preschool and schoolaged

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If the child is gaining weight at an expected rate, a child who weighs 36 lbs. at 3 years of age would weigh which of the following at age 5? a) 44 lbs. b) 58 lbs. c) 38 lbs. d) 50 lbs.

44 lbs. Correct Explanation: The preschool age child gains about 3 to 5 lbs. each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm).

If the child is gaining weight at an expected rate, a child who weighs 36 pounds (16.3 kg) at 3 years of age would weigh what amount at age 5?

44 lbs. (20 kg) The preschool age child gains about 4 to 5 lbs. each year (1.8 to 2.3 kg) and grows about 2.5 to 3 inches (6.3 cm). page 127

A nurse is obtaining a weight on a 7-year-old who weighed 8 pounds at birth. How much does the nurse anticipate that he should weigh now?

56 pounds By age 7, the child weighs about 7 times as much as birth.

A mother comes to the clinic with her 3 year old and tells the nurse that she is worried because the child does not talk much. Upon talking to the child, the nurse learns that the patient has a normal vocabulary for age. The nurse is aware that language for a 3 year old consists of approximately at least how many words?

900 words

The nurse realizes that the 5-year-old's growth chart and BMI indicate the child is at risk for obesity. What other findings reinforce this risk? Select all that apply.

A father who is overweight Food used as reward or punishment Television on during meals Expectations to eat everything on plate Overweight parents, food used as reward or punishment, TV viewing during meals, and the "clean plate club" all are factors that contribute to weight gain. The frequency the family eats fast food is not excessive. Regular, structured meals result in less snacking and more nutritious meals. Family eating together is bonding. Page 141

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 sense of shame A sense of doubt A sense of mistrust A feeling of inferiority

A feeling of inferiority

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

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

A paint-by-numbers activity 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.

A nurse is caring for a hospitalized 7-year-old child whose family members have been unable to visit for 2 days. The nurse is preparing a diversional activity for the child. Which activity would best be suited for a child in this age group? A paint-by-numbers activity creating a picture A board game such as monopoly A card game such as solitaire An activity focusing on learning fractions

A paint-by-numbers activity creating a picture

A paint-by-numbers activity creating a picture 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 child would need additional instruction to learn fractions, which may not be considered fun. A card game such as solitaire and a board game of monopoly may be too hard for the 7-year-old. In addition, the game of monopoly would require additional players.

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 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? Lack of the ability to think abstractly The conventional stage of development A sense of competence, mastery, and worth The principle of conservation

A sense of competence, mastery, and worth

A nurse is preparing a presentation for a health fair discussing various aspects of toddlers. Which example should the nurse use to best illustrate dramatic play?

Acting out a troubling or stressful situation

A parent tells the nurse that the 6-year-old child has been biting his fingernails since beginning first grade. After analysis, the cause is determined to be increased stress. What advice would the nurse give the parent regarding this behavior?

Allow some time every day for the child to talk about new experiences

The nurse is talking with a mother who is concerned that a school-age child is experiencing stress and has been biting the fingernails since beginning the first grade. What should the nurse advise the mother to do about this problem?

Allow some time every day for the child to talk about new experiences. Many first-graders are capable of mature action at school but appear less mature when they return home. They may bite their fingernails. Scolding, nagging, threatening, or punishing does not stop nail biting and may make the problem worse. This behavior will stop when the underlying stress is discovered and alleviated. The mother should be encouraged to spend some time with a child after school or in the evening so the child continues to feel secured in the family and does not feel pushed out by being sent to school. Drinking milk will not help alleviate the child's stress. Using rewards or teaching new skills will not relieve the child's stress.

A 3-year-old is hospitalized unexpectedly and is frightened about the experience. What action could the nurse take to minimize the anxiety the child is experiencing?

Allow the child to handle the equipment before it is used on the child.

Which of the following would be most effective in helping promote initiative and nutritional health for a preschooler? a) Giving the child a high carbohydrate snack after preschool b) Praising the child for cleaning his large plate of food c) Allowing the child to spread soft cheese on crackers d) Encouraging the child to cut up small pieces of apple for a snack

Allowing the child to spread soft cheese on crackers Correct Explanation: Allowing a child to do things such as spreading cheese on crackers helps to foster initiative and nutrition. High carbohydrate snacks should be avoided. Cutting an apple into pieces would be a safety issue. Apples are hard and difficult to cut placing the child at risk for cutting himself. Small servings of food would be more appropriate because preschoolers do not have ravenous appetites. Praising the child for cleaning his plate which contains a small serving of food, not large, would be appropriate.

What would be most effective in helping promote initiative and nutritional health for a preschooler?

Allowing the child to spread soft cheese on crackers. Allowing a child to do things such as spreading cheese on crackers helps to foster initiative and nutrition. High carbohydrate snacks should be avoided. Cutting an apple into pieces would be a safety issue. Apples are hard and difficult to cut, placing the child at risk for cutting himself. Small servings of food would be more appropriate because preschoolers do not have ravenous appetites. Praising the child for cleaning his plate which contains a small serving of food, not large, would be appropriate. page 140

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue?

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers. Page 142

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue? a) Allowing the preschooler to fall asleep wherever and whenever the child is tired enough b) Planning for the child to get 12 hours of sleep daily c) Providing a nightlight d) Taking the TV set out of the child's room e) Eliminating caffeine sources beginning late afternoon

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Correct Explanation: Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers.

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

Answer questions the child asks regarding pain. 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. Page 161

The parents of a 5-year-old tell the nurse that it "seems like our child is afraid of everything from fireworks to butterflies." What actions should the nurse take? Select all that apply.

Ask the parents if they can identify anything that may be causing their child be be fearful. Suggest to the parents to talk with their child about his fears. Work with the parents and child to devise strategies to help deal with the fears. Preschoolers have a vivid imagination, which often leads to a variety of fears. The best way to deal with the child's fears is to address them and work together to determine ways to help minimize the fears. The preschooler is not emotionally equipped to understand why fears are irrational. page 134

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?

Asking the girl to slow down and to think before she talks

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?

Asking the girl to slow down and to think before she talks Many preschoolers stutter as thinking races ahead of their ability to articulate ideas. Most of this stuttering, when not made an issue, will resolve on its own. Calling attention to the dysfluency often exacerbates it. All the other practices are helpful. page 131

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage? a) Giving the child opportunity to speak and finish her ideas b) Asking the girl to slow down and to think before she talks c) Looking at the child while she is speaking d) Enunciating clearly and slowing down parental speech

Asking the girl to slow down and to think before she talks Correct Explanation: Many preschoolers stutter as thinking races ahead of their ability to articulate ideas. Most of this stuttering, when not made an issue, will resolve on its own. Calling attention to the dysfluency often exacerbates it. All the other practices are helpful.

The nurse is caring for a 11-year-old girl who has been identified as weighing 10% more than recommended for her age and height. When developing the plan of care, which intervention is of the highest initial priority? Discuss keeping a food journal with the child and parents. Assess readiness to learn in the child and parents. Review the BMI for other children in the family for familial tendencies. Assess the child's activity level for the past week.

Assess readiness to learn in the child and parents.

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? Determine if there have been other playground bullying incidents. Question those responsible for the bullying. Immediately call the bullied child's parents. Assess the situation with the help of the school staff and parents.

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

In assessing the bilingual 4-year-old's speech and language development, the nurse should find that the child will: a) Be prone to stuttering. b) Mix the two languages in the same sentence. c) Be able to use each language as a separate system. d) Avoid asking questions.

Be able to use each language as a separate system. Correct Explanation: The ability to use both languages separately is developed by 4 years. Mixing the two languages occurred during toddlerhood. The other options are not related to bilingualism and are incorrect.

While the nurse is taking a blood pressure on a 4-year-old, the child states that the blood-pressure cuff is too tight and angrily says, "That hurt, you big poo-poo head." What is the most appropriate response by the nurse?

Calmly explain that you don't mean to hurt her, loosen the cuff, and tell her that is isn't nice to call you names.

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.

Child abuse and sexual abuse are not the same thing The concepts of "good touch" versus "bad touch" should be taught around the age of 10 years The nurse should speak with the family first if child abuse is suspected Child abuse includes physical, emotional, and sexual abuse. 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 sexual abuse, the nurse should report to the appropriate authorities in his or her state. page 166

Children are acting out a troubling situation. Dramatic play allows a child to act out a troubling situation. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. During cooperative play, children play in an organized group with each other as in team sports. Onlooker play occurs when there is observation without participation such as watching television. Page 135

The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of dramatic play? a) Children are playing in an organized group with each other. b) Children are acting out a troubling situation. c) Children are playing apart from others without being part of a group. d) Children are observing without participating.

Children are acting out a troubling situation. Correct Explanation: Dramatic play allows a child to act out a troubling situation. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. During cooperative play, children play in an organized group with each other as in team sports. Onlooker play occurs when there is observation without participation such as watching television.

Children are playing in an organized group with each other.

Children are playing in an organized group with each other. During cooperative play, children play in an organized group with each other as in team sports. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. Parallel play occurs when the toddler plays alongside other children but not with them. Page 135

The nurse observes a school-age child categorize specific desk and clothing items in his hospital room. What cognitive behavior has this child mastered?

Class inclusion Class inclusion is the ability to understand that objects can belong to more than one classification. A school-age child can categorize objects in many ways. Decentering is the ability to project oneself into another person's situation. Accommodation is the ability to adapt thought processes to fit what is perceived. Conservation is the ability to appreciate that a change in shape does not mean a change in size.

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

Classification

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

Classification An important change in thinking during the school-age period is classification. This is the ability to divide things in different sets and identify their relationships to each other. Children in this age group love to collect sports cards, insects, rocks, stamps, coins, etc. These collections may be only a short-term interest, but they are of utmost importance to the child when he or she is collecting them. Decentration occurs in the concrete operational stage from ages 7 to 12 years. It is the ability to consider multiple aspects of a situation. The preoperational stage occurs between ages 2 and 7 years. During this time thinking is at a symbolic level. One part of the preoperational stage is egocentrism. In this stage, the child has the inability to see things from another's point of view.

Which behavior by a 3 year-old child does not validate Erikson's developmental task for preschoolers?

Compares his soccer abilities with his peers.

What action by a parent would be least likely to foster development of self-confidence in a school-age child?

Comparing the child to an older sibling regarding academic achievements A school-age child needs consistency, clearly defined expectations and positive attention in order to develop self-confidence. By being accepting of mistakes the child makes, focusing on the child whenever they are talking and making sure the child understands behavioral expectations, the parents are fostering self-confidence in the child.

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

Compromised parental coping related to inability to enforce school attendance

The nurse is about to see a 9-year-old girl for a well-child checkup. Knowing that the child is in Piaget's period of concrete operational thought, which characteristic should the child display? Consider an action and its consequences. View the world in terms of her own experience. Know lying is bad because she gets sent to her room for it. Make generalized assumptions about groups of things.

Consider an action and its consequences.

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

Consider an action and its consequences. The child will be able to consider an action and its consequences in Piaget's period of concrete operational thought. However, she is now able to empathize with others. She is more adept at classifying and dividing things into sets. Defining lying as bad because she gets punished for it is a Kohlberg characteristic.

The nurse is caring for a hospitalized 10-year-old client. Which nursing action is mostappropriate? Correct each of the child's mistakes to ensure learning. Discourage the child from assisting with dressing change. Structure a competitive environment between clients. Consistently reinforce the child's self-worth.

Consistently reinforce the child's self-worth.

The nurse is caring for a hospitalized 10-year-old client. Which nursing action is most appropriate?

Consistently reinforce the child's self-worth. Helping school-aged clients experience satisfaction in projects, social activities, family life, and school helps them gain a sense of industry. Reinforcing self-worth provides this satisfaction. The child should not be discouraged from participating in his or her care. The child's mistakes may need corrected to learn; however, the child has to be allowed to make mistakes in a safe environment to promote learning. Pointing out these mistakes needs to be done with care. Competition between clients will not facilitate growth and development or psychosocial development.

The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which information would the nurse include in her teaching plan?

Continuous peer relationships provide the most important social interaction for school-age children. ontinuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

A 4-year-old tells the nurse he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which nursing diagnosis is most applicable for his family?

Deficient knowledge of normal preschool development

A 4-year-old tells you he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which nursing diagnosis is most applicable for his family?

Deficient knowledge of normal preschool development Because a preschooler's imagination is at a peak, imaginary friends are not uncommon. Page 128

A 4-year-old tells you he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which of the following nursing diagnoses is most applicable for his family? a) Disturbed thought processes related to deep-set psychological need b) Deficient knowledge of normal preschool development c) Social isolation related to unwillingness to relate except through imaginary friend d) Compromised family coping related to abnormal behavior of child

Deficient knowledge of normal preschool development Correct Explanation: Because a preschooler's imagination is at a peak, imaginary friends are not uncommon.

A nurse is developing a plan of care for a 4-year-old client with cystic fibrosis who has frequent hospitalizations related to his illness. Which would be the most appropriate nursing diagnosis for this client?

Delayed growth and development related to frequent illness

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

Discuss tobacco and alcohol use with the child.

Does not understand the phrase "slow as molasses" when used by the teacher

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? Believed that not turning in homework on time was acceptable, but has since decided it is not acceptable Arrives to class late from recess and apologizes to the teacher Enjoys math instruction and decides to join the math club Does not understand the phrase "slow as molasses" when used by the teacher

Does not understand the phrase "slow as molasses" when used by the teacher

Which project or game would you anticipate that a preschooler would most enjoy while hospitalized?

Dressing in her mother's coat to play house Preschoolers do well with activities that call for imagination. They are not ready for fine-motor or long-term activities. pg 135

Which project or game would you anticipate that a preschooler would most enjoy while hospitalized? a) Planting flower bulbs that she can watch grow next spring b) Dressing in her mother's coat to play house c) Turning out the lights to play hide and seek d) Playing an electronic, hand-held game

Dressing in her mother's coat to play house Correct Explanation: Preschoolers do well with activities that call for imagination. They are not ready for fine-motor or long-term activities

A bilingual family tells the nurse their desire for their child to learn Spanish as well as English. English is the predominant language spoken in the home. The parents ask the nurse when is the best time to teach the child a second language. What time period would the nurse respond?

During the preschool years

A mother confides in a nurse that her preschool daughter only wants to play with her father as soon as he comes home from work in the evenings and doesn't seem to have any interest in spending time with the mother. This phenomenon is an example of which of the following?

