PEDS: Chapter 26: School-Aged Child: 6-10 years

The nurse is assessing the gross motor skills of an 8-year-old boy. Which interview question would facilitate this assessment? "Do you like to do puzzles?" "Do play any instruments?" "Do you participate in any sports?" "Do you like to construct models?"

Correct response: "Do you participate in any sports?" Explanation: To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills.

Question 6 of 20 The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's checkup the child weighed 80 pounds. According to average growth for this age group, what would be his expected current weight? 85 pounds 81 pounds 87 pounds 89 pounds

Correct response: 87 pounds Explanation: From 6 to 12 years of age, an increase of 7 pounds (3 to 3.5 kg) per year in weight is expected.

Question 2 of 5 The Boy Scouts is an organization that continues to be a favorite with school-aged boys because: no girls are included in the organization. hiking is a favorite school-aged activity. merit badges require completing small tasks for rewards. fathers participate in Boy Scouts.

Correct response: merit badges require completing small tasks for rewards. Explanation: An organization that allows school-aged children to complete small tasks and receive rewards helps develop a sense of industry.

Question 19 of 20 The school nurse is planning a class on menstruation for school-age girls. In order for the teaching to be most effective, which grade level would be best for the nurse to plan this class? third grade fourth grade sixth grade fifth grade

Correct response: fifth grade Explanation: The timing of puberty varies widely, between 8 and 14 years of age. The length of time it takes to pass through puberty until sexual maturity is complete also varies. Sexual maturation in girls usually occurs between the ages of 12 and 18. Puberty is occurring increasingly earlier. Approximately ½ of 11-year-olds are menstruating. This means any education for these physical changes needs to be taught prior to this age. Typically, third graders are 8- to 9-year-olds, fourth graders are 9- to 10-year-olds, fifth graders are 10- to 11-year-olds, and sixth graders are 11- to 12-year-olds. The class should occur closest to the time the girls would begin menstruation.

During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. What is the best specific trigger question to determine the preschooler's linguistic and cognitive progress? "Does your son speak in complete sentences all the time?" "How well does your son communicate or follow instructions?" "Is your son's speech clear enough that anyone can understand it?" "Would you say your son has a vocabulary of about 900 words?"

Correct response: "How well does your son communicate or follow instructions?" Explanation: Asking how well the boy communicates and follows instructions is the best trigger question because it is open-ended. Asking if the child uses complete sentences or speaks clearly will elicit a yes or no answer about only those specific areas of development. The parents would have no way of judging the size of their child's vocabulary.

The nurse is discussing nutrition with the mother of a 6-year-old boy. Which response by the boy's mother indicates a need for further discussion? "He won't eat any kind of meat except for hot dogs." "My son mixes all of his food together when he eats it." "I make him eat some of everything I put on his plate." "All he wants to eat is peanut butter sandwiches."

Correct response: "I make him eat some of everything I put on his plate." Explanation: Children will usually accept new foods if they aren't forced upon them. It is better to offer new foods and let the child accept them when he is ready. Children will go on "food strikes" and they will also go through periods of wanting the same foods. Preference of how the child eats lets them exert some independence and allows for experimentation.

Question 18 of 20 The nurse is teaching a group of school age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching? "I will appear heavier due to an increase in fat production". "I will grow an average of 2 inches per year" "There are not many physical differences among school age boys". "I will have improved gross motor skills".

Correct response: "I will grow an average of 2 inches per year" Explanation: During the school age years, the child will grow an average of 1 to 2 inches per year and gain approximately 3 to 5 pounds each year. As puberty approaches, there will be significant differences in development between boys and girls. As development occurs, weight does increase, but it is not directly related to fat production. This is an area where much education needs to occur with young girls because "dieting" can be detrimental to the child's health and increased size is tied to the child's body image and self-esteem. By 10 years of age, brain growth is complete, and fine motor coordination is refined.

