Child Health
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? a) "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." b) "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." c) "The best time to start toilet training is as soon as the child begins walking." d) "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."
A- "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." 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.
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? a) "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." b) "She is 2 years old now and I put her in time out for 5 to 10 minutes when she misbehaves." c) "Our time-out chair is in the master bedroom so she can't see anyone else in the family." d) "We use the time-out chair when our son gets tired but doesn't want to take a nap."
A-"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." 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 nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this? a) A regular routine and rituals will provide stability and security. b) Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly. c) A sense of control can be provided through offering limited choices. d) Aggressive behaviors such as hitting and biting are common in toddlers.
A-A regular routine and rituals will provide stability and security. 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.
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? a) The child became unconscious. b) A tantrum preceded the event. c) The child was lethargic afterward. d) The event took place during a nap.
B- A tantrum preceded the event. 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.
A toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her to: a) pretend she does not hear him. b) give him secondary, not primary, choices. c) tell him never to say, "No" again. d) ask no further questions of him.
B-give him secondary, not primary, choices. Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices encourages this without disrupting family life.
The mother of an 18-month-old girl voices concerns about her child's social skills. She reports that the child does not play well with others and seems to ignore other children who are playing at the same time. What response by the nurse is indicated? a) "Does your child have opportunities to socialize much with other children?" b) "Has your child displayed any aggressive tendencies toward other children?" c) "Perhaps you should consider a preschool to promote more socialization opportunities." d) "It is normal for children to engage in play alongside other children at this age."
D- "It is normal for children to engage in play alongside other children at this age." The social skills of the toddler at this age include parallel play. During parallel play children will play alongside each other rather than cooperatively. There is no indication that the aggression level of the child needs to be investigated. There is no indication the child needs increased socialization with other children.
What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? a) "She drinks three 6-ounce cups of whole milk each day." b) "When she doesn't eat well at meals we give her nutritious snacks." c) "New foods are offered along with ones she likes." d) "I give my daughter juice at breakfast and when she is thirsty during the day."
D-"I give my daughter juice at breakfast and when she is thirsty during the day." 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.
A nurse observes a child engaged in parallel play in a nursery. What is an example of parallel play? a) Two boys playing cooperatively with stuffed animals, pretending that the toys are fighting each other b) A girl sitting by herself and alternating between playing with a doll for a time and then with a toy truck for a time c) A group of children playing hide and seek on the playground d) A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks
D-A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks 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.
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? a) Her vocabulary is between 10 and 15 words. b) She asks many questions. c) She uses complete 3- to 4-word sentences. d) She talks incessantly.
A-Her vocabulary is between 10 and 15 words 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.
The mother of a preschooler reports that her daughter seems to believe in magic. She voices concern that this "fantasy world" may become a problem. What response by the nurse is indicated? Select all that apply. a) "Your daughter is engaging in what we call magical thinking." b) "This type of imagination is not normally seen until a child is school aged." c) "This type of thought process allows your daughter to begin to observe the differences in the world." d) "While imagination is normal, this type of fantasy world can cause problems for your child and should be discouraged." e) "Fantasy play is most often seen in lonely children in an attempt to occupy themselves."
A- "Your daughter is engaging in what we call magical thinking." C- "This type of thought process allows your daughter to begin to observe the differences in the world." Magical thinking is a normal part of preschool development. In magical thinking, the preschooler believes that his or her thoughts are all-powerful. The fantasy experienced through magical thinking allows the preschooler to make room in his or her world for the actual or the real. Through make-believe and magical thinking, preschool-age children satisfy their curiosity about differences in the world around them. There is nothing problematic about this type of imagination.
In discussing their 2-year-old's behavior with the nurse, which of the parents' statements suggests the child may be ready for toilet teaching? a) The child hides behind her bedroom door when defecating. b) The child frequently repeats words parents just said. c) The toddler walks with a wide, swaying gait. d) The child often removes her shoes and socks.
