Pediatrics Quiz 1
The child's mother asks about her son's dependence on large doses of pain medication and whether it will cause addiction later in life. What response by the nurse is most appropriate? "The risk for addiction is extremely low. The child would not want to take this medication if there was no pain." "As long as he uses the pain medication for less than 2 weeks, there shouldn't be any problem." "It will be easier for him to become dependent upon this medication if he needs it later in life." "This is something you really need to address with his surgeon because she ordered the pain medication dosage."
"The risk for addiction is extremely low. The child would not want to take this medication if there was no pain."
Major causes of death during childhood
1. Firearms and firearm related accidents (this was stated in lecture, it surpassed MVAs in 2019) 2. Motor vehicle accidents 3. Drug overdose/Poisoning (equal to 4) 4. Malignant neoplasm (equal to 3)
Separation anxiety in Infant/Toddler
1. Protest: they cry and scream and throw a temper tantrum 2. Despair: Withdrawn, sadness, despair 3. Detachment: Denial, "given up" that family will come back, don't act like they care when family visits
Major causes of illness during childhood
1. Respiratory infection 2. Other infections, parasitic infections 3. Injuries
At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning? 4 months 6 months 10 months 14 months
10 months
By what age should the nurse expect that an infant will be able to pull to a standing position? 6 months 8 months 11 to 12 months 14 to 15 months
11 to 12 months
At what age is it safe to give infants whole milk instead of commercial infant formula? 6 months 9 months 12 months 18 months
12 months
The nurse should expect the apical heart rate of a stabilized neonate to be in which of the following ranges? 60 to 80 beats/min 80 to 100 beats/min 120 to 140 beats/min 160 to 180 beats/min
120 to 140 beats/min
At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? 1 month 2 months 3 months 4 months
2 months
At about what age does an infant start to recognize familiar faces and objects, such as own hand? 1 month 2 months 3 months 4 months
3 months
3 years old
3-4-word sentences Can dress themselves Feed themselves Ride a tricycle
At what age do most infants begin to fear strangers?
6 months
Transition from liquids to solids
6 months of age, add one new food every 3 days which gives enough time for food allergies
At what age can most infants sit steadily unsupported? 4 months 6 months 8 months 12 months
8 months
The psychosocial developmental tasks of toddlerhood include which of the following? Development of a conscience Recognition of sex differences Ability to get along with age-mates Ability to delay gratification
Ability to delay gratification
Which of the following characteristics best describes the fine motor skills of an infant at age 5 months? Neat pincer grasp Strong grasp reflex Builds a tower of two cubes Able to grasp object voluntarily
Able to grasp object voluntarily
A toddler, age 16 months, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? Animism Ritualism Irreversibility Delayed cognitive development
Animism
Separation anxiety in school age
Anxiety from missing school, friends and family
Separation anxiety in Adolescent
Anxiety from missing their friends
Which of the following types of play is most typical of the preschool period? Team Parallel Solitary Associative
Associative
The developmental task with which the child of 15 to 30 months is likely to be struggling is a sense of what? Trust Initiative Intimacy Autonomy
Autonomy
The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries. The nurse's best response is which of the following? Allow him to cry for no longer than 15 minutes, then pick him up Babies need comforting and cuddling. Meeting these needs will not spoil him Babies this young cry when they are hungry. Try feeding him when he cries If he isn't soiled or wet, leave him and he'll cry himself to sleep
Babies need comforting and cuddling. Meeting these needs will not spoil him
Which of the following is most descriptive of the spiritual development of the older adolescent? Beliefs become more abstract Rituals and practices become increasingly important Strict observance of religious customs is common Emphasis is placed on external manifestations, such as whether a person goes to church
Beliefs become more abstract
A mother is upset because her newborn has erythema toxicum neonatorum. The nurse should reassure her that this is which of the following? Easily treated Benign and transient Usually not contagious Usually not disfiguring
Benign and transient
The newborn with severe jaundice is at risk for developing which of the following? Brain damage Bullous impetigo Respiratory distress Blood incompatibility
Brain damage
In girls the initial indication of puberty is which of the following? Menarche Growth spurt Breast development Growth of pubic hair
Breast development
The nurse is caring for a full-term infant who was born after an uneventful pregnancy and delivery. The infant's blood glucose level is 36 mg/dl. Which of the following interventions should the nurse take? Bring the infant to the mother and initiate breast-feeding. Place a nasogastric tube and administer 5% dextrose water. Start a peripheral intravenous line and administer 10% dextrose. Monitor the infant in the nursery and obtain a blood glucose level in 4 hours.
