Pediatrics Exam 1.

Stage Scale of Puberty Development for Males and Females

TANNER STAGES

Which approach should the nurse use to gather information from a child brought to the ED for suspected abuse?

Tell the child that the abuse is not her fault and she is a good person

Which statement would indicate to the nurse that a school-age child is not developmentally on track?

The child has an imaginary friend. **this is for 3/4 year olds not school aged!!

Denver Developmental Screening Test

The most widely used developmental screening test that can detect subtle developmental problems

Which statement accurately describes the best method for assessing a 12- month year old?

The nurse should assess the child while she is in her mother's lap. This is because infants are most secure when in proximity to the parent. Paren't lap is excellent place

A 4 yr. old is hospitalized with FTT has orders for daily weights, strict intake, and output, and calorie counts. Which action is of concern to the nurse?

The nurse weighs the child every morning after breakfast. **not accurate if ate before weighed, should be weighed every morning before eats**

treatment of cradle cap

wash hair every other day w/shampoo, soft toothbrush and petroleum jelly to brush away crusts, no baby powder can cause aspiration pneumonia

The number of lbs. an infant gains their first 5 months

1.5 pounds per month

Shakes head for no at this age

11 months

Can say 3-5 words at this age

12 months/1 year

anterior fontanel closes at this age

12-18 months

Treatment for pinworms

Albenza

Colic

Crying greater than 3 hours per day and more than 3 days per week, fussiness and drawing legs up, more common in kids less than 3 mo.

Treatment of Lyme Disease

DOXYCYCLINE

The best method to explain a procedure to a hospitalized pre-school age child is to

Demonstrate the procedure on a doll

A 9 year old builds a clubhouse and puts a sign on it saying "no boys allowed". The child's parents are concerned because she is excluding the neighbor's son. What should the nurse tell parents?

"This is normal behavior among school-aged children"

A 3 year old is admitted to hospital with croup and has the following vital signs , HR 90 , RR 44, BP 100/52, and temp of 37.1 C (98.8 F). The parents ask if the child's vitals are normal. The best response from nurse is

"You son's RR is elevated (should be between 20-30 breaths/min), but others are within normal ranges

A 3 year old has been hospitalized because he fell down the stairs. His mother is crying and states "this is all my fault." which is the nurse's best response?

"falls are one of the most common injuries in this age group"

A 5 year old boy has always been the shortest of children in class. His mother tells the nurse she is 5'7" and her husband is 6'. What should the nurse tell the mother? (think patterns of growth)

"he is expected to grow about 2 inches every year from 6-9 years "

A 3 year old is attending a funeral. Her parents tell her that her grandfather is in heaven with God. Which statement describes a 3 year old understanding spirituality?

"he is in heaven? is this heaven?"

The nurse realizes that a 5 year old's mother needs further education about the Denver Developmental Screening Test when she states:

"it screens for intelligence level" ***Assesses fine motor skills, lang. development, personal social development***8

Which statement by the mother of an 18 mo. lead the nurse to believe the child should be referred for further evaluation of developmental delay?

"my child is able to stand but not walk independently". This is worrisome because 15 mo is when children should be able to walk independently

Fifth's Disease (Erythema Infectiousm)

"slapped cheek" infant-adolescent. Caused by human parovirus, transmitted by respiratory secretions, lasts 1-4 days, super contagious when rash first appears

The nurse is going to give a 6-month old a dose of Rocephin IM. What must the nurse do when the 1.5 mL dose arrives from the pharmacy?

Divide the dose into two because can not inject more than 1 mL

What types of foods would you recommend to a mother of a 2 year old with anemia?

Meats, eggs, and green veggies. Foods high in ron

According to developmental theories, which important event is essential to the development of the toddler?

The child participates in being potty-trained.

An 8 day old was admitted to the hospital w/ vomiting and dehydration. The newborn's heart rate is 170, RR is 44, BP is 85/52, and temp. is 99/37.2 C. What is the nurses best response to the parent who asks if these vitals are normal?

