Pediatrics Ch 27- Growth & Development of the Preschooler

The mother of a 4-year-old reports using time-outs as a means for disciplining the child. Which statement by the mother would require the nurse to provide additional teaching?

"I usually have him in time-out for about 10 minutes." Explanation: A time-out should be timed appropriately. The time-out should occur at the time the offense occurred, to ensure the child relates the offense (the behavioral problem) to the time-out period. Brief time-outs are more effective than very long ones, because a long time-out enables the child to redirect attention from calming down to being resentful. The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. A time-out should end as soon as the child is calm. Time-outs do not have to occur in the child's room; any location where the child is removed from activity and has an opportunity to become calm will do.

The nurse is 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!" Explanation: Erikson's stage of initiative vs. guilt is prevalent in children between 3 and 6 years of age. This includes activities in which they act out the roles of other people (real or imaginary). Being competitive, learning sports, and comparing skills are important in the industry vs. inferiority stage (6 to 12 years of age) as seen in a child comparing the speed of running a race or playing a game. Staying true to a predefined set of values, such as not cheating in a game, would be typical of a child in the identity vs. role confusion stage (12 to 19 years of age).

The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply.

"My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda." Explanation: Worldwide, over 22 million children younger than 5 years old are obese. In the past 30 years, the number of US children and adolescents who are overweight has doubled, which increases chances for obesity to continue into childhood and increases the risk for obesity-related diseases. The 3- to 5-year-old requires 700 to 1000 mg calcium. Allowing preschoolers controlled choices of foods fosters good eating habits as the child grows. Fruit juice should be limited to 4 to 6 ounces per day, as excess consumption can lead to excess weight gain and dental caries due to the sugar content. Nutrient-poor, high-calorie foods such as sweets and typical fast foods should be offered only in limited amounts.

The nurse is helping parents enhance the developmental task of initiative in their preschool-age child. Which activity would the nurse suggest the parents implement?

Allow the child to experiment with molding clay. Explanation: To gain a sense of initiative, preschoolers need exposure to a wide variety of play materials so they can learn as much about how things work as possible. The parents should be urged to provide play materials that encourage creative play such as modeling clay. Any experience with free-form play is helpful. Street-crossing safety, following rules, and providing clothes that snap will not support the developmental task of initiative as much as providing a substance to experiment during play.

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 school nurse is helping parents choose books for their preschoolers. What literacy skills present in the preschooler would the nurse consider when making choices? Select all that apply.

Preschoolers enjoy books with pictures that tell stories Preschoolers like stories with repeated phrases as they help keep their attention Preschoolers demonstrate early literacy skills by reciting stories or portions of books Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story. Feedback: Preschoolers enjoy books with pictures that tell stories. Stories with repeated phrases help to keep the child's attention. Also, children like stories that describe experiences similar to their own. The preschool child demonstrates early literacy skills by reciting stories or portions of books. He or she also may retell the story from the book, pretend to read books, and ask questions about the story. The preschool child has enough focus and expanded attention to notice when a page is skipped during reading and will call it to the parent's attention.

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 is able to draw shapes such as circles and squares. Explanation: 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.

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of what happening?

Viewing her baby sister's illness as her fault Feedback: Since the preschool child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend.

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. Feedback: 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.

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." Feedback: 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.

The mother of a 4-year-old girl reports her daughter has episodes of wetting her pants. The nurse questions the mother about the frequency. The nurse determines these episodes occur about once every 1 to 2 weeks. Which response by the nurse is indicated?

"At this age it is helpful to remind children to go to the bathroom." Explanation: Preschool-aged children may become occupied with activities around them and not remember to void. Reminding them to void is helpful. Discipline should not be applied to infrequent episodes of incontinence. There is no indication the child has an infection.

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.

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." Feedback: 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.

A mother comes to the clinic with her 4-year-old and tells the nurse that she is worried because the child does not talk much. Upon talking to the child, the nurse learns that the client has a normal vocabulary for age. The nurse is aware that language for a 4-year-old consists of at least approximately how many words?

1500 words Explanation: A 4-year-old has a vocabulary of approximately 1500 words, whereas a 5-year-old has mastered more than 2100 words.

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) Explanation: 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.

The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 in tall at her last examination at age 4. Which height measurement would be within the normal range of growth expected for a preschooler?

43 in Feedback: The average preschool-age child will grow 2.5 to 3 in (6.5 to 7.8 cm) per year. The average 3-year-old is 37 in tall (96.2 cm), the average 4-year-old is 40.5 in tall (103.7 cm), and the average 5-year-old is 43 in tall (118.5 cm).

