Chapter 27: Growth and Development of the Preschooler

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? A.) Tell the child that everything will be fine and not to worry. B.) Insist that the parents stay with the child at all times. C.) Allow the child to handle the equipment before it is used on the child. D.) Provide all of the child's care, including all ADLs.

Answer: C.) Allow the child to handle the equipment before it is used on the child.

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

Answer: A.) cooperative play Rationale: 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.

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

Answer: A.) Orange

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."

Answer: A.) "Your child is not expected to be able to perform those activities at 3 years of age."

When assessing a preschool-aged child, which activity is most closely associated with the primary psychosocial task of this age group? A.) attempting to dress oneself B.) trying not to cry when upset C.) making friends with other children of the same age group D.) self-soothing when upset

Answer; A.) attempting to dress oneself Rationale: The primary psychosocial task of the preschool age is demonstration of initiative. Dressing oneself would be an example of displaying independence in action. Trying not to show emotion and making friends are activities associated with older children. Self-soothing is an activity seen in younger children.

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? A.) hop on one foot B.) walk backwards with heel to toe C.) ride a bicycle D.) jump rope

Answer: A.) hop on one foot Rationale; The 4-year-old should be able to hop on one foot and can control movements of the hands. By the age of 5 the child can walk backwards heel to toe, throw and catch a ball well, and jump rope.

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.

Answer: A.) imagination in a 3-year-old is at its peak.

Which gross motor skill would the 4-year-old child have most recently attained? A.) The child can hop on one foot. B.) The child can tie his/her shoelaces. C.) The child can cut his/her food. D.) The child can button his/her clothes.

Answer; A.) The child can hop on one foot.

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? A.) imagination B.) vocabulary C.) gross motor skills D.) fine motor skills

Answer; A.) imagination

The nurse is organizing an indoor play area for preschool-age children. Which play materials are least important? A.) Electronic teaching toys B.) Cut, paste, drawing, and painting materials C.) Dress-up clothes and hats and puppets D.) CD player with music and musical instruments E.) Balls, blocks, and puzzles

Answer: A.) Electronic teaching toys

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? A.) opening drawers in the room, pulling out supplies, and examining them B.) singing a song he learned at preschool C.) roughhousing with his father D.) reading a book

Answer: A.) opening drawers in the room, pulling out supplies, and examining them Rationale: The developmental task for the preschool-age child is to achieve a sense of initiative versus guilt (Erikson, 1993). Children with a well-developed sense of initiative like to explore as they have discovered that learning new things is fun. Opening the drawers, pulling out supplies, and examining them is the best example of initiation and exploration among these answers. Roughhousing and singing a song learned in preschool are examples of typical play for preschool children. Reading a book at age 4 would be developmentally precocious but would not necessarily be the best example of initiative.

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by a caregiver best indicates a common aspect of the diet and nutrition of the preschool child? A.) "My child is so picky and eats the same thing every day for days on end!" B.) "My 4-year-old eats as much as my teenager does every day." C.) "My spouse is insistent that our 5-year-old not eat any snacks so that he will eat all of his meal at mealtime." D.) "Our child gets into food jags where he will only eat one food all day long."

Answer: A.) "My child is so picky and eats the same thing every day for days on end!"

A nurse is teaching a group of parents of preschoolers about safety. Which information would the nurse include? Select all that apply. - "Do not refer to medicines as candy." - "Do not allow your child to approach strange dogs." - "Allow your child to ride in the front seat of the car." - "Have your child hold hands with a grown-up in parking lots." - "Role-model bicycle safety by wearing a helmet too."

Answer: - "Do not refer to medicines as candy." - "Do not allow your child to approach strange dogs." - "Have your child hold hands with a grown-up in parking lots." - "Role-model bicycle safety by wearing a helmet too."

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."

Answer; C.) "It's best to answer his questions using accurate anatomical names and keep your answers simple."

