PEDS Chapter 18: The Preschool Child

What type of play is most appropriate when planning care for a child with moderate intellectual deficiency? a. Exercise leg and arm muscles. b. Be educationally oriented to make up for lost time. c. Be adjusted to mental age rather than chronological age. d. Involve contact sports and aggressive physical activity with other children.

ANS: C The nurse must consider the child's mental age rather than her chronological age when selecting toys for play.

Which statement best describes the 3-year-old child? a. Boisterous, tattles on others b. Aggressive, shows off c. Helpful, wants to assist with chores d. Talkative, inquisitive about the environment

ANS: C Three-year-old children are helpful and can assist in simple household chores.

What will children who are unable to express themselves with words often do? a. Become reclusive and introspective. b. Develop other methods of verbal communication. c. Engage in more creative play. d. Have tantrums and act out.

ANS: D Children with delayed communication skills will frequently have tantrums and act out when they are unable to make their needs known.

A 4-year-old child insists he has more money with a nickel than his father has with a dime. What is this perception, as described in Piaget's theory? a. Egocentrism b. Artificialism c. Animism d. Intuition

ANS: D The intuitive stage, as described by Piaget, is prelogical thinking that is based on the outside appearance of objects. A nickel is larger than a dime and therefore more valuable.

A 4-year-old child tells the nurse she will not eat peas because they are green. Of what is this an example? a. Egocentrism b. Artificialism c. Animism d. Centering

ANS: D The tendency to concentrate on a single outstanding characteristic of an object while excluding other features is known as centering.

Parents of a 5-year-old child tell the nurse they are concerned about their child's speech development by stating, "No one can understand him but us." What clinical classification of speech disorder does the nurse suspect? a. Global language delay b. Expressive language delay c. Language loss d. Articulation disorder

ANS: D When parents are the only people to understand their preschool child, an articulation disorder is suspected (see Table 18-3).

When planning an activity for a 3-year-old child, the nurse bases the plan on the average attention span of _____ minutes.

ANS: 15 The average attention span of the preschooler is about 15 minutes.

A preschool child is asked, "Why do trees have leaves?" Which response would be an example of animism? a. "So I can have shade over my sandbox." b. "Because God made them that way." c. "To hide behind when they are scared." d. "For the squirrels to play in."

ANS: C Animism describes the tendency of preschool children to attribute human characteristics to nonhuman objects.

Which is an example of associative play? a. Two children playing in house, one playing the role of the dad and the other playing the role of the mom b. Two children playing in a sand box, one building a wall and the other digging a hole c. Two children playing with sports-associated items, one with a football and the other with a bat d. Two children playing with a coloring book, one coloring pictures and the other looking at pictures

ANS: A Associative play allows the preschoolers to use their enlarged vocabulary in play with other children to carry on conversations and describe scenarios for each to play.

The parents of a 4-year-old boy are concerned because they have noticed him frequently touching his penis. What knowledge would act as the basis for the nurse's response? a. This behavior indicates a normal curiosity about sexuality. b. Masturbation suggests the boy has an excessive fear of castration. c. It is usually a result of discomfort from a penile rash or irritation. d. The behavior is abnormal and the child should be referred for counseling.

ANS: A Masturbation at this age is common and indicates that the preschooler has a normal curiosity about sexuality.

A father is concerned about how long his preschool-age child will continue sucking his thumb. What is the most helpful response from the nurse? a. "Most children will stop thumb-sucking naturally by school age." b. "Over-the-counter treatments that give a bad taste can be placed on the thumb to discourage the practice." c. "Consistently touching the child's fingers whenever he sucks his thumb is most effective." d. "Thumb-sucking is detrimental to the eruption of the child's teeth and must be stopped as soon as possible."

ANS: A Most children give up the habit of thumb-sucking by the time they reach school.

What tasks would be appropriate to expect of a 5-year-old child? a. Setting the table with paper plates b. Washing the dirty knives c. Carrying glasses from the table to the sink d. Scrubbing out the sink with cleanser

ANS: A Parents must consider developmental level and safety when asking the 5-year-old child to help with chores.

What is the most appropriate intervention when dealing with occasional aggression in a 4-year-old child? a. Have the child take a time-out in the corner for 4 minutes. b. Spank the child at the time of the incident. c. Take away television privileges for the day. d. Send the child to his room for 30 minutes.

ANS: A Time-out periods, usually lasting 1 minute per year of age, with the child sitting in a chair or corner, are considered an effective disciplinary technique.

Which bedtime preparation rituals are the most appropriate for the nurse to suggest? (Select all that apply.) a. Telling a story b. Placing a favorite toy in bed c. Placing a glass of water at the bedside d. Turning on a night-light e. Playing energetically

ANS: A, B, C, D All options are soothing bedtime rituals except energetic playing, which would be stimulating and counterproductive to sleep.

What does including play in the plan of care for a 5-year-old allow the child to do? (Select all that apply.) a. Exercise his imagination. b. Assume a role and act it out. c. Offer an emotional outlet. d. Avoid magical thinking. e. Interact with other children.

ANS: A, B, C, E Benefits of play for the preschooler include exercising imagination, assuming a role and acting it out, offering an emotional outlet, and interacting with other children. Play employs the use of magical thinking.

