toddlers

A mother brings her 16-month-old daughter to the well-child clinic for a checkup. She is upset and reports, "My child refuses to eat at mealtimes. It's a battle between us." What is the best response by the nurse?

"It may be helpful to keep a daily diary of the food she eats."

A mother asks why her 2-year-old toddler's cleft palate was not repaired at the same time that the cleft lip was repaired. What is the best response by the nurse?

"The palate usually is repaired before a child starts to speak. Some surgeons prefer to wait up to 2 years."

A mother indicates to the nurse in the pediatric clinic that she is concerned that her 20-month-old son's bedtime thumb-sucking will cause his teeth to protrude. How should the nurse respond?

"There is no reason to be concerned about the teeth protruding unless he keeps sucking his thumb after his permanent teeth have come in."

When is a toddler considered ready for toilet training? Select all that apply.

-When the child is able to sit, walk, and squat -When the child is capable of removing his or her own clothing -When the child is able to recognize the urge to defecate or urinate

A 2½-year-old child is admitted to the hospital with deep partial-thickness burns involving the face and chest. The nurse bases a plan of care on concerns related to the child's injury. Place the following concerns in their order of importance.

1.Impaired gas exchange 2.Presence of pain 3.Disturbed fluid balance 4.Potential for infection 5.Compromised body image

To evaluate kidney function, the nurse must accurately measure the hourly urine output of a 1½-year-old toddler weighing 22 lb who has been admitted with extensive burns. What is the minimum safe output per hour for a child this age?

10-20

A nurse notes that a child is exhibiting signs of cerebral palsy. At what age are these signs usually first noticeable?

12months

A nurse is performing health screenings of toddlers in a culturally diverse neighborhood. Which child should the nurse consider at risk for β-thalassemia (Cooley anemia)?

2-year-old child of Greek descent with a large abdomen

A toddler with a history of enlarged lymph nodes, prolonged fever that is unresponsive to antibiotics, erythema of the extremities, and a rash is admitted to the pediatric unit with a diagnosis of Kawasaki disease. What does the nurse suspect was essential in confirming this diagnosis?

A combination of signs

A nurse is teaching a group of assistants in a daycare center about toddlers' developmental milestones. What behavior should indicate to the assistants that one of the milestones has been achieved?

Accepting external limits

The mother of an 18-month-old toddler tells the nurse in the pediatric clinic that her child is "unmanageable and into everything." What is the most important teaching to include during this clinic visit?

Accidents are the leading cause of death and injury in this age group.

A nurse encourages parents to have their toddler's eyes tested especially for monocular strabismus. What should the nurse explain may occur if the condition is not corrected early?

Amblyopia will progress in the weak eye.

A 30-month-old boy with cystic fibrosis is admitted to the pediatric unit with a severe upper respiratory infection. The toddler is small for his age. What pathological process does the nurse know is the cause of his small stature?

An absence of pancreatic enzymes

Several 3-year-old girls in the daycare center are having a tea party with their dolls. The center's nurse concludes that this behavior is:

Appropriate make-believe play

A 13-month-old child is admitted with a tentative diagnosis of bacterial meningitis, and the practitioner schedules a lumbar puncture. What is the most important action the nurse should take in preparation for the lumbar puncture?

Asking the parents what they were told about the test

A mother in the postpartum unit expresses concern that her 3-year-old daughter will be jealous of her new brother. What should the nurse suggest?

Bringing home a new baby doll for the daughter when her baby brother is brought home

A 1-year-old infant is receiving zidovudine (AZT) for management of HIV infection. The nurse determines that the infant is exhibiting signs of life-threatening zidovudine toxicity. What clinical finding supports this conclusion?

Bruises over the body

The mother of a 2½ -year-old child is concerned about how to handle temper tantrums. The nurse replies that tantrums:

Can be reduced with the provision of a less stressful environment

During a nap, a 3-year-old hospitalized child wets the bed. What is the best response by the nurse?

Change the child's clothes without discussing the incident

A nurse is caring for a 2½-year-old child who is expressing pain. What is the most reliable indicator of this child's pain?

Changes in behavior

A 1-year-old child is found to have nutritional iron-deficiency anemia. What nursing interventions are most important in the care of an infant with iron-deficiency anemia? (Select all that apply.)

Conserving the infant's energy Protecting the infant from infection Teaching the parents about nutrition

An 18-month-old toddler who stepped on a rusty nail 4 days ago shows signs of generalized tetanus, including neck and jaw stiffness and facial muscle spasms. The toddler is receiving intravenous diazepam (Valium) as a muscle relaxant every 4 hours. What response to the medication does the nurse anticipate?

Control of hypertonicity and prevention of seizures

During a routine visit to the child health clinic the parent of a 3-year-old girl reports, "My daughter is still sucking her thumb." What is the nurse's best response?

Correct1 "She'll stop when she's ready."

What behavior does a nurse expect from a toddler subjected to prolonged hospitalization with limited parental visits?

