PEDS- Exam 2 Review

The nurse is assessing the neck of an 8-year-old child with Down syndrome. Which finding would the nurse expect during the examination? 1 Webbing 2 Excessive neck skin 3 Lax neck skin 4 Shortened neck

3

__________ stage of separation anxiety: Child is detached and has formed coping mechanisms to avoid any further emotional pain.

Denial

Causes of failure to thrive or physical or ?

Disruption in family process (neglect, abuse, lack of appropriate parental action, parental lack of knowledge).

A 6-year-old child will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child? 1 Tell the parents to bring toys for the child from home. 2 Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. 3 There is no way to adequately prepare a child for an impending hospitalization. 4 Have another child talk with the child to be hospitalized.

2

Educational opportunities for children with special needs up to age __ years are mandated by law

21

__________ stage of separation anxiety: The child appears sad, hopeless, withdrawn, acts ambivalent when parents return. Quit without crying and lacks any interest in play or food

Despair

What is the first and role of the nurse when performing a physical assessment on a child?

Establish rapport and trust.

__________ is when the child fails to demonstrate growth over a prolonged period.

Failure to thrive.

With a school age child what is the best way to assess them? When do you speak to caregiver?

Head to toe with genital area last. Include them in the care. use slow deliberate gestures. speak to caregiver before and after

_________ is bluish discoloration of extremities, Caused by anxiety, hypothermia, heart disease ___________ is bluish coloration of lips, tongue, mucosa, or trunk (hypoxia, shock, CV collapse. congenital heart disease.

Peripheral cyanosis Central cyanosis

Older children over 5 generally get hospitalized for?

-Respiratory diseases, mental health problems, injuries (self harm), and gastrointestinal disorders.

Oral intake, oxygen administration, and nebulized medications or treatments may affect ____ temperature.

Oral temperature

Overall yellow color (_________) may be physiologic in the newborn or related to liver or hematopoietic disease in any age child. Yellowing of nose, palms, and soles may result from excess intake of __________

Overall yellow color (jaundice) may be physiologic in the newborn or related to liver or hematopoietic disease in any age child. Yellowing of nose, palms, and soles may result from excess intake of yellow vegetables

____________ is when skin color becomes pale, decreased pinkness in light skinned patients. caused by anxiety, anemia, SHOCK, fever, and syncope

Pallor

_________ is the single greatest contribution risk factor for failure to thrive.

Poverty

Risks for vulnerable child syndrome?

Preterm birth, congenital anomaly, newborn jaundice, handicapped condition, an accident of illness that child is not expected to recover from, crying or feeding problems in first 5 years of life.

Adolescents generally get hospitalized for?

Problems related to pregnancy, childbearing, mental health, and injury

Incidence in Respiratory function in children is high so making sure you are doing a _________.

Pulse ox

Number one reason children under 5 are hospitalized?

Respiratory disease.

What does innate mean?

born with

syncope means?

fainting

Some potential sources in errors low pulse oximetry readings would be like an abnormal ______n level, poor _______, _______ light interference, artifact and ____________.

abnormal hemoglobin level, poor perfusion, abinion light interference, artifact and skin break down

CN XI

accessory

The nurse is caring for a child admitted to the hospital with a diagnosis of failure to thrive. The nurse is aware that they child will require how many kcal per day to demonstrate proper weight gain? 1 100 kcal/kg/day 2. 120 kcal/kg/day 3 150 kcal/kg/day 4 175 kcal/kg/day

2

how should the nurse perform the auscultation of the heart?

2 different positions. Upright and reclined

acquired means

obtained. developed in overtime

Where is S2 loudest?

sound 2 (S2) is loudest in space (ICS) 2

____________________ and _______________ are the most common cause of disease leading to death in pediatric populations.

Congenital defects and traumatic injuries.

