NURS 232 Exam 1 - Growth and development,

According to Piaget, in this developmental stage children learn best through holding, seeing, and manipulating objects? a) sensorimotor b) pre-operational c) concrete operational d) formal operational

C) Concrete Operational

What specialists a part of the healthcare team provide children with opportunities in gaining a sense of mastery/self-control? They have an expertise in child growth and development and at least a bachelors

Child life practitioners

How long do you count for when assessing HR and RR? Where do you assess these?

Count for full minute! -RR younger children= abdomen, older=chest -HR younger children=apical, older=radial pulse

What is the most common screening tool used to assess developmental status by looking at personal social, gross motor, fine motor, language? What ages should it be performed?

Denver Decelopmental Test 11 (DDST-11) from birth to 6 yrs

According to the 3 psychologists, what are toddlers development stages?

Erickson= autonomy vs shame and doubt Freud= anal stage Piaget= sensori to preop

According to the 3 psychologists, what are school age development stages?

Erikson: industry vs inferiority Freud: latency Piaget: concrete operations

According to the 3 psychologists, what are preschoolers development stages?

Erikson: initiative vs guilt Freud: phallic Piaget: pre op

What do infants prefer to look at?

Faces and black and white designs

T or F: parents exaggerate or aggravate their child's pain

False

T or F: the anterior fontanelle closes 1st

False! It closes 12-18 mos whereas posterior closes 2-3 mos

T or F: single crease aka simian crease is not normal and indicates that the child has chromosomal abnormalities

False! It does sometimes indicates abnormalities, but can have no medical/chromosomal defect

T or F: breast development in boys is not normal and requires further evaluation

False! It's called temporary gynecomastia occurring in 1/3 boys **disappears within 2 yrs

T or F: Infants are incapable of expressing pain

False! Look at behavior

T or F: children will tell you if they are really in pain

False! Make sure to assess

T or F: The nurse should assess the child and match their facial expression to the face that best reflects their pain when using the FACES pain rating scale

False! The child must select face

T or F: children recover more quickly after painful procedures than adults

False! They heal quicker but same pain and tissue injury

T or F: dental hygiene isn't performed until primary teeth erupt around 6 mos

False! Wipe guns w/ washcloth

T or F: The nurse takes BP when the child is crying, then decides to take it again when child is calm. The nurse should record both BP to assess for trends

False! You should not record BP if child is not calm b/c not accurate

What is the term for a philosophy of care that integrates the family's values and potential contributions in the plan of care for a child? (Ex: respect, info sharing, participation, and collaboration)

Family-centered care

What is the term for creation of mind to help deal with unacceptable fear? Ex: hospitalized child who is weak pretends to be superman

Fantasy

How do you calculate the ideal fluid intake/ daily maintenance fluids for pts <70kg? **Per day!

First 10kg x 100ml Second 10kg x 50 ml Remaining x 20 ml Ex: 29 kg 10 x 100 10 x 50 9 x 20 = 1680 ml/day

What are 2 types of fall assessment tools that can be used? What do they generally look at?

"I'm safe fall risk tool" or "Humpty Dumpty fall risk tool" -age, gender, meds, sedation, impairments, environment, etc.

What are common stressors for toddlers? **Biggest risk for stress and anxiety

**separation anxiety -painful procedures -immobilization -loss of self-control -body injury or mutilation -fear of the dark

What are common stressors for an infant?

**separation anxiety -stranger anxiety -painful procedures -immobilization -sleep deprivation -sensory overload

What are some causes of dehydration?

*vomiting *diarhhea -NG suction -hemorrhage -Burns -type 1 DM -radiant warmers -excessive exercise

What are examples of 0RF?

- commercial 0RF like Pedialyte -breast milk

What pediatric difference increase risk of fluid and electrolyte imbalance for infants and young children ?

-% body weight of water highest at birth -little fluid volume reserve -more insensible loss through skin and respiratory track - higher metabolism -longer GI tract -kidneys immature

What is the 1st pubescent changes in boys? When does this occur? later changes?

-1st: testicular enlargement, thinning, reddening, and increased looseness of scrotum @ 9-10 yrs -Later: penile enlargement, pubic hair growth, voice changes, facial hair

According to the 3 psychologists, what are infants development stages?

-Erikson= trust -Freud= orally fixates -Piaget= sensorimotor, object permanence

What techniques are used for giving multiple injections to children?

-Give in one extremity -At least 1" apart -Rapid injection technique -More than one nurse giving at the same time

What is used to determine fluid requirements in children? What should the nurse consider before using?

-Holliday-segar method -used up to 70kg of weight -based on kg of weight so round to tenths -amount per day!

What interventions can be used for adolescents to decrease their stress?

-Include in plan of care -discuss fears and anxieties -explain all procedures -ask about desire for parental involvement -peer interaction

What are the different types of behavioral assessment tools that can be used to assess pain in infants and non-verbal children? When is it used?

-NIPS **0-6 weeks pre and full term infants -PIPP *premature infants -CRIES scale **newborn post op -FLACC **infants and young children

What are some considerations the nurse should make prior to giving sucrose solution to an infant?

-NOT used for irritability or other discomforts -reduce mild to moderate pain for procedures and immunizations -give 2 mins before procedure, then repeat q 3 mins prn -know how much giving, >=8/day too much and may cause necrotizing enterocolitis (NEC)

What is associated with early onset of menarche (menstruation) in girls? Does this also affect puberty for boys ?

-Obesity; 100 lb (17-22% body fat) is usually when girls start -obesity effects are less predictable in boys

What interventions can be used for preschoolers to decrease their stress?

-Parental presence -allow choices -explain all procedures -provide nightlight or flashlight -topical anesthetics or sedation

What interventions can be used for toddlers to decrease their stress?

