peds toddler

Until what age in years does a child need to drink whole milk for adequate neurologic development? Record your answer using a whole number._____ years of age

Toddlers need to drink whole milk until the age of 2 years to ensure adequate intake of the fatty acids necessary for brain and neurologic development.

Which age should the nurse anticipate that a toddler-age client will begin to develop awareness of ownership? 1 15 months 2 18 months 3 24 months 4 30 months

2 A toddler-age client begins to be aware of ownership [1] [2] at the age of 18 months. The nurse would not expect this to begin at 15 months, 24 months, or 30 months.

Which food should the nurse recommend for a toddler-age client who is at risk for developing rickets? 1 Yogurt 2 Carrots 3 Fruit juice 4 Dried fruit

1 A calcium and vitamin D deficiency causes rickets; therefore, the nurse should recommend yogurt for the toddler who is at risk. Carrots, fruit juice, and dried fruits are not food items that are rich in calcium and vitamin D.

A nurse is caring for a toddler who has undergone bone marrow transplantation. What clinical finding(s) should the nurse anticipate if an infection develops? 1 Fever and lethargy 2 Positive blood antibody titers 3 A delay in the growth of bone 4 Neutropenia and lymphocytopenia

1 A fever occurs with an infection because pyrogens affect the temperature-regulating center in the hypothalamus; lethargy occurs with an infection because of the related increased basal metabolic rate. Antibody titers indicate exposure to microorganisms, not the presence of an actual infection. Delayed bone growth is not an indication of infection. After a bone marrow transplant, neutropenia and lymphocytopenia are present until the bone marrow is fully repopulated. An altered white blood cell count is not a reliable indicator of infection.

Three days after the application of a spica cast a toddler has a temperature of 101.4° F (38.6° C). What clinical finding does the nurse anticipate? 1 A foul odor from the cast 2 An irregular respiratory pattern 3 Itching around the top of the cast 4 Complaints of tingling in the toes

1 A foul smell from the cast is usually indicative of an infection under the cast that may be the cause of a fever. Respirations may increase, but do not become irregular with a fever. Itching around the top of the cast should not cause a fever; it may indicate neurovascular impairment. Tingling toes are not a sign of infection; this may indicate a neurovascular complication.

Which assessment data would cause the nurse to suspect that a toddler-age client is experiencing physical neglect? 1 Abdominal distention 2 Bloody underclothing 3 Recurrent urinary tract infections 4 Bruises in various stages of healing

1 Abdominal distention is a physical manifestation associated with malnutrition that is associated with physical neglect. Bloody underclothing and recurrent urinary tract infections are clinical manifestations associated with sexual abuse. Bruises in various stages of healing is a clinical manifestation associated with physical abuse, not physical neglect.

For which clinical manifestation should the nurse monitor the toddler-age client diagnosed with lead toxicity associated with the hematologic system? 1 Anemia 2 Glycosuria 3 Distractibility 4 Hyperactivity

1 Anemia is a clinical manifestation associated with lead toxicity due to the effects that lead has on the hematologic system. Glycosuria is a clinical manifestation caused by the effects of lead toxicity on the renal system. Distractibility and hyperactivity are clinical manifestations caused by the effects of lead toxicity on the neurologic system.

While in the playroom of a pediatric unit the nurse sees several toddlers seated at a table trying to copy the same picture from a book. They are not talking to each other or sharing their crayons. What does the nurse conclude about this behavioral interaction? 1 It is a typical expression of toddlers' social development. 2 This is an example of antisocial behavior found in some children. 3 It is a lack of parental role models to demonstrate acceptable behavior. 4 This is an illustration of separation anxiety typical of hospitalized toddlers.

1 As part of the socialization process, toddlers enjoy playing beside other children (parallel play); they are not developmentally ready for interactive (cooperative) play, which begins in the preschool years. This is not antisocial behavior; it is a misinterpretation of parallel play that is typical of toddlers' behavior. This is not an example of an ineffective parental role model; it is a misinterpretation of parallel play that is typical of toddlers' behavior. There are no data to indicate that the children are experiencing separation anxiety.

A nurse bases the plan of care for a 15-month-old toddler with celiac disease on the pathophysiology of the disorder, which is characterized by what? 1 Inability to metabolize gluten 2 Absence of the enzyme phenylalanine 3 Excessive amount of salt in the sweat glands 4 Increase in the viscosity of mucous secretions

1 Children with celiac disease are unable to digest the gliadin component of gluten, resulting in fatty, foul-smelling diarrheal stools. Phenylketonuria is caused by the absence of phenylalanine; it is not related to celiac disease. Excessive salt in the sweat glands is a manifestation of cystic fibrosis. Increased viscosity of secretions from mucous glands is also related to cystic fibrosis.

Which of these diseases would the nurse explain is most common in toddlers? 1 Influenza 2 Lung cancer 3 Hypertension 4 Angina pectoris

1 Toddlers are very prone to developing upper respiratory tract infections; hence, influenza is seen most frequently among toddlers. Lung cancer is seen commonly in younger or middle-aged adults from smoking. Hypertension is commonly seen in middle age due to an unhealthy diet, lack of exercise, and stress. Angina is common in young and middle-aged adults.

A 2½-year-old boy who has undergone surgery to revise a ventriculoperitoneal shunt is to be discharged. The nurse advises the parents to call the clinic if the child does what? 1 Appears drowsy after a nap and becomes irritable 2 Talks incessantly regardless of the presence of others 3 Becomes angry when frustrated and has a temper tantrum 4 Starts arguments with playmates, claiming that their toys are the child's

1 Drowsiness and irritability are characteristic signs of increasing intracranial pressure; other signs and symptoms include nausea, projectile vomiting, headache, and diminished physical activity. Incessant talking, temper tantrums, and inability to share are all expected behaviors in a 2½-year-old toddler.

A 3-year-old boy in respiratory distress is treated in the emergency department. A diagnosis of acute spasmodic laryngitis (spasmodic croup) is made. At the time of discharge, the mother asks how to handle another attack at home. What should the nurse recommend? 1 Placing him near a cool-mist humidifier 2 Bringing him to the emergency department 3 Giving him an over-the-counter cough syrup 4 Offering him warm tea sweetened with honey

1 During a spasmodic croup attack, cool humidified air to decrease inflammation is a fast home remedy. An attempt should be made to interrupt the attack at home first rather than going to the emergency department. Cough syrup is ineffective because it does not relieve laryngeal spasm. Tea with honey is an ineffective remedy for a spasmodic croup attack, and the tea may present a risk of aspiration.

Which plant, if ingested by a toddler-age client, would necessitate further action by the nurse? 1 Lily 2 Rose 3 Coleus 4 Begonia

1 If a toddler-age client eats a lily, the nurse should tell the parents that the plant is poisonous and to proceed to the emergency department for further care. Rose, coleus, and begonia are not poisonous and would require no further action by the nurse.

A nurse in the pediatric clinic is examining a toddler with suspected enterobiasis (pinworm infestation). For which first sign of an infestation should the nurse assess the child? 1 Anal itching 2 Scaly skin patches 3 Maculopapular rash 4 Bald spot on the head

1 In enterobiasis the adult pinworm lays her eggs around the anal opening, producing itchy irritation. Scaly skin patches are commonly seen with eczema or dermatitis. A maculopapular rash may be seen with hookworm (Necator americanus), not pinworm (Enterobius vermicularis), infestation. A bald spot is produced by ringworm of the scalp (tinea capitis), a fungal infection of the skin.

A 13-month-old child is admitted with a tentative diagnosis of bacterial meningitis, and the practitioner schedules a lumbar puncture. What is the most important action the nurse should take in preparation for the lumbar puncture? 1 Asking the parents what they were told about the test 2 Using a doll to demonstrate the procedure to the child 3 Obtaining a pacifier for the child to suck on during the procedure 4 Telling the parents that they may stay with their child during the test

1 Informed consent is required. The procedure should be explained to the parents by the practitioner, and the nurse should confirm the parents' comprehension and have them sign the consent form. The child is too young to comprehend a demonstration of the procedure. Although staying with the child may be important to the parents, it is not the priority. Although a pacifier may keep the child calm, this is not the priority, either.

Which statement would the nurse state is true for toddlers? 1 The incidence of poisoning is very common in toddlers. 2 An 18-month-old child uses approximately up to 300 words. 3 The average toddler gains 2 to 3 pounds (0.9 to 1.4 kg) each year. 4 Toddlers prefer to engage in parallel play rather than in solitary play.

1 Poisonings occur frequently because children of around 2 years of age place objects or substances in their mouths to learn about them. The 18-month-old child uses approximately 10 words. A toddler gains approximately 5 to 7 pounds (2.3 to 3.2 kg) each year. The toddler begins to engage in parallel play during toddlerhood but also engages in solitary play.

