Conception Through Adolescence

1. To promote parent-child attachment with a healthy newborn, what should the nurse do?

a.
Encourage close physical contact as soon as possible after birth.
b.
Do not allow the newborn to remain with parents until the second hour after delivery.
c.
Never leave the newborn alone with the mother during the first 8 hours after delivery.
d.
Isolate the newborn in the nursery during the first hour after delivery.

ANS: A

After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents’ and newborn’s need for close physical contact. Early parent-child interaction encourages parent-child attachment. Most healthy newborns are awake and alert for the first half-hour after birth. This is a good time for parent-child interaction to begin. No evidence in the question stem suggests that the baby cannot be left alone with the parents during the first 8 hours, or that the baby should remain in the nursery during the first hour.

DIF: Knowledge REF: 140

OBJ: Discuss common physiologic and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Assessment

MSC: Health Promotion and Maintenance

2. The nurse knows that the mother of a newborn understands associated health risks to her baby when she states

a.
“I need to moisten the umbilical cord every hour during the day until the cord falls off.”
b.
“I need to remind anyone who wants to hold the baby to wash their hands.”
c.
“I need to leave the blankets off the baby to prevent smothering.”
d.
“I can throw away the bulb syringe now because my baby is breathing on her own.”

ANS: B

Prevention of infection is a major concern in the care of the newborn. Good handwashing technique is the most important factor in protecting the newborn from infection. The umbilical stump should be kept clean and dry. Newborns are susceptible to heat loss and cold stress. Place the new born directly on the mother’s abdomen, and cover him or her in warm blankets, making sure to keep the head well covered, or placed unclothed in an infant warmer with a temperature probe in place. Removal of nasopharyngeal and oropharyngeal secretions remains a priority of care to maintain a patent airway.

DIF: Understand REF: 140-141

OBJ: Discuss common physiologic and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Assessment

MSC: Health Promotion and Maintenance

3. The priority assessment immediately after birth is to

a.
Assess infant-parent interactions.
b.
Promote parent-newborn physical contact.
c.
Open the airway.
d.
Assess gestational age.

ANS: C

The most extreme physiologic change occurs when the newborn leaves the in utero circulation and develops independent respiratory functioning. Direct nursing care includes maintaining an open airway, stabilizing and maintaining body temperature, and protecting the newborn from infection. After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents’ and newborn’s need for close physical contact. Following a comprehensive physical assessment, the nurse assesses gestational age and interactions between infant and parents.

DIF: Apply REF: 140-141

OBJ: Discuss common physiologic and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Assessment

MSC: Physiologic Integrity

4. Immediate intervention is needed when the newborn exhibits

a.
A soft, protuberant abdomen.
b.
Molding.
c.
Lack of reflexes.
d.
Cyanotic hands and feet.

ANS: C

Normal reflexes include blinking in response to bright lights, startling in response to sudden loud noises, and sucking, rooting, grasping, yawning, coughing, sneezing, and hiccoughing. Assessment of these reflexes is vital because the newborn depends largely on reflexes for survival and in response to its environment. Normal physical characteristics include the continued presence of lanugo on the skin of the back; cyanosis of the hands and feet for the first 24 hours; and a soft, protuberant abdomen. Molding, or overlapping of the soft skull bones, allows the fetal head to adjust to various diameters of the maternal pelvis and is a common occurrence with vaginal births.

DIF: Apply REF: 140-141

OBJ: Discuss common physiologic and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Assessment

MSC: Physiological Integrity

5. Normal physical findings in a healthy newborn include

a.
Sporadic motor movements.
b.
Cyanosis of the feet and hands for the first 48 hours.
c.
Triangle-shaped anterior fontanel.
d.
Weight of 4800 grams.

ANS: A

Movements in the newborn are generally sporadic, but they are symmetric and involve all four extremities. Cyanosis of the hands and feet is normal for the first 24 hours, not 48 hours. The diamond shape of the anterior fontanel and the triangular shape of the posterior fontanel are found between the unfused bones of the skull. The expected, normal weight of a healthy newborn is between 2700 and 4000 grams (6 to 9 pounds).

DIF: Knowledge REF: 140-141| 143

OBJ: Describe characteristics of physical growth of the unborn child from birth to adolescence.

TOP: Assessment MSC: Physiologic Integrity

6. The nursing instructor will need to provide further instruction to the student who states, “Development proceeds

a.
In a proximal-distal pattern.”
b.
In a cephalocaudal pattern.”
c.
At a slower rate during the embryonic stage.”
d.
At a predictive rate from the moment of conception.”

