Peds - Chapter 28: Growth and Development of the School-age Child

The nurse is discussing sleep and the amounts of sleep necessary for an 11-year-old child with the child's caregivers. For the child who gets up at 6:30 a.m., which bedtime would the nurse recommend the caregivers require the child to go to bed?

9:30 p.m.

The nurse is caring for a 10-year-old who has been admitted for surgery. Which of the following would be the most important for the nurse to do when caring for this child? The nurse should

Answer questions the child asks regarding pain

While treating a minor playground injury for an 8-year-old girl, the school nurse discovers that the injury was the result of bullying. What should be the nurse's first action?

Assess the situation with the help of the school staff and parents.

A nurse is assigned to care for a 7 year old with cystic fibrosis. The child wants to show the nurse his collection of baseball cards. The nurse understands that the collection of objects is common in this age group and is known as what type of thinking?

Classification Explanation An important change in thinking during the school-age period is classification, the ability to group objects into a hierarchical arrangement. Children in this age group love to collect sports cards, insects, rocks, stamps, coins, or anything else that strikes their fancy. These collections may be only a short-term interest, but some can develop into lifetime hobbies.

The nurse is about to see a 9-year-old girl for a well child check-up. Knowing that the child is in Piaget's period of concrete operational thought, which characteristic should the child display?

Consider an action and its consequences

An anxious 12-year-old girl receives an injection from the nurse and sighs with relief when it is done. After a moment of reflection, the girl asks the nurse, "Is it hard to give someone an injection?" This girl's question is evidence that she has developed which cognitive skill?

Decentering

The successful resolution of developmental tasks for the school-age child, according to Erikson, would be identified by

Developing a sense of worth and competence

A nurse is carrying on a conversation with a 7-year-old girl during an office visit. Which of the following is an example of the level of language development the nurse should expect in this child?

Difficulty understanding the concept of "half past" in reference to time

Eight-year-old Ted's foster mother is discussing her concerns about Ted's recent dental checkup in which three cavities were found in his permanent teeth. Ted's mother is concerned because Ted eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. What would the nurse suggest to this mother is the most appropriate in regard to Ted's dental health? The nurse would suggest that the mother

Ensure that Ted brushes his teeth after each meal and snacks

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, which is what?

Industry Explanation During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment.

The mother of two sons, ages 6 and 9, states they want to play on the same baseball team. As the school nurse, what advice would you give their mother?

Levels of coordination and concentration differ, so the boys need to be on different teams.

A 9-year-old boy has arrived for a health maintenance visit. Which milestone of physical growth should the nurse expect to observe?

Lymphatic tissue growth is complete providing greater resistance to infections.

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

Participating in a craft project Explanation During this stage, the child is interested in how things are made and run, and engaging in meaningful projects and seeing them through to completion.

Ten-year-old Edgar is above normal weight for a child his age and height. When discussing with him what he likes to eat, he tells the nurse he doesn't eat much candy but he loves to eat fruit, pasta, potatoes, and bread. What would the nurse recommend to Edgar's caregivers as to ways to help him maintain a healthy weight? The caregiver should

Provide activities for Edgar that will increase his physical activity.

The school nurse is working with a group of 6- to 8-year-old children. Which of the following responsibilities would the school nurse most likely have for this age child? The nurse would be

Testing the children's vision and hearing Explanation Vision and hearing screening should be performed before entrance to school and on a periodic basis (annual or biannual) thereafter. The school nurse often conducts these examinations. Most states have immunization requirements that must be met when the child enters school.

The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely?

The child has a leaner body mass than a girl at this age.

Which of the following best describes Erikson's psychosocial development task for the school-age child?

The child wants to successfully complete activities.

Which of the following are reasons that stealing occurs in school-age children? (Choose all that apply.)

To escape punishment Lack of sense of propriety Strong desire to own something

Conformity is vital to school-age children.

True

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

industry versus inferiority Explanation Erikson defines industry versus inferiority in the school-aged child. Activities include interest in how things are made, needing support when they are not successful, and involvement in clubs and sports outside the home

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

During a well child check at the ambulatory clinic, the mother of a 10-year-old boy reports concerns about her son's frequent discussions about death and dying. Based upon knowledge of this age group the nurse understands that:

preoccupation with death and dying is common in the school-aged child. Explanation School-aged children are often preoccupied with thoughts of death and dying.

On physical examination, you discover that a 6-year-old's palatine tonsils are somewhat enlarged in the back of his throat. Your best action would be to

record this as a normal early school-aged finding.