"the HR is elevated (normally bw 90-160 BPM) , but the other vital signs are within normal limits"

A 3 year old is hospitalized for an ASD repair. The parents have decided to go home for a few hours. The child asks when her mommy and daddy will be back. The best response of the nurse is:

"your mommy and daddy will be back after your nap" Remember teacher talking about how preschoolers know time in accordance to events

The mother of 11 year old fraternal twins tells the nurse at their well check up that she is concerned because her daughter gained more weight and height than her twin brother. The mother is concerned that there is something wrong with her son. The nurse's best response is...

"it is normal for girls to grow a little taller and gain more weight than boys at this age"

A first time mother brings in her 5 day old baby for a check up. The nurse weighs the infant and reports a weight of 7 lb. 5 oz. to the mother. The mother looks concerned and tells the nurse that the baby weighed 7 lb. 10 oz when she was discharged 4 days ago. The best response from nurse is

"Al weigh loss of a few ounces is common among newborns, especially for breast-feeding mothers "

The mother of an 11 month with iron deficiency anemia tells the nurse that her infant is currently taking iron and a multivitamin. Which statement made by the mother should be of concern to the nurse?

"I give the iron and multivitamin in the morning 6oz bottle." This is concerning because you cannot be sure that the child will take the entire feeding and the formula decreases the absorption of iron

Which statement by an infant's mother leads the nurse to believe she needs further education about the nutritional needs of a 6 mo. old?

"I will start my son on fruits and gradually introduce veggies" ...This is because the sweetness of fruit may inhibit the infant from taking vegetables

Which comment should the parent of the 2-year old expect from the toddler about a new baby sibling?

"It is time to put him away so we can play" Toddlers are very egocentric and doesn't think of needs of other child.

Infectious Mononucleosis

"Kissing Disease" spread through oral secretions, lasts 1-4 months, s/s: fever, fatigue, swollen glands, tonsillitis, enlarge spleen, liver involvement

What immunizations are administered at two months?

-Rotavirus (RV) -Dtap (tetanus) -Pneumococcal (PCV) -Polio (IPV)

Interventions for Colic

-investigate allergies -anti-gas medications -keep upright after feeds -change position freq. -take on car ride

When can a parent expect Measles, Mumps, Rubella, and Varicella to be administered?

1 year

What age is Hep A immunization given

1 year now

Age adult thinking begins

15 Years

At this stage the infant can walk without help

15 months

Age anterior fontanel fully closed

18 months

Height school age child grows per year

2 inches

Posterior fontanel closes at this age

2 months of age

Adult height is about 2x the height of this age

2 years or 18 months

Weight gain per year for preschooler

2-4 pounds

Preschooler's Visual Acuity

20/20

Visual acuity of a toddler

20/40

A 12 mo. old boy weighed 8 lb 2 oz at birth. Understanding development milestones, what should the nurse caring for the child expect the weight to be?

24 lb 6 oz. At 12 months child should be triple their birth weight.

Age child uses "I, me, You"

24 months or 2 years

Height gain for toddlers per year

3 inches

Inches per year in height of preschooler

3 inches

Age can ride tricycle

3 years

By this age the cranium is about 80-90% adult size

3 years

Deciduous teeth erupt by this age

30 months

Can state first and last name at this age

30 months or 2. 5 years

Birth weight quadruples at this age

30 months or 2.5 years

At this age baby can hold head upright

4 months

Age skips and hops on 1 foot

4 years old

The age (roughly) to begin to introduce solid food

4-6 months

Weight gain for Toddlers per year

5 pounds.

Age can throw and catch ball well

5 years old

Weight school ager gains per year

5-6 pounds

Teeth begin to erupt initially at this time

5/6 months

Can hold bottle at this age

6 months

Can recognize parents at this age

6 months

When can influenza immunization begin?

6 months

Number of teeth child has within 1 year of life

6-8 teeth

Responds to name at this age

7 months

Age baby begins to crawl

8-10 months

Age of puberty for females

8-14 years old, lasts about 3 years

Age of puberty for males

9-16 years and ends by age 19

What information should a school nurse include in a discussion on nutrition with a fourth grade class?

