CH 5: G&D of the Preschooler
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
During the health history, the nurse asks a 4-year-old about objects he is viewing. One of the objects is a car. The child tells the nurse that the car is "what mommy uses to take me to school." The nurse interprets this statement as indicating:
egocentricity
The nurse is evaluating statistics of dental care of preschoolers in the community. Which should the nurse focus on as having the greatest overall impact?
fluoridated water system in the community
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?
height and weight
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."
A preschooler's mother asks the nurse an appropriate time to tell her son that she is pregnant. The nurse's best answer would be:
probably at the point she begins to look pregnant.
Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.
Parent knows the misbehavior was intentional. Warn the child there will be a time-out if the behavior does not stop. Remove the preschooler to a boring spot. Set a timer for no more than 4 minutes. If the child gets up, replace the child and restart the time.
The parents of a toddler are concerned their child is not developing correctly and are questioning the nurse concerning the child's lack of effort to join other children in a group activity. Which response should the nurse prioritize in answering the parents?
"This is normal for this age group. It's referred to as solitary independent play."
If the child is gaining weight at an expected rate, a child who weighs 36 lb (16.3 kg) at 3 years of age would weigh what amount at age 5?
44 to 46lb (20 to 21kg)
The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation?
Presence of 10 deciduous teeth
A parent tells a nurse that the child has recently established some friendships for the first time. In which age group do you expect this child to be?
Preschool
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.
"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."
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.
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.
While the nurse is taking a blood pressure on a 4-year-old, the child states that the blood-pressure cuff is too tight and angrily says, "That hurt, you big poo-poo head." What is the most appropriate response by the nurse?
Calmly explain that you don't mean to hurt her, loosen the cuff, and tell her that is isn't nice to call you names.
A mother is contemplating beginning her 3-year-old child in a Head Start program. What benefits of Head Start would the nurse explain to this mother to encourage her participation? Select all that apply.
Head Start allows children from disadvantaged home environments to experience environmental enrichment. Family caregiver participation is an integral part of the program. Children who attend Head Start are much better prepared for kindergarten than those who are not enrolled. The program helps foster strong cognitive skills in the child.
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.
The nurse is assessing a 4-year-old on a routine well-child visit. When assessing the gross motor skills of this preschooler, which activity will the nurse predict the child to be able to successfully accomplish?
Hop on one foot
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
The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium?
Orange
The nurse is presenting nutritional information at a community health fair. Which suggestion should the nurse prioritize when illustrating proper nutrition for preschoolers?
Snacks throughout the day help the child meet nutritional requirements
What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother?
Specific program goals to be accomplished should be available.
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.
The nurse is caring for several clients on the pediatric unit. When interacting with the preschooler, which action will the nurse predict to occur?
Takes in new information at a rapid rate and asks "why" and "how"
Which gross motor skill would the 4-year-old child have most recently attained?
The child can hop on one foot.
A 4-year-old child is drawing with crayons. Which creation by the child would most be reflective of the anticipated skill level of this age?
The child is able to draw shapes such as circles and squares.
The pediatric nurse is discussing the daily activities of a 4-year-old with the caregiver to assess growth and development status. The nurse would document that the child has reached the initiative stage of development if the caregiver indicates the child participates in which activity?
Tries to sweep up spilled cereal but cries when can't do well
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?
Weight is above an expected range and height is within an expected range.
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.
The student nurse is preparing a presentation on signs of developmental delay in preschoolers. Which examples of delays should be included? Select all that apply.
A 4-year-old that does not use sentences with five or more words
The nurse is caring for a 5-year-old who has been hospitalized after an episode of asthma. As the nurse prepares to teach the child how to use the nebulizer, which action should the nurse prioritize?
Allow the child to touch and play with the nebulizer for a few minutes before the treatment.
The nurse is meeting with a group of young parents to discuss nutrition and their preschooler. Which response should the nurse prioritize when asked if using desserts as a reward for good behavior is an appropriate idea?
