Chapter 14 - Health Promotion of the School-Age Child and Family Pt 1

A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." The most appropriate explanation by the nurse is "This is unusual and requires further evaluation of your son." "This is unusual because the onset of pubescence is usually the same in siblings." ***"This is normal because the onset of pubescence is usually earlier in girls than it is in boys." "This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls."

"This is normal because the onset of pubescence is usually earlier in girls than it is in boys." 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, no further evaluation is necessary at this time. The age of pubescence is gender related, with the average age of puberty onset being 12 years for girls and 14 years for boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, her son is not having an abnormal onset of puberty.

Signs and symptoms that are associated with stress in a school-age child that require intervention are (Select all that apply.) child not wanted to go to sleep occasionally at the usual bedtime. ***reverting to a previous behavioral pattern exhibited several years ago. ***bedwetting. doesn't want to eat a certain food although the child has ate it before. ***doesn't want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable.

- reverting to a previous behavioral pattern exhibited several years ago. - bedwetting. - doesn't want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable. Reverting to a previous behavior indicative of regression, evidence of bedwetting and change in socialization pattern as signs and symptoms of stress should be investigated as they are signal areas of concern. Occasional reluctance to go to sleep at the regularly scheduled bedtime may be an isolated event which is self-limiting. Refusal to eat a food even if the child ate the food before is not by itself indicative of a significant stress event.

Which action would indicate a priority for the nurse in terms of health promotion safety? 8-year-old child uses helmet protection while riding a bicycle. ***4-year-old child wears protective equipment while on a skateboard. School-age child uses car seat restraint system. Protective equipment is used while the 9-year-old child is riding a scooter.

4-year-old child wears protective equipment while on a skateboard. Skateboard use is not recommended for children aged 5 and younger regardless if they are wearing protective equipment. All of the other options indicate that attention has been placed on safety concerns and that the children are developmentally appropriate to handle the physical skill activity.

At which age, is a strong preference exhibited for members of the same sex to engage in play activities rather than play with mixed groups? ***7 6 8 9

7 At age 7, boys prefer to play with boys and girls prefer to play with girls. At age 6, play is considered to be more independent but showing some degree of socialization. Between the ages of 8 and 9, there is more interest in body-girl relationships and beginning to mix group play.

What is the "earliest" age at which puberty begins? ***a. 9 b. 10 c. 11 d. 12

ANS: A There is no universal age at which children assume the characteristics of prepubescence. The first physiologic signs appear at about 9 years of age (particularly in girls) and are usually clearly evident in 11- to 12-year-old children.

The nurse is planning strategies to assist difficult or easily distracted children when they participate in activities. What strategies should the nurse plan? (Select all that apply.) ***a. Role-play before the activity. ***b. Handle behavior with firmness. ***c. Acquaint them with what to expect. ***d. Be patient with inappropriate behavior. e. Don't give them much information about the activity.

ANS: A, B, C, D Difficult or easily distracted children may benefit from "practice" sessions in which they are prepared for a given event by role-playing, visiting the site, reading or listening to stories, or using other methods to acquaint them with what to expect. Nurses need to handle children with difficult temperaments with exceptional patience, firmness, and understanding so they can learn appropriate behavior in their interactions with others.

What growth and development milestones are expected between the ages of 8 and 9 years? (Select all that apply.) ***a. Can help with routine household tasks ***b. Likes the reward system for accomplished tasks c. Uses the telephone for practical purposes d. Chooses friends more selectively ***e. Goes about home and community freely, alone or with friends f. Enjoys family time and is respectful of parents

ANS: A, B, E Children between the age of 8 and 9 years accomplish many growth and development milestones, including helping with routine household tasks, liking the reward system when a task is accomplished well, and going out with friends or alone more independently and freely. Using the telephone for practical reasons, choosing friends more selectively, and finding enjoyment in familywith new-found respect for parents are tasks accomplished between the ages of 10 and 12 years.

