Peds Preschool

2 Four-year-old children can put on a shirt and can fasten it if the buttons are large. Four-year-olds will be able to comb, but not part, their hair. Four-year-olds can handle a fork and spoon, but cannot hold the meat with the fork while cutting it with the knife; children are usually 7 years old before this task is managed. Four-year-olds old can put on shoes, but are usually unable to tie them until age 5.

234 Attention, insecurity, and activity level are sources of stress in four-year-old children. School and separation anxiety are sources of stress in five-year-old children.

1 Learning the sociocultural mores of the family implies that the child is developing a conscience. This does not imply that the child is learning gender roles, developing a sense of security, or learning about the political process.

123 Activities that the nurse notes as potentially harmful include the client swimming unsupervised in the pool, medications that are left within reach of the client, and a parent telling the child that a vitamin is candy. Each of these findings increases the child's risk for bodily harm necessitating the need for intervention. Two hours of television is appropriate for a preschool-age client. A parent question asking the client if he or she has ever been touched inappropriately at school is also appropriate and does not place the child at risk for bodily harm.

2 Identification with a same-sex parent indicates the end of the Oedipus or Electra complex during the preschool stage of development. Identification with siblings, opposite-sex peers, or an opposite-sex parent is not indicative of the end of these complexes.

4 Repetition of brave statements is a treatment option that the nurse should share with the parents of a preschool-age client who experiences severe fear of the dark. Prescription medication, electroconvulsive therapy, and intensive therapy sessions are not appropriate treatment options for the nurse to share with this client's parents.

4 Riding a tricycle is a gross motor skill exhibited by 3-year-olds. Repeatedly catching a ball, skipping, and hopping on one foot are gross motor skills exhibited by 4-year-olds. Walking backward with heel to toe is a gross motor skill exhibited by 5-year-olds.

1 The initiative versus guilt stage is seen in children between ages three to six years. During this stage, the nurse should teach parents about child impulse control and cooperative behaviors for better growth and development of the child. During the identity versus role of confusion stage, the nurse should provide enough information to the adolescents, which allow them to choose the treatment plan. The nurse guides the parents to help their child achieve self-control and willpower during the stage of autonomy versus shame and doubt. The nurse assists ill adults in choosing creative ways to foster their social development during the generativity versus self-absorption and stagnation stage.

3 The average height of a four-year-old child is 3 feet, 4.5 inches (103 cm). The average height of a two-year-old child is 2 feet, 10 inches (86.6 cm). The average height of a three-year-old child is 3 feet, 1.5 inches (95 cm). The average height of a five-year-old child is 3 feet, 7.5 inches (110 cm).

12 Preschoolers need an average of 12 hours of sleep a night for proper development of mental and physical health.

124 The children who would benefit from an IEP include a child with an IQ of 60 who is intellectually disabled, a child with a hearing deficit who will require modification for success, and a child diagnosed with ASD who will have specialized educational needs. The child with a casted arm due to fracture does not have a chronic problem and does not require an IEP. The child diagnosed with DM may require an individual health plan but not an IEP.

1 According to Erikson's theory, a preschooler develops superego or conscience during the initiative versus guilt stage. During the autonomy versus shame and doubt stage, the toddler engages in parallel play and starts to play beside other children. A school-age child learns to work and play with his or her peers during the industry versus inferiority stage. During the identity versus role confusion stage, an adolescent can have a marked preoccupation with appearance and body image.

1 Ice chips are soothing and promote vasoconstriction. Milk and milk products coat the mouth, causing the child to clear the throat, which may precipitate bleeding. The supine position promotes edema and does not allow oral secretions to drain from the mouth. The head of the bed should be elevated, and the child should be positioned on the side. Mouthwash solution is too caustic; a warm saltwater solution is preferred.

2 Blindness indicates that the client is suffering from encephalopathy as a result of high-dose exposure to lead. Hyperactivity, hearing impairment, and mild intellectual deficit are indications of low-dose exposure to lead.

3 A 4-year-old can lace shoes, but may not be able to tie the bow. A 5-year-old uses scissors well. A 3-year-old can build a tower of 9 to 10 cubes. This child cannot draw a stick figure but may make a circle with facial features.

35 Anorexia occurs as a result of catabolism. Platelet count is decreased because of bone marrow depression, resulting in bleeding tendencies; petechiae and ecchymoses result. Edema is not expected with ALL. Alopecia is not related to the disease process; it occurs as a result of chemotherapy. The red blood cell count is decreased because of bone marrow depression; the child will be lethargic and sleep excessively.

4 Fears are a source of stress in children of both age groups. The fears for a 3-year-old may be precipitated by imagination. This child may also fear dogs or other animals. A 4-year-old picks up fears from adults. This child may fear a dark room or anything perceived as "creepy." Insecurity is a source for stress in 4-year-olds. A child in this age group may develop nervous habits, such as nail biting, facial tics, thumb-sucking, and so on. This is not seen in 3-year-olds. Questions and nap or bedtime are sources of stress in 3-year-olds. A 3-year-old continually asks "Why?" and is upset if trusted adults do not respond or do not know the answer. This child may also fear bad dreams, the dark, or missing out on some fun while asleep. These are not sources of stress in 4-year-olds.