Which description provided by the parent of a toddler-age client would suggest to the nurse that the child is experiencing sleep terrors? 1 Sweating profusely 2 Calling out after the dream 3 Awakening during the second half of the night 4 Being aware that others are in the room after awakening

1 Profuse sweating is a characteristic that would cause the nurse to believe that the child is experiencing a sleep terror versus a bad dream. Calling out after the dream is over, awakening during the second half of the night, and being aware that others are with them after the dream is over are characteristics associated with a bad dream, not a sleep terror.

What does a nurse identify as the priority short-term goal for a toddler with dehydration caused by diarrhea? 1 Improvement of fluid balance 2 Continuation of an antidiarrheal diet 3 Preservation of perianal skin integrity 4 Retention of weight appropriate for height

1 Rehydration and correction of electrolyte imbalances are the priorities; diarrhea causes loss of fluid and electrolytes that can be life threatening. Antidiarrheal diets are no longer prescribed for children with diarrhea. Oral rehydration therapy is the treatment of choice. Although maintaining skin integrity in the presence of diarrhea is important, the risk of disrupted skin integrity is not life threatening, nor is it the priority when a young child is dehydrated. There are no data to indicate that the child is overweight or underweight.

A nurse is obtaining a health history from the mother of a 15-month-old toddler with celiac disease. The nurse expects the mother to indicate what about her toddler? 1 Has bulky, foul, frothy stools 2 Drinks large amounts of fluid 3 Is irritable throughout the day 4 Voids strong, concentrated urine

1 Steatorrhea (fatty, foul-smelling, frothy, bulky stools) occurs with celiac disease because of an intolerance to gluten; toxic substances, which can damage the intestinal mucosal cells, accumulate and cause diarrhea. Drinking large amounts of fluid is a response to dehydration. With celiac disease some thirst may occur, but it is not continuous. Although infants with celiac disease are irritable, this sign is too vague for accurate evaluation. Irritability is symptomatic of a variety of problems, ranging from cutting of teeth to leukemia. Concentrated urine is associated with a urinary tract infection or dehydration; this sign is too vague to permit accurate evaluation.

At what age does the anterior fontanel of the skull close? 1 12 to 18 months 2 20 to 24 months 3 26 to 30 months 4 32 to 36 months

1 The anterior fontanel usually closes between 12 and 18 months. Hence, 20 to 24 months, 26 to 30 months, and 32 to 36 months are all incorrect choices.

Which statement is true about the skeletal system of toddlers? 1 The bones of toddlers are less pliable than those of older persons. 2 The bones of toddlers have less cartilage than those of young adults. 3 The bones of toddlers can better withstand falls than those of older adults. 4 The bones of toddlers are more susceptible to osteoporosis than those of women.

1 The bones of toddlers can withstand falls better than those of older adults. Toddlers' bones are more pliable than those of older persons. Toddlers have greater amounts of cartilage and are highly flexible as compared to the cartilage of young adults. Older adults, especially women, are more susceptible to bone-density loss and are more prone to developing osteoporosis, which increases the risk of fractures.

A 3-year-old child is admitted with partial- and full-thickness burns over 30% of the body. What significant adverse outcome during the first 48 hours should the nurse attempt to prevent? 1 Shock 2 Pneumonia 3 Contractures 4 Hypertension

1 The immediate postburn period is marked by dramatic changes in fluid and electrolyte balance. Alterations in electrolyte balance can produce confusion, weakness, cardiac irregularities, and seizures. As a result of large fluid losses through the denuded skin, vasodilation, and edema formation, hypovolemic shock may develop. Pneumonia is a later complication associated with immobility. Contractures are a later complication associated with scarring and aggravated by improper positioning and splinting. Hypotension, not hypertension, occurs with hypovolemic shock.

Which characteristic related to achieving autonomy does the nurse anticipate when providing care to a toddler-age client? 1 Ritualism 2 Positivity 3 Magical thinking 4 Object permanence

1 The nurse anticipates the toddler-age client to exhibit ritualism during this stage of development in order to achieve autonomy. The nurse would also anticipate the toddler-age client to exhibit negativism, not positivity. Magical thinking is a characteristic the nurse anticipates for the preschool-age, not toddler-age, client. Object permanence is a characteristic that the nurse anticipates for the infant, not the toddler.

What does the nurse educate the mother of a toddler to do in order to promote safety? 1 "Throw plastic grocery bags away." 2 "Fill the crib with large, stuffed toys." 3 "Put pacifiers around the neck of the toddler." 4 "Place the toddler to sleep on his or her back."

1 The nurse educates the mother of a toddler to remove plastic grocery or other bags from from the house to reduce the risk of suffocation. The nurse should instruct the mother not to fill the crib with stuffed toys as there is an increased risk of suffocation. Putting pacifiers around the neck of the child attached with a string increases the risk of choking. The nurse should tell the mother to place a newborn on his or her back to sleep; it reduces the risk of sudden infant death syndrome.

Which topic should the nurse include in a teaching session for the parents of a 13-month-old toddler-age client? 1 Gradual weaning from the bottle 2 Signs of toilet training readiness 3 Peer companionship during play 4 Development of nighttime fears

1 The nurse should include information regarding gradual weaning from the bottle for the parents of a 13-month-old toddler age child. Toilet training readiness, peer companionship during play, and the development of nighttime fears are more appropriate for a toddler-age client between the ages of 18 and 24 months.

Which pain scale should a nurse use to measure the intensity of pain in toddlers? 1 FACES scale 2 Visual analogue scale 3 Numerical rating scale 4 Verbal descriptor scale

1 The nurse should use a FACES scale to measure the intensity of pain in children. The scale consists of six cartoon faces ranging from a smiling face ("no hurt") to increasingly less happy faces and finally to a sad, tearful face ("hurts worst"). The visual analogue scale, numerical rating scale, and verbal descriptor scale can be used in young children and adults.

A parent asks a nurse for suggestions because a 2-year-old child wants to take a bath alone. What is the most appropriate suggestion that the nurse should provide? 1 "Allow the child to wash herself with supervision." 2 "Distract the child with other activities." 3 "Instruct the child on how to take a bath alone." 4 "Punish the child for insisting on taking a bath alone."

1 The parent should allow the child to take a bath alone, but should keep an eye over the child to prevent any adverse events. It will help the child in the learning process. The parent should not distract the child with other activities, because the child may become frustrated. The parent should not punish the child if he or she insists on taking a bath alone, because this will induce a sense of fear in the child.

A 2-year-old toddler requires close supervision to protect against potential accidents. The nurse teaches a class for parents about the learning style of toddlers. How do toddlers learn self-protection? 1 Through trial-and-error strategies 2 By imitating playmates and siblings 3 By obeying orders from mother and father 4 By playing with age-appropriate toys and puzzles

1 The toddler is developing autonomy, is curious, and learns self-protection from experience. Toddlerhood play is parallel play, not interactive, play. The struggle for autonomy at this age limits learning from siblings, even though the toddler attempts to copy their behavior. The toddler is still learning from experiences, not from others. The toddler is still attempting to distinguish the self as separate from the parents; the struggle for autonomy limits learning from parents. Toddlers learn gross and fine motor skills as they play with their toys, not self-protection.

A 2-year-old child who has been restricted to bed rest because of a diagnosis of meningitis is now allowed out of bed. The nurse suggests going to the playroom. The child responds by shaking the head vigorously from side to side, screaming, "No! Won't!" However, the child is trying to climb out of the crib at the same time. In light of these behaviors, what is the most likely conclusion by the nurse? 1 The child is trying to assert independence. 2 The child is eager to resume regular play activities. 3 The child is unsure of the difference between yes and no. 4 The child is confused as a result of increased intracranial pressure.

1 The toddler is exhibiting typical behavior for this developmental level; most toddlers will say no as a means of asserting their independence. Although the child may be eager to resume playing, the behavior described is related to the child's assertion of autonomy. Although toddlers who are attempting to assert independence will say no even when they mean yes, they do understand the difference. This child's behavior does not indicate confusion; it is typical of 2-year-old children, who will say no to most things as a means of asserting their independence.

What step should the nurse undertake during the administration of eardrops in children ages 1 to 3 years? 1 Pulling the auricle down and backward 2 Placing the cotton ball in the innermost part of the canal 3 Keeping the toddler in the side-lying position for 10 to 15 minutes 4 Holding the dropper 3 cm above the child's ear canal to instill the drops

1 To administer ear drops to a toddler, pull the auricle down and back. The cotton ball is placed in the outermost part of the ear canal. The toddler is kept in the side-lying position for 2 to 3 minutes. The dropper is held 1 cm above the ear canal for the instillation of drops.

What would the nurse state is true about a toddler's sleep? 1 Total sleep averages 12 hours a day. 2 In the awake period, a toddler exhibits sleepwalking. 3 A toddler normally takes several naps during the day. 4 It is uncommon for toddlers to awaken during the night.

