peds - chapters 1-8 health assessment, Cultural, milestones
which of the following are red flags? A. 1 month old with her hands held fisted B. 5 month old sleeping 14 hours a day C. Doll's eyes D. 4 month old not waking up at night to feed E. 1 month old with a high-pitched cry
A, C, E
Which region globally has the highest infant mortality rate? a. Indonesia b. Southern Asia c. Sub-Saharan Africa d. Syria
ANS: C Although Sub-Saharan Africa and Southern Asia together account for 81% of the infant mortality rate globally, Sub-Saharan Africa has the highest infant mortality rate in the world.
The primary care pediatric nurse practitioner understands that a major child health outcome associated with worldwide climate change is : a. cost of living. b. education. c. nutrition. d. pollution.
ANS: C There is growing evidence that climate change is having a dramatic effect on food crops that leads to food distribution issues and food insecurity among families.
what does arm and leg recoil in the newborn assess?
Arm and leg recoil provide information about the infant's active movements, particularly symmetry and coordination.
which of the following are red flags? A. 24 month old having issues with dressing self B. 36 mo not able to identify colors C. 36 mo old unable to count to 10 D. 36 mo old does not understand "same" and "different" E. 36 mo old not using plurals
D, E at 36 mo they should be able to name familiar colors, but should ID colors by 5 years old not being able to dress self at 36 mo is a red flag, not at 24 mo should be able to count to 10 at 5 years, not a red flag at 36 mo
____________________ reflects the ability to emotionally react to and communicate with others without conscious thought or speaking.
Emotional fusion
what theory of child development was the basis for changes in hospital rooming-in care?
Ethology: Animal Studies The study of animal behavior, looking at the concepts of bonding, altruism, social intelligence, and dominant and submissive behavior, led to theoretic assumptions that frame the study of child development.
what theory is this? Family behaviors affect parenting practice and child development because children learn how to interact with others and social skills are developed via interactions with and mimicking of family members.
Evolutionary life history theories
what theory is this? explain how the family environment affects family conflict and child development
Evolutionary life history theories
By ______________ months old, infants begin to enjoy toys and may wave their arms when a toy is brought into sight.
3
Menarche usually occurs when a girl is in breast stage __________
3 or 4.
how many months old? Play with hands/reach for objects
4-5 mo
at what age should a child be able to string beads?
48 mo
how many months old? Beginning object permanence
6-8 months
A mother brings her 16-month-old son in for an evaluation. She is afraid he is not meeting his developmental milestones and wants to know if he should be sent to therapy. You decide to administer the Denver Developmental Screening Test. You find that he is using a spoon to eat with and can take off his own shoes and shirt. He can build a tower of two cubes and dump raisins. His vocabulary consists of at least 10 words. He can stand alone and stoop and recover, but he is unable to walk without holding onto someone's hand.What type of developmental delay does he have? A) Personal/social B) Fine motor C) Language D) Gross motor
d By 16 months a child should be able to walk unaided and even walk backwards and run. This child was referred to physical therapy and did well.
when should standardized tools be used and which ones are recommended?
developmental surveillance should be conducted at the 2-, 4-, 6-, 9-, and 12-month well-child visit and whenever there is a parent or provider concern The Ages & Stages Questionnaires (ASQ) or the Parents' Evaluation of Developmental Status (PEDS) is recommended for infants and young children and can be completed by parents while waiting to see the provider. use other tools if there is a specific area of concern. RED FLAGS: refer for further delay screenings
true or false: Passive muscle tone is normal in term newborns
false
The newborn's ____________ posture allows the infant to self-console when positioned so that the hands reach the face and mouth.
flexed
what theory is this? Children with difficult temperaments, or temperaments that are at variance with their parents', and grow up with parents who are rejecting or inconsistent, have more difficulty with adjustment and development than children with supportive and consistent parents (for instance, a "geeky" kid growing up in a family that values athletic achievement will have problems if the family rejects that child's unique talents and interests.)
goodness of fit - Chess and Thomas For children with emotional challenges "goodness of fit" is an important component in how well they will adjust and adapt to different situations in the future.
how do you know an infant is ready for solids?
have good head control, able to sit alone and unassisted, have diminished tongue thrust reflex before solids are introduced spoon and finger foods can be introduced around 6 months, but as early as 17 weeks (4 months)
what is Transitivity (piaget)
is a Characteristic of Thought Process in Piaget's Concrete Operational Stage Can deduce new relationships from sets of earlier ones (e.g., if a first-grade rule is to sit still when the teacher talks, and if all grades have the same rules, then children in the second grade should sit still when the teacher talks)
what is decentration (Piaget)
is a Characteristic of Thought Process in Piaget's Concrete Operational Stage Can focus on more than one aspect of a situation at a time (e.g., keeping track of both color and shape when working on a jigsaw puzzle)
what is Classification (piaget)
is a Characteristic of Thought Process in Piaget's Concrete Operational Stage Can group objects on the basis of common features (e.g., separating out all the triangles from circles, squares, and stars)
what is Reversibility (piaget)
is a Characteristic of Thought Process in Piaget's Concrete Operational Stage Can mentally reverse a process or action (e.g., ice can melt to water and then refreeze)
what is Seriation (piaget)
is a Characteristic of Thought Process in Piaget's Concrete Operational Stage Can sequence in order (e.g., ordering triangle shapes from smallest to largest)
what is Conservation (piaget)
is a Characteristic of Thought Process in Piaget's Concrete Operational Stage Can understand that some aspects of things, such as weight and mass, remain the same despite changes in appearance (e.g., one cookie, though broken into two pieces is still one cookie)
you are assessing a preschool age child. what is the best indicator of cognitive development?
language
when is the The Neonatal Visit done?
newborn visit in the hospital A follow-up visit in the office should be scheduled within 48 to 72 hours of discharge to screen for feeding problems and jaundice.
What is thelarche?
often represents the beginning of pubertal development 9-10 yo
Passive muscle tone is not normal in term newborns and is observed on the gestational age scales by assessing what?
shoulder (scarf sign) and knee flexibility (popliteal angle).
summarize the development of a 12 month old
sleeps 13 hours a day with 2 naps 3 solid meals with 1-3 snacks per day may be able to self feed by now stands without support for a few seconds walks 2-3 steps without support speaks a few words - dada mama understands simple commands
summarize the development of a 11 month old
sleeps 13 hours a day with 2 naps milk (breast/formula) 3-5 times a day 3 solid meals plus 1-3 snacks peekaboo still works knows how to stand, scoot, cruise
summarize the development of a 10 month old
sleeps 13 hours a day with 2 naps needs milk 4-5 times a day patty cake understands simple instructions remembers favorite toys
summarize the development of a 4 month old
sleeps 15 hours a day napes 2-3 times a day fed every 3-5 hours may be ready for solid food likes peekaboo and funny faces teething rolls from stomach to back can push up with elbows
summarize the development of a 7 month old
sleeps 15 hours a day sleeps 6-11 hours at night breast feed 3-4 hrs, bottle feed 4-6 hrs eats tablespoon or 2 of solids per day picture books favorite seems full color can support own weight with legs with adult help babbles and imitates sounds
summarize the development of a 8 month old
sleeps 15 hours a day , takes 2 naps needs 750-900 kcal/day (400-500 from milk) soft foods and finger foods sits up by self leans over either already crawling or about to
summarize the development of a 9 month old
sleeps 15 hours a day with 2 naps needs 24 to 32 oz of milk/day eats solids 3-5 times a day learned object permanence
summarize the development of a 1 month old
sleeps 16 hours a day fed every 2-3 hours like faces, not toys responds to familiar sounds keeps hands tight in fists hearing developed
summarize the development of a 3 month old
sleeps about 15 hours a day sleeps straight for 5-6 hrs at night feeds ever 3-4 hours likes to tick and swing/swipe at things mimics sounds, expressions, movements makes eye contact recognizes faces
summarize the development of a 2 month old
sleeps less during the day and more at night than before tracks movement with eyes feeds every 2-3 hours responds with giggles and coos more social learns to thumb/fist suck begins to lift head
summarize the development of a newborn
sleeps most of day. wakes every 2-3 hours feeds every 2-3 hours likes sounds, mirror, colors, communicates through cries, grunts vision best between 8-12 in away
The Period of PURPLE Crying Initiative (www.purplecrying.info) is a resource to assist parents during the developmentally normal fussy period that typically starts at about ________ old, peaks between ______ old, and lasts until ________ old.
starts at about 2 weeks old, peaks between 3 and 5 weeks old, and lasts until 3 to 5 months old
if testicular enlargement doesn't precede the other stages of puberty, what should you suspect?
the provider should consider whether the boy is taking exogenous anabolic steroids
true or false: Jerkiness and tremors may be noted in the newborn and is normal
true
providers can teach parents that providing predictable, consistent, and loving care helps the infant learn _________, which is the first stage of psychosocial development according to Erikson.
trust
What is a lexicon?
vocabulary; all words a person understands Vocabulary size is influenced by many factors, including environment, stimulation, intelligence, multilingualism, culture, and personality.
The PCP serves to provide information and act as a support for the knowledge and skills parents need to develop a healthy parent- child relationship. in the context of the Parent Development Theory, when would concerns develop?
when there is a mismatch of parent role and child development or when strife in the parent-child relationship occurs. remember the 6 role characteristics - If parents view their role as primarily that of a disciplinarian, they may have very specific and defined ways they expect their child to behave, and many of the interactions they have with their child will focus on the child's behavior within the context of the parent's rules. On the other hand, parents who view their primary role as a nurturer and comforter may spend more time expressing love and affection for the child. There is no single approach to parenting, and parenting differs from family to family. Parenting roles are not fixed, parents may move from one role to another depending on the situational context.
what theory? involves a transition from reflexive responses in the newborn period to the ability to recognize and control one's thoughts and actions
with
what are the newborn arousal states?
• Drowsy: quiet and appear sleepy but can become fussy or active if stimulated. respond to stimuli slower than in an alert state. Blinking and yawning common. • Quiet but alert: frequently look around and quietly observe their environment; they brighten with stimulation from caregivers or other sources. Infants who are quiet but alert are often described as being happy. It is common for infants to transition from quiet but alert to sleep states or the alert and active state. • Crying: have bursts of crying that last at least 15 secs. Hunger, cold, fatigue, and other noxious stimuli make this phase more pronounced. typically transition from crying to sleep or alert and active phases. • Alert and active: keep their eyes open but are likely to fuss if hungry, soiled, tired, or overstimulated. may wiggle and make faces. When consoled, they can calm and either fall asleep or go into a quiet but alert state.
when can an infant start eating solids? what are the signs to look for to evaluate readiness?
• Infants are ready for solids as they and their gastrointestinal tract mature. Specifically, they should have good head control, be able to sit alone, and have diminished tongue thrust reflex before solids are introduced. Listen closely to parents' questions and beliefs and the influence of others on the introduction of solids. Exclusive breastfeeding is best until 6 months old, but solid food can be introduced after 17 weeks old, although timing for solid food introduction should be individualized
anticipatory guidance to a mom with a 6 to 8 month old should include what?
•Can go 6-12 hours without eating - sleep longer - feeding in the night is a LEARNED behavior - cereal doesn't make baby sleep longer •Teething may disrupt sleep - can go to room to show baby they are safe, but do not comfort to help them fall back asleep •Teaching to sleep in crib - rituals help play-sleep time transition •Childproofing home, poison control center •Bathwater temperature, hot water heater temperature (120° F to 125° F) •Structured mealtimes •Allow self-feeding with spoon/cup •Solids by 6 months/iron-fortified foods if breastfed •Use names of objects, respond to vocalizations •Read to infant, show picture books •Name body parts •Encourage "transitional object" in anticipation of separation anxiety •Discuss limit-setting, discipline, positive attention •Toys involving cause-and-effect reactions •Common household objects as toys •Interactive games • Introducing solid foods and infant teething often occur simultaneously
what Primary reflexes should be present and symmetric in the newborn?
Primary reflexes, such as sucking, rooting, asymmetric tonic neck, Moro, and grasp, should be present and symmetric.
what are the 2 types of SGA
SGA- Infants whose weight falls below the 10th percentile are considered small for gestational age. 2 types of SGA: (a) Symmetric intrauterine growth retardation (IUGR)—weight, length and head circumference are SGA; reflects long-standing compromise and/or factors that are intrinsic to the infant such as a syndrome complex (b) Asymmetric intrauterine growth retardation (IUGR)—under-weight for length and head circumference; reflects acute compromise extrinsic to fetus such as placental insufficiency
An estimated 30% of 5-year-olds (almost 50% for socioeconomically disadvantaged children) are not ready for school. Why is school readiness so important?
