Quiz: Chapter 34, The School-Age Child and Family

Predominantly inattentive type of ADHD have ___________than six symptoms of hyperactivity and impulsivity

fewer

The nurse should teach volunteers in the after-school program that which characteristic is most descriptive of the social development of school-age children?

Children frequently have "best friends." Rational:Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification with peer group is an important factor toward gaining independence from families. During the school-age years there are more gender-specific groups. Conforming to the rules is an essential part of group membership.

Parents of a 10-year-old child are concerned that their child recently has been showing signs of low self-esteem. What should the nurse consider when discussing this issue with the parents?

Parents of a 10-year-old child are concerned that their child recently has been showing signs of low self-esteem. What should the nurse consider when discussing this issue with the parents? Rational: Self-esteem changes with development. Transient declines are expected and (with positive encouragement and support) are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.

The nurse is teaching a community health-promotion class to parents and school-age children related to bicycle safety. Issues to cover in the sessions include what?

Bicycles should be walked through busy intersections. Rational: Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react accordingly, with safety the number one priority. Bicycle helmets should be worn at all times to prevent head injuries. Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only. Bicycles should always be ridden with the traffic, not against the traffic. This will assist in preventing accidents.

The school nurse has asked a group of 8-year-old children to write a sentence about what they have learned from the class regarding bicycle safety. Which statement indicates the need for further teaching in the children?

"Always ride with traffic and towards parked cars." rational: Nurses play a vital role in educating children about bicycle safety. Children must be instructed to always ride with the traffic and away from parked cars to prevent accidental collisions. It is also important to stay in a single file when riding with friends, keeping as close to the curb as possible, and to walk bikes across busy streets only at crosswalks. All these measures help in reducing accidents and preventing serious injuries to children

A 6-year-old child with attention deficit hyperactivity disorder (ADHD) is brought to the hospital with reports of weight loss and loss of appetite. The child has been on the psychostimulant methylphenidate (Ritalin) for the past few months. The child has shown improvement in school since taking the medication. What is the most appropriate instruction given to the parents?

"Give the medication with a meal." Rational: Loss of appetite and weight loss are possible side effects of psychostimulant medication administration. Parents should be advised to give the medication with or after a meal to help relieve these symptoms. It is not recommended to stop the drug immediately because the child shows improvement after the administration of the drug. Reducing the dose would deprive the child of the therapeutic effect of the drug. Parents should also be advised to give a nutritious snack to the child in the evening, when the drug's effect is decreasing.

The combined type of ADHD occurs when a child shows 6 symptoms of hyperactivity- impulsivity and ___________ inattention symptoms

6

During an assessment, the nurse finds that a child is depressed, frightened, and has low grades in school. By which age-group do children usually worry about school grades?

8 and 9 years of age Rational: Worrying about school grades is an adaptive behavior in children that happens between 8 and 9 years of age. Children who are between 5 and 6 years of age are at their initial schooling age, and their development is not sophisticated enough to bother about the grading system at school. Children who are between 6 and 7 years of age try to be independent in their school environment. They are less bothered about grading. Children who are between 7 and 8 years of age are more involved in playing with their peers.

The nurse is teaching the importance of dental health to a group of parents in the community. Which points does the nurse emphasize in order to prevent dental caries in children? Select all that apply. 1 Do not let the child have too much sleep 2 Decrease excessive fat intake in the diet 3 Demonstrate how to correctly brush their teeth 4 Teach children how to correctly floss their teeth 5 Reduce the intake of fermentable carbohydrates

Decrease excessive fat intake in the diet Correct 3 Demonstrate how to correctly brush their teeth Correct 4 Teach children how to correctly floss their teeth Correct 5 Reduce the intake of fermentable carbohydrates Rational: Proper oral hygiene is the most effective means practiced to prevent dental caries. Not only is it important to teach children how to floss their teeth, but the nurse should also teach the parents to reinforce correct brushing techniques. This helps promote oral hygiene and prevent dental caries. Fermentable carbohydrates tend to increase the risk of dental caries and should be limited in the diet. Excess fat in the diet should not be included in the diets of children who are obese. Excess sleep in a child should not be encouraged as it makes the child more sedentary.

The school nurse is discussing dental health with some children in first grade. What should the nurse include in the discussion?

Emphasize the importance of brushing before bedtime Rational: Children should be taught to brush their teeth after meals, after snacks, and before bedtime. Parents should help with flossing until children develop the dexterity required, which occurs at about the time of third grade. A toothbrush with soft nylon bristles is recommended. The American Dental Association recommends fluoridated toothpaste for this age group.

During an assessment of a late school-age child, the nurse advises the parents to seek immediate orthodontic treatment for the child. What condition does the nurse find in the child?

Improperly arranged teeth Rational: Malocclusion is a dental condition where the relationship between the upper and lower arches of the jaw is inappropriate. This condition may sometimes be a cosmetic concern, which may be the reason for the child's parents to worry. Orthodontic treatment is more effective when started in late school-age than in adolescence. Bleeding gums is a sign of periodontal disease, which can be resolved by maintaining proper oral hygiene such as careful and regular brushing. Teeth discoloration or plaque formation is a common cosmetic concern of all age groups. Flossing of teeth helps in managing this condition. Dental cavities are a universal dental issue that requires treatment in order to reduce the incidence. It can be prevented by maintaining oral hygiene conditions.

The nurse is assessing a child for attention deficit hyperactivity disorder (ADHD). The nurse rates the child's characteristics as eight symptoms of hyperactivity-impulsivity and three symptoms of inattention. What type of ADHD does the child have?

Predominantly hyperactive-impulsive Rational: When the child has eight symptoms of hyperactivity-impulsivity and three symptoms of inattention, then these characteristics belong to the predominantly hyperactive-impulsive type of ADHD. A cognitive learning disability is a serious disorder where the child is unable to listen, understand, reason, or use mathematical skills. This requires medical supervision for treatment. The combined type of ADHD occurs when a child shows six symptoms of hyperactivity-impulsivity and six inattention symptoms. The predominantly inattentive type is one of the major forms of inattention seen in children. Children with predominantly inattentive type of ADHD have fewer than six symptoms of hyperactivity and impulsivity.

Parents reports to the nurse that their 12-year-old child resists going to bed at night. Which advice does the nurse give to the parents to help the child go to bed on time?

"Promote reading a book before bedtime." Rational: Bedtime resistance can be resolved by allowing the child to read before bedtime. Many 12-year-olds prefer to read before bed. The child's bedtime should not be changed because school-age children need adequate sleep. School-age children do not require naps, which can hamper sleeping at night. Children should not play video games before going to bed. This may stimulate and excite the child and make it harder to fall asleep.

A teacher asks a school nurse what sports should be included in the curriculum for school-aged children. What is the nurse's response? Select all that apply. 1)Girls should only compete with girls when they are preadolescents. 2)Sports activities should include both practice sessions and unstructured play. 3)The actual sporting event should aim to stress the point of winning the game. 4)Common sports for school-aged children include baseball, soccer, and swimming. 5)All participants should be recognized in special ceremonies, not just the winners

2)Sports activities should include both practice sessions and unstructured play. 4)Common sports for school-aged children include baseball, soccer, and swimming. 5) All participants should be recognized in special ceremonies, not just the winners. Rational: Teachers should include only age-appropriate sports activities in schools, which a school nurse can help in determining. It is appropriate to have activities that include practice sessions and unstructured play. Common sports for school-aged children include baseball, soccer, and swimming. It is important to recognize all the participants in special ceremonies and not just the ones who excel. In the preadolescence stage, there is no difference between strengths of boys and girls; therefore girls can compete with boys at this age. It should be emphasized to the school management that actual sporting events should aim to stress the point of mastering a sport or enhancing self-image rather than winning

The parent of an 8-year-old child is worried about their child's stealing behavior. The parent informs the nurse that they have punished the child several times for stealing, but the child still repeats the act. What is the most appropriate nursing action?

Advise the parents to give a reasonable punishment including returning the stolen item Rational: Stealing can be expected in children 5 to 8 years of age as their sense of property rights is limited. They may steal things simply because they are attracted to them. Parents should be advised to admonish such behavior and give a reasonable punishment like asking the children to return the stolen items. This would be enough for most children to learn from. Telling children that they could be jailed for the act of stealing may scare them. However, in some children this kind of behavior can indicate that there is something lacking in the child's life. For example, the child could be stealing to make up for a lack of love and affection. Therefore it is not recommended to ignore such behavior. It is also not appropriate to inform the parent that the child needs a psychiatric referral.

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. On what should the nurse's response be based?

Bullies often have difficulties developing and maintaining relationships. Rational: Children who bully are defiant toward adults, antisocial, and likely to break school rules. They have little anxiety, strong self-esteem, and may come from homes where physical punishment is used and there is a lack of parental involvement and warmth. Long-term this negativity continues into adulthood, causing difficulties developing and maintaining relationships. Bullying is a maladaptive response to poor relationships with peers and lack of group identification. Bullying is a maladaptive response to poor relationships with peers and lack of group identification. These individuals usually have strong self-esteem and little anxiety.

