PEDs Chapt 4 Growth and Development of the Toddler
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? a) "Most children are ready for toilet training by the time they are 18 months old." b) "You'll probably notice that your daughter is uncomfortable in wet diapers." c) "Don't worry, your daughter will probably give you very definite signals." d) "Your daughter can understand holding urine and stool by about 1 year of age."
"You'll probably notice that your daughter is uncomfortable in wet diapers." Correct Explanation: The markers of readiness for toilet training are subtle, but, as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. Although the rectal and urethral sphincters are mature by the end of the first year, children are not cognitively and socially ready. In fact, many children do not understand what is being asked of them until they are 2 or even 3 years old.
The toddler grows about how many inches in height per year? a) 3 inches b) 5 inches c) 7 inches d) 1 inch
3 inches Correct Explanation: The toddler age range is one to three years of age. Each year the toddler grows about 3 inches (7.62 cm).
Which of the following is a true statement regarding developmental milestones of the 24-month-old? a) Anterior fontanel closes b) Triples birth weight c) At least 16 temporary teeth d) Head circumference equals chest circumference
At least 16 temporary teeth Correct Explanation: Developmental milestones of a 24-month-old include acquiring 16 temporary teeth. The 12-month-old should double his birth weight. The anterior fontanel closes at 18 to 24 months. Head circumference equals chest circumference at 12 months.
The developmental task of the toddler period, according to Erikson, is achieving a sense of which of the following? a) Initiative b) Autonomy c) Nonstructure d) Leadership
Autonomy Correct Explanation: Achieving a sense of independence or autonomy is the toddler developmental task.
A toddler's "no" can best be eliminated by asking a question instead of making a statement. a) False b) True
False Correct Explanation: A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. Making a statement instead of asking a question this way can avoid a great many negative responses.
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? a) Use unsweetened applesauce as a dessert. b) Include dark greens and spinach in her meals. c) Offer chocolate milk to increase milk intake. d) Give her slices of cheddar cheese as a snack.
Give her slices of cheddar cheese as a snack. Correct Explanation: Two and one-half ounces of cheddar cheese provides the toddler's daily requirement of 500 mg of calcium. Chocolate milk provides calcium but the sugar it contains should not be a regular part of a toddler diet. Applesauce provides fiber, not calcium. Spinach and dark greens do contain calcium, but that calcium has limited bioavailability.
The parents of a 2-year-old boy complain to the nurse because their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child? a) Assuring the parents that food jags are normal, and they can be honored safely b) Offering a variety of foods along with the foods the child likes c) Encouraging the parents to eat a variety of wholesome foods themselves d) Advising the parents to minimize distractions at mealtime
Offering a variety of foods along with the foods the child likes Correct Explanation: Toddlers require fewer calories proportionately than infants, and their appetite decreases (physiologic anorexia). Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods. Prolonged particular food preferences (food jags) are common. It is also important that mealtime be calm, pleasant, and focused on eating. Toddlers mimic behaviors observed. It is important that parents set a good example with their mealtime behaviors and food choices. All options encourage the development of healthy eating habits, but at this time, variety plus preferred foods will be most helpful
A mother expresses surprise to the nurse that her toddler daughter has begun masturbating. The most important initial nursing response is: a) Toilet teaching places much focus on the genitals. b) This is a normal and expected activity best treated matter-of-factly. c) Toddler girls as well as boys will masturbate. d) Check for undue stress in your toddler's life.
This is a normal and expected activity best treated matter-of-factly. Correct Explanation: Masturbation is a normal event to be done in private. Calling attention to the behavior may increase the frequency. Both girls and boys masturbate, and toilet teaching calls attention to the genital area. These two statements are accurate information but not the best first response. Excessive or public masturbation points to stress.
A toddler's father is concerned because his son refuses to share. What is your best response concerning this? a) This is normal toddler behavior; sharing is learned later. b) Play time with other children should be cut back until he learns to share. c) His son is probably reacting to some family crisis. d) Behavior modification techniques can change the child's behavior.
This is normal toddler behavior; sharing is learned later. Correct Explanation: Sharing is not usually learned until the preschool period; toddlers play parallel to each other.
