PEDS Exam 3 review

During a well-child checkup, the mother of a 5-year-old girl reports her daughter seems much smaller than her 2 older children did at this same age. A review of the medical record reveals that the child is 44 inches tall and weighs 42 pounds. What information should be included in the response by the nurse? 1 "Your daughter is within normal limits for her weight but she is slightly shorter in stature than other children her age." 2 "Your daughter is within the acceptable range for her height but she is significantly smaller in weight for her age." 3 "Your daughter is slightly taller than other children her age but her weight is normal." 4 "The weight of your daughter at this time is with normal limits for her age but she is moderately taller than other children her age."

3 The average weight of a child who if 5 years is 41 pounds. The average height is 43 inches. This child is within normal limits for both height and weight.

The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem? 1 "He wasn't bothered by the paint smell." 2 "He was licking the dishwashing soap." 3 "He doesn't respond if I wave to him." 4 "I dropped a pan behind him and he cried."

3 The fact that the child does not respond when the mother waves to him suggests he may have a vision problem. The toddler's sense of smell is still developing, so he may not be affected by odors. Their sense of taste is not well developed either, and this allows him to eat or drink poisons without concern. The child's crying at a sudden noise assures the nurse that his hearing is adequate.

The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response? 1 Some children have large heads but that does not signal a problem. 2 Explain that the child looks normal. 3 Share that the heads of children at this age are large in proportion to the rest of their body. 4 Teach the mother that this larger head than body appearance will be this way until the child is about 6 years old.

3 Head circumference increases about 1 inch between 1 and 2 years of age, then increases an average of a half-inch per year until age 5. The anterior fontanel should be closed by the time the child is 18 months old. Head size becomes more proportional to the rest of the body near the age of 3 years.

When collecting data on a preschool-aged child during a well-child visit, the nurse discovers the child has gained 12 lb (5.4 kg) and grown 2.5 inches (6.3 cm) in the last year. The nurse interprets these findings to indicate which situation? 1 Weight and height are within expected patterns of growth. 2 Weight falls within an expected range and height is less than what would be expected. 3 Weight is above an expected range and height is within an expected range. 4 Weight is below an expected range and height is above an expected range.

3 The preschool period is one of slow growth. The child gains about 3 to 5 lb each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm). The child's weight is above the expected gain and the height is what would be expected.

The father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is most appropriate? 1 "Is there a reason you are concerned about your child's height?" 2 "Your son is slightly below the normal height for his age group but may still grow to be a normal height in the coming year." 3 "Your son is slightly below the normal height for his age but he had demonstrated a normal growth rate this year." 4 "Both your son's height and rate of growth are within normal limits for his age.

4

The mother of an infant questions the nurse about her baby's teething. The nurse provides client education. Which statement by the mother indicates understanding of the information provided? 1 "My baby will most likely have his upper middle teeth come in first." 2 "My baby's first tooth will likely appear between 5 and 6 months." 3 "By 1 year my baby should have about three teeth." 4 "The first teeth that will likely appear are the lower incisors."

4

the nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. The nurse determines the session is successful when the group correctly chooses which example as best displaying toddlers playing? 1 Playing apart from others without being part of a group 2 Playing together in an activity without organization 3 Playing in an organized group with each other 4 Playing independently and are side by side

4

A 4-year-old child is drawing with crayons. Which creation by the child would most be reflective of the anticipated skill level of this age? 1 The child draws a person with 6 body parts. 2 The child is able to proficiently draw several letters of the alphabet. 3 The child draws random lines on the paper and reports it is a person. 4 The child is able to draw shapes such as circles and squares.

4 Preschool children are creative and like to draw. They are able to draw shapes such as circles and squares. Drawing a figure with at least 6 body parts and writing letters are the expected skills of a 5-year-old. Random lines would be demonstrated by a younger child.

A 3-month-old infant has a Moro reflex. Which statement is most true of this reflex? 1 A Moro reflex normally lasts until 9 months. 2 It is not important how long the reflex persists, only that it is present at birth. 3 A Moro reflex present at 3 months of age requires referral for a neurologic exam. 4 Most 3-month-old infants still have a Moro reflex.

