Ch. 16 & 17 Care of a Toddler and School Aged

After teaching a group of parents about language development in toddlers, which statement by a member of the group indicates successful teaching?

"When my 3-year-old asks 'Why?' all the time, this is completely normal." Explanation: Language development occurs rapidly in a toddler. By age 3 years, the child asks "Why?" Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures.

When providing anticipatory guidance to parents about their preschool son who was caught in a lie, what would the nurse emphasize?

"You need to determine the reason for lying before punishing the child." Explanation: 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.

The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond?

"Your child is not expected to be able to perform those activities at 3 years of age." Explanation: Skipping and standing on one foot for up to 10 seconds are motor skills that are expected from a 5-year-old, not a 3-year-old; therefore, the best response is letting the mother know that her child is not behind in motor development.

A nurse is assessing a 3-year-old child in the local health clinic. The child has a persistent cough on examination. Based on the age of the child, which muscle would the nurse view to assess respiratory status?

Abdominal muscle Explanation: Infants and children younger than age 6 years typically use their abdominal and diaphragm muscles for breathing. When assessing respiration, the nurse should watch for the abdominal muscles to rise and fall.

What is a true statement regarding the developmental milestones of the 30-month-old child?

Full set of primary teeth Explanation: Developmental milestones of a 30-month-old child include acquiring a full set of primary or baby teeth. A child at this age is developing a sense of humor, can put on clothes, wash hands and brush teeth. The 12-month-old child should double the birth weight. The anterior fontanel (fontanelle) c

The nurse is teaching a student how to instill ear drops into a 2-year-old. What technique does the nurse demonstrate to the student?

The nurse pulls the pinna of the ear down and back. Explanation: The nurse should pull the pinna of the ear down and back for a child under 3 to help straighten the ear canal. For a child over 3, the pinna is pulled up and back. The other choices are also incorrect positions for this age.

A 4-year-old tells the nurse he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend's help. Which nursing diagnosis is most applicable for his family?

deficient knowledge of normal preschool development Explanation: Because a preschooler's imagination is at a peak, imaginary friends are not uncommon.

Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer?

artificially acquired active immunity Explanation: Artificially acquired active immunity develops through vaccine administration of an antigen that stimulates the child's body to produce antibodies against that antigen (pathogen) and to remember the antigen should it reappear. Natural immunity is produced through natural invasion of an antigen (pathogen). Natural and artificial passive immunity involves providing antibodies to fight a pathogen rather than expecting the child's body to produce them. This type of immunity has a short life.

Which assessment would the nurse expect to introduce for the first time in the physical examination of a 3-year-old child?

blood pressure recording Explanation: Assessing blood pressure is generally introduced at preschool age. The preschool E-chart is used for vision screening at this age.

The nurse is collecting data from the mother of a 3-year-old child. Which report warrants further follow-up?

cannot copy a circle Explanation: A 3-year-old child should have the ability to copy a circle. Stacking five blocks, grasping a crayon, and throwing a ball overhand are not reasonable accomplishments for a 3-year-old child.

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 inches (101.6 cm). How should the nurse respond?

"The average height for a 5-year-old is 43 inches tall (118.5 cm), so your son is within the normal range for height." Explanation: The average preschool-age child will grow 2.5 to 3 inches (6.5 to 7.8 cm) per year. The average 3-year-old is 37 inches tall (96.2 cm), the average 4-year-old is 40.5 inches tall (103.7 cm), and the average 5-year-old is 43 inches tall (118.5 cm).

A nurse is caring for a 4-year-old child. The parents indicate that their child often reports that objects in the house are his friends. The parents are concerned because the child says that the grandfather clock in the hallway smiles and sings to him. Which response by the nurse is best?

"Attributing lifelike qualities to inanimate objects is quite normal at this age." Explanation: The nurse should explain to the parents that attributing lifelike qualities to inanimate objects is quite normal for a 4-year-old child. Telling the parents that the child is demonstrating animism is correct information, but it would be better for the nurse to explain what animism is and then remind the parents that it is developmentally appropriate for their child. Asking whether the parents think the child had a recent trauma or whether there is a family history of mental disorders is inappropriate and does not teach.

A first-time father calls the pediatric nurse stating he is concerned that his 4-year-old daughter still wets the bed almost every night. Remembering his own experience of being punished for wetting the bed at 4 years old, he is not sure punishment is the best approach to address this. Which nursing instruction is the most appropriate?

"Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration." Explanation: Occasional bedwetting is not uncommon for young preschoolers and is not a concern unless it continues past the age of 7. When the child does have an accident, treating it in a matter-of-fact way and providing the child with clean, dry clothing is best. The child should not be disciplined or made to feel he or she is socially unacceptable when bedwetting occurs.

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?

"He will tell us about what happened in his dream." Explanation: 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.

A nurse is providing guidance to the parents of a toddler about way to help the child to achieve the developmental task of autonomy. The nurse determines that the teaching was successful based on which parental statement?

"We'll let our child pick from two choices for what to wear." Explanation: To develop a sense of autonomy is to develop a sense of independence. A healthy level of autonomy is achieved when parents are able to balance independence with consistently sound rules for safety. Allowing the child to make simple decisions helps the child achieve autonomy in a safe setting. Teaching how to count will not help develop autonomy in the child. Providing the child with chores will not develop autonomy. The child is not developmentally prepared to be able to put on clothes independently.

