Chapter 27: Growth and Development of the Preschooler

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

44 to 46 lb (20 to 21 kg) 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).

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? "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." "Is there a reason you are concerned about your child's height?" "Both your son's height and rate of growth are within normal limits for his age." "Your son is slightly below the normal height for his age but he had demonstrated a normal growth rate this year."

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

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." "I have heard that both boys and girls often touch themselves at this age." "I should teach him certain rules about this activity." "This is probably a good time to talk about safety and who can touch him

"I will need to find an appropriate punishment for him if this continues." 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 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? "Stop the car any time the preschooler unbuckles the restraints." "Set a good example. Wear your own seat belt every time you drive." "Explain that wearing a seat belt is a law and the police officer will give a ticket if the seat belt is not buckled." "Reward the child with candy or some other treat each time the child keeps the seat belt on."

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

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? 3.5 to 4 inches (8.89 to 10.16 cm) 2.5 to 3 inches (6.35 to 7.62 cm) 0.5 to 1 inch (1.27 to 2.54 cm) 1 to 2 inches (2.54 to 5.07 cm)

2.5 to 3 inches (6.35 to 7.62 cm) The average preschool child will grow 2.5 to 3 inches (6.35 to 7.62 cm) per year. Thus, the nurse would expect that the child's height would have increased 2.5 to 3 inches (6.35 to 7.62 cm) since last year's well-child examination. Reference:

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

"We just got him a new bike he can grow into." : 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.

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? "Maybe practicing these activities with him would help him improve these motor skills." "Your child is not expected to be able to perform those activities at 3 years of age." "I am sure he will become more proficient in these activities soon." "I wouldn't be too concerned since he seems fine during my assessment."

"Your child is not expected to be able to perform those activities at 3 years of age." Skipping and standing on one foot for up to 10 seconds are motor skills that are expected from a 5-year-old, not a 3-year-old; therefore, the best response is letting the mother know that her child is not behind in motor development.

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." A child plays with a toy while another child sits next to him and plays with a different toy. A child plays alone, with a set of children's kitchen utensils, pots and pans. A group of children play a board game involving matching colored cards to shapes.

A child pretends to be a teacher and asked another child to be the pretend student in "class." Preschool-aged children enjoy games that use imitation such as pretending to be teachers, cowboys, firefighters, and store clerks. They imitate exactly what they see their parents doing. Parallel play is characteristic of toddlers and would be demonstrated by children playing next to each other with different toys. Preschool-aged children typically enjoy cooperative play with other children in the group, rather than playing alone. Older preschool-aged children are interested in group games.

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 Playing apart from others without being part of a group Playing a video game with several other children Watching television or videos

Acting out a troubling or stressful situation 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.

What would be most effective in helping promote initiative and nutritional health for a preschooler? Encouraging the child to cut up small pieces of apple for a snack Allowing the child to spread soft cheese on crackers Praising the child for cleaning his large plate of food Giving the child a high carbohydrate snack after preschool

Allowing the child to spread soft cheese on crackers 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 would be appropriate.

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. Use scissors. Print a few letters. Tie shoelaces.

Button clothes. 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 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 Watching a movie with other children their age Playing a board game Painting pictures in the art corner of the room

Pretending to be mommies and daddies in the playhouse 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. Reference:

A 4-year-old child is drawing with crayons. Which creation by the child would most be reflective of the anticipated skill level of this age? The child draws random lines on the paper and reports it is a person. The child is able to draw shapes such as circles and squares. The child is able to proficiently draw several letters of the alphabet. The child draws a person with 6 body parts.

The child is able to draw shapes such as circles and squares. Preschool children are creative and like to draw. They are able to draw shapes such as circles and squares. Drawing a figure with at least 6 body parts and writing letters are the expected skills of a 5-year-old. Random lines would be demonstrated by a younger child.

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 your children to report others who are bullying. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Wait until children are old enough to tell them how to call for help in an emergency. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable. 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. Urge children never to talk to or accept a ride from a stranger. 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.

