Chapter 17_preschooler
The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of: transduction. magical thinking. animism. beginning empathy.
transduction
The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of what happening? viewing her baby sister's illness as her fault harming the baby experiencing clinical depression creating an imaginary friend to cope with the situation
viewing her baby sister's illness as her fault
A 4-year-old child is brought to the clinic by his parents for evaluation of a cough. Which action by the nurse would be least appropriate in promoting atraumatic care for the child? having the parents stay with the child during the examination allowing the child to touch the stethoscope before listening to his heart informing the child that the stethoscope might feel a bit cold but not hurt wrapping the child tightly in a blanket to prevent him from moving around
wrapping the child tightly in a blanket to prevent him from moving around
The mother of a 4-year-old girl reports her daughter has episodes of wetting her pants. The nurse questions the mother about the frequency. The nurse determines these episodes occur about once every 1 to 2 weeks. Which response by the nurse is indicated? "Consider restricting your daughter's fluid intake." "Discipline should be applied after these times." "At this age it is helpful to remind children to go to the bathroom." "The frequency of these wetting episodes may be consistent with a low-grade urinary tract infection."
"At this age it is helpful to remind children to go to the bathroom."
The nurse is preparing to conduct a health history with the parents of a preschool-age child admitted for an appendectomy. Which questions should the nurse plan to use to learn more about the child's ability to manage pain? (Select all that apply.) "How does your child usually react to pain?" "How do you know when your child is in pain?" "Does your child use pain as a control mechanism?" "Are you concerned about addiction to pain medication?" "What do you do for your child when your child is hurting?"
"How does your child usually react to pain?" "How do you know when your child is in pain?" "What do you do for your child when your child is hurting?"
The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education? "I will add some crayons, chalk and finger paints to my three-year-old's birthday gifts." "I am so glad I can get rid of all of those bath toys because they take up so much room." "It is okay for my four-year-old to still play in his sandbox." "My four-year-old will be getting a tricycle for her birthday. I'm glad it's a good gift for her."
"I am so glad I can get rid of all of those bath toys because they take up so much room."
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 front seat." "Place her in the back seat with the lap and shoulder belts in place." "Place her in a forward-facing car seat with a harness and top tether." "Place her in a booster seat with lap and shoulder belts in the back seat."
"Place her in a booster seat with lap and shoulder belts in the back seat."
A mother reports to the nurse that her 4-year-old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother? "I can imagine that it would be very irritating." "I am sure there are ways to get your daughter to stop imitating you." "This is not normal behavior. I am going to get the doctor's advice." "Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development."
"Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development."
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? "Stop the car any time the preschooler unbuckles the restraints." "Explain that wearing a seat belt is a law and the police officer will give a ticket if the seat belt is not buckled." "Set a good example. Wear your own seat belt every time you drive." "Reward the child with candy or some other treat each time the child keeps the seat belt on."
"Set a good example. Wear your own seat belt every time you drive."
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? "You need to quit that right now. It's not nice to touch your privates." "I will ask your father to talk to you about this since he is a male too." "We do not touch ourselves in public. Please go to your room if you want to continue this behavior." "Your penis is very interesting, isn't it? But you can injure it by touching it so much."
"We do not touch ourselves in public. Please go to your room if you want to continue this behavior."
The nurse is caring for a 5-year-old who has been hospitalized after an episode of asthma. As the nurse prepares to teach the child how to use the nebulizer, which action should the nurse prioritize? Allow the child to touch and play with the nebulizer for a few minutes before the treatment. Show the child how to use the nebulizer and tell the child how much easier it is to breathe afterward. Explain that the child will feel better after the treatment and allow the child to ask questions. Use a poster or brochure to illustrate to the child how the machine works.
Allow the child to touch and play with the nebulizer for a few minutes before the treatment.
The nurse is planning to provide a preschool-age client with an oral medication. Which approach should the nurse use to gain the child's cooperation? Compare the taste of the medicine to a chocolate bar. Offer to play a game with the child if the medicine is swallowed. Ask the child if a cup or oral syringe is preferred to take the medicine. Leave the medicine on the bedside stand; it can be taken independently.
