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Ricci chapter 27 Test Bank

Terms in this set (30)

1. The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 in tall at her last examination at age 4. Which height measurement would be within the normal range of growth expected for a preschooler?
A) 41 in
B) 43 in
C) 45 in
D) 47 in
Ans: B
Feedback:
The average preschool-age child will grow 2.5 to 3 in (6.5 to 7.8 cm) per year. The average 3-year-old is 37 in tall (96.2 cm), the average 4-year-old is 40.5 in tall (103.7 cm), and the average 5-year-old is 43 in tall (118.5 cm).
2. The nurse is teaching the parents of a 4-year-old boy about the normal maturation of the child's organs during the preschool years and their effect on body functions. Which statements accurately describe these changes? Select all that apply.
A) Myelination of the spinal cord allows for bowel and bladder control to be
complete in most children by age 3 years.
B) The respiratory structures are continuing to grow in size, and the number of
alveoli continues to increase, reaching the adult number at about 7 years of
age.
C) Heart rate increases and blood pressure decreases slightly during the
preschool years; an innocent heart murmur may be heard upon auscultation.
D) The bones continue to increase in length and the muscles continue to
strengthen and mature; however, the musculoskeletal system is still not fully
mature.
E) The small intestine is continuing to grow in length, and stool passage usually
occurs once or twice per day in the average preschool-age child.
F) The urethra remains long in both boys and girls, making them more
susceptible to urinary tract infections than adults.
Ans: A, B, D, E
Feedback:
Most of the body systems have matured by the preschool years. Myelination of the spinal cord allows for bowel and bladder control to be complete in most
children by age 3 years. The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult
number at about 7 years of age. The bones continue to increase in length and the muscles continue to strengthen and mature. However, the musculoskeletal
system is still not fully mature. The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average
preschooler. The 4-year-old generally has adequate bowel control. Heart rate decreases and blood pressure increases slightly during the preschool years. An innocent heart murmur may be heard upon auscultation. The urethra remains short in both boys and girls, making them more susceptible to urinary tract
infections than adults.
3. The nurse is assessing the psychosocial development of a preschooler. What are normal activities characteristic of the preschooler? Select all that apply.
A) Plans activities and makes up games.
B) Initiates activities with others.
C) Acts out roles of other people.
D) Engages in parallel play with peers.
E) Classifies or groups objects by their common elements.
F) Understands relationships among objects.
Ans: A, B, C
Feedback:
The many activities of the preschooler include beginning to plan activities, making
up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.
4. The nurse is caring for a 5-year-old girl post tonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which
mental process?
A) Magical thinking
B) Centration
C) Transduction
D) Animism
Ans: A
Feedback:
The nurse understands that the girl is demonstrating magical thinking. Magical
thinking is a normal part of preschool development. The preschool-age child believes
her thoughts to be all-powerful. Transduction is reasoning by viewing one situation as
the basis for another situation whether or not they are truly causally linked. Animism
is attributing life-like qualities to inanimate objects. Centration is focusing on one
aspect of a situation while neglecting others.
5. The parents of a 4-year-old ask the nurse when their child will be able to
differentiate right from wrong and develop morals. What would be the best response
of the nurse?
A) "The preschooler has no sense of right and wrong."
B) "The preschooler is developing a conscience."
C) "The preschooler sees morality as internal to self."
D) "The preschooler's morals are his or her own, right or wrong."
Ans: B
Feedback:
The preschool child can understand the concepts of right and wrong and is
developing a conscience. Preschool children see morality as external to themselves;
they defer to power (that of the adult). The child's moral standards are those of their
parents or other adults who influence them, not necessarily their own.
6. Which activity would the nurse least likely include as exemplifying the
preconceptual phase of Piaget's preoperational stage?
A) Displays of animism
B) Use of active imaginations
C) Understanding of opposites
D) Beginning questioning of parents' values
Ans: D
Feedback:
In the intuitive phase of Piaget's preoperational stage, the child begins to question
parents' values. Animism, active imaginations, and an understanding of opposites
would characterize the preconceptual phase of Piaget's preoperational stage.
7. The nurse is assessing the motor skills of a 5-year-old girl. Which finding would
cause the nurse to be concerned?
