Quizzes 1-3
A 5-year-old is being discharged from the outpatient surgical center. Which statement by the parent would indicate the need for further teaching?
"Since my child just had surgery today, I can expect the pain level to be higher tomorrow."
A mother complains that her 13-year-old has started to grow rapidly, and asks the nurse if this is normal and how long it will last. The best nursing response is:
"This is normal and can last until about age 20."
A 5-year-old is hospitalized with a fractured femur. Which of the following assessment tools are appropriate for this age child? Select all that apply
- FACES pain scale - Oucher scale
The nurse is admitting a 9-year-old child who hit a parked car while riding a bike. The child has a fracture of the left radius and femur in addition to a fractured orbit. The child is alert and oriented. An appropriate action by the nurse is which of the following? Select all that apply.
- Use the Numeric Rating Scale to determine the child's pain level - Tell the child to ring the call bell if the leg starts hurting - Administer pain medication as ordered and as needed per provider specification
Obese children are vulnerable to a number of health problems, including:
- abnormal acceleration of growth in childhood - early onset of puberty in girls & abnormalities in sexual development in boys - type II diabetes - dyslipidemia - coronary heart disease - gallbladder disease - osteoarthritis
Risk factors for child abuse and neglect include which of the following:
- parents who were abused as children - female gender - low socioeconomic status - substance abuse and violence in the family
The nurse explains that the statistics of infant mortality are expressed in number of infant deaths per:
1000 live births
The nurse is working in a pediatric surgical unit. In discussing patient-controlled analgesia in a preop parental meeting, the nurse should explain that PCA is most appropriate for the
12-year-old, postop from spinal fusion for scoliosis
The charge nurse on a hospital unit is developing plans of care related to separation anxiety. The charge nurse recognizes that the hospitalized child at highest risk to experience separation anxiety when parents cannot stay is the
18-month-old
Normal HR and RR for an adolescent is: (choose the best response) (pp. 137, 140)
60-100 HR, 12-20 RR
Tina is 33 inches tall at 24 months. The nurse anticipates that Tina will be how many inches tall when full grown?
66 inches
Huntington's disease, neurofibromatosis-1, achondroplasia, and Marfan syndrome are examples of genetic conditions transmitted by which pattern of inheritance?
Autosomal dominant
If a disorder is (fill in the blank) , it means the affected person only needs to get the abnormal gene from one parent to inherit the disease. One of the parents has to have the disorder. These disorders involve altered genes on autosomes rather than the sex chromosomes X and Y. Both males and females have an equal chance of being affected. There is a 50% chance of an affected child
Autosomal dominant
Beta-thalassemia, cystic fibrosis, Guacher disease, phenylketonuria, sickle cell disease, and Tay-Sachs disease are examples of genetic conditions transmitted by which pattern of inheritance?
Autosomal recessive
Parents of a newborn are confused when their child is diagnosed with a genetic disorder because neither of them has a defect. Testing is done and it is determined that both parents are carriers of the disorder even though they are asymptomatic. Understanding the principles of the Mendelian Pattern of Inheritance, what condition is the likely reason for this genetic disorder?
Autosomal recessive condition
Childhood obesity is defined as:
BMI greater than 95th percentile
Which of the following are accurate statements concerning failure to thrive (FTT)?
Failure to thrive is defined as a weight for age that falls below the 5th percentile on multiple occasions or weight deceleration that crosses two major percentile lines on a growth chart; The cause of FTT can be organic or nonorganic; Most cases of failure to thrive involve inadequate caloric intake caused by behavioral or psychosocial issues; A multidisciplinary approach to treatment, including home nursing visits and nutritional counseling, has been shown to improve weight gain, parent-child relationships, and cognitive development; Nursing care centers on performing a thorough history and physical assessment, documenting accurate weight and height, observing parent-child interactions during feeding times, and providing teaching to enable parents to respond appropriately to their child's needs.
Which role would the pediatric nurse be serving when providing support and assisting with resources and referrals?