When leaving a child who has separation anxiety, parents should say goodbye firmly, explain that they will return, and then leave promptly. a) True b) False
True Prolonged goodbyes only lead to more crying. Sneaking out prevents crying and may ease the parents' guilt, but it can strengthen fear of abandonment so should be discouraged.
A nurse is assessing a 2 year old's language development. Which of the following would the nurse expect to assess? a) Knowledge of full name b) Ability to name one color c) Use of a two-word noun-verb sentence d) Verbalization of 4 to 6 words
Use of a two-word noun-verb sentence Correct Explanation: A 2 year old should be able to say a two-word sentence that consists of a noun and verb. A 15 month old can say 4 to 6 words. A 30 month old knows full name and can name one color.
The way you would advise a toddler's mother to handle temper tantrums would be to a) distract him with a toy when he begins breath holding. b) appear to ignore them. c) mimic his behavior by also holding her breath. d) promise him a special activity if he will stop.
appear to ignore them. Correct Explanation: Rewarding temper tantrums can teach children that they are an effective method of interaction. Ignoring tantrums teaches that they are ineffective.
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? a) "It is normal for toddlers to lose their appetites; try weaning him all at once so that he will be more interested in the solid food." b) "It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition." c) "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." d) "It is not normal for toddlers to lose their appetites; spoon feed him yourself to make sure he gets proper nutrition."
"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." Correct Explanation: Because growth slows abruptly after the first year of life, a toddler's appetite is usually less than an infant's. Children who ate hungrily 2 months earlier now sit and play with their food. It is important to educate parents while the child is still an infant this decline in food intake will occur so they will not be concerned when it happens. Because the actual amount of food eaten daily varies from one child to another, teach parents to place a small amount of food on a plate and allow their child to eat it and ask for more rather than serve a large portion the child cannot finish. One tablespoonful of each food served is a good start. The nurse should recommend that the mother wean her son gradually to avoid confrontation, not all at once. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them.
In working with the toddler, which of the following statements would be most appropriate to say to the toddler to decrease the behavior known as negativism? a) "You love having the same food every day, do you want apples again with lunch?" b) "It is time for lunch, I am going to put your bib on." c) "Do you want help getting into your chair so we can have lunch?" d) "Are you getting hungry and ready for lunch?"
"It is time for lunch, I am going to put your bib on." Correct Explanation: Limiting the number of questions asked of the toddler and making a statement, rather than asking a question or giving a choice, is helpful in decreasing the number of negative responses from the child
The parents of a 3-year-old boy tell the nurse that they are having another baby in several months. They ask the nurse for suggestions to help their son adapt to the new baby. Which of the following would the nurse suggest? a) "Move the boy to a big boy bed to make him feel like the big brother." b) "Tell the child that your time needs to be spent with the new baby." c) "Be prepared to discipline the child if he does something to make the baby cry." d) "Let the child participate in caring for the new baby."
"Let the child participate in caring for the new baby." Correct Explanation: Young children who are involved in a newborn's care adapt better than those who are not and thus have fewer feelings of sibling rivalry. During this time, it is wise not to introduce any new developmental tasks such as toilet training, weaning from a nighttime bottle, or changing from a crib to a toddler bed. Encourage parents to spend extra alone time with the child to decrease sibling rivalry. If the child does something to make the new baby cry, the parents should investigate the reason behind the action and talk to the child about it, rather than discipline the 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? a) "Every night my child follows the same routine at bedtime." b) "My child has temper tantrums when we go to the store." c) "My child uses the potty chair and is dry all day long." d) "When my child falls down, he always wants me to pick him up."
"My child uses the potty chair and is dry all day long." Correct Explanation: Being toilet trained is an example of the toddler developing autonomy or independence.
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? a) "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." b) "Remind her that she is in a public place and ask her to respect those around her; reward her if she responds by calming herself." c) "When the child has a tantrum in a public place, warn her that she will be punished when she is back at home then follow through with the punishment." d) "Spanking is controversial but sometimes necessary, so use it if it works."
