PEDS Chapter 5: Growth and Development of the Preschooler
Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of these actions? Select all that apply. a. When discussing improper behavior, call the behavior "bad" or "naughty," not the child. b. Anticipate situations likely to cause misbehavior and redirect the child to another activity. c. Books and stories can help preschoolers master proper behavior. d. A time-out of about 8 minutes would be appropriate for intentional misbehavior. e. Spank with an open hand only and never with an object.
a, b, c 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. Preschool-age children can learn much from stories and books including appropriate behavior.
A community health center is planning a seminar about the 2030 National Health Goals for preschool-age children. Which topics would be included in this seminar to address safety? Select all that apply. a. Protection against second-hand smoke b. Providing helmets before riding a bicycle c. Using appropriate restraints in motor vehicles d. Removing houseplants from easy to reach areas e. Posting the telephone number of the poison control agency
a, b, c The 2030 National Health Goals for preschool-aged children focus on safety and include protecting these children against second-hand 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.
Parents of a preschooler tell the nurse that their child often refuses to go to sleep at night. Which suggestion by the nurse would be helpful? Select all that apply. a. "Try using a night light in the child's room." b. "Set up some familiar bedtime rituals for your child." c. "Keep the door closed and the lights off so that your child can fall asleep faster." d. "Avoid having your child watch frightening shows on TV before bedtime." e. "Try reading a favorite story before bedtime."
a, b, d, e Preschoolers may refuse to go to sleep because of fear of the dark. A night light, screening out frightening stories or TV shows, and using familiar bedtime routines, including reading a favorite story, can help. Keeping the door closed and the lights off would only help to promote the child's fear.
A nurse is teaching a group of parents of preschoolers about safety. Which information would the nurse include? Select all that apply. a. "Do not refer to medicines as candy." b. "Do not allow your child to approach strange dogs." c. "Allow your child to ride in the front seat of the car." d. "Have your child hold hands with a grown-up in parking lots." e. "Role-model bicycle safety by wearing a helmet too."
a, b, d, e 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 parents of a 5-year-old tell the student nurse, "Our daughter takes after her father's lack of athletic ability. We have worked with her but she can't seem to throw a ball at all when we are playing with her." Which responses by the student are not appropriate? Select all that apply. a. "Athletic ability is often hereditary, so it is good you are aware of her lack of athleticism while she is young." b. "I know how annoying that has to be. Neither my brother nor I have any athletic ability and neither do our parents." c. "It may not be athletic ability. Most preschoolers are able to throw a ball by the age of 5 years. Have you discussed this with your pediatrician?" d. "I am sure she will catch on as she plays with more children and when she starts taking physical education classes at school. e. "Enrolling your daughter in a preschool softball or baseball program might help her athletic and motor skills."
a, b, d, e While at 4 years of age a child typically cannot throw a ball overhand, they are developmentally able to throw a ball by other means, such as underhand or side-handed. It is necessary to address this as a possible developmental delay and be sure the pediatrician is aware of the issue.
The parents of a 5-year-old tell the nurse that it "seems like our child is afraid of everything from fireworks to butterflies." What actions should the nurse take? Select all that apply. a. Ask the parents if they can identify anything that may be causing their child be fearful. b. Encourage the parents to just ignore the fears since this is common behavior with the preschool-aged child. c. Suggest to the parents to talk with their child about his fears. d. Work with the parents and child to devise strategies to help deal with the fears. e. Advise the parents to help the child understand that the fears are irrational.
a, c, d Preschoolers have a vivid imagination, which often leads to a variety of fears. The best way to deal with the child's fears is to address them and work together to determine ways to help minimize the fears. The preschooler is not emotionally equipped to understand why fears are irrational.
The nurse is conducting a well-child exam of a 4-year-old boy. 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 eats a well-balanced diet." c. "He enjoys eggs and fortified cereal for breakfast." d. "He does not like spinach, but he does like chicken and beef."
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 father of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the father would indicate a need for further teaching? a. "I will need to find an appropriate punishment for him if this continues." b. "I have heard that both boys and girls often touch themselves at this age." 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."
a. "I will need to find an appropriate punishment for him if this continues." The nurse should remind the father that overreaction to this behavior may cause it to occur more frequently. Masturbation at this age should be treated matter-of-factly. The other statements are correct.
The parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares? a. "She screams and thrashes when we try to touch her." b. "She is scared after she wakes up." c. "She comes and wakes us up after she awakens." d. "She has a hard time going back to sleep."
a. "She screams and thrashes when we try to touch her." During a night terror, a child is typically unaware of the parent's presence and may scream and thrash more if restrained. During a nightmare, a child is responsive to the parent's soothing and reassurances. The other statements are indicative of a nightmare.
