EAQ 1, 2, &3
what might a 6-7 year old view death as
frightening ghost
what diagnostic test may be used to distinguish vascular from non-vascular structures
magnetic resonance imaging
what is the most appropriate toy for a 3 year old that will foster creativity
mold and clay
what is physical abuse
physical injury inflicted on the child purposely. shown by lacerations
what is the rooting reflex
when you touch the cheek, mouth, or lips of a baby they will turn their heads towards the stimulus and make sucking (rooting) motion with their mouth when cheek and lips are touched. this reflex ensures successful breastfeeding
nurse is caring for a preschooler who is preparing for surgery. what does the nurse expect to have the most influence on the child's response to hospitalization
fear of bodily harm
infants grow ______inches monthly for the first 6 months
1 in (2.5cm)
what is the age range for adolescents
13 years- 18 years
what is the normal visual acuity in newborns
20/100
when do you get the rotavirus vaccine
3 times 2, 4, and 6, months old
when do you get the Hep B vaccine
3 times at birth, between 1-2 months, and then between 6-18 months
what is normal weight gain for infants 3-6 monts
5-7 ounces a week at 3 months a baby of 6kg is normal
nurse is assessing group of children clients. after shift report which client should nurse assess first
6 month old with croupy cough and inspiratory stridor with exertion stridor with exertion is respiratory distress and needs to be evaluated first
what is the age range for school age children
6 years- 12 years
what is the hilum
Area in lung where blood vessels and bronchi enter
what is physical neglect
Deprivation of food, clothing, shelter, supervision, medical care, and education shown by malnutrition and poor hygiene
pregnant client has a BMI of 32 during labor, the nurse observes that the second stage of labor lasts approximately 11 minutes, and the expected birth weight of the child is approximately 4200g. which complication does the nurse anticipate in neonate after birth?
Erb's palsy
do preschoolers view death as a permanent state?
NO!
define vascular
Of or relating to blood vessels
what are alveoli
Small sacs that are the primary site of gas exchange in the lungs.
What is the best toy for a 9-12 month old?
Talking toy and push/pull toy for walking
what is magical thinking
When one believes their thoughts may influence events. Conclusions based on desires of how things should work, rather than how they actually do.
what is the best description for family centered approach
a collaborative care plan is developed to achieve optimal health
during a prenatal exam the nurse draws blood from an Rh-negative mother. the nurse explains that indirect coombs test will be performed to predict if the fetus is at risk for what
acute hemolytic anemia
plan of care with phototherapy
administer additional fluids every 2 hours to prevent dehydration because fluid losses are increased with therapy. turn and reposition the infant every 2 hours
what will be present in a baby with a fractured clavicle
asymmetric moro reflex focal swelling/tenderness
list the BMI, time of second stage labor, and birth weight indicative of Erb's palsy
BMI >30 second stage labor <15 minutes birth weight >4000g all of this puts you at risk for Erb's palsy or Erb duchenne paralysis
an infant is admitted to the nursery after a difficult shoulder dystocia vaginal birth. which condition should the nurse carefully assess this newborn for?
Erb's palsy erbs palsy is the most common injury resulting from shoulder dystocia vaginal births
What is Erb Duchenne paralysis?
Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5-C6 nerves. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5-C8 and thoracic nerve T1.
what is the treatment for hyperbilirubinemia
Phototherapy Double volume exchange transfusion if that doesn't work.
child shows bleeding into subgleal compartment in MRI results. what other conditions should the nurse evaluate for in the child
decreased platelets and decreased hematocrit levels
what is computed tomography used for
diagnosis of lesions difficult to assess by normal X-Ray
Define dystocia
difficult birth
what is the moro reflex (startle reflex)
in response to loud noise or with the sensation of falling. the baby will spread the arms out, pull the arms in, then cry
18 month old child receives all required immunizations. what immunization should the nurse explain is required between 4-6 years of age?
inactivated poliovirus
what finding supports the nurses conclusion that 4 day old newborn has impaired vision
no corneal reflex after light touch
do preschoolers have supernatural thoughts?
