Peds Exam 2 Study Guide

When does the secondary circular reactions stage occur during the sensorimotor phase of Piaget's Cognitive Development and what does it consist of?

4-8 months; Imitation, play, affect

Which developmental characteristic is an 8-month-old infant demonstrating if the child clings to the parent, cries, and turns away from a new babysitter?

stranger fear

Laryngotracheal foreign body aspiration signs

stridor, hoarseness, worsening= cyanosis

What characterizes oral allergy syndrome?

swelling and itching of lips, tongue, throat

Which condition would the nurse suspect when a 6-month old infant demonstrates increased drooling, finger sucking and biting on objects

teething

When does the coordination of secondary schema stage occur during the sensorimotor phase of Piaget's Cognitive Development and what does it consist of?

8-12 months; Beginning of intellectual reasoning

When are finger foods introduced?

9 months

What are the approximate caloric requirements for a preschool aged child?

90 kcal/kg

What is an expected fine motor skill for a 12 month old infant?

the ability to turn pages in a book

Which system maturation is associated with school-age children?

the heart grows more slowly and is smaller in relation to the rest of the body

Which developmental factor increases the risk for infection in infants and young children?

the relatively short and open eustachian tubes of young children give pathogens easy access to the middle ear

Which characteristic may be observed in latchkey children?

they feel more lonely or isolated

Which recommendation would the nurse make for the family of a 9-month old infant who is worried about a baby's thumb sucking?

thumb sucking should be discouraged when permanent teeth begin to erupt

Infant Development of Body Image

Concept of object permanence By end of first year child recognizes that he/she is distinct from parents Increased interest in image As motor skills develop, the child learns that the body is useful

Cognitive development of school-aged children according to Piaget

Concrete operations

Common fears in preschoolers

Dark Being left alone Animals (e.g., snakes, large dogs) Ghosts Objects or persons associated with pain (Technique of desensitization used to overcome fears)

What is Failure to Thrive?

Deceleration of growth in both height and weight Less than 5th percentile Crosses 2+ growth curve lines down on chart

What tool is used to assess speech problems

Denver Articulation Screening Examination (DASE)

What psychosocial stage are preschoolers in according to Erikson?

Developing a sense of initiative

Psychosocial development of school-aged children according to Erikson

Developing sense of industry (purpose)

Which response would the nurse provide the parents of a 6-month old infant who are concerned that their baby pushes the spoonful of baby food away whenever it is near the mouth?

Just keep offering the spoon to him even though he pushes it away

Rickettsialpox is caused by:

Rickettsia akari

Scabies is caused by what?

Sarcoptes scabiei

Cutaneous symptoms of a food allergy:

hives, red rash, flushing

Which type of dressing is appropriate when describing the application of an alginate dressing to a patient's wound?

hydrophilic

Psychosocial development of teens according to Erikson

identity development (group identity, individual identity, sex-role identity)

Which developmental finding in a 5 month old warrants further investigation by the nurse?

inability to hold the head erect and steady when sitting

Which Failure to Thrive (FTT) classification would the nurse use for a 1-month-old infant with FTT secondary to congenital heart disease?

increased metabolism

Why are upper respiratory tract infections, otitis media and tonsillitis more common in toddlers?

inner ear structures are short and straight tonsils are large

Which gross motor skill is developmentally appropriate for an 18-month old toddler?

jumps in place with both feet

Colic is most common in what age of infants?

less than 3 mo

Which clinical findings are suggestive of marasmus?

loose, wrinkled skin and generalized wasting of body tissues

What is a macromineral?

minerals with daily requirements greater than 100 mg (ex. calcium)

Kwashiorkor is of _________________ origin.

multifactorial

Which clinical manifestation would the nurse expect to note when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation?

nasal flaring, retractions and grunting

Signs of immediate GI hypersensitivity to food:

nausea, cyclic vomiting, diarrhea, abdominal cramping

Which is considered the most common allergenic food?

