Evolve: Preschoolers
A 4-year-old child is admitted with burns over the entire right arm and the anterior and posterior aspects of both legs. Using the percentage of total body surface area (TBSA) that was burned, the nurse estimates that the TBSA affected is approximately:
41%
Which belief should a nurse expect a preschooler to hold regarding the concept of death?
A temporary condition
A 3-year-old child is to receive a liquid iron preparation. What should the nurse teach the mother regarding this medication?
Have the child drink the diluted iron preparation through a straw.
A 4-year-old boy with acute lymphocytic leukemia (ALL) is to undergo bone marrow aspiration. While involving the child in therapeutic play before the procedure the nurse should help him understand that:
He did nothing to cause his current illness
Monitoring vital signs, particularly the blood pressure and the rate and quality of the pulse, is essential in detecting physiological adaptations in a preschool child with nephrotic syndrome. Which clinical manifestation should the nurse be able to detect from these vital signs?
Hypovolemia
At what ages are children considered preschoolers? Select all that apply.
3 years 4 years 5 years
A nurse reviews the preoperative instructions for a 3½-year-old child who is to undergo follow-up cleft palate surgery. Which instruction should the nurse question?
"Tapwater enema until clear this pm."
A nurse anticipates that a preschooler will perceive death as:
Separation that is reversible
The parents of a 4-year-old child call the health center and report that their child has a fever of 102.6° F (39.2° C), is complaining of a sore throat, and will not lie down, preferring to sit up and lean forward. The child is drooling and looks ill and agitated. In light of this information, what guidance should the nurse provide the family?
The child needs to be seen immediately by a health care provider.
A preschool child presents to the clinic for a well-child examination. What feature of the child's dress is most important for the nurse to address with the parents?
The child's name is embroidered on a jacket pocket.
The nurse discusses discipline with parents of a 4-year-old child. Which parental statement regarding time-out reflects an appropriate application of this method of discipline?
"I explain the reason for the time-out before and after disciplining him."
Parents express concerns to the nurse that their 4-year-old child is spending a large amount of time playing with an imaginary friend. What is the best response by the nurse?
"Imaginary playmates are an important part of a young child's life."
A nurse is preparing to give a 3-year-old toddler an intramuscular injection, and the child starts to cry. What is the most therapeutic approach for the nurse to take?
"It's all right to cry as loud as you want, but don't move."
A 3-year-old boy is found to have X-linked Duchenne muscular dystrophy. Neither parent has muscular dystrophy. Which statement indicates that the parents understand how the disorder is transmitted?
"Our daughters may be carriers of the disease."
A hospitalized 3-year-old child with leukemia is undergoing chemotherapy. The mother tells the nurse that her child is asking for fried chicken. How should the nurse respond?
Any food that is requested should be given, because the child needs calories.
The parents of a 4½-year-old child are concerned about the effects of hospitalization on the child. Which behavior should the nurse expect the child to exhibit?
Crying when the parents leave and return but not during their absence
A nurse is planning to communicate with a preschool child. What is most important for the nurse to know about the child first?
Developmental level
A 4-year-old child is admitted to the pediatric unit with a diagnosis of Wilms tumor. Considering the unique needs of a child with this diagnosis, the nurse should place a sign on the child's bed that states:
Do not palpate the abdomen
When preparing a child with asthma for discharge, what instructions must the nurse emphasize to the family? (Select all that apply.)
Eliminate allergens in the home. Continue the medications even if the child is asymptomatic.
A 3-year-old child is admitted to the pediatric unit with a diagnosis of nephrotic syndrome. The child has ascites, oliguria, respirations of 40 breaths/min, and a recent weight gain of 10 lb. What nursing intervention may help ease the child's respiratory difficulty?
Ensuring bedrest in the low Fowler position
To confirm a tentative diagnosis of leukemia a bone marrow aspiration and biopsy are to be performed on a 4-year-old boy. The nurse gives an age-appropriate explanation of the procedure to the child. What else is involved in caring for this child?
