Chapter 30: Nursing Care of a Family with a Toddler

2. The developmental task of the toddler period, according to Erikson, is achieving a sense of: A) leadership. B) autonomy. C) initiative. D) nonstructure.

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 815 Feedback: Achieving a sense of independence or autonomy is the toddler developmental task.

26. The mother of a toddler is concerned because the child has taken the wheels off of a toy truck and placed them in a sandbox as stepping stones to walk. What should the nurse explain about this child's behavior? A) This is assimilation. B) The child does not like toy trucks. C) The number of toys should be limited. D) This is abnormal and needs to be evaluated.

Ans: A Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 817 Feedback: At the end of the toddler period, children enter a second major period of cognitive development termed preoperational thought and begin to use a process termed assimilation. This is when the child learns to change a situation and is what causes toddlers to use toys in the "wrong" way such as taking the wheels off of a truck and using them as stepping stones. The child has changed the toy's use to fit his or her thoughts or used assimilation. This behavior does not mean that the child does not like toy trucks. The number of toys does not need to be limited. This behavior is not abnormal but expected.

31. The parents of a toddler are worried that the child is not eating enough because food is always left on the child's plate. What should the nurse encourage the parents to do? A) Place smaller amounts on the child's plate. B) Reinforce that the child is to eat everything on the plate. C) Discipline the child for not eating by removing a toy from play. D) Feed the child if refusing to eat the food on the plate independently.

Ans: A Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 819 Feedback: Because the actual amount of food eaten daily varies, the parents should be instructed 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. Cleaning a plate gives a child a feeling of independent functioning, whereas leaving food uneaten suggests parents expected something more. Allowing self-feeding is a major way to both strengthen independence in a toddler and improve the amount of food consumed. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them. An individual child may react to repeated attempts at being fed by refusing to eat at all. The child does not need discipline.

15. The mother of a 2-year-old tells the nurse she is constantly scolding him for having wet pants. She says her son was trained at 12 months, but since he started to walk, he wets all the time. Which nursing diagnosis would be most applicable? A) Deficient parental knowledge related to inappropriate method for toilet training B) Excess fluid volume related to inability to control urination C) Ineffective coping related to lack of self-control of 2-year-old D) Total urinary incontinence related to delayed toilet training

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 811 Feedback: It is probable that a child toilet trained at 12 months was not truly trained; his mother was trained to remind him or place him on a toilet frequently during the day. When the child begins to play independently, the training is no longer effective.

5. The way you would advise a toddler's mother to handle temper tantrums would be to: A) appear to ignore them. B) distract him with a toy when he begins holding his breath. C) promise him a special activity if he will stop. D) mimic his behavior by also holding her breath.

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 826 Feedback: Rewarding temper tantrums can teach children that they are an effective method of interaction. Ignoring tantrums teaches the child that they are ineffective.

11. A toddler's father is concerned because his son refuses to share. What is your best response concerning this? A) This is normal toddler behavior; sharing is learned later. B) Behavior modification techniques can change the child's behavior. C) Play time with other children should be cut back until he learns to share. D) His son is probably reacting to some family crisis.

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 826 Feedback: Sharing is not usually learned until the preschool period; toddlers play parallel to each other.

12. A toddler's mother notices that he plays next to another child well but does not play with the other child. This type of play is called: A) parallel play. B) peer play. C) adjacent play. D) premature play.

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 815 Feedback: Typical play of the toddler period is beside, not with, another child (parallel play).

4. A 2-year-old holds his breath until he passes out when he wants something his mother does not want him to have. You would base your evaluation of whether these temper tantrums are a form of seizure on the basis that: A) seizures are not provoked; temper tantrums are. B) seizures rarely occur in toddlers. C) seizures typically occur with fever; temper tantrums do not. D) with seizures, cyanosis rarely develops.

Ans: A Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 826 Feedback: Temper tantrums occur because children are angry or frustrated; seizures occur without respect to provocation.

29. A mother brings a 15-month-old child to the clinic for a routine health maintenance visit. Which immunization should the nurse prepare to administer to this child? A) MMR B) Rinne test C) Oral polio D) Hepatitis A

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Page: 818 Feedback: The measles-mumps-rubella (MMR) vaccine is administered at either the 12-month or 15-month visit. Rinne test is not an immunization but rather a test for hearing. The oral polio vaccination is not listed as an immunization needed for toddlers. Hepatitis A vaccination is given at either the 12-month or 18-month visit.

14. Which of the following immunizations would you anticipate administering to a 15-month old at a health maintenance visit? A) Hib B) MMR C) Tine test D) Oral polio

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Page: 818 Feedback: Measles-mumps-rubella vaccine cannot be administered before 12 months because antibodies passively acquired across the placenta take this long to fade.

