ATI PEDS Ch. 6 Growth and Development of the School-age Child
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? a) "Is there fluoride toothpaste available for her use?" b) "Did you teach her how to brush her teeth?" c) "What type of toothbrush does she use?" d) "Are you able to supervise her brushing?"
"Are you able to supervise her brushing?" Correct 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.
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? a) "Even if the weather is cool and cloudy, our children play outside every day." b) "I make sure they have good teeth by giving them calcium and phosphorus." c) "Sometimes we have to be firm, but our children wash their hands before eating." d) "Food is so expensive, we always make our children eat everything on their plate."
"Food is so expensive, we always make our children eat everything on their plate." Correct Explanation: Obesity can be an issue in the school-age child, especially if they are urged to clean their plates even if they have more food than they want or need on the plate. Firm guidance and direction is important with the school-age child. Calcium and phosphorus are important to healthy teeth. Exercise each day is important, especially outdoor exercise.
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? a) "Is your son's speech clear enough that anyone can understand it?" b) "Does your son speak in complete sentences all the time?" c) "How well does your son communicate or follow instructions?" d) "Would you say your son has a vocabulary of about 900 words?"
"How well does your son communicate or follow instructions?" Correct Explanation: Asking how well the boy communicates and follows instructions is the best trigger question because it is open-ended. Asking if the child uses complete sentences or speaks clearly will elicit a yes or no answer about only those specific areas of development. The parents would have no way of judging the size of their child's vocabulary.
The nurse is discussing the topic of obesity with a group of mothers of school-age children. Which of the following statements made by the caregivers indicates the best understanding of factors that contribute to obesity? a) "We eat fast foods on weekends because we are too busy to cook." b) "Neither my husband nor I have ever had any concerns with weight." c) "I keep lots of snacks on hand because my child eats all day long." d) "I always cook foods that are low in fat."
"I always cook foods that are low in fat." Correct Explanation: Limiting dietary fat intake to no more than 35 percent of total calories help control the child's weight. Fast foods tend to have high fat and calorie content and contribute to obesity. Some children may have a genetic tendency to obesity, but environment and a sedentary lifestyle are a concern related to obesity. Caregivers must carefully supervise children's snacking habits to be sure that snacks are nutritious and not too frequent since this can lead to obesity.
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? a) "My dad doesn't like bread so I get my grain in the morning when I eat a bowl of cereal." b) "I love fruit so every day I eat the half of orange my mom puts in my lunch." c) "My gramma cooks for us and she lets me eat two chicken breasts for supper." d) "I drink three big glasses of milk each day."
"I drink three big glasses of milk each day." Explanation: For the school-age child, an adequate intake of milk is three cups a day.
The nurse is discussing nutrition with the mother of a 6-year-old boy. Which of the following responses by the boy's mother indicates a need for further discussion? a) "He won't eat any kind of meat except for hot dogs." b) "I make him eat some of everything I put on his plate." c) "All he wants to eat is peanut butter sandwiches." d) "My son mixes all of his food together when he eats it."
"I make him eat some of everything I put on his plate." Correct Explanation: Children will usually accept new foods if they aren't forced upon them. The dinner table should not be allowed to become a battleground. It is better to offer new foods and let the child accept them when he is ready. Children will go on "food strikes" and they will also go through periods of wanting the same foods. Preference of how the child eats lets them exert some independence and allows for experimentation.
The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which of the following general questions would the nurse direct to the child's parents? a) "Is breakfast eaten regularly?" b) "How important is exercise?" c) "Is there a family history of hypertension, heart disease, or diabetes?" d) "What beverages are preferred?"
"Is there a family history of hypertension, heart disease, or diabetes?" Correct Explanation: 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.
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. Which of the following is an appropriate response? a) "You are doing well in school. Be happy with this success." b) "Remember the methods you have been taught to manage peer pressure." c) "It is common for girls your age to worry about being different." d) "It is normal for there to be differences in the time and rate girls your age develop."
