School-Age Child

24. A school nurse is assessing the childs social environment. Which of the following strategies would the nurse implement? a. Interview family members. b. Conduct a windshield assessment. c. Review the childs past medical history. d. Evaluate the childs activity and rest patterns.

ANS: A The childs social environment includes the family, school, and playmates. Thus, the best way to collect information about this is to interview the childs family members.

6. Which of the following is responsible for ensuring that children are up-to-date on their immunizations? (select all that apply) a. School nurse b. Parent or caregiver c. Teacher d. School principal

ANS: A, B The parent or caregiver bears the major responsibility for ensuring that their child has had all of the required immunizations; however, it is also the school nurses responsibility to ensure that the immunizations are current.

2. A nurse is planning a flu prevention fair for 9- to 11-year-old children. Which of the following activities should be included? (select all that apply) a. Microscopes set up to show bacteria on common objects b. Games such as find the germs in a cartoon picture c. Research poster showing germ transmission d. Hand-washing booth with colored soap

ANS: A, B, D Age-appropriate interactive activities such as games and demonstrations are effective teaching strategies. Formal research poster presentations are not appropriate for this age group.

12. Which of the following children is at risk for developing encopresis? a. A 6-year-old child who takes Colace on a daily basis to soften stool b. A 3-year-old child who is not fully toilet-trained c. A 5-year-old child who has been in four foster care homes since age 3 d. A 4-year old child who sleeps soundly at night

ANS: C Encopresis is diagnosed after age 4. It occurs most frequently during the day, if the child has chronic constipation, which would not occur if the child takes Colace on a daily basis, and if the child has experienced early life stress.

26. Which of the following statements about smoking is true? a. Black children begin smoking at an earlier age than do White children. b. Almost 80% of schools prohibit tobacco use in all locations. c. Each day over 6000 children try smoking. d. Tobacco use prevention programs should be initiated in eighth grade.

ANS: C Every day, more than 6000 school students try to smoke a cigarette. Most students who smoke initiate their habit around 11 years of age. White children begin smoking at an earlier age than do Black children. Approximately 64% of schools are smoke free. Tobacco use prevention programs should begin in elementary school.

29. During a parent-nurse conference, the parent tells the nurse that her child sleeps approximately 7 hours per night. Which of the following potential health problems would be of concern to the nurse? a. Hypertension b. Hyperactivity c. Obesity d. Type 2 diabetes

ANS: C Based on the study by Lumeng et al, children who do not get adequate sleep tend to be less active, which promotes overweight/obesity. Type 2 diabetes and HTN may result from obesity.

17. Which of the following statements concerning hearing in school-age children is correct? a. The rate of otitis media infections met Healthy People 2010 targets. b. Hearing and visual problems occur with the same frequency. c. All 50 states require routine hearing evaluations. d. The use of tympanograms has improved the accuracy of hearing screenings.

ANS: A Hearing problems occur with less frequency than do vision problems. Many states, but not all, require routine hearing evaluations. Tympanograms measure how well the tympanic membrane vibrates.

2. According to the American Heart Association, at what age should blood pressure screening begin? a. 3 b. 6 c. 9 d. 12

ANS: A Blood pressure screening should begin at 3 years of age and should be measured annually.

9. A nurse is planning activities to help children learn about good nutritional practices. Which of the following strategies should the nurse implement? a. Coordinate a Try This food day offering a variety of nutritious snacks. b. Find a book about nutrition to read the students. c. Plan a game using the concept of MyPlate. d. Search on-line for a video about nutrition to the students.

ANS: A Children frequently prepare their own snacks and are more likely to learn from activities that foster active participation rather than passivity.

10. A child who has a BMI of 34 visits the school nurse. Which of the following factors does the nurse recognize that the child may be experiencing? a. Increased bullying by peers b. Increased self-esteem c. Increased resiliency d. Increased motivation to lose weight

ANS: A Children may not be concerned about being overweight/obese and may therefore not be motivated to adopt healthier eating/exercise patterns. They may demonstrate impulsive behavior and have low self-esteem. Obese children are often ridiculed by peers.