School entrance is based on chronologic rather than developmental age. What children bring with them from other life experiences to school either enhances or inhibits their capacity to learn. Children who lack necessary skills to meet school demands and expectations may be unsuccessful, and early school failure can result in significant negative consequences. providers have a responsibility to promote optimal development and school readiness for children. Causes for failed school readiness include language deficiencies, emotional immaturity, poor socialization, presence of problem behaviors, lack of early math and reading skills, and poor physical health. Parents may have ambivalent attitudes toward their child's school and may distrust the school's capacity to meet children's educational needs. Socially and economically disadvantaged children are at greatest risk for difficulties. Head Start has been shown to improve school readiness
what theory? early infant sleep patterns and the ability to self-soothe, the toddler's ability to manage emerging emotions, the preschooler's ability to transition from home to school, the school-age child's ability to focus attention on important tasks, the adolescent's sense of confidence and competence.
Self-Regulation
how is the popliteal angle assessed in the newborn?
The popliteal angle is about 160 degrees and should be about 90 degrees. This indicates low tone in the hamstring muscles. Extension of the leg beyond 90 to 120 degrees would be seen in hypotonia
Exclusive breastfeeding is best until ____a____ months old, but solid food can be introduced after _______b_____ weeks old, although timing for solid food introduction should be individualized
a: 6 b: 17
Beginning at about ____a___ months old and continuing through _____b____ years old, the child learns to chew by moving the jaw up and down while flattening and spreading the tongue, and to control biting by using rotary jaw movements with lateralization of tongue placement.
a: 6 months b: 2 years
Masses or nodules in the breasts of adolescent girls should be examined carefully. They are usually:
benign fibroadenomas or cysts; less likely, etiologies include abscesses or lipomas.
what age should this fine motor movement occur? Momentary head control when held sitting
birth
how many months old? can stack blocks one on top of the other.
by 11 or 12 months old
when do anterior fontanel close?
by 12-18 months of age
when do posterior fontanel close?
by 6-8 weeks of age
what trends do humans grow, develop, and acquire motor skills?
development occurs in a cephalocaudal and proximodistal direction ex: ---infants gain head control before sitting/walking -----Controlled movements occur first toward midline; progress to extremities ------proximodistal: acquire motor skills from the center outward, as when children learn to move their heads, trunks, arms, and legs before learning to move their hands and feet. developmental progress is seen in controlled movements that occur first near the midline of the body, such as rolling over, progressing to distal coordination of the hands, such as mastery of the pincer grasp. -----cephalocaudal: maturation of an embryo or infant, wherein the greatest development takes place at the top of the body (i.e., the head) before the lower parts (i.e., the arms, trunk, legs).
when do the cranial sutures close?
during first year of life
summarize the development of a 6 month old
sleeps for 15 hr a day 2-3 naps a day night sleep getting longer feeds 3-6 hours introduce puree every 3-4 days likes textures, musical instruments, balls rolls in both directions learns to sit up
summarize the development of a 5 month old
sleeps for 15 hr a day sleeps 6-8 hours at night 2-3 naps a day feeds every 3-5 hrs may start to eat solids patty cake and peak a boo reaches with both hands and will grab things
what is the initial sign of male puberty
testicular enlargement, on average at 11 years old
Abdominal respiratory movements continue until what age?
the end of the fifth or sixth year. -
what race/ethnicity has the highest rate of Infant mortality
ØNon-Hispanic black women have higher rate
anticipatory guidance to a mom with a 9-12 month old should include what?
• shouldn't try to anticipate need so it will encourage baby to "ask" for what she wants •Transitional objects •Childproofing environment is critical •Safe storage of purses, medicines •Plastic bags, balloons, small objects out of reach •Oral exploration increases - poison control number •Parents provide healthy foods/infants determine how much they eat •Dental hygiene and caries/fluoride supplements •Practicing with spoons/cups - wean from bottle/pacifier by 12 months •Emerging desire for autonomy •Discipline as a guidance process - teach positive behaviors - •Distraction effective to redirect infant •encourage messy play and tactile stimulation -cycle toys to keep babys interest in them -messy play important
you are giving anticipatory guidance to a mom with a 2 month old. what should this include?
•Place in different positions to encourage movement/strength •Feedings more consistent, increased non-nutritive sucking •Hands as "toys" and for self-soothing/exploration •Temperaments expressed in behaviors - Parents' perception of their temperament plays important role in how they respond to infant. •Increased need to socialize/play •Help baby learn to go to sleep on own - place drowsy, but still awake, infant in crib instead of holding them until they fall asleep. •immature nervous system (continuation of Moro or asymmetric tonic neck reflex) creates a need for swaddling • have social need to play with caregiver. Often fussing or crying is misinterpreted for hunger. Parents may need assistance to set up "play stations". short attention span - 10 to 15 mins at each station for a total of 1 hour will usually lead to a tired, happy baby. • visual acuity is increasing - mirror, mobile, textures
you are giving anticipatory guidance to a mom with a 3 week old. what should this include?
---Breastfed eat more often - wake more at night. ----16 hours of sleep every 24 hours ---need assistance to develop day-night cycles because they do not distinguish between days and nights. consistent daily routine helps ----putting in crib for naps assists with nighttime sleep. ----variety of movement, voice, or touch to move them from sleep to wake states. Rhythmicity of voice, movement, or touch calms infants - will lessen the infant's startle or Moro reflex. ----supine position for sleep, but give "tummy time" when awake and alert as soon as home from the hospital. ---bringing the infant slowly to an awake state for feeding. ----Feedings longer than 40 min or shorter than 20 min should be evaluated. ----babys good at regulating how much they need to eat. may not always be consistent ---pacifiers decrease risk of SIDS - dont use until breastfeeding is well established ---Attending promptly to infant crying helps the infant to develop a sense of trust. ---Imitating infant sounds encourages vocalization
anticipatory guidance to a mom with a 4 to 6 month old should include what?
--should self-soothe when they awaken at night. when put in crib before they fall asleep, more likely to sleep without parent comforting ---nighttime rituals build sense of secrity --babys emerging temperament and parents' perceptions of behaviors may lead to conflicts that will need to be resolved. --childproofing house --moveable walkers unsafe --drooling - teething. will eventually learn to swallow --GI tract mature - ready for solids - be sure they have good head control, able to sit alone, have diminished tongue thrust reflex before solids are introduced ---Spoon-feeding helps develop oral-motor skills --"back-and-forth talking" important --Discipline discussed and differentiated from punishment. - role of "parents as teachers" - redirecting - all should be discussed before needed. --take time for self - baby behavior mirror emotional state of caregivers.
what age should this fine motor movement occur? Extension, nondirected hand swipes Turns head when prone
1 mo
when does Infant crying tends to peak?
1-3 months Many infants have fussy periods in the late evening that may last 1 to 3 hours. Infant crying tends to peak at this age, but fortunately this fussiness usually lasts only a few weeks. The provider should discuss with parents plans to cope with crying before this time is upon them. This is a good time to explain "shaken baby syndrome" and the period of PURPLE crying to parents Regular nap or nighttime routines help keep infants calmer.
what is the order of female puberty?
1. Ovaries increase in size; no visible body changes occur. 2. Breast budding (thelarche) 9-10 yo average 3. Rapid linear growth shortly after breast budding and peaks about 1 year later 4. Adrenarche (pubic hair) - adrenal development - 11.5 yo average 5. Menarche (12.5 yo avg) - approximately 2.5 years after thelarche
Anticipatory guidance is intended to assist parents to adapt parenting styles and strategies to their child's temperament, growth, and development and should include what?
1. PCP assesses the child's development 2. determine the parent's knowledge of general child development 3. determine the parent's knowledge/comfort/experience with the parent role 4. assess the parent's problem solving and coping skills 5. give the parent info about normal child development and variations. give written info and refer to other sources if needed 6. help parents develop realistic expectations of their child's development 7. educate the parent about parenting strategies and concepts 8. continuously evaluate and reinforce healthy parental role development.
what are the stages of puberty in a boy?
1. testicular enlargement (11 years) 2. Pubic hair development (similar pattern to that of girls) 3. Spermarche (13.5 to 14.5 years avg but can occur at any stage of development from SMR 2 to 5) 4. Elongation/widening of penis (begins in SMR 3 and continue through SMR 5) 5. Rapid growth in height (lag about 2 years behind girls - 95% height growth b/w 12-16) 6. Changes in voice (coincides with height growth) 7. Axillary, facial, body hair (A. axillary usually doesn't occur before SMR 4. B. Facial hair ONLY after SMR 4 and in sequence from corners of lip ad moves inward, then upper cheeks, then middle of lip, then lastly along sides and lower chin C. body hair last - areas depend on genetics. should not be used to assess pubertal maturation)
what are the 3 Principles of Behavior Changes in adolescents?
1. the transition from adolescence to adulthood is continuous and generally smooth. ("storm and stress" is a myth 2. changes experienced by adolescents require a reworking of family relationships. Some degree of adolescent- parent conflict is to be expected, but disruptive family conflict is not the norm. arguing is a normal behavior - reflects their use of more abstract thinking 3. about change in cognitive abilities, usually after 14. formal operational thinking - use of propositional thinking and abstract reasoning. The difference between concrete and formal operational thinking is the ability to reason using verbal manipulation rather than in terms of concrete objects. (values, concepts of good/evil, contradictions, etc)
A special-friend phase should occur at around _____ years old. This is an intense attachment to a same-gender child.
10
what Piaget stage is late childhood?
10-12 yo Late concrete operational (Piaget): Able to conceptualize size, shape, quantity, space, and thus able to problem-solve using abstract thought. Able to classify items into a hierarchical system. later: Formal operational (Piaget): Distinguished by the ability to use abstract thinking, complex reasoning, thinking, flexibility, and hypothesis formation. Becomes more aware of contradictions, falsehoods, and shortcomings in previous beliefs. Becomes aware of how others think of them.
Nutritional needs to promote growth are approximately ___________ kcal/kg/day
110
at what age should a child be able to clap hands?
12 mo
what age should this fine motor movement occur? Picks up pellet with pincer grasp Chewing with spreading and rolling tongue movements, tongue lateralization, rotary jaw movements, controlled sustained bite Walks with one hand held, stands alone momentarily
12 mo
what are the dental milestones
12 months: has six to eight primary teeth 2 years: calcification begins for the first and second permanent bicuspids and second molars 3 years: has a complete set of 20 primary teeth and second molars usually erupt.
at what age should a child be able to drink from a cup?
15 mo
at what age should a child be able to put blocks in a cup?
15 mo
at what age should a child be able to stack 2 blocks
15 mo
at what age should a child be able to build a tower with 4 blocks
18 mo
at what age should a child be able to independently walk well
18 mo
at what age should a child be able to put blocks in large holes
18 mo
at what age should a child be able to take their socks off
18 months
Breast asymmetry is common in adolescents, particularly when adolescents are between Tanner stages __________________. This is nearly always a benign condition.
2 and 4
Use of dominant hand usually between _____ and _____ years old
2 and 4
what age do children use of words to convey thoughts
2 year
at what age should a child be able to build a tower of 7 blocks
24 mo
at what age should a child be able to scribble in circles
24 mo
at what age should a child be able to turn a doorknob
24 mo
at what age should a child be able to turn pages 1 at a time
24 mo
at what age should a child be able to unzip and unbutton
24 mo
at what age should a child be able to walk up and down stairs, may not alternate feet
24 mo
Speech and Language Milestones: what age? Actively seeks sound source May look in response to name Responses may vary to angry or happy voice
3-6 mo
Respiratory rate slows to about __________ breaths per minute in the preschool age child
30
at what age should a child be able to imitate drawing a circle
30 mo
at what age should a child be able to walk on tie toes?
30 mo
what age should this fine motor movement occur? Directed swipes, corralling, reaching Sits with support, begins to roll over, head steady in sitting
4 mo
how many months old? Double birth weight
4 to 6 months
when does the infant visually track faces or toys PAST midline?
4 to 8 weeks old
how many months old? Babble, coo, laugh
4-5 mo
how many months old? Bear full weight when standing - love to bounce
4-5 mo
how many months old? Learn to sit - tripod position and then erect
4-5 mo
how many months old? Mouthing behaviors
4-5 mo
how many months old? Roll front to back, then back to front
4-5 mo
how many months old? Spontaneous smile
4-5 mo
how many months old? starts to Interact with parents
4-5 mo
what age should this fine motor movement occur? Ulnar-palmar grasp "Swims" in prone position, no head lag
4-5 mo
what age? Fine motor skills are demonstrated as infants play with their hands and begin to reach for and pull at clothing or other objects that are close, such as the parent's hair, earrings, or eyeglasses.
4-5 mo
when does a baby have Regular sleep, eating, playing patterns and Begin to sleep through night?
4-5 mo
when does the The Landau reflex emerge?
4-5 mo
at what age should a child be able to walk down stairs alternating feet?
