The Infant, Toddler, and Preschooler

Which type of play is most typical of the preschool period? a. Solitary b. Parallel c. Associative d. Team

C Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams.

. A parent asks the nurse "At what age do most babies begin to fear strangers?" The nurse responds that most infants begin to fear strangers at what age? a. 2 months b. 4 months c. 6 months d. 12 months

C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months, the infant is just beginning to respond differentially to the mother. At age 4 months, the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the infant does not fear strangers at this age.

Developmentally, most children at age 12 months demonstrate what behavior? 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 foods 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.

Parent guidelines for relieving colic in an infant include a. avoiding touching the abdomen. b. avoiding using a pacifier. c. changing the infant's position frequently. d. placing the infant where the family cannot hear the crying.

C Changing the infant's position frequently may be beneficial. The parent can walk holding the infant face down and with the infant's chest across the parent's arm. The parent's hand can support the infant's abdomen, applying gentle pressure. Gently massaging the abdomen is effective in some infants. Pacifiers can be used for meeting additional sucking needs. The infant should not be placed where monitoring cannot be done. The infant can be placed in the crib and allowed to cry. Periodically, the infant should be picked up and comforted.

Which comment indicates 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 when leaving 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.

Which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face such as the mother. b. Recognizes familiar object such as a bottle. c. Actively searches for a hidden object. d. Secures objects by pulling on a string.

C During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows that an object exists even when it is not visible. Between ages 8 and 12 weeks, infants begin to respond differentially to their mothers. They cry, smile, vocalize, and show distinct preference for their mothers. This preference is one of the stages that influence the attachment process, but it is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect, such as pulling on a string to secure an object, is part of secondary schema development.

By what age does the posterior fontanel usually close? a. 6 to 8 weeks b. 10 to 12 weeks c. 4 to 6 months d. 8 to 10 months

A The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks. Ten weeks or longer is too late and indicates a problem.

Preschoolers' fears can best be dealt with by which intervention? a. Actively involving them in finding practical methods to deal with the frightening experience b. Forcing them to confront the frightening object or experience in the presence of their parents c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are d. Ridiculing their fears so they understand that there is no need to be afraid

A Actively involving the child in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away.

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

A Animism is the attribution of life-like 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.

Which is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands

A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Playing pat-a-cake and showing how to clap hands will help with kinesthetic stimulation. Imitating animal sounds will help with auditory stimulation.

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as a. a normal finding. b. a questionable finding—the infant should be rechecked in 1 month. c. an abnormal finding—indicates the need for immediate referral to a practitioner. d. an abnormal finding—indicates the need for developmental assessment.

A Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required.

The nurse is interviewing the father of 10-month-old. When the child, playing on the floor and notices an electrical outlet and reaches up to touch it, the father says "No" firmly and removes the child away from the outlet. The nurse should use this opportunity to teach the father that the child is capable of understanding what association? a. Understand the word "No." b. Father always means "No." c. Electrical outlets are dangerous. d. Spanking as a deterrent.

A By age 10 months, children are able to associate meaning with words. The child should be old enough to understand the word "No." The 10-month-old is too young to understand the purpose of an electrical outlet and is not likely to always associate her father with the word "No." The father is using both verbal and physical cues to teach safety measures and alert the child to dangerous situations. Physical discipline should be avoided.

The nurse determines an infant of 7 months is demonstrating appropriate fine motor development when performing which action? a. Transferring a rattler from one hand to the other b. Using thumb and index finger to grasp a piece of food c. Holding a crayon and make a mark on paper d. Releasing cubes into a cup

A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The infant can scribble spontaneously at age 15 months. At age 12 months, the infant can release cubes into a cup.

Which is the most fatal type of burn in the toddler age-group? 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.

Sara, age 4 months, was born at 35 weeks' gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. The nurse should explain that a. infants' temperaments are part of their unique characteristics. b. infants become less difficult if they are not kept on scheduled feedings and structured routines. c. Sara's behavior is suggestive of failure to bond completely with her parents. d. Sara's difficult temperament is the result of painful experiences in the neonatal period.

A Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.

What is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Congenital disorders 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 eats little at mealtimes, only sits at the table with the family briefly, and wants snacks "all the time." The nurse should recommend what intervention to 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.

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. What recommendations should the nurse provide the parents? a. Never heat a bottle in a microwave oven. b. Heat only 10 ounces or more. c. Always leave the bottle top uncovered to allow heat to escape. d. Shake the bottle vigorously for at least 30 seconds after heating.

