Chapter 12: Conception Through Adolescence
A nurse is caring for a preschooler. Which fear should the nurse most plan to minimize? a. Fear of bodily harm b. Fear of weight gain c. Fear of separation d. Fear of strangers
A (The greatest fear of preschoolers appears to be that of bodily harm; this is evident in children's fear of the dark, animals, thunderstorms, and medical personnel. Toddlers who become ill and require hospitalization are most stressed by the separation from their parents. Persons with anorexia nervosa have an intense fear of gaining weight. By 8 months, most infants are able to differentiate a stranger from a familiar person and respond differently to the two.)
Which assessment finding of a school-aged patient should alert the nurse to a possible developmental delay? a. Verbalization of "I have no friends" b. Absence of secondary sex characteristics c. Curiosity about sexuality d. Lack of group identity
A (School-aged children should begin to develop friendships and to socialize with others. Interaction with peers allows them to define their own accomplishments in relation to others as they work to develop a positive self-image. The absence of secondary sex characteristics is a major concern of adolescents, not school-aged children, because physical evidence of maturity encourages the development of masculine and feminine behaviors in the adolescent. Lack of group relationships is also a concern of adolescents, not of school-aged children, because adolescents seek a group identity to fulfill their esteem and acceptance needs. Today many researchers believe that school-aged children have a great deal of curiosity about their sexuality. Some experiment, but this is usually transitory.)
A nurse is teaching parents about appropriate activities for different age groups. Which toy, if selected by the parent of a 12-month-old infant, will indicate a correct understanding of the teaching? a. Busy box b. Electronic games c. Game requiring two to four people d. Small, plastic alphabet letters and magnets
A (Adults facilitate infant learning by planning activities that promote the development of milestones and by providing toys that are safe for the infant to explore with the mouth and manipulate with the hands, such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. For the toddler (not the infant), television, videos, electronic games, and computer programs help support development and learning of basic skills. Infants are not capable of participating in small group activities. By age 4, children play in groups of two or three. Adults should provide toys that are safe for the infant to explore with the mouth. Small, plastic letters and magnets could be choking hazards for an infant.)
A mother has delivered a healthy newborn. Which action is priority? a. Encourage close physical contact as soon as possible after birth. b. Isolate the newborn in the nursery during the first hour after delivery. c. Never leave the newborn alone with the mother during the first 8 hours after delivery. d. Do not allow the newborn to remain with parents until the second hour after delivery.
A (After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents' and newborn's need for close physical contact. Early parent-child interaction encourages parent-child attachment. Most healthy newborns are awake and alert for the first half-hour after birth. This is a good time for parent-child interaction to begin. No evidence in the scenario suggests that the baby cannot be left alone with the parents during the first 8 hours or that the baby should remain in the nursery during the first hour.)
A nurse is working in the delivery room. Which action is priority immediately after birth? a. Open the airway. b. Determine gestational age. c. Monitor infant-parent interactions. d. Promote parent-newborn physical contact.
A (Opening the airway is the priority. The most extreme physiological change occurs when the newborn leaves the utero circulation and develops independent respiratory functioning. Direct nursing care includes maintaining an open airway, stabilizing and maintaining body temperature, and protecting the newborn from infection. After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents' and newborn's need for close physical contact. Following a comprehensive physical assessment, the nurse assesses gestational age and interactions between infant and parents.)
Which information from the parent of an 8-month-old infant will cause the nurse to intervene? a. My baby rides in the front-facing car seat when I go to the grocery store. b. I made sure the slats on the crib were less than 2 inches apart. c. I removed the mobile after my baby could reach it. d. My baby cries every time he sees a new person.
A (The nurse should intervene when parents let infants and toddlers ride in a front-facing car seat. All infants and toddlers should ride in a rear-facing car safety seat until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer or their car safety seat. Parents also need to inspect an older crib to make sure the slats are no more than 6 cm (2.4 inches) apart. Instruct parents to remove mobiles as soon as the infant is able to reach them. By 8 months, most infants are able to differentiate a stranger from a familiar person and respond differently to the two; this is a normal finding.)
