Pediatrics Chapter 5 PrepU
respiratory
101, 102, 103, 104
school age
63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74
adolescent
75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85
The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal? a. builds a tower of 10 cubes b. pedals tricycle without assistance c. unscrews a bolt on a toy d. falls when bending over to touch toes
d. falls when bending over to touch toes Bending over easily without falling is a normal expected gross motor skill in a 3-year-old. Building a tower of nine or ten cubes, pedaling a tricycle without assistance, and unscrewing lids, bolts, or nuts are also expected gross and fine motor skills for this age.
A nurse walks into the room to check on a preschool client. When the nurse asks the preschooler how she is doing, the child says she is Tinker Bell. What is the best response by the nurse? a. "You are not Tinker Bell. Your name is Whitney." b. "Hello, Tinker Bell." c. "That will be fun if you want to pretend you are Tinker Bell!" d. "I will not call you Tinker Bell. I like the name Whitney better."
c. "That will be fun if you want to pretend you are Tinker Bell!" Preschoolers engage in fantasies as part of their development. The nurse, however, needs to support the imitation but at the same time help the child to maintain the difference between pretend and real. The best response by the nurse would be to tell the client it will be fun to pretend she is Tinker Bell. Trying to call the child by the real name when the child is in imaginary play is very confusing to the child.
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? a. "Your child is not expected to be able to perform those activities at 3 years of age." b. "I wouldn't be too concerned since he seems fine during my assessment." c. "Maybe practicing these activities with him would help him improve these motor skills." d. "I am sure he will become more proficient in these activities soon."
quiz 58, 59, 60, 61, 62
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. a. "Try using a night light in the child's room." b. "Set up some familiar bedtime rituals for your child." c. "Keep the door closed and the lights off so that your child can fall asleep faster." d. "Avoid having your child watch frightening shows on TV before bedtime." e. "Try reading a favorite story before bedtime."
a. "Try using a night light in the child's room." b. "Set up some familiar bedtime rituals for your child." d. "Avoid having your child watch frightening shows on TV before bedtime." e. "Try reading a favorite story before bedtime." Preschoolers may refuse to go to sleep because of fear of the dark. A night light, screening out frightening stories or TV shows, and using familiar bedtime routines, including reading a favorite story, can help. Keeping the door closed and the lights off would only help to promote the child's fear.
During a well-child visit, the mother of a preschooler tells the nurse that her daughter is "daddy's girl." She says, "It seems like I don't exist." Which response by the nurse would be most appropriate? a. "Your daughter is showing normal behavior for her age." b. "This might be a problem because your daughter is obviously alienating you." c. "Why do you think she is doing this?" d. "Did you do something to make your daughter angry with you?"
a. "Your daughter is showing normal behavior for her age." The daughter is exhibiting signs of the Electra complex, competing with the same-sex parent for the love and attention of the other parent. This behavior is entirely normal but parents who are not prepared may feel hurt or rejected. Telling the mother that this is a problem, asking the mother about why, and asking the mother if she did something to make the daughter angry are inappropriate responses and focus on the mother's behavior, not the child's.
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? a. Imbalanced nutrition, less than body requirements b. Interrupted family processes c. Readiness for enhanced parenting d. Risk for caregiver role strain
d. Risk for caregiver role strain 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.
The clinic nurse is collecting vital signs on a 4-year-old client being seen for a yearly well check-up. Which measurements should the nurse collect? a. height, weight, and head circumference b. height, weight, and abdominal girth c. height, weight, abdominal girth, and head circumference d. height and weight
d. height and weight Height and weight are the standard measurements at every yearly visit. The nurse should understand that head circumference is not routinely measured past 2 years of age and abdominal girth is only collected in infants.
assessment
86, 87, 88, 89, 90, 91, 92, 93
eyes and ears
94, 95, 96. 97, 98, 99. 100
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? a. "It is not normal to feel that way." b. "Use the time-out technique for discipline." c. "Spank lightly to get the child's attention." d. "Take some toys away when the child acts like that."
