HESI Patient Review--Pediatrics-Out-patient Peds (Infants and Children)

Mrs. Deakin is given amoxicillin for Jeffrey. The concentration of the amoxicillin is 250 mg/5 mL. To receive 266 mg, Jeffrey needs to take ______mL. (Round answer to nearest tenth)

5.3

You also review with Mrs. Deakin the appropriate dose of acetaminophen for Jeffrey. Acetaminophen is available in many different concentrations. Mrs. Deakin reports the concentration she uses at home is 160 mg/5 mL. Jeffrey will need _______mL to receive 200 mg of acetaminophen. (Do not round answer)

6.25

Sarah is mildly dehydrated. Sarah weighs 14 kg (30.8 pounds). She should receive __________mL of fluid over a 4-hour period for initial rehydration.

700

Jeffrey weighs 20 kg (44 pounds). His daily dose of amoxicillin will be ________mg based on a safe dose range of 40 mg/kg/day administered in three divided doses.

800

A consistently depressed (sunken) anterior fontanel is also cause for concern. A sunken anterior fontanel is usually a sign of: - intracranial hemorrhage - microcephaly - dehydration - Down syndrome

Dehydration With dehydration, a depressed (sunken) anterior fontanel is usually observed. With dehydration, body fluids are more concentrated than normal and the amount of fluid in interstitial spaces is decreased. A depressed (sunken) anterior fontanel reflects a decrease in cerebrospinal fluid (CSF) and intracranial pressure.

After Jason's health history is obtained, you prepare to collect essential physical exam data. Jason is sleeping soundly in his mother's arms. Which assessment should be done first? - Temperature - Pulse rate - Respiratory rate - Breath sounds

Respiratory rate It would be wise to determine Jason's respiratory rate first, while he is asleep. The assessment is likely to be most accurate with Jason undisturbed. When assessing respiratory rate, respiratory movement can simply be observed, or a hand can be placed lightly on Jason's abdomen. This can be accomplished while his mother holds him. Respiratory rate is taken for a full minute. After assessment of respiratory rate, auscultation of the lungs, and determination of pulse rate, can be accomplished.

Even though this is a sick-child visit, Sarah's immunization record is reviewed. Sarah has received the following recommended immunizations on schedule: HepB, DTaP, Hib, IPV, PCV, Varicella, and MMR. Which recommended vaccine is considered at this time since Sarah has not received it? - Tdap - MCV4 - PPV - HepA

HepA HepA is the hepatitis A vaccine, which is recommended for all children at one year of age. Sarah has not had this recommened vaccine. Even though Sarah is ill, her illness is mild, and she can safely receive the vaccine now.

One of your responsibilities today is obtaining an initial health history for Jason. You know that a health history gather ______ data. - subjective - objective

Subjective Subjective data is data obtained by interview or record/chart review. Data obtained by interview or record/chart review is referred to as subjective data. Objective data is patient information obtained by clinicians during a physical assessment. The assessment techniques of inspection, auscultation, percussion, and palpation are used to obtain objective data.

Which of the following nursing diagnoses apply to Sarah at this time? (Select 2) - Deficient Fluid Volume related to fluid losses from fever, vomiting, and diarrhea - Risk for Imbalanced Nutrition: Less than Body Requirements related to anorexia and vomiting, and increased needs associated with fever - Hyperthermia related to fever - Social Isolation related to separation from playmates

-Deficient Fluid Volume related to fluid losses from fever, vomiting, and diarrhea This nursing diagnosis applies to Sarah. A significant amount of data supports the fact that she is fluid volume deficient. Supportive nursing measures will help resolve Sarah's fluid deficit. -Risk for Imbalanced Nutrition: Less than Body Requirements related to anorexia and vomiting, and increased needs associated with fever This nursing diagnosis applies to Sarah. A significant amount of data supports the fact that she is not nutritionally deprived at this point but could be. She has been vomiting, her appetite has been poor, and her metabolic needs are greater because of fever. Supportive nursing measures will help maintain Sarah's nutritional status.

Which of the following comments by Mrs. Deakin indicate a need for further education? (Select 5) - "One of the crib slats broke and was removed." - "I usually put Jason to sleep on his stomach because he prefers that position." - "Jason's crib mattress is nice and soft." - "Jason's room is cool, so I place a few blankets on him at night." - "I have a cloth mattress pad on Jason's mattress, covered by a cloth fitted sheet." - "Jason is restless so I get up and change his position a lot during the night."

