Prep-U OB Chapter 26

When leaving a child who has separation anxiety, parents should say goodbye firmly, explain that they will return, and then leave promptly.

True

The nurse is assessing the development of a 15-month-old girl during a regular visit. Which of the following skills would the nurse expect to see?

Stands alone

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

Uses two-word sentences or phrases. A child nearly 3 years of age should speak in three to four word sentences.

Regression is

a change from present behaviors to past developmental levels of behavior. Positive redirection is verbally guiding the child toward the accepted behavior.

According to Piaget, when the child transitions from sensorimotor schemes to mental operation, this form of play is known as which of the following?

Symbolic play occurs when the child transitions form sensorimotor schemes to mental operations

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

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

A mother of a 3-year-old asks the nurse about what kinds of toys would be appropriate. The nurse would suggest which of the following?

The 3-year-old child should have a tricycle, large sturdy toys such as big blocks, active toys like a pounding bench, and musical toys that encourage rhythmic movement.

The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child?

The child demonstrates separation anxiety.

Onlooker play occurs

when the child observes the actions of other children and does not attempt to interact with them.

Solitary play occurs

when the child plays alone

During a well-child visit, the nurse observes the child saying "no" to her mother quite frequently. The mother asks the nurse, "How do I deal with her saying no all the time?" Which of the following would be appropriate for the nurse to suggest? Select all that apply.

• "Limit the number of questions you ask of her." • "Offer her two options from which to choose." • "Make a statement instead of asking a question."

The mother of a toddler boy half-jokingly states: "I am so tired of hearing 'NO!' I wish he would stop!" What suggestions will the nurse offer to reduce toddler negativism? Select all that apply.

• Avoid "yes" and "no" questions. • Offer simple choices: "Blue shirt or red one?" • Make statements: "It is time for lunch." • Avoid ending a request with "Okay?" • Use humor to make "no" funny: "Do cows bark?"

A mother is concerned because her 2-year-old daughter is not speaking much. Which of the following should the nurse suggest to the mother?

• Read books aloud to her • Name aloud the objects that she is playing with • Always answer her questions

The nurse is assessing speech development in the 2-year-old whose family uses both Spanish and English in the home. What finding is of concern?

The toddler speaks 15 words between the two languages. At 20 months, the bilingual child should use 20 words

A mother expresses surprise to the nurse that her toddler daughter has begun masturbating. The most important initial nursing response is:

This is a normal and expected activity best treated matter-of-factly.

A toddler's father is concerned because his son refuses to share. What is your best response concerning this?

This is normal toddler behavior; sharing is learned later.

Once temper tantrums have started, which of the following interventions are appropriate?

Move objects out of the way or move the child to prevent injury.

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

"It might be best to give him a bath in the evening." .

Parents are proud of their toddler's fast-developing fine motor skills. Which one they describe should the nurse point out as a safety risk?

Ability to turn knobs

Deferred imitation

Children at this stage are able to remember an action and imitate it later (deferred imitation); they can do such things as pretend to drive a car or put a baby to sleep because they have not seen this just previously but at a past time

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

He should speak in two-word sentences like "Me go".

The father of a 3-year-old boy is trying unsuccessfully to teach his son to kick a ball into a net. While the child goes to ride his tricycle, the father asks his neighbor, who is a nurse, for advice. Which of the following strategies would help build the child's self-esteem?

"Cheer for misses as well as goals."

The parents of a toddler ask the nurse about disciplining their son. Which of the following would be most helpful for the nurse to suggest? Select all that apply

"It's better to praise correct behavior than to punish wrong behavior."

The parents of a 3-year-old boy tell the nurse that they are having another baby in several months. They ask the nurse for suggestions to help their son adapt to the new baby. Which of the following would the nurse suggest?

"Let the child participate in caring for the new baby."

During the toddler years, the child attempts to become autonomous. If the following statements were made by caregivers of 3-year-old children, which observation reflects that the child is developing autonomy?

"My child uses the potty chair and is dry all day long."

