Module 1 Developmental Stages and Transitions

Module 1 Developmental Stages and TransitionsA nurse is providing information to a group of pregnant clients and their partners about the psychosocial development of an infant. Using Erikson's theory of psychosocial development, the nurse tells the group that infants: A. Need to experience frustration, so it is best to allow an infant to cry for a while before meeting his or her needs B. Must have needs ignored for short periods to develop a healthy personality C. Rely on the fact that their needs will be met D. Need to tolerate a great deal of frustration and discomfort to develop a healthy personality C. Rely on the fact that their needs will be met Rationale: According to Erikson's theory of psychosocial development, infants struggle to establish a sense of basic trust rather than a sense of basic mistrust in their world, their caregivers, and themselves. If provided with consistent satisfying experiences that are delivered in a timely manner, infants come to rely on the fact that their needs are met and that, in turn, they will be able to tolerate some degree of frustration and discomfort until those needs are met. This sense of confidence is an early form of trust and provides the foundation for a healthy personality. Therefore the other options are incorrect. A nurse is weighing a breastfed 6-month-old infant who has been brought to the pediatrician's office for a scheduled visit. The infant's weight at birth was 6 lb 8 oz. The nurse notes that the infant now weighs 13 lb. The nurse should: A. Tell the mother that semisolid foods should not be introduced until the infant's weight stabilizes B. Tell the mother to decrease the daily number of feedings because the weight gain is excessive C. Tell the mother that the infant should be switched from breast milk to formula because the weight gain is inadequate D. Tell the mother that the infant's weight is increasing as expected D. Tell the mother that the infant's weight is increasing as expected Rationale: Infants usually double their birth weight by 6 months and triple it by 1 year of age. If the infant is 6 lb 8 oz, at birth, a weight of 13 lb at 6 months of age is to be expected. Semisolid foods are usually introduced between 4 and 6 months of age. A licensed practical nurse (LPN) is assisting a registered nurse (RN) perform a physical assessment of a 12 month old infant. The RN comments that the infant's head circumference is the same as the chest circumference. On the basis of this finding, the LPN anticipates that the RN will take which action? A. Tell the mother that the infant is growing faster than expected B. Report the presence of hydrocephalus to the healthcare provider C. Document these measurements in the infant's health-care record D. Suggest to the healthcare provider that a skull x-ray be performed C. Document these measurements in the infant's health-care record Rationale: The head circumference growth rate during the first year is approximately 0.4 inch (1 cm) per month. By 10 to 12 months of age, the infant's head and chest circumferences are equal. Therefore, suspecting the presence of hydrocephalus, telling the mother that the infant is growing faster than expected, and suggesting that a skull x-ray be performed are incorrect. A new mother asks the nurse, "I was told that my infant received my antibodies during pregnancy. Does that mean that my infant is protected against infections?" Which statement should the nurse make in response to the mother? A. "The transfer of your antibodies protects your infant until the infant is 12 months old." B. "If you breastfeed, your infant is protected from infection." C. "The immune system of an infant is immature, and the infant is at risk for infection." D. C. "The immune system of an infant is immature, and the infant is at risk for infection." Rationale: Transplacental transfer of maternal antibodies supplements the infant's weak response to infection until approximately 3 to 4 months of age. Although the infant begins to produce immunoglobulin (Ig) soon after birth, by 1 year of age the infant has only approximately 60% of the adult IgG level, 75% of the adult IgM level, and 20% of the adult IgA level. Breast milk transmits additional IgA protection. The activity of T-lymphocytes also increases after birth. Even though the immune system matures during infancy, maximal protection against infection is not achieved until early childhood. This immaturity places the infant at risk for infection. A nurse is assessing the language development of a 9-month-old infant. Which developmental milestone does the nurse expect to note in an infant of this age? A. The infant babbles. B. The infant babbles single consonants. C. The infant says "Mama." D. The infant smiles and coos. C. The infant says "Mama." Rationale: An 8- to 9-month-old infant can string vowels and consonants together. The first words, such as "Mama," "Daddy," "bye-bye," and "baby," begin to have meaning. A 1- to 3-month-old infant produces cooing sounds. Babbling is common in a 3- to 4-month-old. Single-consonant babbling occurs between 6 and 8 months of age. The mother of a 9-month-old infant calls the nurse at the pediatrician's office, tells the nurse that her infant is teething, and asks what can be done to relieve the infant's discomfort. The nurse instructs the mother to: A. Obtain an over-the-counter (OTC) topical medication for gum-pain relief B. Rub the infant's gums with baby aspirin that has been dissolved in water C. Schedule an appointment with a dentist for a dental evaluation D. Give the infant cool liquids or a Popsicle and hard foods such as dry toast D. Give the infant cool liquids or a Popsicle and hard foods such as dry toast Rationale: Although sometimes asymptomatic, teething is often signaled by behavior such as nighttime awakening, daytime restlessness, an increase in nonnutritive sucking, excess drooling, and temporary loss of appetite. Some degree of discomfort is normal. It is unnecessary to obtain a dental evaluation, but a health-care professional should further investigate any incidence of increased temperature, irritability, ear-tugging, or diarrhea. The nurse may suggest that the mother provide cool liquids and hard foods such as dry toast, Popsicles, or a frozen bagel for chewing to relieve discomfort. Hard, cold teethers and ice wrapped in cloth may also provide comfort for inflamed gums. OTC medications for gum relief should only be used as directed by the healthcare provider. Home remedies such as rubbing the gums with aspirin should be discouraged, but acetaminophen (Tylenol), administered as directed for the child's age, can relieve discomfort. A nurse is teaching the mother of an 11-month-old infant how to clean the infant's teeth. The nurse tells the mother to: A. Dip the infant's pacifier in maple syrup so that the infant will suck B. Use diluted fluoride and rub the teeth with a soft washcloth C. Use a small amount of toothpaste and a soft-bristle toothbrush D. Use water and a cotton swab and rub the teeth D. Use water and a cotton swab and rub the teeth Rationale: Because the primary teeth are used for chewing until the permanent teeth erupt and because decay of the primary teeth often results in decay of the permanent teeth, dental care must be started in infancy. The mother can use cotton swabs or a soft washcloth to clean the teeth. Appropriate amounts of fluoride are necessary for the development of healthy teeth, but infants usually receive fluoride when formula and cereal are mixed with fluoridated water or through fluoride supplementation. Toothpaste is not recommended because infants tend to swallow it, possibly ingesting excessive amounts of fluoride. Dipping the infant's pacifier in maple syrup is unacceptable because of the risk of tooth decay. A nurse provides information about feeding to the mother of a 6-month-old infant. Which statement by the mother indicates an understanding of the information? A. "Meats are really important for iron, and I should start feeding meats to my infant right away." B. "Fluoride supplementation is not necessary until permanent teeth come in." C. "Egg white should not be given to my infant because of the risk for an allergy." D. "I can mix the food in the my infant's bottle if he won't eat it." C. "Egg white should not be given to my infant because of the risk for an allergy." Rationale: Egg white, even in small quantities, is not given to the infant until the end of the first year of life because it is a common food allergen. Fluoride supplementation may be needed beginning at of 6 months, depending on the infant's intake of fluoridated tap water. Foods are never mixed with formula in the bottle. It may be difficult for the infant to consume the formula, and it will also be difficult to determine the infant's intake of the formula. Solid foods may be introduced into the diet when the infant is 5 to 6 months old. Rice cereal may be introduced first because of its low allergenic potential; or, depending on the pediatrician's preference, fruits and vegetables may be introduced first. A nurse provides instructions to a mother of a newborn infant who weighs 7 lb 2 oz about car safety. The nurse tells the mother: A. That because of the infant's weight it is acceptable to hold the infant as long as the mother and infant are sitting in the middle of the back seat of the car B. That it is acceptable to place the infant in the front seat in a rear-facing infant safety seat as long as the car has passenger-side air bags C. To place the infant in a booster seat in the front seat of the car with the shoulder and lap belts secured around the infant D. To secure the infant in the middle of the back seat in a rear-facing infant safety seat D. To secure the infant in the middle of the back seat in a rear-facing infant safety seat Rationale: Infants should not be restrained in the front seats of cars. If a passenger-side air bag is deployed, the air bag may severely jolt an infant safety seat, harming the infant. Infants weighing less than 20 lb and those younger than 1 year should always be in the middle of the back seat in a rear-facing car safety seat. An infant must be placed in an infant safety seat and is never to be held by another person when riding in a car. A nurse provides instructions to a mother about crib safety for her infant. Which statement by the mother indicates a need for further instructions? A. "The distance between the slats needs to be no more than 4 inches wide to prevent entrapment of my infant's head or body." B. "Wood surfaces on the crib need to be free of splinters and cracks." C. "The drop side needs to be impossible for my infant to release." D. "I need to keep large toys out of the crib." A. "The distance between the slats needs to be no more than 4 inches wide to prevent entrapment of my infant's head or body." Rationale: The distance between slats must be no more than 2 ⅜ inches to prevent entrapment of the infant's head and body. The mesh in a mesh-sided crib should have openings smaller than ¼ inch. The drop side must be impossible for the infant to release, and wood surfaces should be free of splinters, cracks, and lead-based paint. The mother should avoid placing large toys in the crib, because an older infant may use them as steps to climb over the side, possibly resulting in serious injury. The mother of a 2-year-old tells the nurse that she is very concerned about her child because he has developed "a will of his own" and "acts as if he can control others." The nurse provides information to the mother to alleviate her concern, recalling that, according to Erikson, a toddler is confronting which developmental task? A. Initiative versus guilt B. Autonomy versus doubt and shame C. Industry versus inferiority D. Trust versus mistrust B. Autonomy versus doubt and shame Rationale: According to Erikson, the toddler is struggling with the developmental task of acquiring a sense of autonomy while overcoming a sense of shame and doubt. Toddlers discover that they have wills of their own and that they can control others. Asserting their wills and insisting on their own way, however, often lead to conflict with those they love, whereas submissive behavior is rewarded with affection and approval. Toddlers experience conflict because they want to assert their own wills but do not want to risk losing the approval of loved ones. Trust versus mistrust is the developmental task of the infant. Initiative versus guilt is the developmental task of the preschool-age child. Industry versus inferiority is the developmental task of the school-age child. A nurse in a daycare setting is planning play activities for 2- and 3-year-old children. Which of the following toys are most appropriate for these activities? A. Finger paints and card games B. Simple board games and puzzles C. Blocks and push-pull toys D. Videos and cutting-and-pasting toys C. Blocks and push-pull toys Rationale: Toys for the toddler should meet the child's needs for activity and inquisitiveness. The toddler enjoys objects of different textures such as clay, sand, finger paints, and bubbles; push-pull toys; large balls; sand and water play; blocks; painting; coloring with large crayons; large puzzles; and trucks or dolls. Card games, simple board games, videos, and cutting-and-pasting toys are more appropriate play activities for the preschooler.