Chapter 26: Growth and Development of the Toddler

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

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.

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? "My toddler has temper tantrums when we go to the store." "Every night my toddler follows the same routine at bedtime." "When my toddler falls down, they always wants me to pick them up." "My toddler uses the potty chair and is dry all day long."

"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.

A grandmother who is the primary caregiver of a 2-year-old is expressing concern about how to best handle the temper tantrums that can occur two or three times a day, often in public places. She explains she spanked her own children for this but she is worried this is not the best way to handle the situation. Which response from the nurse will best address this concern? "Remain calm, pick the child up, and move to a quiet and neutral place until the child gains self-control; don't give in to the child's demands." "Remind the child that they are in a public place and ask the child to respect those around them; reward the child if the child responds by calming themself." "Warn the child that they will be punished when they are back at home then follow through with the punishment." "Spanking is controversial but sometimes necessary, so use it if it works."

"Remain calm, pick the child up, and move to a quiet and neutral place until the child gains self-control; don't give in to the child's demands." Remaining calm is a must. It is not easy to handle a small child who drops to the floor screaming and kicking in rage in the middle of the supermarket or the sidewalk, nor are comments from onlookers at all helpful. The best a caregiver can do is pick up the out-of-control child as calmly as possible and carry him or her to a quiet, neutral place to regain self-control. Reasoning, scolding, or punishing during a tantrum is useless. Do not yield the point or give in to the child's whim. That would tell the child that to get whatever one wants, a person need only throw oneself on the floor and scream. The child would have to learn painfully later in life that people cannot be controlled in this manner. Spanking or other physical punishment usually does not work well because the child is merely taught that hitting or other physical violence is acceptable and a child who is spanked frequently becomes immune to it.

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? "Your husband is correct, at the age of 2 your son should have a good amount of urine control." "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." "Two years old is rather early for a boy to be potty-trained." "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

"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 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? 5 ml/hr 15 ml/hr 20 ml/hr 10 ml/hr

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.

A 3-year-old child is seen at the clinic for a checkup. When collecting information, the child's parent reports concern about the child's stools because sometimes the child passes what appears to be undigested food. What response by the nurse is appropriate? "Why are you concerned about this?" "Do you notice other symptoms, such as pain or straining, when this happens?" "Your child may be eating foods that are too harsh or difficult to digest." "At this age, the digestive tract is not completely mature and children may pass undigested food."

"At this age, the digestive tract is not completely mature and children may pass undigested food." The digestive systems of 3-year-old children are not fully mature and they may sometimes pass pieces of undigested food. This is a normal occurrence. The reason for this occurrence should be explained to the child's parent. When the nurse asks the parent "Why," this is demonstrating poor therapeutic communication skills and will cause the parent to become defensive. The symptoms of pain or straining would be indicative of constipation, not passing undigested food. There is no indication that the diet being ingested is not appropriate.

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. "Avoid using physical punishment unless your toddler's behavior is really out of line." "It is better to praise correct behavior than to punish wrong behavior." "You need to wait until the toddler is old enough to understand the rules." "If you allow an unwanted behavior one time at this age, it is difficult to reverse later." "Try using time-out, assigning 1 minute per year of your toddler's age."

"If you allow an unwanted behavior one time at this age, it is difficult to reverse later." "Try using time-out, assigning 1 minute per year of your toddler's age." "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. P hysical punishment is not recommended. Having a consistent caregiver is important for reducing separation anxiety.

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

"Limit the number of questions you ask of her." "Make a statement instead of asking a question." "Offer her two options from which to choose." 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.

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

"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." Because growth slows abruptly after the first year of life, a toddler's appetite is usually less than an infant's. Children who ate hungrily 2 months earlier now sit and play with their food. It is important to educate parents while the child is still an infant 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.

In working with the toddler, which statement would be most appropriate to say to the toddler to decrease the behavior known as negativism? "Do you want help getting into your chair so we can have lunch?" "It is time for lunch. I am going to put your bib on." "Are you getting hungry and ready for lunch?" "You love having the same food every day. Do you want apples again with lunch?"

"It is time for lunch. I am going to put your bib on." Negativism is very typical of the toddler years. It is best to avoid questions with a yes or no answer because the answer will always be no. Limiting the number of questions asked of the toddler and making a statement, rather than asking a question or giving a choice, is helpful in decreasing the number of negative responses from the child. Instead of asking questions like "Do you want help getting in your chair?" make the statement "Get in your chair." The toddler years are also ones where the child becomes a picky eater or "grazes" instead of eating a full meal so the toddler may not actually know if he or she is hungry.

