peds exam1
grew 2.5" since last year
expected findings for an 11y/o physical:
`adolescent dental health
floss daily brush teeth after meals, snacks, & at bedtime have regular checkups (at least 2x a year) corrective appliances (braces) are most common with this age group fluoride treatment if necessary
secondary sex characteristics are embarrassing for both sexes
growth & development of school age children:
adolescent
have a decrease in heart rate (increase in BP)
infants
have short attention span & wont interact with other children during play- solitary play
bladder capacity formula
highly important in diagnosing voiding or bladder dysfunction in children. The convenient formula, the Koff formula (bladder capacity (in ounces) = age (in years) + 2), has been established as gold standard.
testicular enlargement
how does a mom know her son is going through puberty?
lets go to library & checkout book
how to promote learning in an 8y/o:
normal
infant squirming & grunting while passing stool is __ unless stool passed is hard &dry
Myelination of the central nervous system
is reflected by refinement of fine motor skills in the school-age child.
car accident
leading cause of adolescent (12-20) injury is:
unintentional injuries
leading cause of death in adolescent is:
preschoolers
least likely to engage in parallel play
sensory deficit
newborn doesnt respond to loud noise
<18m/o
should not be spanked. there is an increased risk for physical injury in this age group.
3wks old
should place baby on his/her back for sleeping
toddlers (1-3)
solitary play evolves into parallel play, in which toddlers observe other children & then might engage in activities nearby
child doesnt want to play games with other children
6y/o hospitalized, what warrants a nursing intervention?
5mL
=1tsp
45degree angle
newborn should be placed in car seat at __ to prevent slumping & airway obstruction. Should be rear facing, the harness are placed in the slots at or below the level of the infants shoulders, retainer clip at level of armpits.
preschoolers (3-6)
parallel play shifts to associative play; not highly organized but cooperation exists between children
8 rights
patient medication dosage route time documentation right to be educated right to refuse
initative vs. guilt
preschooler says he is hospitalized bc he didnt listen to his parents & his illness is a punishment:
reduce risk taking behaviors
priority to promote healthy lifestyle for adolescent is:
adolescents tend to take risks
program on sexuality & birth control to 14-16y/o's
Amblyopia (lazy eye)
reduced vision in an eye due to inadequate use in earlier development such as: Cross-eyed Nearsightedness Farsightedness Astigmatism
school age (6-12)
respirations become diaphragmatic in nature and abdominal breathing disappears
septic shock s/s
results in hypotension, low blood flow, and multisystem organ failure.
sewing&building models
school age fine motor skills
determine reason
should always __ __ for lying before punishing
preschoolers (3-6) nutrition
should have <10% sat fat avg intake= 1800cal limited intake of poor high calorie foods (bad eating habits should go away at 5, NOT develop)
iron fortified cereal
typically first solid food introduced (around 4months of age)
7months old
would be a concern at this age because step reflex should have disappeared
30mL
=1oz
telegraphic speech
"go potty" "tummy hungry" normal speech pattern in 4y/o & is called:
8months old
10 month old baby born 8 weeks early is developmentally:
step reflex
1st to disappear of primitive reflexes, should be gone by 4-8wks of age (1-2months)
child unable to push toy lawnmower
24m/o delayed gross motor development
"i will encourage my child to drink at least 3cups of juice per day"
2y/o visit, need for further teaching when mom says:
acknowledge fear & develop strategy
4y/o is afraid of cats & dogs & doesnt want to go to playground because of it, what would be appropriate intervention
tell me about the circumstances when this occurs
4y/o occasionally wets pants during the day
thinks illness is her fault
5y/o is usually happy & outgoing & is now sad & withdrawn. her baby sis is being treated in NICU:
discussing childs feeding pattern
A 6-month-old girl weighs 14.7 pounds during a scheduled check-up. Her birth weight was 8 pounds. Which of the following is the priority nursing intervention?