A) Can copy a square on another piece of paper
B) Can dress and undress herself without help
C) Draws a person with three body parts
D) Is beginning to tie her own shoelaces
Ans: C
Feedback:
By the age of 5 years, the child should be able to draw a person with a body and at
least six body parts. She should also be able to copy triangles and other geometric
patterns and dress and undress herself and should be learning to tie her shoelaces.
8. The school nurse is helping parents choose books for their preschoolers. What
literacy skills present in the preschooler would the nurse consider when making
choices? Select all that apply.
A) Preschoolers enjoy books with pictures that tell stories.
B) Preschoolers like stories with repeated phrases as they help keep their
attention.
C) Preschoolers like stories that describe experiences different from their own.
D) Preschoolers demonstrate early literacy skills by reciting stories or portions
of books.
E) Preschoolers may retell the story from the book, pretend to read books, and
ask questions about the story.
F) Preschoolers do not have enough focus and expanded attention to notice
when a page is skipped during reading.
Ans: A, B, D, E
Feedback:
Preschoolers enjoy books with pictures that tell stories. Stories with repeated
phrases help to keep the child's attention. Also, children like stories that describe
experiences similar to their own. The preschool child demonstrates early literacy
skills by reciting stories or portions of books. He or she also may retell the story from
the book, pretend to read books, and ask questions about the story. The preschool
child has enough focus and expanded attention to notice when a page is skipped
during reading and will call it to the parent's attention.
9. The parents of a preschooler ask the nurse to help them choose a preschool for
their child. What are recommended guidelines and goals for choosing a preschool?
Select all that apply.
A) The main goal of preschool is to improve reading and writing skills and
readiness for entering into grade school.
B) When selecting a preschool, the parent may want to consider the
accreditation of the school and the teachers' qualifications.
C) The teachers should decide how focused on curriculum the school should be
for each individual student.
D) The parent should observe the classroom, evaluating the environment,
noise level, and sanitary practices.
E) The type of discipline used in the school is also an important factor. Parents
should choose a preschool that uses corporal punishment.
F) The parent should observe the classroom to determine how the children
interact with each other and how the teachers interact with the children.
Ans: B, D, F
Feedback:
When selecting a preschool, the parent may want to consider the accreditation of the
school, the teachers' qualifications, and recommendations of other parents. The
parent should observe the classroom, evaluating the environment, noise level, and
sanitary practices, as well as how the children interact with each other and how the
teachers interact with the children. The main goal of preschool is to foster the child's
social skills and accustom him or her to the group environment. The parents must
decide how focused on curriculum they want the school to be. The type of discipline
used in the school is also an important factor. Parents should not choose a preschool
that uses corporal punishment.
10. The mother of a 4-year-old boy tells the nurse that her son occasionally wets his
pants during the day. How should the nurse respond?
A) "Is there a family history of diabetes?"
B) "Suddenly having accidents can be a sign of diabetes."
C) "That's normal; don't worry about it."
D) "Tell me about the circumstances when this occurs."
Ans: D
Feedback:
Bladder control is present in the 4- and 5-year-old child, but an occasional accident
may occur, particularly in stressful situations or when the child is absorbed in an
interesting activity. The nurse needs to ask an open-ended question to determine the
circumstances when the child has had accidents. Simply telling the mother that it is
normal does not address the mother's concerns. The nurse does need to gather more
information, because accidents in a previously potty-trained child can be a sign of
diabetes.
11. The nurse is explaining to parents that the preschooler's developmental task is
focused on the development of initiative rather than guilt. What is a priority
intervention the nurse might recommend for parents of preschoolers to stimulate
initiative?
A) Reward the child for initiative in order to build self-esteem.
B) Change the routine of the preschooler often to stimulate initiative.
C) Do not set limits on the preschooler's behavior as this results in low
self-esteem.
D) As a parent, decide how and with whom the child will play.
Ans: A
Feedback:
The building of self-esteem continues throughout the preschool period. It is of
particular importance during these years, as the preschooler's developmental task is
focused on the development of initiative rather than guilt. A sense of guilt will
contribute to low self-esteem, whereas a child who is rewarded for his or her initiative
will have increased self-confidence. Routine and ritual continue to be important
throughout the preschool years, as they help the child to develop a sense of time as
well as provide the structure for the child to feel safe and secure. Also, consistent
limits provide the preschooler with expectation and guidance. Giving children
opportunities to decide how and with whom they want to play also helps them
develop initiative.
