Health Promotion of the Toddler and Family

1. Which one of the following factors is most important in predisposing toddlers to frequent 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. Toddlers have a short, straight internal ear canal and large lymph tissue.

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.

DIF: Cognitive Level: Analysis REF: Page 400 | Page 411
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

2. The psychosocial developmental tasks of toddlerhood include which of the following?

a. Development of a conscience
b. Recognition of sex differences
c. Ability to get along with age-mates d. Ability to delay gratification

ANS: D
If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification.

DIF: Cognitive Level: Comprehension REF: Page 412
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

3. The child of 15 to 30 months is likely to be struggling with what developmental task?

a. Trust
b. Initiative c. Autonomy

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d. Intimacy

ANS: C
Autonomy vs shame and doubt is the developmental task of toddlers.

DIF: Cognitive Level: Knowledge REF: Page 411
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

4. 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 nurse’s best interpretation of this behavior is which of the following? 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.

DIF: Cognitive Level: Comprehension REF:
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

5. A 17-month-old child would be expected to be in what stage according to Piaget? a. Trust

b. Preoperations
c. Secondary circular reaction 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.

DIF: Cognitive Level: Comprehension REF: Page 411
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Developmental Stages and Transitions

6. Which of the following is descriptive of a toddler’s cognitive development at age 20 months?

a. Searches for an object only if he or she sees it being hidden
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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Realizes that “out of sight” is not out of reach
Puts objects into a container but cannot take them out
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.

DIF: Cognitive Level: Comprehension REF: Page 413
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

7. Although a 14-month-old girl received a shock from an electric outlet recently, her parent finds her about to place a paper clip in another outlet. Which of the following 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.

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.

DIF: Cognitive Level: Comprehension REF: Page 413
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

8. Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. Which of the following 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.

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.

DIF: Cognitive Level: Comprehension REF: Page 414
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and

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Development

9. 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
b. Ritualism

c. Irreversibility
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.

DIF: Cognitive Level: Analysis REF: Page 414
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

10. Which of the following is a characteristic of a toddler’s language development at age 18 months?

a. Vocabulary of 25 words
b. Increasing level of comprehension
c. Use of holophrases
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 child’s vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages.

DIF: Cognitive Level: Comprehension REF: Page 415
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

11. Which of the following statements is correct about toilet training?
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 parent by holding on rather than pleasing self by letting go.

DIF: Cognitive Level: Comprehension REF: Page 417
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

12. Which of the following characteristics best describes the gross motor skills of a 24- month-old child?

a. Skips and can hop in place on one foot
b. Rides tricycle and broad jumps
c. Jumps with both feet and stands on one foot momentarily d. Walks up and down stairs and runs with a wide stance

ANS: D
The 24-month-old child can go up and down stairs alone with two feet on each step and runs with a wide stance.

DIF: Cognitive Level: Application REF: Page 418
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

13. In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. The nurse should recognize which of the following in this situation?
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 three or four blocks.

DIF: Cognitive Level: Comprehension REF: Page 418
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

14. At what age should the nurse expect a toddler to give both first and last names when asked?

a. 15 months b. 18 months c. 24 months d. 30 months

ANS: D
At 30 months, the child is able to give both first and last names and refer to self with an appropriate pronoun.

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DIF: Cognitive Level: Comprehension REF: Page 419
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

15. 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 nurse’s best reply is which of the following?
a. “Let’s see if we can figure out why he hates the new baby.”

b. “That’s a strong statement to come from such a small boy.”
c. “Let’s refer him 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.”

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 newborn’s care and to help focus attention on the toddler.

DIF: Cognitive Level: Comprehension REF:
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

16. A toddler’s parent asks the nurse for suggestions on dealing with temper tantrums. Which of the following is the most appropriate recommendation?
a. Punish the child.
b. Leave the child alone until the tantrum is over.

c. Remain close by the child but without eye contact. 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.

DIF: Cognitive Level: Comprehension REF:
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

17. A parent asks the nurse about negativism in toddlers. The most appropriate recommendation is which of the following?
a. Punish the child.
b. Provide more attention.

c. Ask child not always to say “no.”
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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d. Reduce the opportunities for a “no” answer.