1 Toddlers sleep 12 hours a day on an average. In the awake period, preschoolers rather than toddlers exhibit brief crying, walking around, unintelligible speech, sleepwalking, or bed-wetting. An infant normally takes several naps during the day but usually sleeps an average of 8 to 10 hours during the night. It is common for toddlers to awaken during the night.

How should a nurse respond to parents who are concerned about separation anxiety in their 15-month-old toddler? 1 "This is an expected developmental reaction." 2 "You may be spending too much time with your child." 3 "It might be helpful to leave your child with someone once in a while." 4 "Toddlers who have separation anxiety may have difficulty when they start school."

1 Understanding that separation anxiety is an expected developmental occurrence will be reassuring to the parents. Commenting that the parents may be spending too much time with their child is a value judgment and does not address this expected stage of development. Giving advice is not therapeutic and does not address the child's separation anxiety. There is no connection between separation anxiety in a 15-month-old child and difficulty starting school.

A 3-year-old child has been observed in the clinic waiting room taking toys from others, tearing pages out of books, and striking the mother. The nurse takes time when interviewing the mother to ask about television habits because of what reason? 1 Viewing violent programs is positively correlated with the development of aggression. 2 The nurse is interested in how much time the mother spends in interactions with the child. 3 Watching Sesame Street and other children's shows results in slow cognitive development. 4 There is a direct connection between the number of hours of television viewed and toddler aggression.

1 Watching violent programs is positively correlated with the development of aggression. Television viewing time does not necessarily have anything to do with interaction time with the mother. Children's shows have not been shown to slow cognitive development. There are no statistics stating specifically that the number of hours of television watched correlates directly with an intensification of aggression.

The nurse observes a 2-year-old child at play and concludes that the child is engaging in age-appropriate behavior for a toddler. Which activities lead the nurse to this conclusion? Select all that apply. 1 Is possessive of toys 2 Follows simple directions 3 Can play simple card games 4 Enjoys playing with other children 5 Attempts to stay within the lines when coloring

12 Common developmental norms of the toddler, who is struggling for independence, are an inability to share easily, egotism, egocentrism, and possessiveness. Toddlers have a basic understanding of language and the cognitive ability to follow simple directions. Simple card games are too advanced for toddlers. Enjoying playing with other children and attempting to stay within the lines when coloring are true of preschool-aged children.

The nurse is preparing to teach the parents of a toddler about the inability of the toddler-age clients to judge conservation related to mass. Which information should the nurse include in a teaching session during a health maintenance visit? Select all that apply. 1 Size 2 Color 3 Shape 4 Length 5 Volume

1345 The toddler-age client is unable to judge conservation related to mass, including size, shape, length, and volume. Color is not related to the toddler-age client's inability to judge conservation of mass.

Which of these statements about language development in children ages 12 to 36 months are true? Select all that apply. 1 24-month-old children use pronouns. 2 18-month-old children use approximately 25 words. 3 24-month-old children speak in four-word sentences. 4 24-month-old children have a vocabulary of up to 500 words. 5 36-month-old children learn to use five or six new words each day.

15 Children 24-months-old use pronouns and want independence and control. By 36 months, the child can use simple sentences and follow some grammatical rules and is learning to use five or six new words each day. Children 18-months-old use approximately 10 words. Children 24-months-old speak in two-word sentences drawn from a vocabulary of up to 300 words.

During which health maintenance visit for a toddler-age client should the nurse assess the ability to throw a ball overhand without losing balance? 1 12 months 2 18 months 3 24 months 4 30 months

2 A toddler-age client should be able to throw a ball overhand without losing balance by 18 months of age [1] [2]. Twelve months is too young to throw a ball without losing balance. Twenty-four months and 30 months are later than when the nurse anticipates this skill to occur.

According to Erikson's theory, which behavior would the student nurse explain that a toddler exhibits? 1 The child gets casual about body appearance. 2 The child starts performing self-care activities. 3 The child suppresses feelings of the superego. 4 The child becomes dependent on his or her siblings.

2 According to Erikson's theory, a toddler between 1 to 2 years of age becomes involved in self-care activities like walking, feeding, and toileting. During the identity versus role confusion stage, an adolescent can be seen having a preoccupation with appearance and body image. The child moves to the next stage and develops superego, or conscience, during the initiative versus guilt stage. During the autonomy versus shame and doubt stage, the toddler develops his or her autonomy by making choices and does not depend on siblings.

What is the maximum recommended dose of an intramuscular injection in a toddler? 1 0.5 mL 2 1 mL 3 1.5 mL 4 2 mL

2 An intramuscular dose is very small and usually does not exceed 1 mL in toddlers or 0.5 mL in infants. The other options, 1.5 mL and 2 mL, are incorrect.

What is an important nursing intervention in the care of a hospitalized toddler with cystic fibrosis? 1 Discouraging coughing 2 Performing postural drainage 3 Encouraging active exercise 4 Providing small, frequent feedings

2 Because the mucus glands secrete thick mucoid secretions that accumulate, reducing ciliary action and mucus flow, the nurse should perform postural drainage, which promotes the removal of mucopurulent secretions by means of gravity. Coughing should be encouraged; it helps bring up secretions from the respiratory tract. Although the nurse should encourage activities that are appropriate for the child's physical capacity, the child's energy should be conserved during acute phases of illness. Providing small, frequent feedings is not necessary; the child with cystic fibrosis may eat regular meals at the usual times.

A nurse teaches the mother of a 2-year-old child who has celiac disease which foods to avoid. Which foods identified by the mother indicate that she understands the teaching? 1 Bacon and eggs 2 Macaroni and cheese 3 Tuna salad and rice cakes 4 Chicken leg and corn on the cob

2 Children with celiac disease cannot digest the gliadin component of gluten. Foods containing grains such as wheat, rye, oats, and barley should be avoided; macaroni is contraindicated because it is a wheat product. Bacon and eggs, tuna and rice cakes, and chicken and corn are gluten-free foods.

Which gross motor skill should the nurse anticipate when assessing a 15-month-old toddler-age client during a scheduled health maintenance visit? 1 Using a cup well 2 Creeping up stairs 3 Scribbling spontaneously 4 Building a tower of two blocks

2 Creeping up the stairs is a gross motor skill the nurse expects when assessing a 15-month-old toddler-age client during a scheduled health maintenance visit. Using a cup well, scribbling spontaneously, and building a tower with two blocks are all fine, not gross, motor skills the nurse expects when assessing a 15-month-old toddler-age client.

A 3-year-old child is scheduled for cardiac catheterization. What is the priority nursing care after this procedure? 1 Encouraging early ambulation 2 Monitoring the site for bleeding 3 Restricting fluids until the blood pressure has stabilized 4 Comparing blood pressure readings in the lower extremities

2 Hemorrhage is a major life-threatening complication because arterial blood is under pressure and a catheter has been inserted into an artery. The child is kept in bed for 6 to 8 hours after an arterial catheterization. Fluids may be given as soon as they are tolerated. Pulses, not blood pressure, must be compared for quality and symmetry.

An unconscious toddler requires intermittent nasogastric feedings. When should the nurse check placement of the tube? 1 Once a day 2 Before each feeding 3 At every shift change 4 During the night shift

2 It is the nurse's responsibility to assess tube placement before each feeding; withdrawing gastric contents before each feeding ensures that the tip of the tube is in the stomach. The other times are not frequent enough; the tube could be displaced between feedings.

A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend? 1 Ear drops 2 Myringotomy 3 Mastoidectomy 4 Steroid therapy

2 Myringotomy is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Ear drops are not used because they will obscure the view of the tympanic membrane. Removal of the mastoid will not relieve pressure within inflamed ears. Antibiotics, not steroids, are used for an infectious process.

A 3-year-old is placed in a bilateral hip spica cast for the treatment of developmental dysplasia of the hip. The nurse should teach the parents to monitor their child and report to the practitioner the occurrence of what? 1 Warm toes 2 Leg numbness 3 Skin desquamation 4 Generalized discomfort

2 Numbness is a neurologic symptom that should be reported immediately because it indicates pressure on the nerves and blood vessels. Warm toes indicate intact circulation to the lower extremities. Peeling skin (desquamation) is the result of inadequate skin care, but can be managed easily with lotion or oil. Some degree of discomfort is expected after cast application.

A nurse is observing two 18-month-old children playing side by side in a sandbox. Although they watch each other, neither interacts with the other. What type of play does the nurse identify? 1 Solitary 2 Parallel 3 Associative 4 Cooperative

2 Parallel play is typical of the toddler age group, when children play beside but not with each other. Solitary play is a feature of infancy. Associative play is a characteristic of the preschool years, when children interact in loose association. Cooperative play is seen in school-aged children, whose play is organized, such as in sports and board games.

A child sitting on a chair in a playroom starts to have a tonic-clonic seizure with a clenched jaw. What is the best initial action by the nurse? 1 Trying to open the jaw 2 Placing the child on the floor 3 Calling out for assistance from staff 4 Placing a pillow under the child's head

2 Placing the child on the floor limits the danger of falling and striking the head. Attempting to open the jaw is unsafe; it may result in injury. Protecting the child is the priority; assistance at this time is futile. Placing a pillow under the child's head may cause airway occlusion by forcing the chin onto the neck.