48 mo
•Syntax close to adult speech by age ______
5 years
what Piaget stage is early childhood?
5-7 yo Preoperational period (Piaget): Representative language and early reasoning. Problem-solving is intuitive rather than logical. Thought process involves magical thinking, egocentrism, centration, syncretism, juxtaposition, animism, artificialism, participation, and irreversibility.
if the parents do already, at what age should you recommend reading books?
6 mo old their receptive language increases and they start to imitate sounds
when is a child fully intelligible (understand 100% of their communication)?
6 yo
what age should this fine motor movement occur? Radial-palmar grasp, raking Sucking with negative oral cavity pressure, rhythmic jaw movements, firm approximation of lips Sits independently, rolls over, rocks on hands and knees, free head lift in prone position
6-7 mo
how many months old? would enjoy peek-a-boo, does not participate
6-8 mo For some older infants, beginning object permanence is evident, because they will look for partially hidden objects and play peek-a-boo.
what age does resistance to bedtime start?
6-8 mo (separation anxiety) The infant is increasingly aware of surroundings and begins to express individual preferences more clearly. This is often a time when resistance to bedtime, feeding, and parental separation occurs.
how many months old? Rake objects, then use pincer grasp
6-8 months
how many months old? Solids added to diet
6-8 months
how many months old? Specific sound imitation/use of consonants and Receptive language skills increase
6-8 months
how many months old? Teething symptoms start and sleep routine disrupted
6-8 months
how many months old? Transfer objects from one hand to another
6-8 months
how many months old? start to Sit, scoot, crawl
6-8 months
how many months old? starting to understand cause and effect
6-8 months
how many months old? starts to use gestures
6-8 months
how many months old? stranger anxiety and separation anxiety start
6-8 months
how many months old? the weight velocity slows for the first time
6-8 months
how many months old? what age does an infant understand the effect of dropping a toy from the crib?
6-8 months Infant cognitive development grows significantly between 5 and 8 months old. The infant understands cause-and-effect relationships in activities like ringing a bell; pulling on a string to retrieve a ring, train, or phone; and dropping a toy from the crib or highchair. They visually follow a toy if it falls and remains within their visual field.
Speech and Language Milestones: what age? Babbles tunefully Increased sound combinations Uses m, n, b, d, t Initiates sounds, such as click or kiss Uses nonspecific "mama" and "dada"
6-9 mo
Speech and Language Milestones: what age? May look at family member when named Inhibits to "no" Begins interest in pictures when named Individual words begin to take on meaning
6-9 mo
at what age should a child be able to do a somersault?
60 mo
at what age should a child be able to hop and skip?
60 mo
"Baby blues" are normal and occur in ________% of new mothers
60% to 80%
what Piaget stage is middle childhood?
7-10 yo Early concrete operational (Piaget): Begins to use logic and becomes more objective using an external point of view. Thinking becomes dynamic, decentralized, using conservation, transitivity, seriation, classification, and reversibility. Learns to understand size, shape when the physical properties can be manipulated.
what age should this fine motor movement occur? Radial-digital grasp Phasic bite reflex, rhythmic bite and release pattern Supports weight standing, bounces when held
7-8 mo
what age should this fine motor movement occur? Scissors grasp Munching, early chewing Sits alone well, may crawl
7-9 mo
By 5 years, the heart rate is typically _______ bpm.
70 to 110
how many feedings per day for the 1-3 month old?
8 to 10 feedings in 24 hours, each lasting 20 to 30 minutes. Feedings lasting longer than 40 minutes and shorter than 20 minutes need to be evaluated.
what age? They begin to tell jokes because they understand different meanings of words.
8 yo
when should sexual education be initiated in the well visit?
8-10 years old - should be complete by 11-12
the average onset of breast development and pubic hair is between ____________, but can sometimes be as early as ______ for white girls, and ________ years for African American and hispanic girls
8-13 7 for white girls 6 for African American and hispanic girls
what age should this fine motor movement occur? Voluntary release Cruises, pivots while seated, pulls to stand
9-10 mo
Speech and Language Milestones: what age? Gives toy on request Understands simple commands Turns head to own name Understands "hot," "where's ...?" Responds with gestures to "bye-bye"
9-12 mo
Speech and Language Milestones: what age? Increased imitating efforts Has one word with specific reference Accompanies vocalizations with gestures Jargon increases Imitates animal sounds
9-12 mo
how many months old does this start? They usually do not eat the same amount at each meal and often demonstrate specific food preferences. They typically eat breakfast, lunch, and dinner, with midmorning and afternoon snacks.
9-12 mo
how many months old? Emotions, such as affection, anger, jealousy, and anxiety, become more evident
9-12 mo
how many months old? Growth spurts become more apparent to parents as the infant seems to outgrow clothes "overnight."
9-12 mo
how many months old? Name pictures in book, look for objects when named, follow one-step requests
9-12 mo
how many months old? Sit for long periods, crawl on hands and knees
9-12 mo
how many months old? Some parents inaccurately interpret their ability to predict their infant's bowel movements as readiness for toilet training.
9-12 mo
how many months old? They "cruise," walking around furniture holding on with both hands, and pull themselves off the floor to a standing position. some may walk by themselves.
9-12 mo
how many months old? They develop their own games or explore different ways of playing with familiar toys or objects.
9-12 mo
how many months old? They help with dressing by extending an arm or leg
9-12 mo
how many months old? They hold a crayon or pencil with their whole hand and make dots on a piece of paper, imitating a drawn line.
9-12 mo
how many months old? They master object permanence and easily locate a toy placed out of sight or under a cloth.
9-12 mo
how many months old? can say 3 to 4 words and follow simple one-step requests.
9-12 mo
how many months old? complete more complicated tasks, such as stacking and container play.
9-12 mo
how many months old? growth spurts and follows a different growth curve than the one established early in infancy
9-12 mo
how many months old? hold objects of different sizes and pick up small objects using the sides of the fingers and eventually a fine pincer grasp, most often transferring the object directly to their mouth
9-12 mo
how many months old? often begin to hold a cup with two hands, but may still have difficulty sealing their lips around the edge of the cup to take sips.
9-12 mo
how many months old? participates in patty-cake
9-12 mo
how many months old? start to enjoy putting objects into containers and taking them out again
9-12 mo
how many months old? starts to Demonstrate specific food preferences
9-12 mo
how many months old? starts to participate in peek-a-boo
9-12 mo
what percentage of words should you understand by the time a child turns 3 years old
90% 25% at 2 years 66% 24-36 mo 100% by 4 years, may have trouble with consonants
A 38-week gestation, 2500-gram infant is placed on your service. How would she be described? A) Term, normal birth weight B) Term, low birth weight C) Preterm, normal birth weight D) Preterm, low birth weight
A Preterm is defined as less than 37 weeks; term, 37-42 weeks; and post-term, over 42 weeks of gestation. Birth weights have similar limits: extremely low birth weight, less than 1000 grams; very low birth weight, less than 1500 grams; low birth weight, less than 2500 grams; and normal birth weight, equal to or more than 2500 grams. These have prognostic implications and impact on how closely to watch and how aggressively to treat these infants.
An adolescent male admits to wondering a lot lately if he is normal. Although he is in football he really enjoys science and computers more. He is worried that all his buddies will think he is a geek. He is convinced he also won't get a date for the Sadie Hawkins dance next week because the girls all think he is boring, too. he blushes when you mention sex. After hitting all the pertinent age-appropriate education points you give him his sports physical form and he leaves.The patient's concerns during the visit most resemble what developmental stage of adolescence? A) Early adolescence (10 to 14 years old) B) Middle adolescence (15 to 16 years old) C) Late adolescence (17 to 20 years old)
A His concern with whether he is normal or not is often seen in the development of social identity in early adolescence. He is also concerned with the present (Sadie Hawkins dance) and not the distant future, as is seen with late adolescence. He also denies the experimentation often seen in middle adolescence.
when should adolescents get a lipid screening?
A fasting lipoprotein analysis is recommended once during late adolescence (18 to 21, but 15-17 if indicated)
which of the following are red flags? A. 4 year old unable to recall 4 numbers B. 5 year old unable to draw person with a body C. 36 mo old not constructing sentences D. 5 year old unable to draw a star E. 24 mo old unable to balance on one foot for 1 second
A, B, C red flag for balancing on 1 foot for 1 second would be at 36 mo, not 24 mo. a 5 year old should be able to copy a triangle, not a star
which of the following are red flags? A. 18 mo old does not follow instructions B. Does not pull the parent to show showing at 18 mo C. Using mostly vowel sounds at 15 months D. 12 month old frequently falls when walking E. 18 month old mouthing toys
A, B, C, E
which of the following are red flags? A. 36 mo old not able to recall parts of a story B. 36 mo old not able to tell a story C. 4 year old unable to follow rules D. 36 mo old unable to skip E. 4 year old unable to identify what do to when in danger (fire, stranger, etc)
A, B, C, E
which of the following are red flags? A. 9 month old who doesn't respond to their name B. 12 month old who is 2.5 times their birth weight C. 7 month old only using single sound units (ga, ah, ba) D. 4 month old not looking for a hidden object E. 12 month old that does not try to self feed
A, B, E
which of the following are red flags? A. 15 mo old does not have object permanence B. 9 mo old not using a spoon correctly C. Using single words by 16 mo D. 9 month old does not scribble E. 9 mo old does not follow instructions
A, C
which of the following are red flags? A. 3 month old that doesn't attempt to raise head when prone B. 6 month old who doubled her birth weight C. 3 month old with no hand-to-mouth activity D. 6 month old with primitive reflexes E. 4 month old holding her head up at 45 degrees, then progressing to 90 degrees over time
A, C, D
Define AGA, LGA, SGA
AGA-infants whose weight falls between the 10th and 90th percentile are considered appropriate for gestational age. LGA- infants whose wight falls above the 90th percentile are considered large for gestational age. often associated with diabetic pregnancies SGA- Infants whose weight falls below the 10th percentile are considered small for gestational age. 2 types of SGA: (a) Symmetric intrauterine growth retardation (IUGR) (b) Asymmetric intrauterine growth retardation (IUGR)
The primary care pediatric nurse practitioner is performing a well child exam on a 17-year-old female whose mother is present during the history. The mother expresses concern that her daughter wishes to have an eyebrow piercing and states that she is opposed to the idea. What will the nurse practitioner do? a. Provide information about piercings and encourage continued discussion. b. Remind the adolescent that her mother is responsible for her health. c. State that piercings are relatively harmless and are an expression of individuality. d. Suggest that she wait until she is 18 years old and can make her own decisions.
ANS: A Adolescents who pierce their noses or have strange haircuts may be irritating to parents, but these are ways of expressing individuality and help them to achieve psychosocial milestones. The fact that the teen and her mother are discussing this is a good sign that the adolescent isn't in complete rebellion. The PNP should provide accurate health information and encourage continued dialogue. Although it is true that piercings are relatively harmless, the PNP shouldn't "side" with the teen during an open discussion or tell the teen that the mother is "in charge."
The primary care pediatric nurse practitioner is examining a 15-year-old female who reports having her first period at age 13. She states that she has had five periods in the last year, with the last one 2 months prior. She participates in basketball at school. Which action is correct? a. Perform biometric screening to determine lean body mass. b. Prescribe oral contraceptives pills to regulate her periods. c. Reassure her that this is perfectly normal at her age. d. Refer her to an endocrinologist for hormonal evaluation.
ANS: A Although it can take 18 to 24 months for adolescents to establish regulatory cycles, periods can also be affected by athletic activity that decreases body fat. The PNP should assess the percentage of lean body mass, which should be 75% or less to maintain regular ovulatory cycles. OCPs are useful for regulating periods if this persists and other causes are ruled out. It is not necessary to refer her to an endocrinologist unless problems persist in spite of standard management.
The parent of a 16-year-old tells the primary care pediatric nurse practitioner that the teen was recently caught smoking an electronic cigarette (e-cigarette). What will the nurse practitioner tell this parent? a. E-cigarette use may be a risk factor for later substance abuse. b. Experimentation with e-cigarettes does not lead to future tobacco use. c. Most teens who experiment with tobacco usually do not become addicted. d. This form of nicotine ingestion is safer than regular cigarettes.
ANS: A Although many adolescents consider e-cigarettes to be a safe form of tobacco use, increasing evidence indicates that their use may be a significant risk factor for later marijuana and substance abuse. The risk of dependence and addiction is the same for e-cigarettes and other cigarettes, since both use nicotine. Only 41% of teens try tobacco; 80% of older adolescents do not smoke.
