Flashcards in Chapter 5 Deck (44):
Parents are often confused by the terms growth and development and use the terms interchangeably. Based on the nurse’s knowledge of growth and development, the most appropriate explanation of development is
a. A child grows taller all through early childhood.
b. A child learns to throw a ball overhand.
c. A child’s weight triples during the first year.
d. A child’s brain increases in size until school age.
Development is the mental and cognitive attainment of skills.
Growth is the increase in physical size—both height and weight.
Growth is the increase in physical size—both height and weight.
Growth is the increase in physical size.
A nurse is knowledgeable about both growth and development. Which assessment finding indicates the child’s development is on target?
a. The child has not gained weight for 3 months.
b. The child can throw a large ball but not a small ball.
c. The child’s arms are the most rapidly growing part of the child’s body.
d. The child can pull herself or himself to her or his feet before the child is able to sit steadily.
Development is continuous and proceeds from gross to refined, so children whose development is on target can usually throw large objects before small ones.
Not gaining weight for 3 months is an abnormal assessment finding; it would indicate that the child’s development may not be on target.
In children, the legs are normally the most rapidly growing part of the body; if this is not the case, the child’s development may not be on target.
A child whose development is on target can sit steadily before pulling herself or himself up to her or his feet.
Based on Piaget’s theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life?
a. If an object is hidden, that does not mean that it is gone.
b. He or she cannot be fooled by changing shapes.
c. Parents are not perfect.
d. Most procedures can be reversed.
Part of learning permanence is learning that although an object is no longer visible, it still exists.
At 1 year of age, a child may not be able to understand that an object that changes shape is still the same object. Understanding conservation occurs between ages 7 to 11 years.
At 1 year of age, a child is unable to determine or understand that parents make mistakes.
At 1 year of age, a child does not understand the idea of reversed trial and error.
A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson’s theories. Based on the nurse’s knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to
a. feed lunch.
b. allow the toddler to start making choices about what to wear.
c. allow the toddler to pull a talking-duck toy.
d. turn on a TV show with bright colors and loud songs.
A toddler is developing autonomy and is able to start making some choices about what he or she can wear.
A toddler is developing autonomy and focusing on doing things for himself or herself and therefore would not want the mother to feed him or her.
The child is at the stage of autonomy versus shame and doubt, as defined by Erikson. At this age, the mother should provide opportunities for the child to be active and learn by experience and imitation. Providing toys the child can control will help achieve this stage.
A toddler might easily become overstimulated by images from TV and loud sounds. Toddlers are more interested in manipulating and learning from objects in the environment.
A preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. Which statement is appropriate developmentally for this age group?
a. The amount of medicine is less. Correct
b. The amount of medicine did not change, only its appearance.
c. Pouring medicine makes the medicine hot.
d. The glass changed shape to accommodate the medicine.
A preschool child does not have the ability to understand the concept of conservation. This concept is not developed until school age.
Understanding conservation occurs between 7 to 10 years of age, when a child begins to realize that physical factors such as volume, weight, and number remain the same even though outward appearances are changed. Children are able to deal with a number of different aspects of a situation simultaneously.
This is not an expected response by a child.
A preschool child will not typically believe the glass changed shape to accommodate the medicine but rather that the amount of medicine is less in the short, wide glass.
A nurse is discussing various developmental theories at a parenting class. Which individual is associated with the moral development theory?
Kohlberg developed the theory of moral development sequence for children. It includes how children acquire moral reasoning and is based on cognitive developmental theory.
Erikson developed the theory of psychosocial development.
Fowler developed the theory of spiritual development.
Freud developed the theory of psychosexual development.
During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as
a. concrete operations.
c. school-age rhetoric.
d. formal operations.
Black-and-white reasoning involves a situation in which only two alternatives are considered, when in fact there are additional options. Preoperational thinking is concrete and tangible.
During the school-age years, children deal with thoughts and learn through observation. They do not have the ability to do abstract reasoning and learn best with illustration.
Thought at this time is dominated by what the school-age child can see, hear, or otherwise experience.
School-age rhetoric simply refers to the type of ideas that arise out of the years children attend school.
Formal operations are characterized by the adaptability and flexibility that occurs during the adolescent years.
