*Growth and Development of the Preschooler

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A 4-year-old tells the nurse he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which nursing diagnosis is most applicable for his family?

Deficient knowledge of normal preschool development

A nurse is observing a 3-year-old preschooler engaged in play. Which of the following would the nurse most likely expect to observe?

Imitative play

The major developmental task according to Erikson is for the preschool child to develop which of the following?

Initiative

The nurse is providing teaching about preventing poisoning. Which of the following statements by the mother would warrant further discussion?

"All medicine in our bathroom is in childproof containers."

The mother of a 4-year-old girl reports her daughter has episodes of wetting her pants. The nurse questions the mother about the frequency. The nurse determines these episodes occur about once every 1 to 2 weeks. Which response by the nurse is indicated?

"At this age it is helpful to remind children to go to the bathroom."

"At this age it is helpful to remind children to go to the bathroom." Preschool-aged children may become occupied with activities around them and not remember to void. Reminding them to void is helpful. Discipline should not be applied to infrequent episodes of incontinence. There is no indication the child has an infection. page 127

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.

"He tries to sweep up cereal his brother spilled but cries when he can't do it well."

A father tells the nurse that his son has been asking questions about his genitals. The father states that he is unsure how to answer the questions of a 4-year-old. How should the nurse respond?

"It's best to answer his questions using accurate anatomical names and keep your answers simple." It is suggested to keep answers brief and use correct anatomical names of body parts. Offering this advice to the father will help guide him in how to address questions. It is not necessary to go into the detail of using books with pictures for children of this age. page 133

Which action by a preschooler would suggest that his thinking is inconsistent with normal preschooler growth and development?

Refusal to play with "real" children Although preschoolers have "imaginary friends," they also should relate with real playmates. page 128

A mother brings her 4-year-old son in for a check-up. Which of the following findings should the nurse be concerned about?

Resting pulse rate of 120

The child can hop on one foot.

In working with the preschool-age child, the nurse recognizes which of the following as a characteristic of the preschooler?

The child takes in new information at a rapid rate and asks "why" and "how.

The nurse is observing a playgroup of children of all ages. The preschoolers in the group would most likely be doing which activity?

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-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. page 135

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.

"Try using a night light in the child's room." "Set up some familiar bedtime rituals for your child." "Avoid having your child watch frightening shows on TV before bedtime." "Try reading a favorite story before bedtime." 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. Page 143

The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond?

"Your child is not expected to be able to perform those activities at 3 years of age." Skipping and standing on one foot for up to 10 seconds are motor skills that are expected from a 5-year-old, not a 3-year-old; therefore, the best response is letting the mother know that her child is not behind in motor development. page 130

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 father who is overweight Food used as reward or punishment Television on during meals Expectations to eat everything on plate 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. Page 141

The nurse is helping parents develop the developmental task of initiative in their preschool-aged child. Which activity would the nurse suggest the parents implement?

Allow the child to experiment with molding clay.

A 3-year-old is hospitalized unexpectedly and is frightened about the experience. What action could the nurse take to minimize the anxiety the child is experiencing?

Allow the child to handle the equipment before it is used on the child.

Deficient knowledge of normal preschool development

A nurse is developing a plan of care for a 4-year-old client with cystic fibrosis who has frequent hospitalizations related to his illness. Which would be the most appropriate nursing diagnosis for this client?

Delayed growth and development related to frequent illness

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?

Electra complex

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.

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.

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.

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.

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?

Preschool The preschool child begins to develop friendships. p 133

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.

A type of play seen in the preschool child encourages children to act out troubling situations such as those that occur in the hospitalized child who must undergo an upsetting procedure. This type of play is referred to as:

dramatic play. Dramatic play allows a child to act out troubling situations and to control the solution to the problem. This is important to remember when teaching children who are going to be hospitalized. Using dolls and puppets to explain procedures makes the experience less threatening. page 132

When planning how to respond to a child about telling stories, you would base your statement on the fact that

imagination in a 3-year-old is at its peak.

The developmental task of preschoolers is to achieve a sense of

initiative versus guilt.

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.

According to Erikson, the task for the preschool child is to develop:

Initiative 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. page 129

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?

"He loves milk and drinks it every time he is thirsty."

•

A 3-year-old tells the nurse that he has 19 brothers. The nurse knows that the child has two brothers. What would be the nurse's best response concerning his brothers?

