Maternal Exam 4

You're teaching a group of new moms about how to assess toilet training readiness in their toddler. Which statement by a participant demonstrates they did NOT understand the education provided: 1. "I should start potty training once my child has had a dry diaper for 2 hours or more." 2. "It is best to start night-time potty training before day-time potty training." 3. "Having regular bowel movements is a sign of potty training readiness." 4. "My child can sit on the toilet for at least 10 minutes without fussy, so I think I will trying potty training soon."

"It is best to start night-time potty training before day-time potty training."

You're providing caring to a 2-year-old and have noted negativism. Which statement by the nurse to the toddler will help decrease negativism when administering medications to the toddler? 1. "Are you ready for your medicine?" 2. "Can you take your medicine in a cup?" 3. "Do you want to take your medicine now?" 4. "You can take your medicine in the blue or green cup."

"You can take your medicine in the blue or green cup."

What is considered moderate dehydration?

-10% weight loss -Irritable

What is considered severe dehydration?

-15% weight loss -Lethargic or hyperirritable

What is considered Mild dehydration?

-5% weight loss -Normal behavior

What is the leading causes of death in a toddler?

-Accidents -Poisoning

Normal vital signs for a toddler (BP, pulse, and respirations)?

-Blood pressure: 90/56 -Pulse: 70 - 100 beats per minute -Respirations: 25 (abdominal)

Safety requirements for toddler's:

-Childproofing -Knowledge of age-appropriate risks

What are signs of readiness for toilet training?

-Communication -Wakes up dry -Holds urine for 2 hours

Characteristics of athetoid (dyskinetic) cerebral palsy:

-Continuous involuntary writhing movements. -Involves damage to the basal nuclei ganglion. -Often associated with hyperbilirubinemia. -Complications include: Speech, sight, and hearing defects, or seizures.

What is important to check prior to administering digoxin to patient?

-Count resting apical pulse for 1 full minute prior to giving medication. -Do NOT give if pulse is less than 100.

Why does clubbing occur with patients who have tetralogy of fallot?

-Due to venous (non-oxygenated) blood entering the aorta. --Cyanosis increases with age, resulting in clubbing of the fingers and toes.

What can occur as a child grows with patent ductus arteriosus (PDA)?

-Dyspnea -Radial pulse can be bounding -Wide range between systolic and diastolic pulse pressure.

What types of language continue to develop in toddlers?

-Expressive (child's ability to express themselves). -Receptive (understanding expressions and words of others).

What is consoling to a toddler?

-Favorite possessions -Rituals

Feeding strategies for infants with congestive heart failure:

-Feedings are small and frequent -Provide a soft nipple with holes large enough to prevent the infant from tiring is provided. -Formulas with increased caloric density is used (24 calories/ounce -- due to increased metabolic demand). -Feed early if crying, feed late if asleep.

Age 2 developments:

-Jumps (both feet) -Runs, throws ball -Climbs steps -Enjoys push/pull toys (trucks) -Uses 2-word sentences

Isotonic dehydration (Description & risk for):

-Lost fluid = lost electrolytes -Risk for hypovolemic shock

Hypotonic dehydration (Description & risk for):

-Lost more electrolytes than fluid -Risk for water intoxication.

Hypertonic dehydration (Description):

-Lost more fluids than electrolytes.

What do toddler's learn through play?

-Manipulate and understand their environment. -Socialize. -Explore their world.

Signs of digoxin toxicity?

-Nausea -Vomiting -Anorexia -Irregularity in rate and rhythm of the pulse -Sudden change in pulse

Early signs and symptoms of autism in a toddler?

-No pointing, gesturing (bye-bye) by 12 months. -No single words by 16 months. -No spontaneous two-word phrases by 24 months. -Loss of achieved language or social skills previously attained.

How to encourage a toddler to eat?

-Provide a variety of foods. -Provide colorful finger foods. -Serve at moderate temperature. -Serve using colorful dishes.

What are the physiological changes that protect a toddler from disease?

-Skin becomes tougher. -Increased capillary response improves thermoregulation. -Body temperature is stabilized. -Adenoids and tonsils get larger.

How should the nurse approach a patient who may be autistic?

-Slow paced, with few distractions. -The child should be allowed to become familiar with the environment. -Permission should be asked prior to touching patient -Sudden movements or loud noises should be avoided.

Potty chair requirements:

-Small enough for feet to touch the floor. -Sturdy and stable -Supportive of child's back and arms.

Characteristics of spastic cerebral palsy:

-Spasms occur with movement. -Involves damage to the cortex of the brain. -Tension in certain muscle groups -Lower extremities are normally involved -Related to cerebral asphyxia.

What are the four structural anomalies associated with teratology of fallot?

