PEDS test 1 (ATI)

A nurse is assessing a 6 month old infant. The guardian reports that the infant does not appear interested in the brightly colored mobile hanging above the crib at home. which of the following techniques should the nurse use to check the infants visual acuity? a. shine a penlight briefly into the left eye and then the right eye b. move a brightly colored toy from side to side in front of the infants face c. ask the guardian to to sit in front of the infant and nod his head up and down d. observe the infants ability to grasp the feet and pull them to the mouth

b. move a brightly colored toy from side to side on front of the infants face

A nurse is providing education to the parent of a toddler who is about to receive an MMR immunization. which of the following statements by the parent indicates an understanding of the teaching? a. "my child should not play with other children for 2 days" b. "I will return in two weeks for my child to receive the varicella immunization " c. "I will help my child to blow bubbles during the injection" d. "my child may have some drainage from the injection site"

c. "I will help my child to blow bubbles during the injection"

A nurse is caring for a 2 year old child who has cystic fibrosis. The nurse is planning to take the child to the playroom. which of the following activities would be appropriate for the child? a. cutting figures from colored paper b. drawing stick figures using crayons c. riding a tricycle d. building towers with blocks

d. building towers with blocks

A nurse is assessing a 4 year old child. The nurse should expect the child to be able to perform which of the following activities? a. fastening buttons on a shirt b. tying shoe laces c. parting and combing hair d. cutting the meat at dinner

a. fastening buttons on a shirt

a nurse in a pediatric clinic is assessing a toddler at a well child visit which of the following actions should the nurse take? a. perform the assessment in a head to toe sequence b. minimize physical contact with the child initially c. explain procedures using medical terminology d. stop the assessment of the child becomes uncooperative

b. minimize physical contact with the child initially

a nurse is assessing an 18 month old toddler during well child exam. which of the following findings should the nurse report to the provider? a. the toddler is unable to remove his shoes b. the toddler is unable to draw a plus sign c. the toddler is unable to jump off a step d. the toddler is unable to turn 1 page of a book at a time

a. the toddler is unable to remove his shoes

A nurse in the emergency department is caring for an unaccompanied infant following a motor vehicle crash. during the assessment m, the nurse notes that the infants anterior fontanel is almost closed. she has 6 teeth, is able to sit unsupported, and can drink from a cup. the child cries whenever anyone new to her enters the room, says a few words, and is asking for "mama" and "dada". the nurse should make which of the following age assessments for this child? a. 6 months old b. 12 months old c. 18 months old d. 24 months old

b. 12 months old

A nurse is assessing a 9 month old infant during a well child visit. which of the following findings indicate that the infant has a developmental delay? a. creeping on hands and knees b. inability to vocalize vowel sounds c. using a crude pincer grasp d. standing by holding onto a support

b. inability to vocalize vowel sounds

a nurse is providing teaching to the parent of a 2 year old toddler about nutrition. which of the following statements by the parent indicates an understanding of the teaching? a. "my child should consume 1,000 calories per day" b. "my child should have 4oz of protein per day" c. "I should give my child 32oz of milk per day" d. "I should feed my child 4oz of vegetables per day"

a. "my child should consume 1,000 calories per day"

A nurse is teaching the parent of an infant about injury prevention. Which of the following statements by the parent indicates an understanding of the teaching? a. "I should lightly shake talcum powder on my baby's skin after each diaper change" b. "I should use a drop-side crib after my baby is 6 months old" c. "I should make sure my baby's clothing does not have buttons" d. I should ensure the crib slats are no more than 3 inches apart"

c. "i should make sure my baby's clothing does not have buttons"

A charge nurse is reviewing the expected growth and development of school aged children with a group of staff nurses. which of the following statements should the nurse include? a. 7 year old child prefers to play with children of a different gender b. 6 year old child should understand the concept of cause and effect c. 6 year old child should be able to count 13 coins d. 8 year old child should be able to wash his or her own hair independently

c. 6 year old should be able to count 13 coins

a nurse is assessing an 18 month infant who is post op. which of the following pain scales should the nurse use? a. FACES b. CRIES c. FLACC d. PIPP

c. FLACC facial expression, leg movement, activity, cry and consolability in children 2 months to 7 years

