Pediatrics Chapter 4 PrepU
What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? a. "I give my daughter juice at breakfast and when she is thirsty during the day." b. "She drinks three 6-ounce cups of whole milk each day." c. "When she doesn't eat well at meals we give her nutritious snacks." d. "New foods are offered along with ones she likes."
a. "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.
Parents and their nearly 3-year-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? a. Uses two-word sentences or phrases b. Talks about a past event c. Half of speech understood by outsider d. Asks "why" often
a. Uses two-word sentences or phrases 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.
The nurse is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem? a. has persistent separation anxiety b. goes from calm to tantrum suddenly c. sucks his thumb periodically d. is unable to share toys with others
a. has persistent separation anxiety Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might an emotional problem. Emotional lability, self-soothing by thumb sucking, or the inability to share are common for this age.
The nurse is caring for an 18-month-old child who has had surgery. The medical record indicates the child weighs 23 pounds (10.45 kg). When monitoring his urinary output the nurse is aware that normal hourly output should be what value? a. 5 ml/hr b. 10 ml/hr c. 15 ml/hr d. 20 ml/hr
b. 10 ml/hr The normal urinary output for a toddler is approximately 1 ml/kg/hr. This child weighs 23 pounds. This is 10.45 kg. This is approximately 10 ml/hr.
The nurse is educating a parent regarding child safety for the 14-month-old toddler. What would the nurse include in the educational plan? a. If the child reaches to touch a firearm, gently slap the child's hand and firmly state 'No.' b. Assure there are no empty buckets in the home/play area that could result in accidental drowning. c. Utilize a front-facing car seat with appropriate harness straps until at least the age of 24 months. d. Maintain supervision when the child is near stoves, ovens, irons and other hot items the child could reach.
d. Maintain supervision when the child is near stoves, ovens, irons and other hot items the child could reach. Toddlers are more mobile and curious, leading to accidental burns on stoves, ovens, irons etc. They must be supervised when near these objects to avoid burns. If firearms are in the home, they should be unloaded and locked in a secure location. Educating the toddler about firearm safety will not be remembered and is appropriate for a much older child. Buckets are a danger to toddlers (who are top heavy) if they have water in them and could result in a drowning. Empty buckets are not a drowning concern. Children are to be placed in a rear-facing car seat until 2 years of age, not a front-facing one.
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. "It is normal for children to engage in play alongside other children at this age." b. "Has your child displayed any aggressive tendencies toward other children?" c. "Perhaps you should consider a preschool to promote more socialization opportunities." d. "Does your child have opportunities to socialize much with other children?"
a. "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.
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? a. Learning to trust b. Learning to speak c. Learning to act on one's own d. Learning to understand and respond to discipline
c. Learning to act on one's own 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 mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds him daily but is thinking of weaning him soon. How should the nurse respond to this mother? a. "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." b. "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 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."
a. "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." 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 that 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.
A nurse is discussing safety measures with the parents of a toddler. What would the nurse emphasize to address the most frequent type of accident in toddlers? a. "Keep all cleaning products and drugs out of the reach of your child." b. "Turn the handles of your pots away from the edge of the stove when cooking." c. "Make sure to have your child securely fastened in a car seat." d. "Have your child wear a helmet when beginning to ride a tricycle."
a. "Keep all cleaning products and drugs out of the reach of your child." Although all the instructions are important, accidental ingestions (poisoning) are the most frequent accident in toddlers. Therefore, it is imperative to focus on keeping all poisonous substances, drugs, and small objects securely out of the reach of children. Burns, motor vehicle accidents, and falls such as from a tricycle occur frequently in toddlers. However, they occur less frequently than poisonings.
During a well-child visit, the nurse observes the child saying "no" to her mother quite frequently. The mother asks the nurse, "How do I deal with her saying no all the time?" What would be appropriate for the nurse to suggest? Select all that apply. a. "Limit the number of questions you ask of her." b. "Make a statement instead of asking a question." c. "Offer her two options from which to choose." d. "Use time-out every other time she tells you no." e. "Offer her something she would like, such as ice cream, to distract her."
a. "Limit the number of questions you ask of her." b. "Make a statement instead of asking a question." c. "Offer her two options from which to choose." A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. In addition, using statements instead of asking questions and giving the child a choice of two options are effective. Using time-out is a discipline measure and would be inappropriate to counteract a toddler's negativism. Offering a choice rather than a bribe such as ice cream is more effective and long-lasting for modifying the child's behavior.
