CHP 34
Nursing interventions to promote health during middle childhood include:
a) stressing the need for increased calorie intake to meet increased demands.
b) instructing parents to defer questions about sex until the child reaches adolescence.
C
c) educating the child and parents to the need for good dental hygiene because these are the years in which permanent
teeth erupt.
d) advising parents that the child will need decreasing amounts of rest toward the end of this period.
Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. Caloric needs are
diminished; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex
education with a lifespan approach and respond to a child's questions with an answer appropriate to the child's age. School-
age children often need to be reminded to go to sleep.
3.Parents report to the school nurse that their child is hesitant to play with other kids in school. During the assessment, the
nurse instructs the parents to avoid giving high-calorie foods to their child. What condition is the nurse helping the parents
control? The child:
a) Has gained too much weight.
b) Spends a lot of time sleeping.
A
c) Received low grades in school.
d) Watches too much television.
Children who are obese or overweight generally have difficulty in playing with peers. These children need to be guided in
order to find activities that meet their needs. Excess sugar consumption in the diet is responsible for weight gain, so the
nurse should instruct the parents to reduce sugar in the child's diet. The child who is spending more time sleeping should be
involved in active play. It is not necessarily related to eating too much sugar. Low grades in school may be related to
cognitive impairment. When a child spends excess time watching television, the child should be redirected to playing outside.
4.The nurse observes that a child is fidgety, restless, and easily distracted. What does the nurse interpret from these
symptoms? The child:
a) Has many of the signs and symptoms of dysgraphia.
F
b) Demonstrates characteristics of conversion reaction.
c) Exhibits signs of posttraumatic stress disorder (PTSD).
d) May have attention deficit hyperactivity disorder (ADHD).
5.What information should the nurse include when teaching parents about interventions to help their children in school?
Select all that apply. Parents should:
a) Use a rewards system rather than using punishment.
ABC
b) Try to stimulate creative thinking and problem solving.
c) Demonstrate an interest in what the child is learning.
d) Send their child to school based on the child's comfort.
e) Help the children by doing their homework for them.
Parents should take an active part in their child's schooling. Parents should reward their child for good performance; it helps
to reinforce good behavior. In order to prevent the fear of making mistakes, parents should stimulate creative thinking and
problem-solving skills in the child. Parents should show interest in what their child does at the school. This encourages the
child to perform better. Parents should ensure that their children go to school regularly and not leave it to the child's
willingness or comfort. Parents should explain a question instead of answering it when they are helping with their child's
homework. This would improve the thinking abilities of a child.
6.A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she
was 11 years of age." The nurse should explain to this parent that this is:
a) unusual and requires further evaluation of the son.
b) unusual because the onset of pubescence is usually the same in siblings.
C
c) normal because the onset of pubescence is usually earlier in girls than it is in boys.
d) abnormal because the onset of pubescence is usually earlier in boys than it is in girls.
The average age of onset for puberty in boys is 12 years old. Age of pubescence is gender related. Girls begin puberty an
average of approximately 2 years before boys.
7.The nurse teaches progressive relaxation of muscle groups to a 12-year-old child. Which sign of stress is the nurse likely to
find in the child?
a) Calmness
b) Enthusiasm D
c) Facial redness
d) Bradycardia
Redness in the face is a physiologic sign of stress seen in children 7 to 12 years of age. Relaxation techniques such as
progressive relaxation of muscle groups, deep breathing exercises, and positive imagery help to reduce stress. Calmness and
enthusiasm are behavioral patterns of school-age children. These behavioral patterns help the child to develop good peer
relations. If a child is experiencing stress, the heart rate would be increased (tachycardia), instead of a decreased heart rate
(bradycardia).
8.Parents reports to the nurse that their 12-year-old child resists going to bed at night. Which advice does the nurse give to
the parents to help the child go to bed on time?
a) "Allow the child to go to bed at a later time."
b) "Promote daytime naps on a daily basis."
D
c) "Promote reading a book before bedtime."
d) "Urge video game playing before bedtime."
Bedtime resistance can be resolved by allowing the child to read before bedtime. Many 12-year-olds prefer to read before
bed. The child's bedtime should not be changed because school-age children need adequate sleep. School-age children do
not require naps, which can hamper sleeping at night. Children should not play video games before going to bed. This may
stimulate and excite the child and make it harder to fall asleep.
9.The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. The nurse's suggestions
regarding participation in sports at this age should include:
a) organized sports such as soccer are not appropriate at this age.
b) competition is detrimental to the establishment of a positive self-image.
C
, c) sports participation is encouraged if the sport is appropriate to the child's abilities.
d) girls should compete only against girls because at this age boys are larger and have more muscle mass.
Parents and coaches need to recognize the child's abilities and teach proper techniques so the child can compete safely.
Organized sports can provide safe, appropriate activities with supportive parents and coaches. School-age children enjoy
competition. The parent should help the child select a sport that is suitable to her capabilities and interests. These changes
occur at puberty -- before that, boys and girls can compete on the same teams.
