Chapter 27: Growth and Development of the Preschooler

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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? A. "Masturbation is a normal part of preschool development." B. "If you catch your child masturbating, you should immediately make them stop." C. "You will need to speak with the doctor about that behavior since I cannot address sexual issues in a child." D. "Masturbation is not a normal behavior for a child of that age."

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

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. A. "Set up some familiar bedtime rituals for your child." B. "Try reading a favorite story before bedtime." C. "Try using a night light in the child's room." D. "Avoid having your child watch frightening shows on TV before bedtime." E. "Keep the door closed and the lights off so that your child can fall asleep faster."

A. "Set up some familiar bedtime rituals for your child." B. "Try reading a favorite story before bedtime." C. "Try using a night light in the child's room." D. "Avoid having your child watch frightening show 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.

A group of nursing students are completing a clinical day at a preschool. Which behaviors would they identify as common in this preschool group? Select all that apply. A. Regression B. Telling of tall tales C. Imaginary friends D. Sibling rivalry E. Difficulty with sharing F. Completing multi-step tasks

A. Regression B. Telling of tall tales C. Imaginary friends D. Sibling rivalry E. Difficulty with sharing Common behavior variations of preschoolers include telling tall tales, imaginary friends, regression, sibling rivalry and difficulty with sharing. Multi-step tasks are able to be completed by school-aged children.

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

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

The nurse is providing health-promotion teaching to a group of parents of preschoolers at a local day care. What information would the nurse include in this education session? Select all that apply. A. Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry clothing. B. Preschoolers only need to wear bicycle helmets if they are going on long rides. C. Preschoolers are capable of taking a bath independently. D. Parents will need to supervise tooth-brushing and be responsible for flossing. E. Encourage children to select their own clothing to wear each day.

A. Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry clothing. D. Parents will need to supervise tooth-brushing and be responsible for flossing. E. Encourage children to select their own clothing to wear each day. Preschoolers are becoming more independent and need to be allowed to pick out their own clothing, brush their teeth with adult supervision, and take care of their own toileting. If the child has an accident, treat it in a matter-of-fact manner and do not make a big deal out of it. Helmets are worn every time the child rides a bicycle, regardless of distance.

A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group? A. imagination B. vocabulary C. gross motor skills D. fine motor skills

A. imagination Although vocabulary, gross motor skills, and fine motor skills improve during this time, the imagination of preschool-age children is keener than it will be at any other time in their lives. They imitate behavior exactly as they see it.

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? A. play kitchen and food B. brightly colored mobile C. 50-piece jigsaw puzzle D. toy with dials and switches

A. play kitchen and food 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: A. transduction. B. magical thinking. C. animism. D. beginning empathy.

A. transduction. The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.

The parent of a 4-year-old child tells the nurse about being frustrated because all the parent seems to do lately is fight with the child over what the child wants to eat and wear. The parent notes sometimes wanting to spank the child for always disagreeing. What would be the best suggestion for the nurse to make to this parent? A. "It is not normal to feel that way." B. "Use the time-out technique for discipline." C. "Spank lightly to get the child's attention." D. "Take some toys away when the child acts like that."

B. "Use the time-out technique for discipline." Preschoolers have definite opinions, which may bring them into opposition with parents. The best thing to do during these struggles is to guide the child through without discouraging his or her right to an opinion. Time-out is a good technique that allows parents to discipline without using physical punishment. Time-out should last for 1 minute for every year of age. Spanking is never encouraged and is totally discouraged by the American Academy of Pediatrics. Taking the child's toys away does not accomplish the same as time-out. After taking away the toy the child just goes and gets another without understanding the meaning behind the punishment. It is easy for the parent to get frustrated, especially if the child is very willful. This can best be avoided by being consistent with rules.

Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3-year-old is in what stage as identified by Piaget? A. Tertiary circular reaction B. Preoperational thought C. Primary circular reaction D. Coordination of secondary schema

B. Preoperational thought A 3-year-old is in the preoperational stage according to Piaget. Primary circular reaction is seen in infants of 3 months. Coordination of secondary schema is seen in infants at age 10 months. Tertiary circular reaction is seen in toddlers between 12 and 15 months.

