PEDS: Chapter 6 Growth and Development of the School-age Child
A mother calls the advance practice pediatric nurse practitioner about her 7-year-old daughter's dental hygiene. The daughter has had three cavities. She does not know what to do and asks the nurse for guidance. How should the nurse respond?
"Are you able to supervise her brushing?"
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 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. Page 170
The mother of a 7-year-old girl is asking the nurse's advice about getting her daughter a 2-wheel bike. Which response by the nurse is most important?
"Be sure to get the proper size bike." It is very important to get a bike of the proper size for the child. Getting a bike that the child can "grow into" is dangerous. Training wheels and grass to fall on are not acceptable substitutes for the proper protective gear. The child should already demonstrate good coordination in other playing skills before attempting to ride a bike. Page 165
The parents of a 10-year-old girl voice concern to the nurse because their daughter seems to "have a higher amount of body fat" than they expect based on the healthy eating habits and high activity level of the family. What is the best response by the nurse?
"Before adolescence the body fat composition of school-age children increases earlier and in greater amounts in girls than in boys." Boys have more lean body mass per inch of height than girls during the late school-age years, in preparation for adolescence. page 166
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."
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?
"Bullying can have lifelong effects on the self-esteem of a child." 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. page 173
The nurse is working with a group of caregivers of 6-year-olds. One of the mothers states her son has been lying and making up stories; she asks for some advice about how to address the issue. What would be an appropriate response 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 children's 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. Page 171
The nurse is teaching a group of caregivers of school-age children on various topics. Which statement made by the caregivers indicates a need for further teaching?
"Food is so expensive, we always make our children eat everything on their plates."
The parents of a 7-year-old tell the nurse that they are concerned that their child has attention deficit activity disorder (ADHD) because he can't seem to stay focused when playing in a baseball game. What questions/comments by the nurse are appropriate? Select all that apply.
"How is his attention span during school?" "Do you notice him getting distracted in other activities, like bicycling?"
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?"
The nurse is discussing the topic of obesity with a group of mothers of school-age children. Which statement made by the caregivers indicates the best understanding of factors that contribute to obesity?
"I always cook foods that are low in fat."
The school nurse asks a group of school-age children about pedestrian safety. Which comments by the children should the nurse address with either the child or parents of the child? Select all that apply.
"I am 6 years old and I walk my younger brother to the park that is 5 blocks from our house." My friends and I like to walk on the side of the road because our sidewalk is very uneven." "I think it is funny to hide behind my dad's car before he leaves for work and scare him."
The nurse is discussing nutrition with the mother of a 6-year-old boy. Which response by the boy's mother indicates a need for further discussion?
"I make him eat some of everything I put on his plate."
The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which general question would the nurse direct to the child's parents?
"Is there a family history of hypertension, heart disease, or diabetes?" Parents would be more knowledgeable than the child regarding health problems within the family. The other questions are appropriate for the child to answer and may motivate him to think about meal patterns, diet, and exercise habits. The parents will benefit from listening to these questions also since their habits influence the child page 166
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?
"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?"
The nurse is talking with the parents of an 8-year-old boy who has been cheating at school. Which comment should be the nurse's primary message?
"Make sure that your behavior around your son is exemplary."
The nurse is discussing nutrition choices with a group of parents of 10- to 12-year-old children. The nurse determines that the discussion was successful based on which statements by a parent? Select all that apply.
"My 12-year-old son, who plays soccer, needs to consume around 2,000 calories a day to maintain good health." "The highest percentage of my child's diet should come from carbohydrates."
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." The school-age child needs 10 to 12 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. page 168
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. Page 154
The nurse is caring for a 6-year-old boy. During the course of a routine wellness examination, the mother proudly reports that the child eats whatever the mother puts on his plate. The nurse wants to emphasize the importance of allowing the child to make some of his own choices regarding the types of foods he eats. How should the nurse communicate this to the mother?
"Now is the time to let him choose some of his meals."
During a health history assessment, the mother of a 10-year-old girl tells you that her daughter does not have time to "play" because she is busy going to gymnastics, cheerleading, art class, flute lessons, reading club, and soccer. What should the nurse's response be?
"Play helps children to develop cognitively, socially, physically, and emotionally." It is important to recognize that the child is busy with other activities but that this does not replace the need to engage in play. Children need time to play because it helps them to develop cognitively, socially, physically, and emotionally. Play at this age embodies the needs for rules and structures. Engaging in group activities allows children to be part of a social group. Page 155
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 parent's 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. page 159
The mother of two children ages 6 and 12 reports that her 6-year-old child seems to have "cold after cold" while her older child never seems to be ill. She questions if there is something wrong with her younger child. What is the best response by the nurse?
