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Flashcards in Chapter 15 Deck (17):
1

Which behavior is most characteristic of the concrete operations stage of cognitive development?
a. Progression from reflex activity to imitative behavior
b. Inability to put oneself in another's place
c. Increasingly logical and coherent thought processes
d. Ability to think in abstract terms and draw logical conclusions

Ans: C
Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects.
Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which occurs from birth to 2 years of age.
Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years.
Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.

2

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents?
a. Changing self-esteem is difficult after about age 5 years.
b. Self-esteem is the objective judgment of one's worthiness.
c. Transitory periods of lowered self-esteem are expected developmentally.
d. High self-esteem develops when parents show adequate love for the child.

Ans: C
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

What is an important consideration related to childhood stress?
a. Children should be protected from stress.
b. Children do not have coping strategies.
c. Parents cannot prepare children for stress.
d. Some children are more vulnerable to stress than others.

Ans: D
Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress.
It is not feasible to protect children from all stress.
Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children.
Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.

4

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 most appropriate explanation by the nurse is
a. "This is unusual and requires further evaluation of your son."
b. "This is unusual because the onset of pubescence is usually the same in siblings."
c. "This is normal because the onset of pubescence is usually earlier in girls than it is in boys."
d. "This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls."

Ans: C
Girls begin puberty on average approximately 2 years before boys.
Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, no further evaluation is necessary at this time.
The age of pubescence is gender related, with the average age of puberty onset being 12 years for girls and 14 years for boys.
Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, her son is not having an abnormal onset of puberty.

5

Which is characteristic of the psychosocial development of school-age children?
a. A developing sense of initiative is important.
b. Peer approval is not yet a motivating factor.
c. Motivation comes from extrinsic rather than intrinsic sources.
d. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

Ans: D
The school-age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feelings of inferiority, as highlighted in Erikson's stage for this age-group of industry versus inferiority.
Initiative versus guilt is the stage characteristic of preschoolers.
Peer group formation is one of the major characteristics of school-age children.
School-age children gain satisfaction from independent behaviors that are internally driven and accomplished.

6

The parents of 9-year-old twins tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this behavior is characteristic of
a. giftedness.
b. typical "twin" behavior.
c. cognitive development at this age.
d. psychosocial development at this age.

Ans: C
Classification skills are developed during the school-age years. This age-group enjoys sorting objects according to shared characteristics.
Giftedness is not measured simply by a school-age child's ability to classify objects, which is an expected cognitive skill for this age-group. Giftedness signs include specific academic aptitudes, advanced memory skills, creative thinking, ability in the visual or performing arts, and psychomotor ability, either individually or in combination.
The development of classification skills is characteristic of the school-age child and is not related to the behavior of twins.
Psychosocial development of the school-age child is focused on accomplishment or industry, not the cognitive skills of classification that are described.

7

Which is descriptive of the social development of school-age children?
a. Identification with peers is minimal
b. Children frequently have "best friends"
c. Boys and girls play equally with each other
d. Peer approval is not yet an influence toward conformity

Ans: B
Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid.
Identification with the peer group is an important milestone for the school-age child to move toward independence from families.
During the school-age years, same-sex peer groups are more prevalent; therefore, there is less interaction between boys and girls.
Conforming to the rules is an essential part of group membership and, therefore, an important skill for the school-age child to learn in terms of peer relationships.

8

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. The nurse's response should be based on knowledge that
a. Bullying at this age is considered normal
b. Children who bully others usually join gangs
c. Bullying is a short-term problem that is generally outgrown by the end of the school-age years
d. Bullying often manifests itself in children who are different or have poor academic or social skills

Ans: D
Poor relationships with peers and a lack of group identification, such as looking different or having poor academic or social skills, contribute to bullying behavior.
Bullying is a maladaptive response to poor relationships with peers and lack of group identification; therefore, it is not considered normal behavior.
Children who chronically bully tend to be impulsive, easily frustrated, and at increased risk for dropping out of school, but there is no direct correlation between bullies and joining gangs.
Children who bully may be at risk for long-term psychological disturbances and psychiatric symptoms. Future problems for bullies may include violence, substance abuse, and criminal convictions, which often occur in adulthood.

9

What should the nurse include when giving parents guidelines about helping their children in school?
a. Help children as much as possible with their homework.
b. Punish children who fail to perform adequately.
c. Communicate with teachers if there appears to be a problem.
d. Accept responsibility for children's successes and failures.

