Question 1

A 15-year-old adolescent tells the school nurse that he is busy preparing for a forensics competition and would like to be a lawyer one day.According to Piaget's stages of development,the adolescent is in which stage of development?

Accepted Answer

Piaget's final stage of development is the formal operational stage,during which the 11- to 15-year-old child uses abstract reasoning to handle difficult concepts and to analyze both sides of an issue.In the concrete operational stage,the 7- to 11-year-old child is much more able to organize thought in a logical order.The child is able to categorize and label objects.It is also possible at this stage for the child to solve concrete problems.In the preoperational stage,the child is still not capable of logical thinking,but due to an increased ability to use words and actions together,the child is increasingly able to connect ly with the world.The sensorimotor stage is the initial stage,from birth to age 2,in which primary cognition takes place through the senses.

Question 2

A nurse notes that when an infant is startled,she looks at her mother.What conclusion can the nurse make about this infant's development?

Accepted Answer

According to John Bowlby's theory of attachment,the infant becomes attached to the mother as a way to survive the vulnerabilities of infancy.When the attachment is secure,the mother is seen as home base.When the child becomes startled or frightened,he or she will look to the mother for security.Knowing that home base is secure allows the child to go on to develop other relationships.The other statements are not accurate.

Question 3

A pediatric nurse works with the family of twins at designated stages in their lives to help the parents anticipate and move through the periods of disequilibrium.What is the model of child development that focuses on disruptive periods of development?

Accepted Answer

Brazelton described touchpoints as "periods during the first 3 years of life during which children's spurts in development resulted in pronounced disruption in the family system." The touchpoints perspective assumes,among other things,that parents know their children better than they know anyone else,and with that in mind,the nurse works with the family at the various touchpoints to help them anticipate and move through the periods of disequilibrium.Bowlby focuses on the impact of separation from mothers seen in infants.Erickson's theory focuses on the influence of social interaction on development.Freud's theory regards the impact of psychosexual instincts as most important in development.

Question 4

A nurse is observing infants at a day-care center to determine how their behavior fits into attachment theories.The nurse notes a wide variety of attachment behaviors.What other assessment is appropriate for the nurse to make?

Accepted Answer

Cultural background plays an important role in behavior,including demonstrations of attachment.Infants will show attachment in a manner consistent with their culture.The nurse should note the cultural background of the observed infants.The other information may be useful,but is not as important in judging attachment as is cultural background.

Question 5

A 7-year-old hospitalized for a fracture following a car crash tells the pediatric nurse "God is in heaven with his angels and is looking down on me." Which stage of Fowler's spiritual development is this child exhibiting?

Accepted Answer

In stage 0-undifferentiated (infancy)-the infant is learning a "fund of basic trust and the relational experience of mutuality with the one(s)providing primary love and care." In stage 1-intuitive-projective (ages 2 to 6 or 7)-beliefs and faith are unquestioning.It is a time of fantasy and magical thinking.In stage 2-mythical-literal (ages 6 to 11)-the child retells the spiritual stories and takes them literally and concretely.In stage 3-synthetic-convention (typically begins around 12 or 13 years)-the young person begins to personalize beliefs.

Question 6

A hospitalized 11-year-old child turns down opportunities to play or engage in diversionary activities.When questioned,the child states "I'm bad at that" or "I can't do anything." What action by the nurse is best?

Accepted Answer

This 11-year-old child is in the Erikson stage of industry versus inferiority,and it seems he or she has not mastered tasks and developed a sense of self-confidence.Illness can frequently disrupt growth and behavior,and the child developmental specialist is a vital resource in meeting the developmental needs of the hospitalized child.Documentation should always be accurate and thorough,but simply documenting the statements will not help resolve the problem.The child may or may not need a psychology consultation or an abuse assessment,but the focus is on helping the child meet developmental milestones.

Question 7

The pediatric nurse explains to a new mother that two factors,"nature" and "nurture," may influence the formation of her child's essence.Which factor among the following would be considered "nature"?

Accepted Answer

Nature describes the traits inherent in the infant-biologically imposed idiosyncratic factors that create what and how each person "is." Nurture,on the other hand,refers to the influence of external events like parenting received,culture,or the "times" in which a child lives.

Question 8

A nurse observes several preschool-aged children during play and overhears one of them say "My mommy won't let me do that." What conclusion is the most appropriate by the nurse regarding this child's development?

Accepted Answer

According to Freud,between the ages of 3 and 6,children begin to develop a superego,which serves to regulate behavior.The child who knows there are limits to behavior is demonstrating this development.Bandura's concept of self-mastery occurs due to the influence of several factors.This child is too young to have developed this.According to Erikson,the stage of autonomy versus shame and doubt typically occurs between the ages of 1 and 3.The child is also too young to have mastered the tasks involved in moral reasoning,and so one cannot say he is behind.

Question 9

A parent is frustrated that her toddler cannot button a shirt on his own.Which teaching point is most appropriate for the nurse to provide to this parent?

Accepted Answer

A concept in development is that gross motor skills must be developed first and used as the foundation for fine motor skills.The larger muscle groups develop first.Buttoning a shirt requires fine motor skills that this child has not yet mastered.It is too early to expect this activity from the child.Telling the parent to stop pushing the child is disrespectful and does not teach the parent information related to growth and development.Appropriate games and toys can help children with growth and development,but this child is too young to master the skill.The child does not need a developmental consultation.

Question 10

A mother takes her 10-year-old son to the pediatrician for a sprained wrist.During the medical history,the pediatric nurse listens to the mother describe her son as "busy playing basketball all day long with the other boys in the neighborhood." Based on the nurse's assessment,which stage of Freud's psychosocial development is this child experiencing?

