PEDs Chapt 5 Growth and Development of the Preschooler

The caregiver of a 6-year-old tells the clinic nurse that he is concerned that his 5-year-old child cannot yet print his first and last name, and the caregiver is wondering if this is normal. Which of the following responses by the nurse would be most appropriate? a) "Some children this age cannot hold a pencil or crayon well enough to write legibly." b) "Usually by the age of 6, most children can write numbers up to nine, but no letters." c) "It is not unusual for children of this age to be writing their first name in cursive." d) "By the age of 6 most children can print some letters and maybe their first name."

"By the age of 6 most children can print some letters and maybe their first name." Correct Explanation: The 6-year-old can print a few letters or numbers and may be able to print their own name.

The nurse is conducting a well-child exam of a 4-year-old boy. Which of the following statements would alert the nurse that the child is at risk for iron deficiency? a) "He eats a well-balanced diet." b) "He does not like spinach, but he does like chicken and beef." c) "He loves milk and drinks it every time he is thirsty." d) "He enjoys eggs and fortified cereal for breakfast."

"He loves milk and drinks it every time he is thirsty." Correct Explanation: This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency.

The mother of a preschool-age child is discussing normal development of this age child with the pediatric nurse. The nurse explains the developmental milestone of initiative. The mother makes the following statements about her son. Which statement is an example of what might be this developmental milestone? a) "When I leave him with a babysitter he gets upset, but she says he still does what she asks him to do." b) "He refuses to hold my hand while we are crossing the street." c) "He tries to sweep up cereal his brother spilled but cries when he can't do it well." d) "He broke my favorite plate but blamed it on some friend he called Paul, but we don't know anyone named Paul."

"He tries to sweep up cereal his brother spilled but cries when he can't do it well." Correct Explanation: According to Erikson, the developmental task of the preschool age is initiative versus guilt. Preschoolers often try to find ways to do things to help, but they may feel guilty if scolded when they fail because of inexperience or lack of skill. Family caregivers need to remember that preschoolers are developing initiative and a sense of guilt. They want to be good and follow instructions; they feel bad when they do not, even if they are not physically punished. Imaginary playmates are common in the preschool child, but blaming the incident on the imaginary playmate or refusing to hold the mother's hand does not show initiative. A younger child would commonly show anxiety when being left by the caregiver.

A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond? a) "Are you spoofing me?" b) "Tell me about Boo-ga-loo." c) "Where did you get that funny name?" d) "I don't see anyone."

"Tell me about Boo-ga-loo." Correct Explanation: The imaginary friend serves as a companion and playmate for the preschooler. The child knows this friend is not real, yet is very invested in the imaginary playmate who can be and do anything the child's fantasy life can invent. The nurse should acknowledge this friend, not minimize the friend's importance. "Tell me..." does this. The other responses do not.

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

"We just got him a new bike he can grow into." Correct Explanation: The bicycle should fit the rider. 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.

If the child is gaining weight at an expected rate, a child who weighs 36 lbs. at 3 years of age would weigh which of the following at age 5? a) 44 lbs. b) 58 lbs. c) 38 lbs. d) 50 lbs.

44 lbs. Correct Explanation: The preschool age child gains about 3 to 5 lbs. each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm).

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage? a) Giving the child opportunity to speak and finish her ideas b) Asking the girl to slow down and to think before she talks c) Looking at the child while she is speaking d) Enunciating clearly and slowing down parental speech

Asking the girl to slow down and to think before she talks Correct Explanation: Many preschoolers 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.

In assessing the bilingual 4-year-old's speech and language development, the nurse should find that the child will: a) Be prone to stuttering. b) Mix the two languages in the same sentence. c) Be able to use each language as a separate system. d) Avoid asking questions.

Be able to use each language as a separate system. Correct Explanation: The ability to use both languages separately is developed by 4 years. Mixing the two languages occurred during toddlerhood. The other options are not related to bilingualism and are incorrect.

The nurse is organizing an indoor play area for preschoolers. What play materials are least important? a) Dress-up clothes and hats and puppets b) Electronic teaching toys c) Cut, paste, drawing, and painting materials d) CD player with music and musical instruments e) Balls, blocks, and puzzles

Electronic teaching toys Correct Explanation: These are expensive and usually cannot be used in multiple ways or shared with a group of children. All the rest of the items have many uses, stimulate imagination and creativity, promote social interaction, and are relatively inexpensive and readily replaced.

