Peds Exam 1

Physiological signs approaching death

-ascending loss of sensation and movement -thermal dysregulation: child feels hot but skin feels cool -tactile sensation decreases -sensitivity to light -decreased appetite and thirst, trouble swallowing **hearing intact until death

Myths about children and pain

-children don't feel pain unless there is an obvious physical reason -neonates and infants do not feel pain due to immature neuro and immune systems -children can't tell you if they are in pain -children are not in pain if they are distracted or sleeping -children have no memory of pain -children recover more quickly than adults -parents aggravate or exaggerate their children's pain -narcotics are dangerous for children -the best route for drug admin is IM -medicate children as infrequently as possible

The grieving family

-family never recovers, adapts -martital strain - 60% couples divorce -siblings at risk for perfect child response, survivors remorse, shadow sibling -provide time for recreation

0____3_____6____9____12

0- birth 3- roll over 6- sit up 9- crawl 12- walking

Toddler

1-3 years

List 5 basic assessments (measurements) that should be included in the physical assessment of a child over 3 years of age.

1. Height 2. Weight 3. Body Mass Index 4. Blood Pressure/Temperature 5. Vision 6. Hearing

5 markers that signal a child's readiness to toilet train

1. bowel readiness 2. bladder readiness 3. cognitive readiness 4. motor readiness 5. physiological and psychological readiness

eggs and cheese start at

12 months

A nurse is teaching a class about pubertal changes in girls. Once of the children asks a question about when development appears. Number the changes in the order they occur. Menarche Breast Buds Appearance of pubic hair

3 Menarche 1 Breast Buds 2 Appearance of pubic hair

1 oz

30 mL

Rank the following assessments in the order they should be performed on a 9-month-old Axillary temperature Weight Respiratory rate Heart Rate

4 Axillary temperature 3 Weight 1 Respiratory rate 2 Heart Rate

Cereal- start at ___ to ___ months of age

4,6

May begin to add solid foods by ___ to ___ months of age

4,6

1 tsp

5 mL

fruits and vegetables start at

6 to 8 months

fluoride supplementation should be considered for any child older than the age of ____ whose _____ is deficient in fluoride

6, drinking water

meat, fish, poultry start at

8 to 10 months

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a nurse suggests that they consider administering a placebo instead of the usual pain medication. This decision should be based on knowledge that A. it is unjustified and unethical to administer placebos instead of pain medication. B. the absence of a response to a placebo means the child's pain has an organic basis. C. a positive response to a placebo will not occur if the child's pain has an organic basis. D. administering a placebo instead of the usual pain medication is effective in determining whether a child's pain is real.

A

The school health nurse is scheduled to do routine vision testing with a group of students. The nurse would assess each child's visual acuity suing which of the following tests? a. The Snellen eye chart b. An opthalmoscopic exam c. The cover-uncover test d. The Weber test

A

When plotting a child's height and weight on a growth grid, the nurse understands that which range generally represents the normal percentile range for children? a. 10th to 90th percentile b. 25th to 75th percentile c. 50th to 100th percentile d. 15th to 95th percentile

A

Which of the following methods should the nurse use to view the tonsils and oropharynx of a cooperative 6-year-old child? a. Ask child to open mouth wide and say "Ahhh." b. Ask child to open mouth wide, and then place tongue blade in the center back area of the tongue. c. Examine mouth when child is crying to avoid use of tongue blade. d. Pinch nostrils closed until child opens mouth, then insert tongue blade.

A

While preparing to teach a class on child development, a nurse reviews the work of a theorist who postulated that the personality is a structure of 3 parts, called the id, ego and superego. The theorist is: a. Sigmund Freud b. Erik Erikson c. Jean Piaget d. Lawrence Kohlberg

A

If these signs of readiness are not present, what can the nurse do to increase trust and cooperation?

A nurse can talk to the parent while essentially "ignoring" the child and then gradually focus on the child or a favorite object, such as a doll or blanket, tell a funny story or play a simple magic trick, and make complimentary remarks about the child, such as about his or her outfit or favorite object.

