Chapter 27: Growth and Development of the Preschooler
A 4-year-old is hospitalized with a urinary tract infection. Based on what you know of her cognitive development, which approach would be best to prepare her for a radiograph? Tell her a radiograph is a picture of the dark inside her body. Tell her she must follow directions or she will be hurt. Explain that she must behave because the technician is busy. Help her pretend the x-ray machine is a camera.
Help her pretend the x-ray machine is a camera. Most preschoolers express fear of the dark and mutilation. Their active imaginations make it possible to turn almost any procedure into a game.
The community health nurse is providing a class to a group of adolescents training to become "safe babysitters." When discussing activities that are appropriate for 3-year-old children, which should be included? Select all that apply. Running outside and tagging an item Somersaults on safe surface Walking up stairs using alternate feet Skipping Skating with roller skates
Walking up stairs using alternate feet Running outside and tagging an item At the age of 3 years the preschool child is active. They are able to run and thus play tag, they are able to climb stairs using alternate feet. Skipping and skating would be seen in a 5-year-old child, as would somersaulting.
The nurse is conducting a well-child examination of a 4-year-old and is assessing the child's height. By how much should the nurse expect the child's height to have increased since last year's examination? 0.5 to 1 inch (1.27 to 2.54 cm) 1 to 2 inches (2.54 to 5.07 cm) 3.5 to 4 inches (8.89 to 10.16 cm) 2.5 to 3 inches (6.35 to 7.62 cm)
2.5 to 3 inches (6.35 to 7.62 cm) The average preschool child will grow 2.5 to 3 inches (6.35 to 7.62 cm) per year. Thus, the nurse would expect that the child's height would have increased 2.5 to 3 inches (6.35 to 7.62 cm) since last year's well-child examination.
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? 58 to 60 lb (26.3 to 27.2 kg) 38 lb to 40 (17.2 to 18.1 kg) 44 to 46 lb (20 to 21 kg) 50 to 52 lb (22.7 to 23.6 kg)
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).
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? Wash her mouth out with soap if she says it again and tell her it is wrong. Ignore the behavior and she should quit using these words. Calmly correct the child, telling her not to say those words again. Tell the child that language is unacceptable and place the child in time-out.
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.
Which would be a nutritional goal for a preschool client? Introduce new food gradually and include variety. Reduce messiness and spills. Let the child eat only what the child wants. Eat everything on the plate.
Introduce new food gradually and include variety. Mealtimes can become a power struggle between caregivers and the young child. Reassure caregivers that young children go through periods during which they are very particular about food. Therefore, new foods should be gradually introduced and include variety. Foods that look like or smell like other foods they enjoy are the most likely to be eaten. Eating everything on the plate can lead to obesity; the child needs a variety of the 5 food groups; and messiness and spills allow the child to use fine and gross motor skills and practice their use of utensils and cups.
Johnny exhibits the following growth pattern. Which interpretation of the data is accurate? Select all that apply.3 yrs: Ht. 37 inches Wt. 32 pounds4 yrs: Ht. 39 inches Wt. 39 pounds5 yrs: Ht. 40 inches Wt. 46 pounds Johnny is growing slowly in height but rapidly in weight. Johnny's height and weight should be plotted on a growth chart. Johnny may be at risk for overweight or obesity. Johnny is following a normal pattern of growth for the preschool years.
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. 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.
The nurse is assessing a 4-year-old on a routine well-child visit. When assessing the gross motor skills of this preschooler, which activity will the nurse predict the child to be able to successfully accomplish? ride a bicycle hop on one foot jump rope walk backwards with heel to toe
hop on one foot The 4-year-old should be able to hop on one foot and can control movements of the hands. By the age of 5 the child can walk backwards heel to toe, throw and catch a ball well, and jump rope.
Which gross motor skill would the 4-year-old child have most recently attained? The child can cut his/her food. The child can hop on one foot. The child can button his/her clothes. The child can tie his/her shoelaces.
