Stage 1
Level I, preconventional reasoning, includes stage 1, punishment and obedience training. It is during this stage the nurse would anticipate absolute obedience to authority and rules. Stage 2, also in level I, is when the nurse anticipates that the child will realize there is more than one right view. In stage 3, level II, the child wants to win approval and maintain expectations of his or her immediate group. In stage 4, also in level II, the client expands focus from the relationship with others to societal concerns.
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Mark is a 2-month-old infant who is receiving formula. He has inconsolable crying, is gassy, and constantly draws his legs up. It has been determined that Mark has colic. Which of the following would be most appropriate?
Encourage the use of a different formula to assess for sensitivity.
Explain Colic
Colic peaks between 6 weeks of age and stops at about 3 months. In breastfed infants, colic sometimes is a reaction to something the mother has eaten. In other infants, colic may result from sensitivity to milk or milk products. Treatment is a restful, soothing environment. Changing an infant's formula or having a breastfeeding mom decrease her intake of gassy foods may alleviate the symptoms.
The nurse is assessing the Babinski sign in a 3-day-old neonate. What is a normal response?
The neonate's toes fan and the big toe has dorsiflexion.
A mother of a 10-month-old states to the nurse, "I brush my child's teeth every day with flavored kids' toothpaste." Which is the most appropriate response by the nurse?
Toothpaste is not necessary; it is the scrubbing that is required."
Which milestone would the nurse expect an infant to accomplish by 8 months of age?
Sitting without support
Physical development of infants occurs in a cephalocaudal fashion. That means they must learn to control and lift their heads first. This is followed by the ability to turn over. Once this occurs the remainder of development occurs quickly. Most infants are able to sit unsupported by 8 months. They are able to creep at 9 months and pull to a standing position by 10 months. At 12 months the infant is able to sit from a standing position and is learning to walk
The parents of a newborn diagnosed with a chronic illness ask the nurse, "How will this effect our newborn's growth and development?" Which nursing response is most appropriate?
It is common for newborn with chronic illnesses to grow and develop at a slower pace."
Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone?
be able to turn over onto the back
At four months of age, the infant is able to lift the head and look around. The infant can roll from prone to supine. When being pulled up, the head leads. The 4-month-old infant can make simple vowel sounds, laugh aloud, and vocalize in response to voices. A fear of strangers does not occur until the child is older; a 4-month-old infant has not developed emotionally to have "moody" periods and is dependent on parental care.
The parents of a premature newborn are adjusting to the fragile state of their newborn. Which response by the nurse will assist the most in this transition?
You are doing great holding her with all her equipment. Do you have any questions?"
A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through which of the following?
placenta
The _ best way for an infant's parent to help the child complete the developmental task of the first year is to:
respond to the infant consistently.
The nurse is teaching the mother of a 10-month-old baby how to administer nystatin liquid as a treatment for oral candidiasis (thrush). Which information would the nurse include in the teaching?
Administering it immediately before a feeding
.Nystatin is an effective antifungal drug for oral thrush. For oral candidiasis, nystatin is generally administered by mouth approximately four times a day. The lesions need to be cleaned prior to the application of the nystatin and it should be administered after feeding. It should not be mixed with orange juice.
he rash in roseola is pruritic. Which measure would you teach the parent to provide comfort?
Apply cool compresses to the skin to stop local itching.
The nurse is examining the genitals of a healthy newborn girl. The nurse should observe which normal finding?
swollen labia minora
The newborn's labia minora is typically swollen from the effects of maternal estrogen. The minora will decrease in size and be hidden by the labia majora within the first weeks. Lesions on the external genitalia are indicative of sexually transmitted infection. Labial adhesions are not a normal finding for a healthy newborn. A swollen and red anal area would be an abnormal finding.
The nurse is assessing Julie, a 3-month-old infant. Which developmental milestone would the nurse expect?
Julie can hold her head erect and steady.
When an infant matures and grows they move through different developmental milestones. A 3-month-old rolls over from back to side and holds the head erect and steady and begins to replace the reflex grasp with voluntary grasping. Grasping a toy at will occurs at about 6- to 7-months of age. Sitting without support occurs around 6 months. Playing pat-a-cake is characteristic of an 8- to 9-month-old.