Correct1 Cheerful interactions with staff members

A 2-year-old child is admitted to the pediatric unit with a diagnosis of thalassemia major (Cooley anemia). The parents are told that there is no cure but the anemia can be treated with frequent blood transfusions. The father tells the nurse he is glad that there is a treatment that "fixes" his child's problem. Before responding, the nurse should recall that blood transfusions:

Correct1 Correct the anemia but may cause other problems

A 5-year-old child is brought into the clinic with lethargy, abdominal ascites, and peripheral and periorbital edema. The history indicates ongoing diarrhea and decreased urine output. The child is found to have nephrotic syndrome and started on corticosteroid therapy. The nurse informs the parents that after a week or two of medication therapy, they can expect the child to exhibit:

Correct1 Diuresis

A nurse plans to talk to the parents of a toddler about toilet training. What should the nurse tell the parents is the most important factor in the process of toilet training?

Correct1 Parents' attitude about it

A 3-year-old boy in respiratory distress is treated in the emergency department. A diagnosis of acute spasmodic laryngitis (spasmodic croup) is made. At the time of discharge, the mother asks how to handle another attack at home. What should the nurse recommend?

Correct1 Placing him near a cool-mist humidifier

A parent tells the nurse in the emergency department, "My 3-year-old has had a fever for several days and has been vomiting." After prescribed measures to reduce the fever have been instituted, what nursing action is most important?

Correct1 Preventing shivering

When is the best time to prepare a toddler for impending surgery?

Correct1 Shortly before the procedure

During the second week of hospitalization for intravenous antibiotic therapy, a 2-year-old toddler whose family is unable to visit often smiles easily, goes to all the nurses happily, and does not express interest in the parent when the parent does visit. The parent tells the nurse, "I'm so happy he's adjusting, but should I be worried about his reaction to seeing me?" What is the best response by the nurse?

Correct1 The child is repressing feelings for the parent.

A 2-year-old boy born with cryptorchidism is to undergo orchiopexy. What should the nurse tell the parents about the anticipated outcome of this surgery?

Damage to the undescended testicle will be prevented.

A toddler is admitted to the pediatric unit with diarrhea and severe dehydration. After several days of treatment the child is evaluated. What clinical findings indicate that the child is rehydrated? (Select all that apply.)

Decreased hematocrit Increase in daily weight Decreased blood urea nitrogen level

A nurse in the child life center is evaluating a 15-month-old toddler's ability to perform physical tasks. What behavior indicates to the nurse that the child's development is age appropriate? (Select all that apply.

Drinking from a cup Walking with a wide-based gait Throwing toys around the room

What clinical signs should lead a nurse to suspect that a 1-year-old child has rubella (German measles)?

Enlarged posterior cervical and postauricular nodes

A nurse is caring for a 3-year-old child with acute laryngotracheobronchitis. The child has severe dyspnea and a temperature of 104.0º F (40.0° C) and is receiving cool mist by way of a facemask. The mother asks why her child is not receiving warm mist. The nurse explains that cool mist:

Facilitates reduction of mucosal edema

An 18-month-old toddler who has received the appropriate immunizations on time is visiting the pediatric clinic for the next scheduled immunization. What vaccine should the nurse administer?

Fourth diphtheria toxoid, tetanus toxoid and acellular pertussis (DTaP) vaccine

A toddler who swallowed drain cleaner is hospitalized for observation because of the risk for vomiting and aspiration. Over the next 24 hours the child does not exhibit any respiratory distress and does not vomit. At discharge the nurse emphasizes that the parents should monitor their child for the onset of:

Gagging and vomiting

A nurse is teaching a class to parents about keeping medications and household cleaning supplies out of the reach of toddlers. The nurse explains that this is necessary because toddlers:

Have a high level of oral activity

A toddler may not be able to confirm that two glasses of water contain the same amount of liquid if one glass of water is poured into a taller, thinner vessel. What is this behavior characteristic called?

Inability to conserve

An 18-month-old child has received all required immunizations. What immunization should the nurse explain to a parent will be one of the vaccines required between 4 and 6 years of age?

Inactivated poliovirus

A 1-year-old child has a congenital cardiac malformation that causes right-to-left shunting of blood through the heart. What clinical finding should the nurse expect?

Increased hematocrit

A nurse is caring for a toddler with severe dehydration and its associated acid-base imbalance. What compensatory mechanism within the body is activated to counteract the effects of the child's acid-base imbalance?

Increased respiratory rate

A 13-month-old child is undergoing lumbar puncture for confirmation of a diagnosis of bacterial meningitis. During the procedure the nurse notes that the spinal fluid is cloudy. What does this finding indicate?

Increased white blood cell (WBC) count

A 2½-year-old toddler is admitted with a fever of 103º F (39.4° C), stiffness of the neck, and general malaise. The diagnosis is acute bacterial meningitis. What is the priority nursing intervention for this child?