ANS: D
The nurse should suggest to the parent that questions be phrased with realistic choices rather than yes or no answers. This provides the toddler with a sense of control and reduces the opportunity for negativism.

DIF: Cognitive Level: Analysis REF:
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

18. Which one of the following techniques is best for dealing with the negativism of the toddler?

a. Offer the child choices.
b. Remain serious and intent.
c. Provide few or no choices for child.
d. Quietly and calmly ask the child to comply.

ANS: A
The child should have few opportunities to respond in a negative manner. Questions and requests should provide choices. This allows the child to be in control and reduces opportunities for negativism.

DIF: Cognitive Level: Analysis REF: Page 421
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

19. 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 of the following?
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.

DIF: Cognitive Level: Application REF:
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

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20. Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks “all the time.” Which of the following should the nurse recommend?
a. Give her 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 help the child 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.

DIF: Cognitive Level: Application REF:
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

21. 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 which of the following?
a. A sign the child is spoiled

b. A way to exert unhealthy control c. Regression, common at this age 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 the 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.

DIF: Cognitive Level: Analysis REF:
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

22. 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.

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DIF: Cognitive Level: Comprehension REF: Page 422
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

23. The most effective way to clean a toddler’s teeth is:
a. for the child to brush regularly with a toothpaste of his or her choice.
b. for the parent to stabilize the chin with one hand and brush with the other.
c. for the parent to brush the mandibular occlusive surfaces, leaving the rest for the

child.
d. for the 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 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.

DIF: Cognitive Level: Comprehension REF: Page 424
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Disease Prevention

24. Which of the following is an appropriate recommendation for preventing tooth decay in young children?

a. Substitute raisins for candy.
b. Substitute sugarless gum for regular gum.
c. Use honey or molasses instead of refined sugar.
d. When sweets are to be eaten, select a time not during meals.

ANS: B
Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum.

DIF: Cognitive Level: Analysis REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:HealthPromotionandMaintenance:Disease Prevention

25. What is the leading cause of death during the toddler period? a. Injuries

b. Infectious diseases c. Congenital disorders d. Childhood diseases

ANS: A
Injuries are the single most common cause of death in children ages 1 through 4 years. This represents the highest rate of death from injuries of any childhood age- group except adolescence.

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DIF: Cognitive Level: Comprehension REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:SafeandEffectiveCareEnvironment:Safetyand Infection Control (Injury Prevention)

26. Kimberly’s parents have been using a rearward-facing, convertible car seat since she was born. Most car seats can be safely switched to the forward-facing position when the child weighs how many pounds?
a. 10

b. 20 c. 30 d. 40

ANS: B
Although the transition point for switching to the forward-facing position is defined by the manufacturer, it is generally at 9 kg (20 pounds).

DIF: Cognitive Level: Analysis REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:SafeandEffectiveCareEnvironment:Safetyand Infection Control (Injury Prevention)

27. The nurse recommends to parents that peanuts are not a good snack food for toddlers. The nurse’s rationale for this action is which of the following?
a. They are low in nutritive value.
b. They are high in sodium.

c. They cannot be entirely digested. d. They can be easily aspirated.

ANS: D
Foreign-body aspiration is common during the second year of life. Although they chew well, this age child 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.

DIF: Cognitive Level: Analysis REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:SafeandEffectiveCareEnvironment:Safetyand Infection Control (Injury Prevention)

28. 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 which of the following?
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.”

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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.

DIF: Cognitive Level: Application REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:SafeandEffectiveCareEnvironment:Safetyand Infection Control (Injury Prevention)

29. 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 electric outlets.

ANS: A
Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group.

DIF: Cognitive Level: Comprehension REF: Page 431
TOP: Integrated Process: Nursing Process: Planning
MSC: AreaofClientNeeds:SafeandEffectiveCareEnvironment:Safetyand Infection Control (Injury Prevention)

MULTIPLE RESPONSE

1. Which of the following are characteristic of 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.
f. Left or right handedness is established.

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.

DIF: Cognitive Level: Application REF: Page 418
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development