Parents are concerned about their child riding an all-terrain vehicle. What should the nurse tell the parents about safe use of all-terrain vehicles? (Select all that apply.) ***a. Restrict riding to familiar terrain. b. Limit street use to the neighborhood. ***c. Nighttime riding should not be allowed. d. Vehicles should not carry more than two persons. ***e. Vehicles should include seat belts, roll bars, and automatic headlights.

ANS: A, C, E Safe use of all-terrain vehicles includes restricting riding to familiar terrain; not allowing nighttime riding; and assuring the vehicle has seat belts, roll bars, and automatic headlights. Street use should not be allowed, and the vehicle should not carry more than one person.

The school nurse is teaching bicycle safety to a group of school-age children. What should the nurse include in the session? (Select all that apply.) a. Ride double file when possible. ***b. Watch for and yield to pedestrians. c. Only ride double with someone your own size. ***d. Ride bicycles with traffic away from parked cars. ***e. Keep both hands on the handlebars except when signaling.

ANS: B, D, E Bicycle safety includes watching for and yielding to pedestrians, riding bicycles with traffic away from parked cars, and keeping both hands on handlebars except when signaling. It is best to ride single file, not double file, and never to ride double on a bicycle.

What statement accurately describes physical development during the school- age years? a. The child's weight almost triples. b. Muscles become functionally mature. ***c. Boys and girls double strength and physical capabilities. d. Fat gradually increases, which contributes to children's heavier appearance.

ANS: C Boys and girls double both strength and physical capabilities. Their consistent refinement in coordination increases their poise and skill. In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 5 cm/yr and gain 3 kg/yr. Their weight will almost double. Although the strength increases, muscles are still functionally immature when compared with those of adolescents. This age group is more easily injured by overuse. Children take on a slimmer look with longer legs in middle childhood.

The nurse is teaching a class on nutrition to a group of parents of 10- and 11-year-old children. What statement by one of the parents indicates a correct understanding of the teaching? a. "My child does not need to eat a variety of foods, just his favorite food groups." b. "My child can add salt and sugar to foods to make them taste better." ***c. "I will serve foods that are low in saturated fat and cholesterol." d. "I will continue to serve red meat three times per week for extra iron."

ANS: C School-age children should be eating foods that are low in saturated fat and cholesterol to prevent long-term consequences. The child's diet should include a variety of foods, include moderate amounts of extra salt and sugar, emphasize consumption of lean protein (chicken and pork), and limit red meat.

The nurse is teaching parents about safety for their "latchkey" children. What should the nurse include in the teaching session? (Select all that apply.) a. Teach the child first-aid procedures. b. Keep the key in an easy place to find. ***c. Teach the child weather-related safety. d. Teach the child to open the door for delivery people. ***e. Emphasize fire safety rules and conduct practice fire drills.

ANS: C, E Safety for "latchkey" children includes teaching the child first-aid procedures, teaching the child weather-related safety, and emphasizing fire safety rules and conducting practice fire drills. Teach the child not to display keys and to always lock doors. The child should be taught to not open the door to anyone, even delivery people. ***This is the answer in test bank, but I believe it is A, C, E based on rationale

A school-age child falls on the playground and has a small laceration on the forearm. The school nurse should do which to cleanse the wound? a. Slowly pour hydrogen peroxide over wound. b. Soak arm in warm water and soap for at least 30 minutes. c. Gently cleanse with sterile pad and a non-stinging povidone-iodine solution. ***d. Wash wound gently with mild soap and water for several minutes.

ANS: D Lacerations should be washed gently with mild soap and water or normal saline. A sterile pad is not necessary, and hydrogen peroxide and povidone-iodine should not be used because they have a cytotoxic effect on healthy cells and minimal effect on controlling infection. Soaking the arm will not effectively clean the wound. DEFINITION ENGLISH

A 10-year-old child is riding a bicycle on the grounds of the school. Which finding if observed by the school nurse would require intervention? Child is seen walking the bicycle through the crosswalk. Child is riding close to the curb. ***Child's shoes are ill fitting. Child is riding single file.