The nurse points out what advantage(s) of a nursery school or preschool experience? (Select all that apply.) a. Increasing self-confidence b. Fostering group cooperation c. Detecting adjustment problems d. Attainment of toilet training skills e. Playing experiences with other children

ANS: A, B, C, E Nursery school increases self-confidence, group cooperation, social skills, and cooperative play. Objective observations by a nursery school instructor can detect early adjustment problems. The child is usually toilet trained prior to the start of preschool.

What developmental milestone(s) assist the 5-year-old boy toward developing his sexual identity? (Select all that apply.) a. Begins to be less focused on his mother. b. Ignores both parents totally. c. Regresses to a more infantile level. d. Forms a romantic attachment to the mother. e. Identifies with the parent of the same sex.

ANS: A, D, E Children of this age become less focused on the mother as the central person and begin to identify with the parent of the same sex, forming a romantic attachment to the parent of the opposite sex. This little boy might say, "I'm going to marry my mother." A little girl might say, "I'm going to marry my daddy."

The parent of a -year-old child tells the nurse, "My daughter points instead of speaking whenever she wants me to get something for her, but she understands me when I ask her to do something." Based on the parent's comment, what does the nurse suspect? a. Age-appropriate language development b. An expressive language delay c. A receptive language delay d. A potential hearing deficit

ANS: B An expressive language delay is suspected when the child understands spoken language but is not talking.

A parent is concerned about her children's reaction should their grandmother die. What understanding will guide the nurse's response? a. Children are unlikely to notice their grandmother's absence if no one reminds them. b. Young children often understand that other people die, but do not equate it with themselves. c. The children's response will depend entirely on whether they have been acquainted with death before this. d. Children can understand the concept of a higher being much like adults can.

ANS: B Between 3 and 4 years of age, the children become curious about death and dying. They may realize that others die, but they do not relate death to themselves.

What is the nurse's best advice to a parent about a preschooler's "imaginary friend"? a. Having imaginary friends is a sign that the child has low self-esteem. b. It is common for preschoolers to have imaginary friends. c. Preschoolers invent an imaginary friend when they feel overwhelmed. d. The best approach to dealing with an imaginary friend is to ignore them.

ANS: B Imaginary friends are common and normal during the preschool period and serve many purposes, such as relief from loneliness, mastery of fears, and acting as a scapegoat.

Which major developmental tasks will the nurse expect a child to accomplish by the end of the preschool years? (Select all that apply.) a. Development of parallel play b. Acceptance of separation c. Increased communication skills d. Consistent appetite e. Control of bodily functions

ANS: B, C, E The major tasks of the preschool child include preparation to enter school, development of a cooperative type of play, control of body functions, acceptance of separation, and increase in communication skills, memory, and attention span. Appetite remains inconsistent.

The nurse is educating a group of preschool parents about the importance of safety. Which statement by a parent indicates the need for further education? a. "I continue to provide a great deal of indirect supervision for my child." b. "My stairway is always free of clutter." c. "I only leave my child in the car for brief moments." d. "Medications are kept in a locked cabinet."

ANS: C Children must not play in or around the car or be left alone, even for a brief moment, in the car. Preschool children still require a good deal of indirect supervision to protect them from dangers that arise from their immature judgment or social environment. Stairways should be free of clutter and medications kept out of reach.

What intervention might the nurse suggest as helpful for the child with enuresis? a. Applying an electric pad that gently shocks the child b. Waking the child several times during the night to urinate c. Decreasing fluid intake after the evening meal d. Increasing dietary fiber intake

ANS: C If a child is experiencing enuresis, liquids after dinner should be limited and the child should routinely void before going to bed.

What should the nurse suggest as the most appropriate toy choice for a 3-year-old? a. A board game b. A small pet, such as a goldfish c. A large construction set d. Push-pull toys

ANS: C Large construction sets are suitable toys for the preschool-age child.

The parent of a 41/2-year-old child tells the nurse, "Bedtime is difficult. I can't get my son to go to bed at night." The nurse and the child's mother discuss options. What intervention is the most appropriate choice? a. Allow the child to put himself to bed when he is tired. b. Let the child read in his room until he falls asleep. c. Establish a bedtime routine and use it consistently. d. Tire him out with physical activity before bedtime.

ANS: C Parents should engage the child in quiet activities before bedtime and establish a ritual that signals readiness for bedtime.

The nurse is discussing preschoolers' sexual curiosity with the parent. What statement by the mother leads the nurse to determine that the mother understands the information? a. "Make up funny words for body parts." b. "Distract the child with a toy if they ask about sex." c. "Answer their questions when they ask." d. "Tell them to ask you again when they are 6 years old."

ANS: C Parents should provide sex education at the time the child asks about sex.

A 3-year-old child, while playing with his favorite toy in the playroom of the pediatric unit, is approached by another child who also wants to play with the same toy. What behavior will the nurse anticipate from this child? a. Will play well with the other child. b. Will give the toy up and then not play anymore. c. Will become angry and a physical response might ensue. d. Will ignore the toy and go on to something else.

ANS: C The 3-year-old child is egocentric and likely will become angry when others attempt to take his or her possessions.

How does the nurse characterize the play of 5-year-old children? a. Enjoying rough and tumble play b. Playing well-organized games c. Following rules d. Preferring inside activities

ANS: C The 5-year-old child wants to play by the rules but cannot accept losing. The rules may be very strict or change as the game progresses.

What fear is unique to the preschool period? a. Water b. Animals c. Bodily harm d. Death

ANS: C The fear of bodily harm, particularly the loss of body parts, is unique to this stage