1520 Developmental

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When having a conversation with a nurse, an older client states, "I’ve lived a good life. I don’t want to die, but I accept it as a part of life." What developmental stage, according to Erikson, has the client completed?

Integrity is the last stage of life, identified by the acceptance of life as lived and the inevitability of death. Identity is a developmental task of adolescence. Acceptance is not a term used by Erikson; it is the final stage of Kübler-Ross’ theory of death and dying. Generativity is a developmental task of middle-aged people.

A nursing instructor asks a nursing student to describe the "initiative versus guilt" stage of Erikson’s theory of psychosocial development. Which statement made by the student indicates a need for further teaching?

At this stage, the child develops a sense of autonomy A child develops a sense of autonomy during the "autonomy versus sense of shame and doubt" stage of Erikson’s theory. During the initiative versus guilt stage, the child likes to pretend and try out different roles. This stage is also marked by the development of a superego or conscience. At this stage, a child has fantasies and imaginations that encourage him or her to explore the environment.

During the routine assessment of an infant, the nurse finds that the child demonstrates a certain neurologic reflex for the first time. When the infant is suspended in a horizontal prone position, the head is raised and legs and spine are extended. What is most likely to be the infant’s age?

An infant demonstrates the Landau reflex when, on being suspended in a horizontal prone position, the head is raised and legs and spine are extended. This reflex appears at 6 to 8 months and lasts until 12 to 24 months. So, the infant in this scenario is most likely to be 7 months old as she is demonstrating this reflex for the first time. The Landau reflex is not seen at ages 2 or 3 months. Instead, labyrinth righting appears at 2 months, and neck righting appears at 3 months. The Landau reflex lasts until 12 to 24 months. So, the age of the infant is not likely to be 36 months.

The nurse is preparing to administer medications to four different newborns to treat infections. Which newborn is likely to develop Gray syndrome?

Chloramphenicol is a broad-spectrum antibiotic used in the treatment of serious infections such as typhoid. It is likely to cause adverse effects, such as Gray syndrome, in infants and neonates. This is an adverse drug reaction unique to pediatric clients. Fluoroquinolones may cause tendon rupture in pediatric clients. Nalidixic acid may cause cartilage erosion. Sulfonamides may cause kernicterus in neonates.

A mother comes to the clinic with her 7-month-old child for a routine checkup. Which assessment findings noted by the nurse suggest that the child is exhibiting appropriate fine motor development? Select all that apply.

A 7-month-old child should be able to bang objects together and pull a string to get an object. A child between 8 and 10 months old should be able to pick up small objects. A child between 10 and 12 months old should be able to place objects in containers and make marks on a sheet of paper using a crayon or pencil.

When teaching the parents of a preschool-age client about the development of sexuality, which should the nurse include as having the most influence?

Child-rearing practices have the most influence on the development of sexuality for the preschool-age client. Peer and sibling behaviors, in addition to interactions with teachers may influence a child’s sexuality. It is the ways in which parents dress, hold, cuddle, caress, discipline, and talk to their child that express some aspect of sexually-oriented behavior and have the greatest influence.

A nurse is learning about the maturation of systems in a school-age child. Which statement made by the nurse indicates effective learning?

The heart grows slower in the school-age child than at any other period of life he 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. As 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.

The nurse is examining different statements that represent the stages of psychosexual development, according to Sigmund Freud’s psychoanalytical model of personality development. Which statement indicates that the individual is aged between 6 to 12 years?

The individual focuses on educational and social accomplishments. According to Sigmund Freud’s psychoanalytical model of personality development, an individual reaches the latency stage between 6 to 12 years of age. At this stage, the sexual urges of the oedipal stage are repressed and the individual channels them into socially acceptable productive activities. Therefore, the child focuses on educational and social accomplishments. When an individual reaches the genital stage, prior sexual conflicts resurface. He or she tries to resolve them in order to be able to begin an adult mature relationship. At the oral stage, which begins from birth and continues till 12 to 18 months, the infant is able to realize that the parent is something separate from the self. An individual between 3 to 6 years old is in the phallic or oedipal stage. At this stage, the child fantasizes about the parent of the opposite sex as the first love interest.

A young adult tells the nurse, "Society needs to be educated regarding involving people affected with AIDS into the social sphere." According to Lawrence Kohlberg’s Theory of Moral Development, what does the statement indicate?