-"One of the crib slats broke and was removed." Crib slats should be no wider than two inches apart. An infant can fall through or get stuck if the spaces are wider. Mrs. Deakin should be advised that Jason's crib must be repaired or replaced. -"I usually put Jason to sleep on his stomach because he prefers that position." Studies have indicated that the safest sleeping position for babies is on their backs. To prevent sudden infant death syndrome (SIDS), it is recommended that babies be put to sleep on their backs. Mrs. Deakin should be told to place Jason to sleep on his back. -"Jason's crib mattress is nice and soft." An infant can suffocate if a mattress is too soft. A very soft mattress can contour an infant's face and obstruct the airway. To prevent suffocation or sudden infant death syndrome (SIDS), a firm mattress is suggested. Mrs. Deakin should be advised of this fact. -"Jason's room is cool, so I place a few blankets on him at night." Blankets can increase risk of suffocation, especially when used in excess and tucked in. Infants are not able to wiggle out of tucked-in sheets or blankets. Mrs. Deakin should be advised of this fact. -"Jason is restless so I get up and change his position a lot during the night." nce an infant is put down to sleep, continuous repositioning throughout the night is unnecessary. A cloth mattress pad, covered with a fitted crib sheet, helps to make a mattress more comfortable and keep the mattress clean. These are safe to use. Plastic mattress covers increase risk of suffocation and should not be used.

Jason will receive a number of immunizations over the next few months. These include: (Select 4) - Varicella vaccine - A second dose of hepatitis B vaccine (HepB) - Tdap (tetanus and diphtheria toxoids and acellular pertussis) vaccine - Hib (haemophilus influenzae type b) vaccine - IPV (inactivated poliovirus) vaccine - PCV (pneumococcal conjugate) vaccine

-A second dose of hepatitis B vaccine (HepB) A second dose of hepatitis B vaccine (HepB) is given at least one month after the first dose, often at the two-month visit. A third dose is usually given at 6 months if it is monovalent. If in combination, it is given at 15-18 months. -Hib (haemophilus influenzae type b) vaccine The Hib (haemophilus influenzae type B) vaccine is generally started at 2 months of age. -IPV (inactivated poliovirus) vaccine Inactivated poliovirus vaccine (IPV) doses are started at 2 months of age. Subsequent doses are given at 4 months, 6-18 months, and 4-6 years of age. -PCV (pneumococcal conjugate) vaccine PCV (pneumococcal conjugate) vaccine is recommended for all children, starting at 2 months of age. Three subsequent doses are required. Two doses are usually given at 2-month intervals after the first dose. The last dose is given at 12-15 months of age. Tdap (tetanus and diphtheria toxoids and acellular pertussis) vaccine is administered to adolescents. It is recommended at age 11-12 years, followed by tetanus and diphtheria toxoids (Td) boosters every 10 years. Infants receive the DTaP (diphtheria/tetanus/acellular pertussis) vaccine. It is recommended at 2 months, 4 months, 6 months, 12-15 (or 15-18) months, and 4-6 years of age.

It is imperative that Sarah's hydration status be assessed. In addition to urine color and amount, which of the following assessments are important when evaluating hydration status? (Select 5) - Behavior - Quality of pulses - Skin turgor - Color of tympanic membranes - Capillary refill - Characteristics of mucous membranes - Deep tendon reflexes

-Behavior Behavior should be assessed. With minimal fluid volume deficit, blood flow to central areas is preserved, and behavior changes are not usually evident. However, when fluid volume deficit and dehydration are severe, perfusion of brain tissues is decreased. Changes in mental status and behavior, including disorientation, may become evident. -Quality of pulses Pulse strength should be assessed. With significant fluid volume deficit, pulses become weak and thready as less fluid is circulated. -Skin turgor Skin turgor reflects hydration status and should be assessed. Decreased skin turgor occurs when subcutaneous tissue lacks water. Skin turgor may be decreased even when fluid volume deficit is mild or moderate. With decreased skin turgor, loose skin remains in a pinched position after pinching is released. -Capillary refill Capillary refill should be assessed. Even with mild to moderate fluid volume deficit, capillary refill time may be prolonged and extremities may be cool, a result of blood flow being preserved for central areas such as the heart, lungs, and brain. When fluid volume deficit is significant, these signs will surely be evident. Capillary refill time can be checked in an infant/child by pressing on the forehead or top of the hand (or pinching abdominal skin or a large toe or thumb) to produce blanching, and then checking for return of pink color when pressure is released. A capillary refill time of less than 2 seconds is considered brisk, and normal. -Characteristics of mucous membranes Lips and mucous membranes are usually dry with even mild fluid volume deficit and dehydration.

