Homework Lance
1. When caring for a middle-aged adult exhibiting maladaptive coping skills, the nurse is trying to determine the cause of the patient’s behavior. From a growth and development perspective, what should the nurse recall?
a.
Individuals have uniform patterns of growth and development.
b.
Health is promoted based on how many developmental failures a patient experiences.
c.
Culture usually has no effect on predictable patterns of growth and development.
d.
When individuals experience repeated developmental failures, inadequacies sometimes result.
ANS: D
“If individuals experience repeated developmental failures, inadequacies sometimes result” is a true statement. Developmental failures could manifest with ineffective coping skills. However, when an individual experiences successes, health is promoted. Patients have unique patterns of growth and development that are not uniform. Nurses must consider the influence of culture and context on growth and development.
DIF: Knowledge | Remember REF: 131
OBJ: Discuss factors influencing growth and development. TOP: Assessment
MSC: Health Promotion and Maintenance
2. The nursing instructor will need to provide further instruction to the student who states
a.
“Intellectual development is affected by cognitive processes.”
b.
“Socioemotional processes can influence an individual’s growth and development.”
c.
“Breast development is an example of a change resulting from biological processes.”
d.
“An individual’s biological processes determine physical characteristics and do not affect growth and development.”
ANS: D
Human growth and development is a complex pattern of movement that involves changes in biological, cognitive, and socioemotional processes. Cognitive processes comprise changes in intelligence, use of language, and development of thinking. Socioemotional processes consist of variations in personality, emotions, and relationships with others. Height and weight, development of gross and fine motor skills, and sexual maturation resulting from hormonal changes during puberty are examples of changes resulting from biological processes.
DIF: Understand REF: 131
OBJ: Discuss factors influencing growth and development. TOP: Assessment
MSC: Health Promotion and Maintenance
3. Which of these statements would be most appropriate for a nurse to state when assessing an adult patient for growth and developmental delays?
a.
“How many times per week do you exercise?”
b.
“Are you able to stand on one foot for 5 seconds?”
c.
“Would you please describe your usual activities during the day?”
d.
“How many hours a day do you spend watching television or sitting in front of a computer?”
ANS: C
Understanding normal growth and development helps nurses predict, prevent, and detect deviations from patients’ own expected patterns. The nurse can then compare expected patterns of activity based on age with the patient’s stated activity patterns to determine deviations from the patient’s own expected patterns. Asking the patient to describe his/her usual daily activities will provide the nurse with useful information about the patient’s own expected patterns. How many hours are spent watching television or in front of a computer and how many times the patient exercises in a week are closed-ended questions. These questions would not provide the nurse with as much information about the patient’s expected patterns when his/her stated patterns are compared with expected patterns for the patient’s age group to detect delays.
DIF: Apply REF: 130
OBJ: Discuss factors influencing growth and development. TOP: Assessment
MSC: Health Promotion and Maintenance
4. The nurse knows that a priority reason for being knowledgeable about biophysical developmental theories is to
a.
Understand how the physical body grows.
b.
Predict definite patterns of cognitive development.
c.
Anticipate how patients’ social behaviors develop.
d.
Describe the process of psychological development.
ANS: A
Biophysical development refers to how our physical bodies grow and change. Nurses and other health care providers are able to quantify and compare the changes that occur as a newborn infant grows into adulthood against established norms to detect abnormalities. Biophysical development refers to physical growth, not cognitive development, social behaviors, or psychological development.
DIF: Knowledge REF: 131 OBJ: Describe biophysical developmental theories.
TOP: Assessment MSC: Health Promotion and Maintenance
5. While assessing an 18-month-old toddler, the nurse distinguishes normal from abnormal findings by remembering that Gesell’s theory of development states
a.
“The developmental stage of the toddler is affected solely by environmental influence.”
b.
“Developmental patterns are not affected by gene activity.”
c.
“Skill development should be identical to that of other toddlers in the playroom.”
d.