Child's shoes are ill fitting. Shoes that are ill fitting can result in potential injury as they can get caught up in gears and affect the ability of the child to navigate. All of the other observed behaviors are consistent with safe practice.

Which describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Are capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see ***d. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

ANS: D In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly and logically until late adolescence. Making judgments based on what they reason to making judgments based on what they see is not a developmental skill.

Which statement is not accurate regarding the roles and responsibilities of a school nurse? They are responsible for development and implementation of plans of care for all children within the designated school. ***All school nurses are registered nurses. They are responsible for medical needs of the children within the designated school. They evaluate implementation of care delivered to children within the designated school setting.

All school nurses are registered nurses. Not all schools have a school nurse but may have unlicensed assistive personnel that work within the school setting that have received training to provide routine standardized care under the supervision of a school nurse. The other options are all within the roles and responsibilities of a school nurse.

Which is descriptive of the social development of school-age children? Identification with peers is minimal ***Children frequently have "best friends" Boys and girls play equally with each other Peer approval is not yet an influence toward conformity

Children frequently have "best friends" 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; therefore, there is 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.

A middle age child understands that with regards to a mathematical equation that 7 can be composed of 4+3 as well as 2+5. Based on this finding, the nurse documents that the development level of the child reflects? Concrete operations Verification of latency period ***Conservation Accomplished industry versus inferiority

Conservation Piaget's cognitive theory development describes conservation as the ability of the child to understand that the same concept may exist as identified by a different method. Numerical relationships are understood before substance conservation. Concrete operations is the term Piaget applies to the entire stage whereby children are able to use thought processes to experience events and actions. The latency period is described by Freud as the ability of the child to go from peer relationships to heterosexual relationships. Industry versus inferiority refers to Erikson's overview of this time frame whereby children if successful master the challenges between industry and inferiority.

At what age would orthodontic treatment be considered to have the most potential for successful outcome? When the adolescent growth period has stopped. ***Early referral if malocclusion presents regardless of age. Treatment differs based on gender due to difference in growth and development. When all primary teeth are present.

Early referral if malocclusion presents regardless of age. If malocclusion is present, best practice would be to have early referral for evaluation and treatment. Orthodontic treatment should be started prior to the growth period stopping. Orthodontic treatment is based on individual presentation and not gender based variables. Orthodontic treatment is typically not started when all primary teeth are still present.

The school nurse is discussing dental health with some children in first grade. Which should be included? Teach how to floss teeth properly. Recommend a toothbrush with hard nylon bristles to get in between the teeth. ***Emphasize the importance of brushing before bedtime. Recommend nonfluoridated toothpaste.

Emphasize the importance of brushing before bedtime. Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries. 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 American Dental Association recommends fluoridated toothpaste for this age-group.

Which action would improve dental health in the school-age child? Limiting brushing of teeth to three times a day following meals. ***Encouraging the child to floss. Have the parent brush the child's teeth in order to make sure it is done properly. Have the child consume fruit juice rather than soda.

Encouraging the child to floss. Flossing is a critical activity that has been shown to improve dental health. Brushing teeth following meals as well as following snacks has also been shown to improve dental health. At this age, the child should be able to brush their own teeth. Whereas soda should be avoided, the use of fruit juice may contribute to dental caries as it is considered to be a sugar source and example of a fermentable carbohydrate. Water as a drink should be promoted to improve dental health.

Which is characteristic of the psychosocial development of school-age children? A developing sense of initiative is important. Peer approval is not yet a motivating factor. Motivation comes from extrinsic rather than intrinsic sources. ***Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. The school-age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feelings of inferiority, as highlighted in Erikson's stage for this age-group of industry versus inferiority. Initiative versus guilt is the stage characteristic of preschoolers. Peer group formation is one of the major characteristics of school-age children. School-age children gain satisfaction from independent behaviors that are internally driven and accomplished.