The nurse is caring for an 18-month-old child who has had surgery. The medical record indicates the child weighs 23 pounds (10.45 kg). When monitoring his urinary output the nurse is aware that normal hourly output should be what value?

10 ml/hr Explanation: The normal urinary output for a toddler is approximately 1 ml/kg/hr. This child weighs 23 pounds. This is 10.45 kg. This is approximately 10 ml/hr.

A mother asks the nurse, "Now that Jimmy is 14-months-old and drinking from a cup, how much milk should he be getting each day?" Which amount would the nurse recommend?

16 ounces Explanation: A young child should receive at least two servings of milk and other dairy products a day and take milk primarily from a cup. More than 16 oz of milk per day will interfere with the amount of solid food that a child can eat and can also contribute to iron-deficiency anemia.

The nurse is preparing to assess a 2-year-old at a well-child visit and notes the child was 22 lbs (9.98 kg) and 24 in (60.96 cm) tall at 1 year old. The nurse determines the child is following a normal pattern of growth after obtaining which set of current measurements?

32 lbs (14.54 kg) and 27 in (68.58 cm) tall Explanation: Toddlerhood is a time of slowed growth and rapid development. Each year the toddler gains 4.5 to 6.0 lb (2. to 2.7 kg) and about 3 in (7.62 cm). A child weighing 22 lbs (9.98 kg) at age 1 year would be expected to now weigh 31 to 34 lbs (14.1 to 15.45 kg). A height of 24 in at age 1 year (60.96 cm) should now be approximately 27 in (68.58 cm).

The nurse is visualizing the ear canal and tympanic membrane of a 14-month-old boy. Which finding would warrant further investigation?

A bubble behind the tympanic membrane Explanation: A bubble behind the tympanic membrane is not a normal finding and indicates a need for further investigation. The other findings are within normal limits.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching?

Advising them to use praise, not scolding. Explanation: The most helpful guidance for toilet teaching is to urge the parents to use only praise throughout the process—never scold. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.

During a previous well-child visit, the nurse reviews the importance of immunizations for the preschool-age child with the parents. Which outcome indicates that the nurse's instruction to the parents has been effective?

Child has all immunizations up-to-date. Explanation: One of the most important health assessment and promotion measures for children is to establish that their immunization status is up-to-date. The nurse should teach parents about the importance of having their children immunized and the need to be able to describe the record of immunizations a child has received. If gaps are present in a child's number of immunizations, remind the child's health care provider about this lack of protection and prepare to administer the necessary vaccines. The child's immunizations being up-to-date indicate that the nurse's instruction has been effective. Having the child immunized within a year might expose the child to pathogens that could be avoided. Children will cry when receiving injections. This is not a valid reason to postpone immunization. The health care provider needs to understand the importance of childhood immunizations to be received at the correct age and time.

Which behavior by a 3-year-old child does not validate Erikson's developmental task for preschoolers?

Compares his soccer abilities with his peers. Explanation: Preschoolers are seeking out opportunities to prove themselves through completion of new tasks, demonstrating imagination through play activities, and asking many questions—not to be irritating to parents but because they truly want to know. Comparing athletic abilities is seen in Erikson's next stage of Industry vs. Inferiority, where children become competitive and strive to be the best in all areas. They become confident at mastery of skills and seek approval of peers, parents, and teachers.

A nurse is presenting a class on discipline for a group of parents of toddlers. What information would be important for the nurse to teach this group? Select all that apply.

Consistency in the rules is important so the child understands what is expected. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Even at this young age, children need boundaries. Explanation: Discipline for toddlers must have consistency and correct timing. Parents need to come to a consensus on how to discipline their child and do so consistently and in a unified fashion. Also, the toddler needs to receive negative feedback for negative behavior as soon as the infraction occurs so the child understands what they did wrong. Parents should never label the child as bad, just their behavior. Every child needs boundaries—it is just that every family's boundaries may vary. Discipline begins early in life and toddlers can learn self-control.

According to Piaget, when the child transitions from sensorimotor schemes to mental operation, this form of play is known as which of the following?

Symbolic play Explanation: Symbolic play occurs when the child transitions form sensorimotor schemes to mental operations. Solitary play occurs when the child plays alone. Parallel play occurs when the child plays beside other children and with similar toys. Onlooker play occurs when the child observes the actions of other children and does not attempt to interact with them.

A 15-month-old toddler has been brought to the clinic because the toddler is pale and listless. Which finding or observation would lead the nurse to suspect iron-deficiency anemia as the cause of the clinical manifestations?

The toddler drinks 32 oz (1 L) of milk per day. Explanation: Cow's milk is low in iron content. It should be limited to 16 oz (0.5 L) per day in toddlers. This toddler is drinking 32 oz (1 L) of milk per day, which can contribute to iron-deficiency anemia. A good vegetarian diet would not cause the toddler's symptoms. Generally vegetarian diets are more deficient in vitamins D and B12. The grade 2 heart murmur is most likely innocent. Eating an acidic fruit or drinking the juice with iron-containing foods enhances iron absorption.

The nurse has brought a 3-year-old's oral medications into the room for administration. Upon approaching the child, the nurse said, "I have your medication. Would you rather have me hand it to you or Mommy?" In critiquing the nurse's actions, which is most accurate?

