Pediatrics Chapter 4

The nurse is assessing the development of a 15-month-old girl during a regular visit. Which of the following skills would the nurse expect to see?

Stands alone

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which true statement best accomplishes this?

A regular routine and rituals will provide stability and security.

The nurse is presenting an inservice training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of parallel play?

Children are playing independently and are side by side

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?

"Give him more healthy choices with less junk food available."

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?

"He doesn't respond if I wave to him."

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition?

"I give my daughter juice at breakfast and when she is thirsty during the day."

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?

"It is normal for children to engage in play alongside other children at this age."

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."

A nurse is discussing safety measures with the parents of a toddler. Which of the following would the nurse emphasize to address the most frequent type of accident in toddlers?

"Keep all cleaning products and drugs out of the reach of your child."

During the toddler years, the child attempts to become autonomous. If the following statements were made by caregivers of 3-year-old children, which observation reflects that the child is developing autonomy?

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

A mother who is returning to work outside the home has found a daycare center close to her office and is eager to have her 15-month-old son placed there so he can be close by. The center will only take children who are potty-trained. The mother asks the nurse for advice about how to persuade her son to use the potty. Which of the following would be the most appropriate response for the nurse to make to this mother?

"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained."

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

"When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to 'time out.'"

The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. Which of the following should the nurse say in response?

"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."

The nurse is talking with the parents of a newborn who is being discharged following an uneventful delivery. The parents express their excitement about going home but have concerns about what they need to do to help their 2-year-old adjust to the new baby. Which of the following suggestions would be most appropriate for the nurse to offer these parents?

"You should plan some time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant."

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."

By which age should the child know his/her own gender?

3

The toddler grows about how many inches in height per year?

3 inches

The parents of a 30-month-old girl have brought her into the emergency department because she had a seizure. During the health history, the nurse suspects the child had a breath-holding spell. Which of the following parental reports suggests breath-holding?

A tantrum preceded the event.

The nurse is promoting language and cognitive development to the parents of a 3-year-old boy. Which guidance about reading with their child will be most helpful?

Ask the child questions as you read.

The nurse is assessing a 2-year-old boy during a well child visit. The nurse correctly identifies the child's current stage of Erickson's growth and development as:

Autonomy versus shame and doubt

The parent reports the 13-month-old infant was using auditory expressive language. The vocalizations have been diminished over the last month and the child no longer says words. Select the best rationale for the infant's language behavior.

Biological factors such as otitis media could be causing hearing loss.

Which suggestion by the nurse meant to promote good dental health in the 15-month-old is inappropriate?

Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste.

Nursing students reviewing information about discipline demonstrate a need for additional information when they identify which of the following as correct?

Discipline and punishment are interchangeable.

The nurse is talking to the mother of a 19-month-old girl about setting limits and supervising activities. In which of the following situations will the nurse recommend letting the child do as she pleases?

Exploring her body

A toddler's "no" can best be eliminated by asking a question instead of making a statement.

False

Which of the following is a true statement regarding developmental milestones of the 30-month-old?

Full set of primary teeth

The nurse finds the diet of a 30-month-old girl to be low in calcium. What suggestion can significantly increase this toddler's calcium intake?

Give her slices of cheddar cheese as a snack.

The nurse is observing a 3-year-old boy in a daycare center. Which behavior might suggest an emotional problem?

Has persistent separation anxiety

Which of the following is appropriate with reference to enhancing a child's self-esteem?

Include the child in activities that interest the adult.

According to Eric Erikson, the developmental task of the toddler is developing autonomy. Which of the following describes Erikson's psychosocial development task for the toddler?

Learning to act on one's own

A group of students is reviewing material about ways parents can help to foster a child's self-esteem. The students demonstrate a need for additional studying when they identify which method?

Limiting the choices and decisions that the child makes

Once temper tantrums have started, which of the following interventions are appropriate?

Move objects out of the way or move the child to prevent injury.