8. A school nurse is planning a series on nutrition. Which of the following factors should the nurse take into account? a. Television commercials frequently advertise food-related products. b. Children watch approximately two hours of television a day. c. Each day, approximately 60% of children eat fast food. d. A child is three times more likely to eat in a restaurant than at home.

ANS: A Children watch over 3 hours of television a day. About one third of children eat fast food each day, and parents spend approximately 40% of their food budget for restaurant meals, including fast food restaurants.

7. A nurse is conducting a school-wide in-service program about child abuse and is asked to describe common indicators of abuse. Which of the following signs would the nurse include? (select all that apply) a. Caregivers and parents who are reluctant to take the child for treatment for an injury b. Statement by the day care provider that the child was injured by falling off a chair c. Explanation of the injury from the child and caregiver or parent that are similar d. Lack of emotional response from child to a playground injury

ANS: A, B, D Signs of abuse may include physical evidence, conflicting stories about the accident or injury from parents or others, an injury or complaint inconsistent with the childs history or developmental level, inappropriate response of the caregiver or child, the childs report of abuse, previous reports of abuse in the family, or repeated visits to emergency facilities with injuries.

5. The school nurse is evaluating children for signs and symptoms of depression. Which of the following children may be most at risk for depression? (select all that apply) a. 11-year-old girl who has been involved in fighting during the past month b. 10-year-old boy who no longer wants to play on the schools soccer team c. 12-year-old boy who has started lifting weights d. 9-year-old girl who visits the nurse on a daily basis for vague complaints

ANS: A, B, D Symptoms of depression in school-age children include anorexia, sleeplessness, lethargy, changed affect, aggressive behavior, frequent crying, or withdrawal from previously enjoyed activities.

4. Which of the following children may have difficulty with Eriksons industry versus inferiority stage of development? (select all that apply) a. Poor motor skills and is rarely chosen for team play during recess b. Difficulty with math homework c. Difficulty making friends d. Cannot speak his or her native language fluently

ANS: A, C, D The industry versus inferiority stage of development as described by Erikson is mastered when the child has a sense of accomplishment, rather than an inability to perform at the expected level. Children with poor motor skills who are not selected by their peers for a team, those who find it difficult to make new friends, and those who have difficulty assimilating into their dominant culture all are likely to have a sense of inferiority. A child who has difficulty with math homework may not be noticed by his/her peer group.

19. Each of the following children visits the school nurse on a regular basis. Which of these children would the nurse identify as being at risk for educational difficulty and suggest follow-up care? a. 9-year-old whose parents recently divorced b. 10-year-old who cannot sit still longer than 15 minutes c. 12-year-old with a 4000-word vocabulary d. 11-year-old who scored 102 on an IQ test

ANS: B A 10-year-old who displays inattentive behavior should have follow-up care. Hyperactivity may indicate ADHD, which would require follow-up care and potential educational difficulty. An environmental deficit such as a divorce may cause school difficulty for a child, but this does not indicate a learning disability. The average vocabulary for a 12-year-old is 4000 words. A score of 102 on an IQ test falls within the average range of 90 to 110.

15. During a school gift fair, a parent asks the school nurse what gift would be most appropriate for her 6-year-old child. Which of the following should the nurse encourage the parent to purchase? a. A box of wooden blocks of various sizes for sorting b. A jar of sea shells in various shapes, colors, and textures c. A world map d. A beginning encyclopedia of animals

ANS: B Classifying and ordering sea shells according to color, size, shape, and texture will help the child learn about classifying and numbering. These two concepts are necessary in order to learn to read and so on. A world map and encyclopedia are not age-appropriate, nor are wooden blocks.