10.The nurse should teach volunteers in the after school program that which characteristic is most descriptive of the social
development of school-age children?
a) Identification with peers is minimal.
B
b) Children frequently have "best friends."
c) 3Boys and girls play equally well with children of either gender.
d) Peer approval is not yet an influence toward conformity.
Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification
with peer group is an important factor toward gaining independence from families. During the school-age years there are
more gender-specific groups. Conforming to the rules is an essential part of group membership.
11.The parents of a school-age child tell the nurse that to maintain proper nutrition, they give small amounts of food to the
child every 2 hours after school. What advice does the nurse offer the child's parents to prevent stomach pain?
a) "Let your child go outside and play after coming home from school."
D
b) "Make sure that the child takes a nap after coming home from the school."
c) "Do not give snacks to your child after coming home from school."
d) "As children get older, they do not need to eat every 2 hours."
The gastrointestinal system of the school-age child is well developed, which results in fewer stomach upsets. The caloric
needs of the school-age child is smaller than that of the preschooler. Therefore these children need not be fed as frequently
as the preschooler, so the nurses instruct the parents to avoid feeding the child every 2 hours. Allowing the child to play may
help increase the physical activity of the child and promote physical development. The parents must be advised to maintain a
normal sleep schedule. The child must be involved in physical activities and homework after school instead of taking a nap.
The child is usually hungry and tired after coming from school, so the parents must be advised to give nutritious snacks to
the child after coming home from school.
The nurse advises a working single parent to enroll his or her child in an after-school program. What could be the reason
behind the nurse's advice? The child:
a) Fails to have snacks available.
B
b) May be lonely and fearful.
c) Has a developmental disorder.
d) Prefers to spend time outdoors.
After-school programs are generally arranged for latchkey children. These children usually have working parents or may live
with one parent who works. They have no proper supervision after coming home from school. These children may feel lonely
and fearful, and parents are advised to enroll the children in an after-school program. An after-school program is not
necessary just because the child does not have an after-school snack available. Children with developmental disorders need
to attend special training programs rather than an after-school program. When the child plays outdoor games, it signifies
that the child is developing good social interactions. These children do not have to attend an after-school program.
The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. Issues
to cover in the sessions include:
a) bicycle helmets need to be worn only if the child is planning to ride in traffic.
b) reflectors should be installed only on bicycles that are to be ridden at night.
c) bicycles should be ridden against the traffic so that the rider can see the cars.
D
d) bicycles should be walked through busy intersections.
Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react
accordingly, with safety the number one priority. Bicycle helmets should be worn at all times to prevent head injuries.
Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only. Bicycles should
always be ridden with the traffic, not against the traffic. This will assist in preventing accidents.
2.Parents of a 10-year-old child are concerned that their child recently has been showing signs of low self-esteem. What
should the nurse consider when discussing this issue with the parents?
a) Changing self-esteem is difficult after about 5 years old.
b) Self-esteem is the objective judgment of one's worthiness.
C
c) Transitory periods of lowered self-esteem are expected developmentally.
d) High self-esteem develops when parents show adequate love for the child.
Self-esteem changes with development. Transient declines are expected and (with positive encouragement and support) are
only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of
one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and
worthiness of love and acceptance.
3.The nurse is assessing a child for attention deficit hyperactivity disorder (ADHD). The nurse rates the child's
characteristics as eight symptoms of hyperactivity-impulsivity and three symptoms of inattention. What type of ADHD does
the child have?
a) Signs of a cognitive learning disability
b) Symptoms of a combined type of ADHD
c) The predominantly inattentive type
D
d) Predominantly hyperactive-impulsive
When the child has eight symptoms of hyperactivity-impulsivity and three symptoms of inattention, then these characteristics
belong to the predominantly hyperactive-impulsive type of ADHD. A cognitive learning disability is a serious disorder where
the child is unable to listen, understand, reason, or use mathematical skills. This requires medical supervision for treatment.
The combined type of ADHD occurs when a child shows six symptoms of hyperactivity-impulsivity and six inattention
symptoms. The predominantly inattentive type is one of the major forms of inattention seen in children. Children with
predominantly inattentive type of ADHD have fewer than six symptoms of hyperactivity and impulsivity.
4.The primary health care provider (PHP) prescribes a psychostimulant drug for a child. The nurse checks the medical
history of the child and requests that the PHP change the drug. What would be the possible reason for the nurse to make
such a request? The child:
, a) Has had physical trauma.
b) Demonstrates dysgraphia.
c) Has malocclusion.
D
d) Has a history of facial tics.
Psychostimulant drugs are given to children for the treatment of attention deficit hyperactivity disorder (ADHD). These drugs
should be avoided in children who have a history of ticlike behaviors because they can worsen the symptoms. Physical
trauma refers to a serious injury resulting from an assault, a natural disaster, or a sports injury. Dysgraphia is a condition
where a child has difficulty with writing. Psychostimulant drugs do not affect the oral health of the child. These drugs are not
known to aggravate malocclusion problems. Orthodontic treatment is successful for malocclusion problems.
