Health Promotion Throughout the Life Span 7th Edition Edelman Mandle Test Bank
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Edelman: Health Promotion Throughout the Life Span, 7th Edition
Chapter 18: Toddler
- At a visit, a 2-year-old toddler measures 2 feet 8 inches tall. The nurse estimates the toddler’s approximate final adult height to be:
|a.||4 feet 8 inches|
|c.||5 feet 2 inches|
|d.||5 feet 4 inches|
The toddler’s height at 2 years is approximately 50% of final adult height. Thus, at 2 feet 8 inches, the child’s approximate final adult height would be 5 feet 4 inches tall (2 feet 8 inches ´ 2).
DIF: Cognitive Level: Application REF: 458
- A 2 1/2-year-old toddler is in for an office visit. He was born at 6 lb 10 oz. At today’s visit, the nurse expects his weight to be:
|a.||13 lb 4 oz|
|b.||19 lb 14 oz|
|c.||26 lb 8 oz|
|d.||33 lb 2 oz|
Birth weight usually quadruples by 2 1/2 years of age. 6 lb 10 oz ´ 4 = 26 lb 8 oz.
DIF: Cognitive Level: Application REF: 458
- A mother is concerned because her 22-month-old has been skipping meals lately. The nurse should counsel the mother to:
|a.||Put the child in time out whenever he skips a meal|
|b.||Offer him foods he likes such as cookies and chips|
|c.||Limit juices and cookies|
|d.||Talk to the child about how important it is to eat three meals a day|
Toddlers often use mealtime to assert their individuality. They sometimes do this by refusing to eat. Additionally, they are often not hungry because they have been given empty calories by their parents, because the parents want to make sure the toddler eats something. However, empty calories should be avoided. Parents should take control and offer the toddler healthy, age-appropriate foods. Punishment and focusing on food should be avoided.
DIF: Cognitive Level: Application REF: 461
- Which toddler behavior would require further investigation from the nurse?
|a.||A toddler sitting quietly on a couch|
|b.||A toddler experiencing a temper tantrum|
|c.||A toddler playing with a toy next to another child also playing with a toy|
|d.||A toddler exploring his environment and playing with new toys|
Toddlers are always busy. They spend most of their day playing and exploring their environment; a toddler sitting quietly may be doing so because of a dysfunction in the activity-exercise pattern and thus should be evaluated further.
DIF: Cognitive Level: Application REF: 463
- When assessing the cognitive-perceptual pattern of a toddler, which finding would be cause for concern for the nurse?
|a.||A toddler who uses the word blanky to mean both that he wants to go to bed and that he is cold|
|b.||A toddler who refuses to eat something he ate and enjoyed the day before|
|c.||A toddler whose visual acuity is not 20/20|
|d.||A toddler with recurrent ear infections|
Vision, hearing, speech, and taste/smell are all assessed as part of the cognitive-perceptual pattern. A toddler with recurrent ear infections is at risk for hearing loss, which can also lead to speech delay, thus this finding would be cause for concern. Visual acuity during the toddler years is approximately 20/40.
DIF: Cognitive Level: Application REF: 465 | 467-468
- A parent expresses her frustration over the constant fighting between her toddler and preschooler. An appropriate response from the nurse would be to:
|a.||Tell the mother not to worry about it and continue with the office visit|
|b.||Tell the mother this is normal behavior for the toddler, and she should be firm with the child without taking sides|
|c.||Say to the mother, “Don’t you remember fighting with your sibling? Don’t worry; everything will work out.”|
|d.||Say to the mother, “Don’t worry; this behavior will all end soon.”|
Toddlers often imitate those older than them and this can create sibling rivalry. A major role of the nurse is to provide anticipatory guidance. The nurse should include normal family development as part of the anticipatory guidance because discipline can often be influenced by lack of knowledge and skill. Parental anger that goes unchecked can lead to abuse.
DIF: Cognitive Level: Application REF: 469
- Which behavior exemplifies a toddler working through his developmental task?
|a.||A toddler clinging to his mother|
|b.||A toddler refusing to take a bath|
|c.||A toddler playing quietly with one toy|
|d.||A toddler not interested in a new toy|
The development task of toddlers is to acquire a sense of autonomy while overcoming a sense of doubt and shame. Toddlers need to explore the world physically and interpersonally to develop a true sense of autonomy. The child explores relationships with others by searching for the limits of the child’s power. A child refusing to take a bath is trying to exert his autonomy.
DIF: Cognitive Level: Application REF: 468
- An important self-perception–self-concept pattern anticipatory guidance measure a nurse can offer the parents of a toddler is to say:
|a.||“Temper tantrums are expected, so always give in to them.”|
|b.||“Put your toddler in time out if he has a temper tantrum.”|
|c.||“Childproof your home.”|
|d.||“Always provide your toddler with challenging toys.”|
The developmental task of toddler is to acquire a sense of autonomy. During this stage toddlers do a lot of exploring, and this includes climbing, crawling, and tasting. As a result, they are at increased risk for injury and should be provided with a childproof environment.
DIF: Cognitive Level: Application REF: 468
- A 2-year-old Asian boy is being seen for an office visit. While examining the child, the nurse notices round bruises on his back. The mother does not volunteer any information during the exam. After examining the child, the nurse should:
|a.||Report the suspected child abuse to the Department of Children and Families|
|b.||Assume the bruises are the result of a fall|
|c.||Ask the mother about the bruises|
|d.||Schedule a follow-up for 2 weeks from now to see if the bruises are still present|
Many injuries are difficult to differentiate from accidental injuries or culturally appropriate healing practices. Abusive parents are often hesitant to provide information, may be evasive, and may not exhibit feelings of guilt. However, these signs may also be present in nonabusive families. Therefore, signs consistent with abusive parents should serve as a cue for further assessment. Additionally, the nurse who is aware of cultural differences knows that coining, which can result in bruising, is a common cultural practice. Therefore, in this case the nurse should ask the mother about the bruises.
DIF: Cognitive Level: Application
REF: 458 | 469 | 470 (Multicultural Awareness box)
- The mother of a 2-year-old recently lost her job. In addition, her husband asked for a separation. Knowing this information, the nurse should:
|a.||Give the mother information about local support groups|
|b.||Give the mother the name of a prominent local attorney|
|c.||Do not offer any advice unless the mother asks|
|d.||Help the mother find a job|
Child abuse is more likely to occur with a major change or turmoil in the family. Toddlerhood is a trying time for even patient parents. Nurses need to be alert to family changes and stress. Additionally, a major nursing role is to provide anticipatory guidance. Therefore, the nurse should give the mother information about local support groups.
DIF: Cognitive Level: Application REF: 458 | 469
- Toddlers require approximately:
|a.||10 hours of sleep a day|
|b.||11 hours of sleep a day|
|c.||12 hours of sleep a day|
|d.||13 hours of sleep a day|
Toddlers’ need for sleep decreases to 12 hours a day during this developmental period.
DIF: Cognitive Level: Knowledge REF: 464
- The inability of a toddler to put himself in another’s shoes is known as:
The inability of a toddler to put himself in another’s shoes is known as egocentrism.
DIF: Cognitive Level: Knowledge REF: 465 | 467
- A deviation of the line of vision from the midline resulting from extraocular muscle weakness or imbalance is known as:
A deviation of the line of vision from the midline resulting from extraocular muscle weakness or imbalance is known as strabismus.
DIF: Cognitive Level: Knowledge REF: 467
- Amblyopia is treated with:
|a.||The use of corrective lenses|
|b.||Patching of the eye|
|c.||The application of artificial tears to the eye|
|d.||The passage of time|
Management of amblyopia depends on the cause and includes surgery or paralytic and autonomic, centrally acting pharmacologic agents. In addition, management includes strengthening of the eye with reduced vision by applying atropine eye drops or patching the stronger eye.
DIF: Cognitive Level: Knowledge REF: 467
- A toddler needs to have blood drawn at his next appointment. The nurse should counsel the mother to:
|a.||Tell the child about the blood work on the day that the appointment is scheduled|
|b.||Tell the child about the blood work right before leaving the house for the appointment|
|c.||Tell the child when they are in the office right before the phlebotomist enters the room|
|d.||Not tell the child about the blood work|
Parents can help to prepare toddlers for stressful experiences before they happen. However, toddlers’ sense of time and ability to remember are limited. Enough time should be allowed for the toddler to rehearse the coping behavior with the parent but not so far off that the child will forget. Thus, the best time to tell the toddler is right before leaving for the appointment.
