CH 28
The mother of a 7-year-old girl is asking the nurse's advice about getting her daughter a 2-wheel bike. Which response by the nurse is most important? 1. "Teach her where she'll land on the grass if she falls." 2. "Be sure to get the proper size bike." 3. "She won't need a helmet if she has training wheels." 4. "Learning to ride the bike will improve her coordination."
2. "Be sure to get the proper size bike." Rational: It is very important to get a bike of the proper size for the child. Getting a bike that the child can "grow into" is dangerous. Training wheels and grass to fall on are not acceptable substitutes for the proper protective gear. The child should already demonstrate good coordination in other playing skills before attempting to ride a bike.
The school nurse is speaking with a group of teachers about bullying. Which statement by a teacher would indicate a need for further education by the nurse? 1. "Boys bully more often but girls are more likely to be bullied." 2. "Being bullied can have negative effects throughout a child's life." 3. "Children who are bullied can have physical and psychological symptoms from being bullied." 4. "Boys are twice as likely to be bullies and to be victims of bullying."
1. "Boys bully more often but girls are more likely to be bullied." Rational: Both boys and girls are bullied and can bully others; however, boys are twice as likely to be bullies and victims of bullying. Being bullied can have negative results on children throughout life. These children often have increased episodes of headaches, stomachaches, sleep problems, anxiety, loneliness, depression, and suicidal tendencies.
The nurse is caring for a 6-year-old child. During the course of a routine wellness examination, the parent proudly reports that the child eats whatever the parents puts on the plate. The nurse wants to emphasize the importance of allowing the child to make some choices regarding the types of foods eaten. How should the nurse communicate this to the parent? 1. "Now is the time to let your child choose some of the meals." 2. "You must let your child make some choices for oneself." 3. "You need to make sure your child has input regarding the food eaten." 4. "I want you to give your child choices about the food eaten."
1. "Now is the time to let your child choose some of the meals." Rational: Diet preferences are established in the preschool years and continue to develop as the child ages. The diet is influenced by family, peers, and media. Because of these influences and the child striving for interpendence it is important to involve the child in helping select the food choices and guiding the child to healthy food choices. 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.
A nursing student is presenting information to the class about abuse of children. The nursing instructor should intervene when the student presents which information? Select all that apply. 1. Child abuse and intimate partner violence are not the same thing. 2. The majority of child abuse victims suffer from neglect. 3. The concepts of "good touch" versus "bad touch" should be taught around the age of 10 years. 4. The nurse should speak with the family first if child abuse is suspected. 5. The lowest percentage of child abuse is due to emotional abuse.
1. Child abuse and intimate partner violence are not the same thing. 3. The concepts of "good touch" versus "bad touch" should be taught around the age of 10 years. 4. The nurse should speak with the family first if child abuse is suspected. Rational: Child abuse includes physical and emotional abuse as well as intimate partner violence. Parents should teach children the concept of "good touch" versus "bad touch" prior to school-age years. If school-age child's behavior yields suspicion of physical or intimate partner violencer, the nurse should report to the appropriate authorities in his or her state.
While observing a group of 9-year-old children at school, the nurse is concerned that one of the children is not cognitively developing according the Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned? 1. Does not understand the phrase "slow as molasses" when used by the teacher 2. Arrives to class late from recess and apologizes to the teacher 3. Believed that not turning in homework on time was acceptable, but has since decided it is not acceptable 4. Enjoys math instruction and decides to join the math club
1. Does not understand the phrase "slow as molasses" when used by the teacher Rational: Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete-operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about his or her world from different dimensions. Abstract thinking, such as understanding the meaning of the phrase "slow as molasses" is expected at this stage of cognitive development.