The caregivers of 2 ½-year-old Frances tell the nurse that they are working hard to teach her to share and communicate with other children. The nurse recognizes and acknowledges their devotion, but explains to them that a child this age is probably not at a developmental level to play and share with other children. Of the following activities, which activity would the nurse recommend as the most appropriate activity for a 2 ½-year-old?

Mowing the lawn with a toy lawnmower

When observing a group of toddlers playing in a child care setting it is noted that the toddlers are all playing with buckets and shovels but are not playing with each other. This type of play is referred to as which of the following?

Parallel play

The nurse is observing a play group of children of all ages. The toddlers in the group would most likely be doing which of the following activities?

Playing with the plastic vaccum cleaner pushing it around the room

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

Which gross motor developmental milestone is least likely for a 2 year old?

Rides a tricycle

A family has recently moved into the area and is bringing their 18-month-old son in to the office for his first visit. The father is in dusty work clothes and explains that they are in the process of restoring the house they recently moved into, which was built in the 1920s and which had been vacant for many years. The nurse urges the father to have a blood test done on the son. Which of the following is the best rationale for this intervention?

Risk for lead paint poisoning due to the age of the house

The nurse is examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development?

The child does not use the names of familiar objects.

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

The child hides behind her bedroom door when defecating.

A mother expresses surprise to the nurse that her toddler daughter has begun masturbating. The most important initial nursing response is:

This is a normal and expected activity best treated matter-of-factly.

A toddler's father is concerned because his son refuses to share. What is your best response concerning this?

This is normal toddler behavior; sharing is learned later.

A father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which of the following findings should concern the nurse?

Total weight gain of 15 lb in the past year A child gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year during the toddler period

The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it.

True

The nurse is observing a 36-month-old boy during a well visit. Which motor skill has he most recently acquired?

Undress himself

A nurse is assessing a 2 year old's language development. Which of the following would the nurse expect to assess?

Use of a two-word noun-verb sentence

Parents of a 2-year-old girl are having a conversation with the nurse about tantrums. Which of the following techniques would the nurse most likely to suggest?

Use short "time-outs" and remain calm.

Parents and their 35-month-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

The mother of a 2-year-old boy has asked for some ideas for snack foods that would be less likely to cause dental caries. Which of the following items would the nurse most likely suggest?

Whole grain chips broken into pieces

The best way for parents to aid a toddler in achieving his developmental task would be to

allow him to make simple decisions.

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?" Which of the following would be appropriate for the nurse to suggest? Select all that apply.

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

A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child?

• Sticky foods like peanut butter alone, gummy candies, and marshmallows • Round foods such as hot dogs, whole grapes, and cherry tomatoes • Hard foods such as nuts, raw carrots, and popcorn

A nurse is presenting a class on toilet training to a group of parents with toddlers. Which of the following would the nurse include in the class?

• Using training pants that slide down easily and quickly • Praising the child when he or she urinates or defecates • Putting the child on the potty chair at regular intervals during the day

After teaching the mother of a 13-month boy old about suggestions for bathing and hygiene, the nurse determines that the teaching was successful when the mother states which of the following?

"It might be best to give him a bath in the evening."

The grandmother is the primary caregiver of her 2-year-old granddaughter. She expresses her concern that the child has temper tantrums two or three times a day, often in public places. She explains that she spanked her own children when they did this but now she is worried that spanking is not the best way to handle the situation. She asks the nurse for help with ways to deal with the temper tantrums. In answer to her question, the nurse makes the following statements. Which statement is the most appropriate regarding dealing with the child who has a temper tantrum?

"Remain calm, pick the child up, and move her to a quiet and neutral place until she gains self-control; don't give in to her demands."

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 back yard a few days ago. The nurse explains that this is an instance of which of the following?

Deferred imitation

The mother of a 2-year-old tells you 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?

Deficient parental knowledge related to inappropriate method for toilet training

The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child?

The child demonstrates separation anxiety.

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

seizures are not provoked; temper tantrums are.