Explaining to the child that he will sleep during the procedure
A 3½ -year-old child with severe iron-deficiency anemia is seen by a nurse in the clinic. In addition to weakness and fatigue, what should the nurse expect the child to exhibit?
Increased pulse rate
A nurse is caring for a 4-year-old child. In what stage of Erikson's psychosocial development does the nurse expect the child to be in the process of achieving?
Initiative
Which of Erikson's stages of psychosocial development occurs at the preschool age?
Initiative vs. guilt
A nurse is caring for a child with newly diagnosed acute lymphoblastic leukemia. What clinical findings does the nurse anticipate when caring for the child? (Select all that apply.)
Pallor Fatigue Multiple bruises
The health care provider prescribes mebendazole (Vermox) for a 4-year-old child with pinworms. For which expected response to the medication does the nurse teach the parents to be alert?
Passage of worms
A 4-year-old child is receiving prednisone. Which immunizations are safe for the child to receive? (Select all that apply.)
Pertussis Inactivated poliovirus Tetanus immune globulin
A young child with acute nonlymphoid leukemia is admitted to the pediatric unit with a fever and neutropenia. What are the most appropriate nursing interventions to minimize the complications associated with neutropenia?
Placing the child in a private room, restricting ill visitors, and using strict handwashing techniques
On return to the pediatric unit after a tonsillectomy, a nurse notes that a 4-year-old child is swallowing frequently. What is the probable cause of this response?
Postoperative bleeding
A nurse is caring for 3-year-old children. At what stage of cognitive thought does the nurse expect them to be?
Preconceptional
Which statement is accurate regarding the typical growth and development of preschoolers?
Preschoolers believe they are the center of the world.
A nurse is caring for a 4-year-old child whose arm is immobilized. What play activity is most appropriate for this child?
Solving jigsaw puzzles
A health care provider prescribes steroid therapy for a 4-year-old child who has nephrotic syndrome. What goal of this treatment does the nurse explain to the child's parents?
Stimulates diuresis
A preschool child is found to have chickenpox during the acute phase. The nurse tells the parents, "It's important not to expose your child to anyone undergoing certain types of prolonged medication therapy." What medication therapy puts a person at risk?
Systemic steroid
A busy work-at-home parent reports little time to interact with preschool children who become easily bored. Which activity is best for the nurse to recommend to keep the children occupied for long periods?
Teach the children games such as tag, jump rope, and hide-and-seek.
A nurse is trying to involve a hospitalized preschooler in therapeutic play. Why is this so important?
The child can work out ways of coping with fears.
A 3-year-old child is admitted to the pediatric unit with a diagnosis of acute asthma. The child is short of breath, with a respiratory rate of 56 breaths/min; the pulse is 102, and the child has a nonproductive cough. What blood gas value does the nurse expect to see?
pH of 7.32
A 4-year-old child is found to have acute lymphoblastic leukemia. One of the parents tells the nurse, "We just had a discussion with our pediatrician about starting chemotherapy, consolidation therapy, and radiation therapy. We're so confused, and we don't know what to do. We want to do what is best for our child, but we don't want any unnecessary suffering." What is the best response by the nurse?
"Maybe you could talk with your health care provider about getting a second opinion from a specialist in leukemia."
A preschool child is found to have atopic dermatitis. The nurse emphasizes that the child should be discouraged from scratching. The child's mother asks why scratching should be prevented. The nurse responds:
"Scratching results in skin breaks that can lead to infection."
A health care provider writes prescriptions for a young child with a tentative diagnosis of Wilms tumor. Which prescription should the nurse question?
Renal biopsy
With which roommate should the nurse place a 4-year-old boy who has been admitted to the hospital with nephrotic syndrome?