Case manager
A child must be able to sit before he can walk. This is an example of which directional pattern of development?
Cephalocaudal
Factors that contribute to childhood morbidity are: (Select all that apply.)
General health; Psychological factors; Socioeconomic factors
Overarching goals of Healthy People 2020 include: (Select all that apply.)
High-quality, longer lives free of preventable disease, disability, injury and premature death; Create social and physical environment that promote good health for all; Health equity, eliminate disparities, improve the health of all groups
Nurses should make which of the following recommendations to parents, to prevent childhood obesity? (Select all that apply)
If possible, breast-feed children rather than bottle feeding them; Limit the high-calorie and sugary foods kept in the house; Provide a nutritious diet with ample fiber from fruits & vegetables, with no more than 30% of calories derived from fat; Do not use food as a reward or bribe a child to finish a meal by offering sweets; Limit the child's TV viewing or video games to no more than 2 hours per day
The nurse is aware that the prevalence of chronic health conditions in children is:
Increasing as a result of advances in health care and treatment
The pediatric nurse understands that the infant mortality rate is important because:
It represents or describes the overall state of health of a country, region, ethnic group, and/or community
Monique walks into the ED carrying her crying 18-month old daughter. She tells the nurse her daughter crawled into the leg of the ironing board. The hot iron tumbled off the board and the child touched it before she could interfere. But the burn is on the edge of the child's palm and on her wrist, not her fingers. "This isn't the first time she's touched the iron," Monique says. "You would think she'd learn." When the nurse examines the child, the mother complains that there is nothing wrong with her other than the burn on her hand. During her assessment, the nurse notes scars on the child's back and buttocks shaped like the tip of an iron. (pp. 426-432) The nurse's initial interventions are aimed at:
attending to the child's physical injuries
Jane, who is 32-months, insists on dressing herself each morning, even though she generally selects mismatching outfits, misses buttons, and wears her shoes on the wrong feet. When her mother tries to dress Jane or fix her outfit, Jane brushes her mother off and insists on doing it herself. What stage of psychosocial development best describes Jane's behavior?
autonomy vs. shame and doubt
Moral development theory differs from cognitive development theory in what way?
Moral development theory characterizes the value system of people and their respect for others
Which of the following are accurate statements concerning multifactorial inheritance? (pp. 59-62) (Select all that apply)
Most common genetic malfunction; Combination of environmental and genetic factors; Examples are cleft palate and neural tube defects; These disorders do not have a clear-cut pattern of inheritance
A 28-month old child, 30-month old child, and 33-month old child are playing with blocks, dolls, and musical instruments in the hospital playroom. Closer observation reveals they are playing alongside one another, rather than interacting with each other. The nurse is observing:
Parallel play
The pediatric nurse is formulating a disaster preparedness plan for disadvantaged children in a rural community. This plan includes allocation of supplies and equipment, sheltering-in-place, and roles/ assignments for healthcare personnel. This meticulous planning demonstrates which level of preventive health maintenance?
Tertiary prevention
Trust vs. mistrust
The first stage, during which children develop faith and optimism. Develops mistrust if the needs are not adequately met.
Which of the following are examples of primary prevention activities or strategies?
Vaccination, behavioral counseling for smoking cessation, physical activity, and nutrition
When taking the health history of a suspected victim of Munchausen syndrome by proxy, the nurse or other healthcare professional should pay close attention to:
Whether the perpetrator is always present when the child has symptoms
Breastmilk is preferred over formula because:
breastmilk contains antibodies
A 10-year-old has been receiving morphine every two hours for postoperative pain as ordered. The medication relieves the pain for approximately 90 minutes, and then the pain returns. The nurse should
call the family nurse practitioner to see if the child's orders for pain medication can be changed
According to Piaget, this is the third stage of cognitive development that is characterized by the ability to think logically about concrete objects and situations.
concrete operational
According to Piaget, the 7- to 11-year-old-child is at which of the following stages of cognitive development?
