Ch. 17 Care of the Preschooler

Establishment of healthy eating habits that begin during the preschool years can help prevent ___________ later in the school-aged years, adolescence, and adulthood.

obesity

When using time-out as a form of discipline for a preschool child, a general rule is that it should last _____ minute per year of the age of the child.

1

The chest circumference for a child is ___ to ___ inches greater than the head circumference.

2-3

The posterior fontanel (fontanelle) closes around ___ to ___ months of age in infants.

2-3

The normal heart rate for a school-aged child is _____ to _____.

60-110

The normal blood pressure for a preschooler is _______ systolic and _______ diastolic.

89-112/46-72

A school nurse has completed an educational program for parents of preschool children. Which statement by a participant indicates a need for further education? A. "My 5-year-old son still needs me to dress and undress him." B. "I need to work with my 4-year-old; she should be able to cut paper with scissors on her own." C. "My 3-year-old is doing fine, he can hop on one foot already." D. "I'm glad to know that it's okay that my 5-year-old is learning to skate."

A. "My 5-year-old son still needs me to dress and undress him."

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by a caregiver best indicates a common aspect of the diet and nutrition of the preschool child? A. "My child is so picky and eats the same thing every day for days on end!" B. "My 4-year-old eats as much as my teenager does every day." C. "My spouse is insistent that our 5-year-old not eat any snacks so that he will eat all of his meal at mealtime." D. "Our child gets into food jags where he will only eat one food all day long."

A. "My child is so picky and eats the same thing every day for days on end!"

A 5-year-old girl is pretending to be a crocodile during a physical examination. Her mother just smiles and rolls her eyes at the nurse. What would be the best response for the nurse to give the child? A. "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." B. "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you." C. "Oh no! I have a crocodile in my room. Please don't bite me!" D. "What happened to my client? Did you eat her?"

A. "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." Rationale: Parents sometimes strengthen a fantasy role without realizing it. A preschooler might be pretending she is a crocodile. If the nurse plays along, the child may be frightened she has actually become a crocodile. A better response is to support the imitation—this is age-appropriate behavior and a good way of exploring roles—by saying, "What a nice crocodile you're pretending to be." This both supports the fantasy and reassures the child she is still herself.

An advanced practice pediatric nurse practitioner is conducting a mental status examination with a 6-year-old girl. Which question would be most appropriate for the nurse to ask? A. "Why does your pink doll hit all the other dolls?" B. "Isn't it fun to play with dolls?" C. "What is the name of the president of the United States?" D. "Do you like the doll with pink hair or with green hair better?"

A. "Why does your pink doll hit all the other dolls?" Rationale: The nurse is trying to elicit the underlying fantasies and feelings to the child's play. Asking an open-ended question is likely to reveal this information. A 6-year-old might know the name of the president but the meaning is ambiguous. Asking if it is fun to play with dolls, what the president's name is, or which doll she likes better would elicit "yes" or "no" answers and provide little information about the child's feelings.

The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond? A. "Your child is not expected to be able to perform those activities at 3 years of age." B. "I wouldn't be too concerned since he seems fine during my assessment." C. "Maybe practicing these activities with him would help him improve these motor skills." D. "I am sure he will become more proficient in these activities soon."

A. "Your child is not expected to be able to perform those activities at 3 years of age."

Which of the following developmental milestones is most appropriate at age 4 years? A. Imaginary Friends B. Parallel play C. 75% Speech Understood by Stranger D. Completes Toilet Training E. Five-word sentences F. 1/2 of speech is understandable to a stranger

A. Imaginary Friends

A nurse is developing a teaching plan for parents of preschoolers about how to address the issue of strangers and safety. Which would the nurse expect to include in the teaching? Select all that apply. A. Urge children never to talk to or accept a ride from a stranger. B. Wait until children are old enough to tell them how to call for help in an emergency. C. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. D. Urge your children to report others who are bullying. E. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.

A. Urge children never to talk to or accept a ride from a stranger. C. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. D. Urge your children to report others who are bullying. E. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.

