Peds Exam 1

Who should the nurse include as the authority when providing education to the parents of a 7-year-old client related to moral development?

Any adult with authority over the child When a school-age child and an adult differ in judging an act, the adult is right.

A nurse in the pediatric clinic is assessing an 8-year-old child who has had asthma since infancy. What clinical finding requires immediate intervention? Audible wheezing Barrel chest Heart rate of 105 beats/min Respiratory rate of 30 breaths/min

Audible wheezing

Which fine motor skill should the nurse expect when assessing the development of an infant between 10 and 12 months of age? 1. Holds a crayon 2. Walking with assistance 3. standing alone 4. sitting from a standing position

Holds a crayon The ability to hold a crayon is a fine motor skill that the nurse should expect when conducting a developmental assessment for an infant between 10 to 12 months of age. Walking with assistance, standing alone, and sitting from a standing position are all gross motor skills the nurse would anticipate for this infant.

A nurse manager is providing a class on cystic fibrosis for the pediatric staff nurses. Physiologic adaptations to cystic fibrosis are a result of which problem?

Pathology of mucus-secreting glands

The nurse is providing care to an infant who is diagnosed with cystic fibrosis (CF). Which parental statement indicates the need for further education related to the potential for poor growth?

"My child will have a poor appetite, which will lead to poor growth." Pediatric clients who are diagnosed with CF experience poor growth despite a healthy appetite and diet; therefore, the parental statement indicates that the infant's poor appetite will lead to poor growth indicates the need for further education. Pediatric clients diagnosed with CF experience poor growth due to delayed bone growth, increased oxygen demands, and a decreased ability to absorb nutrients.

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The mother states that the toddler being seen for the trauma is very active and is difficult, constantly saying no. What would be an appropriate response?

"Toddlers are curious, trying to make decisions and be independent." Toddlers are curious, trying to make decisions and being independent, and learning autonomy, which is a normal developmental stage for this age group. Saying no is the toddler's means of developing independence rather than a need for therapy.

What is the reason for calculating a body mass index (BMI)-for-age during a health maintenance assessment for school-age clients?

Assessing for obesity or overweight There is an increasing number of overweight children in the US and BMI charts are critical assessments Bulimia and anorexia are more for adolescents FTT is for infant, toddler, and preschool age children

Which type of play should the nurse encourage when providing age-appropriate care to a preschool-age child who is hospitalized? 1. Team 2. Parallel 3. Solitary 4. Associative

Associative The nurse should encourage the hospitalized preschool-age client to participate in associative play. Team play is appropriate for the school-age child. Parallel play is appropriate for the toddler-age client. Solitary play is appropriate for the infant.

What is true about the instrumental relativist orientation stage?

During the instrumental relativist orientation stage, an individual finds that there is more than one correct point of view.

Which psychosocial change does a 2-year-old child exhibit?

Engages in temper tantrums

Which pain scale should a nurse use to measure the intensity of pain in toddlers?

FACES scale

Which is an inborn error of metabolism that affects growth and development? 1. Cystic fibrosis 2. Achondroplasia 3. Turner syndrome 4. Hunter syndrome

Hunter syndrome is an inborn error of metabolism that hinders development and results in altered physical appearance and impaired mental development. Cystic fibrosis is a genetic disorder that results in accumulation of mucus in the lungs and pancreas. Achondroplasia is a congenital disorder that is a common cause for the structural defect called dwarfism. Turner syndrome is a chromosomal abnormality associated with webbed neck and low-set ears.