Bring the infant to the mother and initiate breast-feeding.
18 months
Can turn individual pages of a book Bladder & sphincter control Run clumsily Can turn a couple of pages of a book at a time Use a spoon Anterior (diamond) fontanelle closes at 18 months
12 months
Can turn multiple pages of a book Can drink cow's milk Make animal noises Walk holding 1 hand 2 block towers Understand 3-5 words Jabbering expressively Recognizes simple commands Talks to toys and people
What stages of life are more important in growth?
Certain stages are more important than others o Fetal development, we are exponentially growing during that period o Infancy we are exponentially growing o Adolescence we are exponentially growing
8 months
Child can sit independently Bladder and Bowel pattern begins Stranger danger begins Combines syllables like "dada"
3 months
Child can support their head Plays with their hands, hold objects with 2 hands
Which of the following is the most common form of child maltreatment? Sexual abuse Child neglect Physical abuse Emotional abuse
Child neglect
The child's pain management is of great concern to his mother. What information about this child should the nurse take into account when providing medication for pain? Children with autism do not perceive pain as do regular children. Children with neurologic disorders, such as autism, are at greater risk than other children for undertreatment of pain. EMLA cream would be contraindicated for use prior to restarting the child's intravenous line. Distraction and guided imagery can be used to help make this child comfortable.
Children with neurologic disorders, such as autism, are at greater risk than other children for undertreatment of pain.
1 month old
Closed hands and flexed position Head Lag Begin to self soothe through oral sensation
A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." Which of the following is the nurse's best interpretation of this comment? Sign of stress Common at this age Suggestive of maladaptation Suggestive of excessive discipline at home
Common at this age
Which of the following is true concerning the development of autonomy during adolescence? Development of autonomy typically involves rebellion Development of autonomy typically involves parent-child conflicts Parent and peer influences are opposing forces in the development of autonomy Conformity to both parents and peers gradually declines toward the end of adolescence
Conformity to both parents and peers gradually declines toward the end of adolescence
Which of the following is a central factor responsible for respiratory distress syndrome in the newborn? Absence of alveoli Immature bronchioles Overdeveloped alveoli Deficient surfactant production
Deficient surfactant production
An infant, age 6 months, has six teeth. The nurse should recognize that this is which of the following? Normal tooth eruption Delayed tooth eruption Unusual and dangerous Earlier than expected tooth eruption
Earlier than expected tooth eruption
According to Piaget, adolescents tend to be in which stage of cognitive development? Concrete operations Conventional thought Post-conventional thought Formal operational thought
Formal operational thought
Examples of atraumatic care
Fostering parent-child relationship Prepare child for unfamiliar treatment or procedures Controlling pain Allow child privacy Providing play activities for expression of fear and aggression Providing choices to children Respecting cultural differences
Social Stage Toddler
Freud's anal stage, mastering toilet training Control of body secretions Erikson: Autonomy vs Shame and Doubt Will say no Want to gain independence Have no moral development Take toys away or bite others Must be firm in letting them know what is the right thing to do and what is the wrong thing to do
Factors influencing Grown & Development
Genetics Temperament of the child Environmental exposure Family (where you fall in the birth order) Nutrition Health status (child with chronic illness will not develop as fast as a healthy child) Cultural expectations
Which of the following is the most appropriate recommendation for relief of teething pain? Rub gums with aspirin to relieve inflammation Apply hydrogen peroxide to gums to relieve irritation Give child a frozen teething ring to relieve inflammation Have child chew on a warm teething ring to encourage tooth eruption
Give child a frozen teething ring to relieve inflammation
What information should be given to the parents of a 12-month-old child regarding appropriate play activities for this age? Give large push-pull toys for kinetic stimulation Place cradle gym across crib to help develop fine motor skills Provide child with finger paints to enhance fine motor skills Provide stick horse to develop gross motor coordination
Give large push-pull toys for kinetic stimulation
Girls experience an increase in weight and fat deposition during puberty. Nursing considerations related to this include which of the following? Give reassurance that these changes are normal Suggest dietary measures to control weight gain Encourage low-fat diet to prevent fat deposition Recommend increased exercise to control weight gain
Give reassurance that these changes are normal
Gross and Fine Motor Skills of Toddler
Gross -Walks fast -Runs -Undress by themselves or with little help Fine Motor -Scribbles on everything -Drinks from cups -Uses spoons to eat
The child has patient-controlled analgesia (PCA) of morphine with an 8-minute lockout. Teaching by the nurse has been effective if what behavior is seen in this child? He pushes the button on the PCA whenever he wants. He waits 8 minutes until pushing the button again. The nurse pushes the PCA button whenever she is turning him. The mother pushes the PCA button whenever the child moans or makes a strange face.