ANS: C

From the moment of conception, human development proceeds at a predictive and rapid rate. During gestation or the prenatal period, the embryo grows from a single cell to a complex physiologic being. Development proceeds in a cephalocaudal and proximal-distal pattern.

DIF: Understand REF: 139-140

OBJ: Describe characteristics of physical growth of the unborn child from birth to adolescence.

TOP: Assessment MSC: Health Promotion and Maintenance

7. When comparing physical growth patterns between school-aged children and adolescents, the nurse notes that

a.
Physical growth usually slows during the adolescent period.
b.
Boys usually exceed girls in height and weight by the end of the school years.
c.
Secondary sex characteristics usually develop during the adolescent years.
d.
The distribution of muscle and fat remains constant during the adolescent years.

ANS: C

Hormonal changes during adolescence contribute to the development of secondary sex characteristics such as hair growth and voice changes. Physical growth usually slows during the school-aged period, and then a growth spurt occurs during adolescence. Girls usually exceed boys in height and weight by the end of the school years. As height and weight increase during adolescence, the distribution of muscle and fat changes.

DIF: Understand REF: 149| 151-152

OBJ: Describe characteristics of physical growth of the unborn child from birth to adolescence.

TOP: Assessment MSC: Health Promotion and Maintenance

8. A mother brings her child to the clinic for a 12-month well visit. The child weighed 6 pounds 2 ounces and was 21 inches long at birth. What finding indicates that the child needs further assessment?

a.
Height of 30 inches
b.
Weight of 16 pounds
c.
The infant is not yet potty-trained.
d.
The infant is not yet walking up stairs.

ANS: B

Size increases rapidly during the first year of life. Birth weight doubles in approximately 5 months and triples by 12 months. This infant should weigh at least 18 pounds by this calculation. This child needs further assessment. Height increases an average of 1 inch during each of the first 6 months and about 1/2 inch each month until 12 months: 21 + 6 + 3 = 30 (30 inches is the predicted height). Patterns of body function are just now starting to stabilize. It is quite normal for a 12-month-old child to not be potty-trained or walking up stairs yet. These milestones usually occur in the toddler period of development (12 to 36 months). In the toddler stage, rapid development of motor skills allows the child to participate in self-care activities such as feeding, dressing, and toileting. Soon the child begins to navigate stairs, using a rail or the wall to maintain balance.

DIF: Apply REF: 143-144| 146

OBJ: Describe characteristics of physical growth of the unborn child from birth to adolescence.

TOP: Assessment MSC: Health Promotion and Maintenance | Physiologic Integrity

9. Which of the following is characteristic of the cognitive changes in a preschooler?

a.
The ability to think in a logical manner about the here and now
b.
The ability to think abstractly and deal effectively with hypothetical problems
c.
The inability to assume the view of another person and to use symbols to represent others
d.
The ability to classify objects by size or color

ANS: D

Preschoolers demonstrate their ability to think more complexly by classifying objects according to size or color. Cognitive changes that provide the ability to think in a logical manner about the here and now and to understand the relationships between things and ideas occur during the school-aged years. It is during the teenaged years when the individual thinks abstractly and deals effectively with hypothetical problems. The toddler is unable to assume the view of another. Toddlers also use symbols to represent objects, places, and persons.

DIF: Knowledge REF: 146-150| 152

OBJ: Describe cognitive and psychosocial development from birth to adolescence.

TOP: Assessment MSC: Health Promotion and Maintenance

10. The nursing instructor will need to provide further instruction to the student who uses which of these statements when describing the differences between cognitive and psychosocial development in children?

a.
“The preschooler develops the ability to play in small groups.”
b.
“The toddler may participate in parallel play.”
c.
“The school-aged child still requires total assistance in all activities for safety.”
d.
“The toddler period is a time of potential frustration manifested by temper tantrums.”

ANS: C

The care provider should promote independence within safe limits for the school-aged child. The school-aged child, according to Erikson, is in the industry versus inferiority stage of development. The school-aged child likes to perform tasks by himself when possible and needs to be praised for those tasks. The child continues to engage in solitary play during toddlerhood but also begins to participate in parallel play, which is playing beside rather than with another child. The toddler’s strong will is frequently exhibited in negative behavior when caregivers attempt to direct his actions. Temper tantrums result when parental restrictions frustrate toddlers.

DIF: Understand REF: 146-148

OBJ: Describe cognitive and psychosocial development from birth to adolescence.

