Health Promotion for the Developing Child

MULTIPLE CHOICE

1. A nurse is reviewing developmental concepts for infants and children. Which statement best describes development in infants and children?

a.
Development, a predictable and orderly process, occurs at varying rates within normal limits.
b.
Development is primarily related to the growth in the number and size of cells.
c.
Development occurs in a proximodistal direction with fine muscle development occurring first.
d.
Development is more easily and accurately measured than growth.

ANS: A

Development, a continuous orderly process, provides the basis for increases in the child’s function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. An increase in the number and size of cells is a definition for growth. Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods.

DIF: Cognitive Level: Comprehension REF: p. 50|p. 52

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

2. Frequent developmental assessments are important for which reason?

a.
Stable developmental periods during infancy provide an opportunity to identify any delays or deficits.
b.
Infants need stimulation specific to the stage of development.
c.
Critical periods of development occur during childhood.
d.
Child development is unpredictable and needs monitoring.

ANS: C

Critical periods are blocks of time during which children are ready to master specific developmental tasks. Children can master these tasks more easily during particular periods of time in their growth and developmental process. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development are orderly and proceed in a predictable pattern on the basis of each individual’s abilities and potentials.

DIF: Cognitive Level: Comprehension REF: p. 52

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

3. Which factor has the greatest influence on child growth and development?

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

ANS: C

Genetic factors (heredity) determine each individual’s growth and developmental rate. Although factors such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate the effect of the genetic endowment, which is permanent. Culture is a significant factor that influences how children grow toward adulthood. Culture influences both growth and development but does not eliminate inborn genetic influences. Environment has a significant role in determining growth and development both before and after birth. The environment can influence how and to which extent genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics. Nutrition is critical for growth and plays a significant role throughout childhood.

DIF: Cognitive Level: Comprehension REF: pp. 52-53

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

4. A nurse is planning a teaching session with a child. According to Piagetian theory, the period of cognitive development in which the child is able to distinguish fact from fantasy is the _____ period of cognitive development.

a.
sensorimotor
b.
formal operations
c.
concrete operations
d.
preoperational

ANS: C

Concrete operations is the period of cognitive development in which children’s thinking is shifted from egocentric to being able to see another’s point of view. They develop the ability to distinguish fact from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infant’s world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. The preoperational stage is a period of egocentrism in which the child’s judgments are illogical and dominated by magical thinking and animism.

DIF: Cognitive Level: Application REF: pp. 56-57

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is:

a.
Erikson.
b.
Freud.
c.
Kohlberg.
d.
Piaget.

ANS: A

Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development in which certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget’s. Jean Piaget’s cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.

DIF: Cognitive Level: Comprehension REF: p. 57

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

6. What does the nurse need to know when observing chronically ill children at play?

a.
Play is not important to hospitalized children.
b.
Children need to have structured play periods.
c.
Children’s play is an indication of a child’s response to treatment.
d.
Play is to be discouraged because it tires hospitalized children.

ANS: C

Play for all children is an activity woven with meaning and purpose and is a mechanism for mastering their environment. For chronically ill children, play can indicate their state of wellness and response to treatment. Play is important to all children in all environments. Although children’s play activities appear unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on. Children who have fewer energy reserves still require play. For these children, less-active play activities will be important.

DIF: Cognitive Level: Application REF: p. 66

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

7. Which child is most likely to be frightened by hospitalization?

a.
A 4-month-old infant admitted with a diagnosis of bronchiolitis
b.
A 2-year-old toddler admitted for cystic fibrosis
c.
A 9-year-old child hospitalized with a fractured femur
d.
A 15-year-old adolescent admitted for abdominal pain

ANS: B

Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. Young infants are not as likely to be frightened as toddlers by hospitalization because they are not as aware of the environment. The 9-year-old child’s cognitive ability is sufficient enough for the child to understand the reason for the hospitalization. The 15-year-old adolescent has the cognitive ability to interpret the reason for the hospitalization.