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? "Co-sleeping is viewed acceptable by some professionals, but as interfering with the child's independence by others." "It must be difficult for the two of you to both feel strongly about what is best for you and your child." "Have you thought about just trying to let your child sleep in his own bed to see how it goes?" "I will note this in your child's chart for the doctor to see."

"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.

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. "This is a normal happening for a toddler of this age." "This is actually a regression for your toddler because separation anxiety normally occurs in infancy." "Your care providers may be frightening to your toddler." "As your toddler begins to learn that you will return the toddler will become less upset." "Establishing a routine for saying goodbye to your toddler will be helpful."

"This is a normal happening for a toddler of this age." "As your toddler begins to learn that you will return the toddler will become less upset." "Establishing a routine for saying goodbye to your toddler will be helpful." 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 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? "Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." "Encourage your son to watch his older siblings use the toilet." "Each time you change his diaper, tell your son how important and fun it is to use the potty chair." "Get your son a potty chair and have him sit on it for a few minutes each day."

"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." To be able to cooperate in toilet training, the child's anal and urethral sphincter muscles must have developed to the stage where the child can control them. Control of the anal sphincter usually develops first. The child also must be able to postpone the urge to defecate or urinate until reaching the toilet or potty and must be able to signal the need before the event. In addition, before toilet training can occur, the child must have a desire to please the caregiver by holding feces and urine rather than satisfying his/her own immediate need for gratification. This level of maturation seldom takes place before the age of 18 to 24 months.

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? "We will ignore our child while having the tantrum." "We will offer our child a treat to stop having the tantrum." "We will place our child in time-out for 5 minutes after the tantrum." "We will attempt to reason with our child to limit tantrums."

"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 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? "We will place our child in time-out for 5 minutes after the tantrum." "We will attempt to reason with our child to limit tantrums." "We will offer our child a treat to stop having the tantrum." "We will ignore our child while having the tantrum."

"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.

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? "Our time-out chair is in the master bedroom so my child cannot see anyone else in the family." "We use the time-out chair when our child gets tired but does not want to take a nap." "When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." "My child is 3 years old now and I put my child in time-out for 5 to 10 minutes when misbehaving."

"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 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? "Does your toddler use sentences with 3 or 4 words?" "Is your toddler able to use singular and plural words correctly?" "Can your toddler state his or her name and indicate his or her age?" "When you say "no" does your toddler seem to understand the meaning?"

"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

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? "Do not worry. This is a normal response to being in the hospital." "Why do you believe your child is refusing to use the potty?" "Once discharged, your child will quickly learn to use the toilet again." "Your child is experiencing regression as a result of stress."

"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.

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? "Once discharged, your child will quickly learn to use the toilet again." "Do not worry. This is a normal response to being in the hospital." "Your child is experiencing regression as a result of stress." "Why do you believe your child is refusing to use the potty?"

"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.

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? "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." "How long has your daughter used her index finger to point to objects?" "I notice your daughter is using her index finger to point. This is something we should tell the doctor."

"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.

By what age should the child know his/her own gender? 4 years 2 years 1 year 3 years

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.

A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene? 3-year-old preschool-aged child who goes up stairs on hands and knees 9-month-old infant who can pull self up to a standing position 24-month-old toddler who engages in parallel play 14-month-old toddler who walks with a parent's assistance

3-year-old preschool-aged child who goes up stairs on hands and knees At 3 years of age, a child should be able to climb the stairs one step up at a time or using alternating feet. If the child can only go up on hands and knees, further evaluation is needed. At 9 months of age, an infant can pull oneself up to a standing position and sometimes is able to cruise around furniture or even walk. Toddlers begin to walk between 9 and 18 months of age. Toddler at 24 months of age engage in parallel play rather than cooperative play.

The nurse is interviewing a 3-year-old girl who tells the nurse: "Want go potty." The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern? A) "This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech." B) "This is considered a developmental delay in the 3-year-old and we should consult a speech therapist." C) "This is a condition known as echolalia and can be corrected if you work with your daughter on language skills." D) "This is a condition known as stuttering and it is a normal pattern of speech development in the toddler.

A) "This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech."

After teaching a group of parents about language development in toddlers, which of the following if stated by a member of the group indicates successful teaching? A) "When my 3-year-old asks 'why?' all the time, this is completely normal." B) "A 15-month-old should be able to point to his eyes when asked to do so." C) "At age 2 years, my son should be able to understand things like underor on." D) "An 18-month-old would most likely use words and gestures to communicate."

