Pediatrics Chapter 34

Parents bring a toddler age 19 months to the clinic for a regular checkup. When palpating the toddler's fontanels (fontanelles), what should the nurse expect to find?

Closed anterior and posterior fontanels (fontanelles)

What is typical of a grade II heart murmur?

The murmur is soft but easily heard.

A nurse is interviewing a parent regarding the 2-year-old child's recent illness. The nurse would like the parent to elaborate about any symptoms of the illness noticed. Which would be the mosteffective question for the nurse to ask the parent in this situation?

"What symptoms has your child exhibited?"

The clinic nurse is interviewing a parent about the infant's illness and is in the chief concern part of the health interview. Which question will the nurse ask during this part of the interview?

"Why did you bring your infant to the clinic today?"

Where is the point of maximal impulse (PMI) found in a 5-year-old child?

the fourth intercostal space

When assessing an infant's chest the nurse notes the chest is enlarged on one side. What information is most important to obtain from the family about this finding?

"Has the baby been treated for any health problems?"

The nurse is measuring the head circumference of a 1-year-old infant during a well-child visit. The parent asks the nurse why this assessment is being performed. Which response will the nurse provide to the parent?

"Head circumference is typically assessed until age 2 or 3 to help determine if growth is appropriate."

A 14-year-old boy has come to his primary care physician's office for a routine well-child visit with his parent. Which statement by the parent should the nurse prioritize for further investigation after noting the father has a history of alcohol use disorder?

"Our next door neighbor is older than my son, and he drinks when they hang out together."

The nurse is performing a health history on a 6-year-old child who is having trouble adjusting to a new school. Which question will elicit valuable information?

"What are your new classmates like?"

A nurse realizes the importance of nutritional assessment during the health history. When doing so, the nurse must assess the quality as well as quantity of food eaten. The best way to assess food intake is to do a:

24-hour recall.

The nurse is caring for a toddler who was just diagnosed with a hearing impairment. What would the nurse expect to assess in the child?

A delay or lack of clear, understandable speech pattern

The nurse is assessing a 4-year-old child brought to the emergency department due to abdominal pain. Which method(s) will the nurse use to complete a focused symptom assessment? Select all that apply.

Ask the child to point to the location of symptoms. Ask the parent what seems to aggravate or relieve their child's pain. Note if there are any associated factors or symptoms. Identify if there is a setting in which symptoms occur.

The nurse is conducting the Denver Articulation Screening with a 5-year-old girl to assess her speech. Which of the following should the nurse do while conducting this exam?

Convey the impression that there are no right or wrong answers.

Children of preschool age and older who have pale nasal mucous membranes and a clear discharge should be screened for possible----- .

Allergies

The nurse is assigned to work in the triage area of a pediatric clinic when a 4-year-old child and parent arrives. Which communication technique will the nurse use when determining the chief concern?

Ask the child or family member, "Why have you come to the clinic today?"

The nursing student is preparing to explain the appropriate steps for assessing an infant. The instructor determines the student's presentation is successful after illustrating which location as appropriate for obtaining an apical pulse?

Between the sternum and the left nipple

When auscultating the abdomen, sometimes, a(n)___________ or swishing or blowing sound is heard if there is an aortal aneurysm.

Bruit

Place in order the steps the nurse would implement when gathering the following physical data for an infant?

Count respirations Count the apical pulse Examine the infant's genitalia Measure the infant's chest and head circumferences. Obtain the infant's axillary temperature Look into the ears and mouth

The charge nurse observes a new graduate nurse assess the cremasteric reflex in an 8-month-old boy. The new graduate nurse strokes the lateral aspect of the thigh. Which action should the charge nurse take?

Demonstrate the appropriate technique.

A toddler is brought to the pediatric clinic by the caregiver because the child "doesn't feel well." As the nurse interviews the caregiver about why the client is there, which goal is the nurse prioritizing at this point?

Determining the chief complaint

During the assessment, leading questions are acceptable to provide the parents subtle hints.

False

Infants are usually examined most effectively if the parents are out of the room.

False

Routine vision screening usually begins at 4 years of age.

False

The nurse is assessing a 4-year-old child who reports having ear pain. What would the nurse incorporate into the assessment?

Grasp the pinna and pull up and back gently in order to assess the ear.

A nurse is taking a health history on a new family at the pediatric clinic. Which information is the priority information to gather for a complete history database?

Immunization record

The nurse is teaching the student nurse how to perform a physical assessment based on the child's developmental stage. Which statement accurately describes a recommended guideline for setting the tone of the examination for a school-age child?

Include the child in all parts of the examination; speak to the caregiver before and after the examination.

_________is the ability to think abstractly, to adjust to new situations, and to profit from experience.

Intelligence

The nursing instructor is monitoring the nursing students as they role-play conducting assessments on children and their caregivers. The instructor determines the session is successful after witnessing the students collect the necessary subjective data during which portion of the assessment process?

Interviewing the child's caregiver

What is the first action that a nurse performs when conducting a client interview with a 5-year-old child and the caregiver?

Introduce yourself to the child and caregiver.

When performing a lower extremity assessment which manifestation would be most important for the nurse to evaluate further?

Limping

A young client is admitted with a fever, vomiting, and diarrhea. Upon taking the health history, the nurse asks the client's parent, "What did you do to help your child before coming to health facility?" This is an example of which type of question?

Open-ended

A parent brings the child into the clinic and states that the child cannot hear well. Which characteristics in the child may indicate hearing difficulty? Select all that apply.

Responding inappropriately in conversation Speaking loudly Not speaking clearly Not responding when spoken to

A parent has brought the child into the clinic for a routine health assessment. The parent asks when routine screening for back symmetry will begin. Which response by the nurse is mostaccurate?

School age

To obtain an accurate heart rate in an infant, what would be most important for the nurse to do?

Take the apical pulse.

-------is an important assessment in children because it can reveal subtle infection that has not yet become obvious by other signs.

Temperature

The nurse is working at a pediatric clinic and is preparing an infant for a well-child check-up and immunizations. How will the nurse prepare the infant once the client is escorted to the examination room?

The infant should be totally unclothed for the physical examination.

When testing the deep tendon reflexes of a child, a four-point grading scale is used. What would a 1+ result mean for a reflex tested?

The reflex is diminished.

A child is defined as "failing to thrive" if height or weight drops below the ------percentile on a standardized growth chart.

Third

Bitten fingernails in the school-age child may reflect a high level of stress.

True

Poor sleep patterns can often reveal a psychosocial or physical health problem.

True

The nurse is caring for a child who has just arrived to the emergency department. The child is pale and has labored breathing. The nurse is inspecting the child while placing the child on oxygen, obtaining a pulse oximeter reading, and raising the head of the bed. Which assessment finding best reflects that the child's respiratory status is due to a chronic condition?

clubbing of the fingertips

A 6-month-old has fanning of the toes and dorsiflexion of the big toe seen on physical exam. Based on this finding the nurse should:

document as a normal finding.

A nurse is assessing a Babinski reflex in a 2-day-old newborn. Which finding by the nurse would indicate a positive finding?

fanning of the infant's toes