"It is normal for there to be differences in the time and rate girls your age develop." Correct Explanation: Letting the girl know that differences are normal and that development occurs at different times and rates among girls her age is reassuring. Focusing on strengths is positive but talks around the child's concern. Telling her she has a common worry minimizes her complaint and provides no information. Concern about breast development does not equate to peer pressure.
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? a) "My son doesn't even know when he's tired." b) "My child sleeps between 11 and 12 hours a night." c) "My teenage child doesn't sleep as much as my 9-year-old does." d) "She stays up late when she takes a nap after school."
"My child sleeps between 11 and 12 hours a night." Correct Explanation: The school-age child needs 10 to 12 hours of sleep each night. Staying up late after taking an after-school nap, not knowing when the child is tired, and sleeping more than a teenager when compared with a school-age child refer to sleep behaviors and needs of children of younger and older ages.
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? a) "My daughter likes many different kinds of fruits and vegetables." b) "My daughter eats one item at a time." c) "My daughter must stay at the table until she has cleaned her plate." d) "My daughter likes to have a glass of milk with her meal."
"My daughter must stay at the table until she has cleaned her plate." Correct Explanation: School-aged children understand the concept of satiety, of feeling full, and should not ignore this feeling by cleaning their plate. The nurse must encourage the mother not to force a child to eat as this may also lead to obesity. The other responses are appropriate and indicate an understanding of good nutrition and eating habits
The nurse is caring for a 6-year-old boy. During the course of a routine wellness examination, the mother proudly reports that the child eats whatever the mother puts on his plate. The nurse wants to emphasize the importance of allowing the child to make some of his own choices regarding the types of foods he eats. How should the nurse communicate this to the mother? a) "You need to make sure he has input regarding his food." b) "You must let him make some choices for himself." c) "Now is the time to let him choose some of his meals." d) "I want you to give him choices about the food he eats."
"Now is the time to let him choose some of his meals." Correct Explanation: With parents as well as children, it is more effective and less a matter of personal opinion to say "now is the time" rather than "you need," "I want you to," or "you must" do something. The nurse can emphasize the importance of the child participating in meal selection while encouraging the child's independence in a gentle manner.
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? a) "Play helps children to develop cognitively, socially, physically, and emotionally." b) "Wow, that is a lot of stuff for a girl your age." c) "All of these other activities teach you as much as traditional play." d) "It is understandable, not playing any more with all these other activities."
"Play helps children to develop cognitively, socially, physically, and emotionally." Correct Explanation: 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 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? a) "Wait to tell her about the visit until just before the appointment." b) "Remind her in simple terms what will happen in the dentist's office." c) "Tell your daughter that it is just like going to see the pediatrician." d) "Remind your daughter of the importance of proper oral hygiene."
"Remind her in simple terms what will happen in the dentist's office." Correct Explanation: Due to the girl's temperament, it is best if the parent's talk to the dentist before the first visit to find out exactly what the dentist will be doing and then describe to the child in simple terms what will occur. Reminding the child about the importance of proper oral hygiene is unhelpful. Telling the child that the dental checkup is just like going to see the pediatrician is untrue. It is inappropriate to advise the parents to not prepare the girl in advance.
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? a) "The school-age child should have a routine physical exam every six months." b) "The school-age child needs 10 to 12 hours of sleep per night." c) "The school-age child should be screened for scoliosis once a year." d) "The school-age child should brush their teeth at bedtime."
"The school-age child needs 10 to 12 hours of sleep per night." Correct Explanation: The school-age 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 mother of a 6-year-old girl calls the nurse because her daughter has developed a fear of loud alarms and sirens, and she was recently frightened by her school's fire drill. The mother asks for guidance. How should the nurse respond? a) "Explain to your daughter that fire alarms are for our protection." b) "Read your daughter a book about firemen and then visit the fire station." c) "Try desensitization with an alarm clock or stove buzzer." d) "You should probably ignore this and not make a big deal about it."
