Toddler and Preschooler
The parent of a 2-year-old calls a nurse who is a neighbor and reports that the child just ate several multivitamins with iron. What should the nurse say to the parent?
"Call the Poison Control Center."The Poison Control Center will provide the best guidance for treatment of excess ingestion of a substance; enemas, lavage, or chelation therapy with deferoxamine (Desferal), a heavy metal antagonist, may be recommended, depending on the amount ingested and the child's age and response.
A 15-month-old child is hospitalized after ingesting toilet bowl cleaner. The mother confides that she feels guilty about leaving the cleaner where her child could get it. What is the best response by the nurse?
"It was an accident, but you should consider special locks on your closets."
A nurse is preparing to give a 3-year-old toddler an intramuscular injection, and the child starts to cry. What is the most therapeutic approach for the nurse to take?
"It's all right to cry as loud as you want, but don't move."
How should a nurse respond to parents who are concerned about separation anxiety in their 15-month-old toddler?
"This is an expected developmental reaction."RationaleUnderstanding that separation anxiety is an expected developmental occurrence will be reassuring to the parents. Commenting that the parents may be spending too much time with their child is a value judgment and does not address this expected stage of development. Giving advice is not therapeutic and does not address the child's separation anxiety. There is no connection between separation anxiety in a 15-month-old child and difficulty starting school.
When a nurse brings a dinner tray to a 4-year-old child hospitalized with pneumonia, the child says, "I'm too sick to feed myself." What is the best response by the nurse?
"Wait a few minutes, and I will be back to help you."
An IV catheter is to be inserted into a 3-year-old toddler's peripheral vein. As local topical anesthetic is applied, the toddler starts to cry and asks whether the insertion is going to hurt. How should the nurse respond?
"Yes, it may hurt, but not for very long."
What is the average duration of sleep per night for a preschooler?
12hr
A 4-year-old child is admitted to the pediatric unit with a diagnosis of Wilms tumor. Considering the unique needs of a child with this diagnosis, the nurse should place a sign on the child's bed that states:
4 Do not palpate the abdomen.
Several 3 year old girls in the daycare center are having a tea party with their dolls. The center's nurse concludes that this behavior is:
Appropriate make-believe play
An unconscious toddler requires intermittent nasogastric feedings. When should the nurse check placement of the tube?
Before each feeding
A 4-year-old child with newly diagnosed leukemia is admitted for chemotherapy. While assisting with morning care the nurse observes bloody expectorant after the child has brushed the teeth. How should the nurse respond to this occurrence?
By documenting the incident without alarming the child
A nurse is teaching the parents of an 18-month-old child the procedure for instilling ear drops. How should this procedure be done?
By pulling the pinna down and back to straighten the auditory canal before instillation of the dropsThe canal curves upward in children younger than 3 years of age; pulling the pinna down straightens the canal so medication will reach the eardrum. The ear canal is not cleansed before ear drops are instilled; this could exacerbate the infection. Applying ear wicks is contraindicated because it increases pressure within the ear. Pulling the pinna up and back after instillation of drops is unnecessary; pressing on the tragus several times will help disburse the drops.
What is the best way for the nurse to greet a 3-year-old child sitting in the waiting room of the pediatric clinic?
By walking into the waiting room to greet the child
A 3-year-old child with the diagnosis of tetralogy of Fallot is brought to the United States by a charitable organization for cardiac surgery. What should the nurse expect to observe when caring for the child?
Clubbing of fingers
A parent of a 20-month-old toddler who has experienced an episode of diarrhea calls the pediatric clinic for advice. What instructions should the nurse give the parent, according to evidence-based practice for this situation?
Continue the child's feedings as usual, observe the frequency of stools, and bring the child to the clinic tomorrow if the diarrhea continues.
The parents of a 4½-year-old child are concerned about the effects of hospitalization on the child. Which behavior should the nurse expect the child to exhibit?
Crying when the parents leave and return but not during their absence
On the third day of a 2-year-old toddler's hospitalization the nurse notes that the child, who had been screaming and crying inconsolably, has begun to regress and is now lying quietly in the crib with a blanket. What stage of separation anxiety has developed?
