Peds Ch 26 (Exam 1)

Sensorimotor substage 6: Mental combinations

Age 18 months-24months Places items in and out of containers Imitates domestic chores

A mother of a toddler asks the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate?

"You'll probably notice that your daughter is uncomfortable in wet diapers."

The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet?

"Give him more healthy choices with less junk food available."

By which age should the child know his/her own gender?

3

The toddler grows about how many inches in height per year?

3 inches

The nurse is presenting an inservice training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of parallel play?

Children are playing independently and are side by side

The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which of the following observations would suggest the child is experiencing a problem with language development?

Her vocabulary is between 10 and 15 words.

Which of the following is appropriate with reference to enhancing a child's self-esteem?

Include the child in activities that interest the adult.

A nurse is assessing a 2 year old's language development. Which of the following would the nurse expect to assess?

Use of a two-word noun-verb sentence

The best way for parents to aid a toddler in achieving his developmental task would be to

allow him to make simple decisions.

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition?

"I give my daughter juice at breakfast and when she is thirsty during the day." Explanantion High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily.

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 normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." Explanation 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 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.

In working with the toddler, which of the following statements would be most appropriate to say to the toddler to decrease the behavior known as negativism?

"It is time for lunch, I am going to put your bib on."

During the toddler years, the child attempts to become autonomous. If the following statements were made by caregivers of 3-year-old children, which observation reflects that the child is developing autonomy?

"My child uses the potty chair and is dry all day long."

The nurse is teaching a first-time mother with a 14-month-old boy about child safety. Which is the most effective overall safety information to provide guidance for the mother?

"Never let him out of your sight when outdoors."

A mother who is returning to work outside the home has found a daycare center close to her office and is eager to have her 15-month-old son placed there so he can be close by. The center will only take children who are potty-trained. The mother asks the nurse for advice about how to persuade her son to use the potty. Which of the following would be the most appropriate response for the nurse to make to this mother?

"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained."

The nurse is teaching parents how to avoid a power struggle with their 2-year-old girl. Which comment indicates that more teaching is needed?

"We will make sure she shares her toys with cousins her age."

A group of caregivers of toddlers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which of the following statements made by these caregivers is most appropriate related to this form of discipline?

"When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to 'time out.'"

The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. Which of the following should the nurse say in response?

"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this?

A regular routine and rituals will provide stability and security.

The parents of a 30-month-old girl have brought her into the emergency department because she had a seizure. During the health history, the nurse suspects the child had a breath-holding spell. Which of the following parental reports suggests breath-holding?

A tantrum preceded the event

Parents are proud of their toddler's fast-developing fine motor skills. Which skill they describe should the nurse point out as a safety risk?

Ability to turn knobs

Sensorimotor Substage 5: Tertiary circular reactions

Age 12-18months Increased object permanence (knows that objects that are out of sight still exist (ex. cookies in cookie jar) Uses all senses to explore the environment

The parent reports the 13-month-old infant was using auditory expressive language. The vocalizations have been diminished over the last month and the child no longer says words. Select the best rationale for the infant's language behavior.

Biological factors such as otitis media could be causing hearing loss

Which suggestion by the nurse meant to promote good dental health in the 15-month-old is inappropriate?

Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. Using fluoride toothpaste prior to age 2 years promotes development of fluorosis.

While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their back yard a few days ago. The nurse explains that this is an instance of which of the following?

Deferred imitation

The mother of a 2-year-old tells you she is constantly scolding him for having wet pants. She says her son was trained at 12 months, but since he started to walk, he wets all the time. Which nursing diagnosis would be most applicable

Deficient parental knowledge related to inappropriate method for toilet training Explanation It is probable that a child toilet trained at 12 months was not truly trained; his mother was trained to remind him or place him on a toilet frequently during the day. When the child begins to play independently, the training is no longer effective.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which recommendation should be the most helpful to the parents?

Describing proper behavior when she misbehaves

Autonomy vs shame & doubt

Erikson Age 1-3 years Achieves autonomy and self-control Separates from parent/caregiver Withstands delayed gratification Negativism abounds Imitates adults and playmates Spontaneously shows affection Is increasingly enthusiastic about playmates Cannot take turns in games until age 3 years

The nurse is talking to the mother of a 19-month-old girl about setting limits and supervising activities. In which of the following situations will the nurse recommend letting the child do as she pleases?

Exploring her body Explanation It is normal for toddlers to explore their genitals when they are undressed. The parent should allow this and not punish the child.

