Developmental Influences on Child Health Promotion

1. The head-to-tail direction of growth is referred to as which of the following? a. Cephalocaudal
b. Proximodistal
c. Mass to specific

d. Sequential

ANS: A
a. The first pattern of development is the head-to-tail, or cephalocaudal, direction. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time.
b. Proximodistal, or near to far, is the second pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands.
c. This is not a specific pattern of development.
d. In all dimensions of growth, a definite, sequential pattern is followed.

DIF: Cognitive Level: Comprehension REF: Page 72
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

2. Which of the following refers to those times in an individual’s life when he or she is more susceptible to positive or negative influences?
a. Sensitive period
b. Sequential period

c. Terminal points
d. Differentiation points

ANS: A
a. Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences.
b, c, and d. These developmental times do not make the organism more susceptible to environmental interaction.

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TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance: Developmental

Test Bank 5-2

Stages and Transitions

3. An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year?
a. 14
b. 16

c. 18 d. 21

ANS: D
d. In general birth, weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday.
a, b, and c. These weights are below what would be expected for an infant with a birth weight of 7 pounds.

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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

4. By what age does birth length usually double? a. 1 year

b. 2 years c. 4 years d. 6 years

ANS: C
c. Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average, most children have doubled their birth length at age 4 years.
a and b. This is too young for doubling of length.
d. Most children will have achieved the doubling by age 4 years.

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MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

5. After age 7 years, school-age children usually grow how many inches per year? a. 1

b. 2 c. 3 d. 4

ANS: B
b. The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. a. This is too small an amount.

Test Bank 5-3

c and d. This is greater than the average yearly growth after age 7 years.

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MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

6. How does the onset of the pubertal growth spurt compare in girls and boys? a. It occurs earlier in boys.
b. It occurs earlier in girls.
c. It is about the same in both boys and girls.

d. In both boys and girls, it depends on their growth in infancy.

ANS: B
b. Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys.
a and c. The average earliest age at onset is 1 year earlier for girls.
d. There does not appear to be a relation to growth during infancy.

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MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

7. A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on which of the following?
a. Growth cannot be predicted.

b. Pubertal growth spurt lasts about 1 year.
c. Mature height is achieved when menarche occurs.
d. Approximately 95% of mature height is achieved when menarche occurs.

ANS: D
d. At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed.
a. Although growth cannot be definitively predicted, on average, 95% of adult height has been reached with the onset of menstruation.
b. This answer does not address the girl’s question.
c. Young women usually will grow approximately 5% more after the onset of menstruation.

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TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

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Test Bank 5-4

8. A child’s skeletal age is best determined by which of the following? a. Assessment of dentition
b. Assessment of height over time
c. Facial bone development

d. Radiographs of the hand and wrist

ANS: D
d. The most accurate measure of skeletal age is radiologic examinations of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age.
a. Age of tooth eruption has considerable variation in children. It would not be a good determinant of skeletal age.
b. This will provide a record of the child’s height, but not skeletal age.
c. Facial bone development will not reflect the child’s skeletal age, which is determined by radiographic assessment.

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MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

9. Trauma to which of the following sites can result in a growth problem for children’s long bones?

a. Matrix
b. Connective tissue
c. Calcified cartilage
d. Epiphyseal cartilage plate

ANS: D
d. This is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity.
a, b, and c. These are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones.

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TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

10. Lymphoid tissues such as lymph nodes are: a. adult size by age 1 year.
b. adult size by age 13 years.
c. half their adult size by age 5 years.

d. twice their adult size by age 10 to 12 years. ANS: D

Test Bank 5-5

d. Lymph nodes increase rapidly and reach adult size at approximately age 6 years. They continue growing until they reach maximal development at age 10 to 12 years, which is twice their adult size. A rapid decline in size occurs until they reach adult size by the end of adolescence.

a, b, and c. Adult size is reached at age 6 years and then at the end of adolescence.

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MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

11. Which of the following statements is true about the basal metabolic rate (BMR) in children?

a. Is reduced by fever
b. Is slightly higher in boys than in girls at all ages
c. Increases with age of child
d. Decreases as proportion of surface area to body mass increases

ANS: B
b. The BMR is the rate of metabolism when the body is at rest. At all ages, the rate is slightly higher in boys than in girls.
a. The rate is increased by fever.
c and d. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.

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MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

12. A mother reports that her 6-year-old child is highly active, irritable, and irregular in habits and that she adapts slowly to new routines, people, or situations. According to Chess and Thomas, which of the following categories of temperament would best describe this child?

a. Easy child
b. Difficult child
c. Slow-to-warm-up child d. Fast-to-warm-up child

ANS: B
b. This is a description of difficult children, which compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums.

Test Bank 5-6

a. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. c. These children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description.

d. This is not one of the categories identified by Chess and Thomas.

