PEDS - Exam 1 Pre and Post Quizzes
The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child?
The newborn does not respond to loud noise. Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should response to noices.
Cleft Lip questions
Preventing injury to the suture line Primary or permanent teeth may be missing, malformed, or unusually positioned Special feeding devices with long nipples usually are used, and the infant is fed in the sitting position to avoid aspiration. Some soft restrains may be used to prevent the infant from touching the suture line.
Gross Motor skills at 5 months
Rolls from supine to prone and back again Sits with back upright when supported
Gross Motor skills at 7 months
Sits alone with some use of hands for support
Several ways that the smaller airway puts the child at greater risk for obstruction and a compromised airway.
The young child's neck is shorter than an adult's, resulting in airway structures that are closer together. The child's airway is not only shorter, it is also narrower than an adult's. These differences create a greater potential for obstruction. The infant's airway is approximately 4 mm (0.16 in.) in diameter, about the width of a drinking straw, in contrast to the adult's airway diameter of 20 mm (0.8 in.). The trachea primarily increases in length rather than diameter during the first 5 years of life. The child's little finger is a good estimate of the child's tracheal diameter. The child's trachea divides into two bronchi at a higher and different angle than an adult's. So the trachea is shorter and the angle of the right bronchus at bifurcation is more acute than in the adult. Why is this important to know? Answer: The nurse must allow for these differences when resuscitating or suctioning.
Fine motor skills at 7 months
Transfers object from one hand to the other
The nurse is teaching a prenatal class about respiratory infections. Which statement by a parent indicates that further teaching is necessary?
a) When a newborn has a stuffy nose, he will be okay because newborns are obligatory mouth breathers. Newborns are obligatory nose breathers. The only time newborns breathe through the mouth is when they are crying. The other statements by the parent are correct.
Bacterial pneumonia is suspected in a 4-year old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? a) Fever b) Pale skin color c) Tachypnea with retractions d) Oxygen saturation level of 96%
c) Tachypnea with retractions
Gross motor skills at 8 months
sits unsupported
The nurse is assessing the psychosocial development of a preschooler. What are normal activities characteristic of the preschooler?
A) Acts out roles of other people B) Initiates activities with others C) Plans activities and makes up games
The nurse is caring for a 7 year old who will be in the hospital for several weeks. Which action by the nurse will facilitate the child's psychosocial development? SATA A) Allow the child's peers to visit often. B) Ask the child what color gown he or she prefers to wear daily. C) Encourage the child to complete school work and provide guidance. D) Discourage parent from providing comfort toys that were used in preschool years
A) Allow the child's peers to visit often. B) Ask the child what color gown he or she prefers to wear daily. C) Encourage the child to complete school work and provide guidance.
Which anatomic differences place the infant at risk for respiratory compromise? SATA A) The nasal passages are narrower B) The trachea and chest wall are less compliant C) The bronchi and bronchioles are shorter and wider D) The larynx is more funnel shaped E) The tongue is smaller. F) There are significantly fewer alveoli
A) The nasal passages are narrower D) The larynx is more funnel shaped F) There are significantly fewer alveoli These anatomic difference place the infant at higher risk for respiratory compromise: -nasal passages are narrower -the trachea and chest wall are more compliant -the bronchi and bronchioles are shorter and narrower -the tongue is larger -significantly fewer alveoli
Why is the angle of the right bronchus significant in foreign-body aspiration?
Answer: Since the angle of the right bronchus at bifurcation is more acute (sharper angle), a foreign body is more likely to become lodged at that angle, causing obstruction. As well, the airway can be more easily compressed because the cartilage supporting the trachea is more flexible than an adult's. When airway inflammation is present, the child's narrower airway causes an increase in airway resistance (the effort or force needed to move oxygen through the trachea to the lungs is greater.