Can use food to manipulate others' behavior
Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3-year-old is in what stage as identified by Piaget?
Preoperational thought
A parent brings the 4-year-old child for a check-up. Which finding would concern the nurse?
Resting pulse rate of 120
During an admission assessment the nurse is discussing the developmental level of the child with the parents. Which comments by the parents demonstrate a good understanding of developmental expectations of the preschool-aged child? Select all that apply.
"We think it is important to have play dates with our friend's preschool children." "Our child attends a wonderful preschool 3 times per week." "We have been talking about enrolling in a morning preschool program since this is our only
The father of a 4-year-old is concerned his child is not telling the truth and blaming others for things that have happened. Which response should the nurse prioritize after the father shares that the child is blaming someone named "Andrew" for a broken tool, and they have no idea who this is?
"Your son may have a friend named Andrew, but it could be an imaginary friend."
A nurse is developing a plan of care for a 4-year-old client with cystic fibrosis who has frequent hospitalizations related to his illness. Which would be the most appropriate nursing diagnosis for this client?
Delayed growth and development related to frequent illness
The nurse is presenting an in-service on the types of playing that children may engage in. The nurse determines the session is successful when the attending nurses correctly choose which example as representing cooperative play?
Playing in an organized group with each other.
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.
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."
A nurse is caring for a 4-year-old girl. The parents indicate that their daughter often reports that objects in the house are her friends. They are concerned because the girl says that the grandfather clock in the hallway smiles and sings to her. Which response by the nurse is best?
"Attributing life-like qualities to inanimate objects is quite normal at this age."
A young hospitalized patient cries constantly for daddy even though her mother has not left her side. When talking to the child's mother, the nurse learns that the 4 year old wants only her father. The child has even told her mother that she hates her on numerous occasions. What would be the best response by the nurse to support this mother?
"Her behavior is normal for her age. She will outgrow it."
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?
"Set a good example. Wear your own seat belt every time you drive."
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 nurse is conducting a health screening of a 5-year-old boy as required for kindergarten. The boy is fearful about going to a new school. The mother asks for the nurse's advice. Which response by the nurse is best?
"Talk to your son's new teacher and schedule a tour with him."
The mother and father of a 5-year-old boy are discussing bicycle safety with the nurse. What comment indicates further teaching is needed?
"We just got him a new bike he can grow into."
The mother of a 4-year-old child reports she has been trying in vain to teach her son to tie his shoelaces. She states she fears he may be "slow". Which action by the nurse is most appropriate?
Explain to the parent her child likely does not have the needed motor skills to achieve this task at his current age.
The mother of a 4-year-old girl reports her daughter has episodes of wetting her pants. The nurse questions the mother about the frequency. The nurse determines these episodes occur about once every 1 to 2 weeks. Which response by the nurse is indicated?
"At this age it is helpful to remind children to go to the bathroom."
A first-time father calls the pediatric nurse stating he is concerned that his 4-year-old daughter still wets the bed almost every night. Remembering his own experience of being punished for wetting the bed at 4 years old, he is not sure punishment is the best approach to address this. Which nursing instruction is the most appropriate?
"Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration."
The father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is most appropriate?
"Both your son's height and rate of growth are within normal limits for his age."
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."
In assessing the bilingual 4-year-old's speech and language development, the nurse should find that the child will:
be able to use each language as a separate system.
What would be most effective in helping promote initiative and nutritional health for a preschooler?
Allowing the child to spread soft cheese on crackers
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?
"It's best to answer his questions using accurate anatomical names and keep your answers simple."
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 mother of a 4-year-old child is concerned that she caught him masturbating in the bath tub. Which is the most appropriate response by the nurse?
"Masturbation is a normal part of preschool development."
The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply.
"My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda."
A school nurse has completed an educational program for parents of the preschool children. Which statement by a participant indicates a need for further education?
"My 5-year-old son still needs me to dress and undress him."
The nurse is caring for a 3-year-old at a well child check. 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."
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.
