Developmental Theories

1. A nurse who wants to apply a theory that relates to moral development should read more from the work of:

1.
Gould
2.
Freud
3.
Erikson
4.
Kohlberg

ANS: 4

Kohlberg developed a theory on moral development. Gould developed a theory on psychosocial development. Freud developed a theory on psychosexual development. Erikson developed a theory on psychosocial development.

DIF: A REF: 144 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

2. The nurse using Erikson’s theory to assess a 20-year-old client’s developmental status expects to find which of the following behaviors?

1.
Coping with physical and social losses
2.
Enjoys participating in the community
3.
Applying self to learning skills
4.
Overcoming a sense of guilt or frustration

ANS: 2

According to Erikson, the young adult is in the intimacy versus isolation stage of development. This is the time in which the young adult can become fully participative in the community, enjoying adult freedom and responsibility. Coping with physical and social losses is found in Erikson’s integrity versus despair stage (old age) of development. Applying themselves to learning productive skills is a consistent behavior found in Erikson’s industry versus inferiority stage (6 to 11 years) of development. According to Erikson, overcoming a sense of guilt or frustration is in the initiative versus guilt stage (3 to 6 years) of development.

DIF: A REF: 140 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

3. The nurse recognizes that Freud’s theory approaches development by looking at:

1.
Moral reasoning.
2.
Logical maturity
3.
Psychosexual aspects
4.
Cognitive development

ANS: 3

Freud’s theory of personality development approaches development by looking at psychosexual aspects. Kohlberg’s theory approaches development by looking at moral reasoning. Gould’s theory approaches development by looking at logical maturity. Piaget’s theory approaches development by looking at cognitive development.

DIF: A REF: 138 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

4. According to Piaget, a preschool child (3 to 5 years old) who comes to the clinic is expected by the nurse to exhibit which of the following behaviors?

1.
Far-reaching problem-solving
2.
Exploration of the environment
3.
Cooperation and sharing with others
4.
Thinking with the use of symbols and images

ANS: 4

According to Piaget, the preoperational child (age 2 to 7 years) is learning to think with the use of symbols and mental images. Organization of thoughts and far-reaching problem-solving are noted in Piaget’s formal operations (11 years to adulthood) stage of cognitive development. According to Piaget, the child explores the environment in the sensorimotor stage (birth to 2 years) of cognitive development. Cooperation and sharing are seen in Piaget’s concrete operations (age 7 to 11 years) stage of cognitive development.

DIF: A REF: 142 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

5. For an older adult client, an example of a common behavioral task or critical event is:

1.
Selecting a mate
2.
Rearing children
3.
Finding a congenial social group
4.
Adjusting to decreasing physical strength

ANS: 4

A common behavioral task of the older adult client is adjusting to decreasing physical strength.

Selecting a mate is a developmental task commonly seen in the early adult. Rearing children is a developmental task of the middle-early adult. Finding a congenial social group is a developmental task of the middle-early adult.

DIF: A REF: 137 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

6. The nurse working in an adult medical clinic wishes to learn more about a developmental theory that focuses on the adult years. The nurse investigates different possibilities and selects the theory proposed by:

1.
Gould
2.
Piaget
3.
Freud
4.
Chess and Thomas

ANS: 1

Gould’s theory of psychosocial development specifically focuses on the adult years. Piaget’s theory focused on cognitive development throughout the life span. Freud’s psychosexual theory focused on personality development throughout the life span. The theory of Chess and Thomas focused on development from childhood to early adulthood.

DIF: A REF: 142 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

7. The nurse recognizes that which one of the following statements about growth and development is correct?

1.
Development ends with adolescence.
2.
Growth refers to qualitative events.
3.
Developmental tasks are age-related achievements.
4.
Cognitive theories focus on emotional development.

ANS: 3

“Developmental tasks are age-related achievements” is a correct statement about growth and development. Human growth and development are orderly, predictable processes beginning with conception and continuing until death. Growth refers to quantitative events. Development refers to qualitative events. Cognitive theories focus on reasoning and thinking processes.

