Pediatrics Ch. 29

What is the correct selection of a blood pressure cuff?

Bladder width of approximately 40% of the arm circumference; typically covers 80-100% of the circumference of the arm. Too small cuff reading will be falsely high. Too large cuff reading will be falsely low.

Early childhood communication considerations

Children are egocentric and only able to see things from their point of view. Communication should be focused on them, and equipment should be removed from sight until it is time to be used. Avoid abstract phrases such as "coughing your head off" or "stick in the arm". Explain what, how, and why things are being done.

What is the correct order of vital signs in children?

1. Respirations before disturbing child 2. Apical heart rate 3. BP 4. Temperature

Recumbent length and head circumference for infants is measured up to _____

36 months of age

Standing height and weight is measured after _____

37 months of age

At what values are growth chart percentages considered outside expected parameters?

< 5th percentile > 95th percentile for weight, height, and head circumference

The nurse is seeing an adolescent boy and his parents in the clinic for the first time. Which of the following should the nurse do first? A. Introduce self. B. Make family comfortable. C. Explain purpose of interview. D. Give assurance of privacy.

ANS: A

Head-to-toe assessment modifications for younger children

Auscultate heart and lung sounds first while the child is quiet.

Which of the following is an important consideration for the nurse who is communicating with a very young child? A. Speak loudly, clearly, and directly. B. Use transition objects, such as a doll. C. Disguise own feelings, attitudes, and anxiety. D. Initiate contact with child when parent is not present.

ANS: B Because children like to play, puppets, dolls, and replicas of familiar or unfamiliar objects, serve as excellent means of communicating with small children.

What is the single most important factor to consider when communicating with children? A. The child's physical condition B. Presence or absence of the child's parent C. The child's developmental level D. The child's nonverbal behaviors

ANS: C The normal development of language and thought offers a frame of reference for communicating with children. As children mature their thought processes progress from sensorimotor to perceptual to concrete and finally to abstract, formal operations. Understanding this provides the nurse with a framework to facilitate communication.

Which of the following is an appropriate approach to performing a physical assessment on a toddler? A. Always proceed in a head-to-toe direction. B. Perform traumatic procedures first. C. Use minimal physical contact initially. D. Demonstrate use of equipment.

ANS: C When assessing a toddler the nurse should use minimum physical contact in the beginning and introduce equipment slowly. The child may feel more at ease while sitting in the parent's lap. Traumatic procedures are performed last because the child may become upset and this can interfere with the remainder of the assessment.

The nurse is using the NCHS growth chart for an African-American child. Which of the following should the nurse consider? A. This growth chart should not be used. B. Growth patterns of African-American children are the same as for all other ethnic groups. C. A correction factor is necessary when the NCHS growth chart is used for non-Caucasian ethnic groups. D. The NCHS charts are accurate for U.S. African-American children.

ANS: D The revised growth charts include all infants and children whatever their race or ethnicity because the differences in size and growth that occur among major racial groups in the United States appear to be small and inconsistent. Special charts are used for preterm and very low-birth-weight infants.