PrepU Ch 16: Care of the Toddler
Blood pressure monitoring becomes part of the routine health assessment at what age?
3 years Explanation: Blood pressure monitoring become part of the routine health exam at age 3.
The mother of an 18-month-old girl voices concerns about her child's social skills. She reports that the child does not play well with others and seems to ignore other children who are playing at the same time. What response by the nurse is indicated?
"It is normal for children to engage in play alongside other children at this age." Explanation: The social skills of the toddler at this age include parallel play. During parallel play children will play alongside each other rather than cooperatively. There is no indication that the aggression level of the child needs to be investigated. There is no indication the child needs increased socialization with other children.
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 Explanation: Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time, which 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.
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." Explanation: Suggesting that the parents transition the child to a healthier diet by serving him more healthy choices along with smaller portions of junk food will reassure them that they are not starving their child. The parents would have less success with an abrupt change to healthy foods. Explaining calorie requirements and the time line for acceptance of a new food do not offer a practical reason for making a change in diet.
Parents are beginning potty training their 2-year-old child and seek advice from the nurse on how to be successful in this endeavor. Which statement by the parents indicates that further teaching is needed?
"He wants to accompany me to the bathroom but I prefer to go alone." Explanation: Allowing a toddler to observe a parent or older sibling going to the bathroom serves as a positive role model and helps the child understand what they are to do when they are there.
Which statement by the mother of a 15-month-old with special needs alerts the nurse that more teaching is needed?
"She is so messy I don't let her feed herself." Explanation: Not allowing her to feed herself interferes with development of this skill, as well as with achievement of autonomy. All the rest of the statements describe behaviors that are exhibited during the toddler stage of development and should be supported. Implied is that she does not walk or have speech, yet she is effectively compensating with rolling and head shaking. Toddler medication refusal is not unusual and is being handled appropriately.
During a wellness check up for a 4-year-old client, the parents state, "We just moved into a new home and our child has begun wetting and defecating in the underwear. Which response by the nurse is approprite?
"This is a normal response to stress during childhood." Explanation: The child is exhibiting signs of returning (regressing) to an earlier, possibly safer stage of development caused by a stressor (moving). This is a normal response children have to stress and will subside. There is no indication of a urinary tract infection or constipation; therefore, the nurse would not need to ask about frequency or pain. The nurse should first address the parent's concern and not simply inform the primary health care provider.
A group of caregivers of toddlers are discussing the form of discipline in which the toddler is placed in a "time-out" chair. Which statement 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." Explanation: A method for a toddler 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 toddler 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 toddler in advance of this possibility, but only one warning per event is necessary. The chair should be used for discipline, not because the toddler will not go take a nap. It can be used for all ages of children.
The nurse is caring for a 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?
10 mL/hr Explanation: 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.
When assessing a 33 month old, the nurse would expect to find how many teeth?
20 Explanation: Eight new teeth erupt during the second year. All 20 deciduous teet are generally present by 2.5 to 3 years of age.
The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching?
Advising them to use praise, not scolding Explanation: The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.
Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer?
Artificially acquired active immunity Explanation: Artificially acquired active immunity develops through vaccine administration of an antigen that stimulates the child's body to produce antibodies against that antigen (pathogen) and to remember the antigen should it reappear. Natural immunity is produced through natural invasion of an antigen (pathogen). Natural and artificial passive immunity involves providing antibodies to fight a pathogen rather than expecting the child's body to produce them. This type of immunity has a short life.
A nurse is assessing a 3-year-old's fluid and electrolyte status. When obtaining the child's history, which of the following would be most important?
Asking the parents how often the child has been urinating. Explanation: The parent would be the best historian for the history questions and the questions should focus on all body systems. Intake and output affect fluid and electrolyte balance profoundly. In the health history, include questions about the amount as well as the type of fluids ingested. Major routes of fluid output are urine, stool, and vomiting. To assess voiding patterns, ask the parent how many wet diapers the infant or young child has each day or how often the child is urinating.
The nurse is assessing a 2-year-old boy during a well child visit. The nurse correctly identifies the child's current stage of Erickson's growth and development as:
Autonomy versus shame and doubt Explanation: The Erickson 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.
The pediatric nurse is performing a head-to-toe exam on a 2-year-old child during a well child assessment. Which method will the nurse use to accurately determine the child's heart rate?
Counting the apical rate Explanation: The most accurate way of determining the child's heart rate is to count the apical rate by auscultation. The remaining answer choices do not represent the most accurate method to determine the child's heart rate.
