Peds- Chapter 32
Avoid which route of temperature measurement in the immunosuppressed child as well as the child who has a bleeding disorder, diarrhea, or a history of rectal surgery.
Rectal route
A nurse is preparing to administer drug X 750 mg PO four times each day to a client. The amount available is 200 mg/5 mL.How many mL should the nurse administer per dose? (Round the answer to the nearest hundredths place).
750mg/200mg= 3.75 3.75*5ml= 18.75ml/dose
The nurse is assessing the heart rate of a healthy 13-month-old child. The nurse knows to auscultate which of the following sites to obtain an accurate assessment?
Apical pulse at the third or fourth intercostal space
Inability to straighten the foot in an infant may indicate what?
Clubfoot
What should be obtained from a child visiting a pediatrician's office for the first time?
Comprehensive health history
What may be noticed in the infant's extremities in the first month of life?
Slight tremors
In children you should assess for symmetry in size, color, contour, movement, warmth, and color of what?
The extremities
This instrument is used to assess the mobility of the eardrum (tympanic membrane)
Tympanometer
The nurse is examining the posture of a male toddler and notes the condition "lordosis." What would be the appropriate reaction of the nurse to this finding? A) Explain that the child will need a back brace. B) Refer the toddler to a physical therapist. C) Do nothing; this is a normal condition for toddlers. D) Notify the primary care healthcare provider about the condition.
C) Do nothing; this is a normal condition for toddlers. Feedback: The toddler demonstrates lordosis (swayback) and bowlegs, with a relatively large head and protuberant belly. This is a normal condition and requires no further attention.
The nurse is assessing the neck of an 8-year-old child with Down syndrome. Which of the following findings would the nurse expect during the examination? A) Webbing B) Excessive neck skin C) Lax neck skin D) Shortened neck
C) Lax neck skin Feedback: Lax neck skin may occur with Down syndrome. Webbing or excessive neck skin folds may be associated with Turner syndrome. A shortened neck is expected in a child younger than age 4.
A nurse is preparing to administer drug X 0.1mg/kg/dose PO every 6 hours to a child who weighs 28 pounds. Available is drug X oral solution 0.5 mg/5mL. How many mL should the nurse administer per dose? (Round the answer to the tenth place)
28lbs/2.2= 12.7272727kg 0.1*12.7272727= 1.2727mg 1.2727mg/0.5mg * 5ml= 12.72= 12.7/dose 12.7 ml every 6 hours (rounded to the tenths)
The nurse is conducting a routine health assessment of a 3-month-old boy and notices a flat occiput. The nurse provides teaching and emphasizes the importance of tummy time. Which of the following responses by the mother indicates a need for further teaching? A) "I should have him sleep on his tummy." B) "I need to watch him during his tummy time." C) "I need to change his head position while he is in an upright chair." D) "His head has flattened due to the pressure of his head position."
A) "I should have him sleep on his tummy." Feedback: The nurse needs to emphasize that the boy must be observed and awake during the recommended "tummy time" and to remind the mother that the baby should still sleep on his back. The other statements are correct.
The nurse has four assigned clients. Which patient should the nurse assess first? A) 8 y.o. with respiratory rate of 32 and suprasternal retractions B) 10 y.o. with cystic fibrosis who has a productive cough C) 4 y.o. with thick yellow nasal drainage and a cough D) 5 y.o. with an ear infection and a fever of 101.2F
A) 8 y.o. with respiratory rate of 32 and suprasternal retractions Rationale: 8 y.o. w/respiratory rate of 32 and suprasternal retractions, because the child is demonstrating signs of respiratory distress 10 y.o. w/cystic fibrosis is able to clear their airway since cough is productive 4 y.o. has signs of sinus infection but is not in distress 5 y.o. has an ear infection w/fever but is not in distress
The nurse is assessing heart rate for children on the pediatric ward. Which of the following is a normal finding based on developmental age? A) An infant's rate is 90 bpm. B) A toddler's rate is 150 bpm. C) A preschooler's rate is 130 bpm. D) A school-age child's rate is 50 bpm.
A) An infant's rate is 90 bpm. Feedback: 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, and for a school-age child is 60 to 100 bpm.