A list of nutritious foods with basic scientific information about how they affect organs of body

Which toy is best for a 12 month year old?

A musical Rattle. This is the perfect toy for this child. Infants have a short attention span and enjoy auditory and visual stimulation

Treatment of acne that is teratogenic or harmful to fetus

ACUTANE

Which nursing action would help foster a hospitalized 2 year old's sense of autonomy?

Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe

What can a nurse do to reinforce a 5 year olds intellectual initiative when he asks about his upcoming surgery?

Answer the child's questions in simple terms.

Which action is developmentally appropriate method for eliciting a 4 yr. old's cooperation in obtaining blood pressure?

Ask the child if it squeezes his arm. This engages him in the care and asks for participation

What should parents understand is one of the most common causes of injury and death for a 7 month old infant?

Aspiration.

Erikson's Task for Toddler's

Autonomy versus shame, doubt. Need to promote autonomy, simple brief explanations before procedures, enforced sep. from parents threatening, respect routine, concern for bodies, provide guided choices

TREATMENT OF IMPETIGO

Bactroban, neosporin, Keflex, topical antibiotics

Treatment of Acne

Begin with Benzyol-Peroxide, Retin-A, oral agent (accutane)

Hand, Foot, and Mouth Disease

Caused by coxsackie virus that causes blisters on mouth, hands and feet, may have a fever, little appetite or thirst

SCABIES

Caused by scabies mite commonly seen in schoolaged, burrows in epidermis, located bw digits, underarms, inguinal region, causes itching

Piaget's theory 7-10 years old age

Concrete Operations- conscience develops, thinking differs from egocentrism, problem solving

The parents of a newborn are asking the nurse how to use the infant car seat and where it should be placed in their vehicle. Which is most appropriate action by nurse?

Contact the hospital's car-seat safety officer, and ask the officer to accompany the parents to the car for car seat installation

Stabismus

Cross Eye. Condition where the visual lines of each eye do not simultaneously focus on the same object in space because of lack of muscle coordination, screen 2-3 months

In 5/6 months, the birth weight of an infant...

Doubles

How can the nurse best facilitate the trust relationship between infant and parents while the infant is hospitalized? the nurse should...

Encourage the parents to hold their child as much as possible

Which should the nurse do to prevent separation anxiety in a hospitalized toddler?

Establish a routine similar to that of child's home.

Protest

First stage of separation anxiety seen when the child cries loudly, screams for parent, refuses to pay attention to anyone else, may protest until exhaustion, avoids contact with strangers, may bite, kick, inconsolable*

Piaget's Theory 11-20 years

Formal Operations. Can see logical relationships, can think abstractly, concern for moral and social issues, idealism, think more like adults

Pediculosis Capitis

Head Lice. Infestation of scalp with parasite, itching is the only symptom.

Pinworms

Health problem of toddler that causes per-anal itching that can migrate to vagina. Perform a tape test at night/early morning to check.

Which immunization is given at birth?

Hep B

Roseola

Human herpes virus type 6 occuring 6 months- 3 years. Persistent high fever (102) for several days, rash on abdomen usually lasts 1-2 days

The nurse is instructing a new breastfeeding mother in the need to provide her premature infant with adequate source of iron in her diet. Which statement reflects a need for further education of the new mother?

I will need to add iron supplements to my baby's diet when she is 2 months old. This is because premature infants can store from the mother iron for 2 months.

IMPETIGO

IMPETIGO CONTAGIOSA , bacterial infection caused by step producing large, fragile blisters and is caused mostly by staph germs

Erikson's Task for 13-20 Yr. Olds

Identity vs. Role Confusion. task is to achieve who the stable sense of self really is. Must develop an identity separate from family. Concerned with how they appear in others eyes vs. how they feel they are to others

Erikson's Task 6-12 years old

Industry vs. Inferiority. ready to be a worker and producer, want to engage in tasks that carry out completion

Erikson's Task for Preschooler

Initiative vs. Guilt. Investigating activity rather than responding or imitating others . inner voice/conscience

Which stressor is common in hospitalized toddlers?

