Toddlers

The nurse is designing a nursing care plan for a toddler with lymphoma who is hospitalized for treatment. What intervention is the priority for this toddler's nursing plan?

monitoring the toddler for developmental delays

During a health history, the nurse explores the sleeping habits of a 3-year-old child by interviewing their parents. Which statement from the parents reflects a recommended guideline for promoting healthy sleep in this age group?

"We keep a regular bedtime ritual for our child, which includes a bath and bedtime story."

The parent of a 20-month-old toddler reports the toddler has been becoming distraught when the parent leaves. The parent asks the nurse for advice about what is going on and how to best manage it. What information can be provided? Select all that apply.

"This is a normal happening for a toddler of this age." "As your toddler begins to learn that you will return, they will become less upset." "Establishing a routine for saying goodbye to your toddler will be helpful."

Parents are beginning to potty train their 2-year-old child and seek advice from the nurse on how to be successful in this endeavor. Which statement by the parents indicates that further teaching is needed?

"He wants to accompany me to the bathroom but I prefer to go alone."

Parents are asking a pediatric nurse how to deal with separation anxiety every time they try to have an adult night out. Which advice by the nurse sounds like the most appropriate way to handle this situation?

"Inform the child that you are going out but the regular babysitter will care for them and put them to bed." Most toddlers react best to separation if a regular babysitter is employed or if the day care center has consistent caregivers. It helps if toddlers have fair warning they will have a babysitter. No matter how well prepared toddlers are, they may cry when the babysitter actually appears or may greet the babysitter warmly only to cry when the parents reach for their coats. It helps if parents say good-bye firmly, repeat the explanation they will be there when the child wakes in the morning, and then leave. Prolonged good-byes only lead to more crying. Sneaking out prevents crying and may ease the parents' guilt, but it can strengthen a child's fear of abandonment and so should be discouraged.

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 nurse is reviewing sleep and rest activities of a 16-month-old child with the parents. The father states, "I have told my wife it is unhealthy for our child to sleep with us. It's time for him to sleep in his own bed. What do you think?" What is the nurse's best initial response?

"It must be difficult for the two of you to both feel strongly about what is best for you and your child."

A nurse is reviewing important concepts related to bathing and tub baths with a parent of a toddler. Which statement by the parent indicates the need for additional teaching

"It's okay to let my toddler take bubble baths and play in the bubbles."

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?" What would be appropriate for the nurse to suggest? Select all that apply.

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

During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy?

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

The parents of a toddler ask the nurse, "We are so frustrated. It seems like our child has temper tantrums all the time. What can we do?" Which response by the nurse is appropriate?

"Stay calm and nearby then once it is over, try to distract your child."

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

"When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out."

A mother of a 2-year-old girl is asking her friend when she should start potty training the child. The mother expresses concern about the high cost of diapers and training pants and would really like to have her trained as soon as possible. Which advice by the friend would be considered the best response?

"When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training." 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, or they may bring a parent a clean diaper after they have soiled so they can be changed. The other answers do not address this. Usually the child needs to walk well independently before training can occur.

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."

During a well-child visit, a parent tells the nurse that they use time-out to discipline their 2-year-old child. The nurse determines that the parent understands the concept of time-out when the parent states keeping the child in time-out for how long?

2 minutes Time-out is a discipline technique that involves placing the child in an area with decreased stimulation for several minutes following unacceptable behaviors. A guide regarding how long the child should remain in time-out is 1 minute per year of age. So for a 2-year-old child, the time-out time should be 2 minutes.

When assessing a 33-month-old, the nurse would expect to find how many teeth?

20

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.

A nurse in a busy pediatric clinic is educating a group of parents with toddlers about the nutritional needs of this age group. Which concepts should be addressed in this educational presentation? Select all that apply.

Active, "busy" toddlers may need up to 1,400 cal/day. Try to limit the fat intake to less than 35% of total calories. Milk is still important to incorporate in the diet for bone health.

The parents of a 3-year-old who had bone cancer that resulted in amputation of the lower left leg ask their health care provider about expected behaviors for their child. Which behavior is expected and acceptable during hospitalization for treatments?

Crawling may be their preferred mode of travel because they may not want to wait for help to put the prosthesis on.

The nurse is caring for a toddler in the pediatric unit and notes the child is responding according to expected developmental stages. Which characteristic will the nurse predict this toddler to exhibit while in the hospital?

insists on doing a new skill and then asking for help

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take?