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? Promote the development of new skills such as potty-training in the 3-year-old child. Encourage the 3-year-old child to visit the parents and sibling at the hospital. Have the family remind the 3-year-old child that they are a "big kid" now. Explain to the 3-year-old child that the newborn can be their new friend and playmate.

Encourage the 3-year-old child to visit the parents and sibling at the hospital. A 3-year-old child may experience the hospitalization as separation; encouraging visits can assist with this. The 3-year-old child will experience sibling rivalry with the birth of a new baby and will often also experience regression, so this is not a good time to focus on new skill development (e.g., potty-training) or focus on being a "big kid." Calling the newborn a friend or playmate promotes unrealistic expectations of the relationship and the newborn's role and abilities.

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. Provide treats as a reward for achieving physical activity goals. Enroll the child in fitness classes to promote exercise.

Provide regular meals and snacks with a range of nutritious foods. Limit screen time and encourage physical activity. Promote drinking water instead of juices or sweetened beverages. A preschool-aged child who is obese can be supported through regular, unstructured physical activity (not structured classes), ideally for a minimum of 1 hour daily. Screen time should be limited to promote physical activity. Nutrition can be promoted through regular meals and snacks and avoiding calorie-dense foods. Water is the preferred beverage. Treats should not be used as a reward

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? Imbalanced nutrition, less than body requirements Interrupted family processes Readiness for enhanced parenting Risk for caregiver role strain

Risk for caregiver role strain Given that the parents are trying to care for four children, one of whom is a severely developmentally delayed preschooler in the hospital, and that they are new to the area (making it unlikely that they have a strong support system), the highest priority nursing diagnosis would be caregiver role strain. Family processes are likely altered, but with the hospitalization, strain on the parents is a higher priority nursing diagnosis.

A nurse is evaluating a 5-year-old client in the clinic. Which finding would indicate to the nurse that the client is not meeting Erikson's stages of psychosocial development? The client can tie shoes. The client tells a vivid story. The client asks permission to play. The client sleeps 12 hours a day.

The client asks permission to play. During the preschool years, Erikson's psychosocial stages of development are focused on initiative versus guilt. At 5 years old, the client should begin to move past the egocentric focus of the toddler years and to seek reassurance from the parents.

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 brush and floss teeth after snacks and meals. The preschool child should be screened for amblyopia. The preschool child should be properly restrained when riding in a vehicle. The preschool child should cover mouth when coughing or sneezing.

The preschool child should be properly restrained when riding in a vehicle. 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.

A nurse is assessing a 3 year old at a well-child visit. Which developmental milestones would the nurse expect to assess? Select all that apply. Throws a ball overhand Undresses self without difficulty Completes simple buttons Stacks a tower of blocks Laces sneakers independently

Undresses self without difficulty Stacks a tower of blocks A 3-year-old typically can undress himself or herself and stack a tower of blocks. Simple buttoning is more characteristic of 4-year-olds. The ability to lace sneakers or shoes and throw overhand are typical of 5-year-olds.

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 below an expected range and height is above an expected range. Weight is above an expected range and height is within an expected range. Weight and height are within expected patterns of growth. Weight falls within an expected range and height is less than what would be expected.

Weight is above an expected range and height is within an expected range. 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.

Which type of play should the nurse encourage for a preschool-age child who is hospitalized? playing an electronic handheld game planting flower bulbs that can be watched growing next spring turning out the lights to play hide and seek dressing in the mother's coat to play house

dressing in the mother's coat to play house Preschool-aged children have active imaginations and dressing up to play house would be an appropriate play activity for the nurse to encourage. The child's fine motor skills are not developed enough to play an electronic handheld game. Children of this age are afraid of the dark so turning out the lights to play hide and seek is not appropriate. Planting flower bulbs is an activity that is too long-term for this age range.

Which type of play should the nurse encourage for a preschool-age child who is hospitalized? playing an electronic handheld game dressing in the mother's coat to play house turning out the lights to play hide and seek planting flower bulbs that can be watched growing next spring

dressing in the mother's coat to play house Preschool-aged children have active imaginations and dressing up to play house would be an appropriate play activity for the nurse to encourage. The child's fine motor skills are not developed enough to play an electronic handheld game. Children of this age are afraid of the dark so turning out the lights to play hide and seek is not appropriate. Planting flower bulbs is an activity that is too long-term for this age range.

