Seat belt 2. Booster seat 3. Rear-facing convertible seat 4. Front-facing convertible seat

ANS: 2 Rationale: All children whose weight or height is above the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet, 9 inches in height (145 cm) and are between 8 and 12 years of age. Infants should ride in a car in a semireclined, rear-facing position in an infant-only seat or a convertible seat until they weigh at least 20 pounds (9 kg) and are at least 1 year of age. The transition point for switching to the forward-facing position is defined by the manufacturer of the convertible car safety seat but is generally at a body weight of 9 kilograms (20 pounds) and 1 year of age. Test-Taking Strategy: Focus on the subject, car safety, and note the age and height of the child to identify the appropriate safety device. Remember that children should remain in a booster seat until they are 8 to 12 years old and at least 4 feet, 9 inches (145 cm) tall. Review: Car safety Level of Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process—Planning Content Area: Developmental Stages—Infancy to Adolescence

216. The nurse is evaluating the developmental level of a 2-year-old. Which does the nurse expect to observe in this child? 1. Uses a fork to eat 2. Uses a cup to drink 3. Pours own milk into a cup 4. Uses a knife for cutting food

ANS: 2 Rationale: By age 2 years, the child can use a cup and spoon correctly but with some spilling. By age 3 to 4, the child begins to use a fork. By the end of the preschool period, the child should be able to pour milk into a cup and begin to use a knife for cutting. Test-Taking Strategy: Focus on the subject, the developmental level of a 2-year-old. Option 4 can be eliminated first because of the word knife. Next, think about the fine motor skills that need to be developed in selecting the correct option. With this in mind, eliminate options 1 and 3. Review: Developmental skills of the toddler Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process—Assessment Content Area: Developmental Stages—Infancy to Adolescence

215. The nurse is monitoring a 3-month-old infant for signs of increased intracranial pressure. On palpation of the fontanels, the nurse notes that the anterior fontanel is soft and flat. On the basis of this finding, which nursing action is most appropriate? 1. Increase oral fluids. 2. Document the finding. 3. Notify the health care provider (HCP). 4. Elevate the head of the bed to 90 degrees.

ANS: 2 Rationale: The anterior fontanel is diamond-shaped and located on the top of the head. The fontanel should be soft and flat in a normal infant, and it normally closes by 12 to 18 months of age. The nurse would document the finding because it is normal. There is no useful reason to increase oral fluids, notify the HCP, or elevate the head of the bed to 90 degrees. Test-Taking Strategy: Note the strategic words, most appropriate, and the words soft and flat. This should provide you with the clue that this is a normal finding. A bulging or tense fontanel may result from crying or increased intracranial pressure. Review: Assessment of the fontanels Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process—Implementation Content Area: Developmental Stages—Infancy to Adolescence

214. The nurse assesses the vital signs of a 12-month-old infant with a respiratory infection and notes that the respiratory rate is 35 breaths/minute. On the basis of this finding, which action is most appropriate? 1. Administer oxygen. 2. Document the findings. 3. Notify the health care provider. 4. Reassess the respiratory rate in 15 minutes.

ANS: 2 Rationale: The normal respiratory rate in a 12-month-old infant is 20 to 40 breaths/minute. The normal apical heart rate is 90 to 130 beats/minute, and the average blood pressure is 90/56 mm Hg. The nurse would document the findings. Test-Taking Strategy: Focus on the data in the question and note the strategic words, most appropriate. Recalling the normal vital signs of an infant and noting that the respiratory rate identified in the question is within the normal range will direct you to the correct option. Review: Normal vital signs for the infant Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process—Implementation Content Area: Developmental Stages—Infancy to Adolescence

208. The mother of an 8-year-old child tells the clinic nurse that she is concerned about the child because the child seems to be more attentive to friends than anything else. Using Erikson's psychosocial development theory, the nurse should make which response? 1. "You need to be concerned." 2. "You need to monitor the child's behavior closely." 3. "At this age, the child is developing his own personality." 4. "You need to provide more praise to the child to stop this behavior."

ANS: 3 Rationale: According to Erikson, during school-age years (6 to 12 years of age), the child begins to move toward peers and friends and away from the parents for support. The child also begins to develop special interests that reflect his or her own developing personality instead of the parents. Therefore options 1, 2, and 4 are incorrect responses. Test-Taking Strategy: Use knowledge of Erikson's psychosocial development theory related to middle childhood. Options 1 and 2 can be eliminated first because they are comparable or alike and indicate that the mother should be concerned about the child. Eliminate option 4 next because although praising the child for accomplishments is important at this age, the behavior that the child is exhibiting is normal. Review: Erik Erikson's stages of psychosocial development

223. The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing. 2. Make the decisions for the family. 3. Encourage expression of feelings, concerns, and fears. 4. Explain everything that is happening to all family members. 5. Touch and hold the client's or family member's hand if appropriate. 6. Be honest and let the client and family know they will not be abandoned by the nurse.

