PEDS MIDTERM

Varicella teaching plan (chicken pox)

-comfort:antipyretics and antipruritics -Airborne and contact precautions in the hospitalized child for a minimum of 5 days after onset of rash and as long as vesicular lesions are present -for those with exposure to susceptible persons, airborne and contact precautions, from 8-21 days after exposure -use tepid sponge baths and cool compresses -keeping the child's fingernails short -monitoring intake and output The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which of the following nursing interventions should be questioned? -Provide alcohol baths as needed. 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? -After the lesions have crusted

newborn screening expectations

-plot the head circumference of the child as part of developmental surveillance and screening -guidelines for infant hearing screening recommend universal screening with an auditory brain stem response (ABR) or evoked otoacoustic emissions (EOAE) test by 1 month of age -the American Academy of Pediatric Dentistry recommends that a dentist examine the infant by his or her first birthday.

Measles clinical manifestations (Rubeola)

-prodromal phase: 2-4 days, consisting of fever, cough, coryza -followed by Koplik spots ( bright red spots with blue white centers on mucus membranes, mainly buccal mucosa; look like tiny grains of white sand surrounded by red rings) -Erythematous maculopapular rash appears 3-4 days after the onset of the prodromal phase. Rash gradually proceeds from head downward and outward airborne precautions

Pertussis clinical manifestations (whooping cough)

history may reveal cold and cough symptoms, progressing to paroxysmal coughing spells. During the paroxysms, the child will cough 10-30 times in a row, followed by whooping sound. may be accompanied by redness in face, progressive cyanosis, and protrusion of tough. runny nose

primary medical contact is located where

A large portion of the nurse's efforts is dedicated to health supervision for children who use the facility as their primary medical contact. At which of the following facilities does the nurse work? -A pediatric practice A pediatric practice is most likely to fulfill the characteristics for primary care, also known as a medical home

processes that help support families of children who are technologically dependent

Coordinating care with the schedules and capabilities of the parents provides the greatest support for the family. It gives them a sense of order and control The nurse is providing home care for a 1-year-old girl who is technologically dependent. Which intervention will best support the family process? - Creating schedules for therapies and interventions It is difficult for the father of a technologically dependent 7 year old to leave his work. Which nursing intervention would best involve him in family centered care? schedule education sessions in the evening

deep somatic pain

Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones. It can be localized or diffuse and is usually described as dull, aching, or cramping with tenderness.

false high readings in pulse oximetry

False HIGH O2 sat reading: ANEMIA Low: cold extremities, hypovolemia, and a nonsecure connection

hospice care

Hospice for children allows prolonging treatment that might possibly help/ continuation of hopeful treatment so long as certain criteria are met. This is different from adult hospice. The nurse at a hospice care facility is caring for a 112-year-old girl. Which intervention best meets the needs of this child? urging her to invite her friends to come and visit her

Nociceptive vs neuropathic pain

Nociceptive pain= pain due to noxious stimuli that damages normal tissues or has the potential to do so if the pain is prolonged. Nociceptive pain ranges from sharp or burning; to dull, aching, or cramping; to deep aching or sharp stabbing. Examples of conditions that result in nociceptive pain include chemical burns, sunburn, cuts, appendicitis, and bladder distention. Neuropathic pain is pain due to malfunctioning of the peripheral or central nervous system.

differences affecting pharmokinetics in peds

PHARMACOKINETICS= movement of drugs throughout the body via absorption, distribution, metabolism, and excretion The child's age, weight, body surface area, and body composition also can affect the drug's pharmacokinetics the physiologic immaturity of some body systems in a child can affect a drug's PHARMACODYNAMICS (behavior of the medication at the cellular level). When describing the differences affecting the pharmacokinetics of drugs administered to children, which of the following would the nurse include? -Topical drugs are absorbed more quickly in young children than adults. Topical absorption of drugs is increased in infants and young children because the stratum corneum is thinner and well hydrated. The absorption of oral drugs is slowed by slower gastric emptying, increased intestinal motility, a proportionately larger small intestine surface area, high gastric pH, and decreased lipase and amylase secretion. The absorption of drugs given intramuscularly or subcutaneously is erratic and may be decreased. Age effects how medication is distributed throughout the body. Which factors affect how medication distribution is altered in infants and young children? -infants and young children have an increased percentage of water in their bodies -the livers of infants and children are immature