no, they do have magical thinking, but they are not developed enough to have supernatural thinking
what is epistaxis
nose bleed
"but you dont understand" is a common phrase used by adolescents. what is the nurses best reply
"it would be helpful to understand; lets talk"
what is the max dose for an IM injection in an infant
0.5 ml
what is the max dose for an IM injection in a toddler
1.0 ml
when do you get the haemophilus influenza type b vaccine
4 times 2 months, 4 months, 6 months, and between 12-15 months
what problem is most associated with infants who are exposed to lead in the environment
cognitive impairment
S/S of sexual abuse
genital discharge and recurrent UTI
respiratory distress syndrome develops 6 hours after birth in an infant who was born at 33 weeks gestation. what would the nurses assessment of newborn at this time reveal?
intercostal retractions and an increased HR
nurse assessing a patient for S/S of hyperbilirubinemia (physiologic). which finding confirms this complication
jaundice develops between 48-72 hours after birth
nurse assessing a patient for S/S of hyperbilirubinemia (pathologic). which finding confirms this complication
jaundice develops in the first 12-24 hours after birth
Define asymmetrical
lack of equality or equivalence no symmetry
what is amblyopia
lazy eye brain doesnt get signals from eye
what are some sources of lead
paint/deteriorating paint in home soil water ceramic playground equipment dyes glass batteries cosmetics
mother reports feeding her infant immediately before arriving in the ED. nurse reports which finding immediately to the HCP because it likely indicates pyloric stenosis
peristaltic waves that traverse the epigastrium
what behavior is expected from a 18 month old who has never been separated from mom prior to admission
relentless crying, only consolable by the parent
what child is puppet play best for
school-aged and adolescent
what part of the respiratory system makes the angle of louis
the carina located at the manubriosternal junction
a newborn has an asymmetrical moro reflex, and Erb's palsy is diagnosed. what does the nurse understand about the origin of this problem?
the cause is an injury of the shoulder that is developed during birth
what is a pulmonary angiogram used for
to visualize pulmonary vasculature and locate obstructions
what are peak flow meters
used in asthma PFM can help identify when asthma is getting worse even before your child has symptoms measures the max amount of exhalation
what is an X-Ray used for
used to screen, diagnose, and evaluate changes in respiratory system
nursing intervention appropriate to decrease potentially harmful side effects of phototherapy
using eye shields
what nursing actions are developmentally appropriate when caring for a hospitalized preschooler
using toys for distraction and offering medical equipment to play with prior to the procedure
What is Erb's palsy?
weakness in arm and impaired hand motions. the arm is adducted, internally rotated, but grasp reflex is intact
child abuse is suspected in a 3 year old admitted with many poorly explained injuries. what statement by mom supports the suspicion
"i have no problem with my other children"
what is the proper administration of oral medication to a 4 year old child. what statement indicates effective learning
"i will use a disposable oral syringe to prepare dose" do NOT give in cup, spoon, or dropper because there is a risk for inaccurate measurements
the nurse is preparing to administer an IM injection to a preschooler. what is the most appropriate statement made by the nurse prior to procedure?
"it is okay to cry, after you can go the box and pick out your favorite sticker"
an 8 year olds sister died. the child begins to ask many questions about what happens to the body after death. the parents wonder if this is abnormal morbid behavior picked up from video games. what is the nurses best reply
"school age children are inquisitive (curious) and ask lots of questions about death"
a parent with diabetes needs to take multiple medications for it. what instruction does the nurse give for the child's safety
"store your medication out of reach of the child"
17 year old is to sign consent for son's myringotomy. what should the nurse say to the mom about this procedure?
"tell me what you know about this procedure"
how should the nurse respond to parents who are concerned about separation anxiety in their 15 month old toddler
"this is an expected developmental reaction"
preschooler is admitted with S/S of lead poisoning. what assessment question can help the nurse determine the source of lead
"what year was your home built"
what is the age range for infants
1 month-12 months
what is the age range for toddlers
1 year-3 years
infants head circumference increase by _______cm per month for the first 6 months
1.5cm
16 year old single mom of a 1 year old infant and the infants grandma bring the baby to the ED reporting that the infant accidentally fell down the steps. the nurse knows that who has responsibility for signing the consent form
16 year old mom, despite her age if you have a child before 18 years old, you are considered an emancipated minor
what is the age range for preschoolers
3 years-5 years
when do you get the inactivated poliovirus
4 times total 2 months, 4 months, between 6-18 months, and then between 4-6 years old
what is psychologic abuse
Threats, insults, harassment and behavior designed to increase social isolation a form of emotional neglect
what are healthy snacks to give 2 year old who has a diagnosis of acute asthma
apple slices and sliced veggies not grapes cause child could choke
communicating with cognitively impaired child
ask one question at a time give time for patient to reply visual clues if patient is unable to speak clearly or at all speak in normal tone voice if visually impaired face the patient when hearing impaired so they can read lips
an 18 month old who is getting an IM injection starts to scream and flail when the nurse enters. that father who is sitting at the bedside gets up to leave the room. what action does the nurse take to best handle the situation?
ask the father to stay to comfort the child while the injection is given leaving the child aka separation makes it worse for them
nurse is assessing child with suspected autism. at what age does the nurse determine that S/S of autism may initially be evident
at 2 years old and then by 3 the S/S become more profound
nurse has to give an IM injection to a 15 month old child. why doesn't the nurse administer the injection into the gleutal muscle?
because the muscle mass is underdeveloped and close to the sciatic nerve
3 year old with tentative diagnosis of lead poison. what is the clinical finding
behavioral disturbances such as clumsiness= clue to early identification
When does the rooting reflex disappear?
between 3-4 months
When does the extrusion reflex disappear?
between 3-4 months or 4-6 months
what age does the moro reflex disappear
between 3-6 months
what is the age range for newborns
birth-1 month
effects of lead poisoning in preschoolers
brain damage kidney damage growth retardation
what should the nurse include when priority teaching/ educating parents how to facilitate the developmental task of trust in their newborn
breastfeed the newborn on demand
how can a nurse meet the developmental needs for a preschooler right before a physical exam
by allowing the child to handle the examination equipment for example, letting the child play with your stethoscope
what to do if 5 year old ingests shampoo
call poison control center clean out mouth turn head to the side to prevent aspiration
plumbism
can occur if child eats paint or plaster chips (PICA) containing lead in addition to diet, or if inhaled particles of lead in the air.
what impairment does lead cause
cognitive impairment multisystem impairment damage with worst effects on the CNS
shortly after birth, child is found to have Erb's palsy. which condition does the nurse suspect caused this problem
congenital injury to the brachial plexus during birth
what is strabismus
cross eye/wall eyed abnormal alignment of eyes
what is wrong with this statement, " i will mix my childs medication in a large amount of food so that they cant taste it"
do NOT mix medication in large amount of food incase the child does not eat it all
what not to do if 5 year old ingests shampoo
do not give ipeac syrup do not stimulate vomiting
a baby was just delivered using forceps, the nurse confirms facial paralysis. what information does the nurse provide to the mother regarding facial paralysis?