Despair
The nurse is teaching a parent of a 2-year-old toddler how to administer ear drops. In what direction does the nurse teach the parent to gently pull the pinna?
Down and back
A 4-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute lymphocytic leukemia (ALL). The mother states that changes in her child's behavior and the "black and blue" marks were noticed several days ago. She blames herself for not bringing her child to the clinic sooner. On what information about the pathophysiology of leukemia should the nurse base a response?
Early signs and symptoms of leukemia are similar to those of other mild illnesses of childhood.
A toddler who was physically abused is admitted to the pediatric unit. What behavior does the nurse expect when approaching the child?
Exhibiting fear of physical contact initiated by anyone
A 4½-year-old child is brought to the emergency department with a fractured tibia. Which type of fracture is most common in children of this age?
Greenstick
A nurse is teaching a class to parents about keeping medications and household cleaning supplies out of the reach of toddlers. The nurse explains that this is necessary because toddlers:
Have a high level of oral activity
A 4-year-old child who has never been separated from parents or siblings is admitted to the hospital. What is most important for the nurse to encourage the parents to do?
Have one of them stay with the child.The 4-year-old child has developed trust but still needs frequent support from parents. Visiting during regular visiting hours may be inadequate; preschoolers need the continued support of parents during stressful times. The parents may bring a toy, but their presence to provide support and reinforce trust is more important. The parents should participate in their child's care as much as possible so there will be no interference with the trust relationship and support will be provided.
A 3-year-old child is to receive a liquid iron preparation. What should the nurse teach the mother regarding this medication?
Have the child drink the diluted iron preparation through a straw.
A 4-year-old boy with acute lymphocytic leukemia (ALL) is to undergo bone marrow aspiration. While involving the child in therapeutic play before the procedure, the nurse should help him understand that:
He did nothing to cause his current illness.
A nurse is caring for a 4-year-old child with just-diagnosed cystic fibrosis. The child has been passing loose, bulky, foul-smelling stools and is in the third percentile for weight. What is the best explanation of the growth failure?
Impaired digestion and absorption because of the lack of pancreatic enzymes
What does a nurse identify as the priority short-term goal for a toddler with dehydration caused by diarrhea?
Improvement of fluid balance
A 13-month-old child is undergoing lumbar puncture for confirmation of a diagnosis of bacterial meningitis. During the procedure the nurse notes that the spinal fluid is cloudy. What does this finding indicate?
Increased white blood cell (WBC) count
A nurse who volunteers in a daycare for preschoolers has been asked to give a presentation to parents about health promotion. Which topics should the nurse include?
Injury prevention and dental health
A preschool-age child has been restricted to bed rest since being admitted to the hospital. As he begins to recover, he becomes interested in playing. In light of his developmental level and activity restriction, what should the nurse provide for him?
Little cars and shoebox garage
A nurse accompanies a 3-year-old child to the pediatric unit's playroom. The toddler seems reluctant to select a toy or activity. Which toy is most appropriate for the nurse to offer as a means of fostering creativity?
Mold and clay
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?
Offer the child a choice of two juices.
A nurse is observing two 18-month-old children playing side by side in a sandbox. Although they watch each other, neither interacts with the other. What type of play does the nurse identify?
Parallel play is typical of the toddler age group, when children play beside but not with each other. Solitary play is a feature of infancy. Associative play is a characteristic of the preschool years, when children interact in loose association. Cooperative play is seen in school-aged children, whose play is organized, such as in sports and board games.
The healthcare provider prescribes mebendazole for a 4-year-old child with pinworms. For which expected response to the medication does the nurse teach the parents to be alert?
Passage of worms
A mother tells her neighbor, a nurse, that her toddler has been found to have parasites (worms) and that the whole family will need to be treated. She asks the nurse what kind of worm it is. What is the most likely type of worm infestation?
Pinworm (Enterobius)
A nurse is caring for a 4-year-old child who is terminally ill. The 4-year-old child's concept of death is based on a sense of causality. In what stage of Piaget's cognitive development is this child?