During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy? a. "My toddler uses the potty chair and is dry all day long." b. "When my toddler falls down, they always wants me to pick them up." c. "My toddler has temper tantrums when we go to the store." d. "Every night my toddler follows the same routine at bedtime."
a. "My toddler uses the potty chair and is dry all day long." During the toddler years, the toddler separates from his or her parents, recognizes one's 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 the toddler expresses 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.
A group of caregivers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is appropriate related to this form of discipline? a. "When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." b. "My child is 3 years old now and I put my child in time-out for 5 to 10 minutes when misbehaving." c. "Our time-out chair is in the master bedroom so my child cannot see anyone else in the family." d. "We use the time-out chair when our child gets tired but does not want to take a nap."
a. "When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." A method for a young 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 ages of young children.
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.
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 toddler have brought the toddler into the emergency department because of a seizure. During the health history, the nurse learns that the toddler was frustrated and angry immediately preceding the seizure. The nurse suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding? a. A tantrum preceded the event. b. The event took place during a nap. c. The toddler was lethargic afterward. d. The toddler became unconscious.
a. A tantrum preceded the event. Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the toddler 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.
The nurse is assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern? a. Ability to turn door knobs b. Put shapes into matching openings c. Able to use a spoon to self-feed d. Ability to hold a crayon to write
a. Ability to turn door knobs Turning knobs opens doors and may allow the child access to the outdoors or unsafe areas within the home. Close to follow will be the ability to unscrew lids, creating poisoning risks. The other abilities promote growth and development and involve lesser safety hazards.
What advice should the nurse provide the parent of a toddler, regarding how to handle temper tantrums? a. Appear to ignore the toddler b. Distract the toddler with a toy when the toddler begins holding the breath c. Promise the toddler a special activity if the toddler will stop d. Mimic the toddler's behavior by also holding the breath
a. Appear to ignore the toddler Temper tantrums are the natural result of frustration that toddlers have. Toddlers do not behave badly on purpose. They need time and maturity to learn the rules and regulations. During a temper tantrum, the advice is for the parent to ignore the behavior but ensure the toddler is safe. Rewarding temper tantrums can teach the toddler that tantrums are an effective method of interaction. Ignoring tantrums teaches the toddler that tantrums are ineffective. The parent needs to use self-control when dealing with a temper tantrum. This is a way to model acceptable behavior for the toddler.
The parent of a 2-year-old toddler tells the nurse she needs 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? a. Deficient parental knowledge related to inappropriate method for toilet training b. Excess fluid volume related to inability to control urination c. Ineffective coping related to lack of self-control of 2-year-old toddler d. Total urinary incontinence related to delayed toilet training
a. Deficient parental knowledge related to inappropriate method for toilet training 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 toilet 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 toilet on time.
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.
Parents discuss with the nurse their 2-year-old toddler's temper tantrums. Which technique would the nurse suggest? a. Ignore the toddler's behavior. b. Inform of punishment if the toddler continues. c. Promise a reward if the toddler behaves. d. Use short "time-outs" and remain calm.
a. Ignore the toddler's behavior. When a toddler has a temper tantrum, the parent's best course of action is to ignore the behavior and ensure that the child is safe during the tantrum. Physical punishment will probably just prolong the tantrum and may produce more intense negative behavior. If the tantrum occurs in public, it may be necessary for the parent to remove the toddler from the situation, using a calm voice to soothe the toddler. It is very important for parents to model self-control. One exception to the rule is that biting and hitting should never be ignored and should be disciplined with a time-out.
A group of students is reviewing material about ways parents can help to foster a child's self-esteem. The students demonstrate a need for additional studying when they identify which method as promoting self-esteem? a. Limiting the choices and decisions that the child makes b. Showing respect and support to the child c. Acting as a coach rather than a cheerleader d. Using positive reinforcement while limiting criticism
a. Limiting the choices and decisions that the child makes To promote self-esteem, parents should praise the child's achievements, show respect and support to the child, allow the child to make decisions, listen to the child, and spend time with the child. The parents need to be a coach to the child rather than just a cheerleader who merely praises accomplishments.
Once a temper tantrum has started, which intervention is appropriate? a. Move objects out of the way or move the toddler to prevent injury. b. Speak to the toddler during the tantrum. c. Engage the toddler's behavior. d. Have a long talk with the toddler regarding the tantrum.
a. Move objects out of the way or move the toddler to prevent injury. Temper tantrums are a normal part of the toddler years. Toddlers are very inquisitive and do not know boundaries. They need time and maturity to learn the rules. During the tantrum, it is most important to keep the toddler safe. Appropriate interventions include moving objects out of the way or moving the toddler to prevent injury from occurring. The caregiver should not speak to the toddler and should avoid eye contact until the toddler has calmed down. The toddler's behavior should not be engaged. The caregiver should not talk excessively about the tantrum, because this can negatively impact the toddler's self-esteem.