He pushes the button on the PCA whenever he wants.
Proximodistal
Head and trunk is developing before the limbs are, that is why walking happens later in the first year of life.
Rh hemolytic disease is suspected in a mother's second baby, a son. Which of the following factors is important in understanding how this could develop? The first child was a girl. Her first child was Rh positive. Both parents have type O blood. She was not immunized against hemolysis.
Her first child was Rh positive.
Risk factors to childhood illnesses
Homelessness Poverty Low birth weight Chronic illness Foreign born Malnutrition
Biophysical Development
How our physical bodies grow and change
When discussing development and play activities with the parent of a 2-month-old boy. Which of the following statements by the parent would indicate a correct understanding of the teaching? I can give my baby a ball of yarn to pull apart or different textured fabrics to feel I can use a music box and soft mobiles as appropriate play activities for my baby I should introduce a cup and spoon or push-pull toys for my baby at this age I do not have to worry about appropriate play activities at this age
I can use a music box and soft mobiles as appropriate play activities for my baby
According to Erikson, the psychosocial task of adolescence is developing which of the following? Identity Intimacy Initiative Independence
Identity
Newborn Reflexes
Important for the reflexes to disappear at appropriate time, we adjust those date to accommodate immaturity If they are persistent, it could indicate cerebral palsy or other causes of development delay If we see a delay, the earlier we see a delay and get treatment for it, the better the outcomes are for the child.
Which of the following interventions may decrease the incidence of physiologic jaundice in a healthy full-term infant? Institute early and frequent feedings. Bathe infant when axillary temperature is 36.3° C (97.5° F). Place infant's crib near window for exposure to sunlight. Suggest that mother initiate breast-feeding when danger of jaundice is past.
Institute early and frequent feedings.
Toddler Stage
Is defined by the child walking Develop upright movement Progress to running Toilet training Speech improves Very curious, educate on safety for parent because of this curiosity
The parent of a 4-year-old boy tells the nurse that the child believes "monsters and bogeymen" are in his bedroom at night. The nurse's best suggestion for coping with this problem is which of the following? Let the child sleep with his parents Keep a night light on in the child's bedroom Help the child understand that these fears are illogical Tell the child that monsters and bogeymen do not exist Sleep terror Sleep apnea Seizure activity
Keep a night light on in the child's bedroom Sleep terror
Which of the following terms is used to describe the newborn's first stool? Milia Milk stool Meconium Transitional
Meconium
Parents tell the nurse they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which of the following is the most appropriate recommendation for the nurse to make? Punish children so this behavior stops Neither condone nor condemn the curiosity Get counseling for this unusual and dangerous behavior Allow children unrestricted permission to satisfy this curiosity
Neither condone nor condemn the curiosity
Stages of Childhood and Development
Neonate (first month of life) Infant (birth - 12/15 months) Toddler (12/15 months - 36 months) Pre-school (3 - 6-year-old) School age (6 - 12-year-old) Adolescent (Over 12)
The mother of a 6-month-old infant has returned to work and is expressing breast milk to be frozen. She asks for directions on how to safely thaw the breast milk in the microwave. The nurse should recommend which of the following? Heat only 10 oz or more Never thaw or heat breast milk in a microwave oven Always leave bottle top uncovered to allow heat to escape Shake bottle vigorously for at least 30 seconds after heating
Never thaw or heat breast milk in a microwave oven
2 months
Open hands, more relaxed limbs Social smile Pull at clothes/blanket Cooing Posterior fontanelle closes 8-12 weeks, triangle shape
During a well-child visit the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. The boy's birthday is close to the cut-off date, and he has not attended preschool. Which of the following is the nurse's best recommendation? Start kindergarten Observe a kindergarten class Perform developmental screening Postpone kindergarten and go to preschool
Perform developmental screening
Infant developmental milestones
Period of rapid growth, they double birth rate in the first 6 months Because of rapid growth they are examined every 2-3 months of age by providers Triple birth weight by first year of life Height increases by 1 inch every month for the first 6 months, and ½ inch each month for the last 6 months Brain is 25% adult weight at birth, increases to 60% by 1 year of age