-Parental presence -child sit on parents lap during exam and procedures -allow choices -explain procedures -provide night light -topical anesthetics or sedation

What are some interventions to decrease stress for an infant?

-Parents presence -family member active participation -consistent caregivers -oral stimulation -rocking -soft touch -minimize excessive noise/overstimulation -maintain normal routine -topical anesthetics or sedation -distraction

What are some examples of giving pt sense of control for effective coping?

-Provide information/knowledge -develop problem-solving skills -allow them to make appropriate choices -help them understand how to integrate health issues into life -provide appropriate resources/services

What are common stressors for preschool age pts?

-Separation anxiety -painful procedures -loss of self-control -bodily injury or mutilation **fears of dark, abandonment, being alone

What are common stressors for adolescent pts?

-Separation from peers -loss of control -loss of privacy -fear of altered body image, disfigurement, disability, and death -loss of identity

What are some examples of relaxation strategies for effective coping

-Slow breathing -distraction -progressive muscle relaxation -active imagination and guided imagery -positive self statements -Hipnosis -presence of supportive person -support group -laughter -familiar objects -keeping routines -personalizing environment

What types of play occur and when during preschool age?

-associative @ 3 yrs -interactive and somewhat share toys @ 4 yrs -play well in groups @ 5 yrs

What are the different methods of taking temperature? What age can we start taking oral temp?

-axillary used most often for infants -temporal -tympanic -rectal -oral at around 5 yrs

How should the nurse manage diarrhea without dehydration?

-dilute juice and formula 1:1 with water or ORF -regular diet -watch closely for dehydration

What are common stressors for the families of a hospitalized pt?

-disruption of usual routine -altered roles -sibling guilt or fears of own health -financial concerns

How do you assess the external auditory ear to know if normal or low set?

-draw line from inner to outer corners of eye and extend to ears **1/3 of external ear should be above line

Consent for treatment is not typically from the pt, however when would parent not make their own decisions for their child?

-emancipated minor -married -pregnant -incarcerated -military service -life sustaining treatment and parent not avail -abusive/neglectful parents

What interventions should be done for siblings of hospitalized pts?

-encourage to visit -prepare before visit -reassure -be truthful -encourage to express feelings and ask questions

What might be a siblings response to hospitalization?

-feel responsible -feel neglected -feel guilty -fear of becoming ill

Where can you assess pulse ox? What is the normal range?

-finger if big enough -wrap around finger or toe -foot for small infant **92-94% and up

What are the different assessments the nurse could note examining the fontanelles? What do they indicate?

-flat = normal -sunken = dehydration -bulging = increase ICP

Where should the lymph nodes be found? what's considered a normal finding? abnormal?

-found in cervical, axillary, and inguinal areas -should be small, firm, not hard, freely moveable -warm, swollen, tender, >1cm, hard, red, or fixed abnormal

What should be assessed when examining the mouth?

-gums, tongue, and structures - teeth -breath

BP is taken starting at 3 yrs w/ the exception of:

-hx prematurity, LBW, NICU -congenital heart, kidney, or GU conditions -family hx congenital kidney condition -evidence increased ICP -recurrent UTI, hematuria, or proteinuria -organ/stem cell transplant -malignancy -meds that increase BP -systemic illness that increase BP like neurofibromatosis and tuberous sclerosis

Why are cognitively impaired children at risk of under treatment of pain? What pain tool should be used?

-if non verbal, cannot self report -express feeling of pain in different ways *use Non-communicating Child's Pain Checklist-Postop Version (NCCPC-PV)

How might the body respond to anxiety, pain, or stress?

-increase HR, RR, CO, and BP -dialted pupils -increase BG -nausea/vomiting, loss of appetite -immunosuppression

What are examples of populations who are unable to self-report, requiring behavioral assessment tools to assess pain?

-infants -pre-verbal toddlers -critically ill pts -unconscious pts -intellectual disability -end of life

What are the 3 types of dehydration a.k.a. extracellular fluid volume deficit?

-isotonic or isonatremic (equal loss water and sodium) -hypotonic or hyponatremic (greater loss of sodium) -hypertonic or hypernatremic (greater loss of water)

All infants have hearing screening before discharge. What would indicate infant has hearing impairment?

-lack of startle/blink to loud sound -failure to be awakened by loud noises -failure to localize source of sound by 4 mos -absence of babble or voice by 6 mos -respond to loud noises instead voice -lack of response to spoken word

What should the nurse consider before giving opioid to pt?

-less opioid is required -right dosage (ex: usually requires titration by 25%) -know equianalgesic doses (ex: morphine 2mg IV =4 mg PO) -assess for respiratory depression and sedation -have rescue equipment near by -have narcan available -know peak times (ex: IV push morphine 15-30 mins; PO 60-90 mins) -may rouse, but if don't stay awake may be too much drug

To get the most accurate BP reading, what procedures should the nurse make sure w/ pt

-must be calm and quiet at least 3-5 minutes -sitting legs uncrossed -small children can lay down w/ arm elevated to RA -wait 1 full minute before re-inflating cuff

What teaching should be done when assessing the mouth?

-only water in bottle to bed -brush 2x a day (wipe baby teeth) -pea size amount fluoride toothpaste -rinse after snacks and meals -dentist by 1 yr -discontinue pacifier thumbsucking 2-4 yrs -floss by school age

What interventions can be used for school age pts to decrease their stress?

-parental participation -allow choices -explain all procedures -topical anesthetics or sedation -peer interaction

Why is it important to do more than just an assessment of pain, so interventions are imperative for infants and children?

