Ch. 14 Health Promotion of the School Aged Child & Family
During the assessment of an 8-year-old child, the nurse finds that the child's parents are depressed by the child's behavior. What information does the nurse provide about the behavioral changes in the child to the parents? 1 Children become more demanding at this age. 2 Children have a strong liking for food at this age. 3 Children demonstrate ritualistic behavior at this age. 4 Children have increased masturbation at this age.
1 The nurse should explain the age-associated behavioral changes. During middle childhood children tend to spend more time with peers than with parents. They start demanding toys and games that their friends have. Prior knowledge of this information can reduce stress in the parents. From 6 to 7 years of age the child has strong food preferences. Ritualistic behavior patterns are found in children when they are 2 years old. From 11 to 12 years of age the child has increased masturbation due to the attainment of puberty and changes in hormone levels.
At a primary health care center, the nurse is explaining preadolescence and prepubescence to the parents of children 8 to 12 years of age. Which statement made by the nurse indicates effective teaching? 1 "The first sign of puberty can be seen in girls before 8 years of age." 2 "The onset of pubescence can be seen in boys at 9 years of age." 3 "Rapid growth and development are seen in children during prepubescence." 4 "The preadolescence period starts at 9 years and ends when the child is 11 years old."
3 The nurse should explain to parents the developmental changes in children. Pubescence is a period where children develop secondary sexual characteristics. Rapid growth and development can be seen in children during prepubescence, especially in girls, due to changes in hormonal levels. In girls the onset of prepubescence can be seen from 9 to 11 years of age. Generally, puberty begins at 10 years of age in girls, and first signs of puberty can be seen at 10 years of age but is normal after 8 years of age in any sex. Puberty usually begins at 12 years of age in boys. The preadolescence period starts at 9 years of age and ends when the child is 13 years of age.
Parents of a school-age child tell the nurse that their child is being consistently bullied at school. What is the most important way in which the nurse can encourage the parents to help their child? 1 Call the police. 2 Instruct the child in how to handle the situation. 3 Discipline the child for being the victim of a bully. 4 Communicate concerns to the teacher and principal.
4 When a child is being bullied it is essential that the parents communicate their concerns with the teacher and principle at the school in order to come up with a solution to the problem. Calling the police may not be necessary in all cases, but school officials need to be informed in every case. Instructing the child in how to handle the situation is a good intervention, but consistent bullying at school needs to be reported to the teacher and principal. Disciplining the child is not an appropriate method of addressing bullying.
Why is it important for nurses caring for school-age children to emphasize the importance of dental hygiene to their parents? 1 Because permanent teeth erupt during the school-age years 2 Because school-age children tend to exhibit excellent brushing technique 3 Because school-age children are able to independently care for their teeth 4 Because school-age children do not consume a lot of sugar-containing snacks
1 Because permanent teeth erupt during the school-age years it is particularly important for the nurse to emphasize the importance of dental hygiene to these children's parents. Many school-age children exhibit poor, rather than excellent, dental hygiene and still need to be supervised in brushing in flossing; they also eat a lot of sugary snacks.
6-year-old child's parent tells the nurse that the child has a loose tooth and is worried about it. Which appropriate response does the nurse give to the child's parent? 1 "The child has a chronic disease." 2 "It is a normal finding at this age." 3 "The child has calcium deficiency." 4 "It occurs due to vitamin A deficiency."
2 At the middle childhood stage, the process of shedding deciduous teeth begins. The nurse tells the child's parent that a loose tooth is a normal finding at this age. It does not indicate that the child has chronic disease, calcium deficiency, or vitamin A deficiency. Calcium deficiency affects the bones and does not cause tooth shedding. Vitamin A deficiency does not affect teeth or cause tooth loss.
