PEDS Prep U Chapter 5: Growth and Development of the Preschooler
A nurse is caring for a 4-year-old child. The parents indicate that their child often reports that objects in the house are his friends. The parents are concerned because the child says that the grandfather clock in the hallway smiles and sings to him. Which response by the nurse is best?
"Attributing lifelike qualities to inanimate objects is quite normal at this age." Explanation: The nurse should explain to the parents that attributing lifelike qualities to inanimate objects is quite normal for a 4-year-old child. Telling the parents that the child is demonstrating animism is correct information, but it would be better for the nurse to explain what animism is and then remind the parents that it is developmentally appropriate for their child. Asking whether the parents think the child had a recent trauma or whether there is a family history of mental disorders is inappropriate and does not teach.
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." Explanation: 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.
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." 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
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." Explanation: 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
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." Explanation: 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
A school nurse has completed an educational program for parents of 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." Explanation: 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.
The nurse is preparing a safety presentation for a health fair for families. Which instruction should the nurse prioritize when illustrating car safety and the family?
"Set a good example. Wear your own seat belt every time you drive." Explanation: A preschooler wants to please, and if the caregiver consistently wears the seatbelt, that will become the standard for riding in the car. All states have laws that define safety seat and restraint requirements for children. Adults must teach and reinforce these rules. One primary responsibility of adults is always to wear seat belts themselves and to make certain that the child always is in a safety seat or has a seat belt on when in a motor vehicle. A child can also be calmly taught that the vehicle "won't go" unless everyone in it is properly restrained. The child should be taught respect of rules and laws, but making threats or giving rewards is not appropriate.
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." Explanation: 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
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." Explanation: 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.
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." Explanation: The bicycle should fit the rider to reduce the risk of an accident while riding. 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
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." Explanation: 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
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. Explanation: Four- and 5-year-olds delight in using "naughty" words or swearing. Bathroom words become favorites and taunts, such as "you're a big doo-doo," bring heady excitement to them. Caregivers may become concerned by this turn of events, but the child simply may be trying out words to test their impact. By using a calm, matter-of-fact response when a preschooler uses naughty or swear words, some of the power of using that type of language will be defused. The child learns that this is not language to use in the company of others.
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 Explanation: This client has frequent hospitalizations and is at risk for delayed growth and development. For a client at this age, play, socialization, exploring, and imagination are all important parts of normal growth and development.
A nurse is teaching a group of parents of preschoolers about safety. Which information would the nurse include? Select all that apply. "Do not refer to medicines as candy." "Do not allow your child to approach strange dogs." "Allow your child to ride in the front seat of the car." "Have your child hold hands with a grown-up in parking lots." "Role-model bicycle safety by wearing a helmet too."
Do not refer to medicines as candy." "Do not allow your child to approach strange dogs." "Have your child hold hands with a grown-up in parking lots." "Role-model bicycle safety by wearing a helmet too."
A preschool-age child tells the nurse about an imaginary friend. The parents are concerned because the child refuses to do anything without the friend's help. Which nursing diagnosis is most applicable for the family?
Parental anxiety related to lack of understanding of childhood development Explanation: The parents need to understand that the child's behavior is not uncommon. Imaginary friends are common in the preschool-age child. The child's behavior is not abnormal. The child does not have a deep-set psychological need. The child is not at risk for social isolation.
A nurse is assessing a 3 year old at a well-child visit. Which developmental milestones would the nurse expect to assess? Select all that apply. Completes simple buttons Laces sneakers independently Undresses self without difficulty Stacks a tower of blocks Throws a ball overhand
Undresses self without difficulty Stacks a tower of blocks
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. Explanation: Preschool children are safe around water only when adult supervision is constant. Wearing a personal flotation device adds additional protection and should be as routine as "buckling up" in the car. At 5 years old, most preschoolers are mature enough to become swimmers, yet knowing how to swim does not make the preschooler safe without supervision. CPR is a life-saving skill and using sunscreen will protect the skin, but neither will be a factor in preventing drowning
The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation?
presence of 10 deciduous teeth Explanation: The presence of only 10 deciduous teeth would warrant further investigation. The preschooler should have 20 deciduous teeth present. The absence of dental caries or presence of 19 teeth does not warrant further investigation
The 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." Explanation: 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.
Which would be a nutritional goal for a preschool client?
Introduce new food gradually and include variety. Explanation: Mealtimes can become a power struggle between caregivers and the young child. Reassure caregivers that young children go through periods during which they are very particular about food. Therefore, new foods should be gradually introduced and include variety. Foods that look like or smell like other foods they enjoy are the most likely to be eaten. Eating everything on the plate can lead to obesity; the child needs a variety of the 5 food groups; and messiness and spills allow the child to use fine and gross motor skills and practice their use of utensils and cups.
A parent tells a nurse that the child has recently established some friendships for the first time. In which age group do you expect this child to be?
Preschool Explanation: During the preschool years the preschooler learns to cooperate with other children. Learning how to make a friend is an important part of social development. Preschoolers need a special friend they can talk to, care about, and play with. The toddler is aware of other children but plays parallel to other toddlers; they do not interact or form friendships at their developmental level. School-age children have developed friendships and often have close relationships with one or two friends, but have multiple friends in school. Friendships are very important to the adolescent child. They have established friendships throughout their lives.
