Ch. 27 Growth and Development of a Preschooler

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium? a. Orange b. Banana c. Apple d. Peach

Ans A A medium orange contains 50 mg of calcium and is a good nondairy choice. The other fruits are healthy choices but do not contain as much calcium.

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? a. cooperative play b. associative play c. parallel play d. dramatic play

Ans A Cooperative play is when children play in a group with each other, and play by rules. Examples are board games or sports. Associative play involves allowing the child to work through feelings about procedures and separation; parallel play involves children playing side to side with each engaging in his/her own activities; dramatic play involves living out of the drama of human life.

A 4-year-old child has begun stuttering. Which practice by the parents will the nurse discourage? a. Asking the child to slow down and to think before talking b. Looking at the child while the child is speaking c. Giving the child opportunity to speak and finish ideas d. Enunciating clearly and slowing down parental speech

Ans A Many preschoolers 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. All the other practices are helpful.

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

Ans A The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the child believes that all nurses who wear flowered uniforms give shots. 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 parent 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 parent would indicate a need for further teaching? a. "I will need to find an appropriate punishment for him if this continues." b. "I should teach him certain rules about this activity." c. "I have heard that both boys and girls often touch themselves at this age." d. "This is probably a good time to talk about safety and who can touch him."

Ans A The nurse should remind the parent that overreaction to this behavior may cause it to occur more frequently. Masturbation at this age should be treated matter-of-factly. The other statements are correct.

A male child exhibits the following growth pattern. How should the nurse interpret these data? 3 yrs: Ht. 37 in Wt. 32 lb 4 yrs: Ht. 39 in Wt. 39 lb 5 yrs: Ht. 40 in Wt. 46 lb a. The child is growing slowly in height but rapidly in weight. b. The child is following a normal pattern of growth for the preschool years. c. The child's height and weight should be plotted on a growth chart. d. The child may be at risk for hyperpituitarism

Ans A The preschool child's growth is fairly even. The child should grow about 2½ to 3 in and gain around 5 lb yearly. This child is not following this pattern. The child's pattern is growing slowly in height but rapidly in weight. Thus, the child is at risk for becoming overweight, not hyperpituitarism which is production of excessive growth hormone. Plotting the child's height and weight on a growth chart would make it visually easy to follow his growth pattern and compare it to the norms.

The nurse is organizing an indoor play area for preschoolers. What play materials are least important? a. Electronic teaching toys b. Dress-up clothes and hats and puppets c. Balls, blocks, and puzzles d. Cut, paste, drawing, and painting materials

Ans A These are expensive and usually cannot be used in multiple ways or shared with a group of children. All the rest of the items have many uses, stimulate imagination and creativity, promote social interaction, and are relatively inexpensive and readily replaced.

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

Ans A, B , C, D, and E 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.

The parents of a 6-year-old are worried that their child will fall behind other children academically because they don't buy toys like computer games and handheld electronic devices. Which are acceptable responses by the nurse? (Select all that apply.) a. "I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." b. "All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." c. "Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and Play-Doh? These are the types of toys suggested for preschoolers." d. "There are rental agencies that rent these type of devices. Would that be a possibility financially?" e. "Could you possibly save a little money each paycheck in order to be able to purchase such items."

Ans A, B, C Expensive and elaborate toys do not place a child at an academic or developmental advantage. Simple toys that require interactive rather than passive play, and that may include the involvement of the parent, are recommended to foster development.

The nurse is providing teaching about car seat safety for a parents' meeting at the preschool their children attend. Choose the points the nurse should make. (Select all that apply.) a. Children large enough for a front-facing care seat with a harness for as long as possible. b. Children who weigh less than 40 lb should use a rear-facing car seat. c. The back seat remains the safest place for children to ride. d. Booster seats should be used with both a shoulder and lap belt. e. Many car seats are installed improperly, making them unsafe.

Ans A, B, C, D, E All options are correct and are important safety points for the nurse to make.

A parent describes the 4-year-old child's eating habits as "picky" and goes on to describe using, coaxing, and threatening measures to get the child to eat. The nurse determines the child is growing normally. What interventions will the nurse suggest? (Select all that apply.) a. Offer a variety of healthy foods including those liked and refused. b. Allow the child to decide how much the child will eat. c. Ignore the pickiness. d. Approach mealtime matter-of-factly. e. Offer only nutritious between-meal snacks. f. Focus on quality, not quantity.

Ans A, B, C, D, E, F Preschoolers often become "picky" eaters but when given the opportunity to include a wider variety in their diet eventually do so. At 5 years of age, children become more receptive to different foods. Too much focus on eating may exacerbate the problem.