The child can hop on one foot. Gross and fine motor skills continue to develop rapidly in the preschool-aged child. Gross motor skills have to do with the development of large muscles. Balance improves around the age of 4, thus the child can hop on one foot and stand on one foot for 5 seconds. A 3-year-old child does not have the ability to accomplish these tasks. A 5-year-old child can button his/her own clothes, tie shoes, and cut his/her food.
During a well-child visit, parents asks the nurse what types of snack foods are recommended to give their preschooler to foster nutrition. What would be the nurse's best recommendation? peanuts and trail mix graham crackers and milk cheese cubes and apple slices salsa dip and whole grain chips
cheese cubes and apple slices Snacks for preschoolers should be nutritious and not contain large amounts of sugar, like cookies or graham snacks. Additionally, they need to be safe for the child and not offer choking dangers, such as peanuts do. Children this age prefer nonspicy foods.
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: magical thinking. beginning empathy. transduction. animism.
transduction. The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.
The father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is most appropriate? "Your son is slightly below the normal height for his age but he had demonstrated a normal growth rate this year." "Both your son's height and rate of growth are within normal limits for his age." "Is there a reason you are concerned about your child's height?" "Your son is slightly below the normal height for his age group but may still grow to be a normal height in the coming year."
"Both your son's height and rate of growth are within normal limits for his age." The average 4-year-old child is 40.5 in (103 cm). The average rate of growth per year is between 2.5 and 3 in (6.35 and 7.62 cm). The child in the scenario demonstrates normal stature and growth patterns.
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." "Have your child hold hands with a grown-up in parking lots." "Do not allow your child to approach strange dogs." "Role-model bicycle safety by wearing a helmet too." "Allow your child to ride in the front seat of the car."
"Do not refer to medicines as candy." "Do not allow your child to approach strange dogs." "Have your child hold hands with a grown-up in parking lots." "Role-model bicycle safety by wearing a helmet too." Appropriate safety measures include not referring to medicines as candy, not allowing the child to approach strange dogs, having the child continue to ride in the back seat of the car, ensuring that the child holds an adult's hand when in parking lots, and role-modeling bicycle safety by wearing a helmet themselves.
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 usually have him in time-out for about 10 minutes." "The time-out doesn't just have to be in his room." "I put him in time-out when the problem occurs." "He is allowed out of time-out when he is calm."
"I usually have him in time-out for about 10 minutes." 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 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? "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." "You should answer his questions by whatever feels most comfortable to you." "That is a difficult subject to address. I'm not sure what is the best way to answer that question.""It's best to answer his questions using accurate anatomical names and keep your answers simple."
"It's best to answer his questions using accurate anatomical names and keep your answers simple." It is suggested to keep answers brief and use correct anatomical names of body parts. Offering this advice to the father will help guide him in how to address questions. It is not necessary to go into the detail of using books with pictures for children of this age.
The mother of a 4-year-old child is concerned that she caught him masturbating in the bath tub. Which is the most appropriate response by the nurse? "You will need to speak with the doctor about that behavior since I cannot address sexual issues in a child." "If you catch your child masturbating, you should immediately make them stop." "Masturbation is not a normal behavior for a child of that age." "Masturbation is a normal part of preschool development."
"Masturbation is a normal part of preschool development." 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. The nurse can and should educate the mother on normal growth and development, including sexual
The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention? "The school has a loose environment, which is a good match for his temperament." "There is a very low student-teacher ratio, and they do a lot of hands-on projects." "The school requires processed foods and high sugar foods be avoided." "The school is quite structured and advocates corporal punishment."
"The school is quite structured and advocates corporal punishment." The nurse needs to emphasize that there are number of reasons that a parent should not choose a preschool that utilizes corporal punishment. It may negatively affect a child's self-esteem as well as ability to achieve in school. It may also lead to disruptive and violent behavior in the classroom and should be discouraged. The other statements would not warrant further discussion or intervention.
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." "Your penis is very interesting, isn't it? But you can injure it by touching it so much." "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 boy too."
"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.
The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond? "I am sure he will become more proficient in these activities soon." "I wouldn't be too concerned since he seems fine during my assessment." "Maybe practicing these activities with him would help him improve these motor skills." "Your child is not expected to be able to perform those activities at 3 years of age."
