Peds - Exam 1

The parent of a 12-month-old infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I cannot let him feed himself; he makes too much of a mess." The nurse's BEST response is:

"feeding himself will help foster his growth and development. perhaps we can discuss ways to make the messes more tolerable"

it is time to give a 3 yr old boy his medication. which approach is most likely to receive a positive response?

"it is time for your medication now. would you like water or apple juice afterward"

informed consent is valid when : (SATA)

- a person is over the age of majority and competent - information is provided to make an intelligent decision - the choice exercised is free of force, fraud, duress, or coercion

The primary goals in the nutritional management of children with failure to thrive (FTT) are: (Select all that apply.)

- allow for catch up growth - correct nutritional deficiencies - achieve ideal weight for height - restore optimum body composition - educate the parents or caregiver on child's nutritional requirements

Erikson - psychosocial development

- birth to 1 yr - sense of trust while overcoming mistrust

nutrition

- breastmilk provides optimal nutrition during first 6 mos, followed by gradual introduction of solid food during the second 6 mos - commercial iron fortified infant formula is safe alternative to human milk - whole milk is not recommended until after 12 mos

The nurse should provide further teaching about sudden infant death syndrome (SIDS) prevention when hearing the mother of an 8 week old make which statement? (Select all that apply.)

- i only smoke in the kitchen - i have my baby sleep with me instead of alone in the crib - i make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib - i always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infants risk of a SIDS incident(select all that apply)?

- low apgar scores - male sex - recent viral illness

The nurse is providing education to a parent of a 10-month-old infant receiving iron supplements. What will be included in the teaching? (Select all that apply.)

- place iron toward the back side of the mouth with a dropper - apply barrier ointment if need to buttocks

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do (select all that apply)?

- roll from abd to back - put feet in mouth when supine

when caring for a child with an IV infusion, the most appropriate nursing interventions are to : (SATA)

- use an infusion pump with a microdropper to ensure the prescribed infusion rate - check IV fluids and infusion rate with another licensed professional - observe the insertion site frequently for signs of infiltration

Infants most at risk for sudden infant death syndrome (SIDS) are those: (Select all that apply.)

- who sleep prone - who were premature - with prenatal drug exposure

at what age would the nurse advise parents to expect their infant to be able to say mama and dada with meaning?

10 mos

The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula?

12 mos

the nurse is assessing a 6 mo healthy infant who weight 7 lbs at birth. the nurse should expect the infant to now weight approximately

15 pounds

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli?

2 mos

When is the best age for solid food to be introduced into the infants diet?

4 to 6 mos

A parent asks the nurse At what age do most babies begin to fear strangers? The nurse responds that most infants begin to fear strangers at age:

6 mos

By what age does the posterior fontanel usually close?

6 to 8 weeks

At which age can most infants sit steadily unsupported?

8 mos

By what age should the nurse expect that an infant will be able to pull to a standing position?

9 mos

Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. When teaching the parents about the infant's care, what is the most important information the nurse should include in the discharge teaching plan?

CPR

he nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was "just fine" when they put him in his crib already asleep. The nurse should suspect his death was caused by:

SIDS

feeding

Some children are unable to take nourishment by mouth because of the following: anomalies of the throat, esophagus, or bowel; impaired swallowing capacity; severe debilitation; respiratory distress; or unconsciousness. Alternative forms of feeding include gavage feeding, gastrostomy or jejunostomy feeding, and TPN.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant?

Vit D

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as:

a normal finding

the nurse is preparing a plan to teach a mother how to admin 1 1/2 tsp of medicine to her 6 mo child. the nurse should recommend using

a plastic syringe calibrated in mm

A mother tells the nurse that she doesn't want her infant immunized because of the discomfort associated with injections. The nurse should explain that:

a topical anesthetic (EMLA), can be applied before injections are given

The nurse expects which characteristic of fine motor skills in a 5-month-old infant?

able to grasp objects voluntarily

Which behavior indicates that an infant has developed object permanence?

actively searches for a hidden object

When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration?

admin the med with a syringe placed along the side of the infants tongue

fever

administration of antipyretics; hyperthermia is controlled by environmental means (minimum clothing, increased air circulation, cooling mattress, or cool compresses).

