FINAL EXAM PEDI 2023/ PrepU CH6
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? A. Participating in a craft project B. Playing with a jack-in-the-box C. Playing with blocks D. Writing letters to friends
A. Participating in a craft project Explanation: 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 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? A. "Your child doesn't seem to be overweight, so it isn't a concern." B. "We see most children of this age in our clinic gaining similar amounts." C. "Normal growth and development for this age results in an average weight gain of 7 pounds per year." D. "I understand why you are concerned. Is your child sedentary quite a bit? Encouraging activity may limit weight gain."
C. "Normal growth and development for this age results in an average weight gain of 7 pounds per year."
While treating a minor playground injury for an 8-year-old girl, the school nurse discovers that the injury was the result of bullying. What should be the nurse's first action? A. Assess the situation with the help of the school staff and parents. B. Immediately call the bullied child's parents. C. Question those responsible for the bullying. D. Determine if there have been other playground bullying incidents.
A. Assess the situation with the help of the school staff and parents. Explanation: Assessing the situation and following the school's bullying protocol will be an important first step
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. A sense of mistrust B. A sense of doubt C. A feeling of inferiority D. A sense of shame
C. 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.
The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely? A. The child's body fat has decreased since last year. B. The child has different diet preferences than his parents. C. The child has a leaner body mass than a girl at this age. D. The child described a somewhat reduced appetite.
C. 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 family who are vegetarian voice concern that their child is not growing well. The nurse should suggest which food to increase the calcium intake for A. adequate bone growth? B. oatmeal C. kale D. quinoa E. sweet potato
C. kale Explanation: The consumption of adequate protein and calcium is important for muscle, bone, and dental development. Foods highest in calcium are green leafy vegetables, enriched breads, and cereals. Soybeans, legumes, grains, and immature seeds are high in protein. Oatmeal and quinoa are both high in protein. Sweet potatoes are high in fiber, vitamin A, and potassium.
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? A. "Keep your cigarettes where she can't get to them." B. "Always go outside when you have a cigarette." C. "Tell her only losers smoke and chew tobacco." D. "As parents, you need to be good role models."
D. "As parents, you need to be good role models." Explanation: 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.
What physiological changes would the nurse expect to address in a 10-year-old child? Select all that apply. A. eruption of permanent teeth B. pulse rate 70 to 80 bpm C. blood pressure 98/56 mm Hg D. 20/20 vision E. decreased immune globulins
A,B,D Explanation: By 10 years of age, the eye globe reaches its final shape and adult vision is achieved. The eruption of permanent teeth and growth of the jaw correlate with final head growth. The immune globulins IgG and IgA reach adult levels. The left ventricle of the heart enlarges to be strong enough to pump blood to the growing body. As a result, the heart rate decreases to 70 to 80 beats per minute and the blood pressure rises to 112/60 mm Hg.
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? A. Consider an action and its consequences. B. View the world in terms of her own experience. C. Make generalized assumptions about groups of things. D. Know lying is bad because she gets sent to her room for it.
A. Consider an action and its consequences Explanation: 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.
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? A. signs of scoliosis B. vision and hearing C. review immunization records D. nutritional needs
A. vision and hearing Explanation: 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
A 10-year-old child tells the school nurse that she is embarrassed that she is afraid of the dark. Which is the best response by the nurse? A. "I was afraid of the dark at your age. You will grow out of that fear soon." B. "It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?" C. "Are you afraid that something is going to happen to you or that something or someone may be outside that you can't see?" D. "That is so horrible that you are afraid of the dark. Can you sleep at night at all?"
B. "It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?"
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? A. Weight 62 lb (28.1 kg) B. Height 49.5 in (124 cm) C. The child's weight is seven times his birth weight. D. The child has all of his adult teeth present.
C. Height 49.5 in (124 cm) Explanation: 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 nurse is caring for a hospitalized 5-year-old child. The child's parent has reported the child is becoming very "clingy." Which advice should the nurse provide? Select all that apply. A. "Regression is normal during hospitalization." B."Be careful not to coddle the child or it will result in regressive behaviors." C. "The child is starting to exhibit permanent behaviors of a loss of control." D. "Allowing the child to have some input in the care may be helpful in managing these behaviors." E. "The child may miss school and interaction with peers."
A, D, E Explanation: During hospitalization, the school-aged child may exhibit increased clinging behaviors. The child may also demonstrate regression, but these behaviors are temporary while hospitalized. The nurse should promote that the child be able to make some decisions or have some age-appropriate sense of control, as well as teach the parent to do so. The school-aged child may miss school and the interactions with peers. Ignoring the behaviors may be counterproductive.
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. A. Encourage the child to develop new skills. B. Recommend the child begin to participate in after-school activities. C. Provide the child 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.
A,B,E Explanation: 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 12-year-old child speaks with the school nurse about the stomachaches he has been having lately. He tells the nurse that he is upset because his best friend stole something and he knows this isn't acceptable behavior. The nurse identifies that this child is demonstrating which stage of moral development? A. Kohlberg's Conventional Stage 4 B. Piaget's Concrete Operational Stage C. Erikson's Industry vs. Inferiority Stage D. Freud's Latency Stage
A. Kohlberg's Conventional Stage 4 Explanation: Kohlberg's Conventional Stage 4 describes the child as recognizing that acts are judged in terms of intention,
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? A. Record this as a normal finding in an early school-age child. B. Suggest the health care provider examine the child for breathing difficulty. C. Take the child's temperature; this must be tonsillitis. D. Give the child something for pain.
