Exam 2: School age/adolescent Growth and Development [11]

Question 1

Development for age 5 (Preschool)

Answer 1

5:

Copies square
Can draw a person with 4 body parts

Can ride a bicycle
Likes to help adults (certain household chores)
Can dress and undress self

Question 2

Development for age 6 (kindergarten)

Answer 2

6:

Copies a triangle
Ties shoes
Rides a bike

Well-developed vocabulary
Follows simple directions

Question 3

Approximately how much does a child grow and how much weight does a child gain each year?

Answer 3

Grows 2.5” per year

Gains about 5-7 pounds per year

Question 4

What age does head circumference increase to adult size?

Answer 4

By age 12

Question 5

Development for ages 7 and 8

Answer 5

7/8:

Copies a diamond

Able to solve word problems

Question 6

This Erikson’s stage occurs during school age:

Eager to develop skills and participate in meaningful work
Sense of personal competence and accomplishment
Growing sense of independence
Peer approval is a strong motivator
Relationships center around same-sex peers
Feeling some inferiority regarding skills they can’t master

Answer 6

Industry (competence) vs Inferiority
(School age 6-12)

Eager to develop skills and participate in meaningful work
Sense of personal competence and accomplishment
Growing sense of independence
Peer approval is a strong motivator
Relationships center around same-sex peers

Question 7

Cognitive Development:

Piaget’s Concrete Operations Stage
School ages 7-11

Answer 7

Cognitive Development:
Piaget’s Concrete Operations Stage
(School age 7-11)

Child becomes more stable
Thinks operationally and uses logical reasoning rather than intuitive thought
Able to make judgements based on reason
Understands relationships between things and ideas
Egocentricity decreases
Magical thinking fades, more grounded in reality
Develops empathy

Question 8

What are some red flags for school age and adolescent growth/development?

Answer 8

Red Flags:

Chronic illness
Accidents and frequent injuries
Vision and hearing problems
Sudden change in school performance
Difficult family situations at home
Identification of learning needs

Question 9

What are the tanner stages for girls?

Answer 9

Tanner stages for girls:

1: Prepuberty
2: Breast buds; after buds start menses begins within 1-2 years (puberty starts at this stage)
3: Breast and areola in one mound
4: Areola/nipples separate and form secondary mound
5: Adult pattern (puberty ends)

Question 10

What is the average age of menarche?

Answer 10

Average age of menarche is 12 years old in the U.S. (range 8-15 years)

Question 11

Most girls’ height is gained before menarche. Skeletal growth in girls is considered complete within ____ years after menarche.

Answer 11

2 years after menarche

Question 12

What are the tanner stages for boys?

Answer 12

Tanner stages for boys:

1: Prepuberty
2: Testes enlarge; increased rugation in scrotum (puberty starts at this stage)
3: Penis lengthens; scrotal color starts to darken
4: Penis thickens and increases in size; testes larger
5: Adult pattern (puberty ends)

Question 13

What are the pubic hair stages (both genders)?

Answer 13

Pubic Hair (Both genders):

1: None
2: Few straight, fine hairs, sparse, easily counted
3: Darker, coarse, starts to curl
4: Hair is curly but not medial thigh; hair is coarser
5: Adult pattern; hair spreads to medial thigh and lower abdomen

**Note: Do not need to memorize pubic hair changes for either gender for the boards

Question 14

What is precocious puberty in girls and boys?

Answer 14

Precocious puberty is when puberty begins before age:

8 in girls
9 in boys

Question 15

Puberty is delayed in girls and boys if:

Answer 15

Puberty is delayed in:

Girls if no breast development (Tanner 2) by age 12
Boys if no testicular/scrotal growth (Tanner 2) by age 14

So,
Boys start puberty between the ages of 9 and 14
Girls start puberty between the ages of 8 and 12

Question 16

When do boys and girls get their growth spurts?

Answer 16

Growth spurts:

Girls: Start growth spurt 1 year earlier than boys
Boys: Start growth spurt 1 year later than girls (ages 11-15)

Question 17

What is spermarche and what is the average age?

Answer 17

Spermarche is the beginning of development of sperm in boys’ testicles at puberty. It is the counterpart of menarche in girls. Typically occurs around age 13.