"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." Correct Explanation: Remaining calm is a must. It is not easy to handle a small child who drops to the floor screaming and kicking in rage in the middle of the supermarket or the sidewalk, nor are comments from onlookers at all helpful. The best a caregiver can do is pick up the out-of-control child as calmly as possible and carry him or her to a quiet, neutral place to regain self-control. Reasoning, scolding, or punishing during a tantrum is useless. Do not yield the point or give in to the child's whim. That would tell the child that to get whatever one wants, a person need only throw oneself on the floor and scream. The child would have to learn painfully later in life that people cannot be controlled in this manner. Spanking or other physical punishment usually does not work well because the child is merely taught that hitting or other physical violence is acceptable and a child who is spanked frequently becomes immune to it.
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? a) "Encourage your son to watch his older siblings use the toilet." b) "Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." c) "Each time you change his diaper, tell your son how important and fun it is to use the potty chair." d) "Get your son a potty chair and have him sit on it for a few minutes each day."
"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." Explanation: To be able to cooperate in toilet training, the child's anal and urethral sphincter muscles must have developed to the stage where the child can control them. Control of the anal sphincter usually develops first. The child also must be able to postpone the urge to defecate or urinate until reaching the toilet or potty and must be able to signal the need before the event. In addition, before toilet training can occur, the child must have a desire to please the caregiver by holding feces and urine rather than satisfying his/her own immediate need for gratification. This level of maturation seldom takes place before the age of 18-24 months.
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? a) "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.'" b) "Our 'time-out' chair is in the master bedroom so she can't see anyone else in the family." c) "We use the 'time-out' chair when our son gets tired but doesn't want to take a nap." d) "She is two years old now and I put her in 'time out' for five to 10 minutes when she misbehaves."
"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.'" Correct Explanation: A method for a child who is not cooperating or who is out of control is to send the child to a "time-out" chair. This should be a place where the child can be alone but observed without other distractions. The duration of the isolation should be limited—one minute per year of age is usually adequate. Caregivers should warn the child in advance of this possibility, but only one warning per event is necessary.
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? a) "The best time to start toilet training is as soon as the child begins walking." b) "It is best to wait a little longer, until she is 3; only then will she be socially developed enough to understand what you are asking her to do." c) "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." d) "She's well past the age to begin toilet training; most children are ready by age 1, when they have developed the needed nervous control."
"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." Correct Explanation: The markers of readiness are subtle, but as a rule children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers. Because physiologic development is cephalocaudal, the rectal and urethral sphincters are not mature enough for control in most children until at least the end of the first year, when tracts of the spinal cord are myelinated to the anal level. A good way for a parent to know a child's development has reached this point is to wait until the child can walk well independently. Toilet training need not start this early, however, because cognitively and socially, many children do not understand what is being asked of them until they are 2 or even 3 years old.
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? a) "You should plan some time for the secondary caregiver to focus on the toddler while the primary caregiver focuses on the infant." b) "It would be good to have a grandparent or another special adult in the child's life take the toddler on an errand or a special visit." c) "It would be helpful to move the toddler to a new bedroom with a "grown-up" bed." d) "You should plan some time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant."
"You should plan some time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant." Correct Explanation: The secondary caregiver can occasionally take over the care of the new baby while the mother or other primary caregiver devotes herself to the toddler. The primary caregiver might also plan special times with the toddler when the new infant is sleeping and the caregiver has no interruptions. This approach helps the toddler feel special. Moving the older child to a larger bed lets the toddler take pride in being "grown up" now, but it should be done some time before the new baby appears.
The nurse is talking with a group of caregivers of 3-year-old children. One of the parents asks what an appropriate amount of time would be to have the 3-year-old who is being uncooperative and is out of control to sit alone in a "time out" space? The nurse would suggest that an appropriate amount of time would be a) 15-20 minutes b) 10-12 minutes c) 25-30 minutes d) 2-3 minutes
2-3 minutes Correct Explanation: A useful method for dealing with a child who is not cooperating or who is out of control is to send the child to a "time out" space. This should be a place where the child can be alone but may be observed without other distractions. The duration of the isolation should be limited: 1 minute per year of age is usually adequate.
By which age should the child know his/her own gender? a) 4 b) 2 c) 3 d) 1
3 Explanation: By the age of three, the child should know his or her own gender. The other age ranges are incorrect.
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) A regular routine and rituals will provide stability and security. b) Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly. c) Aggressive behaviors such as hitting and biting are common in toddlers. d) A sense of control can be provided through offering limited choices.
