CH 16 ?'s peds
Which is the priority nursing action when performing a physical assessment on a toddler? 1. Leaving intrusive procedures such as eye and ear examinations until the end 2. Explaining each part of the examination to the child before performing it 3. Performing the assessment from head to toe 4. Asking the mother to tell the child not to be afraid
1 Intrusive procedures such as examinations of the eyes, ears, throat, and genitals should be done last to decrease the anxiety of the child during the initial phases of the examination, which include heart and lungs.
The nurse is preparing to administer an intramuscular injection to a toddler-age client. Which is the most appropriate statement by the nurse prior to this procedure? 1. "It is all right to cry. After we are done, you can go to the box and pick out your favorite sticker." 2. "We will give you your shot when your mommy comes back." 3. "I will wipe your skin with a magic wipe and then hold the needle like this and say 'one, two, three, go' and give you your shot. Are you ready?" 4. "This is a magic sword that will give you your medicine and make you all better."
1 Explanation: The most appropriate response would be to acknowledge the child's feelings and allow the child to pick out a sticker at the conclusion of the injection.
The parents of a toddler are concerned that their child seems different from their other child, stating, "He just doesn't seem to like new people and wants us with him in these situations." Which response by the nurse is appropriate when using the temperament theory to respond to the toddler's parents? 1. "Your child seems to withdraw from new situations. This is typical with slow-to-warm-up children." 2. "Your child is having an intense reaction to the environment and new people and we will need to investigate this more closely." 3. "Difficult children often display a negative mood. Does your child often throw temper tantrums?" 4. "Slow-to-warm-up children are often diagnosed with autism spectrum disorder."
1 Explanation: Slow-to-warm-up children adapt slowly to new situations and initially will withdraw.
Which interventions will the nurse recommend for a toddler-age client who is biting other children at daycare? Select all that apply. 1. Using a time-out as a form of discipline for the child's behavior 2. Separating the child from the situation 3. Telling the child it is not okay to hurt another person 4. Inquiring whether the child is getting enough sleep 5. Implementing distraction to avert the behavior
1, 2, 3, 4 A time-out is an appropriate intervention for the nurse to suggest when a toddler-age child is exhibiting behaviors that include other people, such as biting. Separation of the child from the situation is an appropriate intervention for the nurse to suggest when a toddler-age child is exhibiting behaviors that include other people, such as biting. It is appropriate to encourage the parents to tell the child that the behavior is unacceptable when the child is exhibiting behaviors that include other people, such as biting. When a child is exhibiting behaviors that include other people, such as biting, it is appropriate to assess the amount of sleep the child is getting each night. Lack of sleep is a common cause for behaviors such as biting.
Which nursing actions are appropriate when conducting a mental health assessment for a toddler-age child? Select all that apply. 1. Observing the child's interaction with family members 2. Asking the caregiver to describe the child's typical day 3. Giving the child a crayon to assess ability to use 4. Determining the number of hours the child sleeps each night 5. Inquiring about recent exposure to communicable diseases
1, 2, 3, 4 When conducing a mental health assessment for a toddler-age child it is appropriate for the nurse to observe the child's interaction with family members. When conducting a mental health assessment for a toddler-age child it is appropriate for the nurse to ask the caregiver to describe the child's typical day. When conducting a mental health assessment for a toddler-age child it is appropriate to determine whether the child is mastering age-appropriate skills, such as the use of a crayon for a toddler-age child. When conducting a mental health assessment for a toddler-age child it is appropriate to inquire about the number of hours of sleep the child gets each night.
Which will the nurse assess in the family of a 3-year-old child during a pediatric clinic visit scheduled due to regressive behavior? Select all that apply. 1. Change in parental marital status 2. Level of education for each parent 3. Health of child's siblings 4. Maternal depression 5. Child's exposure to communicable diseases
1,3,4 Changes that occur with the family members of a 3-year-old child could be the source of the regressive behavior being exhibited. It is appropriate for the nurse to assess for a change in parental marital status. A change in the health of the child's siblings could cause regressive behavior. This is appropriate for the nurse to include in the family assessment. Maternal depression can be associated with poor self-concept and could be a reason for regressive behavior. This is appropriate for the nurse to include in the family assessment.