Primary goal of CLS

Primary goal= Decrease anxiety and fear during hospitalization and painful procedures The CLS would provide activities to support normal growth and development, grief and bereavement support, and emergency room interventions for children and families. The CLS would also provide nonmedical preparation for tests, surgeries, and other medical procedures; support during medical procedures; and outpatient consultation with families. The child life nurse practitioner has been assigned to assist the hospitalized child and the child's parents. Which interventions are appropriate for the child life specialist to perform? -talking to the family about a scheduled diagnostic test -showing the child where the pediatric play room is located -speaking to the physician as the child's advocate

uses of TPN as well as delivery methods

TPN= It is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. It is delivered via central venous access to allow rapid dilution of hypertonic solution. It is usually used in a child with a nonfunctioning gastrointestinal (GI) tract, such as a congenital or acquired GI disorder; a child with severe failure to thrive or multisystem trauma or organ involvement; and preterm newborns. The nurse should use occlusive dressings and chlorhexidine-impregnated sponge (Biopatch) dressings to help prevent infection. The nurse is caring for a 6-year-old child who has multisystem trauma due to a motor vehicle accident. The child is receiving total parenteral nutrition (TPN). Which of the following is a recommended nursing intervention for children on TPN? -Initially, check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia. pg 1285

reproductive system development in adolescents

The first menstrual period usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately ages 9 to 11 years and is followed by the growth of pubic hair.

Physical characteristics that are the same in both boy and girl teenagers

The nurse has seen a 15-year-old girl and a 16-year-old boy during health surveillance visits. Which of the following physical characteristics would be seen in both teenagers? -Increased shoulder, chest, and hip widths

what does the nurse emphasis focus on with pediatric health supervision

WELLNESS Health supervision involves providing services proactively, with the goal of optimizing the child's level of functioning. It ensures the child is growing and developing appropriately and it promotes the best possible health of the child by teaching parents and children about preventing injury and illness (e.g., proper immunizations and anticipatory guidance). The framework for the health supervision visit is developed from national guidelines available through the U.S. Department of Health and Human Services (DHHS), the American Medical Association (AMA), and the American Academy of Pediatrics (AAP). The focus of pediatric health supervision is wellness. Injury and disease prevention, health maintenance and promotion, and developmental surveillance are all critical components of wellness. The nurse is preparing a presentation to a local parent group about pediatric health supervision. Which of the following would the nurse emphasize as the focus? -Wellness The nurse is caring for children in a physician's office where health supervision is practiced. Which of the following is a key focus of health supervision? Select all answers that apply. -Optimizing level of functioning -Teaching parents to prevent injury -Providing care developed from national guidelines

Communication techniques to utilize with a hospitalized toddler

When working with toddlers and preschoolers, the nurse should allow them time to complete their thoughts. Though language acquisition at this age is exponential, it often takes longer for the young child to find the right words, particularly in response to a query. use terms that the child will understand, look for nonverbal cues, be patient

priority screening for adopted children overseas

health supervision of the internationally adopted child must include comprehensive screening for infectious disease The nurse is examining a 2-year-old child who was adopted from Guatemala. Which of the following would be a priority screening for this child? -Screening for infectious diseases

Amblyopia

o -(lazy eye)(hint: Brandon) leading cause of visual impairment in children. o -Reduced vision in an eye that has not been adequately used during early development. Inadequate use can result in strabismus(malalignment), one eye being more nearsighted, farsighted, astigmatic than the other eye. o -If untreated can cause monocular visual impairments in adulthood. o -Correctable with glasses or patching forcing the child to use weaker eye. ➢ The school nurse is conducting vision screening for a 7-year-old girl and documents the condition "amblyopia." What would the nurse tell the parents about this condition? A) "Amblyopia is an uncorrected refractive error of the eye." B) "Amblyopia is reduced vision in an eye that has not been adequately used during early development." C) "Amblyopia is a malalignment of the eye, which occurs at birth." D) "Amblyopia is a clouding of the lens of the eye caused by trauma to the eye." Ans: B • Some problems frequently identified in school-age children include amblyopia (lazy eye), uncorrected refractive errors or other eye defects, and malalignment of the eyes (called strabismus). Amblyopia is reduced vision in an eye that has not been adequately used during early development. Inadequate use can result from conditions such as strabismus, being cross-eyed, or one eye being more nearsighted, farsighted, or astigmatic than the other eye. Amblyopia is the leading cause of visual impairment in children (National Eye Institute, 2008) and if untreated can result in vision loss. ➢ The school nurse is performing a vision screening for a 7 y/o child. Which finding should trigger a referral? • Peripheral vision similar to that of the school nurse • Ability to color discriminate • Visual acuity of 20/20 in both eyes • Slight misalignment of the eyes Answer: D • Misalignment of the eyes (strabismus) interferes with vision and eye development. Amblyopia (vision loss) can result. Lack of alignment of the eyes needs referral and treatment. The rest are normal findings.