The nurse is caring for a family with a preschool-aged child. Which statement(s), when made by the parent, would alert the nurse to provide further teaching to the parents about the risk for obesity for their child? Select all that apply. - "I have been overweight since I was an adolescent, so I will be sure to watch for obesity as my child reaches adolescence." - "I like to reward my child with a fresh sliced apple or orange if my child completes the chores each day." - "I limit the amount of fruit juice my child drinks to 2 cups per day." - "We believe that a child should only eat until they are full....regardless of food waste." - "I make sure the servings I serve my child are 3/4 the amount I serve myself." - "We are so glad our child loves to drink milk...we go through a lot of milk each day."

Answer: - "I have been overweight since I was an adolescent, so I will be sure to watch for obesity as my child reaches adolescence." - "I like to reward my child with a fresh sliced apple or orange if my child completes the chores each day." - "I limit the amount of fruit juice my child drinks to 2 cups per day." - "I make sure the servings I serve my child are 3/4 the amount I serve myself." - "We are so glad our child loves to drink milk...we go through a lot of milk each day."

Parents tell the nurse their 3-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify? A.) iron deficiency B.) interference with growth C.) obesity D.) dental caries

Answer: A.) iron deficiency

A nurse is preparing a presentation for a health fair discussing various aspects of preschoolers. Which example should the nurse use to best illustrate dramatic play? A.) Playing apart from others without being part of a group B.) Acting out a troubling or stressful situation C.) Playing a video game with several other children D._ Watching television or videos

Answer: B.) Acting out a troubling or stressful situation

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

Answer: C.) Parental anxiety related to lack of understanding of childhood development Rationale: 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.

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

Answer: A.) Pretending to be mommies and daddies in the playhouse Rationale: 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.

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 is above normal in weight but I'm sure it's just baby fat and will be lost with age." - "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." - "The only way I can get my child to consume sources of vitamin C is through fruit juices. I guess it's better than not at all." - "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda."

Answer: - "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."

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." - "I am very concerned that our child is acting too much like some of the other children at our day care." - "My parents are the only babysitters our child has ever had. I think contact with mostly adults is important for this age." - "We have been talking about enrolling in a morning preschool program since this is our only child."

Answer: - "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 child." Rationale: Making friends and playing with other children of the same age is important for socialization of the preschool-age child. Play dates, preschool, and day care are a means of socialization for the preschool child. Preschool children commonly display behavior of their peers, which is not an issue if it is acceptable behavior.

The nurse is preparing an educational program for parents of preschool-age children to promote personal safety. Which information should the nurse include in this program? Select all that apply. - Reducing the intake of fast-food items - Limiting exposure to household chores - Chewing food thoroughly before swallowing - Explaining who police are and what they look like - Teaching to never talk with or accept a ride from a stranger - Never enter into a street without an adult

Answer: - Explaining who police are and what they look like - Teaching to never talk with or accept a ride from a stranger - Never enter into a street without an adult Rationale: To promote personal safety in the preschool-age child, the nurse should instruct families to explain the role and purpose of police to the child, never enter into a street without an adult, and teach to never talk to or accept a ride from a stranger. Reducing the intake of fast-food items will help with weight control. Limiting exposure to household chores has no identified value. Chewing food thoroughly before swallowing can help with digestion and weight control.

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage? A.) asking the girl to slow down and to think before she talks B.) looking at the child while she is speaking C.) enunciating clearly and slowing down parental speech D.) giving the child opportunity to speak and finish her ideas

Answer: A.) asking the girl to slow down and to think before she talks

The home health nurse, who is visiting a home with a 4-year-old child, prepares a nursing care plan to address the child's risk for injury related to the parents' insufficient knowledge of safety practices for preschool-aged children. Which nursing intervention(s) will the nurse include in the plan of care? Select all that apply. - Teach the parents to use a forward-facing car seat with a harness and top tether. - Teach the parents to smoke one at a time outside the home when the child is inside the home. - Teach the parents that the child should use an approved bicycle helmet when riding a bicycle at any time. - Instruct the parents that they should teach the child to wash the hands when soiled. - Teach the parents that medications can be kept in unlocked cabinets if childproof caps are used.