The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. What is the most appropriate recommendation, based in the nurse's knowledge of this age group? 1 Organized sports, such as soccer, are not appropriate at this age. 2 Competition is detrimental to the establishment of a positive self-image. 3 Sports participation is encouraged if the sport is appropriate to the child's abilities. 4 Girls should compete only against girls because at this age boys are larger and have more muscle mass.
3 The parents should help the child select a sport that is suitable to her capabilities and interests. Team sports contribute to the school-age child's social, intellectual, and skill growth. Organized sports for school-age children can provide safe, appropriate activities with supportive parents and coaches. The desire to participate in competitive team sports develops from a need for peer interaction for the school-age child. A sport that meets the child's capabilities and interests should be selected. The physical changes in boys take place during puberty, later in the school-age years; there is therefore no reason for boys and girls to compete separately at the age of 8 years.
The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. Issues to cover in the sessions include what? 1 Walking bicycles through busy intersections 2 Installing reflectors only on bicycles that are to be ridden at night 3 Wearing a bicycle helmet only if the child is planning to ride in traffic 4 Riding bicycles against, rather than with, traffic so the rider can see the cars
1 Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react accordingly, with safety the number one priority. Bicycle helmets should be worn at all times to prevent head injuries. Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only. Bicycles should always be ridden with the traffic, not against the traffic. This will help prevent accidents.
The nurse manager instructs a nurse to conduct a group activity for assessing physical and mental development in 6- to 12-year old children. Which suggestion given by the nurse manager is appropriate? 1 "Give grades and material rewards to all the children after performing the task." 2 "Compare the performance of one child with the other children based on grades." 3 "Do not allow the children to interact with each other while doing the task." 4 "A child who performs well in all the tasks can be considered as mentally fit."
1 Children 6 to 12 years of age are eager to participate and effectively complete the given tasks. The nurse can conduct group activities to assess the physical and mental abilities of the children, as they are motivated in the presence of peers and effectively participate in the task. The nurse should adopt the reward system, such as giving grades and material rewards to encourage the children. In order to avoid having children feel inferior, the nurse should not compare them with their peers. The children must be encouraged to interact with their peers and help each other in order to develop the ability to cooperate and to compete with other children effectively. No one has the ability to do everything perfectly, so children should not be expected to perform well in all tasks.
What is the primary oral problem in children and adolescents? 1 Dental caries 2 Malocclusion 3 Dental injury 4 Periodontal disease
1 Dental caries is the principal oral problem in children and adolescents. In malocclusion, the teeth of the upper and lower arches do not approximate properly; this is not the principal oral problem in children and adolescents. Dental injury, which includes fractures and other tooth injuries, is not the principal oral problem in children and adolescents. Periodontal disease is an inflammatory and degenerative condition involving the gums and tissues; it is not the principal oral problem in children and adolescents.
During assessment, the nurse observes that the child's new secondary teeth are appearing too large for the face. Which stage of child development is the child in? 1 Inferiority stage 2 Ugly duckling stage 3 Prepubescence stage 4 Accomplishment stage
2 The child is in the ugly duckling stage. In this stage, the teeth appear too large for the face. Facial appearance also changes, making the child's face appear disproportionate. A sense of inferiority is related to the accomplishment stage of Erikson's psychosocial development theory. Prepubescence, which lasts approximately 2 years, begins at the end of middle childhood and ends with the 13th birthday. Accomplishment is one of the stages of Erikson's psychosocial development theory.
The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. What knowledge should the nurse's response should be based on? 1 Bullying at this age is considered normal. 2 Children who bully others usually join gangs. 3 Bullying often manifests itself in children who witness violence or abuse at home. 4 Bullying is a short-term problem that is generally outgrown by the end of the school-age years.
3 Bullying often manifests in children who may witness violence or abuse at home. Children who bully may also come from homes with low parental involvement. Bullying is a maladaptive response to poor relationships with peers and lack of group identification; therefore it is not considered normal behavior. Children who chronically bully tend to be impulsive, easily frustrated, and at increased risk for dropping out of school, but there is no direct correlation between bullying and joining a gang. Children who bully may be at risk for long-term psychologic disturbances and psychiatric symptoms. Future problems for bullies may include violence, substance abuse, and criminal convictions, which often occur in adulthood.
