Chapter 31: Nursing Care of a Family with a Preschool Child
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."
During a well-child visit, the parent of a preschool-aged child tells the nurse that their child is "daddy's girl." The parent says, "It seems like I do not exist." Which response by the nurse would be appropriate?
"Your child is showing normal behavior for their age."
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."
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." "Have your child hold hands with a grown-up in parking lots." "Role-model bicycle safety by wearing a helmet too."
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?
"Often, the afternoon nap will be no longer needed after 4 years."
The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do?
"Place her in a booster seat with lap and shoulder belts in the back seat."
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."
A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond?
"Tell me about Boo-ga-loo."
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 1/2 year-old child is found masturbating in the family living room. Which response by the parent would best address this behavior?
"We do not touch ourselves in public. Please go to your room if you want to continue this behavior."
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."
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."
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 46 lb (20 to 21 kg)
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?
Acting out a troubling or stressful situation
Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue?
Allowing the preschooler to fall asleep wherever and whenever the child is tired enough
A client who has just given birth to their second child is concerned that their preschool-aged child will be jealous when people bring gifts for the newborn. Which nursing instruction is appropriate in this situation?
Ask close relatives to bring a small second gift for the preschool-age child as well.
The nurse needs to discontinue the urinary catheter of a 4-year-old child who is afraid of the procedure. What strategy(ies) will the nurse use to help the child to cope with this procedure? Select all that apply.
Be honest with the child about what to expect with catheter removal. Have a doll available that the child can play with and demonstrate on. Answer all of the child's questions before starting the catheter removal.
The nurse is providing anticipatory guidance for parents of a preschool-age child regarding sex education. What is a recommended guideline when dealing with this issue?
Before answering questions, find out what the child thinks about the subject.
A mother confides in a nurse that her preschool daughter only wants to play with her father as soon as he comes home from work in the evenings and does not seem to have any interest in spending time with the mother. This phenomenon is an example of:
Electra complex.
The parents of a 4-year-old child report challenges with bedtime and falling asleep. The child wakes at 0700 and naps from 1300 to 1500. Bedtime is at 1930, but the parents report that the child often takes up to 3 hours to fall asleep and is tired and cranky the next day. What will the nurse recommend for this child's sleep?
Eliminate the afternoon nap to improve bedtime and nighttime sleep.
The nurse is providing health-promotion teaching to a group of parents of 4-year-old children at a local day care. What information will the nurse include in this education session? Select all that apply.
Encourage your preschool-aged child to brush their teeth twice a day with a pea-sized amount of toothpaste. Ensure your preschool-aged child knows their address and phone number. Encourage unstructured physical activity every day for your preschool-age child.
A 3½-year-old child hits another child in prekindergarten and pushes her down. The mother calls the clinic to ask why her child is so aggressive and asks what to do. The nurse's advice would include which suggestion?
Explain that aggression is a common behavior for a child this age but the child must understand that hurting someone is not acceptable.
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
The child care facility for preschool-aged children has had several outbreaks of gastrointestinal illness. What will the nurse recommend to the teachers to prevent future outbreaks?
Supervise and assist the children with handwashing.
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 preschool-age child, which action does the nurse predict will occur?
Takes in new information at a rapid rate and asks "why" and "how"
A nurse is preparing an educational seminar about the moral and spiritual development of preschoolers. When describing this topic, which information would the nurse include?
Tendency to do good out of self-interest
Which gross motor skill would the 4-year-old child have most recently attained?
The child can hop on one foot.
The nurse is supervising lunch time for preschool-aged children on a pediatric ward. Which observation is considered abnormal for this age group?
The child uses their fingers and refuses to use a fork.
The parents of a preschool-age child express concern to the nurse about their child's new habit of masturbating. What is an appropriate response to this concern?
Treat the action in a matter-of-fact manner, emphasizing safety.
Fear of mutilation is significant during the preschool age.
True
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.
The mother of a 4-year-old is concerned her child is not eating well. In addressing the concerns of this mother, which foods should the nurse point out are high in protein? Select all that apply.
cheese and crackers whole grain granola with yogurt turkey sandwich
The nurse needs to purchase toys or activities for preschool-aged children for the clinic waiting room. Which toy would be the best choice for this age?
play kitchen and food
The nurse assesses a 5-year-old client for a well-child visit prior to the start of school (above). What finding from the assessment requires follow-up?
speech and language
In counseling a group of parents regarding the development of school readiness in preschoolers, it is most important to emphasize:
the home environment.
A 4-year-old female client presents to the clinic with an increased temperature. Based on the assessment findings (above), what does the nurse anticipate the primary health care provider will prescribe for this client?
urinalysis, culture and sensitivity
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.
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 Urge children never to talk to or accept a ride from a stranger.
The nurse is caring for a 4-year-old child who will require intravenous (IV) contrast for magnetic resonance imaging (MRI). What strategy(ies) will the nurse include in the care plan for this child? Select all that apply.
Encourage the child's parents to stay during the IV initiation. Allow the child to ask questions about the procedures. Ensure the child understands that the IV and MRI are not punishment for bad behavior. Provide the opportunity to see equipment in advance of the procedures.
