The nurse is assessing a 12-year-old boy during a well-child clinic visit. Which of the following findings would the nurse expect to see?

Weight gain of 2¼ lb (1 kg) since the last visit 1 year previously

Height increase of 2 in. (5.5 cm) since the last visit 1 year previously

20 secondary teeth

Heart rate 124

Answer and Explanation

The Correct Answer is B

Physical development in 12-year-old children varies, especially as they enter puberty. Growth spurts are common, with noticeable increases in height and weight, and physiological changes like secondary sexual characteristics begin. Monitoring growth patterns, vital signs, and dental development helps identify whether a child is progressing along a healthy developmental trajectory.

Rationale for correct answer:

2. Height increase of 2 in. (5.5 cm) since the last visit 1 year previously is within the normal range for preadolescent boys. On average, children at this age grow about 2–2.5 inches (5–6.5 cm) per year until they hit their adolescent growth spurt. A 2-inch gain in one year is typical and expected in a 12-year-old boy not yet in full puberty.

Rationale for incorrect answers:

1. Weight gain of 2¼ lb (1 kg) since the last visit 1 year previously is insufficient for this age. Normal weight gain in a 12-year-old is typically about 4–7 lb (1.8–3.2 kg) per year, with more if the child has entered puberty. A 1 kg gain may suggest poor nutrition, chronic illness, or growth concerns.

3. By age 12, children typically have most or all of their 28 permanent teeth (excluding third molars/wisdom teeth). Having only 20 permanent teeth is more consistent with younger school-aged children who still retain primary teeth.

4. Heart rate 124 is elevated for a 12-year-old at rest. The normal resting heart rate for this age group ranges from 70 to 110 beats per minute. A rate of 124 could indicate anxiety, fever, dehydration, or cardiac abnormality and warrants further evaluation if persistent.

Take home points

Expected annual height gain for a 12-year-old is around 2 inches (5–6 cm).
Normal weight gain is typically 4–7 lb (1.8–3.2 kg) annually unless a pubertal growth spurt is underway.
By age 12, most children should have nearly all of their 28 permanent teeth.
Resting heart rate in a healthy 12-year-old should be between 70 and 110 bpm; sustained elevation should be evaluated.

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Correct Answer is A

Explanation

Injury prevention and disease prevention are both important components of well-child care. Nurses must assess behaviors that could lead to cumulative health risks, such as sun exposure, and provide anticipatory guidance to promote long-term wellness. Proper protective behaviors reduce risk for both accidental injuries and preventable diseases such as skin cancer.

Rationale for correct answer:

1. Applying sunscreen every 4 hours is inadequate protection during prolonged sun exposure. The child and parents should be educated on applying broad-spectrum SPF 30+ sunscreen at least every 2 hours and after water exposure. Early education supports lifelong skin health and reduces the risk of melanoma and sun damage.

Rationale for incorrect answers:

2. Sitting in the backseat in a car restraint system is an appropriate safety measure for an 11-year-old and does not indicate the need for additional education at this time.

3. Wearing proper body and head protection while rollerblading is a positive safety behavior, indicating that no immediate safety intervention is necessary.

4. Using 2 oven mitts and being assisted by a parent during oven use demonstrates adequate supervision and precaution, which is developmentally appropriate and safe.

Take home points

Disease prevention education should be provided when current practices are insufficient or incomplete, even if partially protective.
Sun safety is a key area of education during well-child visits due to the cumulative effects of UV exposure.
Reinforce protective behaviors (helmets, seat belts, adult supervision) and correct any gaps in disease prevention practices.
Nurses should use well-child visits to guide families toward evidence-based safety and prevention behaviors.

A. “There is the same amount of clay in a snake made out of a ball of clay than there was when it was a ball.” B. “I don’t get as tired when I ride up in an elevator than I do when I walk up a whole flight of stairs.” C. “I’d rather read books and play video games than to play baseball or soccer.” D. “I try to get my homework done as soon as I get home from school.”

Correct Answer is A

Explanation

Conservation is a key cognitive milestone in Piaget’s Concrete Operational Stage (ages 7 to 11 years). It refers to the understanding that quantity remains the same despite changes in shape or appearance. Children who grasp this can tell that mass, volume, or number doesn’t change just because the container or form has changed.

Rationale for correct answer:

1. “There is the same amount of clay in a snake made out of a ball of clay than there was when it

was a ball.” This child demonstrates an understanding that changing the shape of an object does not change its amount, which is the essence of conservation. Recognizing that a ball and a snake-shaped piece of clay contain the same amount of clay indicates cognitive development consistent with Piaget’s stage of concrete operations.

Rationale for incorrect answers:

2. “I don’t get as tired when I ride up in an elevator than I do when I walk up a whole flight of

stairs.” This reflects an understanding of physical exertion or energy use, not conservation. It’s about perceived effort, not quantity or matter.

3. “I’d rather read books and play video games than to play baseball or soccer.” This shows personal preference for activities, which is unrelated to the concept of conservation or cognitive reasoning about mass or volume.

4. “I try to get my homework done as soon as I get home from school.” This is a behavioral statement about responsibility or routine and does not demonstrate the cognitive skill of conservation.

Take home points

Conservation is the understanding that quantity remains the same despite changes in shape, position, or appearance.
It typically emerges during the Concrete Operational Stage (ages 7–11), per Piaget's theory of cognitive development.
Assessing a child’s understanding of conservation involves using familiar materials (like clay, liquid, or objects) in tasks that change appearance but not quantity.

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The nurse is assessing a 12-year-old boy during a well-child clinic visit. Which of the following findings would the nurse expect to see?

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