b. "Use the time-out technique for discipline." 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 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity? a. Draw a picture first for the child to see how to do it. b. Tell the child that it will be fun but that he or she should not make a mess. c. Support whatever the child paints. d. Make a model for the child to follow so it will be easy to copy.
c. Support whatever the child paints. Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because the child believes that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Finger painting is a messy activity, so telling the child not to be messy takes the fun and the creative part out of the activity. The adult should provide aprons or clothing to protect the child's clothing and allow the painting in an area that can be cleaned easily.
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? a. Weight and height are within expected patterns of growth. b. Weight falls within an expected range and height is less than what would be expected. c. Weight is above an expected range and height is within an expected range. d. Weight is below an expected range and height is above an expected range.
c. Weight is above an expected range and height is within an expected range. 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 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? a. preoperational thought b. magical thinking c. imaginary friend d. animism
c. imaginary friend The preschool-age often has an imaginary friend. This friend serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Preoperational thought is a self-centered understanding of the world. Magical thinking is when a preschooler believes that his or her thoughts are all-powerful. Animism is when a preschooler attributes lifelike qualities to inanimate objects.
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? a. Allow the child to play with a procedure doll. b. Don't discuss the procedure in front of the child. c. Distract the child with games and candy. d. Take the child to the playroom for coloring.
a. Allow the child to play with a procedure doll. The nurse can allow the child to play with a procedure doll that will simulate the procedure for the child.
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? a. Allowing the preschooler to fall asleep wherever and whenever the child is tired enough b. Eliminating caffeine sources beginning late afternoon c. Providing a nightlight d. Taking the TV set out of the child's room e. Planning for the child to get 12 hours of sleep daily
a. Allowing the preschooler to fall asleep wherever and whenever the child is tired enough 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 parents of a 5-year-old tell the nurse that it "seems like our child is afraid of everything from fireworks to butterflies." What actions should the nurse take? Select all that apply. a. Ask the parents if they can identify anything that may be causing their child be fearful. b. Encourage the parents to just ignore the fears since this is common behavior with the preschool-aged child. c. Suggest to the parents to talk with their child about his fears. d. Work with the parents and child to devise strategies to help deal with the fears. e. Advise the parents to help the child understand that the fears are irrational.
a. Ask the parents if they can identify anything that may be causing their child be fearful. c. Suggest to the parents to talk with their child about his fears. d. Work with the parents and child to devise strategies to help deal with the fears. Preschoolers have a vivid imagination, which often leads to a variety of fears. The best way to deal with the child's fears is to address them and work together to determine ways to help minimize the fears. The preschooler is not emotionally equipped to understand why fears are irrational.
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? a. Pretending to be mommies and daddies in the playhouse b. Playing a board game c. Painting pictures in the art corner of the room d. Watching a movie with other children their age
a. Pretending to be mommies and daddies in the playhouse Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-aged child enjoys group activities, such as board games, and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities he or she can participate in with their peers.
A group of nursing students are completing a clinical day at a preschool. Which behaviors would they identify as common in this preschool group? Select all that apply. a. Regression b. Telling of tall tales c. Imaginary friends d. Sibling rivalry e. Difficulty with sharing f. Completing multi-step tasks
a. Regression b. Telling of tall tales c. Imaginary friends d. Sibling rivalry f. Completing multi-step tasks Common behavior variations of preschoolers include telling tall tales, imaginary friends, regression, sibling rivalry and difficulty with sharing. Multi-step tasks are able to be completed by school-aged children.