Otitis media may be preventable, and you teach many parents about ways to avoid ear infections, especially in infants. Which of the following can contribute to occurrences of otitis media in infants? (Select 2) -Bottle-propping -frequent breastfeeding -Exposure to passive smoke -use of hats

-Bottle-propping The use of a bottle while a baby lays flat contributes to the incidence of acute otitis media. Bottle-propping should be avoided. -Exposure to passive smoke Passive smoke has been shown to contribute to the incidence of acute otitis media. Babies should not be exposed to passive smoke.

Jeffrey has a high fever. A diagnosis of meningitis must be ruled out in any infant or child with a high fever. Which of the following might be observed in an infant or child with meningitis? (Select 5) - Bulging (tense) fontanel in an infant - Vomiting - Nuchal rigidity - Abdominal pain - Irritability - High-pitched cry in an infant

-Bulging (tense) fontanel in an infant An infant with meningitis often has a bulging (tense) fontanel, because of increased intracranial pressure. -Vomiting Vomiting often occurs with meningitis, secondary to increased intracranial pressure. -Nuchal rigidity Any child with fever and nuchal rigidity (stiffness of the neck) must be suspect for meningitis. -Irritability Irritability is commonly present with meningitis -High-pitched cry in an infant A high-pitched cry, secondary to increased intracranial pressure, is often noted in infants with meningitis

When Mrs. Deakin is situated in the examining room, you ask about the reason for today's visit (history of present complaint). Which of the following are important subjective data to gather from Mrs. Deakin? (Select 6) - Character and frequency of Sarah's bowel movements - Whether or not Jason's crib has been repaired - Whether or not Sarah has had a fever - Whether or not new foods have been added to Sarah's diet - Whether or not siblings or other family members are also ill - The amount and color of Sarah's urine over the last few days - Whether or not Sarah has had any medications

-Character and frequency of Sarah's bowel movements The character and frequency of Sarah's bowel movements are important. This information will help in diagnosis and also help determine the severity of the present condition. Whether or not blood is present in the stool is important, since blood is frequently found in the stool when a bacterial or parasitic GI infection is present. Mrs. Deakin says Sarah has had ongoing episodes of watery diarrhea, with no blood. She has put Sarah back in diapers because of the frequent diarrhea. -Whether or not Sarah has had a fever Whether or not Sarah has had a fever is important to determine. Mrs. Deakin tells you that Sarah developed a fever the same time she started having diarrhea. This information will help in diagnosis, and also guide treatment. Fever is often present when GI symptoms are caused by an infection. Also, when a fever is present, supportive interventions are indicated. Metabolic rate increases dramatically when body temperature is elevated. Fluid is lost as the body eliminates heat through sweating. Fluid volume deficit, dehydration, and weight loss occur quickly if fluid intake and nutrition are not maintained. -Whether or not new foods have been added to Sarah's diet Whether or not new foods have been added to Sarah's diet is important information. This information is needed to rule out the possibility of a food reaction as a cause of Sarah's GI symptoms versus an infectious process. Mrs. Deakin says that Sarah's diet has not changed. -Whether or not siblings or other family members are also ill Whether or not siblings or other family members are also ill is important information. If another family member is ill, viral etiology is a likely cause of Sarah's health problems and symptoms. No other family members are ill in the Deakins household. -The amount and color of Sarah's urine over the last few days GI water losses from diarrhea and vomiting can be significant. Fluid volume deficit and dehydration (a hypernatremic state often caused by deficit of water) can develop quickly. Especially in infants and children, these are potentially serious, since so much of their body weight is water. Urine becomes concentrated (dark amber in color), and less urine is eliminated. Fewer wet diapers will be noted in infants and young children who use diapers. Young children not wearing diapers who are ill must have their urine output closely monitored when they use the bathroom. In response to your questions about Sarah's urine output, Mrs. Deakin says that Sarah has not been urinating much, and her urine has been darker than usual. -Whether or not Sarah has had any medications Laxatives and some antibiotics can cause diarrhea in the healthy child. It is important to determine if Sarah was on any medications before she became ill. It is also important to determine if she has received any medications since she became ill. Mrs. Deakin says that Sarah was not taking medications before she became ill, and has not taken any since being ill.

