Chapter 32: The Toddler and Family

What is a toddler's main type of play?

Parallel play

Toddlers birth weight should be _________ by age 2 1/2.

Quadrupled

What age is a toddler's final sensorimotor stage?

19 to 24 months

At what age can children use multi word sentences?

2 years

At what age can toddlers walk up and down stairs?

24 months

The most fatal type of burn in the toddler age-group is: a. Flame burn from playing with matches. b. Scald burn from high-temperature tap water. c. Hot object burn from cigarettes or irons. d. Electric burn from electrical outlets.

A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group. Scald burns from water, hot object burns from cigarettes or irons, and electric burns from outlets are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature of the hot water in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use.

The leading cause of death during the toddler period is: a. Injuries. c. Congenital disorders. b. Infectious diseases. d. Childhood diseases.

A Injuries are the single most common cause of death in children ages 1 through 4 years. It is the period of highest death rate from injuries of any childhood age-group except adolescence. Infectious and childhood diseases are less common cause of deaths in this age-group. Congenital disorders are the second leading cause of death in this age-group.

Parents tell the nurse that their toddler daughter eats little at mealtimes, only sits at the table with the family briefly, and wants snacks "all the time." The nurse should recommend that the parents: a. Give her planned, frequent, and nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should assist the child to develop healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response.

Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-pull toy c. A bicycle with training wheels b. Nesting blocks d. A computer

A Push-pull toys encourage large muscle activity and are appropriate for toddlers. Nesting blocks are more appropriate for a 12- to 15-month-old child. A bicycle with training wheels is appropriate for a preschool or young school-age child. A computer can be appropriate as early as the preschool years.

The parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend that the parents: a. Ignore the "baby talk." b. Explain to the toddler that "baby talk" is for babies. c. Tell the toddler frequently, "You are a big kid now." d. Encourage the toddler to practice more advanced patterns of speech.

A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of saying that they are expressing stress. The parents should not introduce new expectations and should allow the child to master the developmental tasks without criticism.

The parent of 16-month-old Chris asks, "What is the best way to keep Chris from getting into our medicines at home?" The nurse should advise that: a. "All medicines should be locked securely away." b. "The medicines should be placed in high cabinets." c. "Chris just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize as dangerous all of the different forms of medications that may be available in the home. Teaching them not to touch medicines is not feasible. Many parents require medications for chronic illnesses. They must be taught safe storage for their home and when they visit other homes.

A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddler's preoperational thinking is the nurse using? a. Inability to conserve c. Centration b. Magical thinking d. Irreversibility

A The nurse is using the toddler's inability to conserve. This is when the toddler is unable to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the original mass. Instead, toddlers judge what they see by the immediate perceptual clues given to them. A small glass means less amount of contrast. Magical thinking is believing that thoughts are all-powerful and can cause events. Centration is focusing on one aspect rather than considering all possible alternatives. Irreversibility is the inability to undo or reverse the actions initiated, such as being unable to stop doing an action when told.

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is that: a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she teach (select all that apply)? a. Secure in a rear-facing, upright, car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should be fit snugly. d. Place the car safety seat in the front passenger seat equipped with an air bag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.

A, C, E Toddlers younger than 2 years should be secured in a rear-facing, upright, approved car safety seat. After the age of 2 years, a forward-facing car seat can be used. Harness straps should be adjusted to provide a snug fit. The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an air bag.

What should the nurse recommend to help a toddler cope with the birth of a new sibling? A. Give the toddler a doll on which he or she can imitate parenting. B. Discourage the toddler from helping with care of new sibling. C. Prepare the toddler for upcoming changes about 1 to 2 weeks before birth of the sibling. D. Explain to the toddler that a new playmate will soon come home.

A. Give the toddler a doll on which he or she can imitate parenting.

The parents of a toddler state their child is having trouble sleeping. What is the nurse's BEST suggestion to improve sleep habits? A. Using a transitional object. B. Varying the bedtime ritual. C. Restricting stimulating activities during the day. D. Explaining away fears.

A. Using a transitional object.

When completing the health assessment for a 2-year-old child, the nurse should expect the child to: A. engage in parallel play. B. fully dress self with supervision. C. have a vocabulary of at least 500 words. D. be one third of the adult height.

A. engage in parallel play.

29. A parent is concerned because her son was exposed to varicella at preschool. The nurse would tell this parent that the incubation period for varicella is _____ days.

