Preschool Mastery II

A healthcare provider writes prescriptions for a young child with a tentative diagnosis of Wilms tumor. Which prescription should the nurse question? 1 Renal biopsy 2 Abdominal ultrasound 3 Computed tomography scan 4 Magnetic resonance imaging

1 A renal biopsy is an invasive procedure. In the early stages, Wilms tumor is encapsulated. Any disruption of the tumor capsule may precipitate metastasis. Magnetic resonance imaging, computed tomography, and abdominal ultrasound are all helpful in making the diagnosis.

What does that nurse state that is true about language development in preschoolers? 1 They start questioning events. 2 They realize that words have arbitrary meanings. 3 They distinguish between phonetically similar sounds. 4 They use 2,000 to 8,000 words to express their desires.

1 Preschoolers start to look for the reasons behind events. Their questions expand to "Why?" and "How come?" School-aged children, not preschoolers, realize that words have arbitrary rather than absolute meanings. Phonetically similar words such as die and dye or wood and would cause confusion in preschool children. They use 8,000 to 14,000 words to define familiar objects, identify colors, and express their desires and frustrations.

Which individuals have the greatest impact on the preschool-age client's drawings? Select all that apply. 1 Sister 2 Father 3 Mother 4 Brother 5 Teacher

235 During the preschool stage of development it is the parents (father and mother) and the child's teacher who have the greatest impact on what the preschooler chooses to draw. The child's siblings (sister and brother) do not have a great impact on what a child draws during the preschool stage of development.

At what age should a nurse instruct a parent that his or her child will have finicky eating habits? 1 One year old 2 Two years old 3 Four years old 4 Five years old

3 Four-year-old children have finicky eating habits. Toddlers (one- and two-year-old children) often develop the desire to eat one food repeatedly. Five-year-olds are more interested in trying new foods.

Which is the most important observation for the nurse when assessing the psychosocial stage of development for a preschool-age client? 1 Interactions with an imaginary friend 2 Interactions with siblings during a meal 3 Interactions with other children during play 4 Interactions with parents during a home visit

3 Psychosocial development is best assessed by observing a preschool-age client with other children during play activities. This method allows the nurse to assess the child's thought processes because play becomes the child's way of understanding, adjusting to, and working out life's experiences. Interactions with an imaginary friend, siblings during a meal, and parents during a home visit will not provide the best information related to psychosocial development.

A nurse is caring for a 4-year-old child with just-diagnosed cystic fibrosis. The child has been passing loose, bulky, foul-smelling stools and is in the third percentile for weight. What is the best explanation of the growth failure? 1 Impaired digestion and absorption because of the lack of pancreatic enzymes 2 Dyspnea and shortness of breath, which cause anorexia and disinterest in food 3 Increased bowel motility and diarrhea, which lead to inadequate absorption of nutrients 4 Pulmonary obstruction, which causes an oxygen deficit and inadequate tissue nourishment

1 Obstruction of the pancreatic duct and the absence of enzymes (e.g., trypsin, amylase, and lipase) to aid fat digestion and absorption lead to wasting of tissues and failure to thrive. Currently it is recommended that children with cystic fibrosis consume 150% to 200% of the calories recommended for their body weight. Despite dyspnea and shortness of breath, when feeling well these children have voracious appetites; the difficulty involves poor digestion and malabsorption of fats and fat-soluble vitamins. Increased bowel motility and diarrhea are not associated with cystic fibrosis. The pulmonary disease process leads to localized respiratory dysfunction, not to retarded physical growth.

A 4-year-old child who has never been separated from parents or siblings is admitted to the hospital. What is most important for the nurse to encourage the parents to do? 1 Have one of them stay with the child. 2 Visit the child during regular visiting hours. 3 Bring a favorite toy to the hospital for the child. 4 Allow the nurse to be the child's major caregiver.

