Concepts of Growth and Development (20)

Question 1

The parents of a 5-month-old infant and a 3-year-old child ask the nurse about the sequence and timing of developmental milestones for the infant. Which is the most appropriate response?

1. ) “This infant should reach the milestones at the same time as your older child.”
2. ) “The infant may reach the milestones in a different order than your older child.”
3. ) “The sequence of reaching each milestone should follow the same pattern but may be at a different rate.”
4. ) “There are no predictable patterns. Try to enjoy the uniqueness of each child.”

Answer 1

3.) “The sequence of reaching each milestone should follow the same pattern but may be at a different rate.”

The sequence of each stage of development is predictable, although the time of onset, the length of the stage, and the effects of each stage vary with the person.

Question 2

The nurse knows that the study of growth and development is an exploration of which of the following?

1. ) Physical changes of the growing child
2. ) Increasing complexity of function and skill progression of the growing child
3. ) Environmental factors such as family, religion, and culture of the growing child
4. ) Physical developments and the increasing level and progression of function and skill of the growing child

Answer 2

4.) Physical developments and the increasing level and progression of function and skill of the growing child

The study of growth (physical) and develop- ment (function and skills) is correct because the answer needs to have both components to be complete. Option 1 addresses only the growth aspects. Option 2 addresses only developmental aspects, and option 3 addresses only the environmental factors that might influence growth and development.

Question 3

The nurse examines a 2-year-old child recently hospitalized with pneumonia. Which pattern of behavior is most likely to be exhibited by the child?

1. ) Lies quietly while the nurse listens to the lungs
2. ) Asks many questions about what the nurse is doing and hearing
3. ) Fusses, cries, and pushes the nurse away during assessment of the breath sounds
4. ) Enjoys playing “nurse” with the stethoscope, and listens to self and others’ breath sounds

Answer 3

3.) Fusses, cries, and pushes the nurse away during assessment of the breath sounds

Toddlers typically demonstrate negative behav- ior and are hesitant around strangers, resisting close contact with people they do not know well. They do not have sophisticated language skills and often use crying or fussing to communicate. Older school- age children and adolescents are likely to cooperate without complaint in many health procedures (option 1). School-age children, engaged in the task of industry versus inferiority, display curiosity about how things work, asking many questions of nurses (option 2). Preschool-age children, who are in the fantasy, curiosity, and exploration stage, like to manipulate objects and play “pretend” (option 4).

Question 4

A 14-year-old is scheduled to have surgical repair of a spinal curvature (scoliosis). The adolescent will be hospitalized for about 2 weeks. Which nursing intervention will be most helpful during the hospital stay?

1. ) Have peers visit frequently during the day.
2. ) Instruct parents to room-in with her.
3. ) Encourage her to go to the recreation room.
4. ) Encourage her to arrange for her teachers to provide her with homework.

Answer 4

4.) Encourage her to arrange for her teachers to provide her with homework.

Adolescents need to establish identity, which involves developing a more mature sense of independence and responsibility. Providing her with schoolwork keeps her connected to her peer group and gives a sense of accomplishment. Also, it prevents the client from “worrying” about getting behind in school assignments. Interaction with peers is very important during this stage, but they are likely to be attending school during the day (option 1); an infant’s sense of trust is reinforced if parents room-in, and older infants and toddlers experience less separation anxiety if parents are nearby (option 2); and preschool and school-age children would benefit from the distraction and social interaction of others in the recreation room (option 3).

Question 5

A 65-year-old man who recently retired from 40 years of work as an independent contractor is scheduled for a physical examination. The nurse should be concerned about which comment?

1. ) “My wife and I are planning to drive to Nebraska in June to visit our grandkids.”
2. ) “Every day, when I wake up, it’s hard to find a reason to get out of bed.”
3. ) “I often take ibuprofen for the pain in my knees.”
4. ) “People still call me for advice on building projects. I may never get to retire!”

Answer 5

2.) “Every day, when I wake up, it’s hard to find a reason to get out of bed.”

The client is in Erikson’s stage of integrity versus despair. Finding meaning and purpose in his life after retirement is a sign of achievement. His comments regarding visits to his family and being asked by friends to help with their projects indicate that he is actively involved and purposeful (options 1 and 4). His comment regarding needing medication for knee pain can be expected in many older people, especially those who have been laborers or suffered injury when younger (option 3).

Question 6

An 11-year-old child is scheduled for a yearly physical examination. The accompanying parent expresses concern because the child “seems all wrapped up in the soccer teammates and other peers, leaving very little time for the family.” Using Havighurst’s developmental tasks, what would be the nurse’s best response?

1. ) “This is somewhat unusual. Are there problems that we need to discuss?”
2. ) “Although this is normal for 11-year-olds, this transition can be difficult for families.”
3. ) “Become involved in her life and insist that she set aside time for the family.”
4. ) “This is normal development. You need to let her grow up.”

Answer 6

2.) “Although this is normal for 11-year-olds, this transition can be difficult for families.”

