Pediatric exam 1
vaccinations received at 6 months old:
-DTaP -Hib -IPV -RV -flu -COVID
what fine motor skills are developed at 4 months?
-touches fingers together -begins reaching both hands at the same time -able to grasp small toys with both hands -touches/ bangs objects on table or hard surface
language developed at 15 months:
4-6 words
During the physical assessment of a newborn, the nurse palpates the infant's femoral pulses. Which cardiovascular anomaly is the nurse trying to detect? A. Coarcation of the aorta B. Atrial septal defect C. Patent ductus arteriosus D. Ventricular septal defect
A. Coarcation of the aorta
what is the best indicator fo fluid shift in children?
WEIGHT
which parental statement indicated understanding of recommendations when caring for a 7 month old infant? select all a. i should call my child by name b. i should not change my child's diet c. i should start oral hygeine with my child d. i should not leave my child with an unfamiliar relative e. u should encourage my child to pronounce n,k,g,p, and b sounds
a. i should call my child by name c. i should start oral hygeine with my child d. i should not leave my child with an unfamiliar relative
weight at 12 months old:
triples
weight at 6 months:
weight doubles
Which assessment findings would indicate a possible asthma exacerbation? Select all that apply. •A. Fever •B. Stridor •C. Wheezing •D. Tachycardia •E. Hypotension
•C. Wheezing •D. Tachycardia
s/s of meningitis in infants:
*get rectal temp for accurate results* -HR and RR increases -tense/ bulging fontanel -high temp (often absent in babies under 3 months) -very sleepy -breathing fast/ difficulty breathing -extreme shivering -"pin prick" rash or purple bruises anywhere on the body -vomiting/ refusing to feed -high pitched cry or moaning cry -irritable when picked up -blotchy skin may be pale or turning blue -stiff body with jerky movements -cold hands and feet because they are shunting all their blood to vital organs
ventricular septal defect: (VSD)
*most common heart defect in children* -there can be one or multiple holes in the septum between ventricles -allows oxygenated blood to flow from the L to R side increasing pulmonary flow and increasing blood volume that returns to the L side of the heart which over time results in the L side of the heart to be more dilated S/S are the same as ASD -we can increase calories for poor weight gain to 24 treatment: -1st line of treatment --> diuretic (most commonly furosemide) -will be surgically closed if it doesn't close on its own
abuse:
-#1 failure to thrive -malnourished -bruising -excoriated skin -dirty -mongolian spots --> have to be aware of certain cultural practices
poisining in children:
-*treat the child first and not the poison* -1st step call poison control (they want to now what ehy took, how much, how long ago, weight , height, how they ingested it, and how they look) -treatment is to manage the symptoms, give the antidote if their is one, keep warm and IV fluids
what gross motor skills are developed at 12 months old?
--may take steps without support -stands without support
what vaccinations do 2 month olds receive?
-Hep B -DTaP --> pertussis, tetanus, and diphtheria - Hib --> haemophilus influenzae type B -PCV13 --> pneumococcal -IPV --> polio virus -RV --> rotavirus
DDH (Hip Dysplasia)
-a hip is dislocated at birth -a loose hip will "click" -the affected leg sometimes is shorter and turned outward with uneven skin folds management: -pavlik harness --> loops underneath their foot to retrain their hip to be back in the normal socket (needs to be left on 24 hrs a day can be taken off for bathing) -spica cast--> can be for one or both legs; (pedaling: taping around the cut out hole to protect the cast from moisture) ; good diaper care is #1 education for the parents
what are the fine motor skills developed at 8 months old?
-able to hold objects with the pad of the thumb -can poke objects with index finger -can pull an item straight up
red zone asthma action plan:
-asthma is getting worse fast -medicine is not helping -breathing is hard and fast -nose open wide (nasal flaring) -may or may not wheeze/ cough -ribs show -cannot talk well -they will be using rescue albuterol q 1 hrs
how long do 8 months old sleep?
-awake for 2-3 hrs -naps lasts 45min -2 hrs -2-3 naps a day
how long do 10 month olds sleep?
-awake for 3-4 hrs -naps last 45min-2 hrs -2 naps a day
How long do 12 month olds sleep?
-awake for 3-4 hrs -naps lasts 45 min-2hrs -2 naps a day
what kind of language does a 4 month old have?
-babbles -turns head to sound when speaking
what fine motor skills are developed at 2.5 yrs old?
-better hand and finger coordination -begins to draw and copy shapes -draws circles
treatment for dehydration d/t vomiting or diarrhea:
-bolus 10 mL per kilogram then we can increase to 20 mL -Na is the best level to indicate concentration/ dehydration -oral fluids --> pedialyte (q 5 min give 5 mL for 1 hr; after 1 hr q 15 min give 15 mL) -D5NS if they arent eating anything
nutrition and feeding for infants:
-breastmilk is best but can use formula -breastfeeding is recommended for at least 6 months -if breastfeeding iron and vit D supplements are needed -limit juices -introduction of 1 new food a week (at 6 months or older) -first solid iron should be fortified cereals, followed by strained fruits and veggies -finger foods help develop the pincer grasp (at 10-12 months) -can still breastfeed even if they are eating solid foods -let them explore with baby safe utensils
green zone asthma action plan:
-breathing is good -no cough or wheeze -sleep though the night -can work and play -no albuterol use just daily maintenance med
acetaminphen poisoning:
-call poison control and go to the ED -test how high levels are s/s: -anorexia -#1 symptom N/V treatment: give -AST and ALT will be elevated and liver will be tender on palpation acetylcysteine (given in a 3 bag series with a specific time frame and labs are taken before each bag is hung)
what gross motor skills are developed at 3 yrs old?
-can alternate feet on the stairs -can begin to ride a tricycle -good at copying shapes
language developed at 3 yrs old:
-can formulate 3 word sentences -we understand 75% of what they say -they know their name and usually know what gender they are
what gross motor skills are developed at 2 yrs old?
-can go up and down the stairs without help but doesnt alternate their feet -can open doorknobs and unscrew lids
what fine motor skills are developed at 15 months?
-can stack 2 blocks -uses a cup -cannot do the scooping motion with the spoons yet -can scribble
what fine motor skills are developed at 2 yrs old?
-can stack 6-7 blocks -turns pages 1 at a time
safety for 4 month olds:
-car seat -sleeping -lead -teething
injury prevention of infants:
-car seats are always rear facing from birth until ages 2-4 (protects head, neck, and spine during a crash) -outlet covers -baby gates -sunscreen when in the sun applied every 2 hrs -baby locks for cabinets (cleaning supplies etc.) -bolted shelving units to the wall so it doesn't fall back on the baby
safety for 6 months old babies includes:
-child proof home -choking hazards -respiratory illnesses
language developed at 8 months old:
-communicates using body language -puts sounds together with rythm and tone
management of nephrotic syndrome:
-corticosteroids --> for damage and inflammation (fixes nephrotic syndrome) ; moon face can occur with long term use of steroids and is not the same as the periorbital face edema they get from the syndrome -antibiotics --> only for some cases if its related to a bacterial infection like a UTI -children who are resistant to corticosteroids we will use a chemotherapy agent -last resort --> renal transplant interventions: -keep them upright as much as possible -measure abdominal circumference to measure edema -diuretics --> monitor potassium
what gross motor skills are developed at 8 months old?