16. When assessing the oral cavity of a 2 1/2-year-old toddler, which finding is expected? A) 12 deciduous teeth B) 20 deciduous teeth C) 16 deciduous and 2 permanent teeth D) 6 deciduous and 12 permanent teeth

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Understand Page: 814 Feedback: All 20 deciduous teeth are generally present by 2 1/2 to 3 years of age.

25. The mother 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 mother about these expectations? A) Helping with teeth brushing encourages autonomy. B) It is unusual for a 2-year-old to have such strong opinions. C) The mother should continue to give full care in all aspects. D) Leaving the child alone in the bathtub is a good way to encourage autonomy. Ans: A Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 822 Feedback: 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 mother 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.

Ans: A Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 822 Feedback: 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 mother 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.

10. A toddler insists on brushing his own teeth and being left alone in the bathtub. What advice would you give his parents regarding this? A) Helping with his own tooth brushing allows him to experience autonomy. B) It is unusual for 2-year-olds to have such strong opinions. C) His mother should continue to give full care in all aspects. D) Leaving him alone in the bathtub is a good way to encourage autonomy.

Ans: A Client Needs: Safe, Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Page: 822 Feedback: Toddlers are not safe alone in bathtubs; most toddlers have strong opinions; assisting with brushing his own teeth is a good way to express autonomy.

17. The nurse is preparing a community educational program for the parents of toddlers. Which topics should the nurse include that address the 2020 National Health Goals for safety? Select all that apply. A) Using age-appropriate car seats B) Securing poisonous items out of reach C) Eliminating lead-based paint in the home D) Removing pets from the home environment E) Obtaining foot stools for use during toilet training

Ans: A, B, C Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 811 Feedback: The 2020 National Health Goals for toddlers focus on safety. The nurse can help the nation achieve these goals by educating parents about the importance of using car seats and childproofing the home against poisoning and lead poisoning. The National Health Goals do not address pets in the home. Foot stools for toilet training are not a safety concern.

27. The mother of a toddler observes the child play next to another child but not with the child. What should the nurse explain to the mother about this type of play behavior? A) This is peer play and is abnormal. B) This is parallel play and is expected. C) This is premature play and should be stopped. D) This is adjacent play and is only seen in school-age children.

Ans: B Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 815 Feedback: 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.

18. The parents of a toddler want to assist the child achieve the developmental task of autonomy. Which approach should the nurse suggest to the parents? A) Teach the child how to count. B) Allow the child to make simple decisions. C) Give the child small household chores to do. D) Urge the child to put on clothes independently.

Ans: B Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 822 Feedback: To develop a sense of autonomy is to develop a sense of independence. A healthy level of autonomy is achieved when parents are able to balance independence with consistently sound rules for safety. Allowing the child to make simple decisions helps the child achieve autonomy in a safe setting. Teaching how to count will not help develop autonomy in the child. Providing the child with chores will not develop autonomy. The child is not developmentally prepared to be able to put on clothes independently.

21. The parents of a toddler plan to begin toilet training. Which instruction should the nurse provide to the parents at this time? A) Toilet training is a 12-month process. B) Bowel training is easier than urine training. C) All children should be toilet trained by age 2 years. D) Children can remain dry during the night before they can do so during the day.

Ans: B Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 823 Feedback: Training should begin with defecation training because this is an easier concept for the child to grasp. There is no time limit regarding the amount of time it takes to toilet train a toddler. Even though theoretically a child can begin toilet training once able to walk, the child needs to reach specific milestones before being able to successfully toilet train. Children are more likely to remain dry during the day than during the night.

7. When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old? A) He should say two words plus "ma-ma" and "da-da." B) He should speak in two-word sentences ("Me go"). C) He should be able to count out loud to 20. D) He should say 20 nouns and 4 pronouns.

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 814 Feedback: By 2 years of age, children typically speak in two-word (noun and verb) sentences.

13. The nurse sees a 15-month-old at a health maintenance visit. Of the following assessments, which one is generally included in a 15-month checkup? A) Blood pressure B) Height and weight measurements C) Clean-catch urine D) IQ testing

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 818 Feedback: Because height and weight are such strong determinants of health, they are measured at every health assessment.

6. A toddler's parents want to begin toilet training him. As a rule, the best instruction you could give them is: A) all children should be toilet trained by age 2 years. B) if children can remain dry during the night they can do so during the day. C) bowel training is easier than urine training. D) toilet training is a 12-month process.

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 823 Feedback: Bowel training is often easier than urine training because the substance to be evacuated is so much more tangible.

19. A mother is concerned that her 2-year-old child is having seizures. He holds his breath until he passes out when he wants something his mother does not want him to have. How should the nurse respond to this mother's concern? A) Seizures rarely occur in toddlers. B) With seizures, cyanosis rarely develops. C) Seizures are not provoked; temper tantrums are. D) Seizures typically occur with fever; temper tantrums do not.