• Teaching regarding time outs and preschoolers

o -Can be very effective in this age group o -Punishment should be used only for intention misbehavior o -Helpful with dangerous or destructive behavior o -The preschooler is given a warning that time-out will occur if the behavior does not stop. o -Preschooler is removed from situation and must stay in that time-out for a specified period of time o -A particular time-out area is helpful o -Time period 1 minute of time-out per year of age o -Set a timer, be strict o -Use same procedure every time there's undesirable behavior 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? • Parallel play ➢ Place the steps for using time-out as a disciplinary measure for a 4 y/o in proper order: 1. Parent knows the misbehavior was intentional 2. Warn the child there will be a time-out if the behavior does not stop 3. Remove the preschooler to a boring spot 4. Set a timer for no more than 4 minutes 5. If the child gets up, replace the child and restart the time. ➢ The mother of a 4-year-old asks for advice on using time-out for discipline with her child. What advice should the nurse give the mother? a) If spanking is not working, then time-out is not likely to be helpful either. b) Place the child in time-out for 4 minutes. c) Use time-out only if removing privileges is unsuccessful. d) The child should stay in time-out until crying ceases. • The correct response is B. The generally accepted guidelines recommend keeping the child in time-out for 1 minute per year of age.

• Erikson stages and preschoolers

o -Initiative vs Guilt (age 3-6): o -Likes to please parents o -Begins to plan activities, make up games o -Initiates activities with others o -Acts out the roles of other people (real and imaginary) o -Develops sexual identity o -Develops conscience o -May take frustrations out on siblings o -Likes exploring new things o -Enjoys sports, shopping, cooking, working o -Feels remorse when makes wrong choice or behaves badly o -Cooperates with other children o -Negotiates solutions to conflicts ➢ 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? A) "The preschooler has no sense of right and wrong." B) "The preschooler is developing a conscience." C) "The preschooler sees morality as internal to self." D) "The preschooler's morals are their own, right or wrong." Ans: B • The preschool child can understand the concepts of right and wrong and is developing a conscience. Preschool children see morality as external to themselves; they defer to power (that of the adult). The child's moral standards are those of their parents or other adults who influence them, not necessarily their own. ➢ 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? A) Reward the child for initiative in order to build self-esteem. B) Change the routine of the preschooler often to stimulate initiative. C) Do not set limits on the preschooler's behavior as this results in low self-esteem. D) As a parent, decide how and with whom the child will play. Ans: A

• Speech pattern in 3-year-old

o 36 month language development: o Receptive: • Understands most sentences • Understands physical relationships (on, in, under) • Participates in short conversations • May follow a three-part command o Expressive: • Speech usually understood by those who know the child, about half understood by those outside family • Asks "why?" • Three- to four-word sentences • Talks about something that happened in the past • Vocabulary of 1,000 words • Can say name, age, and gender • Uses pronouns and plurals ➢ The nurse is assessing the language development of a 3 year old girl. Which finding would suggest a problem? a. makes simple conversation b. tells the nurse she saw Na-Na today c. Speaks in 2-3-word sentences d. tells the nurse her name Answer c o If the child is still speaking telegraphically in only 2-3-word sentences, there is a language development problem. If the child makes simple conversation, tells about something that happened in the past, or tells the nurse her name, she is meeting developmental milestones for language. ➢ The nurse is interviewing a 3-year-old girl who tells the nurse: "Want go potty." The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern? A) "This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech." B) "This is considered a developmental delay in the 3-year-old and we should consult a speech therapist." C) "This is a condition known as echolalia and can be corrected if you work with your daughter on language skills." D) "This is a condition known as stuttering and it is a normal pattern of speech development in the toddler." Ans: A ➢ After teaching a group of parents about language development in toddlers, which of the following if stated by a member of the group indicates successful teaching? A) "When my 3-year-old asks 'why?' all the time, this is completely normal." B) "A 15-month-old should be able to point to his eyes when asked to do so." C) "At age 2 years, my son should be able to understand things like under or on." D) "An 18-month-old would most likely use words and gestures to communicate." Ans: A o Language development occurs rapidly in a toddler. By age 3 years, the child asks "why?" Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures. ➢ Parents and their 35-month old child have returned to the clinic for a follow up appointment. Which of the findings may signal a speech delay? a. uses 2-word sentences or phrases b. half of speech understood by outsider c. asks "why" often d. talks about a past event answer a o A child nearly 3 years old should speak in 3-4-word sentences. The