4. The president of the Parent-Teacher Association asks the school nurse about the appropriateness of sponsoring a health fair that focuses on oral health for school-age children. Which of the following statements indicates the nurses correct understanding of this issue? a. Dental problems are not as prevalent a problem as asthma, so you might want to consider a health fair about respiratory problems instead. b. Over 40% of children age 2 to 11 have dental caries, so a health fair that focuses on oral care is very appropriate. c. Children are not usually receptive to learning about dental care, so the topic is not the best choice for a health fair. d. This is not an appropriate focus for a health fair because the incidence of dental caries has dropped dramatically due to the use of sealants.

ANS: B Dental caries are present in up to 42% of children 2 to 11 years of age. Dental caries and other oral health issues remain a problem in the school-age population. Small gains have been made in number of children receiving sealants to prevent caries. Dental caries is the most common chronic disease of children 5 to 17 years of age, 4 times more prevalent than asthma.

23. The school nurse has been asked to conduct a community awareness program about accidents that impact the school-age child. Which of the following facts should be included in the program? a. Poisonings and falls are the leading causes of death. b. Drowning and motor vehicle accidents are the leading causes of fatality. c. The majority of accidents happen in the home. d. Burn accidents are more common in the summer months.

ANS: B Most fatal accidents during the school-age period derive from motor vehicle accidents when the child (host) is a passenger or pedestrian (walking or riding a bike). Other fatal accidents occur from fires and burns, bicycles, drowning, and firearm accidents. Accidents are the leading cause of death in children over 12 months of age. The majority of accidents occur outdoors. Burn accidents are more common in the winter.

20. A parent asks the nurse working in a pediatric clinic how she can help her 6-year-old child feel good about himself. Which of the following statements should be made by the nurse? a. Doing most things for your child will give them a sense of security, and they will have a positive self-image. b. Having your child help around the house with tasks such as setting the table will increase self-esteem. c. Make sure to highly praise even the smallest effort your child makes at completing a task. d. There is little you can do to increase your childs self-esteem. Their peers have much more of an influence than parents at this age.

ANS: B When children succeed at age-specific tasks, they increase their sense of self-worth. Doing everything for a child prevents him or her from becoming proficient at a task. Too much praise makes positive feedback lose its value and gives the child a false sense of mastery. Although peers are important, at age 6, parents influence their children more than do peers.

21. Which of the following statements made by a parent is most helpful when discussing rules of the household? a. You did not feed the dog like you promised, so you cannot have ice cream for dessert. b. I was upset when you did not feed the dog like you promised. We all need to help take care of him because he depends on us. Lets talk about what happened. c. Why did you forget to feed the dog? Would you like me to forget to feed you? d. What you did was bad. We all need to care for the dog.

ANS: B When correcting a child, explaining how one feels, the consequence of the action and then listening to the child discuss the situation is more beneficial than punishment and labeling the child as bad.

MULTIPLE RESPONSE 1. Which of the following children should the school nurse monitor closely for hypertension (HTN)? (select all that apply) a. 7-year-old White male with no known family history of HTN b. 9-year-old White female whose maternal grandfather has HTN c. 6-year-old Black child with no family history of HTN d. 10-year-old Mexican American child with known family history of HTN

ANS: B, C, D A White child with no family history of HTN can receive routine monitoring. The other children are in the high-risk category for HTN because of race and family history.

3. The school nurse has been asked to plan play and recess activities for children in grades 2 through 6. Which of the following activities should be developed by the nurse? (select all that apply) a. Highly competitive games that focus on individual accomplishment and winning b. Family activity days that promote nature walks and biking c. Co-ed organized sports d. Library outings

ANS: B, D Emphasis should move away from highly competitive activities that promote more of a feeling of superiority than team work to reach a goal. Children in this age group generally prefer to play with children of the same gender.

27. A childs parents ask the school nurse if there is any help available to help their child receive health insurance. They state they earn too much money to qualify for Medicaid but not enough to purchase health insurance. Which of the following recommendations should the nurse provide? a. Currently, there is no health care program available for your child. b. The school district has a health insurance policy that you can access. c. The state has an insurance program to assist you. d. You will need to find coverage through another member of your family.

