Chapter 26: Growth and Development of the Toddler

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. Keep story time a reward for being good. B. Read a different book if he knows the story. C. Ask the child questions as you read. D. Have the child sit still during the story.

C. 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.

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

C. Include the child in activities that interest the adult. Parents who give the toddler love and respect regardless of the child's gender, behavior or capabilities are helping to lay the foundation for self-esteem. Toddlers need familiarity with the daily routine to enhance self-esteem development. Routines and rituals not only help develop self-esteem but help develop a conscience. 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 pediatric nurse is planning quiet activities for a hospitalized 18-month-old. What would be an appropriate activity for this age group? A. Painting by number B. Putting shapes into appropriate holes C. Stacking blocks D. Using crayons to color in a coloring book

C. Stacking blocks At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.

The nurse is caring for a 17-month-old child admitted to the acute care facility. The child is fretful and becomes calmer when given a tattered blanket from home. What inference can be made about the child's behavior in response to receiving the blanket? A. No inferences can be made from the child's behavior. B. The child is likely neglected and best obtains comfort from objects rather than human contact. C. The ability of the child to soothe herself is a positive sign of development. D. The child is likely tired and has managed to "cry it out".

C. The ability of the child to soothe herself is a positive sign of development. The ability to achieve emotional comfort by self-soothing behaviors demonstrates a positive adaptation in the stages of growth and development. These actions by the child are not consistent with any type of neglect or problem.

A parent tells the nurse that no matter what is asked of the toddler, the toddler says, "No." What suggestion might the nurse make to help the parent handle this situation? A. pretend the parent does not hear the toddler's response B. tell the toddler never to say "No" again C. give the toddler secondary, not primary, choices D. ask no further questions of the toddler

C. give the toddler secondary, not primary, choices Encouraging toddlers to express their opinion aids in developing a sense of autonomy. By allowing secondary choices, it gives the toddler a sense of mastery. Telling the toddler not to say "No" again is unrealistic as this is a favorite word and reaction of the toddler as he or she develops autonomy to find one's "self." Pretending not to hear the toddler only leads to more frustration for the toddler and the parent. It is also unrealistic not to ask the toddler questions. There would not be two-way communication between the parent and the toddler.

The nurse is discussing proper discipline with the parent of a 15-month-old toddler. Which teaching is most important? A. Only use praise after the child has corrected a wrong behavior. B. Rules and limits should be simple and few. C. Toddlers are unable to follow instructions easily. D. Physical punishment such as spanking is discouraged.

D. Physical punishment such as spanking is discouraged. Because toddlers younger than 18 months of age are at increased risk for physical injury from spanking than other children, the nurse should prioritize discouraging its use. The American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners recommend against corporal or physical punishment, which includes spanking. The other teachings describe toddler characteristics accurately and are basic to good discipline, but are not the most important for this young toddler.

The nurse is preparing the anticipatory guidance sheets that are provided to parents. When organizing the sheets, place the milestones in their proper sequence from earliest to latest. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Run and jump in place 2Creep up stairs 3Engage in parallel play 4Name one color 5Zip up their own jackets

Creep up stairs Run and jump in place Engage in parallel play Name one color Zip up their own jackets A 15-month-old can creep upstairs. An 18-month-old can run and jump in place. A 24-month-old engages in parallel play; a 30-month-old can name one color. Zipping a jacket occurs around a child's 3rd birthday.

By what age should the child know his/her own gender? A. 4 years B. 1 year C. 3 years D. 2 years

C. 3 years Toddlers observe differences in both male and female body parts. They question their parents about the differences. By 3 years of age, toddlers can say their name, their age and their gender. This age group begins to understand and mimic social gender differences. A 1-year-old or 2-year-old child would be too young to make this distinction because these children are just identifying their own body parts. By 4 years of age the child should be able to identify body parts. If not, there may be some delay with the child.

The mother of a 3-year-old is considering the following purchases as a birthday present. Which toy would the nurse suggest as the most age appropriate choice? A. Pounding bench B. 100-piece jigsaw puzzles C. Bicycle with training wheels D. Memory games

A. Pounding bench 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.

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

A. 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.

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. Total weight gain of 15 lb in the past year B. Forward curve of the spine at the sacral area C. Prominent abdomen D. Increase in height of 5 inches in the past year

A. 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.

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

A. 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.

The parents of a 2-year-old boy report to the nurse that 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. 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. 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. 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 preferences for particular foods (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 daughter has begun masturbating. The most important initial nursing response is that: A. there may be undue stress in your child's life. B. this is a normal and expected activity best treated matter-of-factly. C. toilet teaching places much focus on the genitals. D. girls as well as boys will masturbate.

B. 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.

The parent of a toddler notices the child plays nicely next to another toddler but does not play with that child. The parent expresses concern about this behavior to the nurse during an examination. Which response by the nurse is appropriate? A. "This behavior needs to be further assessed to ensure appropriate development." B. "I believe your toddler is exhibiting signs of an autism spectrum disorder." C. "This is called parallel play and is normal for this age group." D. "Be sure to inform the primary health care provider of your concern."

C. "This is called parallel play and is normal for this age group." Typical play of the toddler period is beside, not with, another toddler (parallel play). No further assessment is needed, nor does this indicate an autism spectrum disorder. The nurse should respond to the parent and not simply tell the parent to talk to the primary health care provider as this does not address the parent's concern.

The nurse is teaching the parents of a 2-year-old child how to handle the child's temper tantrums. The nurse determines that the teaching was successful if the parents make which statement? A. "We will offer our child a treat to stop having the tantrum." B. "We will place our child in time-out for 5 minutes after the tantrum." C. "We will ignore our child while having the tantrum." D. "We will attempt to reason with our child to limit tantrums."

C. "We will ignore our child while having the tantrum." The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it. Bribery, such as saying that the child can have a treat if the behavior stops, is rarely effective because by accepting the child's wishes, the parent is encouraging the child to have more tantrums because he or she was successful. Placing the child in time-out does not deal with the actual tantrum. When a child is placed in time-out, the appropriate length is 1 minute per year of age (2 minutes for this child). Tantrums are a result of the child not being able to appropriately express his or her needs, desires, or frustrations. It is not appropriate to attempt to reason with a upset 2-year-old child.