The parents of an 11-year-old girl tell the school nurse that their child has a very "slow to warm up" temperament, and that they are concerned with her starting a new school. Which activities should the nurse tell the child's teacher to initially avoid based on this information? Select all that apply. 1. Having the child introduce herself by standing at the front of the class and telling something interesting about herself 2. Assigning the child a role-play scenario to perform with another student in front of the class 3. Encouraging the child to join the drama club, which is practicing for an upcoming play 4. Asking a small group of students prior to her entering the classroom to ask the child to eat lunch with them 5. Talking to the child after class about her interests, hobbies, family, and previous school
1. Having the child introduce herself by standing at the front of the class and telling something interesting about herself 2. Assigning the child a role-play scenario to perform with another student in front of the class 3. Encouraging the child to join the drama club, which is practicing for an upcoming play Rational: The slow-to-warm school-age child may exhibit discomfort when placed in different or new situations such as school. This child may need time to adjust to the new place or situation, and may demonstrate frustration with tears or somatic complaints, so avoiding detailed introduction, role-playing, and drama club this early after starting a new school may make her transition easier. Asking a small group of students to eat lunch with her and talking with her privately demonstrates caring behavior.
On physical examination, the nurse discovers that a 6-year-old child's palatine tonsils are somewhat enlarged in the back of the throat. What would be the nurse's best action? 1. Record this as a normal finding in an early school-age child. 2. Suggest the health care provider examine the child for breathing difficulty. 3. Take the child's temperature; this must be tonsillitis. 4. Give the child something for pain.
1. Record this as a normal finding in an early school-age child. Rational: Lymphoid tissue reaches maximum growth in early school-aged children. The tonsils may decrease in size somewhat from the preschool years but they remain larger than those of adolescents. The tonsils and adenoids may appear larger than normal even in the absence of infection. The nurse would be correct to document this as a normal finding. The child would not need pain medication or to be examined for respiratory problems if this a normal finding.
Parents of an 11-year-old child are bewildered that their child was caught stealing. The nurse best supports the parent by explaining which? 1. The child had a strong desire to have the item with little other way of obtaining it. 2. The child was attempting to escape punishment. 3. This is one way for the child to increase his self-esteem. 4. The child has not attained the ability to understand ownership.
1. The child had a strong desire to have the item with little other way of obtaining it. Rational: The nurse must consider the age of the child and compare with stages in moral development. The nurse would point out that the desire to have an item may have overcome the child's sense of right and wrong. Lying, not stealing, is used to escape punishment. Stealing is not a way to build self-esteem, although it may help the child gain a certain status among peers. The lack of understanding of ownership and property rights are typical of children between 6 and 8 years.
An 8-year-old child is being seen for a well-child visit. His weight 2 years ago was 44 lb (20 kg) and his height was 3 ft, 10 in (116 cm). If he is developing normally, what would be his expected findings for this visit? 1. The child weighs 57 lb (26 kg). 2. The child is 4 feet (122 cm) tall. 3. The child's weight is seven times his birth weight. 4. The child has all of his adult teeth.
1. The child weighs 57 lb (26 kg). Rational: Normal physical growth for school-age children is a gain in weight of 2 to 3 kg per year and gain in height of 5 to 6 cm each year. Thus, a weight of 26 kg is an expected norm. The growth in height is not within normal parameters. A 7-year-old child should weigh seven times his birth weight. Adult teeth do not normally come in until age 10 to 12.
The parents of a 12-year-old boy voice concern to the nurse that their child wants to dress like peers and not the way they prefer. Which responses by the nurse are appropriate? Select all that apply. 1. "Children at this age often want to connect with their peers. You should probably allow him to dress like his friends." 2. "Have you spoken with your son about his concerns and about your concerns? Open dialogue often helps in resolving these issues." 3. "Peer acceptance is an important part of development for children, especially at this age. Maybe talking about it with your son can lead to an agreement." 4. "If the way your son's friends are dressing is not against school dress code, is it worth it to argue about his clothes?" 5. "Peer pressure is hard enough for children of this age without pressure from their parents. You need to seek family counseling immediately."