TOP: Assessment MSC: Health Promotion and Maintenance

11. The nurse is observing his 2-year-old hospitalized patient in the playroom. The nurse is most likely to observe the child

a.
Participating as the leader of a small group activity.
b.
Sitting beside another child while playing with blocks.
c.
Separating building blocks into groups by size and color.
d.
Seeking out same sex children to play with.

ANS: B

The child beside another child and playing is exhibiting parallel play, characteristic of a toddler. Participating as a group leader does not usually occur until around age 5. Preschoolers (ages 3 to 5) demonstrate their ability to think more complexly by classifying objects according to size or color. A 2-year-old child does not have this ability yet. The play of preschool children becomes more social after the third birthday as it shifts from parallel to associative play. However, gender does not become a factor until the child reaches school age, when she prefers same sex peers to opposite sex peers.

DIF: Apply REF: 146| 148| 150

OBJ: Describe cognitive and psychosocial development from birth to adolescence.

TOP: Assessment MSC: Health Promotion and Maintenance

12. When communicating with a newly admitted teenaged patient, the nurse should

a.
Avoid questioning the patient about cigarette use when she observes a cigarette lighter lying on the bedside table.
b.
Complete the admission database as quickly as possible by asking yes and no questions.
c.
Ignore the patient’s withdrawn behavior.
d.
Observe for congruency between the patient’s facial expressions and verbal responses.

ANS: D

Good communication skills are critical for adolescents. Following are some hints for communicating with adolescents: Do not avoid discussing sensitive issues. Asking questions about sex, drugs, and school opens the channels for further discussion. Ask open-ended questions. Yes and no questions are closed-ended questions. Look for meaning behind their words and actions. The nurse should inquire about a patient’s withdrawn behavior to seek out the meaning of such behaviors. Be alert to clues to their emotional state. The nurse should observe that the patient’s statements are congruent with his/her facial expressions of emotion.

DIF: Apply REF: 152

OBJ: Describe cognitive and psychosocial development from birth to adolescence.

TOP: Assessment MSC: Health Promotion and Maintenance

13. During infant/child development, play is best recognized as

a.
A means to interact with the environment and relate to others.
b.
Independent of cognitive and social development.
c.
Nonexploratory and simply play.
d.
Too soon to achieve milestones.

ANS: A

During infancy, play is a meaningful set of activities through which the child interacts with the environment and relates to others. Play provides opportunities for development of cognitive, social, and motor skills. Much of infant play is exploratory as infants use their senses to observe and examine their own bodies and objects of interest in their surroundings. Adults facilitate infant learning by planning activities that promote the development of milestones and by providing toys that are safe for the infant to explore with the mouth and manipulate with the hands.

DIF: Knowledge REF: 144

OBJ: Explain the role of play in the development of a child. TOP: Assessment

MSC: Health Promotion and Maintenance

14. Which statement by the nurse best explains the importance of play during the toddler stage of development?

a.
“Exploration can suppress the toddler’s curiosity to promote safety.”
b.
“Parental control during play will eliminate the frustration of learning self-control.”
c.
“Play can enhance cognitive and psychosocial development.”
d.
“Play will enhance the toddler’s ability to explore the environment safely without supervision.”

ANS: C

Play can enhance cognitive and psychosocial development. The toddler’s curiosity is evident in his or her exploration of the environment. Children strive for independence. Their strong wills are frequently exhibited in negative behavior when caregivers attempt to direct their actions. Temper tantrums result when parental restrictions frustrate toddlers. Parents need to provide toddlers with graded independence, allowing them to do things that do not result in harm to themselves or others.

DIF: Understand REF: 146

OBJ: Explain the role of play in the development of a child. TOP: Assessment

MSC: Health Promotion and Maintenance

15. After comparing appropriate play activities for infants and preschool children, the nurse should appropriately offer which of the following activities to an infant?

a.
Set of cards to organize and separate into groups
b.
Set of plastic stacking rings
c.
Paperback book
d.
Set of sock puppets with movable eyes

ANS: B

Play becomes manipulative as the child learns control of the hands. Adults facilitate infant learning by planning activities that promote the development of milestones, and by providing toys that are safe for the infant to explore with the mouth and manipulate with the hands, such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Preschoolers demonstrate their ability to think more complexly by classifying objects according to size or color, making the cards more appropriate for them. Neither group is ready for paperback books. The sock puppet with movable eyes could create a choking hazard if one of the eyes comes off.