DIF: Cognitive Level: Comprehension REF: p. 56

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

8. Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of inheritance for the disease?

a.
“My babies will probably not have neurofibromatosis.”
b.
“My babies have a 50% chance of having neurofibromatosis.”
c.
“Whether my babies have problems depends on the father.”
d.
“My babies have a 25% chance of having neurofibromatosis.”

ANS: B

Neurofibromatosis is an autosomal dominant genetic disorder that occurs when the abnormal gene is carried on the affected chromosome with a normal gene. Because the abnormal gene is dominant, an individual with the defective gene has a 50% chance of transmitting the defect to an infant with each pregnancy. Neurofibromatosis is not a sex-linked genetic disease; therefore, either the father or the mother genetically transfers it to the infant. A parent with the defective gene will genetically transfer either a normal or abnormal gene to an infant. Because the defective gene is dominant, there is a 50% probability of the child inheriting the disease.

DIF: Cognitive Level: Application REF: p. 61

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

9. During a routine healthcare visit, a parent asks the nurse why her 9-month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates an understanding of child development?

a.
“She’s a little slow.”
b.
“If she is pulling up, you can help her by holding her hand.”
c.
“Babies progress at different rates. Your infant’s development is within normal limits.”
d.
“Maybe she needs to see a behavioral specialist.”

ANS: C

Ninety percent of infants walk by 14 months of age. The infant is within normal developmental limits. It is inappropriate for the nurse to state that the infant is a little slow. Infants will walk when they are developmentally ready. “Hurrying” an infant does not result in the developmental task being achieved at an earlier time period. Consulting a behavioral specialist for diagnostic evaluation is indicated when a child demonstrates developmental delays. The child has no evidence of a delay.

DIF: Cognitive Level: Application REF: p. 52

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

10. Which “expected outcome” would be developmentally appropriate for a hospitalized 4-year-old child?

a.
The child will be dressed and fed by the parents.
b.
The child will independently ask for play materials or other personal needs.
c.
The child will be able to verbalize an understanding of the reason for the hospitalization.
d.
The child will have a parent stay in the room at all times.

ANS: B

Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrate developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4-year-old child cannot be expected to cognitively understand the reason for his or her hospitalization. Expecting the child to verbalize an understanding for the hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.

DIF: Cognitive Level: Application REF: p. 55

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

11. A nurse has completed a teaching session with parents of preschool aged children. Which statement made by the parent identifies an appropriate level of language development for a 4-year-old child?

a.
The child has a vocabulary of 300 words and uses simple sentences.
b.
The child uses correct grammar in sentences.
c.
The child is able to pronounce consonants clearly.
d.
The child uses language to express abstract thought.

ANS: B

The 4-year-old child is able to use correct grammar in sentence structure and typically has difficulty in pronouncing consonants. Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child. The use of language to express abstract thought is developmentally appropriate for the adolescent.

DIF: Cognitive Level: Application REF: p. 58

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

12. Which should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)?

a.
The child’s height and weight
b.
The parent’s ability to comprehend the results
c.
The child’s mood
d.
The parent–child interaction

ANS: C

The results of the screening test are valid if the child acted in a normal and expected manner. The child’s height and weight are not relevant to the DDST-II screening process. The parent’s ability to understand the results of the screening is not relevant to the validity of the test. The parent–child interaction is not significantly relevant to the test results.

DIF: Cognitive Level: Application REF: p. 65

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

13. Which children are at greater risk for not receiving immunizations?

a.
Children who attend licensed day care programs
b.
Children entering school
c.
Children who are home schooled
d.
Young adults entering college

ANS: C

Home schooled children are at risk for being underimmunized and need to be monitored. All states require immunizations for children in day care programs and entering school. Most colleges require a record of immunizations as part of a health history.

DIF: Cognitive Level: Comprehension REF: p. 70

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

14. Which developmental assessment instrument is appropriate to assess a 5-year-old child?

a.
Brazelton Behavioral Scale
b.
Denver Developmental Screening Test II (DDST-II)
c.
Dubowitz Scale
d.
New Ballard Scale

ANS: B

The DDST-II is used for infants and children between birth and 6 years of age. Brazelton’s Behavioral Scale is used for newborn assessment. The Dubowitz Scale is used for estimation of gestational age. The New Ballard Scale is used for newborn screening.

