Chapter 02: Developmental Tasks and Health Promotion Across the Life Cycle

An adolescent tells the school nurse that he is being pressured by his friends to smoke marijuana. Which nursing diagnosis would be appropriate for this situation? 1.Compromised family coping 2.Decisional conflict 3.Social isolation 4.Ineffective role performance

Decisional conflict is an appropriate nursing diagnosis for an adolescent facing this situation.

An 18-month-old who makes the statement, "All done," is using what form of speech? 1.Telegraphic speech 2.Holophrastic speech 3.Preoperational speech 4.Complex-interactive speech

ANS: 1 At 1 year, sentences begin with the one-word holophrase, in which one word represents a complete thought (e.g., "out" for "I want to go out."). A 2-year-old uses simple two-word phrases— "all gone," "me up,""baby crying." This is called telegraphic speech, which is usually a combination of a noun and a verb and includes only words that have concrete meaning.

An 18-month-old child comes to the well-child clinic for a visit. The nurse notes the following on observation: a rounded "pot belly" abdomen, marked lordosis "sway back," short slightly bowed legs, and a large head. The nurse concludes that the child: 1.is built like a normal toddler. 2.should be worked up for possible hydrocephalus. 3.may have a vitamin deficiency or some form of malnutrition. 4.probably has delayed physical maturation, especially of the long bones.

ANS: 1 Toddler lordosis describes the normal upright posture of the toddler, with the potbelly, sway back, and short, slightly bowed legs.

During which age is belonging to a peer group considered a key socializing agent? 1.The preschool years 2.The school-age years 3.Early adulthood 4.Middle adulthood

ANS: 2 During middle childhood, the peer group is a key socializing agent. The child begins to prefer peer group activities to activities with the parents.

The developmental crisis of generativity versus stagnation could be resolved by: 1.traveling around the world. 2.having and raising a family. 3.buying a large house and filling it with loved belongings. 4.changing jobs frequently to get a feel for what was "missed in youth."

ANS: 2 Erikson believed that during the middle years adults have the urge to contribute to the next generation. This need can be fulfilled either by producing the next genera- tion or by producing something to pass on to the next generation.

An infant weighs 7 pounds at birth. At the well-child visit 6 months later, the nurse would expect the infant to weigh at least: 1.12 pounds. 2.14 pounds. 3.17 pounds. 4.21 pounds.

ANS: 2 Growth spurts double the birth weight by 4 to 6 months and triple the birth weight by 1 year.

The nurse is teaching a class to day care providers. Which of the following statements about growth, development, and preschoolers should be included? 1.Preschoolers are highly egocentric. 2.They are capable of delayed imitation. 3.They are still very unaware of gender and sex. 4.Preschoolers "pretend" to reduce anxiety about their sex roles.

ANS: 2 Piaget's preoperational stage covers age 2 to 7 years, a longer span than the preschool years. It is characterized by symbolic function because the child now uses symbols to represent people, objects, and events. The symbolic function is revealed in child's play, as in delayed imitation.

An adolescent is beginning to develop the ability to deal with hypothetical situations and abstract thinking. The nurse would consider this finding: 1. advanced for this patient's age. 2. an expected finding only in the elderly. 3. a normal finding during this stage of development. 4. abnormal because abstract thinking should begin to take place in early childhood.

ANS: 3 In adolescence, thinking is no longer concrete. Adolescents can analyze and use scientific reasoning.

Erikson's stage of integrity versus despair could be described as: 1.an adjustment to the tasks of middle age. 2.being productive and contributing to society. 3.cataloging life events to gain a sense of satisfaction. 4.a time to review career goals and possibly change paths to avoid despair.

ANS: 3 One important task of late adulthood is performing a life review. Erikson's last ego stage has the key conflict of integrity versus despair. A successful resolution to this conflict occurs when the adult feels satisfied with his or her own life.

At the well-child clinic, a nurse is advising the mother of an 8-month-old child about health and safety. Which of the following is appropriate for this age? 1.Stair guards or gates are important to use at this age. 2.A car seat is not necessary if a lap shoulder belt is used. 3.The home's hot water heater should be set at 135° F. 4.They are prime candidates for toilet training because they are so receptive to new ideas.