• How preschoolers view death and dying

o At this age, children do not completely understand the concept of death or its permanence: they may ask when their grandparent or pet who died is returning. o The child may have a strong belief that if someone is ill or dying, then he or she may be fault and the illness or death is punishment. ➢ The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond? A) "It is best to just ignore this and to not respond to his questions." B) "This is normal; children his age do not understand the permanence of death." C) "You have to keep repeating that his grandfather is never coming back." D) "He will eventually figure this out on his own." Ans: B • The nurse needs to remind the mother that preschoolers do not completely understand the concept of death or its permanence. Telling the mother that it is best to ignore the boy's questions or that the boy will eventually figure this out on his own does not teach. Repeating that the grandfather is not coming back does not consider the developmental stage of the child and is inappropriate. ➢ 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 Ans: A • Since the preschool child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend.

Group of newborns that are at highest risk for iron-deficiency anemia

o During the last 3 months of gestation, maternal iron stores are transferred to the fetus. o These stores may be sufficient for the first 6 to 9 months of life but will become depleted if iron supplementation does not occur o Maternal iron stores are transferred to the fetus throughout the last trimester of pregnancy. Infants born prematurely miss all or at least a portion of this iron store transfer, placing them at increased risk for iron deficiency anemia compared with term infants. ➢ The neonatal nurse assesses newborns for iron-deficiency anemia. Which of the following newborns is at highest risk for this disorder? A) A postterm newborn B) A term newborn with jaundice C) A newborn born to a diabetic mother D) A premature newborn Ans: D

Clinical manifestations in iron deficiency anemia

o Iron-deficiency anemia in the first 2 years of life may be associated with developmental and psychomotor delays o Iron deficiency can cause cognitive and motor deficits resulting in developmental delays and behavioral disturbances. o The AAP recommends assessing for risk factors related to iron-deficiency anemia at 4, 15, 18, and 30 months and then annually and performing a hematocrit or hemoglobin at 12 months. o Nails that curve inward or outward may be hereditary or linked with injury, infection, or iron-deficiency anemia. o Limit milk intake to 16 ounces and limit juice as well o Encourage the parents to provide iron-fortified cereals and other foods rich in iron and vitamin C o Symptoms found on internet: • tiredness and weakness • pale skin, especially around the hands, nails, and eyelids • rapid heartbeat or a heart murmur • irritability • low appetite • dizziness or feeling lightheaded ➢ The nurse advises a mother with a 2-year-old child to avoid encouraging excessive milk consumption by the toddler because excess milk consumption can lead to: a) vitamin C deficiency. b) iron deficiency. c) biotin deficiency. d) folate deficiency. Correct Response iron deficiency. • Explanation: • Excessive milk consumption can lead to the displacement of iron-rich foods in the diet. This can result in iron deficiency anemia. Drinking excess milk will not cause vitamin C, biotin, or folate deficiencies. ➢ The nurse is conducting a well child exam of a 4 y/o boy. Which statement would alert the nurse that the child is at risk for iron deficiency? o He loves milk and drinks it every time he is thirsty. • This is likely to result in very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption.

• What to teach in regards to lying with preschoolers

o Lying is common in preschool children. o It may occur because the child fears punishment, has gotten carried away with imagination, or is imitating what he or she sees the parent do o The parent should ascertain the reason for the lie before punishing the child. o Child needs to learn that lying is usually far worse than the misbehavior itself. o The punishment for the misbehavior should be lessened if the child admits the truth. o Parent should remain calm and serve as a role model of an even temper o If the child's lying is really just his or her imagination getting carried away, then the parent should guide the child in distinguishing between myth and reality o Parents should serve as role models of appropriate behavior, Children who lie because they hear their parents lying simply must not see or hear their parents do it. ➢ When providing anticipatory guidance to parents about lying during the preschool period, which of the following would the nurse emphasize? A) "You need to determine the reason for lying before punishing the child." B) "Lying typically occurs because the child is afraid of being punished." C) "The misbehavior is usually more serious than the lying itself." D) "It is okay to become angry when dealing with the child's lying." Ans: A • Lying is common in preschool children and occurs for a variety of reasons, such as fearing punishment, getting carried away by imagination, or imitating what another person has done. Regardless, the parent should ascertain the reason for the lying before punishing the child. The child also needs to learn that the lying is usually far worse than the misbehavior. Parents need to remain calm and serve as a role model of an even temper.