nuts, eggs, milk, shellfish, fish, soy, wheat

Bronchial foreign body aspiration signs:

paroxysmal cough, wheezing, asymmetric breath sounds, decreased air entry

The nurse understands that which guidelines are followed for administering the tuberculin skin test?

periodic administration for children at high risk

Nasal foreign body aspiration signs:

persistent unilateral discharge

Which intervention lowers the risk for sudden infant death syndrome (SIDS)?

placing the infant in the supine position to sleep

What is an expected fine motor skill for an 8 to 9 month old infant?

crude pincer grasp

Which symptoms are associated with gingivitis in school-aged children?

deposition of plaque inflammation of gums

For which condition would the nurse evaluate when caring for a 12-month-old infant who is unable to pull up to a standing position?

developmental dysplasia of the hip

Anaphylaxis in infants

difficulty with inhalation, facial or throat swelling of any kind, urticaria, wheeze or noisy breathing, croupy cough, difficulty swallowing, excessive drool, dizziness

Which supply is appropriate when removing a tick embedded in the skin?

disinfectant, forceps, sterile needle

Which condition is associated with prolonged bottle feeding?

early childhood caries

Benefits of breast milk

excellent nutritional balance transfers immunologic defenses promotes GI motility/function lowers short and long term risk of some conditions for mother and baby

Which recommendation would the nurse provide the mother of an 8-month old infant who wishes to discontinue breastfeeding?

feed commercial iron-fortified formula

Which characteristic reflects the psychosocial development of school-age children?

feelings of inferiority may emerge if unable to assume responsibilities

Which secondary teeth usually erupt when the child is 6 years old?

first molar

Which recommendation would the nurse provide the parent of an infant experiencing teething pain?

give the child a cold teething ring to relieve inflammation

Obesity

greater than 95th percentile for BMI; larger amount of fatty tissue than lean muscle mass

In which way would the nurse describe growth during the first year of life?

growth is especially rapid during the first 6 months of the first year of life

Concerns related to normal growth and development of toddlers

Toilet training Sibling rivalry Temper tantrums Negativism Regressive behavior

Which clinical manifestation would the nurse expect when caring for a child with dyssomnias?

Trouble falling asleep at night

Potential contributing findings for ASD

Unusual body movements Atypical emotional regulation Reduced motor control

Which best describes the origin of a cow's milk allergy (CMA)?

a multifaceted disorder causing systemic and local reactions

Which type of diet do children with CF require?

a well-balanced, high protein, high calorie diet

Toddlers run by:

18 months

At what age do toddlers gain sphincter control for elimination?

18-24 months

Age range for young adults

18-25

Which nursing advice is appropriate for the parents of a child with cat scratch disease when discussing the timeframe it resolves?

4-6 weeks

Why is a humidified atmosphere recommended for a young child with an upper respiratory tract infection?

It is soothing to inflamed mucous membrane

Which vitamin supplement would the nurse recommend for all pregnant women to prevent neural tube defects in infants?

0.4 mg of folic acid

When does the primary circular reactions stage occur during the sensorimotor phase of Piaget's Cognitive Development?

1-4 months

Which location is appropriate when looking for evidence of nits when inspecting a child for head lice?

1/4 inch (6 mm) from the scalp

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning?

10 months

At what age does puberty generally begin for boys and girls?

10 years for girls, 12 years for boys

What is the approximate fluid requirement for preschool aged children (dependent on activity and climate too)?

100ml/kg

Age range for teens

11 or 12 to 17 years

At what age does the second molars erupt in a school-aged child?

11-13 years

Bedtime resistance is common until about age _____.

12

Toddlers walk by:

12 months

What is prepubescence?

2 year period that precedes puberty

Toddlers can use two or three word phases by what age?

2 years

Toddlers climb stairs by:

2 years

Toddlers usually have a comprehension of 300 words by how old?

2 years

Behavioral signs or Autism or ASD can be detected in what year of life?

2nd

At what age do the primitive reflexes begin to fade?

3 months (fading starting at 5 months of age would be considered a delay)

Toddlers can use simple sentences and acquire 5-6 new words a day by what age?

3 years

The preschool period lasts from _____ to ______ years.

3-5

By age 12 months, infants should say....

3-5 words besides "mama" and "dada"

By which age does the moro reflex disappear in an infant?

4 months

At which age do children begin staring at their own mirror image?

5 months

Until which age is fetal hemoglobin (HgbF) still present in the body?

5 months

What is the age range of a "school-aged" child?

5-12 years (onset of puberty)

When does the posterior fontanel close?

6-8 weeks

Approximately how many kg would the nurse expect a 6-month old infant to weigh if the infant weighed 3.5 kg at birth?

7 kg

At what age is transferring objects from one hand to the other an expected fine motor skill?

7 months

Because the absorption of fat soluble vitamins is decreased in cystic fibrosis which vitamin supplementation is necessary?

A, D, E, K

What does treatment involve for FTT?

Address underlying cause High caloric density feedings Vitamin and mineral supplements Work with family/education

The nurse finds that a 2-month-old infant is not gaining weight despite receiving expressed breast milk. The mother works for 8 hours and expresses milk once during this time. Which recommendation would the nurse make to the mother?

Advise the mother to express milk at least every 3 to 4 hours (to maintain adequate milk supply)

Types of play in preschool aged children

Associative play Imitative play Imaginative play/playmates Dramatic play

At what age would the nurse expect an infant's anterior fontanel to close?

Between 12-18 mo (average of 14 mo)

When does the reflex stage occur during the sensorimotor phase of Piaget's Cognitive Development?

Birth-1 month

Principles of emergency treatment in cases of poisoning:

Call poison control center first before doing anything Assessment Gastric Decontamination (induce vomiting, absorb toxin, gastric lavage) Prevention of reoccurence

Rocky Mountain Spotted Fever

Caused by Rickettsia

Treatment for Lyme Disease?

Doxycycline

Health concerns of adolescents

Emotional well-being Intentional and unintentional injury Dietary habits, eating disorders and obesity Physical fitness Sexual behavior, STIs, and unintended pregnancy LGBT+ considerations Mental health and suicide School and learning problems Hypertension Hyperlipidemia Immunizations Body art Tanning Sleep deprivation and insomnia

Early stages of Lyme Disease (3-30 days)

Erythema migrans (specific rash from bite), fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes

What is Colic?

Excessive crying (rule of 3s: 3 hours for 3 days for 3 weeks+) thought to be caused by abdominal pain

Which type of injury is common in 2-month old infants?

Falls, aspiration, suffocation, MVA

What are physical changes of school-aged children?

Fat distribution changes Increased muscle tissue

Psychosocial development highlights in preschoolers

Feelings of guilt, anxiety and fear may result from thoughts that differ from expected behavior Development of superego (conscience) Moral development (learning right from wrong)

Cognitive development of teens according to Piaget

Formal operations

Preschool age development of sexuality

Forms a strong attachment to the opposite-sex parent while identifying with the same-sex parent Becomes concerned with modesty Sex role limitation; "dressing up like Mommy or Daddy" Sexual exploration is more pronounced Questions arise about sexual reproduction

What conditions to assess for when an ALTE occurs?

GERD, arrhythmias, seizure disorder, sepsis, other infections

Fine motor development in infants

Grasping object at 2-3 months Palmar grasp at 6 months Transfer object between hands at 7 months Pincer grasp at 10 months Remove objects from container at 11 months Build tower of 2 blocks at 12 months

Growth and development of preschoolers

Growth slows and stabilizes Average weight gain remains about 5 pounds per year Average height increases 2.5-3 in per year Body systems mature and stabilize; can adjust to moderate stress and change Gross motor skills well established (walking, running, jumping, climbing) Readiness for school

Many methods to control hypothermia

HATS Appropriate clothing Bathing away from cold sources Covering exposed skin Holding, including kangaroo care Isolette

Gross motor development in infants

Head lag in first 2 months Head control at 4 months Rolling over (from abdomen to back) at 5-6 months Parachute reflex by seven months Sit alone by 7 months Move from prone to sitting position by 10 months

For which reason is low-fat milk not recommended for an infant less than 6 months old? (select all that apply)

High in sodium Inadequate essential fatty acids

The addition of vitamins to commercially prepared infant foods increases the risk for which disorder?

Hypervitaminosis (10 or more times the recommended dietary allowance)

What can cold stress in infants cause?

Hypoxia Metabolic acidosis Hypoglycemia

What is a food sensitivity and example?

Immunoglobulin E (IgE)-mediated immune response Ex. cow's milk

Highly replicated findings for ASD in 12-18 months

Impaired social attention Impaired social communication Atypical object use (tapping and spinning) Abnormal visual attention

Fine motor development of toddlers

Improved manual dexterity at 12-15 months Throws a ball by 18 months Draws circles by age 3

What are classifications of Failure to Thrive?

Inadequate caloric intake Inadequate absorption Increased metabolism Defective utilization

Preschool age development of body image

Increasing comprehension of "desirable" appearances Aware of racial identity, differences in appearances, and biases Poorly defined body boundaries (I.e. Fear that if the skin is "broken," all one's blood and "insides" can leak out, Frightened by intrusive experiences)

Preschool age social development

Individuation-separation process is completed Overcomes stranger anxiety and fear of separation from the parents Still needs parental security and guidance Security from familiar objects Play therapy is beneficial for working through fears, anxieties, and fantasies Minimal help with toileting, eating, or dressing Is willing to please Has internalized values and standards of family and culture May begin to challenge parental values

Apparent Life Threatening Event (ALTE)

Infants exhibit a combination of: Apnea Change in color or muscle tone Choking, gagging, or coughing Usually involves significant intervention

When formula is best for an infant

Infections such as HIV Immunodeficiencies Maternal medications contraindicating breastfeeding Disorders of inborn metabolism

Proper introduction of solid foods after 6 months of age

Introduce foods at intervals of 4-7 days to allow for identification of food allergies May need fluoride supplements Rice or oatmeal cereal starting at 4-6 mo (iron rich) Then, move to veggies and fruit (roughly 6-8 mo) One new food every few days If NKA or high risk for allergy, introduce peanuts, eggs in 4-6 mo Meat, fish, poultry start at 8-10 mo

Which action would the nurse take when the parents of a 12-month old express concern that their infant is still sucking the thumb and ask how to stop this "annoying" behavior?

Investigate the parents' feelings regarding their child's behavior

When caring for an infant with protein-energy malnutrition, which nutritional supplement would the nurse withhold until the infant is able to tolerate a steady food source?

Iron

Which anticipatory guidance would the nurse provide the family of a 6-month-old infant being seen for a well-baby check up?

Keep the crib rails raised to full height at all times

For which condition is an infant at risk if the diet has limited protein-based food sources?

Kwashiorkor

Heavy metal poisoning

Lead ingestion most common (can be inhaled or ingested) Mercury toxicity occurs less frequently

Which disease is suspected after reviewing a lab report stating that a child tested positive for borrelia borgdorferi?

Lyme disease

Treatment of the hospitalized child with ASD:

Maintain consistency in their structured routine Decrease simulation Individual assessment and approach, use family to guide HCP interuptions to a minimum

Which region is endemic for Cryptococcosis?

Mississippi and Ohio River Valleys

Larynx foreign body aspiration signs:

No breathing or speaking

What is a food intolerance and example?

Non-IgE-mediated immune response Ex. Lactose intolerance

High Risk Late Preterm Infant

Respiratory distress Hypoglycemia Temperature instability Poor feeding Jaundice Adverse neurodevelopmental outcome Infection

4 types of conjunctivitis

Opthalmia Neonatorum (chemical) Bacterial Viral Allergic

Toddler play

Parallel play Imitation Little emphasis on gender-stereotyped toys Increased locomotive skills Educational toys and books Tactile play Appropriate safety in relation to size, shape, risk for toxins, and sturdiness of toys

Which technique is the recommended approach to warming frozen breast milk for an infant?

