Pediatric Well-child and Milestones
A nurse is assessing a 6-year-old client at a well-child visit. Which of the following findings requires further assessment by the nurse? Correct: - Presence of sparse, fine pubic hair The development of sexual characteristics prior to the age of 9 years in boys and 8 years in girls is an indication of precocious puberty and requires further evaluation.
- The deciduous teeth start shedding at this age, beginning with the lower central incisors. - Body proportion varies with a slimmer appearance and longer legs in a school-age child. Leg length increases and waist circumference decreases related to height in this age group. - The head circumference of a school-age child decreases when compared to full height due to skeletal lengthening.
A nurse is preparing to assess a 3-month-old infant during a well-child visit. Which of the following observations should the nurse expect? Correct: - The infant looks at his hands Infants usually start to look at their hands while lying down or sitting between 12 to 20 weeks of age. Convergence on near objects is usually well established by 3 months of age
Expected 3-month-old milestones: - A partial to slight head lag -
A nurse in a pediatric clinic is talking with the parent of a toddler who states that her child will not sit at the table to eat with the family. She asks the nurse for recommendations for "finger foods" for her child. Which of the following foods should the nurse suggest? Correct: - Slices of ripe banana Toddlers should have about 8 oz (1 cup) of fruit per day. Bananas are nutritious and, as long as they are soft, do not present a choking hazard for young children.
Popcorn, chunks of cheese, and raisins present choking hazards for young children. Hot dogs, sausages, and tough meat present choking hazards for young children. Raw carrots, nuts, and seeds present choking hazards for young children.
A nurse is performing a well-child assessment on a 7-year-old client who takes great pride in bringing school papers home. The nurse recognizes that this behavior demonstrates which of the following of Erikson's stages of psychosocial development? Correct: - The developmental task of industry vs. inferiority is reflected by a child's level of motivation in relation to personal achievements that build good character during the school-age years (ages 6 to 12 years).
- Initiative vs. guilt is the developmental task of early childhood (ages 3 to 6 years). - Identity vs. role confusion is the task of the adolescent (ages 13 to 19 years). - Autonomy vs. shame and doubt is the developmental task of a toddler (ages 12 months to 3 years).
A nurse is assessing an 18-month-old toddler during a well-child examination. Which of the following findings should the nurse report to the provider? Correct: - The toddler is unable to remove his shoes An 18-month-old toddler should be able to remove his or her own shoes, socks, and gloves. The nurse should report this finding to the provider.
Expected 18-month-old toddler milestones: - Able to remove his or her own shoes, socks, and gloves. - able to turn 2 to 3 pages in a book. - A vocabulary of 10 or more words. - Have 12 teeth. - Anterior fontanel is closed
A nurse is performing a well-child assessment on a 4-year-old child. Which of the following findings should the nurse expect? Correct: - The child is able to hop on 1 foot. The nurse should expect a 4-year-old child to have the gross motor ability to hop on 1 foot.
The skill of hopping on 1 foot is not developed until around the age of 4 years.
2-year-old
Expected 2-year-old milestones: - Speaking in 2- to 3-word sentences is typical of a 2-year-old child. - Able to turn a single page in a book - State his/her name and typically refers to self by name as opposed to using the correct pronoun. - Able to follow and complete simple directional commands. - Have all of her primary teeth (ten teeth on top and ten teeth on the bottom — totaling up to 20), by the time they reach 2 to 3 years of age -
3-year-old A nurse is assessing a 3-year-old preschooler. Which of the following developmental milestones should the nurse expect the preschooler to demonstrate? Correct: - The nurse should expect a 3-year-old preschooler to have the fine motor ability to stack 10 blocks.
Expected 3-year-old milestones: - Building a tower of 9 to 10 blocks. - Draw a circle - Copy a circle - Place beads into a small bottle. - Put on shoes - Language ability to use 3- to 4-word sentences. - Might be able to play a game with simple rules - Bedwetting during sleep
A nurse on a pediatric unit is caring for a preschooler who is prescribed an IV medication. Which of the following actions should the nurse take to prepare the child for the procedure? Correct: - Use role-play activities with the child Using role-play activities with the child will decrease the child's anxiety about the procedure. This will also provide an opportunity for the nurse to clarify any misconceptions the child might have about the procedure.
