NUR410 PrepU PEDS Chapter 18 Care of The School Aged Child

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." Explanation: Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight. Simply comparing them to other children seen in the clinic doesn't mean it is a normal expectation. While activity is important, the nurse must first address the parent's concern.

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.

The 6-year-old at a well-child office visit tells the nurse, "I can't play on teams because I am not as good at doing things as my big sister is." What suggestion should the nurse point out to the caregiver that will help increase the child's feelings of self-confidence?

Set up some play dates that include projects or activities in which the child can be successful. Explanation: As they reach school age, children show an increasing interest in group activities and in making things. Children of this age work at many activities that involve motor, cognitive, and social skills. Success in these activities provides the child with self-confidence and a feeling of competence, but excessive or unrealistic goals set by a teacher or caregiver will defeat a child and possibly lead to the child feeling inferior rather than self-confident. Erikson's developmental task for this age group is industry vs. inferiority. Children who are unsuccessful in completing activities during this stage, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.

Parents of an 11-year-old child are bewildered that their child was caught stealing. The nurse best supports the parent by explaining which?

The child had a strong desire to have the item with little other way of obtaining it. The nurse must consider the age of the child and compare with stages in moral development. The nurse would point out that the desire to have an item may have overcome the child's sense of right and wrong. Lying, not stealing, is used to escape punishment. Stealing is not a way to build self-esteem, although it may help the child gain a certain status among peers. The lack of understanding of ownership and property rights are typical of children between 6 and 8 years.

A mother is concerned that a 7-year-old child has taken money from a sibling's dresser several times. What should the nurse advise the mother about this behavior?

The child needs to be reminded of property rights. Early childhood stealing is best handled without a great deal of emotion. A parent should tell the child the money is missing. The importance of property rights should be reviewed: The sibling's money is his, the child's money is the child's, and they are not interchangeable. Stealing is not unusual for a 7-year-old child. The mother does not need to buy the other child a bank. The behavior does not necessarily occur because of school-related stress.

The nurse at a hospice care facility is caring for a 12-year-old girl. Which intervention best meets the needs of this child?

Urging her to invite her friends to visit Young adolescents require time with their peers. Encouraging her to have visitors would best meet this need. Assuring her illness is not her fault and acting as her personal confidant are interventions suited to school-age children. Explaining her condition in detail meets the needs of an older adolescent.

The mother of a 13-year-old child with special needs reports concerns with her child's requests to eat lunch in the cafeteria at school with the rest of the children as opposed to eating in the nurse's office. What information should be contained in the nurse's response?

"Efforts should be made to accommodate your child's request." Explanation: Children have a desire to interact with their peers and to have the same privileges as much as possible. The child's mother should be encouraged to work toward honoring this request. Forcing the child to eat in the nurses' office promotes isolation. Having a few other children eat with her in the nurses' station has minimal impact on meeting the overall request.

The school nurse is the guest speaker in a classroom of fourth-grade children, and they are discussing eating habits and the number of servings from each of the food groups that is appropriate for the school-age child. Which of the following statements made by the children best indicates an appropriate intake of one of the food groups for this age child?

"I drink three big glasses of milk each day." For the school-age child, an adequate intake of milk is 3 cups per day.

The school-age child develops the ability to recognize that if a block of clay is in a round ball and then is flattened, the shape changes but not the amount of clay. What understanding has this child developed?

conservation Explanation: Piaget described concrete operational thought occurring in the child ages 7 to 10 years. During this time the child develops various skills to see objects and the world. The skill of conservation is the ability to recognize that a change in shape does not necessarily mean a change in amount or mass. Using reversibility, the child can understand that processes can be reversed or canceled out by other things. Decentration is developed when the child can pay attention to multiple attributes of an object or situation instead of only one. In classification, the child is able to put objects together by shared qualities or characteristics.

An 8-year-old develops balanoposthitis. A finding of this is

denuded, reddened surface of the glans of the penis. Explanation: Balanoposthitis is inflammation of the glans and prepuce of the penis. These appear reddened and are painful.

