NSG 334 Chapter 28: Growth and Development of the School-Age Child
On physical examination, the nurse discovers that a 6-year-old child's palatine tonsils are somewhat enlarged in the back of the throat. What would be the nurse's best action?
Record this as a normal finding in an early school-age child. Lymphoid tissue reaches maximum growth in early school-aged children. The tonsils may decrease in size somewhat from the preschool years but they remain larger than those of adolescents. The tonsils and adenoids may appear larger than normal even in the absence of infection. The nurse would be correct to document this as a normal finding. The child would not need pain medication nor an examination for respiratory problems if this a normal finding.
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. 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 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." 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?" 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 nurse is teaching a group of school-age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?
"I will grow an average of 2.5 in (6.5 cm) per year." During the school-age years, the child will grow an average of 2.5 in (6.5 cm). As puberty approaches, there will be significant differences in development between boys and girls. As development occurs, weight does increase, but it is not directly related to fat production. This is an area where much education needs to occur with young girls because "dieting" can be detrimental to the child's health and increased size is tied to the child's body image and self-esteem. By 10 years of age, brain growth is complete, and fine motor coordination is refined.
The nurse is educating a group of parents about childhood nutrition, specifically caloric needs. Which statement, when made by a parent, indicates teaching was successful?
"My 12-year-old child, who plays soccer, needs to consume no more than 2,000 calories a day to maintain good health." Boys and girls 4 to 8 years old who are moderately active will need about 1,400 to 1,600 calories per day. Boys 9 to 13 years old who are moderately active need about 1,800 to 2,000 calories a day and girls 9 to 13 years old who are moderately active need about 1,600 to 2,000 calories a day. Approximately 45% to 65% of calories should come from carbohydrates.
A nurse is assisting in a parent education class on accident prevention. Which statement by a parent indicates that further education is needed?
"My son can let his friend ride as a passenger on his bicycle as long as they both wear helmets." Children should be taught ways to stay safe and prevent accidents. All children should wear bicycle helmets; however, unless the bicycle has a sidecar, the bike riding is safe for only one rider. The parents are correct that their children should learn their names and addresses, should not set up a meeting with a person they met on the Internet without parental supervision, and should wear a life jacket when boating.
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." 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 parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond?
"Remind her in simple terms what will happen in the dentist's office." Due to the girl's temperament, it is best if the parents talk to the dentist before the first visit to find out exactly what the dentist will be doing and then describe to the child in simple terms what will occur. Reminding the child about the importance of proper oral hygiene is unhelpful. Telling the child that the dental checkup is just like going to see the pediatrician is untrue. It is inappropriate to advise the parents to not prepare the girl in advance.
The parent of a 6-year-old child calls the nurse because the child has developed a fear of loud alarms and sirens, and the child was recently frightened by the school's fire drill. The parent asks for guidance. How should the nurse respond?
"Try desensitization with an alarm clock or stove buzzer." Desensitization is a technique in which a fear is conquered by approaching it little by little. The child's fear of alarms and sirens can be addressed by hearing non-threatening, softer-sounding alarms and buzzers that the child can control in the home. The parent can then read to the child about firemen and possibly take the child to the fire station. Telling the parent to ignore the fear or simply advising the parent to tell the child that alarms protect us is not helpful.
A parent brings a 6-year-old to the clinic and informs the nurse that the child is tired all the time, even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse?
"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." Sleep needs for children change according to their ages. A 6- to 8-year-old child needs 12 hours of sleep per night. The 8- to 10-year-old child needs 10 to 12 hours of sleep per night. The 10- to 12-year-old child needs between 9 and 10 hours of sleep per night. Many younger children need a nap or to be provided with quiet time after school to recharge after a busy day in the classroom. Increasing the child's sleeping hours should be attempted before asking for medical intervention.
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?
"Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age." Self-esteem is developed early in childhood. The feedback a child receives from those perceived in authority such as parents and educators impacts the child's sense of self-worth. As the child ages, the influence of peers and their treatment of the child begin to have an increasing influence on self-esteem.
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 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 nurse is about to see a 9-year-old girl for a well-child checkup. Knowing that the child is in Piaget's period of concrete operational thought, which characteristic should the child display?
Consider an action and its consequences. 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.
A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group?
Participating in a craft project During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter.
The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse?
