Chapter 18: Toddler

ANS: 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.

ANS: 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. Therefore the nurse should give the mother information about local support groups.

18. 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.

ANS: 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. Therefore, the best way to tell the toddler is to say, You need the shot to keep you healthy. You will feel a little pinch when you get the shot.

20. 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-chocolatecontaining products that contain antioxidants to help reduce lead levels.

ANS: 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. Thus, orange juice, which contains vitamin C, and yogurt, which contains calcium, should be encouraged. Chocolate products should not be encouraged.

5. 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

ANS: 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.

1. 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

ANS: 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. Additionally, toddlers can drown in water just deep enough to cover their noses and mouths, and this includes 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.

2. 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

ANS: A, C Bare spots and broken hair as well as burns with sharply demarcated edges are warning signs of child abuse. Abusive parents often do not demonstrate any guilt and are hesitant to provide information. Typically, abusive parents have difficulty leaving a child and attempt to identify with their feelings. In addition, bruises caused by abuse are usually located on the back side of the body, from the neck to the knees.

15. An individuals style of emotional and behavioral response across situations, especially those involving change or stress, is known as: a. ritual. b. temperament. c. coping. d. autonomy.

ANS: B An individuals style of emotional and behavioral response across situations, especially those involving change or stress, is known as temperament.

25. How many words are in a toddlers receptive language at 24 months of age? a. 500 words b. 1200 words c. 2400 words d. 3600 words

ANS: B By 24 months of age, a toddlers receptive language is up to 1200 words.

26. 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

ANS: B By 24 months of age, the toddler talks in two- to three-word sentences and averages two words per response. At this age, the toddler also refers to him- or herself by name. Adjectives are only beginning at this age. Thus, a response of Sammy bed is likely that of a 24-month-old.

10. 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

ANS: 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.

17. 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.

ANS: 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. Thus, the best time to tell the toddler is right before leaving for the appointment.

11. 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

ANS: 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.

7. The inability of a toddler to put him- or herself in anothers shoes is known as: a. autonomy. b. egocentrism. c. self-perception. d. integrity.

ANS: B The inability of a toddler to put him- or herself in anothers shoes is known as egocentrism.

23. A mother tells the nurse that ever since she started toileting training, the toddler has been touching his genitals. Which of the following statements is the most appropriate response by the nurse? a. This is a sign that he is not ready to toilet train yet. b. This behavior is developmentally normal. c. Tell him to stop touching himself. d. Dont worry about it.

ANS: B The toilet training process may precipitate curiosity about the genital organs. The nurse should provide anticipatory guidance to help the parents approach this curiosity and exploration, as well as masturbation as a normal developmental process. Telling the mother not to worry does not address her concern. Thus to address the mothers concern and provide anticipatory guidance, the nurse should tell the mother that the behavior is developmentally normal.

9. 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

ANS: B Toddlers are at high risk for accidental injury because they lack judgment, and have limited physical coordination and a heightened level of curiosity. Toddlers love to explore and climb objects. Injuries to toddlers occur most often when they fall from furniture, stairs, or windows. Trying to reach the remote control on the top shelf of the entertainment center puts the child at immediate and greatest risk because of the potential for the entertainment center to fall on the child while he is trying to climb it.

16. A parent expresses her frustration over the constant fighting between her toddler and preschooler. Which of the following would be an appropriate response from the nurse? a. Tell the mother not to worry about it and continue with the office visit. b. Tell the mother this is normal behavior for the toddler, and she should be firm with the child without taking sides. c. Say to the mother, Dont you remember fighting with your sibling? Dont worry; everything will work out. d. Say to the mother, Dont worry; this behavior will all end soon.

ANS: B Toddlers often imitate those older than them and this can create sibling rivalry. A major role of the nurse is to provide anticipatory guidance. The nurse should include normal family development as part of the anticipatory guidance because discipline can often be influenced by lack of knowledge and skill. Parental anger that goes unchecked can lead to abuse.

22. 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. Dont 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.