A 5-year-old girl with acute glomerulonephritis
A 4-year-old child is brought to the emergency department after falling on the handlebars of a tricycle. The child is guarding the abdomen, crying, and not allowing any physical contact with the staff. What is the best action by the nurse?
Allowing the child to guide the examiner's hand to the area that hurts
Which type of play behavior does a preschooler exhibit?
Associative play
A nurse is reviewing the report of a biopsy taken from a preschool child's brain tumor. The tumor is a cerebellar astrocytoma. The nurse determines that this tumor is:
Benign and associated with a high rate of cure
How can a nurse best meet a preschooler's developmental needs just before a physical examination?
By allowing the child to handle the examination equipment
A preschooler is to have a peripheral intravenous catheter inserted. How can the nurse make the experience minimally traumatic for the child?
By applying an epidermal analgesic before the procedure
A preschool child with a spinal cord injury will be on prolonged bedrest. The nurse explains to the parents that certain foods will be restricted to prevent complications associated with immobility. What food should be noted as restricted in the teaching plan?
Cheese
A 3-year-old child with the diagnosis of tetralogy of Fallot is brought to the United States by a charitable organization for cardiac surgery. What should the nurse expect to observe when caring for the child?
Clubbing of fingers
A 4-year-old child is admitted to the pediatric unit for a tonsillectomy. During preoperative planning a nurse reviews the child's laboratory report. Which lab value is of most significance in this situation?
Coagulation studies
A 4-year-old child with a new colostomy is to be discharged in several days. What should the nurse teach the parents about their child's home care?
Encouraging physical activity
A 4½-year-old child is brought to the emergency department with a fractured tibia. Which type of fracture is most common in children of this age?
Greenstick
A nurse is caring for a preschooler who is being prepared for surgery. What does the nurse expect to have the most influence on the child's response to hospitalization?
Fear of bodily harm
A 4-year-old child begins screaming and kicking when the laboratory technician arrives to draw blood. What does the nurse identify as the most likely cause of the child's behavior?
Fear of intrusive procedures
A 4½-year-old child is admitted to the pediatric unit in preparation for surgery. What psychological responses to hospitalization does the nurse anticipate from this preschooler? (Select all that apply.)
Fearfulness regarding intrusive procedures Misgivings about being punished for a misdeed
What play activity should the nurse provide for a 4-year-old child on bedrest?
Finger painting on blank sheets of paper
A 4-year-old child who has never been separated from parents or siblings is admitted to the hospital. What is most important for the nurse to encourage the parents to do?
Have one of them stay with the child
The parents of a 3-year-old child who has recurrent attacks of acute spasmodic laryngitis (spasmodic croup) ask the nurse why this happens to their child. The best rationale for the nurse to convey why this is a disorder of young children is that they:
Have small airways
After several days of bedrest, a preschool-age boy with the diagnosis of a liver laceration becomes demanding and will not listen to the nurses. The child was found in the playroom twice on the previous shift. How can the nurse best meet the needs of this child?
Move the child into a room with another preschooler with whom he can play
A nurse is caring for a preschooler on the pediatric unit. What does the nurse identify as the child's greatest fear at this age?
Mutilation
Which reactions does a nurse expect of a 4-year-old child in response to illness and hospitalization?
Out-of-control behavior, regression to overdependency, and fear of bodily mutilation
What should the nurse do to meet the emotional needs of a 4-year-old child who is receiving daily injections?
Provide the child with a doll and related equipment, and observe what happens
What nursing intervention best meets the developmental needs of hospitalized preschool-age children?
Providing materials for simulating activities
A 4-year-old abused child, after being hospitalized for severe injuries, is placed in temporary foster care. The foster family comes to the hospital to meet the child. What action should the nurse take to facilitate their first meeting?
Providing the child and foster family with a private room
A nurse is planning to foster independence in a group of 4-year-old children. What self-care skill does the nurse expect 4-year-olds to be capable of performing?