influence of media on school-aged children

o Parents should limit television watching and video-game playing to 2 hours per day. o Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image and obesity. o The influence of media is a growing concern for parents and child specialists o Some television shows, video games, and internet activity can have positive influences on children, but parents should be taught guidelines o school-age children need supervision and monitoring when using the internet to ensure they are not exposed to inappropriate material or content ➢ The father of an 11 y/o boy is worried that the child spends too much time watching tv. What information should the nurse share with this father? Select all that apply. a) Establish guidelines on when a child can watch tv b) Use video games that more active to offset sedentary tv viewing c) Watch programs together and discuss subject matter with the child d) The American academy of pediatrics recommends 2 hours or less of tv daily e) Limit tv time by using it as a reward. Answer: A,C,D ➢ The school nurse is preparing a talk on the influence of the media on school-age children to present at the next PTO meeting. Which of the following facts might the nurse include in the introduction? A) Children in the United States spend about 6 hours a day either watching TV or playing video games. B) A child will see 2,000 murders by the end of grade school and 20,000 commercials a year. C) A school-age child cannot determine what is real from what is fantasy; therefore, TV and video games can lead to aggressive behavior. D) Parents should limit television watching and video-game playing to 2 hours per day. Ans: D • Parents should limit television watching and video-game playing to 2 hours per day. Children in the United States spend about 4 hours a day either watching TV or playing video games. A child will see 8,000 murders by the end of grade school and 40,000 commercials a year. Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image

• Know that tasks in which toddlers should be able to perform in accordance with Piaget's sensorimotor stage of cognitive development

o Rather than just repeating a behavior, the toddler is able to experiment with a behavior to see what happens. o By 2 years of age, toddlers are capable of using symbols to allow for imitation. • For example, they may imitate a household task that they observed a parent doing several days ago. o Sensorimotor stage, between 12 and 24 months of age • Sensorimotor • Substage 5: tertiary circular reactions o Age: 12-18 months • Substage 6: Mental combinations o Age: 18-24 months • Preoperational • Age: 2-7 years o Activities: o Differentiates self from objects o Increased object permanence (knows that objects that are out of sight still exist [e.g., cookies in the cabinet]) o Uses ALL senses to explore environment o Places items in and out of containers o Imitates domestic chores (domestic mimicry) o Imitation is more symbolic o Starting to think before acting o Understands requests and is capable of following simple directions o Has a sense of ownership (my, mine) o Time, space, and causality understanding is increasing o Uses mental trial and error rather than physical o Makes mechanical toys work o Plays make-believe with dolls, animals, and people o Increased use of language for mental representation o Understands concept of "two" o Starting to make connections between an experience in the past and a new one that is currently occurring o Sorts objects by shape and color o Completes puzzles with four pieces o Play becomes more complex ➢ During the Preoperational stage of development, according to Piaget, children begin to become more sophisticated with symbolic thought. ➢ The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which of the following tasks would the nurse expect the toddler to be able to perform? A) Completing puzzles with four pieces B) Winding up a mechanical toy C) Playing make-believe with dolls D) Knowing which are his or her toys Ans: D o The toddler in Piaget's sensorimotor stage of cognitive development (18 to 24 months) understands requests, is capable of following simple directions, and has a sense of ownership (knowing which toys are his). The other tasks are accomplished by the child in the preoperational stage (2 to 7 years).

