Chapter 27: Growth and Development of the Preschooler

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?

"When we go to the park, my child never wants to play with the other children."

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?

Do not start the car until seat belts are in place.

Which would be a nutritional goal for a preschool client?

Introduce new food gradually and include variety.

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?

"Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that."

The nurse is conducting a health screening of a 5-year-old boy as required for kindergarten. The boy is fearful about going to a new school. The mother asks for the nurse's advice. Which response by the nurse is best?

"Talk to your son's new teacher and schedule a tour with him."

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?

"He loves milk and drinks it every time he is thirsty."

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?

imagination

The mother of a 4-year-old reports using time-outs as a means for disciplining the child. Which statement by the mother would require the nurse to provide additional teaching?

"I usually have him in time-out for about 10 minutes."

The 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 will need to find an appropriate punishment for him if this continues."

The nurse is assessing a 3-year-old at a well-child visit and the child appears to be progressing well. Which activity will the nurse ask the child to attempt to appropriately assess the fine motor skills of this preschooler?

Button clothes.

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.

Teach your children to say "no" to anyone whose touching makes them feel uncomfortable. 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. Urge children never to talk to or accept a ride from a stranger.

The nurse is evaluating statistics of dental care of preschool-age children in the community. Which should the nurse focus on as having the greatest overall impact?

fluoridated water system in the community

Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3-year-old is in what stage as identified by Piaget?

Preoperational thought

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 is quite structured and advocates corporal punishment."

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?

2.5 to 3 inches (6.35 to 7.62 cm)

If the child is gaining weight at an expected rate, a child who weighs 36 lb (16.3 kg) at 3 years of age would weigh what amount at age 5?

44 to 46 lb (20 to 21 kg)

A 3-year-old is hospitalized unexpectedly and is frightened about the experience. What action could the nurse take to minimize the anxiety the child is experiencing?

Allow the child to handle the equipment before it is used on the child.

A nurse is caring for a 4-year-old child who will be undergoing a procedure to remove a mass from the abdomen. In order to help the child remain calm in preparation for getting an IV catheter placed, what intervention might the nurse implement?

Allow the child to play with a procedure doll.

During the preschool years, female children may develop a strong attachment to their fathers. What is this attachment called?

Electra complex

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?

Parental anxiety related to lack of understanding of childhood development

A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers?

Placing the child in an approved car seat

A parent tells a nurse that the child has recently established some friendships for the first time. In which age group do you expect this child to be?

Preschool

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?

Pretending to be mommies and daddies in the playhouse

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:

centering.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:

having the child wear a personal flotation device whenever near or on the water.

During an assessment, a preschool-aged child tells the nurse about having 12 siblings. The nurse is aware that the child has two older brothers. What would be the nurse's best response?

"That is a good pretend answer but tell me the names of the brothers you really have."

While the nurse is taking a blood pressure on a 4-year-old, the child states that the blood-pressure cuff is too tight and angrily says, "That hurt, you big poo-poo head." What is the most appropriate response by the nurse?

Calmly explain that you don't mean to hurt her, loosen the cuff, and tell her that is isn't nice to call you names.

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium?

Orange

Which gross motor skill would the 4-year-old child have most recently attained?

The child can hop on one foot.

The mother of a preschool-aged child is pregnant and wants to enroll the child in a child care program. When would the nurse suggest that the child be enrolled in this program?

Three months before the baby is born, after the mother stresses that the child is growing up

The father of a 4-year-old is concerned his child is not telling the truth and blaming others for things that have happened. Which response should the nurse prioritize after the father shares that the child is blaming someone named "Andrew" for a broken tool, and they have no idea who this is?

"Your son may have a friend named Andrew, but it could be an imaginary friend."

The parents of a 4-year-old child 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 response(s) by the nurse? Select all that apply.

"I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." "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." "Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and child-safe modeling clay? These are the types of toys suggested for preschoolers."

The nurse is interacting with a 5-year-old child who lives in a home with bilingual parents. Which observation would alert the nurse to further assess the child's language development?

The child is able to enunciate several sounds and has difficulty enunciating the "q" sound in words.

A bilingual family tells the nurse their desire for their child to learn Spanish as well as English. English is the predominant language spoken in the home. The parents ask the nurse when is the best time to teach the child a second language. What time period would the nurse respond?

During the preschool years

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

cooperative play

The nurse is assessing a 4-year-old child. The child tells the nurse about her friend, Nancy, who lives in her room at home. The mother tells the nurse that Nancy is not a real person. The nurse would use which term when documenting this assessment finding?

imaginary friend

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?

opening drawers in the room, pulling out supplies, and examining them

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?

Support whatever the child paints.

A 4-year-old child is drawing with crayons. Which creation by the child would most be reflective of the anticipated skill level of this age?

The child is able to draw shapes such as circles and squares.

What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother?

Specific program goals to be accomplished should be available.

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?

"She can ride on the street if I am riding with her."

The mother of a 4-year-old girl reports her daughter has episodes of wetting her pants. The nurse questions the mother about the frequency. The nurse determines these episodes occur about once every 1 to 2 weeks. Which response by the nurse is indicated?

"At this age it is helpful to remind children to go to the bathroom."

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."

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 is above an expected range and height is within an expected range.

During a well-child visit, the caregiver expresses concern that the 3-year-old child often stutters when speaking. Which response should the nurse prioritize to best assist this family?

"Children of this age may stutter while they search for just the right word."

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?

"Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here."

A father tells the nurse that his son has been asking questions about his genitals. The father states that he is unsure how to answer the questions of a 4-year-old. How should the nurse respond?

"It's best to answer his questions using accurate anatomical names and keep your answers simple."

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!"

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.

"Try using a night light in the child's room." "Try reading a favorite story before bedtime." "Avoid having your child watch frightening shows on TV before bedtime." "Set up some familiar bedtime rituals for your child."

A 5-year-old girl is pretending to be a crocodile during a physical examination. Her mother just smiles and rolls her eyes at the nurse. What would be the best response for the nurse to give the child?

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

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

The nurse is presenting nutritional information at a community health fair. Which suggestion should the nurse prioritize when illustrating proper nutrition for preschoolers?

Snacks throughout the day help the child meet nutritional requirements

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of these actions? Select all that apply.

When discussing improper behavior, call the behavior "bad" or "naughty," not the child.• Anticipate situations likely to cause misbehavior and redirect the child to another activity.• Books and stories can help preschoolers master proper behavior.

The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal?

falls when bending over to touch toes

The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation?

presence of 10 deciduous teeth

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by a caregiver best indicates a common aspect of the diet and nutrition of the preschool child?

"My child is so picky and eats the same thing every day for days on end!"

A school nurse has completed an educational program for parents of preschool children. Which statement by a participant indicates a need for further education?

"My 5-year-old son still needs me to dress and undress him."

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 do to. When providing anticipatory guidance to the parent about sleep patterns, what is the most appropriate response by the nurse?

"Often, the afternoon nap will be no longer needed after 4 years."

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 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."

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?

"Your child is not expected to be able to perform those activities at 3 years of age."

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.

-Parent knows the misbehavior was intentional. -Warn the child there will be a time-out if the behavior does not stop. -Move the preschool-age child to a boring spot. -Set a timer for no more than 4 minutes. -If the child gets up, return the child to the time-out location and restart the time.

In teaching caregivers of preschool children, the nurse would reinforce that which activity would be most important for this age group?

The preschool child should be properly restrained when riding in a vehicle.

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 have been talking about enrolling in a morning preschool program since this is our only child." "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."

The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply.

"We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda." "My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented."

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.