The nurse's behavior is correct. The nurse provided the child a choice between two acceptable options with the outcome of taking the medication. Explanation: The nurse is correct to offer a choice to the preschooler and then for the mother to administer the medication, if chosen. This meets the developmental level of autonomy. The nurse prepared the medication and the medication remained with the nurse until handing it to the mother, who handed it to the child. The nurse witnessed the medication administration and documents it. The nurse firmly requires the medication to be taken but found a way for the child to take it that was acceptable to the child and accomplished the goal.

During a well-child visit, parents asks the nurse what types of snack foods are recommended to give their preschooler to foster nutrition. What would be the nurse's best recommendation?

cheese cubes and apple slices Explanation: Snacks for preschoolers should be nutritious and not contain large amounts of sugar, like cookies or graham snacks. Additionally, they need to be safe for the child and not offer choking dangers, such as peanuts do. Children this age prefer nonspicy foods.

The nurse is watching a 4-year-old child play with another preschool child. The children are playing a game with rules. The nurse notes that the child is demonstrating what type of play?

cooperative play Explanation: Cooperative play is when children play in a group with each other, and play by rules. Examples are board games or sports. Associative play involves allowing the child to work through feelings about procedures and separation; parallel play involves children playing side to side with each engaging in his/her own activities; dramatic play involves living out of the drama of human life.

The mother of a 2-year-old child tells the nurse that she is constantly scolding the child for having wet pants. The child was toilet trained at 12 months, but since walking, the child wets all of the time. Which nursing diagnosis should the nurse use to guide instruction for the mother?

deficient parental knowledge related to inappropriate method for toilet training Explanation: The mother is having difficulty understanding the principles of toilet training. The diagnosis of deficient parental knowledge about toilet training is the most appropriate for the nurse to use to guide instruction for the mother. The child is not experiencing total urinary incontinence. The child does not have an excess in fluid volume. The mother is not demonstrating ineffective coping.

A nurse is preparing to examine the ear of a 2-year-old child. The nurse would pull the pinna in which direction?

down and back Explanation: The nurse should pull the pinna of the ear down and back for a child younger than age 3 years to help straighten the ear canal. For a child older than age 3 years, the pinna is pulled up and back.

The parents of a 2-year-old girl are concerned with her behavior. For which behavior would the nurse share their concern?

frequently babbles to herself when playing Explanation: The nurse would be concerned if the child is babbling to herself rather than using real words. By this age, she should be using simple sentences with a vocabulary of 50 words. Being unwilling to share toys, playing parallel with other children, and moving to different toys frequently are typical toddler behaviors.

The nurse is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem?

has persistent separation anxiety Explanation: Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might an emotional problem. Emotional lability, self-soothing by thumb sucking, or the inability to share are common for this age.

The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of:

transduction. Explanation: The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.

A nurse is caring for a very shy 4-year-old girl. During the course of a well-child assessment, the nurse must take the girl's blood pressure. Which approach is best?

"Help me take your doll's blood pressure" Explanation: It is best to approach a shy 4-year-old by introducing the equipment slowly and demonstrating the process on the girl's doll first. Toddlers are egocentric; referring to how another child performed probably will not be helpful in gaining the child's cooperation. The other questions would most likely elicit a "no" response.

The parents of a toddler express some frustration because they are having a hard time getting their child to take a nap, even though the child is acting tired and cranky. Which suggestion for the parents to try is most appropriate when working with toddlers?

"It's naptime, do you want to sleep with your stuffed bear or with your sock monkey?" Explanation: Toddlers resist naptime as part of their developing negativism. The parent can state simply, "It's naptime now," and then give a secondary choice: "Do you want to sleep with your teddy bear or your rag doll?" The nurse should caution parents when they say, "We'll do this after naptime," that they wait until then to do it. Otherwise, a child may be reluctant to nap the next day for fear of missing another activity. Saying, "If you take your nap, I will see if your friend can come play after your nap" is another example of this, especially if the other child is not available to come play. Punishment for not napping will lead to more negativity in the child.

During a well-child visit, the nurse observes the child saying "no" to her mother quite frequently. The mother asks the nurse, "How do I deal with her saying no all the time?" What would be appropriate for the nurse to suggest? Select all that apply.

"Limit the number of questions you ask of her." "Make a statement instead of asking a question." "Offer her two options from which to choose." Explanation: A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. In addition, using statements instead of asking questions and giving the child a choice of two options are effective. Using time-out is a discipline measure and would be inappropriate to counteract a toddler's negativism. Offering a choice rather than a bribe such as ice cream is more effective and long-lasting for modifying the child's behavior.

The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do?

"Place her in a booster seat with lap and shoulder belts in the back seat." Explanation: A child who weighs between 40 and 80 pounds 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 pounds.

The nurse is providing teaching about proper dental care for the parents of a 5-year-old girl. Which response indicates a need for further teaching?

"She needs to floss her teeth before brushing." Explanation: It is important to remind the parents that they should perform flossing during the preschool years because the child is unable to perform this task.

The nurse is caring for a 5-year-old who has been hospitalized after an episode of asthma. As the nurse prepares to teach the child how to use the nebulizer, which action should the nurse prioritize?

Allow the child to touch and play with the nebulizer for a few minutes before the treatment. Explanation: Children are often less anxious about procedures if they are allowed to handle equipment beforehand— and perhaps "use" it on a doll or another toy. Play is an effective way to let children act out their anxieties and to learn what to expect from the hospital situation. Explaining how the treatment will help him or her feel better, using posters, and encouraging the child to ask questions would be appropriate for the older child, not the preschool-aged child.