Answer: - Teach the parents to use a forward-facing car seat with a harness and top tether. - Teach the parents to smoke one at a time outside the home when the child is inside the home. - Teach the parents that the child should use an approved bicycle helmet when riding a bicycle at any time. - Instruct the parents that they should teach the child to wash the hands when soiled. Rationale: Parents should not smoke in an enclosed space in which the child is located. This would still expose the child to secondhand smoke. Smoking one at a time outside will ensure the child inside the home is supervised. If properly instructed, the preschool-aged child is capable of washing the hands independently. A 4-year-old child who rides a bike should wear a properly fitted helmet. Childproof caps should be used in addition to keeping medications out of the reach of children, preferably a locked cabinet.

A nurse is developing a teaching plan for parents of preschoolers about how to address the issue of strangers and safety. Which would the nurse expect to include in the teaching? Select all that apply. - Urge children never to talk to or accept a ride from a stranger. - Wait until children are old enough to tell them how to call for help in an emergency. - Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. - Urge your children to report others who are bullying. - Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.

Answer: - Urge children never to talk to or accept a ride from a stranger. - Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. - Urge your children to report others who are bullying. - Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.

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. - A time-out of about 8 minutes would be appropriate for intentional misbehavior. - Spank with an open hand only and never with an object.

Answer: - 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. Rationale: 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. Preschool-age children can learn much from stories and books including appropriate behavior.

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? A.) "He loves milk and drinks it every time he is thirsty." B.) "He eats a well-balanced diet." C.) "He enjoys eggs and fortified cereal for breakfast." D.) "He does not like spinach, but he does like chicken and beef."

Answer: A.) "He loves milk and drinks it every time he is thirsty."

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? A.) "I will need to find an appropriate punishment for him if this continues." B.) "I have heard that both boys and girls often touch themselves at this age." C.) "I should teach him certain rules about this activity." D.) "This is probably a good time to talk about safety and who can touch him."

Answer: A.) "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? A.) "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." B.) "Are you sure about this because I haven't noticed this. Maybe he just does this to get a response from you when he is at home." C.) "I will ask your child's teacher if he is speaking this way during class. It may be an attention seeking effort on his part." D.) "Language development is critical at this age. I will notify our language specialist so this can be dealt with as soon as possible."

Answer: A.) "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."

The mother and father of a 5-year-old boy are discussing bicycle safety with the nurse. What comment indicates further teaching is needed? A.) "We just got him a new bike he can grow into." B.) "Our son always wears a helmet." C.) "He never rides in the street." D.) "He is able to ride without training wheels."

Answer: A.) "We just got him a new bike he can grow into." Rationale: The bicycle should fit the rider to reduce the risk of an accident while riding. 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.

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? A.) "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." B.) "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you." C.) "Oh no! I have a crocodile in my room. Please don't bite me!" D.) "What happened to my client? Did you eat her?"

Answer: A.) "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile."

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

Answer: A.) having the child wear a personal flotation device whenever near or on the water. Rationale: 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. CPR is a life-saving skill and using sunscreen will protect the skin, but neither will be a factor in preventing drowning.

A nurse observes a 3-year-old child playing with an older sibling. In which type of play would the nurse expect to see the siblings engaged? A.) imitative play B.) parallel play C.) hand regard D.) nonverbal play

Answer: A.) imitative play Rationale: Preschoolers do not need many toys because, with an imagination keener than it will be at any other time in life, they enjoy games that use imitation or pretending (teacher, cowboy, firefighter, etc.). Four- and 5-year-olds divide their time between rough-housing and imitative play. Five-year-olds become interested in group games or reciting songs they have learned in kindergarten or preschool. Parallel play is the type of play prevalent among toddlers and involves children sitting side by side, each playing with his or her own toys but not interacting with the other. Hand regard is a phenomenon among infants in which they hold their hands in front of their faces and study them. As preschool-age children are actively developing their language skills, their play is not likely to be nonverbal.

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.

Answer: A.) testing and identification of group role. Rationale; 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 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: A.) transduction. B.) magical thinking. C.) animism. D.) beginning empathy.

Answer: A.) transduction. Rationale: The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl 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 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?"

Answer: B.) "Has your child had their hearing tested?"

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? A.) "I will add some crayons, chalk and finger paints to my three-year-old's birthday gifts." B.) "I am so glad I can get rid of all of those bath toys because they take up so much room." C.) "It is okay for my four-year-old to still play in his sandbox." D.) "My four-year-old will be getting a tricycle for her birthday. I'm glad it's a good gift for her."

