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Peds Final exam study cram guide, Study notes of Nursing

Nova Southeastern University (NSU)Nursing

Peds Final exam study cram guide

Typology: Study notes

2024/2025

Uploaded on 04/30/2026

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Pediatrics Final Exam Cram Guide
Condensed, corrected, and tailored to your professor review sheet
Use this as a fast final-pass guide. It keeps the big clues, corrections, diagnosis, treatment, nursing
priorities, and memory tricks most likely to show up on a 40-question final.
1) High-Yield Foundations
Pain scales
Infant/newborn: CRIES or NIPS.
2 months to 7 years or nonverbal child: FLACC.
Preschooler/late toddler: FACES.
Older child/adolescent: numeric 0–10 scale.
Infants do feel pain.
No crying does not mean no pain.
Nonpharmacologic pain relief
Distraction, sucking for infants, guided imagery for older child, positioning, elevation of injured
extremity, relaxation, massage, heat/cold when appropriate.
Atraumatic care / communication
Keep parent and child together when possible.
Use simple truthful language.
Give limited choices when appropriate.
Assess least intrusive to most intrusive.
Count respirations first before the child cries.
Use play, child life, and distraction to reduce fear and pain.
Development quick ladder
Gross motor before fine motor.
Head control around 4 months.
Rolls 4–6 months.
Sits around 6 months.
Cruises / pulls to stand 9–12 months.
Walks around 12 months.
Concerning if not walking by about 18 months.
Birth weight doubles by 6 months, triples by 1 year.
Posterior fontanel closes around 2 months; anterior around 18 months.
Infant feeding basics
Start solids around 4–6 months.
Start slowly; rice cereal is a classic starting point in class notes.
Wait a few days between new foods.
No honey under 1 year.
Ibuprofen is 6 months and older.
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Download Peds Final exam study cram guide and more Study notes Nursing in PDF only on Docsity!

Pediatrics Final Exam Cram Guide

Condensed, corrected, and tailored to your professor review sheet

Use this as a fast final-pass guide. It keeps the big clues, corrections, diagnosis, treatment, nursing

priorities, and memory tricks most likely to show up on a 40-question final.

1) High-Yield Foundations

Pain scales

 Infant/newborn: CRIES or NIPS.

 2 months to 7 years or nonverbal child: FLACC.

 Preschooler/late toddler: FACES.

 Older child/adolescent: numeric 0–10 scale.

 Infants do feel pain.

 No crying does not mean no pain.

Nonpharmacologic pain relief

 Distraction, sucking for infants, guided imagery for older child, positioning, elevation of injured

extremity, relaxation, massage, heat/cold when appropriate. Atraumatic care / communication

 Keep parent and child together when possible.

 Use simple truthful language.

 Give limited choices when appropriate.

 Assess least intrusive to most intrusive.

 Count respirations first before the child cries.

 Use play, child life, and distraction to reduce fear and pain.

Development quick ladder

 Gross motor before fine motor.

 Head control around 4 months.

 Rolls 4–6 months.

 Sits around 6 months.

 Cruises / pulls to stand 9–12 months.

 Walks around 12 months.

 Concerning if not walking by about 18 months.

 Birth weight doubles by 6 months, triples by 1 year.

 Posterior fontanel closes around 2 months; anterior around 18 months.

Infant feeding basics

 Start solids around 4–6 months.

 Start slowly; rice cereal is a classic starting point in class notes.

 Wait a few days between new foods.

 No honey under 1 year.

 Ibuprofen is 6 months and older.

2) Abuse, Development, and Neurobehavioral Topics Child abuse

 Red flags: story does not match injury, wounds/burns in different stages of healing, injuries not

developmentally appropriate, delay seeking care, unusual family dynamics.

 Forms: physical, sexual, emotional, neglect.

 Neglect is commonly tested as the most common form.

 Mandatory reporting if abuse is suspected.

 Do not wait to prove abuse before reporting.

ASD vs ADHD vs Intellectual Disability

 ASD: poor eye contact, poor joint attention, ritualistic behaviors, delayed or regressed

social/communication skills, limited imaginative play.

 ADHD: inattention, impulsivity, distractibility, hyperactivity. Types: inattentive, hyperactive-

impulsive, combined.

 Intellectual disability: deficits in adaptive skills plus cognitive limitation; may see delays in language,

feeding, motor skills, and social responsiveness.

 ASD screens often tested: ASQ-3 and M-CHAT-R.

Toddler psychosocial point

 Erikson: autonomy vs shame and doubt.

 Use controlled choices: “red shoes or blue shoes?” not “do whatever you want.”

3) Neuro Review Seizures

 Tonic-clonic: LOC, apnea/cyanosis, possible bladder loss, tongue bite, postictal phase, no memory

afterward.

 Absence: blank stare, abrupt start/stop, less than 30 seconds, may happen many times daily, no

postictal state.