Katie, 4 years old, is admitted to outpatient surgery for removal of a cyst on her foot. Her mother puts the hospital gown on her, but Katie is crying because she wants to leave on her underpants. The most appropriate nursing action is to

allow her to wear her underpants

The best play activity to provide tactile stimulation for a 6-month-old infant is to:

allow to splash in bath

A 3-month-old bottle-fed infant is allergic to cow's milk. The nurse's BEST option for a substitute is:

amino acid formula

Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant. The most appropriate way to collect small amounts of urine for these tests is to:

aspirate from cotton balls inside the diaper with a syringe

Clinical manifestations of failure to thrive caused by behavioral problems resulting in inadequate intake of calories include:

avoidance of eye contact

Infection control

based on two systems. Standard Precautions provide protection when the infected person is undiagnosed. Transmission-based precautions add extra interventions for patients diagnosed with or suspected of having an infection.

safety

be alert for aspiration of foreign objects, suffocation, falls, poisoning, burns, motor vehicle injuries, drowning, bodily damage

when is bronchial drainage generally performed?

before meals and at bedtime

The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem?

beginning to put her to bed while still awake

Which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake?

being persistent through 10-15 min of food refusal

which statement best described the infants physical development?

birth weight doubles by 5 mos and triples by 1 yr

positional plagiocephaly

can easily be prevented allow child to have periods of tummy time and alternate head position during sleep

colic tx

change in feeding practices, correction of a stressful environment, behavior modification, support of parent

Parent guidelines for relieving colic in an infant include:

changing the infants position frequently

Which information should the nurse include in teaching parents how to care for a childs gastrostomy tube at home?

clean around the insertion site daily with soap and water

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given:

commercial iron fortified formula

Preparation for procedures

consider the child's developmental needs and cognitive abilities, temperament, existing coping strategies, and previous experiences.

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To enable the mother to perform percussion, the nurse should instruct her to:

cover the skin with a shirt or gown before percussing

Using knowledge of child development, the best approach when preparing a toddler for a procedure is to:

demonstrate the procedure on a doll

The nurse is assessing a 6-month-old infant who smiles, coos, and has a head lag. The nurse should recognize that:

developmental/ neuro evaluation is needed

Austin, age 6 months, has six teeth. The nurse should recognize that this is:

earlier than normal tooth eruption

A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan?

eliminate all secondhand smoke contact

A parent of an infant with colic tells the nurse, All this baby does is scream at me; it is a constant worry. The nurses best action is:

encourage parent to verbalize feelings

The nurse must suction a child with a tracheostomy. Interventions should include:

ensure that each pass of suction cath takes no longer than 5 seconds

Which is an important nursing consideration when caring for an infant with failure to thrive?

establish a structured routine and follow it consistently

psychologic preparation of the child for surgery

establish trust, provide support, and give an explanation in easy-to-understand terms.

a 10 yr old female child requires daily medications for a chronic illness. her mother tells the nurse that she is always nagging her to take her medicine before school. what is the most appropriate nursing action to promote the child's compliance?

establishing a contract with her, including rewards

Kimberly, age 3 years, has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102 F even though Kimberly had acetaminophen 2 hours ago. The nurses action should be based on knowing that:

fevers such as this are common with viral illnesses

The mother of a 3-month-old breastfed infant asks about giving her baby water since it is summer and very warm. The nurse should recommend that:

fluids in addition to breast milk are not needed

Which is the most appropriate action when an infant becomes apneic?