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? gross motor skills imagination fine motor skills vocabulary

imagination Although vocabulary, gross motor skills, and fine motor skills improve during this time, the imagination of preschool-age children is keener than it will be at any other time in their lives. They imitate behavior exactly as they see it.

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 brightly colored mobile toy with dials and switches 50-piece jigsaw puzzle

play kitchen and food Preschool-aged children like to engage in pretend play, so a play kitchen and food would be a good choice. A mobile is more appropriate for an infant. A toy with dials and switches is appropriate for a toddler. A 50-piece jigsaw puzzle is a better choice for older children.

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? blood pressure nutrition fine motor development speech and language

speech and language The 5-year-old child's speech should be generally understood by strangers. This child's articulation is delayed, and this issue should be followed up with a speech-language assessment and therapy. The blood pressure is within the normal range. The nutrition is normal for a 5-year-old child; picky eating is a common occurrence. Fine motor development is also normal with writing one's own name, self-dressing, and managing toileting independently.

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. magical thinking. animism. beginning empathy.

transduction. 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.

What skill(s) can the nurse expect in the assessment of the fine motor skills of a 4-year-old child? Select all that apply. cutting with blunt tip scissors undressing self riding a bicycle drawing simple shapes tying shoelaces

undressing self cutting with blunt tip scissors drawing simple shapes Undressing oneself, cutting with safe (blunt-tip) scissors, and drawing simple shapes all demonstrate the fine motor skills of a 4-year-old child. Riding a bicycle is not a gross motor skill expected at this age, and tying shoelaces is not expected until a child is school-aged.

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

"I am so glad I can get rid of all of those bath toys because they take up so much room." 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 has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education? "It is okay for my four-year-old to still play in his sandbox." "I will add some crayons, chalk and finger paints to my three-year-old's birthday gifts." "I am so glad I can get rid of all of those bath toys because they take up so much room." "My four-year-old will be getting a tricycle for her birthday. I'm glad it's a good gift for her." SUBMIT ANSWER

"I am so glad I can get rid of all of those bath toys because they take up so much room." 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 has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education? "My four-year-old will be getting a tricycle for her birthday. I'm glad it's a good gift for her." "I am so glad I can get rid of all of those bath toys because they take up so much room." "It is okay for my four-year-old to still play in his sandbox." "I will add some crayons, chalk and finger paints to my three-year-old's birthday gifts."

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

While the nurse is talking with a 6-year-old who has been a client of the clinic since birth, the child begins to tell the nurse that he is the star of a popular children's television program. What is the nurse's best response? "I bet you like that show a lot. Which character is your favorite?" "You are only 6 years old so I don't think you are the star of that show quite yet." "What makes you think you are the star of the show?" "I don't think your mother would like you telling people that."

"I bet you like that show a lot. Which character is your favorite?" Preschool-age children often engage in magical thinking. Magical thinking allows the preschooler to make room in his world for the actual or real occurrences of life. Responding in a way that allows the child to experience magical thinking is therapeutic.

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. "I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." "Why are you not financially able to provide these toys and games for your child?" "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." "Are there any family members who can help you get these games for your child?" "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."

"I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." "All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." "Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and child-safe modeling clay? These are the types of toys suggested for preschoolers." Expensive and elaborate toys do not place a child at an academic or developmental advantage. Simple toys that require interactive rather than passive play, and that may include the involvement of the parent, are recommended to foster development. The nurse should not question a family's finances nor recommend the family ask for financial assistance. These statements are judgmental and infer the family is not able to provide for the child, which is not the case.

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? "I would suggest getting books with pictures to help explain the differences between male and female genitalia." "It's best to answer his questions using accurate anatomical names and keep your answers simple." "You should answer his questions by whatever feels most comfortable to you." "That is a difficult subject to address. I'm not sure what is the best way to answer that question."

