Chapter 19: Preschooler

Nutritional guidelines (MyPlate/MyPyramid)

* Age 3 - 5 y/o should receive 1200 to 1600 calories * Children should eat a variety of foods with at least 5 servings of fruits and vegetables per day * 50% diet in carbohydrates (whole grains should be plentiful in order to attain a total fiber intake of 20 to 25 g per day) * 5% - 20% protein * 20% - 35% fat (Fat requirements in preschool children are higher than older children.... should consist primarily of unsaturated fat, with saturated fat, trans fatty acids, and cholesterol intake as low as possible)

CDC identifies ___ in ___ children on Autism Spectrum

1 in 68

Preschoolers need approximately ____ kcal/kg of body weight per day for health maintenance, activity, and growth

90

Which of the following foods will a 5-year-old child need help eating? A. Pudding B. Macaroni and cheese C. Chicken D. Jelly sandwich

C. The preschooler will need help with the chicken. In the later preschool years, most children need help cutting meats.

The school nurse assesses preschoolers for genetic conditions such as: A. Down syndrome B. Congenital hypothyroidism C. Sickle cell disease D. Duchenne muscular dystrophy

D. During the preschool years, the genetic conditions that are most likely to appear are cystic fibrosis, Duchenne muscular dystrophy, fragile X syndrome, and Williams syndrome and autism which is generally considered a genetic disorder with a high degree (90%) of heritability. - Down syndrome is usually diagnosed soon after birth because the infant exhibits physical characteristics that warrant evaluation for the chromosome karyotype.

A 4-year-old girl asks her mother for a second cup of yogurt before starting to eat the first cup she was given. What will the child most likely do with the extra helping? A. Eat it herself B. Ask her brother if he wants it C. Feed it to her dog D. Give it to her imaginary friend.

D. Preschoolers may have one or more imaginary companions. They are usually another child. Preschoolers eat, play, and sleep with their imaginary companions.

What is the most common intraocular tumor in young children?

Retinoblastoma

Ishihara's Test

Visual detection screening for color-blindness

According to Erikson, the preschooler is wrestling with ______ vs. ______

initiative vs. guilt sense of initiative = active imagination & vigorous activity parental role to avoid guilt = promote initiative ---> nurture ideas, encourage behaviors to promote child's self-concept

Speech of 42 month old

receptive - 4200 words expressive - 1200 words

An individuals style of emotional and behavioral response across situations, especially those involving change or stress, is known as _____

temperment

Enuresis

wetting the bed

Expressive language

words the child can physically say/communicate

A mother tells the nurse her 3-year-old child has not been himself lately. The nurse examines the child. Which of the following physical findings would be cause for concern? (select all that apply) A. Bruises B. Pale skin C. Enlarged lymph nodes D. Hives

(A, B, C). Bruises, pale skin, and enlarged lymph nodes are all warning signs that may indicate childhood cancer

The nurse working with the preschool age group educates parents about which of the following nutritional guidelines? Select all that apply. A. Preschool children should eat at least five servings of fruits and vegetables per day. B. Children aged 3 to 5 should receive 1000 to 1200 calories per day. C. Preschool children should consume approximately half of their diet in carbohydrates. D. Fat requirements in preschool children are higher than those for older children. E. Cholesterol is not an issue at for this age group.

(A, C, D)

Which of the following physical activities are most appropriate for the preschool age group? Select all that apply. A. Ring around the Rosy B. Watching television C. Electronic video games D. Tee ball (nonpitching vs of softball) E. Paintball

(A, D) Tee ball is intended for children age 4 to 8 and develops skills needed for later playing of softball and baseball. It is an excellent activity for the preschool age group. Similarly ring around the Rosie is a simple game, involving singing and walking. It utilizes motor skills which are developmentally appropriate for the preschooler.

