Peds

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is:

Erikson

When providing care to a dying child and his family, which would be most important?

Focusing on the family as the unit of care

A 2-year-old child has been returned to the nursing unit after an inguinal hernia repair. Which pain assessment tool should the nurse use to assess this child for the presence of pain?

FLACC tool A behavioral pain tool should be used when the child is preverbal or does not have the language skills to express pain. The FLACC (face, legs, activity, cry, consolability) tool should be used with a 2-year-old child.

The teaching plan for the parents of a 3-year-old child with amblyopia (lazy eye) should include which instruction?

Cover good eye completely with a patch

The nurse is counseling the parents of a 10-year-old child who was caught stealing at school. Which topic should the nurse cover?

Discussing ways for the child to save face

Based on Erikson's developmental theory, what is the major developmental task of the adolescent?

Finding indentity

Which is the causative agent of scarlet fever?

Group A -hemolytic streptococci (GABHS)

The nurse is explaining to the student nurse the therapeutic effects of total parenteral nutrition (TPN). What accurately describes the use of TPN?

It is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals.

What is the single most important factor to consider when communicating with children?

The child's developmental level

What is an example of this method of discipline?

Time out

The nurse is preparing a nursing care plan for a child hospitalized for cardiac surgery. Which are examples of interventions that nurses perform in the 'building a trusting relationship' stage? Select all that apply.

-Preparing the child for a procedure by playing games - Explaining in simple terms what will happen during surgery

The nurse is determining the amount of IV fluids to administer in a 24-hour period to a child who weighs 40 kg. How many milliliters should the nurse administer?

1900

The nurse is performing a health assessment of a school-age child. Based on the child's developmental level, on which problem would the nurse focus more attention?

Accidents and injuries

Which situation poses the greatest challenge to the nurse working with a child and family?

Emergency hospitalization

Which nursing action is the most appropriate when applying a face mask to a child prescribed oxygen therapy?

Make sure the mask fits properly

The nurse is performing a physical examination on a sleeping newborn. Which body system should the nurse examine last?

throat

What is the most appropriate statement for the nurse to make to a 5-year-old child who is undergoing a venipuncture?

"This will hurt like a pinch. I'll get someone to help hold your arm still so it will be over fast and hurt less." Honesty is the best approach. Children should be told what sensation they will feel during a procedure. A 5-year-old child should not be expected to hold still, and assistance ensures safety to everyone. Telling the child that "This will be over in just a second" is not supportive or honest. Parents should be encouraged to remain with the child unless they are extremely uncomfortable doing so.

The neonatal nurse researches the neonatal and mortality rates in the United States. Which statements accurately describe these measurements of child health? Select all that apply.

-Neonatal mortality is the number of infant deaths occurring in the first 28 days of life per 1,000 live births -Neonatal mortality is documented as the number of deaths in relation to 1,000 live births. The infant mortality rate is used as an index of the general health of a country. -In 2007, the infant mortality rate in the United States was 6.8 per 1,000 live births.

The nurse is admitting a 7-year-old child to the medical-surgical unit. The child answers questions with very short answers, makes little eye contact with the nurse, and looks to the parent to answer most questions. Which interventions would be appropriate during this admission assessment? Select all that apply.

-When asking questions, look at the child as well as the parent. -Sit at the child's eye level during the admission questioning process.

The earliest age at which a satisfactory radial pulse can be taken in children is: a. 1 year b. 2 years c. 3 years d. 6 years

2 years Satisfactory radial pulses can be used in children older than 2 years. In infants and young children the apical pulse is more reliable. The radial pulse can be used for assessment at ages 3 and 6 years.

Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age?

3-4 months Binocularity is usually achieved by ages 3 to 4 months. Age 1 month is too young for binocularity. If binocularity is not achieved by 6 months, the child must be observed for strabismus*

After teaching the mother about follow-up immunizations for her daughter, who received the varicella vaccine at age 14 months, the nurse determines that the teaching was successful when the mother states that a follow-up dose should be given at which time?

4-6 years

By what age does the posterior fontanel usually close?