DIF: Cognitive Level: Application REF: 470
- What would be the best way for a parent to explain to a toddler that he needs to receive the influenza vaccine at today’s appointment?
|a.||“You need the shot to keep you healthy. You will feel a little pinch when you get the shot.”|
|b.||“You need the shot to prevent the flu. They will use a small needle to administer the shot. It will not take long.”|
|c.||“You need a shot, but don’t worry, you won’t feel a thing.”|
|d.||“No, you will not get any needles today.”|
Parents can help to prepare toddlers for stressful experiences before they happen. Preparation should be honest, simple, and focused on what the toddler will experience. Therefore, the best way to tell the toddler is to say, “You need the shot to keep you healthy. You will feel a little pinch when you get the shot.”
DIF: Cognitive Level: Synthesis REF: 470
- Which poses the greatest and most immediate risk to a toddler?
|a.||A fenced-in pool in the backyard|
|b.||An entertainment center with the remote control on the top shelf|
|c.||A closed window in the child’s bedroom|
|d.||A toddler sitting in a high chair while the mother is feeding him|
Toddlers are at high risk for accidental injury because they lack judgment, and have limited physical coordination and a heightened level of curiosity. Toddlers love to explore and climb objects. Injuries to toddlers occur most often when they fall from furniture, stairs, or windows. Trying to reach the remote control on the top shelf of the entertainment center puts the child at immediate and greatest risk because of the potential for the entertainment center to fall on the child while he is trying to climb it. (The window is closed and the mother is present when the child is in the high chair.)
DIF: Cognitive Level: Synthesis REF: 468 | 471-472
- Which primary prevention recommendation to reduce the risk of lead poisoning should the nurse give to a mother of a toddler?
|a.||Encourage the toddler to drink orange juice and eat yogurt|
|b.||Encourage the toddler to eat plenty of cakes and cookies to help absorb the lead|
|c.||Limit foods high in iron such as spinach to help reduce lead levels|
|d.||Encourage dark-chocolate–containing products that contain antioxidants to help reduce lead levels|
Primary prevention for lead poisoning involves teaching parents about risk factors and the importance of a diet that encourages decreasing fat intake, because lead is retained in fat. Vitamin C, calcium, and iron products should be encouraged. Thus, orange juice, which contains vitamin C, and yogurt, which contains calcium, should be encouraged. Chocolate products should not be encouraged.
DIF: Cognitive Level: Application REF: 474
- By 24 months of age, a toddler’s receptive language is up to:
By 24 months of age, a toddler’s receptive language is up to 1200 words.
DIF: Cognitive Level: Knowledge REF: 466 (Table 18-1)
- An individual’s style of emotional and behavioral response across situations, especially those involving change or stress, is known as:
An individual’s style of emotional and behavioral response across situations, especially those involving change or stress, is known as temperament.
DIF: Cognitive Level: Knowledge REF: 470
- Which is a common temperament pattern described by Chess and Thomas?
|a.||The fussy child|
|b.||The happy child|
|c.||The unhappy child|
|d.||The slow-to-warm-up child|
Chess and Thomas originally described three common temperament patterns they believe are innate. The three patterns are the easy child, the difficult child, and the slow-to-warm-up child.
DIF: Cognitive Level: Knowledge REF: 471 (Hot Topics box)
- A mother asks her toddler if she is tired. The toddler responds by saying “Sammy bed.” Based on her expressive language and speech pattern, the toddler is likely:
|a.||18 months of age|
|b.||24 months of age|
|c.||30 months of age|
|d.||36 months of age|
By 24 months of age, the toddler talks in two- to three-word sentences and averages two words per response. At this age, the toddler also refers to his or herself by name. Adjectives are only beginning at this age. Thus, a response of “Sammy bed” is likely that of a 24-month-old.
DIF: Cognitive Level: Synthesis REF: 466 (Table 18-1)
- The best way for parents to teach their toddler the importance of dental hygiene is to:
|a.||Remind the toddler to brush his teeth every day|
|b.||Have the dentist tell the toddler about the importance of dental hygiene|
|c.||Schedule a time to brush their own teeth with their toddler|
|d.||Have the toddler watch an educational cartoon video on the teeth brushing|
Toddlers identify with parents, caregivers, and other important role models, internalizing a wider range of lifestyle attributes. Parents’ and caregivers’ health perceptions and health behaviors should model the perceptions and behaviors desired for health promotion. Thus, scheduling a time to brush their teeth with their toddler is the best way for parents to teach their toddler the importance of dental hygiene.