A) "When my 3-year-old asks 'why?' all the time, this is completely normal."

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. Which would the nurse correctly include in this description? A) Myelinization of the brain and spinal cord is complete at about 24 months. B) Alveoli reach adult numbers by 3 years of age. C) Urine output in a toddler typically averages approximately 30 mL/hour. D) Toddlers typically have strong abdominal muscles by the age of 2.

A) Myelinization of the brain and spinal cord is complete at about 24 months.

The nurse is teaching the parents of an overweight 18-month-old girl about diet. Which intervention will be most effective for promoting proportionate growth? A) Remove high-calorie, low-nutrient foods from the diet. B) Ensure 30 minutes of unstructured activity per day. C) Avoid sharing your snacks and candy with the child. D) Reduce the amount of high-fat food the child eats.

A) Remove high-calorie, low-nutrient foods from the diet.

The parents of a 1-year-old girl, both of whom have perfect teeth, are concerned about their child getting dental caries. Which is the best advice the nurse can provide? A) Tell the parents to limit the child's eating to meal and snack times. B) Urge the parents to take the child to a dentist for a check-up. C) Advise the parents to reduce carbohydrates in the child's diet. D) Advise the parents to use fluoride toothpaste.

A) Tell the parents to limit the child's eating to meal and snack times.

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? A) The need for separation and control B) The need for love and belonging C) The need for safety and security D) The need for peer approval

A) The need for separation and control

The nurse is watching toddlers at play. Which of the following normal behaviors would the nurse observe? A) Toddlers engage in parallel play. B) Toddlers engage in solitary play. C) Toddlers engage in cooperative play. D) Toddlers do not engage in play outside the home

A) Toddlers engage in parallel play

The nurse is assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern? Put shapes into matching openings Ability to hold a crayon to write Able to use a spoon to self-feed Ability to turn door knobs

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.

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

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.

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

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.

The nurse is teaching good sleep habits for toddlers to the mother of a 2-year-old boy. Which response indicates the mother understands sleep requirements for her son? A) "I'll put him to bed at 7 p.m., except Friday and Saturday." B) "He needs 13 hours of sleep per day including his nap." C) "I need to put the side down on the crib so he can get out." D) "His father can give him a horseback ride into his bed."

B) "He needs 13 hours of sleep per day including his nap."

During a health history, the nurse explores the sleeping habits of a 3-yearold boy by interviewing his parents. Which of the following statements from the parents reflects a recommended guideline for promoting healthy sleep in this age group? A) "Our son sleeps through the night, and we insist that he takes two naps a day." B) "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." C) "Our son still sleeps in a crib because we feel it is the safest place for him at night." D) "Our son occasionally experiences night walking so we allow him to stay up later when this happens."

B) "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story."

The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer them? A) "Respond in a calm but firm manner." B) "You need to adhere to various routines." C) "Put her in time-out when she misbehaves." D) "It's important to toddler-proof your home."

B) "You need to adhere to various routines."

When instructing the parents of a toddler about appropriate nutrition, which of the following would the nurse recommend? A) About 12 to 16 ounces of fruit juice per day B) Approximately 16 to 24 ounces of milk per day C) Fat intake of 30% to 40% of total calories D) An average of 10 to 12 grams of fiber per day

B) Approximately 16 to 24 ounces of milk per day

The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's "negativism." Based on Erikson's theory of development, which of the following would be an appropriate intervention for this child? A) Discourage solitary play; encourage playing with other children. B) Encourage the child to pick out his own clothes. C) Use "time-outs" whenever the child says "no" inappropriately. D) Encourage the child to take turns when playing games.

B) Encourage the child to pick out his own clothes.

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 uses complete 3- to 4-word sentences. She talks incessantly. She asks many questions.

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.

The nurse is helping parents prepare a healthy meal plan for their toddler. Which of the following guidelines for promoting nutrition should be followed when planning meals? Select all answers that apply. A) The child younger than 2 years of age should have his or her fat intake restricted. B) Extending breastfeeding into toddlerhood is believed to be beneficial to the child. C) Weaning from the bottle should occur by 6 to 12 months of age. D) Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. E) The toddler requires an average intake of 500 mg calcium per day. F) Toddlers tend to have the highest daily iron intake of any age group.

