chapter 36: Toddler and family

Question 1

1. Which 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. Defence mechanisms are less efficient than those during infancy.
   d. Short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue

Answer 1

ANS: D
Toddlers still have the short, straight internal ear canal of infants, and the lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomical 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 toddler’s defence mechanisms are more efficient compared to those of infancy.

Question 2

2. Which is a psychosocial developmental task of toddlerhood?
   a. Development of a conscience
   b. Recognition of sex differences
   c. Ability to get along with age-mates
   d. Ability to delay gratification

Answer 2

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 the temptation of an immediate reward to wait for a later, better one, known as delayed gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

Question 3

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. What is the best interpretation of this behaviour?
   a. This is normal behaviour for his age.
   b. This is unusual behaviour for his age.
   c. He is not effectively coping with stress.
   d. He is showing he needs more attention.

Answer 3

ANS: A
Toddlers use distinct behaviours in their quest for autonomy. They express their will with continuous negativity and 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 typical behaviour for an 18-month-old.

Question 4

4. According to Piaget, which stage is a 17-month-old child expected to be in?
   a. Trust
   b. Preoperations
   c. Secondary circular reactions
   d. Tertiary circular reactions

Answer 4

ANS: D
The 17-month-old is in the fifth stage of the sensorimotor phase: tertiary circular reactions (13 to 18 months). The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson’s 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.

Question 5

5. What best describes a toddler’s 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”

Answer 5

ANS: B
At this age the child is in the final sensorimotor stage. Children 19 to 24 months of age will now search for an object in several potential places, even though they saw only the original hiding place. They 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 as well as being able to take it out indicates tertiary circular reactions. An embryonic sense of time exists, but although the children may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.

Question 6

6. Although a 14-month-old girl received a shock from an electrical outlet recently, her parents found her about to place a paper clip in another outlet. What is the best interpretation of this behaviour?
   a. Her cognitive development is delayed.
   b. This is typical behaviour because toddlers are not very developed.
   c. This is typical behaviour because of her inability to transfer knowledge to new situations.
   d. This is not typical behaviour because toddlers should know better than to repeat an act that caused pain.

Answer 6

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 behaviour for a toddler. Only some awareness exists of a causal relation between events.

Question 7

7. Two toddlers are playing in a sandbox, when one child suddenly grabs a toy from the other. What is the best interpretation of this behaviour?
   a. This is typical behaviour because toddlers are aggressive.
   b. This is typical behaviour 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.

Answer 7

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 is typical behaviour for the toddler and is not intentionally aggressive. Shared play is not within their cognitive development. Because the toddler cannot view the situation from the perspective of the other child, it is okay to take the toy, and no sense of right or wrong is associated with the act.

Question 8

8. Which 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.

Answer 8

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 hold on. The child must want to please the parent by holding on rather than pleasing him- or herself by letting go. Bowel training precedes bladder training. Watching older siblings provides role modelling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

Question 9

9. Which characteristic best describes the gross motor skills of a 24-month-old child?
   a. The child skips.
   b. The child rides a tricycle.
   c. The child broad jumps.
   d. The child walks up and down stairs.

Answer 9

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.

Question 10

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. What should the nurse recognize in this situation?
    a. Blocks at this age are used primarily for throwing.
    b. Toddlers are too young to imitate the behaviour of others.
    c. Toddlers are capable of building a tower of blocks.
    d. Toddlers are too young to build a tower of blocks.

Answer 10

ANS: C
This is a good parent–child interaction. The 18-month-old is capable of building a tower of three or four 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.

Question 11

11. A toddler’s parent asks the nurse for suggestions on dealing with temper tantrums. Which is the most appropriate recommendation?
    a. Punish the child.
    b. Leave the child alone until the tantrum is over.
    c. Ignore the behaviour, provided that it is not injurious.
    d. Explain to the child that this is wrong.

Answer 11

ANS: C
The parent should be told that the best way to deal with temper tantrums is to ignore the behaviour, provided that they are not dangerous to the child. Tantrums are common in this age group as the child becomes more independent and increasingly complex tasks overwhelm him or her. Parents and caregivers need to have consistent and developmentally appropriate expectations. Punishments and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

Question 12

12. A parent asks the nurse about how to deal with negativism in toddlers. What is the most appropriate recommendation? a. Punish the child.
    b. Provide more attention.
    c. Ask the child to not always say “no.”
    d. Reduce the opportunities for a “no” answer.

Answer 12

ANS: D
The nurse should suggest to the parent that questions should be phrased to present realistic choices instead of requiring 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.”

Question 13

13. The parents of a 2-year-old tell the nurse that they are concerned because she has started to use “baby talk” since the arrival of their new baby. What should the nurse recommend to 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 practise more advanced patterns of speech.

Answer 13

ANS: A
The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviours. Regression is a child’s way of expressing stress. The parents should not introduce new expectations and instead allow the child to master developmental tasks without criticism.

Question 14

14. Parents tell the nurse that their toddler daughter eats a little at mealtime, only sits at the table with the family briefly, and wants snacks “all the time.” What should the nurse recommend to 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.

Answer 14

ANS: A
Most toddlers exhibit a physiological anorexia in response to the decreased nutritional requirements associated with their slower growth rate. Parents should assist the child in developing healthy eating habits. Toddlers are often unable to sit through a meal, so frequent, nutritious snacks are a good way to ensure they are getting proper nutrition. To help with developing healthy eating habits, food should not be used as positive or negative reinforcement for behaviour. The child may develop habits of overeating or eat non-nutritious foods in response

Question 15

15. 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. Which is the basis for the nurse’s response?
    a. It is a sign that the child is spoiled.
    b. It is a way for her to exert unhealthy control.
    c. It shows regression, which is common at this age.
    d. It demonstrates ritualism, which is common at this age.