DIF: A REF: 137 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

8. In Kohlberg’s Moral Development theory, an individual who reaches level II (conventional thought) is expected to exhibit:

1.
Absolute obedience to authority
2.
Reasoning based on personal gain
3.
Personal internalization of other’s expectations
4.
Self-chosen ethical principles, universality, and impartiality

ANS: 3

At level II—conventional thought, the person sees moral reasoning based on his or her own personal internalization of societal and others’ expectations. In stage 1, the child’s response to a moral dilemma is in terms of absolute obedience to authority and rules. At level I—preconventional thought—the person reflects on moral reasoning based on personal gain. According to Kohlberg, stage 6 is when a person has self-chosen ethical principles, universality, and impartiality.

DIF: A REF: 144 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

9. According to Piaget, the infant is in the first period of development, which is characterized by:

1.
Concrete operations
2.
Preoperational thought
3.
Sensorimotor intelligence
4.
Identity versus role confusion

ANS: 3

According to Piaget, the infant is in the first period of development, which is characterized by sensorimotor intelligence. According to Piaget, children ages 7 to 11 are in the concrete operations period of development, which is characterized by having the ability to perform mental operations, while children ages 2 to 7 are in the preoperational period of development, which is characterized by the child learning to think with the use of symbols and mental images. Identity versus role confusion is a developmental stage (puberty) according to Erikson.

DIF: A REF: 142 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

10. A child’s understanding of the concept of ice becoming water, Piaget’s stage of cognitive development, is seen in:

1.
Sensorimotor
2.
Preoperational
3.
Formal operations
4.
Concrete operations

ANS: 4

During Piaget’s concrete operations stage of cognitive development, the child is able to understand that objects or quantities remain the same despite a change in their physical appearance, such as when ice becomes water. During Piaget’s sensorimotor stage of cognitive development, the child is exploring the environment but is unable to understand the concept of ice becoming water. During Piaget’s preoperational stage of cognitive development, the child is learning to think with the use of symbols and mental images but is not able to understand the concept of ice becoming water. According to Piaget’s formal operations stage of cognitive development, the individual’s thinking moves to abstract and theoretical subjects.

DIF: A REF: 142-143 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

11. The nurse in a pediatric health care setting is using Kohlberg’s developmental theory. A child is evaluated as having reached level I, the preconventional level, if the child:

1.
Makes sure that he or she is not late for school
2.
Cleans the blackboards after school for the teacher
3.
Runs for school council in order to change policies
4.
Stays away from peer groups that harass other children

ANS: 1

According to Kohlberg’s developmental theory of moral development, at level I, the preconventional level, the child’s reasoning is based on personal gain. The moral reason for acting relates to the consequences the person believes will occur. The child who makes sure not to be late for school may do so out of fear of punishment. Cleaning the blackboards after school for the teacher is an example of Kohlberg’s stage 3, good boy-nice girl orientation. The child desires to win the teacher’s approval. Running for school council to change policies is an example of Kohlberg’s stage 5 social contract orientation. Staying away from gangs at school that harass other children is an example of Kohlberg’s stage 4 society-maintaining orientation.

DIF: A REF: 144 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

12. In applying Gould’s developmental theory, the nurse anticipates that a client will have a greater concern for one’s health within the following theme and age-group:

1.
First theme (20s)
2.
Second theme (early 30s)
3.
Fourth theme (40s)
4.
Fifth theme (50s)

ANS: 4

During the fifth theme (50s), Gould finds a realization of mortality with a concern for one’s state of health. During the first theme (20s), Gould finds individuals wanting to get away from their parents. During the second theme (30s), Gould finds young adults working to accept who they are and to accept their growing children as being unique and separate. During the fourth theme (40s), Gould finds resignation and the belief that possibilities are limited.

DIF: A REF: 142 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

13. The nurse is working with a new mother who will require surgery. The follow-up treatment will interfere with bonding. In applying Freud’s theory, the nurse recognizes that the stage of development that may be affected is the:

1.
Oral stage
2.
Anal stage
3.
Phallic stage
4.
Latent stage

ANS: 1

According to Freud, disruption in the physical or emotional availability of the parent for the newborn (e.g., undergoing surgery) will affect the oral stage of development; the anal stage is from 12 to 18 months to 3 years, when the child is toilet-training; the phallic stage is from 3 to 6 years of age, when the child becomes interested in the genital organs; and the latent stage is from 6 to 12 years, when the child represses sexual urges and channels them into productive activities that are socially acceptable.

