peds 16, , 17 , 18
A 2-year-old child is prescribed mediation to take at home for 2 weeks. The child lives with the parent, grandparent, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take the medication at home. Which will have the greatest impact on the nurse's final assessment? parent's and grandparent's understanding of the medication cleanliness of the home environment health status of the other members of the household location where the medication will be stored
location where the medication will be stored Explanation: The nurse is sent to the home to assess the home environment. An important question that should be asked during the assessment is whether there is a safe place to keep drugs out of the reach of the client and other children. Many drugs have potentially serious adverse and toxic effects in children if taken in incorrect doses. Although factors like health status of other family members, the cleanliness of the house, and the parent's understanding about the medication are important considerations, the most important consideration is the safety of the child who is taking the medication and of the other children.
A mother states that her 2-year-old daughter has difficulty falling asleep at night. Upon further assessment, the nurse learns that the toddler takes a 1-hour nap during the late afternoon. Which should the nurse recommend to the mother? omit or shorten the nap during the afternoon add a second nap, typically in the morning integrate the nap into the lunchtime routine allow a 15-30 minute nap after dinnertime
omit or shorten the nap during the afternoon Explanation: If a child has difficulty falling asleep at night, it may be time to omit or shorten an afternoon nap. Adding a second nap is recommended for toddlers who are short-tempered and tired at dinnertime. Integrating the nap into the lunchtime routine is a recommendation to encourage the toddler to take a nap, which is not needed in this case. Taking a quick nap in the evening is too close to bedtime.
The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's "negativism." Based on Erikson's theory of development, what would be an appropriate intervention for this child? Discourage solitary play; encourage playing with other children. Encourage the child to pick out his own clothes. Use "time-outs" whenever the child says "no" inappropriately. Encourage the child to take turns when playing games.
Encourage the child to pick out his own clothes. Explanation: Erikson defines the toddler period as a time of autonomy versus shame and doubt. It is a time of exerting independence. Allowing the child to choose his own clothes helps him to assert his independence. Negativism—always saying "no"—is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. It should not be punished with "time-outs." The toddler should be encouraged to play alone and with other children. Toddlers cannot take turns in games until age 3.
During a clinic visit, the nurse notes a set of twin toddlers have their shoes on the wrong feet and pants inside-out. The mother states that she, "lets them dress themselves." What is the best response to this mother? "I like to see them developing their independence." "You know that you really should put their shoes on the correct feet to help with walking ability." "Why don't you help them put the items on under your close supervision?" "Be sure to point out the correct way to put on clothing next time, before you take them out in public."
I like to see them developing their independence." Explanation: When toddlers dress themselves, they invariably put shoes on the wrong feet and shirt and pants on backwards. The nurse should encourage parents to give up perfection for the benefit of the child's developing sense of autonomy. The other statements are negative and not appropriate as they criticize the parent for letting the child be independent with dressing themselves.
The nurse is designing a nursing care plan for a toddler with lymphoma who is hospitalized for treatment. What is a priority intervention that the nurse should include in this child's nursing plan? Limiting visitors to scheduled visiting hours Planning physical therapy for the child Introducing the toddler to other toddlers in the unit Monitoring the toddler for developmental delays
Monitoring the toddler for developmental delays Explanation: When the toddler is hospitalized, growth and development may be altered. The toddler's primary task is establishing autonomy, and the toddler's focus is mobility and language development. The nurse caring for the hospitalized toddler must use knowledge of normal growth and development to be successful in interactions with the toddler, promote continued development, and recognize delays. Parents should be encouraged to stay with the toddler to avoid separation anxiety. Planning activities and socialization of the toddler are important, but the priority intervention is monitoring for, and addressing, developmental delays that may occur in the hospital.
The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by a caregiver best indicates a common aspect of the diet and nutrition of the preschool child? "My child is so picky and eats the same thing every day for days on end!" "My 4-year-old eats as much as my teenager does every day." "My spouse is insistent that our 5-year-old not eat any snacks so that he will eat all of his meal at mealtime." "Our child gets into food jags where he will only eat one food all day long."
My child is so picky and eats the same thing every day for days on end!" Explanation: The preschooler's appetite is erratic. At one sitting the preschooler may devour everything on the plate, and at the next meal he or she may be satisfied with just a few bites. Food jags, such as eating the same thing for days on end, are common in the toddler, not the preschooler. Preschooler's are picky eaters. They may eat only a limited variety of foods or foods prepared in only one way. Portions for preschoolers are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. Giving the child non-nutritious snacks may cause the child not to eat at mealtimes. The child eating as much as the adolescent sibling is being set up for obesity.