 Focal retained consciousness: child stays aware; symptoms depend on area of brain affected.

 Focal impaired consciousness: automatisms like lip smacking, chewing, picking at clothes.

Seizure precautions

 Priority: safety and airway.

 Side-lying position.

 Protect head; move objects away.

 Time the seizure.

 Nothing in the mouth; do not force jaw open.

 Benzodiazepines are common fast-acting rescue meds (often nasal or rectal depending on order).

 Status epilepticus = seizure over 5 minutes or repeated seizures without recovery; emergency.

Hydrocephalus and VP shunt

 Infant clues: enlarging head circumference, bulging fontanel, sunset eyes, vomiting, irritability, high-

pitched cry.

 Older child clues: headache, vomiting, change in LOC, personality change, ataxia, visual changes.

 VP shunt drains CSF from ventricle to peritoneum.

 Assess neuro status, head circumference, fontanel, signs of shunt infection or malfunction.

 Common complications: infection early, malfunction later.

Meningitis

 Treat as bacterial until ruled out.

 Supportive care plus antimicrobial therapy if bacterial.

Asthma

 Patho: bronchospasm, bronchoconstriction, airway inflammation, mucus production.

 Rescue med: albuterol.

 Controller/preventive med: corticosteroids.

 Rinse mouth after inhaled steroids to prevent thrush.

 Peak flow: blow hard/fast 3 times; record highest number.

 Common triggers: exercise, allergens, animals, environment, infections.

 Frequent need for albuterol means poor control.

Infectious disease clues

 Scarlet fever: strep infection, strawberry tongue, sandpaper rash.

 Pertussis: whooping cough.

 Diphtheria: pseudomembrane.

 Measles: Koplik spots, rash starts at head and moves down.

 Botulism: floppy infant, constipation, raw honey risk under age 1.

5) GI / GU Review Cleft lip / cleft palate

 Concerns: feeding, aspiration, speech, otitis media, dentition.

 Use special bottles/nipples or feeders.

 Cleft lip repaired around 2–3 months; cleft palate around 6–9 months.

Celiac disease

 Immune-mediated gluten intolerance that damages small intestine.

 Symptoms: diarrhea, cramping, distention, poor growth, small frame, nutrient malabsorption,

steatorrhea, anemia.

 Lifelong gluten-free diet.

 Avoid wheat, barley, rye; class mnemonic often includes oats too. Use corn and rice.

 Memory clue: No BROW.

Pyloric stenosis vs GER

 Pyloric stenosis: projectile nonbilious vomiting, olive-shaped mass, dehydration, hungry after

vomiting, young infant, often boys. Treatment: pyloromyotomy.

 GER: passive regurgitation/spit-up, gagging/choking after feeds, aspiration risk, FTT. Manage with

positioning, thickened feeds, meds, sometimes fundoplication. Intussusception

 Telescoping bowel.

 Classic clue: sudden colicky pain and currant jelly stool.

 Can often be reduced with air or barium enema.

Appendicitis

 Guarding, rebound tenderness, fever, nausea/vomiting, psoas sign.

 Most common cause of emergency abdominal surgery in children.

Hirschsprung disease

 Aganglionic megacolon: no ganglion cells, so no peristalsis in part of bowel.

 Common clue: failure to pass meconium in first day of life, constipation, abdominal distention.

 May be seen more in Down syndrome.

 Definitive diagnosis: rectal biopsy.

 Treatment: surgery to remove bad bowel segment; temporary colostomy may be used.

Pinworms

 Nighttime anal itching is the classic clue.

 Tape test first thing in the morning before bath or bowel movement.

Hypospadias vs Epispadias

 Hypospadias: urethral opening under/ventral side of penis.

 Epispadias: urethral opening over/dorsal side.

 Do not circumcise if hypospadias is present; foreskin may be needed for repair.

Cryptorchidism

 Undescended testes.

 If still undescended by about 1 year, surgery (orchiopexy) is indicated.

Vesicoureteral reflux (VUR)

 Urine refluxes from bladder back toward ureters/kidneys.

 Think recurrent UTIs, fever, dysuria, flank/back pain.

 Classic test: VCUG.

Testicular torsion

 Sudden testicular pain = emergency surgery.

 Do not wait around on this question.

6) Cardiac Review Congenital heart defect patterns

 Acyanotic left-to-right shunts (ASD, VSD, PDA): not blue at first; more CHF-type findings.

 Cyanotic defects (especially TOF): low oxygen saturation, blue spells/tet spells.

 Common cardiac clues: poor feeding, sweating with feeds, tachypnea, crackles, poor weight gain,

fluid retention. Defect clues

 ASD: split S2.

 VSD: loud harsh murmur.

 PDA: machinery murmur + bounding pulses.

 TOF: cyanotic, tet spells, knee-to-chest helps.

 COA: higher BP/pulses in arms than legs.