A regular routine and rituals will provide stability and security. Correct Explanation: Toddlers benefit most from routines and rituals that help them anticipate events and teach and reinforce expected behaviors. Knowing that a child can move from calm to temper tantrum very quickly, understanding the benefit of limited choices, and realizing that hitting and biting are common behaviors in toddlerhood provide information but not a guiding concept.
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) The child was lethargic afterward. b) The event took place during a nap. c) The child became unconscious. d) A tantrum preceded the event.
A tantrum preceded the event. Correct Explanation: The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells.
The nurse is 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? a) Read a different book if he knows the story. b) Keep story time a reward for being good. c) Ask the child questions as you read. d) Have the child sit still during the story.
Ask the child questions as you read. Correct Explanation: Engage the child by asking him questions as he listens. This gives him a chance to contribute to the story. The child does not have to sit still. He may want to move around or even act out part of the story. Story time should happen regularly and not be just a reward. Even if the child can tell the story, he may wish to hear it read again because he enjoys the repetition and familiarity.
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. a) The environment has changed since the grandparents moved in with the family. b) Biological factors such as otitis media could be causing hearing loss. c) The parent has decreased the usual sensory stimulation for the child. d) This behavior is common in children when autism is developing.
Biological factors such as otitis media could be causing hearing loss. Explanation: A primary influence on impaired auditory expressive language development is the occurrence of hearing loss. Hearing loss can be acquired or congenital. Approximately 2.2 million children are diagnosed annually with episodes of otitis media with effusion. Delays in speech development and loss of vocalizations are indicators hearing loss may be occurring. Evaluation of hearing is essential since the critical period for speech is within the first two years.
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? a) Children are playing apart from others without being part of a group b) Children are playing in an organized group with each other c) Children are playing together in an activity without organization d) Children are playing independently and are side by side
Children are playing independently and are side by side Correct Explanation: Parallel play occurs when the toddler plays alongside other children but not with them. During cooperative play children play in an organized group with each other as in team sports. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity.
Nursing students are reviewing developmental milestones for toddlers. They demonstrate understanding of these milestones when they put them in the proper sequence. Place the milestones in their proper sequence from earliest to latest. Name one body part Engage in parallel play Creep up stairs Name one color Run and jump in place
Creep up stairs Run and jump in place Name one body part Engage in parallel play Name one color Correct Explanation: A 15 month old can creep upstairs. An 18 month old can run and jump in place and name one body part. A 24 month old engages in parallel play; a 30 month old can name one color.
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? a) Deferred imitation b) Autonomy c) Parallel play d) Assimilation
Deferred imitation Correct Explanation: Children at this stage are able to remember an action and imitate it later (deferred imitation); they can do such things as pretend to drive a car or put a baby to sleep because they have not seen this just previously but at a past time. Toddlers engage in assimilation when they learn to change a situation (or how they perceive it) because they are not able to change their thoughts to fit the situation, such as shaking a toy hammer as if it were a rattle, because they are more familiar with rattles than hammers. All during the toddler period, children play beside children next to them, not with them. This side-by-side play (called parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Autonomy, or independence, is the primary developmental task of the toddler years, according to Erikson. Although this child's act may be a sign of autonomy, it is more specifically an act of 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? a) Excess fluid volume related to inability to control urination b) Total urinary incontinence related to delayed toilet training c) Ineffective coping related to lack of self-control of 2-year old d) Deficient parental knowledge related to inappropriate method for toilet training
Deficient parental knowledge related to inappropriate method for toilet training Correct Explanation: It is probable that a child toilet trained at 12 months was not truly trained; his mother was trained to remind him or place him on a toilet frequently during the day. When the child begins to play independently, the "training" is no longer effective.
The nurse is caring for a 16-month-old child on the pediatric unit. The child's mother is a single mother who has two other young children at home. She must leave her 16-month-old daughter overnight in the hospital. Which of the following actions by the nurse will be most appropriate in helping the child feel secure and in reassuring this mother? a) Tell both the mother and child that the child will be carefully guarded and won't be in as much danger as she might be if she were home exploring her environment b) Remind the child and mother that by staying in the hospital now the child will get well and be home again soon, and that the other children also need their mother c) Distract the child with a special blanket, stuffed animal, or other "lovey" from home while the mother quietly slips out d) Encourage the mother to give her daughter a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return such as "when breakfast comes in the morning."