-crawls forward on belly -gets from sitting to crawling position -sits and plays with toys -sits unsupported
safety for 2 month olds:
-falls -cars seat safety -sleeping -colic
teething in infants:
-first tooth appears by 6-10 months -teething pain can be minimized with frozen teething rings, or topical anesthetics -brush their teeth -there will be an increase in saliva and possibly a slight increase in temp
cleft lip and palate
-genetics can be a cause --> if you had it then you are more prone to give it to your baby -have trouble talking, hearing, and breathing they will have trouble feeding: -breast is best because it can mold to their mouth -pigeon bottle --> helps them eat because one side of the bottle is flat and the other is round (flat part goes toward defect) treatment: surgery -lip done between 6-12 wks -palate done at 6-12 months -the goal of surgery is to restore the jaw and facial structures leading to normal function and improved appearance
what gross motor skills are developed at 18 months?
-gets up to stand from any position -runs clumsily -falls often -jumps in place w/ two feet -pulls and pushed toys -throws balls overhand
language developed at 6 months:
-imitates sounds of speech -laughs
what gross motor skills are developed at 2.5 yrs old?
-jumps with both feet across the floor and off the chair or step -can stand on one foot briefly -cap tiptoe a few steps
what gross motor skills are developed by 4 months?
-lifts head and pushes onto elbows/ forearm at tummy time -rolls both ways -plays w/ feet and brings to mouth when on back -sits with support -reaches with either hand -keeps head steady while being held
what things do 2 month olds play with?
-mobiles -black and white toys -large rings -mirror -focus cards
vesicouretral reflux (VUR)
-most commonly from a UTI -retrograde flow of urine from the bladder into the uterus, occurring when voiding -kidneys increase in size d/t increased pressure and backflow diagnosis: -VCUG --> bladder is injected with dye so we can visualize the flow of urine into the kidneys s/s: -dysuria -flank pain -abdominal fullness management: -can resolve without surgery as the child develops -double voiding --> child urinates and then even if they think they are done they need to urinate again -prophylactic antibiotics -invasive fix --> implantation of stents into ureters to allow free flow of urine (suprapubic cath is placed pain management: -tylenol/ ibuprofen -B& O suppository (has opium in it)
S/S respiratory failure:
-nasal flaring -grunting -tachypnea -tachycardia -low O2 -cyanosis -lethargic -apnea (20 sec no breathing)
what toys are appropriate for a 10 month old?
-nesting toys -large wooden cars -large balls -stacking toys
what are appropriate toys for 6 months?
-nursery rhymes -simples songs -rattlers -board books -spinning drum
oral thrush in infants:
-occurs when baby doesn't completely swallow all of the milk -treatment: nystatin (cream or powder for areas other than the mouth)
appropriate toys for 12 month olds:
-picture books -toy phone -dolls -strollers -dress up -toys with dials -switches -knobs
what are the fine motor skills developed at 12 months old?
-places small objects into a medium or large container -can place multiple medium sized objects into a container -able to let go of an object and pick it back up -begins to make small marks on paper -stacks two blocks
what play activities are appropriate for toddlers?
-playing ball -reading picture books -dumping legos out everywhere (we can encourage them to sort the colors) -parallel play
s/s dehydration:
-poor skin turgor -cool extremities -decreased urine output -low BP -thristy -if really dehydrated --> lethargy
hypertrophic pyloric stenosis
-projectile vomiting because nothing can go down -low birth weight possible failure to thrive -baby will be hungry and high pitched crying treatment: -surgery to cut pylorus so its no longer obstructed -NPO before surgery -NPO breast milk 4 hrs before -NPO formula 6 hrs before -after surgery start feeding with clear liquids like pedialyte for 24 hrs they can still projectile vomit up to 24 hrs after surgery
how long should you take the pulse and respiratory rate for on an infant?
-pulse should be listened to for a full minute at the apex -RR should be listened for a full minute (its best to listen when they are sleeping and not crying?
toys for 8 months old:
-puppets -water toys -jingle toys
what are the fine motor skills developed at 6 months?
-reaches for an object with R or L hand -shakes rattle -uses raking grasp to pick ip small objects -transfers objects from one hand to another
what is language like for a 2 month old?
-reacts to loud sounds -begins to babble -smiles
safety for 10 month olds:
-sleeping safety -no objects in crib
what do 4 month olds play with?
-soft books -textured balls -teething toys -mobile with color -sensory exploration
S/S respiratory distress:
-sternal and intercostal retractions -high HR and RR -tachypnea 1st sign of airway obstruction -cough -cyanosis -clubbing of fingers -restlessness -rhonchi, stridor, wheezing
safety for 12 month olds:
-swim safety
what are the gross motor skills developed at 10 months old?
-takes steps while furniture surfing -pulls self to stand -gets to sitting position without help
toddlers physical growth:
-they are 4x their birth weight at 2.5 yrs -they grow 3 inches taller per yr -all 20 teeth are present by age 2.5-3
nutriton for toddlers:
-they eat 3 meals a day -they are picky eaters -24 oz of low fat cow milk/day at age 2; before the age of 2 they can have whole milk (cow milk contains calcium and fat unlike other milk alternatives) -serving size --> 1 tbsp per yr
teething for toddlers:
-they have all of their teeth so they need to start using flouride toothpaste and going to the dentist -we can offer toddlers fun toothbrushes to encourage them to brush their teeth on their own -sugary drinks and juice need to be limited
what gross motor skills are developed at 2 months?
-tracks parents -looks at a toy for several seconds -raises head and chest when on stomach -opens and shuts hands -brings hand to mouth -stretches and kicks
what are the gross motor skills developed at 6 months?
-transfers objects from hand to hand -supports weight on legs -leans on hands when sitting -begins to pivot L to R while on belly -assumes hands and knees positon
language developed at 10 months:
-understands gestures -can combine sounds
what fine motor skills are developed at 18 months?
-uses a spoon but is messy -can turn pages of a book a few at a time -holds crayon -builds tower of 3-4 blocks good toy for this age is push/ pull vaccum
what are the fine motor skills developed at 10 months old?
-uses pincer grasp to pick things up -claps hands -bangs objects together -releases an object into an adults hand upon request
vaccinations at 12 months old:
-varicella -Hib -hep A -hep B -flu -MMR (measles, mumps, rubella) -IPV
how long do babies sleep at 6 months?
1.5-2 hrs -nap length --> 1.5-2.5 hrs -3-4 naps a day
how long should a toddler sleep?
11-12 hrs a day with 1 nap a day -they have a fear of the dark -begin to have nightmares -can begin to sleep in a regular bed at about 2 yrs old
treatment for bacterial meningitis in infants:
14 day oral antibiotic course ampicillin/ gentamicin
language development at 2 yrs old:
200-300 words, can make 2 word sentences -of the words they say we as adults can understand 50% of it
how long does it take an asthma patient to get back to the green zone after an asthma exacerbation?
24-48 hrs
how much weight does a 2 month old gain per month?
2Ib per month
how long after birth should we be concerned of an elevated temp in an infant?
30 days or longer we are concerned
segar method for IV fluids:
4-2-1 rule ex. 40 kg infant maintenance rate 40-10 -4 x10 = 40 30-10 -2x10 = 20 20x1 = 20 40+20+20 = 80
during potty training how longs should a toddler sit on the toilet?
5-8 min, we ideally want them to be able to hold their urine and stool for 2 hrs
yellow zone asthma action plan
= caution -first sign of a cold -cough -mild wheeze -tight chest -coughing at night -albuterol q 2-4 hrs -patient leave the hospital in the yellow zone
Which clinical finding would the nurse expect during the physical assessment of an infant with DDH? A. Limited abduction of the affected hip B. Downward and inward rotations of the affected hip C. Inability to flex and extend the hip on the affected side D. Free abduction of the affected hip when placed in the frog position
A. Limited abduction of the affected hip
In which way do toddlers learn self protection? A. Through trial and error strategies B. By imitating playmates and siblings C. By obeying orders from their parent D. By playing with age appropriate
A. Through trial and error strategies
You're assessing a 10-month-old infant. You note on examination the anterior fontanelle is open. The nurse will: A. Document this as an abnormal finding because this fontanelle should close at 2 months B. Document this as a normal finding because this fontanelle closes at about 18 months C. Document this as a normal finding because this fontanelle closes at about 11 months D. Document this as an abnormal finding because this fontanelle should close at 6 months
B. Document this as a normal finding because this fontanelle closes at about 18 months
Which nursing intervention would the nurse provide for a 6 month old infant with bronchiolitis? A. Discouraging parental visits to conserve energy B. Monitoring skin color, anterior fontanel and vital signs C. Wearing gown and gloves when providing care D. Promoting stimulating activities to meet developmental needs
B. Monitoring skin color, anterior fontanel and vital signs
The nurse is providing care to a breastfed 6-week-old infant who is hospitalized for poor growth and is diagnosed with failure to thrive. Which assessment would the nurse prioritize for this infant? A. Family financial difficulties B. Suck and swallow coordination C. Neglect and abuse by the parent D. Knowledge deficit related to nutritional intake
B. Suck and swallow coordination
An infant weighed 8 lbs. at birth. How many lbs. should the infant weigh at 6 months? A. 24 lbs B. 10 lbs C. 16 lbs D. 32 lbs
C. 16 lbs rationale: doubles at 6 months
During feedings, a newborn has difficulty sucking and swallowing and tires easily. Which physiological process would the nurse consider when assessing this infant? A. Newborns ten to tire easily, especially when feeding B. Decreased sucking is insignificant in the absence of cyanosis C. Difficulty when feeding may be an early indication of a heart defect D. Some infant retain mucus for several days that may interfere with feeding
C. Difficulty when feeding may be an early indication of a heart defect
At 8-9 months of age, what milestone should an infant be able to successfully perform? A. Begin walking B. Say several words like mama or dada C. Sit without support D. Follow basic commands
C. Sit without support
You're assessing a 2-month-old infant. Which finding below is a normal milestone that should be reached by this infant at this age? A. The infant can sit up with support. B. The infant holds a rattle. C. The infant smiles at its parent. D. The infant is afraid of strangers
C. The infant smiles at its parent.
normal vitals for an infant:
HR: 100-120 BP: 100/60 RR: 20-30 breaths/min
toddler vitals:
HR: 110-90 BP: 99/64
weight at 8 months old:
Ib is gained each month
med adminisatration for infants:
PO --> small amounts via oral syringe to the side of the mouth/ cheek rectal --> use lubrication and may need to hold the butt closed once the med has been inserted for 10-15 sec (commonly tylenol) IM --> preferred site for injections on infants is the vastus lateralis
the maternity nurse is providing instructions to a new mother regarding the psychological development of the newborn infant. using eriksons psychological development theory, the nurse instructs the mother to take which measure? a. allow the newborn infant to signal a need b. anticipate all needs of the newborn infant c. attend to the newborn infant immediately when crying d. avoid the newborn infant during the first 10 minutes of crying
a. allow the newborn infant to signal a need
the nurse is assessing a toddler with vesicouretral reflux. which clinical finding would the nurse expect to identify? a. dysuria b. oliguria c. glycosuria d. proteinuria
a. dysuria
which action would the nurse take to promote the social development of a 9-month old infant? a. engaging in peek-a-boo b. offering soft clay to manipulate c. providing a pegboard for pounding d. demonstrating to speak words
a. engaging in peek-a-boo
which assessment finding should the nurse identify as a physical readiness cue for a toddler-age client related toilet training? a. having regular bowel movements b. willing to invest the time needed c. telling a parent their diaper is wet d. expressing a willingness to please parents
a. having regular bowel movements
when preparing a child with asthma for discharge, which instructions would the nurse emphasize to the family? select all a. limit allergens in the home b. maintain a dry home environment c. avoid placing limits on the childs behavior expectations d. continue the medication even if the child is asymptomatic e. prevent exposure to infection by having the child tutored at home
a. limit allergens in the home d. continue the medication even if the child is asymptomatic
a toddler seems afraid to select a toy or activity in the clinic playroom. which age-appropriate play material would the nurse offer? select all a. plastic tea set b. mold and clay c. play telephone d. pencil and paper e. simple electronic games
a. plastic tea set b. mold and clay c. play telephone e. simple electronic games
which would the nurse teach parents about preventing sudden infant death syndrome (SIDS)? select all a. restrain from smoking around the infant b. avoid co-sleeping or bed sharing c. position the infant on the side while sleeping d. use soft pillow to support the infant while sleeping e. refrain from placing stuffed toys on the infants bed
a. restrain from smoking around the infant b. avoid co-sleeping or bed sharing while sleeping e. refrain from placing stuffed toys on the infants bed
which clinical finding would the nurse expect when assessing a 4 yr old child with suspected mucocutenous lymph node syndrome (kawasaki disease)? a. strawberry tongue b. copious discharge from the eyes c. insidious onset of low-grade fever d. maculopapular rash on the extremities
a. strawberry tongue
which explanation would the nurse provide to the parents of a 2 yrs old who expresses concern regarding the childs rate of growth slowing? a. this growth pattern is typical at this age b. toddlers are too busy exploring their world to eat c. growth patterns cant be interpreted for another year d. toddlers usually lose their taste for foods they liked when they were younger
a. this growth pattern is typical at this age rationale: as a child gets older, growth slows
which stage of Erikson's theory focuses on the needs of an infant? a. trust vs. mistrust b. intimacy versus isolation c. autonomy versus sense of shame and doubt d. generativity versus self-absorption and stagnation
a. trust vs. mistrust
a newborn patient is born with unilateral cleft lip. which potential complications does the nurse include in the plan of care? a. undeveloped sucking ability b. prone to outer ear infections c. impaired swallowing mechanism d. impaired GI functions
a. undeveloped sucking ability
which major gross motor development skills would the nurse expect to see demonstrated during a teaching session with a parent of a 12 month old child? a. walking alone b. drawing a stick figure person c. showing interest in cooperative play d. beginning to develop object permanence
a. walking alone
a child with nephrotic syndrome has been receiving prednisone for 1 wk. which information in the childs record indicates to the nurse that the medication has been effective? select all a. wt loss b. lower blood pH c. decreased lethargy d. increased urine output e. decreased BP
a. wt loss c. decreased lethargy d. increased urine output
what language is developed by 12 months?
