Flashcards in Final Exam Chapter 13 Deck (38):
1. Which should the nurse expect of a healthy 3-year-old child?
a. Jump rope.
b. Ride a two-wheel bicycle.
c. Skip on alternate feet.
d. Balance on one foot for a few seconds.
Three-year-olds are able to accomplish this gross motor skill. Jumping rope, riding a two-wheel bicycle, and skipping on alternate feet are gross motor skills of 5-year-olds.
2. In terms of fine motor development, which should the 3-year-old child be expected to do?
a. Lace shoes and tie shoelaces with a bow.
b. Use scissors to cut pictures, and print a few numbers.
c. Draw a person with seven parts and correctly identify the parts.
d. Draw a circle and name what has been drawn.
Three-year-olds are able to accomplish this fine motor skill. Being able to lace shoes and tie shoelaces with a bow, use scissors to cut pictures, and print a few numbers, or draw a person with seven parts and correctly identify the parts are fine motor skills of 4- or 5-year-olds.
3. A nurse is assessing a preschool-age child and notes the child exhibits magical thinking. According to Piaget, which describes magical thinking?
a. Events have cause and effect.
b. God is like an imaginary friend.
c. Thoughts are all-powerful.
d. If the skin is broken, the child’s insides will come out.
Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all-powerful. Cause-and-effect implies logical thought, not magical thinking. Thinking God is like an imaginary friend is an example of concrete thinking in a preschooler’s spiritual development. Thinking that if the skin is broken, the child’s insides will come out is an example of concrete thinking in development of body image.
4. A nurse, instructing parents of a hospitalized preschool child, explains that which is descriptive of the preschooler’s understanding of time?
a. Has no understanding of time
b. Associates time with events
c. Can tell time on a clock
d. Uses terms like “yesterday” appropriately
In a preschooler’s understanding, time has a relation with 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 use of time-oriented words until age 6 years.
5. The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse that they will be back to visit at 6 PM. When the child asks the nurse when his parents are coming, the nurse’s best response is
a. “They will be here soon.”
b. “They will come after dinner.”
c. “Let me show you on the clock when 6 PM is.”
d. “I will tell you every time I see you how much longer it will be.
A 4-year-old child understands time in relation to events such as meals. Children perceive “soon” as a very short time. 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. I will tell you every time I see you how much longer it will be assumes the child understands the concepts of hours and minutes, which are not developed until age 5 or 6 years.
6. A 4-year-old child is hospitalized with a serious bacterial infection. The child tells the nurse that he is sick because he was “bad.” Which is the nurse’s best interpretation of this comment?
a. Sign of stress
b. Common at this age
c. Suggestive of maladaptation
d. 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, making them feel guilty for things outside their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. Telling the nurse that he is sick because he was “bad” does not imply excessive discipline at home.
7. A 4-year-old child tells the nurse that she does not want another blood sample drawn because “I need all my insides, and I don’t want anyone taking them out.” Which is the nurse’s best interpretation of this?
a. Child is being overly dramatic.
b. Child has a disturbed body image.
c. Preschoolers have poorly defined body boundaries.
d. Preschoolers normally have a good understanding of their bodies.
Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.
8. Which play is most typical of the preschool period?
Associative play is group play in 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 play in teams.
9. Imaginary playmates are beneficial to the preschool child because they:
a. take the place of social interactions.
b. take the place of pets and other toys.
c. become friends in times of loneliness.
d. accomplish what the child has already successfully accomplished.
One purpose of an imaginary friend is to be a friend in time of loneliness. 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. Imaginary friends accomplish what the child is still attempting.
10. 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.
11. By which age should the nurse expect that most children could obey prepositional phrases such as “under,” “on top of,” “beside,” and “behind”?
a. 18 months
b. 24 months
c. 3 years
d. 4 years
At 4 years, children can understand directional phrases. Children at 18 months, 24 months, and 3 years are too young.
12. Which is a useful skill that the nurse should expect a 5-year-old child to be able to master?
a. Tie shoelaces.
b. Use knife to cut meat.
c. Hammer a nail.
d. Make change out of a quarter.
Tying shoelaces is a fine motor task of 5-year-olds. Using a knife to cut meat is a fine motor task of a 7-year-old. Hammering a nail and making change out of a quarter are fine motor and cognitive tasks of an 8- to 9-year-old.
13. The nurse is guiding parents in selecting a daycare facility for their child. Which is especially important to consider when making the selection?