4 Cold and exercise can precipitate bronchospasm, and increased exercise depletes oxygen. Treatment of asthma does not involve a low-fat diet. Asthma is a chronic condition. A return to usual activities after the acute stage is essential for growth and development. Although increased protein and calories may be needed to support the child during a coexisting bacterial infection in the acute stage, a return to usual eating habits is indicated by the time of discharge.

1 Children with leukemia most often die of infection; a low neutrophil count is associated with myelosuppressant therapy. Placing the child in a private room, restricting ill visitors, and using strict hand washing techniques are the best ways to minimize complications. Encouraging a well-balanced diet, including iron-rich foods, and helping the child avoid overexertion are not appropriate measures to prevent infection resulting from neutropenia; they are appropriate for treating the anemia. Avoiding rectal temperatures, limiting injections, and applying direct pressure for 5 minutes after venipuncture are not appropriate measures to prevent infection resulting from neutropenia; they are more appropriate for preventing bleeding. Offering a moist, bland, soft diet; using toothettes rather than a toothbrush; and providing frequent saline mouthwashes are not appropriate measures to prevent infection resulting from neutropenia; they are used to ease and treat stomatitis.

1 Although the local anesthetic will help minimize the discomfort, the needle insertion may still hurt. Telling the child that the insertion will hurt but not for very long is an honest, simple answer that is appropriate for a 3-year-old child. Telling the child that big kids don't cry is a judgmental response that is inappropriate for a 3-year-old child; children sometimes need to cry to express their feelings. Although the child should hold still, there is no guarantee that doing this will cause the insertion to hurt less. Saying, "Maybe it will hurt" or "It may hurt" constitutes false reassurance. Saying that the insertion will hurt just a little because the nurse is skilled is also false reassurance; there is no guarantee of success, despite the nurse's self-proclaimed expertise.

3 The last geometric figures that the preschool-age client masters include the triangle and the diamond. The circle is often mastered by the age of 3 while the square and rectangle are mastered by the age of 5.

1 At the beginning of an asthma episode, wheezing may be heard only with a stethoscope. As the severity of the episode increases, wheezing may become audible to the unaided ear. Children in severe respiratory distress may not demonstrate wheezing because of decreased air movement; diminished breath sounds in a child may signal an inability to move air, so this finding requires action. The normal pulse range for a 4-year-old is 80 to 125 beats/min; a pulse of 110 beats/min does not require action. The normal respiratory range for a 4-year-old is 20 to 30 breaths/min, so a respiratory rate of 24 breaths/min does not require action. A pulse oximetry reading of 95% is acceptable. Once the child has been hospitalized with an acute asthma attack, oxygen saturation should be kept at 95% or higher.

4 Comparison of daily weights is the most accurate way to assess fluid retention or loss. Having the child urinate in a bedpan is difficult for a child of this age, and the findings will not be accurate. Measuring the abdominal girth daily is way to assess the degree of ascites; it indirectly measures fluid retention. Assessment of urine for protein gives information about the disease process, but not about the amount of fluid retention.

3 The weight of an average 5-year-old preschooler is 41 pounds (18.59 kg). The average weight at 3 years of age is 32 pounds (14.51 kg). At the age of 4 years, the average weight is 37 pounds (16.78 kg). Forty-five pounds (20.41 kg) is not the average weight of a 5-year old.

1 Using scissors to cut out pictures is a fine motor skill that can be seen in 4-year-old children, not in a 3-year-old child. A 3-year-old child can draw a circle with facial features, build a tower using 9 to 10 cubes, and place small pellets in a narrow-necked bottle.

14 Environment and cognitive ability influence vocabulary, speech, and comprehension in preschoolers. Health status and physical development influence a child's school readiness. Temperament influences a child's social development and interactions.

2 Three-year-olds are entering the developmental stage of creative and imaginative play; using clay to make shapes, both with and without molds, enhances their creativity and improves their fine motor coordination. A plastic animal will probably be a boring toy for a 3-year-old child; a plastic animal is more appropriate for a 6- to 12-month-old child. A 3-year-old is too young to manipulate a pen or a pencil and may cause a self-injury or an injury to others. Pens and pencils should not be left in a playroom. A 3-year-old does not have the cognitive ability or the fine motor coordination to play even simple video games.

2 Certain hydrocarbons, like lighter fluid, can cause severe pneumonia on ingestion. Bleach, toilet cleaner, and mildew remover are corrosives that are not associated with chemical pneumonia.

4 It is common for 4-year-old children to boast and exaggerate and to be impatient, noisy, and selfish. More advanced, cooperative play is expected of 4-year-old children. Extreme dependence on parents is unusual in 4-year-old children because they are striving for more initiative and less dependence. The toddler's tendency toward tantrums and negativism should have waned by 4 years of age.

345 Five-year-old children may begin to swim and skate. They are interested in trying new foods and can easily draw triangles and diamonds. Toddlers may get involved in parallel play. Four-year-old children have finicky eating habits.

3 Imaginary friends are typical of children of this age. Avoiding injury to the child's imaginary friend will result in less stress for the child. There is no evidence that the parents are having difficulty with child rearing. Disciplining the child is inappropriate. The child was protecting an imaginary friend, and having imaginary friends is typical of a 4-year-old child. Referral to a specialist is unnecessary; this is typical behavior for a 4-year-old child.