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. What is a recommended intervention for this age group?

Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. Explanation: Toddlers should not be blamed for their aggressive behavior; adults can assist the toddler in building empathy by pointing out when someone is hurt and explaining what happened. Adults should allow toddlers to rely upon a security item to self-soothe, as this is a function of autonomy and is viewed as a sign of a nurturing environment rather than one of neglect. Toddlers may question parents about the difference between male and female body parts and may begin to explore their own genitals. This is normal behavior in this age group. Offering limited choices is one way of allowing toddlers some control over their environment and helping them to establish a sense of mastery.

A 3-year-old is admitted to the hospital for pneumonia. Which intervention would be most effective in reducing separation anxiety?

Encourage rooming-in. Explanation: Having parents room-in is the best option for reducing separation anxiety. Mistrust may develop if the child awakens and finds the room empty. Although having a favorite toy may provide comfort, it does not reduce separation anxiety. A 3-year-old does not understand clock time.

The nurse is providing postsurgical care for a 4-year-old boy following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate his pain. When assessing the child's postsurgical pain, the boy refuses to touch the chips and clings to his mother. How should the nurse respond?

Give the mother the FACES pain rating scale to use with her son. Explanation: Different pain rating scales are appropriate for different developmental levels. Children often regress when in pain, so a simpler tool such as the FACES scale may be needed. It is also helpful to enlist the assistance of the parent. Expecting the child to select a chip is developmentally inappropriate when the child shows signs of regression. The child wouldn't understand the phrase "word-graphic scale," and this scale or the visual analog scale is more complex than this 4-year-old can handle.

A mother brings her 2-year-old child to the pediatrician's office, voicing concerns about her toddler's growth over the last year. According to the child's records, the toddler has gained 6 pounds (2.7 kg ) and grown 2.5 in (6.25 cm) since the chld's last visit a year ago. How should the nurse respond to this mother's concerns?

Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about. Explanation: Normally, a toddler's growth is 5 to 10 pounds per year and about 3 inches in height. This child falls within the recommended parameters of growth and the mother has nothing to be worried about.

The nurse is educating a parent regarding child safety for the 14-month-old toddler. What would the nurse include in the educational plan?

Maintain supervision when the child is near stoves, ovens, irons and other hot items the child could reach. Explanation: Toddlers are more mobile and curious, leading to accidental burns on stoves, ovens, irons etc. They must be supervised when near these objects to avoid burns. If firearms are in the home, they should be unloaded and locked in a secure location. Educating the toddler about firearm safety will not be remembered and is appropriate for a much older child. Buckets are a danger to toddlers (who are top heavy) if they have water in them and could result in a drowning. Empty buckets are not a drowning concern. Children are to be placed in a rear-facing car seat until 2 years of age, not a front-facing one.

The nurse is designing a nursing care plan for a toddler with lymphoma who is hospitalized for treatment. What is a priority intervention that the nurse should include in this child's nursing plan?

Monitoring the toddler for developmental delays Explanation: When the toddler is hospitalized, growth and development may be altered. The toddler's primary task is establishing autonomy, and the toddler's focus is mobility and language development. The nurse caring for the hospitalized toddler must use knowledge of normal growth and development to be successful in interactions with the toddler, promote continued development, and recognize delays. Parents should be encouraged to stay with the toddler to avoid separation anxiety. Planning activities and socialization of the toddler are important, but the priority intervention is monitoring for, and addressing, developmental delays that may occur in the hospital.

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. What would the nurse correctly include in this description?

Myelinization of the brain and spinal cord is complete at about 24 months. Explanation: Myelinization of the brain and spinal cord continues to progress and is complete around 24 months of age. Alveoli reach adult numbers usually around the age of 7. Urine output in a toddler typically averages 1 ml/kg/hour. Abdominal musculature in a toddler is weak, resulting in a pot-bellied appearance.

The nurse caring for a 3-year-old client is having a very difficult time persuading the child to take an oral medication. The child yells "Yucky" every time the nurse approaches with the medication. Which of the following is the best approach to take when giving medication to a resistant toddler?

Offer the child a popsicle to numb the mouth and decrease the bad taste of the medicine. Explanation: Offering the child a popsicle to help numb the mouth and therefore decrease the bad taste of the medicine is a good approach to take. Never lie to a child about the taste of the medicine or pretend the medicine is candy. Physical force should never be used to overcome a child.

The parents of a 2-year-old boy report to the nurse that their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child?

Offering a variety of foods along with the foods the child likes. Explanation: Toddlers require fewer calories proportionately than infants, and their appetite decreases (physiologic anorexia). Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods. Prolonged preferences for particular foods (food jags) are common. It is also important that mealtime be calm, pleasant, and focused on eating. Toddlers mimic behaviors observed. It is important that parents set a good example with their mealtime behaviors and food choices. All options encourage the development of healthy eating habits, but at this time, variety plus preferred foods will be most helpful.

The nurse is presenting an in-service on the types of playing that children may engage in. The nurse determines the session is successful when the attending nurses correctly choose which example as representing cooperative play?

Playing in an organized group with each other. Explanation: During cooperative play, children play in an organized group with each other as in team sports. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. Parallel play occurs when the toddler plays alongside other children but not with them.