A 6-year-old is hospitalized with a fractured femur. Based on the nurse's knowledge of pain assessment tools and child development, which assessment tools are most appropriate for this age child? (Select all that apply) A. Oucher scale B. CRIES scale C. Poker chip tool D. Faces pain scale E. Postoperative pain score

A, C, D

Physiological Measures of Pain

Acute pain activates the sympathetic nervous system Physical changes: increased heart rate, increased respiratory rate, increased BP, pupil dilation, pallor, and increased perspiration Less degree of change noted after prolonged exposure to pain Changes last a short time in children so not reliable as indicators of pain Often normal VS w/ chronic pain KEY: DO NOT rely on physiologic changes to assess pain! (but do consider them)

A 17-year-old male is being seen in the ER. In order to obtain the adolescent's health information, his nurse should: a. Interview the adolescent using direct questions. b. Gather information during a casual conversation. c. Interview the adolescent only in the presence of his parents. d. Gather information only from his parents.

B

A child who has been receiving morphine by the intravenous (IV) route will now start receiving it orally. In order for equianalgesia (equal analgesic effect) to be achieved, the oral dose will be A. same as the IV dose. B. greater than the IV dose. C. one half of the IV dose. D. one fourth of the IV dose

B

. Which of the following are stressors common to hospitalized toddlers? Select ALL that apply .a. Social isolation b. Interrupted routine c. Sleep disturbances d. Self-concept disturbances e. Fear of being hurt

B,C,E

Piaget Stages

Birth-2: sensorimotor: uses senses and motor skills, items known by use: object permanence 2-6 years: pre-operational: symbolic thinking, language used, egocentric: imagination grow 7-11 years: concrete operational: logic applied has objective/rational, conservation, numbers, ideas 12 years-adulthood: formal operational: thinks abstractly, hypothetical/ideas: ethics, politics, social/moral issues explored

A 3-year-old female is hospitalized with a fractured femur. As her nurse, what nursing action would help foster the child's sense of autonomy? a. Allow the child to choose what time to take her oral antibiotics. b. Allow the child to have a doll for medical play. c. Allow the child to administer her own dose of Keflex (Cephalexin) via oral syringe. d. Allow the child to watch age-appropriate videos

C

Children are usually brought to the clinic for health care by a parent. Beginning at what age is it appropriate for the nurse to question the child about presenting symptoms? a. 3 years b. 5 years c. 7 years d. 9 years

C

Directional trends in growth and development are easily seen in the neonate and infant. Which term describes development in the head-to-tail direction? a. Sequential trend b. Proximodistal pattern c. Cephalocaudal trend d. Mass to specific pattern

C

How can the nurse best facilitate the trust relationship between infant and parent while the infant is hospitalized? a. The nurse should encourage the parents to remain at the child's bedside as much as possible. b. The nurse should keep parents informed about all aspects of their child's condition c. The nurse should encourage the parents to hold their child as much as possible. d. The nurse should encourage the parents to participate actively in their child's care.

C

In order to prevent separation anxiety in a hospitalized toddler, which of the following should the nurse do? a. Assume the parental role when parents are not able to be at the bedside. b. Encourage the parents to remain at the bedside always. c. Establish a routine that is similar to that of the child's home. d. Rotate nursing staff so the child becomes comfortable with a variety of nurses.

C

The nurse is using the C.R.I.E.S. pain assessment tool on a preterm infant in the neonatal intensive care unit (NICU). Which is a component of this tool? A. Color B.Reflexes C. Oxygen saturation D. Posture of the arms and legs

C

The pediatric nurse would perform abdominal percussion to assess which of the following? Select ALL that apply a. Generalized tenderness b. Local inflammation c. Density of tissues and organs d. Presence of liver and spleen e. Borders and size of abdominal organs

C, E

The nurse is assessing skin turgor in a child. The nurse grasps the skin on the abdomen between thumb and index finger, pulls it taut, and quickly releases it. The tissue remains suspended, or tented, for a few seconds, then slowly falls back on the abdomen. Which of the following evaluations can the nurse correctly assume? a. The tissue shows normal elasticity. b. The child is properly hydrated. c. The assessment is done incorrectly. d. The child has poor skin turgor

D

When assessing a toddler's chest, the nurse would expect: a. Respiratory movements to be chiefly thoracic. b. Anteroposterior diameter to be equal to the transverse diameter. c. Intercostal retractions on respiratory movement. d. Movement of the chest wall to be symmetric bilaterally and coordinated with breathing.

