Exam 2
While observing a 13-month-old and her parents in the playroom of the hospital unit, the nurse notes that the toddler is using her index finger to point towards a toy. What should the nurse say to the parents? "I notice your daughter is using her index finger to point. This is something we should tell the doctor." "How long has your daughter used her index finger to point to objects?" "Your daughter is demonstrating fine motor skills appropriate to her age by pointing with her index finger." "Has your daughter started turning book pages on her own yet."
"Your daughter is demonstrating fine motor skills appropriate to her age by pointing with her index finger." At 12 to 15 months of age the toddler should be feeding herself finger foods and using her index finger to point to objects. Turning the pages of books would not be expected until the age of 18 months.
Parents are beginning to potty train their 2-year-old child and seek advice from the nurse on how to be successful in this endeavor. Which statement by the parents indicates that further teaching is needed? "We will place him on the potty for 5 minutes for each session." "I bought him 'big boy' underwear for him to use instead of diapers." "He wants to accompany me to the bathroom but I prefer to go alone." "I will wait until he is off the toilet before flushing it."
"He wants to accompany me to the bathroom but I prefer to go alone." Allowing a toddler to observe a parent or older sibling going to the bathroom serves as a positive role model and helps the child understand what he or she is to do there.
What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? "I give my daughter juice at breakfast and when she is thirsty during the day." "She drinks three 6-ounce cups of whole milk each day." "When she doesn't eat well at meals we give her nutritious snacks." "New foods are offered along with ones she likes."
"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 assessing the nutrition of a toddler. The parents state that the toddler only will eat grilled cheese sandwiches and macaroni and cheese. Which suggestion(s) would be most helpful? Select all that apply. "Try giving foods like casseroles so the toddler gets all the nutrition needed." "Start with a small amount of new foods on the plate at a time." "Allow your toddler to choose among several different types of food." "Do not be alarmed if the child wants to eat the same food repeatedly." "Try to use colorful foods on the plate."
"Start with a small amount of new foods on the plate at a time." "Do not be alarmed if the child wants to eat the same food repeatedly." "Try to use colorful foods on the plate." Typically, a toddler's appetite is smaller than that of an infant. Offering small amounts of new foods regularly expands the diet and potential nutrients ingested. Also, because the actual amount of food eaten daily varies among toddlers, the nurse should suggest placing a small amount of food on the plate and allowing the toddler to eat it and ask for more, rather than serving a large portion of food the toddler cannot finish. Toddlers also prefer to eat the same type of food over and over because of the sense of security this offers. Toddlers usually do not like food that is "mixed up" such as casseroles. Often they prefer foods that do not touch one another. Moreover, they often prefer brightly colored to bland foods. Allowing choices is appropriate; however, parents should limit the choice to two types of food, rather than several.
A nurse is providing care to a victim of intimate partner violence. Applying the ABCDEs of care, place the actions in the order that reflects this framework from first to last. Use all options. 1. Ensure confidentiality of information. 2. Reassure the victim that he or she is not alone. 3. Ensure that the victim has resources and a plan of action for when he or she decides to leave. 4. Express the belief that violence against women is not acceptable. Provide education about the cycle of violence. 5. Document the findings.
1. Reassure the victim that he or she is not alone. 2. Express the belief that violence against women is not acceptable. 3. Ensure confidentiality of information. 4. Document the findings. 5. Provide education about the cycle of violence. 6. Ensure that the victim has resources and a plan of action for when he or she decides to leave. Explanation: When applying the ABCDEs of caring for victims of intimate partner violence, "A" is reassuring the victim that he or she is not alone; "B" is expressing the belief that violence is not acceptable in any situation; "C" is confidentiality, since the victim might believe that if the abuse is reported, the abuser will retaliate; "D" is documentation; "E" is education about the cycle of violence and that it will escalate; "S" is safety, the most important aspect of the intervention, to ensure that the victim has resources and a plan of action to carry out when he or she decides to leave.
During a well-child visit, a parent tells the nurse that they use time-out to discipline their 2-year-old child. The nurse determines that the parent understands the concept of time-out when the parent states keeping the child in time-out for how long? 30 seconds 4 minutes 1 minute 2 minutes
2 minutes Time-out is a discipline technique that involves placing the child in an area with decreased stimulation for several minutes following unacceptable behaviors. A guide regarding how long the child should remain in time-out is 1 minute per year of age. So for a 2-year-old child, the time-out time should be 2 minutes.
When assessing a 33-month-old, the nurse would expect to find how many teeth? 8 12 16 20
20 Explanation: Eight new teeth erupt during the second year. All 20 deciduous teeth are generally present by 2.5 to 3 years of age.
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. Engage in parallel play Zip up their own jackets Creep up stairs Name one color Run and jump in place
Correct response: 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.
The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which observation would suggest the child is experiencing a problem with language development? Her vocabulary is between 10 and 15 words. She asks many questions. She uses complete 3- to 4-word sentences. She talks incessantly.
Her vocabulary is between 10 and 15 words. A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly. Thus a vocabulary of 10 to 15 words suggests a language problem.
A pediatric nurse is providing anticipatory guidance for the parents of an infant entering the toddler stage. Which instructional topics are appropriate at this time? Select all that apply. toddler's waning need for developing independence Importance of establishing realistic goals need to remain steadfast in their approach to the child development of problem-solving skills for use throughout the child's growth need for developing good communication skills
Importance of establishing realistic goals development of problem-solving skills for use throughout the child's growth need for developing good communication skills Anticipatory guidance involves instructing parents on their child's next developmental level. The instruction is aimed at understanding the level prior to seeing the development occur. During toddlerhood, as abilities of the child increase, the child will be striving for autonomy or independence. As a result, the parents must learn to adapt to the toddler's changes. Realistic goals and the ability to change and adapt are necessary to foster growth and meet the rapidly changing needs of the toddler. Parents need to learn how to approach a current situation and also learn adequate methods for resolving similar situations sure to arise in the future, such that they can apply these methods throughout the child's growing years. Communication also is essential to foster independence and development.
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? Reasoned with the child to stop the behavior Tried to refocus the child's attention as tantrum behavioral cues appeared Made sure the child was rested and not hungry before going to the mall Remained relatively calm even though embarrassed
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.
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. Tantrums at this age can signal the development of an aggression disorder in a toddler. Tantrums are a common occurrence for a toddler of this age. Maintaining a consistent daily routine can help to reduce tantrums. Ignoring the behavior is often helpful in reducing the duration of the tantrum. Tapping the toddler on the hands and voicing displeasure in the toddler's actions can successfully interrupt the behavior.
Tantrums are a common occurrence for a toddler of this age. Maintaining a consistent daily routine can help to reduce tantrums. Ignoring the behavior is often helpful in reducing the duration of the tantrum. 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.
If the toddler is following a normal pattern of dentition at 22 months of age, which teeth would have most recently erupted? cuspid central incisor lateral incisor second molar
cuspid Explanation: By the age of 24 months, the child will have the incisors, cuspid, and first molars erupted. The cuspids will have erupted between 17 and 23 months of age. The second molars erupt between 23 and 33 months of age.
A mother brings her 10-year-old daughter in and tells the nurse that she believes the child has a brain tumor and quickly runs through a list of some classic symptoms associated with brain cancer. On examination and after performing routine blood work, however, the nurse finds nothing wrong with the child. The child says that she feels fine. When the nurse reviews the client's chart, she finds that this is the sixth time the mother has brought the girl in for various serious conditions in the past 6 months. Which of the following situations does the nurse suspect? medical child abuse psychological maltreatment physical neglect failure to thrive
medical child abuse Explan: Medical child abuse, formally known as Munchausen syndrome by proxy, refers to a parent who repeatedly brings a child to a healthcare facility and exaggerates, invents or induces symptoms of illness when, in fact, the child is well For example, a parent might report symptoms such as seizures, excessive sleepiness, or abdominal pain in a child. Because of these symptoms, the child is submitted to needless diagnostic procedures or therapeutic regimens. There is no evidence of psychological maltreatment, physical neglect, or failure to thrive in this case.
The nurse is caring for a client in an abusive situation. In developing a plan of care, which factors does the nurse consider? Select all that apply. It often takes several attempts before a woman leaves an abusive situation. Economic factors rarely play a role in the decision to stay in abusive relationships. Until children reach school age, they are usually not affected by parental discord. Women in abusive relationships usually feel isolated and unsupported. Substance use is a common factor in abusive relationships.
It often takes several attempts before a woman leaves an abusive situation. Women in abusive relationships usually feel isolated and unsupported. Substance use is a common factor in abusive relationships. Explanation: Factors that need to be considered include the following: It often takes several attempts before a woman leaves an abusive situation; women in abusive relationships usually feel isolated and unsupported; and substance use is a common factor in abusive relationships. Economic factors are often a factor because the partner/abuser usually controls the financial resources. Toddlers and preschool-age children can be affected by parental discord and intimate partner violence (physical, emotional, verbal) that takes place in the household.
The nurse is completing a physical assessment of a 24-month-old child who was born at 33 weeks' gestation. Which objective data provide the basis for documenting that this child has progressed from the 15-month-old to the 18-month-old developmental level? Select all that apply. Uses an 8-word vocabulary. Walks while holding the hand of a parent. Stacks two blocks. Follows simple commands such as "sit down." Uses a spoon to feed self.
Uses an 8-word vocabulary. Follows simple commands such as "sit down." Uses a spoon to feed self. Physical assessment and documentation of growth and development is important when analyzing a child who was born at 33 weeks' gestation. The assessment data allow the nurse to determine progress in development. For the 24-month-old child to progress to the 18-month-old developmental level, the objective data would include behaviors that would occur at 18 months of age, such as an increase in vocabulary to an amount typically seen in 18-month-old children. An increase from 4 words to 9 words takes place at the 18-month-old developmental level. Also, following simple commands and feeding oneself with a spoon indicates both cognitive and motor development, which occurs at the 18-month-old level. Needing to hold the hand of a parent while walking occurs at the time that walking begins (around 9 to 12 months) and continues as the child's balance improves. Holding another person's hand does not show progression. Stacking two blocks does not indicate progression to the 18-month-old developmental level; it is identified previously at the 15-month-old developmental level.
The triage nurse receives a phone call from a client stating, "I was just raped and I need help. What should I do?" Which response by the nurse is a priority? "Tell me if you are in a safe location away from the assailant now." "Go to the nearest rape crisis center for a medical examination." "You need to call the local authorities and they will help you file a report." "Come to the emergency department and do not shower or change clothes."
"Tell me if you are in a safe location away from the assailant now." Explan: It is a priority for the nurse to determine the client's safety. After ensuring the client is safe, the nurse would tell the client to come to the emergency department, not a crisis center, prior to bathing or changing clothes. The authorities will be contacted from the emergency department. It is best to obtain evidence and specimens as soon as possible after the attack.
A mother of a 2-year-old girl is asking her friend when she should start potty training the child. The mother expresses concern about the high cost of diapers and training pants and would really like to have her trained as soon as possible. Which advice by the friend would be considered the best response? "You will just have to condition yourself to take her to the potty chair every hour until they get the hang of it." "I started training my kids when they started to pull themselves up to a standing position." "It doesn't hurt to start when they turn 2 as long as you don't punish them for having many accidents." "When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training."
"When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training." 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, or they may bring a parent a clean diaper after they have soiled so they can be changed. The other answers do not address this. Usually the child needs to walk well independently before training can occur.
The nurse is preparing to assess a 2-year-old at a well-child visit and notes the child was 22 lbs (9.98 kg) and 24 in (60.96 cm) tall at 1 year old. The nurse determines the child is following a normal pattern of growth after obtaining which set of current measurements? 27 lbs (12.27 kg) and 26 in (66.04 cm) tall 32 lbs (14.54 kg) and 27 in (68.58 cm) tall 38 lbs (17.27 kg) and 32 in (81.28 cm) tall 40 lbs (18.18 kg) and 33 in (83.82 cm) tall
32 lbs (14.54 kg) and 27 in (68.58 cm) tall Explanation: Toddlerhood is a time of slowed growth and rapid development. Each year the toddler gains 4.5 to 6.0 lb (2. to 2.7 kg) and about 3 in (7.62 cm). A child weighing 22 lbs (9.98 kg) at age 1 year would be expected to now weigh 31 to 34 lbs (14.1 to 15.45 kg). A height of 24 in at age 1 year (60.96 cm) should now be approximately 27 in (68.58 cm).
The nurse is assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern? Ability to turn door knobs Put shapes into matching openings Able to use a spoon to self-feed Ability to hold a crayon to write
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.
The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior? The need for separation and control The need for love and belonging The need for safety and security The need for peer approval
The need for separation and control Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.
A nurse is presenting a class on discipline for a group of parents of toddlers. What information would be important for the nurse to teach this group? Select all that apply. Toddlers cannot learn self-control until at least 3 to 4 years of age. Consistency in the rules is important so the child understands what is expected. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Even at this young age, children need boundaries. If a child hits or bites another child, the parents should scold them, saying such things as "You are very naughty for biting Rachel."
onsistency in the rules is important so the child understands what is expected. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Even at this young age, children need boundaries. Discipline for toddlers must have consistency and correct timing. Parents need to come to a consensus on how to discipline their child and do so consistently and in a unified fashion. Also, the toddler needs to receive negative feedback for negative behavior as soon as the infraction occurs so the child understands what they did wrong. Parents should never label the child as bad, just their behavior. Every child needs boundaries—it is just that every family's boundaries may vary. Discipline begins early in life and toddlers can learn self-control.