Question 16 of 20 A nurse is assisting in a parent education class on accident prevention. Which statement by a parent indicates that further education is needed? "We will be sure that our child wears a life jacket the next time we go to the lake boating." "I will teach my child that policemen are our friends and to they are there to help us." "I will teach my daughter her full name and phone number." "My son should only wear his helmet when he goes on long rides around the neighborhood."

Correct response: "My son should only wear his helmet when he goes on long rides around the neighborhood." Explanation: Bike helmets are intended to wear anytime a child is on a bike, regardless of the distance they are going. Many serious accidents occur in the family driveway. All other responses are appropriate.

Question 3 of 5 The nurse is caring for a school-aged child in the primary care setting. The parent of the child asks how often the child should see the dentist. Which is the best response made by the nurse? "The child should see a dentist once a year." "The child should see a dentist twice a year." "The child should see a dentist when adult teeth erupt." "The child should see a dentist only when a problem is encountered."

Correct response: "The child should see a dentist twice a year." Explanation: A school-aged child should see the dentist twice a year for preventive care. Seeing the dentist once a year, when adult teeth erupt, or only when a problem is encountered does not provide recommended preventive care.

Question 3 of 20 Typical development for the school-aged child includes playing games with friends. At what age are children typically ready for games that include playing on a team that has a winner or loser? 7 years 13 years 5 years 10 years

Correct response: 10 years Explanation: Consider growth and development when advising. Erikson's stages can be helpful in determining. Before about 10 years, children are unable to lose a game and still maintain the self-concept that they are good people.

The nurse knows that being able to tell time helps a child become more independent. At which age should the nurse expect a school-age child to begin to tell time? 6 years old 7 years old 8 years old 9 years old

Correct response: 7 years old Explanation: Most 7-year-olds can tell the time in hours, but they may have trouble with concepts such as "half past" and "quarter to," especially with the prevalence of digital clocks. Six-year-olds still define objects by use. Eight- and nine-year-olds have moved passed telling time and are interested in mastering other things.

Once children are able to tell time, they can be much more independent. The age at which school-aged children learn to tell time is usually: 6 years. 7 years. 8 years. 9 years.

Correct response: 7 years. Explanation: At about 7 years of age, children are able to learn how to read a clock face and comprehend abstract concepts, such as "tomorrow" and "yesterday."

Question 8 of 20 What finding would the nurse most likely discover in a 10-year-old child in the period of concrete operational thought? Problem solving via the scientific method Ability to make independent decisions Ability to classify similar objects Participation in abstract thinking

Correct response: Ability to classify similar objects Explanation: During the period of concrete operational thought, children are able to classify or group objects based on their common elements. Abstract thinking, problem solving via the scientific method, and independent decision making are higher-level functions, typically seen in adolescents.

The nurse is talking with a mother who is concerned that a school-age child is experiencing stress and has been biting the fingernails since beginning the first grade. What should the nurse advise the mother to do about this problem? Encourage the child to drink more milk for stronger nails. Allow the child to choose a reward for not biting the nails. Distract the child by teaching a new skill such as whistling. Allow some time every day for the child to talk about new experiences.

Correct response: Allow some time every day for the child to talk about new experiences. Explanation: Many first-graders are capable of mature action at school but appear less mature when they return home. They may bite their fingernails. Scolding, nagging, threatening, or punishing does not stop nail biting and may make the problem worse. This behavior will stop when the underlying stress is discovered and alleviated. The mother should be encouraged to spend some time with a child after school or in the evening so the child continues to feel secured in the family and does not feel pushed out by being sent to school. Drinking milk will not help alleviate the child's stress. Using rewards or teaching new skills will not relieve the child's stress.

A mother tells the nurse she is very concerned because her 7-year-old tattles on the other siblings and it causes much friction among them. How can the nurse best help the mother to understand the underlying problem with tattling? Children this age have a need to be important. Children this age have a strong sense of justice. The child is angry because the siblings will not play. The child is asking for attention.