D

How should the nurse explain to a parent what is meant by the "80th percentile"?

Explain if 100 children were place in a room together, there would be 80 children same or smaller than your child and 20 would be taller/ than your child

T/F: Comprehension of words always precedes verbalization of those words

False

Balls and buds

First signs of sexual maturation

Infants, whether breastfed or bottle fed, do not require additional _____. Excessive intake of water in infants may result in ________ and ______.

Fluids, water intoxication, hyponatremia

Erikson's Stages

Infant: trust vs mistrust Toddler: autonomy vs shame/doubt Preschool: initiate vs guilt School age: industry vs inferiority Adolescence: Identity vs role confusion Young Adult: intimacy vs isolation

Behavioral measures of pain

Infants: no understanding, have memory of painful procedures, will hold breath when approached by care providers Infants 6-12 months of age shown remember pain and will respond with fear Toddlers: demonstrate fear and can verbalize words for pain(i.e. owie and boo boo) Preschoolers: understand pain as hurt, may not be able to relate it to illness, may see as a punishment, may not believe an injection may take pain away School age: 7-9 can understand the relationship to pain and disease but not the cause of pain. 10-12 have more complex understanding of pain. Adolescents: 13-18 have sophisticated understanding of the causes of pain, pain has both qualitative and quantitative aspects

Identify signs of readiness you may observe in a child that indicate appropriate to begin exam.

Observable behaviors that signal a child's readiness to cooperate include: talking to the nurse, making eye contact, accepting the offered equipment, allowing physical touch, and choosing to sit on the examining table rather than the parent's lap.

Med Admin

Oral = preferred route - mix with sweet fluid (not formula or milk) IM: 1ml max volume for infants, 2ml max for children Vastus Lateralis: use before 2 Deltiod: use after 2 SQ: -max 0.5ml -26-30 gauge needle IV: assess q2hr- infiltrate easily

Nursing Pain Management

Pharmacological methods: Opioids, nonsteroidal antinflammatories, combination drugs, etc Ordered by physician or licensed health care provide Non pharmacological methods: distraction, cutaneous stimulation, imagery, relaxation techniques, hypnosis, and application of heat and/or cold

Physiological consequences of Unrelieved Pain

RESPIRATORY CHANGES: Acidosis Decreased oxygenation Retention of secretions NEUROLOGICAL CHANGES: Increased heart rate Sleep pattern changes Increased glucose levels and cortisol levels METABOLIC CHANGES: Increased rate leads to increased fluid and electrolyte needs

Behavioral Consequences of Unrelieved Pain

Restless, agitated, hyperalert, or vigilant Short attention span Irritability Facial grimacing Drawing up knees, flexing limbs and massaging affected areas Anorexia Lethargy: remaining quiet, withdrawal Sleep disturbances

What are Erikson's 5 stages of childhood?

a. Trust vs. mistrust b. Autonomy vs. shame/doubt c. Initiative vs. guilt d. Industry vs. inferiority e. Identity vs. role confusion

Most infants are obligatory _____ breathers

belly

Infant

birth to 1 year

Separation Anxiety

distressed behavior observed in children when separated from familiar care givers begins: 9 months, peaks 16 months Stages: Protest: screams, cries, searches for parents, clings to parents, rejects strangers, attempts to escape, kicks/ bites strangers, may last hours to day, stops only when exhausted Despair: inactive, uncommunicative, withdraws from others depressed, regresses to earlier behavior, may last for a long time, condition may deteriorate r/t refusal to eat, drink, move Detachment: increased interest in surroundings, interacts with strangers, forms new but superficial relationships, appears happy, occurs after prolonged separation, rejects parents

one of the most dramatic advances in pediatrics has been the decline of infectious diseases during the 20th century because of the widespread use of ______ for preventable diseases

immunizations

dietary considerations are important because habits begin during ____ tend to continue until later years

infancy

If the infant is being exclusively breastfed after 4 months, _____ supplementation is recommended

iron because fetal iron stores are depleted at 4 months

The AAP recommends that all infants receive a daily supplement of 400 IU of vitamin D in the first few days of life the prevent ___ and ___

rickets and vitamin D deficiency

Describe how to most accurately measure a head circumference in an infant (include equipment and location used).