Maturation of organ systems in school aged child

o Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. The school-age child's blood pressure increases and the pulse rate decreases. The heart grows more slowly during the middle years and is smaller in size in relation to the rest of the body than at any other development stage. Bladder capacity increases, but varies among individual children. o -Girls generally have a greater bladder capacity than boys. Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics. The brain and skull grow very slowly during the school-age years. o -Brain growth is complete by the time the child is 10 years of age. The shape of the head is longer and the growth of the facial bones changes facial proportions. o The school-age child experiences fewer gastrointestinal upsets compared with earlier years. Stomach capacity increases, which permits retention of food for longer periods of time. o 2 years' difference in the onset of prepubescence between boys and girls o Sexual development in both boys and girls can lead to a negative perception of physical appearance and lowered self-esteem ➢ During a well child visit, an 11 y/o girl states to the nurse that she looks different from her friends who are wearing bras. What is an appropriate response? a) It is common for girls your age to worry about being different b) It is normal for there to be differences in the time and rate girls your age develop c) You are doing well in school. Be happy with this success. d) Remember the methods you have been taught to manage peer pressure. Answer B ➢ The mother of two sons, ages 6 and 9, states they want to play on the same baseball team. As the school nurse, what advice would you give their mother? a) Having the boys on the same team will make it more convenient for the mother. b) Levels of coordination and concentration differ, so the boys need to be on different teams. c) Put the boys on the same team because they are both school-age children. d) It is best to avoid putting the boys on the same team to prevent sibling rivalry. Answer: B • The correct response is B. With age, concentration and coordination increase, so the 9-year-old would be operating at a higher level of maturity. ➢ The pediatric nurse is aware of the maturation of organ systems in the school-age child. Which of the following accurately describe these changes? Select all answers that apply. A) The brain grows very slowly during the school-age years and growth is complete by the time the child is 12 years of age. B) Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. C) The school-age child's blood pressure increases and the pulse rate decreases, and the heart grows more slowly during the middle years. D) The school-age child experiences more gastrointestinal upsets compared with earlier years since the stomach capacity increases. E) Bladder capacity increases, but varies among individual children, and girls generally have a greater bladder capacity than boys. F) Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics. Ans: B, C, E, F • Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. The school-age child's blood pressure increases and the pulse rate decreases. The heart grows more slowly during the middle years and is smaller in size in relation to the rest of the body than at any other development stage. Bladder capacity increases, but varies among individual children. Girls generally have a greater bladder capacity than boys. Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics. The brain and skull grow very slowly during the school-age years. Brain growth is complete by the time the child is 10 years of age. The school-age child experiences fewer gastrointestinal upsets compared with earlier years. Stomach capacity increases, which permits retention of food for longer periods of time. ➢ A 9 y/o boy has arrived for a health maintenance visit. Which milestone of physical growth should the nurse expect to observe? a) Brain growth is complete, and the shape of the head is longer b) Lymphatic tissue growth is complete providing greater resistance to infections. c) Frontal sinuses are developed while tonsils have decreased in size. d) All deciduous teeth are replaced by 32 teeth permanent teeth. Answer: B ➢ The nurse is using the formula for bladder capacity to measure the bladder capacity of a 9-year-old girl. What number would the nurse document for this measurement? A) 9 ounces B) 10 ounces C) 11 ounces D) 12 ounces Ans: C • The formula for bladder capacity is age in years plus 2 ounces. Therefore, the bladder capacity of the 9-year-old would be 11 ounces.

When infant reflexes disappear

o Root (stroke cheek, infant turns head to that side) = 3 months o Sucking (reflexive sucking when nipple or finger placed in mouth) = 2-5 months o Moro ("startle" arms abduct, hands form "C") = 4 months o Asymmetric tonic neck ("fencing" head turned, opposite arm flexed) = 4 months o Palmar grasp (infant grasps when palm is touched) = 4-6 months o Plantar grasp (infant grasps with bottom of foot when pressure applied) = 9 months. o Step (with 1 foot flat, infant puts the other down as if to "step") = 4-8 weeks o Babinski (stroke lateral foot, toes fan out (hyper-extension)) = 12 months o Order when reflexes disappear: "Some Reflexes Might Pass By" • Step • Root • Moro • Plantar • Babinski ➢ Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned? A) Plantar grasp B) Step C) Babinski D) Neck righting Answer B ➢ Place these primitive protective reflexes of infancy in the order in which they will disappear as the child matures: o Step, Root, Moro, Plantar, Babinski ➢ The nurse is conducting a physical examination of a 5 month old boy. Which observation may be cause for concern about the infant's neurologic development? a. The infant displays an asymmetric tonic neck reflex (fencing reflex) b. The anterior fontanel is open and easily palpated c. The infant grasps a finger when it is placed in his palm d. His toes hyperextend when the bottom of the foot is stroked. Answer a ➢ The nurse conducting a 6-month well-baby check-up assess for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex: a. should be pronounced and easy to elicit b. should have disappeared c. is a protective reflex and retained for life d. is expected to appear within 1 month Answer b

• Sex ed and preschoolers

o The child may recognize, but not understand, sexual activity. o They are very likely to ask questions about sex and where babies come from. o Additional questions will occur in the future and should be addressed as they arise. o Preschool years often leads children to explore their own genitals ➢ 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. Ans: B • Preschoolers are very inquisitive and want to learn about everything around them; therefore, they are very likely to ask questions about sex and where babies come from. Before attempting to answer questions, parents should try to find out first what the child is really asking and what the child already thinks about that subject. Then they should provide a simple, direct, and honest answer. The child needs only the information that he or she is requesting. ➢ The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. Which of the following is an appropriate response to this concern? A) Tell the child in a firm manner that this behavior is not acceptable. B) When the child displays this behavior, place him in a "time-out." C) Treat the action in a matter-of-fact manner emphasizing safety. D) Consult a psychotherapist to determine the reason for this behavior. Ans: C • Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong. ➢ The mother of a 4 y/o boy reports her son has voiced curiosity about her breasts. She asks the nurse what she should do. Which information is best for the nurse to give the parent? a) Advise the parent that sexual curiosity is unusual at this age. b) Encourage the parent to provide a detailed discussion about human sexuality with the child c) Encourage the parent determine what the child's specific questions are and answer them briefly d) Advise the parent to explain to the child that he is too young to discuss such things. Answer: C • Sexual curiosity is normal in the preschool child. Parents should be encouraged to provide brief, honest answers to the child and determine the type of curiosity the child has. Explanations should be within the level of understanding of the child. ➢ The father of a 4 ½ y/o boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the father would indicate a need for further teaching? a) I have heard that both boys and girls often touch themselves at this age b) This is probably a good time to talk about safety and who can touch him c) I will need to find an appropriate punishment for him if this continues d) I should teach him certain rules about this activity. Answer: C • Overreaction to this behavior may cause it to occur more frequently. Masturbation at this age should be treated matter of factly. The other statements are correct.