The nurse is evaluating a group of preschool-aged children playing freely with toys. When discussing the children's development with their parents, which behavior(s) validates Erikson's developmental task for preschool-aged children? Select all that apply. a. Dresses up and pretends to be a superhero. b. "Cooks" a meal on the toy stove. c. Compares their soccer abilities with peers. d. Asks the parent "why" about everything that happens. e. Plays with a toy stethoscope because their parent is a nurse.

Ans A, B, D, E Preschool-aged children are seeking out opportunities to prove themselves through completion of new tasks, demonstrating imagination through play activities, and asking many questions—the Initiative vs. Guilt stage of Erikson's stages of psychosocial development. The child is doing this not to be irritating to parents but because they truly want to know. Comparing athletic abilities is seen in Erikson's next stage of Industry vs. Inferiority (ages 6-13), where children become competitive and strive to be the best in all areas. They become confident at mastering skills and they seek the approval of peers, parents, and teachers.

The parent of a 4-year-old is expressing concern that this child is not talking as much—or as well—as her other children did at that age. Which question should the nurse prioritize when assessing this preschooler for this concern? a. "How often do you or a family member read to your child?" b. "Has your child had their hearing tested?" c. "Does your child have opportunities to have conversations with other people?" d. "Do you praise and give your child encouragement when the child tries to talk with you?"

Ans B Delays or other difficulties in language development may result from hearing impairment or other physical problems. Although reading to the child, having conversations with family members and other people, and praising and encouraging the child's efforts to communicate help the child develop language skills, most importantly a hearing concern would need to be assessed and treated.

A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The parent explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond? a. "Are you kidding me?" b. "Tell me about Boo-ga-loo." c. "Where did you get that funny name?" d. "I don't see anyone."

Ans B 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. "Tell me..." does this. The other responses do not.

The nurse is conducting a physical examination of a young preschooler and detects the odor of tobacco smoke on the parents' hair and clothing. How should the nurse respond? a. "You should stop smoking around your child." b. "Tell me about your child's exposure to tobacco smoke." c. "Tobacco smoke is linked with an increased number of ear infections." d. "Are you aware that exposure to tobacco smoke can be associated with behavioral difficulties?"

Ans B The nurse needs to emphasize that parents should protect their child from all tobacco smoke. It is best to ask an open-ended question to determine who uses tobacco products or where exposure to tobacco smoke could be occurring. The nurse should not assume that the parents are smokers and telling them to stop is inappropriate. Telling the parent tobacco smoke can be linked to ear infection and behavioral difficulties is true but is unlikely to open a dialogue.

The nurse is providing teaching about preventing poisoning. Which statement by the parent would warrant further discussion? a. "We keep our lawn and garden products on a high shelf in the garage." b. "All medicine in our bathroom is in childproof containers." c. "I never transfer cleaning products out of their original containers." d. "We have the poison control number located near our phone."

Ans B The nurse should emphasize that while childproof caps on medications are important, all medications including those with childproof caps should still be kept locked. (Vitamins are medications.) The other statements are correct.

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of these actions? (Select all that apply.) a. A time-out of about 8 minutes would be appropriate for intentional misbehavior. b. Anticipate situations likely to cause misbehavior and redirect the child to another activity. c. When discussing improper behavior, call the behavior "bad" or "naughty," not the child. d. Books and stories can help preschoolers master proper behavior. e. Spank with an open hand only and never with an object.

Ans B, C, D Spanking is the least effective discipline and discouraged by pediatric professionals. If chosen by parents, it should be infrequent and done only with an open hand. Labeling behavior and not the child supports self-esteem. One minute per year of age is an appropriate length for time-outs. Redirecting from events that tend to lead to misbehavior is wise and reduces conflict. Preschoolers can learn much from stories and books including appropriate behavior.

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? (Select all that apply.) a. Fast food eaten once a month b. Food used as reward or punishment c. A parent who is overweight d. Television on during meals e. Mealtimes organized and regular f. Expectations to eat everything on plate

Ans B, C, D, F Overweight parents, food used as reward or punishment, TV viewing during meals, and the "clean plate club" all are factors that contribute to weight gain. The frequency the family eats fast food is not excessive. Regular, structured meals result in less snacking and more nutritious meals. Family eating together is bonding.

The nurse is doing a well-child exam of a 5½-year-old child. Which statement by the parent would alert the nurse that further teaching is needed about healthy eating habits? a. "I try to set a good example and eat a variety of fruits and vegetables." b. "My child enjoys planning meals and helping me in the kitchen." c. "Our family rule is that all children clean up their plates at each meal, and we feed them a lot." d. "We eat fast food less than once a month."

Ans C Children should not be expected to always eat everything on their plates, nor should they be rewarded for doing so. Appropriate serving sizes are important here. Children need to learn to self-regulate and eat only until full. The other statements indicate knowledge of healthy eating habits and are useful in developing positive attitudes toward eating and toward trying different foods.

