Chapter 25: Growth and Development of the Preschool Child

A nurse is noting common changes in a group of preschoolers. Which predominant change during this period is a topic for anticipatory guidance? Physical growth accelerates. Cognitive growth slows. Physical growth slows. Personality growth slows.

Correct response: Physical growth slows. Explanation: During the preschool period, physical growth slows considerably, while personality and cognitive growth continue at a rapid rate.

Which gross motor skill would the 4-year-old child have most recently attained? The child can hop on one foot. The child can tie his/her shoelaces. The child can cut his/her food. The child can button his/her clothes.

The child can hop on one foot. Gross and fine motor skills continue to develop rapidly in the preschool-age child. Gross motor skills have to do with the development of large muscles. Balance improves and around the age of 4 the child can hop on one foot and stand on one foot for five seconds. A three year old does not have the ability to accomplish these tasks. A five year old can button his/her own clothes, tie their shoes and cut their food.

A nurse walks into the room to check on a preschool client. When the nurse asks the preschooler how she is doing, the child says she is Tinker Bell. What is the best response by the nurse? "You are not Tinker Bell. Your name is Whitney." "Hello, Tinker Bell." "That will be fun if you want to pretend you are Tinker Bell!" "I will not call you Tinker Bell. I like the name Whitney better."

Correct response: "That will be fun if you want to pretend you are Tinker Bell!" Explanation: Preschoolers engage in fantasies as part of their development. The nurse, however, needs to support the imitation but at the same time help the child to maintain the difference between pretend and real. The best response by the nurse would be to tell the client it will be fun to pretend she is Tinker Bell.

A mother tells the nurse that she is frustrated because her preschooler screams every time that she attempts to buckle the child's seat belt. What advice should the nurse give this mother? Tell the child that you will give her 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 so that you do not have to take the child in the car.

Correct response: Do not start the car until seat belts are in place. Explanation: Accident prevention is important for preschoolers. It can best be taught by role modeling. Not starting the car until everyone is buckled up is an example. Bribing and threatening are not appropriate, nor is keeping the child home at all times.

A parent brings the 4-year-old child for a check-up. Which finding would concern the nurse? Resting pulse rate of 120 Ectomorphic body type No increase in appetite compared with that in toddler years Weight gain of 5 lb (2.27 kg) in the past year

Correct response: Resting pulse rate of 120 Explanation: Pulse rate in preschool children decreases to about 85 bpm typically, so the nurse should be concerned about a pulse rate of 120 in a 4-year-old. Contour changes in preschool children are so definite that future body type—ectomorphic (slim body build) or endomorphic (large body build)—becomes apparent. Neither of these body types is a reason for concern. During these years, appetite remains the same as it was during the toddler years, a level perhaps considerably less than some parents would like or expect. Weight gain is slight during the preschool years as the average child gains only about 4.5 lb (2 kg) a year.

A nurse is instructing a young mother on how to ensure a safe bath time for her 4-year-old son. Which are important suggestions for the nurse to give to the mother? Select all that apply. Turn down the temperature of the water heater to under 120°F. Do not leave the child unsupervised in the bath tub. Assist the child in cleaning under fingernails and around ears. Do not hang a mobile over the tub. Do not use bubble bath. Have the child drink cranberry juice to avoid developing infections from the bath

Correct response: Turn down the temperature of the water heater to under 120°F. Do not leave the child unsupervised in the bath tub. Assist the child in cleaning under fingernails and around ears. Explanation: When possible, parents should turn down the temperature of the water heater in their home to under 120°F to help prevent scalds. Although preschoolers certainly sit well in bathtubs, they should still not be left unsupervised at bath time in case they decide to add more hot water or to practice swimming and then be unable to get their head out of the water again. Some girls develop vulvar irritation (and perhaps bladder infection) from exposure to bubble bath so parents shouldn't add such products to the water. Although not well studied, cranberry juice may help prevent these infections the same as in adult women. However, in this case, the child is a boy, so a bubble bath would be fine and cranberry juice not needed. Preschoolers do not clean their fingernails or ears well, so these areas often need "touching up" by a parent or older sibling. Using a nonirritating shampoo and hanging a mobile over the tub so they have a reason to look up while their hair is rinsed helps make hair washing a fun procedure.

The parents of a 5-year-old call the nurse for advice about night terrors. The child has had them nightly for almost 2 weeks. What is the most appropriate intervention? Wake the child up nightly 30 to 45 minutes after going to sleep. Explain that this is a developmental phase that will not last. Tell the parents to be sure to wake the child up during the next episode. Encourage the parents to let the child fall asleep in a safe place such as their bed.

Correct response: Wake the child up nightly 30 to 45 minutes after going to sleep. Explanation: Awakening children early in their sleep cycle often interrupts the night terror events and should be continued nightly for about 7 days. Suggesting the parent wake the child during a night terror is both difficult and ineffective. A major reason parents find night terrors frightening is that the child does not respond to the parent's presence. Indicating this is a developmental phase may be somewhat accurate, but does not assist the parents in handling the situation. Having the child fall asleep in a "safe" place or the parents' bed is likely to predispose to other sleep problems without helping to solve this one.

A nurse is providing an anticipatory guidance class on safety for parents of preschoolers. Which interventions are important for the nurse to address during the class? Select all that apply. swimming lessons stranger awareness gun safety drug awareness bicycle safety

Correct response: swimming lessons stranger awareness bicycle safety Explanation: It is in the preschool years that children often begin to feel comfortable in water. It is important for parents to teach beginning swimming to reduce the risk for accidental drowning. Parents should teach preschoolers that not all people are friends and to be aware of anyone that the child does not know. Bicycle safety is important at a young age and includes helmet safety and crossing streets.

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? "The preschooler has no sense of right and wrong." "The preschooler is developing a conscience." "The preschooler sees morality as internal to self." "The preschooler's morals are their own, right or wrong."

Correct response: "The preschooler is developing a conscience." Explanation: The preschool child can understand the concepts of right and wrong and is developing a conscience. Preschool children see morality as external to themselves; they defer to power (that of the adult). The child's moral standards are those of their parents or other adults who influence them, not necessarily their own.

Which type of play would the nurse use to prepare a preschooler for upcoming surgery to reduce the stress of the event? Associative play Dramatic play Onlooker play Cooperative play

Correct response: Dramatic play Explanation: Dramatic play allows the child to act out concerns or stress through the use of dolls or puppets and serves as an excellent way to prepare children for upcoming events such as surgery. Associative play involves children playing together. Onlooker play is where the child observes but does not participate in the activity. Cooperative play involves children playing together in an organized manner.

What statement by the mother of a preschooler indicates the need for further education by the nurse? "My child should not to drink from someone else's cup." "After blowing the nose, my child should wash hands." "My child should not share a toothbrush with another person." "If food falls on the floor, my child should pick it up quickly and wipe it off before eating it."

Correct response: "If food falls on the floor, my child should pick it up quickly and wipe it off before eating it." Explanation: If food falls to the floor, it should be discarded and not eaten. All other advice is appropriate for a preschooler.

A 3-year-old is hospitalized unexpectedly and is frightened about the experience. What action could the nurse take to minimize the anxiety the child is experiencing? • Insist that the parents stay with the child at all times. • Provide all of the child's care, including all ADLs. • Tell the child that everything will be fine and not to worry. • Allow the child to handle the equipment before it is used on the child.

