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Peds EXAM 1 questions and answers
grade A+
In order to administer a medication safely to a pediatric client, what drug information must the nurse be aware of that is not always essential when administering a medication to an adult client? Indicators of drug toxicity. Recommended dose per kg of body weight. Incompatibilities with other medications. Commonly expected side effects. - Recommended dose per kg of body weight. The nurse recognizes the need to update knowledge related to the most common cause of hospitalization in children. On which body system should continuing education focus? Gastrointestinal. Respiratory. Cardiac. Musculoskeletal. - Respiratory. The nurse is planning educational interventions to reduce the incidence of the number one cause of mortality in children ages 1-4. Recognizing the developmental needs of this age group, the nurse would focus the session on which topic? Seizure disorder management. Sudden infant death syndrome (SIDS) recognition. Child abuse prevention. Unintentional injury awareness. - Unintentional injury awareness. A mother asks the pediatric nurse about what she should begin to feed her 6-month-old infant. The correct response is: Egg whites are the least allergenic food to be introduced into the baby's diet. Rice cereal is the first solid introduced that is least allergenic of the cereals. Formula is the only source of nutrition given for the first year. Fruits and vegetables are good sources of iron. - Rice cereal is the first solid introduced that is least allergenic of the cereals. Introduction of solid food is recommended at age 4 to 6 months, when the gastrointestinal system has matured sufficiently to handle complex nutrients. The suck reflex and tongue-thrust reflex diminish at 4 months of age. Rice cereal is the first solid food because it is a rich source of iron and rarely induces allergic reactions.
**Fruits and vegetables, good sources of vitamins and fiber, are introduced after cereal, one at a time to determine allergic reactions. Egg whites are highly allergenic. Birth weight doubles by which month? - 6 months Birth weight triples by? - End of 12 months (1st year) T/F Infants are unable to digest the large molecules of cow's milk. - True When are solids begun? - Solids are begun around age 6 months w/ pureed forms of food T/F Infants younger than age 6 months have little or no concept of differentiating family and caregiver from the general public. - True When does separation anxiety become an issue with infants? - Separation anxiety becomes an issue around age 6 months when the infant Which of the following milestones are specific to the toddler stage of development? --Walks alone, climb stairs --Explores environment, no understanding of danger --Language development; no, dada, mama --Engages in parallel play --Less protest at naptime, but dislikes bedtime - --Walks alone; climbs stairs --Language development: no dada/mama --Engages in parallel play --Issues with bedtime tend to arise in the preschool phase of development. When should infants sit in tripod position? - -By 6 months When should head be steadily supported when sitting and can raise head & chest when prone? - -By 4 months When should the infant be able to roll over in both directions and transfer objects from hand to hand? - -By 6 months (ATI)- -at 4 months should roll from BACK to SIDE -at 5 months rolls from FRONT to BACK -at 6 months BACK to FRONT What type of family is one where parents have terminated spousal roles but continue their parenting roles? - -Binuclear family When does the infant's posterior fontanel close? - 2-3 months of age
Varied degree of consistency to table food; can feed self, prefers finger foods Has acquired food taste and preferences By the end of this period, has some primary teeth Growth is slower than during infancy Quadruples birth weight by age 2 Less appetite than infants Development (12 to 15 months): Begins walking with help, gait unsteady, progresses to climbing and running Increased mobility Language development: no, dada, mama 16 to 36 months: Walks alone, climbs stairs, picks up objects from floor by stooping Begins to ride a tricycle Runs, jumps Feeds self, uses eating utensils Developmental Stage: Preschool-Age - MNL says 3-5 years Preschool Age Play - Associative play Plays in groups Rules may or may not be defined Preschool Age Children Nutrition - Develops strong preferences Prefers to eat the same food at each meal Can feed self Growth slows By the end of this period, has all primary teeth Preschool Age Development - Climbs stairs, jumps, and runs with increasing skill Increased mobility Language development: Egocentric, knows colors Is developing socialization skills, differentiates gender of peers and/or siblings Less protest related to naptime but dislikes bedtime Magical thinking Prefers routine When does growth plateau? - School age 6-12 yrs Stranger anxiety starts at what age? - -6 months For which age group could the nurse use play as an effective means of communicating?