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 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, so cultural similarities are not necessary.
14. Parents tell the nurse that they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which is the most appropriate recommendation the nurse should make?
a. Punish children so this behavior stops.
b. Neither condone nor condemn the curiosity.
c. Allow children unrestricted permission to satisfy this curiosity.
d. Get counseling for this unusual and dangerous behavior.
Three-year-olds become aware of anatomic differences and are concerned about how the other “works.” Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. Encouraging the children to ask questions of the parents and redirecting their activity are more appropriate than giving permission. Exploration is age-appropriate and not dangerous behavior.
15. The parent of a 4-year-old boy tells the nurse that the child believes that monsters and boogeymen are in his bedroom at night. The nurse’s best suggestion for coping with this problem is to:
a. let the child sleep with his parents.
b. keep a night-light on in the child’s bedroom.
c. help the child understand that these fears are illogical.
d. tell the child frequently that monsters and boogeymen do not exist.
A night-light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old child is in the preconceptual age and cannot understand logical thought.
16. Preschoolers’ fears can best be dealt with by which intervention?
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 the fears are
d. Ridiculing their fears so that they understand that there is no need to be afraid
Actively involving them 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.
17. Which accurately describes the speech of the preschool child?
a. Dysfluency in speech patterns is normal.
b. Sentence structure and grammatic usage are limited.
c. By age 5 years, child can be expected to have a vocabulary of about 1000 words.
d. Rate of vocabulary acquisition keeps pace with the degree of comprehension of speech.
Dysfluency includes stuttering and stammering, a normal characteristic of language development. Children speak in sentences of three or four words at age 3 to 4 years and eight words by age 5 years. At 5 years, children have a vocabulary of 2100 words. Children often gain vocabulary beyond degree of comprehension.
18. A nurse is teaching parents about language development for preschool children. Which dysfunctional speech pattern is a normal characteristic the parents might expect?
d. Repetition without meaning
Stammering and stuttering are normal dysfluency patterns in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers’ language.
19. During the preschool period, injury prevention efforts should emphasize:
a. constant vigilance and protection.
b. punishment for unsafe behaviors.
c. education for safety and potential hazards.
d. limitation of physical activities.
Education for 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 because preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate.
20. Parents are concerned that their child is showing aggressive behaviors. Which suggestion should the nurse make to the parents?
a. Supervise television viewing.
b. Ignore the behavior.
c. Punish the child for the behavior.
d. Accept the behavior if the child is male.
Television is also a significant source for modeling at this impressionable age. Research indicates there is a direct correlation between media exposure, both violent and educational media, and preschoolers exhibiting physical and relational aggression (Ostrov, Gentile, and Crick, 2006). Therefore, parents should be encouraged to supervise television viewing. The behavior should not be ignored because it can escalate to hyperaggression. The child should not be punished because it may reinforce the behavior if the child is seeking attention. For example, children who are ignored by a parent until they hit a sibling or the parent learn that this act garners attention. The behavior should not be accepted from a male child; this is using a “double standard” and aggression should not be equated with masculinity.
21. Which snack should the nurse recommend parents offer to their slightly overweight preschool child?
a. Carbonated beverage
b. 10% fruit juice
c. Low fat chocolate milk
d. Whole milk
Milk and dairy products are excellent sources of calcium and vitamin D (fortified). Low-fat milk may be substituted, so the quantity of milk may remain the same while limiting fat intake overall. Parents should be educated regarding non-nutritious fruit drinks, which usually contain less than 10% fruit juice yet are often advertised as healthy and nutritious; sugar content is dramatically increased and often precludes an adequate intake of milk by the child. In young children, intake of carbonated beverages that are acidic or that contain high amounts of sugar is also known to contribute to dental caries. Low fat milk should be substituted for whole milk if the child is slightly overweight.
1. In terms of language and cognitive development, a 4-year-old child would be expected to have which traits? (Select all that apply.)
a. Think in abstract terms.
b. Follow directional commands.
c. Understand conservation of matter.
d. Use sentences of eight words.
e. Tell exaggerated stories.
f. Comprehend another person’s perspective.
ANS: B, E
Children ages 3 to 4 years can give and follow simple commands and tell exaggerated stories. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. Five-year-old children use sentences with eight words with all parts of speech. A 4-year-old child cannot comprehend another’s perspective.