Answer 15

ANS: D
The child is exhibiting the ritualism that is characteristic of this age. Ritualism comes from the need to maintain sameness and reliability that provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favourite food because it is served in a different container. This does not indicate a child who has unreasonable expectations, but rather normal development. Toddlers use ritualistic behaviours to maintain necessary structure in their lives. This is also not regression, which is a retreat from a present pattern of functioning.

Question 16

16. Developmentally, which behaviour is seen in 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 for the bottle.

Answer 16

ANS: C
By age 12 months, most children are eating the same food that is prepared for the rest of the family. They usually do not master using a spoon until age 18 months. Parents should be engaged in weaning a child from the 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.

Question 17

17. What is the most effective way to clean a toddler’s teeth?
    a. Child brushes regularly with toothpaste of his or her choice.
    b. Parent stabilizes the chin with one hand and brushes with the other.
    c. Parent brushes the mandibular occlusive surfaces, leaving the rest for the child.
    d. Parent brushes the front labial surfaces, leaving the rest for the child.

Answer 17

ANS: B
The most effective way to clean young children’s teeth is for parents to do it. Different positions can be used if the child’s back is to the adult, but if they are facing each other, the adult should use one hand to stabilize the chin and the other to brush the child’s teeth. The child can participate in brushing, but for a thorough cleaning adult intervention is necessary.

Question 18

18. The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What should the nurse recommend to the parents?
    a. Use fluoridated mouth rinses in children older than 1 year.
    b. Have children brush their teeth with fluoridated toothpaste unless the fluoride
    content of the water supply is adequate.
    c. Give fluoride supplements to breastfed infants beginning at age 1 month.
    d. Determine whether the water supply is fluoridated.

Answer 18

ANS: D
The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride, and if so, in what amount. It is difficult to teach this age group to spit out mouthwash, and 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.

Question 19

19. What is an appropriate recommendation for preventing tooth decay in young children?
    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.

Answer 19

ANS: B
Sweets should be consumed immediately after meals so the teeth can be cleaned afterward. This decreases the amount of time that sugar is in contact with the child’s teeth. Raisins, honey, and molasses are highly cariogenic and should be avoided.

Question 20

20. What is the leading cause of death for toddlers?
    a. Injuries
    b. Infectious diseases
    c. Congenital disorders
    d. Childhood diseases

Answer 20

ANS: A
Injury is the single most common cause of death for children between the ages of 1 and 4 years. Toddlers have the highest death rate from injuries of any childhood age group except adolescents. Infectious and childhood diseases are less common causes of death for this age group. Congenital disorders are the second leading cause of death in this age group.

Question 21

21. Most car seats can be safely switched from rearward-facing to the forward-facing position when the child reaches which weight, in kilograms?
    a. 5
    b. 10
    c. 15
    d. 20

Answer 21

ANS: B
The transition point for switching to the forward-facing position is defined by the manufacturer but is generally at a body weight of at least 10 kg and 1 year of age. Infants who weigh 10 kg before 1 year of age should continue to ride in a rear-facing seat. Five kilograms is too small to be safe. The relatively large head of this size child should be in the rear-facing position. It is usually safe to put children who weigh more than 15 to 20 kilograms in forward-facing convertible safety seats.

Question 22

23. What is the most fatal type of burn for the toddler age group?
    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

Answer 22

ANS: A
Flame burns from matches and lighters are the most fatal burn type 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 hazards by reducing the temperature of hot water in the home, keeping objects such as cigarettes and irons out of reach, and placing protective guards over electric outlets when not in use.

Question 22

22. The nurse informs parents that peanuts are not a good snack food for toddlers. What is the nurse’s rationale for this advice?
    a. They are low in nutritive value.
    b. They are very high in sodium.
    c. They cannot be entirely digested.
    d. They can be easily aspirated.

Answer 22

ANS: D
Foreign-body aspiration is common during the second year of life. Although he or she chews well, a child this age may have difficulty with large pieces of food such as meat and whole hot dogs, and 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, and this is not necessarily detrimental to the child.

Question 23

24. What is a characteristic of physical development for a 30-month-old child?
    a. Birth weight has doubled.
    b. Primary dentition is complete.
    c. Left- or right-handedness is established.
    d. The anterior fontanel is op

Answer 23

ANS: B
Usually by age 30 months, the primary dentition of 20 teeth is complete. The doubling of birth weight, opening of the anterior fontanel, and handedness orientation are not characteristic of the physical development for a 30-month-old child.

Question 24

1. When assessing a 2-year-old’s language development, which would the nurse document as normal findings? Select all that apply. Express answer with small letters followed by a comma and a space—e.g., a, b, c.
   a. Uses plurals
   b. Has vocabulary of about 300 words
   c. Understands directional commands
   d. Refers to self by first name
   e. Names one colour
   f. Able to string four to five words together in a sentence

Answer 24

ANS: B, C, D
Normal language achievements in a 24-month-old include a vocabulary of 300 words, understanding directional commands, and referring to self by first name. The 2-year-old can use two- or three-word phrases, not four or five. Naming one colour and using plurals are characteristics of a 30-month-old child.

Question 25

2. Which are characteristics of preoperational thought? Select all that apply. Express answer with small letters followed by a comma and a space—e.g., a, b, c.
   a. Centration
   b. Magical thinking
   c. Ritualism
   d. Negativism
   e. Egocentrism
   f. Global organization

Answer 25

ANS: A, B, E, F
Characteristics of preoperational thought include egocentrism, transductive reasoning, global organization, centration, animism, irreversibility, magical thinking, and inability to conserve.