NURS 355 Chapter 13
The nurse is teaching parents of a 4-year-old child about fine motor developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.)
Builds a tower of 9 or 10 cubes Builds a bridge with three cubes Adeptly places small pellets in a narrow-necked bottle The fine motor milestones of a 4-year-old child include building a tower of nine or 10 cubes, building a bridge with three cubes, and adeptly placing small pellets in a narrow-necked bottle. Lacing shoes and using scissors successfully are fine motor milestones seen at the age of 5 years.
In terms of fine motor development, what should the 3-year-old child be expected to do?
Copy (draw) a circle Three-year-old children are able to accomplish the fine motor skill of copying (drawing) a circle. The ability to tie shoelaces, to use scissors or a pencil very well, and to draw a person with seven to nine parts are fine motor skills of 5-year-old children.
Parents are worried that their preschool-aged child is showing hyperaggressive behavior. What are signs of hyperaggresive behavior? (Select all that apply.)
Disrespect Noncompliance Unprovoked physical attacks on other children Hyperaggressive behavior in preschoolers is characterized by unprovoked physical attacks on other children and adults, destruction of others' property, frequent intense temper tantrums, extreme impulsivity, disrespect, and noncompliance.
The nurse is talking to the parent of a 5-year-old child who refuses to go to sleep at night. What intervention should the nurse suggest in helping the parent to cope with this sleep disturbance?
Establish limited rituals that signal readiness for bedtime An appropriate intervention for a child who resists going to bed is to establish limited rituals such as a bath or story that signal readiness for bed and consistently follow through with the ritual. Punishing the child will not alleviate the resistance problem and may only add to the frustration. Allowing the child to fall asleep in a different room and to watch television to fall asleep are not recommended approaches to sleep resistance.
What signals the resolution of the Oedipus or Electra complex?
Identifies with the same-sex parent The resolution of the Oedipus or Electra complex is identification with the same-sex parent. Learning sex differences and sexually appropriate behavior is a goal in further differentiation of oneself but does not signal the resolution of the Oedipus or Electra complex. Guilt over feelings toward the father or mother is seen as a stage in the complex, not the resolution.
A parent taking a preschool child to school on the first day asks the nurse, "What do I do if my child wants me to stay?" What is an appropriate response by the nurse?
It is OK to stay part of the first day, but be inconspicuous On the first day of preschool, in some instances, it is helpful for parents to remain for at least part of the first day until the child is comfortable. If parents stay, they should be available to the child but inconspicuous. It would not be appropriate not to stay, to have someone else take the child to school, or to stay and participate in activities.
The nurse has just given a subcutaneous injection to a preschool child, and the child asks for a Band-Aid over the site. Which action should the nurse implement?
Place a Band-Aid over the site Despite the advances in body image development, preschoolers have poorly defined body boundaries and little knowledge of their internal anatomy. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin (e.g., injections and surgery). They fear that all their blood and "insides" can leak out if the skin is "broken." Therefore, preschoolers may believe it is critical to use bandages after an injury. The nurse should place a Band-Aid over the site.
Parents ask the nurse, "Should we be concerned our preschooler has an imaginary friend, and how should we react?" Which responses should the nurse give to the parents? (Select all that apply.)
"The imaginary playmate is a sign of health." "You can acknowledge the presence of the imaginary companion." "It is normal for a preschool-aged child to have an imaginary friend." Parents should be reassured that the child's fantasy is a sign of health that helps differentiate between make-believe and reality. Parents can acknowledge the presence of the imaginary companion by calling him or her by name and even agreeing to simple requests such as setting an extra place at the table, but they should not allow the child to use the playmate to avoid punishment or responsibility.
At a seminar for parents with preschool-age children, the nurse has discussed anticipatory tasks during the preschool years. Which statement by a parent should indicate a correct understanding of the teaching?
"I should expect my 3-year-old child to have a more stable appetite and an increase in food selections." A 3-year-old child exhibits a more stable appetite than during the toddler years and is more willing to try different foods. A 4-year-old child is imaginative and indulges in telling "tall tales" and may have an imaginary playmate; these are normal findings, not signs of stress. Also a 4-year-old child has an increasing curiosity in sexuality, which is not a sign of child abuse. A 5-year-old child is usually tranquil, not aggressive like a 4-year-old child.
The nurse is teaching parents about instilling a positive body image for the preschool age. What statement made by the parents indicates the teaching is understood?
"We will make sure our child is praised about his or her looks." Because these are formative years for both boys and girls, parents should make efforts to instill positive principles regarding body image. Children at this age are aware of the meaning of words such as "pretty" or "ugly," and they reflect the opinions of others regarding their own appearance. Despite the advances in body image development, preschoolers have poorly defined body boundaries. By 5 years of age, children compare their size with that of their peers and can become conscious of being large or short, especially if others refer to them as "so big" or "so little" for their age. Parents should not suggest their child compare him- or herself with other children in regard to size, and parents should not focus on their child's size as being little.
The nurse is teaching parents of a 3-year-old child about language developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.)
