Evolve: Toddlers

A nurse reviews the diet with the parents of a toddler with recently diagnosed celiac disease. What foods selected by the parents indicate that further teaching is needed?

Frankfurters and baked beans

An 18-month-old toddler who is inadequately immunized contracts tetanus after sustaining a puncture injury. The parents are concerned about how the disease will affect their child's intellectual abilities in the future. What is the best response by the nurse concerning the child's intellectual function?

"Intellect should remain intact."

A mother brings her 16-month-old daughter to the well-child clinic for a checkup. She is upset and reports, "My child refuses to eat at mealtimes. It's a battle between us." What is the best response by the nurse?

"It may be helpful to keep a daily diary of the food she eats."

The nurse accompanies a 3-year-old child to the playroom. The toddler seems afraid to select a toy or activity. What age-appropriate play materials should the nurse offer? Select all that apply.

Plastic tea set Mold and clay Play telephone

After tolerating an oral rehydration solution (Pedialyte) being given because of dehydration resulting from diarrhea, a 20-month-old toddler's condition improves and a regular diet is started. What foods should the nurse suggest that the parents offer their child? Select all that apply.

Poached eggs Strained carrots Animal crackers

The nurse is assessing a toddler with a diagnosis of pinworms. What complication of pinworm infestation, although rare, should the nurse be aware of?

Appendicitis

A nurse notes that a child is exhibiting signs of cerebral palsy. At what age are these signs usually first noticeable?

12 months

When planning long-term care for a 2-year-old child with cerebral palsy (CP), it is important for the nurse to consider that:

CP is not progressively degenerative.

The mother of a 2½-year-old child is concerned about how to handle temper tantrums. The nurse replies that tantrums:

Can be reduced with the provision of a less stressful environment

During a nap, a 3-year-old hospitalized child wets the bed. What is the best response by the nurse?

Change the child's clothes without discussing the incident.

A nurse in the child life center is evaluating a 15-month-old toddler's ability to perform physical tasks. What behavior indicates to the nurse that the child's development is age appropriate? Select all that apply.

Drinking from a cup Walking with a wide-based gait Throwing toys around the room

A toddler is admitted to the pediatric unit with a temperature of 103.5° F (40.0° C), a runny nose, and a productive cough. Respiratory secretion specimens are sent for culture and sensitivity tests. Standard precautions are followed until the results are known. What other precautions should the nurse include? Select all that apply.

Droplet Contact Airborne

A 2½-year-old child is admitted to the hospital with deep partial-thickness burns involving the face and chest. The nurse bases a plan of care on concerns related to the child's injury. Place the following concerns in their order of importance.

Impaired gas exchange Presence of pain Disturbed fluid balance Potential for infection Compromised body image

A 16-month-old toddler has had large, frothy, foul-smelling stools since the introduction of table foods and is irritable and apathetic. The child is diagnosed with celiac disease and a gluten-free diet is prescribed. What response does the nurse anticipate in the child after 2 days on the diet?

Improved behavior

A 1-year-old child has a congenital cardiac malformation that causes right-to-left shunting of blood through the heart. What clinical finding should the nurse expect?

Increased hematocrit

The nurse is giving discharge instructions to the parents of a toddler who had a myringotomy. The nurse tells them about which most common complications associated with this surgery? Select all that apply.

Lack of drainage Increasing ear pain

What should a nurse offer a 3-year-old child to help occupy time while in the hospital?

Lunch box filled with plastic figures

What toys should a nurse offer a young toddler during hospitalization? Select all that apply.

Pounding toy Carton of clay

A toddler undergoes the implantation of a low-profile (skin-level) device (button) for a gastrostomy. The gastrostomy is now healed, and the parents are being taught to care for the stoma. What parental behavior indicates to the nurse that additional teaching is needed?

The button is being maintained in the same position within the stoma.

The nurse manager of a home health care agency is teaching a group of nursing assistants about pica. Which age group is most likely to engage in this practice?

Toddlers

A 2-year-old child is admitted to the pediatric unit with a diagnosis of thalassemia major (Cooley anemia). The parents are told that there is no cure but the anemia can be treated with frequent blood transfusions. The father tells the nurse he is glad that there is a treatment that "fixes" his child's problem. Before responding, the nurse should recall that blood transfusions:

Correct the anemia but may cause other problems

When reviewing the results of a toddler's complete blood count, a nurse concludes on the basis of decreased hemoglobin and hematocrit levels that the child has iron-deficiency anemia. Which other laboratory findings are indicative of iron-deficiency anemia? Select all that apply.