1 The child from 1 to 4 years of age is learning to use the body and manipulate and experiment with all aspects of the environment; these abilities may challenge the nursing assistant, especially during the taking of vital signs. The school-age child is able to cooperate and understand when receiving care; however, modesty should be respected. From 6 to 12 months of age, it is usually helpful to have the infant held on the parent's lap during care or to allow the parent to provide basic care (e.g., changing diapers, bathing) to limit stranger anxiety. Infants are usually not a challenge to care for. The infant is usually easily distracted with sounds and smiles.

2 Raising the foot of the bed increases blood flow to the brain, thereby increasing intracranial pressure. An increase in temperature may occur after a craniotomy as a result of stimulation of the hypothalamus. A hypothermic blanket should be ready if the temperature climbs precipitously. Monitoring of vital signs is a critical component of postoperative care. IV infusions must be regulated precisely to minimize the possibility of cerebral edema.

3 A 4-year-old child is in the phase of intuitive thought. A 3-year-old child is egocentric in thought and behavior. A 5-year-old child begins to question what parents think by comparing them with age-mates and other adults. A 3-year-old has beginning ability to view concepts from another perspective.

1 Myringotomy is surgical incision of the eardrum to permit drainage of infected middle ear fluid and thus improve hearing. Removal of the adenoids will not relieve the pressure from inflamed ears. Antibiotics are administered systemically, not locally, if needed. Systemic antibiotics, not steroids, are prescribed; a myringotomy is performed if antibiotics are ineffective.

3 Preschoolers (ages 3 to 5 years) are in the preoperational stage of cognitive development; it consists of a preconceptual phase that involves egocentric thought and the phase of intuitive thought, which transitions to the more logical thought of school-age children. Four-year-old children often believe that they cause their own illnesses. Emphasizing that the child did not cause the illness will help elicit and eliminate any fantasy he might have; it helps the child understand that treatment is not a punishment. Telling a 4-year-old to have a positive attitude is inappropriate and does not elicit feelings. Although parental concern is important, it does not address the developmental concerns of a 4-year-old child. Environmental factors are not currently supported as a cause of ALL; it is an inappropriate discussion for a 4-year-old child.

14 Parents should be taught to limit allergens in the home that can precipitate asthma attacks (e.g., no carpets, no down pillows, no scented products; wet-mopping floors, vacuuming when the child is not in the home). Medications to control inflammation, including inhaled corticosteroids and long-acting β2-agonists, must be continued to suppress exacerbations of asthma. Environmental moisture is necessary for these children; in addition, cold environments should be avoided. Consistent limits should be placed on the child's behavior, regardless of the illness; a chronic illness does not eliminate the need for limit setting. The child should return to school and continue to interact with schoolmates and friends.

3 Between the ages of 3 and 5 years death is viewed as a departure or sleep and as reversible. The universality and irreversibility of death are concepts held by children starting at 8 to 9 years of age. The early school-age child of 6 or 7 years personifies death, possibly envisioning it as a ghost, and sees it as horrible and frightening; this is consistent with the concrete thinking present at this age.

1 The parent need not restrict the preschooler from trying to swim. The parent may teach the child to swim, but it should be done under supervision. A parent should restrict the child from walking alone in parking lots and running after a ball or toy because pedestrian accidents involving young children are common. The parent should not allow the child to play with a used refrigerator. If a child cannot exit from a used refrigerator, asphyxiation can occur.

3 A few minutes will be enough time for the child to begin self-feeding. The nurse should provide both physical and emotional support because the child's request for help indicates regression and the need for dependence during a period of stress. Telling the child to eat as much as he or she can does not provide the child with the help that may be needed. It may be a while until the child feels better; in the meantime, adequate nourishment to foster healing is needed. Telling the child that he or she is not that sick and can feed himself or herself could cause stress, feelings of guilt, and embarrassment.

2 Tonsillectomy may result in hemorrhage because of the vascularity of the oropharynx; clotting function must be adequate. The potassium level, RBC count, and ESR are not significant in this type of surgery if the child is otherwise healthy.

1 Preschooler children find phonetically similar words such as "die" and "dye" confusing. School-aged children realize that words have arbitrary rather than absolute meanings. School-aged children become aware of the rules for linking words into phrases and sentences; they also accept language as a means of representing the world in a subjective manner.

45 By the third year of life, the child's body becomes slimmer, taller, and better balanced. In addition, abdominal protrusion decreases. A newborn infant's spine is flexed and lacks the anteroposterior curves of the adult. Feet eversion decreases at the preschooler age. Adolescence usually begins with a tremendous growth spurt.

3 Ingestions of 20 to 60 mg/kg of iron are considered mildly to moderately toxic. So, ingestion of 35 mg/kg of iron is in the range of mildly to moderately toxic. Ingestion of either 8 mg/kg or 15 mg/kg is too little to be considered toxic. Ingestion of amounts greater than 60 mg/kg (here, 65 mg/kg) is severely toxic and may be fatal.