The young adult’s statement indicates that the individual has reached the "Social Contract Orientation" stage. In this stage, an individual recognizes that the law needs to be changed in order to improve society. In the Society-Maintaining Orientation stage, an individual understands that certain actions are not done not because it can lead to punishment, but because the act is not right. In the Instrumental Relativist Orientation stage, a child understands that punishment is not a proof of being wrong, but is an action that one wants to prevent. In the Punishment and Obedience Orientation stage, a child thinks that he or she may get punished if he or she does not adhere to the rules and regulations.

The nurse is teaching the parents of a 3-year-old client about fine motor skills, particularly the progression of drawing during this stage of development. Which order of progression stated by the client’s parent would indicate understanding of the progression of drawing for the preschool-age child?

Preschool drawing goes through several stages from the beginning to the end during this stage of development. The first stage is the scribble stage, the second is the pattern stage, the third is the shape stage, the fourth is the design stage, and the fifth stage is the pictorial stage.

Which nursing action would enhance independence and assist the 2-year-old client in achieving autonomy?

Encouraging a toddler-age client to use a fork during meals is a nursing action that enhances independence and fosters autonomy. Playing peek-a-boo is an appropriate nursing action when providing care to an infant, not a toddler. It is not uncommon for the toddler-age client to need a diaper overnight due to accidents; this will not enhance independence or autonomy, but it is an age-appropriate intervention. Assisting the child with coloring while his or her parents are away is an appropriate action; however, this will not enhance independence nor will it allow the toddler to achieve autonomy.

A nurse is teaching a class about behavioral expectations of infants and children to a group of parents. What does the nurse include as behaviors expected of 8-month-old infants? Select all that apply.

Stranger anxiety is a typical behavior of an 8-month-old. Stranger anxiety (stranger fear) indicates healthy parent-child attachment. Playing peek-a-boo is a typical behavior for an 8-month-old. The infant understands that a person is still there even when out of sight. Standing by and holding on to furniture is typical behavior in an 8-month-old. Walking while holding on to furniture with one hand begins around 11 to 12 months of age. Drinking from a cup requires coordination that develops around 12 months of age. Removing clothing requires coordination that develops around 18 months of age.

A nursing instructor asks a student to describe the moral developmental theory. Which statement made by the student indicates a need for further teaching?

The sixth stage of the moral developmental theory (universal ethical principle orientation stage) defines "right" by the decision of conscience in accordance with self-chosen ethical principles. Moral developmental theory encompasses both interpersonal and intrapersonal dimensions. During the instrumental relativist orientation stage, a child recognizes that there is more than one right view. During the punishment and obedience orientation stage, a child’s response to a moral dilemma is influenced by authority and rules.

Which of the following are congenital anomalies or birth defects seen in children? Select all that apply.

Dysplasias Correct 2 Disruptions Correct 4 Deformations Correct 5 Malformations

A registered nurse is teaching a nursing student about various developmental theories. What points mentioned by the registered nurse are accurate? Select all that apply.

Moral development theory attempts to define how moral reasoning matures in an individual. Developmental theory provides a basis for nurses to assess and understand a client’s responses. Cognitive development focuses on rational thinking processes that include the changes in children, adolescents, and adults to perform intellectual operations

A registered nurse teaches a nursing student about how to interview an adolescent. Which statements made by the nursing student indicate the need for further education? Select all that apply.

I should make assumptions regarding his or her feelings." "I should interview an adolescent along with his or her parents.

Which statement made by a toddler-age client during a health maintenance visit is an example of centration?

Not wanting to eat a food because it is green is an example of centration. The toddler statement about the chair being mean is an example of animism. The response related to the grandpa is an example of magical thinking. Wanting another cup of juice because it appears to have more, even though both have the same volume, is an example of lack of conservation.

How would an adolescent mother ensure the appropriate cognitive development of her child?

The adolescent mother should receive nursing guidance

A nurse is teaching parents how to facilitate their 10-week-old infant’s optimal growth and development. What type of age-appropriate activity should the nurse encourage?

Placing the baby in an infant seat is a suggested activity for 2- to 3-month-old infants because it enables them to more easily observe their environment. Playing pat-a-cake is a suggested activity for 6- to 9-month-old infants. Pull toys are suggested for 12- to 24-month-old infants. Placing the infant in a room with others to facilitate human interaction is a suggested activity for 4- to 6-month-old infants.