Speak with the parents about the unusual increased number of respiratory infections. In the school-age child, the respiratory system continues to mature with the development of the lungs and alveoli, resulting in fewer respiratory infections. Because the child is absent excessively for respiratory infections the nurse should speak with the parents to aid in determining if there is an underlying cause, or suggest the child visit the pediatrician to discuss the issue.
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. Which factor does this best represent?
appropriate social development During the school-age years, peer groups tend to be same-sex. This helps children learn to work together and to see viewpoints different then their own. Being part of a peer group helps with positive socialization of the school-aged child. The other choices are not represented by this scenario.
While observing a group of 9-year-old children at school, the nurse is concerned that one of the children is not cognitively developing according to Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned?
does not understand the phrase "slow as molasses" when used by the teacher Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete-operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about his or her world from different dimensions. Abstract thinking, such as understanding the meaning of the phrase "slow as molasses," is expected at this stage of cognitive development.
A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to:
make her child attend school every day. School refusal or phobia may result from both a parent not wanting a child to attend school and a child not wanting to leave a parent. Th nurse's role is to help them work together while keeping the child in school to resolve the issue.
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 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 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.
The nurse is admitting a 10-year-old for surgery. What action should the nurse prioritize when caring for this child?
Answer questions regarding pain. School-age children need privacy more than younger children do and may not want to have physical contact with adults; this wish should be respected. These attitudes should be recognized and handled in a way that ensures as much privacy as possible. Children's questions, including those about pain, should be answered truthfully. An opportunity to verbalize anxieties will help a child deal with them. Family caregivers may feel guilty about the child's need for hospitalization and, as a result, may overindulge the child. The child may regress in response to this, but this regression should not be encouraged.
The nurse is teaching parents of an 11-year-old child how to deal with the issue of peer pressure regarding the use of tobacco and alcohol. Which suggestion by the nurse provides the best course of action for the parents?
Discuss tobacco and alcohol use and effects with the child. Parents are major influences on school-age 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 discouraging the child from making friends with kids that use tobacco or alcohol.
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. 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.
Parents of an 8-year-old client report the child struggles with the chore of cleaning their bedroom. What advice will the nurse give to assist with this challenge for a child at this stage of development?
Break the chore into smaller tasks that the child can accomplish more easily. In the early school-age years, children have the developmental task of achieving a sense of industry. Breaking the job into smaller tasks that they can feel accomplished about provides a "reward" to assist them in completing a larger job. Treats are not required as a reward for children of this age. Providing consequences, such as loss of toys or loss of privileges, does not allow for the development of industry nor support children to learn how to complete the job.
A mother brings her 8-year-old daughter into the doctor's office because over the past year her tonsils have increased in size to the point that the mother is concerned that her breathing will be obstructed. The girl has no pain, fever or other symptoms. Following this data collection, which instruction is best?
"This may be normal growth of lymphatic tissue for this age." The immunoglobulins IgG and IgA each reach adult levels during the school-age period; lymphatic tissue continues to grow in size until about age 9. The resulting abundance of tonsillar and adenoid tissue in schoolchildren is often mistaken for disease as the tonsils seem to fill the entire back of the throat. The fact that there are no other symptoms indicates that this child's enlarged tonsils are simply a result of the normal growth of lymphatic tissue for this age.
The nurse is caring for a hospitalized 10-year-old client. Which nursing action is most appropriate?
Consistently reinforce the child's self-worth. Helping school-aged clients experience satisfaction in projects, social activities, family life, and school helps them gain a sense of industry. Reinforcing self-worth provides this satisfaction. The child should not be discouraged from participating in his or her care. The child's mistakes may need corrected to learn; however, the child has to be allowed to make mistakes in a safe environment to promote learning. Pointing out these mistakes needs to be done with care. Competition between clients will not facilitate growth and development or psychosocial development.
A 10 year-old child on the oncology unit has attended mass every Sunday in the hospital chapel during every stay in the facility. What does the nurse suspect is the most likely reason for this attendance?
The child is comforted by participating in the rituals associated with their religion While any of these scenarios could be true in some circumstances, the most common reason most children attend services while being hospitalized is that they find comfort in participating in their religious practice rituals.
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:
preoccupation with death and dying is common in the school-aged child. 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?
"As parents, you need to be good role models." 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.
The nurse is teaching a group of school-aged children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?
"Girls typically experience a rapid growth spurt before boys." Girls typically experience a rapid growth spurt before boys, and are usually taller by about 2 in (5 cm) or more than preadolescent boys. During the school-age years, the child will grow approximately 1 to 2.5 in (2.5 to 6.25 cm) per year. As puberty approaches, there will be significant differences in development between boys and girls. The first sign of puberty for girls is breast changes, not menarche.
