Growth and Development Flashcards
1. Discuss the major concepts associated with growth and development, and describe their impact on pediatric nursing. 2. Identify the physical, psychosocial, and cognitive development tasks for the child from birth through adolescence. 3. Plan developmentally based nursing care strategies that promote anticipatory guidance and injury prevention. 4. Determine the child's nutrition and safety needs. 5. Identify behavioral reactions to illness and hospitalization in the child from birth through
Which action would be most important in the psychosocial support of a 2-year-old who is having an invasive procedure?
a. Assuring her that it is not her fault.
b. Providing for parental presence.
c. Providing adequate pain control.
d. Performing the procedure quickly.
b
Toddlerhood is a marked time of heightened separation anxiety with a marked fear of strangers. For a child of this age, the most appropriate psychosocial support is to promote the presence of the primary caregiver.
Which of the following would be most helpful when assessing a child’s bone age?
a. Growth percentile
b. Body mass index
c. Blood test
d. X-rays
d
Bone age is performed by taking an x-ray of the child’s hands and wrists for comparison against an atlas of standard x-rays categorized by age. This test is used to predict the remaining height growth given a certain bone age. Typically, a child’s bone age should match his or her chronological age.
Which of the following assessments would be most concerning in a 3-month-old?
a. Closed posterior fontanel
b. Inability to roll over
c. Failure to track objects through visual fields
d. Failure to laugh
c
An infant develops the ability to track objects by 3 months, so the failure to do so is a concerning sign in a 3-month-old infant. The posterior fontanel closes by 2-3 months of age. Rolling over and laughing typically occurs at 4 months of age.
Which of the following developmental milestones of the 5-month-old best reflects the principle of proximodistal growth and development?
a. Babbling
b. Raking objects
c. Rolling over
d. Eating solid foods
b
The principle of proximodistal growth and development states that children develop from the trunk to the tips of the extremities. Raking objects, which develops at 4 months, involves the use of hands to “rake” objects prior to the development of the more specific pincer grasp occurring by 9 months of age.
The 5-year-old uses how many words in a sentence?
a. 3-4
b. 4-5
c. 5-6
d. 6-7
c
The 5-year-old typically uses 5-to-6 word sentences. A good rule-of-thumb to remember is that a typical preschool-age child will speak a sentence in the number of words equal to his age up to one more than his age.
A nurse would expect a 4-month-old to:
a. Sit alone
b. Attempt to roll over
c. Begin to crawl
d. Grasp feet and pull them to mouth
b
The infant begins to roll over at 4 months, first from stomach to back then from back to stomach. Infants sit with support beginning at 5 months and eventually develop the ability to sit without support by 8 months. At 6 months, the infant pushes up from stomach onto hands and knees and rocks back and forth in that position until he eventually crawls by 9 months. Grasping feet and pulling them to the mouth occurs at 5 months of age.
A 6-month-old infant is brought to the clinic. The mother reports that the infant weighed seven pounds at birth. What is the anticipated weight?
a. 10 pounds
b. 14 pounds
c. 18 pounds
d. 21 pounds
b
An infant doubles his birth weight minimally by 6 months of age and triples his birth weight by one year.
A parent calls the clinic to express concern over her child’s eating habits. She says the child eats very little and consumes only a single type of food for weeks on end. The nurse knows this behavior is characteristic of:
a. toddlers
b. preschool-age children
c. school-age children
d. adolescents
b
Preschool-age children are known for their relatively small appetites and food jag-eating behaviors. Also, preschoolers have a relatively slow rate of growth and require fewer calories for growth.
What is the best way to prepare 4-year-old Bryant for his admission to the hospital for same-day surgery?
a. Allow him to play with the medical equipment at the pre-operative visit and explain that he will be staying in the hospital for a few days.
b. Do not mention anything to Bryant until he arrives at the hospital for the operation.
c. Explain the details of the operation and what will happen.
d. Tell him that a hospital is a place where kids visit each other and eat ice cream.
a
It is developmentally appropriate to give the preschooler brief and understandable information. Allowing the child to handle equipment is an excellent way to orient the child to the hospital equipment and to involve him in the pre-operative teaching. It is important to always tell the truth to children while keeping in mind that concrete explanations without a lot of detail are most appropriate for preschoolers.