Which behavior is most characteristic of the concrete operations stage of cognitive development? Progression from reflex activity to imitative behavior Inability to put oneself in another's place ***Increasingly logical and coherent thought processes Ability to think in abstract terms and draw logical conclusions

Increasingly logical and coherent thought processes 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 occurs 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.

The school nurse is teaching a class on safety. Which activities require protective athletic gear? Select all that apply. ***Lacrosse ***Football Swimming Gymnastics ***Skateboarding

Lacrosse Football Skateboarding Any sport that involves body contact such as lacrosse, football, and 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.

Examination of a child's mouth reveals that teeth do not line up properly upon attempts to have the child bite down. This finding is noted as? ***Malocclusion Gingivitis Evidence of dental caries Dental injury

Malocclusion Malocclusion occurs when upper and lower teeth do not approximate when a child bites down. Gingivitis refers to inflammation of the gums. Evidence of dental caries would refer to the presence of a cavity. Dental injury refers to evidence of chipping or dislocation as a result of trauma.

Which benchmark serves as the ending period for the middle year period of development? Beginning school ***Onset of puberty Wisdom teeth appearing Loss of deciduous teeth

Onset of puberty The onset of puberty signals the end of the middle year period. Beginning school and loss of deciduous teeth are associated with the beginning of the middle year period. Appearance of wisdom teeth occurs later on in life.

A child has sustained an injury and lost a primary tooth. Which priority action should be taken by the nurse at this time? ***Provide comfort measures and assess for bleeding. Referral to the dentist for immediate consultation. Recover the tooth and prepare for reimplantation. If the tooth is dirty, rinse it off and cover in gauze until needed for reimplantation.

Provide comfort measures and assess for bleeding. Avulsed primary teeth are usually not reimplanted. Therefore the nurse should focus on assessment of the site and comfort measures. All of the other options would be indicated if an avulsed tooth were to be reimplanted.

What is an important consideration related to childhood stress? Children should be protected from stress. Children do not have coping strategies. Parents cannot prepare children for stress. ***Some children are more vulnerable to stress than others.

Some children are more vulnerable to stress than others. Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. 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 them develop coping strategies for dealing with stress.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents? Changing self-esteem is difficult after about age 5 years. Self-esteem is the objective judgment of one's worthiness. ***Transitory periods of lowered self-esteem are expected developmentally. High self-esteem develops when parents show adequate love for the child.

Transitory periods of lowered self-esteem are expected developmentally. 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 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: bicycle helmets need to be worn only if the child is planning to ride in traffic. reflectors should be installed only on bicycles that are to be ridden at night. bicycles should be ridden against the traffic so that the rider can see the cars. ***bicycles should be walked through busy intersections.

bicycles should be walked through busy intersections. 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 assist in preventing accidents.

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. The nurse's response should be based on knowledge that: bullying at this age is considered normal. children who bully others usually join gangs. bullying is a short-term problem that is generally outgrown by the end of the school-age years. ***bullying often manifests itself in children who are different or have poor academic or social skills.

bullying often manifests itself in children who are different or have poor academic or social skills. Poor relationships with peers and a lack of group identification, such as looking different or having poor academic or social skills, contribute to bullying behavior. 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 bullies and joining gangs. Children who bully may be at risk for long-term psychological disturbances and psychiatric symptoms. Future problems for bullies may include violence, substance abuse, and criminal convictions, which often occur in adulthood.

What should the nurse include when giving parents guidelines about helping their children in school? a. Help children as much as possible with their homework. b. Punish children who fail to perform adequately. *c. Communicate with teachers if there appears to be a problem. d. Accept responsibility for children's successes and failures.

c Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parent involvement is one factor in children'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.

