OB/Peds Chapter 31 Pre-School Child

The nurse is observing a group of 5 year olds playing in the playroom. Which developmental milestones does the nurse identify as newly acquired skills since turning 5 years old? Select all that apply.

Drawing a 6-part man Lacing one's shoes Explanation: A 5 year old can draw a 6-part man and lace his or her own shoes. The ability to draw a cross and stand on one foot is characteristic of a 3 year old. Jumping is characteristic of a 4 year old.

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 Explanation: The preschool period is not a time of rapid growth, so children do not need large quantities of food. Protein needs are high to provide for muscle growth. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. The preschool child needs 2 to 3 cups of milk each day.

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 Explanation: Dramatic play allows a child to act out a troubling or stressful situation. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. During cooperative play, children play in an organized group with each other as in team sports or video games. Onlooker play occurs when there is observation without participation, such as watching television or videos.

The parent of a four year-old child has expressed concern that the child is wetting her bed several times each week. What should the nurse teach the parent?

Bed wetting is not an unexpected behavior at this age Explanation: Bed wetting is not normally considered a problem unless it persists after the ages of 5 to 7. Limiting fluids after midafternoon may create a risk for dehydration.

A patient who has just given birth to her second child is concerned that her preschooler will be jealous when people bring gifts for the newborn. What would be the best suggestion to make to this mother about the gifts?

Ask people to bring a small second gift for the preschooler as well. Explanation: One suggestion to help minimize sibling rivalry when there is a newborn is for people who bring the baby gifts to also bring something for the preschooler. When friends and family visit the baby, they should try to spend some time also with the preschooler. The mother and visitors should not ask preschoolers if they like new siblings. It is better to convey empathy with the changes the situation are bringing by saying something like, "New babies cry a lot. I bet it is hard to get used to it."

Which activity would the nurse least likely include as exemplifying the preconceptual phase of Piaget's preoperational stage?

Beginning questioning of parents' values Explanation: In the intuitive phase of Piaget's preoperational stage, the child begins to question parents' values. Animism, active imaginations, and an understanding of opposites would characterize the preconceptual phase of Piaget's preoperational stage.

A 5-year-old child is overheard by her parents calling her dog a "fat boo-boo butt" and they are concerned. What advice would the nurse provide for them regarding this behavior?

Calmly correct the child, telling her not to say those words again. Explanation: Children this age often try out naughty words to see what kind of reaction they will get from their parents. Parents are encouraged to express their disapproval with the language and calmly tell the child not to say those words again. Ignoring the behavior will not correct it and punishment is not necessary.

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 Explanation: Meat, poultry, fish, milk products, and eggs are good sources of protein. Whole wheat grains, nuts, peanut butter, and legumes are also good sources of protein but need to be supplemented by some animal protein, such as meat, eggs, milk, cheese, cottage cheese, or yogurt. Cookies are usually high in sugar and not the best for supplying good nutrition. Fruit juices and fruit are good sources of vitamin C.

Which behavior by a 3 year-old child does not validate Erikson's developmental task for preschoolers?

Compares his soccer abilities with his peers. Explanation: Preschoolers are seeking out opportunities to prove themselves through completion of new tasks, demonstrating imagination through play activities and asking many questions -- 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, where children become competitive and strive to be the best in all areas. They become confident at mastery of skills and seek approval of peers, parents and teacher.

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. Explanation: Children who attend Head Start have an opportunity to experience a broadened understanding of the world, enhance their physical and emotional well-being, and foster and improve their cognitive skills. Caregiver participation is a central function of the program, which involves and educates the family. The program is free to all enrolled 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?

Hop on one foot Explanation: 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

During a well-child visit, the nurse is providing anticipatory guidance to the parents of a 3 year old about language development. When talking with the parents about this topic, the nurse would instruct that most of the preschooler's questions typically focus on which? Select all that apply.

How Why Explanation: The preschooler can ask up to 400 questions a day. Although the preschooler asks questions constantly, the majority of those questions focus on how and why.

Johnny exhibits the following growth pattern. Which interpretation of the data is accurate? Select all that apply.3 yrs: Ht. 37 inches Wt. 32 pounds4 yrs: Ht. 39 inches Wt. 39 pounds5 yrs: Ht. 40 inches Wt. 46 pounds

Johnny is growing slowly in height but rapidly in weight. Johnny may be at risk for overweight or obesity. Johnny's height and weight should be plotted on a growth chart. Explanation: The preschool child's growth is fairly even. The child should grow about 2½ to 3 inches and gain around 5 pounds yearly. Johnny is not following this pattern. 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 caring for a 5-year-old girl post-tonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process?

