Chapter 14: Health Promotion of the School-Age Child and Family

Question 1

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 teacher if there appears to be a problem
d. Accept responsibility for children’s successes and failures

Answer 1

c. Communicate with teacher if there appears to be a problem

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.

Question 2

A 10-year-old child is riding a bicycle on the grounds of the school. Which finding if observed by the nurse would require intervention?

a. Child is seen walking the bicycle through the crosswalk
b. Child is riding close to the curb
c. Child’s shoes are ill fitting
d. Child is riding single file

Answer 2

c. Child’s shoes are ill fitting

Shoes that are ill fitting can result in potential injury as they can get caught up in gears and affect the ability of the child to navigate. All of the other observed behaviors are consistent with safe practice.

Question 3

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

Answer 3

b. Most injuries occur in or near school or home

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.

Question 4

A parent tells the nurse, “I am worried about by 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.”

Answer 4

c. “This is normal because the onset of pubescence is usually earlier in girls than it is in boys.”

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.

Question 5

A parent is concerned as her 6-year-old child “cheats” when playing games with other children. The parent is concerned that this behavior will affect future behaviors as the child gets older. The nurse understand that the parent’s anxiety about the described behaviors and provides the following assurance”

a. This type of behavior occurs around this age period and is due to the child not being able to understand what it means to lose
b. This is a prompted behavior that occurs intermittently at this age
c. You are right to be concerned about this type of behavior
d. It is best to ignore the behavior as it will stop eventually

Answer 5

a. This type of behavior occurs around this age period and is due to the child not being able to understand what it means to lose

Cheating as a behavior occurs primarily between the ages of 5 and 6. It is almost at times displayed as an automatic behavior as the child does not understand about winning and losing. The behavior typically goes away as the child matures. Ignoring the behavior without some direction is not advised as it is best to address the situation and help the child to begin understanding of the concept.

Question 6

Which is characteristic of 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

Answer 6

d. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment

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.

Question 7

In reviewing information about a school-age child, the nurse notes that the child goes to after school activities each day as the parents do not get home until considerably later in the day. Based on this description, the nurse would document:

a. Concern for the growth and development due to lack of parental influence
b. No further action is needed
c. Referral to a social worker for evaluation of the family unit
d. Notation of being a latchkey child

Answer 7

b. No further action is needed

Many children have working parents and do not exhibit any adverse outcomes if they attend after school activities each day following release from school. There is no need for referral to a social worker. A latchkey child by definition is one that has no parental or supervision contact following the school day and are responsible for their own care until the parent comes home.

Question 8

A middle age child understands that with regards to a mathematical equation that 7 can be composed of 4+3 as well as 2+5. Based on this finding, the nurse documents that the development level of the child reflects?

a. Concrete operations
b. Verification of latency period
c. Conservation
d. Accomplished industry versus inferiority

Answer 8

c. Conservation

Piaget’s cognitive theory development describes conservation as the ability of the child to understand that the same concept may exist as identified by a different method. Numerical relationships are understood before substance conservation. Concrete operations is the term Piaget applies to the entire stage whereby children are able to use thought processes to experience events and actions. The latency period is described by Freud as the ability of the child to go from peer relationships to heterosexual relationships. Industry versus inferiority refers to Erikson’s overview of this time frame whereby children if successful master the challenges between industry and inferiority.

Question 9

At what age would orthodontic treatment be considered to have the most potential for successful outcome?

a. When the adolescent growth period has stopped
b. Early referral if malocclusion presents regardless of age
c. Treatment differs based on gender due to difference in growth and development
d. When all primary teeth are present

Answer 9

b. Early referral if malocclusion presents regardless of age

If malocclusion is present, best practice would be to have early referral for evaluation and treatment. Orthodontic treatment should be started prior to the growth period stopping. Orthodontic treatment is based on individual presentation and not gender based variables. Orthodontic treatment is typically not started when all primary teeth are still present.

Question 10

Which statement is not accurate regarding the roles and responsibilities of a school nurse?

a. They are responsible for development and implementation of plans of care for all children within the designated school
b. All school nurses are registered nurses
c. They are responsible for medical needs of the children within the designated school
d. They evaluate implementation of care delivered to children within the designated school setting

Answer 10

b. All school nurses are registered nurses

Not all schools have a school nurse but may have unlicensed assistive personnel that work within the school setting that have received training to provide routine standardized care under the supervision of a school nurse. The other options are all within the roles and responsibilities of a school nurse.

Question 11

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 encourage 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

Answer 11

c. Sports participation is encourage if the sport is appropriate to the child’s abilities

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.

Question 12

Nursing interventions to promote health during middle childhood should include stressing the need for increased calorie intake to meet the:

a. 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

Answer 12

c. Educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt

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 answer questions appropriate to the child’s age. School-age children often need to be reminded to go to sleep.

Question 13

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

Answer 13

b. Children frequently have “best friends”

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.

Question 14

Signs and symptoms that are associated with stress in a school-age child that require intervention are: (Select all that apply).

a. Child did not want to go to sleep occasionally at the usual bedtime
b. Reverting to a previous behavioral pattern exhibited several years ago
c. Bedwetting
d. Doesn’t want to eat a certain food although the child used to eat it before
e. Doesn’t want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable

Answer 14

b. Reverting to a previous behavioral pattern exhibited several years ago
c. Bedwetting
e. Doesn’t want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable

Reverting to a previous behavior indicative of regression, evidence of bedwetting and change in socialization pattern as signs and symptoms of stress should be investigated as they are signal areas of concern. Occasional reluctance to go to sleep at the regularly scheduled bedtime may be an isolated event which is self-limiting. Refusal to eat a food even if the child ate the food before is not by itself indicative of a significant stress event.

