Chapter 32: developmental influences

Question 1

1. What is the term for head-to-tail direction of growth?
   a. Cephalocaudal
   b. Proximodistal
   c. Mass to specific
   d. Sequential

Answer 1

ANS: A
The first pattern of development is in 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. 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. Mass to specific is not a pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.

Question 2

2. Which 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

Answer 2

ANS: 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. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.

Question 3

3. If an infant weighed 3 kg at birth, how much would he or she be expected to weigh at age 1 year?
   a. 6
   b. 9
   c. 12
   d. 15

Answer 3

ANS: B
In general, birth weight triples by the end of the first year of life. For an infant who was 3 kg at birth, 9 kg would be the anticipated weight at the first birthday. A weight of 6 kg is below what one would anticipate, and weights of 12 and 15 kg are above what would be expected for an infant with a birth weight of 3 kg.

Question 4

4. 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.

Answer 4

ANS: B
Girls seem to be more advanced in physiological growth at all ages than boys. There does not appear to be a relation to growth during infancy.

Question 5

5. How is a child’s skeletal age best determined?
   a. Assessment of dentition
   b. Assessment of height over time
   c. Facial bone development
   d. Radiographs of the hand and wrist

Answer 5

ANS: D
The most accurate measure of skeletal age is radiological 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. Age of tooth eruption varies considerably in children, so it would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child’s height, not skeletal age. Facial bone development does not reflect the child’s skeletal age, which is determined by radiographic assessment.

Question 6

6. Trauma to which site can result in a growth problem for children’s long bones?
   a. Matrix
   b. Connective tissue
   c. Calcified cartilage
   d. Epiphyseal cartilage plate

Answer 6

ANS: 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. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma at these sites will not result in growth problems for the long bones.

Question 7

7. Which is true about lymphoid tissues such as lymph nodes?
   a. They reach adult size by age 1 year.
   b. They reach adult size by age 13.
   c. They reach half their adult size by age 5.
   d. They are twice their adult size by age 10 to 12.

Answer 7

ANS: D
Lymph nodes grow 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 lymph node size occurs until they reach adult size by the end of adolescence.

Question 8

8. Which is true about the basal metabolic rate (BMR) in children?
   a. It is reduced by fever.
   b. It is slightly higher in boys than it is in girls at all ages.
   c. It increases with the age of the child.
   d. It decreases as the proportion of surface area to body mass increases.

Answer 8

ANS: 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 it is in girls. The rate is increased by fever. The BMR is highest in infancy and then is closely related to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.

Question 9

9. A mother reports that her 6-year-old child is highly active and irritable. She has irregular habits and adapts slowly to new routines, people, or situations. According to Chess and Thomas, which temperament category best describes this child?
   a. Easy child
   b. Difficult child
   c. Slow-to-warm-up child
   d. Fast-to-warm-up child

Answer 9

ANS: B
This is a description of a difficult child, who 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. 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. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. Fast-to-warm-up children is not one of the categories identified by Chess and Thomas.

Question 10

10. By the time children reach their twelfth birthday, which should they have developed a sense of according to Erikson?
    a. Identity
    b. Industry
    c. Integrity
    d. Intimacy

Answer 10

ANS: B
Industry 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. Identity versus role confusion is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.

Question 11

11. The predominant characteristic of the intellectual development for children ages 2 to 7 years is egocentrism. What best describes this concept?
    a. Selfishness
    b. Self-centredness
    c. A preference for playing alone
    d. Inability to put oneself in another’s place

Answer 11

ANS: D
According to Piaget, a child this age is in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their own relationships to them. This egocentrism does not allow children in this age group to put themselves in another’s place. Selfishness, self-centredness, and preferring to play alone do not describe the concept of egocentricity.

Question 12

12. The nurse is observing parents playing with their 10-month-old daughter. What should the nurse recognize as evidence that the child is developing object permanence?
    a. The child looks for the toy parents hide under the blanket.
    b. The child returns the blocks to the same spot on the table.
    c. The child recognizes that a ball of clay is the same when flattened out.
    d. The child bangs two cubes held in her hands.