For children younger than 10 years of age auscultate the _______ pulse for a full minute to get pulse rate

For children younger than 10 years of age, auscultate the apical pulse with the stethoscope for a full minute

Though they may continue to be available in some instances, _____ thermometers are not recommended for use due to the mercury they contain

Glass

Which statement indicates the best sequence for the nurse to conduct an assessment in a nonemergency situation? a. Introduce yourself, ask about any problems, take a history, and do the physical examination. b. Perform the physical examination and then ask the family if there are any problems in the child's life. c. Do the physical examination while at the same time asking about the child's previous illnesses; then talk about the family's concerns. d. Get a complete history of the family's health beliefs and practices, and then assess the child.

A The nurse will have the information to do a better physical examination if he or she first determines any significant history or problems.

______ stage of separation anxiety: the child appears sad, agitated, cries, is angry and inconsolable, and looks for parents to return

Protest

the placement of electrodes for the apnea and cardiopulmonary monitors: nurse should Assess the skin where the electrodes are placed to ensure there is no skin breakdown. If the alarm sounds, immediately check the child to ensure the leads are not ____________ or the child is not in ________.

disconnected or the child is not in distress.

Explain unfamilar sounds to the child so for example if MRI you can explain that there will be loud rattling noises and offer to put ___________ on with music to help?

headphones

a technique to reduce stress in children during IV procedures is by avoiding medical terms. Use developmental appropriate language so for example?

•If a family calls an IV a little sting or poke call it that)

The nurse is assessing the temperature of a diaphoretic toddler who is crying and being uncooperative. What would be the best method to assess temperature in this child? 1 Oral thermometer 2 Axillary method 3 Temporal scanning 4 Rectal route

2. Patient is diaphortic and screaming so temporal and oral would not be appropriate and rectal is no longer recommended

Definition for ____________ is those who have or are at risk for, a chronic physical, developmental, behavioral, or emotional condition beyond needs generally required by children.

Special needs

deep tendon reflexes measure?

Tendon reflex tests are used to determine the integrity of the spinal cord and peripheral nervous system, and they can be used to determine the presence of a neuromuscular disease

The _____ monitor measures abnormal or irregular breathing in infants. The _______________ monitor generally measures heart rate and respiratory rate. Additional equipment on this monitor also allows for blood pressure and temperature monitoring. Set ____ and ___ alarm limits according to the healthcare facility's policies

The apnea monitor measures abnormal or irregular breathing in infants. The cardiopulmonary monitor generally measures heart rate and respiratory rate. Additional equipment on this monitor also allows for blood pressure and temperature monitoring. Set high and low limits according to the healthcare facility's policies

Steps for school age children examination Introduce yourself include child in _______ parts of examination Do head to toe approach with _________ exam last Speak to _______

Include child in ALL Parts of examination Do head to toe approach with genital exam last Speak to caregiver

The nurse is caring for a 1-year-old boy who was a premature infant. What must the nurse do to attain accurate developmental assessment data? 1 Assess for developmental progress based on the child's corrected or adjusted age. 2 Screen with the Denver II using the child's chronological age. 3 Use open-ended questions when discussing the child with his parents. 4 Compare the child to his siblings.

1 Premature infants should be compared to developmental norms using their corrected age through 3 years' chronological age

For a restraint policy it needs to be a written order by a licensed independent practitioner (LIP) within __ hour of application of the restraint. Need for face to face evaluation by LIP within __ hour of application of restraint.

1 hour for both

Risk factors for cardiac problems?

History of prematurity, LOW BIRTH WEIGHT Treatment with medications that raise BP Systemic illness associated with hypertension such as neurofibromatosis and tuberous sclerosis.

Infants' respirations are primarily diaphragmatic, so count the _________ movements. After 1 year of age, count the ________ movements

Infants' respirations are primarily diaphragmatic, so count the abdominal movements. After 1 year of age, count the thoracic movements

Order for examination with toddler? _______ yourself explain _____ steps to child and ____ steps to caregiver Allow child to handle _________ Perform most _______ parts last.