An infant is admitted to the pediatric unit with bronchiolitis caused by respiratory syncytial virus (RSV). What interventions are appropriate nursing care for the infant? Select all that apply. Instilling saline nose drops Limiting fluid intake Maintaining contact precautions Administering warm humidified oxygen Suctioning mucus with a bulb syringe

Instilling saline nose drops Maintaining contact precautions Suctioning mucus with a bulb syringe

The nurse is teaching hygiene practices to a 16-year-old client who has recently had her first menstrual flow. Under which phase of development does the nurse classify the client? 1. Prepubescence 2. Postpubescence 3. Late adolescence 4. Middle adolescence

Middle adolescence There are subphases of adolescence. Middle adolescence occurs between the ages of 15 and 17 years. Prepubescence occurs 2 years before the onset of puberty. However, this client has already achieved puberty and had her first menstrual flow. Postpubescence extends for 1 to 2 years after puberty. The client has recently had her first menstrual flow and is at the point of puberty. Late adolescence occurs between the ages of 18 and 20 years.

During testing of the neurologic reflexes of an infant, which reflex should the nurse expect to appear at 3 months and persist until 24 to 36 months of age?

Neck righting While the infant is supine, if the head is turned to one side, the shoulder, trunk, and finally pelvis will turn toward that side. This reflex appears at 3 months, and persists until 24 to 36 months of age.

According to Freud's theory, in what order do the stages of child development occur?

Oral Anal Oedipal (phallic) Latency Genital

Which period of Piaget's theory explains animism in a child?

Period II - Pre-operational Stage During period II of Piaget's theory, children demonstrate animism, in which they personify objects. During period I, infants develop a schema or action pattern for dealing with the environment. During period III, a child is able to think about an action that previously was performed physically. During period IV, adolescents demonstrate feelings and behaviors characterized by self-consciousness.

The nurse is providing care to an infant who is diagnosed with bronchiolitis. Which breath sounds indicate the infant is experiencing respiratory distress? Select all that apply. Wheezing Grunting Retractions Tachypnea

Wheezing Grunting Tachypnea Wheezing and grunting are adventitious respiratory sounds that indicates respiratory distress in the neonate. Tachypnea is the term used to indicate a respiratory rate of greater than 60 breaths per minute in an infant. While this does indicate respiratory distress, tachynpea is not a type of breath sound. Retractions, or the use of accessory muscles, are indicative of respiratory distress in the neonate, but this is not a type of breath sound.

Which nursing action is most accurate when assessing the chest circumference of a newborn during the initial physical assessment?

Placing the measuring tape around the rib cage at the nipple line

A parent is worried about the infant's excessive dependence on nonnutritive sucking. Which intervention will help decrease this dependence?

Prolong the feeding time

Several hours after admission of a child to the pediatric unit with laryngotracheobronchitis (viral croup), the nurse determines that tachypnea and tachycardia, accompanied by intercostal and substernal retractions and increased restlessness, have developed. What is the priority nursing action?

Reporting the respiratory status to the practitionerReporting the respiratory status to the practitioner

Which stage of development classifies boys and girls as differing very little in terms of size?

School-age During the school-age stage of development, boys and girl differ very little in terms of size. During the toddler, preschool, and adolescence stages of development boys are often larger than girls.

Which period of Piaget's theory describes the idea of object permanence?

Sensorimotor period

Which assessment findings should the nurse expect when caring for a child with cystic fibrosis? (Select all that apply.) Steatorrhea Obesity Foul-smelling stools Delayed growth Pulmonary congestion

Steatorrhea Foul-smelling stools Delayed growth Pulmonary congestion Weight loss, not weight gain, is associated with cystic fibrosis.

The nurse instructs parents to avoid placing their infant in a prone position while sleeping. Which risk does the nurse seek to prevent with this instruction?

Sudden infant death syndrome

Which type of relationship is most important to the school-age child?

same-sex peer relationships

According to the Piaget's theory, which behavior does a nine-year-old child show? 1. Logical reasoning 2. Concrete thinking 3. Object permanence 4. Imaginary audience

2. Concrete thinking

How many days is the neonatal period?

28 days

What developmental skills does a preschooler exhibit? Select all that apply. 1. Personal identity 2. Specific reasoning 3. Increased curiosity 4. Magical thinking 5. Understanding of others

2. Specific reasoning 3. Increased curiosity 4. Magical thinking Preschoolers begin to engage in specific reasoning and become curious. Preschoolers' thinking is often described as magical thinking. Between the ages of 12 and 36 months, toddlers start thinking of the self as separate from the mother. School-age children around the age of 12 years start concentrating on more than one aspect of a situation. They also start understanding different points of view.

The nurse educates the parents of a toddler-age client regarding play and toys appropriate for this stage of development. Which parental responses indicate correct understanding of the information presented? Select all that apply. 1 "We should expect our child to participate in parallel play." 2 "We should provide our child with finger paints to foster creativity." 3 "We should allow our child to watch as much television as she wants." 4 "We should provide our child with toys that foster her imagination, such as a doll." 5 "We should provide our child with toys so that we are able to finish household chores."

1-"We should expect our child to participate in parallel play." 2-"We should provide our child with finger paints to foster creativity." 4-"We should provide our child with toys that foster her imagination, such as a doll." The toddler-age client should participate in parallel play, use finger paints to foster creativity, and play with dolls to foster imagination. The toddler-age client should not be allowed to watch as much television as he wants. The toddler-age child should not be provided toys as a substitute for interaction with parents.

Which physiologic body functions decrease in response to certain pubertal changes? Select all that apply. 1. Pulse rate 2. Blood volume 3. Strength of the heart 4. Basal heat production 5. Systolic blood pressure

1. Pulse rate 4. Basal heat production

Which behaviors should the nurse anticipate when conducting a developmental assessment for a newborn? Select all that apply. 1. Sucking on a pacifier 2. Grasping a parents finger 3. Discovering hands and feet 4. Swallowing while breastfeeding 5. Rooting when the cheek is stroked

1. Sucking on a pacifier 2. Grasping a parents finger 4. Swallowing while breastfeeding 5. Rooting when the cheek is stroked

A nurse is performing a respiratory assessment of an 8-month-old child with the diagnosis of viral pneumonia. The nurse identifies bronchial breath sounds over areas of consolidation, mild substernal retractions, profuse mucus production, pallor, and a temperature of 102° F (38.9° C). What is the priority nursing action? 1. Suctioning the nasopharynx so a patent airway can be maintained 2. Starting an intravenous infusion to provide necessary fluids and electrolytes 3. Calling the respiratory therapist to start preparations for oxygen administration 4.Notifying the practitioner of the fever so a prescription for an antipyretic can be issued

1. Suctioning the nasopharynx so a patent airway can be maintained

Which major gross motor development skills would the nurse expect to see demonstrated during a teaching session with parents of a 12-month old client who is entering the toddler stage of development? 1. Walking alone 2. Drawing a stick figure person 3. Showing interest in cooperative play 4. Beginning to develop object permanence

1. Walking alone A major gross motor development the nurse should include in the teaching session with the parents of a 12-month old client is walking alone [1] [2]. Drawing a stick figure person is a fine motor skill that is not developed until the preschool stage of development. Showing interest in cooperative play does not occur until late in the preschool stage of development. Object permanence occurs during infancy.

What is the correct order of the different stages in Piaget's theory of cognitive development?

1. sensorimotor 2. preoperational 3. concrete operational 4. formal operational According to Piaget's theory of cognitive development, the first stage is the sensorimotor stage, which starts from birth and lasts until two years. After this stage, the child moves to the preoperational stage, which lasts from two years of age until seven years of age. The next stage is the concrete operations stage, which lasts and continues from seven to eleven years. The last stage is the formal operations stage, which lasts from eleven years to adulthood.

Which statement is true about Piaget's theory of cognitive development? 1. Piaget's theory includes five periods that are related to age. 2. In the late preoperational stage, the children experience animism. 3. In the preoperational stage, children are able to perform mental operations. 4. During the sensorimotor stage, infants develop an action pattern for dealing with their environment.

4. During the sensorimotor stage, infants develop an action pattern for dealing with their environment.

Which actions demonstrate fine motor skills? Select all that apply. 1. Crawling 2. Creeping 3. Sitting erect 4. Holding a rattle 5. Picking up objects 6. Holding a baby bottle

4. Holding a rattle 5. Picking up objects 6. Holding a baby bottle Gross-motor skills include crawling, creeping, and sitting erect.

