PEDS CH 26 & 27

The nurse is discussing an adolescent's development with the client's parents. Which statement by the parents indicate an understanding of the nurse's teaching?

"Our adolescent is working toward achieving a sense of personal identity." Rationale: According to Erikson's theory of psychosocial development, the major challenge of adolescence is the achievement of identity. Achieving independence from parental domination is another task of adolescence, but not the ultimate one. Helping other adolescents achieve higher goals is not a part of Erikson's theory of psychosocial development. Developing trust occurs in infancy

The parents of an adolescent boy ask the nurse when they will know that their son has reached puberty. What is the best response by the nurse?

"Puberty occurs when the person becomes able to reproduce sexually." Rationale: Puberty is the period when a person becomes able to reproduce sexually. Adolescence is the developmental period between puberty and maturity. It spans the ages between 11 and 20 years, after which a person enters early adulthood. Rapid growth spurt marks adolescence, by the end of which individuals achieve adult height. Although tremendous physical growth occurs, emotional needs predominate during this period and adolescents spend much of their time searching for meaning in life and for a sense of identity.

The nurse is collecting data on a 7-year-old child who weighed 7 lb 2 oz (3.2 kg) at birth. If the child is following a normal pattern of weight gain, the nurse would anticipate the child would weigh approximately:

50 pounds. Rationale: By age 7, the child weighs about 7 times as much as at birth

Which of the following is accurately related to growth patterns in adolescent girls?

Growth slows after the beginning of menstruation. Rationale: Girls grow about 3 in (7.6 cm) each year until menarche (the beginning of menstruation), after which growth slows considerably.

A nurse is teaching a female adolescent diagnosed with a vitamin A deficiency about appropriate nutritional recommendations to address this issue. The nurse determines that the teaching was successful based on which statement(s) by the adolescent? Select all that apply.

I guess I should start eating more yellow vegetables." , "I am willing to try liver and see if I like it." , "I will try to eat more broccoli and tomatoes from now on." Rationale: With a vitamin A deficiency, the adolescent needs to increase intake of foods high in that vitamin, such as liver, whole milk, carotene sources such as yellow vegetables as well as green leafy vegetables and tomatoes. Egg yolks, peanuts and bananas are good soures of vitamin B6. Egg yolks are also high in vitamin D.

The nurse caring for a hospitalized 8-year-old child recognizes that the child has developed an understanding of reversibility. Which of the following relates to the development of this understanding?

The child understands that their illness is probably only temporary. Rationale: Reversibility is the ability to think in either direction. 7-year-old children can add and subtract, count forward and backward, and see how it is possible to put something back the way it was. A 7- or 8-year-old can understand that illness is probably only temporary, whereas a 6-year-old may think it is permanent.

The school nurse is assessing a 15-year-old female client. The client states, "I just want to be pretty and to look like everyone else." Which response by the nurse is appropriate?

You seem concerned. Let's talk about your feelings." Rationale: Body image is closely related to self-esteem. Seeing one's body as attractive and functional contributes to a positive sense of self-esteem. During adolescence, the desire not to be different can extend to feelings about one's body and can cause adolescents to feel that their bodies are inadequate even though they are actually healthy and attractive. The nurse would acknowledge the client's concern and discuss the client's feelings. Stating the client is beautiful as is does not address the client's concern. Closed statements which require no response do not offer any insight for the nurse. The nurse would also avoid yes/no questions.

At a routine health checkup, a nurse assesses a child who has just turned 8 years of age. The nurse determines that the child is meeting developmental milestones for this age based on which finding(s)? Select all that apply.

able to move gracefully , demonstrates symmetrical balance Rationale: An 8-year-old child can typically put one's thoughts in chronological order, but the child is not yet able to group things in descending order or look at others' points of view. Grouping things in descending order and considering others' points of view are more commonly achieved by age 9. This age group also has symmetric balance and has graceful movements.

A nurse is discussing ways parents can foster the development of self-confidence in their school-aged child. Which action if stated by the parents would lead the nurse to continue the discussion?

comparing the child to an older sibling regarding academic achievements Rationale: A school-age child needs consistency, clearly defined expectations, and positive attention in order to develop self-confidence. By being accepting of mistakes the child makes, focusing on the child whenever they are talking, and making sure the child understands behavioral expectations, the parents are fostering self-confidence in the child.

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 Rationale: 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.

Which developmental findings would be considered normal for a 7-year-old child? Select all that apply.

engages in same-sex play activities , weighs 7 times his birth weight Rationale: At age 7, most children weigh 7 times their birth weight, grow about 2.5 inches each year and enjoy same-sex activities. Almost perfect eye-hand coordination and seeing others' point of view are not noted until age 9 or 10.