concrete operations
As an advocate for the child undergoing bone-marrow aspiration, the nurse should most appropriately suggest
conscious sedation
The 20-month-old child appears to be happy and content with multiple caregivers and other children. She also ignores her parents when they reappear on the unit. The pediatric nurse determines that the child is experiencing which stage of separation anxiety?
detachment
A 2-year-old child recently diagnosed with a seizure disorder will be discharged home on an anticonvulsant. Which of the following actions by the mother best demonstrates understanding of how to give the medication?
draws up the medication correctly in an oral syringe and administers it to the child
The charge nurse is concerned with reducing stressors of hospitalization. The nursing intervention that is most helpful in decreasing the stressors for the toddler is to:
encourage a parent to stay with the child
A 3-year-old is hospitalized following surgery for a ruptured appendix. During assessment of the child, the nurse notes that the child is sleeping. Vital signs are as follows: temperature 97.8 degrees F axillary, pulse 90, respirations 12, and blood pressure 100/60. Based on this assessment, the nurse concludes that the child is:
experiencing respiratory depression secondary to opioid administration for postoperative pain
While teaching a 10 year-old child about his impending heart surgery, the nurse should:
explain the surgery using a model of the heart
Eight-year old Steven has a difficult time making friends at school. He has trouble completing his schoolwork accurately and on time, and as a result, receives little positive feedback from his teacher and parents. According to Erikson's theory, failure at this stage of development results in _____________?
feelings of inferiority
According to Piaget, this is the fourth stage of cognitive development. This stage is characterized by the ability to think logically about abstract principles and hypothetical situations.
formal operational
Monique walks into the ED carrying her crying 18-month old daughter. She tells the nurse her daughter crawled into the leg of the ironing board. The hot iron tumbled off the board and the child touched it before she could interfere. But the burn is on the edge of the child's palm and on her wrist, not her fingers. "This isn't the first time she's touched the iron," Monique says. "You would think she'd learn." When the nurse examines the child, the mother complains that there is nothing wrong with her other than the burn on her hand. During her assessment, the nurse notes scars on the child's back and buttocks shaped like the tip of an iron. (pp. 426-432) When child abuse is suspected, the nurse's initial assessment should include:
gathering information from many sources to determine how the injury occurred
Monique walks into the ED carrying her crying 18-month old daughter. She tells the nurse her daughter crawled into the leg of the ironing board. The hot iron tumbled off the board and the child touched it before she could interfere. But the burn is on the edge of the child's palm and on her wrist, not her fingers. "This isn't the first time she's touched the iron," Monique says. "You would think she'd learn." When the nurse examines the child, the mother complains that there is nothing wrong with her other than the burn on her hand. During her assessment, the nurse notes scars on the child's back and buttocks shaped like the tip of an iron. (pp. 426-432) Monique's explanation of how the child was injured is:
inconsistent with the injury
A 10-year-old fifth-grader enjoys having his artwork displayed on the family refrigerator. This behavior is indicative of which developmental stage as described by Erikson?
industry vs. inferiority
A child is 5 years old and has been recently admitted into the hospital. According to Erikson, in which of the following stages is this child?
initiative vs. guilt
A group of children on one hospital unit are all suffering separation anxiety. When determining the stages of separation anxiety, the nurse recognizes that the child in the "despair" phase is the child who
lies quietly in bed
An inborn error of metabolism that makes it impossible for the body to use the amino acid valine is:
maple syrup urine disease
Which of the following features is NOT commonly seen in children with Down syndrome?
muscle spasticity
If respiratory depression occurs with opioid use, the pediatric nurse should use which reversal agent when oxygen and stimulation of the child are ineffective?
nalaxone hydrochloride
A 2-year-old is hospitalized with a fractured femur. In addition to pain medication, which of the following will best provide pain relief for this child?
parents' presence at the bedside
A nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that the child is in which stage of Kohlberg's Theory of Moral Development?
preconventional moral reasoning
According to Piaget, the second stage of cognitive development that is characterized by the increased use of symbols and prelogic thought processes. When Piaget uses the word "operational", "operations", etc., he refers to logical, mental activities.