1 The 4-year-old child has developed trust but still needs frequent support from parents. Visiting during regular visiting hours may be inadequate; preschoolers need the continued support of parents during stressful times. The parents may bring a toy, but their presence to provide support and reinforce trust is more important. The parents should participate in their child's care as much as possible so there will be no interference with the trust relationship and support will be provided.

Which major concern related to temperament should the nurse assess closely when providing care to a preschool-age client who is beginning school? 1 Adaptability 2 Socialization 3 Language skills 4 Fine motor skills

1 The degree of adaptability to new situations may influence a child's chances for success in school; therefore, the nurse should assess this closely when providing care to a preschool-age client. Socialization, language skills, and fine motor skills are not aspects of temperament; however, these may also influence the child's success at school.

A nurse on the pediatric unit receives a change-of-shift report. In which order should the nurse assess the children? Begin with the child whose status is most critical and end with the child whose status is most stable.

1. 8-month-old with vomiting and diarrhea lasting 1 day 2. 5-year-old with diarrhea lasting 2 days 3. 11-year-old with abdominal cramps lasting 4 hours 4. 6-year-old with low-grade fever lasting 3 days 5. 3-year-old with celiac disease who is to be discharged within 2 hours

The nurse caring for a 3-year-old child with meningitis should be alert for which signs and symptoms of increased intracranial pressure? Select all that apply. 1 Vomiting 2 Headache 3 Irritability 4 Tachypnea 5 Hypotension

123 Increased intracranial pressure can precipitate vomiting because of its effect on the chemoreceptor trigger zone in the medulla. Because the cranial sutures are closed by this age, increased pressure can cause headache. Irritability results from increased pressure in the cranium and as a response to related discomforts. Pressure on the respiratory center in the brain results in a decreased, not increased, respiratory rate. Blood pressure is increased, not decreased, in the toddler with closed fontanels.

The mother of a preschooler reports to a nurse that her child has reverted back to bed wetting. Which questions asked by the nurse are appropriate? Select all that apply. 1 "Does your child have an illness?" 2 "Is there a new sibling in the family?" 3 "Did you recently move in to a new home?" 4 "Does your child regularly visit a house that was built before 1950?" 5 "Does your child live in a house built before 1978 with ongoing renovations?"

123 Stress can cause preschoolers to revert to bed wetting. Sources of stress for preschoolers may include illness, the birth of a sibling, and relocation to a new home. Regular visits to a house that was built before 1950 or living in a house built before 1978 with ongoing renovations may result in lead poisoning.

Which language characteristics should the nurse expect when assessing a preschool-age client during a scheduled health maintenance visit? Select all that apply. 1 Explaining opposites 2 Defining simple objects 3 Describing the use of an object 4 Verbalizing simple classifications 5 Using deviations from grammar rules

1234 The nurse would expect that the preschool-age client is able to explain opposites, define simple objects, describe the use of an object, and verbalize simple classifications. The nurse would not anticipate that the preschool-age client would be able to use deviations from grammar rules.

A 3-year-old child is brought to the emergency department after the sudden onset of high fever, drooling, and respiratory distress. What nursing actions should the nurse perform? Select all that apply. 1 Starting an intravenous line 2 Drawing a blood sample for a complete blood count and differential 3 Examining the child's throat with a flashlight and tongue depressor for swelling 4 Assessing oxygen saturation of the blood and administering oxygen by mask if it is below 94% 5 Asking the parents to remain in the waiting room during the examination and interventions 6 Assessing the child's temperature and administering an antipyretic if the rectal temperature is higher than 101° F (38.3° C).

1246 The child is presenting with signs of epiglottitis. An intravenous line will prevent dehydration and provide access for emergency medications if needed. Oxygen saturation should be kept above 94% to prevent hypoxia. Determination of the cause of the epiglottis (bacterial versus viral) will be necessary to manage the illness. Children in this age range can have febrile seizures; antipyretics will control the temperature. Examining the back of the throat with a tongue blade and flashlight is contraindicated unless preparations for emergency intubation have been made. Separating the child from the parents will increase the child's anxiety and may worsen the respiratory distress. Parents should be allowed to stay to provide comfort for their child.

