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What activity can the nurse expect of a healthy 3-year-old child?
a. The child is able to jump rope.
b. The child can ride a two-wheeled bicycle.
c. The child can skip on alternate feet.
d. The child can balance on one foot for a few seconds.

Three-year-olds can accomplish the gross motor skill of balancing on one foot. Jumping rope, riding a two-wheeled bike, and skipping on alternative feet are gross motor skills of 5-year-old children.


In terms of fine motor development, what is a 3-year-old child expected to do?
a. Tie shoelaces.
b. Use scissors or a pencil very well.
c. Draw a person with seven to nine parts.
d. Copy (draw) a circle.

Three-year-olds are able to accomplish the fine motor skill of drawing a circle. Tying shoelaces, using scissors or a pencil very well, and drawing a person with multiple parts are fine motor skills of 5-year-old children


In terms of cognitive development, what is expected of a 5-year-old child?
a. The child can use magical thinking.
b. The child is able to think abstractly.
c. The child can understand the conservation of matter.
d. The child may be unable to comprehend another person’s perspective.

Magical thinking is the belief that thoughts can cause events. Abstract thought does not develop until the school-age years. The concept of conservation is the cognitive task of school-age children aged 5 to 7 years. Five-year-olds cannot understand another’s perspective.


Which phrase is most descriptive of a preschooler’s understanding of time?
a. A preschooler has no understanding of time.
b. A preschooler associates time with events.
c. A preschooler can tell time on a clock.
d. A preschooler uses terms like “yesterday” appropriately.

In a preschooler’s understanding, time has a relation to events, such as, “We’ll go outside after lunch.” Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand the use of time-oriented words until age 6 years.


The nurse is caring for a hospitalized 4-year-old boy, Ryan. His parents tell the nurse that they will be back to visit at 6 p.m. When Ryan asks the nurse when his parents are coming, what is the nurse’s best response?
a. “They will be here soon.”
b. “They will come after dinner.”
c. “Let me show you on the clock when 6 p.m. is.”
d. “I will tell you every time I see you how much longer it will be.”

A 4-year-old understands time in relation to events such as meals. Children perceive “soon” as a very short time, so the nurse may lose the child’s trust if his parents do not return in the time he perceives as “soon.” Children cannot read or use a clock for practical purposes until age 7 years. The (d) response assumes that the child understands the concept of hours and minutes, which are not developed until age 5 or 6 years.


A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was “bad.” What is the best way for the nurse to interpret this comment?
a. It is a sign of stress.
b. It is a common belief at this age.
c. It is suggestive of maladaptation.
d. It is suggestive of excessive discipline at home.

Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, so they feel guilt for things outside of their control. Children of this age show stress by regressing developmentally or acting out—maladaptation is unlikely. This comment does not imply excessive discipline at home.


In terms of language and cognitive development, which one of the following can be expected from a 5-year-old child?
a. Think in abstract terms.
b. Follow 3 commands in succession.
c. Understand conservation of matter.
d. Comprehend another person’s perspective.

Children aged 5 years can follow 3 commands in succession. Children cannot think abstractly at that age. Conservation of matter is a developmental task for the school-age child. A 5-year-old child cannot comprehend another’s perspective


Which type of play is most typical of the preschool period?
a. Solitary
b. Parallel
c. Associative
d. Team

Associative play is group play involving similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children often play in teams.


Why are imaginary playmates beneficial to the preschool child?
a. They take the place of social interactions.
b. They take the place of pets and other toys.
c. They become friends in times of loneliness.
d. They accomplish what the child has already successfully accomplished.

One purpose of an imaginary friend is to be a companion when a child is lonely. Imaginary friends do not take the place of social interaction, but may encourage conversation. Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what he has already accomplished.


Which characteristic best describes the language of a 3-year-old child?
a. Asks meanings of words
b. Follows directional commands
c. Describes an object according to its composition
d. Talks incessantly, regardless of whether anyone is listening

Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly, regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition


By what age does a nurse expect most children to obey directions using prepositional phrases such as “under,” “on top of,” “beside,” and “in back of”?
a. 18 months
b. 24 months
c. 3 years
d. 4 years

At 4 years, children can understand directional prepositional phrases. Toddlers who are 18 months, 24 months, and 3 years of age are too young to obey directions that use prepositional phrases


Which one of the following is a useful skill that the nurse expects a 5-year-old child to be able to master?
a. Tie shoelaces.
b. Use a knife to cut meat.
c. Hammer a nail.
d. Make change from a quarter.

Tying shoelaces is a fine motor task typical of 5-year-olds. Using a knife to cut meat is a fine motor task for a 7-year-old. Hammering a nail and making change from a quarter are fine motor tasks for an 8- to 9-year-old.


The nurse is guiding parents in selecting a daycare facility for their child. When making the selection, which one of the following factors is it especially important to consider?
a. Structured learning environment
b. Socioeconomic status of children
c. Cultural similarities of children
d. Teachers knowledgeable about development

A teacher knowledgeable about development will structure appropriate activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others; cultural similarities are not necessary


The parent of a 4-year-old son tells the nurse that the child believes “monsters and the boogeyman” are in his bedroom at night. What is the best suggestion the nurse can make for coping with this issue?
a. Insist that the child sleep with his parents until the fearful phase passes.
b. Suggest involving the child in finding a practical solution, such as a night light.
c. Help the child understand that these fears are illogical.
d. Tell the child frequently that monsters and boogeyman do not exist.

