Study Guide PEDS Ch. 31 Growth and Development
What was founded by Lillian Wald?
Henry street settlement
What observation in an emergency department should lead a nurse to suspect child abuse in a child with a fractured arm?
Inconsistency between the injury and the parents explanation of it
When attempting to provide information to the parents of a child undergoing surgery, the nurse notes that the parents appear confused and do not seem to remember what they are being told. What is the most probable cause of the parents forgetfullness?
Increased level of parents anxiety
The mother of a child with diabetes asks the nurse in charge of the family-centered pediatric unit if she might see her childs laboratory reports. What response by the nurse is the most appropriate?
"Come to the conference room where we can have privacy while you look at them."
When using anticipatory guidance to prepare a 5-year-old for an IM injection, what statement by the nurse would be most appropriate?
"Ethan I am going to give you some medicine that will sting, but only for a little while."
A nurse is reinforcing teaching with a group of parents of early adolescent females about expected changes during puberty. Which of the following parent statements indicates an understanding of the teaching?
"Females usually stop growing about 2 years after menarche."
A nurse is reinforcing teaching about dental care and teething to the parent of a 9 month old infant. Which of the following statements indicate that the parent understands the information?
"I should clean my baby's teeth with a cool, wet wash cloth."
A nurse is reinforcing teaching with the parent of a preschooler about methods to promote sleep. Which of the following statements by the parent indicates an understanding of the instructions?
"I will keep a dim light on in my child's room during the night."
A nurse is reinforcing teaching about age-appropriate activities to the parent of a 24 month old. Which of the following indicates that the parent understands the information?
"I will send my child's favorite stuffed animal when she will be napping away from home."
An 8 yr old child asks how a blood pressure is taken. What would be the most appropriate response?
"The armband will hug your arm and tell me how well your blood is going through your arm."
When the newly admitted 2-year-old who was potty-trained before admission begins to wet the bed, the mother is frightened. What statement by the nurse will be most helpful to the mother?
"The stress of hospitalization makes children regress a little."
The mother of a 3 year old expresses concern about her daughters slowed growth rate. What would be the most informative response by the nurse?
"Three yr olds have typically finished a growth spurt, and you may notice a decreased rate in your daughters growth."
A disfiguring facial wound would have the most significant developmental impact on which child?
14 year old
What is the maximum amount of time that a nurse should suction an artificial airway?
5 seconds
A child's refraction does not reach 20/20 until about the age of?
6 years old
When measuring the head circumference of an infant, where should the nurse place the tape measure?
Above the eyebrows and pinnas, and around the occipital lobe
What should the nurse do to minimize an unpleasant-tasting drug?
Administer the drug through a straw
What are the advantages of a mist tent?
All of the device's parts are located outside of the tent; the child is easily observed through the plastic canopy.
Following a lumbar puncture of a 2 year old, what should the nurse do?
Allow the child to play quietly at will
A nurse is caring for a preschooler who says she needs to leave the hospital because her doll is scared to be at home alone. The nurse recognizes that the child is exhibiting which of the following characteristics of preoperative thoughts?
Animism
What is the correct way to assess for the presence of jaundice in an African American child?
Apply pressure to the gum
What should be done before initiating a gavage feeding?
Aspirating stomach contents and a small amount of air while listening for stomach gurgling to ensure the correct placement.
A nurse is assisting with a nutrition education program for a group of parents of preschoolers. Which of the following dietary guidelines should the nurse plan to include?
Average intake should be 1,800 calories per day
What are the aspects of bathing?
Bathe infant before feeding; bathing provides opportunity for skin assessment; pay special attention to genitalia; be careful to remove soap and dry creases to maintain skin integrity; never use Q-tips to cleanse baby's ears; use dry hands to pick up infants
When the pediatric nurse is attempting to establish a trusting relationship with a child, what is the most important and lasting thing to do?
Be honest
What is the best time to bathe an infant?
Before feeding
A nurse is collecting data from a 12 month old infant during a well-child visit. Which of the following findings should the nurse report to the provider?
Birth weight doubled
A nurse is reinforcing teaching about health promotion with the parent of a 13 year old adolescent. Which of the following screenings should the nurse recommend? sata:
Body mass index; Weight; & Scoliosis
How does the nurse establish a trusting relationship?
By being honest
How does the nurse measure output for an infant?
By weighing diapers before and after voiding. & Subtracting the weight of the dry diaper from the weight of the wet diaper
4 yr old vitals:
HR- 100 ; RR- 23 ; BP- 100/70 ; Temp- 98.5
2 yr old vitals:
HR- 110 ; RR- 25 ; BP- 96/68 ; Temp- 98.9
1-11 month vitals:
HR- 120 ; RR- 30 ; BP- 90/60 ; 99.7
The nurse clarifies that child abuse and neglect are complicated and preventable problems falling under which broader term?
Child maltreatment
What is the special category that encompasses children who have congenital abnormalities, malignancies, GI diseases, or CNS anomalies?
Children with special needs
Sexual abuse:
Comission of a sexual offense by a person responsible for a child's care, against a child who is dependent or developmentally immature, for the purpose of the predators own sexual stimulation or gratification.