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. Eliminating caffeine sources beginning late afternoon b. Taking the TV set out of the child's room c. Allowing the preschooler to fall asleep wherever and whenever the child is tired enough d. Providing a nightlight

Ans C 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 the child awake.

Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased the child drinks "lots of milk." What risk does the nurse identify? a. Interference with growth b. Obesity c. Iron deficiency d. Dental caries

Ans C Meat is an important iron source while calcium in milk consumed in large quantities can block iron absorption. Alternate protein sources can replace the meat in the child's diet for growth. Excess milk intake that boosts calories consumed can be an obesity-causing factor. Lactose from milk in constant contact with the teeth can promote development of dental caries. However, these risks are slight, with the iron deficiency risk pronounced.

The nurse is conducting a well-child examination of a 4-year-old and is assessing the child's height. By how much should the nurse expect the child's height to have increased since last year's examination? a. 0.5 to 1 inch (1.27 to 2.54 cm) b. 1 to 2 inches (2.54 to 5.07 cm) c. 2.5 to 3 inches (6.35 to 7.62 cm) d. 3.5 to 4 inches (8.89 to 10.16 cm)

Ans C The average preschool child will grow 2.5 to 3 inches (6.35 to 7.62 cm) per year. Thus, the nurse would expect that the child's height would have increased 2.5 to 3 inches (6.35 to 7.62 cm) since last year's well-child examination.

The parents of a 5-year-old child are discussing bicycle safety with the nurse. What comment indicates further teaching is needed? a. "He never rides in the street." b. "Our son always wears a helmet." c. "We just got him a new bike he can grow into." d. "He is able to ride without training wheels."

Ans C The bicycle should fit the rider. The balls of his feet should reach both pedals while he is sitting on the seat and has both hands on the handlebars. The other comments describe no safety risk.

In counseling a group of parents regarding the development of school readiness in preschoolers, the nurse emphasizes: a. enrollment in a preschool. b. visiting the kindergarten. c. the home environment. d. library visits and story hour.

Ans C The home environment is the foundation for the child's learning and is the most important element for developing school readiness. Values regarding learning originate at home. Parents are the first teachers and role models. Structure, proper behavior with others, and language skills are all developed at home and are essential for school success. The other options are important but not as vital as the home environment. A preschool experience can foster social skills and group interaction. Library story hour and books develop language skills, and visiting a kindergarten can help the child make the transition to school.

The nurse is conducting a well-child exam of a 4-year-old child. Which statement would alert the nurse that the child is at risk for iron deficiency? a. "He does not like spinach, but he does like chicken and beef." b. "He eats a well-balanced diet." c. "He loves milk and drinks it every time he is thirsty." d. He enjoys eggs and fortified cereal for breakfast."

Ans C This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency.

In assessing the bilingual 4-year-old's speech and language development, the nurse should find that the child will: a. be prone to stuttering. b. mix the two languages in the same sentence. c. avoid asking questions. d. be able to use each language as a separate system.

Ans D The ability to use both languages separately is developed by 4 years. Mixing the two languages occurs during toddlerhood. The other options are not related to bilingualism and are incorrect.

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? a. "The balls of her feet should reach both pedals while sitting." b. "Pedal back brakes are better for her age group." c. "She should always ride on the sidewalk." d. "She can ride on the street if I am riding with her."

Ans D The preschooler is not mature enough to ride a bicycle in the street even if riding with adults, so the nurse should emphasize that the girl should always ride on the sidewalk even if the mother is riding with her daughter. The other statements are correct.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize: a. using and renewing sunscreen regularly. b. adults learning infant/child cardiopulmonary resuscitation (CPR). c. enrolling the child in swimming lessons. d. having the child wear a personal flotation device whenever near or on the water.

Ans. D

The parents of a 5-year-old call the nurse for advice about night terrors. The child has had them nightly for almost 2 weeks. What is the most appropriate intervention? a. Encourage the parents to let the child fall asleep in a safe place such as their bed. b. Explain that this is a developmental phase that will not last. c. Tell the parents to be sure to wake the child up during the next episode. d. Wake the child up nightly 30 to 45 minutes after going to sleep

Ans. D Awakening children early in their sleep cycle often interrupts the night terror events and should be continued nightly for about 7 days. Suggesting the parent wake the child during a night terror is both difficult and ineffective. A major reason parents find night terrors frightening is that the child does not respond to the parent's presence. Indicating this is a developmental phase may be somewhat accurate, but does not assist the parents in handling the situation. Having the child fall asleep in a "safe" place or the parents' bed is likely to predispose to other sleep problems without helping to solve this one.