“Environmental influence does not affect the sequence of development.”
ANS: D
Gesell’s theory of development states that environment plays a part in child development, but it does not have any part in the sequence of development. Other factors influencing growth and development include biological, cognitive, and socioemotional processes. Environmental factors support, change, and modify the pattern of development, but they do not generate progressions of development. Each child’s pattern of growth and development is unique and is directed by gene activity. Not every child develops certain skills at the same time. Children grow according to their own genetic blueprint.
DIF: Understand REF: 131 OBJ: Describe biophysical developmental theories.
TOP: Assessment MSC: Health Promotion and Maintenance
6. When utilizing Freud’s psychoanalytical/psychosocial theory, the nurse recalls that
a.
Adult personality is the result of resolved conflicts between sources of sexual pleasure and the mandates of reality.
b.
Development occurs throughout the life span and focuses on psychosocial stages.
c.
The genital stage precedes the phallic stage of development.
d.
Problems evident in adult life are due to early successes and resolution of earlier developmental stages.
ANS: A
Freud believed that adult personality is the result of how an individual resolved conflicts between sources of sexual pleasure and the mandates of reality. Freud had a strong influence on Erik Erikson, but Erikson’s theory differed from Freud’s in that it focused on psychosocial stages rather than psychosexual stages. Freud’s five stages of psychoanalytical development in sequential order include oral, anal, phallic, latency, and genital. The phallic stage precedes the genital stage. In theory, problems in adult life would be due to unresolved conflicts and failures.
DIF: Knowledge REF: 131-132
OBJ: Describe and compare the psychoanalytical/psychosocial theories proposed by Freud and Erikson. TOP: Assessment MSC: Health Promotion and Maintenance
7. The nurse is teaching a young adult couple about promoting the health of their 8-year-old child. The nurse knows that the parents understand the developmental stage their child is in according to Erikson when they state, “We should
a.
Provide proper support for learning new skills.”
b.
Encourage devoted relationships with others.”
c.
Limit choices and provide harsh punishment for mistakes.”
d.
Not leave our child at school for longer than 3 hours at a time.”
ANS: A
An 8-year-child would be in the industry versus inferiority stage of development. During this stage, the child needs to be praised for accomplishments such as learning new skills. Developing devoted relationships is part of the identity versus role confusion stage, usually occurring during puberty. During the autonomy versus shame and doubt stage, limiting choices and harsh punishment lead to feelings of shame and doubt. Separation anxiety is usually a part of the trust versus mistrust stage.
DIF: Understand REF: 131-132
OBJ: Describe and compare the psychoanalytical/psychosocial theories proposed by Freud and Erikson. TOP: Evaluation MSC: Health Promotion and Maintenance
8. Jean Piaget’s cognitive developmental theory focuses on four stages of development, including
a.
Formal operations.
b.
Intimacy versus isolation.
c.
Latency.
d.
The postconventional level.
ANS: A
Jean Piaget’s theory includes four stages in sequential order: sensorimotor, preoperational, concrete operations, and formal operations. Intimacy versus isolation is part of Erik Erikson’s psychosocial theory of development. Latency is stage 4 of Freud’s five-stage psychosexual theory of development. The postconventional level of reasoning is part of Kohlberg’s theory of moral development.
DIF: Knowledge REF: 134 OBJ: Describe Piaget’s theory of cognitive development.
TOP: Assessment MSC: Health Promotion and Maintenance
9. According to Piaget’s formal operations level, a 13-year-old adolescent will likely
a.
Hit other students to deal with environmental change.
b.
Use play to understand her surroundings.
c.
Question her parents about an upcoming presidential election.
d.
Question where the ice is hiding when ice has melted in her drink.
