Prep-U Chapter 27
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."
During a well-child visit, the caregiver tells the nurse she is concerned that her 3-year-old often stutters when he is speaking. Which of the following statements made by the nurse is the best explanation to give this mother regarding her concern?
"Children of this age may stutter while they search for just the right word."
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."
The mother of a preschool-age child is discussing normal development of this age child with the pediatric nurse. The nurse explains the developmental milestone of initiative. The mother makes the following statements about her son. Which statement is an example of what might be this developmental milestone?
"He tries to sweep up cereal his brother spilled but cries when he can't do it well."
The nurse is doing teaching with a group of caregivers of preschool children on various topics. The topic of sexual development is discussed. Which of the following statements made by the caregivers indicates an understanding of the sexual development of the preschool age child?
"I feel better knowing that what she is doing is normal."
The mother of a 4-year-old reports using time-outs as a means for disciplining the child. Which statement by the mother would require the nurse to provide additional teaching?
"I usually have him in time-out for about 10 minutes." The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. A time-out should end as soon as the child is calm.
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 of the following statements by the father would indicate a need for further teaching?
"I will need to find an appropriate punishment for him if this continues."
The nurse is discussing the topic of nutrition with a group of caregivers of preschoolers. Which of the following statements made by the caregivers is most accurate regarding nutrition in the preschooler?
"If I give snacks throughout the day, my child can meet her nutritional requirements."
The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which of the following statements made by the caregivers best indicates a common aspect of the diet and nutrition of the preschool child?
"One day my child will eat everything on his plate, the next day he will eat almost nothing."
The nurse is doing a well-child exam of a 5½-year-old girl. Which of the statements by the mother would alert the nurse that further teaching is needed about healthy eating habits?
"Our family rule is that all children clean up their plates at each meal, and we feed them a lot."
A mother reports to the nurse that her 4 year old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother?
"Preschoolers imitate as a healthy behavior--it is part of their imagination and normal growth and development."
A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond?
"Tell me about Boo-ga-loo."
The nurse is conducting a physical examination of a young preschooler and detects the odor of tobacco smoke on the parents' hair and clothing. How should the nurse respond?
"Tell me about your child's exposure to tobacco smoke."
A 3-year-old tells you he has 19 brothers. You know that he has two. What is your best response to him concerning his brothers?
"That's a good pretend answer, but tell me the names of the brothers you really have."
The mother of a 4 year old tells the nurse that she is frustrated, because all she seems to do lately is fight with the child over what the child wants to eat and wear. The mother says that she sometimes wants to spank the child for always disagreeing. What would be the best suggestion for the nurse to make to this mother?
"Use the timeout technique for discipline."
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."
The father of a 4-year-old confides in the school nurse that he is concerned about his child not telling the truth. The father states, "I found a broken tool in my garage and when I asked my son about it, he said that his friend Andrew broke it, but we don't know anyone named Andrew." The best response by the nurse would be
"Your son may have a friend named Andrew, but it could be an imaginary friend."
Language development is rapid in the preschool years. At the age of 2 most children know about 300 words. By the time the child is 6 years of age how many additional words have most children learned?
1,500 words
The preschool period is one of slow growth. The child gains about
3 to 5 lb each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm).
If the child is gaining weight at an expected rate, a child who weighs 36 lbs. at 3 years of age would weigh which of the following at age 5?
44 lbs. The preschool age child gains about 3 to 5 lbs. each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm)
A mother comes to the clinic with her 3 year old and tells the nurse that she is worried because the child does not talk much. Upon talking to the child, the nurse learns that the patient has a normal vocabulary for age. The nurse is aware that language for a 3 year old consists of approximately at least how many words?
900 words, while a 4 year old has one consisting of 1500 words, and a 5 year old has mastered more than 2100 words
Which of the following would be most effective in helping promote initiative and nutritional health for a preschooler?
Allowing the child to spread soft cheese on crackers
Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue?
Allowing the preschooler to fall asleep wherever and whenever the child is tired enough
A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?
Asking the girl to slow down and to think before she talks
In assessing the bilingual 4-year-old's speech and language development, the nurse should find that the child will:
Be able to use each language as a separate system.
Which of the following statements is most accurate regarding the gross motor skills of a 5-year-old?
By the age of 5 the child can walk backwards heel to toe, throw and catch a ball well, and jump rope.