ANS: 14 to 21 The incubation period for varicella is 2 to 3 weeks, usually 13 to 17 days. DIF: Cognitive Level: Knowledge REF: Page 722, Health Promotion box OBJ: 2 TOP: Varicella KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

26. The nurse explains that the ______________ test determines the child's susceptibility to tuberculosis.

ANS: Mantoux The Mantoux test is a screening test for the susceptibility to TB. An intradermal injection is given and read 3 days later. An erythema and induration of more than 5 mm is considered a positive reading. DIF: Cognitive Level: Knowledge REF: Page 726 OBJ: 4 TOP: Mantoux KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

31. Children are generally more vulnerable to biological warfare, because their ____________________ are not fully developed.

ANS: immune systems The immune systems of children are not fully developed, which makes them a vulnerable population. DIF: Cognitive Level: Comprehension REF: Page 737 OBJ: 7 TOP: Bioterrorism KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation

32. A __________ is a worldwide high incidence of a communicable disease. An ___________ is a sudden increase of a communicable disease in a localized area. _________________ refers to a continuous incidence of a communicable disease expected in a localized area.

ANS: pandemic; epidemic; Endemic A pandemic is a worldwide high incidence of a communicable disease. An epidemic is a sudden increase of a communicable disease in a localized area. Endemic refers to a continuous incidence of a communicable disease expected in a localized area. DIF: Cognitive Level: Knowledge REF: Page 725 OBJ: 1 TOP: Key Terms KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

28. The school nurse recognizes the presence of macules, papules, vesicles, pustules, and scabs on the child as the particular sign of the communicable disease of _________________.

ANS: varicella (chickenpox) Varicella has the distinctive sign of showing several types of skin lesions at the same time. DIF: Cognitive Level: Comprehension REF: Page 722, Health Promotion box OBJ: 2 TOP: Varicella KEY: Nursing Process Step: Data Collection MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

27. The nurse uses a diagram showing how the wood tick acts as a(n) ______________ in the transmission of Lyme disease.

ANS: vector A vector is an insect or animal that carries a communicable disease. DIF: Cognitive Level: Comprehension REF: Page 725 OBJ: 4 TOP: Vector KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

9. The mother of a newborn asked the nurse, "When will my baby get the hepatitis B vaccine?" When will the nurse explain the first dose of Comvax should be given to infants born to a hepatitis B-positive mother? a. Within 12 hours after birth b. Within 2 weeks after birth c. Within 1 month after birth d. Within 2 months after birth

ANS: A The American Academy of Pediatrics recommends that Comvax, the only thimerosal-free hepatitis B vaccine, should be used for infants born to HBsAg-positive mothers within 12 hours of birth. DIF: Cognitive Level: Knowledge REF: Page 733, Figure 32-6 OBJ: 4 TOP: Immunization Schedule KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

6. Which statement assures the nurse that parents understand how long a child who has varicella is contagious? a. "My child should stay home from school for 6 days after the pox appear." b. "My child can return to school when the rash fades." c. "My child must stay away from other children until all of the lesions have healed." d. "My child is contagious as long as he has a fever."

ANS: A The child with varicella is contagious for 6 days after the appearance of the rash. DIF: Cognitive Level: Comprehension REF: Page 722, Health Promotion box OBJ: 2 TOP: Common Varicella KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

17. An adolescent is taking tetracycline for a sexually transmitted disease. What would the nurse stress when providing instruction about this medication? a. Finish all of the medication. b. Get plenty of fresh air and sunlight. c. Take the medication with food. d. Take an antacid if the medication causes an upset stomach.

ANS: A The nurse would teach the adolescent to take all of the prescribed medication to avoid making the microorganism resistant to tetracyclines. DIF: Cognitive Level: Comprehension REF: Page 740, Table 32-3 OBJ: 9 TOP: Sexually Transmitted Diseases KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

21. Why would a female adolescent with STDs resist reporting the condition? (Select all that apply.) a. She is reluctant to name contacts. b. She is embarrassed. c. She doubts confidentiality. d. She doesn't want to take the medication. e. She dreads the pelvic examination.

ANS: A, B, C, E Adolescents are uncomfortable about the pelvic examination and require a lot of support. Adolescents doubt the confidentiality of the agency and are reluctant to name contacts. DIF: Cognitive Level: Comprehension REF: Page 739-740 OBJ: 9 TOP: Reporting STDs KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

ANS: B, D Acquired immunity is acquiring the antibodies by way of having the disease or having the vaccination. Gamma globulin is simply a support to the immune system. Immune globulin is receiving the antibodies from some other source, giving the person an immediate immunity but one that does not last. DIF: Cognitive Level: Knowledge REF: Page 726 OBJ: 1 TOP: Acquired Immunity KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

ANS: A, B, C, E All the options are the expected inoculations of a healthy 2-month-old with the exception of MMR. Mumps, measles, rubella are not expected until the child is 1 year old. DIF: Cognitive Level: Knowledge REF: Page 733, Figure 32-6 OBJ: 6 TOP: Inoculations for a 2-Month-Old KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

25. The nurse is assisting with an admission assessment of a child with scarlet fever. Which actions will the nurse expect to implement? (Select all that apply.) a. Obtain a throat culture. b. Encourage ambulation. c. Assess for desquamation. d. Initiate droplet precautions. e. Administer isoniazid.

ANS: A, C A diagnosis of scarlet fever would indicate throat culture and assessment for desquamation. Bed rest with quiet activity is indicated. Droplet precautions would not be implemented for scarlet fever. Isoniazid is administered for tuberculosis. DIF: Cognitive Level: Application REF: Page 724, Health Promotion box OBJ: 2 TOP: Scarlet Fever KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

3. How would the nurse document a rash that has erythematous, circular raised lesions? a. Macular b. Papular c. Vesicular d. Pustular

ANS: B A papule is a circular, reddened elevated area on the skin. DIF: Cognitive Level: Knowledge REF: Page 727 OBJ: 2 TOP: Rashes KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. The nurse is preparing to administer immunizations at a well-child clinic. Which method of administration will the nurse implement? a. DTaP subcutaneously b. Hib vaccine prepared in a separate syringe c. Varicella intramuscularly d. Varicella 1 week after the MMR vaccine

ANS: B Hib vaccine must be given in a separate syringe from other vaccines administered at the same time. DIF: Cognitive Level: Knowledge REF: Page 733, Figure 32-6 OBJ: 6 TOP: Hib KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

19. Which is an example of an opportunistic infection? a. Measles b. Pneumocystis jiroveci c. Clostridium difficile d. Smallpox

ANS: B Pneumocystis jiroveci is the most common of opportunistic diseases. DIF: Cognitive Level: Knowledge REF: Page 741 OBJ: 1 TOP: Opportunistic Diseases KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

12. A 9-year-old child hospitalized for neutropenia is placed in protective isolation. What is the most appropriate response for the nurse to make when the child asks, "Why do you have to wear a gown and mask when you are in my room?" a. "Nurses and doctors wear gowns and masks because you have a condition that could be spread to others." b. "The gown and mask are to protect you because you could get an infection very easily." c. "I'm wearing this because there are a lot of bacteria in the hospital." d. "I might look scary but you won't need this after you have had medication for 24 hours."

ANS: B Protective isolation is used for patients who are not communicable but have a lowered resistance and are highly susceptible to infection. DIF: Cognitive Level: Application REF: Page 727 OBJ: 3 TOP: Protective Isolation KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

20. A child is admitted to the pediatric unit with a diagnosis of cellulitis on the right upper thigh. Patient history reveals the child had a 2-cm laceration on the right thigh prior to infection. When explaining the chain of infection, how does the nurse identify this laceration? a. Reservoir b. Portal of entry c. Portal of exit d. Cector

ANS: B The chain of infection refers to the way in which organisms spread and infect the individual. A portal of entry is a route by which the organisms enter the body (e.g., a cut in the skin). A portal of exit is the route by which the organisms exit the body (e.g., feces or urine). A reservoir for infection is a place that supports the growth of organisms (e.g., standing, stagnant water). A vector is an insect or animal that carries and spreads a disease. DIF: Cognitive Level: Comprehension REF: Page 725 OBJ: 1 TOP: Chain of Infection KEY: Nursing Process Step: Data Collection MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

18. The nurse explains to the parents that their child is in the prodromal stage of varicella. What does this mean? a. The child is now immune to varicella. b. The child has varicella but has not yet broken out. c. The child is infected with varicella but is not contagious. d. The child does not have varicella but has been exposed to it.

ANS: B The prodromal stage is the initial stage of the communicable disease in which the child is infected and contagious but does not yet have outward signs of the disease. DIF: Cognitive Level: Comprehension REF: Page 725 OBJ: 1 TOP: Prodromal Period KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

2. An 8-year-old asks the nurse how she got the antibodies that kept her from getting whooping cough. What is the nurse's best explanation? a. "You received borrowed antibodies from another person who had whooping cough." b. "You were given a tiny case of whooping cough and then you made your own antibodies." c. "An immunization strengthened antibodies you were born with." d. "You received only temporary borrowed antibodies and you need to have another shot every 5 years."

ANS: B Vaccines contain live weakened or dead organisms not strong enough to cause disease but they stimulate the body to develop an immune reaction and antibodies. This is active acquired immunity. DIF: Cognitive Level: Comprehension REF: Page 728, Table 32-1 OBJ: 4 TOP: Vaccines KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. The nurse is explaining to a family about disaster preparedness. What will the nurse instruct the family to prepare in a disaster kit in case of emergency? (Select all that apply.) a. Small television b. Vital documents c. Nonperishable food d. Pet food e. Blankets

ANS: B, C, D, E The nurse can assist families to prepare for natural disasters, such as hurricanes or floods, or manmade disasters, such as bioterrorist attacks or bombings. The American Medical Association (AMA) office guidelines for preparing a family and community disaster plan state that the family should keep several days' supply of food, water, pet food, warm clothing, blankets, copies of vital documents, and toiletries on hand. A battery-powered radio and extra medications, eyeglasses, and basic first aid supplies are also essential. DIF: Cognitive Level: Knowledge REF: Page 738-739 OBJ: 8 TOP: Disaster Preparedness KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

22. What sources are examples of acquired immunity? (Select all that apply.) a. Gamma globulin b. The disease c. Maternal antibodies d. The vaccine e. Immune globulin

ANS: B, D Acquired immunity is acquiring the antibodies by way of having the disease or having the vaccination. Gamma globulin is simply a support to the immune system. Immune globulin is receiving the antibodies from some other source, giving the person an immediate immunity but one that does not last. DIF: Cognitive Level: Knowledge REF: Page 726 OBJ: 1 TOP: Acquired Immunity KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

5. What type of precautions are necessary when caring for a toddler with varicella? a. Contact b. Protective c. Airborne infection d. Large droplet infection

ANS: C Airborne-infection precautions are used for patients with conditions such as tuberculosis, varicella, and rubella. Small airborne particles caught on floating dust in the room can be inhaled from anywhere in the room. DIF: Cognitive Level: Application REF: Page 722, Health Promotion box OBJ: 4 TOP: Medical Asepsis and Standard Precautions KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

11. An infant is hospitalized for RSV bronchiolitis. Which type of precautions would the nurse use when caring for the infant? a. Large-droplet infection precautions b. Airborne-infection precautions c. Contact precautions d. Protective precautions

ANS: C Contact precautions are used when the condition transmits organisms via skin-to-skin contact or indirect touch of a contaminated fomite. DIF: Cognitive Level: Application REF: Page 726-727 OBJ: 4 TOP: Medical Asepsis and Standard Precautions KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

7. Which statement made by a sexually active adolescent girl indicates an understanding of the prevention of sexually transmitted diseases? a. "I always douche after intercourse." b. "I think you can get a vaccination for STDs now." c. "I insist that my partner wear a condom." d. "I am protected because I take the pill."

ANS: C The use of condoms to prevent STDs is not considered 100% effective but is recommended for sexual intercourse. DIF: Cognitive Level: Comprehension REF: Page 739, Nursing Tip OBJ: 9 TOP: Sexually Transmitted Diseases KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

10. A 10-year-old child is diagnosed with Hepatitis A. What is the most likely way the child contracted this disease? a. Came in contact with infected blood b. Came in contact with droplets in the air c. Was bitten by a mosquito or a tick d. Ate shrimp while in Mexico

ANS: D Hepatitis A results from ingestion of contaminated water or shellfish. DIF: Cognitive Level: Comprehension REF: Page 723, Health Promotion box OBJ: 3 TOP: Hepatitis A KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

15. A child was sent to the school nurse because of a rash. The nurse noted the rash was present on the trunk, extremities, and face. The child's cheeks were bright red. With what is the nurse aware this type of rash is consistent? a. Measles b. Roseola c. Varicella d. Fifth disease

ANS: D In fifth disease, the child has a generalized rash and the cheeks have a slapped-cheek appearance. DIF: Cognitive Level: Comprehension REF: Page 722, Health Promotion box OBJ: 2 TOP: Fifth Disease KEY: Nursing Process Step: Data Collection MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

16. What statement leads the nurse to determine that a child's parent understands information related to tick bites? a. "I'll have my son wear dark clothing on his hike." b. "We should all get the Lyme disease vaccine before our trip." c. "I'll get a prescription for amoxicillin to take with us." d. "We will wear long pants and long-sleeved shirts in the woods."

ANS: D People should keep skin covered by wearing protective clothing in wooded areas to prevent tick bites. DIF: Cognitive Level: Application REF: Page 724, Health Promotion box OBJ: 4 TOP: Prevention of Tick Bites KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

1. Which classification of medication would make a child most susceptible to an opportunistic infection? a. Anticonvulsant b. Beta-adrenergic agent c. Antibiotic d. Corticosteroid

ANS: D Steroids are immunosuppressive drugs that make the child very susceptible to opportunistic infections. DIF: Cognitive Level: Knowledge REF: Page 725 OBJ: 3 TOP: Effect of Steroids KEY: Nursing Process Step: Data Collection MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

8. What is the priority nursing diagnosis for a hospitalized infant who is HIV positive? a. Risk for injury b. Altered nutrition c. Impaired skin integrity d. Risk for infection

ANS: D The infant who is HIV positive has impaired immunologic functioning and is at high risk for infection. DIF: Cognitive Level: Application REF: Page 742-743, NCP 32-1 OBJ: 10 TOP: Human Immunodeficiency Virus KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

What is a toddlers stage according to Erikson?