The mother of a 15-year-old adolescent female tells the primary care pediatric nurse practitioner that her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies. When asked if she notices anything different just before her periods, the adolescent points to her mother and says, "She gets really hard to live with." This demonstrates which characteristic of adolescent thinking? a. Apparent hypocrisy b. Imaginary audience c. Overthinking d. Personal fable
ANS: A Apparent hypocrisy is the notion that rules apply differently to adolescents than to others. The adolescent who chalks up the conflict with her mother related to her premenstrual mood swings does not see her own role in the conflict. Imaginary audience is the perception that everyone is thinking about them. Personal fable is the idea that they are special. Overthinking involves making things more complicated than they need to be.
The mother of a 6-month-old infant is distressed because the infant can say "dada" but not "mama" and asks the primary care pediatric nurse practitioner why this is when she is the one who spends more time with the infant. How will the nurse practitioner respond? a. "At this age, your baby does not understand the meaning of sounds." b. "Babies at this age cannot make the 'ma' sound." c. "Most sounds made by babies at this age are accidental." d. "This may mean that your baby doesn't hear well."
ANS: A At 6 months, infants delight in vocalizing sounds that they learn by imitation but do not ascribe meaning to the sounds they make. Infants can say "mama" but without meaning. Babies make sounds on purpose by imitating what they hear. A preference for one sound early in speech does not indicate a hearing deficit.
The parent of a 5-month-old is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent? a. The infant may be expressing a desire to play or to rest. b. The parent should give ibuprofen for teething pain before nursing. c. This is an indication that the infant is ready for solid foods. d. This may indicate gastrointestinal discomfort such as constipation.
ANS: A At this age, infants may cry when they are tired or need social interaction and not just when they are hungry. The PNP should teach parents about this change in social development so they can be responsive to their infant's needs. Solid foods are not added until age 6 months. Teething usually does not begin until at least 6 months. GI discomfort usually occurs after eating.
The primary care pediatric nurse practitioner has a cohort of patients who have special health care needs. Which is an important role of the nurse practitioner when caring for these children? a. Care coordination and collaboration b. Developing protocols for parents to follow c. Monitoring individual education plans (IEPs) d. Providing lists of resources for families
ANS: A Care coordination is one of the key elements for children with special health care needs. PNPs are especially suited for this role and have the unique skills to function as care coordinators. Care for these children should involve shared decision making and individualized care and not "cookbook" approaches. The PNP may advocate for children's health care needs for the IEP but does not monitor these. The PNP should not just give parents lists of phone numbers but should assist them to make appointments.
The primary care pediatric nurse practitioner is examining a school-age child who complains of frequent stomach pain and headaches. The parent reports that the child misses several days of school each month. The child has a normal exam. Before proceeding with further diagnostic tests, what will the nurse practitioner initially ask the parent? a. About the timing of the symptoms each day and during the week b. How well the child performs in school and in extracurricular activities c. If the parent feels a strong need to protect the child from problems d. Whether there are any unusual stressors or circumstances at home
ANS: A Children with school refusal or school phobia often have symptoms that gradually improve as the day progresses and often disappear on weekends. The PNP should ask about the frequency and duration of the symptoms to evaluate this pattern. The other options are important questions when management of school phobia has begun as a way of understanding underlying causes for the reluctance to go to school.
A primary care pediatric nurse practitioner working in a community health center wishes to develop a program to assist impoverished children and families to have access to healthy foods. Which strategy will the pediatric nurse practitioner employ to ensure the success of such a program? a. Asking community members to assist in researching and implementing a program b. Designing a community garden approach that involves children and their parents c. Gaining support from the corporate community to provide needed resources d. Providing evidence-based information about the importance of a healthy diet
ANS: A Community collaboration can be fostered through community-based participatory research (CBPR), which is transformative research that bridges the gap between science and practice by actively engaging communities with formally trained researchers. In this type of research, community members formally participate in all aspects of the process, making the findings more relevant to the community it affects the most. Designing a community garden approach without first knowing whether the community needs or wants it does not ensure success. Gaining support from the corporate community without input from the affected community does not guarantee success. Giving evidence-based information does not involve the community members in research and does not increase success.
The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially? a. Ask the parents if they have an individualized family service plan (IFSP). b. Consult with a physician to ensure the child gets appropriate care. c. Inform the family that services are provided when the child begins school. d. Refer the family to a social worker for assistance with referrals and services.
ANS: A Families with children who have developmental delays are eligible for early intervention services and should have IFSPs in place. This family may have one from their previous community, and it can be used as a starting point to determine needs. It is not necessary to consult with a physician to coordinate community resources. Early intervention is provided from birth, according to federal law. Until the specific referrals are known, the social worker is not consulted.
The parents of a special needs child tell the primary care pediatric nurse practitioner that they are planning a 3-month visit to their home country in Africa. The pediatric nurse practitioner assists the family to obtain a sufficient supply of medications and formula and to make sure that the child's equipment can be transported and used during the trip and at the destination. This is an example of a. global application. b. global awareness. c. system application. d. system awareness.
ANS: A Global application involves having a willingness and ability to adjust to the needs of clients, families, and communities both nationally and globally. Global awareness involves knowledge of diseases, political, and economic factors worldwide that affect health. System application involves assisting clients to overcome institutional barriers to effective interventions. System awareness is knowledge of these barriers.
The primary care pediatric nurse practitioner prescribes a twice daily inhaled corticosteroid for a 12-year-old child. At a well child visit, the child reports not using the medication on a regular basis. Which response by the pediatric nurse practitioner demonstrates an understanding of client-centered care? a. Asking the child to describe usual daily routines and schedules b. Referring the family to a social worker to help with medication compliance c. Reviewing the asthma action plan with the parent and the child d. Teaching the child how the medication will help to control asthma symptoms
ANS: A In a client-centered relationship, there is reciprocal communication and understanding. The PNP should be able to understand the client's perspective and unique situation. The first step is to evaluate possible reasons for nonadherence and not to make referrals or re-educate until potential barriers have been identified and negotiation with the client has occurred.
During an assessment of a 4-week-old infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4-hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend? a. Continuing to nurse the infant using the current pattern b. Nursing the infant for longer periods every 4 hours c. Supplementing with formula at the last nighttime feeding d. Waking the infant every 2 hours to nurse during the night
ANS: A Infants who are encouraged to breastfeed every 2 to 3 hours may have one longer stretch of 4 hours at night. This infant is gaining between 0.5 and 1 gram per day, which is appropriate. It is not necessary to alter the pattern of nursing or to supplement with formula.
The primary care pediatric nurse practitioner is evaluating a 2-year-old with a documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the pediatric nurse practitioner do next? a. Ask the child's parents whether they read to the child. b. Give parents educational materials to encourage speech. c. Refer the child to an early intervention program. d. Suggest that they purchase age-appropriate music videos.
ANS: A Language development requires oral-motor ability, auditory perception, and cognitive ability, which this child has been shown to have, as well as the psychosocial-cultural environment to motivate the child to engage in language use. The PCPNP's initial step should be to determine whether the parents provide such an environment. Educational materials may be used after it is determined that these are useful. Early intervention may be used if the speech delay persists. Music videos do not necessarily engage the child in expression of speech.
The primary care pediatric nurse practitioner performs a physical examination on a 12-year-old child and notes poor hygiene and inappropriate clothes for the weather. The child's mother appears clean and well dressed. The child reports getting 6 to 7 hours of sleep each night because of texting with friends late each evening. What action by the nurse practitioner will help promote healthy practices? a. Discuss setting clear expectations about self-care with the mother b. Give the child information about sleep and self-care c. Reassure the mother that this "non-compliance" is temporary d. Tell the mother that experimenting with self-care behaviors is normal
ANS: A Parents of school-age children should be advised to set clear limits for their children for cleanliness, healthy exercise, hours of sleep, and other health promotion behaviors to encourage the development of responsibility for these things. Giving the child information can be done along with setting expectations, but, at this age, the parent should still be supervising. While "non-compliance" is a part of this process, and is a means of asserting independence, parents need to discuss this with children to resolve the issue.
A single mother of an infant worries that living in a household with only one parent will cause her child to be maladjusted. To help address the mother's concerns, the primary care pediatric nurse practitioner will suggest : a. developing consistent daily routines for the child. b. exposing her child to extended family members when possible. c. not working outside the home during the first few years. d. taking her child to regular play date activities with other children.
ANS: A Providers can teach parents that providing predictable, consistent, and loving care helps an infant to learn trust and help influence positive brain development. Involving extended family members and going to play dates are good ways to socialize children but are not essential to learning trust. It may not be possible for her to be a stay-at-home mother.
The primary care pediatric nurse practitioner is examining a child whose parents recently emigrated from a war-torn country in the Middle East. Which is a priority assessment when performing the patient history? a. Asking about physical, psychological, and emotional trauma b. Determining the parents' English language competency and literacy level c. Learning about cultural preferences and complementary medicine practices d. Reviewing the child's previous health and illness records
ANS: A Recent history that includes trauma, loss, and refugee camp experience may exacerbate difficulties adjusting to life in the U.S. and can lead to acute and chronic physical and mental health concerns. All of the other parts of the history will be necessary, but this should be a priority, since the family has escaped a war-torn country.
During a well child exam of a school-age child, the primary care pediatric nurse practitioner learns that the child has been having angry episodes at school. The nurse practitioner observes the child to appear withdrawn and sad. Which action is appropriate? a. Ask the child and the parent about stressors at home b. Make a referral to a child behavioral specialist c. Provide information about anger management d. Suggest consideration of a different classroom
ANS: A School-age children are learning to manage emotions and need help to manage their feelings in acceptable ways. A variety of stressors, including parental divorce, substance abuse, bullying in school, and early responsibilities, can cause anxiety in the child, who may not manage these feelings well. Until the underlying cause is better understood, management options cannot be determined, so referrals to specialists, information about anger management, or moving to a different classroom may not be indicated.
The parent of an adolescent reports noting cutting marks on the teen's arms and asks the primary care pediatric nurse practitioner what it means. What will the nurse practitioner tell this parent? a. Cutting is a way of dealing with emotional distress. b. It is a method of fitting in with other adolescents. c. The behavior is common and will usually stop. d. This type of behavior is a type of suicide attempt.
ANS: A Self-injurious behavior (SIB) is used as a coping strategy to relieve distress, anger, and stress. It is not commonly done among adolescents and is not a way of fitting in with a peer group. Because it indicates underlying distress, adolescents must get help identifying these causes. Many have a history of physical, sexual, or emotional abuse. Although individuals who engage in SIB are more likely to attempt suicide in the future, the act itself is not a suicide attempt.
The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschool-age child. How will the nurse practitioner assess this? a. Ask the child how many books he has at home. b. Ask the mother about her highest grade in school. c. Ask the mother to determine the correct dose of a drug from a label. d. Ask the mother to read a health information handout aloud.
ANS: A The "newest vital sign," or health literacy, can be determined quickly by asking the parent how many children's books are in the home. Greater than 10 books in the home is an independent positive predictor of adequate parent health literacy. The other questions may determine a specific level of literacy in general but are not as efficient.
The primary care pediatric nurse practitioner is performing a well child assessment on an adolescent and is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner use? a. CRAFFT b. HEEADSSS c. PHQ-2 d. RAAPS
ANS: A The CRAFFT tool is a six-question tool used to screen for adolescent substance abuse. The HEEADSSS is used as a psychosocial screening tool. The PHQ-2 is a rapid screen for depression. The RAAPS is used to assess risk behaviors that contribute to most morbidity, mortality, and social problems in teens.
When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource? a. DC: 0-3R b. ICD-10-CM c. ICSD-3 d. NANDA International
ANS: A The DC: 0-3R refers to the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood and is useful for developmental problem diagnosis. The ICD-10-CM is the International Classification of Diseases-Tenth Revision, Clinical Modification and is useful for identifying physiologic diseases. The ICSD-3 is the International Classification of Sleep Disorders - 3rd edition. NANDA International is used to label problems in the functional health domain.
The primary care pediatric nurse practitioner is evaluating recurrent stomach pain in a school-age child. The child's exam is normal. The nurse practitioner learns that the child reports pain most evenings after school and refuses to participate in sports but does not have nausea or vomiting. The child's grandmother recently had gallbladder surgery. Which action is correct? a. Encourage the child to keep a log of pain, stool patterns, and dietary intake b. Order radiologic studies and laboratory tests to rule out systemic causes c. Reassure the child and encourage resuming sports when symptoms subside d. Refer the child to a counselor to discuss anxiety about health problems
ANS: A The PNP suspects a somatic disorder after a normal exam and should encourage the child to keep a food or pain diary to help manage symptoms. The PNP should not "medicalize" the problem with tests. The child should be encouraged to resume sports and participate in normal activities. If the symptoms persist, referral for counseling is warranted.
The primary care pediatric nurse practitioner cares for children from a Native American family and learns that they used many herbs to treat and prevent illness. Which approach will the pediatric nurse practitioner use to promote optimum health in the children? a. Ask about the types of practices used and when they are applied. b. Provide a list of harmful herbs and ask the family to avoid those. c. Suggest that the family avoid using these remedies in their children. d. Tell the parents to use the herbs in conjunction with modern medications.
ANS: A The challenge, when working with families from different cultural backgrounds, who use alternative or complementary medicines, is to find ways to achieve a mutual understanding of the differences and to negotiate an acceptable plan of care. The first step is to begin a discussion about these practices. Providing a list of harmful herbs, suggesting that the family avoid certain herbs, and suggesting that the herbs are only an adjunct to "modern medicine" will sound disparaging and will convey a sense of mistrust.
The primary care pediatric nurse practitioner is counseling the parents of a toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. What will the pediatric nurse practitioner recommend? a. Allow the child to explore and experiment while providing appropriate limits. b. Be present while the child plays to continually teach the child what is appropriate. c. Let the child experiment at will and to make mistakes in order to learn. d. Say "no" whenever the child does something that is not acceptable.
ANS: A The child who is securely attached uses the parents as a base from which to safely explore the world. Toddlers learn by doing and need to experiment to gain mastery over the environment. It is important that parents are present for safety, but parents should not be ever-present and controlling. Parents should be close by and should intervene if the child is at risk for injury. Continual criticism and the use of the word "no" can make the toddler feel powerless.
The mother of a newborn tells the primary care pediatric nurse practitioner that she is worried that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk? a. Three-generation pedigree b. Review of systems c. Genogram d. Ecomap
ANS: A The three-generation pedigree is used to map out risks for genetic diseases in families, as well as conditions with modifiable risk factors. The review of systems is used to evaluate the history of the child's body systems. The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The ecomap is used to identify relationships in the family and community that are supportive or harmful.
The primary care pediatric nurse practitioner is performing a well child check-up on a 20-month-old child. The child was 4 weeks premature and, according to a parent-completed developmental questionnaire, has achieved milestones for a 15-month-old infant. Which action is correct? a. Perform an in-depth developmental assessment screen at this visit to evaluate this child. b. Reassure the parent that the child will catch up to normal development by age 2 years. c. Re-evaluate this child's development and milestone achievements at the 2-year visit. d. Refer the child to a specialty clinic for evaluation and treatment of developmental delay.
ANS: A This child should be at a 19-month adjusted age for prematurity so, according to the parent screen, is 4 months behind. The PNP should perform a more in-depth screen to evaluate this delay. Waiting to see if the child will "catch up" or assuring the parent that this will happen will cause the delays to become more severe. A referral to a specialty clinic should not be made solely on the basis of the parent-completed questionnaire but only after further evaluation of possible delays.
The primary care pediatric nurse practitioner is preparing to conduct a well child assessment of an 8-year-old child. How will the nurse practitioner begin the exam? a. Ask the child about school, friends, home activities, and sports b. Discuss the purpose of the visit and explain the procedures that will be performed c. Offer age-appropriate information about usual developmental tasks d. Provide information about healthy nutrition and physical activities
ANS: A To build rapport with the child and parent, the PNP will begin by asking direct questions to the child, encouraging the child to share information about daily routines. The other answers list aspects of the well child visit that can be introduced after the initial conversation.
The primary care pediatric nurse practitioner is examining a 12-month-old infant who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse practitioner do first? a. Perform an in-depth developmental assessment. b. Reassure the parent that this is normal for a premature infant. c. Refer the infant to a developmental specialist. d. Suggest activities to improve fine motor skills.
ANS: A When developmental screening indicates an infant is not progressing at the expected rate, additional testing to determine the degree of delay is necessary. A referral may be needed if a delay is determined. This is not normal for this degree of prematurity; infants should develop a pincer grasp by 9 to 10 months of age.
The mother of a 3-month-old child tells the primary care pediatric nurse practitioner that it is "so much fun" now that her infant coos and smiles and wants to play. What is important for the nurse practitioner to teach this mother? a. Appropriate ways to stimulate and entertain the infant b. How to read the infant's cues for overstimulation c. The importance of scheduling "play dates" with other infants d. To provide musical toys to engage the infant
ANS: B By 3 months, infants demonstrate a social smile and will become more active, alert, and responsive. Parents may mistakenly assume that the infant can handle more activity and stimulation when this occurs, and the PNP should teach caregivers how to recognize infant cues for the need to rest or to have decreased stimulation.
A school-age child has begun refusing all cooked vegetables. What will the primary care pediatric nurse practitioner recommend to the parent? a. Allow the child to make food choices since this is usually a phase b. Ensure that the child has three nutritious meals and two nutritious snacks each day c. Prepare vegetables separately for the child to encourage adequate intake d. Teach the child how important it is to eat healthy fruits and vegetables
ANS: B Children have food jags that are generally self-limited. The parent's responsibility is to provide three nutritious meals and two nutritious snacks each day so that all available choices are acceptable. Allowing food choices may result in an overabundance of non-nutritious foods selected. It is not necessary to prepare separate dishes for a child who is going through a temporary phase. Teaching the child about nutrition is important but will not likely have much impact during this phase.
The primary care pediatric nurse practitioner performs a developmental assessment on a 3-year-old child and notes normal cognitive, fine-motor, and gross-motor abilities. The child responds appropriately to verbal commands during the assessment but refuses to speak when asked questions. The parent tells the nurse practitioner that the child talks at home and that most other adults can understand what the child says. The nurse practitioner will : a. ask the parent to consider a possible speech delay and report any concerns. b. continue to evaluate the child's speech at subsequent visits. c. refer the child for a speech and hearing evaluation. d. tell the parent to spend more time in interactive conversations with the child.
ANS: B Development should be monitored over time and within the context of the child's overall well-being, rather than at an isolated testing session. The child has normal development in observed measures and appears to hear and understand well. By parental report, the child is able to speak. The PNP should continue to evaluate speech over time, since this refusal to speak may be associated with shyness or intimidation in the clinic. It is not necessary to tell the parent that the child has a possible speech delay. Unless an actual speech delay is observed, a referral is not indicated, nor is it necessary to implement a home therapy.
Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3-year-old child who draws on the walls with crayons? a. Give the child washable markers so the drawings can be removed easily. b. Provide a roll of paper for drawing and teach the child to use this. c. Put the child in "timeout" each time the child draws on the walls. d. Take the crayons away from the child to prevent the behavior.
ANS: B Discipline involves training or education that molds appropriate behavior and is used to teach the child what is permitted and encouraged. Providing an appropriate outlet for drawing helps to teach the child where to use the crayons. Using washable markers allows the parents to clean the walls but does not teach the child appropriate behaviors. Timeout and taking away the crayons are forms of punishment, or a loss of privileges, that are administered as a form of retribution.
Which is true about the health status of children in the United States? a. Globalism has relatively little impact on child health measures in the U.S. b. Obesity rates among 2- to 5-year-olds have shown a recent significant decrease. c. The rate of household poverty is lower than in other economically developed nations. d. Young children who attend preschool or day care have higher food insecurity.
ANS: B Obesity rates are a major concern for child health in the U.S. but recently have stabilized in the rate of increase and have declined among 2- to 5-year-olds between 2004 and 2013. Globalism has an increasing effect on child health in the U.S. The rate of household poverty in the U.S. is higher than in other economically developed nations. Young children who attend preschool or day care have lower food insecurity.
The primary care pediatric nurse practitioner is performing a well child examination on a 9-month-old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant? a. Provide educational videos that focus on language. b. Read simple board books to the infant at bedtime. c. Sing to the child and play lullabies in the baby's room. d. Turn the television to Sesame Street during the day.
ANS: B The best way to improve language skills is to read to children. As long as the reading includes positive interactions with the baby and the reader, the baby is learning language. Educational videos, music, and television are all passive media and do not involve this interaction.
A Somalian immigrant mother is concerned that her 8-year-old child is underweight. The primary care pediatric nurse practitioner notes that the child's weight is at the 25th percentile. After realizing that the mother is comparing her child to a group of American-born children who are overweight, the pediatric nurse practitioner is able to convince the mother that this is a normal weight. Which domain of cultural competence does this represent? a. Global b. Interpersonal c. Intrapersonal d. Organizational
ANS: B The interpersonal domain of cultural competence refers to how cultural competence is manifested between and among individuals and includes all relationships within the health care setting. The PNP becomes aware of cultural norms in body weight and uses this knowledge to discuss healthy weights with the parent. The global domain recognizes a movement toward integration and interconnection of the world population in economic, political, technological, and sociocultural terms. The intrapersonal domain refers to an understanding of the self to understand one's own cultural background. The organizational domain is knowledge of institutional culture and how it affects health care.
The primary care pediatric nurse practitioner is performing a well child assessment on a 13-year-old female whose mother asks when her daughter's periods may start. Which information will the nurse practitioner use to help estimate the onset of periods? a. The age of the mother's menarche b. The patient's age at thelarche c. When adrenarche occurred d. Whether linear growth has stopped
ANS: B Thelarche, or the development of breast budding, generally precedes menarche by 2.5 years, so this should be determined when attempting to predict this milestone. The age of the mother at menarche is not a reliable indicator. Adrenarche is related to adrenal and not gonadal development and is less valid than other secondary sex characteristics in assessing sexual maturation. Rapid linear growth usually begins after thelarche and peaks about a year later but is not used to predict menarche.
The primary care pediatric nurse practitioner is performing a well child exam on a 12-year-old female who has achieved early sexual maturation. The mother reports that she spends more time with her older sister's friends instead of her own classmates. What will the nurse practitioner tell this parent? a. Early-maturing girls need to identify with older adolescents to feel a sense of belonging. b. Girls who join an older group of peers may become sexually active at an earlier age. c. Spending time with older adolescents indicates a healthy adjustment to her maturing body. d. The association with older adolescents will help her daughter to gain social maturity.
ANS: B While it is true that early maturing females may join an older group of peers to feel that they fit in, the ones who do put themselves at risk for risky behaviors, including sexual activity. Although many teens feel awkward when they mature at different rates than their peers, joining a group of older peers demonstrates a poor adjustment and does not promote social maturity.
The parents of a 3-year-old child are concerned that the child has begun refusing usual foods and wants to eat mashed potatoes and chicken strips at every meal and snack. The child's rate of weight has slowed, but the child remains at the same percentile for weight on a growth chart. What will the primary care pediatric nurse practitioner tell the parents to do? a. Allow the child to choose foods for meals to improve caloric intake. b. Place a variety of nutritious foods on the child's plate at each meal. c. Prepare mashed potatoes and chicken strips for the child at mealtimes. d. Suggest cutting out snacks to improve the child's appetite at mealtimes.
ANS: B Young children should have three meals and two nutritious snacks each day. The parents' responsibility is to provide nutritious foods and allow children to choose how much they will eat. Children who are allowed to choose foods will likely make selections that are not healthy. Parents should be discouraged from preparing separate meals for their children. Snacks are necessary to maintain adequate intake and energy.
The primary care pediatric nurse practitioner enters an exam room and finds a 2-month-old infant in a car seat on the exam table. The infant's mother is playing a game on her smart phone. The nurse practitioner interprets this behavior as : a. a sign that the mother has postpartum depression. b. extremely concerning for potential parental neglect. c. of moderate concern for parenting problems. d. within the normal range of behavior in early parenthood.
ANS: C A parent who seems disinterested in a child raises moderate concerns for parenting problems. It does not necessarily signal postpartum depression. It is not a mark for extreme concern. It is not within the expected range of behaviors.
The primary care pediatric nurse practitioner evaluates a school-age child whose body mass index (BMI) is greater than the 97th percentile. The nurse practitioner is concerned about possible metabolic syndrome and orders laboratory tests to evaluate this. Which diagnosis will the nurse practitioner document for this visit? a. Metabolic syndrome b. Nutritional alteration: more than required c. Obesity d. Rule out type 2 diabetes mellitus
ANS: C A problem should never be included on the problem list that is not supported by subjective and objective data found and recorded in the database. This child has a BMI that suggests obesity, so this may be used as a diagnosis. Metabolic syndrome is a diagnosis that is determined by laboratory data, which has not been evaluated yet. Nutritional alteration is a NANDA diagnosis and not acceptable for reimbursement. "Rule out" should not be used as a diagnosis, but may be considered part of a plan.
The primary care pediatric nurse practitioner provides well child care for a community of immigrant children from Central America. The pediatric nurse practitioner is surprised to learn that some of the families are Jewish and not Catholic. This response is an example of cultural : a. collectivism. b. constructivism. c. essentialism. d. individualism.
ANS: C An essentialist view of culture, which dominates the health care literature, portrays an ethnic minority group as having a static set of traits and oversimplifies cultural information, applying traits to all members of the group. Assuming that all people from Central America are Catholic is an example of this oversimplification. Collectivism refers to a member of an ethnic group who perceives himself or herself to be intrinsically part of that group. A constructive view recognizes culture as complex and dynamic and sees people as individuals who may belong to multiple cultures simultaneously. Individualism recognizes the individual, and not the group, as the basic unit of survival.
