Chapter 24: Growth and Development of the Toddler
The nurse is preparing to assess a toddler during a routine health maintenance visit. Which assessment will the nurse perform to determine the child's growth milestone? • Blood pressure • Height and weight • Urine specimen • Hemoglobin level
• Height and weight Explanation: Growth milestones are assessed at every health maintenance visit and are determined by measuring height and weight. Blood pressure does not assess a growth milestone. A urine specimen would be done at specific times. A hemoglobin level would be determined during specific times. Urine specimens and hemoglobin levels do not measure growth milestones.
The nurse sees a 15-month-old at a health maintenance visit. Of the following assessments, which one is generally included in a 15-month checkup? • Clean-catch urine • Height and weight measurements • Blood pressure • IQ testing
• Height and weight measurements Explanation: Because height and weight are such strong determinants of health, they are measured at every health assessment. Question 7
A nurse is discussing oral care with the parents of 4-year-old. The nurse determines that the parents are performing this aspect of their child's care appropriately when they state that they use which amount of toothpaste? • 1/4-inch strip • Pea-sized • Smear • 1-inch strip
• Pea-sized Explanation: The AAPD (2012a) recommends a "smear" of fluoridated toothpaste in children younger than 2 years of age and a "pea-size" amount of fluoridated toothpaste be used on children aged 2 to 5 years.
The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it. • True • False
• True Explanation: Probably the best approach is for parents to tell a child simply they disapprove of the tantrum and then ignore it. They might say, "I'll be in the bedroom. When you're done kicking, you come into the bedroom, too." Children who are left alone in a kitchen this way will usually not continue a tantrum but will stop after 1 or 2 minutes and rejoin their parents. Parents should then accept the child warmly and proceed as if the tantrum had not occurred. This same approach works well for nurses caring for hospitalized toddlers.
A 2-year-old toddler holds the breath until passing out when the toddler wants something the parent does not want the toddler to have. The nurse would base evaluation of whether these temper tantrums are a form of seizure on the basis that: • seizures typically occur with fever; temper tantrums do not. • seizures are not provoked; temper tantrums are. • seizures rarely occur in toddlers. • with seizures, cyanosis rarely develops.
• seizures are not provoked; temper tantrums are. Explanation: Temper tantrums are the natural result of toddler frustration. Toddlers are eager to explore new things but their efforts can be thwarted, especially for safety reasons. Toddlers do not behave badly on purpose. Temper tantrums occur out of anger and frustration. Seizures do not. Seizures can occur at any age. The client may or not be febrile. Depending upon how long a seizure lasts, cyanosis can occur. Question 4
The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this? • A regular routine and rituals will provide stability and security. • Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly. • Aggressive behaviors such as hitting and biting are common in toddlers. • A sense of control can be provided through offering limited choices.
• A regular routine and rituals will provide stability and security. Explanation: Toddlers benefit most from routines and rituals that help them anticipate events and teach and reinforce expected behaviors. Knowing that a child can move from calm to temper tantrum very quickly, understanding the benefit of limited choices, and realizing that hitting and biting are common behaviors in toddlerhood provide information but not a guiding concept. Question 11
Which of the following immunizations would you anticipate administering to a 15-month old at a health maintenance visit? • Hib • MMR • Oral polio • Tine test
• MMR Explanation: Measles-mumps-rubella vaccine cannot be administered before 12 months because antibodies passively acquired across the placenta take this long to fade. Question 5
The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? • The child has trouble undressing himself. • The child falls when he bends over. • The child is unable to unscrew a jar lid. • The child is unable to push a toy lawnmower.
• The child is unable to push a toy lawnmower. Explanation: Children with normal motor development are able to push toys with wheels at 24 months of age. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age. Question 12
The nurse is teaching good sleep habits for toddlers to the mother of a 3-year-old boy. Which response indicates the mother understands sleep requirements for her son? • "I need to put the side down on the crib so he can get out." • "His father can give him a horseback ride into his bed." • "I'll put him to bed at 7 p.m., except Friday and Saturday." • "He needs 12 hours of sleep per day including his nap."