Which of the following are appropriate interventions for Sarah's care? (Select 3) - Antibiotics for 7-10 days - Excellent handwashing - Oral rehydration therapy - Disinfection of toilets and diapering surfaces - Anti-diarrheal agents to decrease the frequency of bowel movements

-Excellent handwashing Sarah's illness can be transmitted to others by the fecal-oral route. Excellent hand washing is an effective method for limiting the spread of disease. Anyone having contact with Sarah should wash his hands after the contact. Hands should also be washed after having contact with Sarah's vomit, saliva, or stool. -Oral rehydration therapy Oral rehydration therapy is indicated for Sarah. She is dehydrated. Oral rehydration therapy includes rehydration with water and electrolytes, followed by a maintenance phase during which a usual diet is resumed and any ongoing fluid and electrolyte losses are replaced. -Disinfection of toilets and diapering surfaces In the Deakins home, toilets and all surfaces where diapering is done should be cleaned with a chlorine-based solution. Cleaning possibly-contaminated surfaces will help control the spread of Sarah's infection.

Some forms of bacterial meningitis can be prevented with immunization. Which vaccines are designed to prevent invasive bacterial infections that can result in meningitis? (Select 2) - HepB - DTaP - Hib - IPV - MMR - PCV

-Hib Hib is the haemophilus influenzae type b conjugate vaccine, which is designed to prevent invasive bacterial infections from haemophilus influenzae type b, which can cause meningitis, epiglottis, and pneumonia. Hib infections have dramatically decreased since the vaccine was introduced. IPV -PCV PCV is the pneumococcal vaccine, which is designed to prevent invasive bacterial infections from pneumococcus bacteria, which can cause meningitis, pneumonia, and ear infections.

Your initial health history of Jason will be comprehensive. Which of the following should be included as part of Jason's initial health history? (Select 5) - His medical history - A family medical history - A psychosocial history - A nutrition history - A review of systems - Developmental screening

-His medical history -A family medical history -A psychosocial history -A nutrition history -A review of systems Although information about a child's growth and development (obtained as part of the child's medical history) is relevant when developmental screening is done, developmental screening is not part of an initial health history. Developmental screening involves use of checklists, administration of tests, and assessments of physical status to determine if a child is developing normally.

You inquire further to determine if Jason is getting enough nutrition. Which of the following suggest that Jason is probably receiving enough breast milk? (Select 5) - Jason latches on easily when starting to nurse then quickly falls to sleep while feeding - Jason sleeps at least two hours after a feeding - Jason has a bowel movement after most feedings - Jason has 6-8 wet diapers in each 24-hour period - Jason nurses every 2-4 hours for 15 minutes - Jason is a content, alert, and responsive baby - Jason appears to have adequate body fat

-Jason sleeps at least two hours after a feeding -Jason has a bowel movement after most feedings A breast-fed baby that is getting enough breast milk usually has a soft, yellow, seedy bowel movement after almost every feeding. These bowel movements reflect adequate hydration and nutrition. Bottle-fed babies have stools that are more formed, less frequent, and stronger in odor than breast-fed babies. -Jason has 6-8 wet diapers in each 24-hour period -Jason nurses every 2-4 hours for 15 minutes -Jason is a content, alert, and responsive baby A vague assessment of Jason's appearance tells you little about his nutrition. Even an infant who appears to have adequate body fat (subcutaneous tissue) may not be getting enough nutrients and calories.