The school nurse is discussing dental health with some children in first grade. Which teaching should be included? 1 Teaching how to floss teeth properly 2 Recommending nonfluoridated toothpaste 3 Emphasizing the importance of brushing before bedtime 4 Recommending a toothbrush with hard nylon bristles to get between the teeth
3 Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries. The American Dental Association recommends fluoridated toothpaste for this age group. Parents should help with flossing until children develop the dexterity required, when they are in about the third grade. A toothbrush with soft nylon bristles is recommended to prevent damage to the gums.
The parents of 9-year-old twins tell the nurse, "They've filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this behavior is characteristic of what? 1 Giftedness 2 Typical "twin" behavior 3 Cognitive development at this age 4 Psychosocial development at this age
3 Classification skills are developed during the school-age years. This age group enjoys sorting objects according to shared characteristics. Giftedness is not measured simply by a school-age child's ability to classify objects, which is an expected cognitive skill for this age group. Giftedness signs include specific academic aptitudes, advanced memory skills, creative thinking, ability in the visual or performing arts, and psychomotor ability, either individually or in combination. The development of classification skills is characteristic of the school-age child and is not related to the behavior of twins. Psychosocial development of the school-age child is focused on accomplishment or industry, not the cognitive skills of classification that are described.
What has the most significant impact on the socialization of school-age children? 1 Parents 2 Teachers 3 Classmates 4 The child's self-concept
3 Classmates have a significant impact on the socialization of children. Teachers and parents are important but classmates have the most significant impact on the socialization of school-age children; peer relationships become increasingly important as the child grows older. The school-age child's self-concept is important but does not have the most significant impact on socialization.
The parent of a 6-year-old child is worried because the child frequently suffers from diarrhea and stomach upset. What does the nurse tell the child's parent? 1 "The immune system in 6-year-old children is not well developed." 2 "The digestive system in 6-year-old children is not well developed." 3 "Children tend to acquire infections during the first two years of schooling." 4 "Children at age 6 eat less due to reduced appetite."
3 During early middle childhood, children are more prone to infections, as they start going to school and are exposed to other children who may have infections. The immune system is well developed, and 6-year-old children are able to combat localized infections. The digestive system is well developed, so there are fewer stomach upsets. 6-year-olds begin eating more as their appetites increase.
A parent tells the nurse, "I'm worried about my 13-year-old son. He hasn't started puberty, but my daughter did when she was 11 years old." What is the most appropriate explanation by the nurse? 1 "This is unusual and requires further evaluation of your son." 2 "This is unusual because the onset of pubescence is usually the same in siblings." 3 "This is normal because the onset of pubescence is usually earlier in girls than it is in boys." 4 "This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls."
3 Girls begin puberty on average approximately 2 years before boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore onset of puberty is not abnormal in this case, and no further evaluation is necessary at this time.
Which behavior is most characteristic of the concrete operations stage of cognitive development? 1 Inability to put oneself in another's place 2 Progression from reflex to imitative behavior 3 Increasingly logical and coherent thought processes 4 Ability to think in abstract terms and draw logical conclusions
3 Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which spans the period from birth to 2 years of age. Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.
Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. What should the nurse consider when discussing this issue with the parents? 1 Changing self-esteem is difficult after about age 5 years. 2 Self-esteem is the objective judgment of one's worthiness. 3 Transitory periods of lowered self-esteem are expected developmentally. 4 High self-esteem develops when parents show adequate love for the child.
3 Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.
The parents of a 12-year-old child complain to the nurse that the child asks them about masturbation after watching a contraceptive advertisement. The parents are anxious about their child. Which response of the nurse helps relieve the parents' anxiety? 1 The child has a mental disorder. 2 The child has a hormonal disorder. 3 It is an age-associated behavior. 4 The child needs psychiatric treatment.
