Maternal Child Chap 27 Point Qs: Preschoolers

The parents of a 6-year-old tell the school nurse that they are worried that their child will fall behind other children academically because they are not able to afford expensive toys like computer games and handheld electronic devices. Which are acceptable responses by the nurse? (Select all that apply.) A. "All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." B. "Could you possibly save a little money each paycheck in order to be able to purchase such items." C. "I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." D. "There are rental agencies that rent these type of devices. Would that be a possibility financially?" E. "Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and Play-Doh? These are the types of toys suggested for preschoolers."

"All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." "I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." "Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and Play-Doh? These are the types of toys suggested for preschoolers." Rationale: Expensive and elaborate toys do not place a child at an academic or developmental advantage. Simple toys that require interactive rather than passive play, and that may include the involvement of the parent, are recommended to foster development.

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order. If the child gets up, replace the child and restart the time. Warn the child there will be a time-out if the behavior does not stop. Set a timer for no more than 4 minutes. Remove the preschooler to a boring spot. Parent knows the misbehavior was intentional.

1) Parent knows the misbehavior was intentional. 2) Warn the child there will be a time-out if the behavior does not stop. 3) Remove the preschooler to a boring spot. 4) Set a timer for no more than 4 minutes. 5) If the child gets up, replace the child and restart the time. Rationale: Time-out is an extinction method of discipline that avoids reinforcing the unacceptable behavior with attention. One minute per year of age is the appropriate length of a time-out. Five minutes is the recommended maximum length.

The nurse is conducting a well-child exam of a 4-year-old child. Which statement would alert the nurse that the child is at risk for iron deficiency? A. "He loves milk and drinks it every time he is thirsty." B. "He does not like spinach, but he does like chicken and beef." C. "He enjoys eggs and fortified cereal for breakfast." D. "He eats a well-balanced diet."

A. "He loves milk and drinks it every time he is thirsty." This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency.

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? A. "Tell me about your child's exposure to tobacco smoke." B. "Tobacco smoke is linked with an increased number of ear infections." C. "You should stop smoking around your child." D. "Are you aware that exposure to tobacco smoke can be associated with behavioral difficulties?"

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

Parents 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? A. Allowing the preschooler to fall asleep wherever and whenever the child is tired enough B. Taking the TV set out of the child's room C. Providing a nightlight D. Eliminating caffeine sources beginning late afternoon

A. Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Rationale: 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 the child awake.

The nurse is organizing an indoor play area for preschoolers. What play materials are least important? A. Electronic teaching toys B. Cut, paste, drawing, and painting materials C. Balls, blocks, and puzzles D. Dress-up clothes and hats and puppets

A. Electronic teaching toys Rationale: These 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.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize: A. having the child wear a personal flotation device whenever near or on the water. B. enrolling the child in swimming lessons. C. using and renewing sunscreen regularly. D. adults learning infant/child cardiopulmonary resuscitation (CPR).

A. having the child wear a personal flotation device whenever near or on the water. Rationale: 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 4 to 5 years of age, 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.

A parent describes the 4-year-old child's eating habits as "picky" and goes on to describe using, coaxing, and threatening measures to get the child to eat. The nurse determines the child is growing normally. What interventions will the nurse suggest? (Select all that apply.) A. Allow the child to decide how much the child will eat. B. Offer only nutritious between-meal snacks. C. Ignore the pickiness. D. Focus on quality, not quantity. E. Offer a variety of healthy foods including those liked and refused. F. Approach mealtime matter-of-factly.

Allow the child to decide how much the child will eat. Offer only nutritious between-meal snacks. Ignore the pickiness. Focus on quality, not quantity. Offer a variety of healthy foods including those liked and refused. Approach mealtime matter-of-factly. Rationale: Preschoolers often become "picky" eaters but when given the opportunity to include a wider variety in their diet eventually do so. At 5 years of age, children become more receptive to different foods. Too much focus on eating may exacerbate the problem.

The parent 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 parent would indicate a need for further teaching? A. "I have heard that both boys and girls often touch themselves at this age." B. "I will need to find an appropriate punishment for him if this continues." C. "I should teach him certain rules about this activity." D. "This is probably a good time to talk about safety and who can touch him."

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

A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The parent explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond? A. "Are you kidding me?" B. "Tell me about Boo-ga-loo." C. "Where did you get that funny name?" D. "I don't see anyone."

B. "Tell me about Boo-ga-loo." Rationale: 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 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? A. Encourage the parents to let the child fall asleep in a safe place such as their bed. B. Wake the child up nightly 30 to 45 minutes after going to sleep. C. Explain that this is a developmental phase that will not last. D. Tell the parents to be sure to wake the child up during the next episode.

B. Wake the child up nightly 30 to 45 minutes after going to sleep. Rationale: 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.

The nurse is providing teaching about preventing poisoning. Which statement by the parent would warrant further discussion? A. "We keep our lawn and garden products on a high shelf in the garage." B. "I never transfer cleaning products out of their original containers." C. "All medicine in our bathroom is in childproof containers." D. "We have the poison control number located near our phone."