What information should the nurse include when giving parents guidelines about helping their children in school?

Communicate with teachers if there appears to be a problem Rational: Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Children need to do their own homework. This cultivates responsibility. Discipline should be used to help children control behaviors. School-age children can use reasoning skills. School-age children need to develop responsibility. This helps with keeping promises and meeting deadlines, thereby laying successful foundations for adulthood.

A child is diagnosed with attention deficit hyperactivity disorder (ADHD). What symptoms in the child support the diagnosis? Select all that apply. 1 The child squirms when sitting in a seat. 2 The child does not talk to others frequently. 3 The child is interested in quiet-time activities. 4 The child refuses to work on a jigsaw puzzle. 5 The child cannot remember instructions given.

Correct 1 The child squirms when sitting in a seat. Correct 4 The child refuses to work on a jigsaw puzzle. Correct 5 The child cannot remember instructions given. Rational: Children with attention deficit hyperactivity disorder (ADHD) have three major symptoms: inattentiveness, hyperactivity, and impulsiveness. The children squirm when seated, which signifies hyperactivity. Children with ADHD dislike engaging in activities that require concentration and a lot of mental effort. Therefore putting together a jigsaw puzzle would be difficult for a child with ADHD to perform. Children with ADHD tend to forget things very easily because they have difficulty paying attention to the directions given. Children tend to talk too much when they are hyperactive. This is a sign of ADHD. Children with ADHD show less interest in activities that keep them quiet or that are time consuming.

What information should the nurse include when teaching parents about interventions to help their children in school? Select all that apply. 1 Parents should help the children by doing their homework for them. 2 Parents should demonstrate an interest in what the child is learning. 3 Parents should use a rewards system rather than using punishment. 4 Parents should try to stimulate creative thinking and problem solving. 5 Parents should send their child to school based on the child's comfort.

Correct 2 Parents should demonstrate an interest in what the child is learning. Correct 3 Parents should use a rewards system rather than using punishment. Correct 4 Parents should try to stimulate creative thinking and problem solving. Rational: Parents should take an active part in their child's schooling. Parents should reward their child for good performance; it helps to reinforce good behavior. In order to prevent the fear of making mistakes, parents should stimulate creative thinking and problem-solving skills in the child. Parents should show interest in what their child does at the school. This encourages the child to perform better. Parents should ensure that their children go to school regularly and not leave it to the child's willingness or comfort. Parents should explain a question instead of answering it when they are helping with their child's homework. This would improve the thinking abilities of a child.

What do nursing interventions to promote health during middle childhood include?

Educating the child and parents to the need for good dental hygiene because these are the years in which permanent teeth erupt Rational: Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. Caloric needs are diminished; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex education with a life span approach and respond to a child's questions with an answer appropriate to the child's age. School-age children often need to be reminded to go to sleep.

The nurse teaches progressive relaxation of muscle groups to a 12-year-old child. Which sign of stress is the nurse likely to find in the child?

Facial redness rational:Redness in the face is a physiologic sign of stress seen in children 7 to 12 years of age. Relaxation techniques such as progressive relaxation of muscle groups, deep breathing exercises, and positive imagery help to reduce stress. Calmness and enthusiasm are behavioral patterns of school-age children. These behavioral patterns help the child to develop good peer relations. If a child is experiencing stress, the heart rate would be increased (tachycardia), instead of a decreased heart rate (bradycardia).

The nurse is assessing the concept of conservation in a group of children 7 years of age. The nurse pours 200 mL water in a small glass, 200 mL water in a big glass, and 100 mL water in a tea cup. The capacities of the small glass (s), big glass (B), and tea cup (t) are 250 mL, 500 mL, and 100 mL respectively. A 7-year-old child is asked to choose the glass with more water. Which glass or glasses would the child choose if the child understands the concept of conservation?

Glass B and s Rational: The concept of conservation is one of the cognitive tasks mastered by children aged 5 to 7 years. They are able to understand that when the same amount of water is poured into glasses or containers of different sizes and shapes, the volume remains the same. Therefore the child will choose glass B and s. Conservation of volume is usually the last concept mastered by school-aged children. Glass B has the same amount of water as glass s. Glass t has less water compared to glasses B and s.

The parents of 9-year-old twin children tell the nurse, "They have filled their bedroom with collections of rocks, shells, stamps, and cars." What should the nurse recognize about this behavior?

It is characteristic of cognitive development at this age. Rational: Classification skills are developed during the school-age years. This age-group enjoys sorting objects according to shared characteristics. This behavior is characteristic of the age-group, not giftedness or a twin status. Psychosocial development at this age is focused on accomplishment.