2. "Have you spoken with your son about his concerns and about your concerns? Open dialogue often helps in resolving these issues." 3. "Peer acceptance is an important part of development for children, especially at this age. Maybe talking about it with your son can lead to an agreement." Rational: It is important for late school-age children to feel accepted by peers. Lifelong effects can occur if they feel different and are teased. Dialogue is always a good way to resolve conflict so suggesting the parents talk and listen to their child is acceptable guidance by the nurse. Telling the parent what to do is not in the nurse's scope of practice. The situation does not warrant immediate counseling.
During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. What is the best specific trigger question to determine the preschooler's linguistic and cognitive progress? 1. "Does your son speak in complete sentences all the time?" 2. "How well does your son communicate or follow instructions?" 3. "Is your son's speech clear enough that anyone can understand it?" 4. "Would you say your son has a vocabulary of about 900 words?"
2. "How well does your son communicate or follow instructions?" Rational: 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 talking with the parents of an 8-year-old boy who has been cheating at school. Which comment should be the nurse's primary message? 1. "Punishment should be severe and long lasting." 2. "Make sure that your behavior around your son is exemplary." 3. "Resolve this by providing an opportunity for him to cheat and then dealing with it." 4. "You may be putting too much pressure on him to succeed."
2. "Make sure that your behavior around your son is exemplary." Rational: Because they are role models for their children, parents must first realize the importance of their own behaviors. It is possible that the parents are pressuring the child, but that is not the primary message. Punishment should be appropriate, consistent, and not too severe.
The nurse is assessing the psychosocial development of a 10-year-old child. What observations would lead the nurse to determine that the child is not achieving the developmental task of Erikson's industry versus inferiority? Select all that apply. 1. The child joins 3 different clubs at school 2. The child tries out for various teams at school but does not make any of them 3. The child is an average soccer player and the parents enforce 1 to 2 hours of practice per day 4. The child enjoys music so the parents offer the child music lessons 5. The child is interested in science and attends a science camp every year
2. The child tries out for various teams at school but does not make any of them 3. The child is an average soccer player and the parents enforce 1 to 2 hours of practice per day Rational: During the task of industry versus inferiority, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community. It is important to nurture and encourage the child in areas the child enjoys in order to increase self-worth and self-esteem. Setting expectations too high can cause the child to feel inferior and incompetent.
The school nurse is preparing to conduct routine health screenings of the elementary school students. Which screening will the nurse prioritize for students ages 6 to 8? 1. Signs of scoliosis 2. Vision and hearing 3. Review immunization records 4. Nutritional needs
2. Vision and hearing Rational: Vision and hearing screening are often conducted by the school nurse, who then alerts the caregivers if there is a need for further evaluation from the primary care provider. Most states have immunization requirements that must be met when the child enters school. Signs of scoliosis are usually evaluated at about the age of 10 to 11 years. There are no specific tests which the school nurse would use to evaluate nutrition; however, the nurse would be monitoring all students who come to the nurse's office for potential nutritional situations as deemed appropriate.
The family who are vegetarian voice concern that their child is not growing well. The nurse should suggest which food to increase the calcium intake for adequate bone growth? 1. oatmeal 2. kale 3. quinoa 4. sweet potato
2. kale Rational: The consumption of adequate protein and calcium is important for muscle, bone, and dental development. Foods highest in calcium are green leafy vegetables, enriched breads, and cereals. Soybeans, legumes, grains, and immature seeds are high in protein. Oatmeal and quinoa are both high in protein. Sweet potatoes are high in fiber, vitamin A, and potassium.
A parent calls the health care provider about the 7-year-old child's dental hygiene. The child has had three cavities. The parent does not know what to do and asks the nurse for guidance. How should the nurse respond? 1. "Did you teach your child how to brush the teeth?" 2. "What type of toothbrush does your child use?" 3. "Are you able to supervise your child's brushing?" 4. "Is there fluoride toothpaste available for use?"
3. "Are you able to supervise your child's brushing?" Rational: Dental caries is the leading chronic disease in the United States. Children need help with toothbrushing until they are between 7 and 10 years of age. The parent should monitor the toothbrushing to make sure it is thorough, observe for any abnormal tooth alignment and schedule cleanings every 6 months. 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 teeth are brushed carefully.