A nurse needs to use an electronic infrared thermometer to measure the temperature of the tympanic membrane of a 4-year-old child. What steps does the nurse need to take? Select all that apply. 1 Pull the pinna up and out. 2 Pull the pinna backward, up, and out. 3 Avoid applying pressure to the ejection button. 4 Obtain temperature from patient's right ear if nurse is right-handed. 5 Point covered probe toward midpoint between eyebrow and side burns.

134 The nurse should pull the pinna up and out for a child of 4 years of age. The nurse should be careful not to apply pressure to the ejection button. If the nurse is right-handed, the temperature is measured from the child's right ear. When obtaining an adult's temperature, the nurse should pull the pinna backward, up, and out to measure body temperature. The nurse should point the covered probe toward midpoint between eyebrow and side burns for measuring body temperature in children 3 years and younger.

Which interventions should the nurse recommend for a preschool-age client who is biting other children at daycare? Select all that apply. 1 Separating the child from the situation 2 Implementing distraction to avert the behavior 3 Enquiring whether the child is getting enough sleep 4 Telling the child it is not okay to hurt another person 5 Using a time-out form of discipline for the child's behavior

1345 Appropriate interventions for a child who is biting others at daycare include separating the child from the situation, enquiring about child's sleep (lack of sleep is a common cause for this behavior), telling the child that is it not okay to hurt another person, and using a time-out as discipline for the behavior. Distraction is not appropriate for a child who is exhibiting behaviors that include other people, such as biting.

During a community health survey, the nurse is conducting a survey about the language development in preschoolers. What behavior is the nurse able to document in preschoolers? Select all that apply. 1 Preschoolers start to understand riddles and jokes. 2 Preschoolers want to know the reason behind an event. 3 Preschoolers have a vocabulary of 8,000 to 14,000 words. 4 Preschoolers know that words may have arbitrary meanings. 5 Preschoolers cannot distinguish between phonetically similar words.

135 Preschoolers start to question "Why?" and "How come?" Their vocabulary increases rapidly and they can define their feelings by using 8,000 to 14,000 words. School-aged children are able to understand riddles and jokes. This is not seen in preschool children. School-aged children clearly understand that words have arbitrary meanings. This is not seen in preschoolers. Preschoolers get confused between phonetically similar sounds. They are not able to understand the difference between die and dye or wood or would. Therefore, the nurse will not document this behavior with preschoolers.

The nurse is providing education to the parents of a preschool-age client who is obese. Which parental statements indicate correct understanding of the information presented? Select all that apply. 1 "I should avoid giving sugar-sweetened beverages to my child." 2 "It is ok for my child to watch 3 to 4 hours of television per day." 3 "My child should have 3 to 5 servings of carbohydrates each day." 4 "My child should have 5 servings of fruits and vegetables each day." 5 "It is important for my child to have at least 1 hour of activity per day."

145 An obese child should avoid sugar-sweetened beverages; eat 5 servings of fruits and vegetables each day; and have at least 1 hour of activity; therefore, these statements indicate correct understanding of the information presented. Television time should be limited to 1 hour each day. Currently there are no recommendations related to carbohydrate consumption.

Which item the nurse discusses is true about the brain maturation and cognitive development of preschoolers? 1 Preschoolers are least concerned about bodily harm. 2 Preschoolers are aware of the cause and effect relationship. 3 Most rapid growth occurs in the temporal lobes of the brain. 4 Preschoolers are inept at classifying objects according to size.

2 During the learning process, preschoolers start relating things. They become aware of the cause and effect relationship. For example, they may think, "The sun sets because people want to go to bed." The greatest fear of preschoolers appears to be that of bodily harm. This is evident in children's fear of the dark, animals, thunderstorms, and medical personnel. Most rapid growth is seen in the frontal lobes during brain maturation. Organizing new activities and maintaining attention to tasks are paramount. Preschoolers demonstrate their complex thinking abilities by classifying objects according to size or color and by questioning.