able to speak 3-5 words
Hydrocephalus:
abnormal expansion of the cerebral ventricles d/t the accumulation of CSF detected through prenatal sonogram in utero or by transillumination at birth -is cured by a shunt that goes into the peritoneal cavity -it is important to make sure they are pooping because the shunt drains into the same cavity of the abdomen and puts pressure on where the shunt ends (if they aren't pooping give them a stool softener) --> x-ray or CT can confirm is the shunt is working properly -kids with this may have difficulty with fine and gross motor skills and may be delayed developmental -important to watch for infection and obstruction (d/t constipation) s/s: -shiny scalp with veins prominent -brow bulges froward (blossing) -eyes become "sunset eyes" -decrease pulse and respirations, increase BP and temp d/t intracranial pressure
kawasaki: acquired heart disease
acute multisystem inflammatory dz of blood vessels (vasculitis); the cause is unknown s/s: -*#1 sign is strawberry tongue* -dry cracked lips -peeling of the skin on the hands and feet -swollen lymph nodes in the neck -red palms/ soles '-bloodshot eyes -rash diagnosis: -by symptom rule out treatment: -aspirin (high dose) 80-100 mg/kg/day divided 4 x a day (d/t the increased risk for clotting because platelets are increased)
treatment for viral meningitis:
acyclovir
what vaccinations do 4 months olds receive?
all the 2 month old vaccinations besides hep B
nephrotic syndrome:
altered glomerular permeability d/t an autoimmune process that results in fusion of the glomeruli to membrane surfaces --> leads to abnormal loss of protein in the urine congenital --> from autosomal abnormality secondary --> from progression of a disease idiopathic --> can be from a virus or unkown cause diagnosis: MRI or invasive renal biopsy S/S: -*#1 proteinuria* -*facial edema (periorbital)* --> always looks worse in the morning because kids like to sleep face down -*hypoalbuminemia* -*hyperlipidemia* -abdominal fullness -anorexia -trouble breathing
sickle cell disease:
an autosomal recessively inherited disease that makes erythrocytes (RBCs) elongated and crescent shaped -acute onset. usually lasts 4-6 days; these pts tend to be deficient in folic acid -stasis and sickling causes blood flow to stop causes of sickle cell crisis: -dehydration -stress -pain -hypoxia -anaerobic metabolism -cold temperatures s/s: -severe pain -swollen joints -hematuria -jaundice -vision changes -anemia interventions: -rest -hydration -pain management -fever -oxygenation
what is the fontanelle like at 12 months old?
anterior starts to close by 12-18 months
when is the 4th dose of Dtap needed?
at 15 months
when is the second hep A vaccine needed?
at 18 months old
at what age does an infant adjust to cold?
at 6 months they can shiver in response to cold -there is a decrease in brown fat over the first yr of life
what phase of eriksons development are toddlers in?
autonomy vs. shame -they strive for independence -to foster autonomy allow them to pick from two options, let them eat on their own with supervision, and trial and error shame: -timeouts should only be 1 min per yr (ex. 2 min for a 2 yr old)
during which health maintenance visit for a toddler age-client should the nurse assess the ability to throw a ball overhand without losing balance? a. 12 months b. 18 months c. 24 months d. 30 months
b. 18 months
an infant is brought to the clinic for his third Dtap vaccination. the mother reports that the infant developed a 99.4 degree F temp after the last Dtap vaccine. which action is most appropriate? a. withhold the vaccination b. administer the vaccination c. draw blood for pertussis titer d. notify the HCP
b. administer the vaccination
a 12 month old receives a series of vaccinations which includes the Hep A vaccine. when should the child receive the 2nd dose of this vaccination? a. in 3 months b. at the 18 month visit c. when the child is 4-6 yrs old d. in 2 months
b. at the 18 month visit
which treatment would the nurse anticipate for an infant admitted with acute laryngotracheobronchitis? a. IV antibiotics and hydration b. corticosteroids and nebulized raemic epinephrine c. antiviral medication and oxygen d. nasopharyngeal suctioning and antipyretics
b. corticosteroids and nebulized raemic epinephrine
which nursing assessment finding indicated dehydration in an infant? a. flat anterior fontanel b. decreased urine output c. warm skin temp d. slow, labored respirations
b. decreased urine output
which care plan would the nurse implement for an infant with nonorganic failure to thrive? a. maintaining silence while feeding the infant b. following a structured routine throughout the day c. periodically changing the seating arrangement during meals d. distracting the infant with playful activities during feedings
b. following a structured routine throughout the day
which nursing concern is a priority when a 6 yr old child with sickle cell disease is admitted with vasoocclusive crisis (pain episode)? select all a. nutriton b. hydration c. pain management d. prevention of infection e. oxygen supplementation
b. hydration c. pain management e. oxygen supplementation
an infant is admitted to the pediatric unit with bronchiolitis caused by respiratory syncytial virus (RSV). which intervention would the nurse provide for the infant? select all a. limiting fluid intake b. instilling saline nose drops c. maintaining contact precautions d. nasal suctioning to remove mucous e. administering inhaled bronchodilators
b. instilling saline nose drops c. maintaining contact precautions d. nasal suctioning to remove mucous
which action would the nurse include in the plan of care for a 6 month old infants with respiratory syncytial virus (RSV) who is in respiratory distress? a. begin a clear fluid diet b. maintain droplet and contact precautions c. administer prescribed antibiotic immediately d. allow parents and siblings to room in with the infant
b. maintain droplet and contact precautions
which nursing intervention would the nurse provide for an infant with an unrepaired cleft lip? a. preventing crying b. modifying feeding c. preventing infection d. minimizing handling
b. modifying feeding
the nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the parent about the childs symptoms? a. watery diarrhea b. projectile vomiting c. increased urine output d. vomiting large amount of bile
b. projectile vomiting
which information would be included when teaching the parent of a newborn about automobile infant restraint systems? select all a. use a forward facing infant car seat b. secure the infant seat so that is faces the rear c. position the seat between the drivers and passengers seats in the front seat d. follow the manufacturers directions to secure the infant seat in the back seat e. be sure to follow weight guidelines set forth in the manufactures instructions
b. secure the infant seat so that is faces the rear d. follow the manufacturers directions to secure the infant seat in the back seat e. be sure to follow weight guidelines set forth in the manufactures instructions
which are stages of cognitive development of infants according to piaget? select all a. narcissism b. separation c. attachment d. using symbols e. object permanence
b. separation d. using symbols e. object permanence
according to Erikson's theory, which behavior would the student nurse explain that a toddler exhibits? a. the child gets casual about body appearance b. the child starts preforming self care activities c. the child suppresses feelings of superego d. the child becomes dependent on his/ her siblings
b. the child starts preforming self care activities
why is the vomitus of an infant with pyloric stenosis white rather than bile-stained? a. the pyloric sphincter obstructs the bile duct b. there is an obstruction above the opening of the common bile duct c. the bile duct sphincter is connected to the hypertrophied pyloric muscle d. there is a constriction of the cardiac sphincter that obstructs the flow of bile
b. there is an obstruction above the opening of the common bile duct
what is vision like for 2 month olds?