Answer 12

ANS: 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 she has developed a sense of object permanence. Returning blocks to the same spot on a table is not an example of object permanence. Recognizing a ball of clay is the same when flat is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years of age. Banging cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect

Question 13

13. Which is a 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.

Answer 13

ANS: B
Preoperational thinking is concrete and tangible. Children in this stage of development cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Increasingly logical thought, inductive reasoning, and the ability to make generalizations are characteristic of the concrete operations stage of development that takes place from 7 to 11 years of age.

Question 14

14. Which behaviour is most characteristic of the concrete operations stage in cognitive development?
    a. Progression from reflex activity to imitative behaviour
    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

Answer 14

ANS: C
During the concrete operations stage of development, which occurs approximately between the ages of 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. The progression from reflex activity to imitative behaviour is characteristic of the sensorimotor stage of development. The inability to put oneself in another’s place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.

Question 15

15. According to Kohlberg, children develop moral reasoning as they mature. What characteristic is most descriptive of the preschooler’s stage of moral development?
    a. Obeying the rules of correct behaviour is important.
    b. Showing respect for authority is important behaviour.
    c. Behaviour that pleases others is considered good.
    d. Actions are determined good or bad in terms of their consequences.

Answer 15

ANS: 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. Obeying rules of correct behaviour, showing respect for authority, and knowing behaviour that pleases others are characteristic of Kohlberg’s conventional level of moral development.

Question 16

16. At what age do children tend to imitate the religious gestures and behaviours of others without understanding their significance?
    a. Toddlerhood
    b. Younger school-age period
    c. Older school-age period
    d. Adolescence

Answer 16

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

Question 17

17. A toddler playing with sand and water is engaging in what type of play?
    a. Skill
    b. Dramatic
    c. Social-affective
    d. Sense-pleasure

Answer 17

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

Question 18

18. What type of play involves children engaged in a similar or identical activity without organization, division of labour, or a mutual goal?
    a. Solitary
    b. Parallel
    c. Associative d. Cooperative

Answer 18

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

Question 19

19. The nurse observes some children in the playroom. Which situation exhibits the characteristics of parallel play?
    a. Kimberly and Amanda are sharing clay to each make things.
    b. Brian is playing with his truck next to Kristina, who is playing with her truck.
    c. Adam is playing a board game with Kyle, Steven, and Erich.
    d. Danielle is playing with a music box on her mother’s lap.

Answer 19

ANS: B
An example of parallel play is when both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play, such as Brian and Kristina playing with their own trucks side by side. Sharing clay is characteristic of associative play. A group of children playing a board game is characteristic of cooperative play. Playing alone on the mother’s lap is an example of solitary play.

Question 20

20. Three children playing a board game is an example of which type of play?
    a. Solitary
    b. Parallel
    c. Associative
    d. Cooperative

Answer 20

ANS: D
Using a board game requires cooperative play. The children must be able to play in a group and carry out the formal game. In solitary, parallel, and associative play, children do not play in a group with a common goal.

Question 21

21. Which function is a major component of play at all ages?
    a. Creativity
    b. Socialization
    c. Intellectual development
    d. Sensorimotor activity

Answer 21

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

Question 22

22. Which statement 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.

Answer 22

ANS: B
Parents should be alert to notices of toys found to be defective and recalled by manufacturers. Children do not have the ability to determine the safety of a toy, this is the adult’s responsibility.

Question 23

23. What is the single most important influence on growth at all stages of development? a. Nutrition
    b. Heredity
    c. Culture
    d. Environment

Answer 23

ANS: 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. Heredity, culture, and environment all contribute to the child’s growth and development; however, good nutrition is essential throughout the lifespan to maintain optimal health.