The nurse is caring for a 3-year-old at a well-child checkup. The parent states that her child still has an afternoon nap but she has a friend whose toddler no longer naps in the afternoon. She is seeking advice on what do to. When providing anticipatory guidance to the parent about sleep patterns, what is the most appropriate response by the nurse? "Children no longer nap in the afternoon after 1 year." "Children begin to give up afternoon napping at 2 years." "Often, the afternoon nap will be no longer needed after 4 years." Since they are in school now all day, napping ends at 6 years.
Often, the afternoon nap will be no longer needed after 4 years." Explanation: Exact duration of a child's daily sleep patterns varies based on temperament, activity levels, and overall health. Around the age of 4, many children discontinue the afternoon nap.
The nurse is discussing proper discipline with the parent of a 15-month-old toddler. Which teaching is most important? Physical punishment such as spanking is discouraged. Toddlers are unable to follow instructions easily. Rules and limits should be simple and few. Only use praise after the child has corrected a wrong behavior.
Physical punishment such as spanking is discouraged. Explanation: 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.
The nurse of a preschool-aged child is helping parents develop a healthy meal plan for their child. What statement, when made by the parents. indicates teaching was successful? "We plan to offer our child food with less iron each day since our child is not in a growth spurt." "We realize our child does well when we offer healthy snacks as rewards for doing the chores." "We know it is fine that our child does not like high fiber foods, since our child only needs about 5 mg per day." "We are going to research the calories in food so our child consumes about 85 kcal/kg each day."
We are going to research the calories in food so our child consumes about 85 kcal/kg each day." Explanation: The nurse would know teaching has been successful when the parents indicate they will offer a daily calorie amount equivalent to 85 kcal/kg of body weight. The preschool-aged child, even though not in a growth spurt compared to infancy and adolescence, is still growing and requires 10 mg of iron each day. The preschool-aged child is recommended to consume 19 mg of dietary fiber daily, while the 4- to 8-year-old child requires 25 mg dietary fiber per day. Food and snacks (even healthy ones) should not be used as a reward or punishment in this age group.
While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their backyard a few days ago. The nurse explains that this is an instance of which of the following? deferred imitation assimilation parallel play autonomy
deferred imitation Explanation: Children at this stage are able to remember an action and imitate it later (deferred imitation); they can do such things as pretend to drive a car or put a baby to sleep because they have not seen this just previously but at a past time. Toddlers engage in assimilation when they learn to change a situation (or how they perceive it) because they are not able to change their thoughts to fit the situation, such as shaking a toy hammer as if it were a rattle because they are more familiar with rattles than hammers. All during the toddler period, children play beside children next to them, not with them. This side-by-side play (called parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Autonomy, or independence, is the primary developmental task of the toddler years, according to Erikson. Although this child's act may be a sign of autonomy, it is more specifically an act of deferred imitation.
The mother of a 2-year-old child tells the nurse that she is constantly scolding the child for having wet pants. The child was toilet trained at 12 months, but since walking, the child wets all of the time. Which nursing diagnosis should the nurse use to guide instruction for the mother? total urinary incontinence related to delayed toilet training excess fluid volume related to inability to control urination ineffective coping related to lack of self-control of 2-year-old deficient parental knowledge related to inappropriate method for toilet training
deficient parental knowledge related to inappropriate method for toilet training Explanation: The mother is having difficulty understanding the principles of toilet training. The diagnosis of deficient parental knowledge about toilet training is the most appropriate for the nurse to use to guide instruction for the mother. The child is not experiencing total urinary incontinence. The child does not have an excess in fluid volume. The mother is not demonstrating ineffective coping.
During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. What is the best specific trigger question to determine the preschooler's linguistic and cognitive progress? "Does your son speak in complete sentences all the time?" "How well does your son communicate or follow instructions?" "Is your son's speech clear enough that anyone can understand it?" "Would you say your son has a vocabulary of about 900 words?"
"How well does your son communicate or follow instructions?" Explanation: Asking how well the boy communicates and follows instructions is the best trigger question because it is open-ended. Asking if the child uses complete sentences or speaks clearly will elicit a yes or no answer about only those specific areas of development. The parents would have no way of judging the size of their child's vocabulary.