A 7-year-old child has taken money from a sibling's dresser on two occasions. When counseling the parent about this behavior, what would the nurse advise?
"You may need to remind your child about property rights." Antisocial behaviors develop during the school-age years. Between the ages of 6 and 8 years, the child has difficulty understanding the concept of ownership and property rights. At this age, children often take things because they like the look of an item. By age 9, children learn to respect other's possessions and property. Buying a more secure bank may keep the child from taking the money, but it does not take into consideration the child's developmental level. The behavior is a developmental issue and not an emotional issue of having too much pressure.
The parents of an 11-year-old are discussing having their child come home after school alone rather than continue attending after-school care. They ask the nurse about the implications of making this decision. What should be included in the information provided by the nurse? Select all that apply.
-"Children who are considered "latch key kids" are at an increased risk for engaging in risky behaviors." -"Children who do not come home to an adult do not perform as well in school." -"Maturity and not age should be considered when deciding when a child is ready to stay home alone." Despite the level of maturity, children who are unsupervised are more likely to participate in risky behaviors such as smoking, drinking, and doing drugs. In addition, latch-key children may feel anxiety, stress, fear, boredom, and/or loneliness; they miss more days of school and have lower academic scores. The level of maturity of the child and not age is the most important factor to consider when deciding when the child may stay home alone. Local laws vary with regard to the age when children are approved to stay home alone; however, at current, all states allow children younger than 15 years to be left alone.
The nurse at an elementary school is explaining the concept of industry versus inferiority to a group of nursing students. What is part of this stage of Erikson's theory?
A sense of competence, mastery, and worth Erikson states that school-agers receive satisfaction from developing new skills and successfully using them to accomplish goals (industry). Failing (without adult support) or being unable to meet expectations that are set too high can result in feelings of inferiority. Lacking the ability for abstract thought is a cognitive skill and part of Piaget's theory, as is the principle of conservation. The conventional stage belongs to Kohlberg's theory of moral development.
A parent tells the nurse that the 6-year-old child has been biting his fingernails since beginning first grade. After analysis, the cause is determined to be increased stress. What advice would the nurse give the parent regarding this behavior?
Allow some time every day for the child to talk about new experiences The developmental task of the school-age child is industry. They are busy learning, achieving, and exploring. With school comes separation from the parents, new people, new activities. Beginning school can be a time of extreme stress for children. Biting the nails can be a symptom that something is concerning the child. Spending time with the child and allowing the child time to discuss these new experiences of school helps the child to put experiences in perspective and begin to deal with them. Allowing the child a reward for not biting the nails does not address the underlying issue of why the child is biting the nails in the first place. The underlying issue is emotionally based, so adding milk or providing a distraction will not correct the problem.
The school nurse is speaking with a group of teachers about bullying. Which statement by a teacher would indicate a need for further education by the nurse?
"Boys bully more often but girls are more likely to be bullied." Both boys and girls are bullied and can bully others; however, boys are twice as likely to be bullies and victims of bullying. Being bullied can have negative results on children throughout life. These children often have increased episodes of headaches, stomachaches, sleep problems, anxiety, loneliness, depression, and suicidal tendencies.
The nurse is caring for a 7-year-old child who will be in the hospital for several weeks. Which action by the nurse will facilitate the child's psychosocial development?
Encourage the child to complete school work and provide guidance. At this age, Erikson states the child's stage of psychosocial development is industry versus inferiority. To meet this stage, children need to develop a sense of pride and accomplishment for their schoolwork, sports, activities, or social life, or they will feel inferior. The nurse can encourage the child to complete his or her schoolwork and assist the child as needed to help facilitate this stage. An adolescent needs peer interaction. Selecting what to wear facilitates autonomy, a stage for children 2 to 3 years of age. Quickly responding to the call bell facilitates trust, a stage for neonates through their first year.
The developmental task of the school-aged period, according to Erikson, is gaining a sense of:
industry versus inferiority. The school-age years, according to Erickson, are the stage of industry versus inferiority. The developmental stage helps increase the child's sense of self worth. Industry is associated with the child's increased interest in knowledge and the development of social skills. Autonomy versus shame is the developmental tasks of 1 to 3 year old children. Erickson's stages do not include the developmental tasks of independence versus dependence nor identity versus failure.