A nurse is teaching a parenting class for families with adolescents. Which health concerns will the nurse include in the teaching session? (Select all that apply.) a. Suicide b. Eating disorders c. Violence/Homicide d. Sexually transmitted infections e. Gonadotropic hormone stimulation
A, B, C, D (Suicide is a major leading cause of death in adolescents 15 to 24 years of age. Adolescent overweight and obesity are current concerns in the United States, and most teens try dieting at some time to control weight. Unfortunately the number of eating disorders is on the rise in adolescent girls. Homicide is the second leading cause of death in the 15- to 24-year-old age-group, and for African-American teenagers it is the most likely cause of death. Sexually transmitted diseases annually affect three million sexually active adolescents. Gonadotropic hormones stimulate ovarian cells to produce estrogen and testicular cells to produce testosterone. These hormones are normally occurring and contribute to the development of secondary sex characteristics, such as hair growth and voice changes, and play an essential role in reproduction. It is not a health concern.)
A nurse is assessing a newborn that was just born. Which newborn finding will cause the nurse to intervene immediately? a. Molding b. A lack of reflexes c. Cyanotic hands and feet d. A soft, protuberant abdomen
B (A lack of reflexes must be addressed quickly. Assessment of these reflexes is vital because the newborn depends largely on reflexes for survival and in response to its environment. Molding, or overlapping of the soft skull bones, allows the fetal head to adjust to various diameters of the maternal pelvis and is a common occurrence with vaginal births. Normal physical characteristics include the continued presence of lanugo on the skin of the back; cyanosis of the hands and feet for the first 24 hours; and a soft, protuberant abdomen.)
A nurse is teaching the parents of a school-aged child about accidents most common in this age group. Which topic should the nurse address? a. Falls b. Fires c. Drownings d. Poisonings
B (Because accidents such as fires and car and bicycle crashes are the leading cause of death and injury in the school-age period, safety is a priority health teaching consideration. Falls, drownings, and poisonings are priority for toddlers.)
A nurse is teaching the staff about development. Which information indicates the nurse needs to follow up? a. "Development proceeds in a cephalocaudal pattern." b. "Development proceeds in a proximal-distal pattern." c. "Development proceeds at a slower rate during the embryonic stage." d. "Development proceeds at a predictive rate from the moment of conception."
C (Development proceeds at a slower rate during embryonic stage indicates the nurse needs to follow up to correct the misconception. From the moment of conception until birth, human development proceeds at a predictive and rapid rate. All the rest of the information is correct and does not need follow-up. Development proceeds in a cephalocaudal and proximal-distal pattern.)
A nurse performs an assessment on a healthy newborn. Which assessment finding will the nurse document as normal? a. Cyanosis of the feet and hands for the first 48 hours b. Triangle-shaped anterior fontanel c. Sporadic motor movements d. Weight of 4800 grams
C (Movements in the newborn are generally sporadic, but they are symmetric and involve all four extremities. Cyanosis of the hands and feet is normal for the first 24 hours, not 48 hours. The diamond shape of the anterior fontanel and the triangular shape of the posterior fontanel are found between the unfused bones of the skull. The average newborn is 2700 to 4000 grams (6 to 9 pounds), not 4800 grams.)
A nurse is teaching parents about the fine motor skills of infants to help parents understand development growth and needs. Match the information to the correct age that the nurse should include in the teaching session. a. Can place objects into containers b. Pulls a string to obtain an object c. Can hold a baby bottle d. Holds rattle for short periods e. Uses pincer grasp well 1. 2 to 4 months 2. 4 to 6 months 3. 6 to 8 months 4. 8 to 10 months 5. 10 to 12 months
a. 5 b. 3 c. 2 d. 1 e. 4
The nurse is teaching a parent about developmental needs of a 9-month-old infant. Which statement from the parent indicates a correct understanding of the teaching? a. "My child will begin to speak in sentences by 1 year of age." b. "My child will probably enjoy playing peek-a-boo." c. "My child will sleep about 7 to 8 hours a night." d. "My child will be ready to try low-fat milk."
B (By 9 months, infants play simple social games such as patty-cake and peek-a-boo. By 1 year, infants not only recognize their own names but are also able to say three to five words and understand almost 100 words; a 2 year old is generally able to speak in two-word sentences. The use of whole cow's milk, 2% cow's milk, or alternate milk products before the age of 12 months is not recommended. By 6 months, most infants are nocturnal and sleep between 9 and 11 hours at night. Total daily sleep averages 15 hours.)
A nurse is comparing physical growth patterns between school-aged children and adolescents. Which principle should the nurse consider? a. Physical growth usually slows during the adolescent period. b. Secondary sex characteristics usually develop during the adolescent years. c. Boys usually exceed girls in height and weight by the end of the school years. d. The distribution of muscle and fat remains constant during the adolescent years.