-Stenosis/narrowing of pulmonary artery (decreases blood flow to the lungs). -Enlargement of the right ventricle (due to the extra work needed to pump blood through the narrow pulmonary artery). -Dextroposition (right placement) of the aorta (blood from both ventricles can then enter the aorta). -Ventricular septal defect (opening between the right and left ventricles of the heart).

Clinical manifestations of Severe dehydration:

-Thirst: Intense -Mucous membranes: Parched -Tears: Absent -Anterior fontanelle: Sunken -Skin turgor: Decreased -Urinary output: Minimal

Clinical signs of moderate dehydration:

-Thirst: Moderate -Mucous membranes: Dry -Tears: Decreased -Anterior fontanelle: +/- -Skin turgor: +/- -Urinary output: Decreased

Clinical signs of mild dehydration:

-Thirst: Slight -Mucous membranes: Normal -Tears: Present -Anterior fontanelle: Flat -Skin turgor: Normal -Urinary output: Normal

What is recommended dietary wise for toddler's with constipation?

-Whole grain cereals -Raw vegetables -Raw fruits -Increased fluids

The mother of a toddler verbalizes her child has become a picky eater. What are some strategies the mother can implement to help her child? Select-all-that-apply: 1. Have small easy to grab nutritious snacks available rather than 3 large meals a day 2. Give the child new foods to try 3. Use the same plate and cup for meals 4. Offer food items that are mixed

1 & 3 -Have small easy to grab nutritious snacks available rather than 3 large meals a day. -Use the same plate and cup for meals.

Your patient, who is 2 years old, is having a temper tantrum. What actions below are not appropriate for dealing with this situation? Select-all-that-apply: 1. Attempt to stop the tantrum 2. Protect the child from hurting themselves 3. Ignore the behavior 4. Reason with the child 5. Leave the child alone until the tantrum stops 6. Be consistent with your approach

1 & 5 -Attempt to stop the tantrum -Leave the child alone until the tantrum stops

What age group is considered a toddler?

1 - 3 years.

What is the time frames for time-out?

1 minute per year of age.

What is the normal serving size for toddlers?

1 tablespoon of solid food per year of age.

What is the caloric need of a toddler?

100 calories/kg/day.

What age does voluntary control of anal and urethral sphincters begin?

18 - 24 months.

Fill-in-the-blank: The anal and urethral sphincter can be voluntarily controlled around _______________. 1. 12-18 months. 2. 24-36 months. 3. 6-12 months. 4. 18-24 months.

18-24 months.

The nurse is educating the parents of a 13-month-old on how to avoid dental caries. Which statements should the nurse include in the education about this topic to the parents? Select-all-that-apply: 1. "If a bottle is given at night, be sure to water down the juice before giving it to the child". 2. "When your child's first teeth erupt, it is time to go to the dentist." 3. "If your water at home does not contain fluoride, fluoride supplementation may be needed". 4. "To help promote autonomy in your child, he should brush his teeth by himself without assistance".

2 & 3 -"When your child's first teeth erupt, it is time to go to the dentist." -"If your water at home does not contain fluoride, fluoride supplementation may be needed".

How much does the height in a toddler increase by each year?

2 - 3 inches/year.

The mother of a 2-year-old verbalizes concern about how her child has suddenly developed temper tantrums. She asks about preventive measures. What are some preventive measures you can educate the mother about? Select-all-that-apply: 1. Avoid giving the child choices 2. Distract the child 3. Give in to the child's request 4. Prepare the child for a change in activity or an event a few minutes before it occurs. 5. Avoid new activities when the child is hungry or tired.

2, 4, 5 -Distract the child. -Prepare the child for a change in activity or an event a few minutes before it occurs. -Avoid new activities when the child is hungry or tired.

What age does bowel and bladder control usually complete by?

2.5 - 3 years of age.

At what age does deciduous teeth completely erupt?

2.5 years of age.

A 2-year-old weighed 7 lbs. at birth. How much should the child weigh now? 1. 14 lbs. 2. 28 lbs. 3. 21 lbs. 4. 36 lbs.

28 lbs.

You're assessing the height of a 24-month-old. The child is 34 inches. Based on this measurement, what is an estimated adult height for this child? 1. 6 feet 2 inches 2. 5 feet 8 inches 3. 5 feet 2 inches 4. 6 feet

5 feet 8 inches.

You're providing car seat safety education to a mother of an 18-month-old. Which statement by the mother requires you to re-educate her about this topic? 1. The safest place for the child is in the back seat. 2. A child is switched to a forward-facing car seat at 12 months. 3. A child less than 24 months of age should be in a rear-facing car seat. 4. My son sits in a rear-facing car seat in the back of the car.

A child is switched to a forward-facing car seat at 12 months.

How is a ventricular septal defect (VSD) recognized?

A loud, harsh murmur combined with a systolic thrill is heard.

What is patent ductus arteriosus (PDA)?

