A child age 4 1/2 years sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened, yet she is not aware of her parents presence when they check on her. She lies down and sleeps without any parental intervention. This is most likely what?
- A. Nightmare
- B. Sleep terror
- C. Sleep apnea
- D. Seizure activity
Correct Answer: B
Rationale: This is a description of a sleep terror. The child is observed during the episode and not disturbed unless there is a possibility of injury. A child who awakes from a nightmare is distressed. She is aware of and reassured by the parents presence. This is not the case with sleep apnea. This behavior is not indicative of seizure activity.
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The nurse is talking to the parent of a 5-year-old child who refuses to go to sleep at night. What intervention should the nurse suggest in helping the parent to cope with this sleep disturbance?
- A. Establish a consistent punishment if the child does not go to bed when told.
- B. Allow the child to fall asleep in a different room and then gently move the child to his or her bed.
- C. Establish limited rituals that signal readiness for bedtime.
- D. Allow the child to watch television until almost asleep.
Correct Answer: C
Rationale: An appropriate intervention for a child who resists going to bed is to establish limited rituals such as a bath or story that signal readiness for bed and consistently follow through with the ritual. Punishing the child will not alleviate the resistance problem and may only add to the frustration. Allowing the child to fall asleep in a different room and to watch television to fall asleep are not recommended approaches to sleep resistance.
The nurse has just given a subcutaneous injection to a preschool child, and the child asks for a Band-Aid over the site. Which action should the nurse implement?
- A. Place a Band-Aid over the site.
- B. Massage the injection site with an alcohol swab.
- C. Show the child there is no bleeding from the site.
- D. Explain that a Band-Aid is not needed after a subcutaneous injection.
Correct Answer: A
Rationale: Despite the advances in body image development, preschoolers have poorly defined body boundaries and little knowledge of their internal anatomy. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin (e.g., injections and surgery). They fear that all their blood and insides can leak out if the skin is broken. Therefore, preschoolers may believe it is critical to use bandages after an injury. The nurse should place a Band-Aid over the site.
Which type of play is most typical of the preschool period?
- A. Team
- B. Parallel
- C. Solitary
- D. Associative
Correct Answer: D
Rationale: Associative play is group play in similar or identical activities but without rigid organization or rules. School-age children play in teams. Parallel play is that of toddlers. Solitary play is that of infants.
During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. The boys birthday is close to the cut-off date, and he has not attended preschool. What is the nurses best recommendation?
- A. Start kindergarten.
- B. Talk to other parents about readiness.
- C. Perform a developmental screening.
- D. Postpone kindergarten and go to preschool.
Correct Answer: C
Rationale: A developmental assessment with a screening tool that addresses cognitive, social, and physical milestones can help identify children who may need further assessment. A readiness assessment involves an evaluation of skill acquisition. Stating the child should start kindergarten or go to preschool and postpone kindergarten does not address the fathers concerns about readiness for school. Talking to other parents about readiness does not ascertain if the child is ready and does not address the fathers concerns.
The nurse is planning to bring a preschool child a toy from the playroom. What toy is appropriate for this age group?
- A. Building blocks
- B. A 500-piece puzzle
- C. Paint by number picture
- D. Farm animals and equipment
Correct Answer: D
Rationale: The most characteristic and pervasive preschooler activity is imitative, imaginative, and dramatic play. Farm animals and equipment would provide hours of self-expression. Building blocks are appropriate for older infants and toddlers. A 500-piece puzzle or a paint by number picture would be appropriate for a school-age child.
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