ANS: C The State Childrens Health Insurance Program was created to assist parents in this economic category. This program supports comprehensive care to children 0 to 18 years who do not meet Medicaid criteria but live in families too poor to afford private insurance.

3. The school nurse has seen several students in the health office. For which of the following students should the nurse suggest a follow-up exam? a. A 14-year-old girl who has not experienced menarche b. A 7-year-old boy who has grown 2 inches in a year c. A 10-year-old girl who has gained 11 pounds in a year d. An 8-year-old boy who has lost four deciduous teeth in the past year

ANS: C The average age of menarche is between 11 and 15 years of age. School-age children grow approximately 2 inches a year, gain between approximately 4.4 to 6.6 pounds a year, and lose four deciduous teeth a year between ages 6 and 13. A weight gain of 11 pounds in 1 year requires a follow-up because of the rising rate of obesity in children.

18. A third grade teacher asks the school nurse what she can reasonably expect from children in her classroom related to language ability. Which of the following statements would be the best response from the nurse? a. Children in the second grade should have about a 4000-word vocabulary. b. Research has shown that children will learn to read more quickly if you use the whole word approach. c. You can expect that the children will write b and d without reversing them, and all of the letters in a word will be about the same size. d. You can evaluate the cognitive ability of the children in your classroom by noting how legible their writing is.

ANS: C The child will not have a 4000-word vocabulary until about the age of 12. Both the whole word approach and the phonics approach will help children learn to read. The legibility of handwriting has no correlation to intelligence.

6. Which of the following elements is most likely deficient in a school-age childs diet? a. Protein b. Sodium c. Iron d. Vitamin B12

ANS: C The diet of school-age children is frequently deficient in calcium, iron, and vitamin C, while it is high in fat and sodium.

22. A nurse has recently accepted a position as a school nurse at a middle school and plans to offer sex education to the students and parents. Which of the following should be in the initial action taken by the nurse? a. Offer gender-segregated sex education classes. b. Develop information to teach about abstinence and condom use. c. Determine how this education has been provided in the past. d. Survey parents to determine their desire for this education to be provided.

ANS: C The nurse employed in the school is in an ideal position to teach group sex education programs using literature and games. Children at this age appear to respond most favorably with gender-segregated classes, based on their general discomfort with sexual topics and unique needs and questions. Some schools appropriately incorporate these classes into school curricula as part of a health-promotion curriculum. Other schools have special programs focused only on sex education based on parental desires or school board policies. Therefore, the first action by the nurse should be to determine what has been done in the past.

7. Which of the following initiatives related to childhood nutrition outlined in Healthy People 2010 was most successful? a. Reduction of fat consumption b. Increase in consumption of fruit c. Adequate food supplies at home d. Reducing obesity rates

ANS: C The target rate of 94% related to household adequate food supplies was surpassed with up to 98% of households found to be food secure. Children continue to eat too many foods high in fat, obesity rates are increasing, and consumption of fruit and vegetables is low.

1. The school nurse conducting an in-service program for teachers is asked about general growth and development of school-age children. Which of the following statements would be the best response by the nurse? a. By age 11, blood pressure readings are the same as for an adult. b. Because of the rapid growth pattern in this age group, snacks are important to ensure sufficient caloric intake. c. Children in this age group have some difficulty with coordination and balance, so playground supervision is important. d. Overall growth in school-age children is slower than during infancy and adolescence.

ANS: D Children grow (physically) much more slowly during this time period as compared with growth during infancy and adolescence. Blood pressure readings for children in this age group are lower than for adults. Growth slows until adolescence. Children in this age group generally have good coordination and balance

11. During a well-child visit, parents report to the nurse that they are concerned that their 8-year-old son has started wetting the bed at night. Which of the following statements should the nurse make to the parents? a. Ill be sure to mention this to the doctor because we rarely see a child who wets the bed at this age. b. There is not much you can do to stop this problem until he gets older. c. This is a common disease in children his age. Lets talk about some options for helping him stay dry. d. Im going to collect a urine sample from him and then we will talk about bed wetting.