Question 18

What defines adolescence?

Answer 18

Adolescence is defined as the onset of puberty until sexual maturity.

Question 19

In terms of communication, what does HEADSS mean?

Answer 19

Home (what’s going on at home?)
Education, employment (How’s school? Are you working?)
Activities (What do you do outside of school, sports, music, hobbies?)
Drugs
Sexuality
Suicide

** Can be good to ask what their friends are up to in the HEADSS; non-judgmental approach

Question 20

What are factors that increase risky behaviors?

Answer 20

Increase risky behaviors?

Poor academics
Impulsivity
ADHD/ADD
Lack of role models
Low self-esteem
Poverty
Abuse
Lack of support

Question 21

What are common dangers for adolescents?

Answer 21

Common dangers:

MVA
Homicide, suicide
Depression
Drugs
Risky sexual behavior

Question 22

Review of early adolescence (11-14 years)

Physiological
Psychological
Social
Potential problems

Answer 22

Early adolescence (11-14 years)

Physiological:
Onset of puberty
Growth spurt
Menarche (females)

Psychological:
Concrete thought
Preoccupation with rapid body changes
Sexual identity
Questioning independence
Parental controls remain strong

Social:
Search for same-sex peer affiliation
Good parental relationships
Other adults as role models
Transition to middle school
Involvement in extracurricular activities
Sensitivity to differences between home culture and culture of others

Potential problems:
Delayed puberty
Acne
Orthopedic problems
Psychosomatic concerns
Depression
Unintended pregnancy
Initiation of tobacco, ETOH, other drugs

Question 23

Review of middle adolescence (15-17 years)

Physiological
Psychological
Social
Potential problems

Answer 23

Middle adolescence (15-17 years)

Physiological:
Ovulation (females)
Growth spurt (males)

Psychological:
Competence in abstract and future thought, idealism
Sense of invincibility or narcissism
Sexual identity
Beginning of cognitive capacity to provide legal consent

Social: 
Beginning emotional emancipation
Increased power of peer group
Conflicts over parental control
Interest in sexual relationships
Start of driving
Risky behavior
Transition to high school
Reduced involvement in extracurricular activities
Possible cultural conflict between family's and peers' culture

Potential problems:
Experiment with risky behaviors (sex, drinking, smoking, drugs)
Motor vehicle crashes
Menstrual disorders, unintended pregnancy
Acne, overweight, short stature (males)
Conflicts with parents
Eating disorders and poor eating habits

Question 24

Review of late adolescence (18-21 years)

Physiological
Psychological
Social
Potential problems

Answer 24

Late adolescence (18-21 years)

Physiological:
Growth completed

Psychological:
Future orientation
Emotional independence
Unmasking of psychiatric disorders
Capacity for empathy
Intimacy, reciprocity with interpersonal relationships
Self identity
Recognized as legally capable of providing consent
Attainment of legal age for (voting) but not (drinking ETOH)

Social:
Individual of peer relationships
Transition in parent-child relationship
Transition out of home
May begin preparation for further education, career, marriage, parenting 

Potential problems:
Eating disorders
Depression, suicide
Auto crashes
Unintended pregnancy
Acne
ETOH, smoking, drug dependence

Question 25

Erikson’s ___ versus ____is when the infant’s needs are consistently met or unmet

Answer 25

“Trust vs Mistrust”

Depends on care given or not given by caregivers, especially the mother

Question 26

This phase of cognitive development has four stages in infancy and includes reflexive, repetitive, and imitative.

Answer 26

Piaget’s Sensorimotor Phase; learn through trial and error

Question 27

Erikson’s _______ occurs in toddlerhood (12-36 months) where the major task is acquiring a sense of autonomy. The child uses “no” and right and wrong are determined by the consequences of their action. Toilet training is most important in this stage. Wants to choose own clothes and dress self.

