Peds EAQs 1

At 18 months of age a child born with a cleft lip and palate is readmitted for palate surgery. Why does the nurse teach the parents not to brush their child's teeth immediately after the surgery? 1. The suture line might be injured. 2. A toothbrush might be frightening. 3. The child will probably have no teeth. 4. A toothbrush has not been used before.

1, A priority during the immediate postoperative period is protecting the surgical site. A toothbrush should be a familiar sight, not a frightening one, to an 18-month-old child. An 18-month-old child has about 16 teeth; although tooth development may not be as expected, there usually are teeth. Brushing the teeth with a soft toothbrush is usually started around 6 months of age.

Discharge planning for a toddler with newly diagnosed celiac disease includes instructions regarding dietary restrictions. What foods should the nurse recommend? Select all that apply. 1. Oatmeal 2. Ice cream 3. Rice cakes 4. Corn crisps 5. Whole-wheat toast

1, 2, 3, 4 Ice cream, if it does not contain wheat fillers, is acceptable on the celiac diet. Rice is a gluten-free grain and is tolerated by the child with celiac disease. Corn and oats are gluten free and can be tolerated by the child with celiac disease. Primary sources of gluten are wheat, rye, and barley; whole-wheat bread contains wheat flour and wheat by-products. Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night's sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best.

Which social development tasks should the nurse anticipate when assessing a toddler-age client during a health maintenance visit? Select all that apply. 1. Separation 2. Parallel play 3. Irreversibility 4. Individuation 5. Temper tantrums

1, 4, Separation and individuation are two social development tasks the nurse anticipates for the toddler-age client. Parallel play, irreversibility, and temper tantrums are also expected during the toddler stage of development; however, these are not social development tasks.

A parent tells a nurse at the clinic, "Each morning I offer my 24-month-old juice, and all I hear is 'No.' What should I do? I know she needs fluid!" What is the best response by the nurse? 1. Offer the child a choice of two juices. 2. Distract the child with a favorite food. 3. Offer the child the glass in a firm manner. 4. Allow the child to see the parent getting angry.

1, Children who are expressing negativism need to have a feeling of control. One way of achieving this within reasonable limits is for the parent or caregiver to provide a choice of two items instead of forcing one on the child. Distracting the child with a favorite food will not achieve the goal of giving fluids. Offering the child the glass in a firm manner will probably not be successful with a toddler. Allowing the child to see the parent getting angry will complicate the situation and further inhibit the child's willingness to take fluids.

A nursing instructor asks a nursing student about language development in toddlers. Which statement by the student indicates a need for further learning? 1. "A 24-month-old child uses pronouns." 2. "An 18-month-old child uses approximately 25 words." 3. "A 24-month-old child has a vocabulary of up to 300 words." 4. "A 36-month-old child can use simple sentences and follow some grammatical rules."

2, An 18-month-old child can use approximately 10 words, not 25. A 24-month-old child can use pronouns and has a vocabulary of up to 300 words. A 36-month-old child can use simple sentences and follow some grammatical rules. STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know.

Which age group does the nurse observe engaging in parallel play? 1. Infants 2. Toddlers 3. Adolescents 4. Preschoolers

2, Parallel play is common among toddlers. In this form of play, each one engages in an independent activity that is similar to, but not influenced by or shared with, others. Infants do not perform parallel play. Adolescents spend time with multiple friends at one time. Preschoolers are able to play with one other child in a cooperative manner in which they make something or play designated roles.

The parents of a 2-year-old child who is being admitted to the hospital tell the nurse that their child is accustomed to sleeping with a favorite blanket. What should the nurse do, knowing that the blanket is worn and dirty? 1. Refuse to allow the parents to leave it. 2. Allow the parents to give it to the child. 3. Offer to wash the blanket later when the child is asleep. 4. Suggest that the parents take this one home when they bring in another blanket.

2, The blanket represents a security object to the child, who needs security in the unfamiliar setting of a hospital. Refusing to allow the parents to leave the blanket is insensitive because it ignores the emotional needs of the child. Washing the blanket later would be catastrophic for the child if the blanket were to disappear while the child was asleep; the blanket provides comfort and security. Children do not readily transfer their feelings of security to other objects; a different blanket will not meet the child's emotional needs.

Which form of discipline should the nurse recommend for the parents of a toddler-age client who has an easy temperament? 1. Ignoring the behavior 2. Implementing a time-out 3. Using physical containment 4. Making sustained eye contact

4, The parents of a toddler-age client who has an easy temperament should be encouraged to make sustained eye contact with the child as a form of discipline. Ignoring the behavior is not affective for any temperament. Implementing a time-out and using physical containment is appropriate for the child with a difficult temperament.

Which food should the nurse recommend for a toddler-age client who is at risk for developing rickets? 1. Yogurt 2. Carrots 3. Fruit juice 4. Dried fruit

A calcium and vitamin D deficiency causes rickets; therefore, the nurse should recommend yogurt for the toddler who is at risk. Carrots, fruit juice, and dried fruits are not food items that are rich in calcium and vitamin D.