Magical thinking Explanation: The nurse understands that the girl is demonstrating magical thinking. Magical thinking is a normal part of preschool development. The preschool-age child believes her thoughts to be all-powerful. Transduction is reasoning by viewing one situation as the basis for another situation whether or not they are truly causally linked. Animism is attributing life-like qualities to inanimate objects. Centration is focusing on one aspect of a situation while neglecting others.

A mother describes her 4-year-old girl's eating habits as "picky" and goes on to describe using coaxing and threatening measures to get her to eat. The girl is at the 40th percentile for weight and 50th percentile for height. What interventions will be suggested? Select all that apply.

Offer a variety of healthy foods including those liked and refused. Approach mealtime matter-of-factly. Allow the child to decide how much she will eat. Offer only nutritious between-meal snacks. Focus on quality, not quantity. Explanation: Preschoolers often become "picky" eaters but when given the opportunity to include a wider variety in their diet eventually they do so. At 5 years of age, children become more receptive to different foods. Too much focus on eating may exacerbate the problem and requiring that the plate is cleaned may result in conflict at mealtime.

A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers?

Placing the child is an approved car seat. Explanation: 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.

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. Explanation: During cooperative play, children play in an organized group with each other as in team sports. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. Parallel play occurs when the toddler plays alongside other children but not with them.

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 Explanation: A 3-year-old is in the preoperational stage according to Piaget. Primary circular reaction is seen in infants of 3 months. Coordination of secondary schema is seen in infants at age 10 months. Tertiary circular reaction is seen in toddlers between 12 and 15 months.

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 Explanation: During the preschool years the preschooler learns to cooperate with other children. Learning how to make a friend is an important part of social development. Preschoolers need a special friend they can talk to, care about, and play with. The toddler is aware of other children but plays parallel to other toddlers, they do not interact or form friendships at their developmental level. School age children have developed friendships and often have close relationships with one or two friends, but have multiple friends in school. Friendships are very important to the adolescent child.They have established friendships throughout their lives.

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 Explanation: 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 explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. What is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative?

Reward the child for initiative in order to build self-esteem. Explanation: The building of self-esteem continues throughout the preschool period. It is of particular importance during these years, as the preschooler's developmental task is focused on the development of initiative rather than guilt. A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence. Routine and ritual continue to be important throughout the preschool years, as they help the child to develop a sense of time as well as provide the structure for the child to feel safe and secure. Also, consistent limits provide the preschooler with expectation and guidance. Giving children opportunities to decide how and with whom they want to play also helps them develop initiative.

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. Explanation: Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because the child believes that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Finger painting is a messy activity, so telling the child not to be messy takes the fun and the creative part out of the activity. The adult should provide aprons or clothing to protect the child's clothing and allow the painting in an area that can be cleaned easily.

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" Explanation: 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 they can do things one minute and then becomes dependent the next minute. The infant grows and develops skills more rapidly than they ever will again.

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 Explanation: Preschoolers tend to do good out of self-interest rather than from the development of a conscience. They determine right and wrong based on rules, not the reason or rationale for the rules. They have difficulty with rules that they know apply to a new situation. Preschoolers enjoy religious holidays and rituals based on the fact that these offer them reassurance and security.

Which gross motor skill would the 4-year-old child have most recently attained?

The child can hop on one foot. Explanation: Gross and fine motor skills continue to develop rapidly in the preschool-aged child. Gross motor skills have to do with the development of large muscles. Balance improves around the age of 4, thus the child can hop on one foot and stand on one foot for 5 seconds. A 3-year-old child does not have the ability to accomplish these tasks. A 5-year-old child can button his/her own clothes, tie shoes, and cut his/her food.

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which behavior would warrant nursing intervention?

The child does not want to play games with other children on the hospital ward. Explanation: The preschooler begins to plan activities, make up games, and initiate activities with others. Not wanting to play games with other children is a sign of a developmental delay and nursing intervention is recommended. The preschooler often has an imaginary friend who serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Through make-believe and magical thinking, preschool children satisfy their curiosity about differences in the world around them. The preschooler uses transduction when reasoning: he or she extrapolates from a particular situation to another, even though the events may be unrelated.

The nurse is supervising lunch time for children on a pediatric ward. Which observation is considered abnormal for this age group?

The child uses his fingers and refuses to use a fork. Explanation: The preschool child has learned to use utensils fairly effectively to feed himself or herself, has a full set of primary teeth, and is able to chew and swallow competently. Preschool children may be picky eaters. They may eat only a limited variety of foods or foods prepared in certain ways and may not be very willing to try new things.