ANS: C
In the formal operations period, adolescents and young adults begin to think about such subjects as achieving world peace, finding justice, and seeking meaning in life. Asking about a presidential election demonstrates that the adolescent is concerned about political issues that affect others besides her. Hitting would be a common schema during the sensorimotor stage of development. Using play to learn about the environment is indicative of the preoperational stage. During the concrete operations stage (ages 6 to 12 years), children are able to coordinate two concrete perspectives in social and scientific thinking, such as understanding the difference between “hiding” and “melting.”
DIF: Understand REF: 134 OBJ: Describe Piaget’s theory of cognitive development.
TOP: Assessment MSC: Health Promotion and Maintenance
10. According to Piaget’s theory of cognitive development, the nurse should allow a hospitalized 4-year-old patient to safely play with
a.
The pump administering intravenous fluids.
b.
The blood pressure cuff.
c.
A baseball bat.
d.
A book to read alone in a quiet place.
ANS: B
A 4-year-old child would be in the preoperational period. Children at this stage are still egocentric. Play is very important to foster cognitive development. Children should be allowed to play with any equipment that is safe and should be allowed to communicate feelings about their health care. The IV pump is not a safe piece of equipment for a 4-year-old child to play with. A baseball bat typically is not found in a hospital setting and is a potentially dangerous toy to play with in the hospital. The blood pressure cuff is a safer option. A 4-year-old child is of preschool age and more than likely is not able to read yet. Also, the book does not allow for any human interaction and communication if read alone.
DIF: Apply REF: 134 OBJ: Describe Piaget’s theory of cognitive development.
TOP: Planning MSC: Health Promotion and Maintenance; Safe Effective Care Environment
11. Which of these manifestations, if identified in a 6-year-old patient, should the nurse associate with a possible developmental delay based on Piaget’s theory?
a.
The child speaks in complete sentences but often talks only about himself.
b.
The child still plays with a favorite doll that he has had since he was a toddler.
c.
The child continues to suck his thumb.
d.
The child describes an event from his own perspective, even though the entire family was present.
ANS: C
This is a characteristic of the sensorimotor stage (birth to 2 years), where schemas become self-initiated activities. For example, the infant who learns that sucking achieves a pleasing result generalizes the action to suck fingers, blanket, or clothing. Successful achievement leads to greater exploration. By age 6, the child is in the preoperational stage of development. The child is expected to be egocentric, even though language ability is progressing. Play becomes a primary means by which children foster their cognitive development; therefore playing with a doll is considered normal at this age. Children see objects and persons from only one point of view—their own—at this stage.
DIF: Analyze REF: 134 OBJ: Describe Piaget’s theory of cognitive development.
TOP: Assessment MSC: Health Promotion and Maintenance
12. An 18-month-old patient is brought into the clinic for evaluation because the mother is concerned. The 18-month-old child hits her siblings and says only “No” when communicating verbally. According to Piaget’s theory, what recommendation should the nurse make a priority?
a.
Consult the social worker because the child is hitting other children.
b.
Reassure the mother that the child is developmentally within specified norms.
c.
Encourage the mother to seek psychological counseling for the child.
d.
Remove all toys from the child’s room until this behavior ceases.
ANS: C
At 18 months, the child is in the sensorimotor period of development. Piaget describes hitting, looking, grasping, and kicking as normal schemas to deal with the environment. The social worker does not need to be consulted in this case, nor is psychological counseling warranted, because the child is exhibiting normal behaviors. Play is an important part of all children’s development. Removing the toys is not necessary because this child is exhibiting normal behaviors. Removing toys and the opportunity to play with them may actually hinder the child’s development.
DIF: Evaluate REF: 134 OBJ: Describe Piaget’s theory of cognitive development.
TOP: Implementation MSC: Health Promotion and Maintenance
13. A formerly independent and active older adult becomes severely withdrawn upon admission to a nursing home. When approaching this patient, which intervention should the nurse plan first?
a.
Offer a reward for participation in all events.
b.
Encourage the patient to attend all social events scheduled for the patients.
c.
Allow the patient to incorporate personal belongings into her room.
d.
Advise the patient of the importance of attending mandatory activities.
