HESI PEDS-set #2

autonomy versus sense of shame and doubt

Erikson theory for toddlers (1-3); This stage is one of autonomy versus sense of shame and doubt. Between the ages of one to three years old, a child starts walking, feeding, using the toilet, and handling some basic self-care activities.

At which stage does an adolescent develop abstract thinking?

Formal operations period

What age can a child tie shoes?

Four-year-olds can put on shoes, but are usually unable to tie them until age 5.

What suggestions should a nurse give to a parent to help a 2-month-old infant who has colic? .

Giving smaller, more frequent feedings may limit the occurrence of intestinal cramping. Burping frequently when giving a feeding reduces the amount of air entering the intestine, which may limit the occurrence of intestinal cramping. One important nursing intervention (before or after an organic cause has been eliminated) is reassuring both parents that they are not doing anything wrong and that the infant is not experiencing any physical or emotional harm. Parents, especially mothers, become easily frustrated with their infant's crying and perceive this as a sign that something is horribly wrong.

For which clinical manifestation should the nurse monitor the toddler-age client diagnosed with lead toxicity associated with the renal system?

Glycosuria is a clinical manifestation caused by the effects of lead toxicity on the renal system.

The practitioner prescribes no weight bearing on a leg that has been casted because of a fracture of the femur. How should the nurse determine the appropriate length of the crutches for this child?

The crutches should reach 2 inches (5 centimeters) below the axillae and The tips of the crutches should rest 6 inches (15.2 centimeters) outside the feet; Stooping of the shoulders when the child walks indicates that the crutches are too short. elbows should be flexed slightly when the child is holding the crossbar (no more than 30 degrees) and the shoulders should be straight.

dystonic CP

The dystonic type of CP is a combination of the spastic and athetoid types.

Korotkoff sound represents diastolic pressure in adults and adolescents

The fifth Korotkoff sound marks the disappearance of sound. In adolescents and adults the fifth sound corresponds with the diastolic pressure.

Korotkoff sound represents the systolic blood pressure

The first is sharp and represents systolic blood pressure.

Korotkoff sound represents diastolic pressure in toddlers

The fourth Korotkoff sound is muffled and low. This sound is the diastolic pressure in toddlers.

ID

The id is basic instinctual impulses driven to achieve pleasure.

initiative versus guilt stage

The initiative versus guilt stage is characterized by a child having fantasies and imaginations that motivate the child to explore the environment.

The nurse is helping an adolescent with iron-deficiency anemia make breakfast meal choices. Which foods should the nurse suggest?

The iron content in the options is as follows: ¾ cup raisin bran, 13.5 mg; one slice of wheat bread, 0.9 mg; 1 cup of blueberry fruit yogurt, 0.2 mg; and apple fruit cup, 0.2 mg. iron-fortified cereal has more iron than iron-fortified bread

Which method of contraception may provide adolescents with the longest duration of protection?

The levonorgestrel intrauterine system is a T-shaped intrauterine system which releases levonorgestrel. It must be placed within seven days of menses and provides protection up to five years. The NuvaRing, a flexible, soft, and transparent ring placed in the vagina, must be replaced every three weeks. The levonorgestrel implant is a small rod that provides protection for up to three years

Which treatment should the nurse anticipate when providing care to a toddler-age client who ingested bleach?

The nurse should anticipate an order for analgesics for a toddler-age client who presents after the ingestion of bleach. Gastric lavage (washing out of the stomach), activated charcoal, and vomiting are contraindicated because each can cause more harm to the child.

spastic CP

The spastic type of CP is characterized by hypertonicity of muscles.

Which statement by the student nurse is true about the appearance of a toddler's body?

Toddlers have a gap between their legs while walking. As a toddler walks, his or her legs and feet are usually far apart. They have a protruding abdomen. Toddlers have slightly everted feet while walking. An infant lacks the anteroposterior curves of an adult.

What is the maximum recommended dose of an intramuscular injection in a toddler?

0.5 mL in infants

adolescence age

12-18

About what age can a child hold the meat with the fork while cutting it with the knife?

7 years old

clinical manifestations of Meningococcal meningitis

A low-grade fever progressing to a high fever occurs in meningitis, rigidity and hyperextension of the neck (opisthotonos). Central nervous system irritation results in irritability, lethargy, and anorexia. The fontanels will be tense or bulging as intracranial pressure increases; purpuric skin rash. Glossitis and tremors are not characteristic of meningococcal meningitis.

Which event is considered as the hallmark of puberty in young girls?

Breast enlargement along with change in pubic hair to adult type sexual hair covering the mons pubis and labia majora occurs during mid-puberty stage

Which is a sign of a ruptured ectopic pregnancy in an adolescent?