DIF: Cognitive Level: Application REF: p. 65

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

15. A 2-month-old child has not received any immunizations. Which immunizations should the nurse give?

a.
DTaP, Hib, HepB, IPV, varicella
b.
DTaP, Hib, HepB, MMR, IPV
c.
DTaP, Hib, HepB, PCV, IPV, rotavirus
d.
DTaP, Hib, HepB, PCV, IPV, HepA

ANS: C

DTaP, Hib, HepB, PCV, IPV, and rotavirus are appropriate immunizations for an unimmunized 2-month-old child. The child should not receive varicella until at or after 12 months of age. MMR is not given to children until at or after 12 months of age. HepA is recommended for all children at 1 year of age.

DIF: Cognitive Level: Application REF: pp. 68-69

OBJ: Nursing Process Step: Analysis MSC: Health Promotion and Maintenance

16. You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunizationcannot be given?

a.
DTaP
b.
HepA
c.
IPV
d.
Varicella

ANS: D

Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine, and should not be given except in special circumstances. DTaP, HepA, and IPV can be safely given.

DIF: Cognitive Level: Analysis REF: p. 71

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

17. Which immunization can cause fever and rash to occur 1 to 2 weeks after administration?

a.
HepB
b.
DTaP
c.
Hib
d.
MMR

ANS: D

MMR is a live virus vaccine and can cause fever and rash 1 to 2 weeks after administration. HepB, DTaP, and Hib do not cause fever or rash.

DIF: Cognitive Level: Application REF: p. 70

OBJ: Nursing Process Step: Analysis MSC: Physiological Integrity

MULTIPLE RESPONSE

1. The nurse is preparing immunizations for a healthy 11-year-old boy who has received all his primary immunizations. Which immunizations will the nurse consider? Select all that apply.

a.
Meningococcal
b.
DTaP
c.
OPV
d.
Smallpox

ANS: A, B

Meningococcal conjugate vaccine should be given to all children at age 11 to 12 years. The American Academy of Pediatrics recommends one dose of DTaP vaccine for children at age 11 to 12 years, as long as they have received the primary DTaP series. Oral polio vaccine is no longer administered in the U.S. The current smallpox vaccine is not recommended for healthy, low-risk children younger than 18 years of age.

DIF: Cognitive Level: Application REF: pp. 68-69

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

2. Parents of a 4-month-old child ask the nurse what they can do to help relieve the discomfort of teething. The nurse should include which suggestions for the parents? Select all that apply.

a.
Provide warm liquids.
b.
Rub the gums with aspirin.
c.
Over-the-counter topical medications for gum pain relief can be used as directed.
d.
Administer acetaminophen (Tylenol) as directed.
e.
Provide a hard food such as a frozen bagel for chewing.

ANS: C, D, E

To help parents cope with teething, nurses can suggest that they provide cool liquids and hard foods (e.g., dry toast, Popsicles, frozen bagels) for chewing. Hard, cold teethers and ice wrapped in cloth may also provide comfort for inflamed gums. Nurses should explain to parents that over-the-counter topical medications for gum pain relief should be used only as directed. Home remedies, such as rubbing the gums with whiskey or aspirin, should be discouraged, but acetaminophen administered as directed for the child’s age can relieve discomfort.

DIF: Cognitive Level: Application REF: p. 52|p. 78

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

OTHER

1. Place in order the gross motor developmental milestones a nurse expects to assess in an infant. Begin with the earliest gross motor milestone expected and progress to the last gross motor milestone attained.

a. Turns from abdomen to back

b. Lifts head off of bed when in a prone position

c. Walks holding on to furniture

d. Turns from back to abdomen

e. Sits unsupported

ANS:

B, A, D, E, C

The infant lifts its head off of the bed when in a prone position at 3 months, turns from abdomen to back at 4 to 5 months, turns from back to abdomen at 6 to 7 months, sits unsupported at 8 to 9 months, and can walk holding on to furniture at 10 to 12 months.

DIF: Cognitive Level: Analysis REF: p. 93

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance