PEDI

A 16-month-old child is attending a well-child visit at a pediatric clinic. Which assessment would indicate the biggest cause for concern? ✓A. Does not walk independently B. Prefers finger feeding C. Limited to single words D. Is unable to climb steps

Rationale: A child should be walking independently by 16 months old. It is normal for a child this age to prefer finger feeding and to be limited to single words. Many children do not climb steps until 24 months of age.

A 13-year-old boy states, "The girls in my class tower over me." What would be the nurse's most informative response? ✓A. "It may seem that way because girls have a growth spurt 2 years earlier than boys." B. "Perhaps your parents are not exceptionally tall." C. "Boys usually experience a growth spurt 1 year earlier than girls." D. "You may feel short, but you are actually average height for your age."

Rationale: Although the age for growth spurts during puberty varies, growth spurts occur 2 years earlier for girls than for boys.

An infant's birth weight is 7 pounds, 8 ounces. What can the nurse project the weight to be at 6 months? A. 12 pounds B. 15 pounds C. 18 pounds D. 22 pounds

Rationale: An infant usually doubles his or her birth weight by 5 to 6 months.

The nurse is planning to teach parents about prevention of Reye's syndrome. What information would the nurse include in this teaching? A. Use aspirin instead of acetaminophen for children with viral illness. B. Advise parents to have their children immunized against Reye's syndrome. ✓C. Avoid giving salicylate-containing medications to a child who has viral symptoms. D. Get the child tested for Reye's syndrome if the child exhibits fever, vomiting, and lethargy.

Rationale: Prevention of Reye's syndrome includes educating parents not to give aspirin-containing medication to children with viral symptoms.

What are the basic fears of a young child being hospitalized? (Select all that apply.) ✓A. Separation B. Permanent scarring ✓C. Pain D. Cost ✓E. Body intrusion

Rationale: Small children all share the same basic fears relative to hospitalization, which are separation from family, pain, and body intrusion or mutilation

What type of development is the nurse assessing when an infant can lift his or her head before he or she can sit? A. Specific to general B. Proximodistal C. Cephalocaudal D. General to specific

C Rationale: Cephalocaudal development proceeds from head to toe.

A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, the nurse's best action is to: ✓A. Prepare child for conscious sedation during the test. B. Set up a tray with equipment the same size as for adults. C. Reassure the parents that the test is simple, painless, and risk free. D. Apply EMLA to puncture site 15 minutes before procedure.

Rationale: Because of the urgency of the child's condition, conscious sedation should be used for the procedure. Pediatric spinal trays have smaller needles than do adult trays. Reassuring the parents that the test is simple, painless, and risk free is incorrect information. A spinal tap does have associated risks, and analgesia will be given for the pain. EMLA (a eutectic mixture of local anesthetics) should be applied approximately 60 minutes before the procedure.

A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. What will the nurse weighing the infant today would expect her weight to be? A. At least 12 pounds ✓B. At least 16 pounds C. At least 20 pounds D. At least 24 pounds

Rationale: Birth weight is usually doubled by 6 months of age.

What statement by an 11-year-old leads the nurse to determine he has moved from the mind set of egocentrism? A. "I am a member of the best Cub Scout group in the world." B. "I must do my homework before I can play." C. "My dad can do anything!" ✓D. "I'm sorry. I bet that hurt your feelings."

Rationale: The ability to see another's point of view indicates moving away from egocentrism into a more altruistic mind-set

A 9-year-old child is preparing for a lumbar puncture. What position will the nurse explain the child will assume for this procedure? A. "On your stomach with your head turned to the side." B. "On your side, keeping the legs bent and the head arched back." C. "On your back with your legs extended straight out." ✓D. "On your side with the knees bent and the head close to the knees."

Rationale: The child is positioned on his or her side with the knees flexed, and the head is brought down close to the flexed knees.

The nurse is advising parents of a 10-year-old boy about the most developmentally supportive experiences for their son. What is the best experience for this child according to Erikson's theory? A. Constant variety of activities ✓B. Successful performance in Little League C. Feeling healthy and strong D. Having a girlfriend

Rationale: The child who is successful in activities will feel positively about himself or herself.