The caregivers of a 2-year-old are concerned the child is not learning how to share and play well with other children. While acknowledging their concern and devotion, the nurse should point out which activity would be best for this child's developmental level? a. Mowing the lawn with a toy lawnmower b. Looking at large print magazines c. Sharing finger paints and painting with the caregiver d. Throwing a baseball-sized ball
a. Mowing the lawn with a toy lawnmower Toddlers enjoy talking on a play telephone. They like pots, pans, and toys such as brooms, dishes, and lawnmowers that help them imitate the adults in their environment and promote socialization. Toys that involve the toddler's new gross motor skills, such as push-pull toys, rocking horses, large blocks, and balls are popular. Fine motor skills are developed by use of thick crayons, modeling clay, finger paints, wooden puzzles with large pieces, toys with pieces that fit into shaped holes, and cloth books. The toddler will not be interested in sharing toys until the later stage of toddlerhood; adults should not make an issue of sharing at this early stage.
The parents of a 2-year-old boy report to the nurse that their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child? a. Offering a variety of foods along with the foods the child likes. b. Assuring the parents that food jags are normal, and they can be honored safely. c. Advising the parents to minimize distractions at mealtime. d. Encouraging the parents to eat a variety of wholesome foods themselves.
a. Offering a variety of foods along with the foods the child likes. Toddlers require fewer calories proportionately than infants, and their appetite decreases (physiologic anorexia). Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods. Prolonged preferences for particular foods (food jags) are common. It is also important that mealtime be calm, pleasant, and focused on eating. Toddlers mimic behaviors observed. It is important that parents set a good example with their mealtime behaviors and food choices. All options encourage the development of healthy eating habits, but at this time, variety plus preferred foods will be most helpful.
The nurse is discussing proper discipline with the parent of a 15-month-old toddler. Which teaching is most important? a. Physical punishment such as spanking is discouraged. b. Toddlers are unable to follow instructions easily. c. Rules and limits should be simple and few. d. Only use praise after the child has corrected a wrong behavior.
a. Physical punishment such as spanking is discouraged. Because toddlers younger than 18 months of age are at increased risk for physical injury from spanking than other children, the nurse should prioritize discouraging its use. The American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners recommend against corporal or physical punishment, which includes spanking. The other teachings describe toddler characteristics accurately and are basic to good discipline, but are not the most important for this young toddler.
A mother of a 2-year-old asks the nurse, "What would be a good between-meal snack?" What foods would be appropriate for the nurse to suggest? Select all that apply. a. Pieces of apples b. Orange slices c. Cheese d. Cookies e. Yogurt
a. Pieces of apples b. Orange slices c. Cheese d. Cookies e. Yogurt Good choices for between-meal snacks include fruits (e.g., pieces of apples or orange slices) and high-protein foods (e.g., cheese or pieces of chicken). Cheese as well as yogurt provide calcium. Cookies and other high-carbohydrate foods should be avoided because they promote dental caries.
Which gross motor developmental milestone is least likely for a 2-year-old? a. Rides a tricycle b. Jumps in place c. Climbing stairs with assistance d. Stands on one foot with help
a. Rides a tricycle Gross motor developmental milestones for a 2-year-old include jumping in place, standing on tiptoes, kicking a ball, and running. At 3 years old, the child should be able to pedal a tricycle, run easily, and walk up and down the stairs with alternate feet. At 12 to 18 months of age, the child should be able to stand on one foot with help, walk independently, climb the stairs with assistance, and pull toys.
A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply. a. Round foods such as hot dogs, whole grapes, and cherry tomatoes b. Hard foods such as nuts, raw carrots, and popcorn c. Sticky foods like peanut butter alone, gummy candies, and marshmallows d. Vegetables such as corn, green beans, and peas e. Fruits such as peaches, pears, and kiwi
a. Round foods such as hot dogs, whole grapes, and cherry tomatoes b. Hard foods such as nuts, raw carrots, and popcorn c. Sticky foods like peanut butter alone, gummy candies, and marshmallows To offer soft round foods safely, cut hot dogs in uneven pieces and cut grapes and cherry tomatoes into quarters. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits.
The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child? a. The child demonstrates separation anxiety. b. The child imitates the nurse in use of a stethoscope. c. The child copies a circle on a piece of paper. d. The child follows directions when made one at a time.
a. The child demonstrates separation anxiety. The child should be past the stage of separation anxiety by age 3 years. Imitating actions, copying a circle on paper, and responding to single requests are developmentally appropriate.