Electra complex

Electra complex Correct Explanation: An Electra complex is the attachment of a preschool girl to her father; an Oedipus complex refers to the strong emotional attachment a preschool boy demonstrates toward his mother. A daughter demonstrating an Electra complex might prefer to always sit beside her father at the table; she asks her father to tuck her in at night. She makes a point she is "Daddy's girl." A mother who is not prepared for this behavior may feel hurt and cut off from family interaction. Although children during this period do enter a second phase called intuitional thought, they lack the insight to view themselves as others see them or put themselves in another's place (this is termed centering). Many children at the beginning of the preschool period exhibit genu valgus (knock-knees); this disappears with increased skeletal growth at the end of the preschool period.

The nurse is organizing an indoor play area for preschoolers. What play materials are least important?

Electronic teaching toys These are expensive and usually cannot be used in multiple ways or shared with a group of children. All the rest of the items have many uses, stimulate imagination and creativity, promote social interaction, and are relatively inexpensive and readily replaced.

The nurse is organizing an indoor play area for preschoolers. What play materials are least important? a) Dress-up clothes and hats and puppets b) Electronic teaching toys c) Cut, paste, drawing, and painting materials d) CD player with music and musical instruments e) Balls, blocks, and puzzles

Electronic teaching toys Correct Explanation: These are expensive and usually cannot be used in multiple ways or shared with a group of children. All the rest of the items have many uses, stimulate imagination and creativity, promote social interaction, and are relatively inexpensive and readily replaced.

The school nurse is meeting with a 10-year-boy who is concerned about his weight. He reports he doesn't eat much candy but loves fruit, pasta, potatoes, and bread. Which suggestion should the nurse prioritize to help him maintain a healthy weight? Encourage portion control at each meal Encourage the child to not worry about weight until he is older. Change to a very low-fat and no-carbohydrate diet. Encourage activities that will increase his physical activity. SUBMIT ANSWER

Encourage activities that will increase his physical activity.

The nurse is caring for a 7-year-old child who will be in the hospital for several weeks. Which action by the nurse will facilitate the child's psychosocial development? Allow the child's peers to visit often. Quickly come to the room while the child presses the call bell. Encourage the child to complete school work and provide guidance. Ask the child what color gown he or she prefers to wear daily.

Encourage the child to complete school work and provide guidance.

The parent of a 12-year-old child reports the child does not have high self-esteem. The parent asks for suggestions to increase feelings of self-worth. What activity(ies) would be appropriate for the nurse to suggest? Select all that apply. Encourage the child to develop new skills. Provide the child with a weekly allowance. Recommend the child investigate opportunities for volunteering at local charities. Recommend the child begin to participate in after-school activities. Allow the child to begin staying home alone after school when possible.

Encourage the child to develop new skills. Recommend the child begin to participate in after-school activities. Recommend the child investigate opportunities for volunteering at local charities.

The father of a 12-year-old girl reports his daughter does not have high self-esteem. He asks for suggestions to increase her feels of self-worth. What activities would be appropriate for the nurse to suggest? Select all that apply.

Encourage the child to join a club at school. Recommend she begin to participate in after-school activities. Recommend the child investigate opportunities for volunteering at local charities.

The mother of a 3-year-old child reports her son is afraid of the dark. She asks the nurse for help. Which advice is best for the nurse to offer?

Encourage the parent to allow a small night light Fears are normal in the preschool-aged child. Some children are afraid of the dark. The parents should be advised to show patience with their child as he works through this fear. Refusing a night light will further increase the stress of the child. Parents should not give credibility to the fear by checking under the bed for monsters. Parents should not use the television to soothe the child, rather develop a routine that relaxing such as one-on-time with the child. Parents should disrupt the usual bedtime routine by allowing the child to sleep with them.

A nurse is working with a family that has two children who 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 Emphasizing that the family not skip meals Involving the entire family in the program The entire family needs to be involved in the treatment plan, with emphasis on long-term permanent changes, not rapid weight loss and promoting moderate exercise for all for 60 minutes/day. Additionally, the nurse would encourage meal planning and discourage skipping meals and counsel the family not to use food as punishment or reward.

Ensure that the child brushes his teeth after each meal and snacks.

An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother in regard to the child's dental health? Have the child's teeth professionally cleaned every 3 months. Ensure that the child brushes his teeth after each meal and snacks. Accept that the child is genetically predisposed to having more cavities than most children. Encourage the child to abstain from eating sugary snacks at school.

Ensure that the child brushes his teeth after each meal and snacks.

An 8-year-old boy's foster mother is discussing her concerns about three recent cavities found in his permanent teeth. The mother reports that her child 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 the child's dental health?

Ensure that the child brushes his teeth after each meal and snacks. 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. page 168

When considering the psychosocial development of a school-aged child, which is the primary developmental task?

Establishing a social network Erikson describes the task of the school-age years as industry versus inferiority. During this period, 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, which develops his or her cognitive and social skills.

A mother is discussing with the nurse a recent story in the local news about a child being abducted. She is concerned about the safety of her preschool child and wonders what she should tell her child to keep her safe but without frightening her. Which of the following would be the best recommendation for the nurse to give the mother in this case?

Explain in a calm and everyday manner how the child should stay away from strangers in cars

The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal?

Falls when bending over to touch toes Bending over easily without falling is a normal expected gross motor skill in a 3-year-old. Building a tower of nine or ten cubes, pedaling a tricycle without assistance and unscrewing lids, bolts or nuts are also expected gross and fine motor skills for this age. page 141.

Telling tall tales is harmless and should be encouraged in preschoolers because it helps them develop their imaginations.

False Parents may be concerned "tall tales" can lead to chronic lying if supported. Caution them, therefore, not to encourage this kind of storytelling, but instead help the child separate fact from fiction by saying, "That's a good story, but now tell me what really happened." This conveys the idea a child has not told the truth, yet does not squash imagination or initiative. page 145

Broken fluency is a serious condition, and children who exhibit it should be referred to a speech pathologist for treatment.

False The nurse may need to remind parents that broken fluency is a part of normal development and, if accepted as such, will pass. page 131

Broken fluency is a serious condition, and children who exhibit it should be referred to a speech pathologist for treatment. a) False b) True

False Correct Explanation: You may need to remind parents that broken fluency is a part of normal development and, if accepted as such, will pass

Broken fluency is a serious condition, and children who exhibit it should be referred to a speech pathologist for treatment. a) True b) False

False Correct Explanation: You may need to remind parents that broken fluency is a part of normal development and, if accepted as such, will pass.

The student nurse is preparing a presentation on obesity in children. What information should the student nurse include regarding factors linked to causing obesity? Select all that apply.

Family role modeling Reduced physical education programs Unsafe neighborhoods Lack or reduced amount of recess periods during the school day

What foods could a parent provide that would be the most beneficial to support healthy dentition for a school-aged child? Hamburger and a cherry Coke Fish, spinach salad and a glass of milk Chicken sandwich with pretzels and apple juice Bagels and cream cheese with sherbet

Fish, spinach salad and a glass of milk

What foods could a parent provide that would be the most beneficial to support healthy dentition for a school-aged child?

Fish, spinach salad and a glass of milk A well-balanced diet rich in calcium and phosphorus fosters healthy teeth. Minimal sugar, a diet of whole grain breads, and fish and cheeses are all good sources of calcium and/or phosphorus. Sugary soda drinks and juices, pretzels and bagels, beef and sherbet do not provide substantial amounts of calcium or phosphorus.

An 8-year-old boy is doing well with adding and subtraction. His father asks for suggestions regarding projects that would help increase his understanding of conservation of mass. What project would the nurse suggest?

Form vases from blocks of clay.

A 9-year-old girl tells the nurse about belonging to a spite club. How does belonging to this group support the child's development?

Fulfills peer group needs Nine-year-olds take the values of their peer group very seriously. This is typically the friend or club age because children form groups, usually "spite clubs." This type of club does not teach the child leadership skills, develop autonomy, or to learn rules.

A mother suspects that her 11-year-old son is experimenting with deliriants with his friends. Which symptoms would the nurse advise the mother to look for that would validate her concerns?

Giddiness and coughing Inhalation of substances can cause numerous symptoms, including giddiness and coughing. The child will not experience diarrhea, hyperactivity or develop bad breath from experimenting with inhalants.

What teaching points would a nurse provide for families of school-aged children to help prevent substance abuse? Select all that apply.

Give the child "what if" examples to situations they may face. Set firm rules regarding alcohol and other drug usage and discuss consequences associated with breaking the rules. Encourage decision-making and discuss family values. Children mimic what adults do so it is important to set good examples for behavior regarding substance abuse. Offering children opportunities to think through " what if" situations allows the child to have already thought about difficult situations they may find themselves in. Although threats are not productive, setting strict rules regarding substance abuse are very important. Also encourage decision-making by the child based upon previous good decisions.

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.

Having the child introduce herself by standing at the front of the class and telling something interesting about herself Assigning the child a role-play scenario to perform with another student in front of the class Encouraging the child to join the drama club, which is practicing for an upcoming play

An 8-year-old child is being seen for a well-child visit. His weight at his visit last year was 50 lb (22.7 kg) and his height was 47 in (119 cm). If he is developing normally, which finding will the nurse expect to note this year? Height 49 in (124.5 cm) The child's weight is seven times his birth weight. The child has all of his adult teeth present. Weight 62 lb (28.1 kg)

Height 49 in (124.5 cm)

A 4-year-old is hospitalized with a urinary tract infection. Based on what you know of her cognitive development, which approach would be best to prepare her for a radiograph?

Help her pretend the x-ray machine is a camera.

A 4-year-old is hospitalized with a urinary tract infection. Based on what you know of her cognitive development, which approach would be best to prepare her for a radiograph? a) Explain that she must behave because the technician is busy. b) Help her pretend the x-ray machine is a camera. c) Tell her a radiograph is a picture of the dark inside her body. d) Tell her she must follow directions or she will be hurt.

Help her pretend the x-ray machine is a camera. Correct Explanation: Most preschoolers express fear of the dark and mutilation. Their active imaginations make it possible to turn almost any procedure into a game.

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

How often does everyone in your family eat together?

The school nurse is assessing the nutritional status of an overweight 12-year-old girl. Which question is appropriate for the nurse to ask? How often does everyone in your family eat together? Does your family have rules about foods and how they are prepared? What does your family do for exercise? Have you gained weight recently?

How often does everyone in your family eat together?

The nurse is assessing a 4-year-old child. The child tells the nurse about her friend, Nancy, who lives in her room at home. The mother tells the nurse that Nancy is not a real person. The nurse would use which term when documenting this assessment finding?

Imaginary friend The preschooler often has an imaginary friend. This friend serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Preoperational thought is a self-centered understanding of the world. Magical thinking is when a preschooler believes that his or her thoughts are all-powerful. Animism is when a preschooler attributes lifelike qualities to inanimate objects. Page 128

A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group?

Imagination

A nurse is describing growth and development during the preschool period. Which of the following would the nurse identify as a predominant and heightened characteristic for this age group?

Imagination

A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group?

Imagination Although vocabulary, gross motor skills, and fine motor skills improve during this time, the imagination of preschoolers is keener than it will be at any other time in their lives. They imitate behavior that they see exactly. page 128

A nurse is describing growth and development during the preschool period. Which of the following would the nurse identify as a predominant and heightened characteristic for this age group? a) Gross motor skills b) Vocabulary c) Fine motor skills d) Imagination

Imagination Correct Explanation: Although vocabulary, gross motor skills, and fine motor skills improve during this time, the imagination of preschoolers is keener than it will be at any other time in their lives. They imitate behavior that they see exactly.

A nurse is observing a 3-year-old preschooler engaged in play. What behavior would the nurse most likely expect to observe?

Imitative play

A nurse is observing a 3-year-old preschooler engaged in play. Which of the following would the nurse most likely expect to observe?

Imitative play

A nurse is observing a 3-year-old preschooler engaged in play. What behavior would the nurse most likely expect to observe?

Imitative play Preschoolers enjoy games that use imitation such as pretending to be teachers, cowboys, firefighters, and store clerks. They imitate exactly what they see their parents doing. Parallel play is characteristic of toddlers. Preschoolers are capable of sharing and play with other children as a means for socialization. Older preschoolers are interested in group games. page 135

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. Increased appetite and a tendency to go on food "jags" (the desire for only one kind of food for awhile) are typical of 6 year olds. This stage soon passes and is unimportant if the child generally gets the necessary nutrients.

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? Perfectionism Accommodation Industry Conservation

Industry

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

The nurse has just completed an assessment on a child who voices an interest in how things are made and who needs support when they are not successful. The child further reports he is involved in clubs and sports outside the home. The nurse is aware that this child is in which of Erikson's states of development?

Industry versus inferiority

The major developmental task according to Erikson is for the preschool child to develop which of the following?

Initiative

According to Erikson, the task for the preschool child is to develop:

Initiative According to Erikson, the developmental task of the preschool-age child is initiative versus guilt. Preschoolers often try to find ways to do things to help, but they may feel guilty if scolded when they fail because of inexperience or lack of skill. page 129

Nursing students are reviewing information about the emotional development of the preschooler. They demonstrate understanding of the information when they identify what task as the task of the preschooler?

Initiative The developmental task of the preschool period is initiative versus guilt. Industry is the developmental task of the school-aged child. Trust is the developmental task of infancy. Autonomy is the developmental task of toddlerhood. page 132

The major developmental task according to Erikson is for the preschool child to develop which of the following? a) Initiative b) Trust c) Autonomy d) Industry

Initiative Correct Explanation: According to Erikson, the developmental task of the preschool-age child is initiative versus guilt. Preschoolers often try to find ways to do things to help, but they may feel guilty if scolded when they fail because of inexperience or lack of skill.

Nursing students are reviewing information about the emotional development of the preschooler. They demonstrate understanding of he information when they identify which of the following as the task of the preschooler? a) Initiative b) Autonomy c) Trust d) Industry

Initiative Correct Explanation: The developmental task of the preschool period is initiative versus guilt. Industry is the developmental task of the school-aged child. Trust is the developmental task of infancy. Autonomy is the developmental task of toddlerhood.

Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify?

Iron deficiency

Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify? a) Dental caries b) Iron deficiency c) Obesity d) Interference with growth

Iron deficiency Correct Explanation: Meat is an important iron source while calcium in milk consumed in large quantities can block iron absorption. Alternate protein sources can replace the meat in the child's diet for growth. Excess milk intake that boosts calories consumed can be an obesity-causing factor. Lactose from milk in constant contact with the teeth can promote development of dental caries. However, these risks are slight, with the iron deficiency risk pronounced.

Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify? a) Interference with growth b) Obesity c) Iron deficiency d) Dental caries

Which assessment findings of the speech of a 5-year-old child warrant further follow-up? Select all that apply.

It is difficult for people outside of the household to understand his conversation. The child has a vocabulary of an estimated 1,200 words. The child is unable to provide his address when asked. By the age of 5 a child should have the ability to be understood in conversation by people outside of the immediate family even in the presence of some speech articulation issues. The child's vocabulary should exceed 2000 words. The child should be able to provide his address when asked. page 132

Jack wanted to go with his father on the motorcycle ride. When he was told he couldn't go he told his father he hoped he would crash, so Jack believes he caused the accident.