Answer: B.) "I am so glad I can get rid of all of those bath toys because they take up so much room." Rationale: Bath toys that squeak, float and squirt are appropriate toys for preschoolers. Creative toys like crayons, chalk and finger paints; gross motor toys like tricycles, big wheels and swing sets; and a sandbox with shovels and other toys for building are also appropriate toys for preschoolers.

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? A.) "Kindergarten is a big step for a child. Be patient with him." B.) "Talk to your son's new teacher and schedule a tour with him." C.) "Be aware that he may have difficulty adjusting being away from home 5 days a week." D.) "Remind him that kindergarten will be a lot of fun and he'll make new friends."

Answer: B.) "Talk to your son's new teacher and schedule a tour with him."

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."

Answer: B.) "Use the time-out technique for discipline."

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."

Answer: B.) "When we go to the park, my child never wants to play with the other children." Rationale: 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

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? A.) 38 lb to 40 (17.2 to 18.1 kg) B.) 44 to 46 lb (20 to 21 kg) C.) 50 to 52 lb (22.7 to 23.6 kg) D.) 58 to 60 lb (26.3 to 27.2 kg)

Answer: B.) 44 to 46 lb (20 to 21 kg) Rationale: The preschool age child gains about 4 to 5 lb (1.8 to 2.3 kg) each year and grows about 2.5 to 3 in (6.3 to 7.6 cm). So a 36 lb (16.3 kg) child at 3 years gaining 4 to 5 lb (1.8 to 2.3 kg) per year would be 44 to 46 lb (36 lb + 8 lb = 44 lb; 36 lb + 10 lb = 46 lb).

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? A.) Scold the child for the insult while apologizing for hurting her, and loosen the cuff. B.) 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. C.) Explain that the cuff will only hurt for minute and ask the child's caregiver to please tell the child not to speak to you that way. D.) Ask the child's caregiver to please hold the child on their lap until she calms down.

Answer: B.) 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 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? A.) Tell the child that you will give a treat for buckling up. B.) Do not start the car until seat belts are in place. C.) Warn the child of punishment for not buckling up and then follow through. D.) Arrange for a babysitter to avoid taking the child in the car.

Answer: B.) Do not start the car until seat belts are in place.

A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers? A.) Washing hands after using the bathroom B.) Placing the child in an approved car seat C.) Using gates at the top of the stairs D.) Putting latches on lower cabinets

Answer: B.) Placing the child in an approved car seat Rationale: The leading cause of death in the preschool group is automobile accidents, followed by poisonings and falls. Placing the child in an approved car seat is a safety precaution to help prevent serious injury and even death. All safety measures help keep children safe. Putting latches on the lower cabinets and using a baby gate at the top of the stairs are important to prevent poisonings and to prevent falls which could cause head injuries and fractures. Many infectious diseases are preventable as a result of health promotion and illness prevention techniques.

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? A.) Toddler B.) Preschool C.) School age D.) Adolescence

Answer: B.) Preschool

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.

Answer: B.) Specific program goals to be accomplished should be available.

The nurse is caring for several clients on the pediatric unit. When interacting with the preschool-age child, which action does the nurse predict will occur? A.) Increased attention span and can be interested in an activity for a long length of time B.) Takes in new information at a rapid rate and asks "why" and "how" C.) Insists doing something and the next moment reverts to being dependent D.) Grows and develops skills more rapidly than at any other time in their life

Answer: B.) Takes in new information at a rapid rate and asks "why" and "how" Rationale: The preschool-aged child soaks in information and asks "why" and "how" over and over. The school-aged child has a longer attention span and can become absorbed in a craft or activity for several hours. The toddler insists he or she can do things one minute and then becomes dependent the next minute. The infant grows and develops skills more rapidly than he or she ever will again.

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

Answer: B.) dressing in the mother's coat to play house

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

Answer: B.) presence of 10 deciduous teeth Rationale: 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 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? A.) Health-seeking behaviors B.) Risk for imbalance nutrition, more than body requirements C.) Parental anxiety related to lack of understanding D.) Delayed growth and development related to frequent illness

Answer: D.) Delayed growth and development related to frequent illness

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? A.) "I think we need to plan how to discipline your child when acting out this way." B.) "We don't allow children of this age to throw tantrums so you will need to manage your child's behavior." C.) "Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." D.) "I am concerned that your child may have a developmental delay since most children of this age don't throw temper tantrums."

