Chapter 18: Toddler

Avoid foods that may cause choking in the toddler, such as...

hard candy, mini-marshmallows, popcorn, pretzels, chips, spoonfuls of peanut butter, nuts, seeds, large chunks of meat, hot dogs, raw carrots, dried fruits, & whole grapes

Chess and Thomas originally described 3 common temperament patterns they believe are innate of the toddler. The 3 patterns are...

1) the easy child 2) the difficult child 3) the slow-to-warm-up child

Toddler requires ___ hours of sleep/night

12

Toddler period covers ages...

12-18 months up to 3 years old

By 24 months of age, a toddlers receptive language is up to ______ words.

1200

The ___ month-old toddler uses jargon & echolalia speech

18

At ______ of age, toddlers height is 50% of adult height

2 years

Toddlers grow __ to __ inches in height per year and gain __ to __ pounds in weight per year

2-4 inch. 4-6 lbs.

Once children reach ___ lbs, they should be switched to a forward-facing child safety seat.

20

The ___-month-old toddler repeats 2 digits from memory, and the average sentence length is approximately 2½ words for these children.

30

strabismus

A deviation of the line of vision from the midline resulting from extraocular muscle weakness or imbalance (cross-eyed)

Which scenario places a toddler at risk for injury? (select all that apply) A. Toddler playing with his preschool siblings toy B. Mop and a bucket of clean water in the kitchen C. Cup of hot coffee on the kitchen counter D. Twenty-five pound toddler sitting in a forward-facing car seat in the back seat of a car

A,B,C Toys are a common source of injury, especially toys intended for older children. Hot water, boiling water, coffee, tea, and food are the most common sources of injury and should not be kept within reach of the child. Toddlers can drown in water just deep enough to cover their noses and mouths, including pails of water. Once children reach 20 lb, they should be switched to a forward-facing child safety seat, and preferably be placed in the rear seat because of the risk of injury from air bags in the front seat.

A nurse is assessing a toddler during a well-child visit. Which of the following findings warrant further investigation? (select all that apply) A. Bare spots on the scalp, and broken hair B. Overly concerned parents C. Burns with sharply demarcated edges D. Bruises anywhere on the body

A,C Bare spots, broken hair, & burns with sharply demarcated edges are warning signs of child abuse. Bruises caused by abuse are usually located on the back side of the body, from the neck to the knees.

The nurse offers interventions to parents to enhance toddlers' nutritional pattern by telling the parents to: Select all that apply. A. avoid foods that may cause choking B. serve the toddlers' favorite foods when he or she refuses to eat C. send the toddler to bed if he or she does not want to eat D. Do not use food to bribe, reward, or punish the toddler E. serve small portions, and let the toddler ask for more F. serve single foods as mixtures of foods

A,D,E

Which physical growth and development change in toddlers places them at risk for airway obstruction? A. The diameter of the upper respiratory tract is small B. The respiratory rate decreases to 25 breaths per minute C. All 20 primary or deciduous teeth erupt be the end of toddlerhood D. The swallowing pattern using the tongue is fully developed

A. As the toddler grows, the respiratory rate decreases for a mean of 30 breaths/min, at 1 y/o to 25 breaths/min at 3 y/o. The diameter of the toddler's upper respiratory tract is small (when compared with an older child), coupled with their exploratory nature & lack of judgment in deciding what to place in the mouth, can result in airway obstruction. A mature swallowing pattern, using the tongue rather than the cheeks, has not yet developed, and toddlers continue to be at risk for choking.

The mother of a 2-year-old toddler recently lost her job. In addition, her husband asked for a separation. Which of the following actions should the nurse take based on this information? A. Give the mother information about local support groups B. Provide the mother the name of a prominent local attorney C. Do not offer any advice unless the mother asks D. Help the mother find a job

A. Child abuse is more likely to occur with a major change or turmoil in the family. Toddlerhood is a trying time for even patient parents. Nurses need to be alert to family changes and stress. Additionally a major nursing role is to provide anticipatory guidance.