Type of play used in procedures with preschoolers

o The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). o -Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects. o Toys that require interactive rather than passive play, and that may include the involvement of the parent, are recommended o Preschool aged children often interact with imaginary friends. ➢ 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 Ans: A, B, C • The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects. ➢ The nurse is caring for a hospitalized 4-year-old who insists on having the nurse perform every assessment and intervention on her imaginary friend first. She then agrees to have the assessment or intervention done to herself. The nurse identifies this preschooler's behavior as: a) Problematic; the child is old enough to begin to have a basis in reality. b) Normal, because the child is hospitalized and out of her routine. c) Normal for this stage of growth and development. d) Problematic, as it interferes with needed nursing care. Answer: The correct response is C. • Imaginary friends help the preschooler cope with stress in his or her life.

Anatomical differences in infant respiratory system

o The respiratory system continues to mature over the first year of life. o Average of 30 to 60 breaths in the newborn to about 20 to 30 in the 12-month-old. o The newborn breathes irregularly, with periodic pauses. o In comparison with the adult, in the infant: • The nasal passages are narrower. • The trachea and chest wall are more compliant. • The bronchi and bronchioles are shorter and narrower. • The larynx is more funnel shaped. • The tongue is larger. • There are significantly fewer alveoli. o Differences place the infant at higher risk for respiratory compromise. o Reaches adult levels of maturity until about 7 years of age. o The lack of immunoglobulin A (IgA) in contributes to the frequent infections in infancy. ➢ The mother of a 1-month old infant voices concern about her baby's respirations. Which information should the nurse provide? a. The normal respiratory rate for an infant at this age is between 0 and 30 breaths per minute. b. The respirations of a 1-month old infant are normally irregular and periodically pause. c. An infant at this age should have regular respirations. d. The irregularity of the infant's respirations are concerning; I will notify the physician. Answer b ➢ The nurse is assessing the respiratory system of a newborn. Which of the following anatomic differences place the infant at risk for respiratory compromise? Select all answers that apply 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. Ans: A, D, F ➢ The nurse is providing anticipatory guidance regarding the respiratory development of a 4 week old girl for her mother. Which action is accurate? a. Telling the mother that abdominal breathing disappears by 9 months of age. b. Informing the mother that the respiratory system reaches similar adult maturity by 12 months of age. c. Advising the mother that the usual respiratory rate should slow to about 20 breath per minute by age 6 months. d. Explaining to the mother the risk for infection is high due to the lack of antibodies answer d

• Sensory alterations in regards to taste of a preschooler

o The young preschooler may have a less discriminating sense of taste than the older child, putting him or her at increased risk for accidental ingestion. o never try to coax a child to take a vitamin supplement, tablet, or pill by calling it "candy." o Dangerous fluids should be stored in their original containers and should be kept out of reach of preschoolers; o Medications should have childproof caps and should be kept in a locked cabinet. ➢ The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? a. A lack of fully developed hearing. b. A less discriminating sense of touch. c. Visual acuity that has not fully developed. d. A less discriminating sense of taste. The answer is D. • Less discriminating sense of taste. The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.