ANS: 1 By 8 months, a child is crawling and may be able to pull to a standing position and stand while holding an object for support. Stair guards are necessary to prevent injury. A car seat is necessary for children under age 5 years, and the hot water heater should be set below 120° to 130° F.

Levinson describes the period of middle adulthood as beginning with a mid-life transition. Which statement best describes this mid-life transition? 1. This is a time of major reassessment—"What have I done with my life?" 2. Most people experience a need to change careers around the age of 40 years. 3. This is a time when people feel a desire to pursue more youthful activities. 4. Most people find that they have basically met all of their goals and experience rejuvenation.

ANS: 1 Levinson (1986) describes the era of middle adulthood as beginning with a mid-life transition. Roughly between 40 and 45 years, the person starts a major reassess- ment, "What have I done with my life?"

Finding a partner or committing one's life to a cause indicates successful resolution of which of Erikson's stages? 1.Intimacy versus isolation 2.Identity versus role confusion 3.Generativity versus stagnation 4.Autonomy versus shame and doubt

ANS: 1 Once self-identity is established after adolescence, it can be merged with another's in an intimate relationship. During the early 20s the adult seeks the love, commitment, and intimacy of a lasting relationship.

Physical growth is most rapid during which period? 1.Birth to 1 year of age 2.3 to 5 years of age 3.6 to 10 years of age 4.16 to 18 years of age

ANS: 1 The first year is the most dramatic period of growth and development. Height, weight, and head circumference reflect physical growth and are sensitive indicators of an infant's general health.

A baby can sit alone before he or she is able to crawl. This is true because development of gross motor skills: 1.occurs in a cephalocaudal direction. 2.occurs in a distal to proximal direction. 3.is generally the result of a baby's chronological age. 4.is simply the result of the baby's increased desire to move.

ANS: 1 A baby's development of gross motor skills is predictable because it follows the direction of myelinization (laying down of myelin) in the nervous system, cephalo- caudal (head to foot direction), and proximodistal (central to peripheral direction, or midline before extremities).

Being able to think about history and philosophy and analyze and use scientific reasoning corresponds to which of Piaget's stages? 1. Formal operations 2.Sensorimotor skills 3.Concrete operations 4.Preoperational skills

ANS: 1 Adolescence corresponds to Piaget's fourth stage, in which the person focuses on formal operations and the ability to develop abstract thinking, deal with hypothetical situations, and make logical conclusions from reviewing evidence. The adolescent is no longer limited to the present but can ponder the lessons of the past and the possibilities of the future. The adolescent now can analyze and use scientific reasoning.

A 12-month-old infant is screened with the Denver II and is found to have some delays in gross motor skills. The screening is important because it: 1.can help diagnose a child with problems. 2.provides for early detection, leading to earlier intervention. 3.can be used by a physical therapist to determine the appropriate treatment. 4.can be used in conjunction with other tests to determine a child's overall intellectu- al level.

ANS: 2 The Denver II is a screening instrument designed to detect developmental delays. What the Denver II does do is screen: it helps identify children who may be slow in development. This is important because early detection increases the opportunities for effective treatment.

Jean Piaget proposed four stages of cognitive development. Which of the following statements is true in regard to these stages? 1.The child's current stage is determined by the child's age. 2.Each stage builds on the foundations of the previous stages. 3.Each stage is distinct and clearly separate from the other stages. 4.A child who is "gifted" may actually skip a stage and move on to a higher stage.

ANS: 2 The child's cognitive development proceeds through four definite and sequential stages. Although the ages of reaching the stages are approximate, the sequence of stages never varies. All children move through the same stages in the same order. No stage is skipped.

The nurse is advising a father about his 2-year-old daughter's eating habits. He is concerned because she seems "not to eat anything anymore." The nurse tells him that this is normal because: 1.of a decrease in activity. 2.of a slower period of growth. 3.growth stops for a while at age 2 years. 4.the basal metabolic rate decreases at this age.

