Chapter 9. Development: Infancy Through Middle Age My Nursing Test Banks

Chapter 9. Development: Infancy Through Middle Age

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is providing prenatal counseling for a couple who is trying to become pregnant. The priority for the nurse is to include which of the following pieces of information?

1)

Stages of growth and development of the fetus

2)

Recommended schedule of visits to her healthcare provider

3)

Recommended average weight gain during pregnancy

4)

Healthy eating habits before and during pregnancy

ANS: 4

Maternal nutrition is vital to the healthy growth of the fetus. Poor maternal nutrition leads to an undergrown placenta. A small, poorly functioning placenta and smaller than normal umbilical cord are the causes for small-for-gestational age (otherwise known as small-for-dates) babies. The other options are all things the prospective mother needs to know, but they would not have an immediate impact on fetal health.

PTS: 1 DIF: Moderate REF: p. 166

KEY: Nursing process: Planning | Client need: HPM | Cognitive level: Analysis

____ 2. Which of the following would indicate a 4-year-old child has successfully gone through Eriksons Stage 3 (Initiative Versus Guilt)? The child

1)

Refrains from hitting a friend

2)

Plays cooperatively with friends

3)

Is able to develop friendships

4)

Is able to express his feelings

ANS: 1

Stage 3 is Initiative Versus Guilt, in which the child becomes responsible for his behavior, develops self-discipline, and is able to manage his impulses. Cooperation and expressing feelings are tasks for Stage 2. Children develop friendships during the preschool age.

PTS: 1 DIF: Moderate REF: pp. 163-164

KEY: Nursing process: Assessment | Client need: PSI | Cognitive level: Application

____ 3. The nurse is preparing to assess a toddler. To make the assessment go smoothly, before examining the child the nurse should first

1)

Talk to the mother before talking to the child

2)

Ask the child about his favorite toy

3)

Get the childs height and weight

4)

Ask the mother to undress the child

ANS: 2

Toddlers have a fear of strangers, so it would be important to establish rapport before examining the child. Although talking to the mother before the child prior to a physical assessment does not lead to distrust, the action simply does not contribute to building a rapport with the child. Undressing the child before a trusting relationship is established often creates anxiety in the child, leading to uncooperativeness, fear, or withdrawal. Obtaining the childs height and weight would not help the child feel secure.

PTS: 1 DIF: Moderate REF: p. 175

KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Application

____ 4. According to Erikson, a behavior demonstrating an important psychosocial task for a toddler would be for the child to

1)

Act defiantly by refusing to hold her mothers hand while crossing the street

2)

Recognize that it is wrong to take a toy away from someone else

3)

Be able to understand the concept of time in hours

4)

Express to his parents and playmates that he does not like something

ANS: 1

The primary task during Eriksons stage 2, Autonomy Versus Shame and Doubt, is establishing an identity as separate from the parent/caregiver. A child between 18 months and 3 years typically tests the boundaries as part of exercising his will to control his environment. No is a declaration of independence and a bid for increased autonomy. Acts of independence and autonomy (e.g., refusing to hold her mothers hand) are normal during this developmental stage. The toddler should be able to tolerate time away from her parents, delay gratification, and have elimination control. The other tasks are accomplished during the preschool stage.

PTS: 1 DIF: Moderate REF: p. 163

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

____ 5. A mother comes to the clinic with her infant for a newborn checkup at 1 week of age. The mother tells the nurse, My baby looks yellow to me. The nurses best response is which of the following?

1)

What type of detergent are you using to wash the baby clothes?

2)

Is there a possibility you had hepatitis during your pregnancy?

3)

The color is from the breakdown of maternal red blood cells.

4)

There is a cream you can use to reduce the yellowing.

ANS: 3

Jaundice results from the breakdown of the maternal red blood cells that are in the babys system after birth, which elevates the bilirubin in the serum. If detergent caused a reaction, the reaction would commonly present as a rash. Although hepatitis B virus may pass through the placenta to the fetus, the infant does not typically show signs at 1 week of life. If treatment becomes necessary, the infant would receive phototherapy; there is no cream to reduce the yellow appearance related to newborn jaundice.

