PEDS EXAM 1

Which of the following responses is appropriate to address to the mother's concern that the infant "gets so red when he cries'?

"A deeper pink to reddish color is not uncommon in a newborn who is crying."

Which of the following responses is appropriate when discussing the client's previous HbA1c of 10%?

"A good HbA1c is less than 8%. Let's discuss possible problems with the treatment plan."

Which instruction does the nurse repeat to the parents of an infant to prevent problems related to the oral cavity?

"Avoid feeding the infant milk immediately before putting the infant to bed." TR: Milk should not be fed to the infant before putting him to bed because of the increased risk of cavities. Its necessary to clean an infants teeth and gums by using a damp washcloth.

Which statement by the new pediatric nurse indicates an understanding of medication administration to children? (Select all that apply.)

"BSA is a reliable method of calculating children's medication dosage." The six rights of medication must be followed when administering medication.

When counseling the parents of a 6-month-old about dental health, the nurse includes which statement?

"Begin cleansing the oral cavity by wiping teeth and gums with a damp washcloth." "Avoid toothpaste at this age, especially if it is fluoridated." "Initiate fluoride supplementation at 6 months of age if infant's home water supply is not fluoridated."

A nurse is performing a screening for scoliosis on a school-age child. Which of the following instructions should the nurse provide?

"Bend forward with your knees straight and your arms dangling." RT:This position allows for adequate visualization to detect any asymmetry of the spine or rib cage. The nurse should observe the child from behind to note any asymmetry of the hips or shoulders.

Which of the following statements is a correct response to the parent's concern that their child is "such a fussy eater"?

"Children this age typically have a decrease in appetite and can be ritualistic about eating the same foods. Continue to offer a well-balanced diet including their favorite foods."

Which of the following responses to the parent reflects the best understanding of this client's nutritional needs?

"Children who have diabetes will need adequate amounts of complex carbohydrates. It is acceptable to have a slice of pizza, as long as the carbohydrates are counted as part of the daily intake."

Which instruction will the nurse give to the parents of an uncircumcised infant at the time of discharge?

"Do not attempt to retract the foreskin of the penis." RT: Parents should be advised not at attempt to retract the foreskin, because it is attached to the glands. Forcing the foreskin back may cause pain and bleeding. In an uncircumcised male, external washing and rinsing of the penis and scrotum is necessary to maintain proper skin condition. Usually, the application of powder is not advisable id the skin is retracted. Use of ointment is not advisable if the skin is retracted.

A child has nausea due to the intake of oral medication. Which advice does the nurse give to the child's mother to reduce nausea?

"Give the child a carbonated drink immediately after the medication." RT: Carbonated drinks reduce the queasy feeling. It is therefore advisable to give carbonated drinks immediately after administering medication. It is not advisable to ix the medication in essential foods, as the child may refuse the food later. Ice cubes are given before administering the drug to create numbness; however, it does not reduce nausea. Water will reduce the unpleasant taste of medication but will not reduce nausea.

Which of the following statements is a correct response to the parent's concern about the child's bellyache?

"I found nothing unusual with the assessment, but let the provider know if they develop diarrhea or begin to vomit."

The nurse is discussing dietary intake with the mother of an 18- month-old child. What statement(s) by the mother indicate(s) the need for further instruction?

"I need to begin to decrease the amount of milk my child is allowed to drink." "Until my child is 3 years of age, whole milk is recommended."

The nurse is teaching the parents of a 4-year-old child about measures to take to prevent accidents. Which response of the parents indicates the need for further teaching?

"I should permit the child to play on the sidewalks of the road." RT: The child should not be allowed to play on the sidewalks of the road, as the child is too young to understand road safety measures. Playing on the pavement may lead to accidents. Leaving the child in the bathtub id harmful, as the child may drown; parents should avoid leaving the child alone in the bathtub. Using a car seat or seat belt avoids injury, so it is appropriate to use them. As a 4-year-old child has developed exploring abilities, loaded firearms should be kept away.

The nurse repeats instructions to prevent nursing bottle caries in an infant. Which statement by the mother indicates the need for additional teaching?

"I should use sugar-coated pacifiers for the child." TR: Nursing bottle caries are common in bottle-fed infants due to they tend to have milk or juice as their last feed. This feed remains in the mouth and, as salivary secretion is reduced during the night, results in dental caries.

Which of the following statements is a correct response to the mother's concern that their daughter has "such a big round belly"?

"It's normal for children to have a prominent abdomen until about age 4."

Which instruction regarding safety restraints does the nurse give to the parents of a child who weight 50 lb?

"Keep the child in a booster seat and secured with lap and shoulder belts." TR: Kids who weight more than 40 lb should be secured in a booster seat with lap and shoulder belts. Properly fitted shoulder belt lies across the chest, and the lap belt sits below the hip bones to prevent internal injuries in accident.

Which statement by the LPN/LVN will best prepare the child for an intramuscular IM injection?

"Other kids tell me different things about how this feels. Some say it feel like a cat scratch. Will you tell me

A 4-year-old child has a respiratory infection. The health care provider has ordered Rocephin IM for treatment. Which statement by the LPN/LVN will best prepare the child for the injection?

"Other kids tell me different things about how this feels. Some say it feels like a cat scratch. Will you tell me how it felt to you after we are done?" RT: Being honest is important, but only the child can relate what an injection feels like.

Which instructions regarding dental care does the nurse provide to the parents of a preschool child?

"Perform flossing for the child regularly." RT: The nurse should instruct the parents to perform flossing to remove the foods remnants lodged in between teeth to prevent dental decay. Fluoride toothpaste should be used for preschoolers to promote dental health.

The nurse is teaching parents about caring for their 2-year-old child. Which instructions would be included in the teaching?

"Practice good hygiene measures." "Include whole grains and dairy products in the diet." "Use a federally approved car seat and seat belts for the child." RT: Good hygiene to prevent infection. A diet of whole grains, proteins, & diary promotes adequate growth. Fedarally approved car seat to ensure safety.

A nurse is educating a group of parents regarding accidental poisoning. Which prevention measures will the nurse be sure to include?

"Remind grandparents to keep their medications out of reach of children." RT: Grandparents may not be used to having children around. They may leave medications that can lead to accidental overdose within reach of children. Medications should be placed in a locked cabinet.

A 16-year-old teen reports he uses smokeless tobacco. Which statements by the teen indicate the need for further instruction?

"Smokeless tobacco is safer for me than a cigarette." "As long as I brush my teeth after use I am going to be OK." "I can become sterile from smokeless tobacco use."

A 7-year-old is about to have a finger-stick blood draw. Which statement by the nurse is most effective?

"Some children say that they feel a little pinch."

The nurse is providing postoperative care instructions to parents of a 5-month-old who is recovering from surgery. Which statement indicates that the teaching was effective? (Select all that apply.)

"The baby will perhaps be comforted by sucking on a pacifier, being swaddled, or being rocked." "I can continue to breast feed as soon as my child is able to eat."

A patient is getting ready to go home with her newborn son. The nurse is doing discharge teaching regarding the use of an infant car seat. Which statement by the patient would indicate the patient's i=understanding?

"The car seat should be secured in the back seat, rear facing until the infant reaches 20 pounds." TR:

Which of the following statements by the nurse reflects the best understanding of the molding of this infant's head?

"The elongated are on the skull is temporary. It is a result of the pressure experienced coming through the birth canal."

The mother expresses concern that their newborn seems to jump when there is a loud noise. Which of the following responses by the nurse is appropriate?

"The reaction to loud noise is a temporary reflex that shows that the nervous system is well developed."

Which of the following responses is appropriate to address the mother's concern that the markings on their newborn's body might suggest abuse?

"Those spots are called Mongolian spots. They are common and temporary. They should fade over time."

While interacting with a school-age child, the nurse learns that the child uses a lanolin-based sunscreen. Which suggestion does the nurse give to the child?

"Use a non-alcohol-based sunscreen." RT: It is advisable to use a sunscreen containing a nonalcoholic base to avoid allergies in children. It is not advisable to use a sunscreen with SPF 40 or an alcohol-based sunscreen because they can be harmful to the child's skin. The Lanolin in the sunscreen would harm a child's sensitive skin and may lead to rashes.

The nurse is teaching some parents about safety precautions to prevent accidental burns and injuries in children. Which instructions would help the parents provide a safe environment for their children?

"Use and maintain smoke detectors in the home." "Use plastic caps to cover electrical outlets in the home." "Keep electrical wires hidden and out of reach of children." "Use guards around fireplaces, space heaters, and other heating sources." RT: Infants and childrens acquire new mother skills; so they are more susceptible to accidental burns and injuries. Hot water heater should be at 49°C.

Which statement by a student nurse indicates the need for additional teaching regarding the nutritional needs of a 6-month-old child?

"Use honey as sweetener in the child's diet." RT: Honey may cause botulism, so parents avoid it use in the child's diet. The child should be offered finger food after the teeth erupt to help the hand-to-mouth cycle. The new food should be fed at 1-week intervals to determine whether the child has any allergy. Fruit juices are more easily digestible than strained vegetables; therefore, strained vegetables are fed after fruit juices.

The mother of the newborn is expressing concern that the examination will cause them to cry. Which of the following responses should the nurse make?

"You can sit in the rocking chair with baby in your arms."

Which of the following statements in appropriate to make in response to the parent's expressed concern?

"Your child's weight is about in the center of the growth chart for their age."

Erickson's Psychosocial Development

-based on a series of crises that derive from conflicts b/w needs and social demands -successful resolution of a stage is marked by answering an essential existential question (individual gains skills & traits that are carried through subsequent stages) *Trust vs Mistrust *Autonomy vs shame and doubt *Initiative vs. guilt *Industry vs Inferiority *Identity vs role confusion *Intimacy vs Isolation *Generativity vs Stagnation *Integrity vs Despair

Physical Activity Guidelines for Americans

1 hour or more daily. Most activities of moderate or vigorous intensity. Muscle-strengthening at least 3 days per week.

healthy people 2020: substance abuse

1 of the 12 recognized topics of concerns to the health and well-being of Americans. Substance abuse include drugs, alcohol, or both-- contributes to a # of negative health outcomes. It is associated with a range destructive social conditions, including family disruptions, financial problems, lost productivity, failure in school, domestic violence, child abuse, and crime. Alcohol and Illicit Drug Use in Adolescents In 2011, 31.8% of adolescents age 16 to17 reported using alcohol or illicit drugs during the past 30 days, more than 6 times the rate for adolescents age 12 to 13. 5.1% Age 12-13 31.8% Age 16-17 In 2011, 18.0% of adolescents age 12 to 17 reported use of alcohol or illicit drugs during the past 30 days. 18.0% 2011 16.6% 2020 Target 7.8% decrease needed Binge Drinking in Adults In 2011, 26.7% of adults age 18 and older reported that they engaged in binge drinking during the past 30 days. 26.7% 2011 24.4% 2020 Target 8.6% decrease needed

Expected Growth Rates at Various Ages:

1-6 mo: 18-22 cm, 7.2-8.8 inches. 6-12 mo: 14-18 cm, 5.6-7.2 inches. 2nd year: 11 cm, 4.4 inches. 3rd year: 8 cm, 2.8 inches. 4th year: 8 cm, 2.8 inches. 5th-10th years: 5-6 cm, 2-2.4 inches.