A Neither infant formula nor breast milk should be warmed in a microwave oven as this may cause oral burns as a result of uneven heating in the container. The bottle may remain cool while hot spots develop in the milk. Warming expressed milk in a microwave decreases the availability of anti-infective properties and causes separation of the fat content. Milk should be warmed in a lukewarm water bath. None of the other options adequately deals with the issue of overheating.

Which clinical manifestations should cause the nurse to suspect that a child, diagnosed with a digestive disorder, may be demonstrating signs of failure to thrive? a. Avoidance of eye contact b. An associated malabsorption defect c. Weight that falls below the 15th percentile d. Normal achievement of developmental landmarks

A One of the clinical manifestations of nonorganic failure to thrive is the child's avoidance of eye contact with the health professional. A malabsorption defect would result in a physiologic problem, not behavioral. Weight (but not height) below the 5th percentile is indicative of failure to thrive. Developmental delays, including social, motor, adaptive, and language, exist.

In terms of cognitive development, the preschooler would be expected to engage in what behavior? a. Use magical thinking. b. Think abstractly. c. Understand conservation of matter. d. Be able to comprehend another person's perspective.

A Preschoolers' thinking is often described as magical thinking. Because of their egocentrism and transductive reasoning, they believe that thoughts are all-powerful. Abstract thought does not develop until school-age years. The concept of conservation is the cognitive task of school-age children ages 5 to 7 years. Five year olds cannot understand another's perspective.

With the goal of preventing plagiocephaly, the nurse should teach new parents to consider which intervention? a. Place the infant prone for 30 to 60 minutes per day. b. Buy a soft mattress. c. Allow the infant to nap in the car safety seat. d. Have the infant sleep with the parents.

A Prevention of positional plagiocephaly may begin shortly after birth by implementing prone positioning or "tummy time" for approximately 30 to 60 minutes per day when the infant is awake. Soft mattresses or sleeping with parents (co-sleeping) are not recommended because they put the infant at a higher risk for a sudden infant death incident. To prevent plagiocephaly, prolonged placement in car safety seats should be avoided.

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

In terms of gross motor development, what hallmark action should the nurse identify for the parents of a 5-month-old infant to anticipate? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position.

A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

A common characteristic of those who sexually abuse children is that they a. pressure the victim into secrecy. b. are usually unemployed and unmarried. c. are unknown to victims and victims' families. d. have many victims that are each abused only once.

A Sex offenders may pressure the victim into secrecy, regarding the activity as a "secret between us" that other people may take away if they find out. Abusers are often employed upstanding members of the community. Most sexual abuse is committed by men and persons who are well known to the child. Abuse is often repeated with the same child over time. The relationship may start insidiously without the child realizing that sexual activity is part of the offer.

Which information could be given to the parents of a 12-month-old child regarding appropriate play activities for this age? a. Give large push-pull toys for kinesthetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with finger paints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.

A The 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for a child of this age include large push-pull toys for kinesthetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse.

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 which intervention for 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.

Which consideration should be considered when planning care for an infant diagnosed with failure to thrive? a. Establishing a structured routine and follow it consistently b. Maintaining a nondistracting environment by not speaking to the infant during feeding c. Placing the infant in an infant seat during feedings to prevent overstimulation d. Limiting sensory stimulation and play activities to alleviate fatigue

A The infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The nurse should talk to the infant by giving directions about eating. This will help the infant maintain focus. Young children should be held while being fed, and older children can sit at a feeding table. The infant should be fed in the same manner at each meal. The infant can engage in sensory and play activities at times other than mealtime

The parent of a 16 month old asks, "What is the best way to keep our toddler from getting into our medicines at home?" The nurse should provide which advice? 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 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands; however, she will not voluntarily grasp it. How should the nurse interpret this behavior? a. Normal development b. Significant developmental lag c. Slightly delayed development caused by prematurity d. Suggestive of a neurologic disorder such as cerebral palsy

A This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of developmental lag, delayed development, or neurologic dysfunction is present by this behavior.

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

What skill that the nurse should expect a 5-year-old child to be able to master? a. Tie shoelaces. b. Use a knife to cut meat. c. Hammer a nail. d. Make change from a quarter.

A Tying shoelaces is a fine motor task typical of 5 year olds. Using a knife to cut meat is a fine motor task of a 7 year old. Hammering a nail and making change from a quarter are fine motor tasks of an 8 to 9 year old.

