Peds CH 16

The nurse is assessing a 3-year-old child. The nurse notes the child is able to understand that objects hidden from sight still exist. The nurse correctly documents the child is displaying:

object permanence.

A 2-year-old toddler holds the breath until passing out when the toddler wants something the parent does not want the toddler to have. The nurse would base evaluation of whether these temper tantrums are a form of seizure on the basis that:

seizures are not provoked; temper tantrums are.

When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old toddler?

The toddler should speak in two-word sentences ("Me go").

Parents bring a toddler age 19 months to the clinic for a regular checkup. When palpating the toddler's fontanels, what should the nurse expect to find?

Closed anterior and posterior fontanels By age 18 months, the anterior and posterior fontanels should be closed. The diamond-shaped anterior fontanel normally closes between ages 9 and 18 months. The triangular posterior fontanel normally closes between ages 2 and 3 months.

Parents of 3-year-old son ask the nurse for suggestions on how to deal with their son's nightmares. Which suggestion would be least effective?

Talk to him that night about the details of the dreams.

Which would be least effective in gaining the cooperation of a toddler during a physical examination?

Tell the child that another child the same age wasn't afraid.

In discussing their 2-year-old's behavior with the nurse, which of the parents' statements suggests the child may be ready for toilet teaching?

The child hides behind her bedroom door when defecating.

A 2-year-old boy has been diagnosed with nephrotic syndrome. The nurse is teaching the boy's mother about the disease. Which of the following statements will be the most valuable related to home care?

"Follow the doctor's medication directions exactly."

The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet?

"Give him more healthy choices with less junk food available."

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."

Which gross motor developmental milestone is least likely for a 2 year old?

Rides a tricycle

How many servings of vegetables should be consumed during early childhood?

Three

A mother is concerned because her 14-month-old son, who had a big appetite when breast-feeding a few months ago, seems uninterested in eating solid food. She still breast-feeds him daily, but is thinking of weaning him soon. How should the nurse respond to this mother?

"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate."

After teaching the mother of a 13-month-old boy old about suggestions for bathing and hygiene, the nurse determines that the teaching was successful when the mother states which of the following?

"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.

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."

The mother of a 2-year-old asks the clinic nurse why her child's blood pressure is never measured. The mother states, "My blood pressure is measured during each visit to the doctor." What is the best response by the nurse?

"Typically, children younger than 3 don't need blood pressure measured unless they have a serious or chronic condition."

The nurse is presenting a program about development to a group of parents with young children and preschoolers. The nurse would explain that a young child of which age most likely would have an imaginary friend?

3 years Around age 3 years, children are cognitively involved with fantasy and will drift from reality to fantasy often. At times, they may have imaginary friends. After the child turns 4 years old, he or she focuses more on reality. Children at this age can distinguish that they are not a superhero or storybook princess.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching?

Advising them to use praise, not scolding The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.

The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson?

Autonomy versus shame and doubt

Nursing students reviewing information about discipline demonstrate a need for additional education when they identify what information as correct?

Discipline and punishment are interchangeable.

During a developmental screening, the nurse notes the toddler is not meeting expected developmental milestones. What is the best action by the nurse?

Discuss the delay in milestones with the primary care provider and family.

A mother brings a 15-month-old child to the clinic for a routine health maintenance visit. Which immunization should the nurse prepare to administer to this child?

MMR The measles-mumps-rubella (MMR) vaccine is administered at either the 12-month or 15-month visit. Rinne test is not an immunization but rather a test for hearing. The oral polio vaccination is not listed as an immunization needed for toddlers. Hepatitis A vaccination is given at either the 12-month or 18-month visit.

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.

The nurse is supervising a play group of children on the unit. The nurse expect the toddlers will most likely be involved in which activity?

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 nurse is teaching the parents of an overweight 18-month-old girl about diet. Which intervention will be most effective for promoting proportionate growth?

Remove high-calorie, low-nutrient foods from the diet.

The nurse is preparing a female toddler for the repair of an eyebrow laceration. The girl is most likely to demonstrate which response in anticipation of the procedure?

Scream and cling tightly to her parent.