A nurse instructor is educating the parents about activities preschoolers can successfully perform independently. Which activities would the nurse include? Select all that apply. A. Washing hands B. Brushing teeth C. Flossing teeth D. Dressing self E. Playing active games

A. Washing hands B. Brushing teeth D. Dressing self E. Playing active games

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of these actions? Select all that apply. A. When discussing improper behavior, call the behavior "bad" or "naughty," not the child. B. Anticipate situations likely to cause misbehavior and redirect the child to another activity. C. Books and stories can help preschoolers master proper behavior. D. A time-out of about 8 minutes would be appropriate for intentional misbehavior. E. Spank with an open hand only and never with an object.

A. When discussing improper behavior, call the behavior "bad" or "naughty," not the child. B. Anticipate situations likely to cause misbehavior and redirect the child to another activity. C. Books and stories can help preschoolers master proper behavior.

A mother expresses surprise to the nurse that her daughter has begun masturbating. The most important initial nursing response is that: A. this is a normal and expected activity best treated matter-of-factly. B. girls as well as boys will masturbate. C. toilet teaching places much focus on the genitals. D. there may be undue stress in your child's life.

A. this is a normal and expected activity best treated matter-of-factly.

Which of the following fine motor milestones is most appropriate for a child at age 4 years? A. Rides Tricycle B. Ties Shoelaces C. Shaking D. Copies Triangle E. Copies Circle F. Uses Fork Well

F. Uses Fork Well

True or False: During nightmares, a child is not actually awake when they occur and may push the parent away before falling back to sleep.

False

True or False: Social determinants of health should not influence health promotion teaching provided by the nurse.

False

True or False: Children living in poverty are at greater risk for language delay than other children.

True

The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse? A. "The preschool-age child has no sense of right and wrong." B. "The preschool-age child is developing a conscience." C. "The preschool-age child sees morality as internal to self." D. "The preschool-age child's morals are their own, right or wrong."

B. "The preschool-age child is developing a conscience."

The nurse is speaking with the parent of a 4-year-old child. Which statement by the parent would suggest a need for further investigation? A. "My child loves to play dress-up with friends at day care." B. "When we go to the park, my child never wants to play with the other children." C. "I think it is so cute when my child wants to help my spouse with yardwork." D. "Sometimes I wish my child would play with a toy in the way it was intended. My child is constantly pretending it is something else." E. "My son loves to follow around his older sister."

B. "When we go to the park, my child never wants to play with the other children."

The nurse teaches a preschooler to use a FACES pain rating scale prior to surgery. At that time, the preschooler points to the smiling face. Following surgery when the nurse suspects the child has pain, the preschooler points again to the smiling face. How would the nurse interpret this response? A. The child does not have pain. B. The child is using the scale to predict what they would like, not what the child has. C. The child has difficulty focusing on the right side of the scale. D. The nurse must be interpreting the child's degree of pain falsely.

B. The child is using the scale to predict what they would like, not what the child has.

A 4-year-old tells the nurse he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which nursing diagnosis is most applicable for his family? A. compromised family coping related to abnormal behavior of child B. deficient knowledge of normal preschool development C. disturbed thought processes related to deep-set psychological need D. social isolation related to unwillingness to relate except through imaginary friend

B. deficient knowledge of normal preschool development

____________ conjunctivitis in children includes signs and symptoms of erythema of the conjunctiva and purulent drainage from the eye.

Bacterial

The nurse is preparing a 4-year-old child for surgery. According to hospital policy, the surgical site must be marked prior to entering the operating room. The child pulls away from the nurse when approached with a black marker. Which nursing statement may provide the best chance of a favorable response? A. "It is time to mark your surgical site. Sit still on the bed like a good child for me." B. "I have a fun sticker to give you once I mark your arm." C. "Would you like your parent or me to draw a smiley face on your arm?" D. "You do not have to have a surgical marker if you do not want one."

C. "Would you like your parent or me to draw a smiley face on your arm?"

Which physical assessment data would the nurse find concerning and would warrant reporting to the primary care provider? A. Head circumference is 2 inches less than the chest circumference in a 5-year-old child. B. A school-aged child has a heart rate of 90. C. A blood pressure of 128/80 in a preschool-aged child D. An infant who has a closed posterior fontanel (fontanelle) at age 4 months

C. A blood pressure of 128/80 in a preschool-aged child Rationale: The normal blood pressure for a preschooler is 89-112 systolic and 46-72 diastolic, so a blood pressure of 128/80 is abnormal and needs reporting to the physician. The chest circumference for a child is 2 to 3 inches greater than the head circumference. The normal heart rate for a school-aged child is 60-110. The posterior fontanel (fontanelle) closes around 2 to 3 months of age in infants.