Putting on a shirt and buttoning it
A 3-year-old child with sickle cell anemia is admitted to the child health unit during a painful episode. Splenomegaly is identified. The nurse explains to the parents that splenomegaly is:
Triggered by a vaso-occlusive crisis
A child who has been undergoing prolonged steroid therapy takes on a cushingoid appearance. What will the nursing evaluation probably reveal? (Select all that apply.)
Truncal obesity Thin extremities
When talking with a 4-year-old child, a nurse determines that the child is shy and stutters. What does stuttering in a 4-year-old child indicate?
Typical preschooler speech
What is the best approach for the nurse to use when preparing a preschooler for surgery?
Using a doll to demonstrate perioperative care
Which skill, if it cannot be performed by a 3-year-old child, should alert the nurse that the child may be developmentally delayed?
Using a spoon effectively
The nurse, caring for a 3-year-old child with meningitis, should be alert for which signs and symptoms of increased intracranial pressure? (Select all that apply.)
Vomiting Headache Irritability
A preschooler who is allergic to environmental pollutants is to be given a hyposensitization injection. What clinical finding prompts the nurse to withhold the injection?
Wheezing and dyspnea
The mother of a preschool-age child tells the nurse that her husband is dying of cancer and that she is worried about how her child will cope. As part of their discussion, the nurse includes that preschool-age children view death as:
A form of sleep
A 4-year-old child with nephrotic syndrome has repeated relapses. As the child gets older, what is the most important attribute for the child to develop?
A positive body image
A nurse is planning to give a preschool child an immunization consisting of bacterial cells that have been modified. What is the substance called?
A vaccine
During a clinic visit a 4-year-old girl suddenly yells, "Don't sit on Erin!" The parent whispers that Erin is an imaginary friend. What is the nurse's best action?
Avoiding sitting where the child says her imaginary friend is located
A nurse is preparing an intramuscular injection to be administered to a 2-year-old child. What approach is the most therapeutic?
"This might hurt, but it's important that you be very still."
When a nurse brings a dinner tray to a 4-year-old child hospitalized with pneumonia, the child says, "I'm too sick to feed myself." What is the best response by the nurse?
"Wait a few minutes, and I will be back to help you."
What is the average duration of sleep per night for a preschooler?
12 hours
A 4-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute lymphocytic leukemia (ALL). The mother states that changes in her child's behavior and the "black and blue" marks were noticed several days ago. She blames herself for not bringing her child to the clinic sooner. On what information about the pathophysiology of leukemia should the nurse base a response?
Early signs and symptoms of leukemia are similar to those of other mild illnesses of childhood.
Which statement is true regarding nightmares in preschoolers?
The child may be reassured by another's presence.
A nurse is preparing to take the vital signs of a 4-year-old child who was brought to the well-child clinic. What criterion should the nurse use when selecting the appropriate size of blood pressure cuff?
The width is approximately 40% of the circumference of the upper arm.
The nurse finds a 4½ -year-old hospitalized girl, who has several siblings, crying and shouting at her teddy bear, "There! You bad girl! Don't be mad at your brother! Go to the hospital!" An understanding of preschooler development leads the nurse to believe that this behavior is based on the fact that the child:
Thinks that being sick is related to bad thoughts about the brother
A 4-year-old boy with Reye syndrome is beginning to show signs of recovery. The intracranial pressure has receded, the vital signs are stable, the fever has subsided, and urine output is within the acceptable range for the child's weight and fluid intake. What should the nurse tell the parents about their son's recovery?
"The recovery is now progressing as we'd hoped."
A 3½ -year-old child has been ill with nephrotic syndrome. The child has been toilet-trained for longer than a year but has been incontinent lately. The child's parents express concern over this behavior. What is the most therapeutic response by the nurse to the parents?
"This is an expected response to hospitalization. Ignore the regressive behavior and be supportive."
A nurse is teaching the parents of a 3-year-old child with a diagnosis of cystic fibrosis about their child's special needs. What statement indicates that the parents need further teaching about the issues related to cystic fibrosis?