4 The Moro reflex is seen in the infant as a sudden extension of the head with the arms abducted and moving upward. In this position the hands for the letter "C". This reflex is present at birth and disappears around 4 months of age.

______ mg of calcium per day for toddlers Toddlers who do a strict vegan diet are at risk for __________, ___, and ____. May need supplemental nutrients.

500 mg of calcium per day for toddlers Toddlers who do strictly vegan diet are at risk for Vitamin D, B12 and iron. May need to supplement nutrients

-Sense of smell develops rapidly in the first _ day old infant so he can tell the difference of breast milk from his mothers to another.

7 days

what age level becomes aware of gender differences?

Toddler

With these average head circumference is about ___ cm. Head circumference rapidly increases in first 6 months. And usually after 6-12 months the head growth will slow down and they should be an average of ____ cm or ___ inches gained from birth to the first year.

With these average head circumference is about 35 cm. Head circumference rapidly increases in first 6 months. And usually after 6-12 months the head growth will slow down and they should be an average of 10 cm or 4 inches gained from birth to the first year.

A sign of developmental delay in 5 year olds is if they cannot complete_________?

Cannot complete self-care activities (toileting, dressing teeth, brushing)

Immunizations for premature infant?

still based on congenital age. not adjusted age.

Introduce the cup early. ____ months to start

6 months

First primary teeth to erupt?

6-8 months on the bottom

Obesity is defined as BMI greater than ___th percentile for age and sex.

95th

Head size more proportional to body by age

3

Most children discountiue daytime napping at around ___ years of age. Although this is highly individualized.

3 years of age

With toddlers heart rate ________ and blood pressure _______ in relation to infants

-Heart rate decreases; blood pressure increases

The parents of an 8-month-old boy voice concern to the nurse that their child is not developing motor skills as he should. What question would be appropriate for the nurse to ask in determining if their fears are warranted? 1 "Does he move a toy back and forth from one hand to the other when you give it to him?" 2 "Does he place toys into a box or container and take them out?" 3 Is he able to drink with a cup by himself?" 4 "Is he able to hold a pencil and scribble on paper?"

1

3 year old's require how much sleep ?

12 hours

Anterior fontanelle closes by ___ months?

18

Toddler development theories: Erickson? Piaget? Freud?

Erickson= autonomy vs shame. separates from caregiver and wants to be autonomic. Piaget- sensorimotor and preoperational- Differentiates self from object Freud- Anal- achieving sphincter control

For infancy: Erikson's stage? Piaget? Freud?

Erikson= trust vs. mistrust. Sense of trust for caregiver to respond to needs. Piaget- sensorimotor. senses and motor skills to learn about world Freud- Oral stage. feeding, sucking etc.

MCHAT test for?

Modified Checklist for Autism in Toddlers

If a baby has colic provide support and educate parents that it typically resolved about ___ months of age.

3

Having a bilingual house hold can make it harder to _____ for provider.

assess.

toddler speech: Echolalia? Telegraphic?

automatic and immediate repetition of what others say. Repeating words or phases without understanding them. Speech of just a few words to get point across. Ex. instead of "I want this" it a just be " want this" or "this"

Respiratory system in toddlers: Trachea and airways are small compared to adults: tonsils and adenoids are ____ relative to size of oral cavity

large

Preschooler development theories Erickson? Piaget? Kohlberg? Freud?

•Erikson: initiative versus guilt (3 to 6 years) •Piaget: preoperational substages: preconceptual (2 to 4 years) and intuitive phases (4 to 7 years) •Kohlberg: punishment-obedience orientation (2 to 7 years) •Freud: phallic stage (3 to 7 years)

Hearing is likely to be _____ levels in the toddler. so if they do not respond to ___ or _________ test it may be concerning

•Hearing likely to be at adult levels in the toddler. So if they don't respond to sounds or whisper test may be conserning

Foods high in iron includes?

Beans, tofu, chicken, beef, fortified cereals.