12. The parents of a 5-year-old boy tell the nurse that their son is having frequent
episodes of night terrors. Which statement would indicate that the boy is having
nightmares instead of night terrors?
A) "It usually happens about an hour after he falls asleep."
B) "He will tell us about what happened in his dream."
C) "He is completely unaware that we are there."
D) "When we try to comfort him, he screams even more."
Ans: B
Feedback:
During a nightmare, a child will have a memory of the occurrence and may
remember the dream and talk about it later. With night terrors, the child has no
memory of the event. The other statements are indicative of night terrors.
13. The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist
the child with the recent death of his paternal grandfather. The boy keeps asking
when his grandpa is coming back. How should the nurse respond?
A) "It is best to just ignore this and to not respond to his questions."
B) "This is normal; children his age do not understand the permanence of
death."
C) "You have to keep repeating that his grandfather is never coming back."
D) "He will eventually figure this out on his own."
Ans: B
Feedback:
The nurse needs to remind the mother that preschoolers do not completely
understand the concept of death or its permanence. Telling the mother that it is best
to ignore the boy's questions or that the boy will eventually figure this out on his own
does not teach. Repeating that the grandfather is not coming back does not consider
the developmental stage of the child and is inappropriate.
14. The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which
behavior would warrant nursing intervention?
A) The child pretends he is talking to an imaginary friend when the nurse addresses the child.
B) The child states that her fairy godmother is going to come and take her home.
C) The child starts talking about his grandmother and then quickly changes the
subject to a new toy he received.
D) The child does not want to play games with other children on the hospital ward.
Ans: D
Feedback:
The preschooler begins to plan activities, make up games, and initiate activities with
others. Not wanting to play games with other children is a sign of a developmental
delay and nursing intervention is recommended. The preschooler often has an
imaginary friend who serves as a creative way for the preschooler to sample different
activities and behaviors and practice conversational skills. Through make-believe and
magical thinking, preschool children satisfy their curiosity about differences in the
world around them. The preschooler uses transduction when reasoning: he or she
extrapolates from a particular situation to another, even though the events may be
unrelated.
15. The nurse is caring for preschoolers in a day care center. For this age group, of
what developmental milestones should the nurse be aware? Select all that apply.
A) Counting 10 or more objects
B) Correctly naming at least four colors
C) Understanding the concept of time
D) Knowing everyday objects
E) Understanding the differences of others
F) Forming concepts as logical as an adult's
Ans: A, B, C, D
Feedback:
The child in the intuitive phase can count 10 or more objects, correctly name at least
four colors, and better understand the concept of time, and he or she knows about
things that are used in everyday life, such as appliances, money, and food. The
preschooler forms concepts that are not as complete or as logical as the adult's, and
tolerates others' differences but doesn't understand them.
16. When observing a group of preschoolers at play in the clinic waiting room, which
type of play would the nurse be least likely to note?
A) Parallel play
B) Cooperative play
C) Dramatic play
D) Fantasy play
Ans: A
Feedback:
Parallel play is associated with toddlers. Cooperative, dramatic, and fantasy play are commonly used by preschoolers.
17. The nurse is supervising lunch time for children on a pediatric ward. Which
observation, if noted by the nurse, would require further assessment?
A) A child has a full set of primary teeth.
B) A child has no difficulty chewing and swallowing meat.
C) A child uses his fingers and refuses to use a fork.
D) A child is a picky eater.
Ans: C
Feedback:
The preschool child has learned to use utensils fairly effectively to feed himself or
herself, has a full set of primary teeth, and is able to chew and swallow competently.
Preschool children may be picky eaters. They may eat only a limited variety of foods
or foods prepared in certain ways and may not be very willing to try new things.
18. The nurse of a preschool child is helping parents develop a healthy meal plan for
their child. What nutritional requirements for this age group should the nurse
consider?
A) The 3- to 5-year-old requires 300 to 500 mg calcium and 10 mg iron daily.
B) The 3-year-old should consume 10 mg dietary fiber daily.