3 Regression frequently occurs during and after hospitalization. Guilt about regression should be avoided, but this behavior should not be encouraged. Although punishment is a form of attention, it will not help the child overcome the problem that is causing the behavior. Nephrotic syndrome is not associated with neurogenic control of the bladder. Using diapers and saying nothing are both incorrect options because they will shame the child.

23 The most critical ages for speech development for the preschool-age client are 3 and 4 years of age. While critical speech development occurs at the age of 2, this is the toddler, not preschool, stage of development. The ages of 5 and 6 years are not considered critical ages for speech development for the preschool-age client.

1 Attention is a particular source of stress in 4-year-olds. A child in this age group likes to talk and is frustrated if ignored or put off. Confusion, stranger anxiety, and separation anxiety are sources of stress in 3-year-olds.

4 The average daily intake of calories required in preschoolers is 1800 calories. Four hundred, 700, and 1,000 would be too low.

1 Hospitalization is traumatic to the preschooler because of separation from significant family members. When parents are unable to visit, the nurse should make arrangements with the parents for daily contact. Preschoolers are not interested in food; children with nephrotic syndrome often have decreased appetites. Preschoolers are not concerned about attitudes of peers; it is too early in their social development to have this concern. Massive edema results in easy fatigability and a lack of interest in play.

1 By 5 years of age, children compare their size with that of their peers and can become conscious of being large or short, especially if others refer to them as "so big" or "so little" for their age. Despite the advances in body image development, preschoolers have poorly defined body boundaries and little knowledge of their internal anatomy. They recognize differences in skin color and racial identity and are vulnerable to learning prejudices and biases. They are aware of the meaning of words such as "pretty" or "ugly," and they reflect the opinions of others regarding their own appearance.

145 Education, prior experiences, and adequate finances are all resources that enable families to develop and adapt to stressors. While effective communication and problem-solving enables families to develop and adapt to stressors, these are not considered resources.

3 According to the principles of growth and the development of skills, feeding is taught first, and this is no different for a child who is developmentally disabled. Dressing, toileting, and hair combing are more difficult skills than self-feeding.

2 If a child has nightmares, the parent should avoid sleeping with the child. Sleeping with the child may create a habit of delaying bedtime. In case of nightmares, keeping the lights on may help the child to overcome fear. Tucking in a soft toy gives the feeling of security to the child. The parent should comfort the child and leave the child in his or her own bed so that the child does not use the fear as an excuse to delay bedtime.

4 Imaginary playmates experience what preschoolers want to remember or forget. Imaginary playmates do not make preschoolers feel inferior. They accomplish what a child attempts to achieve and help preschoolers to distinguish between reality and fantasy.

4 In order to perform a postural drainage in a 4-year-old child, the nurse should place the child sitting on the nurse's lap, leaning forward against a pillow. In order to perform a postural drainage of the apical segments of adults, the client should sit on the side of the bed. In order to perform a right upper lobe drainage in an adult, the client should be the supine position with the head elevated. In order to perform a drainage of both lower lobes in an adult, the client should lie supine in Trendelenburg position.

3 Therapeutic play is an excellent medium for preparing a child in this age group for surgery. Although a simple explanation is understood, preschoolers need to act out their feelings. Waiting so long does not give the child an opportunity to act out or express feelings. Showing pictures of the surgery is too graphic for a preschooler; it is more appropriate for the school-age child.

2 Fear of mutilation is typical of the preschooler because they have vague views of body boundaries. Toddlers are more likely to fear separation from parents. Preschoolers do not view death as final. Although preschoolers do indulge in magical thinking, they have not yet developed the concept of supernatural beliefs.

2 The nurse should not ask the parent to restrain the child. The parent should act as a comforter. Before giving an injection, the nurse should awaken the child. Distracting the child with conversation, bubbles, or a toy reduces pain perception. The nurse should apply lidocaine ointment over the injection site before giving the injection to reduce pain.

3 Role play encourages expression of concerns through behavior because children's ability to verbalize feelings is limited. The preschooler is too young to think about careers. Teaching children about stereotypes may be a benefit of role play but is not the purpose of this type of play. Although preschoolers try to imitate adults, providing guidelines for adult behavior is premature.

4 Imaginary friends and imaginary play are normal for children at the preschool developmental level. Their thinking is influenced by role fantasy. Children believe that their wishes are real and that dreams come to life. They believe that inanimate objects have feelings and thoughts. It is important for the mother to know that this form of thinking is normal for a child of this age and that there is no need for a psychiatrist, medication, or a developmental assessment.

The maximum recommended intramuscular dose in preschoolers is 1 mL.

3 Preschoolers should be taught to swim, but under supervision. Learning to swim is a useful skill that can someday save a child's life. The mother of a toddler should be instructed to place window guards on all windows and never leave a child alone in the bathroom, tub, or near any water source. Adolescents should be taught about the effects of using alcohol and drugs and referred to community and school-sponsored activities. The mother of a school-age child should be taught about the safe use of equipment for play and work and proper bicycle safety.

1 Gifted children need discipline like any other child to feel loved and safe. Punishment is appropriate for behavior that is unsafe or falls outside set boundaries. Discipline appropriately applied does not lead to physical aggression. Free expression does not mean overstepping the boundaries of appropriate behavior.