- Younger school-age children
Infants communicate non-verbally Older school-age children may communicate their feelings about surgery or treatment through - -Through journaling or direct conversation How should the nurse communicate with toddlers? - Toddlers respond well to clear, concise verbal messages. A 4-year-old scores two failures on the Denver II. Which of the following statements is most accurate? -The child is not as intelligent as expected for age and should be referred to a learning specialist. -The child has a speech problem and should be referred to a speech therapist. -The child is at risk for school problems and should be retested. -The failures are to be expected in preschoolers who may not be cooperative with testing. - The child is at risk for school problems and should be retested. A teenager refuses to wear the clothes his mother bought for him. He states he wants to look like the other kids at school and wear clothes like they wear. The nurse explains this behavior is an example of teenage rebellion related to internal conflicts of: -Autonomy vs. shame and doubt. -Trust vs. mistrust. -Identity vs. role confusion. -Initiative vs. inferiority. - -Identity vs. role confusion. A mother of a 4-year-old tells the nurse that her son is a "picky eater." The nurse should inform the mother that she should: Increase the amount of carbohydrates in the daily menu plan. -Administer vitamins twice a day to her child. -Be more concerned with the quantity of food than the quality of food. -Recognize this is common for preschoolers as their caloric requirements have decreased slightly. - -Recognize this is common for preschoolers as their caloric requirements have decreased slightly. -The preschooler will be influenced by others' eating habits and demonstrate their likes and dislikes for food preferences. The caloric requirement decreases slightly, to 90 kcal/kg/day. Quality, not quantity, is important. It is not necessary to give vitamins after infancy unless the child is at nutritional risk. Indicators of hearing loss in an infant: - -No startle reaction to loud noises -Does not turn towards sounds by 4 months of age -Babbles as a young infant, but stops babbling and does not develop speech sounds after 6 months of age Indicators of hearing loss in a young child: - -No speech by 2 years of age -Speech sounds are not distinct at appropriate ages
When do permanent teeth begin to erupt? - Permanent teeth begin to erupt about he age of 6 as deciduous teeth fall out Screening for strabismus (crossed eyes) and amblyopia (reduced vision in one or both eyes) should be part of the physical assessment of which children? -All children under 18. -Infants. -Preschool children. -School-age children. - Pre-school children Rationale: Strabismus is detected with the cover-uncover test that can first be reliably administered to children over the age of 2. It is important to detect the problem early to prevent amblyopia. By school age, vision loss would have occurred. In infants, a positive Babinski reflex is: An indication of a neurological problem. Dorsiflexion of the toes. Fanning of the toes. Withdrawing the foot from the stimulus. - Fanning of the toes. Rationale: A positive Babinski in infants is a fanning of the toes when a stimulus is applied to the foot along the lateral edge and across the ball. The response disappears by about age 2. When assessing a child for strabismus, the nurse should select which of the following eye tests? The Snellen eye chart. The cover-uncover test. An ophthalmoscope exam. The convergence test. - The cover-uncover test Rationale: The cover-uncover test assesses coordination of eye muscle movement. In strabismus, one muscle is weaker and the eye wanders rather than focusing forward. Undetected and untreated strabismus can lead to amblyopia. When assessing a 4-year-old child with a persistent cough, the nurse would assess respirations by observing which muscle group? Thoracic. Abdomina l. Accessory . Intercostal. - Abdominal Rationale: Infants and young children use the diaphragm and abdominal muscles for respiration, so the nurse would watch the rise and fall of the abdomen to
count respirations. Use of accessory or intercostal muscles may be observed in respiratory distress.
hematocrit in children. To assess a child's gait, the nurse should: Perform Barlow's maneuver.