Correct response: Children this age have a strong sense of justice. Explanation: Seven-year-olds are increasingly aware of family roles and responsibilities. Promises must be kept because 7-year-olds view them as definite, firm commitments. Children this age tattle because they have a strong sense of justice. Depending on the age of the other siblings, this can cause much friction among the children. Tattling does not occur because children are angry or seeking attention. It occurs so that an injustice may be made right.

What action by a parent would be least likely to foster development of self-confidence in a school-age child? Being accepting of mistakes the child makes Focusing on what the child is saying in a conversation Comparing the child to an older sibling regarding academic achievements Having clear expectations of behavior whenever the family is out in public.

Correct response: Comparing the child to an older sibling regarding academic achievements Explanation: A school-age child needs consistency, clearly defined expectations and positive attention in order to develop self-confidence. By being accepting of mistakes the child makes, focusing on the child whenever they are talking and making sure the child understands behavioral expectations, the parents are fostering self-confidence in the child.

Question 1 of 20 A school-age child has demonstrated the ability to recognize several aspects of a problem at the same time and to understand cause and effect. The nurse should document the presence of which concept? Conservation Classification Reversibility Decentration

Correct response: Decentration Explanation: Decentration means being able to see several aspects of a problem at the same time and to understand the relation of various parts to the whole situation. Cause-and-effect relations become clear.

Question 12 of 20 A 7-year-old is told that she will have to have her tonsils out during school break. Though disappointed, the child understands the problems with missing school. What type of behavior is the child displaying? Egocentric thinking Conservation Decentration Therapeutic thinking

Correct response: Decentration Explanation: Decentration means being able to see several aspects of a problem at the same time and to understand the relation of various parts to the whole situation. Cause-and-effect relations become clear; consequently, magical thinking begins to disappear.

The nurse is providing information to the parents of a 6-year-old boy who has been caught lying at home and at school. Which information would the nurse share with the parents? Select all that apply. Explain that children this age typically lie to avoid punishment. Suggest reading a story with the child about the consequences of lying. Indicate that the child is probably lying to impress his friends. Recommend the use of immediate and firm punishment.

Correct response: Explain that children this age typically lie to avoid punishment. Suggest reading a story with the child about the consequences of lying. Explanation: Parents need to know that lying is common at this age and that it is usually done to avoid punishment. Reading the story would address the unacceptable behavior and reinforce the value of reading. Immediate and firm punishment precludes a calm, measured approach to the issue and may damage self-worth. An older child between 8 and 12 years is more likely to lie to impress friends.

Question 7 of 20 The nurse is talking with a chatty 7-year-old girl during her regular check-up. Which behavior would the child also be expected to exhibit? Demonstrating independence from her mother by sitting by herself Showing little concern when the nurse hurts her own finger Showing no interest in the medical equipment in the room Explaining what she thinks is right or wrong when taking her temperature

Correct response: Explaining what she thinks is right or wrong when taking her temperature Explanation: At this age, behavior is seen by the child as either completely right or wrong. The child will almost surely want to know why the nurse looks in her ears. The child depends heavily on parents for support and encouragement at this age. This is a time when children gain empathy, so the child would show concern for the nurse's injury.

Question 14 of 20 A mother suspects that her 11-year-old son is experimenting with deliriants with his friends. Which symptoms would the nurse advise the mother to look for that would validate her concerns? Hyperactivity Having bad breath when returning from school Giddiness and coughing Unexpected bouts of diarrhea

Correct response: Giddiness and coughing Explanation: Inhalation of substances can cause numerous symptoms, including giddiness and coughing. The child will not experience diarrhea, hyperactivity or develop bad breath from experimenting with inhalants.

Question 11 of 20 A nurse is teaching the parent of a 6-year-old with decay in several deciduous teeth about tooth care and the importance of seeing a dentist. What instruction is best for the nurse to inform the parent about the new 6-year molars? The 6-year molars are not important in shaping the jaw, so it will not be a problem if they are decayed. It is important to begin dental care when the permanent teeth, such as the 6-year molars, begin to come in. If the 6-year molars become decayed and have to be pulled, the child could have dental problems later. The 6-year molars are temporary teeth and will fall out, so it doesn't matter if there is decay.