During an annual visit of a 6-year-old boy, the nurse observes dental caries on two of the child's primary teeth. Which response by the parents suggests more education is needed regarding the importance of primary teeth?
"These are only his baby teeth so we are not worried." Parents need to understand the value of the primary teeth and not see them only as temporary and soon-to-be replaced. Referral to a pediatric dentist and parental supervision of tooth brushing both lead to dental health and may be better appreciated once parents understand the importance of the primary teeth. Fluoride supplementation is not necessary if fluoride is part of the local water supply.
A nurse is caring for a hospitalized 7-year-old child whose family members have been unable to visit for 2 days. The nurse is preparing a diversional activity for the child. Which activity would best be suited for a child in this age group?
A paint-by-numbers activity creating a picture Between the ages of 6 and 8 years, children begin to enjoy participating in real-life activities, such as helping with gardening, housework, and other chores. They love making things, such as drawings, paintings, and craft projects. The child would need additional instruction to learn fractions, which may not be considered fun. A card game such as solitaire and a board game of monopoly may be too hard for the 7-year-old. In addition, the game of monopoly would require additional players.
An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother in regard to the child's dental health?
Ensure that the child brushes his teeth after each meal and snacks. Proper dental hygiene includes a routine inspection and conscientious brushing after meals. A well-balanced diet with plenty of calcium and phosphorus and minimal sugar is important to healthy teeth. Foods containing sugar should be eaten only at mealtimes and should be followed immediately by proper brushing. The school-aged child should visit the dentist at least twice a year for a cleaning and application of fluoride.
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." 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.
The parent of a 12-year-old child reports the child does not have high self-esteem. The parent asks for suggestions to increase feelings of self-worth. What activity(ies) would be appropriate for the nurse to suggest? Select all that apply.
-Encourage the child to develop new skills. -Recommend the child begin to participate in after-school activities. -Recommend the child investigate opportunities for volunteering at local charities. The school-age child's satisfaction from achieving success in developing new skills leads him or her to an increased sense of self-worth, which is a person's feeling about one's own value. The child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. The school-aged child is very interested in learning how things are made and work. Providing the child an allowance and allowing the child to stay home alone after school will not help increase self confidence, which is how much a person believes in oneself and what one can do.
The nursing instructor is leading a discussion on school-aged children. The instructor determines the session is successful when the students correctly choose which factor as being a priority for the school-aged child?
Needs 10 to 12 hours of sleep per night The school-aged child needs 10 to 12 hours of sleep per night. They need to brush their teeth after every meal and at bedtime. A routine physical exam once a year is all that is necessary. Children are screened around the age of 10 or 11 for scoliosis.
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." 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.
The nurse is conducting a routine well-child evaluation for a family with five children. The parent seems frazzled, and the two oldest children are engrossed in their hand-held video games. The other three children—all preschoolers—are gathered around a portable DVD player watching a movie while they wait for their appointment. The nurse suspects that the children spend a great deal of time in front of electronic screens and that the nurse's values greatly differ from this family's. How should the nurse approach the issue of television exposure during this evaluation?
"Would you like a pamphlet telling how TV watching affects children's health?" It can be difficult to initiate a conversation when the nurse perceives that his or her values are different from those of the client. The nurse should approach the subject in a factual and nonjudgmental way. This gives the parent the opportunity to invite further discussion on the subject. Telling the parent that the children appear to be watching too much TV could cause the parent to become defensive. The other responses are true, but the nurse will likely have more success if the nurse lets the parent initiate further discussion.
What activities would a nurse recommend to the families of school-aged children to promote attainment of Erikson's developmental stage of industry vs. inferiority? Select all that apply.
-Participating on the school soccer team -Praising the child for their academic efforts -Allowing the child to assist her teacher in straightening up the classroom School-age children need support in order to achieve attainment of the developmental stage of industry vs. inferiority; parents can play a large role in the child accomplishing this. Encouraging participation in group sports, allowing children to assist their teacher and praising their academic efforts, even though they may not have made the best grade, are all ways to help the child accomplish this task. Expressing doubts about the child's abilities or defending them when they are not successful in accomplishing a skill only increases the chance the child will develop a sense of inferiority.
An 8-year-old boy who says he wants to be a doctor when he grows up pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step?
Industry During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment. Accommodation is the ability to adapt thought processes to fit what is perceived, such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Perfectionism is the desire to do something perfectly. The boy's desire to apply the band-aid "the right way" is a hallmark of the development of industry. The other answers are not as pertinent.
