Ch. 27: Growth and Development of the Preschooler
A nurse is teaching a group of parents of preschoolers about safety. Which information would the nurse include? Select all that apply. "Do not allow your child to approach strange dogs." "Do not refer to medicines as candy." "Role-model bicycle safety by wearing a helmet too." "Allow your child to ride in the front seat of the car." "Have your child hold hands with a grown-up in parking lots."
"Do not allow your child to approach strange dogs." "Do not refer to medicines as candy." "Role-model bicycle safety by wearing a helmet too." "Have your child hold hands with a grown-up in parking lots." RATIONALE: Appropriate safety measures include not referring to medicines as candy, not allowing the child to approach strange dogs, having the child continue to ride in the back seat of the car, ensuring that the child holds an adult's hand when in parking lots, and role-modeling bicycle safety by wearing a helmet themselves.
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." "He eats a well-balanced diet." "He enjoys eggs and fortified cereal for breakfast." "He does not like spinach, but he does like chicken and beef."
"He loves milk and drinks it every time he is thirsty." RATIONALE: 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.
A 3 1/2 year-old child is found masturbating in the family living room. Which response by the parent would best address this behavior? "We do not touch ourselves in public. Please go to your room if you want to continue this behavior." "Your penis is very interesting, isn't it? But you can injure it by touching it so much." "You need to quit that right now. It's not nice to touch your privates." "I will ask your father to talk to you about this since he is a boy too."
"We do not touch ourselves in public. Please go to your room if you want to continue this behavior." RATIONALE: Although masturbation in this age group is not an uncommon behavior, the child must be told in a matter-of-fact manner that this is not appropriate activity in public. The parent needs to remain calm and not get angry or embarrassed. Usually, masturbation is just part of a young child's curiosity about his or her body.
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." "We need to know the basics of CPR and first aid." "She still needs a booster seat in the car." "We need to continually remind her about safety rules."
"We need to tell her that her vitamins are candy." RATIONALE: 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.
The nurse is speaking with the parent of a 4-year-old child. Which statement by the parent would suggest a need for further investigation? "My son loves to follow around his older sister." "My child loves to play dress-up with friends at day care." "When we go to the park, my child never wants to play with the other children." "I think it is so cute when my child wants to help my spouse with yardwork." "Sometimes I wish my child would play with a toy in the way it was intended. My child is constantly pretending it is something else."
"When we go to the park, my child never wants to play with the other children." RATIONALE: 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 a sensitive and critical time for socialization. Preschoolers who are exposed to other playmates have an easier time learning to relate to people than those raised in an environment where they rarely see other children of the same age
If the child is gaining weight at an expected rate, a child who weighs 36 lb (16.3 kg) at 3 years of age would weigh what amount at age 5? 50 to 52 lb (22.7 to 23.6 kg) 58 to 60 lb (26.3 to 27.2 kg) 38 lb to 40 (17.2 to 18.1 kg) 44 to 46 lb (20 to 21 kg)
44 to 46 lb (20 to 21 kg) RATIONALE: The preschool age child gains about 4 to 5 lb (1.8 to 2.3 kg) each year and grows about 2.5 to 3 in (6.3 to 7.6 cm). So a 36 lb (16.3 kg) child at 3 years gaining 4 to 5 lb (1.8 to 2.3 kg) per year would be 44 to 46 lb (36 lb + 8 lb = 44 lb; 36 lb + 10 lb = 46 lb).
A nurse is caring for a 4-year-old child who will be undergoing a procedure to remove a mass from the abdomen. In order to help the child remain calm in preparation for getting an IV catheter placed, what intervention might the nurse implement? Don't discuss the procedure in front of the child. Allow the child to play with a procedure doll. Take the child to the playroom for coloring. Distract the child with games and candy.
Allow the child to play with a procedure doll. RATIONALE: The nurse can allow the child to play with a procedure doll that will simulate the procedure for the child.