"The immune system of your younger child is less mature and may result in having more infections."
The nurse is conducting teaching with families of school-age children. Which statement made by the nurse is most appropriate related to topics that would be covered with this group of individuals?
"The school-age child needs 10 to 12 hours of sleep per night."
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?
"The values of the family will likely prevail for your son."
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."
The parents of a 9-year-old child voice concern that their daughter seems to be gaining weight rapidly. The nurse reviews the medical record and notes the child has increased his weight by 6 or 7 pounds (2.7 to 3.2 kg) per year for the past 2 years. What response by the nurse is indicated?
"Weight gains of about 7 pounds per year are normal for children in this age range."
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." The 6-year-old needs 12 hours of sleep and should be provided with a quiet time after school to recharge after a busy day in the classroom.
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."
The school nurse notices that one of the children in the classroom next to the nurse's room frequently goes to the bathroom. The nurse knows that the bladder capacity for this 11-year-old child should be how much?
13
The nurse is assessing the nutritional needs of an 8-year-old girl who weighs 65 pounds (29.5 kg). Which amount of calories would provide the proper daily caloric intake for this child?
2,065 calories per day
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. Page 155
A nurse is caring for a hospitalized 7-year-old 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 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 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
The nurse is caring for a 10-year-old who has been admitted for surgery. What action would be the most important for the nurse to do when caring for this child?
Answer questions the child asks 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. Page 161
An 11-year-old boy is significantly above the 100% percentile for height. The boy tells the school nurse that his parents expect so much out of him when he is playing basketball for the school team that he is thinking of quitting. What action should the nurse take?
Arrange a conference with the parents, son, and nurse to discuss the child's concerns.
A nursing student is presenting information to the class about abuse of children. The nursing instructor should intervene when the student presents which information? Select all that apply.
Child abuse and sexual abuse 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 is suspected Child abuse includes physical, emotional, and sexual abuse. Parents should teach children the concept of "good touch" versus "bad touch" prior to school-age years. If school-age child's behavior yields suspicion of physical or sexual abuse, the nurse should report to the appropriate authorities in his or her state. page 166
A nurse is assigned to care for a 7-year-old with cystic fibrosis. The child wants to show the nurse his 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
The parents of a school-aged child with school phobia have taken her to three different psychiatrists trying to resolve this problem. Based on this, which nursing diagnosis would be most appropriate?
Compromised parental coping related to inability to enforce school attendance
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.
The nurse is teaching parents of an 11-year-old girl how to deal with the issues relating to peer pressure to use tobacco and alcohol. Which suggestion provides the best course of action for the parents?
Discuss tobacco and alcohol use with the child.
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 the 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
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.
Encourage the child to join a club at school. Recommend she begin to participate in after-school activities. Recommend the child investigate opportunities for volunteering at local charities.
An 8-year-old boy's foster mother is discussing her concerns about three recent cavities found in his permanent teeth. The mother reports that her child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. What would the nurse suggest to this mother is the most appropriate 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-age child should visit the dentist at least twice a year for a cleaning and application of fluoride. page 168
When considering the psychosocial development of a school-aged child, which is the primary developmental task?
Establishing a social network Erikson describes the task of the school-age years as industry versus inferiority. During this period, 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 student nurse is preparing a presentation on obesity in children. What information should the student nurse include regarding factors linked to causing obesity? Select all that apply.
Family role modeling Reduced physical education programs Unsafe neighborhoods Lack or reduced amount of recess periods during the school day
An 8-year-old boy is doing well with adding and subtraction. His father asks for suggestions regarding projects that would help increase his understanding of conservation of mass. What project would the nurse suggest?
Form vases from blocks of clay.
The parents of an 11-year-old girl tell the school nurse that their child has a very "slow to warm up" temperament, and that they are concerned with her starting a new school. Which activities should the nurse tell the child's teacher to initially avoid based on this information? Select all that apply.
Having the child introduce herself by standing at the front of the class and telling something interesting about herself Assigning the child a role-play scenario to perform with another student in front of the class Encouraging the child to join the drama club, which is practicing for an upcoming play
The school nurse is assessing the nutritional status of an overweight 12-year-old girl. Which question is appropriate for the nurse to ask?
How often does everyone in your family eat together?
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
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 there is something wrong. The girl has no other symptoms, however. The nurse knows that this is most likely the cause of the enlarged tonsils:
Normal growth of lymphatic tissue for this age
The nurse is observing a playgroup of children of all ages. The school-age child in the group would most likely be doing which activity?
Painting pictures in the art corner of the room.
