Toddlers EAQ
A 2-year-old child who has been restricted to bedrest 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 child is trying to assert independence. 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.
A toddler with hemophilia A is receiving factor VIII. The mother asks the nurse, "If my son hurts himself, I'll give him 2 children's Advil. Is that right?" How should the nurse respond? 1 "That's right. Advil will ease the pain." 2 'Give him Tylenol—Advil may cause bleeding." 3 "No. I'll explain why he isn't allowed pain medications." 4 "You seem concerned about giving medications to your child."
2 'Give him Tylenol—Advil may cause bleeding." The parent is asking a specific question that should be answered by the nurse. Ibuprofen (Advil) is contraindicated because it may cause more bleeding. Ibuprofen interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen (Tylenol) should be administered, because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects.
During a nap, a 3-year-old hospitalized child wets the bed. What is the best response by the nurse? 1 Ask the child to help remake the bed 2 Put clean sheets on the bed over a rubber sheet 3 Change the child's clothes without discussing the incident 4 Explain that children should call the nurse when they need to go to the bathroom
3 Change the child's clothes without discussing the incident Bedwetting accidents are not uncommon in this age group, especially during hospitalization, when regression may occur. Therefore the best approach is to ignore the event. The child may interpret being asked to help remake the bed as punishment, and punishment for regressive behavior is inappropriate. Because skin breakdown is a concern, rubber sheets are contraindicated; they hold moisture close to the skin. Explaining that children should call the nurse when they need to go to the bathroom may make the child feel guilty for the behavior.
A 19-month-old boy who has been in the hospital for 2 weeks becomes increasingly withdrawn and mute. What is the most appropriate nursing action? 1 Offering distracting toys 2 Moving him into a room with other children 3 Encouraging the parents to stay with him as much as possible 4 Providing sensory stimulation by assigning different nurses to care for him
3 Encouraging the parents to stay with him as much as possible Withdrawn behavior is associated with separation anxiety; parental contact should be encouraged. Separation anxiety can be minimized by increasing contact with parents, not by distraction with toys. Toddlers are too young for peer interaction, so moving the child into a room with other children is not the solution. Assigning a variety of caregivers increases feelings of anxiety; one nurse, rather than several, should care for the child as much as possible to promote consistency, continuity, and the development of trust.
A nurse teaches the mother of a toddler which foods are the best sources of thiamine, a B-complex vitamin. What food that is high in thiamine should the nurse include in the teaching plan? 1 Eggs 2 Fruits 3 Whole grains 4 Green leafy vegetables
3 Whole grains Whole grains, legumes, and meat are excellent sources of thiamine, an essential coenzyme factor in carbohydrate metabolism. Eggs are a fair source of thiamine. Fruits do not contain thiamine. Vegetables are a fair source of thiamine.
A nurse in the well-baby clinic determines that a 15-month-old toddler's motor development is age appropriate. Which behavior confirms this conclusion? 1 Hopping on one foot 2 Throwing and catching a ball 3 Completing a four-piece puzzle 4 Holding and scribbling with a crayon
4 Holding and scribbling with a crayon The finger-in-opposition-to-thumb grasp is developed in the 15-month-old toddler. Hopping on one foot is behavior demonstrating the motor ability of a 3-year-old child. Although a 15-month-old toddler can throw a ball, the ability to catch it is more appropriate for a 4-year-old child. Completing a four-piece puzzle is behavior demonstrating the motor ability of a 2-year-old child.
As the working mother of a toddler is preparing to take her child home after a prolonged hospitalization during which she was not able to visit often, she asks the nurse what type of behavior she should expect. What is the most appropriate description by the nurse of her child's probable behavior? 1 Excessively demanding behavior 2 Hostile attitude toward the mother 3 Cheerful, with shallow attachment behaviors 4 Withdrawn, without emotional ties to the mother
4 Withdrawn, without emotional ties to the mother Until trust has been reestablished, the child will be unable to develop an emotional tie to the mother. After trust has been reestablished, the child may test the parent's love by being very demanding. At this stage of separation anxiety, the child is too detached to be hostile. The child will be despairing and withdrawn, not cheerful.
When is a toddler considered ready for toilet training? Select all that apply. A When the child is able to sit, walk, and squat B When the child is unable to stay dry for 2 hours C When the child has irregular bowel movements D When the child is capable of removing his or her own clothing E When the child is able to recognize the urge to defecate or urinate
A When the child is able to sit, walk, and squat D When the child is capable of removing his or her own clothing E When the child is able to recognize the urge to defecate or urinate Toilet training requires a toddler to have developed certain motor and cognitive skills. If the child has the ability to sit, walk, and squat, then the child will be able to sit on a potty chair. The child needs to have fine motor skills to be able to remove his or her own clothing to go to the toilet. If the child is able to recognize the urge to defecate or urinate, it indicates the child's readiness for toilet training. The child may be able to stay dry for at least 2 hours and have regular bowel movements, but still not be quite ready for toilet training.
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 Macaroni and cheese 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 are gluten-free foods. Tuna and rice cakes are gluten-free foods. Chicken and corn are gluten-free foods.
A mother tells her neighbor, a nurse, that her toddler has been found to have parasites (worms) and that the whole family will need to be treated. She asks the nurse what kind of worm it is. What is the most likely type of worm infestation? 1 Tapeworm (Taenia) 2 Pinworm (Enterobius) 3 Roundworm (Ascaris) 4 Hookworm (Ancylostoma)
2 Pinworm (Enterobius) Pinworms can spread from person to person when transferred to the mouth by way of contaminated food, toys, or linens. Tapeworms are acquired from undercooked meat and do not spread from person to person. Roundworms require a dirt cycle to become infectious and do not spread from person to person. Hookworms are acquired from direct contact with contaminated soil, usually when someone goes barefoot.
A toddler with cystic fibrosis has been hospitalized with bacterial pneumonia. The nurse determines that the child has no known allergies. What does the nurse conclude is the reason that the health care provider selected a specific antibiotic? 1 Tolerance of the child 2 Sensitivity of the bacteria 3 Selectivity of the bacteria 4 Preference of the health care provider
2 Sensitivity of the bacteria When the causative organism is isolated, it is tested for antimicrobial susceptibility (sensitivity) to various antimicrobial agents. When a microorganism is sensitive to a medication, the medication is capable of destroying the microorganism. The tolerance of the child of the particular antibiotic is unknown because up to this time the child has not exhibited any allergies. Bacteria are not selective. Although the health care provider may have a preference for a particular antibiotic, it first must be determined whether the bacteria are sensitive to it.
A 30-month-old toddler is brought to the emergency department in acute respiratory distress, and a diagnosis of laryngotracheobronchitis (viral croup) is made. What is the most important equipment for the nurse to have available when the child is admitted to the pediatric unit? 1 Intravenous set 2 Tracheotomy set 3 Nasal cannula for oxygen 4 Crib with padded side rails
2 Tracheotomy set A patent airway is the priority. A tracheotomy set should be kept immediately available in case of complete obstruction of the airway. An intravenous setup may be needed later if the child does not respond to treatment. Humidified mist, not oxygen, is the treatment of choice unless the child does not respond to the treatment. Padded side rails are appropriate for seizures, which are not associated with croup.
