NUR101 - Chp. 25 - Growth & Development of the Preschool-Aged Child

The caregiver of a 6-year-old expresses concern that the child cannot yet print her first and last name. The caregiver is wondering if this is normal. Which response by the nurse would be most appropriate?

"By the age of 6, most children can print some letters and maybe their first name." ** By 3 years of age, a child should be able to hold a pencil in the writing position. By age 4, the child can draw circles and squares and a body with four parts. At age 5, the child can print letters, copy a triangle and a picture of a person with six parts and cut with scissors. The 6-year-old child can print letters or numbers and may be able to print his or her own name. Children do not write in cursive until school age.

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." ** Max of 1-minute per age # for time-out. Child should only be in time-out for 4 minutes based on child's age in this question.

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 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 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?

"Keep the time to about 4 minutes." ** 1 minute per age.

The nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child?

"Look! I am a nurse, and I am helping people feel better!" ** Imagination.

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." ** 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 mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond?

"Tell me about the circumstances when this occurs." ** Bladder control is present in 4- and 5-year-olds, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents.

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." ** 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.

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?

"We do not touch ourselves in public. Please go to your room if you want to continue this behavior." ** 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 a wonderful imagination you have! I've never seen anyone who was so good at pretending to be 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.

The nurse is conducting a well-child checkup for a 4-year-old child. At the child's 3-year-old checkup, the child weighed weighs 34 lb (15.4 kg), was 35 in. (0.89 m) tall, had 20 teeth and was developmentally on target. What would be the expected findings for this visit? Select all that apply.

- Able to climb steps with alternating feet - Height of 38 in. (0.96 m) ** Preschoolers grow at a rate of 4 to 5 lb (1.8 to 2.3 kg) and about 2.5 to 3.0 in (6.3 to 7.8 cm each year). They should have all deciduous teeth in by the beginning of the preschool period and begin to lose them with the eruption of permanent teeth at the end of the preschool period, usually age 5 to 6 years.

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. - Answer all of the child's questions before starting the catheter removal.

Noncommunicative Language

3-year-old children often talk to themselves or to their toys or pets w/o any apparent purpose other than the pleasure of using words. ** Piaget called this egocentric, or noncommunicative language.

The nurse is conducting a well-child examination of a 5-year-old girl who was 40 inches tall at her last examination at age 4. Which height measurement would be within the normal range of growth expected for a preschooler?

43 inches ** The average preschool-age child will grow 2.5 to 3 inches (6.5 to 7.8 cm) per year. The average 3-year-old is 37 inches tall (96.2 cm), the average 4-year-old is 40.5 inches tall (103.7 cm), and the average 5-year-old is 43 inches tall (118.5 cm).

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.

Dramatic Play

Allows a child to act out troubling situations and to control the solution to the problem.

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?

Asking the girl to slow down and to think before she talks ** 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.

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. What is a recommended guideline when dealing with this issue?

Before answering questions, find out what the child thinks about the subject.

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?

Blaming an imaginary friend for accidents is normal behavior for this age group. ** 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.

Unoccupied Behavior

Child may be daydreaming or fingering clothing or a toy w/o apparent purpose.

Cooperative Play

Children play in an organized group with each other, as in team sports.

Associative Play

Children play together and are engaged in a similar or even identical activity, but there is no organization, division of labor, leadership assignment, or mutual goal.

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

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.

The nurse is assessing the motor skills of a 5-year-old client. Which finding will cause the nurse to be concerned?

Draws a person with three body parts. ** By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. The child should be able to dress and undress independently and should be learning to tie shoelaces. Deductive reasoning is achieved at 6 to 7 years of age.

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. ** Preschool-aged children have active imaginations and dressing up to play house would be an appropriate play activity for the nurse to encourage.

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. ** Preschool children are safe around water only when adult supervision is constant. Wearing a personal flotation device adds additional protection and should be as routine as "buckling up" in the car. At 5 years old, most preschoolers are mature enough to become swimmers, yet knowing how to swim does not make the preschooler safe without supervision.

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. ** 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.

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

When planning how to respond to a 3-year-old child about telling stories ("tall tales"), the nurse would base the statement on the fact that:

Imagination in a 3-year-old is at its peak.

Which would be a nutritional goal for a preschool client?

Introduce new food gradually and include variety. ** Mealtimes can become a power struggle between caregivers and the young child. Reassure caregivers that young children go through periods during which they are very particular about food. Therefore, new foods should be gradually introduced and include variety. Foods that look like or smell like other foods they enjoy are the most likely to be eaten.

Onlooker Play

Observation w/o participation.

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 concern will the nurse address in the care plan?