-preterm infants have altered pain response -painful procedures reset basal arousal stress response -infants exposed to repeated pain results in more anxiety, altered pain sensitivity, stress disorders, and attention deficit disorders -children in ICU have more medical fears and PTSD symptoms up to 6 mos post discharge -high childhood pain and fear of medical procedure results in high adult fear, pain, and avoidance of HC

The kidneys are immature in children and may lead to fluid and electrolyte imbalances. Why does this occur and what ages does it mostly affect?

-pts <2 yrs can't conserve or excrete water and solutes effectively -pts <2 yrs difficulty regulating Na+ and Ca+ - Response to high solute is slower and less developed

What are common stressors for school age pts?

-separation from family and friends -painful procedures -loss of control -bodily injury -loss of privacy and control over bodily functions -fear of death

What are some examples of comfort positioning that should be taught to parents?

-swaddle/snuggle -bearhug -kangaroo hug -Comfort touch

What are some of the roles for child life practitioners?

-therapeutic play -education to prepare for procedures -work with parents to do comfort positioning -help pt and families cope with stress of being in the hospital -provide opportunities to play or do craft projects with other kids their age -emotional support -collaboration

What are the different sleep requirements for each age groups that the nurse should consider?

-toddler = 10-12 hrs -school age= 9.5 hrs **may resist going to bed 8-11 yrs -adolescent= 8 hrs

Where can you assess BP? What age do we start taking BP?

-upper arm (most reliable) -thigh (most uncomfortable) -forearm -calf/ankle *upper arm and thigh are same <1 yr; after, thigh is higher *starting at 3 yrs

What are some examples of comfort measures that the nurse can use during painful procedures?

-vapocoolant sprays -EMLA/LMX-4 cream (lidocaine cream) -Buzzy -LET (lidocain, epi, tetracaine) -comfort positioning

What should be taught to parents when assessing readiness for toilet training?

-voluntarily sphincter control -stay dry for 2 hrs -remove clothing -willingness to please parents -curiosity about toilet habits -impatient w/ wet or soiled diapers

What age range does child: -hold hand in fist -draw arms/legs to body when cry

0-1 mos

What age range does child: -startle and rooting reflex -May lift head -alert to high pitch noises

0-1 mos

What specific age range gains 5-7 oz/week?

0-6 months

What age range does child: -grow 0.5 inch/month -gain 5-7 oz/week -head circumference 0.5 inch/month

0-6 mos

When should the child start going to the dentist?

1 year

What are the normal heart rate ranges for: 1) newborns 2) infant to 2 yrs 3) 2-6 yrs 4) 6-10 yrs 5) 10-16 yrs

1) 100-170 2) 80-130 3) 70-120 4) 70-110 5) 60-100

What are the normal respiratory rate ranges for: 1) newborn 2) 1 yr 3) 3 yr 4) 6 yr 5) 10 yr 6) 17 yrs

1) 30-55 2) 25-40 3) 20-30 4) 16-22 5) 16-20 6) 12-20

What ages does child: 1) understand time 2) know difference between right and left 3) understands metaphors

1) 7 yrs 2) 7 yrs 3) 11 yrs

When does infant: 1) sit w/out support 2) roll from front to back 3) roll from back to abd

1) 8 mos 2) 4 mos 3) 6 mos

1) What assessment is done to see if pt uses both eyes together by holding a light >= 12-16 inches from face? 2)When do we start testing? 3)What might occur is cross eyed (strabismus) not corrected?

1) Binocularity 2) 3-4 mos 3) if not corrected by 4-6 yrs, CNS problems w/ vision (amblyopia ) may occur

1) What is the 1st verbal communication from an infant? 2) When does vocalization begin? 3) when do they laugh by? 4) when do they imitate sounds by? 5) when do they comprehend "no" and obey simple commands 6) when do they say 3-5 words with meaning?

1) Crying; 2) 5-6 weeks 3) 4 mos 4) 8 mos 5) 8-10 mos 6) 1 yr

Sara, 4 years old, is at the clinic to receive her immunizations before she starts school. She is current in immunizations. She has no health concerns; however she is very fearful of receiving "shots". According to the CDC immunization schedule... 1) Where is the appropriate site? 2) What size needle should be used? 3) What gauge should be used? 4) What can we do to help her cope with the stress of injections?

1) Deltoid is preferred but may use vastus lateralis 2) 5/8" to 1 1/4" needle; 3) 22 to 25 gauge 4) use distraction, buzzy bee, have her sit on parent's lap

What are the 3 types of self-reporting pain assessment tools? When are they used?

1) FACES pain rating scale **3 yrs and up 2) Oucher Scale ** 3-12 yrs 3) Numeric Pain Scale **5 yrs if can count to 10 and identify larger number OR by 7-8 yrs

What nursing interventions can be do to decrease pain?

1) Pharmcaological -acetaminophen -NSAID after 6 mos -opioids -adjunt therapy (ex: benadrul for itching from opioids) 2) non-pharmcologic -sucrose solution for infant -distraction -cutaneuos stimulation -hypnosis -parents -guided imagery, relaxation technique, breathing technique for school age and adolescent

Joey is at the clinic today for a well-child check. He is currently up to day on all of his immunizations and his parents are planning for him to receive his 6-month vaccines. According to the CDC immunization schedule... 1) Where is the appropriate site? 2) What size needle should be used? 3) What gauge should be used?

1) Vastus lateralis 2) 5/8" to 1" needle; 3) 25 gauge

1) What are the best places to assess pulses in infants? 2) What site do you use in arrest situations?

1) brachial and femoral pulse 2) brachial

What 3 things accomplish atraumatic care accomplished?

1) prevent/minimize pt separation from family 2) promote a sense of control by giving choices 3) prevent/minimize bodily injury and pain

What are the 3 stages of separation anxiety?

1) protest 2) despair 3) denial/detachment

What are the two ways of measuring height, and when should they be done?