do not panic, this is only temporary. it will resolve within a few hrs/days. note: there is no brain damage with facial paralysis and breast feeding is NOT contraindicated
the infants weight ________ by 6 months
doubles
nurse is caring for a child with lead poison (pulmbism). what are associated complications the nurse should assess the child for
encephalopathy (causing increased ICP leading to tissue ischemia, resulting in mental retardation) marked anemia kidney damage/proteinuria glycosuria ketonuria
what should be included in the plan of care to limit development of hyperbilirubinemia in breast fed neonate
encourage more frequent breast feeding during the first 2 days. this will stimulate more frequent evacuation of meconium which prevents the reabsorption of bilirubin into the circulatory system
when assessing older adult, nurse observes visual impairment. which technique should the nurse use to communicate
encourage the older adult to use assistive devices such as glasses
what is good nurse teaching to decrease the risk for drown injury for a school aged client
enroll in swim lessons
dietary management for chelation therapy related to lead poisoning
ensure adequate fluid intake because lead complexes released during chelation therapy are excreted via kidneys
what should be considered in terms of prevention of lead poisoning in children
environmental factors are involved because lead is available for ingestion and inhaliation
what pain scale is used for a preschooler
faces pain scale (0-5)
a neonate right after birth has inability to close their eyes completely, drooping of corner of the mouth, and absence of wrinkling of their forehead and nasolabial fold. what does the nurse infer from those findings
facial paralysis caused by the pressure on cranial nerve VII during labor
what is emotional neglect
failure to meet childs needs for affection, attention, and emotional nurturance shown by enuresis and sleep disorders
nurse is caring for a toddler who is preparing for surgery. what does the nurse expect to have the most influence on the child's response to hospitalization
fear of separation
communicating with impaired haring child
first get patients attention before speaking never shout, speak normally reduce environmental noise before starting the conversation always rephrase sentences rather than restating them if misunderstood because it can cause confusion
assessing newborn of 33 weeks gestation. what sign alerts the nurse to call the health care provider?
flaring nares because it is a compensatory mechanism for a baby in respiratory distress
caring for an infant with hypertrophic pyloric stenosis. a pyloromyotomy is scheduled. which pathophysiologic modification must be addressed before this surgery and be performed safely
fluid and electrolyte imbalances must be corrected
What is Erb's palsy caused by
forces that alter the alignment of the arm, shoulder, and neck; stretching or pulling away of the shoulder from the head during birth, and damages the brachial plexus
what antibiotic may have caused impaired hearing in a child
gentamicin it can be ototoxic because of its effects on CN VIII
nurse visits infant who was born 24 hours ago at home and notices a slight jaundice on face and trunk. what should the nurse do next
get a bilirubin level stat
Anthropomorphism (Personification)
giving human characteristics to an animal or inanimate object
when does the glabellar reflex disappear
gone when the brain matures, allowing inhibition
what interventions does the nurse implement to empower a family who has a child with down syndrome
help the family recognize possible stressors encourage the use of problem solving stratigies refer family to support groups and internet resources
S/S of right sided heart failure
hepatomegaly weight gain JVD peripheral edema decreased appetite
diet for school-aged child with cystic fibrosis to achieve optimal growth
high calorie and moderate fat
what insect or arthropod is the most common allergen for children prone to asthma
household cockroach
in order to relate to parents who you know abuse their child, the nurse has to do what first?
identify personal feelings about child abusers
11 month old is 9 lbs, the nurses suspects physical and emotional neglect. what observations lead nurse to suspect maltreatment?
inappropriate clothing frequent rocking motion social unresponsiveness
6 year old has a fractured arm and multiple old injuries. child maltreatment is suspected. what parental characteristic supports this suspicion
inconsistent stories about injuries parents do not feel guilty or concerned, but more angry parent is unable to comfort child
parents of a 4 week old boy reports that "he cries all the time and always acts hungry, but he throws up everything. he looks like a skinny old man". in light of this information, what is the focus of the nurses assessment?
palpating the abdomen to confirm hypertrophic pyloric stenosis
what is the most accurate nursing action when assessing chest circumference of a newborn during the initial physical assessment
placing measuring tape around rib cage and nipple line. taking two measurements, one during inspiration and the other during expiration. the average of the two is then plotted on the growth chart
nurse in the birthing unit recognizes that newborns may have impaired thermoregulation. what nurse intervention may help prevent heat loss
placing naked baby on mothers abdomen keep baby in a radiant warmer keep baby covered in warm blanket
what is the priority action to facilitate growth and development when providing care to a pediatric client who is diagnosed with a chronic illness
planning activities to promote progression from one stage of development to the next.