The parent of a 10-year-old boy tells the primary care pediatric nurse practitioner that the child doesn't appear to have any interest in girls and spends most of his time with a couple of other boys. The parent is worried about the child's sexual identity. The nurse practitioner will tell the parent a. children at this age who prefer interactions with same-gender peers usually have a homosexual orientation. b. children experiment with sexuality at this age as a means of deciding later sexual orientation. c. this attachment to other same-gender children is how the child learns to interact with others. d. to encourage mixed-gender interactions in order to promote development of sexual values.
ANS: C At age 10, children usually develop an intense same-gender relationship with a peer. This is how the child learns to expand the self, shares feelings, and learns how others manage problems. It does not indicate later sexual orientation and is not a characteristic of experimentation with sexuality. It is not necessary to encourage mixed-gender interactions.
The primary care pediatric nurse practitioner works with families from a variety of cultures and socioeconomic classes. Which is an example of cultural humility in practice? a. Giving health care advice that takes cultural differences into account b. Identification of other cultures that may be superior to one's own culture c. Receptivity to learning about the perspectives of other cultures d. Respecting other cultures while maintaining the views of one's own
ANS: C Cultural humility is defined as the lifelong commitment to developing mutually beneficial, nonpaternalistic partnerships and is based on a model of passive volition, receptivity, and being open to learning from others. Practitioners who have cultural humility are always seeking to learn about other cultures. Cultural humility involves asking questions, rather than giving answers. Cultural humility does not mean identifying one's own culture as inferior. Practitioners who are culturally competent are open to the influence of other cultures.
The parent of a 14-year-old child tells the primary care pediatric nurse practitioner that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home, and wants the family to eat vegetarian meals. What will the nurse practitioner tell the parent? a. Do not allow a vegetarian diet in order to maintain appropriate limits for the adolescent. b. Provide vegetarian options for the adolescent that preserve adequate nutrition and protein intake. c. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals. d. Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home.
ANS: C Early adolescents begin to develop their own value system and may try value systems other than the one that they have learned from their family, which is a normal part of establishing personal identity. The parent may allow expression of other values, such as a vegetarian diet, as long as nutritional needs are met and the adolescent takes responsibility for preparing the food.
The primary care pediatric nurse practitioner sees a 3-year-old child who chronically withholds stools, in spite of the parents' attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diagnosis will the nurse practitioner use to facilitate third-party reimbursement? a. Altered elimination pattern b. Elimination disorder c. Encopresis d. Parenting alteration
ANS: C Encopresis is a medical diagnosis, classified in the ICD-10-CM, and is recognized for reimbursement purposes. "Altered elimination pattern" and "Parenting alteration" are NANDA International diagnoses and are not recognized for reimbursement. "Elimination disorder" is a developmental diagnosis.
The parent of a 5-year-old child who has just begun kindergarten expresses concern that the child will have difficulty adjusting to the birth of a sibling. What will the primary care pediatric nurse practitioner recommend? a. Allowing the child opportunities to discuss feelings about the baby b. Giving the child specific baby care tasks to promote sibling bonding c. Having snack time with the child each day to discuss the school day d. Providing reassurance that the sibling will not replace the child
ANS: C Family routines provide support to children and help them self-regulate, especially during times of change, and serve as a buffer during times of change and transition. This child has two major changes, so setting aside regular time to spend with the child will help stabilize these changes. The other options may be useful as well, but routines and special activities are most important.
The parent of a 14-year-old child tells the primary care pediatric nurse practitioner that the child skips classes frequently in spite of various disciplinary measures, such as grounding and extra homework and is earning Cs and Ds in most classes. What will the nurse practitioner recommend? a. Counseling for emotional problems b. Development of an Individual Education Plan c. Evaluation for possible learning disorders d. Referral for a behavioral disorder
ANS: C Frequent school absenteeism, class skipping, and other types of school avoidance may indicate a problem with cognitive ability and should be assessed. When cognitive disorders are ruled out, other issues, such as behavioral and emotional problems may be considered. IEPs are used for children who have identified special physiological or cognitive needs and may be useful if a cognitive disorder is identified.
The parent of a newborn infant asks the primary care pediatric nurse practitioner when to intervene to help the infant's future intellectual growth. What will the nurse practitioner tell the parent? a. Cognitive learning begins during the toddler years. b. Intellectual growth begin when speech develops. c. Language and literacy skills begin at birth. d. Preschool is an optimal time to begin general learning.
ANS: C General learning and acquisition of skills for later reading and writing begin at birth, not in kindergarten or first grade, and these skills grow with everyday loving interactions between infants and caregivers. Cognitive learning changes during toddler years but begins at birth. Intellectual growth is not tied to speech alone.
When providing well child care for an infant in the first year of life, the primary care pediatric nurse practitioner is adhering to the most recent American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care guidelines by : a. focusing less on development and more on illness prevention and nutrition. b. following guidelines established by the Bright Futures publication. c. scheduling well-baby visits to coincide with key developmental milestones. d. seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due.
ANS: C In the most recent AAP Recommendations for Preventive Pediatric Health Care, there is a greater emphasis on behavioral and developmental issues and a recommendation that well child care be based on child and family development rather than the periodicity of immunization schedules. This will require a revision of the current recommendations in Bright Futures.
The primary care pediatric nurse practitioner is performing a well baby examination on a 2-month-old infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her? a. She may not be making as much breastmilk as before. b. She should keep a log of the frequency and duration of each feeding. c. The infant may be going through an expected growth spurt. d. The infant should stay on the previously established nursing schedule.
ANS: C Infants may have a growth spurt at 6 to 8 weeks, and mothers who are breastfeeding may be concerned that they are not making enough milk when they notice that the infant is fussy and wanting to nurse more often. The PNP should reassure the mother that this is expected. It is not necessary, since the infant is gaining weight appropriately, for the mother to keep a log. The mother should follow the infant's cues for feeding since the extra suckling will increase the milk supply to meet the growing infant's needs.
The primary care pediatric nurse practitioner performs a developmental assessment on a 32-month-old child. The child's parent reports that about 70% of the child's speech is intelligible. The pediatric nurse practitioner observes that the child has difficulty pronouncing "t," "d," "k," and "g" sounds. Which action is correct? a. Evaluate the child's cognitive abilities. b. Obtain a hearing evaluation. c. Reassure the parent that this is normal. d. Refer the child to a speech therapist.
ANS: C Intelligibility of speech reaches about 66% between the ages of 24 and 36 months. Tongue-contact sounds are more intelligible by age 5 years. This child exhibits normal speech for age. It is not necessary to perform a cognitive assessment based on these findings. Referrals for hearing and speech evaluations are not indicated, since these findings are within normal limits.
During a well child exam, the primary care pediatric nurse practitioner learns that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father's job layoff. What will the nurse practitioner do? a. Reassure them that the child is too young to understand. b. Recommend that they continue to not argue in front of the child. c. Suggest counseling to learn ways to handle stress. d. Tell them that the conflict will resolve when the situation changes.
ANS: C Marital problems can result in child behavior difficulties and anxieties, and conflict can be picked up by the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict during stressful situations. Even when children do not understand, they pick up on cues from the parents about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation may indicate a pattern of response to stress and will only recur with each subsequent stressful period.
The mother of a 3-year-old child takes the child to a play group once a week. She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother? a. The child probably is very shy but will outgrow this tendency with repeated exposure to other children. b. The toddler may have a language delay that interferes with socialization with other children. c. Toddlers may be interested in other children but usually do not engage in interactive play. d. Toddlers need more structured play to encourage interaction and socialization with others.
ANS: C Parallel play is common among toddlers who, although they may be fascinated by other children, generally do not engage with peers in an interactive manner. This does not mean that the child is shy or has a language delay, although in preschool years, the development of symbolic language increases interactive play. Children need both structured and free play, but structured play will not increase interaction during this normally parallel period.
During a well child exam on a 5-year-old child, the primary care pediatric nurse practitioner assesses the child for school readiness. Which finding may be a factor in limiting school readiness for this child? a. Adherence to daily family routines and regular activities b. Having two older siblings who attend the same school c. Parental concerns about bullying in the school d. The child's ability to recognize four different colors
ANS: C Parental expectation is the strongest predictor of school success in children. Parents who are worried about what may happen in school can transmit this anxiety to the child. Children who have a secure family life with daily routines will do better in school. Having older siblings who attend school increases success. Children at this age are expected to know four colors, so this is an indication of school readiness.
The primary care pediatric nurse practitioner learns that an African-American family lives in a neighborhood with a high crime rate and suggests that they try moving to another neighborhood for the safety of their children. This is an example of a. cultural sensitivity. b. group bias. c. individual privilege. d. racial awareness.
ANS: C Privilege can be individual- or group-based and refers to the often unconscious lack of understanding of what other groups must deal with. The PNP is not aware that the family may lack the resources to move, may be fearful of moving to a "white" neighborhood, or may even feel safe around people that they know. Cultural sensitivity is an awareness of and respect for other cultures. Group bias is a prejudice, based on cultural, racial, or ethnic differences, toward a group of people. Racial awareness would describe an awareness of cultural differences based on race.
The primary care pediatric nurse practitioner understands that, to achieve the greatest world-wide reduction in child mortality from pneumonia and diarrhea, which intervention is most effective? a. Antibiotics b. Optimal nutrition c. Vaccinations d. Water purification
ANS: C Rotavirus is the most common cause of diarrhea globally and Strep pneumonia is the leading cause of pneumonia, and together these are the leading infectious causes of childhood morbidity and mortality globally. Both are vaccine-preventable diseases. Antibiotics to treat pneumonia, optimal nutrition, and clean water all help to reduce morbidity and mortality, but vaccination prevents the diseases from occurring.
The parent of a 6-year-old child expresses concern that the child may have ADHD. Which screening tool will the primary care pediatric nurse practitioner use to evaluate this possibility? a. Behavioral and Emotional Screening System for Children (BESS-2) b. Behavioral Assessment for Children - 2nd ed. (BASC-2) c. Conner's 3 Parent and Teacher Rating Scale d. Pediatric Symptom Checklist (PSC)
ANS: C The Conner's Parent and Teacher Rating Scale is used to assess ADHD symptoms in children aged 6 to 18 years. The BESS-2 is used to evaluate social emotional and mental health in children. The BASC-2 is used to further assess children who have positive findings on the BESS-2. The PSC is used to assess cognitive, emotional, and behavioral problems in children.
The parent of a toddler is concerned that the child may have autism. The primary care pediatric nurse practitioner completes a Modified Checklist for Autism in Toddlers (M-CHAT) tool, which indicates several areas of concern. What will the nurse practitioner do? a. Administer a Childhood Autism Rating Scale (CARS) in the clinic. b. Consult a specialist to determine appropriate early intervention strategies. c. Refer the child to a behavioral specialist for further evaluation. d. Tell the parent that this result indicates that the child has autism.
ANS: C The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate autism. This instrument has been found to have acceptable sensitivity, specificity, and significant positive predictive value. If these behaviors are detected, the PNP should refer the child to a specialist for further assessment, using more diagnostic tools. The CARS may be used but requires specialty training and proper credentials. Until the diagnosis is determined, strategies for intervention are not discussed. The M-CHAT is a screening tool and is not diagnostic.
During a well child assessment of an 18-month-old child, the primary care pediatric nurse practitioner observes the child becoming irritable and uncooperative. The parent tells the child to stop fussing. What will the nurse practitioner do? a. Allow the parent to put the child in a "timeout." b. Ask the parent about usual discipline practices. c. Offer the child a book or a toy to look at. d. Stop the exam since the child has reached a "meltdown."
ANS: C The child has exhibited early signs of misbehavior. At this stage, distraction and active engagement may be used to stop more problems from occurring. It is not necessary to use a timeout because the child hasn't reached the point where cooperation is impossible. The PNP should model appropriate interventions by offering the child a distraction and may ask the parent about discipline practices later in the visit. The child is not at a "meltdown" state.
The primary care pediatric nurse practitioner is examining a 6-year-old child who attends first grade. The child reports "hating" school. The parent states that the child pretends to be sick frequently in order to stay home from school. To further assess this situation, the nurse practitioner will first ask the child : a. about school performance and grades. b. why school is so distressing. c. to name one or two friends. d. whether bullying is taking place.
ANS: C The earliest school-age psychosocial milestone occurs when children learn to separate easily from family, allowing them to go to school. Mastery of these skills enables them to develop and maintain peer friendships. Social interaction skills are necessary in order to develop mastery over school activities. Asking the child to describe why school is distressing may not elicit information, since the child may not be able to articulate this. Bullying is not the only reason for disliking school, but, if it is, will emerge during a discussion about friends and schoolmates.
