RNSG 2201 Care of Children and Families Ch 15 Evolve

A parent tells the nurse, "I'm worried about my 13-year-old son. He hasn't started puberty, but my daughter did when she was 11 years old." What is the appropriate explanation by the nurse?

"This is normal because the onset of pubescence is usually earlier in girls than it is in boys." (Girls begin puberty on average approximately 2 years before boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore onset of puberty is not abnormal in this case, and no further evaluation is necessary at this time.)

What is one cognitive task that a school-age child is working to master?

Conservation (Piaget describes the cognitive developmental task of children between 7 and 11 years as mastering the concept of conservation. Intuitive reasoning occurs in the preoperational stage, from 2 to 7 years of age. Object permanence occurs in the sensorimotor stage, between birth and 2 years. Transductive reasoning occurs in the preoperational stage, between 2 and 7 years.)

What is a common characteristic of the psychosocial development of school-age children?

Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. (The school-age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feelings of inferiority, as highlighted in Erikson's stage for this age group of industry versus inferiority. Initiative versus guilt is the stage characteristic of preschoolers. Peer group formation is one of the major characteristics of school-age children. School-age children gain satisfaction from independent behaviors that are internally driven and accomplished.)

A nurse is teaching student nurses about the adaptive behaviors exhibited by children at different stages of development. What statement made by a student nurse indicates the need for further teaching?

"A 5-year-old child can brush and comb hair acceptably without help." (In general, a 7-year-old child can brush and comb hair acceptably without help; a 5-year-old child is too young to display such behavior. This statement by the student nurse indicates a need for further teaching. Children ages 10 to 12 can raise pets. A 7-year-old child can use a table knife for cutting meat, even though help may be needed with tough or difficult pieces. Children in the age group of 8 to 9 years can help with routine household tasks such as dusting and sweeping.)

A nurse is teaching student nurses about the cognitive milestones reached by children at different stages of development. What statement made by a student nurse indicates effective learning?

"An 11-year-old child can write occasional short letters to friends on self-initiative." (An 11-year-old child can write occasional short letters to friends or relatives on self-initiative. This statement made by the nurse indicates effective learning. Children in the age group of 10 to 12 years can use the telephone for practical purposes; a 7-year-old usually cannot do so. Children in the age group of 10 to 12 years read stories or library books for practical information or enjoyment; an 8-year-old usually cannot do so. Children in the age group of 8 to 9 years understand the concepts of space, cause and effect, nesting puzzles, and conservation, that is, permanence of mass and volume; a 6-year-old usually does not.)

A nurse is teaching student nurses about cognitive milestones reached by average American children at different stages of development. What statement made by a student nurse indicates effective learning?

"An 8-year-old child can describe common objects in detail." (An 8-year-old child can describe common objects in detail, and not merely enumerate their use. A 7-year-old child can repeat three numbers backward; a 5-year-old child usually cannot. Children in the age group of 8 to 9 years can give similarities and differences between two things from memory; a 7-year-old child usually cannot. A 7-year-old child can read an ordinary clock or watch correctly to the nearest quarter hour; a 6-year-old child usually cannot.)

A nurse is providing general guidelines and teaching to a group of parents of 10-year-old children on how to best help their children in school. What statement made by a parent indicates effective learning?

"I should encourage my child to ask questions."

What statement is true regarding peer groups formed by children during the early school years?

"The groups are loosely organized and have little formal structure." (During the early school years, groups are small and loosely organized, with changing membership and little formal structure. Groups formed in the later school years are composed predominantly of children of the same sex. In the earlier school years, there may be a mixture of both sexes in a group. Poor relationships with peers and a lack of group identification can contribute to bullying behavior. Excessive identification with the peers in a group does not do so. Children in a peer group merge their identities with the identities of their peers. They substitute conformity to a peer-group pattern for conformity to a family pattern while they are still too insecure to function independently.)

During the home visit, the parents of a 10-year-old child ask the nurse about safety guidelines because the child wants a bicycle. What statement by the parents indicates the nurse's teaching has been effective?