B) Extending breastfeeding into toddlerhood is believed to be beneficial to the child. D) Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. E) The toddler requires an average intake of 500 mg calcium per day

The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? A) The mother is suffering from depression. B) The child is homeless and has no toys. C) The mother describes an inadequate diet. D) The child is unperturbed by a loud noise

B) The child is homeless and has no toys

The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? A) The child has trouble undressing himself. B) The child is unable to push a toy lawnmower. C) The child is unable to unscrew a jar lid. D) The child falls when he bends over

B) The child is unable to push a toy lawnmower.

Which of the following would the nurse expect to find in an 18-month-old? A) Standing on tiptoes B) Pedaling a tricycle C) Climbing stairs with assistance D) Carrying a large toy while walking

C) Climbing stairs with assistance

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. Which of the following is a recommended intervention for this age group? A) Remove children's security blankets at this stage to help them assert their autonomy. B) Distract toddlers from exploring their own body parts, particularly their genitals. C) Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. D) Offer toddlers many choices to foster control over their environment.

C) Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior.

The nurse is assessing a 3-year-old boy's development during a well-child visit. Which response by the child indicates the need for further assessment? A) He says a swear word when he hurts himself playing. B) He says "pew" when his sister has soiled her diaper. C) He laughs when his brother cries getting vaccinated. D) He constantly asks "why?" whenever he is told a fact.

C) He laughs when his brother cries getting vaccinated

The pediatric nurse is planning quiet activities for hospitalized 18-month-olds. Which of the following 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

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly? A) Telling the child to stop tearing pages from magazines B) Asking the child if he would please quit throwing toys C) Telling the child firmly that we don't scream in the office D) Saying, "Please come over here and sit in this chair. OK?"

C) Telling the child firmly that we don't scream in the office

The nurse is testing the sensory development of a toddler brought to the clinic for a well visit. Which of the following might alert the nurse to a potential problem with the child's sensory development? A) The toddler places the nurse's stethoscope in his mouth. B) The toddler's vision tests at 20/50 in both eyes C) The toddler does not respond to commands whispered in his ear. D) The toddler's taste discrimination is not at adult levels yet.

C) The toddler does not respond to commands whispered in his ear.

The nurse is performing a physical assessment of a 3-year-old girl. Which of the following would be a concern for the nurse? A) The toddler gained 4 pounds in weight since last year. B) The toddler gained 3 inches in height since last year. C) The toddler's anterior fontanel is not fully closed. D) The circumference of the child's head increased 1 inch since last year.

C) The toddler's anterior fontanel is not fully closed.

The nurse is developing a teaching plan for toddler safety to present at a parenting seminar. Which of the following are safety interventions that the nurse should address? A) Encourage parents to enroll toddlers in swimming classes to avoid the need for constant supervision around water. B) Advise parents to keep pot handles on stoves turned outward to avoid accidental burns. C) Encourage parents to smoke only in designated rooms in the house or outside the house. D) Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car.

D) Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching? A) Telling them either one may demonstrate toilet use B) Assuring them that bladder control occurs first C) Telling them that curiosity is a sure sign of readiness D) Advising them to use praise, not scolding

D) Advising them to use praise, not scolding

The nurse is teaching the parents of a 2-year-old girl how to deal with common toddler situations. Which is the best advice? A) Discipline the child for regressive behavior. B) Scold the child for public thumb sucking. C) Tell the older sibling to not act like a baby. D) Have the child help clean up a bowel accident.

D) Have the child help clean up a bowel accident.

The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which of the following tasks would the nurse expect the toddler to be able to perform? A) Completing puzzles with four pieces B) Winding up a mechanical toy C) Playing make-believe with dolls D) Knowing which are his or her toys

D) Knowing which are his or her toys

The nurse is designing a nursing care plan for a toddler with lymphoma, who is hospitalized for treatment. Which of the following is a priority intervention that the nurse should include in this child's nursing plan? A) Limiting visitors to scheduled visiting hours B) Planning physical therapy for the child C) Introducing the toddler to other toddlers in the unit D) Monitoring the toddler for developmental delays

D) Monitoring the toddler for developmental delays

The nurse is choosing foods for a toddler's diet that are high in vitamin A. Which of the following could be added to the menu? Select all answers that apply. A) Applesauce B) Avocados C) Broccoli D) Sweet potatoes E) Spinach F) Carrots

D) Sweet potatoes E) Spinach F) Carrots

The nurse is performing a cognitive assessment of a 2-year-old. Which of the following behaviors would alert the nurse to a developmental delay in this area? A) The child cannot say name, age, and gender. B) The child cannot follow a series of two independent commands. C) The child has a vocabulary of 40 to 50 words. D) The child does not point to named body parts.