When meeting with a new family, the primary care pediatric nurse practitioner develops a database that identifies family members and others living in the household, relationships with others outside the household, and significant behavioral and emotional problems. Which tool will the nurse practitioner use to record this information? a. CRAFFT b. Ecomap c. Genogram d. Pedigree
ANS: C The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The CRAFFT tool is used to assess substance abuse in adolescents. The ecomap is used to identify relationships in the family and community that are supportive or harmful. The pedigree is used to identify potential genetic disorders.
The primary care pediatric nurse practitioner performs a well baby examination on a 7-day-old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is correct? a. Follow up at the 2-month checkup. b. Refer to a lactation consultant. c. Schedule a weight check in 1 week. d. Suggest supplementing with formula.
ANS: C This infant lost about 8% of its birth weight, which is normal and, since discharge home, has gained at least 15 grams per day, which is also normal. The PNP should schedule a weight check in a week to make sure the infant regains its birth weight, since most should regain this in 10 to 14 days and since this loss of birth weight is at the high end of normal. It is not necessary to refer to a lactation consultant or supplement with formula, since the infant is gaining weight adequately.
The parent of a 24-month-old child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond? a. "Begin by reading to your child about toileting." b. "Most children are capable by age 2 years." c. "Tell me about your child's daily habits." d. "We should assess your child's motor skills."
ANS: C To assess the parent's understanding of toilet readiness, the nurse practitioner will ask the parents about the child's daily habits and routines to see if the child has predictable patterns that can be the basis for toilet training. While providing storybooks about toileting can help children learn, the first step is to assess toilet readiness. Even though many children are capable at this age, evaluating personal readiness is key to beginning toilet training. Assessment of motor skills may be a second step.
The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the nurse practitioner do in this situation? a. Explain to the parent that developmental delays often do not manifest at first. b. Perform a developmental assessment and tell the parent which delays are evident. c. Point out the tasks that the infant can perform while conducting the assessment. d. Refer the infant to a developmental specialist for a complete evaluation.
ANS: C When discussing developmental delays with parents, it is important to be positive and to initially focus on strengths. Explaining that developmental delays develop over time is true but does not reassure the parent or help the parent cope with feelings. Referrals are not indicated unless delays are present and may take time.
The mother of a 16-year-old male was recently divorced after several years of an abusive relationship and tells the primary care pediatric nurse practitioner that the adolescent has begun skipping school and hanging out with friends at the local shopping mall. When she confronts her child, he responds by saying that he hates her. What will the nurse practitioner tell this mother? a. Adolescence is marked by an inability to comprehend complex situations. b. Adolescence is typically marked by tempestuous and transient episodes. c. Adolescents normally have extreme, disruptive conflicts with parents. d. Adolescents often need counseling to help them cope with life events.
ANS: D Adolescent brains respond differently to toxic stress, so counseling is indicated to help them manage serious events, such as family abuse and divorce. Early adolescents have concrete thinking, but the formal operational thinking occurs later. "Storm and stress" are not the norm in adolescence nor are disruptive periods of conflict.
The primary care pediatric nurse practitioner is performing an exam on an adolescent male who asks about sexual identity because of concern that a friend is worried about being gay. Which response will the nurse practitioner make in this situation? a. Provide the teen with a questionnaire to gain information about his sexuality. b. Remind the adolescent that mandatory reporting requires disclosure to parents. c. Suggest that the adolescent discuss sexual concerns with his parents. d. Tell the adolescent that, unless he is at risk, what he says will be confidential.
ANS: D Adolescents should be encouraged to divulge information about their sexuality to providers by assuring them that confidentiality will be maintained unless the health of the child or others is at risk. The adolescent may be trying to ask questions about himself in a manner that doesn't implicate his own sexuality, so the PNP should attempt to gain his confidence. Questionnaires may be useful when collecting information, but this adolescent has already begun a discussion about the topic. An adolescent who is concerned about being gay may not be ready to come out to his parents.
The parents of a 12-year-old child are concerned that some of the child's older classmates may be a bad influence on their child, who, they say, has been raised to believe in right and wrong. What will the primary care pediatric nurse practitioner tell the parent? a. Allowing the child to make poor choices and accept consequences is important for learning values b. Children at this age have a high regard for authority and social norms, so this is not likely to happen c. Moral values instilled in the early school-age period will persist throughout childhood d. The pressures from outside influences may supersede parental teachings and should be confronted
ANS: D Although early school-age children learn values from their parents, these may be challenged as children learn that others have different values. Parents must confront and negotiate these issues daily with their children. While children may make poor choices and subsequently learn from the consequences, it is best for parents to actively discuss these issues with their children. Children do have a high regard for authority and social norms but may easily transfer this authority to other, less reliable people, such as peers. Moral values may not persist if other sources of authority become prominent.
The primary care pediatric nurse practitioner is obtaining a medical history about a child. To integrate both nursing and medical aspects of primary care, which will be included in the medical history? a. Complementary medications, alternative health practices, and chief complaint b. Developmental delays, nutritional status, and linear growth patterns c. Medication currently taking, allergy information, and family medical history d. Speech and language development, beliefs about health, and previous illnesses
ANS: D An assessment model that integrates the nursing and medical aspects of primary care uses three domains: developmental problems (speech and language development), functional health problems (beliefs about health), and diseases (chief complaint). The other examples all use domains associated with the traditional medical model and do not contain nursing aspects associated with functional health problems.
The primary care pediatric nurse practitioner is assessing a toddler whose weight and body mass index (BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem? a. Failure to thrive b. Home care resources inadequate c. Nutrition alteration - less than required d. Parenting alteration
ANS: D Because the PNP is planning to intervene by helping the parents to provide appropriate food habits, the correct diagnosis should be "Parenting alteration." "Failure to thrive" is a medical diagnosis and requires a medical and social evaluation to rule out organic causes or detect neglect. "Home care resources inadequate" would be used if the PNP suspects that the family lacks adequate funds to purchase food. "Nutrition alteration" is a NANDA diagnosis and would be used if the PNP planned to consult with a dietician or give nutritional information.
The parent of a 4-year-old points to a picture and says, "That's your sister." The child responds by saying, "No! It's my baby!" This is an example of which type of thinking in preschool-age children? a. Animism b. Artificialism c. Egocentrism d. Realism
ANS: D Children at this age are developing their ability to establish causality. Nominal realism occurs when children think that one type of thing can only be called by one name. All dogs are dogs and not various breeds. Animism refers to the belief that objects possess person-like qualities. Artificialism occurs when children think things are caused by a controlling force. Egocentrism is when children see things only as they relate to themselves.
The primary care pediatric nurse practitioner in a community health center meets a family who has recently immigrated to the United States who speak only Karon. They arrive in the clinic with a church sponsor, who translates for them. The pediatric nurse practitioner notices that the sponsor answers for the family without giving them time to speak. The pediatric nurse practitioner will : a. ask the sponsor to allow the family to respond. b. develop the plan of care and ask the sponsor to make sure it is followed. c. request that the sponsor translate written instructions for the family. d. use the telephone interpreter service to communicate with the family.
ANS: D Federally funded managed care networks and community health centers are required to have interpreters accessible for clients with limited English proficiency. A commercial telephone interpreter service has been shown to be as effective as an "in-person" interpreter. Relying on family members or community members may not be reliable and may jeopardize patient confidentiality. This interpreter is answering for the clients without hearing what they have to say, which can compromise care.
The mother of a 6-week-old breastfeeding infant tells the primary care pediatric nurse practitioner that her baby, who previously had bowel movements with each feeding, now has a bowel movement once every third day. What will the nurse practitioner tell her? a. Her baby is probably constipated. b. It may be related to her dietary intake. c. She should consume more water. d. This may be normal for breastfed babies.
ANS: D Infants begin to have fewer bowel movements and may have bowel movements ranging from once or twice daily to once every other day when breastfed. Unless there are other signs, the baby is probably not constipated. The mother does not need to change her intake of foods or water, unless constipation is present.
The primary care pediatric nurse practitioner learns that the mother of a 3-year-old child has been treated for depression for over 5 years. Which aspect of this child's development will be of the most concern to the nurse practitioner? a. Fine motor b. Gross motor c. Social/emotional d. Speech and language
ANS: D Maternal depression in the first year of life has been associated with poorer language development at 3 years of age.
The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 12-month-old child. The parents are bilingual in Spanish and English and have many Spanish-speaking relatives nearby. They are resisting exposing the child to Spanish out of concern that the child will not learn English well. What will the pediatric nurse practitioner tell the parents? a. Children who learn two languages simultaneously often confuse them in conversation. b. Children with multi-language proficiency do not understand that others cannot do this. c. Learning two languages at an early age prevents children from developing a dominant language. d. Most bilingual children are able to shift from one language to another when appropriate.
ANS: D Most children who are bilingual are able to sort out the languages in conversation but may "code switch" at times for clarity as they speak. They seem to understand that not everyone has this ability. Most children who are bilingual develop a dominant language.
During a well child assessment of an 18-month-old child, the primary care pediatric nurse practitioner observes the child point to a picture of a dog and say, "Want puppy!" The nurse practitioner recognizes this as an example of a. holophrastic speech. b. receptive speech. c. semantic speech. d. telegraphic speech.
ANS: D Syntax, or the structure of words in sentences or phrases, is developed in stages between the ages of 8 months and 3.5 years. Telegraphic speech begins at about 18 months of age when children speak in phrases with many words omitted, so that the sentence sounds like a telegram. Holophrastic speech is the use of a single word to express a complete idea. Receptive speech refers to the ability to understand a word without necessarily being able to use the word. Semantics is the understanding that words have specific meanings.
The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? a. To begin brushing the infant's teeth with toothpaste b. To consider weaning the infant from breastfeeding c. To discontinue giving fluoride supplements d. To make an appointment for an initial dental examination
ANS: D The American Academy of Pediatric Dentistry recommends a first dental examination at the time of eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride supplements should not be discontinued.
A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse practitioner notes that the child's last visit was for a pre-kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially? a. Ask the child's parent why the child is so anxious. b. Perform a physical assessment to rule out shortness of breath. c. Reassure the child that there is nothing to be afraid of. d. Review the purpose of this visit and any anticipated procedures.
ANS: D The PNP should remember that young children are learning "scripts" for health care visits and may be stressed when recalling previous visits, especially if those involved immunizations. The PNP should explain the purpose and any anticipated procedures for this visit to help put the child at ease.
The primary care pediatric nurse practitioner conducts a well baby exam on an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend? a. Consult a developmental specialist for a more complete evaluation. b. Prepare the parents for a potentially serious developmental disorder. c. Refer the infant to an early intervention program for physical therapy. d. Teach the parents to provide exercises to encourage motor development.
ANS: D The child who has mild delays in only one area may be managed initially by having the parent provide appropriate exercises. If this is not effective, or if delays become more severe, referrals for evaluation or early intervention services are warranted. A mild delay does not necessarily signal a serious disorder, so this action is not indicated.
During a well child assessment of a 13-year-old male, the primary care pediatric nurse practitioner notes small testicles and pubic and axillary hair. To further evaluate these findings, the nurse practitioner will ask the patient about a. alcohol and tobacco use. b. changes in voice. c. increase in height and weight. d. participation in sports.
ANS: D The initial sign of puberty in males is testicular enlargement. If this does not precede other changes, the PNP should consider whether the boy is taking exogenous anabolic steroids, common among those who wish to improve athletic ability. These findings are not concerning for alcohol or tobacco use. Voice changes and rapid growth may occur with pubic hair development, but the primary concern is anabolic steroid use.
at what age should blood pressure start to be assessed during well visits? when should hearing and vision assessments start?
Annually, toddlers and preschool children need anthropometric measurement, including blood pressure for 3-year-olds and at-risk children. Hearing and vision assessment is recommended at 4 and 5 years old
A new mother asks the nurse how much weight loss is expected of the baby after birth. The most accurate reply is a. 10-15% b. 5-8% c. 4% d. None
Ans: (B) A weight loss of 5-8% of a newborn's weight within 3-4 days of life is normal. This is due to passage of urine and feces, and also of metabolic and physiologic adjustments to extrauterine feeding.
A 24-year-old mother who is a smoker and cocaine addict gave birth at 39 weeks to a 2,000-gram female infant who is in the neonatal intensive care unit. Using the Intrauterine Growth Curve chart, you determine whether the infant's weight is appropriate for her gestational age.In which category does the infant best fit? A) Large for gestational age B) Normal for gestational age C) Small for gestational age
Ans: C For a 39-week infant, any weight less than 2,500 grams would be considered small. Intrauterine growth retardation and low birth weight would be expected in a smoker who also abuses cocaine.