When teaching a mother how to administer eyedrops, where should the nurse tell her to place them ✓A. In the conjunctival sac that is formed when the lower lid is pulled down B. Carefully under the upper eyelid while it is gently pulled upward C. On the sclera while the child looks to the side D. Anywhere as long as drops contact the eye's surface

Rationale: The lower lid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball.

How often should a child who has a continuous intravenous infusion should be assessed? ✓A. Hourly B. Every 2 hours C. Every 3 hours D. Every 4 hours

Rationale: The nurse must assess hourly an intravenous infusion for complications, such as inflammation and infiltration.

A child is admitted to the hospital because she had a seizure. Her parents report that for the past few weeks she has had headaches, with vomiting, that are worse in the morning. What does the nurse suspect? A. Meningitis B. Reye's syndrome ✓C. Brain tumor D. Encephalitis

Rationale: The signs and symptoms of a brain tumor are related to its size and location. Most tumors create increased intracranial pressure (ICP) with the hallmark symptoms of headache, vomiting, drowsiness, and seizures.

Where is the best site for giving an IM injection to a 15-month-old child? A. Ventrogluteal muscle B. Dorsogluteal muscle C. Deltoid muscle ✓D. Vastus lateralis muscle

Rationale: The vastus lateralis muscle is free of major blood vessels and nerves and can be used in children of any age.

Gentamicin ear drops are prescribed for a 4-year-old child. How would the nurse position the auricle when administering the ear drops? ✓A. Up and back B. Down and back C. Up and out D. Down and out

Rationale: For children 3 years of age and older, the auricle is gently pulled upward and backward to straighten the canal.

A school-age child becomes frustrated with a school assignment and says, "I can't do this!" What is the most developmentally supportive response from the parent? ✓A. Ask, "What is it that is so difficult?" B. Allow the child to quit the effort. C. Call in older siblings to help. D. Finish the project for them.

Rationale: Helping the child focus on the problem that is keeping him from mastery can limit frustration. Quitting or having someone else finish is detrimental to the development of industry.

Which behavior reported by a parent of an 18-month-old toddler would the nurse report to the pediatrician as a cause for concern? A. Has temper tantrums B. Feeds self sloppily ✓C. Walks by holding onto furniture D. Speaks in short sentences

Rationale: By 18 months, a toddler should have been walking alone for several months. The toddler who walks holding onto furniture should be evaluated by a developmental specialist.

What characteristics are typical in a child diagnosed with Down syndrome? (Select all that apply.) ✓A. Close-set eyes ✓B. Simian creases C. Wide-spaced front teeth ✓D. Protruding tongue ✓E. Curved, small fingers

Rationale: Children with Down syndrome have close-set upturned eyes, simian creases in palms of hands, protruding tongues, and curved, small fingers. They also have a wide space between their first and second toe and a high incidence of heart defects.

What would the nurse include when creating a teaching plan that includes the long-term administration of phenytoin (Dilantin)? A. The medication should be given on an empty stomach. B. Insomnia can be a significant side effect. ✓C. Gums should be massaged regularly to prevent hyperplasia. D. Blood pressure should be closely monitored.

Rationale: Dilantin can cause gum overgrowth, which can be minimized by regular massaging. Dilantin frequently causes drowsiness and should be given with meals at the same time each day.

What is an appropriate nursing action when a child is experiencing a generalized tonic-clonic seizure? A. Guide the child to the floor if the child is standing, and then go for help. ✓B. Move objects out of the child's immediate area. C. Stick a padded tongue blade between the child's teeth. D. Manually restrain the child.

Rationale: During a generalized tonic-clonic seizure, the immediate area is cleared to protect the child from injury

Gentamicin ear drops are prescribed for a 4-year-old child. How would the nurse position the auricle when administering the ear drops? ✓A. Up and back B. Down and back C. Up and out D. Down and ou

Rationale: For children 3 years of age and older, the auricle is gently pulled upward and backward to straighten the canal.