D) The child does not point to named body parts

The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? A) Spanking in a child this age predisposes the child to a pro-violence attitude. B) The child will become resentful and angry, leading to more outbursts. C) Spanking demonstrates a poor model for problem-solving skills. D) There is an increased risk for physical injury in this age group.

D) There is an increased risk for physical injury in this age group.

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? Slap the hand using one or two fingers if the child hits another. Describe proper behavior when the child misbehaves. Ignore bad behavior until the child is older. When needed, place the child in time out for 1½ minutes.

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.

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take? Refer the child to a developmental specialist for evaluation. Explain that children can take their first steps as late as 18 months of age. Ask the parent if the child has been ill recently. Explain that the child could start walking any day.

Explain that children can take their first steps as late as 18 months of age. Infants can begin walking as early as 8 to 9 months and as late as 18 months of age. Telling the parent that the child will start walking any day is true but not guaranteed. Asking if the child has been ill recently is an appropriate question during a well-child visit but does not address the parent's concerns. Since the child is on track developmentally, there is no indication to refer the child to a developmental specialist.

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? Document the finding in the medical records. Determine when this form of play was first noted. Encourage the toddlers to play to allow for observation. Explain that this is normal behavior for toddlers.

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.

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

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.

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? Providing a brightly colored plastic bucket and shovel Giving the child bowls, pot, pans, and large spoons Giving the child a toy vacuum cleaner Offering the child a variety of large stuffed toys

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.

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

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? Using positive reinforcement while limiting criticism Limiting the choices and decisions that the child makes Showing respect and support to the child Acting as a coach rather than a cheerleader

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? Maintain supervision when the child is near stoves, ovens, irons and other hot items the child could reach. Assure there are no empty buckets in the home/play area that could result in accidental drowning. Utilize a front-facing car seat with appropriate harness straps until at least the age of 24 months. If the child reaches to touch a firearm, gently slap the child's hand and firmly state 'No.'

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

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? Move the toddler to a new bedroom with a "grown-up-bed." Have a grandparent or another special adult in the child's life take the toddler on an errand or a special visit. Plan time for the secondary caregiver to focus on the toddler while the primary caregiver focuses on the infant. Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant.

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.

The nurse is supervising a play group of children on the unit. The nurse expects the toddlers will most likely be involved in which activity? Pretending to be mommies and daddies in the play house Painting pictures in the art corner of the room Playing with the plastic vacuum cleaner and pushing it around the room Watching a movie with other children their age

Playing with the plastic vacuum cleaner and pushing it around the room Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.

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 Made sure the child was rested and not hungry before going to the mall Tried to refocus the child's attention as tantrum behavioral cues appeared 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.

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? Tried to refocus the child's attention as tantrum behavioral cues appeared Reasoned with the child to stop the behavior 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.

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

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.

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

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 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 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? Explain that the child looks normal. Share that the heads of children at this age are large in proportion to the rest of their body. Some children have large heads but that does not signal a problem. Teach the mother that this larger head than body appearance will be this way until the child is about 6 years old.

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.

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? Runs to her mother Feeds herself with a spoon Points to her nose and mouth Stands alone

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.

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 are a common occurrence for a toddler of this age. Tapping the toddler on the hands and voicing displeasure in the toddler's actions can successfully interrupt the behavior. Ignoring the behavior is often helpful in reducing the duration of the tantrum. Maintaining a consistent daily routine can help to reduce tantrums. 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. 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 nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child? The child demonstrates separation anxiety. The child copies a circle on a piece of paper. The child imitates the nurse in use of a stethoscope. The child follows directions when made one at a time.

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. Reference:

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

The child does not use the names of familiar objects. By 24 months most children will name objects familiar to them in their daily lives. Not doing so is strong evidence that a speech delay may exist. Repeating words heard or phrases out of context (echolalia) is normal and a way to practice words and incorporate them in the vocabulary. At 2 years, most children understand much more than they can clearly repeat. Using two-word sentences is a developmental expectation at this age.

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

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.

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

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

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

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.

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? Uses two-word sentences or phrases Talks about a past event Half of speech understood by outsider Asks "why" often

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.

The nurse is assessing a 2-year-old boy during a well-child visit. The nurse correctly identifies the child's current stage of Erikson's growth and development as: initiative versus guilt autonomy versus shame and doubt industry versus inferiority trust versus mistrust

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