"It's best to answer his questions using accurate anatomical names and keep your answers simple." It is suggested to keep answers brief and use correct anatomical names of body parts. Offering this advice to the father will help guide him in how to address questions. It is not necessary to go into the detail of using books with pictures for children of this age.

A mother tells the nurse that her 5-year-old son always pretends his toy rake is a fishing pole no matter how many times she shows him how a rake is used. How should the nurse respond? "Do you model how to use a rake for your child? This may help your child use the toy rake the correct way." "Preschoolers have a vivid imagination so it is very common for them to invent ways to use their toys." "This is a sign of high intelligence since your child has thought of alternative uses for a toy." "Developmentally your child should be using toys for what they were intended. I will let the pediatrician know."

"Preschoolers have a vivid imagination so it is very common for them to invent ways to use their toys." Growth and development are promoted through play and preschoolers like using toys for their intended purpose as well as for whatever invented purpose they can imagine, such as using the rake as a fishing pole. Using imagination with the rake does not correlate to high intelligence. Modeling "proper" use of the rake can be done, but the preschooler is encouraged to use his or her imagination; there is no right or wrong way to play with toys at this age.

The nurse is providing teaching to the mother of a 4-year-old girl about bike safety. Which statement by the mother indicates a need for further teaching? "She can ride on the street if I am riding with her." "She should always ride on the sidewalk." "Pedal back brakes are better for her age group." "The balls of her feet should reach both pedals while sitting."

"She can ride on the street if I am riding with her." The preschooler is not mature enough to ride a bicycle in the street even if riding with adults, so the nurse should emphasize that the girl should always ride on the sidewalk even if the mother is riding with her daughter. The other statements are correct.

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? "I am glad to know that my 4-year-old child asking so many questions is normal." "When my child counts numbers, it is only to 10 and we are slowing working on counting higher." "My child is finally talking in a way that most of my friends can understand her speech." "Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that."

"Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that." 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? "Don't lie to me. That's never a nice thing to do to someone." "I guess you don't know much about counting yet." "Does it make you feel more important when you add on brothers?" "That is a good pretend answer but tell me the names of the brothers you really have."

"That is a good pretend answer but tell me the names of the brothers you really have." Stretching stories to make them seem more interesting is a phenomenon frequently encountered in preschoolers. This kind of storytelling should not be encouraged. The child should be helped to separate fact from fiction. The nurse should ask the child to say the names of the brothers the child really has. The nurse should not insult the child's counting ability. The nurse should not accuse the child of lying or making the child seem more important by having more brothers.

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? "I will not call you Tinker Bell. I like the name Whitney better." "Hello, Tinker Bell." "You are not Tinker Bell. Your name is Whitney." "That will be fun if you want to pretend you are Tinker Bell!"

"That will be fun if you want to pretend you are Tinker Bell!" 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.

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention? "The school requires processed foods and high sugar foods be avoided." "The school is quite structured and advocates corporal punishment." "There is a very low student-teacher ratio, and they do a lot of hands-on projects." "The school has a loose environment, which is a good match for his temperament."

"The school is quite structured and advocates corporal punishment." The nurse needs to emphasize that there are number of reasons that a parent should not choose a preschool that utilizes corporal punishment. It may negatively affect a child's self-esteem as well as ability to achieve in school. It may also lead to disruptive and violent behavior in the classroom and should be discouraged. The other statements would not warrant further discussion or intervention.

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

Orange A medium orange contains 50 mg of calcium and is a good nondairy choice. The other fruits are healthy choices but do not contain as much calcium.

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? Advise the parent to explain to the child that he is too young to discuss such things. Encourage the parent to provide a detailed discussion about human sexuality with the child. Advise the parent that sexual curiosity is unusual at this age. Encourage the parent to determine what the child's specific questions are and answer them briefly.

Encourage the parent to determine what the child's specific questions are and answer them briefly. Sexual curiosity is normal in the preschool-aged child. The parents should be encouraged to provide brief, honest answers to the child. The parents must also determine the type of curiosity the child has. Explanations should be within the level of understanding of the 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? Punish the preschooler for hurting the other child. Recommend that the mother change schools with her child to provide a more pleasant environment. Explain that aggression is a common behavior for a child this age but the child must understand that hurting someone is not acceptable. Encourage the teachers to have the other children hit the child if the child hits them.