Which statement is true regarding the importance of play for children? 1 Pretend play hampers the cognitive development of children. 2 Playing is important because it helps children to release frustration. 3 Children should be introduced to reality if they have imaginary playmates. 4 Children should completely avoid television, electronic games, and computer programs.

2 Playing serves as a medium for children to release frustration. Pretend play allows children to learn to understand others' points of view, develop skills in solving social problems, and become more creative. Some children have imaginary playmates. Imaginary playmates are a sign of health and help children to distinguish between reality and fantasy. Television, videos, electronic games, and computer programs support development and the learning of basic skills. There should be limited use of these for preschoolers, but these need not be completely avoided. On the other hand, television, electronic games, and computer programs have lasting negative effects on a toddler's language development, reading skills, and short-term memory.

Several 3-year-old girls in the daycare center are having a tea party with their dolls. The center's nurse concludes that this behavior is what? 1 Evidence of abstract thought 2 Appropriate make-believe play 3 Inappropriate exclusion of boys 4 Maladaptive use of magical thinking

2 Preschool children use imitation of adult situations to help learn social skills; they enjoy make-believe play. Abstract thinking does not develop until adolescence. Same-gender play is common among preschoolers. Magical thinking is expected in toddlers, preschoolers, and early school-age children.

The nurse is preparing to conduct a scheduled health maintenance visit for a 15-month-old toddler-age client. Which information should the nurse include in the teaching session with the toddler's parents related to socialization and cognition? 1 Engages in parallel play 2 Imitation of parental activities 3 An elevated fear of strangers 4 Tolerates long periods of parental separation

2 The 15-month-old toddler will imitate parental activities such as cleaning house or sweeping the floors; therefore, this is an appropriate topic for the nurse to include in the teaching session. Engagement in parallel play does not occur until approximately 24 months of age. The 15-month-old toddler will have a decreased, not elevated, fear of strangers. The 15-month-old toddler tolerates some, but not long, periods of parental separation.

A 3-year-old child ingests a substance that may be a poison. The parent calls a neighbor who is a nurse and asks what to do. What is the best response by the nurse? 1 Administer syrup of ipecac. 2 Call the Poison Control Center. 3 Take the child to the emergency department. 4 Give the child bread dipped in milk to absorb the poison.

2 The Poison Control Center has the most current and up-to-date information on how to treat any type of poisoning. Also, the center can advise the parent whether to bring the child to the hospital and what data to collect to bring to the hospital, if this becomes necessary. Administration of syrup of ipecac is no longer recommended by the American Academy of Pediatrics. A potential poisoning may or may not require emergency intervention; with expert advice the child may be treated in the home. Also, the experts at the Poison Control Center can provide advice about initial interventions at home before going to the hospital. No treatment should begin before obtaining information about the amount and kind of substance ingested and the advice of a healthcare provider.

The parent of a 2-year-old calls a nurse who is a neighbor and reports that the child just ate several multivitamins with iron. What should the nurse say to the parent? 1 "Give your child orange juice." 2 "Call the Poison Control Center." 3 "Iron-fortified multivitamins are safe for your child." 4 "Administer an emetic—syrup of ipecac, if you have it."

2 The Poison Control Center will provide the best guidance for treatment of excess ingestion of a substance; enemas, lavage, or chelation therapy with deferoxamine (Desferal), a heavy metal antagonist, may be recommended, depending on the amount ingested and the child's age and response. Orange juice will enhance absorption of the iron and will create a greater risk for toxicity. Iron is the most toxic substance in multivitamins. Although signs and symptoms may not be evident for several hours, treatment should be initiated before a problem develops. Emetics are not used for poisonings; they are not effective in removing the toxic substance, and causing the child to vomit creates a risk for aspiration.

What would the student nurse claim is an acceptable respiratory rate range in a toddler of 2 years of age? 1 20 to 30 breaths/minute 2 25 to 32 breaths/minute 3 30 to 50 breaths/minute 4 35 to 40 breaths/minute

2 The acceptable respiratory rate range in a toddler is 25-32 breaths/minute. The acceptable range in a child is 20-30 breaths/minute. The respiratory rate in a 6-month-old infant is 30-50 breaths/minute; in newborns, it is 35-40 breaths/minute.

How would the nurse explain that the skeletal system of toddlers differs from older adults? 1 Bones of toddlers are less pliable than those of older persons. 2 Bones of toddlers can withstand falls better than those of older adults. 3 Bones of toddlers are more susceptible to osteoporosis than those of older adults. 4 Bones of toddlers are more susceptible to bone loss than the bones of older persons.

2 The bones of toddlers can better withstand falls than the bones of older adults. Toddlers' bones are more pliable than those of older people. Older adults, especially women, are more prone to developing osteoporosis, which increases the risk of fractures. Older adults, especially women, are more susceptible to bone loss.

The parents of an 18-month-old toddler are anxious to know why their child has experienced several episodes of acute otitis media. What should the nurse explain to the parents about why toddlers are prone to middle ear infections? 1 Immunologic differences between adults and young children 2 Structural differences between eustachian tubes of younger and older children 3 Functional differences between eustachian tubes of younger and older children 4 Circumference differences between middle ear cavity size of adults and young children

2 The eustachian tube in young children is shorter and wider, allowing a reflux of nasopharyngeal secretions. Immunologic differences are not a factor in the development of otitis media. There is no difference in the function of the eustachian tube among age groups. The size of the middle ear does not play a role in the occurrence of otitis media in young children.

A nurse is educating parents about the changes to expect when their child enters toddlerhood. Which information does the nurse include? 1 The toddler's body appears slender. 2 The toddler has a protruded abdomen. 3 The toddler's feet are severely everted. 4 The toddler has inconspicuous cervical curves.

2 The nurse explains to the parents that at the start of toddlerhood, the abdomen of the child will be protruded. The bodies of toddlers start appearing slender by the age of 3 years, not in the beginning of toddlerhood. As the child walks, the legs and feet are usually far apart, and the feet are slightly everted, not severely everted. Toward the end of toddlerhood, curves in the cervical and lumbar vertebrae are accentuated.

A nurse is measuring the blood pressure of toddlers during a community health camp. What blood pressure finding is the nurse most often to find in the toddlers? 1 85/54 mm Hg 2 95/65 mm Hg 3 105/65 mm Hg 4 110/65 mm Hg

2 The nurse is most likely to find 95/65 mm Hg as a toddler's blood pressure because this is the normal blood pressure of toddlers. The normal blood pressure in infants is 85/54 mm Hg. The optimal blood pressure for children above the age of 6 years is 105/65 mm Hg. Between the ages of 10 and 13 years, normal blood pressure is 110/65 mm Hg.

A nurse receives an order to prepare the solution for administering a cleansing enema to a 3-year-old child. What is the volume of solution the nurse should prepare? 1 150 to 250 mL 2 250 to 350 mL 3 300 to 500 mL 4 500 to 750 mL

2 The nurse should prepare 250 to 350 mL of warmed solution for administering a cleansing enema in a toddler. The nurse should prepare 150 to 250 mL of warmed solution for infants. In school-aged children, the volume of warmed solution is 300 to 500 mL. In adolescents, the volume required is 500 to 750 mL.

How many words should the nurse expect the 3-year-old child to acquire each day? 1 2 to 3 2 5 to 6 3 8 to 10 4 11 to 13

2 The nurse would expect the 3-year-old toddler-age child to acquire 5 to 6 new words each day. Two to 3 new words, 8 to 10 new words, and 11 to 13 new words are not expected parameters for language development.

While in the hospital's playroom a toddler suddenly has a nosebleed that leaves blood on the play table. What is the nurse's first response in this situation? 1 Taking the child back to the room for care 2 Providing nursing care to stop the nosebleed 3 Calling the housekeeping department to clean the room 4 Securing a prescription for the blood to be tested for pathogens

2 The nurse's priority is caring for the child. Once the child's problem has been resolved, the nurse may address the problem of the blood on the play table. The child's needs must be met immediately, even if the intervention must be performed in the playroom. Cleaning up the blood in the playroom is done after the child's immediate needs have been met. The hospital's protocol for the removal of the blood should be followed. Having the blood tested for pathogens is unnecessary unless the nurse or another individual has had direct contact with the blood; the hospital's protocol should be followed.

Which term should the nurse use when describing the physical growth that occurs during the toddler years? 1 Linear 2 Steplike 3 Sporadic 4 Unpredictable

2 The physical growth of a toddler-age client is steplike. The growth pattern is not linear, sporadic, or unpredictable.

The mother of an 18-month-old toddler tells the nurse in the pediatric clinic that her child is "unmanageable and into everything." What is the most important teaching to include during this clinic visit? 1 Toddlers are eager to taste new and different foods. 2 Accidents are the leading cause of death and injury in this age group. 3 Childhood infections are prevented by adhering to the immunization schedule. 4 Monthly examinations are essential to facilitate early identification of problems.

2 The priority of care, in light of the mother's statement, is safety. Accidents are the leading cause of death among toddlers because they are in the age of autonomy; they explore their world with no understanding of negative consequences. Toddlers are finicky eaters, and their negativism precludes their trying new foods; however, they use their mouths to help explore objects in the environment that arouse their curiosity. There are infections that cannot be prevented by immunizations. Monthly examinations are not necessary for a healthy toddler.

What is the recommended size of the urinary catheter that can be used in a 3-year-old child? 1 5 to 6 Fr 2 8 to 10 Fr 3 14 to 16 Fr 4 16 to 18 Fr

2 The recommended size of a urinary catheter that can be used in a 3-year-old child is 8 to 10 Fr. A urinary catheter of 5 to 6 Fr is generally used in infants. A length of 14 to 16 Fr is recommended for most adult clients. A length of 16 to 18 Fr is commonly used in adult males.

A toddler on the pediatric unit is required to have temporary dietary restrictions after colorectal surgery. What is the best way for the nurse to promote adherence to the restrictions? 1 By limiting restrictions to nonessential foods 2 By handling dietary changes in a matter-of-fact way 3 By having the dietitian explain the restrictions to the parents 4 By arranging to have an adult other than a parent stay at mealtime

2 Toddlers are ritualistic and do not tolerate change well; any change in diet should be done matter of factly. Because of their characteristic struggle for autonomy, toddlers should not be forced to eat. Limited restrictions on nonessential foods are not always possible. Although the parents should consult with the dietitian, this will not affect the toddler's response to the dietary restrictions. The toddler is still dependent on the parents and therefore will respond better to them than to a stranger

Until what age in years does a child need to drink whole milk for adequate neurologic development? Record your answer using a whole number._____ years of age

2 Toddlers need to drink whole milk until the age of 2 years to ensure adequate intake of the fatty acids necessary for brain and neurologic development.

A nurse in the daycare center is teaching several aides about the play behavior of 2-year-old toddlers. What is this type of play called? 1 Group 2 Parallel 3 Dramatic 4 Cooperative

2 Toddlers play independently but beside other children; they are aware of the other children, often grabbing toys from them, but do not socially interact with them. Group play is characteristic of older children. Dramatic play or acting is characteristic of older children; starting at the preschool age, they assume and act out roles. Cooperative play is also characteristic of older children; starting at the preschool age; they learn to share, wait their turn, and become sensitive to their peers' needs.

The nurse notes that a 3-year-old child in a crib has a clamped jaw and is having a tonic-clonic seizure. What is the priority nursing responsibility at this time? 1 Applying restraints 2 Administering oxygen 3 Protecting the child from self-injury 4 Inserting a plastic airway in the child's mouth

3 Because the child is in a crib, the nurse should remain, observe, and protect the child from injury to the head or extremities during seizure activity. An individual should never be restrained during a seizure; fractured bones or torn muscles and ligaments may result. Administering oxygen is useless until the seizure is over; the child is apneic during the seizure. Attempts at inserting an airway are futile and may damage the child's teeth and jaws.

A nurse in the emergency department notes large welts and scars on the back of a toddler who has been admitted for an asthma attack. What additional information must be included in the nurse's assessment? 1 History of an injury 2 Signs of child abuse 3 Presence of food allergies 4 Recent recovery from chickenpox

2 When unexplained injuries are found, further assessment is required because it is the nurse's legal responsibility to report suspected child abuse. History of an injury is just one aspect of the assessment for child abuse. The presence of food allergies is not related to scars on the child's back. Although chickenpox may leave scars, it does not cause welts.

While obtaining the health history of a 15-month-old toddler, the child of a migrant worker, a nurse learns that the infant recently had a fever, runny nose, cough, and white spots in the mouth lasting 3 days. A rash started on the face and spread to the whole body. What communicable disease does the nurse suspect the infant suffered from? 1 Rubella 2 Rubeola 3 Pertussis 4 Varicella

2 White spots in the mouth (Koplik spots) and the rash, combined with increased mucus secretions (coryza), are indicative of measles (rubeola). Rubella (German measles) does not cause Koplik spots. Pertussis (whooping cough) has a distinctive cough, but there are no Koplik spots or rash. Varicella (chickenpox) features skin lesions rather than a rash and lesions in the mouth.

Which heart sound is normally heard in a toddler that is considered abnormal in an adult over 30-years-old? 1 S1 2 S2 3 S3 4 S4

3 An S3 is considered abnormal in adults over 30 years of age, but can often be heard normally in toddlers and young adults. S1, S2, and S4 are normally heard in older adults over 30 years of age and in children and athletes.

The mother of a 2-year-old child tells the nurse that she is concerned about her child's vision. What behavior when the child is tired leads the nurse to suspect strabismus? 1 One eyelid droops. 2 Both eyes look cloudy. 3 One eye moves inward. 4 Both eyes blink excessively.

3 An inward moving eye (tropia) is one form of strabismus. A drooping eyelid is called ptosis; it may be congenital or caused by trauma. Cloudy eyes are associated with congenital cataracts. Blinking may be a tic.

The parents of a toddler with newly diagnosed cystic fibrosis (CF) tell a nurse that even though they were told it is an inherited disorder, there is no history of CF in the family. How can the nurse clarify the way in which the disease was inherited? 1 It is a mutated gene. 2 It involves an X-linked gene. 3 The inheritance is autosomal recessive. 4 The inheritance is autosomal dominant.

3 Both parents are carriers; the gene for CF is recessive, not dominant, and the parents do not have the disease. The gene for CF is not a mutant gene, nor is it located on the X or Y chromosome.

A toddler is admitted to the emergency department with a diagnosis of acute spasmodic laryngitis. After the spasms subside, the child is ready to be discharged. What should the nurse teach the parents to do at home to help prevent another croup episode? 1 Perform postural drainage. 2 Discourage before-bedtime snacks. 3 Use a cool mist vaporizer in the child's room. 4 Demonstrate to the child how to expel air after inspiration.

3 Cool mist provides humidification. Postural drainage would likely increase the child's anxiety. There is no relationship between eating and the onset of spasmodic croup. It is useless to give instruction while the child is fighting to breathe.

A nurse is planning for the discharge of a child after a sickle cell vaso-occlusive crisis. What is most important for the nurse to emphasize? 1 A high-calorie diet 2 A rigorous exercise regimen 3 An increased intake of fluids 4 An increase in the hours spent sleeping

3 Dehydration promotes the sickling of erythrocytes. Increased fluid intake minimizes the chance that sickle cell pain will recur. A high-calorie diet is not necessary or helpful for a child with sickle cell anemia. Rigorous exercise is contraindicated because the decrease in oxygenation may cause sickling. An increase in the hours spent sleeping is not necessary.

A 15-month-old child is hospitalized after ingesting toilet bowl cleaner. The mother confides that she feels guilty about leaving the cleaner where her child could get it. What is the best response by the nurse? 1 "Anyone could make a mistake. Don't dwell on it." 2 "Let's not worry about the past. Your child is going to get better." 3 "It was an accident, but you should consider special locks on your closets." 4 "That was careless of you. Please make sure that you poison-proof your house."

3 Describing the incident as an accident and recommending locks on closets accepts the mother's statement and helps the mother express her guilt while providing directions to safeguard her child. Poisoning is not an everyday occurrence; teaching should be incorporated to protect the child. Telling the mother that the child will get better is false reassurance; the child's condition is still in question. Calling the mother careless only increases the mother's guilt and provides nothing more than a vague suggestion of how to remedy the problem.

Which clinical manifestation would cause the nurse to suspect that a toddler-age client ingested a corrosive agent, such as bleach? 1 Choking 2 Gagging 3 Drooling 4 Vomiting

3 Drooling is often associated with the ingestion of a corrosive agent, such as bleach. Choking, gagging, and vomiting are clinical manifestations associated with the ingestion of hydrocarbons, not corrosive agents.

What would the nurse claim is true regarding play in toddlers? 1 Children have imaginary playmates. 2 Children prefer to play with other children. 3 Children get curious and explore the environment. 4 Children prefer to stay away from parents while playing.

3 During toddlerhood, the child is curious, which is evident in their exploration of the environment. Preschoolers have fantasies and imaginations. Imaginary playmates are a sign of health and allow children to distinguish between reality and fantasy. Children continue to engage in solitary play during toddlerhood but also begin to participate in parallel play. Children prefer playing beside rather than with another child. Toddlers fear separation from their parents and feel safer in their presence.