A type of play seen in preschool children encourages children to act out troubling situations, such as one that might occur in the hospitalized child who must undergo an upsetting procedure. This type of play is referred to as: a. dramatic play. b. parallel play. c. independent play. d. solitary independent play.
a. dramatic play. Dramatic play allows a child to act out troubling situations and to control the solution to the problem. Through dramatic play the child can express anxiety, try out new feelings and conquer fears. This is important to remember when teaching children who are going to be hospitalized. Using dolls and puppets to explain procedures makes the experience less threatening. Parallel play is the play of toddlers where two toddlers play side by side but not with each other. Independent play occurs when a group of children are all playing but each is playing something different (i.e., all may be playing with trucks but each one has a different truck and they do not do the same thing with the trucks). Solitary play is a child playing alone, even in a group. The child does not participate with other children.
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: a. imagination in a 3-year-old is at its peak. b. a 3-year-old knows the word two but not the concept of two. c. a preschooler is in an insecure period. d. preschoolers have a limited vocabulary.
a. imagination in a 3-year-old is at its peak. Preschoolers have vivid imaginations and love to play "make believe." They are inquisitive learners. It is not unusual for their imaginations to create "tall tales" and be in a world of make-believe. Preschoolers have a vocabulary of between 1,500 and 2,100 words, depending upon their age. They can count to 10 and know at least four colors. Their communication is concrete. At this age they are not capable of abstract thought. During the preschool years, the child develops a sense of identity. They know who they are and to the family in which they belong. They develop the knowledge of right and wrong. The preschool years help develop a child's sense of belonging and his or her place in the world.
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: a. testing and identification of group role. b. playing in an even-number group of children (four). c. preschoolers having a harder time sharing than toddlers. d. regression.
a. testing and identification of group role. 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 nurse is speaking with the parent of a 4-year-old child. Which statement by the parent would suggest a need for further investigation? a. "My child loves to play dress-up with friends at day care." b. "When we go to the park, my child never wants to play with the other children." c. "I think it is so cute when my child wants to help my spouse with yardwork." d. "Sometimes I wish my child would play with a toy in the way it was intended. My child is constantly pretending it is something else." e. "My son loves to follow around his older sister."
b. "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
The nurse is providing health-promotion teaching to a group of parents of preschoolers at a local day care. What information would the nurse include in this education session? Select all that apply. a. Preschoolers are capable of taking a bath independently. b. Encourage children to select their own clothing to wear each day. c. Parents will need to supervise tooth-brushing and be responsible for flossing. d. Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry clothing. e. Preschoolers only need to wear bicycle helmets if they are going on long rides.
b. Encourage children to select their own clothing to wear each day. c. Parents will need to supervise tooth-brushing and be responsible for flossing. d. Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry clothing. Preschoolers are becoming more independent and need to be allowed to pick out their own clothing, brush their teeth with adult supervision, and take care of their own toileting. If the child has an accident, treat it in a matter-of-fact manner and do not make a big deal out of it. Helmets are worn every time the child rides a bicycle, regardless of distance.
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? a. Tell the child to follow directions to avoid being hurt. b. Help the child to pretend that the CT scan machine is a camera. c. Explain that the child must behave because the technician is busy. d. Tell the child that the CT scan is a picture of the dark parts inside the body.
b. 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. 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 would be a nutritional goal for a preschool client? a. Eat everything on the plate. b. Introduce new food gradually and include variety. c. Reduce messiness and spills. d. Let the child eat only what the child wants.
b. 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. 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.
A family from India has recently moved to the United States. Their 5-year-old child often visits the school nurse after lunch reporting a "stomachache." The lunch staff tell the nurse that the child eats very little for lunch. What is the best action by the nurse? a. Explain to the child that the reason for the stomachache is that not enough is being eaten during lunch. b. Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch. c. Talk with the child and encourage that lunches be brought from home so that nutrient needs are met. d. Speak to the child and parents to discuss the repercussions of visiting the nurse so frequently.
b. Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch. Food served in the home is often very specific to the family's ethnic background. As the preschool-age child is exposed to persons of other cultures in school, he or she may or may not like the food that is served. It is important to first determine if this is the reason for the child eating very little at lunch so that appropriate interventions can be determined. Bringing lunch from home may be an option, but it must first be determined if food preference is the underlying cause of lack of eating.