The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson? A. Trust versus mistrust B. Initiative versus guilt C. Autonomy versus shame and doubt D. Industry versus inferiority

C. Autonomy versus shame and doubt Erikson defines the toddler period as a time of autonomy versus shame and doubt. Erikson defines Initiative versus guilt as the preschool period. Erikson defines trust versus mistrust as the infancy period and industry versus inferiority as the school age period.

The parents of a 2 year old are concerned because the toddler only says a few words. What strategies should the nurse suggest to the parents? Select all that apply. A. Use baby talk when speaking. B. Use pronouns when speaking. C. Name aloud the objects being played with. D. Have the toddler watch educational television. E. Always answer questions using correct grammar. F. Read books aloud to the toddler.

C. Name aloud the objects being played with. E. Always answer questions using correct grammar. F. Read books aloud to the toddler. 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."

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

D. "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.

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. "Turn the handles of your pots away from the edge of the stove when cooking." B. "Make sure to have your child securely fastened in a car seat." C. "Have your child wear a helmet when beginning to ride a tricycle." D. "Keep all cleaning products and drugs out of the reach of your child."

D. "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 nurse is discussing language development with the parent of a 20-month-old toddler. To accurately assess the toddler's language development, which question would the nurse ask the parent? A. "Does your toddler use sentences with 3 or 4 words?" B. "Is your toddler able to use singular and plural words correctly?" C. "Can your toddler state his or her name and indicate his or her age?" D. "When you say "no" does your toddler seem to understand the meaning?

D. "When you say "no" does your toddler seem to understand the meaning? The 20-month-old toddler should understand the word "no." Being able to use plurals, using 3 to 4 word sentences, and stating one's name and age are expectations of a child 36 months of age or older.

Parents and their nearly 3-year-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. Talks about a past event C. Half of speech understood by outsider D. Uses two-word sentences or phrases

D. 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 reports that her child will only eat peanut butter and jelly sandwiches for several days in a row. The child will then refuse to eat them for several weeks. Which term would the nurse use to document this behavior? A. egocentrism B. echolalia C. physiologic anorexia D. food jag

D. food jag During a food jag, the toddler may prefer only one particular food for several days, then not want it for weeks. Physiologic anorexia describes the fact that toddlers do not require as much food intake for their size as they did in infancy. Echolalia is repetition of words and phrases. Egocentrism describes the focus on self that is present in toddlers.

The parents of a 30-month-old toddler have brought the toddler into the emergency department because of a seizure. During the health history, the nurse learns that the toddler was frustrated and angry immediately preceding the seizure. The nurse suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding? A. A tantrum preceded the event. B. The toddler became unconscious. C. The event took place during a nap. D. The toddler was lethargic afterward.

A. A tantrum preceded the event. Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the toddler is old enough to verbalize feelings. 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 assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern? A. Ability to turn door knobs B. Able to use a spoon to self-feed C. Put shapes into matching openings D. Ability to hold a crayon to write

A. Ability to turn door knobs Turning knobs opens doors and may allow the child access to the outdoors or unsafe areas within the home. Close to follow will be the ability to unscrew lids, creating poisoning risks. The other abilities promote growth and development and involve lesser safety hazards.

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. poor role modeling C. improper snacking D. iron-deficiency anemia

A. 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 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 was licking the dishwashing soap." B. "He doesn't respond if I wave to him." C. "He wasn't bothered by the paint smell." D. "I dropped a pan behind him and he cried."

B. "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.

The nurse is assessing a healthy 2-year-old client. Which assessment finding most concerns the nurse? A. The child is pointing to named body parts. B. The child speaks in one-word sentences. C. The child can stand on his tiptoes. D. The child has difficulty with stairs.

B. The child speaks in one-word sentences. A 2-year-old child not using at least two-word sentences is a sign of a potential developmental delay. Normal development for a 2-year-old child is standing on tiptoes and pointing to named body parts. Having difficulty with stairs is considered a potential delay in a 3-year-old, not a 2-year-old child.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia. The child's condition has improved, and the child is much more active and eager to play. Which toy should the nurse offer the child? A. board games B. large piece puzzle C. fabric books D. squeaky toy

B. large piece puzzle An appropriate toy for a 3-year-old child is a large piece puzzle. Board games are more appropriate for preschool and school-aged children; fabric books and squeaky toys are more appropriate for older infants and younger toddlers (10 to 18 month of age).

What advice should the nurse provide the parent of a toddler, regarding how to handle temper tantrums? A. Mimic the toddler's behavior by also holding the breath B. Promise the toddler a special activity if the toddler will stop C. Appear to ignore the toddler D. Distract the toddler with a toy when the toddler begins holding the breath

C. Appear to ignore the toddler Temper tantrums are the natural result of frustration that toddlers have. Toddlers do not behave badly on purpose. They need time and maturity to learn the rules and regulations. During a temper tantrum, the advice is for the parent to ignore the behavior but ensure the toddler is safe. Rewarding temper tantrums can teach the toddler that tantrums are an effective method of interaction. Ignoring tantrums teaches the toddler that tantrums are ineffective. The parent needs to use self-control when dealing with a temper tantrum. This is a way to model acceptable behavior for the toddler.

A parent is concerned because the toddler refuses to share. What is the nurse's best response to the parent regarding this concern? A. Play time with other toddlers should be cut back until your toddler learns to share. B. Behavior modification techniques can change the toddler's behavior. C. This is normal toddler behavior; sharing is learned later. D. The toddler is probably reacting to some family crisis.

C. This is normal toddler behavior; sharing is learned later. Play is the major socializing medium for the toddler. Toddlers exhibit parallel play instead of cooperative play. Sharing is not usually learned until the preschool period. Because toddlers have such short attention spans, they change toys and activities frequently. This also is not conducive to sharing. Because parallel play is normal for the toddler, the parent should be assured the toddler is developing normally and no restrictions are needed.