PTS: 1 DIF: Moderate REF: p. 170

KEY: Nursing process: Implementation | Client need: PHSI | Cognitive level: Application

____ 6. A father brings his toddler to the clinic for well-child care. Which of the following would be most important for the nurse to assess?

1)

How successful the child is with potty training

2)

How the child acts when you enter the room

3)

Whether the child is using eating utensils

4)

Whether the home is child-proofed

ANS: 4

Although all of these areas address important developmental tasks during the toddler period, safety is the highest priority at this age because the child has increased dexterity, mobility, and determination and is becoming more independent. Potty training is typically accomplished between 18 months and 3 years of age but is not a safety concern. It would be normal for a child at this age to be afraid of strangers. The child should be using utensils for most foods, but again it is not a safety concern.

PTS: 1 DIF: Moderate REF: pp. 174-175

KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Analysis

____ 7. Which comment made by a woman in her early 50s would be a cue indicating the need for further assessment for a problem?

1)

My skin is so dry I need to use lotion every day after I bathe.

2)

I have episodes when I feel really hot even when others are not.

3)

Its getting harder to lift those big bags of dog food.

4)

I have to write myself notes because Im getting so forgetful.

ANS: 4

Memory in middle adulthood should remain intact. There is a normal decrease in skin moisture and muscle tone in middle adulthood. The perimenopausal period occurs during this time, hallmarked by hot flashes and night sweats.

PTS: 1 DIF: Moderate REF: pp. 189-191

KEY: Nursing process: Diagnosis | Client need: PHSI | Cognitive level: Analysis

____ 8. The nurse has instructed a group of parents on common adolescent behavior. Which comment by the parent would indicate the most urgent need for further discussion?

1)

I guess my daughter wont be asking my opinion very much.

2)

Im really going to watch my daughters eating habits.

3)

We are really going to have to think about rules we want to enforce after he gets his drivers license.

4)

We dont keep alcohol in the house, so thats at least one thing we dont need to worry about.

ANS: 4

Concerns about alcohol intake during adolescence is highest priority, regardless of whether or not it is stored in the home. Alcohol-related injury and death are a risk that should be avoided in every circumstance. Not having alcohol in the house does not guarantee the teenager wont consume it with his friends. During the teen years, the relationships among peers strengthen and strongly influence adolescent behavior. Although the parents typically still maintain influence on the core values in the home, teens seek peers opinions for matters about social life or concerns of everyday living. As teens are developmentally concerned with appearance and social relationships, there can be an overemphasis on body image, leading to obesity, as well as eating disorders. Motor vehicle accidents are the leading cause of death for teenagers, typically due to distractibility, inattention, impulsiveness, and inexperience in various driving situations.

PTS: 1 DIF: Moderate REF: p. 183

KEY: Nursing process: Evaluation | Client need: SECE | Cognitive level: Analysis

____ 9. Which of the following would be the priority for most adolescents? Being

1)

A good student

2)

Sexually active

3)

Picked to be on the soccer team

4)

Able to function independently

ANS: 3

The developmental task during adolescence is to establish personal identity. Socially, preteens and teens are driven by a need to belong to a group. School-age children need to receive positive reinforcement for accomplishments and desired behavior, such as being good students. Although a small number of preadolescents are sexually active, it is not the major focus for this age. Functioning independently is a task for the young adult.

PTS: 1 DIF: Moderate REF: p. 182

KEY: Nursing process: Diagnosis | Client need: HPM | Cognitive level: Analysis

____ 10. During adolescence, it would be most important to encourage the teen to eat plenty of

1)

Grains

2)

Dairy products

3)

Vegetables

4)

Fruit

ANS: 2

Both males and females experience a growth spurt during adolescence. Although the childs diet should include adequate amounts of all the food groups, peak bone mass is attained during this stage, so the child needs to consume adequate calcium, vitamin D, iron, and protein. These nutrients are found in dairy products.