Introduce yourself to caregiver and child Explain MOST steps to child and ALL steps to caregiver Allow child to handle instruments Perform most evasive parts last

The nurse is performing a physical assessment of a 16-year-old girl. Which of the following is a recommended guideline for interviewing a child at this developmental stage? a. During the interview ask the caregiver to answer any questions the teen is too embarrassed to answer b. Keep up a running dialogue with the caregiver, explaining each step as it is performed c. Perform the genital exam first, and then use a head-to-toe approach to examine other systems d. Explain to the caregiver that the teen needs privacy and ask him or her to wait outside the room

D

Impact on special needs child: Infant may fail to develop a sense of ___________ and _________ Toddler may have difficulty developing __________. Preschooler may have difficulty achieving sense of __________. School age child may have difficulty achieving _________. Adolescent may have difficulty forming a sense of ____________

•Infant: may fail to develop a sense of trust and bonding •Toddler: may have difficulty developing autonomy •Preschooler: may have difficulty achieving sense of initiative •School-age child: may have difficulty achieving industry •Adolescent: may have difficulty forming a sense of self-identity relative to peers

•By age ___ -> ensure a transition plan is initiated; IEP must reflect post-high school plans.

14

What approach by the nurse would most likely encourage a child to cooperate with an assessment of physical and developmental health? a. Explain to the child what's going to happen when the child asks questions. b. Explain what is going to happen in words the child can understand. c. Force the child to cooperate by having a parent hold him or her down. d. Give the child a sticker before beginning the examination.

B Explain briefly what is going to happen, using words the child can understand.

How to we immunize for premature infants based of CDC recommendations?

schedule based on chronological age. For example, all former preemies should receive flu vaccine after 6 months of age.

cranial nerve XI in the older child by requesting that the child ___________________while you apply downward pressure.

shrugging the shoulders

The nurse is assessing a child's heart sounds for the characteristic S1 and S2. Where would the nurse place the stethoscope to hear S2 "dub" sound the loudest? 1 The fourth intercostal space 2 The third intercostal space 3 The fifth intercostal space 4 The second intercostal space

4

The nurse is assessing the heart rate of a healthy school-age child. The nurse expects that the child's heart rate will be in what range? 1 80 to 150 bpm 2 70 to 120 bpm 3 65 to 110 bpm 4 60 to 100 bpm

4 1= infant 2- toddler 3- preschool 4- school-age Adolescents will be 55-95

The normal infant may exhibit intermittent strabismus (crossing of the eyes) until about 3 months of age. However, persistent strabismus at any age or intermittent strabismus after _ months of age should be evaluated by a pediatric ophthalmologist

6

Valves associated with S2?

Aortic and pulmonic

By convention the deep tendon reflexes are graded as follows: _ = no response; always abnormal. _+ = a slight but definitely present response; may or may not be normal. _+ = a brisk response; normal. _+ = a very brisk response; may or may not be normal

By convention the deep tendon reflexes are graded as follows: 0 = no response; always abnormal. 1+ = a slight but definitely present response; may or may not be normal. 2+ = a brisk response; normal. 3+ = a very brisk response; may or may not be normal

Ears should not hang any lower than the ears. low set ears can be a sign of?

Chromosomal issues.

Classify bowel sounds as absent after listening for 5 full minutes in each area. Absent bowel sounds may indicate __________ or ___________

Classify bowel sounds as absent after listening for 5 full minutes in each area. Absent bowel sounds may indicate ileus or peritonitis.

valve located in the 3rd intercostal space on the left side?

Erb's point

abnormal anterior curvature of the lumbar spine (sway-back condition) (inward)

Lordosis

A ________ is dark purple red flat patch and grows with the child. Commonly called port wine stain.

Nevus Flammerus.

Steps of doing a physical examination?

Observation, palpation, percussion, Auscultation

Observe the nail beds for clubbing, which occurs with diseases inducing chronic _______ states.