The nurse is examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development? a. The child does not use the names of familiar objects. b. The child repeats what the parents say out of context and at random moments. c. The child does not speak clearly but shows understanding of what is said. d. The child puts together sentences of two words.
a. The child does not use the names of familiar objects. By 24 months most children will name objects familiar to them in their daily lives. Not doing so is strong evidence that a speech delay may exist. Repeating words heard or phrases out of context (echolalia) is normal and a way to practice words and incorporate them in the vocabulary. At 2 years, most children understand much more than they can clearly repeat. Using two-word sentences is a developmental expectation at this age.
A parent is concerned because the toddler refuses to share. What is the nurse's best response to the parent regarding this concern? a. This is normal toddler behavior; sharing is learned later. b. Behavior modification techniques can change the toddler's behavior. c. Play time with other toddlers should be cut back until your toddler learns to share. d. The toddler is probably reacting to some family crisis.
a. This is normal toddler behavior; sharing is learned later. 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 activities 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.
During a well-child visit to the health care provider, the parent reveals a family struggling with the changes from their "sweet, cuddly 16-month-old child" to that of a negative, more aggressive 2-year-old toddler. After the clinic visit, the nurse will document which priority nursing focus for this visit? a. ready for enhanced family coping b. potential risk for child abuse c. malfunctioning family coping d. impairment in family's resilience
a. ready for enhanced family coping The most appropriate nursing focus would be that the family is ready for enhanced family coping related to the parents' ability to adjust to the new needs of the toddler. There is no indication that the other issues require a nursing action.
A mother expresses surprise to the nurse that her daughter has begun masturbating. The most important initial nursing response is that: a. this is a normal and expected activity best treated matter-of-factly. b. girls as well as boys will masturbate. c. toilet teaching places much focus on the genitals. d. there may be undue stress in your child's life.
a. this is a normal and expected activity best treated matter-of-factly. Masturbation is a normal event to be done in private. Calling attention to the behavior may increase the frequency. Both girls and boys masturbate, and toilet teaching calls attention to the genital area. These two statements are accurate information but not the best first response. Excessive or public masturbation points to stress.
After teaching the mother of a 13-month-old boy about suggestions for bathing and hygiene, the nurse determines that the teaching was successful when the mother states: a. "I'll wash his hair everyday with just plain soap." b. "It might be best to give him a bath in the evening." c. "I'll drain the tub while he's still in it so he won't fall." d. "I can use bubble baths to lure him into the tub."
b. "It might be best to give him a bath in the evening." The young child's increased activity level necessitates bathing daily or every other day. A good time to bathe the child is after eating, either after breakfast or in the evening. Hair is washed two to three times per week with a mild shampoo. Bubble baths should be avoided, to prevent urethral irritation and possible development of cystitis. Some children may have fears associated with bathing such as being afraid of being sucked down the plug hole. In this case, do not drain the tub until the child is out of the room.
The parents of a toddler ask the nurse, "We are so frustrated. It seems like our child has temper tantrums all the time. What can we do?" Which response by the nurse is appropriate? a. "It is important to show the child who is in control." b. "Stay calm and nearby then once it is over, try to distract your child." c. "Try reasoning with your child when the tantrum starts." d. "When your child gets like this, it is best to give into what the child wants."
b. "Stay calm and nearby then once it is over, try to distract your child." Temper tantrums, aggressive displays of temper during which the child reacts with rebellion to the wishes of the family caregiver, spring from the many frustrations that are natural results of a child's urge to be independent. Add to this a child's reluctance to leave the scene for necessary rest, and frequently the frustrations become too great. The child is out of control and needs help regaining control. A trusted person who remains calm and patient needs to be nearby until the child gains self-control. In addition, the adult must maintain self-control to reassure the child and provide security. Showing the child who is in control would only further add to the child's frustrations. Trying to reason with the child, scolding the child, or punishing the child during a tantrum is useless. After the tantrum is over, the parent may divert attention with a toy or some other interesting distraction, which can help the child relax. However, the parent should not yield the point or give in to the child's whim.
A mother of a toddler asks the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate? a. "Most children are ready for toilet training by the time they are 18 months old." b. "You'll probably notice that your daughter is uncomfortable in wet diapers." c. "Don't worry, your daughter will probably give you very definite signals." d. "Your daughter can understand holding urine and stool by about 1 year of age."
b. "You'll probably notice that your daughter is uncomfortable in wet diapers." The markers of readiness for toilet training are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. Although the rectal and urethral sphincters are mature by the end of the first year, children are not cognitively and socially ready. In fact, many children do not understand what is being asked of them until they are 2 or even 3 years old.