Broken fluency is a serious condition, and children who exhibit it should be referred to a speech pathologist for treatment. a) False b) True

False Correct Explanation: You may need to remind parents that broken fluency is a part of normal development and, if accepted as such, will pass

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize: a) Using and renewing sunscreen regularly b) Adults learning infant/child cardiopulmonary resuscitation (CPR) c) Enrolling the child in swimming lessons d) Having the child wear a personal flotation device whenever near or on the water

Having the child wear a personal flotation device whenever near or on the water Correct 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 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 4-year-old is hospitalized with a urinary tract infection. Based on what you know of her cognitive development, which approach would be best to prepare her for a radiograph? a) Explain that she must behave because the technician is busy. b) Help her pretend the x-ray machine is a camera. c) Tell her a radiograph is a picture of the dark inside her body. d) Tell her she must follow directions or she will be hurt.

Help her pretend the x-ray machine is a camera. Correct Explanation: Most preschoolers express fear of the dark and mutilation. Their active imaginations make it possible to turn almost any procedure into a game.

The developmental task of preschoolers is to achieve a sense of a) accomplishment versus inefficiency. b) initiative versus guilt. c) autonomy versus shame and doubt. d) cognition versus attitude.

Initiative versus guilt. Correct Explanation: Developing a sense of initiative, or learning how to do things, is the developmental task of the preschool period.

Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify? a) Interference with growth b) Obesity c) Iron deficiency d) Dental caries

Iron deficiency Correct Explanation: 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 mother brings her 4-year-old son in for a check-up. Which of the following findings should the nurse be concerned about? a) Weight gain of 5 lb in the past year b) No increase in appetite compared with that in toddler years c) Resting pulse rate of 120 d) Ectomorphic body type

Resting pulse rate of 120 Correct Explanation: Pulse rate in preschool children decreases to about 85 bpm typically, so the nurse should be concerned about a pulse rate of 120 in a 4-year-old. Contour changes in preschool children are so definite that future body type—ectomorphic (slim body build) or endomorphic (large body build)—becomes apparent. Neither of these body types is a reason for concern. During these years, appetite remains the same as it was during the toddler years, a level perhaps considerably less than some parents would like or expect. Weight gain is slight during the preschool years as the average child gains only about 4.5 lb (2 kg) a year.

A 4 year old is going to finger paint for the first time. Which of the following is the best action for the adult supervisor of this activity? a) Make a model for the child to follow so it will be easy to copy. b) Tell the child that it will be fun but that he or she should not make a mess. c) Draw a picture first for the child to see how to do it. d) Support whatever the child paints.

Support whatever the child paints. Correct Explanation: Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because he or she knows that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity.

In working with the preschool-age child, the nurse recognizes which of the following as a characteristic of the preschooler? a) The child grows and develops skills more rapidly than at any other time in their life. b) The child has an increased attention span and can be interested in an activity for a long length of time. c) The child takes in new information at a rapid rate and asks "why" and "how." d) The child insists they can "do it," and the next moment they revert to being dependent.

The child takes in new information at a rapid rate and asks "why" and "how." Correct Explanation: The preschool-age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft of activity for several hours. The toddler insists they can do things one minute and then becomes dependent the next minute. The infant grows and develops skills more rapidly than he or she ever will again.

In counseling a group of parents regarding the development of school readiness in preschoolers, the nurse emphasizes: a) Library visits and story hour b) Visiting the kindergarten c) Enrollment in a preschool d) The home environment

The home environment Correct Explanation: The home environment is the foundation for the child's learning and is the most important element for developing school readiness. Values regarding learning originate at home. Parents are the first teachers and role models. Structure, proper behavior with others, and language skills are all developed at home and are essential for school success. The other options are important but not as vital as the home environment. A preschool experience can foster social skills and group interaction. Library story hour and books develop language skills, and visiting a kindergarten can help the child make the transition to school.

The parents of a 5-year-old call the nurse for advice about night terrors. The child has had them nightly for almost 2 weeks. Which of the following is the most appropriate intervention? a) Wake the child up nightly 30 to 45 minutes after going to sleep. b) Tell the parents to be sure to wake the child up during the next episode. c) Encourage the parents to let the child fall asleep in a safe place such as their bed. d) Explain that this is a developmental phase that will not last.

