Carman Essentials of Pediatric Nursing 3rd Ed - Ch. 6 Growth and Development of the School-Aged Child

The nurse is about to see a 9-year-old girl for a well-child check-up. Knowing that the child is in Piaget's period of concrete operational thought, which characteristic should the child display? a. Consider an action and its consequences b. View the world in terms of her own experience c. Make generalized assumptions about groups of things d. Know lying is bad because she gets sent to her room for it

Answer: a The child will be able to consider an action and its consequences in Piaget's period of concrete operational thought. However, she is now able to empathize with others. She is more adept at classifying and dividing things into sets. Defining lying as bad because she gets punished for it is a Kohlberg characteristic.

The nurse is caring for a hospitalized 5-year-old child. The child's mother has reported her child is becoming very "clingy." Which advice should the nurse provide? Select all that apply. a. "Regression is normal during hospitalization." b. "Be careful not to coddle the child or it will result in regressive behaviors." c. "These behaviors are the result of a loss of self-control and are likely temporary." d. "Allowing the child to have some input in the care may be helpful in managing these behaviors." e. "The child may miss school and interaction with peers."

Answer: a, d, e During hospitalization the school-aged child may exhibit increased clinging behaviors. The child may also demonstrate regression. It will be helpful to promote the child be able to make some decisions or have some age-appropriate sense of control. The school-aged child may miss school and the interactions with his or her peers. Ignoring the behaviors may be counterproductive.

The nurse is talking with the parents of an 8-year-old boy who has been cheating at school. Which comment should be the nurse's primary message? a. "Punishment should be severe and long lasting." b. "Make sure that your behavior around your son is exemplary." c. "Resolve this by providing an opportunity for him to cheat and then dealing with it." d. "You may be putting too much pressure on him to succeed."

Answer: b Because they are role models for their children, parents must first realize the importance of their own behaviors. It is possible that the parents are pressuring the child, but that is not the primary message. Punishment should be appropriate, consistent, and not too severe.

The mother of a 7-year-old girl is asking the nurse's advice about getting her daughter a two-wheel bike. Which response by the nurse is most important? a. "Teach her where she'll land on the grass if she falls." b. "Be sure to get the proper size bike." c. "She won't need a helmet if she has training wheels." d. "Learning to ride the bike will improve her coordination."

Answer: b It is very important to get a bike of the proper size for the child. Getting a bike that the child can "grow into" is dangerous. Training wheels and grass to fall on are not acceptable substitutes for the proper protective gear. The child should already demonstrate good coordination in other playing skills before attempting to ride a bike.

A 9-year-old boy has arrived for a health maintenance visit. Which milestone of physical growth should the nurse expect to observe? a. Brain growth is complete and the shape of the head is longer. b. Lymphatic tissue growth is complete providing greater resistance to infections. c. Frontal sinuses are developed while tonsils have decreased in size. d. All deciduous teeth are replaced by 32 permanent teeth.

Answer: b Lymphatic tissue growth is complete by age 9 better helping to localize infections and produce antibody-antigen responses. Brain growth will be complete by age 10. Frontal sinuses are developed at age 7. Third molars do not erupt until the teen years.

The parents of an 8-year-old boy report their son is being bullied and teased by a group of boys in the neighborhood. Which response by the nurse is best? a. "Perhaps teaching your son self-defense courses will help him to have a greater sense of control and safety." b. "Bullying can have lifelong effects on the self-esteem of a child." c. "Fortunately the scars of being picked on will fade as your son grows up." d. "Your son is at high risk for bullying other children as a result of this situation."

Answer: b The child can be permanently scarred by negative experiences such a bullying. Activities such as self-defense and sports can promote a sense of accomplishment but do relate directly to the problem of bullying. There is no indication the child in the scenario will become a bully.

The nurse is educating the parents of a 6-year-old boy how to manage the child's introduction into elementary school. The child has an easy temperament. Which should the nurse suggest? a. Comforting the child when he is frustrated b. Helping the child deal with minor stresses c. Scheduling several visits to the school before classes start d. Being firm with episodes of moodiness and irritability

Answer: b The child with an easy temperament will adapt to school with only minor stresses. The slow-to-warm child will experience frustration. The difficult child will be moody and irritable and may benefit from a preschool visit.