• "He needs 12 hours of sleep per day including his nap." Explanation: The mother understands her child needs 12 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. However, a horseback ride to bed may cause problems because it may not provide a calming transition from play to sleep. A bath and reading a book would be better. If the child can climb out of a crib, he needs to be in a youth bed or regular bed to avoid injury. Question 14
A nurse is teaching parents of a 2-year-old child about discipline and limit setting. When describing the use of time out, the nurse would inform the parents that the maximum duration of time out should be how many minutes per each year of age? • 2 minutes • 1 minute • 90 seconds • 30 seconds
• 1 minute Explanation: The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. The other time frames are incorrect. Question 4
A parent tells the nurse that no matter what is asked of the toddler, the toddler says, "No." What suggestion maight the nurse make to help the parent handle this situation? • pretend the parent does not hear the toddler's response • tell the toddler never to say, "No" again • ask no further questions of the toddler • give the toddler secondary, not primary, choices
• give the toddler secondary, not primary, choices Explanation: Encouraging toddlers to express their opinion aids in developing a sense of autonomy. By allowing secondary choices, it gives the toddler a sense of mastery. Telling the toddler not to say "No" again is unrealistic as this is a favorite word and reaction of the toddler as he or she develops autonomy and find one's "self." Pretending not to hear the toddler only leads to more frustration for the toddler and the parent. It is also unrealistic not to ask the toddler questions. There would not be two-way communication between the parent and the toddler. Question 4
When observing a group of toddlers playing in a child care setting, it is noted that the toddlers are all playing with buckets and shovels but are not playing with each other. This type of play is referred to as: • associative play. • solitary play. • onlooker play. • parallel play.
• parallel play. Explanation: The toddler's play moves from the solitary play of the infant to parallel play, in which the toddler plays alongside other children but not with them. Onlooker play is when the child watches others playing but does not engage with them. In associative play toddlers form a group and may even play with the same toy but there is no formal structure of the group. Question 4
The mother of a 2-year-old boy asks the nurse about when she should begin toilet training. The nurse questions the mother about the boy's readiness. Which of the following statements by the mother would indicate that the child is ready? • "He often pulls at his diaper right before a bowel movement." • "He moves his bowels at all different times." • "His diaper usually stays dry for about an hour or less." • "He has trouble pulling his pants up and down."
• "He often pulls at his diaper right before a bowel movement." Explanation: The key to toilet training is the readiness of the child. Parents usually find that the older child (2 to 3 years) is more successful. Some of the signals that indicate a child is ready for toilet training are: a predictable bowel movement schedule; diapers remaining dry for periods of 2 hours or more; ability to follow instructions; an interest in imitating family members in the bathroom; an indication (either by a facial expression or some other change in activity) that the bladder is full or the bowel needs to be evacuated; the ability to pull pants up and down. Question 3
What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? • "New foods are offered along with ones she likes." • "I give my daughter juice at breakfast and when she is thirsty during the day." • "When she doesn't eat well at meals we give her nutritious snacks." • "She drinks three 6-ounce cups of whole milk each day."
• "I give my daughter juice at breakfast and when she is thirsty during the day." Explanation: High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new. Question 10
The maximum time-out duration is how many minutes for each year of age? • 2 minutes • 1 minute • 30 seconds • 90 seconds
• 1 minute Explanation: The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. The other timeframes are incorrect. Question 2
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? • She asks many questions. • She uses complete 3- to 4-word sentences. • She talks incessantly. • Her vocabulary is between 10 and 15 words.
• 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. Question 2
A mother is concerned that her 2-year-old child is having seizures. He holds his breath until he passes out when he wants something his mother does not want him to have. How should the nurse respond to this mother's concern? • With seizures, cyanosis rarely develops. • Seizures typically occur with fever; temper tantrums do not. • Seizures are not provoked; temper tantrums are. • Seizures rarely occur in toddlers.