Wake the child up nightly 30 to 45 minutes after going to sleep. Correct Explanation: Awakening children early in their sleep cycle often interrupts the night terror events and should be continued nightly for about 7 days. Suggesting the parent wake the child during a night terror is both difficult and ineffective. A major reason parents find night terrors frightening is that the child does not respond to the parent's presence. Indicating this is a developmental phase may be somewhat accurate, but does not assist the parents in handling the situation. Having the child fall asleep in a "safe" place or the parents' bed is likely to predispose to other sleep problems without helping to solve this one.

When planning how to respond to a child about telling stories, you would base your statement on the fact that a) a preschooler is in an insecure period. b) imagination in a 3-year-old is at its peak. c) a 3-year-old knows the word two but not the concept 2. d) preschoolers have a limited vocabulary.

imagination in a 3-year-old is at its peak. Correct Explanation: It is easy for preschoolers to engage in "tall tales" because of their active imagination.

A 3 year old wants to do everything independently, including putting on shoes. Every day, no matter how hard he tries, he puts the shoes on the wrong feet until finally he is successful. According to Erikson, what developmental task is this child trying to master? a) industry vs. inferiority b) trust vs. mistrust c) autonomy vs. shame d) initiative vs. guilt

initiative vs. guilt Correct Explanation: The developmental task of the preschooler, according to Erikson, is initiative vs. guilt. The others are not associated with the preschooler.

A mother tells a nurse that her child has recently established some friendships for the first time. In which age group do you expect this child to be? a) school age b) preschool c) adolescence d) toddler

preschool Correct Explanation: The preschool child begins to develop friendships.

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of the following? Select all that apply. a) Books and stories can help preschoolers master proper behavior. b) A time-out of about 8 minutes would be appropriate for intentional misbehavior. c) When discussing improper behavior, call the behavior "bad" or "naughty," not the child. d) Anticipate situations likely to cause misbehavior and redirect the child to another activity. e) Spank with an open hand only and never with an object.

• Books and stories can help preschoolers master proper behavior. • When discussing improper behavior, call the behavior "bad" or "naughty," not the child. • Anticipate situations likely to cause misbehavior and redirect the child to another activity. Correct Explanation: Spanking is the least effective discipline and discouraged by pediatric professionals. If chosen by parents, it should be infrequent and done only with an open hand. Labeling behavior and not the child supports self-esteem. One minute per year of age is an appropriate length for time-outs. Redirecting from events that tend to lead to misbehavior is wise and reduces conflict. Preschoolers can learn much from stories and books including appropriate behavior.

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 of the following statements by the father would indicate a need for further teaching? a) "I will need to find an appropriate punishment for him if this continues." b) "This is probably a good time to talk about safety and who can touch him." c) "I should teach him certain rules about this activity." d) "I have heard that both boys and girls often touch themselves at this age."

"I will need to find an appropriate punishment for him if this continues." Correct Explanation: The nurse should remind the father that overreaction to this behavior may cause it to occur more frequently. Masturbation at this age should be treated matter-of-factly. The other statements are correct.

The nurse is conducting a physical examination of a young preschooler and detects the odor of tobacco smoke on the parents' hair and clothing. How should the nurse respond? a) "Are you aware that exposure to tobacco smoke can be associated with behavioral difficulties?" b) "You should stop smoking around your child." c) "Tell me about your child's exposure to tobacco smoke." d) "Tobacco smoke is linked with an increased number of ear infections."

"Tell me about your child's exposure to tobacco smoke." Correct Explanation: The nurse needs to emphasize that parents should protect their child from all tobacco smoke. It is best to ask an open-ended question to determine who uses tobacco products or where exposure to tobacco smoke could be occurring. The nurse should not assume that the parents are smokers and telling them to stop is inappropriate. Telling the parent tobacco smoke can be linked to ear infection and behavioral difficulties is true but is unlikely to open a dialogue.

The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of dramatic play? a) Children are playing in an organized group with each other. b) Children are acting out a troubling situation. c) Children are playing apart from others without being part of a group. d) Children are observing without participating.

Children are acting out a troubling situation. Correct Explanation: Dramatic play allows a child to act out a troubling 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. Onlooker play occurs when there is observation without participation such as watching television.

Which project or game would you anticipate that a preschooler would most enjoy while hospitalized? a) Planting flower bulbs that she can watch grow next spring b) Dressing in her mother's coat to play house c) Turning out the lights to play hide and seek d) Playing an electronic, hand-held game

Dressing in her mother's coat to play house Correct Explanation: Preschoolers do well with activities that call for imagination. They are not ready for fine-motor or long-term activities

A 4-year-old tells you he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which of the following nursing diagnoses is most applicable for his family? a) Disturbed thought processes related to deep-set psychological need b) Deficient knowledge of normal preschool development c) Social isolation related to unwillingness to relate except through imaginary friend d) Compromised family coping related to abnormal behavior of child

Deficient knowledge of normal preschool development Correct Explanation: Because a preschooler's imagination is at a peak, imaginary friends are not uncommon.