"Try desensitization with an alarm clock or stove buzzer." Correct Explanation: Desensitization is a technique in which a fear is conquered by approaching it little by little. The girl's fear of alarms and sirens can be addressed by hearing non-threatening, softer-sounding alarms and buzzers that she can control in her own home. The mother can then read to her about firemen and possibly take her to the fire station. Telling the mother to ignore the fear or simply advising her to tell her daughter that alarms protect us is not helpful.
The nurse is conducting a required wellness examination for a 5-year-old girl who is starting kindergarten in a few months. Her mother confides that she thinks her daughter, who is the baby of the family, is not quite ready for kindergarten. How should the nurse respond? a) "Do you think that maybe you are not ready to let her go?" b) "What worries you the most about her readiness?" c) "Let's conduct a Denver Developmental exam to see if she is ready." d) "She has older siblings. She will be just fine."
"What worries you the most about her readiness?" Correct Explanation: It would be best to get more information before giving advice. The nurse should first ask what worries the mother. This open-ended question is likely to provide additional information to help the nurse determine the mother's concerns. Assuring her that the girl will be fine dismisses the mother's concerns. The nurse should gather more information before recommending a Denver II. Asking if the mother is not ready to let the girl go is presumptuous.
The nurse is conducting a routine well-child evaluation for a family with five children. The mother seems frazzled, and the two oldest boys are engrossed in their hand-held video games. The other three children—all preschoolers—are gathered around a portable DVD player watching a movie while they wait for their appointment. The nurse suspects that the children spend a great deal of time in front of electronic screens and that her values greatly differ from this family's. How should the nurse approach the issue of television exposure during this evaluation? a) "Would you like a pamphlet telling how TV watching affects children's health?" b) "It appears as if your children are watching too much TV. What do you think?" c) "One to two hours of television or video games a day should be the limit for children." d) "Children who watch a great deal of television are more likely to become obese."
"Would you like a pamphlet telling how TV watching affects children's health?" Correct Explanation: It can be difficult to initiate a conversation when the nurse perceives that her values are different from those of the client. Approach the subject in a factual and nonjudgmental way. This gives the parent the opportunity to invite further discussion on the subject. Telling the mother that the children appear to be watching too much TV could cause her to be defensive. The other responses are true, but the nurse will likely have more success if she lets the mother initiate further discussion.
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? a) "We should ask the physician to run some tests; with that much sleep, the child should not be tired." b) "Your child should be getting at least 9 hours of sleep per night." c) "Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." d) "Your child should be getting 8 to 9 hours of sleep per night."
"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." Correct Explanation: The 6 year old needs 12 hours of sleep and should be provided with a quiet time after school to recharge after a busy day in the classroom.
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) A paint-by-numbers activity b) A jack-in-the box c) A mobile d) A board game such as monopoly
A paint-by-numbers activity Correct 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.
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? a) 10:00 p.m. b) 9:30 p.m. c) 8:00 p.m. d) 7:30 p.m.
9:30 p.m. Explanation: Exercise and sufficient rest are important for school-age children. Parents and caregivers need to help children balance their rest needs and their extracurricular activities. An 11-year-old child needs 9 to 10 hours of sleep per night.
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) A sense of mistrust b) A sense of doubt c) A sense of shame d) A feeling of inferiority
A feeling of inferiority Correct 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 nurse at an elementary school is explaining the concept of industry versus inferiority to a group of nursing students. Which of the following is part of this stage of Erikson's theory? a) The principle of conservation b) A sense of competence, mastery, and worth c) The conventional stage of development d) Lack of the ability to think abstractly
A sense of competence, mastery, and worth Correct Explanation: 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 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 a) Offer to help the child wash her private parts when bathing b) Avoid prolonged discussions about the patient's anxiety c) Answer questions the child asks regarding pain d) Encourage family caregivers to frequently sing songs the child enjoys
Answer questions the child asks regarding pain Correct Explanation: School-age children need privacy more than younger children do and may not want to have physical contact with adults; this wish should be respected. These attitudes should be recognized and handled in a way that ensures as much privacy as possible. Children's questions, including those about pain, should be answered truthfully. An opportunity to verbalize anxieties will help a child deal with them. Family caregivers may feel guilty about the child's need for hospitalization and, as a result, may overindulge the child. The child may regress in response to this, but this regression should not be encouraged.