The nurse should avoid giving a detailed explanation of the procedure because this could increase the child's anxiety. The nurse should explain the procedure to the preschooler using simple words and phrases. To maintain the child's attention, the nurse should limit interactive sessions for a preschooler to 10 to 15 minutes each. The nurse should allow the child to see, hold, and ask questions about needleless IV supplies to familiarize the child with the potentially frightening aspects of the procedure, which will decrease the child's anxiety. Giving the child identical IV supplies to play with is a major safety risk because the child may be injured by the needle.
A nurse on a pediatric unit is admitting a 4-year-old child. Which of the following toys should the nurse plan to provide for the child to engage in independent play? Correct: - Plastic stethoscope Preschool play centers on imitative activities. Providing a stethoscope allows the child to engage in therapeutic play. Imitating health care personnel may ease the child's fear of unfamiliar equipment.
A brightly colored mobile is appropriate for a young infant but does not meet the activity needs of a preschool-age child. A small-piece jigsaw puzzle is too difficult for most preschool-age children and can frustrate them rather than entertain them. A 4-year-old child is not able to read independently a book of short stories. The nurse should provide a picture book instead.
During a well-child visit, the guardian of a toddler reports that the toddler takes several hours to fall asleep at night. Which of the following recommendations should the nurse make? Correct: - Provide the toddler with a favorite stuffed animal at bedtime. Providing the toddler with a favorite soft toy at bedtime can help the toddler feel more secure and facilitate sleep.
A consistent bedtime routine is helpful in promoting sleep for a toddler. Watching television before bedtime can stimulate the toddler and cause sleep disturbances. Activity should be decreased prior to bedtime to facilitate sleep because increased activity can stimulate the toddler and cause sleep disturbances.
A nurse is assessing a 9-month-old infant. Which of the following findings should the nurse report to the provider as a possible developmental delay? Correct: - Inability to vocalize vowel sounds The infant should begin vocalizing vowel sounds at the age of 7 months. By the age of 10 months, the infant should be able to say at least 1 word.
Expected 9-month-old milestones: - A crude pincer grasp - Use of a dominant hand is also evident. - Able to sit alone - Drinking well from a cup - Creep on hands and knees -
A nurse is assessing a 1-week-old infant at a well-child visit. The nurse should notify the provider about which of the following assessment findings? Correct: - A blue coloring of the sclera This discoloration is associated with osteogenesis imperfecta, a genetic disorder that results in bone fragility. The nurse should notify the provider of this finding.
Findings that do not require notification of the provider.: - An area of deep blue pigmentation over the buttocks.. This discoloration is known as a Mongolian spot. It is typically observed in infants who have increased skin pigmentation (e.g., those of African, Asian, or Hispanic descent) - A flat, dark pink area between the eyes that blanches. This discoloration is known as a nevus simplex, or stork bite. It typically blanches with pressure and becomes more prominent with crying - A patchy, red rash with raised centers. This discoloration is known as erythema toxicum, or newborn rash. It is a benign, transient finding
A nurse is teaching the parents of a 4-month-old infant who has gastroesophageal reflux. Which of the following statements by a parent indicates an understanding of the teaching? Correct: - "I will add 1 teaspoon of rice cereal per ounce to my baby's formula." The parents can give the infant thickened feedings with rice cereal to help decrease reflux. The added calories also can help infants who are underweight due to gastroesophageal reflux.
Infants who have gastroesophageal reflux should be placed in a supine position with the head elevated. An infant who has gastroesophageal reflux can benefit from an H2 receptor antagonist or proton pump inhibitor. Decreasing the number of feedings per day is contraindicated.
A nurse in an acute pediatric unit is caring for a 2-year-old child who has separation anxiety when her parents to leave for work. The nurse should identify which of the following behaviors as a manifestation of the stage of despair? Correct: - The child is withdrawn and refuses to talk. Separation anxiety manifests in 3 stages: protest, despair, and detachment. Withdrawal and lack of communication are manifestations of the stage of despair.
Separation anxiety manifests in 3 stages: protest, despair, and detachment. - Stage of protest: manifestations such as physical attacks (The child tries to bite the nurse, attempts to run away to find her parents, screaming and loud crying) - Stage of despair: manifestations such as withdrawal and lack of communication (The child is crying, withdrawn and refuses to talk) - Stage of detachment: loss of the original attachment, and children are emotionally distant from an attachment figure even if they returned.
A nurse at a clinic is preparing to administer immunizations to a 5-year-old child. Which of the following immunizations should the nurse plan to give? Correct: - Diphtheria, tetanus, and pertussis (DTaP) Children should receive booster doses of the DTaP immunization between the ages of 4 and 6. Around this age, blood titers drop due to decreasing antibodies.
