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Flashcards in Chapter 39 Deck (22)
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1

Which statement accurately describes physical development during the school-age years?
a.
The child’s weight almost triples.
b.
A child grows an average of 5 cm per year.
c.
Few physical differences are apparent among children at the end of middle childhood.
d.
Fat gradually increases, which contributes to the child’s heavier appearance.

B
In middle childhood, growth in height and weight occur at a slower pace. Between the ages of 6 and 12, children grow 5 cm per year. Children’s weight will almost double during this stage; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

2

Generally, what is the earliest age when puberty begins?
a.
13 years in girls, 13 years in boys
b.
11 years in girls, 11 years in boys
c.
10 years in girls; 12 years in boys
d.
12 years in girls, 10 years in boys

C
Secondary sex characteristics start to develop with the onset of puberty, which begins earlier in girls than it does in boys. Usually there is a 2-year difference in the age at onset between the sexes.

3

Which sentence best describes the cognitive abilities of school-age children?
a.
They have developed the ability to reason abstractly.
b.
They become capable of scientific reasoning and formal logic.
c.
They progress from making judgements based on what they reason, to making judgements based on what they see.
d.
They have the ability to classify, group and sort, and hold a concept in their minds while making decisions based on that concept.

D
In Piaget’s stage of concrete operations, children have the ability to group, sort, and make conceptual decisions. Children cannot reason abstractly until late adolescence. Scientific reasoning and formal logic are also skills of adolescents. Making judgements based on what the child sees versus what they reason is not a developmental skill.

4

Which statement describes moral development in younger school-age children?
a.
The standards of behaviour now come from within themselves.
b.
They do not yet experience a sense of guilt when they misbehave.
c.
They know the rules and behaviours expected of them, but do not understand the reasons behind them.
d.
They no longer interpret accidents and misfortunes as punishment for misdeeds.

C
Children who are aged 6 and 7 years know the rules and behaviours expected of them, but do not understand the reasons for them. Young children do not believe that standards of behaviour come from within themselves, but that rules are established and set down by others. Younger school-age children learn standards for acceptable behaviour, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

5

Which statement best describes moral development in older school-age children?
a.
They are able to judge an act by the intentions that prompted it rather than just by the consequences.
b.
Rules and judgements become more absolute and authoritarian.
c.
They view rule violations in an isolated context.
d.
They know the rules, but cannot understand the reasons behind them.

A
Older school-age children are able to judge and act according to the intentions that prompted the behaviour rather than just the consequences. For this group, rules and judgements become less absolute and authoritarian, and rule violation is likely to be viewed in relation to the total context in which it appears. Both the situation and the morality of the rule itself influence reactions.

6

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for “being bad.” She shares her concern that, if she dies, she will go to hell. How should the nurse interpret this concern?
a.
Such a belief that is common at this age.
b.
Such a belief forms the basis for most religions.
c.
It is suggestive of excessive family pressure.
d.
It is suggestive of the failure to develop a conscience.

A
Children at this age may view illness or injury as a punishment for real or imagined acts and thoughts. Belief in divine punishment is common at this age. It is not indicative of pressure from the family, or that the girl has failed to develop a conscience.

7

What is the role of the peer group in the life of school-age children?
a.
It gives them an opportunity to learn dominance and hostility.
b.
It allows them to remain dependent on their parents for a longer time.
c.
It decreases their need to learn appropriate sex roles.
d.
It provides them with security as they gain independence from their parents.

D
Peer group identification is an important factor that allows children to gain independence from their parents. Through peer relationships, children learn ways to deal with dominance and hostility. They also learn how to relate to people in positions of leadership and authority, and they can explore ideas and the physical environment. A child’s concept of appropriate sex roles is influenced by relationships with peers.

8

A group of boys, ages 9 and 10 years, have formed a “boys-only” club that is open to neighbourhood and school friends who have skateboards. How should this be interpreted?
a.
It is behaviour that encourages bullying and sexism.
b.
It is behaviour that reinforces poor peer relationships.
c.
It is characteristic of social development at this age.
d.
It is characteristic of children who later are at risk for gang involvement.