The nurse is teaching a prenatal class about respiratory infections. Which statement by a parent indicates that further teaching is necessary? a) "When my newborn has a stuffy nose, he will be okay because newborns are obligatory mouth breathers." b) "Children's narrower airways cause them to breathe harder when they are congested." c) "The only time a newborn breathes through the mouth is when he's crying." d) "I should keep my newborn's nose clean so he can breathe and eat without difficulty."
Answer: a. "When my newborn has a stuffy nose, he will be okay because newborns are obligatory mouth breathers." Rationale: Newborns are obligatory nose breathers. The only time newborns breathe through the mouth is when they are crying. The other statements by the parent are correct.
Chronic Issues in Pediatrics?
Asthma Cystic Fibrosis
Which patient finding would the nurse identify as a factor leading to increased risk for impaired gas exchange? A) Anticoagulant therapy for 10 days B) Blood glucose of 350 mg/dL C) Hemoglobin of 8.5 g/dL D) SaO2 greater than 95%
C) Hemoglobin of 8.5 g/dL Hemoglobin value is low (anemia). Therefore, the ability of the blood to carry oxygen is decreased, leading to an increased risk for impaired gas exchange. High blood glucose and/or anticoagulants do not alter the oxygen-carrying capacity of the blood. Adequate ventilation is apparent when the oxygen saturation (SaO2) value is between 95-100%. This indicates oxygen is being effectively transported by hemoglobin to the cells.
The Child With Alterations in Respiratory Function
Children have a significantly higher metabolic rate than adults. Their resting respiratory rates are faster and their demand for oxygen is higher. Adult oxygen consumption is 3 to 4 L/min, while infants consume 6 to 8 L/min. In any situation of respiratory distress, infants and children will develop hypoxemia more rapidly than adults
The nurse is assessing the gross motor skills of an 8-year old boy. Which interview question would facilitate this assessment?
Do you participate in any sports?
What are examples of assessment findings that would lead the nurse to conclude that further evaluation of developmental level is indicated?
Does not smile in response to people When on back, keeps knees flexed and flat out to each side Raises head but not chest when lying on stomach Keeps hands in fists Seems disinterested in people Make sounds consisting of crying and grunting Hand and eyes are uncoordinated
What are clinical manifestations of Severe Hypoxia and Imminent Respiratory Arrest
Dyspnea Bradycardia Cyanosis Stupor and coma
A nurse is teaching the parents of 2 year old some methods of dealing with their child's "negativism". Based on Erikson's theory of development, what would be an appropriate intervention for this child?
Encourage the child to pick out his own clothes. Erickson defines the toddler period as a time of autonomy versus shame and doubt. It is a time of exerting independence. Allowing the child to choose his own clothes helps him to assert his independence. Negativism and always saying "no" is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. It should not be punished with "time-outs". The toddler should be encouraged to play alone and with other children. Toddlers cannot take turns in games until age 3.
Fine motor skills develop in a cephalocaudal fashion?
False. Fine motor skills develop in a proximodistal fashion (from the center to the periphery). Rationale: Gross motor skills develop in a cephalocaudal fashion (from the head to the tail).
A colorful simple board game that requires multiple players to cooperate with each other for a common goal would be the best type of toy for toddlers.
False. Toddlers tend to engage in parallel, solitary play and are not likely to cooperate in a group game situation because of their basic egocentric nature. Rationale: The best toys for toddlers are familiar household items, child-size household items, blocks, cars, plastic figures, stuffed animals, dolls, doll beds, and carriages. Manipulative toys with knobs and buttons that make things happen, shapes to insert into matching holes, puzzles, chalk, buckets and shovels, and floating toys are also recommended. Appropriate gross motor toys include gyms, tricycles, pull toys, and wagons.
Gross Motor skills at 4 months
Lifts head and looks around, rolls from prone to supine
What factors impact growth and development?
Malnutrition can have a significant effect on lung development, decreasing both lung function and lung size. decreased energy intake and increased energy expenditure.