Observe the nail beds for clubbing, which occurs with diseases inducing chronic hypoxic states.

Valve located in the 4th intercostal space on the left side?

Tricuspid valve

Webbing and excessive neck skin can be associated with?

Turners

Can lordosis be normal?

Yes in toddlers. that's why we really don't monitor until school age.

Three stages of separation anxiety

protest, despair, detachment

rubor means

redness

Which assessment finding is considered normal in children? a. Irregular respiratory rate and rhythm b. Split S2 and sinus arrhythmia c. Decreased heart rate with crying d. Genu varum past the age of 5 years

B

excessive outward curvature of the spine, causing hunching of the back.

Kyphosis

Valve located in the 5th intercostal space on the left?

Mitral valve

valve heard in the 2nd intercostal space on the left side?

Pulmonic valve

transition time in care of special needs can be ______ diagnosis or _______ in prognosis. Other things that are included in transition time is

•Initial diagnosis or change in prognosis •Increased symptoms •When the child moves to a new setting (hospital, school) •During a parent's absence (separation anxiety) •During periods of developmental change •Arrival of new family members or death with family members

when grading murmurs the nurse should note the _________ and __________?

•Note the anatomic location where the murmur is best heard. •Note where and if murmur radiates to other parts of the chest.

Shorten neck in kids is considered

normal under age 4.

When a child has been in the hospital several times in the past month the nurse would want to assess what?

parents coping abilities, because it will impact overall child's well-being. Listen to parents and being their for them is especially important.

Avoid the ______ route of temperature measurement in the immunosuppressed child as well as the child who has diarrhea, a bleeding disorder, or a history of rectal surgery

rectal

stadlometer

scale that you stand on

abnormal lateral curvature of the spine

scoliosis

__________ is classified as a clinical state in which the parents reactions continue to have psychological potentially harmful effects

Vulnerable child syndrome.

Grades of heart murmurs 1-6?

Grade 1 (soft and intermittent, barely heard. sometimes, heard. sometimes not.) Grade 2 (soft and heard each time chest is auscultated) Grade 3- (audible with intermediate intensity) Grade 4 ( audible with a thrill) Grade 5- loud audible with edges of stethoscope lifted off chest) Grade 6 (audible with stethoscope off the chest)

What is the first thing to INSPECT for preschool children or actually for any age?

Airway, respiration rate, are they breathing okay. monitor the A, B, C's

The nurse is conducting a health assessment of a teenager and asks about his daily routine. What aspect of the health history is the nurse assessing? a. Developmental history b. Functional history c. Family health history d. Demographics

B. Functional history.

Nurse responsibilities for a fragile child being discharged?

Be professional. Avoid becoming a personal friend make sure they have supplies assess living environment for safety education about financial aid

Falsely high/normal readings can be associated with __________ poisoning and severe _________

carbon monoxide poisoning and severe anemia

Ask the older child to touch the tongue to the roof of the mouth and then stick out the tongue and move it from side to side (testing cranial nerve XII [__________]

[hypoglossal

What is a genogram?

a tool used to assemble a 3 generational family history. Its a diagram that depicts patterns and influences. Can show what the child may be predisposed to

how should you pull the ear for kids younger than 3 years old?

Back and down

_______ motor skills are small movements — such as picking up small objects and holding a spoon — that use the small muscles of the fingers, toes, wrists, lips, and tongue. __________ motor skills are the bigger movements — such as rolling over and sitting — that use the large muscles in the arms, legs, torso, and feet

Fine= small movements Gross= bigger movements

Valves associated with S1 sounds?

Tricuspid and Mitral

The __________ history determines the age when landmarks in gross motor control were achieved. The __________ health history obtains information about the family's health, __________ refers to data such as the child's name, birth date, gender, race, ethnicity, and language spoken.

The developmental history determines the age when landmarks in gross motor control were achieved. The family health history obtains information about the family's health, and demographics refers to data such as the child's name, birth date, gender, race, ethnicity, and language spoken.