b
A group of nursing students are reviewing the six links in the chain of infection and the nursing implications for each. The students demonstrate understanding of the information when they identify which precaution as helping to break the chain of infection to the susceptible host? A) Keeping linens dry and clean B) Maintaining skin integrity C) Washing hands frequently D) Coughing into a handkerchief
d
A mother and her 4-week-old infant have arrived for a health maintenance visit. Which of the following activities will the nurse perform? A) Assess the child for an upper respiratory infection B) Take a health history for a minor injury C) Administer a varicella injection D) Plot the child's head circumference on a growth chart
b
A nursing instructor is teaching a group of students about the action of antipyretic agents in children. The instructor determines that the teaching has been successful when the students identify which of the following as the primary action? A) Cause vasodilation to promote heat loss B) Decrease the temperature set point C) Block release of histamine D) Promote prostaglandin production
when the child is age 4-6
After teaching the mother about follow-up immunizations for her daughter, who received the varicella vaccine at age 14 months, the nurse determines that the teaching was successful when the mother states that a follow-up dose should be given at which time?
d
After teaching the parents of a child with varicella zoster, the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time? A) After day 5 of the rash B) When the rash is completely healed C) Once the rash appears D) After the lesions have crusted
safety issues for school age children
Car safety-Twelve and younger in the back seat. SAC over 40 lbs - booster seat with lap and shoulder belts. Booster seats until 4'9". Pedestrian safety- sidewalks; look right/left/right Bicycle and sport safety Fire safety- smoke detectors, escape plan Water safety-lessons, life jackets, buddies Abuse in children 3.4 million reports of child abuse/year Teach "good" touch, "bad" touch Report suspected abuse
vit a foods
D) Sweet potatoes E) Spinach F) Carrots
"This protects your child from infection that can cause liver disease."
The mother of a 15-month-old child is questioning the nurse about the need for the hepatitis B vaccination. Which of the following comments provides the most compelling reason for the vaccine?
measles
The nurse determines that it is necessary to implement airborne precautions for children with which of the following infections?
d
The nurse is administering a hepatitis B vaccine to a child. What is the classification of this type of vaccine? A) Killed vaccines B) Toxoid vaccines C) Conjugate vaccines D) Recombinant vaccines
draws a person with 3 body parts
The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned?
a, b, c
The nurse is assessing the psychosocial development of a preschooler. Which of the following are normal activities characteristic of the preschooler? Select all answers that apply. A) Plans activities and makes up games B) Initiates activities with others C) Acts out roles of other people D) Engages in parallel play with peers E) Classifies or groups objects by their common elements F) Understands relationships among objects
Telling how and when to introduce rice cereal
The nurse is caring for a 4-week-old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance?
a
The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of which of the following? A) Viewing her baby sister's illness as her fault B) Harming the baby C) Experiencing clinical depression D) Creating an imaginary friend to cope with the situation
a, b, c, d
The nurse is caring for preschoolers in a day care center. Of which of the following developmental milestones of this age group should the nurse be aware? Select all answers that apply. A) Counting 10 or more objects B) Correctly naming at least four colors C) Understanding the concept of time D) Knowing everyday objects E) Understanding the differences of others F) Forming concepts as logical as an adult's
43"
The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 inches tall at her last examination at age 4. Which of the following height measurements would be within the normal range of growth expected for a preschooler?
Present the food matter-of-factly and allow the child to choose what to eat.
The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which of the following interventions would be appropriate advice?
monitor toddler for developmental delays
The nurse is designing a nursing care plan for a toddler with lymphoma, who is hospitalized for treatment. Which of the following is a priority intervention that the nurse should include in this child's nursing plan?
adolescents
erikson: identity vs. role confusion should develop a sense of personal identity & view themselves as an individual
Reward the child for initiative in order to build self-esteem.