• Allow the child to handle the equipment before it is used on the child. Explanation: Allowing the child to handle the equipment prior to its use lets the child become more comfortable with what is happening and decreases anxiety. Preschoolers need the opportunity to participate in their care. Minimizing the child's fright by saying everything will be fine is not helpful, nor is providing all of the child's care. Expecting parents to remain with the child all the time is unrealistic due to other family obligations they may have. Question 19

A nurse is caring for a 4-year-old child that will be undergoing a procedure to remove a mass from the abdomen. In order to help the child remain calm in preparation for getting an IV catheter placed, what intervention might the nurse implement? • Allow the child to play with a procedure doll. • Distract the child with games and candy. • Not discuss the procedure in front of the child. • Take the child to the playroom for coloring.

• Allow the child to play with a procedure doll. Explanation: The nurse can allow the child to play with a procedure doll that will simulate the procedure for the child.

The clinic nurse is collecting vital signs on a 4-year-old client being seen for a yearly well check-up. Which measurements should the nurse collect? height, weight, and head circumference height, weight, and abdominal girth height, weight, abdominal girth, and head circumference height and weight

Correct response: height and weight Explanation: Height and weight are the standard measurements at every yearly visit. The nurse should understand that head circumference is not routinely measured past 2 years of age and abdominal girth is only collected in infants.

The nurse is caring for a 5-year-old girl post-tonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process? Magical thinking Centration Transduction Animism

Magical thinking The nurse understands that the girl is demonstrating magical thinking. Magical thinking is a normal part of preschool development. The preschool-age child believes her thoughts to be all-powerful. Transduction is reasoning by viewing one situation as the basis for another situation whether or not they are truly causally linked. Animism is attributing life-like qualities to inanimate objects. Centration is focusing on one aspect of a situation while neglecting others.

The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned? • Is beginning to tie her own shoelaces • Can copy a square on another piece of paper • Draws a person with three body parts • Can dress and undress herself without help

• Draws a person with three body parts Explanation: By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. She should also be able to copy triangles and other geometric patterns and dress and undress herself and should be learning to tie her shoelaces. Question 8

The nurse is providing health-promotion teaching to a group of parents of preschoolers at a local daycare. 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. • Preschoolers only need to wear bicycle helmets if they are going on long rides. • 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 capable of taking a bath independently.

• Encourage children to select their own clothing to wear each day. • Parents will need to supervise tooth-brushing and be responsible for flossing. • Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry clothing. Explanation: 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. Question 18

Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium? • Spinach • White beans • Fortified cereal • Enriched bread

• White beans Explanation: To ensure an adequate intake of calcium, the nurse should suggest white beans, because 1 ounce of dried white beans when cooked provides 160 mg of calcium. Spinach, enriched bread, and fortified cereal are good sources of iron. Question 12

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. • When the child displays this behavior, place him in a "time-out." • Tell the child in a firm manner that this behavior is not acceptable. • Consult a psychotherapist to determine the reason for this behavior.

• Treat the action in a matter-of-fact manner, emphasizing safety. Explanation: 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. Question 15

When planning how to respond to a 3-year-old child about telling stories ("tall tales"), the nurse would base the statement on the fact that: • preschoolers have a limited vocabulary. • imagination in a 3-year-old is at its peak. • a 3-year-old knows the word two but not the concept of two. • a preschooler is in an insecure period.

• imagination in a 3-year-old is at its peak. Explanation: Preschoolers have vivid imaginations and love to play "make believe." They are inquisitive learners. It is not unusual for their imaginations to create "tall tales" and be in a world of make-believe. Preschoolers have a vocabulary of between 1,500 and 2,100 words, depending upon their age. They can count to 10 and know at least 4 colors. Their comminication is concrete. At this age they are not capable of abstract thought. During the preschool years, the child develops a sense of identity. They know who they are and to the family in which they belong. They develop the knowledge of right and wrong. The preschool years help develop the child's sense of belonging and their place in the world. Question 5

The most important safety precaution for parents to teach preschoolers is: • not to ride in a car with strangers. • not to begin formal dance classes. • not to watch their father mow the lawn. • to chew bites of food three times.