Measure the head at its greatest circumference, usually slightly above the eyebrows and pinna of the ears and around the occipital prominence at the back of the skull. Use a paper or metal tape because cloth tape can stretch and give a falsely small measurement. For greatest accuracy, use devices marked with tenths of a centimeter because percentile charts have only 0.5cm increments

A child is being seen in the emergency department with multiple facial abrasions and lacerations. The combination agent lidocaine, adrenaline, and tetracaine (LAT) is applied topically to the wounds. The purpose of this combination therapy is to A. cleanse the wound. B. promote scab formation C. prevent infection of the wound. D. provide anesthesia to the wound.

D

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on the knowledge that A. children tend to be overmedicated for pain. B. giving large doses of opioids causes euthanasia. C. narcotic addiction is common in terminally ill children. D. large doses of opioids are justified when there are no other treatment options

D

A mother has brought her 4-year-old child for developmental testing for routine assessment of social and physical abilities. The child refuses to complete the testing. What should the nurse do?a. Refer the child to a specialist. b. Explain that the child is developmentally delayed. c. Complete the test as scheduled d. Reschedule the testing for another day.

D

A nurse is starting an intravenous (IV) line for a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that A.children tolerate pain better than adults. B.children become accustomed to painful procedures. C.children often lie about experiencing pain. D.children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

D

An 11-year-old male is being evaluated in the ER for an inguinal hernia. Which statement accurately describes how the nurse should approach him for his physical assessment? a. The nurse should ask the child's parents to remain in the room during the physical exam .b. The nurse should auscultate the child's heart, lungs, and abdomen first. c. The nurse should explain to the child that the physical exam will not hurt. d. The nurse should explain to the child what the nurse will be doing in basic understandable terms

D

An ER nurse is assessing a 12-month-old female. Which statement accurately describes the best method for assessing this child? a. The nurse should assess the child on the examination table. b. The nurse should assess the child in a head-to-toe sequence. c. The nurse should have the child's mother assist in holding her down. d. The nurse should assess the child while she is in her mother's lap.

D

By what age should the anterior fontanel be closed? a. 2 weeks b. 6 months c. 12 months d. 18 months

D

Superficial palpation of the abdomen is often perceived by the child as tickling. Which of the following measures by the nurse is most likely to minimize this sensation and promote relaxation? a. Palpate another area simultaneously. b. Ask child not to laugh or move if it tickles. c. Begin with deeper palpation and gradually progress to superficial palpation. d. Have child "help" with palpation by placing his or her hand over the palpating hand.

D

The most consistent indicator of pain in infants is A. increased respirations. B. increased heart rate. C. clenching the teeth and lips. D. a facial expression of discomfort.

D

The mother of a neonate states she is concerned about her relationship with the infant. She states the baby goes to anyone and doesn't seem to care if she is present or not. The nurse explains that prior to developing a dependence on the mother, the infant must develop which of the following? a. Ritualistic behavior b. Egocentrism c. Reversibility d. Object permanence

D

The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too large and one is too small. The best nursing action is which of the following? a. Use the small cuff. b. Use the large cuff. c. Use either cuff, using palpation method. d. Locate the proper sized cuff before taking the blood pressure.

D

The nurse prepares to transport a sedated 3-year-old from the pediatric unit to the endoscopy department. Taking into consideration the child's developmental stage and safety, how should he or she be transported to the area? a. Wagon b. Wheelchair c. Crib d. Gurney (stretcher)

D

The parents of a 2-year-old boy are concerned about his behavior. Since his admission to the hospital 2 days ago, he has been crying much more than usual and is inconsolable much of the time. The nurse's best response to the child's parents is: a. The child is in the detachment phase of separation anxiety, which is normal for children during hospitalization. b. The child is in the despair stage of separation anxiety, which is normal for children during hospitalization. c. The child is in the bargaining stage of separation anxiety, which is normal for children during hospitalization. d. The child is in the protest stage of separation anxiety, which is normal for children during hospitalization.