In teaching caregivers of preschool children, the nurse would reinforce that which activity would be most important for this age group?

The preschool child should be properly restrained when riding in a vehicle. Explanation: A major cause of accidents in the preschool child occurs when the child is not properly restrained in a motor vehicle. Safety is the highest priority.

The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. What is an appropriate response to this concern?

Treat the action in a matter-of-fact manner, emphasizing safety. Explanation: Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong.

Fear of mutilation is significant during the preschool age.

True Explanation: Fear of mutilation is significant during the preschool age, as revealed by the intense reaction of a preschooler to even a simple injury such as falling and scraping a knee or having a needle inserted for an immunization. A child cries afterward not only from the pain but also from the intrusiveness of the injury or procedure.

A nurse is instructing a young mother on how to ensure a safe bath time for her 4-year-old son. Which are important suggestions for the nurse to give to the mother? Select all that apply.

Turn down the temperature of the water heater to under 120°F. Do not leave the child unsupervised in the bath tub. Assist the child in cleaning under fingernails and around ears. Explanation: When possible, parents should turn down the temperature of the water heater in their home to under 120°F to help prevent scalds. Although preschoolers certainly sit well in bathtubs, they should still not be left unsupervised at bath time in case they decide to add more hot water or to practice swimming and then be unable to get their head out of the water again. Some girls develop vulvar irritation (and perhaps bladder infection) from exposure to bubble bath so parents shouldn't add such products to the water. Although not well studied, cranberry juice may help prevent these infections the same as in adult women. However, in this case, the child is a boy, so a bubble bath would be fine and cranberry juice not needed. Preschoolers do not clean their fingernails or ears well, so these areas often need "touching up" by a parent or older sibling. Using a nonirritating shampoo and hanging a mobile over the tub so they have a reason to look up while their hair is rinsed helps make hair washing a fun procedure.

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. 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. Explanation: The preschool years are not too early to educate children about the potential threat of harm from strangers or how to address bullying from others. Appropriate measures include urging children never to talk to or accept a ride from a stranger; teaching them how to call for help in an emergency, encouraging them to tell parents if someone asks them to keep a secret about something that makes them uncomfortable, urging children to report any bullying behavior, and teaching them to say "no" to anyone whose touching makes them feel uncomfortable.

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. Explanation: The preschool period is one of slow growth. The child gains about 3 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 parents of a preschooler ask the nurse to help them choose a preschool for their child. What are recommended guidelines and goals for choosing a preschool? Select all that apply.

When selecting a preschool the parent may want to consider the accreditation of the school and the teachers' qualifications. The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices. The parent should observe the classroom to determine how the children interact with each other and how the teachers interact with the children. Explanation: When selecting a preschool, the parent may want to consider the accreditation of the school, the teachers' qualifications, and recommendations of other parents. The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices, as well as how the children interact with each other and how the teachers interact with the children. The main goal of preschool is to foster the child's social skills and accustom him or her to the group environment. The parents must decide how focused on curriculum they want the school to be. The type of discipline used in the school is also an important factor. Parents should not choose a preschool that uses corporal punishment.

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. Explanation: Preschoolers are becoming more independent and need to be allowed to pick out their own clothing, brush their teeth with adult supervision, and take care of their own toileting. If the child has an accident, treat it in a matter-of-fact manner and do not make a big deal out of it. Helmets are worn every time the child rides a bicycle, regardless of distance.

A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother?

"Acknowledge her fear and help her develop a strategy for dealing with it." Explanation: Preschoolers have vivid imaginations and experience a variety of fears. It is best to acknowledge the fear, rather than minimize it, and then collaborate with the child on strategies for dealing with the fear. Avoiding the playground will not address the child's fears. Forcing the child to face her fear without enlisting her input to help deal with the fear does not teach. It is also important for the mother to find out if an incident involving cats and dogs occurred without her knowledge.

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." Explanation: Occasional bedwetting is not uncommon for young preschoolers and is not a concern unless it continues past the age of 7. When the child does have an accident, treating it in a matter-of-fact way and providing the child with clean, dry clothing is best. The child should not be disciplined or made to feel he or she is socially unacceptable when bedwetting occurs.

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." Explanation: Between ages 3 and 5, language development is generally rapid. Most 3-year-old children can construct simple sentences, but their speech has many hesitations and repetitions as they search for the right word or try to make the right sound. Stuttering can develop during this period but usually disappears within 3 to 6 months. Physical capability, hearing loss, or lack of being read to are not reasons stuttering occurs.

