Maternal Child Chap 26 Point Qs: Toddler

The student nurse is assigned to care for a 15-month-old child. When developing a care plan addressing the nutritional needs of the toddler, which client goals demonstrate the student nurse's understanding of these needs? (Select all that apply.) A. "The child will drink amounts suggested by the pediatrician of milk and other fluids on a daily basis." B. "The child will be weaned from breastfeeding within the next month." C. "The child will drink milk from a bottle every day for the next 2 months." 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."

"The child will drink amounts suggested by the pediatrician of milk and other fluids on a daily basis." "The child will learn to drink from a cup within the next month." "The child will stop drinking from a bottle while in bed within the next 2 weeks." Rationale: 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.

The parent of a preschooler reports that the child seems to believe in magic. The parent voices concern that this "fantasy world" may become a problem. What response by the nurse is indicated? (Select all that apply.) A. "Fantasy play is most often seen in lonely children in an attempt to occupy themselves." B. "This type of imagination is not normally seen until a child is school aged." C. "Your child is engaging in what we call magical thinking." D. "While imagination is normal, this type of fantasy world can cause problems for your child and should be discouraged." E. "This type of thought process allows your child to begin to observe the differences in the world."

"Your child is engaging in what we call magical thinking." "This type of thought process allows your child to begin to observe the differences in the world." Rationale: Magical thinking is a normal part of preschool development. In magical thinking, the preschooler believes that his or her thoughts are all-powerful. The fantasy experienced through magical thinking allows the preschooler to make room in his or her world for the actual or the real. Through make-believe and magical thinking, preschool-age children satisfy their curiosity about differences in the world around them. There is nothing problematic about this type of imagination.

Parents are proud of their toddler's fast-developing fine motor skills. Which skill should the nurse point out as a safety risk? A. Ability to turn knobs B. Turn book pages C. Put shapes into matching openings D. Hold crayon to write

A. Ability to turn knobs Rationale: 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 learning and involve lesser safety hazards.

The nurse is playing a game with a toddler in the hospital room. What is the most important benefit of this nurse--client interaction? A. Developing a trusting relationship with the nurse B. Utilizing clinical time when the unit is not busy C. Distracting the toddler from expending too much energy with active playing D. Occupying the toddler's time while the parents are meeting with the health care provider

A. Developing a trusting relationship with the nurse Rationale: While all of these are benefits of playing a game with the child, the most important benefit is establishing a relationship with the nurse. This will help the child to be less fearful in an unfamiliar environment and foster a better treatment and recovery period while hospitalized.

The nurse is discussing proper discipline with the parent of a 15-month-old child. Which statement is most important? A. Never spank the child for any reason. B. Use praise when the child is doing something right. C. Toddlers are unable to learn rules easily. D. Rules and limits should be simple and few.

A. Never spank the child for any reason. Rationale: Toddlers younger than 18 months of age should not be spanked due to the possibility of injury. All the other statements describe toddler characteristics accurately and are basic to good discipline but are not the most important for this young toddler.

The parents of a 2-year-old child report to the nurse because their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child? A. Offering a variety of foods along with the foods the child likes B. Advising the parents to minimize distractions at mealtime 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

A. Offering a variety of foods along with the foods the child likes Rationale: Toddlers require fewer calories proportionately than infants, and their appetite decreases (physiologic anorexia). Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods. Prolonged particular food preferences (food jags) are common. It is also important that mealtime be calm, pleasant, and focused on eating. Toddlers mimic behaviors observed. It is important that parents set a good example with their mealtime behaviors and food choices. All options encourage the development of healthy eating habits, but at this time, variety plus preferred foods will be most helpful.

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

B. Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. Rationale: 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 period

The nurse finds the diet of a 30-month-old child to be low in calcium. What suggestion can significantly increase this toddler's calcium intake? A. Include dark greens and spinach in her meals. B. Give her slices of cheddar cheese as a snack. C. Offer chocolate milk to increase milk intake. D. Use unsweetened applesauce as a dessert.

B. Give her slices of cheddar cheese as a snack. Rationale: 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 parent 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 parent's concern? A. Iron-deficiency anemia B. Physiologic anorexia C. Improper snacking D. Poor role modeling

B. Physiologic anorexia Rationale: 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 parent 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 visiting a day care center and watches two toddlers at play. What best describes the play observed? A. Playing for significant stretches of time in one activity B. Playing alongside one another C. Sitting quietly with several toys D. Sharing stuffed animals

B. Playing alongside one another Rationale: Playing beside one another is parallel play and typical of toddlerhood. Toddlers have short attention spans and frequently change toys and activities. Because toddlers are egocentric, sharing is difficult. Toddlers move about and explore during play rather than sit quietly.

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

B. Reasoned with the child to stop the behavior Rationale: 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.

Parents who just moved into their "dream home" are concerned because their toddler, who had achieved daytime bowel and bladder control, has begun wetting and defecating in the underwear. The nurse explains this is called: A. Autonomy B. Ritualism C. Egocentrism D. Regression

B. Regression Rationale: He is returning (regressing) to an earlier, possibly safer stage of development caused by a stressor (moving). Autonomy is a stage of development in Erikson's theory. Egocentrism refers to the toddler's focus on self. Ritualism for toddlers provides sameness, the expected, and security.

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

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

A parent expresses surprise to the nurse that her toddler daughter has begun masturbating. The most important initial nursing response is: A. Toddler girls as well as boys will masturbate. B. This is a normal and expected activity best treated matter-of-factly. C. Check for undue stress in your toddler's life. D. Toilet teaching places much focus on the genitals.

