prep-u chapter 27: growth and development of the preschooler

The nurse is assessing a 4-year-old child. Which assessment finding concerns the nurse?

Grasps a pencil with their fist.

The nurse is caring for a child who is described as being an inquisitive learner, loves to learn new things, and feels a sense of accomplishment when succeeding in activities. The nurse understands that this child is in which of Erikson's stages of development?

Initiative versus guilt

When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate?

tells a fantasy story about a bear and a car

The caregiver of a 6-year-old expresses concern that the child cannot yet print her first and last name. The caregiver is wondering if this is normal. Which response by the nurse would be most appropriate?

"By the age of 6, most children can print some letters and maybe their first name."

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."

The parent of a 4-year-old is expressing concern that this child is not talking as much—or as well—as her other children did at that age. Which question should the nurse prioritize when assessing this preschooler for this concern?

"Has your child had their hearing tested?"

The nurse is conducting a well-child exam of a 4-year-old boy. Which statement would alert the nurse that the child is at risk for iron deficiency?

"He loves milk and drinks it every time he is thirsty."

The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education?

"I am so glad I can get rid of all of those bath toys because they take up so much room."

Which statement by the parents of a 4-year-old child indicates to the nurse the need for further education about development and discipline in a preschool-aged child?

"When our child misbehaves, we use a 15-minute time-out."

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?

"Attributing lifelike qualities to inanimate objects is quite normal at this age."

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"

The nurse is interacting with a 5-year-old child who lives in a home with bilingual parents. Which observation would alert the nurse to further assess the child's language development?

The child is able to enunciate several sounds and has difficulty enunciating the "q" sound in words.

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 father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is most appropriate?

"Both your son's height and rate of growth are within normal limits for his age."

The father of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the father would indicate a need for further teaching?

"I will need to find an appropriate punishment for him if this continues."

The nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child?

"Look! I am a nurse, and I am helping people feel better!"

A school nurse has completed an educational program for parents of preschool children. Which statement by a participant indicates a need for further education?

"My 5-year-old son still needs me to dress and undress him."

The nurse is 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!"

The nurse is doing a well-child exam of a 5½-year-old girl. Which statement by the mother would alert the nurse that further teaching is needed about healthy eating habits?

"Our family rule is that all children 'clean their plates' at each meal, and we feed them a lot."

The nurse is preparing a safety presentation for a health fair for families. Which instruction should the nurse prioritize when illustrating car safety and the family?

"Set a good example. Wear your own seat belt every time you drive."

The nurse 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?

"Stating their name and address is too hard for my 5-year-old child; it will be another year before they can do that."

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!"

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."

The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond?

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

The parents of a 4-year-old child tell the school nurse that they are worried that their child will fall behind other children academically because they are not able to afford expensive toys like computer games and handheld electronic devices. Which are acceptable response(s) by the nurse? Select all that apply.

-"All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." -"Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and child-safe modeling clay? These are the types of toys suggested for preschoolers." -"I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically."

A nurse is teaching a group of parents of preschoolers about safety. Which information would the nurse include? Select all that apply.

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

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.

-"Set up some familiar bedtime rituals for your child." -"Try using a night light in the child's room." -"Avoid having your child watch frightening shows on TV before bedtime." -"Try reading a favorite story before bedtime."

During an admission assessment, the nurse is discussing the developmental level of the child with the parents. Which comment(s) by the parents confirm they are aware of developmental expectations of the preschool-age child? Select all that apply.

-"We think it is important to have play dates with our friend's preschool children." -"Our child attends a wonderful preschool 3 times per week." -"We have been talking about enrolling in a morning preschool program since this is our only"

The 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 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 3-year-old child has a body mass index (BMI) in the 95th percentile. What action(s) will the nurse recommend for the family to promote normal weight gain and health for this child? Select all that apply.

-Limit screen time and encourage physical activity. -Provide regular meals and snacks with a range of nutritious foods. -Promote drinking water instead of juices or sweetened beverages.