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." Explanation: Appropriate safety measures include not referring to medicines as candy, not allowing the child to approach strange dogs, having the child continue to ride in the back seat of the car, ensuring that the child holds a grown-up's hand when in parking lots, and role modeling bicycle safety by wearing a helmet themselves.

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." Explanation: According to Freud children ages 3-7 years develop a jealousy and rivalry with the same sex parent and a love of the opposite sex parent. This usually resolves around the end of the preschool years. At this time the child generally develops a strong identity with the same sex parent. If parents are not aware of this stage of development then they can become resentful and hurtful of the child. Explaining this part of growth and development to the parent is an important role of the pediatric nurse. Making such statement such as having the dad put a stop to the behavior or the behavior not healthy is making an assumption or judgment that is not fact.

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." Explanation: The nurse should remind the father 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.

The parent of a preschooler asks the nurse, "Now that my child goes to preschool and goes to friends' houses, how can I make sure that he is eating enough?" Which response by the nurse would be most appropriate?

"Keeping an eye on how active he is will give you a good indication." Explanation: Preschoolers begin to eat away from home at friends' homes or at child care or stay overnight with friends or grandparents, so parents don't observe daily food intake as accurately as before. The best suggestion would be to inform the parent to observe whether the child is growing and being active, good indicators of nutrition. This action would be better than monitoring any one day intake, including attempting to get a list from others or asking the child what he has eaten. Giving the child extra food could foster overeating.

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?

"My child is so picky and eats the same thing every day for days on end!" Explanation: The preschooler's appetite is erratic. At one sitting the preschooler may devour everything on the plate, and at the next meal he or she may be satisfied with just a few bites. Food jags, such as eating the same thing for days on end, are common in the toddler, not the preschooler. Preschooler's are picky eaters. They may eat only a limited variety of foods or foods prepared in only one way. Portions for preschoolers are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. Giving the child non-nutritious snacks may cause the child not to eat at mealtimes. The child eating as much as the adolescent sibling is being set up for obesity.

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." Explanation: Exact duration of a child's daily sleep patterns varies based on temperament, activity levels, and overall health. Around the age of 4, many children discontinue the afternoon nap.

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." Explanation: A child who weighs between 40 and 80 pounds should ride in a booster seat that utilizes both the lap and shoulder belts in the back seat. When a child is large enough to sit up straight with the knees bent at the front edge of the seat, then he or she may sit directly on the seat of the car with lap/shoulder belt securely and appropriately attached. The back seat of the car is the safest place for a child to ride. A forward-facing car seat with harness and top tether is for a preschooler who weighs less than 40 pounds.

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." Explanation: A preschooler wants to please, and if the caregiver consistently wears the seatbelt, that will become the standard for riding in the car. All states have laws that define safety seat and restraint requirements for children. Adults must teach and reinforce these rules. One primary responsibility of adults is always to wear seat belts themselves and to make certain that the child always is in a safety seat or has a seat belt on when in a motor vehicle. A child can also be calmly taught that the vehicle "won't go" unless everyone in it is properly restrained. The child should be taught respect of rules and laws, but making threats or giving rewards is not appropriate.

A nurse walks into the room to check on a preschool client. When the nurse asks the preschooler how she is doing, the child says she is Tinker Bell. What is the best response by the nurse?

"That will be fun if you want to pretend you are Tinker Bell!" Explanation: Preschoolers engage in fantasies as part of their development. The nurse, however, needs to support the imitation but at the same time help the child to maintain the difference between pretend and real. The best response by the nurse would be to tell the client it will be fun to pretend she is Tinker Bell. Trying to call the child by the real name when the child is in imaginary play is very confusing to the child.

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." Explanation: Preschoolers may refuse to go to sleep because of fear of the dark. A night light, screening out frightening stories or TV shows, and using familiar bedtime routines, including reading a favorite story, can help. Keeping the door closed and the lights off would only help to promote the child's fear.

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?

"Use the time-out technique for discipline." Explanation: Preschoolers have definite opinions, which may bring them into opposition with parents. The best thing to do during these struggles is to guide the child through without discouraging his or her right to an opinion. Time out is a good technique that allows parents to discipline without using physical punishment. Time out should be for 1 minute of time out for every year of age. Spanking is never encouraged and is totally discouragaed by the American Academy of Pediatrics. Taking the child's toys away does not accomplish the same as time out. After taking away the toy the child just goes and gets another without understanding the meaning behind the punishment. It is easy for the parent to get frustrated, especially if the child is very willful. This can best be avoided by continuing to be consistent with rules.