Which nursing interventions help the toddler diagnosed with a chronic illness to meet the developmental expectation of autonomy? Select all that apply.

Encouraging self-feeding [1] [2] and allowing independence with dressing are nursing interventions that enhance autonomy for the toddler-age client who is diagnosed with a chronic illness. Instituting age-appropriate limits and allowing meal choices allows for the development of preoperational thought. Providing gross motor skill activities allows the toddler to master locomotor skills.

A 9-year-old child who is undergoing intravenous antibiotic therapy becomes bored and irritable. What activities for school-aged children should the nurse suggest? Select all that apply.

Starting a collection Correct 3 Making a model airplane

When planning activities for a child with autism, what does the nurse remember that autistic children respond best to?

Their own self-stimulating acts

Which observation during a developmental appraisal of a 6-month-old infant is most important to the nurse in light of a diagnosis of hydrocephalus?

Head lag in an infant who is 6 months old is abnormal and is frequently a sign of cerebral damage. The Babinski reflex may be present until 2 years of age. The ability to sit unsupported is achieved at 7 to 8 months. The grasp reflex usually disappears by 3 months.

An infant is found to have cerebral palsy (CP) several months after birth. When the infant is 10 months old the mother comes to the pediatric clinic because the child has begun to exhibit slow writhing movements. The nurse explains that these movements are characteristically associated with what type of CP?

The athetoid type of CP consists of slow, wormlike, writhing movements. The ataxic type of CP is characterized by rapid, repetitive movements. The spastic type of CP is characterized by hypertonicity of muscles. The dystonic type of CP is a combination of the spastic and athetoid types.

The parents inform the nurse that their preschooler’s teachers often complain about the child’s bullying behavior in school. The parents are surprised, because they say the child is well behaved at home. What could be the reason for this inconsistency in the child’s behavior?

If the child is scared of the parents, the child will displace the anger that is experienced on others, especially peers and authority figures. The child is likely well behaved at home out of fear, but not out of respect for the parents. The parents are not lying about the child being well behaved at home if the child does behave in a disciplined manner out of fear. The parents may be very strict but not lack consistency in this scenario. Not spending enough time with the child does not result in aggressive behavior but may increase feelings of loneliness.

What age-related fear should the nurse expect when preparing a 4-year-old child for surgery?

Intrusive procedures threaten the developing body image of the preschooler. The preschooler is more tolerant of strangers than is a younger child. Routines are important to the preschooler, but some deviations in structure of activities can be tolerated. The preschooler can tolerate short periods of separation from parents.

The nurse finds that an adolescent has a tattoo on the neck and piercings on the ear and eyebrow. During the next visit, the nurse finds that the adolescent has an additional tattoo on the right upper arm and another piercing on the nose. What are the priority nursing interventions in this situation? Select all that apply.

HIV Hepatitis screening

Which gross-motor skills would the nurse explain are developed in children between 3 to 5 years of age? Select all that apply.

Jumping rope Correct2 Walking stairs

A 3½-year-old boy from Central America who has tetralogy of Fallot attends the pediatric cardiac clinic for a diagnostic workup before corrective surgery is scheduled. The nurse’s assessment of the child’s motor ability demonstrates that he is just beginning to walk unsupported. When comparing this child with other 3½-year-old children, what does the nurse determine about the child?

Should have started to walk about 2 years earlier

Which behavior does a nurse expect of a newborn approximately 1 hour after birth?

sleeping quietly

Which fine motor skill should the nurse expect when assessing the development of an infant between 10 and 12 months of age?

hold a crayon

he nurse is assessing a newborn in the birthing room. Which finding indicates that a newborn has failed to make the appropriate adaptation to extrauterine life?

central cyanosis

What of these stages should the nurse include when explaining Piaget’s theory of child development to a parent? Select all that apply.

Sensorimotor stage Correct4 Formal operations stage

What is true about a preschooler’s imaginary playmates?

Imaginary playmates experience what preschoolers want to remember or forget. Imaginary playmates do not make preschoolers feel inferior. They accomplish what a child attempts to achieve and help preschoolers to distinguish between reality and fantasy.

A professor asks a student nurse to explain the stage when an adolescent has prevalence of egocentric thought. Which period of the Piaget’s theory will the nurse explain?