A nurse is planning to communicate with a preschool child. What is most important for the nurse to know about the child first? 1 State of health 2 Developmental level 3 Ability for self-expression 4 Fear of authoritarian figures

2 Each age group has different means of communication; the approach used with a school-aged child differs from that used with a toddler or a teenager. The child's state of health may modify the approach, but it is not most important to promote effective communication. The capacity for self-expression is related to the child's developmental level, which must be assessed first. Although children may fear authoritarian figures, this is just one aspect in the assessment of developmental level.

A preschool child is found to have chickenpox during the acute phase. The nurse tells the parents, "It's important not to expose your child to anyone undergoing certain types of prolonged medication therapy." What medication therapy puts a person at risk? 1 Anticonvulsant 2 Systemic steroid 3 Antihypertensive 4 Topical antibiotic

2 Individuals who are taking steroids have lowered resistance and may become fatally ill if exposed to the varicella virus. Anticonvulsants and antihypertensives do not lower body resistance; therefore they do not increase susceptibility. Topical antibiotics do not affect body resistance because topical antibiotics do not have systemic effects.

A father asks a nurse for strategies to convince his 5-year-old to wear a helmet while bicycling. What should the nurse suggest to the father? 1 "You should forbid your child from riding a bicycle." 2 "You should wear your helmet while riding your bicycle." 3 "You should limit your child's bicycling to a defined area." 4 "You should tell your child about the risks associated with not wearing a helmet."

2 The nurse should suggest the father to wear a helmet when he rides his bicycle. This sets a positive example for the child to wear his or her helmet. Restricting the child will interfere with the cognitive development. Limiting the child's bicycling to a defined area may lead to conflicts between the father and the child. Telling the child about the risks of not wearing a helmet may interfere with the child's willingness to ride.

Which actions should a nurse take while caring for a preschooler whose blood lead level is found to be 25 mcg/dL? Select all that apply. 1 Contact social services 2 Provide the family with lead education 3 Consider treating the child with appropriate chelation therapy 4 Refer the child to a clinical center specializing in lead poisoning 5 Immediately provide diagnostic testing and initiate chelation therapy

234 If the blood lead level of a preschooler is found to be between 20 and 44 mcg/dL, the nurse should provide lead education to the family. The nurse should also consider treating the child with appropriate chelation therapy. The nurse may refer the child to a clinical center specializing in lead poisoning. The nurse should refer the child to social services if the child's blood lead level is between 15 and 19 mcg/dL. The nurse should immediately provide diagnostic testing and initiate chelation therapy if the child's blood lead level is 70 mcg/dL or greater.

Which recommendation should the nurse make to the parents of a preschool-age client who is experiencing frequent nightmares? Select all that apply. 1 Bring the child to the parental bed. 2 Allow the child time to settle back into sleep. 3 Reassure the child by rubbing his or her back. 4 Repeat a nighttime routine, such as reading a story. 5 Place a television in the child's room as a distraction.

234 Recommendations to the parents of a preschool-age client who is experiencing nightmares include allowing the child time to settle back into sleep, reassuring the child by rubbing his or her back, and repeating a nighttime routine, such as reading a story. It is not recommended for the parent to bring the child to the parental bed as the child may continue to awaken at night to continue this practice. It is also not recommended to place a television in the child's room as a form of distraction for the nightmare.

A nursing instructor asks a nursing student about tips for examining a 4-year-old sick child. Which statements made by the nurse indicate adequate teaching? Select all that apply. 1 "I should call the child as 'Mr.' or 'Ms.'" 2 "I should give the child time to play around." 3 "I should start the examination with the child's fingers and hands." 4 "I should gather all information related to the child's sickness from the parents." 5 "I should make judgments when parents share the details of their child's sickness."