2. Which toys should a nurse provide to promote imaginative play for a 3-year-old hospitalized child? (Select all that apply.)
a. Plastic telephone
b. Hand puppets
c. Jigsaw puzzle (100 pieces)
d. Farm animals and equipment
e. Jump rope
ANS: A, B, D
To promote imaginative play for a 3-year-old child, the nurse should provide: dress-up clothes, dolls, housekeeping toys, dollhouses, play-store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, or medical kits. A 100-piece jigsaw puzzle and a jump rope would be appropriate for a young, school-age child but not a 3-year-old child.
1. The recommendation for calcium for children 1 to 3 years of age is _____ milligrams. (Record your answer in a whole number.)
While limiting fat consumption, it is important to ensure diets contain adequate nutrients such as calcium. The recommendation for daily calcium intake for children 1 to 3 years of age is 500 mg, and the recommendation for children 4 to 8 years of age is 800 mg.
A mother tells the nurse that her daughter's favorite toy is a large, empty box that contained a stove. She plays "house" in it with her toddler brother. Based on the nurse’s knowledge of growth and development, the nurse recognizes that this is
a. unsafe play that should be discouraged.
b. creative play that should be encouraged.
c. suggestive of limited family resources.
d. suggestive of limited adult supervision.
This type of play should be encouraged. After children create something new, they can then transfer it to other situations. There should be some supervision to prevent injury or accidents.
As long as the play is supervised, it should be encouraged. This is not considered unsafe play.
There is no indication of limited resources.
There is no indication of limited adult supervision.
According to Erikson, the primary psychosocial task of the preschool period is developing a sense of
Preschoolers focus on developing initiative. The stage is known as initiative versus guilt.
Identity versus role confusion is associated with adolescence.
Intimacy versus isolation is associated with young adulthood.
Industry versus inferiority is associated with the school-aged child
The best approach for effective communication with a preschooler is through
Preschoolers' most effective means of communication is through play. Play allows preschoolers to understand, adjust to, and work out life's experiences through their imagination and ability to invent and imitate.
Speech is not effective, because preschoolers assume that everyone thinks as they do and that a brief explanation of their thinking makes them understood by others, which is often not true. Also, preschoolers often do not understand the meaning of words and often take statements literally.
Drawing is still being developed as a fine motor skill; therefore, it is not the most effective means of communication.
Actions are not an appropriate means of communication for a preschooler.
The preschooler's body image has developed to include
a. a well-defined body boundary.
b. knowledge about his or her internal anatomy.
c. fear of intrusive procedures.
d. fear of looking different from his or her friends.
Preschoolers fear that their insides will come out with intrusive procedures.
Preschoolers have poorly defined body images.
Preschoolers have little or no knowledge of their internal anatomy.
The fear of looking different is a concept that occurs in later school-aged children and adolescents.
The parents of a 4½-year-old girl are worried because she has an imaginary playmate. Based on the nurse’s knowledge of the preschooler, the most appropriate response is
a. a psychosocial evaluation is indicated.
b. an evaluation of possible parent-child conflict is indicated.
c. having imaginary playmates is normal and useful at this age.
d. having imaginary playmates is abnormal after age 2 years.
Imaginary playmates are a part of normal development at this age and serve many purposes, including being a friend in times of loneliness, accomplishing what the preschooler is still attempting, and experiencing what the preschooler wants to forget or remember.
Because an imaginary playmate is part of normal development, a psychosocial evaluation is not warranted.
Because an imaginary playmate is part of normal development, an evaluation of the parent-child relationship is not warranted.
Imaginary playmates are commonly present during the preschool years; therefore, they are not abnormal after the age of 2 years.
By what age would the nurse expect most children to use sentences of four or five words?
a. 18 months
b. 24 months
c. 3 years
d. 4½ years
Children ages 4 to 5 years use sentences of four or five words.
An 18-month-old child has a vocabulary of approximately 10 words.
A 24-month-old child uses two- or three-word phrases.
A 3-year-old child uses sentences of three or four complete words.
During a well-child visit, the father of a 4-year-old child tells the nurse that he is not certain if his child is ready for kindergarten. The child's birthday is close to the cutoff date, and the child has not attended preschool. The most appropriate recommendation by the nurse is to
a. Encourage the father to have the child start kindergarten
b. Recommend to the father that he postpone kindergarten and send the child to preschool
c. Refer the child for developmental screening and make a recommendation based on the results
d. Have the father observe a kindergarten class and then decide if his child would enjoy the experience
A developmental screening will provide the necessary information to help the family determine readiness.