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.
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 cooperative play?
Children are playing in an organized group with each other.
Children should not be expected to always eat everything on their plates, nor should they be rewarded for doing so. Appropriate serving sizes are important here.
Children need to learn to self-regulate and eat only until full.
A 4-year-old tells you he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which of the following nursing diagnoses is most applicable for his family?
Deficient knowledge of normal preschool development
Which of the following actions by a preschooler would suggest that his thinking is inconsistent with normal preschooler growth and development?
Refusal to play with "real" children
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
Which project or game would you anticipate that a preschooler would most enjoy while hospitalized?
Dressing in her mother's coat to play house
During the health history, the nurse asks a 4 year old about objects he sees. One of the objects is a car. The child tells the nurse that the car is "what mommy uses to take me to school." The nurse interprets this statement as indicating which of the following?
Egocentricity
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
A mother is discussing with the nurse a recent story in the local news about a child being abducted. She is concerned about the safety of her preschool child and wonders what she should tell her child to keep her safe but without frightening her. Which of the following would be the best recommendation for the nurse to give the mother in this case?
Explain in a calm and everyday manner how the child should stay away from strangers in cars
Telling tall tales is harmless and should be encouraged in preschoolers because it helps them develop their imaginations.
False. Parents may be concerned "tall tales" can lead to chronic lying if supported. Caution them, therefore, not to encourage this kind of storytelling, but instead help the child separate fact from fiction by saying, "That's a good story, but now tell me what really happened." This conveys the idea a child has not told the truth, yet does not squash imagination or initiative.
Broken fluency is a serious condition, and children who exhibit it should be referred to a speech pathologist for treatment.
False. you may need to remind parents that broken fluency is a part of normal development and, if accepted as such, will pass.
Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:
Having the child wear a personal flotation device whenever near or on the water
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?
Help her pretend the x-ray machine is a camera.
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
A mother brings her 3-year-old daughter in for a sick visit for the third time this year. The child, who attends a preschool program, continues to develop upper respiratory infections. The mother is frustrated with the situation and asks the nurse for advice. Which of the following would be the best recommendation for the nurse to give to the mother in this situation?
Make sure that frequent handwashing is being stressed at the preschool
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. Although vocabulary, gross motor skills, and fine motor skills improve during this time, the imagination of preschoolers is keener than it will be at any other time in their lives. They imitate behavior that they see exactly
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
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?
In preschool child begins to develop friendships.
Nursing students are reviewing information about the emotional development of the preschooler. They demonstrate understanding of he information when they identify which of the following as the task of the preschooler?
Initiative
The major developmental task according to Erikson is for the preschool child to develop which of the following?
Initiative
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. 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.
Recently, 5-year-old Jack's father was injured in a motorcycle accident. The father is healthy and back at work. Jack's father confides to the school nurse that he is concerned about Jack. When questioned further, he tells the nurse that Jack is not acting like he was before the accident. He says he keeps telling Jack he is a good boy; indeed Jack is not testing or challenging his boundaries like he was before the accident. Which of the following best describes the reason for the behavior Jack's father is seeing?
Jack wanted to go with his father on the motorcycle ride. When he was told he couldn't go he told his father he hoped he would crash, so Jack believes he caused the accident.
Teaching a group of caregivers about the topic of nutrition, one caregiver tells the group, "I use desserts as a reward for good behavior." A person in the group asks the nurse what she thinks about that idea. Which of the following statements by the nurse would be the most appropriate? Using dessert as a reward for good behavior may cause the child to
Learn to use food to manipulate others' behavior
A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which of the following activities that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson?
Opening drawers in the room, pulling out supplies, and examining them
The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of the following is the highest calcium-containing fruit?
Orange
Preschoolers enjoy games that use imitation such as pretending to be teachers, cowboys, firefighters, and store clerks. They imitate exactly what they see their parents doing
Parallel play is characteristic of toddlers. Preschoolers are capable of sharing and play with other children as a means for socialization. Older preschoolers are interested in group games.
Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.
Parent knows the misbehavior was intentional. Warn the child there will be a time-out if the behavior does not stop. Remove the preschooler to a boring spot. Set a timer for no more than 4 minutes. If the child gets up, replace the child and restart the time.
A nursing instructor is teaching students about changes during the preschool years. One predominant change that the teacher would emphasize is which of the following?