"Your child is not expected to be able to perform those activities at 3 years of age." Skipping and standing on one foot for up to 10 seconds are motor skills that are expected from a 5-year-old, not a 3-year-old; therefore, the best response is letting the mother know that her child is not behind in motor development.
A nurse is preparing a presentation for a health fair discussing various aspects of preschoolers. Which example should the nurse use to best illustrate dramatic play? Acting out a troubling or stressful situation Playing a video game with several other children Playing apart from others without being part of a group Watching television or videos
Acting out a troubling or stressful situation Dramatic play allows a child to act out a troubling or stressful situation. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. During cooperative play, children play in an organized group with each other as in team sports or video games. Onlooker play occurs when there is observation without participation, such as watching television or videos.
What would be most effective in helping promote initiative and nutritional health for a preschooler? Praising the child for cleaning his large plate of food Encouraging the child to cut up small pieces of apple for a snack Giving the child a high carbohydrate snack after preschool Allowing the child to spread soft cheese on crackers
Allowing the child to spread soft cheese on crackers Allowing a child to do things such as spreading cheese on crackers helps to foster initiative and nutrition. High carbohydrate snacks should be avoided. Cutting an apple into pieces would be a safety issue. Apples are hard and difficult to cut, placing the child at risk for cutting himself. Small servings of food would be more appropriate because preschoolers do not have ravenous appetites. Praising the child for cleaning his plate which contains a small serving of food would be appropriate.
A nurse is assessing a preschooler and asks the child a question about pets. The child responds by saying, "I-I-I have a t-t-turtle and a f-f-fish." The child's parent states that this problem just started over the past month or so. The nurse interprets this as which? Broken fluency. Deferred imitation. Bathroom language. A stuttering disorder.
Broken fluency. The child is demonstrating broken fluency or secondary stuttering, the repetition and prolongation of sounds, syllables, and words. The child began to speak without this problem and then, during the preschool years, developed it. Stuttering would have been present prior to this period. Bathroom language refers to crude or inappropriate language. Deferred imitation is characteristic of toddlers in which the child can remember an action and then imitate it.
The nurse is organizing an indoor play area for preschool-age children. Which play materials are least important? CD player with music and musical instruments Dress-up clothes and hats and puppets Electronic teaching toys Balls, blocks, and puzzles Cut, paste, drawing, and painting materials
Electronic teaching toys Electronic teaching toys are expensive and usually cannot be used in multiple ways or shared with a group of children. All the rest of the items have many uses, stimulate imagination and creativity, promote social interaction, and are relatively inexpensive and readily replaced.
A family from India has recently moved to the United States. Their 5-year-old child often visits the school nurse after lunch reporting a "stomachache." The lunch staff tell the nurse that the child eats very little for lunch. What is the best action by the nurse? Speak to the child and parents to discuss the repercussions of visiting the nurse so frequently. Talk with the child and encourage that lunches be brought from home so that nutrient needs are met. Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch. Explain to the child that the reason for the stomachache is that not enough is being eaten during lunch.
Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch. Food served in the home is often very specific to the family's ethnic background. As the preschool-age child is exposed to persons of other cultures in school, he or she may or may not like the food that is served. It is important to first determine if this is the reason for the child eating very little at lunch so that appropriate interventions can be determined. Bringing lunch from home may be an option, but it must first be determined if food preference is the underlying cause of lack of eating.
The nurse is meeting with a group of young parents to discuss nutrition and their preschooler. Which response should the nurse prioritize when asked if using desserts as a reward for good behavior is an appropriate idea? This will result in the child being overweight. The child will learn to choose sweets over nutritious food. The child may only behave on days when dessert is something that is liked. The child can use food to manipulate others' behavior.
The child can use food to manipulate others' behavior. Food should never be used as a reward or bribe; otherwise, the child will continue to use food as a means to manipulate the environment and the behavior of others. Because of the high fat and sugar content of most desserts, the nutritional value of desserts is usually less than a balanced diet of healthier foods and could add to the concern of obesity in some children. A child might prefer sweets over nutritious foods and behave differently if dessert were a reward, but these choices are not the most appropriate answer.
