Chapter 32, The Toddler and Family: Growth and Development of the Toddler- Sherpath

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Question 1 of 9

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Which physical changes are normally seen as an infant transitions into a toddler?

    • Cherub appearanceA cherub appearance, resulting from excess adipose stores, is typical of an infant. This physical attribute disappears as the infant transitions into the toddler and the baby fat disappears.
  • Correct
    • Protruding abdomenA potbellied abdomen due to immature abdominal muscles is a normal physical change as an infant transitions into a toddler.
    • Increased adipose tissueDecreased, not increased, adipose tissue is a normal physical change as an infant transitions into a toddler.
  • Correct
    • Excessive curve of the backAn exaggerated lumbar curve is a normal physical change as an infant transitions into a toddler.
  • Correct
    • Wide gap between knees when standing erectA gap between the knees is the result of short, bowed legs, which are a normal physical change as an infant transitions into a toddler.

Question 2 of 9

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Which head circumference measurement would be expected for a two-year-old whose head circumference was 18 inches at the 12-month checkup?

    • 18 inchesA lack of head circumference growth over the course of a year is an unexpected finding and may indicate a problem.
    • 17 inchesA decrease in head circumference over the course of a year is an unexpected finding and may indicate a problem.
  • Correct
    • 19.5 inchesHead circumference increases approximately 1.5 inches from 12 months to 24 months.
    • 21.5 inchesA growth of head circumference of 3.5 inches is excessive and may indicate a problem such as macrocephaly.

Question 3 of 9

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Which would be the expected adult height for a toddler who is 34 inches tall at the 30-month checkup? __

    • Your answer: 68Correct answer: 68Children attain half their adult height between ages 2 and 3 years. A child who was 34 inches tall at the 30-month checkup would be expected to be approximately 68 inches tall as an adult.

Question 4 of 9

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Match the activity with the age at which it is first exhibited.

  • Walking independently
  • Turning the pages as they are read to
  • Dressing themselves
  • Stacking multiple blocks to build towers

Question 5 of 9

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How does the ability for a 24-month-old to build a two-block tower demonstrate a toddler’s fine motor development?

    • The ability to stack one block on top of another demonstrates an improvement in the toddler’s balance.An improvement in a toddler’s balance is typical at this stage but stacking blocks does not demonstrate development of balance.
    • The ability to stack one block on top of another demonstrates an improvement in the toddler’s autonomy.An improvement in a toddler’s autonomy is typical at this stage but stacking blocks does not demonstrate development of autonomy.
    • The ability to stack one block on top of another demonstrates an improvement in the toddler’s visual acuity.An improvement in a toddler’s visual acuity is typical at this stage but stacking blocks does not demonstrate direct development of visual acuity.
  • Correct
    • The ability to stack one block on top of another demonstrates an improvement in a toddler’s hand-eye coordination.An improvement in a toddler’s hand-eye coordination is typical at this stage and stacking blocks demonstrates development of fine motor skills.

Question 6 of 9

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What important parental guidance advisory needs should caregivers be reminded of when discussing motor development in the toddler?

    • Encourage the toddler to walk because he or she will fall down when running.Toddlers will fall when walking or running, but should not be discouraged from increasing mobility.
    • Keep the toddler in a crib until 3 years of age, even if he or she tries to climb out.Because toddlers are avid climbers and could become injured if they fall while trying to climb out of a crib, the parents should consider moving the toddler to a bed.
    • As motor development increases, allow the toddler to use a toothbrush unsupervised.Because toddlers are not effective at removing plaque, the parents should not leave the toddler unsupervised when brushing teeth.
  • Correct
    • Motor development in this age group is far ahead of development of judgment and perception.This difference in timing of the development of different skills increases the risk for injury.

Question 7 of 9

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When caring for a toddler in the hospital, which nursing intervention is most developmentally appropriate?

    • Not allowing the child to have a pacifier while in the hospital.The toddler may experience distress if a comfort object is not allowed in the hospital. The nurse should allow the child to have a pacifier if he or she normally uses one.
    • Allowing the child to decide if the nurse can perform a procedure.The toddler will engage in negativism, so asking if the toddler gives permission will most likely end in the toddler saying “no.”
    • Asking the parents to leave the room when performing an assessment.The toddler may experience separation anxiety, so the nurse should ask the parents to remain in the room.
  • Correct
    • Scheduling evening medications to follow the toddler’s bedtime routine.The toddler may experience distress when a routine is not followed. The nurse can provide care in the hospital that helps support routines, if possible.

Question 8 of 9

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Which one of the following developmental characteristics explains why a toddler frequently uses the words me, I, and mine?

    • AnimismAnimism is when a toddler believes that inanimate objects are animated, but it does not explain why the predominant words in the toddler’s language are me, I, and mine.
    • RitualismRitualism is when a toddler likes to follow the same daily routine, but it does not explain why the predominant words in the toddler’s language are me, I, and mine.
    • NegativismNegativism is when a toddler expresses independence by saying “no,” but it does not explain why the predominant words in the toddler’s language are me, I, and mine.
  • Correct
    • EgocentrismEgocentrism is when a toddler views everything in relation to self and is unable to consider another’s point of view, and it explains why the predominant words in the toddler’s language are me, I, and mine.

Question 9 of 9

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Which report by a parent would indicate normal social development of the 2-year-old patient?

    • “He doesn’t care at all when I leave him.”Toddlers normally have separation anxiety. A toddler that did not care if parents leave would not indicate normal social development of the toddler.
    • “He only talks to himself, and not to me.”By 2 years of age the child should be engaging in more conversation and less monologue. Only speaking in monologue does not indicate normal social development of the toddler.
    • “I never really know what he is saying to me.”The parents should be able to understand 60-70% of the child’s language by age 2. Not understanding any of the child’s language does not indicate normal social development of the toddler.
  • Correct
    • “He will play next to another child and watch the child, but won’t interact with the child.”Playing beside other children, or parallel play, indicates normal social development of the toddler.