Ask the child if a cup or oral syringe is preferred to take the medicine.
The nurse is caring for a 5-year-old child who underwent a painful surgical procedure earlier in the day. The nurse notes the child has not reported pain to any of the nursing staff. Which action by the nurse is indicated? Contact the physician to report the child's condition. Administer prophylactic analgesics. Observe for behavioral cues consistent with pain. Encourage the child to report pain.
Observe for behavioral cues consistent with pain.
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? Compromised family coping related to abnormal behavior of child Deficient knowledge of normal preschool development Disturbed thought processes related to deep-set psychological need Social isolation related to unwillingness to relate except through imaginary friend
Deficient knowledge of normal preschool development
A parent tells the nurse about being frustrated because the preschool-aged child screams every time the parent attempts to buckle the child's seat belt. What advice should the nurse give this parent? Tell the child that you will give a treat for buckling up. Do not start the car until seat belts are in place. Warn the child of punishment for not buckling up and then follow through. Arrange for a babysitter to avoid taking the child in the car.
Do not start the car until seat belts are in place.
Which fears may a preschooler perceive as real? Select all that apply. Fear of the dark Fear of mutilation Fear of dying Fear of separation Fear of abandonment
Fear of separation Fear of abandonment Fear of the dark
The nurse is identifying a diagnosis appropriate for a preschool-age child who began to cry after learning about needing intravenous fluid therapy. Which diagnosis should the nurse select to address this specific reaction? Fear related to intravenous infusion Discomfort related to intravenous infusion Health-seeking behavior by the child related to the intravenous infusion Deficient knowledge related to actions and effects of intravenous fluid therapy
Fear related to intravenous infusion
The nurse is providing postsurgical care for a 4-year-old boy following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate his pain. When assessing the child's postsurgical pain, the boy refuses to touch the chips and clings to his mother. How should the nurse respond? Give the mother the FACES pain rating scale to use with her son. Show the child once more how to use the chips. Substitute the word-graphic rating scale for the poker chips. Select the visual analog scale as the best one to use.
Give the mother the FACES pain rating scale to use with her son.
During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. Which of the following is the best specific trigger question to determine the preschooler's linguistic and cognitive progress? "Does your son speak in complete sentences all the time?" "How well does your son communicate or follow instructions?" "Is your son's speech clear enough that anyone can understand it?" "Would you say your son has a vocabulary of about 900 words?"
How well does your son communicate or follow instructions?"
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? "Children no longer nap in the afternoon after 1 year." "Children begin to give up afternoon napping at 2 years." "Often, the afternoon nap will be no longer needed after 4 years." Since they are in school now all day, napping ends at 6 years.
Often, the afternoon nap will be no longer needed after 4 years."
A preschool-age child tells the nurse about an imaginary friend. The parents are concerned because the child refuses to do anything without the friend's help. Which nursing diagnosis is most applicable for the family? Compromised family coping related to abnormal behavior of child Disturbed thought processes related to deep-set psychological need Parental anxiety related to lack of understanding of childhood development Social isolation related to unwillingness to relate except through imaginary friend
Parental anxiety related to lack of understanding of childhood development
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? Primary circular reaction Coordination of secondary schema Tertiary circular reaction Preoperational thought
Preoperational thought
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 Playing a board game Painting pictures in the art corner of the room Watching a movie with other children their age
Pretending to be mommies and daddies in the playhouse
What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother? A ratio of 10 children to 1 teacher is adequate. Specific program goals to be accomplished should be available. The longer the center has been in operation, the better it is. Research local newspapers to see if there are any complaints against the center.
Specific program goals to be accomplished should be available.
The parents of a 5-year-old tell the nurse that it "seems like our child is afraid of everything from fireworks to butterflies." What actions should the nurse take? Select all that apply. Ask the parents if they can identify anything that may be causing their child be fearful. Encourage the parents to just ignore the fears since this is common behavior with the preschool-aged child. Suggest to the parents to talk with their child about his fears. Work with the parents and child to devise strategies to help deal with the fears. Advise the parents to help the child understand that the fears are irrational.