Which statement helps explain the growth and development of children?
a. Development proceeds at a predictable rate.
b. The sequence of developmental milestones is predictable.
c. Rates of growth are consistent among children.
d. At times of rapid growth, there is also acceleration of development.
There is a fixed, precise order to development.
There are periods of both accelerated and decelerated growth and development.
Each child develops at his or her own rate.
Physical growth and development proceed at differing rates.
During a well-baby visit, the parents of a 12-month-old ask the nurse for advice on age-appropriate toys for their child. Based on the nurse’s knowledge of developmental levels, the most appropriate toys to suggest are (Select all that apply)
a. push-pull toys.
b. toys with black-white patterns.
c. pop-up toy such as Jack-in-the-box.
d. soft toys that can be put in the mouth.
e. toys that pop apart and go back together.
Ans: A, C, E
1. An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development?
c. Mass to specific
The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant’s ability to gain head control before sitting unassisted. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.
2. Which refers to those times in an individual’s life when he or she is more susceptible to positive or negative influences?
a. Sensitive period
b. Sequential period
c. Terminal points
d. Differentiation points
Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.
3. An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year?
In general, birth weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday; 14, 16, or 18 pounds is below what would be expected for an infant with a birth weight of 7 pounds.
4. By what age does birth length usually double?
a. 1 year
b. 2 years
c. 4 years
d. 6 years
Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average, most children have doubled their birth length at age 4 years. One and 2 years are too young for doubling of length. Most children will have achieved the doubling by age 4 years.
5. Parents of an 8-year-old child ask the nurse how many inches their child should grow each year. The nurse bases the answer on the knowledge that after age 7 years, school-age children usually grow what number of inches per year?
The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. One inch is too small an amount. Three and 4 inches are greater than the average yearly growth after age 7 years.
6. Parents express concern that their pubertal daughter is taller than the boys in her class. The nurse should respond with which statement regarding how the onset of pubertal growth spurt compares in girls and boys?
a. It occurs earlier in boys.
b. It occurs earlier in girls.
c. It is about the same in both boys and girls.
d. In both boys and girls, the pubertal growth spurt depends on growth in infancy.
Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy.
7. A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on which statement?
a. Growth cannot be predicted.
b. Pubertal growth spurt lasts about 1 year.
c. Mature height is achieved when menarche occurs.
d. Approximately 95% of mature height is achieved when menarche occurs.
At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Although growth cannot be definitively predicted, on average, 95% of adult height has been reached with the onset of menstruation. Pubertal growth spurt lasts about 1 year does not address the girl’s question. Young women usually will grow approximately 5% more after the onset of menstruation.
8. A child’s skeletal age is best determined by:
a. assessment of dentition.
b. assessment of height over time.
c. facial bone development.
d. radiographs of the hand and wrist.
The most accurate measure of skeletal age is radiologic examinations of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption has considerable variation in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child’s height but not skeletal age. Facial bone development will not reflect the child’s skeletal age, which is determined by radiographic assessment.
9. Trauma to which site can result in a growth problem for children’s long bones?
b. Connective tissue
c. Calcified cartilage
d. Epiphyseal cartilage plate
The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones.
10. A nurse has completed a teaching session for adolescents regarding lymphoid tissue growth. Which statement, by the adolescents, indicates understanding of the teaching?
a. The tissue reaches adult size by age 1 year.
b. The tissue quits growing by 6 years of age.
c. The tissue is poorly developed at birth.
d. The tissue is twice the adult size by ages 10 to 12 years.
Lymphoid tissue continues growing until it reaches maximal development at ages 10 to 12 years, which is twice its adult size. A rapid decline in size occurs until it reaches adult size by the end of adolescence. The tissue reaches adult size at 6 years of age but continues to grow. The tissue is well developed at birth.
11. Which statement is true about the basal metabolic rate (BMR) in children?
a. It is reduced by fever.
b. It is slightly higher in boys than in girls at all ages.
c. It increases with age of child.
d. It decreases as proportion of surface area to body mass increases.
The BMR is the rate of metabolism when the body is at rest. At all ages, the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.
12. A mother reports that her 6-year-old child is highly active, irritable, and irregular in habits and that the child adapts slowly to new routines, people, or situations. The nurse should chart this type of temperament as:
Being highly active, irritable, irregular in habits, and adapting slowly to new routines, people, or situations is a description of difficult children, which compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. “Fast-to-warm-up” is not one of the categories identified.