The nurse is teaching a group of mothers about toddlers and their play activities by explaining that toddlers: A. Participate in parallel play B. Demonstrate skill in sharing and cooperative play C. Enjoy playing together with a group of toddlers D. Learn best with intensive drill during play

A. Most toddlers are interested in other children. However, this interest is limited, because toddlers, though ready to be with other children, are not ready to share. Successful social encounters with toddlers are best described as parallel play, where children play side by side, doing similar things with similar toys, but each working independently. Sharing and cooperative play will not develop until well into the preschool years.

What would be the best way for a parent to explain to a toddler that he needs to receive the influenza vaccine at todays appointment? A. You need the shot to keep you healthy. You will feel a little pinch when you get the shot B. You need the shot to prevent the flu. They will use a small needle to administer the shot. It will not take long C. You need a shot, but dont worry, you wont feel a thing D. No, you will not get any needles today

A. Parents can help to prepare toddlers for stressful experiences before they happen. Preparation should be honest, simple, and focused on what the toddler will experience.

A nurse is providing primary prevention education to reduce the risk of lead poisoning to a mother of a toddler. Which of the following recommendations would the nurse make? A. Encourage the toddler to drink orange juice and eat yogurt. B. Encourage the toddler to eat plenty of cakes and cookies to help absorb the lead C. Limit foods high in iron such as spinach to help reduce lead levels D. Encourage dark-chocolate containing products that contain antioxidants to help reduce lead levels

A. Primary prevention for lead poisoning involves teaching parents about risk factors and the importance of a diet that encourages decreasing fat intake, because lead is retained in fat. Vitamin C, calcium, and iron products should be encouraged (orange juice contains vitamin C & yogurt contains calcium). Chocolate products should not be encouraged.

Which of the following toddlers would require further investigation from the nurse? A. Sitting quietly on a couch B. Experiencing a temper tantrum C. Playing with a toy next to another child also playing with a toy D. Exploring his environment and playing with new toys

A. Toddlers are always busy. They spend most of their day playing and exploring their environment. Thus, a toddler sitting quietly is not an anticipated behavior and should be evaluated further.

Which of the following physical changes are expected during the toddler years? Select all that apply. A. Growth in height of 4 to 6 inches per year B. Weight gain of 4 to 6 pounds per year C. Urine specific gravity lower than that of an adult D. Bowel control generally occurs before urinary control E. Increase in heart rate because of increase in size

B,D

Nurses caring for the toddler population instruct parents that one of the leading causes of visits to health care providers is: A. Amblyopia B. Otitis media C. Burns D. Neglect

B.

A mother asks her toddler if she is tired. The toddler responds by saying, Sammy bed. Based on her expressive language and speech pattern, the nurses determines that this child is likely how old? A. 18 months B. 24 months C. 30 months D. 36 months

B. By 24 months of age, the toddler talks in 2- to 3-word sentences and averages 2 words per response. At this age, the toddler also refers to him- or herself by name. Adjectives are only beginning at this age.

A toddler has been diagnosed with amblyopia. Which of the following treatment measures would most likely be prescribed for the child? A. Using corrective lenses B. Patching of the eye C. Applying artificial tears to the eye D. Allowing the passage of time

B. Management of amblyopia depends on the cause and includes surgery or paralytic and autonomic, centrally acting pharmacologic agents. In addition, management includes strengthening of the eye with reduced vision by applying atropine eye drops or patching the stronger eye.

When the nurse is assessing a toddler for signs of child abuse, observations of parental behavior may include: A. Difficulty leaving the child B. Parental delays in seeking help C. Spontaneous reporting of the details of the injury D. Parental questions about progress and discharge

B. Parental behaviors observed by the nurse supporting child abuse may include: - Parental delays in seeking help - Inconsistencies in the history of how the injury occurred - Injury inconsistent with the history or child's developmental capacity - X-rays show old, unexplained fractures - Bruises confined to back surface of the body—neck to knees - Bare spots and broken hair - Pattern to injury or bruising descriptive of object used to inflict injury - Burns with sharply demarcated edges or circumferential patterns - Perineal injuries of any kind

A toddler needs to have blood drawn at his next appointment. Which of the following actions would the nurse suggest that the mother do with the child before the next visit? A. Tell the child about the blood work on the day that the appointment is scheduled B. Tell the child about the blood work right before leaving the house for the appointment C. Tell the child when they are in the office right before the phlebotomist enters the room D. Do not tell the child about the blood work

B. Parents can help to prepare toddlers for stressful experiences before they happen. However, toddlers sense of time and ability to remember are limited. Enough time should be allowed for the toddler to rehearse the coping behavior with the parent but not so far off that the child will forget.