Recently, 5-year-old Jack's father was injured in a motorcycle accident. The father is healthy and back at work. Jack's father confides to the school nurse that he is concerned about Jack. When questioned further, he tells the nurse that Jack is not acting like he was before the accident. He says he keeps telling Jack he is a good boy; indeed Jack is not testing or challenging his boundaries like he was before the accident. Which of the following best describes the reason for the behavior Jack's father is seeing? a) Everyone in Jack's family is being nicer to each other and, as most preschoolers will, Jack is imitating the "grown up" behavior. b) Jack is afraid of being hurt himself and thinks being especially good will protect him from accidents. c) The thought of losing his father was scary, and Jack is trying to show his father how much he loves him. d) Jack wanted to go with his father on the motorcycle ride. When he was told he couldn't go he told his father he hoped he would crash, so Jack believes he caused the accident.

Jack wanted to go with his father on the motorcycle ride. When he was told he couldn't go he told his father he hoped he would crash, so Jack believes he caused the accident. Correct Explanation: Preschoolers have learned to think about something without actually seeing it: to visualize or imagine. This normal development, sometimes called magical thinking, makes it difficult for them to separate fantasy from reality. Preschoolers believe that words or thoughts can make things real, and this belief can have either positive or negative results. For example, in a moment of anger, a child may wish that a parent or a sibling would die; if that person later is hurt, the child feels responsible and suffers guilt. The child needs reassurance that this is not so.

The mother of a school-age child is distraught because the child has been diagnosed with obesity. What actions should the nurse suggest to the mother to help the child with this problem? Select all that apply.

Maintain a balanced eating approach in the home. Seek out a preteen weight loss group for the child to participate. Encourage increased activity such as walking the dog after school. Strategies to help the school-age child with obesity include maintaining a healthy eating approach in the home, seeking a weight loss group with other preteens for the child to attend, and encouraging increased activity. Explaining that obesity will lead to an early death could cause the child to become obsessed with dieting and create an eating disorder. The child should not be encouraged to use fad diets to lose weight.

A mother states that her 6-year-old has starting biting nails and regressing to baby talk since beginning school. What instructions are best for the nurse to give the mother regarding this behavior? Get a description of the classroom behavior from the teacher. Apply a nail biting product to the nails to deter biting. Remind the child to stop each time the behavior is witnessed. Make time each day to spend with the child individually.

Make time each day to spend with the child individually.

A mother states that her 6-year-old has starting biting nails and regressing to baby talk since beginning school. What instructions are best for the nurse to give the mother regarding this behavior? Remind the child to stop each time the behavior is witnessed. Make time each day to spend with the child individually. Apply a nail biting product to the nails to deter biting. Get a description of the classroom behavior from the teacher.

Make time each day to spend with the child individually.

A mother states that her 6-year-old has starting biting nails and regressing to baby talk since beginning school. What instructions are best for the nurse to give the mother regarding this behavior?

Make time each day to spend with the child individually. Many first graders are capable of mature action at school but appear less mature when they return home. They may bite their fingernails, suck their thumb, or talk baby talk. Scolding, nagging, threatening, or punishing does not stop the problem and can actually make them worse. Methods such as bad-flavored nail polish or restraining the child's hands make the problems worse. These behaviors stop when the underlying stress is discovered and alleviated. Parents should be urged to spend time with the child after school or in the evening so the child continues to feel secure in the family and does not feel pushed out by being sent to school.

A family from India has recently moved to the United States. Their 5-year-old often visits the school nurse after lunch complaining of a "stomachache". The lunch staff tell the nurse that the child eats very little for lunch. What is the best action by the nurse?

Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch. Food served in the home is often very specific to the family's ethnic background. As the preschool-age child is exposed to persons of other cultures in school, he or she may or may not like the food that is served. It is important to first determine if this is the reason for the child eating very little at lunch so that appropriate interventions can be determined. Bringing lunch from home may be an option, but it must first be determined if food preference is the underlying cause of lack of eating.

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 this is most likely the cause of the enlarged tonsils:

Normal growth of lymphatic tissue for this age

The mother of a 10-year-old daughter is concerned that her child is becoming overweight. Her weight plots in the 95th percentile in the growth chart. Which action would the nurse recommend to the mother to address her concerns? Limit daily fat intake to 40% of the total calories for the day. Place the child on a diet, eliminating all sweets and snacks. Offer to go walking every day after school with her for 30 minutes. Remind the child daily that she needs to watch what she eats.

Offer to go walking every day after school with her for 30 minutes.

After watching a news broadcast of a school shooting, a child begins experiencing nightmares and bed wetting. How can the nurse instruct the parents to help their child feel safe? Select all that apply. Only allow one viewing of a news broadcast. Have the child sleep in the same room as the parents. Allow children to watch news broadcast only in parent's presence. Continue to provide assurance of safety. Schedule an appointment with the counselor.

Only allow one viewing of a news broadcast. Continue to provide assurance of safety. Allow children to watch news broadcast only in parent's presence.

Opening drawers in the room, pulling out supplies, and examining them

A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which of the following activities that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson? a) Rough-housing with his father b) Singing a song he learned at preschool c) Opening drawers in the room, pulling out supplies, and examining them d) Reading a book

Opening drawers in the room, pulling out supplies, and examining them Correct Explanation: The developmental task for the preschool-age child is to achieve a sense of initiative versus guilt (Erikson, 1993). Children with a well-developed sense of initiative like to explore as they have discovered that learning new things is fun. Opening the drawers, pulling out supplies, and examining them is the best example of initiation and exploration among these answers. Rough-housing and singing a song learned in preschool are examples of typical play for preschool children. Reading a book at age four would be developmentally precocious but would not necessarily be the best example of initiative.

A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which activity that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson?

Opening drawers in the room, pulling out supplies, and examining them. The developmental task for the preschool-age child is to achieve a sense of initiative versus guilt (Erikson, 1993). Children with a well-developed sense of initiative like to explore as they have discovered that learning new things is fun. Opening the drawers, pulling out supplies, and examining them is the best example of initiation and exploration among these answers. Rough-housing and singing a song learned in preschool are examples of typical play for preschool children. Reading a book at age four would be developmentally precocious but would not necessarily be the best example of initiative. page 129

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of the following is the highest calcium-containing fruit?

Orange

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium?

Orange A medium orange contains 50 mg of calcium and is a good nondairy choice. The other fruits are healthy choices but do not contain as much calcium. Page 141

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of the following is the highest calcium-containing fruit? a) Apple b) Orange c) Banana d) Peach

Orange Correct Explanation: A medium orange contains 50 mg of calcium and is a good nondairy choice. The other fruits are healthy choices but do not contain as much calcium.

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

Painting pictures in the art corner of the room.

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order. Warn the child there will be a time-out if the behavior does not stop. If the child gets up, replace the child and restart the time. Set a timer for no more than 4 minutes. Parent knows the misbehavior was intentional. Remove the preschooler to a boring spot.

Parent knows the misbehavior was intentional. Warn the child there will be a time-out if the behavior does not stop. Remove the preschooler to a boring spot. Set a timer for no more than 4 minutes. If the child gets up, replace the child and restart the time. Correct Explanation: Time-out is an extinction method of discipline that avoids reinforcing the unacceptable behavior with attention. One minute per year of age is the appropriate length of a time-out. Five minutes is the recommended maximum length.

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.

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?

Parents

A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group? Writing letters to friends Participating in a craft project Playing with blocks Playing with a jack-in-the-box

Participating in a craft project

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

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

Participating in a craft project During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter.

When providing anticipatory guidance to a group of parents with school-aged children, what would the nurse describe as the most important aspect of social interaction?

Peer relationships Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

A nursing instructor is teaching students about changes during the preschool years. One predominant change that the teacher would emphasize is which of the following?

Physical growth slows.

A nursing instructor is teaching students about changes during the preschool years. One predominant change that the teacher would emphasize is:

Physical growth slows. During the preschool period, physical growth slows considerably, while personality and cognitive growth continue at a rapid rate. Page 127

A nursing instructor is teaching students about changes during the preschool years. One predominant change that the teacher would emphasize is which of the following? a) Personality growth slows. b) Cognitive growth slows. c) Physical growth accelerates. d) Physical growth slows.

Physical growth slows. Correct Explanation: During the preschool period, physical growth slows considerably, while personality and cognitive growth continue at a rapid rate.

Preoperational thought A 3-year-old is in the preoperational stage according to Piaget. Primary circular reaction is seen in infants of 3 months. Coordination of secondary schema is seen in infants at age 10 months. Tertiary circular reaction is seen in toddlers between 12 and 15 months. page 129

Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3 year old is in which of the following stages as identified by Piaget? a) Tertiary circular reaction b) Coordination of secondary schema c) Preoperational thought d) Primary circular reaction

Preoperational thought Correct Explanation: A 3 year old is in the preoperational stage according to Piaget. Primary circular reaction is seen in infants of 3 months. Coordination of secondary schema is seen in infants at age 10 months. Tertiary circular reaction is seen in toddlers between 12 to 15 months.

A mother tells a nurse that her child has recently established some friendships for the first time. In which age group do you expect this child to be?

Preschool The preschool child begins to develop friendships. p 133

A mother reports to the nurse that her 4 year old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother?

Preschoolers imitate as a healthy behavior--it is part of their imagination and normal growth and development."

The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation?

Presence of 10 deciduous teeth The presence of only 10 deciduous teeth would warrant further investigation. The preschooler should have 20 deciduous teeth present. The absence of dental caries or presence of 19 teeth does not warrant further investigation. page 127

The nurse has brought a group of preschoolers to the playroom to play. Which activity would the nurse predict the children to become involved in?

Pretending to be mommies and daddies in the playhouse

The nurse is observing a playgroup of children of all ages. The preschoolers in the group would most likely be doing which activity?

Pretending to be mommies and daddies in the playhouse. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities, such as board games, and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers. page 135

The nurse is observing a playgroup of children of all ages. The preschoolers in the group would most likely be doing which activity? a) Pretending to be mommies and daddies in the playhouse. b) Watching a movie with other children their age. c) Painting pictures in the art corner of the room. d) Playing a board game.

Pretending to be mommies and daddies in the playhouse. Correct Explanation: Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities, such as board games, and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.

A 10-year-old boy is above normal weight for a child his age and height. 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 the boy's caregivers as to ways to help him maintain a healthy weight?

Provide activities for the child that will increase his physical activity.

The nurse is observing a group of 8-year-olds who are being taught the concept of conservation of numbers. Which activity would best help these children understand this concept?

Rearranging a group of coins first into a circle, then a triangle and then a square

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? Suggest the health care provider examine the child for breathing difficulty. Give the child something for pain. Take the child's temperature; this must be tonsillitis. Record this as a normal finding in an early school-age child.

Record this as a normal finding in an early school-age child.

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?

Record this as a normal finding in an early school-age child. 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 nor an examination for respiratory problems if this a normal finding.

Which action by a preschooler would suggest that his thinking is inconsistent with normal preschooler growth and development?

Refusal to play with "real" children Although preschoolers have "imaginary friends," they also should relate with real playmates. page 128

The nurse is reviewing the medical record for a 13-year-old child who is being seen for concerns about school attendance. The physician has noted the child has "school phobia". What behaviors may be noted in a child experiencing this phenomena? Select all that apply.

Reports of fear when attending school Demonstrates negative behaviors before school Chronically late for school

A mother brings her 4-year-old son in for a check-up. Which of the following findings should the nurse be concerned about?

Resting pulse rate of 120

A mother brings her 4-year-old son in for a check-up. Which of the following findings should the nurse be concerned about? a) Weight gain of 5 lb in the past year b) No increase in appetite compared with that in toddler years c) Resting pulse rate of 120 d) Ectomorphic body type

Resting pulse rate of 120 Correct Explanation: Pulse rate in preschool children decreases to about 85 bpm typically, so the nurse should be concerned about a pulse rate of 120 in a 4-year-old. Contour changes in preschool children are so definite that future body type—ectomorphic (slim body build) or endomorphic (large body build)—becomes apparent. Neither of these body types is a reason for concern. During these years, appetite remains the same as it was during the toddler years, a level perhaps considerably less than some parents would like or expect. Weight gain is slight during the preschool years as the average child gains only about 4.5 lb (2 kg) a year.

The nurse is caring for a preschool child in the hospital with severe developmental delays. The parents have 3 other younger children at home and both parents work full-time outside the home. The family has just moved to this area. Which nursing diagnosis would be the highest priority in regard to the parents at this time?

Risk for caregiver role strain Given that the parents are trying to care for 4 children with a severely developmentally delayed preschooler in the hospital, and they are new to the area (making it unlikely that they have a strong support system), the highest priority nursing diagnosis would be caregiver role strain. Family processes are likely altered, but with the hospitalization, strain on the parents is a higher priority nursing diagnosis

The nurse is preparing a care plan for a 7-year-old child on the pediatric unit newly diagnosed with asthma. One of the child's parents is employed as a family practice physician and the other as a lawyer. The child has two older siblings and two younger siblings. Which nursing diagnoses would apply to this situation? Select all that apply.

Risk for caregiver role strain Risk for infection Knowledge deficit regarding disease process Knowledge deficit regarding use of inhaler medication for asthma

The nurse is talking with a school-aged child about her interests. In which interest do most school-aged children place the most focus?

School

The nurse is talking with a school-aged child about her interests. In which interest do most school-aged children place the most focus? Pets Family School Church

School

What resource should school-aged children be taught to use whenever they have questions about sex education, if their parents will not discuss the subject? Older siblings School nurse Their friends Material found on the internet

School nurse

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. School-age children can be taught how to think critically to interpret messages seen in advertising, media, sports, and entertainment personalities. School-age children are ready to absorb information that deals with drugs and alcohol and may be exposed to messages that are in conflict with their parents' values regarding smoking and alcohol. This may occur at school and cannot be prevented. Discussions with children need to be based on facts and focused on the present.

An 11-year-old female child is at the pediatrician's office for a well-child check-up. Which health screening would the nurse anticipate that the child would undergo today?

Scoliosis screening Initial screening for scoliosis begins at age 10 to 11 years; the child is monitored into adolescence for development of scoliosis (or progression if scoliosis is already noted).

The nurse is preparing a presentation for a local parent-teacher organization about the growth and development of school-age children. Which of the following would the nurse include?

Secondary sex characteristics are often embarrassing for both sexes. Secondary sex characteristics are often a source of embarrassment for both sexes because preadolescent boys and girls do not want to be different from their peers of the same or opposite sex. In the later school years, girls begin to surpass boys in both height and weight. During this time, children grow an average of 2 inches (5 cm) per year. Physical maturity is not necessarily associated with emotional or social maturity.