The nurse is conducting a well-child examination of a 4-year-old and is assessing the child's height. By how much should the nurse expect the child's height to have increased since last year's examination? 0.5 to 1 inch (1.27 to 2.54 cm) 1 to 2 inches (2.54 to 5.07 cm) 2.5 to 3 inches (6.35 to 7.62 cm) 3.5 to 4 inches (8.89 to 10.16 cm)
2.5 to 3 inches (6.35 to 7.62 cm) Explanation: The average preschool child will grow 2.5 to 3 inches (6.35 to 7.62 cm) per year. Thus, the nurse would expect that the child's height would have increased 2.5 to 3 inches (6.35 to 7.62 cm) since last year's well-child examination.
When assessing a 33-month-old, the nurse would expect to find how many teeth? 8 12 16 20
20 Explanation: Eight new teeth erupt during the second year. All 20 deciduous teeth are generally present by 2.5 to 3 years of age.
If the child is gaining weight at an expected rate, a child who weighs 36 lb (16.3 kg) at 3 years of age would weigh what amount at age 5? 38 lb to 40 (17.2 to 18.1 kg) 44 to 46 lb (20 to 21 kg) 50 to 52 lb (22.7 to 23.6 kg) 58 to 60 lb (26.3 to 27.2 kg)
44 to 46 lb (20 to 21 kg) Explanation: The preschool age child gains about 4 to 5 lb (1.8 to 2.3 kg) each year and grows about 2.5 to 3 in (6.3 to 7.6 cm). So a 36 lb (16.3 kg) child at 3 years gaining 4 to 5 lb (1.8 to 2.3 kg) per year would be 44 to 46 lb (36 lb + 8 lb = 44 lb; 36 lb + 10 lb = 46 lb).
The nurse is assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern? Ability to turn door knobs Put shapes into matching openings Able to use a spoon to self-feed Ability to hold a crayon to write
Ability to turn door knobs Explanation: 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.
The nurse is teaching a group of school-age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching? "There are not many physical differences among school age boys." "I will appear heavier due to an increase in fat production." "I will grow an average of 2.5 in (6.5 cm) per year." "I will have improved gross motor skills."
"I will grow an average of 2.5 in (6.5 cm) per year." Explanation: During the school-age years, the child will grow an average of 2.5 in (6.5 cm). As puberty approaches, there will be significant differences in development between boys and girls. As development occurs, weight does increase, but it is not directly related to fat production. This is an area where much education needs to occur with young girls because "dieting" can be detrimental to the child's health and increased size is tied to the child's body image and self-esteem. By 10 years of age, brain growth is complete, and fine motor coordination is refined.
The nurse is evaluating the diet of a 9-year-old boy who is fairly active. The nurse determines that the child's nutritional intake is adequate based on the understanding that this child needs how many calories per day? 2000 1600 1800 2500
2000 Explanation: An active boy, at age 9 years, requires an intake of 2000 to 2400 calories per day.
If a toddler is following a normal pattern of growth, which of the following weights would be most likely for a 3-year-old toddler who weighed 21 lb at the age of 12 months? 24 lb 27 lb 33 lb 45 lb
33 lb Explanation: The toddler age range is 1 to 3 years of age. Each year the toddler gains 4.5 to 6 lb (2. to 2.7 kg). So a toddler weighing 21 lbs at 1 year, would expect to gain from 9 to 12 pounds by the age of 3, making the expected weight to be between 30 and 33 lbs. Reference:
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? Her vocabulary is between 10 and 15 words. She asks many questions. She uses complete 3- to 4-word sentences. She talks incessantly.
A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly. Thus a vocabulary of 10 to 15 words suggests a language problem.
The pediatric nurse is planning quiet activities for a hospitalized 18-month-old. What would be an appropriate activity for this age group? Painting by number Putting shapes into appropriate holes Stacking blocks Using crayons to color in a coloring book
Stacking blocks Explanation: At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.
Nursing students reviewing information about discipline demonstrate a need for additional education when they identify what information as correct? Discipline and punishment are interchangeable. Discipline involves setting rules. Discipline helps children know what is expected. When discipline breaks down, the consequence is punishment.
Discipline and punishment are interchangeable. Explanation: Discipline and punishment are not interchangeable. Discipline refers to setting rules or road signs so children know what is expected of them. Punishment is a consequence that results from a breakdown in discipline, from a child's disregard of rules that were learned.