Encouraging the father to have the child start kindergarten does not address the father's concern about readiness and suggests that his concerns are not warranted.
Recommending to the father that he postpone kindergarten and send the child to preschool assumes that the child is not ready for kindergarten, but the recommendation is not based on any data or facts. Recommending to the father that he simply place his child in preschool may lead to the child's boredom with school.
Having the father observe a kindergarten class and then decide if the child would enjoy the experience will provide information about kindergarten but not about whether his child is ready to begin and thrive there.
When preparing parents to teach their preschool child about human sexuality, what should the nurse emphasize?
a. A parent's words may have a greater influence on the child's understanding than the parent's actions.
b. Parents should determine exactly what the child wants to know before answering a question about sexuality.
c. Parents should avoid using correct anatomic terms because they are confusing to the preschooler.
d. Parents should encourage preschoolers to satisfy their sexual curiosity by playing "doctor."
It is important that the parent answer the question that the child is asking.
Actions may have a greater influence because language is not fully developed in the preschool years.
Using correct terminology lays the foundation for later discussion of human sexuality.
Parents should encourage children to ask questions to provide accurate information at their cognitive level.
Ashley, age 4½ years, is afraid of dogs. What should the nurse recommend to her parents to help her with this fear?
a. Keep her away from dogs.
b. Buy her a stuffed dog toy.
c. Force her to touch a dog briefly.
d. Let her watch other children play with a dog.
The parents should actively seek ways to deal with fear. By observing other children at play with dogs, the child can adapt.
Keeping their child away from dogs avoids the object of fear rather than addressing the fear and finding solutions.
Buying a child a stuffed dog toy avoids the object of fear rather than addressing the fear and finding solutions.
Forcing the child to touch a dog without working up to it may increase the level of fear.
A 4½-year-old boy has been having increasingly frequent angry outbursts in preschool for approximately 8 to 10 weeks. In addition, he is aggressive toward the other children and teachers. His parents ask the nurse for advice. The most appropriate nursing intervention is to
a. explain that this is normal in preschoolers, especially boys.
b. refer the child for counseling.
c. talk to the preschool teacher to obtain validation for the behavior the parent reports.
d. encourage the parent to try more consistent and firm discipline
This is not expected behavior. The child should be referred to a competent professional to deal with his aggression so that an accurate assessment can be made and a care plan determined.
Outward aggression to others is not normal behavior and should be evaluated.
The validation will be helpful for the referral, but the referral is the priority action.
This may be recommended by the professional once an accurate assessment is made.
Which is descriptive of the nutritional requirements of preschool children?
a. The quality of the food consumed is more important than the quantity.
b. Nutritional requirements for preschoolers are different from requirements for toddlers.
c. The requirement for calories per unit of body weight increases slightly during the preschool period.
d. The average daily intake of preschoolers should be about 3000 calories.
It is essential that the child eat a balanced diet with essential nutrients; the amount of food is less important than the quality of the food.
Requirements are similar for both toddlers and preschoolers.
The caloric requirement decreases slightly for preschoolers.
The average intake is about 1800 calories each day for preschoolers.
Kimberly, age 4 years, sometimes wakes her parents up at night, screaming, thrashing, sweating, and apparently frightened. Yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This most likely scenario is
b. sleep terrors.
c. seizure activity.
d. sleep apnea.
In sleep terrors, the child is only partially aroused; therefore, she does not remember her parents' presence.
A nightmare is a frightening dream followed by full awakening; therefore, the child would realize that her parents are present.
The description of the child's experience does not indicate the presence of seizure activity.
Sleep apnea is a cessation of breathing during sleep.
The nurse is giving anticipatory guidance to the parent of a 5-year-old. What is the most appropriate information to include?
a. Prepare the parent for increased aggression.
b. Encourage the parent to offer the child choices. Incorrect
c. Inform the parent that he or she can expect a more tranquil period at this age.
d. Advise the parent that this is the age when stuttering may develop.
The end of preschool and the beginning of school age is a more tranquil period.
Preparing the parent for increased aggression is anticipatory guidance for 4-year-old children.
Encouraging the parent to offer the child choices is anticipatory guidance for 3-year-old children.
Advising the parent that this is the age when stuttering may develop is anticipatory guidance for 3-year-old children.