In terms of gross motor development, what would the nurse educate the parents to expect a 5-month-old infant to do? (Select all that apply.) a. Roll from abdomen to back. b. Put feet in mouth when supine. c. Roll from back to abdomen. d. Sit erect without support. e. Move from prone to sitting position.

A, B Rolling from abdomen to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. Rolling from back to abdomen is developmentally appropriate for a 6-month-old infant. An 8-month-old infant should be able to sit erect without support. A 10-month-old infant can usually move from a prone to a sitting position.

Which play patterns does a 3-year-old child typically display? (Select all that apply.) a. Imaginary play b. Parallel play c. Cooperative play d. Structured play e. Associative play

A, B, C, E Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years. Structured play is typical of school-age children.

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 into the child's demands only increases the behavior.

In teaching parents about appropriate pacifier selection, the nurse should explain that a pacifier should have which characteristics? (Select all that apply.) a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material

A, B, E A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible. An attached ribbon or string and soft, pliable material are not characteristics of a good pacifier.

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

Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.) a. Allow parents to say goodbye to their infant. b. Once parents leave the hospital, no further follow-up is required. c. Arrange for someone to take the parents home from the hospital. d. Avoid requesting an autopsy of the deceased infant. e. Conduct a debriefing session with the parents before they leave the hospital.

A, C, E An important aspect of compassionate care for parents experiencing a SIDS incident is allowing them to say good-bye to their infant. These are the parents' last moments with their infant, and they should be as quiet, meaningful, peaceful, and undisturbed as possible. Because the parents leave the hospital without their infant, it is helpful to accompany them to the car or arrange for someone else to take them home. A debriefing session may help health care workers who dealt with the family and deceased infant to cope with emotions that are often engendered when a SIDS victim is brought into the acute care facility. An autopsy may clear up possible misconceptions regarding the death. When the parents return home, a competent, qualified professional should visit them after the death as soon as possible.

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.

In terms of language and cognitive development, which behavior is expected of a 4-year-old child? a. Thinking in abstract terms b. Following simple commands c. Understanding conservation of matter d. Comprehending another person's perspective

B Children ages 3 to 4 years can give and follow simple commands. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. A 4-year-old child cannot comprehend another's perspective.

What is descriptive of the preschooler's understanding of time? a. Has no understanding of time. b. Associates time with events. c. Can tell time on a clock. d. Uses terms like "yesterday" appropriately.

B In a preschooler's understanding, time has a relation with events such as, "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years.

The nurse is caring for a hospitalized 4 year old. The parents tell the nurse that they will be back to visit at 6 PM. When the child asks the nurse, "when my parents are coming", what is the nurse's best response? a. "They will be here soon." b. "They will come after dinner." c. "Let me show you on the clock when 6 PM is." d. "I will tell you every time I see you how much longer it will be."

B A 4 year old understands time in relation to events such as meals. Children perceive :soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. This answer assumes that the child understands the concept of hours and minutes, which is not developed until age 5 or 6 years.

The parent of a 4 year old tells the nurse that the child believes "monsters and the boogeyman" are in the bedroom at night. What is the nurse's best suggestion for coping with this problem? a. Insist that the child sleep with his parents until the fearful phase passes. b. Suggest involving the child to find a practical solution such as a night-light. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and the boogeyman do not exist.

B A night-light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents or telling the child that these creatures do not exist will not get rid of the fears. A 4 year old is in the preconceptual age and cannot understand logical thought.

Acyclovir is given to children with chickenpox for what purpose? a. Minimize scarring. b. Decrease the number of lesions. c. Prevent aplastic anemia. d. Prevent spread of the disease.

B Acyclovir decreases the number of lesions, shortens duration of fever, and decreases itching, lethargy, and anorexia; however, it does not prevent scarring. Preventing aplastic anemia is not a function of acyclovir. Only quarantine of the infected child can prevent the spread of disease.

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months, the infant can enjoy social interactions.

Which statement 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.

The nurse assessing a 6-month-old healthy infant who weighed 7 lbs at birth, shares with the parents that the infant should weigh approximately how many pounds? a. 10 lbs b. 15 lbs c. 20 lbs d. 25 lbs

B Birth weight doubles at about age 5 to 6 months. At 6 months, an infant who weighed 7 lbs at birth would weigh approximately 15 lbs. Ten pounds is too little; the infant would have gone from the 50th percentile at birth to below the 5th percentile. Twenty pounds or more is too much; the infant would have tripled the birth weight at 6 months.

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.