The mother of a 2-year-old child becomes very anxious when the child has a temper tantrum in the medical office. Which response by the nurse to the mother is appropriate? 1. "Let's ignore this behavior. It will stop sooner." 2. "What do you usually do or say during a temper tantrum?" 3. "This is definitely a temper tantrum. I know exactly what you are feeling right now." 4. "Pick up and cuddle your child now, please."
2 Asking the mother to describe her usual behavior via an open-ended question will encourage the mother to talk about home management and will lead the nurse to assist the mother in making a plan of care for temper tantrums.
The home health nurse is conducting a home visit for a family. The toddler-age child, who is potty training, has an "accident." The mother becomes angry with the child and calls him a baby for messing himself. Which is the nurse concerned with regarding the toddler's development, based on the mother's reaction? 1. The child's cognitive development 2. The child's sense of independence 3. The child's conscience 4. The child's superego
2 Erikson's toddler stage is autonomy (independence) versus shame and doubt. The mother's criticism may hinder the child's sense of independence.
Which nursing actions are developmentally appropriate when providing care to a hospitalized toddler-age child? Select all that apply. 1. Using a crib mobile for distraction during a procedure 2. Having a potty-chair available 3. Allowing self-feeding opportunities 4. Showing equipment that will be used during the scheduled surgery 5. Assessing drawings to determine concerns
2, 3 Many toddlers are potty training; therefore, it is appropriate for the nurse to have a potty-chair available for the child. It is appropriate for the nurse to allow for self-feeding opportunities as this is developmentally appropriate for a toddler-age child.
The parents of a 2.5-year-old boy are concerned about their child's finicky eating habits. While counseling the parents, which statements by the nurse would be accurate? Select all that apply. 1. "Nutritious foods should be made available at all times of the day so that the child is able to 'graze' whenever he is hungry." 2. "The child is experiencing physiologic anorexia, which is normal for this age group." 3. "A general guideline for food quantity at a meal is one quarter cup of each food per year of age." 4. "It is more appropriate to assess a toddler's nutritional demands over a 1-week period rather than a 24-hour one." 5. "The toddler should drink 16 to 24 ounces of milk daily."
2, 4, 5 Physiologic anorexia is caused when the extremely high metabolic demands of infancy slow to keep pace with the slower growth of toddlerhood, and it is a very normal finding at this age. It is not unusual for toddlers to have food jags where they only want one or two food items for that day. So it is more helpful to look at what their intake has been over a week instead of a day. Two to three cups of milk per day are sufficient for a toddler; more than that can decrease his desire for other foods and lead to dietary deficiencies. Children should sit at the table while eating to encourage socialization skills.
The parents of a 2-year-old girl inquire about information to help their child transition to bed each night. Which response by the nurse is appropriate? 1. Let the child cry self to sleep a few nights to adjust to the transition. 2. Play a favorite video at bedtime on a television in the child's room to enhance relaxation. 3. Read a book to the child just before bedtime each night. 4. Let the child fall asleep while playing and then put the child in bed
3 Developing a quiet routine just before bedtime can help calm the child and give an expectation to what will happen next: going to bed.
Two 3-year-old clients are playing together in a hospital playroom. One is working on a puzzle, while the other is stacking blocks. Which type of play are these children participating in based on this scenario? 1. Cooperative play 2. Solitary play 3. Parallel play 4. Associative play
3 Explanation: Parallel play is when two or more children play together, each engaging in his or her own activities.
Which action by the nurse is appropriate when teaching the parents of a 2-year-old child during a scheduled health maintenance visit? 1. Encouraging the parents to allow the child to pour liquids using a pitcher 2. Being sure that all major foods group have been introduced to the child 3. Teaching the parents that it is appropriate to switch from whole to 2% milk 4. Educating the child about food groups
3 The nurse will teach the parents that it is appropriate to switch from whole to 2% milk during the 2-year-old's health maintenance visit.