The nurse is teaching parents about strategies concerning injury prevention for preschoolers. Instructions for parents would include which of the following? Select all that apply. A. Dress child only in flame-retardant clothing B. Administer ipecac syrup immediately in event of any poison ingestion. C. Use heat mist humidifier on sturdy tables. D. Practice emergency escape plan from the home. E. Obtain training in CPR and abdominal thrusts.

(A, D, E) - Preschoolers should only wear flame-retardant clothing, especially at night - For safety, use only cool mist humidifiers to treat upper respiratory tract infections --> Additional precautions include closing the doors of the dishwasher, oven, washer, and dryer; mark all glass doors with decals to delineate doors; use gates at the top and bottom of stairs for the younger child; set water heater temperature at a maximum of 120°F to avoid burns; store all poisonous substances out of the reach of children; discourage running in the house; avoid throw rugs on bare floors.

Which of the following behaviors by a preschooler indicates use of an effective coping mechanism? (select all that apply) A. The preschooler walks away from the situation B. The preschooler blames a friend for causing the problem C. The preschooler states what he is upset about D. The preschooler has a temper tantrum

(B, C) Preschoolers use many of the coping mechanisms developed during their toddler years, but they generally show greater ability to verbalize frustration, fewer temper tantrums, and more patience in experimentation to resolve difficulty than the typical toddler. Preschoolers refine their problem-solving skills. Through fantasy play, they investigate solutions or responses to stressful events and find inner control for challenging situations. Preschoolers tend to project blame.

A nurse administers the Draw-a-Person and Draw-a-Family tests with a preschool student. Which of the following purposes will these tests serve? (select all that apply) A. Assess verbal development B. Assess intelligence development C. Assess social development D. Assess emotional development

(B, D) Draw-a-Person & Draw-a-Family tests approximate intelligence and emotional development; however, scoring figure drawings requires standardized test conditions and analysis of findings by a psychometric specialist. Nurses, however, use these methods in conjunction with other information to help establish rapport and provide a starting point to guide assessment. Drawings may indicate general developmental level, fine motor control, and evidence of concept formation.

Risk factors for Autism

- atypical birth weight - low Apgar score - hemolytic disease - jaundice - respiratory distress - older parents

4 most commonly diagnosed genetic problems most likely to appear during the preschool years are:

1. Cystic fibrosis 2. Duchenne muscular dystrophy 3. Fragile X syndrome 4. William's syndrome

A 4-year-old boy had an episode of enuresis. Which of the following actions should be taken by the parents? A. Have him change his own pajamas before going to bed B. Take away one video game C. Tell his 6-year-old sister about the incident D. Make him wear his diaper to bed.

A.

Which of the following is a hallmark of Piagets preconceptual substage? A. Using language to function symbolically B. Using concrete thought processes C. Using mental abstracting D. Using transductive reasoning

A.

A nurse is using primary prevention strategies to prevent child abuse in the community. Which of the following interventions would the nurse implement? A. Educate the public about violence and the potential for abuse B. Remove a child who has been abused from the home C. Report a case of child abuse D. Refer a parent who abused their child to counseling.

A. Educating the public about violence and the potential for abuse is a form of primary prevention. Nurses provide primary prevention for violence by promoting awareness and providing anticipatory guidance. Primary prevention is used before violence actually occurs.

During a well-child visit, a parent tells the nurse that their preschooler occasionally wakes up during the middle of the night. Based on growth and development, which of the following would be the most common reason for the preschooler to wake up? A. Nightmares B. Night terrors C. Enuresis D. Hunger

A. Nightmares are a common reason for nighttime awakenings. Nightmares fully waken the child and give them a feeling of fearfulness and helplessness.

The nurse is conducting a physical exam on a 3-year-old child. Which of the following would be the best way for the nurse to approach the child during the exam? A. Let the child listen to the nurses heart with the stethoscope B. Tell him to sit quietly while the nurse examines him C. Ask his parents to leave the room to minimize distractions D. Ask another nurse to hold him while the nurse examines him.