3 Preschoolers experience loss of control caused by physical restriction, loss of routines, and enforced dependency, which may make them feel out of control. Preschoolers are also likely to experience feelings of regression or overdependency and fear of bodily mutilation. Anger, resentment over depersonalization, and loss of peer support are typical feelings expressed in adolescence. Boredom, depression over separation from family, and fear of death are typical feelings expressed by school-age children. Intense panic, loss of security over separation from parents, and low frustration tolerance are feelings usually experienced by toddlers.

2 The maximum recommended intramuscular dose in preschoolers should not exceed 1 mL.

3 Drooling is often associated with the ingestion of a corrosive agent, such as bleach. Choking, gagging, and vomiting are clinical manifestations associated with the ingestion of hydrocarbons, not corrosive agents.

3 Scratching can break the integrity of the skin, leaving it vulnerable to infection. Dermatitis is a response to an allergen; it is not contagious. Scratching will not cause the dermatitis to spread. There are no data to indicate that scratching or dermatitis is a precursor to skin cancer.

1 Both 3-year-old and 4-year-old children have fear. Children of 3 years of age may engage in parallel as well as associative play, whereas 4-year-old children get engaged only in associative play. Children of 4 years of age tell family tales to others without limit, 3-year-old children do not. Children of 5 years of age are eager to do things that please others, not 3-year-old or 4-year-old children.

3 Wilms tumor is a nephroblastoma that is first observed as a firm, painless intraabdominal mass located on one side of the abdomen. Periorbital edema is a sign of glomerulonephritis, not Wilms tumor. Projectile vomiting is indicative of central nervous system problems or a gastrointestinal obstruction, not Wilms tumor. A low-grade fever is a nonspecific sign of many illnesses, not necessarily Wilms tumor.

1 A preschooler learns to copy crosses and squares. Also, they run well and walk up and down steps with ease. They begin to learn to jump and hop rather jumping and hopping with ease.

4 The nurse should stress to the parents that sleep terrors are a normal, common phenomenon in preschoolers that requires relatively little intervention. The nurse may advise the parents to guide the child back to bed, if needed, after an episode of sleep terrors. In case the child has a nightmare, the parents should avoid forcing the child back to bed. Professional counselling might be needed for recurrent episodes of nightmares; sleep terrors, on the other hand, are natural in preschoolers. For episodes of nightmares, the nurse would advise the parents to sit with the child and offer comfort, assurance, and sense of protection. For episodes of sleep terrors, the parents should be instructed to intervene only if necessary to protect the child from injury.

4 Current practice encourages parents to stay with the child as long as possible; this helps reduce stress related to a frightening experience. Removing undergarments is usually not necessary for a myringotomy procedure. Toys, especially a favorite one, should accompany the child until sedation is induced. The child is too young to climb onto a stretcher.

2 The average weight of a three-year-old child is 32 lb (14.5 kg). The average weight of a two-year-old child is 26.5 lb (12 kg). The average weight of a five-year-old child is 41 lb (18.5 kg). The average weight of a four-year-old child is 36.5 lb (16.5 kg).

1 Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips. A fever is not expected unless the child has an infection or is dehydrated; the data do not indicate this. The child's respiratory rate will be increased, not decreased. The child's problems are related to decreased oxygenation, not to a clotting deficiency.

4 Because the child now has one kidney, the parents must watch carefully for signs and symptoms of urinary tract infection (UTI) on an ongoing basis. A UTI can compromise kidney function; therefore it should be identified in the early stage and treated immediately. A kidney transplant is not necessary because the child has a functioning kidney. Sodium is usually not restricted. Fluids are not restricted; adequate fluid intake is encouraged to prevent UTI.

1 Imaginary friends typically appear by 3 years of age and can last throughout the preschool stage of development. If an imaginary friend has not appeared by this age, it is unlikely to expect this to surface at 4, 5, or 6 years of age.

4 Cranial radiation destroys leukemic cells in the brain; it is necessary because chemotherapeutic agents are inadequately absorbed across the blood-brain barrier. Cranial radiation does not prevent infection. Radiation therapy is not related to chemotherapy; it has a different purpose. Cranial radiation does not prevent metastasis to the lymphatic system; leukemia affects the bone marrow and lymphatic system.

4 According to the Glasgow Coma Scale, a confused verbal response indicates a score of 4. When the child gives no response, the score is a 1. If the child makes incomprehensible sounds, then the score is a 2. When the child speaks inappropriate words, then the score is a 3.

4 Admission to school is the most significant lifestyle change the nurse should prepare the preschool-age client and family for during this stage of development. Day care may continue during this stage of development. Team sports do not often begin until the school-age stage of development. Toilet training is a significant lifestyle change for a toddler, not a preschool-age, client.

1 Reye syndrome is associated with viral infections, such as influenza or varicella, and commonly follows the ingestion of aspirin during the prodromal stage of these diseases. The child's metabolism is increased during illness; the child should have a high caloric intake. Cold-water sponge baths should not be used; the temperature may decrease too quickly and be too shocking for the child. There is no vaccine to prevent Reye syndrome.