DIF: Understand REF: 144| 148

OBJ: Explain the role of play in the development of a child. TOP: Implementation

MSC: Health Promotion and Maintenance

16. A mother expresses concern because her 5-year-old child frequently talks about friends who don’t exist. What is the nurse’s best response to this mother’s concern?

a.
“Have you considered a child psychological evaluation?”
b.
“It’s very normal for a 5-year-old child to have imaginary playmates.”
c.
“You should stop your child from playing electronic games.”
d.
“Pretend play is a sign your child watches too much television.”

ANS: B

At age 5, some children have imaginary playmates. Imaginary playmates are a sign of health and allow the child to distinguish between reality and fantasy. The child does not need a psychological evaluation based on this information. Television, videos, electronic games, and computer programs help support development and the learning of basic skills. However, these should be only one part of the child’s total play activities.

DIF: Apply REF: 148

OBJ: Explain the role of play in the development of a child. TOP: Implementation

MSC: Health Promotion and Maintenance

17. Encouraging children to play a game of kickball would be best suited for which age group?

a.
Infant
b.
Toddler
c.
Preschool
d.
School-aged

ANS: D

A game of kickball would be best suited for school-aged children because in this age group, play involves peers and the pursuit of group goals. Although solitary activities are not eliminated, group play overshadows them. Younger children typically are not able to participate cooperatively in groups yet. Infants begin to play simple social games such as patty-cake and peek-a-boo. Toddlers engage in solitary play but also begin to participate in parallel play. Preschoolers playing together engage in similar if not identical activities; however, no division of labor nor rigid organization nor rules are observed. By the age of 5, the group has a temporary leader for each activity.

DIF: Apply REF: 144| 146| 148| 150

OBJ: Explain the role of play in the development of a child. TOP: Implementation

MSC: Health Promotion and Maintenance

18. Which of these manifestations, if identified in a school-aged child during a routine assessment, should a nurse associate with a possible developmental delay or problem?

a.
Withdrawn demeanor and verbalizes that he has no friends
b.
Absence of secondary sex characteristics
c.
Lack of peer relationships
d.
Curiosity about his or her sexuality

ANS: A

School-aged children should begin to develop friendships and to socialize with others. Interaction with peers allows them to define their own accomplishments in relation to others as they work to develop a positive self-image. The absence of secondary sex characteristics is a major concern of adolescents, not school-aged children, because physical evidence of maturity encourages the development of masculine and feminine behaviors in the adolescent. Lack of peer relationships is also a concern of adolescents, not of school-aged children, because adolescents seek a group identity to fulfill their esteem and acceptance needs. Today many researchers believe that school-aged children have a great deal of curiosity about their sexuality. Some experiment, but this play is usually transitory.

DIF: Analyze REF: 150| 152

OBJ: Explain the role of play in the development of a child. TOP: Assessment

MSC: Health Promotion and Maintenance

19. The nurse who is teaching a parent about developmental needs of the infant knows that the parent has verbalized understanding of a infant’s developmental needs when he states

a.
“My child is too young to understand words.”
b.
“My child will begin to speak in sentences by 1 year of age.”
c.
“My child will probably enjoy playing peek-a-boo.”
d.
“While my child is in the hospital, I should let the nurses provide most of the care.”

ANS: C

By 9 months, infants play simple social games such as patty-cake and peek-a-boo. By 1 year, infants not only recognize their own names but are able to say three to five words and understand almost 100 words. Extended separations from parents complicate the attachment process and increase the number of caregivers with whom they must interact. Ideally, the parents provide most of the care during hospitalizations.

DIF: Apply REF: 143-144

OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs.

TOP: Assessment MSC: Health Promotion and Maintenance

20. During hospitalization, the nurse should encourage the parents of an 8-month-old infant to

a.
Provide as much care as possible.
b.
Not worry about attachments because the infant is too young to develop them.
c.
Remember that infants cannot differentiate a stranger from a familiar person.
d.
Relax and allow nursing staff to care for the child at all times.

ANS: A

Extended separations from parents complicate the attachment process and increase the number of caregivers with whom the infant must interact. Ideally, the parents provide most of the care during hospitalizations. Close attachment to the primary caregivers, most often parents, usually occurs by this age. Infants seek out these persons for support and comfort during times of stress. By 8 months, most infants are able to differentiate a stranger from a familiar person and respond differently to the two.

DIF: Apply REF: 143-144

OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs.

TOP: Implementation MSC: Health Promotion and Maintenance

21. The nursing student correctly explains health promotion teaching points for parents of toddlers when she states

a.
“Setting consistent, firm limits will help the child cope with the frustration of learning self-control.”
b.
“Slower development of motor skills prevents the child from participating in self-care activities.”
c.
“Toddlers have a natural sense of right and wrong and know when they do something wrong.”
d.
“Temper tantrums should never be tolerated, and toddlers need to do what they are told.”