Cognitive development in Toddlers
Piaget states they are in the Preoperational stage Child thinks by using symbols and words 15 months - place round objects in round hole 18 months - imitates sounds and movements 24 months names three body parts, colors Attention span is approximately 2 min at a time
Which of the following is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? Playing peek-a-boo Playing pat-a-cake Imitating animal sounds Showing how to clap hands
Playing peek-a-boo
7 months
Plays peek a boo Knows their own name
Physical characteristics of Toddler stage
Potbellied bodies Big heads, big bellies, stomach muscles are developing Slow weight gain Nutritional intake decreases
A 4-year-old child tells the nurse that she doesn't want another blood sample drawn because "I need all of my insides and I don't want anyone taking them out." Which of the following is the nurse's best interpretation of this? Child is being overly dramatic Child has a disturbed body image Preschoolers have poorly defined sense of skin properties Preschoolers normally have a good understanding of their bodies
Preschoolers have poorly defined sense of skin properties
Growth
Quantitative measurements
A boy age 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. Which of the following is the most appropriate intervention? Refer the child for a professional psychosocial assessment Explain that this is normal in preschoolers, especially boys Encourage the parent to try more consistent and firm discipline Talk to the preschool teacher to obtain validation for behavior parent reports
Refer the child for a professional psychosocial assessment
A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which of the following is the most appropriate recommendation? Punish the child Explain to child that this is wrong Leave the child alone until the tantrum is over Remain close by the child but without eye contact
Remain close by the child but without eye contact
9 months
Remember the 3 P's Pincer grasp Pleasing (understands "no") Pulls to standing
4 months
Roll back to side Bring things to mouth, 2 hands No head lag Laugh Can fall off changing table Able to lift head and chest when prone
5 months
Rolls front to back
A nursing approach to separation anxiety is
Rooming in, encourage parents to stay with the child Reassurance that they will go home Build trust with the patient Keep promises and don't trick or lie to get them to cooperate.
According to Piaget, the 6-month-old infant would be in what developmental stage? Use of reflexes Primary circular reactions Secondary circular reactions Coordination of secondary schemata
Secondary circular reactions
3 major categories of stress in pediatrics
Separation anxiety Fear of pain and injury Loss of control
6 months
Sit in high chair Roll back to front Can hold their own bottle Understands object permanence Babbling can sound like one-syllable sounds Transfer objects from one hand to another
Which one of the following dysfunctional speech patterns is a normal characteristic of the language development of a preschool child? Lisp Echolalia Stammering Repetition without meaning
Stammering
In about 1 week a stable preterm infant will be discharged. The nurse should place the infant in which of the following positions for sleep? Prone Supine Position of comfort Abdomen with head elevated
Supine
Which of the following characteristics best describes the language skills of a 3-year-old child? Asks meanings of words Follows directional commands Can describe an object according to its composition Talks incessantly regardless of whether anyone is listening
Talks incessantly regardless of whether anyone is listening
A 17-month-old child would be expected to be in what stage, according to Piaget? Preoperations Concrete operations Tertiary circular reaction Secondary circular reaction
Tertiary circular reaction
In boys the initial indication of puberty is which of the following? Voice changes Growth of pubic hair Testicular enlargement Increased size of penis
Testicular enlargement
The parents of a newborn say that their toddler "hates the baby. . . . He suggested that we put him in the trash can so the trash truck could take him away." The nurse's best reply is which of the following? Let's see if we can figure out why he hates the new baby. That's a strong statement to come from such a small boy. Let's refer him to counseling to work this hatred out. It's not a normal response. That is a normal response to the birth of a sibling. Let's look at ways to deal with this.
That is a normal response to the birth of a sibling. Let's look at ways to deal with this.
