Chapter 31: Nursing Care of a Family with a Pre-School Child

When planning how to respond to a child about telling stories ("tall tales"), the nurse would base her statement on the fact that:

imagination in a 3-year-old is at its peak. RATIONALE: It is easy for preschoolers to engage in "tall tales" because of their active imagination.

The developmental task of preschoolers is to achieve a sense of:

initiative versus guilt RATIONALE: Developing a sense of initiative, or learning how to do things, is the developmental task of the preschool period.

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." RATIONALE: Stretching stories to make them seem more interesting is a phenomenon frequently encountered in preschoolers. This kind of storytelling should not be encouraged. The child should be helped to separate fact from fiction. The nurse should ask the child to say the names of the brothers the child really has. The nurse should not insult the child's counting ability. The nurse should not accuse the child of lying or making the child seem more important by having more brothers.

A 3-year-old tells the nurse that he has 19 brothers. The nurse knows that the child has two brothers. What would be the nurse's best response concerning his brothers?

"That's a good pretend answer, but tell me the names of the brothers you really have." RATIONALE: Preschoolers often respond to any question asked of them in a way they think will please an adult. The nurse should encourage and respect creativity while seeking the actual circumstances.

The parents of a preschooler are preparing the child to meet all developmental tasks. Which activity best fits at this time?

Allow the preschooler to experiment with Play-Doh. RATIONALE: Preschoolers enjoy toys or material that they can manipulate (free-form play) because this helps them learn how things work.

The parents of a preschool-aged child are investigating child care centers to enroll the child. What would the nurse review with the parents prior to them making a decision? Select all that apply:

A) Ask about the child-staff ratio. C) Find out if parents can visit at any time. D) Find out how long the center has been in operation. E) Ask about the center's licenses and compliance with regulations. RATIONALE: When investigating child care centers, the nurse should counsel the parents to find out about the child-staff ratio, parental visiting hours, the time the center has been in operation, and compliance with licenses and regulations. The payment plan might be important to the parents; however, it should not be the sole factor in making a decision about a child care center.

A community health center is planning a seminar about the 2020 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 RATIONALE: The 2020 National Health Goals for preschool-aged children focus on safety and include protecting preschoolers against secondhand 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.

The nurse is helping parents develop the developmental task of initiative in their preschool-aged child. Which activity would the nurse suggest the parents implement?

Allow the child to experiment with molding clay. RATIONALE: To gain a sense of initiative, preschoolers need exposure to a wide variety of play materials so they can learn as much about how things work as possible. The parents should be urged to provide play materials that encourage creative play such as modeling clay. Any experience with free-form play is helpful. Street-crossing safety, following rules, and providing clothes that snap will not support the developmental task of initiative as much as providing a substance to experiment during play.

The mother of a female preschool-age child is concerned that the child is developing an unhealthy attachment to her father. About which behavior should the nurse instruct the mother?

Electra complex RATIONALE: An Electra complex is the attachment of a preschool girl to her father. This phenomenon in preschoolers is a normal part of maturing. Oedipus complex is the attachment of a preschool-age boy to his mother. There is not one specific Freudian complex. There is not an identified sexual identification complex.

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

Electra complex RATIONALE: Freud stressed that girls experience a deep attachment to their father during this time (Electra complex) similar to an Oedipus complex in boys.

The nurse is preparing an educational program for parents of preschool-age children to promote personal safety. Which information should the nurse include in this program? Select all that apply:

D) Explaining who police are and what they look like E) Teaching to never talk with or accept a ride from a stranger F) Never enter into a street without an adult RATIONALE: To promote personal safety in the preschool-age child, the nurse should instruct families to explain the role and purpose of police to the child, never enter into a street without an adult, and teach to never talk to or accept a ride from a stranger. Reducing the intake of fast-food items will help with weight control. Limiting exposure to household chores has no identified value. Chewing food thoroughly before swallowing can help with digestion and weight control.

The nurse instructs a mother on actions to prevent sibling rivalry between a preschool-age child and a newborn. Which observation indicates that instruction has been effective?

Mother sets aside afternoon time for the preschool-age child while the baby naps. RATIONALE: To help reduce sibling rivalry, the mother should set aside afternoon time for the preschool-age child while the baby naps. Sleeping when the baby sleep, asking if the preschool-age child likes the baby, and limiting gifts to the preschool-age child until behavior changes will promote sibling rivalry.

Which immunization would you plan to administer at a preschool health maintenance visit?

DTaP RATIONALE: Preschoolers are typically administered a booster or their fourth dose of DTaP vaccine prior to starting school.

A 4-year-old tells the nurse he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which nursing diagnosis is most applicable for his family?

Deficient knowledge of normal preschool development RATIONALE: Because a preschooler's imagination is at a peak, imaginary friends are not uncommon.