ANS: 2 The rate of growth decelerates during the second year, with the child gaining an average of 2.5 kg (51/2 lb) in body weight.

Which of the following statements best describes the tasks of late adulthood? 1.Older adults must quickly try to resolve the conflicts of earlier times. 2.Older adults must accept that they cannot change the past and make peace with their lives. 3.Older adults generally feel great sadness and worry about death; this allows them to accept their mortality. 4.Older adults must never feel satisfied with their lives because it gives them goals to achieve in the future.

ANS: 2 This period relates to Erikson's last stage, with its key polarity of integrity versus despair. A successful resolution to this final conflict occurs when the adult accepts "one's one and only life cycle as something that had to be and that, by necessity, permitted of no substitutions" (1963). The adult feels content with his or her one life on earth, satisfied that if it were possible to do it over again, he or she would live it the same way.

Which statement correctly characterizes ageism? 1.Ageism indicates respect for the aged. 2.Ageism is most common in Asian cultures. 3.Ageism means discrimination on the basis of age. 4.Ageism is the result of true concern about the aged population.

ANS: 3 Ageism means discrimination based on age. It is a derogatory attitude that characterizes older adults as sickly, senile, useless, and a burden on the economy. The attitude stems in part from our cultural emphasis on youth, beauty, and vigor. Other cultures respect and revere their aging members.

The nurse is observing a mother with her 2-year-old child. In a period of just a few minutes the child has said "No" to her many times. He even says "No" when he would like to have said yes. Which statement about this child's behavior is true? 1.He is very spoiled and needs to be punished. 2.He is a toddler and is exhibiting ritualistic behavior. 3.He is trying to assert his autonomy through negativism. 4.He is just trying to test his limits and see how far he can get.

ANS: 3 As they test their powers, they sometimes clash with their parents' restrictions, and a battle of wills results. "No" seems to be their favorite word. This negativism is a normal part of the quest for autonomy.

A new mother asks the nurse, "Why does my baby cry so much?" Which statement by the nurse is correct? 1."You need to try to hold your baby for longer periods of time." 2."This means he is hungry. He needs to be fed more." 3."Your baby uses crying to tell us if he feels hungry, uncomfortable, or lonely." 4."We should examine him for signs of illness."

ANS: 3 Crying is the infant's first means of communication. For the first month, cries are undifferentiated. After 1 month of age, the infant alters the crying pitch and intensity to reflect hunger, discomfort, or loneliness.

Normal physical changes that occur during middle adulthood (40 to 64 years) include: 1.deterioration of internal organ systems. 2.increased muscle tone and decreased muscle strength. 3.increased abdominal fat deposits from decreased activity. 4.decreased sensory function and visual changes for far vision.

ANS: 3 During middle adulthood, the hair thins, an abdominal paunch grows from increased fat deposits and decreased activity, most organ systems remain constant, and sensory function remains intact except for some visual changes for near vision.

A father describes his adolescent son's "strange new clothes and hair style." He states that he is worried about the frequent changes his son seems to make in his appearance. The nurse explains that his son is: 1.possibly getting into trouble and should begin counseling. 2.experiencing a loss of self-esteem and may need help to overcome this difficult time. 3.experimenting with different identities, which is necessary to forming an identity of his own. 4.probably experimenting with drugs or alcohol because such behavior is unusual in an adolescent.

ANS: 3 Erikson believes the main conflict of the fifth stage in his theory to be identity versus role diffusion. Finding one's own identity is stressful. In the search for identity, teens often form cliques, wear fad clothing, and follow rock singers, movie stars, or charismatic heroes in an attempt to siphon identity from them.

The mother of a 2-month-old baby reports that she often lets the baby "cry it out" instead of going to her in the middle of the night. In talking over this practice with her, the nurse should make her aware that: 1. 2-month-old babies are old enough to learn to sleep through the night. 2. babies can become spoiled if they're picked up in the middle of the night. 3. babies are developing a sense of trust and need to be responded to when they cry. 4. babies are just developing the ability to manipulate and should not be picked up if it is unnecessary.