D

At what age should a mother seek further evaluation if her child hasn't been successful at toilet training? a. 18 months b. 24 months c. 3 years d. 5 years

D

At what age would the pediatric nurse change the sequence of the examination of a child from that of chest and thorax first to head-to-toe? a. Infant b. Toddler c. Preschool child d. School-age child

D

When preparing to assess a preschool child, the nurse should do which of the following? Select ALL that apply. Allow the child to play with the BP cuff and explain used to take your BP a. Give detailed explanations to alleviate the child's anxiety b. Give reassurance and feedback to the child during the assessment c. Suggest that the child act "like the big kids" when he or she is assessed. d. Say that the shirt is the only clothing that must be removed. e. Allow the child to play with the BP cuff and explain used to take your BP

E

sexual maturation in girls starts between ____ and ____ years of age

8, 13

The nurse is assessing a 3-year-old African-American child who is being seen in the clinic for the first time. The child's height and weight are in the 30th percentile on the commonly used growth chart from the National Center for Health Statistics (CDC). When interpreting these data, the nurse should recognize which of the following? a. Child's growth is within normal limits. b. Child's growth is not within normal limits. c. The growth chart is not accurate for African-American children. d. The growth chart is not useful until several measurements are plotted over time.

D

Human milk is the best option for infant nutrition up to what age?

up to 12 months

Preschooler

3-6 years

When introducing solid foos, one food item is introduced at intervals of ___ to ___ days to allow for identification of ________.

4,7, food allergies

A nurse is teaching a class about sexual maturation in males. Identify the order in which sexual maturation changes occur in males by numbering the changes from 1 to 6. The voice changes Pubic hair appears Size of testes increases Downy hair appears on the upper lip Axillary hair grows Rapid growth of genitalia occurs

6 The voice changes 2 Pubic hair appears 1 Size of testes increases 5 Downy hair appears on the upper lip 4 Axillary hair grows 3 Rapid growth of genitalia occurs

sexual maturation in boys starts between ____ and ___ years of age

9.5, 14

An inexperienced mother is playing with her 8-month-old in the playroom. The nurse has taught the mother about toys that are developmentally appropriate for the child. The nurse will conclude that teaching has been successful when the mother selects which type of toy? a. A set of large blocks b.A wagon c.A puzzle with large pieces d.A rattle 3-6 month

A

During an otoscopic examination on an infant, in which direction is the pinna pulled? a. Down and back b. Down and forward c. Up and forward d. Up and back

A

In a clinic, the mother of an 8-month-old asks the nurse what to feed her infant because she wants to stop breast-feeding. The nurse recommends: a. formula. b. 2% milk. c. whole milk. d. orange juice.

A

Nonpharmacologic strategies for pain management A. may reduce pain perception B. make pharmacologic strategies unnecessary. C. usually take too long to implement. D. trick children into believing they do not have pain.

A

The grandparents of a 2 ½ year-old ask what would be an appropriate toy to buy their grandson. Which of the following should the nurse recommend? a. A play telephone b. A 54-piece puzzle c. A paint-by-number set d. A musical mobile

A

The nurse is caring for a 12-year-old child who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action? A. Request a psychological consultation. B. Ask why the child does not have pain. C. Praise the child for the ability to withstand pain. D. Encourage continued bravery as a coping strategy.

A

If the child still refuses to cooperate and other methods for cooperation have been tried, what techniques can the nurse use as he proceeds with the exam?

A nurse can involve the child and parent in the process, assess the reason for uncooperative behavior - maybe the child has had a previous traumatic experience, avoid prolonged explanations about the examination process, use a firm, direct approach regarding expected behavior, and use a calm, quiet, and confident voice. Minimize any disruptions and stimulation. Have an attendant gently restrain child if needed.

A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. As the nurse caring for this patient, what action can you take that will most enhance his psychosocial development? a. Fax the teen's teacher and have her send in his homework. b. Encourage the teen's friends to visit him in the hospital. c. Encourage the teen's grandparents to visit frequently. d. Tell the teen he is free to use his phone to call friends.