B (Sexual maturation in adolescence occurs with the development of primary and secondary sexual characteristics. Physical growth usually slows during the school-aged period, and then a growth spurt occurs during adolescence. Girls usually exceed boys in height and weight by the end of the school years. As height and weight increase during adolescence, the distribution of muscle and fat changes.)
The parent brings a child to the clinic for a 12-month well visit. The child weighed 6 pounds 2 ounces and was 21 inches long at birth. Which finding will cause the nurse to intervene? a. Height of 30 inches b. Weight of 16 pounds c. Is not yet potty-trained d. Is not yet walking up stairs
B (Size increases rapidly during the first year of life. Birth weight doubles in approximately 5 months and triples by 12 months. This infant should weigh at least 18 (6 × 3) pounds by this calculation. This child needs the nurse to intervene for further assessment. Height increases an average of 1 inch during each of the first 6 months and about 1/2 inch each month until 12 months: 21 + 6 + 3 = 30 (30 inches is the predicted height). Patterns of body function are just now starting to stabilize. It is quite normal for a 12-month-old child to not be potty-trained or walking up stairs yet. These milestones usually occur in the toddler period of development (12 to 36 months).)
The nurse is caring for an infant. Which activity is most appropriate for the nurse to offer to the infant? a. Set of cards to organize and separate into groups b. Set of sock puppets with movable eyes c. Set of plastic stacking rings d. Set of paperback book
C (Adults and nurses facilitate infant learning by planning activities that promote the development of milestones and providing toys that are safe for the infant to explore with the mouth and manipulate with the hands such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Preschoolers demonstrate their ability to think more complexly by classifying objects according to size or color, making the cards more appropriate for them. Neither group is ready for paperback books. The sock puppet with movable eyes could create a choking hazard if one of the eyes comes off.)
The nurse is teaching a parenting class. One of the topics is development. Which statement from a parent indicates more teaching is needed? a. "The toddler may use parallel play." b. "The preschooler has the ability to play in small groups." c. "The school-aged child still needs total assistance in all safety activities." d. "The toddler may have temper tantrums from parent's acting on safety rules."
C (At this age (school-age), encourage children to take responsibility for their own safety. The toddler continues to engage in solitary play but also begins to participate in parallel play, which is playing beside rather than with another child. The play of preschool children becomes more social after the third birthday as it shifts from parallel to associative play with others in small groups. The toddler's strong will is frequently exhibited in negative behavior when caregivers attempt to direct actions. Temper tantrums result when parental restrictions )
A nurse is communicating with a newly admitted teenaged patient. Which action should the nurse take? a. Avoid questioning the patient about cigarette use when the nurse observes a cigarette lighter lying on the bedside table. b. Complete the admission database as quickly as possible by asking yes and no questions. c. Look for meaning behind the patient's words and actions. d. Ignore the patient's withdrawn behavior.
C (Good communication skills are critical for adolescents. Look for meaning behind the adolescent's words and actions. Following are some hints for communicating with adolescents: Do not avoid discussing sensitive issues. Asking questions about sex, drugs, and school opens the channels for further discussion. Ask open-ended questions. (Yes and no questions are closed-ended questions.) The nurse should inquire about a patient's withdrawn behavior to seek out the meaning of such behaviors. Be alert to clues about adolescents' emotional states.)
A nurse teaches a new mother about the associated health risks to the infant. Which statement by the mother indicates a correct understanding of the teaching? a. "I will feed my baby every 4 hours around-the-clock." b. "I need to leave the blankets off my baby to prevent smothering." c. "I need to remind friends who want to hold my baby to wash their hands." d. "I will throw away the bulb syringe now because my baby is breathing fine."
C (Good handwashing technique is the most important factor in protecting the newborn from infection. You can help prevent infection by instructing parents and visitors to wash their hands before touching the infant. The nurse can help parents identify ways to meet needs by counseling them to feed their baby on demand rather than on a rigid schedule. Newborns are susceptible to heat loss and cold stress. Place the healthy newborn directly on the mother's abdomen, covering with warm blankets. Removal of nasopharyngeal and oropharyngeal secretions remains a priority of care to maintain a patent airway; keeping the bulb syringe is important.)