Question 24

24. Which coping strategy is the least appropriate for a child to use?
    a. Learn problem-solving.
    b. Listen to music.
    c. Have parents solve their problems.
    d. Use relaxation techniques.

Answer 24

ANS: C
Children respond to everyday stresses by trying to change the circumstances or adjusting to the circumstances the way they are. An inappropriate response is for parents to solve their child’s problems. Learning problem-solving skills, listening to music, and using relaxation techniques are positive coping strategies for children.

Question 25

25. A parent tells the school nurse that her grade 1 child watches television for about 4 hours per day. What should the nurse remember when discussing this issue with the parent?
    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 of TV and types of programs their children watch.
    d. Most children watch this much TV without any negative effects.

Answer 25

ANS: C
Supervising the amount of television and types of programs their children watch is an important parental role. In addition, parents should be teaching their children how to be informed consumers of television programming. Parents should limit children’s viewing to 2 hours or less 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 relationships between television viewing and the use of alcohol or tobacco, violence and aggressive behaviour, the use of guns to commit violent acts, and early sexual activity.

Question 26

26. What 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 behaviour.

Answer 26

ANS: B
Television programs, movies, and commercials contain many implicit and explicit messages that promote alcohol consumption, smoking, violence, and promiscuous or unsafe sexual activity. Children often cannot discriminate between advertisements and television programming. Television viewing is a passive activity, and as the amount of time a child spends watching television increases, participation in physical activity decreases. In addition to the evidence linking television viewing with agg ressive behaviour, there is also evidence of a link to the use of alcohol and tobacco.

Question 27

27. When teaching parents about appropriate play activities, which function of play should the nurse inform them about?
    a. Ethical reasoning
    b. Physical development
    c. Development of self-awareness
    d. Temperament development

Answer 27

ANS: C
As the saying goes, play is the work of childhood. Self-awareness is the process of developing a self-identity. Other purposes for play include intellectual development, enhanced through the manipulation and exploration of objects, and creativity is developed through the experimentation of imaginative play. Ethical reasoning is not a function of play, rather it is moral development. Physical development depends on many factors; play is not one of them. Temperament refers to behavioural tendencies that are observable from the time of birth. The actual behaviours, but not the child’s temperament attributes, may be modified through play.

Question 28

1. Which aspects do children assess in themselves in forming an overall evaluation of their self-esteem? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Competence
   b. Sense of control
   c. Moral worth
   d. Worthiness of love
   e. Self-concept
   f. Body image

Answer 28

ANS: A, B, C, D
Children assess aspects of themselves in forming an overall evaluation of their self-esteem including competence, sense of control, moral worth, and worthiness of love and acceptance. Self-concept is the cognitive component of self-esteem, and body image is a vital component of self-concept.

Question 29

2. According to spiritual development as conceptualized by Fowler (1981), which are stages in the development of faith for children? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Preconvention
   b. Undifferentiated
   c. Intuitive-projective
   d. Principled
   e. Mythic-literal
   f. Synthetic-conventional

Answer 29

ANS: B, C, E, F
Fowler (1981) identified six stages of faith development, four of which occur during childhood: undifferentiated, intuitive-projective, mythic-literal and synthetic-conventional. Preconvention is the first stage of Kohlberg’s moral development. Principled, or postconventional, autonomous level is the last stage of moral development according to Kohlberg.

Question 30

3. When assessing children at play, which would the nurse document as sense-pleasure play? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Learning to sit on a play motorcycle
   b. Playing with sand at a beach
   c. Smelling flowers in a garden
   d. Daydreaming
   e. Using a play telephone to make a “phone call”
   f. Rocking a doll to sleep

Answer 30

ANS: B,C
Playing with sand at a beach and smelling flowers in a garden are examples of sense-pleasure play. Learning to sit on a motorcycle is an example of skill play. Daydreaming is an example of unoccupied behaviour. Using a play telephone to make a call and rocking a doll to sleep are examples of dramatic or pretend play.