FINAL PED Chapter 1---> 5

The 18-month-old toddler has most likely attained which gross motor skill? The ability to walk independently. The ability to walk up stairs alone. The ability to balance on one foot. The ability to pedal a tricycle.

The ability to walk independently.

During a well-child visit, the caregiver expresses concern that the 3-year-old child often stutters when speaking. Which response should the nurse prioritize to best assist this family? "Stuttering is common in young children because they are not physically capable of forming all the sounds." "Stuttering is usually indicative of a hearing loss." "Difficulties with speaking generally indicate that the adults in the child's life are not reading to the child enough." "Children of this age may stutter while they search for just the right word."

"Children of this age may stutter while they search for just the right word." etween ages 3 and 5, language development is generally rapid. Most 3-year-old children can construct simple sentences, but their speech has many hesitations and repetitions as they search for the right word or try to make the right sound. Stuttering can develop during this period but usually disappears within 3 to 6 months. Physical capability, hearing loss, or lack of being read to are not reasons stuttering occurs.

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse? "It's okay to start puréed solids at this age if fed via the bottle." "Infants don't require solid food until 12 months of age." "Solid foods should be delayed until age 6 months, when the infant can handle a spoon on his own." "The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods."

"The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods."

The nurse is speaking with the parent of a 4-year-old child. Which statement by the parent would suggest a need for further investigation? "My child loves to play dress-up with friends at day care." "When we go to the park, my child never wants to play with the other children." "I think it is so cute when my child wants to help my spouse with yardwork." "Sometimes I wish my child would play with a toy in the way it was intended. My child is constantly pretending it is something else." "My son loves to follow around his older sister."

"When we go to the park, my child never wants to play with the other children."

A parent takes the 4-month-old infant to the health care provider. The parent asks what type of baby cereal to provide now that the infant is starting solid foods. How should the nurse respond? "You should buy wheat cereal." "You should buy oat cereal." "You should buy rice cereal." "You should buy barley cereal."

"You should buy rice cereal." Explanation: The rice cereal should be first. The infant should be monitored for food allergies by following the rice cereal with oats, barley, and wheat. Wheat has the highest allergy reaction in infants.

A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene? 9-month-old infant who can pull self up to a standing position 14-month-old toddler who walks with a parent's assistance 24-month-old toddler who engages in parallel play 3-year-old preschool-aged child who goes up stairs on hands and knees

3-year-old preschool-aged child who goes up stairs on hands and knees

A nurse is observing a group of 4-year-old children in a play area. What action, when observed by the nurse, would alert the nurse to typical play for this age group? A child plays with a toy while another child sits next to him and plays with a different toy. A child pretends to be a teacher and asked another child to be the pretend student in "class." A child plays alone, with a set of children's kitchen utensils, pots and pans. A group of children play a board game involving matching colored cards to shapes.

A child pretends to be a teacher and asked another child to be the pretend student in "class."

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. A sense of control can be provided through offering limited choices. Aggressive behaviors such as hitting and biting are common in toddlers.

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.

The nurse is assessing the neurological status of a 10-month-old infant. Which finding(s) does the nurse determine to be abnormal when performing this assessment? Select all that apply. A. The infant turns to the right side, searching with mouth, when the right side of the cheek is stroked. B. The infant demonstrates reflexive sucking when nipple or finger is placed in infant's mouth. C. The infant reflexively grasps when the nurse touches the palm. D. The infant fans and extends the toes when the nurse strokes along the lateral aspect of the sole and across the plantar surface of the foot. E. With sudden extension of the infant's head, the arms abduct and move upward and the hands form a "C".

A,B,C, E Explanation: The primitive reflexes (root, suck, palmar grasp, moro) should be absent by 10 months of age. A positive Babinski sign normally persists until 12 months of age so the presence of this sign would be considered a normal finding in the 10-month-old.

The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson? Initiative versus guilt Autonomy versus shame and doubt Trust versus mistrust Industry versus inferiority

Autonomy versus shame and doubt

A 2-year-old is having a temper tantrum. What advice should the nurse give the mother? A.For safety reasons, the toddler should be restrained during the tantrum. B. Punishment should be initiated, as tantrums should be controlled. C. The mother should promise the toddler a reward if the tantrum stops. D.The tantrum should be ignored as long as the toddler is safe.

D.The tantrum should be ignored as long as the toddler is safe.

The parents express concern about their child who has an imaginary friend. The nurse explains that as long as the imaginary friend does not become the center of attention and also the child has real friends, this can be beneficial. What benefits are discussed? Select all that apply. Encourages language development by conversation. Provides an outlet by which the child can express innermost feelings. Protects the child by separating from those who are unkind. Serves as someone to blame or decrease the child's guilt. Helps the child know what is real and what is not.

