Chapter 33: The Preschooler and Family Nursing School Test Banks

Chapter 33: The Preschooler and Family

MULTIPLE CHOICE

1. Which accomplishment would 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

ANS: D

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

PTS: 1 DIF: Cognitive Level: Comprehension REF: 953

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. In terms of fine motor development, what could the 3-year-old child be 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.

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 958

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. In terms of cognitive development, the 5-year-old child would be expected to:

a.

Use magical thinking.

b.

Think abstractly.

c.

Understand conservation of matter.

d.

Be able to comprehend another persons perspective.

ANS: A

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

PTS: 1 DIF: Cognitive Level: Comprehension REF: 953

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. What is descriptive of the preschoolers 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

ANS: B

In a preschoolers understanding, time has a relation with events such as, Well 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 953

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. 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 PM. When Ryan asks the nurse when his parents are coming, the nurses 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.

ANS: B

A 4-year-old understands time in relation to events such as meals. Children perceive soon as a very short time. The nurse may lose the childs 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. This answer assumes that the child understands the concept of hours and minutes, which is not developed until age 5 or 6 years.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 953

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

6. A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was bad. The nurses best interpretation of this comment is that it is:

a.

A sign of stress.

b.

Common at this age.

c.

Suggestive of maladaptation.

d.

Suggestive of excessive discipline at home.

ANS: B

Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 954

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

7. In terms of language and cognitive development, a 4-year-old child would be expected to:

a.

Think in abstract terms.

b.

Follow simple commands.

c.

Understand conservation of matter.

d.

Comprehend another persons perspective.

ANS: B

Children ages 3 to 4 years can give and follow simple commands. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. A 4-year-old child cannot comprehend anothers perspective.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 955

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. Which type of play is most typical of the preschool period?

a.

Solitary

c.

Associative

b.

Parallel

d.

Team

ANS: C

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 956

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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.

ANS: C

One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interactions 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 has already been accomplished.

PTS: 1 DIF: Cognitive Level: Analysis REF: 957

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

10. Which characteristic best describes the language of a 3-year-old child?

a.

Asks meanings of words

b.

Follows directional commands

c.

Can describe an object according to its composition

d.

Talks incessantly, regardless of whether anyone is listening

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 958

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

11. By what age would the nurse expect that most children could understand prepositional phrases such as under, on top of, beside, and in back of?

a.

18 months

c.

3 years

b.

24 months

d.

4 years

ANS: D

At 4 years, children can understand directional phrases. Children 18 to 24 months and 3 years of age are too young.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 955

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

12. A useful skill that the nurse should expect a 5-year-old child to be able to master is to:

a.

Tie shoelaces.

c.

Hammer a nail.

b.

Use a knife to cut meat.

d.

Make change from a quarter.

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 of a 7-year-old. Hammering a nail and making change from a quarter are fine motor tasks of an 8- to 9-year-old.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 959

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

13. The nurse is guiding parents in selecting a day care facility for their child. When making the selection, it is especially important to consider:

a.

Structured learning environment.

b.

Socioeconomic status of children.

c.

Cultural similarities of children.

d.

Teachers knowledgeable about development.

ANS: D

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; cultural similarities are not necessary.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 957

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

14. 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. The nurses best suggestion for coping with this problem is to:

a.

Insist that the child sleep with his parents until the fearful phase passes.

b.

Suggest involving the child to find 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 the boogeyman do not exist.

ANS: B

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

PTS: 1 DIF: Cognitive Level: Comprehension REF: 961

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

15. 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 they understand that there is no need to be afraid

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 961

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

16. A normal characteristic of the language development of a preschool-age child is:

a.

Lisp.

c.

Echolalia.

b.

Stammering.

d.

Repetition without meaning.

ANS: B

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

PTS: 1 DIF: Cognitive Level: Comprehension REF: 962

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

17. During the preschool period, the emphasis of injury prevention should be placed on:

a.

Constant vigilance and protection.

b.

Punishment for unsafe behaviors.

c.

Education for safety and potential hazards.

d.

Limitation of physical activities.

ANS: C

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 since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 964

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

18. Acyclovir (Zovirax) is given to children with chickenpox to:

a.

Minimize scarring.

c.

Prevent aplastic anemia.

b.

Decrease the number of lesions.

d.

Prevent spread of the disease.

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 disease.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 973

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

19. Which medication may be given to high risk children after exposure to chickenpox to prevent varicella?

a.

Acyclovir

b.

Vitamin A

c.

Diphenhydramine hydrochloride

d.

Varicella zoster immune globulin (VZIG)

ANS: D

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 morbidity and mortality associated with the measles. The antihistamine diphenhydramine is administered to reduce the itching associated with chickenpox.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 973

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

20. Vitamin A supplementation may be recommended for the young child who has:

a.

Mumps.

c.

Measles (rubeola).

b.

Rubella.

d.

Erythema infectiosum.

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 973

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

21. When is a child with chickenpox considered to be no longer contagious?

a.