A toddler who was 33 inches in height on his or her second birthday would be expected to
measure approximately inches in height on his or her third birthday.
36
The average toddler grows approximately 3 in. (7.62 cm) each year. The toddler would
therefore be expected to be 36 inches (33 + 3) on his or her third birthday.
A toddler who weighs 22 lbs at 1 year of age would be expected to weigh approximately
_ lbs by the third birthday.
32
The average weight gain is 5 lbs (2.26 kg) per year. Therefore, a toddler weighing 22 pounds
at 1 year of age would be expected to weigh approximately 32 pounds (22 + 5 + 5) by the
third birthday.

Which characteristics are typical of the toddler’s physical appearance?
Select all that apply.
A. Leaner
B. Knees curved inward
C. Flattened plantar arch
D. Inward curve of the spine
E. Mature abdominal muscles
A, C and D
Leaner
Loss of adipose (fat) tissue as the toddler becomes more active is typical of a toddler’s
appearance.
Flattened plantar arch
Toddler’s feet seem flat because of a plantar fat pad that disappears around 2 years of age.
This is typical of a toddler’s appearance.
Inward curve of the spine
An exaggerated lumbar curve is typical of a toddler’s appearance

Identify the gross motor capability of the toddler.
Select all that apply.
A. Riding a bicycle
B. Ascending the stairs
C. Jumping over objects
D. Hop on one foot
E. Throwing a ball overhand
B and E
Ascending the stairs
Learning to climb is a gross motor milestone of the toddler.
Throwing a ball overhand
Throwing a ball overhand is a gross motor skill capability of the toddler.
Identify fine motor capabilities for the toddler.
Select all that apply.
A. Drawing a circle
B. Stacking blocks or toys
C. Drinking from a sippy cup
D. Using a spoon without difficulty
E. Drawing a person with several body parts
A, B and C
Drawing a circle
Drawing loops and lines (scribbling) is a fine motor skill capability of the toddler.
Stacking blocks or toys
Building a tower of blocks is a fine motor skill capability of the toddler.
Drinking from a sippy cup
By 12-18 months, the toddler should have mastered the use of a sippy cup and can use an
adult cup without much spilling.

What anticipatory guidance can the nurse give parents of a toddler to support the toddler’s
need for increasing autonomy?
A. Take the food away if the toddler spills it.
B. Continue feeding the toddler during mealtime.
C. Give the toddler finger foods to decrease messes.
D. Allow the toddler to practice feeding with a spoon.
D. Allow the toddler to practice feeding with a spoon.
Allowing the toddler to practice feeding with a spoon will help increase autonomy at mealtimes.
Which cognitive advancements are expected between 19 and 24 months?
A. Domestic mimicry
B. Ability to relate to time of day
C. Abstract thinking to solve problems
D. Imitating an action only while another person is performing it
A. Domestic mimicry
Domestic mimicry (imitating a parent of the same sex) and deferred imitation (imitating an
action hours after the toddler watched the original action) are expected cognitive advancements of the toddler.

Which behaviors are expected in the toddler?
Select all that apply.
A. Throwing tantrums
B. Crying when the toddler’s parent leaves for work
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A, B, C and D
Throwing tantrums
Negativism, or saying “no” to requests, is an expected behavior in toddlers and is a way that
they can test their independence and boundaries. In extreme cases, it can lead to screaming,
kicking, hitting, biting, or breath-holding.
Crying when the toddler’s parent leaves for work
Crying when a parent leaves, or separation anxiety, is an expected behavior in the toddler.
Developing a sense that bad behavior is punished
Controlling behavior to avoid punishment is an expected behavior in the toddler.
Insisting on same book being read every morning
Reading the same book, or ritualism, is an expected behavior in the toddler.

Which toy is appropriate to encourage cognitive development in the toddler?
A. Card game
B. Board game
C. Stacking cups
D. One-hundred-piece puzzle
C. Stacking cups
Stacking cups would encourage cognitive development. Cups are also safe and durable. This
would be an appropriate toy.
Which physical changes are normally seen as an infant transitions into a toddler?
Select all that apply.
A. Cherub appearance
B. Protruding abdomen
C. Increased adipose tissue
D. Excessive curve of the back
E. Wide gap between knees when standing erect
B, D and E
Protruding abdomen
A potbellied abdomen due to immature abdominal muscles is a normal physical change as
an infant transitions into a toddler.
Excessive curve of the back
An exaggerated lumbar curve is a normal physical change as an infant transitions into a
toddler.
Wide gap between knees when standing erect
A gap between the knees is the result of short, bowed legs, which are a normal physical change
as an infant transitions into a toddler.
Which head circumference measurement would be expected for a two-year-old whose head
circumference was 18 inches at the 12-month checkup?
A. 18 inches
B. 17 inches
C. 19.5 inches
D. 21.5 inches
C. 19.5 inches
Head circumference increases approximately 1.5 inches from 12 months to 24 months.

Which would be the expected adult height for a toddler who is 34 inches tall at the 30-month
checkup? __
Use numbers only.
68
Children attain half their adult height between ages 2 and 3 years. A child who was 34 inches
tall at the 30-month checkup would be expected to be approximately 68 inches tall as an adult.
Match the activity with the age at which it is first exhibited.

  1. 15 months
  2. 18 months
  3. 24 months
  4. 36 months
    A. Turning the pages as they are read to
    B. Stacking multiple blocks to build towers
    C. Dressing themselves
    D. Walking independently
  5. D
  6. A
  7. C
  8. B