Encourages language development by conversation. Provides an outlet by which the child can express innermost feelings. Serves as someone to blame or decrease the child's guilt.

The nurse is assessing 2-year-old twins. The parent states, "My twins will not play together, only alongside each other." Which action will the nurse take first? Explain that this is normal behavior for toddlers. Encourage the toddlers to play to allow for observation. Document the finding in the medical records. Determine when this form of play was first noted.

Explain that this is normal behavior for toddlers.

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? Blood pressure Height and weight measurements Clean-catch urine IQ testing

Height and weight measurements

A parent tells a nurse that the child has recently established some friendships for the first time. In which age group do you expect this child to be? Toddler Preschool School age Adolescence

Preschool

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 Tried to refocus the child's attention as tantrum behavioral cues appeared Made sure the child was rested and not hungry before going to the mall 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.

Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior? Crying when left with the sitter may indicate difficulty with building trust. Stranger anxiety should not occur until toddlerhood; this concern should be investigated. Separation anxiety is normal at this age; the infant recognizes parents as separate beings. Perhaps the sitter doesn't meet the infant's needs; choose a different sitter.

Separation anxiety is normal at this age; the infant recognizes parents as separate beings.

During a wellness care visit, the parents of a 2-year-old toddler report that they are struggling to deal with their toddler's daily and increasing number of tantrums. What information should be provided to the parents? Select all that apply. Tantrums at this age can signal the development of an aggression disorder in a toddler. Tantrums are a common occurrence for a toddler of this age. Maintaining a consistent daily routine can help to reduce tantrums. Ignoring the behavior is often helpful in reducing the duration of the tantrum. Tapping the toddler on the hands and voicing displeasure with the toddler's actions can successfully interrupt the behavior.

Tantrums are a common occurrence for a toddler of this age. Maintaining a consistent daily routine can help to reduce tantrums. Ignoring the behavior is often helpful in reducing the duration of the tantrum.

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior? a. The need for separation and control b. The need for love and belonging c. The need for safety and security d. The need for peer approval

The need for separation and control Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.

A nurse is developing a teaching plan for parents of preschoolers about how to address the issue of strangers and safety. Which would the nurse expect to include in the teaching? Select all that apply. Urge children never to talk to or accept a ride from a stranger. Wait until children are old enough to tell them how to call for help in an emergency. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.

Urge children never to talk to or accept a ride from a stranger. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly? a. Telling the child to stop tearing pages from magazines b. Asking the child if he would please quit throwing toys c. Telling the child firmly that we don't scream in the office d. Saying, "Please come over here and sit in this chair. OK?"

a. Telling the child to stop tearing pages from magazines

When is the best age for solid food to be introduced into the infants diet? a. 2 to 3 months c. When birth weight has tripled b. 4 to 6 months d. When tooth eruption has started

b. 4 to 6 months

The best way for an infant's parent to help the child complete the developmental task of the first year is to: expose the infant to many caregivers to help the infant learn variability. talk to the infant at a special time each day. respond to the infant consistently. keep the infant stimulated with many toys.

respond to the infant consistently. Explanation: The developmental task of an infant is gaining a sense of trust. The infant develops this sense from the caretakers who respond to the child's needs, such as feeding, changing diapers, being held. It is a continuous process. A sense of trust is difficult to learn if things are constantly changing. Consistently responding to an infant's needs helps to build a sense of trust. An infant is too young to have variability in caretakers. This causes mistrust. The parents or caretakers do not need a special time to talk to the infant each day. It should be done with each interaction. Providing too much stimulus before the infant develops gross motor skills causes frustration from the child and not enjoyment.

The nurse is assessing the psychosocial development of a preschooler. What are normal activities characteristic of the preschooler? Select all that apply. a. Plans activities and makes up games. b. Initiates activities with others. c. Acts out roles of other people. d. Engages in parallel play with peers. e. Classifies or groups objects by their common elements. f. Understands relationships among objects.

ANS: A, B, C Feedback: The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.

The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer to prevent confrontations? a. "Respond in a calm but firm manner." b. "You need to adhere to various routines." c. "Put her in time-out when she misbehaves." d. "It's important to toddler-proof your home."

ANS: B Feedback: Making expectations known through everyday routines helps to avoid confrontations. This helps the child know what to expect and how to behave. It is the best guidance to give these parents. Calm response and time-out are effective ways to discipline, but do not help to prevent confrontations. Toddler-proofing the house doesn't eliminate all the opportunities for confrontation.

The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week-old baby. Which recommended guideline might be included in the teaching plan? a. Place the baby on a soft mattress with a firm, flat pillow for the head. b. Place the head of the bed near the window to provide fresh air, weather permitting. c. Place the baby on his or her back when sleeping. d. If the baby sleeps through the night, wake him or her up for the night feeding.

