GROWTH AND DEVELOPMENT Certification Review June 2007

Growth and Development Erik Erikson AGE Psychosocial Crisis Task Infancy (birth-18 months) Trust vs Mistrust Attachment to the Mother Early Childhood (18 mo-3 yrs) Autonomy vs Shame Gaining some basic control over self and environment Late Childhood (3-6 years) Initiative vs Guilt Becoming purposeful and directive

Growth and Development Erik Erikson Table from Comprehensive Review for the NCLEX-RN® Examination-Saunders,2005 p365-366 Age Psychosocial Crisis Task School Age (6-12 years) Industry vs Inferiority Developing social, physical and school skills Adolescence (12-20 years) Identity vs Role Confusion Developing sense of identity

Growth and Development Piaget- Reference chart in review book p.19 Kohlberg- Reference chart in review book p. 20

Growth and Development Major Growth Parameters Weight Length/Height Head Circumference Double BW by 5 months NB=20inches Use paper tape to measure Triple BW by 1 year Growth in 1st year=10 inches (50%) Ave NB= 33-35 cm-2cm/mo (up to 3 mo); 1cm/mo 4-6 mo and 0.5 cm/mo x second 6 mo. Ave=43 cm @ 6mo and 46 cm @12 mo. BMI use 2 years and greater Growth in 2nd year=5 inches 33% increase in HC growth by age 1 BMI <5%=Underweight BMI 85 < 95% = At risk BMI > 95%=Overweight Age2-puberty=2.5 inches/yr (linear measurement at age 2 approx half child's adult ht. 75% of brain growth completed by 3 yrs-90% by age 7. Weigh laying down up to Birth length doubles at 4 years Anterior Fontanel-Closes by 12-18 months (average 14) Posterior Fontanel-Closes by 6-8 wks Expanding head circumference reflects brain growth and differentiation/maturation of the nervous system. Evidenced by transition from neonatal primitive reflexes to voluntary purposeful movements and new motor development. By 1 year of age, the brain weight is approximately 2 and 1/2 times the weight it was at birth.

Growth and Development Practice Questions 1. The maternity nurse is providing instructions to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's therory, the nurse would instruct the mother to: A. Allow the newborn infant to signal a need B. Anticipate all of the needs of the newborn infant. C. Avoid the newborn infant during the first 10 minutes of crying. D. Attend to the newborn infant immediately when crying. Answer A NCLEX p 371

Growth and Development 2. A mother of a 3-year old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. The nruse most appropriately tells the mother to: A. Punish the child every time the child says "no" to change the behavior. B. Allow the behavior because this is normal at this age period. C. Set limits on the child's behavior. D. Ignore the child when this behavior occurs. Answer: C

Growth and Development 3. The mother of an 8 year old child tells the clinic nurse that she is concerned about the child because the child seems to be more attentive to friends than anything else. The most appropriate nursing response would be which of the following? A. "You need to be concerned" B. "You need to monitor the child's behavior closely" C. " At this age, the child is developing his own personality" D. "You need to provide more praise to the child to stop this behavior" Answer C - question 4 answer key NCLEX p. 371

Growth and Development 4. The mother of a 4-year old child calls the clinic nurse and expresses concern because the child has been masturbating. The most appropriate response by the nurse is which of the following? A. "The child is very young to begin this behavior and should be brought to the clinic." B. "This is not normal behavior, and the child should be seen by the physician." C. " This is a normal behavior at this age." D. "Children usually begin this behavior at age 8 years." Answer: C question # 5 p. 372 NCLEX

Growth and Development 5. A nursing instructor asks a nursing student to present a clinical conference to peers regarding Freud's psychosexual stages of development., specifically the anal stage. The student plans the conference, knowing that which of the following most appropriately relates to this stage of development? A. This stage is associated with toilet training B. This stage is associated with pleasurable and conflicting feelings about the genital organs. C. This stage is characterized by a tapering off of conscious biological and sexual urges. D. This stage is characterized by the gratification of self. Answer: A - #6 p. 372 NCLEX