Autonomy vs shame and doubt

What describes a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time such as "just a minute" and "in an hour"

B At this age the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. Putting an object in a container but being unable to take it out indicates tertiary circular reactions. An embryonic sense of time exists; although toddlers may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.

Which should the nurse expect for a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Increasing level of comprehension c. Use of phrases d. Approximately one third of speech understandable

B During the second year of life, level of comprehension and understanding of speech increases and is far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old child has a vocabulary of 10 or more words. At this age, the child does not use one-word sentences or phrases. The child has a limited vocabulary of single words that are comprehensible.

The most effective way to clean a toddler's teeth is for the: a. Child to brush regularly with toothpaste of his or her choice. b. Parent to stabilize the chin with one hand and brush with the other. c. Parent to brush the mandibular occlusive surfaces, leaving the rest for the child. d. Parent to brush the front labial surfaces, leaving the rest for the child.

B For young children, the most effective cleaning of teeth is done by the parents. Different positions can be used if the child's back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the child's teeth. The child can participate in brushing, but for a thorough cleaning adult intervention is necessary.

Kimberly's parents have been using a rearward-facing, convertible car seat since she was born. The parents should be taught that most car seats can be safely switched to the forward-facing position when the child reaches which age? a. 1 year c. 3 years b. 2 years d. 4 years

B It is now recommended that all infants and toddlers ride in rear-facing car safety seats until they reach the age of 2 years or the height or weight recommended by the car seat manufacturer. Children 2 years old and older who have outgrown the rear-facing height or weight limit for their car safety seat should use a forward-facing car safety seat with a harness up to the maximum height or weight recommended by the manufacturer. One year is too young to switch to a forward-facing position.

Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation? a. Small plastic Legos c. Brightly colored balloon b. Set of large plastic building blocks d. Coloring book and crayons

B Large plastic blocks are appropriate for a toddler in isolation. Play objects for toddlers must still be chosen with an awareness of danger from small parts. Large, sturdy toys without sharp edges or removable parts are safest. Small plastic toys such as Legos can cause choking or can be aspirated. Balloons can cause significant harm if swallowed or aspirated. Coloring book and crayons would be too advanced for a toddler.

Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. The best interpretation of this behavior is that: a. This is typical behavior because toddlers are aggressive. b. This is typical behavior because toddlers are egocentric. c. Toddlers should know that sharing toys is expected of them. d. Toddlers should have the cognitive ability to know right from wrong.

B Play develops from the solitary play of infancy to the parallel play of toddlers. The toddler plays alongside other children, not with them. This typical behavior of the toddler is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because the toddler cannot view the situation from the perspective of the other child, it is okay to take the toy. Therefore, no right or wrong is associated with taking a toy.

An appropriate recommendation in preventing tooth decay in young children is to: a. Substitute raisins for candy. b. Serve sweets after a meal. c. Use honey or molasses instead of refined sugar. d. Serve sweets between meals.

B Sweets should be consumed with meals so the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth. Raisins, honey, and molasses are highly cariogenic and should be avoided.

The mother of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the mother is: a. "It is important for your toddler to eat three meals a day and nothing in between." b. "It is not unusual for toddlers to eat less." c. "Be sure to increase your child's milk consumption, which will improve nutrition." d. "Giving your child a multivitamin supplement daily will increase your toddler's appetite."

B Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. Physiologically, growth slows and appetite decreases during the toddler period. Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. Supplemental vitamins are important for all children, but they do not increase appetite.

Which statement about toilet training is correct? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning.

B Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

Which are characteristic of the physical development of a 30-month-old child (select all that apply)? a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled.

B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. A doubling of birth weight, opening of the anterior fontanel, and doubling of length are not characteristic of the physical development of a 30-month-old child.

A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage (select all that apply)? a. Concrete thinking b. Egocentrism c. Animism d. Magical thinking e. Ability to reason

B, C, D The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thinking (believes that thinking something causes that event). Concrete thinking is seen in school-age children and ability to reason is seen with adolescents.

The parents of a toddler ask the nurse how to handle their child's increasing number of temper tantrums. The nurse should include which positive reinforcement methods of reducing the number of tantrums? (Select all that apply.) A. Suggest that parents provide the child an "all or none" position. B. Suggest that parents ignore the behavior as long as child is not harming self. C. Encourage the parents to provide comfort once the child has calmed down. D. Ask parents to praise the child for positive behavior when not having a tantrum. E. Tell parents not to give in to the original request that started the temper tantrum.