When examining a 6-month-old who is quietly sitting on her mother’s lap, which of the following should the nurse do first?
a. assessment of the fontanel
b. palpation of pulses
c. auscultation of the chest
d. palpation of the abdoment
c
The 6-month-old is developing stranger anxiety and may cry during invasive procedures. It is best to perform assessments which require the child to be quiet first. Assessment of the fontanel and pulses can be performed next. Palpation of the abdomen would be performed last.
Which developmental milestone would you expect to see the 9-month-old developing?
a. pincer grasp
b. walking
c. speaking intelligible words
d. sitting up without support
a
The normally developing 9-month-old is using the pincer grasp. Walking is a milestone for 12 to 16 months. The 9-month-old typically says ma-ma and da-da in correct context. Sitting up without support is achieved by 8 months.
Which of the following developmental milestones would be most advanced for 6-month-old Harry?
a. reaching for objects
b. rolling over from back to front
c. laughing aloud
d. sitting up unsupported for short periods
d
Sitting up unassisted for short periods is the most advanced of the developmental milestones listed. Infants sit with support by 5 months and then sit unassisted by 8 months. Reaching for objects occurs between 4 and 6 months. Rolling over from front to back occurs first at 4 months followed by rolling from back to front between 5 and 6 months. Laughing aloud is a social milestone that occurs at 4 months.
A baby’s length is twenty inches at birth. You approximate her height at 4 years of age to be:
a. 30 inches
b. 35 inches
c. 40 inches
d. 45 inches
c
Normal growth patterns predict that a baby’s birth length roughly doubles at four years of age.
An 18-month-old is admitted for same day surgery. What does the nurse anticipate as his biggest fear?
a. pain
b. separation
c. death
d. body integrity
b
Separation anxiety is the greatest fear among toddlers. Fear of pain and invasion of the body integrity are issues of concern for older preschoolers and particularly school-age children. Gear of death is a more common concern for the adolescent who can think abstractly.
You are evaluating a child who says “no,” is not toilet trained, has a closed anterior fontanel, and started to climb stairs a few months ago. How old is s/he?
a. 12 months
b. 18 months
c. 24 months
d. 36 months
c
The child is 24 months old. Saying “no” is typical of a toddler. The anterior fontanel closes between 12 and 18 months. Climbing stairs occurs at 21 months. Toilet training occurs at either 2 or 3 years of age.
You are the nurse in an adolescent clinic caring for 14-year-old Lisa, who experienced menarche one year ago. Lisa is concerned that she is short and wants to know if she will grow taller. Based on your knowledge of growth and development, you know that:
a. In girls, menarche occurs early in puberty before the height spurt
b. In girls, menarche occurs late in puberty after the height spurt.
c. In girls, the peak height velocity is usually around 15 years.
d. It is impossible to predict how much more Lisa will grow.
b
The height spurt occurs earlier in puberty among girls as compared to boys. The average peak height velocity among girls is 12 years. There is limited growth potential after menarche with an average of 2.5 cm. Girls have a shorter period of time in which to grow and a lower rate of growth during the pubertal height spurt as compared to boys.
When assessing the development of a 6-month-old, which of the following would be most concerning?
a. the child weighs twice as much as his birth weight.
b. the child does not look for hidden objects
c. the child does not understand the word “no.”
d. the child does not transfer objects from one hand to the other.
d
The infant can transfer objects from one hand to another at give months of age. Failure to achieve this fine motor skill is considered a developmental delay in a 6-month-old. The 6-month-old infant should weigh at least twice her birth weight. Looking for hidden objects is an example of the understanding of object permanence, a phenomenon that occurs between 8 and 12 months. The infant understands the word “no” by approximately 9 months.
In which of the following age groups does the child experience the fastest rate of growth in the limbs?
a. infancy
b. preschool
c. school-age
d. adolescent
c
The limbs experience the fastest rate of growth during the school-age years. The head experiences the fastest rate of growth during infancy. The trunk grows the fastest during the toddler and preschool years. The gonads and associated tissues experience the fastest rate of growth during the adolescent years.