A toddler's "no" can best be eliminated by asking a question instead of making a statement.

False

The parents of a 2-year-old girl are concerned with her behavior. For which behavior would the nurse share their concern?

Frequently babbles to herself when playing

To gain cooperation from a toddler, what is the best approach by the nurse? a) Immediately pick the toddler up from the mother's lap b) Kneel in front of the toddler while he or she is on the mother's lap. c) Do the nursing tasks quickly so the toddler can play d) Ask the toddler if it is ok if you begin the needed task

Kneel in front of the toddler while he or she is on the mother's lap.

According to Eric Erikson, the developmental task of the toddler is developing autonomy. Which of the following describes Erikson's psychosocial development task for the toddler?

Learning to act on one's own

Once temper tantrums have started, which of the following interventions are appropriate?

Move objects out of the way or move the child to prevent injury.

The nurse is observing a play group of children of all ages. The toddlers in the group would most likely be doing which of the following activities?

Playing with the plastic vaccum cleaner pushing it around the room

A mother of a 3-year-old asks the nurse about what kinds of toys would be appropriate. The nurse would suggest which of the following?

Pounding bench

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

Which gross motor developmental milestone is least likely for a 2 year old?

Rides a tricycle Explanation: A gross motor developmental milestone for a 2- to 3-year-old includes jumping in place. Riding a tricycle occurs at 3 to 4 years of age. Climbing occurs at occurs at 18 months to 2 years. At 12 to 18 months, the child can stand on one foot with help.

A father and his 12-month-old son are in for an office visit. The son is now walking regularly, and the father asks the nurse for recommendations on shoes. Which of the following should the nurse suggest?

Sneakers

The nurse is assessing the development of a 15-month-old girl during a regular visit. Which of the following skills would the nurse expect to see?

Stands alone

Parents of 3-year-old son ask the nurse for suggestions on how to deal with their son's nightmares. Which suggestion would be least effective?

Talk to him that night about the details of the dreams.

The 18-month-old has most likely attained which of the following gross motor skills?

The ability to walk independently.

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. Explanation The child should be past the stage of separation anxiety by age 3 years.

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 does not use the names of familiar objects.

A 15-month-old boy has been brought to the clinic because he is pale and listless. Which of the following findings and observations would lead the nurse to suspect iron deficiency anemia as the cause of the clinical manifestations?

The child drinks four cups of milk per day

In discussing with the nurse their 2-year-old's behavior, which of the parents' descriptors suggests the child may be ready for toilet teaching?

The child hides behind her bedroom door when defecating. Explanation Hiding while defecating indicates awareness of this need.

A mother expresses surprise to the nurse that her toddler daughter has begun masturbating. The most important initial nursing response is:

This is a normal and expected activity best treated matter-of-factly.

Parents and their 35-month-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay?

Uses two-word sentences or phrases Explanation A child nearly 3 years of age should speak in three- to four-word sentences.

Motor skill development of the toddler

Walking progresses to running, climbing and jumping. Pushing or pulling a toy, throwing a ball, and pedaling a tricycle are accomplished in toddlerhood. Fine motor skills progress from holding and pinching to the ability to manage utensils, hold a crayon, string a bead, and use the computer. Development of eye-hand coordination is necessary for the refinement of fine motor skills. Mastery in motor skill development contributes to the toddler's growing sense of self-esteem.

The way you would advise a toddler's mother to handle temper tantrums would be to

appear to ignore them.

The nurse is caring for a hospitalized 30-month-old who is resistant to care, is angry, and yells "no" all the time. The nurse identifies this toddler's behavior as: a) problematic, as it interferes with needed nursing care b) normal for this stage of growth and development c) normal because the child is hospitalized and out of his routine

b) normal for this stage of growth and development

A toddler's parents want to begin toilet training him. As a rule, the best instruction you could give them is:

bowel training is easier than urine training.

A toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her to

give him secondary, not primary, choices

What type of play do toddlers use?

parallel play: playing alongside another child rather than cooperatively.

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?" Which of the following would be appropriate for the nurse to suggest? Select all that apply.

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

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.

• Hard foods such as nuts, raw carrots, and popcorn • Sticky foods like peanut butter alone, gummy candies, and marshmallows • Round foods such as hot dogs, whole grapes, and cherry tomatoes

A mother of a 2-year-old asks the nurse, "What would be a good between-meal snack?" Which of the following would be appropriate for the nurse to suggest? Select all that apply.