preoperational
The nurse is working with a hospitalized preschool-age child. The nurse is planning activities to reduce anxiety in this child. The most appropriate action by the nurse is to
provide the child with a doll & safe medical equipment
According to Piaget, this is the first stage of cognitive development. This is the period where the infant explores the environment and acquires knowledge through sensing and manipulation of objects.
sensorimotor
The nurse correctly recognizes that a shared goal of early intervention for both maple syrup urine disease (MUSD) and phenylketonuria (PKU) is avoidance of which complication?
severe neurologic impairment
A 5-year-old is in the playroom when the respiratory therapist arrives on the pediatric unit to give the child a scheduled breathing treatment. The nurse should
ssist the child back to his room for the treatment but reassure the child that he may return when the procedure is completed
With phenylketouria:
the child typically has lighter skin, hair, and eyes
Monique walks into the ED carrying her crying 18-month old daughter. She tells the nurse her daughter crawled into the leg of the ironing board. The hot iron tumbled off the board and the child touched it before she could interfere. But the burn is on the edge of the child's palm and on her wrist, not her fingers. "This isn't the first time she's touched the iron," Monique says. "You would think she'd learn." When the nurse examines the child, the mother complains that there is nothing wrong with her other than the burn on her hand. During her assessment, the nurse notes scars on the child's back and buttocks shaped like the tip of an iron. (pp. 426-432) The nurse documents:
the location, shape, color, & size of the burn
The stage that occurs between birth and one year of age is concerned with:
trust vs. mistrust
Children in the preoperational stage lack the ability to understand the principle of conservation. The principle of conservation states that two equal quantities remain equal even though the form or appearance is rearranged, as long as nothing is added and subtracted. The lack of understanding of conservation can be reflected in centration and irreversibility
True
Munchausen syndrome by proxy is usually difficult to diagnose. T/F?
True
Which of the following is the best example of appropriate communication with a young child in the hospital setting?
"I'm going to count how fast your heart beats."
During the nurse's initial assessment of a school-age child, the child reports a pain level of 6 out of 10. The child is lying quietly in bed watching television. The nurse should
administer prescribed analgesic
Which stage of development is most unstable and challenging regarding development of personal identity?
adolescence
Which of the following developmental delays are seen in children with Down syndrome?
all of the above
The nurse must perform a procedure on a toddler. The technique most appropriate when performing the procedure is to
allow the child to cry or scream
Object permanence
an object continues to exist even when it can no longer be seen
The nurse is caring for a child who has been sedated for a painful procedure. The priority nursing activity for this child should be
assess the child's respiratory effort
Baby Smith weighs 14 pounds. What is his hourly fluid needs?
26.5 mL/hr
The home health nurse practices anticipatory guidance for a family with a 12-month-old child by giving information and brochures about:
Accident-proofing their home
The pediatric nurse takes into consideration that the primary cause of infant mortality is:
Congenital deformities
A maternity nurse is providing instruction to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse should instruct the mother to: (Choose the one best answer.)
Consistently meet the infant's needs, when the newborn signals a need
Identity vs. role confusion
Consumed with looks and viewpoints of others
School-age children engage in a type of play that is goal-oriented (in other words, the children play in an organized manner toward a common goal). The children plan, assign roles, and play together with established rules. This type of play is known as:
Cooperative play
Initiative vs. guilt
During this stage which occurs from ages 3 to 6 years, children develop direction and purpose. Teaching impulse control and cooperative behaviors during this stage help the child to avoid risks of altered growth and development. Develops conscience.
Industry vs. inferiority
During this stage, children develop a sense of competency. Learns to socialize.
Autonomy vs. shame and doubt
During this stage, toddlers learn to achieve self-control and willpower. Learns to control bodily functions
A parent asks the nurse if there is anything that can be done to reduce the pain that his 3-year-old experiences each morning when blood is drawn for lab studies. The most appropriate method the nurse can suggest to relieve pain associated with the venipuncture is
EMLA cream (lidocaine 2.5% and prilocaine 2.5%) applied to skin at least one hour prior to the procedure
A client and her husband are positive for the sickle cell trait. The client asks the nurse about chances of her children having sickle cell disease. Which of the following is an appropriate response by the nurse?