Which of the following behaviors exemplifies a toddler working through his developmental task? A. Clinging to his mother B. Refusing to take a bath C. Playing quietly with one toy D. Having no interest in a new toy

B. The development task of toddlers is to acquire a sense of autonomy while overcoming a sense of doubt and shame. Toddlers need to explore the world physically and interpersonally to develop a true sense of autonomy. The child explores relationships with others by searching for the limits of the childs power. A child refusing to take a bath is trying to exert his autonomy.

A nurse is assessing the home environment of a toddler. Which of the following poses the greatest and most immediate risk to the child? A. A fenced-in pool in the backyard B. An entertainment center with the remote control on the top shelf C. A closed window in the childs bedroom D. A toy box overflowing with toys

B. Toddlers are at high risk for accidental injury because they lack judgment, and have limited physical coordination and a heightened level of curiosity.

A mother expresses her concern and frustration over the fact that her toddler has not been successful at toilet training yet. Which of the following would be the best response by the nurse? A. Don't worry; it will happen eventually B. How long does the child stay dry during the day? C. Train him on a regular toilet instead of a potty chair D. Here is a training schedule to follow

B. toddler should be able to stay dry for at least 2 hours during the day before potty training

Sun-hwa recognizes that a lack of economic resources has an effect on the toddler's health and well-being. About which of the following determinants should Sun-hwa be most concerned? (Selelct all that apply.) A. Lower mortality rates B. Lower rates of accidental injury C. Poorer health and growth D. Dental caries E. Higher rates of asthma and otitis media

C, D, E

According to Erikson, what is the developmental task of toddlers? A. Doubt B. Shame C. Autonomy D. Preoperational

C.

The nurse assessing a 24-month-old toddler expects expressive language to include: A. Repeats 2 digits from memory B. Jargon and echolalia are predominately used C. Talks in word phrases, and 2 to 3 word sentences D. Average sentence length is approximately 2½ words

C. 24-month-old toddler talks in word phrases & 2 - 3 words sentence Vocabulary up to 270 words with 75 words/hr. Jargon and echolalia are almost gone. First pronouns appear; adverbs beginning to appear.

Which statement, if made by a parent after attending a teaching session on initiating a toilet training program for toddlers, indicates a need for further teaching? A. "I take my child to the potty after a meal." B. "I offer praise when my child uses the potty." C. "I require my child to sit on the potty until she goes." D. "I have given my child underpants as a reward for using the potty."

C. Before beginning toilet training, toddlers should be able to walk well, stoop and recover, stay dry for at least 2 hours during the day, and communicate sensations before elimination as well as the discomfort of wet or messy pants, and the need for assistance. First, introduce the child to the potty seat or chair. The potty should provide secure seating with the child's feet touching the floor. Because of the gastrocolic reflex, bowel elimination is more likely after a meal; this is a good time to place the toddler on the potty. Encourage the toddler to stay on the chair for 2 to 3 minutes and always explain what to do ("Go potty") rather than what not to do ("Don't wet your pants"). Do not refer to elimination as dirty or yucky. Remember that this is your child's first creation.Praise the child for the desired behavior. Introduce underwear as a badge of success. Ignore undesired behavior and never punish the child by scolding, spanking, or other punitive measures.

