Chapter 18: Care of the School-Age Child

When describing play by the school-aged child to a group of nursing students, the instructor would emphasize the need for which of the following? A. Rules B. Recreation C. Physical activity D. Ritualism

ANS A Rationale: Middle childhood is characterized by play that embodies the need for rules and structure. Although recreation and physical activity may be involved, rules and structure are essential for play in this age group.

A nurse is working with the local community on promoting physical fitness for children. The nurse encourages the community to develop programs that meet the needs of the school-aged child for physical activity, based on the understanding that this age group requires how much physical activity daily? A. 60 minutes B. 15 minutes C. 30 minutes D. 90 minutes

ANS A Rationale: School-aged children should be encouraged to participate in 60 minutes of vigorous physical activity a day

The nurse is caring for a 5-year-old girl. During a routine wellness examination, the mother tells the nurse that the girl's father has enrolled her in a mini pom-pom cheering squad. The girl dislikes it immensely, but her father doesn't want the girl to be a "quitter." The mother asks for some guidance. How should the nurse respond? A. "Bad experiences can cause her to avoid other similar activities" B. "Tell your husband that requiring her to continue is inappropriate" C. "Your daughter may not be able to keep up with the instructions" D. "This may not suit your child's temperament or her physical abilities"

ANS A Rationale: The nurse must provide the mother with concrete information that will help the father understand that allowing the girl to quit an activity she dislikes will not make her "a quitter." The father is most likely to respond to the fact that this may cause lasting repercussions. Telling the husband that his expectations are inappropriate does not teach. Not being able to keep up with instructions or not suiting your child's temperament or physical abilities may be true, but these responses are not therapeutic or helpful in teaching the parents.

The mother of an 11-year-old child tells the nurse that her child seems to be "hungry all of the time" and seems to "never get full". The nurse suspects a physiological developmental problem. What is the rationale for the nurse suspecting a physiological developmental issue?Select all that apply. A. Stomach capacity increases, which should permit retention of food for longer periods of time B. The caloric needs of the school-age child are lower than in the earlier years of life C. School-age children typically consume less food than adolescents D. Peer pressure tends to cause the child to eat less E. The school-age child is very selective in the type of foods they prefer

ANS AB Rationale: Stomach capacity increases, which permits retention of food for longer periods of time. In addition, the caloric needs of the school-age child are lower than in the earlier years. These are physiological developmental reasons that support the nurse questioning if there is a problem.

The father of a 12-year-old girl reports his daughter does not have high self-esteem. He asks for suggestions to increase her feels of self-worth. What activities would be appropriate for the nurse to suggest? Select all that apply. A. Encourage the child to join a club at school. B. Recommend she begin to participate in after-school activities. C. Provide her with a weekly allowance. D. Allow the child to begin staying home alone after school when possible. E. Recommend the child investigate opportunities for volunteering at local charities.

ANS ABE Rationale: 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 child is very interested in learning how things are made and work. The school-age child's satisfaction from achieving success in developing new skills leads him to an increased sense of self-worth and level of competence.

Parents of an 8-year-old ask the nurse when they can stop using the booster seat in the car for their child. When responding to the parents, the nurse needs to keep in mind which of the following? Select all that apply. A. The child must be at least 4 ft 9 in. tall. B. It's okay to use the adult seat belt now based on his age. C. The child should be between 8 and 12 years of age. D. The child should wear the lap belt but not the shoulder belt. E. The lap belt must fit snugly over the child's stomach area.

ANS AC Rationale: A child should use a booster seat until the adult seat belt fits correctly. That is, the child should reach 4 ft 9 in. in height and be between 8 and 12 years of age before quitting the use of a booster seat. When an adult seat belt is used, both the lap and shoulder belt should be worn. The lap belt should be worn low and snug across the thighs, not the stomach.

The parents of a 10-year-old boy report they are having problems with their son. The child's mother reports her son is not a talented athlete but her husband continues to encourage him to play and try to excel. The child's father reports sports will help his son build character. What response by the nurse is most appropriate? A. "Encouraging involvement in sports can build valuable skills for a child." B. "Although your son is not a talented athlete, continue to encourage him to try." C. "Perhaps another pursuit would be better suited for your son." D. "It is important not to let him quit without trying."

ANS C Rationale: Children should be encouraged to try new things but, when they are faced with things they are not good at, the pressures can ultimately be counterproductive if they feel they are disappointing their parents or others of importance to them.