6.The nurse is assessing the concept of conservation in a group of children 7 years of age. The nurse pours 200 mL water in
a small glass, 200 mL water in a big glass, and 100 mL water in a tea cup. The capacities of the small glass (s), big glass (B),
and tea cup (t) are 250 mL, 500 mL, and 100 mL respectively. A 7-year-old child is asked to choose the glass with more water.
Which glass or glasses would the child choose if the child understands the concept of conservation?
a) Glass B
b) Glass s C
c) Glass B and s
d) Glass t and s
The concept of conservation is one of the cognitive tasks mastered by children aged 5 to 7 years. They are able to understand
that when the same amount of water is poured into glasses or containers of different sizes and shapes, the volume remains
the same. Therefore, the child will choose glass B and s. Conservation of volume is usually the last concept mastered by
school-aged children. Glass B has the same amount of water as glass s. Glass t has less water compared to glasses B and s.
8.A parent expresses to the nurse that the parents delayed sending their child to school because the child did not want to
leave home. What information should the nurse give to the parent to improve the child's adaptability to school?
a) "I know it is hard to see your child mature, but you need to let your child go to school."
b) "Enroll the child as well as the child's best friend in the school at the same time."
A
c) "Provide special care and a lot of attention to the child at home after school."
d) "Let the child be at home until the child feels comfortable attending the school."
The child's adaptation to school is a major milestone for the developmental stage. The child's adaptation to school depends
on various factors. Clinging behavior by the parents is a major factor. This behavior prevents the child from becoming mature
and adapting to the school. It is not necessary to enroll the child with a friend; the child may develop relations once adapted
to the school. Special care and extra attention is not required for a child with normal growth and development. Delaying the
schooling would hamper the cognitive development in the child. Therefore the parents should enroll the child in the school as
per the age.
10.The parents of 9-year-old twin children tell the nurse, "They have filled their bedroom with collections of rocks, shells,
stamps, and cars." The nurse should recognize that this behavior:
a) indicates giftedness.
b) indicates typical "twin" behavior.
C
c) is characteristic of cognitive development at this age.
d) is characteristic of psychosocial development at this age.
Classification skills are developed during the school-age years. This age group enjoys sorting objects according to shared
characteristics. This behavior is characteristic of the age group, not giftedness or a twin status. Psychosocial development at
this age is focused on accomplishment.
11.During an assessment, the nurse finds that a child is depressed and frightened and has low grades in school. By which
age-group do children usually worry about school grades?
a) 5 and 6 years of age
b) 6 and 7 years of age
D
c) 7 and 8 years of age
d) 8 and 9 years of age
Worrying about school grades is an adaptive behavior in children that happens between 8 and 9 years of age. Children who
are between 5 and 6 years of age are at their initial schooling age, and their development is not sophisticated enough to
bother about the grading system at school. Children who are between 6 and 7 years of age try to be independent in their
school environment. They are less bothered about grading. Children who are between 7 and 8 years of age are more involved
in playing with their peers.
The nurse is preparing a health teaching session for school-age children. What information should the nurse include about
injury prevention in the plan?
a) Peer pressure is not strong enough to affect risk-taking behavior.
b) Most injuries occur in or near school or home.
B
c) Injuries from burns are the highest at this age because of fascination with fire.
d) Lack of muscular coordination and control results in an increased incidence of injuries.
Most injuries occur in or near school or home. Peer pressure is significant in this age group. Automobile accidents account
for the majority of severe accidents, either as a pedestrian or passenger. School-age children have more refined muscle
development, which results in an overall decrease in the number of accidents.
7.A child is being treated with methylphenidate hydrochloride (Ritalin). After assessing the child, the nurse decides to
administer the medicine early in the day. What effect of the drug does the nurse note in the child?
a) Causes some seizure activity
b) Keeps the child awake B
c) Results in decreased appetite
d) Caused the development of foot numbness
The child who is taking methylphenidate hydrochloride (Ritalin), a psychostimulant, may experience sleeplessness as a side
effect. Therefore the nurse should administer the medication early in the day to counteract the effect. Seizures are not a side
effect of Ritalin. Reduced appetite is a side effect of Ritalin, and therefore the nurse should administer the drug after the
meals. The child doesn't develop numbness when administered Ritalin.
9.A 9-year-old child is put on tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD). How does the
nurse advise the parents of this child? The child should: Select all that apply.
a) Be advised to limit physical exercise.
b) Be encouraged to have plenty of oral fluids.
BCE
, c) Have a dental checkup done regularly.
d) Be referred to a cardiologist at the earliest date possible.
e) Have limited intake of refined carbohydrates.
The anticholinergic action of tricyclic antidepressants leads to increased viscosity of saliva and dry mouth. These drugs lead
to increased incidences of dental caries. Therefore, the nurse should advise the parents to encourage the child to take more
oral fluids, take the child for regular dental visits, and limit the intake of refined carbohydrates. Tricyclic antidepressants do
not affect the cardiac system, and so it is not required for the child to limit physical activity or to have regular visits to the
cardiologist.