• Seizures are not provoked; temper tantrums are. Explanation: Some children hold their breath as part of a temper tantrum until they become cyanotic. Breath holding occurs when a child is provoked; the child develops a distended chest, often has air-filled cheeks, and shows increasing distress as the body registers oxygen want. A seizure cannot be provoked. Seizures can occur in all ages. Cyanosis can occur with seizures. Seizures can occur in those with neurologic problems and not just with a fever. Question 16
Parents are asking a pediatric nurse how to deal with separation anxiety every time they try to have an adult night out. Which advice by the nurse sounds like the most appropriate way to handle this situation? • "Note if your child cries as you leave because this may be an indication the babysitter is ignoring the child." • "If your child starts crying, stay a little longer and read a story before leaving." • "Inform the child that you are going out but the regular babysitter will care for them and put them to bed." • "Try to sneak out the back door to avoid the long crying scene at the door."
• "Inform the child that you are going out but the regular babysitter will care for them and put them to bed." Explanation: Most toddlers react best to separation if a regular babysitter is employed or if the day care center has consistent caregivers. It helps if toddlers have fair warning they will have a babysitter. No matter how well prepared toddlers are, they may cry when the babysitter actually appears or may greet the babysitter warmly only to cry when the parents reach for their coats. It helps if parents say good-bye firmly, repeat the explanation they will be there when the child wakes in the morning, and then leave. Prolonged good-byes only lead to more crying. Sneaking out prevents crying and may ease the parents' guilt, but it can strengthen a child's fear of abandonment and so should be discouraged.
A mother is concerned because her 14-month-old son, who had a big appetite when breast-feeding a few months ago, seems uninterested in eating solid food. She still breast-feeds him daily, but is thinking of weaning him soon. How should the nurse respond to this mother? • "It is normal for toddlers to lose their appetites; try weaning him all at once so that he will be more interested in the solid food." • "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." • "It is not normal for toddlers to lose their appetites; spoon feed him yourself to make sure he gets proper nutrition." • "It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition."
• "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." Explanation: Because growth slows abruptly after the first year of life, a toddler's appetite is usually less than an infant's. Children who ate hungrily 2 months earlier now sit and play with their food. It is important to educate parents while the child is still an infant this decline in food intake will occur so they will not be concerned when it happens. Because the actual amount of food eaten daily varies from one child to another, teach parents to place a small amount of food on a plate and allow their child to eat it and ask for more rather than serve a large portion the child cannot finish. One tablespoonful of each food served is a good start. The nurse should recommend that the mother wean her son gradually to avoid confrontation, not all at once. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them. Question 3
During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old's caregiver indicates that the child is developing autonomy? • "My child has temper tantrums when we go to the store." • "My child uses the potty chair and is dry all day long." • "Every night my child follows the same routine at bedtime." • "When my child falls down, he always wants me to pick him up."
• "My child uses the potty chair and is dry all day long." Explanation: During the toddler years the toddler separates from his/her parents, recognizes their own individuality and exerts autonomy. Being toilet trained is an example of the toddler developing autonomy or independence. Having temper tantrums is a normal response of the toddler as it is a way they express frustration of being tired or not being able to accomplish a task. Having the parent pick up the child after the child falls is a security and emotional need. All children need this so it is not indicative of toddlerhood or autonomy.Having the same routine for bedtime each night provides security but it does not demonstrate autonomy. Question 3
During a health history, the nurse explores the sleeping habits of a 3-year-old boy by interviewing his parents. Which statement from the parents reflects a recommended guideline for promoting healthy sleep in this age group? • "Our son still sleeps in a crib because we feel it is the safest place for him at night." • "Our son sleeps through the night, and we insist that he takes two naps a day." • "Our son occasionally experiences night walking so we allow him to stay up later when this happens." • "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story."
• "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." Explanation: Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night. Question 13
A group of caregivers of toddlers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is most appropriate related to this form of discipline? • "She is 2 years old now and I put her in time out for 5 to 10 minutes when she misbehaves." • "When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to time out." • "Our time-out chair is in the master bedroom so she can't see anyone else in the family." • "We use the time-out chair when our son gets tired but doesn't want to take a nap."