Parents and their 35-month-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? 1 Uses two-word sentences or phrases 2 Talks about a past event 3 Half of speech understood by outsider 4 Asks "why" often

1 A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.

The nurse is assessing a 4-year-old on a routine well-child visit. When assessing the gross motor skills of this preschooler, which activity will the nurse predict the child to be able to successfully accomplish? 1 Hop on one foot 2 Walk backwards with heel to toe 3 Throw and catch a ball 4 Jump rope

1 The 4-year-old should be able to hop on one foot and can control movements of the hands. By the age of 5 the child can walk backwards heel to toe, throw and catch a ball well, and jump rope.

The nurse is conducting a well-child exam of a 4-year-old boy. Which statement would alert the nurse that the child is at risk for iron deficiency? 1 "He loves milk and drinks it every time he is thirsty." 2 "He eats a well-balanced diet." 3 "He enjoys eggs and fortified cereal for breakfast." 4 "He does not like spinach, but he does like chicken and beef."

1 This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency.

For safe home environment avoid exposure to ________ and prevent injury including _____ safety

-Avoid exposure to tobacco smoke -Prevent injury; water safety (very important for the toddler age group)

For toddlers bones increase in ________, Muscle _________; Swayback and pot belly appear (_______) due to weak muscles until 3 years old.

-Bones increase in length; muscle matures; swayback and pot belly appear (lordosis) due to weak muscles until 3 years old

Generally toddlers reach half adult height by ___ Average weight gain is __ to __ lbs per year Height increases by average of ___ inches per year.

-Generally reach half adult height by age 2 -Average weight gain is 3 to 5 lb per year -Height increases by an average of 3 in per year

When performing neurological reflexes on the infant, which primitive reflex will be present longest? 1 Moro 2 Babinski 3 Rooting 4 Step

2

The nurse at a family health clinic is teaching a group of parents about normal infant development. What patterns of communication should the nurse tell parents to expect from an infant at age 1? 1 Squeals and makes pleasure sound 2 Understands "no" and other simple commands 3 Uses speech-like rhythm when talking with an adult 4 Uses multisyllabic babbling

2 At age 1, most babies understand the word "no" and other simple commands. Children at this age also learn one or two other words. Babies squeal, make pleasure sounds, and use multisyllabic babbling at age 6 months. Using speech-like rhythm when talking with an adult usually occurs between ages 9 to 12 months.

Brain reaches about 90% or size by age ___. Increase in myelination. What is myelination

2 Myelination- improves coordination, balance, and sphincter control

The nurse is performing an assessment on a 8-month-old infant. The infant's medical history notes that he was born at 32 weeks' gestation. The infant is progressing normally. At what adjusted age should the nurse expect the infant's developmental accomplishments? 1 The infant can be expected to display developmental skills consistent with a 8-month-old infant. 2 By 8 months of age, the child's skill level will vary greatly and cannot be predicted. 3 The infant will most likely present with developmental skills consistent with a 6-month-old infant. 4 The infant will likely show the skills of an infant with the adjusted age of 7 month.

3

___ year old's should be able to grasp utensils and crayons in adult fashion. also trace square and circles. Feed themselves without spilling much.

3

_________ can decrease postpartum hemorrhage, risk for ovarian and premenopausal breast cancer, possible delay ovulation,

Breastfeeding

Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. Except for the _________, which disappears around 1 year of age, these primitive reflexes diminish over the first few months of life, giving way to protective reflexes.

Babinski

by ___ months toddler should be climbing stairs with assistance. pulling up on toys By ___ months- running with kickball, stand on tippy toes. several objects while walking, go up furniture/ stairs without assistance By ___ months- climbing well, pedaling tricycle, running easily, bending over without falling.

By 18 months- climbing stairs with assistance. Pulling up on to toys while walking By 24 months- running with kickball, stand on tippy toes, carry several toys while walking, go up and down stairs/ furniture without assistance By 36 months- climbing well, pedaling tricycle, running easily, bending over without falling

Bottles should be cleaned and stored how?

Clean bottles in hot soapy water and rinse well or run them through the dishwasher. Store them covered

Because of fewer alveoli in infants this allows for respiratory rates to be _______ and then _________ as the child matures.