B. This is a normal and expected activity best treated matter-of-factly. Rationale: 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 nurse is recommending food items for an 18-month-old child. Which ones will benefit the child's neurologic system most? A. Ground beef, broccoli, and apple slices B. Vegetable soup, whole wheat bread, and blueberries C. Peanut butter on crackers, cheese, and whole milk D. Oatmeal pancakes with bananas

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

The nurse is reviewing sleep and rest activities of a 16-month-old child with the parents. The parent states, "I have told my spouse it is unhealthy for our child to sleep with us. It's time for the child to sleep in one's 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 healthcare provider to see." B. "Co-sleeping is viewed acceptable by some professionals, but interfering with the child's independence by others." C. "Have you thought about just trying to let your child sleep in one's own bed to see how it goes?" D. "It must be difficult for the two of you to both feel strongly about what is best for you and your child."

D. "It must be difficult for the two of you to both feel strongly about what is best for you and your child." Rationale: Acknowledging the struggle 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 cosleeping, while is accurate, does not address the parent's voiced concerns, nor does noting the sleep activities in the chart. Suggesting the child sleep in one's own bed is not up to the nurse to suggest, and it does not address the issue.

The nurse is teaching parents how to avoid a power struggle with their 2-year-old child. Which comment indicates that more teaching is needed? A. "Both of us, as parents, will agree on and consistently enforce the limits we set." B. "Childproofing our home will make it less necessary to say 'No!'" C. "We will give our child a choice whenever possible." D. "We will make sure our child shares toys with cousins of this age."

D. "We will make sure our child shares toys with cousins of this age." Rationale: A 2-year-old's thinking is not mature enough to include the concept of "sharing." The child sees situations from a child's point of view (egocentrism). That makes sharing with another beyond what the child can accept as an understandable action. All the other statements are age appropriate and support the capabilities and growing independence of the toddler.

A stay-at-home parent wants to purchase commercial toddler meals because the 16-month-old child recently choked on table food. Which food items will the nurse suggest not be given to this child? (Select all that apply.) A. Hard foods such as nuts, raw carrots, and popcorn B. Fruits such as peaches, pears, and kiwi C. Vegetables such as corn, green beans, and peas D. Sticky foods like peanut butter alone, gummy candies, and marshmallows E. Round foods such as hot dogs, whole grapes, and cherry tomatoes

Hard foods such as nuts, raw carrots, and popcorn Sticky foods like peanut butter alone, gummy candies, and marshmallows Round foods such as hot dogs, whole grapes, and cherry tomatoes Rationale: To offer soft round foods safely, cut hot dogs in uneven pieces and quarter grapes and cherry tomatoes. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits.

The parent of a toddler half-jokingly states: "I am so tired of hearing 'NO!' I wish he would stop!" What suggestions will the nurse offer to reduce toddler negativism? (Select all that apply.) A. Offer simple choices: "Blue shirt or red one?" B. Make statements: "It is time for lunch." C. Avoid ending a request with "Okay?" D. Emphasize what is not to be done: "Don't sit there." E. Use humor to make "no" funny: "Do cows bark?" Avoid "yes" and "no" questions.

Offer simple choices: "Blue shirt or red one?" Make statements: "It is time for lunch." Avoid ending a request with "Okay?" Use humor to make "no" funny: "Do cows bark?" Avoid "yes" and "no" questions.

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

The child's vocabulary consists of the words "ball," "dada," "mum," "drink" and "up." The child will not pick up a toy or touch the nose when directed by the nurse.

The nurse is examining a 2-year-old child for speech and language development. Which finding would suggest a delay in speech development? A. The child does not speak clearly but shows understanding of what is said. B. The child puts together sentences of two words. C. The child does not use the names of familiar objects. D. The child repeats what the parents say out of context and at random moments.

C. The child does not use the names of familiar objects. Rationale: 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.

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

C. The child hides behind her bedroom door when defecating. Rationale: 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 signal toileting readiness. Removal of shoes and socks is easily done. Greater fine motor clothing removal skill is needed for toileting.

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old child. 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 sense of control can be provided through offering limited choices. C. Aggressive behaviors such as hitting and biting are common in toddlers. D. A regular routine and rituals will provide stability and security.

D. A regular routine and rituals will provide stability and security. Rationale: Toddlers benefit most from routines and rituals that help them anticipate events and teach and reinforce expected behaviors. Knowing that a child can move from calm to temper tantrum very quickly, understanding the benefit of limited choices, and realizing that hitting and biting are common behaviors in toddlerhood provide information but not a guiding concept.

The nurse is promoting language and cognitive development to the parents of a 3-year-old child. Which guidance about reading with their child will be most helpful? A. Read a different book if he knows the story. B. Have the child sit still during the story. C. Keep story time a reward for being good. D. Ask the child questions as you read.

D. Ask the child questions as you read. Rationale: Engage the child by asking him questions as he listens. This gives him a chance to contribute to the story. The child does not have to sit still. He may want to move around or even act out part of the story. Story time should happen regularly and not be just a reward. Even if the child can tell the story, he may wish to hear it read again because he enjoys the repetition and familiarity.

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

D. Giving the child bowls, pot, pans, and large spoons Rationale: 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.

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

D. I give my child juice at breakfast and when my child is thirsty during the day." Rationale: 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.

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

D. The child demonstrates separation anxiety. Rationale: 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.

Parents and their 35-month-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? A. Asks "why" often B. Half of speech understood by outsider C. Talks about a past event D. Uses two-word sentences or phrases

D. Uses two-word sentences or phrases Rationale: 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.