What suggestions regarding the evaluation of a child-care center would the nurse share with a preschooler's mother?

Specific program goals to be accomplished should be available.

The mother of an 11-year-old child tells the nurse that her child seems to be "hungry all of the time" and seems to "never get full". The nurse suspects a physiological developmental problem. What is the rationale for the nurse suspecting a physiological developmental issue? Select all that apply.

Stomach capacity increases, which should permit retention of food for longer periods of time The caloric needs of the school-age child are lower than in the earlier years of life

A 4 year old is going to finger paint for the first time. Which of the following is the best action for the adult supervisor of this activity?

Support whatever the child paints.

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?

Support whatever the child paints. Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because he knows that his tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Page 128

A 4 year old is going to finger paint for the first time. Which of the following is the best action for the adult supervisor of this activity? a) Make a model for the child to follow so it will be easy to copy. b) Tell the child that it will be fun but that he or she should not make a mess. c) Draw a picture first for the child to see how to do it. d) Support whatever the child paints.

Support whatever the child paints. Correct Explanation: Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because he or she knows that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity.

The home health nurse, who is visiting the home of a 4-year-old, prepares a nursing care plan with the nursing diagnosis of "At risk for injury related to the parents insufficient knowledge of safety practices for preschooler." Which nursing interventions should the nurse include in the plan of care? Select all that apply.

Teach the parents to use a forward-facing car seat with harness and top tether. Teach the parents that the preschooler should use an approved bicycle helmet when riding a bicycle at any time. Parents should not smoke in an enclosed space such as a vehicle, even if the window is open. This would still expose the child to secondhand smoke. If properly instructed, the preschool child is capable of washing her hands independently. Childproof caps should be used in addition to keeping medications out of the reach of children, preferably a locked cabinet. p138

Testing and identification of group role

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to which of the following? a) Regression b) Playing in an even-number group of children (four) c) Testing and identification of group role d) The fact that preschoolers have a harder time sharing than toddlers

Testing and identification of group role Correct Explanation: Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.

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

Testing the children's vision and hearing

The nurse is assessing the moral developmental level of children being seen in the clinic according to the Kohlberg's conventional stage of moral development. Which children does the nurse determine have met this stage of development? Select all that apply.

The 8-year-old child who frequently asks the teacher if he is doing his math correctly The 10-year-old child who visits his elderly neighbor three times per week The 9-year-old child who tells his friends that they shouldn't throw rocks because they will "get in trouble" The 7-year-old child who yells at his mother, "I don't understand why I can't go to the park!" The 10-year-old who states, "I sure wouldn't want to be my friend taking that bad report card home."

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

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

During a well-child checkup, the nurse observes and interacts with a 7-year-old child and parent. Which behavior by the child would the nurse note as not age appropriate for this child?

The child asks the parent to wait in the waiting room rather than accompany the child. The child depends on the parents for support and encouragement at this age, and it would be unexpected for the child to request the parent to wait in the waiting room and to be assessed by the nurse alone. At this age, the child is gaining empathy and would show concern for the parent's injury. The child would explain to the nurse the "right" way to assess for a temperature as behavior is seen as right or wrong and the parent's technique would be considered "right." The child would have a curiosity about the medical equipment in the room.

The nurse is discussing development of fine motor skills in the preschool-age group with a group of nursing students. Which statement is most accurate regarding the fine motor skills of a 3-year-old?

The child can button his clothes. The 3-year-old is able to button their clothes and use a pencil or crayon. By the age of 4 to 5, the child can use scissors, tie shoelaces, and print his first name. page 130

The nurse is discussing development of fine motor skills in the preschool-age group with a group of nursing students. Which of the following statements is most accurate regarding the fine motor skills of a 3-year-old? a) The child can button their clothes. b) The child can print a few letters. c) The child can tie their shoelaces. d) The child can use scissors.

The child can button their clothes. Explanation: The 3-year-old is able to button their clothes and use a pencil or crayon. By the age of 4 to 5, the child can use scissors, tie their shoelaces, and print their first name.

The child can hop on one foot.

The nurse is discussing development of motor skills in the preschool-age group with a group of nursing students. Which statement is most accurate regarding the gross motor skills of a 4-year-old?

The child can hop on one foot. The 4-year-old can hop on one foot and can control movements of the hands. By the age of 5 the child can walk backwards heel to toe, throw and catch a ball well, and jump rope. page 130

The nurse is discussing development of motor skills in the preschool-age group with a group of nursing students. Which of the following statements is most accurate regarding the gross motor skills of a 4-year-old? a) The child can hop on one foot. b) The child can walk backwards with heel to toe. c) The child can jump rope. d) The child can throw and catch a ball.

The child can hop on one foot. Correct Explanation: The 4-year-old can hop on one foot and can control movements of the hands. By the age of 5 the child can walk backwards heel to toe, throw and catch a ball well, and jump rope.

Which of the following gross motor skills would the 4-year-old child have most recently attained? a) The child can cut his/her food. b) The child can hop on one foot. c) The child can button his/her clothes. d) The child can tie his/her shoelaces.

The child can hop on one foot. Explanation: Gross and fine motor skills continue to develop rapidly in the preschool-age child. Gross motor skills have to do with the development of large muscles. Balance improves and around the age of 4 the child can hop on one foot

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

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

The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely? The child has a leaner body mass than a girl at this age. The child has different diet preferences than his parents. The child described a somewhat reduced appetite. The child's body fat has decreased since last year.

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

Which behavior involving a 11-year-old child warrants further education to the family? Select all that apply.

The child is allowed to sit in the front seat of the car. The child wears a lap belt when riding in the car. The child uses a backpack to carry books when riding their back to and from school. When riding in the car children under the age of 12 should ride in the back seat and not the front seat. Safety belts consisting of a lap and shoulder harness should be employed. Front bike baskets should be used to carry heavy objects. Using a backpack can cause balance issues leading to a fall and should be avoided. page 163

The nurse is observing a 5-year-old in the play room of the medical unit of the hospital. The child uses the toy medical equipment and proceeds to change the bandage on a doll, pretends to give the doll medication, and talks elaborately to the doll. How does the nurse accurately interpret this play?

The child is expressing anxiety about the hospitalization through play Preschool age children often use dramatic play to express anxiety, try out negative feelings, or conquer their fears. Page 135

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 school-aged child needs consistent rules, positive attention, and clear expectations in order to develop self-confidence.

A mother is concerned that a 7-year-old child has taken money from a sibling's dresser several times. What should the nurse advise the mother about this behavior?

The child needs to be reminded of property rights. Early childhood stealing is best handled without a great deal of emotion. A parent should tell the child the money is missing. The importance of property rights should be reviewed: The sibling's money is his, the child's money is the child's, and they are not interchangeable. Stealing is not unusual for a 7-year-old child. The mother does not need to buy the other child a bank. The behavior does not necessarily occur because of school-related stress.

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

The child signs up for after-school activities. Erikson (1963) describes the task of the school-age years to be a sense of industry versus inferiority. During this time, 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 that help to develop his or her cognitive and social skills. Achieving independence is a task of the preschooler who also is developing a conscience at that age. Awareness of the opposite sex occurs in, but is not the focus of, the school-age child.

In working with the preschool-age child, the nurse recognizes which of the following as a characteristic of the preschooler?

The child takes in new information at a rapid rate and asks "why" and "how.

In working with the preschool-age child, the nurse recognizes what action as characteristic of a preschooler?

The child takes in new information at a rapid rate and asks "why" and "how." The preschool-age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft of activity for several hours. The toddler insists he can do things one minute and then becomes dependent the next minute. The infant grows and develops skills more rapidly than he ever will again.

In working with the preschool-age child, the nurse recognizes which of the following as a characteristic of the preschooler? a) The child grows and develops skills more rapidly than at any other time in their life. b) The child has an increased attention span and can be interested in an activity for a long length of time. c) The child takes in new information at a rapid rate and asks "why" and "how." d) The child insists they can "do it," and the next moment they revert to being dependent.

The child takes in new information at a rapid rate and asks "why" and "how." Correct Explanation: The preschool-age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft of activity for several hours. 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.

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.

The child tries out for various teams at school but does not make any of them The child is an average soccer player and the parents enforce 1 to 2 hours of practice per day

The nurse caring for a hospitalized 8-year-old child recognizes that the child has developed an understanding of reversibility. Which of the following relates to the development of this understanding?

The child understands that his or her illness is probably only temporary. Reversibility is the ability to think in either direction. 7-year-old children can add and subtract, count forward and backward, and see how it is possible to put something back the way it was. A 7- or 8-year-old can understand that illness is probably only temporary, whereas a 6-year-old may think it is permanent.

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

The child wants to successfully complete activities.

The school nurse is monitoring children as they arrive at school riding their bicycles. Which children should the nurse speak with about their riding habits? Select all that apply.

The child who is wearing flip flops when riding the bicycle to school The child who is wearing a book bag hanging off one shoulder The child who wears a stocking cap under the helmet during cold weather

When collecting data on a preschool-age child during a well-child visit, the nurse finds that the child has gained 12 lb and grown 2.5 inches in the last year. Using knowledge of normal growth patterns of the preschool child, the nurse recognizes that these findings indicate which of the following?

The child's weight is above an expected range and the height is within an expected range.

In counseling a group of parents regarding the development of school readiness in preschoolers, the nurse emphasizes: a) Library visits and story hour b) Visiting the kindergarten c) Enrollment in a preschool d) The home environment

The home environment Correct Explanation: The home environment is the foundation for the child's learning and is the most important element for developing school readiness. Values regarding learning originate at home. Parents are the first teachers and role models. Structure, proper behavior with others, and language skills are all developed at home and are essential for school success. The other options are important but not as vital as the home environment. A preschool experience can foster social skills and group interaction. Library story hour and books develop language skills, and visiting a kindergarten can help the child make the transition to school.

The nurse is caring for a 4-year-old child who is hospitalized and in traction. The child talks about an invisible friend to the nurse. Which action by the nurse is indicated?

The nurse should recognize this behavior as normal for the child's developmental age and do nothing. Preschool-aged children often interact with imaginary friends. The nurse should recognize this as normal for the age group. No special actions are needed. Page 128

The parents of a 12-year-old girl report their daughter is missing an increasing amount of school. They further share that the child says she feels ill and begs to stay home. What action by the parents will be most therapeutic?

The parents need to attempt to determine why the child is avoiding school.

In teaching caregivers of preschool children, the nurse would reinforce that which of the following would be most important for this age group? a) The preschool child should cover mouth when coughing or sneezing. b) The preschool child should brush and floss teeth after snacks and meals. c) The preschool child should be screened for amblyopia. d) The preschool child should wear a seat belt when riding in a vehicle.

The preschool child should wear a seat belt when riding in a vehicle. Correct Explanation: A major cause of accidents in the preschool child occurs when the child is not properly restrained in a motor vehicle. Safety is the highest priority.

The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that the girl is demonstrating which of the following?

Transduction

Transduction Correct Explanation: The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.

Fear of mutilation is significant during the preschool age.

True

Fear of mutilation is significant during the preschool age.

True Fear of mutilation is significant during the preschool age, as revealed by the intense reaction of a preschooler to even a simple injury such as falling and scraping a knee or having a needle inserted for an immunization. A child cries afterward not only from the pain but also from the intrusiveness of the injury or procedure. Page 134

Fear of mutilation is significant during the preschool age. a) True b) False

True Correct Explanation: Fear of mutilation is significant during the preschool age, as revealed by the intense reaction of a preschooler to even a simple injury such as falling and scraping a knee or having a needle inserted for an immunization. A child cries afterward not only from the pain but also from the intrusiveness of the injury or procedure.

A nurse is developing a teaching plan for parents of preschoolers about how to address the issue of strangers and safety. Which would the nurse expect to include in the teaching? Select all that apply.

Urge children never to talk to or accept a ride from a stranger. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.

The school nurse is teaching a class on sports injuries. What information is most important for the nurse to teach? Play the same sport regularly to become proficient. Little league tackle football is not safe for a school age child. Vary the sports to prevent use injuries. Fractures are minimal due to bone growth and calcification.

Vary the sports to prevent use injuries.

The parents of a 5-year-old call the nurse for advice about night terrors. The child has had them nightly for almost 2 weeks. Which of the following is the most appropriate intervention? a) Wake the child up nightly 30 to 45 minutes after going to sleep. b) Tell the parents to be sure to wake the child up during the next episode. c) Encourage the parents to let the child fall asleep in a safe place such as their bed. d) Explain that this is a developmental phase that will not last.

Wake the child up nightly 30 to 45 minutes after going to sleep. Correct Explanation: Awakening children early in their sleep cycle often interrupts the night terror events and should be continued nightly for about 7 days. Suggesting the parent wake the child during a night terror is both difficult and ineffective. A major reason parents find night terrors frightening is that the child does not respond to the parent's presence. Indicating this is a developmental phase may be somewhat accurate, but does not assist the parents in handling the situation. Having the child fall asleep in a "safe" place or the parents' bed is likely to predispose to other sleep problems without helping to solve this one.

A nurse instructor is educating the parents about activities preschoolers can successfully perform independently. Which activities would the nurse include? Select all that apply.

Washing hands Brushing teeth Dressing self Playing active games

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of these actions? Select all that apply.

When discussing improper behavior, call the behavior "bad" or "naughty," not the child. Anticipate situations likely to cause misbehavior and redirect the child to another activity. Books and stories can help preschoolers master proper behavior. Spanking is the least effective discipline and discouraged by pediatric professionals. If chosen by parents, it should be infrequent and done only with an open hand. Labeling behavior and not the child supports self-esteem. One minute per year of age is an appropriate length for time-outs. Redirecting from events that tend to lead to misbehavior is wise and reduces conflict. Preschoolers can learn much from stories and books including appropriate behavior. p144

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of the following? Select all that apply.

When discussing improper behavior, call the behavior "bad" or "naughty," not the child. • Anticipate situations likely to cause misbehavior and redirect the child to another activity. • Books and stories can help preschoolers master proper behavior.

The nurse is conducting a support group for parents of 9- and 10-year-olds. The parents express concern about the amount of time their children want to spend with friends outside the home. What should the nurse teach the parents that peer groups provide? time to establish relationships with the opposite sex a sense of security as children gain independence time to remain dependent on their parents an opportunity for children to become self sufficient

a sense of security as children gain independence

a sense of security as children gain independence Nine-year-olds take their peer group seriously. They are more interested in how other children dress than what their parents want them to wear. This is the age where groups are formed and others are excluded from the club. This age group is imitating their peers as they develop their own identity and separate from their parents. Groups are fluid as they change regularly due to many reasons: each member lives on the same street, each member plays on the same ball team, or one member has fewer material things than the others, etc. Security is gained through these clubs because it helps the school-age child develop independence away from the family. Most of the time in the school-age child, peer group relationships are with same-sex friends. Children do not become self-sufficient through these clubs. They remain dependent on their families for their physical needs.

The best activity that a preschooler's parents could use to help her achieve the developmental task of the preschool period is to

allow her to experiment with PlayDoh.

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

allow some time every day for the child to talk about new experiences. Beginning school can be a time of extreme stress for children. Allowing them time to discuss these experiences helps them to put experiences in perspective and begin to deal with them. page 159

A group of 10-year-old girls have formed a "girls only" club. It is only open to girls who still like to play with dolls. How should this behavior be interpreted? immaturity for this age group encouragement for bullying and sexism appropriate social development poor peer relationships

appropriate social development

A group of 10-year-old girls have formed a "girls only" club. It is only open to girls who still like to play with dolls. How should this behavior be interpreted?

appropriate social development Ten-year-olds take the values of their peer group seriously. They are interested in being with peers of like mind and activities. Clubs are formed with specific exclusions of peers. Such clubs typically have a secret password and secret meeting place. Membership is generally all girls or all boys. These groups are not based on the immaturity of the children nor do they encourage sexism and bullying.

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. What understanding has this child developed?

conservation Piaget described concrete operational thought occurring in the child ages 7 to 10 years. During this time the child develops various skills to see objects and the world. The skill of conservation is the ability to recognize that a change in shape does not necessarily mean a change in amount or mass. Using reversibility, the child can understand that processes can be reversed or canceled out by other things. Decentration is developed when the child can pay attention to multiple attributes of an object or situation instead of only one. In classification, the child is able to put objects together by shared qualities or characteristics.

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:

conservation.

A type of play seen in the preschool child encourages children to act out troubling situations, such as one that might occur in the hospitalized child who must undergo an upsetting procedure. This type of play is referred to as:

dramatic play

A type of play seen in the preschool child encourages children to act out troubling situations such as those that occur in the hospitalized child who must undergo an upsetting procedure. This type of play is referred to as:

dramatic play. Dramatic play allows a child to act out troubling situations and to control the solution to the problem. This is important to remember when teaching children who are going to be hospitalized. Using dolls and puppets to explain procedures makes the experience less threatening. page 132

What physiological changes would the nurse expect to address in a 10-year-old child? Select all that apply.

eruption of permanent teeth pulse rate 70 to 80 bpm 20/20 vision By 10 years of age, the eye globe reaches its final shape and adult vision is achieved. The eruption of permanent teeth and growth of the jaw correlate with final head growth. The immune globulins IgG and IgA reach adult levels. The left ventricle of the heart enlarges to be strong enough to pump blood to the growing body. As a result, the heart rate decreases to 70 to 80 beats per minute and the blood pressure rises to 112/60 mm Hg.

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?

fifth grade 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 half 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.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:

having the child wear a personal flotation device whenever near or on the water. Preschool children are safe around water only when adult supervision is constant. Wearing a personal flotation device adds additional protection and should be as routine as "buckling up" in the car. At 5 years old, most preschoolers are mature enough to become swimmers; yet knowing how to swim does not make the preschooler safe without supervision. CPR is a life-saving skill and using sunscreen will protect the skin, but neither will be a factor in preventing drowning. Page 140

When planning how to respond to a child about telling stories, you would base your statement on the fact that:

imagination in a 3-year-old is at its peak It is easy for preschoolers to engage in "tall tales" because of their active imagination. page 128

When planning how to respond to a child about telling stories, you would base your statement on the fact that

imagination in a 3-year-old is at its peak.

industry 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.

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

industry versus inferiority.

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

industry versus inferiority. Industry is learning how to do things well, the school-aged developmental task. page 155

The developmental task of preschoolers is to achieve a sense of

initiative versus guilt.

The developmental task of preschoolers is to achieve a sense of

initiative versus guilt. Developing a sense of initiative, or learning how to do things, is the developmental task of the preschool period. p135

A 3 year old wants to do everything independently, including putting on shoes. Every day, no matter how hard he tries, he puts the shoes on the wrong feet until finally he is successful. According to Erikson, what developmental task is this child trying to master? a) industry vs. inferiority b) trust vs. mistrust c) autonomy vs. shame d) initiative vs. guilt

initiative vs. guilt Correct Explanation: The developmental task of the preschooler, according to Erikson, is initiative vs. guilt. The others are not associated with the preschooler.

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? sweet potato quinoa kale oatmeal

kale

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?

kale 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.

The elementary school teachers are in a class on bullying taught by the school nurse. The nurse encourages the teachers to look for common traits of bullies. What are these traits? Select all that apply. large physical size economically deprived permissive parents becomes angry at small issues poor school grades

large physical size becomes angry at small issues permissive parents

Teaching a group of caregivers about the topic of nutrition, one caregiver tells the group, "I use desserts as a reward for good behavior." A person in the group asks the nurse what she thinks about that idea. Which statement by the nurse would be the most appropriate? Using dessert as a reward for good behavior may cause the child to:

learn to use food to manipulate others' behavior. Food should never be used as a reward or bribe; otherwise, the child will continue to use food as a means to manipulate the environment and the behavior of others. Because of the high fat and sugar content of most desserts, the nutritional value of desserts is usually less than a balanced diet of healthier foods and could add to the concern of obesity in some children. A child might prefer sweets over nutritious foods and behave differently if dessert were a reward, but these choices are not the most appropriate answer. page 141

A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to:

make her child attend school every day.

A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to:

make her child attend school every day. 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. page 172

The Boy Scouts is an organization that continues to be a favorite with school-aged boys because:

merit badges require completing small tasks for rewards. An organization that allows school-aged children to complete small tasks and receive rewards helps develop a sense of industry.

The most important safety precaution for parents to teach preschoolers is:

not to ride in a car with strangers

During a well-child check at the ambulatory clinic, the mother of a 10-year-old boy reports concerns about her son's frequent discussions about death and dying. Based upon knowledge of this age group, the nurse understands that: preoccupation with death and dying is common in the school-aged child. consistent thoughts of death and dying at this age lead to the later development of depression. discussing death and dying may hint at a psychological disorder. at this age, children are not afraid of death.

preoccupation with death and dying is common in the school-aged child.

preoccupation with death and dying is common in the school-aged child. School-aged children are often preoccupied with thoughts of death and dying. There is no indication these thoughts will lead to mental health issues or the development of depression. School-aged children fear death but are fascinated by death and dying. page 159

A mother tells a nurse that her child has recently established some friendships for the first time. In which age group do you expect this child to be? a) school age b) preschool c) adolescence d) toddler

preschool Correct Explanation: The preschool child begins to develop friendships.

A mother tells the nurse she is having difficulty getting her 6-year-old to do chores. Based on the child's developmental level, what activity would be best for the nurse to recommend to the mother? vacuuming putting books on shelf folding clothes raking leaves

putting books on shelf

A mother tells the nurse she is having difficulty getting her 6-year-old to do chores. Based on the child's developmental level, what activity would be best for the nurse to recommend to the mother?

putting books on shelf School age children need rewards for their accomplishments. Small chores which can be completed quickly give this type of reward. Children can survey their finished work and see they have done a good job. Picking up toys or putting books on the shelf offers a reward because children can clearly see the result of their work. Vacuuming is a chore children do not necessarily like because once finished the rug looks the same before they started. There is no reward for the process. Raking leaves serves as only a temporary reward because even though the child can see the result of the leaves in a pile the leaves still need to be bagged or disposed. Folding clothes also offers small reward because for many 6-year-olds larger pieces of clothing can be too cumbersome to fold correctly and they are not rewarded as the clothes still need to be put away.

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

she may need to remind him of property rights. 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. Page 172

testing and identification of group role. Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel. Page 132

transduction. The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings. Page 128

The nurse is performing a physical assessment of an 11-year-old boy. The nurse notes that during last year's checkup the child weighed 80 lb (36.3 kg). Which assessment finding at this year's check-up is most concerning?

weight in the 5th percentile A child in the 5th percentile for weight is most concerning. At the last year check-up, the child was 10 years old with a weight of 80 lb (36.3 kg), which placed the child in between the 75th and 90th percentile for weight. A sudden decrease in percentile within a one year time frame indicates a potential problem with growth or nutrition. From 6 to 12 years of age, an increase of 3 to 7 lb (1.3 to 3.5 kg) on average per year in weight is expected. A BMI of 20 is considered healthy. A height of 56 in (140 cm) is near the 50th percentile and considered normal.

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Parents of a preschooler tell the nurse that their child often refuses to go to sleep at night. Which suggestion by the nurse would be helpful? Select all that apply.

• "Try using a night light in the child's room." • "Set up some familiar bedtime rituals for your child." • "Avoid having your child watch frightening shows on TV before bedtime." • "Try reading a favorite story before bedtime."

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of the following? Select all that apply. a) Books and stories can help preschoolers master proper behavior. b) A time-out of about 8 minutes would be appropriate for intentional misbehavior. c) When discussing improper behavior, call the behavior "bad" or "naughty," not the child. d) Anticipate situations likely to cause misbehavior and redirect the child to another activity. e) Spank with an open hand only and never with an object.

• Books and stories can help preschoolers master proper behavior. • When discussing improper behavior, call the behavior "bad" or "naughty," not the child. • Anticipate situations likely to cause misbehavior and redirect the child to another activity. Correct Explanation: Spanking is the least effective discipline and discouraged by pediatric professionals. If chosen by parents, it should be infrequent and done only with an open hand. Labeling behavior and not the child supports self-esteem. One minute per year of age is an appropriate length for time-outs. Redirecting from events that tend to lead to misbehavior is wise and reduces conflict. Preschoolers can learn much from stories and books including appropriate behavior.

The nurse is providing teaching about car seat safety for a parents' meeting at the preschool their children attend. Choose the points the nurse should make. Select all that apply.

• Children who weigh less than 40 pounds should use a car seat with harness and top tether. • Many car seats are installed improperly, making them unsafe. • The back seat remains the safest place for children to ride. • Booster seats should be used with both a shoulder and lap belt.

A mother describes her 4-year-old girl's eating habits as "picky" and goes on to describe using wheedling, coaxing, and threatening measures to get her to eat. The nurse determines the child is growing normally. What interventions will be suggested? Select all that apply.

• Offer a variety of healthy foods including those liked and refused. • Approach mealtime matter-of-factly. • Allow the child to decide how much she will eat. • Ignore the pickiness. • Offer only nutritious between-meal snacks. • Focus on quality, not quantity.

A nurse is instructing a young mother on how to ensure a safe bath time for her 4-year-old son. Which of the following are important suggestions for the nurse to give to the mother? (Select all that apply.)

• Turn down the temperature of the water heater to under 120°F • Do not leave the child unsupervised in the bath tub • Assist the child in cleaning under fingernails and around ears

The nurse is providing teaching about preventing poisoning. Which of the following statements by the mother would warrant further discussion?

"All medicine in our bathroom is in childproof containers."

The nurse is providing teaching about preventing poisoning. Which statement by the mother would warrant further discussion?

"All medicine in our bathroom is in childproof containers." The nurse should emphasize that while childproof caps on medications are important, all medications including those with childproof caps should still be kept locked. (Vitamins are medications.) The other statements are correct. Page 139

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

"Are you able to supervise her brushing?"

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

"Are you able to supervise her brushing?" The number one dental problem in middle childhood is tooth decay. Until age seven, the child may need assistance brushing their teeth. Children tend to concentrate on the front teeth, because they can see them easily and "forget" the teeth in the back. Parental oversight is needed to be sure those overlooked are brushed carefully.

A 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? "Did you teach your child how to brush the teeth?" "What type of toothbrush does your child use?" "Are you able to supervise your child's brushing?" "Is there fluoride toothpaste available for use?"

"Are you able to supervise your child's brushing?"

The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. Which suggestion should be part of the nurse's advice?

"As parents, you need to be good role models."

The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. Which suggestion should be part of the nurse's advice?

"As parents, you need to be good role models." The nurse would recommend that the parents be good role models and quit smoking. Locking up or hiding your cigarettes and going outside to smoke is not as effective as having a tobacco-free environment in the home. Page 170

The mother of a 4-year-old girl reports her daughter has episodes of wetting her pants. The nurse questions the mother about the frequency. The nurse determines these episodes occur about once every 1 to 2 weeks. Which response by the nurse is indicated?

"At this age it is helpful to remind children to go to the bathroom." Preschool-aged children may become occupied with activities around them and not remember to void. Reminding them to void is helpful. Discipline should not be applied to infrequent episodes of incontinence. There is no indication the child has an infection. page 127

The parents of a 5-year-old tell the student nurse, "Our daughter takes after her father's lack of athletic ability. We have worked with her but she can't seem to throw a ball at all when we are playing with her." Which responses by the student are not appropriate? Select all that apply.

"Athletic ability is often hereditary, so it is good you are aware of her lack of athleticism while she is young." "I know how annoying that has to be. Neither my brother nor I have any athletic ability and neither do our parents." "I am sure she will catch on as she plays with more children and when she starts taking physical education classes at school. "Enrolling your daughter in a preschool softball or baseball program might help her athletic and motor skills." While at 4 years of age a child typically cannot throw a ball overhand, they are developmentally able to throw a ball by other means, such as underhand or side-handed. It is necessary to address this as a possible developmental delay and be sure the pediatrician is aware of the issue. page 135

A nurse is caring for a 4-year-old girl. The parents indicate that their daughter often reports that objects in the house are her friends. They are concerned because the girl says that the grandfather clock in the hallway smiles and sings to her. Which response by the nurse is best?

"Attributing life-like qualities to inanimate objects is quite normal at this age." The nurse should explain to the parents that attributing life-like qualities to inanimate objects is quite normal. Telling the parents that their daughter is demonstrating animism is correct, but it would be better to explain what animism is and then remind them that it is developmentally appropriate. Asking whether they think their daughter is hallucinating or whether there is a family history of mental history is inappropriate and does not teach. page 128

The nurse is talking with the parents of an 8-year-old child who has been cheating at school. Which comment by the nurse would be appropriate as a first step? "Punishment should be subtle to allow the child to confess to cheating and lessen the behavior." "If cheating is noted at this age, referral to a family counselor is highly recommended." "Be sure the adults in the child's life, including you, as parents, demonstrate positive behavior." "Perhaps the academic environment is too easy for your child, causing the cheating."

"Be sure the adults in the child's life, including you, as parents, demonstrate positive behavior."

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? "Learning to ride the bike will improve her coordination." "Teach her where she'll land on the grass if she falls." "Be sure to get the proper size bike." "She won't need a helmet if she has training wheels."

"Be sure to get the proper size bike."