Encourage the mother to give her daughter a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return such as "when breakfast comes in the morning." Correct Explanation: When the family caregiver must leave the toddler, it may be helpful for the adult to give the child some personal item to keep until the adult returns. The caregiver can tell the child he or she will return "when the cartoons come on TV" or "when your lunch comes." These are concrete times that the toddler will probably understand. The toddler is too young to understand that staying is important for her recovery. Distracting the child while the mother leaves may increase the child's anxiety when she realizes her mother is gone. Although the child will be watched closely in the hospital setting, toddlers explore their environment wherever they are
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? a) Exploring her body b) Playing on the picnic table c) Choosing her own foods d) Deciding her bedtime schedule
Exploring her body Correct Explanation: It is normal for toddlers to explore their genitals when they are undressed. The parent should allow this and not punish the child. Choosing food and deciding bedtimes need to be done by an adult. Likewise, safety dictates that the picnic table is not a safe play area.
Which of the following is appropriate with reference to enhancing a child's self-esteem? a) Avoid applauding for unsuccessful attempts. b) Utilize negative criticism as well as positive reinforcement. c) Include the child in activities that interest the adult. d) Utilize belittling techniques as opposed to time-outs.
Include the child in activities that interest the adult. Correct Explanation: Strategies for enhancing self-esteem encompass including the child in activities that interest the adult. Belittling techniques should not be used. Negative criticism should be avoided. Applauding for unsuccessful attempts as well as successes should be reinforced.
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? a) Learning to understand and respond to discipline b) Learning to act on one's own c) Learning to speak d) Learning to trust
Learning to act on one's own Correct Explanation: Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) while overcoming doubt and shame. Erikson's psychosocial developmental task for infants is to develop a sense of trust. Learning to speak and to understand and respond to discipline are not developmental tasks according to Erikson.
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? a) Throwing a baseball sized ball b) Sharing finger paints and painting with the caregiver c) Mowing the lawn with a toy lawnmower d) Looking at large print magazines
Mowing the lawn with a toy lawnmower Correct Explanation: Toddlers enjoy talking on a play telephone. They like pots, pans, and toys such as brooms, dishes, and lawnmowers that help them imitate the adults in their environment and promote socialization. Toys that involve the toddler's new gross motor skills, such as push-pull toys, rocking horses, large blocks, and balls, are popular. Fine motor skills are developed by use of thick crayons, modeling clay, finger paints, wooden puzzles with large pieces, toys with pieces that fit into shaped holes, and cloth books. The toddler will not be interested in sharing toys until the later stage of toddlerhood; adults should not make an issue of sharing at its early stage.
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? a) Watching a movie with other children their age b) Pretending to be mommies and daddies in the play house c) Playing with the plastic vaccum cleaner pushing it around the room d) Painting pictures in the art corner of the room
Playing with the plastic vaccum cleaner pushing it around the room Correct Explanation: Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.
A mother of a 3-year-old asks the nurse about what kinds of toys would be appropriate. The nurse would suggest which of the following? a) Pounding bench b) 100-piece jigsaw puzzles c) Bicycle with training wheels d) Memory games
Pounding bench Correct Explanation: The 3-year-old child should have a tricycle, large sturdy toys such as big blocks, active toys like a pounding bench, and musical toys that encourage rhythmic movement. The preschooler also likes show-and-tell, guessing games (because his or her memory is improving), and big-pieced jigsaw puzzles. For the 4-year-old, construction toys, jigsaw puzzles, memory games, and fantasy play are favorites.
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? a) Made sure the child was rested and not hungry before going to the mall b) Tried to refocus the child's attention as tantrum behavioral cues appeared c) Reasoned with the child to stop the behavior d) Remained relatively calm even though embarrassed
Reasoned with the child to stop the behavior Correct Explanation: The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place. The other actions are helpful in preventing a tantrum.