The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?

The child's nonverbal behaviors may indicate the presence of discomfort.

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior?

The need for separation and control

Parents and their 35-month-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay?

Uses two-word sentences or phrases

The nurse is caring for a 3-year-old child who has an intravenous line. When medications are delivered through the line the child experiences burning. What action by the nurse will be most helpful?

Sit with the child and use distractions such as toys during the infusion.

The nurse is assessing the language development of a 3-year-old girl. Which finding would suggest a problem?

Speaks in 2- to 3-word sentences

Parents of 3-year-old boy ask the nurse for suggestions on how to deal with their son's occasional nightmares. Which of the following suggestions would be least effective?

Talk to him that night about the details of the dreams.

The nurse is preparing to assess a 2-year-old at a well-child visit and notes the child was 22 lbs (9.98 kg) and 24 in (60.96 cm) tall at 1 year old. The nurse determines the child is following a normal pattern of growth after obtaining which set of current measurements?

30 lbs (13.60 kg) and 27 in (68.58 cm) tall Toddlerhood is a time of slowed growth and rapid development. Each year a toddler gains 5 to 10 lbs (2.26 to 4.53 kg) and about 3 in (7.62 cm). A child weighing 22 lbs (9.98 kg) at age 1 year would be expected to now weigh 27 to 32 lbs (12.24 to 14.41 kg). A height of 24 in at age 1 year (60.96 cm) should now be approximately 27 in (68.58 cm).

After teaching a group of parents about language development in toddlers, which statement by a member of the group indicates successful teaching?

"When my 3-year-old asks 'Why?' all the time, this is completely normal."

A group of caregivers of toddlers are discussing the form of discipline in which the toddler is placed in a "time-out" chair. Which statement made by these caregivers is most appropriate related to this form of discipline?

"When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to time out."

Two-year-old Johnny does not like his new sister. When his mom leaves the room, he tries to pull her out of her bouncy seat. She cries and mom comes in running. Mom talks with the nurse at the pediatrician's office about ways to discipline him. Which of the following would be most helpful for the nurse to suggest?

"You should try and reinforce to Johnny not to hurt the baby."

The nurse is caring for a 2-year-old and is preparing to administer an IV push medication through a percutaneous intravenous central catheter (PICC) line as ordered. The nurse selects which of the following size syringes?

6-mL syringe A 5-mL or larger syringe should be used to administer medications or flush intravenous lines. PICC lines can be particularly fragile. Using a larger-volume syringe exerts less pressure on all IV lines including the PICC line, reducing the risk of damage to the line or irritation of a vessel.

The nurse is caring for a toddler who was just diagnosed with a hearing impairment. What would the nurse expect to assess in the child?

A delay or lack of clear, understandable speech pattern

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this?

A regular routine and rituals will provide stability and security.

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 suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding?

A tantrum preceded the event.

What advice should the nurse provide the parent of a toddler, regarding how to handle temper tantrums?

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 nurse is assessing a 2-year-old boy during a well child visit. The nurse correctly identifies the child's current stage of Erickson's growth and development as:

Autonomy versus shame and doubt The Erickson stage of development for the toddler is autonomy versus shame and doubt. During this period of time the child works to establish independence. Trust versus mistrust is the stage of infancy. Initiative versus guilt is the stage for the preschooler. Industry versus inferiority is the stage for school-aged children.

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.

Biological factors such as otitis media could be causing hearing loss.

The nurse is preparing to conduct a physical examination of a 3-year-old child. Which assessment will the nurse introduce for the first time to this client?

Blood pressure recording

The nurse is reviewing vital signs taken by the unlicensed assistive personnel on a group of toddlers. Which warrants follow up by the nurse?

Heart rate 60, respiratory rate 31 In the toddler the heart rate may range from 70 to 120 beats per minute. The respiratory rate may range from 20 to 30 per minute.

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?

Horizontal brushing technique

A toddler is ordered amoxicillin for bilateral otitis media. The mother complains that the child refuses to take the oral medication. The nurse knows that more education is needed when the mother states:

I will shake the medication well, and draw up the medication to the top of the syringe. My husband and I will hold the child down and force the medication down his throat.