A 5-year-old child is overheard by her parents calling her dog a "fat boo-boo butt" and they are concerned. What advice would the nurse provide for them regarding this behavior? Wash her mouth out with soap if she says it again and tell her it is wrong. Tell the child that language is unacceptable and place the child in time-out. Calmly correct the child, telling her not to say those words again. Ignore the behavior and she should quit using these words.
Calmly correct the child, telling her not to say those words again. RATIONALE: Children this age often try out naughty words to see what kind of reaction they will get from their parents. Parents are encouraged to express their disapproval with the language and calmly tell the child not to say those words again. Ignoring the behavior will not correct it and punishment is not necessary.
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? Health-seeking behaviors Risk for imbalance nutrition, more than body requirements Delayed growth and development related to frequent illness Parental anxiety related to lack of understanding
Delayed growth and development related to frequent illness RATIONALE: 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 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? Tell her she must follow directions or she will be hurt. Explain that she must behave because the technician is busy. Tell her a radiograph is a picture of the dark inside her body. Help her pretend the x-ray machine is a camera.
Help her pretend the x-ray machine is a camera. RATIONALE: Most preschoolers express fear of the dark and mutilation. Their active imaginations make it possible to turn almost any procedure into a game.
The home health nurse, who is visiting a home with a 4-year-old child, prepares a nursing care plan to address the child's risk for injury related to the parents' insufficient knowledge of safety practices for preschool-aged children. Which nursing intervention(s) will the nurse include in the plan of care? Select all that apply. Teach the parents that medications can be kept in unlocked cabinets if childproof caps are used. Instruct the parents that they should teach the child to wash the hands when soiled. Teach the parents to use a forward-facing car seat with a harness and top tether. Teach the parents that the child should use an approved bicycle helmet when riding a bicycle at any time. Teach the parents to smoke one at a time outside the home when the child is inside the home.
Instruct the parents that they should teach the child to wash the hands when soiled. Teach the parents to use a forward-facing car seat with a harness and top tether. Teach the parents that the child should use an approved bicycle helmet when riding a bicycle at any time. Teach the parents to smoke one at a time outside the home when the child is inside the home. RATIONALE: Parents should not smoke in an enclosed space in which the child is located. This would still expose the child to secondhand smoke. Smoking one at a time outside will ensure the child inside the home is supervised. If properly instructed, the preschool-aged child is capable of washing the hands independently. A 4-year-old child who rides a bike should wear a properly fitted helmet. Childproof caps should be used in addition to keeping medications out of the reach of children, preferably a locked cabinet.
A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers? Putting latches on lower cabinets Placing the child in an approved car seat Washing hands after using the bathroom Using gates at the top of the stairs
Placing the child in an approved car seat RATIONALE: The leading cause of death in the preschool group is automobile accidents, followed by poisonings and falls. Placing the child in an approved car seat is a safety precaution to help prevent serious injury and even death. All safety measures help keep children safe. Putting latches on the lower cabinets and using a baby gate at the top of the stairs are important to prevent poisonings and to prevent falls which could cause head injuries and fractures. Many infectious diseases are preventable as a result of health promotion and illness prevention techniques
What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother? The longer the center has been in operation, the better it is. A ratio of 10 children to 1 teacher is adequate. Specific program goals to be accomplished should be available. Research local newspapers to see if there are any complaints against the center.
Specific program goals to be accomplished should be available. RATIONALE: Preschool is used for toddlers to foster social skills and to acclimate them to the group environment. When a parent is searching for a preschool, he or she should check the school's accreditation, the teacher's qualifications, and seek the recommendations of other parents. Parents should visit the school to see the teacher interact with the children, the focus of the activities, and hygiene practices. Parents should look at the school's daily schedule and the types of activities offered. Are the activities structured or loose? Preschoolers need planned activities. They are very ready to learn, but the activities should be planned to focus on their short attention spans.