Ask the child to stretch out the legs as far as possible. Ask the parent if the child has any problems ambulating. Observe the child moving about the examining room. - Observe the child moving about the examining room. Rationale: The easiest way for a nurse to observe a child's gait is to unobtrusively observe the child move about the examining room. If that is not possible, the nurse can ask the child to walk across the room at the conclusion of the physical assessment. Barlow's maneuver is performed to assess for congenital hip dislocation in infants. When examining the child, the nurse should remember that tonsillar tissue: Enlarges until adolescence and then shrinks. Continues to enlarge throughout childhood and adolescence. Is readily visible in toddlers. Normally has a small amount of exudate. - Enlarges until adolescence and then shrinks. Rationale: Tonsils enlarge throughout childhood and gradually begin to shrink with puberty. Exudate should not be present on tonsils. Which of the following should be included in the child's health history? Blood pressure 80/40. Mother states child has a rash. Child appears feverish. Diminished reflexes. - Mother states child has a rash. Rationale: The history deals with subjective data, that which is reported by parents, for example. Other data listed is objective data. An example of objective information about a child obtained by the nurse is: Allergy to peanuts. Uses inhaler once a day for asthma. Two-inch scar on right lower leg. Appendectomy 6 months ago. - Two-inch scar on right lower leg. Rationale: Objective data is that which the nurse obtains through physical assessment or diagnostic studies. The presence of a scar is objective data. Other selections listed are part of the health history and therefore are subjective data. When observing an 18-month-old child, the nurse notes a rounded belly, sway back, bowlegs, and slightly large head. The nursing conclusion is that: The child appears to be a normal toddler. The child is likely developmentally delayed. The child may be malnourished, especially with respect to calcium.
Rationale: The typical toddler has lordosis and a protruding belly. The head still appears somewhat large in proportion to the rest of the body. Because these are normal findings, there is no need to be concerned about developmental delays, malnutrition, or neurological problems. Regardless of the child's age, which assessment technique is always used first? Palpation. Percussion. Auscultation. Inspection. - Inspection A pediatric healthcare nurse visit should include: -Family-centered care and partnership for primary care provision. -Different nurses for each visit to gather different perspectives. -Instruction on how to raise children according to U.S. norms. -Brief record keeping to prevent other staff from accessing the information. - -Family- centered care and partnership for primary care provision. Rationale: Pediatric home healthcare visits by the nurse should be family-centered, a trusting relationship, provision of unbiased information, primary care of acute and chronic conditions, continuously available care with nurse continuity, referrals as needed with care coordination, maintenance of comprehensive records, and provided in a culturally appropriate manner. While interviewing the parents of a 2-year-old female, the nurse notes the mother is pregnant. At the end of the visit, the nurse decides to give a new pamphlet to the parents about car seat usage for newborns. This action is an example of: Developmental screening. Primary preventative health maintenance. Tertiary preventative health maintenance. Secondary preventative health maintenance. - Primary Preventative Health Maintenance Rationale: The teaching regarding proper car seat use is an example of an activity that might decrease the opportunity for injury in a newborn. The tertiary level of preventative care is related to restoring a level of functioning that is below an expected level, such as in a rehabilitation situation. This is education, and not a developmental screening to elicit data. -The secondary level of prevention is focused on diagnosis of a problem, usually medical in nature, in order to address it and make a plan of care. During a health supervision visit, the nurse is attempting to develop a partnering relationship with the child and family. Initially, the nurse should: -Discuss with the family a plan to address the child's health needs.
-Set goals for the family related to the child's health. -Tell the family what the child should be doing physically for the age level. -Tell the family that the physician will answer any questions they might have related to their child's growth and development. - -Discuss with the family a plan to address the child's health needs. Rationale: Discussing and developing a plan with the family will actively involve the family members and will build more trust, as they are not just being told what to do. The nurse should not set the goals without family involvement. Not all children develop each skill at the same age. While waiting for a physical exam from the physician, the mother of a 4- month-old female begins changing a soiled diaper. The nurse notes a reddened diaper area on the baby. Which of the following interventions would be most appropriate in this situation? Say nothing, as the mother appears comfortable with diaper care. Ask the mother what care she provides to the diaper area during routine diaper changes. Report the red area to the physician. Give the mother a pamphlet on diaper rashes as she leaves the office. - Ask the mother what care she provides to the diaper area during routine diaper changes. Rationale: Discussing the care the mother generally provides opens up the opportunity for the nurse to ask detailed assessment questions about the red area and to provide information on a health maintenance activity for the infant. As part of the assessment process, the pediatric nurse often utilizes a standardized tool for a developmental screening. Which nursing action is appropriate related to the use of a developmental screening tool? -Practice administering the screening tool. -Have the parent administer the screening tool. -Select the tool the nurse is most comfortable using. -Administer the part of the tool that will assess the child's problem area first.