The nurse is supervising lunch time for children on a pediatric ward. Which observation, if noted by the nurse, would require further assessment?

A child uses his fingers and refuses to use a fork. Feedback: 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.

The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse?

"The preschooler is developing a conscience." Feedback: The preschool child can understand the concepts of right and wrong and is developing a conscience. Preschool children see morality as external to themselves; they defer to power (that of the adult). The child's moral standards are those of their parents or other adults who influence them, not necessarily their own.

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." Explanation: 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.

While the nurse is taking a blood pressure on a 4-year-old, the child states that the blood-pressure cuff is too tight and angrily says, "That hurt, you big poo-poo head." What is the most appropriate response by the nurse?

Calmly explain that you don't mean to hurt her, loosen the cuff, and tell her that is isn't nice to call you names. Explanation: Four- and 5-year-olds delight in using "naughty" words or swearing. Bathroom words become favorites and taunts, such as "you're a big doo-doo," bring heady excitement to them. Caregivers may become concerned by this turn of events, but the child simply may be trying out words to test their impact. By using a calm, matter-of-fact response when a preschooler uses naughty or swear words, some of the power of using that type of language will be defused. The child learns that this is not language to use in the company of others.

The nurse is caring for preschoolers in a day care center. For this age group, of what developmental milestones should the nurse be aware? Select all that apply.

Counting 10 or more objects Correctly naming at least four colors Understanding the concept of time Knowing everyday objects Feedback: The child in the intuitive phase can count 10 or more objects, correctly name at least four colors, and better understand the concept of time, and he or she knows about things that are used in everyday life, such as appliances, money, and food. The preschooler forms concepts that are not as complete or as logical as the adult's, and tolerates others' differences but doesn't understand them.

The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned?

Draws a person with three body parts Feedback: By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. She should also be able to copy triangles and other geometric patterns and dress and undress herself and should be learning to tie her shoelaces.

The nurse is conducting a well-child assessment for a 5-year-old boy in preparation for kindergarten. The boy's grandmother is his primary caregiver because the boy's mother has suffered from depression and substance abuse issues. The nurse understands that the child is at increased risk for which developmental problem?

Lack of social and emotional readiness for school Feedback: Risk factors for lack of social and emotional readiness for school include insecure attachment in the early years, maternal depression, parental substance abuse, and low socioeconomic status.

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

Orange Explanation: 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 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 Explanation: 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 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. Explanation: Dramatic play allows a child to act out troubling situations and to control the solution to the problem. Through dramatic play the child can express anxiety, try out new feelings and conquer fears. This is important to remember when teaching children who are going to be hospitalized. Using dolls and puppets to explain procedures makes the experience less threatening. Parallel play is the play of toddlers where two toddlers play side by side but not with each other. Independent play occurs when a group of children are all playing but each is playing something different (i.e., all may be playing with trucks but each one has a different truck and they do not do the same thing with the trucks). Solitary play is a child playing alone, even in a group. The child does not participate with other children.

During the health history, the nurse asks a 4-year-old about objects he is viewing. One of the objects is a car. The child tells the nurse that the car is "what mommy uses to take me to school." The nurse interprets this statement as indicating:

egocentricity. Explanation: The statement reflects egocentricity of preschoolers, such that they define objects in relation to themselves. For example, the car is not a means of transportation but rather what is used to take the child to school. Play is reflected in imitation and imagination, such as imaginary friends. Initiative is reflected in being exposed to a wide variety of experiences for learning. Fantasy is reflected in the preschooler's pretending.

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 Explanation: 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 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." Explanation: By 3 years of age, a child should be able to hold a pencil in the writing position. By age 4, the child can draw circles and squares and a body with four parts. At age 5, the child can print letters, copy a triangle and a picture of a person with six parts and cut with scissors. The 6-year-old child can print letters or numbers and may be able to print his or her own name. Children do not write in cursive until school age.

The parents of a 5-year-old boy tell the nurse that their son is having frequent episodes of night terrors. Which statement would indicate that the boy is having nightmares instead of night terrors?

"He will tell us about what happened in his dream." Feedback: During a nightmare, a child will have a memory of the occurrence and may remember the dream and talk about it later. With night terrors, the child has no memory of the event. The other statements are indicative of night terrors.

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." Explanation: 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?" Explanation: 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 pediatric nurse is meeting with a group of preschoolers' family members to discuss various health topics. The nurse determines the sexual development session is successful after overhearing which comment by one of the participants?