Which of the following milestones is most appropriate at age 4 years? A. Babbles B. Five-word sentences C. Identifies Colors D. 75% Speech Understood by Stranger E. Coos F. 1/2 of speech is understandable to a stranger

C. Identifies Colors

The nurse is providing anticipatory guidance and education to the parents of child entering into the preschool age group. What information would the nurse include in the teaching? A. The child will have an emergence of permanent teeth by the age of 4 years. B. The child's cognitive growth will not be as intense as the child leaves the toddler stage. C. The preschool-age child's physical growth will slow compared to previous years. D. The preschool-age child will be less tolerant of separation from parents than during the toddler stage.

C. The preschool-age child's physical growth will slow compared to previous years.

Which project or game would you anticipate that a preschooler would most enjoy while hospitalized? A. turning out the lights to play hide and seek B. planting flower bulbs that she can watch grow next spring C. dressing in her mother's coat to play house D. playing an electronic, hand-held game

C. dressing in her mother's coat to play house

True or False: Children who are 4 years old engage in creative play and may not be able to differentiate "real" from "make-believe."

True

True or False: The primary muscle for breathing until 5 years of age is the diaphragm; therefore, the abdomen should be observed to determine the respiratory rate.

True

The nurse is caring for a 5-year-old child who is receiving daily antibiotic injections due to a wound infection. The child is scared when seeing the nurse and cries. The nurse goes into the toy bin to select a toy for the child. Which toy provides the most therapeutic play? A. anatomically correct puppet B. doll in a client gown C. play syringe and doll D. stuffed bear with bandage

C. play syringe and doll Rationale: Fear of injections is common in 5-year-old children. The nurse is correct to use play as a way of relating to the child and decreasing the fear and anxiety. Playing with medical instruments, such as syringes, stethoscopes, and thermometers, helps reduce fear about this equipment. It is also an outlet for the child's feelings, making this the best choice. An anatomically correct puppet or doll in a gown is appropriate to explain information about the body but is not the best choice to decrease anxiety of injections. A stuffed bear with a bandage is appropriate if the concern was wound care.

Which technique should the nurse use to administer ear drops to a 18-month-old child? A. Press the pinna of the ear forward. B. Pull the pinna of the ear downward. C. Pull the pinna of the ear up and back. D. Lift the pinna of the ear down and back.

D. Lift the pinna of the ear down and back. Rationale: If the child is younger than 2 years of age, straighten the external ear canal by pulling the pinna down and back. If the child is older than 2 years of age, pull the pinna of the ear up and back.

Where is the point of maximal impulse (PMI) found in a 5-year-old child? A. the sternum B. the clavicle C. the third intercostal space D. the fourth intercostal space

D. the fourth intercostal space

Which of the following language milestones is most appropriate at age 4 years? A. 1/2 of speech is understandable to a stranger B. Coos C. Babbles D. Three-Word Sentences E. Five-word sentences F. 100% Speech Understandable

F. 100% Speech Understandable

Which of the following developmental milestones is most appropriate at age 4 years? A. Positive Babinski B. Five-word sentences C. 1/2 of speech is understandable to a stranger D. 75% Speech Understood by Stranger E. Completes Toilet Training F. Cooperative Play

F. Cooperative Play

Which of the following fine motor milestones is most appropriate for a child at age 4 years? A. Ties Shoelaces B. Rolls from stomach to back C. Increased Alertness D. Copies Circle E. Rides Tricycle F. Copies Square

F. Copies Square

Which of the following gross motor milestones is most appropriate for a child at age 4 years? A. Rides Tricycle B. Ties Shoelaces C. Rolls from stomach to back D. Copies Circle E. Pulls to stand F. Hop on One Foot

F. Hop on One Foot

Imaginary friends are often a part of ___________ thinking, a hallmark of preschool cognitive development.

magical

Bright red cheeks and a lacey, erythematous rash on the trunk and extremities are characteristics of ______________ disease.

fifth