B, C, D, E B. Suggest that parents ignore the behavior as long as child is not harming self. C. Encourage the parents to provide comfort once the child has calmed down. D. Ask parents to praise the child for positive behavior when not having a tantrum. E. Tell parents not to give in to the original request that started the temper tantrum.

Which should the nurse teach to parents of toddlers about accidental poison prevention (select all that apply)? a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants.

B, C, E To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, to know the number of the nearest poison control center, and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications, in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances.

Which statement about early childhood caries (ECC) is correct? A. The syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple. B. Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. C. The syndrome can be prevented by breastfeeding. D. Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome.

B. Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome.

A hospitalized toddler clings to a worn, tattered blanket. She screams when anyone tries to take it away. What is the nurse's BEST explanation to the parents for the child's attachment to the blanket? A. The blanket encourages immature behavior. B. The blanket is an important transitional object. C. She has not mastered the developmental task of individuation-separation. D. She has not bonded adequately with her mother.

B. The blanket is an important transitional object.

The nurse is teaching the parents of a 24-month-old about motor skill development. The nurse should include which statement in the teaching? A. The toddler walks alone but falls easily. B. The toddler's activities begin to produce purposeful results. C. The toddler is able to grasp small objects but cannot release them at will. D. The toddler's motor skills are fully developed but occur in isolation from the environment.

B. The toddler's activities begin to produce purposeful results.

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that: A. nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. C. the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. D. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first.

Poisoning in toddlers can best be prevented by: A. consistently using safety caps. B. storing poisonous substances in a locked cabinet. C. keeping ipecac syrup in the home. D. storing poisonous substances out of reach.

B. storing poisonous substances in a locked cabinet.

At what age do toddlers have refinement of coordination?

Between ages 2 and 3 years

Developmentally, most children at age 12 months: a. Use a spoon adeptly. b. Relinquish the bottle voluntarily. c. Eat the same food as the rest of the family. d. Reject all solid food in preference to the bottle.

C By age 12 months, most children are eating the same food that is prepared for the rest of the family. Using a spoon usually is not mastered until age 18 months. The parents should be engaged in weaning a child from a bottle if that is the source of liquid. Toddlers should be encouraged to drink from a cup at the first birthday and weaned totally by 14 months. The child should be weaned from a milk/formula-based diet to a balanced diet that includes iron-rich sources of food.

Which comments indicate that the mother of a toddler needs further teaching about dental care? a. "We use well water so I give my toddler fluoride supplements." b. "My toddler brushes his teeth with my help." c. "My child will not need a dental checkup until his permanent teeth come in." d. "I use a small nylon bristle brush for my toddler's teeth."

C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. Toddlers need fluoride supplements when they use a water supply that is not fluorinated. Toddlers also require supervision with dental care. The parent should finish brushing areas not reached by the child. A small nylon bristle brush works best for cleaning toddlers' teeth.

What is the primary purpose of a transitional object? a. It helps the parents deal with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.

C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. A decrease in parental guilt (distress) is an indirect benefit of a transitional object. A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

Although a 14-month-old girl received a shock from an electrical outlet recently, her parents find her about to place a paper clip in another outlet. The best interpretation of this behavior is that: a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age and represents typical behavior for a toddler. Only some awareness exists of a causal relation between events.

Parents need further teaching about the use of car safety seats if they make which statement? a. "Even if our toddler helps buckle the straps, we will double-check the fastenings." b. "We won't start the car until everyone is properly restrained." c. "We won't need to use the car seat on short trips to the store." d. "We will anchor the car seat to the car's anchoring system."

C Parents need to be taught to always use the restraint even for short trips. Further teaching is needed if they make this statement. Parents have understood the teaching if they encourage the child to help attach buckles, straps, and shields but always double-check fastenings; do not start the car until everyone is properly restrained; and anchor the car safety seat securely to the car's anchoring system and apply the harness snugly to the child.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. The most appropriate recommendation is to: a. Punish the child. b. Leave the child alone until the tantrum is over. c. Ignore the behavior, provided that it is not injurious. d. Explain to child that this is wrong.

C The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age-group as the child becomes more independent and increasingly complex tasks overwhelm him or her. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial.

In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. In this situation the nurse should recognize that: a. Blocks at this age are used primarily for throwing. b. Toddlers are too young to imitate the behavior of others. c. Toddlers are capable of building a tower of blocks. d. Toddlers are too young to build a tower of blocks.