"I feel better knowing that her curiosity is normal." Explanation: The child's sexual curiosity is a normal, natural part of total curiosity about oneself and the world. Exploration of the genitalia is natural for the preschooler. It is one way the child learns to perceive the body as a possible source of pleasure and is the beginning of the acceptance of sex as natural and pleasurable. Caregivers can be reassured that this is not uncommon behavior.

The parents of a 5-year-old are concerned that their son is too short for his age. The nurse measures the child's height at 40 in (101.6 cm). How should the nurse respond?

"The average height for a 5-year-old is 43 in tall (118.5 cm), so your son is within the normal range for height." Feedback: The average preschool-age child will grow 2.5 to 3 in (6.5 to 7.8 cm) per year. The average 3-year-old is 37 in tall (96.2 cm), the average 4-year-old is 40.5 in tall (103.7 cm), and the average 5-year-old is 43 in tall (118.5 cm).

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 is quite structured and advocates corporal punishment." Explanation: 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 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." Explanation: 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.

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration?

A less discriminating sense of taste Feedback: The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.

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. Feedback: 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.

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

Beginning questioning of parents' values Feedback: 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.

The parents of a 4-year-old who is a picky eater ask the nurse what foods to include in their child's diet to provide adequate iron consumption. Which food would the nurse recommend?

Cooked lentils Feedback: Lentils are a good source of iron. Whole milk, oranges, and sweet potatoes are good sources of calcium.

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. Explanation: Tying shoes is a skill that is usually not accomplished until about 5 years of age. The child in the scenario is likely too young to master this task. He likely lacks the fine motor skills. Alternative methods of instruction will likely not be successful. There is no indication the child has motor skill delays.

Nursing students are reviewing information about preschooler growth and development. The students demonstrate understanding of the information when they identify which of the following as a common fear during this period? Select all that apply.

Fear of the dark Fear of mutilation Fear of separation Fear of abandonment Explanation: Common fears of the preschooler period include fear of the dark, mutilation, separation, and abandonment.

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

Which 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. Feedback: 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.

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 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.

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 nurse of a preschool child is helping parents develop a healthy meal plan for their child. What nutritional requirements for this age group should the nurse consider?

The typical preschooler requires about 85 kcal/kg of body weight. Feedback: The typical preschooler requires about 85 kcal/kg of body weight. The 3- to 5-year-old requires 700 to 1,000 mg calcium and 10 mg iron daily. The 3-year-old should consume 19 mg dietary fiber daily, while the 4- to 8-year-old requires 25 mg dietary fiber per day.

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. Feedback: 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, healthcare provider, or nurse checking to see when something is wrong.

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.

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." "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." Explanation: 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.

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.

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?

"It's best to answer his questions using accurate anatomical names and keep your answers simple." Explanation: 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 3-year-old is hospitalized unexpectedly and is frightened about the experience. What action could the nurse take to minimize the anxiety the child is experiencing?

Allow the child to handle the equipment before it is used on the child. Explanation: Allowing the child to handle the equipment prior to its use lets the child become more comfortable with what is happening and decreases anxiety. Preschoolers need the opportunity to participate in their care. Minimizing the child's fright by saying everything will be fine is not helpful, nor is providing all of the child's care. Expecting parents to remain with the child all the time is unrealistic due to other family obligations they may have.

The nurse is caring for a 5-year-old girl posttonsillectomy. 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 Feedback: 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.

When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note?

Parallel play Feedback: Parallel play is associated with toddlers. Cooperative, dramatic, and fantasy play are commonly used by preschoolers.

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.

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. Feedback: 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.

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.

What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother?

Specific program goals to be accomplished should be available. Explanation: Preschool is used for toddlers to foster social skills and to acclimate them to the group environment. When a parent is searching for a preschool, he or she should check the school's accreditation, the teacher's qualifications, and seek the recommendations of other parents. Parents should visit the school to see the teacher interact with the children, the focus of the activities, and hygiene practices. Parents should look at the school's daily schedule and the types of activities offered. Are the activities structured or loose? Preschoolers need planned activities. They are very ready to learn, but the activities should be planned to focus on their short attention spans.

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 Explanation: Cooperative play is when children play in a group with each other, and play by rules. Examples are board games or sports. Associative play involves allowing the child to work through feelings about procedures and separation; parallel play involves children playing side to side with each engaging in his/her own activities; dramatic play involves living out of the drama of human life.

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. Explanation: 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.

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. Explanation: Preschoolers have vivid imaginations and love to play "make believe." They are inquisitive learners. It is not unusual for their imaginations to create "tall tales" and be in a world of make-believe. Preschoolers have a vocabulary of between 1,500 and 2,100 words, depending upon their age. They can count to 10 and know at least four colors. Their communication is concrete. At this age they are not capable of abstract thought. During the preschool years, the child develops a sense of identity. They know who they are and to the family in which they belong. They develop the knowledge of right and wrong. The preschool years help develop a child's sense of belonging and his or her place in the world.