The charge nurse observes a new graduate nurse assess the cremasteric reflex in an 8-month-old boy. The new graduate nurse strokes the lateral aspect of the thigh. Which action should the charge nurse take?
Demonstrate the appropriate technique. Explanation: A cremasteric reflex is elicited by stroking the medial aspect of the thigh in boys. With this, the testes move perceptibly upward. The presence of this reflex indicates integrity of the first and second lumbar nerves. Abdominal reflexes should be assessed in both sexes. An abdominal reflex is elicited by lightly stroking each quadrant of the abdomen. Normally, the umbilicus moves perceptibly toward the stroke. Presence of this reflex indicates integrity of the 10th thoracic nerve and the first lumbar nerve of the spinal cord. The new graduate nurse needs to be shown the correct aspect of the thigh to stroke so that she/he can perform the technique correctly in the future. Explaining why the technique is incorrect does not show the nurse how to perform the procedure correctly. The charge nurse would not want to applaud an incorrect procedure, nor is this reason to counsel the nurse.
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?
Giving the child bowls, pot, pans, and large spoons Explanation: 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.
The mother of a toddler is frustrated because the toddler insists on brushing his own teeth and being left alone in the bathtub. What advice should the nurse provide to the mother about these expectations?
Helping with teeth brushing encourages autonomy. Explanation: Toddlers need a toothbrush they recognize as their own. Toward the end of the toddler period, they can begin to do the brushing themselves under supervision; although, almost all children need some supervision until about age 8 years. It is not unusual for a toddler to have opinions and want to do things themselves. The mother needs to permit the child to perform autonomous acts with supervision. The child is too young to be permitted in the bathtub alone. This is a safety hazard.
During a health promotion seminar with community members, the nurse provides information to support the 2020 National Health Goal to prevent and reduce the incidence of infectious disease in children. What information did the nurse most likely provide?
Importance of maintaining appropriate immunizations Explanation: Nurses can help the nation achieve the 2020 National Health Goals to prevent and reduce the incidence of infectious disease in children by educating parents about the importance of immunizations. Rest, sleep, exercise, and dietary intake are not identified interventions to help achieve the 2020 National Health Goals for infectious disease in children.
The parents of a 2-year-old child born with short-gut syndrome feed their toddler via a feeding tube. Knowing this is a developmental time when children usually feed themselves, the parents are asking the nurses what they can do to help foster the child's independence. Which suggestion would be most appropriate at this time?
Let the child choose what clothing he or she will wear the next day. Explanation: If children are tube fed, they receive no experience at all with finger foods. For these children, parents should try to provide other, comparable experiences in independence, such as letting them choose what toy to take to bed or what clothing to wear. Playing, reading, or pretending a toy is food at feeding time are not appropriate activities since the child's feeding is usually scheduled around normal meal times.
A nurse is assisting the parents of 2-year-old who is having temper tantrums. What would the nurse encourage the parents to do once temper tantrums have started?
Move objects out of the way or move the child to prevent injury. Explanation: Appropriate interventions include moving objects out of the way or moving the child to prevent injury from occurring during the temper tantrum. The caregiver should not speak to the child and should avoid eye contact until the child has calmed down. The child's behavior should be ignored. Do not talk excessively about the tantrum because this can negatively impact the child's self-esteem.
The nurse caring for a 3-year-old patient is having a very difficult time persuading the child to take an oral medication. The child yells "Yucky" every time the nurse approaches with the medication. Which of the following is the best approach to take when giving medication to a resistant toddler?
Offer the child a popsicle to numb the mouth and decrease the bad taste of the medicine. Explanation: Offering the child a popsicle to help numb the mouth and therefore decrease the bad taste of the medicine is a good approach to take. Never lie to a child about the taste of the medicine or pretend the medicine is candy. Physical force should never be used to overcome a child.
The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?
The child's nonverbal behaviors may indicate the presence of discomfort. Explanation: Responses to pain can vary in children. A child of this age may present with vocal behaviors indicating pain. The child may be tearful or crying loudly. Being quiet can also signal pain.
The nurse is teaching a student how to instill ear drops into a 2-year-old. What technique does the nurse demonstrate to the student?
The nurse pulls the pinna of the ear down and back. Explanation: The nurse should pull the pinna of the ear down and back for a child under 3 to help straighten the ear canal. For a child over 3, the pinna is pulled up and back. The other choices are also incorrect positions for this age.
The nurse is completing an assessment on a 2-year-old child. The nurse notes the presence of a raised reddish purple spot on the back of the child's neck. Which statement about this finding is correct?