C
One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer group identification and association are essential to a child’s socialization. Poor relationships with peers and a lack of group identification can contribute to bullying behaviours. There is no evidence that children who form a boys-only club later become involved with gang activity.

9

Which statement best describes the play of school-age children?
a.
Individuality in play is better tolerated than it was at earlier ages.
b.
Knowing the rules of a game provides an important sense of belonging.
c.
They like to invent games, making up the rules as they go.
d.
Team play helps children learn the universal importance of competition and winning.

B
Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, attributes that are highly valued in Canada.

10

What is characteristic of dishonest behaviour in children aged 8 to 10 years?
a.
Cheating during games is now more common.
b.
Lying results from the inability to distinguish between fact and fantasy.
c.
They may steal because their sense of property rights is limited.
d.
They may lie to meet expectations set by others that they have been unable to attain.

D
Older school-age children may lie to meet expectations set by others that they have been unable to meet. Cheating usually becomes less frequent as the child matures. In this age group, children are able to distinguish between fact and fantasy. In terms of theft, young children may lack a sense of property rights, while older children may steal to supplement an inadequate allowance, or the act may be an indication of serious problems.

11

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says that she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as which one of the following?
a.
Signs of stress
b.
Developmental delay
c.
A physical problem causing emotional stress
d.
Lack of adjustment to the school environment

A
Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behaviour, reluctance to participate, or regression to early behaviours. This child is exhibiting signs of stress.

12

Which statement best describes fear in school-age children?
a.
They are increasingly fearful for body safety.
b.
Most of the new fears that trouble them are related to school and family.
c.
They should be encouraged to hide their fears to avoid ridicule from peers.
d.
Those who have numerous fears need continuous protective behaviour from parents to eliminate them.

B
During the school-age years, children experience a wide variety of fears, but new fears related predominantly to school and family bother children during this time. During the middle-school years, children become less fearful of body safety than they were as preschoolers. Parents and other people involved with children should discuss their fear with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding fears does not resolve them, and may lead to the development of phobias.

13

The father of 12-year-old Ryan tells the nurse that he is concerned about his son getting “fat.” Ryan’s body mass index for his age is at the 60th percentile. Which act out of the following is the most appropriate for the nurse to take?
a.
Reassure the father that Ryan is not “fat.”
b.
Reassure the father that Ryan is just a growing child.
c.
Suggest a low-calorie, low-fat diet.
d.
Explain that this is typical of the growth pattern for boys his age.

D
This is a characteristic pattern of growth in preadolescent boys; growth in height has slowed in preparation for the pubertal growth spurt, but the child still gains weight. This reality should be reviewed with both the father and Ryan, and a plan should be developed to maintain physical exercise and a balanced diet. Saying that Ryan is not “fat” is false reassurance, because his weight is high for his height. Ryan needs to maintain or increase his physical activity. The father is concerned, so an explanation is required. A nutritional diet with physical activity should be sufficient to maintain a healthy weight balance.

14

The school nurse has been asked to begin teaching sex education in Grade 5. What should the nurse recognize about this grade level and sex education?
a.
Children in the fifth grade are too young for sex education.
b.
Children should be discouraged from asking too many questions.
c.
Correct terminology should be reserved for children who are older.
d.
Sex can be presented as a normal part of growth and development.

D
When sex information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth graders are usually ages 10 to 11 years, so this group is not too young to speak about the physiological changes in their bodies. Preadolescents should be encouraged to ask questions, and they need precise and concrete information.

15

What is one important consideration for the school nurse who is planning a class on bicycle safety?
a.
Most bicycle injuries involve collision with an automobile.
b.
Head injuries are the major cause of bicycle-related fatalities.
c.
Children should wear bicycle helmets if they ride on paved streets.
d.
Children should not ride double unless the bicycle has an extra-large seat.

B
The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. Children should always wear a properly fitted helmet approved by the Canadian Paediatric Society. They should not ride double.