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 is assessing a 3-year-old at a well-child visit and the child appears to be progressing well. Which activity will the nurse ask the child to attempt to appropriately assess the fine motor skills of this preschooler?
Button clothes
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?
Imaginary friend
The nurse is assessing a 4-year-old child. Which assessment finding would the nurse identify as being of the highest concern?
Resting pulse rate of 120
The community health nurse is providing a class to a group of teens training to become "safe babysitters". When discussing activities that are appropriate for 3-year-olds, which should be included? Select all that apply.
Riding a tricycle Playing tag
A nurse is caring for a 4-year-old child that 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?
Allow the child to play with a procedure doll.
The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by the caregivers best indicates a common aspect of the diet and nutrition of the preschool child?
"My child is so picky and eats the same thing every day for days on end!"
During a well-child visit, the caregiver expresses concern that the 3-year-old child often stutters when speaking. Which response should the nurse prioritize to best assist this family?
"Children of this age may stutter while they search for just the right word."
During an extended stay in a hospital the nurse has observed a 5-year-old having several temper tantrums. How should the nurse address this behavior with the parents?
"Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here."
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?
"Has your child had her hearing tested?"
The nurse is conducting a well-child exam of a 4-year-old boy. Which statement would alert the nurse that the child is at risk for iron deficiency?
"He loves milk and drinks it every time he is thirsty."
The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education?
"I am so glad I can get rid of all of those bath toys because they take up so much room."
The parents of a 6-year-old tell the school nurse that they are worried that their child will fall behind other children academically because they are not able to afford expensive toys like computer games and handheld electronic devices. Which are acceptable responses by the nurse? Select all that apply.
"I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." "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." "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."
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 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?
2.5 to 3 inches (6.35 to 7.62 cm)
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."
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?
"Your child is not expected to be able to perform those activities at 3 years of age."
During a well-child checkup, the mother of a 5-year-old girl reports her daughter seems much smaller than her 2 older children did at this same age. A review of the medical record reveals that the child is 44 inches tall and weighs 42 pounds. What information should be included in the response by the nurse?
"Your daughter is slightly taller than other children her age but her weight is normal."
A mother comes to the clinic with her 4-year-old and tells the nurse that she is worried because the child does not talk much. Upon talking to the child, the nurse learns that the client has a normal vocabulary for age. The nurse is aware that language for a 4-year-old consists of at least approximately how many words?
1500 words
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 father who is overweight Food used as reward or punishment Television on during meals Expectations to eat everything on plate
A nurse is preparing a presentation for a health fair discussing various aspects of toddlers. Which example should the nurse use to best illustrate dramatic play?
Acting out a troubling or stressful situation
A family from India has recently moved to the United States. Their 5-year-old often visits the school nurse after lunch complaining of a "stomachache". The lunch staff tell the nurse that the child eats very little for lunch. What is the best action by the nurse?
Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch.
The nurse is providing health-promotion teaching to a group of parents of preschoolers at a local daycare. What information would the nurse include in this education session? Select all that apply.
Encourage children to select their own clothing to wear each day. Parents will need to supervise tooth-brushing and be responsible for flossing. Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry clothing.
The mother of a 3-year-old child reports her son is afraid of the dark. She asks the nurse for help. Which advice is best for the nurse to offer?
Encourage the parent to allow a small night light
A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which activity that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson?
Opening drawers in the room, pulling out supplies, and examining them
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?
Parental anxiety related to lack of understanding of childhood development
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?
Pretending to be mommies and daddies in the playhouse
A community health center is planning a seminar about the 2020 National Health Goals for preschool-age children. Which topics would be included in this seminar to address safety? Select all that apply.
Protection against second-hand smoke Providing helmets before riding a bicycle Using appropriate restraints in motor vehicles
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 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.
The developmental task of preschoolers is to achieve a sense of:
initiative versus guilt
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
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.
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
A parnt tells the nurse about being frustrated because the preschooler screams every time that 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.
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
The nurse is organizing an indoor play area for preschoolers. What play materials are least important?
Electronic teaching toys