What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother? a. A ratio of 10 children to 1 teacher is adequate. b. Specific program goals to be accomplished should be available. c. The longer the center has been in operation, the better it is. d. Research local newspapers to see if there are any complaints against the center.
b. Specific program goals to be accomplished should be available. Preschool is used for toddlers to foster social skills and to acclimate them to the group environment. When a parent is searching for a preschool, he or she should check the school's accreditation, the teacher's qualifications, and seek the recommendations of other parents. Parents should visit the school to see the teacher interact with the children, the focus of the activities, and hygiene practices. Parents should look at the school's daily schedule and the types of activities offered. Are the activities structured or loose? Preschoolers need planned activities. They are very ready to learn, but the activities should be planned to focus on their short attention spans.
Which type of play should the nurse encourage for a preschool-age child who is hospitalized? a. playing an electronic handheld game b. dressing in the mother's coat to play house c. turning out the lights to play hide and seek d. planting flower bulbs that can be watched growing next spring
b. 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. The child's fine motor skills are not developed enough 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.
The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation? a. presence of 20 deciduous teeth b. presence of 10 deciduous teeth c. absence of dental caries d. presence of 19 deciduous teeth
b. presence of 10 deciduous teeth The presence of only 10 deciduous teeth would warrant further investigation. The preschooler should have 20 deciduous teeth present. The absence of dental caries or presence of 19 teeth does not warrant further investigation.
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? a. "That is a difficult subject to address. I'm not sure what is the best way to answer that question." b. "You should answer his questions by whatever feels most comfortable to you." c. "It's best to answer his questions using accurate anatomical names and keep your answers simple." d. "I would suggest getting books with pictures to help explain the differences between male and female genitalia."
c. "It's best to answer his questions using accurate anatomical names and keep your answers simple." 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.
The nurse is preparing a safety presentation for a health fair for families. Which instruction should the nurse prioritize when illustrating car safety and the family? a. "Stop the car any time the preschooler unbuckles the restraints." b. "Explain that wearing a seat belt is a law and the police officer will give a ticket if the seat belt is not buckled." c. "Set a good example. Wear your own seat belt every time you drive." d. "Reward the child with candy or some other treat each time the child keeps the seat belt on."
c. "Set a good example. Wear your own seat belt every time you drive." A preschooler wants to please, and if the caregiver consistently wears the seatbelt, that will become the standard for riding in the car. All states have laws that define safety seat and restraint requirements for children. Adults must teach and reinforce these rules. One primary responsibility of adults is always to wear seat belts themselves and to make certain that the child always is in a safety seat or has a seat belt on when in a motor vehicle. A child can also be calmly taught that the vehicle "won't go" unless everyone in it is properly restrained. The child should be taught respect of rules and laws, but making threats or giving rewards is not appropriate.
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? a. Compromised family coping related to abnormal behavior of child b. Disturbed thought processes related to deep-set psychological need c. Parental anxiety related to lack of understanding of childhood development d. Social isolation related to unwillingness to relate except through imaginary friend
c. 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 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.
During a well-child visit, the nurse assesses a 3-year-old child's visual development. Which finding(s) will the nurse interpret as normal for this child? Select all that apply. a. adult-level depth perception b. 20/20 visual acuity c. good eye-hand coordination d. issues with judging distances e. lazy right eye
c. good eye-hand coordination d. issues with judging distances Although the senses of taste and smell are acute in the preschool-aged child, visual development is still immature at age 3. Eye-hand coordination is good, but the judgment of distances generally is faulty, leading to many bumps and falls. During the preschool years, the child's vision should be checked to screen for amblyopia (lazy eye), which is not considered a normal condition. A child at 3 years of age would not have achieved a visual acuity of 20/20. This is usually accomplished by 6 years of age, but mature (adult) depth perception may not develop in some children until 8 to 10 years of age.
