PEDS Exam 1 Prep U (1-11 and 13/14)

The parents of a 2-year-old boy report to the nurse because their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child?

Offering a variety of foods along with the foods the child likes

A nurse is caring for a hospitalized 10-year-old. What would be an appropriate activity for this child to meet the developmental tasks of this age group?

Participating in a craft project During this stage, the child is interested in how things are made and run, and engaging in meaningful projects and seeing them through to completion.

The parents of an 8-year-old boy report their son is being bullied and teased by a group of boys in the neighborhood. Which response by the nurse is best?

"Bullying can have lifelong effects on the self-esteem of a child."

The nurse is caring for an 11-year-old girl. The girl's mother reports that the girl does not want to play team sports like soccer or volleyball anymore. Her daughter insists she does not enjoy them. The mother is concerned that her daughter will not get enough physical activity and asks the nurse for guidance. How should the nurse respond?

"Give her some options; it's important to find something she enjoys."

The nurse is doing teaching with a group of caregivers of preschool children on various topics. The topic of sexual development is discussed. Which statement made by the caregivers indicates an understanding of the sexual development of the preschool-age child?

"I feel better knowing that what she is doing is normal."

The nurse has finished completing a client education program for parents on proper medication administration to children. Which statement by a parent would indicate a need for further education?

"If my toddler won't swallow her medication, I will hold her nose until she has to swallow." Proper medication administration includes placing a pill in applesauce or ice cream to help a child learn how to swallow it. When giving medications to an infant or small child, always have them in an upright position to avoid aspiration. Allowing a toddler or preschooler to squirt medication into their own mouth. You should never force medication into a child's mouth or pinch their nose. This increases the risk for aspiration and interferes with developing a trusting relationship.

A nurse is interviewing the mother of a sleeping 10-year-old girl to assess the level of the child's postoperative pain. Which comment should trigger additional questions and necessitate further teaching?

"She is asleep, so she must not be in pain." Just because the girl is sleeping does not mean she is not in pain. Sleep may be a coping strategy or reflect excessive exhaustion due to coping with pain. An easygoing temperament and the ability to articulate how she feels will be helpful for the nurse to establish a baseline assessment. If the girl had never had surgery before, she is less likely to have previous memories or episodes of prolonged or severe pain.

An adolescent confides in the nurse that he is currently in a homosexual relationship with a classmate. He states, "I am not sure if I am really gay?" What is the best response by the nurse?

"Some teenagers experiment with homosexuality at this age. It may take some time before you determine if you are gay."

The nurse is preparing to remove an IV device from the arm of a 6-year-old girl. Which approach is best for minimizing fear and anxiety?

"The first step is for you to help me remove this dressing from your IV." The nurse should explain what is to occur and enlist the child's help in the removal of the tape or dressing. This provides the child with a sense of control over the situation and also encourages his or her cooperation. The nurse should avoid using scissors to remove the tape or dressing and the comment regarding cutting may be perceived as threatening and/or frightening. Telling the child to be a big girl is inappropriate and does not teach. Telling the child the procedure will not hurt and using the terms tug and pinch could increase the child's fear and lead to misunderstanding.

The nurse is discussing psychosocial development of the adolescent with a group of family caregivers. Which statement made by the caregiver is an example of the most effective way the caregiver can support the adolescent?

"The hairstyles she chooses are not what I think looks good on her, but I just let her do what she wants to with her hair."

The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching?

"This can be taken with other medications we have at home that didn't require a prescription." The nurse must emphasize that the parents should read closely labels of over-the-counter medications they already have or purchase. Some may contain ibuprofen or other nonsteroidal anti-inflammatory drugs, and if given in conjunction with ibuprofen may lead to overdose. The other statements are correct

What feeding practice used by the parents of an 8-month-old should the nurse discourage?

Placing all liquids given the child in a "no spill" sippy cup

The infant weighs 7 lbs. 4 oz. (3.3 kg) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months?

21 lbs. 12 oz. (9.9 kg) triple by 12 mos and double by 4-6 mos

can introduce solid foods

4-6 mos

strict breastfeeding for

6 mos recommended up to 1 yr

The nurse is preparing a female toddler for the repair of an eyebrow laceration. The girl is most likely to demonstrate which response in anticipation of the procedure?

A toddler is most likely to show regressive behaviors such as clinging and crying loudly. Preschoolers may say they need to go to the bathroom or get an item from another place to try to postpone the procedure. School-age children are more likely to withdraw into supposed inattention or silence and show muscular tension. Adolescents may look stoic in order to appear in control of themselves, or they may ask many questions (intellectualizing

The mother of a 9-year-old girl calls the physician's office complaining that her daughter continues to vomit soon after being given an oral amoxicillin capsule for her strep throat. The nurse recognizes that the child's vomiting will interfere with which pharmacokinetic process?

Absorption

The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of cooperative play?

Children are playing in an organized group with each other. During cooperative play, children play in an organized group with each other as in team sports. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. Parallel play occurs when the toddler plays alongside other children but not with them

An 8-year-old boy's foster mother is discussing her concerns about three recent cavities found in his permanent teeth. The mother reports that her child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. What would the nurse suggest to this mother is the most appropriate in regard to the child's dental health?