DIF: A REF: 138 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

14. In accordance with Erikson’s theory, it is expected by the nurse that a middle-aged adult client will be involved in the process of:

1.
Developing a sense of identity
2.
Searching for meaning in life
3.
Enhancing one’s capability to love others
4.
Expanding personal and social involvement

ANS: 4

In accordance with Erikson’s theory, the middle-aged adult client is involved in the process of expanding one’s personal and social involvement. Middle-aged adults should be able to see beyond their needs and accomplishments to the needs of society. Developing a sense of identity is in accordance with Erikson’s identity versus role confusion (puberty) stage of development. Searching for meaning in life is in accordance with Erikson’s integrity versus despair (old age) stage of development. Enhancing one’s capability to love others is in accordance with Erikson’s intimacy versus isolation (young adult) stage of development.

DIF: A REF: 140 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

15. The primary purpose for the nurse to understand human growth and development is to be best able to:

1.
Identify deviations from normal
2.
Select effective nursing interventions
3.
Be sensitive to age-appropriate needs
4.
Enhance nurse-client communication

ANS: 1

Understanding normal growth and development helps nurses predict, prevent, and detect any deviations from clients’ normal expected patterns. While being familiar with the characteristics of the various stages of human growth and development and being able to apply that knowledge to the individual client do have a positive impact on determining the most appropriate nursing interventions, the primary purpose is to predict, prevent, and detect any deviations from the client’s normal expected patterns. Although being familiar with the characteristics of the various stages of human growth and development and being able to apply that knowledge to the individual client do have a positive impact on identifying age-appropriate needs, the primary purpose is to predict, prevent, and detect any deviations from the client’s normal expected patterns. While being familiar with the characteristics of the various stages of human growth and development and being able to apply that knowledge to the individual client do have a positive impact on the nurse’s ability to communicate with the client in an appropriate manner, the primary purpose is to predict, prevent, and detect any deviations from the client’s normal expected patterns.

DIF: C REF: 137 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

16. Which of the following should the nurse consider first when assessing the cognitive ability of an older adult?

1.
A life-long bachelor
2.
Orphaned at age 12
3.
History of a chronic disease process
4.
Recent immigration to the United States

ANS: 4

Cognitive processes comprise changes in intelligence, ability to understand and use language, and the development of thinking that shapes an individual’s attitudes, beliefs, and behaviors. Recent immigration to the United States would present language and life experiences that should be considered by the nurse. Socioemotional processes consist of the variations that occur in an individual’s personality, emotions, and relationships with others during their lifetime. Being a bachelor and not having experienced a marital relationship should be considered by the nurse. Socioemotional processes consist of the variations that occur in an individual’s personality, emotions, and relationships with others during their lifetime. Being orphaned at a young age should be considered by the nurse. Biological processes produce changes in an individual’s physical growth and development. A chronic disease process should be considered by the nurse.

DIF: C REF: 142 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

17. A nurse caring for a 78-year-old client recently diagnosed with pneumonia will find Erikson’s psychosocial development theory most helpful in determining:

1.
Which needs the client will typically develop
2.
Which coping mechanisms the client will likely use
3.
How the client will respond to the respiratory problem
4.
How the client and his family will adjust to the stressors

ANS: 3

Developmental theories are important in helping nurses assess and treat a person’s response to an illness. Understanding and being able to apply the concepts of the theory will enable the nurse to determine a variety of generalized information that will assist in providing appropriate nursing care. The other options are only one area of information that is made available when applying Erikson’s psychosocial development theory.