What is the nurse's best advice to a parent about a preschooler's "imaginary friend"? A. Having imaginary friends is a sign that the child has low self-esteem. ✓B. It is common for preschoolers to have imaginary friends. C. Preschoolers invent an imaginary friend when they feel overwhelmed. D. The best approach to dealing with an imaginary friend is to ignore them.

Rationale: Imaginary friends are common and normal during the preschool period and serve many purposes, such as relief from loneliness, mastery of fears, and acting as a scapegoat.

What manifestations of increasing ICP in the hydrocephalic child should the nurse be aware of? (Select all that apply.) ✓A. High-pitched cry ✓B. Inequality of pupils ✓C. Bulging fontanelles D. Diarrhea E. Hiccups

Rationale: Increased ICP is manifested by high-pitched cry, inequality of pupils, and bulging fontanelle

The nurse is caring for a 3-year-old with a head injury. Which assessment would lead the nurse to report the probability of increasing intracranial pressure (ICP)? A. Temperature increase from 37.2° C (99° F) to 37.7° C (100° F) ✓B. Increase in blood pressure with an attendant decrease in pulse C. Increase in respirations D. Equilateral pupils

Rationale: Increasing blood pressure, accompanied by decreasing pulse, and accompanied by unequal pupils are indicators of ICP.

What assessment made by the school nurse would lead to the suspicion of strabismus? A. Reddened sclera in one eye ✓B. Child covers one eye to read the chalkboard C. Child complains of a headache D. Copious tears while watching TV

Rationale: Indicators of strabismus include covering one eye to see, tilting the head to see, and missing objects in attempts to pick them up. Although headaches may be associated with amblyopia, this symptom is too vague to point suspicion to any disorder.

What will the nurse advise a parent to do when introducing solid foods? A. Begin with one tablespoon of food. B. Mix foods together. C. Eliminate a refused food from the diet. ✓D. Introduce each new food 4 to 7 days apart.

Rationale: Only one new food is offered in a 4- to 7-day period to determine tolerance.

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because: ✓A. Regression is seen during hospitalization. B. Developmental delays occur because of the hospitalization. C. The child is experiencing urinary urgency because of hospitalization. D. The child was too young to be "potty-trained."

Rationale: Regression is expected and normal for all age-groups when hospitalized. Nurses should assure the parents this is temporary and the child will return to the previously mastered developmental milestone when back home. This does not indicate a developmental delay. The child should not be experiencing urinary urgency because of hospitalization and this would not be normal. Successful "potty-training" can be started at 2 years of age if the child is ready.

The nurse is assessing a 1-year-old infant in the pediatric office. What finding should the nurse report to the physician immediately? ✓A. Respiratory rate of 60 breaths per minute B. Pulse rate of 100 beats per minute C. Minimal verbalization D. Fussy behavior

Rationale: Respirations of a 1-year-old should be 20 to 40 breaths per minute. Increased respiratory rate can lead to distress and should be reported immediately. Pulse rate of 100 to 140 beats/minute is normal. Minimal verbalization and fussy behavior are not emergency situations or abnormal for this age.

A 4-year-old asks tearfully if the IM injection will hurt. What is the nurse's most effective response? A. "No. It is over before you know it." ✓B. "Yes. It will sting a little." C. "No. Would you like to see the syringe?" D. "Yes. Your mom and I are going to hold you to help you be still."

Rationale: Truthful answers will give a child a realistic expectation and help establish trust in the nurse.

An infant's dry diaper weighs 2.5 grams. The wet diaper weighs 47 grams. How would the nurse record the infant's urine output? A. 47 mL ✓B. 44.5 mL C. 43.5 mL D. 40.5 mL

Rationale: Urine output is determined by calculating the difference in weight between the wet diaper and a dry diaper. One gram is equivalent to one milliliter of output. 47 - 2.5 = 44.5 grams = 44.5 mL of urine.