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." Explanation: Although masturbation in this age group is not an uncommon behavior, the child must be told in a matter-of-fact manner that this is not appropriate activity in public. The parent needs to remain calm and not get angry or embarrassed. Usually, masturbation is just part of a young child's curiosity about his or her body.

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." Explanation: Parents sometimes strengthen a fantasy role without realizing it. A preschooler might be pretending she is a crocodile. If the nurse plays along, the child may be frightened she has actually become a crocodile. A better response is to support the imitation—this is age-appropriate behavior and a good way of exploring roles—by saying, "What a nice crocodile you're pretending to be." This both supports the fantasy and reassures the child she is still herself.

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." Explanation: Preschool aged children start to play together. This is defined as cooperative play. Imaginative play such as dress-up, role play and utilizing toys/objects for other purposes other than they were intended is common in this age.

When providing anticipatory guidance to parents about their preschool son who was caught in a lie, what would the nurse emphasize?

"You need to determine the reason for lying before punishing the child." Explanation: Lying is common in preschool children and occurs for a variety of reasons, such as fearing punishment, getting carried away by imagination, or imitating what another person has done. Regardless, the parent should ascertain the reason for the lying before punishing the child. The child also needs to learn that the lying is usually far worse than the misbehavior. Parents need to remain calm and serve as a role model of an even temper.

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." Explanation: The preschool-aged child may have imaginary playmates who are very real to them. The imaginary friend often has the characteristics that the child might wish for. Sometimes the child blames the imaginary friend for breaking a toy or engaging in another act for which the child does not want to take responsibility. The child should not be punished because the child is not intentionally telling a lie. At this age the child can think about things without actually seeing them.

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) Explanation: 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).

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. Explanation: The nurse can allow the child to play with a procedure doll that will simulate the procedure for the child.

What would be most effective in helping promote initiative and nutritional health for a preschooler?

Allowing the child to spread soft cheese on crackers Explanation: Allowing a child to do things such as spreading cheese on crackers helps to foster initiative and nutrition. High carbohydrate snacks should be avoided. Cutting an apple into pieces would be a safety issue. Apples are hard and difficult to cut, placing the child at risk for cutting himself. Small servings of food would be more appropriate because preschoolers do not have ravenous appetites. Praising the child for cleaning his plate which contains a small serving of food, not large, would be appropriate.

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 Explanation: 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 her awake. Twelve hours of sleep daily is an average amount for preschoolers.

The nurse is providing anticipatory guidance for parents of a preschooler 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. Explanation: Preschoolers are very inquisitive and want to learn about everything around them; therefore, they are very likely to ask questions about sex and where babies come from. Before attempting to answer questions, parents should try to find out first what the child is really asking and what the child already thinks about that subject. Then they should provide a simple, direct, and honest answer. The child needs only the information that he or she is requesting.

The mother of a preschooler finds a broken plate in her kitchen floor and asks the child what happened. The child tells the mother that her imaginary friend Lulu dropped it when she was getting it out of the cabinet. How should the mother interpret this fabrication?

Blaming an imaginary friend for accidents is normal behavior for this age group. Explanation: Children this age often have imaginary friends to play with and may blame the friend for accidents or other occurrences in the home that they may have caused. This should not be interpreted as intentionally lying or abnormal but rather normal preschool behavior.

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. Explanation: The 3-year-old should be able to button his clothes and use a pencil or crayon. By the age of 4 to 5, the child should be able to use scissors, tie shoelaces, and print his first name.

The parent of 3 1/2-year-old preschooler tells the nurse that the child argues quite a bit and says that the child is always right. The nurse interprets this information as indicating:

centering. Explanation: At age 3 years, cognitive development is still preoperational. Although children during this period do enter a second phase called intuitional thought, they lack insight to view themselves as others see them or put themselves in another's place. This is called centering. Because preschoolers cannot make this kind of mental substitution, they feel that they are always right and causes them to argue. Conservation is reflected in the child's ability to distinguish that two items of equal size are the same despite a change in form. Initiative is the developmental task of preschoolers and is reflected in the child's learning as much as possible about the world around them by trying new activities or having new experiences. Guilt occurs if children are punished or criticized for attempts at initiative.

A nurse is preparing to administer vaccines to a child who is entering kindergarten. Which vaccines should the nurse anticipate administering to this child? Select all that apply.

poliomyelitis (inactivated) varicella measles, mumps, and rubella (MMR) diphtheria, pertussis, and tetanus (DTaP) Explanation: The nurse should anticipate administering IPV, varicella, MMR, and DTaP, which, according to the CDC immunization schedule, are given between 5 and 6 years of age.

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. Explanation: 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.