Explain that aggression is a common behavior for a child this age but the child must understand that hurting someone is not acceptable. Aggression is a common behavior in preschoolers, starting with temper tantrums. Aggression is often an expression of frustration and anger at their inability to control their environment. However, children must be made aware that hitting or other aggressive behaviors will not be tolerated and are not acceptable. It is never recommended to use aggression in response to aggressive behaviors, and the child should not be punished unless the behavior continues. Changing schools will not solve the problem because the child will still face frustration and become angry.

A family from India has recently moved to the United States. Their 5-year-old child often visits the school nurse after lunch reporting a "stomachache." The lunch staff tell the nurse that the child eats very little for lunch. What is the best action by the nurse? Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch. Speak to the child and parents to discuss the repercussions of visiting the nurse so frequently. Talk with the child and encourage that lunches be brought from home so that nutrient needs are met. Explain to the child that the reason for the stomachache is that not enough is being eaten during lunch.

Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch. Food served in the home is often very specific to the family's ethnic background. As the preschool-age child is exposed to persons of other cultures in school, he or she may or may not like the food that is served. It is important to first determine if this is the reason for the child eating very little at lunch so that appropriate interventions can be determined. Bringing lunch from home may be an option, but it must first be determined if food preference is the underlying cause of lack of eating.

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? Compromised family coping related to abnormal behavior of child Social isolation related to unwillingness to relate except through imaginary friend Disturbed thought processes related to deep-set psychological need Parental anxiety related to lack of understanding of childhood development

Parental anxiety related to lack of understanding of childhood development 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.

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? Social isolation related to unwillingness to relate except through imaginary friend Compromised family coping related to abnormal behavior of child Disturbed thought processes related to deep-set psychological need Parental anxiety related to lack of understanding of childhood development

Parental anxiety related to lack of understanding of childhood development 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.

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

Placing the child in an approved car seat 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 apart from others without being part of a group. Playing together in an activity without organization. Playing independently and are side-by-side. Playing in an organized group with each other.

Playing in an organized group with each other. 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.

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. Tell the child that it will be fun but that he or she should not make a mess. Draw a picture first for the child to see how to do it. Make a model for the child to follow so it will be easy to copy.

Support whatever the child paints. 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 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 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 to smoke one at a time outside the home when the child is inside the home. Teach the parents to use a forward-facing car seat with a harness and top tether. Teach the parents that medications can be kept in unlocked cabinets if childproof caps are used.

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. 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.

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

The child can hop on one foot. 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.

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

asking the girl to slow down and to think before she talks Many preschool-age children stutter as thinking races ahead of their ability to articulate ideas. Most of this stuttering, when not made an issue, will resolve on its own. Calling attention to the dysfluency often exacerbates it. All the other practices are helpful.

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. guilt. conservation. initiative.

centering. 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 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 attempting to learn 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.

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? anti-sugar drink campaign in the community the number of dentists in the community free toothbrushes to all preschool-age children fluoridated water system in the community

fluoridated water system in the community When looking to have the largest impact, having a fluoridated water supply within the community would be the focus of the nurse. This would reach every preschool-age child in the community and can significantly reduce the number of dental caries.

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. enrolling the child in swimming lessons. adults learning infant/child cardiopulmonary resuscitation (CPR). using and renewing sunscreen regularly.

having the child wear a personal flotation device whenever near or on the water. 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? hand regard nonverbal play imitative play parallel play

imitative play 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.

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? iron deficiency interference with growth dental caries obesity

iron deficiency Meat is an important iron source while calcium in milk consumed in large quantities can block iron absorption. Alternate protein sources can replace the meat in the child's diet for growth. Excess milk intake that boosts calories consumed can be an obesity-causing factor. Lactose from milk in constant contact with the teeth can promote development of dental caries. However, these risks are slight, with the iron deficiency risk pronounced.

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

opening drawers in the room, pulling out supplies, and examining them 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.