Chapter 27: Growth and Development of the Preschooler
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? "Attributing lifelike qualities to inanimate objects is quite normal at this age." "Your child is demonstrating animism, which is common." "Is there any family history of mental health disorders?" "Has your child suffered any type of physical trauma lately?"
"Attributing lifelike qualities to inanimate objects is quite normal at this age." Explanation: 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 father of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the father would indicate a need for further teaching? "I should teach him certain rules about this activity." "I will need to find an appropriate punishment for him if this continues." "This is probably a good time to talk about safety and who can touch him." "I have heard that both boys and girls often touch themselves at this age."
"I will need to find an appropriate punishment for him if this continues." Explanation: 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.
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? "You should answer his questions by whatever feels most comfortable to you." "It's best to answer his questions using accurate anatomical names and keep your answers simple." "That is a difficult subject to address. I'm not sure what is the best way to answer that question." "I would suggest getting books with pictures to help explain the differences between male and female genitalia."
"It's best to answer his questions using accurate anatomical names and keep your answers simple." Explanation: 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.
A school nurse has completed an educational program for parents of preschool children. Which statement by a participant indicates a need for further education? "I need to work with my 4-year-old; she should be able to cut paper with scissors on her own." "I'm glad to know that it's okay that my 5-year-old is learning to skate." "My 3-year-old is doing fine, he can hop on one foot already." "My 5-year-old son still needs me to dress and undress him."
"My 5-year-old son still needs me to dress and undress him." Explanation: Dressing and undressing without assistance is an expected motor skill in a 5-year-old. Four-year-olds should be able to use scissors without assistance. Hopping on one foot is an expected motor skill for a 4-year-old. Learning to skate and swim are normal motor skills for 5-year-olds.
A mother reports to the nurse that her 4-year-old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother? "I can imagine that it would be very irritating." "I am sure there are ways to get your daughter to stop imitating you." "Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development." "This is not normal behavior. I am going to get the doctor's advice."
"Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development." Explanation: The nurse needs to inform the mother that preschoolers have an imagination that is keener than it will be at any other stage. They enjoy games using imitation and they mimic exactly what they see parents do. It is a normal part of their development.
The parent of a 5-year-old child calls the doctor's office to seek advice about proper nutrition for her child. Which statement by the mother indicates that further teaching is needed? "We offer her the same foods we are eating, just in smaller portions." "She loves fruit, so I give her 1 cup each day." "Since she doesn't like vegetables, we no longer serve them to her." "I give her three meals a day and some snacks in between if she gets hungry."
"Since she doesn't like vegetables, we no longer serve them to her." Explanation: Although preschoolers may not like every food offered to them, they need to try them. If the foods are refused, the parent needs to offer them at a later date. A preschooler needs 1.5 to 2.5 cups of vegetables each day, so the nurse could recommend alternative ways of getting the needed amount of vegetables into the child's diet. Suggestions would include offering raw vegetables with dip or baking with vegetables incorporated into the food, such as zucchini bread. All other statements are reflective of successful teaching.
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 requires processed foods and high sugar foods be avoided." "The school has a loose environment, which is a good match for his temperament." "The school is quite structured and advocates corporal punishment." "There is a very low student-teacher ratio, and they do a lot of hands-on projects."
"The school is quite structured and advocates corporal punishment." Explanation: 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.
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. "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." "My parents are the only babysitters our child has ever had. I think contact with mostly adults is important for this age." "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." "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." Explanation: 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.
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." "Your child is not expected to be able to perform those activities at 3 years of age." "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." Explanation: 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 5-year-old child weighs 17.7 kg. How many kilocalories per day (kcal/day) will the nurse instruct the parent are necessary to maintain the child's weight? Record your answering using a whole number. ________kcal/day
1505 Explanation: The typical 5-year-old child requires approximately 85 kcal/kg of body weight per day. 17.7 kg × 85 kcal/kg/day = 1,504.5 kcal/day Rounded to the whole number = 1,505 kcal/day.
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? 3.5 to 4 inches (8.89 to 10.16 cm) 2.5 to 3 inches (6.35 to 7.62 cm) 1 to 2 inches (2.54 to 5.07 cm) 0.5 to 1 inch (1.27 to 2.54 cm)
2.5 to 3 inches (6.35 to 7.62 cm) Explanation: 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.