Piaget’s theory divides child development into four periods. During the period of formal operations, there is a prevalence of egocentric thought in adolescents. During the sensorimotor period, infants develop a schema or action pattern for dealing with the environment. During the preoperational period, a toddler has egocentric thoughts. During the concrete operations period, the child thinks about an action before it was performed physically.

Which fine motor skill should the nurse anticipate when assessing an infant who is 3 months of age?

Looking at and playing with fingers is a fine motor skill that the nurse should anticipate for a 3-month-old infant [1] [2] [3] [4]. Complete head lag is a gross motor finding expected for a newborn, not an infant. Turning from side to back and the ability to sit erect with support are gross motor, not fine motor, skills expected for a 3-month-old infant.

During follow-up visits, the nurse informs the mother of a 3-month-old infant how to feed the infant expressed milk. Which statements by the mother indicate effective learning? Select all that apply.

"I can express milk by hand or with a breast pump." Correct4 "I can store expressed milk in the refrigerator for 5 days.

Which fine-motor skills may be observed in an 8 to 10 month-old infant? Select all that apply.

The fine-motor skills evident in 8 to 10 month-old infants include the accurate use of the pincer grasp. It also involves picking up small objects. At this stage, the infants may also demonstrate a hand preference. Crawling on hands and knees and pulling oneself to standing or sitting position are considered gross motor skills.

An ultrasound scan of a baby shows that the proximal tubule in the kidney is not well developed. Which drug treatment in the mother during her pregnancy might have caused this condition in the baby?

Angiotensin-converting enzyme inhibitors may cause poor development or absence of the proximal tubule as a teratogenic effect. Antimicrobials may cause heart defects. Sex hormones may cause defects related to the reproductive system. Antiseizure drugs may cause neural tube defects.

A nurse is caring for a hospitalized school-aged child. What development-related activity is most important for the nurse to encourage?

School-aged children have a need to be successful in school; this will help ensure that the child keeps up with the work being presented in class. Although contact with family is important, the school-aged child is beginning to move away from the family and into other realms. Although peer and social interactions and play are important, industrious activities and educational success are more important at this age. The school-aged child does not benefit from therapeutic play as much as the preschooler does. At this age the child can understand a simple explanation of treatment, although it is helpful to be shown and to handle the equipment.

An 8-year-old boy who has been undergoing chemotherapy will soon return to school after a prolonged absence. What should the school nurse do to help prepare the class for his return to school?

Initiate a general discussion with the students about cancer, its treatments, and the side effects of chemotherapy. According to Piaget’s cognitive development theory, school-aged children use concrete operational thinking; a general discussion in concrete terms will be understood and transferred to the actual situation. Having the students address their feelings or discuss tolerance requires conceptual thinking that is just beginning to develop during the school-aged years; 8-year-olds are not ready for these thought processes. These children are capable of understanding a concrete explanation; asking them not to mock the classmate belittles them.

A nurse takes a 1-year-old child to the hospital playroom. What toy should the nurse select for this child?

Squeaky toy

Which item the nurse discusses is true about the brain maturation and cognitive development of preschoolers?

During the learning process, preschoolers start relating things. They become aware of the cause and effect relationship. For example, they may think, "The sun sets because people want to go to bed." 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. Most rapid growth is seen in the frontal lobes during brain maturation. Organizing new activities and maintaining attention to tasks are paramount. Preschoolers demonstrate their complex thinking abilities by classifying objects according to size or color and by questioning.

The nurse is preparing to administer an intramuscular injection to a preschool-age client. Which is the most appropriate statement by the nurse prior to this procedure?

"It is all right to cry. After we are done, you can go to the box and pick out your favorite sticker."

The nurse is caring for an infant undergoing laser therapy for port-wine stain. Which instruction does the nurse give to the infant’s parents?

Laser therapy can effectively reduce port-wine stain in an infant. Picking at the scab during therapy increases the risk of infection. Therefore the parents should avoid any trauma to the lesion. Salicylates can reduce the effectiveness of the therapy; therefore they should not be used during therapy. The infant may have access to the lesions and may scratch them with the fingernails. Therefore the fingernails should be trimmed frequently during therapy. During therapy, the child should not be exposed to the sunlight, because it aggravates the condition.

Which action should the nurse recommend to the parents of a toddler-age client who has a difficult temperament when disciplining the child? Select all that apply.

