Test 6: School Age

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 teaching a group of caregivers of school-age children about the importance of setting a consistent bedtime for the school-age child. Which statement 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 preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?

"She has been down, but playing in soccer camp will cheer her up."

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with asthma. Which statement best indicates an understanding of the management and treatment for this diagnosis?

"We have taken the carpet out of our house and let my mom take our dog."

The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. What would be an appropriate learning setting for a child with ADHD?

A classroom with a plan of study that is followed each day.

The nurse is talking with a chatty 7-year-old girl during her regular check-up. Which behaviors would the child also be expected to exhibit?

Explaining what is right and what is wrong

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?

Factor VIII

The nurse is conducting an assessment of a 5-year-old girl who is suspected of having autism spectrum disorder. The nurse would focus the assessment on which of the following?

Functional level

The type of fracture often seen in young children is a fracture in which there is not complete ossification of the bone and the bone bends and just partially breaks. What type of fracture is this?

Greenstick

The nurse is teaching a group of parents about head lice. Which statement is essential to include during the presentation?

Head lice are becoming very resistant to treatment.

The nurse admits a 9-year-old who is complaining of pain in the lower right quadrant of the abdomen, nausea, and constipation. She also has a fever of 101 degrees Fahrenheit. Of the following nursing actions, which will most likely be done at this time for this child? The nurse will

Help her find a comfortable position

A school-aged child diagnosed with glomerulonephritis is in the physician's office for a 6-month follow-up visit. Hematuria is found in the urine. The parents are concerned and want to know why the glomerulonephritis is not gone. What is the best response by the nurse?

Hematuria can remain in the urine for up to one year.

A nurse is teaching the parent of a 6 year old with decay in several deciduous teeth about tooth care and the importance of seeing a dentist. What should the nurse inform the parent about the 6-year molars?

If the 6-year molars become decayed and have to be pulled, the child could have dental problems later.

A nurse is caring for a hospitalized 6 year old with pneumonia. The child frequently requests peanut butter crackers during the day and evening hours. What does the nurse understand about food intake for children of this age group?

Increased appetite and a tendency to go on "food jags" are typical.

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

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

Infection

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority?

Maintaining a fluid intravenous line

An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority?

Notifying the doctor immediately -- fear of compartment syndrome

The caregiver of a fifth-grade boy calls the pediatrician's office and reports that her son has been scratching at his groin for a week or so. Despite his need for privacy, he's finally allowed the caregiver to look at the groin area. The caregiver describes the area to the nurse saying, "It looks like black pin dots that seem to have dark tails." The nurse suspects that the child may have which of the following?

Scabies

The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. What advice might be helpful for these parents?

School-age children can think critically to interpret messages seen in advertising, media, and sports.

The nurse is caring for a child in the postanesthesia care unit following a surgical procedure to place pins in the child's fractured femur. This pin placement is an example of which type of traction?

Skeletal

The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction?

Skin traction

The nurse recognizes that what would be a likely physiologic cause for a child to have enuresis?

Sleeping too soundly

The common speech problem of the school-age child

articulation

Factors that may precipitate a sickle cell crisis include:

fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity.

Enuresis is primary, or functional

if bladder training was never achieved

Enuresis is : secondary -- acquired or organic

if control was established but has now been lost.

Erikson's developmental task for school age child is

industry versus inferiority

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

industry versus inferiority.

The common speech problem of the preschool years

is broken fluency;

Piaget's stage of cognitive development for the 7- to 11-year-old

is the period of concrete operational thoughts.

Sickle cell complication: prone to dehydration d/t

kidney's inability to concentrate urine

Psychological causes of enuresis:

might include rigorous toilet training, resentment toward family caregivers or a desire to regress to an earlier level of development to receive more care and attention or emotional stress and stressful situations

The nurse is caring for a child after an accident in which the child fractured his arm. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.

• Check radial pulse in the both arms. • Document any signs of pain. • Monitor the color of the nail beds in the right hand.

After teaching the parents of a child diagnosed with sickle cell disease, the nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if the child develops which of the following? Select all that apply.

• Chest pain • Severe dizziness • Sudden change in vision

When teaching the parents of a school-aged child about promoting adequate sleep, which of the following would the nurse most likely emphasize? Select all that apply

• Consistent bedtime • Bedtime routine

The mother of a 9-year-old boy brings the boy to the clinic for an evaluation because he has a fever. The history reveals a recent trauma to the knee. The nurse inspects the joint. Which of the following would lead the nurse to suspect osteomyelitis? Select all that apply.

• Edema of the area • Localized tenderness • Pain on palpation

An overly tired school-aged child enters the school clinic. The nurse asks the child to state the times he/she usually goes to bed at night and wakes up in the morning. The child answers 11:00 PM and 6:00 AM. Which is the best response made by the nurse?

"That is not enough sleep. You should get at least 8 to 10 hours of sleep each night."

The nurse is caring for a school-aged child in the primary care setting. The parent of the child asks how often the child should see the dentist. Which is the best response made by the nurse?