A 3-year-old child is hospitalized. The parents are concerned because the child is now refusing to use the potty and is wetting the bed even though the child has achieved toilet training. Which response by the nurse is most appropriate? a. "Do not worry. This is a normal response to being in the hospital." b. "Your child is experiencing regression as a result of stress." c. "Once discharged, your child will quickly learn to use the toilet again." d. "Why do you believe your child is refusing to use the potty?"
b. "Your child is experiencing regression as a result of stress." Regression is a change from present behaviors to past developmental levels of behavior. This is a normal response among children during times of intense stress, such as a hospitalization or the birth of a new sibling. The nurse should not tell the parents not to worry. The child will not have to learn to use the toilet again. The behavior is already learned. Asking why is not a therapeutic form of communication and may cause the parents to become unnecessarily defensive.
The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson? a. Initiative versus guilt b. Autonomy versus shame and doubt c. Trust versus mistrust d. Industry versus inferiority
b. Autonomy versus shame and doubt Erikson defines the toddler period as a time of autonomy versus shame and doubt. Erikson defines Initiative versus guilt as the preschool period. Erikson defines trust versus mistrust as the infancy period and industry versus inferiority as the school age period.
The nurse is teaching a mother of a 1-year old girl about weaning her from the bottle and breast. Which recommendation should be part of the nurse's plan? a. Wean from breast by 18 months of age at the latest. b. Give the child an iron-fortified cereal. c. Switch the child to a no-spill sippy cup. d. Wean from the bottle at 15 months of age.
b. Give the child an iron-fortified cereal. The nurse would be sure to tell the mother to feed her child iron-fortified cereal and other iron-rich foods when she weans her child off the breast or formula. Weaning from the breast is dependent upon the mother's need and desires with no set time. Weaning from the bottle is recommended at 1 year of age in order to prevent dental caries. Use of a no-spill sippy cup is not recommended because it too is associated with dental caries.
Which action is appropriate to enhance a toddler's self-esteem? a. Utilize belittling techniques as opposed to time-outs. b. Include the child in activities that interest the adult. c. Utilize negative criticism as well as positive reinforcement. d. Avoid applauding for unsuccessful attempts.
b. Include the child in activities that interest the adult. Parents who give the toddler love and respect regardless of the child's gender, behavior or capabilities are helping to lay the foundation for self-esteem. Toddlers need familiarity with the daily routine to enhance self-esteem development. Routines and rituals not only help develop self-esteem but help develop a conscience. Strategies for enhancing self-esteem encompass including the child in activities that interest the adult. Belittling techniques should not be used. Negative criticism should be avoided. Applauding for unsuccessful attempts as well as successes should be reinforced.
A nurse is assessing a 2-year-old's language development. What would the nurse expect to assess? a. Verbalization of 4 to 6 words b. Use of a two-word noun-verb sentence c. Knowledge of full name d. Ability to name one color
b. Use of a two-word noun-verb sentence A 2-year-old should be able to say a two-word sentence that consists of a noun and verb. A 15-month-old can say 4 to 6 words. A 30-month-old knows his full name and can name one color.
The nurse is preparing a presentation for a health fair which will illustrate various ways to help introduce siblings to a new member of the family. Which suggestion should the nurse prioritize to help older siblings, especially toddlers, understand the change in the family dynamics? a. Plan time for the secondary caregiver to focus on the toddler while the primary caregiver focuses on the infant. b. Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. c. Have a grandparent or another special adult in the child's life take the toddler on an errand or a special visit. d. Move the toddler to a new bedroom with a "grown-up-bed."
b. Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. The secondary caregiver can occasionally take over the care of the new baby while the mother or other primary caregiver devotes herself to the toddler. The primary caregiver might also plan special times with the toddler when the new infant is sleeping and the caregiver has no interruptions. This approach helps the toddler feel special. Moving the older child to a larger bed lets the toddler take pride in being "grown up" now, but it should be done some time before the new baby appears. While acknowledging that time with another adult can be a special time, the main concern is for the toddler to understand they are not being replaced by the newest member of the family.
The nurse is supervising a play group of children on the unit. The nurse expects the toddlers will most likely be involved in which activity? a. Pretending to be mommies and daddies in the play house b. Playing with the plastic vacuum cleaner and pushing it around the room c. Painting pictures in the art corner of the room d. Watching a movie with other children their age
b. Playing with the plastic vacuum cleaner and pushing it around the room Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.