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
A nurse is caring for a hospitalized 10-year-old. What would be an appropriate activity for this child to meet the developmental tasks of this age group?
Participating in a craft project
A 10-year-old boy is above normal weight for a child his age and height. He tells the nurse he doesn't eat much candy but he loves to eat fruit, pasta, potatoes, and bread. What would the nurse recommend to the boy's caregivers as to ways to help him maintain a healthy weight?
Provide activities for the child that will increase his physical activity.
The nurse is observing a group of 8-year-olds who are being taught the concept of conservation of numbers. Which activity would best help these children understand this concept?
Rearranging a group of coins first into a circle, then a triangle and then a square
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.
Reports of fear when attending school Demonstrates negative behaviors before school Chronically late for school
The nurse is preparing a care plan for a 7-year-old child on the pediatric unit newly diagnosed with asthma. One of the child's parents is employed as a family practice physician and the other as a lawyer. The child has two older siblings and two younger siblings. Which nursing diagnoses would apply to this situation? Select all that apply.
Risk for caregiver role strain Risk for infection Knowledge deficit regarding disease process Knowledge deficit regarding use of inhaler medication for asthma
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 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
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.
Stomach capacity increases, which should permit retention of food for longer periods of time The caloric needs of the school-age child are lower than in the earlier years of life
The school nurse is working with a group of 6- to 8-year-old children. Which responsibility would the school nurse most likely have for this age child?
Testing the children's vision and hearing
The nurse is assessing the moral developmental level of children being seen in the clinic according to the Kohlberg's conventional stage of moral development. Which children does the nurse determine have met this stage of development? Select all that apply.
The 8-year-old child who frequently asks the teacher if he is doing his math correctly The 10-year-old child who visits his elderly neighbor three times per week The 9-year-old child who tells his friends that they shouldn't throw rocks because they will "get in trouble" The 7-year-old child who yells at his mother, "I don't understand why I can't go to the park!" The 10-year-old who states, "I sure wouldn't want to be my friend taking that bad report card home."
The father of an 11-year-old boy is worried that the child spends too much time watching TV. What information should the nurse share with this father? Select all that apply.
The American Academy of Pediatrics recommends 2 hours or less of TV daily. Establish guidelines on when a child can watch TV. Watch programs together and discuss subject matter with the child.
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.
Which behavior involving a 11-year-old child warrants further education to the family? Select all that apply.
The child is allowed to sit in the front seat of the car. The child wears a lap belt when riding in the car. The child uses a backpack to carry books when riding their back to and from school. When riding in the car children under the age of 12 should ride in the back seat and not the front seat. Safety belts consisting of a lap and shoulder harness should be employed. Front bike baskets should be used to carry heavy objects. Using a backpack can cause balance issues leading to a fall and should be avoided. page 163
The nurse is assessing the psychosocial development of a 10-year-old child. What observations would lead the nurse to determine that the child is not achieving the developmental task of Erikson's industry versus inferiority? Select all that apply.
The child tries out for various teams at school but does not make any of them The child is an average soccer player and the parents enforce 1 to 2 hours of practice per day
Which statement best describes Erikson's psychosocial development task for the school-age child?
The child wants to successfully complete activities.
The school nurse is monitoring children as they arrive at school riding their bicycles. Which children should the nurse speak with about their riding habits? Select all that apply.
The child who is wearing flip flops when riding the bicycle to school The child who is wearing a book bag hanging off one shoulder The child who wears a stocking cap under the helmet during cold weather
The parents of a 12-year-old girl report their daughter is missing an increasing amount of school. They further share that the child says she feels ill and begs to stay home. What action by the parents will be most therapeutic?
The parents need to attempt to determine why the child is avoiding school.
A mother tells you her 6-year-old has been biting his fingernails since he began first grade. After analyzing the cause of this as increased stress, the advice you would give his mother regarding this problem would be to:
allow some time every day for the child to talk about new experiences. Beginning school can be a time of extreme stress for children. Allowing them time to discuss these experiences helps them to put experiences in perspective and begin to deal with them. page 159
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. This child has developed an understanding of:
conservation.
The developmental task of the school-aged period, according to Erikson, is gaining a sense of:
industry versus inferiority. Industry is learning how to do things well, the school-aged developmental task. page 155
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 phobia may result from both a parent not wanting a child to attend school and a child not wanting to leave a parent. Helping them work together while keeping the child in school to resolve the issue is helpful. page 172
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. page 159
A 7-year-old has taken money from his brother's dresser on two occasions. When counseling his mother about this, you would advise her that:
she may need to remind him of property rights. As children begin to be aware of the importance of money, they may fail to realize that property rights regarding money need to be respected. Page 172