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

"Be sure to get the proper size bike." 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. Page 165

A first-time father calls the pediatric nurse stating he is concerned that his 4-year-old daughter still wets the bed almost every night. Remembering his own experience of being punished for wetting the bed at 4 years old, he is not sure punishment is the best approach to address this. Which nursing instruction is the most appropriate?

"Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration."

The parents of a 10-year-old girl voice concern to the nurse because their daughter seems to "have a higher amount of body fat" than they expect based on the healthy eating habits and high activity level of the family. What is the best response by the nurse?

"Before adolescence the body fat composition of school-age children increases earlier and in greater amounts in girls than in boys."

"Before adolescence the body fat composition of school-age children increases earlier and in greater amounts in girls than in boys." Boys have more lean body mass per inch of height than girls during the late school-age years, in preparation for adolescence. page 166

The father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is most appropriate?

"Both your son's height and rate of growth are within normal limits for his age." The average 4-year-old child is 40.5 in (103 cm). The average rate of growth per year is between 2.5 and 3 in (6.35 and 7.62 cm). The child in the scenario demonstrates normal stature and growth patterns. pg 127

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?

"Boys bully more often but girls are more likely to be bullied."

The parents of an 8-year-old boy report their son is being bullied and teased by a group of boys in the neighborhood. Which response by the nurse is best?

"Bullying can have lifelong effects on the self-esteem of a child." The child can be permanently scarred by negative experiences such a bullying. Activities such as self-defense and sports can promote a sense of accomplishment but don't relate directly to the problem of bullying. There is no indication the child in the scenario will become a bully. page 173

"By the age of 6 most children can print some letters and maybe their first name."

The caregiver of a 6-year-old tells the clinic nurse that he is concerned that his child cannot yet print his first and last name; the caregiver is wondering if this is normal. Which response by the nurse would be most appropriate?

"By the age of 6 most children can print some letters and maybe their first name."

"By the age of 6 most children can print some letters and maybe their first name." The 6-year-old can print a few letters or numbers and may be able to print their own name.

The caregiver of a 6-year-old tells the clinic nurse that he is concerned that his 5-year-old child cannot yet print his first and last name, and the caregiver is wondering if this is normal. Which of the following responses by the nurse would be most appropriate? a) "Some children this age cannot hold a pencil or crayon well enough to write legibly." b) "Usually by the age of 6, most children can write numbers up to nine, but no letters." c) "It is not unusual for children of this age to be writing their first name in cursive." d) "By the age of 6 most children can print some letters and maybe their first name."

"By the age of 6 most children can print some letters and maybe their first name." Correct Explanation: The 6-year-old can print a few letters or numbers and may be able to print their own name.

The mother of a 6-year-old is asking the nurse how to handle the child's lying and fabricated stories when confronted with questionable actions. Which response would be most appropriate by the nurse? "The child should have privileges taken away for several days each time he tells a lie." "Is there any possibility he is telling the truth and you just don't know it is the truth?" "Your child could be in serious trouble in school if he continues to tell lies." "Children this age sometimes can't distinguish between fantasy and reality."

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

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

"Children this age sometimes can't distinguish between fantasy and reality." Children in the age group 6 to 7 years often engage in magical thinking. They may still believe in the tooth fairy, Santa Claus, monsters under the bed, and other imaginary characters. These children's keen imaginations may also conjure up fears, especially at night, about remote, fanciful, or imaginary events. If a child of this age has trouble distinguishing fantasy from reality, it may incline them to lie to escape punishment or to boost self-confidence. The other choices do not consider this child's stage of development or give the mother the most appropriate information for the situation. Page 171

The parents of an 11-year-old are discussing having their child come home after school alone rather than continue attending after-school care. They ask the nurse about the implications of making this decision. What should be included in the information provided by the nurse? Select all that apply. "Children who are considered "latch key kids" are at an increased risk for engaging in risky behaviors." "Laws do not support children under the age of 15 years being left home alone." "Maturity and not age should be considered when deciding when a child is ready to stay home alone." "It is recommended that children interact daily with others of a similar age." "Children who do not come home to an adult do not perform as well in school."

"Children who are considered "latch key kids" are at an increased risk for engaging in risky behaviors." "Children who do not come home to an adult do not perform as well in school." "Maturity and not age should be considered when deciding when a child is ready to stay home alone."

The nurse is presenting information about school-aged children at a community event. Which statement should the nurse prioritize for further teaching and providing more information? "Sometimes we have to be firm, but our children wash their hands before eating." "Even if the weather is cool and cloudy, our children play outside every day." "I make sure they have good teeth by giving them calcium and phosphorus." "Food is so expensive, we always make our children eat everything on their plates."

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

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

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

The nurse is teaching a group of school-aged children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?

"Girls typically experience a rapid growth spurt before boys." Girls typically experience a rapid growth spurt before boys, and are usually taller by about 2 in (5 cm) or more than preadolescent boys. During the school-age years, the child will grow approximately 1 to 2.5 in (2.5 to 6.25 cm) per year. As puberty approaches, there will be significant differences in development between boys and girls. The first sign of puberty for girls is breast changes, not menarche.

A 12-year-old child tells the school nurse, "I do not understand why my parents will not allow me to go to concerts without chaperones like some of my friends' parents. I feel like a baby compared to my friends." How will the nurse respond? "You are so young that you have plenty of time to go to concerts alone. Your parents care about you." "Your parents are right. Twelve years of age is too young to be attending concerts without a chaperone." "I am sure your parents are worried about your safety when attending concerts at a young age." "Have you given any thought to why they do not let you go without a chaperone?"

"Have you given any thought to why they do not let you go without a chaperone?"

The nurse is conducting a well-child exam of a 4-year-old boy. Which of the following statements would alert the nurse that the child is at risk for iron deficiency?

"He loves milk and drinks it every time he is thirsty."

The nurse is conducting a well-child exam of a 4-year-old boy. Which statement would alert the nurse that the child is at risk for iron deficiency?

"He loves milk and drinks it every time he is thirsty."

The nurse is conducting a well-child exam of a 4-year-old boy. Which statement would alert the nurse that the child is at risk for iron deficiency?

"He loves milk and drinks it every time he is thirsty." This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency. Page 140

The nurse is conducting a well-child exam of a 4-year-old boy. Which of the following statements would alert the nurse that the child is at risk for iron deficiency? a) "He eats a well-balanced diet." b) "He does not like spinach, but he does like chicken and beef." c) "He loves milk and drinks it every time he is thirsty." d) "He enjoys eggs and fortified cereal for breakfast."

"He loves milk and drinks it every time he is thirsty." Correct Explanation: This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency.

"He tries to sweep up cereal his brother spilled but cries when he can't do it well."

The mother of a preschool-age child is discussing normal development with the pediatric nurse. The nurse explains the developmental milestone of initiative. Which statement by the mother might be an example of this developmental milestone?

"He tries to sweep up cereal his brother spilled but cries when he can't do it well." According to Erikson, the developmental task of the preschool age is initiative versus guilt. Preschoolers often try to find ways to do things to help, but they may feel guilty if scolded when they fail because of inexperience or lack of skill. Family caregivers need to remember that preschoolers are developing initiative and a sense of guilt. They want to be good and follow instructions; they feel bad when they do not, even if they are not physically punished. Imaginary playmates are common in the preschool child, but blaming the incident on the imaginary playmate or refusing to hold the mother's hand does not show initiative. A younger child would commonly show anxiety when being left by the caregiver.

The mother of a preschool-age child is discussing normal development of this age child with the pediatric nurse. The nurse explains the developmental milestone of initiative. The mother makes the following statements about her son. Which statement is an example of what might be this developmental milestone? a) "When I leave him with a babysitter he gets upset, but she says he still does what she asks him to do." b) "He refuses to hold my hand while we are crossing the street." c) "He tries to sweep up cereal his brother spilled but cries when he can't do it well." d) "He broke my favorite plate but blamed it on some friend he called Paul, but we don't know anyone named Paul."

"He tries to sweep up cereal his brother spilled but cries when he can't do it well." Correct Explanation: According to Erikson, the developmental task of the preschool age is initiative versus guilt. Preschoolers often try to find ways to do things to help, but they may feel guilty if scolded when they fail because of inexperience or lack of skill. Family caregivers need to remember that preschoolers are developing initiative and a sense of guilt. They want to be good and follow instructions; they feel bad when they do not, even if they are not physically punished. Imaginary playmates are common in the preschool child, but blaming the incident on the imaginary playmate or refusing to hold the mother's hand does not show initiative. A younger child would commonly show anxiety when being left by the caregiver.

A young hospitalized patient cries constantly for daddy even though her mother has not left her side. When talking to the child's mother, the nurse learns that the 4 year old wants only her father. The child has even told her mother that she hates her on numerous occasions. What would be the best response by the nurse to support this mother?

"Her behavior is normal for her age. She will outgrow it."

The parents of a 7-year-old tell the nurse that they are concerned that their child has attention deficit activity disorder (ADHD) because he can't seem to stay focused when playing in a baseball game. What questions/comments by the nurse are appropriate? Select all that apply.

"How is his attention span during school?" "Do you notice him getting distracted in other activities, like bicycling?"

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

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? "Does your son speak in complete sentences all the time?" "Would you say your son has a vocabulary of about 900 words?" "How well does your son communicate or follow instructions?" "Is your son's speech clear enough that anyone can understand it?"

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

"How well does your son communicate or follow instructions?" 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 statement made by the caregivers indicates the best understanding of factors that contribute to obesity?

"I always cook foods that are low in fat."

"I am 6 years old and I walk my younger brother to the park that is 5 blocks from our house." My friends and I like to walk on the side of the road because our sidewalk is very uneven." "I think it is funny to hide behind my dad's car before he leaves for work and scare him."

The school nurse asks a group of school-age children about pedestrian safety. Which comments by the children should the nurse address with either the child or parents of the child? Select all that apply. "My mom always says she looks around really well to be sure I'm not playing behind our car before she leaves." "I always remind my sister to look right, then left, then right again before we cross the street." "I am 6 years old and I walk my younger brother to the park that is 5 blocks from our house." My friends and I like to walk on the side of the road because our sidewalk is very uneven." "I think it is funny to hide behind my dad's car before he leaves for work and scare him."

The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education?

"I am so glad I can get rid of all of those bath toys because they take up so much room." Bath toys that squeak, float and squirt are appropriate toys for preschoolers. Creative toys like crayons, chalk and finger paints; gross motor toys like tricycles, big wheels and swing sets; and a sandbox with shovels and other toys for building are also appropriate toys for preschoolers. page 137

The school nurse is the guest speaker in a classroom of fourth-grade children. 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 statement 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." For the school-age child, an adequate intake of milk is 3 cups per day.

The nurse is doing teaching with a group of caregivers of preschool children on various topics. The topic of sexual development is discussed. Which statement made by the caregivers indicates an understanding of the sexual development of the preschool-age child?

"I feel better knowing that what she is doing is normal." The child's sexual curiosity is a normal, natural part of total curiosity about oneself and the world. Exploration of the genitalia is natural for the preschooler. It is one way the child learns to perceive the body as a possible source of pleasure and is the beginning of the acceptance of sex as natural and pleasurable. Caregivers can be reassured that this is not uncommon behavior. Page 145

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."

The parents of a 6-year-old tell the school nurse that they are worried that their child will fall behind other children academically because they are not able to afford expensive toys like computer games and handheld electronic devices. Which are acceptable responses by the nurse? Select all that apply.

"I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." "All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." "Do you play with your child and provide means of play through things like dolls, puzzles, crayons,and Play-Doh? These are the types of toys suggested for preschoolers." Expensive and elaborate toys do not place a child at an academic or developmental advantage. Simple toys that require interactive rather than passive play, and that may include the involvement of the parent, are recommended to foster development.

The mother of a 4-year-old reports using time-outs as a means for disciplining the child. Which statement by the mother would require the nurse to provide additional teaching?

"I usually have him in time-out for about 10 minutes."

The mother of a 4-year-old reports using time-outs as a means for disciplining the child. Which statement by the mother would require the nurse to provide additional teaching?

"I usually have him in time-out for about 10 minutes." A time-out should be timed appropriately. The time-out should occur at the time the offense occurred, to ensure the child relates the offense (the behavioral problem) to the time-out period. Brief time-outs are more effective than very long ones, because a long time-out enables the child to redirect attention from calming down to being resentful. The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. A time-out should end as soon as the child is calm. Time-outs do not have to occur in the child's room; any location where the child is removed from activity and has an opportunity to become calm will do. Page 144

The mother of a 4-year-old reports using time-outs as a means for disciplining the child. Which statement by the mother would require the nurse to provide additional teaching? a) "He is allowed out of time-out when he is calm." b) "I put him in time-out when the problem occurs." c) "I usually have him in time-out for about 10 minutes." d) "The time-out doesn't just have to be in his room."

"I usually have him in time-out for about 10 minutes." Correct Explanation: A time-out should be timed appropriately. The time-out should occur at the time the offense occurred, to ensure the child relates the offense (the behavioral problem) to the time-out period. Brief time-outs are more effective than very long ones, because a long time-out enables the child to redirect attention from calming down to being resentful. The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. A time-out should end as soon as the child is calm. Time-outs do not have to occur in the child's room; any location where the child is removed from activity and has an opportunity to become calm will do.

The nurse is teaching a group of school-age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching? "There are not many physical differences among school age boys." "I will have improved gross motor skills." "I will appear heavier due to an increase in fat production." "I will grow an average of 2.5 in (6.5 cm) per year."

"I will grow an average of 2.5 in (6.5 cm) per year."

The nurse is teaching a group of school-age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?

"I will grow an average of 2.5 in (6.5 cm) per year." During the school-age years, the child will grow an average of 2.5 in (6.5 cm). As puberty approaches, there will be significant differences in development between boys and girls. As development occurs, weight does increase, but it is not directly related to fat production. This is an area where much education needs to occur with young girls because "dieting" can be detrimental to the child's health and increased size is tied to the child's body image and self-esteem. By 10 years of age, brain growth is complete, and fine motor coordination is refined.

The father of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which of the following statements by the father would indicate a need for further teaching?

"I will need to find an appropriate punishment for him if this continues."

The father of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the father would indicate a need for further teaching?

"I will need to find an appropriate punishment for him if this continues."

The father of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the father would indicate a need for further teaching?

"I will need to find an appropriate punishment for him if this continues." The nurse should remind the father that overreaction to this behavior may cause it to occur more frequently. Masturbation at this age should be treated matter-of-factly. The other statements are correct. Page 132

The nurse has completed an education program on normal communication abilities in the preschool child. Which statement by a participant indicates a need for further education?

"I'm concerned that my 5-year-old can only count to 20." Normal communication abilities for a 5-year-old include counting to 10, not 20. It also included stating their name and address. Normal communication abilities in the 4-year-old include asking lots of questions and counting only a few numbers. Page 132

The nurse is discussing the topic of nutrition with a group of caregivers of preschoolers. Which statement by the caregivers is most accurate regarding nutrition in the preschooler?

