Growth and Development of the Preschooler (3-6 years)
Moral Development
actions are taken based on whether or not it will result in a reward or punishment; older preschoolers primarily take actions based on satisfying personal needs, yet are beginning to understand the concepts of justice and fairness
A nurse is caring for a preschool-age child who says she needs to leave the hospital because her doll is scared to be at home alone. Which of the following characteristics of preoperational thought is the child exhibiting?
animism
The caregiver of a 6-year-old tells the clinic nurse that he is concerned that his 5-year-old child cannot yet print his first and last name, and the caregiver is wondering if this is normal. Which of the following responses by the nurse would be most appropriate?
"By the age of 6 most children can print some letters and maybe their first name."
The nurse is conducting a well-child exam of a 4-year-old boy. Which of the following statements would alert the nurse that the child is at risk for iron deficiency?
"He loves milk and drinks it every time he is thirsty."
A nurse is providing teaching about methods to promote sleep to the parent of a preschool-age child. Which of the following statements by the parent indicates an understanding of the teaching?
"I will keep a dim lamp on in my child's room during the night."
Parents of a preschooler tell the nurse that their child often refuses to go to sleep at night. Which suggestion by the nurse would be helpful? (Select all that apply.)
"Try reading a favorite story before bedtime; Set up some familiar bedtime rituals for your child; Avoid having your child watch frightening shows on TV before bedtime; Try using a night light in the child's room."
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."
Immunizations
4-6 yrs- diphtheria and tetanus toxoids and pertussis (DTaP); measles, mumps, and rubella (MMR); varicella; and inactivated poliovirus (IPV) 3-6 yrs- yearly seasonal influenza vaccine; trivalent inactivated influenza vaccine (TIV); or live, attenuated influenza vaccine (LAIV) by nasal spray
Safety in the water
5 yrs of age is an appropriate time for a child to learn to swim; swimming pools should be secured by a 5-feet high fence and a self-latching gate
The nurse realizes that the 5-year-old's growth chart and BMI indicate the child is at risk for obesity. What other findings reinforce this risk? (Select all that apply.)
a father who is overweight; food used as reward or punishment; television on during meals; expectations to eat everything on plate
Time
begin to understand the sequence of daily events; by the end of the preschool years, children have a better comprehension of time-oriented words
Kohlberg's preconventional stage
characterized by punishment-and-obedience orientation; determines good vs. bad dependent upon associated punishment; children may learn inappropriate behavior at this stage if parental intervention does not occur
The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of dramatic play?
children are acting out a troubling situation
Nutrition
consume about half the amount of energy that adults do; picky eaters by age 5; need protein, adequate calcium, iron, folate, and vitamins A & C; drinking excess amounts of milk may lead to iron deficiency; the parent should offer the meal or snack, and then allow the child to decide how much of the food, if any, he or she is going to eat
A nurse is conducting a well-child visit with a child who is scheduled to receive the recommended immunizations for 4- to 6-year- olds. Which of the following immunizations should the nurse administer? (Select all that apply.)
diphtheria, tetanus, pertussis (DTaP), inactivated poliovirus (IPV), measles, mumps, rubella (MMR)
Social Development
do not exhibit stranger anxiety and have less separation anxiety; prolonged separation can provoke anxiety (toys and play should help); pretend play is healthy and allows preschoolers to determine the difference between reality and fantasy
A type of play seen in the preschool child encourages children to act out troubling situations such as occur in the hospitalized child who must undergo an upsetting procedure. This type of play is referred to as which of the following?
dramatic play
A mother confides in a nurse that her preschool daughter only wants to play with her father as soon as he comes home from work in the evenings and doesn't seem to have any interest in spending time with the mother. This phenomenon is an example of which of the following?
electra complex
Erikson- initiative vs. guilt
energetic learners; guilt may occur when preschoolers believe they have misbehaved or when they are unable to accomplish a task; guiding preschoolers to attempt activities within their capabilities while setting limits is appropriate
Bedtime routines
enforce a bedtime as well as morning wake-up time; avoid sugar or caffeine consumption in the evening; avoid stimulating activities such as roughhousing before bedtime; no watching television in the bed; provide a nightlight; conform to a nightly routine
Centration
focus on one aspect instead of considering the whole
Transduction when reasoning
he or she extrapolates from a particular situation to another, even though the events may be unrelated
A nurse is describing growth and development during the preschool period. Which of the following would the nurse identify as a predominant and heightened characteristic for this age group?