DIF: C REF: 140 OBJ: Analysis

TOP: Nursing Process: Assessment/Planning

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

18. As described by Freud, the nurse recognizes that a young adult best shows a well-developed superego when he:

1.
Tells a friend that he’ll help him stop smoking
2.
Returns a lost wallet to a stranger who dropped it
3.
Arranges for a cab ride home after consuming alcohol
4.
Has 10% of his salary automatically transferred to savings

ANS: 3

Components of the human personality develop through Freud’s developmental stages. Freud believed that the functions of these components regulate behavior. These components are the id, the ego, and the superego. The superego performs regulating, restraining, and prohibiting actions. Often referred to as the conscience, the superego is influenced by the standards of outside social forces (i.e., the law). The ego represents the reality component mediating conflicts between the environment and the forces of the id. The ego helps us judge reality accurately, regulate impulses, and make good decisions.

DIF: C REF: 139 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

19. A nurse is preparing to discharge an 11-month-old child after a hospitalization for a viral infection. The nurse uses anticipatory guidance most effectively when:

1.
Encouraging the parents to limit visitors for 14 days
2.
Providing the parents with written discharge instructions
3.
Arranging the follow-up pediatrician appointment for the parents
4.
Informing the parents that the child may cry when taken to daycare

ANS: 4

A nurse’s use of anticipatory guidance (derived from an understanding of the characteristics shown by clients in the trust versus mistrust phase of development) will help parents cope with the hospitalization of an infant and the infant’s behaviors when discharged to home. The child’s sense of trust may be challenged during hospitalization and may need support from parents when returning home. Encouraging the parents to limit visitors for 14 days is more educational and related to the child’s physical recovery. Providing the parents with written discharge instructions is more educational and designed to reinforce the information. Arranging the follow-up pediatrician appointment for the parents is an action included in the discharge planning.

DIF: C REF: 139 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

20. Which of the following situations/statements best depicts Gould’s fourth theme of adult development?

1.
“When I made that decision, I didn’t expect it to turn out like it did.”
2.
“I have to take the opportunity to be my own boss and not rely on others.”
3.
“I think you can do anything if only you have your health and good friends.”
4.
“As much as I’d love to open my own shop, I just can’t take that kind of chance.”

ANS: 4

The fourth theme, identified in the 40s and called “the die is cast,” indicates resignation and the belief that possibilities are limited. The personality is set. Individuals believe changes in career are less likely to be successful. Parents are blamed for their lack of choices. Individuals face regret for mistakes made with children. The second theme occurs during the early 30s and asks, “Is what I am the only way for me to be?” This question occurs when young adults experience the consequences of the decisions of their independence. Gould’s development themes start when individuals are in their 20s with, “I have to get away from my parents.” This is challenged in minor ways before the end of high school but ends as young persons begin to live away from home. The move away from parental influence is gradual as young adults establish themselves as adults. During the 50s a decrease in negativism occurs. Gould finds a realization of mortality with a concern for one’s state of health.

DIF: C REF: 142 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

21. The nurse is caring for an older adult client who has reported symptoms suggestive of depression. Which of the following questions asked by the nurse is most therapeutic in assessing the client’s perception of the impact depression has had on her life?

1.
“What does it mean to be depressed?”
2.
“How does being depressed make you feel?”
3.
“Were you happy before becoming depressed?”
4.
“What makes you think that you are depressed?”

ANS: 1

Understanding the older person’s concept of depression assists nurses in explaining complementary and alternative treatment measures. Asking how depression make the client feel or whether the client was previously happy are best saved until the client defines depression and is open to the possibility of being depressed. Asking what makes the client think they are depressed could be interpreted as being somewhat threatening and may interfere with the client’s desire to talk about the situation.