ANS: C Feedback: Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age, night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which behavior would warrant nursing intervention? a. The child pretends he is talking to an imaginary friend when the nurse addresses the child. b. The child states that her fairy godmother is going to come and take her home. c. The child starts talking about his grandmother and then quickly changes the subject to a new toy he received. d. The child does not want to play games with other children on the hospital ward.

ANS: D Feedback: The preschooler begins to plan activities, make up games, and initiate activities with others. Not wanting to play games with other children is a sign of a developmental delay and nursing intervention is recommended. The preschooler often has an imaginary friend who serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Through make-believe and magical thinking, preschool children satisfy their curiosity about differences in the world around them. The preschooler uses transduction when reasoning: he or she extrapolates from a particular situation to another, even though the events may be unrelated.

The mother of a 3-year-old is concerned about her child's speech. She describes her preschooler as hesitating at the beginning of sentences and repeating consonant sounds. What is the nurse's best response? Hesitancy and dysfluency are normal during this period of development. Reading to the child will help model appropriate speech. Expressive language concerns warrant a developmental evaluation. The mother should ask her child's physician for a speech therapy evaluation.

Hesitancy and dysfluency are normal during this period of development.

A parent is concerned because the toddler refuses to share. What is the nurse's best response to the parent regarding this concern? This is normal toddler behavior; sharing is learned later. Behavior modification techniques can change the toddler's behavior. Play time with other toddlers should be cut back until your toddler learns to share. The toddler is probably reacting to some family crisis.

This is normal toddler behavior; sharing is learned later.

A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby. Which suggestion should the nurse prioritize to help the mother establish healthy sleeping patterns in her infant? Put the baby to bed at various times of the evening. Let the baby cry during the night and she will eventually fall back to sleep. Use the crib for sleeping only, not for play activities. Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime.

Use the crib for sleeping only, not for play activities. Explanation: A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems. Using the crib for sleeping only helps the child associate the bed with sleep. Depriving the baby of sleep during the afternoon or evening will make the baby over-tired and less able to establish a healthy sleeping pattern. While letting a baby cry for a while is acceptable, this does not promote consistency in the baby's sleeping pattern.

The nurse is watching toddlers at play. Which normal behavior would the nurse observe? a. Toddlers engage in parallel play. b. Toddlers engage in solitary play. c. Toddlers engage in cooperative play. d. Toddlers do not engage in play outside the home.

a. Toddlers engage in parallel play. Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.

When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate? has best friends at preschool and sleepovers begins to show logical thought processes tells a fantasy story about a bear and a car scribbles with no discernable pictures/letters

tells a fantasy story about a bear and a car

The nurse praises a 3-year-old child for using the potty. Which of thefollowing theorists focuses on the satisfaction/frustration of expellingfeces? a. Piaget b. Freud c. Erickson d. Kohlberg

b. Freud - Freud's theory focuses on the satisfaction and/or frustration ofexpelling feces (anal stage). Rationale: Piaget's theory focuses on development of the senses ofthe toddler; Erickson's theory focuses on achievement of autonomyand self-control; Kohlberg's theory focuses on the moral developmentof the toddler.

The nurse is assessing a 5-year-old child for signs of developmentaldelay. Which of the following would alert the nurse to a potentialproblem? a. the child can build a tower of six blocks b. the child does not play with other children c. the child engages in fantasy play d. the child separates from parent easily

b. the child does not play with other children. This is a sign of apotential developmental delay. Rationale: Signs of developmental delay in preschool-age childreninclude not playing with other children, not being able to build a blocktower of six to eight blocks, not engaging in fantasy play, and notseparating from the parent without major protest.

A 2-year-old toddler holds his breath until passing out when he wants something the parent does not want him to have. The nurse would decide whether these temper tantrums are a form of seizure based on the fact that: seizures are not provoked; temper tantrums are. seizures rarely occur in toddlers. seizures typically occur with fever; temper tantrums do not. 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.

A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. The nurse can explain to him that beginning solid foods before 4 to 6 months may: a. Decrease the infants intake of sufficient calories. b. Lead to early cessation of breastfeeding. c. Help the infant sleep through the night. d. Limit the infants growth.

ANS: B Introduction of solid foods before the infant is 4 to 6 months of age may result in overfeeding and decreased intake of breast milk. It is not true that feeding of solids helps infants sleep through the night. The proper balance of carbohydrate, protein, and fat for an infant to grow properly is in the breast milk or formula.

The parents of a 5-year-old tell the nurse that it "seems like our child is afraid of everything from fireworks to butterflies." What actions should the nurse take? Select all that apply. Ask the parents if they can identify anything that may be causing their child be fearful. Encourage the parents to just ignore the fears since this is common behavior with the preschool-aged child. Suggest to the parents to talk with their child about his fears. Work with the parents and child to devise strategies to help deal with the fears. Advise the parents to help the child understand that the fears are irrational.