What are the categories of children with special needs?
Congenital abnormalities, malignancies, GI disease, or CNS anomalies. (Know our community resources so we can advise pt and they can get help)
What activity by an infant would cause a false elevation of the tympanic temperature?
Crying vigorously
A nurse collecting data from a 2 1/2 year old toddler at a well-child visit. Which of the following findings should the nurse report to the provider?
Head circumference exceeds chest chest circumference
A nurse is reinforcing anticipatory guidance to the parents of a toddler. Which of the following instructions should the nurse include? sata:
Develop food habits that will prevent dental caries; Expression of bedtime fears is common; & Expect behaviors associated with negativism and ritualism
A nurse in a provider's office is preparing to administer immunizations to a 5 year old child. Which of the following immunizations should the nurse plan to administer? sata:
Diptheria, tetanus, pertussis (DTaP); Inactivated polio virus (IPV); & Measles, mumps, rubella (MMR)
Emotional neglect:
Failure of a parent or caretaker to meet child's needs for emotional nurturance, affection, & attention
Physical neglect:
Failure to provide adequate food, shelter, education, or health care
Gavage feeding:
Feeding with a tube into the stomach. The tube is passed through the mouth for infants because they are nose breathers, and often through the nose for older infants and children.
What are the aspects of feeding of infants?
Feeding: breastmilk exclusively for first 6 months then breastmilk in addition to solids for at least a year. It is important to wait till the baby is ready to start solid foods, usually about 6 months.
How do you explain BP to a child so he/she will not be fearful?
For preschool and early school-age children, explain how the cuff will feel, such as "tight feeling" , "arm hug" , "I want to feel your muscle" , or "I want to see how strong your muscle is"
What are the appropriate measures to discuss health care with family and maintain confidentiality?
Gain trust of the parents by (1): reviewing and interpreting info from the dr as need; (2) asking the parents whether they have any questions; (3) conveying concern for the pt's wellbeing; (4) listening & being available; (5) respecting them as experts on their child and soliciting their input. ; When obtaining a nursing hx or giving information, select a quiet place on the unit to listen to the parents' responses and to provide them with opportunities to ask questions
A nurse is assisting with data collection for a developmental screening on a 10-month-old infant. Which of the following fine motor skills should the nurse expect the infant to perform? sata:
Grasps a rattle by the handle ; Uses a crude pincer grasp
A nurse is discussing prepubescence and preadolescence with a group of parents of school-age children. Which of the following information should the nurse include in the discussion?
Growth differences between males and female become evident
Newborn vitals:
HR - 120 ; RR - 35 ; BP - 70/50 ; Temp: 3mo- 99.4 , 6 mo- 99.5
How does the nurse teach parents about the use of opioids for pain management in children?
Infants are not able to verbalize their pain, assess for physiological and behavioral variables. Use the Wong-Baker Faces pain rating scale. Advise parent opioids cause no greater respiratory depression than in adults and nothing indicates that children are at any increased risk of physiologic or psychological dependence from the use of it for pain management
Why does obtaining the respirations of an infant require a modified approach from that of an adult?
Infants respiratory movements are abdominal
Physical abuse:
Intentional attempt by a parent or caregiver to impair or destory the mental or emotional state of a child
When communicating with parents suspected of child abuse, what should the nurse be sure to do?
Interact with them in a nonjudgmental manner
A nurse is reinforcing education about introducing new foods to the parents of a 4 month old infant. The nurse should recommend that the parents introduce which of the following foods first?
Iron-fortified cereals
How do you measure head circumference?
It is measured above the eyebrows and pinna of the ears and around the occipital prominence of the back of the skull
What is the importance of nutrition r/t growth and development?
It is the single most important influence on growth. During infancy and childhood, the demand for calories is great because of the rapid increase in height and weight. Growth is uneven during these stages, and a child's appetite fluctuates in response to growth spurts.
What was one of the major strides in pediatric care made by Dr. Abraham Jacobi?
Milk stations in the city of New York
NI for abuse and neglect:
Most important is the identification of a child who is being maltreated; thorough hx and physical examination are most effective dx tools; document using direct quotes, and report only objective findings; If abuse is suspected the child and parent must be questioned separately. ALL STATES HAVE REGULATIONS FOR THE MANDATORY REPORTING OF CHILD MALTREATMENT WHEN THERE'S A REASON TO SUSPECT ABUSE OR NEGLECT HAS OCCURRED OR IS OCCURRING
When the nurse is inserting a feeding tube in an 8 month old, what safety reminder device (SRD) should the nurse most likely use?
Mummy restraint (controls the arms and body of the infant)
What is one way to enhance the nutrition of the hospitalized toddler?
Offer nutritious fluids frequently
How should an infant be positioned after a feeding?
On the right side
The parents ask about preparation of their toddler for hospital admission. When does the nurse suggest that the parents tell their toddler of the admission?
Only two or three days before
What are signs a child needs suctioning?