1) recumbent length/horizontal height <2yrs 2) standing height/ vertical height >2 yrs

What are the four types of common defense mechanisms used by children?

1) regression 2) repression 3) rationalization 4) fantasy

When is a child able to: 1) comprehend much greater than number words said 2) 1 word sentences 3) multi word sentences 4) knows 300 words

1) toddler 2) 1 yrs 3) 2 yrs 4) 2 yrs

What specific age range can undress themselves?

1-2 years

What specific age range is able to climb up and down stairs?

1-2 years

What age range does child: -build 4 block tower -scribbles -throws ball -can undress self

1-2 yrs

What age range does child: -grow 3.5-5 inch/year -gain 8 oz/month

1-2 yrs

What age range does child: -run -walk w/ ease -walks up and down stairs -likes push pull toys

1-2 yrs

What specific age range has a significat increase in vocabulary?

1-3 years (toddlers)

A child's BSA is 1.25 m2. Calculate the daily fluid requirements for this child in liters (Round to nearest tenth)

1.9 L/day

What specific age range is the head circumference equal to the chest circumference?

10-12 months

What specific age range loves peek-a-boo and patty cake?

10-12 months

What age range does child: -may hold crayon and mark paper -place objects in container with holes

10-12 mos

What age range does child: -play peek a boo and patty cake

10-12 mos

What age range does child: -stands alone -walks holding furniture -sits down from standing

10-12 mos

What temp is considered a fever?

100.4 and higher

What specific age does the birth weight triple?

12 months

Calculate the minimum expected daily urine output for a child weighing 13 lbs

141.6 ml/day

When does child have voluntary control of elimination with sphincter control?

18-24 mos

Calculate the daily food requirements for a child weighing 38 kg. (Round to nearest whole number ml/24 hrs)

1860 ml/24 hrs

You are caring for a child who is receiving IV fluids of D5. 0.45 NS with 20 meq KCL/liter, which is running at 40 ml/hr. Calculate how much potassium the child will receive from the IV fluids in 24 hours (Round to nearest tenth)

19.2 meq/day

What opioid is recommended as a 1st line opioid analgesic for pain management? Which ones are not recommended?

1st) Morphine *NOT meperidine [Demerol] b/c CNS stimulant (ex: restlessness, irritability, twitching, tremors, seizures, jerking, and agitation) *NOT Codeine b/c increased risk respiratory depression

What specific age uses 2-3 word sentences?

2 years

What ages is there a complexity of language use and dramatic increase in vocabulary from 300 words to 2,100 words!

2 yrs to 5 yrs

What specific age range is able to draw a circle?

2-3 years

What specific age range is able to throw a ball overhand?

2-3 years

What age range does child: -draws circle -learns to pout -learns to dress self

2-3 yrs

What age range does child: -jump -kicks ball -throws ball overhand

2-3 yrs

What age range does child: -grow 2-2.5 inch/year -gain 3-5lb/year

2-3 yrs **same weight gain 3-5 lb/year 2-12 yrs but different height

What age range does child: -Moro reflex fade -turn from side to back -sits with head bobbin -holds head up and supports weight w/ arms

2-4 mos

What age range does child: -hold objects places in hand -looks and plays w/ own fingers -brings hands to midline

2-4 mos

When should pacifiers/thumbsucking be discontinued by?

2-4 yrs

Calculate the minimum daily potassium requirement for a child weighing 22 lbs (Round to nearest tenth)

20 meq/day

Calculate the minimum expected daily urine output for a child weighing 18 lb 8 oz

201.6 ml/day

When age can child: -ride a tricycle -balance on 1 foot -jump off bottom step -alternate feet going up stairs -copy a circle -build 9-10 block tower

3 yrs

What age range does child: -grow 1.5-2.5 inch/year -gain 3-5 lbs

3-12 yrs **same weight gain 3-5 lb/year 2-12 yrs but different height

What age can child: -hop and skip on 1 foot -walk forward heel to toe -catch ball both arms -alternate feet going down stairs -use scissors -draw 3 part stick figure -lace shoes -button simple buttons -copy square; trace cross or diamond -show hand preference

4 yrs

What are does asking questions peak?

4 yrs ("why, why, why")

What specific age range holds their head steady when sitting?

4-6 months

What age range does child: -grasp objects w/ whole hand (Palmer) -drop to pick up offered toy -mouths objects -holds feet and pulls to mouth -holds bottle -manipulate objects

4-6 mos

What age range does child: -hold head steady when sitting -turns front to back -turns back to front -supports most weight when held sitting

4-6 mos *front to back 4 mos *back to front 6 mos

You are caring for a child who weighs 10 lbs 8 oz. what would be the daily maintenance requirement for this child? (Round to nearest tenth)

480 ml/ day

What age can child: -skip on alternate foot -self dress -throw and catch ball -walk backward heel toe -hit a ball -begin tie shoelaces -copy square and triangle -draw 6 part person -uses pencil and scissors w/ skill

5 yrs

What specific age does the birth weight double? Triple?

6 months double; 1 yr triples

What specific age range can roll front to back and back to front? Which way does the infant roll first?

6 months; Front to Back at 4 months

When do teeth erupt by?

6 mos

What age range does child: -grow 3/8 inch/month -gain 3-5 oz/week

6-12 mos

What specific age range is able to transfer objects from one hand to another?

6-8 months

What specific age range recognize their own name?

6-8 months

What age range does child: -bang objects on hands -transfer objects from one hand to other -beginning pincer grasp

6-8 mos

What age range does child: -respond readily to sounds -recognize own name -enjoy small complex objects at play

6-8 mos

What age range does child: -most reflexes gone -sits alone w/out support -like to bounce on legs when standing

6-8 mos *sits alone no support 8 mos

A child weighs 22 kg. Calculate the hourly maintenance fluid needs (ml/hr) of this child. (Round to the nearest whole number)

64 ml/hr

Calculate the maximum potassium requirement for a child weighing 26.4 kg (Round to nearest tenth)

79.2 meq/day

What specific age can sit without support?