3 Preschoolers should be taught how to cross roads and walk in parking lots. Parents of toddlers should be instructed to place window guards on all windows and to never leave a child alone in the bathroom, tub, or near any water source. Adolescents should be taught about the effects of using alcohol and drugs and referred to community and school-sponsored activities. School-aged child should be taught about the safe use of equipment for play and work as well as proper bicycle safety.

3 The nurse will notice that the 4-year-old child is curious about his or her surroundings and wants to make new friends. School-aged children begin to define their self-concept and develop self-esteem, an overall self-evaluation. School-aged children have the ability to think in a logical manner about the here and now and to understand the relationship between things and ideas. At around the age of 12 years old, children start concentrating on more than one aspect of a situation. They start understanding the point of view of other people also.

2 a 4-year-old knows simple songs. A 5-year-old can name four or more colors, has a vocabulary of about 2100 words, and uses sentences of six to eight words with all parts of speech.

4 Stating that the recovery is progressing is a realistic and optimistic appraisal of the child's status. Concluding that the illness has resolved, that the child is no longer critically ill, or that the child has escaped complications are premature statements.

124 Pallor is the result of anemia associated with leukemia. Fatigue is the result of anemia associated with leukemia. Multiple bruises are the result of thrombocytopenia associated with leukemia. Jaundice usually indicates liver damage or excessive hemolysis and is not an early sign of leukemia. Edema is not a manifestation of the disease because the pathophysiology does not involve transport of fluids.

1 Handling the equipment permits the child to investigate and become familiar with the instruments to be used. An explanation is beyond the comprehension of the average 4-year-old and will do little to ease anxiety. Another child's explanation is beyond the ability of a 4-year-old to understand and will do little to reduce anxiety. Having a parent present is supportive; however, the child should be given an opportunity to handle the equipment before the procedure, whether or not a parent is present.

3 The nurse anticipates that the preschool-age client will participate in the social side of eating at 5 years of age. The 3-year- and 4-year-old clients are not expected to participate in the social side of eating. The 6-year-old client is expected to already be participating in the social side of eating.

1 Poor appetite and decreased energy are associated with the accumulation of toxic waste; anemia accounts for the pallor. Activity does not cause these signs and symptoms. An increased temperature will probably be present, but an infection will not cause a muddy pallor. Discontinuing the corticosteroids and diuretics that are usually prescribed will probably result in recurrence of edema in a steroid-dependent child.

3 Lead ultimately settles in the bones and teeth, where it remains inert and in storage. This makes up the largest portion of the body burden, approximately 75% to 90%. Lead does not settle in the liver, blood, or soft tissues. Lead in the body moves via an equilibration process between the blood, the soft tissues and organs, and the bones and teeth.

4 The eruption of permanent dentition may begin at the age of five years, not two years, three years, or four years.

2 A motor response score of a 3 on the Glasgow Coma Scale indicates abnormal flexion of muscles. Localized pain is indicated as a score of 5. Flexion withdrawal is indicated as a score of 4. An abnormal extension is indicated as a score of 2.

3 Children with celiac disease have a gluten-induced enteropathy and are unable to absorb fats from the intestinal tract, resulting in the typical characteristics of their stools. The stools are large and fatty or frothy, not mucoid. Although the stools are large and frothy, they are pale because of their high fat content. The stools are large and foul-smelling and have little color.

4 Palpation increases the risk of tumor rupture and is contraindicated. There are no data to indicate that surgery is scheduled; therefore there is no reason to maintain nothing-by-mouth (NPO) status. There is no contraindication to intravenous medication. Recording of intake and output may or may not be instituted; it is not specific to children with Wilms tumor.

3 Preschoolers desire to extend their bedtimes. They show hyperactivity during sleeping hours. Preschoolers have sleep disturbances instead of sleeping soundly. Daytime naps are infrequent in preschoolers. Preschoolers sleep around 12 hours each night.

2 Preschoolers view death as a separation; they believe that the deceased will return to life. This is part of their fantasy world; they view death as possibly a kind of sleep rather than a cessation of life and expect the deceased to return or wake up. The preschooler does not yet have the understanding that older people are more likely to die. The preschooler believes that the separation was initiated by the deceased, not by another force.

3 Blood seeping from the surgical site drains into the oral cavity, causing the child to swallow. Snoring is to be expected after a tonsillectomy because of edema. A child who has been on nothing-by-mouth for an extended time and is not able to swallow fluids easily will probably ask for fluids. Gradual onset of pallor may be a later sign of hemorrhage.

3 Sources of stress for preschoolers can include changes in caregiving arrangements, the birth of a sibling, and parental marital distress. Hence, preschoolers are less likely to feel happy with the birth of a new baby in the family. Preschoolers may revert to bedwetting or thumb sucking during times of stress. Guilt arises in children when they believe that they have not behaved correctly. Preschoolers tend to be curious about their environment.

1 Smell functions are difficult to assess in preschoolers; this function can be assessed in children six years of age of older. Taste, vision, and touch can be assessed in a preschooler.

123 The pit of plum; all parts of azalea; and leaves, seeds, and flowers of foxglove are all poisonous. Gardenia and asparagus fern are non-poisonous plants.