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? a. "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." b. "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you." c. "Oh no! I have a crocodile in my room. Please don't bite me!" d. "What happened to my client? Did you eat her?"
a. "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 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? a. "Your child is not expected to be able to perform those activities at 3 years of age." b. "I wouldn't be too concerned since he seems fine during my assessment." c. "Maybe practicing these activities with him would help him improve these motor skills." d. "I am sure he will become more proficient in these activities soon."
a. "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.
The nurse has brought a group of preschoolers to the playroom to play. Which activity would the nurse predict the children to become involved in? a. Pretending to be mommies and daddies in the playhouse b. Playing a board game c. Painting pictures in the art corner of the room d. Watching a movie with other children their age
a. Pretending to be mommies and daddies in the playhouse Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-aged child enjoys group activities, such as board games, and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities he or she can participate in with their peers.
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. adults learning infant/child cardiopulmonary resuscitation (CPR). d. using and renewing sunscreen regularly.
a. 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 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? a. hop on one foot b. walk backwards with heel to toe c. ride a bicycle d. jump rope
a. 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.
A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group? a. imagination b. vocabulary c. gross motor skills d. fine motor skills
a. imagination Although vocabulary, gross motor skills, and fine motor skills improve during this time, the imagination of preschool-age children is keener than it will be at any other time in their lives. They imitate behavior exactly as they see it.
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: a. imagination in a 3-year-old is at its peak. b. a 3-year-old knows the word two but not the concept of two. c. a preschooler is in an insecure period. d. preschoolers have a limited vocabulary.
a. imagination in a 3-year-old is at its peak. 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 four colors. Their communication 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 a child's sense of belonging and his or her place in the world.
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: a. testing and identification of group role. b. playing in an even-number group of children (four). c. preschoolers having a harder time sharing than toddlers. d. regression.
a. 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.
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: a. transduction. b. magical thinking. c. animism. d. beginning empathy.
a. 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 pediatric nurse is discussing the daily activities of a 4-year-old with the caregiver to assess growth and development status. The nurse would document that the child has reached the initiative stage of development if the caregiver indicates the child participates in which activity? a. tries to sweep up spilled cereal but cries when can't do well b. broke a dish but blamed it on a friend the caregivers don't know c. refuses to hold anyone's hand while crossing the street d. gets upset when a babysitter is in charge, but will do what is asked by the babysitter
a. tries to sweep up spilled cereal but cries when can't do well According to Erikson, the developmental task of the preschool age is initiative versus guilt. Preschoolers often try to find ways to do things to help, but they may feel guilty if scolded when they fail because of inexperience or lack of skill. Family caregivers need to remember that preschoolers are developing initiative and a sense of guilt. They want to be good and follow instructions; they feel bad when they do not, even if they are not physically punished. Imaginary playmates are common in the preschool child, but blaming the incident on the imaginary playmate or refusing to hold the mother's hand does not show initiative. A younger child would commonly show anxiety when being left with the caregiver.
A nurse is caring for a 4-year-old child. The parents indicate that their child often reports that objects in the house are his friends. The parents are concerned because the child says that the grandfather clock in the hallway smiles and sings to him. Which response by the nurse is best? a. "Your child is demonstrating animism, which is common." b. "Attributing lifelike qualities to inanimate objects is quite normal at this age." c. "Has your child suffered any type of physical trauma lately?" d. "Is there any family history of mental health disorders?"
b. "Attributing lifelike qualities to inanimate objects is quite normal at this age." The nurse should explain to the parents that attributing lifelike qualities to inanimate objects is quite normal for a 4-year-old child. Telling the parents that the child is demonstrating animism is correct information, but it would be better for the nurse to explain what animism is and then remind the parents that it is developmentally appropriate for their child. Asking whether the parents think the child had a recent trauma or whether there is a family history of mental disorders is inappropriate and does not teach.
The parent of a 4-year-old is expressing concern that this child is not talking as much—or as well—as her other children did at that age. Which question should the nurse prioritize when assessing this preschooler for this concern? a. "How often do you or a family member read to your child?" b. "Has your child had their hearing tested?" c. "Does your child have opportunities to have conversations with other people?" d. "Do you praise and give your child encouragement when the child tries to talk with you?"
b. "Has your child had their hearing tested?" Delays or other difficulties in language development may result from hearing impairment or other physical problems. Although reading to the child, having conversations with family members and other people, and praising and encouraging the child's efforts to communicate help the child develop language skills, most importantly a hearing concern would need to be assessed and treated.