A nurse is assessing a client before administering the hepatitis B vaccine. which of the following allergies should the nurse identify as a contraindication to receiving this vaccine? a. shellfish b. gelatin c. bakers yeast d. eggs

c. bakers yeast

a nurse is assessing the vital signs of a 1 month old infant. which of the following actions should the nurse perform? a. use a cuff to auscultate blood pressure b. determine heart rate by taking the radial pulse c. count respirations before taking other vital signs d. measure temperature not placing the thermometer in the infants ear

c. count respirations before taking other vital signs

A nurse is performing a neurological exam on a 15 month old toddler. which of the following findings should the nurse expect? a. negative babinki reflex b. presence of the moro reflex c. absence of corneal reflexes d. positive palmer grasp

a. negative babinki reflex should expect negative reflex because it usually disappears around 4 months of age

a nurse is performing a well child assessment on a 4 year old child. which of the following findings should the nurse expect? a. the child is able to hop on 1 foot b. the child if able to build a tower of up to 6 blocks c. the child is able to name the days of the week d. the child is able to identify left and right

a. the child is able to hop on 1 foot

a nurse is preparing to assess a 3 month old infant during a well child visit. which of the following observations should the nurse expect? a. the infant looks at his hands b. the infant has a pincer grasp c. the infant has no head lag when pulled to a sitting position d. the infant can independently roll from his back back to his abdomen

a. the infant looks at his hands

A nurse is performing a physical assessment on a 12 month old infant. which of the following findings should the nurse report to the provider? a. the infants current weight is double his birth weight b. the infants posterior fontanel is closed c. the infant is unable to walk without support d. a total of 6 teeth are present

a. the infants current weight is double his birth weight

a nurse is conducting a health assessment for a 24 month old toddler at the local health department. the nurse should expect which of the following findings? (select all that apply) a. 8 deciduous teeth b. ability to build a tower of 6 blocks c. vocab of 10-20 words d. slightly bowed or curved leg appearance c. head circumference greater then chest circumference

b. ability to build a tower of 6 blocks d. slightly bowed or curved leg appearance

a nurse is performing physical assessment in a 6 month old infant. which of the following reflexes should the nurse expect to find? a. stepping b. babinski c. extrusion d. moro

b. babinski present until the age of 1 a. disappears at 4wks c. disappears at 4 months d. disappears at 3-4 months

A nurse is assessing the fine motor skill development of a 4 year old child. The nurse should expect the child to be able to perform which of the following activities? a. tying shoelaces into a bow b. copying a square c. drawing a person with at least 8 parts d. printing the letters of her name

b. copying a square

A nurse is assessing a 9 month old infant. Which of the following findings should the nurse report to the provider a possible developmental delay? a. grasping a small object with just the thumb and index finger b. dropping a cube when passing from 1 hand to the other c. falling from a standing position to sitting d. losing balance when leaving sideways while eating

b. dropping a cube when passing from 1 hand to the other

A nurse is assessing a 12 year old child during a well child checkup. Which of the following physical findings should the nurse report to the provider? a. 5cm (2in) growth in the past year b. hyperopia c. presence of public hair d. weight gain of 3kg in the last year

b. hyperopia hyperopia, or farsightedness is an unexpected finding after the age of 7

A nurse is performing well child assessment on a 7 year old client who takes great pride in bringing school papers home. The nurse recognizes that this behavior demonstrates which of the following of eriksons stages of psychosocial development? a. initiative vs. guilt b. industry vs. inferiority c. identity vs. role confusions d. autonomy vs. shame and doubt

b. industry vs. inferiority ages 6-12 a. ages 3-6 c. ages 13-19 d. ages 12mons-3 years

a nurse is discussing play activities with a group of parents of toddlers. which of the following activities should the nurse recommend for this age group? a. jumping rope b. pushing a toy lawn mower c. sorting colored marbles d. playing a board game

b. pushing a toy lawn mower

a nurse is performing a physical assessment of a newborn. which of the following actions should the nurse take? a. measure newborns length from anterior front ask to the heel b. measure the newborns weight while be is wearing a clean diaper c. measure the circumference of the newborns head with a tape just above eyebrows d. measure the circumference of the newborn chest with a tape measure 2cm below the nipple line

c. measure the circumference of the newborns head with a tape just above eyebrows