A mother of a 2-year-old asks the nurse, "What would be a good between-meal snack?" What foods would be appropriate for the nurse to suggest? Select all that apply. A. Cheese B. Cookies C. Yogurt D. Pieces of apples E. Orange slices

A. Cheese C. Yogurt D. Pieces of apples E. Orange slices Good choices for between-meal snacks include fruits (e.g., pieces of apples or orange slices) and high-protein foods (e.g., cheese or pieces of chicken). Cheese as well as yogurt provide calcium. Cookies and other high-carbohydrate foods should be avoided because they promote dental caries.

The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet? A. "Give him more healthy choices with less junk food available." B. "You may have to serve a new food 10 or more times." C. "Calorie requirements for toddlers are less than infants." D. "Serve only healthy foods. He'll eat when he's hungry."

A. "Give him more healthy choices with less junk food available." Suggesting that the parents transition the child to a healthier diet by serving him more healthy choices along with smaller portions of junk food will reassure them that they are not starving their child. The parents would have less success with an abrupt change to healthy foods. Explaining calorie requirements and the timeline for acceptance of a new food does not offer a practical reason for making a change in diet.

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. "Offer her two options from which to choose." B. "Use time-out every other time she tells you no." C. "Make a statement instead of asking a question." D. "Limit the number of questions you ask of her." E. "Offer her something she would like, such as ice cream, to distract her."

A. "Offer her two options from which to choose." C. "Make a statement instead of asking a question." D. "Limit the number of questions you ask of her." 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 giving the child a choice of two options are effective. Using time-out 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 long-lasting for modifying the child's behavior.

During a wellness care visit, the parents of a 2-year-old toddler report that they are struggling to deal with their toddler's daily and increasing number of tantrums. What information should be provided to the parents? Select all that apply. A. Ignoring the behavior is often helpful in reducing the duration of the tantrum. B. Tapping the toddler on the hands and voicing displeasure in the toddler's actions can successfully interrupt the behavior. C. Tantrums are a common occurrence for a toddler of this age. D. Maintaining a consistent daily routine can help to reduce tantrums. E. Tantrums at this age can signal the development of an aggression disorder in a toddler.

A. Ignoring the behavior is often helpful in reducing the duration of the tantrum. C. Tantrums are a common occurrence for a toddler of this age. D. Maintaining a consistent daily routine can help to reduce tantrums. Temper tantrums can be a frequent occurrence in toddlerhood. Some toddlers are more prone to displaying these behaviors than others. For the toddler who experiences frequent tantrum outbursts, maintaining a consistent schedule for activities is helpful. Tantrum-prone toddlers benefit from consistent nap, meal and play periods. Ignoring the behavior signals to the toddler that the behavior is futile. Avoiding interaction with the toddler having the tantrum is beneficial. Discipline such as spanking, swatting or yelling at the toddler does not reduce the episode and may escalate it.

The father of a toddler reports his son says "no" every time he attempts to correct him. What is the best advice the nurse can offer to the parent? A. Saying no is your son's way of trying to exert his independence and is expected. B. You may need to lessen the amount of correction being given to the child as he seems to be responding to feeling "overly restricted." C. Continue to correct him because he needs discipline. D. This is a normal part of toddlerhood.

A. Saying no is your son's way of trying to exert his independence and is expected. It often seems that "no" is a toddler's favorite word. Saying no is his way of beginning to exert his independence. Telling the parent this is a normal happening does not provide the necessary education to the parent. Saying "no" does not indicate the discipline being provided is too restrictive. Telling the father to continue the discipline does not offer the needed education about his child's behavior and stage of development.

The nurse is writing a care plan for the nursing diagnosis "Knowledge deficit related to proper seat belt use, as evidenced by improper buckling of seat belt." Choose goals that are appropriate for this diagnosis. Select all that apply. A. The parents will voice an understanding that a rear-facing car seat should be used until at least the age of 2. B. The parents will demonstrate the proper use of a car seat with a harness strap for the child under the age of 2. C. The parents will voice an understanding that the child should not sit in the front seat of the vehicle. D. The parents will demonstrate the proper use of the seat belt for securing the child car seat. E. The parents will voice an understanding that in trucks the car seat will be placed in the back seat.

A. The parents will voice an understanding that a rear-facing car seat should be used until at least the age of 2. B. The parents will demonstrate the proper use of a car seat with a harness strap for the child under the age of 2. C. The parents will voice an understanding that the child should not sit in the front seat of the vehicle. D. The parents will demonstrate the proper use of the seat belt for securing the child car seat. E. The parents will voice an understanding that in trucks the car seat will be placed in the back seat. All of these goals are correctly written in measurable terms and are accurate in content.

The nurse is assessing speech development in the 2-year-old toddler whose family uses two languages in the home. What finding is of concern? A. The toddler speaks 15 words between the two languages. B. The child mixes words from the two languages within a sentence. C. Some words the toddler speaks are a blend of the two languages. D. The parents understand the child much of the time.

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

During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy? A. "When my toddler falls down, they always wants me to pick them up." B. "My toddler uses the potty chair and is dry all day long." C. "Every night my toddler follows the same routine at bedtime." D. "My toddler has temper tantrums when we go to the store."

B. "My toddler uses the potty chair and is dry all day long." During the toddler years, the toddler separates from his or her parents, recognizes one's own individuality and exerts autonomy. Being toilet trained is an example of the toddler developing autonomy or independence. Having temper tantrums is a normal response of the toddler as it is a way the toddler expresses frustration of being tired or not being able to accomplish a task. Having the parent pick up the child after the child falls is a security and emotional need. All children need this, so it is not indicative of toddlerhood or autonomy. Having the same routine for bedtime each night provides security but it does not demonstrate autonomy.

The nurse is teaching a mother of a 1-year old girl about weaning her from the bottle and breast. Which recommendation should be part of the nurse's plan? A. Switch the child to a no-spill sippy cup. B. Give the child an iron-fortified cereal. C. Wean from the bottle at 15 months of age. D. Wean from breast by 18 months of age at the latest.