The nurse is assessing the nutritional needs of an 8-year-old girl who weighs 65 lb (29.48 kg). Which of the following amounts would provide the proper daily caloric intake for this child? a. 1,895 calories per day b. 2,065 calories per day c. 2,245 calories per day d. 2,385 calories per day

Answer: b The girl would need approximately 2,065 calories per day (29.5 kg × 70 calories per day per kg = 2,065 calories per day).

The parents of a 9-year-old boy report they have been homeschooling their son and now plan to enroll him in the local public school. They voice concerns about the influence of the other children on their son's values. Which information should the nurse provide the parents? a. "At your son's age, values are most influenced by peers." b. "The values of the family will likely prevail for your son." c. "Values are largely inborn and will be impacted only in a limited way by environ mental influences." d. "The teacher will begin to have the largest influence on a child's values at this age."

Answer: b The values of a child are determined largely by the influences of their parents. As the child ages the impact of peers does begin to enter the picture. Children may also begin to test the values with their actions. In most cases the values of the family will prevail.

The school nurse is assessing the nutritional status of an overweight 12-year-old girl. Which question is appropriate for the nurse to ask? a. Does your family have rules about foods and how they are prepared? b. What does your family do for exercise? c. How often does everyone in your family eat together? d. Have you gained weight recently?

Answer: c Asking how often the family eats together is an appropriate question for the girl. All the others should be directed to the parents.

The parents of a 7-year-old girl report concerns about her seemingly low self-esteem. The parents question how self-esteem is developed in a young girl. Which response by the nurse is best? a. "The peers of a child at this age are the greatest influence on self-esteem." b. "Several interrelated factors are to blame for low self-esteem." c. "Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age." d. "A child's self-esteem is greatly inborn and environmental influences guide it."

Answer: c Self-esteem is developed early in childhood. The feedback a child receives from those perceived in authority such as parents and educators impact the child's sense of self-worth. As the child ages, the influences of peers and their treatment of the child begin to have an increasing influence on self-esteem.

The nurse has taken a health history and performed a physical examination for a 12-year-old boy. Which finding is the most likely? a. The child's body fat has decreased since last year. b. The child has different diet preferences than his parents. c. The child has a leaner body mass than a girl at this age. d. The child described a somewhat reduced appetite.

Answer: c The nurse would have found that the child still has a leaner body mass than girls at this age. Both boys and girls increase body fat at this age. Food preferences will be highly influenced by those of her parents. Although caloric intake may diminish, appetite will increase.

The nurse is teaching parents of an 11-year-old girl how to deal with the issues relating to peer pressure to use tobacco and alcohol. Which suggestion provides the best course of action for the parents? a. Avoid smoking in the house or in front of the child. b. Hide alcohol out of the child's reach. c. Forbid the child to have friends that smoke or drink. d. Discuss tobacco and alcohol use with the child.

Answer: d Parents are major influences on school-aged children and should discuss the dangers of tobacco and alcohol use with the child. Not smoking in the house and hiding alcohol send mixed messages to the child. Open and honest discussion is the best approach rather than forbidding the child to make friends with kids that use tobacco or alcohol.

During a well-child check at the ambulatory clinic, the mother of a 10-year-old boy reports concerns about her son's frequent discussions about death and dying. Based upon knowledge of this age group the nurse understands that: a. at this age, children are not afraid of death. b. discussing death and dying may hint at a psychological disorder. c. consistent thoughts of death and dying at this age leads to the later development of depression. d. preoccupation with death and dying is common in the school-aged child.

Answer: d School-aged children are often preoccupied with thoughts of death and dying. There is no indication these thoughts will lead to mental health issues or the development of depression. School-aged children fear death but are fascinated by death and dying.

The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. Which suggestion should be part of the nurse's advice? a. "Keep your cigarettes where she can't get to them." b. "Always go outside when you have a cigarette." c. "Tell her only losers smoke and chew tobacco." d. "As parents, you need to be good role models."

Answer: d The nurse would recommend that the parents be good role models and quit smoking. Locking up or hiding your cigarettes and going outside to smoke is not as effective as having a tobacco-free environment in the home.