ANS: 3 Erikson viewed the mother as the primary caregiver. The crucial element in this stage (trust vs. mistrust) then, is the quality of the mother-child relationship. When the mother is responsive and consistent in her nurturing, the infant learns trust.

A 24-month-old child comes to the clinic for a well-child visit. His mother describes him as a child who falls apart if she changes even the smallest thing in his environment. The nurse tells his mother that this behavior: 1.is unusual in a toddler because negativism generally doesn't emerge until age 3. 2.indicates that he is insecure and probably hasn't successfully developed trust in infancy. 3.can be expected from a toddler because they typically experience ritualism and global thinking. 4.indicates that he has been spoiled and she should change things in his environment often to get him used to it.

ANS: 3 Ritualism emerges with negativity. A 2-year-old wants things done in the same way; any change in schedule is upsetting. Another mark of the toddler's sensitivity to change is global thinking. A change in one small part (such as a minor shift in room arrangement) changes the whole environment, and the 2-year-old child's equanimity disintegrates.

The stage of early adulthood (20 to 40 years) is concerned with emancipation from parents and building an independent lifestyle. Tasks of this era include: 1.pursuing activities enjoyed during childhood. 2.assisting younger siblings with gaining their identity. 3.Forming an intimate bond with another and choosing a mate. 4.becoming more involved with activities in their family of origin.

ANS: 3 Tasks of early adulthood include such things as growing independent from the parents' home, establishing a career, forming an intimate bond with another and choosing a mate, managing one's own household, and forming a meaningful philosophy of life.

The nurse is performing the Denver II screening test on a 12-month-old infant during a routine well-child visit. The nurse should tell the infant's parents that the Denver II: 1.tests three areas of development: cognitive, physical, and psychologic. 2.will indicate whether the child has a speech disorder so that treatment can begin. 3.is a screening instrument designed to detect children who are slow in development. 4.is a test to determine intellectual ability and may indicate whether there will be problems later in school.

ANS: 3 The Denver II is a screening instrument designed to detect developmental delays in infants and preschoolers. It tests four functions: gross motor, language, fine motor- adaptive, and personal-social. The Denver II is not an intelligence test; it does not predict current or future intellectual ability. It is not diagnostic; it does not suggest treatment regimens.

Which of the following is an appropriate developmental task for a toddler (age 1 to 3 years)? 1.Taking a place in a peer group 2.Identifying sex roles and their function 3.Tolerating separation from the mother or parent 4.Building self-esteem and a positive self-concept

ANS: 3 Tolerating separation from the mother or parent is a developmental task for the toddler. The others listed are for the preschool child (response 2) and the school-age child (responses 1 and 4).

The nurse is testing a 10-year-old child's ability to understand conservation of matter. Which test would be appropriate? 1.Ask her to sort blocks by color and by shape. 2.Ask her to order the blocks from smallest to biggest. 3.Ask her to determine which glass of water has more water in it, the tall skinny glass or the short fat glass. 4.Ask her to make a code using the alphabet and then write a message in the code she has made up.

ANS: 3 Understanding conservation of matter is the ability to tell the difference between how things seem and how they really are. It is the ability to see that mass or quantity stays constant even though shape or position is transformed.

Which of the following statements best characterizes resolution of Erikson's last ego stage, integrity versus despair? 1. The individual becomes more interested in society's extrinsic rewards. 2. The individual experiences a loss of recognition and authority. 3. The adult feels the need to pursue youthful activities as a culmination of life experiences. 4. The adult feels satisfied that if it were possible to do it over again, he or she would live it the same way.

ANS: 4 A successful resolution to Erikson's final stage of integrity versus despair comes when the adult feels content with his or her life on earth, satisfied that if it were possible to do it over again, he or she would live it the same way.

A mother notes that her 4-year-old child often chatters to herself while playing alone. She is worried that her child has a psychological problem. The nurse explains to her that: 1. she is just imitating what she hears around her. 2. this happens when a child is lonely or needs a playmate. 3. there is a concern about her child's psychologic development and further testing will be required. 4.this private speech is normal at this age and is a problem-solving tool as she works through unfamiliar situations.