8 months

What age are children who are overweight more likely to be obese adults?

8 yrs

What specific age range understands "no"?

8-10 months

What specific age range uses pincer grasp?

8-10 months

What age range does child: -picks up small objects -uses pincer grasp well

8-10 mos

What age range does child: -understands "no" -May say 1 word plus "mama/dada"

8-10 mos

What age range does child: -crawls or pulls body by arms -pulls self to standing and sitting -revivers balance when sitting

8-10 mos *pulls self to standing and sitting 10 mos

When does separation anxiety begin?

8-12 mos

Where is the point of maximum impulse aka apical rate taken?

<7 yrs= 4 ICS left midclav >7 yrs= 5 ICS at midclav

How many stool would the nurse consider diarrhea?

>= 3 stools

What type of parenting style will express affection, smile frequently, limit criticism/punishment, express approval, warm, and nurturing? a) High level of warmth b) Low level of warmth c) High level of control d) Low level of control

A) High level of warmth

What is the growth of pubic hair on mons pubis for girls? When does is occur?

Adrenarche @ 2-6 mos after Thelarche (breast buds @ 8-10 yrs)

What measurements should we get every visit such as: -height/length/stature -weight -head circumference -chest circumference -BMI (>2) -growth chart

Anthropometric meauseremt

What is the term for assisting parents in being proactive in nurturing growth and development, not reactive?

Anticipatory guidance

What is the term for therapeutic care with the use of interventions that eliminate or minimize the psychological and physical distress for children and their families in the HC setting?

Atraumatic care

According to Piaget, the child meets this developmental stage giving inanimate objects life-like characteristics a) sensorimotor b) pre-operational c) concrete operational d) formal operational

B) Pre-operational

How do you calculate the ideal of fluid intake/maintenance fluids for pt >70 kg? **per day!

Body surface area (m2) x 1.5 l/m2/day Ex: BSA 1.3 1.3 x 1.5 = 1.95 L/day or 1950 ml/day

What age does the child recognize they are distinct from their parents?

By the end of the 1st yr

According to the 3 psychologists, what are adolescents development stages?

Freud: genital Erikson: identity vs role confusion Piaget: formal operational

What is the inflammation of the stomach and intestines that may be accompanied by vomiting and diarrhea affecting any part of the GI tract caused by bacterial, viral, or parasitic infection

Gastroenteritis

What is used to evaluate physical growth by assessing weight, height/length, head circumference, and BMI until the age of 20

Growth Charts

The pinna should be pulled back and up >3, and down <3 for ear irrigation and ear drops. How is this helpful?

It straightens the auditory canal to better instill medication

What med should be administered to manage gastroenteritis?

Lactobacillus -start ASAP -dose 1 billion CFU/day -duration 5-7 days

What is the most common cause of severe injury and death in school age children?

MVC

What is the initial appearance of menstruation? When does it occur?

Menarche @ 2 yrs after 1st pubescent changes (thelarche=breast buds @ 8-10 yrs) **average age 12 yrs, 9.5 months

What should be assessed before hanging the first IV solution containing potassium?

Must have voided at least once *if not hang fluid contents w/out k+ and contact dr

What is an appropriate pain scale tool for a child that is 6 yrs old that knows how to count and that 10 is larger than 3?

Numeric scale *as young as 5 yrs if can count and know larger number

What is it considered when a child understands that an object is still present if it is not visible?

Object permanence

What self reporting pain tool is appropriate for children 3-12 yrs and consists of pictures and numbers of different ethnicity so that the pt can choose pain intensity?

Oucher scale

What is 1-2 yrs after puberty where skeletal growth is complete and reproductive functions are well established

Post-pubescence

What is approximately 2 yrs before onset of puberty where preliminary physical changes occur (small changes)

Prepubescence

What is defined as: -2yrs before puberty -typically occurs in adolescence -varying ages from 9-12 ur -girls about 2 yrs before boys -breast buds 1st sign in girls -average age of puberty 12 in girls; 14 boys

Prepubescence

What age group is the child: -walking, running, climbing well established -drawing, artwork, skillful manipulation

Preschool

What age range does child: -throw ball overhand -climbs well -rides bike

Preschool 3-6 yrs

What age range does child: -use scissors -draws circle, square, cross -draws 6 part person -enjoys art projects -ties shoes -buttons clothes -brushes teeth -uses fork, spoon, knife -eats 3 meals w/ snacks

Preschool 3-6 yrs

What is the development of secondary characteristics? Give examples of these changes

Puberty ex: voice changes, hair growth, nreast enlargement, fat deposits **plays no direct role in reproduction

What is the term for attempt to make uncomfortable feelings acceptable? Ex: Child explain sitting another b/c "he took my toy"

Rationalization

What is the type of measuring height for children <2 yrs by measuring from head to heal with a length of board or measuring tape?

Recumbent length **0-35 mos

What is the term for a return to an earlier behavior? Ex: Child previously toilet trained becomes incontinent when it new infant born

Regression

When does a child need more fluid per day than just maintenance fluid? How do you calculate?

Replacement fluids and losses: Mild (5% weight loss) = 50 ml/kg 1st 4 hrs Moderate (6-9%) = 100 ml/kg 1st 4 hrs Severe (>=10%) by IV **if vomiting/diarrhea add losses 10ml/kg/stool

What is the term for involuntary forgetting of uncomfortable event? Ex: abused child can't recall abuse

Repression

What vaccine has decreased rates of severe dehydration caused by gastroenteritis?

