CAQ: Pediatric Cognitive and Sensory & Pain

What pain scale is used to measure the intensity of pain in preschoolers? 1 FACES scale 2 Visual analogue scale 3 Numerical rating scale 4 Verbal descriptor scale

1- FACES scale The FACES scale is used to measure the intensity of pain in a preschooler. The scale consists of six cartoon faces ranging from a smiling face ("no hurt") to increasingly less happy faces to a final sad and tearful face ("hurts worst"). The visual analogue scale, numerical rating scale, and verbal descriptor scale can be used in young children and adults.

When picked up by a parent or the nurse, an 8-month-old infant screams and seems to be in pain. After observing this behavior, what should the nurse discuss with the parent? 1 Accidents and the importance of their prevention 2 Limiting playtime with other children in the family 3 Any other behaviors that the parent might have noticed 4 Food and specific vitamins that should be given to infants

3- Any other behaviors that the parent might have noticed When a health history is being taken, all areas of behavior should be explored fully before the nurse decides how to address the problem. The nurse should gather more data to determine the basis for the problem before recommendations can be made. The data are insufficient for the nurse to focus on nutrition as the cause of the problem.

A nurse is teaching a class for staff members working in a group home about the cognitive development of children with cognitive impairments. What concept can these children probably learn the fastest? 1 Love versus hate 2 Life versus death 3 Large versus small 4 Right versus wrong

3- Large versus small Children who are cognitively impaired can learn concrete concepts faster than they can learn abstract concepts. Love versus hate is an abstract concept that children begin to learn between the ages of 7 and 11 years. Life versus death is an abstract concept that children begin to learn between the ages of 7 and 11 years. Right versus wrong is an abstract concept that children begin to learn between the ages of 7 and 11 years.

A 15-year-old adolescent with Down syndrome is scheduled for surgery. The parents inform the nurse that their child has a mental age of 8 years. At what age level should the nurse prepare the child's preoperative teaching plan? 1 Adult, for the parents to understand 2 Specific age, as ordered by the healthcare provider 3 Adolescent, because this is the child's chronologic age 4 School-age, because this is the child's developmental age

4-School-age, because this is the child's developmental age A child who is undergoing a procedure needs to be prepared in an easily understood manner; teaching should be directed at the developmental, not chronologic, age of this adolescent. The healthcare provider informs the parents about the surgery and its outcomes as a part of informed consent; the nurse may elaborate on this information or correct misinterpretations. It is the nurse's responsibility to prepare the adolescent for the surgery; the healthcare provider may or may not address this need. Information designed for an adolescent will exceed the cognitive ability of a child with the developmental age of 8 years.

Which pain scale should a nurse use to measure the intensity of pain in toddlers? 1 FACES scale 2 Visual analogue scale 3 Numerical rating scale 4 Verbal descriptor scale

1- FACES scale The nurse should use a FACES scale to measure the intensity of pain in children. The scale consists of six cartoon faces ranging from a smiling face ("no hurt") to increasingly less happy faces and finally to a sad, tearful face ("hurts worst"). The visual analogue scale, numerical rating scale, and verbal descriptor scale can be used in young children and adults.

A nurse is caring for a 2½-year-old child who is expressing pain. What is the most reliable indicator of this child's pain? 1 Crying and sobbing 2 Changes in behavior 3 Verbal exclamations of pain 4 Changes in pulse and respiratory rate

2- Changes in behavior Although there are several indicators of pain in children, a change in behavior is the one that occurs most often. Crying is not a valid indicator of pain; there is more than one cause for crying, including pain, separation, fear, and unhappiness. Children often hide their pain; they may perceive it as punishment, or they may fear the treatment that will be given to relieve the pain. Vital signs often do not change, even if the child is in pain.

The school nurse is working with a child with a hearing deficit. The child arrives at school today without hearing aids. When the nurse talks with the child about the reasons for not wearing the aids, the nurse will need to ensure that the child understands what is being said. What actions by the nurse will promote effective communication? Select all that apply. 1 Speaking slower, louder than normal, and excessively fast 2 Facing the child directly when talking to the child 3 Avoiding chewing gum while communicating with the child 4 Avoiding using hand expressions that could interfere with lip reading 5 Moving from side to side while talking to the child to keep the child looking at the nurse

2- Facing the child directly when talking to the child 3- Avoiding chewing gum while communicating with the child Many hearing-impaired children have some degree of lip reading skills. This will help the child understand what is being said. Chewing gum alters speech sounds and may alter lip movement, adding to the child's confusion. The nurse should speak slowly but not excessively, because this modifies speech. Speaking louder than normal may distort speech. Hand expressions can add meaning to the spoken words. Standing still while speaking to the child ensures that the speaker's face remains clearly visible.

A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend? 1 Ear drops 2 Myringotomy 3 Mastoidectomy 4 Steroid therapy

2- Myringotomy Myringotomy is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Ear drops are not used because they will obscure the view of the tympanic membrane. Removal of the mastoid will not relieve pressure within inflamed ears. Antibiotics, not steroids, are used for an infectious process.