C This is a good parent-child interaction. The 18-month-old is capable of building a tower of 3 or 4 blocks. The ability to build towers of blocks usually begins at age 15 months. With ongoing development, the child is able to build taller towers. At this age, children imitate others around them and no longer throw blocks.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which of the following should be included? A. Flossing is not recommended at this age. B. The child is old enough to brush teeth effectively. C. Brush teeth with plain water if child does not like toothpaste. D. Toothbrush should be small and have hard, rounded, nylon bristles.

C. Brush teeth with plain water if child does not like toothpaste.

The nurse notices that a toddler is more cooperative when taking medicine from a small cup rather than from a large cup. This is an example of which characteristic of preoperational thought? A. Egocentrism B. Irreversibility C. Inability to conserve D. Transductive reasoning

C. Inability to conserve

The parents of a toddler ask the nurse for suggestions about discipline. When discussing the use of timeouts, which of the following suggestions should the nurse include? A. Send the child to his or her room. B. If the child cries, refuses, or is more disruptive, try another approach. C. Select an area that is safe and nonstimulating, such as a hallway. D. The general rule for length of time is 1 hour per year of age.

C. Select an area that is safe and nonstimulating, such as a hallway.

A 2-year-old child has recently started having temper tantrums during which she holds her breath and sometimes faints. The nurse should: A. refer the child for respiratory evaluation. B. refer the child for psychologic evaluation. C. explain to the parent that this is not harmful. D. explain to the parent that the child is spoiled.

C. explain to the parent that this is not harmful.

The nurse recommends to parents that peanuts are not a good snack food for toddlers. The nurse's rationale for this action is that: a. They are low in nutritive value. c. They cannot be entirely digested. b. They are very high in sodium. d. They can be easily aspirated.

D Foreign-body aspiration is common during the second year of life. Although they chew well, children at this age may have difficulty with large pieces of food such as meat and whole hot dogs and with hard foods such as nuts or dried beans. Peanuts have many beneficial nutrients but should be avoided because of the risk of aspiration in this age-group. The sodium level may be a concern, but the risk of aspiration is more important. Many foods pass through the gastrointestinal tract incompletely digested. This is not necessarily detrimental to the child.

The psychosocial developmental tasks of toddlerhood include: a. Development of a conscience. b. Recognition of sex differences. c. Ability to get along with age mates. d. Ability to withstand delayed gratification.

D If the need for basic trust has been satisfied, toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to withstand delayed gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years. The ability to get along with age mates develops during the preschool and school-age years.

The nurse is planning care for a 17-month-old child. According to Piaget, in what stage would the nurse expect the child to be? a. Trust c. Secondary circular reaction b. Preoperations d. Tertiary circular reaction

D The 17-month-old is in the fifth stage of the sensorimotor phase: tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperations is the stage of cognitive development, usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips c. Broad jumps b. Rides tricycle d. Walks up and down stairs

D The 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and the ability to broad jump are skills acquired at age 3. Tricycle riding is achieved at age 4.

The parents of a newborn say that their toddler "hates the baby . . . he suggested that we put him in the trash can so the trash truck could take him away." The nurse's best reply is: a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and help focus attention on the toddler. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. This is a normal response. The toddler can be provided with a doll to tend to its needs when the parent is performing similar care for the newborn.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is: a. A sign that the child is spoiled. c. Regression, common at this age. b. A way to exert unhealthy control. d. Ritualism, common at this age.

D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate a child who has unreasonable expectations or a need to exert control, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. The nurse should recommend that the parents: a. Use fluoridated mouth rinses in children older than 1 year. b. Have children brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate. c. Give fluoride supplements to breastfed infants beginning at age 1 month. d. Determine whether water supply is fluoridated.

D The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach this age-group to spit out the mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoridated toothpaste is still indicated, but very small amounts are used. Fluoride supplementation is not recommended until after age 6 months.

A parent asks the nurse about how to respond to negativism in toddlers. The most appropriate recommendation is to: a. Punish the child. b. Provide more attention. c. Ask child not always to say "no." d. Reduce the opportunities for a "no" answer.

D The nurse should suggest to the parent that questions should be phrased with realistic choices rather than "yes" or "no" answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to be asked to not always say "no."

What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Communicate with the child's daytime caregiver about eliminating the afternoon nap. d. Use a night-light in the child's room.

D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Night-lights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room. A dark, quiet room may be scary to a preschooler. High-carbohydrate snacks increase energy and do not promote relaxation. Most 2-year-olds take one nap each day. Many give up the habit by age 3. Insufficient rest during the day can lead to irritability and difficulty sleeping at night.

Which factor is most important in predisposing toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue are present.

D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

Characteristics of physical development of a 30-month-old child are the: (Select all that apply.) A. anterior fontanel is open. B. birth weight has doubled. C. genital fondling is noted. D. sphincter control is achieved. E. primary dentition is complete.