DIF: Cognitive Level: Comprehension REF:
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

13. By the time children reach their twelfth birthday, they should have learned to trust others and should have developed a sense of which of the following?
a. Identity
b. Industry

c. Integrity d. Intimacy

ANS: B
b. This is the developmental task of school-age children. By age 12 years, children engage in tasks that they can carry through to completion. They learn to compete and cooperate with others, and they learn rules.
a. Identity vs role confusion is the developmental task of adolescence.
c and d. These are not developmental tasks of childhood.

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MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

14. The predominant characteristic of the intellectual development of the child ages 2 to 7 years is egocentricity. Which of the following best describes this concept?
a. Selfishness
b. Self-centeredness

c. Preferring to play alone
d. Unable to put self in another’s place

ANS: D
d. According to Piaget, this age child is in the preoperational stage of development. Children interpret objects and events not in terms of their general properties, but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another’s place.
a, b, and c. These do not describe the concept of egocentricity.

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TOP: Integrated Process: Nursing Process: Problem Identification

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Test Bank 5-7

MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

15. The nurse is observing parents playing with their 10-month-old daughter. Which of the following should the nurse recognize as evidence that the child is developing object permanence?
a. Looks for the toy parents hide under the blanket

b. Returns the blocks to the same spot on the table
c. Recognizes that a ball of clay is the same when flattened out d. Bangs two cubes held in her hands

ANS: A
a. Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed.
b. This is not an example of object permanence.
c. This is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years.
d. This is a simple repetitive activity characteristic of developing a sense of cause and effect.

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MSC: Area of Client Needs: Health Promotion and Maintenance: Developmental Stages and Transitions

16. A father tells the nurse that his child is “filling up the house with collections” like seashells, bottle caps, baseball cards, and pennies. The nurse should recognize that the child is developing which of the following?
a. Object permanence

b. Preoperational thinking
c. Concrete operational thinking d. Ability to use abstract symbols

ANS: C
c. During concrete operations, children develop logical thought processes. They are able to classify, sort, order, and otherwise organize facts about the world. This ability fosters the child’s ability to create collections.
a. Object permanence is the realization that items that leave the visual field still exist. This is a task of infancy and does not contribute to collections.
b. Preoperational thinking is concrete and tangible. Children in this age-group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Collections are not typical for this developmental level.
d. The ability to use abstract symbols is a characteristic of formal operations, which develops during adolescence. These children can develop and test hypotheses.

DIF: Cognitive Level: Comprehension REF: Page 81
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 5-8

TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

17. Which of the following is characteristic of the preoperational stage of cognitive development?

a. Thinking is logical.
b. Thinking is concrete.
c. Reasoning is inductive.
d. Generalizations can be made.

ANS: B
b. Preoperational thinking is concrete and tangible. Children in this age-group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations.
a, c, and d. Increasingly logical thought, inductive reasoning, and the ability to make generalizations are characteristic of the concrete operations stage of development, ages 7 to 11 years.

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MSC: Area of Client Needs: Health Promotion and Maintenance: Developmental Stages and Transitions

18. Which of the following behaviors is most characteristic of the concrete operations stage of cognitive development?
a. Progression from reflex activity to imitative behavior
b. Inability to put oneself in another’s place

c. Increasingly logical and coherent thought processes
d. Ability to think in abstract terms and draw logical conclusions

ANS: C
c. During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child’s ability to classify, sort, order, and organize facts to use in problem solving.
a. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development.
b. The inability to put oneself in another’s place is characteristic of the preoperational stage of development.
d. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.

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Test Bank 5-9

19. According to Kohlberg, children develop moral reasoning as they mature. Which of the following is most characteristic of a preschooler’s stage of moral development? a. Obeying the rules of correct behavior is important.
b. Showing respect for authority is important behavior.

c. Behavior that pleases others is considered good.
d. Actions are determined as good or bad in terms of their consequences.

ANS: D
d. Preschoolers are most likely to exhibit characteristics of Kohlberg’s preconventional level of moral development. During this stage, they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions.
a, b, and c. These are characteristic of Kohlberg’s conventional level of moral development.

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20. At what age do children tend to imitate the religious gestures and behaviors of others without understanding their significance?
a. Toddlerhood
b. Young school-age period

c. Older school-age period d. Adolescence

ANS: A
a. Toddlerhood is a time of imitative behavior. Children will copy the behavior of others without comprehending any significance or meaning to the activities.
b and c. During the school-age period, most children develop a strong interest in religion. The existence of a deity is accepted, and petitions to an omnipotent being are important.
d. Although adolescents become more skeptical and uncertain about religious beliefs, they do understand the significance of religious rituals.

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MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

21. A toddler playing with sand and water would be participating in: a. skill play.

b. dramatic play.
c. social-affective play. d. sense-pleasure play.

Test Bank 5-10

ANS: D
d. The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment.
a. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities.
b. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize.
c. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people.

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22. In what type of play are children engaged in similar or identical activity, without organization, division of labor, or mutual goal?
a. Solitary
b. Parallel

c. Associative d. Cooperative

ANS: C
c. In associative play, no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists.
a. Solitary play describes children playing alone with toys different from those used by other children in the same area.
b. Parallel play describes children playing independently but being among other children.
d. Cooperative play is organized. Children play in a group with other children who play activities for a common goal.