Which project or game would you anticipate that a preschooler would most enjoy while hospitalized?

Dressing in her mother's coat to play house. RATIONALE: Preschoolers do well with activities that call for imagination. They are not ready for fine-motor or long-term activities.

Which type of play should the nurse encourage for a preschool-age child who is hospitalized?

Dressing in the mother's coat to play house RATIONALE: Preschool-aged children have active imaginations and dressing up to play house would be an appropriate play activity for the nurse to encourage. The child's fine motor skills are not developed to play an electronic handheld game. Children of this age are afraid of the dark so turning out the lights to play hide and seek is not appropriate. Planting flower bulbs is an activity that is too long-term for this age range.

A 4-year-old is hospitalized with a urinary tract infection. Based on what you know of her cognitive development, which approach would be best to prepare her for a radiograph?

Help her pretend the x-ray machine is a camera. RATIONALE: Most preschoolers express fear of the dark and mutilation. Their active imaginations make it possible to turn almost any procedure into a game.

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?

Help the child to pretend that the CT scan machine is a camera. RATIONALE: 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.

Which immunization should the nurse plan to administer to a preschooler during a health maintenance visit?

Influenza RATIONALE: Influenza vaccination would be administered annually. The diphtheria, pertussis, and tetanus (DTaP) vaccination should be provided before the child starts school. Hepatitis B and tetanus booster are not identified as vaccinations appropriate for this age group.

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. RATIONALE: 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.

Which action by a preschooler would suggest that his thinking is inconsistent with normal preschooler growth and development?

Refusal to play with "real" children RATIONALE: Although preschoolers have "imaginary friends," they also should relate with real playmates.

The nurse is observing the behavior of a preschool-aged child and becomes concerned. Which observation suggests that the child's thinking is inconsistent with normal preschooler growth and development?

Refusing to play with "real" children RATIONALE: Many preschoolers have an imaginary friend who plays with them. Imaginary friends are a normal, creative part of the preschool years and can be invented by children who are surrounded by real playmates as well as by those who have few friends. As long as the child has exposure to real playmates, imaginary friends do not take center stage in the child's life or prevent them from socializing with other children. In these cases, the imaginary friend should not pose a problem. Refusing to go to bed without the friend, having the friend eat dinner with the family, and watching television with the friend are all acceptable behaviors by the preschool-age child.

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

Specific program goals to be accomplished should be available. RATIONALE: Preschoolers need planned activities because they are so ready to learn, yet they have short attention spans.

The parents of a preschool-aged child want to begin preparing the child to attend school. What would the nurse suggest the parents discuss with the child to help with this preparation?

Talk about school as an enjoyable experience. RATIONALE: If school is discussed as something to look forward to, as an adventure that will be satisfying and rewarding, a child comes to look forward to it as a positive experience. Pointing out how to get home from school might be more important than how to get to school. Warning about rules and expecting to work on the floor may cause the child to view school as punishment.

The parent of a preschooler asks the nurse for methods to orient the child to school. Which activity would the nurse recommend the parent perform?

Talking about school as an enjoyable experience RATIONALE: School needs to be presented as a positive experience. Pointing out how to get home from school may be more important than how to go to school for a child with many fears.

The most important safety precaution for parents to teach preschoolers is:

not to ride in a car with strangers. RATIONALE: Preschoolers begin to spend more time away from parents than formerly as they begin preschool. That makes it a time to learn about people and traffic safety.

The nurse is identifying outcomes for a family with a preschool-age child who has broken fluency. Which initial outcome would be the most appropriate?

The parents will not call attention to the child's broken fluency. RATIONALE: Calling attention to broken fluency can make the situation worse. The child should not be encouraged to speak or practice words if he or she does not want to. The parents should intercept any children who desire to finish the child with broken fluency's words or sentences. The child should not be punished or corrected for broken fluency because this is a normal part of speech development.

A preschooler's mother is pregnant. She wants to start her preschooler in a child-care program and asks the nurse when would be a good time to do so. At which time would the nurse suggest?

Three months before the baby is born, after the mother stresses that he is growing up. RATIONALE: Being displaced by a new sibling can lead to jealousy; starting a new adventure is a sign of growing up.

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 preschooler is growing up. RATIONALE: If children are to start preschool or child care, it's best if they can do so either before the new baby is born or 2 or 3 months afterward. That way, children can perceive starting school as a result of maturity and not of being pushed out of the house by the new child. There is no time limit about when a child should start preschool. The mother should not explain to the child that the new baby will be taking up all of the mother's time.

A preschooler's mother asks the nurse an appropriate time to tell her son that she is pregnant. The nurse's best answer would be:

probably at the point she begins to look pregnant. RATIONALE: Preschoolers have many fears and do not adjust well to secrets kept from them. When the mother looks pregnant, therefore, she should tell the preschooler, so he can begin to prepare as well.