ATI Ped Unit 1 Assessment Fall

The correct answer is B. Normal for this stage of growth and development.

Option B is correct because at 30 months (about 2.5 years old), toddlers are in the autonomy vs. shame and doubt stage of Erikson's psychosocial development. This stage is characterized by the toddler's desire to assert independence and develop a sense of control over their environment. Saying "no" is a typical way toddlers express this newfound autonomy, even if it causes frustration for caregivers. While it may seem defiant or oppositional, it is a normal developmental milestone.

Why Other Options are Incorrect

Option A ("Problematic, as it interferes with needed nursing care") is incorrect in this context. While the child's behavior may pose challenges for care, it is a normal part of development at this age. The nurse should approach the situation with patience and understanding, offering choices when possible to empower the child while still ensuring necessary care.

Option C ("Normal because the child is hospitalized and out of his routine") is also incorrect. Although hospitalization can make toddlers more upset due to unfamiliar surroundings and disruption of routine, the behavior described (resistance, anger, and saying "no") is more directly linked to typical developmental milestones rather than solely being a reaction to hospitalization.

Summary:

The 30-month-old's behavior of resisting care and frequently saying "no" is a normal part of the autonomy vs. shame and doubt stage of toddlerhood. This behavior reflects the child’s developing sense of independence and desire for control over their environment.

Correct Answer: A soft, button-eyed stuffed animal is a good toy for my baby.

The correct response highlights a safety concern. Button-eyed stuffed animals pose a choking hazard for infants, as they can easily detach and be swallowed. Infants tend to explore objects by mouthing them, and small parts like buttons can be dangerous. Therefore, a stuffed animal should not have small, detachable pieces.

Why the Other Options Are Correct:

"I can give my baby a soft, squishy ball to play with":

A soft, squishy ball is a safe toy for an infant, as it is non-toxic, soft, and large enough to avoid being swallowed. It also helps in developing motor skills.

"My baby can play with a colorful rattle":

A rattle is an appropriate toy for an infant as it stimulates their sensory development (hearing, sight) and helps develop hand-eye coordination.

"My baby can play with a cloth book that they can touch":

Cloth books are safe for infants, as they are soft, washable, and often contain interactive elements such as different textures or sounds. They are great for developing tactile and cognitive skills.

Summary:

The statement about a button-eyed stuffed animal indicates a need for further instruction due to the choking hazard posed by the detachable parts. All other options are suitable toys for infants, promoting sensory and motor development.

The most appropriate time to prepare a 2-year-old for a procedure is: B. A few days in advance of the scheduled date.

At 2 years old, toddlers have limited cognitive abilities and are typically not able to understand complex explanations. However, they can sense anxiety and changes in their routine. It's best to give them simple, short explanations of what will happen a few days before the procedure, rather than overwhelming them with information too far in advance or right before the procedure. Providing preparation closer to the time of the procedure helps avoid unnecessary anxiety. For this age group, it's important to use simple language, maintain a calm demeanor, and focus on reassurance. Parents should be involved in helping prepare the child in an age-appropriate way.

Why the Other Options Are Incorrect:

A. About 1 week before the scheduled date:

At this age, preparing a child too early (e.g., a week before) may cause confusion or unnecessary anxiety, as toddlers have limited understanding of time. A few days before the procedure is more appropriate for explaining what will happen.

C. About 1 hour before the procedure is to occur:

While last-minute preparation might seem practical, toddlers may be too anxious or distressed to fully process information so close to the procedure. It's better to provide reassurance earlier, with time to allow the child to adjust to the idea.

D. Just before the procedure is to be performed:

Waiting until just before the procedure may lead to confusion or distress. Providing reassurance and a simple explanation a few days in advance helps the child feel more comfortable and prepared.

Summary:

For a 2-year-old, it's best to provide simple, reassuring information a few days before the procedure. This allows the child to process the information and feel supported without overwhelming them with too much detail.

Correct Answer: A. Hesitancy and dysfluency are normal during this period of development.