• Orange slices • Yogurt • Cheese • Pieces of apples

A mother is concerned because her 2-year-old daughter is not speaking much. What should the nurse suggest to the mother? Select all that apply.

• Read books aloud to her. • Name aloud the objects that she is playing with. • Always answer her questions.

A nurse is presenting a class on toilet training to a group of parents with toddlers. Which of the following would the nurse include in the class? Select all that apply

• Using training pants that slide down easily and quickly • Putting the child on the potty chair at regular intervals during the day • Praising the child when he or she urinates or defecates

The nurse is caring for a 16-month-old child on the pediatric unit. The child's mother is a single mother who has two other young children at home. She must leave her 16-month-old daughter overnight in the hospital. Which of the following actions by the nurse will be most appropriate in helping the child feel secure and in reassuring this mother?

Encourage the mother to give her daughter a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return such as "when breakfast comes in the morning." Explanation When the family caregiver must leave the toddler, it may be helpful for the adult to give the child some personal item to keep until the adult returns. The caregiver can tell the child he or she will return "when the cartoons come on TV" or "when your lunch comes." These are concrete times that the toddler will probably understand.

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?

Give her slices of cheddar cheese as a snack

The nurse is discussing proper discipline with the mother of a 15-month-old boy. Which statement is most important?

Never spank the child for any reason.

The parents of a 2-year-old boy report to the nurse because their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child?

Offering a variety of foods along with the foods the child likes

When observing a group of toddlers playing in a child care setting it is noted that the toddlers are all playing with buckets and shovels but are not playing with each other. This type of play is referred to as which of the following?

Parallel play

Sensorimotor (substages 5-6)

Piaget Differentiates self from objects

Parents who just moved into their "dream home" are concerned because their toddler boy, who had achieved daytime bowel and bladder control, has begun wetting and defecating in his underwear. The nurse explains this is called:

Regression

The mother of a 2-year-old boy has asked for some ideas for snack foods that would be less likely to cause dental caries. Which of the following items would the nurse most likely suggest?

Whole grain chips broken into pieces

A toddler's father is concerned because his son refuses to share. What is your best response concerning this?

This is normal toddler behavior; sharing is learned later.

A father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which of the following findings should concern the nurse?

Total weight gain of 15 lb in the past year

It is naptime and the caregiver of a 2-year-old says to her child, "I will help you put all of your stuffed animals in a row next to your bed just like we do every day." This statement is an example of:

ritualism

The nurse is talking with the parents of a newborn who is being discharged following an uneventful delivery. The parents express their excitement about going home but have concerns about what they need to do to help their 2-year-old adjust to the new baby. Which of the following suggestions would be most appropriate for the nurse to offer these parents?

"You should plan some time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant."

A toddler insists on brushing his own teeth and being left alone in the bathtub. What advice would you give his parents regarding this?

Helping with his own tooth brushing allows him to experience autonomy.

Preoperational

Age 2-7years old Starts to think before acting Understands requests and is capable of following simple directions Has a sense of ownership (my, mine) Time, space, and causality understanding increases Uses mental trial and error method instead of physical Makes mechanical toys work Plays make-believe with dolls, animals, and people Increased use of language for mental representation Understands concept of "two" Starting to make connections between and experience in the past, and a new one that is currently occuring Sorts objects by shape and color Completes puzzles with 4 pieces Play becomes more complex

When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old?

He should speak in two-word sentences ("Me go") Explanation By 2 years of age, children typically speak in two-word (noun and verb) sentences.

Expected gross motor and fine motor skills of a 36 month old (3 years old)

Gross: climbs well, pedals tricycle, runs easily, walks up and down stairs with alternate feet, bends over easily without falling. Fine: undresses self, copies circle, builds tower of 9 or 10 cubes, holds a pencil in writing position, screws/unscrews lids, nuts, bolts, turn book pages one at a time.

Expected gross motor and fine motor skills of a 24 month old (2 year old)

Gross: runs, kicks ball, can stand on tiptoe, carries several toys, or a large toy while walking, climbs onto and down from furniture without assistance Fine: Builds tower of 6 or 7 cubes, right or left handed. imitates circular and vertical strokes, scribbles and paints, starting to turn knobs, puts round pegs into holes.

Expected gross motor and fine motor skills of a 12-15 month old

Gross: walks independently Fine: feeds self finger foods, uses index finger to point

The nurse is observing a 3-year-old boy in a daycare center. Which behavior might suggest an emotional problem?