The nurse is planning care for a school-aged child with autism spectrum disorder (ASD) who has been hospitalized for some tests. Which intervention should the nurse plan to implement? 1 Providing adequate stimulation through play 2 Placing the child in a private room 3 Encouraging staff to visit the child frequently 4 Giving detailed explanations about the upcoming tests

2- Placing the child in a private room The child with ASD should be placed in a private room. Decreasing stimulation by placing the child in a private room may lessen the disruptiveness of hospitalization. Play should be carefully planned; overstimulation can precipitate behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits from staff caregivers kept short whenever possible. Because these children have difficulty organizing their behavior and redirecting their energy, they need to be told directly what to do. Explanations about tests should be at the child's developmental level, brief, and concrete.

A 1-year-old infant is brought to the pediatric clinic for the first time. During the assessment the nurse suspects a developmental delay. What developmental milestone should have been achieved by this age? 1 Saying six words 2 Responding to peek-a-boo 3 Building a tower of two cubes 4 Pointing to things when they are named

2- Responding to peek-a-boo Typically infants respond to social play by 10 months of age. A six-word vocabulary and building a two-cube tower are typical of a 15-month-old. The child pointing to objects when they are named is typical of a child at 2 years of age.

Which data collected during the nursing assessment for a 24-month-old client indicates the need for further evaluation for delayed language? Select all that apply. 1 The child uses two-word sentences. 2 The child cries and points at an object he wants. 3 The child states, "Me do it" when asked to stack blocks. 4 The child understands the meaning of as many as 50 words. 5 The child asks, "What's that?" when the nurse uses the stethoscope to assess lung sounds.

2- The child cries and points at an object he wants. 4- The child understands the meaning of as many as 50 words. Observations made during the nursing assessment for a 24-month-old client that would require further evaluation for a language delay include: the child crying and pointing at an object that is wanted and the child who understands the meaning of only 50 words (300 is expected by this stage of development). The use of two-word sentences, "Me do it," and asking "What's that?" are all expected findings for the 24-month-old client in regards to language development.

What strategy should the nurse employ to be effective when using play therapy with a 6-year-old child with autism? 1 Play music and dance with the child. 2 Use mechanical and inanimate objects for play. 3 Employing positive reinforcements such as hugging. 4 Provide brightly colored toys and blocks that can be held.

2- Use mechanical and inanimate objects for play. Self-isolation and disinterest in interpersonal relationships lead the autistic child to find security in nonthreatening, impersonal objects. Dancing with the child is too threatening for a child with autism because of the close personal contact it requires. Close interaction, such as hugging, with others is too threatening for a child with autism. These children do not respond to brightly colored toys and blocks as other children do unless movement is involved.

The nurse is providing care to an infant diagnosed with Down syndrome. Which parental statement related to the infant's growth indicates the need for further education? 1 "My baby will have growth deficiencies during infancy." 2 "My child will have accelerated growth during adolescence." 3 "My child will most likely be overweight by 3 years of age." 4 "My baby will have reduced growth in both height and weight."

2-"My child will have accelerated growth during adolescence." Children diagnosed with Down syndrome will often have growth deficiencies. These deficiencies are most pronounced during adolescence and infancy. Because weight gain is more rapid than growth in stature, many children with Down syndrome are overweight by 3 years of age. Overall reduced growth is noted for both height and weight.

How can a nurse best soothe a hospitalized infant who appears to be in pain? 1 Feeding the infant 2 Holding the infant 3 Playing soft music in the room 4 Providing a quiet environment

2-- Holding the infant Physical contact provides security for a distressed infant. Feeding to provide comfort is not always an option because the infant may have been fed recently, may be anorexic, or may be on nothing-by-mouth status. Music or a quiet environment may not always have a calming influence; often infants are not aware of the environment.

A parent tearfully tells a nurse, "They think our toddler is developmentally delayed. We're investigating a preschool program for cognitively impaired children." What is the most appropriate response by the nurse? 1 Praising the parent for the decision and encouraging the plan 2 Asking for more specific information related to the developmental delays 3 Advising the parent to have the healthcare provider help choose an appropriate program 4 Explaining that this action may be premature and that the developmental delays could disappear

2--Asking for more specific information related to the developmental delays More information is needed. The term developmental delay suggests that some milestones for age are not being met at the average time; it is not synonymous with cognitive impairment. Praising the parent for the decision and encouraging the plan is inappropriate; more information must be obtained. Although the healthcare provider may help, it is not yet known whether such a program is needed. The nurse does not know, without more information, whether the parents' plan is premature or that the delays will disappear.

When assessing a toddler with Autism Spectrum Disorder (ASD), what characteristic findings or behaviors should the nurse expect? Select all that apply. 1 The desire to hug the nurse 2 Flat, blank facial expression 3 Laughing when pulse is taken 4 Inability to maintain eye contact 5 Enjoys climbing on stairs and furniture

2-Flat, blank facial expression 3- Laughing when pulse is taken 4- Inability to maintain eye contact Toddlers with Autism Spectrum Disorder (ASD) have communicative and behavioral impairment and developmental delay; they struggle with social communication and social interaction. Characteristic findings the nurse would expect in a toddler with ASD include a flat affect, inappropriate laughing while measuring the pulse, lack of eye contact, and humming or grunting. The toddler with autism also tends to overrespond to environmental stimuli. Toddlers with ASD will rarely hug anyone and would not enjoy climbing on stairs or furniture.