Growth and development assessments for premature infants is based upon ___________.

calculated age. (so if they are born 32 weeks and they are 6 months old then they will be calculated at 4 months old).

Vagus nerve testing? The vagus nerve interfaces with the __________ control over the _________, ______, and _________.

check the gag reflex. CN X, and interfaces with the parasympathetic control of the heart, lungs, and digestive tract.

If the infant is asleep, auscultate the _________, _______ and __________ first while baby is quiet.

heart, lungs, and abdomen

For discharge planning: we would want to do things like: Assist with referrals for ________. Arranging for necessary _______ and ______ Assessing families ____________

Assisting with referrals for financial support Arranging for necessary equipment and supplies And assessing families home environment.

Tympanic temperature reflects the _________ artery temperature and can be measured with the tympanic thermometer within seconds.

Pulmonary artery Tympanic= ear

Light pink macules typically found on the eyelids, nasal bridge, or back of neck are called ___________

Salmon Nevi or "stork bites" think about the underside of a salmon belly being light pink Will fade overtime but may never go away completely

A ___________ is a raised reddish papule made of blood vessels. They recede over time usually by age 9.

Strawberry nevus Think of strawberries being papule

When should the nurse do ausculation after inspection before palpation takes place?

When examination the abdomen or if infant is sleeping nurse can auscultate their heart, lungs, abdomen first.

Individualized Education Program (IEP)

Written document required by the Individuals with Disabilities Education Act (P.L. 94-142) for every child with a disability; includes statements of present performance, annual goals, instructional objectives, specific educational services needed, extent of participation in the general education program, evaluation procedures, and relevant dates, and must be signed by parents as well as educational personnel.

The nurse is questioning the parents of a 2-year-old child to obtain a functional history. Which topics might the nurse include? Select all that apply. 1 The child's toileting habits 2 Use of car seats and other safety measures 3 Problems with growth and development 4 Prenatal and perinatal history 5 The child's race and ethnicity 6 Use of supplements and vitamins

1, 2, 6

The nurse is caring for an 8-year-old girl who requires numerous venipunctures and injections daily. The nurse understands that the child is exhibiting signs of sensory overload and enlists the assistance of the child-life specialist. What should the therapeutic play involve to best deal with the child's stressors? 1 Puppets and dolls 2 Drawing paper and crayons 3 Wooden hammer and pegs 4 Sewing puppets with needles

4

The nurse is taking a family history of a 10-year-old with asthma. What would be a helpful tool to obtain a family history of illness and disease? 1 Make a family tree for tracking purposes. 2 Have the family write down any history they remember. 3 Have the family fill out a health questionnaire. 4 Help the family design a genogram.

4

The nurse is meeting with a group of families to assist them in dealing with the hospitalization of their child. Which comment by a family member should alert the nurse to assist the family in coping with the situation? 1 "We have really good insurance—it covered everything the last time she was in the hospital." 2 "When my sister was in the hospital before, the nurse let me get up on her bed while she read me a story." 3 "Sometimes I wonder if the reason she is sick is because I have so many responsibilities at work and at home." 4 "My husband was so relieved when he heard that after the next surgery our son will probably not need to have any more, and will be fine."

3

Heart rate and Respiratory rate: For infant? For Toddler? For Preschooler? For school age? For adolescent? For adult?

-Infant= HR 80-150 RR 25-55 (Newborn HR 110-180.RR 40-60) - Toddler= HR 70-120 RR 20-30 - Preschooler= HR 65-110 RR 20-25 -School age= HR 60-100 RR 14-22 Adolescents= HR 55-95 RR 12-18 Adult= HR 60-100 RR 12-20

-_______ and _________ may prefer to be examined on caretaker's lap. -________ or __________age may want to inspect stethoscope; need sense of control. -_________ prefer privacy.