What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? "I give my daughter juice at breakfast and when she is thirsty during the day." "She drinks three 6-ounce cups of whole milk each day." "When she doesn't eat well at meals we give her nutritious snacks." "New foods are offered along with ones she likes."
I give my daughter juice at breakfast and when she is thirsty during the day." Explanation: High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new.
To give eardrops to a 4-year-old child, what would be the best technique to use? Pull the pinna of the ear downward. Lift the pinna of the ear down and back. Press the pinna of the ear forward. Pull the pinna of the ear up and back.
Pull the pinna of the ear up and back. Explanation: Pulling the pinna upward and back straightens the ear canal in the child older than 3 years of age. To administer otic drops to a child younger than 3 years, the pinna would be pulled downward and back. Pressing the pinna of the ear forward or downward would occlude the ear canal.
The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child? The child demonstrates separation anxiety. The child imitates the nurse in use of a stethoscope. The child copies a circle on a piece of paper. The child follows directions when made one at a time.
The child demonstrates separation anxiety. Explanation: 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.
Parents share that their toddler often needs a snack in between meals. Which snack choice is nutritious enough to give the toddler energy but also may help prevent dental caries? Select all that apply. orange slices raisin oatmeal cookies cheese slices yogurt sugar-free candy bars
orange slices cheese slices yogurt
The nurse begins the physical exam to obtain the child's vital signs. Which would the nurse assess first? respirations pulse temperature blood pressure
respirations Explanation: The child's respirations are measured first before any other measurements that may affect the rate.
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.
"It might be best to give him a bath in the evening." Explanation: 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 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? 5 ml/hr 10 ml/hr 15 ml/hr 20 ml/hr
10 ml/hr Explanation: 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 parent reports the 13-month-old infant was using auditory expressive language. The vocalizations have been diminished over the last month and the child no longer says words. Select the best rationale for the infant's language behavior. The environment has changed since the grandparents moved in with the family. The parent has decreased the usual sensory stimulation for the child. This behavior is common in children when autism is developing. Biological factors such as otitis media could be causing hearing loss.
Biological factors such as otitis media could be causing hearing loss. Explanation: A primary influence on impaired auditory expressive language development is the occurrence of hearing loss. Hearing loss can be acquired or congenital. Approximately 2.2 million children are diagnosed annually with episodes of otitis media with effusion. Delays in speech development and loss of vocalizations are indicators hearing loss may be occurring. Evaluation of hearing is essential since the critical period for speech is within the first two years.
The nurse is providing home care for a 1-year-old girl who is technologically dependent. Which intervention will best support the family process? Finding an integrated health program for the family. Teaching modifications of the medical regimen for vacation. Assessing family expectations for the special needs child. Creating schedules for therapies and interventions.
Creating schedules for therapies and interventions. Explanation: Coordinating care with the schedules and capabilities of the parents provides the greatest support for the family. It gives them a sense of order and control. Integrated health care programs may not be available in the family's area. Teaching therapy modifications for travel and assessing family expectations are not supportive interventions.
The nurse is organizing an indoor play area for preschool-age children. Which play materials are least important? Electronic teaching toys Cut, paste, drawing, and painting materials Dress-up clothes and hats and puppets CD player with music and musical instruments Balls, blocks, and puzzles
Electronic teaching toys Explanation: Electronic teaching toys are expensive and usually cannot be used in multiple ways or shared with a group of children. All the rest of the items have many uses, stimulate imagination and creativity, promote social interaction, and are relatively inexpensive and readily replaced.
A 3-year-old is admitted to the hospital for pneumonia. Which intervention would be most effective in reducing separation anxiety? Encourage rooming-in. Have the parents leave when the child is sleeping. Arrange for the child to have her favorite toy. Encourage parents to use concrete times, such as 5 PM, for their return.
Encourage rooming-in. Explanation: Having parents room-in is the best option for reducing separation anxiety. Mistrust may develop if the child awakens and finds the room empty. Although having a favorite toy may provide comfort, it does not reduce separation anxiety. A 3-year-old does not understand clock time. Reference:
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? Offering a variety of foods along with the foods the child likes. Assuring the parents that food jags are normal, and they can be honored safely. Advising the parents to minimize distractions at mealtime. Encouraging the parents to eat a variety of wholesome foods themselves.