Answer 27

“Autonomy vs Shame and Doubt”

Erikson’s Autonomy versus shame and doubt applies to early childhood (ages 1-3)
Toddler strives for autonomy
Most important in this stage: Toilet training
“No”
“Me do it” stage
Wants to choose own clothes and dress self
Children who experience too much doubt in this stage will lack confidence throughout life

Question 28

This phase occurs between 12-24 months. There is an awareness of casual relationships between 2 events (cause and effect or trial and error). Learn spatial relationships and through imitation. As the child gets closer to age 2 he/she is able to perform more complex mental operations and has a limited awareness of time.

Answer 28

Piaget’s Sensorimotor phase (trial and error learning)

Question 29

In this cognitive stage 2, children from ages 3-7 develop language, memory, intuitive intelligence through make believe play. Magical thinking occurs in this stage around ages 3-5.

Answer 29

Piaget’s Preoperational Phase

Question 30

Erikson's initiative versus guilt applies to:
A. Early childhood
B. Preschool
C. School age
D. Adolescence

Answer 30

Answer: B
Erikson’s “initiative versus guilt” applies to preschool (ages 3-6)
Most important in this stage: independence
Eager for responsibility and likes to help with chores
Hero worship
Pretend play like house (pretend to be the mommy or daddy)

Question 31

Piaget’s ______ occurs in school-age children (6-12) and includes:

Developing an understanding of relationships between things and ideas
Use thought processes to experience events and actions
Able to make judgments based on reason and logic

Answer 31

Piaget’s Concrete Operational Phase

Occurs in school-age children (6-12) and includes:

Developing an understanding of relationships between things and ideas
Use thought processes to experience events and actions
Able to make judgments based on reason and logic

Question 32

This psychosocial stage occurs from onset of puberty (ages 12-18) and includes:

Social relationships
Develop sense of self and personal identity
Sex role identity
Failure leads to role confusion and a weak sense of self

Answer 32

Erikson’s “Identity vs Role Confusion”

This stage occurs from onset of puberty (age 12-18) and includes:

Social relationships
Develop sense of self and personal identity
Sex role identity
Failure leads to role confusion and a weak sense of self

Question 33

This 4th and final cognitive stage starts around age 12 and goes into adulthood. The use of deductive reasoning, abstract thinking, and theoretical concepts can be used to find creative answers to problems. Concerned about others thoughts and needs.

Answer 33

Piaget’s Formal Operational Phase

Question 34

What are Piaget’s 4 Stages of cognitive development and at what ages do they occur?

Answer 34

Piaget’s 4 Stages of Cognitive Development:

Sensory-motor: 0-2
Pre-operational: 2-7
Concrete operations: 7-12
Formal operations: 12 and up

Question 35

What change in boys indicates the onset of puberty?
A. Voice changes
B. Testicular enlargement
C. Growth of dark pubic hair
D. An increasing penis size

Answer 35

B. Testicular enlargement is the first change that signals puberty in boys.
It usually occurs between the ages of 9-14 (Tanner Stage 2).
Voice change occurs between Tanner stages 3-4.
Fine pubic hair may occur at the base of the penis; darker hair and increasing penis size occurs during Tanner stage 3.
** Tanner staging very important for contact sports physicals **

Question 36

Erikson's industry versus inferiority applies to:
A. Early childhood
B. Preschool
C. School age
D. Adolescence

Answer 36

Answer: C (school age 6-12)

Most important: school
Eager to develop skills
Do productive work on their own
Develop increasing sense of independence
Motivated by peer approval
Relationship centered on same-sex peers
Feel some inferiority regarding skills they can't master

Question 37

Erikson's identity versus role confusion applies to:
A. Early childhood
B. Preschool
C. School age
D. Adolescence

Answer 37

Answer: D - Erikson’s “identity versus role confusion” applies to adolescence (ages 12-20s)

Most important: Peer relationships
Develop sense of self-worth
Develop sense of identity
Develop sex role identity
Gain sense of belonging in valued group
Acquire skills important to valued group
Build reliable relationships with others
See themselves as separate from their parents

Question 38

The NP is performing a well child exam on an 8-month-old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the NP recommend to the parents to improve speech and language skills:

A. Provide educational videos that focus on language
B. Read simple board books to the infant at bedtime
C. Sing to the child and play lullabies in the baby’s room
D. Turn the television to Sesame Street during the day

Answer 38

B. Read simple board books to the infant at bedtime
As long as the reading includes positive interactions with the baby and the reader, the baby is learning language.
Educational videos, music, and TV are all passive media and do not involve this interaction.