Suggest to the parents to talk with their child about his fears. Ask the parents if they can identify anything that may be causing their child be fearful. Work with the parents and child to devise strategies to help deal with the fears.
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.
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? The child does not have pain. The child is using the scale to predict what he or she would like, not what the child has. The child has difficulty focusing on the right side of the scale. The nurse must be interpreting the child's degree of pain falsely.
The child is using the scale to predict what he or she would like, not what the child has
Martha has her 5-year-old child at the clinic for a checkup. When reviewing the child's history, which of the following would the nurse identify as a primary preventive measure? The last immunizations the child obtained The type of diet the child is on The last hospitalization The last medication the child took
The last immunizations the child obtained
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? Tell the child in a firm manner that this behavior is not acceptable. When the child displays this behavior, place him in a "time-out." Treat the action in a matter-of-fact manner, emphasizing safety. Consult a psychotherapist to determine the reason for this behavior.
Treat the action in a matter-of-fact manner, emphasizing safety.
The nurse is providing postsurgical care for a 5-year-old. The nurse knows to avoid which question when assessing the child's pain level? Would you say that the pain you are feeling is sharp or dull? Would you point to the cartoon face that best describes your pain? Would you point to the spot where your pain is? Would you please show me which photograph and number best describes your hurt?
Would you say that the pain you are feeling is sharp or dull?
A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group?
imagination
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? Toddler Preschool School age Adolescence
preschool
A nurse is conducting the health history of a 5-year-old child. Which data would the nurse collect last? review of systems current medications allergy history spiritual history
review of systems
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. playing in an even-number group of children (four). preschoolers having a harder time sharing than toddlers. regression.
testing and identification of group role.
Where is the point of maximal impulse (PMI) found in a 5-year-old child? the sternum the clavicle the third intercostal space the fourth intercostal space
the fourth intercostal space
A mother expresses surprise to the nurse that her daughter has begun masturbating. The most important initial nursing response is that: this is a normal and expected activity best treated matter-of-factly. girls as well as boys will masturbate. toilet teaching places much focus on the genitals. there may be undue stress in your child's life.
this is a normal and expected activity best treated matter-of-factly.
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 using a night light in the child's room." "Set up some familiar bedtime rituals for your child." "Keep the door closed and the lights off so that your child can fall asleep faster." "Avoid having your child watch frightening shows on TV before bedtime." "Try reading a favorite story before bedtime."
"Set up some familiar bedtime rituals for your child." "Try reading a favorite story before bedtime." "Avoid having your child watch frightening shows on TV before bedtime." "Try using a night light in the child's room."
The nurse is providing teaching to the mother of a 4-year-old girl about bike safety. Which statement by the mother indicates a need for further teaching? "The balls of her feet should reach both pedals while sitting." "Pedal back brakes are better for her age group." "She should always ride on the sidewalk." "She can ride on the street if I am riding with her."
"She can ride on the street if I am riding with her."
The parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares? "She screams and thrashes when we try to touch her." "She is scared after she wakes up." "She comes and wakes us up after she awakens." "She has a hard time going back to sleep."
"She screams and thrashes when we try to touch her."
A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond? "Tell me about Boo-ga-loo." "I don't see anyone." "Are you kidding me?" "Where did you get that funny name?"
"Tell me about Boo-ga-loo."
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." "You should stop smoking around your child." "Tobacco smoke is linked with an increased number of ear infections." "Are you aware that exposure to tobacco smoke can be associated with behavioral difficulties?"
"Tell me about your child's exposure to tobacco smoke."
The parents of a 5-year-old are concerned that their son is too short for his age. The nurse measures the child's height at 40 inches (101.6 cm). How should the nurse respond? "Some children are short for their age during the preschool years but usually catch up during early childhood." "Are most of the adults in your family short? It may be hereditary that your child will be shorter than average." "The average height for a 5-year-old is 43 inches tall (118.5 cm), so your son is within the normal range for height." "I am sure his height is a concern, but if you start choosing nutrient-dense foods he will likely catch up to normal in height."