Which nursing actions are developmentally appropriate when caring for a hospitalized preschool-age child? Select all that apply. 1. Providing brochures regarding home care options 2. Using toys for distraction during a painful procedure 3. Knocking on the child's hospital room door prior to entering 4. Offering medical equipment to play with prior to a procedure 5. Providing clear instructions about details of a procedure that will occur near discharge

2. Using toys for distraction 4. Offering medical equipment to play with When providing care to a preschool-age client who is hospitalized, the nurse should use toys for distraction during a painful procedure and offer medical equipment for the client to play with prior to a procedure. Brochures are not an age-appropriate teaching strategy for the preschool-age client. Knocking on the door prior to entering the room is a hospital policy and not developmentally appropriate care. Instructions for any procedure should be provided just prior to initiation when caring for a preschool-age client.

The nurse is providing care to the family of a preschool-age child who is diagnosed with sickle cell disease. Which statement made by the sibling would initiate a teaching session with the parents regarding discipline? 1. "I really wish my brother wasn't sick all the time." 2."I am afraid that I caused my brother to get sick again because I was mad at him." 3. "When I lied to my parents, I was punished for a week and my brother never gets punished." 4. "I never get to go over to my friends' houses because we are always taking my brother to the doctor."

3. "When I lied to my parents, I was punished for a week and my brother never gets punished." A critical component of any child's development is discipline. Applying appropriate discipline to the child who is chronically ill or disabled can also limit the resentment and hostility that can develop among siblings if parents apply different standards to each child. The nurse's responsibility is to help parents learn successful methods of guiding the child. The statements regarding wishing that the brother wasn't sick, fears of having caused the illness, and missing play dates may require further assessment and family teaching, but the teaching would not be related to discipline.

According to Piaget during which developmental state is the pediatric client egocentric? 1. Infancy 2. Adolescence 3. Early childhood 4. Middle childhood

3. Early childhood

The parents of an 8-year-old state that their son seems very interested in trying new activities. When the parents ask for suggested activities for this age child, the nurse recommends scouts as an activity that will foster growth and development. In which stage of Erikson's "psychosocial stages of development" is this child? 1. Trust versus mistrust 2. Initiative versus guilt 3. Industry versus inferiority 4. Identity versus role confusion

3. Industry vs inferiority Rationale : Trust versus mistrust (birth to 1 year)—The task of the first year of life is to establish trust in the people providing care. Trust is fostered by provision of food, clean clothing, touch, and comfort. If basic needs are not met, the infant will eventually learn to mistrust others. Initiative versus guilt (3 to 6 years)—The young child initiates new activities and considers new ideas. This interest in exploring the world creates a child who is involved and busy. Constant criticism, on the other hand, leads to feelings of guilt and a lack of purpose. Identity versus role confusion (12 to 18 years)—In adolescence, as the body matures and thought processes become more complex, a new sense of identity or self is established. The self, family, peer group, and community are all examined and redefined. The adolescent who is unable to establish a meaningful definition of self will experience confusion in one or more roles of life. Industry versus inferiority (6 to 12 years)—The middle years of childhood are characterized by development of new interests and by involvement in activities. The child takes pride in accomplishments in sports, school, home, and community. If the child cannot accomplish what is expected, however, the result will be a sense of inferiority.

A 14-month-old toddler is able to recognize the shapes of objects and fit smaller boxes into larger boxes. Which type of cognitive development does this action indicate? 1. Domestic mimicry 2. Causal relationship 3. Spatial relationship 4. Object permanence

3. Spatial relationship The toddler's ability to recognize the shapes of objects and fit smaller boxes in larger boxes indicates awareness of spatial relationships. If the toddler is acutely aware of others' actions and attempts to copy them in gestures and words, it indicates domestic mimicry. When the toddler explores an object each time it appears in a new place, it indicates an awareness of causal relationships. If the toddler understands that objects continue to exist even when they cannot be observed in the same place, it indicates an awareness of object permanence.