Ensure that the child brushes his teeth after each meal and snacks.

The nurse is assessing a child who is receiving TPN. The nurse determines the TPN bag was hung 24 hours ago. What initial action by the nurse is indicated?

Hang a new bag of TPN. TPN bags should not hang over 24 hours. The nurse should discontinue the current bag and hang a new one. There is no need to notify the physician. The rate of the TPN should never be changed without a physician's order

The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which observation would suggest the child is experiencing a problem with language development?

Her vocabulary is between 10 and 15 words. A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly. Thus a vocabulary of 10 to 15 words suggests a language problem

According to Erikson, the adolescent develops their own sense of being independent people with their own thoughts and goals. This stage is referred to as:

Identity vs. role confusion they must develop their own personal identity—a sense of being independent people with unique ideals and goals

The nurse is working with a 5-year-old boy who must receive repeated intravenous injections as part of his treatment. He hates the injections, however, and is frightened whenever he sees the syringe and needle. In an attempt to overcome this fear, the nurse holds the syringe up for him to see and tells him, "This looks kind of like a space rocket, don't you think? Here comes the space rocket—it needs to refuel." Which pain management technique is the nurse using here?

Imagery Imagery involves the use of the imagination to create a mental image. This mental image usually is a positive, pleasurable image, but it need not be real. As an example, a child could imagine a venipuncture needle as a silver rocket ship probing the moon or a submarine diving under the water to escape a torpedo just in time. Thought stopping is a technique in which children learn to stop anxious thoughts by substituting a positive or relaxing thought in its place. Hypnosis involves the child entering a trance-like state to effectively avoid sensing pain. Biofeedback is based on the theory people can regulate internal events such as heart rate and pain response in response to a stimulus. A biofeedback apparatus is used to measure muscle tone or the child's ability to relax.

The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age?

No teeth Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months

The nurse is preparing to give a diphtheria, pertussis, and tetanus (DPT) immunization to a child in an acute care setting before discharge. The label on the DPT bottle indicates the immunization expired yesterday. What is the correct nursing action to take?

Return the bottle to the pharmacy and request a replacement. The expired immunization bottle should be returned to the pharmacy and a replacement should be requested. Never give expired medications. Simply discarding the bottle does not solve the problem and it is not necessary to inform the prescribing practitioner

A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?

Support whatever the child paints.

The nurse is assessing the behavioral indicators of a 9-month-old to determine the child's pain level. Which description would be commonly associated with a pain response?

The child has an angry facial expression with the eyes open. The older infant typically displays an angry facial expression and keeps the eyes open. In the younger infant, the brows may be lowered and drawn together with the eyes tightly closed. The younger infant's body may be stiff but may continue to thrash around. Unless the infant is extremely ill, there will be response to painful stimulation

The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?

The child's nonverbal behaviors may indicate the presence of discomfort. Responses to pain can vary in children. A child of this age may present with vocal behaviors indicating pain. The child may be tearful or crying loudly. Being quiet can also signal pain

The nurse is calculating the urinary output for the infant. The infant's diaper weighed 40 grams prior to placing the diaper on the infant. After removal of the wet diaper, the diaper weighed 75 grams. How many milliliters of urine can the nurse document as urinary output? Record your answer using a whole number.

The diaper must be weighed before being placed on the infant and after removal to determine urinary output. For each 1 gram of increased weight, this is the equivalent of 1 milliliter of fluid. 75 grams - 40 grams = 35 grams = 35 mL

The student nurse is preparing to care for a recently placed gastrostomy tube. Which action would prompt further instruction from the overseeing nurse?

The student obtains an antimicrobial soap to clean the area surrounding the tube. The skin around a gastrostomy tube requires cleaning at least once a day. Routine site care includes gentle cleansing with sterile water or saline for newly placed tubes, or for established tubes, soap and water followed by rinsing or cleaning with water alone. To clean under an external disc or bumper, a cotton-tipped applicator may be used.

The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking?

They put her to bed when she falls asleep.

A toddler's father is concerned because his son refuses to share. What is your best response concerning this?

This is normal toddler behavior; sharing is learned later.

Which statement is the goal of distraction techniques used to control pain?

To divert the child's attention away from the pain through controlled, purposeful behaviors

Suicide is so common in adolescents it ranks third as a cause of death in the 10- to 24-year-old age group.

True

The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it.

True

The nurse is caring for a 2-year-old postoperative PET client. Which consideration is the most appropriate for this child's developmental stage?

Uses words for pain such as owie, boo-boo, or hurt The toddler uses simple terms to describe pain, such as owie, boo-boo, or hurt. School-aged and preschool-aged children fear bodily mutilation. Preschool-aged children delay or put off treatment, and school-aged children understand time

A nurse is preparing to administer an ordered IM injection to an infant. The nurse knows that the most appropriate injection site for this child is which muscle?

Vastus lateralis

Anticipatory guidance for an infant for the 4th month should include the fact that she probably will:

be able to turn over onto the back. Infants typically turn over front to back at 4 months, enlarging the area of the house that needs to be childproofed.