• not to ride in a car with strangers. Explanation: Preschoolers begin to spend more time away from parents than formerly as they begin preschool. That makes it a time to learn about people and traffic safety. Question 4

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? • Experiencing clinical depression • Harming the baby • Creating an imaginary friend to cope with the situation • Viewing her baby sister's illness as her fault

• Viewing her baby sister's illness as her fault Explanation: Since the preschool child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend. Question 13

Which deciduous teeth are usually the first to fall out? • Second molars • Canines • Central incisors • First molars

• Central incisors Explanation: The deciduous teeth fall out in the exact opposite of when they erupted.The first deciduous teeth that the preschool age child normally loses are the central incisors around 6-7 years of age. The lateral incisors fall out next around 7-8 years of age. The cannines or cuspid fall out around ages 10-12 year. The first molars fall out around 9-11 years. The second molars come out around ages 10-12 years. Question 3

The mother of a 4-year-old reports using time-outs as a means for disciplining the child. Which statement by the mother would require the nurse to provide additional teaching? "I put him in time-out when the problem occurs." "He is allowed out of time-out when he is calm." "The time-out doesn't just have to be in his room." "I usually have him in time-out for about 10 minutes."

Correct response: "I usually have him in time-out for about 10 minutes." Explanation: A time-out should be timed appropriately. The time-out should occur at the time the offense occurred, to ensure the child relates the offense (the behavioral problem) to the time-out period. Brief time-outs are more effective than very long ones, because a long time-out enables the child to redirect attention from calming down to being resentful. The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. A time-out should end as soon as the child is calm. Time-outs do not have to occur in the child's room; any location where the child is removed from activity and has an opportunity to become calm will do.

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." "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you." "Oh no! I have a crocodile in my room. Please don't bite me!" "What happened to my client? Did you eat her?"

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

The nurse is helping parents develop the developmental task of initiative in their preschool-aged child. Which activity would the nurse suggest the parents implement? Teach the child street-crossing safety. Help the child learn how to follow rules. Allow the child to experiment with molding clay. Provide the child with clothes that snap rather than button.

Correct response: Allow the child to experiment with molding clay. Explanation: To gain a sense of initiative, preschoolers need exposure to a wide variety of play materials so they can learn as much about how things work as possible. The parents should be urged to provide play materials that encourage creative play such as modeling clay. Any experience with free-form play is helpful. Street-crossing safety, following rules, and providing clothes that snap will not support the developmental task of initiative as much as providing a substance to experiment during play.

The parent of a four year-old child has expressed concern that the child is wetting her bed several times each week. What should the nurse teach the parent? Bed wetting is not an unexpected behavior at this age The child's fluid intake should be limited after 3:00 p.m. The parents should try to dialogue with the child about possible causes and solutions The parents should provide incentives for keeping the bed dry

Correct response: Bed wetting is not an unexpected behavior at this age Explanation: Bed wetting is not normally considered a problem unless it persists after the ages of 5 to 7. Limiting fluids after midafternoon may create a risk for dehydration.

A mother of a 4-year-old boy brings a local toy store's advertisement to the nurse, seeking advice on selection of appropriate toys for her son. Which toy would the nurse recognize as being inappropriate for him? Tonka truck Drawing pad and crayons Pretend play dress-up clothing Building blocks

Correct response: Building blocks Explanation: Building blocks are appropriate for a much younger child than 4 years, such as a toddler. All of the other play items are correctly matched to his age and developmental level.

A 3½-year-old child hits another child in prekindergarten and pushes her down. The mother calls the clinic to ask why her child is so aggressive and asks what to do. The nurse's advice would include which suggestion? Punish the preschooler for hurting the other child. Recommend that the mother change schools with her child to provide a more pleasant environment. Explain that aggression is a common behavior for a child this age but the child must understand that hurting someone is not acceptable. Encourage the teachers to have the other children hit the child if the child hits them.

