NUR 128 - Maternity and Pediatric Nursing, Ch. 25 ,26, 27, 28-- Ricci, Kyle & Carman Fourth Edition

The mother of a 7-year-old girl is asking the nurse's advice about getting her daughter a 2-wheel bike. Which response by the nurse is most important?

"Be sure to get the proper size bike." Explanation: 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.

The mother of a 6-year-old is asking the nurse how to handle the child's lying and fabricated stories when confronted with questionable actions. Which response would be most appropriate by the nurse?

"Children this age sometimes can't distinguish between fantasy and reality." Explanation: Children in the age group 6 to 7 years often engage in magical thinking. They may still believe in the tooth fairy, Santa Claus, monsters under the bed, and other imaginary characters. These keen imaginations may also conjure up fears—especially at night—about remote, fanciful, or imaginary events. If a child of this age has trouble distinguishing fantasy from reality, it may incline them to lie to escape punishment or to boost self-confidence. The other choices do not consider this child's stage of development or give the mother the most appropriate information for the situation.

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?

"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 parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse?

"Normal growth and development for this age results in an average weight gain of 7 pounds per year." Explanation: Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight. Simply comparing them to other children seen in the clinic doesn't mean it is a normal expectation. While activity is important, the nurse must first address the parent's concern.

The nurse is caring for a 6-year-old child. During the course of a routine wellness examination, the parent proudly reports that the child eats whatever the parent puts on the plate. The nurse wants to emphasize the importance of allowing the child to make some choices regarding the types of foods eaten. How should the nurse communicate this to the parent?

"Now is the time to let your child choose some of the meals." Explanation: Diet preferences are established in the preschool years and continue to develop as the child ages. The diet is influenced by family, peers, and media. Because of these influences and the child striving for independence, it is important to involve the child in helping select the food choices and guiding the child to healthy food choices. With parents, as well as children, it is more effective and less a matter of personal opinion to say "now is the time" rather than "you need," "I want you to," or "you must" do something. The nurse can emphasize the importance of the child participating in meal selection while encouraging the child's independence in a gentle manner.

An overly tired school-aged child enters the school clinic. The nurse asks the child to state the times he/she usually goes to bed at night and wakes up in the morning. The child answers 11:00 PM and 6:00 AM. Which is the best response made by the nurse?

"That is not enough sleep. You should get at least 9 to 12 hours of sleep each night." Explanation: The school-aged child needs 9 to 12 hours of sleep per night. Seven hours of sleep is not enough sleep for this child. It is not appropriate to ask judgmental questions concerning parenting skills nor why the child goes to bed at 11:00 PM.

A hospitalized 7-year-old is recovering from a head injury. Occupational therapy has been ordered to assist the child in regaining eye/hand coordination. If the child cannot master this skill, what feelings may arise?

A feeling of inferiority Explanation: Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.

A nursing student is presenting information to the class about abuse of children (child maltreatment). The nursing instructor should intervene when the student presents which information? Select all that apply. Child abuse (child maltreatment) and intimate partner violence are not the same thing. The majority of victims of child abuse (child mistreatment) suffer from neglect. The concepts of "good touch" versus "bad touch" should be taught around the age of 10 years. The nurse should speak with the family first if child abuse (child mistreatment) is suspected. The lowest percentage of child abuse (child mistreatment) is due to emotional abuse.

Child abuse (child maltreatment) and intimate partner violence are not the same thing. The concepts of "good touch" versus "bad touch" should be taught around the age of 10 years. The nurse should speak with the family first if child abuse (child mistreatment) is suspected.

A nurse is assigned to care for a 7-year-old child. The child wants to show the nurse a collection of baseball cards. The nurse understands that the collection of objects is common in this age group and is known as what type of thinking?

Classification Explanation: An important change in thinking during the school-age period is classification. This is the ability to divide things in different sets and identify their relationships to each other. Children in this age group love to collect sports cards, insects, rocks, stamps, coins, etc. These collections may be only a short-term interest, but they are of utmost importance to the child when he or she is collecting them. Decentration occurs in the concrete operational stage from ages 7 to 12 years. It is the ability to consider multiple aspects of a situation. The preoperational stage occurs between ages 2 and 7 years. During this time thinking is at a symbolic level. One part of the preoperational stage is egocentrism. In this stage, the child has the inability to see things from another's point of view.

The parents of a school-aged child with school refusal have received professional guidance by the school psychologist, pediatrician, and three different psychiatrists. Based on this, which nursing diagnosis would be most appropriate?