3 The nurse tells the parents that masturbation is common in school-aged children due to hormonal changes in the body. The parents should have a good relationship with the child and provide sex education. Curiosity about sex does not indicate that the child has a mental, hormonal, or psychiatric disorder.
The nurse teaches progressive relaxation of muscle groups to a 12-year-old child who is under stress. Which sign of stress would the nurse have likely found in the child? 1 Calmness 2 Enthusiasm 3 Bradycardia 4 Facial redness
4 Redness in the face is a physiologic sign of stress in children between the ages of 7 to 12 years. Relaxation techniques like progressive relaxation of muscle groups, deep-breathing exercises, and positive imagery help to reduce stress. Calmness and enthusiasm are behavioral patterns of school-age children to get into peer groups. If a child experiences stress, the heart rate increases (tachycardia) rather than decreases (bradycardia).
What maturation of systems is associated with school-age children? 1 Bladder capacity is greater in boys than in girls. 2 The immune system becomes less competent in its ability to localize infections. 3 Bones cease to ossify and yield to pressure, and muscle tissue pulls more readily. 4 The heart grows more slowly during the middle years and is smaller in relation to the rest of the body.
4 The heart grows more slowly during the middle childhood years and is smaller in relation to the rest of the body. Bladder capacity is greater in girls than in boys. The immune system is not less, but more, competent in its ability to localize infections. Bones continue to ossify throughout childhood but yield to pressure, and muscle pulls more readily than with mature bones.
During a home visit, the nurse assesses the growth and development of a 7-year-old child. After the assessment, the nurse documents that the child's physical development is inadequate. Which physical characteristic did the nurse find in the child? 1 Decreased leg length in relation to height 2 Decreased head circumference in relation to height 3 Decreased waist circumference in relation to height 4 Increased arm length in relation to other parts of body
1 During middle childhood, the child's physical maturity can be assessed by comparing the growth of body parts in relation to height. The child is considered to have inadequate physical development if the leg length is inadequate when compared to the increase in height. A healthy child with proper physical maturity can be identified by reduced head circumference when compared to height. Waist circumference is also decreased when compared to height. These children have longer limbs due to skeletal lengthening.
A child presents with toothache and inability to chew properly. Following a dental assessment, the nurse finds that the child has malocclusion. Which treatment strategy is included in the treatment plan to relieve the child from symptoms? 1 Flossing 2 Orthodontics 3 Tooth replacement 4 Fluoride supplements
2 Malocclusion is a condition in which the child has disrupted arrangement of the secondary teeth. The upper and lower dental arches are not aligned properly. This condition can be treated by orthodontics to attain proper arrangement of the teeth. Regular flossing helps to remove plaque and other food material but doesn't help in setting the teeth and may not be helpful to relieve the symptoms of the child. Tooth replacement can be helpful when the secondary teeth are avulsed. Fluoride supplements are prescribed to treat and prevent gingivitis in children.
Which statement is descriptive of the social development of school-age children? 1 Identification with peers is minimal. 2 Children frequently have "best friends." 3 Boys and girls play equally with one another. 4 Peer approval is not yet an influence toward conformity.
2 Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification with the peer group is an important milestone for the school-age child to move toward independence from families. During the school-age years, same-sex peer groups are more prevalent; there is therefore less interaction between boys and girls. Conforming to the rules is an essential part of group membership and therefore an important skill for the school-age child to learn in terms of peer relationships.
What is an important consideration in the prevention of injuries during middle childhood? 1 Most injuries occur in or near school or home. 2 Peer pressure is not strong enough to affect risk-taking behavior. 3 Injuries from burns are the highest at this age because of fascination with fire. 4 Lack of muscle coordination and control results in an increased incidence of injuries.