Instituting droplet precautions

The parents of a 3-year-old tell the nurse that their child is afraid to sleep alone because of monsters under the bed. They ask for suggestions. What should the nurse recommend?

Leave a small light on at night and state, "Monsters aren't allowed in the house."

A nurse is caring for a toddler in acute respiratory distress precipitated by laryngotracheobronchitis. The child has a temperature of 103° F (39.4° C). What is the priority nursing intervention?

Monitoring respiratory status continuously

The nurse manager of the infection control service is teaching a class for nurses on the care of young children with viral infection-related diarrhea. What therapy should the nurse manager recommend?

Oral rehydration therapy until fluid balance is restored

A nurse is obtaining a health history from the parents of a toddler who has recently been diagnosed with acute lymphocytic leukemia. Which early physiological changes does the nurse expect the parents to report? (Select all that apply.)

Pale skin Eating less food Purplish spots on the skin

A toddler who was admitted in acute respiratory distress is now resting quietly. The parents tell the nurse that they must leave. What should the nurse suggest that the parents do?

Plan to visit the child as frequently as possible

A 2-year-old boy who has fallen from a tree tells his parents and the nurse, "Bad, bad tree." The nurse concludes that the child is within the cognitive developmental norm of Piaget's:

Preconceptual operations

A toddler has just had a cast applied for a fractured wrist. The wrist and elbow are immobilized. What information should the nurse include in the home care instructions before discharge? (Select all that apply.)

Report swelling of fingers. Elevate casted arm when the child is standing.

A toddler undergoes cardiac catheterization as part of a diagnostic workup for pulmonic stenosis. In which part of the cardiovascular system should the nurse expect an increase in pressure?

Right ventricle

A nurse is teaching a mother how to care for her toddler who is in a spica cast. In what position should the nurse suggest that the mother place the toddler during a feeding?

Semi-Fowler on a padded, adjustable tilt board

What should the nurse teach a mother that will best help her 2½ -year-old son learn to control his behavior?

Set limits and be consistent.

At 1 am a 28-month-old toddler is admitted to the pediatric unit with suspected meningitis. At 3 am, after the child is settled in, the mother tells the nurse, "I have to leave now, but whenever I try to go my child gets upset and then I start to cry." What is the best action by the nurse?

Staying with the child while the mother leaves

The health care provider is assessing a 2-year-old child for the presence of celiac disease. For what specific signs and symptoms should the nurse be alert? (Select all that apply.)

Steatorrhea Distended abdomen Iron-deficiency anemia

A nurse in the pediatric clinic is advising the mother of a toddler who has a pinworm infestation. What should the nurse teach the mother about caring for her child during and after treatment? (Select all that apply.

Strategies to prevent reinfestation The need for medication for the entire family The importance of handwashing before eating

A major developmental milestone of a toddler is the achievement of autonomy. What should the nurse instruct the parents to do to enhance their toddler's need for autonomy?

Teach the child to accept external limits

A nurse is evaluating a toddler and the family dynamics of the child's family, in which abuse is suspected. What behavior is expected? (Select all that apply.)

The child cringes when approached. The child has unexplained healed injuries. The child lies still while surveying the environment.

A toddler with lead poisoning is started on chelation therapy. Succimer (Chemet) is ordered. What information should the nurse give the parents concerning the administration of this medication?

The contents of the capsules may be sprinkled on food.

A parent tells the nurse, "Our 2½ -year-old child only uses two-word phrases when he's talking, and we can only understood him maybe a quarter of the time. We're really concerned." What should the nurse consider before responding?

This seems to be slow language development for a 2½ -year-old.

Which of the following signs are indications of hydration status during a sickle cell crisis? (Select all that apply.)

Turgor of tissue Texture of mucous membranes

A 2-year-old child with previously diagnosed hemophilia is admitted to the pediatric unit for observation after a motor vehicle collision. The toddler has several bruises but no other apparent injuries. What is the nurse's specific concern regarding this child?

Undetected injury

A nurse is observing the growth and development skills of several 2-year-olds in the clinic playroom. The nurse determines that the child requiring further evaluation is the one who:

Uses echolalia when speaking

A 3-year-old boy has been observed in the clinic waiting room taking toys from others, tearing pages out of books, and striking his mother. The nurse takes time when interviewing the mother to ask about television habits because:

Viewing violent programs is positively correlated with the development of aggression

A nurse must administer a medication by means of injection to a 2-year-old whose parent is not present. What is the most therapeutic approach for the nurse to use?

Warning the child about the injection just before administering it, saying that it is OK to cry, and then comforting the child

A nurse is providing preoperative teaching to the parents of a toddler who is to undergo myringotomy. The nurse explains that the type of infection most common in children that are prone to otitis media is:

bacterial

A 30-month-old toddler is brought to the emergency department in acute respiratory distress, and a diagnosis of laryngotracheobronchitis (viral croup) is made. What is the most important equipment for the nurse to have available when the child is admitted to the pediatric unit?

tracheostomy set