A nurse on the pediatric unit is observing the developmental skills of several 2-year-old children in the playroom. Which child should the nurse continue to evaluate? 1 One who cannot stand on one foot 2 One who builds a tower of seven blocks 3 One who exhibits echolalia when speaking 4 Once who colors outside the lines of a picture

3 Echolalia in a 2-year-old child may be a sign of autism; imitation of sounds begins around 6 months of age and may continue for several more months. The average 2-year-old child has a 300-word vocabulary and uses two- and three-word phrases. It is not until 30 months of age that the toddler is able to stand on one foot. Building a tower of five or six blocks is expected at the age of 2 years. Although the pincer grasp is achieved at 11 months, it is not until the age of 30 months that the toddler is expected to hold crayons with the fingers rather than the fists and to be able to color within the lines of a picture.

A 13-month-old toddler has a respiratory tract infection with a low-grade fever. When teaching the parents, which intervention should the nurse emphasize? 1 Encouraging high-calorie snacks to prevent weight loss 2 Keeping the toddler wrapped in blankets to prevent shivering 3 Giving small amounts of clear liquids frequently to prevent dehydration 4 Using cool-water baths to prevent the toddler's fever from increasing further

3 Fluid is lost through perspiration and the increased metabolic rate associated with a fever; an intake of small, frequent amounts of fluids will replenish lost fluid and prevent dehydration. Although caloric intake is important, it is not the priority. Keeping the toddler wrapped in blankets to prevent shivering interferes with the radiation of heat from the body; dressing the toddler in light clothing will help reduce the fever. Cool baths may produce shivering; this will increase the fever; a low-grade fever is part of the body's adaptive mechanism that limits the multiplication of microorganisms.

While assessing an 18-month-old child a nurse observes that the toddler can crawl up stairs but needs assistance when climbing the stairs upright. What does this indicate to the nurse? 1 Presence of talipes equinovarus 2 Presence of neurologic damage 3 Expected behavior in a toddler of this age 4 Existence of developmental dysplasia of the hip

3 It is not until 2 years of age that toddlers are able to use their feet to walk up stairs instead of crawling. Talipes equinovarus is identified with the use of other criteria. At 18 months of age the inability of the toddler to use the feet to go up stairs is not a problem; it is expected and does not indicate neurologic damage. Developmental dysplasia of the hip is identified with the use of other criteria.

What step should the nurse follow when taking a toddler's blood pressure? 1 Use an ultrasonic stethoscope. 2 Choose a cuff labeled "toddler". 3 Use a pediatric stethoscope bell to hear Korotkoff sounds. 4 Place the stethoscope firmly on the antecubital fossa for good auscultation.

3 Korotkoff sounds are difficult to hear in toddlers because of their low frequency and amplitude. Hence the pediatric stethoscope bell is used to hear these sounds. An ultrasonic stethoscope is used to measure blood pressure when auscultation is not possible because of weak arterial pulses. It need not be used for all toddlers. The choice of cuff should not be based on the name of the cuff. For instance, a cuff labeled "infant" may not fit, despite its name. Placing the stethoscope too firmly on the antecubital fossa results in errors in auscultation.

A nurse is teaching a class to parents about keeping medications and household cleaning supplies out of the reach of toddlers. The nurse explains that this is necessary because of what characteristic of toddlers? 1 They have increased appetites. 2 They are developing a sense of taste. 3 They have a high level of oral activity. 4 They are rebelling against parental authority.

3 One way in which toddlers explore their environment is by putting objects in their mouths. An expected decline in appetite occurs during this period; it is called physiologic anorexia. The sense of taste is developed at birth. Toddlers assert themselves, but are not rebellious against adult authority; adolescents rebel against adult authority.

According to the student nurse, in which stage of Erikson's theory does the child initiate self-care activities? 1 Initiative versus guilt 2 Integrity versus despair 3 Autonomy versus sense of shame and doubt 4 Generativity versus self-absorption and stagnation

3 The development of self-care activities in a toddler occurs at the stage of autonomy versus a sense of shame and doubt. This is the second stage of Erikson's theory. The initiative versus guilt stage is the third stage of Erikson's theory. During this stage, children like to pretend and try out new roles. Integrity versus despair is the eighth stage of Erikson's theory. At this stage, many older adults view their lives with a sense of satisfaction. Middle-aged adults achieve success at the stage of generativity versus self-absorption and stagnation. Individuals contribute to future generations through parenthood, teaching, and community involvement.

Which toddler behavior should the nurse identify as global organization, a characteristic of preoperational thought? 1 Yells at the chair for causing a fall 2 Not wanting to eat food due to the color 3 Refusal to sleep in bedroom because the bed has been moved 4 Inability to understand that others have a different perspective

3 Refusal to sleep in a bedroom because the bed has been moved to another location is an example of global organization. Egocentrism causes the toddler-age client to be unable to understand the perspectives of others. Yelling at the chair for causing a fall is an example of animism. Not wanting to eat food due to the color is an example of centration.

Which statement by the nurse is true about health promotion in infants and toddlers? 1 Allow a toddler to sleep on his side. 2 Place pillows in the crib of an infant. 3 Remove grocery plastic bags from the home. 4 Keep pacifiers on a ribbon around a toddler's neck.

3 Removing grocery and dry cleaner's plastic bags from the home reduces the risk of suffocation from plastic bags. Parents should have infants sleep on their backs to reduce the risk of sudden infant death syndrome. Placing pillows in the crib increases the chances of suffocation. A string or ribbon around the neck increases the risk of choking. Snug-fitted sheets should be used in cribs because the possibility exists for infants to become entwined in sheets and other bedding and suffocate.

A nurse is observing hospitalized toddlers in the playroom. What does the nurse identify as their most important need? 1 Stimulating play 2 Therapeutic play 3 Contact with their parents 4 Gentle discipline from the nurse

3 Separation anxiety becomes an issue at this age; toddlers need contact with parents, who provide a sense of security. Stimulating play may offer a distraction, but the greater need is for parental contact. Toddlers are too young for therapeutic play, which is more successful with preschoolers and young school-age children. Gentle discipline from the nurse may be necessary at times, but the greatest need of hospitalized toddlers is to have parental contact.

The parents of a 2-year-old child are watching the nurse administer the Denver II Developmental Screening Test to their child. They ask, "Why did you make our child draw on paper? We don't let our child draw at home." What is the best response by the nurse? 1 "I should have asked you about drawing first." 2 "These drawings help us determine your child's intelligence." 3 "It lets us test the child's ability to perform tasks requiring the hands." 4 "I don't understand why drawing is forbidden in your home."

3 The Denver II Developmental Screening Test is one of the tests used to evaluate young children whose development appears to be behind the norm. It involves the use of a variety of methods to determine the level of development. The parents gave their consent to have the test done and were told that a variety of skills would be tested. A developmental screening test is designed not to test intelligence, but rather to test the child's ability to perform specific age-appropriate developmental tasks. It is inappropriate to question the parents' childrearing ability.

Which age range does the nurse know is classified as the toddler years? 1 12 to 18 months 2 12 to 24 months 3 12 to 36 months 4 12 to 48 months

3 The age range for the toddler years is 12 to 36 months of age. The toddler years are not 12 to 18 months, 12 to 24 months, or 12 to 48 months.

Which Korotkoff sound represents the diastolic blood pressure in toddlers? 1 First 2 Third 3 Fourth 4 Fifth

3 The fourth Korotkoff sound is muffled and low. This sound is the diastolic pressure in toddlers. The first Korotkoff sound is sharp and represents systolic blood pressure. The third Korotkoff sound is crispier and includes intense tapping. The fifth Korotkoff sound marks the disappearance of sound. In adolescents and adults the fifth sound corresponds with the diastolic pressure.

Which method of drug administration does the nurse state is commonly used in toddlers when the child has poor intravenous (IV) access? 1 Intrathecal 2 Intraarterial 3 Intraosseous 4 Intraperitoneal

3 The intraosseous route is commonly used in toddlers for drug administration in an emergency situation. It is most commonly used in infants and toddlers in whom there is poor access to the intravascular space. Intrathecal administration is often associated with long-term medication administration through surgically implanted catheters. Intraarterial infusions are common in clients who have arterial clots. Chemotherapeutic agents, insulin, and antibiotics are administered via the intraperitoneal route.

What behavior does the nurse suggest a parent will notice in her 2-year-old child after the death of a family member? 1 The child shows resiliency over the loss. 2 The child understands the cause of the loss. 3 The child exhibits changes in sleeping patterns. 4 The child is unable to develop an autonomous sense of self.

3 The parent will notice that after the death of a family member, her child is exhibits changes in eating and sleeping patterns. Older adults, not toddlers, show resiliency over the loss of a family member. Toddlers do not understand the cause of the loss. The loss of a family member may disrupt the development of autonomy in young adults.

Elbow restraints are prescribed for an 18-month-old toddler who just had surgery for a cleft palate. The nurse explains to the parents that the restraints are used to keep the child from doing what? 1 Playing with unsterile toys 2 Rolling to a supine position 3 Putting fingers into the mouth 4 Removing the nasogastric tube

3 The suture lines in the mouth must be protected. Because the toddler uses the mouth to explore the environment, elbow restraints are needed to keep the child from placing fingers or objects in the mouth. The child should have time to play with toys, but with supervision to prevent mouthing activities that could disrupt the suture line. The supine position is acceptable; the toddler should be able to move freely when asleep. A nasogastric tube is not used.

What is the cause of milk anemia in toddlers? 1 Drinking skim milk 2 Drinking whole milk 3 Increased milk intake 4 Increased intake of fruits

3 Toddlers who consume more than 24 ounces of milk daily in place of other foods sometimes develop milk anemia because milk is a poor source of iron. Children are usually not offered low-fat or skim milk until age 2 because they need the fat for satisfactory physical and intellectual growth. Toddlers need to drink whole milk until the age of 2 years to make sure that there is adequate intake of fatty acids necessary for brain and neurological development. Other solid food items are necessary for healthy growth and development in toddlers.

A nurse explains to the mother of a 1-year-old with a history of frequent ear infections that the primary cause of otitis media in young children is what? 1 Sinusitis 2 Recurrent tonsillitis 3 An inflamed mastoid process 4 An obstructed eustachian tube

4 A blocked eustachian tube impairs drainage and creates negative pressure; when the tube opens, bacteria are pulled into the middle ear. Sinusitis is not related to otitis media. Recurrent tonsillitis is not the direct cause of otitis media. Mastoiditis is a complication, not a cause, of otitis media.

During a well-child visit the parents tell a nurse, "Our 3-year-old doesn't listen to us when we speak and ignores us!" An auditory screening reveals that the child has a mild hearing loss. What should the nurse explain to the parents about this degree of hearing loss? 1 A severe hearing deficit may develop. 2 It will not interfere with progress in school. 3 An immediate follow-up visit is not necessary. 4 Speech therapy in addition to hearing aids may be required.

4 A mild degree of hearing loss causes the child to miss approximately 25% to 40% of conversations; it may result in speech deficits and interfere with the child's educational progress if it is not corrected. Hearing aids usually help improve function. There is no evidence that this child's hearing loss is progressive. The significance of the hearing loss requires further analysis and intervention.

A parent asks the nurse what to do when the toddler has temper tantrums. What play materials should the nurse suggest that the child be offered as another means of expressing anger? 1 Ball and bat 2 Wad of clay 3 Punching bag 4 Pegs and pounding board

4 A pounding board with pegs to hammer into holes is a safe toy for toddlers because it is fairly large, easy to manipulate, and sturdy. It also provides an acceptable way for anger to be expressed. The child's motor and hand-eye coordination are too immature for the child to use a ball and bat. A wad of clay is not as effective for releasing anger as a pounding board. A punching bag is appropriate for an older child with more mature motor coordination to compensate for a moving object.

Which toddler-age client has reached a height in which it is no longer safe to sleep in a crib? 1 26 inches 2 28 inches 3 33 inches 4 36 inches

4 A toddler-age client who reaches 35 inches should sleep in a bed versus a crib for safety reasons. The other heights in inches (26, 28, and 33) can remain in a crib because safety is not a concern.

Which statement is true about the diet plan for toddlers? 1 Refrain from serving finger foods. 2 Toddlers need 4 to 6 cups of milk per day. 3 Low-fat or skimmed milk should be given until the child is 2 years old. 4 Milk should be supplemented with solid food items like vegetables and fruits.

4 In toddlers, the parents should be supplementing the child's intake of milk with solid foods items, ensuring a balanced diet for adequate growth. Serving finger foods to toddlers allows them to eat by themselves and to satisfy their need for independence and control. The intake of milk should be limited to 2 to 3 cups because the consumption of more than a quart of milk per day tends to decrease the child's appetite for essential solid foods and results in inadequate iron intake. Children below 2 years of age should not be given low-fat or skimmed milk because the fat is important for the physical and intellectual growth of the child.

A nurse encourages parents to have their toddler's eyes tested especially for monocular strabismus. What should the nurse explain may occur if the condition is not corrected early? 1 Dyslexia will develop. 2 Peripheral vision will disappear. 3 Vision in both eyes will be diminished. 4 Amblyopia will progress in the weak eye.

4 Amblyopia is reduced visual acuity that may occur when an eye weakened by strabismus is not forced to function. The lack of binocularity may result in impaired depth and spatial perception, not dyslexia. Depth and spatial perceptions are impaired when vision in one eye is severely impaired, not peripheral vision. Only vision in the affected eye will be diminished.

Which statement by the student nurse is true about the appearance of a toddler's body? 1 Toddlers have a concave-shaped abdomen. 2 Toddlers have slightly inverted feet while walking. 3 Toddlers lack the anteroposterior curves of an adult. 4 Toddlers have a gap between their legs while walking.

4 As a toddler walks, his or her legs and feet are usually far apart. They have a protruding abdomen. Toddlers have slightly everted feet while walking. An infant lacks the anteroposterior curves of an adult.

What does the nurse explain happens during the transition from infanthood to toddlerhood? 1 Reduced activity levels 2 Increased need for fats 3 Increased food choices 4 Reduced need for sleep

4 As the infant enters the toddler stage, the need for sleep declines and the activity level increases. Toddlers need less fat and more proteins. Children establish lifetime eating habits during toddlerhood, and there is increased emphasis on food choices.

A 3-year-old child's parents have been unable to visit since the child was admitted to the hospital. The toddler has become quiet and withdrawn. To best help the child at this time, what should the nurse do? 1 Bring the child a stuffed animal to cuddle. 2 Contact the parents to encourage them to visit the child. 3 Encourage the child to play games with the other children. 4 Assign the same nurse to care for the child whenever possible.

4 Assigning the same nurse when possible ensures the presence of a familiar, consistent caregiver with whom the child can relate. Bringing the child a stuffed animal may provide some comfort, but the child needs to receive love and attention from an adult. Encouraging the parents to visit may increase the parents' guilt and anxiety; the data given indicate that the parents have been unable, not unwilling, to visit the child. Playing games with other children may provide some comfort, but the child still needs to receive love and attention from an adult.

Which assessment data would cause the nurse to suspect that a toddler-age client is experiencing physical abuse? 1 Abdominal distention 2 Bloody underclothing 3 Recurrent urinary tract infections 4 Bruises in various stages of healing

4 Bruises in various stages of healing would cause the nurse to suspect the toddler-age client is being physically abused. Abdominal distension, a symptom of malnutrition, would cause the nurse to suspect physical neglect, not abuse. Bloody underclothing and recurrent urinary tract infection would cause the nurse to suspect sexual abuse.

Which toddler behavior should the nurse identify as egocentrism, a characteristic of preoperational thought? 1 Yells at the chair for causing a fall 2 Not wanting to eat food due to the color 3 Refusal to sleep in bedroom because the bed has been moved 4 Inability to understand that others have a different perspective

4 Egocentrism causes the toddler-age client to be unable to understand a different perspective. Yelling at the chair for causing a fall is an example of animism. Not wanting to eat food due to the color is an example of centration. Refusal to sleep in a bedroom because the bed has been moved to another location is an example of global organization.

What does the nurse state is the cause of frequent upper respiratory tract infections in toddlers? 1 Stress 2 Unhealthy diet 3 Lack of exercise 4 Immature immune system

4 Infants and toddlers are at risk for upper respiratory tract infections as a result of frequent exposure to other children, an immature immune system, and exposure to second-hand smoke. Stress, unhealthy diet, and lack of exercise predispose young and middle-age adults to multiple cardiopulmonary risk factors.

Which theory helps pediatric nurses to design appropriate therapeutic play interventions for ill toddlers? 1 Grand theories 2 Peplau's theory 3 Descriptive theories 4 Interdisciplinary theory

4 Interdisciplinary theory helps pediatric nurses design appropriate therapeutic play interventions for ill toddlers or school-aged children. Grand theories are systematic and broad in scope, complex, and, therefore, require further specification through research. A grand theory does not provide guidance for specific nursing interventions. Hildegard Peplau's theory (1952) focuses on interpersonal relations between the nurse, the client, and the client's family and developing the nurse-client relationship. Descriptive theories describe phenomena, speculate on why they occur, and describe their consequences.

What is the priority nursing responsibility in the care of a young toddler after a circumcision? 1 Limiting oral fluids 2 Monitoring intravenous fluid intake 3 Applying ice packs to the genital area 4 Watching for bleeding around the penis

4 It is difficult to apply adequate pressure to this vascular site; therefore observation for bleeding is imperative. Fluids should be encouraged as soon as the child can tolerate them. Circumcision requires minimal or no IV fluid therapy. Ice packs are not necessary and may injure the delicate tissue of the penis.

A nurse is assessing a 15-month-old girl at the well-child clinic. The nurse determines that further education about toddler development is necessary when the mother says what? 1 "She's always trying to get out of her car seat." 2 "She cries when I leave her at the daycare center." 3 "She gets into everything and scatters toys everywhere." 4 "She has a temper tantrum every time I put her on the potty chair."