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MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

23. The nurse observes some children in the playroom. Which of the following play situations exhibits the characteristics of parallel play?
a. Kimberly and Amanda sharing clay to each make things
b. Brian playing with his truck next to Kristina playing with her truck

c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother’s lap

Test Bank 5-11

b. This is an example of parallel play. Both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play.
a. This is characteristic of associative play.
c. This is characteristic of cooperative play.

d. This is an example of solitary play.

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MSC: Area of Client Needs: Health Promotion and Maintenance: Developmental Stages and Transitions

24. Three children playing a board game would be an example of: a. solitary play.

b. parallel play.
c. associative play. d. cooperative play.

ANS: D
d. Using a board game requires cooperative play. The children must be able to play in a group and carry out the formal game.
a, b, and c. In these stages, children do not play in a group with a common goal.

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25. Which one of the following functions of play is a major component of play at all ages?

a. Creativity
b. Socialization
c. Intellectual development d. Sensorimotor activity

ANS: D
d. Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation.
a, b, and c. These are each functions of play that are major components at different ages.

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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Developmental Stages and Transitions

Test Bank 5-12

26. Which one of the following statements is true about toy safety? a. Adults should be the only ones who select toys.
b. Adults should be alert to notices of recalls by manufacturers. c. Government agencies inspect all toys on the market.

d. Evaluation of toy safety is a joint effort between children and adults.

ANS: B
b. Adults should be involved in the selection of toys for children to ensure that they are safe and age appropriate. Once the child is using a toy, the adult should be alert to manufacturer recalls.
a. The child and adult should be involved in the joint process of toy selection.
c. Government agencies do not inspect all toys for sale. The U.S. Consumer Products Safety Commission does keep track of potentially dangerous and recalled toys.
d. Children do not have the ability to determine the safety of a toy. It is the adult’s responsibility.

DIF: Cognitive Level: Comprehension REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

27. What is probably the single most important influence on growth at all stages of development?

a. Nutrition
b. Heredity
c. Culture
d. Environment

ANS: A
a. Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life.
b, c, and d. Each of these contributes to the child’s growth and development. However, good nutrition is essential throughout the life span for optimal health.

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28. Which one of the following strategies would be the least appropriate for a child to use to cope?

a. Learning problem solving
b. Listening to music
c. Having parents solve problems d. Using relaxation techniques

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Test Bank 5-13

ANS: C
c. Children respond to everyday stress by trying to change the circumstances or trying to adjust to the circumstances the way they are. Strategies that provide relaxation and other stress-reduction techniques should be used. An inappropriate response would be for the parents to solve the problems. Some children develop socially unacceptable strategies such as lying, stealing, or cheating.
a, b, and d. These are positive approaches for coping in children.

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MSC: AreaofClientNeeds:PsychosocialIntegrity:CopingMechanisms

29. A parent tells the school nurse that her first-grade child watches television about 4 hours per day. When discussing this issue with the parent, the nurse should consider which of the following?
a. The length of time watching TV is not important if the programs are educational. b. The length of time watching TV is not important if child is doing well in school. c. Parents should supervise the amount and type of TV programs their children

watch.
d. Most children watch this much TV without any negative effects.

ANS: C
c. Supervising the amount and type of television programs watched by their children is an important parental role. In addition, the parents should be teaching the child how to be a consumer of television programming.
a, b, and d. The American Academy of Pediatrics recommends limiting television viewing to no more than 2 hours each day. The sedentary nature of watching television is usually accompanied by eating, which contributes to high levels of cholesterol and obesity. Evidence also suggests a relationship between television viewing and the use of alcohol or tobacco, violence and aggressive behavior, the use of guns to commit violent acts, and early sexual activity.

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MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

30. Which of the following should the elementary school nurse consider when discussing television and movie viewing with parents?
a. Children usually ignore advertisements on television.
b. Alcohol and tobacco use can be encouraged by television and movies.
c. Children become more physically active when watching television and movies. d. No evidence exists that television and movies affect aggressive behavior.

ANS: B

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Test Bank 5-14

b. Television programs, movies, and commercials contain many implicit and explicit messages that promote alcohol consumption, smoking, violence, and promiscuous or unsafe sexual activity.
a. Children often cannot discriminate between the advertisements and the television programming.

c. Television viewing is a passive activity. As the amount of time a child spends watching television increases, participation in physical activity decreases.
d. In addition to the evidence linking television viewing with aggressive behavior, there is a link to the use of alcohol and tobacco.

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TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

MULTIPLE RESPONSE

1. Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves the following function(s). (Select all that apply.)
a. Intellectual development

b. Physical development
c. Socialization
d. Creativity
e. Temperament development

ANS: A, C, D
a, c, and d. A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play.
b. Physical development depends on many factors; play is not one of them.
e. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but not the child’s temperament attributes, may be modified through play.

DIF: Cognitive Level: Comprehension REF: Page 85
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