12.The nurse is assessing a child with attention deficit hyperactivity disorder (ADHD) and finds underdeveloped fine motor
skills. The nurse instructs the teacher to provide the child with a computer. Which findings in the child prompt the nurse to
do so? The child has:
a) A vision defect.
b) A learning disability.
D
c) A hearing problem.
d) Difficulty in writing.
The child who has ADHD would face difficulty in writing, which is referred to as dysgraphia. The child should be assisted by
integrating a computer into the classroom for the child's use because handwriting may not improve. A visual defect is not a
sign of ADHD. In such a case, the child must be evaluated by a medical professional. A learning disability is a disorder in
which children find difficulty in learning new things. Children with ADHD have reduced attention span, which may impair
their ability to learn. However, learning disability is not a sign of fine motor impairment. Hearing impairment is not a sign
associated with ADHD.
The nurse is assessing a child during a checkup and notes the child has all permanent teeth and is a healthy weight for his
age. What would be the approximate weight of the child?
a) 16 to 26.3 kg (35.5 to 58 pounds)
b) 17.7 to 30 kg (39 to 66.5 pounds)
D
c) 19.5 to 39.5 kg (43 to 87 pounds)
d) 24.5 to 58 kg (54 to 128 pounds)
By the age of 10 to 12 years, the permanent teeth have erupted in children. Therefore the child is probably in this age group.
A healthy weight of a child in the age group of 10 to 12 years is 24.5 to 58 kg (54 to 128 pounds). A 6-year-old child may have
a weight of 16 to 26.3 kg (35.5 to 58 pounds). This is the age where loss of first teeth occurs in the children. A 7-year-old may
have a weight of 17.7 to 30 kg (39 to 66.5 pounds). The child's teeth start forming at this stage. An 8-year-old child may have
a weight of 19.5 to 39.5 kg (43 to 87 pounds). Lateral incisors (maxillary) and mandibular cuspids erupt at this age.
7.The school teacher speaks with the school nurse about a child who has improper conduct and tends to be aggressive with
younger children. The school nurse observes that the child also influences the behavior of others in the group. What is the
most appropriate nursing approach for the child's behavior?
a) Use corporal punishment to discipline the child.
b) Advise the child to participate in safety training.
C
c) Encourage the child to join an anti-bullying program.
d) Suggest the child undergo behavioral therapy.
The child who is isolated from the family or under poor supervision tends to develop unacceptable behavior and acts against
established rules. These children also try to influence other weaker groups such as small children. This behavior is
considered bullying. The child should be encouraged to join an antibullying program to help set the behavior right. The nurse
should not use corporal punishment on the child because it can worsen the child's behavior. Limits should be set and time-
outs utilized for punishment. Safety training is given to the child for protection from injuries. Behavioral therapy is given to
the child with attention deficit hyperactivity disorder.
8.The nurse is teaching a group of parents about the importance of children building peer relationships. What points should
the nurse plan to incorporate in the teaching plan? Select all that apply.
a) Teach the children to appreciate differences in others.
ABE
b) This is the time when children develop best friends.
c) Peers help to improve the cognition level in many children.
d) Children become more egocentric in their peer group.
e) Teach the child to behave in an acceptable manner.
Daily interactions and maintaining of peer relations have a great impact in the social development of children. Peer
relationships teach children to appreciate the differences in others and others' opinions. Peer relationships help to develop
good friends, and children develop best friends with whom they share secrets and have fun. The peer relationship teaches
the child to behave in an acceptable manner by watching appropriate behavior in others. Children's cognition levels are
developed according to their age and their coordination. Peer relationships do not affect the child's cognition level. Peer
relationships have a great impact in reducing the egocentric outlook in children and help in maintaining healthy relations.
The nurse is assessing the oral cavity of a child who is approximately 7 to 8 years of age. The nurse notices that the lateral
incisor in the mandible and central incisor in the maxilla have already been lost. Which teeth would erupt when the child is
about 11 to 12 years old?
a) The first molar in both the maxilla and in the mandible
b) The third molar in both the maxilla and in the mandible
D
c) The second bicuspid in both the maxilla and the mandible
d) The second bicuspid in the mandible and the cuspid in the maxilla
The second bicuspid teeth in the mandible and the cuspid in the maxilla would erupt in the child who is about 11 to 12 years.
The first molar in both the maxilla and the mandible erupts in a 6- to 7-year-old child. The third molar in both the maxilla and
the mandible would erupt somewhere between the ages of 17 to 21 years. The second bicuspid in the mandible would erupt
between the ages of 11 to 12 years, and the second bicuspid in the maxilla would erupt during 10 to 12 years of age.
3.The nurse is caring for a child who has just had the eruption of lateral maxillary incisors and mandibular cuspids. Which
developmental activity corresponds with this child's age? The child:
a) Is unable to do useful errands.
b) Likes mainly pictorial magazines.
D
c) Chooses friends selectively.
d) Plans to wake up early just to read.
