Prep Chp 16 Peds
A toddler is prescribed amoxicillin for bilateral otitis media. The parent reports that the toddler refuses to take the oral medication. The nurse knows that more education is needed when the parent makes which statement?
"I will shake the medication well, and draw up the medication to the top of the syringe. My spouse and I will hold our toddler down and force the medication down his throat." The objective of administering oral medications is to administer the entire dose to the toddler while creating the least aversion to the medication as possible. No force should be used. Allowing the toddler to take the medication slowly from a medicine spoon or syringe is one way to reduce aversion.
A mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds him daily but is thinking of weaning him soon. How should the nurse respond to this mother?
"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." Because growth slows abruptly after the first year of life, a toddler's appetite is usually less than an infant's. Children who ate hungrily 2 months earlier now sit and play with their food. It is important to educate parents while the child is still an infant that this decline in food intake will occur so they will not be concerned when it happens. Because the actual amount of food eaten daily varies from one child to another, teach parents to place a small amount of food on a plate and allow their child to eat it and ask for more rather than serve a large portion the child cannot finish. One tablespoonful of each food served is a good start. The nurse should recommend that the mother wean her son gradually to avoid confrontation, not all at once. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them.
The parents state they are afraid to have their child vaccinated and ask the nurse for more information. Which response by the nurse is most appropriate?
"Vaccinations are very effective at preventing serious disease and infection." Nurses should provide education about the effectiveness of vaccines to prevent serious diseases at every visit. Although state-required vaccinations are needed for the child to attend school (some states allow medical, religious, and philosophical exemptions), this statement does not address the parents' concern. The child may not acquire the disease because others are vaccinated, but this statement could give the parents a false sense of security. Although most vaccinations do not have serious side effects, the nurse cannot ensure the child will not have a serious reaction to the vaccine.
A nurse is interviewing a parent regarding the 2-year-old child's recent illness. The nurse would like the parent to elaborate about any symptoms of the illness noticed. Which would be the most effective question for the nurse to ask the parent in this situation?
"What symptoms has your child exhibited?" An open-ended question, such as, "What symptoms has your child exhibited?" allows a parent to elaborate, which is what the nurse desires in this case. A closed-ended question, such as, "Has your child exhibited any symptoms?" does not allow the parent to elaborate, and thus would be inappropriate in this case. Compound questions, such as, "Has your child exhibited a fever and vomiting?" should be avoided because the information they elicit is often inaccurate and must be clarified. Likewise, leading questions, such as, "Your child hasn't exhibited a fever, has she?" should be avoided.
A mother of a toddler asks the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate?
"You'll probably notice that your daughter is uncomfortable in wet diapers." The markers of readiness for toilet training are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. Although the rectal and urethral sphincters are mature by the end of the first year, children are not cognitively and socially ready. In fact, many children do not understand what is being asked of them until they are 2 or even 3 years old.
A 3-year-old child is hospitalized. The parents are concerned because the child is now refusing to use the potty and is wetting the bed even though the child has achieved toilet training. Which response by the nurse is most appropriate?
"Your child is experiencing regression as a result of stress." Regression is a change from present behaviors to past developmental levels of behavior. This is a normal response among children during times of intense stress, such as a hospitalization or the birth of a new sibling. The nurse should not tell the parents not to worry. The child will not have to learn to use the toilet again. The behavior is already learned. Asking why is not a therapeutic form of communication and may cause the parents to become unnecessarily defensive.
The nurse is 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. Toddlers benefit most from routines and rituals that help them anticipate events and teach and reinforce expected behaviors. Knowing that a child can move from calm to temper tantrum very quickly, understanding the benefit of limited choices, and realizing that hitting and biting are common behaviors in toddlerhood provide information but not a guiding concept.
The nurse is 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.
When preparing a program for a group of parents about children and television, which of the following would the nurse expect to include?
Children who watch a great deal of television have an increased risk for obesity. Children who watch a great deal of television are also more likely than others to become obese. Television can contribute to many psychological and physical problems, because it lessens the child's creative ability and can undermine the capacity for independent thinking. Young children believe that everything they see on TV is real. They develop a distorted view of how to deal with problems, because their favorite cartoon character uses violence as a method to cope with anger and frustration.
Parents bring a toddler age 19 months to the clinic for a regular checkup. When palpating the toddler's fontanels (fontanelles), what should the nurse expect to find?