Faster. decreases as child matures

Asymmetric Tonic Neck Reflex

Fencing Stimulus: Fully rotate infant's head and hold for 5 seconds. Response: Extension of extremities on the face side, flexion of extremities on the skull side. Relevance: Promotes visual hand regard.

_________- is normal and -Believes thoughts are all-powerful. Satisfy curiosity about the world around them

Magical thinking

Also newborn and young infants may do grunting, straining or crying while they are having a bowel movement. Typically not a concerning unless the stool is ______ and ____

Hard and dry

in toddlers visual acuity continues to _______

Improve

Exceptions to recommending breast feeding?

Infants with galactosemia ( deficiency in liver enzymes) Maternal use of drugs and a few prescription medications Maternal untreated active tuberculosis Maternal HIV infection in developed countries,

Overweight in preschooler is defined as BMI at or above ___the percentile and below the ___ the percentile for age and sex

Overweight is defined as BMI at or above the 85th percentile and below the 95th percentile for age and sex

The Babinski Reflex?

Reflex in which a newborn fans out the toes when the sole of the foot is touched

Leading cause for hospitalization among infants?

Respiratory infections

Respiratory maturity is not until age ____. Lack of _____ is the mucosal track of the lining also contributes to frequent infections to occur.

age 7 IgA

When does the Moro reflex disappear?

around 4 months of age

Why are infants more susceptible to dehydration?

because the infant's extracellular fluid (ex. Blood plasma) counts for about 35% of body weight. And intracellular fluid counts for about 40% compared to adult of quantities of 20 and 40% respectively. Because of change in the fluid shifts is why they are more susceptible to dehydration.

Growth and development of a premature infant is based on _______ age?

calculated or adjusted age.

Babies born before 37 weeks have what issues?

higher rates of immature respiratory, metabolic needs with low blood sugars. Inadequate stores of iron and immunoglobulins, immature GI system. Basically everything is immature.

Emotional and social development of a toddler is focused on ?

ones self

Toddlers engage in _______ play

parallel

age group where they may start telling you how they feel and making friends becomes important

preschooler.

Pulse and Respiration rate of toddler?

pulse= 70-120 RR- 20-30

Excessive skin or webbing is a sign of ?

turners

Average growth of a preschooler is ____ inches per year weight gain around ___ jlbs per year

•Average growth of 2.5 to 3 inch per year •Average weight gain around 5 lb per year

warning signs of language development: Does not make sounds at ___ months of age Does not laugh or squeal by ____ months of age Does not babble by ___ months of age Infants should use single words by ____ months of age.

•Does not make sounds at 4 months of age •Does not laugh or squeal by 6 months of age •Does not babble by 8 months of age; infant does not use single words with meaning at 12 months of age (mama, dada)

Early warning signs of hearing or vision problems in infant: Does not make sounds at ___ months old Doe not turn to location of sound at ___ months old Cross eyes most of the time at ___ months old Does not try to study object in visual field

•Does not start to make sounds or babble by 4 months of age •Does not turn to locate sound at age 4 months •Crosses eyes most of the time at age 6 months

Spitting up is normal, but if a baby spits up more than expected education to do what?

•Small amount of feedings more frequently, burping the baby, and sitting up for 30 minutes after they feed.

The nurse is providing anticipatory guidance to the mother of a 2-month-old in relation to interpersonal development. Which behavior is most likely to occur over the next 8 weeks? 1 Mimicking mother's facial expressions 2 Becoming clingy around strangers 3 Participating in a game of peek-a-boo 4 Crying when the mother is out of sight

1

The pediatric nurse is discussing the daily activities of a 4-year-old with the caregiver to assess growth and development status. The nurse would document that the child has reached the initiative stage of development if the caregiver indicates the child participates in which activity? 1 Tries to sweep up spilled cereal but cries when can't do well 2 Broke a dish but blamed it on some friend the caregivers don't know 3 Refuses to hold anyone's hand while crossing the street 4 Gets upset when a babysitter is in charge, but will do what is asked by the babysitter