The nurse is providing information to the parents of a 6-year-old boy who has been caught lying at home and at school. Which would the nurse share with the parents? Select all that apply.

• Explain that children this age typically lie to avoid punishment. • Suggest reading a story with the child about the consequences of lying.

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 mother of a 7-year-old girl is asking the nurse's advice about getting her daughter a 2-wheel bike. Which response by the nurse is most important?

"Be sure to get the proper size bike."

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 nurse is working with a group of caregivers of 6-year-olds. One of the mothers states her son has been lying and making up stories; she asks for some advice about how to address the issue. Which of the following would be an appropriate response by the nurse?

"Children this age sometimes can't distinguish between fantasy and reality."

The nurse is teaching a group of caregivers of school-age children on various topics. Which of the following statements made by the caregivers indicates a need for further teaching?

"Food is so expensive, we always make our children eat everything on their plate."

During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. Which of the following is the best specific trigger question to determine the preschooler's linguistic and cognitive progress?

"How well does your son communicate or follow instructions?"

The nurse is 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?"

The nurse is conducting teaching with families of school-age children. Which of the following statements made by the nurse is most appropriate related to topics that would be covered with this group of individuals?

"The school-age child needs 10 to 12 hours of sleep per night."

A parent brings a 6 year old to the clinic and informs the nurse that the child is tired all the time even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse?

"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school."

The parents of a 7-year-old girl report concerns about her seemingly low self-esteem. The parents question how self-esteem is developed in a young girl. Which response by the nurse is best?

"Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age." Explanation Self-esteem is developed early in childhood. The feedback a child receives from those perceived in authority such as parents and educators impacts the child's sense of self-worth. As the child ages, the influence of peers and their treatment of the child begin to have an increasing influence on self-esteem.

The nurse is assessing the nutritional needs of an 8-year-old girl who weighs 65 pounds. Which of the following amounts would provide the proper daily caloric intake for this child?

2,065 calories per day (29.5 kg x 70 calories per day per kg = 2,065 calories per day).

As the school nurse conducting screening for vision in a 6-year-old child, you would refer the child to a specialist if the visual acuity in both eyes is:

20/50

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?"

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."

The nurse is talking with the parents of an 8-year-old boy who has been cheating at school. Which comment should be the nurse's primary message?

"Make sure that your behavior around your son is exemplary."

The nurse is teaching a group of caregivers of school-age children about the importance of setting a consistent bedtime for the school-age child. Which of the following statements made by a caregiver indicates an understanding of the sleep patterns and needs of the school-age child?

"My child sleeps between 11 and 12 hours a night."

The nurse is caring for an 8-year-old girl. She is reviewing her nutritional requirements and describing interventions that promote healthy eating habits. Which of the following responses by the girl's mother indicates a need for further discussion?

"My daughter must stay at the table until she has cleaned her plate."

The parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond?

"Remind her in simple terms what will happen in the dentist's office."

The parents of a 9-year-old boy report they have been homeschooling their son and now plan to enroll him in the local public school. They voice concerns about the influence of the other children on their son's values. Which information should the nurse provide the parents?

"The values of the family will likely prevail for your son." Explanation The values of a child are determined largely by the influences of their parents. As the child ages the impact of peers does begin to enter the picture. Children may also begin to test the values with their actions. In most cases the values of the family will prevail.

A hospitalized 7 year old is recovering from a head injury. Occupational therapy has been ordered to assist the child in regaining eye/hand coordination. If the child cannot master this skill, what feelings may arise?

A feeling of inferiority Explanation Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.

The parents of a school-aged child with school phobia have taken her to three different psychiatrists trying to resolve this problem. Based on this, which nursing diagnosis would be most appropriate?

Compromised parental coping related to inability to enforce school attendance

The nurse is teaching parents of an 11-year old girl how to deal with the issues relating to peer pressure to use tobacco and alcohol. Which suggestion provides the best course of action for the parents?

Discuss tobacco and alcohol use with the child

Children can become physically addicted to glue

False Explanation: Children do not become physically addicted to glue but do become psychologically dependent on it.

A nurse overhears a 7 year old calling her hospital roommate a vulgar name. What is the best action by the nurse?

Inform the child that talking to the roommate using that language is not acceptable behavior.

A father brings his 6-year-old son in to the doctor's office. He says his son just began first grade a week ago and, after attending the first day of classes, has refused to go to school each day since, complaining of stomach cramps and nausea. He says he has spoken to the boy's teacher, who says she did not notice anything unusual with her interaction with the boy, other than perhaps a bit of homesickness. After the nurse examines the boy and finds nothing wrong, the father asks how he should handle the problem. Which of the following should the nurse recommend?