Asks many questions Repeats sentence of 6 syllables Uses primarily "telegraphic" speech The language milestones of a 3-year-old child include asking many questions, repeating a sentence of six syllables, and using primarily "telegraphic" speech. Naming one or more colors and having a vocabulary of 1500 words or more footing are language milestones seen at the age of 4 years.
Which type of play is most typical of the preschool period?
Associative Associative play is group play in similar or identical activities but without rigid organization or rules. School-age children play in teams. Parallel play is that of toddlers. Solitary play is that of infants.
What are common causes of speech problems? (Select all that apply.)
Autism hearing loss Developmental delay Common causes of speech problems are hearing loss, developmental delay, autism, lack of environmental stimulation, and physical conditions that impede normal speech production. Prematurity and an overstimulated environment are not causes of speech problems.
The nurse is planning to bring a preschool child a toy from the playroom. What toy is appropriate for this age group?
Farm animals and equipment The most characteristic and pervasive preschooler activity is imitative, imaginative, and dramatic play. Farm animals and equipment would provide hours of self-expression. Building blocks are appropriate for older infants and toddlers. A 500-piece puzzle or a paint by number picture would be appropriate for a school-age child.
The parent of a 4-year-old boy tells the nurse that the child believes "monsters and bogeymen" are in his bedroom at night. What is the nurse's best suggestion for coping with this problem?
Keep a night light on in the child's bedroom Involve the child in problem solving. A night light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with his parents will not get rid of the fears. A 4-year-old child is in the preconceptual stage and cannot understand logical thought.
The nurse is teaching parents of a 3-year-old child about gross motor developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.)
Rides a tricycle Jumps off the bottom step Stands on one foot for a few seconds The gross motor milestones of a 3-year-old child include riding a tricycle, jumping off the bottom step, and standing on one foot for a few seconds. Catching a ball reliably and walking downstairs using alternate footing are gross motor milestones seen at the age of 4 years.
According to Piaget, magical thinking is the belief of which?
Thoughts are all powerful Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all powerful. Believing God is an imaginary friend is an example of concrete thinking in a preschooler's spiritual development. Cause-and-effect implies logical thought, not magical thinking. Believing that if the skin is broken, the insides will come out is an example of concrete thinking in development of body image.
What developmental achievements are demonstrated by a 4-year-old child? (Select all that apply.)
Throws a ball overhead Has a vocabulary of 1500 words Tends to be selfish and impatient Commonly has an imaginary playmate Developmental achievements for a 4-year-old child include throwing a ball overhead, having a vocabulary of 1500 words, tending to be selfish and impatient, and perhaps having an imaginary playmate. Caring for oneself totally and skipping and hopping on alternate feet are achievements normally seen in the 5-year-old age group.
The nurse is explaining average weight gain during the preschool years to a group of parents. Which average weight gain should the nurse suggest to the parents?
2 to 3 kg The average weight gain remains approximately 2 to 3 kg (4.5-6.5 lb) per year during the preschool period.
The nurse is conducting an assessment of fine motor development in a 3-year-old child. Which is the expected drawing skill for this age?
Can copy a circle and imitate a cross A 3-year-old child copies a circle and imitates a cross and vertical and horizontal lines. He or she holds the writing instrument with the fingers rather than the fist. A 3-year-old is not able to draw a complete stick figure but draws a circle, later adds facial features, and by age 5 or 6 years can draw several parts (head, arms, legs, body, and facial features). Copying a triangle and diamond are mastered sometime between ages 5 and 6 years.
The nurse is explaining the preconventional stage of moral development to a group of nursing students. What characterizes this stage?
Children in this stage have little, if any, concern for why something is wrong. Young children's development of moral judgment is at the most basic level in the preconventional stage. They have little, if any, concern for why something is wrong. Following the rules, living up to social expectations, and having a concrete sense of justice and fairness are characteristics in the conventional stage.
A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." What is the nurse's best interpretation of this comment?
Common at this age Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age react to stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.
What are sources of stress in preschoolers? (Select all that apply.)
Damages or destroys objects May fear dogs or other animals Seems to be in perpetual motion May stutter or stumble over words Sources of stress in preschoolers include damaging or destroying objects, fearing dogs or other animals, in perpetual motion, and may stutter or stumble over words. Guarding possessions, not sharing, is a source of stress.
What should the nurse suggest to parents of preschoolers about sensitive questions regarding sex?
Find out what your child knows or thinks Two rules govern answering sensitive questions about topics such as sex. The first is to find out what children know and think. By investigating the theories children have produced as a reasonable explanation, parents can not only give correct information but also help children understand why their explanation is inaccurate. Another reason for ascertaining what the child thinks before offering any information is to avoid giving an "unasked for" answer. The child should not be distracted from the topic. If parents offer too much information, the child will simply become bored or end the conversation with an irrelevant question. What matters is that parents are approachable and do not dismiss their child's inquiries.
Parents of a preschool child tell the nurse, "Our child seems to have many imaginary fears." What suggestion should the nurse give to the parents to help their child resolve the fears?