The nurse is supervising a play group of children on the unit. The nurse expects the toddlers will most likely be involved in which activity?

Playing with the plastic vacuum cleaner and pushing it around the room Explanation: Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.

The nursing staff at the clinic are discussing the best way to encourage cooperation from young pediatric clients during screenings. Which suggestion would be appropriate?

Purchase stickers or make coloring pages to be given to the children after the screening is completed. Explanation: Young children respond well to a reward system. Allowing them to have a sticker or a coloring page after the screening is finished will encourage cooperation. They should not be permitted to play with equipment that is dangerous (syringes/medication) or should be sterile when used on them. Playing with medication is contraindicated also because it gives the illusion that medication is a toy. Allowing a child the choice of completing the reward before the screening will hinder cooperation; the child should only complete the reward after screening.

Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching?

Reasoned with the child to stop the behavior Explanation: The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place. The other actions are helpful in preventing a tantrum.

What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother?

Specific program goals to be accomplished should be available. Explanation: Preschool is used for toddlers to foster social skills and to acclimate them to the group environment. When a parent is searching for a preschool, he or she should check the school's accreditation, the teacher's qualifications, and seek the recommendations of other parents. Parents should visit the school to see the teacher interact with the children, the focus of the activities, and hygiene practices. Parents should look at the school's daily schedule and the types of activities offered. Are the activities structured or loose? Preschoolers need planned activities. They are very ready to learn, but the activities should be planned to focus on their short attention spans.

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?

Support whatever the child paints. Explanation: Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because the child believes that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Finger painting is a messy activity, so telling the child not to be messy takes the fun and the creative part out of the activity. The adult should provide aprons or clothing to protect the child's clothing and allow the painting in an area that can be cleaned easily.

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly?

Telling the child firmly that we don't scream in the office Explanation: Telling the child firmly that we don't scream in the office gets the point across to the child that his behavior is unacceptable while role modeling appropriate communication. Telling the child to stop tearing up magazines does not give him direction for appropriate behavior. Asking the child if he would quit throwing toys gives him an opportunity to say "no," and is the same as asking "OK?" at the end of a direction.

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which behavior would warrant nursing intervention?

The child does not want to play games with other children on the hospital ward. Explanation: 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.

The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason?

There is an increased risk for physical injury in this age group. Explanation: Spanking should never be used with toddlers younger than 18 months of age because there is an increased risk for physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk for physical injury in this age group is paramount.

The parent of a toddler observes the child play next to another child but not with the child. What should the nurse explain to the parent about this type of play behavior?

This is parallel play and is expected. Explanation: All during the toddler period, children play beside children next to them, not with them. This side-by-side play called parallel play is not unfriendly but is a normal developmental sequence that occurs during the toddler period. This is not peer, adjacent, or premature play. This behavior is not abnormal, does not need to be stopped, and is not seen in school-age children.

A nurse is presenting a class on toilet training to a group of parents with toddlers. Which information would the nurse include in the class? Select all that apply.

Using training pants that slide down easily and quickly Praising the child when he or she urinates or defecates Putting the child on the potty chair at regular intervals during the day Explanation: For effective toilet training, parents should allow 1 to 2 weeks to psychologically prepare the child for training, using training pants that slide down easily and quickly, praising the child when he or she urinates or defecates, limiting the time spent on the potty chair to no longer than 10 minutes (or less if the child is resistant), and putting the child on the potty chair at regular intervals during the day.

The nurse is teaching the parents of a 2-year-old child how to handle the child's temper tantrums. The nurse determines that the teaching was successful if the parents make which statement?

We will ignore our child while having the tantrum." Explanation: The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it. Bribery, such as saying that the child can have a treat if the behavior stops, is rarely effective because by accepting the child's wishes, the parent is encouraging the child to have more tantrums because he or she was successful. Placing the child in time-out does not deal with the actual tantrum. When a child is placed in time-out, the appropriate length is 1 minute per year of age (2 minutes for this child). Tantrums are a result of the child not being able to appropriately express his or her needs, desires, or frustrations. It is not appropriate to attempt to reason with a upset 2-year-old child.

A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group?

imagination Explanation: Although vocabulary, gross motor skills, and fine motor skills improve during this time, the imagination of preschool-age children is keener than it will be at any other time in their lives. They imitate behavior exactly as they see it.

The nurse is caring for a toddler in the pediatric unit and notes the child is responding according to expected developmental stages. Which characteristic will the nurse predict this toddler to exhibit while in the hospital?

insists on doing a new skill and then asking for help Explanation: The toddler insists they can do things one minute and then becomes dependent the next minute. The preschool-age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft or activity for several hours. The infant grows and develops skills more rapidly than he or she ever will again.

A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should:

offer the child a flavored ice chip or ice pop prior to administering the drug. Explanation: Children can be offered a flavored ice pop or ice chips prior to administering the drug to help numb the taste buds and promote cooperation to take a foul-tasting drug. Most 5-year-old children cannot swallow pills, and only certain pills can be crushed and dissolved in small amounts of liquid or soft food, such as applesauce, gelatin, or ice cream, to mask the flavor of the drug. Medication should never be forced on a child; it increases the risk of aspiration. Play therapy reduces the anxiety related to drug therapy, but you should never tell the children that the medicine is candy.

