Chapter 28: Growth and Development of the School-Age Child (Final)

26. When providing anticipatory guidance to a group of parents with school-aged children, what would the nurse describe as the most important aspect of social interaction? A) School B) Peer relationships C) Family D) Temperament

Ans: B Feedback: Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

15. The nurse is performing a physical examination of an 11-year-old girl. What observations would be expected? A) The child has not gained weight since last year. B) The child has grown 2.5 inches since last year. C) The child breathes abdominally. D) The child's third molars are about to erupt.

Ans: B Feedback: From 6 to 12 years of age, children grow an average of 2.5 inches (6 to 7 cm) per year, increasing their height by at least 1 foot. An increase of 7 pounds (3 to 3.5 kg) per year in weight is expected. Abdominal breathing is typical of a preschooler and would have disappeared several years earlier. The third molars do not erupt until late adolescence.

30. The mother of a 12-year-old boy is talking with the school nurse about her son's clumsiness. She reports that he seems to fall a lot, his writing is horrible, and as much as he practices he can't play his guitar very well. How should the nurse respond to the mother? A) "Boys tend to take a bit longer than girls to mature." B) "Have you spoken with your pediatrician about your observations?" C) "Boys tend to refine their fine motor skills by this age." D) "I will make a note of your observations and talk to his teachers."

Ans: B Feedback: Myelinization of the central nervous system is reflected by refinement of fine motor skills. The child between 10 and 12 years of age begins to exhibit manipulative skills comparable to adults. In order to determine if the child is delayed in fine motor skill development, the pediatrician should be made aware because further examination or testing may be warranted. Just stating the fact that his motor skills should be developed by this age, although true, does not address the mother's concerns. The teachers can be notified of the mother's observations, but the child should still be assessed by the pediatrician.

10. The school nurse is conducting vision screening for a 7-year-old girl and documents the condition 'amblyopia.' What would the nurse tell the parents about this condition? A) 'Amblyopia is an uncorrected refractive error of the eye.' B) 'Amblyopia is reduced vision in an eye that has not been adequately used during early development.' C) 'Amblyopia is a malalignment of the eye, which occurs at birth.' D) 'Amblyopia is a clouding of the lens of the eye caused by trauma to the eye.'

Ans: B Feedback: Some problems frequently identified in school-age children include amblyopia (lazy eye), uncorrected refractive errors or other eye defects, and malalignment of the eyes (called strabismus). Amblyopia is reduced vision in an eye that has not been adequately used during early development. Inadequate use can result from conditions such as strabismus, being cross-eyed, or one eye being more nearsighted, farsighted, or astigmatic than the other eye. Amblyopia is the leading cause of visual impairment in children (National Eye Institute, 2008) and if untreated can result in vision loss.

3. The pediatric nurse is aware of the maturation of organ systems in the school-age child. What accurately describes these changes? Select all that apply. A) The brain grows very slowly during the school-age years and growth is complete by the time the child is 12 years of age. B) Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. C) The school-age child's blood pressure increases and the pulse rate decreases, and the heart grows more slowly during the middle years. D) The school-age child experiences more gastrointestinal upsets compared with earlier years since the stomach capacity increases. E) Bladder capacity increases, but varies among individual children, and girls generally have a greater bladder capacity than boys. F) Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sex

Ans: B, C, E, F Feedback: Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. The school-age child's blood pressure increases and the pulse rate decreases. The heart grows more slowly during the middle years and is smaller in size in relation to the rest of the body than at any other development stage. Bladder capacity increases, but varies among individual children. Girls generally have a greater bladder capacity than boys. Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics. The brain and skull grow very slowly during the school-age years. Brain growth is complete by the time the child is 10 years of age. The school-age child experiences fewer gastrointestinal upsets compared with earlier years. Stomach capacity increases, which permits retention of food for longer periods of time.

1. The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's check-up the child weighed 80 pounds. According to average growth for this age group, what would be his expected current weight? A) 81 pounds B) 85 pounds C) 87 pounds D) 89 pounds

Ans: C Feedback: From 6 to 12 years of age, an increase of 7 pounds (3 to 3.5 kg) per year in weight is expected.

11. The school nurse knows that school-age children are developing metalinguistic awareness. Which is an example of this skill? A) The child enjoys reading books. B) The child enjoys conversations with peers. C) The child enjoys speaking on the phone. D) The child enjoys telling jokes.

Ans: D Feedback: Language skills continue to accelerate during the school-age years. School-age children develop metalinguistic awareness—an ability to think about language and comment on its properties. This enables them to enjoy jokes and riddles due to their understanding of double meanings and play on words and sounds.

20. The school nurse is preparing a talk on the influence of the media on school-age children to present at the next PTO meeting. Which fact might the nurse include in the introduction? A) Children in the United States spend about 6 hours a day either watching TV or playing video games. B) A child will see 2,000 murders by the end of grade school and 20,000 commercials a year. C) A school-age child cannot determine what is real from what is fantasy; therefore, TV and video games can lead to aggressive behavior. D) Parents should limit television watching and video-game playing to 2 hours per day.

Ans: D Feedback: Parents should limit television watching and video-game playing to 2 hours per day. Children in the United States spend about 4 hours a day either watching TV or playing video games. A child will see 8,000 murders by the end of grade school and 40,000 commercials a year. Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image.

14. During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups? A) "The child's best friends will continue playing soccer." B) "The children will cheer for each other regardless of the sport being played." C) "Your child will rarely talk to you about his friends." D) "Acceptance by friends, especially of the same sex, is very important at this age."

Ans: D Feedback: Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.