The nurse is inspecting the genitals of a prepubescent girl. Which of the following are normal signs of the onset of puberty? A) Appearance of pubic hair around 11 to 13 years old B) Swelling or redness of the labia minora C) Presence of labial adhesions D) Lesions on the external genitalia
A) Appearance of pubic hair around 11 to 13 years old Feedback: Infants and young girls (particularly those of dark-skinned races) may have a small amount of downy pubic hair. Otherwise, the appearance of pubic hair indicates the onset of pubertal changes, sometimes prior to breast changes. Pubic hair generally begins to appear by age 11 years, with age 13 being the latest. Redness or swelling of the labia may occur with infection, sexual abuse, or masturbation. Lesions on the external genitalia may indicate sexually transmitted infection.
When assessing a child's general appearance, the nurse should assess for which of the following? SATA A) Do they give off an impression of being ill or well? B) What's the child's expression and energy level? C) Observe the child's state of alertness and whether they're responding appropriately to the stress of the situation. D) Note the child's posture/positioning E) Note whether the child's development appears appropriate for their age F) Is the child active/moving about the room? G) Does the child's speech seem appropriate for their age? H) Does the child appear well nourished or small/obese for their age? I) Note the scent of alcohol/tobacco smoke on family members J) Assess whether siblings look equally as cared for K) Does the child appear clean/well-cared for? L) Notice whether the family interacts appropriately with one another and the child. M) Observe tension in the room between adults and children N) Observe patient's hair, skin, and nails.
A) Do they give off an impression of being ill or well? B) What's the child's expression and energy level? C) Observe the child's state of alertness and whether they're responding appropriately to the stress of the situation. D) Note the child's posture/positioning E) Note whether the child's development appears appropriate for their age F) Is the child active/moving about the room? G) Does the child's speech seem appropriate for their age? H) Does the child appear well nourished or small/obese for their age? I) Note the scent of alcohol/tobacco smoke on family members J) Assess whether siblings look equally as cared for K) Does the child appear clean/well-cared for? L) Notice whether the family interacts appropriately with one another and the child. M) Observe tension in the room between adults and children
The nurse performing a health history on a child asks the parents if their child has experienced increased appetite or thirst. What body system is the nurse assessing with this question? A) Endocrine B) Genitourinary C) Hematologic D) Neurologic
A) Endocrine Feedback: Indicators of problems with the endocrine system include increased thirst, excessive appetite, delayed or early pubertal changes, and problems with growth. For the genitourinary system, the nurse would assess urinary patterns and genitals. For the hematologic system, the nurse would assess lymph nodes, skin color, and bruising. Signs of neurologic problems include numbness, tingling, difficulty learning, altered mood or ability to stay alert, tremors, tics, and seizures.
The nurse is teaching the student nurse the sequence for performing the assessment techniques during a physical examination. What is the appropriate order? A) Inspection, palpation, percussion, auscultation B) Inspection, percussion, palpation, auscultation C) Palpation, percussion, inspection, auscultation D) Inspection, auscultation, palpation, percussion
A) Inspection, palpation, percussion, auscultation Feedback: The physical examination of children, just as for adults, begins with a systematic inspection: checking color, warmth, characteristics, and texture visually and smelling for any odor. Palpation follows inspection to validate observations. Next, percussion is used to determine the location, size, and density of organs or masses. The stethoscope is used last to auscultate the heart, lungs, and abdomen.
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? A) Radial B) Brachial C) Pedal D) Femoral
A) Radial Feedback: 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.
Match the description of clinical manifestations to the correct viral exanthems of childhood: A) Rubella B) Rubeola (measles) C) Varicella (chickenpox) D) Fifth disease 1) Maculopopular rash that begins on face and spreads head to foot, and disappears in the same order it was spread. 2) Begins with prodromal phase, then bright red spots with blue white centers on mucous membranes. 3) Pruritic erythematous macules that evolve into papules, and then form clear, fluid filled vesicles 4) Erythematous flushing, often described as "slapped-cheek" appearance with circumolar pallor
A) Rubella- 1) Maculopopular rash that begins on face and spreads head to foot, and disappears in the same order it was spread. B) Rubeola - 2) Begins with prodromal phase, then bright red spots with blue white centers on mucous membranes. C) Varicella (chickenpox) 3) Pruritic erythematous macules that evolve into papules, and then form clear, fluid filled vesicles D) Fifth disease- 4) Erythematous flushing, often described as "slapped-cheek" appearance with circumolar pallor
Which of the following would be least effective in gaining the cooperation of a toddler during a physical examination? A) Tell the child that another child the same age wasn't afraid. B) Allow the child to touch and hold the equipment when possible. C) Permit the child to sit on the parent's lap during the examination. D) Offer immediate praise for holding still or doing what was asked.