4 Most 15-month-old toddlers are not ready for toilet training. Voluntary sphincter control develops between 18 and 24 months of age. A tantrum on being placed on the potty chair is autonomous behavior, typical of a 15-month-old toddler. Crying when the mother leaves her at the daycare center demonstrates separation anxiety, common in 15-month-old toddlers. Scattering toys everywhere demonstrates autonomous behavior, typical of a 15-month-old toddler.

Which statement by the nurse is true about the diet plan for toddlers? 1 Finger foods should be avoided. 2 Toddlers need 4 to 6 cups of milk per day. 3 Low-fat or skim milk should be given until the child is 2 years old. 4 Milk should be supplemented with solid food items like vegetables and fruits.

4 Mothers of toddlers should supplement their children's milk intake with solid food items; this will ensure a balanced diet for adequate growth. Serving finger foods to toddlers allows them to eat by themselves and to satisfy their need for independence and control. The intake of milk should be limited to 2 to 3 cups per day in toddlers.The consumption of more than a quart of milk per day will decrease the child's appetite for essential solid foods and result in inadequate iron intake. Children below 2 years of age should not be given low-fat or skim milk because the fat is important for growth.

The parents of a toddler tell the nurse the family has been living in a very old building. The nurse should carefully assess the child for the irreversible effects of possible lead poisoning by focusing on the what? 1 Urinary system 2 Skeletal system 3 Hematologic system 4 Central nervous system

4 Nerve cells do not regenerate; once neurologic damage has occurred, changes are irreversible. Changes in the urinary, skeletal, and hematologic systems are reversible with treatment.

Antibiotic prophylaxis is prescribed for a 2-year-old child with a cardiac malformation who is awaiting corrective surgery. The nurse explains to the child's parents that the antibiotic will prevent what? 1 Bacterial pneumonia 2 Laryngotracheobronchitis 3 Upper respiratory infections 4 Subacute bacterial endocarditis

4 Prophylaxis before surgery can prevent bacterial endocarditis, which often occurs in children and adults with heart structure anomalies. Prophylactic antibiotics are not used to prevent bacterial pneumonia in a child with cardiac problems. Laryngotracheobronchitis is a viral infection; if this infection develops, corrective surgery will be postponed. Avoidance of crowds, not taking antibiotics, is recommended to prevent upper respiratory infection in children with cardiac problems.

Which should the nurse anticipate when assessing a toddler-age client's respirations? 1 Dyspnea 2 Tachypnea 3 Nasal breathing 4 Abdominal breathing

4 Respirations for the toddler-age client continue to be abdominal during the toddler-age years. Respirations are normal; therefore, the nurse does not anticipate tachypnea or dyspnea. Nasal breathing is not expected when assessing the respirations of the toddler-age client.

Which statement by the nurse is true for collecting a urine sample in toddlers? 1 A hat is placed under the toilet seat. 2 Urine can be squeezed from the diaper. 3 Force the child to void in the unfamiliar receptacle. 4 Single-use bags can be placed over the child's urethral meatus.

4 Single-use bags are placed over the child's urethral meatus for collecting urine in toddlers. A potty chair or specimen hat placed under the toilet seat is usually effective in cases of young children. Specimens obtained by squeezing urine from the diaper are not used because the results will be inaccurate. A young child is often reluctant to void in unfamiliar receptacles. They should not be forced to void.

An 18-month-old toddler who stepped on a rusty nail is brought to the emergency department a week later. The nurse determines that the family lives in a rural area and that the toddler has never received health care. The child shows signs of generalized tetanus, including neck and jaw stiffness and facial muscle spasms. What does the nurse conclude is the cause of these clinical findings? 1 Bacterial infection of the upper respiratory tissues progressing to sepsis and death 2 Neuropathy caused by an allergic reaction to the presence of the invading organism 3 Localized edema of the upper trunk and neck tissues resulting in obstruction of the airway 4 Painful muscle rigidity caused by exposure of the nervous system to the exotoxin of the causative organism

4 Tetanus is characterized by trismus (difficulty opening the mouth), stiffness of the facial and neck muscles progressing to laryngospasm, generalized rigidity, opisthotonos, and respiratory arrest. Tetanus is not caused by a bacterial infection of the respiratory tract; it is caused by an exotoxin of an anaerobic bacillus that affects the central nervous system. Neuropathy is a result of nervous excitability from the effects of the tetanus exotoxin; it is not an allergic response. Airway obstruction occurs because of stiffness of facial and neck muscles with ensuing laryngospasm, not edema.

At what age is a toddler-age client physiologically and psychologically prepared for toilet training? 1 13 months 2 16 months 3 19 months 4 22 months

4 The 22-month-old toddler-age client is both physiologically and psychologically prepared for toilet training. The 13-month-old, the 16-month old, and the 19-month old are not yet physiologically and psychologically prepared for toilet training.

A nurse is teaching the parents of an 18-month-old child the procedure for instilling ear drops. How should this procedure be done? 1 By cleansing the ear canal before instilling the drops 2 By applying medicated ear wicks after instilling the drops 3 By pulling the pinna up and back after drop instillation to promote distribution of the drops 4 By pulling the pinna down and back to straighten the auditory canal before instillation of the drops

4 The canal curves upward in children younger than 3 years of age; pulling the pinna down straightens the canal so medication will reach the eardrum. The ear canal is not cleansed before ear drops are instilled; this could exacerbate the infection. Applying ear wicks is contraindicated because it increases pressure within the ear. Pulling the pinna up and back after instillation of drops is unnecessary; pressing on the tragus several times will help disperse the drops.

After a prolonged period in a regional hospital far from home to which the parents were unable to travel, an 18-month-old toddler becomes depressed, withdrawn, and apathetic. Eventually the toddler begins playing with toys and relating to others, even strangers. When the parents visit, the child ignores them. The parents tell the nurse that their child has forgotten them. How does the nurse explain the child's behavior? 1 The nurse suggests that they may be right and that their child will have to get to know them again. 2 The behavior indicates approval of the staff and the child's understanding that they will not inflict bodily harm. 3 The behavior reflects acceptance of the hospitalization and that the experience will enhance their child's maturation. 4 This signifies typical behavior in toddlers who are separated from their parents for prolonged periods and that their child will need special attention from them.

4 The child has progressed to the third phase of separation anxiety, detachment or denial, in which there is a resignation to the loss of the parents and a superficial appearance of adjustment to the environment. Eighteen-month-old children do not forget their parents. The child's behavior indicates resignation, not acceptance or understanding of the situation. Toddlers who have parental support usually view staff members as unfamiliar, frightening, and often threatening. Acceptance of the hospitalization is often the mistaken interpretation of such behavior.

Which treatment should the nurse anticipate when providing care to a toddler-age client who ingested bleach? 1 Gastric lavage 2 Activated charcoal 3 Encourage vomiting 4 Analgesics, per order

4 The nurse should anticipate an order for analgesics for a toddler-age client who presents after the ingestion of bleach. Gastric lavage, activated charcoal, and vomiting are contraindicated because each can cause more harm to the child.

A parent of a 20-month-old toddler who has experienced an episode of diarrhea calls the pediatric clinic for advice. What instructions should the nurse give the parent, according to evidence-based practice for this situation? 1 Limit the child's activities, withhold oral feedings, and call the clinic in 4 hours. 2 Wrap the child snugly, offer sugar water, and bring the child to the clinic immediately. 3 Allow the child to continue activities, withhold oral feedings for 24 hours, and call the clinic tomorrow. 4 Continue the child's feedings as usual, observe the frequency of stools, and bring the child to the clinic tomorrow if the diarrhea continues.

4 The recommendation for treatment of mild diarrhea is to continue the regular diet. If diarrhea continues for 12 to 24 hours, the child needs to be medically evaluated. Withholding food and fluid puts the child at risk for dehydration, especially if the diarrhea continues; activities are not a factor in the treatment of diarrhea because children self-limit activity when they feel sick. Wrapping the child in a blanket will cause body temperature to increase; sugar water does not include electrolytes and may cause further gastric irritation. This is not an emergency that requires immediate intervention. Although activities are permitted, withholding food and fluid puts the child at risk for dehydration, especially if the diarrhea continues.

A nurse is evaluating a 3-year-old child's developmental progress. The inability to perform which task indicates to the nurse that there is a developmental delay? 1 Copying a square 2 Hopping on one foot 3 Catching a ball reliably 4 Using a spoon effectively

4 Using a spoon effectively is a task expected of 3-year-old children. Copying a square is a task expected of 4- or 5-year-old children. Hopping on one foot and catching a ball reliably are tasks expected of 4-year-old children.

What would the nurse explain is the recommended age when a child can start having whole cow's milk? Record your answer using a whole number. _____ year(s) old

The use of whole cow's milk, 2% cow's milk, or alternate milk products before the age of 12 months is not recommended.