A nurse is caring for an infant with Down syndrome. What does the nurse recall as the most common serious anomaly associated with this disorder? 1 Renal disease 2 Hepatic defects 3 Congenital heart disease 4 Endocrine gland malfunction

3- Congenital heart disease Many children with Down syndrome have cardiac anomalies, most often ventricular septal defects, which can be life threatening. Renal disease, hepatic defects, and endocrine gland malfunction are not characteristic findings in children with Down syndrome.

After abdominal surgery, a 5-year-old child is experiencing pain, and an opioid analgesic is prescribed. What should the nurse consider about children in pain and their response to opioid analgesics when an opioid analgesic is prescribed? 1 Addiction to opioids is more of a risk for children than adults. 2 Analgesics are not needed as frequently because pain is not as strongly felt by children as it is by adults. 3 Even though children do not like taking medicines, analgesics will make them more comfortable. 4 Children do not need analgesics because they are easily distracted and will quickly return to play or sleep.

3- Even though children do not like taking medicines, analgesics will make them more comfortable.

The mother of an infant with Down syndrome asks the nurse what causes the disorder. Before responding, the nurse recalls that the genetic factor of Down syndrome results from what? 1 An intrauterine infection 2 An X-linked genetic disorder 3 Extra chromosomal material 4 An autosomal recessive gene

3- Extra chromosomal material Down syndrome (trisomy 21) results from extra chromosomal material on chromosome 21. Down syndrome does not result from a maternal infection. Down syndrome is not related to an X-linked or Y-linked gene. An autosomal recessive gene is not the cause of Down syndrome, although translocation of chromosomes 15 and 21 or 22 is a genetic aberration found in some children with Down syndrome.

How should a nurse assess a 4-year-old child with abdominal pain? 1 By asking the child to point to where it hurts 2 By auscultating the child's abdomen for bowel sounds 3 By observing position and behavior while the child is moving 4 By questioning the parents about their child's eating and bowel habits

3-- By observing position and behavior while the child is moving The child with abdominal pain may assume the side-lying position with the knees flexed to the abdomen or self-splint when moving. A 4-year-old may be unable to identify the exact location of the pain; in addition, the pain may be generalized rather than localized. Auscultation may be included in the physical assessment, but it is not specific to the assessment of pain. Questioning the parents may be included when the nurse is taking the health history, but it is not specific to the current assessment of pain.

The mother of a 2-year-old child tells the nurse that she is concerned about her child's vision. What behavior when the child is tired leads the nurse to suspect strabismus? 1 One eyelid droops. 2 Both eyes look cloudy. 3 One eye moves inward. 4 Both eyes blink excessively.

3-- One eye moves inward. An inward moving eye (tropia) is one form of strabismus. A drooping eyelid is called ptosis; it may be congenital or caused by trauma. Cloudy eyes are associated with congenital cataracts. Blinking may be a tic.

A parent brings a 2-month-old infant with Down syndrome to the pediatric clinic for a physical and administration of immunizations. Which clinical finding should prompt the nurse to perform further assessment? 1 Flat occiput 2 Small, low-set ears 3 Circumoral cyanosis 4 Protruding furrowed tongue

3-Circumoral cyanosis Circumoral cyanosis is not a specific characteristic of Down syndrome. It is a clinical finding associated with congenital heart disease, which these infants may have as a concurrent problem. A flat occiput and a broad nose with a depressed bridge (saddle nose) are features of children with Down syndrome. Small, misshapen, low-set ears are also a clinical manifestation of Down syndrome. Children with Down syndrome often keep their mouths open, with their tongues protruding; the surface of the tongue is often wrinkled.

During a well-child visit the parents tell a nurse, "Our 3-year-old doesn't listen to us when we speak and ignores us!" An auditory screening reveals that the child has a mild hearing loss. What should the nurse explain to the parents about this degree of hearing loss? 1 A severe hearing deficit may develop. 2 It will not interfere with progress in school. 3 An immediate follow-up visit is not necessary. 4 Speech therapy in addition to hearing aids may be required.

4- Speech therapy in addition to hearing aids may be required. A mild degree of hearing loss causes the child to miss approximately 25% to 40% of conversations; it may result in speech deficits and interfere with the child's educational progress if it is not corrected. Hearing aids usually help improve function. There is no evidence that this child's hearing loss is progressive. The significance of the hearing loss requires further analysis and intervention.

A nurse is evaluating a 3-year-old child's developmental progress. The inability to perform which task indicates to the nurse that there is a developmental delay? 1 Copying a square 2 Hopping on one foot 3 Catching a ball reliably 4 Using a spoon effectively

4-- Using a spoon effectively Using a spoon effectively is a task expected of 3-year-old children. Copying a square is a task expected of 4- or 5-year-old children. Hopping on one foot and catching a ball reliably are tasks expected of 4-year-old children.