13. A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout activities. The nurse recognizes that the child is displaying which developmental task?
Industry is engaging in tasks that can be carried through to completion, learning to compete and cooperate with others, and learning rules. Industry is the developmental task characteristic of the school-age child. Identity is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.
14. A nurse is conducting parenting classes for parents of children ranging in ages 2 to 7 years. The parents understand the term egocentrism when they indicate it means:
c. preferring to play alone.
d. unable to put self in another’s place.
According to Piaget, children ages 2 to 7 years are in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another’s place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity.
15. The nurse is observing parents playing with their 10-month-old child. Which should the nurse recognize as evidence that the child is developing object permanence?
a. Looks for the toy that parents hide under the blanket
b. Returns the blocks to the same spot on the table
c. Recognizes that a ball of clay is the same when flattened out
d. Bangs two cubes held in her hands
Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning the blocks to the same spot on the table is not an example of object permanence. Recognizing that a ball of clay is the same when flattened out is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging two cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.
16. A father tells the nurse that his child is “filling up the house with collections” like seashells, bottle caps, baseball cards, and pennies. The nurse should recognize that the child is developing:
a. object permanence.
b. preoperational thinking.
c. concrete operational thinking.
d. ability to use abstract symbols.
During concrete operations, children develop logical thought processes. They are able to classify, sort, order, and otherwise organize facts about the world. This ability fosters the child’s ability to create collections. Object permanence is the realization that items that leave the visual field still exist. This is a task of infancy and does not contribute to collections. Preoperational thinking is concrete and tangible. Children in this age group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Collections are not typical for this developmental level. The ability to use abstract symbols is a characteristic of formal operations, which develops during adolescence. These children can develop and test hypotheses.
17. A visitor arrives at a daycare center during lunch time. The preschool children think that every time they have lunch a visitor will arrive. Which preoperational characteristic is being displayed?
b. Transductive reasoning
c. Intuitive reasoning
Transductive reasoning is when two events occur together, they cause each other. The expectation that every time lunch is served a visitor will arrive is descriptive of transductive reasoning. Egocentrism is the inability to see things from any perspective than their own. Intuitive reasoning (e.g., the stars have to go to bed just as they do) is predominantly egocentric thought. Conservation (able to realize that physical factors such as volume, weight, and number remain the same even though outward appearances are changed) does not occur until school age.
18. Which behavior is most characteristic of the concrete operations stage of cognitive development?
a. Progression from reflex activity to imitative behavior
b. Inability to put oneself in another’s place
c. Increasingly logical and coherent thought processes
d. Ability to think in abstract terms and draw logical conclusions
During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child’s ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another’s place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.
19. According to Kohlberg, children develop moral reasoning as they mature. Which statement is most characteristic of a preschooler’s stage of moral development?
a. Obeying the rules of correct behavior is important.
b. Showing respect for authority is important behavior.
c. Behavior that pleases others is considered good.
d. Actions are determined as good or bad in terms of their consequences.
Preschoolers are most likely to exhibit characteristics of Kohlberg’s preconventional level of moral development. During this stage, they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions. Obeying the rules of correct behavior, showing respect for authority, and engaging in behavior that pleases others are characteristics of Kohlberg’s conventional level of moral development.
20. A school nurse notes that school-age children generally obey the rules at school. The nurse recognizes that the children are displaying which stage of moral development?
Conventional stage of moral development is described as obeying the rules, doing one’s duty, showing respect for authority, and maintaining the social order. This stage is characteristic of school-age children’s behavior. The preconventional stage is characteristic of the toddler and preschool age. At this stage, the child has no concept of the basic moral order that supports being good or bad. The post-conventional level is characteristic of an adolescent and occurs at the formal stage of operation. Undifferentiated describes an infant’s understanding of moral development.
21. A nurse observes a toddler playing with sand and water. The nurse appropriately documents this type of play as _____ play.
The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people.
22. In which type of play are children engaged in similar or identical activity, without organization, division of labor, or mutual goal?
In associative play, no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play in activities for a common goal.
23. The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play?
a. Kimberly and Amanda sharing clay to each make things
b. Brian playing with his truck next to Kristina playing with her truck
c. Adam playing a board game with Kyle, Steven, and Erich
d. Danielle playing with a music box on her mother’s lap
Playing with trucks next to each other but not together is an example of parallel play. Both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play. Sharing clay to make things is characteristic of associative play. Friends playing a board game together is characteristic of cooperative play. A child playing with something by herself on her mother’s lap is an example of solitary play.