The nurse is observing a 4-year-old child in the play room of the medical unit of the hospital. The child uses the toy medical equipment and proceeds to change the bandage on a doll, pretends to give the doll medication, and talks elaborately to the doll. How does the nurse accurately interpret this play? The child is demonstrating behavior suggestive of a developmental delay. The child wants to be a doctor and is copying the pediatrician's behaviors. The child is portraying anxiety about the hospitalization through play. The child is using parallel play while in the hospital.
The child is portraying anxiety about the hospitalization through play. Preschool-aged children often use dramatic play to express anxiety, try out negative feelings, or conquer their fears. This child, at 4 years of age, is demonstrating behavior that is developmentally appropriate. Parallel play involves children playing adjacent to each other but not engaging in interaction or affecting each other's play. Pretend play, such as acting like the pediatrician, is more common among toddlers.
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 cover mouth when coughing or sneezing. The preschool child should be properly restrained when riding in a vehicle. The preschool child should brush and floss teeth after snacks and meals. The preschool child should be screened for amblyopia.
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.
When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate? tells a fantasy story about a bear and a car begins to show logical thought processes scribbles with no discernable pictures/letters has best friends at preschool and sleepovers
tells a fantasy story about a bear and a car The nurse should recognize that by age 4, the preschooler should have a vocabulary of about 1,400 words. Preschool-age children are able to communicate in sentences of five words or more and often like to use their imagination. This is a normal part of growth and development and should be encouraged.
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? "Reward the child with candy or some other treat each time the child keeps the seat belt on." "Stop the car any time the preschooler unbuckles the restraints." "Set a good example. Wear your own seat belt every time you drive." "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." 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.
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? Delayed growth and development related to frequent illness Risk for imbalance nutrition, more than body requirements Health-seeking behaviors Parental anxiety related to lack of understanding
Delayed growth and development related to frequent illness 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.
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? deficient knowledge of normal preschool development compromised family coping related to abnormal behavior of child 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 Because a preschooler's imagination is at a peak, imaginary friends are not uncommon.
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? parallel play cooperative play associative play dramatic play
cooperative play 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.
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? "Are you kidding me?" "Where did you get that funny name?" "I don't see anyone." "Tell me about Boo-ga-loo."
"Tell me about Boo-ga-loo." The imaginary friend serves as a companion and playmate for the preschooler. The child knows this friend is not real, yet is very invested in the imaginary playmate who can be and do anything the child's fantasy life can invent. The nurse should acknowledge this friend, not minimize the friend's importance. "Tell me..." does this. The other responses do not.
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? "You need to show your child the broken tool since at this age they must see something in order to understand." "Your son may have a friend named Andrew, but it could be an imaginary friend." "You should punish your son because no child should be telling lies at this age." "You should watch this type of behavior closely since most children this age tell the truth."
"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.
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? 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 Eliminating caffeine sources beginning late afternoon Providing a nightlight
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.
Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize: enrolling the child in swimming lessons. having the child wear a personal flotation device whenever near or on the water. adults learning infant/child cardiopulmonary resuscitation (CPR). using and renewing sunscreen regularly.
having the child wear a personal flotation device whenever near or on the water. Preschool children are safe around water only when adult supervision is constant. Wearing a personal flotation device adds additional protection and should be as routine as "buckling up" in the car. At 5 years old, most preschoolers are mature enough to become swimmers, yet knowing how to swim does not make the preschooler safe without supervision. CPR is a life-saving skill and using sunscreen will protect the skin, but neither will be a factor in preventing drowning.
The nursing instructor is illustrating the various types of play. The instructor determines the class is successful when the students correctly choose which example as best representing onlooker play? playing apart from others without being part of a group observing without participating acting out a troubling situation playing in an organized group with each other
observing without participating Onlooker play occurs when there is observation without participation, such as watching television. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Dramatic play allows a child to act out a troubling situation. During cooperative play, children play in an organized group with each other as in team sports.