Closed anterior and posterior fontanels By age 18 months, the anterior and posterior fontanels (fontanelles) should be closed. The diamond-shaped anterior fontanel (fontanelle) normally closes between ages 9 and 18 months. The triangular posterior fontanel (fontanelle) normally closes between ages 2 and 3 months.
The parent of a 2-year-old toddler tells the nurse she needs to constantly scold the toddler for having wet pants. The parent says the toddler was potty trained at 12 months, but since starting to walk, the toddler wets the pants all the time. Which nursing diagnosis would be most applicable?
Deficient parental knowledge related to inappropriate method for toilet training Myelination of the spinal cord is achieved around 2 years of age. When this occurs, the toddler can exercise voluntary control over the sphincters. It is probable that a toddler toilet trained at 12 months of age was not truly trained, because the infant would not be developmentally able to complete the task. It is most likely the parent used a training method of reminding the infant or placing the infant on a toilet frequently during the day. When the toddler begins to play independently, the toddler forgets the regimented schedule. This toddler is not toilet trained independently. The toddler does not display total urinary incontinence. The toddler is only incontinent when playing and not reminded to potty. A 2-year-old toddler has limited coping skills. Frequent wetting of the pants does not indicate too much fluid intake. It is a symptom that the toddler does not feel the urge to urinate until the bladder is too full and the toddler cannot get to the toilet on time.
The mother of a 2-year-old child tells the nurse that she is constantly scolding the child for having wet pants. The child was toilet trained at 12 months, but since walking, the child wets all of the time. Which nursing diagnosis should the nurse use to guide instruction for the mother?
Deficient parental knowledge related to inappropriate method for toilet training The mother is having difficulty understanding the principles of toilet training. The diagnosis of deficient parental knowledge about toilet training is the most appropriate for the nurse to use to guide instruction for the mother. The child is not experiencing total urinary incontinence. The child does not have an excess in fluid volume. The mother is not demonstrating ineffective coping.
A 3-year-old is admitted to the hospital for pneumonia. Which intervention would be most effective in reducing separation anxiety?
Having parents room-in is the best option for reducing separation anxiety. Mistrust may develop if the child awakens and finds the room empty. Although having a favorite toy may provide comfort, it does not reduce separation anxiety. A 3-year-old does not understand clock time.
The parent of a toddler is frustrated because the toddler insists on brushing his own teeth and being left alone in the bathtub. What advice should the nurse provide to the parent about these expectations?
Helping with his own tooth brushing allows him to experience autonomy. Toddlers need a toothbrush they recognize as their own. Toward the end of the toddler period, they can begin to do the brushing themselves under supervision; although, almost all children need some supervision until about age 8 years. It is not unusual for a toddler to have opinions and want to do things themselves. The parent needs to permit the child to perform autonomous acts with supervision. The child is too young to be permitted in the bathtub alone. This is a safety hazard.
The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which observation would suggest the child is experiencing a problem with language development?
Her vocabulary is between 10 and 15 words.A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly. Thus a vocabulary of 10 to 15 words suggests a language problem.
The parents of a 2-year-old child born with short-gut syndrome feed their toddler via a feeding tube. Knowing this is a developmental time when children usually feed themselves, the parents are asking the nurses what they can do to help foster the child's independence. Which suggestion would be most appropriate at this time?
If children are tube fed, they receive no experience at all with finger foods. For these children, parents should try to provide other, comparable experiences in independence, such as letting them choose what toy to take to bed or what clothes to wear. Playing, reading, or pretending a toy is food at feeding time are not appropriate activities since the child's feeding is usually scheduled around normal meal times.
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 immunizationsExplanation: Nurses can help the nation achieve the 2020 National Health Goals to prevent and reduce the incidence of infectious disease in children by educating parents about the importance of immunizations. Rest, sleep, exercise, and dietary intake are not identified interventions to help achieve the 2020 National Health Goals for infectious disease in children.
A nurse is assisting the parents of 2-year-old who is having temper tantrums. What would the nurse encourage the parents to do once temper tantrums have started?
Move objects out of the way or move the child to prevent injury. Explanation: Appropriate interventions include moving objects out of the way or moving the child to prevent injury from occurring during the temper tantrum. The caregiver should not speak to the child and should avoid eye contact until the child has calmed down. The child's behavior should be ignored. Do not talk excessively about the tantrum because this can negatively impact the child's self-esteem.
When observing a group of toddlers playing in a child care setting, it is noted that the toddlers are all playing with buckets and shovels but are not playing with each other. This type of play is referred to as:
Parallel Play The toddler's play moves from the solitary play of the infant to parallel play, in which the toddler plays alongside other children but not with them. Onlooker play is when the child watches others playing but does not engage with them. In associative play toddlers form a group and may even play with the same toy but there is no formal structure of the group.