PTS: 1 DIF: Easy REF: pp. 181-182

KEY: Nursing process: Implementation | Client need: HPM | Cognitive level: Application

____ 11. According to Erikson, which of the following must a middle-aged adult do to be prepared for the final stages of life?

1)

Accept the fact that she is getting older.

2)

Reconcile that death is a part of life.

3)

Feel she has made a contribution to society.

4)

Have had a meaningful and intimate relationship.

ANS: 3

Generativity Versus Stagnation is the stage Erikson describes for the middle adult. During this stage, a mature adult either continues to gain skills, be productive, and pass on his or her knowledge to the next generation or stagnates. During the middle years, many adults are realistic and insightful about age-related physical and emotional changes. Others experience difficulty coping with passing youth and advancing age. Accepting death as a part of the continuum of life is a task for the older adult. Developing meaningful relationships is a task most influential for the young adult.

PTS: 1 DIF: Moderate REF: p. 190

KEY: Nursing process: N/A | Client need: HPM  | Cognitive level: Recall

____ 12. The nurse teaches a mother of a preschool-age child about expected development. Which comment by the parent indicates that she understands the information?

1)

She understands the monsters in books are not real.

2)

When I mention that her birthday is in a week, she understands.

3)

I am saving to buy her the roller skates shes been asking for.

4)

I cant expect her to understand when a friend doesnt agree with her.

ANS: 3

Preschoolers hand-eye coordination develops markedly during this period. They can hop on one foot, skip, and begin to learn to skate. The imagination of a preschool-age child is typically active, whereby they have fears of mythical figures, such as monsters. They have a limited ability to understand the concept of time or to tell time. A preschooler has the ability to consider simple viewpoints of other people.

PTS: 1 DIF: Moderate REF: p. 176

KEY: Nursing process: Evaluation | Client need: HPM | Cognitive level: Application

____ 13. A mother has brought her 8-month-old daughter to the healthcare clinic for a well-child appointment and any needed immunizations. To assess the childs physical development with age-appropriate norms, which of the following questions should the nurse ask?

1)

Is your child able to walk while holding onto furniture?

2)

Is your child able to crawl on her hands and knees?

3)

Is your child able to pick up food with her fingers?

4)

Is your child able to sit up without support?

ANS: 4

At 7 months, most children can sit up by themselves. Cruising usually occurs around 8 to 12 months. At about 7 to 10 months, a child begins to crawl. Infants develop a pincer grasp around 10 months.

PTS: 1 DIF: Moderate REF: p. 171

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

____ 14. A mother comes to the healthcare clinic for a regular health examination for her 5-year-old son prior to kindergarten admission. Which comment by the mother would indicate the need for follow-up questions to the mother?

1)

Hes not a good boy like my other son.

2)

Ive had to treat him for lice a couple of times.

3)

He has an imaginary friend he calls Buddy.

4)

Hes so funny when he imitates his dad doing things.

ANS: 1

Negative comments or comparisons with another child can be an indicator of or potential for child abuse. The nurse needs to determine whether this is an actual problem. Head lice are a common health problem for children of this age because of close physical contact with play. The mother seems to have a healthy attitude about the infestations and to be knowledgeable in the treatment. Imaginary play, magical thinking, and belief in mythical figures are normal at age 5. A child this age will normally imitate the same-sex parent.

PTS: 1 DIF: Difficult REF: p. 177

p. 82

KEY: Nursing process: Diagnosis | Client need: HPM | Cognitive level: Analysis

____ 15. Which behavior by the mother is most likely to help the infant to develop trust?

1)

Talking to the infant

2)

Breastfeeding instead of bottle-feeding

3)

Promptly responding to the infants crying

4)

Having the infant sleep in the same room with the parent

ANS: 3

Because the infant is totally dependent on the parents, quickly responding to his cries promotes attachment and trust. Although all options may promote attachment, they are not absolutely necessary for bonding to occur. Mother-infant attachment is complex and involves all sensesnot simply hearing the mother talk to him. There are physical and emotional benefits to breastfeeding, but it is not necessary for mother-infant attachment. Sleeping in the same room may help the parent respond more quickly to the infants needs but is not the basis for attachment.