C. "All medicine in our bathroom is in childproof containers." Rationale: The nurse should emphasize that while childproof caps on medications are important, all medications including those with childproof caps should still be kept locked. (Vitamins are medications.) The other statements are correct.

The nurse is doing a well-child exam of a 5½-year-old child. Which statement by the parent would alert the nurse that further teaching is needed about healthy eating habits? A. "My child enjoys planning meals and helping me in the kitchen." B. "I try to set a good example and eat a variety of fruits and vegetables." C. "Our family rule is that all children clean up their plates at each meal, and we feed them a lot." D. "We eat fast food less than once a month."

C. "Our family rule is that all children clean up their plates at each meal, and we feed them a lot." Rationale: Children should not be expected to always eat everything on their plates, nor should they be rewarded for doing so. Appropriate serving sizes are important here. Children need to learn to self-regulate and eat only until full. The other statements indicate knowledge of healthy eating habits and are useful in developing positive attitudes toward eating and toward trying different foods.

The parents of a 5-year-old child are discussing bicycle safety with the nurse. What comment indicates further teaching is needed? A. "He is able to ride without training wheels." B. "Our son always wears a helmet." C. "We just got him a new bike he can grow into." D. "He never rides in the street."

C. "We just got him a new bike he can grow into." Rationale: The bicycle should fit the rider. The balls of his feet should reach both pedals while he is sitting on the seat and has both hands on the handlebars. The other comments describe no safety risk.

A 4-year-old child has begun stuttering. Which practice by the parents will the nurse discourage? A. Enunciating clearly and slowing down parental speech B. Giving the child opportunity to speak and finish ideas C. Asking the child to slow down and to think before talking D. Looking at the child while the child is speaking

C. Asking the child to slow down and to think before talking Rationale: Many preschoolers stutter as thinking races ahead of their ability to articulate ideas. Most of this stuttering, when not made an issue, will resolve on its own. Calling attention to the dysfluency often exacerbates it. All the other practices are helpful.

Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased the child drinks "lots of milk." What risk does the nurse identify? A. Obesity B. Dental caries C. Iron deficiency D. Interference with growth

C. Iron deficiency Rationale: 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 nurse is providing teaching about car seat safety for a parents' meeting at the preschool their children attend. Choose the points the nurse should make. (Select all that apply.) A. Children who weigh less than 40 lb should use a rear-facing car seat. B. Many car seats are installed improperly, making them unsafe. C. Booster seats should be used with both a shoulder and lap belt. D. Children large enough for a front-facing care seat with a harness for as long as possible. E. The back seat remains the safest place for children to ride.

Children who weigh less than 40 lb should use a rear-facing car seat. Many car seats are installed improperly, making them unsafe. Booster seats should be used with both a shoulder and lap belt. Children large enough for a front-facing care seat with a harness for as long as possible. The back seat remains the safest place for children to ride. Rationale: All options are correct and are important safety points for the nurse to make.

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium? A. Apple B. Peach C. Banana D. Orange

D. Orange Rationale: A medium orange contains 50 mg of calcium and is a good nondairy choice. The other fruits are healthy choices but do not contain as much calcium.

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

D. be able to use each language as a separate system. Rationale: 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.

In counseling a group of parents regarding the development of school readiness in preschoolers, the nurse emphasizes: A. library visits and story hour. B. visiting the kindergarten. C. enrollment in a preschool. D. the home environment.

D. the home environment. Rationale: The home environment is the foundation for the child's learning and is the most important element for developing school readiness. Values regarding learning originate at home. Parents are the first teachers and role models. Structure, proper behavior with others, and language skills are all developed at home and are essential for school success. The other options are important but not as vital as the home environment. A preschool experience can foster social skills and group interaction. Library story hour and books develop language skills, and visiting a kindergarten can help the child make the transition to school.

The nurse is caring for a 4-year-old child following an appendectomy. The child becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the child says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of: A. magical thinking. B. beginning empathy. C. animism. D. transduction.

D. transduction Rationale: The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the child 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 nurse realizes that the 5-year-old's growth chart and BMI indicate the child is at risk for obesity. What other findings reinforce this risk? (Select all that apply.) A. Expectations to eat everything on plate B. Mealtimes organized and regular C. A parent who is overweight D. Food used as reward or punishment E. Fast food eaten once a month Television on during meals

Expectations to eat everything on plate A parent who is overweight Food used as reward or punishment Television on during meals Rationale: Overweight parents, food used as reward or punishment, TV viewing during meals, and the "clean plate club" all are factors that contribute to weight gain. The frequency the family eats fast food is not excessive. Regular, structured meals result in less snacking and more nutritious meals. Family eating together is bonding.

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

When discussing improper behavior, call the behavior "bad" or "naughty," not the child. Books and stories can help preschoolers master proper behavior. Anticipate situations likely to cause misbehavior and redirect the child to another activity. Rationale: Spanking is the least effective discipline and discouraged by pediatric professionals. If chosen by parents, it should be infrequent and done only with an open hand. Labeling behavior and not the child supports self-esteem. One minute per year of age is an appropriate length for time-outs. Redirecting from events that tend to lead to misbehavior is wise and reduces conflict. Preschoolers can learn much from stories and books including appropriate behavior.