Correct response: Explain that aggression is a common behavior for a child this age but the child must understand that hurting someone is not acceptable. Explanation: Aggression is a common behavior in preschoolers, starting with temper tantrums. Aggression is often an expression of frustration and anger at their inability to control their environment. However, children must be made aware that hitting or other aggressive behaviors will not be tolerated and are not acceptable. It is never recommended to use aggression in response to aggressive behaviors, and the child should not be punished unless the behavior continues. Changing schools will not solve the problem because the child will still face frustration and become angry.

A nurse is observing a 3-year-old preschooler engaged in play. What behavior would the nurse most likely expect to observe? Parallel play Imitative play Solitary play Group play

Correct response: Imitative play Explanation: Preschoolers enjoy games that use imitation such as pretending to be teachers, cowboys, firefighters, and store clerks. They imitate exactly what they see their parents doing. Parallel play is characteristic of toddlers. Preschoolers are capable of sharing and play with other children as a means for socialization. Older preschoolers are interested in group games.

Which immunization should the nurse plan to administer to a preschooler during a health maintenance visit? DTaP Influenza Hepatitis B Tetanus booster

Correct response: Influenza Explanation: Influenza vaccination would be administered annually. The diphtheria, pertussis, and tetanus (DTaP) vaccination should be provided before the child starts school. Hepatitis B and tetanus booster are not identified as vaccinations appropriate for this age group.

Johnny exhibits the following growth pattern. Which interpretation of the data is accurate? Select all that apply. 3 yrs: Ht. 37 inches Wt. 32 pounds 4 yrs: Ht. 39 inches Wt. 39 pounds 5 yrs: Ht. 40 inches Wt. 46 pounds Johnny is growing slowly in height but rapidly in weight. Johnny may be at risk for overweight or obesity. Johnny's height and weight should be plotted on a growth chart. Johnny is following a normal pattern of growth for the preschool years.

Correct response: Johnny is growing slowly in height but rapidly in weight. Johnny may be at risk for overweight or obesity. Johnny's height and weight should be plotted on a growth chart. Explanation: The preschool child's growth is fairly even. The child should grow about 2½ to 3 inches and gain around 5 pounds yearly. Johnny is not following this pattern. Plotting the child's height and weight on a growth chart would make it visually easy to follow his growth pattern and compare it to the norms.

When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note? Parallel play Cooperative play Dramatic play Fantasy play

Correct response: Parallel play Explanation: Parallel play is associated with toddlers. Cooperative, dramatic, and fantasy play are commonly used by preschoolers.

The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which intervention would be appropriate advice? Allow the child to pick out his or her own foods for meals. Present the food matter-of-factly and allow the child to choose what to eat. Offer high-fat snacks if the child does not eat to get him or her to eat something. Offer the child a special treat if he or she eats all the food on the plate.

Correct response: Present the food matter-of-factly and allow the child to choose what to eat. Explanation: The parents should maintain a matter-of-fact approach, offer the meal or snack, and then allow the child to decide how much of the food, if any, he or she is going to eat. High-fat, nutrient-poor snacks should not be substituted for healthy foods just to coax the child to "eat something." If the preschooler is growing well, then the pickiness is not a cause for concern. A larger concern may be the negative relationship that can develop between the parent and child relating to mealtime. The more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is to try new foods or even eat the ones he or she likes that are served. The child should be offered a healthy diet, with foods from all groups over the course of the day as recommended by the U.S. Department of Agriculture.

A community health center is planning a seminar about the 2020 National Health Goals for preschool-age children. Which topics would be included in this seminar to address safety? Select all that apply. Protection against second-hand smoke Providing helmets before riding a bicycle Using appropriate restraints in motor vehicles Removing houseplants from easy to reach areas Posting the telephone number of the poison control agency

Correct response: Protection against second-hand smoke Providing helmets before riding a bicycle Using appropriate restraints in motor vehicles Explanation: The 2020 National Health Goals for preschool-aged children focus on safety and include protecting preschoolers against secondhand smoke, using recommended automobile restraints, and fitting children with helmets before beginning bicycle riding. Removing houseplants and posting the telephone number of the poison control agency would be appropriate for families with toddlers.