The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply. "My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "My 4-year-old is above normal in weight but I'm sure it's just baby fat and will be lost with age." "The only way I can get my child to consume sources of vitamin C is through fruit juices. I guess it's better than not at all." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda."
"My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda." Worldwide, over 22 million children younger than 5 years old are obese. In the past 30 years, the number of US children and adolescents who are overweight has doubled, which increases chances for obesity to continue into childhood and increases the risk for obesity-related diseases. The 3- to 5-year-old requires 700 to 1000 mg calcium. Allowing preschoolers controlled choices of foods fosters good eating habits as the child grows. Fruit juice should be limited to 4 to 6 ounces per day, as excess consumption can lead to excess weight gain and dental caries due to the sugar content. Nutrient-poor, high-calorie foods such as sweets and typical fast foods should be offered only in limited amounts.
The nurse has completed an education program on normal communication abilities in the preschool-age child. Which statement by a participant indicates a need for further education? "My child is finally talking in a way that most of my friends can understand her speech." "When my child counts numbers, it is only to 10 and we are slowing working on counting higher." "Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that." "I am glad to know that my 4-year-old child asking so many questions is normal."
"Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that." The preschool-age child is known for asking lots of questions, and this is normal. At this age, 75% of the child's speech is understood by others outside of the family. The preschool-age child can easily count to 10, and the parents stating they were slowly working on counting higher is acceptable, as long as the parents do not push the child. A child at 5 years of age should be able to state one's name and address.
The nurse of a preschool-aged child is helping parents develop a healthy meal plan for their child. What statement, when made by the parents. indicates teaching was successful? "We are going to research the calories in food so our child consumes about 85 kcal/kg each day." "We plan to offer our child food with less iron each day since our child is not in a growth spurt." "We know it is fine that our child does not like high fiber foods, since our child only needs about 5 mg per day." "We realize our child does well when we offer healthy snacks as rewards for doing the chores."
"We are going to research the calories in food so our child consumes about 85 kcal/kg each day." The nurse would know teaching has been successful when the parents indicate they will offer a daily calorie amount equivalent to 85 kcal/kg of body weight. The preschool-aged child, even though not in a growth spurt compared to infancy and adolescence, is still growing and requires 10 mg of iron each day. The preschool-aged child is recommended to consume 19 mg of dietary fiber daily, while the 4- to 8-year-old child requires 25 mg dietary fiber per day. Food and snacks (even healthy ones) should not be used as a reward or punishment in this age group.
During an admission assessment the nurse is discussing the developmental level of the child with the parents. Which comments by the parents demonstrate a good understanding of developmental expectations of the preschool-aged child? Select all that apply. "Our child attends a wonderful preschool 3 times per week." "My parents are the only babysitters our child has ever had. I think contact with mostly adults is important for this age." "We have been talking about enrolling in a morning preschool program since this is our only child." "I am very concerned that our child is acting too much like some of the other children at our day care." "We think it is important to have play dates with our friend's preschool children."
"We think it is important to have play dates with our friend's preschool children." "Our child attends a wonderful preschool 3 times per week." "We have been talking about enrolling in a morning preschool program since this is our only child." Making friends and playing with other children of the same age is important for socialization of the preschool-age child. Play dates, preschool, and day care are a means of socialization for the preschool child. Preschool children commonly display behavior of their peers, which is not an issue if it is acceptable behavior.
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." "What happened to my client? Did you eat her?" "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 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.
The nurse is speaking with the parent of a 4-year-old child. Which statement by the parent would suggest a need for further investigation? "My child loves to play dress-up with friends at day care." "When we go to the park, my child never wants to play with the other children." "I think it is so cute when my child wants to help my spouse with yardwork." "My son loves to follow around his older sister." "Sometimes I wish my child would play with a toy in the way it was intended. My child is constantly pretending it is something else."