"The child should see a dentist twice a year."

During an annual visit of a 6-year-old boy, the nurse observes dental caries on two of the child's primary teeth. Which response by the parents suggests more education is needed regarding the importance of primary teeth?

"These are only his baby teeth so we are not worried."

The nurse is working with a group caregivers of children who are diagnosed with autism. Which of the following statements made by the parents shows an example of echolalia?

"When she watches TV and hears a commercial, she repeats one word from the commercial but doesn't seem to understand what she is saying."

The mother of a 6-year-old girl tells the nurse she is very concerned that her daughter develops good self-esteem. Which of the following comments provides the most effective advice?

"You need to be a coach and a cheerleader."

Sickle cell symptoms:

* chronic anemia * poor appetite * severe/acute abdominal pain (d/t sludging --> enlargement of spleen) * absence of bowel sounds

The mother and her 8-year-old daughter come to the clinic for a well-child visit. The mother asks the nurse, "About how much sleep should my daughter be getting?" The nurse responds by saying which of the following?

10-12 hours

The nurse is evaluating the diet of a 9-year-old boy who is fairly active. The nurse determines that the child's nutritional intake is adequate based on the understanding that this child needs how many calories per day?

2000

A nurse is conducting a teaching program for a group of children in the clinic who are diagnosed with asthma. The nurse is teaching the group how to use a peak flow meter. The nurse would include a child who is at least how old?

5 years

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with acute glomerulonephritis. In which of the following age ranges is the peak incidence of this disorder noted?

6 to 7 years of age * 2x as likely in males

From 6 to 12 years of age, an increase of ____ per year in weight is expected.

7

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?

87 pounds

The nurse is teaching a group of peers regarding different types of fractures seen in children. Which statement best describes a complete fracture?

A fracture in which the bone breaks into two pieces.

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

The school-aged child understands that a change in an object's shape does not necessitate a change in size. The nurse knows that this is an example of which type of cognitive development of the school-aged child?

Conservation

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

A 7 year old is told that she will have to have her tonsils out during school break. The child understands the problems that would arise if this was to be done while still in school. What type of behavior is the child displaying?

Decentration

In a child diagnosed with sickle cell disease, which clinical manifestation would the nurse most likely see?

Decreased Hemoglobin level infant normal: 11 to 15g/dL

Disease process of Osteomyelitis:

Osteomyelitis is caused by Staphylococcus aureus. The bacteria enter the bloodstream and are carried to the metaphysis, the growing portion of the bone, where an abscess forms, ruptures, and spreads the infection along the bone under the periosteum. Transmission-based precautions may be required if a wound is open and draining.

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

When describing play by the school-aged child to a group of nursing students, the instructor would emphasize the need for which of the following?

Rules

An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal?

Spiral fracture

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

Tea-colored urine (bloody urine - hematuria) Also includes: * Periorbital edema *hypertension

A 5-year-old boy occasionally wets his bed at night and his pants during the day. Which finding would indicate an organic as opposed to a functional cause of this enuresis?

The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained

An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast?

The child initially may experience a very warm feeling inside the cast.

Decentration means

being able to see several aspects of a problem at the same time and to understand the relation of various parts to the whole situation. Cause-and-effect relations become clear; consequently, magical thinking begins to disappear. the ability to project one's self into other people's situations and see the world from their viewpoint rather than focusing only on their own,

Enuresis when exceptionally tired, while absorbed in some activity, or when a parent forgets to remind the child is more likely to be _____ vs ____

primary (functional) vs secondary (organic)

The school nurse providing school health screenings knows that the 7- to 11-year-old is in Piaget's stage of concrete operational thoughts. What should this age group accomplish when developing operations? Select all that apply.

• Ability to assimilate and coordinate information about the world from different dimensions • Ability to see things from another person's point of view and think through an action • Ability to use stored memories of past experiences to evaluate and interpret present situations • Ability to understand the principle of conservation—that matter does not change when its form changes

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child includes which actions? Select all that apply.

• Administering oxygen • Administering analgesics • Maintaining fluid intake (d/t dehydration & acidosis)

A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. What nursing interventions should be implemented in this case? Select all that apply.

• Administration of IV antibiotics at the hospital • Instruction to the parents regarding how to care for an antibiotic IV line at home • Instruction to the parents regarding the importance of the child maintaining bed rest • Instituting infection-control precautions related to drainage tubes

When teaching the parents of a school-aged child about promoting adequate sleep, which of the following would the nurse most likely emphasize? Select all that apply.

• Bedtime routine • Consistent bedtime

The nurse is caring for a child with osteomyelitis. Which of the following is true regarding this diagnosis? Select all that apply.

• Caused by Staphylococcus aureus • As abscess forms, ruptures and spreads infection in the metaphysis of the bone • Transmission-based precautions are followed in most cases

The mother of a 9-year-old girl with attention-deficit/hyperactivity disorder (ADHD) is frustrated because of her daughter's inability to complete tasks due to her constant distractedness. Which of the following recommendations should the nurse make to the mother? (Select all that apply.)