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? A. "There is a very low student-teacher ratio, and they do a lot of hands-on projects." B. "The school requires processed foods and high sugar foods be avoided." C. "The school is quite structured and advocates corporal punishment." D. "The school has a loose environment, which is a good match for his temperament."

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

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? A. "My child loves to play dress-up with friends at day care." B. "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." C. "When we go to the park, my child never wants to play with the other children." D. "I think it is so cute when my child wants to help my spouse with yardwork." E. "My son loves to follow around his older sister."

C. "When we go to the park, my child never wants to play with the other children." 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

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

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

The nurse is interacting with a 5-year-old child who lives in a home with bilingual parents. Which observation would alert the nurse to further assess the child's language development? A. The child occasionally stutters when telling the nurse a story about planting vegetable seeds in the garden. B. parents report the child interchanges words from both languages for communication at home. C. The child says "um" frequently when describing things to the nurse, such as the family pet. D. The child is able to enunciate several sounds and has difficulty enunciating the "q" sound in words.

D. The child is able to enunciate several sounds and has difficulty enunciating the "q" sound in words. The preschool-aged child should have mastered the "q" sound, although the child may still struggle with other sounds such as "f," "v," "s," and "z" sounds. Speech may include stuttering, which will resolve in 80% of children by age 8 years. The child may use "um" in when speaking, which is a typical finding in the preschool age. The child in a bilingual home can differentiate and use both languages spoken in the home.

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. a 3-year-old knows the word two but not the concept of two. B. a preschooler is in an insecure period. C. preschoolers have a limited vocabulary. D. imagination in a 3-year-old is at its peak.

D. imagination in a 3-year-old is at its peak. 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 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? A. "He loves milk and drinks it every time he is thirsty." B. "He eats a well-balanced diet." C. "He enjoys eggs and fortified cereal for breakfast." D. "He does not like spinach, but he does like chicken and beef."

A. "He loves milk and drinks it every time he is thirsty." This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency.

The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal? A. falls when bending over to touch toes B. unscrews a bolt on a toy C. builds a tower of 10 cubes D. pedals tricycle without assistance

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

The mother of a 4-year-old girl reports her daughter has episodes of wetting her pants. The nurse questions the mother about the frequency. The nurse determines these episodes occur about once every 1 to 2 weeks. Which response by the nurse is indicated? A. "Consider restricting your daughter's fluid intake." B. "At this age it is helpful to remind children to go to the bathroom." C. "The frequency of these wetting episodes may be consistent with a low-grade urinary tract infection." D. "Discipline should be applied after these times."

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

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

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

When collecting data on a preschool-aged child during a well-child visit, the nurse discovers the child has gained 12 lb (5.4 kg) and grown 2.5 inches (6.3 cm) in the last year. The nurse interprets these findings to indicate which situation? A. Weight and height are within expected patterns of growth. B. Weight is below an expected range and height is above an expected range. C. Weight falls within an expected range and height is less than what would be expected. D. Weight is above an expected range and height is within an expected range.

D. Weight is above an expected range and height is within an expected range. The preschool period is one of slow growth. The child gains about 4 to 5 lb each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm). The child's weight is above the expected gain and the height is what would be expected.

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 A. cardiopulmonary resuscitation (CPR). B. enrolling the child in swimming lessons. C. using and renewing sunscreen regularly. D. having the child wear a personal flotation device whenever near or on the water.

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

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. A. Urge children never to talk to or accept a ride from a stranger. B. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. C. Wait until children are old enough to tell them how to call for help in an emergency. D. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable. E. Urge your children to report others who are bullying.

. Urge children never to talk to or accept a ride from a stranger. B. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. D. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable. E. Urge your children to report others who are bullying. 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.

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? A. cooperative play B. dramatic play C. parallel play D. associative play

A. cooperative play 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.

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? A. "I am concerned that your child may have a developmental delay since most children of this age don't throw temper tantrums." B. "Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here." C. "I think we need to plan how to discipline your child when acting out this way." D. "We don't allow children of this age to throw tantrums so you will need to manage your child's behavior."