Offering a variety of foods along with the foods the child likes. Explanation: 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.
A 2-year-old child has vomited his oral medication dose 3 minutes after swallowing it. What would the nurse do next? Readminister the medication right away. Wait until the next dose is due and give it then. Wait one hour, then readminister the medication. Notify the prescribing health care provider.
Readminister the medication right away. Explanation: If an oral medication is vomited immediately after it is given (usually within 5 minutes), the medication can be readministered right away. If it has been vomited twice, the prescribing practitioner should be notified.
A 4-year-old child is drawing with crayons. Which creation by the child would most be reflective of the anticipated skill level of this age? The child draws a person with 6 body parts. The child is able to proficiently draw several letters of the alphabet. The child draws random lines on the paper and reports it is a person. The child is able to draw shapes such as circles and squares.
The child is able to draw shapes such as circles and squares. Explanation: Preschool children are creative and like to draw. They are able to draw shapes such as circles and squares. Drawing a figure with at least 6 body parts and writing letters are the expected skills of a 5-year-old. Random lines would be demonstrated by a younger child.
The nurse is collecting data from the mother of a 3-year-old child. Which report warrants further follow-up? cannot stack five blocks cannot grasp a crayon with the thumb and fingers cannot copy a circle cannot throw a ball overhand
cannot copy a circle Explanation: A 3-year-old child should have the ability to copy a circle. Stacking five blocks, grasping a crayon, and throwing a ball overhand are not reasonable accomplishments for a 3-year-old child.
The nurse is helping explain the dietary plan to the mother of an 18-month-old girl who has diabetes. Which of the following food categories would the nurse explain as being affected by the child's condition? grains vegetables dairy products fruits
dairy products Explanation: The dairy products category will be affected. Normally, children younger than 2 years of age would consume whole milk because the fat content is needed for brain development. Because the child is diabetic, low fat or skim milk would be used.
The nurse is assessing the motor skills of a 5-year-old client. Which finding will cause the nurse to be concerned? unable to perform deductive reasoning can dress and undress self without assistance draws a person with three body parts is beginning to tie own shoelaces
draws a person with three body parts Explanation: By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. The child should be able to dress and undress independently and should be learning to tie shoelaces. Deductive reasoning is achieved at 6 to 7 years of age. Reference:
The nurse is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem? has persistent separation anxiety goes from calm to tantrum suddenly sucks his thumb periodically is unable to share toys with other
has persistent separation anxiety Explanation: 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.
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? Select all that apply. limiting the choices and decisions that the child makes showing respect and support to the child acting as a coach rather than a cheerleader using positive reinforcement while limiting criticism avoid talking with the child about his or her dissatisfaction
limiting the choices and decisions that the child makes avoid talking with the child about his or her dissatisfaction Explanation: 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 listen to the child and talk with him or her and be a coach to the child rather than just a cheerleader who merely praises accomplishments.
The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of: transduction. magical thinking. animism. beginning empathy.
transduction. Explanation: The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.
The nurse is observing a 36-month-old boy during a well-child visit. Which motor skill has he most recently acquired? undress himself push a toy lawnmower kick a ball pull a toy while walking
undress himself Explanation: This child has most recently acquired the ability to undress himself. Pushing a toy lawnmower and kicking a ball are things he learned at about 24 months. He was able to pull a toy while walking at about 18 months.
The parent of a preschooler asks the nurse, "Now that my child goes to preschool and goes to friends' houses, how can I make sure that he is eating enough?" Which response by the nurse would be most appropriate? "You need to get a list from everyone about what he has eaten throughout the day." "Ask the child what he has eaten and drank at school and at his friend's house." "Keeping an eye on how active he is will give you a good indication." "Just give him some extra food when he's with you to make up for anything he missed."
"Keeping an eye on how active he is will give you a good indication." Explanation: Preschoolers begin to eat away from home at friends' homes or at child care or stay overnight with friends or grandparents, so parents don't observe daily food intake as accurately as before. The best suggestion would be to inform the parent to observe whether the child is growing and being active, good indicators of nutrition. This action would be better than monitoring any one day intake, including attempting to get a list from others, or asking the child what he has eaten. Giving the child extra food could foster overeating.
The nurse enters the room of a 4-year-old client to administer an oral medication. The child takes one look at the medication in the nurse's hand and yells "This is yucky!!" Which response by the nurse would be most appropriate? "Let's hold our noses! It's medicine time!" "Time for a yummy treat!" "Are you ready to take your medicine now?" "Let's pour this in your milk so it doesn't taste so yucky!"