A- The child hides behind her bedroom door when defecating. Hiding while defecating indicates awareness of this need. Repeating words promotes language development but doesn't indicate readiness for toilet teaching. Walking with a wide, swaying gait is early walking behavior. Steady walking and running signals toileting readiness. Removal of shoes and socks is easily done. Greater fine motor clothing removal skill is needed for toileting.
The 18-month-old has most likely attained which gross motor skill? a) The ability to walk independently. b) The ability to walk up stairs alone. c) The ability to balance on one foot. d) The ability to pedal a tricycle.
A-The ability to walk independently. The 18-month-old child can walk alone, but the gait may still be a little unsteady
A 2-year-old holds his breath until he passes out when he wants something his mother does not want him to have. You would base your evaluation of whether these temper tantrums are a form of seizure on the basis that: a) seizures are not provoked; temper tantrums are. b) with seizures, cyanosis rarely develops. c) seizures typically occur with fever; temper tantrums do not. d) seizures rarely occur in toddlers.
A-seizures are not provoked; temper tantrums are. Temper tantrums occur because children are angry or frustrated; seizures occur without respect to provocation.
When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old? a) He should say 20 nouns and 4 pronouns. b) He should speak in two-word sentences ("Me go"). c) He should say two words plus "ma-ma" and "da-da." d) He should be able to count out loud to 20.
AHe should speak in two-word sentences ("Me go"). By 2 years of age, children typically speak in two-word (noun and verb) sentences.
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? a) Tried to refocus the child's attention as tantrum behavioral cues appeared b) Reasoned with the child to stop the behavior c) Made sure the child was rested and not hungry before going to the mall d)Remained relatively calm even though embarrassed
B-Reasoned with the child to stop the behavior 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.
The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet? a) "You may have to serve a new food 10 or more times." b) "Serve only healthy foods. He'll eat when he's hungry." c) "Give him more healthy choices with less junk food available." d) "Calorie requirements for toddlers are less than infants."
C-"Give him more healthy choices with less junk food available." Suggesting that the parents transition the child to a healthier diet by serving him more healthy choices along with smaller portions of junk food will reassure them that they are not starving their child. The parents would have less success with an abrupt change to healthy foods. Explaining calorie requirements and the time line for acceptance of a new food do not offer a practical reason for making a change in diet.
The mother of a 2-year-old tells you she is constantly scolding him for having wet pants. She says her son was trained at 12 months, but since he started to walk, he wets all the time. Which nursing diagnosis would be most applicable? a) Total urinary incontinence related to delayed toilet training b) Excess fluid volume related to inability to control urination c) Deficient parental knowledge related to inappropriate method for toilet training d) Ineffective coping related to lack of self-control of 2- year-old
C-Deficient parental knowledge related to inappropriate method for toilet training It is probable that a child toilet trained at 12 months was not truly trained; his mother was trained to remind him or place him on a toilet frequently during the day. When the child begins to play independently, the training is no longer effective.
A toddler's mother reports that her child will only eat peanut butter and jelly sandwiches for several days in a row. The child will then refuse to eat them for several weeks. Which term would the nurse use to document this behavior? a) Physiologic anorexia b) Echolalia c) Food jag d) Egocentrism
C-Food jag During a food jag, the toddler may prefer only one particular food for several days, then not want it for weeks. Physiologic anorexia describes the fact that toddlers do not require as much food intake for their size as they did in infancy. Echolalia is repetition of words and phrases. Egocentrism describes the focus on self that is present in toddlers.
Parents of a 2-year-old girl are having a conversation with the nurse about tantrums. Which technique would the nurse most likely suggest? a) Promise a reward if she behaves. b) Tell her she is bad and will be punished. c) Use short "time-outs" and remain calm. d) Vary the response based on the situation.
C-Use short "time-outs" and remain calm. The best response to tantrums is to remain calm and use short "time-outs." 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.