The parents of a toddler are asking the nurse if their child is lagging behind since the child does not have a very large vocabulary at the present time. Many times their toddler just points to an object and the parents give it to the toddler. Which concepts/statements should the nurse share with this family about language development of a toddler? Select all that apply. a. When the child points to an object, wait and make the child name the object before giving it to him or her. b. Reinforce language by voicing a request, "You want the apple?" c. If the child asks, "Why?" be sure to give him or her a full explanation since the child is showing initiative. d. Read aloud to the toddler to help build and strengthen vocabulary by pointing to pictures in the book. e. Since toddlers imitate what they hear, use good grammar and incorporate pronouns like "I" and "you."
b. Reinforce language by voicing a request, "You want the apple?" d. Read aloud to the toddler to help build and strengthen vocabulary by pointing to pictures in the book. e. Since toddlers imitate what they hear, use good grammar and incorporate pronouns like "I" and "you." The nurse should urge parents to encourage language development by naming objects (e.g., ball, block, music box, doll) as they play and while reading a book with their child. To assess whether parents are encouraging language development, the nurse should ask them what happens when the child wants something (for example, point to an object). Do they provide opportunities for the child to ask for things? Children should not be made to name an object before they can have it because their vocabulary is so limited, but parents can reinforce language by voicing the request (e.g., "You want the ball?"). Reading aloud is another effective way to strengthen vocabulary. Pointing to pictures and describing what the picture shows, such as "See Jane throwing the ball?" assists with language development. Because children learn language from imitating what they hear, if they hear examples of bad grammar, they will not use good grammar. Remind parents that pronouns are difficult for children to use correctly; many children are 3 1/2 or 4 years of age before they can separate the different uses of "I," "me," "him," and "her."
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. a. Tantrums at this age can signal the development of an aggression disorder in a toddler. b. Tantrums are a common occurrence for a toddler of this age. c. Maintaining a consistent daily routine can help to reduce tantrums. d. Ignoring the behavior is often helpful in reducing the duration of the tantrum. e. Tapping the toddler on the hands and voicing displeasure in the toddler's actions can successfully interrupt the behavior.
b. Tantrums are a common occurrence for a toddler of this age. c. Maintaining a consistent daily routine can help to reduce tantrums. d. Ignoring the behavior is often helpful in reducing the duration of the tantrum. Temper tantrums can be a frequent occurrence in toddlerhood. Some toddlers are more prone to displaying these behaviors than others. For the toddler who experiences frequent tantrum outbursts, maintaining a consistent schedule for activities is helpful. Tantrum-prone toddlers benefit from consistent nap, meal and play periods. Ignoring the behavior signals to the toddler that the behavior is futile. Avoiding interaction with the toddler having the tantrum is beneficial. Discipline such as spanking, swatting or yelling at the toddler does not reduce the episode and may escalate it.
The nurse is assessing a healthy 2-year-old client. Which assessment finding most concerns the nurse? a. The child can stand on his tiptoes. b. The child speaks in one-word sentences. c. The child has difficulty with stairs. d. The child is pointing to named body parts.
b. The child speaks in one-word sentences. A 2-year-old child not using at least two-word sentences is a sign of a potential developmental delay. Normal development for a 2-year-old child is standing on tiptoes and pointing to named body parts. Having difficulty with stairs is considered a potential delay in a 3-year-old, not a 2-year-old child.
When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old toddler? a. The toddler should say two words plus "ma-ma" and "da-da." b. The toddler should speak in two-word sentences ("Me go"). c. The toddler should be able to count out loud to 20. d. The toddler should say 20 nouns and 4 pronouns.
b. The toddler should speak in two-word sentences ("Me go"). A toddler can understand language and is able to follow commands far sooner than he or she 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 the 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.
A nurse is presenting a class on toilet training to a group of parents with toddlers. Which information would the nurse include in the class? Select all that apply. a. Allowing at least 6 weeks to prepare the child psychologically for the training b. Using training pants that slide down easily and quickly c. Praising the child when he or she urinates or defecates d. Keeping the child on the potty chair for as long as necessary e. Putting the child on the potty chair at regular intervals during the day
b. Using training pants that slide down easily and quickly c. Praising the child when he or she urinates or defecates e. Putting the child on the potty chair at regular intervals during the day For effective toilet training, parents should allow 1 to 2 weeks to psychologically prepare the child for training, using training pants that slide down easily and quickly, praising the child when he or she urinates or defecates, limiting the time spent on the potty chair to no longer than 10 minutes (or less if the child is resistant), and putting the child on the potty chair at regular intervals during the day.