Healthy People 2020 LHI factors

1. Access to health services 2. Clinical preventive services 3. Environmental quality 4. Injury and violence 5. Maternal, infant, and child health 6. Mental health 7. Nutrition, physical activity, and obesity 8. Oral health 9. Reproductive and sexual health 10. Social determinants 11. Substance abuse 12. Tobacco

A nurse preparing to give a child an intramuscular injection identifies which area on the thigh as the vastus lateralis muscle?

2 RT: The vastus lateralis muscle, shown as number 2, along with the ventrogluteal muscle, is the primary site for intramuscular injections. The rectus femoris is shown as number 1 and 4, and the vastus medialis muscle is shown as number 3.

Which visual acuity is typical of a newborn?

20/400. RT: A newborn's visual acuity is typically 20/400. This means that the vision is clear only at very close range. That is why it is important to hold the infant face to face, approximately 8 inches away and on the same plan. Acuity of 20/22 is generally achieved by age 2 or 3. Visual acuity of 20/100 is typical of a 1-year-old child. Visual acuity of 20/200 is typically achieved by month 4 or 5.

Newborns develop the ability to follow bright, colorful objects by

2nd or 3rd week of life

Normal Temperature in Children

3 mo 99.4°F = 37.5 6 mo 99.5°F = 37.5 1 yr 99.7°F = 37.7 3 yr 99.0°F = 37.2 5 yr 98.6°F = 37.0 7 yr 98.3°F = 36.8 9 yr 98.1°F = 36.7 11 yr 98.0°F = 36.7 13 yr 97.8°F = 36.6

By which age are all of the primary teeth typically present in a child?

3 years old. RT: The 20 primary "deciduous" teeth are all typically present by a child's birthday. Permanent teeth begin to appear at about 6 to 9 months. At 12 months the first dental visit should have taken place.

Normal BMI percentile for a 18-month-old child is?

45th percentile

5-2-1-0 Let's Go!

5 or more fruits & veggies daily. 2 hours or less of screen time daily. 1 hour or more of physical activity daily. More water and low-fat milk, no sugary drinks.

Which patient demonstrates an abnormal growth pattern that should be reported to the pediatrician?

5-year-old child who has a widely disparate height-to-weight ratio. RT: A 5-year-old child with a widely disparate height-to-weight ratio indicates an abnormal growth pattern. This requires further assessment to determine the cause of abnormality and should be reported to the pediatrician.

An accurate apical heart rate measurement is assessed at the ________________ intercostal space

5th

Initiation of fluoride supplementation at

6 months of age if the water in the infant's residential area is not fluoridated.

Normal growth patter for infants, toddles, adolescents

A 1 -year-old child will triple his birth weight. A 12-year-old adolescent generally will have a sudden growth spurt. A 7 -year-old child should have a gradual increase in height and weight.

WORDS

A 1-year-old has a three-word or four-word vocabulary. It usually includes mama and dada. In toddlerhood, more words are understood than expressed. Children usually know 25 to 50 words by 18 months, but by 2 years, they often know more than 250 words.

A nurse is inspecting the thorax of an infant. Which of the following findings should the nurse expect?

A barrel-shaped chest in which the anterior-posterior are equal. RT: A barrel-shaped chest is an expected finding in an infant. As the child grows, the lateral diameter will increase more than the posterior diameter.

Mommy restraint

A mummy SRD is used when it is necessary to immobilize head, neck, trunk, and upper and lower extremities. A jugular venipuncture or the insertion of an NG tube sometimes calls for this type of SRD.

family-centered care

A philosophy of care that recognizes the family as the constant in the child's life and holds that systems and personnel must support, respect, encourage, and enhance the strengths and competence of the family.

Expected Growth Rates at Various Ages

AGE EXPECTED GROWTH RATE PER YEAR 1 to 6 mo: 18-22 cm 7.2-8.8 inches 6 to 12 mo: 14-18 cm 5.6-7.2 inches Second year: 11 cm 4.4 inches Third year: 8 cm 3.2 inches Fourth year: 7 cm 2.8 inches Fifth to tenth years: 5-6 cm 2-2.4 inches

sign of infant breaths

Abdomen move

important ability for nurse to have to enjoy working in pediatrics?

Ability to recognize and appreciate the uniqueness of each child

The nursing student is reviewing what he/she knows about the development of pediatrics as a discipline. The nursing student recognizes which of the following individuals as being credited with being the "father of pediatrics"?

Abraham Jacobi

Responsible sexual behavior among young people most importantly should include what characteristic?

Abstaining from sexual activity or properly using condoms

A nurse teaches a teen that which method is most effective in preventing sexually transmitted diseases?

Abstinence. RT: Abstinence is the only protection that is 100% effective against sexually transmitted diseases.

John Piaget stages of Cognitive Development: The Formal Operational Stage

Ages: 12 and up At this stage, the adolescent or young adult begins to think abstractly and reason about hypothetical problems. Abstract thought emerges. Teens begin to think more about moral, philosophical, ethical, social, and political issues that require theoretical and abstract reasoning. Begin to use deductive logic, or reasoning from a general principle to specific information

John Piaget stages of Cognitive Development: The Preoperational Stage

Ages: 2 to 7 years

John Piaget stages of Cognitive Development: The Concrete Operational Stage

Ages: 7 to 11 years During this stage, children begin to thinking logically about concrete events. They begin to understand the concept of conservation; that the amount of liquid in a short, wide cup is equal to that in a tall, skinny glass, for example. Their thinking becomes more logical and organized, but still very concrete. Children begin using inductive logic, or reasoning from specific information to a general principle

Which factor is associated with high-risk sexual behavior among adolescents and with teen pregnancy?

Alcohol abuse. RT: Alcohol and the use of other drugs frequently lead to high-risk sexual behavior and increase the risk of teen pregnancy.

A child is addicted to watching violent shows on television, and this has resulted in negative behavior in the child. Which instruction would the nurse provide to the parents to encourage positive behavior in the child?

Allow the child to play nonviolent video games. RT: The nurse can recommend that the parents allow the child to play nonviolent video games rather than watch television. The video game can be a substitute for children addicted to television. Video games increase hand-eye coordination, inductive reasoning skills, and perception.

morbidity

An illness or an abnormal condition or quality.

A nurse is performing an abdominal examination on a preschooler. Which of the following actions should the nurse take during the assessment?

Ask the child to "help" with the exam by placing their hand on top of the nurse's hand. RT: Encouraging the child the assist with the examination will promote distraction and relaxation of the abdominal wall muscles.

The LPN/ LVN enters and observes an object in a Vietnamese mother's hand and bright red welts on her toddler's skin. Which nursing intervention is appropriate?

Ask the parent to explain what is occuring. RT: Nurses should be aware of cultural practices. An understanding of these practices is important, yet the family should be informed that the practices are possibly harmful and may place them in jeopardy with child protective services. An example of this is coining. Coining is the repeated rubbing of a coin's edge on the skin until a welt appears to rid the body of disease.

An LPN/LVN hears a 1-year-old Vietnamese patient crying shortly after the parents enter the room. The LPN/LVN enters and observes an object in the mother's hand and bright red welts on the toddler's skin. What is the appropriate nursing intervention?

Ask the parent to explain what is occurring. RT: Nurses need to be aware of cultural practices. Coining is the repeated rubbing of a coin's edge until a welt appears to rid the body of disease.

Which practice would the nurse follow in a pediatric hospital that incorporates family-centered care?

Asking family members to decide whether they wish to participate in the procedures. RT: The system of family-centered care acknowledges the family as an essential child's care and illness experience. The parents can independently decide whether to stay with the child or be parted from their child during the procedure.

The parent of an adolescent reports that the adolescent talks to his dead grandmother. Upon reviewing the adolescent's blood reports, the nurse finds traces of heroin in the blood sample. Which nursing intervention would help the adolescent?

Asking parents to discuss the risk of substance abuse and supervise the adolescent. TR: Discussing the risk of substance abuse with their children and supervising them will help prevent their child from indulging in harmful activities.

Which of the following interventions is most likely to facilitate the child's initial cooperation while you palpate their abdomen?

Asking the child to help by placing their hands on yours during palpation.

Which of the following nursing actions is most likely to foster a therapeutic nurse-client relationship with this child?

Asking the client to demonstrate how to perform a fingerstick glucose.

Which is the most common cause of death among children younger than 1 year of age?

Asphyxiation caused by aspiration of foreign materials. RT: In children younger than 1 year of age, the leading cause of fatal injury is asphyxiation caused by aspiration of foreign materials such as foods, buttons, toy parts, and other small foreign objects into the respiratory tract.

The nurse is discussing planned well child appointments with the mother of a toddler who frequently misses them. What actions should be taken by the nurse?

Assess the parent's beliefs on the importance of the health promotion activities. Determine if the family has transportation for the appointments. Seek family input on the dates and times for scheduling the appointments. Review the family's ability to pay for health care.

The mother of a 6-month-old is worried because the child's grandmother is concerned that the child is "slow" because she is not yet crawling. What action by the nurse is most appropriate?

Assure the mother that children develop at their own rate, but most children do not crawl at age 6 months.

Asymmetrical movement of the chest.

Asymmetrical chest movement is an unexpected findings at any age and should be reported to the provider.

primary deciduous teeth

Baby teeth; the set of 20 teeth that normally appear during infancy. Starts to descent between the 6th and 9th month of life.

anterior fontanel

Baby's soft spot. Roughly diamond-shaped, covered by tough membranes between the bones of an infant's cranium.

A 12-year-old tearfully informs the school nurse that she does not "fit in." Which intervention would be most appropriate?

Be aware that these feelings are common in adolescents and place the girl at risk for substance abuse, depression, and eating disorders. RT: Peer pressure in adolescent is widespread and lead to a common feeling of "not fitting in." Further assessment needs to be completed to determine the present of depression or suicidal feelings.

A nurse is meeting a new 4-year-old patient for the first time. Which intervention is most effective when entering the patient's room for the first time?

Be careful not to use words that may be misinterpreted by the child, such as "take your temperature."

Why does using sugar-coated pacifiers increases the risk of dental caries?

Because the sugar on the pacifiers promotes growth of microorganisms. TR: Sugar-coated pacifiers should be avoided. Using water instead of juice or milk in the bedtime feeding bottle decreases the risk of dental caries.

Strategies to Promote Dental Health

Begin cleansing the oral cavity in infancy by wiping the teeth and gums with a damp washcloth A toothbrush usually is too harsh for an infant's tender gums. As an infant gets more teeth, use a small softbristled toothbrush with plain water to cleanse the teeth and gums. Avoid use of toothpaste during this age, especially if fluoridated, because swallowing by the infant leads to ingestion of excessive amounts of fluoride.

A nurse is performing a physical assessment on an 18-month-old child. Which finding suggests that the parents need more counseling and early childhood education?

Beginning of some dental caries. RT: Beginning of dental caries means that the parents need dental health promotion and education. Presence of dental caries at 18 month old or nursing bottle caries is an indication of tooth decay resulting from prolonged drinking from a bottle after the infant has been put to bed.

The nurse is planning a program for parents and adolescents in the community related to obesity. What information is most appropriate for inclusion in the information that will be provided?

Being overweight or obese sometimes results in major physical and psychological health problems.

John Piaget stages of Cognitive Development: The Sensorimotor Stage

Birth to 2 years. Infant knows world through their movements and sensations. Children learn about the world through basic actions such as sucking, grasping, looking, and listening. infants learn that things continue to exist even though they cannot be seen [object permanence]. They are separate beings from the people and objects around them. They realize that their actions can cause things to happen in the world around them.

Which statement is true about orthopedic injuries in the pediatric patient?