"That's a good pretend answer, but tell me the names of the brothers you really have."

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?

"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile."

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.

1.Parent knows the misbehavior was intentional. 2.Warn the child there will be a time-out if the behavior does not stop. 3.Remove the preschooler to a boring spot. 4.Set a timer for no more than 4 minutes. 5.If the child gets up, replace the child and restart the time.

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?

44 lbs.

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?

Asking the girl to slow down and to think before she talks 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. page 131

Which behavior by a 3 year-old child does not validate Erikson's developmental task for preschoolers?

Compares his soccer abilities with his peers.

The nursing instructor is illustrating the various types of play. The instructor determines the class is successful when the students correctly choose which example as best representing onlooker play?

Observing without participating

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of the following is the highest calcium-containing fruit?

Orange

Fear of mutilation is significant during the preschool age.

True

The nurse is providing teaching about car seat safety for a parents' meeting at the preschool their children attend. Choose the points the nurse should make. Select all that apply.

- Many car seats are installed improperly, making them unsafe. - The back seat remains the safest place for children to ride. - Children who weigh less than 40 pounds should use a car seat with harness and top tether. - Booster seats should be used with both a shoulder and lap belt.

Telling tall tales is harmless and should be encouraged in preschoolers because it helps them develop their imaginations.

False Parents may be concerned "tall tales" can lead to chronic lying if supported. Caution them, therefore, not to encourage this kind of storytelling, but instead help the child separate fact from fiction by saying, "That's a good story, but now tell me what really happened." This conveys the idea a child has not told the truth, yet does not squash imagination or initiative. page 145

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?

Help her pretend the x-ray machine is a camera.

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 nurse is caring for a preschool-aged child who needs a CT scan. Which action would the nurse use to best prepare the child for this diagnostic test?

Help the child to pretend that the CT scan machine is a camera

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.

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention?

"The school is quite structured and advocates corporal punishment."

"By the age of 6 most children can print some letters and maybe their first name."

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?

"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. page 137

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?

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

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?

"I will need to find an appropriate punishment for him if this continues."

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.

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.

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 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?

Asking the girl to slow down and to think before she talks

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.

Children are playing in an organized group with each other.

The nurse is organizing an indoor play area for preschoolers. What play materials are least important?

Electronic teaching toys 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.

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 family from India has recently moved to the United States. Their 5-year-old often visits the school nurse after lunch complaining of a "stomachache". The lunch staff tell the nurse that the child eats very little for lunch. What is the best action by the nurse?

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 nurse is observing a 5-year-old in the play room of the medical unit of the hospital. The child uses the toy medical equipment and proceeds to change the bandage on a doll, pretends to give the doll medication, and talks elaborately to the doll. How does the nurse accurately interpret this play?

The child is expressing anxiety about the hospitalization through play Preschool age children often use dramatic play to express anxiety, try out negative feelings, or conquer their fears. Page 135

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.

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium?

Orange 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. Page 141

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 caring for a preschool child in the hospital with severe developmental delays. The parents have 3 other younger children at home and both parents work full-time outside the home. The family has just moved to this area. Which nursing diagnosis would be the highest priority in regard to the parents at this time?

Risk for caregiver role strain Given that the parents are trying to care for 4 children with a severely developmentally delayed preschooler in the hospital, and they are new to the area (making it unlikely that they have a strong support system), the highest priority nursing diagnosis would be caregiver role strain. Family processes are likely altered, but with the hospitalization, strain on the parents is a higher priority nursing diagnosis

The nurse is presenting nutritional information at a community health fair. Which suggestion should the nurse prioritize when illustrating proper nutrition for preschoolers?

Snacks throughout the day help the child meet nutritional requirements

What suggestions regarding the evaluation of a child-care center would the nurse share with a preschooler's mother?

Specific program goals to be accomplished should be available.

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?

Support whatever the child paints.

The home health nurse, who is visiting the home of a 4-year-old, prepares a nursing care plan with the nursing diagnosis of "At risk for injury related to the parents insufficient knowledge of safety practices for preschooler." Which nursing interventions should the nurse include in the plan of care? Select all that apply.

Teach the parents to use a forward-facing car seat with harness and top tether. Teach the parents that the preschooler should use an approved bicycle helmet when riding a bicycle at any time. Parents should not smoke in an enclosed space such as a vehicle, even if the window is open. This would still expose the child to secondhand smoke. If properly instructed, the preschool child is capable of washing her hands independently. Childproof caps should be used in addition to keeping medications out of the reach of children, preferably a locked cabinet. p138

Testing and identification of group role

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.