A toddler-age child who has a difficult temperament should be disciplined with time-outs and physical containment. Ignoring the child’s behavior is not effective for any type of temperament. Making sustained eye contact is more appropriate for a child with an easy temperament. Allowing the child adequate time to adjust to a new situation prior to implementing discipline is appropriate for the child with a slow-to-warm-up temperament.

The nurse observes that an infant has lost 5% of body weight a few days after birth. Which reason does the nurse attribute to this weight loss?

Extracellular fluid (ECF) compartment contraction ECF compartment contraction causes a loss of 5% to 10% of body weight in a newborn infant during the first 5 days of life. The amount of ECF decreases as the percentage of body water decreases in the infant’s body, resulting in weight loss. Dehydration and electrolyte imbalance result from the immaturity of the renal structures. The increasing glomerular filtration rate causes weight loss in infants.

Which statement is true about toddlers?

According to Erikson, a sense of autonomy emerges during toddlerhood. Children strive for independence by using their developing muscles to do everything for themselves and becoming the master of their bodily functions. The average toddler grows 6.2 cm per year. Toddlers’ lack of awareness regarding the danger of water and their newly developed walking skills make drowning a major cause of accidental death in this age group. Toddlers gain approximately 5 to 7 pounds (2.3 to 3.2 kg) each year.

A nursing instructor asks a nursing student about language development in toddlers. Which statement by the student indicates a need for further learning?

An 18-month-old child can use approximately 10 words, not 25. A 24-month-old child can use pronouns and has a vocabulary of up to 300 words. A 36-month-old child can use simple sentences and follow some grammatical rules.

Which major gross motor development skills would the nurse expect to see demonstrated during a teaching session with parents of a 12-month old client who is entering the toddler stage of development?

A major gross motor development the nurse should include in the teaching session with the parents of a 12-month old client is walking alone [1] [2]. Drawing a stick figure person is a fine motor skill that is not developed until the preschool stage of development. Showing interest in cooperative play does not occur until late in the preschool stage of development. Object permanence occurs during infancy.

A preschooler who is recently admitted to a school shows aggressive behavior towards his or her teacher. The child resists playing and interacting with other children. What is the temperament of the child according to Stella Chess and Alexander Thomas’s longitudinal study?

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.

A mother worries about the delayed bedtime of her 4-year-old child. What should the nurse suggest to the mother?

The nurse should suggest the mother to offer a glass of milk to the child before bedtime. Certain dairy products contain L-tryptophan, which promotes sleep. The nurse should not suggest the mother to sleep with the child because it may cause further bedtime delays. Scolding the child will induce a sense of fear. A parent should listen to the child’s concerns, but this action should not be done at bedtime because the child may further delay sleeping.

Which teratogenic effects can be suspected in the newborn if a pregnant client was prescribed cyclophosphamide? Select all that apply.

Cyclophosphamide is a drug used in the treatment of cancer. It is shown to have teratogenic effect if taken during pregnancy. The teratogenic effect includes secondary cancer and central nervous system malfunction. Shortened limbs and internal organ defects are the teratogenic effects associated with thalidomide taken by the mother for the treatment of complications associated with leprosy or certain cancers of the bone. Limb malformation is suspected to occur with methotrexate, a drug taken by the mother for the treatment of certain cancers, rheumatoid arthritis, or psoriasis.

When assisting an older adult (ages 65 to 75 years) in successfully completing Erikson’s task of this stage, the nurse should help the client with what task?

Feeling a sense of satisfaction when reflecting on past achievements encourages the client to accept what life is or was and helps prevent feelings of despair. Although older adults may invest creative energies in promoting social welfare, it is not the task associated with Erikson’s theory concerning older adults. According to Erikson’s developmental theory, redefining a role in society is the task of young adults. Looking to recapture those opportunities that were not experienced is a desire that must come from the client.

A parent brings an 18-month-old toddler to the clinic. The parent reports, "My child is so difficult to please! He has temper tantrums and annoys me by throwing food from the table." What is the best response by the nurse?

"Toddlers are learning to assert independence, and this behavior is expected at this age.

A nurse is assessing the impact of pregnancy on the social aspect of an adolescent girl’s life. Which statement by the adolescent indicates that the pregnancy is affecting the social aspect of her life directly?