Help your child to resolve the fears through play activities Preschoolers are able to work through many of their unresolved fears, fantasies, and anxieties through play, especially if guided with appropriate play objects (e.g., dolls or puppets) that represent family members, health professionals, and other children. The fears should not be ignored because they may escalate. Preschoolers are not cognitively prepared for explanations about the fears. They gain security and comfort from familiar objects such as toys, dolls, or photographs of family members, so new toys should not be introduced.
Parents tell the nurse they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. What is the most appropriate recommendation for the nurse to make?
Neither condone nor condemn the curiosity Three-year-old children become aware of anatomic differences and are concerned about how the other sex "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. This is age appropriate and not dangerous behavior. Encouraging the children to ask their parents questions and redirecting their activity is more appropriate than giving permission.
The nurse understands that traits of gifted children include what? (Select all that apply.)
Perfectionism as a focus Inquisitive; always asking questions Displays intense feelings and emotions Characteristics of gifted children include perfectionism as a focus; inquisitive, always asking questions; and displaying intense feelings and emotion. Memory skills are pronounced, and humor is exceptional.
During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. The boy's birthday is close to the cut-off date, and he has not attended preschool. What is the nurse's best recommendation?
Perform a developmental screening A developmental assessment with a screening tool that addresses cognitive, social, and physical milestones can help identify children who may need further assessment. A readiness assessment involves an evaluation of skill acquisition. Stating the child should start kindergarten or go to preschool and postpone kindergarten does not address the father's concerns about readiness for school. Talking to other parents about readiness does not ascertain if the child is ready and does not address the father's concerns.
A 4-year-old child tells the nurse that she doesn't want another blood sample drawn because "I need all of my insides and I don't want anyone taking them out." What is the nurse's best interpretation of this?
Preschoolers have poorly defined body boundaries Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at this age. She truly has fear. Body image is just developing in school-age children. Preschoolers do not have good understanding of their bodies.
A boy age 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. What is the most appropriate intervention?
Refer the child for a professional psychosocial assessment The preschool years are a time when children learn socially acceptable behavior. The difference between normal and problematic behavior is not the behavior but the severity, frequency, and duration. This child's behavior meets the definition requiring professional evaluation. Some aggressive behavior is within normal limits, but at 8 to 10 weeks, this behavior has persisted too long. There is no indication that the parent is using inconsistent discipline. A part of the evaluation is to obtain validation for behavior parent reports.
What is the reason pedestrian motor vehicle injuries increase in the preschool age? (Select all that apply.)
Riding tricycles Running after balls Playing in the street Pedestrian motor vehicle injuries increase because of activities such as playing in the street, riding tricycles, running after balls, and forgetting safety regulations when crossing streets. Crossing streets at the crosswalk or with an adult are safety measures.
What is descriptive of the nutritional requirements of preschool children?
The quality of the food consumed is more important than the quantity Parents need to be reassured that the quality of food eaten is more important than the quantity. Children are able to self-regulate their intake when offered foods high in nutritional value. The average daily caloric intake should be approximately 1800 calories. Toddlers and preschoolers have similar nutritional requirements. There is an overall slight decrease in needed calories and fluids during the preschool period.
A child age 4 1/2 years sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened, yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This is most likely what?
Sleep terror This is a description of a sleep terror. The child is observed during the episode and not disturbed unless there is a possibility of injury. A child who awakes from a nightmare is distressed. She is aware of and reassured by the parent's presence. This is not the case with sleep apnea. This behavior is not indicative of seizure activity.
What dysfunctional speech pattern is a normal characteristic of the language development of a preschool child?
Stammering Stammering and stuttering are normal dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language.
What characteristic best describes the language skills of a 3-year-old child?
Talks incessantly regardless of whether anyone is listening Because of the dramatic vocabulary increase at this age, 3-year-old children are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old child asks lots of questions and can follow simple directional commands. A 6-year-old child can describe an object according to its composition.
During the preschool period, the emphasis of injury prevention should be placed on what?
Teaching about safety and potential hazards Education about safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Limitation of physical activities is not appropriate. Punishment may make children scared of trying new things. Constant vigilance and protection are not practical at this age because preschoolers are becoming more independent.
The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse they will be back to visit at 6 PM. When he asks the nurse when his parents are coming, what would the nurse's best response be?
They will come after dinner A 4-year-old child understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. "I will tell you every time I see you how much longer it will be" assumes the child understands the concepts of hours and minutes, which does not occur until age 5 or 6 years
In terms of cognitive development, a 5-year-old child should be expected to do which?
Use magical thinking Magical thinking is believing that thoughts can cause events. An example is thinking of the death of a parent might cause it to happen. Abstract thought does not develop until the school-age years. The concept of conservation is the cognitive task of school-age children, ages 5 to 7 years. A 5-year-old child cannot understand another person's perspective.
The nurse is teaching parents of a 4-year-old child about socialization developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.)
Very independent Has mood swings Tends to be selfish and impatient The socialization milestones of a 4-year-old child include being very independent, having moods swings, and tending to be selfish and impatient. Having better manners and being eager to do things right are socialization milestones seen at the age of 5 years.