Abdominal pain and hypotension An ectopic pregnancy occurs when a fertilized egg implants outside the uterus. Hypotension and abdominal pain indicates that the ectopic pregnancy might have ruptured. Ectopic pregnancy is ruled out if abdominal pain is associated with bleeding or hypertension.

Ego

According to Freud the ego allows an individual to judge reality accurately.

Achondroplasia

Achondroplasia is a congenital disorder that is a common cause for the structural defect called dwarfism

An adolescent displaying low self-esteem complains of inflamed, red, and painful lesions on his forehead. What condition does he have?

Acne vulgaris; Acne vulgaris is a common skin problem that adolescents experience.

The parents of a 4-month-old infant with a diagnosis of acute otitis media and fever ask the nurse about the use of antibiotics to treat this condition. What is the best response by the nurse?

All cases of acute otitis media (AOM) in infants younger than 6 months should be treated with antibiotics because of their immature immune systems and the potential for infection with bacteria. Current literature indicates that waiting up to 72 hours for spontaneous resolution is safe and appropriate management of AOM in healthy infants older than 6 months and children. However, the watchful waiting approach is not recommended for children younger than 2 years of age who have persistent acute symptoms of fever and severe ear pain.

What is the maximum recommended dose of an intramuscular injection in a toddler?

An intramuscular dose is very small and usually does not exceed 1 mL in toddlers

For which clinical manifestation should the nurse monitor the toddler-age client diagnosed with lead toxicity associated with the hematologic system?

Anemia is a clinical manifestation associated with lead toxicity due to the effects that lead has on the hematologic system.

How should a nurse turn a 10-year-old child in a spica cast?

By log-rolling the body as one unit The child should be rolled as one unit, with the shoulders and hips turned at the same time to prevent injury. The crossbar is not used to facilitate turns because it may be dislodged, weakening the cast. The child will not be able to sit up because the cast immobilizes the hips. The overhead trapeze is used for lifting, not turning

A nurse is caring for a child with a diagnosis of cystic fibrosis. Which schedule of chest physiotherapy (CPT) is best?

CPT is performed several hours after meals to avoid regurgitation and several hours before meals so unpleasant odors and tastes do not affect the appetite. CPT should be done more frequently than two times a day. CPT performed after a meal may result in vomiting.

A preschool child with a spinal cord injury will be on prolonged bed rest. The nurse explains to the parents that certain foods will be restricted to prevent complications associated with immobility. What food should be noted as restricted in the teaching plan?

Cheese contains calcium, which is excreted by the kidneys and may contribute to the formation of kidney stones; it adds to the child's risk because immobility causes bone decalcification

A nurse is teaching a group of parents about communicable diseases. What information about chickenpox should the nurse include?

Chickenpox is communicable until the vesicles have dried. When all vesicles are dried, chickenpox is no longer transmissible; dried vesicles do not harbor the varicella virus and a fever is not usually associated with chickenpox

What would the nurse claim is true regarding play in toddlers?

Children get curious and explore the environment. Children continue to engage in solitary play during toddlerhood but also begin to participate in parallel play. Children prefer playing beside rather than with another child. Toddlers fear separation from their parents and feel safer in their presence.

Which food items should a parent wait to introduce until 1 years old?

Cow milk, soy milk and chocolate Cow's milk is introduced after 1 year. Although often considered hypoallergenic, soy products can cause food allergies. However, because of the infrequency of soy in the American diet, its entry is not delayed after the first year. Chocolate may be introduced after the first year of life.

A school-aged child with sickle cell anemia is admitted to the pediatric unit in a vaso-occlusive crisis. The nurse's priority is to relieve the excruciating pain. Which interventions would be implemented after the pain is under control?

Deliver rehydration and promote rest During a sickle cell crisis the RBCs are sickled and interfere with the peripheral vascular circulation; fluids are needed to increase the circulating volume. Promoting rest minimizes energy expenditure and improves oxygen utilization There is no indication for antibiotic therapy as routine management.

Developmental reflexes of a newborn

Developmental behaviors for a newborn are mostly reflective, including sucking, grasping, swallowing, and rooting.

A nurse is planning a conference for parents of school-aged children with sickle cell anemia. Which common concern of most parents of children with sickle cell anemia should the nurse address at the conference?

Discussions with parents who have children with similar problems help ease their discomfort and feelings of guilt. This is especially true in regard to genetically transmitted diseases.

For which clinical manifestation should the nurse monitor the toddler-age client diagnosed with lead toxicity associated with the neurologic system?

Distractibility and hyperactivity are clinical manifestations caused by the effects of lead toxicity on the neurologic system.