Mild speech hesitancy and repetition, often referred to as "normal dysfluency," are common between ages 2 and 5 as children rapidly expand their vocabulary and language skills. It often resolves without intervention as the child's language matures.

Why Other Options are Incorrect

Reading to the child will help model appropriate speech.

While reading is beneficial for language development, it is not a direct solution for normal developmental dysfluency, which often resolves on its own.

Expressive language concerns warrant a developmental evaluation.

Expressive language concerns requiring developmental evaluation would include significantly delayed speech milestones or limited vocabulary, not the typical stuttering seen in preschoolers.

The mother should ask her child's physician for a speech therapy evaluation.

Speech therapy is not typically warranted for normal dysfluency in a 3-year-old. If the issue persists past age 5 or worsens, a referral might be appropriate.

Summary:

Mild speech hesitancy and repetition are normal in 3-year-olds due to rapid language development. Reassurance to the mother is appropriate unless the dysfluency persists beyond age 5 or worsens.

Correct Answers:

a.) Closed-ended questions with yes or no answers

b.) Biases about race, age, or ethnicity

d.) Addressing caregivers when questions are asked by the child

Explanation

a.) Closed-ended questions with yes or no answers:

These limit communication by preventing children or families from providing detailed responses or expressing their thoughts, concerns, and feelings. Open-ended questions are more effective for fostering meaningful dialogue.

b.) Biases about race, age, or ethnicity:

Prejudices or assumptions based on these factors can hinder communication by creating mistrust or misunderstandings, making families feel unwelcome or unheard. Cultural competence is essential to avoid these barriers.

d.) Addressing caregivers when questions are asked by the child:

This approach dismisses the child’s agency and involvement in their care, which can make them feel excluded or insignificant. It’s crucial to acknowledge and answer the child directly to foster trust and communication.

Why the Other Options Are Wrong:

c.) Direct answers to questions:

Providing clear, honest, and direct answers enhances communication. It helps build trust and ensures that the child and family understand the situation, fostering a sense of control and security.

e.) Observing verbal and nonverbal cues:

Observing cues enhances communication by providing insight into feelings or concerns that may not be expressed verbally. It is an important skill for understanding and addressing the needs of the child and family effectively.

Summary:

Barriers to communication in the hospital setting include closed-ended questions, biases, and dismissing the child’s direct questions by addressing caregivers instead. Effective communication requires cultural sensitivity, open-ended questions, and attentiveness to verbal and nonverbal cues, all of which build trust and improve the overall hospital experience for children and families.

Correct Answer: "When my baby is sick, the car seat can temporarily go in the front seat."

The safest position for an infant car seat is always in the back seat, preferably in the middle to avoid side-impact collisions. Placing the seat in the front seat is dangerous due to the risk of airbag deployment, which can seriously injure an infant even during minor accidents. This rule applies regardless of whether the child is ill or not.

Why the Other Options Are Correct:

"We will need to go by the weight and height of the child when deciding to change to a booster seat."

Transitioning to a booster seat depends on the child's height and weight as specified by car seat guidelines.

"I will place the infant safety seat in the middle of the back seat, away from the windows."

The middle of the back seat is the safest location because it reduces the risk of injury during side-impact crashes.

"My baby will be able to watch me drive while sitting in the back seat."

 Rear-facing car seats allow the infant to face backward, which is the safest position for spinal protection in case of a collision.

Summary:

The safest practice for infant car seats involves placing them rear-facing in the back seat, ideally in the center. Infants should never be placed in the front seat due to airbag hazards. Safety transitions depend on the child’s weight and height, not age alone.

The overriding goal of atraumatic care is D. Prevent or minimize bodily injury and pain

Atraumatic care focuses on minimizing the physical and emotional trauma that can occur during medical treatment or hospitalization, especially for children. The goal is to provide care in a way that reduces pain, injury, and distress, while ensuring the safety and well-being of the child.

While A (Prevent or minimize the child's separation from the family), B (Do no harm), and C (Promote a sense of control) are also important considerations in pediatric care, D is the primary focus of atraumatic care.