What is the most effective way to clean a toddler's teeth? 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.

Parents have been using a rearward-facing, convertible car seat since their baby 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 b. 2 years c. 3 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.

The nurse is performing an assessment on a child and notes the presence of Koplik's spots. In which communicable disease are Koplik's spots present? a. Rubella b. Measles (rubeola) c. Chickenpox (varicella) d. Exanthema subitum (roseola)

B Koplik's spots are small, irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before the systemic rash of measles appears. Koplik's spots are not present with rubella, varicella, or roseola.

When is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started

B Physiologically and developmentally, the 4 to 6 months old is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding. Two to three months is too young. The extrusion reflex is strong, and the infant will push food out with the tongue. No research base indicates that the addition of solid food to bottle-feeding has any benefit. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability.

Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. What is the best interpretation of this behavior? 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.

A 4 year old is hospitalized with a serious bacterial infection. The child tells the nurse that, "I am sick because I was bad." What is the nurse's best interpretation of this comment? a. It is a sign of stress. b. It is common at this age. c. It is suggestive of maladaptation. d. It is suggestive of excessive discipline at home.

B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

What is a normal characteristic of the language development of a preschool-age child? a. Lisp b. Stammering c. Echolalia d. Repetition without meaning

B Stammering and stuttering are normal dysfluencies in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language.

An appropriate recommendation in preventing tooth decay in young children would include which intervention? 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 clinic is lending a federally approved car seat to an infant's family. Where in the car should the nurse explain is the safest place to put the car seat? a. Front facing in back seat b. Rear facing in back seat c. Front facing in front seat if an air bag is on the passenger side d. Rear facing in front seat if an air bag is on the passenger side

B The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. Infants should face the rear from birth to 20 lbs and as close to 1 year of age as possible. The middle of the back seat provides the safest position. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.

Parents tell the nurse that they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which is the most appropriate recommendation the nurse should make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Allow children unrestricted permission to satisfy this curiosity. d. Get counseling for this unusual and dangerous behavior.

B Three year olds become aware of anatomic differences and are concerned about how the other "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. Encouraging the children to ask questions of the parents and redirecting their activity are more appropriate than giving permission. Exploration is age-appropriate and not dangerous behavior.

A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan? a. Avoid use of pacifiers. b. Eliminate all secondhand smoke contact. c. Lay infant flat after feeding. d. Avoid swaddling the infant.

B To prevent and treat colic, teach parents that if household members smoke, they should avoid smoking near the infant; smoking activity should preferably be confined to outside of the home. A pacifier can be introduced for added sucking. The infant should be swaddled tightly with a soft, stretchy blanket, and placed in an upright seat after feedings

Which statement, made by a 4-year-old child's father, demonstrates an understanding about the care of the preschooler's teeth? a. "Because the 'baby teeth' are not permanent, they are not important to the child." b. "My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth." c. "My son's 'permanent teeth' will begin to come in at 4 to 5 years of age." d. "Fluoride supplements can be discontinued when my son's 'permanent teeth' erupt."

B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. Secondary teeth erupt at about 6 years of age. If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

The mother of an 18-month-old child is concerned because the child's appetite has decreased. Which is the best response for the nurse to make to the mother? 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 during this developmental stage." 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 ounces daily. Juice should be limited to 4 to 6 ounces 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.

When is a child with chickenpox considered to be no longer contagious? a. When fever is absent b. When lesions are crusted c. 24 hours after lesions erupt d. 8 days after onset of illness

B When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. The child is still contagious once the fever has subsided and after the lesions erupt, and may or may not be contagious any time after 6 days as long as all lesions are crusted over.

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.

Which are characteristics 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 conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a SIDS incident? (Select all that apply.) a. Breastfeeding b. Low Apgar scores c. Male sex d. Birth weight in the 50th or higher percentile e. Recent viral illness

B, C, E Certain groups of infants are at increased risk for SIDS: those with low birth weight, low Apgar scores, or recent viral illness, and those of male sex. Breastfed infants and infants of average or above-average weight are not at higher risk for SIDS.

In terms of language and cognitive development, a 4-year-old child would be expected to have which traits? (Select all that apply.) a. Think in abstract terms b. Sexual curiosity c. Understand conservation of matter d. Use sentences of eight words e. Tell exaggerated stories

B, E Children 4 years of age demonstrate sexual curiosity and tell exaggerated stories. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. Five-year-old children use sentences with eight words with all parts of speech

Although a 14 month old received a shock from an electrical outlet recently, the parents find the child about to place a paper clip in another outlet. What is the best interpretation of this behavior? 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.

