Developmental Transitions Across The Lifespan
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NCLEX-PN › Developmental Transitions Across The Lifespan
The nurse is collecting data on a 6-month-old infant during a well-child visit. Which finding is an expected gross motor skill for this age?
Pulls to a standing position.
Sits without support for a short time.
Walks while holding onto furniture.
Builds a tower of two blocks.
Explanation
At 6 months of age, an infant is developing the ability to sit. They can typically sit with support and are beginning to sit without support for brief periods. Pulling to a standing position and walking while holding furniture (cruising) are milestones expected around 9-12 months. Building a tower of two blocks is a fine motor skill expected around 15 months.
The nurse is reinforcing teaching with the parent of a 2-year-old child. Which statement by the parent indicates an understanding of this developmental stage?
“I expect my child to share toys with other children during playdates.”
“I should offer my child simple choices, like which of two snacks to eat.”
“My child should be able to follow a three-step command.”
“I will punish my child for saying 'no' to my requests.”
Explanation
Toddlers are in Erikson's stage of Autonomy vs. Shame and Doubt. Providing simple, appropriate choices allows them to develop a sense of control and autonomy. Toddlers engage in parallel play and are not yet developmentally ready to share. Negativism (saying 'no') is a normal part of developing autonomy. Toddlers can typically follow one- or two-step commands, not three-step commands.
A 4-year-old child is hospitalized for a minor procedure. Which nursing action best supports the child's psychosocial development according to Erikson?
Explaining the procedure in detail using correct medical terms.
Performing all care activities for the child to keep them comfortable.
Encouraging the parents to wait outside the room during procedures.
Allowing the child to place the bandage on a doll first.
Explanation
Preschoolers are in the stage of Initiative vs. Guilt. Engaging in therapeutic play, such as placing a bandage on a doll, allows the child to take initiative, understand the procedure in a non-threatening way, and feel a sense of control. Using medical terms is inappropriate for this age. The presence of parents is supportive. Performing all care for the child can lead to feelings of guilt and loss of initiative.
The nurse is preparing to administer an oral medication to a 5-year-old child. Which approach is most developmentally appropriate?
Mixing the medication in the child's favorite bottle of milk.
Informing the child that they will get a shot if they refuse the medicine.
Telling the child the medicine is candy.
Letting the child choose between taking the medicine from a cup or an oral syringe.
Explanation
Giving a preschooler a simple, appropriate choice helps them feel a sense of control and promotes cooperation, aligning with their developmental stage of initiative. Deceiving a child by calling medicine candy can erode trust. Mixing medication in a large volume like a bottle of milk risks the child not finishing it and receiving an incomplete dose. Using threats is inappropriate and can increase fear and anxiety.
The nurse is contributing to the plan of care for a hospitalized 8-year-old child. Which activity would be most appropriate to promote a sense of industry?
Assisting the child with completing a schoolwork packet.
Telling the child that friends cannot visit while in the hospital.
Encouraging the child to play video games throughout the day.
Allowing the child to sleep as much as they want.
Explanation
School-aged children are in Erikson's stage of Industry vs. Inferiority. They gain a sense of accomplishment and pride from completing tasks, such as schoolwork. While rest and play are important, focusing solely on them without opportunities for achievement can lead to feelings of inferiority. Social interaction with peers is also important for this age group.
A 16-year-old client is recovering from an appendectomy. To support the client's psychosocial needs, what is the nurse's most appropriate action?
Encourage the client to rest and not worry about school.
Restrict phone calls to only immediate family members.
Insist that the client's parents make all decisions about care.
Allow the client's friends to visit during visiting hours.
Explanation
Adolescents are in Erikson's stage of Identity vs. Role Confusion. Peer relationships are critically important for developing identity. Allowing friends to visit provides social support and normalcy. Parents should be involved, but the adolescent should be encouraged to participate in decisions. Restricting peer contact can lead to feelings of isolation. While rest is important, dismissing concerns about school ignores a central part of the adolescent's life.
The nurse is providing care to a 50-year-old client who is mentoring younger colleagues at work and volunteering at a local youth center. The nurse recognizes that these activities are fulfilling which of Erikson's developmental tasks?
Intimacy
Industry
Identity
Generativity
Explanation
Middle adulthood (approximately 40-65 years) is characterized by the psychosocial task of Generativity vs. Stagnation. Generativity involves contributing to society and guiding the next generation, often through work, community involvement, and raising children. These activities are prime examples of generativity. Intimacy is for young adults, Industry for school-age children, and Identity for adolescents.
The nurse is reinforcing teaching with a 45-year-old client about routine health screenings. Which screening should the nurse emphasize as being particularly important for this developmental stage?
Hearing screening for presbycusis.
Developmental milestone screening.
Scoliosis screening.
Blood pressure and cholesterol screening.
Explanation
Middle adulthood is a time when the risk for chronic diseases such as hypertension and hyperlipidemia increases. Therefore, routine screening for blood pressure and cholesterol is a key health promotion activity. Scoliosis screening is done during adolescence. Developmental milestone screening is for infants and children. While hearing changes can begin in middle age, routine screening for presbycusis is more commonly associated with older adulthood.
An 82-year-old client in a long-term care facility frequently talks about past accomplishments and experiences. What is the nurse's most therapeutic action?
Sit with the client and listen to the stories.
Redirect the client to current events.
Suggest that the client seems to be living in the past.
Limit the time the client spends reminiscing.
Explanation
Older adults are in the developmental stage of Ego Integrity vs. Despair. Reminiscence, or life review, is a normal and therapeutic process that helps them find meaning in their lives and achieve a sense of ego integrity. The nurse should facilitate this process by actively listening. Redirecting the conversation or suggesting they are living in the past is non-therapeutic and dismisses the client's needs. Limiting the time for this important task is also inappropriate.
The nurse is collecting data on a 2-month-old infant. The nurse notes that when a loud noise occurs, the infant abducts and extends the arms, and the fingers fan out. Which action should the nurse take?
Place the infant in a quiet room to prevent further startle responses.
Report the finding immediately to the registered nurse (RN).
Document the finding as a normal Moro reflex.
Reinforce teaching with the parents about seizure activity.
Explanation
The behavior described is the Moro (startle) reflex, which is a normal primitive reflex present at birth. It typically disappears between 3 and 6 months of age. Its presence at 2 months is an expected finding and should be documented as such. There is no need to report this normal finding, and it does not indicate seizure activity.