When fever is absent

c.

24 hours after lesions erupt

b.

When lesions are crusted

d.

8 days after onset of illness

ANS: B

When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. The child is still contagious once the fever has subsided and after the lesions erupt, and may or may not be contagious any time after 6 days as long as all lesions are crusted over.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 965

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

22. The nurse is performing an assessment on a child and notes the presence of Kopliks spots. In which communicable disease are Kopliks spots present?

a.

Rubella

c.

Chickenpox (varicella)

b.

Measles (rubeola)

d.

Exanthema subitum (roseola)

ANS: B

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

PTS: 1 DIF: Cognitive Level: Application REF: 967

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

23. Which statement best describes a child who is abused by the parent(s)?

a.

Unintentionally contributes to the abusing situation

b.

Belongs to a low socioeconomic population

c.

Is healthier than the nonabused siblings

d.

Abuses siblings in the same way as child is abused by the parent(s)

ANS: A

A childs temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contributes to the abusing situation. Socioeconomic status is an environmentalcharacteristic. This 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 980

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

24. A common characteristic of those who sexually abuse children is that they:

a.

Pressure the victim into secrecy.

b.

Are usually unemployed and unmarried.

c.

Are unknown to victims and victims families.

d.

Have many victims that are each abused only once.

ANS: A

Sex offenders may pressure the victim into secrecy, regarding the activity as a secret between us that other people may take away 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 part of the offer.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 980

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

25. Which statement, made by a 4-year-old childs father, is true about the care of the preschoolers teeth?

a.

Because the baby teeth are not permanent, they are not important to the child.

b.

My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth.

c.

My sons permanent teeth will begin to come in at 4 to 5 years of age.

d.

Fluoride supplements can be discontinued when my sons permanent teeth erupt.

ANS: B

Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. Secondary teeth erupt at about 6 years of age. If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

PTS: 1 DIF: Cognitive Level: Application REF: 964

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

26. In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor in preparing a child for kindergarten entry?

a.

The childs ability to sit still

b.

The childs sense of learned helplessness

c.

The parents interactions and responsiveness to the child

d.

Attending a preschool program

ANS: C

Interactions between the parent and child are an important factor in the development of academic competence. Parental encouragement and support maximize a childs potential. The childs ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. Learned helplessness is the result of a child feeling that he or she has no effect on the environment and that his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning. Preschool and day care programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 957

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

27. 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 dont want anyone taking them out. Which is the nurses 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.

ANS: C

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.

PTS: 1 DIF: Cognitive Level: Application REF: 961

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

28. 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.

ANS: B

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.

PTS: 1 DIF: Cognitive Level: Application REF: 961

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

29. Which common childhood communicable disease may cause severe defects in the fetus when it occurs in its congenital form?

a.

Erythema infectiosum

c.

Rubeola

b.

Roseola

d.

Rubella

ANS: D

Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not dangerous to the fetus.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 970

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

30. Which is the causative agent of scarlet fever?

a.

Enteroviruses

b.

Corynebacterium organisms

c.

Scarlet fever virus

d.

Group A b-hemolytic streptococci (GABHS)

ANS: D

GABHS infection causes scarlet fever. Enteroviruses do not cause the same complications. Corynebacterium organisms cause diphtheria. Scarlet fever is not caused by a virus.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 971

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

31. Which is probably the most important criterion on which to base the decision to report suspected child abuse?

a.

Inappropriate parental concern for the degree of injury

b.

Absence of parents for questioning about childs injuries

c.

Inappropriate response of child

d.

Incompatibility between the history and injury observed

ANS: D

Conflicting stories about the accident are the most indicative red flags of abuse. Inappropriate response of caregiver or child may be present, but is subjective. Parents should be questioned at some point during the investigation.

PTS: 1 DIF: Cognitive Level: Application REF: 977

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

32. Which play patterns does a 3-year-old child typically display (select all that apply)?

a.

Imaginary play

b.

Parallel play

c.

Cooperative play

d.

Structured play

e.

Associative play

ANS: A, B, C, E

Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years. Structured play is typical of school-age children.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 956-957

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

33. Strict isolation is required for a child who is hospitalized with (select all that apply):

a.

Mumps.

b.

Chickenpox.

c.

Exanthema subitum (roseola).

d.

Erythema infectiosum (fifth disease).

e.

Parvovirus B19.

ANS: A, B, C, D

Childhood communicable diseases requiring strict transmission-based precautions (Contact, Airborne, and Droplet Precautions) include diphtheria, chickenpox, measles, mumps, tuberculosis, adenovirus, Haemophilus influenzae type B, mumps, pertussis, plague, streptococcal pharyngitis, and scarlet fever. Strict isolation is not required for parvovirus B19.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 968

OBJ: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

34. 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.

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.

PTS: 1 DIF: Cognitive Level: Application REF: 955

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

35. 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 and dollhouses, housekeeping toys, play-store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, and 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.

PTS: 1 DIF: Cognitive Level: Application REF: 956

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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