baby focuses on the parents
what daily activitiess should be done with an infant?
bathing --> bathe with soap only 2-3 x a week diaper care --> if there is a rash apply a baby safe barrier cream care of teeth --> brush their teeth with bannana brush dressing sleep --> they sleep less and for longer periods of time as they get older (they still need to be woken up to get fed at night)
feeding at 6 months:
begins solid foods -one solid food introduced at a time
Cognitive Development (Piaget)
birth-6 months = sensorimotor phase -they realize they are a separate individual -object permanence is lost at around 9-10 months -separation anxiety occurs at 4-8 months -stranger anxiety occurs at 6-8 months -infants learn about the world through basic actions such as sucking, grasping, looking and listening
hirchsprung disease:
blockage of the intestines d/t lack of nerves that allows muscles to contract and eliminate waste dx --> ultrasound treatment: -surgery to remove the non-functional segment of the intestines and to restore ability to push stool through the GI tract
isotonic dehydration:
blood volume is decreased but they dont necessarily loose weight
what type of feeding do 2 month olds engage in?
breastfed or bottle
Burns:
burns more than 10% total BSA require fluid resuscitation (*#1 thing we are concerned about is dehydration*) -electrolyte imbalances leads to hypovolemic shock -since children have an immature immune system there is an increased risk for infection -scarring is more severe in children -delayed growth may occur after a burn
when can children produce IgG and IgM antibodies?
by 1 yr old
when does the anterior fontanel close?
by 12-18 months
when does the posterior fontanel close?
by 2-3 months
at which age will an infants anterior fontanel close? a. 6-8 months b. 9-12 months c. 12-18 months d. 19-36 months
c. 12-18 months
which childhood disease is best described as a viral disease that starts with malaise and a highly pruritic rash that begins on the abdomen and spreads to the face and proximal extremities and can result in grave complications? a. rubella b. rubeola c. chickenpox d. scarlet fever
c. chickenpox
parents bring their 2 wk old infant to a clinic for treatment after diagnosis of clubfoot made at birth. which statement by the parents indicated a need for further teaching regarding this disorder? a. treatment needs to be started as soon as possible b. i realize my infant will require follow up care until fully grown c. i need to bring my infant back to the clinic in 1 month for a new cast d. i need to come to the clinic every week with my infant for casting
c. i need to bring my infant back to the clinic in 1 month for a new cast
during a lumbar puncture procedure for confirmation of bacterial meningitis, the nurse notes that the infants spinal fluid is cloudy. the nurse recalls this information indicates which result? a. healthy spinal fluid b. increased glucose level c. increased WBC d. rising number of RBCs
c. increased WBC
an infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. the nurse should place the infant un which best position at this time? a. prone positon b. on the stomach c. left lateral position d. right lateral position
c. left lateral position
the nurse cares for a neonatal patient diagnosed with congenital hip dysplasia. which assessment findings support this diagnosis? a. characteristic limp b. trendelenburg sign c. ortolani sign d. symmetrical gluteal folds
c. ortolani sign
which type of acid-base imbalance would the nurse expect in a child admitted with severe asthma exacerbation? a. metabolic alkalosis caused by excessive production of acid metabolites b. respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide c. respiratory acidosis caused by impaired respiration and increased formation of carbonic acid d. metabolic acidosis caused by the kidneys inability to compensate for increase carbonic acid formation
c. respiratory acidosis caused by impaired respiration and increased formation of carbonic acid
an infant is being seen in the pediatrics office for a 2 month old well child visit. the nurse encourages the mother to allow the infant to suck on a pacifier during a routine immunization. the nurse explains to the mother that the child is at which stage of Piagets cognitive development? a. trust development b. autonomy development c. sensorimotor development d. preconceptual development
c. sensorimotor development
which rationale would the nurse provide the parent of a toddler to encourage pretend play? select all a. to help improve sleeping habits b. to help develop fine muscle skills c. to help the child become more creative d. to help the child develop social-problem solving skills e. to help the child learn to understand other points of view
c. to help the child become more creative d. to help the child develop social-problem solving skills e. to help the child learn to understand other points of view
which assessment finding would indicate a possible asthma exacerbation? select all a. fever b. stridor c. wheezing d. tachycardia e. hypotension
c. wheezing d. tachycardia
based on Erikson's theory, which guidance would the nurse provide the parent about discipline for their 2 yr old child? a. discipline may induce a feeling of isolation in your child b. you need to establish a sense of trust or the child may lose trust in you c. your child needs support and love or else they may develop feelings of shame and doubt d. you should control your childs impulses or the child may suffer guilt and frustration
c. your child needs support and love or else they may develop feelings of shame and doubt
an infants parents ask a nurse how ling the child is required to use a front facing car seat? the nurse responds with which statement? a. when the child is mature enough to stay seated in a booster seat, you can stop using the front facing care seat b. the child must be at least 6 yrs old to use a regular seat belt c. your child should use a car seat with a harness ass long as possible until the care seat is outgrown d. you child must be at least 4 yrs old and able to see out of the window
c. your child should use a car seat with a harness ass long as possible until the care seat is outgrown
language development at 18 months:
can speak 10-25 worse -they also formulate possession and say "my toy"
what fine motor skills are developed at 3 yrs old?