A 10-year-old child undergoes open heart surgery to repair a cardiac defect. The healthcare provider informs the parents that antibiotics are required before any dental work is performed. Later the parents ask the nurse why this is necessary. When responding, the nurse explains that this is done to prevent what type of infection?

Endocarditis; the administration of antibiotics before an invasive procedure can prevent subacute bacterial endocarditis, which may occur in children and adults with heart abnormalities. The endocardium is the lining membrane of the cavities of the heart and the connective tissue bed on which it lies. Gingivitis, an inflammation of the gums, frequently is related to the accumulation of food particles in the crevices between the gums and teeth.

A nurse is determining whether a 5-year-old child is displaying appropriate behaviors for this age. What developmental findings does the nurse expect?

Enjoys imitative play and makes up rules for a new game Imitating adults by playing adult roles in society is at its peak in children 5 years of age; activities are strongly identified with same-sex parent. A 5-year-old is able to negotiate and use make-believe to play. These children are able to follow some rules but may cheat to win.

identity versus role confusion stage

Erikson theory for adolescence. The identity versus role confusion stage begins after adolescence; during this stage, an individual tries to figure out his or her own identity.

Which event is considered as the hallmark of late puberty in young girls?

First menstrual period

Hunter syndrome

Hunter syndrome is an inborn error of metabolism that hinders development and results in altered physical appearance and impaired mental development.

Which behavior noted by the nurse when observing a preschool-age client indicates the end of the Oedipus or Electra complex?

Identification with same-sex parent;

Which quantity of iron, ingested by a child, would be considered in the range of mildly to moderately toxic?

Ingestions of 20 to 60 mg/kg of iron are considered mildly to moderately toxic; over 60 severely toxic or fatal

Which of these features are exhibited by an adolescent?

Invulnerability and Personal fable (they think their thoughts and feelings are unique)

A 15-year-old plans to go to a nightclub without informing his or her parents but is afraid of being caught. Which behavior does this indicate?

Invulnerability; an illusion that breeds excessive optimism and risk taking

Late adolescence

Late adolescence occurs between the ages of 18 and 20 years.

A nurse is conducting an assessment of a young infant who is dehydrated. Which clinical sign is the most important indication of an accurate degree of dehydration?

Loss of fluid as a result of dehydration is most objectively assessed by weighing the infants daily because total body water accounts for approximately 75% of an infant's body weight. One liter of fluid weighs approximately 2.2 lb (1 kg).

Middle adolescence

Middle adolescence occurs between the ages of 15 and 17 years.

What major cause of iron-deficiency anemia should the nurse include when planning a discussion with an infant's parents?

Milk is an inadequate source of iron. Milk ingested in large amounts to the exclusion of solid foods after 4 to 6 months of age results in iron-deficiency anemia.

A 3-year-old child is scheduled for cardiac catheterization. What is the priority nursing care after this procedure?

Monitoring the site for bleeding; hemorrhage is a major life-threatening complication because arterial blood is under pressure and a catheter has been inserted into an artery. The child is kept in bed for 6 to 8 hours after an arterial catheterization.

A nurse is caring for a 9-year-old child in the postanesthesia care unit after craniotomy for the removal of an astrocytoma. Suddenly the child's right pupil dilates. What is the priority nursing intervention?

Notify the healthcare provider; Sudden dilation of one pupil denotes an emergency situation; pressure is suddenly being exerted on the third cranial nerve on the affected side as a result of displacement of the tentorium or uncus. The healthcare provider should be notified immediately.

what child engages in ritualistic games?

Older children in the middle childhood years need conformity and rituals, whether they play games or amass collections. Rules to games are fixed, unvarying, and rigid. Knowing the rules means belonging.

During a parenting class a nurse is discussing infant/toddler nutrition and ways to reduce the risk of food allergies. What food item should the nurse recommend that the parents avoid until their children are 3 years old?

Peanut allergies tend to be very severe. To reduce the risk of peanut allergies, parents should delay their introduction into the diet until the gastrointestinal tract has matured.

Which event is considered as the hallmark of early puberty in young girls?

Physiologic leukorrhea (increased normal vaginal discharge) marks the uterine development early in puberty.

A 3-year-old boy in respiratory distress is treated in the emergency department. A diagnosis of acute spasmodic laryngitis (spasmodic croup) is made. At the time of discharge, the mother asks how to handle another attack at home. What should the nurse recommend?

Placing him near a cool-mist humidifier; during a spasmodic croup attack, cool humidified air to decrease inflammation is a fast home remedy.

Postpubescence

Postpubescence extends for 1 to 2 years after puberty.

Prepubescence

Prepubescence occurs 2 years before the onset of puberty.