6-8 weeks

The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child's mother says that she has rubbed the edge of a coin on her child's oiled skin. The nurse should recognize that this is:

A cultural practice to rid the body of disease

The nurse is assisting low-income families to access health care. The nurse is aware that, in today's society, this most accurately defines the diversity of a modern family.

A family is whatever the child and family say it is

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents based on what knowledge concerning regressive behaviors?

Regression Regression is expected and normal for all age-groups when hospitalized. Nurses should assure the parents this is temporary and the child will return to the previously mastered developmental milestone when back home. This does not indicate a developmental delay. The child should not be experiencing urinary urgency because of hospitalization and this would not be normal. Successful "potty-training" can be started at 2 years of age if the child is ready.

The nurse is caring for a 7-year-old girl hospitalized in isolation. The nurse notices that she has begun sucking her thumb and changing her speech patterns to those of a toddler. What condition is the girl manifesting?

Regression Sucking the thumb and changing of speech pattern (such as to baby talk) are signs of regression, a defense mechanism used by children to deal with unpleasant experiences by returning to a previous stage that may be more comfortable to the child.

A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child?

Allow the child to hold the digital thermometer while taking the child's blood pressure.

The school nurse is conducting vision screening for a 7-year-old girl and documents the condition 'amblyopia.' What would the nurse tell the parents about this condition?

Amblyopia is reduced vision in an eye that has not been adequately used during early development.'

The nurse is assessing heart rate for children on the pediatric ward. What is a normal finding based on developmental age?

An infant's rate is 90 bpm The normal heart rate for an infant is 80 to 150 bpm, for a toddler is 70 to 120 bpm for a preschooler is 65 to 110 bpm, for a school-age child is 60 to 100 bpm.

Emma, age 3 years, is being admitted for about 1 week of hospitalization. The parents of a 3 year old being admitted tell the nurse that they are going to buy their child "a lot of new toys to help during the hospital." The nurse's reply should be based on an understanding of comfort measures for that age-group?

At this age children often need the comfort and reassurance of familiar toys from home. Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items.

A 14-year-old tells the nurse that he feels like he can never live up to his parents' standards and that they won't even discuss their rules. What parenting style do this child's parents most likely practice

Authoritarian

The nurse is providing developmentally appropriate care for a toddler hospitalized for observation following a fall down the steps. Which measures might the nurse consider when caring for this child? Select all that apply.

Avoid leaving small objects that can be swallowed in the bed. Encourage parents to stay to prevent separation anxiety.

The nurse is providing atraumatic care to children in a hospital setting. What are 1. principles of this philosophy of care? Select all that apply.

Avoid or reduce painful procedures Avoid or reduce physical distress Use core primary nursing

The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which heading?

Birth History

It is important to make certain that sensory connectors and oximeters are compatible since wiring that is incompatible increases the risk of which injury

Burns under sensors is important to make certain that sensor connectors and oximeters are compatible. Wiring that is incompatible can generate considerable heat at the tip of the sensor, causing second- and third-degree burns under the sensor. Incompatibility would cause a local irritation or burn, not hyperthermia. A low voltage is used, which should not present risk of electrocution. Pressure necrosis can occur from the sensor being attached too tightly, but this is not a problem of incompatibility.

The nurse is conducting a physical examination of a child following a comprehensive health history. What should be the focus of the physical examination?

Chief complaint

The nurse is weighing an underweight infant diagnosed with failure to thrive (FTT) and notes that the baby does not make eye contact and is less active than the other infants. What would be a probable cause for the FTT related to the infant's body language?

Maternal abuse

The nurse is performing an assessment on a child and notes the presence of Koplik's spots. In which communicable disease are Koplik's spots present?

Measles (rubeola)

A mother brings her 3-year-old daughter to the emergency department because the child has been vomiting and having diarrhea for the past 36 hours. When assessing this child's temperature, which method would be least appropriate?

Rectal

. The nurse is administering a hepatitis B vaccine to a child. What is the classification of this type of vaccine?

Recumbent

The nurse teaches parents of adolescents that adolescents need the support of parents andnurses to facilitate healthy lifestyles. What should be a priority focus of this guidance?