Answer: C.) "Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." Rationale: Typically temper tantrums are few or absent in occurrence by the time the child is of preschool age. Asking if this is typical behavior at home is appropriate in determining if this is just aggressive behavior or if this is a sign of a developmental delay. It is generally not necessary to discipline a child for temper tantrums and disciplining is not in the nurse's scope of practice.

The nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child? A.) "I ran the race better than my best friend because he was slow." B.) "I told the other child no, when he asked me to cheat at the game." C.) "Look! I am a nurse, and I am helping people feel better!" D.) "I lost the game because I did not play good, and I am sad."

Answer: C.) "Look! I am a nurse, and I am helping people feel better!"

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? A.) "Children no longer nap in the afternoon after 1 year." B.) "Children begin to give up afternoon napping at 2 years." C.) "Often, the afternoon nap will be no longer needed after 4 years." D.) Since they are in school now all day, napping ends at 6 years.

Answer: C.) "Often, the afternoon nap will be no longer needed after 4 years."

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? A.) "The school has a loose environment, which is a good match for his temperament." B.) "The school requires processed foods and high sugar foods be avoided." C.) "The school is quite structured and advocates corporal punishment." D.) "There is a very low student-teacher ratio, and they do a lot of hands-on projects."

Answer: C.) "The school is quite structured and advocates corporal punishment."

The mother of a 4-year-old boy reports her son has voiced curiosity about her breasts. She asks the nurse what she should do. Which information is best for the nurse to give the parent? A.) Advise the parent that sexual curiosity is unusual at this age. B.) Encourage the parent to provide a detailed discussion about human sexuality with the child. C.) Encourage the parent to determine what the child's specific questions are and answer them briefly. D.) Advise the parent to explain to the child that he is too young to discuss such things.

Answer: C.) Encourage the parent to determine what the child's specific questions are and answer them briefly.

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? A.) Playing apart from others without being part of a group. B.) Playing together in an activity without organization. C.) Playing in an organized group with each other. D.) Playing independently and are side-by-side.

Answer: C.) Playing in an organized group with each other.

The nurse is presenting nutritional information at a community health fair. Which suggestion should the nurse prioritize when illustrating proper nutrition for preschoolers? A.) Need three big meals a day due to rapid growth B.) Need extra calcium for proper muscle growth C.) Snacks throughout the day help the child meet nutritional requirements D.) Should drink at least 4 cups of milk each day

Answer: C.) Snacks throughout the day help the child meet nutritional requirements

The parents of 5-year-old boy are concerned about the how a recent motorcycle accident to his father will affect the child. Although the father has fully recovered, the child is very concerned if the father is away longer than expected; the child is not as talkative but appears withdrawn and quiet. The nurse should point out the child's behavior is likely related to which factor? A.) The child is afraid of losing his father and trying show how much he loves him. B.) The boy is afraid of being hurt himself and thinks being "especially good" will protect him from accidents. C.) The boy believes he caused the accident by telling his father he "hoped he crashed" when the boy couldn't go along. D.) The child is imitating the adults' behavior and just trying to be nice to everyone.

Answer: C.) The boy believes he caused the accident by telling his father he "hoped he crashed" when the boy couldn't go along.

The nurse is providing anticipatory guidance and education to the parents of child entering into the preschool age group. What information would the nurse include in the teaching? A.) The child will have an emergence of permanent teeth by the age of 4 years. B.) The child's cognitive growth will not be as intense as the child leaves the toddler stage. C.) The preschool-age child's physical growth will slow compared to previous years. D.) The preschool-age child will be less tolerant of separation from parents than during the toddler stage.

Answer: C.) The preschool-age child's physical growth will slow compared to previous years.