When collecting data on a preschool-age child during a well-child visit, the nurse finds that the child has gained 12 lb and grown 2.5 inches in the last year. Using knowledge of normal growth patterns of the preschool child, the nurse recognizes that these findings indicate which of the following?

The child's weight is above an expected range and the height is within an expected range.

The nurse is caring for a 4-year-old child who is hospitalized and in traction. The child talks about an invisible friend to the nurse. Which action by the nurse is indicated?

The nurse should recognize this behavior as normal for the child's developmental age and do nothing. Preschool-aged children often interact with imaginary friends. The nurse should recognize this as normal for the age group. No special actions are needed. Page 128

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?

Transduction

Fear of mutilation is significant during the preschool age.

True 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. Page 134

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.

Teaching a group of caregivers about the topic of nutrition, one caregiver tells the group, "I use desserts as a reward for good behavior." A person in the group asks the nurse what she thinks about that idea. Which statement by the nurse would be the most appropriate? Using dessert as a reward for good behavior may cause the child to:

learn to use food to manipulate others' behavior. Food should never be used as a reward or bribe; otherwise, the child will continue to use food as a means to manipulate the environment and the behavior of others. Because of the high fat and sugar content of most desserts, the nutritional value of desserts is usually less than a balanced diet of healthier foods and could add to the concern of obesity in some children. A child might prefer sweets over nutritious foods and behave differently if dessert were a reward, but these choices are not the most appropriate answer. page 141

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.

transduction. 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. Page 128

The nurse is providing teaching about preventing poisoning. Which statement by the mother would warrant further discussion?

"All medicine in our bathroom is in childproof containers." The nurse should emphasize that while childproof caps on medications are important, all medications including those with childproof caps should still be kept locked. (Vitamins are medications.) The other statements are correct. Page 139

A nurse is caring for a 4-year-old girl. The parents indicate that their daughter often reports that objects in the house are her friends. They are concerned because the girl says that the grandfather clock in the hallway smiles and sings to her. Which response by the nurse is best?

"Attributing life-like qualities to inanimate objects is quite normal at this age." The nurse should explain to the parents that attributing life-like qualities to inanimate objects is quite normal. Telling the parents that their daughter is demonstrating animism is correct, but it would be better to explain what animism is and then remind them that it is developmentally appropriate. Asking whether they think their daughter is hallucinating or whether there is a family history of mental history is inappropriate and does not teach. page 128

The father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is most appropriate?

"Both your son's height and rate of growth are within normal limits for his age." The average 4-year-old child is 40.5 in (103 cm). The average rate of growth per year is between 2.5 and 3 in (6.35 and 7.62 cm). The child in the scenario demonstrates normal stature and growth patterns. pg 127

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

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 statement would alert the nurse that the child is at risk for iron deficiency?

"He loves milk and drinks it every time he is thirsty."

The nurse is conducting a well-child exam of a 4-year-old boy. Which statement would alert the nurse that the child is at risk for iron deficiency?

"He loves milk and drinks it every time he is thirsty." 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. Page 140

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.

The nurse is doing teaching with a group of caregivers of preschool children on various topics. The topic of sexual development is discussed. Which statement made by the caregivers indicates an understanding of the sexual development of the preschool-age child?

"I feel better knowing that what she is doing is normal." The child's sexual curiosity is a normal, natural part of total curiosity about oneself and the world. Exploration of the genitalia is natural for the preschooler. It is one way the child learns to perceive the body as a possible source of pleasure and is the beginning of the acceptance of sex as natural and pleasurable. Caregivers can be reassured that this is not uncommon behavior. Page 145

The parents of a 6-year-old 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 responses by the nurse? Select all that apply.

"I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." "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." "Do you play with your child and provide means of play through things like dolls, puzzles, crayons,and Play-Doh? 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 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?

"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. Page 144

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.

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 statement by the father would indicate a need for further teaching?

"I will need to find an appropriate punishment for him if this continues." 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. Page 132

The nurse has completed an education program on normal communication abilities in the preschool child. Which statement by a participant indicates a need for further education?