Insist that the child return to school

A mother brings her 8-year-old daughter into the doctor's office because over the past year her tonsils have increased in size to the point that the mother is concerned that there is something wrong. The girl has no other symptoms, however. The nurse knows that which of the following is most likely the cause of the enlarged tonsils?

Normal growth of lymphatic tissue for this age

The nurse is observing a playgroup of children of all ages. The school-age child in the group would most likely be doing which of the following activities?

Painting pictures in the art corner of the room.

A nurse is speaking with a 7-year-old boy in the hospital. The boy asks the nurse, "Where is the westroom? I need to use the westroom." The nurse recognizes that this developmental problem is which of the following?

Poor articulation

A 10-year-old spends 2 hours by herself every afternoon before her parents arrive home. Which of the following would be the most appropriate safety measure to suggest that the parents teach the child?

Preparing a no-cook snack for herself

A 12-year-old girl has recently begun menstruating and is well into puberty. She is visiting the doctor today for a routine physical examination. Which of the following findings should cause concern in the nurse?

Vulvar irritation

A mother tells you her 6-year-old has been biting his fingernails since he began first grade. After analyzing the cause of this as increased stress, the advice you would give his mother regarding this problem would be to

allow some time every day for the child to talk about new experiences. Explanation Beginning school can be a time of extreme stress for children. Allowing them time to discuss these experiences helps them to put experiences in perspective and begin to deal with them.

A 7-year-old has taken money from his brother's dresser on two occasions. When counseling his mother about this, you would advise her that

she may need to remind him of property rights.

The nurse is caring for a hospitalized 5-year old child. The child's mother has reported her child is becoming very "clingy." Which advice should the nurse provide? Select all that apply.

• "Regression is normal during hospitalization." • "Allowing the child to have some input in the care may be helpful in managing these behaviors." • "The child may miss school and interaction with peers." Explanation During hospitalization the school-aged child may exhibit increased clinging behaviors. The child may also demonstrate regression. It will be helpful to promote the child be able to make some decisions or have some age-appropriate sense of control. The school-age child may miss school and the interactions with his or her peers. Ignoring the behaviors may be counterproductive.

A nurse is discussing a 9-year-old girl's obesity with her parents. Which of the following recommendations should she make to the parents? (Select all that apply.)

• Intake of about 1,200 calories a day • Limiting time spent in physical inactivity • Participation in a formal weight-control organization • Participation in formal exercise classes

The father of an 11-year-old boy is worried that the child spends too much time watching TV. What information should the nurse share with this father? Select all that apply.

• The American Academy of Pediatrics recommends 2 hours or less of TV daily. • Establish guidelines on when a child can watch TV. • Watch programs together and discuss subject matter with the child.

During a well-child visit, an 11-year-old girl complains to the nurse that she looks different from her friends who are wearing bras. What is an appropriate response?

"It is normal for there to be differences in the time and rate girls your age develop."

Eight-year-old Matt is doing well with adding and subtraction. His father asks for suggestions regarding projects that would help increase Matt's understanding of conservation of mass. Of the following projects, which would most help Matt understand conservation of mass?

Form vases from blocks of clay.

The nurse is educating the parents of a 6-year-old boy how to manage the child's introduction into elementary school. The child has an easy temperament. Which should the nurse suggest?

Helping the child deal with minor stresses

The school nurse is assessing the nutritional status of an overweight 12-year-old girl. Which question is appropriate for the nurse to ask?

How often does everyone in your family eat together?

A mother calls the advance practice pediatric nurse practitioner about her 7-year-old daughter's dental hygiene. The daughter has had three cavities. She does not know what to do and asks the nurse for guidance. How should the nurse respond?

"Are you able to supervise her brushing?" Explanation 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.

A nurse is caring for a hospitalized 7 year old whose family members have been unable to visit for 2 days. The nurse is preparing a diversional activity for the child. Which activity would best be suited for a child in this age group?

A paint-by-numbers activity Explanation Between the ages of 6 and 8 years, children begin to enjoy participating in real-life activities, such as helping with gardening, housework, and other chores. They love making things, such as drawings, paintings, and craft projects.

Which activities will promote weight loss in an obese school-age child? (Choose all that apply.)

Role modeling by family Becoming active in sports Involving child in meal planning and grocery shopping

Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.The nurse is observing a group of 8-year-olds who are being taught the concept of conservation of weight. Which of the following activities would best help these children understand this concept

Weighing a pound of oranges and a pound of bricks and counting how many of each make a pound.