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? a) Determine if there have been other playground bullying incidents. b) Immediately call the bullied child's parents. c) Question those responsible for the bullying. d) Assess the situation with the help of the school staff and parents.
Assess the situation with the help of the school staff and parents. Correct Explanation: Assessing the situation and following the school's bullying protocol will be an important first step. Immediately calling the bullied child's parents may be premature. Questioning those responsible for the bullying and determining if there have been other playground incidents of bullying may be part of the overall assessment, but would not be the first action taken.
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? a) Decentration b) Classification c) Preoperational thinking d) Egocentric thinking
Classification Correct 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 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 of the following nursing diagnoses would be most appropriate? a) Compromised parental coping related to inability to enforce school attendance b) Disturbed thought processes related to difficulty in school adjustment c) Ineffective tissue perfusion, cerebral, related to anxiety over attending school d) Noncompliance with expected school behavior related to school phobia
Compromised parental coping related to inability to enforce school attendance Correct Explanation: School phobia may be a problem of both parent and child.
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. This child has developed an understanding of which of the following? a) Decentration b) Reversibility c) Classification d) Conservation
Conservation Correct Explanation: The skill of conservation is the ability to recognize that a change in shape does not necessarily mean a change in amount or mass.
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? a) Accommodation b) Decentering c) Conservation d) Class inclusion
Decentering Correct Explanation: Decentering is 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, which is what the girl in this scenario demonstrates in her ability to consider the injection from the nurse's point of view instead of just her own. 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. Class inclusion is the ability to understand that objects can belong to more than one classification.
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? a) Inability to speak in full sentences b) Difficulty understanding the concept of "half past" in reference to time c) Ability to carry on an adult conversation d) Fascination with bathroom language
Difficulty understanding the concept of "half past" in reference to time Correct Explanation: Most 7-year-olds can tell the time in hours, but they may have trouble with concepts such as "half past" and "quarter to," especially with the prevalence of digital clocks. Six-year-olds talk in full sentences, using language easily and with meaning. As children discover "dirty" jokes at about age 9, they like to tell them to friends or try to understand those told by adults. They use swear words to express anger or just to show other children they are growing up. They may have a short period of intense fascination with "bathroom language," as they did during preschool years. By 12 years of age, children can carry on an adult conversation, although stories are limited because of lack of experience.
During an annual visit of a 6-year-old boy, the nurse observes dental caries on two of the child's primary teeth. What should be the nurse's first response? a) Educate the parents about the importance of the primary teeth. b) Refer the child to a pediatric dentist. c) Suggest use of a fluoride supplement. d) Encourage parents to supervise the child's tooth brushing.
Educate the parents about the importance of the primary teeth. Correct Explanation: Parents need to understand the value of the primary teeth and not see them only as temporary and soon-to-be replaced. Referral to a pediatric dentist and parental supervision of tooth brushing both lead to dental health and may be better appreciated once parents understand the importance of the primary teeth. Fluoride supplementation is not necessary if fluoride is part of the local water supply
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 a) Encourage Ted to abstain from eating sugary snacks at school b) Have Ted's teeth professionally cleaned every three months c) Ensure that Ted brushes his teeth after each meal and snacks d) Accept Ted is genetically predisposed to having more cavities than most children
Ensure that Ted brushes his teeth after each meal and snacks Correct Explanation: 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-age child should visit the dentist at least twice a year for a cleaning and application of fluoride.
Children can become physically addicted to glue. a) True b) False
False Correct Explanation: Children do not become physically addicted to glue but do become psychologically dependent on it.
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? a) Build a doghouse. b) Form vases from blocks of clay. c) Stack blocks in a tower. d) Build a sandcastle with a water-filled moat.