can stack a 9 block tower -they master the use of utensils
talipes disorder:
clubfoot --> angled foot turned in towards midline types: -plantar flexion: forefoot lower than the heel -dorsiflexion: heel is held lower than the forefoot or the anterior foot is flexed toward the anterior leg -varus deviation: the foot turns in -valgus deviation: the foot turns out treatment: -series of 6-7 casts to help align the foot in a proper position -needs to be kept on for 24hrs except for bathing
a nurse confirms that a 9 month old infants immunization schedule is up to date. which immunization will the infant receive at 15 months? a. hep B b. polio vaccine (IPV) c. rotavirus d. MMR
d. MMR
which treatment would the nurse anticipate when caring for a preschooler with kawasaki disease? a. restricting fluids, especially fruit juices b. ensuring bright lighting in the room during assessments c. administering penicillin G benzathine (bicillin) as prescribed d. administering IV immune globin (IVIG) as prescribed
d. administering IV immune globin (IVIG) as prescribed
which change in lab values and/or intake and output would the nurse expect after corticosteorid therapy for a 4 yr old child with nephrotic syndrome? a. oliguria b. increase in hematuria c. decreased in glycosuria d. decrease in proteinuria
d. decrease in proteinuria
a clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirshprungs disease. the nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? a. diarrhea b. projectile vomiting c. regurgitation of feedings d. foul smelling ribbon like stools
d. foul smelling ribbon like stools
which description would the nurse provide the parents of an infant who are asking about what a patent ductus arteriousus (PDA) is? a. the diameter of the aorta is enlarged b. the wall between the right and left ventricles is open c. it is a narrowing of the entrance to the pulmonary artery d. it is a connection between the pulmonary artery and the aorta
d. it is a connection between the pulmonary artery and the aorta
which physical examination finding would the nurse expect when assessing an infant with a ventricular septal defect (VSD)? a. bradycardia at rest b. activity related peripheral pulses c. bounding peripheral pulses d. murmur at the left sternal border
d. murmur at the left sternal border
which strategy would the nurse use to manage negative behavior of a toddler? a. allowing for more openness b. using invasive methods c. using a flexible routine d. offering the toddler choices
d. offering the toddler choices
which is the priority nursing action to facilitate growth and development when providing care to a pediatric client who is diagnosed with a chronic illness? a. monitoring growth patterns and plotting on the growth chart b. teaching the client and family how the illness affects physical growth c. assessing stage of development frequently and documenting it in the medical record d. planning activities to promote progression from one stage of development to the next
d. planning activities to promote progression from one stage of development to the next
which assessment would the nurse make when observing an infant use their thumb an index finger to hold an object? a. the infant is exhibiting moro reflex b. the infant is showing tonic neck reflex c. the infant is exhibiting parachute reflex d. the infant is showing crude pincer grasp reflex
d. the infant is showing crude pincer grasp reflex
the nurse notes that an infant with the diagnosis of hydrocephalus has a head that is heavier than that of the average infant. the nurse should determine that special safety precautions are needed when moving the infant with hydrocephalus. which statement should the nurse plan to include in the discharge teaching with the parents to reflect this safety need? a. feed your infant in a side-lying position b. place a helmet on your infant when in bed c. hyperextend your infants head with a rolled blanket under the neck area d. when picking up your infant support the infants neck and head with the open palm of your hand
d. when picking up your infant support the infants neck and head with the open palm of your hand
coarctication of the aorta
defect of the ductus arteriosus --> ductal tissue, thoracic aorta has a tight stricture -requires immediate intervention -there will be a drastic change in HR with cardiac screening -leads to HF quickly -as they grow older they will have HTN because the artery is narrower treatment: -surgery: a stent is placed to dilate the artery
vision developed at 6 months:
depth perception
temper tantrums:
discipline should be consistent with well-defined boundaries -show them that the act was not acceptable -do not give them rewards and dont ignore them
influenza:
everyone 6 months and older should get a flu shot S/S: -chills -fever -high HR and RR -feeling weak and more tired -runny/ stuffy nose -loss of appetite -diarrhea -cough -headache -abdominal pain and body aches -sore throat prevention: -wash hands -sanitize toys -teach to cough in elbow -keep kids home if they have s/s Interventions: -fluids -tylenol/ ibuprofen
metabolic acidosis:
from diarrhea d/t electrolytes being lost through stool
metabolic alkalosis:
from vomiting because acid is lost
safety for 8 month old babies:
furniture safety (like bolting shelving unit to walls)
hypotonic dehydration:
greater loss of electrolytes compared to fluid -low concentration of electrolytes -causes by vomiting, diarrhea, or diabetes insipidus
hypertonic dehydration:
greater loss of water than electrolytes -caused by vomiting, fever, or renal disease -electrolyte levels will be high because of hemoconcentration
organic failure to thrive (FTT)
growth failure is due to an acute or chronic disorder that interferes with nutrient intake, absorption, metabolism, excretion, or that increase energy requirements ex. clef pallet can cause them to not be able to suck well so they arent getting the sufficient amount of feeding needed -usually see in infants 2 months of age or earlier treatment: -NGT -for babies with cardiac issues we can increase the amount of calories to 24 in the same amount of volume -metabolic testing
nonorganic failure to thrive (FTT)
growth failure occurs d/t environmental neglect (lack of food), stimulus deprivation or both (abuse and neglect) -needs to be reported to the DCYF is we suspect its neglect and abuse education: -how often to feed their baby -refer them to social services and resources the hospital provides -if they have low economic stability we can educate on WIC of VNA
Hep A:
hep A vaccine is given at 12 and 18 months transmission: -fecal/ oral route s/s: -abd pain -fever -dark urine -N/V -joint pain -diarrhea -fatigue -increases AST & ALT d/t liver damage -jaundice -anorexia
what is an 8 month olds vision like?
improvement of hand eye coordination
length at 12 months old:
increases by 50%
Broncholitis
inflammation of fine bronchioles and small bronchi due to a viral illness -peak between 3-6 months of age s/s --> fever and congestion, increase in HR and R, low O2, rhonchi, crackles hydration is very important to help break up the mucous -we can give then 1/2-2 L of oxygen -lowest O2 we allow kids to go to is 88% when awake and 92% when sleeping
laryngotracheobronchitis (croup):
inflammation of the larynx, trachea and major bronchi -a viral infection s/s: -*barking cough* --> NO fever -inspiratory stridor and marked retractions from inflammation of the larynx, trachea and major bronchi management: -cool air mist --> to decrease inflammation -corticosteroids --> 2nd line of treatment -raemic epinephrine --> 1st line of treatment (nebulized and helps bronchodilate); watch for rebound after 6 hrs -avoid getting the child upset because it increases inflammation education: -exposure to cool air -hydration -avoid excessive play until the virus is over -steam -run humidifier at night
lead exposure:
lead exposure affects erythrocytes (RBCs), and blocks iron from being effective in bones and teeth, organs and tissues including the brain and nervous system, hearing, speech, and learning disabilities may develop without treatment -1-2 yrs of age is the highest risk so testing is done no matter what at 1-2 yrs old -a lead level over 5 is harmful education: -more supervision -put duct tap over holes in the paint -wash toys, blankets and bedding in warm water -regularly mop and clean the floors -if lead is on the porch take shoes off before entering the house treatment: -agent that bind to lead that eventually causes the lead to be pooped out; given as an IM injection
what can a toddlers weak abdominal muscles cause?
lordosis
asthma:
most common chronic illness in children -is a reactive airway disease --> obstruction happens because mast cells release histamines and leukotrienes which causes inflammation and/ or airway hyper responsiveness s/s: -wheezing -coughing -SOB -chest tightness -inspiratory wheeze -intercostal retractions main s/s: -bronchoconstriction -increase in mucous production -inflammation
respiratory syncytial virus (RSV)
most severe with anyone who is under 2 yrs old -most common way its spread is kissing though saliva S/S: -may see apnea (20 sec not breathing) -cough --> wheezing -decreased appetite -irritability treatment: -suctioning -IV fluids -oxygen
nasopharyngitis
mucous membranes becomes inflamed and constrict the airway making it difficult to breath related to viral infection s/s --> nasal congestion and fever -nasal suction before they eat so they dont aspirate -can give tylenol under 6 months and motrin for infants over 6 months
vaccinations at 8 months old:
none
vision developed at 10 months:
object permanence
where do you take the BP of an infant?