B. Give the child an iron-fortified cereal. The nurse would be sure to tell the mother to feed her child iron-fortified cereal and other iron-rich foods when she weans her child off the breast or formula. Weaning from the breast is dependent upon the mother's need and desires with no set time. Weaning from the bottle is recommended at 1 year of age in order to prevent dental caries. Use of a no-spill sippy cup is not recommended because it too is associated with dental caries.

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. Runs to her mother B. Stands alone C. Feeds herself with a spoon D. Points to her nose and mouth

B. 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 nurse is assessing a 2-year-old toddler. Which observation(s) will alert the nurse that the child may be experiencing a developmental delay? Select all that apply. A. The toddler is unable to stack more than four blocks on top of another. B. The toddler will not pick up a toy or touch the nose when directed by the nurse. C. The toddler claps the hands in response to the nurse clapping hands. D. The toddler pushes and pulls the play vacuum cleaner in the toy room. E. The toddler's vocabulary consists of the words "ball," "dadda," "mum," "drink," and "up."

B. The toddler will not pick up a toy or touch the nose when directed by the nurse. E. The toddler's vocabulary consists of the words "ball," "dadda," "mum," "drink," and "up." The 2-year-old toddler should be speaking in two-word sentences, and should be able to follow simple commands. Imitating the clapping of hands and pushing and pulling objects is expected of a 2-year-old toddler. The child should not be able to stack more than four blocks until the age of 3, so this observation would not be a concern at this age.

The nurse is reviewing sleep and rest activities of a 16-month-old child with the parents. The father states, "I have told my wife it is unhealthy for our child to sleep with us. It's time for him to sleep in his own bed. What do you think?" What is the nurse's best initial response? A. "I will note this in your child's chart for the doctor to see." B. "Have you thought about just trying to let your child sleep in his own bed to see how it goes?" C. "It must be difficult for the two of you to both feel strongly about what is best for you and your child." "D. Co-sleeping is viewed acceptable by some professionals, but as interfering with the child's independence by others."

C. "It must be difficult for the two of you to both feel strongly about what is best for you and your child." Acknowledging the difference of opinion between the mother and father allows for open conversation about the sleeping arrangement, which may lead to an acceptable resolution. Stating the views of professionals about co-sleeping, while accurate, does not address the parent's voiced concerns, nor does noting the sleep activities in the chart. Suggesting the child sleep in his own bed is not up to the nurse to do, and it does not address the issue.

During a visit to the pediatric clinic the mother of a 2-year-old tells the nurse that her husband is concerned that their son isn't potty trained yet. The mother states, "There is no way he could be potty trained. His bladder is too small." How should the nurse respond? A. "Your husband is correct, at the age of 2 your son should have a good amount of urine control." B. "Two years old is rather early for a boy to be potty-trained." C. "The bladder of a 2-year-old is actually the size of an adult's bladder, but there are a lot of variables to when a child is potty-trained." D. "You should talk to the physician about your son not being potty-trained in case there are issues preventing him from being able to control his urine flow."

C. "The bladder of a 2-year-old is actually the size of an adult's bladder, but there are a lot of variables to when a child is potty-trained." Bladder and kidney function reach adult levels by 16 to 24 months of age, but there are many factors that determine when a child is ready to be potty-trained. The other options are misleading the parent regarding potty-training.

The nurse is teaching the parent of a 2-year-old about age-appropriate toys. Which would be of most interest plus stimulating to the growth and development? A. Providing a brightly colored plastic bucket and shovel B. Offering the child a variety of large stuffed toys C. Giving the child bowls, pot, pans, and large spoons D. Giving the child a toy vacuum cleaner

C. Giving the child bowls, pot, pans, and large spoons The kitchen items are usually of most interest since they give opportunity to copy observed parental actions. Also, these items can be used not only to role model but also to stack, nest, make noise, and rearrange in many configurations. They are also inexpensive. However, all the other toys are appropriate and safe for toddlers.

The caregivers of a 2-year-old are concerned the child is not learning how to share and play well with other children. While acknowledging their concern and devotion, the nurse should point out which activity would be best for this child's developmental level? A. Sharing finger paints and painting with the caregiver B. Throwing a baseball-sized ball C. Mowing the lawn with a toy lawnmower D. Looking at large print magazines

C. 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 this early stage.

The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response? A. Some children have large heads but that does not signal a problem. B. Explain that the child looks normal. C. Share that the heads of children at this age are large in proportion to the rest of their body. D. Teach the mother that this larger head than body appearance will be this way until the child is about 6 years old.

C. Share that the heads of children at this age are large in proportion to the rest of their body. Head circumference increases about 1 inch between 1 and 2 years of age, then increases an average of a half-inch per year until age 5. The anterior fontanel (fontanelle) should be closed by the time the child is 18 months old. Head size becomes more proportional to the rest of the body near the age of 3 years.

A toddler's parents want to begin toilet training. As a rule, the best instruction the nurse could give them is: A. toilet training is a 12-month process. B. if children can remain dry during the night, they can do so during the day. C. bowel training is easier than urine training. D. all children should be toilet trained by age 2 years.

C. bowel training is easier than urine training. Myelination from the spinal cord is complete at age 2. Toilet training can begin somewhere around this period. All children are not the same in their emotional and physical development. Some may be ready before their second birthday and others need a little longer. This time should be positive and nonthreatening if the toddler is to be successful. Bowel training is often easier than urine training because the substance to be evacuated is so much more tangible. The best time for defecation is usually following a meal. Toddlers may need to wear diapers at night during the toilet training process until successful voiding and defecating in the potty is complete. The length of the process for toilet training completion depends upon the child's readiness.

The parents of a 2-year-old girl are concerned with her behavior. For which behavior would the nurse share their concern? A. plays by herself even when other children are present B. refuses to share toys with her sister C. frequently babbles to herself when playing D. likes to change toys frequently

C. 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 mother of an 18-month-old girl voices concerns about her child's social skills. She reports that the child does not play well with others and seems to ignore other children who are playing at the same time. What response by the nurse is indicated? A. "Has your child displayed any aggressive tendencies toward other children?" B. "Perhaps you should consider a preschool to promote more socialization opportunities." C. "Does your child have opportunities to socialize much with other children?" D. "It is normal for children to engage in play alongside other children at this age."