Each pregnancy carries a 25% chance of the child being affected
Applications of the principle of atraumatic care in the pediatric setting include which of the following? (Select all that apply)
Encouraging the family to room in with child; Identifying child/ family stressors; Effectively managing pain
Which of the following are accurate statements concerning anticipatory guidance?
Examples of anticipatory guidance are informing parents of newborns about physical changes in their infant (e.g., teething), and anticipating concerns in parents of adolescents due to alcohol and drug abuse; Anticipatory guidance is key to achieving a primary goal of pediatric nursing care, which is health promotion; This is guidance provided by the pediatric nurse to parents, in anticipating likely upcoming concerns with the child; Anticipatory guidance is challenging because of the range and complexity of appropriate issues, the enormous individual differences among normal children and their families, and the limited time in health supervision visits.
Which of the following statements concerning Down syndrome is FALSE?
People with Down syndrome have profound intellectual disability and cannot function meaningfully in society
Which of the following hereditary disorders is transmitted by autosomal recessive inheritance?
Phenylketonuria
Which role would the pediatric nurse be serving when reading and analyzing new research findings and applying those findings to practice?
Researcher
Which of the following does NOT demonstrate atraumatic care for the hospitalized child?
Restrain the child, holding him down firmly during procedures to prevent injury
The nurse conducts developmental screenings at a community center for infants and young children. The nurse explains that the purpose of these screenings is to:
See if there's cause to suspect that a baby or toddler has a disability or developmental delay
The core concepts of Family Centered Care on the inpatient hospital unit are: 1. Dignity and Respect-To Listen to and honor patient and family ideas and choices and to use patient and family knowledge, values, beliefs and cultural backgrounds to improve care planning and delivery. 2. Information Sharing-To communicate and share complete and unbiased information with patients and families in useful ways. Patients and families receive timely, complete and accurate details so they can take part in care and decision making. 3. Involvement-To encourage and support patients and families in care and decision making at the level they choose. 4. Collaboration-To invite patients and family members to work together with health care staff to develop and evaluate policies and programs. True or False?
True
The purpose of adult-directed play in the hospital setting is to increase a young patient's sense of predictability regarding pending medical procedures and health care experiences, increase a sense of self-control, reduce stress from unrealistic fantasies about medical procedures, increase effective coping skills, and to clear up confusions and misconceptions. True or False?
True
Which of the following strategies should be employed to reduce pediatric medication errors? (Select all that apply)
Use capital letters to distinguish between medications; Include the child's weight, age, and calculated dose
Irreversibility
They cannot reverse a sequence or logical operations. A child displaying irreversibly says 2 x 4 is different from 4 x 2. Likewise a child may be able to perform multiplication, but can't divide
Symbolic thinking
They start to use words, images, and symbols to represent their world. Such behaviors are characterized by: - the use of language (the word "fly" represents an annoying, buzzing creature) - use of fantasy and imagination (remember when you built a fort out of couch cushions?)
Egocentrism
This does not mean selfishness or conceit as social psychologists use the word. This means that children lack the ability to consider another person's point of view or perspective
Centration
This is the tendency to focus or center on one aspect of the situation and ignore other important aspects of the situation
What types of disorders are abnormalities that result from an abnormal sex chromosome?
X-linked
The nurse is aware that emancipated minors and those who qualify under the mature minor doctrine may sign consents for their own medical treatment without parent approval. Persons not needing parent approval for medical care would be: (Select all that apply.)
a 14-year-old girl married to a 16-year-old boy; a 17-year-old serving in the U.S. Navy; a 17-year-old seeking medical care for a sexually transmitted disease
The nurse cautions a group of parents that the leading cause of childhood mortality is:
accidents