These lesions will normally fade as the child ages. Explanation: The lesions described are consistent with strawberry nevus. They are benign and normally fade as the child ages, usually by the age of 9 years. Nevus flammeus are associated with the development of Sturge-Weber syndrome.
Parents of a 2-year-old girl are having a conversation with the nurse about tantrums. Which technique would the nurse most likely suggest?
Use short "time-outs" and remain calm. Explanation: The best response to tantrums is to remain calm and use short "time-outs." Responses need to be consistent rather than varied. Telling the child she is bad is negative. Promising a reward for good behavior will result in rewarding bad behavior.
A mother of a 2-year-old girl is asking her friend when she should start potty training the child. The mother expresses concern about the high cost of diapers and training pants and would really like to have her trained as soon as possible. Which advice by the friend would be considered the best response?
When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training." Explanation: The markers of readiness are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers, or they may bring a parent a clean diaper after they have soiled so they can be changed. The other answers do not address this. Usually the child needs to walk well independently before training can occur.
The parent of a 2-year-old toddler tells the nurse she needs to constantly scold the toddler for having wet pants. The parent says the toddler was potty trained at 12 months, but since starting to walk, the toddler wets the pants all the time. Which nursing diagnosis would be most applicable?
Deficient parental knowledge related to inappropriate method for toilet training Explanation: Myelination of the spinal cord is achieved around 2 years of age. When this occurs, the toddler can exercise voluntary control over the sphincters. It is probable that a toddler toilet trained at 12 months of age was not truly trained, because the infant would not be developmentally able to complete the task. It is most likely the parent used a training method of reminding the infant or placing the infant on a toilet frequently during the day. When the toddler begins to play independently, the toddler forgets the regimented schedule. This toddler is not toilet trained independently. The toddler does not display total urinary incontinence. The toddler is only incontinent when playing and not reminded to potty. A 2-year-old toddler has limited coping skills. Frequent wetting of the pants does not indicate too much fluid intake. It is a symptom that the toddler does not feel the urge to urinate until the bladder is too full and the toddler cannot get to the toilet on time.
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 uses the potty chair and is dry all day long." Explanation: 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 first-time parent asks the nurse what toys would be appropriate for her son's second birthday next month. What recommendations would be nurse make?
Play lawn mower Explanation: Toys for toddlers should include imitative toys, toys that encourage fine and gross motor development and involve socialization. A play lawn mower meets these criteria by being something the child can push and imitate the parent's activities. A rattle is too young of a toy and dress-up clothing and a water gun are too advanced.
The nurse is supervising a play group of children on the unit. The nurse expect the toddlers will most likely be involved in which activity?
Playing with the plastic vacuum cleaner and pushing it around the room Explanation: 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.
The nurse has brought a 3-year-old's oral medications into the room for administration. Upon approaching the child, the nurse said, "I have your medication. Would you rather have me hand it to you or Mommy?" In critiquing the nurse's actions, which is most accurate?
The nurse's behavior is correct. The nurse provided the child a choice between two acceptable options with the outcome of taking the medication. Explanation: The nurse is correct to offer a choice to the preschooler and then for the mother to administer the medication, if chosen. This meets the developmental level of autonomy. The nurse prepared the medication and the medication remained with the nurse until handing it to the mother, who handed it to the child. The nurse witnessed the medication administration and documents it. The nurse firmly requires the medication to be taken but found a way for the child to take it that was acceptable to the child and accomplished the goal.
A 2-year-old toddler holds his breath until passing out when he wants something the parent does not want him to have. The nurse would decide whether these temper tantrums are a form of seizure based on the fact that:
seizures are not provoked; temper tantrums are. Explanation: Temper tantrums are the natural result of toddler frustration. Toddlers are eager to explore new things but their efforts can be thwarted, especially for safety reasons. Toddlers do not behave badly on purpose. Temper tantrums occur out of anger and frustration. Seizures do not. Seizures can occur at any age. The client may or not be febrile. Depending upon how long a seizure lasts, cyanosis can occur.
The nurse caring for a 3-year-old patient is having a very difficult time persuading the child to take an oral medication. The child yells "Yucky" every time the nurse approaches with the medication. Which of the following would be the best approach for the nurse?
Offer the child an ice pop to numb the mouth and decrease the bad taste of the medicine. Explanation: Offering the child a Popsicle to help numb the mouth and therefore decrease the bad taste of the medicine is a good approach to take. Never lie to a child about the taste of the medicine or pretend the medicine is candy. Physical force should never be used to overcome a child.