Which age group would the nurse state engages in associative play?

Preschoolers play with one other child in a cooperative manner in which they make something or play designated roles

which age group display an eagerness for formal education?

Preschoolers refine the mastery of their bodies and eagerly await the beginning of formal education.

A nurse is planning to foster independence in a group of 4-year-old children. What self-care skill does the nurse expect 4-year-olds to be capable of performing?

Putting on a shirt and buttoning it; comb, but not part, their hair and can handle a fork and spoon, but cannot hold the meat with the fork while cutting it with the knife, can put on shoes, but are usually unable to tie them until age 5.

A nurse is assessing a school-aged child with cystic fibrosis. Which complication related to frequent stools and tenacious mucus should the nurse assess for?

Rectal prolapse, is a common gastrointestinal complication of cystic fibrosis, results from wasting of perirectal supporting tissues because of malnutrition.

A father asks the nurse about the immunization schedule for his 15-month-old toddler, who is being treated for acute lymphoid leukemia. What vaccine is contraindicated for a child undergoing chemotherapy?

The MMR vaccine contains attenuated live virus and should not be administered to a child undergoing chemotherapy because of the compromise of the child's immune system. The varicella vaccine is also a live virus. There are no contraindications to administering the Hib vaccine, Hep B vaccine, or DTaP vaccine to a child who is immunosuppressed.

Turner syndrome

The abnormality is due to a loss of all or part of one of the sex chromosome (X); affects women; chromosomal abnormality associated with webbed neck and low-set ears.

ataxic CP

The ataxic type of CP is characterized by rapid, repetitive movements.

athetoid CP

The athetoid type of CP consists of slow, wormlike, writhing movements.

The clinic nurse is teaching the parents of a 3½-year-old child who is up to date on all vaccinations when it will be necessary to return to the clinic for the next set of vaccinations?

The child who is up to date on vaccinations at 3½ years of age will need to return to the clinic for an annual influenza vaccination. In addition, between 4 and 6 years of age the child will need the diphtheria, tetanus, pertussis (DTaP); measles, mumps, rubella (MMR); inactivated polio (IPV); and varicella vaccination boosters.

A nurse in the pediatric clinic is evaluating a 6-year-old child with sickle cell anemia whose spleen autoinfarcted by age 4. What is the priority nursing care at this time?

The spleen plays a role in immunity. Initially the spleen enlarges and becomes congested with accumulated sickled red blood cells; in time, fibrous material replaces the tissue in the spleen, and by age 5 the spleen is obliterated. Without a spleen the child is prone to infection, which can precipitate a sickle cell crisis.

trust versus mistrust stage

The stage from birth to one year old when an infant develops trust towards his or her parents or caregivers is known as the trust versus mistrust stage.

Superego

The superego is often referred to as the conscience.

How many calories a day do preschoolers need?

They need around 1800 calories in a day (half of average adult portion sizes) Preschoolers are over-particular about their food at 4 years of age. At the age of 5 years, they typically become more interested in eating different foods.

How long should time out be limited?

Time-out should be limited to 1 minute per year of age, so a time-out for a 4-year-old should be limited to 4 minutes.

growth rate of toddlers

Toddlers develop physiologic anorexia because their appetite decreases along with their growth rate.

rooting reflex

a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple

Oedipus complex

according to Freud, a boy's sexual desires toward his mother and feelings of jealousy and hatred for the rival father

Yelling at the chair for causing a fall is an example of

animism- attributing lifelike qualities to inanimate objects

associative play

associative play children play together and are engaged in a similar or identical activity.

Not wanting to eat food due to the color is an example of

centration- focuses on one aspect rather than considering all possible alternatives

separation anxiety

emotional distress seen in many infants when they are separated from people with whom they have formed an attachment

Refusal to sleep in a bedroom because the bed has been moved to another location is an example of

global organization- changes in any one part of the whole changes the entire whole

what age should a nurse expect an infant to discover hands and feet?

he nurse would not anticipate hands and feet to be discovered until 1 to 4 months of age.

how to avoid plagiocephaly?

head is positioned on alternating sides to prevent positional plagiocephaly.

glossitis

inflammation of the tongue

what happens if a young adult is unable to establish companionship and intimacy?

isolation may result.

associative play

play in which two or more children actually interact with one another by sharing or borrowing toys or materials, although they do not do the same thing

rectal prolapse

rectal walls have prolapsed and can be seen outside of the body; part of the large intestine slips outside the anus.

stranger anxiety

the fear of strangers that infants commonly display, beginning by about 8 months of age

Electra complex

the unconscious desire of girls to replace their mother and win their father's romantic love

lavage

to wash out a cavity