According to Erikson, the adolescent develops their own sense of being an independent person with individual thoughts and goals. This stage is referred to as:

identity vs. role confusion. Rationale: Adolescents must develop their own personal identity—a sense of being independent people with unique ideals and goals. This is the period Erikson calls identity versus role confusion. Erikson believes during this time the adolescent goes back through all previous developmental periods to achieve this identity. The stage of autonomy versus shame and doubt occurs between 18 months and 3 years. Industry versus inferiority occurs between 5 to 12 years. Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.

In observing a group of young adolescents playing basketball, it is noted that many of the adolescents appear to be uncoordinated and drop the ball often. The most common reason this occurs is because:

large muscles grow before small muscles grow. Rationale: Because the hands and feet increase in size first, when fine motor skills such as the use of the fingers are needed, the actions of the adolescent appear to lack coordination. These fine motor skills are well-developed by this age

An 11-year-old female child is at the pediatrician's office for a well-child check-up. Which health screening would the nurse anticipate that the child would undergo today?

scoliosis screening Rationale: Initial screening for scoliosis begins at age 10 to 11 years; the child is monitored into adolescence for development of scoliosis (or progression if scoliosis is already noted).

The nurse is discussing nutrition with a group of caregivers of adolescents. One of the caregivers tells the group she is concerned because her daughter has decided to become a vegetarian. With further discussion, the caregiver says her child won't eat any food of animal origin, including dairy products, eggs, fish, meat, and poultry. The vegetarian diet the caregiver is describing is:

vegan. Rationale: Vegan diets exclude all food of animal origin, including dairy products, eggs, fish, meat, and poultry.

The school nurse is the guest speaker in a classroom of fourth-grade children. They are discussing eating habits and the number of servings from each of the food groups that is appropriate for the school-age child. Which statement made by the children best indicates an appropriate intake of one of the food groups for this age child?

"I drink three big glasses of milk each day." Rationale: For the school-age child, an adequate intake of milk is 3 cups per day. The other statements do not reflect the recommended amounts for this age group.

A parent is concerned about nutrition for her school-age child, voicing questions on how to encourage a healthy diet. The nurse would recommend which action? Select all that apply.

Limit fat intake to no more than 35% of total calories to help control weight. , Allow the child to voice food dislikes and respect them. Rational: Parents are encouraged to offer healthy foods to children, allow them to choose their foods, and not encourage frequent snacking, especially with non-nutritious foods. Fat intake needs to be limited to less than 35% of the total daily calories to avoid obesity. Forcing a child to "clean their plate" is not a good idea either, since it forces the child to eat more than they often want to eat. Eating fast food more than twice a week is discouraged because "fast food" contributes to obesity.

A mother suspects that her 11-year-old son is experimenting with deliriants with his friends. Which symptoms would the nurse advise the mother to look for that would validate her concerns?

giddiness and coughing Rationale: Inhalation of substances can cause numerous symptoms, including giddiness and coughing. The child will not experience diarrhea, hyperactivity, or develop bad breath from experimenting with inhalants.

The caregiver of a 10-year-old calls the clinic and tells the nurse that her child came home late after school and is acting differently. The caregiver states, "I think my child might have taken something.: When questioned further, the caregiver reports the child is giddy, coughing, nauseated, and has a nosebleed. These findings indicate that most likely the child has experimented with which of the following?

inhalants Rationale: Inhalants are substances whose volatile vapors can be abused. The child initially may experience a temporary high, giddiness, nausea, coughing, nosebleed, fatigue, lack of coordination, or loss of appetite.

A nurse is attending to a group of boys at a school. The nurse is required to document the sexual development in boys on a regular basis. The nurse would anticipate which clients having the highest incidence of nocturnal emissions?

Clients who are showing pubertal changes Rationale: The nurse should know that boys who are undergoing pubertal changes are more likely to experience nocturnal emissions. The first sign of pubertal changes and sex maturation is testosterone secretion. As this increased so does the penis and scrotum enlargement. This is a time when nocturnal emissions occur. In late adolescence, which lasts from age 18 to 20, the transition into adulthood is completed. The nurse should also know that boys in the age group of age 12 to 20 experience various chemical and physical changes taking place within their body. A strong, muscular appearance does not indicate the presence of nocturnal emissions.

A 17-year-old girl has come to the clinic to get a rubella immunization that is required by the college she plans to attend. Before administering this immunization, the child should have which screening or test?

pregnancy test Rationale: A urine pregnancy screening is advisable before the rubella vaccine is administered to a girl of childbearing age; administration of the vaccine during pregnancy can cause serious risks to the developing fetus.

During the admission process the nurse learns a 14-year-old female client has not experienced menarche yet. Which nursing action is appropriate?

Continue with the admission process. Rationale: Menarche, the first menstrual period, is generally experienced between the ages of 9 and 15 years. The nurse would document the finding and continue with the admission process. There is no need to notify the health care provider, perform further assessment, or ask about the client's maternal history.

A nurse is admitting a 16-year-old male to the floor for an appendectomy. How can the nurse prepare this client for hospitalization? Select all that apply.