Which assessment finding for a toddler-age child indicates an increased risk for an unhealthy self-concept? 1. A parent who praises the child for his or her accomplishments 2. A parent who is attempting potty training but who understands that accidents will happen 3. A parent who is observed spanking a child for taking a toy from another child in the waiting room 4. A parent who reads a book to the toddler-age child each night before bed to encourage cooperation
3 Physical discipline is a risk factor for the toddler to develop an unhealthy self-concept.
Which immunization will the nurse provide parental education during the health maintenance visit for a 4-year-old child? 1. Hepatitis B #3 2. Haemophilus influenzae type B #2 3. Inactive poliovirus #3 4. Measles, mumps, and rubella #1
3 The third inactive poliovirus vaccine is often administered between 4 and 6 years of age. The nurse would provide parental education during the health maintenance visit.
During a well-child visit with a 4-year-old girl the nurse notes that the parents speaks harshly to the child and used negative remarks when speaking with the nurse. Which statement by the nurse would be beneficial in this situation? 1. "Perhaps you should leave the room so that I can speak with your child privately." 2. "I am going to refer you for counseling since your interactions with your child seem so negative." 3. Addressing the child, the nurse says, "Are you unhappy when mommy talks to you like this?" 4. "Let's talk privately. We should discuss the way you speak with your child and possible ways to be more positive."
4 The best approach to this encounter would be for the nurse to discuss concerns with the parent privately, since the nurse wants to help the parent develop a good relationship with the child. The child should not be a part of this conversation.
Which strategy by the nurse is best when communicating with a 3 year old? a. Avoid telling the toddler about the hernia repair procedure too far in advance. b. Talk and sing frequently during care. c. Make sure to speak in a high-pitched voice to ensure the toddler pays attention. d. Teach the toddler to count backwards from 10 in order to relax before the procedure.
A Feedback: Avoid telling toddlers about procedures too far in advance. They do not have an understanding of time and can become quite anxious. Talking and singing during care and speaking in a high-pitched voice are strategies to communicate with infants. Counting to manage difficult situations is a strategy of communication used with school-aged children.
A parent is concerned that his 4-year-old will eat only Cheerios and chicken nuggets. What is the best anticipatory guidance that the nurse can offer this parent? a. Offer chicken nuggets and Cheerios with other foods at mealtimes. b. Make the child sit at the table until she eats all her food. c. Give the child the desired food between mealtimes. d. Encourage the child to drink at least 24 ounces of juice a day.
A Feedback: If chicken nuggets and Cheerios are offered with other foods at mealtimes, this will foster and establish good eating patterns. The child needs to learn to eat when food is provided. Preschool-age children should not consume more than 12 ounces of juice daily. Children should not be forced to sit at the table until they eat all of their food. This serves as a type of punishment and does not foster good eating habits.
The nurse is preparing a 4 year old for surgery. Which technique is most appropriate? a.allow the child to handle safe medical equipment b.limit the teaching to one 1 hour session c.explain to the child that she will be put to sleep for the procedure d.use an anatomically correct doll to explain the procedure
A Feedback: The preschool-age child learns well by participating in therapeutic play, such as handling safe medical equipment. The child might misinterpret terms such as "put to sleep." Anatomically correct dolls are not appropriate for preschool-age children. The preschool-age child benefits from several short teaching sessions.
The parent of a 2-year-old reports that the child drinks six 8-ounce cups of milk per day and eats very little solid food. Based on this information, for what should the nurse further assess in this child? a. Iron deficiency anemia b. Obesity c. Failure to thrive d. Rickets
A Feedback: Toddlers should not drink more than 16-24 ounces of milk per day; drinking more keeps them from being hungry for foods and limits the amount of nutrients they receive. Milk does not contain iron; therefore, when the diet consists primarily of milk, the child is at high risk for iron deficiency anemia. The child likely is gaining weight. There is no indication of failure to thrive. Rickets are a problem in children with severe vitamin D deficiency. Based on the information given, obesity is not a concern. Further data would be needed to suspect that the child will become obese.
When assessing the food choices of a 4-year-old boy, the nurse learns that the child loves certain foods and has a normal weight and BMI. Which responses by the parent would indicate a need for nutritional teaching? Select all that apply. Hint: Nutrition a. "I give him all the milk he wants because he is a picky eater." b. "He won't eat all vegetables, but he will eat carrots and celery for a snack." c. "I give him an extra dessert most days when he is being good." d. "We have fun preparing foods together when I get home from work." e. "I let him eat as much cheese and yogurt as he wants because it's healthy."