The major developmental task according to Erikson is for the preschool child to develop which of the following? a) Initiative b) Trust c) Autonomy d) Industry

Initiative Correct Explanation: According to Erikson, the developmental task of the preschool-age child is initiative versus guilt. Preschoolers often try to find ways to do things to help, but they may feel guilty if scolded when they fail because of inexperience or lack of skill.

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of the following is the highest calcium-containing fruit? a) Apple b) Orange c) Banana d) Peach

Orange Correct 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 discussing development of fine motor skills in the preschool-age group with a group of nursing students. Which of the following statements is most accurate regarding the fine motor skills of a 3-year-old? a) The child can button their clothes. b) The child can print a few letters. c) The child can tie their shoelaces. d) The child can use scissors.

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

In teaching caregivers of preschool children, the nurse would reinforce that which of the following would be most important for this age group? a) The preschool child should cover mouth when coughing or sneezing. b) The preschool child should brush and floss teeth after snacks and meals. c) The preschool child should be screened for amblyopia. d) The preschool child should wear a seat belt when riding in a vehicle.

The preschool child should wear a seat belt when riding in a vehicle. Correct 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 mother of a 4 year old tells the nurse that she is frustrated, because all she seems to do lately is fight with the child over what the child wants to eat and wear. The mother says that she sometimes wants to spank the child for always disagreeing. What would be the best suggestion for the nurse to make to this mother? a) "It's not normal to feel that way." b) "Use the timeout technique for discipline." c) "Spank lightly to get the child's attention." d) "Take some toys away when the child acts like that."

"Use the timeout technique for discipline." Correct 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. Timeout is a good technique that allows parents to discipline without using physical punishment.

The father of a 4-year-old confides in the school nurse that he is concerned about his child not telling the truth. The father states, "I found a broken tool in my garage and when I asked my son about it, he said that his friend Andrew broke it, but we don't know anyone named Andrew." The best response by the nurse would be a) "Your son may have a friend named Andrew, but it could be an imaginary friend." b) "You need to show your child the broken tool since at this age they must see something in order to understand." c) "Your son may be afraid of being punished so he is telling lies to protect himself." d) "You should watch this type of behavior closely since most children this age tell the truth."

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

Broken fluency is a serious condition, and children who exhibit it should be referred to a speech pathologist for treatment. a) True b) False

False Correct Explanation: You may need to remind parents that broken fluency is a part of normal development and, if accepted as such, will pass.

A nurse is describing growth and development during the preschool period. Which of the following would the nurse identify as a predominant and heightened characteristic for this age group? a) Gross motor skills b) Vocabulary c) Fine motor skills d) Imagination

Imagination Correct Explanation: Although vocabulary, gross motor skills, and fine motor skills improve during this time, the imagination of preschoolers is keener than it will be at any other time in their lives. They imitate behavior that they see exactly.

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order. Warn the child there will be a time-out if the behavior does not stop. If the child gets up, replace the child and restart the time. Set a timer for no more than 4 minutes. Parent knows the misbehavior was intentional. Remove the preschooler to a boring spot.

Parent knows the misbehavior was intentional. Warn the child there will be a time-out if the behavior does not stop. Remove the preschooler to a boring spot. Set a timer for no more than 4 minutes. If the child gets up, replace the child and restart the time. Correct Explanation: Time-out is an extinction method of discipline that avoids reinforcing the unacceptable behavior with attention. One minute per year of age is the appropriate length of a time-out. Five minutes is the recommended maximum length.

Which of the following gross motor skills would the 4-year-old child have most recently attained? a) The child can cut his/her food. b) The child can hop on one foot. c) The child can button his/her clothes. d) The child can tie his/her shoelaces.

The child can hop on one foot. Explanation: Gross and fine motor skills continue to develop rapidly in the preschool-age child. Gross motor skills have to do with the development of large muscles. Balance improves and around the age of 4 the child can hop on one foot

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? a) "He is allowed out of time-out when he is calm." b) "I put him in time-out when the problem occurs." c) "I usually have him in time-out for about 10 minutes." d) "The time-out doesn't just have to be in his room."

"I usually have him in time-out for about 10 minutes." Correct 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.