The mother asks the nurse for advice about how to persuade her 15 month son to use the potty. Which of the following would be the most appropriate response for the nurse to make to this mother?

"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained."

The toddler grows about how many inches in height per year?

3 inches

During a 2-year-old's well-child visit, the nurse notes that the child weighed 22 pounds and was 24 inches tall at age 1. If this child is following a normal pattern of growth, the nurse would expect the child to now weigh about

30 pounds and be 27 inches tall. Toddlerhood is a time of slowed growth and rapid development. Each year a toddler gains 5 to 10 pounds and about 3 inches

A 15 month old can say

4 to 6 words

Developmental milestones for toddlers put them in the proper sequence.from earliest to latest.

A 15 month old can creep upstairs. An 18 month old can run and jump in place and name one body part. A 24 month old engages in parallel play; a 30 month old can name one color.

A nurse observes a child engaged in parallel play in a nursery. Which of the following is an example of parallel play?

A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks

Autonomy, or independence, is the primary developmental task of the toddler years, according to Erikson

Although this child's act may be a sign of autonomy, it is more specifically an act of deferred imitation.

The nurse is promoting language and cognitive development to the parents of a 3-year-old boy. Which guidance about reading with their child will be most helpful?

Ask the child questions as you read.

The nurse is presenting an inservice training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of parallel play?

Children are playing independently and are side by side

Nursing students reviewing information about discipline demonstrate a need for additional information when they identify which of the following as correct?

Discipline and punishment are interchangeable. Discipline and punishment are not interchangeable. Discipline refers to setting rules or road signs so children know what is expected of them. Punishment is a consequence that results from a breakdown in discipline, from a child's disregard of rules that were learned

The nurse is talking to the mother of a 19-month-old girl about setting limits and supervising activities. In which of the following situations will the nurse recommend letting the child do as she pleases?

Exploring her body

A toddler's "no" can best be eliminated by asking a question instead of making a statement.

False. A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. Making a statement instead of asking a question this way can avoid a great many negative responses.

A good time to bathe the child is after eating, either after breakfast or in the evening.

Hair is washed two to three times per week with a mild shampoo. Bubble baths should be avoided, to prevent urethral irritation and possible development of cystitis.

You see a 15-month-old at a health maintenance visit. Of the following assessments, which one is generally included in a 15-month check-up?

Height and weight measurements

The caregivers of 2 ½-year-old Frances tell the nurse that they are working hard to teach her to share and communicate with other children. The nurse recognizes and acknowledges their devotion, but explains to them that a child this age is probably not at a developmental level to play and share with other children. Of the following activities, which activity would the nurse recommend as the most appropriate activity for a 2 ½-year-old?

Mowing the lawn with a toy lawnmower. Toddlers enjoy talking on a play telephone. They like pots, pans, and toys such as brooms, dishes, and lawnmowers that help them imitate the adults in their environment and promote socialization

The nurse is discussing proper discipline with the mother of a 15-month-old boy. Which statement is most important?

Never spank the child for any reason.

The parents of a 2-year-old boy complain to the nurse because their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child?

Offering a variety of foods along with the foods the child likes

The father of a 3-year-old boy asks the nurse what he can do to get his son ready to play sports. Which of the following activities will the nurse describe as age-appropriate?

Playing toss with a large, soft ball

The nurse is observing a play group of children of all ages. The toddlers in the group would most likely be doing which of the following activities?

Playing with the plastic vaccum cleaner pushing it around the room

A child is refusing to use the potty and having accidents, even though he has achieved toilet training. This is an example of which type of behavior?

Regression

Echolalia is

Repeating words heard or phrases out of context. This is normal and a way to practice words and incorporate them in the vocabulary. At 2 years, most children understand much more than they can clearly repeat. Using two-word sentences is a developmental expectation at this age.

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

Rides a tricycle

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

Three

The mother of a 2-year-old boy asks the nurse about when she should begin toilet training. The nurse questions the mother about the boy's readiness. Which of the following statements by the mother would indicate that the child is ready?