Nursing interventions to promote health during middle childhood should include stressing the need for increased calorie intake to meet the: increased demands on the body. instructing parents to defer questions about sex until the child reaches adolescence. ***educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. advising parents that the child will need decreasing amounts of rest toward the end of this period.

educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. 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. Parents should approach sex education with a life span approach and answer questions appropriate to the child's age. School-age children often need to be reminded to go to sleep.

An important consideration in preventing injuries during middle childhood is that peer pressure is not strong enough to affect risk-taking behavior. ***most injuries occur in or near school or home. injuries from burns are the highest at this age because of fascination with fire. lack of muscular coordination and control results in an increased incidence of injuries.

most injuries occur in or near school or home. 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, either as a pedestrian or passenger, 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 muscular coordination and control leading to injuries occurs in younger children.

In reviewing information about a school-age child, the nurse notes that the child goes to after school activities each day as the parents do not get home until considerably later in the day. Based on this description, the nurse would document concern for the growth and development due to lack of parental influence. ***no further action is needed. referral to a social worker for evaluation of the family unit. notation of being a latchkey child.

no further action is needed. Many children have working parents and do not exhibit any adverse outcomes if they attend after school activities each day following release from school. There is no need for referral to a social worker. A latchkey child by definition is one that has no parental or supervision contact following the school day and are responsible for their own care until the parent comes home.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. Based on the nurse's knowledge of this age-group, the most appropriate recommendation is organized sports, such as soccer, are not appropriate at this age. competition is detrimental to the establishment of a positive self-image. ***sports participation is encouraged if the sport is appropriate to the child's abilities. girls should compete only against girls because at this age boys are larger and have more muscle mass.

sports participation is encouraged if the sport is appropriate to the child's abilities. 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 out of a need for peer interaction for the school-age child. A sport should be selected that meets the child's capabilities and interests. The physical changes in boys described take place during puberty, later in the school-age years; therefore, there is no reason for boys and girls to compete separately at age 8 years.

A parent is concerned as her 6-year-old child "cheats" when playing games with other children. The parent is concerned that this behavior will affect future behaviors as the child gets older. The nurse understands the parent's anxiety about the described behavior and provides the following assurance ***this type of behavior occurs around this age period and is due to the child not being able to understand what it means to lose. this is a prompted behavior that occurs intermittently at this age. you are right to be concerned about this type of behavior. it is best to ignore the behavior as it will stop eventually.

this type of behavior occurs around this age period and is due to the child not being able to understand what it means to lose. Cheating as a behavior occurs primarily between the ages of 5 and 6. It is almost at times displayed as an automatic behavior as the child does not understand about winning and losing. The behavior typically goes away as the child matures. Ignoring the behavior without some direction is not advised as it is best to address the situation and help the child to begin understanding of the concept.

An example of indirect bullying would be if: telling an individual that you don't like them because you were hurt by their actions. raising one's hand to prevent another person from hitting you. taking a toy away from someone because you want it to see it. ***using social media to make offensive comments about an individual.

using social media to make offensive comments about an individual. Indirect bullying are actions that are taken that are meant to cause harm to an individual or group. The use of social media to make offensive comments about an individual is not the place for professing feelings. One must take into account that offensive comments by definition are offensive. Telling an individual that you don't like them as a result of their exhibited behavior is an example of direct communication. Taking a toy away from someone because you want to see it may not be the best approach but it does involve direct action.

A finding that is consistent with prepubescence is: ***variation in physical appearance between boys and girls. age of onset of physical signs is the same for both boys and girls. does not occur during the preadolescence period. appearance of secondary sex characteristics is the same for both boys and girls.

variation in physical appearance between boys and girls. During the period of prepubescence there is a variation in physical appearance between boys and girls. The age of onset of these appearances also varies with girls exhibiting changes earlier than their male counterparts. The changes occur during the preadolescence period. Secondary sex characteristics also present at different times for boys and girls.