Bone fractures tend to heal most quickly in the pediatric population. RT: A fracture in a pediatric patient, male or female, will heal fastest, needing approximately 8 weeks. The younger child has a higher metabolic rate, resulting in an accelerated rate all bodily functions. Bone fractures do typically need some intervention for healing. It is not extremely easy for a pediatric patient to break a bone before age 10. Calcium supplements will not decrease risk for breaks.

Dietary Guidelines for Americans

Build a health plate. Cut back on foods high in solid fats, added sugars, and salt. Eat the right # of cal for you. Be activite. Use food labels to help for better choices.

Speech and Communication

CRYING earliest evidence of speech at birth. Wordless though it is. Infants used when hungry, in pain or needs to be changed. Crying is followed gradually by other sounds, such as cooing, laughing, or babbling. By 9 months, infants practice the noises they can make and painstakingly repeat them. Infants enjoy the sounds of their own voice. While they begin to express themselves, they also begin to imitate the vocal sounds of an adult. The adult speaks, the infant responds, the adult answers, and so on. As the infant begins to enjoy experimenting with these sounds, encouragement of these vocalizations is important; it is positive reinforcement for oral communication.

A nurse is presenting information on sexual health to teens. The nurse teaches that which 3-dose vaccines are given to prevent infection from Human papillomavirus HPV?

Cervarix and Gardasil. TR: Cervarix and Gardasil are 3-dose vaccines used to prevent HPV infection, the main cause of genital warts and cervical cancer.

HPV infection is associated with what health complication?

Cervical cancer

Which action of a mother indicates effective learning regarding prevention of accidents an injuries in her baby?

Checking the bath water temperature. RT: The mother of the baby should check the temperature of the bath water to prevent exposure of the baby to extreme temperatures. The mother should not drink hot fluids while holding the baby, this may pose a risk to the baby. Th baby should be allowed to sleep in a supine or side-lying position. The mother should not tuck the blankets in while covering the baby. This may make the baby feel uncomfortable and restricted.

John Piaget stages of Cognitive Development:

Children begin to think symbolically and learn to use words and pictures to represent objects. Children at this stage tend to be egocentric and struggle to see things from the perspective of others. While they are getting better with language and thinking, they still tend to think about things in very concrete terms.

A school nurse is presenting a health class to teens. What does the nurse teach is the single most preventable cause of death and disease in the US?

Cigarette smoking. TR: Cigarette smoking continues to be the single most preventable cause of death and disease in the US. Nicotine is considered a gateway drug, and teens who smoke are more likely to go on to use illicit drugs.

The nurse is bathing an infant who has an intact umbilical cord. Which procedure should the nurse follow?

Clean the face and dry it before proceeding to other parts. RT: The nurse should be careful when bathing an infant who has an intact umbilical cord, because is it prone to injury and infection. During bathing, the nurse should start with the infants face, cleaning it with a sponge. The nurse should dry the face thoroughly before moving on to bathe other body parts. The are around the infant's umbilical cord is cleaned with alcohol instead of water, because it dries faster and prevents infections. The infant's ear canal is not cleaned by using a cotton-tipped applicator, because it may cause injury if the infant moves suddenly. The nurse should not use mild soap to clean the are around the infant's eyes, because this may cause irritation to the eyes. The may use water instead.

birth defects

Congenital anomalies. Any abnormality present at birth, particularly a structural one, that is possible to inherit genetically, acquire during gestation, or acquire during parturition "process of giving birth".

Which nursing interventions should be performed to prevent the risk of poisoning in children?

Counsel parents to store medicines with childproof caps. Teach parents to store harmful substances out of reach of children in a locked cabinet. Educate parents to contact the poison control center immediately if ingestion is suspected. TR: The nurse should educate parents to prevent accidental poisoning.

Which of the following is an effective method for assessing respiration for a child this age?

Count the upward abdominal expansions for 1 full minute.

The nurse would instruct parents of a 4-month-old to clean the infant's teeth with which tools?

Damp washcloth and water. TR: A 4-month-old infant's oral cavity has to be cleaned by using a damp washcloth and water.

Regular physical activities lowers

Death rates in adults and reduces the risk for development of heart disease, high blood pressure, diabetes mellitus, and colon cancer.

Which muscle is the most suitable site for administration of the hepatitis B Vaccine for a 2-year old chile?

Deltoid. RT: The hap B Vaccine is administered IM. The deltoid muscle is the most suitable for administration of the hep B Vaccine in children who are 18 month old or older. The dorsogluteal muscle is insufficiently developed in infants and is therefore not used. The vastus intermedius is a deep-seated muscle, which is not used to administer vaccinations. The biceps brachii has lower muscle mass when compared to muscles like the deltoid and vastus lateralis; so, this muscle is not a suitable site for administration of the hep B Vaccine.

What should the head circumference be in infancy?

During infancy, the chest and head circumferences should be approximately equal in size.

The hospital environment can be frightening and traumatic for children. How can the nurse help alleviate these stressors?

During preadmission, offer the parents and child a tour of the pediatric unit and invite the parents to room in which the child during hospitalization. RT: Offering tours of the pediatric unit and allowing the parents to room in with the child allows time for the family to ask questions become familiar with th eunit routines, thus alleviating any fears. The other interventions will only increase the stress of being hospitalized.

The hospital environment can be frightening and traumatic for children. How can the pediatric nurse help alleviate these stressors?

During preadmission, offer the parents and child a tour of the pediatric unit and inviting the parents to room-in with the child during hospitalization. RT:This intervention allows time for the family to ask questions and become familiar with the unit routines, thus alleviating any fears. The other interventions will only increase the stress of being hospitalized.

A nurse is inspecting the skin of a toddler. Which of the following findings should the nurse report to the provider?

Ecchymotic area on the abdomen. RT: Although bruising on the extremities is a common finding in children, bruising in other areas, such as the abdomen, should be investigated to determine the cause. Therefore, the nurse should report this finding to the provider.

The nurse addresses the local PTA about accident prevention for adolescents. What is most important for the nurse to highlight during the session?

Education and review of basic first aid; setting consequences for substance abuse; and discussing the dangers of swimming alone RT: Education and review of basic first aid; setting consequences for substance abuse, especially drinking; and discussing the dangers of swimming alone are age appropriate interventions for adolescents. The remaining options are not age appropriate for adolescents.

anticipatory guidance

Education of parents to prepare them for normal growth and development of their children. It is also psychological preparation of a person for an event expected to be stressful, as in preparation of a child for surgery by explaining what will happen and what it will feel like.

The nurse is caring for a child who is obese. The nurse discovers that the child's cholesterol level is high. Which suggestion would the nurse provide to the parents to help decrease the child's cholesterol levels?

Encourage regular physical exercise. TR: Regular exercise would help reduce the child's body weight and decrease cholesterol levels.

Which of the following nursing actions is most likely to foster a therapeutic nurse-client relationship with this child?

Encourage the child to their doll during the exam.

An 18-month-old is hospitalized for surgery in the morning. Which intervention is most helpful in relieving the child's stress?

Encouraging parental presence and rooming-in

Which qualities are desirable in a competent pediatric nurse?

Enjoys working with children. Teaches parents about childcare. Explains healthy habits to the child. RT: Teach parents about childcare to promote child wellness, explains healthy habits to child, promotes health and hygiene.

Secondhand smoke is also referred to as which type of tobacco smoke?

Environmental. TR: Secondhand smoke is also called environmental tobacco smoke because someone smoking can cause anyone in the room or near the smoker to be exposed to the exhaled tobacco smoke.

The parents of a 13-year-old boy report their son spends several hours on the Internet and social media sites each day before and after school. What information should be provided by the nurse?

Excessive hours on social media can result in an imbalance between the rest of the social activities of the child. Social media use may result in mental health concerns. Social media has some benefits including improved communication with others. The Internet can provide educational benefits.

A nurse is listening to a child talk about favorite television shows. The nurse knows that children who view violent television shows are likely to do what?

Experience nightmares. Have obsessive thought. Participate in or start fights. TR: Research has shown that kids who view violent shows are more likely to participate in or start fights, to have obsessive thoughts, and experience nightmares.

A nurse is preparing to perform a physical examination on a 10-year-old child. Which of the following interventions should the nurse plan to implement?

Explain how the equipment works using correct medical terminology. RT: School-age children are interested in learning and building language skills. Therefore, the nurse should explain the function of the equipment using correct medical terminology. Allow the child to touch and play with the equipment is a technique best used with toddlers, preschoolers, and young school-age children. Play games while performing the physical examination is a technique best used with toddlers and uncooperative preschoolers because it can help decrease the child's anxiety. Discuss the benefits of performing the examination with the child is a technique best used with adolescents because discussing the benefits and long-term consequences of the examination requires abstract thinking. This developmental skill does not appear until adolescence.

Wong-Baker FACES Pain Rating Scale

Explain to the patient that each face is for a person who feels happy because he has no pain (hurt) or sad because he has some or a lot of pain. Face 0 is very happy because he does not hurt at all. Face 1 hurts just a little bit. Face 2 hurts a little more. Face 3 hurts even more. Face 4 hurts a whole lot. Face 5 hurts as much as you can imagine, although you do not have to be crying to feel this bad. Ask the patient to choose the face that best describes now how he or she is feeling. Recommended for children ages 3 years or older.

What is the most accurate definition of the focus of pediatric nursing?

Family-centered nursing. RT: Pediatric nursing is family-centered nursing in it truest sense. It is important for the family to be totally involved and have a feeling of control over the decision making concerning their child.

Proper counseling of the parent of a 1-year-old regarding safety includes which instruction(s)?

Fence pools with a self-locking gate. Keep drapery cords out of children's reach. Place infant on back to sleep.

Presence of fine hair on the lower arms and legs

Fine hair on the arms and legs is an expected finding for a toddler.

Which needs, if not supplied, are indicators of physical neglect of a child?

Food. Shelter. Clothing. Health care. RT: Neglect can be divided into two categories: physical neglect and emotional neglect.

Human papillomavirus (HPV) vaccine is recommended for what population?

Girls from age 13 to 26 years who are not sexually active

Which statements does the nurse include in the teaching plan about measures parents can take to prevent dental caries in their infants?

Give water, if the child needs a bottle at bedtime. Avoid snacks containing high concentrated sugars. RT: I f the infant needs a bottle at bedtime, give the child water to prevent dental caries. Avoiding snack containing high concentrated sugars, such as lollipops, helps prevent the dental caries. These sticky substances remain in the mouth for a long time and can cause dental caries in deciduous teeth. The infant may experience constipation if high-fiber snacks are avoided. Giving the child a bottle of milk in the evening is recommended, but it should be avoided at night. Sweetened liquids, such as honey, should never be given to the infant at night, because they damage the deciduous teeth and make the infant prone to infections.

weaning

Gradual elimination of breast or bottle feeding and instituting cup and table feeding.

Which finding would the nurse report as a concern of possible spina bifida in a newborn?

Hair on the sacrum. RT: Spina bifida occurs as a result of reduced folic acid levels in the mother during pregnancy. A tuff of hair on the spin, especially on the sacrum, indicates the presence of spina bifida. Newborn usually have convex-shaped nails. Newborns usually have a C-shaped spine; as they grow, it becomes an S-shaped. A heart rate of 120 beats/ min is a normal observation in newborns.

The nurse is instructing parents regarding dental care of their school-age child, who has abnormal eruption of teeth. What should the nurse include in the teaching?

Have the child screened for malocclusion problems. RT: Good dental hygiene and professional supervision are very important for school-age children because permanent teeth begin to erupt at this age.

Which measurement does the nurse take assess a 3-year-old child's growth?

