Ch 31 Nursing Care of a Family with a Pre-School Child

A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers?

Placing the child in an approved car seat The leading cause of death in the preschool group is automobile accidents, followed by poisonings and falls. Placing the child in an approved car seat is a safety precaution to help prevent serious injury and even death. All safety measures help keep children safe. Putting latches on the lower cabinets and using a baby gate at the top of the stairs are important to prevent poisonings and to prevent falls which could cause head injuries and fractures. Many infectious diseases are preventable as a result of health promotion and illness prevention techniques.

The nurse is presenting an in-service on the types of playing that children may engage in. The nurse determines the session is successful when the attending nurses correctly choose which example as representing cooperative play?

Playing in an organized group with each other. During cooperative play, children play in an organized group with each other as in team sports. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. Parallel play occurs when the toddler plays alongside other children but not with them.

Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3-year-old is in what stage as identified by Piaget?

Preoperational thought A 3-year-old is in the preoperational stage according to Piaget. Primary circular reaction is seen in infants of 3 months. Coordination of secondary schema is seen in infants at age 10 months. Tertiary circular reaction is seen in toddlers between 12 and 15 months.

A parent tells a nurse that the child has recently established some friendships for the first time. In which age group do you expect this child to be?

Preschool During the preschool years the preschooler learns to cooperate with other children. Learning how to make a friend is an important part of social development. Preschoolers need a special friend they can talk to, care about, and play with. The toddler is aware of other children but plays parallel to other toddlers; they do not interact or form friendships at their developmental level. School-age children have developed friendships and often have close relationships with one or two friends, but have multiple friends in school. Friendships are very important to the adolescent child. They have established friendships throughout their lives.

The nurse has brought a group of preschoolers to the playroom to play. Which activity would the nurse predict the children to become involved in?

Pretending to be mommies and daddies in the playhouse Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-aged child enjoys group activities, such as board games, and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities he or she can participate in with their peers.

The nurse is presenting nutritional information at a community health fair. Which suggestion should the nurse prioritize when illustrating proper nutrition for preschoolers?

Snacks throughout the day help the child meet nutritional requirements The preschool period is not a time of rapid growth, so children do not need large quantities of food. Protein needs are high to provide for muscle growth. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. The preschool child needs 2 to 3 cups of milk each day.

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?

Support whatever the child paints. Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because the child believes that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Finger painting is a messy activity, so telling the child not to be messy takes the fun and the creative part out of the activity. The adult should provide aprons or clothing to protect the child's clothing and allow the painting in an area that can be cleaned easily.f

In teaching caregivers of preschool children, the nurse would reinforce that which activity would be most important for this age group?

The preschool child should be properly restrained when riding in a vehicle. A major cause of accidents in the preschool child occurs when the child is not properly restrained in a motor vehicle. Safety is the highest priority.

The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. What is an appropriate response to this concern?

Treat the action in a matter-of-fact manner, emphasizing safety. Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong.

Fear of mutilation is significant during the preschool age.

True Fear of mutilation is significant during the preschool age, as revealed by the intense reaction of a preschooler to even a simple injury such as falling and scraping a knee or having a needle inserted for an immunization. A child cries afterward not only from the pain but also from the intrusiveness of the injury or procedure.

A nurse is assessing a 3 year old at a well-child visit. Which developmental milestones would the nurse expect to assess? Select all that apply.

Undresses self without difficulty Stacks a tower of blocks A 3-year-old typically can undress himself or herself and stack a tower of blocks. Simple buttoning is more characteristic of 4-year-olds. The ability to lace sneakers or shoes and throw overhand are typical of 5-year-olds.

The mother of a 4-year-old is concerned her child is not eating well. In addressing the concerns of this mother, which foods should the nurse point out are high in protein? Select all that apply.