A mother brings her 2-year-old child to the pediatrician's office, voicing concerns about her toddler's growth over the last year. According to the child's records, the toddler has gained 6 pounds (2.7 kg ) and grown 2.5 in (6.25 cm) since his last visit a year ago. How should the nurse respond to this mother's concerns?

Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about. Normally, a toddler's growth is 5 to 10 pounds per year and about 3 inches in height. This child falls within the recommended parameters of growth and the mother has nothing to be worried about.

A nurse is providing teaching to a group of parents about safety in the home. The nurse determines that the teaching was successful when the group identifies which areas of the home as being the most hazardous? Select all that apply.

Kitchen Bathroom

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

The nurse is examining a 15-month-old child who was able to walk at the last visit and now can no longer walk. What would be the nurse's best intervention in this case?

Schedule a full evaluation since this may indicate a neurologic disorder. Any child who "loses" a developmental milestone—for example, the child able to sit without support who now cannot—needs an immediate full evaluation, since this indicates a significant neurologic problem. Regression is when there is a cause to the loss of skill like hospitalization

The nurse is weighing a 20-month-old child who is in the clinic for a well-child visit. Which action by the nurse would be most appropriate for weighing this child?

The nurse should have the child sit on the scale while keeping a hand close to but not touching the child.

A nurse is preparing to examine the ear of a 2-year-old child. The nurse would pull the pinna in which direction?

The nurse should pull the pinna of the ear down and back for a child younger than age 3 years to help straighten the ear canal. For a child older than age 3 years, the pinna is pulled up and back.

The nurse has brought a 3-year-old's oral medications into the room for administration. Upon approaching the child, the nurse said, "I have your medication. Would you rather have me hand it to you or Mommy?" In critiquing the nurse's actions, which is most accurate?

The nurse's behavior is correct. The nurse provided the child a choice between two acceptable options with the outcome of taking the medication.

The nurse is caring for a 2-year-old child who has had surgery. When assessing this child's pain, which of the following development characteristics would the nurse need to keep in mind?

Uses words for pain such as owie, boo-boo, or hurt

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.

Using training pants that slide down easily and quickly Praising the child when he or she urinates or defecates Putting the child on the potty chair at regular intervals during the day

The parents of a toddler express some frustration because they are having a hard time getting their child to take a nap, even though the child is acting tired and cranky. Which suggestion for the parents to try is most appropriate when working with toddlers?

"It's naptime, do you want to sleep with your stuffed bear or with your sock monkey?"

The nurse is preparing to assess the respiratory rate of a crying 15-month-old boy. To get the mostaccurate assessment, what approach should the nurse take?

Count after the child stops crying and is comfortable.

The pediatric nurse is performing a head-to-toe exam on a 2-year-old child during a well child assessment. Which method will the nurse use to accurately determine the child's heart rate?

Counting the apical rate

A nurse is caring for a 9-month-old infant in a pediatric unit. The nurse finds that the infant cries and screams every time the parents leave the room for any period of time. The nurse reassures the parents by explaining that the infant is experiencing which of the following?

Separation anxiety

During a wellness care visit, the parents of a 2-year-old toddler report that they are struggling to deal with their toddler's daily and increasing number of tantrums. What information should be provided to the parents? Select all that apply.

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

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly?

Telling the child firmly that we don't scream in the office Telling the child firmly that we don't scream in the office gets the point across to the child that his behavior is unacceptable while role modeling appropriate communication. Telling the child to stop tearing up magazines does not give him direction for appropriate behavior. Asking the child if he would quit throwing toys gives him an opportunity to say "no," and is the same as asking "OK?" at the end of a direction.

The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development?

The child is unable to push a toy lawnmower.

The nurse is instructing a group of parents about transmission of infectious diseases in children. Which would the nurse cite as the primary method for prevention?

Immunization not hand washing which would be more for infants

During a health promotion seminar with community members, the nurse provides information to support the 2020 National Health Goal to prevent and reduce the incidence of infectious disease in children. What information did the nurse most likely provide?

Importance of maintaining appropriate immunizations