Poor school performance usually precedes adolescent pregnancy. The girl in this situation views motherhood, rather than education, as a rite of passage into adult status because she is unable to achieve academic success. Nausea at the sight of food may have a negative impact on the girl’s nutrition but likely does not affect her social status. Sleeping for longer periods as a result of fatigue is not an effect of the pregnancy on the girl’s social life. Feeling the need to seek emotional support from others is not an effect of pregnancy on the girl’s social life.

Which thought in an individual corresponds to the society maintaining orientation stage?

When an individual thinks of avoiding parties where alcohol is served, this thought corresponds to the society maintaining orientation stage. During the society maintaining orientation stage, the individual’s thought is influenced by moral values and societal concerns. When an individual thinks that breaking a rule will lead to a physical punishment, this thought corresponds to punishment and obedience orientation stage. When an individual feels that he or she should follow all the laws formulated by the government, this thought corresponds to universal ethical principle orientation. When an individual feels that doing a certain task will lead to a reward, this thought corresponds to the good boy-nice girl orientation stage.

A pregnant woman was exposed to a teratogenic drug during her first trimester. Which nursing interventions would be beneficial to the client? Select all that apply.

The woman should be referred for evaluation. Correct 4 The woman should be educated about the risks of drug-induced malformations. Correct 5 The woman should be assured that the risk is minimal if the malformation is minor. If a pregnant woman is exposed to a teratogenic drug, further evaluation is needed to determine the type of malformation that can be expected. The woman should be educated about the effects of drugs on the fetus so she can avoid being exposed to drugs with teratogenic effects. If the malformations are minor, the woman should be assured the risk is minimal and can be corrected by surgery. Ultrasound scanning should be done to assess the extent of the injury. The pregnancy should be terminated only if the malformation is severe.

How does the nurse apply the identity versus role confusion stage in the care delivery of an adolescent ? Select all that apply.

Helps hospitalized adolescents in decision-making about their treatment plan Provides anticipatory guidance to parents about the changes faced by children The nurse helps hospitalized adolescents in decision-making about their treatment plan during the identity versus role confusion stage of Erikson’s theory. The nurse provides education and anticipatory guidance for the parent about the changes and challenges to the adolescent. The nurse guides the parents to cope with the hospitalization of an infant during the stage of trust versus mistrust. The nurse guides the parents to help the child in achieving self-control and willpower during the autonomy versus sense of shame and doubt stage. The nurse assists physically ill adults in choosing creative ways to foster social development during the generativity versus self-absorption and stagnation stage.

Which activities should the nurse encourage for a preschool-age client diagnosed with a chronic illness in order to enhance socialization? Select all that apply.

Activities that are appropriate for the nurse to encourage for a preschool-age child diagnosed with a chronic illness include trips to the park, day care experiences, and play dates with friends. Special Olympics participation and club membership with the Scouts are appropriate activities for a school-age, not preschool-age, child.

The school nurse is planning to teach a class about nutrition and to recommend healthy snacks and food choices to children. Which age group will be most receptive to this information?

Eight-year-old children are beginning to achieve a sense of industry and accomplishment. They are in Piaget’s stage of concrete operations, wherein they are able to use their thought processes to experience actions. Their growing independence enables them to base decisions on what they have learned. Six-year-old children are just beginning to experience the developmental goals of the school-aged child. They are not ready to base choices on what they have learned. Preadolescents are beginning to assert their independence and probably will rebel if taught what they should eat. Adolescents need to conform to their peer group; what is learned in a nutrition class probably will be ignored in favor of preestablished preferences.

The nurse is caring for a 6-year-old child admitted from the emergency department after an acute asthma attack. The child has a new prescription for fluticasone. What instructions must the family be given about this drug before the child’s discharge?

Fluticasone is a steroid commonly administered by way of inhalation for long-term control of asthma symptoms. Oral thrush is a side effect that manifests as white patches. Fluticasone is administered via inhalation so food or milk is not needed prior to administration. Dry mouth is not a side effect of fluticasone.

The nurse is preparing to assess a preschool-age child who states, "This is Bella, my bear. People tell me that they can’t hear Bella talking, but that hurts her feelings and makes her cry." When documenting this interaction in the child’s medical record, which term should the nurse use?