The mother of a preschool-aged child is pregnant and wants to enroll the child in a child care program. When would the nurse suggest that the child be enrolled in this program? A.) By 4 years of age regardless of the pregnancy B.) Now, because the new sibling will take up the mother's time C.) Three months before the baby is born, after the mother stresses that the child is growing up D.) Immediately after the baby is born so that the child will feel less jealous and more secure

Answer: C.) Three months before the baby is born, after the mother stresses that the child is growing up Rationale: If children are to start preschool or child care, it's best if they can do so either before the new baby is born or 2 or 3 months afterward. That way, children can perceive starting school as a result of maturity and not of being pushed out of the house by the new child. There is no time limit about when a child should start preschool. The mother should not tell the child that the new baby will be taking up all of the mother's time.

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.

Answer: C.) Weight is above an expected range and height is within an expected range. Rationale: 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

Answer: C.) imaginary friend

When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate? A.) has best friends at preschool and sleepovers B.) begins to show logical thought processes C.) tells a fantasy story about a bear and a car D.) scribbles with no discernable pictures/letters

Answer: C.) tells a fantasy story about a bear and a car Rationale: 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.

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? A.) "Is there a reason you are concerned about your child's height?" B.) "Your son is slightly below the normal height for his age group but may still grow to be a normal height in the coming year." C.) "Your son is slightly below the normal height for his age but he had demonstrated a normal growth rate this year." D.) "Both your son's height and rate of growth are within normal limits for his age."

Answer: D.) "Both your son's height and rate of growth are within normal limits for his age." Rationale: The average 4-year-old child is 40.5 in (103 cm). The average rate of growth per year is between 2.5 and 3 in (6.35 and 7.62 cm). The child in the scenario demonstrates normal stature and growth patterns.

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? A.) "Stuttering is common in young children because they are not physically capable of forming all the sounds." B.) "Stuttering is usually indicative of a hearing loss." C.) "Difficulties with speaking generally indicate that the adults in the child's life are not reading to the child enough." D.) "Children of this age may stutter while they search for just the right word."

Answer: D.) "Children of this age may stutter while they search for just the right word."

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? A.) "I put him in time-out when the problem occurs." B.) "He is allowed out of time-out when he is calm." C.) "The time-out doesn't just have to be in his room." D.) "I usually have him in time-out for about 10 minutes."

Answer: D.) "I usually have him in time-out for about 10 minutes." Rationale: 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. Time-outs do not have to occur in the child's room; any location where the child is removed from activity and has an opportunity to become calm will do.

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."

Answer: D.) "She can ride on the street if I am riding with her."

The nurse has completed an education program on normal communication abilities in the preschool-age child. Which statement by a participant indicates a need for further education? A.) "I am glad to know that my 4-year-old child asking so many questions is normal." B.) "My child is finally talking in a way that most of my friends can understand her speech." C.) "When my child counts numbers, it is only to 10 and we are slowing working on counting higher." D.) "Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that."

Answer: D.) "Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that." Rationale: The preschool-age child is known for asking lots of questions, and this is normal. At this age, 75% of the child's speech is understood by others outside of the family. The preschool-age child can easily count to 10, and the parents stating they were slowly working on counting higher is acceptable, as long as the parents do not push the child. A child at 5 years of age should be able to state one's name and address.

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? A.) "I guess you don't know much about counting yet." B.) "Don't lie to me. That's never a nice thing to do to someone." C.) "Does it make you feel more important when you add on brothers?" D.) "That is a good pretend answer but tell me the names of the brothers you really have."

Answer: D.) "That is a good pretend answer but tell me the names of the brothers you really have."

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

Answer: D.) Risk for caregiver role strain

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? A.) Initiative versus guilt B.) Autonomy versus shame and doubt C.) Trust versus mistrust D.) Industry versus inferiority

Answer; A.) Initiative versus guilt

A nurse is caring for a 4-year-old child. The parents indicate that their child often reports that objects in the house are his friends. The parents are concerned because the child says that the grandfather clock in the hallway smiles and sings to him. Which response by the nurse is best? A.) "Your child is demonstrating animism, which is common." B.) "Attributing lifelike qualities to inanimate objects is quite normal at this age." C.) "Has your child suffered any type of physical trauma lately?" D.) "Is there any family history of mental health disorders?"

Answer; B.) "Attributing lifelike qualities to inanimate objects is quite normal at this age."