Height in upright position. RT: Growth of children above 2 years is assessed by measuring the height in an upright position. The growth of a baby under the age of 36 months is assessed by measuring the head circumference and length in the supine position. The head circumference is measured above the eyebrows and pinna, and around the occipital prominence at the back of the skull. Height is always measured in an upright position. Measuring the height of a 3-year-old child in a supine position is not a reliable indicator of growth.

four essential features of nursing practice:

Human responses of individuals to actual or potential health problems of concern to nurses, including any observable need, concern, condition, or fact of interest that may be the target of evidence-based nursing practice. Theory application is built on understanding theories of nursing and other disciplines as a basis for evidence-based nursing actions. Nursing actions are theoretically derived and evidence based and require well-developed intellectual competencies to prevent illness and injury, to alleviate suffering, and to advocate for all populations. Outcomes of nursing actions produce beneficial results in relation to identified human responses. Evaluation of those actions determines whether they have been effective. Findings from nursing research provide rigorous scientific evidence of beneficial outcomes of specific nursing actions.

Which of the following findings indicates that the child is in the Erikson's psychosocial developmental stage of industry vs. inferiority?

Identifies math and music as favorite school subjects

Which behavior indicates that a 3-year-old child is cooperative during the examination procedure?

If the child smiles at the nurse during the procedure, it indicates that the child is willing to cooperate during the procedure. If the child does not smile or look at the nurse, it indicates that the child is not interested in the in the procedure or has some unaddressed fears. The child is expected to sit on the examination table during the procedure. sitting on the parent's lap is a sign of unwillingness toward the procedure. Rejection of offered equipment indicates the child's unwillingness regarding the procedure.

Poisonous substances should be kepts where?

In a locked upper cabinets out of reach of childrens, not under the sink. Not all types of poisons should be treated by inducing vomiting with ipecac.

Expected movements in infants during respiration.

In an infant, the nurse should expect to observe primarily abdominal movement with respiration. This finding persists until young school-age when children transition to thoracic repirations.

Correct Blood Pressure Cuff Size

In choosing cuffs, use an appropriately sized one. A cuff of proper size covers 2-3rd of the length of the upper arm or leg. If a cuff of the correct size is not available, use an oversize cuff rather than an undersized one, or use another site that more appropriately fits the cuff size. Do not choose a cuff based on the name of the cuff; an infant cuff is too small far some infants.

A nurse is educating parents about the importance of physical activity for children. The nurse states that decreased activity places a child at risk of what?

Increased risk of high body mass and increased risk of obesity. TR: Decreased physical activity in the pediatric population is clearly related to increased risk of high body mass and increased risk of obesity.

An adolescent informs the nurse about using tanning machines. The nurse advises the adolescent to avoid using tanning machines because this practice can have long-term adverse effects. Which adverse effect is the nurse trying to prevent in the adolescent?

Increased risk of skin cancer TR: This has the same long-term risk as sun tanning. Tanning can increase the risk for skin cancer.

Daily Caloric Needs of Infants, Children, and Adolescents

Infants Birth to 6 mo 108 kcal/kg 6-12 mo 94.4 kcal/kg Children 1-3 yr 100 kcal/kg 4-6 yr 90 kcal/kg 7-10 yr 71.4 kcal/kg Adolescents Males 11-14 yr 55.6 kcal/kg 15-18 yr 45.5 kcal/kg Females 11-14 yr 47.8 kcal/kg 15-18 yr 40 kcal/kg

Children's Concepts of Illness

Infants Perceive illness as generalized discomfort and pain. Preschoolers Conceive of illness as a punishment for bad thoughts or behavior; believe that adults have the power to magically cure the illness if they want. School-Age Children Sometimes perceive illness as a result of bad or indiscreet behavior; sometimes have an accurate awareness of the location of body parts and a beginning understanding of body processes and functions. Adolescents Focus on discrete symptoms rather than overall effect of illness; often intellectually question and deal with information about illness; at times use denial of illness or overcompensate in areas not affected.

What is true regarding the child's nutrition? (Select all that apply.)

Infants can begin solid foods at 4 to 6 months of age Solid foods should be introduced one at a time and a new one each week.

The parents of a 10-month-old are concerned about motor vehicle safety. What education should be provided from the nurse to the parents?

Infants from birth to 20 pounds must be in a rear-facing safety seat.

Which cause of death and disabilities in children is the most common?

Injuries. RT: Injuries cause more death and disabilities in children than all causes of disease combined. Disease is far less likely than injury to cause death or disability. Carelessness and risk-taking activities also contribute to illness or abnormal conditions or qualities, but, again, these are not the leading cause of death or disability.

How does the nurse best describe to the nursing student the term separation anxiety as it pertains to hospitalized children?

Isolation from parents and family. RT: Desire to bond with hospital staff has nothing to do with separation. Fear of losing the support of their friends and peers is a real concern but not as strong as the fear of being removed from family members.

Let's Move

Kids: have fun being active & eating healthy. Parents: get on track to eat well and stay fit. Schools: add healthy living to the lesson plan. Community leaders: empower families to make healthy decisions. Health care professionals: educate & support patients in living healthier.

A nurse is performing a cardiac assessment on a preschooler. The nurse should plan to auscultate the apical pulse at which of the following precordial landmarks?

Left of the midclavicular line at the 4th intercostal space. RT:This is the site where the mitral valve is best auscultated in children who are younger than 7 years old. Therefore, the nurse should plan to auscultate the child's apical pulse at this site. Along the sternal border at the third intercostal space is where murmurs are best auscultated. It is also referred to as Erb's point. At the second intercostal space, to the right of the sternum is where the nurse can best auscultate sounds from the pulmonic valve. At the fifth intercostal space, left of the midclavicular line is the site where the mitral valve is best auscultated in children who are older than 7 years old. The nurse should use this site to auscultate the apical pulse in an older child.

Foods that are not pasteurized

Like honey are not recommended for toddles because they may cause infections. Low-fat milk is advised for toddlers, but fat-free dairy products are not recommended as well because toddlers obtain 30% of their calories from fat.

An 18-month-old child is having difficulty maintaining his respiratory status. The child's health care provider orders oxygen therapy per nasal cannula. Which statements are true regarding oxygen therapy for children?

Maintaining cannula placement may be difficult as the child is able to remove it from the nares. To assess adequate oxygenation, the nurse checks cannula placement and oxygen saturation using a pulse oximeter every 2 hours and PRN. Oxygen flow by nasal cannula allows constant oxygen delivery even while eating and talking, because the mouth remains unobstructed. RT: At 18 months, the child can remove the cannula easily, and the nurse needs to initiate other measures as needed to keep it in place. The nurse knows that continued assessment is needed, and that a cannula will allow the child to eat and talk, yet still receive oxygen therapy. If a child breathes through the mouth, then a mask is a more effective device. Crying does not indicate adequate oxygen supply so the nurse must use standard measurements to ensure that child's oxygen supply is adequate.

Which suspicious finding would indicate possible physical abuse in a child?

Marks of symmetric burns. RT: Symmetric marks on the child's body indicate physical abuse. Accidental burn marks is never symmetric; it is in the form of splash marks. Torn underclothing is observed if a child has been sexually abused. A physically neglect child has poor personal hygiene due to lack of parent supervision. Anxiety and hyperalertness indicate that the child may be abused; however, this behavior doe not confirm whether the child has been subjected to physical or sexual abuse.

The nurse has only an undersized cuff to check an infant's blood pressure. Which nursing intervention would be best in this situation?

Measure the blood pressure in the calf. RT: While measuring blood pressure, the nurse should use an appropriately sized cuff. It a cuff of the correct size is not available, the nurse should use another site, such as the calf, for a measurement that suits the size of the cuff. This intervention helps accurately measure blood pressure. The nurse should not measure blood pressure with an undersized cuff, because this can give a false reading. Advising the parent to visit the next day is not an accurate nursing nursing intervention, because a delay in the measurement of blood pressure may increase the risk for the infant. Reporting to the health care be done once the blood pressure is measured.

Mongolian spot across the buttocks

Mongolian spots are a variation of skin coloring commonly present on the skin of toddlers from some ethnic backgrounds. This is an expected finding for a toddler.

How many words is the 2-year-old child likely to know?

More than 250 RT: A 2-year-old child is likely to know more than 250 words. An 18-month-old child usually knows 25 to 50 words. Preschoolers are likely to have a fairly extensive vocabulary.

Sleep and Rest

Most babies sleep through the night by the latter part of their first year and take one or two naps a day. Most 12- to 18-month-olds usually nap once a day. The 3-year-old child usually has given up all daytime naps. T he best way to prevent sleep problems with the infant and child is to establish bedtime rituals that do not foster problematic patterns. Bed= sleep not playpen

The first White House Conference on Children focused on issues of child labor, dependent children, and infant care. As a result, what was established in 1987 on behalf of children?

National Commission on Children

Pulse expected reference range

Newborn full-term birth to 4 weeks: 110 to 160/min Infant 1 mo to 1 year: 90 to 160/min toddler 1 to 2 years: 80 to 140/mim preschooler 3 to 5 years: 70 to 120/min school age 6 to 12 years: 60 to 110/min adolescent 13 to 18 years: 50 to 100/min

Normal Heart rate in children

Newborn: 120/min 1-11 mo: 120/min 2 year: 110/min 4 year: 100/min 6 year: 100/min 10 year: 90/min 12 year: 88/min 16 year: 70/min Whereas an apical pulse is taken in infants and young children, with children 5 years of age and older, a radial pulse often is taken.

Normal Respiration in children

Newborn: 35 1-11 mo: 30 2 year: 25 4 year: 23 6 year: 21 10 year: 20 12 year: 20 16 year: 20

Normal Blood Pressure in children

Newborn: 70/50 1-11 mo: 90/60 2 year: 96/68 4 year: 100/70 6 year: 105/70 10 year: 108/70 12 year: 110/70 16 year: 120/70

Expected Reference range core temperature

Newborns: 36.5° to 37.5° C [97.7° to 99.5° F] Infants and Childrens: 37° to 37.5° C[98.6° to 99.5° F]

Breathing patterns

Newborns: obligate nasal breathers, meaning they breathe only through their noses; they do not breathe through the mouth until they reach 3 or 4 weeks of age. The infant's respirations are primarily diaphragmatic; children younger than 7 years of age, respiratory movements are abdominal or diaphragmatic. In older children, respirations are chiefly thoracic. The respiratory rate also slows as a child progresses from infancy to adolescence.

An off-duty LPN/LVN recognizes cigarette burns on a child. Which response would be best as a health care professional/

Notify the appropriate agency that that there is reason to believe a child had been abused. RT: It is the responsibility of a nurse to report to an appropriate agency anytime there is suspected abuse of a child. It would be inappropriate to hand the mother a brochure and refer the child to a health care provider. A health care provider under the permission of the parent is allowed to examine a child. Ignoring the possibility of abuse is against the law because health care professionals are mandatory reporters.

An off-duty LPN/LVN is buying groceries and observes a child sitting in the cart ahead. The child raises her shirt and picks at some scabs on her abdomen. The LPN/LVN recognizes that the wounds look like the result of cigarette burns. What is the best response as a health care professional?

Notify the appropriate agency that there is reason to believe a child has been abused. RT: It is the responsibility of a nurse to report to an appropriate agency anytime there is suspected abuse of a child.

Lillian Ward, founder of the Henry Street Settlement in New York City, focused on which of the following? (Select all that apply.)

Nursing services Social work Educational activities

Which factor is a major influence on the child's growth?