In teaching caregivers of preschool children, the nurse would reinforce that which activity would be most important for this age group? The preschool child should brush and floss teeth after snacks and meals. The preschool child should be screened for amblyopia. The preschool child should cover mouth when coughing or sneezing. The preschool child should be properly restrained when riding in a vehicle.
The preschool child should be properly restrained when riding in a vehicle. RATIONALE: 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.
Fear of mutilation is significant during the preschool age. False True
True RATIONALE: 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.
The nurse is watching a 4-year-old child play with another preschool child. The children are playing a game with rules. The nurse notes that the child is demonstrating what type of play? dramatic play cooperative play parallel play associative play
cooperative play RATIONALE: Cooperative play is when children play in a group with each other, and play by rules. Examples are board games or sports. Associative play involves allowing the child to work through feelings about procedures and separation; parallel play involves children playing side to side with each engaging in his/her own activities; dramatic play involves living out of the drama of human life.
Parents tell the nurse their 3-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify? dental caries iron deficiency interference with growth obesity
iron deficiency RATIONALE: 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.
When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate? has best friends at preschool and sleepovers scribbles with no discernable pictures/letters begins to show logical thought processes tells a fantasy story about a bear and a car
tells a fantasy story about a bear and a car RATIONALE: 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 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 school has a loose environment, which is a good match for his temperament." "There is a very low student-teacher ratio, and they do a lot of hands-on projects." "The school requires processed foods and high sugar foods be avoided."
"The school is quite structured and advocates corporal punishment." RATIONALE: 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 nurse needs to purchase toys or activities for preschool-aged children for the clinic waiting room. Which toy would be the best choice for this age? 50-piece jigsaw puzzle brightly colored mobile toy with dials and switches play kitchen and food
play kitchen and food RATIONALE: Preschool-aged children like to engage in pretend play, so a play kitchen and food would be a good choice. A mobile is more appropriate for an infant. A toy with dials and switches is appropriate for a toddler. A 50-piece jigsaw puzzle is a better choice for older children.
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 this statement is an example of: magical thinking. beginning empathy. transduction. animism.
transduction. RATIONALE: 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.
The nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child? "I lost the game because I did not play good, and I am sad." "Look! I am a nurse, and I am helping people feel better!" "I told the other child no, when he asked me to cheat at the game." "I ran the race better than my best friend because he was slow."
"Look! I am a nurse, and I am helping people feel better!" RATIONALE: Erikson's stage of initiative vs. guilt is prevalent in children between 3 and 6 years of age. This includes activities in which they act out the roles of other people (real or imaginary). Being competitive, learning sports, and comparing skills are important in the industry vs. inferiority stage (6 to 12 years of age) as seen in a child comparing the speed of running a race or playing a game. Staying true to a predefined set of values, such as not cheating in a game, would be typical of a child in the identity vs. role confusion stage (12 to 19 years of age).
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. "Set up some familiar bedtime rituals for your child." "Try using a night light in the child's room." "Try reading a favorite story before bedtime." "Avoid having your child watch frightening shows on TV before bedtime." "Keep the door closed and the lights off so that your child can fall asleep faster."
"Set up some familiar bedtime rituals for your child." "Try using a night light in the child's room." "Try reading a favorite story before bedtime." "Avoid having your child watch frightening shows on TV before bedtime." RATIONALE: 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.
During a well-child visit, the mother of a preschooler tells the nurse that her daughter is "daddy's girl." She says, "It seems like I don't exist." Which response by the nurse would be most appropriate? "Why do you think she is doing this?" "Your daughter is showing normal behavior for her age." "This might be a problem because your daughter is obviously alienating you." "Did you do something to make your daughter angry with you?"
"Your daughter is showing normal behavior for her age." RATIONALE: The daughter is exhibiting signs of the Electra complex, competing with the same-sex parent for the love and attention of the other parent. This behavior is entirely normal but parents who are not prepared may feel hurt or rejected. Telling the mother that this is a problem, asking the mother about why, and asking the mother if she did something to make the daughter angry are inappropriate responses and focus on the mother's behavior, not the child's.