ANS: C
The older adult is in the mature thinking stages of development according to Piaget and Kohlberg. According to Gould, the older adult needs help in realistically appreciating his/her accomplishments and in fostering continued development. Erikson’s theory proposes that the older adult faces integrity versus despair. To avoid despair, the nurse should allow the patient to actively participate in an independent activity, such as preparing his/her own room with personal belongings. Offering a reward does not address the need for continued independence. Encouraging participation in social events again does not address independence, and the question is asking for the best first intervention. Advising the patient to attend all mandatory activities as the first intervention does not allow for the patient’s independence. Some activities may be mandatory, but by first allowing the patient to decorate her room, the nurse is fostering independence and is helping the patient feel welcome and more at home.
DIF: Apply REF: 132| 134-135
OBJ: Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Planning MSC: Health Promotion and Maintenance
14. The parents of a 14-year-old boy express concern over their child’s rebellious behavior. The nurse should plan to respond to the parents’ concern by informing them that their
a.
Child should be referred to a juvenile correctional facility.
b.
Child’s behavior is normal because the adolescent is trying to adjust to his emerging identity.
c.
Child’s behavior is a matter of concern because he is likely conflicted about establishing companionship with a partner.
d.
Child’s behavior is expected because he is expressing his need to support future generations.
ANS: B
According to Erikson, a 14-year-old adolescent is developing his identity versus role confusion. A teenager is very concerned with self and is often preoccupied with body image. Frequently, teenagers express themselves rebelliously as they struggle to discover their own identities. Rebellious behavior is very common and normal at this stage of development. A juvenile correctional facility usually is not necessary. Establishing companionship occurs in the young adult age group. Feeling the need to support future generations is usually experienced by the middle-aged adult.
DIF: Apply REF: 132
OBJ: Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Planning MSC: Health Promotion and Maintenance
15. The teaching plan for a 3-year-old child who is at risk for developmental delay should include which of these instructions for the parents?
a.
Encourage play as your child is exploring his or her surroundings.
b.
Insist that your child discuss various points of view, not just his or her own.
c.
Discuss world events with your child to foster language development.
d.
Actively encourage your child to read lengthy books to expedite reading and writing abilities.
ANS: A
A 3-year-old child is going to use play to learn and discover the surrounding environment. Children at this age are egocentric and often are unable to see the world from any perspective other than their own. Very young children are not able to understand and comment on world events because their thinking has not advanced to abstract reasoning yet. A 3-year-old child is likely unable to read. Asking a child to perform an activity that is beyond his or her developmental abilities will likely result in frustration at not being able to complete the task.
DIF: Plan REF: 132
OBJ: Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Application MSC: Health Promotion and Maintenance
16. A nurse should instruct the parents of a 10-year-old child to keep which of the following theoretical principles in mind when dealing with a behavioral problem at home?
a.
Strategies that worked well with the first child will be equally as effective for the second child.
b.
Encourage the child to volunteer some time at a local hospital to instill a sense of fulfillment.
c.
Bargaining about chores in exchange for privileges may be an effective method of encouraging helpful activities.
d.
Do not offer praise for accomplishments and punishment for behavioral issues.
ANS: C
In the concrete operations period, children begin to cooperate and share new information about the acts they perform. Parents will be able to adjust their approaches to guide the child into helpful activities within the home, such as bargaining about chores in exchange for privileges. With the birth of a second child, most parents find that the strategies that worked well with the first child no longer work at all. After birth, children grow according to their genetic blueprint and gain skills in an orderly fashion, but at each individual’s own pace. The need for a sense of fulfillment is usually experienced by middle-aged adults, not children. School-aged children need praise to discourage a sense of inferiority; providing praise is the best choice for encouraging positive behaviors while nurturing growth and development.
DIF: Understand REF: 132| 134
OBJ: Discuss nursing implications for the application of developmental principles to patient care.