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? a) Risk for developing tetanus due to all of the construction going on b) Risk for ingestion of cleaning products they may have been left out due to the renovation c) Risk for lead paint poisoning due to the age of the house d) Risk for development of diabetes due to all of the high-calorie fast foods the family is consuming while their kitchen is under construction
Risk for lead paint poisoning due to the age of the house Correct Explanation: The best rationale for the nurse's intervention is the risk for lead paint poisoning due to the age of the house. All children between the ages of 6 months and 6 years who live in communities with buildings built before 1950 should be tested for the presence of too much lead in their body (lead poisoning). Elevated lead levels are caused by eating, chewing, or sucking on objects (such as windowsills, paint chips, or furniture) that are covered with lead-based paint. There is not enough evidence in the scenario to indicate that the child may be at risk for developing tetanus or that he has ingested cleaning products; in any case, the interventions for these would not include a blood test. There is no basis in the scenario for the suspicion of diabetes in the child.
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? a) Runs to her mother b) Stands alone c) Feeds herself with a spoon d) Points to her nose and mouth
Stands alone Explanation: At 15 months, toddlers have mastered standing and walking alone. The child has yet to develop the ability to feed herself with a spoon, point to her nose and mouth, or run to her mother.
Parents of 3-year-old son ask the nurse for suggestions on how to deal with their son's nightmares. Which of the following suggestions would be least effective? a) Try having him sleep with a nightlight on in his room. b) Search the room to show him that there aren't any monsters. c) Talk to him that night about the details of the dreams. d) Try reassuring him that it was a dream and not real.
Talk to him that night about the details of the dreams. Correct Explanation: When the child has an occasional nightmare, parents should reassure the child that it was just a dream and was not real. Giving lots of hugs and words of reassurance can be supportive. The child may want the parent to search the room to reassure that there are no monsters about. Advise parents to wait until the next morning to talk about the details of the dream, at which time the child should be calmer. The parent should try to determine if there was a specific event or stressor that may have triggered the nightmare. In addition, to decrease nightmares, parents should avoid having the child watch television in the hour before bedtime, avoid telling scary bedtime stories, let the child sleep with a nightlight, and examine how to decrease perceived stress in the child's life.
The nurse is examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development? a) The child puts together sentences of two words. b) The child does not speak clearly but shows understanding of what is said. c) The child does not use the names of familiar objects. d) The child repeats what the parents say out of context and at random moments.
The child does not use the names of familiar objects. Correct Explanation: By 24 months most children will name objects familiar to them in their daily lives. Not doing so is strong evidence that a speech delay may exist. Repeating words heard or phrases out of context (echolalia) is normal and a way to practice words and incorporate them in the vocabulary. At 2 years, most children understand much more than they can clearly repeat. Using two-word sentences is a developmental expectation at this age.
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? a) Total weight gain of 15 lb in the past year b) Increase in height of 5 inches in the past year c) Prominent abdomen d) Forward curve of the spine at the sacral area
Total weight gain of 15 lb in the past year Explanation: A child gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year during the toddler period, much less than the rate of growth during the infant year. Because the weight gain of the boy in this scenario is so much greater than normal, the nurse should be concerned that the boy is overweight or obese. All of the other findings listed are normal for a 2-year-old.
The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it. a) True b) False
True Correct Explanation: Probably the best approach is for parents to tell a child simply they disapprove of the tantrum and then ignore it. They might say, "I'll be in the bedroom. When you're done kicking, you come into the bedroom, too." Children who are left alone in a kitchen this way will usually not continue a tantrum but will stop after 1 or 2 minutes and rejoin their parents. Parents should then accept the child warmly and proceed as if the tantrum had not occurred. This same approach works well for nurses caring for hospitalized toddlers
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? a) Asks "why" often b) Half of speech understood by outsider c) Uses two-word sentences or phrases d) Talks about a past event
Uses two-word sentences or phrases Correct Explanation: A child nearly 3 years of age should speak in three to four word sentences. The other findings indicate normal expressive language for the age.
The best way for parents to aid a toddler in achieving his developmental task would be to a) allow him to make simple decisions. b) help him learn to count. c) give him small household chores to do. d) urge him to dress himself completely alone.
allow him to make simple decisions. Correct Explanation: Making decisions is primary practice toward achieving independence.