Heart failure treatment

 Diuretics, ACE inhibitors, BP support, surgery depending on defect.

 Best growth/fluid clue: daily weight.

Kawasaki disease

 Acute vasculitis. Biggest feared complication: coronary artery aneurysm.

 Classic clue set: fever at least 5 days, strawberry tongue, red eyes without pus, red hands/feet,

rash, irritability, later peeling of fingers/toes.

 Treatment: IVIG + aspirin + comfort care + cardiac follow-up.

Rheumatic fever

 Follows strep infection.

 Think joints, carditis, chorea, fever.

 Different from Kawasaki even though both can have fever and inflammation.

Wilms tumor

 Kidney tumor with abdominal mass and hypertension.

 Do not palpate the abdomen.

9) Musculoskeletal Review Duchenne muscular dystrophy (DMD)

 X-linked recessive, usually boys.

 Onset around 3–5 years.

 Progressive muscle weakness, proximal muscles first.

 Gower sign is classic.

 Pseudohypertrophy can happen because muscle is replaced by fat/connective tissue.

 Diagnosis: dystrophin gene testing, elevated CK, muscle biopsy.

 No cure; supportive management, ROM, breathing exercises, prevent obesity.

Clubfoot

 Fixed twisted foot; treat early with serial casting.

 Best correction begins in newborn period.

DDH / Pavlik harness

 Think hip, not foot.

 Clues: asymmetrical gluteal/thigh folds, limited abduction, positive Ortolani/Barlow.

 Pavlik harness is used in young infant to keep hips positioned correctly.

 Teaching: skin integrity, proper fit, do not randomly remove or adjust unless instructed.

Scoliosis

 Common in preadolescent/adolescent girls during growth spurt.

 Often painless; clues are asymmetry of shoulders, waist, scapula, or clothes hanging unevenly.

 Mild curves are monitored.

 Moderate curves may need brace; class slide says brace worn 23 hours/day.

 Severe curves may need surgery.

 Post-op spinal fusion priorities: log roll, neuro checks, deep breathing, pain control, monitor bowel

sounds/ileus, monitor H&H. Fractures

 Classic clues: pain, swelling, tenderness, deformity, inability to use/walk, crepitus.

 Nursing care: cold first 24 hours, elevate cast above heart first 24–48 hours, frequent neurovascular

checks, pain control, tetanus/antibiotics for open fracture. 10) Pediatric Vital Signs

 Trend rule: HR and RR go down with age; BP goes up with age.

 Newborn: HR 110–160, RR 30–60, BP about 60–80/40–50.

 Infant: HR 100–160, RR 30–50, BP about 70–100/50–65.

 Toddler: HR 90–150, RR 24–40, BP about 80–110/50–80.

 Preschool: HR 80–140, RR 22–34, BP about 80–110/50–80.

 School-age: HR 70–120, RR 18–30, BP about 90–120/60–80.

 Adolescent: HR 60–100, RR 12–20, BP about 100–130/65–85.

 Normal temperature is roughly 97.7–99.5°F (36.5–37.5°C); fever is commonly 100.4°F / 38°C or

higher.

11) Ultra-Fast “Do Not Miss These” Clues

 Child abuse: story does not fit injury; mandatory report.

 Bacterial conjunctivitis = purulent drainage.

 Asthma rescue = albuterol; controller = corticosteroid.

 Celiac = no BROW.

 Pyloric stenosis = projectile nonbilious vomiting.

 Intussusception = currant jelly stool.

 Hirschsprung = no meconium; rectal biopsy confirms.

 Hypospadias = do not circumcise.

 Kawasaki = 5 days fever + strawberry tongue + IVIG + aspirin.

 DKA = fruity breath + Kussmaul + ketones + fluids then insulin.

 Acute glomerulonephritis = post-strep tea urine + HTN.

 Nephrotic = puffy with proteinuria and hyperlipidemia.

 Leukemia = low RBC, low platelets, high immature WBCs.

 VP shunt = watch for infection or malfunction.

 Seizure = side-lying, time it, nothing in mouth.

 Meningitis = droplet, LP, antibiotics fast.

 DMD = Gower sign.

 DDH = Pavlik harness.

 Scoliosis brace = 23 hours/day.

 Tonsillectomy = no red/brown fluids, no straws, frequent swallowing means bleeding.

 Testicular torsion = emergency surgery.

12) Final Cram Strategy for the Last 1.5 Days

 First pass: read the ultra-fast clues and the comparison sections only.

 Second pass: focus on disorders with look-alike traps (DI vs SIADH, nephrotic vs AGN, pyloric

stenosis vs GER, croup vs epiglottitis, ASD vs VSD vs PDA vs TOF).

 Third pass: drill nursing priorities and safety rules because those are often what make the right

answer stand out.

 If a question feels close, ask: What is the immediate danger here—airway, bleeding, dehydration,

infection, increased ICP, or low oxygen?