Chapter 5: Growth & Development of the Preschooler

In teaching caregivers of preschool children, the nurse would reinforce that which activity would be most important for this age group? A) The preschool child should be properly restrained when riding in a vehicle. 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 cover mouth when coughing or sneezing.

A) The preschool child should be properly restrained when riding in a vehicle. A major cause of accidents in the preschool child occurs when the child is not properly restrained in a motor vehicle. Safety is the highest priority.

The nurse is assessing a 5-year-old child. Which statement by the parents would indicate the child is behind in communication skills? A) "My child finally has speech that my family and friends can understand." B) "My child knows the city we live in, but not the street address." C) "My child can describe how a microwave and television remote work." D) "My child talks about things that happened the previous week and even future plans."

B) "My child knows the city we live in, but not the street address." Normal communication skills in a 5-year-old child include the ability to state one's name and address, so this statement would indicate a delay. The other comments (recalling past and future plans, understanding how things work and has speech that most people can understand clearly) indicate a normal communication skill for a 5-year-old child.

Parents tell the nurse their 3-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

C) iron deficiency 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.

The nurse has brought a group of preschoolers to the playroom to play. Which activity would the nurse predict the children to become involved in? A) Playing a board game B) Watching a movie with other children their age C) Painting pictures in the art corner of the room D) Pretending to be mommies and daddies in the playhouse

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

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

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

The nurse assesses a 5-year-old client for a well-child visit prior to the start of school (above). What finding from the assessment requires follow-up? A) speech and language B) nutrition C) fine motor development D) blood pressure

A) speech and language The 5-year-old child's speech should be generally understood by strangers. This child's articulation is delayed, and this issue should be followed up with a speech-language assessment and therapy. The blood pressure is within the normal range. The nutrition is normal for a 5-year-old child; picky eating is a common occurrence. Fine motor development is also normal with writing one's own name, self-dressing, and managing toileting independently.

A 4-year-old female client presents to the clinic with an increased temperature. Based on the assessment findings (above), what does the nurse anticipate the primary health care provider will prescribe for this client? A) urinalysis, culture & sensitivity B) IV lactated ringer's solution C) complete blood count D) IV ciprofloxacin

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

A preschool-age child tells the nurse about an imaginary friend. The parents are concerned because the child refuses to do anything without the friend's help. Which nursing diagnosis is most applicable for the family? A) Compromised family coping related to abnormal behavior of child B) Parental anxiety related to lack of understanding of childhood development C) Disturbed thought processes related to deep-set psychological need D) Social isolation related to unwillingness to relate except through imaginary friend

B) Parental anxiety related to lack of understanding of childhood development The parents need to understand that the child's behavior is not uncommon. Imaginary friends are common in the preschool-age child. The child's behavior is not abnormal. The child does not have a deep-set psychological need. The child is not at risk for social isolation.

The parents of a 4-year-old child tell the school nurse that they are worried that their child will fall behind other children academically because they are not able to afford expensive toys like computer games and handheld electronic devices. Which are acceptable response(s) by the nurse? (Select all that apply.) A) "All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." B) "Are there any family members who can help you get these games for your child?" C) "I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." D) "Why are you not financially able to provide these toys and games for your child?" E) "Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and child-safe modeling clay? These are the types of toys suggested for preschoolers."

A,C,E A) "All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." C) "I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." E) "Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and child-safe modeling clay? These are the types of toys suggested for preschoolers." Expensive and elaborate toys do not place a child at an academic or developmental advantage. Simple toys that require interactive rather than passive play, and that may include the involvement of the parent, are recommended to foster development. The nurse should not question a family's finances nor recommend the family ask for financial assistance. These statements are judgmental and infer the family is not able to provide for the child, which is not the case.

A hospitalized 4-year-old child reports having difficulty falling asleep at night due to a fear of monsters. How will the nurse respond? A) "The monsters will not hurt you as long as you go to sleep at bedtime." B) "You sound scared. I will show you under the bed that there are no monsters." C) "Do not be silly, there are no monsters in the hospital!" D) "That is not a monster. That's just your IV pump making scary noises."

B) "You sound scared. I will show you under the bed that there are no monsters." Fears are very real to a preschool-aged child, because the child's imagination is active at this age. Acknowledging the emotion and working together to combat the fear are useful strategies. Denying the fear or giving credence to the reality of an imagined monster can make the fear worse.

A parent tells a nurse that the child has recently established some friendships for the first time. In which age group do you expect this child to be? A) School age B) Preschool C) Toddler D) Adolescence

B) Preschool During the preschool years the preschooler learns to cooperate with other children. Learning how to make a friend is an important part of social development. Preschoolers need a special friend they can talk to, care about, and play with. The toddler is aware of other children but plays parallel to other toddlers; they do not interact or form friendships at their developmental level. School-age children have developed friendships and often have close relationships with one or two friends, but have multiple friends in school. Friendships are very important to the adolescent child. They have established friendships throughout their lives.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize: A) adults learning infant/child cardiopulmonary resuscitation (CPR). B) having the child wear a personal flotation device whenever near or on the water. C) using and renewing sunscreen regularly. D) enrolling the child in swimming lessons.