This stage includes the preadolescent period. The peer group increasingly influences behavior. Physical, cognitive, and social development increases and communication skills improve. One needs to allow time and energy for the school-age child to pursue hobbies and school activities and to recognize and support the child’s achievement. Option 1 is a judgmental statement as this is not unusual and not indicative of problems in the home. It is good to be supportive of the school-age child; however, making her stay home with her family might cause anger and resentment (option 3). Option 4 is also a judgmental statement. Even though this is normal development, calling the father “silly” is not therapeutic communication.

Question 7

A nurse decides that a review of which theorist would be help- ful before teaching 4- and 5-year olds in a preschool class how to brush their teeth?

1. ) Fowler
2. ) Erikson
3. ) Gould
4. ) Peck

Answer 7

2.) Erikson

Erikson’s late childhood stage focuses on initia- tive versus guilt. During this stage, the children are beginning to have the ability to evaluate their own behavior and are learning the degree to which assertiveness and purpose influence the environment. Option 1 is incorrect because Fowler’s focus is spiritual development. Both options 3 and 4 are names of adult theorists.

Question 8

A 5-year-old boy arrives for the preadmission work-up for a surgical procedure. When the nurse brings in the intravenous (IV) control pump the child states: “It’s going to bite me because I have been bad.” Using knowledge of Piaget, Erikson, and Fowler, which is the best nursing action?

1. ) Reassure him by providing opportunities to touch and explore the machine, as well as explaining how it works.
2. ) Understand that his imagination is out of control. Tell him that his fears are unfounded and that he needs to be a “big boy.”
3. ) Recognize that he is too young to understand and that he needs to be quickly distracted.
4. ) Acknowledge his need for fantasy by reassuring him that if he is a “good boy” the bad machine will not bite him.

Answer 8

1.) Reassure him by providing opportunities to touch and explore the machine, as well as explaining how it works.

Piaget identifies this phase as the intuitive thought phase with significant behaviors as follows: egocentric thinking diminishes, thinks of one idea at a time, includes others in the environment, words express thoughts. Erikson identifies this developmental stage as industry versus inferiority, and the children are learning the degree to which assertiveness and purpose influence the environment. They begin to have the ability to evaluate their own behavior. Fowler identifies this stage as intuitive-projective, a combi- nation of images and beliefs given by trusted others, mixed with the child’s own experience and imagination. Therefore, the nurse knows that this child has a normal imagination and needs to explore and learn about this new piece of equipment in language appropriate to his age. For option 2, imagination is normal for this age group, and stating that he needs to be “a big boy” is counterproductive. Option 3 is incorrect because his language skills are developing and he needs to understand the world around him. Option 4 is incorrect because adding to his fears will only increase his anxiety level and decrease his trust in you as a nurse.

Question 9

A 15-month-old is admitted to the hospital for hernia surgery. When his mother leaves him, he cries inconsolably. Using knowledge of attachment theory and cognitive theory, which is the best nursing action?

1. ) Encourage his mother to stay with him as much as possible.
2. ) Put a picture of his mother in his crib to remind him that she will return soon.
3. ) Hold and cuddle him as much as possible.
4. ) Distract him with toys and music.

Answer 9

1.) Encourage his mother to stay with him as much as possible.

All of the nursing actions listed here are appropriate, but attachment theory emphasizes the importance of parents being available to their child when the child is experiencing stress. The best action would be to encourage the mother to stay with her child as much as possible. Putting a picture of the mother in the crib (option 2) may provide some comfort, since by 15 months of age, children demonstrate object permanence and people permanence, so the child “knows” the mother will return. Holding and cuddling the child (option 3) may also provide comfort, but the child must trust the caregiver, and the nurse’s other responsibilities may restrict the amount of time and when he or she can be with the child. Distraction (option 4) can temporarily refocus the child’s attention, but it does not address the need for emotional and physical contact with the parent.

Question 10

Which behavior is of most concern to the nurse caring for a 25-year-old client after surgery for an appendectomy?

1. ) The client states: “It will be good to get back on my bike. I miss the exercise.”
2. ) The client states: “I have no problem living at my parents’ house. They have lots of room and money and it’s a very comfortable and easy lifestyle for me.”
3. ) The client gets out of bed and walks to the bathroom with assistance.
4. ) Several age-mate friends visit while the client is hospitalized.

Answer 10

2.) The client states: “I have no problem living at my parents’ house. They have lots of room and money and it’s a very comfortable and easy lifestyle for me.”

Although many young adults are choosing to live with their parents, often for economic reasons, option 2 raises concern, because it implies a degree of selfishness and lack of effort to establish independence. This may not be the case, however, and the nurse would need to gather more information before making any judgments. Twenty-five-year-olds, according to psychosocial development theory, have established a sense of self-identity, made a commitment to their community through work and the social group, and are engaged in intimate relationships. According to Erikson, they are in the stage of intimacy versus isolation, moving into the adult stage of generativity versus stagnation. From Havighurst’s perspective, early adults are starting families of their own, managing a home, and taking on the responsibility of work and civic life. Avoiding a relationship and neglect- ing a career or lifestyle commitment are red flags for failure to achieve developmental milestones at this age. Engaging in healthy exercise (option 1) reflects a quality of self-identity for this individual. Option 3 suggests the client actively cooperates in his recovery and is able to fo- cus on the future (wanting to recover from surgery). Option 4 indicates the client is part of a “congenial social group” (Havighurst).