imagination
A nurse is observing a 3-year-old preschooler engaged in play. Which of the following would the nurse most likely expect to observe?
imitative play
Animism
inanimate objects are alive
Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify?
iron deficiency
Gross motor skills of a 5-year-old
jumps rope; walks backward with heel to toe; throws and catches a ball with ease
Activities of Erikson's initiative vs. guilt
likes to please parents; begins to plan activities, make up games; initiates activities with others; acts out the roles of other people (real and imaginary); develops sexual identity; develops conscience; may take frustrations out on siblings; likes exploring new things; enjoys sports, shopping, cooking, working; feels remorse when he or she makes a wrong choice or behaves badly; cooperates with other children; negotiates solutions to conflicts
Sleep and rest
on average, preschoolers need about 12 hr of sleep per day; some require a daytime nap; decrease sleep disturbances by keeping a consistent bedtime routine, use a night-light, and avoid allowing preschoolers to sleep with their parents; validate the child's fear rather than discounting it after the child has a nightmare
Age-appropriate activities
parallel play shifts to associative play; play is not highly organized, but cooperation does exist between children; includes playing ball, putting puzzles together, riding tricycles, playing pretend and dress-up activities, role playing, painting, simple sewing, reading books, wading pools, skating, computer programs, electronic games
Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3 year old is in which of the following stages as identified by Piaget?
preoperational thought
A mother tells a nurse that her child has recently established some friendships for the first time. In which age group do you expect this child to be?
preschool
Body-image changes
preschoolers begin to recognize differences in appearances, and identify what is considered acceptable and unacceptable; by the age of 5, preschoolers begin comparing themselves with peers; intrusive experiences, such as injections or cuts, are frightening
Self-concept development
preschoolers feel good about themselves when they master skills that allow independence; during stress, insecurity, or illness, preschoolers may regress to previous immature behaviors or develop habits (e.g., nose picking, bedwetting, thumb sucking)
A nurse is performing a developmental screening on a 3-year-old child. Which of the following skills should the child be able to perform?
ride a tricycle
Gross motor skills of a 3-year-old
rides a tricycle; jumps off bottom step; stands on one foot for a few seconds
Gross motor skills of a 4-year-old
skips and hops on one foot; throws ball overhead
Dental health
teeth begin to erupt; use a pea-sized amount of toothpaste to prevent excess fluoride consumption, which can contribute to fluorosis; cariogenic foods should be avoided; visit the dentist every 6 months
At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to which of the following?
testing and identification of group role
The nurse is discussing development of motor skills in the preschool-age group with a group of nursing students. Which of the following statements is most accurate regarding the gross motor skills of a 4-year-old?
the child can hop on one foot
When collecting data on a preschool-age child during a well-child visit, the nurse finds that the child has gained 12 lb and grown 2.5 inches in the last year. Using knowledge of normal growth patterns of the preschool child, the nurse recognizes that these findings indicate which of the following?
the child's weight is above an expected range and the height is within an expected range
In counseling a group of parents regarding the development of school readiness in preschoolers, the nurse emphasizes:
the home environment
Piaget- cognitive development
the preconceptual phase transitions to the phase of intuitive thought around the age of 4 yrs; the phase of intuitive thought last until the age of 7 yrs; the preschooler moves from totally egocentric thoughts to social awareness and the ability to understand the viewpoints of others
In teaching caregivers of preschool children, the nurse would reinforce that which of the following would be most important for this age group?
the preschool child should wear a seat belt when riding in a vehicle
Magical thinking
thoughts can cause events to occur
The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that the girl is demonstrating which of the following?
transduction
Safety in the car
transition to a booster seat when the forward-facing seat is outgrown by 4 yrs old; use a booster seat till the age of 8-12; deactivate the front passenger seat air bag for children younger than 12
Language development
vocabulary increases to more than 2,100 words by the end of the 5th year; speak in sentences of 3-4 words at the ages of 3 and 4 years, and 4-5 words at the age of 4-5 years; enjoys talking, and language becomes their primary method of communication
Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of the following? (Select all that apply.)
when discussing improper behavior, call the behavior "bad" or "naughty," not the child; anticipate situations likely to cause misbehavior and redirect the child to another activity; books and stories can help preschoolers master proper behavior