B) having the child wear a personal flotation device whenever near or on the water. Preschool children are safe around water only when adult supervision is constant. Wearing a personal flotation device adds additional protection and should be as routine as "buckling up" in the car. At 5 years old, most preschoolers are mature enough to become swimmers, yet knowing how to swim does not make the preschooler safe without supervision. CPR is a life-saving skill and using sunscreen will protect the skin, but neither will be a factor in preventing drowning.

The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation? A) presence of 19 deciduous teeth B) presence of 10 deciduous teeth C) absence of dental caries D) presence of 20 deciduous teeth

B) presence of 10 deciduous teeth The presence of only 10 deciduous teeth would warrant further investigation. The preschooler should have 20 deciduous teeth present. The absence of dental caries or presence of 19 teeth does not warrant further investigation.

The parents of a preschooler ask the nurse, "What snacks are appripriate for us to give our child?" Which suggestion would the nurse provide? A) whole carrots B) sliced cheese sticks C) donut holes D) jelly beans E) a bunch of grapes

B) sliced cheese sticks Parents should offer the child healthy options that are not choking hazards. Cheese sticks that have been cut are healthy and are not a potential choking hazard. Whole carrots and grapes are healthy but also hold the potential to cause choking. Unhealthy snacks include candy such as jelly beans or sweets such as donut holes.

The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education? A) "It is okay for my four-year-old to still play in his sandbox." B) "I will add some crayons, chalk and finger paints to my three-year-old's birthday gifts." C) "I am so glad I can get rid of all of those bath toys because they take up so much room." D) "My four-year-old will be getting a tricycle for her birthday. I'm glad it's a good gift for her."

C) "I am so glad I can get rid of all of those bath toys because they take up so much room." Bath toys that squeak, float and squirt are appropriate toys for preschoolers. Creative toys like crayons, chalk and finger paints; gross motor toys like tricycles, big wheels and swing sets; and a sandbox with shovels and other toys for building are also appropriate toys for preschoolers.

Which would be a nutritional goal for a preschool client? A) Eat everything on the plate. B) Reduce messiness and spills. C) Introduce new food gradually and include variety. D) Let the child eat only what the child wants.

C) Introduce new food gradually and include variety. Mealtimes can become a power struggle between caregivers and the young child. Reassure caregivers that young children go through periods during which they are very particular about food. Therefore, new foods should be gradually introduced and include variety. Foods that look like or smell like other foods they enjoy are the most likely to be eaten. Eating everything on the plate can lead to obesity; the child needs a variety of the 5 food groups; and messiness and spills allow the child to use fine and gross motor skills and practice their use of utensils and cups.

The nurse is assessing a 4-year-old child. The child tells the nurse about her friend, Nancy, who lives in her room at home. The mother tells the nurse that Nancy is not a real person. The nurse would use which term when documenting this assessment finding? A) magical thinking B) preoperational thought C) imaginary friend D) animism

C) imaginary friend The preschool-age often has an imaginary friend. This friend serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Preoperational thought is a self-centered understanding of the world. Magical thinking is when a preschooler believes that his or her thoughts are all-powerful. Animism is when a preschooler attributes lifelike qualities to inanimate objects.

A family from India has recently moved to the United States. Their 5-year-old child often visits the school nurse after lunch reporting a "stomachache." The lunch staff tell the nurse that the child eats very little for lunch. What is the best action by the nurse? A) Speak to the child and parents to discuss the repercussions of visiting the nurse so frequently. B) Explain to the child that the reason for the stomachache is that not enough is being eaten during lunch. C) Talk with the child and encourage that lunches be brought from home so that nutrient needs are met. D) Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch.

D) Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch. Food served in the home is often very specific to the family's ethnic background. As the preschool-age child is exposed to persons of other cultures in school, he or she may or may not like the food that is served. It is important to first determine if this is the reason for the child eating very little at lunch so that appropriate interventions can be determined. Bringing lunch from home may be an option, but it must first be determined if food preference is the underlying cause of lack of eating.

The child care facility for preschool-aged children has had several outbreaks of gastrointestinal illness. What will the nurse recommend to the teachers to prevent future outbreaks? A) Post signs with written instructions about handwashing. B) Have parents provide food from home instead of facility-prepared. C) Disinfect all tables and chairs with bleach before meal times. D) Supervise and assist the children with handwashing.

D) Supervise and assist the children with handwashing. Preschool-aged children still need assistance with handwashing to ensure that they are using soap and washing hands thoroughly before meals and after using the bathroom. Because they cannot read, written instructions are not helpful for this age group. Diaper-changing surfaces should be disinfected, but tables and chairs do not require disinfection. Food from home is not necessary.

Which gross motor skill would the 4-year-old child have most recently attained? A) The child can button his/her clothes. B) The child can cut his/her food. C) The child can tie his/her shoelaces. D) The child can hop on one foot.

D) The child can hop on one foot. Gross and fine motor skills continue to develop rapidly in the preschool-aged child. Gross motor skills have to do with the development of large muscles. Balance improves around the age of 4, thus the child can hop on one foot and stand on one foot for 5 seconds. A 3-year-old child does not have the ability to accomplish these tasks. A 5-year-old child can button his/her own clothes, tie shoes, and cut his/her food.