PTS: 1 DIF: Moderate REF: p. 171

KEY: Nursing process: N/A | Client need: HPM | Cognitive level: Comprehension

____ 16. The nurse is talking to a class of children, ages 9 to 11 years. For this age group, it would be most important for the nurse to discuss

1)

Safe sex practices

2)

Healthy food choices

3)

Use of seat belts and safety equipment

4)

The importance of getting enough sleep

ANS: 3

All are important topics to discuss with this age, but children of this age are very active, and injuries are common. Motor vehicle accidents are the most common cause of injury. They are just starting puberty, so sexual activity is still not usual. The discussion of appropriate food choices and getting enough sleep should be done throughout the childs developmental stages; it is not peculiar to ages 10 to 12 years. The preteen years are particularly important for adequate sleep and rest primarily because of the physical changes, active social lives, and increasingly complex demands on their lives.

PTS: 1 DIF: Moderate REF: p. 181

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Analysis

____ 17. A 38-year-old client comes into the clinic for a health examination. Knowing the psychosocial development tasks and common health problems for this age group, it would be most important for the nurse to ask

1)

If the client has episodes of feeling depressed

2)

Whether the client practices safe sex

3)

About the clients exercise habits

4)

About the health history of the clients parents

ANS: 1

Striving to be self-sufficient and successful and to establish a career and family are the tasks for this age. These tasks are demanding and can be emotionally difficult and potentially cause depression. Untreated depression is a leading cause of death among young adults. Sexually transmitted infections are a risk for this age group but are not as severe a threat as depression. Exercise is important to overall health but is not a source of stress. There are genetic health problems that can impact the client, but the question is asking about psychosocial development and common health problems.

PTS: 1 DIF: Difficult REF: p. 187-188

KEY: Nursing process: Assessment | Client need: PSI | Cognitive level: Application

____ 18. A mother watches the nurse perform an assessment on her newborn and asks the nurse why she is doing things like stroking the bottom of his feet. The nurse should respond in which of the following ways?

1)

Im checking the blood flow to your babys feet to make sure its normal.

2)

Im testing to see if your babys neuromuscular system is fully developed.

3)

Im checking to see if your baby has the reflex responses we anticipate.

4)

Im testing to see if your baby has normal sensation in his feet.

ANS: 3

The Babinski reflex is elicited by stroking upward of the side of the sole of the foot. This is one of several reflexes that should be present at birth. Stoking the bottom of the foot is not an assessment of circulation to the feet. The neuromuscular system is not fully developed at birth, but reflexes are present. Because an infant is not able to report sensation, which is a subjective finding, this is not the purpose of the nurses action.

PTS: 1 DIF: Moderate REF: p. 168

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

____ 19. The nurse conducts a class on health promotion to a group of young adults. Which of the following comments would indicate the teaching was effective?

1)

I need to get screened for colon cancer.

2)

Ill start doing testicular self-exams.

3)

I have to have my prostate checked.

4)

I dont need to do breast self-exams until I am 40.

ANS: 2

Men may choose to perform monthly testicular exams until they are 40 years old. Colon cancer screening begins at age 50. Prostate exams are part of an annual health exam for middle adults. Even young adults should perform breast self-examination (although some practitioners question recommending it routinely). Whatever screening method is chosen, young adults do develop breast cancer; it is not a problem only for those past age 40.

PTS: 1 DIF: Easy REF: p. 186

KEY: Nursing process: Evaluation | Client need: HPM | Cognitive level: Application

____ 20. Which of the following is an example of a school-aged childs meeting psychosocial development tasks? The child

1)

Wants to show off the latest trick he can do on his bike

2)

Becomes interested in friendships with the opposite sex

3)

Starts to see the value of making good decisions

4)

Wants to buy the same jacket his friend has

ANS: 4

Peers are increasingly more important to the school-age child. The child wants to have what his friends have. Pride in showing off new skills and possessions is normal for all stages of development, particularly during the preschool period. Friendships are typically between those the same sex at this age. A value system does not start to develop until adolescence.