A) Tell the child that another child the same age wasn't afraid. Feedback: Toddlers are egocentric and telling the toddler how well another child behaved or cooperated probably will not help gain this child's cooperation. Allowing the child to touch and hold the equipment, permitting the child to sit on the parent's lap during the examination, and offering praise immediately for cooperating would foster cooperation.
The nurse is questioning the parents of a 2-year-old child to obtain a functional history. Which of the following topics might the nurse include? Select all answers that apply. A) The child's toileting habits B) Use of car seats and other safety measures C) Problems with growth and development D) Prenatal and perinatal histories E) The child's race and ethnicity F) Use of supplements and vitamins
A) The child's toileting habits B) Use of car seats and other safety measures F) Use of supplements and vitamins Feedback: The functional history should contain information about the child's daily routine, such as toileting habits, safety measures, and nutrition. Problems with growth and development would be covered in the developmental history. Prenatal and perinatal history is assessed in the past health history and the child's race and ethnicity is part of the demographics.
This method of taking temperature may be used for children who are uncooperative, neurologically impaired, or immunosuppressed or have injuries or have had to have surgery to the oral cavity.
Axillary method
A teenage client tells the nurse that she is being abused by her boyfriend, but she doesn't want her parents to know because they won't let her see him any longer. What is the best response by the nurse? A) "It's my responsibility to tell your parents if you are in danger." B) "I understand your fear, but I am obligated to be sure your parents know you are in danger. Would you like for us to talk to them together?" C) "I won't tell them this time, but I must inform you that legally I must inform your parents if abuse is occurring. Next time it happens, I will have to tell them." D) "You need to tell them because the abuse isn't going to get any better. It will only escalate no matter what your boyfriend says."
B) "I understand your fear, but I am obligated to be sure your parents know you are in danger. Would you like for us to talk to them together?" Feedback: The most empathetic and informative response is recognizing the teen's fear. This response also establishes trust by letting the client know what the nurse's responsibility is while also offering support by talking to the parents with the teen. Responding that the nurse won't inform the parents this time is incorrect because the nurse is legally bound to notify the parents if the child is in danger, as in the case of abuse.
For which of the following children would the nurse conduct an immediate comprehensive health history? A) A child who is brought to the emergency room with labored breathing B) A child who is a new client in a pediatric office C) A child who is a routine client and presents with signs of a sinus infection D) A child whose condition is improving
B) A child who is a new client in a pediatric office Feedback: The purpose of the examination will determine how comprehensive the history must be. A comprehensive history would be performed for a new child in a pediatric office or a child who is admitted to the hospital. Also, if the healthcare provider or nurse practitioner rarely sees the child or if the child is critically ill, a complete and detailed history is in order, no matter what the setting. The child who has received routine health care and presents with a mild illness may need only a problem-focused history. In critical situations, some of the history taking must be delayed until after the child's condition is stabilized.
The nurse is conducting a health history for a 9-year-old child with stomach pains. Which of the following is a recommended guideline when approaching the child for information? A) Wear a white examination coat when conducting the interview. B) Allow the child to control the pace and order of the health history. C) Use quick deliberate gestures to get your point across. D) Do not make physical contact with the child during the interview.
B) Allow the child to control the pace and order of the health history. Feedback: The nurse should elicit the child's cooperation by allowing him or her control over the pace and order of the health history, or anything else that the child can control while still allowing the nurse to obtain the information needed. A white examination coat or all-white uniform may be frightening to children, who may associate the uniform with painful experiences or find it too unfamiliar. The nurse should use slow deliberate gestures rather than very quick or grand ones, which may be frightening to shy children. The nurse should make physical contact with the child in a nonthreatening way at first by briefly cuddling newborns before returning them to caregivers, laying a hand on the head or arm of toddlers and preschoolers, and warmly shaking the hand of older children and teens to convey a gentle demeanor.