Rotavirus

What age group: -grows 2.5"/yr -gains 7lb/yr -makes and females differ little in size -increase bladder capacity -immune system more effective -bones increase ossification

School age

What age range does child: -ride 2 wheeler -jump rope -roller skates or ice skates

School age

When should you teach the child to floss by?

School age

What is a guide used to estimate sexual maturity by stages of development of secondary sex characteristics and genital development?

Tanner stages

What is the appearance of breast buds in girls? When does it occur?

Thelarche @ 8-10 yrs

Facilitate normal development, learn about healthcare, express anxieties, work through feelings, and achieve sense of control are all benefits to what?

Therapeutic play

T or F: Infants and children feel pain with the same intensity

True

T or F: Starbismus is normal when focusing until 4 yrs old

True

T or F: periodic pauses in breathing is normal for infants if <=20 secs

True

T or F: the child should be started on regular diet instead of BRAT diet as soon as rehydrated

True

T or F: there are differences in general growth patterns between sexes as a result of hormonal effects at puberty

True

T or F: sinus arrhythmia are a normal variation in HR w/ respiration and are considered normal

True *Breathe in increase HR, breathe out decrease HR

What is the sensorimotor phase according to Piaget? When does it occur?

Use of senses to explore the world and learn @ 0-2 yrs

How do you calculate urine output? **per hour!

Weight x 1-2 ml/kg/hr Ex: 12.5kg Min 1 x 12.5 =12.5 ml/hr Max 2 x 12.5 = 25 ml/hr

How do you calculate potassium requirement? **per day!

Weight x 2-3 mEq/kg/day Ex: 9kg Min 9kg x 2 = 18 mEq/day Max 9kg x 3 = 27 mEq/day

You are caring for a child weighing 8.2 kg, Who is receiving the following IV fluids: D5 0.45NS w/ 20 meq of KCL/ liter at 40 ml/hr. Is this amount of KCL the child receives in 24 hrs safe for this pt?

Yes; 19.2 which is within range of 16.4-24.6

You have a 1 liter bag of NS. You are hanging a new bag and it is to infuse over 8 hours a)what volume do you program the pump to? b) what rate of infusion do you set? c) when do you anticipate the IV bag will be empty?

a) 1000 b) 125 c) 8 hrs

When should the posterior fontanelle close? a) 2-4 months b) 6-8 months c) 12-16 months d) 18-24 months

a) 2-3 months **anterior fontanelle closes by 18 months

What type of parenting style has high control, low warmth, issues commands, little communication, inflexible, permits little independence? a) Authoritarian b) Authoritative c) Permissive d) Indifferent

a) Authoritarian

What type of parenting style will result in a child becoming fearful, withdrawn, unassertive, rebellious, or aggressive a) Authoritarian b) Authoritative c) Permissive d) Indifferent

a) Authoritarian

The majority of 4-5 month olds are expected to do which of the following? a) Roll over from front to back b) get first tooth c) transfer an object from hand to hand d) say "dada"

a) Roll over from front to back by 4 mos ** able to roll from front to back AND back to front by 6 mos **teeth erupt by 6 mos ** transfer objects from hand to hand by 6-8 mos **say mama/dad by 8-10 mos

According to Piaget, the child meets this developmental stage by exploring their world a) sensorimotor b) pre-operational c) concrete operational d) formal operational

a) Sensorimotor

Which of the following findings would indicate a potential developmental delay in an 18 month old? a) The child can stand independently but does not walk yet b) The child can undress themself c) The child can say approximately 12 to 15 words d) The child sucks on their thumb

a) The child can stand independently but does not walk yet **should be able to run, walk w/ ease, walk up and down stairs, and undress themself **discontinue thumb sucking by 4 yrs

According to Erickson, the child achieve this developmental stage when a caregiver promptly responds to crying a) trust vs mistrust b) autonomy vs shame and doubt c) initiative vs guilt d) industry vs inferiority e) identity vs role confusion

a) Trust vs Mistrust

16 yr old pt weighs 50 kg. Ordered: Vanvomycin 1200 mg IV q 12 hrs Drug Reference Information: 2-4 g/day divided q 6-12 hrs Dilution: 10-40 mg/ml Rate of administration: Give over 2 hrs a)Is this an appropriate dose? b) pharmacy deliver drug as 1200 mg in 100 mL of D5W. Is this a safe diluton?

a) Yes, the pt will receive 2400 mg (2.4 g) per day. The safe dose 2000-4000 mg (2-4 g) per day b) Yes, the pt's dose came from pharmacy as 12 mg/ml (1200 mg/100ml) the safe dilution/concentration is 10-40 mg/ml.

6 yr old pt weighs 28 kg. Ordered: Clindamycin 245 mg IV q 6 hrs Drug Reference Information: Clindamycin 25-40 mg/kg/24 hrs divided q 6-8 hrs Dilution: 10 mg/ml Rate of administration: Give over 1 hr a)Is this an appropriate dose? b) what volume will the dose come from pharmacy?

a) Yes; range is 700-1120 mg/day or 175-280 mg/q6hr dose. The pt is getting 35 mg/kg/day b) 24.5 ml

Where is skin turgor best assessed on the pediatric pt? a) abdomen b) clavicle c) back of neck d) shin

a) abdomen

The nursing care plan for the hospitalized infant should always include which of the following? a) adherence to home routines as much as possible b) allow choices when possible c) explain all procedures to the client d) provide a night light

a) adherence to home routines as much as possible

A hospitalized five-year-old is experiencing a loss of control. The most appropriate nursing intervention in this situation would be: a) allow the child choices when possible b) encourage peer interaction c) provide a nightlight or flashlight d) use topical anesthetics as prescribed prior to a needle poke

a) allow the child choices when possible

To straighten the auditory canal of a child under 3 pull the pinna: a) down and back b) up and back c) down and forward d) up and forward

a) down and back **up and back is over 3!