"Let's hold our noses! It's medicine time!" Explanation: Holding the nose is a good method to reduce the offending taste of medications. The use of play can help to distract a child's attention away from the offending medication. Medications should never be disguised as candy or sweet treats. Children should not be given the opportunity to refuse a medication. Medication should not be given in a staple food or drink since it could cause an aversion to this food or drink in the future
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? "My toddler uses the potty chair and is dry all day long." "When my toddler falls down, they always wants me to pick them up." "My toddler has temper tantrums when we go to the store." "Every night my toddler follows the same routine at bedtime."
My toddler uses the potty chair and is dry all day long." Explanation: 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.
The nurse is describing the maturation of various organ systems during toddlerhood to the parents. What would the nurse correctly include in this description? Myelinization of the brain and spinal cord is complete at about 24 months. Alveoli reach adult numbers by 3 years of age. Urine output in a toddler typically averages approximately 30 ml/hour. Toddlers typically have strong abdominal muscles by the age of 2.
Myelinization of the brain and spinal cord is complete at about 24 months. Explanation: Myelinization of the brain and spinal cord continues to progress and is complete around 24 months of age. Alveoli reach adult numbers usually around the age of 7. Urine output in a toddler typically averages 1 ml/kg/hour. Abdominal musculature in a toddler is weak, resulting in a pot-bellied appearance. Reference:
Which gross motor developmental milestone is least likely for a 2-year-old? Rides a tricycle Jumps in place Climbing stairs with assistance Stands on one foot with help
Rides a tricycle Explanation: 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. Round foods such as hot dogs, whole grapes, and cherry tomatoes Hard foods such as nuts, raw carrots, and popcorn Sticky foods like peanut butter alone, gummy candies, and marshmallows Vegetables such as corn, green beans, and peas Fruits such as peaches, pears, and kiwi
Round foods such as hot dogs, whole grapes, and cherry tomatoes Hard foods such as nuts, raw carrots, and popcorn Sticky foods like peanut butter alone, gummy candies, and marshmallows
The nurse is providing anticipatory guidance for a 7-year-old and the parents. Which change in attitude may the parents identify throughout this school year? The child wants to perform well. The child is self-absorbed and likes to complete work independently. The child tends to exaggerate his misdeeds or lie excessively. The child shows characteristics of magical thinking.
The child wants to perform well. Explanation: As children adjust to school, they take on school values, including learning to do things well. They may not be completely happy with what they have done. Toddlers are self absorbed and participate in parallel play. The 3-5 year olds most frequently believe in magical thinking. Common development does not include lying excessively.
Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of these actions? Select all that apply. When discussing improper behavior, call the behavior "bad" or "naughty," not the child. Anticipate situations likely to cause misbehavior and redirect the child to another activity. Books and stories can help preschoolers master proper behavior. A time-out of about 8 minutes would be appropriate for intentional misbehavior. Spank with an open hand only and never with an object.
When discussing improper behavior, call the behavior "bad" or "naughty," not the child. Anticipate situations likely to cause misbehavior and redirect the child to another activity. Books and stories can help preschoolers master proper behavior.
The parent of 3 1/2-year-old preschooler tells the nurse that the child argues quite a bit and says that the child is always right. The nurse interprets this information as indicating: centering. conservation. initiative. guilt.
centering. Explanation: At age 3 years, cognitive development is still preoperational. Although children during this period do enter a second phase called intuitional thought, they lack insight to view themselves as others see them or put themselves in another's place. This is called centering. Because preschoolers cannot make this kind of mental substitution, they feel they are always right and causes them to argue. Conservation is reflected in the child's ability to distinguish that two items of equal size are the same despite a change in form. Initiative is the developmental task of preschoolers and is reflected in the child attempting to learn as much as possible about the world around them by trying new activities or having new experiences. Guilt occurs if children are punished or criticized for attempts at initiative.
