NSG332 Exam 1 Peds Passpoint

After teaching a community class to new parents, the nurse evaluates client understanding of strategies to prevent sudden unexpected infant death (SUID). Which statement indicates appropriate understanding? "I will place my baby in a supine position for sleep during the first year." "I will use a baby monitor so I can hear if my baby stops breathing." "I will avoid feeding my baby cereal for the first 6 months." "I will keep my baby's crib at our bedside when we sleep."

"I will place my baby in a supine position for sleep during the first year." SUID has no specific cause but occurs most often in male infants who were low birth weight, were placed on their stomachs for sleep, and had maternal parents who used tobacco or alcohol. White infants have a lower risk than infants of color. SUID can occur anytime between ages 1 week and 1 year. The incidence peaks at ages 2-4 months.

A first-time parent is concerned that their 6-month-old infant is not gaining enough weight. What should the nurse tell the parent? "Birth weight doubles by 6 months of age." "Using a body mass index (BMI) for age growth chart is the best way to assess proper weight gain." "The baby will eat what they need." "You need to make sure the baby finishes each bottle."

A general growth parameter is that the birth weight doubles in 6 months and triples in a year. A child must be at least 2 years of age before they can be assessed with a BMI for age growth chart. Telling the parent that the baby will eat what they need is not appropriate. The nurse needs to investigate whether the baby's weight is within the normal parameters of infant weight gain. A bottle-fed baby should not be forced to complete the bottle because this may contribute to obesity.

A 4-year-old child is admitted to the hospital for surgery. The nurse applies interventions to address what major stressor for a child of this age? separation from family fear of bodily injury loss of control fear of pain

For infants through preschoolers, separation from the family is the major stressor posed by hospitalization. To minimize the effects of separation, the nurse may suggest that a family member stay with the child as much as possible. Reducing this stressor may help a young child withstand other possible stressors of hospitalization, such as fear of bodily injury, loss of control, and fear of pain.

An 18-month-old child is admitted to the pediatric unit. Which of the following can the nurse do to reduce the stress on the client during this hospitalization? Encourage the client's caregivers to be with the client as much as possible Minimize needle sticks to the client Allow the child to explore the environment Encourage play times with other children on the unit

For infants through preschoolers, separation from the family is the major stressor posed by hospitalization. To minimize the effects of separation, the nurse may suggest that a family member stay with the child as much as possible. Reducing this stressor may help a young child withstand other possible stressors of hospitalization, such as fear of bodily injury, loss of control, and fear of pain. Allowing the child to explore their environment would not impact potential stressors, and at this age the child engages in parallel play; therefore, encouraging play times would not reduce stressors.

A 10-month-old child with recurrent otitis media is brought to the clinic for evaluation. What is most important for the nurse to ask the family about the baby's symptoms? "Does water ever get into the baby's ears during shampooing?" "Do you give the baby a bottle to take to bed?" "Have you noticed a lot of wax in the baby's ears?" "Can the baby combine two words when speaking?"

In a young child, the eustachian tube is relatively short, wide, and horizontal, promoting drainage of secretions from the nasopharynx into the middle ear. Therefore, asking if the child takes a bottle to bed is appropriate because drinking while lying down may cause fluids to pool in the pharyngeal cavity, increasing the risk of otitis media. Asking if the parent noticed earwax, or cerumen, in the external ear canal is incorrect because wax doesn't promote the development of otitis media. During shampooing, water may become trapped in the external ear canal by large amounts of cerumen, possibly causing otitis external (external ear inflammation) as opposed to internal ear inflammation. Asking if the infant can combine two words is incorrect because a 10-month-old child isn't expected to do so.

The nurse is evaluating an infant for auditory ability. What is the expected response in an infant with normal hearing? blinking and stopping body movements when sound is introduced evidence of shy and withdrawn behaviors saying "da-da" by age 5 months absence of squealing by age 4 months

In response to hearing a noise, normally hearing infants blink or startle and stop body movements. Shy and withdrawn behaviors are characteristic of older children with hearing impairment. Squealing occurs in 90% of infants by age 4 months. Most infants can say "da-da" by age 9 months.

Which nursing interventions are important when caring for a hospitalized toddler? Select all that apply. Provide thorough explanation to toddler prior to a procedure. Instruct parent that regression commonly occurs. Encourage use of a security object from home. Allow client autonomy by offering select choices. Maintain the toddler's routine when able. Discourage parents' participation in client care.

Instruct parent that regression commonly occurs. Encourage use of a security object from home. Allow client autonomy by offering select choices. Maintain the toddler's routine when able. Hospitalization is a stressful time for both the toddler and the parents. Important nursing interventions decrease the stress level. Toddler inventions include allowing security objects from home, maintaining the usual routine and providing autonomy by allowing select, or appropriate choices. Parental interventions include instruction on common regression behavior and allowing participation in the toddler's care. Brief, age appropriate explanations to a toddler immediately prior to a procedure are best.

The nurse creates a teaching plan for parents on how to reduce the risk for sudden unexpected infant death (SUID). What measure(s) should the nurse include in the teaching plan? Select all that apply. Maintain a smoke-free environment. Use a wedge for side-lying positions. Breastfeed/chestfeed the baby. Place the baby on their back to sleep. Use bumper pads over the bed rails. Have the baby sleep in the parents' bed.

Maintain a smoke-free environment. Breastfeed/chestfeed the baby. Place the baby on their back to sleep. Exposure to environmental tobacco increases the risk for SUID. Sleeping on the back and breastfeeding both decrease the risk for SUID. The side-lying position is not recommended for sleep. t is recommended that babies be dressed in sleepers and that cribs are free of blankets, pillows, bumper pads, and stuffed animals. Co-bedding with parents is not recommended as parents may roll on the child.