"The average height for a 5-year-old is 43 inches tall (118.5 cm), so your son is within the normal range for height."
A nurse is caring for a 4-year-old child. The parents indicate that their child often reports that objects in the house are his friends. The parents are concerned because the child says that the grandfather clock in the hallway smiles and sings to him. Which response by the nurse is best? "Your child is demonstrating animism which is common." "Attributing lifelike qualities to inanimate objects is quite normal at this age." "Has your child suffered any type of physical trauma lately?" "Is there any family history of mental health disorders?"
"Attributing lifelike qualities to inanimate objects is quite normal at this age."
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? "Disciplining is not likely to be effective, but if the child keeps wetting the bed it may be necessary." "Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration." "Setting rules is a parent's job to help the child have acceptable social behavior, so take away a privilege each time she wets the bed." "Nightly bedwetting up to age 12 is developmentally typical, so you will need to practice patience with your daughter."
"Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration."
A nurse is teaching a group of parents of preschoolers about safety. Which information would the nurse include? Select all that apply. "Do not refer to medicines as candy." "Do not allow your child to approach strange dogs." "Allow your child to ride in the front seat of the car." "Have your child hold hands with a grown-up in parking lots." "Role-model bicycle safety by wearing a helmet too."
"Have your child hold hands with a grown-up in parking lots." "Role-model bicycle safety by wearing a helmet too." "Do not allow your child to approach strange dogs." "Do not refer to medicines as candy."
The parents of a 5-year-old boy tell the nurse that their son is having frequent episodes of night terrors. Which statement would indicate that the boy is having nightmares instead of night terrors?
"He will tell us about what happened in his dream."
A nurse is caring for a very shy 4-year-old girl. During the course of a well-child assessment, the nurse must take the girl's blood pressure. Which approach is best? "May I take your blood pressure?" "Your sister did a great job when I took hers." "Help me take your doll's blood pressure" "Will you let me put this cuff on your arm?"
"Help me take your doll's blood pressure"
The nurse is communicating with a preschooler with a chronic illness. Which statement by the child would indicate the child has a healthy sense of initiative? "I like to play pretend hospital with mommy. She is the sick person and I am the nurse." "When I color in this book, mommy told me to color inside the lines with my red crayon." "I want to watch this movie, but I am afraid to ask because my brother thinks the movie is silly." "Sometimes I sing loud songs but when somebody comes inside the room, I stop because I am embarrassed."
"I like to play pretend hospital with mommy. She is the sick person and I am the nurse."
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." "I have heard that both boys and girls often touch themselves at this age." "I should teach him certain rules about this activity." "This is probably a good time to talk about safety and who can touch him."
"I will need to find an appropriate punishment for him if this continues."
A father tells the nurse that his son has been asking questions about his genitals. The father states that he is unsure how to answer the questions of a 4-year-old. How should the nurse respond? "That is a difficult subject to address. I'm not sure what is the best way to answer that question." "You should answer his questions by whatever feels most comfortable to you." "It's best to answer his questions using accurate anatomical names and keep your answers simple." "I would suggest getting books with pictures to help explain the differences between male and female genitalia."
"It's best to answer his questions using accurate anatomical names and keep your answers simple."
The parents of a 5-year-old tell the nurse that it "seems like our child is afraid of everything from fireworks to butterflies." What actions should the nurse take? Select all that apply. Ask the parents if they can identify anything that may be causing their child be fearful. Encourage the parents to just ignore the fears since this is common behavior with the preschool-aged child. Suggest to the parents to talk with their child about his fears. Work with the parents and child to devise strategies to help deal with the fears. Advise the parents to help the child understand that the fears are irrational.
Ask the parents if they can identify anything that may be causing their child be fearful. Suggest to the parents to talk with their child about his fears. Work with the parents and child to devise strategies to help deal with the fears.