- -Practice administering the screening tool. Rationale: The nurse must feel comfortable administering the tool as it is directed to be used. There are certain tools that should be used depending upon the child's age and what information is being sought. It is not the parent's role to administer the tool, although they may answer questions during the use of the tools. A 6-month-old infant is in for a well baby check-up. Which of the following is an unexpected finding? -There is no head lag when pulled to a sitting position. -The baby vocalizes through babbling "baba baba". -The baby passes a rattle from one hand to the other. -No interest is shown in surroundings or in toys present. - -No interest is shown in surroundings or in toys present.
The parents of a jaundiced newborn want to know why this happened. How should the nurse address their concerns? -Inform the parents that breastfeeding caused the jaundice. -Tell the parents that a blood incompatibility caused the jaundice. -Explain that infants born at 35 weeks have immature livers. -Reassure the parents that jaundice does not lead to permanent problems. - -Explain that infants born at 35 weeks have immature livers. Rationale: Jaundice in the newborn is a common occurrence, especially in infants born at 35 weeks or less, due to liver immaturity. Breastfeeding jaundice is rare, and occurs after lactation is established. Blood incompatibilities like Rh factor can create hemolysis, and resulting in jaundice occurring within 24 hours of birth. *Kernicterus is permanent neurologic damage caused by excessive bilirubin levels, and is mostly preventable through prompt treatment of jaundice. The mother of a newborn is attempting to breastfeed. Which statement on breastfeeding should the nurse include? -"Breastfed babies will experience more ear infections." -"Babies who nurse have lower likelihood of SIDS." -"Diabetes is more common in breast fed babies." -"Respiratory tract infections are more common in nursed babies." - -"Babies who nurse have lower likelihood of SIDS." Rationale: Breastfeeding has many advantages, including the decreased incidence of common infections (otitis media, respiratory tract infections, and meningitis.) Allergies, diarrhea, and vomiting are also less common. Nursing also provides protection from SIDS, diabetes, asthma, and obesity The nutrition teaching that is appropriate to give the family of a 2- month-old includes: -Food safety for partially used bottles of formula or breast milk. -Introducing solids such as vegetables to the infant soon. -Instruction on how to teach the infant to use a cup to drink from. -Feedings should be focused on nutrition rather than social interactions. - Food safety for partially used bottles of formula or breast milk. Rationale: Nutrition teaching for a 2-month-old should support continued nursing, food safety for partially used bottles, avoidance of honey, and the need for supplements as appropriate. Feedings should continue to be viewed as social interactions to facilitate attachment. A cup is usually introduced at 6 months, as are solid foods. Which of the following infants should receive a nutritional supplement? A baby whose:
-Family has well water. -Mother is anemic. -Brother has cystic fibrosis. -Grandmother has diabetes. - -Family has well water. Rationale: Well water lacks fluoride, which should be given as a supplement for healthy teeth development. An anemic mother should receive iron supplements, but not the infant. No supplements are required for family history of either cystic fibrosis or diabetes. The nurse understands that stranger anxiety in an infant is: -An abnormal developmental stage. -A sign of attachment to parents. -Crying when mother leaves the room. -An indication of mental illness. - A sign of attachment to parents. Rationale: Stranger anxiety is a normal and common development that occurs at about 6 months of age, characterized by crying when another person holds them. Crying when the parent leaves is separation anxiety. The parents of a newborn are requesting information on car seats. Which statement should the nurse include? -"Infants should always be placed in rear- facing car seats." -"Car seats are easily installed and checked for placement." -"Short trips in the car don't require the full car seat straps." -"Harness straps should be above shoulder level on your child." - -"Infants should always be placed in rear- facing car seats." Rationale: -Infants should always be in rear-facing car seats, placed in the back seat, and used every time the infant is in the car. Harness straps should be at or below shoulder level. Installation can be tricky, and should be assessed at an examiner station for correct placement. In providing her 8-month-old child's medical history, the mother states the child has received one MMR vaccine. The nurse taking the history should: -Ask the mother if the child has received the MMR booster. -Plan to administer the MMR booster. -Explain that one MMR vaccine is all that is required. -Plan to administer another MMR vaccine after the child is 1-year-old. - Plan to administer another MMR vaccine after the child is 1-year-old. Rationale: This mother may have been mistaken about the vaccine. Maternal antibodies interfere with the vaccine when it is given before 12 months of age. Even if the child has had the vaccine, it will need to be repeated. The first measles-mumps-rubella (MMR) should be
