Peds-Growth and Development

A nurse is discussing the need for genetic counseling with a male teenager who has a sibling with cystic fibrosis (CF). The identification of which test by the teenager indicates that he understands the genetic counseling?

Carrier testing Rationale: More than one gene can cause cystic fibrosis (CF); carrier testing is done to detect known alleles. The results of a chest x-ray will not determine whether the individual is a carrier of CF; this may be one of the tests that are conducted when CF is suspected. A sweat chloride test is performed to diagnose CF, not to determine whether the adolescent is a carrier. CF does not result from a chromosomal anomaly.

Considerations in caring for an infant who is failing to thrive (FTT) should include: select all that apply

Dietary history, Signs of malnutrition, Familial stress factors, Parent and infant interaction, Sustained growth under 5th percentile Rationale: Dietary history should include type of feedings, as failure to thrive may be a result of an inadequate milk supply in a breast feeding mother. Signs of malnutrition can affect hair and skin. The infant also may be listless and slow to achieve milestones. Familial stress factors, such as depression and substance abuse, impact the ability of the caregiver to meet the infant needs. Lack of parent and infant interactions contributes to failure to thrive, as infancy is the time to develop trust or mistrust. Sustained growth under the 5th percentile indicates FTT. It is expected that an infant will double birth weight by 6 months of age. Weight in the 75th percentile indicates thriving.

While caring for a breastfeeding patient, the nurse instructs the patient to begin feeding the infant when the child is quiet and alert. The nurse observes that the infant begins fussing and crying. What behavior does the infant display?

Prefeeding behavior Rationale: The infant is crying and fussing, which indicates high arousal and hunger. This behavior is termed prefeeding behavior. To enable the infant to gain a proper grasp of the mother's breast, the nurse instructs the mother to begin feeding before the onset of prefeeding behavior. The infant who is satisfied with the feeding exhibits satiety and usually becomes calm and falls asleep. Sucking movements and rooting reflex indicate approach behavior. Consummatory behavior is demonstrated by coordinated sucking and swallowing.

What are the different patterns of physical development and maturation of neuromuscular functions in a child? Select all that apply.

Proximodistal, Cephalocaudal , Differentiation Rationale: Proximodistal development refers to near-to-far development in the infant. The infant first gains motor control of the shoulder and then the hands. Additionally, the infant's central nervous system (CNS) develops more rapidly than the peripheral nervous system (PNS). Cephalocaudal is the head-to-tail growth seen in a child. The infant achieves control of the head first, followed by the trunks and extremities. Infants gain control of their hands before they are able to control their feet. Differentiation refers to the development from simple operations to more complex activities and functions. For instance, early embryonal cells develop into an immensely complex organism made up of highly specialized and diversified cells, tissues, and organs. Sensorimotor development is not a pattern of development, but a part of the theory of cognitive development as proposed by Piaget. Fowler proposed the undifferentiated stage of spiritual development, in which the child has no concept of right and wrong to guide the child's behavior.

Which physiologic functions decrease in response to certain pubertal changes? Select all that apply.

Pulse rate, Basal heat production Rationale: Pubertal changes induce physiologic changes. The physiologic functions that decrease in response to pubertal changes include pulse rate and basal heat production. Blood volume, strength of the heart, and systolic blood pressure increase along with changes occurring during puberty. Pubertal changes herald adulthood and therefore the heart increases in size and strength and the systolic blood pressure increases to reach the adult level.

While assessing a stool sample from an infant, the nurse finds that the infant has passed golden-colored stool. What does the nurse interpret from this finding?

The infant is breastfeeding. Rationale: An infant who is being breastfed will pass golden-colored stool. An infant with jaundice will pass greenish-yellow stools due to excess bilirubin. An infant who is on formula milk will pass pale-yellow to light-brown stools. The first stool passed by an infant after birth is called meconium and is black and tarry.

Which aspects of the "self" do children assess while forming an evaluation of their self-esteem? Select all that apply.