A teenager has come into the clinic requesting birth control. She says she does not want to tell her parents. Which of the following is the best response:
a. we can give you birth control and not tell your parents
b. we are not permitted to give you birth control without parental consent
c. is there someone else i can talk to about this?
d. you will need to become emancipated before we can give you birth control without parental consent
a
In most states, parental consent is not required for birth control or treatment for a sexually transmitted infection.
The nurse is teaching a parenting class when a mother asks when a child develops a conscience. Basing her response on Erikson’s theory of development, the nurse knows that this usually occurs during which of the following stages?
a. by the end of the first year of life.
b. by the end of the toddler stage.
c. during the preschool stage.
d. during the school age years.
c
Children usually recognize an “inner voice” during the preschool years.
The nurse is caring for a child who is very outgoing and likes to talk about his friends. He asks to play board games and is very concerned about the rules of the game. When the nurse wins the game, he throws the game and says, “You cheated!” How old is this child likely to be?
a. 2
b. 4
c. 7
d. 13
c
School are children are very competitive and enjoy games. They often focus on rules, but do not like to lose.
You note that Joshua’s head circumference is now smaller than his chest circumference. His age is most likely?
a. 3 months
b. 9 months
c. 15 months
d. 30 months
d
The chest circumference is greater than the head circumference after the age of 24 months. The head circumference is greater than the chest circumference from birth to 6 months. The head circumference is equal to the chest circumference between the ages of 6 and 24 months.
Jessica’s physical reveals that her BMI is at the 90th percentile. You correctly explain to her mother:
a. “A BMI in the 90th percentile indicates that Jessica is overweight, would you like to talk to a dietician?”
b. “Jessica is very healthy and is taller than most children her age.”
c. “A BMI in the 90th percentile indicates a risk of becoming overweight, we can discuss ways to reduce this risk.”
d. “A BMI in the 90th percentile indicates that Jessica is underweight, let’s talk about her dietary intake.”
a
A BMI between 85% and 95% (25 - 29.9) indicates that the child is overweight. A child is considered obese when the BMI is equal to or greater than 95% (≥30). A child is considered underweight when the BMI is less than 5% (<18.5).
A group of children are playing in the playroom. The children are tested on the concept of conservation. One child has just mastered this concept. How old is this child most likely to be?
a. 4 years
b. 6 years
c. 8 years
d. 12 years
c
An 8-year-old child is in the concrete operational phase of cognitive development and would understand the concept of conservation. Conservation is not typically understood prior to the age of 8. A 12-year-old child is in the formal operational phase of cognitive development and is likely to have mastered the concept of conservation years earlier.
The nurse is playing with an infant who has just had a PICC line placed. When the nurse hides a toy rattle under a blanket, the infant actively looks for it while lifting up the blanket. How old is this infant most likely to be?
a. 2 months
b. 4 months
c. 6 months
d. 8 months
d
Object permanence is a concept that usually develops between 8 and 9 months.
Six-year-old Josie is being seen in the emergency room after falling off her bike. The nurse is preparing to assist with suturing her scalp lacerations, when Josie cries out, “I’m sorry I didn’t wear my helmet, I promise I’ll be good next time, please don’t hurt me!” Which of the following is the nurse’s best response?
a. “Helmets are very important and protect your head, please make sure that you wear it in the future.”
b. “We need to fix your head; you are doing such a good job of trying to stay still.”
c. “ You’re right, you probably wouldn’t be here if you had been wearing a helmet.”
d. “This won’t take very long. You’re actually very lucky, it could have been a lot worse.”
b
The nurse is to encourage the child to help her cope with a stressful procedure. Although education should be provided, it is inappropriate to do so during a painful procedure. It is important to dispel feelings of guilt as she is experiencing magical thinking and likely thinks that the sutures are a form of punishment.