Growth and Development 6. A mother of a 5-year old child tells the nurse that the child scolds the floor or a table if the child hurts herself on the object. According to Piaget's theory of cognitive development, this behavior is identified as : A. Object permanence B. Egocentric speech C. Animism. D. Global organization Answer: C #7 p. 372 NCLEX

Growth and Development 7. A nursing instructor asks a nursing student to describe the formal operations stage of Piaget's cognitive developmental theory. The most appropriate response by the nursing student is: A. "The child has the ability to think abstractly." B. " The child develops logical thought patterns." C. " The child has difficulty separating fantasy from reality." D. "The child begins to understand the environment." Answer: A- #8 p. 372 NCLEX

Growth and Development 8. A clinic nurse is preparing to discuss the concepts of moral development with a mother. The nurse understands that according to Kohlberg's theory of moral development, in the pre-conventional level, moral development is thought to be motivated by which of the following? A. The parents' behavior B. Peer Pressure C. Social Pressure D. Punishment and reward Answer: D- #9 p. 372 NCLEX

Growth and Development 9. The nurse educator is preparing to conduct a session to the nursing staff regarding the theories of growth and development. The nurse educator plans to discuss Kohlberg's theory of moral development and understands that which of the following is not a component of the theory? A. Moral development progresses in relationship to cognitive development. B. Individuals move through all six stages in a sequential fashion. C. The theory provides a framework for understanding how individuals determine a moral code to guide their behavior. D. A person's ability to make moral judgments develops over a period of time. Answer: B #2 p. 372 NCLEX

Growth and Development 10. Freud's psychosocial stages of human development proceed through a series of stages from infancy to adulthood. List the stages in order, as they proceed from infancy to adulthood (number 1 would indicate the stage occurs in infancy). _________Latency Stage _________Anal Stage _________Oral Stage _________Phallic Stage _________Genital Stage Questions 1-10 from Saunders Comprehensive Review for the NCLEX-RN® Examination Answer: 4, 2, 1, 3, 5

Growth and Development Questions: Development and Safety 1. The parents of a 2-year old arrive at a hospital to visit their child. The child is in the playroom when the parents arrive. When the parents enter the playroom, the child does not readily approach the parents. The nurse interprets this behavior as indicating that : A. The child is withdrawn B. The child is self-centered C. The child has adjusted to the hospitalized setting D. This is a normal pattern Answer D- pg 385 NCLEX

Growth and Development 2. A mother arrives at a clinic with her toddler and tells a nurse that she has a difficult time getting the child to go to bed at night. Which of the following is most appropriate for the nurse to suggest to the mother ? A. Inform the child of bedtime a few minutes before it is time for bed. B. Allow the child to have temper tantrums. C. Allow the child to set bedtime limits. D. Avoid a nap during the day. Answer: A p. 384 NCLEX

Growth and Development 3. A mother of a 3-year old asks a clinic nurse about appropriate and safe toys for the child. The nurse tells the mother that the most appropriate toy for a 3-year old is which of the following? A. A farm set. B. A golf set. C. A jack set with marbles. D. A wagon. Answer: D p. 384 NCLEX

Growth and Development 4. A clinic nurse provides information to the mother of a toddler regarding toilet training. Which statement if made by the mother indicates a need for further information regarding the toilet training? A. "The child will not be ready to toilet train until the age of about 18 to 24 months." B. "Bladder control usually is achieved before bowel control." C. " The child should not be forced to sit on the potty for long periods." D. "The ability of the child to remove clothing is a sign of physical readiness." Answer: B p. 384 NCLEX

Growth and Development 5. The mother of a 3-year old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which of the following is the most appropriate suggestion to the mother? A. Do not allow the child to have the bottle. B. Allow the bottle during naps but not at bedtime C. Allow the bottle if it contains juice D. Allow the bottle if it contains water. Answer: D p. 384 NCLEX