Ask the parents if they can identify anything that may be causing their child be fearful. Suggest to the parents to talk with their child about his fears. Work with the parents and child to devise strategies to help deal with the fears.

The school nurse is helping parents choose books for their preschoolers. What literacy skills present in the preschooler would the nurse consider when making choices? Select all that apply. a. Preschoolers enjoy books with pictures that tell stories. b. Preschoolers like stories with repeated phrases as they help keep their attention. c. Preschoolers like stories that describe experiences different from their own. d. Preschoolers demonstrate early literacy skills by reciting stories or portions of books. e. Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story. f. Preschoolers do not have enough focus and expanded attention to notice when apage is skipped during reading.

ANS: A, B, D, E Feedback: Preschoolers enjoy books with pictures that tell stories. Stories with repeated phrases help to keep the child's attention. Also, children like stories that describe experiences similar to their own. The preschool child demonstrates early literacy skills by reciting stories or portions of books. He or she also may retell the story from the book, pretend to read books, and ask questions about the story. The preschool child has enough focus and expanded attention to notice when a page is skipped during reading and will call it to the parent's attention.

The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred? a. "I'll start with baby oatmeal cereal mixed with low-fat milk." b. "The cereal should be a fairly thin consistency at first." c. "I can puree the meat that we are eating to give to my baby." d. "Once he gets used to the cereal, then we'll try giving him a cup."

ANS: B Feedback: Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.

A nursing instructor is leading a class discussion exploring the various aspects of Erikson's theories of the developmental tasks of toddlers. The instructor determines the session is successful when the students correctly choose which task as a priority for toddlers? Learning to trust Learning to speak Learning to act on one's own Learning to understand and respond to discipline

Learning to act on one's own Explanation: Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) while overcoming doubt and shame. Erikson's psychosocial developmental task for infants is to develop a sense of trust. Learning to speak and to understand and respond to discipline are not developmental tasks according to Erikson.

A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene? 9-month-old infant who can pull self up to a standing position 14-month-old toddler who walks with a parent's assistance 24-month-old toddler who engages in parallel play 3-year-old preschool-aged child who goes up stairs on hands and knees

3-year-old preschool-aged child who goes up stairs on hands and knees

Which is the best way for parents to aid a toddler in achieving the developmental task? Urge the toddler to dress oneself completely alone Give the toddler small household chores to do Help the toddler learn to count Allow the toddler to make simple decisions

Allow the toddler to make simple decisions Explanation: The toddler years see a refinement of motor skills, continuous cognitive growth, and the acquisition of language skills. During this time the toddler achieves autonomy and self-control. Allowing the child to make decisions is a good way to help the toddler achieve autonomy and gain independence. Rewarding the child for accomplishing the task after making the decision is a good way to reinforce self-esteem. A younger toddler may not successfully dress alone because he or she may not have mastered such techniques as buttons, zippers, or tying shoes. A toddler can help with household tasks but these are generally limited because the toddler's attention span and motor skills may not be refined enough to complete the task. Helping the child learn to count is improving cognitive development but does not necessarily help the child with gaining autonomy or self-control

The nurse is observing 4-year-old twins during their well-child appointment. Which observation by the nurse would indicate the children are demonstrating cooperative play? They competitively stack blocks and keep score of who stacks the highest number of blocks. They play with dollhouse furniture, each with different room furnishings. They are building a house for their dolls with blocks in the room. They sit on the floor, near each other, and look at different picture books.

They are building a house for their dolls with blocks in the room. Explanation: Cooperative play is when children work toward a common goal together, with a distinct theme. The 4-year-old twins demonstrate cooperative play when they build a house with blocks. Associative play occurs when children play together and are engaged in similar activity, but without organization, rules, or a leader, and when each child does what she or he wishes, such as playing with the dollhouse furniture separately. In parallel play, children play alongside each other but independently, such as looking at different picture books. Competing for the most blocks stacked would be an example of competitive play.

The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education? "I will add some crayons, chalk and finger paints to my three-year-old's birthday gifts." "I am so glad I can get rid of all of those bath toys because they take up so much room." "It is okay for my four-year-old to still play in his sandbox." "My four-year-old will be getting a tricycle for her birthday. I'm glad it's a good gift for her."

"I am so glad I can get rid of all of those bath toys because they take up so much room." Explanation: Bath toys that squeak, float and squirt are appropriate toys for preschoolers. Creative toys like crayons, chalk and finger paints; gross motor toys like tricycles, big wheels and swing sets; and a sandbox with shovels and other toys for building are also appropriate toys for preschoolers. (The Nurse's Role in Preschool Growth and Development)