When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate?
tells a fantasy story about a bear and a car Explanation: The nurse should recognize that by age 4, the preschooler should have a vocabulary of about 1,400 words. Preschool-age children are able to communicate in sentences of five words or more and often like to use their imagination. This is a normal part of growth and development and should be encouraged.
The parents of a 4-year-old child tell the school nurse that they are worried that their child will fall behind other children academically because they are not able to afford expensive toys like computer games and handheld electronic devices. Which are acceptable response(s) by the nurse? Select all that apply. "Why are you not financially able to provide these toys and games for your child?" "Are there any family members who can help you get these games for your child?" "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 child-safe modeling clay? These are the types of toys suggested for preschoolers."
"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 child-safe modeling clay? These are the types of toys suggested for preschoolers."
The nurse is providing health-promotion teaching to a group of parents of 4-year-old children at a local day care. What information will the nurse include in this education session? Select all that apply. Carefully strap your preschool-age child in a forward-facing car seat with a five-point harness. Encourage your preschool-aged child to brush their teeth twice a day with a pea-sized amount of toothpaste. Ensure your preschool-aged child knows their address and phone number. Encourage unstructured physical activity every day for your preschool-age child. Use a bicycle helmet solely for long bike rides taken by your preschool-age child.
Encourage your preschool-aged child to brush their teeth twice a day with a pea-sized amount of toothpaste. Ensure your preschool-aged child knows their address and phone number. Encourage unstructured physical activity every day for your preschool-age child.
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. Explanation: Because preschoolers' imagination is so active, this leads to several fears such as fear of the dark and mutilation. The nurse needs to help the child understand that the CT scanner is like a camera to take pictures of the body parts. Threatening the child to follow directions or becoming hurt plays into the child's fear of mutilation. Telling the child to behave creates a fear of punishment. Telling the child that the CT scan is a picture of the body's dark parts plays into the child's fear of the dark
The nurse is caring for a child who is described as being an inquisitive learner, loves to learn new things, and feels a sense of accomplishment when succeeding in activities. The nurse understands that this child is in which of Erikson's stages of development?
Initiative versus guilt Explanation: Erikson defines Initiative versus guilt as the preschool period. Erikson defines the toddler period as a time of autonomy versus shame and doubt. Erikson defines trust versus mistrust as the infancy period and industry versus inferiority as taking place during the school-age period
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 Explanation: Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-aged child enjoys group activities, such as board games, and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities he or she can participate in with their peers.
A nurse is developing a teaching plan for parents of preschoolers about how to address the issue of strangers and safety. Which would the nurse expect to include in the teaching? Select all that apply. Urge children never to talk to or accept a ride from a stranger. Wait until children are old enough to tell them how to call for help in an emergency. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.
Urge children never to talk to or accept a ride from a stranger. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.
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 fearful. Encourage the parents to just ignore the fears since this is common behavior with the preschool-aged child. 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. Advise the parents to help the child understand that the fears are irrational.
Ask the parents if they can identify anything that may be causing their child 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.
The nurse is caring for a preschool-age child in the hospital with severe developmental delays. The parents have three 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 Explanation: Given that the parents are trying to care for four children, one of whom is a severely developmentally delayed preschooler in the hospital, and that 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.
A type of play seen in preschool children encourages children to act out troubling situations, such as one that might occur in the hospitalized child who must undergo an upsetting procedure. This type of play is referred to as:
dramatic play. Explanation: Dramatic play allows a child to act out troubling situations and to control the solution to the problem. Through dramatic play the child can express anxiety, try out new feelings and conquer fears. 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. Parallel play is the play of toddlers where two toddlers play side by side but not with each other. Independent play occurs when a group of children are all playing but each is playing something different (i.e., all may be playing with trucks but each one has a different truck and they do not do the same thing with the trucks). Solitary play is a child playing alone, even in a group. The child does not participate with other children.
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:
testing and identification of group role. 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
The nurse has completed an education program on normal communication abilities in the preschool-age child. Which statement by a participant indicates a need for further education?
"Stating their name and address is too hard for my 5-year-old child; it will be another year before they can do that." Explanation: The preschool-age child is known for asking lots of questions, and this is normal. At this age, 75% of the child's speech is understood by others outside of the family. The preschool-age child can easily count to 10, and the parents stating they were slowly working on counting higher is acceptable, as long as the parents do not push the child. A child at 5 years of age should be able to state one's name and address
The nurse is observing 4-year-old twins during their well-child appointment. Which observation by the nurse would indicate the children are demonstrating cooperative play?
They are building a house for their dolls with blocks in the room. Explanation: Cooperative play is when children work toward a common goal together, with a distinct theme. The 4-year-old twins demonstrate cooperative play when they build a house with blocks. Associative play occurs when children play together and are engaged in similar activity, but without organization, rules, or a leader, and when each child does what she or he wishes, such as playing with the dollhouse furniture separately. In parallel play, children play alongside each other but independently, such as looking at different picture books. Competing for the most blocks stacked would be an example of competitive play
A mother comes to the clinic with her 4-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 client has a normal vocabulary for age. The nurse is aware that language for a 4-year-old consists of at least approximately how many words?
1500 words Explanation: A 4-year-old has a vocabulary of approximately 1500 words, whereas a 5-year-old has mastered more than 2100 words.