Animism is the personification of objects. The child between the ages of 2 and 7 years often believe that inanimate objects have life-like thoughts, wishes, and feelings. Their thinking is influenced greatly by fantasy and magical thinking. Seriation is the ability to mentally classify objects according to their quantitative dimensions, which often occurs between the ages of 7 and 11 years. Conservation, which also occurs during the ages of 7 to 11 years, is the ability to see objects or quantities as remaining the same despite a change in their physical appearance. The understanding that objects continue to exist even when they cannot be seen, heard, or touched is referred to as object permanence, which occurs between birth and 2 years of age.

Which statement regarding anesthetic drugs in pediatric clients requires correction?

Neonates have a respiratory structure that is small in diameter, and they have a high metabolic rate. Because of this, the chance of upper air obstruction during general anesthesia is quite high. In pediatric clients, drug accumulation and toxicity also increases because the child’s liver and kidney functions are immature. Thus children are more affected by anesthesia than adults. A child’s cardiac system is not fully developed, which causes problems with the excretion and metabolism of anesthetics and leads to cardiac abnormalities. Because the blood brain barrier is underdeveloped in pediatric clients, the central nervous system becomes more affected by anesthetics.

According to Kohlberg’s development of moral reasoning, at which phase of life would a child develop premoral orientation?

The preschool stage, from 3 years up to 5 years, is characterized by development of premoral orientation according to the Kohlberg’s stages of moral development. The adolescence period, called the postconventional level, involves development of social contract orientation. The middle childhood period, from the age of 6 to 12 years, is called the conventional level, and involves development of good boy-nice girl orientation. Toddlers are considered to be in the preconventional level, characterized by development of punishment-obedience orientation.

Kohlberg’s stages of moral development.

see 1520 folder Potter Table 11-1

A nurse is assessing a young adult for evidence of achievement of the age-related developmental stage set forth in Erikson’s developmental theory. What developmental crisis is associated with this age group?

The major task of young adulthood is centered on human closeness and sexual fulfillment; lack of love results in isolation. The trust-versus-mistrust stage is associated with infancy. The industry-versus-inferiority stage is associated with middle childhood (school age). The generativity-versus-stagnation stage is associated with middle adulthood.

Which statement is true according to Piaget’s theory of cognitive or moral development in the adolescent? Select all that apply.

The child develops abstract thinking. Correct 4 The child is in the formal operations period. According to Piaget’s theory of cognitive or moral development in an adolescent, a child is in formal operations period and develops abstract thinking. The child is egocentric and begins using symbols in the preschool developmental stage. In the toddler stage, the child is in the pre-operational period and starts to think about using symbols.

A client is exposed to a low concentration of a teratogen in her second week of pregnancy. What could be the effect of the exposure on the fetus or child?

The development of the fetus occurs in three stages: presomite period (conception through week 2), embryonic period (week 3 to week 8), and fetal period (week 9 to term). During the presomite period, teratogens act in an all-or-nothing fashion. When the concentration is low, the fetus may have normal growth. Exposure to high concentrations of a teratogen during this period may cause fetal death. If the fetus is exposed to the teratogen in the embryonic stage, internal organ developmental defects may occur.

Which drug would place a client’s offspring at risk for vaginal cancer?

Diethylstilbestrol is a synthetic nonsteroidal estrogen used in the treatment of menopausal and postmenopausal disorders. When it is consumed during pregnancy, it may show the delayed teratogenic effect of vaginal cancer in female offspring by the age of 18. Danazol is an androgen that may cause masculinization of the female fetus. Estrogen causes congenital defects of the female reproductive organs. Valproic acid, a drug used to control seizures, may cause neural tube defects.

What developmental task should the nurse consider when caring for toddlers?

Autonomy Testing the self both physically and psychologically occurs during the toddler stage, after trust has been achieved. Trust is the task of infancy. The task of industry is accomplished between the ages of 6 and 12 years. Identification is not a developmental task. However, between the ages of 3 and 6 years a child starts to identify with the parent of the same sex.

What psychosocial clues should be explored to confirm substance abuse in an adolescent? Select all that apply.

Psychosocial clues to substance abuse include increased school absenteeism and changes in interpersonal relationships. Other psychosocial clues include falling grades, changes in dress, isolation, and increased aggressiveness. Adolescents with substance abuse problems become increasingly aggressive rather than overly polite. The presence of drug-oriented magazines may indicate substance abuse, but this is an environmental clue, not a psychosocial one. Adolescents with substance abuse issues tend to wear long-sleeved shirts in hot weather.