A. Preschoolers like to imitate adults and like to play with medical devices.

A school nurse is planning to assess the visual acuity of the preschool students at the school. Which of the following tests would be used? A. Snellen Screening test B. Denver Eye Screening test C. Ishiharas test D. Cover test

A. The Snellen Screening test is a reliable estimate of actual visual acuity. -- > detects refractive errors (ex: myopia)

The preoperative stage of thinking is displayed by the child as: A. transductive reasoning. B. the trait of irreversibility. C. understanding the perspectives of others. D. an ability to consider more than one factor when solving simple problems.

A. The child cannot proceed from general to particular (deduction) or from particular to general (induction); rather, the child moves only from particular to particular in making associations and solving problems.

A 4-year-old child tells the school nurse that he invented a new song. Which of the following would be the best response by the nurse? A. Congratulate the child on a job well done B. Tell the child that he is too young to invent anything C. Nicely tell the child that it does not sound like a song D. Ask the child to come back later when there is more time to listen to the song.

A. When children perceive their value, they experience good feelings about themselves. They develop initiative through active imagination. According to Erikson, this is the most important developmental task in the development of self-concept. Reinforcement of behaviors and praising are methods that help develop self-concept.

Which sleep ritual is age appropriate for a preschooler? A. Asking for every light in the home to be turned on at bedtime B. Saying good night to all 20 stuffed animals in the room before going to sleep C. Going right to sleep D. Asking the parent to read all books on the bookshelf before going to bed

B. An age-appropriate sleep ritual for a preschooler is to say good night to all 20 stuffed animals in the room before going to sleep. Preschoolers have longer, more rigid bedtime rituals than toddlers. They prolong bedtime routines, which for them generally last about 30 minutes. Reasonable rituals should be honored.

The school nurse is observing the development of gross motor skills of young children at the school and watches a child who is learning how to throw a ball overhand. How old is this child? A. 3 years old B. 4 years old C. 5 years old D. 6 years old

B. At the age of 4, most children have mastered throwing a ball overhand.

How old is a preschooler with a receptive vocabulary of up to 5600 words? A. 42 months old B. 48 months old C. 54 months old D. 60 months old

B. By 48 months of age, most preschoolers have receptive languages skills of up to 5600 words.

The nurse suspects a 5-year-old child has asthma. Which information from the childs past medical history is a risk factor? A. The child was breast-fed B. The child had respiratory infections as an infant C. The child was born via a C-section D. The child had pressure equalizer tubes as an infant.

B. Having respiratory infections (such as RSV) as an infant is a risk factor for asthma. Others include genetic predisposition, allergens (such as animal dander/dust mites), and other nonspecific precipitants such as exercise, weather, or stress.

A nurse is reviewing the chart of a preschool child who has been diagnosed with Aspergers syndrome. Which of the following findings is the nurse most likely to discover? A. Eating finger foods at 10 months old B. Absent crawling at 10 months old C. Separation anxiety at 10 months old D. Saying ma-ma at 10 months old

B. Manifestations of autism spectrum disorders vary considerably. Usually have had some childhood stressors such as chronic ear infections, sleeping/eating problems, absent/brief crawling phase, language delays, atypical responses to sensory stimulation, lack of separation anxiety, and failure to attain motor skill developmental milestones as warning signs that warrant further assessment.

A 2-year-old child has hives. Of the following items ingested, which is most likely to have caused the allergic reaction? A. Apple juice B. Oatmeal raisin cookies C. Jelly sandwich D. Banana

B. Oatmeal raisin cookies are most likely to have caused the allergic reaction. Nuts are a food that is likely to cause allergic reactions, and oatmeal raisin cookies often contain nut products.

A 5-year-old is consuming a daily caloric intake of 1400 calories. Approximately what portion of the diet should be comprised of carbohydrates? A. 300 calories B. 700 calories C. 900 calories D. 1200 calories

B. Preschoolers should consume approximately half of their diet in carbohydrates. Children ages 3 to 5 years old should receive 1200 to 1600 calories per day depending on their activity level and gender.