When administering medications to an infant, what information will the nurse consider?
The oral medication should be directed toward the side of the mouth when using a syringe or
When planning how to respond to a 3-year-old child about telling stories ("tall tales"), the nurse would base the statement on the fact that:
imagination in a 3-year-old is at its peak.
Preschoolers have vivid imaginations and love to play "make believe." They are inquisitive learners. It is not unusual for their imaginations to create "tall tales" and be in a world of make-believe. Preschoolers have a vocabulary of between 1,500 and 2,100 words, depending upon their age. They can count to 10 and know at least four colors. Their communication is concrete. At this age they are not capable of abstract thought. During the preschool years, the child develops a sense of identity. They know who they are and to the family in which they belong. They develop the knowledge of right and wrong. The preschool years help develop a child's sense of belonging and his or her place in the world.
The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. What is a recommended intervention for this age group?
Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior.
Toddlers should not be blamed for their aggressive behavior; adults can assist the toddler in building empathy by pointing out when someone is hurt and explaining what happened. Adults should allow toddlers to rely upon a security item to self-soothe, as this is a function of autonomy and is viewed as a sign of a nurturing environment rather than one of neglect. Toddlers may question parents about the difference between male and female body parts and may begin to explore their own genitals. This is normal behavior in this age group. Offering limited choices is one way of allowing toddlers some control over their environment and helping them to establish a sense of mastery.
nurse is assessing the language development of a 3-year-old girl. Which finding would suggest a problem?
speaks in 2- to 3-word sentences
If the child is still speaking telegraphically in only 2- to 3-word sentences, it suggests there is a language development problem. If the child makes simple conversation, tells about something that happened in the past, or tells the nurse her name she is meeting developmental milestones for language.
The nursing staff at the clinic are discussing the best way to encourage cooperation from young pediatric clients during screenings. Which suggestion would be appropriate?
Purchase stickers or make coloring pages to be given to the children after the screening is completed.
Which is the best way for parents to aid a toddler in achieving the developmental task?
Allow the toddler to make simple decisions
A nurse is assessing a 3-year-old's fluid and electrolyte status. When obtaining the child's history, which of the following would be most important?
asking the parents how often the child has been urinating
Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching?
Reasoned with the child to stop the behavior
The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place. The other actions are helpful in preventing a tantrum.
A nurse is assessing a 4-year-old's fluid and electrolyte status. What is an important aspect of history taking in this area?
Ask the parent how often the child has been voiding.
A 3-year-old girl is admitted to the hospital for eye surgery. The nurse provides her with a doll and syringe for therapeutic play. She sticks the doll in the eye with the syringe and says, "You won't watch TV again when I tell you not to!" What is your best response to this?
Ask her if she thinks having surgery is punishing her.
A nurse is preparing to examine the ear of a 2-year-old child. The nurse would pull the pinna in which direction?
down and back
The nurse should pull the pinna of the ear down and back for a child younger than age 3 years to help straighten the ear canal. For a child older than age 3 years, the pinna is pulled up and back.
The nurse is assessing a toddler's language development. What finding would the nurse interpret as reflecting expected development for a 2-year-old?
speaks in two-word sentences using a noun and a verb
A 2-year-old child should be speaking in simple two-word sentences using a noun and a verb. Any 2-year-old child who does not talk in two-word, noun-verb simple sentences needs a careful assessment to determine the cause because this is beyond a point of normal development. Counting is not an expectation for a 2-year-old child. The child will not be able to speak 20 nouns and 4 pronouns.
Which immunization would the nurse expect to administer at a preschool health maintenance visit?
diphtheria, pertussis, and tetanus (DTaP) booster
Preschool-aged children are typically administered a booster dose of DTaP vaccine prior to starting school. Other vaccines that may be given at this visit include measles, mumps, and rubella (MMR) booster; poliomyelitis (inactivated) booster; varicella booster; and influenza, which is administered yearly.
A toddler is receiving oral antibiotic treatment for an ear infection. Before administering the drug, which factors must the nurse consider? Select all that apply.
the child's body surface area
the child's food and drug interactions
the child's weight
The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this?
A regular routine and rituals will provide stability and security.
Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer?
artificially acquired active immunity
The nurse has provided an education conference for a group of teachers about suicide risks for adolescents. Which statement by a teacher indicates a correct understanding of the nurse's teaching?