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 Explanation: 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.
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 Providing a nightlight Planning for the child to get 12 hours of sleep daily Eliminating caffeine sources beginning late afternoon Allowing the preschooler to fall asleep wherever and whenever the child is tired enough
Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Explanation: Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers.
The mother of a preschooler finds a broken plate in her kitchen floor and asks the child what happened. The child tells the mother that her imaginary friend Lulu dropped it when she was getting it out of the cabinet. How should the mother interpret this fabrication? Telling the mother that an imaginary friend did it is concerning and the child needs to be evaluated. The child feels guilty and wants to pass the blame to someone else. The child is lying to cover up her wrongdoing to avoid punishment. Blaming an imaginary friend for accidents is normal behavior for this age group.
Blaming an imaginary friend for accidents is normal behavior for this age group. Explanation: Children this age often have imaginary friends to play with and may blame the friend for accidents or other occurrences in the home that they may have caused. This should not be interpreted as intentionally lying or abnormal but rather normal preschool behavior.
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 imbalanced nutrition, more than body requirements Health-seeking behaviors Parental anxiety related to lack of understanding
Delayed growth and development related to frequent illness Explanation: This client has frequent hospitalizations and is at risk for delayed growth and development. For a client at this age, play, socialization, exploring, and imagination are all important parts of normal growth and development.
The mother of a 4-year-old boy reports her son has voiced curiosity about her breasts. She asks the nurse what she should do. Which information is best for the nurse to give the parent? Encourage the parent to determine what the child's specific questions are and answer them briefly. Advise the parent to explain to the child that he is too young to discuss such things. Encourage the parent to provide a detailed discussion about human sexuality with the child. Advise the parent that sexual curiosity is unusual at this age.
Encourage the parent to determine what the child's specific questions are and answer them briefly. Explanation: Sexual curiosity is normal in the preschool-aged child. The parents should be encouraged to provide brief, honest answers to the child. The parents must also determine the type of curiosity the child has. Explanations should be within the level of understanding of the child.
Which would be a nutritional goal for a preschool client? Let the child eat only what the child wants. Reduce messiness and spills. Eat everything on the plate. Introduce new food gradually and include variety.
Introduce new food gradually and include variety. Explanation: 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 pounds 4 yrs: Ht. 39 inches Wt. 39 pounds 5 yrs: Ht. 40 inches Wt. 46 pounds Johnny's height and weight should be plotted on a growth chart. 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 is growing slowly in height but rapidly in weight. Johnny may be at risk for overweight or obesity. Johnny's height and weight should be plotted on a growth chart. Explanation: The preschool child's growth is fairly even. The child should grow about 2½ to 3 inches and gain around 5 pounds yearly. Johnny is not following this pattern. Plotting the child's height and weight on a growth chart would make it visually easy to follow his growth pattern and compare it to the norms.
The nurse is providing teaching about good non-dairy sources of calcium for preschoolers. Which of these fruits contains the most calcium? Orange Banana Apple Peach
Orange Explanation: 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.
A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers? Using gates at the top of the stairs Putting latches on lower cabinets Washing hands after using the bathroom Placing the child in an approved car seat
Placing the child in an approved car seat Explanation: The leading cause of death in the preschool group is automobile accidents, followed by poisonings and falls. Placing the child in an approved car seat is a safety precaution to help prevent serious injury and even death. All safety measures help keep children safe. Putting latches on the lower cabinets and using a baby gate at the top of the stairs are important to prevent poisonings and to prevent falls which could cause head injuries and fractures. Many infectious diseases are preventable as a result of health promotion and illness prevention techniques.
The nurse is teaching the parents of a preschool-age child about injury prevention. Which method would the nurse advise for the parents as the best way to enforce injury prevention? Safety rules Repetition and reinforcement Repetition, modeling, and reinforcement Constant vigilance Adequate supervision
Repetition and reinforcement Explanation: Injury prevention involves adults actively searching the indoor and outdoor environment of the home and other areas where the child may frequently spend time. This keeps the environment "explorable," prevents conflicts, and enables the child to expand on skills that need mastering. Safety rules and constant vigilance are only a small part of enforcing injury prevention.