A. Record this as a normal finding in an early school-age child. Explanation: 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 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? A. conservation B. decentration C. classification D. reversibility
A. conservation Explanation: 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 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? A. "Punishment should be subtle to allow the child to confess to cheating and lessen the behavior." B. "Be sure the adults in the child's life, including you, as parents, demonstrate positive behavior." C. "Perhaps the academic environment is too easy for your child, causing the cheating." D. "If cheating is noted at this age, referral to a family counselor is highly recommended.
B. "Be sure the adults in the child's life, including you, as parents, demonstrate positive behavior." Explanation: 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.
The parents of an 8-year-old boy report their son is being bullied and teased by a group of boys in the neighborhood. Which response by the nurse is best? A. "Perhaps teaching your son self-defense courses will help him to have a greater sense of control and safety." B. "Bullying can have lifelong effects on the self-esteem of a child." C. "Fortunately the scars of being picked on will fade as your son grows up." D. "Your son is at high risk for bullying other children as a result of this situation."
B. "Bullying can have lifelong effects on the self-esteem of a child." Explanation: The child can be permanently scarred by negative experiences such a bullying. Activities such as self-defense and sports can promote a sense of accomplishment but don't relate directly to the problem of bullying. There is no indication the child in the scenario will become a bully.
The parents of a 9-year-old boy report they have been homeschooling their son and now plan to enroll him in the local public school. They voice concerns about the influence of the other children on their son's values. Which information should the nurse provide the parents? A. "At your son's age, values are most influenced by peers." B. "The values of the family will likely prevail for your son." C. "Values are largely inborn and will be impacted only in a limited way by environmental influences." D. "The teacher will begin to have the largest influence on a child's values at this age."
B. "The values of the family will likely prevail for your son." Explanation: The values of a child are determined largely by the influences of their parents. As the child ages the impact of peers does begin to enter the picture. Children may also begin to test the values with their actions. In most cases the values of the family will prevail.
A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to: A. keep her child home until this fear passes. B. make her child attend school every day. C. allow her child to decide daily if she wants to go to school or not. D. ask the teacher to decide if the child should come to school or not each day.
B. make her child attend school every day. Explanation: 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.
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? A. "Your child doesn't seem to be overweight, so it isn't a concern." B. "We see most children of this age in our clinic gaining similar amounts." C. "Normal growth and development for this age results in an average weight gain of 7 pounds per year." D. "I understand why you are concerned. Is your child sedentary quite a bit? Encouraging activity may limit weight gain."
C. "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.
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? A. "We should ask the health care provider to run some tests; with that much sleep, the child should not be tired." B. "Your child should be getting at least 9 hours of sleep per night." C. "Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." D. "Your child should be getting 8 to 9 hours of sleep per night."
C. "Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." Explanation: 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 school nurse is meeting with a 10-year-boy who is concerned about his weight. He reports he doesn't eat much candy but loves fruit, pasta, potatoes, and bread. Which suggestion should the nurse prioritize to help him maintain a healthy weight? A. Encourage portion control at each meal B. Change to a very low-fat and no-carbohydrate diet. C. Encourage activities that will increase his physical activity. D. Encourage the child to not worry about weight until he is older.
C. Encourage activities that will increase his physical activity. Explanation: Encouraging daily physical activity and following the dietary standards (such as ChooseMyPlate guidelines) will help the child meet necessary nutritional guidelines. Following popular fad diets or using weight-loss supplements must be avoided because they do not supply adequate nutrients for the growing child. The child is aware of the weight problem, but it would not be beneficial to just ignore it because the child may develop harmful eating habits such as bingeing.
The nurse is educating foster parents regarding their recently fostered 9-year-old girl. What statement by the parents indicate the need for further assessment with regard to her age-appropriate growth and development? Select all that apply. A. "She has been reluctant to go to school each morning." B. "She was very quiet when she was put into a new classroom at school." C. "She seems intent on being part of a club that has a secret password." D. "She gets argumentative and refuses to follow the rules to board games and card games." E. "She is very concerned with cleanliness and showers two to three times a day most days."
D,E Explanation: The lack of interest or willingness to attend school is not abnormal for a child of this age facing change. The parent indicating the child is not willing or interested in following the rules of a game is a concern. Typically, this age group enjoys learning the rules and are strict with them. Children in this age group can perform their own hygiene but do not place importance on showering as much as their parents. Showering twice per day is a concern as this isn't usually apparent until the child's teen years. This age group enjoys clubs with secret passwords, handshakes and languages. Depending on their temperament, they may be quiet when in a new or unfamiliar environment. If this is not a drastic change to their usual temperament, it is not a concern. Activities like sports are important for this age group for both physical development and for learning rules and teamwork.
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? A. "There are not many physical differences between school-aged boys and girls." B. "Menarche is usually the first sign of puberty in school-aged girls." C. "Boys normally grow an average of 5 in (12.5 cm) each year." D. "Girls typically experience a rapid growth spurt before boys."
D. "Girls typically experience a rapid growth spurt before boys." Explanation: 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.
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? A. Allow the child's peers to visit often. B. Ask the child what color gown he or she prefers to wear daily. C. Quickly come to the room while the child presses the call bell. D. Encourage the child to complete school work and provide guidance.
D. Encourage the child to complete school work and provide guidance. Explanation: 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.