• Paint the child's room in pastels • Be certain you have the child's attention before giving instructions • Ask questions such as "Why?" "Where?" or "Who?" to help when the child is struggling to relate a story • Break down a chore into several steps

The nurse is caring for a number of children with bone fractures who are being treated with casts, traction, or external fixation. Which of the following would be most important for the nurse to address when caring for a child with an external fixation device?

• Preventing further injury • Maintaining skin integrity • Assessing neurovascular status • Completing daily pin care

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 nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which best examplifies a school-ager working toward accomplishing this developmental task?

The child signs up for after-school activities.

In caring for a child with sickle cell disease, the highest priority goal is:

The child's fluid intake will improve.

The nurse is reinforcing teaching regarding the treatment for head lice with the caregiver of a child who has the disorder. Which of the following is most accurate related to the treatment for the child with an infection of head lice?

The treatment will need to be repeated in about two weeks.

The nurse is caring for a child in a type of traction in which weights are being used. What is true regarding the weights?

The weights must be hanging freely, not touching the bed or floor.

The nurse is caring for a child who has had a cast applied to treat a fracture of the fibula. To monitor the pulse of the child's involved extremity the nurse will monitor which of the following?

Tibial pulse

Name the type of traction: uses weights, sandbags, or body weight to accomplish pulling

counter

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to:

notify a health care provider if the child develops an upper respiratory infection.

A nurse is working with a family that has 2 children that were identified as overweight based on screening. Which of the following strategies would be important for the nurse to include in assisting the family? Select all that apply.

• Encouraging moderate exercise for 60 minutes/day • Involving the entire family in the program • Emphasizing that the family not skip meals

A nurse is working with a school-aged child and his parents to identify triggers for the child asthma. Which of the following would the nurse identify as a common trigger? Select all that apply.

• Exercise • Strong emotions • Dust mites • Molds • Upper respiratory tract infections

A nurse is assessing a 5-year-old boy and suspects that the child may have an autism spectrum disorder. Which of the following would help support the nurse's suspicions? Select all that apply.

• Hypersensitivity to touch • Lack of facial expression

A nurse is discussing a 9-year-old girl's obesity with her parents. Which recommendation 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

A child with sickle cell anemia comes to the emergency department for evaluation. The nurse suspects that the child is experiencing a vaso-occlusive crisis based on assessment of which of the following? Select all that apply.

• Low back pain • Fever • Distended abdomen

12-year-old Hilary is brought to the emergency department by her parents with severe abdominal pain. The nurse suspects appendicitis which has not perforated based on which of the following assessment findings? Select all that apply

• Normal to hyperactive bowel sounds early • Irritation and pain in the right lower quadrant • Low-grade fever, anorexia • Nausea, vomiting

The characteristics of the child with autism fall into three categories. What are these three categories?

• Obviously limited activities and interests. • Inability to communicate with others • Inability to relate to others

Which of the following demonstrates an example of Erikson's developmental task for the school age child?

The child spends a rainy day putting together a puzzle of a large jungle animal.

The highest priority goals for a sickle cell patient is:

maintaining comfort and relieving pain

Physiologic causes of enuresis:

may include a small bladder capacity, urinary tract infection, and lack of awareness of the signal to empty the bladder because of sleeping too soundly

When you are cleaning the bedside stand of a hospitalized 10-year-old, you find 48 packages of sugar. Your best action in relation to this would be to:

put them back in the drawer as they were.

Known risk factors for glomerulonephritis:

recent streptococcal infection, pharyngitis, age >2, male

Name the type of traction: adding pull through the use of pins, wires, screws, or tongs

skeletal

Name the type of traction: applying pull to the skin, and manual traction involves direct pulling by the physician or nurse

skin

You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is:

slightly yellow sclerae

Findings associated with osteomyelitis include

swelling, point tenderness, warmth over the site, decreased range of motion, and an elevated sedimentation rate.

The nurse is discussing nutrition with the mother of a 6-year-old boy. Which response by the boy's mother indicates a need for further discussion?

"I make him eat some of everything I put on his plate."

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode?

Apply heat to the site of bleeding.

A nurse is performing a physical assessment on a child who is undergoing an asthma attack. Which of the following would the nurse most likely observe?

Central cyanosis

"We have taken the carpet out of our house and let my mom take our dog."

• Preventing symptoms • Preventing recurrence Correct

*** A nurse in the clinic observes a school-age child pushing another child. The parent is watching without disciplining the child and tells the nurse, "He just does what he wants to and doesn't listen to anything I say." What can the nurse inform that parent about the development of self-confidence in the child? (Select all that apply.)

• The child needs consistent rules to develop self-confidence. • The child needs positive attention to develop self-confidence. • The child needs clear expectations to develop self-confidence.

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, all of these goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family?

• The child will maintain a clear airway. • The child will have adequate fluid intake