Form vases from blocks of clay. Correct Explanation: Children can generally add and subtract by the time they are 6. At about age 7, the child enters the concrete operational stage (as identified by Piaget). The skills of conservation (the ability to recognize that a change in shape does not necessarily mean a change in amount or mass) are significant in this stage. This begins with the conservation of numbers, when the child understands that the number of cookies does not change even though they may be rearranged, along with the conservation of mass, when the child can see that an amount of cookie dough is the same whether in ball form or flattened for baking. This is followed by conservation of weight, in which the child recognizes that a pound is a pound, regardless of whether plastic or bricks are weighed. Conservation of volume (for instance, understanding that a cup of water is the same amount regardless of the shape of the container) does not come until late in the concrete operational stage at 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, which is what? a) Perfectionism b) Accommodation c) Industry d) Conservation
Industry Correct Explanation: 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.
A nurse overhears a 7 year old calling her hospital roommate a vulgar name. What is the best action by the nurse? a) Inform the child that she will not be able to stay in the hospital if she is going to use that type of language. b) Inform the child that talking to the roommate using that language is not acceptable behavior. c) Inform the child that the nurse is going to call the parents and tell them what was said. d) Inform the child that if she does not behave, she will get a shot.
Inform the child that talking to the roommate using that language is not acceptable behavior. Correct Explanation: Judgment about acceptable and unacceptable behavior is not well developed in children of this age and can possibly result in name-calling and the use of vulgar words.
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? a) Hold the child back a year and let him try again next year b) Have the child attend a different school c) Homeschool the child d) Insist that the child return to school
Insist that the child return to school Correct Explanation: Because the problem of school refusal is usually only partly the child's, the entire family generally requires counseling to resolve the issue. As a rule, once it has been established the child is free of any illness and the resistance stems from separation anxiety or phobia, the child should be made to attend school. Reinforcement by parents to go to school this way helps to prevent problems such as school failure, peer ridicule, or a pattern of avoiding difficulties. Because the child has only attended one day of class, it is far too soon to recommend that the child be held back a year, moved to another school, or homeschooled. In any case, these may not be options for the family, anyway.
A father shares with a nurse that his 12-year-old son has begun ejaculating in his sleep and is deeply embarrassed about it. The father says he has tried to explain to his son that this is a normal occurrence in puberty, but the son is still humiliated by it. The nurse recognizes this occurrence as which of the following? a) Gynecomastia b) Premature ejaculation c) Nocturnal emissions d) Dysmenorrhea
Nocturnal emissions Correct Explanation: As increased seminal fluid begins to be produced, boys begin to notice ejaculation during sleep, termed nocturnal emissions. Premature ejaculation is ejaculation before vaginal penetration or before female orgasm during coitus. Hypertrophy of breast tissue (gynecomastia) can occur in prepuberty in boys, most often in those who are stocky or obese. Dysmenorrhea is painful menstruation.
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? a) Normal growth of lymphatic tissue for this age b) Tonsillitis c) A pituitary disorder d) An allergic reaction
Normal growth of lymphatic tissue for this age Explanation: The immunoglobulins IgG and IgA each reach adult levels during the school-age period; lymphatic tissue continues to grow in size until about age 9. The resulting abundance of tonsillar and adenoid tissue in early school children is often mistaken for disease as the tonsils seem to fill the entire back of the throat. The fact that there are no other symptoms indicates that this child's enlarged tonsils are simply a result of the normal growth of lymphatic tissue for this age.
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? a) Participating in a craft project b) Playing with blocks c) Playing with a jack-in-the-box d) Writing letters to friends
Participating in a craft project Correct Explanation: During this stage, the child is interested in engaging in meaningful projects and seeing them through to completion.
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? a) Caries b) Malocclusion c) Broken fluency d) Poor articulation
Poor articulation Correct Explanation: The common speech problem of the preschool years is broken fluency; the most common problem of a school-age child is articulation. The child has difficulty pronouncing s, z, th, l, r, and w or substitutes w for r ("westroom" instead of "restroom") or r for l ("radies' room" instead of "ladies' room"). Malocclusion (a deviation tooth position from the normal) may be congenital due to conditions such as cleft palate, a small lower jaw, or familial traits tending toward malocclusion. Caries (cavities) are progressive, destructive lesions or decalcification of the tooth enamel and dentin.