Whole grain granola with yogurt Cheese and crackers Turkey sandwich Meat, poultry, fish, milk products, and eggs are good sources of protein. Whole wheat grains, nuts, peanut butter, and legumes are also good sources of protein but need to be supplemented by some animal protein, such as meat, eggs, milk, cheese, cottage cheese, or yogurt. Cookies are usually high in sugar and not the best for supplying good nutrition. Fruit juices and fruit are good sources of vitamin C.

A mother confides in a nurse that her preschool daughter only wants to play with her father as soon as he comes home from work in the evenings and does not seem to have any interest in spending time with the mother. This phenomenon is an example of:

Electra complex. An Electra complex is the attachment of a preschool girl to her father; an Oedipus complex refers to the strong emotional attachment a preschool boy demonstrates toward his mother. A daughter demonstrating an Electra complex might prefer to always sit beside her father at the table; she asks her father to tuck her in at night. She makes a point she is "Daddy's girl." A mother who is not prepared for this behavior may feel hurt and cut off from family interaction. Although children during this period do enter a second phase called intuitional thought, they lack the insight to view themselves as others see them or put themselves in another's place (this is termed centering). Many children at the beginning of the preschool period exhibit knock-knees (genu valgum); this disappears with increased skeletal growth at the end of the preschool period.

When providing anticipatory guidance to parents about their preschool son who was caught in a lie, what would the nurse emphasize?

"You need to determine the reason for lying before punishing the child." Lying is common in preschool children and occurs for a variety of reasons, such as fearing punishment, getting carried away by imagination, or imitating what another person has done. Regardless, the parent should ascertain the reason for the lying before punishing the child. The child also needs to learn that the lying is usually far worse than the misbehavior. Parents need to remain calm and serve as a role model of an even temper.

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.

Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable. Urge children never to talk to or accept a ride from a stranger. The preschool years are not too early to educate children about the potential threat of harm from strangers or how to address bullying from others. Appropriate measures include urging children never to talk to or accept a ride from a stranger; teaching them how to call for help in an emergency; encouraging them to tell parents if someone asks them to keep a secret about something that makes them uncomfortable; urging children to report any bullying behavior; and teaching them to say "no" to anyone whose touching makes them feel uncomfortable.

Which fears may a preschooler perceive as real? Select all that apply.

Fear of the dark Fear of mutilation Fear of separation Fear of abandonment Because the imagination of preschoolers is so active, they are susceptible to a number of real fears, including fear of the dark, fear of mutilation, fear of separation, and fear of abandonment. They do not typically fear death. The concept of death usually does not develop until between 4 to 6 years of age. It is not fully developed until around age 9 years.

The nurse is providing health-promotion teaching to a group of parents of preschoolers at a local day care. What information would the nurse include in this education session? Select all that apply.

Encourage children to select their own clothing to wear each day. Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry clothing. Parents will need to supervise tooth-brushing and be responsible for flossing. Preschoolers are becoming more independent and need to be allowed to pick out their own clothing, brush their teeth with adult supervision, and take care of their own toileting. If the child has an accident, treat it in a matter-of-fact manner and do not make a big deal out of it. Helmets are worn every time the child rides a bicycle, regardless of distance.

The nurse is caring for several clients on the pediatric unit. When interacting with the preschool-age child, which action does the nurse predict will occur?

Takes in new information at a rapid rate and asks "why" and "how" The preschool-aged child soaks in information and asks "why" and "how" over and over. The school-aged child has a longer attention span and can become absorbed in a craft or activity for several hours. The toddler insists he or she can do things one minute and then becomes dependent the next minute. The infant grows and develops skills more rapidly than he or she ever will again.

A first-time father calls the pediatric nurse stating he is concerned that his 4-year-old daughter still wets the bed almost every night. Remembering his own experience of being punished for wetting the bed at 4 years old, he is not sure punishment is the best approach to address this. Which nursing instruction is the most appropriate?

"Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration." Occasional bedwetting is not uncommon for young preschoolers and is not a concern unless it continues past the age of 7. When the child does have an accident, treating it in a matter-of-fact way and providing the child with clean, dry clothing is best. The child should not be disciplined or made to feel he or she is socially unacceptable when bedwetting occurs.