The nurse is observing a 2-year-old hospitalized patient in the playroom. Which activity will the nurse most likely observe? a. Seeking out same sex children to play with b. Participating as the leader of a small group activity c. Sitting beside another child while playing with blocks d. Separating building blocks into groups by size and color
C (The child beside another child and playing is exhibiting parallel play, characteristic of a toddler. Participating as a group leader does not usually occur until around age 5. Preschoolers (ages 3 to 5) demonstrate their ability to think more complexly by classifying objects according to size or color. A 2-year-old child does not have this ability yet. Gender does not become a factor until the child reaches school-age when the child prefers same sex peers to opposite sex peers.)
. Which statement, if made by a parent, will require further instruction from the nurse? a. "I should not be surprised that my teenage son has so many friends." b. "I get worried because my teenage son thinks he's indestructible." c. "I should cover for my 10-year-old son when he makes mistakes until he learns the ropes." d. "I usually have nutritious snacks available because my 10-year-old son is always hungry right after school."
C (The nurse will need to teach the parent of a school-aged child covering for the child's mistakes; this is a misconception that needs to be corrected. Parents have to learn to allow their school-aged child (6 to 12 years old) to make decisions, accept responsibility, and learn from life's experiences. All the other statements are normal and do not need further teaching. Teenagers typically are very social and have many friends. Adolescents seek a group identity because they need esteem and acceptance. Adolescents feel they are indestructible, which leads to risk-taking behaviors. School-age children are developing eating patterns that are independent of parental supervision. Having nutritious snacks available is a healthy option.)
The nurse is preparing to teach a group of parents with infants about growth and development. Which information should the nurse include in the teaching session? a. 3-month-old infants will be able to bang objects together. b. 4-month-old infants will be able to sit alone with support. c. 5-month-old infants will be able to creep on hands and knees. d. 6-month-old infants will be able to turn from back to abdomen.
D (6-month-old infants will be able to turn from back to abdomen. 6 to 8 month olds can sit alone without support and bang objects together. 8 to 10 month olds can creep on hands and knees.)
A school nurse is encouraging children to play a game of kickball. Which group of children is the nurse most likely addressing? a. Infant b. Toddler c. Preschool d. School-aged
D (A game of kickball would be best suited for school-aged children because in this age group, play involves peers and the pursuit of group goals. Although solitary activities are not eliminated, group play overshadows them. Younger children typically are not able to participate cooperatively in groups yet. Infants begin to play simple social games such as patty-cake and peek-a-boo. Toddlers engage in solitary play but also begin to participate in parallel play. Preschoolers playing together engage in similar if not identical activities; however, no division of labor or rigid organization or rules are observed. By the age of 5, the group has a temporary leader for each activity.)
A mother expresses concern because her 5-year-old child frequently talks about friends who don't exist. What is the nurse's best response to this mother's concern? a. "Have you considered a child psychological evaluation?" b. "You should stop your child from playing electronic games." c. "Pretend play is a sign your child watches too much television." d. "It's very normal for a child this age to have imaginary playmates."
D (At age 5, some children have imaginary playmates. Imaginary playmates are a sign of health and allow the child to distinguish between reality and fantasy. The child does not need a psychological evaluation because this is normal behavior. Television, videos, electronic games, and computer programs help support development and the learning of basic skills. However, these should be only one part of the child's total play activities. Pretend play is not a sign of watching too much television.)
A nurse is assessing the cognitive changes in a preschooler. Which standard will the nurse use to determine normal? a. The ability to think abstractly and deal effectively with hypothetical problems b. The ability to think in a logical manner about the here and now c. The ability to assume the view of another person d. The ability to classify objects by size or color
D (Preschoolers demonstrate their ability to think more complexly by classifying objects according to size or color. Cognitive changes that provide the ability to think in a logical manner about the here and now occur during the school-aged years. It is during the teenaged years when the individual thinks abstractly and deals effectively with hypothetical problems. The toddler is unable to assume the view of another.)
A nurse is teaching a class about the effects of nutrition on fetal growth and development. A pregnant patient asks the nurse how much weight should normally be gained over the pregnancy. Which information should the nurse share with the patient? a. About 10 to 20 pounds b. About 15 to 25 pounds c. About 20 to 30 pounds d. About 25 to 35 pounds
D (The diet of a woman both before and during pregnancy has a significant effect on fetal development. For women who are at normal weight for height, the recommended weight gain is 25 to 35 pounds over three trimesters. Weight gains of 10 to 20, 15 to 25, and 20 to 30 pounds are too low.)