Chapter 11: Growth and Development: Infancy Through Adolescence

Williams: deWit’s Fundamental Concepts and Skills for Nursing, 5th Edition

MULTIPLE CHOICE

1.A mother of an 11-month-old is concerned about her baby not walking and states that his older brother was walking at 10 months. The nurse’s response, based on knowledge of normal development, should be:

a. “Your son may be somewhat slow developmentally. You might have him evaluated by a neurologist.”

b. “The rate of development can be very different from one child to another, even among brothers and sisters.”

c. “Don’t worry. Children can be perfectly normal and not walk until they are 2 years of age.”

d. “It’s hard to predict when a child will walk. Some walk before they are able to crawl or sit alone.”

ANS: B

Development follows a pattern (sit before creep, creep before walk) but varies in normal children. Eleven months is not developmentally slow, but children normally do walk before 2 years of age.

DIF:Cognitive Level: ApplicationREF:p. 148|Box 11-1

OBJ:Theory #3TOP:Motor Development, Infants

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

2.The nurse is aware that according to Piaget’s theory, the child’s cognitive development is:

a. present at birth as a genetic imprint that will begin to unfold in the first year, independent of the child’s environment.

b. a series of psychosocial tasks to be accomplished at various stages throughout life, such as developing a sense of identity in adolescence.

c. the physical increase in size that occurs in the brain of the child, with most of the growth completed by the age of adolescence.

d. occurring in stages, which allows a child to organize knowledge and adapt to the environment in increasingly complex ways.

ANS: D

Cognitive refers to intellectual aspects. It is strongly influenced by environment and is more than just physical development of the brain. Piaget theorized stages a child goes through in organizing knowledge and adapting to the environment.

DIF: Cognitive Level: Comprehension REF: p. 148 OBJ: Theory #7

TOP: Cognitive Development KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

3.A new parent with her first child tells the nurse that her mother has advised her to feed the baby on a schedule and let the baby cry between feedings so that he does not get spoiled. Based on Erikson’s growth and development theory, the nurse’s most informative response would be:

a. a sense of trust is developed in infancy when a child’s needs are met by warm, loving people.

b. an infant who learns to adapt to uncomfortable situations and to comfort himself will develop autonomy and independence.

c. the infant learns cause and effect at this stage and will learn he can’t cry and get his own way.

d. in the first year, crying and learning to wait have positive outcomes for both the mother and the baby.

ANS: A

Meeting the crying baby’s needs fosters trust; it does not “spoil” a child. Crying inconsolably is not a positive outcome for a baby when he fails to have his needs met.

DIF: Cognitive Level: Application REF: p. 148 OBJ: Theory #6

TOP:Psychosocial Development, Infants

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

4.A 4-year-old attends a preschool group three mornings a week. He has been treated kindly and lovingly at home. At school, according to Kohlberg’s theory of moral development, he is likely to:

a. treat his peers and siblings in a loving and kind manner, because he has internalized the value of treating others as he has been treated.

b. conform to social standards and rules to avoid feeling guilty or risking social disapproval.

c. follow the rules regarding peer interactions to avoid punishment.

d. be developmentally advanced and have a conscience that is based on an innate sense of justice and duty.

ANS: C

According to Kohlberg, the child’s behavior at preschool will be preconventional reasoning, governed by fear of punishment. This stage lasts until about the age of 9 years.

DIF: Cognitive Level: Comprehension REF: p. 144 OBJ: Theory #5

TOP: Developmental Theories KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

5.During the first trimester of pregnancy, the most important teaching a nurse can provide the expectant mother is:

a. avoiding very strenuous exercises or activities.

b. eating large high caloric meals to provide for the growing fetus.

c. preparing self-physically and mentally for the work of labor.

d. acquiring adequate prenatal care.

ANS: D

Early prenatal care is the most important factor in a healthy pregnancy outcome.

DIF: Cognitive Level: Application REF: p. 146 OBJ: Clinical Practice #1

TOP: Prenatal Development KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6.A nurse encourages the father of a newborn infant to hold the baby close, talk softly, stroke the baby’s fingers, and make eye contact in order to:

a. assist the father’s confidence in holding the baby.

b. promote bonding, which in turn promotes a sense of trust in infancy.

c. generate a sense of parenting.

d. accustom the baby to being handled by different caregivers.

ANS: B

Bonding is an important feature of the parent-child relationship that must be supported and facilitated in the first weeks of life (a teachable moment).

DIF: Cognitive Level: Comprehension REF: p. 148 OBJ: Theory #6

TOP:Psychosocial Development, Infant Bondings

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

7.The nurse confirms that in the embryonic stage of prenatal development (third to eighth week), the embryo’s:

a. growth slows.

b. organs begin to function.

c. limbs move.

d. heart begins to beat.

ANS: D

The embryo’s heart begins to beat at 3.5 weeks.

DIF: Cognitive Level: Comprehension REF: p. 142 OBJ: Clinical Practice #4

TOP: Health Promotion, Infants KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

8.A parent asks the nurse about how to discipline her 2-year-old who has become uncooperative and negative and is having temper tantrums. The most helpful suggestion made by the nurse would be for the parent to deal with this normal behavior by:

a. scolding the child sternly to discourage this behavior.

b. taking away a favorite toy until behavior improves.

c. using a “time-out” (a quiet time without toys).

d. asking the child to “help Mama” by not being naughty.