-infants and toddlers may prefer to be examined on caretaker's lap. -preschool or school age may want to inspect stethoscope; need sense of control. -teens prefer privacy.

A 15-year-old boy asks numerous questions about recovery from anesthesia and typical behaviors of someone awakening from sedation. The nurse interprets the concern of this teen to be: 1 about his ability to control his own behavior. 2 about a change in body image. 3 anxiety related to the surgical procedure itself. 4 adequacy of postsurgical pain control.

1

The nurse caring for a hospitalized child with failure to thrive (FTT) will focus first on: 1 assisting the child to attain adequate nutrition to demonstrate weight gain. 2 determining the quality of the parent-child relationship. 3 forming a positive relationship with the child. 4 providing appropriate developmental stimulation.

1

what valve is heard at the second intercostal space on the right sternal boarder.

Aortic valve

Location of point of maximal impulse (PMI) Under age 4? 4-6? 7 and older?

Under age 4- Located in the 3rd- 4th intercostal space just to the left of midclavicular line 4-6- at the 4th intercostal space at the left midclavicular line 7 and older- the left midclavicular line at the 5th intercostal space

Munchausen syndrome is what?

a condition in which the "patient" repeatedly makes up clinically convincing simulations of disease for the purpose of gaining medical attention Parents make their child out to be sicker than they are. think of the parents wanting to munch off others to gain medical attention.

Hippotherapy?

a therapy that uses animals such as horses to help physically challenged people

Newborn assessment what should be done first? what should be done last?

Respirations first. Mouth, genitals, and hip flexion *basically doing anything that is invasive last that may make the newborn upset and cry

What is typical of a grade II heart murmur? 1 The murmur is soft but easily heard. 2 The murmur is soft and hard to hear. 3 The murmur is loud with an associated thrill. 4 The murmur is loud without an associated thrill.

1 2- Grade I 3- grade IV (thrill) 4- Grade III Grade V- edge of stethoscope off chest Grade VI- heard when stethoscope is not on chest

A 3-month-old boy was diagnosed with failure to thrive. What action will be most helpful in assisting the nurse to determine if there is an inorganic cause? 1 Observing the mother-child interaction during feeding and hygiene activities 2 Observing the child's interest in and ability to feed 3 Assessing for adequate calorie intake through recording ounces of formula consumed 4 Reviewing the medical records for a history of prematurity or a congenital anomaly

1 Inorganic cause could be abuse or inability to provide like poverty

A sleeping 5-month-old girl is being held by the mother when the nurse comes in to do a physical examination. What assessment should be done initially? a. Listening to the bowel sounds b. Counting the heart rate c. Checking the temperature d. Looking in the ears

B To assess heart rate accurately, the infant should be calm and not crying. Assess areas where listening is critical, such as the breath and heart sounds, while the child is asleep. The other assessments can be done even if the infant is fussing.

lax neck skin can be a sign of?

down syndrome

_________________ (1975, amended as PL 99-457): early intervention from birth to age 2 and preschool for 3-5 year old. ________________ (2004) requires local school systems to provide for the education of children with special needs through the public school system, from age 3 to 21 years.

•Education for All Handicapped Children Act (1975, amended as PL 99-457): early intervention from birth to age 2 and preschool for 3-5 year olds. •Individual with Disabilities Education Act (2004) requires local school systems to provide for the education of children with special needs through the public school system, from age 3 to 21 years.

functional health means?

level of health defined by one's ability to carry out usual and desired daily activities

A 5-year-old boy visits the pediatric office with an upper respiratory infection. Which approach would give the nurse the most information about the child's developmental level? a. Playing a game with the child. b. Talking with the child about the teddy bear next to him. c. Using a screening tool during a follow-up office visit. d. Asking the 10-year-old sibling about the child

C Assessment of development should not be done when a child is ill. It is more accurate when the child is alert and able to participate fully.

Clonus means?

rapidly alternating involuntary contraction and relaxation of a muscle in response to sudden stretch