D. "It is normal for children to engage in play alongside other children at this age." The social skills of the toddler at this age include parallel play. During parallel play children will play alongside each other rather than cooperatively. There is no indication that the aggression level of the child needs to be investigated. There is no indication the child needs increased socialization with other children.

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

D. 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.

When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old toddler? A. The toddler should be able to count out loud to 20. B. The toddler should say 20 nouns and 4 pronouns. C. The toddler should say two words plus "ma-ma" and "da-da." D. The toddler should speak in two-word sentences ("Me go").

D. The toddler should speak in two-word sentences ("Me go"). A toddler can understand language and is able to follow commands far sooner than he or she can actually use the words. By 2 years of age, a toddler typically speaks in two-word (noun and verb) sentences. Two-year-old toddlers have a vocabulary of about 40 to 50 words, and they start to use descriptive words (hungry, hot). The words "ma-ma" and da-da" occur much earlier than the toddler stage. The toddler is about 36 months of age before using pronouns or plurals in sentences. Children are unable to count to 20 until they are 5 to 6 years old.

The nurse is explaining safety precautions for toddlers to the mother of a normal 30-month-old boy. Which activity might the nurse suggest may be done without supervision? A. Turning on the bath water B. Playing in the basement C. Eating a mid-afternoon snack D. Undressing himself

D. Undressing himself The child would be capable of safely dressing or undressing himself with some success. Turning on the bath water, playing in the basement, or eating a mid-afternoon snack could present significant risk for injury if not supervised.

The parent of a 2-year-old client states it is the child's naptime. The child is refusing to take a nap and cries, "I have to put my babies to sleep first!" The parent states, "I am so sorry, I do not know what is wrong. My child does not act this way at home. My child has 2 baby dolls we rock to sleep each day at home before nap." Which response by the nurse is most appropriate? A. "A 2-year-old child's behavior can be greatly altered if rituals are not maintained." B. "I am sure your child is just acting out since your child is in the hospital and not at home." C. "You need to have someone bring the baby dolls to the hospital." D. "Your child's behavior indicates discipline occurring at home is not consistent."

A. "A 2-year-old child's behavior can be greatly altered if rituals are not maintained." Ritualism employed by the young child to help develop security involves following routines that make rituals of even simple tasks. The child's self-esteem is built through familiarity with the daily routine. When these rituals are interrupted, the child's behavior can be negatively impacted, resulting in temper tantrums for 2-year-old children. The nurse can recommend someone bring the dolls to the hospital; however, the nurse first needs to address the parent's concern. Stating the child is "just acting out" does not address the parent's concern or current situation. There is nothing in the scenario indicating inconsistent discipline.

The parent of a 20-month-old toddler reports the toddler has been becoming distraught when the parent leaves. The parent asks the nurse for advice about what is going on and how to best manage it. What information can be provided? Select all that apply. A. "Establishing a routine for saying goodbye to your toddler will be helpful." B. "Your care providers may be frightening to your toddler." C. "This is a normal happening for a toddler of this age." D. "As your toddler begins to learn that you will return the toddler will become less upset." E. "This is actually a regression for your toddler because separation anxiety normally occurs in infancy."

A. "Establishing a routine for saying goodbye to your toddler will be helpful." C. "This is a normal happening for a toddler of this age." D. "As your toddler begins to learn that you will return the toddler will become less upset." Separation anxiety occurs initially in infancy and then reoccurs again during the toddler stage. Separation anxiety for the toddler is normal. As the toddler begins to develop an understanding of object constancy, separation anxiety will ease. The toddler, while missing the parent, will begin to recognize that the parent will return. Establishing a routine for saying goodbye is helpful for the toddler. There is no indication that the care providers are problematic.

The parents of a 3-year-old toddler tell the nurse that their child constantly says "no" to everything and they are very frustrated. The parents ask the nurse what they should do. Which response(s) by the nurse are appropriate? Select all that apply. A. "Have you tried using "time-outs" for negative behavior?" B. "This action is normal for this age. If measures to stop this behavior do not work, you should make the decision for your toddler to move on with the activity occurring." C. "Giving your toddler choices instead of posing 'yes' or 'no' questions may decrease the 'no' response." D. "Asking your toddler the reason why most responses are 'no' might help you understand this behavior." E. "An occasional light spank on the bottom is often helpful when your toddler continually says 'no.'"

A. "Have you tried using "time-outs" for negative behavior?" B. "This action is normal for this age. If measures to stop this behavior do not work, you should make the decision for your toddler to move on with the activity occurring." C. "Giving your toddler choices instead of posing 'yes' or 'no' questions may decrease the 'no' response." As the toddler separates from the parent and recognizes his or her own individuality and exerts autonomy, it is very common for the child to display negativism. Time-outs are helpful ways of disciplining for this age group. Offering choices, such as "Do you want the red or blue shirt?" lends to autonomy. If measures fail, the parent needs to calmly make choices for the toddler. Spanking is not recommended for any age. Asking the child to explain is not developmentally appropriate for a 3-year-old toddler.

The parents of a toddler ask the nurse about disciplining their 2-year-old toddler. What suggestions will the nurse provide? Select all that apply. A. "If you allow an unwanted behavior one time at this age, it is difficult to reverse later." B. "Try using time-out, assigning 1 minute per year of your toddler's age." C. "You need to wait until the toddler is old enough to understand the rules." D. "Avoid using physical punishment unless your toddler's behavior is really out of line." E. "It is better to praise correct behavior than to punish wrong behavior."

A. "If you allow an unwanted behavior one time at this age, it is difficult to reverse later." B. "Try using time-out, assigning 1 minute per year of your toddler's age." E. "It is better to praise correct behavior than to punish wrong behavior." Parents should begin to instill some sense of discipline early in life because part of it involves safety limits. Two general rules to follow include the need to be consistent and the use of praise for correct behavior rather than punishment for wrong behavior so that the child can learn the rules. Parents should implement consistent discipline early. Once an unwanted behavior is allowed, it is difficult to reverse as the child grows older. Time-out is an effective technique to help children learn that actions have consequences. One minute per year of the child's age is the common standard. Physical punishment is not recommended. Having a consistent caregiver is important for reducing separation anxiety.