Respiratory Failure Signs and Symptoms
Nasal flaring Retractions Grunting Wheezing Anxiety irritability Mood changes Headache Hypertension Confusion
The Child With Alterations in Respiratory Function
Newborns are obligatory nose breathers. The only time newborns breathe through the mouth is when they are crying! Infants up to 2 to 3 months of age do not automatically open the mouth to breathe when the nose is obstructed. Keep the newborn's nasal passages patent for such activities as breathing and eating. ***** Newborns are preferential nose breathers until at least 4 weeks of age. The young infant cannot automatically open his or her mouth to breathe if the nose is obstructed. The nares must be patent for breathing to be successful while feeding. Newborns breathe through their mouths only while crying. The upper respiratory mucus serves as a cleansing agent, yet newborns produce very little mucus, making them more susceptible to infection. However, the newborn and young infant have very small nasal passages, so when excess mucus is present, airway obstruction is more likely.
Anatomy and Physiology of the Child's Nose and Throat
Nose •Infants: •Obligate nose breathers •Produce very little mucus •More susceptible to infections •Sinuses are not developed •Newborns: •Very small nasal passages •More prone to obstruction Throat—increased risk for airway obstruction •Infants' tongues larger in relation to oropharynx •Children have enlarged tonsillar and adenoid tissue
What is the main CONCEPTS related to Respiratory Function?
OXYGENATION TISSUE PERFUSION GAS EXCHANGE
What developmental milestones will the nurse check for at the 7-month well-baby visit to the clinic?
Social and Emotional Enjoys social play Interested in mirror images Responds to other people's expressions of emotion, and often appears joyful Movement Rolls both ways (front to back, back to front) Sits with and then without support on hands Supports whole weight on legs Reaches with one hand Transfers objects from hand to hand Uses hand to rake objects Vision Develop full color vision Distance vision matures Ability to track moving objects improves Language Responds to own name Begins to respond to "no" Can tell emotions by tone of voice Responds to sound by making sounds Uses voice to express joy and displeasure Babbles chains of sounds Cognitive Finds partially hidden object Explores with hands and mouth Struggles to get objects that are out of reach
A nurse is assessing a 3 year old at a well child visit. Which developmental milestones would the nurse expect to assess? SATA
Stack tower of blocks Undresses self without difficulty
The school nurse is conducting a seminar for parents of adolescents on how to communicate with teenagers. Which guidelines might the nurse recommend? SATA
Talk face to face and be aware of body language Don't pretend you know all the answers Ask questions to see why he or she feels the way they do
The preschool period is the period between 3 and 6 years of age. What are Piaget and ERickson's stages?
a) Piaget's Theory of Cognitive Development - preoperational stage b) Erickson's Theory of Psychosocial Development - Initiative versus guilt
Dyspnea can progress to respiratory distress? a) True b) False
a) True
The nurse is watching toddlers at play. Which typical behavior would the nurse observe?
Toddlers engage in parallel play. Toddlers are egocentric, a normal part of their development (Piaget). This makes it difficult for them to share. As they are developing a sense of self (who they are as a person). They may see their toys as an extension of themselves. Toddlers also like dramatic play and play that recreates familiar activities in the home. Infants engage in solitary play.
Respiratory distress can progress to respiratory failure? a) True b) False
a) True
The nurse should anticipate which patient will need to be treated with the insertion of a chest tube?
a) A patient with a pneumothorax A patient with a pneumothorax will require a chest tube. When air is allowed to enter the pleural space, the lung will collapse and a chest tube needs to be inserted to remove the air and reestablish negative pressure in the pleural space. Patients with asthma do not require a chest tube. A bronchoscopy is done to evaluate the bronchi and lungs and to obtain a biopsy. A thoracentesis may be done to remove fluid from the pleural space. A chest tube may be inserted if there are complications from the thoracentesis or for the bronchoscopy.