"When we go to the park, my child never wants to play with the other children." 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 a sensitive and critical time for socialization. Preschoolers who are exposed to other playmates have an easier time learning to relate to people than those raised in an environment where they rarely see other children of the same age
The parents express concern about their child who has an imaginary friend. The nurse explains that as long as the imaginary friend does not become the center of attention and also the child has real friends, this can be beneficial. What benefits are discussed? Select all that apply. Provides an outlet by which the child can express innermost feelings. Protects the child by separating from those who are unkind. Encourages language development by conversation. Serves as someone to blame or decrease the child's guilt. Helps the child know what is real and what is not.
Encourages language development by conversation. Provides an outlet by which the child can express innermost feelings. Serves as someone to blame or decrease the child's guilt. Benefits of imaginary friends include that they can encourage language development, provide an outlet for a child to express innermost feelings, and serve as a handy "scapegoat" or decreasing guilt for behavior about which a child has some conflict. Preschoolers have vivid imaginations and they can use these imaginations to develop social skills and explore complex social ideas. The imaginary friend does not help the child know what is real or what is not. The child is still trying to develop one's place in the world.
The nurse is presenting nutritional information at a community health fair. Which suggestion should the nurse prioritize when illustrating proper nutrition for preschoolers? Need three big meals a day due to rapid growth Snacks throughout the day help the child meet nutritional requirements Need extra calcium for proper muscle growth Should drink at least 4 cups of milk each day
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.
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. A ratio of 10 children to 1 teacher is adequate. Research local newspapers to see if there are any complaints against the center. Specific program goals to be accomplished should be available.
Specific program goals to be accomplished should be available. Preschool is used for toddlers to foster social skills and to acclimate them to the group environment. When a parent is searching for a preschool, he or she should check the school's accreditation, the teacher's qualifications, and seek the recommendations of other parents. Parents should visit the school to see the teacher interact with the children, the focus of the activities, and hygiene practices. Parents should look at the school's daily schedule and the types of activities offered. Are the activities 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.
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. Make a model for the child to follow so it will be easy to copy. Draw a picture first for the child to see how to do it. Tell the child that it will be fun but that he or she should not make a mess.
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.
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. Urge children never to talk to or accept a ride from a stranger. 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. Wait until children are old enough to tell them how to call for help in an emergency.
Urge children never to talk to or accept a ride from a stranger. 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. 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.
Parents tell the nurse their 3-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify? iron deficiency interference with growth dental caries obesity
iron deficiency Meat is an important iron source while calcium in milk consumed in large quantities can block iron absorption. Alternate protein sources can replace the meat in the child's diet for growth. Excess milk intake that boosts calories consumed can be an obesity-causing factor. Lactose from milk in constant contact with the teeth can promote development of dental caries. However, these risks are slight, with the iron deficiency risk pronounced.
The most important safety precaution for parents to teach preschoolers is: not to watch their father mow the lawn. not to begin formal dance classes. to chew bites of food three times. not to ride in a car with strangers.
not to ride in a car with strangers. Preschoolers begin to spend more time away from parents as they begin preschool. That makes it a time to learn about people and not to enter a car if offered a ride (or candy) from a stranger.
A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which activity that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson? reading a book roughhousing with his father singing a song he learned at preschool opening drawers in the room, pulling out supplies, and examining them
opening drawers in the room, pulling out supplies, and examining them The developmental task for the preschool-age child is to achieve a sense of initiative versus guilt (Erikson, 1993). Children with a well-developed sense of initiative like to explore as they have discovered that learning new things is fun. Opening the drawers, pulling out supplies, and examining them is the best example of initiation and exploration among these answers. Roughhousing and singing a song learned in preschool are examples of typical play for preschool children. Reading a book at age 4 would be developmentally precocious but would not necessarily be the best example of initiative.
The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation? presence of 10 deciduous teeth presence of 19 deciduous teeth presence of 20 deciduous teeth absence of dental caries
presence of 10 deciduous teeth The presence of only 10 deciduous teeth would warrant further investigation. The preschooler should have 20 deciduous teeth present. The absence of dental caries or presence of 19 teeth does not warrant further investigation.
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: preschoolers having a harder time sharing than toddlers. playing in an even-number group of children (four). regression. testing and identification of group role.
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.