"He often pulls at his diaper right before a bowel movement."

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition?

"I give my daughter juice at breakfast and when she is thirsty during the day." Juice should be limit to the amount to 4 to 6 ounces daily. Water should be the choice for thirst.

A nurse is teaching the parents of a toddler how to handle the child's temper tantrums. The nurse determines that the teaching was successful when the parents state which of the following as an appropriate response to the tantrum?

"I'll be in the kitchen. When you're done, you can come in, too.

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."

The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. Which of the following should the nurse say in response?

"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."

The parents express their excitement about going home but have concerns about what they need to do to help their 2-year-old adjust to the new baby. Which of the following suggestions would be most appropriate for the nurse to offer these parents?

"You should plan some time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant."

This side-by-side play (called parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period

All during the toddler period, children play beside children next to them, not with them

The nurse is giving a presentation to a parent's group about child safety and poison prevention. The nurse understands that the primary risk factor for toddler poisoning includes which of the following?

Gaining motor skills

The nurse finds the diet of a 30-month-old girl to be low in calcium. What suggestion can significantly increase this toddler's calcium intake?

Give her slices of cheddar cheese as a snack. Two and one-half ounces of cheddar cheese provides the toddler's daily requirement of 500 mg of calcium.

A toddler insists on brushing his own teeth and being left alone in the bathtub. What advice would you give his parents regarding this?

Helping with his own tooth brushing allows him to experience autonomy.

The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which of the following observations 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

To be able to cooperate in toilet training, the child's anal and urethral sphincter muscles must have developed to the stage where the child can control them. Control of the anal sphincter usually develops first. The child also must be able to postpone the urge to defecate or urinate until reaching the toilet or potty and must be able to signal the need before the event.

In addition, before toilet training can occur, the child must have a desire to please the caregiver by holding feces and urine rather than satisfying his/her own immediate need for gratification. This level of maturation seldom takes place before the age of 18-24 months

The parent should try to determine if there was a specific event or stressor that may have triggered the nightmare

In addition, to decrease nightmares, parents should avoid having the child watch television in the hour before bedtime, avoid telling scary bedtime stories, let the child sleep with a nightlight, and examine how to decrease perceived stress in the child's life

Some children may have fears associated with bathing such as being afraid of being sucked down the plug hole.

In this case, do not drain the tub until the child is out of the room.

Which of the following is appropriate with reference to enhancing a child's self-esteem?

Include the child in activities that interest the adult.

A group of students is reviewing material about ways parents can help to foster a child's self-esteem. The students demonstrate a need for additional studying when they identify which method?

Limiting the choices and decisions that the child makes

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 which of the following?

Parallel play

A mother complains her 2-year-old daughter has gradually eaten more and more poorly since her 1-year-old well-child visit. The nurse assesses the child's growth and development as normal. What concept explains the mother's concern?

Physiologic anorexia results when the rapid growth of infancy slows in toddlerhood and less food is required for body size.

A family has recently moved into the area and is bringing their 18-month-old son in to the office for his first visit. The father is in dusty work clothes and explains that they are in the process of restoring the house they recently moved into, which was built in the 1920s and which had been vacant for many years. The nurse urges the father to have a blood test done on the son. Which of the following is the best rationale for this intervention?

Risk for lead paint poisoning due to the age of the house

It is naptime and the caregiver of a 2-year-old says to her child, "I will help you put all of your stuffed animals in a row next to your bed just like we do every day." This statement is an example of which of the following?

Ritualism. Ritualism employed by the young child to help develop security involves following routines that make rituals of even simple tasks.

Parents of a 2-year-old girl are having a conversation with the nurse about tantrums. Which of the following techniques would the nurse most likely to suggest?

Use short "time-outs" and remain calm. The best response to tantrums is to remain calm and use short "time-outs."

The nurse is examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development?

The child does not use the names of familiar objects. By 24 months most children will name objects familiar to them in their daily lives. Not doing so is strong evidence that a speech delay may exist.