During the preschool period, what should the emphasis of injury prevention be placed on? a. Constant vigilance and protection b. Punishment for unsafe behaviors c. Education for safety and potential hazards d. Limitation of physical activities

C Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate.

The parent of a 2-week-old asks the nurse if the infant needs fluoride supplements because they plan to exclusively breastfed. What is the nurse's best response? a. "Your infant needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "Your infant may need to begin taking them at age 6 months." d. "Your infant can have infant cereal mixed with fluoridated water instead of supplements."

C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. The recommendation is to begin supplementation at 6 months, not at 2 weeks. The amount of water that is ingested and the amount of fluoride in the water are evaluated when supplementation is being considered.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What should the nurse recommend to be used as substitute for the breastmilk? a. Skim milk b. Whole cow's milk c. Commercial iron-fortified formula d. Commercial formula without iron

C For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron deficiency anemia.

Which statement accurately describes an event associated with an infant's physical development? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

C Growth is very rapid during the first year of life. The birth weight approximately doubles by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

According to Piaget, the 6-month-old infant would be in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

C Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. For example, shaking of a rattle is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. The primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

By what age should the nurse expect that an infant will be able to pull to a standing position? a. 6 months b. 8 months c. 9 months d. 11 to 12 months

C Most infants can pull themselves to a standing position at age 9 months. Any infant who cannot pull to a standing position by age 11 to 12 months should be referred for further evaluation for developmental dysplasia of the hips (DDH). At 6 months, the infant has just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs.

Why are imaginary playmates beneficial to the preschool child? a. Take the place of social interactions. b. Take the place of pets and other toys. c. Become friends in times of loneliness. d. Accomplish what the child has already successfully accomplished.

C One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interactions but may encourage conversation. Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what has already been accomplished.

A 4-year-old child tells the nurse, "I do not want another blood sample drawn because I need all my insides, and I do not want anyone taking them out." Which is the nurse's best interpretation of this statement? a. Child is being overly dramatic. b. Child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.

At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months

C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

The mother of a breastfed infant being seen in the clinic for the sixth month checkup is concerned that the infant has begun thumb sucking. How should the nurse respond to the mother's concern? a. Recommend that the mother substitute a pacifier for the infant's thumb. b. Assess the infant for other signs of sensory deprivation. c. Reassure the mother that this behavior is very normal at this age. d. Suggest that the mother breastfeed more often to satisfy sucking needs.

C Sucking is an infant's chief pleasure, and she may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood, there is no need to restrict nonnutritive sucking. Dental damage does not appear to occur unless the use of the pacifier or finger persists after age 4 to 6 years. The nurse should explore with the mother her feelings about pacifier versus thumb. This is a normal behavior to meet nonnutritive sucking needs. No data support that Latasha has sensory deprivation

The nurse should teach parents that at what age it is safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months

C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. What intervention is the most appropriate recommendation? a. Punish the child with an age appropriate punishment. 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 fact about this task. 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.

Which is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate parental concern for the degree of injury b. Absence of parents for questioning about child's injuries c. Inappropriate response of child d. Incompatibility between the history and injury observed

D Conflicting stories about the "accident" are the most indicative red flags of abuse. Inappropriate response of caregiver or child may be present, but is subjective. Parents should be questioned at some point during the investigation.

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)? a. Explain how SIDS could have been predicted and prevented. b. Interview parents in depth concerning the circumstances surrounding the infant's death. c. Discourage parents from making a last visit with the infant. d. Make a follow-up home visit to parents as soon as possible after the infant's death.

D A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their infant.

The nurse is guiding parents in selecting a day care facility for their child. When making the selection, it is especially important to focus on which consideration? a. Structured learning environment b. Socioeconomic status of children c. Cultural similarities of children d. Teachers knowledgeable about development

D A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others; cultural similarities are not necessary.

By what age would the nurse expect that most children could understand prepositional phrases such as "under," "on top of," "beside," and "in back of"? a. 18 months b. 24 months c. 3 years d. 4 years

D At 4 years, children can understand directional phrases. Children 18 to 24 months and 3 years of age are too young.

Which characteristics best describes the language of a 3-year-old child? a. Asks meanings of words. b. Follows directional commands. c. Can describe an object according to its composition. d. Talks incessantly, regardless of whether anyone is listening

D Because of the dramatic vocabulary increase at this age, 3 year olds are known to talk incessantly, regardless of whether anyone is listening. A 4 to 5 year old asks lots of questions and can follow simple directional commands. A 6 year old can describe an object according to its composition.