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? a) Lighting candles in case there is a power failure b) Wearing the house key prominently around her neck c) Telling people at school she is by herself for added safety d) Preparing a no-cook snack for herself
Preparing a no-cook snack for herself Correct Explanation: Latchkey children need to learn to be independent but to respect fire-safety rules.
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 a) Remind Edgar at each meal that he must not eat too much food. b) Feed Edgar a very low-fat and no-carbohydrate diet. c) Provide activities for Edgar that will increase his physical activity. d) Avoid talking to Edgar about his weight.
Provide activities for Edgar that will increase his physical activity. Correct Explanation: Encouraging physical activity and limiting dietary fat intake to 35 percent of total calories will help control the child's weight. Popular fad diets must be avoided because they do not supply adequate nutrients for the growing child. Caregivers must avoid nagging and creating feelings of inferiority or guilt because the child may simply rebel. The child who is pressured too much to lose weight may become a food sneak, setting up patterns that will be harmful later in life.
The nurse is observing a group of 8-year-olds who are being taught the concept of conservation of numbers. Which of the following activities would best help these children understand this concept? a) Stacking blocks in a tower and counting how many can be stacked without falling. b) Measuring the weight of a handful of popcorn and then the weight of a handful of pennies. c) Rearranging a group of coins first into a circle, then a triangle and then a square. d) Forming vases from blocks of clay that are of various weights.
Rearranging a group of coins first into a circle, then a triangle and then a square. Correct Explanation: In understanding the concept of conservation of numbers, the child understands that the number of objects does not change even though they may be rearranged. Stacking the blocks in a tower and counting them, forming vases out of clay, and measuring the weight of handfuls of different objects does not illustrate conservation of numbers.
The school nurse is performing a vision screening for a 7-year-old child. Which finding should trigger a referral? a) Visual acuity of 20/20 in both eyes b) Ability to color discriminate c) Slight misalignment of the eyes d) Peripheral vision similar to that of the school nurse
Slight misalignment of the eyes Correct Explanation: Misalignment of the eyes (strabismus) interferes with vision and eye development. Amblyopia (vision loss) can result. Lack of alignment of the eyes needs referral and treatment. The rest represent normal visual findings in a 7-year-old.
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 a) Monitoring the children for signs of scoliosis b) Teaching a class on sex education c) Testing the children's vision and hearing d) Giving tetanus-diphtheria booster shots
Testing the children's vision and hearing Correct 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. During a physical examination at about the age of 10 to 11 years, the child is initially examined for signs of scoliosis (lateral curvature of the spine). Sex education is often limited to one classroom session, usually in the fifth grade, in which children are shown films about menstruation and their developing bodies.
Parents of an 11-year-old boy are bewildered that their son was caught stealing. Which of the following reasons for this behavior would the nurse suggest? a) The child had a strong desire to own the item. b) This is one way for the child to increase his self-esteem. c) The child was attempting to escape punishment. d) The child has not attained the ability to understand ownership and property rights.
The child had a strong desire to own the item. Correct Explanation: The nurse would point out that the desire to own the item may have overcome his 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 his peers. The lack of understanding of ownership and property rights are typical of children between 6 and 8 years.
In working with the school-age child, the nurse recognizes which of the following as a characteristic of the school-age child? a) The child takes in new information at a rapid rate and asks "why" and "how." b) The child has an increased attention span and can be interested in an activity for a long length of time. c) The child insists they can do things one minute and then becomes dependent the next. d) The child grows and develops skills more rapidly than he or she ever will again.
The child has an increased attention span and can be interested in an activity for a long length of time. Explanation: The school-age child has a longer attention span and can become absorbed in a craft of activity for several hours. The preschool-age child soaks in information and asks "why" and "how" over and over. The toddler insists they can do things one minute and then becomes dependent the next minute. The infant grows and develops skills more rapidly than he or she ever will again.