Which of Jason's measurements are recorded on clinical growth charts? (Select 3) - Heart rate - Length - Chest circumference - Head circumference - Weight - Temperature

-Length -Head circumference -Weight

Jeffrey's immunization status is reviewed before he leaves. All immunizations are current. He will be going to Kindergarten in the fall. Which of the following boosters, which are usually given at the 4-6 year old visit, will he need at that time? (Select 3) - HepB (hepatitis B) - MMR (measles, mumps, rubella) - IPV (inactivated poliovirus) - DTaP (diphtheria, tetanus, acellular pertussis) - Hib (Haemophilus influenzae type b) - Td (tetanus, diphtheria)

-MMR (measles, mumps, rubella) Jeffrey will need his second and last dose of MMR (measles, mumps, rubella) vaccine. It is recommended routinely at 4-6 years of age. -IPV (inactivated poliovirus) Jeffrey will need his fourth and last dose of IPV (inactivated poliovirus) vaccine. It is recommended at 4-6 years of age. -DTap (diphtheria, tetanus, acellular pertussis) Jeffrey will need his fifth and last dose of DTaP (diphtheria, tetanus, acellular pertussis) vaccine. Jeffrey will not need Hep B. His Hepatitis B vaccine series was completed when he was 15 months old. Jeffrey will not need a Hib (Haemophilus influenzae type b) booster. His Hib series was completed when he was 15 months old. Jeffrey will not need a Tdap (tetanus and diphtheria toxoids and acellular pertussis) vaccine. Tdap (tetanus and diphtheria toxoids and acellular pertussis) vaccine is administered to adolescents. It is recommended at age 11-12 years, followed by tetanus and diphtheria toxoids (Td) boosters every 10 years. Infants receive the DTaP (diphtheria/tetanus/acellular pertussis) vaccine. It is recommended at 2 months, 4 months, 6 months, 12-15 (or 15-18) months, and 4-6 years of age.

Which of the following are appropriate rehydration solutions for Sarah? (Select 2) - Water - Pedialyte - Ginger ale - Gatorade - Rehydralyte - Flat coke

-Pedialyte Pedialyte solution is useful and appropriate for rehydration. Pedialyte provides fluids and is rich in electrolytes and nutrients, which are also needed. Pedialyte freezer pops are available. Children usually enjoy and willingly take freezer pops. -Rehydralyte Rehydralyte is an appropriate rehydrating solution rich in electrolytes.

On his mother's lap, Jeffrey is crying quietly with his hand over his right ear as he is examined by the Nurse Practitioner. Which of the following are important assessments when an upper respiratory tract infection has been present and an ear infection is suspected? (Select 5) - Pharynx and nasal mucosa - Tympanic membranes - Abdomen - Sinuses - External auditory canals and pinna - Auricular and cervical lymph glands - Balance

-Pharynx and nasal mucosa It is likely that Jeffrey has an ear infection. Ear, nose, and throat infections often occur simultaneously. Therefore, the pharynx and nasal passages should be examined. Jeffrey's conjunctiva should also be examined, since conjunctivitis also commonly occurs with upper respiratory tract and ear, nose, and throat infections. -Tympanic membranes Because of Jeffrey's ear pain, both tympanic membranes should be examined and compared. Abdomen -Sinuses Sinuses should be examined. A sinus infection can follow an upper respiratory tract infection, although this is more likely in an older child. -External auditory canals and pinna Whenever ear pain is present, the external ear should be examined. The auditory canal and pinna are painful to touch with otitis externa. -Auricular and cervical lymph glands With otitis media, lymphadenopathy is often present. The auricular and cervical lymph glands are usually involved

Which of the following are associated with acute otitis media? (Select 4) - Recent upper respiratory tract infection - History of allergies - Passive smoking in the home - Pain with movement of the pinna - Fever

-Recent upper respiratory tract infection An upper respiratory tract infection frequently precedes an ear infection. The ear, nose, and throat are anatomically connected. Problems with any of these body areas can also affect the other body areas. -History of allergies Allergies can cause congestion in the eustachian tube, which may predispose a person to otitis media. The ear, nose, and throat are anatomically connected. Problems with any of these body areas can also affect the other body areas. -Passive smoking in the home Passive smoking in the home has been found to be a risk factor for otitis media. The ear, nose, and throat are anatomically connected. Problems with any of these body areas, or exposure to irritants, can also affect the other body areas. -Fever Fever is often present in an acute otitis media, but can be absent.

Mrs. Deakin asks when the "spaces" will close. You explain to Mrs. Deakin that the anterior fontanel is expected to close by: - 2 months of age - 4 months of age - 6 months of age - 18 months of age

18 months of age The anterior fontanel normally closes by 18-24 months of age (and often sooner). The posterior fontanel normally closes by 2-3 months of age.

Jeffrey will receive ________mg of amoxicillin three times a day. (Round answer to nearest whole number)

267

If on abdominal examination, a steady pain localized in the right lower quadrant was noted, which medical diagnosis would be highly suspected? - Hepatitis - Appendicitis - Meningitis - Infectious mononucleosis

Appendicitis Steady pain in the right lower quadrant suggests acute appendicitis. Acute appendicitis must always be ruled out when gastrointestinal complaints are present. Symptoms often begin with a slow and steady onset, starting with fever, and pain localized in the right lower quadrant. Guarding and rebound tenderness are usually observed. Associated symptoms include anorexia, vomiting, and diarrhea or constipation.

Jason remains asleep in his mother's arms. You prepare to obtain his pulse rate. Which pulse rate should be determined? - Brachial pulse rate - Radial pulse rate - Apical pulse rate - Femoral pulse rate

Apical pulse rate The apical heart rate is the most reliable pulse rate in infants, and children less than two years of age. It is auscultated and heard best at the fifth left intercostal space. The rate is counted for a full minute. Abnormal heart sounds or murmurs can also be detected as the stethoscope is held in place at the chest. The apical pulsation can sometimes be seen in the small chest of an infant. Observing the pulsation is not an accurate method for obtaining an apical heart rate.

An immunization record is started for Jason. Mrs. Deakin has provided you with paper work indicating that Jason was vaccinated before he was discharged from the hospital where he was born. Which vaccine is recommended for newborns? - Oral polio vaccine (OPV) - Hepatitis B vaccine (HepB) - DTaP (diphtheria/tetanus/acellular pertussis) vaccine - MMR (measles, mumps, rubella) vaccine - Varicella vaccine

Hepatitis B vaccine (HepB) Hepatitis B vaccine (HepB) is recommended for all children. It is recommended that the first dose be given soon after birth, before discharge from the birth facility. This vaccine is the only vaccine administered to a newborn. Live, oral polio vaccine (OPV) is no longer recommended. Inactivated poliovirus vaccine (IPV) is now recommended. IPV doses are started at 2 months of age DTaP (diphtheria/tetanus/acellular pertussis) doses are started at 2 months of age. MMR (measles, mumps, rubella) doses are started at 12-15 months of age. Varicella vaccine is given after 12 months of age.

You record a weight of 3.7 kg (8 pounds 1 ounce) for Jason and note that his birth weight was 3.6 kg (8 pounds). Your correct judgment regarding Jason's change in weight since birth is that: - his weight gain is insufficient and intervention is indicated - his weight is as expected at two weeks of age - breastfeeding may need to be supplemented with bottle-feeding - a strict feeding schedule may be needed

His weight is as expected at two weeks of age Given his birth weight, Jason's current weight is as expected at two weeks of age. At two weeks of age, Jason's weight is approximately the same as when he was born. Typically, newborns lose 10% of their weight after birth. By two weeks of age, birth weight is usually restored. Birth weight usually triples by the end of the first year of life.

You also discuss car seat safety with Mrs. Deakin. You explain that Jason must always be in an approved infant car restraint. Which of the following is an appropriate place and position for Jason to ride in the car at this time? - In the front seat facing forward - In the back seat facing forward - In the front seat facing backward - In the back seat facing backward

In the back seat facing backward Facing backward in an appropriate car safety seat in the back seat of a motor vehicle, in the middle of the seat, is the best place for infants under 20 pounds and less than one year of age. The top of the infant's head must be below the top of the seat back. Children over 20 pounds and one year of age may ride an appropriate car safety seat in the back seat facing forward, in accordance with the safety seat manufacturer's instructions.

He then does an abdominal exam on Sarah, using the techniques of inspection, palpation, percussion, and auscultation. In which order are these techniques implemented? - Inspection, auscultation, percussion, and palpation - Inspection, palpation, percussion, and auscultation - Auscultation, inspection, palpation and percussion - Inspection, percussion, auscultation and percussion

Inspection, auscultation, percussion, and palpation This order of implementing abdominal assessment techniques is correct. Inspection, followed by auscultation, should be performed before the abdomen is manipulated with palpation, which might alter the character and frequency of bowel sounds. Inspection should always be done first.