Accepted Answer

In the latency stage (6 to 12 years)Freud believed that the child "takes a break" psychosexually.This allows the child to focus more intently on other aspects of growth and learning,such as spending time with same-gender friends or excelling in sports or video games.At this age,the child presumably has little interest in issues of sexuality.The oral stage occurs from birth to 1 year,and the infant is fascinated with oral curiosity.The genital stage occurs between 12 and 18,and sexuality and relationships are the focus.The phallic stage occurs from 3 to 6 years,during which sexual differences are discovered.

Question 11

The pediatric nurse teaches the parents of a 3-month-old baby the principles of growth and development that will occur in their child's lifetime.Which statement accurately describes one of these principles?

Accepted Answer

Growth refers to the continuous adjustment in the size of the child internally and externally.Development,on the other hand,refers to the ongoing process of adapting throughout the life span.Growth and development are continuous processes from conception to death.Although development advances in an orderly sequence,each child progresses through the predictable stages within a predictable timeframe.The established guidelines are only guidelines that have been developed through observation over time,and within each individual body systems develop at differing rates.

Question 12

A parent is frustrated that her toddler wants to do everything on his own and in "my way." The parent wants to know the appropriate way to discipline the child for not obeying and allowing the parent to dress him quickly in the morning.Which response by the nurse is most appropriate?

Accepted Answer

According to Erikson's theory,between 1 and 3 years of age,children are in the stage of autonomy versus shame and doubt.It is the time for the child to establish willpower,determination,and a can-do attitude about self.Discipline can be effective at this age.The parent should not be instructed to put the child in time-out for developmentally appropriate behavior.Simply telling the parent she should let the child be independent does nothing to reduce frustration,as the parent does not know the rationale behind it.

Question 13

A pediatric nurse examines a 7-year-old at a well-child visit.Based on Erikson's theory,which basic task does the nurse anticipate for this child?

Accepted Answer

In the trust vs.mistrust stage (birth to 1 year),the task is for the child to recognize that there are people in his or her life (parents)who can be trusted to take care of his or her basic needs.In the autonomy vs.shame and doubt stage (1 to 3 years),the task is for the child to balance independence and self-sufficiency against the predictable sense of uncertainty and misgiving when placed in life's situations.In the initiative vs.guilt stage (3 to 6 years),the child's task is to develop resourcefulness to achieve and learn new things without receiving self-reproach.In the accomplishment/industry vs.inferiority stage (6 to 12 years),the child develops a sense of confidence through mastery of tasks.

Question 14

A young couple brings their 20-month-old daughter to the pediatrician's office for immunizations.The mother tells the nurse that she is going back to work and is looking for a day-care center in the vicinity of the clinic.What assessment is priority before recommending a day-care center that would help the parent and child adapt to the experience?

Accepted Answer

During a normal daily routine,the child may be exposed to a variety of settings and to several people in a day-care center or while visiting extended family,visiting a physician's office,or in public places in the community.Understanding an infant's temperament is essential in the care of the child to help both the parent and child adapt to these experiences.Although the other options are certainly considerations,they are not nearly as important as assessing the child's temperament.

Question 15

A mother has brought her 3-year-old child in to the clinic over concern about the child's lack of development in the last 3 months.Which information is the most appropriate for the nurse to provide to this mother?

Accepted Answer

Periods of growth and development are often followed by a period of "rest." The periods of rest allow the child to incorporate the new growth or the newly developed skill into his or her personal repertoire more completely before attempting the next level.The other statements are in accurate.

Question 16

During a well-child visit,the pediatric nurse assesses a 2-year-old child for language development.Which developmental domain is the nurse assessing?

Accepted Answer

Developmental domain refers to a way of understanding the total child in relation to the mind,body,and spirit.These domains include: physical,psychosocial (emotional,psychological,and social), (including language and intelligence),moral/spiritual,and family development.

Question 17

A student nurse asks a pediatric nurse what cephalocaudal development means.Which response by the nurse is most accurate?

Accepted Answer

Growth in infants occurs in a cephalocaudal direction,that is,from head to toe (top to bottom).Growth that occurs from midline outward is termed proximodistal.Growth does not occur from bottom to top or from the periphery to the midline.

Question 18

A 10-year-old child who has been hospitalized frequently and for long periods of time has the nursing diagnosis of delayed growth and development.Which action by the child would demonstrate that outcomes for this diagnosis have been met?

Accepted Answer

A 10-year-old child is in the Erikson stage of industry versus inferiority.Mastery of tasks leads to self-confidence.Industry is apparent when the child feels capable of doing homework or other assigned tasks independently.This shows resolution of the nursing diagnosis,as appropriate developmental tasks have been accomplished.The other actions do not show resolution of this task.

Question 19

The pediatric nurse is examining a newborn infant and notes a turning in of the foot and turning out of the toes when the sole of the foot is stroked.Which action by the nurse is most appropriate?

Accepted Answer

The newborn is exhibiting the Babinski reflex,one of the normal primitive reflexes that should disappear by 9 months of age.Documentation is all that is required.

Question 20

A 12-year-old child is in the hospital for an extended period of time.Which action by the nurse would most promote the child's sense of self-esteem?

Accepted Answer

A schedule enhances normalcy,and allowing the child to participate in setting the schedule will help boost self-esteem.The other actions are all good nursing interventions,but giving the child some control and encouraging participation will help self-esteem.

Quiz 20: Caring for the Developing Child