Nursing interventions to promote health during middle childhood include:
a) stressing the need for increased calorie intake to meet increased demands.
b) instructing parents to defer questions about sex until the child reaches adolescence.
C
c) educating the child and parents to the need for good dental hygiene because these are the years in which permanent
teeth erupt.
d) advising parents that the child will need decreasing amounts of rest toward the end of this period.
Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. Caloric needs are
diminished; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex
education with a lifespan approach and respond to a child's questions with an answer appropriate to the child's age. School-
age children often need to be reminded to go to sleep.
3.Parents report to the school nurse that their child is hesitant to play with other kids in school. During the assessment, the
nurse instructs the parents to avoid giving high-calorie foods to their child. What condition is the nurse helping the parents
control? The child:
a) Has gained too much weight.
b) Spends a lot of time sleeping.
A
c) Received low grades in school.
d) Watches too much television.
Children who are obese or overweight generally have difficulty in playing with peers. These children need to be guided in
order to find activities that meet their needs. Excess sugar consumption in the diet is responsible for weight gain, so the
nurse should instruct the parents to reduce sugar in the child's diet. The child who is spending more time sleeping should be
involved in active play. It is not necessarily related to eating too much sugar. Low grades in school may be related to
cognitive impairment. When a child spends excess time watching television, the child should be redirected to playing outside.
4.The nurse observes that a child is fidgety, restless, and easily distracted. What does the nurse interpret from these
symptoms? The child:
a) Has many of the signs and symptoms of dysgraphia.
F
b) Demonstrates characteristics of conversion reaction.
c) Exhibits signs of posttraumatic stress disorder (PTSD).
d) May have attention deficit hyperactivity disorder (ADHD).
5.What information should the nurse include when teaching parents about interventions to help their children in school?
Select all that apply. Parents should:
a) Use a rewards system rather than using punishment.
ABC
b) Try to stimulate creative thinking and problem solving.
c) Demonstrate an interest in what the child is learning.
d) Send their child to school based on the child's comfort.
e) Help the children by doing their homework for them.
Parents should take an active part in their child's schooling. Parents should reward their child for good performance; it helps
to reinforce good behavior. In order to prevent the fear of making mistakes, parents should stimulate creative thinking and
problem-solving skills in the child. Parents should show interest in what their child does at the school. This encourages the
child to perform better. Parents should ensure that their children go to school regularly and not leave it to the child's
willingness or comfort. Parents should explain a question instead of answering it when they are helping with their child's
homework. This would improve the thinking abilities of a child.
6.A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she
was 11 years of age." The nurse should explain to this parent that this is:
a) unusual and requires further evaluation of the son.
b) unusual because the onset of pubescence is usually the same in siblings.
C
c) normal because the onset of pubescence is usually earlier in girls than it is in boys.
d) abnormal because the onset of pubescence is usually earlier in boys than it is in girls.
The average age of onset for puberty in boys is 12 years old. Age of pubescence is gender related. Girls begin puberty an
average of approximately 2 years before boys.
7.The nurse teaches progressive relaxation of muscle groups to a 12-year-old child. Which sign of stress is the nurse likely to
find in the child?
a) Calmness
b) Enthusiasm D
c) Facial redness
d) Bradycardia
Redness in the face is a physiologic sign of stress seen in children 7 to 12 years of age. Relaxation techniques such as
progressive relaxation of muscle groups, deep breathing exercises, and positive imagery help to reduce stress. Calmness and
enthusiasm are behavioral patterns of school-age children. These behavioral patterns help the child to develop good peer
relations. If a child is experiencing stress, the heart rate would be increased (tachycardia), instead of a decreased heart rate
(bradycardia).
8.Parents reports to the nurse that their 12-year-old child resists going to bed at night. Which advice does the nurse give to
the parents to help the child go to bed on time?
a) "Allow the child to go to bed at a later time."
b) "Promote daytime naps on a daily basis."
D
c) "Promote reading a book before bedtime."
d) "Urge video game playing before bedtime."
Bedtime resistance can be resolved by allowing the child to read before bedtime. Many 12-year-olds prefer to read before
bed. The child's bedtime should not be changed because school-age children need adequate sleep. School-age children do
not require naps, which can hamper sleeping at night. Children should not play video games before going to bed. This may
stimulate and excite the child and make it harder to fall asleep.
9.The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. The nurse's suggestions
regarding participation in sports at this age should include:
a) organized sports such as soccer are not appropriate at this age.
b) competition is detrimental to the establishment of a positive self-image.
C
, c) sports participation is encouraged if the sport is appropriate to the child's abilities.
d) girls should compete only against girls because at this age boys are larger and have more muscle mass.
Parents and coaches need to recognize the child's abilities and teach proper techniques so the child can compete safely.
Organized sports can provide safe, appropriate activities with supportive parents and coaches. School-age children enjoy
competition. The parent should help the child select a sport that is suitable to her capabilities and interests. These changes
occur at puberty -- before that, boys and girls can compete on the same teams.
