Evolve Toddlers

A nurse is obtaining a health history from the parents of a toddler who has recently diagnosed acute lymphocytic leukemia. Which early physiologic changes does the nurse expect the parents to report? Select all that apply. 1 Pale skin 2 Loss of hair 3 Eating less food 4 Sores in the mouth 5 Purple spots

1,3,5 Pallor is a presenting sign of leukemia and reflects anemia because of decreased erythrocytes. Lack of appetite (anorexia) resulting in the consumption of less food is a presenting symptom of leukemia; it may be the result of enlarged lymph nodes and areas of inflammation in the intestinal tract. Decreased platelet production with petechiae and bleeding is a presenting sign of leukemia. Alopecia results from chemotherapy, not the leukemia. Sores in the mouth are not a presenting sign but often result from chemotherapy.

A nurse is teaching a group of assistants in a daycare center about toddlers' developmental milestones. What behavior should indicate to the assistants that one of the milestones has been achieved? 1 Trusting others 2 Accepting external limits 3 Initiating superego control 4 Distinguishing roles in society

2

A toddler is being discharged after myringotomy. What potential complications should the nurse teach the child's parents to report? Select all that apply. 1 Bleeding 2 Headache 3 Increased pain 4 Lack of drainage 5 Moderate hearing loss

3, 4

A nurse plans to talk to the parents of a toddler about toilet training. What should the nurse tell the parents is the most important factor in the process of toilet training? 1 Parents' attitude about it 2 Child's desire to remain dry 3 Child's ability to sit still on the toilet 4 Parents' willingness to work at the toilet training

1 The parents' attitude, approach, and understanding of the child's physical and psychological readiness are essential to letting the child proceed at his or her own pace with appropriate parental intervention. A child's desire to remain dry is not the major motivation for toilet training. Although the child's ability to sit still on the toilet is definitely a factor, it is not a major one. A parents' willingness to work at the toilet training is, of course, a factor, but the major factor is the child, who is strongly influenced by the parents' attitudes and approach.

Besides hospital policy, what is one of the most important factors that a nurse must consider when parents of a toddler ask to be present for a procedure being performed on the hospital unit? 1 Type of procedure to be performed 2 Individual assessment of the parents 3 Whether the toddler wants the parents present 4 Probable reaction to the toddler's response to pain

2

A nurse knows that play is an integral part of a child's social development. Place in order the types of play children engage in as they get older. 1. Dramatic play 2 Solitary play 3.Competitive team play 4. Parallel play 5. Peer group team play

Solitary > Parallel > Dramatic > Peer group > Competitive The infant plays alone, inspecting the self and the environment and manipulating toys (solitary play). The toddler plays next to, but not with, other children; toys are inspected, tested, and used in new ways (parallel play). The preschooler loves to dress up, play house, imitate adult behavior, and use the imagination (dramatic play). The young school-aged child enjoys playing team games; the rules are made up by the child during the game (peer group team play). The middle school-aged child plays organized team games (e.g., Little League) with prearranged, specific rules (competitive team play).

During the second week of hospitalization for intravenous antibiotic therapy, a 2-year-old toddler whose family is unable to visit often smiles easily, goes to all the nurses happily, and does not express interest in the parent when the parent does visit. The parent tells the nurse, "I'm so happy he's adjusting, but should I be worried about his reaction to seeing me?" What is the best response by the nurse? 1 The child is repressing feelings for the parent. 2 Routines have been established and the child feels safe. 3 The child has given up fighting and accepts the separation. 4 Behavior has improved because the child feels better physically.

1 Detachment is the result of trying to escape the emotional pain of desiring the mother by repressing feelings for her. Responding that routines have been established and the child feels safe is an interpretation that is not appropriate to the situation. Stating that the child has given up fighting and accepted the separation is a conclusion that cannot be drawn from this situation. Stating that the behavior has improved because the child feels better physically response lacks insight.

A 13-month-old child is admitted with a tentative diagnosis of bacterial meningitis, and the practitioner schedules a lumbar puncture. What is the most important action the nurse should take in preparation for the lumbar puncture? 1 Asking the parents what they were told about the test 2 Using a doll to demonstrate the procedure to the child 3 Obtaining a pacifier for the child to suck on during the procedure 4 Telling the parents that they may stay with their child during the test

1 Informed consent is required. The procedure should be explained to the parents by the practitioner, and the nurse should confirm the parents' comprehension and have them sign the consent form. The child is too young to comprehend a demonstration of the procedure. Although staying with the child may be important to the parents, it is not the priority. Although a pacifier may keep the child calm, this is not the priority, either.

When reviewing the results of a toddler's complete blood count, a nurse concludes on the basis of decreased hemoglobin and hematocrit levels that the child has iron-deficiency anemia. Which other laboratory findings are indicative of iron-deficiency anemia? Select all that apply. 1 Microcytic red blood cells 2 Hyperchromic red blood cells 3 Low total iron-binding capacity 4 Slightly reduced reticulocyte count 5 Increased erythrocyte sedimentation rate

1,4 In iron-deficiency anemia the red blood cells are microcytic, with a decreased mean corpuscular volume. The reticulocyte count is within the expected range or slightly reduced. The red blood cells are hypochromic, not hyperchromic. The total iron-binding capacity is increased in children with iron-deficiency anemia as the body attempts to absorb more iron. An increased erythrocyte sedimentation rate (ESR) indicates an inflammatory process. The ESR is not related to iron-deficiency anemia.

Which of the following signs are indications of hydration status during a sickle cell crisis? Select all that apply. 1 Turgor of tissue 2 Edema of the ankles 3 Specific gravity of urine 4 Amount of urinary output 5 Texture of mucous membranes

1,5 Loss of tissue elasticity (decreased tissue turgor) indicates dehydration. Skin that takes 30 or more seconds to return to its original position after being pinched (tenting) is a sign of dehydration. Dry mucous membranes indicate inadequate hydration; moist mucous membranes indicate adequate hydration. The problem is dehydration, not retention of fluid; ankle edema is associated with interstitial fluid accumulation around the ankles. The amount and specific gravity of urine are not reliable indicators of hydration, because the kidneys' ability to concentrate urine is impaired in sickle cell anemia.

A toddler with a puncture wound to the sole is brought to the emergency department. Because of a language barrier the caregiver cannot provide a clear history of previous tetanus immunizations. Tetanus immunoglobulin (TIG) is prescribed by the practitioner. The nurse explains to the caregiver that this medication is given because it: 1 Produces lifelong passive immunity to tetanus 2 Confers short-term passive defense against tetanus 3 Induces long-lasting active protection from tetanus 4 Stimulates the production of antibodies to fight tetanus

2 TIG contains antibodies, not the live or attenuated virus; it confers short-term passive immunity that is temporary. Tetanus toxoid, not TIG, stimulates the production of antibodies.

A toddler with a history of enlarged lymph nodes, prolonged fever that is unresponsive to antibiotics, erythema of the extremities, and a rash is admitted to the pediatric unit with a diagnosis of Kawasaki disease. What does the nurse suspect was essential in confirming this diagnosis? 1 An increased ASO titer 2 A combination of signs 3 A low-grade temperature 4 An increased sedimentation rate

2

A 2-year-old child is admitted to the pediatric unit with a diagnosis of thalassemia major (Cooley anemia). The parents are told that there is no cure but the anemia can be treated with frequent blood transfusions. The father tells the nurse he is glad that there is a treatment that "fixes" his child's problem. Before responding, the nurse should recall that blood transfusions: 1 Correct the anemia but may cause other problems 2 Reverse the anemia but also present a risk of hepatitis 3 Are a supportive treatment; fewer will be needed as the child grows older 4 Are a replacement for defective red blood cells; they are like giving insulin to a person with diabetes

1

A nurse anticipates that surgery will be needed for an 18-month-old child with undescended testes because: 1 Psychological damage is limited. 2 Maturation of testes starts at age 7. 3 Future malignancy may be prevented. 4 The puboscrotal ring is more elastic at age 2.

1

An 18-month-old toddler who stepped on a rusty nail 4 days ago shows signs of generalized tetanus, including neck and jaw stiffness and facial muscle spasms. The toddler is receiving intravenous diazepam (Valium) as a muscle relaxant every 4 hours. What response to the medication does the nurse anticipate? 1 Control of hypertonicity and prevention of seizures 2 Control of laryngospasms and neck and jaw rigidity 3 Prevention of excess oxygen and caloric expenditure 4 Prevention of restlessness and resistance to assisted ventilation

1

When planning long-term care for a 2-year-old child with cerebral palsy (CP), it is important for the nurse to consider that: 1 CP is not progressively degenerative. 2 The effects of CP are unpredictable. 3 The child probably has some degree of cognitive impairment (CI). 4 The child should have genetic counseling before planning a family.

1

A health care provider diagnoses acute nonlymphoid leukemia in a 2½-year-old child and the child is admitted to the hospital. What clinical manifestations of the disease should the nurse expect when assessing the child? Select all that apply. 1 Anorexia 2 Petechiae 3 Irritability 4 Skin pallor 5 Listlessness

12345 Anorexia and vague abdominal discomfort occur because of areas of intestinal inflammation. Bleeding tendencies (e.g., petechiae, bleeding gums) occur because of decreased platelets. Irritability results because of the stress of the pathophysiological changes that occur with the disease. Pallor results because of decreased erythrocytes (anemia). Listlessness and lethargy result because of decreased erythrocytes (anemia).

In addition to hepatitis B, pneumococcal, H. influenza type B, and varicella vaccines, what should the nurse expect a 20-month-old child who has been receiving immunizations on schedule to have had? 1 Two DTaPs, two IPVs, and one MMR 2 Four DTaPs, three IPVs, and one MMR 3 Three DTaPs, two IPVs, and two MMRs 4 Three DTaPs, three IPVs, and three MMRs

2 By 18 months of age a child should have received four diphtheria, tetanus, and pertussis (DTaP) vaccinations, three inactivated polio vaccinations (IPVs), and one measles, mumps, rubella (MMR) vaccination, as well as hepatitis B, pneumococcal, Haemophilus influenzae type B, and varicella vaccines.

An 18-month-old toddler who is inadequately immunized contracts tetanus after sustaining a puncture injury. The parents are concerned about how the disease will affect their child's intellectual abilities in the future. What is the best response by the nurse concerning the child's intellectual function? 1 "There may be some damage." 2 "Intellect should remain intact." 3 "It depends on the severity of complications." 4 "Development of the intellect may be delayed."

2 The higher brain centers are not invaded by the exotoxin. Interference with intellectual function occurs as a result of inadequate management of oxygen needs during episodes of respiratory difficulty, not the disease process.

A nurse in the pediatric clinic is advising the mother of a toddler who has a pinworm infestation. What should the nurse teach the mother about caring for her child during and after treatment? Select all that apply. 1 How to identify pinworm eggs 2 Strategies to prevent reinfestation 3 The need for medication for the entire family 4 The importance of handwashing before eating 5 The reason for obtaining stool specimens from the child

2 3 5

A nurse in the pediatric clinic is taking the health history of a toddler with an exacerbation of eczema. What are the nurse's priority assessments of the child? Select all that apply. 1 Increase in appetite 2 Wearing cotton clothes 3 Tolerance of new foods 4 Exposure to a viral infection 5 Recent contact with someone with eczema

2,3 Eczema is a common manifestation of allergies in the young child and is often related to foods and clothing. Wearing cotton clothing indicates that the parents understand and are trying to minimize their child's allergic reaction. Tolerance of new foods is a positive sign that the child is outgrowing some food allergies. Appetite does not play a role in the occurrence of eczema. Eczema is an allergic manifestation; it is not contagious.

Which healthy snacks should the nurse teach the parents to give their 2-year-old child who has a diagnosis of acute asthma? Select all that apply. 1 Grapes 2 Ice cream 3 Apple slices 4 Oatmeal cookies 5 Sliced vegetables 6 Cold glass of milk

3,5 Apple slices are easy to handle and chew and provide excellent nutrition for a toddler. Vegetables cut up into small pieces can be handled and chewed effectively by a 2-year-old child; also, they are nutritious and help prevent constipation. Cookies are high in fat and sugar and are not as healthy as fruit. Cold fluids and foods may cause bronchospasm and should be avoided. Grapes are unsafe; a toddler may choke because of the shape of the grape and because of its skin.