Microcytic red blood cells Slightly reduced reticulocyte count

A nurse is obtaining a health history from the parents of a toddler who has recently diagnosed acute lymphocytic leukemia. Which early physiologic changes does the nurse expect the parents to report? Select all that apply.

Pale skin Eating less food Purplish spots on the skin

A toddler who was admitted in acute respiratory distress is now resting quietly. The parents tell the nurse that they must leave. What should the nurse suggest that the parents do?

Plan to visit the child as frequently as possible. Plan to visit the child as frequently as possible.

A toddler has just had a cast applied for a fractured wrist. The wrist and elbow are immobilized. What information should the nurse include in the home care instructions before discharge? Select all that apply.

Report swelling of fingers. Elevate casted arm when the child is standing.

An emergency tracheotomy is performed on a toddler in acute respiratory distress from laryngotracheobronchitis (viral croup). What early signs of respiratory distress indicate that it is necessary for the nurse to suction the tracheotomy? Select all that apply.

Restlessness Increased pulse rate

When assessing a toddler with autism, what characteristic findings or behaviors should the nurse expect? Select all that apply.

Sad, blank facial expression Inability to maintain eye contact

A 3-year-old child is admitted to the pediatric unit with a hemoglobin level of 6.4 g/dL. What should the nurse's priority assessment be?

Signs of cardiac decompensation

A toddler who has undergone cleft palate repair is now able to tolerate fluids. What should the nurse use to offer the toddler fluids?

Small cup

A nurse knows that play is an integral part of a child's social development. Place in order the types of play children engage in as they get older.

Solitary play Parallel play Dramatic play Peer group team play Competitive team play

A nurse is teaching a group of assistants in a daycare center about toddlers' developmental milestones. What behavior should indicate to the assistants that one of the milestones has been achieved?

Accepting external limits

During the second week of hospitalization for intravenous antibiotic therapy, a 2-year-old toddler whose family is unable to visit often smiles easily, goes to all the nurses happily, and does not express interest in the parent when the parent does visit. The parent tells the nurse, "I'm so happy he's adjusting, but should I be worried about his reaction to seeing me?" What is the best response by the nurse?

The child is repressing feelings for the parent.

A 2-year-old child with developmental dysplasia of the hip has a spica cast applied. The mother asks the nurse how to keep the cast clean. How should the nurse respond?

"Place plastic wrap or duct tape around the perineal edges of the cast."

A nurse is assessing an 18-month-old toddler with suspected developmental dysplasia of the left hip. In what position should the nurse place the toddler to elicit the Trendelenburg sign?

Standing on the affected leg

A toddler on the pediatric unit is required to have temporary dietary restrictions after colorectal surgery. What is the best way for the nurse to promote adherence to the restrictions?

By handling dietary changes in a matter-of-fact way

A toddler who swallowed drain cleaner is hospitalized for observation because of the risk for vomiting and aspiration. Over the next 24 hours the child does not exhibit any respiratory distress and does not vomit. At discharge the nurse emphasizes that the parents should monitor their child for the onset of:

Gagging and vomiting

A 13-month-old child is admitted with a tentative diagnosis of bacterial meningitis, and the practitioner schedules a lumbar puncture. What is the most important action the nurse should take in preparation for the lumbar puncture?

Asking the parents what they were told about the test

Which of the following signs are indications of hydration status during a sickle cell crisis? Select all that apply.

Turgor of tissue Texture of mucous membranes

In addition to hepatitis B, pneumococcal, H. influenza type B, and varicella vaccines, what should the nurse expect a 20-month-old child who has been receiving immunizations on schedule to have had?

Four DTaPs, three IPVs, and one MMR

The nurse observes a 2-year-old child at play and concludes that the child is engaging in age-appropriate behavior for a toddler. Which activities lead the nurse to this conclusion? Select all that apply.

Is possessive of toys Follows simple directions

A nurse is assessing a toddler and the family dynamics of the child's family, in which abuse is suspected. What behaviors are expected? Select all that apply.

The child cringes when approached. The child has unexplained healed injuries. The child lies still while surveying the environment.