Parental anxiety related to lack of understanding of childhood development. ** The parents need to understand that the child's behavior is not uncommon. Imaginary friends are common in the preschool-age child.

The 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?

Play kitchen and food. ** Preschool-aged children like to engage in pretend play, so a play kitchen and food would be a good choice.

Solitary Independent Play

Playing apart from others w/o masking an effort to be part of the group or group activity..

The parents of a preschooler ask the nurse, "What snacks are appripriate for us to give our child?" Which suggestion would the nurse provide? Select all that apply.

Sliced cheese sticks. ** Parents should offer the child healthy options that are not choking hazards. Cheese sticks that have been cut are healthy and are not a potential choking hazard.

When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate?

Tells a fantasy story about a bear and a car. ** 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.

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

The child can hop on one foot. ** 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.

Magical Thinking

Thinking about something w/o actually seeing it - the visualize or imagine it; makes difficult for child to separate fantasy from reality.

The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. What is an appropriate response to this concern?

Treat the action in a matter-of-fact manner, emphasizing safety. ** Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong.

Fear of mutilation is significant during the preschool age.

True ** Fear of mutilation is significant during the preschool age, as revealed by the intense reaction of a preschooler to even a simple injury such as falling and scraping a knee or having a needle inserted for an immunization. A child cries afterward not only from the pain but also from the intrusiveness of the injury or procedure.

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." ** Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period a sensitive and critical time for socialization. Preschoolers who are exposed to other playmates have an easier time learning to relate to people than those raised in an environment where they rarely see other children of the same age.

A hospitalized 4-year-old child reports having difficulty falling asleep at night due to a fear of monsters. How will the nurse respond?

"You sound scared. I will show you under the bed that there are no monsters." ** Fears are very real to a preschool-aged child, because the child's imagination is active at this age. Acknowledging the emotion and working together to combat the fear are useful strategies.

The nurse is providing health-promotion teaching to a group of parents of 4-year-old children at a local day care. What information will the nurse include in this education session? Select all that apply.

- Encourage your preschool-aged child to brush their teeth twice a day with a pea-sized amount of toothpaste. - Ensure your preschool-aged child knows their address and phone number. - Encourage unstructured physical activity every day for your preschool-age child.

The nurse assesses a 5-year-old client for a well-child visit prior to the start of school (above). What finding from the assessment requires follow-up?

Speech and language ** The 5-year-old child's speech should be generally understood by strangers. This child's articulation is delayed, and this issue should be followed up with a speech-language assessment and therapy.

The child care facility for preschool-aged children has had several outbreaks of gastrointestinal illness. What will the nurse recommend to the teachers to prevent future outbreaks?

Supervise and assist the children with handwashing. ** Preschool-aged children still need assistance with handwashing to ensure that they are using soap and washing hands thoroughly before meals and after using the bathroom.

The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. What is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative?

Reward the child for initiative in order to build self-esteem. ** A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence.

Which statement by the parents of a 4-year-old child indicates to the nurse the need for further education about development and discipline in a preschool-aged child?

"When our child misbehaves, we use a 15-minute time-out." ** Challenges with sharing, lying, and imagination are common in preschool-aged children. The approaches in the options address the challenge while promoting the child's initiative (vs. guilt). Providing choices can also help to support positive behavior at this age. A time-out is an effective disciplinary strategy, but should only be as many minutes as the child's age. Fifteen minutes is too long for a 4-year-old child.

A 5-year-old child is overheard by her parents calling her dog a "fat boo-boo butt" and they are concerned. What advice would the nurse provide for them regarding this behavior?

Calmly correct the child, telling her not to say those words again. ** Children this age often try out naughty words to see what kind of reaction they will get from their parents. Parents are encouraged to express their disapproval with the language and calmly tell the child not to say those words again.

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?

Repetition and reinforcement. ** 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.

A 4-year-old female client presents to the clinic with an increased temperature. Based on the assessment findings (above), what does the nurse anticipate the primary health care provider will prescribe for this client?

Urinalysis, culture and sensitivity. ** In notes, it was noted the patient was experiencing frequent bathroom trips as well as holding lower abdomen.

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of what happening?

Viewing her baby sister's illness as her fault. ** Since the preschool-age child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment.

A nurse in a pediatrician's office is assessing a 4-year-old child. What assessment techniques will the nurse use with a preschool-age child? Complete the following sentence(s) by choosing from the lists of options. To improve the assessment process with a preschool-age child, the nurse will

- Involve the child in the assessment and - Allow the child to play with safe medical equipment.

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 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.

The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which intervention would be appropriate advice?

Present the food matter-of-factly and allow the child to choose what to eat. ** The more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is likely to try new foods or even eat the ones he or she likes that are served.