Has persistent separation anxiety

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?

Limiting the choices and decisions that the child makes

The caregivers of 2 ½-year-old Frances tell the nurse that they are working hard to teach her to share and communicate with other children. The nurse recognizes and acknowledges their devotion, but explains to them that a child this age is probably not at a developmental level to play and share with other children. Of the following activities, which activity would the nurse recommend as the most appropriate activity for a 2 ½-year-old?

Mowing the lawn with a toy lawnmower

The nurse is recommending food items for an 18-month-old girl. Which ones will benefit the child's neurologic system most?

Peanut butter on crackers, cheese, and whole milk

A mother reports her 2-year-old daughter has gradually eaten more and more poorly since her 1-year-old well-child visit. The nurse assesses the child's growth and development as normal. What concept explains the mother's concern?

Physiologic anorexia

The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it.

True

The nurse is observing a 36-month-old boy during a well visit. Which motor skill has he most recently acquired?

Undress himself

What is the best advice about nutrition for the toddler? a) Encourage cup drinking and give water between meals and snacks. b) encourage unlimited milk intake, because toddlers need the protein for growth c) avoid sugar-sweetened fruit drinks and allow as much natural fruit juice as desired. d) allow the toddler unlimited access to the sippy cup to ensure adequate hydration.

a) Encourage cup drinking and give water between meals and snacks.

Parents of a 2-year-old girl are having a conversation with the nurse about tantrums. Which of the following techniques would the nurse most likely to suggest?

Use short "time-outs" and remain calm

Cognitive development of toddlers

Young toddlers engage in tertiary circular reactions and progress to mental combinations. Rather that just repeating a behavior, the toddler is able to experiment with a behavior to see what happens. By age 2, toddlers are capable of using symbols to allow for imitation. They may engage in delayed imitation (for ex they may imitate a household task that they observed a parent doing several days ago). During ages 2-7 toddlers begin to become more sophisticated with symbolic thought. the thinking of the older toddler is far more advanced than that of the infant or young toddler who views the world as a series of objects. During the preoperational stage objects begin to have characteristics that make them unique from one another. Objects are considered large or small, having a particular color, or shape, or having a unique texture. Toddlers also use symbols in dramatic play. First they imitate life with appropriate toy objects, and then they are able to substitute objects in their play. A bowl may be used to pretend to eat from, but then later it can be used upside-down on the head as a hat. Human feelings and characteristics may also be attributed to objects (animism).

The mother of a 15-month-old is concerned about a speech delay. She describes her toddler as being able to understand what she says, sometimes following commands, but using only one or two words with any consistency. What is the nurse's best response to this information a) the toddler should have a developmental evaluation ASAP b) if the mother would read to the child, then speech would develop faster c) receptive language normally develops earlier than expressive language d) the mother should ask her child's physician for a speech therapy evaluation

c) receptive language normally develops earlier than expressive language

A 2-year-old is having a temper tantrum. What advice should the nurse give the mother? a) for safety reasons, the toddler should be restrained during the tantrum b) punishment should be initiated as tantrums should be controlled c)the mother should promise the toddler a reward if the tantrum stops d) the tantrum should be ignored as long as the toddler is safe

d) the tantrum should be ignored as long as the toddler is safe

A 2-year-old holds his breath until he passes out when he wants something his mother does not want him to have. You would base your evaluation of whether these temper tantrums are a form of seizure on the basis that

seizures are not provoked; temper tantrums are.

The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem?

"He doesn't respond if I wave to him." Explanantion The fact that the child does not respond when the mother waves to him suggests he may have a vision problem. T

After teaching the mother of a 13-month boy old about suggestions for bathing and hygiene, the nurse determines that the teaching was successful when the mother states which of the following?

"It might be best to give him a bath in the evening."

A nurse is discussing safety measures with the parents of a toddler. Which of the following would the nurse emphasize to address the most frequent type of accident in toddlers?

"Keep all cleaning products and drugs out of the reach of your child."

The nurse is teaching the mother of a 2-year-old boy about age-appropriate toys. Which would be of most interest plus stimulating to the growth and development of this child?

Giving the child bowls, pot, pans, and large spoons

Expected gross motor and fine motor skills of an 18 month old

Gross: climbs stairs with assistance, pulls toys while walking Fine: masters reaching, grasping, and releasing: stacks blocks, puts things in slots, Turns book pages (singly with board book, multiple if paper), removes socks and shoes, and stacks 4 cubes