A preschooler and her school-age brother both received the same swimming tube as a gift. The brother accidentally took his sisters swimming tube. The sister protested that she needed her swimming tube to go swimming. Which of the following is being demonstrated by this behavior by the sister? A. Abstract thinking B. Concrete thinking C. Jealousy D. A temper tantrum

B. The behavior is indicative of concrete thinking. Egocentrism exemplifies the concept of concrete thinking. Children can only concentrate on their own perspective. The preschooler is not able to consider more than one factor at a time when solving problems.

A mother comments to the school nurse that her child has poor hygiene habits and asks the nurse for suggestions as to how to teach her child to improve on his hygiene. Which of the following recommendations would the nurse give the mother? A. Have him learn it at school B. Model the behavior at home C. Lecture him about hygiene D. Punish him when he forgets to brush his teeth

B. The best way for a parent to teach a child good hygiene is to model the behavior at home. Reinforcement of health-promotion activities helps to instill behaviors. Additionally, preschoolers like to imitate adults.

A 5-year-old is prescribed a medication that is renally excreted. Which of the following considerations should be made when the nurse examines the dosage of the medication? A. The dosage should be lower than the recommended dose B. The dosage should be at the recommended dose C. The dosage should be higher than the recommended dose D. The medication should not be administered

B. The dose should be at the recommended dose. Kidneys reach full maturity by the end of infancy and early toddler years. As a result, medications that are renally excreted can be given at the recommended doses.

A nurse is discussing genetic disorders with a local community group. Which of the following statements would the nurse make during the presentation? A. Downs syndrome is most likely to appear during the preschool years B. Hemophilia is most likely to appear during the preschool years C. Cystic fibrosis is most likely to appear during the preschool years D. Multiple sclerosis is most likely to appear during the preschool years.

C.

The nurse is teaching parents about typical sleep disturbances of the preschooler. Which recommendation would the nurse make to the parents? A. Bedtime rituals of 1 hour or more should decrease sleep disturbances. B. Nighttime wakening, frequently seen in toddlers, is uncommon in preschool years. C. Parents should help the child differentiate between "pretend" and "real" occurrences. D. When the child has night wakening events, reassurance occurs when the child is taken to the parent's bed.

C.

During a well-child visit, a father tells the nurse that the preschool-aged child has been enjoying their road trips that they take together when the child gets to sit in the front seat of the car with him. Which of the following actions should the nurse take next? A. Report the father to the Department of Human Services B. Encourage the father to have the child sit in the back seat instead C. Instruct the father on the dangers of having small children in the front seat D. Provide the parent with educational materials about car seat safety.

C. Federal investigations concluded that children under age 13 should ride in the back seat of a motor vehicle, particularly because of potential injury or death from a passenger seat air bag that could inflate in a severe car accident. Although parents may know that infants should be placed in the back seat, they do not always know that children in the front seat of a motor vehicle face danger, even if they are using a restraint system.

A nurse is using the Healthy People 2020 health promotion and disease prevention objectives for preschoolers when planning for health policy development in the community. Which of the following health policies would the nurse support? A. Elimination of the school requirement for the MMR vaccine B. Regulation of the use of electronic devices used by preschoolers C. Regulation of the paint allowed for use with toys D. Elimination of WIC programs

C. Paints can contain lead, and lead poisoning can lead to disabilities. A Healthy People 2020 objective is to eliminate elevated blood-lead levels in children.

A mother thinks her 2-year-old child drank Drano. What should the nurse tell the mother to do next? A. Call the pediatrician on call B. Give ipecac syrup C. Call the Poison Control Center D. Wait to see if the child will vomit.

C. Parents should have the number for the poison control center handy. Ipecac syrup should also be in the home; however, The Poison Control Center should be contacted before administration of ipecac syrup in order to determine if this would be appropriate following ingestion of this substance.

A nurse is discussing with parents how to prevent burns in a preschooler. Which of the following recommendations is the nurse most likely to give the parents? A. Do not read to the child while sitting on the sofa in front of the fireplace B. Do not cook on a gas grill until the child is a teenager C. Do not leave cigarettes and matches on the kitchen counter D. Do not cook with the child in the kitchen.

