Carman Essentials of Pediatric Nursing 3rd Ed - Ch. 4 Growth and Development of the Toddler

The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet? a. "You may have to serve a new food 10 or more times." b. "Serve only healthy foods. He'll eat when he's hungry." c. "Give him more healthy choices with less junk food available." d. "Calorie requirements for toddlers are less than infants."

Answer: c Suggesting that the parents transition the child to a healthier diet by serving him more healthy choices along with smaller portions of junk food will reassure them that they are not starving their child. The parents would have less success with an abrupt change to healthy foods. Explaining calorie requirements and the time line for acceptance of a new food do not offer a practical reason for making a change in diet.

The nurse is observing a 36-month-old boy during a well-visit. Which motor skill has he most recently acquired? a. Undress himself b. Push a toy lawnmower c. Kick a ball d. Pull a toy while walking

Answer: a This child has most recently acquired the ability to undress himself. Pushing a toy lawnmower and kicking a ball are things he learned at about 24 months. He was able to pull a toy while walking at about 18 months.

The nurse is assessing a 3-year-old child. The nurse notes the child is able to understand that objects hidden from sight still exist. The nurse correctly documents the child is displaying: a. object permanence. b. mental combinations. c. preoperational thinking. d. concrete thinking.

Answer: a Object permanence means that the child knows that objects that are out of sight still exist.

The nurse is observing a 3-year-old boy in a daycare center. Which behavior might suggest an emotional problem? a. Has persistent separation anxiety b. Goes from calm to tantrum suddenly c. Sucks his thumb periodically d. Is unable to share toys with others

Answer: a Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might be an emotional problem. Emotional lability, self soothing by thumb sucking, or the inability to share are common for this age.

The mother of an 18-month-old girl voices concerns about her child's social skills. She reports that the child does not play well with others and seems to ignore other children who are playing at the same time. What response by the nurse is indicated? a. "It is normal for children to engage in play alongside other children at this age." b. "Has your child displayed any aggressive tendencies toward other children?" c. "Perhaps you should consider a preschool to promote more socialization opportunities." d. "Does your child have opportunities to socialize much with other children?"

Answer: a The social skills of the toddler at this age include parallel play. During parallel play children will play alongside each other, rather than cooperatively. There is no indication that the aggression level of the child needs to be investigated. There is no indication the child needs increased socialization with other children.

The nurse is teaching a first-time mother with a 14-month-old boy about child safety. Which is the most effective overall safety information to provide guidance for the mother? a. "Place a gate at the top of each stairway." b. "Never let him out of your sight when outdoors." c. "Put chemicals in a locked cabinet." d. "Don't smoke in the house or car."

Answer: b Because they are curious and mobile, toddlers require direct observation and cannot be trusted to be left alone, especially when outdoors. The priority guidance is to never let the child be out of sight. Gating stairways, locking up chemicals, and not smoking around the child are excellent, but specific, safety interventions.

The nurse is assessing a 2-year-old boy during a well-child visit. The nurse correctly identifies the child's current stage of Erikson's growth and development as: a. trust versus mistrust. b. autonomy versus shame and doubt. c. initiative versus guilt. d. industry versus inferiority.

Answer: b The Erickson stage of development for the toddler is autonomy versus shame and doubt. During this period of time the child works to establish independence. Trust versus mistrust is the stage of infancy. Initiative versus guilt is the stage for the preschooler. Industry versus inferiority is the stage for school-aged children.

The parents of a 2-year-old girl are concerned with her behavior. For which behavior would the nurse share their concern? a. Refuses to share toys with her sister b. Frequently babbles to herself when playing c. Likes to change toys frequently d. Plays by herself even when other children are present

Answer: b The nurse would be concerned if the child is babbling to herself rather than using real words. By this age, she should be using simple sentences with a vocabulary of 50 words. Being unwilling to share toys, playing parallel with other children, and moving to different toys frequently are typical toddler behaviors.

The nurse is teaching a mother of a 1-year-old girl about weaning her from the bottle and breast. Which recommendation should be part of the nurse's plan? a. Wean from breast by 18 months of age at the latest b. Give the child an iron-fortified cereal c. Switch the child to a no-spill sippy cup d. Wean from the bottle at 15 months of age

Answer: b The nurse would be sure to tell the mother to feed her child iron-fortified cereal and other iron-rich foods when she weans her child off the breast or formula. Weaning from the breast is dependent upon the mother's need and desires with no set time. Weaning from the bottle is recommended at 1 year of age in order to prevent dental caries. Use of a no-spill sippy cup is not recommended because it too is associated with dental caries.

The nurse is assessing the language development of a 3-year-old girl. Which finding would suggest a problem? a. Makes simple conversation b. Tells the nurse she saw Na-Na today c. Speaks in 2- to 3-word sentences d. Tells the nurse her name

Answer: c If the child is still speaking telegraphically in only two- to three-word sentences, it suggests there is a language development problem. If the child makes simple conversation, tells about something that happened in the past, or tells the nurse her name she is meeting developmental milestones for language.

The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem? a. "He wasn't bothered by the paint smell." b. "He was licking the dishwashing soap." c. "He doesn't respond if I wave to him." d. "I dropped a pan behind him and he cried."

Answer: c The fact that the child does not respond when the mother waves to him suggests he may have a vision problem. The toddler's sense of smell is still developing, so he may not be affected by odors. Their sense of taste is not well developed either, and this allows him to eat or drink poisons without concern. The child's crying at a sudden noise assures the nurse that his hearing is adequate.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which recommendation should be the most helpful to the parents? a. Giving the child time out for 1 ½ minute b. Ignoring bad behavior and praising good behavior c. Slapping her hand using one or two fingers d. Describing proper behavior when she misbehaves

Answer: d Stopping the child when she is misbehaving and describing proper behavior sets limits and models good behavior and will be the most helpful advice to the parents. The child is too young to use time out or extinction as discipline. Slapping her hand, even done carefully with two fingers, is corporal punishment, which has been found to have negative effects on child development.

The nurse is discussing the activities of a 20-month-old child with his mother. The mother reports the children of her friends seem to have more advanced speech abilities than her child. After assessing the child, which finding is cause for follow up? a. Inability to point to named body parts b. Inability to talk with the nurse about something that happened a few days ago c. Points to pictures in books when asked d. Understands approximately 200 words

Answer: d The 20-month-old toddler should have a vocabulary greater than 40 to 50 words and should comprehend approximately 200 words. The ability to point to named body points, discuss past events, and point to pictures in a book when asked are communication skills associated with an older child.

The parents of a 3-year-old boy have asked the nurse for advice about a preschool for their child. Which suggestion is most important for the nurse to make? a. "Look for a preschool that is clean and has a loving staff." b. "Check to make sure your child can attend with the sniffles." c. "Make sure that you can easily get an appointment to visit." d. "The staff should be trained in early childhood development."

Answer: d The nurse would recommend a preschool where the staff is trained in early childhood development and cardiopulmonary resuscitation. Cleanliness and a loving staff are not enough without competence. Good hygiene procedures require that a sick child not be allowed to attend. It is also important that parents are allowed to visit any time without an appointment.