chapter 37: pre-schooler

Question 1

1. 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 stand on one foot for a few seconds.

Answer 1

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

Question 2

2. 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.

Answer 2

ANS: D
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.

Question 3

3. 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.

Answer 3

ANS: A
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.

Question 4

4. 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.

Answer 4

ANS: B
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.

Question 5

5. 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.

Answer 5

ANS: B
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.

Question 6

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

Answer 6

ANS: B
Children aged 5 years can follow three 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.

Question 7

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

Answer 7

ANS: C
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.

Question 8

8. 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.

Answer 8

ANS: C
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 they 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 or she has already accomplished.

Question 9

9. 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

Answer 9

ANS: D
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.

Question 10

10. 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

Answer 10

ANS: D
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.

Question 11

11. Which 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.

Answer 11

ANS: A
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.

Question 12

12. The nurse is guiding parents in selecting a daycare facility for their child. When making the selection, which factor 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

Answer 12

ANS: D
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.

Question 13

13. 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.

Answer 13

ANS: B
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.

Question 14

14. Which method 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 it 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

Answer 14

ANS: A
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.

Question 15

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

Answer 15

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

Question 16

16. During the preschool period, which method 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

Answer 16

ANS: C
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.

Question 17

17. 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.

Answer 17

ANS: B
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.

Question 18

18. 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 (VariZIG)

Answer 18

ANS: D
VariZIG 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.

Question 19

19. A child with which disease would have a recommendation for vitamin A supplementation? a. Mumps
    b. Rubella
    c. Measles (rubeola)
    d. Erythema infectiosum

Answer 19

ANS: C
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.

Question 20

20. 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

Answer 20

ANS: B
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.

Question 21

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

Answer 21

ANS: B
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.

Question 22

1. Which conditions require strict isolation for a child who is hospitalized? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Mumps
   b. Parvovirus B19
   c. Exanthema subitum (roseola)
   d. Erythema infectiosum (fifth disease)
   e. Rubella (German measles)

Answer 22

ANS: A, C, D, E
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, and scarlet fever.

Question 23

2. Which information should the nurse include when teaching parents about the use of Caladryl? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Apply as often as required.
   b. It should be used with caution when the child is taking an oral antihistamine.
   c. Lotion should be warmed in the hands prior to application.
   d. Lotion should be applied sparingly.
   e. It should not be used on children under 5 years of age.
   f. Excessive absorption when applied to open lesions can lead to drug toxicity

Answer 23

ANS: B, D, F
When lotions with active ingredients such as diphenhydramine in Caladryl are used, they should be applied sparingly, especially over open lesions, where excessive absorption can lead to drug toxicity. These lotions should be used with caution in children who are simultaneously receiving an oral antihistamine. Cooling the lotion in the refrigerator beforehand often makes it more soothing on the skin than using it at room temperature.

Question 24

3. Which are normal findings when assessing the physical growth of a 5-year-old child? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Bowel and bladder control at nighttime is achieved.
   b. Birth length is doubled.
   c. Pulse and respiration rates decrease slightly from a 4-year-old.
   d. Handedness is established.
   e. Average height is 110 cm.
   f. Average weight is 16.7 kg.

Answer 24

ANS: C, D, E
Normal physical findings of a 5-year-old include a slight decrease in pulse and respiration rates, the establishment of handedness (approximately 90% are right-handed), and average height of 110 cm. Average weight is 18.7 kg, not 16.7 kg. Birth length is doubled at the age of 4 years old, not 5 years of age. Most 3-year-olds have nighttime control of their bladder and bowel.

Question 25

4. Which are normal findings when assessing the language development of a 4-year-old child? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Has a vocabulary of 1500 words or more
   b. Uses sentences of four to five words
   c. Tells exaggerated stories
   d. Can sing simple songs
   e. Names five colours
   f. Can follow three commands in succession

Answer 25

ANS: A, B, C, D
Normal language findings in a 4-year-old child include a vocabulary of 1500 or more words, using sentences of four to five words, telling exaggerated stories, and singing simple songs. It is not until 5 years old that the child would be expected to name five colours and follow three commands in succession.

Question 26

5. Which are true related to nutrition in the preschool-aged child? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. The required number of calories per unit of body weight continues to increase
   slightly throughout the preschool period.
   b. Fluid requirements continue to increase slightly to 125 mL/kg/day.
   c. Protein requirements increase.
   d. Daily calcium intake is recommended to be 1000 mg for 4-year-old children.
   e. Children aged 2 to 4 years should have six servings of fruit or vegetables each
   day.
   f. Daily milk intake should be 500 mL to meet the child’s vitamin D needs.

Answer 26

ANS: C, D, F
True nutrition-related statements for the preschool child are that protein requirements continue to increase, daily calcium intake of 1000 mg is needed for children 4 to 8 years old, and a daily milk intake of 500 mL is recommended to meet the child’s need for vitamin D. The required number of calories per unit of body weight continues to decrease slightly. Fluid requirements decrease slightly to approximately 100 mL/kg/day. It is recommended that children aged 2 to 4 have four servings of fruits or vegetables per day.