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? A) Oral thermometer B) Axillary method C) Temporal scanning D) Rectal route
B) Axillary method Feedback: The axillary method may be used for children who are uncooperative, neurologically impaired, or immunosuppressed or have injuries or surgery to the oral cavity. Since the child is crying and uncooperative, the oral method would not be a good choice. The accuracy of the temporal method may be affected by excessive sweating. The rectal route is invasive, not well accepted by children or parents, and probably unnecessary with the modern alternative methods now available.
The nurse is inspecting the fingernails of an 18-month-old girl. Which of the following findings indicates chronic hypoxemia? A) Nails that curve inward B) Clubbing of the nails C) Nails that curve outward D) Dry, brittle nails
B) Clubbing of the nails Feedback: Clubbing of the nails indicates chronic hypoxemia related to either respiratory or cardiac disease. Nails that curve inward or outward may be hereditary or linked with injury, infection, or iron-deficiency anemia. Dry, brittle nails may indicate a nutritional deficiency.
The nurse is preparing to take a tympanic temperature reading of a 4-year-old. In order to get an accurate reading, what does the nurse need to do? A) Pull the earlobe back and down. B) Direct the infrared sensor at the tympanic membrane. C) Pull the earlobe down and forward. D) Remove any visible cerumen from inside the ear canal.
B) Direct the infrared sensor at the tympanic membrane. Feedback: The accuracy of tympanic temperature reading is dependent on appropriate technique. The nurse needs to be sure to direct the infrared sensor at the tympanic membrane. Since the child is older than age 3, the earlobe does not need to be pulled back and down. The nurse would not remove earwax from inside the ear canal.
While auscultating the heart of a 5-year-old child, the nurse notes a murmur that is soft and quiet and heard each time the heart is auscultated. The nurse documents this finding as which of the following? A) Grade 1 B) Grade 2 C) Grade 3 D) Grade 4
B) Grade 2 Feedback: A grade 2 murmur is soft and quiet and is heard each time the chest is auscultated. A grade 1 murmur is barely audible and is heard at some times and not at other times. A grade 3 murmur is audible with intermediate intensity. A grade 4 murmur is audible and accompanied by a palpable thrill.
The nurse is conducting a physical examination of a child following a comprehensive health history. What should be the focus of the physical examination? A) The child B) The parents C) Chief complaint D) Developmental age
C) Chief complaint Feedback: The next step after the health history is the physical examination. It should focus on the chief complaint or any of the systems that engaged the nurse's critical thinking while obtaining the history. The child and parents are involved in the assessment, but the focus is on the health problem. The nurse should conduct a physical examination with the child's developmental age in mind.
The nurse is teaching the student nurse how to perform a physical assessment based on the child's developmental stage. Which of the following statements accurately describes a recommended guideline for setting the tone of the examination for a school-age child? A) Keep up a running dialogue with the caregiver, explaining each step as you do it. B) Include the child in all parts of the examination; speak to the caregiver before and after the examination. C) Speak to the child using mature language and appeal to his or her desire for self-care. D) Address the child by name; speak to the caregiver and do the most invasive parts last.
B) Include the child in all parts of the examination; speak to the caregiver before and after the examination. Feedback: For a school-age child, the nurse should include the child in all parts of the examination and speak to the caregiver before and after the examination. For a newborn, the nurse should keep up a running dialogue with the caregiver, explaining each step as it is done. The nurse should speak to the early teen using mature language and appeal to his or her desire for self-care. For an infant, the nurse should address the child by name, and speak to the caregiver and do the most invasive parts last.
The nurse is measuring the blood pressure of a 12-year-old boy with an oscillometric device. The boy's reading is greater than the 90th percentile for gender and height. What is the appropriate nursing action? A) Repeat the reading with the oscillometric device. B) Repeat the blood pressure reading using auscultation. C) Measure the blood pressure in all four extremities. D) Measure the blood pressure with a Doppler.
B) Repeat the blood pressure reading using auscultation. Feedback: The nurse should repeat the reading using auscultation. The nurse should not use the Doppler ultrasound method in this circumstance. The nurse would only measure the blood pressure in all four extremities with a child presenting with cardiac complaints.
