PEDs Chapt 4 Growth and Development of the Toddler

When leaving a child who has separation anxiety, parents should say goodbye firmly, explain that they will return, and then leave promptly. a) True

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.

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

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

A nurse is assessing a 2 year old's language development. Which of the following would the nurse expect to assess? c) Use of a two-word noun-verb sentence

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.

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? c) Uses two-word sentences or phrases

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.

A mother expresses surprise to the nurse that her toddler daughter has begun masturbating. The most important initial nursing response is: b) This is a normal and expected activity best treated matter-of-factly.

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.

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? b) Learning to act on one's own

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.

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? c) "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate."

"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.

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 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? c) 3

3 Explanation: By the age of three, the child should know his or her own gender. The other age ranges are incorrect.

The toddler grows about how many inches in height per year? a) 3 inches

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).

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.

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 developmental task of the toddler period, according to Erikson, is achieving a sense of which of the following? b) Autonomy

Autonomy Correct Explanation: Achieving a sense of independence or autonomy is the toddler developmental task.

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? c) Ask the child questions as you read.

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 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? 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. *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.

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

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.

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

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? c) Reasoned with the child to stop the behavior

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.

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? b) Stands alone

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.

The nurse is examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development? c) The child does not use the names of familiar objects.

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 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.

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.

The best way for parents to aid a toddler in achieving his developmental task would be to a) allow him to make simple decisions.

allow him to make simple decisions. Correct Explanation: Making decisions is primary practice toward achieving independence.

The way you would advise a toddler's mother to handle temper tantrums would be to b) appear to ignore them.

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.

When childproofing the home for a toddler, the most important thing her parents should consider is to b) put medicine in a locked cupboard.

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 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

• 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 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? c) Risk for lead paint poisoning due to the age of the house

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 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."

"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.

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? 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

Which of the following is appropriate with reference to enhancing a child's self-esteem? c) Include the child in activities that interest the adult.

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.

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

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 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? b) Offering a variety of foods along with the foods the child likes

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