A nurse is providing anticipatory guidance to parents about the self-perceptionself-concept pattern of a toddler. Which of the following statements would the nurse most likely make? A. Temper tantrums are expected, so always give in to them B. Put your toddler in time out if he has a temper tantrum C. Childproof your home D. Always provide your toddler with challenging toys

C. The developmental task of toddler is to acquire a sense of autonomy. During this stage toddlers do a lot of exploring, and this includes climbing, crawling, and tasting. As a result, they are at increased risk for injury and should be provided with a childproof environment.

An 18-month-old toddler is being seen for a well-child visit. Which of the following strategies would the nurse use to enlist the toddlers cooperation? A. Ask the toddler if he wants to be examined today B. Ask his mother leave the room while the nurse examines him C. Have him hold the stethoscope diaphragm on his chest while the nurse listens to his chest D. Have his mother hold him down while the nurse examines him

C. Toddlers need to explore their environment to master it. This includes health care visits. They need to observe and listen to their parents interact with the health care provider, be allowed to manipulate the equipment, and be given simple instructions and choices so they can maintain some control. Having the child hold the stethoscope while being examined will help make the visit more productive.

A -year-old toddler is in for an office visit. He was born at 6 pounds, 10 ounces. At todays visit, the nurse expects his weight to be: a. 13 pounds, 4 ounces b. 19 pounds, 14 ounces c. 26 pounds, 8 ounces d. 33 pounds, 2 ounces

C. 6 pounds, 10 ounces X 4 = 26 pounds 8 ounces

At a well-child visit, a 2-year-old toddler measures 2 feet 8 inches tall. The nurse estimates the toddlers approximate final adult height to be: a. 4 feet 8 inches b. 5 feet c. 5 feet 2 inches d. 5 feet 4 inches

D.

Sun-hwa is concerned about the physical activity needs of the children living in the homeless shelter. What is the best method of entertaining the toddlers in the shelter? A. Playing educational DVDs on the television B. Playing Legos with the older children in the shelter C. Organizing games geared toward each age group D. Supervising parallel play building towers with blocks

D.

The nurse, presenting a class on strategies to prevent drowning in toddlers, instructs parents to: A. Teach their toddler how to swim B. Place the toddler in the tub with 1 or 2 inches of water C. Make sure pails of water are less than ½ full D. Use personal flotation devices on the toddler when boating

D. Children between the ages of 1 and 3 years old are the highest risk for drowning. Toddlers can drown in water just deep enough to cover their noses and mouths. Toddlers should never be left unattended—even for a few seconds—near the bathtub, hot tub, wading or swimming pool, toilet, or pail of water. All swimming pools should be fenced and have self-closing gates and latches. Toddlers must be supervised constantly and competently whenever they are near water and fitted properly with personal flotation devices whenever they are on a boat.

A nurse is assessing the cognitive-perceptual pattern of a toddler. Which of the following findings would be cause for concern for the nurse? A. Uses the word blanky to mean both that he wants to go to bed and that he is cold B. Refuses to eat something he ate and enjoyed the day before C. Has visual acuity that is not 20/20 D. Has a history of recurrent ear infections

D. Vision, hearing, speech, and taste/smell are all assessed as part of the cognitive-perceptual pattern. A toddler with recurrent ear infections is at risk for hearing loss, which can also lead to speech delay; thus this finding would be cause for concern. Visual acuity during the toddler years is approximately 20/40.

Before beginning toilet training, parents should check their toddlers prerequisite skills. What are some things they need to be able to do? When do these skills typically develop?

Must be able to walk, stop, recover, stay dry for at least 2 hours during the day, communicate sensation before elimination, as well as about the discomfort of wet or messy pants & the need for assistance. --> these prerequisites rarely develop before 18 months old

amblyopia

a dimness of vision or the partial loss of sight, especially in one eye, without detectable disease of the eye (lazy eye)

Toddlers begin to move into a _________________ stage, according to Piaget.

preoperational

Birth weight _____ by years of age

quadruples (X4)

Parents of toddlers should be encouraged to follow ___________ as much as possible

routines, rituals, structure

The overall growth rate of the toddler ______ significantly

slows, and remains steady until puberty

An individuals style of emotional and behavioral response across situations, especially those involving change or stress, is known as ______________

temperament