The nurse is assessing a toddler's language development. What finding would the nurse interpret as reflecting expected development for a 2-year-old?

speaks in two-word sentences using a noun and a verb Explanation: A 2-year-old child should be speaking in simple two-word sentences using a noun and a verb. Any 2-year-old child who does not talk in two-word, noun-verb simple sentences needs a careful assessment to determine the cause because this is beyond a point of normal development. Counting is not an expectation for a 2-year-old child. The child will not be able to speak 20 nouns and 4 pronouns.

Where is the point of maximal impulse (PMI) found in a 5-year-old child?

the fourth intercostal space Explanation: The area of most intense cardiac pulsation, or point of maximal impulse (PMI), varies with age. Up until the age 4 years it is located between the 3rd and 4th intercostal space (ICS). From ages 4 to 6 years it is found at the 4th ICS medial to the left midclavicular line. From age 7 upward it is located at the 5th ICS lateral to the left midclavicular line. Heart sounds radiate and can be heard either to the right or left of the sternum but never directly over the sternum. The clavicle is located too high to hear heart sounds.

During an assessment, a preschool-aged child tells the nurse about having 12 siblings. The nurse is aware that the child has two older brothers. What would be the nurse's best response?

"That is a good pretend answer but tell me the names of the brothers you really have." Explanation: Stretching stories to make them seem more interesting is a phenomenon frequently encountered in preschoolers. This kind of storytelling should not be encouraged. The child should be helped to separate fact from fiction. The nurse should ask the child to say the names of the brothers the child really has. The nurse should not insult the child's counting ability. The nurse should not accuse the child of lying or making the child seem more important by having more brothers.

The nurse is assessing a 4-year-old on a routine well-child visit. When assessing the gross motor skills of this preschooler, which activity will the nurse predict the child to be able to successfully accomplish?

Hop on one foot Explanation: The 4-year-old should be able to hop on one foot and can control movements of the hands. By the age of 5 the child can walk backwards heel to toe, throw and catch a ball well, and jump rope.

The nurse is teaching the parents of a 3-year-old child how to help the child complete the developmental task of initiative versus guilt. Which nursing example is the appropriate task and instruction?

Praise the child when demonstrating correct dressing, eating, and toileting independently. Explanation: Successful completion of initiative vs guilt occurs when the preschool-aged child begins to assert one's power and control over the world. From successful completion of the first two levels, the child accepts that the world is trustworthy and that the child can act independently. To meet this task, the child takes initiative in planning activities, accomplishing tasks, and facing challenges. A nursing example and instruction of meeting this task is to praise the child's independent completion of the appropriate tasks of dressing, eating, and toileting. The child still requires assistance in brushing the teeth and does not have the reasoning skills to determine schedule. The parent remains in power when providing structured play and instruction and offering guidance and support.

Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3-year-old is in what stage as identified by Piaget?

Preoperational thought Explanation: A 3-year-old is in the preoperational stage according to Piaget. Primary circular reaction is seen in infants of 3 months. Coordination of secondary schema is seen in infants at age 10 months. Tertiary circular reaction is seen in toddlers between 12 and 15 months.

The nurse has brought a group of preschoolers to the playroom to play. Which activity would the nurse predict the children to become involved in?

Pretending to be mommies and daddies in the playhouse Explanation: Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-aged child enjoys group activities, such as board games, and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities he or she can participate in with their peers.

A 2-year-old child is shopping with her mother when she suddenly falls to the ground and begins to scream, "I want it!" over and over regarding a bag of candy. What would the nurse recommend to the mother to deal with this behavior? Select all that apply.

Remain calm and ignore the tantrum. Stay nearby to ensure the child's safety without giving in to the child's desires. Explanation: Temper tantrums in toddlers are very common as they try to control their environment and the caregiver's environment. They become frustrated at their inability to do so or to verbalize their desires. If a toddler has a temper tantrum, the best thing for the parent to do is ignore them and protect them from harm. Parents cannot reason with a toddler—they lack the ability to understand or the desire to change their behavior. Never give in to their demands; they will only learn that if you scream loud enough, they get their way. However, spanking is not recommended. The child has just lost control and needs time to regain self-control.

A 6-year-old child who does not speak the dominant language is on bed rest at home and being seen by a home health nurse who speaks only the dominant language. The child's parent informs the nurse that the child is very bored, which makes it hard to keep the child in bed. What will the nurse do for this child?

Stack/build blocks with the child. Explanation: Because the child cannot understand the nurse's language, the best option to help this child would be for the nurse to play games such as stacking blocks or building with Tinker toys. These activities can be done despite communication difficulty.

A 4-year-old child was recently poisoned when the child found a bottle of ibuprofen on the bathroom counter and swallowed the entire contents. At the emergency room, the child was treated successfully, and now the nurse is counseling the parents before discharge. Which nursing instruction is best to give the parents?

Store all medications in a locked area which only the parent knows how to access. Explanation: As poisoning from medicine is the number one cause of poisoning in preschool children, children's medicine should be secured in a locked, safe place. In most homes, this is in a locked medicine cabinet or a locked drawer. The parent should be the only one who knows how to access the medication. Remind parents most childhood poisonings occur when a family is under stress because, during these times, the family may forget usual procedures and leave medications unlocked. Children are often curious and may use medications to see what they are like, which makes having a locked area important. Having the medication above the child's height is helpful, but will need to be changed as the child grows. This is not the best action. It is important to have access to the poison control number available if needed. Prevention is always the best option.