• "When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to time out." Explanation: A method for a child who is not cooperating or who is out of control is to send the child to a "time-out" chair. This should be a place where the child can be alone but observed without other distractions. The duration of the isolation should be limited—1 minute per year of age is usually adequate. Caregivers should warn the child in advance of this possibility, but only one warning per event is necessary. The chair should be used for discipline not because the child will not go take a nap. It can be used for all age children. Question 3
A mother of a 2-year-old girl is asking her friend when she should start potty training the child. The mother expresses concern about the high cost of diapers and training pants and would really like to have her trained as soon as possible. Which advice by the friend would be considered the best response? • "When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training." • "It doesn't hurt to start when they turn 2 as long as you don't punish them for having many accidents." • "I started training my kids when they started to pull themselves up to a standing position." • "You will just have to condition yourself to take her to the potty chair every hour until they get the hang of it."
• "When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training." Explanation: The markers of readiness are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers, or they may bring a parent a clean diaper after they have soiled so they can be changed. The other answers do not address this. Usually the child needs to walk well independently before training can occur. Question 20
The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. What should the nurse say in response? • "The best time to start toilet training is as soon as the child begins walking." • "It is best to wait a little longer, until she is 3; only then will she be socially developed enough to understand what you are asking her to do." • "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." • "She's well past the age to begin toilet training; most children are ready by age 1, when they have developed the needed nervous system control."
• "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." Explanation: The markers of readiness are subtle, but as a rule children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers. Because physiologic development is cephalocaudal, the rectal and urethral sphincters are not mature enough for control in most children until at least the end of the first year, when tracts of the spinal cord are myelinated to the anal level. A good way for a parent to know a child's development has reached this point is to wait until the child can walk well independently. Toilet training need not start this early, however, because cognitively and socially, many children do not understand what is being asked of them until they are 2 or even 3 years old. Question 4
A nurse observes a child engaged in parallel play in a nursery. What is an example of parallel play? • Two boys playing cooperatively with stuffed animals, pretending that the toys are fighting each other • A group of children playing hide and seek on the playground • A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks • A girl sitting by herself and alternating between playing with a doll for a time and then with a toy truck for a time
• A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks 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. The other answers are not examples of parallel play. Question 4
The parents of a 30-month-old girl have brought her into the emergency department because she had a seizure. During the health history, the nurse suspects the child had a breath-holding spell. Which parental report suggests breath-holding? • The event took place during a nap. • The child was lethargic afterward. • A tantrum preceded the event. • The child became unconscious.
• A tantrum preceded the event. Explanation: Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the child is old enough to verbalize feelings.The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells. Question 2
The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching? • Telling them that curiosity is a sure sign of readiness • Telling them either one may demonstrate toilet use • Advising them to use praise, not scolding • Assuring them that bladder control occurs first
• Advising them to use praise, not scolding Explanation: The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. 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. Question 3
The nurse had instructed the family of a toddler on home safety during a previous visit. During this current visit, what observation indicates that instruction has been effective? • All windows in the home have locked screens. • Small bowl of mixed nuts on the coffee table • Prescribed medication sitting on countertop • House plant on a small table next to the sofa