Correct response: If the 6-year molars become decayed and have to be pulled, the child could have dental problems later. Explanation: The 6-year molars are of the utmost importance: they are the key or pivot teeth that help to shape the jaw and affect the alignment of the permanent teeth. If these molars are allowed to decay so severely that they must be removed, the child will have dental problems later.

An 8-year-old boy who says he wants to be a doctor when he grows up pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step? Industry Perfectionism Accommodation Conservation

Correct response: Industry Explanation: During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment. Accommodation is the ability to adapt thought processes to fit what is perceived, such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Perfectionism is the desire to do something perfectly. The boy's desire to apply the band-aid "the right way" is a hallmark of the development of industry. The other answers are not as pertinent.

Question 9 of 20 When providing anticipatory guidance to a group of parents with school-aged children, what would the nurse describe as the most important aspect of social interaction? Family Peer relationships Temperament School

Correct response: Peer relationships Explanation: Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

Question 4 of 20 On physical examination, the nurse discovers that a 6-year-old child's palatine tonsils are somewhat enlarged in the back of the throat. What would be the nurse's best action? Record this as a normal finding in an early school-age child. Suggest the health care provider examine the child for breathing difficulty. Take the child's temperature; this must be tonsillitis. Give the child something for pain.

Correct response: Record this as a normal finding in an early school-age child. Explanation: Lymphoid tissue reaches maximum growth in early school-aged children. The tonsils may decrease in size somewhat from the preschool years but they remain larger than those of adolescents. The tonsils and adenoids may appear larger than normal even in the absence of infection. The nurse would be correct to document this as a normal finding. The child would not need pain medication or to be examined for respiratory problems if this a normal finding.

Question 13 of 20 When describing play by the school-aged child to a group of nursing students, the instructor would emphasize the need for which of the following? Rules Ritualism Recreation Physical activity

Correct response: Rules Explanation: Middle childhood is characterized by play that embodies the need for rules and structure. Although recreation and physical activity may be involved, rules and structure are essential for play in this age group.

Question 10 of 20 The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. What advice might be helpful for these parents? School-age children are not ready to absorb information that deals with drugs and alcohol. School-age children can think critically to interpret messages seen in advertising, media, and sports. Discussions with children need to be based on facts and focused on the past and future. Parents must prevent their child from being exposed to messages that are in conflict with their values.

Correct response: School-age children can think critically to interpret messages seen in advertising, media, and sports. Explanation: School-age children can be taught how to think critically to interpret messages seen in advertising, media, sports, and entertainment personalities. School-age children are ready to absorb information that deals with drugs and alcohol and may be exposed to messages that are in conflict with their parents' values regarding smoking and alcohol. This may occur at school and cannot be prevented. Discussions with children need to be based on facts and focused on the present.

The nurse is preparing a presentation for a local parent-teacher organization about the growth and development of school-age children. Which of the following would the nurse include? Boys mature much more quickly than girls of the same age during this time. From 6 to 12 years of age, children grow an average of 4 inches per year. The child's body size is in direct correlation with his or her maturity level. Secondary sex characteristics are often embarrassing for both sexes.

Correct response: Secondary sex characteristics are often embarrassing for both sexes. Explanation: Secondary sex characteristics are often a source of embarrassment for both sexes because preadolescent boys and girls do not want to be different from their peers of the same or opposite sex. In the later school years, girls begin to surpass boys in both height and weight. During this time, children grow an average of 2 inches (5 cm) per year. Physical maturity is not necessarily associated with emotional or social maturity.

A mother is concerned that a 7-year-old child has taken money from a sibling's dresser several times. What should the nurse advise the mother about this behavior? The child needs to be reminded of property rights. Stealing is unusual for a 7-year-old and needs to be investigated. The mother should purchase a bank for the other child that cannot be opened. The mother should talk to the child's teacher about putting less pressure on the child.