Growth and Development 6. A nurse assesses the vital signs of a 12-month old infant with a respiratory infection. The respiratory rate is 35 breaths per minute. Based on this finding, which action is most appropriate? A. Notify the physician. B. Administer oxygen. C. Reassess the respiratory rate in 15 minutes. D. Document the findings. Answer: 4 p. 383 NCLEX

Growth and Development 7. A nurse prepares to take the blood pressure of a school-aged child. To obtain an accurate measurement, the nurse ensures that the blood pressure cuff covers: A. One half of the distance between the antecubital fossa and the shoulder. B. One third of the distance between the antecubital fossa and the shoulder. C. Two thirds of the distance between the antecubital fossa and the shoulder. D. One quarter of the distance between the antecubital fossa and the shoulder. Answer: C p. 386 NCLEX

Growth and Development 8. A nurse provides instructions to the parents of an infant regarding car travel and safety seats. Which of the following is the most appropriate information related to the safety of the infant? A. Restrain in a car seat in the front seat in a semi-reclined, rear-facing position. B. Retrain in a car seat in the front seat in a semi-reclined, forward facing position. C. Restrain in a car seat in the back seat in a semi-reclined, rear-facing position. D. Restrain in a car seat in the back seat in a semi-relined, forward -facing position. Answer C p. 387 NCLEX

Growth and Development 9. A nurse is monitoring a 3-month old infant for signs of increased intracranial pressure. On palpation of the fontanels, the nurse notes that the anterior fontanel is soft and flat. Based on this finding, which nursing action is most appropriate? A. Elevate the head of the bed to 90 degrees B. Notify the physician C. Increase oral fluids D. Document the finding Answer: D p. 386

Growth and Development 10. A nurse is evaluating the developmental level of a 2-year old. Which of the following does the nurse expect to observe in this child? A. Uses a fork to eat B. Uses a cup to drink C. Uses a knife for cutting food D. Pours own milk into a cup Answer: B p. 386 NCLEX

Growth and Development 10. A nurse is evaluating the developmental level of a 2-year old. Which of the following does the nurse expect to observe in this child? A. Uses a fork to eat B. Uses a cup to drink C. Uses a knife for cutting food D. Pours own milk into a cup Answer: B p. 386 NCLEX

Growth and Development 10. A nurse is evaluating the developmental level of a 2-year old. Which of the following does the nurse expect to observe in this child? A. Uses a fork to eat B. Uses a cup to drink C. Uses a knife for cutting food D. Pours own milk into a cup Answer: B p. 386 NCLEX

Growth and Development 10. A nurse is evaluating the developmental level of a 2-year old. Which of the following does the nurse expect to observe in this child? A. Uses a fork to eat B. Uses a cup to drink C. Uses a knife for cutting food D. Pours own milk into a cup Answer: B p. 386 NCLEX

Growth and Development 11. A nurse is preparing to care for a 5-year old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which of the following is the most appropriate activity for this child? A. Large picture books B. A radio C. Crayons and coloring books D. A sports video Answer : C p. 386 NCLEX

Growth and Development 12. The mother of a 16-year old tells a nurse that she is concerned because the child sleeps about 8 hours every night and until noontime every weekend. The most appropriate nursing response is which of the following? A. " The child probably is anemic and should eat more foods containing iron." B. "Adolescents need that amount of sleep every night." C. "The child should not be staying up so late at night." D. "If the child eats properly, that should not be happening." Answer: B p. 384 NCLEX

Growth and Development 13. A 4-year old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention would be most appropriate to alleviate the child's fears? A. Advise the family to visit only during the scheduled visiting hours. B. Encourage play with other children of the same age. C. Provide a private room, allowing the child to bring the favorite toys from home. D. Encourage the child's parent to stay with the child. Answer: D p. 384 NCLEX