• All windows in the home have locked screens. Explanation: To prevent falls, the parents should keep the house windows closed or keep secure screens in place. Prescribed medication should be stored in a locked cabinet and not left out on a table because this could cause accidental poisoning. House plants should not be within reach of the toddler because this could cause an accidental poisoning or injury if the plant is pulled on top of the child. Nuts could cause accidental choking and should not be within the child's reach. Question 17
The nurse is determining a toddler's language development. What is an expected finding for language development in a 2-year-old? • Speaks in two-word sentences using a noun and a verb • Speaks two words plus "ma-ma" and "da-da" • Able to count out loud to 20 • Speaks 20 nouns and 4 pronouns
• 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. Question 5
While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their back yard a few days ago. The nurse explains that this is an instance of which of the following? • Parallel play • Assimilation • Deferred imitation • Autonomy
• Deferred imitation Explanation: Children at this stage are able to remember an action and imitate it later (deferred imitation); they can do such things as pretend to drive a car or put a baby to sleep because they have not seen this just previously but at a past time. Toddlers engage in assimilation when they learn to change a situation (or how they perceive it) because they are not able to change their thoughts to fit the situation, such as shaking a toy hammer as if it were a rattle, because they are more familiar with rattles than hammers. 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. Autonomy, or independence, is the primary developmental task of the toddler years, according to Erikson. Although this child's act may be a sign of autonomy, it is more specifically an act of deferred imitation. Question 15
The parent of a 2-year-old toddler tells the nurse needing to constantly scold the toddler for having wet pants. The parent says the toddler was potty trained at 12 months, but since starting to walk, the toddler wets the pants all the time. Which nursing diagnosis would be most applicable? • Ineffective coping related to lack of self-control of 2-year-old toddler • Total urinary incontinence related to delayed toilet training • Deficient parental knowledge related to inappropriate method for toilet training • Excess fluid volume related to inability to control urination
• Deficient parental knowledge related to inappropriate method for toilet training Explanation: Myelination of the spinal cord is achieved around 2 years of age. When this occurs, the toddler can exercise voluntary control over the sphincters. It is probable that a toddler toilet trained at 12 months of age was not truly trained, because the infant would not be developmentally able to complete the task. It is most likely the parent used a training method of reminding the infant or placing the infant on a toilet frequently during the day. When the toddler begins to play independently, the toddler forgets the regimented schedule. This toddler is not toliet trained independently. The toddler does not display total urinary incontinence. The toddler is only incontinent when playing and not reminded to potty. A 2-year-old toddler has limited coping skills. Frequent wetting of the pants does not indicate too much fluid intake. It is a symptom that the toddler does not feel the urge to urinate until the bladder is too full and the toddler cannot get to the toliet on time.
A mother brings a 15-month-old child to the clinic for a routine health maintenance visit. Which immunization should the nurse prepare to administer to this child? • MMR • Oral polio • Rinne test • Hepatitis A
• MMR Explanation: The measles-mumps-rubella (MMR) vaccine is administered at either the 12-month or 15-month visit. Rinne test is not an immunization but rather a test for hearing. The oral polio vaccination is not listed as an immunization needed for toddlers. Hepatitis A vaccination is given at either the 12-month or 18-month visit.
A parent with a 2-year-old invites a friend with a toddler over for a play date when they notice their children are not really interacting while playing. The children are playing side-by-side when one toddler gets up and grabs a toy car out of the hands of the other toddler, which results in both toddlers crying. To prevent this from occuring again, which intervention should the parents make? • Sit the toddlers down and give a lecture about "sharing." • Parent of the toddler who started the fight should put this child in "time out." • Parents should ensure that toys in front of each child are "similar" to prevent fighting over one toy. • Parents should decide that they need to wait about a year when the children are more ready to share toys.
