Prep-u: Chapter 5: Growth and Development of the Preschooler

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 presence of only 10 deciduous teeth would warrant further investigation. The preschooler should have 20 deciduous teeth present.

The caregiver of a 6-year-old tells the clinic nurse that he is concerned that his 5-year-old child cannot yet print his first and last name, and 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."

While the nurse is talking with a 6-year-old who has been a client of the clinic since birth, the child begins to tell the nurse that he is the star of a popular children's television program. What is the nurse's best response?

"I bet you like that show a lot. Which character is your favorite?" -Preschool-age children often engage in magical thinking. Magical thinking allows the preschooler to make room in his world for the actual or real occurrences of life. Responding in a way that allows the child to experience magical thinking is therapeutic

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." -A time-out should be timed appropriately. The time-out should occur at the time the offense occurred, to ensure the child relates the offense (the behavioral problem) to the time-out period. Brief time-outs are more effective than very long ones, because a long time-out enables the child to redirect attention from calming down to being resentful. The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. A time-out should end as soon as the child is calm.

The nurse is speaking to a parent of a 4-year-old. The parent states that she has trouble getting her child to go to bed at night. Which is the best response by the nurse?

"It's just as important to establish a morning wake-up time as it is as establishing a bedtime. Children tend to do better when they have a normal routine to follow."

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 parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares?

"She screams and thrashes when we try to touch her." -During a night terror, a child is typically unaware of the parent's presence and may scream and thrash more if restrained. During a nightmare, a child is responsive to the parent's soothing and reassurances. The other statements are indicative of a nightmare.

A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond?

"Tell me about Boo-ga-loo." -The imaginary friend serves as a companion and playmate for the preschooler. The child knows this friend is not real, yet is very invested in the imaginary playmate who can be and do anything the child's fantasy life can invent. The nurse should acknowledge this friend, not minimize the friend's importance.

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 providing teaching about child safety to the parents of a 4-year-old girl. Which statement by the parents indicates a need for further teaching?

"We need to tell her that her vitamins are candy."

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?

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough -Consistent bedtimes and places for sleep promote good sleep habits.

The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of dramatic play?

Children are acting out a troubling situation.

The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of cooperative play?

Children are playing in an organized group with each other

A 4-year-old tells you 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

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.

Broken fluency is a serious condition, and children who exhibit it should be referred to a speech pathologist for treatment.

False

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. -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 assessing a 5-year-old child. Which assessment finding would be documented as abnormal?.

Inability to state address

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

Orange

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

Preschool

The nurse is caring for a preschool child in the hospital with severe developmental delays. The parents have 3 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

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?

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

The nurse is doing teaching with a group of caregivers of preschool children on various topics. The topic of sexual development is discussed. Which statement made by the caregivers indicates an understanding of the sexual development of the preschool-age child?

"I feel better knowing that what she is doing is normal." -The child's sexual curiosity is a normal, natural part of total curiosity about oneself and the world. Exploration of the genitalia is natural for the preschooler. It is one way the child learns to perceive the body as a possible source of pleasure and is the beginning of the acceptance of sex as natural and pleasurable. Caregivers can be reassured that this is not uncommon behavior

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 mother of a 5-year-old kindergarten student tells the school nurse she is concerned that her son doesn't seem to be able to pronounce words correctly that begin with the letters "th" and "r." What is the best response by the nurse?

"It is very common for children 6 years and younger to have difficulty with these sounds, but I will let our speech therapist know so it can be monitored."

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 nurse is caring for a child who is described as being an inquisitive learner, loves to learn new things, and feels a sense of accomplishment when succeeding in activities. The nurse understands that this child is in which of Erikson's stages of development?

Initiative versus guilt -Erikson defines Initiative versus guilt as the preschool period. Erikson defines the toddler period as a time of autonomy versus shame and doubt. Erikson defines trust versus mistrust as the infancy period and industry versus inferiority as taking place during the school-age period.

A preschooler's mother asks you when she should tell him that she is pregnant. Your best answer would be:

Probably at the point she begins to look pregnant. -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.

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. -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 he knows that his tree will not look as good.

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.

The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of:

Transduction. -Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings

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?

• Ask the parents if they can identify anything that may be causing their child be be fearful. • Suggest to the parents to talk with their child about his fears. • Work with the parents and child to devise strategies to help deal with the fears.

The nurse realizes that the 5-year-old's growth chart and BMI indicate the child is at risk for obesity. What other findings reinforce this risk?

• Expectations to eat everything on plate • A father who is overweight • Food used as reward or punishment • Television on during meals

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.