Nutritional intake. RT: Nutrition is probably the single most important influence on growth. Good nutrition begins before conception and is closely related to good health throughout life. Genetic factors do no influence growth. They may determine appearance and eventual size and makeup, but growth is determined in larger part by nutrition. Parental influence and sibling and peer influence have no effect on growth except as an influence to convince the child to consume different types of nutrition.

Using a stethoscope

Place ear pieces in ears directed toward the nose. Gently rub or tap on the diaphragm to ensure that the stethoscope's head is rotated correctly. Apply frim pressure on the diaphragm using the index and middle fingers when placing it on the client's kin. Rotate the head to the bell for low-pitched sounds. Use light pressure but ensure that the entire rubber ring around the bell is in contact with the client's skin.

A nurse is preparing to obtain a temperature on an 18-month-old toddler during a well child examination. Which of the following actions should the nurse take?

Place the thermometer tip in the center of the toddle's axilla against their skin. RT: The nurse should use the axilla method to obtain the young child's temperature during a screening assessment.

The nurse learns that child is inactive and has poor hand-eye coordination. Which activity would help the child to improve hand-eye coordination?

Playing video games for a limited period. RT: Video games are believed to improve hand-eye coordination and have a positive influence in children with passivity. Children should be allowed to play video games only for a limited period.

en face position

Position in which the adult's face and the infant's face are approximately 8 inches apart and on the same plan; when a mother holds the infant up in front of her face or when she nurses th einfant.

A nurse is assessing the reflexes of a 6-month-old infant. Which of the following reflex finding should the nurse expect?

Positive Babinski reflex. RT: The Babinski reflex is elicited by stroking up the side of the foot and across the ball of the foot. A positive Babinski reflex is present when this action causes the toes to fan outwards. This is an expected finding through the first year of life, after which it begins to fade.

What is true of intramuscular injections in children younger than 2 years old? (Select all that apply.)

Possible to give in the vastus lateralis muscle. Possible to give in the ventrogluteal muscle. Help should be obtained to restrain the child.

Along with assessing for any mental health disorders, which additional assessment would the pediatric nurse make when trying to prevent deaths by homicide in the pediatric population?

Potential violent behavior. RT: When attempting to reduce deaths by homicide in the pediatric population, the pediatric nurse must assess for potential violent behavior along with mental health disorders.

cognitive impairment

Preferred term for mental retardation. loss of ability to think logically; concentration and memory are affected.

Kidney Function and Urine Output

Preterm newborn: 1-3 ml/kg/h Full-term newborn 3-4 ml/kg/h 6 mo 12 ml/h 1 year 22 ml/h 5 year 28 ml/h 12 year 33-35 ml/h

Nutrition, Physical Activity, and Obesity

Promote health and reduce chronic disease risk by consuming a healthy diet as well as achieving and maintaining a healthy body weight

Which services are offered by the woman, infant, and children WIC program?

Provide adequate food to breats-feeding mothers.

A 4-year-old child is to be hospitalized for the first time, and the parents voice anxiety about his condition and hospitalization. Which action by the nurse best addresses the concerns of the child's parents?

Provide anticipatory guidance and explain all procedures.

What is the appropriate method to examine a 6-month-old's ear with an otoscope?

Pull the ear down and back.

Signs of allergic reaction

Rash, wheezing, diarrhea

Which of the following history data best reflects appropriate psychosocial development of this, according to Erikson?

Repeated responds to requests by saying "NO"

child-based care

Scheduling the child's diet is a practice followed in child-based care. Parents are not advised to leave the child during the procedures.

A nurse is obtaining the blood pressure of a school-age child. Which of the following actions should the nurse take?

Select a cuff width that covers 40% of the upper arm. RT: Using a blood pressure cuff that is too large or too small will lead to inaccurate blood pressure measurement. Therefore, the nurse should inspect the limb size of the child and choose a cuff which covers 40% of the upper arm circumference. The cuff bladder length should encircle 80 to 100% of the upper arm. The cuff pressure should be released at a rate of 2 to 3 mm Hg per second. The arm should be positioned and supported with the cubital fossa at the level of the heart.

Which method is the most effective when preparing a child for a pediatric procedure?

Sensation-based approach

John Piaget stages of Cognitive Development

Sensorimotor stage: birth to 2 years Preoperational stage: ages 2 to 7 Concrete operational stage: ages 7 to 11 Formal operational stage: ages 12 and up

Skinfold Thickness and Arm Circumference

Skinfold thickness is determined at one site, with at least two measurements taken for the greatest reliability

When preparing snacks for an 18-month-old child, which would be appropriate?

Sliced apples Orange segments Crackers

tympanic thermometer

Specialized electronic thermometer that records the aural temperature in the ear. But should not be used to assess the temperature of a child who is younger than 2 years old due to the small size of the ear canal.

The nurse warns parents not to place an infant in the side-lying position while sleeping. This intervention assists in reducing which risk?

Sudden infant death syndrome SIDS. TR: The risk of SIDS increases if infants are placed in the side-lying or prone position. The nurse should advise parents to place the infant in supine position.

The nurse working with pediatric patients knows which are the most prevalent mental health issues in this population?

Suicide. Depression. Eating disorders. Substance abuse.

Telangiectatic nevi on the back of the neck

Telangiectatic nevi are commonly referred to as stork bites. They are flat and deep pink in coloring and are most commonly observed on the face and head. They are an expected finding for a toddler.

A nurse is performing an annual physical examination on an adolescent. Which of the following should the nurse include in the general survey?

The adolescent makes good eye contact. RT: The nurse should include this information in the general survey. The general survey includes identifying the client's demeanor, mood, and interactions with others.

The nurse is teaching a group of adolescents about responsible sexual behavior. Which changes would the nurse expect to see in the behavior of adolescents if they follow the teaching?

The adolescents use condoms to avoid unintended pregnancy. TR: Adolescents should be encouraged to practice responsible sexual behavior, including the use of condoms to prevent unintended pregnancy and sexually transmitted diseases.

Positive extrusion reflex

The extrusion reflex is elicited when the infant's tongue is depressed or touched. A positive extrusion reflex is present when the infant responds by forcing their tongue outwards. This reflex should disappear by 4 months of age.

vastus lateralis muscle

The largest of the 4 muscles of the quadriceps femoris, situated on the lateral side of the thigh.

Which statement regarding nutrition in children is true?

The most important tool for children who are overweight and obese is education. TR: Educating children and their parents regarding obesity and being overweight is the most important role a nurse can play.

What should the nurse say to the parents of a child who is overweight?

The nurse should emphasize the importance of physical activity for the child. TR: Childhood obesity is becoming a major concern because it often leads to chronic disease, such as type 2 diabetes, hypertension, and heart disease. Weight-loss measures, such as increased physical activity and avoiding sedentary lifestyle, plan an important role.

Negative plantar grasp reflex

The plantar grasp reflex is elicited by touching the foot at the base of the toes. A positive plantar grasp reflex is present when the toes curl downwards in response to this action. This is an expected finding in a 6-month-old infant.

Assimilation

The process of taking in new information into our already existing schemas is known as assimilation. The process is somewhat subjective because we tend to modify experiences and information slightly to fit in with our preexisting beliefs

The nurse must know how to compute medication doses correctly for children. Which is correct regarding the dosage calculation for children?

The proportional amount of BSA to body weight is calculated. RT: Calculating the proportional amount of BSA to body weight is the most reliable method of determining children's doses. Children are susceptible to toxic effects of medications and cannot eliminate them as efficiently as adults. Unit dose is not used in pediatrics because children are of various ages and weights. The BSA of an adult divided by the BSA of a child multiplied by the adult dose equals the child's dose is the wrong formula.

Which action by a student nurse when measuring the weight of a 5-year-old child would need correcting?

The student nurse uses a different scale every day. RT: The child should be weighed on the same scale every day for accurate measurement. The nurse should respect the child's privacy, the 5 year-old child should be allowed to wear a light gown. Any kind of attachments made should be measured; IV, NG tube.

Negative sucking reflex

The sucking reflex is elicited by touching the lips. A positive sucking reflex is present when the infant responds to the touch with strong sucking movements if the circumoral area. This is an expected finding throughout the first year of life.

separation anxiety

The typical fear and anxiety young children experience when they are isolated from their parents and family

A 15-year-old male patient states that he does not smoke. Further assessment reveals he uses chewing tobacco. What information should the nurse provide to the patient about smokeless tobacco?

The use of smokeless tobacco carries a similar risk for the development of lung cancer. Individuals using smokeless tobacco have an increased risk for the development of lip, gum, and throat cancer. Heart disease risk is increased by the use of smokeless tobacco.

Which muscle is the most appropriate site to administer site administer an intramuscular IM injection in a 3-month-old child?

The vastus laterals is the most developed muscle in young infants and is not located near any major nerves or blood vessels. The gluteal muscles should not be used in children younger than 3 years because their gluteal muscles are not developed from walking. The deltoid is too small in children, and proximity of the brachial vein and artery and the radial nerve make it a potentially dangerous site. The rectus femoris is a potentially dangerous site because of the proximity of the sciatic nerve and major blood vessels.

children with special needs

Those with congenital abnormalities; chronic physical conditions like malignant or GI diseases, or CNS anomalies; and chronic developmental, behavioral, and emotional conditions. Many need special care in childhood, and as they age.

Why would the nurse keep the fingers free from the chest piece while auscultating breath sounds?

To avoid false resembling sounds. RT: The nurse keeps his/ her fingers away from the chest while performing auscultating of the patient in order to avoid false resembling sounds, which may lead to incorrect pathological findings. Keeping the room quite will help the nurse clearly hear the sounds. Placing fingers away from the chest piece will not help the nurse clearly hear the sounds clearly. A symmetric is used to compare different sounds. Applying firm pressure on the chest piece prevents interference from outside during auscultation.

Correct Blood Pressure Cuff Size

To ensure accuracy with a blood pressure reading, use the correct cuff size. Be sure the cuff covers two-thirds of the length of the upper arm or leg. • In choosing cuffs, use an appropriately sized one. • A cuff of proper size covers two-thirds of the length of the upper arm or leg. • If a cuff of the correct size is not available, use an oversized cuff rather than an undersized one, or use another site that more appropriately fits the cuff size. • Do not choose a cuff based on the name of the cuff (e.g., an "infant" cuff is too small for some infants).

After the dental checkup of a 9-year-old child, the health care provider advises the child to reduce the intake of sugary foods. Which rationale supports this advice?

To prevent tooth decay or dental caries. RT: Ingestion of sugary foods may cause tooth decay or dental problems as a result of changes in the pH of the oral cavity.

A nurse observes that a hospitalized child is not eating, is crying for the parents, and is uncooperative. The nurse recognizes that this behavior raises concerns about separation, loss of control, and fear of pain and bodily harm. A child of which age level would typically demonstrate these esponses?

Toddler. RT: Separation from parents is a major issues for toddlers. They are concerned with loss of control and loss of routine and rituals. They fear pain and bodily injury. These fears manifest as lack of cooperation, not eating, crying for parents, verbal and physical attacks, despair, uncommunicativeness, temper tantrums, and resistance. Infants demonstrate less dramatic responses than toddlers. They tend to develop distrust and anxiety. The parent's presence is very useful. Preschoolers may show anger at parents, act out, withdraw, be aggressive, or demonstrate immature behavior. School-age children may regress, display anger, or withdraw. They may become lethargic, spending much of their time sleeping or watching TV. They are concerned with lack of body control and mastery or may feel inadequate. They may be rebellious or demanding to try to get control back.