Explain that children can take their first steps as late as 18 months of age.

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take?

Explain that children can take their first steps as late as 18 months of age. Infants can begin walking as early as 8 to 9 months and as late as 18 months of age. Telling the parent that the child will start walking any day is true but not guaranteed. Asking if the child has been ill recently is an appropriate question during a well-child visit but does not address the parent's concerns. Since the child is on track developmentally, there is no indication to refer the child to a developmental specialist.

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

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

The nurse is performing a cognitive assessment of a 2-year-old child. Which behavior alerts the nurse to a developmental delay in this area?

The child does not point to named body parts.

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

Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about.

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

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

A nursing instructor is leading a class discussion exploring the various aspects of Erikson's theories of the developmental tasks of toddlers. The instructor determines the session is successful when the students correctly choose which task as a priority for toddlers?

Learning to act on one's own

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?

Let the child choose what clothing he or she will wear the next day.

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.

The nurse is discussing proper discipline with the parent of a 15-month-old toddler. Which teaching is most important

Physical punishment such as spanking is discouraged.

The nurse is preparing a presentation for a health fair which will illustrate various ways to help introduce siblings to a new member of the family. Which suggestion should the nurse prioritize to help older siblings, especially toddlers, understand the change in the family dynamics?

Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. The secondary caregiver can occasionally take over the care of the new baby while the mother or other primary caregiver devotes herself to the toddler. The primary caregiver might also plan special times with the toddler when the new infant is sleeping and the caregiver has no interruptions. This approach helps the toddler feel special. Moving the older child to a larger bed lets the toddler take pride in being "grown up" now, but it should be done some time before the new baby appears. While acknowledging that time with another adult can be a special time, the main concern is for the toddler to understand they are not being replaced by the newest member of the family.

The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. The nurse determines the session is successful when the group correctly chooses which example as best displaying toddlers playing?

Playing independently and are side by side Parallel play occurs when the toddler plays alongside other children but not with them. During cooperative play children play in an organized group with each other, as in team sports. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader—and each child does what she or he wishes. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity.

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

The nurse in a pediatric clinic is observing a 2-year-old playing in the waiting room. Which action is an example of normal growth and development for a 2-year-old (24-month old) at play?

imitating adult action like wrapping a doll in a blanket

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

The child hides behind her bedroom door when defecating.

The nurse is watching toddlers at play. Which normal behavior does the nurse expect to observe?

Toddlers engage in parallel play. Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.

A nurse is assessing a 2-year-old's language development. What would the nurse expect to assess?

Use of a two-word noun-verb sentence

While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their backyard a few days ago. The nurse explains that this is an instance of which of the following?

deferred imitation Children at this stage are able to remember an action and imitate it later (deferred imitation); they can do such things as pretend to drive a car or put a baby to sleep because they have not seen this just previously but at a past time. Toddlers engage in assimilation when they learn to change a situation (or how they perceive it) because they are not able to change their thoughts to fit the situation, such as shaking a toy hammer as if it were a rattle because they are more familiar with rattles than hammers. All during the toddler period, children play beside children next to them, not with them. This side-by-side play (called parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Autonomy, or independence, is the primary developmental task of the toddler years, according to Erikson. Although this child's act may be a sign of autonomy, it is more specifically an act of deferred imitation.

Parents share that their toddler often needs a snack in between meals. Which snack choice is nutritious enough to give the toddler energy but also may help prevent dental caries? Select all that apply.

orange slices cheese slices yogurt

The nurse is recommending food items for an 18-month-old girl. Which ones will benefit the child's neurologic system most?

peanut butter on crackers, cheese, and whole milk

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

playing with the plastic vacuum cleaner and pushing it around the room Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool-age children have imitative play, pretending to be the mommy, the daddy, or other familiar characters. School-age children enjoy group activities and making things, such as drawings, paintings, and craft projects. Adolescent enjoy activities they can participate in with their peers.

The pediatric nurse is presenting basic safety tips at a local health fair for families. The nurse should point out the majority of hospital visits for toddlers can be prevented by exercising which precaution

safely store all chemical substances

The parents are trying to promote toddler independence by allowing the child to dress himself. Which types of clothing would be appropriate to suggest? Select all that apply.

shirts with large neck openings shoes with Velcro closures

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