"If I give snacks throughout the day, my child can meet her nutritional requirements." The preschool period is not a time of rapid growth, so children do not need large quantities of food. Protein needs are high to provide for muscle growth. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. The preschool child needs 2 to 3 cups of milk each day. page 141

The nurse is discussing the topic of nutrition with a group of caregivers of preschoolers. Which of the following statements made by the caregivers is most accurate regarding nutrition in the preschooler? a) "It is hard for me to get my child to drink the 4 cups of milk he needs each day." b) "My child is growing so rapidly, she needs to eat three big meals a day." c) "It is important for me to give my child calcium so his muscles will grow." d) "If I give snacks throughout the day, my child can meet her nutritional requirements."

"If I give snacks throughout the day, my child can meet her nutritional requirements." Correct Explanation: The preschool period is not a time of rapid growth, so children do not need large quantities of food. Protein needs are high to provide for muscle growth. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. The preschool child needs 2 to 3 cups of milk each day.

During an extended stay in a hospital the nurse has observed a 5-year-old having several temper tantrums. How should the nurse address this behavior with the parents?

"Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." Typically temper tantrums are few or absent in occurrence by the time the child is of preschool age. Asking if this is typical behavior at home is appropriate in determining if this is just aggressive behavior or if this is a sign of a developmental delay. It is generally not necessary to discipline a child for temper tantrums and disciplining is not in the nurse's scope of practice. Page 134

The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which general question would the nurse direct to the child's parents? "What beverages are preferred?" "How important is exercise?" "Is breakfast eaten regularly?" "Is there a family history of hypertension, heart disease, or diabetes?"

"Is there a family history of hypertension, heart disease, or diabetes?"

The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which general question would the nurse direct to the child's parents?

"Is there a family history of hypertension, heart disease, or diabetes?" 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 page 166

A 10-year-old child tells the school nurse that she is embarrassed that she is afraid of the dark. Which is the best response by the nurse? "I was afraid of the dark at your age. You will grow out of that fear soon." "Are you afraid that something is going to happen to you or that something or someone may be outside that you can't see?" "That is so horrible that you are afraid of the dark. Can you sleep at night at all?" "It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?"

"It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?"

The mother of a 5-year-old kindergarten student tells the school nurse she is concerned that her son doesn't seem to be able to pronounce words correctly that begin with the letters "th" and "r." What is the best response by the nurse?

"It is very common for children 6 years and younger to have difficulty with these sounds, but I will let our speech therapist know so it can be monitored." It is not unusual for children over the age of 6 to have difficulty with several different letters. The nurse is correct in notifying the speech therapist so that the child's speech can be monitored. There is no indication of the child being attention seeking or of this being a critical issue so these statement by the nurse are not appropriate. 131

A father tells the nurse that his son has been asking questions about his genitals. The father states that he is unsure how to answer the questions of a 4-year-old. How should the nurse respond?

"It's best to answer his questions using accurate anatomical names and keep your answers simple." It is suggested to keep answers brief and use correct anatomical names of body parts. Offering this advice to the father will help guide him in how to address questions. It is not necessary to go into the detail of using books with pictures for children of this age. page 133

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

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

The mother of a 4-year-old child is concerned that she caught him masturbating in the bath tub. Which is the most appropriate response by the nurse?

"Masturbation is a normal part of preschool development."

The mother of a 4-year-old child is concerned that she caught him masturbating in the bath tub. Which is the most appropriate response by the nurse?

"Masturbation is a normal part of preschool development." Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. The nurse can and should educate the mother on normal growth and development, including sexual issues. Page 145

The nurse is educating a group of parents about childhood nutrition, specifically caloric needs. Which statement, when made by a parent, indicates teaching was successful?

"My 12-year-old child, who plays soccer, needs to consume no more than 2,000 calories a day to maintain good health." Boys and girls 4 to 8 years old who are moderately active will need about 1,400 to 1,600 calories per day. Boys 9 to 13 years old who are moderately active need about 1,800 to 2,000 calories a day and girls 9 to 13 years old who are moderately active need about 1,600 to 2,000 calories a day. Approximately 45% to 65% of calories should come from carbohydrates.

The nurse is discussing nutrition choices with a group of parents of 10- to 12-year-old children. The nurse determines that the discussion was successful based on which statements by a parent? Select all that apply.

"My 12-year-old son, who plays soccer, needs to consume around 2,000 calories a day to maintain good health." "The highest percentage of my child's diet should come from carbohydrates."

A school nurse has completed an educational program for parents of the preschool children. Which statement by a participant indicates a need for further education?

"My 5-year-old son still needs me to dress and undress him." Dressing and undressing without assistance is an expected motor skill in a 5-year-old. Four-year-olds should be able to use scissors without assistance. Hopping on one foot is an expected motor skill for a 4-year-old. Learning to skate and swim are normal motor skills for 5-year-olds. Page 135

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by the caregivers best indicates a common aspect of the diet and nutrition of the preschool child?

"My child is so picky and eats the same thing every day for days on end!" The preschooler's appetite is erratic; at one sitting the preschooler may devour everything on the plate, and at the next meal he or she may be satisfied with just a few bites. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks.

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 stays up late when she takes a nap after school." "My child does not even know when he is tired." "My teenage child does not sleep as much as my 9-year-old does." "My child sleeps between 11 and 12 hours a night."

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

"My child sleeps between 11 and 12 hours a night." Sleep for the school-age child varies with the age of the child. A child between the ages 6 to 8 years needs 12 hours of sleep each night. The child between the ages of 8 to 10 years needs 10 to 12 hours of sleep each night. The 10 to 12 year old needs 9 to 10 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.

"My child sleeps between 11 and 12 hours a night." 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. page 168

A nurse is assisting in a parent education class on accident prevention. Which statement by a parent indicates that further education is needed?

"My son should can let his friend ride as a passenger on his bicycle as long as they both wear helmets." Children should be taught ways to stay safe and prevent accidents. All children should wear bicycle helmets; however, unless the bicycle has a sidecar, the bike riding is safe for only one rider. The parents are correct that their children should learn their names and addresses, should not set up a meeting with a person they met on the Internet without parental supervision, and should wear a life jacket when boating.

A nurse is assisting in a parent education class on accident prevention. Which statement by a parent indicates that further education is needed? "I will teach my daughter her full name and phone number." "I will teach my child that policemen are our friends and to they are there to help us." "We will be sure that our child wears a life jacket the next time we go to the lake boating." "My son should only wear his helmet when he goes on long rides around the neighborhood."

"My son should only wear his helmet when he goes on long rides around the neighborhood."

The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse? "Normal growth and development for this age results in an average weight gain of 7 pounds per year." "I understand why you are concerned. Is your child sedentary quite a bit? Encouraging activity may limit weight gain." "Your child doesn't seem to be overweight, so it isn't a concern." "We see most children of this age in our clinic gaining similar amounts."

"Normal growth and development for this age results in an average weight gain of 7 pounds per year."

"Normal growth and development for this age results in an average weight gain of 7 pounds per year." Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight. Simply comparing them to other children seen in the clinic doesn't mean it is a normal expectation. While activity is important, the nurse must first address the parent's concern. Page 154

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?

"Now is the time to let him choose some of his meals."

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which of the following statements made by the caregivers best indicates a common aspect of the diet and nutrition of the preschool child? a) "Our child gets into food jags where she will only eat one food all day long." b) "My husband is insistent that our 5-year-old not eat any snacks so he will eat he all of his meals at mealtime." c) "My 4-year-old eats as much as my adolescent does every day." d) "One day my child will eat everything on his plate, the next day he will eat almost nothing."

"One day my child will eat everything on his plate, the next day he will eat almost nothing." Correct Explanation: The preschooler's appetite is erratic; at one sitting the preschooler may devour everything on the plate, and at the next meal he or she may be satisfied with just a few bites. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks.

"Play helps children to develop cognitively, socially, physically, and emotionally."

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? "Wow, that is a lot of stuff for a girl her age." "Play helps children to develop cognitively, socially, physically, and emotionally." "It is understandable not playing any more with all these other activities." "All of these other activities teach you as much as traditional play."

"Play helps children to develop cognitively, socially, physically, and emotionally."

"Play helps children to develop cognitively, socially, physically, and emotionally." 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.

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

The parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond? "Remind your daughter of the importance of proper oral hygiene." "Remind her in simple terms what will happen in the dentist's office." "Wait to tell her about the visit until just before the appointment." "Tell your daughter that it is just like going to see the pediatrician."

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

"Remind her in simple terms what will happen in the dentist's office." 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. page 159

The nurse is preparing a safety presentation for a health fair for families. Which instruction should the nurse prioritize when illustrating car safety and the family?

"Set a good example. Wear your own seat belt every time you drive."

The nurse is providing teaching to the mother of a 4-year-old girl about bike safety. Which statement by the mother indicates a need for further teaching?

"She can ride on the street if I am riding with her."

The nurse is providing teaching to the mother of a 4-year-old girl about bike safety. Which statement by the mother indicates a need for further teaching?

"She can ride on the street if I am riding with her." The preschooler is not mature enough to ride a bicycle in the street even if riding with adults, so the nurse should emphasize that the girl should always ride on the sidewalk even if the mother is riding with her daughter. The other statements are correct. page 139

The parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares?

"She screams and thrashes when we try to touch her." During a night terror, a child is typically unaware of the parent's presence and may scream and thrash more if restrained. During a nightmare, a child is responsive to the parent's soothing and reassurances. The other statements are indicative of a nightmare. page 143

The nurse is conducting a health screening of a 5-year-old boy as required for kindergarten. The boy is fearful about going to a new school. The mother asks for the nurse's advice. Which response by the nurse is best?

"Talk to your son's new teacher and schedule a tour with him." The nurse should encourage the mother to schedule a meeting with the teacher prior to school's start date and set up a time to tour the classroom and school so the boy knows what to expect. The other statements are not helpful and do not address the mother's or boy's concerns. page 134

A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond? a) "Are you spoofing me?" b) "Tell me about Boo-ga-loo." c) "Where did you get that funny name?" d) "I don't see anyone."

"Tell me about Boo-ga-loo." Correct Explanation: The imaginary friend serves as a companion and playmate for the preschooler. The child knows this friend is not real, yet is very invested in the imaginary playmate who can be and do anything the child's fantasy life can invent. The nurse should acknowledge this friend, not minimize the friend's importance. "Tell me..." does this. The other responses do not.

The nurse is conducting a physical examination of a young preschooler and detects the odor of tobacco smoke on the parents' hair and clothing. How should the nurse respond?

"Tell me about your child's exposure to tobacco smoke."

The nurse is conducting a physical examination of a young preschooler and detects the odor of tobacco smoke on the parents' hair and clothing. How should the nurse respond? a) "Are you aware that exposure to tobacco smoke can be associated with behavioral difficulties?" b) "You should stop smoking around your child." c) "Tell me about your child's exposure to tobacco smoke." d) "Tobacco smoke is linked with an increased number of ear infections."

"Tell me about your child's exposure to tobacco smoke." Correct Explanation: The nurse needs to emphasize that parents should protect their child from all tobacco smoke. It is best to ask an open-ended question to determine who uses tobacco products or where exposure to tobacco smoke could be occurring. The nurse should not assume that the parents are smokers and telling them to stop is inappropriate. Telling the parent tobacco smoke can be linked to ear infection and behavioral difficulties is true but is unlikely to open a dialogue.

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention?

"The school is quite structured and advocates corporal punishment." The nurse needs to emphasize that there are number of reasons that a parent should not choose a preschool that utilizes corporal punishment. It may negatively affect a child's self-esteem as well as ability to achieve in school. It may also lead to disruptive and violent behavior in the classroom and should be discouraged. The other statements would not warrant further discussion or intervention. Page 138

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

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

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

"The values of the family will likely prevail for your son."

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

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? "I see now we need to use a fluoride toothpaste for our child." "I guess we better look for a pediatric dentist for our son." "These are only his baby teeth so we are not worried." "I guess we will need to supervise our son while he brushes."

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

Parents of a preschooler tell the nurse that their child often refuses to go to sleep at night. Which suggestion by the nurse would be helpful? Select all that apply.

"Try using a night light in the child's room." "Set up some familiar bedtime rituals for your child." "Avoid having your child watch frightening shows on TV before bedtime." "Try reading a favorite story before bedtime." Preschoolers may refuse to go to sleep because of fear of the dark. A night light, screening out frightening stories or TV shows, and using familiar bedtime routines, including reading a favorite story, can help. Keeping the door closed and the lights off would only help to promote the child's fear. Page 143

The mother of a 4-year-old tells the nurse that she is frustrated because all she seems to do lately is fight with the child over what the child wants to eat and wear. The mother says that she sometimes wants to spank the child for always disagreeing. What would be the best suggestion for the nurse to make to this mother?

"Use the time-out technique for discipline." Preschoolers have definite opinions, which may bring them into opposition with parents. The best thing to do during these struggles is to guide the child through without discouraging his or her right to an opinion. Time-out is a good technique that allows parents to discipline without using physical punishment. Page 144

The mother of a 4 year old tells the nurse that she is frustrated, because all she seems to do lately is fight with the child over what the child wants to eat and wear. The mother says that she sometimes wants to spank the child for always disagreeing. What would be the best suggestion for the nurse to make to this mother? a) "It's not normal to feel that way." b) "Use the timeout technique for discipline." c) "Spank lightly to get the child's attention." d) "Take some toys away when the child acts like that."

"Use the timeout technique for discipline." Correct Explanation: Preschoolers have definite opinions, which may bring them into opposition with parents. The best thing to do during these struggles is to guide the child through without discouraging his or her right to an opinion. Timeout is a good technique that allows parents to discipline without using physical punishment.

The mother and father of a 5-year-old boy are discussing bicycle safety with the nurse. What comment indicates further teaching is needed?

"We just got him a new bike he can grow into."

The mother and father of a 5-year-old boy are discussing bicycle safety with the nurse. What comment indicates further teaching is needed? a) "He is able to ride without training wheels." b) "Our son always wears a helmet." c) "He never rides in the street." d) "We just got him a new bike he can grow into."

"We just got him a new bike he can grow into." Correct Explanation: The bicycle should fit the rider. The balls of his feet should reach both pedals while he is sitting on the seat and has both hands on the handlebars. The other comments describe no safety risk.

The nurse is providing teaching about child safety to the parents of a 4-year-old girl. Which statement by the parents indicates a need for further teaching?

"We need to tell her that her vitamins are candy." The nurse needs to remind the parents not to coax a child to take a vitamin supplement, tablet, or pill by calling it candy. The other statements are correct. page 139

A nurse is providing a routine wellness examination for a 5-year-old boy. Which response by the parents indicates a need for an additional referral or follow-up?