What is the longest time after birth that the Apgar test is conducted for the second time?

5 Minutes after birth Apgar assessments are generally conducted 5 minutes after birth.

The nurse is using Piaget's theory to assess the cognitive development in a child. What is most likely to be the age of the child who has reached a developmental milestone by grasping the concept of conservation of numbers for the first time?

5 years There appears to be a developmental sequence in children's capacity to conserve matter. Children usually grasp conservation of numbers between the ages of 5 and 6 years. So, in this scenario, the child who is most likely to have grasped the concept of conservation of numbers for the first time is likely to 5 years old. Conservation of liquids, mass, and length usually is accomplished at about ages 6 to 7 years old. Conservation of weight is understood sometime later, around ages 9 to 10 years old. The child begins to understand conservation of volume or displacement last, between ages 9 and 12 years old.

At what age does an infant achieve permanent eye color?

6 months Permanent eye color is usually established between 6 and 12 months of age.

Which school-age client does the nurse anticipate will experience sibling rivalry as a source of stress?

6 year old The 9-year old, 7-year-old, and 8-year-old are not as likely to experience sibling rivalry as a source of stress.

What is the expected average weight for a 6-month-old child?

7.26 kg (16 lbs)

From which client does the nurse expect dramatic physical growth and marked development? A) 9-month-old infant B) 24-month-old toddler C) 4-year-old preschool-age child D) 10-year-old school-age child

A) 9-month-old infant

What assessment finding in a newborn is suggestive of cystic fibrosis? Abdominal distention Rapid heart rate Excessive crying Sternal retractions

Abdominal distention

A 2-year-old child is admitted with multiple fractures and bruises, and abuse is suspected. Which nursing assessment findings support this suspicion? Select all that apply. A: Bedwetting B: Thumb-sucking C: Difficulty consoling D: Underdevelopment for age E: Demands for physical closeness

C: Difficulty consoling D: Underdevelopment for age

An adolescent is accompanied by the mother for an annual physical examination. The nurse is aware of privacy issues related to the adolescent. While the mother is in the room, the nurse should avoid which questions? Select all that apply. 1. Sexual activity 2. Cigarette smoking 3. School performance 4. Use of alcohol 5. Car seatbelt use

Correct Answer: 1. sexual activity 2. cigarette smoking 4. use of alcohol Rationale: The nurse must maintain the nurse-client relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seatbelt use and academic performance without breaching confidentiality.

The nurse observes that a child fails to make eye contact and has poor impulse control. Upon further assessment, the nurse finds that the parent is an alcoholic and often neglects the child. What can be said about the child? 1. The child needs to be screened for autism. 2. The child is experiencing separation anxiety. 3. The child feels solitary because of the parent's behavior. 4. The child has developed reactive attachment disorder (RAD)

The child has developed reactive attachment disorder (RAD RAD is a psychological and developmental disorder that occurs in children who are neglected by their primary caregivers. Children with RAD are not cuddly with parents and fail to make eye contact. They also exhibit poor impulse control and may be destructive to themselves and others. Poor eye contact is seen in autistic children as well, but in this case, there is parental neglect that indicates RAD. Separation anxiety is indicated by crying and screaming when the parent leaves the child. Feelings of solitariness do not result in poor impulse control or eye contact.

A child who is recently admitted to school is introverted and prefers being alone at the school. What is the temperament of the child according to Stella Chess and Alexander Thomas's longitudinal study?

The child will be categorized as a slow to warm-up child. These children are uneasy or cautious in new situations or with unfamiliar people. They react negatively with mild intensity to new stimuli.

A 6-year-old child with a leg fracture of suspicious origin is brought into the emergency department by the mother and the mother's boyfriend. It is the child's first visit to this hospital. After assessing the child, a nurse anticipates that the healthcare provider will order a skeletal survey. Why is a skeletal survey the preferred diagnostic tool?

The skeletal history of the current fracture and any previous healing or healed fractures are identified.