Ch 4 - growth and development of the toddler

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) Reasoned with the child to stop the behavior b) Tried to refocus the child's attention as tantrum behavioral cues appeared c) Remained relatively calm even though embarrassed d) Made sure the child was rested and not hungry before going to the mall

Reasoned with the child to stop the behavior 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.

Which gross motor developmental milestone is least likely for a 2 year old? a) Stands on one foot with help b) Rides a tricycle c) Jumps in place d) Climbs

Rides a tricycle A gross motor developmental milestone for a 2- to 3-year-old includes jumping in place. Riding a tricycle occurs at 3 to 4 years of age. Climbing occurs at occurs at 18 months to 2 years. At 12 to 18 months, the child can stand on one foot with help.

The nurse is assessing the language development of a 3-year-old girl. Which finding would suggest a problem? a) Speaks in 2- to 3-word sentences b) Tells the nurse her name c) Tells the nurse she saw Na-Na today d) Makes simple conversation

Speaks in 2- to 3-word sentences If the child is still speaking telegraphically in only 2- to 3-word sentences, it suggests there is a language development problem. If the child makes simple conversation, tells about something that happened in the past, or tells the nurse her name she is meeting developmental milestones for language.

The nurse is assessing the development of a 15-month-old girl during a well-child visit. Which skill would the nurse expect to see? a) Stands alone b) Points to her nose and mouth c) Runs to her mother d) Feeds herself with a spoon

Stands alone 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 18-month-old has most likely attained which gross motor skill? a) The ability to balance on one foot. b) The ability to pedal a tricycle. c) The ability to walk up stairs alone. d) The ability to walk independently.

The ability to walk independently. The 18-month-old child can walk alone, but their gait may still be a little unsteady.

The 18-month-old has most likely attained which gross motor skill? a) The ability to walk independently. b) The ability to walk up stairs alone. c) The ability to pedal a tricycle. d) The ability to balance on one foot.

The ability to walk independently. The 18-month-old child can walk alone, but their gait may still be a little unsteady.

The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem? a) "He doesn't respond if I wave to him." b) "I dropped a pan behind him and he cried." c) "He wasn't bothered by the paint smell." d) "He was licking the dishwashing soap."

"He doesn't respond if I wave to him." The fact that the child does not respond when the mother waves to him suggests he may have a vision problem. The toddler's sense of smell is still developing, so he may not be affected by odors. Their sense of taste is not well developed either, and this allows him to eat or drink poisons without concern. The child's crying at a sudden noise assures the nurse that his hearing is adequate.

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? a) "I give my daughter juice at breakfast and when she is thirsty during the day." b) "New foods are offered along with ones she likes." c) "When she doesn't eat well at meals we give her nutritious snacks." d) "She drinks three 6-ounce cups of whole milk each day."

"I give my daughter juice at breakfast and when she is thirsty during the day." High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new.

By what age should the child know his/her own gender? a) 1 b) 2 c) 3 d) 4

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

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 not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition." b) "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." c) "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." 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." 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.

After teaching the mother of a 13-month boy old about suggestions for bathing and hygiene, the nurse determines that the teaching was successful when the mother states: a) "It might be best to give him a bath in the evening." b) "I'll drain the tub while he's still in it so he won't fall." c) "I'll wash his hair everyday with just plain soap." d) "I can use bubble baths to lure him into the tub."

"It might be best to give him a bath in the evening." The young child's increased activity level necessitates bathing daily or every other day. A good time to bathe the child is after eating, either after breakfast or in the evening. Hair is washed two to three times per week with a mild shampoo. Bubble baths should be avoided, to prevent urethral irritation and possible development of cystitis. Some children may have fears associated with bathing such as being afraid of being sucked down the plug hole. In this case, do not drain the tub until the child is out of the room.

A nurse is discussing safety measures with the parents of a toddler. What would the nurse emphasize to address the most frequent type of accident in toddlers? a) "Keep all cleaning products and drugs out of the reach of your child." b) "Have your child wear a helmet when beginning to ride a tricycle." c) "Turn the handles of your pots away from the edge of the stove when cooking." d) "Make sure to have your child securely fastened in a car seat."

"Keep all cleaning products and drugs out of the reach of your child." Although all the instructions are important, accidental ingestions (poisoning) are the most frequent accident in toddlers. Therefore, it is imperative to focus on keeping all poisonous substances, drugs, and small objects securely out of the reach of children. Burns, motor vehicle accidents, and falls such as from a tricycle occur frequently in toddlers, However, they occur less frequently than poisonings.

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. Which statement is the mostappropriate regarding dealing with the child who has a temper tantrum? a) "Spanking is controversial but sometimes necessary, so use it if it works." b) "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." c) "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." d) "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."

"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." 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 day care 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. What would be the most appropriate response for the nurse to give to this mother? a) "Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." b) "Encourage your son to watch his older siblings use the toilet." 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." 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.

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 suggestion would be most appropriate for the nurse to offer these parents? a) "It would be helpful to move the toddler to a new bedroom with a "grown-up" bed." 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) "You should plan some time for the secondary caregiver to focus on the toddler while the primary caregiver focuses on the infant." 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." 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.