1 Most children in the middle years spend the majority of their time in and around school or home; therefore the risk for injuries is increased in and around these areas. Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence. Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, with children as pedestrians or passengers, account for the majority of severe accidents in the middle years. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscle coordination and control leading to injuries occurs in younger children.
The nurse is caring for a 7-year-old child. The nurse finds that the child is very curious about God and states that God is very loving towards children. Which statement appropriately describes spiritual development in the child? 1 The child assumes God to be a human. 2 The child feels illness to be due to God's anger. 3 The child does not believe in hell or heaven. 4 The child's beliefs are not influenced by culture.
1 School-age children are avid learners and their spiritual development is an ongoing process. The children may assume God to be a human, and may use words like "loving" and "helping" in context to God. These children feel that illness or injury may be a punishment for their misdeeds. The children may get fascinated by the idea of hell or heaven but do not have a completely formed concept. Their spiritual beliefs are largely influenced by their families and culture.
While performing assessments of students at a grade school, the nurse learns that some are latchkey children. Which characteristics does the nurse find in the latchkey children? 1 The children spend most of their time at home. 2 The children are brave and free from illness. 3 The children have a large number of friends. 4 The children are frequently supervised by adults.
1 The children belonging to a single-parent family or a family in which both parents are working are referred to as latchkey children. Such children lack proper care. They spend most of their time at home and do not spend time in outside and physical activities. These children are fearful and have chronic illnesses due to lack of care and physical activities. These children have fewer friends, because they are not able to interact with peers. Such children have to spend time alone before and after school and lack supervision by adults and parents.
The school nurse is teaching a class on safety. Which activities require protective athletic gear? Select all that apply. 1 Football 2 Lacrosse 3 Swimming 4 Gymnastics 5 Skateboarding
1, 2, 5 Any sport that involves body contact, such as lacrosse, football, or skateboarding, requires a child to wear protective equipment. Swimming does not involve body contact and requires no protective equipment. Gymnastics does not require protective equipment.
The parents of a 12-year-old child often have to work until late at night and cannot take care of the child when the child returns from school. Which actions employed by the parent are appropriate? 1 The parents set the water heater to 69.9° C for faster heating. 2 The parents advise the child to play on the trampoline if the child is bored. 3 The parents instruct the child to heat food in the microwave at low heat. 4 The parents advise the child to take aspirin if the child has fever.
3 The parents should follow safety guidelines and instruct the child to follow them to prevent accidents. Children in middle childhood exhibit explorative behavior and often tend to do experiments. The parents should give repeated instructions and teach safety guidelines. The parents should teach the child to use the microwave at low heat to prevent burns. The parents should set the water heater to 48.9° C to avoid scald burns. Trampoline injuries can be very serious, and the child should be allowed to play on them only under adult supervision. Medicines, including aspirin, should be taken only with adult supervision.
Nursing interventions to promote health during middle childhood should include what? 1 Instructing parents to defer questions about sex until the child reaches adolescence 2 Stressing the need for increased calorie intake to meet the increased demands on the body 3 Advising parents that the child will need decreasing amounts of rest toward the end of this period 4 Educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt
4 Because the permanent teeth are present, it is important for the child to learn how to care for them. Parents should approach sex education with a lifespan approach and answer questions in a manner appropriate for the child's age. Caloric needs are diminished in relation to body size during the middle years; however, a balanced diet is important to prepare for the adolescent growth spurt. School-age children often need to be reminded to go to sleep.
What is an important consideration related to childhood stress? 1 Children do not have coping strategies. 2 Children should be protected from stress. 3 Parents cannot prepare children for stress. 4 Children 7 to 12 years of age are capable of identifying physiologic stress responses.
4 Children 7 to 12 years of age are capable of identifying physiologic stress responses. It is not feasible to protect children from all stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps children develop coping strategies for dealing with stress.