16

What should the nurse include in her lesson when teaching injury prevention to school-age children?
a.
The need to fear strangers
b.
The basic rules of water safety
c.
To avoid cooking with microwave ovens
d.
Caution against engaging in competitive sports

B
Water safety instruction is an important source of injury prevention at this age. The child should be taught how to swim, to select safe and supervised places to swim, to always swim with a companion, to check for sufficient water depth before diving, and to use an approved flotation device. The nurse should teach stranger safety, not fear of strangers. This includes not going with strangers, not having personalized clothing in public places, having children tell parents if anyone makes them uncomfortable, and teaching children to say “no” in uncomfortable situations. The nurse can also teach children safe cooking methods, and may caution against engaging in hazardous sports, such as those involving trampolines.

17

Turner’s syndrome is suspected in an adolescent girl with short stature. The nurse knows that this is caused by which of the following?
a.
Absence of one of the X chromosomes
b.
Presence of an incomplete Y chromosome
c.
Precocious puberty in an otherwise healthy child
d.
Excess production of both androgens and estrogens

A
Turner’s syndrome is caused by the absence of one of the X chromosomes. Most girls who have this disorder have one X chromosome missing from all cells. The Y chromosome is not part of the genetic makeup of girls. In girls with this syndrome, puberty is delayed and amenorrhea is a clinical manifestation. They often need hormone therapy to increase their levels of androgen and estrogen hormones.

18

Which is an important consideration when the nurse is discussing enuresis with the parents of a young child?
a.
Enuresis is more common in girls than in boys.
b.
Enuresis is neither inherited nor does it have a familial tendency.
c.
Organic causes that may be related to enuresis should be considered first.
d.
Psychogenic factors that cause enuresis persist into adulthood.

C
Organic causes that may be related to enuresis should be ruled out before psychogenic factors are considered. Enuresis is more common in boys, and has a strong familial tendency. Nocturnal bed-wetting usually ceases long before adulthood.

19

The nurse expects a child with post-traumatic stress disorder (PTSD) to be in the intense arousal response for what duration of time?
a.
2 hours
b.
2 days
c.
2 weeks
d.
2 months

A
The initial response involves intense arousal, which usually lasts for a few minutes to 1 or 2 hours.

20

A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school for 3 days. What action should the nurse recommend?
a.
Immediately return the child to school.
b.
Explain to the child that this is the last day she can stay home.
c.
Determine the cause of the phobia before returning child to school.
d.
Seek professional counselling before forcing the child to return to school.

A
The primary goal is to return the child to school. Parents must be convinced gently but firmly that immediate return is essential, and that it is their responsibility to insist on school attendance. Telling the child that this is the last day she can stay home will increase her fear. She must play a role in preparing for her return to school. Beginning with half days might be beneficial. The child may not be able to identify the cause for the phobia. Treatment will depend on the cause if it is known, but relaxation techniques are commonly used. Professional counselling is usually not necessary to resolve this condition.

21

Which of the following is a characteristic of children with depression?
a.
Increased range of affective response
b.
Preoccupation with the need to perform well in school
c.
Change in appetite, resulting in weight loss or gain
d.
Tendency to prefer play instead of schoolwork

C
Physiological characteristics of children with depression include a change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern, insomnia or hypersomnia, and constipation. The child displays a predominantly sad facial expression with absence or diminished range of affective response. He or she has lower grades in school, with lack of interest in doing homework or achieving in school. Solitary play, disinterest in play, or a tendency to be alone are more characteristic.

22

A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). What should the nurse state when preparing the family for discharge?
a.
“Your child should be on a high-fibre diet.”
b.
“You may give your child a stimulant laxative once a week.”
c.
“You should avoid administering antispasmodics.”
d.
“Your child may place ice packs on the abdomen when pain occurs.”

A
A high-fibre diet with the possible addition of bulk laxatives is beneficial for children with RAP. Bowel training is recommended to assist the child in establishing regular bowel habits. Giving a child a stimulant laxative once a week and placing ice packs on the abdomen for pain would not be included in discharge teaching for this patient and family. When pain is not relieved by these simple measures, the parents need to be taught how to administer antispasmodics, if they are prescribed.