DIF: Cognitive Level: Application REF: 461
- A mother expresses her concern and frustration over the fact that her toddler has not been successful at toilet training yet. The best response by the nurse is to say:
|a.||“Don’t worry; it will happen eventually.”|
|b.||“How long does the child stay dry during the day?”|
|c.||“Train him on a regular toilet instead of a potty chair.”|
|d.||“Here is a training schedule to follow.”|
Toilet training is a major parental concern during toddlerhood. The nurse anticipates this and initiates discussion with the parent to determine their understanding of the child’s signs of development readiness. Before beginning toilet training, parents should check their toddler’s prerequisite skills. These include being able to walk, stop and recover, stay dry for at least 2 hours during the day, and communicate sensation before elimination, as well as about the discomfort of wet or messy pants and the need for assistance. These prerequisites rarely develop before 18 months of age. Determining whether the child is ready will help to guide the discussion with the mother as well as help to determine the appropriate recommendations. This response also helps the mother understand and accept the reason for the potential delay in toilet training.
DIF: Cognitive Level: Synthesis REF: 463 (Health Teaching box)
- A mother tells the nurse that ever since she started toileting training, the toddler has been touching his genitals. The most appropriate response by the nurse is to tell the mother:
|a.||“This is a sign that he is not ready to toilet train yet.”|
|b.||“This behavior is developmentally normal.”|
|c.||“Tell him to stop touching himself.”|
|d.||“Don’t worry about it.”|
The toilet training process may precipitate curiosity about the genital organs. The nurse should provide anticipatory guidance to help the parents approach this curiosity and exploration, as well as masturbation as a normal developmental process. Telling the mother not to worry does not address her concern. Thus, to address the mother’s concern and provide anticipatory guidance, the nurse should tell the mother that the behavior is developmentally normal.
DIF: Cognitive Level: Application REF: 463 (Health Teaching box) | 470
- An 18-month-old is in for a well-child visit. The best way for the nurse to enlist the toddler’s cooperation is to:
|a.||Ask the toddler if he wants to be examined today|
|b.||Have his mother leave the room while the nurse examines him|
|c.||Have him hold the stethoscope diaphragm on his chest while the nurse listens to his chest|
|d.||Have his mother hold him down while the nurse examines him|
Toddlers need to explore their environment to master it. This includes health care visits. They need to observe and listen to their parents interact with the health care provider, be allowed to manipulate the equipment, and be given simple instructions and choices so they can maintain some control. Therefore, having the child hold the stethoscope on his chest while being examined will help make the visit more productive.
DIF: Cognitive Level: Application REF: 475
- Signs of child abuse include (select all that apply):
|a.||Bare spots on the scalp, and broken hair|
|b.||Overly concerned parents|
|c.||Burns with sharply demarcated edges|
|d.||Bruises anywhere on the body|
ANS: A, C
Bare spots and broken hair as well as burns with sharply demarcated edges are warning signs of child abuse. Abusive parents often do not demonstrate any guilt and are hesitant to provide information. Typically, abusive parents have difficulty leaving a child and attempt to identify with their feelings. In addition, bruises due to abuse are usually located on the back side of the body, from the neck to the knees.
DIF: Cognitive Level: Knowledge REF: 469 (Box 18-3)
- Which scenario places a toddler at risk for injury? Select all that apply.
|a.||A toddler playing with his preschool sibling’s toy|
|b.||A mop and a bucket of clean water in the kitchen|
|c.||A cup of hot coffee on the kitchen counter|
|d.||A 25-lb toddler sitting in a forward-facing car seat in the back seat of a car|
ANS: A, B, C
Toys are a common source of injury, especially toys intended for older children. Hot water, boiling water, coffee, tea, and food are the most common source of injury and should not be kept within reach of the child. Additionally, toddlers can drown in water just deep enough to cover their noses and mouths, and this includes pails of water. Once children reach 20 lb, they should be switched to a forward-facing child safety seat, and preferably be placed in the rear seat due to the risk of injury from air bags in the front seat.
DIF: Cognitive Level: Application REF: 472-473