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) "Don't worry, your daughter will probably give you very definite signals." b) "You'll probably notice that your daughter is uncomfortable in wet diapers." c) "Your daughter can understand holding urine and stool by about 1 year of age." d) "Most children are ready for toilet training by the time they are 18 months old."

"You'll probably notice that your daughter is uncomfortable in wet diapers." 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) 1 inch b) 3 inches c) 5 inches d) 7 inches

3 inches 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 statement best accomplishes this? a) A regular routine and rituals will provide stability and security. b) Aggressive behaviors such as hitting and biting are common in toddlers. c) Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly. d) A sense of control can be provided through offering limited choices.

A regular routine and rituals will provide stability and security. 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 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) Have the child sit still during the story. b) Keep story time a reward for being good. c) Read a different book if he knows the story. d) Ask the child questions as you read.

Ask the child questions as you read. 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 assessing a 2-year-old boy during a well child visit. The nurse correctly identifies the child's current stage of Erickson's growth and development as: a) Autonomy versus shame and doubt b) Industry versus inferiority c) Trust versus mistrust d) Initiative versus guilt

Autonomy versus shame and doubt The Erickson stage of development for the toddler is autonomy versus shame and doubt. During this period of time the child works to establish independence. Trust versus mistrust is the stage of infancy. Initiative versus guilt is the stage for the preschooler. Industry versus inferiority is the stage for school-aged children.

The parents of a 2-year-old girl are concerned with her behavior. For which behavior would the nurse share their concern? a) Frequently babbles to herself when playing b) Refuses to share toys with her sister c) Likes to change toys frequently d) Plays by herself even when other children are present

Frequently babbles to herself when playing The nurse would be concerned if the child is babbling to herself rather than using real words. By this age, she should be using simple sentences with a vocabulary of 50 words. Being unwilling to share toys, playing parallel with other children, and moving to different toys frequently are typical toddler behaviors.

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 action by the nurse will be most appropriate in helping the child feel secure and in reassuring this mother? a) Distract the child with a special blanket, stuffed animal, or other "lovey" from home while the mother quietly slips out. b) 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." c) 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. d) 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.

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." 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 situation will the nurse recommend letting the child do as she pleases? a) Playing on the picnic table b) Exploring her body c) Choosing her own foods d) Deciding her bedtime schedule

Exploring her body 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.

A toddler's "no" can best be eliminated by asking a question instead of making a statement. a) True b) False

False 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 is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem? a) Has persistent separation anxiety b) Sucks his thumb periodically c) Is unable to share toys with others d) Goes from calm to tantrum suddenly

Has persistent separation anxiety Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might an emotional problem. Emotional lability, self-soothing by thumb sucking, or the inability to share are common for this age.

According to Eric Erikson, the developmental task of the toddler is developing autonomy. What describes Erikson's psychosocial development task for the toddler? a) Learning to speak b) Learning to understand and respond to discipline c) Learning to trust d) Learning to act on one's own

Learning to act on one's own 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 a 2 ½-year-old 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. Which activity would the nurse recommend as the most appropriate activity for a 2 ½-year-old? a) Mowing the lawn with a toy lawnmower b) Throwing a baseball-sized ball c) Sharing finger paints and painting with the caregiver d) Looking at large print magazines

Mowing the lawn with a toy lawnmower 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 parents of a 2-year-old boy report 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) Advising the parents to minimize distractions at mealtime b) Encouraging the parents to eat a variety of wholesome foods themselves c) Assuring the parents that food jags are normal, and they can be honored safely d) Offering a variety of foods along with the foods the child likes

Offering a variety of foods along with the foods the child likes 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.

The nurse is recommending food items for an 18-month-old girl. Which ones will benefit the child's neurologic system most? a) Vegetable soup, whole wheat bread, and blueberries b) Ground beef, broccoli, and apple slices c) Peanut butter on crackers, cheese, and whole milk d) Oatmeal pancakes with bananas

Peanut butter on crackers, cheese, and whole milk At 18 months, the child's neurologic system is still developing rapidly and needs dietary fat for myelinization. Peanut butter on crackers, cheese, and whole milk all provide this. The other foods are appropriate for the toddler as part of a balanced diet.

A mother reports her 2-year-old daughter has gradually eaten more and more poorly since her 1-year-old well-child visit. The nurse assesses the child's growth and development as normal. What concept explains the mother's concern? a) Physiologic anorexia b) Improper snacking c) Iron-deficiency anemia d) Poor role modeling

Physiologic anorexia Physiologic anorexia results when the rapid growth of infancy slows in toddlerhood and less food is required for body size. Sugary and fatty snacks as well as role modeling poor eating habits can influence a toddler's food intake negatively. However, this is not what the mother is describing. Iron-deficiency anemia is extremely common among toddlers and could be present in this child, but this is not the reason for her lessened food intake.