234 While examining a 4-year-old, the nurse should let the child play for some time so that the child may get acquainted to the new surroundings. This action will increase child's cooperative behavior. The nurse should start the examination with nonthreatening areas like the fingers or hands. Information related to the child's sickness is gathered from the parents or guardians. The nurse should call the child by his or her first name and address the parents as "Mr.," "Ms.," or "Mrs." The nurse should refrain from passing judgment when parents explain about their child's illness.

The nurse is studying the stages that characterize the progression of chemical pneumonia in young children following ingestion of a hydrocarbon. Which symptoms does the nurse correctly list as occurring in the third stage postingestion, between 72 to 96 hours? Select all that apply. 1 Sweating 2 Stupor 3 Multiple organ failure 4 Coagulation abnormalities 5 Pain in right upper quadrant

245 Stupor, coagulation abnormalities, and pain in the right upper quadrant are seen in the third stage postingestion, between 72 and 96 hours. Sweating is generally seen in the first stage, between 0 and 24 hours postingestion. In the fourth stage, which occurs after 5 days, hepatotoxicity resolves, or the situation progresses to multiple organ failure, which may be fatal.

A 10-year-old child is admitted to the hospital for surgery. The parents state that the child is mentally challenged and functions on the level of a 3-year-old. What should the nurse include in the child's preoperative teaching plan? 1 Excluding the child from this complicated preparation 2 Encouraging parents to teach the child the needed information 3 Providing explanations at a preschooler's level of understanding 4 Presenting the lesson at the cognitive level of a young school-age child

3 The child is functioning at the level of a 3-year-old; explanations should be provided in simple terms immediately before each procedure. All children who comprehend language should be included in preoperative teaching. The parents will not have the knowledge necessary to prepare the child for the procedure. A young school-age child understands at a higher level than this child; explaining at this level is nonproductive.

What developmental intervention should the nurse provide to the parents of preschoolers? 1 Educating parents about the risk of falls and other accidents 2 Educating parents about the importance of immunization 3 Teaching parents about reducing risks of physical injuries at home and during play 4 Guiding parents in making lifestyle modifications for stress reduction in their child

3 The nurse should educate the parents of preschoolers about reducing the risks of physical injuries at home and during play. The nurse should educate older adults about measures to reduce the risk of falls and other accidents. The nurse should educate the parents of infants and toddlers about the importance of vaccinations. The nurse should educate adults who are preparing to become parents about making lifestyle modifications.

Which is often a source of stress for 5-year-old clients that the nurse should include in the assessment process during the health maintenance visit? 1 Jealousy 2 Stubbornness 3 Procrastination 4 Companionship

3 Procrastination, or a delay completing chores or activities, is a source of stress for 5-year-old clients. Jealousy, stubbornness, and companionship are sources of stress for 3- and 4-year-old preschool-age clients.

What gross motor skills should the nurse expect a developmentally appropriate 3-year-old child to perform? Select all that apply. 1 Skipping on alternate feet 2 Riding alone on a small bicycle 3 Standing on one foot for a few seconds 4 Alternating the feet when walking up stairs 5 Jumping rope by lifting both feet simultaneously

34 Standing on one foot can be expected; usually it is accomplished by 3 years of age. Children at 3 years of age are able to walk up the stairs by alternating the feet; they can also jump off the bottom step. Skipping on alternate feet is usually accomplished at 5 years of age. Riding a small bike requires balance that is not present until 4 or 5 years of age; the 3-year-old child usually can ride a tricycle. Jumping rope by lifting both feet simultaneously is not accomplished until later in the school-age years.

A child is brought in to the emergency department with acute aspirin poisoning. Which clinical manifestations indicate that the child exhibits early symptoms of aspirin poisoning? Select all that apply. 1 Hyperactivity 2 Seizures 3 Tinnitus 4 Hyperventilation 5 Respiratory failure

34 Tinnitus and hyperventilation are early symptoms of aspirin poisoning. Seizures, hyperactivity, and respiratory failure are later symptoms of acute aspirin poisoning.