on the leg
how many doses of Tdap are given to adolescents/ teens?
one dose
infant pain:
pain should be minimized to prevent interfering with infants developing sense of trust -numbing cream (emla takes 1 hr to work and stops within 4 hrs of being wiped off) -can use distractions like noise and bubbles -for a 2 month old we can shush and swaddle the baby to help with pain
trust vs. mistrust:
physical development --> erikson infants develop trust by getting their needs met i.e being fed, being picked up when then are crying, talking to them, picking up the baby often etc mistrust develops when babies dont have their needs met -they will be quite -they dont cry as much because they know their needs wont be met
what color is CSF in viral meningitis?
pink tinged
car seat safety:
rear facing from birth to age 2-4 -in order for them to be forward facing it depends on how much they weigh, how tall they are, their development, and the range of the car seat -usually at 2 yrs old you can switch to forward facing -chest strap should be at the babies nipples line -use the pinch test to make sure straps are tight enough -no mirrors on the back of the seat, nothing on the windows because it is a projectile in the time of a crash
what is vision like in a 4 month old?
recognizes familiar objects
Arterial septal defect (ASD)
septal part of the atria doesn't completely form s/s: -heart murmur -SOB -easily tired -poor weight gain (bcuz the heart has to work harder) -doesnt feed well treatment: -1st line of treatment --> diuretic (most commonly furosemide) to get rid of pulmonary congestion -last resort if it does not close on its own i surgery
what is the treatment for GERD in an infant?
simethicone (should work immediately on a fussy baby if they have GERD) -too much of this med can cause potassium toxicity
treatment of asthma:
spacers: -very important to prevent oral thrush -puff count to 10 -rinse mouth out after use -clean the spacer albuterol (bronchodilator) -*rescue med* -LS should be clear after giving albuterol -listen to LS before and after giving -listen q 1 hr after giving and if wheezing occurs again another dose needs to be given -tachycardia and decreased O2 (for 30 min) --> normal to happen after giving albuterol -can cause shakiness/ nervousness/ and tremors long acting beta agonist: salmeterol -*to prevent exacerbations* -should be taking every day no matter what anti-inflammatory agents: -corticosteroids to decrease airway inflammation -leukotriene receptor agonist --> montelukast non pharm: -cough to clear expiratory wheeze -PFT to determine if they are back to baseline -if tripoding --> low flow oxygen -high flow oxygen (keeps alveoli open) --> fast breathing, low oxygen, albuterol q 1 hr
drowning:
suffocation when water fills the lungs and blocks exchange of oxygen in the alveoli -most common cause of infant death -most common place for a child to drown is in the bathtub -children can drown in 1 in of water s/s: -sodium and potassium imbalances -hypovolemic shock -tachycardia -high BP management: -NG or OGT -albuterol to dilate alveoli -plasma for salt water drowning
patent ductus arteriosus (PDA)
the fetal shunt fails to close (mostly in premature infants) and allows blood to flow from aorta through ductus arteriosus into the pulmonary artery S/S are the same as ASD and VSD treatment: -1st line of treatment --> diuretic (most commonly furosemide) -NSAID, prostaglandin inhibitor, indomethacin --> 3 doses IV to help close defect -surgically fixed all other methods failed
how much does a 4 month old sleep?
they are awake for 1.5-2 hrs, nap lasts for 1.5-2 hrs, nap 3-4 times a day
what factors determine if the baby is thriving?
they are: -gaining weight -eating 80% of their meals -mom is more educated
how often should a 2 month old be sleeping?
they should be awake for 60 min, nap fro 1-3 hrs, and have 3-4 naps a day
parellel play:
toddlers have parallel play where they play next to each other in the same space just not with each other
varicella (chicken pox):
transmission: -airborne, herpes zoster virus s/s: -macular rash with vesicles that ooze (starts on the trunk and then spreads) -not contagious once the vesicles are dried out and crusted over management: -benadryl and hydrocortisone for itching -tylenol and ibuprofen
parvovirus B19 (hand foot and mouth):
transmission: -contact/ droplet s/s: -mild fever -malaise -slapped cheek appearance -rash on the mouth, hands, and feet (there is no vaccine and its super contagious)
mumps:
transmission: -droplet, incubation 16-18 days s/s: -anorexia -malaise -fever -erythemic rash of the 3rd day -swelling of the testicles
Rubella:
transmission: -droplet, incubation is 14 days s/s: -lymph node swelling in the neck -pink/red macular rash that starts on the face then moves to the trunk -low grade fever -mild conjunctivitis -upper respiratory symptoms -joint pain and swelling vaccine: -multiple doses of MMR through childhood -a child develops immunity after they contract rubella management: -symptom management -tylenol/ ibuprofen for fever and joint pain -IV fluids for if they arent eating
pinworm:
transmission: -highly contagious through the fecal oral route -ingested/ inhaled eggs hatch in the upper intestine and matures, once matured they migrate out of the intestine and lay eggs in the skin folds of the anus s/s: -perianal itching -enuresis -sleeplessness/ irritability d/t itching diagnosis: -tape test --> tape is put over the bum and worms come out at night so worms get stuck to the tape treatment: (all single dose that usually needs to be repeated 2 wks later); all family members should be treated at the same time -mebendazole -albendazole -pyrantel pamoate
measles:
transmission: -saliva (airborne precautions), incubation 8-12 days s/s: -*white kopliks spots* -cough -fever -nasal drainage -pink/ red rash head to feet which gets worse over 3-6 days (after 6 days becomes brown and sluffs off) -conjunctivitis -lymph enlargement vaccine: -MMR management: -vit A to reduce mortality -fluids -tylenol/ ibuprofen
true or false: it is okay to send a baby home with intercostal retractions and belly breathing
true
safe drug levels for ibuprofen and tylenol for infants:
tylenol --> 10-15 mg/kg/dose ibuprofen --> 5-10 mg/kg/dose max --> 3g or 3000mg
what gross motor skills are developed at 15 months?
walks well, creeps up stairs
Interventions for if an infant is bottle feeding but only finishes half their bottle:
we can: -place an NGT (start at nose --> to ear--> to xiphoid process 1/3 of the way down the abdomen) -increase calories to 24 within the same volume the infant needs to finish 80% of the bottle PO before they can be taken off NGT
tubal myringotomy:
when kids get frequent ear infections a teflon tube is inserted through the tympanic membranes and taken out after 6-12 months to help eustachian tubes drain -cannot go under water after having this procedure
when are toddlers able to potty train?
when they get control over their urinary and anal sphincters
what is pacing?
when you fill half the nipple with formula to slow them down
what color is CSF in bacterial meningitis?