A parent asks the nurse what to do when the toddler has temper tantrums. What play materials should the nurse suggest that the child be offered as another means of expressing anger? 1. Ball and bat 2. Wad of clay 3. Punching bag 4. Pegs and pounding board

A pounding board with pegs to hammer into holes is a safe toy for toddlers because it is fairly large, easy to manipulate, and sturdy. It also provides an acceptable way for anger to be expressed. The child's motor and hand-eye coordination are too immature for the child to use a ball and bat. A wad of clay is not as effective for releasing anger as a pounding board. A punching bag is appropriate for an older child with more mature motor coordination to compensate for a moving object.

Which toddler-age client has reached a height in which it is no longer safe to sleep in a crib? 1. 26 inches 2. 28 inches 3. 33 inches 4. 36 inches

A toddler-age client who reaches 35 inches should sleep in a bed versus a crib for safety reasons. The other heights in inches (26, 28, and 33) can remain in a crib because safety is not a concern.

A nurse bases the plan of care for a 15-month-old toddler with celiac disease on the pathophysiology of the disorder, which is characterized by what? 1. Inability to metabolize gluten 2. Absence of the enzyme phenylalanine 3. Excessive amount of salt in the sweat glands 4. Increase in the viscosity of mucous secretions

Children with celiac disease are unable to digest the gliadin component of gluten, resulting in fatty, foul-smelling diarrheal stools. Phenylketonuria is caused by the absence of phenylalanine; it is not related to celiac disease. Excessive salt in the sweat glands is a manifestation of cystic fibrosis. Increased viscosity of secretions from mucous glands is also related to cystic fibrosis.

What would the nurse claim is true regarding play in toddlers? 1. Children have imaginary playmates. 2. Children prefer to play with other children. 3. Children get curious and explore the environment. 4. Children prefer to stay away from parents while playing.

During toddlerhood, the child is curious, which is evident in their exploration of the environment. Preschoolers have fantasies and imaginations. Imaginary playmates are a sign of health and allow children to distinguish between reality and fantasy. Children continue to engage in solitary play during toddlerhood but also begin to participate in parallel play. Children prefer playing beside rather than with another child. Toddlers fear separation from their parents and feel safer in their presence.

A nurse on the pediatric unit is observing the developmental skills of several 2-year-old children in the playroom. Which child should the nurse continue to evaluate? 1. One who cannot stand on one foot 2. One who builds a tower of seven block 3. One who exhibits echolalia when speaking 4. Once who colors outside the lines of a picture

Echolalia in a 2-year-old child may be a sign of autism; imitation of sounds begins around 6 months of age and may continue for several more months. The average 2-year-old child has a 300-word vocabulary and uses two- and three-word phrases. It is not until 30 months of age that the toddler is able to stand on one foot. Building a tower of five or six blocks is expected at the age of 2 years. Although the pincer grasp is achieved at 11 months, it is not until the age of 30 months that the toddler is expected to hold crayons with the fingers rather than the fists and to be able to color within the lines of a picture.

What does the nurse state is the cause of frequent upper respiratory tract infections in toddlers? 1. Stress 2. Unhealthy diet 3. Lack of exercise 4. Immature immune system

Infants and toddlers are at risk for upper respiratory tract infections as a result of frequent exposure to other children, an immature immune system, and exposure to second-hand smoke. Stress, unhealthy diet, and lack of exercise predispose young and middle-age adults to multiple cardiopulmonary risk factors

Which statement by the nurse is true about health promotion in infants and toddlers? 1. Allow a toddler to sleep on his side. 2. Place pillows in the crib of an infant. 3. Remove grocery plastic bags from the home. 4. Keep pacifiers on a ribbon around a toddler's neck.

Removing grocery and dry cleaner's plastic bags from the home reduces the risk of suffocation from plastic bags. Parents should have infants sleep on their backs to reduce the risk of sudden infant death syndrome. Placing pillows in the crib increases the chances of suffocation. A string or ribbon around the neck increases the risk of choking. Snug-fitted sheets should be used in cribs because the possibility exists for infants to become entwined in sheets and other bedding and suffocate. Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, "I know the material, and I'll do well on the test." Try it; many students have found that it works because it reduces "test anxiety."

How would the nurse explain that the skeletal system of toddlers differs from older adults? 1. Bones of toddlers are less pliable than those of older persons. 2. Bones of toddlers can withstand falls better than those of older adults. 3. Bones of toddlers are more susceptible to osteoporosis than those of older adults. 4. Bones of toddlers are more susceptible to bone loss than the bones of older persons.

The bones of toddlers can better withstand falls than the bones of older adults. Toddlers' bones are more pliable than those of older people. Older adults, especially women, are more prone to developing osteoporosis, which increases the risk of fractures. Older adults, especially women, are more susceptible to bone loss.