What physical findings would promote the nurse to suspect that an infant may have a hearing deficit? (Select all that apply) a) no startle reaction to loud noises b) not yet speaking in sentences c) does not turn toward sounds by 4 months of age d) does not make eye contact with caregivers

a) no startle reaction to loud noises c) does not turn toward sounds by 4 months of age

Which of the following assessment findings is the most reliable to indicate adequate fluid volume replacement in a young child admitted for severe dehydration? a) urine output of 1-2 ml/kg/hr b) decreasing hematocrit values c) absence of thirst d) VS within normal limits for age

a) urine output of 1-2 ml/kg/hr **others are late signs or not the MOST reliable

You hang a 500 ml bag of D5 0.45% sodium chloride on your pts IV. It is to infuse at 45 ml/hr a)what volume do you program the pump to? b) what rate of infusion do you set? c) when do you anticipate the IV bag will be empty?

a)500 b)45 c)11 hrs

Metaphors can help school age children adjust to diagnostic tests. Which of the following is an example of an appropriate metaphor? a) " I need to put a little stick in your arm" b) " WBc's are bodyguards to protect your body from germs" c) " this needle will not hurt" d) " you are not wheelchair-bound. You are mobility challenged"

b) " WBC's are bodyguards to protect your body from germs"

What would be the most therapeutic response for the mother of a 2 month old who tells the nurse she does not want her infant to receive immunizations? a) "That's okay. It's your choice" b) " can we discuss your concerns about immunizations?" c) " you need to reconsider your decision" d) " do you want your child to become ill?"

b) " can we discuss your concerns about immunizations?"

The oucher pain assessment scale is appropriate for what ages? a) infants b) 3-12 years c) 2-13 years d)adolescences

b) 3-12 years

The BP cuff bladder should be what length of circumference? a) 100% b) 80% c) 75% d) 40%

b) 80% ** think 80/40 rule

A normal HR for an infant to a 2 year old is: a) 100-150 b) 80-130 c) 50-110 d)60-95

b) 80-130

What type of parenting style has moderately high control, high warmth, encourages growth, open communication, flexible rules a) Authoritarian b) Authoritative c) Permissive d) Indifferent

b) Authoritative

What type of parenting style will result in a child becoming best adjusted, self-reliant, self controlled, socially competent, higher self-esteem, better school performance. **This is the most effective style a) Authoritarian b) Authoritative c) Permissive d) Indifferent

b) Authoritative

According to Erickson, the child demonstrates this developmental stage by learning to control their bladder a) trust vs mistrust b) autonomy vs shame and doubt c) initiative vs guilt d) industry vs inferiority e) identity vs role confusion

b) Autonomy vs Shame and Doubt

Initial signs of pubertal development in boys are: a) Penis enlargement b) Enlargement of the testicles and thinning of the scrotum c) Pubic hair becomes dense and curly d) Voice deepens

b) Enlargement of the testicles and thinning of the scrotum

According to Piaget, the child meets this developmental stage by drawing conclusions from similar situations a) sensorimotor b) pre-operational c) concrete operational d) formal operational

b) Formal operations

What type of parenting style is cool, hostile, quick to criticize or punish, ignore children, rarely express affection or approval, rejection? a) High level of warmth b) Low level of warmth c) High level of control d) Low level of control

b) Low level of warmth

According to Erikson's theory of psychosocial development, which of the following nursing interventions would best meet the developmental need of an infant? (Select all that apply) a) allow self feeding opportunities b) Manage pain effectively c) Offer a pacifier d) Use crib mobiles

b) Manage pain effectively c) Offer a pacifier

Deviating from the normal adult head to toe sequence of physical examination is often necessary during a pediatric examination. Which system is often examined out of sequence? a) integumentary b) VS c) neurological d) musculoskeletal

b) VS *HR and RR should be taken when the pt is calm

Pt and family teaching is an important nursing role. The best way to evaluate if learning has occurred is which of the following seen in the learner? a) answering verbal questions correctly b) giving a return demonstration or teach back c) observing a smile and nodding "yes" when asked if they understand d) Reading a brochure written at the 9th grade reading level

b) giving a return demonstration or teach back

A child life specialist is: (select all that apply) a) A volunteer b) has at least a baccalaureate c) only works in a children's hospital d) part of the healthcare team

b) has at least a baccalaureate d) part of the healthcare team

Based on an adolescent developmental level, the nurse would expect what understanding of health and illness? a) developing a beginning understanding of germs and how they are spread b) perceive an illness in terms of its affect on body image c) unaware of a long term outcomes of illness d) view illness as a form of punishment

b) perceive an illness in terms of its affect on body image

How would you decrease stress for a preschool age child before they are hospitalized? a) avoid the issue b) provide a tour and have the child therapist review the procedure using props c) talk below the developmental level of the child d) have the parents explain what events will occur prior to the hospitalization

b) provide a tour and have the child therapist review the procedure using props

The parent of an 11 month old must leave the hospital in order to pick up siblings from school. As a parent is ready to leave, the child cries and clings to the parent. The nurse should make which of the following statements to the parent? a) " don't worry. The nurses can replace you whenever you are not here" b)" I can give your child and ordered sedative so that this crying will stop" c) " this is normal behavior and represents healthy parent infant attachment" d) "you should wait until tomorrow to return so that your child can adjust to the hospital setting"

c) "this is normal behavior and represents healthy parent infant attachment"

When is the earliest age the nurse would expect a child to use "mama" and "dada" with meaning? a) 4 months b) 6 months c) 10 months d) 14 months

c) 10 months **says one word plus "mama/dada" by 8-10 months **6-8 months is considered babbling

