Chapter 32: The Toddler and Family Nursing School Test Banks

Chapter 32: The Toddler and Family

MULTIPLE CHOICE

1. 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.

Short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue are present.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: 923

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. The psychosocial developmental tasks of toddlerhood include:

a.

Development of a conscience.

b.

Recognition of sex differences.

c.

Ability to get along with age mates.

d.

Ability to withstand delayed gratification.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 924

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

3. A parent of an 18-month-old boy tells the nurse that he says no to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurses best interpretation of this behavior is that:

a.

This is normal behavior for his age.

b.

This is unusual behavior for his age.

c.

He is not effectively coping with stress.

d.

He is showing he needs more attention.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 933

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. 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

c.

Secondary circular reaction

b.

Preoperations

d.

Tertiary circular reaction

ANS: 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 Eriksons first stage. Preoperations is the stage of cognitive development, usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 924

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. What describes a toddlers 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

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 924

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

6. Although a 14-month-old girl received a shock from an electrical outlet recently, her parents find her about to place a paper clip in another outlet. The best interpretation of this behavior is that:

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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 924

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

7. Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. The best interpretation of this behavior is that:

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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 928

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. 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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 930

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

9. Which characteristic best describes the gross motor skills of a 24-month-old child?

a.

Skips

c.

Broad jumps

b.

Rides tricycle

d.

Walks up and down stairs

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 929

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

10. 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:

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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 929

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

11. The parents of a newborn say that their toddler hates the baby . . . he suggested that we put him in the trash can so the trash truck could take him away. The nurses best reply is:

a.

Lets see if we can figure out why he hates the new baby.

b.

Thats a strong statement to come from such a small boy.

c.

Lets refer him to counseling to work this hatred out. Its not a normal response.

d.

That is a normal response to the birth of a sibling. Lets look at ways to deal with this.

ANS: 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 newborns 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 932

OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

12. A toddlers parent asks the nurse for suggestions on dealing with temper tantrums. The most appropriate recommendation is to:

a.

Punish the child.

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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 932

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

13. A parent asks the nurse about how to respond to negativism in toddlers. The most appropriate recommendation is to:

a.

Punish the child.

b.

Provide more attention.

c.

Ask child not always to say no.

d.

Reduce the opportunities for a no answer.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: 933

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

14. 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 that 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.

ANS: 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 childrens 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.

PTS: 1 DIF: Cognitive Level: Application REF: 932

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

15. Parents tell the nurse that their toddler daughter eats little at mealtimes, only sits at the table with the family briefly, and wants snacks all the time. The nurse should recommend that 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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Application REF: 934

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

16. A father tells the nurse that his daughter 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.

A sign that the child is spoiled.

c.

Regression, common at this age.

b.

A way to exert unhealthy control.

d.

Ritualism, common at this age.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: 934

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

17. Developmentally, most children at age 12 months:

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 food in preference to the bottle.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 934

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

18. The most effective way to clean a toddlers teeth is for the:

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.

ANS: B

For young children, the most effective cleaning of teeth is done by the parents. Different positions can be used if the childs back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the childs teeth. The child can participate in brushing, but for a thorough cleaning adult intervention is necessary.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 939

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

19. The nurse is discussing with a parent group the importance of fluoride for healthy teeth. The nurse should recommend that 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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: 940

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

20. An appropriate recommendation in preventing tooth decay in young children is to:

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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: 940

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

21. The leading cause of death during the toddler period is:

a.

Injuries.

c.

Congenital disorders.

b.

Infectious diseases.

d.

Childhood diseases.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 941

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

22. The nurse recommends to parents that peanuts are not a good snack food for toddlers. The nurses rationale for this action is that:

a.

They are low in nutritive value.

c.

They cannot be entirely digested.

b.

They are very high in sodium.

d.

They can be easily aspirated.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: 948

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

23. The parent of 16-month-old Chris asks, What is the best way to keep Chris from getting into our medicines at home? The nurse should advise that:

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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Application REF: 947

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

24. The most fatal type of burn in the toddler age-group is:

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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 946

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

25. The mother of a 14-month-old child is concerned because the childs appetite has decreased. The best response for the nurse to make to the mother is:

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.

c.

Be sure to increase your childs milk consumption, which will improve nutrition.

d.

Giving your child a multivitamin supplement daily will increase your toddlers appetite.

ANS: 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 oz daily. Juice should be limited to 4 to 6 oz 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.

PTS: 1 DIF: Cognitive Level: Application REF: 934

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

26. Which toy is the most developmentally appropriate for an 18- to 24-month-old child?

a.

A push-pull toy

c.

A bicycle with training wheels

b.

Nesting blocks

d.

A computer

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 928

OBJ: Nursing Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

27. What is the primary purpose of a transitional object?

a.

It helps the parents deal with the guilt they feel when they leave 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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 927

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

28. Which comments indicate 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 toddlers teeth.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 941

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

29. What is helpful to tell 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 childs daytime caregiver about eliminating the afternoon nap.

d.

Use a night-light in the childs room.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Application REF: 938

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

30. Steven, 16 months old, falls down a few stairs. He gets up and scolds the stairs as if they caused him to fall. This is an example of which of the following?

a.

Animism

c.

Irreversibility

b.

Ritualism

d.

Delayed cognitive development

ANS: A

Animism is the attribution of lifelike 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 926

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

31. Which should the nurse expect for a toddlers 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

ANS: B

During the second year of life, level of comprehension and understanding of speech increases and is far greater than the childs 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 927

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

32. Kimberlys parents have been using a rearward-facing, convertible car seat since she 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

c.

3 years

b.

2 years

d.

4 years

ANS: 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.

PTS: 1 DIF: Cognitive Level: Application REF: 941

OBJ: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

33. Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation?

a.

Small plastic Legos

c.

Brightly colored balloon

b.

Set of large plastic building blocks

d.

Coloring book and crayons

ANS: B

Large plastic blocks are appropriate for a toddler in isolation. Play objects for toddlers must still be chosen with an awareness of danger from small parts. Large, sturdy toys without sharp edges or removable parts are safest. Small plastic toys such as Legos can cause choking or can be aspirated. Balloons can cause significant harm if swallowed or aspirated. Coloring book and crayons would be too advanced for a toddler.

PTS: 1 DIF: Cognitive Level: Application REF: 948

OBJ: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

34. A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddlers preoperational thinking is the nurse using?

a.

Inability to conserve

c.

Centration

b.

Magical thinking

d.

Irreversibility

ANS: A

The nurse is using the toddlers inability to conserve. This is when the toddler is unable to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the original mass. Instead, toddlers judge what they see by the immediate perceptual clues given to them. A small glass means less amount of contrast. Magical thinking is believing that thoughts are all-powerful and can cause events. Centration is focusing on one aspect rather than considering all possible alternatives. Irreversibility is the inability to undo or reverse the actions initiated, such as being unable to stop doing an action when told.

PTS: 1 DIF: Cognitive Level: Application REF: 926

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

35. Parents need further teaching about the use of car safety seats if they make which statement?

a.

Even if our toddler helps buckle the straps, we will double-check the fastenings.

b.

We wont start the car until everyone is properly restrained.

c.

We wont need to use the car seat on short trips to the store.

d.

We will anchor the car seat to the cars anchoring system.

ANS: C

Parents need to be taught to always use the restraint even for short trips. Further teaching is needed if they make this statement. Parents have understood the teaching if they encourage the child to help attach buckles, straps, and shields but always double-check fastenings; do not start the car until everyone is properly restrained; and anchor the car safety seat securely to the cars anchoring system and apply the harness snugly to the child.

PTS: 1 DIF: Cognitive Level: Application REF: 941

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

36. Which are characteristic 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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Application REF: 923

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

37. Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddlers 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 drivers 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.

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 944

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

38. 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 childs 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.

ANS: 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 in to the childs demands only increases the behavior.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 933

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

39. 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

ANS: 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.

PTS: 1 DIF: Cognitive Level: Application REF: 926

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

40. Which should the nurse teach to parents of toddlers about accidental poison prevention (select all that apply)?

a.

Keep toxic substances in the garage.

b.

Discard empty poison containers.

c.

Know the number of the nearest poison control center.

d.

Remove colorful labels from containers of toxic substances.

e.

Caution child against eating nonedible items, such as plants.

ANS: B, C, E

To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, to know the number of the nearest poison control center, and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications, in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances.

PTS: 1 DIF: Cognitive Level: Application REF: 942

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

41. 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

ANS: 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 928

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Leave a Reply