A shunt where blood passes from the pulmonary artery to the aorta in a fetus, to bypass the deflated lungs. --This usually closes soon after birth. --If this shunt does not close after birth it can push oxygenated blood from the aorta (higher pressure) to the lungs, resulting in the heart pumping harder.

What type of acid/base imbalance occurs with severe diarrhea?

Acidosis.

What type of acid/base imbalance occurs with severe vomiting?

Alkalosis.

What is an Atrial septal defect (ASD)?

An abnormal opening between the right and left atria. --Oxygenated blood from the left atrium is forced back into the right atrium.

A 20-month-old is in what stage of development according to Erickson's Stages of Development? 1. Industry vs. inferiority 2. Initiative vs. guilt 3. Autonomy vs. shame and guilt 4. Trust vs. mistrust

Autonomy vs. shame and guilt.

What is the expected weight of a 2.5 year old?

Birthweight X 4. --Example: 9 lbs at birth X 4 = 36 lbs.

A toddler is hospitalized and the parent had to temporarily leave the child. The child was inconsolable when the parent left, but now is quite and withdrawn. This is known as what stage of separation anxiety? 1. Detachment 2. Denial 3. Despair 4. Protest

Despair.

When potty training a child, it is important to remember that bladder control occurs before bowel control. True or False?

False. -Bowel control occurs first.

True or false: Cyanosis occurs when there are defects that increase pulmonary blood flow (blood shunts left to right)?

False. --Oxygenated blood recirculates to the lungs.

You're creating a plan of care for a 24-month-old and developing interventions to help with the development of the child. According to Erickson's Stages of Development, what intervention below would help promote development in this patient? 1. Thoroughly communicate the rules of the child. 2. Encourage the child to ask questions about care. 3. Take time to swaddle and rock the child when crying. 4. Give the child opportunities to make food and drink selections.

Give the child opportunities to make food and drink selections.

How does fear affect toddlers?

It is difficult to eliminate once learned.

What is preventative pain control?

More effective pain relief at lower dosages of the analgesic around the clock.

How much milk should be given to a toddler per day?

No more than 24 oz/day. --They need nutrients from food.

How to encourage independence of a toddler?

Offering a choice between 2 items.

What is a ventricular septal defect (VSD)?

Opening between the right and left ventricle. --It is the most common defect.

What is the key intervention for dehydration in toddlers?

Oral rehydrating solutions.

You observe toddlers playing. The children are playing with toys, but they are not playing together. This type of play is known as? 1. Solitary play 2. Parallel play 3. Associate play 4. Co-operative

Parallel play.

What type of play is normal for a toddler?

Parallel play. --Toddlers play next to but not with each other.

How do patients recover from a Tet spell (what is recommended)?

Position the child in the squatting position. --It increases venous return back to the heart.

A 3-year-old is hospitalized. The parent verbalizes to you that at home the child was potty trained but now the child is refusing to use the toilet and is voiding on themselves. The parent expresses concern. As the nurse you should tell the parent? 1. Try potty training again while the child is hospitalized. 2. Reassure the parent that this is temporary and is most likely occurring because the child is hospitalized. 3. Advise the parent to set limits and implement discipline strategies for toilet accidents. 4. Recommend the parent avoids ritualistic routines until the child is not hospitalized.

Reassure the parent that this is temporary and is most likely occurring because the child is hospitalized.

What is the primary goal when a toddler has dehydration?

Restoring fluid and electrolyte balance.

According to Piaget's Theory of Development, what stage would a 14-month-old be in? 1. Formal operational 2. Sensorimotor 3. Preoperational 4. Concrete operational

Sensorimotor.

What are Paroxysmal hypercyanotic episodes (Tet spells)?

Spontaneous cyanosis, respiratory distress, weakness, and syncope that occurs with tetralogy of fallot patients. --Occur during the first 2 years of life.

According to Piaget's Theory of Development, your patient is in the Preoperational Stage based on their age. The patient demonstrates they are in this stage by which finding below? 1. The child understands time and quantity. 2. The child likes to play pretend. 3. This concept of object permanence is not developed yet. 4. The child possesses abstract thinking rather than concrete thinking.

The child likes to play pretend.

What structure in the heart allows for infants with hypoplastic left heart to obtain oxygenated blood?

The foramen ovale and ductus arteriosus is left open, by giving prostaglandin E1.

What is negativism in toddler growth?

The toddler tries to gain control by saying "no" to EVERYTHING.

When is a echocardiogram used for a congenital cardiac anomaly?

To check status of the patent ductus arteriosus (PDA), as the echocardiogram determines blood flow across the PDA.

Why is digoxin provided to an infant with CHF?

To help slow and strengthen the heart beat.

How is an atrial septal defect (ASD) recognized?

When a murmur is heard during a routine health examination.