Moral worth, Competence, Sense of control, Worthiness of love Rationale: A child's self-esteem is based on certain aspects of the personality. Moral worth helps develop self-esteem when children question if their actions and behaviors meet the established moral standards. Children assess their competence to understand the adequacy of their cognitive, physical, and social skills. One's sense of control is assessed by understanding if one can complete tasks needed to produce desired actions. Worthiness of love is important in developing self-esteem, as the child questions if he or she is worthy of the parent's love and acceptance from peers. Body image is an important element in shaping personality during adolescence, but not during childhood.

What should the nurse suggest when parents ask what to do about their preschooler's stuttering?

Speak clearly and do not complete the child's sentences. Rationale: During the preschool years speech dysfluency is a typical characteristic of language development; it will resolve if the child is spoken to clearly and is not corrected. Avoiding eye contact, supplying the correct word, or drawing attention to the stuttering is demeaning; it may decrease the child's self-esteem and worsen the stuttering.

A 1-month-old infant is fed breast milk exclusively. The parent asks the nurse if fluoride supplementation is required. What is the best response from the nurse?

"Fluoride supplementation may result in dental fluorosis." Rationale: Fluoride supplementation before 6 months of age may result in dental fluorosis. Fluoride supplementation is not associated with hot climates. The appearance of the child does not determine the need for fluoride. Fluoride supplementation is necessary only if the breastfeeding mother's water supply does not contain the required amount of fluoridation, and not after 3 months of age.

During follow-up visits, the nurse informs the mother of a 3-month-old infant how to feed the infant expressed milk. Which statements by the mother indicate effective learning? Select all that apply.

"I can express milk by hand or with a breast pump.", "I can store expressed milk in the refrigerator for 5 days." Rationale: Expressing milk by hand or with a breast pump does not result in contamination. Expressed milk can be stored in the refrigerator at a temperature of 4° C or 39° F for 5 days without bacterial contamination. Giving excess water to infants of less than 4 months of age can result in hyponatremia and water intoxication. High temperatures can spoil expressed milk; therefore, the expressed milk should not be stored at room temperature. Honey can cause botulism in infants.

Which characteristics does the nurse observe in a patient who has secondary amenorrhea?

Absence of menstrual bleeding for three cycles after menarche Rationale: When the patient's menstrual cycle is absent three successive times after menarche, it indicates secondary amenorrhea. The absence of uterine bleeding 4 years after breast development indicates primary amenorrhea. The absence of uterine bleeding and secondary sex characteristics at the age of 16 years indicates primary amenorrhea. No uterine bleeding for 1 year after attaining a sexual maturity rating of 5 on the Tanner scale is indicative of primary amenorrhea.

The diabetic parent of a school-age child receives home care education for diabetes. The parent needs to take multiple medications. Which instruction does the nurse give for the child's safety?

"Store medications away from the child's reach." Rationale: The school-age child is at risk of being poisoned if there is ingestion of any drugs or medications. Therefore, the nurse instructs the parent to store the medicines out of reach of the child. Telling the child that the medicines are bitter is not an effective suggestion. Instead, the parents should teach the child about the risks of consuming the medication. The parent can take the medication in front of the child, as it is not going to affect the child in any way. Keeping the medications near the bed may be dangerous, as the child can easily access it.

The parents inform the nurse that their child is often seen daydreaming. What does the nurse inform the parents?

"The child is exhibiting normal behavior seen in children." Rationale: Sometimes a child can be found engaging in unoccupied behavior, wherein the child focuses attention on anything that is of interest, such as daydreaming. Therefore, the nurse should inform the parents that it is a normal behavior seen in children. Onlooker play is different from daydreaming, as it is characterized by the child actively observing when other children are playing. A child may also engage in daydreaming even while playing with other children. Neurological issues would be suspected if the child exhibited jerking movements or experienced fainting spells.

What does the nurse expect the primary health care provider (PCP) to advise the parents after their child is diagnosed with a mitochondrial disorder?