Question 39

The NP performs a developmental assessment of a 32-month-old child. The child’s parents reports that about 70% of the child’s speech is intelligible. The NP observes that the child has difficulty pronouncing “t,” “d,” “k,” and “g” sounds. What is the correct action?

A. Evaluate the child’s cognitive abilities
B. Obtain a hearing evaluation
C. Reassure the parent this is normal
D. Refer the child to a speech therapist

Answer 39

C. Reassure the parent this is normal

Intelligibility of speech reaches about 75% by age 3. Tongue-contact sounds are more intelligible by age 5. This child exhibits normal speech for age. It is not necessary to perform a cognitive assessment based on these findings. Referrals for hearing and speech evaluations are not indicated since these finding are within normal limits.

Question 40

During a well child exam on a 6-year-old, the NP assesses the child for school readiness. Which finding may be a factor in limiting school readiness for this child?

A. Adherence to daily family routines and regular activities
B. Having 2 older siblings who attend the same school
C. Parental concerns about bullying in the school
D. The child’s ability to recognize 4 different colors

Answer 40

C. Parental concerns about bullying in the school

Parental expectation is the strongest predictor of school success in children. Parents who are worried about what may happen in school can transmit this anxiety to the child.

Children who have a secure family life with daily routines will do better in school. Having older siblings who attend school increases success. Children at this age are expected to know 4 colors so this is an indication of school readiness.

Question 41

The NP is performing a well child assessment on a 13-year-old female whose mother asks when her daughter’s periods may start. Which information with the NP use to help estimate the onset of menses?

A. The age of mother’s menarche
B. The patient’s age at thelarche
C. When adrenarche occurred
D. Whether linear growth has stopped

Answer 41

B. The patient’s age at thelarche
Thelarche, or the development of breast budding generally precedes menarche by 2.5 years so this should be determined when attempting to predict this milestone. The age of the mother at menarche is not a reliable indicator. Adrenarche is related to adrenal and not gonadal development and is less valid than other secondary sex characteristics in assessing sexual maturation. Rapid linear growth usually begins after thelarche and peaks about a year later but is not used to predict menarche.

Question 42

The NP is performing an exam on an adolescent male who asks about sexual identity because of a concern that a friend is worried about being gay. What is the response?

A. Provide the teen with a questionnaire to gain information about his sexuality
B. Remind the adolescent that mandatory reporting requires disclosure to parents
C. Suggest that the adolescent discuss sexual concerns with parents
D. Tell the adolescent that unless he is at risk, what he says will be confidential

Answer 42

D. Tell the adolescent that unless he is at risk, what he says will be confidential

Adolescents should be encouraged to divulge information about their sexuality to providers by assuring them that confidentiality will be maintained unless the health of the child or others is at risk. The patient may be trying to ask questions about himself in a manner that does not implicate his own sexuality so the NP needs to gain his trust

Question 43

The parent of a 14-year-old tells the NP that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home and wants the family to eat vegetarian meals. What would the NP tell the parent?

A. Do not allow a vegetarian diet in order to maintain appropriate limits for the adolescent
B. Provide vegetarian options for the adolescent to preserve adequate nutrition and protein intake
C. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals
D. Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home

Answer 43

C. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals

Early adolescents begin to develop their own value system and may try value systems other than the one that they have learned from their family. The parent may allow expression of other values such as a vegetarian diet as long as nutritional needs are met and the adolescent takes responsibility for preparing the food.
Adequate protein intake is not really a big problem in the US. If an illness occurs then you can address the protein/nutrition issue.

Question 44

What is characteristic of the psychosocial development of school-age children?

A. Peer approval is not yet a motivating factor
B. Developing sense of initiative is very important
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 44

The school-age child is eager to develop skills and participate in activities. Not all children are able to do all tasks well and the child must be prepared to accept some feelings of inferiority.
Peer group formation is one of the major characteristics of this age group
A developing sense of initiative is characteristic of preschoolers.
School age children gain satisfaction from successful independent behaviors