Correct response: The child needs to be reminded of property rights. Explanation: Early childhood stealing is best handled without a great deal of emotion. A parent should tell the child the money is missing. The importance of property rights should be reviewed: The sibling's money is his, the child's money is the child's, and they are not interchangeable. Stealing is not unusual for a 7-year-old child. The mother does not need to buy the other child a bank. The behavior does not necessarily occur because of school-related stress.

A 9-year-old boy is admitted into the hospital with a broken femur. What is important for the nurse to consider when caring for this child? Children this age are not old enough yet to worry about their body image and how they look to their friends. If a child's behavior regresses, it should be accepted because the parents cannot help but feel guilty when their child is hospitalized. Some questions children ask cannot be answered truthfully without increasing their anxiety; therefore, those questions should be deferred to their parents. The child should be prepared for procedures and should be allowed to view and handle equipment that is going to be used when appropriate.

Correct response: The child should be prepared for procedures and should be allowed to view and handle equipment that is going to be used when appropriate. Explanation: The school-aged child should be prepared for procedures by way of hands-on explanations when feasible. Children this age do have anxiety regarding their appearance and should be allowed to express their feelings to lessen anxiety. Parents who feel guilty may overindulge their child, which may result in regressive behaviors. The nurse should not encourage the behaviors but should reassure the parents instead. Questions that the child asks should be answered truthfully using appropriate terms and language.

Question 15 of 20 An 8-year-old child is being seen for a well-child visit. His weight 2 years ago was 44 lb (20 kg) and his height was 3 ft, 10 in (116 cm). If he is developing normally, what would be his expected findings for this visit? The child weighs 57 lb (26 kg). The child's weight is seven times his birth weight. The child has all of his adult teeth. The child is 4 feet (122 cm) tall.

Correct response: The child weighs 57 lb (26 kg). Explanation: Normal physical growth for school-age children is a gain in weight of 2 to 3 kg per year and gain in height of 5 to 6 cm each year. Thus, a weight of 26 kg is an expected norm. The growth in height is not within normal parameters. A 7-year-old child should weigh seven times his birth weight. Adult teeth do not normally come in until age 10 to 12.

Question 17 of 20 The school nurse is teaching a class on sports injuries. What information is most important for the nurse to teach? Vary the sports to prevent use injuries. Fractures are minimal due to bone growth and calcification. Play the same sport regularly to become proficient. Little league tackle football is not safe for a school age child.

Correct response: Vary the sports to prevent use injuries. Explanation: With any organized sport there is the possibility of athletic injuries. Prior to having the child participate in organized activities the parents need to take into consideration the child's maturity and the risk of injury before they decide whether team competition is right for their child. Parents should encourage children to vary the types of sports throughout the year to avoid repetitive use injuries by using the same muscle groups. Any sport comes with the risk of injury, and children should wear the appropriate protective equipment. Allowing children to play tackle football and playing the same sport regularly will be decisions made by the parents and child. The nurse can only teach the safety aspects to prevent injury.

Question 20 of 20 The nurse plans an activity for a chronically ill hospitalized child. Which activity is the best choice to provide stimulation for the child? painting a picture reading a book listening to music playing a video game

Correct response: painting a picture Explanation: When providing stimulation for the chronically ill school-age child, the nurse should encourage activities that end in a product. This could be painting a picture, crafts, or putting together a puzzle. Reading a book, playing a video game, and listening to music are good activities, but they do not end in a product that has been created by the child.

Question 2 of 20 A 9-year-old is hospitalized for a long-term illness. The best project to give her to help achieve her developmental task would be: sewing a purse that will take one afternoon. a puppet show that will take 2 weeks to plan. watching her favorite program on television. a scrapbook that will take 3 weeks to complete.

Correct response: sewing a purse that will take one afternoon. Explanation: Small projects that can be completed quickly offer a sense of reward and are best to help children develop a sense of industry.