A nurse is developing a teaching plan for parents of preschoolers about how to address the issue of strangers and safety. Which would the nurse expect to include in the teaching? Select all that apply.

Urge children never to talk to or accept a ride from a stranger. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable. Explanation: The preschool years are not too early to educate children about the potential threat of harm from strangers or how to address bullying from others. Appropriate measures include urging children never to talk to or accept a ride from a stranger; teaching them how to call for help in an emergency; encouraging them to tell parents if someone asks them to keep a secret about something that makes them uncomfortable; urging children to report any bullying behavior; and teaching them to say "no" to anyone whose touching makes them feel uncomfortable.

Parents share that their toddler often needs a snack in between meals. Which snack choice is nutritious enough to give the toddler energy but also may help prevent dental caries? Select all that apply.

orange slices cheese slices yogurt Explanation: Toddlers often need between-meal snacks. To help prevent dental caries from frequent snacking, encourage parents to offer fruit (e.g., bananas, pieces of apple, orange slices) or protein foods (e.g., cheese, pieces of chicken) for snacks rather than high-carbohydrate items such as cookies and candy bars to limit exposure of the child's teeth to carbohydrates. Calcium (found in large amounts in milk, cheese, and yogurt) is especially important for the development of strong teeth.

A group of students is reviewing material about ways parents can help to foster a child's self-esteem. The students demonstrate a need for additional studying when they identify which method? Select all that apply.

limiting the choices and decisions that the child makes avoid talking with the child about his or her dissatisfaction Explanation: To promote self-esteem, parents should praise the child's achievements, show respect and support to the child, allow the child to make decisions, listen to the child, and spend time with the child. The parents need to listen to the child and talk with him or her and be a coach to the child rather than just a cheerleader who merely praises accomplishments.

During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. What is the best specific trigger question to determine the preschooler's linguistic and cognitive progress?

"How well does your son communicate or follow instructions?" Explanation: Asking how well the boy communicates and follows instructions is the best trigger question because it is open-ended. Asking if the child uses complete sentences or speaks clearly will elicit a yes or no answer about only those specific areas of development. The parents would have no way of judging the size of their child's vocabulary.

Which statement by a parent would best prepare the toddler for the parent's return if the parent must leave the hospital?

"I will be back after you eat your dinner and SpongeBob goes off." Explanation: Toddlers have no real concept of time and equate time to events in their lives. So, the best way for the mother to tell the child when she will be back at the hospital is to relate her arrival to events such as the child's dinner and TV programs the child likes.

A nursing instructor is leading a class discussion exploring the various aspects of Erikson's theories of the developmental tasks of toddlers. The instructor determines the session is successful when the students correctly choose which task as a priority for toddlers?

Learning to act on one's own Explanation: Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) while overcoming doubt and shame. Erikson's psychosocial developmental task for infants is to develop a sense of trust. Learning to speak and to understand and respond to discipline are not developmental tasks according to Erikson.

Which gross motor developmental milestone is least likely for a 2-year-old?

Rides a tricycle Explanation: Gross motor developmental milestones for a 2-year-old include jumping in place, standing on tiptoes, kicking a ball, and running. At 3 years old, the child should be able to pedal a tricycle, run easily, and walk up and down the stairs with alternate feet. At 12 to 18 months of age, the child should be able to stand on one foot with help, walk independently, climb the stairs with assistance, and pull toys.

The father of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the father would indicate a need for further teaching?

"I will need to find an appropriate punishment for him if this continues." Explanation: The nurse should remind the father that overreaction to this behavior may cause it to occur more frequently. Masturbation at this age should be treated matter-of-factly. The other statements are correct.

Parents of a 2-year-old girl are having a conversation with the nurse about tantrums and how best to deal with them. Which technique would the nurse be most likely to suggest?

"Stay calm and ignore the child's behavior." Explanation: The best response to tantrums is to remain calm, ignore the child's behavior, stand about 5 ft away and keep doing the activity they were previously engaged in, or leave the room as long as the child is safe. The parents should not speak to the child and should avoid eye contact until the child has calmed down. Responses need to be consistent rather than varied. Telling the child she is bad is negative. Promising a reward for good behavior will result in rewarding bad behavior.

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?

"Tell me about the circumstances when this occurs." Explanation: Bladder control is present in 4- and 5-year-olds, 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.

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue?

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Explanation: Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers.

The nurse is providing teaching about car seat safety for a parents' meeting at the preschool their children attend. Choose the points the nurse should make. Select all that apply.

Children who weigh less than 40 pounds should use a car seat with harness and top tether. Many car seats are installed improperly, making them unsafe. The back seat remains the safest place for children to ride. Booster seats should be used with both a shoulder and lap belt.

The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which observation would suggest the child is experiencing a problem with language development?

Her vocabulary is between 10 and 15 words. Explanation: A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly. Thus a vocabulary of 10 to 15 words suggests a language problem. Reference:

The father of a toddler reports his son says "no" every time he attempts to correct him. What is the best advice the nurse can offer to the parent?

Saying no is your son's way of trying to exert his independence and is expected. Explanation: It often seems that "no" is a toddler's favorite word. Saying no is his way of beginning to exert his independence. Telling the parent this is a normal happening does not provide the necessary education to the parent. Saying "no" does not indicate the discipline being provided is too restrictive. Telling the father to continue the discipline does not offer the needed education about his child's behavior and stage of development.