Preoperational thoughtRationale: Piaget describes preoperational thought as the preschooler's thought processes. A 4-year-old child is a preschooler. Piaget describes formal operations as the adolescent's thought processes. Piaget describes sensorimotor operations as the infant's thought processes. Piaget describes concrete operational thought as the school-age child's thought processes.
A child recovering from a severe asthma attack is given oral prednisone 15 mg twice daily. What is the priority nursing intervention?
Preventing exposure of the child to infectionRationale: Prednisone reduces the child's resistance to certain infectious processes and, as an anti-inflammatory drug, masks infection. The child will self-limit activity depending on respiratory status. The eosinophil count is often consistently increased in children with asthma. The child will need adequate
The nurse notes that a 3-year-old child in a crib has a clamped jaw and is having a tonic-clonic seizure. What is the priority nursing responsibility at this time?
Protecting the child from self-injury
While in the hospital's playroom a male toddler suddenly has a nosebleed that leaves blood on the play table. What is the nurse's first response in this situation?
Providing nursing care to stop his nosebleed
A 3½-year-old boy from Central America who has tetralogy of Fallot attends the pediatric cardiac clinic for a diagnostic workup before corrective surgery is scheduled. The nurse's evaluation of the child's motor ability demonstrates that he is just beginning to walk unsupported. When comparing this child with other 3½-year-old children, the nurse determines that t
Should have started to walk about 2 years earlier
At 18 months of age a child born with a cleft lip palate is readmitted for palate surgery. Why does the nurse teach the parents not to brush their child's teeth immediately after the surgery?
The suture line might be injured.
A nurse explains to the parents of a toddler why 2-year-old children are at risk for lead poisoning. What major risk factor does the nurse include in the discussion?
They explore the environment by touching and tasting.
Which toddler behavior reflects animism?
Toddlers attribute lifelike qualities to inanimate objects.
A 3-year-old child with sickle cell anemia is admitted to the child health unit during a painful episode. Splenomegaly is identified. The nurse explains to the parents that splenomegaly is:
Triggered by a vaso-occlusive crisis
A 2-year-old child with previously diagnosed hemophilia is admitted to the pediatric unit for observation after a motor vehicle collision. The toddler has several bruises but no other apparent injuries. What is the nurse's specific concern regarding this child?
Undetected injury
What is the priority nursing responsibility in the care of a young toddler after a circumcision?
Watching for bleeding around the penis
The parents of a 31/2 year old tell the nurse that their child has become a "picky eater" and has not gained much weight. How should the nurse respond?
Your child is growing slower;preschoolers don't have large appetites
The nurse finds a 4½ -year-old hospitalized girl, who has several siblings, crying and shouting at her teddy bear, "There! You bad girl! Don't be mad at your brother! Go to the hospital!" An understanding of preschooler development leads the nurse to believe that this behavior is based on the fact that the child:
thinks that being sick is related to bad thoughts about the brother
While reviewing the admission assessment the nurse finds that a 2-year-old child has not received immunization for measles, mumps, and rubella (MMR). At what age should the child have received this vaccine?
12 months
A 4-year-old child is brought to the emergency department after falling on the handlebars of a tricycle. The child is guarding the abdomen, crying, and not allowing any physical contact with the staff. What is the best action by the nurse?
Allowing the child to guide the examiner's hand to the area that hurts
What is the priority nursing care in the immediate postoperative period for a toddler with a newly applied hip spica cast?
Checking the toddler's peripheral circulation. Priority nursing care for any cast application includes checking the color and temperature of the area surrounding the cast to ensure that the cast is not too tight. A tight cast compresses arteries and veins, thereby impairing circulation.
A 13-month-old toddler has a respiratory tract infection with a low-grade fever. When teaching the parents, which intervention should the nurse emphasize?
Giving small amounts of clear liquids frequently to prevent dehydration
While in the playroom of a pediatric unit the nurse sees several toddlers seated at a table trying to copy the same picture from a book. They are not talking to each other or sharing their crayons. What does the nurse conclude about this behavioral interaction?
It is a typical expression of toddlers' social development
Which statement is accurate regarding the typical growth and development of preschoolers?
Preschoolers believe they are the center of the world.