The mother of a 4-year-old child reports she has been trying in vain to teach her son to tie his shoelaces. She states she fears he may be "slow". Which action by the nurse is most appropriate? Demonstrate a few methods for the parent to use to teach this skill to her child. Explain to the parent her child likely does not have the needed motor skills to achieve this task at his current age. Ask to assess the child's fine motor skills for developmental delays in light of her reports. Explain that she may need to change the way she is instructing him to do this.
Explain to the parent her child likely does not have the needed motor skills to achieve this task at his current age. RATIONALE: Tying shoes is a skill that is usually not accomplished until about 5 years of age. The child in the scenario is likely too young to master this task. He likely lacks the fine motor skills. Alternative methods of instruction will likely not be successful. There is no indication the child has motor skill delays.
The nurse is presenting nutritional information at a community health fair. Which suggestion should the nurse prioritize when illustrating proper nutrition for preschoolers? Need extra calcium for proper muscle growth Need three big meals a day due to rapid growth Snacks throughout the day help the child meet nutritional requirements Should drink at least 4 cups of milk each day
Snacks throughout the day help the child meet nutritional requirements RATIONALE: 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.
Which gross motor skill would the 4-year-old child have most recently attained? The child can button his/her clothes. The child can hop on one foot. The child can cut his/her food. The child can tie his/her shoelaces.
The child can hop on one foot. RATIONALE: Gross and fine motor skills continue to develop rapidly in the preschool-aged child. Gross motor skills have to do with the development of large muscles. Balance improves around the age of 4, thus the child can hop on one foot and stand on one foot for 5 seconds. A 3-year-old child does not have the ability to accomplish these tasks. A 5-year-old child can button his/her own clothes, tie shoes, and cut his/her food.
The nurse is identifying outcomes for a family with a preschool-age child who has broken fluency. Which initial outcome would be the most appropriate? The parents will correct the child each time there is a break in fluency. The parents will not call attention to the child's broken fluency. Other children will help the child by finishing words and sentences. The mother will encourage the child to repeat words after her.
The parents will not call attention to the child's broken fluency. RATIONALE: Calling attention to broken fluency can make the situation worse. The child should not be encouraged to speak or practice words if he or she does not want to. The parents should stop any other siblings who desire to finish the child's words or sentences. The child should not be punished or corrected for broken fluency because this is a normal part of speech development.
When planning how to respond to a 3-year-old child about telling stories ("tall tales"), the nurse would base the statement on the fact that: a 3-year-old knows the word two but not the concept of two. a preschooler is in an insecure period. preschoolers have a limited vocabulary. imagination in a 3-year-old is at its peak.
imagination in a 3-year-old is at its peak. RATIONALE: Preschoolers have vivid imaginations and love to play "make believe." They are inquisitive learners. It is not unusual for their imaginations to create "tall tales" and be in a world of make-believe. Preschoolers have a vocabulary of between 1,500 and 2,100 words, depending upon their age. They can count to 10 and know at least four colors. Their communication is concrete. At this age they are not capable of abstract thought. During the preschool years, the child develops a sense of identity. They know who they are and to the family in which they belong. They develop the knowledge of right and wrong. The preschool years help develop a child's sense of belonging and his or her place in the world.
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? playing apart from others without being part of a group playing in an organized group with each other observing without participating acting out a troubling situation
observing without participating RATIONALE: Onlooker play occurs when there is observation without participation, such as watching television. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Dramatic play allows a child to act out a troubling situation. During cooperative play, children play in an organized group with each other as in team sports.
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? "When my child counts numbers, it is only to 10 and we are slowing working on counting higher." "I am glad to know that my 4-year-old child asking so many questions is normal." "My child is finally talking in a way that most of my friends can understand her speech." "Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that."
"Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that." RATIONALE: 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 pediatric nurse is discussing the daily activities of a 4-year-old with the caregiver to assess growth and development status. The nurse would document that the child has reached the initiative stage of development if the caregiver indicates the child participates in which activity? gets upset when a babysitter is in charge, but will do what is asked by the babysitter refuses to hold anyone's hand while crossing the street tries to sweep up spilled cereal but cries when can't do well broke a dish but blamed it on a friend the caregivers don't know
tries to sweep up spilled cereal but cries when can't do well RATIONALE: 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 with the caregiver.
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. "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." "Why are you not financially able to provide these toys and games for your child?" "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." "Are there any family members who can help you get these games for your child?"
"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." RATIONALE: Expensive and elaborate toys do not place a child at an academic or developmental advantage. Simple toys that require interactive rather than passive play, and that may include the involvement of the parent, are recommended to foster development. The nurse should not question a family's finances nor recommend the family ask for financial assistance. These statements are judgmental and infer the family is not able to provide for the child, which is not the case.
A first-time father calls the pediatric nurse stating he is concerned that his 4-year-old daughter still wets the bed almost every night. Remembering his own experience of being punished for wetting the bed at 4 years old, he is not sure punishment is the best approach to address this. Which nursing instruction is the most appropriate? "Setting rules is a parent's job to help the child have acceptable social behavior, so take away a privilege each time she wets the bed." "Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration." "Disciplining is not likely to be effective, but if the child keeps wetting the bed it may be necessary." "Nightly bedwetting up to age 12 is developmentally typical, so you will need to practice patience with your daughter."
"Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration." RATIONALE: Occasional bedwetting is not uncommon for young preschoolers and is not a concern unless it continues past the age of 7. When the child does have an accident, treating it in a matter-of-fact way and providing the child with clean, dry clothing is best. The child should not be disciplined or made to feel he or she is socially unacceptable when bedwetting occurs.
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? "Your son is slightly below the normal height for his age group but may still grow to be a normal height in the coming year." "Your son is slightly below the normal height for his age but he had demonstrated a normal growth rate this year." "Is there a reason you are concerned about your child's height?" "Both your son's height and rate of growth are within normal limits for his age."
"Both your son's height and rate of growth are within normal limits for his age." RATIONALE: 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.
A young hospitalized patient cries constantly for daddy even though her mother has not left her side. When talking to the child's mother, the nurse learns that the 4-year-old wants only her father. The child has even told her mother that she hates her on numerous occasions. What would be the best response by the nurse to support this mother? "You need to definitely put a stop to this. So much attachment to one parent is not healthy." "I am so sorry. I know that must be very difficult for you." "You need to get the child's father to put a stop to this behavior as soon as possible." "Her behavior is normal for her age. She will outgrow it."
"Her behavior is normal for her age. She will outgrow it." RATIONALE: According to Freud, children ages 3-7 years develop a jealousy and rivalry with the same-sex parent and a love of the opposite-sex parent. This usually resolves around the end of the preschool years. At this time the child generally develops a strong identity with the same-sex parent. If parents are not aware of this stage of development then they can become resentful and hurtful of the child. Explaining this part of growth and development to the parent is an important role of the pediatric nurse. Making statements such as having the dad put a stop to the behavior or the behavior not being healthy is making an assumption or judgment that is not fact.
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? "I think we need to plan how to discipline your child when acting out this way." "I am concerned that your child may have a developmental delay since most children of this age don't throw temper tantrums." "Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." "We don't allow children of this age to throw tantrums so you will need to manage your child's behavior."
"Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." RATIONALE: 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 parents of a 4-year-old ask the nurse, "We want to use 'time-out' to help discipline our child. But we're not sure how long we should keep our child in time-out?" Which response by the nurse would be appropriate? "Try keeping the child in time-out for about a minute or two." "How long doesn't matter. Just be consistent." "Keep your child in time-out until they calm down." "Keep the time to about 4 minutes."