A 3-year-old child is seen at the clinic for a checkup. When collecting information, the child's parent reports concern about the child's stools because sometimes the child passes what appears to be undigested food. What response by the nurse is appropriate? a. "Why are you concerned about this?" b. "Your child may be eating foods that are too harsh or difficult to digest." c. "At this age, the digestive tract is not completely mature and children may pass undigested food." d. "Do you notice other symptoms, such as pain or straining, when this happens?"
c. "At this age, the digestive tract is not completely mature and children may pass undigested food." The digestive systems of 3-year-old children are not fully mature and they may sometimes pass pieces of undigested food. This is a normal occurrence. The reason for this occurrence should be explained to the child's parent. When the nurse asks the parent "Why," this is demonstrating poor therapeutic communication skills and will cause the parent to become defensive. The symptoms of pain or straining would be indicative of constipation, not passing undigested food. There is no indication that the diet being ingested is not appropriate.
The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem? a. "He wasn't bothered by the paint smell." b. "He was licking the dishwashing soap." c. "He doesn't respond if I wave to him." d. "I dropped a pan behind him and he cried."
c. "He doesn't respond if I wave to him." The fact that the child does not respond when the mother waves to him suggests he may have a vision problem. The toddler's sense of smell is still developing, so he may not be affected by odors. Their sense of taste is not well developed either, and this allows him to eat or drink poisons without concern. The child's crying at a sudden noise assures the nurse that his hearing is adequate.
By what age should the child know his/her own gender? a. 1 year b. 2 years c. 3 years d. 4 years
c. 3 years Toddlers observe differences in both male and female body parts. They question their parents about the differences. By 3 years of age, toddlers can say their name, their age and their gender. This age group begins to understand and mimic social gender differences. A 1-year-old or 2-year-old child would be too young to make this distinction because these children are just identifying their own body parts. By 4 years of age the child should be able to identify body parts. If not, there may be some delay with the child.
A single mother with three young children is reluctant to leave her crying and upset 16-month-old daughter overnight in the hospital but needs to go home to care for the other children. Which suggestion from the nurse will best address the fears and concerns of both the child and mother? a. Remind them staying in the hospital now will help the child get well quicker and be home soon, but the other children should not be alone. b. Distract the child with a special blanket, stuffed animal, or other "lovey" from home while the mother quietly slips out. c. Encourage the mother to give the child a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return, such as "when breakfast comes in the morning." d. Tell both the mother and child that the child will be carefully guarded and won't be in as much danger as she might be if she were home exploring her environment.
c. Encourage the mother to give the child a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return, such as "when breakfast comes in the morning." When the family caregiver must leave the toddler, it may be helpful for the adult to give the child some personal item to keep until the adult returns. The caregiver can tell the child he or she will return "when the cartoons come on TV" or "when your lunch comes." These are concrete times that the toddler will probably understand. The toddler is too young to understand that staying is important for her recovery. Distracting the child while the mother leaves may increase the child's anxiety when she realizes her mother is gone. Although the child will be watched closely in the hospital setting, toddlers explore their environment wherever they are.
The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response? a. Some children have large heads but that does not signal a problem. b. Explain that the child looks normal. c. Share that the heads of children at this age are large in proportion to the rest of their body. d. Teach the mother that this larger head than body appearance will be this way until the child is about 6 years old.
c. Share that the heads of children at this age are large in proportion to the rest of their body. Head circumference increases about 1 inch between 1 and 2 years of age, then increases an average of a half-inch per year until age 5. The anterior fontanel (fontanelle) should be closed by the time the child is 18 months old. Head size becomes more proportional to the rest of the body near the age of 3 years.
The nurse is providing anticipatory guidance to the parents of an 18-month-old child. Which recommendation should be the most helpful to the parents? a. When needed, place the child in time out for 1½ minutes. b. Ignore bad behavior until the child is older. c. Slap the hand using one or two fingers if the child hits another. d. Describe proper behavior when the child misbehaves.
d. Describe proper behavior when the child misbehaves. Stopping the child when misbehaving and describing proper behavior sets limits and models good behavior. This will be the most helpful advice to the parents. At 18 months, the child is too young to use time out or extinction (ignoring the child's behavior) as discipline. Slapping the child's hand, even done carefully with two fingers, is corporal punishment, which has been found to have negative effects on child development.