The parents of a 3-year-old boy have asked the nurse for advice about a preschool for their child. Which suggestion is most important for the nurse to make? A. "The staff should be trained in early childhood development." B. "Check to make sure your child can attend with the sniffles." C. "Make sure that you can easily get an appointment to visit." D. "Look for a preschool that is clean and has a loving staff."

A. "The staff should be trained in early childhood development." A. "The staff should be trained in early childhood development."

The mother of a 15-month-old son is returning to work and wants to place her son in the day care close to work; however, they will only accept potty-trained children. Which response from the nurse will best address this situation in answering the mother's questions of how best to potty train her son? 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. "Get your son a potty chair and have him sit on it for a few minutes each day." D. "Each time you change his diaper, tell your son how important and fun it is to use the potty chair."

A. "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 to 24 months.

A 3-year-old child is hospitalized. The parents are concerned because the child is now refusing to use the potty and is wetting the bed even though the child has achieved toilet training. Which response by the nurse is most appropriate? A. "Your child is experiencing regression as a result of stress." B. "Do not worry. This is a normal response to being in the hospital." C. "Why do you believe your child is refusing to use the potty?" D. "Once discharged, your child will quickly learn to use the toilet again."

A. "Your child is experiencing regression as a result of stress." Regression is a change from present behaviors to past developmental levels of behavior. This is a normal response among children during times of intense stress, such as a hospitalization or the birth of a new sibling. The nurse should not tell the parents not to worry. The child will not have to learn to use the toilet again. The behavior is already learned. Asking why is not a therapeutic form of communication and may cause the parents to become unnecessarily defensive.

The nurse is assessing 2-year-old twins. The parent states, "My twins will not play together, only alongside each other." Which action will the nurse take first? A. Explain that this is normal behavior for toddlers. B. Encourage the toddlers to play to allow for observation. C. Determine when this form of play was first noted. D. Document the finding in the medical records.

A. Explain that this is normal behavior for toddlers. Playing beside one another is parallel play and typical of toddlerhood. The nurse would explain this is normal behavior for the twins and then document the finding. The nurse would not need to observe the twins at play or ask additional questions as this is an expected finding.

What is a true statement regarding the developmental milestones of the 30-month-old child? A. Full set of primary teeth B. Anterior fontanel (fontanelle) closes C. Head circumference equals chest circumference D. Triples birth weight

A. Full set of primary teeth Developmental milestones of a 30-month-old child include acquiring a full set of primary or baby teeth. A child at this age is developing a sense of humor, can put on clothes, wash hands and brush teeth. The 12-month-old child should double the birth weight. The anterior fontanel (fontanelle) closes at 18 to 24 months. Head circumference equals chest circumference at 12 months.

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. Give her slices of cheddar cheese as a snack. B. Include dark greens and spinach in her meals. C. Use unsweetened applesauce as a dessert. D. Offer chocolate milk to increase milk intake.

A. Give her slices of cheddar cheese as a snack. 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.

A nursing instructor is leading a class discussion exploring the various aspects of Erikson's theories of the developmental tasks of toddlers. The instructor determines the session is successful when the students correctly choose which task as a priority for toddlers? A. Learning to act on one's own B. Learning to trust C. Learning to speak D. Learning to understand and respond to discipline

A. 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.

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. Putting the child on the potty chair at regular intervals during the day C. Keeping the child on the potty chair for as long as necessary D. Using training pants that slide down easily and quickly E. Allowing at least 6 weeks to prepare the child psychologically for the training

A. Praising the child when he or she urinates or defecates B. Putting the child on the potty chair at regular intervals during the day D. Using training pants that slide down easily and quickly 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. Sticky foods like peanut butter alone, gummy candies, and marshmallows B. Round foods such as hot dogs, whole grapes, and cherry tomatoes C. Hard foods such as nuts, raw carrots, and popcorn D. Fruits such as peaches, pears, and kiwi E. Vegetables such as corn, green beans, and peas

A. Sticky foods like peanut butter alone, gummy candies, and marshmallows B. Round foods such as hot dogs, whole grapes, and cherry tomatoes C. Hard foods such as nuts, raw carrots, and popcorn To offer soft round foods safely, cut hot dogs in uneven pieces and cut grapes and cherry tomatoes into quarters. 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.

The student nurse is preparing a presentation on normal physical growth for toddlers. What information should the student include? Select all that apply. A. The average weight gain is 3 to 5 pounds per year. B. Toddlers generally reach half of their adult height by 3 years of age. C. The anterior fontanel (fontanelle) should be closed by the time the child is 24 months old. D. Toddlers gain height and weight in spurts. E. Head size becomes more proportional to the rest of the body near 3 years.

A. The average weight gain is 3 to 5 pounds per year. D. Toddlers gain height and weight in spurts. E. Head size becomes more proportional to the rest of the body near 3 years. The average toddler weight gain is 3 to 5 pounds per year. The anterior fontanel (fontanelle) should be closed by the time the child is 18 months old, not 24 months. Toddler gains in height and weight tend to occur in spurts, rather than in a linear fashion. Toddlers generally reach about half of their adult height by 2 years of age, not 3 years of age. Head size becomes more proportional to the rest of the body near the age of 3 years.

The nurse is talking to the parent of a 19-month-old toddler about setting limits and supervising activities. In which situation will the nurse recommend letting the toddler do as he or she pleases? A. exploring one's body B. playing on the picnic table C. deciding one's bedtime schedule D. choosing one's own foods

A. exploring one's body Children learn about gender differences during the toddler years. They observe differences between male and female body parts if they are exposed to seeing it. They question their parents about the differences. It is normal for toddlers to explore their genitals as they develop their own sense of self. 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 3-year-old boy in a day care center. Which behavior might suggest an emotional problem? A. has persistent separation anxiety B. unable to share toys with others C. goes from calm to tantrum suddenly D. sucks his thumb periodically

A. 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.

The home health nurse is visiting a 2-year-old client's home. Which finding will cause the nurse to intervene? A. All of the windows in the home are locked. B. The family's medications are located in a kitchen drawer. C. The toddler goes to the bathroom alone to urinate. D. The toddler in not allowed in the kitchen while food is being prepared.

