Prep-u: Chapter 4: Growth and Development of the Toddler

Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching?

Reasoned with the child to stop the behavior -The child having a tantrum is out of control, making reasoning impossible

While observing a 13-month-old and her parents in the playroom of the hospital unit, the nurse notes that the toddler is using her index finger to point towards a toy. How should the nurse respond?

"Your daughter is demonstrating fine motor skills appropriate to her age by pointing with her index finger." -At 12 to 15 months of age the toddler should be feeding herself finger foods and using her index finger to point to objects.

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

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

The grandmother is the primary caregiver of her 2-year-old granddaughter. She expresses her concern that the child has temper tantrums two or three times a day, often in public places. She explains that she spanked her own children when they did this but now she is worried that spanking is not the best way to handle the situation. Which statement is the most appropriate regarding dealing with the child who has a temper tantrum?

"Remain calm, pick the child up, and move her to a quiet and neutral place until she gains self-control; don't give in to her demands."

The parents of a 3-year-old boy have asked the nurse for advice about a preschool for their child. Which suggestion is most important for the nurse to make?

"The staff should be trained in early childhood development."

A group of caregivers of toddlers are discussing the form of discipline in which the child 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." -A method for a child who is not cooperating or who is out of control is to send the child to a "time-out" chair. This should be a place where the child can be alone but observed without other distractions. The duration of the isolation should be limited—one minute per year of age is usually adequate. Caregivers should warn the child in advance of this possibility, but only one warning per event is necessary.

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

Allow him to make simple decisions. -Making decisions is primary practice toward achieving independence

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

"You should plan some time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant." -The secondary caregiver can occasionally take over the care of the new baby while the mother or other primary caregiver devotes herself to the toddler. The primary caregiver might also plan special times with the toddler when the new infant is sleeping and the caregiver has no interruptions. This approach helps the toddler feel special.

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

A regular routine and rituals will provide stability and security. -Toddlers benefit most from routines and rituals that help them anticipate events and teach and reinforce expected behaviors

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

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

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

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

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

Has persistent separation anxiety -Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might an emotional problem.

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

Her vocabulary is between 10 and 15 words. -A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly.

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

Playing with the plastic vacuum cleaner pushing it around the room -Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills.

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

Seizures are not provoked; temper tantrums are.

The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response?

Share that the heads of children at this age are large in proportion to the rest of their body. -Head circumference increases about 1 inch between 1 and 2 years of age, then increases an average of a half-inch per year until age 5. The anterior fontanel should be closed by the time the child is 18 months old. Head size becomes more proportional to the rest of the body near the age of 3 years.

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

True

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

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

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

A tantrum preceded the event. -The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion.