Homework Lance
1. The mother of a 14-month-old child is concerned because the child’s 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 child’s milk consumption, which will improve nutrition.”
d.
“Giving your child a multivitamin supplement daily will increase your toddler’s appetite.”
ANS: B
Physiologically, growth slows and appetite decreases during the toddler period. Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age group. Milk consumption should not exceed 24 to 32 ounces daily. 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.
DIF: Cognitive Level: Application REF: p. 116
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
2. Which toy is the most developmentally appropriate for an 18- to 24-month-old child?
a.
A push and pull toy
b.
Nesting blocks
c.
A bicycle with training wheels
d.
A computer
ANS: A
Push and pull toys encourage large muscle activity and are appropriate for the child between 18 and 24 months of age. 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.
DIF: Cognitive Level: Comprehension REF: p. 115
OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance
3. Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child?
a.
Toilet training guidelines
b.
Guidelines for weaning children from bottles
c.
Instructions on preschool readiness
d.
Instructions on a home safety assessment
ANS: D
Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age group because of toddlers’ increased mobility, which puts them at greater risk in an unsafe environment. Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. Parents of a 15-month-old child should have been advised to begin weaning from the breast or bottle at 6 to 12 months of age. Educating a parent about preschool readiness is important and can occur later in the parents’ educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment.
DIF: Cognitive Level: Application REF: p. 120
OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance
4. 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.
DIF: Cognitive Level: Comprehension REF: p. 114
OBJ: Nursing Process Step: Implementation
MSC: Health Promotion and Maintenance
5. A nurse is teaching parents of a toddler about language development. Which statement best identifies the characteristics of language development in a toddler?
a.
Language development skills slow during the toddler period.
b.
The toddler understands more than he or she can express.
c.
Most of the toddler’s speech is not easily understood.
d.
The toddler’s vocabulary contains approximately 600 words.
ANS: B
The toddler’s ability to understand language (receptive language) exceeds the child’s ability to speak it (expressive language). Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. By 2 years of age, 60% to 70% of the toddler’s speech is understandable. The toddler’s vocabulary contains approximately 300 or more words.
DIF: Cognitive Level: Application REF: p. 112
OBJ: Nursing Process Step: Implementation
MSC: Health Promotion and Maintenance
6. Parents of a toddler ask the nurse when they should start toilet training. Which statement best addresses their concerns
a.
When the child is 18 months of age
b.
When the child exhibits signs of physical and psychological readiness
c.
When the child has been walking for 9 months
d.
When the child is able to sit on the “potty” for 10 to 15 minutes
ANS: B
Neurological development is completed at approximately 18 months of age. Parents need to know that both physical and psychological readiness are necessary for toilet training to be successful. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents. One of the physical signs of readiness for toilet training is that the child has been walking for 1 year. The ability to sit on the “potty” 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.
DIF: Cognitive Level: Application REF: p. 125
OBJ: Nursing Process Step: Implementation
MSC: Health Promotion and Maintenance
7. Which statement by a mother of a toddler indicates a correct understanding of the use of discipline?
a.
“I always include explanations and morals when I am disciplining my toddler.”
b.
“I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving.”
c.
“I believe that discipline should be done by only one family member.”
d.
“My rule of thumb is no more than one spanking a day.”
ANS: B
Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. The toddler’s cognitive level of development precludes the use of explanations and morals as a part of discipline. Discipline for the toddler should be immediate; therefore, the family member caring for the child should provide discipline to the toddler when it is necessary. Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. Additionally, spanking is an inappropriate method of disciplining a child.
DIF: Cognitive Level: Comprehension REF: p. 119
OBJ: Nursing Process Step: Implementation
MSC: Health Promotion and Maintenance
8. 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.”
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 need 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.
DIF: Cognitive Level: Comprehension REF: p. 118
OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity
9. Which assessment finding in a preschooler would suggest the need for further investigation?
a.
The child is able to dress independently.
b.
The child rides a tricycle.
c.
The child has an imaginary friend.
d.
The child has a 2-pound weight gain in 12 months.
ANS: D
Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated. A preschool child should be able to dress independently and be able to ride a tricycle. Imaginary friends are common for preschoolers.
DIF: Cognitive Level: Comprehension REF: p. 107
OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance
10. Which is the most appropriate action for the nurse to take when telling a preschool child about an upcoming procedure?
a.
Explain all the information in detail to the child.
b.
Speak loudly and clearly to the child.
c.
Inform the parents of the procedure and ask them to tell the child.
d.
Use symbolic play to explain the procedure.
ANS: D
Symbolic play is important for emotional development because it allows the child to work through distressing feelings and can be therapeutic. It is inappropriate to give a preschooler all the information in detail. The child needs to understand what is going to happen to him without explicit details of the procedure. Speaking in clear sentences with simple words is important, but the conversation should be conducted at a nonthreatening normal sound level. The nurse has the most knowledge and best ability for explaining the procedure to the child; however, the parents can be an important resource when explaining the procedure.