Social Media Use

Top Social Media Platforms for Teens % of all teens 13 to 17 who use: Facebook 71% Instagram 52% Snapchat 41% Twitter 33% Google+ 33% Vine 24% Tumblr 14% Different social media site 11%

Accessory Structures of skin

Tufts of hair anywhere along the spine, especially the sacrum, are significant because they sometimes mark the site of spina bifida occulta

Which measurement of the body temperature is insensitive in detecting fever in a 2-year-old patient?

Tympanic membrane. The hypothalamus is responsible for temperature regulation and is situated in close proximity to the ear; hence, the tympanic membrane of the ear is the most desirable area, reflecting true body temperature. But, because the ear probes are too large to be placed correctly in the pediatric ear canal, these procedures are considered to be fairly insensitive in children younger that 3 years.

Papoose board

Type of restraining device that holds a pediatric patients hands, arms, and legs still

A mother tells the nurse, "I feed my infant with cow's milk, because breast milk is not sufficient." Which data would the nurse collect in the infants?

Urinary output. RT: Cow's milk contains a high quantity of minerals and proteins, which strain an infant's kidney function. The nurse should therefore assess the child's urinary output. Lesion is the anal are occur due to parasitic infections, which are not promoted by cow's milk. Blood pressure in infants varies during crying or due to congenital heart disease. It is not related to the consumption of cow's milk. Yellow discoloration of the skin or the nails may be caused by the increased bilirubin levels, in the body, which are not caused by cow's milk.

Because pain is often underestimated in children, how will the nurse best assess a child's pain?

Use accepted pain assessment tools, such as the Wong-Baker FACES scale. RT: Assessment tools allow the child to illustrate the level of pain being experienced. Being engaged in playing or reading does not mean that the child is not experiencing pain. Facial expressions are not always a good indicator as to whether a child is experiencing pain. Changes in vital signs are not always an indicator of pain; they can mean other problems are occuring.

Because pain is often underestimated in children, how will the nurse best assess a child's pain?

Use accepted pain assessment tools. RT: Assessment tools allow the child to illustrate the level of pain being experienced. Being engaged in playing or reading does not mean that the child is not experiencing pain. Facial expressions are not always a good indicator as to whether a child is experiencing pain. Changes in vital signs are not always indicators of pain; they can mean other problems are occurring.

Assessment of Body Systems

Use of developmental and chronologic age as the main criteria for the choice of method to assess each body system accomplishes several goals: • It minimizes stress and anxiety associated with assessment of various body parts. • It fosters a trusting nurse-child-parent relationship. • It allows for maximum preparation of the child. • It preserves the essential security of the parent-child relationship, especially with young children. • It maximizes the accuracy and reliability of assessment findings.

Which information about child restraints and seat belts should the nurse share with parents?

Use only infant car seats designed according to federal guidelines Infants, birthweight to 20 lb: rear-facing safety seats secured in the rear seat. Children, greater than 40 lb: secured in booster seat with lap and shoulder belts.

Calculation of Normal Blood Pressure

Use the following quick formula to calculate normal systolic blood pressure: • 1 to 7 years: Age in years + 90 mm Hg • 8 to 18 years: (2 × Age in years) + 83 mm Hg Use the following quick formula to calculate normal diastolic blood pressure: • 1 to 5 years: 56 mm Hg • 6 to 8 years: Age in years + 52 mm Hg

The nurse uses many communication strategies when talking with children. Which strategies would be appropriate for the pediatric nurse?

Using a calm, unhurried voice in a positive way to give directions or information. Avoid phrases that may be misinterpreted or provide more information than the child can understand. As a general guide, use sentences whose sum of words is equal to the child's age in years plus one. RT: Using a calm, unhurried voice helps build a trusting relationship to foster cooperation. Avoiding complicated phrases helps the nurse to speak at the child's stage of development. Speaking in sentences with the number of words equal to the child's age in years, plus one, helps build the patient-nurse relationship. Choices should be offered when options exist, but often with medical procedures and treatments, there is not an option. It is better to encourage participation in the procedures or treatments. It is important for the nurse to include the child in the communication.

Which of the following techniques should be used to ensure accurate blood pressure monitoring?

Using a cuff with a bladder width that covers at least 40% of the client's upper arm and bladder length that encircles at least 80% of the extremity.

A 3 month old at the clinic is to receive an intramuscular injection. What is the most appropriate site for this injection?

Vastus lateralis muscle RT: The vastus lateralis is the most developed muscle in young infants and is not located near any major nerves or blood vessels. The gluteal muscles should not be used in children younger than age 3 because their gluteal muscles are not developed from walking. The deltoid is too small in children, and the proximity of the brachial vein and artery and the radial nerve makes it a potentially dangerous site. The rectus femoris is a potentially dangerous site due to the proximity of the sciatic nerve and major blood vessels.

Which IM injection site would the nurse use in a 12-month-old child?

Vastus lateralis. The primary site for IM injections are vastus lateralis muscle and the ventrogluteal muscle. The deltoid muscle may be use in children 18 month or older as as site for IM injections but is not recommended in a 1-year-old child. The rectus femoris is not a rectus femoris muscle is not a recommended injection site. The gluteus medius is not recommended injection site in children.

What is the most accurate method to measure urine output in an infant?

Weigh the diaper before and after the infant voids.

What define obesity

a BMI greater than the 95th percentile.

The parent-professional partnership

a powerful mechanism for enabling and empowering families. Parents serve as respected equals with professionals and have the right to decide what is important for themselves and their family. The professional supports and strengthens the family's ability to nurture and promote family development.

Pallor

a sign of potential anemia, chronic disease, edema, or shock. Compare pallor or cyanosis (bluish tone) against the color change normally produced by blanching, with use of the nonpigmented nail: press down on the free edge of the nail and observe return blood flow.

Homesickness

a similar feeling involving less fear and anxiety that true separation anxiety.

Scoliosis

abnormal lateral curvature of the spine

The inability to engage in health care services can result in

absence or delay in receiving education about healthful practices

Accommodation

adapting our current understandings (schemas) to incorporate new information or experiences. New schemas may also be developed during this process.

Best time to bathe an infant

after feeding

botulism

an often fatal form of food poisoning caused by an endotoxin produced by the bacillus (clostridium botulinum).

baby's first teeth

antipyretic for fever Ice ring teething rings Ped rubbing

Injuries in children

are associated with age, developmental level, and the physical and cognitive skills of the child.

During the male genital examination

assess the external appearance of the glans and the shaft of the penis, the prepuce, the urethral meatus, and the scrotum. Edema, skin lesions, inflammation, or other irregularities are possible signs of underlying disorders, especially sexually transmitted infections (STIs).

fractured femur

at birth is united in 3 weeks, but an 8-year-old with the same type of fracture needs 8 weeks for union, and a 20-year-old takes 20 weeks to heal.

posterior fontanel

back soft spot on fetal skull between parietal and occipital bone. Its triangular shaped.

Time Out: Child

based on the age. 2 years= 2 minutes 4 years = 4 minutes

what age the child is considered a pediatric patient

birth to 21 and not sexually active.

Speech ability is determined

by the child's stage of development, the amount of stimulation or encouragement received from adults, the child's health status, and many other factors. In addition, the development of language does not occur in isolation; it is related to the physiologic, neurologic, and psychosocial progress that is occurring simultaneously. Children learn the complex symbol system of language with astonishing speed.

Professionals enable families by

creating opportunities for all family members to make use of their abilities and competencies and to acquire new ones that are necessary to meet the needs of the child and the family.

mortality

death

Schemas

describes both the mental and physical actions involved in understanding and knowing. Schemas are categories of knowledge that help us to interpret and understand the world.

Use of infant safety seats

designed according to federal safety guidelines: birth to 20 pounds, rear-facing safety seats secured in the rear seat; toddlers 20 to 40 pounds, front-facing safety seats secured in the rear seat; children over 40 pounds, secured in booster seats with lap and shoulder belts per federal safety protocol.

Psychological risk associated with excess weight includes;

discrimination, social stigmatization, lowered self-esteem, social isolation, and feelings of depression and rejection.

Nurses can promote physical activity in the pediatric population by

educating parents, teachers, school administrators, and daycare providers.

Two basic concepts in family-centered care

enabling and empowerment

Professionals empower families to

establish or confirm a sense of control over their lives. Empowerment frees families to foster their own strengths, abilities, and actions and thus enables them to make positive changes in their lives.

check pulse oximetry

every 2 hours or as needed

99th percentile

extremely obese

Other common barriers associated with access to health care

financial, include lack of primary care providers, cultural and spiritual differences, language barriers, discrimination, and concerns about confidentiality

Physical activity and a balanced diet are

for the healthy growth and development of children and adolescents.

development of immunizations against communicable diseases

has significantly reduced the morbidity and mortality associated with many diseases.

A 16-month-old child is admitted to the pediatric floor after surgery to repair a cleft palate. The child's mother asks why her child is restrained. The nurse explains that the elbow SRD is being used to:

help to prevent injury to the operative site.

Physical risks associated with excess weight includes:

high BP & cholesterol, type 2 diabetes mellitus, fatty liver disease, heart disease, stroke, gallbladder disease, arthritis, sleep apnea, & problems breathing.

Healthy People 2020

identified 12 leading health indicators for health promotion and disease prevention.

Psychological benefits of regular physical activity includes

improvement in self-esteem and reduction in stress and depression.

Emotional neglect

include failure to supply affection and attention to the child.

Physical neglect

includes failure to supply a child with adequate food, clothing, shelter, education, or health care.

Regular physical activities increases

increases bone and muscle strength and helps decrease body fat.

The use of electronic media

is a strong presence in the lives of children. The healthful balance of the media and other activities is needed

Access to Health Care

is impacted by the availability of services in a community, as well as individual, family, and community circumstances. Inability to engage in health care services can result in the absence or delay in receiving education about healthful practices. It can cause delays in the diagnosis and treatment of disease.

Factors that contribute to the excess weight carried by children includes;

lack of physical activity, increased fast food consumption, working mothers, and poverty.

Diet and exercise

lay the foundation to maintain health throughout the lifetime. Aid in the prevention of diseases like hypertension, cancer, and heart disease.

Common Measurements: Head circumference

measured in children up to 36 months. Head circumference usually is measured above the eyebrows and pinna of the ears and around the occipital prominence at the back of the skull.

Malocclusion problems

occur because of abnormal eruption of permanent teeth in children of school age.

Malocclusion problems may result from abnormal eruption of;

permanent teeth, leading to irregular spaces between teeth. It is therefore important to screen for malocclusion problems at this age.

Common Measurements: Height

refers to a measurement when a child stands upright.

Common Measurements: Length

refers to measurements taken when children are supine. Until children are 2 years old, recumbent length is measured. Request assistance in holding the child's head in midline while you extend the child's legs to take a measurement.

A child's weight

reflects fluid loss and inadequate calories, especially in the infant and the toddler.

System-based care

restrictions are imposed on the age, number of visitors, and visiting hours.

The most common asymmetry with lateral curvature of the spine in the adolescent is known as ________________.

scoliosis

Speech Communication Process

speaker, message, channel, listener, feedback, interference, situation

Implementation of Family-Centered Care

system-based care are exclusionary policies, such as not allowing family members to stay with their children during a procedure and restricting visiting hours and the number and the age of visitors.

Key elements in evaluation of physical status are vital signs:

temperature, pulse, respiration, and blood pressure. (For best results taking vital signs of an infant, count respirations first, before the infant is disturbed; take pulse second, and temperature last.)

What reflects physical activities in childrens

the adults in their environment. Positive role modeling promote healthy living.

body surface area BSA

the area of the external surface of the body. used to calibrate nutritional requirements, drug dosage and expected pulmonary function measurements.

acoustic stethoscope

the head picks up sounds that are transmitted through hollow tubing to the ears.

possible indication of deafness or hearing impairment

the lack of babbling or the inability of a 9-month-old to imitate sounds. All babies make verbal sounds until 6 or 7 months of age, but then the child who is unable to hear decreases these verbalizations in favor of gesturing or some expression of body language (or nonverbal communication)

Equilibration

the process by which children (or other people) balance assimilation and accommodation to create stable understanding. helps explain how children can move from one stage of thought to the next.

According to Hockenberry and Wilson (2015), "The major goal of pediatric nursing

to improve the quality of healthcare for children and their families." Attained with improvements with immunization rates, nutrition counseling, teen pregnancy prevention, and improved oral health.

nursing bottle caries

tooth decay resulting from prolonged drinking from the bottle after infant has been put to bed; when the milk, juice, or other fluids is allowed to bathe the teeth, thus providing sugar to oral bacteria for growth.

Stool of breast-fed baby

typically light mustard color, grainy in texture, and runny in consistency.

Stethoscopes

used to auscultate (listen to) a variety of sounds generated within the body.

Examination of female genitalia

usually is limited to the inspection and palpation of external structures

Erythema

usually is the result of increased temperature, local inflammation, or infection. Normal skin texture in the young child is smooth, soft, and slightly dry to the touch.

Stools of formula-fed baby

usually tan, yellow, or light brown in color and firmer than that of the breast-fed baby.

Safety Alert Adolescent

• Adolescents feel indestructible and tend to be more prone to deliberate (suicide) or nondeliberate accidents, such as in the use of guns, drugs, or motor vehicles. • Emphasize and encourage safe pedestrian behavior. • At night, walk with a friend. • Do not walk in secluded area; take well-traveled walkways. • Provide competent driver education; encourage judicious use of vehicle; discourage drag racing, "playing chicken"; maintain vehicle in proper condition (e.g., brakes, tires). • Teach and promote safety and maintenance of two-wheeled vehicles. • Promote use of seatbelts. • Promote and encourage wearing of safety apparel, such as helmet or long pants, when skateboarding and bike riding. • Reinforce the dangers of using drugs, including alcohol, when operating a motor vehicle. • Teach nonswimmer to swim. • Teach basic rules of water safety; stress the need to make sure water is of sufficient depth for diving. • Reinforce proper behavior in areas that involve contact with burn hazards (gasoline, electrical wires, fires). • Advise regarding excessive exposure to natural or artificial sunlight (ultraviolet burn); encourage use of sunscreen. • Discourage use of all tobacco products. • Educate in hazards of drug use, including alcohol. • Promote acquisition of proper instruction in sports and use of sports equipment. • Instruct in safe use of and respect for firearms and other devices with potential danger (e.g., power tools, fireworks).

Health Promotion Characteristics of the Adolescent

• Adolescents need to be more independent and vacillate between independent and dependent roles, which may be reflected in mood swings. • Concern about body image, looks, and clothes increases. • Interest in the opposite sex is heightened. • Adolescents exhibit logical thought and reasoning and often question the values of parents. • Adolescents prefer being with peers to establish identity, spending less time with parents and more time with friends.

Strategies to Promote Dental Health

• Although the rate of caries formation slows during the adolescent years, continuing good dental practices is still important. Adolescence is often when orthodontic appliances are applied to correct malocclusions. Adolescents typically are concerned with body image and often must be reminded of the temporary nature of these devices and their proper use and care.

Guidelines for Effective Auscultation of Lungs

• Be sure the child is relaxed and not crying, talking, or laughing. Record if the child is crying. • Check that the room is comfortable and quiet. • Warm the stethoscope before placing it against the skin. • Apply firm pressure on the chest piece but not enough to prevent vibrations and transmission of sound. • Avoid placing the stethoscope over hair or clothing, moving it against the skin, breathing on the tubing, or sliding fingers over the chest piece, all of which often cause sounds that falsely resemble pathologic findings. • Use a symmetric and orderly approach to compare sounds. • Ask the child to "blow out" the light on an otoscope or pocket flashlight; discreetly turn off the light on the last try so that the child feels successful • Place a cotton ball in the child's palm; ask the child to blow the ball into the air, and have the parent catch it. • Place a small tissue on the top of a pencil and ask the child to blow off the tissue. • Have child blow a pinwheel, a party horn, or bubbles

Children whose growth necessitates further investigation include the following:

• Children whose height and weight percentiles are widely disparate (e.g., height in the 10th percentile and weight in the 90th percentile, especially with above-average skinfold thickness). • Children who fail to show the expected growth rates in height and weight, especially during the rapid growth periods of infancy and adolescence. • Children who show a sudden increase, except during puberty, or a decrease in a previously steady growth pattern.

Risk factors of characteristics of bullies:

• Display aggression • Have friends who bully others • Have limited parental involvement • Are experiencing problems at home • Have difficulty following rules

Strategies to Promote Dental Health

• Eruption of permanent teeth begins during the school-age years. Good dental hygiene and professional dental supervision are especially important during this period. Screening for malocclusion problems that result from abnormal eruption of permanent teeth is also important. Teach or reinforce correct brushing and flossing techniques. Have children brush teeth after meals and snacks and at bedtime. Encourage the child to decrease the ingestion of sugary food.

Strategies to Promote Dental Health

• For preschool children, when the eruption of the deciduous teeth is complete, continued good dental hygiene is important. Parental assistance and supervision is necessary with brushing; also teach parents to perform flossing. Promote continuation of professional dental care and fluoride supplementation. Encourage proper nutrition.

The risk factors for being bullied include the following:

• Have a history of depression • Are viewed by others as not "fitting in" • Are overweight or have some other physical characteristic that makes them stand apart from the rest of the peer group

Key Elements of Family-Centered Care

• Identify and mobilize internal and external strengths. • Access appropriate resources in the extended family and community. • Recognize and enhance positive communication patterns. • Decide on a consistent discipline approach and access parenting programs if needed. • Maintain comforting cultural and religious traditions and sources of healing. • Engage in joint problem solving. • Acquire new knowledge by providing information about a specific health problem or issue. • Become empowered. • Allocate sufficient privacy, space, and time for leisure activities. • Promote health for all family members during times of crisis.

Strategies to Promote Dental Health

• Initiate fluoride supplementation at 6 months of age if the water in the infant's residential area is not fluoridated. Fluoride supplementation no longer is recommended for infants under 6 months of age. •Encourage proper nutrition during infancy and childhood to promote good dental health. Avoid, or use sparingly, food with concentrated sugars. In addition, advise against use of honey during the first year of life because some cases of infant botulism (an often-fatal form of food poisoning caused by an endotoxin produced by the bacillus Clostridium botulinum) have been associated with it. Other foods associated with an increased incidence of dental caries include molasses, corn syrup, and dried fruits such as raisins.

Foreign Body Aspiration Prevention Strategies

• Keep small objects and toys away from infants and young children, who are developmentally unable to obey restrictions. Small children may place small objects in the nose or the ear, causing obstruction. • Inform parents of the dangers of round foods to children too young to chew these foods properly; they are acceptable to introduce when the child is older. • When administering medications via syringe, stress to parents the need to remove the cap first. • Encourage parents to choose one-piece pacifiers that do not come apart and cause aspiration. Have the parents check the pacifier frequently by pulling on the nipple. If it becomes separated from the shield, it is to be discarded.

Preventions for accidental burns and injuries

• Keep the hot water heater set at no more than 120°F (49°C). • Turn all pot handles on the stove toward the back of the stove. • Keep hot objects, such as cigarettes, coffee pots, and hot liquids or foods, out of the reach of small hands. • Remove hanging tablecloths and electrical cords, especially around children who crawl or walk. • Teach older children safe cooking methods and emphasize that it is never acceptable to wear loose clothing near the stove or other heat source (e.g., fireplace, wood-burning stove). • Use guardrails or guards around fireplaces, space heaters, and other heating sources. • Use and maintain smoke detectors in the home. • Keep electrical wires hidden and out of the reach of children. • Use plastic caps to cover electrical outlets. • Keep small, hot appliances such as curling irons and steam irons out of the reach of children. • Keep a fire extinguisher in the home and know how to operate it. • Use a cool mist rather than a hot mist vaporizer. • Use a hat and sunscreen on children when outdoors, especially during peak sun hours. • Teach older children the potential of burn hazards, such as gasoline, matches, barbecue grills, candles, and fireworks (e.g., Roman candles). • Have parents map out an escape route in the home and practice fire drills with family members. • Keep the telephone numbers of the fire and rescue squads near the telephone (911 in most areas). Teach small children "nine-one-one" (911), because how to dial nine-eleven is not necessarily a concept they are able to grasp.

Safety Alert Infant

• Keep your hands on the infant at all times when crib rail is down. • Use an infant car safety seat restraint that has been federally approved. • Always place an infant who weighs less than 20 pounds (9 kg) or who is younger than 1 year of age in a rear-facing child safety seat in the back seat of the automobile. Never place an infant in the front seat of a vehicle. a • Leave no gaps between crib side and mattress. • Place infants on the back to sleep. The risk of sudden infant death syndrome (SIDS) is increased in infants placed in side-lying or prone position. • Check all toys for small parts to reduce risk of choking or wounds. • Support head, and shield head from injury. • Do not prop bottle. • Place infant in upright position when feeding solid foods. • Use clean bowl and spoon to feed, and do not feed directly from jar; this prevents contamination of food. • Never leave infant unattended in or near water. • Never, under any circumstances, leave infant unsupervised in bathtub. • Apply a sunscreen when infant is exposed to sunlight (year round).

clinical situations allow for the use of SRDs:

• Maintenance of oxygen therapy without interruption • Protection from harm if child has an indwelling catheter, IV tubes, pacemaker wire, or sutures • Patients who are confused, agitated, or unable to comprehend instructions

Electronic Nicotine Delivery Systems [ENDS]

• More than 3 million middle and high school students were current users of e-cigarettes in 2015, up from an estimated 2.46 million in 2014. • 16% of high school and 5.3% of middle school students were current users of e-cigarettes in 2015, making e-cigarettes the most commonly used tobacco product among youth for the second consecutive year. • During 2011 to 2015, e-cigarette use rose from 1.5% to 16.0% among high school students and from 0.6% to 5.3% among middle school students. • In 2013-2014, 81% of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use.

Prevention of accidental poisoning

• Never refer to medicines as candy; medicines are drugs. Store them with childproof caps, and keep them out of reach or in a locked cabinet. • Place cleaning supplies and other toxic substances, including batteries, up high and out of reach of curious youngsters or in a locked cabinet. • Do not keep large quantities of toxic agents (e.g., pesticides, cleaning fluids, drugs) in the home. • Inspect the home for possible sources of lead contamination, including lead-based paint on windowsills, stair rails, and door moldings and peeling wall paint. • Keep toxic plants out of reach of small hands. • Remember that many grandparents take medications, and they, too, need to keep them in a locked cabinet or up high and out of the reach of children. Keep purses out of the child's reach. • Educate older children and adolescents about the dangers of drugs and alcohol.