The nurse is caring for a 5-year-old child who is receiving daily antibiotic injections due to a wound infection. The child is scared when seeing the nurse and cries. The nurse goes into the toy bin to select a toy for the child. Which toy provides the most therapeutic play?

play syringe and doll Explanation: Fear of injections is common in 5-year-old children. The nurse is correct to use play as a way of relating to the child and decreasing the fear and anxiety. Playing with medical instruments, such as syringes, stethoscopes, and thermometers, helps reduce fear about this equipment. It is also an outlet for the child's feelings, making this the best choice. An anatomically correct puppet or doll in a gown is appropriate to explain information about the body but is not the best choice to decrease anxiety of injections. A stuffed bear with a bandage is appropriate if the concern was wound care.

The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation?

presence of 10 deciduous teeth Explanation: The presence of only 10 deciduous teeth would warrant further investigation. The preschooler should have 20 deciduous teeth present. The absence of dental caries or presence of 19 teeth does not warrant further investigation.

A 4-year-old is ordered on bed rest. Which activity would be most appropriate for promoting play?

providing a basin with water and toys while bathing the child Explanation: Allowing the child to play with water toys while taking a bath encourages play. The child is on bed rest and therefore is unable to play ring-around-the-rosie. Watching TV is a nonparticipant activity that does not stimulate play. Gauze and tongue depressors are choking hazards.

Which statement by the mother of a 15-month-old with special needs alerts the nurse that more teaching is needed?

"She is so messy I don't let her feed herself." Explanation: Not allowing her to feed herself interferes with development of this skill, as well as with achievement of autonomy. All the rest of the statements describe behaviors that are exhibited during the toddler stage of development and should be supported. Implied is that she does not walk or have speech, yet she is effectively compensating with rolling and head shaking. Toddler medication refusal is not unusual and is being handled appropriately.

A nurse in a busy pediatric clinic is educating a group of parents with toddlers about the nutritional needs of this age group. Which concepts should be addressed in this educational presentation? Select all that apply.

Active, "busy" toddlers may need up to 1,400 cal/day. Try to limit the fat intake to less than 35% of total calories. Milk is still important to incorporate in the diet for bone health. Explanation: Active children in this age group may need up to 1,400 kcal daily. Children over 2 years old should have a total fat intake between 30% and 35% of calories, with most fat coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils, the same as adults. Adequate calcium and phosphorus intake is important for bone mineralization. Milk should be whole milk until age 2 years, after which 2% milk can be introduced. Trans fats should be kept to a minimum. Diets high in sugar (like cookies) should be avoided to help prevent toddler obesity.

A nurse is assessing a 4-year-old's fluid and electrolyte status. What is an important aspect of history taking in this area?

Ask the parent how often the child has been voiding. Explanation: The parent would be the best historian for the history questions and the questions should focus on all body systems including exposures.

The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson?

Autonomy versus shame and doubt Explanation: Erikson defines the toddler period as a time of autonomy versus shame and doubt. Erikson defines Initiative versus guilt as the preschool period. Erikson defines trust versus mistrust as the infancy period and industry versus inferiority as the school age period.

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?

Reward the child for initiative in order to build self-esteem. Explanation: 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.

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to:

testing and identification of group role. Explanation: Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.

A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply.

Round foods such as hot dogs, whole grapes, and cherry tomatoes Hard foods such as nuts, raw carrots, and popcorn Sticky foods like peanut butter alone, gummy candies, and marshmallows Explanation: To offer soft round foods safely, cut hot dogs in uneven pieces and cut grapes and cherry tomatoes into quarters. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits.

The pediatric nurse is presenting basic safety tips at a local health fair for families. The nurse should point out the majority of hospital visits for toddlers can be prevented by exercising which precaution?

safely store all chemical substances Explanation: Poisoning is still the most common medical emergency in children with the highest incidence between the ages of 1 to 4 years. Even with precautionary labeling and "child-resistant" packaging of medication and household cleaners, children display amazing ingenuity in opening bottles and packages that catch their curiosity. Medications such as acetaminophen, salicylates (aspirin), laxatives, sedatives, tranquilizers, analgesics, antihistamines, cold medicines, and birth-control pills are commonly associated with poisoning and also need to properly be stored out of reach of the toddler. The proper use of car seats, preventing access to electrical outlets, and bath time supervision are also noted to be the cause of medical emergencies. However, poisoning remains the number one reason.

The nurse is observing a 36-month-old boy during a well-child visit. Which motor skill has he most recently acquired?

undress himself Explanation: This child has most recently acquired the ability to undress himself. Pushing a toy lawnmower and kicking a ball are things he learned at about 24 months. He was able to pull a toy while walking at about 18 months.

A 4-year-old child is brought to the clinic by his parents for evaluation of a cough. Which action by the nurse would be least appropriate in promoting atraumatic care for the child?

wrapping the child tightly in a blanket to prevent him from moving around Explanation: Atraumatic care refers to the delivery of care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system. The key principles of atraumatic care include preventing or minimizing physical stressors, preventing or minimizing separation of the child from the family, and promoting a sense of control. Allowing the parents to stay, allowing the child to touch the stethoscope, and explaining that the stethoscope may feel cold are appropriate. Wrapping the child so that he cannot move would be stressful and traumatic.