During middle childhood, some children tend to tell stories to their parents by exaggerating events at school. What suggestion does the nurse give to the parents to manage this? 1 Consult to a child psychiatrist immediately. 2 Inform the child's teacher immediately. 3 Check with the peers and playmates of the child. 4 Teach the difference between reality and fantasy.
4 During middle childhood, children tend to tell stories and often exaggerate the events that take place in school. They tell these stories to impress their friends and family. However, most children are able to distinguish between fantasy and reality, but some may not acknowledge the difference. The nurse should suggest that parents teach them the difference between reality and fantasy. Telling stories to the parents and peer in an exaggerated way is a normal behavior in school aged children. Therefore it does not indicate that the child has mental illness and the child need not be referred to a psychiatrist. The parents should not encourage the child by listening to the child's stories. The child may get confused or feel rejected if parents complain to the teacher. Checking with the peers and playmates of the child may not stop the child from telling imaginary stories.
What does Erikson describe in his theory of psychosocial development as the most important task for school-age children? 1 Sense of autonomy, in which children want to do things for themselves 2 Sense of trust, in which children form basic trust in the people around them 3 Sense of initiative, in which children explore their world with all their senses and powers 4 Sense of industry, in which children have access to tasks that need to be done and are able to complete them
4 In his theory of psychosocial development, Erikson posits that the most important task for school-age children is to develop a sense of industry, in which children have access to tasks that need to be done and are able to complete them. A sense of autonomy, in which children want to do things for themselves, is the task for psychosocial development in children ages 1 to 3 years. A sense of trust, in which children form basic trust in the people around them, is the task for psychosocial development in children from birth to 1 year of age. A sense of initiative, in which children form basic trust in the people around them, is the task for psychosocial development in children ages 3 to 6 years.
What instruction should the nurse include when giving parents guidelines about helping their children in school? 1 Punish children who fail to perform adequately. 2 Help children as much as possible with their homework. 3 Accept responsibility for children's successes and failures. 4 Communicate with teachers if there appears to be a problem.
4 Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parental involvement is one factor in a child's success in school. Children need to do their own homework; this cultivates responsibility. Discipline should be used to help children control behaviors that might be affecting school performance, but failure to perform adequately should not be punished itself. Communicating with the child is a better solution to getting to the root of the school performance problem. School-age children need to develop responsibility; keeping promises and meeting deadlines lays a successful foundation for adulthood and adult responsibilities.
A nurse receives a call from a parent who says that her 12-year-old son just lost a permanent tooth while playing soccer. What instruction should the nurse give to the parent to increase the likelihood that the tooth can be re-implanted? 1 Do not rinse the tooth. 2 Hold the tooth by its root area. 3 Call the dentist first thing the next morning. 4 Place the avulsed tooth in cold milk for transport to the dentist.
4 Placing an avulsed tooth in cold milk for transport to the dentist enhances the likelihood that the tooth will be able to be reimplanted. It is permissible to rinse the tooth under running water or saline solution if it is dirty. Never hold a tooth by the root area; instead hold it by the crown. The child should be transported to the dentist immediately.
After interacting with the parents of a 10-year-old child, the nurse understands that they are effectively following guidelines to help the child in getting good grades in school. Which statement made by the parents supports the nurse's conclusion? 1 "We discuss all our concerns with the teacher at the annual parent-teacher conference." 2 "We have arranged home tutoring sessions for our child twice a day." 3 "We are strict and allow our child to watch television only on achieving good grades." 4 "We help our child with homework by explaining the questions and avoiding giving answers."
4 The parents should help the child complete homework by explaining the concepts and encouraging them to find the answers. If the parents give answers, the child may not read the complete material and will not gain complete knowledge. Parents should communicate with the child's teachers regularly instead of meeting once during an annual conference. The child may feel stressed due to excessive sessions of tutoring. The parents should arrange tutoring sessions only when they are recommended by the child's teachers. Parents should encourage the child to focus on studies rather than on grades. The child may feel stressed if strict rules are imposed for not getting good grades.