"I'm concerned that my 5-year-old can only count to 20." Normal communication abilities for a 5-year-old include counting to 10, not 20. It also included stating their name and address. Normal communication abilities in the 4-year-old include asking lots of questions and counting only a few numbers. Page 132

The nurse is discussing the topic of nutrition with a group of caregivers of preschoolers. Which statement by the caregivers is most accurate regarding nutrition in the preschooler?

"If I give snacks throughout the day, my child can meet her nutritional requirements." 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. page 141

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 mother of a 4-year-old child is concerned that she caught him masturbating in the bath tub. Which is the most appropriate response by the nurse?

"Masturbation is a normal part of preschool development." Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. The nurse can and should educate the mother on normal growth and development, including sexual issues. Page 145

A school nurse has completed an educational program for parents of the preschool children. Which statement by a participant indicates a need for further education?

"My 5-year-old son still needs me to dress and undress him." Dressing and undressing without assistance is an expected motor skill in a 5-year-old. Four-year-olds should be able to use scissors without assistance. Hopping on one foot is an expected motor skill for a 4-year-old. Learning to skate and swim are normal motor skills for 5-year-olds. Page 135

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by the caregivers best indicates a common aspect of the diet and nutrition of the preschool child?

"My child is so picky and eats the same thing every day for days on end!" 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.

The parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares?

"She screams and thrashes when we try to touch her." During a night terror, a child is typically unaware of the parent's presence and may scream and thrash more if restrained. During a nightmare, a child is responsive to the parent's soothing and reassurances. The other statements are indicative of a nightmare. page 143

The nurse is conducting a health screening of a 5-year-old boy as required for kindergarten. The boy is fearful about going to a new school. The mother asks for the nurse's advice. Which response by the nurse is best?

"Talk to your son's new teacher and schedule a tour with him." The nurse should encourage the mother to schedule a meeting with the teacher prior to school's start date and set up a time to tour the classroom and school so the boy knows what to expect. The other statements are not helpful and do not address the mother's or boy's concerns. page 134

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 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?

"Tell me about your child's exposure to tobacco smoke."

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 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?

"Use the time-out technique for discipline." 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. Time-out is a good technique that allows parents to discipline without using physical punishment. Page 144

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 nurse is providing teaching about child safety to the parents of a 4-year-old girl. Which statement by the parents indicates a need for further teaching?

"We need to tell her that her vitamins are candy." The nurse needs to remind the parents not to coax a child to take a vitamin supplement, tablet, or pill by calling it candy. The other statements are correct. page 139

During an admission assessment the nurse is discussing the developmental level of the child with the parents. Which comments by the parents demonstrate a good understanding of developmental expectations of the preschool-aged child? Select all that apply.

"We think it is important to have play dates with our friend's preschool children." "Our child attends a wonderful preschool 3 times per week." "We have been talking about enrolling in a morning preschool program since this is our only child." Making friends and playing with other children of the same age is important for socialization of the preschool-age child. Play dates, preschool, and day care are a means of socialization for the preschool child. Preschool children commonly display behavior of their peers, which is not an issue if it is acceptable behavior. pg 133

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. What would be the best response for the nurse to give the child?

"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." Parents sometimes strengthen a fantasy role without realizing it. A preschooler might be pretending she is a crocodile. If the nurse plays along, the child may be frightened she has actually become a crocodile. A better response is to support the imitation—this is age-appropriate behavior and a good way of exploring roles—by saying, "What a nice crocodile you're pretending to be." This both supports the fantasy and reassures the child she is still herself. page 128

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.

The nurse is conducting a well-child examination of a 4-year-old and is assessing the child's height. By how much should the nurse expect the child's height to have increased since last year's examination?

2.5 to 3 inches (6.35 to 7.62 cm) The average preschool child will grow 2.5 to 3 inches (6.35 to 7.62 cm) per year. Thus, the nurse would expect that the child's height would have increased 2.5 to 3 inches (6.35 to 7.62 cm) since last year's well-child examination. Page 127

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 mother comes to the clinic with her 3 year old and tells the nurse that she is worried because the child does not talk much. Upon talking to the child, the nurse learns that the patient has a normal vocabulary for age. The nurse is aware that language for a 3 year old consists of approximately at least how many words?

900 words

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?

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough 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. Page 142

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 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.

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.

Children are playing in an organized group with each other. During cooperative play, children play in an organized group with each other as in team sports. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. Parallel play occurs when the toddler plays alongside other children but not with them. Page 135

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.