ANS: B Toilet training is a major parental concern during toddlerhood. The nurse anticipates this and initiates discussion with the parent to determine their understanding of the childs signs of development readiness. Before beginning toilet training, parents should check their toddlers prerequisite skills. These include being able to walk, stop, and recover, stay dry for at least 2 hours during the day, and communicate sensation before elimination, as well as about the discomfort of wet or messy pants and the need for assistance. These prerequisites rarely develop before 18 months of age. Determining whether the child is ready will help to guide the discussion with the mother as well as help to determine the appropriate recommendations. This response also helps the mother understand and accept the reason for the potential delay in toilet training.

2. 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.

ANS: C Birth weight usually quadruples by years of age: 6 pounds, 10 ounces 4 = 26 pounds 8 ounces.

14. A 2-year-old Asian American boy is being seen for an office visit. While examining the child, the nurse notices round bruises on his back. The mother does not volunteer any information during the exam. Which of the following actions should the nurse take after examining the child? a. Report the suspected child abuse to the Department of Children and Families. b. Assume the bruises are the result of a fall. c. Ask the mother about the bruises. d. Schedule a follow-up appointment in 2 weeks to see if the bruises are still present.

ANS: C Many injuries are difficult to differentiate from accidental injuries or culturally appropriate healing practices. Abusive parents are often hesitant to provide information, may be evasive, and may not exhibit feelings of guilt. However, these signs may also be present in nonabusive families. Therefore signs consistent with abusive parents should serve as a cue for further assessment. Additionally the nurse who is aware of cultural differences knows that coining, which can result in bruising, is a common cultural practice. Therefore in this case the nurse should ask the mother about the bruises.

12. 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.

ANS: 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.

3. At a well-child visit, the parents of a toddler ask the nurse how they should teach their toddler the importance of dental hygiene. Which of the following actions should the nurse recommend to the parents? a. Remind the toddler to brush his teeth every day. b. Have the dentist tell the toddler about the importance of dental hygiene. c. Schedule a time to brush their own teeth with their toddler. d. Have the toddler watch an educational cartoon video on the teeth brushing.

ANS: C Toddlers identify with parents, caregivers, and other important role models, internalizing a wider range of lifestyle attributes. Parents and caregivers health perceptions and health behaviors should model the perceptions and behaviors desired for health promotion. Thus, scheduling a time to brush their teeth with their toddler is the best way for parents to teach their toddler the importance of dental hygiene.

6. Approximately how much sleep do toddlers require each day? a. 10 hours b. 11 hours c. 12 hours d. 13 hours

ANS: C Toddlers need for sleep decreases to 12 hours a day during this developmental period.

21. 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.

ANS: 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. Therefore having the child hold the stethoscope on his chest while being examined will help make the visit more productive.

4. A mother is concerned because her 22-month-old has been skipping meals lately. Which of the following actions should the nurse recommend to the mother? a. Put the child in time out whenever he skips a meal. b. Offer him foods he likes such as cookies and chips. c. Limit the childs consumption of juices and cookies. d. Talk to the child about how important it is to eat three meals a day.

ANS: C Toddlers often use mealtime to assert their individuality. They sometimes do this by refusing to eat. Additionally they are often not hungry because they have been given empty calories by their parents, because the parents want to make sure the toddler eats something. However empty calories should be avoided. Parents should take control and offer the toddler healthy, age-appropriate foods. Punishment and focusing on food should be avoided.

9. A deviation of the line of vision from the midline resulting from extraocular muscle weakness or imbalance is known as: a. amblyopia. b. farsightedness. c. nearsightedness. d. strabismus.

ANS: D A deviation of the line of vision from the midline resulting from extraocular muscle weakness or imbalance is known as strabismus.

24. Which is a common temperament pattern described by Chess and Thomas? a. The fussy child b. The happy child c. The unhappy child d. The slow-to-warm-up child

ANS: D Chess and Thomas originally described three common temperament patterns they believe are innate. The three patterns are the easy child, the difficult child, and the slow-to-warm-up child.

1. 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.

ANS: D The toddlers height at 2 years is approximately 50% of final adult height. Thus, at 2 feet 8 inches, the childs approximate final adult height would be 5 feet 4 inches tall (2 feet 8 inches 2).

8. 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

ANS: 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.