A toddler's parents want to begin toilet training him. As a rule, the best instruction you could give them is a) toilet training is a 12-month process. b) all children should be toilet trained by age 2 years. c) children can remain dry during the night before they can do so during the day. d) bowel training is easier than urine training.
bowel training is easier than urine training. Correct Explanation: Bowel training is often easier than urine training because the substance to be evacuated is so much more tangible.
A toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her to a) give him secondary, not primary, choices. b) ask no further questions of him. c) pretend she does not hear him. d) tell him never to say, "No" again.
give him secondary, not primary, choices. Correct Explanation: Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices encourages this without disrupting family life.
When childproofing the home for a toddler, the most important thing her parents should consider is to a) lock downstairs windows. b) put medicine in a locked cupboard. c) keep the child in a playpen while the parents cook. d) teach the child not to tease dogs.
put medicine in a locked cupboard. Correct Explanation: Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time.
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 a) seizures rarely occur in toddlers. b) seizures are not provoked; temper tantrums are. c) with seizures, cyanosis rarely develops. d) seizures typically occur with fever; temper tantrums do not.
seizures are not provoked; temper tantrums are. Correct Explanation: Temper tantrums occur because children are angry or frustrated; seizures occur without respect to provocation.
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. a) "Use timeout every other time she tells you no." b) "Offer her something she would like, such as ice cream, to distract her." c) "Limit the number of questions you ask of her." d) "Offer her two options from which to choose." e) "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." • "Make a statement instead of asking a question." Correct Explanation: A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. In addition, using statements instead of asking questions and keeping the child to a choice between two options are effective. Using timeout is a discipline measure and would be inappropriate to counteract a toddler's negativism. Offering a choice rather than a bribe such as ice cream is more effective and longer lasting for modifying the child's behavior.
A mother is concerned because her 2-year-old daughter is not speaking much. Which of the following should the nurse suggest to the mother? a) Always answer her questions b) Name aloud the objects that she is playing with c) Use baby talk when speaking to her d) Have her watch educational television e) Read books aloud to her f) Use pronouns when speaking to her
• Always answer her questions • Name aloud the objects that she is playing with • Read books aloud to her Correct Explanation: Reading aloud is an effective way to strengthen vocabulary. Also, urge parents to encourage language development by naming objects as they play with their child or when they give their toddler something. This helps children grasp the fact words are not meaningless sounds; they apply to people and objects and have uses. Always answering a child's questions is another good way to do this. Watching television promotes little learning as the activity is passive and it is difficult to discern how language caused the action. The American Academy of Pediatrics recommends television viewing should be severely limited until at least 2 years of age. Because children learn language from imitating what they hear, if they are spoken to in baby talk, their enunciation of words can be poor; if they hear examples of bad grammar, they will not use good grammar. Remind parents pronouns are difficult for children to use correctly; many children are 3½ or 4 years of age before they can separate the different uses of "I," "me," "him," and "her."
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? Select all that apply. a) Round foods such as hot dogs, whole grapes, and cherry tomatoes b) Sticky foods like peanut butter alone, gummy candies, and marshmallows c) Hard foods such as nuts, raw carrots, and popcorn d) Vegetables such as corn, green beans, and peas e) Fruits such as peaches, pears, and kiwi
• Round foods such as hot dogs, whole grapes, and cherry tomatoes • Sticky foods like peanut butter alone, gummy candies, and marshmallows • Hard foods such as nuts, raw carrots, and popcorn Correct Explanation: To offer soft round foods safely, cut hot dogs in uneven pieces and quarter grapes and cherry tomatoes. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits
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? Select all that apply. a) Keeping the child on the potty chair for as long as necessary b) Putting the child on the potty chair at regular intervals during the day c) Using training pants that slide down easily and quickly d) Allowing at least 6 weeks to prepare the child psychologically for the training e) Praising the child when he or she urinates or defecates
• 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 Explanation: For effective toilet training, parents should allow 1 to 2 weeks to psychologically prepare the child for training, using training pants that slide down easily and quickly, praising the child when he or she urinates or defecates, limiting the time spent on the potty chair to no longer than 10 minutes (or less if the child is resistant), and putting the child on the potty chair at regular intervals during the day.