B

A nurse is caring for an infant who will soon eat solid foods. The nurse should inform the parents that which of the following foods should be introduced into the infant's diet first? a. Strained yellow vegetables b. Iron-fortified cereals c. Pureed fruits d. Whole milk

B

A nurse is caring for children in a day care center. According to the theorist Jean Piaget, an infant who learns about objects by placing them in his mouth is in which stage of development? a. Preoperational b. Sensorimotor c. Concrete operational d. Formal operational

B

A parent whose family drinks low-fat milk asks if her child can begin to drink low-fat milk. The AAP recommends that children can begin to drink low-fat milk at what age? a. 1 year b. 2 years c. 6 years d. 12 years

B

An 18-year-old boy comes to the ER complaining of a rash and itching in the groin area. He is concerned that he has contracted a sexually transmitted disease and worries that his parents will find out. The nurse's best response is: a. "We will need to contact your parents to let them know you are in the ER." b. "We will not contact your parents regarding this visit." c. "Who would you like us to contact about your visit here today." d. "We cannot promise that the hospital will not contact your parents."

B

If the nurse measures the standing height of an appropriately cooperative 30 month-old child using a stadiometer, on which growth chart should she plot this measurement? a. 0-36 month chart b. 2-20 year chart c. Either chart is acceptable

B

The father of a 17-month-old toddler is frustrated with the toddler's behavior. The father tells the nurse that the toddler is "bad", but he doesn't know how to make the toddler behave better. Which of the following responses is appropriate? a. "Allow your child to learn by trial and error." b. "Consistently enforce well-defined limits." c. "Reward your child's good behavior, but ignore the bad behaviors. d. Punish your child when he behaves badly."

B

The nurse admitting 4 children to the hospital unit learns that none of the parents will be staying with the children. The nurse would be most concerned with adjustment to hospitalization and separation from parents in the infant or child of which age? a. 2 months old b. 13 months old c. 8 years old d. 14 years old

B

The nurse discusses swimming pool safety with the parents of 4-year-old twins. Which statement identifies that more instruction is needed? a. "We remove all toys from the pool area when not in use." b. "The twins wear flotation devices when they are in the pool by themselves." c. "Our children are enrolled in swimming classes." d. "We always tell the twins not to run by the pool."

B

The nurse is caring for a 6-month-old in the ER. The physician orders the nurse to give the child a dose of Rocephin IM. The 1.5 mL dose arrives from the pharmacy. The nurse must do which of the following? a. Administer the injection in the deltoid muscle. b. Split the dose into 2 injections. c. Administer the injection in the dorsal gluteal muscle. d. Administer the dose a single injection to the vastus lateralis.

B

The nurse is providing nutritional teaching to a group of parents whose children attend a local day care. Which of the following is an effective way to encourage good nutritional habits for a preschooler? a. Offer snacks if the child does not like what is served. b. Serve nutritious foods that all family members will eat. c. Allow the child to eat only what she asks for. d. Insist that the child eat all the food that is served to her.

B

The nurse is ready to begin a physical examination on an 8-month-old infant. The child is sitting contentedly on his mother's lap, chewing on a toy. Which of the following should the nurse do first? a. Elicit reflexes b. Auscultate heart and lungs c. Examine eyes, ears, and mouth d. Examine head, systematically moving toward feet

B

Transdermal fentanyl (Duragesic) is being used for an adolescent with cancer who is in hospice care. The adolescent has been comfortable for several hours but now complains of severe pain. The most appropriate nursing action is to A. administer meperidine (Demerol) intramuscularly. B. administer morphine sulfate immediate release (MSIR) intravenously. C. use a nonpharmacologic strategy. D.place another fentanyl (Duragesic) patch on the adolescent.

B

Which is an important consideration when using the FACES Pain Rating Scale with children? A. Children color the face with the color they choose to best describe their pain. B. The scale can be used with most children as young as 3 years of age. C. The scale is not appropriate for use with adolescents. D. The scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

B

Which of the following explains the importance of detecting strabismus in young children? a. Color vision deficit may result. b. Amblyopia, a type of blindness, may result. c. Epicanthal folds may develop in affected eye. d. Ptosis may develop secondarily.