Question 15

At which age, is a strong preference exhibited for members of the same sex to engage in play activities rather than play with mixed groups?

a. 7
b. 6
c. 8
d. 9

Answer 15

a. 7

At age 7, boys prefer to play with boys and girls prefer to play with girls. At age 6, play is considered to be more independent but showing some degree of socialization. Between the ages of 8 and 9, there is more interest in body-girl relationships and beginning to mix group play.

Question 16

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

Answer 16

a. Lacrosse
b. Football
e. Skateboarding

Any sport that involves body contact such as lacrosse, football, and skateboarding requires a child to wear protective equipment. Swimming does not involve body contact and requires no protective equipment. Gymnastics does not require protective equipment.

Question 17

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 of have poor academic or social skills

Answer 17

d. Bullying often manifests itself in children who are different of have poor academic or social skills

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.

Question 18

The parents of 9-year-old twins tell the nurse, “They have filled 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

Answer 18

c. Cognitive development at this age

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.

Question 19

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

Answer 19

c. Emphasize the importance of brushing before bedtime

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.

Question 20

Which benchmark serves as the ending period for the middle year period of development?

a. Beginning school
b. Onset of puberty
c. Wisdom teeth appearing
d. Loss of deciduous teeth

Answer 20

b. Onset of puberty

The onset of puberty signals the end of the middle year period. Beginning school and loss of deciduous teeth are associated with the beginning of the middle year period. Appearance of wisdom teeth occurs later on in life.

Question 21

A child has sustained an injury and lost a primary tooth. Which priority action should be taken by the nurse at this time?

a. Provide comfort measures and assess for bleeding
b. Referral to the dentist for immediate consultation
c. Recover the tooth and prepare for reimplantation
d. If the tooth is dirty, rinse it off and cover in gauze until needed for reimplantation

Answer 21

a. Provide comfort measures and assess for bleeding

Avulsed primary teeth are usually not reimplanted. Therefore the nurse should focus on assessment of the site and comfort measures. All of the other options would be indicated if an avulsed tooth were to be reimplanted.

Question 22

Examination of a child’s mouth reveals that teeth do not line up properly upon attempts to have the child bite down. This finding is noted as?

a. Malocclusion
b. Gingivitis
c. Evidence of dental caries
d. Dental injury

Answer 22

a. Malocclusion

Malocclusion occurs when upper and lower teeth do not approximate when a child bites down. Gingivitis refers to inflammation of the gums. Evidence of dental caries would refer to the presence of a cavity. Dental injury refers to evidence of chipping or dislocation as a result of trauma.

Question 23

A finding that is consistent with prepubesence is:

a. Variation in physical appearance between boys and girls
b. Age of onset of physical signs is the same for both boys and girls
c. Does not occur during the preadolescence period
d. Appearance of secondary sex characteristics is the same for both boys and girls

Answer 23

a. Variation in physical appearance between boys and girls

During the period of prepubescence there is a variation in physical appearance between boys and girls. The age of onset of these appearances also varies with girls exhibiting changes earlier than their male counterparts. The changes occur during the preadolescence period. Secondary sex characteristics also present at different times for boys and girls.

Question 24

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

Answer 24

d. Some children are more vulnerable to stress than others

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.

Question 25

Which action would improve dental health in the school-age child?

a. Limiting brushing of teeth to three times a day following meals
b. Encouraging the child to floss
c. Have the parent brush the child’s teeth in order to make sure it is done properly
d. Have the child consume fruit juice rather than soda

Answer 25

b. Encouraging the child to floss

Flossing is a critical activity that has been shown to improve dental health. Brushing teeth following meals as well as following snacks has also been shown to improve dental health. At this age, the child should be able to brush their own teeth. Whereas soda should be avoided, the use of fruit juice may contribute to dental caries as it is considered to be a sugar source and example of a fermentable carbohydrate. Water as a drink should be promoted to improve dental health.

Question 26

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

Answer 26

c. Transitory periods of lowered self-esteem are expected developmentally

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.

Question 27

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 in 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

Answer 27

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.

Question 28

Which action would indicate a priority for the nurse in terms of health promotion safety?

a. 8-year-old child uses helmet protection while riding a bicycle
b. 4-year-old child wears protective equipment while on a skateboard
c. School-age child uses car seat restraint system
d. Protective equipment is used while the 9-year-old child is riding a scooter

Answer 28

b. 4-year-old child wears protective equipment while on a skateboard

Skateboard use is not recommended for children aged 5 and younger regardless if they are wearing protective equipment. All of the other options indicate that attention has been placed on safety concerns and that the children are developmentally appropriate to handle the physical skill activity.

Question 29

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

Answer 29

c. Increasingly logical and coherent thought processes

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.

Question 30

An example of indirect bullying would be:

a. Telling an individual that you don’t like them because you were hurt by their actions
b. Raising one’s hand to prevent another person from hitting you
c. Taking a toy away from someone because you want to see it
d. Using social media to make offensive comments about an individual

Answer 30

d. Using social media to make offensive comments about an individual

Indirect bullying are actions that are taken that are meant to cause harm to an individual or group. The use of social media to make offensive comments about an individual is not the place for professing feelings. One must take into account that offensive comments by definition are offensive. Telling an individual that you don’t like them as a result of their exhibited behavior is an example of direct communication. Taking a toy away from someone because you want to see it may not be the best approach but it does involve direct action.