Adolescents who have attempted suicide once are at increased risk to try to commit suicide again."
Adolescents who have attempted suicide are at an increased risk for attempting to take their own lives again. Gay adolescents are at an elevated risk for suicide. Risk factors for suicide include a multitude of mental health disorders and are not limited to depression.
A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation? Select all that apply.
-My favorite time of day to be outside is the middle of the day, around noon."
-"The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older."
-"I only tan before going on spring break to get a base tan so I won't
burn."
A 17-year-old boy chats excitedly with the nurse about his plans for college and a career. He says he has checked out every college in the region and determined which one is the best fit for him and which one offers the best career optio...
Formal operational thought
When considering the psychosocial development of a school-aged child, which is the primary developmental task?
establishing a social network
Erikson describes the task of the school-age years as industry versus inferiority. During this period, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills.
The nurse is educating an adolescent's parents on the importance of self-esteem. Which factor will the nurse include as being most important to an adolescent's self-esteem?
Body Image
What activities would a nurse recommend to the families of school-aged children to promote attainment of Erikson's developmental stage of industry vs. inferiority? Select all that apply.
Praising the child for their academic efforts
Allowing the
child to assist her teacher in straightening up the classroom
Participating on the school soccer team
A mother is concerned that a 7-year-old child has taken money from a sibling's dresser several times. What should the nurse advise the mother about this behavior?
child needs to be reminded of property rights.
A 17-year-old girl comes to the clinic for her first check-up and informs the physician that she has yet to have a period. After ruling out any pathology problems, which treatment would the nurse suspect the physician to order?
estrogen
teen is suspected of having anovulatory menstrual cycles. This would be the result of which hormone?
luteinizing hormone
Luteinizing hormone is responsible for ovulation. Estrogen and progesterone impact the menstrual cycle but do not control ovulation. Prolactin is responsible for preparing the breasts for nursing.
The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse?
Speak with the parents about the unusual increased number of respiratory infections.
In the school-age child, the respiratory system continues to mature with the development of the lungs and alveoli, resulting in fewer respiratory infections. Because the child is absent excessively for respiratory infections the nurse should speak with the parents to aid in determining if there is an underlying cause, or suggest the child visit the pediatrician to discuss the issue.
When caring for pediatric clients, which distraction technique is age-appropriate for the nurse to use?
Provide action-oriented video games to a 15-year-old client.
Behavioral cognitive strategies used for pain management are measures that require the child to focus on a specific area rather than the pain. They can decrease the pain perception or make the pain more tolerable. Action video games have demonstrated a unique ability to engross adolescents' attention. They are a useful strategy to help take the focus off the pain. Blowing bubbles are an intervention more suitable to a preschool-aged child, not a school-age child. A board game is more suitable for an older preschool- or school-aged child, not a 3-year-old child. Puppets are more suitable for a preschool-aged child, not a 10-year-old child.
The mother of a 6-year-old is asking the nurse how to handle the child's lying and fabricated stories when confronted with questionable actions. Which response would be most appropriate by the nurse?
"Children this age sometimes can't distinguish between fantasy and reality."
Children in the age group 6 to 7 years often engage in magical thinking. They may still believe in the tooth fairy, Santa Claus, monsters under the bed, and other imaginary characters. These keen imaginations may also conjure up fears—especially at night—about remote, fanciful, or imaginary events. If a child of this age has trouble distinguishing fantasy from reality, it may incline them to lie to escape punishment or to boost self-confidence. The other choices do not consider this child's stage of development or give the mother the most appropriate information for the situation.
The nurse is teaching a group of school-age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?
"I will grow an average of 2.5 in (6.5 cm) per year."
A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group?
Participating in a craft project
During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter.
The developmental task of the school-aged period, according to Erikson, is gaining a sense of:
industry versus inferiority.
The nurse teaches a 14-year-old client's mother about the adolescent developmental task of identity versus role confusion. What is the best way for the mother to help her adolescent complete this task?
Allow the adolescent to participate in decisions.
Erikson describes the developmental task of adolescence as "identity versus role confusion." Adolescents must develop their own personal identities—a sense of being independent people with unique ideals and goals.
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