B. The family's medications are located in a kitchen drawer. Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time. This includes keeping all medications in a high, locked cabinet. It is appropriate for all windows to be locked to prevent a toddler from exiting the home out a window. The toddler may go to the bathroom alone once toilet training is well established. Not allowing the toddler in the kitchen during meal preparation will prevent accidental burns from hot foods and surfaces.

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 normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." C. "It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition." D. "It is not normal for toddlers to lose their appetites; spoon feed him yourself to make sure he gets proper nutrition."

B. "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 that 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 assigned to care for a 15-month-old toddler. When developing a care plan addressing the nutritional needs of the toddler, which client goal(s) demonstrate the nurse's understanding of these needs? Select all that apply. A. "The child will drink milk from a bottle for the next 2 months." B. "The child will drink specified amounts of milk and other fluids on a daily basis, as suggested by the pediatrician." C. "The child will be weaned from breastfeeding within the next month." D. "The child will learn to drink from a cup within the next month." E. "The child will stop drinking from a bottle while in bed within the next 2 weeks."

B. "The child will drink specified amounts of milk and other fluids on a daily basis, as suggested by the pediatrician." D. "The child will learn to drink from a cup within the next month." E. "The child will stop drinking from a bottle while in bed within the next 2 weeks." A 15-month-old toddler should be drinking fluid (other than breast milk if still breastfeeding) from a cup because extended bottle feedings at any time of day promote dental caries at this age. Most professional organizations suggest that infants be breastfed for at least 12 months. Breastfeeding beyond 12 months provides nutritional, immunologic, and emotional benefits to the child.

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."

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

B. 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.

Which suggestion by the nurse meant to promote good dental health in the 15-month-old is inappropriate? A. Arrange for your child's first dental visit as soon as possible. B. Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. C. Avoid grazing (continual snacking) throughout the day. D. the child from the bottle.

B. Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. Using fluoride toothpaste prior to age 2 years promotes development of fluorosis. The first dental visit should be made at 1 year. This check-up is overdue. Continual snacking and bottle drinking keep the teeth in contact with cariogenic substances for extended periods.

The parents of a toddler are asking the nurse if their child is lagging behind since the child does not have a very large vocabulary at the present time. Many times their toddler just points to an object and the parents give it to the toddler. Which concepts/statements should the nurse share with this family about language development of a toddler? Select all that apply. A. When the child points to an object, wait and make the child name the object before giving it to him or her. B. Read aloud to the toddler to help build and strengthen vocabulary by pointing to pictures in the book. C. Reinforce language by voicing a request, "You want the apple?" D. Since toddlers imitate what they hear, use good grammar and incorporate pronouns like "I" and "you." E. If the child asks, "Why?" be sure to give him or her a full explanation since the child is showing initiative.

B. Read aloud to the toddler to help build and strengthen vocabulary by pointing to pictures in the book. C. Reinforce language by voicing a request, "You want the apple?" D. Since toddlers imitate what they hear, use good grammar and incorporate pronouns like "I" and "you." The nurse should urge parents to encourage language development by naming objects (e.g., ball, block, music box, doll) as they play and while reading a book with their child. To assess whether parents are encouraging language development, the nurse should ask them what happens when the child wants something (for example, point to an object). Do they provide opportunities for the child to ask for things? Children should not be made to name an object before they can have it because their vocabulary is so limited, but parents can reinforce language by voicing the request (e.g., "You want the ball?"). Reading aloud is another effective way to strengthen vocabulary. Pointing to pictures and describing what the picture shows, such as "See Jane throwing the ball?" assists with language development. Because children learn language from imitating what they hear, if they hear examples of bad grammar, they will not use good grammar. Remind parents that pronouns are difficult for children to use correctly; many children are 3 1/2 or 4 years of age before they can separate the different uses of "I," "me," "him," and "her."

A group of caregivers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is appropriate related to this form of discipline? A. "We use the time-out chair when our child gets tired but does not want to take a nap." B. "Our time-out chair is in the master bedroom so my child cannot see anyone else in the family." C. "My child is 3 years old now and I put my child in time-out for 5 to 10 minutes when misbehaving." D. "When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out."

D. "When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." A method for a young 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—1 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 chair should be used for discipline, not because the child will not go take a nap. It can be used for all ages of young children.

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. What 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. "She's well past the age to begin toilet training; most children are ready by age 1, when they have developed the needed nervous system control." D. "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."

D. "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." 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 caring for an 18-month-old child who has had surgery. The medical record indicates the child weighs 23 pounds (10.45 kg). When monitoring his urinary output the nurse is aware that normal hourly output should be what value? A. 20 ml/hr B. 5 ml/hr C. 15 ml/hr D. 10 ml/hr

D. 10 ml/hr The normal urinary output for a toddler is approximately 1 ml/kg/hr. This child weighs 23 pounds. This is 10.45 kg. This is approximately 10 ml/hr.

Which is the best way for parents to aid a toddler in achieving the developmental task? A. Give the toddler small household chores to do B. Help the toddler learn to count C. Urge the toddler to dress oneself completely alone D. Allow the toddler to make simple decisions

D. Allow the toddler to make simple decisions The toddler years see a refinement of motor skills, continuous cognitive growth, and the acquisition of language skills. During this time the toddler achieves autonomy and self-control. Allowing the child to make decisions is a good way to help the toddler achieve autonomy and gain independence. Rewarding the child for accomplishing the task after making the decision is a good way to reinforce self-esteem. A younger toddler may not successfully dress alone because he or she may not have mastered such techniques as buttons, zippers, or tying shoes. A toddler can help with household tasks but these are generally limited because the toddler's attention span and motor skills may not be refined enough to complete the task. Helping the child learn to count is improving cognitive development but does not necessarily help the child with gaining autonomy or self-control.

