# Situation: The nurse works in the outpatient mental health clinic of a tertiary hospital, where clients of all ages are seen. A 9-year-old boy is to begin a sticker chart that rewards finishing his homework without tantrums. Using Piaget's theory, how should the nurse explain the chart to him?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630072  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: The nurse works in the outpatient mental health clinic of a tertiary hospital, where clients of all ages are seen.

A 9-year-old boy is to begin a sticker chart that rewards finishing his homework without tantrums. Using Piaget's theory, how should the nurse explain the chart to him?

## 보기

1. Explain how the chart will build his self-control later in life
2. Show him a sample chart and let him place the first sticker **✔ 정답**
3. Tell a make-believe story about a puppet who earns stars
4. Give him a leaflet with the chart rules to read on his own

**정답: 2**

## 해설

At 9 years the child is in Piaget's concrete operational stage (about 7–11 years): he reasons logically about real, concrete objects but not yet about abstract or hypothetical ideas. Explaining with the actual chart and a hands-on trial matches this level.

## 심화 해설

A 9-year-old learns from the concrete
According to Piaget's theory of cognitive development, a 9-year-old is in the concrete operational stage, which spans about 7 to 11 years. Children at this stage reason logically about real, concrete objects and events, understand rules, and can classify and order things, but they cannot yet reason well about abstract or hypothetical ideas. Showing him a sample chart and letting him place the first sticker matches his level: he sees, handles, and does the activity himself. A hands-on trial also lets the nurse check his understanding right away.

| Stage | Approximate age | How to teach |
| --- | --- | --- |
| Sensorimotor | 0 to 2 years | Sensory experiences, routines, parent involvement |
| Preoperational | 2 to 7 years | Play, make-believe, puppets, simple words |
| Concrete operational | 7 to 11 years | Real objects, demonstration, hands-on practice, simple rules |
| Formal operational | 11 years and older | Abstract reasoning, discussion of future consequences |

Why the other approaches do not fit
Explaining how the chart will build his self-control later in life asks him to reason about long-term, abstract benefits, which requires formal operational thought that begins around age 11. A make-believe story about a puppet earning stars suits the preoperational stage of about 2 to 7 years, when symbolic play is the main way children understand the world; a 9-year-old may find it too childish. Handing him a leaflet to read on his own gives no concrete demonstration and no chance to check understanding, even if he can read the words.

Applying the sticker chart well
A sticker chart is a form of positive reinforcement: a desired behavior, finishing homework without tantrums, is followed promptly by a reward. Children in the concrete operational stage respond well to clear, specific rules and visible progress. The chart should name the exact behavior, give the sticker soon after it occurs, and set a simple goal, such as a small reward after a certain number of stickers. Involving the parents ensures the chart is used consistently at home.

Watch out! Age ranges in Piaget's stages are approximate. In exam questions, use the age in the stem to pick the stage, then choose the teaching method that matches that stage's way of thinking.

Exam takeaway
Key point! For school-age children in the concrete operational stage, teach with real objects, demonstration, and hands-on practice. Save abstract explanations for adolescents and make-believe play for preschoolers.

## 임상 시나리오

Teaching a School-Age ChildPiaget's concrete operational stage
At 9 years, the child is in the concrete operational stage (about 7 to 11 years). He reasons logically about real objects but not yet about abstract ideas.

Show him a sample chart and let him place the first sticker. Hands-on demonstration matches his thinking and lets the nurse check understanding.

Name the exact behavior, reward it promptly, and involve parents so the chart is used consistently.

CautionAbstract talk about future self-control suits adolescents, and puppet stories suit preschoolers.

## 핵심 개념

- **Concrete operational stage** — Piaget's stage from about 7 to 11 years, when children reason logically about concrete objects.
- **Formal operational stage** — Piaget's stage from about 11 years, when abstract and hypothetical reasoning develops.
- **Preoperational stage** — Piaget's stage from about 2 to 7 years, marked by symbolic play and egocentric thinking.
- **Positive reinforcement** — Following a desired behavior with a reward to make the behavior more likely.

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