-Displaying a change of color, decreased temperature. -Demonstrating shortness of breath, lack of responsiveness. -Sleeping more, refusing to eat. - Crying loudly, grimacing, restlessness. Rationale: A child's response to pain depends on his or her developmental stage. The infant is unable to describe or quantify pain because of limited vocabulary. Infant behaviors, such as crying, facial expressions, and change of activity are used to identify pain and distress. What nursing role is exhibited?: -Nurses help children adapt to the hospital setting and prepare them for procedures - Educator What nursing role is being exhibited? -Nurse assesses the child, IDs the health concerns, and lists the nursing diagnoses describing the responses of the child and family to those health concerns in the nursing care plan - Direct Care What nursing role is being exhibited? The nurse must be aware of the needs of the child and family, the family's resources, and the health care services available in the community → can then assist the family and child to make informed choices about these services and to act in the child's best interest - Client advocacy Which nursing role is being exhibited? A process of coordinating the delivery of health care services in a manner that focuses on both quality and cost outcomes -Often a collaborative practice with other health care providers that promotes continuity of care -Discharge planning - Case Management The common causes of child mortality and reasons for hospitalization in infants - Leading cause of mortality: unintentional injury (suffocation), congential malformations, short gestation/LBW, and SIDS Leading cause for hospitalization in infants: Respiratory disorders The common causes of child mortality and reasons for hospitalization in toddlers - Leading cause of death: unintentional injury/Motor Vehicle Accidents Leading cause for hospitalization: respiratory disorders The common causes of child mortality and reasons for hospitalization in preschoolers - Leading cause of death: unintentional injury/Motor Vehicle Accidents Leading cause for hospitalization: respiratory disorders
The common causes of child mortality and reasons for hospitalization in children 10-14 - Leading cause of death: unintentional injury/Motor Vehicle accidents Leading cause for hospitalization: dz of digestive system The common causes of child mortality and reasons for hospitalization in adolescence - Leading cause of death: unintentional injuries/motor vehicle accidents Leading cause for hospitalizations: mental disorders Mature Minors - Adolescents btwn 14-18 years able to understand treatment risks: -may give independent consent to receive or refuse treatment for limited conditions, such as testing and treating sexually transmitted infections, family planning, drug and slcohol abuse, blood donation, and mental health care The Child Abuse and Treatment Act of 1984, also known as the Baby Doe Regulations: - Defines withholding of medically indicated treatment as child abuse, except when care is futile Believe that early childhood experiences form the unconscious motivation for actions in later life. -developed a theory that sexual energy is centered in specific parts of the body at certain ages. -Unresolved conflict and unmet needs at a certain stage lead to a fixation of development at that stage - Freud's theory of psychosexual development Freud: Personality: Structure: 3 parts - Personality has a structure with 3 basic parts: -id→basic sexual energy that is present at birth and drives the individual to seek pleasure -ego→the realistic part of the person, which develops during infancy and searches for acceptable methods of meeting impulses -superego→ the moral and ethical system, which develops in childhood and contains a set of values and conscience Freud's first stage: - -Oral (Birth to 1 Year)→The infant derives pleasure largely from the mouth, with sucking and eating as primary desires. -Nursing application→When a baby is NPO, offer a pacifier if not contraindicated. Alter painful procedures, offer a baby a bottle or pacifier or have the mother breastfeed. Freud's 2nd stage: - -Anal (1 to 3 Years)→ The young child's pleasure is centered in the anal area with control over body secretions as a prime force in behavior -Nursing Application→Ask about toilet training and the child's rituals and