The nurse is assessing a child who presents with a high fever, whisper when talking, and sits up with the neck thrusted forward. Based on these findings, what would be the least appropriate intervention? A) Providing 100% oxygen B) Visualizing the throat C) Having the child sit forward D) Auscultating for lung sounds
B) Visualizing the throat Rationale: The child is exhibiting signs of epiglottis, which can be life-threatening. Under no circumstances should the nurse attempt to visualize the throat. Reflex laryngospasm may occur, precipitating immediate airway occlusion. Providing 100% oxygen in the least invasive manner that's most acceptable to the child is a sound intervention, as is allowing the child to sit forward w/neck extended. Auscultation would reveal breath sounds consistent with an obstructed airway.
The nurse is collecting information from the parents of a 3-year-old child about her sleeping patterns. Which question by the nurse will best elicit information from the parents? A) "How are things going at home?" B) "Is your child sleeping well at night?" C) "How many hours does your child sleep at night?" D) "What time does your child go to bed at night?"
C) "How many hours does your child sleep at night?" Feedback: Asking an open-ended question will provide the most opportunity for data to be collected from the parents. Asking how things are going at home is vague and may or may not give the needed information. Asking if the child is sleeping well is problematic, as the term "well" is subjective and may be interpreted differently by different individuals. Asking when the child goes to bed is a broad question that may not provide the needed information about the quantity of sleep being achieved by the child each night.
The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond? A) "Your daughter has acrocyanosis; this is causing her blue hands and feet." B) "Let's watch her carefully to make sure she does not have a circulatory problem." C) "This is normal; her circulatory system will take a few days to adjust." D) "This is a vasomotor response caused by cooling or warming."
C) "This is normal; her circulatory system will take a few days to adjust." Feedback: The nurse should tell the parents that this is normal and that the baby's circulatory system is adjusting to extrauterine life. Using the technical term "acrocyanosis" would most likely scare the parents. Telling the parents that the child may have a circulatory problem is inaccurate as this is a normal variation. Acrocyanosis and the mottling caused by cooling and warming are two different variations.
Assessment reveals that a child weighs 73 lb and is 4 ft 1 in. tall. The nurse calculates this child's body mass index as: A) 19.1 B) 20.7 C) 21.4 D) 24.5
C) 21.4 Feedback: Body mass index is determined by dividing the child's weight (in pounds) by the child's height (in inches) squared and then multiplying this figure by 703. Thus, 73 lb divided by 49 in × 49 in equals 0.0304 multiplied by 703 equals 21.37 or 21.4.
A mother brings her 31/2-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? A) Oral B) Tympanic C) Rectal D) Axillary
C) Rectal Feedback: Obtaining the child's temperature via the rectal route would be least appropriate because the child has diarrhea, and insertion of the thermometer might traumatize the rectal mucosa. Additionally, the rectal route is highly invasive and a child of this age fears body invasion. Using the oral route might be problematic due to the child's age and inability to cooperate, especially in light of the child's vomiting. However, it would not be as dangerous as obtaining a rectal temperature. The tympanic or axillary method would be the most appropriate method.
The nurse is performing a health history on a 6-year-old boy who is having trouble adjusting to school. Which of the following questions would be most likely to elicit valuable information? A) "Do you like your new school?" B) "Are you happy with your teacher?" C) "Do you enjoy reading a book?" D) "What are your new classmates like?"
D) "What are your new classmates like?" Feedback: A careful conversation and interview with the child and/or the caregiver will provide important information about the child's health. Depending on the intent of the health assessment, many of the questions will be direct, and many will require the caregiver or child to answer simply "yes" or "no." In other than emergency situations, though, asking open-ended questions such as "What are your classmates like?" offers an excellent opportunity to learn more about the child's life.
The nurse is assessing the heart rate of a healthy school-age child. The nurse expects that the child's heart rate will be in which of the following ranges? A) 80 to 150 bpm B) 70 to 120 bpm C) 65 to 110 bpm D) 60 to 100 bpm
D) 60 to 100 bpm Feedback: The normal heart rate for a school-age child is 60 to 100 bpm, for an infant is 80 to 150 bpm, for a toddler is 70 to 120 bpm, and for a preschooler is 65 to 110 bpm.