3 Acknowledging that the child is scared and referring to the teddy bear focuses on the child's feelings and a familiar object of security. The child may experience pain as part of the treatment, so the statement that no one will hurt the child is untruthful. Diverting the child's attention will not alleviate fear and anxiety.

4 The average increase in height of preschoolers per year is 2.5 to 3 inches (6.2 to 7.5 cm). The average increase in height of school-age children per year is 2 inches (5 cm). The average increase in height of adolescent girls is 2 to 8 inches (5 to 20 cm). The average increase in height of adolescent boys is 4 to 8 inches (10 to 30 cm).

2 The diet of preschoolers is half of the diet of an adult. They need approximately 1800 calories on a daily basis. Preschoolers are over-particular about their food at 4 years of age. At the age of 5 years, they typically become more interested in eating different foods. The physical growth of preschoolers is slower than cognitive and psychosocial development.

2 Enjoyment of fantasy and listening to stories are quiet, pleasurable pastimes for a 4-year-old. Riding a tricycle requires too much energy, and playing with large blocks is below a 4-year-old child's developmental level. Although preschool children may enjoy video games, they are not expected to be able to read for enjoyment. The pull toy is below a 4-year-old child's developmental level, and a map puzzle is too advanced.

1 The child may be fearful of the examining room experience. Greeting the child while in the safety of the waiting room may help make the experience less threatening. Calling the child without entering the room is an authoritarian approach that will not limit the child's anxiety. Having someone else bring the child into the examining room is an authoritarian approach that may make the child more fearful. Standing at the examining room door while the child walks down the hall is an authoritarian approach that may increase the child's anxiety.

1 Profuse sweating is a characteristic that would cause the nurse to believe that the child is experiencing a sleep terror versus a bad dream. Calling out after the dream is over, awakening during the second half of the night, and being aware that others are with them after the dream is over are characteristics associated with a bad dream, not a sleep terror.

1 Toddlers and preschoolers are very prone to developing upper respiratory tract infections such as sinusitis. Lung cancer is seen commonly in young or middle-aged adults due to a smoking habit. Hypertension is commonly seen in middle-aged adults due to an unhealthy diet, lack of exercise, and stress. Angina also tends to affect young and middle-aged adults.

4 Preschoolers play with one other child in a cooperative manner in which they make something or play designated roles. Infants do not perform allied play. Parallel play is common among toddlers. In this form of play, each one engages in an independent activity that is similar to, but not influenced by or shared with others. Adolescents spend time with multiple friends at one time.

1 When administering ear drops to preschoolers, the nurse should pull the auricle up and out. The cotton ball is placed into the outermost part of the ear canal. The toddler is kept in side-lying position for 2 to 3 minutes, and then the prescribed drops are instilled by holding the dropper 1 cm above the ear canal.

1 When administering ear drops to preschoolers, the nurse should pull the auricle up and out. The cotton ball is placed into the outermost part of the ear canal. The toddler is kept in side-lying position for 2 to 3 minutes, and then the prescribed drops are instilled by holding the dropper 1 cm above the ear canal.

4 Riding a tricycle is a gross motor skill exhibited by 3-year-olds. Repeatedly catching a ball, skipping, and hopping on one foot are gross motor skills exhibited by 4-year-olds. Walking backward with heel to toe is a gross motor skill exhibited by 5-year-olds.

4 Fears are a source of stress in children of both age groups. The fears for a 3-year-old may be precipitated by imagination. This child may also fear dogs or other animals. A 4-year-old picks up fears from adults. This child may fear a dark room or anything perceived as "creepy." Insecurity is a source for stress in 4-year-olds. A child in this age group may develop nervous habits, such as nail biting, facial tics, thumb-sucking, and so on. This is not seen in 3-year-olds. Questions and nap or bedtime are sources of stress in 3-year-olds. A 3-year-old continually asks "Why?" and is upset if trusted adults do not respond or do not know the answer. This child may also fear bad dreams, the dark, or missing out on some fun while asleep. These are not sources of stress in 4-year-olds.

124 The children who would benefit from an IEP include a child with an IQ of 60 who is intellectually disabled, a child with a hearing deficit who will require modification for success, and a child diagnosed with ASD who will have specialized educational needs. The child with a casted arm due to fracture does not have a chronic problem and does not require an IEP. The child diagnosed with DM may require an individual health plan but not an IEP.

4 It is common for 4-year-old children to boast and exaggerate and to be impatient, noisy, and selfish. More advanced, cooperative play is expected of 4-year-old children. Extreme dependence on parents is unusual in 4-year-old children because they are striving for more initiative and less dependence. The toddler's tendency toward tantrums and negativism should have waned by 4 years of age.

3 A 4-year-old child is in the phase of intuitive thought. A 3-year-old child is egocentric in thought and behavior. A 5-year-old child begins to question what parents think by comparing them with age-mates and other adults. A 3-year-old has beginning ability to view concepts from another perspective.

3 Drooling is often associated with the ingestion of a corrosive agent, such as bleach. Choking, gagging, and vomiting are clinical manifestations associated with the ingestion of hydrocarbons, not corrosive agents.

1 Children who follow the American Academy of Pediatrics Committee on Nutrition guidelines have a decreased risk for obesity. Hypoglycemia, hypothyroidism, and anorexia nervosa are not reduced or eliminated by following these guidelines.