ANS: 3, 5, 6 Rationale: The nurse must determine whether there is a spokesperson for the family and how much the client and family want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse should encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know they will not be abandoned. The nurse should touch and hold the client's or family member's hand, if appropriate. Test-Taking Strategy: Use therapeutic communication techniques and recall client and family rights to assist in directing you to the correct options. Review: End-of-life care Level of Cognitive Ability: Analyzing Client Needs: Psychosocial Integrity Integrated Process: Caring Content Area: Developmental Stages—End-of-Life Care

212. A 16-year-old client is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing intervention is most appropriate to facilitate normal growth and development postoperatively? 1. Encourage the client to rest and read. 2. Encourage the parents to room in with the client. 3. Allow the family to bring in the client's favorite computer games. 4. Allow the client to interact with others in his or her (Adolescent) same age group.

ANS: 4 Rationale: Adolescents often are not sure whether they want their parents with them when they are hospitalized. Because of the importance of their peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their ill friend. Options 1, 2, and 3 isolate the client from the peer group. Test-Taking Strategy: Note the strategic words, most appropriate. Consider the psychosocial needs of the adolescent and remember that the peer group is very important. Options 1, 2, and 3 are comparable or alike in that they isolate the client from his or her own peer group. Review: Psychosocial needs of the adolescent Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Caring Content Area: Developmental Stages—Infancy to Adolescence

220. The nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which is the most appropriate activity for this child? 1. A radio 2. A sports video 3. Large picture books 4. Crayons and a coloring book

ANS: 4 Rationale: In the preschooler, play is simple and imaginative, and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh. A radio or a sports video is most appropriate for the adolescent. Large picture books are most appropriate for the infant. Test-Taking Strategy: Note the strategic words, most appropriate. Note the age of the child, and think about the age-related activity that would be most appropriate. Eliminate options 1 and 2, knowing that they are most appropriate for the adolescent. From the remaining options, the word large in option 3 should provide you with the clue that this activity would be more appropriate for a child younger than age 5. Review: Age-appropriate activities Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process—Planning Content Area: Developmental Stages—Infancy to Adolescence

218. A mother arrives at a clinic with her toddler and tells the nurse that she has a difficult time getting the child to go to bed at night. What measure is most appropriate for the nurse to suggest to the mother? 1. Allow the child to set bedtime limits. 2. Allow the child to have temper tantrums. 3. Avoid letting the child nap during the day. 4. Inform the child of bedtime a few minutes before it is time for bed.

ANS: 4 Rationale: Toddlers often resist going to bed. Bedtime protests may be reduced by establishing a consistent before-bedtime routine and enforcing consistent limits regarding the child's bedtime behavior. Informing the child of bedtime a few minutes before it is time for bed is the most appropriate option. Most toddlers take an afternoon nap and, until their second birthday, also may require a morning nap. Firm, consistent limits are needed for temper tantrums or when toddlers try stalling tactics. Test-Taking Strategy: Note the strategic words, most appropriate, and focus on the subject, the toddler. Eliminate options 1, 2, and 3 by using concepts related to growth and development. Remember that preparing the toddler for an event will minimize resistive behavior. Review: Sleep patterns for the toddler Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Teaching and Learning Content Area: Developmental Stages—Infancy to Adolescence

221. The mother of a 3-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse should tell the mother that the most appropriate toy for a 3-year-old is which? 1. A wagon 2. A golf set 3. A farm set 4. A jack set with marbles

ANS:1 Rationale: Toys for the toddler must be strong, safe, and too large to swallow or place in the ear or nose. Toddlers need supervision at all times. Push-pull toys, large balls, large crayons, large trucks, and dolls are some of the appropriate toys. A farm set, a golf set, and jacks with marbles may contain items that the child could swallow. Test-Taking Strategy: Note the strategic words, most appropriate, and focus on the subject, the appropriate toy for a 3-year-old. Options 2, 3, and 4 can be eliminated because they are comparable or alike and could contain items that the child could swallow. Remember that large and strong toys are safest for the toddler. Review: Age-appropriate activities Level of Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment Integrated Process: Teaching and Learning Content Area: Developmental Stages—Infancy to Adolescence