10.The nurse should teach volunteers in the after school program that which characteristic is most descriptive of the social
development of school-age children?
a) Identification with peers is minimal.
B
b) Children frequently have "best friends."
c) 3Boys and girls play equally well with children of either gender.
d) Peer approval is not yet an influence toward conformity.
Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification
with peer group is an important factor toward gaining independence from families. During the school-age years there are
more gender-specific groups. Conforming to the rules is an essential part of group membership.
11.The parents of a school-age child tell the nurse that to maintain proper nutrition, they give small amounts of food to the
child every 2 hours after school. What advice does the nurse offer the child's parents to prevent stomach pain?
a) "Let your child go outside and play after coming home from school."
D
b) "Make sure that the child takes a nap after coming home from the school."
c) "Do not give snacks to your child after coming home from school."
d) "As children get older, they do not need to eat every 2 hours."
The gastrointestinal system of the school-age child is well developed, which results in fewer stomach upsets. The caloric
needs of the school-age child is smaller than that of the preschooler. Therefore these children need not be fed as frequently
as the preschooler, so the nurses instruct the parents to avoid feeding the child every 2 hours. Allowing the child to play may
help increase the physical activity of the child and promote physical development. The parents must be advised to maintain a
normal sleep schedule. The child must be involved in physical activities and homework after school instead of taking a nap.
The child is usually hungry and tired after coming from school, so the parents must be advised to give nutritious snacks to
the child after coming home from school.
The nurse advises a working single parent to enroll his or her child in an after-school program. What could be the reason
behind the nurse's advice? The child:
a) Fails to have snacks available.
B
b) May be lonely and fearful.
c) Has a developmental disorder.
d) Prefers to spend time outdoors.
After-school programs are generally arranged for latchkey children. These children usually have working parents or may live
with one parent who works. They have no proper supervision after coming home from school. These children may feel lonely
and fearful, and parents are advised to enroll the children in an after-school program. An after-school program is not
necessary just because the child does not have an after-school snack available. Children with developmental disorders need
to attend special training programs rather than an after-school program. When the child plays outdoor games, it signifies
that the child is developing good social interactions. These children do not have to attend an after-school program.
The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. Issues
to cover in the sessions include:
a) bicycle helmets need to be worn only if the child is planning to ride in traffic.
b) reflectors should be installed only on bicycles that are to be ridden at night.
c) bicycles should be ridden against the traffic so that the rider can see the cars.
D
d) bicycles should be walked through busy intersections.
Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react
accordingly, with safety the number one priority. Bicycle helmets should be worn at all times to prevent head injuries.
Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only. Bicycles should
always be ridden with the traffic, not against the traffic. This will assist in preventing accidents.
2.Parents of a 10-year-old child are concerned that their child recently has been showing signs of low self-esteem. What
should the nurse consider when discussing this issue with the parents?
a) Changing self-esteem is difficult after about 5 years old.
b) Self-esteem is the objective judgment of one's worthiness.
C
c) Transitory periods of lowered self-esteem are expected developmentally.
d) High self-esteem develops when parents show adequate love for the child.
Self-esteem changes with development. Transient declines are expected and (with positive encouragement and support) are
only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of
one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and
worthiness of love and acceptance.
3.The nurse is assessing a child for attention deficit hyperactivity disorder (ADHD). The nurse rates the child's
characteristics as eight symptoms of hyperactivity-impulsivity and three symptoms of inattention. What type of ADHD does
the child have?
a) Signs of a cognitive learning disability
b) Symptoms of a combined type of ADHD
c) The predominantly inattentive type
D
d) Predominantly hyperactive-impulsive
When the child has eight symptoms of hyperactivity-impulsivity and three symptoms of inattention, then these characteristics
belong to the predominantly hyperactive-impulsive type of ADHD. A cognitive learning disability is a serious disorder where
the child is unable to listen, understand, reason, or use mathematical skills. This requires medical supervision for treatment.
The combined type of ADHD occurs when a child shows six symptoms of hyperactivity-impulsivity and six inattention
symptoms. The predominantly inattentive type is one of the major forms of inattention seen in children. Children with
predominantly inattentive type of ADHD have fewer than six symptoms of hyperactivity and impulsivity.
4.The primary health care provider (PHP) prescribes a psychostimulant drug for a child. The nurse checks the medical
history of the child and requests that the PHP change the drug. What would be the possible reason for the nurse to make
such a request? The child:
, a) Has had physical trauma.
b) Demonstrates dysgraphia.
c) Has malocclusion.
D
d) Has a history of facial tics.
Psychostimulant drugs are given to children for the treatment of attention deficit hyperactivity disorder (ADHD). These drugs
should be avoided in children who have a history of ticlike behaviors because they can worsen the symptoms. Physical
trauma refers to a serious injury resulting from an assault, a natural disaster, or a sports injury. Dysgraphia is a condition
where a child has difficulty with writing. Psychostimulant drugs do not affect the oral health of the child. These drugs are not
known to aggravate malocclusion problems. Orthodontic treatment is successful for malocclusion problems.