4 Explaining the reason for the time-out before and after reinforces the child's association of the time-out with the undesirable behavior, allowing the child to work to control those behaviors. Sending the child to the bedroom may result in the child's associating bedtime with punishment or may be ineffective if the child is happy playing in the bedroom. Time-out should be limited to 1 minute per year of age, so a time-out for a 4-year-old should be limited to 4 minutes. Putting a child in a dark closet will create fear and may damage the child's trust of the parents as a source of safety. Even if this approach is effective, the short-term benefit is not worth the long-term risk.

3 Preschoolers desire to extend their bedtimes. They show hyperactivity during sleeping hours. Preschoolers have sleep disturbances instead of sleeping soundly. Daytime naps are infrequent in preschoolers. Preschoolers sleep around 12 hours each night.

2 The child who is up to date on vaccinations at 3½ years of age will need to return to the clinic for an annual influenza vaccination. In addition, between 4 and 6 years of age the child will need the diphtheria, tetanus, pertussis (DTaP); measles, mumps, rubella (MMR); inactivated polio (IPV); and varicella vaccination boosters. The child will not need any additional vaccinations until the 1-year milestone, so returning in 2 or 6 months would be too soon.

1 Profuse sweating is a characteristic that would cause the nurse to believe that the child is experiencing a sleep terror versus a bad dream. Calling out after the dream is over, awakening during the second half of the night, and being aware that others are with them after the dream is over are characteristics associated with a bad dream, not a sleep terror.

3 The nurse will notice that the 4-year-old child is curious about his or her surroundings and wants to make new friends. School-aged children begin to define their self-concept and develop self-esteem, an overall self-evaluation. School-aged children have the ability to think in a logical manner about the here and now and to understand the relationship between things and ideas. At around the age of 12 years old, children start concentrating on more than one aspect of a situation. They start understanding the point of view of other people also.

2 If a child has nightmares, the parent should avoid sleeping with the child. Sleeping with the child may create a habit of delaying bedtime. In case of nightmares, keeping the lights on may help the child to overcome fear. Tucking in a soft toy gives the feeling of security to the child. The parent should comfort the child and leave the child in his or her own bed so that the child does not use the fear as an excuse to delay bedtime.

1 Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips. A fever is not expected unless the child has an infection or is dehydrated; the data do not indicate this. The child's respiratory rate will be increased, not decreased. The child's problems are related to decreased oxygenation, not to a clotting deficiency.

3 Preschoolers should be taught to swim, but under supervision. Learning to swim is a useful skill that can someday save a child's life. The mother of a toddler should be instructed to place window guards on all windows and never leave a child alone in the bathroom, tub, or near any water source. Adolescents should be taught about the effects of using alcohol and drugs and referred to community and school-sponsored activities. The mother of a school-age child should be taught about the safe use of equipment for play and work and proper bicycle safety.

3 Drooling is often associated with the ingestion of a corrosive agent, such as bleach. Choking, gagging, and vomiting are clinical manifestations associated with the ingestion of hydrocarbons, not corrosive agents.

14 Environment and cognitive ability influence vocabulary, speech, and comprehension in preschoolers. Health status and physical development influence a child's school readiness. Temperament influences a child's social development and interactions.

2 Dark, frothy urine is characteristic of a child with nephrotic syndrome; large amounts of protein in the urine cause it to take this appearance. The child may be somewhat, not severely, lethargic. Blood pressure is normal or decreased; hypertension is associated with glomerulonephritis. Children with nephrotic syndrome usually have a pale complexion and are not flushed and ruddy in appearance.

1 Gifted children need discipline like any other child to feel loved and safe. Punishment is appropriate for behavior that is unsafe or falls outside set boundaries. Discipline appropriately applied does not lead to physical aggression. Free expression does not mean overstepping the boundaries of appropriate behavior.

4 Stating that the recovery is progressing is a realistic and optimistic appraisal of the child's status. Concluding that the illness has resolved, that the child is no longer critically ill, or that the child has escaped complications are premature statements.

4 Cheese contains calcium, which is excreted by the kidneys and may contribute to the formation of kidney stones; it adds to the child's risk because immobility causes bone decalcification. Fish contains protein, which is needed for wound healing and growth. Fruit contains some fiber, which will help decrease the risk of constipation. Beef contains protein, which is needed for wound healing and growth.

4 Cold and exercise can precipitate bronchospasm, and increased exercise depletes oxygen. Treatment of asthma does not involve a low-fat diet. Asthma is a chronic condition. A return to usual activities after the acute stage is essential for growth and development. Although increased protein and calories may be needed to support the child during a coexisting bacterial infection in the acute stage, a return to usual eating habits is indicated by the time of discharge.

3 Dysfunction of the exocrine glands leads to the secretion of mucus that is thicker and more tenacious than normal. The characteristics of this mucus cause it to pool in the lungs and make expectoration difficult. In addition to airway obstruction, children with cystic fibrosis are more likely to have respiratory infections. Airway irritability is associated with hyperactive airway disease. Inflamed lung parenchyma is associated with pneumonia; this a secondary complication related to stasis of secretions. The endocrine glands are not directly affected in cystic fibrosis.