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which behavior would warrant nursing intervention? The child pretends he is talking to an imaginary friend when the nurse addresses the child. The child states that her fairy godmother is going to come and take her home. The child starts talking about his grandmother and then quickly changes the subject to a new toy he received. The child does not want to play games with other children on the hospital ward.

Correct response: The child does not want to play games with other children on the hospital ward. Explanation: The preschooler begins to plan activities, make up games, and initiate activities with others. Not wanting to play games with other children is a sign of a developmental delay and nursing intervention is recommended. The preschooler often has an imaginary friend who serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Through make-believe and magical thinking, preschool children satisfy their curiosity about differences in the world around them. The preschooler uses transduction when reasoning: he or she extrapolates from a particular situation to another, even though the events may be unrelated.

The nurse is identifying outcomes for a family with a preschool-age child who has broken fluency. Which initial outcome would be the most appropriate? The parents will not call attention to the child's broken fluency. The mother will encourage the child to repeat words after her. Other children will help the child by finishing words and sentences. The parents will correct the child each time there is a break in fluency.

Correct response: The parents will not call attention to the child's broken fluency. Explanation: Calling attention to broken fluency can make the situation worse. The child should not be encouraged to speak or practice words if he or she does not want to. The parents should intercept any children who desire to finish the child with broken fluency's words or sentences. The child should not be punished or corrected for broken fluency because this is a normal part of speech development.

In assessing the bilingual 4-year-old's speech and language development, the nurse should find that the child will: be able to use each language as a separate system. mix the two languages in the same sentence. be prone to stuttering. avoid asking questions.

Correct response: be able to use each language as a separate system. Explanation: The ability to use both languages separately is developed by 4 years. Mixing the two languages occurs during toddlerhood. The other options are not related to bilingualism and are incorrect.

A nurse is developing a plan of care for a 4-year-old client with cystic fibrosis who has frequent hospitalizations related to his illness. Which would be the most appropriate nursing diagnosis for this client? • Health-seeking behaviors • Parental anxiety related to lack of understanding • Delayed growth and development related to frequent illness • Risk for imbalance nutrition, more than body requirements

• Delayed growth and development related to frequent illness Explanation: This client has frequent hospitalizations and is at risk for delayed growth and development. For a client at this age, play, socialization, exploring, and imagination are all important parts of normal growth and development. Question 20

The caregiver of a 6-year-old tells the clinic nurse that he is concerned that his child cannot yet print his first and last name. The caregiver is wondering if this is normal. Which response by the nurse would be most appropriate? • "Some children this age cannot hold a pencil or crayon well enough to write legibly." • "By the age of 6 most children can print some letters and maybe their first name." • "Usually by the age of 6, most children can write numbers up to nine, but no letters." • "It is not unusual for children of this age to be writing their first name in cursive."

• "By the age of 6 most children can print some letters and maybe their first name." Explanation: By three years of age a child should be able to hold a pencil in the writing position. By age four the child can draw circles and squares and a body with four parts. At age five the child can print letters, copy a triangle and a pictue of a person with six parts and cut with scissors. The 6-year-old can print letters or numbers and may be able to print his or her own name. Children do not write in cursive until school age. Question 2

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? • "That's normal; don't worry about it." • "Tell me about the circumstances when this occurs." • "Is there a family history of diabetes?" • "Suddenly having accidents can be a sign of diabetes."