ANS: 4 Children will chatter to themselves between the ages of 4 to 6 years, and this private speech is a problem-solving tool that is beneficial as they try new tasks or work through unfamiliar situations.

Levinson proposed a view of middle adulthood that differed from Erikson's. Which of the following statements best illustrates Levinson's views? 1. The main task of middle-aged adults is to overcome boredom with life. 2. Career reassessment in middle age is rare because of the fear of change at this age. 3. Middle age is a time when adults push to meet the goals that were set at a younger age. 4. Middle-aged adults adjust goals and emerge with a new perception of the self and the environment.

ANS: 4 During the 40s, the person is involved in making choices and building a new life. The person accepts that some goals may not be met, takes stock, and emerges with a new perception of self and the environment.

If a mother hides a block under her baby's blanket and the baby looks for it, the nurse understands that the baby has begun to develop the concept of: 1.relativism. 2.object prehension. 3.separation anxiety. 4.object permanence.

ANS: 4 Gradually the infant learns that objects and people continue to exist even when they are no longer in sight. This starts around 7 months when the infant searches for an object that is partially hidden but does not search for one completely out of sight.

An 8-year-old boy's father is very interested in seeing his child succeed in soccer. During the assessment, the nurse finds out that the child is a small boy who expresses a sincere interest in playing chess and who feels like a failure at soccer. Which statement is true in regard to this situation? 1.This father needs to decrease his expectations for his son. 2.This father needs to encourage his son to participate in team sports. 3.This child obviously has an introverted personality and should be "left alone." 4.This child should be given opportunities to achieve success in any area he chooses.

ANS: 4 Real achievement at this stage (industry vs. inferiority) builds a feeling of confidence, competence, and industry. The reality is that no one can master everything. If the child believes that he or she cannot measure up to society's expectations, the child loses confidence and does not take pleasure in the work.

A 42-year-old woman has come in for counseling. As the nurse administers the Hassles and Uplifts Scale questionnaire, the woman is told that this tool: 1. will indicate the level of stress in her life. 2. will show her areas of self-improvement needed to regain control in her life. 3. is unable to measure stress but can help her cope with the day-to-day hassles of life. 4.may show a relationship between daily stress and the occurrence of physical health problems.

ANS: 4 Research has shown a significant relationship between daily stress and concurrent or later occurrence of physical health problems.

Erik Erikson's theory of psychosocial development proposes eight stages of ego development. Each stage involves a "bipolar issue." Which statement is true regarding these crises? 1.There is always an absolute resolution to each crisis. 2.Most people never resolve all the crises and therefore never complete all eight stages. 3.If the crisis cannot be resolved at a certain stage, a person generally skips that stage. 4.The issues can be resolved along a continuum, with a mix of positive and negative outcomes.

ANS: 4 The bipolar aspect means that the crisis can have a positive or a negative outcome and is resolved along a continuum. The crisis must be resolved for the person to continue into the next stage. Not everyone reaches absolute resolution to each crisis. The other responses do not illustrate the bipolar issue of Erik Erikson's stages of ego development.

Erikson believes toilet training to be representative of which of his stages? 1.Initiative versus guilt 2.Integrity versus despair 3.Industry versus inferiority 4.Autonomy versus shame and doubt

ANS: 4 The quest for autonomy characterizes Erikson's second stage. The toddler wants to be autonomous and to govern his or her own body and experiences. Erikson believed that toilet training symbolizes this stage.

While examining an 18-month-old child, the nurse notes that he does not demonstrate skills typical for his age. He walks while holding on to furniture but prefers to crawl, rarely speaks, has a flat affect, and is small for his age. Which of the following is an appropriate nursing diagnosis for this child? 1.Impaired parenting 2.Imbalanced nutrition 3.Situational low self esteem 4.Delayed growth and development

ANS: 4 The related factors listed are indicative of delayed growth and development.

At what age should the nurse expect to see an infant exhibiting social smiles? 1.At birth 2.At 2 weeks of age 3.At 4 weeks of age 4.At 6 to 8 weeks of age

ANS: 4 The social smile erupts at age 6 to 8 weeks.