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? Risk for caregiver role strain Readiness for enhanced parenting Imbalanced nutrition, less than body requirements Interrupted family processes
Risk for caregiver role strain Explanation: 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.
Which gross motor skill would the 4-year-old child have most recently attained? The child can cut his/her food. The child can button his/her clothes. The child can hop on one foot. The child can tie his/her shoelaces.
The child can hop on one foot. Explanation: 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.
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. Wait until children are old enough to tell them how to call for help in an emergency. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge children never to talk to or accept a ride from a stranger. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.
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. Explanation: 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.
A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage? looking at the child while she is speaking asking the girl to slow down and to think before she talks giving the child opportunity to speak and finish her ideas enunciating clearly and slowing down parental speech
asking the girl to slow down and to think before she talks Explanation: Many preschool-age children 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.
Which type of play would the nurse use to prepare a preschooler for upcoming surgery to reduce the stress of the event? dramatic play associative play onlooker play cooperative play
dramatic play Explanation: Dramatic play allows the child to act out concerns or stress through the use of dolls or puppets and serves as an excellent way to prepare children for upcoming events such as surgery. Associative play involves children playing together. Onlooker play is where the child observes but does not participate in the activity. Cooperative play involves children playing together in an organized manner.
The most important safety precaution for parents to teach preschoolers is: not to ride in a car with strangers. not to watch their father mow the lawn. to chew bites of food three times. not to begin formal dance classes.
not to ride in a car with strangers. Explanation: 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 needs to purchase toys or activities for preschool-aged children for the clinic waiting room. Which toy would be the best choice for this age? brightly colored mobile toy with dials and switches play kitchen and food 50-piece jigsaw puzzle
play kitchen and food Explanation: Preschool-aged children like to engage in pretend play, so a play kitchen and food would be a good choice. A mobile is more appropriate for an infant. A toy with dials and switches is appropriate for a toddler. A 50-piece jigsaw puzzle is a better choice for older children.
When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate? has best friends at preschool and sleepovers tells a fantasy story about a bear and a car begins to show logical thought processes scribbles with no discernable pictures/letters
tells a fantasy story about a bear and a car Explanation: 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 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? "Both your son's height and rate of growth are within normal limits for his age." "Your son is slightly below the normal height for his age but he had demonstrated a normal growth rate this year." "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." Explanation: 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. "Role-model bicycle safety by wearing a helmet too." "Do not allow your child to approach strange dogs." "Allow your child to ride in the front seat of the car." "Do not refer to medicines as candy." "Have your child hold hands with a grown-up in parking lots."
"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." Explanation: 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 4-year-old ask the nurse, "We want to use 'time-out' to help discipline our child. But we're not sure how long we should keep our child in time-out?" Which response by the nurse would be appropriate? "Try keeping the child in time-out for about a minute or two." "Keep your child in time-out until they calm down." "How long doesn't matter. Just be consistent." "Keep the time to about 4 minutes."
"Keep the time to about 4 minutes." Explanation: A "time-out" is a useful technique for parents to correct behavior throughout the preschool years. Although the technique has some critics, it allows for discipline without using physical punishment and allows a child to learn a new way of behavior without extreme stress. Time-out periods should be as many minutes long as the child is old, so 3 to 5 minutes is appropriate for preschoolers. Since the child is 4 years of age, 4 minutes would be appropriate. Although consistency is key, the length of time spent in time-out should reflect the age of the child, not whether the child calms down.
The parent of a preschooler asks the nurse, "Now that my child goes to preschool and goes to friends' houses, how can I make sure that he is eating enough?" Which response by the nurse would be most appropriate? "Keeping an eye on how active he is will give you a good indication." "You need to get a list from everyone about what he has eaten throughout the day." "Just give him some extra food when he's with you to make up for anything he missed." "Ask the child what he has eaten and drank at school and at his friend's house."
"Keeping an eye on how active he is will give you a good indication." Explanation: Preschoolers begin to eat away from home at friends' homes or at child care or stay overnight with friends or grandparents, so parents don't observe daily food intake as accurately as before. The best suggestion would be to inform the parent to observe whether the child is growing and being active, good indicators of nutrition. This action would be better than monitoring any one day intake, including attempting to get a list from others, or asking the child what he has eaten. Giving the child extra food could foster overeating.
The nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child? "Look! I am a nurse, and I am helping people feel better!" "I ran the race better than my best friend because he was slow." "I told the other child no, when he asked me to cheat at the game." "I lost the game because I did not play good, and I am sad."
"Look! I am a nurse, and I am helping people feel better!" Explanation: 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 nurse is caring for a 3-year-old at a well-child checkup. The parent states that her child still has an afternoon nap but she has a friend whose toddler no longer naps in the afternoon. She is seeking advice on what to do. When providing anticipatory guidance to the parent about sleep patterns, what is the most appropriate response by the nurse? "Children begin to give up afternoon napping at 2 years." "Often, the afternoon nap will be no longer needed after 4 years." "Children no longer nap in the afternoon after 1 year." Since they are in school now all day, napping ends at 6 years.
"Often, the afternoon nap will be no longer needed after 4 years." Explanation: Exact duration of a child's daily sleep patterns varies based on temperament, activity levels, and overall health. Around the age of 4, many children discontinue the afternoon nap.
The parent of a 4-year-old child tells the nurse about being frustrated because all the parent seems to do lately is fight with the child over what the child wants to eat and wear. The parent notes sometimes wanting to spank the child for always disagreeing. What would be the best suggestion for the nurse to make to this parent? "Take some toys away when the child acts like that." "It is not normal to feel that way." "Use the time-out technique for discipline." "Spank lightly to get the child's attention."
"Use the time-out technique for discipline." Explanation: Preschoolers have definite opinions, which may bring them into opposition with parents. The best thing to do during these struggles is to guide the child through without discouraging his or her right to an opinion. Time-out is a good technique that allows parents to discipline without using physical punishment. Time-out should last for 1 minute for every year of age. Spanking is never encouraged and is totally discouraged by the American Academy of Pediatrics. Taking the child's toys away does not accomplish the same as time-out. After taking away the toy the child just goes and gets another without understanding the meaning behind the punishment. It is easy for the parent to get frustrated, especially if the child is very willful. This can best be avoided by being consistent with rules.
A 3 1/2 year-old child is found masturbating in the family living room. Which response by the parent would best address this behavior? "You need to quit that right now. It's not nice to touch your privates." "I will ask your father to talk to you about this since he is a boy too." "We do not touch ourselves in public. Please go to your room if you want to continue this behavior." "Your penis is very interesting, isn't it? But you can injure it by touching it so much."
"We do not touch ourselves in public. Please go to your room if you want to continue this behavior." Explanation: 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.
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 happened to my client? Did you eat her?" "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." "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you."
"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." Explanation: Parents sometimes strengthen a fantasy role without realizing it. A preschooler might be pretending she is a crocodile. If the nurse plays along, the child may be frightened she has actually become a crocodile. A better response is to support the imitation—this is age-appropriate behavior and a good way of exploring roles—by saying, "What a nice crocodile you're pretending to be." This both supports the fantasy and reassures the child she is still herself.
A nurse is observing a group of 4-year-old children in a play area. What action, when observed by the nurse, would alert the nurse to typical play for this age group? A child plays with a toy while another child sits next to him and plays with a different toy. A child plays alone, with a set of children's kitchen utensils, pots and pans. A group of children play a board game involving matching colored cards to shapes. A child pretends to be a teacher and asked another child to be the pretend student in "class."
A child pretends to be a teacher and asked another child to be the pretend student in "class." Explanation: Preschool-aged children enjoy games that use imitation such as pretending to be teachers, cowboys, firefighters, and store clerks. They imitate exactly what they see their parents doing. Parallel play is characteristic of toddlers and would be demonstrated by children playing next to each other with different toys. Preschool-aged children typically enjoy cooperative play with other children in the group, rather than playing alone. Older preschool-aged children are interested in group games.
The nurse needs to discontinue the urinary catheter of a 4-year-old child who is afraid of the procedure. What strategy(ies) will the nurse use to help the child to cope with this procedure? Select all that apply. Be honest with the child about what to expect with catheter removal. Have a doll available that the child can play with and demonstrate on. Let the child know that the procedure will be completed at 1000. Answer all of the child's questions before starting the catheter removal. Provide for privacy by asking the parents to wait outside the room during the procedure.