Ans: C
Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parent involvement is one factor in children's success in school.
Children need to do their own homework. This cultivates responsibility.
Discipline should be used to help children control behaviors that might be affecting school performance, but failure to perform adequately should not be punished itself. Communicating with the child is a better solution to getting to the "root" of the school performance problem.
School-age children need to develop responsibility. Keeping promises and meeting deadlines lays a successful foundation for adulthood and adult responsibilities.

10

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. Based on the nurse’s knowledge of this age-group, the most appropriate recommendation is
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. 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

Ans: C
The parents should help the child select a sport that is suitable to her capabilities and interests. Team sports contribute to the school-age child's social, intellectual, and skill growth.
Organized sports for school-age children can provide safe, appropriate activities with supportive parents and coaches.
The desire to participate in competitive team sports develops out of a need for peer interaction for the school-age child. A sport should be selected that meets the child's capabilities and interests.
The physical changes in boys described take place during puberty, later in the school-age years; therefore, there is no reason for boys and girls to compete separately at age 8 years.

11

Nursing interventions to promote health during middle childhood should include
a. stressing the need for increased calorie intake to meet the increased demands on the body.
b. instructing parents to defer questions about sex until the child reaches adolescence.
c. educating the child and parents about the need for effective 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.

Ans: C
Because the permanent teeth are present, it is important for the child to learn how to care for these teeth.
Caloric needs are diminished in relation to body size during the middle years; however, a balanced diet is important to prepare for the adolescent growth spurt.
Parents should approach sex education with a life span approach and ANS questions appropriate to the child's age.
School-age children often need to be reminded to go to sleep.

12

The school nurse is discussing dental health with some children in first grade. Which should be included?
a. Teach how to floss teeth properly.
b. Recommend a toothbrush with hard nylon bristles to get in between the teeth.
c. Emphasize the importance of brushing before bedtime.
d. Recommend nonfluoridated toothpaste.

Ans: C
Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries.
Parents should help with flossing until children develop the dexterity required, when they are in about the third grade.
A toothbrush with soft nylon bristles is recommended to prevent damage to the gums.
The American Dental Association recommends fluoridated toothpaste for this age-group.

13

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. bicycles should be walked through busy intersections.

Ans: D
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.

14

An important consideration in preventing injuries during middle childhood is that
a. peer pressure is not strong enough to affect risk-taking behavior.
b. most injuries occur in or near school or home.
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.

Ans: B
Most children in the middle years spend the majority of their time in and around school or home; therefore, the risk for injuries is increased in and around these areas.
Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence.
Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, either as a pedestrian or passenger, account for the majority of severe accidents in the middle years.
School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscular coordination and control leading to injuries occurs in younger children.

15

A 12-year-old child being seen in the clinic has not received the hepatitis B (HBV) vaccine. Based on the nurse’s knowledge of vaccines, the most appropriate recommendation is
a. only one dose of HBV will be needed sometime during adolescence.
b. one dose of HBV is needed at age 14 years.
c. the three-dose series of HBV should be started at this time.
d. the three-dose series of HBV should be started at age 16 years or sooner if the adolescent becomes sexually active.

Ans: C
Adolescents should be vaccinated against hepatitis B at this age if they have not been previously.
Three doses of HBV are required to achieve immunity.
Three doses of HBV are required to achieve immunity.
The recommendation is that the HBV vaccine series be started at birth. The American Academy of Pediatrics recommends that vaccinations be completed by age 13 years.

16

Therapeutic management of an 11-year-old girl with Turner syndrome involves
a. administration of thyroid and human growth hormones.
b. progesterone therapy until development of secondary sex characteristics.
c. estrogen therapy to promote development of secondary sex characteristics.
d. estrogen therapy until menses are well established and height no longer increases.

Ans: C
Although the response is variable, most girls with Turner syndrome will achieve some feminization with estrogen therapy.
Growth hormone may be administered, but unless there is a concurrent hypothyroidism, thyroid hormone is not indicated.
Progesterone does not facilitate development of secondary sex characteristics and thus is not warranted.
Menses may never be established due to lack of a uterus and ovaries, and estrogen will not promote increased height.

17

The school nurse is teaching a class on safety. Which activities require protective athletic gear? (Select all that apply)
a. Lacrosse
b. Football
c. Swimming
d. Gymnastics
e. Skateboarding

Ans: A, B, E