The nurse is caring for a 5-year-old child. The child's parent reports that the parent and child are constantly fighting about the child's choice of clothing. The child insists on selecting ones own clothes. The parent is tired of the power struggle and is embarrassed by the child's mismatched apparel. The parent asks for guidance. How should the nurse respond? A. "Offer two or three coordinated outfits and let the child choose." B. "Lay the clothes out in the order in which they are to be put on." C. "Only give your child clothes that are easy to put on." D. "Remind your child of the importance of dressing appropriately."

ANS: A Rationale: By the time children are 5 years old, they should be deciding what they wear and be able to dress themselves completely. The parent should encourage this independence and avoid a power struggle. The best way to do this is to let the child choose from two or three coordinated outfits. Suggesting that the clothes are laid out in the order that they are to be put on or recommending clothes that are easy to put on does not address the parent's concern. Reminding the child about needing to dress appropriately does not address the parent's concern and is unhelpful.

An anxious 12-year-old girl receives an injection from the nurse and sighs with relief when it is done. After a moment of reflection, the girl asks the nurse, "Is it hard to give someone an injection?" This girl's question is evidence that she has developed which cognitive skill? A. Decentering B. Accommodation C. Conservation D. Class inclusion

ANS: A Rationale: Decentering is the ability to project one's self into other people's situations and see the world from their viewpoint rather than focusing only on their own, which is what the girl in this scenario demonstrates in her ability to consider the injection from the nurse's point of view instead of just her own. 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. Class inclusion is the ability to understand that objects can belong to more than one classification.

A nurse is carrying on a conversation with a 7-year-old girl during an office visit. Which of the following is an example of the level of language development the nurse should expect in this child? A. Difficulty understanding the concept of "half past" in reference to time B. Ability to carry on an adult conversation C. Inability to speak in full sentences D. Fascination with bathroom language

ANS: A Rationale: Most 7-year-olds can tell the time in hours, but they may have trouble with discover "dirty" jokes at about age 9, they like to tell them to friends or try to understand those concepts such as "half past" and "quarter to," especially with the prevalence of digital clocks. Six-year-olds talk in full sentences, using language easily and with meaning. As children told by adults. They use swear words to express anger or just to show other children they are growing up. They may have a short period of intense fascination with "bathroom language," as they did during preschool years. By 12 years of age, children can carry on an adult conversation, although stories are limited because of lack of experience.

A nurse in the clinic observes a school-age child pushing another child. The parent is watching without disciplining the child and tells the nurse, "He just does what he wants to and doesn't listen to anything I say." What can the nurse inform that parent about the development of self-confidence in the child? Select all that apply. A. The child needs consistent rules to develop self-confidence. B. The child needs to be able to do what he wants to develop self-confidence. C. The child needs positive attention to develop self-confidence. D. The child needs clear expectations to develop self-confidence. E. The child needs to make his own decisions about behavior to develop self-confidence.

ANS: A,C,D Rationale: The school-aged child needs consistent rules, positive attention, and clear expectations in order to develop self confidence

A nurse is preparing a presentation for a parent group about media and school-aged children. Which of the following would the nurse most likely include in the presentation? Select all that apply. A. Media use is displacing other activities in a child's life. B. Children watch about 2 hours of television on average per day. C. Programs viewed often glamorize violence. D. A child's weight decreases with the number of hours spent watching television. E. Risky behaviors are often portrayed with little emphasis on consequences.

ANS: A,C,E Rationale: Media use by children and adolescents has increasingly displaced other activities in the child's life, such as reading, exercising, and playing with friends. The average child or adolescent watches an average of 3 to 4 hours of television a day. Some of the major concerns associated with media include the glamorization of violence, increased weight associated with the number of hours spent watching television, and the promotion of risky behaviors with little emphasis on consequences.

A nurse is working with a family that has two children who were identified as overweight based on screening. Which of the following strategies would be important for the nurse to include in assisting the family? Select all that apply. A. Encouraging moderate exercise for 60 minutes/day B. Emphasizing that the family not skip meals C. Involving the entire family in the program D. Focusing on rapid weight loss regimens E. Using food as a punishment

ANS: ABC Rationale: The entire family needs to be involved in the treatment plan, with emphasis on long-term permanent changes, not rapid weight loss and promoting moderate exercise for all for 60 minutes/day. Additionally, the nurse would encourage meal planning and discourage skipping meals and counsel the family not to use food as punishment or reward.