Interview the adolescent separately from the parent to allow expression of information that he may not be comfortable sharing in front of the parent. , Provide privacy when client is changing into the hospital gown or going to the bathroom. , Encourage him to keep his cell phone nearby to communicate with his friends. Rationale: In order for an adolescent to adapt well to hospitalization, the nurse needs to provide him privacy and allow him control over his surroundings and care when possible. Keeping in contact with peers is very important to an adolescent, as is being discreet in regard to sharing personal information that typically is elicited in an admission interview.

The nurse is teaching a group of caregivers of school-age children about the importance of setting a consistent bedtime for the school-age child. Which statement made by a caregiver indicates an understanding of the sleep patterns and needs of the school-age child?

My child sleeps between 11 and 12 hours a night." Rationale: Sleep for the school-age child varies with the age of the child. A child between the ages 6 to 8 years needs 12 hours of sleep each night. The child between the ages of 8 to 10 years needs 10 to 12 hours of sleep each night. The 10 to 12 year old needs 9 to 10 hours of sleep each night. Staying up late after taking an after-school nap, not knowing when the child is tired, and sleeping more than a teenager when compared with a school-age child refer to sleep behaviors and needs of children of younger and older ages

What teaching points would a nurse provide for families of school-aged children to help prevent substance abuse? Select all that apply.

Set firm rules regarding alcohol and other drug usage and discuss consequences associated with breaking the rules. , Encourage decision-making and discuss family values. , Give the child "what if" examples to situations they may face. Children mimic what adults do so it is important to set good examples for behavior regarding substance abuse. Offering children opportunities to think through "what if" situations allows the child to have already thought about difficult situations they may find themselves in. Although threats are not productive, setting strict rules regarding substance abuse is very important. Also, encourage decision-making by the child based upon previous good decisions.

When interviewed by the school nurse, a 13-year-old adolescent female states she has a boyfriend and that her parents do not talk about sex with her. She says is confused about the facts and wants to know the truth. Which approach would best address this adolescent's concerns?

Sit down with her and openly discuss her concerns and questions in an honest, straightforward manner. Rationale: Discussions about human sexuality need to be open, honest and straightforward with adolescents. Parents and health care providers must remain nonjudgmental if they want adolescents to come to them with questions. Sitting down with the student and addressing her questions is the best way to establish a trusting relationship with her. Recommending that she talk with her parents will not help her since they are apparently not open to discussing the topic. Brochures cannot answer her specific questions and may result in more confusion on her part. Referring her to the health department is passing the nurse's responsibility to someone else, and there is no indication that any pregnancy prevention is needed.

True adolescence is said to begin when what occurs?

Sperm is produced in the male. Rationale: True adolescence begins with the onset of menstruation in the female and the production of sperm in the male. In early adolescence (10 to 13 years) the female experiences the first menstrual cycle and the male experiences growth of the testes. In middle adolescence (14 to 16 years) the female areola and papilla separate from the contour of the breast to form a mound and the male testes and scrotum grow and the voice changes. In late adolescence (17 to 20 years) breast enlargement stops in the female and the male achieves adult size penis and scrotum. The growth spurt in the female adolescent ends about 2 to 2.5 years after menarche. For boys it occurs around age 14 years.

The nurse is admitting a 15-year-old adolescent to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent?

The adolescent's need for privacy should be respected. Rationale: When an adolescent is ill or injured, it affects the body and body image. A hospitalized adolescent's primary concerns are pain and the loss of privacy. The adolescent is also anxious about being separated from friends and losing control of one's life. When an adolescent is hospitalized, it is very important the adolescent be given privacy. The adolescent needs individualized attention, confidentiality, and the right to participate in decisions about one's own health care. The adolescent should have contact with friends and be allowed in unit activities. Because the adolescent is under the age of 18, the parents should be involved and informed of the care. The nurse can talk with the adolescent and parents about care decisions and the adolescent's need for support from family.

Which action by a 7-year-old child best demonstrates development of decentration?

The child is able to recognize other people's point of view. Rationale: Around age 7, a child's thought processes change and magical thinking begins to disappear. Decentration is when the child is able to see several sides to a problem and begins to understand the different parts of a situation, as when the child is able to see another person's point of view. Reversibility is when a child can think in both directions, as in recognizing that an illness is not permanent. Conservation of volume means that the child understands that the amount remains the same even when the shape of the container changes, as with the water or the Legos.

Which nurse best fosters a school-aged child's adaptation to hospitalization? The nurse who:

explains procedures and shows the child equipment that will be used on them. Rationale: Hospitalized school-aged children adapt best if the nurse explains what is going to happen to them and shows them the equipment that the nurse will be using. Honesty is also imperative for development of trust in the caregiver, so if a procedure is going to be uncomfortable or painful, the nurse needs to tell the child this. Encouraging parental overindulgence or being accepting of regressive or acting-out behaviors is not recommended.