A 5-year-old girl is pretending to be a crocodile during a physical examination. Her mother just smiles and rolls her eyes at the nurse. Which of the following would be the best response for the nurse to give the child? a) "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." b) "What happened to my patient? Did you eat her?" c) "Oh no! I have a crocodile in my room. Please don't bite me!" d) "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you."

"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." Correct Explanation: Parents sometimes strengthen a fantasy role without realizing it so they (and you) need to be careful in this regard. A preschooler such as the one in this scenario, for example, might be pretending she is a crocodile. When you walk into the room, you are aware of the game, so say, "That's strange, I don't see you anywhere. All I see is a crocodile." The child can be frightened she has actually become a crocodile; how will she ever get home again? A better response from you would be to support the imitation—this is age-appropriate behavior and a good way of exploring roles—by saying instead, "What a nice crocodile you're pretending to be." This both supports the fantasy and yet reassures the child she is still herself.

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue? a) Allowing the preschooler to fall asleep wherever and whenever the child is tired enough b) Planning for the child to get 12 hours of sleep daily c) Providing a nightlight d) Taking the TV set out of the child's room e) Eliminating caffeine sources beginning late afternoon

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Correct Explanation: Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers.

A nursing instructor is teaching students about changes during the preschool years. One predominant change that the teacher would emphasize is which of the following? a) Personality growth slows. b) Cognitive growth slows. c) Physical growth accelerates. d) Physical growth slows.

Physical growth slows. Correct Explanation: During the preschool period, physical growth slows considerably, while personality and cognitive growth continue at a rapid rate.

The nurse is observing a playgroup of children of all ages. The preschoolers in the group would most likely be doing which activity? a) Pretending to be mommies and daddies in the playhouse. b) Watching a movie with other children their age. c) Painting pictures in the art corner of the room. d) Playing a board game.

Pretending to be mommies and daddies in the playhouse. Correct Explanation: Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities, such as board games, and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.

The nurse is discussing development of motor skills in the preschool-age group with a group of nursing students. Which of the following statements is most accurate regarding the gross motor skills of a 4-year-old? a) The child can hop on one foot. b) The child can walk backwards with heel to toe. c) The child can jump rope. d) The child can throw and catch a ball.

The child can hop on one foot. Correct Explanation: The 4-year-old can hop on one foot and can control movements of the hands. By the age of 5 the child can walk backwards heel to toe, throw and catch a ball well, and jump rope.

Fear of mutilation is significant during the preschool age. a) True b) False

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

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. a) "Avoid having your child watch frightening shows on TV before bedtime." b) "Set up some familiar bedtime rituals for your child." c) "Try using a night light in the child's room." d) "Try reading a favorite story before bedtime." e) "Keep the door closed and the lights off so that your child can fall asleep faster."

• "Avoid having your child watch frightening shows on TV before bedtime." • "Set up some familiar bedtime rituals for your child." • "Try using a night light in the child's room." • "Try reading a favorite story before bedtime." Correct Explanation: Preschoolers may refuse to go to sleep because of fear of the dark. A night light, screening out frightening stories or TV shows, and using familiar bedtime routines, including reading a favorite story, can help. Keeping the door closed and the lights off would only help to promote the child's fear.

The nurse is discussing the topic of nutrition with a group of caregivers of preschoolers. Which of the following statements made by the caregivers is most accurate regarding nutrition in the preschooler? a) "It is hard for me to get my child to drink the 4 cups of milk he needs each day." b) "My child is growing so rapidly, she needs to eat three big meals a day." c) "It is important for me to give my child calcium so his muscles will grow." d) "If I give snacks throughout the day, my child can meet her nutritional requirements."

"If I give snacks throughout the day, my child can meet her nutritional requirements." Correct 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.

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which of the following statements made by the caregivers best indicates a common aspect of the diet and nutrition of the preschool child? a) "Our child gets into food jags where she will only eat one food all day long." b) "My husband is insistent that our 5-year-old not eat any snacks so he will eat he all of his meals at mealtime." c) "My 4-year-old eats as much as my adolescent does every day." d) "One day my child will eat everything on his plate, the next day he will eat almost nothing."

"One day my child will eat everything on his plate, the next day he will eat almost nothing." Correct Explanation: The preschooler's appetite is erratic; at one sitting the preschooler may devour everything on the plate, and at the next meal he or she may be satisfied with just a few bites. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks.