A 12-year-old child tells the school nurse, "I do not understand why my parents will not allow me to go to concerts without chaperones like some of my friends' parents. I feel like a baby compared to my friends." How will the nurse respond? A. "Your parents are right. Twelve years old is too young to be attending concerts without a chaperone." B. "I'm sure your parents are just very worried that you could get into trouble attending concerts at a young age." C. "Have you given any thought to why they don't let you go without a chaperone?Let's talk about some of the reasons they feel this way." D. "You are so young that you have plenty of time to go to concerts alone. Your parents just care about you."

ANS: C Rationale: Keeping dialogue open with the child and encouraging exploration of feelings is beneficial and therapeutic communication. This will allow the child to identify reasons without being told why the parents have this rule. Peer pressure can be difficult for children to manage. Helping them identify reasons for the parents' actions can help. Telling the child how to feel or that the parents only care doesn't allow conversation

The parents of a 10-year-old are experiencing problems with their son having fears when faced with new experiences. Which actions by the parents will be beneficial in helping the child effectively manage new experiences? Select all that apply. A. The parents should show support to the child by agreeing that these new experiences are indeed scary. B. The parents should limit exposing the child to new experiences. C. Teach the child relaxation techniques to use when feeling anxious. D. Encourage the child to use positive self-talk, such as saying, "I can do this" when faced with new experiences. E. The parents should allow the child to avoid situations when they feel anxious.

ANS: CD Rationale: Fears and anxiety to a degree are normal in children. The child should be encouraged to work through his fears. The child would benefit from positive self-talk and utilizing relaxation techniques. The parents should acknowledge fears and anxiety but should avoid catering to them.

The nurse has just completed an assessment on a child who voices an interest in how things are made and who needs support when they are not successful. The child further reports he is involved in clubs and sports outside the home. The nurse is aware that this child is in which of Erikson's states of development? A. Initiative versus guilt B. Autonomy versus shame and doubt C. Trust versus mistrust D. Industry versus inferiority

ANS: D Rationale: Erikson defines industry versus inferiority in the school-aged child. Activities include interest in how things are made, needing support when they are not successful, and involvement in clubs and sports outside the home. Erikson defines initiative versus guilt as the preschool period, the toddler period as a time of autonomy versus shame and doubt, and trust versus mistrust as the infancy period.

A 12-year-old girl has recently begun menstruating and is well into puberty. She is visiting the doctor today for a routine physical examination. Which of the following findings should cause concern in the nurse? A. Vulvar irritation B. Irregular periods C. Breasts of slightly different sizes D. Supernumerary nipple

Rationale: Any secretions that can cause vulvar irritation should be evaluated by a health care provider, because this does suggest infection. Most girls have some menstrual irregularity during the first year or two after menarche (the start of menstruation). Breast development is not always symmetrical, so it is not unusual for a girl to have breasts of slightly different sizes. After the condition has been checked during a physical examination to assure that no tumors are present to make one breast larger or that the other is diseased in some way to make it smaller, she can be reassured this development is normal. Supernumerary (additional) nipples may darken or increase in size at puberty girls understand a supernumerary nipple is affected by the hormones in her body in the same way as other breast tissue, so she isn't frightened by the accessory nipple enlarging with puberty or in a future pregnancy.

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? A. poor peer relationships B. encouragement for bullying and sexism C. appropriate social development D. immaturity for this age group

Rationale: Nine-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.

The mother of a school-age child is distraught because the child has been diagnosed with obesity. What actions should the nurse suggest to the mother to help the child with this problem? Select all that apply. A. Explain that obesity will lead to an early death. B. Maintain a balanced eating approach in the home. C. Purchase books explaining the latest ways to lose weight. D. Seek out a preteen weight loss group for the child to participate. E. Encourage increased activity such as walking the dog after school.

Rationale:Strategies to help the school age child with obesity include maintaining a healthy eating approach in the home, seeking a weight loss group with other preteens for the child to attend, and encouraging increased activity. Explaining that obesity will lead to an early death could cause the child to become obsessed with dieting and create an eating disorder. The child shouldn't be encouraged to use fad diets

The nurse is reviewing the medical record for a 13-year-old child who is being seen for concerns about school attendance. The physician has noted the child has "school phobia". What behaviors may be noted in a child experiencing this phenomena? Select all that apply. A. Reports of fear when attending school B. Demonstrates negative behaviors before school C. Chronically late for school D. Reports of feeling bored at school E. Difficulty making friends

School refusal /phobia has been defined as a refusal to attend school or difficulty remaining in school for an entire day. Behaviors include frequent absences, skipping classes, chronically late for school, severe misbehavior before school or attending school with great fear