Which of the following best describes Erikson's psychosocial development task for the school-age child? a) The child wants to successfully complete activities. b) The child understands and responds to discipline. c) The child is developing his or her own personal identity. d) The child is learning to do things on its own.
The child wants to successfully complete activities. Correct Explanation: The developmental task for the school-age child is to develop a sense of industry and completing activities builds that feeling of confidence. The adolescent is developing his or her own personality. Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) and do things on their own. Learning to speak and to understand and respond to discipline are not developmental tasks according to Erikson.
A nurse will talk with two 10-year-old fraternal twin boys who are concerned about their physical differences. What concept should guide the nurse initially? a) Twins are usually very much alike in their height and weight. b) Physical maturity is not necessarily linked with emotional maturity. c) Variations in height and weight are common during middle childhood. d) There are many differences between fraternal twins including growth rates.
There are many differences between fraternal twins including growth rates. Explanation: The boys first need to understand the differences between fraternal and identical twins. Then, the variation in growth rates typical during middle childhood can be addressed. Using the generic term "twins" does not recognize the differences between fraternal and identical twins, and with these fraternal twins, incorrect information is being provided. It is true that physical maturity in not necessarily linked with emotional maturity, but this is not presently the concern.
Conformity is vital to school-age children. a) False b) True
True Correct Explanation: Parents who enjoyed fostering imagination in a preschooler may feel frustrated when a school-age child chooses to conform to rules and insists on the "right way" to do things. They may feel they have failed to encourage the child's creativity, but conformity is vital to children at this age. It is how they learn more about their world's rules.
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? a) Irregular periods b) Supernumerary nipple c) Vulvar irritation d) Breasts of slightly different sizes
Vulvar irritation Correct Explanation: Any secretions that cause vulvar irritation should be evaluated by a health care provider, because this does suggest infection. Most girls have some menstrual irregularity during the first year or two after menarche (the start of menstruation). Breast development is not always symmetrical, so it is not unusual for a girl to have breasts of slightly different sizes. After the condition has been checked during a physical examination to assure that no tumors are present to make one breast larger or that the other is diseased in some way to make it smaller, she can be reassured this development is normal. Supernumerary (additional) nipples may darken or increase in size at puberty. Be sure girls understand a supernumerary nipple is affected by the hormones in her body in the same way as other breast tissue, so she isn't frightened by the accessory nipple enlarging with puberty or in a future pregnancy.
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 a) encourage the child to drink more milk for stronger nails. b) allow some time every day for the child to talk about new experiences. c) distract the child by teaching him a new skill, such as whistling. d) allow the child to choose a reward for not biting his nails.
allow some time every day for the child to talk about new experiences. Correct Explanation: Beginning school can be a time of extreme stress for children. Allowing them time to discuss these experiences allows them to put experiences in perspective and begin to deal with them.
When caring for hospitalized school-aged children, it is important to a) correct mistakes with harsh penalties. b) consistently reinforce their worth. c) structure a competitive environment for them. d) discourage their participation in care.
consistently reinforce their worth. Correct Explanation: Helping children experience satisfaction in projects they complete helps them gain a sense of industry.
A school-aged child develops school phobia. When counseling her mother, you would advise her that the accepted therapy for this is to a) keep her child home until this fear passes. b) make her child attend school every day. c) ask the teacher to decide if the child should come to school or not each day. d) allow her child to decide daily if she wants to go to school or not.
make her child attend school every day. Correct Explanation: School phobia may result from both a parent not wanting a child to attend school and a child not wanting to leave a parent. Helping them work together while keeping the child in school to resolve the issue is helpful.
The developmental task of the school-aged period, according to Erikson, is gaining a sense of a) identity versus failure. b) autonomy versus shame. c) independence versus dependence. d) industry versus inferiority.
industry versus inferiority. Correct Explanation: Industry is learning how to do things well, the school-aged developmental task.