Reducing risk-taking behavior

The nurse volunteering at a homeless shelter to assist families with children identifies homelessness as a risk preventing families from achieving positive outcomes in life. What family theory encompasses this approach to assessing family dynamics?

Resiliency model of family stress, adjustment, and adaptation

Which common childhood communicable disease may cause severe defects in the fetus when it occurs in its congenital form?

Rubella Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not dangerous to the fetus.

A Chinese toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items such as Jell-O, Popsicles, and juices are left. What would best explain this?

The parent is trying to restore normal balance through appropriate "hot" remedies.

The nurse is caring for a 4-year-old girl of Mexican descent who is recovering in the hospital following a diagnosis of epileptic seizures. The child's mother insists on a visit from her curandera to provide healing powers to her daughter. What would be the best intervention of the nurse in this situation?

Discuss the situation with the child's physician and arrange for a visit from the curandera at the hospital if appropriate.

The nurse is examining the posture of a male toddler and notes lordosis. What would be the appropriate reaction of the nurse to this finding

Do nothing; this is a normal condition for toddlers.

The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned?

Draws a person with three body parts By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. She should also be able to copy triangles and other geometric patterns and dress and undress herself and should be learning to tie her shoelaces.

What is an appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler?

Encourage parents to room in A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible.

A lumbar puncture is needed on a school-age child. The most appropriate action to provide analgesia during this procedure is to apply:

Eutectic mixture of local anesthetics (EMLA) 1 hour before the procedure. EMLA is an effective analgesic agent when applied to the skin 60 minutes before a procedure.

The nurse is caring for an 8-year-old boy hospitalized for a bone marrow transplant. His parents are in and out of his room throughout the day. Which behaviors of the child would alert the nurse that he is in the second stage of separation anxiety?

He sits quietly and is uninterested in playing and eating. Feedback: Separation anxiety consists of three stages—protest, despair, and detachment. In the protest stage, the child reacts aggressively to separation and exhibits great distress by crying, expressing agitation, and rejecting others who attempt to offer comfort. In the despair phase the child displays hopelessness by withdrawing from others, becoming quiet without crying, and exhibiting apathy, depression, lack of interest in play and food, and overall feelings of sadness. In the detachment stage the child shows interest in the environment, starts to play again, and forms superficial relationships with the nurses and other children. If the parents return, the child ignores them. A child in this phase of separation anxiety exhibits resignation, not contentment.

The nurse is teaching the student nurse how to perform a physical assessment based on the child's developmental stage. Which statements accurately describes a recommended guideline for setting the tone of the examination for a school-age child?

Include the child in all parts of the examination; speak to the caregiver before and after the examination.

Which is probably the most important criterion on which to base the decision to report suspected child abuse?

Incompatibility between the history and injury observed

The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first?

Introduce self

The nurse is counseling a young couple who in 2 months are having their third baby. The nurse uses the family system theory applied to families to analyze the family structure. Which best describes the main emphasis of this theory and its application to family dynamics?

It emphasizes the family as a system with interdependent, interacting parts that endure over time to ensure the survival, continuity, and growth of its components

Which statement is most descriptive of pediatric family-centered care?

It recognizes that the family is the constant in a child's life. The key components of family-centered care are for the nurse to support, respect, encourage, and embrace the family's strength by developing a partnership with the child's parents. Family-centered care recognizes the family as the constant in the child's life. The nurse should support the cultural diversity of the family, not reduce its effect. The family should be enabled and empowered to work with the health care system and to be part of the decision-making process.

An adolescent male visits his primary care provider complaining of difficulty with his vision. When the nurse asks the adolescent to explain what visual deficits he/she is experiencing, the adolescent states, "I am having difficulty seeing distant objects; they are less clear than things that are close." What disorder does the nurse suspect the adolescent has?

Myopia

During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is: a. A normal finding. b. An abnormal finding; the child needs referral to an ophthalmologist. c. A sign of a possible visual defect; the child needs vision screening. d. A sign of small hemorrhages, which usually resolve spontaneously.

Normal finding A brilliant, uniform red reflex is an important normal and expected finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber.