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

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? A. "Oh no! I have a crocodile in my room. Please don't bite me!" B. "What happened to my client? Did you eat her?" C. "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." D. "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you."

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

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? A. Parental anxiety related to lack of understanding B. Health-seeking behaviors C. Delayed growth and development related to frequent illness D. Risk for imbalance nutrition, more than body requirements

C. Delayed growth and development related to frequent illness 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 preparing a presentation for a health fair discussing various aspects of preschoolers. Which example should the nurse use to best illustrate dramatic play? A. Playing a video game with several other children B. Playing apart from others without being part of a group C. Watching television or videos D. Acting out a troubling or stressful situation

D. Acting out a troubling or stressful situation Dramatic play allows a child to act out a troubling or stressful situation. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. During cooperative play, children play in an organized group with each other as in team sports or video games. Onlooker play occurs when there is observation without participation, such as watching television or videos.

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: A. testing and identification of group role. B. playing in an even-number group of children (four). C. preschoolers having a harder time sharing than toddlers. D. regression.

A. testing and identification of group role. Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.

During an admission assessment the nurse is discussing the developmental level of the child with the parents. Which comments by the parents demonstrate a good understanding of developmental expectations of the preschool-aged child? Select all that apply. A. "I am very concerned that our child is acting too much like some of the other children at our day care." B. "Our child attends a wonderful preschool 3 times per week." C. "We have been talking about enrolling in a morning preschool program since this is our only child." D. "We think it is important to have play dates with our friend's preschool children." E. "My parents are the only babysitters our child has ever had. I think contact with mostly adults is important for this age."

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

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? A. "Pedal back brakes are better for her age group." B. "She can ride on the street if I am riding with her." C. "She should always ride on the sidewalk." D. "The balls of her feet should reach both pedals while sitting."

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

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

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

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

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

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

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

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

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

A 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? A. "Is there any family history of mental health disorders?" B. "Your child is demonstrating animism, which is common." C. "Attributing lifelike qualities to inanimate objects is quite normal at this age." D. "Has your child suffered any type of physical trauma lately?"

C. "Attributing lifelike qualities to inanimate objects is quite normal at this age." 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 is preparing a safety presentation for a health fair for families. Which instruction should the nurse prioritize when illustrating car safety and the family? A. "Stop the car any time the preschooler unbuckles the restraints." B. "Reward the child with candy or some other treat each time the child keeps the seat belt on." C. "Set a good example. Wear your own seat belt every time you drive." D. "Explain that wearing a seat belt is a law and the police officer will give a ticket if the seat belt is not buckled."

C. "Set a good example. Wear your own seat belt every time you drive." 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.

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity? A. Tell the child that it will be fun but that he or she should not make a mess. B. Make a model for the child to follow so it will be easy to copy. C. Support whatever the child paints. D. Draw a picture first for the child to see how to do it.

C. Support whatever the child paints. Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because the child believes that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Finger painting is a messy activity, so telling the child not to be messy takes the fun and the creative part out of the activity. The adult should provide aprons or clothing to protect the child's clothing and allow the painting in an area that can be cleaned easily.

A nurse is teaching a group of parents of preschoolers about safety. Which information would the nurse include? Select all that apply. A. "Do not allow your child to approach strange dogs." B. "Do not refer to medicines as candy." C. "Have your child hold hands with a grown-up in parking lots." D. "Allow your child to ride in the front seat of the car." E. "Role-model bicycle safety by wearing a helmet too."

A. "Do not allow your child to approach strange dogs." B. "Do not refer to medicines as candy." C. "Have your child hold hands with a grown-up in parking lots." E. "Role-model bicycle safety by wearing a helmet too." 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 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? A. "I will need to find an appropriate punishment for him if this continues." B. "I have heard that both boys and girls often touch themselves at this age." C. "I should teach him certain rules about this activity." D. "This is probably a good time to talk about safety and who can touch him."

A. "I will need to find an appropriate punishment for him if this continues." The nurse should remind the father that overreaction to this behavior may cause it to occur more frequently. Masturbation at this age should be treated matter-of-factly. The other statements are correct.


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