The nurse is using pulse oximetry to measure oxygen saturation in a 3-year-old girl. The nurse understands that falsely high readings may be associated with which situation or condition? A) A nonsecure connection B) Cold extremities C) Hypovolemia D) Anemia
D) Anemia Feedback: Falsely high readings may be associated with anemia. Falsely low readings may be associated with cold extremities, hypovolemia, and a nonsecure connection.
The nurse is teaching the student nurse about abnormal findings when assessing the breasts of children. Which of the following may be associated with renal disorders? A) Swollen nipples upon inspection of a newborn's breasts B) Tender nodule palpated under the nipple of a 10-year-old C) Observation of enlarged breast tissue in a male adolescent D) Observation of a supernumerary nipple along the mammary ridge
D) Observation of a supernumerary nipple along the mammary ridge Feedback: Supernumerary nipples are usually of no concern as they do not change over time, but they may be associated with renal disorders. Newborns of both genders may have swollen nipples from the influence of maternal estrogen, but by several weeks of age the nipples should be flat. A tender nodule palpated just under the nipple confirms pubertal changes and is a normal finding. Adolescent boys may develop gynecomastia (enlargement of the breast tissue) due to hormonal pubertal changes. When the hormone levels stabilize, male adolescents then have flat nipples.
A nurse is assessing the fontanels of a crying newborn and notes that the posterior fontanel pulsates and briefly bulges. What do these findings indicate? A) Increased intracranial pressure B) Overhydration C) Dehydration D) These are normal findings
D) These are normal findings Feedback: It is common to see the fontanel pulsate or briefly bulge if a baby cries. Overhydration or increased intracranial pressure would cause a persistent bulging. Dehydration would cause the fontanel to be sunken.
The nurse is performing a physical examination on a sleeping newborn. Which of the following body systems should the nurse examine last? A) Heart B) Abdomen C) Lungs D) Throat
D) Throat Feedback: If the infant is asleep, the nurse should auscultate the heart, lungs, and abdomen first while the baby is quiet. The nurse performs the assessment in a head-to-toe manner, leaving the most traumatic procedures, such as examination of the ears, nose, mouth, and throat, until last.
In critical situations, some of the history taking must be ______________ until after the child's condition is stabilized.
Delayed
The feet of a toddler and or child should appear to be what?
Flat The arch develops as the child grows and the muscles become less lax, though some children may continue with flexible flat feet.
Regular HR and RR for an adolescent child=
HR= 55-95 RR= 12-20
Regular HR and RR for a school-age child=
HR= 60-100 RR= 14-26
Regular HR and RR for a preschooler=
HR= 65-110 RR= 20-25
Regular HR and RR for a toddler=
HR= 70-120 RR= 20-30
Regular HR and RR for an infant=
HR= 80-100 RR= 20-55
Using an accurate BP cuff size is important, a wider cuff yields a ________________ reading and a narrower cuff yields a ______________ reading.
Lower, higher
This method of taking temperature is highly reliable if the child can cooperate. By 5 years, the child can hold one of these thermometers themselves.
Oral temperature
The child who has received routine health care and presents with a mild illness may need only a ____________- focused history.
Problem
Considered to reflect core temperature, this is an invasive way of recording temperature, not well accepted by some children, and probably unnecessary with the modern alternative methods now available.
Rectal route
If the oscillometric device yields a blood pressure greater than the 90th percentile for gender and height, then what should the nurse do?
Repeat the reading using auscultation
This type of route of taking a temperature reflects the pulmonary artery temperature and can be measure with a thermometer within seconds. Can be used in children 3 months of age and older. Can be used with any age child, EXCEPT infants younger than 90 days of age who are ill or have a fever for whom the rectal method would be used.
Tympanic temperature
Palpate the joints for ________________ or tenderness. Check the mobility of the joints and the upper/lower extremities by performing what test?
Warmth Range of motion (ROM)
Gently pull down on the earlobe of infants and toddlers and up on the outer edge of the pinna in older children to straighten the ear canal and press the tip of the tympanometer over the external canal
When using a tympanometer
If the physician or nurse practitioner rarely sees the child or if the child is critically ill, a complete and detailed _______________ is in order, no matter what the setting.
history (health history)