6.The nurse is assessing the concept of conservation in a group of children 7 years of age. The nurse pours 200 mL water in
a small glass, 200 mL water in a big glass, and 100 mL water in a tea cup. The capacities of the small glass (s), big glass (B),
and tea cup (t) are 250 mL, 500 mL, and 100 mL respectively. A 7-year-old child is asked to choose the glass with more water.
Which glass or glasses would the child choose if the child understands the concept of conservation?
a) Glass B
b) Glass s C
c) Glass B and s
d) Glass t and s
The concept of conservation is one of the cognitive tasks mastered by children aged 5 to 7 years. They are able to understand
that when the same amount of water is poured into glasses or containers of different sizes and shapes, the volume remains
the same. Therefore, the child will choose glass B and s. Conservation of volume is usually the last concept mastered by
school-aged children. Glass B has the same amount of water as glass s. Glass t has less water compared to glasses B and s.
8.A parent expresses to the nurse that the parents delayed sending their child to school because the child did not want to
leave home. What information should the nurse give to the parent to improve the child's adaptability to school?
a) "I know it is hard to see your child mature, but you need to let your child go to school."
b) "Enroll the child as well as the child's best friend in the school at the same time."
A
c) "Provide special care and a lot of attention to the child at home after school."
d) "Let the child be at home until the child feels comfortable attending the school."
The child's adaptation to school is a major milestone for the developmental stage. The child's adaptation to school depends
on various factors. Clinging behavior by the parents is a major factor. This behavior prevents the child from becoming mature
and adapting to the school. It is not necessary to enroll the child with a friend; the child may develop relations once adapted
to the school. Special care and extra attention is not required for a child with normal growth and development. Delaying the
schooling would hamper the cognitive development in the child. Therefore the parents should enroll the child in the school as
per the age.
10.The parents of 9-year-old twin children tell the nurse, "They have filled their bedroom with collections of rocks, shells,
stamps, and cars." The nurse should recognize that this behavior:
a) indicates giftedness.
b) indicates typical "twin" behavior.
C
c) is characteristic of cognitive development at this age.
d) is characteristic of psychosocial development at this age.
Classification skills are developed during the school-age years. This age group enjoys sorting objects according to shared
characteristics. This behavior is characteristic of the age group, not giftedness or a twin status. Psychosocial development at
this age is focused on accomplishment.
11.During an assessment, the nurse finds that a child is depressed and frightened and has low grades in school. By which
age-group do children usually worry about school grades?
a) 5 and 6 years of age
b) 6 and 7 years of age
D
c) 7 and 8 years of age
d) 8 and 9 years of age
Worrying about school grades is an adaptive behavior in children that happens between 8 and 9 years of age. Children who
are between 5 and 6 years of age are at their initial schooling age, and their development is not sophisticated enough to
bother about the grading system at school. Children who are between 6 and 7 years of age try to be independent in their
school environment. They are less bothered about grading. Children who are between 7 and 8 years of age are more involved
in playing with their peers.
The nurse is preparing a health teaching session for school-age children. What information should the nurse include about
injury prevention in the plan?
a) Peer pressure is not strong enough to affect risk-taking behavior.
b) Most injuries occur in or near school or home.
B
c) Injuries from burns are the highest at this age because of fascination with fire.
d) Lack of muscular coordination and control results in an increased incidence of injuries.
Most injuries occur in or near school or home. Peer pressure is significant in this age group. Automobile accidents account
for the majority of severe accidents, either as a pedestrian or passenger. School-age children have more refined muscle
development, which results in an overall decrease in the number of accidents.
7.A child is being treated with methylphenidate hydrochloride (Ritalin). After assessing the child, the nurse decides to
administer the medicine early in the day. What effect of the drug does the nurse note in the child?
a) Causes some seizure activity
b) Keeps the child awake B
c) Results in decreased appetite
d) Caused the development of foot numbness
The child who is taking methylphenidate hydrochloride (Ritalin), a psychostimulant, may experience sleeplessness as a side
effect. Therefore the nurse should administer the medication early in the day to counteract the effect. Seizures are not a side
effect of Ritalin. Reduced appetite is a side effect of Ritalin, and therefore the nurse should administer the drug after the
meals. The child doesn't develop numbness when administered Ritalin.
9.A 9-year-old child is put on tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD). How does the
nurse advise the parents of this child? The child should: Select all that apply.
a) Be advised to limit physical exercise.
b) Be encouraged to have plenty of oral fluids.
BCE
, c) Have a dental checkup done regularly.
d) Be referred to a cardiologist at the earliest date possible.
e) Have limited intake of refined carbohydrates.
The anticholinergic action of tricyclic antidepressants leads to increased viscosity of saliva and dry mouth. These drugs lead
to increased incidences of dental caries. Therefore, the nurse should advise the parents to encourage the child to take more
oral fluids, take the child for regular dental visits, and limit the intake of refined carbohydrates. Tricyclic antidepressants do
not affect the cardiac system, and so it is not required for the child to limit physical activity or to have regular visits to the
cardiologist.