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 Explanation: The nurse should recognize that by age 4, the preschooler should have a vocabulary of about 1,400 words. Preschool-age children are able to communicate in sentences of five words or more and often like to use their imagination. This is a normal part of growth and development and should be encouraged.

A 4-year-old female client presents to the clinic with an increased temperature. Based on the assessment findings (above), what does the nurse anticipate the primary health care provider will prescribe for this client?

urinalysis, culture and sensitivity Explanation: This client is presenting with typical symptoms of a urinary tract infection (UTI): increased urinary frequency, bedwetting, increased temperature, and abdominal pain. Though the child denies abdominal pain, the child is exhibiting symptoms of pain. The UTI can be diagnosed with a urinalysis and culture and sensitivity. Most uncomplicated UTIs can be treated with oral antibiotics and oral hydration. IV hydration, such as lactated Ringer's, is not required.

The parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares?

"She screams and thrashes when we try to touch her." Explanation: During a night terror, a child is typically unaware of the parent's presence and may scream and thrash more if restrained. During a nightmare, a child is responsive to the parent's soothing and reassurances. The other statements are indicative of a nightmare.

The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 lb. What should the nurse instruct the parents to do?

"Place her in a booster seat with lap and shoulder belts in the back seat." Feedback: A child who weighs between 40 and 80 lb 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 lb.

The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond?

"Tell me about the circumstances when this occurs." Feedback: Bladder control is present in the 4- and 5-year-old child, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents. Simply telling the mother that it is normal does not address the mother's concerns. The nurse does need to gather more information, because accidents in a previously potty-trained child can be a sign of diabetes.

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 last for 1 minute for every year of age. Spanking is never encouraged and is totally discouraged 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 being consistent with rules.

The nurse is teaching the parents of a 4-year-old boy about the normal maturation of the child's organs during the preschool years and their effect on body functions. Which statements accurately describe these changes? Select all that apply.

Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age The bones continue to increase in length and the muscles continue to strengthen and mature; however, the musculoskeletal system is still not fully mature. The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschool-age child. Feedback: Most of the body systems have matured by the preschool years. Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. The bones continue to increase in length and the muscles continue to strengthen and mature. However, the musculoskeletal system is still not fully mature. The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. The 4-year-old generally has adequate bowel control. Heart rate decreases and blood pressure increases slightly during the preschool years. An innocent heart murmur may be heard upon auscultation. The urethra remains short in both boys and girls, making them more susceptible to urinary tract infections than adults.

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 in 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 assessing the psychosocial development of a preschooler. What are normal activities characteristic of the preschooler? Select all that apply.

Plans activities and makes up games Initiates activities with others Acts out roles of other people. Feedback: The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.

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.

The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which intervention would be appropriate advice?

Present the food matter-of-factly and allow the child to choose what to eat. Feedback: The parents should maintain a matter-of-fact approach, offer the meal or snack, and then allow the child to decide how much of the food, if any, he or she is going to eat. High-fat, nutrient-poor snacks should not be substituted for healthy foods just to coax the child to "eat something." If the preschooler is growing well, then the pickiness is not a cause for concern. A larger concern may be the negative relationship that can develop between the parent and child relating to mealtime. The more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is to try new foods or even eat the ones he or she likes that are served. The child should be offered a healthy diet, with foods from all groups over the course of the day as recommended by the U.S. Department of Agriculture.

Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium?

White beans Feedback: To ensure an adequate intake of calcium, the nurse should suggest white beans, because 1 ounce of dried white beans when cooked provides 160 mg of calcium. Spinach, enriched bread, and fortified cereal are good sources of iron.

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." Explanation: The nurse should explain to the parents that attributing lifelike qualities to inanimate objects is quite normal for a 4-year-old child. Telling the parents that the child is demonstrating animism is correct information, but it would be better for the nurse to explain what animism is and then remind the parents that it is developmentally appropriate for their child. Asking whether the parents think the child had a recent trauma or whether there is a family history of mental disorders is inappropriate and does not teach.

The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond?

"This is normal; children his age do not understand the permanence of death." Feedback: The nurse needs to remind the mother that preschoolers do not completely understand the concept of death or its permanence. Telling the mother that it is best to ignore the boy's questions or that the boy will eventually figure this out on his own does not teach. Repeating that the grandfather is not coming back does not consider the developmental stage of the child and is inappropriate.