Ans: C Client Needs: Physiological Integrity: Basic Care and Comfort Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 826 Feedback: Some children hold their breath as part of a temper tantrum until they become cyanotic. Breath holding occurs when a child is provoked; the child develops a distended chest, often has air-filled cheeks, and shows increasing distress as the body registers oxygen want. A seizure cannot be provoked. Seizures can occur in all ages. Cyanosis can occur with seizures. Seizures can occur in those with neurologic problems and not just with a fever.

8. When childproofing the home for a toddler, the most important thing her parents should consider is to: A) lock downstairs windows. B) teach the child not to tease dogs. C) put medicine in a locked cupboard. D) keep the child in a playpen while the parents cook.

Ans: C Client Needs: Safe, Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Page: 820 Feedback: Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time.

30. 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? A) Total urinary incontinence related to delayed toilet training B) Excess fluid volume related to inability to control urination C) Ineffective coping related to lack of self-control of 2-year-old D) Deficient parental knowledge related to inappropriate method for toilet training

Ans: D Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Page: 823 Feedback: 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.

3. The best way for parents to aid a toddler in achieving his developmental task would be to: A) urge him to dress himself completely alone. B) give him small household chores to do. C) help him learn to count. D) allow him to make simple decisions.

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 822 Feedback: Making decisions is primary practice toward achieving independence.

9. 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: A) pretend she does not hear him. B) ask no further questions of him. C) tell him never to say, "No" again. D) give him secondary, not primary, choices.

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 822-825 Feedback: Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices encourages this without disrupting family life.

1. When assessing a 21/2 year old, the nurse would expect him or her to have: A) 6 deciduous and 12 permanent teeth. B) 12 deciduous teeth. C) 16 deciduous and 2 permanent teeth. D) 20 deciduous teeth.

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 814 Feedback: Children develop their first tooth at about 6 months. By 21/2, they typically have all 20 of their deciduous teeth.

24. The mother of a toddler is frustrated because no matter what she asks of the child, the response is "no." What can the nurse suggest to the mother to assist with this problem? A) Pretend she does not hear the child. B) Ask no further questions to the child. C) Tell the child to never to say "no" again. D) Give the child secondary, not primary, choices.

Ans: D Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 825 Feedback: A toddler needs experience in making choices, and to provide the opportunity to do this, a parent could give a secondary choice. Pretending not to hear the child, asking no further questions, and telling the child to never say "no" again will not help with the toddler's obstinacy.

22. The nurse is determining a toddler's language development. What is an expected finding for language development in a 2-year-old? A) Able to count out loud to 20 B) Speaks 20 nouns and 4 pronouns C) Speaks two words plus "ma-ma" and "da-da" D) Speaks in two-word sentences using a noun and a verb

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 814 Feedback: A 2-year-old child should be speaking in simple two-word sentences using a noun and a verb. Any 2-year-old child who does not talk in two-word, noun-verb simple sentences needs a careful assessment to determine the cause because this is beyond a point of normal development. Counting is not an expectation for a 2-year-old child. The child will not be able to speak 20 nouns and 4 pronouns.

28. The nurse is preparing to assess a toddler during a routine health maintenance visit. Which assessment will the nurse perform to determine the child's growth milestone? A) Blood pressure B) Urine specimen C) Hemoglobin level D) Height and weight

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 818 Feedback: Growth milestones are assessed at every health maintenance visit and are determined by measuring height and weight. Blood pressure does not assess a growth milestone. A urine specimen would be done at specific times. A hemoglobin level would be determined during specific times. Urine specimens and hemoglobin levels do not measure growth milestones.

20. The nurse had instructed the family of a toddler on home safety during a previous visit. During this current visit, what observation indicates that instruction has been effective? A) Prescribed medication sitting on countertop B) House plant on a small table next to the sofa C) Small bowl of mixed nuts on the coffee table D) All windows in the home have locked screens.

Ans: D Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Page: 820 Feedback: To prevent falls, the parents should keep the house windows closed or keep secure screens in place. Prescribed medication should be stored in a locked cabinet and not left out on a table because this could cause accidental poisoning. House plants should not be within reach of the toddler because this could cause an accidental poisoning or injury if the plant is pulled on top of the child. Nuts could cause accidental choking and should not be within the child's reach.

23. The nurse observes a toddler riding a tricycle and decides that the parents need additional safety education. What did the nurse observe? A) Toddler wearing a helmet B) Toddler wearing long pants C) Toddler wearing tennis shoes D) Toddler not wearing a helmet

Ans: D Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 817 Feedback: Toddlers need to wear a helmet as soon as they begin riding a tricycle. Parents are not as conscientious about using helmets as they are for bicycle riding so this is an area where health teaching is necessary. Wearing a helmet would be expected, and the nurse would not need to provide additional safety education for the parents. Long pants and tennis shoes do not pose a safety issue