During a well-child visit, the caregiver expresses concern that the 3-year-old child often stutters when speaking. Which response should the nurse prioritize to best assist this family?

"Children of this age may stutter while they search for just the right word." Between ages 3 and 5, language development is generally rapid. Most 3-year-old children can construct simple sentences, but their speech has many hesitations and repetitions as they search for the right word or try to make the right sound. Stuttering can develop during this period but usually disappears within 3 to 6 months. Physical capability, hearing loss, or lack of being read to are not reasons stuttering occurs.

The nurse is caring for a 3-year-old at a well-child checkup. The parent states that her child still has an afternoon nap but she has a friend whose toddler no longer naps in the afternoon. She is seeking advice on what do to. When providing anticipatory guidance to the parent about sleep patterns, what is the most appropriate response by the nurse?

"Often, the afternoon nap will be no longer needed after 4 years." Exact duration of a child's daily sleep patterns varies based on temperament, activity levels, and overall health. Around the age of 4, many children discontinue the afternoon nap.

When collecting data on a preschool-aged child during a well-child visit, the nurse discovers the child has gained 12 lb (5.4 kg) and grown 2.5 inches (6.3 cm) in the last year. The nurse interprets these findings to indicate which situation?

Weight is above an expected range and height is within an expected range. The preschool period is one of slow growth. The child gains about 3 to 5 lb each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm). The child's weight is above the expected gain and the height is what would be expected.

The father of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the father would indicate a need for further teaching?

"I will need to find an appropriate punishment for him if this continues." The nurse should remind the father that overreaction to this behavior may cause it to occur more frequently. Masturbation at this age should be treated matter-of-factly. The other statements are correct.

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?

"My child is so picky and eats the same thing every day for days on end!" The preschooler's appetite is erratic. At one sitting the preschooler may devour everything on the plate, and at the next meal he or she may be satisfied with just a few bites. Food jags, such as eating the same thing for days on end, are common in the toddler, not the preschooler. Preschooler's are picky eaters. They may eat only a limited variety of foods or foods prepared in only one way. Portions for preschoolers are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. Giving the child non-nutritious snacks may cause the child not to eat at mealtimes. The child eating as much as the adolescent sibling is being set up for obesity.

The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do?

"Place her in a booster seat with lap and shoulder belts in the back seat." A child who weighs between 40 and 80 pounds should ride in a booster seat that utilizes both the lap and shoulder belts in the back seat. When a child is large enough to sit up straight with the knees bent at the front edge of the seat, then he or she may sit directly on the seat of the car with lap/shoulder belt securely and appropriately attached. The back seat of the car is the safest place for a child to ride. A forward-facing car seat with harness and top tether is for a preschooler who weighs less than 40 pounds.

The nurse is preparing a safety presentation for a health fair for families. Which instruction should the nurse prioritize when illustrating car safety and the family?

"Set a good example. Wear your own seat belt every time you drive." A preschooler wants to please, and if the caregiver consistently wears the seatbelt, that will become the standard for riding in the car. All states have laws that define safety seat and restraint requirements for children. Adults must teach and reinforce these rules. One primary responsibility of adults is always to wear seat belts themselves and to make certain that the child always is in a safety seat or has a seat belt on when in a motor vehicle. A child can also be calmly taught that the vehicle "won't go" unless everyone in it is properly restrained. The child should be taught respect of rules and laws, but making threats or giving rewards is not appropriate.

The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond?

"Tell me about the circumstances when this occurs." Bladder control is present in 4- and 5-year-olds, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents. Simply telling the mother that it is normal does not address the mother's concerns. The nurse does need to gather more information, because accidents in a previously potty-trained child can be a sign of diabetes.

The nurse is conducting a physical examination of a young preschooler and detects the odor of tobacco smoke on the parents' hair and clothing. How should the nurse respond?