24. A nurse is planning play activities for school-age children. Which type of a play activity should the nurse plan?
School-age children engage in cooperative play where it is organized and interactive. Playing a game is a good example of cooperative play. Solitary play is appropriate for infants, parallel play is an activity appropriate for toddlers, and associative play is an activity appropriate for preschool-age children.
25. Which following function of play is a major component of play at all ages?
c. Intellectual development
d. Sensorimotor activity
Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages.
26. Parents are asking the clinic nurse about an appropriate toy for their toddler. Which response by the nurse is appropriate?
a. “Your child would enjoy playing a board game.”
b. “A toy your child can push or pull would help develop muscles.”
c. “An action figure toy would be a good choice.”
d. “A 25-piece puzzle would help your child develop recognition of shapes.”
Toys should be appropriate for the child’s age. A toddler would benefit from a toy he or she could push or pull. The child is too young for a board game, action figure, or 25-piece puzzle.
27. Which is probably the single most important influence on growth at all stages of development?
Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment contribute to the child’s growth and development. However, good nutrition is essential throughout the life span for optimal health.
28. A nurse is counseling an adolescent, in her second month of pregnancy, about the risk of teratogens. The adolescent has understood the teaching if she makes which statement?
a. “I will be able to continue taking isotretinoin (Accutane) for my acne.”
b. “I can continue to clean my cat’s litter box.”
c. “I should avoid any alcoholic beverages.”
d. “I will ask my physician to adjust my phenytoin (Dilantin) dosage.”
Teratogens are agents that cause birth defects when present in the prenatal period. Avoidance of alcoholic beverages is recommended to prevent fetal alcohol syndrome. Isotretinoin (Accutane) and phenytoin (Dilantin) have been shown to have teratogenic effects and should not be taken during pregnancy. Cytomegalovirus, an infection agent and a teratogen, can be transmitted through cat feces, and cleaning the litter box during pregnancy should be avoided
29. What should the nurse consider when discussing language development with parents of toddlers?
a. Sentences by toddlers include adverbs and adjectives.
b. The toddler expresses himself or herself with verbs or combination words.
c. The toddler uses simple sentences.
d. Pronouns are used frequently by the toddler.
The first parts of speech used are nouns, sometimes verbs (e.g., “go”), and combination words (e.g., “bye-bye”). Responses are usually structurally incomplete during the toddler period. The preschool child begins to use adjectives and adverbs to qualify nouns followed by adverbs to qualify nouns and verbs. Pronouns are not added until the later preschool years. By the time children enter school, they are able to use simple, structurally complete sentences that average five to seven words.
30. A nurse is observing children at play. Which figure depicts associative play?
The children depicted in the figure at the carnival ride are demonstrating associative play. They are engaged in similar or identical activities. The child depicted playing alone is demonstrating solitary play. The children playing on the beach depict parallel play. They are playing side by side but are participating in different activities. The children depicted playing a board game are engaging in cooperative play.
1. Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves which of the following function? (Select all that apply.)
a. Intellectual development
b. Physical development
e. Temperament development
ANS: A, C, D
A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but not the child’s temperament attributes, may be modified through play.
2. What factors indicate parents should seek genetic counseling for their child? (Select all that apply.)
a. Abnormal newborn screen
b. Family history of a hereditary disease
c. History of hypertension in the family
d. Severe colic as an infant
e. Metabolic disorder
ANS: A, B, E
Factors that are indicative parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease.
3. A nurse is preparing to administer a Denver II. Which is a correct statement about the Denver II? (Select all that apply.)
a. All items intersected by the age line should be administered.
b. There is no correction for a child born prematurely.
c. The tool is an intelligence test.
d. Toddlers and preschoolers should be prepared by presenting the test as a game.
e. Presentation of the toys from the kit should be done one at a time.
ANS: A, D, E
To identify “cautions,” all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age.
1. The nurse is recording a normal interpretation of a Denver II assessment. The nurse understands that the maximum number of cautions determined for a normal interpretation is _____. (Record your answer in a whole number.)
Interpretation of normal for a Denver II is no delays and a maximum of one caution.