Physical growth slows. while personality and cognitive growth continue at a rapid rate.
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
The nurse is observing a playgroup of children of all ages. The preschoolers in the group would most likely be doing which of the following activities?
Pretending to be mommies and daddies in the playhouse.
A mother brings her 4-year-old son in for a check-up. Which of the following findings should the nurse be concerned about?
Resting pulse rate of 120. Pulse rate in preschool children decreases to about 85 bpm typically, so the nurse should be concerned about a pulse rate of 120 in a 4-year-old.
The preschool-age child may have imaginary playmates who are very real to them. The imaginary friend often has the characteristics that the child might wish for.
Sometimes the child blames the imaginary friend for breaking a toy or engaging in another act for which the child does not want to take responsibility. The child should not be punished because the child is not intentionally telling a lie.
What suggestions regarding the evaluation of a child-care center would you share with a preschooler's mother?
Specific program goals to be accomplished should be available.
A 4 year old is going to finger paint for the first time. Which of the following is the best action for the adult supervisor of this activity?
Support whatever the child paints.
A nursing instructor is preparing a class for students about the moral and spiritual development of preschoolers. When describing this topic, the instructor would include which of the following?
Tendency to do good out of self-interest rather than from the development of a conscience. They determine right and wrong based on rules, not the reason or rationale for the rules. They have difficulty with rules that they know apply to a new situation. Preschoolers enjoy religious holidays and rituals based on the fact that these offer them reassurance and security.
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.The 4-year-old can hop on one foot and can control movements of the hands.
In working with the preschool-age child, the nurse recognizes which of the following as a characteristic of the preschooler?
The child takes in new information at a rapid rate and asks "why" and "how."
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
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.
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
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
The parents of a 5-year-old call the nurse for advice about night terrors. The child has had them nightly for almost 2 weeks. Which of the following is the most appropriate intervention?
Wake the child up nightly 30 to 45 minutes after going to sleep.
The best activity that a preschooler's parents could use to help her achieve the developmental task of the preschool period is to
allow her to experiment with PlayDoh.Preschoolers enjoy toys or material that they can manipulate -free-form play-because this helps them learn how things work.
The school-age child has a longer attention span
and can become absorbed in a craft of activity for several hours.
Structure, proper behavior with others, and language skills are all developed
at home and are essential for school success.
Animism is
attributing life-like characteristics to inanimate objects.
The toddler insists they can do things one minute and then
becomes dependent the next minute.
Magical thinking involves
believing that one's thoughts are all-powerful.
Dody types
ectomorphic: slim body build endomorphic: large body build
When planning how to respond to a child about telling stories, you would base your statement on the fact that
imagination in a 3-year-old is at its peak.
Coordination of secondary schema is seen in
infants at age 10 months.
Primary circular reaction is seen in
infants of 3 months.
The developmental task of preschoolers is to achieve a sense of
initiative versus guilt.
The infant grows and develops skills more
rapidly than he or she ever will again.
Transduction is
reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked
The home environment is the foundation for the child's learning and is
the most important element for developing school readiness. Values regarding learning originate at home. Parents are the first teachers and role models
Oedipus complex refers to
the strong emotional attachment a preschool boy demonstrates toward his mother.
Empathy is
the understanding of others' feelings
Tertiary circular reaction is seen in
toddlers between 12 to 15 months
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 reading a favorite story before bedtime." • "Avoid having your child watch frightening shows on TV before bedtime." • "Try using a night light in the child's room."
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
The nurse is providing teaching about car seat safety for a parents' meeting at the preschool their children attend. Choose the points the nurse should make. Select all that apply.
• Children who weigh less than 40 pounds should use a car seat with harness and top tether. • Many car seats are installed improperly, making them unsafe. • The back seat remains the safest place for children to ride. • Booster seats should be used with both a shoulder and lap belt.
A mother describes her 4-year-old girl's eating habits as "picky" and goes on to describe using wheedling, coaxing, and threatening measures to get her to eat. The nurse determines the child is growing normally. What interventions will be suggested? Select all that apply.
• Offer a variety of healthy foods including those liked and refused. • Approach mealtime matter-of-factly. • Allow the child to decide how much she will eat. • Ignore the pickiness. • Offer only nutritious between-meal snacks. • Focus on quality, not quantity.