The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. Which of the following is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative?
d
The nurse is preparing to obtain a blood specimen via capillary heel puncture. Which of the following would be most appropriate for the nurse to do? A) Apply a cool compress for several minutes before collection B) Elevate the extremity used after puncturing it C) Squeeze the area to facilitate specimen collection D) Wipe away the first drop of blood with dry gauze
b
The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. Which of the following is a recommended guideline when dealing with this issue? A) Be prepared to thoroughly cover a topic before the child asks about it. B) Before answering questions, find out what the child thinks about the subject. C) Expand upon the topic when answering questions to prevent further confusion. D) Provide a less than honest response to shelter the child from knowledge that is too advanced.
Place the baby on his or her back when sleeping.
The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week old baby. Which of the following recommended guidelines might be included in the teaching plan?
d
The nurse is providing anticipatory guidance to an obese teenager. Which of the following interventions would be most likely to promote healthy weight in teenagers? A) Make the focus of the program weight centered. B) Begin directly advising children about their weight at age 6. C) Focus physical activity on competitive sports and activities. D) Obtain nutritional histories directly from the school-age child and adolescent.
telling the child firmly we dont scream in the office
The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly?
75mg
The nurse is providing instructions to parents of a 2-year-old child with a fever. The child weighs 33 pounds. Based on the recommended dose for ibuprofen, how much would the nurse instruct the parents to give as the lowest amount per dose?
Encourage the child to pick out his own clothes.
The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's "negativism." Based on Erokson's theory of development, which of the following would be an appropriate intervention for this child?
a, b, d, e
The nurse is teaching the parents of a 4-year-old boy about the normal maturations of the child's organs during the preschool years and their effect on body functions. Which of the following statements accurately describe these changes? Select all answers that apply. A) Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. B) The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. C) Heart rate increases and blood pressure decreases slightly during the preschool years; an innocent heart murmur may be heard upon auscultation. D) The bones continue to increase in length and the muscles continue to strengthen and mature; however, the musculoskeletal system is still not fully mature. E) The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. F) The urethra remains long in both boys and girls, making them more susceptible to urinary tract infections than adults.
The need for safety and security
The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior?
you need to adhere to various routines
The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer them?
the child is developing a conscience
The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse?
parallel play
When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note? A) Parallel play B) Cooperative play C) Dramatic play D) Fantasy play
subq
When preparing to administer the polio vaccine to an infant, the nurse would expect to administer the vaccine by which route?
anticipatory guidance
__ __ for a 9mo old is advising how to create a toddler safe home
9y/o peer group effects
acceptance by friends of all sexes is very important
she can ride in front seat of car once she is 10
additional teaching for parents is needed when mom states:
piajet cognitive development
adolescent develops ability to think beyond current circumstances
body image
adolescent(12-20) self esteem=
do you participate in any sports
appropriate ? for an 8y/o
asking about sport participation
assess gross motor skills of an 8y/o by:
12.5y/o
average age for girls to experience menarche
palmar grasp
baby grabs finger
2y/o methods for dealing with negatism
based on Erikson, an appropriate intervention would be to offer the child a limited amount of safe choices, avoid asking "yes or no" ?s
12 month old concern
birth weight doubled (by 12months should have tripled)
12oz
bladder capacity of a 10y/o
female sexual maturation order
breast development pubic hair growth axillary hair growth menstruation
industry vs. inferiority
child signs up for after school activities
endurance
develops in adolescence
can recall nightmare
difference between nightmares & night terrors
6months of age
do not give ibuprofen under:
male sexual maturation order
testicular enlargement pubic hair growth penile enlargement growth of axillary hair facial hair growth vocal changes
concrete operational phase
theory of development: 10y/o ability to classify similar objects:
kohlberg
theory of development: school age child motivation to follow rules is the sense of being a good person
food diary
to promote nutrition in an overweight 13y/o:
autonomy & control
toddler is happy one minute & overreacts to limit setting the next minute by throwing a tantrum, expressing need for:
3 y/o concern
toddlers anterior fontanel is not fully closed
preschooler is masturbating
treat the action in a matter of fact manner, emphasizing safety