white a purulent (its usually clear)
how do we diagnosis meningitis?
with a lumbar puncture testing CSF -they need to be put on droplet and contact precautions -antibiotics start after all testing is done so it doesnt skew the results
Which information would a nurse provide regarding varicella? •A. Communicable until all vesicles are dry •B. Still communicable even when dry scabs remain •C. No longer communicable after the fever has subsided •D. Not communicable while vesicles are surrounded by red areolas
•A. Communicable until all vesicles are dry
A parent of a child asks the nurse how to tell the difference between measles (rubeola) and rubella (German measles). Which finding would the nurse tell the parent differentiates measles from rubella? •A. High fever and Koplik spots •B. Rash on the trunk and pruritus •C. Nausea, vomiting, and abdominal cramps •D. Characteristics of a cold, followed by a rash
•A. High fever and Koplik spots
Which goal would the nurse identify for a toddler with dehydration caused by diarrhea? •A. Improvement of fluid balance •B. Continuation of an antidiarrheal diet •C. Administration of antimicrobial treatments •D. Retention of weight appropriate for height
•A. Improvement of fluid balance
After completing education on accidental poisoning in the home for the parent of a toddler, which parent statements would concern the nurse? Select all that apply. •A. My cosmetics are in my purse •B. I only keep children's chewable vitamins on the counter •C. I keep my cigarettes and lighter on the shelf in the garage •D. The cleaning solutions are in a locked cabinet above the washing machine •E. I make sure all of my medications are stored in a bottle with a childproof cap
•A. My cosmetics are in my purse •B. I only keep children's chewable vitamins on the counter •E. I make sure all of my medications are stored in a bottle with a childproof cap
A child in respiratory distress is admitted to the hospital and diagnosed with acute spasmodic laryngitis (croup). At the time of discharge, which recommendation would the nurse make to the parent for handling another attack at home? •A. Place them near a cool-mist humidifier •B. Bring them to the emergency department •C. Give them an over the counter cough syrup •D. Offer then warm tea sweetened with honey
•A. Place them near a cool-mist humidifier
A toddler seems afraid to select a toy or activity in the clinical playroom. Which age-appropriate play materials would the nurse offer? Select all that apply. •A. Plastic tea set •B. Mold and clay •C. Play telephone •D. Pencil and paper → it would only be bigger crayons and markers not pencils •E. Simple electronic games
•A. Plastic tea set •B. Mold and clay •C. Play telephone
calls to report their child has a fever of 39.2 C, sore throat, irritability and refuses to lie down, preferring to sit up and lean forward? •A. The child needs immediate medication attention; call 911 •B. The parents should provide cool mist and continue to give fluids to the child •C. The child should receive ibuprofen in an appropriate dose to decrease the fever •D. The parents should call back in several hours with an update on the child's condition
•A. The child needs immediate medication attention; call 911
Which adverse effects will the nurse instruct the client to anticipate when prescribed albuterol to relieve severe asthma? Select all that apply. •A. Tremors •B. Lethargy •C. Palpitations •D. Bronchoconstriction •E. Decreased pulse rate
•A. Tremors •C. Palpitations
A toddler with a history of enlarged lymph nodes, prolonged fever, erythema of the extremities, and a rash is admitted to the pediatric unit with a diagnosis of Kawasaki disease. Which criteria would the nurse recognize as essential to confirm this diagnosis? •A. An increased antistreptolysin O (ASO) titer •B. A combination of signs •C. A low-grade temperature •D. An increased sedimentation rate
•B. A combination of signs
Which parental statements would the nurse recognize as requiring additional education about drowning prevention? •A. My baby likes to take a bath in the kitchen sink •B. My baby loves to watch the birds play in the birdbath •C. Our pool is surrounded by a fence and has a locked gate •D. Any time my baby is in the pool, I make sure I am in there as well
•B. My baby loves to watch the birds play in the birdbath
Which information would the nurse provide the parent of a 2 year old child about how to handle temper tantrums? •A. The child will require counseling by a behavioral child psychologist •B. Tantrums can be reduced with the provision of a less stressful environment •C. Tantrums should be ignored because they are an expected occurrence in toddlers •D. Tantrum will subside quickly if the parents holds the child during the tantrum
•B. Tantrums can be reduced with the provision of a less stressful environment
Which Statement explains the importance of play in toddlers? Select all that apply. •A. Toddlers have imaginations and fantasies •B. Toddlers prefer to play beside other children •C. Toddlers like to pretend and play different roles •D. Toddler prefer to stay close to their parent while playing •E. Toddler should watch television to expand their vocabulary
•B. Toddlers prefer to play beside other children •D. Toddler prefer to stay close to their parent while playing
Which immunizations would a child who has received all primary immunizations before starting preschool? •A. IPV, Hep B, Td •B. DTaP, Hep B, Td •C. MMR, DTaP, Hib •D. TDaP, IPV, Hib
•C. MMR, DTaP, Hib
Which therapy would the nurse manager recommend for young children with viral infection-related diarrhea? •A. A bananas, rice, applesauce, and tea/toast (BRAT) diet until after the diarrhea has stopped •B. An antiviral agent until the prescription is restored •C. Oral rehydration therapy (ORT) until fluid balance is restored
•C. Oral rehydration therapy (ORT) until fluid balance is restored
A child with Kawasaki disease is in pain caused by the desquamating rash. Which would the nurse identify as the best short term goal for this child? •A. The rash will diminish after lotion is applied •B. Analgesics will be administered as prescribed •C. Pain will be maintained at a level of 3 on a 0-10 scale → they're never gonna be at 0 •D. Diversional activities will help distract the child from the discomfort
•C. Pain will be maintained at a level of 3 on a 0-10 scale → they're never gonna be at 0
At which age is a toddler physiologically and psychologically prepared for toilet training? •A. 13 months •B. 16 months •C. 19 months •D. 22 months
•D. 22 months
Which etiology is the primary cause of otitis media in young children? •A. Sinusitis •B. Recurrent tonsillitis •C. An inflamed mastoid process •D. An obstructed eustachian tube
•D. An obstructed eustachian tube
Which plan of care would the nurse provide for a newborn with hypospadias? •A. Preparing the infant for insertion of a cystostomy tube •B. Explaining to the parents the generic basis for the defect •C. Keeping the infants penis wrapped with petrolatum gauze •D. Giving the parents reasons why circumcision should not be performed
•D. Giving the parents reasons why circumcision should not be performed
Which recommendation would the nurse provide the parent of a 3- year old who is concerned that their child is afraid to sleep alone because of monsters under the bed? •A. Tell the child that monsters do not exist •B. Allow the child to sleep with the parent temporarily •C. Look under the bed and say "I don't see any monsters" •D. Leave a small light on at night and state "monsters aren't allowed in the house"
•D. Leave a small light on at night and state "monsters aren't allowed in the house"
Which strategy would the nurse use to manage negative behavior of a toddler? •A. Allowing for more openness •B. Using invasive methods •C. Using a flexible routine •D. Offering the toddler choices
•D. Offering the toddler choices