The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education? a. "I will add some crayons, chalk and finger paints to my three-year-old's birthday gifts." b. "I am so glad I can get rid of all of those bath toys because they take up so much room." c. "It is okay for my four-year-old to still play in his sandbox." d. "My four-year-old will be getting a tricycle for her birthday. I'm glad it's a good gift for her."
b. "I am so glad I can get rid of all of those bath toys because they take up so much room." Bath toys that squeak, float and squirt are appropriate toys for preschoolers. Creative toys like crayons, chalk and finger paints; gross motor toys like tricycles, big wheels and swing sets; and a sandbox with shovels and other toys for building are also appropriate toys for preschoolers.
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? a. "My child loves to play dress-up with friends at day care." b. "When we go to the park, my child never wants to play with the other children." c. "I think it is so cute when my child wants to help my spouse with yardwork." "Sometimes I wish my child would play with a toy in the way it was intended. d. My child is constantly pretending it is something else." e. "My son loves to follow around his older sister."
b. "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
Which would be a nutritional goal for a preschool client? a. Eat everything on the plate. b. Introduce new food gradually and include variety. c. Reduce messiness and spills. d. Let the child eat only what the child wants.
b. 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.
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? a. Explain to the child that the reason for the stomachache is that not enough is being eaten during lunch. b. Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch. c. Talk with the child and encourage that lunches be brought from home so that nutrient needs are met. d. Speak to the child and parents to discuss the repercussions of visiting the nurse so frequently.
b. 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 most important safety precaution for parents to teach preschoolers is: a. to chew bites of food three times. b. not to ride in a car with strangers. c. not to begin formal dance classes. d. not to watch their father mow the lawn.
b. 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.
The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation? a. presence of 20 deciduous teeth b. presence of 10 deciduous teeth c. absence of dental caries d. presence of 19 deciduous teeth
b. 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.
During an extended stay in a hospital the nurse has observed a 5-year-old having several temper tantrums. How should the nurse address this behavior with the parents? a. "I think we need to plan how to discipline your child when acting out this way." b. "We don't allow children of this age to throw tantrums so you will need to manage your child's behavior." c. "Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." d. "I am concerned that your child may have a developmental delay since most children of this age don't throw temper tantrums."
c. "Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." Typically temper tantrums are few or absent in occurrence by the time the child is of preschool age. Asking if this is typical behavior at home is appropriate in determining if this is just aggressive behavior or if this is a sign of a developmental delay. It is generally not necessary to discipline a child for temper tantrums and disciplining is not in the nurse's scope of practice.
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? a. "That is a difficult subject to address. I'm not sure what is the best way to answer that question." b. "You should answer his questions by whatever feels most comfortable to you." c. "It's best to answer his questions using accurate anatomical names and keep your answers simple." d. "I would suggest getting books with pictures to help explain the differences between male and female genitalia."
c. "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 nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child? a. "I ran the race better than my best friend because he was slow." b. "I told the other child no, when he asked me to cheat at the game." c. "Look! I am a nurse, and I am helping people feel better!" d. "I lost the game because I did not play good, and I am sad."
c. "Look! I am a nurse, and I am helping people feel better!" Erikson's stage of initiative vs. guilt is prevalent in children between 3 and 6 years of age. This includes activities in which they act out the roles of other people (real or imaginary). Being competitive, learning sports, and comparing skills are important in the industry vs. inferiority stage (6 to 12 years of age) as seen in a child comparing the speed of running a race or playing a game. Staying true to a predefined set of values, such as not cheating in a game, would be typical of a child in the identity vs. role confusion stage (12 to 19 years of 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? a. "Masturbation is not a normal behavior for a child of that age." b. "You will need to speak with the doctor about that behavior since I cannot address sexual issues in a child." c. "Masturbation is a normal part of preschool development." d. "If you catch your child masturbating, you should immediately make them stop."
c. "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 issues.
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? a. "Stop the car any time the preschooler unbuckles the restraints." b. "Explain that wearing a seat belt is a law and the police officer will give a ticket if the seat belt is not buckled." c. "Set a good example. Wear your own seat belt every time you drive." d. "Reward the child with candy or some other treat each time the child keeps the seat belt on."
c. "Set a good example. Wear your own seat belt every time you drive." A preschooler wants to please, and if the caregiver consistently wears the seatbelt, that will become the standard for riding in the car. All states have laws that define safety seat and restraint requirements for children. Adults must teach and reinforce these rules. One primary responsibility of adults is always to wear seat belts themselves and to make certain that the child always is in a safety seat or has a seat belt on when in a motor vehicle. A child can also be calmly taught that the vehicle "won't go" unless everyone in it is properly restrained. The child should be taught respect of rules and laws, but making threats or giving rewards is not appropriate.