Compromised parental coping related to inability to assist with school fears Explanation: School refusal is a fear of attending school. Some of the behaviors of this problem include frequent absences, skipping classes, or being chronically late. School refusal may be a problem for both the parent and child. When parents have multiple professionals focusing on the same issue, there is an inability of the parent to find and apply an appropriate treatment. A child with school refusal oes not have a delusional pattern. It is a strong fear. The parents in this situation are seeking help. That does not demonstrate noncompliance. Ineffective tissue perfusion is not the cause of anxiety.

The nurse is assessing an 11-year-old child with back pain. What approach(es) will the nurse use for this assessment? Select all that apply. Ask the parent to describe the history and onset of the pain. Have the child rate the pain on a 0 to 10 scale. Respect the child's request to have the parent leave during the physical assessment. Provide explanations of the actions during the head-to-toe assessment. Explain the assessment findings to the parent without the child present.

Explanation: 3. Have the child rate the pain on a 0 to 10 scale. 2. Respect the child's request to have the parent leave during the physical assessment. 1. Provide explanations of the actions during the head-to-toe assessment. The 11-year old child can provide their own history of the pain, and they should first be asked. The nurse can check for additional information about medical history from the parent if needed. The explanation of assessment findings should include the child, who may worry if not included. An 11-year-old child can use a numeric pain scale and understand explanations of the nursing assessment. At this age, the child is often more private, and this should be respected during the assessment if the child wishes the parent to leave.

A mother states that her 6-year-old has starting biting nails and regressing to baby talk since beginning school. What instructions are best for the nurse to give the mother regarding this behavior?

Make time each day to spend with the child individually. Explanation: Many first graders are capable of mature action at school but appear less mature when they return home. They may bite their fingernails, suck their thumb, or talk baby talk. Scolding, nagging, threatening, or punishing does not stop the problem and can actually make them worse. Methods such as bad-flavored nail polish or restraining the child's hands make the problems worse. These behaviors stop when the underlying stress is discovered and alleviated. Parents should be urged to spend time with the child after school or in the evening so the child continues to feel secure in the family and does not feel pushed out by being sent to school.

When considering the moral development of a 7-year-old child, which actions are most consistent with the anticipated state of development?

The child focuses on being a good girl or boy. Explanation: The 7- to 10-year-old usually follows rules out of a sense of being a "good" person. He or she wants to be a good person to parents, friends, and teachers and to himself or herself. The adult is viewed as being right. This is stage 3: interpersonal conformity (good child, bad child), according to Kohlberg. Younger children focus on their actions on avoiding punishment and base actions on what is best for them. Older children will give consideration to how their personal actions will impact others.

The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely?

The child has a leaner body mass than a girl at this age. Explanation: 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 conducting a support group for parents of 9- and 10-year-olds. The parents express concern about the amount of time their children want to spend with friends outside the home. What should the nurse teach the parents that peer groups provide?

a sense of security as children gain independence Explanation: Nine-year-olds take their peer group seriously. They are more interested in how other children dress than what their parents want them to wear. This is the age where groups are formed and others are excluded from the club. This age group is imitating their peers as they develop their own identity and separate from their parents. Groups are fluid as they change regularly due to many reasons: each member lives on the same street, each member plays on the same ball team, or one member has fewer material things than the others, etc. Security is gained through these clubs because it helps the school-age child develop independence away from the family. Most of the time in the school-age child, peer group relationships are with same-sex friends. Children do not become self-sufficient through these clubs. They remain dependent on their families for their physical needs.

A group of 10-year-old girls have formed a "girls only" club. It is only open to girls who still like to play with dolls. How should this behavior be interpreted?

appropriate social development Explanation: Ten-year-olds take the values of their peer group seriously. They are interested in being with peers of like mind and activities. Clubs are formed with specific exclusions of peers. Such clubs typically have a secret password and secret meeting place. Membership is generally all girls or all boys. These groups are not based on the immaturity of the children nor do they encourage sexism and bullying.

A 9-year-old child is feeling conflict from seeing other children in her class engaging in behaviors she senses are not appropriate. When making decisions about what actions are most appropriate, a child of this age will rely most heavily on which party of influence?

parents Explanation: All the above have an influence on the actions of the school-age child. The parents have the highest degree of influence on the school-age child's ultimate actions.

The nurse is talking with a school-aged child about her interests. In which interest do most school-aged children place the most focus?

school Explanation: The school-age child typically values school attendance and school activities. During school-age, the focus expands from family to teachers, peers, and other outside influences.

A nurse is providing anticipatory guidance to the parents of an 8-year-old child, explaining that when the child returns next year for a well check-up, the child will likely undergo which screening?

scoliosis Explanation: Scoliosis may become apparent for the first time in late childhood. All school-age children older than 8 years should be screened for scoliosis at all health assessments. Lead screening is done earlier. Screening for sexually transmitted infections or hepatitis B is not age-dependent and would not be done unless there is an indication of high risk behavior.