1

Which activity is most beneficial in the development of the newborn? 1 Being sung to by his mother 2 Placement in an infant swing in a position to allow observation of the family's activities 3 Laying on his back with a mobile overhead to watch 4 Listening to classical music

1

Which milestone would the nurse expect an infant to accomplish by 8 months of age? 1 Sitting without support 2 Creeping on all fours 3 Pulling self to a standing position 4 Being able to sit from a standing position

1

Preschoolers need ____ mg of iron

10

The student nurse is reviewing the chart of a newborn. The document indicates the newborn is in the quiet alert state. Which is the best description of this sleep phase? 1 The newborn's eyes are open and he is smacking his lips. 2 The newborn's eyes are open and no body movements are noted. 3 The infant's eyes are partially open and there are small movements in the extremities. 4 The infant is awake but appears drowsy.

2

When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old toddler? 1 The toddler should say two words plus "ma-ma" and "da-da." 2 The toddler should speak in two-word sentences ("Me go"). 3 The toddler should be able to count out loud to 20. 4 The toddler should say 20 nouns and 4 pronouns.

2

The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age? 1 1 to 3 natal teeth 2 No teeth 3 1 to 2 lower teeth 4 1 upper tooth

2 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 caring for a 18-month-old child who has had surgery. The medical record indicates the child weighs 23 pounds (10.45 kg). When monitoring his urinary output the nurse is aware that normal hourly output should be what value? 1 5 mL/hr 2 10 mL/hr 3 15 mL/hr 4 20 mL/hr

2 The normal urinary output for a toddler is approximately 1 mL/kg/hr. This child weighs 23 pounds. This is 10.45 kg. This is approximately 10 mL/hr.

Benefits to __________ for infants can be •Immunologic protection, anti-infective properties •Increased bonding with mother •Decreased incidence and severity of diarrhea diseases •Decreased incidence of asthma, otitis media, bacterial meningitis, botulism, urinary tract infections •Possible enhancement of cognitive development •Decreased incidence of obesity later in life

Breastfeeding

Lax skin is a sign of?

Down syndrome

In infancy tongue is ______ relative to oral cavity size

Larger. it must be able to latch onto the nipple

__________ are bad dreams that are not to be confused- they may talk about it ________- they make awake 30-60 minutes later and are screaming. May not respond to parents' ability to sooth them and may just go back to sleep after they calm down.

Nightmares Night terrors

shorten neck is _______ in younger children

Norma

what age group Developing sexual ability, developing conscious, may negotiate with parents when conflict. Like to explore new things

Preschooler

Cardiovascular system in infants for 1st year *Heart _______ in size the first year. *Blood pressure steadily ______ from an average of _____ in the infant to _____ in the 12 month old *Peripheral capillaries are closer to the surface of the skin, making the newborn and young infant more susceptible to ______.

•Heart doubles in size in the first year •Blood pressure steadily increases, from an average of 60/40 in the newborn to 100/50 in the 12 month old •Peripheral capillaries are closer to the surface of the skin, making the newborn and young infant more susceptible to heat loss

Maturation of the organs in preschooler: ____________ of the spinal cord allows for bowel and bladder control to be complete. ________ tubes remain short and straight. This age group is highers for ear infections because of this. Heart rate ____, blood pressure _____ slightly, innocent heart murmurs may be heard _______ remains short in children making them more susceptible to UTI Bones ____________ in length and muscles strengthen and mature

•Myelination of the spinal cord allows for bowel and bladder control to be complete; small intestine grows in length •Respiratory structures continue to grow in size; number of alveoli increase •Eustachian tubes remain short and straight. Why this is one of the ages highest for ear infections •Heart rate decreases; blood pressure increases slightly; innocent heart murmur may be heard •Urethra remains short in children, making them susceptible to urinary tract infections •Bones increase in length and muscles strengthen and mature

Resp system for infants versus adults Nasal passage are ____________ Larynx is more ________ shape Trachea and chest wall are more ___________ Bronchi and bronchioles are _______ and __________ Significantly fewer __________.

•Nasal passages are narrower •Larynx is more funnel shaped •Trachea and chest wall are more compliant •Bronchi and bronchioles are shorter and narrower •Significantly fewer alveoli