Chapter 12: Health Promotion of the Preschooler and Family Flashcards
A 4-year-old child is seen playing with his father while waiting in the clinic area for a well checkup visit. The nurse observing the interaction notes that this behavior as being an example of?
a. Imaginative play
b. Mutual play
c. Dramatic play
d. Avoidance play
b. Mutual play
Children playing with a parent is an example of mutual play. Play can be described as being imaginative or dramatic as a characteristic but there is no specific information given that defines the type of play interaction that is occurring. The concept avoidance play does not exist as a characteristic term describing play behaviors.
During a well-child visit, the father of a 4-year-old 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
c. Refer the child for developmental screening and make a recommendation based on the results
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 placed 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.
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
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
c. Inform the parent that he or she can expect a more tranquil period at this age
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.
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. 4 ½ years
d. 4 ½ 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.
The parents of a 4 1/2 -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 an imaginary playmate is normal and useful at this age
d. Having imaginary playmate is abnormal after age 2
c. Having an imaginary playmate is normal and useful at this age
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.
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
c. Fear of intrusive procedures
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.
A 4 ½-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 parents reports
d. Encourage the parents to try more consistent and first discipline
b. Refer the child for counseling
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.
Parents are concerned about the behavior of their preschool child as he is exhibiting aggressive behavior in interactions with other children. Which information would be relevant in determining if the behavior represents an abnormal pattern? Select all that apply.
a. How many times this type of behavior has occurred in recent weeks?
b. Does the behavior seem to be escalating?
c. How long has this behavior been going on?
d. Do you think that the behavior is warranted considering the situation that has occurred?
a. How many times this type of behavior has occurred in recent weeks?
b. Does the behavior seem to be escalating?
In terms of making an evaluation as to whether or not this aggressive behavior is a problem, the nurse would want to obtain information related to quantity, severity, distribution, onset and duration. Asking the parent if they think the behavior is justified given the situation does not address any of the aforementioned variables of concern but rather reflects a judgment value.
Which observation is associated with nightmares as opposed to sleep terrors?
a. Child has no memory of the event or dreamlike state
b. Has a hard time returning to sleep following the event
c. Thrashing type behaviors continue when the child awakens
d. Is not comforted by traditional methods of contact
b. Has a hard time returning to sleep following the event
Nightmares are associated with difficulty returning to sleep as opposed to sleep terrors where the individual easily goes back to sleep. With the advent of a nightmare, the child has a memory of the dream-like state, is comforted by traditional methods of contact and thrashing type behaviors cease upon awakening. In sleep terrors, the child has no memory of the event, continues thrashing behaviors when awaken, and is not comforted by traditional methods of contact.
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 anatomical terms because they are confusing to the preschooler
d. Parents should encourage preschoolers to satisfy their sexual curiosity by playing “doctor”
b. Parents should determine exactly what the child wants to know before answering a question about sexuality
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.
A mother tells the nurse that her daughter’s favorite toy is a large, empty box that contains 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
b. Creative play that should be encouraged
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.
Parents of a preschooler relate that their child is having some difficulties falling asleep. This is a recent occurrence and the parents report that they have tried virtually everything to get their child to go to sleep. Based on this self-report, the nurse would advise the parents to?
a. Do not feed the child 2 hours before sleep as food might be causing excess stimulation
b. Do not let the child watch any television in the evening as this may cause stimulation
c. Have the child fall asleep on the couch and then transfer the child to the bed
d. Maintaining a consistent approach to bedtime routine serves as a basis for promoting sleep patterns
d. Maintaining a consistent approach to bedtime routine serves as a basis for promoting sleep patterns
Children in this age group often experience changes in their sleep patterns but consistent approaches in bedtime rituals may help to promote sleep patterns. By the parents self-report that they have “tried virtually everything” may have contributed to the child’s altered sleep pattern. There is not enough information provided for the nurse to make any other of the provided options.
Ashley, age 4 ½ 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 hand to touch a dog briefly
d. Let her watch other children play with a dog
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 nurse is presenting a class on injury prevention to parents of preschoolers. Which injuries should the nurse identify as occurring in this age group? Select all that apply.
a. Falls
b. Drowning
c. Poisoning
d. Sports injuries
e. Tricycle and bicycle accidents
a. Falls
b. Drowning
c. Poisoning
e. Tricycle and bicycle accidents
Falls occur frequently in preschoolers. Closely monitor playground activities such as climbing jungle-gym. Closely supervise around any water and ensure swimming pools are securely fenced to prevent submersion injury. Place all medications and poisons out of reach and in locked cabinets. Administer medications as a drug, not as candy. Keep poison control phone number by telephone. When riding tricycles and bicycles, children often forget not to ride in the streets. Sports injuries occur in older children.
The best approach for effective communication with a preschooler is through:
a. Speech
b. Play
c. Drawing
d. Actions
b. Play
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.