D, E D. sphincter control is achieved. E. primary dentition is complete.

The parents of a toddler express frustration to the nurse because their child is a "fussy eater." The nurse's BEST response is: A. "You should provide larger servings of different foods. B. "Provide more bland food varieties as toddlers have few food preferences." C. "Table manners will improve if you provide finger foods." D. "Becoming a fussy eater is expected during the toddler years."

D. "Becoming a fussy eater is expected during the toddler years."

A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? A. "We locked all the medicines in the bathroom cabinet." B. "We turned the thermostat down on our hot water heater." C. "We placed gates at the top and bottom of the basement steps." D. "We stopped using the car seat now that my child is older."

D. "We stopped using the car seat now that my child is older."

Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, the toddler can gradually achieve: A. throwing a ball without falling. B. slowing of gastrointestinal transit time. C. visual acuity of 20/20. D. control of anal and urethral sphincters.

D. control of anal and urethral sphincters.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? A. help the toddler complete tasks. B. provide opportunities for the toddler to play with other children. C. help the toddler learn the difference between right and wrong. D. encourage the toddler to do things for himself or herself when he or she is capable of doing them.

D. encourage the toddler to do things for himself or herself when he or she is capable of doing them.

When explaining the proper restraint of toddlers in motor vehicles to a group of parents, the nurse should include: A. wearing safety belts snugly over the toddler's abdomen. B. placing the car seat in the front passenger seat if there is an airbag. C. using lap and shoulder belts when the child is over 3 years of age. D. placing the car seat in the back seat of the car facing forward.

D. placing the car seat in the back seat of the car facing forward.

Why is otitis media common in toddlers?

Due to the short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue

What grows more, legs or trunk?

Legs

What is relatiely mature by the end of toddlerhood?

Most physiologic systems

13. The nurse is planning to administer immunizations at a well-child visit when a parent reports the 18-month-old child is allergic to eggs. Which vaccine would be contraindicated? a. Influenza b. Inactivated polio vaccine c. Diphtheria, tetanus, acellular pertussis d. Hepatitis B

NS: A The influenza vaccine should not be given to children who are allergic to eggs. DIF: Cognitive Level: Knowledge REF: Page 729 OBJ: 6 TOP: Nurse's Role in Immunizations—Allergy KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

What stage are toddlers in according to Piaget?

Sensorimotor and preoperational phase

How many pounds do toddlers gain a year?

Slows to 4 to 6 pounds

Is growth steplike or linear?

Steplike

What sicknesses are common among toddlers?

Upper respiratory infections, otitis media, and tonsillitis

At what age can children use one-word sentences?

1 year

Cognitive proccesses develop rapidly between what ages?

12 to 24 months

What age is a toddler?

12 to 36 months

Child recognizes gender differences by what age?

2 years

What is the normal visual acuity of toddlers?

20/40

How much height does a toddler gain a year?

3 inches

Gender identity is formed by what age?

3 years

Steven, 16 months old, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? a. Animism c. Irreversibility b. Ritualism d. Delayed cognitive development

A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. Steven is acting in an age-appropriate manner.

The nurse is assessing parental knowledge of temper tantrums. Which are true statements regarding temper tantrums (select all that apply)? a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur.

A, B, D, E Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap prior to fatigue or a snack if mealtime is delayed will be helpful in alleviated the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior.

Which gross motor milestones should the nurse assess in an 18-month-old child (select all that apply)? a. Jumps in place with both feet b. Takes a few steps on tiptoe c. Throws ball overhand without falling d. Pulls and pushes toys e. Stands on one foot momentarily

A, C, D An 18-month-old child can jump in place with both feet, throw a ball overhand without falling, and pull and push toys. Taking a few steps on tiptoe and standing on one foot momentarily are not acquired until 30 months of age.

30. The nurse demonstrates proper hand hygiene pointing out that the process should take a minimum of ____ seconds.

ANS: 15 Hand hygiene should take a minimum of 15 seconds to complete. DIF: Cognitive Level: Knowledge REF: Page 727, Nursing Tip OBJ: 4 TOP: Hand Hygiene KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

4. Which finding would lead the nurse to delay the administration of DTaP for an infant? a. Diarrhea b. Temperature of 40.5° C (105° F) from the previous inoculation c. Teething d. Traveling to Europe in a week

ANS: B A contraindication to giving the DTaP vaccine is a 40.5° C (105° F) temperature following the previous vaccination. DIF: Cognitive Level: Application REF: Page 731 OBJ: 6 TOP: Immunizations KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

What age does the preoperational phase begin and when does it end?

About age 2 years Lasts until 4 years

At what age do toddlers have improved manual dexterity?

Ages 12 to 15 months

At what age can toddlers throw a ball?

By 18 months