The 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? a. "The school has a loose environment, which is a good match for his temperament." b. "The school requires processed foods and high sugar foods be avoided." c. "The school is quite structured and advocates corporal punishment." d. "There is a very low student-teacher ratio, and they do a lot of hands-on projects."
c. "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 preschool-age child tells the nurse about an imaginary friend. The parents are concerned because the child refuses to do anything without the friend's help. Which nursing diagnosis is most applicable for the family? a. Compromised family coping related to abnormal behavior of child b. Disturbed thought processes related to deep-set psychological need c. Parental anxiety related to lack of understanding of childhood development d. Social isolation related to unwillingness to relate except through imaginary friend
c. Parental anxiety related to lack of understanding of childhood development The parents need to understand that the child's behavior is not uncommon. Imaginary friends are common in the preschool-age child. The child's behavior is not abnormal. The child does not have a deep-set psychological need. The child is not at risk for social isolation.
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? a. Draw a picture first for the child to see how to do it. b. Tell the child that it will be fun but that he or she should not make a mess. c. Support whatever the child paints. d. Make a model for the child to follow so it will be easy to copy.
c. 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.
The parents of 5-year-old boy are concerned about the how a recent motorcycle accident to his father will affect the child. Although the father has fully recovered, the child is very concerned if the father is away longer than expected; the child is not as talkative but appears withdrawn and quiet. The nurse should point out the child's behavior is likely related to which factor? a. The child is afraid of losing his father and trying show how much he loves him. b. The boy is afraid of being hurt himself and thinks being "especially good" will protect him from accidents. c. The boy believes he caused the accident by telling his father he "hoped he crashed" when the boy couldn't go along. d. The child is imitating the adults' behavior and just trying to be nice to everyone.
c. The boy believes he caused the accident by telling his father he "hoped he crashed" when the boy couldn't go along. Preschoolers have learned to think about something without actually seeing it: to visualize or imagine. This normal development, sometimes called magical thinking, makes it difficult for them to separate fantasy from reality. Preschoolers believe that words or thoughts can make things real, and this belief can have either positive or negative results. The child needs reassurance that the accident was not his fault. The other choices do not demonstrate the "magical thinking" that preschoolers tend to demonstrate later in life.
When collecting data on a preschool-aged child during a well-child visit, the nurse discovers the child has gained 12 lb (5.4 kg) and grown 2.5 inches (6.3 cm) in the last year. The nurse interprets these findings to indicate which situation? a. Weight and height are within expected patterns of growth. b. Weight falls within an expected range and height is less than what would be expected. c. Weight is above an expected range and height is within an expected range. d. Weight is below an expected range and height is above an expected range.
c. Weight is above an expected range and height is within an expected range. The preschool period is one of slow growth. The child gains about 4 to 5 lb each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm). The child's weight is above the expected gain and the height is what would be expected.
The nurse is providing teaching to the mother of a 4-year-old girl about bike safety. Which statement by the mother indicates a need for further teaching? a. "The balls of her feet should reach both pedals while sitting." b. "Pedal back brakes are better for her age group." c. "She should always ride on the sidewalk." d. "She can ride on the street if I am riding with her."
d. "She can ride on the street if I am riding with her." The preschooler is not mature enough to ride a bicycle in the street even if riding with adults, so the nurse should emphasize that the girl should always ride on the sidewalk even if the mother is riding with her daughter. The other statements are correct.
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? a. "I am glad to know that my 4-year-old child asking so many questions is normal." b. "My child is finally talking in a way that most of my friends can understand their speech." c. "When my child counts numbers, it is only to 10 and we are slowing working on counting higher." d. "Stating their name and address is too hard for my 5-year-old child; it will be another year before they can do that."
d. "Stating their name and address is too hard for my 5-year-old child; it will be another year before they 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.
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? a. Health-seeking behaviors b. Risk for imbalance nutrition, more than body requirements c. Parental anxiety related to lack of understanding d. Delayed growth and development related to frequent illness
d. 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.
The nurse is caring for a preschool-age child in the hospital with severe developmental delays. The parents have three other younger children at home and both parents work full-time outside the home. The family has just moved to this area. Which nursing diagnosis would be the highest priority in regard to the parents at this time? a. Imbalanced nutrition, less than body requirements b. Interrupted family processes c. Readiness for enhanced parenting d. Risk for caregiver role strain
d. Risk for caregiver role strain Given that the parents are trying to care for four children, one of whom is a severely developmentally delayed preschooler in the hospital, and that they are new to the area (making it unlikely that they have a strong support system), the highest priority nursing diagnosis would be caregiver role strain. Family processes are likely altered, but with the hospitalization, strain on the parents is a higher priority nursing diagnosis.