ANS: A

Firm consistent limits, patience, and support allow toddlers to develop socially acceptable behaviors and to cope with the frustration of learning self-control. Rapid development of motor skills allows the child to participate in self-care activities such as feeding, dressing, and toileting. Because children’s moral development is closely associated with their cognitive abilities, the moral development of toddlers is only beginning. Toddlers do not understand concepts of right and wrong. Temper tantrums result when parental restrictions frustrate toddlers. Parents need to provide toddlers with graded independence, allowing them to do things that do not result in harm to themselves or others.

DIF: Apply REF: 146-147

OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs.

TOP: Implementation MSC: Health Promotion and Maintenance

22. The nursing student is preparing a teaching project for parents of school-aged children. Which statement correctly identifies health risks in this age group?

a.
“School-aged children are more likely to suffer from unintentional injury.”
b.
“The risk for infection is not a major concern of this age group as immunity develops.”
c.
“Mental retardation, learning disorders, and malnutrition are prevalent across all socioeconomic categories.”
d.
“Poor nutrition and lack of immunizations continue to be health concerns for children of the poor.”

ANS: D

Infant mortality, dental problems, poor nutrition, and lack of immunizations continue to be major health concerns for uninsured or impoverished families. Accidents and injuries are major health problems affecting school-aged children. They now have more exposure to various environments and less supervision, but their developed cognitive and motor skills make them less likely to suffer from unintentional injury. Infections account for most childhood illnesses. Mental retardation, learning disorders, and malnutrition are far more prevalent among children living in poverty.

DIF: Apply REF: 149-150

OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs.

TOP: Implementation MSC: Health Promotion and Maintenance

23. Which of these statements, if made by a parent, would require further instruction?

a.
“I should not be surprised that my teenager has so many friends.”
b.
“I get worried because my teenager thinks he’s indestructible. He takes a lot of risks.”
c.
“I should cover for my school-aged child when he makes a mistake until he learns the ropes.”
d.
“My 10-year-old child is always hungry right after school, so I usually fix him a nutritious snack.”

ANS: C

School and home influence growth and development, requiring adjustment by parents and by the child. The child learns to cope with rules and expectations presented by the school and by peers. Parents have to learn to allow their child to make decisions, accept responsibility, and learn from life’s experiences. Teenagers typically are very social and have many friends. Adolescents seek a group identity because they need esteem and acceptance. By midadolescence, adolescents believe that they are unique and the exception, giving rise to their risk-taking behaviors. Obesity occurs because children often rush into the home after school or play and eat the most easily obtainable and appealing foods. Providing nutritious snacks is often the best way to ensure good nutritional intake.

DIF: Evaluate REF: 151-154

OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs.

TOP: Implementation MSC: Health Promotion and Maintenance

24. Which of these toys, if selected by the parent of a 10-month-old child, would indicate that the parent has a correct understanding of infant growth and development?

a.
A game requiring two to four players
b.
Electronic games
c.
Small, plastic alphabet letters and magnets
d.
Plastic stacking rings

ANS: D

Adults facilitate infant learning by planning activities that promote the development of milestones and by providing toys that are safe for the infant to explore with the mouth and manipulate with the hands, such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Infants are not capable of participating in small group activities. By age 4, children play in groups of two or three. For the toddler (not the infant), television, videos, electronic games, and computer programs help support development and learning of basic skills. Adults should provide toys that are safe for the infant to explore with the mouth. Small, plastic letters and magnets could be choking hazards for an infant.

DIF: Evaluate REF: 144| 146| 148

OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs.

TOP: Implementation MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. The nurse should instruct the parents of an adolescent about which of the following health concerns? (Select all that apply.)

a.
Signs of substance abuse
b.
Suicide prevention
c.
Safe sex practices
d.
Pregnancy
e.
Gonadotropic hormone stimulation
f.
Voice changes

ANS: A, B, C, D

All adolescents are at risk for experimental or recreational substance use because some believe that substance use makes them more mature. Suicide is the third leading cause of death in adolescents. Sexually transmitted diseases annually affect 3 million sexually active adolescents. Adolescent pregnancy continues to be a major social challenge for our nation. Gonadotropic hormones stimulate ovarian cells to produce estrogen and testicular cells to produce testosterone. These hormones are normally occurring and contribute to the development of secondary sex characteristics, such as hair growth and voice changes, and play an essential role in reproduction.

DIF: Understand REF: 153-154

OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs.

TOP: Implementation MSC: Health Promotion and Maintenance