The nurse is visiting a preschool to provide health education. Which observation(s) by the nurse is a cause for concern? Select all that apply.

-There are small-sized toilets for preschool-aged children in the kitchen area. -There are 2 teachers for 25 students.

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.

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.

1.) Parent knows the misbehavior was intentional. 2.) Warn the child there will be a time-out if the behavior does not stop. 3.) Move the preschool-age child to a boring spot. 4.) Set a timer for no more than 4 minutes. 5.) If the child gets up, return the child to the time-out location and restart the time.

The nurse is conducting a well-child examination of a 4-year-old and is assessing the child's height. By how much should the nurse expect the child's height to have increased since last year's examination?

2.5 to 3 inches (6.35 to 7.62 cm)

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 observing a group of 4-year-old children in a play area. What action, when observed by the nurse, would alert the nurse to typical play for this age group?

A child pretends to be a teacher and asked another child to be the pretend student in "class."

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

transduction.

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.

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?

Do not start the car until seat belts are in place.

A bilingual family tells the nurse their desire for their child to learn both languages. One language is spoken predominantly in the home. The parents ask the nurse when is the best time to teach the child the other language. What time period would the nurse respond?

During the preschool years

The nurse is organizing an indoor play area for preschool-age children. Which play materials are least important?

Electronic teaching toys

The nurse is caring for a family with a newborn and a 3-year-old child. What will the nurse suggest to the family to assist with the 3-year-old child's adjustment to having a new sibling?

Encourage the 3-year-old child to visit the parents and sibling at the hospital.

The mother of a 4-year-old child reports she has been trying in vain to teach her son to tie his shoelaces. She states she fears he may be "slow". Which action by the nurse is most appropriate?

Explain to the parent her child likely does not have the needed motor skills to achieve this task at his current age.

Which would be a nutritional goal for a preschool client?

Introduce new food gradually and include variety.

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium?

Orange

The nurse is presenting 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.

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?

Risk for caregiver role strain

The 4-year-old child has begun stuttering while hospitalized. The client has not previously had any problems with stuttering or with speech. How should the nurse respond?

Speak slowly and provide the child with more time to respond to questions.

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?

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

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

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.

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.

The nurse is observing 4-year-old twins during their well-child appointment. Which observation by the nurse would indicate the children are demonstrating cooperative play?

They are building a house for their dolls with blocks in the room.

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.

A nurse is meeting with a group of parents of preschool-aged children to provide information concerning their growth and development. What factor(s) should the nurse include because it is effective in helping promote initiative and nutritional health for children?

allowing the child to spread peanut butter on crackers

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?

asking the girl to slow down and to think before she talks

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.

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?

cooperative play

A type of play seen in preschool children encourages children to act out troubling situations, such as one that might occur in the hospitalized child who must undergo an upsetting procedure. This type of play is referred to as:

dramatic play.

Which type of play should the nurse encourage for a preschool-age child who is hospitalized?

dressing in the mother's coat to play house

The nurse is evaluating statistics of dental care of preschool-age children in the community. Which should the nurse focus on as having the greatest overall impact?

fluoridated water system in the community

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:

having the child wear a personal flotation device whenever near or on the water.

The clinic nurse is collecting vital signs on a 4-year-old client being seen for a yearly well check-up. Which measurements should the nurse collect?

height and weight

The nurse is assessing a 4-year-old child. The child tells the nurse about her friend, Nancy, who lives in her room at home. The mother tells the nurse that Nancy is not a real person. The nurse would use which term when documenting this assessment finding?

imaginary friend

A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group?

imagination

When planning how to respond to a 3-year-old child about telling stories ("tall tales"), the nurse would base the statement on the fact that:

imagination in a 3-year-old is at its peak.

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?

imitative play

The most important safety precaution for parents to teach preschoolers is:

not to ride in a car with strangers.

A parent and their 4-year-old child are waiting in an exam room when the nurse enters and greets and observes them. Which activity of the child best demonstrates the primary developmental task of the preschool-age child, according to Erikson?

opening drawers in the room, pulling out and examining supplies

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