C) The 4- to 8-year-old requires 15 mg dietary fiber per day.
D) The typical preschooler requires about 85 kcal/kg of body weight.
Ans: D
Feedback:
The typical preschooler requires about 85 kcal/kg of body weight. The 3- to
5-year-old requires 700 to 1,000 mg calcium and 10 mg iron daily. The 3-year-old
should consume 19 mg dietary fiber daily, while the 4- to 8-year-old requires 25 mg
dietary fiber per day.
19. The parents of a 4-year-old who is a picky eater ask the nurse what foods to
include in their child's diet to provide adequate iron consumption. Which food would
the nurse recommend?
A) Cooked lentils
B) Whole milk
C) Oranges
D) Sweet potatoes
Ans: A
Feedback:
Lentils are a good source of iron. Whole milk, oranges, and sweet potatoes are good
sources of calcium.
20. The nurse is counseling parents of a picky eater on how to promote healthy eating
habits in their child. Which intervention would be appropriate advice?
A) Allow the child to pick out his or her own foods for meals.
B) Present the food matter-of-factly and allow the child to choose what to eat.
C) Offer high-fat snacks if the child does not eat, to get them to eat something.
D) Offer the child a special treat if he or she eats all the food on the plate.
Ans: B
Feedback:
The parents should maintain a matter-of-fact approach, offer the meal or snack, and
then allow the child to decide how much of the food, if any, he or she is going to eat.
High-fat, nutrient-poor snacks should not be substituted for healthy foods just to
coax the child to "eat something." If the preschooler is growing well, then the
pickiness is not a cause for concern. A larger concern may be the negative
relationship that can develop between the parent and child relating to mealtime. The
more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is to
try new foods or even eat the ones he or she likes that are served. The child should be
offered a healthy diet, with foods from all groups over the course of the day as
recommended by the U.S. Department of Agriculture.
21. Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium?
A) Spinach
B) White beans
C) Enriched bread
D) Fortified cereal
Ans: B
Feedback:
To ensure an adequate intake of calcium, the nurse should suggest white beans,
because 1 ounce of dried white beans when cooked provides 160 mg of calcium.
Spinach, enriched bread, and fortified cereal are good sources of iron.
22. The nurse is providing teaching about accidental poisoning to the family of a
3-year-old. The nurse understands that a child of this age is at increased risk of
accidental ingestion due to which sensory alteration?
A) A less discriminating sense of taste
B) A lack of fully developed hearing
C) Visual acuity that has not fully developed
D) A less discriminating sense of touch
Ans: A
Feedback:
The young preschooler may have a less discriminating sense of taste than the older
child, making him or her at increased risk for accidental ingestion. A less
discriminating sense of touch and developing visual acuity would not increase the
risk. Hearing is intact at birth and it does not increase the child's risk for accidental
ingestion.
23. The nurse is conducting a well-child assessment for a 5-year-old boy in preparation for kindergarten. The boy's grandmother is his primary caregiver because the boy's mother has suffered from depression and substance abuse issues. The nurse understands that the child is at increased risk for which developmental problem?
A) Lack of social and emotional readiness for school
B) Stuttering
C) Speech and language delays
D) Fine motor skills delay
Ans: A
Feedback:
Risk factors for lack of social and emotional readiness for school include insecure
attachment in the early years, maternal depression, parental substance abuse, and
low socioeconomic status.
24. A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother?
A) "It is best to avoid the playground until she outgrows the fear."
B) "She needs to face her fears head-on; take her to the park as much as possible."
C) "Acknowledge her fear and help her develop a strategy for dealing with it."
D) "Try to minimize her fears and insist that she go to the park."
Ans: C
Feedback:
Preschoolers have vivid imaginations and experience a variety of fears. It is best to
acknowledge the fear, rather than minimize it, and then collaborate with the child on
strategies for dealing with the fear. Avoiding the playground will not address the
child's fears. Forcing the child to face her fear without enlisting her input to help deal
with the fear does not teach. It is also important for the mother to find out if an
incident involving cats and dogs occurred without her knowledge.
25. The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 lb. What should the nurse instruct the parents to do?
A) "Place her in a booster seat with lap and shoulder belts in the front seat."
B) "Place her in the back seat with the lap and shoulder belts in place."