Which instruction is a nurse least likely to provide about nutrition while educating the parent of a 2-year-old child?

The nurse will not tell the parent to increase daily sodium intake but rather that sodium intake should be reduced. The variety of fruits and vegetables should be enhanced in the daily diet of toddlers. The nurse will instruct the parent to decrease the intake of saturated fats. Also, the nurse should instruct the parent to increase grain products and calcium in the diet of her 2-year-old child.

The nurse assesses the growth and development of a 12-month-old infant and compares the results with the previous assessment findings. Which finding indicates an abnormality in the neonate?

Chest circumference

Which teaching point regarding safety should the nurse include in the instructions for the parents of a school-age client who is a latchkey child?

"Teach your child not to display the keys used to enter the home after school."

Which fine motor skills should the nurse assess for during a health maintenance visit for a toddler-age client? Select all that apply.

Throwing a ball Grasping small objects Placing a round object in the correctly shaped hole

A nurse is assessing a 1-year-old infant. What behavior does the nurse expect to observe? Select all that apply.

Tries to ascend stairs Explores away from the parent

Which injuries would cause the nurse to place a bandage on a preschool-age client based specifically on the child’s stage of development? Select all that apply.

An injection site A sutured surgical site

A worried parent informs the nurse, "My 6-year-old is otherwise healthy but still wets the bed at night." The nurse is teaching the parent necessary steps to manage the child’s nocturnal enuresis. Which statement made by the parent indicates effective learning? Select all that apply.

I should avoid giving my child fruit juice after 4:00 pm." "I should encourage my child to drink lots of water during the day." "I should wake my child at the same time every night to use the bathroom."

Which of these features would the nurse state are exhibited by a preschooler?

Eagerness for formal education

A nursing student is learning about theories related to temperament. Which steps listed by the nursing student are appropriate? Select all that apply.

"An easy child is open and adaptable to changes." "A difficult child requires a more structured environment." "A difficult child shows an intense and primarily negative mood."

What intrauterine medication exposure may lead to the child being born with a cleft lip?

The mother was on nitrofurantoin therapy

The nurse educates the parents of a toddler-age client regarding play and toys appropriate for this stage of development. Which parental responses indicate correct understanding of the information presented? Select all that apply.

"We should expect our child to participate in parallel play." "We should provide our child with finger paints to foster creativity." "We should provide our child with toys that foster her imagination, such as a doll."

Which statements made by a toddler-age client during a health maintenance visit indicate preoperational magical thinking? Select all that apply.

My grandpa died because he yelled at me for making a mess." "My brother fell off his bike because I was mad he wouldn’t play with me."

A nurse records the temperature of a 4-year-old child as 40 °C. The doctor asks the nurse to record the temperature in Fahrenheit. What temperature does the nurse document? Record your answer using a whole number. __________ °F


The parents of a toddler ask the nurse about the importance of play for a child. What is the best answer by the nurse?

"Play activities will help release the child’s surplus of energy."

During a follow-up visit, the mother of a 10-month-old infant says, "My child lifts one foot to take a step, stands by holding the furniture, but does not attempt to stand alone without support, and walks while holding onto a hand." What is the accurate nursing response in this situation?

"Your child should be able to stand alone in another 2 months."

A nurse is caring for a 4-year-old child who is terminally ill. The 4-year-old child’s concept of death is based on a sense of causality. In what stage of Piaget’s cognitive development is this child?

Preoperational thought

The diabetic parent of a school-age child receives home care education for diabetes. The parent needs to take multiple medications. Which instruction does the nurse give for the child’s safety?

"Store medications away from the child’s reach."

After completing the physical examination of a 6-month-old infant, the nurse compares the infant’s height, weight, and head circumference with the previous findings. What does the nurse infer from these findings?

The infant is developing normally.

A registered nurse is teaching a nursing student about various developmental theories. What points mentioned by the registered nurse are accurate? Select all that apply.

Moral development theory attempts to define how moral reasoning matures in an individual. Developmental theory provides a basis for nurses to assess and understand a client’s responses. Cognitive development focuses on rational thinking processes that include changes in children, adolescents, and adults to perform intellectual operations.

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?

"Many children learn empathy and responsibility when helping to take care of a pet."

What nursing intervention is most effective in alleviating the fretfulness of a hospitalized 5-year-old child?

Reading a story to the child

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