a 9 year old who is undergoing IV antibiotics becomes bored and irritable. what activities for school-aged children should the nurse suggest
play games on a tablet and making model airplanes
list the risk factors indicative of a fractured clavicle
post term births vaginal delivery weight >8.5 lbs (3.8kg)
how would the nurse say preschoolers are different from school-aged children
preschoolers have imaginary playmates and school aged children do not preschoolers think that inanimate objects have feelings/life like qualities. for example, they think that trees cry when branches break
what are the stages of separation anxiety
protest (excessive crying) despair (sadness through the day/limited emotional response) detachment (superficial interest in environment/friendly interactions with strangers)
nurse is caring for a mother and neonate. what is the priority nursing action to prevent heat loss in the neonate immediately after birth
putting the naked baby on the mothers skin and cover the infant with a blanket
S/S of autism
repetitive activities self-injuries behaviors lack of communication with others lack of eye contact
What is Klumpke's palsy?
results from severe stretching of upper extremities while the trunk is relatively less mobile during labor. example is seen in a fall when a mother jerks a child by one arm.
what is the normal concept of death for a 4 year old
reversible separation/ kind of sleep
what is the normal concept of death for a preschooler
reversible separation/ kind of sleep not permanent/ temporary sleep
where will you see olive like mass during hypertrophic pyloric stenosis
right side of child under liver
lead poisoning can result in what
seizures cognitive impairment death abdominal cramps and headache related to chronic lead poison
What is a myringotomy?
small incision in the eardrum to relieve pressure caused by excessive build-up of fluid or to drain pul from the middle ear.
what is the best toy to buy for a 6 month old
soft stuffed animal
what does bleeding in the subgleal compartment indicate?
subgleal hemorrhage tachycardia degradation of RBC (hyperbilirubinemia) megacephaly
what is the glabellar reflex
tapping between the babies eyebrows or on their nose, they will blink their eyes this reflex protects their eyes from threats
what reflex does the nurse assess in a newborn to determine auditory ability?
the startle reflex
the nurse is planning to communicate with a preschooler. what is most important for the nurse to know about the child first
their developmental level
3 1/2 year old is admitted for an appendectomy. what should the nurse use to best prepare the child for the hospital experience
therapeutic play to reduce stress and anxiety
what is true about language development in preschoolers
they start to question events
what behavior is expected from a toddler who is subjected to prolonged hospitalization with limited parental visits
they will be in the detachment phase of separation anxiety you should expect cheerful interactions with the staff members
parents of an infant with pyloric stenosis ask nurse many questions about the problem. what information should the nurse communicate when answering these questions?
this is a condition with an excellent prognosis
parents of a 2 1/2 year old whose older sibling just died tell the nurse at the well child clinic that their child has started to hit them and refuses to go to bed at night. what is the best explanation from the nurse
this is an appropriate reaction to anxiety within the household
a neonate of 42 weeks was vaginally birthed at 9 lbs (4.1 kg). the nurse assessed for moro reflex and focal swelling or tenderness in the baby. why does the nurse do these interventions?
to evaluate for clavicle fracture
what is the extrusion reflex
tongue thrust reflex protects babies from choking or aspirating food and other foreign objects and also helps the baby latch onto nipples
Where to give an IM Injection on infants
vastus lateralis because it is a larger muscle that can tolerate larger quantities of fluid and is easily accessible if child is supine, lying on side, or sitting
physical assessment on infant with pyloric stenosis. what findings does the nurse expect
visible peristaltic waves because the stomach is attempting to propel its contents through the stenotic pyloric sphincter
patient comes in with acute exacerbation of COPD. the nurse instructs to this patient the importance of assessing for right sided heart failure after discharge. what does the nurse instruct the client to assess for?
weight gain
a working mom of a toddler is preparing to take the child home after prolonged hospitalization during which she was not able to visit the child often. she asks the nurse what type of behavior should she expect from her child
withdrawn, without emotional ties to the mother until trust is built. once the trust is built, the child may be demanding to test the trust, but right now the child is too detached to be hostile