A child is being treated with methylphenidate hydrochloride (Ritalin). After assessing the child, the nurse decides to administer the medicine early in the day. What effect of the drug does the nurse note in the child?

Keeps the child awake Rational: The child who is taking methylphenidate hydrochloride (Ritalin), a psychostimulant, may experience sleeplessness as a side effect. Therefore the nurse should administer the medication early in the day to counteract the effect. Seizures are not a side effect of Ritalin. Reduced appetite is a side effect of Ritalin, and therefore the nurse should administer the drug after the meals. The child doesn't develop numbness when administered Ritalin.

The parents of a child report that their child has difficulty chewing and they are worried about the arrangement of the child's teeth. What type of dental issue should the nurse assess for in the child?

Malocclusion Rational: Malocclusion is the condition where the relationship between upper and lower arches of the jaw is inappropriate. This condition may result in difficulty in chewing and sometimes causes a cosmetic concern. The patient with gingivitis would primarily complain about bleeding gums. Malocclusion of the teeth is not related to gingivitis. Dental caries or cavities are common problems that occur at all ages; when left untreated, they result in total destruction of the teeth. Periodontal diseases are inflammatory diseases involving gums and tissues of the teeth. Bleeding gums and loss of teeth observed in the child would hardly impact the arrangement of the teeth.

The nurse is preparing a health teaching session for school-age children. What information should the nurse include about injury prevention in the plan?

Most injuries occur in or near school or home. Rational: Most injuries occur in or near school or home. Peer pressure is significant in this age group. Automobile accidents account for the majority of severe accidents, either as a pedestrian or passenger. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents.

The school nurse is assessing a child who is taking psychostimulants. The child is instructed to approach the nurse for the medication soon after lunch. What is the most appropriate reason for giving this instruction to the child?

Psychostimulants reduce the appetite. Rational: Children who are taking psychostimulants commonly experience a decrease in appetite as a side effect. Therefore the nurse should administer medication with or after meals. Keeping the child awake is also a side effect of psychostimulant drugs. However, this has nothing to do with why the medication would be administered after lunch. Reduced or suppressed growth is also observed as a side effect of psychostimulant drug and should be monitored regularly. Food intake does not affect the efficacy of psychostimulant drugs.

What is an important consideration related to childhood stress?

Some children are more vulnerable to stress than others. Rational:Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. It is not feasible to protect children from all stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. The nurse's suggestions regarding participation in sports at this age should include what?

Sports participation is encouraged if the sport is appropriate to the child's abilities Rational: Parents and coaches need to recognize the child's abilities and teach proper techniques so the child can compete safely. Organized sports can provide safe, appropriate activities with supportive parents and coaches. School-age children enjoy competition. The parent should help the child select a sport that is suitable to her capabilities and interests. These changes occur at puberty -- before that, boys and girls can compete on the same teams.

The nurse is assessing a child who has frequent headaches. The nurse teaches breathing exercises to the child to help relieve the headaches. What condition in the child is the nurse trying to treat?

Stress Rational: Children at different developmental stages undergo different types of stress that manifests as abdominal pain, headaches, and breathlessness. These symptoms can be relieved by practicing relaxation techniques such as deep breathing. Meningitis is an infection of the meninges. It may be treated by antibiotics; breathing exercises play no role in treating meningitis. Children with asthma are prescribed medications used to treat the disease and instructed to stay away from triggers. Children with influenza are provided supportive measures such as complete bed rest and good nutrition for recovery.

A 9-year-old child reports having a headache, stomach pain, and neck pain. On examination the nurse finds that the child is jittery and has a flushed face and a fast heartbeat. What is the nurse's next intervention?

Talk to the child and explore in depth the child's symptoms Rational: The signs and symptoms of the child are indicative of stress. Once stress is suspected, the nurse should talk to the child and explore more of the symptoms to determine the reason behind the stress. Parents and children should be taught the symptoms to recognize stress and also formulate strategies to be used to cope with it. It is not necessary for the child to have complete bed rest or hospitalization. These symptoms are not common in this age group.

At the beginning of the school year, the school nurse identifies several new children at the school. The nurse knows that which factors place the children at high risk for adjustment problems? Select all that apply.

The child appears physically immature. Correct 3 The child exhibits signs of emotional immaturity. Correct 4 The child has not attended a preschool program. Rational: Successful adjustment is related to the child's physical and emotional maturity and the parent's readiness to accept the separation associated with school entrance. Unfortunately, some parents express their unconscious attempts to delay the child's maturity by clinging behavior, particularly with their youngest child. Middle-class children have fewer adjustments to make and less to learn about expected behavior because schools tend to reflect dominant middle-class customs and values. If the child has attended a preschool program, the focus of the preschool program also affects the child's adjustment. Some preschool programs provide custodial care only, but others emphasize emotional, social, and intellectual development.