A nurse is assessing a 7 month old infant during a well child visit and notes the presence of a full moro reflex. for which of the following conditions should the nurse screen the infant? a. congenital heart disease b. hearing loss c. neurological disorder d. amblyopia

c. numerological disorder the reflex should be gone by 4 months

a nurse is assessing a 3 year old child during a well child exam. which of the following findings should the nurse report to the provider? a. the child sets the bed when sleeping b. the child cannot catch a ball c. the child cannot walk on tiptoe d. the child build a tower of 10 cubes

c. the child cannot walk on tiptoe

A nurse is assessing a 30 month old toddler during a well child visit. Which of the following findings requires further assessments by the nurse? a. primary dentition is complete b. the toddler is unable to hop on 1 foot c. the toddlers birth weight is tripled d. the toddler is able to state her first and last name

c. the toddlers birth weight is tripled triple at 12 months, should be quadrupled at 30

a nurse is assessing a school aged child who reports horseback riding 3x per week and has injuries reportedly r/t a fall from a horse. which of the following findings should the nurse investigate further as an indication of child maltreatment? a. bruising of the right elbow b. dislocated left shoulder revealed by xray c. thin, frail extremities d. abrasions on both wrists

c. thin, frail extremities

a nurse is performing an annual physical assessment of a preschooler. the parent expressed concern about the child's 1.8kg (4lb) weight gain over the past year. which of the following responses should the nurse make? a. "the amount of weight gain could likely indicate a serious problem" b. "this weight change seems to be the result of poor eating habits" c. "your child should have gained double this amount in a year" d. "your child's weight change is expected for this age group"

d. "your child's weight change is expected for this age group"

a nurse is planning care for a child who has meningococcal meningitis. which of the following isolation precautions should the nurse plan to implement? a. airborne precautions b. contact precautions c. protective environment d. droplet precautions

d. droplet precautions

a nurse is planning to use guided imagery for an early school aged child who continues to have mild discomfort following the administration of an analgesic. which of the following techniques should the nurse plan to use? a. give the child a kaleidoscope and ask the child to find different designs b. encourage the child to take a deep breath and let the body go limp in the exhale c. teach the child to picture a stop sign whenever the pain begins d. encourage the child to focus on a recent pleasurable experience

d. encourage the child to focus on a recent pleasurable experience

a nurse is planning to implement relaxation strategies with a young child prior to a painful procedure. which of the following actions should the nurse take? a. ask the child to hold a breath and blow it out slowly b. ask the child to describe a pleasurable event c. bounce the child gently while holding him upright d. rock the child using long, rhythmic movements

d. rock the child using long, rhythmic movements

a nurse is assessing the development of a 3 year old child. which of the following gross motor skills should the nurse expect the child to be able to perform? a. skipping around the room b. hopping on 1 foot c. throwing a ball overhead d. standing on 1 foot

d. standing on 1 foot

A nurse is assessing a 10 month old infant at a well infant checkup. which of the following assessment findings should the nurse report to the provider? a. the infant is unable to walk independently b. the infants moro reflex is absent c. the infants anterior fontana's is open d. the infant needs assistance to sit up

d. the infant needs assistance to sit up

A nurse is testing the reflexes of a newborn to assess neurologic maturity. What reflexes is the nurse assessing when she quickly and gently turns the newborn's head to one side? a. moro b. babinski c. rooting d. tonic neck

d. tonic neck

A nurse is assessing the gross and fine motor behaviors of a toddler. which of the following behaviors should the nurse identify as an expected achievement for a 3 year old child? a. walking backward while moving heel to toe b. standing on 1 foot for several seconds c. using scissors to cut out shapes d. printing letters with a pencil

b. standing on 1 foot for several seconds

A nurse is assessing the dynamics of a family in which child maltreatment is suspected. which of the following findings should the nurse report to the provider? a. the parents provide emotional support to the child during the assessment process b. the child has several unexplained scars and bruises c. the child cried and appears afraid if the health care provider d. the parents offer consistent, detailed stories about the child's injuries

b. the child has several unexplained scars and bruises

A nurse in a providers office enters an examination room to assess an 8 month old infant for the first time. which of the following reactions by the infant should the nurse expect? a. the infant gives the nurse a social smile b. the infant turns away when the nurse approaches c. the infant reaches out to the nurse to be held d. the infant is responsive and alert as the nurse comes closer

b. the infant turns away when the nurse approaches

a nurse is assessing a 6 month old infant during a well child visit. which of the following motor activities should the nurse expect the infant to have achieved? a. sitting alone b. attempting to stack objects c. picking up small objects with a crude pincer grasp d. turning from back to stomach

d. turning from back to stomach