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 think it is funny to hide behind my dad's car before he leaves for work and scare him." "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." Older children and adults should provide supervision of younger children, but 6 years old is not considered an older child, especially for 5 blocks of supervision of a younger sibling. Children should always walk on sidewalks because cars may not see children walking in the streets or be distracted while driving. Children should stay away from vehicles when a vehicle is about to be driven and definitely not behind a vehicle.

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.

The nurse is addressing a caregiver's concerns regarding adequate sleep for an 11-year-old child who gets up at 6:30 a.m. each morning. The nurse should point out which time as the most appropriate bedtime for this child?

9:30 p.m. Exercise and sufficient rest are important for school-age children. An 11-year-old child needs 9 to 10 hours of sleep per night, which would mean going to bed at 8:30 to 9:30 p.m. The 6-year-old should sleep for 12 hours. The older adolescent could go to bed at 10 p.m. and get adequate sleep.

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 Erikson states that school-agers receive satisfaction from developing new skills and successfully using them to accomplish goals (industry). Failing (without adult support) or being unable to meet expectations that are set too high can result in feelings of inferiority.Lacking the ability for abstract thought is a cognitive skill and part of Piaget's theory, as is the principle of conservation. The conventional stage belongs to Kohlberg's theory of moral development.

The nurse is inspecting the genitals of a prepubescent girl. What is a normal sign of the onset of puberty?

Appearance of pubic hair around 11 to 13 years old. Infants and young girls (particularly those of dark-skinned races) may have a small amount of downy pubic hair. Otherwise, the appearance of pubic hair indicates the onset of pubertal changes, sometimes prior to breast changes. Pubic hair generally begins to appear by age 11 years, with age 13 being the latest. Redness or swelling of the labia may occur with infection, sexual abuse, or masturbation. Lesions on the external genitalia may indicate sexually transmitted infection.

The nurse is collecting data on a 9-year-old child being admitted to the pediatric unit. What is the most appropriate way to gather information from the child's caregiver?

Ask the caregiver questions and document the answers. The family caregiver provides most of the information needed in caring for the child, especially the infant or toddler. Rather than simply asking the caregiver to fill out a form, it may be helpful to ask the questions and write down the answers. This provides a personal interaction between the nurse and the caregiver. If the caregiver can not read then the nurse would help with the completion of the form by asking questions and documenting the answers. Children should not be used as interpreters or complete a form. If the child is under the age of 18 it would not be a legal document and with a child's language skills and comprehension much needed information could be not obtained.

The nurse is preparing to remove an IV device from the arm of a 6-year-old girl. Which approach is best for minimizing fear and anxiety?

Ask the child if they would like to help remove the tape from the IV. The nurse needs to openly discuss the procedure with the child at an age appropriate level. The nurse should explain what is to occur and enlist the child's help in the removal of the tape or dressing. This provides the child with a sense of control over the situation and also encourages his or her cooperation. The nurse should avoid using scissors to remove the tape or dressing and the comment regarding cutting may be perceived as threatening and/or frightening. The procedure may be minorly uncomfortable so it is best to be honest with the child.

An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother 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-aged child should visit the dentist at least twice a year for a cleaning and application of fluoride.

The nurse is preparing to assess the pain of a developmentally and cognitively delayed 8-year-old. Which pain rating scales should the nurse choose?

FACES pain rating scale The nurse should select the pain assessment tool that is appropriate for the child's cognitive abilities. The FACES pain rating scale is designed for use with children ages 3 and up. A child with limited reading skills or vocabulary may have difficulty with some of the words listed to describe pain on the word graphic scale. Some of the concepts might be too difficult on the visual analog and numerical scales for a developmentally disabled child. The base age for the Adolescent pediatric pain tool is 8 years, but its use would likely be inappropriate for an 8-year-old with cognitive delays.

What teaching points would a nurse provide for families of school-aged children to help prevent substance abuse? Select all that apply.

Give the child "what if" examples to situations they may face. Set firm rules regarding alcohol and other drug usage and discuss consequences associated with breaking the rules. Encourage decision-making and discuss family values. Explanation: Children mimic what adults do so it is important to set good examples for behavior regarding substance abuse. Offering children opportunities to think through " what if" situations allows the child to have already thought about difficult situations they may find themselves in. Although threats are not productive, setting strict rules regarding substance abuse are very important. Also encourage decision-making by the child based upon previous good decisions.