"Wear light-colored clothes while riding the bicycle at night." (The nurse teaches bicycle safety guidelines to the child to prevent injuries due to accidents. The child should be instructed to wear light-colored clothes and attach a florescent cloth to the bicycle at night to increase visibility and prevent accidents. The child should be instructed to buy properly fitted helmets that are approved by the Consumer Product Safety Commission. The helmets should be replaced every 5 years or sooner as recommended by the manufacturer. Old helmets may not protect from head injuries. The child should be instructed not to carry heavy objects either on front or back of the bicycle, because the child may not be able to balance and can fall. Hand signals should be given well in advance so that others can regulate their speed and change their direction.)

A mother catches her child stealing money from her handbag. What are the appropriate and effective responses from the mother in this situation? Select all that apply.

"You have to pay back the money that you took." "I am disappointed that you took the money without asking me." (An appropriate and reasonable punishment is an effective way of dealing with the situation when the parent realizes that the child is stealing. Making the older child pay back the stolen money is an appropriate punishment. A child who is caught stealing should be reprimanded so that it is clear to the child that such behavior is not acceptable. However, the reprimand should be reasonable. The statement, "I am disappointed that you took the money without asking me," is an acceptable response in this situation. It is seldom helpful to trap children into admission by asking directly if they did the offensive thing, because children do not take on such responsibility until nearer to the end of middle childhood. Demanding angrily, "Did you steal money from my purse?" might not be an effective reaction on the mother's part. Spanking and other forms of corporal punishment are of limited value and are associated with increasingly disruptive behavior in children. Although children do sometimes wish for revenge to "get back at someone," usually a parent, for what they consider to be unfair treatment, in most situations it is best not to attempt to find a hidden or deep meaning to the stealing.)

What is the average age of second permanent molar eruption in the child?

12 to 13 years (Tooth eruption occurs at specific ages. Second molar eruption in the upper jaw occurs at the age of 12 to 13 years old. First molar eruption occurs between 6 and 7 years of age. Central incisor eruption occurs between 7 and 8 years of age. First bicuspid eruption occurs between 10 and 11 years of age.)

What is the most effective means of preventing dental caries in school-age children?

Brushing teeth after meals, after snacks, and at bedtime (Brushing teeth after meals and snacks and at bedtime is the most effective means of preventing dental caries in school-age children. Teeth need to be flossed, after brushing, two or three times a day, not three times per week. Unsupervised brushing of teeth before bedtime is not effective in preventing dental caries in school-age children. Regular consumption of fluorinated drinking water is not the most effective means of preventing dental caries in school-age children.)

The parents of 9-year-old twins tell the nurse, "They've filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse would understand this behavior demonstrates what for this child?

Cognitive development at this age (Classification skills are developed during the school-age years. This age group enjoys sorting objects according to shared characteristics. Giftedness is not measured simply by a school-age child's ability to classify objects, which is an expected cognitive skill for this age group. Giftedness signs include specific academic aptitudes, advanced memory skills, creative thinking, ability in the visual or performing arts, and psychomotor ability, either individually or in combination. The development of classification skills is characteristic of the school-age child and is not related to the behavior of twins. Psychosocial development of the school-age child is focused on accomplishment or industry, not the cognitive skills of classification that are described.)

Parents are asking for information on ways to assist their 10-year-old child with school. What information would the nurse include when giving parents guidelines about helping their children in the school-age years?

Communicate with teachers if there appears to be a problem. (Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parental involvement is one factor in a child's success in school. Children need to do their own homework; this cultivates responsibility. Discipline should be used to help children control behaviors that might be affecting school performance, but failure to perform adequately should not be punished itself. Communicating with the child is a better solution to getting to the root of the school performance problem. School-age children need to develop responsibility; keeping promises and meeting deadlines lays a successful foundation for adulthood and adult responsibilities.)

The nurse is teaching parents and their child about health promotion. What interventions to promote health during middle childhood would be included?

Educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt (Because the permanent teeth are present, it is important for the child to learn how to care for them. Parents should approach sex education with a life span approach and answer questions in a manner appropriate for the child's age. Caloric needs are diminished in relation to body size during the middle years; however, a balanced diet is important to prepare for the adolescent growth spurt. School-age children often need to be reminded to go to sleep.)

The school nurse is discussing dental health with a class of first grade children. What teaching would be included by the nurse?

Emphasizing the importance of brushing before bedtime (Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries. The American Dental Association recommends fluoridated toothpaste for this age group. Parents should help with flossing until children develop the dexterity required, when they are in about the third grade. A toothbrush with soft nylon bristles is recommended to prevent damage to the gums.)

What instructions would the nurse include when teaching the parents of school-age children ways to reduce the risk of injury during sports activities? Select all that apply.

Encourage physical activity outside of sports. Have children wear helmets and other protective equipment. Have children compete against kids who are about the same size. (When instructing the parents of school-age children in ways to reduce the risk of injury in sports, the nurse should stress the importance of wearing helmets and proper equipment, competition with children who are close to the same size, and regular physical activities outside of sports to keep the children in shape. Discouraging sports participation at this age is not helpful because most school-age children enjoy sports. Encouraging lots of competitive activities is not recommended because too much competition at a young age can lead to sport-related injuries.)

A parent tells the nurse that her 8-year-old child throws a fit each night, refusing to go to bed. What interventions can the nurse suggest to the mother to help promote sleep in the school-age child?

Encouraging a quiet activity before bedtime (A quiet activity such as coloring, reading, or listening to music before bed can help facilitate the process of going to bed. Many school-age children do not feel tired and therefore resist bedtime. Forcing the child to take a nap after school is not appropriate because children at this age no longer require naps. Having the child watch a movie before bedtime is not an effective way to promote sleep; watching TV or being in front of a screen has been shown to interfere with sleep. Setting back the bedtime, rather than moving it up, as the child gets older is a better way to promote sleep in the school-age child.)

The nurse is caring for a child with a history of recurrent diarrhea and no identified physical cause for the diarrhea. The nurse believes the child to have diarrhea secondary to stress. What signs and symptoms of stress does the nurse anticipate assessing in this child? Select all that apply.

Headache. Bedwetting. Disturbed sleep patterns. (While caring for children, a nurse should look for signs and symptoms of excessive stress. The nurse should further explore the feelings of the patient if there are symptoms such as headache, bedwetting, and disturbed sleep patterns. Chronic illness is not a symptom of stress. Pyrexia is not a symptom of stress but can be seen in other conditions such as diarrhea.)

The nurse is assessing a 10-year-old child in a pediatric unit. What changes does the nurse assess that indicate the child's degree of physical maturity? Select all that apply.

Increase in leg length in relation to height. Decrease in head circumference in relation to height. Decrease in waist circumference in relation to height. (In school-age children physical changes are observed because growth occurs rapidly. The nurse observes increase in leg length in relation to height, decrease in head circumference in relation to height, and decrease in waist circumference in relation to height. Body muscle strength increases, but these muscles are immature when compared with those of adolescents and can more readily be damaged by muscular injury caused by overuse. At this age the child's body weight increases due to increase in muscle tissue.)

What behavior is characteristic of the concrete operations stage of cognitive development?

Increasingly logical and coherent thought processes (Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which spans the period from birth to 2 years of age. Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.)

A nurse discusses with the parents the actions they can take to help their children in school. What are some of the guidelines the nurse would suggest to the parents? Select all that apply.

Meet the teacher at the beginning of school. Be involved in helping with homework in any way to foster a habit of independence in the child. (The parents should meet the teacher at the beginning of school and plan to visit the school to see what is taught and expected. Parents should focus on content and major concepts learned versus grades. Daily questioning of grades could cause stress for the child. Parents can help their children with homework if needed, as long as the help focuses on explaining the question, and not giving the answer. The parents should communicate with the teacher if there appears to be a problem, not wait for a scheduled conference. The parents should demonstrate an interest in what the child is learning; the focus should be on expressing an interest in the content and growth more than in grades.)