Which description by the nurse is true about the play of preschoolers? Select all that apply. 1 Preschoolers hinder play of other children. 2 Preschoolers follow set rules while playing. 3 Preschoolers pretend to play different roles. 4 Preschoolers get engaged in associative play. 5 Preschoolers need a temporary leader to play.

345 Preschoolers pretend to play different roles. They are social and shift from parallel play to associative play. Playing helps them learn to understand others and become more creative. Also, they select an interim leader for each activity. Preschoolers play with other children in a cooperative manner, rather than hindering their play. However, there is no division of labor or rigid organization or rules.

Which condition may a 4-year-old child develop due to a failure in mastering sensorimotor integration? 1 Obesity 2 Dyslalia 3 Sleep disturbance 4 Developmental stuttering

4 A failure in mastering sensorimotor integration may lead to stammering, which is also called developmental stuttering. Exposure to domestic violence may cause obesity in school-age children. Dyslalia may develop in children who are pressured into producing sounds ahead of their developmental level. Sleep disturbance is a common problem during preschool years.

The pediatric nurse compares the sources of stress in preschoolers of different ages. Which source of stress is common to 3-year-olds, 4-year-olds, and 5-year-olds? 1 Destructiveness 2 Procrastination 3 Companionship 4 Belongings

4 Belongings are a source of stress to children of all three age groups. Children of age 3, 4, and 5 years guard and protect their possessions. Procrastination is a source of stress in only 5-year-olds. A 5-year-old child delays completing chores or activities. Companionship is a source of stress in only 4-year-olds. A 4-year-old enjoys interacting with friends, although they may quarrel. Destructiveness is a source of stress in only 3-year-olds. A 3-year-old may damage or destroy objects.

Which teaching statement related to the growth of a preschool-age client is appropriate when educating the family during a scheduled health maintenance visit? 1 "The rate of physical growth accelerates during this stage of development." 2 "Muscle and bone development is mature during this stage of development." 3 "You can expect your child to keep the potbelly appearance during this stage of development." 4 "Your child's legs will grow in length versus the trunk of the body during this stage of development."

4 During the preschool stage of development the legs will grow in length versus the trunk as seen during the previous stages of development. The rate of physical growth slows and stabilizes during the preschool stage of development. Muscle and bone development continue to be immature. The potbelly appearance disappears during the preschool stage of development; the preschooler is slender but sturdy, graceful, agile, and posturally erect.

Which statement regarding injury prevention should the nurse include in a presentation for the parents of preschool-age clients? 1 "Preschool-age children are more prone to falls than toddler." 2 "Preschool-age children are at risk for injury due to poor gross motor skills." 3 "Preschool-age children are less likely to follow rules which increase the risk for injury." 4 "Preschool-age children are at risk for injury because they are provided more freedom, such as riding a tricycle in the street."

4 Preschool-age children are at risk for injury because they are provided more freedom, such as riding a tricycle in the street; therefore, the nurse should include this statement in the presentation. The preschool-age child is at a decreased risk for falls when compared to the toddler. The preschool-age child has better gross motor skills; therefore, this decreases their risk for injury. The preschool-age child is more, not less, likely to follow the rules which also decrease the risk for injury.

A father worries about the effects that an imaginary playmate will have over his 5-year-old child. What should the nurse inform the father? Select all that apply. 1 "Your child will achieve what the imaginary playmate attempts." 2 "Your child will have an inferiority complex because of imaginary playmates." 3 "Imaginary playmates will confuse your child's grasp of reality." 4 "Imaginary playmates will experience what your child wants to remember." 5 "Your child's imagination of a playmate means that your child is healthy."

45 Imaginary playmates will experience what a child wants to remember or forget. A preschooler who has imaginary playmates is considered healthy. Imaginary playmates achieve what the child tries to accomplish. Imaginary friends will not make the child feel inferior. These characters help the child to differentiate between reality and fantasy.