DIF: Cognitive Level: Application REF: p. 112
OBJ: Nursing Process Step: Implementation
MSC: Health Promotion and Maintenance
11. In caring for a 4-year-old child with a diagnosis of suspected child abuse, which is the best nursing intervention?
a.
Avoid touching the child.
b.
Provide the child with play situations that allow for disclosure.
c.
Discourage the child from remembering the incident.
d.
Deny the suspected perpetrator visiting rights to the child.
ANS: B
Play allows the child to disclose what happened to him or her without having to talk about the incident. Symbolic play is important for emotional development and it allows the child to work through distressing feelings. All children need to be touched. What is important is to tell the child in simple, clear terms what you are doing and why you are doing it. Nurses have the opportunity to teach children the normal, healthy boundaries of their bodies and what constitutes inappropriate behavior. If the child chooses to remember what happened, it is inappropriate to discourage it. It is important to listen to the child in a nonjudgmental way, allowing the child to discuss what happened, to make statements, or to ask questions. It is not the nurse’s role or responsibility to restrict visitors unless child safety is an issue. The child may be negatively affected if a caregiver, who may be the abuser, does not visit.
DIF: Cognitive Level: Application REF: p. 112|p. 115
OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity
12. Which is helpful to tell a mother who is concerned about preventing sleep problems in her preschool 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 caretaker to encourage a longer nap.
d.
Use a nightlight in the child’s room.
ANS: D
The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Nightlights 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. Taking a longer nap during the day will not cause the child to sleep longer at night. A child who has slept for a long time at the babysitter’s may not be ready to sleep again.
DIF: Cognitive Level: Application REF: p. 119
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
13. Which statement is true about the care of the toddler’s teeth?
a.
Because deciduous teeth are not permanent, they are not important to the child.
b.
Children can be encouraged to brush their teeth after the teeth have been thoroughly cleaned by the parent.
c.
Secondary tooth eruption begins at 4 to 5 years of age.
d.
Fluoride supplements can be discontinued when the secondary teeth erupt.
ANS: B
Toddlers 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 in which fluoride is included in the water supply, fluoride supplements should be continued.
DIF: Cognitive Level: Comprehension REF: p. 118
OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance
14. What do parents of preschool children need to understand about discipline?
a.
Both parents and the child should agree on the method of discipline.
b.
Discipline should involve some physical restriction.
c.
The method of discipline should be consistent with the discipline methods of the child’s peers.
d.
Discipline should include positive reinforcement of desired behaviors.
ANS: D
Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent–child relationship, reinforcement of desired behaviors, and consequences for negative behaviors. Discipline does not need to be agreed on by the child. Both parents should be in agreement so the discipline is consistently applied. Discipline does not necessarily need to include physical restriction and does not need to be consistent with that of the child’s peers.
DIF: Cognitive Level: Comprehension REF: p. 120|p. 128
OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance
15. Parents of a preschool child ask the nurse, “What can we do to prepare our child for kindergarten?” In response, the nurse should include which critical factor in preparing a child for kindergarten entry?
a.
The child’s ability to sit still
b.
The child’s sense of learned helplessness
c.
The parent’s interactions and responsiveness to the child
d.
Attending a preschool program
ANS: C
Interactions between the parent and child are an important factor in the development of academic competence. Parent encouragement and support maximize a child’s potential. The child’s ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. Learned helplessness is the result of a child feeling that he or she has no effect on the environment and his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning. Preschool and day care programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.
DIF: Cognitive Level: Application REF: p. 128
OBJ: Nursing Process Step: Implementation
MSC: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. 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
ANS: A, B, C
Children between the ages of 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 near the age of 3 years. Structured play is typical of school-age children.
DIF: Cognitive Level: Comprehension REF: p. 115
OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance
2. 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 thought
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 thought (believes that thinking something causes that event). Concrete thinking is seen in school age children and ability to reason is seen with adolescents.
DIF: Cognitive Level: Application REF: p. 109|p. 111
OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance
OTHER
1. Place in order the gross motor developmental milestones a nurse expects to assess in a toddler. Begin with the earliest gross motor milestone expected and progress to the last gross motor milestone attained. Use the following format for your answers: A, B, C, D
a. Throws a ball overhand
b. Walks
c Kicks a ball
d. Runs
ANS:
B, D, A, C
The toddler walks between 12 months and 15 months of age. The next gross motor milestone seen in the toddler is running. The toddler runs soon after learning how to walk, but may fall down. By the end of 24 months the toddler can throw a ball overhand. The toddler does not kick a ball until after 24 months of age.
DIF: Cognitive Level: Analysis REF: p. 110
OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance
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