A. "I give him all the milk he wants because he is a picky eater."; C. "I give him an extra dessert most days when he is being good."; E. "I let him eat as much cheese and yogurt as he wants because it's healthy." Feedback: The nurse should encourage the inclusion of the child in snack selection and preparation and teach the parents how to teach the child about food groups and the importance of nutrition for the body. Intake should be altered only as appropriate and never in excess. Dairy products should be low- or reduced-fat.
The most fatal type of burn in the toddler age-group is a. Flame burn from playing with matches b. Scald burn from high-temperature tap water c. Hot object burn from cigarettes or irons d. Electric burn from electrical outlets
ANS: A Feedback A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group. B These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. C These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. D These are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use.
Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-and-pull toy b. Nesting blocks c. A bicycle with training wheels d. A computer
ANS: A Feedback A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers. B Nesting blocks are more appropriate for a 12- to 15-month-old child. C A bicycle with training wheels is appropriate for a preschool or young school-age child. D A computer can be appropriate as early as the preschool years.
The parent of 16-month-old Chris asks, "What is the best way to keep Chris from getting into our medicines at home?" The nurse should advise that a. "All medicines should be locked away securely." b. "The medicines should be placed in high cabinets." c. "Chris just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."
ANS: A Feedback A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. B Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. C Toddlers are not able to generalize as dangerous all of the different forms of medications that may be available in the home. D This is not feasible. Many parents require medications for chronic illnesses. Parents must be taught safe storage for their home and when they visit other homes
A disturbance in the flow and time patterning of speech is known as ____________. A. stuttering B. pause C. pronunce D. articulate
ANS: A stuttering During the preschool years, children often have experiences they want to share but had difficulty putting the words together. Children at this stage commonly repeat whole words or phrases and interject "um" into their speech. This may be more frequent during times of excitement or when formulating long and complex sentences. Parents can help their child by focusing on the idea that the child is expressing not on how the child is speaking. Parents should not complete the child's sentences or draw attention to the child's speech.
Which play patterns does a 3-year-old child typically display? Select all that apply. a. Imaginary play b. Parallel play c. Cooperative play d. Structured play e. Associative play
ANS: A, B, C, E Feedback Correct Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years. Incorrect Structured play is typical of school-age children.
The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? Select all that apply. a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur.
ANS: A, B, D, E Feedback Correct Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap before fatigue or a snack if mealtime is delayed will be helpful in alleviating the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. Incorrect The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior.
Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she teach? Select all that apply. a. Secure in a rear-facing, upright car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should fit snugly. d. Place the car safety seat in the front passenger seat equipped with an airbag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.
ANS: A, C, E Feedback Correct Toddlers should be secured in a rear-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit. Incorrect The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an airbag.
The nurse is teaching parents of a toddler about language development. Which statement best identifies the characteristics of language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.
ANS: B Feedback A Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language). C By 2 years of age, 60% to 70% of the toddler's speech is understandable. D The toddler's vocabulary contains approximately 300 or more words.
Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning.
ANS: B Feedback A Bowel training precedes bladder training. B Voluntary control of the anal and urethral sphincters is achieved some time after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing himself or herself by letting go. C Watching older siblings provides role modeling and facilitates imitation for the toddler. D The child should be introduced to the potty chair or toilet in a nonthreatening manner.
Which statement, made by a 4-year-old child's father, is true about the care of the preschooler's teeth? a. "Because the 'baby teeth' are not permanent, they are not important to the child." b. "My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth." c. "My son's 'permanent teeth' will begin to come in at 4 to 5 years of age." d. "Fluoride supplements can be discontinued when my son's 'permanent teeth' erupt."
ANS: B Feedback A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. C Secondary teeth erupt at approximately 6 years of age. D If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.
Which statement by a mother of a toddler indicates a correct understanding of the use of discipline? a. "I always include explanations and morals when I am disciplining my toddler." b. "I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving." c. "I believe that discipline should be done by only one family member." d. "My rule of thumb is no more than one spanking a day."
ANS: B Feedback A The toddler's cognitive level of development precludes the use of explanations and morals as a part of discipline. B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. C Discipline for the toddler should be immediate; therefore the family member caring for the child should provide discipline to the toddler when it is necessary. D Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. In addition, spanking is an inappropriate method of disciplining a child.
