Chapter 4: Growth and Development of the Toddler Q's
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? "Perhaps you should consider a preschool to promote more socialization opportunities." "Does your child have opportunities to socialize much with other children?" "It is normal for children to engage in play alongside other children at this age." "Has your child displayed any aggressive tendencies toward other children?"
"It is normal for children to engage in play alongside other children at this age." 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.
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. "Use time-out every other time she tells you no." "Offer her two options from which to choose." "Make a statement instead of asking a question." "Offer her something she would like, such as ice cream, to distract her." "Limit the number of questions you ask of her."
"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." A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. In addition, using statements instead of asking questions and giving the child a choice of two options are effective. Using time-out is a discipline measure and would be inappropriate to counteract a toddler's negativism. Offering a choice rather than a bribe such as ice cream is more effective and long-lasting for modifying the child's behavior.
The nurse is teaching the parents of a 2-year-old child how to handle the child's temper tantrums. The nurse determines that the teaching was successful if the parents make which statement? "We will place our child in time-out for 5 minutes after the tantrum." "We will attempt to reason with our child to limit tantrums." "We will offer our child a treat to stop having the tantrum." "We will ignore our child while having the tantrum."
"We will ignore our child while having the tantrum." The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it. Bribery, such as saying that the child can have a treat if the behavior stops, is rarely effective because by accepting the child's wishes, the parent is encouraging the child to have more tantrums because he or she was successful. Placing the child in time-out does not deal with the actual tantrum. When a child is placed in time-out, the appropriate length is 1 minute per year of age (2 minutes for this child). Tantrums are a result of the child not being able to appropriately express his or her needs, desires, or frustrations. It is not appropriate to attempt to reason with a upset 2-year-old child.
A 3-year-old child is hospitalized. The parents are concerned because the child is now refusing to use the potty and is wetting the bed even though the child has achieved toilet training. Which response by the nurse is most appropriate? "Your child is experiencing regression as a result of stress." "Do not worry. This is a normal response to being in the hospital." "Why do you believe your child is refusing to use the potty?" "Once discharged, your child will quickly learn to use the toilet again."
"Your child is experiencing regression as a result of stress." Regression is a change from present behaviors to past developmental levels of behavior. This is a normal response among children during times of intense stress, such as a hospitalization or the birth of a new sibling. The nurse should not tell the parents not to worry. The child will not have to learn to use the toilet again. The behavior is already learned. Asking why is not a therapeutic form of communication and may cause the parents to become unnecessarily defensive.
A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene? 3-year-old preschool-aged child who goes up stairs on hands and knees 14-month-old toddler who walks with a parent's assistance 24-month-old toddler who engages in parallel play 9-month-old infant who can pull self up to a standing position
3-year-old preschool-aged child who goes up stairs on hands and knees At 3 years of age, a child should be able to climb the stairs one step up at a time or using alternating feet. If the child can only go up on hands and knees, further evaluation is needed. At 9 months of age, an infant can pull oneself up to a standing position and sometimes is able to cruise around furniture or even walk. Toddlers begin to walk between 9 and 18 months of age. Toddler at 24 months of age engage in parallel play rather than cooperative play.
The parents of a 30-month-old toddler have brought the toddler into the emergency department because of a seizure. During the health history, the nurse learns that the toddler was frustrated and angry immediately preceding the seizure. The nurse suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding? The toddler was lethargic afterward. The toddler became unconscious. A tantrum preceded the event. The event took place during a nap.
A tantrum preceded the event. Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the toddler is old enough to verbalize feelings. The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells.
The nurse is assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern? Ability to turn door knobs Put shapes into matching openings Ability to hold a crayon to write Able to use a spoon to self-feed
Ability to turn door knobs
What advice should the nurse provide the parent of a toddler, regarding how to handle temper tantrums? Appear to ignore the toddler Mimic the toddler's behavior by also holding the breath Distract the toddler with a toy when the toddler begins holding the breath Promise the toddler a special activity if the toddler will stop
Appear to ignore the toddler Temper tantrums are the natural result of frustration that toddlers have. Toddlers do not behave badly on purpose. They need time and maturity to learn the rules and regulations. During a temper tantrum, the advice is for the parent to ignore the behavior but ensure the toddler is safe. Rewarding temper tantrums can teach the toddler that tantrums are an effective method of interaction. Ignoring tantrums teaches the toddler that tantrums are ineffective. The parent needs to use self-control when dealing with a temper tantrum. This is a way to model acceptable behavior for the toddler.