• Normal sensory development of toddlers

o use all of their senses to explore the world around them • feel them, look at them, shake them to hear what sound they make, smell them, and place them in their mouths o vision should be 20/50 to 20/40 in both eyes o Hearing should be at the adult level (since birth) o sense of smell continues to mature o taste discrimination is not completely developed • places the toddler at risk of accidental ingestion. ➢ The nurse is discussing sensory development with the mother of a 2 year old boy. Which parental comment suggests the child may have a sensory problem? a. "he wasn't bothered by the paint smell" b. "he was licking the dishwashing soap" c. "he doesn't respond if I wave at him" d. "I dropped a pan behind him and he cried" answer c o The fact that the child doesn't respond when the mom waves at him suggests that he may a vision problem. The toddler's sense of smell is still developing, so he may not be affected by odors. Their sense of taste is not well developed either, and this allows him to eat or drink poison without concern. The child's crying at a sudden noise assures the nurse that his hearing is adequate. ➢ The nurse is testing the sensory development of a toddler brought to the clinic for a well visit. Which of the following might alert the nurse to a potential problem with the child's sensory development? A) The toddler places the nurse's stethoscope in his mouth. B) The toddler's vision tests at 20/50 in both eyes C) The toddler does not respond to commands whispered in his ear. D) The toddler's taste discrimination is not at adult levels yet. Ans: C o Hearing should be at the adult level, as infants are ordinarily born with hearing intact. Therefore, the toddler should hear commands whispered in his ear. Toddlers examine new items by feeling them, looking at them, shaking them to hear what sound they make, smelling them, and placing them in their mouths. Toddler vision continues to progress and should be 20/50 to 20/40 in both eyes. Though taste discrimination is not completely developed, toddlers may exhibit preferences for certain flavors of foods. ➢ The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? • A less discriminating sense of taste

Assessment expectations in the school aged child

• Assessment expectations in the school aged child o School aged (between 6-12 years old) experience a time of slow progressive physical growth while their social and developmental growth accelerates. o Assess child's functioning at home, school, and community o From 6 to 12 years of age, an increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected o Grow an average of 6 to 7 cm (2.5 inches) per year, increasing their height by at least 1 foot. An increase of 3 to 3.5 kg (7 lb) per year in weight is expected o The child's respiratory system is maturing, so abdominal breathing has been replaced by diaphragmatic breathing. Pulse rate will decrease, rather than increase, during this time. o Secondary sex characteristics will not appear until the late school-age years. o Blood pressure will not reach the adult level until adolescence. o Brain growth is complete by the time the child is 10 years of age. o The adenoids and tonsils may appear large normally, even in the absence of infection. o Lymphatic tissues continue to grow until the child is 9 years old; o During the school-age years, all 20 primary deciduous teeth are lost, replaced by 28 of 32 permanent teeth, with the exception of the third molars (commonly known as wisdom teeth). ➢ As the school nurse conducting screening for vision in a 6-year-old child, you would refer the child to a specialist if the visual acuity in both eyes is: a) 20/20 b) 20/25 c) 20/30 d) 20/50 Answer: The correct response is D. Visual acuity of 20/20 is not expected until 7 years of age. ➢ The nurse has taken a health Hx and performed a physical examination for a 12 y/o boy. Which finding is the MOST likely? a) The child's body fat has decreased since last year b) The child has different diet preferences than his parents c) The child has a leaner body mass than a girl at this age d) The child described a somewhat reduced appetite Answer: C ➢ The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's check-up the child weighed 80 pounds. According to average growth for this age group, what would be his expected current weight? A) 83 pounds B) 85 pounds C) 87 pounds D) 89 pounds Ans: B • From 6 to 12 years of age, an increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected. ➢ The nurse is performing an annual check-up for an 8-year-old child. Compared to the previous assessment of this child, which of the following characteristics would most likely be observed? A) Breathing is diaphragmatic. B) Pulse rate is increased. C) Secondary sex characteristics are present. D) Blood pressure has reached adult level. Ans: A • The child's respiratory system is maturing, so abdominal breathing has been replaced by diaphragmatic breathing. Pulse rate will decrease, rather than increase, during this time. Secondary sex characteristics will not appear until the late school-age years. Blood pressure will not reach the adult level until adolescence. ➢ The nurse is assessing the gross motor skills of an 8-year-old boy. Which of the following interview questions would facilitate this assessment? A) "Do you like to do puzzles?" B) "Do play any instruments?" C) "Do you participate in any sports?" D) "Do you like to construct models?" Ans: C • To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills. ➢ The nurse is performing a physical examination of an 11-year-old girl. Which of the following observations would be expected? A) The child has not gained weight since last year. B) The child has grown 3 inches since last year. C) The child breathes abdominally. D) The child's third molars are about to erupt. Ans: B • From 6 to 12 years of age, children grow an average of 2 inches (5 cm) per year, increasing their height by at least 1 foot. An increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected. Abdominal breathing is typical of a preschooler and would have disappeared several years earlier. The third molars do not erupt until late adolescence. ➢ A nurse assessing the heart rate and rhythm of an 8-year-old child hears a murmur that's barely audible even in a quiet room. The child's heart rate is 80 beats/minute. The nurse should document her assessment findings as: • "Heart rate regular, grade I murmur auscultated."