A nurse is assessing a 24-month-old toddler. Which of the following findings should the nurse report to the provider?

Eats a large amount of food one day then very little the next

Holds his breath when having a temper tantrum

Sleeps 11 to 12 hr per day

Has a vocabulary of 30 words

Answer and Explanation

The Correct Answer is B

A. Eating a large amount of food one day and very little the next is a normal eating pattern for toddlers. They may have days when they eat more and days when they eat less.

B. This finding should be reported to the provider. Breath-holding spells during temper tantrums can be concerning and may require further evaluation.

C. Toddlers typically need about 11-14 hours of sleep per day, so sleeping 11 to 12 hours is within the normal range.

D. A vocabulary of 30 words is considered normal for a 24-month-old toddler.

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Correct Answer is A

Explanation

A. In infants, the foot is a commonly used site for IV insertion due to the size of the veins and accessibility. However, it's important to ensure proper immobilization of the
extremity to prevent dislodgement.
B. A 24-gauge catheter may be too small for effective IV therapy in an infant. A larger gauge catheter is typically used for IV access in infants.

C. The IV site should be changed according to facility policy and based on assessment of the site. There is no specific guideline for changing the IV site every 3 days.
D. An opaque dressing is not typically used for IV insertion sites. A transparent dressing allows for continuous assessment of the site without removal.

A. Minimize movement of the limbs. B. Place the child in a prone position. C. Clear the area of hard objects. D. Insert a tongue blade between the teeth.

Correct Answer is C

Explanation

A. Minimizing movement of the limbs is not a recommended action during a seizure. It is important to allow the seizure to run its course while ensuring the safety of the child.

B. Placing the child in a prone position is not recommended during a seizure. The child should be placed in a lateral (side-lying) position to help prevent aspiration and maintain an open airway.

C. This is the correct action. Clearing the area of hard objects helps prevent injury to the child during the seizure. It is important to create a safe environment.

D. Inserting a tongue blade between the teeth is not recommended. This action can cause injury to the child's mouth or teeth. It is a myth that individuals can swallow their tongue during a seizure.

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A nurse is assessing a 24-month-old toddler. Which of the following findings should the nurse report to the provider?

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