DIF: C REF: 141 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

22. The nurse is caring for a 6-year-old child who is scheduled for outpatient surgery. Piaget’s theory of cognitive development suggests that the nurse can help the child cope with the stressors of this hospital experience best by:

1.
Arranging for the parents to be with the child until the anesthetic takes affect
2.
Explaining the entire process with the child using age-appropriate language
3.
Using play as a means of familiarizing the child with the events he will experience
4.
Providing the child with a coloring book that shows the events he will be experiencing

ANS: 3

Play becomes a primary means by which children foster their cognitive development and learn about the world. Nursing interventions during this period will recognize the use of play as the way the child understands the events taking place. You will assist parents in the use of play materials such as thermometers, blood pressure equipment, and play needles that will allow children to communicate feelings about health care procedures they experience. Arranging for the parents to be with the child until the anesthetic takes affect may be an appropriate intervention but it does not reflect effective care suggested by Piaget’s theory of cognitive development. Explaining the entire process with the child using age-appropriate language would be more appropriate for the older child. Providing the child with a coloring book that shows the events he will be experiencing

DIF: C REF: 142 OBJ: Analysis

TOP: Nursing Process: Planning/Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

23. Which of the following nursing responses is most therapeutic when made in response to a parent’s concern about her 3-year-old child’s tendency to “break the rules”?

1.
“Just keep reminding her of the rules.”
2.
“Daycare will help her learn to play fair.”
3.
“She will begin to understand that concept in a year or so.”
4.
“Add an age appropriate punishment for breaking the rules.”

ANS: 3

The first stage, heteronomous morality, occurs between 4 and 7 years and is characterized by a belief that rules are unchangeable and that when a rule is broken, there is imminent justice. Before that stage, the child is not able to fully understand rules or other moral issues. While telling the client to keep reminding her of the rules may be useful, it does not help assure the parent that the child is displaying normal, age-appropriate behavior. While socialization will often have a positive effect on a child’s sense of fair play, this option does not help assure the parent that the child is displaying normal, age-appropriate behavior. The child is too young to understand the concept that makes punishment effective in acquiring fair play.

DIF: C REF: 144 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

24. To help a comatose client’s family make a moral decision regarding the termination of life support, the nurse must first:

1.
Refrain from expressing his/her personal beliefs concerning the life support issue
2.
Provide the family with information regarding the process of terminating life support
3.
Determine whether the client had expressed any written or oral wishes regarding the issue
4.
Facilitate the family’s decision-making process by providing them with a quiet, private space for discussion

ANS: 1

Nurses need to know their own moral reasoning level. Recognizing one’s own moral developmental level is essential in separating your own beliefs from others when helping clients with their moral decision-making process. Information regarding the process of terminating life support should be provided only after the family makes their decision or has asked for the information. To not influence the family, the nurse must first refrain from interjecting any personal feelings about the termination of life support measures.

DIF: C REF: 145 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

25. Which of the following best describes a nurse thinking at stage 5 of Kohlberg’s Moral Developmental Theory?

1.
“The client has a right to decide whether or not to proceed with the treatment plan.”
2.
“The hospital’s policies and procedures are excellent tools for making client oriented decisions.”
3.
“It won’t be fair to expect to get every weekend and holiday off, so I’ll certainly work my share.”
4.
“If you don’t keep client information confidential you could be terminated immediately.”

ANS: 1

The individual also recognizes that different social groups have different values but believes that all rational people would agree on basic rights, such as liberty and life. (Stage 5: Social Contract Orientation). Moral decisions take into account societal perspectives. Right behavior is doing one’s duty, showing respect for authority, and maintaining the social order. (Stage 4: Society—Maintaining Orientation). The principles of justice require the individual to treat everyone in an impartial manner, respecting the basic dignity of all people, and guides the individual to base decisions on an equal respect for all. (Stage 6: Universal Ethical Principle Orientation). Avoidance of punishment or the unquestioning deference to authority is the characteristic motivation to behave. (Stage 1: Punishment and Obedience Orientation)

DIF: C REF: 144 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

26. Which of the following client statements made by an older adult best reflects an understanding of the decrease in physical strength and stamina in this developmental stage?

1.
“I know I’m not as young as I use to be.”
2.
“I just hire help with jobs I can’t do myself.”
3.
“You get older you can’t do as much, that’s life.”
4.
“I have to ask my son for help with the yard work.”

ANS: 2

A common behavioral task of the older adult client is adjusting to decreasing physical strength. This option reflects the best adjustment because the client has developed a plan for coping. While the other options appear to address the issue, they do not present any proof of the client’s healthy acceptance or adjustment to the decrease in physical strength and stamina.

DIF: C REF: 140 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Staff Education

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