Infants should hold their head up and steady when sitting on their parents lap by what age? a) 1-2 months b) 2-4 months c) 4-6 months d) 6-8 months

c) 4-6 months **2-4 months they are not steady and will bob their head

What type of parenting style has restrictive control, enforce compliance, encourage fulfilling responsibilities, limit freedom a) High level of warmth b) Low level of warmth c) High level of control d) Low level of control

c) High level of control

According to Erickson, what developmental stage is a child in if they are playing house with another child? a) trust vs mistrust b) autonomy vs shame and doubt c) initiative vs guilt d) industry vs inferiority e) identity vs role confusion

c) Initiative vs guilt

What type of parenting style has low control, high warmth, few/no restraints, unconditional love, communication flows, much freedom, and little guidance a) Authoritarian b) Authoritative c) Permissive d) Indifferent

c) Permissive

What type of parenting style will result in a child becoming rebellious, aggressive, socially inept, self-indulgent, impulsive or maybe creative, active, and outgoing a) Authoritarian b) Authoritative c) Permissive d) Indifferent

c) Permissive

What age group can use scissors effectively? a) infant b) toddler c) preschool age d) school age e) adolescents

c) Preschool age *3-6 yrs

Which of the following statements helps explain the growth and development of children? a) at times of rapid growth, there is also acceleration of development b) development proceeds at a predictable rate c) The sequence of developmental milestones is predictable d) rates of development are consistent among children

c) The sequence of developmental milestones is predictable

What is most important when taking a BP on a pediatric pt? a) asking the caregiver to hold the child still b) double checking the BP reading after initial measurement c) choosing an appropriate sized cuff d) holding the extremity at the level of the heart

c) choosing an appropriate sized cuff

By preschool age, the child's body image has developed to include: a) anxiety and fear of separation b) A well defined body boundary c) fear of intrusive procedures d) knowledge about his or her internal anatomy

c) fear of intrusive procedures

Which of the following behaviors is most characteristic of the concrete operations stage of cognitive development (Piaget)? a) ability to think in abstract terms and draw logical conclusions b) inability to put oneself in another's place c) increasingly logical and has more accurate understanding of cause and effect d) progression from reflex activity to imitative behavior

c) increasingly logical and has more accurate understanding of cause and effect

Genitourinary procedures are PARTICULARLY stressful for which developmental age? a) infants b) toddler c) preschoolers d) adolescence

c) preschoolers **b/c many fears!!

A 7 month old Is admitted with severe dehydration. Which data suggests that fluid volume replacement is is less than adequate?a) decreasing hematocrit and increasing urine output b) falling a hematocrit and decreasing urine output c) rising hematocrit and decreasing urine output d) decreasing hematocrit and urine output of 1.4 ml/kg/hr

c) rising hematocrit and decreasing urine output

What age groups gain 3-5 pounds and grows 1.5- 2.5 inches per year? (Select all that apply) a) infant b) toddler c) preschool d) school age e) adolescents

c)Preschool d) school age *from 3-12 yrs

What assessment is done by shining a light into pts eyes to see where reflection is?

corneal light reflex

What type of parenting style has low control, low warmth, no limit setting, lacks affection, focused on own stress a) Authoritarian b) Authoritative c) Permissive d) Indifferent

d) Indifferent

What type of parenting style will result in a child exhibiting destructive impulses and delinquent behavior a) Authoritarian b) Authoritative c) Permissive d) Indifferent

d) Indifferent

According to Erickson, what developmental stage is a child in that is learning to play a sport? a) trust vs mistrust b) autonomy vs shame and doubt c) initiative vs guilt d) industry vs inferiority e) identity vs role confusion

d) Industry vs Inferiority

What type of parenting style is permissive, minimally controlling, fewer demands, fewer restrictions, permits freedom a) High level of warmth b) Low level of warmth c) High level of control d) Low level of control

d) Low level of control

A 16-year-old is having her annual physical exam. What approach should be used when examining the genitalia? a) assure privacy b) explain what will be done and why c) proceed matter-of-factly d) all of the above

d) all of the above

The nurse might use which of the following strategies to give the hospitalized teen a sense of control? a) encourage discussion of fear or questions b) explain all procedures c) include teen in plan of care d) all of the above

d) all of the above

The following is associated with chronic pain: a) increased BP b) increased pulse c) hypotension d) focus on other things

d) focus on other things

There are two growth charts available. One is for 0-36 months and one is for 2-20 years. When recording the length/height of a 32 month old which do you use? a) 0-36 month chart b) 2-20 year chart c) Either one d) it depends on which method of measurement you used — standing height or recumbent length

d) it depends on which method of measurement you used — standing height or recumbent length

The child may resist palpation of the abdomen because of being ticklish. What intervention by the nurse would help assist in examination if the child is ticklish? a) light palpation b) pretending to tickle the child during other parts of the physical exam c) explaining to the child that it is critical that they stay still during the exam d) place the child's hand on the abdomen and place your hand over the child's. slide your fingertips over the child's to touch the abdomen

d) place the child's hand on the abdomen and place your hand over the child's. slide your fingertips over the child's to touch the abdomen

A 15 month old should be able to do the following: a) jump in place b) kick a ball c) throw ball overhand d) walk alone well

d) walk alone well **runs, walk w/ ease, walk up and down stair by 1-2 yrs **jumps, kicks ball, throws ball overhand by 2-3 yrs

According to Erickson, the child demonstrates this developmental stage by questioning their parent's religious beliefs a) trust vs mistrust b) autonomy vs shame and doubt c) initiative vs guilt d) industry vs inferiority e) identity vs role confusion

e) Identity vs Role Confusion

What is the term for the external and internal organs necessary for reproduction ? ex: ovaries, vagina, penis, testes

primary sex characteristics

What age group knows literal meaning of words and begins to understand nonliteral

school age