Based on Sarah's signs and symptoms and your assessment findings, you determine that she is probably: - not dehydrated - mildly to moderately dehydrated - moderately to severely dehydrated

Mildly to moderately dehydrated Sarah is probably mildly dehydrated. Her vital signs and mental status are normal. Except for temperature, her vital signs are normal. Her urine output is decreased, her urine is concentrated, and her lips are dry. Capillary refill time is normal. Skin turgor is decreased. In children, signs of mild dehydration are seen when 3-4% of body weight has been lost with fluid loss. In infants, signs of mild dehydration occur when 5% of body weight has been lost with fluid loss.

Before Mrs. Deakin leaves the office, she mentions that Sarah started having temper tantrums recently. She wants to know if these are normal. You correctly advise Mrs. Deakin that: - temper tantrums are common and normal in toddlers - temper tantrums are not normal in toddlers and may indicate a need for behavioral evaluation - temper tantrums could be a result of Sarah's illness and if so should stop when Sarah is feeling better

Temper tantrums are common and normal in toddlers Temper tantrums are common and normal in toddlers. The toddler, striving for autonomy, is confronted with many challenges. Any rules or demands that interfere with a desired activity lead to frustration, and perhaps explosive activity (tantrum) that helps release pent-up tensions.

Which of the following infants is NOT given the DTaP vaccine at this six-month visit? - The afebrile infant with a resolving ear infection who is still on antibiotics - The infant who had local redness and a fever of 39 degrees C (102.2 degrees F) after a previous DTaP injection - The infant who cried uncontrollably for an hour after his last DTaP injection - The infant with a cough and an axillary temperature of 38 degrees C (100.4 degrees F) - The infant who developed hives and had difficulty breathing after a previous DTaP injection

The infant who developed hives and had difficulty breathing after a previous DTaP injection To avoid serious illness, a vaccine should be given on schedule and not withheld unless a very serious contraindication exists. A severe allergic reaction to a vaccine is a true contraindication to subsequent vaccination. A serious allergic reaction can cause hives, difficulty breathing, wheezing, throat swelling, pallor, weakness, tachycardia, and dizziness, and may result in death. A child who develops a severe allergic reaction with administration of a vaccine should NOT be given subsequent doses of the vaccine.

You spend time speaking with Mrs. Deakin about Jason's emotional care and developmental stage. According to Erikson, Jason is in which psychosocial stage of development? - Autonomy vs. Shame and Doubt - Industry vs. Inferiority - Trust vs. Mistrust - Initiative vs. Guilt

Trust vs. Mistrust Jason is in Erikson's stage of Trust vs. Mistrust. This stage occurs between birth and 12-18 months of age. During this stage, the task of developing trust in people and the environment is accomplished as a nurturing person, usually the mother, provides consistent, loving care.

For each ear, the middle ear is examined. To straighten the ear canal, the pinna is pulled: - up and back - down and out

Up and back Jeffrey is five years old. For children older then three years of age, the ear canal is best viewed with the pinna pulled up and back. For children younger than three years of age, the ear canal is best viewed with the pinna pulled down and out.

Especially with infants, weight should be obtained at every well-child and sick-child visit. Which of the following do you correctly implement to weigh Jason? - Hold Jason in your arms, weigh yourself on the stand-up scale, and subtract your weight from the total weight displayed - Ask Mrs. Deakin to hold Jason in her arms, weigh herself on the stand-up scale, and subtract her weight from the total weight displayed - Weigh Jason nude on an infant scale - Weigh Jason in a dry diaper on an infant scale

Weigh Jason nude on an infant scale To obtain an accurate weight measurement of a newborn infant, all clothes (including diaper) must be removed. An infant scale should be used. A clean liner should be used for each infant. OSHA guidelines for disinfection of the scale should be followed. Generally, children are weighed nude on a platform scale until three years of age. After three years, children can usually balance enough to stand on a scale. Young children are usually weighed with their underpants on.

A consistently bulging (tense) anterior fontanel may be abnormal, and a result of: - decreased intracranial pressure - increased intracranial pressure

increased intracranial pressure A bulging anterior fontanel is associated with increased intracranial pressure. A variety of conditions may result in increased intracranial pressure that is reflected as a bulging anterior fontanel. These include space-occupying lesions such as tumors, infections (encephalitis, meningitis), disorders of cerebrospinal fluid production/absorption (hydrocephalus), metabolic disorders, and intracranial injury.