PTS: 1 DIF: Moderate REF: p. 179

KEY: Nursing process: Evaluation | Client need: HPM | Cognitive level: Analysis

____ 21. Which of the following would be the most important health assessment focus for middle adulthood?

1)

Cancer screening with the annual health examinations

2)

Seeking information about consistent use of seat belts

3)

Screening for eating disorders

4)

Mental status exam for cognitive changes

ANS: 1

Chronic diseases, including cancer, are major health problems for adults in the middle years. Habits for seat belt use should have already been established; although it may be important to reinforce seat belt use, the most important assessment is cancer screening. Eating disorders are more common in adolescence. In general, cognitive changes such as memory loss and dementia do not develop until older adulthood.

PTS: 1 DIF: Difficult REF: p. 190

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Comprehension

____ 22. A mother and father have brought their school-age child to the emergency department with injuries that cause the nurse to suspect child abuse. The nurse wishes to assess further for abuse and neglect. Which of the following should the nurse do?

1)

Interview the parents together and the child separately.

2)

Have one parent in the room to reassure the child during the interview.

3)

Interview the child and each parent separately.

4)

Request that a sexual assault nurse examiner (SANE) interview the family members.

ANS: 3

Interviewing each family member separately allows the suspected victim more freedom to express concerns. An abused person may be afraid to talk with the abuser present and may even support the abusers version of events. If two adults accompany a child, the situation still does not allow such freedom, because it may be that one of the adults is abusing both the partner and child. The nurse should separate the caregivers and child to be certain they all tell the same story. A SANE is needed to perform the physical examination only if sexual abuse is suspected from the interview.

PTS: 1 DIF: Difficult REF: p. 180

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Comprehension

Matching

Match the developmental milestones with the appropriate age group. There may be more than one answer for each age group.

1)

Infant

2)

Toddler

3)

Preschool

4)

School age

5)

Adolescent

1.Bones have reached maximum strength

____ 2. Puts toys into toy box

____ 3. Ties her tennis shoes

____ 4. Matches colors and shapes

____ 5. Compares balls with blocks

6.Writes sentences using appropriate grammar

____ 7. Understands that characters in cartoons are not real

____ 8. Finds toys that are hidden

____ 9. Applies reason to his thinking

____ 10. Puts a simple jigsaw puzzle together

____ 11. Tells someone his name, age, and address

____ 12. Understands how much a dollar is

____ 13. Understands what no means

1. ANS: 5 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

2. ANS: 1 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

3. ANS: 4 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

4. ANS: 2 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

5. ANS: 3 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

6. ANS: 4 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

7. ANS: 3 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

8. ANS: 2 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

9. ANS: 5 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

10. ANS: 1 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

11. ANS: 3 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

12. ANS: 4 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

13. ANS: 1 PTS: 1 DIF: Moderate REF: pp. 171-187

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

Match the growth and development theory with the appropriate theorist.

1)

Human behavior and personality development are driven by instincts; there are four forces and five stages that influence a persons personality.

2)

Cognitive development is progressive and sequential through four stages; the person must have the basic abilities of assimilation, accommodation, and adaptation.

3)

There are eight stages of personality development with tasks that must be accomplished at each stage; the greater the achievement of the tasks, the more adjusted the personality.

4)

Humans are born with instinctive needs; lower-level needs must be met before higher-level needs and the ability to achieve self-actualization is developed.

5)

People interact with their social environment in a process of lifelong learning; there are six stages, each with tasks that must be accomplished during that stage.

____ 14. Erikson

____ 15. Freud

____ 16. Havighurst

____ 17. Piaget

14. ANS: 3 PTS: 1 DIF: Moderate REF: pp. 160-165

KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall

15. ANS: 1 PTS: 1 DIF: Moderate REF: pp. 160-165

KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall

16. ANS: 5 PTS: 1 DIF: Moderate REF: pp. 160-165

KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall

17. ANS: 2 PTS: 1 DIF: Moderate REF: pp. 160-165

KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall

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