Nokea
A boy age 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. What is the most appropriate intervention?
- A. Refer the child for a professional psychosocial assessment.
- B. Explain that this is normal in preschoolers, especially boys.
- C. Encourage the parent to try more consistent and firm discipline.
- D. Talk to the preschool teacher to obtain validation for behavior parent reports.
Correct Answer: A
Rationale: The preschool years are a time when children learn socially acceptable behavior. The difference between normal and problematic behavior is not the behavior but the severity, frequency, and duration. This childs behavior meets the definition requiring professional evaluation. Some aggressive behavior is within normal limits, but at 8 to 10 weeks, this behavior has persisted too long. There is no indication that the parent is using inconsistent discipline. A part of the evaluation is to obtain validation for behavior parent reports.
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In terms of cognitive development, a 5-year-old child should be expected to do which?
- A. Think abstractly.
- B. Use magical thinking.
- C. Understand conservation of matter.
- D. Understand another persons perspective.
Correct Answer: B
Rationale: Magical thinking is believing that thoughts can cause events. An example is thinking of the death of a parent might cause it to happen. Abstract thought does not develop until the school-age years. The concept of conservation is the cognitive task of school-age children, ages 5 to 7 years. A 5-year-old child cannot understand another persons perspective.
In terms of fine motor development, what should the 3-year-old child be expected to do?
- A. Tie shoelaces.
- B. Copy (draw) a circle.
- C. Use scissors or a pencil very well.
- D. Draw a person with seven to nine parts.
Correct Answer: B
Rationale: Three-year-old children are able to accomplish the fine motor skill of copying (drawing) a circle. The ability to tie shoelaces, to use scissors or a pencil very well, and to draw a person with seven to nine parts are fine motor skills of 5-year-old children.
At a seminar for parents with preschool-age children, the nurse has discussed anticipatory tasks during the preschool years. Which statement by a parent should indicate a correct understanding of the teaching?
- A. I should be worried if my 4-year-old child has an increase in sexual curiosity because this is a sign of sexual abuse.
- B. I should expect my 5-year-old to change from a tranquil child to an aggressive child when school starts.
- C. I should be concerned if my 4-year-old child starts telling exaggerated stories and has an imaginary playmate, since these could be signs of stress.
- D. I should expect my 3-year-old child to have a more stable appetite and an increase in food selections.
Correct Answer: D
Rationale: A 3-year-old child exhibits a more stable appetite than during the toddler years and is more willing to try different foods. A 4-year-old child is imaginative and indulges in telling tall tales and may have an imaginary playmate; these are normal findings, not signs of stress. Also a 4-year-old child has an increasing curiosity in sexuality, which is not a sign of child abuse. A 5-year-old child is usually tranquil, not aggressive like a 4-year-old child.
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 nurses 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
Correct Answer: B
Rationale: Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age react to stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.
Parents tell the nurse they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. What is the most appropriate recommendation for the nurse to make?
- A. Punish the children so this behavior stops.
- B. Neither condone nor condemn the curiosity.
- C. Get counseling for this unusual and dangerous behavior.
- D. Allow the children unrestricted permission to satisfy this curiosity.
Correct Answer: B
Rationale: Three-year-old children become aware of anatomic differences and are concerned about how the other sex works. Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. This is age appropriate and not dangerous behavior. Encouraging the children to ask their parents questions and redirecting their activity is more appropriate than giving permission.