Julianne is a 4-year-old newly diagnosed with diabetes who is frightened of finger sticks. The nurse’s best response is:
a. Allow Julianne to hold her favorite stuffed animal during finger sticks.
b. Encourage Julianne’s mother to coach her during finger sticks.
c. Encourage Julianne to count backward from 10 during finger sticks.
d. Encourage Julianne to play with the equipment and ‘practice’ on her dolls.
d
Play therapy uses the therapeutic powers of play to help children resolve various challenges. Although a 4-year-old child will likely find comfort in a favorite animal, she is more likely to learn to cope through play therapy.
Mrs. Garcia brings 5-year-old Jeffery to a local museum where children are encouraged to interact with the attractions. She praises and helps him explore the museum. This is known as what kind of play?
a. Mutual play
b. Imaginative play
c. Solitary play
d. Parallel play
a
Mutual play occurs when a parent offers praise and support while encouraging a child to explore their environment. Imaginative play occurs when children pretend. Solitary play occurs when children play without regard for what others around them are doing. Parallel play occurs when children play side-by-side.
The nurse is watching a group of toddlers in the playroom. Which of the following type of play is typical of older toddlers?
a. Solitary
b. Parallel
c. Team play
d. Mutual play
b
Parallel play with children play side by side, is associated with toddler years. Solitary play is associated with infancy and early toddler years. Team play is associated with school-age children. Mutual play is associated with children from infancy though school-age. It is not seen in groups but occurs between caregiver and child.
The nurse is caring for an infant who raises her chest when lying on her stomach, is beginning to babble, and follows an object 180 degrees with her eyes. How old is this infant most likely to be?
a. 4 weeks
b. 3 months
c. 4 months
d. 5 months
b
The described skills are appropriate for a 3-month-old child.
Which of the following is a cause for concern in a 6-month-old child?
a. The infant does not sit without support.
b. The infant does not clap his hands.
c. The infant does not grasp and hold objects.
d. The infant does not have a pincer grasp.
c
The infant should grasp and hold objects by 3 months, sit without support at 8 months, demonstrate pincer grasp at 9 months, and clap hands between 10 and 12 months.
Four-month-old Jessie is being evaluated in the developmental clinic. Which of the following would be most concerning?
a. He doesn’t hold objects in his hands.
b. He doesn’t rake objects with his hands.
c. He doesn’t transfer objects from hand to hand.
d. He doesn’t clap his hands.
a
A 3-month-old infant should grasp and hold objects in his hands. A 4-month-old infant should be developing the skill of raking objects with his hands and transferring objects from hand to hand. An infant develops the skill of clapping his hands between 10 and 12 months.
The nurse is caring for Marissa and notes that she pushes up from her stomach onto her knees and rocks back and forth. Which of the following most likely represents Marissa’s age?
a. 4 weeks
b. 3 months
c. 6 months
d. 8 months
c
Pushing up to the knees from the stomach and rocking back and forth is appropriate for a 6-month-old to be doing.
Evan, who measured 20 inches at birth, now measures 30 inches. Which of the following most likely represents Evan’s current age?
a. 6 months
b. 12 months
c. 18 months
d. 24 months
b
An infant’s length usually increases by 50% by 12 months of age. From 1 to 2 years, a toddler grows 5 inches on average. Beginning from 2 to 3 years, the child grows an average of 2.5 inches annually until the adolescent growth spurt.
Two-year-old Maria’s mother needs to briefly leave the hospital to pick up Maria’s sister, Christie, from preschool. She is worried about how Maria will react. The nurse’s best suggestion is:
a. “Tell Maria that you need to get Christie and you will be back when lunch is over, and Dora the Explorer comes on TV.”
b. “ Tell Maria that you need to leave to get Christie and if she doesn’t cry you will bring her a surprise.”
c. “Wait until Maria starts her nap and quietly sneak out. You’ll be back before she wakes up.”
d. “I’ll distract Maria while you leave, we’ll bring her a special toy to keep her entertained.”
a
Two-year-old children understand time in terms of routine. A toddler would comprehend that her mother is returning after lunch and at the start of a favorite show. Although toddlers enjoy rewards, it is inappropriate to discourage her from expressing her feelings. Anxiety would be increased if the child was to wake up during the time when her parent was absent.