Which project or game would you anticipate that a preschooler would most enjoy while hospitalized?

Dressing in her mother's coat to play house Preschoolers do well with activities that call for imagination. They are not ready for fine-motor or long-term activities. pg 135

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 nurse is observing a 3-year-old preschooler engaged in play. What behavior would the nurse most likely expect to observe?

Imitative play Preschoolers enjoy games that use imitation such as pretending to be teachers, cowboys, firefighters, and store clerks. They imitate exactly what they see their parents doing. Parallel play is characteristic of toddlers. Preschoolers are capable of sharing and play with other children as a means for socialization. Older preschoolers are interested in group games. page 135

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.

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.

The mother of a 3-year-old child reports her son is afraid of the dark. She asks the nurse for help. Which advice is best for the nurse to offer?

Encourage the parent to allow a small night light Fears are normal in the preschool-aged child. Some children are afraid of the dark. The parents should be advised to show patience with their child as he works through this fear. Refusing a night light will further increase the stress of the child. Parents should not give credibility to the fear by checking under the bed for monsters. Parents should not use the television to soothe the child, rather develop a routine that relaxing such as one-on-time with the child. Parents should disrupt the usual bedtime routine by allowing the child to sleep with them.

A mother is discussing with the nurse a recent story in the local news about a child being abducted. She is concerned about the safety of her preschool child and wonders what she should tell her child to keep her safe but without frightening her. Which of the following would be the best recommendation for the nurse to give the mother in this case?

Explain in a calm and everyday manner how the child should stay away from strangers in cars

The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal?

Falls when bending over to touch toes Bending over easily without falling is a normal expected gross motor skill in a 3-year-old. Building a tower of nine or ten cubes, pedaling a tricycle without assistance and unscrewing lids, bolts or nuts are also expected gross and fine motor skills for this age. page 141.

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

False The nurse may need to remind parents that broken fluency is a part of normal development and, if accepted as such, will pass. page 131

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

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.

The nurse is assessing a 4-year-old on a routine well-child visit. When assessing the gross motor skills of this preschooler, which activity will the nurse predict the child to be able to successfully accomplish?

Hop on one foot

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?

Imaginary friend

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?

Imagination

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.

Nursing students are reviewing information about the emotional development of the preschooler. They demonstrate understanding of the information when they identify what task as the task of the preschooler?

Initiative 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. page 132

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.

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) Interference with growth b) Obesity c) Iron deficiency d) Dental caries

Which assessment findings of the speech of a 5-year-old child warrant further follow-up? Select all that apply.

It is difficult for people outside of the household to understand his conversation. The child has a vocabulary of an estimated 1,200 words. The child is unable to provide his address when asked. By the age of 5 a child should have the ability to be understood in conversation by people outside of the immediate family even in the presence of some speech articulation issues. The child's vocabulary should exceed 2000 words. The child should be able to provide his address when asked. page 132

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.

Opening drawers in the room, pulling out supplies, and examining them

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?

Physical growth slows.

A nursing instructor is teaching students about changes during the preschool years. One predominant change that the teacher would emphasize is:

Physical growth slows. During the preschool period, physical growth slows considerably, while personality and cognitive growth continue at a rapid rate. Page 127

Preoperational thought 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 and 15 months. page 129

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.

A mother reports to the nurse that her 4 year old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother?

Preschoolers imitate as a healthy behavior--it is part of their imagination and normal growth and development."

The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation?

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. page 127

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.

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.

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 nurse is discussing development of fine motor skills in the preschool-age group with a group of nursing students. Which statement is most accurate regarding the fine motor skills of a 3-year-old?

The child can button his clothes. 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 shoelaces, and print his first name. page 130

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.

The nurse is discussing development of motor skills in the preschool-age group with a group of nursing students. Which statement is most accurate regarding the gross motor skills of a 4-year-old?

The child can hop on one foot. 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. page 130

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.

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

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.

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.

When collecting data on a preschool-aged child during a well-child visit, the nurse discovers the child has gained 12 lb (5.4 kg) and grown 2.5 inches (6.3 cm) in the last year. The nurse interprets these findings to indicate which situation?

Weight is above an expected range and height is within an expected range.

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of these actions? Select all that apply.

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. Books and stories can help preschoolers master proper behavior. 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. p144

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of the following? Select all that apply.

