ADVENTIST MEDICAL CENTER COLLEGE

BRGY. SAN MIGUEL, ILIGAN CITY

SCHOOL OF NURSING

CARE OF MOTHER, CHILD, AND ADOLSECENT – SECTION A

Related Learning Experience (Clinical: DR)
First Semester, AY 2021 – 2022

Name of Students: _____________________________________ Date: _______ Score: 40 pts

Case Scenario #11: Nursing Care of a Family with a Toddler

A TODDLER WITH DELAYED LANGUAGE DEVELOPMENT

Terri is a 2.5-year-old you see at a private pediatrician’s office for a health
maintenance visit.

CHIEF CONCERN:
“All she says is no, no, no. Shouldn’t she speak in sentences by now?”

HISTORY OF CHIEF CONCERN:

Terri’s mother states she feels her child’s development is behind typical milestones.
Terri says words clearly but frequently reverts to baby talk. The best sentence she
can accomplish is “me go.” Terri’s mother is presently pregnant with second child
and appears exhausted and grew impatient with Terri because she wouldn’t talk to
clinic personnel. Terri’s mother states she works in the chemical industry and is
concerned “chemicals affected Terri mentally during her pregnancy.” She is
concerned same thing will happen to baby from present pregnancy.

FAMILY PROFILE:
Terri’s mother has a PhD in Chemistry and works as a researcher in local chemical
plant; her father is personnel manager at same company. Finances are “no
problem.” Family lives in large home in suburbs of city; Terri has own room; she
has an adequate play space. She attends day care center from 7 AM to 5 PM daily.

HISTORY OF PAST ILLNESSES:

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Terri has had two episodes of bilateral otitis media: one at 4 months and one at 18
months. Both parents smoke and do not try to keep a “smoke-free” area for child.
She has had one episode of diarrhea at 12 months, required overnight
hospitalization. Routine health maintenance visits have been kept. Immunizations
are up to date.

PREGNANCY HISTORY:
Pregnancy was planned following 4 years of an infertility workup. Terri’s mother
was treated with medication and surgery for endometriosis and is currently
pregnant again as she was told to have a second child close to first before
endometriosis returned.
Prenatal care was begun at 2 months. Terri was a vaginal birth attended by a
nurse-midwife; she has no complications known; she breathed spontaneously.
Apgar scores are 9 and 9. Both Terri and her mother were discharged from the
birthing center 12 hours postbirth.

FAMILY MEDICAL HISTORY:

An uncle of child’s father has sickle-cell anemia. Both parents are negative for trait
and disease. The maternal grandfather has lung cancer.

DAY HISTORY:
Nutrition: Terri sits at family table for meals and is a “picky eater,” but overall
intake is good.
Sleep: Sleeps 8 hours at night; 1 hour nap at day care
Recreation: Plays with toy telephone and pulls a toy spider on wheels; takes teddy
bear with her for bed and nap
Growth and development: 2 months: social smile; 4 months: rolled over; 6
months: first word (da-da); 7 months: sat alone; 14 months: walked
steadily.

REVIEW OF SYSTEMS:
Genitourinary: Toilet training not started as yet.

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PHYSICAL EXAMINATION:
Height: 34 in. (55%); Weight: 25 lb (50%); HC: 19.0 in. (50%); BMI: 16.1
General appearance: Alert-appearing, black, well-proportioned 2-year-old
Head: Normocephalic; both fontanelles closed
Eyes: PERRLA; red reflex present
Ears: Normal alignment; TMs; pink with cone of light present; moderate amount of
cerumen in left canal; drum not obstructed. The child turns toward whispered
word; hearing comparable to examiner’s.
Nose: Nares patent; midline septum; no rhinitis
Mouth and throat: Palate intact; 20 teeth present; no cavities; gag reflex active
Neck: Supple; no palpable lymph nodes; midline trachea
Chest: No adventitious sounds on auscultation; respiratory rate: 22 breaths/min
Heart: Rate: 110 beats/min; no murmurs
Abdomen: Bowel sounds present in all four quadrants; liver palpable 1 cm under
right lower costal margin; spleen not palpable
Genitalia: Normal female
Neuromuscular: Patellar reflex 2+; fine motor: picks up raisin with pincer grasp;
gross motor: walks with wide-spaced steps; language: not assessed; child
refused to repeat words for examiner

STUDY QUESTIONS:
1. According to Erikson, what is the primary developmental task during Terri’s
current state of development? (2 pts)
A. Develop a sense of initiative
B. Learn to relate to other children
C. Venture into the real world
D. Develop a sense of autonomy
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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2. In childproofing home for Terri, what is the most important action her mother
should consider?
A. Locking downstairs windows
B. Teaching Terri not to tease dogs
C. Putting medicine in a locked cupboard
D. Keeping Terri in a playpen while she cooks
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

3. When assessing Terri’s mouth, how many teeth would you expect her to have at
2.5 years old?
A. 6 deciduous and 12 permanent
B. All of her upper deciduous teeth
C. 16 deciduous and 2 permanent
D. 20 deciduous teeth
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