A. Prevent or minimize the child's separation from the family: A is important in promoting family-centered care, which is a key principle in pediatric nursing.

B. Do no harm: refers to the ethical principle of non-maleficence, which underpins all nursing care.

C. Promote a sense of control: helps foster a sense of security and reduces anxiety for the child during healthcare experiences, but the primary goal remains minimizing harm.

Summary

Therefore, D best encapsulates the overarching aim of atraumatic care.

Correct Answers:

Educate the parents about developmental milestones and ways to support their child's growth.

Collaborate with the child's parents and healthcare professionals to develop and individualize a plan of care.

Focus on age-appropriate activities that will stimulate the toddler's cognitive and motor skills.

Explanation

In caring for a 2-year-old toddler with developmental delays, the priority actions should focus on supporting the child's development, educating the parents, and ensuring a collaborative, individualized care plan that includes appropriate activities to help the child progress.

Educate the parents about developmental milestones and ways to support their child's growth:

Educating the parents is essential to help them understand their child’s specific developmental needs and how they can support their child’s growth. This promotes an active role for parents in their child's development and ensures they are aware of what milestones to look for and how to encourage growth.

Collaborate with the child's parents and healthcare professionals to develop and individualize a plan of care:

A team approach is crucial in managing developmental delays. Collaboration ensures that all caregivers, including parents, physicians, and specialists, are working together to create a personalized care plan that addresses the child’s unique needs.

Focus on age-appropriate activities that will stimulate the toddler's cognitive and motor skills:

Engaging the child in age-appropriate activities is key to promoting the development of cognitive and motor skills. These activities should be tailored to the child's abilities to encourage growth and minimize frustration.

Why the Other Options Are Incorrect:

Limit interaction with other children to avoid overstimulation:

While some children with developmental delays may be sensitive to overstimulation, isolation from peers is not generally recommended for toddlers. Interaction with other children helps promote social skills and provides opportunities for developmental learning. It's important to assess each child’s individual needs, but total isolation may hinder social growth.

Implement strict routines to discourage any negative behaviors:

While routines can be beneficial for toddlers, particularly those with developmental delays, they should not be excessively rigid. Flexibility is also important to encourage exploration and learning. An overly strict routine can be stressful for both the child and caregivers and might limit the child’s opportunity for learning and adaptability.

Encourage the toddler to play independently in order to promote self-sufficiency:

Although promoting independence is important, toddlers, especially those with developmental delays, often benefit from guided play and interaction with others to help them develop social and motor skills. Encouraging too much independent play might lead to social isolation and delay in social development.

Summary:

The most appropriate actions to prioritize when caring for a toddler with developmental delays include educating the parents, collaborating with the care team, and engaging the child in developmentally appropriate activities that promote cognitive and motor development. It is important to balance structure with flexibility to support both developmental and social growth.

Correct Answer: C. Normal for this stage of growth and development.

It is normal for preschoolers to engage in imaginative play, including having imaginary friends. This behavior helps children express feelings, explore social roles, and gain control over their experiences, especially in unfamiliar situations like hospitalization. Using the imaginary friend as part of care can be a supportive strategy for building rapport and reducing anxiety.

Why Other Options are Incorrect

Problematic; the child is old enough to begin to have a basis in reality.

Preschoolers, especially around age 4, are still highly imaginative and often blur reality with fantasy. This stage is marked by magical thinking and imaginary friends, so it is not a sign of being out of touch with reality but typical for their developmental level.

Normal, because the child is hospitalized and out of her routine.

While being hospitalized can increase stress, the presence of an imaginary friend is not necessarily linked to being out of routine but is part of typical development

Problematic, as it interferes with needed nursing care.

The child's behavior does not interfere with care but rather facilitates it, as the child is more cooperative when the nurse includes the imaginary friend.

Summary:

The 4-year-old's insistence on involving an imaginary friend during care is a normal part of preschool development. Engaging with the imaginary friend can help the child feel secure and more cooperative during medical procedures.