The nurse is observing a play group of children of all ages. The toddlers in the group would most likely be doing which activity? a) Pretending to be mommies and daddies in the play house b) Painting pictures in the art corner of the room c) Watching a movie with other children their age d) Playing with the plastic vaccum cleaner pushing it around the room

Playing with the plastic vaccum cleaner pushing it around the room 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.

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 repeats what the parents say out of context and at random moments. b) The child puts together sentences of two words. c) The child does not use the names of familiar objects. d) The child does not speak clearly but shows understanding of what is said.

The child does not use the names of familiar objects. 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.

The nurse is assessing speech development in the 2-year-old whose family uses both Spanish and English in the home. What finding is of concern? a) The parents understand the child much of the time. b) Some words the toddler speaks are a blend of English and Spanish. c) The child mixes words from the two languages within a sentence. d) The toddler speaks 15 words between the two languages.

The toddler speaks 15 words between the two languages. Of concern is speaking only 15 words between Spanish and English. At 20 months, the bilingual child should use 20 words. The other findings fit the norms for a bilingual child.

A mother expresses surprise to the nurse that her toddler daughter has begun masturbating. The most important initial nursing response is that: a) There may be undue stress in your toddler's life. b) Toddler girls as well as boys will masturbate. c) Toilet teaching places much focus on the genitals. d) This is a normal and expected activity best treated matter-of-factly.

This is a normal and expected activity best treated matter-of-factly. 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 father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which finding should concern the nurse? a) Forward curve of the spine at the sacral area b) Total weight gain of 15 lb in the past year c) Increase in height of 5 inches in the past year d) Prominent abdomen

Total weight gain of 15 lb in the past year 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 nurse is observing a 36-month-old boy during a well-child visit. Which motor skill has he most recently acquired? a) Push a toy lawnmower b) Kick a ball c) Pull a toy while walking d) Undress himself

Undress himself This child has most recently acquired the ability to undress himself. Pushing a toy lawnmower and kicking a ball are things he learned at about 24 months. He was able to pull a toy while walking at about 18 months.

A nurse is assessing a 2-year-old's language development. What would the nurse expect to assess? a) Use of a two-word noun-verb sentence b) Knowledge of full name c) Ability to name one color d) Verbalization of 4 to 6 words

Use of a two-word noun-verb sentence 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 his 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? a) Half of speech understood by outsider b) Talks about a past event c) Asks "why" often d) Uses two-word sentences or phrases

Uses two-word sentences or phrases 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 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) pretend she does not hear him. b) tell him never to say, "No" again. c) give him secondary, not primary, choices. d) ask no further questions of him.

give him secondary, not primary, choices. Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices encourages this without disrupting family life.

When observing a group of toddlers playing in a child care setting, it is noted that the toddlers are all playing with buckets and shovels but are not playing with each other. This type of play is referred to as: a) solitary play. b) associative play. c) onlooker play. d) parallel play.

parallel play. The toddler's play moves from the solitary play of the infant to parallel play, in which the toddler plays alongside other children but not with them.

A nurse is presenting a class on toilet training to a group of parents with toddlers. Which information would the nurse include in the class? Select all that apply. a) Praising the child when he or she urinates or defecates b) Using training pants that slide down easily and quickly c) Putting the child on the potty chair at regular intervals during the day d) Keeping the child on the potty chair for as long as necessary e) Allowing at least 6 weeks to prepare the child psychologically for the training

• Putting the child on the potty chair at regular intervals during the day • Using training pants that slide down easily and quickly • Praising the child when he or she urinates or defecates 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

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) Hard foods such as nuts, raw carrots, and popcorn b) Vegetables such as corn, green beans, and peas c) Fruits such as peaches, pears, and kiwi d) Round foods such as hot dogs, whole grapes, and cherry tomatoes e) Sticky foods like peanut butter alone, gummy candies, and marshmallows

• Sticky foods like peanut butter alone, gummy candies, and marshmallows • Hard foods such as nuts, raw carrots, and popcorn • Round foods such as hot dogs, whole grapes, and cherry tomatoes 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

Which action is appropriate to enhance a child's self-esteem? a) Utilize belittling techniques as opposed to time-outs. b) Include the child in activities that interest the adult. c) Avoid applauding for unsuccessful attempts. d) Utilize negative criticism as well as positive reinforcement.

Include the child in activities that interest the adult. 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

The best way for parents to aid a toddler in achieving his developmental task would be to: a) help him learn to count. b) urge him to dress himself completely alone. c) give him small household chores to do. d) allow him to make simple decisions.

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

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this? a) A sense of control can be provided through offering limited choices. b) A regular routine and rituals will provide stability and security. c) Aggressive behaviors such as hitting and biting are common in toddlers. d) Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly.

A regular routine and rituals will provide stability and security. 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.

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?" What would be appropriate for the nurse to suggest? Select all that apply. a) "Use timeout every other time she tells you no." b) "Make a statement instead of asking a question." c) "Offer her two options from which to choose." d) "Offer her something she would like, such as ice cream, to distract her." e) "Limit the number of questions you ask of her."

• "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." 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.

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) Assimilation b) Autonomy c) Deferred imitation d) Parallel play

Deferred imitation 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.