At 2 years of age a child is readmitted to the hospital for additional surgery. What is the most important factor in preparing the toddler for this experience? 1 Gratification of the child's wishes 2 Previous experience of being hospitalized 3 Avoidance of leaving the child with strangers 4 Assurance of continuation of parental affection

4

By what route should the nurse administer the chelating agent calcium disodium edetate (EDTA) to a toddler? 1 Transdermally 2 Orally with milk 3 Z-track injection 4 Intravenous infusion

4

What clinical signs should lead a nurse to suspect that a 1-year-old child has rubella (German measles)? 1 Bulging fontanel and nuchal rigidity 2 Conjunctivitis and sensitivity to light 3 Koplik spots on the soft palate and buccal mucosa 4 Enlarged posterior cervical and postauricular nodes

4

The parents of a toddler with a right ventriculoperitoneal (VP) shunt for the treatment of hydrocephalus are taught about postoperative positioning. The nurse concludes that they understand the teaching when they state that they will place the infant: 1 In the position that provides the most comfort 2 On the back with a small support beneath the neck 3 On the abdomen with the head turned to the left side 4 Flat on the left side with the head and back supported

4 The side-lying position on the unaffected side and the use of supports help prevent pressure on the shunt; the horizontal position prevents too-rapid drainage of cerebrospinal fluid. Basing the infant's placement in the immediate postoperative period solely on comfort is unsafe. Neck supports should not be used for infants because they flex the neck, which can cause airway occlusion. The prone position is contraindicated; turning the head to the side puts pressure on the shun

A nurse is teaching the mother of an 18-month-old toddler with iron-deficiency anemia about her child's dietary needs. What foods should the nurse suggest for inclusion in the child's diet? 1 A slice of pumpkin pie 2 1 cup of seedless grapes 3 Slices from a whole apple 4 Gingerbread molasses cookies

4 Gingerbread cookies made with molasses are an excellent source of iron. They may be eaten as a finger food, which toddlers prefer. Pumpkin pie provides some protein and iron but has a spicy taste that is generally not a favorite of toddlers. Although grapes contain iron, a cup is an excessive amount for an 18-month-old child to ingest. Apples, although nutritious, are low in protein and iron.

The mother of a 30-month-old toddler who has been treated for pinworm infestation is taught how to prevent a recurrence. Which statement by the mother indicates that the teaching has been effective? Select all that apply. 1 "I'll keep the cat off my child's bed." 2 "I'll disinfect my child's room every 2 days." 3 "We'll need to wash all of our sheets every day." 4 "I need to tell the school nurse to have all surfaces disinfected." 5 "I'll have the whole family take the medication again in 2 weeks.

3,5 Washing clothing and bed linens daily will help limit transmission. Medications such as mebendazole (Vermox), pyrantel pamoate (Antiminth), and pyrvinium (Povan) are effective but must be repeated in 2 weeks to prevent reinfestation. Cats do not transmit pinworms. Disinfection of surfaces does not help prevent transmission. The rectal-oral cycle must be completed for infestation to occur.

A 2½-year-old child is admitted to the hospital with deep partial-thickness burns involving the face and chest. The nurse bases a plan of care on concerns related to the child's injury. Place the following concerns in their order of importance. 1. Disturbed fluid balance 2. Impaired gas exchange 3. Potential for infection 4. Presence of pain 5. Compromised body image

Rationale: A compromised airway may occur with burns to the face and chest as a result of inhalation of hot gases and smoke, which cause mucosal damage and edema. Deep partial-thickness burns are painful; pain management is a priority after maintenance of a patent airway and promotion of gas exchange. Because of the fluid and electrolyte losses during the first 24 to 36 hours and the resulting shift of electrolytes after the first 24 to 36 hours, fluid and electrolyte balance become a priority after airway maintenance and pain management. Prevention of infection becomes a priority after airway maintenance, pain management, and maintenance of fluid and electrolyte balance; the potential for infection increases as the postinjury time frame progresses because of the damaged dermis. Body image becomes more of a priority after immediate physiological needs have been met.

Two hours after a 1-year-old child with acute laryngitis is admitted to the hospital, the nurse observes increases in the child's respiratory and cardiac rates, increased restlessness, and substernal and intercostal retractions. What action should the nurse take immediately? 1 Removing the secretions with a suction apparatus 2 Increasing the concentration of oxygen that is being delivered 3 Striking the child on the back repeatedly to help dislodge the mucus 4 Calling the health care provider to report the child's respiratory status

4 A tracheostomy may be necessary to maintain an open airway; therefore the healthcare provider needs to be notified immediately. The child's change in status is not indicative of increased secretions. Suctioning could precipitate laryngospasm and should be avoided in this case. Increased oxygen therapy will be ineffective with a severe spasm of the airway. Striking the child on the back is ineffective against laryngeal spasm.