On observing a parent propping a bottle for a 2-month-old child in the waiting room, the nurse explains the dangers to the parent. Which statement indicates that the parent has understood the nurse's teaching? "I didn't know it would cause my baby to have trouble gaining weight." I can see how it might cause choking and cause tooth decay." "Propping the bottle now can lead to later problems with weaning." "I'll stop propping the bottle so my child will sleep through the night."

Many parents prop a bottle of formula or fruit juice for their infants at bedtime. The infant then awakens periodically to take more formula or juice, constantly bathing the teeth with high-carbohydrate liquid that predisposes the infant to dental caries. Because of the fluids dripping from the hole in the nipple, choking is also a risk if the child falls asleep while the nipple is still in the mouth. Propping a bottle does not necessarily result in poor weight gain, prolonged use of a bottle, or nighttime feedings.

The nurse assesses infant development at a well-child clinic. Which infant most needs a developmental referral for a gross motor delay? 2-month-old who does not roll over 4-month-old who does not sit without support 6-month-old who does not crawl 9-month-old who does not stand holding on

More than 90% of 9-month-olds are able to stand holding onto objects. Rolling over is expected at 4 to 6 months, and sitting without support is expected at 6 months. Crawling is expected at 9 months.

A 3-month-old infant is admitted to the hospital to rule out nonaccidental trauma. X-ray findings indicate a fractured right humerus, fractured ribs, and a fractured left scapula. In this situation, a nurse is responsible for: ensuring that the suspected child abuse is reported to local authorities. contacting the infant's next of kin to begin discharge planning. reporting the suspicions to the hospital's chief of pediatric services. contacting the local children's protective service office with an anonymous tip.

Nurses must report suspicions of child abuse to local authorities. The contact procedure may vary among hospitals, but the nurse is responsible for making the report. Reporting suspected abuse to the hospital's chief of pediatric services isn't appropriate. Contacting the infant's next of kin to begin discharge planning is inappropriate because the infant may not be discharged to the next of kin. Providing an anonymous tip isn't appropriate behavior for a professional nurse. The hospital record is important to the legal process, and the nurse must handle it professionally.

A parent brings a 15-month-old child to the well-baby clinic. They state the child has been taking approximately 18 to 20 oz (540 to 600 mL) of whole milk per day from a bottle with meals and at bedtime. The nurse should suggest that they begin weaning the child from the bottle to avoid risking: malnutrition. anemia. dental caries. malocclusion.

Nursing bottle caries occur when a child is routinely given a bottle of milk or juice at nap and bedtime. When teeth become coated in sugar before sleep, the lack of activity in the child's mouth for several hours during sleep allows the sugar to convert to acid, leading to decay. A child drinking 18 to 20 oz of whole milk in a day should not be malnourished, although they may lack essential vitamins and iron. Anemia may occur if they are only drinking milk because it contains no iron; however, the parent indicates they are eating meals. Regardless, children of this age should be taking no more than 16 oz of milk per day, and most children at this age should be drinking from a cup. The parent should be instructed to wean the child to a cup one feeding at a time until the child is completely weaned to a cup for all feedings. The last bottle-feeding to be replaced is usually the night bottle. Malocclusion of the teeth does not occur at 15 months. If the child were to continue to suck on a bottle until age 4 years or later, then malocclusion may occur.

The parent of a 6-month-old reports starting the child on 2% milk. What should the nurse ask the parent first? "Do you think your baby will be fine with this milk?" "Is it possible for you to switch your baby to whole milk?" "Can you tell me more about the reason you switched your baby to 2% milk?" "You cannot switch to 2% milk right now. Did your pediatrician tell you to do this?"

The American Academy of Pediatrics and Canadian Pediatric Society recommend that infants remain on iron-fortified formula or breast milk until 1 year of age. The nurse needs to first assess if the parent switched the baby prematurely because of a lack of information or lack of resources. Then appropriate teaching or referrals may be determined. At 1 year of age, the infant may be switched to whole milk, which has a higher fat content than 2%. A higher fat content is needed for brain growth. Demanding clients change behaviors without addressing the cause is unlikely to produce desired results.

A parent is concerned about spoiling a 2-month-old child by picking up the child each time the child cries. Which suggestion should the nurse offer? "If the baby's diaper is dry, leave the baby alone to fall asleep." "Continue to pick up the crying baby because young infants need cuddling and holding to meet their needs." "Leave your baby alone for 10 minutes. If the crying hasn't stopped then, pick up the baby." "Crying at this age indicates hunger. Try feeding when your baby cries."

The nurse should advise the parent to continue to pick up the crying infant because a young infant needs to be cuddled and held when crying. Because the infant's cognitive development isn't advanced enough to associate crying with getting attention, it would be difficult to spoil the infant at this age. Even if the diaper is dry, a gentle touch may be necessary until the infant falls asleep. Crying for 10 minutes wears an infant out; ignoring crying can make the infant mistrust caregivers and the environment. Infants cry for many reasons, not just when hungry, so the parent shouldn't assume the infant is crying from hunger.

A child who is of preschool age is diagnosed as having severe autism. The most effective therapy involves which intervention? antipsychotic medications group psychotherapy one-on-one play therapy social skills group

The preschool-aged child with severe autism will benefit from one-on-one play therapy. The therapist can develop a rapport with this child with nonverbal play. Antipsychotic medications are not indicated for the autism client. The child has difficulty with interpersonal relationships; therefore, group psychotherapy and social skills groups would not be effective.