Guidelines for Pediatric Physical Assessment

• Perform examination in appropriate, nonthreatening area: • Have room well lit and decorated with neutral colors. • Have room temperature comfortably warm. • Place all strange and potentially frightening equipment out of sight. • Have some toys, dolls, stuffed animals, and games available for child. • If possible, have rooms decorated and equipped for children of different ages. • Provide privacy, especially for school-age children and adolescents. • Provide time for play and becoming acquainted. • Look for behaviors that signal child's readiness to cooperate: • Talking to nurse • Making eye contact • Accepting offered equipment • Allowing physical touching • Choosing to sit on examining table rather than parent's lap • If you observe no signs of readiness, use the following techniques: • Talk to patient; gradually focus on a favorite object, such as a doll. • Make complimentary remarks about child, such as appearance, dress, or a favorite object. • Tell a funny story or play a simple magic trick. • Have a nonthreatening "friend" available, such as a hand puppet, to "talk" to child for the nurse. • If child refuses to cooperate, use the following techniques: • Assess reason for uncooperative behavior; consider that a child who is unduly afraid has perhaps had a previous experience that was traumatic. • Try to involve child and parent in process. • Avoid prolonged explanations about examining procedure. • Use a firm, direct approach regarding expected behavior. • Perform examination as quickly as possible. • Have attendant gently restrain child. • Minimize any disruptions or stimulations: limit number of people in room; use isolated room; use quiet, calm, confident voice. • Begin examination in a nonthreatening manner for young children or children who are fearful: • Use approaches such as "Simon says" to encourage child to make a face, squeeze a hand, stand on one foot, and so on. • Use "paper-doll" technique: 1. Lay child supine on an examining table or floor that is covered with a large sheet of paper. 2. Trace around child's body. 3. Use body outline to demonstrate what will be examined, such as drawing a heart and listening with the stethoscope before performing the activity on child. • Involve child in examination process: • Provide choices, such as sitting on the bed or the chair. • Allow child to handle or hold equipment. • Encourage child to use equipment on a doll, family member, or examiner. • Explain each step of the procedure in simple language. • Examine child in a comfortable and secure position: sitting in parent's lap; sitting upright if in respiratory distress. • Proceed to examine the body in an organized sequence (usually headto-toe) with the following exceptions: examine painful areas last; in emergency situation, examine vital functions (airway, breathing, and circulation) and injured area first. • Reassure child throughout examination, especially about bodily concerns that arise during puberty. • Discuss findings with family at end of examination. • Praise child for cooperation during examination; give reward such as small toy, stickers, or sucker.

General strategies to consider when talking with children include the following:

• Use a calm, unhurried, and confident voice. • Speak clearly, be specific, and use as few words as possible. As a general guide, use sentences whose sum of words is equal to the child's age in years plus one. • State directions and suggestions in a positive way; for example, say, "You need to stay very still, " rather than, "Don't move." • Because children see things only in relation to themselves and from their viewpoint, focus communication on them. • After greeting the child, continue to talk to the child and the parent while pursuing activities that do not involve the child directly. • Use play as a strategy for getting to know the child. For example, if the child has a doll or a stuffed animal, begin by speaking to the toy. Then, initiate conversation with the child by asking simple questions about the toy. • Listen to and observe the child at play. Often children express important information, such as complicated or difficult feelings, through this familiar medium. • Look for opportunities to offer the child choices, but 2345 offer them only when they really exist. (Children are confused by choices being offered when there actually are none.) For example, when a child needs to change into a gown, a statement such as, "I need your dress off so that I can listen to your chest. Shall I help you take it off?" gives the child an explanation, a choice, and some control. • Be honest with children. However, be careful about creating overly scary impressions. Instead of saying, "This will hurt" before a procedure, it is better to prepare the child with a statement such as, "Children tell me different things about how this feels. Some say it feels like a cat or dog scratching. Afterward, will you tell me what it felt like for you?" • Use direct and concrete communication with young children because they are unable to work with abstractions or to separate fact from fantasy. For example, they attach literal meanings to such common phrases as "a frog in the throat" or "hold your horses." • Avoid use of a phrase that is open to a young child's misinterpretation. For example, the statement, "Let's see how warm your body is, " is preferred to "Let's take your temperature, " because young children may wonder what you are going to do with their temperature once you have it and whether you are planning to give it back. Words such as "shot" are frightening if a child envisions a shot from a gun. Instead substitute "putting some medicine under the skin." • Children between 5 and 8 years want concrete explanations and reasons for everything because they rely more on what they know than what they see when 2346 faced with new problems. Continue to use relatively simple explanations, remembering that their expanding vocabulary facilitates communication.

Safety Alert Toddler and Child

• Use a toddler car safety seat restraint that has been federally approved; the safety seat restraint can be switched to forward facing once the child weighs more than 20 pounds and is older than 1 year. a • Use car booster seats, also known as belt-positioning devices, for children less than 4 feet 9 inches tall and weighing more than 40 pounds, typically between 4 and 8 years. • Never leave toddler unattended in vehicle or shopping cart. • Protect from falls, burns, and collisions with objects that result from running and climbing. • Use washable toys without small parts or sharp edges. • Supervise closely when near any source of water. • Never leave unsupervised in a bathtub. • Cover electrical outlets with protective plastic caps. • Do not allow toddler or child to play on curb or behind a parked car. • Supervise tricycle and bicycle riding; have child wear helmet. • Teach child to obey pedestrian safety rules. • Never leave infant or toddler unattended in high chair. • Supervise at playgrounds; select safe play areas. • Apply a sunscreen when toddler or child is exposed to sunlight (year round). • Stress danger of open flames. • Always check bath water temperature; adjust water temperature to 120°F (48.9°C) or cooler (infants, toddlers, children). • Place all potentially toxic agents out of reach or in a locked cabinet. • Discard all unused refrigerators, ovens, and other appliances; if storing an old appliance, remove door. • Keep venetian blind cords out of reach of a toddler or child. • Teach child to never go with strangers. • Teach child to tell parents if anyone makes child feel uncomfortable in any way.

Car safety guidelines:

• Use infant car seats designed according to federal safety guidelines: • Birth to 20 pounds: Rear-facing safety seats secured in the rear seat. • Toddlers 20 to 40 pounds: Front-facing safety seats secured in the rear seat • Children more than 40 pounds: Secured in booster seats with lap and shoulder belts. The properly fitted shoulder belt lies across the chest, and the lap belt sits below the hip bones to prevent internal injuries in the event of a vehicular accident. • Teach the child pedestrian safety: "Stop, Look, Listen" at crosswalks; use sidewalks; wear light-colored clothing at night. • Supervise children when playing outdoors—no playing at the curb or behind parked cars. • Insist that the child wear an approved helmet when riding tricycles, bicycles, scooters, mopeds, and skateboards Protective wrist, elbow, and knee pads are necessary during play involving skateboards and while roller-skating or in-line skating. • Reinforce the danger of using drugs or alcohol when driving, and insist that no child ride in a car with a person who has been drinking alcohol or using drugs. • Emphasize rules for safe driving with the adolescent driver.

Considerations when weighting a child

• Use the same scale and weigh the child at the same time every day. • Perform weight measurements in a warm room. • What children wear and what is attached to them affects weight. • If equipment has been added or removed, document this on the graphic sheet. • Usually older children are weighed with underpants or a light gown

Health Promotion Characteristics of the Infant

• Weight doubles by 6 months and triples by 1 year. • Vision at birth is approximately 20/400; by 12 months, vision is 20/100. • Play requires stimulation activities that involve motor skills, language, and social skills. • Infants like toys that bang, shake, or can be pulled and enjoy playing "peek-a-boo." • Infants like verbal praise and encouragement. Guidance • Encourage parents to not use baby talk but to instead pronounce words correctly. • Sleep usually is established by the spacing of feedings. Encourage parents to give care during awake times either before or after feedings.

Health Promotion Characteristics of the Toddler and Child

• Weight gain from 1 to 3 years is about 5 pounds per year. The weight is usually four times the birth weight by 3 years of age. • This period consists of intense activity and exploration. • The toddler or child takes 1 or 2 naps a day and sleeps up to 9 to 12 hours a night. • Bowel and bladder control usually are achieved by 3 years of age. • The toddler or child practices parallel play. • Cognition regarding thinking and reasoning is based on magical or egocentric processes. • The toddler or child experiences physiologic anorexia, which causes the child to either binge or be picky depending on individual growth spurts and plateaus. Guidance • Recommend milk as a drink of choice because of increased needs for calcium. Milk should be fat free or low fat to avoid a large number of "empty calories." Lactose-free milk and soymilk are available for those who are lactose intolerant.

Measurement of Triceps Skinfold Thickness

• With child's right arm flexed 90 degrees at elbow, mark midpoint between acromion and olecranon on posterior aspect of arm. • With arm hanging freely, grasp a fold of skin between thumb and forefinger 1 cm above midpoint. • Gently pull fold away from underlying muscle and continue to hold through the remaining steps until measurement is completed. • Place caliper jaws over skinfold at midpoint mark; if a plastic catheter (e.g., Ross Adipometer) is used, apply pressure with thumb to align lines on caliper; follow directions for use of other calipers. • Estimate reading to nearest millimeter, 2 or 3 seconds after applying pressure. • Take measurements until you obtain two readings that agree within 1 mm.

Health Promotion: Encouraging Healthy Behaviors in Toddler and Child

•Encourage a healthy diet to include high-nutrient foods such as fruits, vegetables, whole grains, and low-fat dairy and protein products [child and adolescent]. •Continue to provide health care, including immunizations and dental care. •Encourage developmentally appropriate play. •Remember that autonomy and initiative are paramount, and offer toddler and child choice of nutritionally dense foods. •Teach parents and child appropriate methods for good hygiene, such as handwashing and covering mouth when coughing or sneezing. •Mandate use of seatbelts while riding in vehicle: •Toddler, 20 to 40 pounds: Front-facing safety seat secured in rear seat •Child, more than 40 pounds: Secured in booster seat with lap and shoulder belt •Children should wear protective helmets when riding tricycles and bicycles. •Maintain immunization schedule as recommended.

Health Promotion: Encouraging Healthy Behaviors in the Infant

•Encourage parental bonding. •Monitor growth and development through well-baby clinic appointments. •Encourage breast-feeding, if appropriate. •Use prescribed baby formula to provide necessary nutrients and vitamins. •Introduce baby foods as recommended. Begin with rice cereal and introduce one new food per week to monitor for allergic reactions. •Monitor transitioning stools as the gastrointestinal system matures. •Provide age-appropriate play to encourage physical and mental development. •Transport infant in child carrier that faces the rear of the car [birth to 20 pounds]. •Maintain immunization schedule as recommended.

Health Promotion: Encouraging Healthy Behaviors in Adolescent

•Instruct parents to monitor adolescent for use of drugs or alcohol by noting changes in behavior. •Adolescents should wear protective helmets when riding bikes or motorcycles, or when skateboarding. •Provide nutritionally dense foods and snacks to support this period of growth. •Allow privacy in telephone use and interactions with friends. •Allow the child to establish an identity even if it is different from that of the parents. •Insist on mandatory use of seatbelts when in vehicle. •Maintain immunization schedule as recommended. •Encourage dental care. •Encourage safe sun practices: •Teach that the long-term effects of sun exposure, such as tanning, include premature aging of the skin, increased risk of skin cancer, and, in susceptible individuals, phototoxic reactions. •Teach that the long-term effects of tanning machines are similar to those of the sun; dermatologists do not recommend suntanning by this means. •Provide education that the use of sunscreens, including hypoallergenic products, with a sun protective factor [SPF] of at least 15 and a nonalcohol base without lanolin or fragrance is important