A single mother with three young children is reluctant to leave her crying and upset 16-month-old daughter overnight in the hospital but needs to go home to care for the other children. Which suggestion from the nurse will best address the fears and concerns of both the child and mother? Tell both the mother and child that the child will be carefully guarded and won't be in as much danger as she might be if she were home exploring her environment. Encourage the mother to give the child a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return, such as "when breakfast comes in the morning." Remind them staying in the hospital now will help the child get well quicker and be home soon, but the other children should not be alone. Distract the child with a special blanket, stuffed animal, or other "lovey" from home while the mother quietly slips out.
Encourage the mother to give the child a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return, such as "when breakfast comes in the morning." When the family caregiver must leave the toddler, it may be helpful for the adult to give the child some personal item to keep until the adult returns. The caregiver can tell the child he or she will return "when the cartoons come on TV" or "when your lunch comes." These are concrete times that the toddler will probably understand. The toddler is too young to understand that staying is important for her recovery. Distracting the child while the mother leaves may increase the child's anxiety when she realizes her mother is gone. Although the child will be watched closely in the hospital setting, toddlers explore their environment wherever they are.
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. Explain that the child could start walking any day. Refer the child to a developmental specialist for evaluation. Ask the parent if the child has been ill recently.
Explain that children can take their first steps as late as 18 months of age.
The nurse is assessing 2-year-old twins. The parent states, "My twins will not play together, only alongside each other." Which action will the nurse take first? Determine when this form of play was first noted. Explain that this is normal behavior for toddlers. Document the finding in the medical records. Encourage the toddlers to play to allow for observation.
Explain that this is normal behavior for toddlers. Playing beside one another is parallel play and typical of toddlerhood. The nurse would explain this is normal behavior for the twins and then document the finding. The nurse would not need to observe the twins at play or ask additional questions as this is an expected finding.
The caregivers of a 2-year-old are concerned the child is not learning how to share and play well with other children. While acknowledging their concern and devotion, the nurse should point out which activity would be best for this child's developmental level? Mowing the lawn with a toy lawnmower Looking at large print magazines Throwing a baseball-sized ball Sharing finger paints and painting with the caregiver
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. Toys that involve the toddler's new gross motor skills, such as push-pull toys, rocking horses, large blocks, and balls are popular. Fine motor skills are developed by use of thick crayons, modeling clay, finger paints, wooden puzzles with large pieces, toys with pieces that fit into shaped holes, and cloth books. The toddler will not be interested in sharing toys until the later stage of toddlerhood; adults should not make an issue of sharing at this early stage.
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 Made sure the child was rested and not hungry before going to the mall Tried to refocus the child's attention as tantrum behavioral cues appeared Remained relatively calm even though embarrassed
Reasoned with the child to stop the behavior The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place. The other actions are helpful in preventing a tantrum.
The father of a toddler reports his son says "no" every time he attempts to correct him. What is the best advice the nurse can offer to the parent? This is a normal part of toddlerhood. Saying no is your son's way of trying to exert his independence and is expected. You may need to lessen the amount of correction being given to the child as he seems to be responding to feeling "overly restricted." Continue to correct him because he needs discipline.
Saying no is your son's way of trying to exert his independence and is expected. It often seems that "no" is a toddler's favorite word. Saying no is his way of beginning to exert his independence. Telling the parent this is a normal happening does not provide the necessary education to the parent. Saying "no" does not indicate the discipline being provided is too restrictive. Telling the father to continue the discipline does not offer the needed education about his child's behavior and stage of development.
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 often removes her shoes and socks. The child hides behind her bedroom door when defecating. The toddler walks with a wide, swaying gait. The child frequently repeats words parents just said.
The child hides behind her bedroom door when defecating. Hiding while defecating indicates awareness of this need. Repeating words promotes language development but doesn't indicate readiness for toilet teaching. Walking with a wide, swaying gait is early walking behavior. Steady walking and running signals toileting readiness. Removal of shoes and socks is easily done. Greater fine motor clothing removal skill is needed for toileting.
A parent is concerned because the toddler refuses to share. What is the nurse's best response to the parent regarding this concern? The toddler is probably reacting to some family crisis. This is normal toddler behavior; sharing is learned later. Behavior modification techniques can change the toddler's behavior. Play time with other toddlers should be cut back until your toddler learns to share.
This is normal toddler behavior; sharing is learned later. Play is the major socializing medium for the toddler. Toddlers exhibit parallel play instead of cooperative play. Sharing is not usually learned until the preschool period. Because toddlers have such short attention spans, they change toys and activities frequently. This also is not conducive to sharing. Because parallel play is normal for the toddler, the parent should be assured the toddler is developing normally and no restrictions are needed.
Parents and their nearly 3-year-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 Asks "why" often Half of speech understood by outsider Talks about a past event
Uses two-word sentences or phrases A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.
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 watching a movie with other children their age painting pictures in the art corner of the room pretending to be mommies and daddies in the play house
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.