Parents of 3-year-old boy ask the nurse for suggestions on how to deal with their son's nightmares. Which suggestion would be least effective? a. Try reassuring him that it was a dream and not real. b. Search the room to show him that there aren't any monsters. c. Talk to him that night about the details of the dreams. d. Try having him sleep with a night-light on in his room.
c. Talk to him that night about the details of the dreams. When the child has an occasional nightmare, parents should reassure the child that it was just a dream and was not real. Giving lots of hugs and words of reassurance can be supportive. The child may want the parent to search the room to reassure that there are no monsters about. Advise parents to wait until the next morning to talk about the details of the dream, at which time the child should be calmer. The parent should try to determine if there was a specific event or stressor that may have triggered the nightmare. In addition, to decrease nightmares, parents should avoid having the child watch television in the hour before bedtime, avoid telling scary bedtime stories, let the child sleep with a night-light, and examine how to decrease perceived stress in the child's life.
The home health nurse is visiting a 2-year-old client's home. Which finding will cause the nurse to intervene? a. All of the windows in the home are locked. b. The toddler goes to the bathroom alone to urinate. c. The family's medications are located in a kitchen drawer. d. The toddler in not allowed in the kitchen while food is being prepared.
c. The family's medications are located in a kitchen drawer. Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time. This includes keeping all medications in a high, locked cabinet. It is appropriate for all windows to be locked to prevent a toddler from exiting the home out a window. The toddler may go to the bathroom alone once toilet training is well established. Not allowing the toddler in the kitchen during meal preparation will prevent accidental burns from hot foods and surfaces.
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.
The nurse is assessing the language development of a 3-year-old girl. Which finding would suggest a problem? a. makes simple conversation b. tells the nurse she saw Na-Na today c. speaks in 2- to 3-word sentences d. tells the nurse her name
c. speaks in 2- to 3-word sentences If the child is still speaking telegraphically in only 2- to 3-word sentences, it suggests there is a language development problem. If the child makes simple conversation, tells about something that happened in the past, or tells the nurse her name she is meeting developmental milestones for language.
The mother of a 15-month-old son is returning to work and wants to place her son in the day care close to work; however, they will only accept potty-trained children. Which response from the nurse will best address this situation in answering the mother's questions of how best to potty train her son? a. "Encourage your son to watch his older siblings use the toilet." b. "Get your son a potty chair and have him sit on it for a few minutes each day." c. "Each time you change his diaper, tell your son how important and fun it is to use the potty chair." d. "Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained."
d. "Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." To be able to cooperate in toilet training, the child's anal and urethral sphincter muscles must have developed to the stage where the child can control them. Control of the anal sphincter usually develops first. The child also must be able to postpone the urge to defecate or urinate until reaching the toilet or potty and must be able to signal the need before the event. In addition, before toilet training can occur, the child must have a desire to please the caregiver by holding feces and urine rather than satisfying his/her own immediate need for gratification. This level of maturation seldom takes place before the age of 18 to 24 months.
The nurse is teaching the parents of a 2-year-old child how to handle the child's temper tantrums. The nurse determines that the teaching was successful if the parents make which statement? a. "We will offer our child a treat to stop having the tantrum." b. "We will place our child in time-out for 5 minutes after the tantrum." c. "We will attempt to reason with our child to limit tantrums." d. "We will ignore our child while having the tantrum."
d. "We will ignore our child while having the tantrum." The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it. Bribery, such as saying that the child can have a treat if the behavior stops, is rarely effective because by accepting the child's wishes, the parent is encouraging the child to have more tantrums because he or she was successful. Placing the child in time-out does not deal with the actual tantrum. When a child is placed in time-out, the appropriate length is 1 minute per year of age (2 minutes for this child). Tantrums are a result of the child not being able to appropriately express his or her needs, desires, or frustrations. It is not appropriate to attempt to reason with a upset 2-year-old child.
Which is the best way for parents to aid a toddler in achieving the developmental task? a. Urge the toddler to dress oneself completely alone b. Give the toddler small household chores to do c. Help the toddler learn to count d. Allow the toddler to make simple decisions
d. Allow the toddler to make simple decisions 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 father of a toddler reports his son says "no" every time he attempts to correct him. What is the best advice the nurse can offer to the parent? a. This is a normal part of toddlerhood. b. You may need to lessen the amount of correction being given to the child as he seems to be responding to feeling "overly restricted." c. Continue to correct him because he needs discipline. d. Saying no is your son's way of trying to exert his independence and is expected.
d. Saying no is your son's way of trying to exert his independence and is expected. It often seems that "no" is a toddler's favorite word. Saying no is his way of beginning to exert his independence. Telling the parent this is a normal happening does not provide the necessary education to the parent. Saying "no" does not indicate the discipline being provided is too restrictive. Telling the father to continue the discipline does not offer the needed education about his child's behavior and stage of development.