The mother of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the mother is a. "It is important for your toddler to eat three meals a day and nothing in between." b. "It is not unusual for toddlers to eat less." c. "Be sure to increase your child's milk consumption, which will improve nutrition." d. "Giving your child a multivitamin supplement daily will increase your toddler's appetite."
ANS: B Feedback A Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. B Physiologically, growth slows and appetite decreases during the toddler period. C Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. D Supplemental vitamins are important for all children, but they do not increase appetite.
A mother asks when toilet training is most appropriately initiated. What is the nurse's best response? a. "When your child is 12 to 18 months of age." b. "When your child exhibits signs of physical and psychological readiness." c. "When your child has been walking for 9 months." d. "When your child is able to sit on the 'potty' for 10 to 15 minutes."
ANS: B Feedback A Toilet training is not arbitrarily started at 12 to 18 months of age. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. The average toddler is not ready until 18 to 24 months of age. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents. B Neurologic development is completed at approximately 18 months of age. Parents need to know that both physical and psychological readiness are necessary for toilet training to be successful. C One of the physical signs of readiness for toilet training is that the child has been walking for 1 year. D The ability to sit on the "potty" for 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.
A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? Select all that apply. a. Concrete thinking b. Egocentrism c. Animism d. Magical thought e. Ability to reason
ANS: B, C, D Feedback Correct The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thought (believes that thinking something causes that event). Incorrect Concrete thinking is seen in school-age children, and ability to reason is seen with adolescents.
The prevalence of obesity in the United States has risen dramatically in both adults and children. The increase in the number of overweight children is addressed in Healthy People 2020. Strategies designed to approach this issue include (select all that apply) a. Decreased calcium and iron intake b. Increased fiber and whole grain intake c. Decreased use of sugar and sodium d. Increase fruit and vegetable intake e. Decrease the use of solid fats
ANS: B, C, D, E Feedback Correct Along with these recommendations, children at risk for being overweight should be screened beginning at age 2 years. Children with a family history of dyslipidemia or early cardiovascular disease development, children whose body mass index percentile exceeds the definition for overweight, and children who have high blood pressure should have a fasting lipid screen. Incorrect The nurse should instruct parents that calcium and iron intake should be increased as part of this strategy.
What is the primary purpose of a transitional object? a. It helps the parents deal with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.
ANS: C Feedback A Decreased parental guilt (distress) is an indirect benefit of a transitional object. B A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. D A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.
In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor in preparing a child for kindergarten entry? a. The child's ability to sit still b. The child's sense of learned helplessness c. The parent's interactions and responsiveness to the child d. Attending a preschool program
ANS: C Feedback A The child's ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. B Learned helplessness is the result of a child feeling that he or she has no effect on the environment and that his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning. C Interactions between the parent and child are an important factor in the development of academic competence. Parental encouragement and support maximize a child's potential. D Preschool and daycare programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.
Which comments indicate that the mother of a toddler needs further teaching about dental care? a. "We use well water so I give my toddler fluoride supplements." b. "My toddler brushes his teeth with my help." c. "My child will not need a dental checkup until his permanent teeth come in." d. "I use a small nylon bristle brush for my toddler's teeth."
ANS: C Feedback A Toddlers need fluoride supplements when they use a water supply that is not fluorinated. B Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child. C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. D A small nylon bristle brush works best for cleaning toddlers' teeth.
A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is a. A sign the child is spoiled b. A way to exert unhealthy control c. Regression, common at this age d. Ritualism, common at this age
ANS: D Feedback The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container.
The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What should the nurse recommend? a. Use fluoridated mouth rinses in children older than 1 year. b. Brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate. c. Give fluoride supplements to breastfed infants beginning at age 1 month. d. Determine whether water supply is fluoridated.
ANS: D Feedback The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount.
What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Communicate with the child's daytime caretaker about eliminating the afternoon nap. d. Use a nightlight in the child's room.
ANS: D Feedback A A dark, quiet room may be scary to a preschooler. B High-carbohydrate snacks increase energy and do not promote relaxation. C Most 2-year-olds take one nap each day. Many give up the habit by age 3 years. Insufficient rest during the day can lead to irritability and difficulty sleeping at night. D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Nightlights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room.
Which assessment finding in a preschooler suggests the need for further investigation? a. The child is able to dress independently. b. The child rides a tricycle. c. The child has an imaginary friend. d. The child has a 2-lb weight gain in 12 months.
ANS: D Feedback A A preschool child should be able to dress independently. B A preschool child should be able to ride a tricycle. C Imaginary friends are common for preschoolers. D Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated
Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment
ANS: D Feedback A Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age. C Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment. D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment.
What do parents of preschool children need to understand about discipline? a. Both parents and the child should agree on the method of discipline. b. Discipline should involve some physical restriction. c. The method of discipline should be consistent with the discipline methods of the child's peers. d. Discipline should include positive reinforcement of desired behaviors.
ANS: D Feedback A Discipline does not need to be agreed on by the child. Preschoolers feel secure with limits and appropriate, consistent discipline. Both parents should be in agreement so that the discipline is consistently applied. B Discipline does not necessarily need to include physical restriction. C Discipline does not need to be consistent with that of the child's peers. D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors.
A parent asks the nurse about negativism in toddlers. The most appropriate recommendation is to a. Punish the child b. Provide more attention c. Ask the child to not always say "no" d. Reduce the opportunities for a "no" answer
ANS: D Feedback A Negativism is not an indication of stubbornness or insolence and should not be punished. B The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. C The toddler is too young for this approach. D The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism.
The parents of a newborn say that their toddler "hates the baby...he suggested that we put him in the trash can so the trash truck could take him away." The nurse's best reply is a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."
ANS: D Feedback A The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. B This is a normal response. The toddler can be provided with a doll to care for and tend to the doll's needs at the same time the parent is performing similar care for the newborn. C The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler.
A 17-month-old child is expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Sensorimotor period
ANS: D Feedback A Trust is Erikson's first stage. B Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. C Secondary circular reactions last from approximately ages 4 to 8 months. D The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. Learning in this stage occurs mainly by trial and error.
Parents are often concerned about their toddler's interest in and curiosity about gender differences. Sex play and masturbation are common among toddlers. Is this statement true or false?
ANS: T Nurses can reassure parents that self-exploration and exploration of another toddler's body is normal behavior during early childhood. Parents should respect the child's curiosity as normal and not judge them as being "bad."
A 4 year old has been toilet-trained becomes incontinent when hospitalized for surgery. What is the most appropriate nursing diagnosis based on this assessment finding? a. growth and development, altered r/t incontinence b. ineffective individual coping r/t hospitalization c.urinary elimination, altered r/t incontinence d.Coping, defensive r/t stress of hospitalization
D Feedback: A toilet-trained 4-year-old who becomes incontinent during hospitalization is coping with the stress of this experience through the defense mechanism of regression. This is an effective means of coping for a child this age.
Which toy is most age-appropriate for a 2 year old? a.mobile b.toy vacuum c.nesting cups d.playhouse
B Feedback: A 2-year-old benefits from having push-pull toys that encourage movement and autonomy. Nesting cups are appropriate for older infants. Mobiles are appropriate for young infants. Playhouses are appropriate for preschool-age children. Nursing Process: Planning
Which observation is most representative of the type of play usually seen in toddlers? a.the child who dresses up like a fireman b.two children sitting side by side, each playing with a toy truck c.two children putting a puzzle together d.a child who sits on the floor by himself playing with blocks
B Feedback: Two children sitting side by side playing with similar toys are an example of parallel play, which dominates in toddlers. The child who sits on the floor by himself playing with blocks is demonstrating solitary play, seen in infants. The child who dresses up like a firefighter is demonstrating dramatic play, seen in preschool-age children. Two children putting a puzzle together are demonstrating associative play, also characteristic of preschool-age children.
At a 2-year-old's checkup, measurement of weight indicates that the infant has lost 4 pounds since his last checkup. What should the nurse do first? a. Plot the weight on a growth chart. b. Assess the child for signs of malnutrition. c. Reweigh the child. d. Ask the mother about the child's daily intake.`
C Feedback: The nurse should reweigh the child first to make sure the weight is accurate. Two-year-olds frequently move around when being weighed, so it is most important that the initial action is to verify the results. After verifying the results, the nurse can plot the weight on a growth chart and a full history and physical, including nutritional assessment, can be obtained.