"Keep the time to about 4 minutes." RATIONALE: A "time-out" is a useful technique for parents to correct behavior throughout the preschool years. Although the technique has some critics, it allows for discipline without using physical punishment and allows a child to learn a new way of behavior without extreme stress. Time-out periods should be as many minutes long as the child is old, so 3 to 5 minutes is appropriate for preschoolers. Since the child is 4 years of age, 4 minutes would be appropriate. Although consistency is key, the length of time spent in time-out should reflect the age of the child, not whether the child calms down.
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 not a normal behavior for a child of that age." "If you catch your child masturbating, you should immediately make them stop." "You will need to speak with the doctor about that behavior since I cannot address sexual issues in a child."
"Masturbation is a normal part of preschool development." RATIONALE: 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 3-year-old is doing fine, he can hop on one foot already." "I'm glad to know that it's okay that my 5-year-old is learning to skate." "My 5-year-old son still needs me to dress and undress him." "I need to work with my 4-year-old; she should be able to cut paper with scissors on her own."
"My 5-year-old son still needs me to dress and undress him." RATIONALE: 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 parents of a toddler are concerned their child is not developing correctly and are questioning the nurse concerning the child's lack of effort to join other children in a group activity. Which response should the nurse prioritize in answering the parents? "Your child is involved with others, just indirectly. See how they sit next to the other children and play with the same toys?" "You should try to get your child involved in a local Boys and Girls club to encourage more interaction." "Perhaps getting your child interested in sports will improve their other play habits." "This is normal for this age group. It's referred to as solitary independent play."
"This is normal for this age group. It's referred to as solitary independent play." RATIONALE: Solitary independent play means playing apart from others without making an effort to be part of the group or group activity, which is normal for this age group. 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. During cooperative play, children play in an organized group with each other as in team sports. Parallel play occurs when the toddler plays alongside other children but not with them. As the child continues to mature, they will be more prepared and willing to join with others to play alongside in organized or unorganized situations.
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 happened to my client? Did you eat her?" "Oh no! I have a crocodile in my room. Please don't bite me!" "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you."
"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." RATIONALE: 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.
The nurse needs to discontinue the urinary catheter of a 4-year-old child who is afraid of the procedure. What strategy(ies) will the nurse use to help the child to cope with this procedure? Select all that apply. Provide for privacy by asking the parents to wait outside the room during the procedure. Answer all of the child's questions before starting the catheter removal. Be honest with the child about what to expect with catheter removal. Let the child know that the procedure will be completed at 1000. Have a doll available that the child can play with and demonstrate on.
Answer all of the child's questions before starting the catheter removal. Be honest with the child about what to expect with catheter removal. Have a doll available that the child can play with and demonstrate on. RATIONALE: Providing honest explanations, demonstrating on a doll, and encouraging and answering questions are effective strategies for a child of this age. At 4 years of age, a child does not have a strong sense of time, so setting a specific time is not effective. The child will feel supported and less fearful with the parents present, so they should not be asked to leave during the procedure.
A parent of a 4-year-old preschooler asks the nurse about how to discipline her child for bad behavior. The nurse would recommend that the parent take which steps to discipline the child? Select all that apply. Attend only to the good behavior—ignore acting out. Place the child in time out for 8 minutes. Spank the child, explaining what he or she did wrong. Take away the child's favorite toy until behavior improves. Set consistent limits and adhere to them.
Attend only to the good behavior—ignore acting out. Take away the child's favorite toy until behavior improves. Set consistent limits and adhere to them. RATIONALE: Preschoolers require consistency in discipline and limit-setting. Although each family determines their limits, children need limits that are the same every time. Discipline for preschoolers also includes time out for one minute per year of age, ignoring negative behavior, and praising good behavior. Additionally, taking away a toy or activity that the child loves can be an effective form of discipline. Physical punishment removes the responsibility of correct behavior from the child and expresses anger by the parent.