Place the container with frozen milk in a lukewarm water bath to warm it

Which would be expected, in regard to the healing process, for the immunocompromised child who sustained a skin injury after falling?

Poor inflammatory response

What cognitive development stage are preschoolers in according to Piaget?

Preoperational phase spans 2-7 years Divided into 2 phases: Preconceptual phase at 2-4 Intuitive thought phase at 4-7

Which factors are associated with an increased occurrence of SIDS?

Preterm infant, Low APGAR, Bronchopulmonary dysplasia

Lead poisoning diagnosis

Rarely symptomatic but affects renal, neurologic, and hematologic systems (bone marrow) (Diagnosis involves anemia, venous blood sample lead level of 10 or higher)

Toddler development of body image

Refers to body parts by name Avoid negative labels about physical appearance Recognizes differences between male and female by age 2 Gender roles understood Gender identity by age 3

Cognitive development highlights of the preschooler

Shifts from egocentric thought to social awareness Able to consider other viewpoints Egocentricity is still evident Language continues to develop Concept of causality is beginning to develop Concept of time is incompletely understood Uses magical thinking frequently

Piaget's sensorimotor stage is characterized by:

Six stages, Birth to 24 months Reflex stage, Primary circular reactions, secondary circular reactions, coordination of secondary schema (details in another flashcard)

Common concerns for preschool aged children

Sleep problems (terrors, nightmares, etc) Skin disorders (contact dermatitis, human bites, burns) Ingestion of Injurious Agents (children younger than 6) Foreign Body Aspiration Conjunctivitis Ear infections Lyme Disease Poison Ivy Insect bites and stings Neurodevelopmental concerns (Autism and Autism Spectrum Disorders)

Sleep and activity of preschool aged children

Sleeps for 12 hours per night; infrequent naps Free play is encouraged Emphasis is on fun and safety

Which response would the nurse provide the parent of a 10 month old who is worried that the baby cries and screams whenever being left with the grandparents?

Stranger anxiety is common for an infant this age

Oral Readiness Assessment

Strong suck Coordination of suck, swallow, breathe Intact gag reflex Rooting Waking around feedings

Safety acronym: SAFE PAD

Suffocation Aspiration, asphyxia, animal bites Falls Electrical and other burns Poisoning and Ingestions Automobile safety Drowning

Which antibiotic is appropriate when treating a child who has been diagnosed with MRSA?

Sulfamethoxazole/trimethoprim, vancomycin

Piaget's sensorimotor stages in toddlers

Tertiary circular reactions at 13-18 months Invention of new means through mental combinations at 19-24 months

Which statement characterizes the eating behavior of toddlers?

They become fussy eaters (around 18 months)

Which evaluation would the nurse make when observing a 5-month old who has no head lag when pulled to a sitting position?

This is an expected finding

What is the rationale for the nurse recommending that the parent of a 7-month old infant reduce pacifier use?

To prevent otitis media (a middle ear infection)

Which vitamin supplement would the nurse anticipate being prescribed for a 13-month-old infant diagnosed with measles?

Vitamin A

Which vitamin would the nurse anticipate being prescribed for an exclusively breastfed 4-month old infant?

Vitamin D

Assessing Readiness for Toilet Training

Voluntary sphincter control Ability to stay dry for 2 hours Fine motor skills to remove clothing Willingness to please parents Curiosity about adult's or sibling's toilet habits Impatience with wet or soiled diapers

Proportional changes in infants

Weight gain is 5 to 7 ounces per week Double the birth weight by age six months Triple the birth weight by age 1 year Growth occurs In spurts rather than gradually

Biologic development of toddlers (ages 12 mo-36 mo)

Weight gain slows to 4-6 pounds per year Birth weight should be quadrupled by 2.5 years Height increases about 3 in per year Growth is steplike rather than linear Adult height is 2 times the height at age 2 years Anterior fontanel closes by 12 months

Which dietary supplement is appropriate to facilitate healing when educating the parents of a child who was burned?