"You may need to use a donor egg or sperm for future children." Rationale: The nurse informs the parents about alternative options, such as the use of a donor egg or sperm for the next pregnancy. This is because there are an increased risk for mitochondrial disorder in future children. The diagnosis of mitochondrial disorder in this child does not carry an increased chance of miscarriage for the mother in future pregnancies. It is not a good idea to encourage the parents to look for additional information on the Internet, as some information may be inaccurate.

An adolescent is hospitalized with multiple internal injuries after an automobile collision. The adolescent is being kept NPO and is receiving an IV infusion at 125 mL/hr and an antibiotic reconstituted in 10 mL of normal saline every 6 hours (6 am, 12 pm, 6 pm, 12 am). What is the intake from 7 am to 3 pm? Record your answer as a whole number with no punctuation. ___ mL

1010

The nurse is teaching an adolescent about the different methods of contraception. Which statement made by the adolescent indicates a need for further teaching?

A diaphragm is a soft rubber dome with a firm but pliable rim. Rationale: A diaphragm is a contraceptive device used along with spermicidal jelly to cover the cervical opening. A cervical cap is a soft rubber dome with a firm, pliable rim. A condom covers the penis and traps the sperm. Condoms need to be used consistently and may cause decreased spontaneity. Lea's shield is a reusable vaginal contraceptive that is elliptical in shape. However, it is not effective in women who have already delivered a baby, as the vagina does not remain elliptical. The cervical cap should not be used by women who have a history of toxic shock syndrome.

The mother of a 17-year-old adolescent who is going to be a foreign exchange student asks the nurse why her child must have a tetanus toxoid immunization instead of tetanus immunoglobulin. The nurse responds that the tetanus toxoid immunization provides:

Longer-lasting active immunity Rationale: Toxoids are modified toxins that stimulate the body to form antibodies that can last up to 10 years against the specific disease. Because the adolescent will be in a foreign country, the tetanus toxoid is given prophylactically. The tetanus toxoid provides active, not passive, immunity; all passive immunity is short acting. Only by having the disease can a person gain natural immunity.

The nurse is caring for an infant who has been prescribed nystatin (Mycostatin). The nurse teaches the mother how to prevent aggravation of oral thrush. Which statements by the mother indicate the need for further teaching? Select all that apply.

"I should boil the pacifier for at least 20 minutes on alternate days." "I should apply the medication at least 20 minutes before feeding." "I should boil the reusable nipples for at least 5 minutes after washing." Rationale: Nystatin (Mycostatin) is used to treat oral thrush in infants. Boiling the pacifier for 20 minutes on alternate days can increase the risk of infection because daily boiling of the pacifier is the best way to ensure efficient sterilization and killing of pathogens. Therefore, pacifiers should be boiled daily for at least 20 minutes. Nystatin (Mycostatin) should be administered to the child after feeding, not before feeding. Reusable nipples should be boiled at least 20 minutes after washing to remove spores, which are heat-resistant. Rinsing the infant's mouth after feeding with plain water reduces the risk of infection in the infant. Nystatin (Mycostatin) should be applied four times a day to the infant's oral cavity to ensure effective drug action.

A practitioner recommends that an adolescent with the diagnosis of osteogenic sarcoma have the affected leg amputated and then be treated with chemotherapy. The parents are concerned about what to tell their child and ask the nurse for advice. The nurse suggests that they discuss the:

Amputation and provide information about chemotherapy Rationale: Honesty is essential in helping the adolescent accept the loss of the leg; only a brief discussion of chemotherapy is needed because otherwise the adolescent may be overwhelmed. A theoretical discussion and detailed information will not be heard or understood during a crisis situation. The amputation is necessary; lying avoids the issue and may destroy the adolescent's trust in parents and staff.

An adolescent with type 1 diabetes is brought to the emergency department in ketoacidosis. The adolescent admits to not adhering to the diabetic regimen. What can the nurse do to help the adolescent become more accepting of the diabetic regimen?