A child is in the emergency department with an asthma exacerbation. Upon auscultation, the nurse is unable to hear air movement in the lungs. What action should the nurse take first?
a) Administer a beta-2 adrenergic agonist When lung sounds are unable to be heard in a child with asthma, the child is very ill. This means there is sever airway obstruction. The air movement is so severe that wheezes cannot be heard. The priority treatment is to administer an inhaled short-term bronchodilator (beta-2 adrenergic agonist). The child may require numerous inhalations until bronchodilation occurs and air can pass through the bronchi. Oxygen can be started, but until the bronchi are dilated, no oxygen can get through to the lung fields. An IV would need to be started and IV steroids administered to reduce the inflammation, but the priority is bronchodilation.
A child has been prescribed a nasal cannula for oxygen delivery. What should the nurse do before applying the cannula? a) Assess patency of the nares b) measure the patient's oxygen saturation level c) add humidification to the delivery device d) assess the lung sounds
a) Assess patency of the nares
What activity would the nurse expect to find in an 18 month old?
a) Climbing stairs with assistance Toddlers continue to progress with motor skills. A 24 month old should be able to stand on his or her tiptoes and carry a large toy while walking. A 36 month old would be able to pedal a tricycle.
The nurse is administering oral glucocorticoids to a patient with asthma. What finding indicates a therapeutic response to the medication? a) No dyspnea over the last 24 hours b) relief of an acute asthmatic attack c) no sputum production, and a decrease in coughing episodes d) a decrease in the amount of nasal drainage and sneezing
a) No dyspnea over the last 24 hours Glucocorticoids (corticosteroids) decrease inflammation and prevent bronchospasm in patient with asthma. The glucocorticoids are used to prevent potential obstruction caused by inflammation. Anticholinergics decrease the allergic response of sneezing and rhinorrhea. Antitussives are used to decrease cough, and mucolytics assist in the removal of mucus. Sympathomimetic agents (B2 agonist) are used to relieve bronchospasm in an acute episode.
Impaired gas exchange can be result of an alteration in ventilation, perfusion and/or transportation of oxygen and carbon dioxide. Which respiratory disorders are an example of an issue with ventilation? SATA a) respiratory syncytial virus b) pulmonary embolism c) pneumonia d) sickle cell anemia e) asthma
a) respiratory syncytial virus c) pneumonia e) asthma The three gas exchange categories are ventilation, transport, and perfusion. Ventilation is the process of inhaling oxygen into the lungs and exhaling carbon dioxide from the lungs. Transport refers to the availability and ability of hemoglobin to carry oxygen from the alveoli to the cells for metabolism and to carry carbon dioxide produced by cellular metabolism from the cells to the alveoli to be eliminated. Perfusion refers to the ability of the blood to transport oxygen-containing hemoglobin to the cells and then return carbon dioxide-containing hemoglobin to the alveoli. Thus, these three categories are different in their roles in gas exchange but are similar in that all involve the movement of both oxygen and carbon dioxide. They depend on one another; without ventilation, there would not be oxygen or carbon dioxide to move or exchange, and without transport and perfusion, gas exchange at the cellular level would not be possible.
Children under age 6 years use their diaphragm to breathe because the intercostal muscles are immature a) True b) False
a) true By 6 years of age, the child uses the intercostal muscles more effectively. When a child is in respiratory distress, the diaphragm movement causes the chest wall to be drawn inward, causing retractions. pg 1149
A nurse explains why a 4-year old presenting with respiratory distress has retractions. Which statement by the parent indicates that the teaching was understood? a) Children breathe primarily with the muscles between the ribs, so when distress occurs, the extra work of breathing causes retractions. b) Children breathe primarily with their diaphragm, but when distress occurs the muscles between the rib cage work with extra effort to move air through narrow airways.