The Boy Scouts is an organization that continues to be a favorite with school-aged boys because a) hiking is a favorite school-aged activity. b) merit badges require completing small tasks for rewards. c) no girls are included in the organization. d) fathers participate in Boy Scouts.
merit badges require completing small tasks for rewards. Correct Explanation: An organization that allows school-aged children to complete small tasks and receive rewards helps develop a sense of industry.
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 a) throw out the sugar; the child will develop cavities if he eats it. b) advise the child's mother to have him tested for diabetes. c) put them back in the drawer as they were. d) ask the child's mother if he has a history of craving sweets.
put them back in the drawer as they were. Correct Explanation: At 10 years, children often enter a "collecting" stage, making whatever object they are collecting precious and important to them.
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 a) suggest a resident examine him for breathing difficulty. b) take the child's temperature; this must be tonsillitis. c) record this as a normal early school-aged finding. d) give the child something for pain.
record this as a normal early school-aged finding. Explanation: Lymphoid tissue reaches maximum growth in early school-aged children.
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 a) she should talk to the child's teacher about putting less pressure on him. b) she should buy his brother a bank that cannot be opened. c) she may need to remind him of property rights. d) stealing is unusual for a 7-year-old.
she may need to remind him of property rights. Correct Explanation: As children begin to be aware of the importance of money, they may fail to realize that property rights regarding money need to be respected.
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 of the following would the nurse share with the parents? Select all that apply. a) Explain that children this age typically lie to avoid punishment. b) Recommend the use of immediate and firm punishment. c) Suggest reading a story with the child about the consequences of lying. d) Indicate that the child is probably lying to impress his friends.
• Explain that children this age typically lie to avoid punishment. • Suggest reading a story with the child about the consequences of lying. Correct Explanation: Parents need to know that lying is common at this age and that it is usually done to avoid punishment. Reading the story would address the unacceptable behavior and reinforce the value of reading. Immediate and firm punishment precludes a calm, measured approach to the issue and may damage self-worth. An older child between 8 and 12 years is more likely to lie to impress friends.
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.) a) Limiting time spent in physical inactivity b) Adherence to a high-protein diet c) Preparation of a special meal just for the child d) Intake of about 1,200 calories a day e) Participation in a formal weight-control organization f) Participation in formal exercise classes
• Limiting time spent in physical inactivity • Intake of about 1,200 calories a day • Participation in a formal weight-control organization • Participation in formal exercise classes Correct Explanation: The type of weight-reduction program that will probably work best is one that emphasizes long-term lifestyle changes. Such a program should include intake of about 1,200 calories a day (no more than 30% as fat), with lifestyle changes such as a structured family meal, eliminating eating or snacking in front of the television, decreased portion sizes, and elimination of sugar-rich drinks. It should also include an active exercise program, including monitoring and limiting time spent in physical inactivity (watching television, playing computer and video games, surfing the Internet, or texting). Overweight school-age children often do well if a dieters' club is formed; they are not too young to participate in formal weight-control organizations. As a way of increasing daily activity, preadolescents do well with formal exercise classes because, again, they enjoy the support from other children. Rather than preparing special meals for just the obese child, the entire family probably needs to eat in a healthier manner. Caution children not to try faddish high-protein diets (as most adults should not), because such diets do not supply enough carbohydrates and may produce a heavy renal solute load (the breakdown product of proteins) to the kidneys.
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. a) Use video games that are more active to offset sedentary TV viewing. b) Limit TV time by using it as a reward. c) Watch programs together and discuss subject matter with the child. d) The American Academy of Pediatrics recommends 2 hours or less of TV daily. e) Establish guidelines on when a child can watch TV.
• 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. Explanation: The American Academy of Pediatrics recommendation is correct. The parents should establish guidelines on when the child can watch TV, such as after chores are completed. Using TV as a reward elevates its importance and may not decrease viewing time. Certain TV programs and video games have merit, yet both represent screen time with little activity difference between the two. The parents should watch TV with the child and use the opportunity to discuss the subject matter with the child.