"We often have to translate his speech to others." By the age of 5, persons outside of the family should be able to understand most of the child's speech without the parents "translation." The other statements would not warrant additional referral or follow-up. A child of 5 years should be able to count to at least 10, know his or her address, and participate in long detailed conversations. Page 132

During an admission assessment the nurse is discussing the developmental level of the child with the parents. Which comments by the parents demonstrate a good understanding of developmental expectations of the preschool-aged child? Select all that apply.

"We think it is important to have play dates with our friend's preschool children." "Our child attends a wonderful preschool 3 times per week." "We have been talking about enrolling in a morning preschool program since this is our only child." Making friends and playing with other children of the same age is important for socialization of the preschool-age child. Play dates, preschool, and day care are a means of socialization for the preschool child. Preschool children commonly display behavior of their peers, which is not an issue if it is acceptable behavior. pg 133

The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply.

"We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." Page 140

The parents of a 9-year-old child voice concern that the child seems to be gaining weight rapidly. The nurse reviews the medical record and notes the child has increased weight by 6 or 7 lb (2.7 to 3.2 kg) per year for the past 2 years. What response by the nurse is indicated? "On the contrary, your child's annual weight gain is somewhat low for this age." "Children in this age range on average gain about 5 lb (2.3 kg) per year." "Weight gains of about 7 lb (3.2 kg) per year are normal for children in this age range." "Your child does seem to be rapidly gaining weight."

"Weight gains of about 7 lb (3.2 kg) per year are normal for children in this age range."

The parents of a 9-year-old child voice concern that the child seems to be gaining weight rapidly. The nurse reviews the medical record and notes the child has increased weight by 6 or 7 lb (2.7 to 3.2 kg) per year for the past 2 years. What response by the nurse is indicated? "Your child does seem to be rapidly gaining weight." "Weight gains of about 7 lb (3.2 kg) per year are normal for children in this age range." "On the contrary, your child's annual weight gain is somewhat low for this age." "Children in this age range on average gain about 5 lb (2.3 kg) per year."

"Weight gains of about 7 lb (3.2 kg) per year are normal for children in this age range."

A 5-year-old girl is pretending to be a crocodile during a physical examination. Her mother just smiles and rolls her eyes at the nurse. Which of the following would be the best response for the nurse to give the child?

"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile."

A 5-year-old girl is pretending to be a crocodile during a physical examination. Her mother just smiles and rolls her eyes at the nurse. What would be the best response for the nurse to give the child?

"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." Parents sometimes strengthen a fantasy role without realizing it. A preschooler might be pretending she is a crocodile. If the nurse plays along, the child may be frightened she has actually become a crocodile. A better response is to support the imitation—this is age-appropriate behavior and a good way of exploring roles—by saying, "What a nice crocodile you're pretending to be." This both supports the fantasy and reassures the child she is still herself. page 128

The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond?

"Your child is not expected to be able to perform those activities at 3 years of age." Skipping and standing on one foot for up to 10 seconds are motor skills that are expected from a 5-year-old, not a 3-year-old; therefore, the best response is letting the mother know that her child is not behind in motor development. page 130

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 at least 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." "We should ask the health care provider to run some tests; with that much sleep, the child should not be tired." "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."

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." Sleep needs for children change according to their ages. A 6- to 8-year-old child needs 12 hours of sleep per night. The 8- to 10-year-old child needs 10 to 12 hours of sleep per night. The 10- to 12-year-old child needs between 9 and 10 hours of sleep per night. Many younger children need a nap or to be provided with quiet time after school to recharge after a busy day in the classroom. Increasing the child's sleeping hours should be attempted before asking for medical intervention.

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 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.

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

"Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age."

The parents of a 7-year-old girl report concerns about her seemingly low self-esteem. The parents question how self-esteem is developed in a young girl. Which response by the nurse is best? "A child's self-esteem is greatly inborn and environmental influences guide it." "Several interrelated factors are to blame for low self-esteem." "Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age." "The peers of a child at this age are the greatest influence on self-esteem."

"Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age."

"Your son may have a friend named Andrew, but it could be an imaginary friend." The preschool-age child may have imaginary playmates who are very real to them. The imaginary friend often has the characteristics that the child might wish for. Sometimes the child blames the imaginary friend for breaking a toy or engaging in another act for which the child does not want to take responsibility. The child should not be punished because the child is not intentionally telling a lie. At this age the child can think about things without actually seeing them. Page 128

The father of a 4-year-old confides in the school nurse that he is concerned about his child not telling the truth. The father states, "I found a broken tool in my garage and when I asked my son about it, he said that his friend Andrew broke it, but we don't know anyone named Andrew." The best response by the nurse would be a) "Your son may have a friend named Andrew, but it could be an imaginary friend." b) "You need to show your child the broken tool since at this age they must see something in order to understand." c) "Your son may be afraid of being punished so he is telling lies to protect himself." d) "You should watch this type of behavior closely since most children this age tell the truth."

"Your son may have a friend named Andrew, but it could be an imaginary friend." Correct Explanation: The preschool-age child may have imaginary playmates who are very real to them. The imaginary friend often has the characteristics that the child might wish for. Sometimes the child blames the imaginary friend for breaking a toy or engaging in another act for which the child does not want to take responsibility. The child should not be punished because the child is not intentionally telling a lie. At this age the child can think about things without actually seeing them.

Parents of a preschooler tell the nurse that their child often refuses to go to sleep at night. Which suggestion by the nurse would be helpful? Select all that apply.

- "Try using a night light in the child's room." - "Set up some familiar bedtime rituals for your child." - "Avoid having your child watch frightening shows on TV before bedtime." - "Try reading a favorite story before bedtime."

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.

1.Parent knows the misbehavior was intentional. 2.Warn the child there will be a time-out if the behavior does not stop. 3.Remove the preschooler to a boring spot. 4.Set a timer for no more than 4 minutes. 5.If the child gets up, replace the child and restart the time.

Typical development for the school-aged child includes playing games with friends. At what age are children typically ready for games that include playing on a team that has a winner or loser?

10 years Consider growth and development when advising. Erikson's stages can be helpful in determining. Before about 10 years, children are unable to lose a game and still maintain the self-concept that they are good people.

The school nurse notices that one of the children in the classroom next to the nurse's room frequently goes to the bathroom. The nurse knows that the bladder capacity for this 11-year-old child should be how much?

The nurse is assessing the nutritional needs of an 8-year-old girl who weighs 65 pounds (29.5 kg). Which amount of calories would provide the proper daily caloric intake for this child?

2,065 calories per day

The nurse is conducting a well-child examination of a 4-year-old and is assessing the child's height. By how much should the nurse expect the child's height to have increased since last year's examination?

2.5 to 3 inches (6.35 to 7.62 cm) The average preschool child will grow 2.5 to 3 inches (6.35 to 7.62 cm) per year. Thus, the nurse would expect that the child's height would have increased 2.5 to 3 inches (6.35 to 7.62 cm) since last year's well-child examination. Page 127

If the child is gaining weight at an expected rate, a child who weighs 36 lbs. at 3 years of age would weigh which of the following at age 5?

44 lbs.

"At this age it is helpful to remind children to go to the bathroom."

The mother of a 6-year-old is asking the nurse how to handle the child's lying and fabricated stories when confronted with questionable actions. Which response would be most appropriate by the nurse?

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

The parent of a 4-year-old is expressing concern that this child is not talking as much—or as well—as her other children did at that age. Which question should the nurse prioritize when assessing this preschooler for this concern?

"Has your child had her hearing tested?"

The school nurse is speaking with a child who is a latch-key kid. Which statement by the child would need further investigation?

"I answered the door yesterday and the salesman wanted to come in even though my mom wasn't home."

While the nurse is talking with a 6-year-old who has been a client of the clinic since birth, the child begins to tell the nurse that he is the star of a popular children's television program. What is the nurse's best response?

"I bet you like that show a lot. Which character is your favorite?"

The pediatric nurse is meeting with a group of preschoolers' family members to discuss various health topics. The nurse determines the sexual development session is successful after overhearing which comment by one of the participants?

"I feel better knowing that her curiosity is normal."

During an extended stay in a hospital the nurse has observed a 5-year-old having several temper tantrums. How should the nurse address this behavior with the parents?

"Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here."

A 10-year-old child tells the school nurse that she is embarrassed that she is afraid of the dark. Which is the best response by the nurse?

"It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?"

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

"Normal growth and development for this age results in an average weight gain of 7 pounds per year."

The parents of a 4-year-old child tells the nurse that they are worried about the child. They state says that the child used to play well with others, but lately when they invite two other children for a play date, all the children do is argue. Which instruction is best for these parents?

"Only invite one or three other children to the play date, to make it an even number."

During an assessment, a preschool-aged child tells the nurse about having 12 siblings. The nurse is aware that the child has two older brothers. What would be the nurse's best response?

"That is a good pretend answer but tell me the names of the brothers you really have."

A 3-year-old tells the nurse that he has 19 brothers. The nurse knows that the child has two brothers. What would be the nurse's best response concerning his brothers?

"That's a good pretend answer, but tell me the names of the brothers you really have."

The mother of two children ages 6 and 12 reports that her 6-year-old child seems to have "cold after cold" while her older child never seems to be ill. She questions if there is something wrong with her younger child. What is the best response by the nurse?

"The immune system of your younger child is less mature and may result in having more infections."

The parents of a 9-year-old child voice concern that their daughter seems to be gaining weight rapidly. The nurse reviews the medical record and notes the child has increased his weight by 6 or 7 pounds (2.7 to 3.2 kg) per year for the past 2 years. What response by the nurse is indicated?

"Weight gains of about 7 pounds per year are normal for children in this age range."

The father of a 4-year-old is concerned his child is not telling the truth and blaming others for things that have happened. Which response should the nurse prioritize after the father shares that the child is blaming someone named "Andrew" for a broken tool, and they have no idea who this is?

"Your son may have a friend named Andrew, but it could be an imaginary friend."

The nurse is creating a care plan for a school-aged child with a nursing diagnosis of ineffective health maintenance related to lack of exercise and poor food choices. Which nursing interventions should the nurse include? Select all that apply.

- Educate the parents and the child on the need to decrease TV/computer/device time. - Educate the parents and child on the need to increase the amount of daily exercise. - Interview the parents about their eating and exercising habits. - Plot out the child's height, weight and BMI to detect weight loss or gain.

The nurse is helping parents develop the developmental task of initiative in their preschool-aged child. Which activity would the nurse suggest the parents implement?

Allow the child to experiment with molding clay.

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue?

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough

An 11-year-old boy is significantly above the 100% percentile for height. The boy tells the school nurse that his parents expect so much out of him when he is playing basketball for the school team that he is thinking of quitting. What action should the nurse take?

Arrange a conference with the parents, son, and nurse to discuss the child's concerns.

What action by a parent would be least likely to foster development of self-confidence in a school-age child?

Comparing the child to an older sibling regarding academic achievements

The nurse is providing health-promotion teaching to a group of parents of preschoolers at a local daycare. What information would the nurse include in this education session? Select all that apply.

Encourage children to select their own clothing to wear each day. Parents will need to supervise tooth-brushing and be responsible for flossing. Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry clothing.

A mother suspects that her 11-year-old son is experimenting with deliriants with his friends. Which symptoms would the nurse advise the mother to look for that would validate her concerns?

Giddiness and coughing

The nurse is caring for a preschool-aged child who needs a CT scan. Which action would the nurse use to best prepare the child for this diagnostic test?

Help the child to pretend that the CT scan machine is a camera.

The nurse is assessing a 4-year-old on a routine well-child visit. When assessing the gross motor skills of this preschooler, which activity will the nurse predict the child to be able to successfully accomplish?

Hop on one foot

Imaginary friend

Industry

The nursing instructor is illustrating the various types of play. The instructor determines the class is successful when the students correctly choose which example as best representing onlooker play?

Observing without participating

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium?

Orange

A preschool-age child tells the nurse about an imaginary friend. The parents are concerned because the child refuses to do anything without the friend's help. Which nursing diagnosis is most applicable for the family?

Parental anxiety related to lack of understanding of childhood development

A mother tells a nurse that her child has recently established some friendships for the first time. In which age group do you expect this child to be?

Preschool

Risk for caregiver role strain

The nurse is presenting nutritional information at a community health fair. Which suggestion should the nurse prioritize when illustrating proper nutrition for preschoolers?

Snacks throughout the day help the child meet nutritional requirements

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?

Support whatever the child paints.

When collecting data on a preschool-aged child during a well-child visit, the nurse discovers the child has gained 12 lb (5.4 kg) and grown 2.5 inches (6.3 cm) in the last year. The nurse interprets these findings to indicate which situation?

Weight is above an expected range and height is within an expected range.

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 the nurse would give the mother regarding this problem would be to:

allow some time every day for the child to talk about new experiences.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:

having the child wear a personal flotation device whenever near or on the water.

A 9-year-old is hospitalized for a long-term illness. The best project to give her to help achieve her developmental task would be:

sewing a purse that will take one afternoon

When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate?

tells a fantasy story about a bear and a car

The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which general question would the nurse direct to the child's parents?

"Is there a family history of hypertension, heart disease, or diabetes?"

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention?

"The school is quite structured and advocates corporal punishment."

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."

What teaching points would a nurse provide for families of school-aged children to help prevent substance abuse? Select all that apply.

- Give the child "what if" examples to situations they may face. - Set firm rules regarding alcohol and other drug usage and discuss consequences associated with breaking the rules. - Encourage decision-making and discuss family values.

The nurse is providing teaching about car seat safety for a parents' meeting at the preschool their children attend. Choose the points the nurse should make. Select all that apply.

- Many car seats are installed improperly, making them unsafe. - The back seat remains the safest place for children to ride. - Children who weigh less than 40 pounds should use a car seat with harness and top tether. - Booster seats should be used with both a shoulder and lap belt.

A feeling of inferiority

The nurse is caring for a 5-year-old who has been hospitalized after an episode of asthma. As the nurse prepares to teach the child how to use the nebulizer, which action should the nurse prioritize?

Allow the child to touch and play with the nebulizer for a few minutes before the treatment.

The 11-year-old arrives in the emergency department presenting with the following: nosebleed with no apparent trauma, disoriented, confused, difficulty walking, nausea, and coughing. The nurse should question the child concerning which potential activity?

Experimenting with an inhalant

The nurse is caring for a preschool-aged child who needs a CT scan. Which action would the nurse use to best prepare the child for this diagnostic test?

Help the child to pretend that the CT scan machine is a camera

The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse?

Speak with the parents about the unusual increased number of respiratory infections

preoccupation with death and dying is common in the school-aged child

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