b) Children breathe primarily with their diaphragm, but when distress occurs the muscles between the rib cage work with extra effort to move air through narrow airways. Children <6 years use the diaphragm to breathe because the intercostal muscles are immature. By 6 years of age, the child uses the intercostal muscles more effectively. The ribs are primarily cartilage and very flexible. In cases of respiratory distress, the negative pressure caused by the diaphragm movement causes the chest wall to be drawn inward, causing retractions, seen as sunken areas between the ribs during inspiration Intercostal retractions are seen in mild respiratory distress. Substernal and subcostal retractions are seen, when the severity of respiratory distress increases. Supraclavicular and suprasternal retractions occur as the accessory muscles (sternocleidomastoid and trapezius muscles) are used, when a child is in severe respiratory distress. The child also has fewer glycogen reserves, leading to more rapid muscle fatigue when accessory muscles must be used for breathing
The successful resolution of developmental tasks for the school-child according to Erikson, would be identified by which of the following:
b) Developing a sense of worth and competence Learning from repeating tasks - toddlers Using fantasy and magical thinking to cope with problems - preschoolers Developing a sense of trust - infants
Which is associated with early adolescence? SATA
b) Still at times wants to be dependent upon parents d) is influenced by peers and values memberships in cliques
All of the following are abnormal respiratory findings, indicating impaired gas exchange, except: a) wheezing b) bronchovesicular breath sounds c) stridor d) rhonchi
b) bronchovesicular breath sounds Vesicular "soft sighing" sounds are heard over the peripheral lungs; bronchovesicular "blowing" sounds are heard between the shoulder blades and lateral to the sternum at first and second intercostal spaces, and bronchial sounds are heard on the front of the chest over the trachea.
The mother of two sons, ages 6 & 9, states they want to play on the same baseball team. As the school nurse, what advice would you give their mother?
b) levels of coordination and concentration differ, so the boys need to be on different teams
At which age would the nurse expect to observe the beginning of object permanence?
c) 6 months Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.
A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which finding?
c) children develop hypoxemia more rapidly than adults do. Children develop hypoxemia more rapidly than adult do because they have a significantly higher metabolic rate and faster resting respiratory rates than adults do, which leads to a higher demand for oxygen. A smaller decrease in oxygen saturation reflects a disproportionately much larger decrease inPO2. The bronchi in children are narrower than in adults, placing them at higher risk for lower airway obstruction.
The nurse is examining a 5 year old. Which sign or symptom is a reliable first indication of respiratory illness in children? a) increasing lethargy b) slow, irregular breathing c) a bluish tinge to the lips d) tachypnea (increased respiratory rate)
d) tachypnea (increased respiratory rate)
The nurse is planning a diet for a toddler that is rich in vitamin A. Which of the following foods might the nurse include? a. Avocados b. Corn c. Strawberries d. Carrots
d. Carrots. Carrots are rich in vitamin A. Rationale: Avocados are rich in folate, corn is rich in fiber, and strawberries are rich in vitamin C. Other foods rich in vitamin A include apricots, cantaloupe, spinach, mangos, dark greens, and sweet potatoes.
infant's airway is approximately 4 mm (0.16 in.) in diameter, about the width of a drinking straw, in contrast to the adult's airway diameter of 20 mm (0.8 in.). An inflammatory process in the airway causes swelling that narrows the airway, and airway resistance increases.
when airway inflammation is present, the child's narrower airway causes an increase in airway resistance (the effort or force needed to move oxygen through the trachea to the lungs is greater). The infant must use more effort to breathe and must breathe faster to get adequate oxygen.
Children vs. Adults Lower Respiratory Structures
•Bifurcation of trachea at level of the third thoracic vertebra: important when suctioning or intubating children •Narrower bronchi and bronchioles of infants and children: increased risk for lower airway obstruction •Smaller numbers of alveoli: higher risk of hypoxemia
Risk factors for respiratory disorders
•Prematurity •Chronic illness (diabetes, sickle cell anemia, cystic fibrosis, congenital heart disease, chronic lung disease) •Developmental disorders (cerebral palsy) •Passive exposure to cigarette smoke •Immune deficiency •Crowded living conditions or lower socioeconomic status •Daycare attendance