Pallor; restlessness or anxiety; increased pulse, rr, & temp; dyspnea; bubbling; rattling; drooling; mouth breathing; nasal flaring; grunting; gasping; retractions; cyanosis; and erythema (flushed face)
What is the positioning of a child/adolescent post-lumbar puncture?
Place older child supine for several hr; no need for the younger child
A nurse is conducting a well-baby visit with a 4 month old infant. Which of the following immunizations should the nurse plan to administer to the infant? sata:
Polio (IPV; Pneumococcal vaccine (PCV); & Rotavirus vaccine (RV)
What is the positioning of a child/adolescent pre-lumbar puncture?
Position child at the edge of the examining table or bed, on the side, facing nurse with the neck and legs gently flexed
What is the correct way to assess vitals in infants and why?
RR before the infant is disturbed➝P➝Temp. ; (BP is usually not taken until the child is 3 yrs) ; The things that cause the least amount of anxiety, we do first.
A nurse is caring for an adolescent whose mother expresses concerns about her adolescent sleeping long hours on weekends. The nurse should inform the mother that which of the following issues require additional sleep?
Rapid growth
When a safety reminder device (SRD) is used to protect a child, what is a responsibility of the nurse?
Remove it every 2 hrs
What is the correct order for assessing vital signs in an infant to ensure the accuracy of measurements?
Respiration, pulse, temperature
A nurse is assisting the provider with a developmental screening on a 3 year old child. Which of the following gross motor skills should the nurse expect the child to perform?
Ride a tricycle
The nurse clarifies that the family-centered care approach terminate which policies? sata:
Rigid visiting hours; Exclusion of family during procedures; Discouraging family to stay overnight; & Restricting parents from reading the chart
Where is the typical IV insertion site in an infant younger than 9 months of age?
Scalp vein
The nurse welcomes the presence of the family in a pediatric unit because it reduces the stressors of hospitalization. Which are common stressors for the hospitalized child? sata:
Separation; Fear of pain; & Loss of control
What should be the focus of a practice where the pediatric nurse uses a developmental approach?
Strengths and abilities of the child
A nurse is reinforcing teaching about recommended activities with the parents of a school-age child. Which of the following activities should the nurse suggest to the parents?
Team play
A school nurse is preparing a class about male puberty. Which of the following manifestations should the nurse identify as occurring first when sexual maturation begins?
Testicular enlargement
What attributes of a child would be important to evaluate using the developmental approach?
The growth parameters include weight, height, and head circumference and sometimes skin fold thickness and arm circumference
What is the disadvantage of using a mist tent with a toddler?
The nurse must remove the restless child
What should be included in the teaching plan for the parents of a 3 year old child who has been prescribed an opioid analgesic?
The opioid is very effective as a pain control method
What are the disadvantages of a mist tent?
The tent must be opened for the treatments and procedures, which lowers the concentration of the mist; linens and clothing must be changed every 3-4 hr
Why must the pediatric nurse be cautious about medicating infants and young children?
They are more susceptible to medication effects than adults
A nurse is assisting with the collection of data for developmental screening on an 18 month old. The nurse should expect the toddler to be able to perform which of the following skills? sata:
Throws a ball overhand; & Uses a spoon without rotation
What is the purpose of a mist tent?
To improve a child's respiratory status by liquefying pulmonary secretions
What is the purpose of a mist tent? (test)
To liquefy respiratory secretions
How soon should a child be prepared for admission to hospital? consider all age groups:
Toddlers should be told 2-3 days before, because they don't understand time and the future. School-aged children should be told 2 weeks in advance, and adolescents we need to tell asap, allowing time for them to tell their peers and solicit them for support
A nurse in a provider's office is preparing to administer immunizations to an 11 year old child. Which of the following should the nurse plan to administer? sata:
Trivalent inactivated influenza (TIV); Meningococcal (MCV4); & Tetanus and diphtheria toxoids and pertussis (Tdap)
A G tube (tube feeding):
Used for children whom a nasogastric tube is contraindicated. TPN is given when feeding by way of the GIU tract is inadequate or hazardous
What are aspects of suctioning a child?
Used when secretions are audible in the airway or when signs of airway obstruction or oxygen deficit are present. Various devices are used such as a bulb syring or a straight suction catheter. Depth approx 1/4 to 1/2 in depending on age of child; Timing is no longer than 5 secs; Allow 30 secs between attempts. No more than 3 attempts
What is the preferred IM injection site for a 2 year old?
Vastus lateralis
A nurse is assisting with an in-service for a group of parents about child safety during the school-age years. Which of the following information should the nurse include? sata:
Wearing helmets when riding bicycles or skateboarding; Implementing firearm safety; & Wearing seatbelts when riding in a vehicle
After observing the parental behavior that leads the nurse to suspect child abuse, when should the nurse report the abuse?
Whenever maltreatment of a child is suspected
The pediatric nurse, along with the primary caregiver(s), has a special duty to ______ the child and the family.
teach
When discussing growth and development with the parents of a child, the nurse explains the nutrition is the single most influence on:
the growth of bones and muscle
How are medication doses for calculated for children?
•LB to KG = divide by 2.2 ; •KG to LB = multiply by 2.2 & •1 oz = 30 mL