What pain scale would be most appropriate for the nurse to use for a four year old child? The FLACC Pain Assessment Tool The Comfort Scale The Wong-Baker FACES Pain Scale The Oucher Pain Scale
The FLACC Pain Assessment Tool
Development
The behavioral aspect of growth
Atraumatic Care
Therapeutic care that uses interventions that eliminate or minimize the psychological and physical distress experienced by children and their families in the health care system
A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is which of the following? This is normal behavior for his age This is unusual behavior for his age He is not effectively coping with stress He is showing he needs more attention
This is normal behavior for his age
Although a 14-month-old girl received a shock from an electrical outlet recently, her parent finds her about to place a paper clip in another outlet. Which of the following is the best interpretation of this behavior? Her cognitive development is delayed This is typical behavior because toddlers are not very developed This is typical behavior because of inability to transfer knowledge to new situations This is not typical behavior because toddlers should know better than to repeat an act that caused pain
This is typical behavior because of inability to transfer knowledge to new situations
Toys and Play in Infancy
Toys need to be appropriate for age and not too challenging Bright objects, different textures, sounds, musical toys and jack-n-box Peek-a-boo Pacifiers, mobiles, soft stuffed animals, mirrors, busy boxes, large picture books
In terms of gross motor development, what would the nurse expect an infant age 5 months to do? Sit erect without support Roll from back to abdomen Turn from abdomen to back Move from prone to sitting position
Turn from abdomen to back
24 months
Turn one page of a book at a time Can turn door knobs Unscrew lids Parallel play begins
During the 2-month well-child check-up the nurse expects the infant to respond to sound in the following manner: Responds to name Reacts to loud noise with Moro reflex Turns head to side when sound is at ear level Locates sound by turning head in a curving arc
Turns head to side when sound is at ear level
Separation anxiety in preschooler
Uncooperative
In terms of cognitive development, the 5-year-old child would be expected to do which of the following? Think abstractly Use magical thinking Understand conservation of matter Understand another person's perspective
Use magical thinking
4 years old
Use scissors Associative and Parallel play
The grayish white, cheeselike substance that covers the newborn's skin is: Milia Meconium Amniotic fluid Vernix caseosa
Vernix caseosa
15 months
Walking Uses word "no" Can use a cup and maybe a spoon
Which of the following characteristics best describes the gross motor skills of a 24-month-old child? Skips Broad jumps Rides tricycle Walks up and down stairs Binocularity may be established
Walks up and down stairs
Which of the following statements is correct about toilet training? Bladder training is usually accomplished before bowel training Wanting to please the parent helps motivate the child to use the toilet Watching older siblings use the toilet confuses the child Children must be forced to sit on the toilet when first learning
Wanting to please the parent helps motivate the child to use the toilet
How does the head grow in children?
We grow cephalocaudal. Our head grows first and the rest of our body will eventually catch up o Newborn, head is ¼ of the body o Toddler, head is 1/5 body o School age, head is 1/6 of the body o Teen, head is 1/7 of body o Adult, had is 1/8th of the body
The parents of a 7-year-old boy tell the nurse that lately he has been cruel to their family pets and actually caused physical harm. The nurse's recommendations should be based on knowledge that this is: expected behavior at this age. a warning sign of a serious problem. harmless venting of anger and frustration. common in children who are physically abused.
a warning sign of a serious problem.
Adolescents often do not use reasoned decision making when issues such as substance abuse and sexual behavior are involved. This is because they: tend to be immature do not need to use reasoned decision making lack cognitive skills to use reasoned decision making are dealing with issues that are stressful and emotionally laden
are dealing with issues that are stressful and emotionally laden
The mother of a 3-month-old breast-fed infant asks about giving her baby water because it is summer and very warm. The nurse should tell her that: fluids in addition to breast milk are not needed water should be given if infant seems to nurse longer than usual clear juices would be better than water to promote adequate fluid intake water once or twice a day will make up for losses resulting from environmental temperature
fluids in addition to breast milk are not needed
The nurse is interviewing the father of a 10-month-old. The child is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says "no" firmly and moves her away from the outlet. The nurse should use this opportunity to teach the father that the child: should be given a time-out is old enough to understand the word "no." will learn safety issues better if she is spanked should already know that electrical outlets are dangerous
is old enough to understand the word "no."