gently stimulate trunk by patting or rubbing

The MOST appropriate recommendation for relief of teething pain is to instruct the parents to:

give child a frozen teething ring to relieve inflammation

An appropriate intervention to encourage food and fluid intake in a hospitalized child is to:

give high quality foods and snacks whenever child expresses hunger

standard precautions for infection control include that :

gloves are worn to change diapers when there are loose stools

social development

guided by attachment, language development, personal / social behavior, and participation in play

he parents of a 12-month-old child ask the nurse if the child can eat hot dogs. The nurses reply should be based on knowing that:

hot dogs must be cut into small irregular pieces to prevent aspiration

the nurse observes erythema, pain, and edema at a child's IV site with streaking along the vein. what should the nurse do first?

immediately stop the infusion

Bronchial drainage

indicated whenever excessive fluid or mucus in the bronchi is not being removed by normal ciliary activity and cough. Positioning the child to take maximum advantage of gravity facilitates removal of secretions. Postural drainage can be effective in children with chronic lung disease characterized by thick mucus, such as cystic fibrosis.

temperament

influences the type of interaction that occurs between the child and parent and siblings

An important nursing consideration when performing a bladder catheterization on a young boy is to:

insert lidocaine into the urethra

the best explanation for why pulse ox is used on young children is that it :

is noninvasive

The nurse is interviewing the father of 10-month-old Megan. She is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says No firmly and removes her from near the outlet. The nurse should use this opportunity to teach the father that Megan:

is old enough to understand the word no

several types of long term central venous access devices are used. a benefit of using an implanted port is

it does not limit regular physical activity, including swimming

a neonate had corrective surgery 3 days ago for esophageal atresia. the nurse notices that after the child received his gastrostomy feeding, there is often backup of formula feeding into the tube. as a result, the nurse should

leave the gastrostomy tube open and suspended after feedings

nursing care for a patient with a tracheostomy

maintaining a patent airway, facilitating the removal of pulmonary secretions, providing humidified air or oxygen, cleansing the stoma, monitoring the child's ability to swallow, and teaching while simultaneously preventing complications.

An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) is to:

make a follow up home visit to parents as soon as possible after the infants death

A venipuncture will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. The nurse should recognize that this:

may help the child relax

failure to thrive

may occur in child with chronic illness, poorly managed feeding

In some genetically susceptible children, anesthetic agents can trigger malignant hyperthermia. The nurse should be alert in observing that, in addition to an increased temperature, an early sign of this disorder is:

muscle rigidity

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the babys formula faster. The nurse should recommend:

never heating a bottle in a microwave oven

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands; however, she will not voluntarily grasp it. The nurse should interpret this as:

normal development

post procedural support

nurse should encourage children to express their feelings and praise them for completion of the procedure.

performance of a procedure

nurse should expect success, involve the child when possible in the procedure, provide distraction, and allow for expression of feelings.

When caring for a child with an intravenous infusion, the nurse should:

observe the insertion site frequently for signs of infiltration

A 9-month-old infant is seen in the emergency department after developing a urticaric rash with cough and wheezing. When collecting the history of events before the sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." Which food is the possible cause of this type of reaction in the infant?

peanut butter

the nurse needs to take the blood pressure of a preschool boy for the first time. which action would be best in gaining cooperation?

permitting him to handle equipment and see the dial move before putting the cuff in place

With the goal of preventing plagiocephaly, the nurse should teach new parents to:

place the infant prone for 30 to 60 min per day

An appropriate play activity for a 7-month-old infant to encourage visual stimulation is:

playing peek a boo

When administering a gavage feeding to a school-age child, the nurse should:

position the child on the right side after administering the feeding

Tracheostomy suctioning

pre measured insertion of the catheter, application of suction for 5 seconds for infants and 10 seconds for children when withdrawing the catheter, and supplemental oxygen before and after suctioning.

the nurse is doing preoperative teaching with a child and his parents. the parents say that he is "dreading the shot" for premedication. the nurse's response should be based on the knowledge that

preanesthetic meds should be atraumatic, using oral, existing intravenous, or rectal routes

biological development

proportional changes, maturation of biological systems, fine and gross motor development

play activities

provide teaching about necessary nursing and medical interventions is an effective tool for use with children.

