Question 1

The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which statement by a parent indicates a correct understanding of the teaching?

Accepted Answer

A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline because the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot "hurry up or we will be late."

Question 2

The nurse is planning care for a hospitalized toddler. What is the rationale for planning to continue the toddler's rituals while hospitalized?

Accepted Answer

Ritualism, the need to maintain sameness and reliability, provides a sense of security and comfort. It will not prevent regression or dependency or decrease negativism.

Question 3

The nurse is teaching parents of a toddler how to handle temper tantrums. What should the nurse include in the teaching? (Select all that apply.)

Accepted Answer

The best approach toward tapering temper tantrums requires consistency and developmentally appropriate expectations and rewards. Ensuring consistency among all caregivers in expectations, prioritizing what rules are important, and developing consequences that are reasonable for the child's level of development help manage the behavior. During tantrums, ignore the behavior, provided the behavior is not injurious to the child, such as violently banging the head on the floor. Continue to be present to provide a feeling of control and security to the child after the tantrum has subsided. Starting at 18 months, time-outs work well for managing temper tantrums, but not at 12 months.

Question 4

A nurse is observing children playing in the playroom. What describes parallel play?

Accepted Answer

Parallel play is when a toddler plays alongside, not with, other children. A child playing with blocks next to a child playing with trucks is descriptive of parallel play. The child playing a video game is descriptive of solitary play. Two children playing cards is descriptive of cooperative play. Two children watching a television is descriptive of associative play.

Question 5

The nurse understands that which guideline should be followed to determine serving sizes for toddlers?

Accepted Answer

To determine serving sizes for young children, the guideline to follow is 1 tbsp of solid food per year of age. One-half tbsp per year of age would not be adequate. Two or 2 1/2 tbsp per year of age would be excessive.

Question 6

What is the most common type of burn in the toddler age group?

Accepted Answer

Scald burns are the most common type of thermal injury in children, especially 1- and 2-year-old children. Temperature should be reduced on the hot water in the house and hot liquids placed out of the child's reach. Electric burns from electrical outlets and hot object burns from cigarettes or irons are both significant causes of burn injury. The child should be protected by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group but not one of the most common types of burn.

Question 7

The nurse is teaching parents about toilet training. What should the nurse include in the teaching session?

Accepted Answer

The physiologic ability to control the sphincters occurs somewhere between ages 18 and 24 months. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The mastery of skills required for training are not present before 24 months of age. By 14 to 18 months of age, the child is able to retain urine for up to 2 hours or longer.

Question 8

Parents ask the nurse for strategies to help their toddler adjust to a new baby. What should the nurse suggest?

Accepted Answer

Parents can minimize sibling rivalry by alerting visitors to the toddler's needs, having small presents on hand for the toddler, and including the child in the visits as much as possible. Time is a vague concept for toddlers. A good time to start talking about the new baby is when the toddler becomes aware of the pregnancy and the changes occurring in the home in anticipation of the new member. To avoid additional stresses when the newborn arrives, parents should perform anticipated changes, such as moving the toddler to a different room or bed, well in advance of the birth. Telling the toddler that a new playmate will come home soon sets up unrealistic expectations.

Question 9

Parents are switching their toddler, who has met the weight requirement, from a rear-facing car seat to a forward-facing seat. The nurse should recommend the parents place the seat where in the car?

Accepted Answer

Children 0 to 3 years of age riding properly restrained in the middle of the backseat have a 43% lower risk of injury than children riding in the outboard (window) seat during a crash.

Question 10

The nurse is preparing a staff education program about growth and development of an 18-month-old toddler. Which characteristics should the nurse include in the staff education program? (Select all that apply.)

Accepted Answer

Tasks accomplished by an 18-month-old toddler include eating well with a spoon and cup, running clumsily, walking up stairs, pointing to common objects such as shoes, and building a tower with three or four blocks. An 18-month-old toddler has a vocabulary of only 10 words, not 300. Toddlers cannot dress themselves in simple clothing until 24 months of age.

Question 11

To avoid a fall from a crib, the nurse recommends to parents that their toddler should sleep in a bed rather than a crib when reaching what height?

Accepted Answer

When children reach a height of 89 cm (35 in), they should sleep in a bed rather than a crib.

Question 12

What preventive measures should the nurse teach parents of toddlers to prevent early childhood caries? (Select all that apply.)

Accepted Answer

Prevention of dental caries involves eliminating the bedtime bottle completely, feeding the last bottle before bedtime, substituting a bottle of water for milk or juice, not using the bottle as a pacifier, and never coating pacifiers in sweet substances. Juice in bottles, especially commercially available ready-to-use bottles, is discouraged; these beverages are especially damaging because the sugar is more readily converted to acid. Juice should always be offered in a cup to avoid prolonging the bottle-feeding habit. Toddlers should be encouraged to drink from a cup at the first birthday and weaned from a bottle by 14 months of age, not 18 months.

Question 13

A toddler is in the sensorimotor, tertiary circular reactions stage of cognitive development. What behavior should the nurse expect to assess? (Select all that apply.)

Accepted Answer

Children in the sensorimotor, tertiary circular reactions stage of cognitive development show the behaviors of gesturing "up" and "down," have the ability to insert round objects into a hole, and can find hidden objects but only in the first location. The behaviors of referring to oneself by pronoun and using future-oriented words such as "tomorrow" are seen in the preoperational stage of cognitive development.

Question 14

The nurse is assessing a toddler's visual acuity. Which visual acuity is considered acceptable during the toddler years?

Accepted Answer

Visual acuity of 20/40 is considered acceptable during the toddler years.

Question 15

The nurse is teaching parents about avoiding accidental burns with their toddler. What water heater setting should the nurse recommend to the parents?

Accepted Answer

The water heater should be set to limit household water temperatures to less than 49° C (120° F). At this temperature, it takes 10 minutes for exposure to the water to cause a full-thickness burn. Conversely, water temperatures of 54° C (130° F), the usual setting of most water heaters, expose household members to the risk of full-thickness burns within 30 seconds.

Question 16

The parent of 16-month-old child asks, "What is the best way to keep my child from getting into our medicines at home?" What should the nurse advise?

Accepted Answer

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 using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize that all the different forms of medications in the home may be dangerous. Keeping medicines out of the homes of small children is not feasible because many parents require medications for chronic or acute illnesses. Parents must be taught safe storage for their home and when they visit other homes.

Question 17

The nurse is teaching a parent of an 18-month-old about developmental milestones associated with feeding. What should the nurse include in the teaching? (Select all that apply.)

Accepted Answer

An 18-month-old child can hold a cup with both hands, is able to drink from a cup with a lid, and begins to use a spoon but may turn it before reaching the mouth. Using a fork is a developmental milestone of a 36-month-old child. Using a straw and cup is a milestone seen at 24 months.

Question 18

A parent asks the nurse, "When will I know my child is ready for toilet training?" The nurse should include what in the response? (Select all that apply.)

Accepted Answer

Signs of toilet training readiness include physical and psychological readiness. The ability to sit, walk, and squat and having regular bowel movements are physical readiness signs. Expressing a willingness to please is a sign of psychological readiness. The child should be able to stay dry for 2 hours, not 1.

Question 19

Parents ask the nurse, "How should we deal with our toddler's regression since our new baby has come home?" The nurse should give the parents which response?

Accepted Answer

When regression does occur, the best approach is to ignore it while praising existing patterns of appropriate behavior. It is advisable not to introduce new areas of learning when an additional crisis is present or expected, such as beginning toilet training shortly before a sibling is born or during a brief hospitalization. Time-out should not be used as a punishment, and the toddler does not have the cognitive ability to understand an explanation that the behavior is not acceptable.

Question 20

The nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by what?

Accepted Answer

One cause of early childhood caries is allowing the child to go to sleep with a bottle of milk or juice; as the sweet liquid pools in the mouth, the teeth are bathed for several hours in this cariogenic environment. Eating citrus fruit at bedtime and poor fluoride supply in drinking water do not cause early childhood caries. The problem is not hereditary and can be prevented with proper education.

Quiz 12: Health Promotion of the Toddler and Family