An appropriate tool to assess pain in a 3-year-old child is the: (Select all that apply.)

Oucher tool FACES pain-rating scale ANS: C, D The Oucher tool can be used to assess pain in children 3 to 12 years of age. The FACES pain-rating scale can be used to assess pain for children 3 years of age and older

The nurse is transporting a 6-month-old with a suspected blood disorder to the nursery. What is the most appropriate method of transporting the child by the nurse?

Over the shoulder

The nurse is assessing a toddler for temperament and documents a 'difficult' temperament. Which traits are often seen in this type of personality?

Overly active Irritability

The nurse is explaining the difference between active and passive immunity to the student nurse. Which statement accurately describes a characteristic of the process of immunity?

Passive immunity can be obtained by injection of exogenous immunoglobulins.

Which is an appropriate play activity for a 7-month-old infant to encourage visual stimulation?

Peek a boo Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation.

A common characteristic of those who sexually abuse children is that

Pressure victim into secrecy

The nurse caring for a child on a pediatric intensive care unit notices that when the parents go to work the child is very angry and cries easily. What does the nurse suspect is occurring with this patient?

Protest phase

The nurse is preparing to assess the pulse of an 18-month-old child. Which pulse would be most difficult for the nurse to palpate?

Radial In a child younger than 2 years of age, the radial pulse is very difficult to palpate, whereas the pedal, brachial, and femoral pulses are usually easily palpated.

The nurse is performing a risk assessment of a 5-year-old and determines the child has a risk factor for cystic fibrosis. What type of screening would the nurse perform to confirm or rule out this disease?

Selective screening

1. What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

Separaition anxiety

During the first 4 days of hospitalization, an 18 month old cried inconsolably when his/her parents left and he/she refused the staff's attention. Now the nurse observes that the child appears to be "settled in" and unconcerned about seeing his/her parents. How should the nurse interpret this change in behavior?

The child may be experiencing detachment Detachment is the third stage in behavioral manifestation of separation anxiety. Superficially it appears that the child has adjusted to the loss and transferred his trust to the nursing staff. Detachment is a sign of resignation, not contentment. Parents should be encouraged to be with their child. If parents restrict visits, they may begin a pattern of misunderstanding the child's cues and not meeting his needs.

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based?

The family is the constant in the child's life and the primary source of strength.

A child needs a consent form signed for a minor surgical procedure. Which statement accurately describes the responsibilities of the health care providers when obtaining the consent?

The nurse is responsible for determining that the parents or legal guardians understand what they are signing by asking them pertinent questions

1. What should the nurse consider when having consent forms signed for surgery and procedures on children? a. Only a parent or legal guardian can give consent. b. The person giving consent must be at least 18 years old. c. The risks and benefits of a procedure are part of the consent process. d. A mental age of 7 years or older is required for a consent to be considered "informed."

The risks and benefits of a procedure are part of the consent process. The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances such as emancipated minors, the consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.

A parent of an 18 month old tells the nurse that the child says "no" to everything and has rapid mood swings. If scolded, the child shows anger and then immediately wants to be held. What is the nurse's best interpretation of this behavior

This is normal behavior for the child's age. Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18 month old.

The nurse teaching safety to teens knows that which of these is the leading cause of death among adolescents?

Unintentional injuries

Which action is most likely to encourage parents to talk about their feelings related to their child's illness?

Use open ended questions

The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select?

Vastus lateralis

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of what happening?

Viewing her baby sister's illness as her fault

When is a child with chickenpox considered to be no longer contagious?

When lesions are crusted

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. The nurse should explain that:

a topical anesthetic, eutectic mixture of local anesthetic (EMLA), will minimize the discomfort.

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?

axillary method

What type of family is one in which all members are related by blood?

consanguineous A consanguineous family is one of the most common types and consists of members who have a blood relationship.

During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is:

normal because the lower back and leg muscles are not yet well developed. Lateral bowing of the tibia (bowlegged) is common in toddlers when they begin to walk, not an abnormal finding. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children.

Which age-group is most concerned with body integrity?

school age

Which is the preferred site for intramuscular injections in infants

vastus lateralis