- Pneumococcal (PCV). Infants should receive the PCV immunization at 2 months, 4 months, and 6 months, as well as the fourth dose between 12 and 18 months. - Haemophilus influenzae type B (Hib). Infants should receive the Hib immunization at 2 months, 4 months, and 6 months, as well as the fourth dose between 12 and 18 months. - Hepatitis B (Hep B). The infant should receive the Hep B immunization at birth, 1 to 2 months, and 6 to 18 months.
Erikson's psychosocial stages of development: A nurse is planning care for a preschooler who is scheduled for a surgical procedure. The nurse should identify that the preschooler is in which of the following of Erikson's psychosocial stages of development? Correct: - Initiative vs. guilt A preschooler is in the developmental stage of initiative versus guilt. Preschoolers initiate play activities and experience a feeling of guilt if their efforts at independence receive a negative reaction from caregivers.
- The nurse should identify that an infant is in the developmental stage of trust versus mistrust. In this stage, a caregiver's response to the infant's needs builds trust and reassures the infant that his or her needs are being met. A caregiver who is inconsistent or rejecting can cause a feeling of mistrust.
A school bus crash in the community creates an urgent need for pediatric hospital beds. Which of the following clients should the nurse manager recommend for discharge? Correct: - A preschooler admitted with tonsillitis who has been receiving oral antibiotics for 24 hr This preschooler admitted with tonsillitis is stable and is receiving oral antibiotics; therefore, the preschooler can be discharged with antibiotics to be continued at home.
A school-age child admitted the day before with status asthmaticus has an acute illness and is not considered stable; therefore, the child should remain hospitalized. A toddler admitted the day before with dehydration is not considered stable; therefore, the toddler should remain hospitalized. An adolescent who has acute glomerulonephritis and a urine output of 20 mL/hr is not stable; therefore, the adolescent should remain hospitalized.
A nurse on a pediatric unit is caring for a child who has autism spectrum disorder. Which of the following actions should the nurse take? Correct: - Ensure that staff visits with the child are kept short Children who have autism spectrum disorders have difficulty adjusting to new situations. The staff members should keep interactions with the child as brief as possible.
Children who have autism spectrum disorders have difficulty adjusting to new situations. The nurse should assign this child to a private room with decreased auditory and visual stimulation to assist the child's adaptation. Children who have autism spectrum disorders prefer minimal physical contact. The nurse should refrain from holding or restraining the child and should reduce eye contact as much as possible to prevent outbursts. Children who have autism spectrum disorders have difficulty redirecting their focus and changing activities. The nurse should clearly state expectations and instructions at the appropriate developmental level and should not provide choices about scheduling planned care.
A nurse is assessing a 4-year-old child for growth and developmental milestones during a well-child visit. Which of the following findings suggests a possible delay in development? Correct: - Speaking using 2- or 3-word sentences
Expected 4-year-old milestones: - Speaking in 4- to - 5-word sentences. - Adding 3 parts to a stick figure - Have the gross motor ability to hop on 1 foot. - Ability to catch a ball
A nurse at a clinic is preparing to administer immunizations to a 5-year-old child. Which of the following immunizations should the nurse plan to give? Correct: - Diphtheria, tetanus, and pertussis (DTaP) Children should receive booster doses of the DTaP immunization between the ages of 4 and 6. Around this age, blood titers drop due to decreasing antibodies.
Infants should receive the PCV immunization at 2 months, 4 months, and 6 months, as well as the fourth dose between 12 and 18 months. Infants should receive the Hib immunization at 2 months, 4 months, and 6 months, as well as the fourth dose between 12 and 18 months. The infant should receive the Hep B immunization at birth, 1 to 2 months, and 6 to 18 months.
A nurse is assessing a 4-year-old child's cognitive development during a well-child visit. Which of the following should the nurse expect the child to display? Correct: - Development of the superego This is the development of a conscience. Preschoolers begin to develop an understanding of right from wrong. While they might be unable to understand the "why" of acceptable vs unacceptable behaviors, they learn the concept through punishment and reward and the principles to which their parents adhere.
Conservation is the ability to understand that quantity does not change if shape changes. The ability to understand conservation typically develops in a school-age child. Concrete operational thought. This is the ability to use previous experiences to solve current problems, which typically develops in the school-aged child. Separation anxiety. Preschoolers are typically able to tolerate brief periods of separation from their parents and interact with unfamiliar persons.