TOP: Implementation MSC: Health Promotion and Maintenance
17. The parents of a 15-month-old child express concern to the nurse about their child’s thumb-sucking habit. Which of these explanations related to the child’s age and developmental level would be most appropriate for the nurse to give the parents?
a.
Thumb sucking at this age indicates a developmental delay and should be further assessed.
b.
Sucking achieves a pleasing result for infants, and generalizing that action by thumb sucking is normal.
c.
Thumb sucking at this age demonstrates a transition away from egocentric thinking.
d.
At this age, thumb sucking will enhance language development.
ANS: B
Action patterns are used by infants and toddlers to deal with the environment. For example, the infant who learns that sucking achieves a pleasing result generalizes that action to suck fingers, blankets, or clothing. Children remain egocentric into the preoperational period. Thumb sucking does not indicate transition away from egocentric thinking. No statements have supported thumb sucking as enhancing language development.
DIF: Apply REF: 132| 134
OBJ: Discuss nursing implications for the application of developmental principles to patient care.
TOP: Implementation MSC: Health Promotion and Maintenance
18. Which of these approaches would be most appropriate for the nurse to use when teaching a 4-year-old patient about a scheduled surgery?
a.
Give the parents a book to read about the procedure and do not discuss the procedure with the child to decrease anxiety.
b.
Set boundaries before teaching by telling the child that she can ask only three questions because time is limited.
c.
Insist that the parents wait outside the room to ensure privacy of the child.
d.
Allow the child to touch and hold medical equipment such as thermometers and syringes.
ANS: D
Nursing interventions during the preoperational period (age 2 to 7 years) should recognize the use of play (such as handling equipment) to help the child understand the events taking place. Giving the parents a book and not involving the child is not the best option, because the nurse should explain all procedures to children and their parents. Children tend to ask a lot of questions; therefore limiting questions may increase anxiety. Parents and the child all should be involved in preoperative teaching because the parents will be the primary caregivers upon discharge.
DIF: Apply REF: 134
OBJ: Discuss nursing implications for the application of developmental principles to patient care.
TOP: Implementation MSC: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. When developing a plan of care concerning growth and development for a hospitalized adolescent, what should the nurse do? (Select all that apply.)
a.
Stick with one developmental theory for consistency.
b.
Apply developmental theories when making observations of the individual’s patterns of growth and development.
c.
Compare the individual’s assessment findings versus established normal findings.
d.
Recognize his/her own moral developmental level.
e.
Apply a unidimensional life span perspective.
ANS: B, C, D
No one theory successfully describes all the intricacies of human growth and development. Today’s nurses need to be knowledgeable about several theoretical perspectives when working with patients. These theories form the basis for meaningful observation of an individual’s pattern of growth and development. They provide important guidelines for an understanding of important human processes that allows the nurse to begin to predict human responses, not medical diagnoses, and to recognize deviations from the norm. Recognizing your own moral developmental level is essential in separating your own beliefs from those of others when helping patients with their moral decision-making process. Growth and development, as supported by a life span perspective, is multidimensional.
DIF: Understand REF: 136
OBJ: Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Planning MSC: Health Promotion and Maintenance
2. The nurse is planning playroom activities for a hospitalized 6-year-old patient. Which of the following age appropriate items that the nurse should ensure are available? (Select all that apply.)
a.
Crayons and paper
b.
Children’s books
c.
500-piece puzzle
d.
Building blocks
e.
Magazines and newspapers
ANS: A, B, D
A school-aged child thrives on feelings of accomplishment. Drawing pictures, looking at children’s books, and building blocks are all ways that a child this age could play while developing a sense of accomplishment. A 500-piece puzzle would be too difficult for a 6-year-old child to complete without the possibility of getting frustrated. Magazines and newspapers would be written at too high a reading level for a 6-year-old child. If play items offered to the child are too difficult, the child may become frustrated and may experience a feeling of inferiority.
DIF: Apply REF: 132
OBJ: Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Planning MSC: Health Promotion and Maintenance
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