peds toddler Exam Fall 2022 {Answered/Rationales}

peds toddler Exam Fall 2022 {Answered/Rationales} A parent asks the nurse what to do when the toddler has temper tantrums. What play materials should the nurse suggest that the child be offered as another means of expressing anger? 1 Ball and bat 2 Wad of clay 3 Punching bag 4 Pegs and pounding board 4 A pounding board with pegs to hammer into holes is a safe toy for toddlers because it is fairly large, easy to manipulate, and sturdy. It also provides an acceptable way for anger to be expressed. The child's motor and hand-eye coordination are too immature for the child to use a ball and bat. A wad of clay is not as effective for releasing anger as a pounding board. A punching bag is appropriate for an older child with more mature motor coordination to compensate for a moving object. Which statement would the nurse state is true for toddlers? 1 The incidence of poisoning is very common in toddlers. 2 An 18-month-old child uses approximately up to 300 words. 3 The average toddler gains 2 to 3 pounds (0.9 to 1.4 kg) each year. 4 Toddlers prefer to engage in parallel play rather than in solitary play. 1 Poisonings occur frequently because children of around 2 years of age place objects or substances in their mouths to learn about them. The 18-month-old child uses approximately 10 words. A toddler gains approximately 5 to 7 pounds (2.3 to 3.2 kg) each year. The toddler begins to engage in parallel play during toddlerhood but also engages in solitary play. Which of these diseases would the nurse explain is most common in toddlers? 1 Influenza 2 Lung cancer 3 Hypertension 4 Angina pectoris 1 Toddlers are very prone to developing upper respiratory tract infections; hence, influenza is seen most frequently among toddlers. Lung cancer is seen commonly in younger or middle-aged adults from smoking. Hypertension is commonly seen in middle age due to an unhealthy diet, lack of exercise, and stress. Angina is common in young and middle-aged adults. A nurse teaches the mother of a 2-year-old child who has celiac disease which foods to avoid. Which foods identified by the mother indicate that she understands the teaching? 1 Bacon and eggs 2 Macaroni and cheese 3 Tuna salad and rice cakes 4 Chicken leg and corn on the cob 2 Children with celiac disease cannot digest the gliadin component of gluten. Foods containing grains such as wheat, rye, oats, and barley should be avoided; macaroni is contraindicated because it is a wheat product. Bacon and eggs, tuna and rice cakes, and chicken and corn are gluten-free foods. Which pain scale should a nurse use to measure the intensity of pain in toddlers? 1 FACES scale 2 Visual analogue scale 3 Numerical rating scale 4 Verbal descriptor scale 1 The nurse should use a FACES scale to measure the intensity of pain in children. The scale consists of six cartoon faces ranging from a smiling face ("no hurt") to increasingly less happy faces and finally to a sad, tearful face ("hurts worst"). The visual analogue scale, numerical rating scale, and verbal descriptor scale can be used in young children and adults. Which Korotkoff sound represents the diastolic blood pressure in toddlers? 1 First 2 Third 3 Fourth 4 Fifth 3 The fourth Korotkoff sound is muffled and low. This sound is the diastolic pressure in toddlers. The first Korotkoff sound is sharp and represents systolic blood pressure. The third Korotkoff sound is crispier and includes intense tapping. The fifth Korotkoff sound marks the disappearance of sound. In adolescents and adults the fifth sound corresponds with the diastolic pressure. A 3-year-old child has been observed in the clinic waiting room taking toys from others, tearing pages out of books, and striking the mother. The nurse takes time when interviewing the mother to ask about television habits because of what reason? 1 Viewing violent programs is positively correlated with the development of aggression. 2 The nurse is interested in how much time the mother spends in interactions with the child. 3 Watching Sesame Street and other children's shows results in slow cognitive development. 4 There is a direct connection between the number of hours of television viewed and toddler aggression. 1 Watching violent programs is positively correlated with the development of aggression. Television viewing time does not necessarily have anything to do with interaction time with the mother. Children's shows have not been shown to slow cognitive development. There are no statistics stating specifically that the number of hours of television watched correlates directly with an intensification of aggression. What does the nurse explain happens during the transition from infanthood to toddlerhood? 1 Reduced activity levels 2 Increased need for fats 3 Increased food choices 4 Reduced need for sleep 4 As the infant enters the toddler stage, the need for sleep declines and the activity level increases. Toddlers need less fat and more proteins. Children establish lifetime eating habits during toddlerhood, and there is increased emphasis on food choices. A toddler on the pediatric unit is required to have temporary dietary restrictions after colorectal surgery. What is the best way for the nurse to promote adherence to the restrictions? 1 By limiting restrictions to nonessential foods 2 By handling dietary changes in a matter-of-fact way 3 By having the dietitian explain the restrictions to the parents 4 By arranging to have an adult other than a parent stay at mealtime 2 Toddlers are ritualistic and do not tolerate change well; any change in diet should be done matter of factly. Because of their characteristic struggle for autonomy, toddlers should not be forced to eat. Limited restrictions on nonessential foods are not always possible. Although the parents should consult with the dietitian, this will not affect the toddler's response to the dietary restrictions. The toddler is still dependent on the parents and therefore will respond better to them than to a stranger What is an important nursing intervention in the care of a hospitalized toddler with cystic fibrosis? 1 Discouraging coughing 2 Performing postural drainage 3 Encouraging active exercise 4 Providing small, frequent feedings 2 Because the mucus glands secrete thick mucoid secretions that accumulate, reducing ciliary action and mucus flow, the nurse should perform postural drainage, which promotes the removal of mucopurulent secretions by means of gravity. Coughing should be encouraged; it helps bring up secretions from the respiratory tract. Although the nurse should encourage activities that are appropriate for the child's physical capacity, the child's energy should be conserved during acute phases of illness. Providing small, frequent feedings is not necessary; the child with cystic fibrosis may eat regular meals at the usual times. 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? 1 Asking the parents what they were told about the test 2 Using a doll to demonstrate the procedure to the child 3 Obtaining a pacifier for the child to suck on during the procedure 4 Telling the parents that they may stay with their child during the test 1 Informed consent is required. The procedure should be explained to the parents by the practitioner, and the nurse should confirm the parents' comprehension and have them sign the consent form. The child is too young to comprehend a demonstration of the procedure. Although staying with the child may be important to the parents, it is not the priority. Although a pacifier may keep the child calm, this is not the priority, either. What does the nurse educate the mother of a toddler to do in order to promote safety? 1 "Throw plastic grocery bags away." 2 "Fill the crib with large, stuffed toys." 3 "Put pacifiers around the neck of the toddler." 4 "Place the toddler to sleep on his or her back." 1 The nurse educates the mother of a toddler to remove plastic grocery or other bags from from the house to reduce the risk of suffocation. The nurse should instruct the mother not to fill the crib with stuffed toys as there is an increased risk of suffocation. Putting pacifiers around the neck of the child attached with a string increases the risk of choking. The nurse should tell the mother to place a newborn on his or her back to sleep; it reduces the risk of sudden infant death syndrome. The parents of a toddler with newly diagnosed cystic fibrosis (CF) tell a nurse that even though they were told it is an inherited disorder, there is no history of CF in the family. How can the nurse clarify the way in which the disease was inherited? 1 It is a mutated gene. 2 It involves an X-linked gene. 3 The inheritance is autosomal recessive. 4 The inheritance is autosomal dominant. 3 Both parents are carriers; the gene for CF is recessive, not dominant, and the parents do not have the disease. The gene for CF is not a mutant gene, nor is it located on the X or Y chromosome. Which age should the nurse anticipate that a toddler-age client will begin to develop awareness of ownership? 1 15 months 2 18 months 3 24 months 4 30 months 2 A toddler-age client begins to be aware of ownership [1] [2] at the age of 18 months. The nurse would not expect this to begin at 15 months, 24 months, or 30 months. What is the cause of milk anemia in toddlers? 1 Drinking skim milk 2 Drinking whole milk 3 Increased milk intake 4 Increased intake of fruits 3 Toddlers who consume more than 24 ounces of milk daily in place of other foods sometimes develop milk anemia because milk is a poor source of iron. Children are usually not offered low-fat or skim milk until age 2 because they need the fat for satisfactory physical and intellectual growth. Toddlers need to drink whole milk until the age of 2 years to make sure that there is adequate intake of fatty acids necessary for brain and neurological development. Other solid food items are necessary for healthy growth and development in toddlers. Which of these statements about language development in children ages 12 to 36 months are true? Select all that apply. 1 24-month-old children use pronouns. 2 18-month-old children use approximately 25 words. 3 24-month-old children speak in four-word sentences. 4 24-month-old children have a vocabulary of up to 500 words. 5 36-month-old children learn to use five or six new words each day. 15 Children 24-months-old use pronouns and want independence and control. By 36 months, the child can use simple sentences and follow some grammatical rules and is learning to use five or six new words each day. Children 18-months-old use approximately 10 words. Children 24-months-old speak in two-word sentences drawn from a vocabulary of up to 300 words. Which should the nurse anticipate when assessing a toddler-age client's respirations? 1 Dyspnea 2 Tachypnea 3 Nasal breathing 4 Abdominal breathing 4 Respirations for the toddler-age client continue to be abdominal during the toddler-age years. Respirations are normal; therefore, the nurse does not anticipate tachypnea or dyspnea. Nasal breathing is not expected when assessing the respirations of the toddler-age client. A nurse is assessing a 15-month-old girl at the well-child clinic. The nurse determines that further education about toddler development is necessary when the mother says what? 1 "She's always trying to get out of her car seat." 2 "She cries when I leave her at the daycare center." 3 "She gets into everything and scatters toys everywhere." 4 "She has a temper tantrum every time I put her on the potty chair." 4 Most 15-month-old toddlers are not ready for toilet training. Voluntary sphincter control develops between 18 and 24 months of age. A tantrum on being placed on the potty chair is autonomous behavior, typical of a 15-month-old toddler. Crying when the mother leaves her at the daycare center demonstrates separation anxiety, common in 15-month-old toddlers. Scattering toys everywhere demonstrates autonomous behavior, typical of a 15-month-old toddler. A nurse is educating parents about the changes to expect when their child enters toddlerhood. Which information does the nurse include? 1 The toddler's body appears slender. 2 The toddler has a protruded abdomen. 3 The toddler's feet are severely everted. 4 The toddler has inconspicuous cervical curves. 2 The nurse explains to the parents that at the start of toddlerhood, the abdomen of the child will be protruded. The bodies of toddlers start appearing slender by the age of 3 years, not in the beginning of toddlerhood. As the child walks, the legs and feet are usually far apart, and the feet are slightly everted, not severely everted. Toward the end of toddlerhood, curves in the cervical and lumbar vertebrae are accentuated. What step should the nurse follow when taking a toddler's blood pressure? 1 Use an ultrasonic stethoscope. 2 Choose a cuff labeled "toddler". 3 Use a pediatric stethoscope bell to hear Korotkoff sounds. 4 Place the stethoscope firmly on the antecubital fossa for good auscultation. 3 Korotkoff sounds are difficult to hear in toddlers because of their low frequency and amplitude. Hence the pediatric stethoscope bell is used to hear these sounds. An ultrasonic stethoscope is used to measure blood pressure when auscultation is not possible because of weak arterial pulses. It need not be used for all toddlers. The choice of cuff should not be based on the name of the cuff. For instance, a cuff labeled "infant" may not fit, despite its name. Placing the stethoscope too firmly on the antecubital fossa results in errors in auscultation. Elbow restraints are prescribed for an 18-month-old toddler who just had surgery for a cleft palate. The nurse explains to the parents that the restraints are used to keep the child from doing what? 1 Playing with unsterile toys 2 Rolling to a supine position 3 Putting fingers into the mouth 4 Removing the nasogastric tube 3 The suture lines in the mouth must be protected. Because the toddler uses the mouth to explore the environment, elbow restraints are needed to keep the child from placing fingers or objects in the mouth. The child should have time to play with toys, but with supervision to prevent mouthing activities that could disrupt the suture line. The supine position is acceptable; the toddler should be able to move freely when asleep. A nasogastric tube is not used. A 2½-year-old boy who has undergone surgery to revise a ventriculoperitoneal shunt is to be discharged. The nurse advises the parents to call the clinic if the child does what? 1 Appears drowsy after a nap and becomes irritable 2 Talks incessantly regardless of the presence of others 3 Becomes angry when frustrated and has a temper tantrum 4 Starts arguments with playmates, claiming that their toys are the child's 1 Drowsiness and irritability are characteristic signs of increasing intracranial pressure; other signs and symptoms include nausea, projectile vomiting, headache, and diminished physical activity. Incessant talking, temper tantrums, and inability to share are all expected behaviors in a 2½-year-old toddler. Which statement is true about the diet plan for toddlers? 1 Refrain from serving finger foods. 2 Toddlers need 4 to 6 cups of milk per day. 3 Low-fat or skimmed milk should be given until the child is 2 years old. 4 Milk should be supplemented with solid food items like vegetables and fruits. 4 In toddlers, the parents should be supplementing the child's intake of milk with solid foods items, ensuring a balanced diet for adequate growth. Serving finger foods to toddlers allows them to eat by themselves and to satisfy their need for independence and control. The intake of milk should be limited to 2 to 3 cups because the consumption of more than a quart of milk per day tends to decrease the child's appetite for essential solid foods and results in inadequate iron intake. Children below 2 years of age should not be given low-fat or skimmed milk because the fat is important for the physical and intellectual growth of the child. At what age is a toddler-age client physiologically and psychologically prepared for toilet training? 1 13 months 2 16 months 3 19 months 4 22 months 4 The 22-month-old toddler-age client is both physiologically and psychologically prepared for toilet training. The 13-month-old, the 16-month old, and the 19-month old are not yet physiologically and psychologically prepared for toilet training. Which assessment data would cause the nurse to suspect that a toddler-age client is experiencing physical neglect? 1 Abdominal distention 2 Bloody underclothing 3 Recurrent urinary tract infections 4 Bruises in various stages of healing 1 Abdominal distention is a physical manifestation associated with malnutrition that is associated with physical neglect. Bloody underclothing and recurrent urinary tract infections are clinical manifestations associated with sexual abuse. Bruises in various