4. Terri’s mother asks if it is time to begin brushing Terri’s teeth. How should you
advise her?
A. Toothbrushing should start with the eruption of the first tooth.
B. Toothbrushing is dangerous because toddlers often aspirate toothpaste.
C. Toddlers tend to swallow toothpaste causing bowel obstruction.
D. Yes, but only if she uses a manual, not an electric toothbrush.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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5. Terri’s mother asks if her language is adequate. Again, what standard should you
assess her language development?
A. She should say two words plus “ma-ma” and “da-da.”
B. She should speak in two-word sentences.
C. She should be able to count out loud to 20.
D. She should say 20 nouns and 4 pronouns.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

6. Which of the following is the best example of a toddler two-word sentence?

a. “Mommy! Mommy!”
b. “Me go.”
c. “Car big.”
d. “Grandma Mary.”
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
7. Terri’s mother is also concerned because Terri does not share. How should you
advise her about this behavior?
A. Not sharing is normal behavior for a toddler-age child.
B. Terri may be experiencing some social isolation.
C. Terri is probably reacting to some family crisis.
D. Terri’s parents should ask themselves whether they role model sharing.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
8. Parents sometimes confuse not sharing with the typical toddler method of
playing. Toddler play is typically called:
A. Parallel play.
B. Peer play.
C. Adjacent play.
D. Permanent play.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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9. You are teaching Terri’s parents how to maximize her health through nutrition.
After the age of 2 years, parents should reduce the total fat intake of children to
what percentage of total calories?
A. 10% of total calories
B. 30% of total calories
C. 60% of total calories
D. 75% of total calories
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
10. Terri’s mother tells you that Terri has a temper tantrum almost every night
after dinner because she wants dessert. How would you advise her to handle this?
A. Mimic a temper tantrum to show how one looks.
B. Put a teaspoonful of sugar or honey on her tongue.
C. Punish her by giving her “time out” for 15 minutes.
D. Tell her no one is listening to her and then ignore her.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
11. On two occasions, Terri has held her breath until she turns blue, faints, and
slumps to the floor when she doesn’t like a food. Which of the following would
assure you that this was a temper tantrum and not a seizure?
A. The episode occurred when Terri was provoked.
B. Terri slept following the episode and was difficult to rouse.
C. The episodes occurred when Terri was in public.
D. The episode occurred when Terri was eating.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
12. You notice on physical assessment that Terri walks with a wide-spaced gait. In
relation to this, you should do which of the following?
A. Ask if there is a cartoon character she is mimicking.
B. Alert her parents it is time to buy her bigger shoes.
C. Assess her hips because they may not be completely formed.
D. Assure her parents this is the typical gait of a toddler.

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Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
13. Following QSEN competencies, what immunization would you want your care
team to know that are usually administered if this were Terri’s 15-month well-child
visit?
A. Her first oral poliomyelitis injection
B. A bacterial meningitis vaccine
C. Measles, mumps, and rubella immunization
D. Her second pertussis immunization
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
14. Terri does not always eat as much as her mother thinks she should. What is a
type of food that would be healthy and that Terri might eat more readily?
A. Soft, “squishy” foods, which don’t need chewed
B. Foods she can pick up readily in her fingers
C. Fast foods such as French fries and onion rings
D. Casseroles that cleverly disguise vegetables
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

15. Terri’s mother has not begun toilet training as yet. Before beginning this task,
Terri’s mother should assess whether:
A. Terri has the cognitive capacity to understand what is being asked of her.
B. Terri has enough vocabulary to explain when she needs to void.
C. Terri’s motor development has progressed to where she can grasp small items.
D. Terri’s awareness of her comfort level makes her want to remain to be dry at
night.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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16. Terri often replies, “No! No! No!” to the most simple requests. A suggestion you
might make to her mother to enlarge her vocabulary would be:
A. Be certain Terri hears her parents talking.
B. Name items as she hands them to her.
C. Buy a toy telephone so she can talk on it.
D. Encourage Terri to look at the pictures in a book every day.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
17. A second suggestion to prevent Terri from saying no constantly would be for
her mother to:
A. Tell Terri when she says “no,” she hears “yes.”
B. Insist Terri not speak unless spoken to.
C. Never ask her questions that Terri has to answer.
D. Give Terri secondary, not primary, choices.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
18. Terri’s mother uses “time out” for punishment. An age-appropriate time-out
period should be:
A. 5 minutes of time per year of age.
B. 5 minutes for lying; 1 for anything else.
C. 1 minute of time per year of age.
D. 10 minutes for any infraction of rules.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
19. Terri insists on taking a teddy bear to bed with her and her mother wonders if
this fosters emotional dependence. What principle should guide your response?
A. Toys such as teddy bears can pose a safety threat.
B. Toddlers enjoy rituals as a way of feeling secure.
C. Favorite toys are often dirty, and they can be an infection risk.
D. Close attachment to a toy can stifle social interaction.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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20. If toddlers chew on the windowsills of old houses, they can develop:
A. Lead poisoning
B. Drug poisoning
C. Gasoline poisoning
D. Paint poisoning
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

Assessed by:

________________________
Name of Clinical Instructor