During a regular checkup for a 24-month-old girl, the nurse observes that all incisors and cuspids and some first molars have erupted. This would be a good time to promote optimal oral care. Which of the following topics would be most appropriate for the nurse to include in the teaching plan for the parents? flossing between teeth up-and-down brushing technique plastic occlusal sealant horizontal brushing technique
horizontal brushing technique Explanation: Horizontal brushing technique would be most appropriate because it would be easiest for the child to use as she is introduced to oral care. The child is not ready for more complicated techniques such as up-and-down brushing. Flossing may be introduced, but the child does not have the manual dexterity to accomplish flossing and needs parental assistance. Plastic occlusal sealant is a subject to be discussed with a pediatric dentist if the child's tooth enamel is impaired
The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply. "My 4-year-old is above normal in weight but I'm sure it's just baby fat and will be lost with age." "My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "The only way I can get my child to consume sources of vitamin C is through fruit juices. I guess it's better than not at all." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda."
"My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda.
A nurse is discussing ways parents can foster the development of self-confidence in their school-aged child. Which action if stated by the parents would lead the nurse to continue the discussion? being accepting of mistakes the child makes focusing on what the child is saying in a conversation comparing the child to an older sibling regarding academic achievements having clear expectations of behavior whenever the family is out in public
comparing the child to an older sibling regarding academic achievements Explanation: A school-age child needs consistency, clearly defined expectations, and positive attention in order to develop self-confidence. By being accepting of mistakes the child makes, focusing on the child whenever they are talking, and making sure the child understands behavioral expectations, the parents are fostering self-confidence in the child.
The nurse is collecting data on a 9-year-old child being admitted to the pediatric unit. What is the most appropriate way to gather information from the child's caregiver? Ask the caregiver questions and document the answers. Have the caregiver sit in a quiet room and fill out a questionnaire. Ask the caregiver if he or she can read or if someone is needed to read the questions on the admission form to him or her. Have the child read the questions to the caregiver and then write down the answers on the form.
Ask the caregiver questions and document the answers. Explanation: The family caregiver provides most of the information needed in caring for the child. Rather than simply asking the caregiver to fill out a form, it may be helpful to ask the questions and write down the answers. This provides a personal interaction between the nurse and the caregiver. If the caregiver cannot read, the nurse would help with the completion of the form by asking questions and documenting the answers. Children should not be used as interpreters or complete a form. If the child is under the age of 18 it would not be a legal document, and with a child's language skills and comprehension much-needed information could be not obtained. Reference:
The nurse is preparing the anticipatory guidance sheets that are provided to parents. When organizing the sheets, place the milestones in their proper sequence from earliest to latest. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Creep up stairs 2Run and jump in place 3Engage in parallel play 4Name one color 5Zip up their own jackets
Creep up stairs Run and jump in place Engage in parallel play Name one color Zip up their own jackets Explanation: A 15-month-old can creep upstairs. An 18-month-old can run and jump in place. A 24-month-old engages in parallel play; a 30-month-old can name one color. Zipping a jacket occurs around a child's 3rd birthday.
A parent tells the nurse about being frustrated because the preschool-aged child screams every time the parent attempts to buckle the child's seat belt. What advice should the nurse give this parent? Tell the child that you will give a treat for buckling up. Do not start the car until seat belts are in place. Warn the child of punishment for not buckling up and then follow through. Arrange for a babysitter to avoid taking the child in the car.
Do not start the car until seat belts are in place. Explanation: Accident prevention is important for preschool-aged children. It can best be taught by role modeling. Not starting the car until everyone is buckled up is an example. Bribing and threatening are not appropriate, nor is keeping the child home at all times. All children up to 4 years whose height meets car seat requirements should be in an approved car seat with harness and top tether. After reaching the height requirements the child can transition to a booster seat with lap and shoulder belts.
The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? The mother is suffering from depression. The child is homeless and has no toys. The mother describes an inadequate diet. The child is unperturbed by a loud noise.
The child is homeless and has no toys. Explanation: Children develop through play, so a child without any toys may have trouble developing the motor skills appropriate to his age. Maternal depression is a risk factor for poor cognitive development. Inadequate diet will cause growth deficiencies. A child who does not respond to a loud noise probably has hearing loss, which will lead to a language deficit.
During a health history, the nurse explores the sleeping habits of a 3-year-old boy by interviewing his parents. Which statement from the parents reflects a recommended guideline for promoting healthy sleep in this age group? "Our son sleeps through the night, and we insist that he takes two naps a day." "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." "Our son still sleeps in a crib because we feel it is the safest place for him at night." "Our son occasionally experiences night walking so we allow him to stay up later when this happens."
We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." Explanation: Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night.