"Tell me about your child's exposure to tobacco smoke." The nurse needs to emphasize that parents should protect their child from all tobacco smoke. It is best to ask an open-ended question to determine who uses tobacco products or where exposure to tobacco smoke could be occurring. The nurse should not assume that the parents are smokers and telling them to stop is inappropriate. Telling the parent tobacco smoke can be linked to ear infection and behavioral difficulties is true but is unlikely to open a dialogue.

Parents of a preschooler tell the nurse that their child often refuses to go to sleep at night. Which suggestion by the nurse would be helpful? Select all that apply.

"Try reading a favorite story before bedtime." "Try using a night light in the child's room." "Avoid having your child watch frightening shows on TV before bedtime." "Set up some familiar bedtime rituals for your child." Preschoolers may refuse to go to sleep because of fear of the dark. A night light, screening out frightening stories or TV shows, and using familiar bedtime routines, including reading a favorite story, can help. Keeping the door closed and the lights off would only help to promote the child's fear.

The parent of a 4-year-old child tells the nurse about being frustrated because all the parent seems to do lately is fight with the child over what the child wants to eat and wear. The parent notes sometimes wanting to spank the child for always disagreeing. What would be the best suggestion for the nurse to make to this parent?

"Use the time-out technique for discipline." Preschoolers have definite opinions, which may bring them into opposition with parents. The best thing to do during these struggles is to guide the child through without discouraging his or her right to an opinion. Time-out is a good technique that allows parents to discipline without using physical punishment. Time-out should last for 1 minute for every year of age. Spanking is never encouraged and is totally discouraged by the American Academy of Pediatrics. Taking the child's toys away does not accomplish the same as time-out. After taking away the toy the child just goes and gets another without understanding the meaning behind the punishment. It is easy for the parent to get frustrated, especially if the child is very willful. This can best be avoided by being consistent with rules.

A 3 1/2 year-old child is found masturbating in the family living room. Which response by the parent would best address this behavior?

"We do not touch ourselves in public. Please go to your room if you want to continue this behavior." Although masturbation in this age group is not an uncommon behavior, the child must be told in a matter-of-fact manner that this is not appropriate activity in public. The parent needs to remain calm and not get angry or embarrassed. Usually, masturbation is just part of a young child's curiosity about his or her body.

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?

"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." 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.

During a well-child visit, the mother of a preschooler tells the nurse that her daughter is "daddy's girl." She says, "It seems like I don't exist." Which response by the nurse would be most appropriate?

"Your daughter is showing normal behavior for her age." The daughter is exhibiting signs of the Electra complex, competing with the same-sex parent for the love and attention of the other parent. This behavior is entirely normal but parents who are not prepared may feel hurt or rejected. Telling the mother that this is a problem, asking the mother about why, and asking the mother if she did something to make the daughter angry are inappropriate responses and focus on the mother's behavior, not the child's.

The father of a 4-year-old is concerned his child is not telling the truth and blaming others for things that have happened. Which response should the nurse prioritize after the father shares that the child is blaming someone named "Andrew" for a broken tool, and they have no idea who this is?

"Your son may have a friend named Andrew, but it could be an imaginary friend." The preschool-aged child may have imaginary playmates who are very real to them. The imaginary friend often has the characteristics that the child might wish for. Sometimes the child blames the imaginary friend for breaking a toy or engaging in another act for which the child does not want to take responsibility. The child should not be punished because the child is not intentionally telling a lie. At this age the child can think about things without actually seeing them.

If the child is gaining weight at an expected rate, a child who weighs 36 lb (16.3 kg) at 3 years of age would weigh what amount at age 5?

44 to 46 lb (20 to 21 kg) The preschool age child gains about 4 to 5 lb (1.8 to 2.3 kg) each year and grows about 2.5 to 3 in (6.3 to 7.6 cm). So a 36 lb (16.3 kg) child at 3 years gaining 4 to 5 lb (1.8 to 2.3 kg) per year would be 44 to 46 lb (36 lb + 8 lb = 44 lb; 36 lb + 10 lb = 46 lb).