Interrupted routine, sleep disturbances, fear of being hurt

3 Dietary deficiencies of adolescents

Iron, Zinc, and Folate

Treatment of Pediculosis Capitis

Nix and Rid Shampoo.

What type of interaction might mothers of two 2-year olds expect to see when their children are playing?

Parallel Play! playing along side one another but not actively with one another.

This food is restricted for the first 3 years of life

Peanuts/peanut-products

Which is the best method of distraction for an 8 year old who is having surgery later today and NPO?

Play a board game. *Optimal choice because school-age children enjoy being engaged in an activity with others that require skill and challenge

Which assessment finding would the nurse consider abnormal when performing a physical assessment on a 6 month year old?

Posterior fontanel is open. Rationale: this is because the posterior fontanel closes by 2 months, now the anterior fontanel doesn't close until 12-18 mo.

Piaget's framework theory for toddlers

Pre-operational (2-6 years) non-logical, egocentric, increased magical thinking

A two year old is admitted to the hospital 2 days ago crying inconsolably much of the time. The nurse's best response to the child's parents who are concerned about this behavior is that the child is in...

Protest stage. Stage one of separation anxiety which is normal for children during hospitalization

Which nursing action is most important to gain information in how a school age child is feeling?

Provide the child with some paper to draw a picture of how they feel

Which activity can the nurse provide for a 9 year old to encourage a sense of industry?

Provide the child with the homework his teacher sent. *Industry vs. inferiority 6-12

The mother of a newborn asks the nurse when the infant will receive the first hep B immunization. What is the nurse's best reply?

The first does of hep B vaccine will be given before discharge today. Hep B vaccine is recommended from birth until 2 months and usually given in hospital prior to discharge

Management of Mononucleosis

Rest, OTC Meds, plenty of fluids, alter physical activities, corticosteroids

Which technique should the nurse suggest of a mother of an 8 year old who won't complete chores?

Reward system

Growth in height during the first year of life

Roughly 1 foot

Treatment of Scabies

Scabicide (Elimite)

Despair

Second stage of sep. anxiety when crying stops and child is less active or lies quietly. Disinterested in food/play, may withdraw from others, child looks lonely, sad, isolated and apathetic , may regress to earlier behavior thumb-sucking, may not make eye contact when parent returns

Detachment

Third and most serious stage of separation anxiety. Sometimes called denial, is uncommon. Occurs after length separation from parent/caregiver. Child becomes more interested in new friendships, surroundings, child detaches from parent

Erikson's Task that applies from 1-12 months (infant)

Trust vs. Mistrust

Treatment of MRSA

Vancomycin

A nurse should not expect what vaccine to be administered prior to the age of one?

Varicella (chicken pox)

Eczema (atopic dermatitis)

causes itchiness of the skin, can come on as a result of family allergy history, may relate to history of mother rubbing face on sheets

Nose Bleeds

common in preschoolers for trauma to nose: nose picking, irritation from cold, elevated bp. Most common (90%) anteriorly. Pinch nose and lean forward, after ten mins ER

Sudden Infant Death Syndrome (SIDS)

death of an infant spontaneously due to cessation of breathing, 3rd leading cause of death 1 mo.-1 year , "back to sleep"

Cradle Cap

dry scaly condition of the scalp

When 20 deciduous teeth are replaced by 28/32 permanent teeth

end of schoolage years

Which statement accurately describes how the nurse should approach an 11 year old to do a physical assessment?

explain what the nurse will be doing in basic understandable terms

This food is restricted from the infant in 1st year of life

honey

Failure to thrive

inadequate growth below the 5th percentile on growth chart

Factor that determines when toddler can potty train

myelination of spinal cord

Toddlers are known to engage in this type of play

parallel

MRSA- Methicillin Resistant Staph Aureus

staph infection most freq. occurs in hospitals and health care facilities w/those w weakened immune systems

Which reaction would a nurse expect when giving a preschool immunizations?

the child cries and tells the nurse that it hurts