ANS: D Enuresis may be caused by a UTI. It is not a disease and not uncommon in school-age children. Various therapies exist to help the child maintain nighttime bladder control.

5. Which of the following statements is correct? a. Tonsils in a school-age child are smaller than in an adult. b. The nervous system generally matures between ages 11 to 13. c. Fractures heal more slowly in a 10-year-old child than in an adult. d. Overweight children have muscle pain more often than average-weight children.

ANS: D Overweight children are more likely to suffer bone fractures, have joint pain, and more muscle pain than their normal weight counterparts. Tonsils, which are lymphoid tissue, are larger in a child than in an adult. The nervous system matures by ages 7 to 8. Fractures heal more quickly in children than in adults.

16. The school nurse has written a grant to obtain funding for a vision screening program and glasses for children in his pre-K to 6th grade elementary school. Which of the following statements should be included with the rationale for the need for funding? a. Many preschool children are hyperopic and need glasses to prevent headaches. b. Fewer than 10% of children entering school have had eye exams. c. Vision screening can diagnose vision/eye problems before they become severe. d. Approximately one in four children has a vision problem.

ANS: D Preschool children who are farsighted do not need corrective glasses. Their vision will improve as they mature. Approximately 33% of children entering school have had eye exams. Vision screening does not diagnose vision problems.

13. A nurse is discussing sleep patterns in school-age children. Which of the following should be stressed by the nurse? a. Sharing a bed with siblings/parents has a long-lasting psychological impact. b. School-age children need between 6 and 9 hours of sleep a night. c. Daytime naps are important in children until they reach the age of 9 or 10. d. School-age children generally agree with and adhere to a regular bedtime.

ANS: D Research has not demonstrated that sharing a bed with siblings/parents has a long-lasting psychological impact on the child. Children sleep between 8 and 12 hours per night and do not need daytime naps.

28. During orientation, the new school nurse asks his preceptor about the role of the school nurse. Which of the following statements is the best response by the nurse? a. School nurses need to focus their attention on children who are economically disadvantaged, because other children have all the resources necessary to assist them maintain a healthy lifestyle. b. There is little school nurses can do to improve the health of children. That really is the job of parents and caregivers. Our role is to conduct routine screening and deal with emergencies. c. We are primarily focused on physical and psychological health, rather than environmental concerns. d. We are an important part of the team that helps to maintain and improve childrens health in a variety of ways from screenings to advocacy.

ANS: D School nurses care for children in all economic groups and recognize the unique challenges faced by each population. Nurses are a primary force related to improving childrens health and well-being taking into account all facets of a childs world from the environment to health deviations.

14. Parents of an 8-year-old boy tell the nurse that they are concerned about their son because he occasionally sleepwalks. Which of the following is the best response from the nurse? a. Sleepwalking is much more common in girls than boys. b. I am glad you mentioned this. Sleepwalking is sometimes a sign of a neurological deficit. c. Does he also have nightmares? Do the two problems often occur together? d. This is not abnormal for a child of this age. He will most likely outgrow this tendency as his nervous system matures.

ANS: D Sleepwalking occurs more frequently in boys than girls, is most likely caused by an immature CNS, and is not associated with nightmares.

25. A school nurse is caring for a child with an upper respiratory tract infection. Which of the following nursing interventions should the nurse implement? a. Send the child with a mild sore throat back to class. b. Advise the parent of a child with a group A strep throat infection that they cannot return to school for 5 days. c. Educate the parent that treatment of group A strep infections usually requires extra fluid intake. d. Ask the parent of a child with a mild fever and mild sore throat to take the child to his or her health care provider.

ANS: D Untreated strep throat caused by group A bacteria can result in serious complications. Signs and symptoms may include a mild sore throat. After 24 hours on antibiotics, the child can return to school. Thus, the parents of a child with a mild fever and mild sore through should be evaluated by his or her health care provider.