You are assessing Tanner staging of the breast in a young woman. You notice projection of the areola and nipple to form a secondary mound above the level of the breast. Which Tanner stage would this be? A) I B) II C) III D) IV
Ans: D This would be a Tanner stage 4 because there is elevation of the nipple and areola above the level of the surrounding breast tissue and because the areola has not receded to the general contour of the breast.
what is the scarf sign?
Arm across chest toward opposite shoulder until resistance met. Resistance increases with GA
during what age (weeks/months) may the mother be concerned that she is not producing enough milk and why?
At about 6 to 8 weeks, the infant may experience a growth spurt and fuss to eat more frequently. Mothers who are breastfeeding need extra encouragement during this time because they may believe that they do not have enough milk for their baby. Provider reassurance can be backed up by an interval infant weight check if the mother is overly concerned. Providers should instruct mothers to follow their infant's cues for feeding; pointing out that the extra suckling will increase the milk supply sufficiently to meet their growing infant's needs
A toddler is able to jump in place and balance on one foot as well. She can also speak in full sentences and feed herself. What is the approximate developmental age of this child? A) 2 years B) 3 years C) 4 years D) 5 years
B These milestones are consistent with a physical, cognitive/language, and social and emotional developmental age of 3 years.
which of the following are red flags? A. 16 mo old not able to jump in place B. 24 mo old does not pretend play C. 24 mo old unable to go down stairs D. 24 mo old and not potty trained E. 18 mo old not understanding taking turns
B, C not being able to jump by 30 mo would be a red flag, not at 16 mo issues with potty training at 36 mo is a red flag, not 24 mo not understanding taking turns at 18 mo is not a red flag, but at 36 mo it is a red flag
which of the following are red flags? A. 7 month old gaining 1 pound a month B. 9 month old that awakes throughout the night C. 6 month old turning head 180 degrees to see surroundings D. 6 month old 1.5 times the birth weight E. 6 month old with teething symptoms
B, D
which of the following are red flags? A. 18 month old not using pronouns B. 24 mo old can identify 3 out of 5 pictures C. 24 mo old using jargon D. 24 mo old able to stack 2 blocks E. Does not parallel play at 24 mo
B, E, D Should be able to ID 5 pictures. should be able to stack 4-5 blocks at 24 mo not using pronouns at 30 mo would be a red flag, not 18 mo
Breast maturity stage 2
Breast bud stage: elevation of breast and nipple as a small mound; enlargement of areolar diameter
You are observing an infant who is able to pull to a stand, uses "mama" and "dada" specifically, and indicates his wants by vocalization and pointing. Where would you place this child's developmental age? A) 12 months B) 10 months C) 8 months D) 6 months
C Assessing developmental milestones is of major importance during the first year and beyond. These accomplishments in the physical, cognitive/language, and social domains are normal for an 8-month-old infant.
6-month-old infant is brought in for a well check. It is noted his head circumference is off the chart and at a much higher percentile than was previously measured. What should you do next? A) Recommend a neurology consult. B) Order a CT of the head. C) Remeasure the circumference. D) Admit the child to the hospital for further workup.
C It is difficult to obtain accurate measurements of a squirming infant. The first step would be to remeasure. Some recommend starting with three measurements and averaging or picking the middle measurement. Height is technically not measured until a child is standing, so infants' measurements are recorded as length.
what stage of development is this? Children use symbols to represent concrete objects and to perform mental tasks. This requires cognitive skill to organize experiences and classify increasingly complex information. Most schoolwork requires functioning at this level. This stage is characterized by flexibility of thought, declining egocentrism, logical reasoning, and greater social cognition.
Concrete Operational Stage (7 to 12 Years)
__________________ refers to the individual's ability to recognize that he or she is a unique individual, with characteristics and traits different from those of other family members, who can function as a distinct person while developing and maintaining emotional connections to others.
Differentiation of self
what is the difference between discipline and punishment
Discipline is training or education that molds the behavior, mental capacities, or moral character of an individual. Discipline is used by the parent to teach the child appropriate behavior and to keep the child safe. • Punishment, on the other hand, is loss, pain, or suffering that is administered in response to behavior; it is a form of retribution.
when is early, middle and late childhood?
Early childhood (5 to 7 years) Middle childhood (8 to 10 years) Late childhood (11 to 12 years)
what happens to the elimination pattern during 1-3 months?
Elimination patterns become more regular. Infants go from defecating with each feeding to having one or two bowel movements daily or every other day if formula fed, and bowel movements that range from once or twice daily to once every 3 to 5 days or longer if breastfed. Wet diapers typically occur after each feeding.
what theorist said that Each stage has a problem to master; if not resolved, would be revisited in future stages
Erikson
what theory is this? some parents focus on long-term pair bond outcomes and selective interpersonal relationships and tend to be highly invested in their parenting role and the long-term success of their offspring. Other parents focus more on short-term gains and may be more focused on forming pair bonds and less focused on parenting. This can result in cool parent-child relationships, early onset sexual expression, and inappropriate relationship expectations, especially in adolescent females.
Evolutionary life history theories
what theory is this? the belief that just as physical evolution occurs in nature, families evolve over time and learned family behaviors are inherited. These theories hold that behaviors are intrinsic and the genetic influences of behavior are largely driven by the biologic imperative to reproduce.
Evolutionary life history theories
what anticipatory guidance should you give a parent for a preschooler or toddler regarding a their concrete and preoperational thinking?
Explain to parents that toddlers and preschoolers are concrete and preoperational in their thinking. As a result, parents need to be ready to explain things over and over patiently, without expecting the child to understand the adult's interpretation clearly. Also, children may use words to convey thoughts and feelings, but many responses are repetitive, and trial-and-error problem solving is usually crude. They frequently attend to only one aspect of a problem, giving partial answers.
what theory is this? how family dynamics influence adult and child behaviors.
Family systems theory
what theory is this? this theory holds that an individual's emotional dysfunction has a profound impact on overall family health Anxious family members, those with highly-fused relationships or those with poor self-differentiation, express their anxiety in ways that result in family dysfunction. This can cause parental discord, parent or child health or emotional problems or triangulation, a process where anxiety and/or tension between two family members is passed on to a third family member
Family systems theory
what theory is this? This theory helps explain how parental relationship problems can result in child behavior difficulties or how an enmeshed parent-child relationship can result in inappropriate worries about child health and/or strain in the parents' relationship.
Family systems theory Anxious family members, those with highly-fused relationships or those with poor self-differentiation, express their anxiety in ways that result in family dysfunction. This can cause parental discord, parent or child health or emotional problems or triangulation, a process where anxiety and/or tension between two family members is passed on to a third family member
what stage of development is this? At this stage, children begin to think abstractly and imagine different solutions and outcomes to problems. Adolescents begin to develop increased awareness of health and illness and recognize how their behaviors can impact health. Renewed egocentrism may be noted early in this stage as a result of a lack of differentiation between what others are thinking and one's own thoughts. This egocentric thinking eventually gives way to an appreciation of the differences in judgment between the adolescent and other individuals, societies, and cultures.
Formal Operational Stage (13 Years through Adulthood)
define LBW, VLBW and ELBW
Low birth weight (LBW)— 2500 g Very low birth weight (VLBW)— 1500 g Extremely low birth weight (ELBW)— 1000 g
Breast maturity stage 5
Mature stage: projection of nipple only; areola has receded to general contour of the breast (although in some normal individuals the areola continues to form a secondary mound)
when age does visually track objects to midline start?
Newborn
what are normal patterns of crying?
PURPLE
how often should a middle and late adolescent get a pap smear?
Papanicolaou (Pap) smears are no longer recommended until after age 21 years regardless of sexual activity. if sexually active, they should get STI screening
what stage of development is this? Children next attempt to make sense of the world and reality. In this stage, children are egocentric and are only able to reason when there are connections to concrete objects. They learn cause and effect, and their reasoning is often flawed. Children begin to use semiotic functioning, or the use of one thing to represent another. Intuitive reasoning emerges toward the end of this stage, but reasoning remains connected to the concrete reality of the here and now.
Preoperational Stage (2 to 7 Years)
Preterm—define Late pre-term- define
Preterm—newborn with gestational age estimated as less than 37 weeks. Late pre- term is newborn 34 weeks to 36 6 7 weeks.
Breast maturity stage 4
Projection of areola and nipple to form a secondary mound above the level of breast
what are the 2 sleep states in a newborn?
Quiet sleep occurs when the infant is in deep sleep, shows little movement, and is difficult to arouse even when touched or stimulated by sound. Active sleep, the most common type of sleep, involves rapid eye movement (REM), smiling, sucking, and brief fussing or crying. Babies who fuss during active sleep are not in distress or hungry.
what stage of development is this? Key concepts during this period include object permanence, spatial relationships, causality, use of instruments, and combination of objects. The child's framework for learning is the self, and there is little cognitive connection to objects outside the self.
Sensorimotor Stage (Birth to 2 Years)
Self-injurious behaviors (SIBs) are repetitive behaviors with the intent of intentionally causing physical harm to oneself for nonsocially sanctioned and nonsuicidal reasons. what are the parameters to diagnose a patient with SIB?
Symptoms must have occurred at least five times and be associated with at least two of the following: • Previous negative emotions • Preoccupation with activity and a repetitive desire to engage in activity • Feelings of relief from negative emotions or a sensation of positive feelings with activity • Impaired interpersonal relationships includes cutting, scraping; hitting; burning or ripping of skin, subdermal tissue, or hair; hindering wound healing (e.g., picking at scabs); swallowing toxic substances; breaking bones; and bruising oneself individuals who engage in SIB are more likely to attempt suicide or to have an eating disorder, a history of abuse or trauma, a mood disorder, or psychological distress than those in the general population and should be assessed for suicide risk
what growth charts should be used to measure weight for length in children less than 24 months? After 24 months, what chart is used to measure children?
The World Health Organization (WHO) before 2 years old the Centers for Disease Control and Prevention (CDC) charts after 2 years old
What is syntax?
The arrangement of words and phrases to create well-formed sentences in a language. word order sentence structure grammar structure of words in sentences or phrases
when should a child start going to the dentist?
The guidelines recommend the first examination occur at the time of the eruption of the first tooth and no later than 12 months old. Health professions should support the identification of a dental home for all infants by 12 months old
during months 1-3 how much does the infant gain per day?
The infant typically gains 0.5 to 1 ounce (14 to 28 g) per day
what theory asserts that the parenting role begins in childhood, evolves over time, and is influenced by personal experience, social norms, the health of the parent-child relationship, family dynamics, and the child's own characteristics?
The parent development theory
what theory identifies six characteristics of parenting that vary in their importance based on the child's developmental needs? (Sensitivity, Responsivity, Generalwelfare and protection, Education, Discipline, Bonding) Parenting evolves as a child ages. For example, a parent of a toddler who is just learning to walk has a very different role from the parent of an adolescent who is a senior in high school and preparing to leave for college.
The parent development theory
which of the following are red flags? A. A 1 month old with tachypnea or bradycardia with feedings B. 3 month old who quiets in response to voice C. Lack of return to birth weight by 2- week examination D. 3 month old who has a BM every other day E. 2 week old that does not laugh
a and c = red flags when formula fed, may have BMs qod. if breastfed, could be up to once every 3-5 days. laughing starts 3-6 mo
Limit TV/videos to ______a____hours/day. No TV before age of ____-b_____
a: 1-2 b: 2 years
Infants 4 through 5 months old have regular patterns of eating, sleeping, and playing. They sleep ____a___ hours a day with ____b____ feedings during the day and _____ during the night.
a: 12 to 15 b: five c: 1
The newborn sleeps about ____a___ hou,rs and, if encouraged, breastfeed every ___________ hours (The infant may have one longer stretch of _______ hours at night)
a: 16 b: 2 to 3 c: four
the anterior fontanelle should completely closed by ___a___ months. Most children have no palpable fontanelles by ___b___ months
a: 18 to 19 b: 12 mo
a: at what age should a child be able to dress self with assistance b: at what age should a child be able to undress self
a: 30 mo b: 48 mo
a: at what age should a child be able to put on her shoes b: at what age should a child be able to tie laces?
a: 36 mo b: 60 mo
a: at what age should a child be able to imitate a 3 cube bridge? b: at what age should a child be able to copy a bridge from a model?
a: 36 mo b; 48 mo
a: at what age should a child be able to use scissors b: at what age should a child be able to cut a curved line with scissors c: at what age should a child be able to cut out simple shapes?
a: 36 mo b: 48 mo c: 60 mo
The infant may initially lose up to ________a________ of birth weight but should regain it within 10 to 14 days. Weight loss of _______b_______ requires close monitoring and may require further evaluation. Weight gain after the initial loss averages _________c______ per day, or about _______d_____ per month.
a: 5% to 8% b: 10% or more c: 0.5 or 1 ounce (14 to 28 g) d: 2 pounds (nearly 1 kg)