C. Preschoolers like to imitate and act older than they are. Having cigarettes and matches on the kitchen counter makes them available for use by the preschooler and can lead to burns. Preschoolers should also be taught the dangers of matches and fire.

During the 5-year-old well-child visit, the father tells the nurse that he is unsure if the child is socially ready to attend school. The nurse asks the father to describe some of the social interactions of the child. Which of the following behaviors would indicate that the preschooler is socially ready to attend school? A. He gives his brother the ball when he is tired of playing with it B. He never engages in any activity until his mother tells him to C. He plays well with a group of neighborhood children D. He moves from one activity to another.

C. Social interaction prepares preschoolers for school. The child acquires readiness to interact in group situations, follow directions, and take turns by interacting with others.

A nurse is determining caloric needs for a preschooler who weighs 18 kilograms. Which of the following represents the daily caloric needs for this child? A. 1360 calories B. 1540 calories C. 1620 calories D. 1800 calories

C. The approximate number of calories required by an 18-kg preschooler is 1620. Preschoolers need approximately 90 kcal/kg of body weight per day for health maintenance, activity, and growth.

The nurse makes a home visit to a child who has recently been diagnosed with asthma. Which environmental finding has the potential to trigger an asthma exacerbation? A. Radiator heating system B. Air conditioner C. Hardwood flooring D. Leaky roof

D. A leaky roof has the potential to trigger an asthma exacerbation because water or moisture can lead to mold growth, and mold is an allergen that can trigger asthma.

A nurse is working with a local daycare center to develop appropriate outdoor play activities for 5-year-old children at the center. Which of the following activities would the nurse most likely recommend? A. Having the children bring their bikes to the center so they can go for bike rides in the neighborhood B. Playing hopscotch on the sidewalk in front of the daycare center C. Taking the children swimming at the neighborhood pool D. Playing on the outdoor preschool equipment while being supervised by daycare personnel

D. Appropriate outdoor play for a 5-year-old child includes playing on age-appropriate playground equipment while being supervised by daycare personnel. At the age of 5, the child is still not proficient at controlling a bike in the streets or being safe with many children at a neighborhood pool. Additionally, children of this age have less fear of strangers.

Which play activity would the nurse plan for a 4-year-old girl 2 days after undergoing an appendectomy? A. Playing a game of Monopoly B. Dressing up in a Cinderella gown C. Participating in a game of hopscotch D. Drawing pictures of her mother and father

D. Most 4-year-old children play simple interactive games, dress themselves, copy a number of basic geometric figures well, and draw recognizable people. Preschoolers enjoy using language skills in telling stories and asking questions, and they can balance on one foot, jump, and run well. Because the child is 2 days postappendectomy, the activity selected would have to be one that is appropriate for her condition and recovery.

The hallmark of the first substage of Piaget's preoperational stage is the ability of the preschooler to function using: A. abstract thinking B. concrete thinking C. auditory cues D. language

D. The older toddler enters the first substage of the preoperational stage which includes the ability to function symbolically using language. The preschool child demonstrates increased symbolic functioning during the intuitive substage, from age 4 to 7 years. The predominant feature of this and the following period is the concrete thought process, as compared with adult abstract thinking. As they experience symbolic mental representations, preschoolers process mental symbols as though they were actually participating in the event. Adults analyze and synthesize symbolic information without concrete connections between the mental process and the actual event. At this stage, mental abstraction, such as skipping from one part of an operation to another, reversing the operation mentally, or thinking of the whole in relation to the parts, is not feasible.

Speech of 48 month old

receptive - 5600 expressive - 1500

Speech of 54 month old

receptive - 6500 expressive - 1800

Speech of 60 month old

receptive - 9600 expressive - 2200 knows # concepts to 5 knows names & colors understand left/right

Receptive language

words/phrases child has ability to comprehend but not say