C) "Place her in a forward-facing car seat with a harness and top tether."
D) "Place her in a booster seat with lap and shoulder belts in the back seat."
Ans: D
Feedback:
A child who weighs between 40 and 80 lb should ride in a booster seat that utilizes
both the lap and shoulder belts in the back seat. When a child is large enough to sit
up straight with the knees bent at the front edge of the seat, then he or she may sit
directly on the seat of the car with lap/shoulder belt securely and appropriately
attached. The back seat of the car is the safest place for a child to ride. A
forward-facing car seat with harness and top tether is for a preschooler who weighs
less than 40 lb.
26. The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of what happening?
A) Viewing her baby sister's illness as her fault
B) Harming the baby
C) Experiencing clinical depression
D) Creating an imaginary friend to cope with the situation
Ans: A
Feedback:
Since the preschool child is facing the psychosocial task of initiative versus guilt, it is
natural for the child to experience guilt when something goes wrong. The child may
have a strong belief that if someone is ill or dying, he or she may be at fault and the
illness or death is punishment. It is less likely that the girl would be at risk of harming
the baby or experiencing clinical depression as a result of the baby's illness. The child
may create an imaginary friend to cope with the illness, but would not withdraw or
express sadness as a result of the imaginary friend.
27. When providing anticipatory guidance to parents about their preschool son who was caught in a lie, what would the nurse emphasize?
A) "You need to determine the reason for lying before punishing the child."
B) "Lying should never be tolerated and the child should be punished."
C) "The misbehavior is usually more serious than the lying itself."
D) "It is okay to become angry when dealing with the child's lying."
Ans: A
Feedback:
Lying is common in preschool children and occurs for a variety of reasons, such as
fearing punishment, getting carried away by imagination, or imitating what another
person has done. Regardless, the parent should ascertain the reason for the lying
before punishing the child. The child also needs to learn that the lying is usually far
worse than the misbehavior. Parents need to remain calm and serve as a role model
of an even temper.
28. The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. What is a recommended guideline when dealing with this issue?
A) Be prepared to thoroughly cover a topic before the child asks about it.
B) Before answering questions, find out what the child thinks about the subject.
C) Expand upon the topic when answering questions to prevent further confusion.
D) Provide a less than honest response to shelter the child from knowledge that is too advanced.
Ans: B
Feedback:
Preschoolers are very inquisitive and want to learn about everything around them;
therefore, they are very likely to ask questions about sex and where babies come
from. Before attempting to answer questions, parents should try to find out first what
the child is really asking and what the child already thinks about that subject. Then
they should provide a simple, direct, and honest answer. The child needs only the
information that he or she is requesting.
29. The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. What is an appropriate response to this concern?
A) Tell the child in a firm manner that this behavior is not acceptable.
B) When the child displays this behavior, place him in a "time-out."
C) Treat the action in a matter-of-fact manner emphasizing safety.
D) Consult a psychotherapist to determine the reason for this behavior.
Ans: C
Feedback:
Masturbation is a healthy and natural part of normal preschool development if it
occurs in moderation. If the parent overreacts to this behavior, then it may occur
more frequently. Masturbation should be treated in a matter-of-fact way by the
parent. The child needs to learn certain rules about this activity: nudity and
masturbation are not acceptable in public. The child should also be taught safety: no
other person can touch the private parts unless it is the parent, healthcare provider,
or nurse checking to see when something is wrong.
30. The parents of a 5-year-old are concerned that their son is too short for his age. The nurse measures the child's height at 40 in (101.6 cm). How should the nurse respond?
A) "Some children are short for their age during the preschool years but usually catch up during early childhood."
B) "Are most of the adults in your family short? It may be hereditary that your child will be shorter than average."
C) "The average height for a 5-year-old is 43 in tall (118.5 cm), so your son is within the normal range for height."
D) "I am sure his height is a concern, but if you start choosing nutrient-dense foods, he will likely catch up to normal in height."
Ans: C
Feedback:
The average preschool-age child will grow 2.5 to 3 in (6.5 to 7.8 cm) per year. The average 3-year-old is 37 in tall (96.2 cm), the average 4-year-old is 40.5 in tall
(103.7 cm), and the average 5-year-old is 43 in tall (118.5 cm).
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