The nurse is working with the parents of an 8-year-old child and discovers that the child has bedtime problems. The nurse instructs the parents to encourage a quiet activity before bedtime. Why does the nurse recommend this intervention?

The child does not go to sleep. Rational When children have difficulty going to bed, they need quiet activities such as reading or coloring. These activities decrease the amount of stimuli and help them relax and be ready to go to sleep. This, in turn, helps resolve bedtime problems. Talking in the sleep is common in children and does not require intervention. Bed-wetting is normal in preschoolers and occasionally in young school-age children. However, if the problem continues in later ages, a medical consultation is necessary. The child may snore a little during sleep, but this does not necessitate quiet activities before bedtime.

The nurse is assessing the oral cavity of a child. The nurse instructs the child to floss the teeth regularly and use a fluoride toothpaste for brushing. Why did the nurse give this instruction to the child?

The child had bleeding gums with plaque. Rational: Dental problems are commonly observed in children, but most of them are ignored. The child who has inflammation that causes the gums to bleed and has plaque most likely has gingivitis. The nurse should recommend that the child regularly brush and floss the teeth. Fluoride-based toothpaste is also used to reduce plaque. When the child experiences a dental injury from sports or any other cause, it may cause a fracture, chipping, and dislocation of the teeth. This needs immediate attention by a dentist. When a tooth is reimplanted in a child, it is recommended to not floss for a particular duration of time. Children develop their permanent teeth when they are school-age.

The primary health care provider (PHP) prescribes a psychostimulant drug for a child. The nurse checks the medical history of the child and requests that the PHP change the drug. What would be the possible reason for the nurse to make such a request?

The child has a history of facial tics. Rational: Psychostimulant drugs are given to children for the treatment of attention deficit hyperactivity disorder (ADHD). These drugs should be avoided in children who have a history of ticlike behaviors because they can worsen the symptoms. Physical trauma refers to a serious injury resulting from an assault, a natural disaster, or a sports injury. Dysgraphia is a condition where a child has difficulty with writing. Psychostimulant drugs do not affect the oral health of the child. These drugs are not known to aggravate malocclusion problems. Orthodontic treatment is successful for malocclusion problems.

The nurse is assessing a child with attention deficit hyperactivity disorder (ADHD) and finds underdeveloped fine motor skills. The nurse instructs the teacher to provide the child with a computer. Which findings in the child prompt the nurse to do so?

The child has difficulty in writing. Rational: The child who has ADHD would face difficulty in writing, which is referred to as dysgraphia. The child should be assisted by integrating a computer into the classroom for the child's use because handwriting may not improve. A visual defect is not a sign of ADHD. In such a case, the child must be evaluated by a medical professional. A learning disability is a disorder in which children find difficulty in learning new things. Children with ADHD have reduced attention span, which may impair their ability to learn. However, learning disability is not a sign of fine motor impairment. Hearing impairment is not a sign associated with ADHD.

A 10-year-old boy reports vomiting, diarrhea, and stomach pain for the past couple of days. The child does not go to school because of these symptoms. However, the child is usually healthy on weekends and whenever allowed to stay at home. On examination the nurse finds that the child's temperature is mildly elevated. What does the nurse inform the parents?

The child has school phobia, which is the likely reason for the child's presentation. Rational: School phobia can occur in children of all ages, but it is more common in those 10 years of age and above. It can be manifested by the child reporting vomiting, diarrhea, stomach pain, mild fever, and headache during weekdays. A striking feature of this condition is that the child is healthy on weekends and whenever the child is allowed to stay at home. It is also important to find out the reason behind it and eliminate the cause. Though the symptoms of the child are similar to gastroenteritis, the absence of symptoms during weekends indicates school phobia as the most likely diagnosis. Therefore antibiotics are not required in this case.

The nurse advises a working single parent to enroll his or her child in an after-school program. What could be the reason behind the nurse's advice?

The child may be lonely and fearful. Rational After-school programs are generally arranged for latchkey children. These children usually have working parents or may live with one parent who works. They have no proper supervision after coming home from school. These children may feel lonely and fearful, and parents are advised to enroll the children in an after-school program. An after-school program is not necessary just because the child does not have an after-school snack available. Children with developmental disorders need to attend special training programs rather than an after-school program. When the child plays outdoor games, it signifies that the child is developing good social interactions. These children do not have to attend an after-school program.