The school nurse is assessing a 6-year-old child's dentition. Which assessment should the nurse prioritize for this child?

Has first permanent molars At about age 6, the child start to lose the deciduous teeth, usually beginning with the lower incisors. They will continue to lose the deciduous teeth while they are school-aged. The first permanent molars usually erupt about the age of 6. The child would not have six permanent teeth until between 7 and 8 years of age. The upper two cuspid or canine teeth erupt about 9 or 10 years or age. The lower cuspid teeth erupt about 11 or 12 years of age.

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 During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment. Accommodation is the ability to adapt thought processes to fit what is perceived such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Perfectionism is the desire to do something perfectly. The boy's desire to apply the band-aid "the right way" is a hallmark of the development of industry. The other answers are not as pertinent.

The nursing instructor is leading a discussion on school-aged children. The instructor determines the session is successful when the students correctly choose which factor as being a priority for the school-aged child?

Needs 10 to 12 hours of sleep per night Explanation: The school-aged child needs 10 to 12 hours of sleep per night. They need to brush their teeth after every meal and at bedtime. A routine physical exam once a year is all that is necessary. Children are screened around the age of 10 or 11 for scoliosis.

The nurse is monitoring a playgroup of children on the pediatric unit. The nurse predicts the school-age child will most likely be participating in which activity?

Painting pictures in the art corner of the room Explanation: The school-aged child enjoys group activities and making things, such as drawings, paintings, and craft projects. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. Playtime for the toddler involves imitation of the people around them, such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. The adolescent enjoys activities they can participate in with their peers.

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?

Peer relationships Explanation: 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.

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.

The nurse is assessing the gross motor skills of an 8-year-old boy. Which interview question would facilitate this assessment?

"Do you participate in any sports?" Explanation: To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills.

The nurse is inspecting the genitals of a prepubescent girl. What is a normal sign of the onset of puberty?

Appearance of pubic hair around 11 to 13 years old Explanation: Infants and young girls (particularly those of dark-skinned races) may have a small amount of downy pubic hair. Otherwise, the appearance of pubic hair indicates the onset of pubertal changes, sometimes prior to breast changes. Pubic hair generally begins to appear by age 11 years, with age 13 being the latest. Redness or swelling of the labia may occur with infection, sexual abuse, or masturbation. Lesions on the external genitalia may indicate sexually transmitted infection.

The nurse is promoting the benefits of achieving a healthy weight to an overweight 12-year-old child and her parents. Which approach is best?

Ask what activities she enjoys such as dance or sports Asking what activities the child enjoys in order to promote exercise is best for several reasons. It provides assessment of the child's activity preferences and whether the child is health-centered (positive) or weight-centered (negative). It also offers variety. If one sport doesn't work, others might. Emphasizing appropriate weight or dietary shortcomings can lead to eating disorders or body hatred. Suggesting only softball limits the success of the healthy weight promotion.

The nurse is preparing a presentation for a community health fair on the topic of helping school-aged children develop the self-confidence they will need to mature into responsible adults. Which suggestion should the nurse prioritize to caregivers to enable them to help their children in this area?

Caregivers should maintain consistent rules and expectations. Explanation: The school-age child needs consistent rules, positive attention, and clear expectations in order to develop self-confidence. Although peers are important, caregivers have more influence over the school-age child relating to building confidence. Reactions from teachers and trying to keep up with older siblings may lead to lack of self-confidence.

The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which information would the nurse include in her teaching plan?

Continuous peer relationships provide the most important social interaction for school-age children. Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

A group of nursing students are reviewing information about bullying and children who are bullied. The students demonstrate a need for additional review when they identify which of the following as characteristic?

Having numerous friends Children who are bullied tend to be insecure and cautious, have low self-esteem, and lack social skills and friends, all of which makes them easy targets. Boys tend to be more involved in bullying others than girls.

The nurse is interviewing a 9-year-old child and during the interview the child states, "There's this kid at school who is always taking my lunch money and my homework." The nurse interprets this statement as which of the following?