• Parents should ensure that toys in front of each child are "similar" to prevent fighting over one toy. Explanation: All during the toddler period, children play beside other children, not with them. This side-by-side play (parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Caution parents that if two toddlers are going to play together, they must provide similar toys because an argument over one toy is likely to occur. Avoiding introducing playing with others, time out, or lecturing toddlers about "sharing" concept are inappropriate at this time. Question 18
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 • Made sure the child was rested and not hungry before going to the mall • Tried to refocus the child's attention as tantrum behavioral cues appeared • Remained relatively calm even though embarrassed
• 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. Question 8
A family has recently moved into the area and is bringing their 18-month-old son in to the office for his first visit. The father is in dusty work clothes and explains that they are in the process of restoring the house they recently moved into, which was built in the 1920s and which had been vacant for many years. The nurse urges the father to have a blood test done on the son. Which of the following is the best rationale for this intervention? • Risk for development of diabetes due to all of the high-calorie fast foods the family is consuming while their kitchen is under construction • Risk for developing tetanus due to all of the construction going on • Risk for ingestion of cleaning products they may have been left out due to the renovation • Risk for lead paint poisoning due to the age of the house
• Risk for lead paint poisoning due to the age of the house Explanation: The best rationale for the nurse's intervention is the risk for lead paint poisoning due to the age of the house. All children between the ages of 6 months and 6 years who live in communities with buildings built before 1950 should be tested for the presence of too much lead in their body (lead poisoning). Elevated lead levels are caused by eating, chewing, or sucking on objects (such as windowsills, paint chips, or furniture) that are covered with lead-based paint. There is not enough evidence in the scenario to indicate that the child may be at risk for developing tetanus or that he has ingested cleaning products; in any case, the interventions for these would not include a blood test. There is no basis in the scenario for the suspicion of diabetes in the child. Question 5
A nurse, who is also a mother of a 2-year-old child, attends a party at a friend's house and notes some safety concerns that she would like to share with the other mother privately. Which observations during the party would be considered a safety concern that should be addressed privately when appropriate? Select all that apply. • The safety gate/fence surrounding the pool area is secure and a little hard, even for parents, to unlatch. • The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. • Only toddlers with helmets on are allowed to ride the tricycle. • The parents allow the toddler to climb up on the counter and watch as food is stirred on the stove. • The nurse/mother notes that the toddler's car seat is located in the passenger front seat.
• The nurse/mother notes that the toddler's car seat is located in the passenger front seat. • The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. • The parents allow the toddler to climb up on the counter and watch as food is stirred on the stove. Explanation: Toddlers' motor ability jumps ahead of their judgment. To prevent serious injury, the nurse should teach parents to be alert as to what their toddler is doing at all times (like climbing on a countertop next to a stove). Toddlers have no judgment concerning moving cars so they walk across streets with no regard for oncoming cars. Toddlers need to ride in a car seat with a five-point restraint placed in the back seat (not the front seat) so the child is not struck by the passenger seat airbag. Toddlers need to wear a helmet as soon as they begin riding a tricycle. Because they cannot swim well, parents need to check whether backyard pools—another area prone to unintended injury—are securely fenced. Question 19
When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old toddler? • The toddler should be able to count out loud to 20. • The toddler should say 20 nouns and 4 pronouns. • The toddler should speak in two-word sentences ("Me go"). • The toddler should say two words plus "ma-ma" and "da-da."
• The toddler should speak in two-word sentences ("Me go"). Explanation: A toddler can understand language and is able to follow commands far sooner than can actually use the words. By 2 years of age, a toddler typically speaks in two-word (noun and verb) sentences. Two-year-old toddlers have a vocabulary of about 40 to 50 words, and they start to use descriptive words (hungry, hot). The words "ma-ma" and da-da" occur much earlier than toddler stage. The toddler is about 36 months of age before using pronouns or plurals in sentences. Children are unable to count to 20 until they are 5 to 6 years old. Question 5
A parent is concerned because the toddler refuses to share. What is the nurses best response to the parent regarding this concern? • The toddler is probably reacting to some family crisis. • Play time with other toddler should be cut back until your toddler learns to share. • This is normal toddler behavior; sharing is learned later. • Behavior modification techniques can change the toddler's behavior.
• This is normal toddler behavior; sharing is learned later. Explanation: Play is the major socializing medium for the toddler. Toddlers exhibit parallel play instead of cooperative play. Sharing is not usually learned until the preschool period. Because toddlers have such short attention spans, they change toys and actvities frequently. This also is not conducive to sharing. Because parallel play is normal for the toddler, the parent should be assured the toddler is developing normally and no restrictions are needed. Question 6
Parents and their 35-month-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? • Asks "why" often • Uses two-word sentences or phrases • Half of speech understood by outsider • Talks about a past event SUBMIT ANSWER
• Uses two-word sentences or phrases Explanation: A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age. Question 9