Encourage the adolescent to express feelings about having diabetes. Rationale: Psychosociocultural factors related to chronic illness often affect individual adherence to a medical regimen, particularly in an adolescent. These feelings must be explored and addressed before there can be acceptance of the treatment plan. The adolescent's feelings should be explored before it is determined what the adolescent knows about diabetes. Although it is important for the parents to demonstrate acceptance, adolescents need control and therefore the teaching must begin with the adolescent. Printed materials may be helpful later, but scare tactics rarely prompt changes with any lasting benefit.

What play activity should the nurse provide for a 4-year-old child on bedrest?

Finger painting on blank sheets of paper Rationale: Finger painting is appropriate for this age child; it provides the child an opportunity for free expression, and its freeform nature can give the child a sense of mobility. Coloring within the lines of pictures in a coloring book requires more skill than most 4-year-olds possess; also, it does not allow freedom of expression or movement. Checkers is a game with too many rules for a 4-year-old to comprehend. Playing dominoes requires the ability to count and conserve numbers, which most 4-year-olds do not possess.

The nurse is preparing to bathe a neonate born at 30 weeks gestation. Which practices by the nurse ensure the infant's safety? Select all that apply.

Immerses the neonate fully (except the head) in the tub, Measures the body temperature within 2 to 4 hours before giving the bath, Uses cleansing agents with neutral pH and minimal dyes while giving the bath Rationale: A neonate born before 32 weeks of gestational age is known as a preterm infant. Immersing the neonate's head in water during a bath can increase the risk of respiratory depression. The neonate's body temperature should be stable 2 to 4 hours before giving the initial bath. Therefore, the nurse monitors body temperature before giving a bath. Cleansing agents with neutral pH and minimal dyes reduce skin irritation, so these are used when bathing the neonate. The nurse should give a warm-water bath every second or third day, not daily, to prevent hypothermia. Removing vernix completely during the initial bath can alter thermoregulation in a neonate.

A preschooler with partial-thickness burns on 21% of the total body surface area progresses from the emergency phase to the acute phase of burn care. What is the most important nursing intervention at this time?

Instituting a pain management plan Rationale: Implementing a pain-management plan is the priority action of the medical and nursing staff. There is less physiological stress when the child's pain is managed, which allows healing to occur. Although monitoring of intake and output, monitoring for infection, and maintaining nutrition are all important and will be done, none of these is the priority.

A 13-year-old adolescent is found to have idiopathic scoliosis. Because exercise and avoidance of fatigue are essential components of care, which sport should the nurse suggest as the most therapeutic for this preadolescent?

Swimming Rationale: The hyperextension required in swimming helps strengthen back muscles and necessitates deeper respirations, both of which are necessary before surgery and before wearing a brace or cast. The other options involve twisting the back muscles, which is not therapeutic for a child with this condition.

A nurse is assessing an adolescent after the administration of epinephrine. What side effect is most important for the nurse to identify?

Tachycardia Rationale: Epinephrine is a sympathetic nervous system stimulant that causes tachycardia. Hyperglycemia, not hypoglycemia, may result. The pupils will be dilated, not constricted. Epinephrine is more likely to cause hypertension than hypotension.

Which assessment findings of a child would indicate a need for genetic consultation? Select all that apply.

Visual or hearing problems , Family history of mental illness, Development and speech delays, Excessive bleeding or excessive clotting Rationale: Visual or hearing problems may indicate a genetic disorder and should be assessed thoroughly. Mental illness is a hereditary disorder that can be transmitted through genes to the child. Therefore, a family history of any mental illness indicates a need for genetic consultation so that preventive measures and treatment can be initiated. Development and speech delays may indicate a genetic disorder, like autism or another behavioral disorder. Bleeding disorders like sickle cell anemia are also inherited and need genetic consultation. Fetal alcohol syndrome is not inherited, but caused by maternal consumption of alcohol during pregnancy.