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

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

A mother confides in a nurse that her preschool daughter only wants to play with her father as soon as he comes home from work in the evenings and doesn't seem to have any interest in spending time with the mother. This phenomenon is an example of which of the following? a) Electra complex b) Genu valgus c) Oedipus complex d) Centering

Electra complex Correct Explanation: An Electra complex is the attachment of a preschool girl to her father; an Oedipus complex refers to the strong emotional attachment a preschool boy demonstrates toward his mother. A daughter demonstrating an Electra complex might prefer to always sit beside her father at the table; she asks her father to tuck her in at night. She makes a point she is "Daddy's girl." A mother who is not prepared for this behavior may feel hurt and cut off from family interaction. Although children during this period do enter a second phase called intuitional thought, they lack the insight to view themselves as others see them or put themselves in another's place (this is termed centering). Many children at the beginning of the preschool period exhibit genu valgus (knock-knees); this disappears with increased skeletal growth at the end of the preschool period.

Nursing students are reviewing information about the emotional development of the preschooler. They demonstrate understanding of he information when they identify which of the following as the task of the preschooler? a) Initiative b) Autonomy c) Trust d) Industry

Initiative Correct Explanation: The developmental task of the preschool period is initiative versus guilt. Industry is the developmental task of the school-aged child. Trust is the developmental task of infancy. Autonomy is the developmental task of toddlerhood.

Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify? a) Dental caries b) Iron deficiency c) Obesity d) Interference with growth

Iron deficiency Correct Explanation: 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.

Recently, 5-year-old Jack's father was injured in a motorcycle accident. The father is healthy and back at work. Jack's father confides to the school nurse that he is concerned about Jack. When questioned further, he tells the nurse that Jack is not acting like he was before the accident. He says he keeps telling Jack he is a good boy; indeed Jack is not testing or challenging his boundaries like he was before the accident. Which of the following best describes the reason for the behavior Jack's father is seeing? a) Everyone in Jack's family is being nicer to each other and, as most preschoolers will, Jack is imitating the "grown up" behavior. b) Jack is afraid of being hurt himself and thinks being especially good will protect him from accidents. c) The thought of losing his father was scary, and Jack is trying to show his father how much he loves him. d) Jack wanted to go with his father on the motorcycle ride. When he was told he couldn't go he told his father he hoped he would crash, so Jack believes he caused the accident.

Jack wanted to go with his father on the motorcycle ride. When he was told he couldn't go he told his father he hoped he would crash, so Jack believes he caused the accident. Correct Explanation: Preschoolers have learned to think about something without actually seeing it: to visualize or imagine. This normal development, sometimes called magical thinking, makes it difficult for them to separate fantasy from reality. Preschoolers believe that words or thoughts can make things real, and this belief can have either positive or negative results. For example, in a moment of anger, a child may wish that a parent or a sibling would die; if that person later is hurt, the child feels responsible and suffers guilt. The child needs reassurance that this is not so.

A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which of the following activities that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson? a) Rough-housing with his father b) Singing a song he learned at preschool c) Opening drawers in the room, pulling out supplies, and examining them d) Reading a book

Opening drawers in the room, pulling out supplies, and examining them Correct Explanation: 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. Rough-housing and singing a song learned in preschool are examples of typical play for preschool children. Reading a book at age four would be developmentally precocious but would not necessarily be the best example of initiative.

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 which of the following stages as identified by Piaget? a) Tertiary circular reaction b) Coordination of secondary schema c) Preoperational thought d) Primary circular reaction

Preoperational thought Correct 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 to 15 months.

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to which of the following? a) Regression b) Playing in an even-number group of children (four) c) Testing and identification of group role d) The fact that preschoolers have a harder time sharing than toddlers

Testing and identification of group role Correct Explanation: Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.

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 the girl is demonstrating which of the following? a) Animism b) Transduction c) Beginning empathy d) Magical thinking

Transduction Correct Explanation: 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.

The nurse realizes that the 5-year-old's growth chart and BMI indicate the child is at risk for obesity. What other findings reinforce this risk? Select all that apply. a) Expectations to eat everything on plate b) Food used as reward or punishment c) Mealtimes organized and regular d) Television on during meals e) A father who is overweight f) Fast food eaten once a month

• Expectations to eat everything on plate • Food used as reward or punishment • Television on during meals • A father who is overweight Correct Explanation: Overweight parents, food used as reward or punishment, TV viewing during meals, and the "clean plate club" all are factors that contribute to weight gain. The frequency the family eats fast food is not excessive. Regular, structured meals result in less snacking and more nutritious meals. Family eating together is bonding.