Immunizations: DTaP: Children should receive a total of five DTaP immunizations during childhood. The first four doses are administered at 2, 4, 6, and 15 to 18 months of age. The fifth dose is received at 4 to 6 years of age. IPV: Children should receive three doses of the IPV vaccine by the age of 6 months. The next scheduled dose of IPV is recommended at 4 to 6 years of age. HepB: Hib: Rotavirus: MMR: Varicella:
The common adverse effects of vaccine administration are low-grade fever, pain at the injection site, and drowsiness. Some of the contraindications to vaccine administration are severe febrile illness, immunocompromise, or previous allergic reaction. Children who have an acute febrile illness should not receive immunizations, because the adverse effects of the immunization could be mistaken for the disease. Children who are immunocompromised should not receive live virus vaccines, because it increases their susceptibility to the disease.
A nurse on a pediatric mental health unit is caring for a school-age child. Which of the following questions or statements should the nurse provide to foster a rapport and encourage conversation? Correct: - "Tell me about your favorite video game." The nurse should use the therapeutic communication technique of exploring to encourage the child to respond with more than just the name of the game. This type of communication fosters a rapport and encourages communication.
The nurse should avoid the use of closed-ended questions when attempting to foster a rapport: "Do you like school?" and "Would you like your friends to visit you?" These type of questions typically results in a yes or no answer and does not encourage further communication. When the nurse say, "We have another child your age on the unit.". the nurse should avoid nontherapeutic statements that shift the focus away from the client and do not show interest in him as an individual.
A nurse is preparing to administer routine immunizations to a 6-year-old child. In addition to the diphtheria, tetanus, and pertussis (DTaP) vaccine; the measles, mumps, and rubella (MMR) vaccine; and the varicella vaccine, which of the following immunizations should the nurse plan to administer? Correct: - Inactivated poliovirus vaccine (IPV) The nurse should plan to administer the fourth dose of the inactivated poliovirus vaccine between 4 and 6 years of age. The first 3 doses are administered between 2 and 18 months of age..
The nurse should verify that the child received the Hib vaccine at age 2, 4, and 6 months as well as at age 12 to 15 months. This immunization is not routinely administered at 6 years of age. The nurse should verify that the child received the pneumococcal conjugate vaccine at 2, 4, 6, and 12 to 15 months of age. This immunization is not routinely administered at 6 years of age. The nurse should verify that the child received the HBV vaccine within 12 hours after birth and received additional doses at 1 to 2 months and 6 to 18 months of age. This immunization is not routinely administered at 6 years of age.
A nurse is caring for a newborn. The nurse should obtain informed consent before taking which of the following actions? Correct: - Giving the hepatitis B vaccine The nurse must obtain informed consent from the newborn's guardian before administering the hepatitis B vaccine.
These actions does not require the nurse to obtain informed consent from the newborn's guardian: - Administering erythromycin ophthalmic ointment - Conducting a newborn hearing screening - Screening for critical congenital heart disease
A nurse at a pediatric clinic is assessing a 5-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? Correct: - Head lagging when the infant is pulled from a lying to a sitting position At the age of 5 months, the infant should have no head lag when pulled to a sitting position; therefore, the nurse should report this finding to the provider.
Expected 5-month-old milestones: - Can visually follow a dropped object but is unable to pick up the object until around the age of 6 months. -
A nurse is assessing a 6-month-old infant during a well-child visit. Which of the following motor activities should the nurse expect the infant to have achieved? Correct: - Turning from back to stomach
Expected 6-month-old milestones: - Roll from their back to their abdomen - Grab the feet and pull them to their mouth - Pick up a dropped object - Hold a bottle. - Double their birth weight
A nurse in the emergency department is caring for an unaccompanied infant following a motor-vehicle crash. During the assessment, the nurse notes that the infant's anterior fontanel is almost closed. She has 6 teeth, is able to sit unsupported, and can drink from a cup. The child cries whenever anyone new to her enters the room, says a few words, and is asking for "mama" and "dada." The nurse should make which of the following age assessments for this child? Correct: - 12 months old
The nurse should know that this infant must be less than 18 months old because her anterior fontanel is still open. The infant is approximately 12 months old due to the presence of 6 teeth. Her skills—sitting unsupported (8 months), drinking well from a cup (9 months), stranger anxiety (8 months), and ability to say 2 words (12 months)—should also help the nurse estimate the infant's age as 12 months.