A 2-year-old has been biting other children at daycare. Which response by the nurse to the parent is appropriate? Hint: Mental and Spiritual Health a. "Encourage the daycare staff to separate the child immediately from the situation and use time-out." b. "Ask the daycare staff to call you, then go bite your child, so she understands it hurts." c. "Switch daycares; it's obvious there are problems there with the staff." d. "Tell the child she will be spanked if it happens again and follow through with it."
a. "Encourage the daycare staff to separate the child immediately from the situation and use time-out." Feedback: Since the child is in a daycare, the parents should collaborate with the daycare staff and tell them to separate the child immediately from the situation and use a time-out. The parent should not bite the child, switch daycare, or threaten the child with spanking.
During an assessment of the neck of a 2-year-old child, the nurse notes firm, nontender, movable lymph nodes 1 cm in diameter in the cervical chain. How should the nurse explain this finding to the parents? a. As a normal finding in a child this age b. As abnormal and probably related to a minor viral URI c. As abnormal and indicative of illness requiring antibiotic treatment d. As abnormal and potentially indicative of a serious health problem
a. As a normal finding in a child this age Feedback: Firm, nontender, movable lymph nodes up to 1 cm in diameter are common in young children; therefore, this is a normal finding. Minor viral URIs may not cause lymph node enlargement. Lymph node enlargement does not indicate antibiotic treatment. Diffuse lymph node enlargement can sometimes be indicative of a serious health problem, such as leukemia; however, in a child this age, cervical lymph nodes and tonsillar lymph nodes in particular are often residually enlarged.
The parents of a 2-year-old work out of their home. During the day, they allow their child to watch television as they work. What are some suggestions the nurse can make for this child to promote health? Hint: Table 35-3: Risk and Protective Factors Regarding Physical Activity in Toddlerhood and Preschool a. Encourage the parents to limit television to no more than 2 hours daily. b. Teach the parents to engage the child in other screen activities. c. Suggest that the family plan play dates with another child the same age. d. Refer the child to a psychologist to discuss the child's inability to socialize.
a. Encourage the parents to limit television to no more than 2 hours daily. Feedback: Television and other screen activities should be limited to no more than 2 hours daily. A play date with another child the same age does not address the issue with the television. The child does not have an inability to socialize and does not need a psychologist
A 3-year-old presents to the emergency department with signs of respiratory distress. The child has epiglottitis associated with high fever, is apprehensive, and is drooling. What should the nurse avoid? a. Inspecting the child's mouth and throat with a tongue blade b. Weighing the child c. Listening to the child's lungs d. Assessing the child's vital signs
a. Inspecting the child's mouth and throat with a tongue blade Feedback: Insertion of a gloved finger or an instrument into the mouth (e.g., a tongue blade) might trigger complete airway obstruction. Although other aspects of the assessment can be deferred if doing them increases the child's anxiety and hence his respiratory distress, they would not trigger complete airway obstruction. It is important to obtain weight, if possible, so that an appropriate dose of antibiotic can be administered. Lung assessment and vital signs will give more data related to the child's condition and should be obtained if possible.
A nurse is assessing a 2-year-old boy with the following vital signs: temperature 97.8˚F axillary, apical pulse 100, respirations 28 breaths per minute, and blood pressure 125/80 mmHg. Which action by the nurse is the most appropriate based on these vital signs? a. Determining why the child has tachycardia b. Assessing for additional signs of respiratory distress in the child c. Reevaluating the child's temperature in 1 hour d. Reporting the blood pressure to the primary healthcare provider
d. Reporting the blood pressure to the primary healthcare provider Feedback: All of the vital signs listed are normal for a 2-year-old except for the blood pressure. This reading is greater than the 99th percentile for a 2-year-old and should be reported promptly to the primary healthcare provider.
The nurse is preparing to conduct a health history on a 3-year-old. When should the nurse collect a detailed birth history? a. When the nurse identifies a variation from normal in the physical exam b. When the chief complaint has been identified c. When the nurse is conducting the review of systems d. When the history of present illness might relate to birth history
d. When the history of present illness might relate to birth history Feedback: A detailed birth history should be collected when the child's current illness might be related to the birth history. Many variations from the norm are not related to the birth history. A review of systems provides a comprehensive overview of the child's current state of health from a system point of view. The chief complaint is related to the child's current problem and is not part of the history.