Growth and Development 14. A 16-yearl old is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which of the following nursing interventions is most appropriate to facilitate normal growth and development? A. Allow the family to bring in the child's favorite computer games. B. Encourage the parents to room-in with the child. C. Encourage the child to rest and read. D. Allow the child to participate in activities with other individuals in the same age group when condition permits. Answer: D p. 386 NCLEX

Growth and Development 15. A nurse prepares to administer digoxin (Lanoxin) to a 3-year old child with a diagnosis of congestive heart failure. The nurse notes that the apical rate is 110 beats/minute. Based on this finding, which nursing action is most appropriate? A. Administer digoxin B. Recheck the apical rate in 15 minutes C. Notify the physician D. Hold the medication Answer: A p. 386 NCLEX

Growth and Development 16. A 2-year old child is treated in the emergency room for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement, if made by the parents, indicates an understanding of the measures to provide safety in the home? A. " I guess my children need to understand what the word hot means." B. "We will install a safety gate as soon as we get home so the children cannot get into the kitchen." C. "We will be sure that the children stay in their rooms when we work in the kitchen." D. "We will be sure not to leave hot liquids unattended." Answer: D p. 386 NCLEX

Growth and Development 17. A clinic nurse provides instructions to a parent of a toddler experiencing physiological anorexia. Which statement if made by the parent indicates a need for further instructions? A. "I will not force-feed my child" B. "I will limit the juice intake to less than 12 ounces per day." C. "I will feed my child if she will not eat." D. "At mealtime, I will offer less than my child may eat and let my child ask for more." Answer: C p. 386 NCLEX

Growth and Development 18. A mother of a 4-year old expresses concern because her hospitalized child has begun thumb sucking. The mother states that this behavior began 2 days after hospital admission. The most appropriate nursing response is which of the following? A. "A 4-year old is too old for this type of behavior" B. "Your child is acting like a baby." C. "The doctor will need to be notified" D. "It is best to ignore the behavior" Answer: D p. 387 NCLEX

Growth and Development 19. A clinic nurse assesses the communication patterns of a 5-month old infant. The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant: A. Uses simple words such as "mama" B. Uses monosyllabic babbling C. Links syllables together. D. Coos when comforted Answer: B p. 386 NCLEX

Growth and Development 20. The mother of a toddler asks a nurse when it is safe to place the car safety seat in a face-forward position. The best nursing response is which of the following? A. When the toddler weighs 20 lb. B. The seat should not be placed in a face-forward position unless there are safety locks in the car. C. The seat should never be placed in a face-forward position because of the risk of the child unbuckling the harness. D. When the weight of the toddler is greater than 40 lb. Answer: A p. 387 NCLEX

Growth and Development 21. Select the interventions appropriate in the care of an infant. _________Provide Swaddling _________Talk in a loud voice _________ Hang mobiles with black and white contrast designs _________Allow the infant to cry for at least 10 minutes before responding. _________Caress infant while bathing or during diaper changes Answers: A, C, D p. 388 NCLEX

Growth and Development Certification through PNCB PNCB-Pediatric Nursing Certification Board= Certifying body used by Society of Pediatric Nurses. Magnet approved-well recognized Donna Wong certified through them

Growth and Development Eligibility: Current RN licensure and 1800 hours as RN in pediatrics. Fee= $280 (CBT)/$250 (on site) $100 of that is non-refundable registration fee On-Site Exam: Advantage=slight reduction in fee Requires a minimum of 10 people to test

Growth and Development Eligibility: Current RN licensure and 1800 hours as RN in pediatrics. Fee= $280 (CBT)/$250 (on site) $100 of that is non-refundable registration fee On-Site Exam: Advantage=slight reduction in fee Requires a minimum of 10 people to test

Growth and Development The exam is administered in written format. 200 questions- 3.5 hours long. Exam scores are reported within 3 weeks of testing. You will need to complete an application and verify eligibility. This will be sent in ahead of the test. Need to register approximately 1 month before the test- pay fee at that time

Growth and Development