Be honest with the child about what to expect with catheter removal. Have a doll available that the child can play with and demonstrate on. Answer all of the child's questions before starting the catheter removal. Explanation: Providing honest explanations, demonstrating on a doll, and encouraging and answering questions are effective strategies for a child of this age. At 4 years of age, a child does not have a strong sense of time, so setting a specific time is not effective. The child will feel supported and less fearful with the parents present, so they should not be asked to leave during the procedure.
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? A stuttering disorder. Deferred imitation. Bathroom language. Broken fluency.
Broken fluency. Explanation: 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.
A parent tells the nurse about being frustrated because the preschool-aged child screams every time the parent attempts to buckle the child's seat belt. What advice should the nurse give this parent? Arrange for a babysitter to avoid taking the child in the car. Warn the child of punishment for not buckling up and then follow through. Tell the child that you will give a treat for buckling up. Do not start the car until seat belts are in place.
Do not start the car until seat belts are in place. Explanation: Accident prevention is important for preschool-aged children. It can best be taught by role modeling. Not starting the car until everyone is buckled up is an example. Bribing and threatening are not appropriate, nor is keeping the child home at all times. All children up to 4 years whose height meets car seat requirements should be in an approved car seat with harness and top tether. After reaching the height requirements the child can transition to a booster seat with lap and shoulder belts.
The nurse is caring for a preschool-aged child who needs a CT scan. Which action would the nurse use to best prepare the child for this diagnostic test? Tell the child that the CT scan is a picture of the dark parts inside the body. Explain that the child must behave because the technician is busy. Tell the child to follow directions to avoid being hurt. Help the child to pretend that the CT scan machine is a camera.
Help the child to pretend that the CT scan machine is a camera. Explanation: Because preschoolers' imagination is so active, this leads to several fears such as fear of the dark and mutilation. The nurse needs to help the child understand that the CT scanner is like a camera to take pictures of the body parts. Threatening the child to follow directions or becoming hurt plays into the child's fear of mutilation. Telling the child to behave creates a fear of punishment. Telling the child that the CT scan is a picture of the body's dark parts plays into the child's fear of the dark.
The nurse is presenting an in-service on the types of playing that children may engage in. The nurse determines the session is successful when the attending nurses correctly choose which example as representing cooperative play? Playing apart from others without being part of a group. Playing in an organized group with each other. Playing independently and are side-by-side. Playing together in an activity without organization.
Playing in an organized group with each other. Explanation: During cooperative play, children play in an organized group with each other as in team sports. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. Parallel play occurs when the toddler plays alongside other children but not with them.
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? Weight and height are within expected patterns of growth. Weight is above an expected range and height is within an expected range. Weight is below an expected range and height is above an expected range. Weight falls within an expected range and height is less than what would be expected.
Weight is above an expected range and height is within an expected range. Explanation: 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 parent of 3 1/2-year-old preschooler tells the nurse that the child argues quite a bit and says that the child is always right. The nurse interprets this information as indicating: initiative. centering. conservation. guilt.
centering. Explanation: At age 3 years, cognitive development is still preoperational. Although children during this period do enter a second phase called intuitional thought, they lack insight to view themselves as others see them or put themselves in another's place. This is called centering. Because preschoolers cannot make this kind of mental substitution, they feel they are always right and causes them to argue. Conservation is reflected in the child's ability to distinguish that two items of equal size are the same despite a change in form. Initiative is the developmental task of preschoolers and is reflected in the child attempting to learn as much as possible about the world around them by trying new activities or having new experiences. Guilt occurs if children are punished or criticized for attempts at initiative.
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? singing a song he learned at preschool opening drawers in the room, pulling out supplies, and examining them roughhousing with his father reading a book
opening drawers in the room, pulling out supplies, and examining them Explanation: 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.
At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to: testing and identification of group role. regression. preschoolers having a harder time sharing than toddlers. playing in an even-number group of children (four).
testing and identification of group role. Explanation: 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 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? broke a dish but blamed it on a friend the caregivers don't know gets upset when a babysitter is in charge, but will do what is asked by the babysitter tries to sweep up spilled cereal but cries when can't do well refuses to hold anyone's hand while crossing the street
tries to sweep up spilled cereal but cries when can't do well Explanation: 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.