A nurse is counselling a parent about the changes a toddler may exhibit after the death of a family member. What should the nurse include in the counselling? Select all that apply. 1. "The toddler will be resilient over the loss." 2. "The toddler will understand the cause of the loss." 3. "The toddler may have bowel or bladder disturbances." 4. "The toddler may express changes in sleeping patterns." 5. "The toddler will get disrupted in developing an autonomous sense of self."

The nurse should tell the parent that after the death of a family member, toddlers will express the sense of absence they feel through changes in eating and in sleeping patterns, fussiness, or bowel and bladder disturbances. Older adults, not toddlers, show resiliency over the loss of a family member. Toddlers do not understand the cause of the loss. The loss of a family member may disrupt the development of autonomy in young adults.

Which of these diseases would the nurse explain is most common in toddlers? 1. Influenza 2. Lung cancer 3. Hypertension 4. Angina pectoris

Toddlers are very prone to developing upper respiratory tract infections; hence, influenza is seen most frequently among toddlers. Lung cancer is seen commonly in younger or middle-aged adults from smoking. Hypertension is commonly seen in middle age due to an unhealthy diet, lack of exercise, and stress. Angina is common in young and middle-aged adults.

Which assessment data would cause the nurse to initiate treatment for a potential aspirin overdose for a toddler-age child who presents in the emergency department (ED)? Select all that apply. 1. Emesis 2. Nausea 3. Tinnitus 4. Ecchymosis 5. Hypoventilation

1,2,3, Emesis, tinnitus, and nausea are all early clinical manifestations of acute aspirin poisoning; therefore, it would be appropriate for the nurse to initiate treatment for an aspirin overdose. Ecchymosis is a late symptom associated with a chronic aspirin overdose. Hyperventilation, not hypoventilation, would support the initiation of treatment for an aspirin overdose.

The parent of a 2-year-old child with just-diagnosed cystic fibrosis expresses concern about the child's frailty and low weight. What is the most appropriate reply by the nurse? 1. "Digestive enzymes will be given to help your child digest food." 2. "Your child's appetite will improve once respiratory therapy is started." 3. "Your child's coughing and shortness of breath prevent adequate chewing of food." 4. "I suggest that you offer baby foods to your child because they are more easily digested."

Because the pancreatic ducts are blocked and fibrotic, oral pancreatic enzymes must be given to make the nutrients digestible and absorbable. Children with cystic fibrosis have good, even voracious, appetites despite respiratory impairment. Chewing is adequate despite coughing and shortness of breath; undernourishment results from inadequate nutrient absorption. It is not the consistency of the foods that leads to inadequate digestion and absorption, but the lack of enzymes from the pancreatic duct. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.

The nurse is providing care to a toddler-age client during a health maintenance visit whose parents are expecting the birth of another child. Which statements should the nurse include in the teaching session to prepare the toddler-age client for the arrival of a new sibling? Select all that apply. 1. "You should tell your child that a new playmate will be coming home." 2. "You should begin to prepare your child now so there are no surprises." 3. "You should promise your child that normal bedtime routines will continue after the baby is born." 4. "You should buy your child a doll so that she can take care of her baby while you take care of the new baby." 5. "You should include your child in the normal day to day activities with the new baby, such as helping with diaper changes."

In order to prepare a toddler-age client for the birth of a younger sibling, the nurse should teach the parents to promise that normal bedtime routines will continue after the baby is born; buy the child a doll so that she can take care of her baby while the parent takes care of the new baby; include the child in the normal day to day activities with the new baby, such as helping with diaper changes. Telling the toddler-age client that the newborn will be a playmate sets up unrealistic expectations. The parents should be taught that the toddler-age client should be prepared for the birth of a new sibling when the toddler becomes aware of the pregnancy, such as the mother beginning to show.

Which method of drug administration does the nurse state is commonly used in toddlers when the child has poor intravenous (IV) access? 1. Intrathecal 2. Intraarterial 3. Intraosseous 4. Intraperitoneal

The intraosseous route is commonly used in toddlers for drug administration in an emergency situation. It is most commonly used in infants and toddlers in whom there is poor access to the intravascular space. Intrathecal administration is often associated with long-term medication administration through surgically implanted catheters. Intraarterial infusions are common in clients who have arterial clots. Chemotherapeutic agents, insulin, and antibiotics are administered via the intraperitoneal route

A nurse is educating parents about the changes to expect when their child enters toddlerhood. Which information does the nurse include? 1. The toddler's body appears slender. 2. The toddler has a protruded abdomen. 3. The toddler's feet are severely everted. 4. The toddler has inconspicuous cervical curves.

The nurse explains to the parents that at the start of toddlerhood, the abdomen of the child will be protruded. The bodies of toddlers start appearing slender by the age of 3 years, not in the beginning of toddlerhood. As the child walks, the legs and feet are usually far apart, and the feet are slightly everted, not severely everted. Toward the end of toddlerhood, curves in the cervical and lumbar vertebrae are accentuated.