A night light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with his parents will not get rid of the fears. A 4-year-old is in the preconceptual age and cannot understand logical thought


Which one of the following methods is the best way to deal with preschoolers’ fears?
a. Actively involving them in finding practical methods to deal with the frightening experience
b. Forcing them to confront the frightening object or experience in the presence of their parents
c. Using logical persuasion to explain away their fears and help them recognize how unrealistic they are
d. Ridiculing their fears so they understand that there is no need to be afraid

Actively involving the child in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away.


What is one normal characteristic of language development for a preschool-age child?
a. Lisp
b. Stammering
c. Echolalia
d. Repetition without meaning

Stammering and stuttering are normal elements of dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers’ language


During the preschool period, which one of the following methods should be emphasized to prevent injury?
a. Constant vigilance and protection
b. Punishment for unsafe behaviours
c. Education about safety and potential hazards
d. Limitation of physical activities

Education about safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age, since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limiting physical activities is not an appropriate response.


Why is Acyclovir (Zovirax) given to children with chickenpox?
a. It minimizes scarring.
b. It decreases the number of lesions.
c. It prevents aplastic anemia.
d. It prevents the spread of the disease.

Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia; however, it does not prevent scarring. Preventing aplastic anemia is not a function of acyclovir. Only quarantine of the infected child can prevent the spread of this disease.


To prevent varicella, what may be given to high-risk children after exposure to chickenpox?
a. Acyclovir
b. Vitamin A
c. Diphenhydramine hydrochloride
d. Varicella zoster immune globulin (VZIG)

VZIG is given to high-risk children to help prevent the development of chickenpox. Immune globulin intravenous may also be recommended. Acyclovir is given to immunocompromised children to reduce the severity of symptoms. Vitamin A reduces the morbidity and mortality associated with the measles. The antihistamine diphenhydramine is administered to reduce the itching associated with chickenpox.


Vitamin A supplementation may be recommended for a young child who has which one of the following diseases?
a. Mumps
b. Rubella
c. Measles (rubeola)
d. Erythema infectiosum

Evidence shows that vitamin A decreases morbidity and mortality associated with measles. Vitamin A will not lessen the effects of mumps, rubella, or fifth disease.


When is a child with chickenpox considered to be no longer contagious?
a. When fever is absent
b. When the lesions are crusted
c. 24 hours after the lesions erupt
d. 8 days after the onset of illness

When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after the onset of disease. The child is still contagious once the fever has subsided, after the lesions erupt, and may or may not be contagious any time after 8 days depending on whether all lesions are crusted over.


In which communicable disease are Koplik spots present?
a. Rubella
b. Measles (rubeola)
c. Chickenpox (varicella)
d. Exanthema subitum (roseola)

Koplik spots are small, irregular red spots with a minute, bluish-white centre found on the buccal mucosa 2 days before systemic rash with measles. Koplik spots are not present with rubella, varicella, or roseola.


Which sentence below best describes a child who is abused by the parent(s)?
a. The child unintentionally contributes to the abusing situation.
b. The child belongs to a low socioeconomic population.
c. The child is healthier than the non-abused siblings.
d. The child abuses siblings in the same way as he or she is abused by the parent(s).

A child’s temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contributes to the abusive situation. Socioeconomic status is an environmental characteristic that can indicate abuse. A healthy child is less likely to be abused than one who is premature, disabled, or very young. The abused child does not in turn abuse his or her siblings


Which is one common characteristic among those who sexually abuse children?
a. They pressure the victim into secrecy.
b. They are usually unemployed and unmarried.
c. They are unknown to victims and their families.
d. They have many victims and abuse each only once.

Sex offenders may pressure the victim into secrecy, regarding the activity as a “secret between us” that other people will prevent if they find out. Abusers are often employed, upstanding members of the community. Most sexual abuse is committed by men and persons who are well known to the child. Abuse is often repeated with the same child over time. The relationship may start insidiously, without the child realizing that sexual activity is the abuser’s goal.


What is the most important criterion on which to base the decision to report suspected abuse?
a. Unintentional injury
b. An arm fracture
c. Blunt trauma to the abdomen
d. Incompatibility between history and injury

Incompatibility between the history and the injury is probably the most important criterion on which to base the decision to report suspected abuse. Unintentional injury is not a criterion. Blunt trauma to the abdomen or an arm fracture may be signs, but they are not the most important ones, as such injuries may have been accidents.


Which condition does not require strict isolation for a child who is hospitalized?
a. Mumps
b. Parvovirus B19
c. Exanthema subitum (roseola)
d. Erythema infectiosum (fifth disease)

Strict isolation is not required for parvovirus B19. Childhood communicable diseases requiring strict transmission-based precautions (contact, airborne, droplet) include diphtheria, chickenpox, measles, mumps, tuberculosis, adenovirus, hemophilus B, mumps, pertussis, plague, streptococcal pharyngitis, or scarlet fever.