Zinc, Vitamins C and D

Which category of medication is the first line therapy for inflammation in children with asthma?

corticosteroids

Which characteristic best describes the fine motor skills of a 5-month old infant?

able to grasp an object voluntarily

There is NO need for what during the first four months of infancy when it comes to nutrition?

additional fluids besides breastmilk or fortified formula

When to wean from breast or bottle to cup?

after 1 year

When to introduce solid foods to an infant?

after 6 months

Which therapeutic management would the nurse expect the primary health care provider to prescribe for an infant with nasopharyngitis?

antipyretic

Dyslalia

articulation problems in speech

What psychosocial development stage are toddlers in according to Erikson?

autonomy vs. shame and doubt

Challenges of formula feeding

cost, storage and prep concerns

Prevention of Lyme Disease:

cover skin, light color clothing, promethin treated clothing, DEET

Which symptom would the nurse expect to find in a child with acute laryngotracheobronchitis?

barky, brassy cough

Why should NO honey be given to infants in their first year of life?

botulism

Infant nutrition for the first 6 months of life

breastmilk or fortified formula

Which is the MOST effective means of preventing dental caries in school-age children?

brushing teeth after meals, after snacks, and at bedtime

For which condition are infants with acute marasmus at risk if food is reintroduced too quickly?

cardiac failure

Which diet alternative would the nurse recommend to a 3-month-old infant who is allergic to cow's milk?

casein hydrolysate milk formula

Which is an important consideration related to stress in school-age children?

children are capable of identifying stress responses

Achievement of which cognitive task occurs during the school years?

conservation

Which is the most important factor in determining the degree of fit between an infant's temperament and the interactions between the child and parents?

harmony between the parent's expectations and the child's actual temperament

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child is experiencing tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse would tell the parent to bring the child to the clinic because these symptoms are indicative of what?

pneumothorax

Which postoperative nursing care must be provided for the child who had a tonsillectomy?

provide analgesics rectally or intravenously

The nurse observes a toddler playign with other children, then coming to the parent to be held, then returning to play with others. Which developmental task would the nurse recognize this toddler to be demonstrating?

rapprochement

Encopresis and constipation in the child

repeated inappropriate stooling in a child who has reached an age (4 yrs) where bowel control is expected

Enuresis in the child

repeated inappropriate voiding in a child who has reached an age (5 yrs) where bladder control is expected

Colic is self limiting meaning it...

resolves on its own by 12-16 weeks

Which recommendation would the nurse provide to the parent of a 6-month-old infant about the introduction of solid foods?

rice cereal is a good first food because it is easily digested and low in allergenic potential

Which developmental achievement is characteristic of the motor skills of a 24-month-old?

runs well with a wide stance

Which new gross motor skill would the nurse expect a 7-month old infant to perform?

sitting erect momentarily

Late stages of Lyme Disease (weeks to months)

stiff neck, swelling and arthritis in joints, facial palsy, arrhythmia

Which is the purpose of the peak expiratory flow rate (PEFR) test for a child with asthma undergoing pulmonary function tests?

to assess the severity of asthma

When an infant with congenital heart disease is given palivizumab, which is the purpose?

to prevent RSV

Which are clinical manifestations of failure to thrive?

undernutrition, developmental delays, avoidance of eye contact, apathy, withdrawn behavior, feeding or eating disorders

For how long do infants have iron stores from the prenatal period?

up to 6 months

Which gross motor developmental milestone would the nurse expect to observe in a 15-month-old?

walking alone, using a wide stance

Which is the MOST appropriate nursing intervention for a child after a tonsillectomy?

watching for continuous swallowing (early sign of bleeding)