What is the rationale for the nurse recommends to parents that peanuts are not a good snack food for toddlers? a. They are low in nutritive value. b. They are very high in sodium. c. They cannot be entirely digested. 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.

Which is the causative agent of scarlet fever? a. Enteroviruses b. Corynebacterium organisms c. Scarlet fever virus d. Group A beta-hemolytic streptococci (GABHS)

D GABHS infection causes scarlet fever. Enteroviruses do not cause the same complications. Corynebacterium organisms cause diphtheria. Scarlet fever is not caused by a virus.

The parents of a 12-month-old child ask the nurse if the child can eat hot dogs. The nurse's reply should be based on what understanding? a. The child is too young to digest hot dogs. b. The child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut into irregularly shaped pieces.

What are the psychosocial developmental tasks of toddlerhood? 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.

Which common childhood communicable disease may cause severe defects in the fetus when it occurs in its congenital form? a. Erythema infectiosum b. Roseola c. Rubeola d. Rubella

D Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not dangerous to the fetus.

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. The nurse should explain that a. this cannot be prevented. b. infants do not feel pain as adults do. c. this is not a good reason for refusing immunizations. d. a topical anesthetic, eutectic mixture of local anesthetic (EMLA), will minimize the discomfort

D Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. With preparation, the injection site can be properly anesthetized to decrease the amount of pain felt by the infant. Infants have the neural pathways to sense pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

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 b. Preoperations c. Secondary circular reaction 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. Preoperation 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 b. Rides tricycle c. Broad jumps 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.

A parent asks the nurse whether her infant is susceptible to pertussis. The nurse's response should be based on which statement concerning susceptibility to pertussis? a. Neonates will be immune the first few months. b. If the mother has had the disease, the infant will receive passive immunity. c. Children younger than 1 year seldom contract this disease. d. Most children are highly susceptible from birth.

D The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age-group.

The parents of a newborn say that their toddler "hates the baby and suggested that we put the baby in the trash can so the trash truck could take him away." What is the nurse's best response to the parent's concern? a. "Let's see if we can figure out why your toddler hates the new baby." b. "That's a strong statement to come from such a small child." c. "Let's refer your child 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 toddler 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 result of what factor? a. A sign that the child is spoiled b. A way to exert unhealthy control c. Regression, common at this age 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. What recommendation should the nurse make to 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.

The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stool. The nurse bases her explanation on what fact? a. Children should not be given fibrous foods until the digestive tract matures at age 4 years. b. The infant should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age

D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces but it is not necessity to eliminate solid foods. An excess quantity of fiber predisposes the child to large, bulky stools. This is a normal part of the maturational process, and no further investigation is necessary.

A parent asks the nurse about how to respond to negativism in toddlers. What is the most appropriate recommendation? 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."

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on what knowledge? a. Unacceptable because of the risk of sudden infant death syndrome (SIDS). b. Unacceptable because it does not encourage achievement of developmental milestones. c. Unacceptable to encourage fine motor development. d. Acceptable to encourage head control and turning over.

D These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and positioning on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor development.

How should the nurse describe the fact that a 6 month old has 6 teeth? a. Normal tooth eruption b. Delayed tooth eruption c. Unusual and dangerous d. Earlier-than-normal tooth eruption

D This is earlier than expected. Most infants at age 6 months have two teeth, the lower central incisors. Six teeth at 6 months is not delayed; it is early tooth eruption. Although unusual, it is not dangerous.

Which accomplishment would the nurse expect of a healthy 3-year-old child? a. Jump rope. b. Ride a two-wheel bicycle. c. Skip on alternate feet. d. Balance on one foot for a few seconds.

D Three year olds are able to accomplish the gross motor skill of balancing on one foot. Jumping rope, riding a two-wheel bike, and skipping on alternate feet are gross motor skills of 5-year-old children

In terms of fine motor development, what could the 3-year-old child be expected to do? a. Tie shoelaces. b. Use scissors or a pencil very well. c. Draw a person with 7 to 9 parts. d. Copy (draw) a circle.

D Three-year-olds are able to accomplish the fine motor skill of drawing a circle. Tying shoelaces, using scissors or a pencil very well, and drawing a person with multiple parts are fine motor skills of 5-year-old children.

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. The presence of short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue.

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.

What information should a nurse provide 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.