EAQ- Perry Peds CH.34, The School-Age and Family

Parents report to the school nurse that their child is hesitant to play with other kids in school. During the assessment, the nurse instructs the parents to avoid giving high-calorie foods to their child. What condition is the nurse helping the parents control? The child: 1. Has gained too much weight. 2. Spends a lot of time sleeping. 3. Received low grades in school. 4. Watches too much television.

1. Has gained too much weight Children who are obese or overweight generally have difficulty in playing with peers. These children need to be guided in order to find activities that meet their needs. Excess sugar consumption in the diet is responsible for weight gain, so the nurse should instruct the parents to reduce sugar in the child's diet. The child who is spending more time sleeping should be involved in active play. It is not necessarily related to eating too much sugar. Low grades in school may be related to cognitive impairment. When a child spends excess time watching television, the child should be redirected to playing outside.

Parents reports to the nurse that their 12-year-old child resists going to bed at night. Which advice does the nurse give to the parents to help the child go to bed on time? 1. "Allow the child to go to bed at a later time." 2. "Promote daytime naps on a daily basis." 3. "Promote reading a book before bedtime." 4. "Urge video game playing before bedtime."

2. "Promote daytime naps on a daily basis." Bedtime resistance can be resolved by allowing the child to read before bedtime. Many 12-year-olds prefer to read before bed. The child's bedtime should not be changed because school-age children need adequate sleep. School-age children do not require naps, which can hamper sleeping at night. Children should not play video games before going to bed. This may stimulate and excite the child and make it harder to fall asleep.

The nurse advises a working single parent to enroll his or her child in an after-school program. What could be the reason behind the nurse's advice? The child: 1. Fails to have snacks available. 2. May be lonely and fearful. 3. Has a developmental disorder. 4. Prefers to spend time outdoors.

2. May be lonely and fearful After-school programs are generally arranged for latchkey children. These children usually have working parents or may live with one parent who works. They have no proper supervision after coming home from school. These children may feel lonely and fearful, and parents are advised to enroll the children in an after-school program. An after-school program is not necessary just because the child does not have an after-school snack available. Children with developmental disorders need to attend special training programs rather than an after-school program. When the child plays outdoor games, it signifies that the child is developing good social interactions. These children do not have to attend an after-school program.

What information should the nurse include when giving parents guidelines about helping their children in school? 1. Help children as much as possible with their homework. 2. Punish children who fail to perform adequately. 3. Communicate with teachers if there appears to be a problem. 4. Accept responsibility for children's successes and failures.

3. Communicate with teachers if there appears to be a problem. Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Children need to do their own homework. This cultivates responsibility. Discipline should be used to help children control behaviors. School-age children can use reasoning skills. School-age children need to develop responsibility. This helps with keeping promises and meeting deadlines, thereby laying successful foundations for adulthood.

The nurse teaches progressive relaxation of muscle groups to a 12-year-old child. Which sign of stress is the nurse likely to find in the child? 1. Calmness 2. Enthusiasm 3. Facial redness 4. Bradycardia

3. Facial redness Redness in the face is a physiologic sign of stress seen in children 7 to 12 years of age. Relaxation techniques such as 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. These behavioral patterns help the child to develop good peer relations. If a child is experiencing stress, the heart rate would be increased (tachycardia), instead of a decreased heart rate (bradycardia).

Nursing interventions to promote health during middle childhood include: 1. stressing the need for increased calorie intake to meet increased demands. 2. instructing parents to defer questions about sex until the child reaches adolescence. 3. educating the child and parents to the need for good dental hygiene because these are the years in which permanent teeth erupt. 4. advising parents that the child will need decreasing amounts of rest toward the end of this period.

3. educating the child and parents to the need for good 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; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex education with a lifespan approach and respond to a child's questions with an answer appropriate to the child's age. School-age children often need to be reminded to go to sleep.

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 nurse should explain to this parent that this is: 1. unusual and requires further evaluation of the son. 2. unusual because the onset of pubescence is usually the same in siblings. 3. normal because the onset of pubescence is usually earlier in girls than it is in boys. 4. abnormal because the onset of pubescence is usually earlier in boys than it is in girls.

3. normal because the onset of pubescence is usually earlier in girls than it is in boys. The average age of onset for puberty in boys is 12 years old. Age of pubescence is gender related. Girls begin puberty an average of approximately 2 years before boys.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. The nurse's suggestions regarding participation in sports at this age should include: 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. sports participation is encourages if the sport is appropriate to the child's abilities. Parents and coaches need to recognize the child's abilities and teach proper techniques so the child can compete safely. Organized sports can provide safe, appropriate activities with supportive parents and coaches. School-age children enjoy competition. The parent should help the child select a sport that is suitable to her capabilities and interests. These changes occur at puberty -- before that, boys and girls can compete on the same teams.

The parents of a school-age child tell the nurse that to maintain proper nutrition, they give small amounts of food to the child every 2 hours after school. What advice does the nurse offer the child's parents to prevent stomach pain? 1. "Let your child go outside and play after coming home from school." 2. "Make sure that the child takes a nap after coming home from the school." 3. "Do not give snacks to your child after coming home from school." 4. "As children get older, they do not need to eat every 2 hours."

4. "As children get older, they do not need to eat every 2 hours." The gastrointestinal system of the school-age child is well developed, which results in fewer stomach upsets. The caloric needs of the school-age child is smaller than that of the preschooler. Therefore these children need not be fed as frequently as the preschooler, so the nurses instruct the parents to avoid feeding the child every 2 hours. Allowing the child to play may help increase the physical activity of the child and promote physical development. The parents must be advised to maintain a normal sleep schedule. The child must be involved in physical activities and homework after school instead of taking a nap. The child is usually hungry and tired after coming from school, so the parents must be advised to give nutritious snacks to the child after coming home from school.

The nurse observes that a child is fidgety, restless, and easily distracted. What does the nurse interpret from these symptoms? The child: 1. Has many of the signs and symptoms of dysgraphia. 2. Demonstrates characteristics of conversion reaction. 3. Exhibits signs of posttraumatic stress disorder (PTSD). 4. May have attention deficit hyperactivity disorder (ADHD).

4. May have attention deficit hyperactivity disorder (ADHD) If a child displays fidgetiness and restlessness and is easily distracted, the child may have ADHD. Dysgraphia is the difficulty of the child with writing. Abdominal pain, fainting, pseudoseizures, paralysis, headaches, and visual field restriction are the symptoms of conversion reaction. The symptoms of PTSD include persistent re-experiencing of the traumatic event and avoidance of stimuli associated with the event or trauma.

What is an important consideration related to childhood stress? 1. Children should be protected from stress. 2. Children do not have coping strategies. 3. Parents cannot prepare children for stress. 4. Some children are more vulnerable to stress than others.

4. 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.

The nurse is assessing a child who has frequent headaches. The nurse teaches breathing exercises to the child to help relieve the headaches. What condition in the child is the nurse trying to treat? 1. Meningitis 2. Asthma 3. Influenza 4. Stress

4. Stress Children at different developmental stages undergo different types of stress that manifests as abdominal pain, headaches, and breathlessness. These symptoms can be relieved by practicing relaxation techniques such as deep breathing. Meningitis is an infection of the meninges. It may be treated by antibiotics; breathing exercises play no role in treating meningitis. Children with asthma are prescribed medications used to treat the disease and instructed to stay away from triggers. Children with influenza are provided supportive measures such as complete bed rest and good nutrition for recovery.