Parents of a preschool child are discussing a recent story in the local news about a child being abducted. The parents are concerned about the safety of their child and wonder what to tell the child to keep the child safe but without frightening the child. Which would be the best recommendation for the nurse to give these parents? Don't worry about it; the odds of your child being abducted are very low. It is your responsibility to keep your child safe, not your child's; keep the child in your sight at all times. Explain in a calm and everyday manner how the child should stay away from strangers in cars. Wait until the child is school-aged before telling the child what to do, so the child will be better able to handle it.
Explain in a calm and everyday manner how the child should stay away from strangers in cars. RATIONALE: The preschool years are not too early a time to educate children about the potential threat of harm from strangers. It is often difficult for parents to impart this type of information to preschoolers because they don't want to terrify their child about the world. They also can't imagine their child will ever be in a situation in which the information will be needed. If the information is presented in a calm and everyday manner, however, children can use it to begin to build safe habits that will help them later when they are old enough to walk home from school alone or play with their friends, unsupervised.
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? Tell the child that the CT scan is a picture of the dark parts inside the body. Tell the child to follow directions to avoid being hurt. Explain that the child must behave because the technician is busy. Help the child to pretend that the CT scan machine is a camera.
Help the child to pretend that the CT scan machine is a camera. RATIONALE: 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 Trust versus mistrust Industry versus inferiority Autonomy versus shame and doubt
Initiative versus guilt RATIONALE: 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 is caring for several clients on the pediatric unit. When interacting with the preschool-age child, which action does the nurse predict will occur? Insists doing something and the next moment reverts to being dependent Grows and develops skills more rapidly than at any other time in their life Increased attention span and can be interested in an activity for a long length of time Takes in new information at a rapid rate and asks "why" and "how"
Takes in new information at a rapid rate and asks "why" and "how" RATIONALE: The preschool-aged child soaks in information and asks "why" and "how" over and over. The school-aged child has a longer attention span and can become absorbed in a craft or activity for several hours. The toddler insists he or she 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.
A 4-year-old child is drawing with crayons. Which creation by the child would most be reflective of the anticipated skill level of this age? The child is able to draw shapes such as circles and squares. The child draws a person with 6 body parts. The child draws random lines on the paper and reports it is a person. The child is able to proficiently draw several letters of the alphabet.
The child is able to draw shapes such as circles and squares. RATIONALE: Preschool children are creative and like to draw. They are able to draw shapes such as circles and squares. Drawing a figure with at least 6 body parts and writing letters are the expected skills of a 5-year-old. Random lines would be demonstrated by a younger child.
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 your children to report others who are bullying. Wait until children are old enough to tell them how to call for help in an emergency. 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. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.
Urge your children to report others who are bullying. 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. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable. RATIONALE: The preschool years are not too early to educate children about the potential threat of harm from strangers or how to address bullying from others. Appropriate measures include urging children never to talk to or accept a ride from a stranger; teaching them how to call for help in an emergency; encouraging them to tell parents if someone asks them to keep a secret about something that makes them uncomfortable; urging children to report any bullying behavior; and teaching them to say "no" to anyone whose touching makes them feel uncomfortable.
Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize: adults learning infant/child cardiopulmonary resuscitation (CPR). using and renewing sunscreen regularly. having the child wear a personal flotation device whenever near or on the water. enrolling the child in swimming lessons.
having the child wear a personal flotation device whenever near or on the water. RATIONALE: 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 monitoring children playing in the unit's playroom. The nurse notes that some children are involved in associative play by which actions? pushing toy cars around on a large rug with roads several children engrossed in their own tool-and-bench set drawing pictures in the art area playing a board game with each other
pushing toy cars around on a large rug with roads RATIONALE: Associative play occurs when children play together and are engaged in a similar activity, but without organization, rules, or a leader; each child does what they wish, such as pushing toy cars around on a rug that has roads. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity, such as drawing a picture in the art area. During cooperative play, children play in an organized group with each other as in team sports or a board game. Parallel play occurs when the toddler plays alongside other children but not with them, such as each having their own tool-and-bench set to play with the hammers and other tools.