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 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.
The school-age child develops the ability to recognize that if a block of clay is in a round ball and then is flattened, the shape changes but not the amount of clay. What understanding has this child developed?
conservation Piaget described concrete operational thought occurring in the child ages 7 to 10 years. During this time the child develops various skills to see objects and the world. The skill of conservation is the ability to recognize that a change in shape does not necessarily mean a change in amount or mass. Using reversibility, the child can understand that processes can be reversed or canceled out by other things. Decentration is developed when the child can pay attention to multiple attributes of an object or situation instead of only one. In classification, the child is able to put objects together by shared qualities or characteristics.
The school nurse is speaking with a child who is a latch-key kid. Which statement by the child would need further investigation?
"I answered the door yesterday and the salesman wanted to come in even though my mom wasn't home." When children are home alone after school they need to have an understanding of rules to promote safety. The child who answers the door when her parents are not at home has demonstrated a lapse in judgment. This needs further investigation and education. The remaining items are appropriate actions.
A parent calls the health care provider about the 7-year-old child's dental hygiene. The child has had three cavities. The parent does not know what to do and asks the nurse for guidance. How should the nurse respond?
"Are you able to supervise your child's brushing?" Dental caries is the leading chronic disease in the United States. Children need help with toothbrushing until they are between 7 and 10 years of age. The parent should monitor the toothbrushing to make sure it is thorough, observe for any abnormal tooth alignment, and schedule cleanings every 6 months. Children tend to concentrate on the front teeth, because they can see them easily and "forget" the teeth in the back. Parental oversight is needed to be sure those teeth are brushed carefully.
The nurse is talking with the parents of an 8-year-old child who has been cheating at school. Which comment by the nurse would be appropriate as a first step?
"Be sure the adults in the child's life, including you, as parents, demonstrate positive behavior." Because they are role models for their children, parents must first realize the importance of their own behaviors. If the academic environment is too difficult, not too easy, the child may be cheating to keep up with the increased rigor. Punishment should be geared toward discussion and helping the child understand the seriousness of cheating, and not be a subtle approach. After a discussion with the child, a review of the child's academic situation (is the work too hard? Is tutoring needed?) and positive role-modeling is assured, then referral to a counselor would be indicated but not as the first step in the resolution.
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 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. Child abuse (child maltreatment) includes physical and emotional abuse as well as intimate partner violence. Parents should teach children the concept of "good touch" versus "bad touch" prior to the school-age years. If a school-age child's behavior yields suspicion of physical or intimate partner violence, the nurse should report it to the appropriate authorities in his or her state.
The nurse is addressing a caregiver's concerns regarding adequate sleep for an 11-year-old child who gets up at 6:30 a.m. each morning. The nurse should point out which time as the most appropriate bedtime for this child?
9:00 p.m. Exercise and sufficient rest are important for school-age children. The school-aged child needs 10 to 12 hours of sleep per night. The 6-year-old needs 12 hours of sleep whereas an 11-year-old child needs closer to 10 hours of sleep per night, which would mean going to bed at 8:30 to 9:00 p.m. The older adolescent could go to bed slightly later and get adequate sleep.
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 Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.
An 8-year-old male child is being seen for a well-child visit. His weight at his visit last year was 50 lb (22.7 kg) and his height was 47 in (119 cm). If he is developing normally, which finding will the nurse expect to note this year?
Height 49.5 in (124 cm) Normal physical growth for school-age children is a gain in height of 2.5 inches (6.25 cm) each year. Thus, a height of 49.5 in (124 cm) would be expected growth. The growth in weight is not within normal parameters as this is a 12 lb (5.4 kg) weight gain. A 7-year-old child, not 8-year-old child, should weigh seven times his birth weight. Adult teeth do not normally come in until age 10 to 12.
The school nurse is preparing to conduct routine health screenings of the elementary school students. Which screening will the nurse prioritize for students ages 6 to 8?
vision and hearing Vision and hearing screening are often conducted by the school nurse, who then alerts the caregivers if there is a need for further evaluation from the health care provider. Most states have immunization requirements that must be met when the child enters school. Signs of scoliosis are usually evaluated at about the age of 10 to 11 years. There are no specific tests that the school nurse would use to evaluate nutrition; however, the nurse would be monitoring all students who come to the nurse's office for potential nutritional situations as deemed appropriate.