A 15-month-old boy has been brought to the clinic because he is pale and listless. Which of the following findings and observations would lead the nurse to suspect iron deficiency anemia as the cause of the clinical manifestations?

The child drinks four cups of milk per day.

When the child has an occasional nightmare, parents should reassure the child that it was just a dream and was not real. Giving lots of hugs and words of reassurance can be supportive.

The child may want the parent to search the room to reassure that there are no monsters about.

What is physiologic anorexia in toddlers

Toddlers require fewer calories proportionately than infants, and their appetite decreases. Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods

The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it.

True

Desensitization occurs when

a fear is conquered by approaching it little by little. If the fear becomes a phobia, then the healthcare team must be consulted.

The way you would advise a toddler's mother to handle temper tantrums would be to

appear to ignore them.

The markers of readiness are subtle, but as a rule children are ready for toilet training when they

begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers.

A toddler's parents want to begin toilet training him. As a rule, the best instruction you could give them is

bowel training is easier than urine training. Because the substance to be evacuated is so much more tangible

A 30 month old knows

full name and can name one color.

Toddlers engage in assimilation when they learn to change a situation (or how they perceive it) because

they are not able to change their thoughts to fit the situation, such as shaking a toy hammer as if it were a rattle, because they are more familiar with rattles than hammers

The American Academy of Pediatrics recommends television viewing should be severely limited

until at least 2 years of age

The grandmother is the primary caregiver of her 2-year-old granddaughter. She expresses her concern that the child has temper tantrums two or three times a day, often in public places. She explains that she spanked her own children when they did this but now she is worried that spanking is not the best way to handle the situation. She asks the nurse for help with ways to deal with the temper tantrums. In answer to her question, the nurse makes the following statements. Which statement is the most appropriate regarding dealing with the child who has a temper tantrum?

"Remain calm, pick the child up, and move her to a quiet and neutral place until she gains self-control; don't give in to her demands."

A young father is astonished to see his 20 month daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. The nurse explains that this is an instance of which of the following?

Deferred imitation

According to Eric Erikson, the developmental task of the toddler is developing autonomy. Which of the following describes Erikson's psychosocial development task for the toddler?

Learning to act on one's own

Parents should begin to instill some sense of discipline early in life because part of it involves safety limits.

Two general rules to follow include the need to be consistent and the use of praise for correct behavior rather than punishment for wrong behavior so that the child can learn the rules.

The nurse is explaining safety precautions for toddlers to the mother of a normal 30-month-old boy. Which of the following activities might the nurse suggest may be done without supervision?

Undressing himself

A nurse is assessing a 2 year old's language development. Which of the following would the nurse expect to assess?

Use of a two-word noun-verb sentence

The best way for parents to aid a toddler in achieving his developmental task would be to

allow him to make simple decisions. Making decisions is primary practice toward achieving independence

A toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her to

give him secondary, not primary, choices

A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply

• Round foods such as hot dogs, whole grapes, and cherry tomatoes • Hard foods such as nuts, raw carrots, and popcorn • Sticky foods like peanut butter alone, gummy candies, and marshmallows

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

A regular routine and rituals will provide stability and security

The parents of a 30-month-old girl have brought her into the emergency department because she had a seizure. During the health history, the nurse suspects the child had a breath-holding spell. Which of the following parental reports suggests breath-holding?

A tantrum preceded the event.

The nurse takes a call from the mother of a 26-month-old girl with constipation, and she recommends a higher fiber diet to the mother. Which of the following would be among the nurse's suggested meals?

Bean soup and banana slices

Which suggestion by the nurse meant to promote good dental health in the 15-month-old is inappropriate?

Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste.

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 behavior. The child having a tantrum is out of control, making reasoning impossible

A father and his 12-month-old son are in for an office visit. The son is now walking regularly, and the father asks the nurse for recommendations on shoes. Which of the following should the nurse suggest?

Sneakers