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. • Books and stories can help preschoolers master proper behavior.

The best activity that a preschooler's parents could use to help her achieve the developmental task of the preschool period is to

allow her to experiment with PlayDoh.

The developmental task of preschoolers is to achieve a sense of

initiative versus guilt. Developing a sense of initiative, or learning how to do things, is the developmental task of the preschool period. p135

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.

• "Try using a night light in the child's room." • "Set up some familiar bedtime rituals for your child." • "Avoid having your child watch frightening shows on TV before bedtime." • "Try reading a favorite story before bedtime."

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 nurse is providing teaching about car seat safety for a parents' meeting at the preschool their children attend. Choose the points the nurse should make. Select all that apply.

• Children who weigh less than 40 pounds should use a car seat with harness and top tether. • Many car seats are installed improperly, making them unsafe. • The back seat remains the safest place for children to ride. • Booster seats should be used with both a shoulder and lap belt.

A mother describes her 4-year-old girl's eating habits as "picky" and goes on to describe using wheedling, coaxing, and threatening measures to get her to eat. The nurse determines the child is growing normally. What interventions will be suggested? Select all that apply.

• Offer a variety of healthy foods including those liked and refused. • Approach mealtime matter-of-factly. • Allow the child to decide how much she will eat. • Ignore the pickiness. • Offer only nutritious between-meal snacks. • Focus on quality, not quantity.

A nurse is instructing a young mother on how to ensure a safe bath time for her 4-year-old son. Which of the following are important suggestions for the nurse to give to the mother? (Select all that apply.)

• Turn down the temperature of the water heater to under 120°F • Do not leave the child unsupervised in the bath tub • Assist the child in cleaning under fingernails and around ears

The most important safety precaution for parents to teach preschoolers is:

not to ride in a car with strangers

The parents of a 5-year-old tell the student nurse, "Our daughter takes after her father's lack of athletic ability. We have worked with her but she can't seem to throw a ball at all when we are playing with her." Which responses by the student are not appropriate? Select all that apply.

"Athletic ability is often hereditary, so it is good you are aware of her lack of athleticism while she is young." "I know how annoying that has to be. Neither my brother nor I have any athletic ability and neither do our parents." "I am sure she will catch on as she plays with more children and when she starts taking physical education classes at school. "Enrolling your daughter in a preschool softball or baseball program might help her athletic and motor skills." While at 4 years of age a child typically cannot throw a ball overhand, they are developmentally able to throw a ball by other means, such as underhand or side-handed. It is necessary to address this as a possible developmental delay and be sure the pediatrician is aware of the issue. page 135

The caregiver of a 6-year-old tells the clinic nurse that he is concerned that his child cannot yet print his first and last name; the caregiver is wondering if this is normal. Which response by the nurse would be most appropriate?

"By the age of 6 most children can print some letters and maybe their first name."

The mother of a preschool-age child is discussing normal development with the pediatric nurse. The nurse explains the developmental milestone of initiative. Which statement by the mother might be an example of this developmental milestone?

"He tries to sweep up cereal his brother spilled but cries when he can't do it well." 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.

During an extended stay in a hospital the nurse has observed a 5-year-old having several temper tantrums. How should the nurse address this behavior with the parents?

"Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." Typically temper tantrums are few or absent in occurrence by the time the child is of preschool age. Asking if this is typical behavior at home is appropriate in determining if this is just aggressive behavior or if this is a sign of a developmental delay. It is generally not necessary to discipline a child for temper tantrums and disciplining is not in the nurse's scope of practice. Page 134

The parents of a 4-year-old child tells the nurse that they are worried about the child. They state says that the child used to play well with others, but lately when they invite two other children for a play date, all the children do is argue. Which instruction is best for these parents?

"Only invite one or three other children to the play date, to make it an even number."

The nurse is providing teaching to the mother of a 4-year-old girl about bike safety. Which statement by the mother indicates a need for further teaching?

"She can ride on the street if I am riding with her."

The nurse is providing teaching to the mother of a 4-year-old girl about bike safety. Which statement by the mother indicates a need for further teaching?

"She can ride on the street if I am riding with her." The preschooler is not mature enough to ride a bicycle in the street even if riding with adults, so the nurse should emphasize that the girl should always ride on the sidewalk even if the mother is riding with her daughter. The other statements are correct. page 139

During an assessment, a preschool-aged child tells the nurse about having 12 siblings. The nurse is aware that the child has two older brothers. What would be the nurse's best response?