What is an important consideration in the prevention of injuries during middle childhood?

Most injuries occur in or near school or home. (Most children in the middle years spend the majority of their time in and around school or home; therefore the risk for injuries is increased in and around these areas. Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence. Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, with children as pedestrians or passengers, account for the majority of severe accidents in the middle years. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscle coordination and control leading to injuries occurs in younger children.)

A group of boys has formed a club that is open to other boys who like to play sports. What is this behavior considered?

Normal social development of school-age children (One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. Poor relationships with peers can promote gang violence and isolation or exclusion.)

Piaget described a change in the cognitive process of school-age children during the concrete operational phase. What is the change that helps form the basis for logical thought and the development and maturation of morality?

Reduction in egocentricity (During the concrete operational period, children acquire the ability to perform cognitive operations and apply these new skills when thinking about objects, situations, and events. Their rigid, egocentric outlook is replaced by thought processes that allow them to see things from another's point of view. This steady reduction in egocentricity helps to form the basis for logical thought and the development and maturation of morality. Mastery over the concept of conservation is one of the major cognitive tasks of school-age children. Children in the concrete operational phase develop an understanding of relationships between things and ideas. School-age children are able to articulate the actions involved in the process and perform the actions mentally without the need to carry out the behavior. However, none of these three skills are specifically related to forming the basis for logical thought and the development and maturation of morality.)

The parents of a 7-year-old boy tell the nurse that their son wants to join a baseball team. What guidelines about sports at this age would the nurse include when responding to the parents' statement?

Sports participation is encouraged if the sport is appropriate to the child's abilities. (Sports participation should be encouraged if the sport is appropriate to the child's abilities and physical and emotional development. Organized sports can be beneficial for school-age children. School-age children enjoy competition. With appropriate guidelines, children can be taught the proper techniques and safety measures to avoid injuries. Before puberty there is no essential difference in strength and size between boys and girls.)

The parents of a 10-year-old child reveal to the nurse that after watching the news of a child-kidnapping case, their child is experiencing nightmares and bedwetting. The child has also stopped going out to play due to the fear of being kidnapped. What priority intervention does the nurse employ for the child?

Teach relaxation techniques to the child. (The increase in violence and rapid spread of information through media may cause stress in the child. Nightmares and bedwetting are indications of stress. The immediate nursing intervention is to teach relaxation techniques to the child. The child needs physical activity, so the nurse should encourage the child to play outdoor games under the parent's supervision. Explaining the reasons for nightmares and bedwetting should be postponed until the child is free from immediate stress. The nurse should not suggest waking the child at this time. Work on removing the fear and stress of kidnapping.)

The nurse is completing physical assessments on school-age children. What is a physical change the nurse would anticipate noting on physical exam for these children?

The strength of school-age children is less than what the increase in their muscles would warrant. (The school-age child has an increase in the percentage of body weight represented by muscle tissue. By the end of this age period, both boys and girls have doubled their strength and physical capabilities. This increased strength is often misleading, because the muscles are still functionally immature when compared with those of the adolescent, and they are more readily injured by overuse. Facial proportions change in the school-age child, because the face grows faster in relation to the remainder of the cranium; in fact, the skull and brain grow very slowly during this period. The physical indicators of maturity seem to correlate with success in school. The decrease in head circumference with respect to standing height in a school-age child is one of the most pronounced changes that seems to best indicate increasing maturity.)

What characteristic is often observed in latchkey children?

They feel isolated and lonely. (Children who are left to care for themselves before or after school without adult supervision are called latchkey children. These children feel isolated and do not interact with their peers. They are not brave but fearful. These children do not prefer to socialize with peers. It is very unlikely that they bully others; instead they are bullied by other children. As they feel lonely, they are less likely to be confident.)

The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. What information would be included in this educational session?

Walking bicycles through busy intersections (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 help prevent accidents.)