Sammy enjoys copying shapes and can identify most colors. He draws a picture of the nurse with just two body parts. Sammy is most likely how old?
a. 2 years old
b. 3 years old
c. 4 years old
d. 5 years old
c
Most 4-year-olds can identify most colors and copy shapes.
The nurse asks a child if it is ever OK to tell a fib. The child responds, “I think that telling a lie to get out of trouble is wrong, but telling your mom you like her hair cut when it’s really ugly is OK.” What age is this child likely to be?
a. 7 years old
b. 8 years old
c. 9 years old
d. 10 years old
d
Most 10-year-old children can recognize shades of gray and see beyond the firm concept of right and wrong. Children ages 7 to 9 years have a rigid concept of right and wrong.
Which of the following is the first sign of puberty in males?
a. Testicular enlargement
b. Pubic hair development
c. Growth spurt
d. There is no specific order of events as puberty follows an individual development pattern.
a
The following is the progression of pubertal milestones among boys. Testicular enlargement is the first sign of puberty and occurs on average at 11 years of age. Pubic hair is the second sign of pubertal development and occurs on average at 12 years of age. The height spurt is the last sign of puberty and occurs on average at 13-14 years of age. The average age of height spurt in boys occurs 2 years later than girls (on average) because boys enter puberty 1 year later and boys’ height spurt is a late pubertal event.
The nurse should begin lead screening when the child reaches what age?
a. 6 months
b. 12 months
c. 18 months
d. 24 months
a
Lead screening should begin at 6 months using a standard lead screening questionnaire and should continue at regularly scheduled primary care visits.
All interventions are based on the following principles:
All interventions are family-centered, treating the child and family as a unit.
2. The goal is to help the child and family unit attain, maintain, or regain optimal health.
3. Nursing interventions are guided by both the child’s chronologic age and level of development (physical and mental).
4. Health and development are affected by environment and heredity.
Cephalocaudally
From head to toe
Proximodistally
From the trunk to the tips of the extremities
Growth pattern in infancy
(birth to 12-15 months)
a period of rapid growth in which the head grows faster than other tissues.
Growth pattern in toddler-preschool age
(12-15 months to 5 years)
a period of slow growth in which the trunk grows more quickly.
Growth pattern in school age
(6-12 years)
a period of slow growth in which the limbs grow the fastest.
Growth pattern in adolescence
(13 to 18-20 years)
a period of rapid growth for the trunk, including the gonads and associated tissues.
Erikson’s Psychosocial Development
Infancy
(0 to 12-15 months)
Trust vs mistrust
Trust is essential for development of a healthy personality and is fostered by consistent and loving care from a consistent, caring figure.
Consistency allows the infant to predict responses.
Mistrust is promoted when trust-promoting experiences are not present and when basic needs are inconsistently or inadequately met.
Assure parents that they cannot spoil an infant.
What is the age of a child in the Trust vs Mistrust psychosocial development stage?
0 to 12-15 months
Erikson’s Psychosocial Development
Toddlerhood
(1-3 years)
Autonomy vs shame and doubt
Autonomy is fostered through the freedom and encouragement to master new things and become independent related to themselves and the environment.
Shame and doubt are promoted when overdependency is fostered where independence is possible; the child is made to feel self-conscious, or their independent decisions have negative consequences.
What is the age of a child in the Autonomy vs Shame and Doubt psychosocial development stage?
1-3 years
Erikson’s Psychosocial Development
Early Childhood
(3-5 years)
Initiative vs guilt
The conscience develops here when a child recognizes the guidence of not only outsiders but also an “inner voice.”
The focus is maintaining a sense of initiative without impinging on the rights and privileges of others or developing an overwhelming sense of guilt.
What is the age of a child in the Initiative vs guilt psychosocial development stage?
3-5 years
Erikson’s Psychosocial Development
Middle Childhood
(6-12 years)
Industry vs inferiority
The focus here is on achievement. Competition and cooperation with others is an important component of this stage.; learning rules is also important. This stage is marked by social relatioships.
Inferiority or inadequacy occurs when a child is unable to meet others’ expectations or if he/she feels that external standards are too hight.