"That is a good pretend answer but tell me the names of the brothers you really have."

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention?

"The school is quite structured and advocates corporal punishment." The nurse needs to emphasize that there are number of reasons that a parent should not choose a preschool that utilizes corporal punishment. It may negatively affect a child's self-esteem as well as ability to achieve in school. It may also lead to disruptive and violent behavior in the classroom and should be discouraged. The other statements would not warrant further discussion or intervention. Page 138

The mother and father of a 5-year-old boy are discussing bicycle safety with the nurse. What comment indicates further teaching is needed?

"We just got him a new bike he can grow into."

A nurse is providing a routine wellness examination for a 5-year-old boy. Which response by the parents indicates a need for an additional referral or follow-up?

"We often have to translate his speech to others." By the age of 5, persons outside of the family should be able to understand most of the child's speech without the parents "translation." The other statements would not warrant additional referral or follow-up. A child of 5 years should be able to count to at least 10, know his or her address, and participate in long detailed conversations. Page 132

The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply.

"We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." Page 140

"Your son may have a friend named Andrew, but it could be an imaginary friend." 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. Page 128

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.

- "Try using a night light in the child's room." - "Set up some familiar bedtime rituals for your child." - "Avoid having your child watch frightening shows on TV before bedtime." - "Try reading a favorite story before bedtime."

What would be most effective in helping promote initiative and nutritional health for a preschooler?

Allowing the child to spread soft cheese on crackers. 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. page 140

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?

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough

The parents of a 5-year-old tell the nurse that it "seems like our child is afraid of everything from fireworks to butterflies." What actions should the nurse take? Select all that apply.

Ask the parents if they can identify anything that may be causing their child be be fearful. Suggest to the parents to talk with their child about his fears. Work with the parents and child to devise strategies to help deal with the fears. Preschoolers have a vivid imagination, which often leads to a variety of fears. The best way to deal with the child's fears is to address them and work together to determine ways to help minimize the fears. The preschooler is not emotionally equipped to understand why fears are irrational. page 134

While the nurse is taking a blood pressure on a 4-year-old, the child states that the blood-pressure cuff is too tight and angrily says, "That hurt, you big poo-poo head." What is the most appropriate response by the nurse?

Calmly explain that you don't mean to hurt her, loosen the cuff, and tell her that is isn't nice to call you names.

Children are acting out a troubling situation. 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. Page 135

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 nursing diagnosis is most applicable for his family?

Deficient knowledge of normal preschool development Because a preschooler's imagination is at a peak, imaginary friends are not uncommon. Page 128

Imaginary friend The preschooler 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. Page 128

A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group?

Imagination 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. page 128

A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which activity that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson?

Opening drawers in the room, pulling out supplies, and examining them. 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. page 129

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?

Pretending to be mommies and daddies in the playhouse

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?

Support whatever the child paints. 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 knows that his tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Page 128

When planning how to respond to a child about telling stories, you would base your statement on the fact that:

imagination in a 3-year-old is at its peak It is easy for preschoolers to engage in "tall tales" because of their active imagination. page 128

In working with the preschool-age child, the nurse recognizes what action as characteristic of a preschooler?

The child takes in new information at a rapid rate and asks "why" and "how." 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 he can do things one minute and then becomes dependent the next minute. The infant grows and develops skills more rapidly than he ever will again.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:

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. Page 140

The mother of a 5-year-old kindergarten student tells the school nurse she is concerned that her son doesn't seem to be able to pronounce words correctly that begin with the letters "th" and "r." What is the best response by the nurse?

"It is very common for children 6 years and younger to have difficulty with these sounds, but I will let our speech therapist know so it can be monitored." It is not unusual for children over the age of 6 to have difficulty with several different letters. The nurse is correct in notifying the speech therapist so that the child's speech can be monitored. There is no indication of the child being attention seeking or of this being a critical issue so these statement by the nurse are not appropriate. 131

If the child is gaining weight at an expected rate, a child who weighs 36 pounds (16.3 kg) at 3 years of age would weigh what amount at age 5?

44 lbs. (20 kg) The preschool age child gains about 4 to 5 lbs. each year (1.8 to 2.3 kg) and grows about 2.5 to 3 inches (6.3 cm). page 127

testing and identification of group role. 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. Page 132

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