A parent with a 2-year-old invites a friend with a toddler over for a play date when they notice their children are not really interacting while playing. The children are playing side-by-side when one toddler gets up and grabs a toy car out of the hands of the other toddler, which results in both toddlers crying. To prevent this from occurring again, which intervention should the parents make?
Parents should ensure that toys in front of each child are "similar" to prevent fighting over one toy. All during the toddler period, children play beside other children, not with them. This side-by-side play (parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Caution parents that if two toddlers are going to play together, they must provide similar toys because an argument over one toy is likely to occur. Avoiding introducing playing with others, time out, or lecturing toddlers about "sharing" concept are inappropriate at this time.
Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching?
Reasoned with the child to stop the behaviorCorrect Explanation: The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place. The other actions are helpful in preventing a tantrum.
The pediatric nurse is planning quiet activities for a hospitalized 18-month-old. What would be an appropriate activity for this age group?
Stacking blocks At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.
The nurse is assessing a healthy 2-year-old client. Which assessment finding most concerns the nurse?
The child speaks in one-word sentences A 2-year-old child not using at least two-word sentences is a sign of a potential developmental delay. Normal development for a 2-year-old child is standing on tiptoes and pointing to named body parts. Having difficulty with stairs is considered a potential delay in a 3-year-old, not a 2-year-old child.
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. Responses to pain can vary in children. A child of this age may present with vocal behaviors indicating pain. The child may be tearful or crying loudly. Being quiet can also signal pain.
The home health nurse is visiting a 2-year-old client's home. Which finding will cause the nurse to intervene?
The family's medications are located in a kitchen drawer. Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time. This includes keeping all medications in a high, locked cabinet. It is appropriate for all windows to be locked to prevent a toddler from exiting the home out a window. The toddler may go to the bathroom alone once toilet training is well established. Not allowing the toddler in the kitchen during meal preparation will prevent accidental burns from hot foods and surfaces.
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 Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.
A nurse, who is also a mother of a 2-year-old child, attends a party at a friend's house and notes some safety concerns that she would like to share with the other mother privately. Which observations during the party would be considered a safety concern that should be addressed privately when appropriate? Select all that apply.
The nurse/mother notes that the toddler's car seat is located in the passenger front seat. The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. The parents allow the toddler to climb up on the counter and watch as food is stirred on the stove. Toddlers' motor ability jumps ahead of their judgment. To prevent serious injury, the nurse should teach parents to be alert as to what their toddler is doing at all times (like climbing on a countertop next to a stove). Toddlers have no judgment concerning moving cars so they walk across streets with no regard for oncoming cars. Toddlers need to ride in a car seat with a five-point restraint placed in the back seat (not the front seat) so the child is not struck by the passenger seat airbag. Toddlers need to wear a helmet as soon as they begin riding a tricycle. Because they cannot swim well, parents need to check whether backyard pools—another area prone to unintended injury—are securely fenced.
The nurse is completing an assessment on a 2-year-old child. The nurse notes the presence of a raised reddish purple spot on the back of the child's neck. Which statement about this finding is correct?
These lesions will normally fade as the child ages. The lesions described are consistent with infantile (strawberry) hemangioma. They are benign and normally fade as the child ages, usually by the age of 9 years. Nevus flammeus (port-wine stain) are associated with the development of Sturge-Weber syndrome.
The parent of a toddler observes the child play next to another child but not with the child. What should the nurse explain to the parent about this type of play behavior?
This is parallel play and is expected. All during the toddler period, children play beside children next to them, not with them. This side-by-side play called parallel play is not unfriendly but is a normal developmental sequence that occurs during the toddler period. This is not peer, adjacent, or premature play. This behavior is not abnormal, does not need to be stopped, and is not seen in school-age children.
A parent tells the nurse that no matter what is asked of the toddler, the toddler says, "No." What suggestion might the nurse make to help the parent handle this situation?
give the toddler secondary, not primary, choices Encouraging toddlers to express their opinion aids in developing a sense of autonomy. By allowing secondary choices, it gives the toddler a sense of mastery. Telling the toddler not to say "No" again is unrealistic as this is a favorite word and reaction of the toddler as he or she develops autonomy and find one's "self." Pretending not to hear the toddler only leads to more frustration for the toddler and the parent. It is also unrealistic not to ask the toddler questions. There would not be two-way communication between the parent and the toddler.