"We'll have to move to a very warm climate."
An IV catheter is to be inserted into a 3-year-old toddler's peripheral vein. As local topical anesthetic is applied, the toddler starts to cry and asks whether the insertion is going to hurt. How should the nurse respond?
"Yes, it may hurt, but not for very long."
The parents of a 3½ -year-old tell the nurse that their child has become a "picky eater" and has not gained much weight. How should the nurse respond?
"Your child is growing slower; preschoolers don't have large appetites."
A child with nephrotic syndrome visits the clinic for a follow-up visit. During the visit the parent states that the child is always tired and has no appetite. The nurse notes that the child has a muddy, pale complexion. What problem does the nurse suspect?
Impending renal failure
A 3½-year-old boy from Central America who has tetralogy of Fallot attends the pediatric cardiac clinic for a diagnostic workup before corrective surgery is scheduled. The nurse's evaluation of the child's motor ability demonstrates that he is just beginning to walk unsupported. When comparing this child with other 3½-year-old children, the nurse determines that the child:
Should have started to walk about 2 years earlier
A nurse plans care of 4-year-old hospitalized children on the basis of their developmental level. What is the major vulnerability of children this age?
Intrusive procedures
What age-related fear should the nurse expect when preparing a 4-year-old child for surgery?
Intrusive procedures
A parent of three young children has contracted tuberculosis. Which should the nurse expect the health care provider to prescribe for members of the family who have a positive reaction to the tuberculin skin test and are candidates for treatment?
Isoniazid
A nurse is caring for a child with acute lymphoid leukemia who is undergoing chemotherapy. The parents ask why the child needs prednisone. How should the nurse respond?
It decreases inflammation.
A nurse in the child life center encourages preschool children to engage in role play. Why does the nurse consider this an important part of socialization?
It encourages expression of concerns.
A 3-year-old child is hospitalized with nephrotic syndrome. The child has oliguria and generalized edema. What factor does the nurse identify that will have the greatest effect on the child's adjustment to hospitalization?
Lack of parental visits
A preschool-age boy has been restricted to bedrest since being admitted to the hospital. As he begins to recover, he becomes interested in playing. In light of his developmental level and activity restriction, what should the nurse provide for him?
Little cars and a shoebox garage
A 3-year-old child is seen in the emergency department after a fall off a swing, and a possible concussion is diagnosed. When using the Glasgow Coma Scale, the nurse should remember that most children 3 years of age:
May not respond to strangers asking questions
A parent and 4-year-old child who recently emigrated from Colombia arrive at the pediatric clinic. The child has a temperature of 102° F (38.8° C), is irritable, and has a runny nose. Inspection reveals a rash and several small, red, irregularly shaped spots with blue-white centers in the mouth. What illness does the nurse suspect?
Measles
A 4-year-old child with newly diagnosed leukemia is admitted for chemotherapy. While assisting with morning care the nurse observes bloody expectorant after the child has brushed the teeth. How should the nurse respond to this occurrence?
By documenting the incident without alarming the child
How should parents practice "time-out" with preschoolers?
By encouraging quiet time alone without toys
When planning discharge teaching for the parents of a child with asthma, what information should be included?
Minimize exertion and exposure to cold.
A nurse accompanies a 3-year-old child to the pediatric unit's playroom. The toddler seems reluctant to select a toy or activity. Which toy is most appropriate for the nurse to offer as a means of fostering creativity?
Mold and clay
What is the best way for the nurse to greet a 3-year-old child sitting in the waiting room of the pediatric clinic?
By walking into the waiting room to greet the child
A nurse who volunteers in a daycare for preschoolers has been asked to give a presentation to parents about health promotion. Which topics should the nurse include?
Injury prevention and dental health
A child recovering from a severe asthma attack is given oral prednisone 15 mg twice daily. What is the priority nursing intervention?
Preventing exposure of the child to infection