The nurse is assessing the moral developmental level of children being seen in the clinic according to the Kohlberg's conventional stage of moral development. Which children does the nurse determine have met this stage of development? Select all that apply. the 8-year-old child who frequently asks the teacher if he is doing his math correctly the 10-year-old child who visits his elderly neighbor three times per week the 9-year-old child who tells his friends that they shouldn't throw rocks because they will "get in trouble" the 7-year-old child who yells at his mother, "I don't understand why I can't go to the park!" the 10-year-old who states, "I sure wouldn't want to be my friend taking that bad report card home."
the 8-year-old child who frequently asks the teacher if he is doing his math correctly the 10-year-old child who visits his elderly neighbor three times per week the 9-year-old child who tells his friends that they shouldn't throw rocks because they will "get in trouble" the 7-year-old child who yells at his mother, "I don't understand why I can't go to the park!" the 10-year-old who states, "I sure wouldn't want to be my friend taking that bad report card home." In the conventional stage of moral development according to Kohlberg, the 7- to 10-year-old usually follows rules out of a sense of being a "good" person. He or she wants to be a good person to parents, friends, and teachers and to himself or herself. The adult is viewed as being right. The child believes an act is wrong only if it brings punishment, not because of the outcome of an act. The child in this phase also doesn't understand the reason behind rules, but can put himself or herself in another person's position.
The nurse is developing a teaching plan for toddler safety to present at a parenting seminar. Which safety intervention should the nurse address? Encourage parents to enroll toddlers in swimming classes to avoid the need for constant supervision around water. Advise parents to keep pot handles on stoves turned outward to avoid accidental burns. Encourage parents to smoke only in designated rooms in the house or outside the house. Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car.
Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car. Explanation: Safety is of prime concern throughout the toddler period. The safest place for the toddler to ride is in the back seat of the car. Parents should use the appropriate size and style of car seat for the child's weight and age as required by the state. At a minimum, all children over 20 pounds and up to 40 pounds should be in a forward-facing car seat with harness straps and a clip. Parents who want to enroll a toddler in a swimming class should be aware that a water safety skills class would be most appropriate. However, even toddlers who have completed a swimming program still need constant supervision in the water. Pot handles on stoves should be turned inward to avoid accidental burn. Nurses should counsel parents to stop smoking (optimal), but if they continue smoking never to smoke inside the home or car with children present.
Parents of a toddler are expressing concern about their child's extreme negativism. Every question is answered with a forceful, "no." Which information would be most appropriate for the nurse to share with this couple about their toddler's negativity? Select all that apply. This is not only normal for toddlers but demonstrates a positive stage of development. This is a step in the child's development toward independence and to take care of his or her own needs. After one warning, place the child in time-out if they say "no" again in response to questions. With regards to bath time, ask the child "Will you please go get ready to take your bath?" Rather than ask, "Do you want to come to dinner now?" instead state, "It's dinner time. Do you want to drink milk or water with your dinner?"
This is not only normal for toddlers but demonstrates a positive stage of development. This is a step in the child's development toward independence and to take care of his or her own needs. Rather than ask, "Do you want to come to dinner now?" instead state, "It's dinner time. Do you want to drink milk or water with your dinner?" Correct response: Incorrect response: Your selection: Explanation: Parents can be baffled by the extreme change in their child—from a happy, cooperative infant who lived to please them to an irritating, uncooperative toddler. They may need some help to realize that this is not only a normal phenomenon of toddlerhood but also a positive stage in development. This change indicates toddlers have learned that they are separate individuals with separate needs. It is important toddlers do this if they are to grow up to be persons who are independent and able to take care of their own needs and desires. Punishment for a normal developmental task is inappropriate. Making a statement instead of asking a yes-or-no question in this way can avoid a great many negative responses. One example is, "It's lunchtime. Do you want to use a big or little plate?"
The nurse is discussing language development with the parent of a 20-month-old toddler. To accurately assess the toddler's language development, which question would the nurse ask the parent? "Can your toddler state his or her name and indicate his or her age?" "Does your toddler use sentences with 3 or 4 words?" "Is your toddler able to use singular and plural words correctly?" "When you say "no" does your toddler seem to understand the meaning?"
When you say "no" does your toddler seem to understand the meaning?" Explanation: The 20-month-old toddler should understand the word "no." Being able to use plurals, using 3 to 4 word sentences, and stating one's name and age are expectations of a child 36 months of age or older.