The clinic is lending a federally approved car seat to an infants family. The nurse should explain that the safest place to put the car seat is:

rear facing in back seat

Latasha is a breastfed infant being seen in the clinic for her 6-month checkup. Her mother tells the nurse that Latasha recently began to suck her thumb. The best nursing intervention is to:

reassure the mother that this is very normal at this age

a 7 yr old female child has a fever associated with a viral illness. she is being cared for at home. the nurse should recognize that the principal reason for tx of fever in this child is

relief of discomfort

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do?

roll from abdomen to back

A nurse is caring for a 2-month-old exclusively breast-fed infant with an admitting diagnosis of colic. Based on the nurse's knowledge of breastfed infants, what type of stool is expected?

semiformed, seedy, yellow

piaget - cognitive development

sensorimotor phase : - reflexes - primary circular reactions - secondary circular reactions - coordination of secondary schemata and their application to new situations

According to Piaget, the 6-month-old infant would be in what stage of the sensorimotor phase?

sensory circular reactions

The parent of 2-week-old Sarah asks the nurse if Sarah needs fluoride supplements because she is exclusively breastfed. The nurses best response is:

she may need to begin taking them at age 6 mos

The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high- top shoes. The nurse should explain that:

soft and flexible shoes are generally better

Tepid water or sponge baths are indicated for hyperthermia in children. The nurse should:

stop the bath if the child begins to chill

the exhausted parents of a 2 mo infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. The nurse's advice is to

take a thorough detailed hx of usual daily events

The emergency department nurse is cleaning multiple facial abrasions on 9-year-old Mike. His mother is present. He is crying and screaming loudly. The nurse should:

tell him it is okay to cry and scream

The nurse is planning how to best prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include:

telling the child that procedures are never a form of punishment

What should the nurse consider when having consent forms signed for surgery and procedures on children?

the risks and benefits of a procedure are part of the consent process

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. What is the nurse's BEST reply?

there is no need to restrain nonnutritive sucking during infancy

SIDS

third leading cause of infant death risk factors : prone sleeping position, soft bedding, noninfant bed with adult, maternal prenatal smoking nursing responsibility : educate family of risks, teach to place infant in supine position for sleep

Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurses response should be based on the knowledge that:

this is a common and accepted practice, especially in some cultural groups

A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse's reply should be based on knowledge that:

this is a normal reaction for this age

the parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infants stool. The nurse bases her explanation on knowing that:

this is normal because of the immaturity of digestive processes at this age

The nurse in the pediatric clinic identifies which infants at risk for developing vitamin D-deficient rickets?

those using yogurt as primary source of milk

In terms of fine motor development, the infant of 7 months should be able to:

transfer objects from one hand to the other

The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of:

trust

the nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. the nurse is unable to reinsert the tube. what should be the next action by the nurse?

trying to insert a smaller size tube

What is critical information for the nurse to incorporate into her care when using restraints on a child?

use least restrictive

restraints

used cautiously and require a medical order. use least invasive

informed consent

valid when the person is capable of giving consent (is over the age of majority and is competent), supplied with info needed to make decision, acts voluntarily when exercising freedom of choice

Which is the preferred site for intramuscular injections in infants?

vastus lateralis

preferred sites for IM injection

vastus lateralis and ventrogluteal areas.

An infant experienced an apparent life-threatening event and is being placed on home apnea monitoring. The parents have understood the instructions for use of a home apnea monitor when they state:

we will check the monitor several times a day to be sure the alarm is working

The nurse must do a heel stick on an ill neonate to obtain a blood sample. Which procedure is recommended to facilitate this?

wrap foot in a warm washcloth