ANS: C

This is a normal 2-year-old behavior; the mother needs to learn the use of “time-out” or nonpunitive, less authoritarian ways of dealing with the 2-year-old that are not so likely to provoke “no.”

DIF: Cognitive Level: Application REF: p. 151 OBJ: Clinical Practice #9

TOP: Discipline, Young Child KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

9.A woman in her first trimester of pregnancy asks the nurse how much weight she can expect to gain by the time of EDD (estimated delivery date). The nurse correctly responds approximately by informing her:

a. 5 to 10 pounds.

b. 15 to 20 pounds.

c. 25 to 30 pounds.

d. 35 to 40 pounds.

ANS: D

A woman beginning pregnancy at a healthy weight should expect to gain approximately 30 pounds.

DIF: Cognitive Level: Knowledge REF: p. 146 OBJ: Clinical Practice #1

TOP: Nutrition KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

10.The nurse reminds a parent that a major milestone for a 2- to 3-year-old child is to learn to:

a. play team games with others his age.

b. speak clearly and fluently.

c. use the toilet for bladder and bowel functions.

d. tie shoelaces.

ANS: C

Toilet training is usually accomplished in the second or third year. Team games are a young school age phenomenon, as is tying shoelaces. Speaking clearly and fluently does not occur until after the toddler stage.

DIF: Cognitive Level: Comprehension REF: p. 150 OBJ: Theory #8

TOP: Motor Development, Young Child KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

11.When the clinic nurse speaks to the 3-year-old child and says, “You can get dressed now and put your shirt and pants back on,” she is promoting his sense of:

a. autonomy.

b. industry.

c. initiative.

d. trust.

ANS: A

Autonomy is the sense of independence—“I can do it myself.” It is accomplished in the toddler stage as evidenced by toilet training, self-feeding, and self-dressing. Industry is a school age task, initiative is a 4- to 6-year-old task (preschool), and trust is a task of infancy.

DIF: Cognitive Level: Comprehension REF: p. 144|Tables 11-2 and 11-27

OBJ:Theory #6TOP:Psychosocial Development, Young Child

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

12.A 4-year-old child tells other children that last night he flew to the moon and walked around with his friend Sam. He says that he is the only one who can see Sam. The nurse should:

a. warn the child’s mother that he may be developing emotional problems.

b. interrupt the conversation with a comment that children can’t fly to the moon.

c. take the child aside and tell him gently that he should stop telling such stories or people will not trust him.

d. recognize that imaginary friends and fantasy are normal at this age.

ANS: D

Fantasy and imaginary friends are normal in this age group.

DIF: Cognitive Level: Analysis REF: p. 150 OBJ: Theory #7

TOP:Cognitive Development, Young Child

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

13.The risk for poisoning is most likely in a situation in which:

a. a caretaker with an infant with a high fever has been instructed by the clinic nurse to give a liquid fever reducer (antipyretic).

b. a toddler is staying with his grandparents for a week while his mother is in the hospital.

c. a 7-year-old has asthma and uses daily medications for it.

d. a 12-year-old is home alone after school until his parents return from work.

ANS: B

A toddler staying with grandparents for an extended emergency visit is at risk for poisoning related to the grandparents’ home not being “toddler proof.”

DIF: Cognitive Level: Analysis REF: p. 150 OBJ: Clinical Practice #7

TOP:Cognitive Development, Young Child

KEY:Nursing Process Step: Diagnosis

MSC: NCLEX: Safe, Effective Care Environment: Growth and Development

14.A 9-year-old has returned to the pediatric unit from the recovery room after having his appendix removed. He has an intravenous solution running into a vein and a dressing covering the operative site. His parents went home briefly. When he becomes upset and starts crying, the nurse should:

a. help the child recall the events of the previous day, explaining that his mother will be back later in the morning.

b. recognize his need for family by calling his mother on the telephone and telling her to come back and stay with her son.

c. appeal to his gender identity by telling him he is a big boy, and big boys don’t cry.

d. be aware that the child cannot reliably tell the nurse about pain at this age and call the care provider for an order for a pain medication or sedative.

ANS: A

A 9-year-old can use cognitive abilities to understand the nurse’s explanation. He can also tell about pain.

DIF:Cognitive Level: ApplicationREF:p. 153|Table 11-3

OBJ: Clinical Practice #7 TOP: Cognition, Middle and Older Child

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

15.In planning anticipatory guidance for the parents of an 18-month-old child at a well child clinic, the nurse should include information about the:

a. child’s need for and ability to participate in quiet activities such as reading stories and watching television and movies on a phone or computer for long periods of time.

b. advantages of having the child begin to attend day care to develop his social interactions and group play skills with other children.

c. need for close supervision and making the environment safe related to poisons, motor vehicles, stairs, and electrical hazards.

d. need for increased nutritional intake to maintain the continued rapid growth of infancy into this stage.

ANS: C

Parents with a child at 18 months of age need to be guided in how to protect their child from his own curiosity and dangers. An 18-month-old is not capable of sitting still for stories for long periods, and at this age, children engage in parallel play rather than group play. His nutrition needs to be balanced but will probably decline in amount because growth is not as rapid as in infancy. The American Academy of Pediatrics guidelines recommend no television, smart phones, or computers for children under 2 years, and less than 2 hours of screen time per day for children and teens. These activities have been linked to an increase in attention problems, development of unhealthy eating habits, higher body mass index, and obesity.

DIF: Cognitive Level: Application REF: p. 150 OBJ: Clinical Practice #3

TOP:Cognitive Development, Young Child

KEY:Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Growth and Development