12.The nurse is assessing a child with attention deficit hyperactivity disorder (ADHD) and finds underdeveloped fine motor
skills. The nurse instructs the teacher to provide the child with a computer. Which findings in the child prompt the nurse to
do so? The child has:
a) A vision defect.
b) A learning disability.
D
c) A hearing problem.
d) Difficulty in writing.
The child who has ADHD would face difficulty in writing, which is referred to as dysgraphia. The child should be assisted by
integrating a computer into the classroom for the child's use because handwriting may not improve. A visual defect is not a
sign of ADHD. In such a case, the child must be evaluated by a medical professional. A learning disability is a disorder in
which children find difficulty in learning new things. Children with ADHD have reduced attention span, which may impair
their ability to learn. However, learning disability is not a sign of fine motor impairment. Hearing impairment is not a sign
associated with ADHD.
The nurse is assessing a child during a checkup and notes the child has all permanent teeth and is a healthy weight for his
age. What would be the approximate weight of the child?
a) 16 to 26.3 kg (35.5 to 58 pounds)
b) 17.7 to 30 kg (39 to 66.5 pounds)
D
c) 19.5 to 39.5 kg (43 to 87 pounds)
d) 24.5 to 58 kg (54 to 128 pounds)
By the age of 10 to 12 years, the permanent teeth have erupted in children. Therefore the child is probably in this age group.
A healthy weight of a child in the age group of 10 to 12 years is 24.5 to 58 kg (54 to 128 pounds). A 6-year-old child may have
a weight of 16 to 26.3 kg (35.5 to 58 pounds). This is the age where loss of first teeth occurs in the children. A 7-year-old may
have a weight of 17.7 to 30 kg (39 to 66.5 pounds). The child's teeth start forming at this stage. An 8-year-old child may have
a weight of 19.5 to 39.5 kg (43 to 87 pounds). Lateral incisors (maxillary) and mandibular cuspids erupt at this age.
7.The school teacher speaks with the school nurse about a child who has improper conduct and tends to be aggressive with
younger children. The school nurse observes that the child also influences the behavior of others in the group. What is the
most appropriate nursing approach for the child's behavior?
a) Use corporal punishment to discipline the child.
b) Advise the child to participate in safety training.
C
c) Encourage the child to join an anti-bullying program.
d) Suggest the child undergo behavioral therapy.
The child who is isolated from the family or under poor supervision tends to develop unacceptable behavior and acts against
established rules. These children also try to influence other weaker groups such as small children. This behavior is
considered bullying. The child should be encouraged to join an antibullying program to help set the behavior right. The nurse
should not use corporal punishment on the child because it can worsen the child's behavior. Limits should be set and time-
outs utilized for punishment. Safety training is given to the child for protection from injuries. Behavioral therapy is given to
the child with attention deficit hyperactivity disorder.
8.The nurse is teaching a group of parents about the importance of children building peer relationships. What points should
the nurse plan to incorporate in the teaching plan? Select all that apply.
a) Teach the children to appreciate differences in others.
ABE
b) This is the time when children develop best friends.
c) Peers help to improve the cognition level in many children.
d) Children become more egocentric in their peer group.
e) Teach the child to behave in an acceptable manner.
Daily interactions and maintaining of peer relations have a great impact in the social development of children. Peer
relationships teach children to appreciate the differences in others and others' opinions. Peer relationships help to develop
good friends, and children develop best friends with whom they share secrets and have fun. The peer relationship teaches
the child to behave in an acceptable manner by watching appropriate behavior in others. Children's cognition levels are
developed according to their age and their coordination. Peer relationships do not affect the child's cognition level. Peer
relationships have a great impact in reducing the egocentric outlook in children and help in maintaining healthy relations.
The nurse is assessing the oral cavity of a child who is approximately 7 to 8 years of age. The nurse notices that the lateral
incisor in the mandible and central incisor in the maxilla have already been lost. Which teeth would erupt when the child is
about 11 to 12 years old?
a) The first molar in both the maxilla and in the mandible
b) The third molar in both the maxilla and in the mandible
D
c) The second bicuspid in both the maxilla and the mandible
d) The second bicuspid in the mandible and the cuspid in the maxilla
The second bicuspid teeth in the mandible and the cuspid in the maxilla would erupt in the child who is about 11 to 12 years.
The first molar in both the maxilla and the mandible erupts in a 6- to 7-year-old child. The third molar in both the maxilla and
the mandible would erupt somewhere between the ages of 17 to 21 years. The second bicuspid in the mandible would erupt
between the ages of 11 to 12 years, and the second bicuspid in the maxilla would erupt during 10 to 12 years of age.
3.The nurse is caring for a child who has just had the eruption of lateral maxillary incisors and mandibular cuspids. Which
developmental activity corresponds with this child's age? The child:
a) Is unable to do useful errands.
b) Likes mainly pictorial magazines.
D
c) Chooses friends selectively.
d) Plans to wake up early just to read.