B

A 7-year-old female is being admitted to hospital for a diagnosis of acute lymphocytic leukemia (ALL). The nurse wants to gather information from the child regarding her feelings about her diagnosis. Which nursing action is appropriate to gain information on how the child is feeling? a. The nurse should actively attempt to make friends with the child before asking her about her feelings. b. The nurse should ask the child's parents what feelings she has expressed in regard to her diagnosis. c. The nurse should provide the child with some paper to draw a picture of how she is feeling. d. The nurse should ask the child direct questions about how she is feeling.

C

A mother brings her 15-month-old son to the clinic. During the nursing assessment, the mother makes the following comments. Which comment merits further investigation? a."My son cries sometimes when I leave him at his grandparents' house." b."My son always takes his blanket with him." c."My son is not crawling yet." d."My son likes to eat mashed potatoes."

C

A nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. Which is an important consideration in managing the child's pain? A. Give only an opioid analgesic at this time. B. Increase the dosage of analgesic until the child is adequately sedated. C. Plan a preventive schedule of pain medication around the clock. D. Give the child a clock and explain when he or she can have pain medications.

C

The Denver Developmental Screening Test has shown a 6-month-old infant is delayed in gross motor development. Activities by the nurse aimed at helping the child to attain appropriate developmental levels would include which of the following? a. Encouraging the child to stand b. Talking to the child and playing music c. Pulling the child to a sitting position or propping the child in a sitting position d. Encouraging the child to hold a rattle or playing patty-cake with him or her

C

The nurse discusses the risk of aspiration with the parents of an 18-month-old. The nurse recommends the parents avoid giving their child which of the following food items to minimize this risk?a. Oranges, crackers, and applesauce b. Apples, fruit juice, and raisins c. Cherries, peanuts, and hard candy d. Cheerios, toast, and bananas

C

The nurse is caring for a 7-year-old child scheduled for surgery in the morning. While conducting preoperative teaching, the nurse would choose which of the following visual aids to enhance the child's learning about the perioperative experience? a. Videotapes b. Colorful brochures c. Dolls and puppets d. A visit from the surgeon

C

The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain A. cannot occur if child is comatose. B. may occur if child regains consciousness. C. requires astute nursing assessment and management. D. is best assessed by family members who are familiar with child.

C

The nurse who is examining an infant would document a positive Babinski reflex after noting which of the following? a. Curling downward of the toes b. Dorsiflexion of the toes c. Fanning of the toes d. Withdrawing the foot from the stimulus

C

The nurse working in a sexually transmitted infection (STI) clinic of the city health department gives a tour to a group of student nurses. A student notes that the clinic population consists largely of teenagers. The nurse explains to the group that adolescents are at greater risk for contracting STIs because of which of the following factors? a. The immune system of an adolescent is immature. b. Untreated urinary tract infections will develop into an STI. c. Adolescents are risk-takers and believe they are invincible. d. Adolescents often lack parental supervision.

C

When assessing a child who reports abdominal pain, what is the most appropriate nursing action? a. Palpate the most painful area first b. Palpate for rebound tenderness c. Avoid painful areas until the end of the assessment d. Use deep palpation for abdominal tenderness

C

he pediatric nurse should plan to include the cover-uncover test screening for strabismus into the physical assessment of children at which developmental level? a. All children under 18 years old b. Infants c. Preschool children d. School-age children

C

Match the following reflexes with their best response. Rooting reflex Palmar grasp Plantar grasp Moro reflex (startle) Asymmetric tonic neck reflex (fencer) a. Extension of the arm and leg on the side when the head is turned to that side with flexion of the arm and leg of the opposite side. b. Legs flex, arms and hands extend when startled by a loud noise. c. Turns head to side when cheek or mouth is touched. d. Will grasp object when palm is touched. e. Toes will curl downward when sole of foot is touched.

c Rooting reflex d Palmar grasp e Plantar grasp b Moro reflex (startle) a Asymmetric tonic neck reflex (fencer) a. Extension of the arm and leg on the side when the head is turned to that side with flexion of the arm and leg of the opposite side. b. Legs flex, arms and hands extend when startled by a loud noise. c. Turns head to side when cheek or mouth is touched. d. Will grasp object when palm is touched. e. Toes will curl downward when sole of foot is touched.

First foods are _____,____, or finely ______

strained, pureed, mashed