An 11-year-old boy continually is late for the bus, resulting in asking if it's okay to stay home that day from school. The parents ask the school nurse for advice on what they should do. What is the best response by the nurse? 1. "I am sure he has school phobia. We will need to speak with the school counselor." 2. "Is there anything happening at home that is making him want to stay there instead of school?" 3. "Could both of you and your son come in for a conference so we can discuss this situation?" 4. "It is best if you make him get on the bus whether he is ready or not in order to let him know you are in control."
3. "Could both of you and your son come in for a conference so we can discuss this situation?" Rational: While the child is demonstrating a sign of school phobia, it is not possible to determine this without talking with the child and the parents. Forcing him to get on the bus does not address the situation.
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? 1. "He won't eat any kind of meat except for hot dogs." 2. "My son mixes all of his food together when he eats it." 3. "I make him eat some of everything I put on his plate." 4. "All he wants to eat is peanut butter sandwiches."
3. "I make him eat some of everything I put on his plate." Rational: Children will usually accept new foods if they aren't forced upon them. 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 parents of a 10-year-old boy report they are having problems with their son. The child's mother reports her son is not a talented athlete but her husband continues to encourage him to play and try to excel. The child's father reports sports will help his son build character. What response by the nurse is most appropriate? 1. "Encouraging involvement in sports can build valuable skills for a child." 2. "Although your son is not a talented athlete, continue to encourage him to try." 3. "Perhaps another pursuit would be better suited for your son." 4. "It is important not to let him quit without trying."
3. "Perhaps another pursuit would be better suited for your son." Rational: Children should be encouraged to try new things but, when they are faced with things they are not good at, the pressures can ultimately be counterproductive if they feel they are disappointing their parents or others of importance to them.
The nurse is monitoring a playgroup of children on the pediatric unti. The nurse predicts the school-age child will most likely be participating in which activity? 1. Pretending to be mommies and daddies in the playhouse 2. Playing with the plastic vacuum cleaner, pushing it around the room 3. Painting pictures in the art corner of the room 4. Watching a movie with other children their age
3. Painting pictures in the art corner of the room Rational: The school-aged child enjoys group activities and making things, such as drawings, paintings, and craft projects. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. Playtime for the toddler involves imitation of the people around them, such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. The adolescent enjoys activities they can participate in with their peers.
An 11-year-old child is preparing to see the dentist to have his teeth cleaned. Which finding would considered most appropriate for this age? 1. The child has 4 primary teeth and 24 permanent teeth. 2. The child has 32 permanent teeth. 3. The child has 28 permanent teeth. 4. The child has 2 primary teeth and 26 permanent teeth.
3. The child has 28 permanent teeth.
The school nurse is planning a class on menstruation for school-age girls. In order for the teaching to be most effective, which grade level would be best for the nurse to plan this class? 1. third grade 2. fourth grade 3. fifth grade 4. sixth grade
3. fifth grade Rational: The timing of puberty varies widely, between 8 and 14 years of age. The length of time it takes to pass through puberty until sexual maturity is complete also varies. Sexual maturation in girls usually occurs between the ages of 12 and 18. Puberty is occurring increasingly earlier. Approximately ½ of 11-year-olds are menstruating. This means any education for these physical changes needs to be taught prior to this age. Typically, third graders are 8- to 9-year-olds, fourth graders are 9- to 10-year-olds, fifth graders are 10- to 11-year-olds, and sixth graders are 11- to 12-year-olds. The class should occur closest to the time the girls would begin menstruation.
A 9-year-old child is feeling conflict from seeing other children in her class engaging in behaviors she senses are not appropriate. When making decisions about what actions are most appropriate, a child of this age will rely most heavily on which party of influence? 1. Characters in media such as television 2. Peers at school 3. The teacher 4. Parents
4. Parents Rational: All the above have an influence on the actions of the school-age child. The parents have the highest degree of influence on their ultimate actions.