• "Tell me about the circumstances when this occurs." Explanation: 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. Question 9

During an assessment, a preschool-aged child tells the nurse about having 12 siblings. The nurse is aware that the child has two older brothers. What would be the nurse's best response? • "Does it make you feel more important when you add on brothers?" • "I guess you don't know much about counting yet." • "Don't lie to me. That's never a nice thing to do to someone." • "That is a good pretend answer but tell me the names of the brothers you really have." SUBMIT ANSWER

• "That is a good pretend answer but tell me the names of the brothers you really have." Explanation: Stretching stories to make them seem more interesting is a phenomenon frequently encountered in preschoolers. This kind of storytelling should not be encouraged. The child should be helped to separate fact from fiction. The nurse should ask the child to say the names of the brothers the child really has. The nurse should not insult the child's counting ability. The nurse should not accuse the child of lying or making the child seem more important by having more brothers. Question 16

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? • Providing a nightlight • Eliminating caffeine sources beginning late afternoon • Taking the TV set out of the child's room • Planning for the child to get 12 hours of sleep daily • Allowing the preschooler to fall asleep wherever and whenever the child is tired enough

• Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Explanation: 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. Question 7

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. What is a recommended guideline when dealing with this issue? • Be prepared to thoroughly cover a topic before the child asks about it. • Provide a less than honest response to shelter the child from knowledge that is too advanced. • Expand upon the topic when answering questions to prevent further confusion. • Before answering questions, find out what the child thinks about the subject.

• Before answering questions, find out what the child thinks about the subject. Explanation: 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. Question 14

The nurse is watching a 4-year-old child play with another preschool child. The children are playing a game with rules. The nurse notes that the child is demonstrating what type of play? • Cooperative play • Associative play • Parallel play • Dramatic play

• Cooperative play Explanation: Cooperative play is when children play in a group with each other, and play by rules. Examples are board games or sports. Associative play involves allowing the child to work through feelings about procedures and separation; parallel play involves children playing side to side with each engaging in his/her own activities; dramatic play involves living out of the drama of human life. Question 17

The nurse is caring for preschoolers in a day care center. For this age group, of what developmental milestones should the nurse be aware? Select all that apply. • Understanding the differences of others • Knowing everyday objects • Counting 10 or more objects • Understanding the concept of time • Forming concepts as logical as an adult's • Correctly naming at least four colors

• Counting 10 or more objects • Correctly naming at least four colors • Understanding the concept of time • Knowing everyday objects Explanation: The child in the intuitive phase can count 10 or more objects, correctly name at least four colors, and better understand the concept of time, and he or she knows about things that are used in everyday life, such as appliances, money, and food. The preschooler forms concepts that are not as complete or as logical as the adult's, and tolerates others' differences but doesn't understand them. Question 11

The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. What is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative? • Reward the child for initiative in order to build self-esteem. • Change the routine of the preschooler often to stimulate initiative. • As a parent, decide how and with whom the child will play. • Do not set limits on the preschooler's behavior as this results in low self-esteem.

• Reward the child for initiative in order to build self-esteem. Explanation: The building of self-esteem continues throughout the preschool period. It is of particular importance during these years, as the preschooler's developmental task is focused on the development of initiative rather than guilt. A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence. Routine and ritual continue to be important throughout the preschool years, as they help the child to develop a sense of time as well as provide the structure for the child to feel safe and secure. Also, consistent limits provide the preschooler with expectation and guidance. Giving children opportunities to decide how and with whom they want to play also helps them develop initiative. Question 10

What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother? • 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. • A ratio of 10 children to 1 teacher is adequate. • Specific program goals to be accomplished should be available.

• Specific program goals to be accomplished should be available. Explanation: Preschool is used for toddlers to foster social skills and to accustom them to the group environment. When a parent is searching for a preschool they should check the school's accreditation, the teacher's qualifications, and seek the recommendations of other parents. They should visit the school to see the teacher's interact with the children, the focus of the activities and hygeine practices. Parents should look at the school's daily schedule and the types of activities offered. Are the actvities structured or loose? Preschoolers need planned activities. They are very ready to learn, but the activities should be planned to focus on their short attention spans. Question 6