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue?

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers.

A patient who has just given birth to her second child is concerned that her preschooler will be jealous when people bring gifts for the newborn. What would be the best suggestion to make to this mother about the gifts?

Ask people to bring a small second gift for the preschooler as well. One suggestion to help minimize sibling rivalry when there is a newborn is for people who bring the baby gifts to also bring something for the preschooler. When friends and family visit the baby, they should try to spend some time also with the preschooler. The mother and visitors should not ask preschoolers if they like new siblings. It is better to convey empathy with the changes the situation are bringing by saying something like, "New babies cry a lot. I bet it is hard to get used to it."

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. What is a recommended guideline when dealing with this issue?

Before answering questions, find out what the child thinks about the subject. Preschoolers are very inquisitive and want to learn about everything around them; therefore, they are very likely to ask questions about sex and where babies come from. Before attempting to answer questions, parents should try to find out first what the child is really asking and what the child already thinks about that subject. Then they should provide a simple, direct, and honest answer. The child needs only the information that he or she is requesting.

The mother of a preschooler finds a broken plate in her kitchen floor and asks the child what happened. The child tells the mother that her imaginary friend Lulu dropped it when she was getting it out of the cabinet. How should the mother interpret this fabrication?

Blaming an imaginary friend for accidents is normal behavior for this age group. Children this age often have imaginary friends to play with and may blame the friend for accidents or other occurrences in the home that they may have caused. This should not be interpreted as intentionally lying or abnormal but rather normal preschool behavior.

The nurse is assessing a 3-year-old at a well-child visit and the child appears to be progressing well. Which activity will the nurse ask the child to attempt to appropriately assess the fine motor skills of this preschooler?

Button clothes. The 3-year-old should be able to button his clothes and use a pencil or crayon. By the age of 4 to 5, the child should be able to use scissors, tie shoelaces, and print his first name.

A 5-year-old child is overheard by her parents calling her dog a "fat boo-boo butt" and they are concerned. What advice would the nurse provide for them regarding this behavior?

Calmly correct the child, telling her not to say those words again. Children this age often try out naughty words to see what kind of reaction they will get from their parents. Parents are encouraged to express their disapproval with the language and calmly tell the child not to say those words again. Ignoring the behavior will not correct it and punishment is not necessary.

The parent of 3 1/2-year-old preschooler tells the nurse that the child argues quite a bit and says that the child is always right. The nurse interprets this information as indicating:

centering. At age 3 years, cognitive development is still preoperational. Although children during this period do enter a second phase called intuitional thought, they lack insight to view themselves as others see them or put themselves in another's place. This is called centering. Because preschoolers cannot make this kind of mental substitution, they feel they are always right and causes them to argue. Conservation is reflected in the child's ability to distinguish that two items of equal size are the same despite a change in form. Initiative is the developmental task of preschoolers and is reflected in the child attempting to learn as much as possible about the world around them by trying new activities or having new experiences. Guilt occurs if children are punished or criticized for attempts at initiative.

The nurse and a client are discussing the client's preschool child. The client states, "When I tell my child it's time for bed, he/she screams and cries for almost an hour each night before going to sleep." The client and the nurse decide that the next course of action is:

follow a routine and set a bedtime. The child exhibits frustration by acting out or hitting. Limits are needed to define acceptable behaviors during early childhood. A child welcomes the setting of limits because it defines expected boundaries of behavior. Promising a new toy is counterproductive.

A nursing instructor is teaching students about changes in the preschool-aged child. One such change is genu valgum, which refers to:

knock-knees. Many children at the beginning of the preschool period exhibit genu valgum, which is knock-knees. Innocent murmurs are called just that. A slim body type is referred to as ectomorphic, while a large body type is called endomorphic.

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to:

testing and identification of group role. Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.