The nurse is providing anticipatory guidance to the parents of an 18-month-old child. Which recommendation should be the most helpful to the parents? A. When needed, place the child in time out for 1½ minutes. B. Slap the hand using one or two fingers if the child hits another. C. Ignore bad behavior until the child is older. D. Describe proper behavior when the child misbehaves.

D. Describe proper behavior when the child misbehaves. Stopping the child when misbehaving and describing proper behavior sets limits and models good behavior. This will be the most helpful advice to the parents. At 18 months, the child is too young to use time out or extinction (ignoring the child's behavior) as discipline. Slapping the child's hand, even done carefully with two fingers, is corporal punishment, which has been found to have negative effects on child development.

Parents discuss with the nurse their 2-year-old toddler's temper tantrums. Which technique would the nurse suggest? A. Inform of punishment if the toddler continues. B. Promise a reward if the toddler behaves. C. Use short "time-outs" and remain calm. D. Ignore the toddler's behavior.

D. Ignore the toddler's behavior. When a toddler has a temper tantrum, the parent's best course of action is to ignore the behavior and ensure that the child is safe during the tantrum. Physical punishment will probably just prolong the tantrum and may produce more intense negative behavior. If the tantrum occurs in public, it may be necessary for the parent to remove the toddler from the situation, using a calm voice to soothe the toddler. It is very important for parents to model self-control. One exception to the rule is that biting and hitting should never be ignored and should be disciplined with a time-out.

A group of students is reviewing material about ways parents can help to foster a child's self-esteem. The students demonstrate a need for additional studying when they identify which method as promoting self-esteem? A. Using positive reinforcement while limiting criticism B. Acting as a coach rather than a cheerleader C. Showing respect and support to the child D. Limiting the choices and decisions that the child makes

D. Limiting the choices and decisions that the child makes To promote self-esteem, parents should praise the child's achievements, show respect and support to the child, allow the child to make decisions, listen to the child, and spend time with the child. The parents need to be a coach to the child rather than just a cheerleader who merely praises accomplishments.

The nurse is educating a parent regarding child safety for the 14-month-old toddler. What would the nurse include in the educational plan? A. Assure there are no empty buckets in the home/play area that could result in accidental drowning. B. If the child reaches to touch a firearm, gently slap the child's hand and firmly state 'No.' C. Utilize a front-facing car seat with appropriate harness straps until at least the age of 24 months. D. Maintain supervision when the child is near stoves, ovens, irons and other hot items the child could reach.

D. Maintain supervision when the child is near stoves, ovens, irons and other hot items the child could reach. Toddlers are more mobile and curious, leading to accidental burns on stoves, ovens, irons etc. They must be supervised when near these objects to avoid burns. If firearms are in the home, they should be unloaded and locked in a secure location. Educating the toddler about firearm safety will not be remembered and is appropriate for a much older child. Buckets are a danger to toddlers (who are top heavy) if they have water in them and could result in a drowning. Empty buckets are not a drowning concern. Children are to be placed in a rear-facing car seat until 2 years of age, not a front-facing one.

The nurse is preparing a presentation for a health fair which will illustrate various ways to help introduce siblings to a new member of the family. Which suggestion should the nurse prioritize to help older siblings, especially toddlers, understand the change in the family dynamics? A. Have a grandparent or another special adult in the child's life take the toddler on an errand or a special visit. B. Plan time for the secondary caregiver to focus on the toddler while the primary caregiver focuses on the infant. C. Move the toddler to a new bedroom with a "grown-up-bed." D. Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant.

D. Plan 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. While acknowledging that time with another adult can be a special time, the main concern is for the toddler to understand they are not being replaced by the newest member of the family.

Which gross motor developmental milestone is least likely for a 2-year-old? A. Climbing stairs with assistance B. Jumps in place C. Stands on one foot with help D. Rides a tricycle

D. Rides a tricycle Gross motor developmental milestones for a 2-year-old include jumping in place, standing on tiptoes, kicking a ball, and running. At 3 years old, the child should be able to pedal a tricycle, run easily, and walk up and down the stairs with alternate feet. At 12 to 18 months of age, the child should be able to stand on one foot with help, walk independently, climb the stairs with assistance, and pull toys.

The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child? A. The child imitates the nurse in use of a stethoscope. B. The child copies a circle on a piece of paper. C. The child follows directions when made one at a time. D. The child demonstrates separation anxiety.

D. The child demonstrates separation anxiety. The child should be past the stage of separation anxiety by age 3 years. Imitating actions, copying a circle on paper, and responding to single requests are developmentally appropriate.

In discussing their 2-year-old's behavior with the nurse, which of the parents' statements suggests the child may be ready for toilet teaching? A. The child frequently repeats words parents just said. B. The toddler walks with a wide, swaying gait. C. The child often removes her shoes and socks. D. The child hides behind her bedroom door when defecating.

D. The child hides behind her bedroom door when defecating. Hiding while defecating indicates awareness of this need. Repeating words promotes language development but doesn't indicate readiness for toilet teaching. Walking with a wide, swaying gait is early walking behavior. Steady walking and running signals toileting readiness. Removal of shoes and socks is easily done. Greater fine motor clothing removal skill is needed for toileting.

A 15-month-old toddler has been brought to the clinic because the toddler is pale and listless. Which finding or observation would lead the nurse to suspect iron-deficiency anemia as the cause of the clinical manifestations? A. The nurse hears a grade 2 heart murmur. B. The toddler drinks very little fruit juice. C. The toddler eats a vegetarian diet. D. The toddler drinks 32 oz (1 L) of milk per day.

D. The toddler drinks 32 oz (1 L) of milk per day. Cow's milk is low in iron content. It should be limited to 16 oz (0.5 L) per day in toddlers. This toddler is drinking 32 oz (1 L) of milk per day, which can contribute to iron-deficiency anemia. A good vegetarian diet would not cause the toddler's symptoms. Generally vegetarian diets are more deficient in vitamins D and B12. The grade 2 heart murmur is most likely innocent. Eating an acidic fruit or drinking the juice with iron-containing foods enhances iron absorption.

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. pull a toy while walking C. kick a ball D. undress himself

D. 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.