Physical bullying Explanation: The child is describing physical bullying. Verbal bullying would include things like teasing, name calling, and insults. Emotional bullying would involve intimidation by gestures, shunning, or social exclusion. Bullying by proxy would involve coercing others to steal from or bully a victim.

A parent has brought the child into the clinic for a routine health assessment. The parent asks when routine screening for back symmetry will begin. Which response by the nurse is most accurate?

School age Screening for curvatures of the spine begin at school age when the child is most likely to develop this kind of deformity.

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?

"Have you spoken with your pediatrician about your observations?" 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.

The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond?

"I understand your concern, but girls typically enter puberty around the age of 9 or 10." Explanation: Voicing empathy regarding the mother's concern conveys support, and letting her know that this is normal growth and development helps ease her concerns. The other responses don't address her concerns or show genuine empathy.

After teaching a group of nursing students about common fears of middle childhood, the instructor determines that the teaching was successful when the students identify which of the following as a common fear? Select all that apply.

Darkness Separation Injury Disasters Explanation: The most common fears identified during middle childhood are still some of the same fears experienced during early childhood, such as a fear of darkness, separation, and injury. Some newer fears that are now expressed have to do with failure at school and with peer relationships (not being liked, fear of being bullied) and fears related to increasing violent events in schools and the community.

A nurse is preparing a dose of insulin to give Billy, an 11-year-old boy. Which of the following actions would be most appropriate for the nurse to do when giving this medication?

Double check the dose with another registered nurse before giving it. Explanation: Insulin is a high alert medication, that is it has a high risk of causing harm when an error occurs. Therefore it must be checked with another registered nurse before it is given. Insulin is typically ordered as specific units, so no calculations are needed. Insulin injections do not have to be witnessed. Insulin can cause adverse reactions but this is not the main concern with administration.

A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group?

Participating in a craft project During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter.

An 11-year-old female child is at the pediatrician's office for a well-child check-up. Which health screening would the nurse anticipate that the child would undergo today?

Scoliosis screening Initial screening for scoliosis begins at age 10 to 11 years; the child is monitored into adolescence for development of scoliosis (or progression if scoliosis is already noted).

The parents of a 9-year-old child voice concern that the child seems to be gaining weight rapidly. The nurse reviews the medical record and notes the child has increased weight by 6 or 7 lb (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 lb (3.2 kg) per year are normal for children in this age range." Explanation: Children who are between the ages of 6 to 12 years usually gain about 7 lb (3.2 kg) per year. The child in the scenario is gaining weight an the normal rate.

The nurse is performing a health history on a 6-year-old who is having trouble adjusting to school. Which question would most likely elicit valuable information?

What are your new classmates like?" Explanation: A careful conversation and interview with the child and/or the caregiver will provide important information about the child's health. Depending on the intent of the health assessment, many of the questions will be direct, and many will require the caregiver or child to answer simply "yes" or "no." In other than emergency situations, though, asking open-ended questions such as "What are your classmates like?" offers an excellent opportunity to learn more about the child's life.

The developmental task of the school-aged period, according to Erikson, is gaining a sense of

industry versus inferiority. The school-age years, according to Erickson, are the stage of industry versus inferiority. The developmental stage helps increase the child's sense of self worth. Industry is associated with the child's increased interest in knowledge and the development of social skills. Autonomy versus shame is the developmental tasks of 1 to 3 year old children. Erickson's stages do not include the developmental tasks of independence versus dependence nor identity versus failure.

The Boy Scouts is an organization that continues to be a favorite with school-aged boys because

merit badges require completing small tasks for rewards An organization that allows school-aged children to complete small tasks and receive rewards helps develop a sense of industry.

A mother calls the 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 number one dental problem in middle childhood is tooth decay. Until age 7, the child may need assistance brushing her teeth. Children tend to concentrate on the front teeth, because they can see them easily and "forget" the teeth in the back. Parental oversight is needed to be sure those overlooked are brushed carefully.

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.

The mother of a 6-year-old is asking the nurse how to handle the child's lying and fabricated stories when confronted with questionable actions. Which response would be most appropriate 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 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.