PEDIA: exam 1 review
A nurse is preparing a discharge teaching plan for a 6-year old client with asthma who has several prescription medications using metered dose inhalers (MDIs) which of the following interventions should the nurse include in the plan? a) add a spacer to each mdi b) instruct the child to inhale more rapidly than usual when using an mdi c) ask the provider to change the child's medications from inhaled to oral formulations d) administer oxygen by facemark along with the MDI
a mdi are difficult to use correctly; even when properly used, only a portion of the medication is delivered yo the lungs. a spacer applied to an mdi can make up for a lack of hand-lung coordination by increasing the amount of medication delivered to the lungs
GROSS MOTOR SKILL A nurse is providing teaching to the parents of a 4-year-old child about fine motor development. which of the following tasks should the nurse include as an expected finding for this age group? a) copying a circle b) cutting foods using a table knife c) beginning to write in cursive d) printing the first and last name clearly
a) copying a circle the nurse should explain that copying a circle is a skill achieved by the age of 4 years
a nurse at a pediatric clinic is assessing a 5 month old infant during a well child visit. which of the following findings should the nurse report to the provider? a) head lagging when the infant is pulled fro a lying to a sitting position b) absence of startle and crawl reflexes c) inability to pick up a rattle after dropping it d) rolling from back to side
a) head lagging when the infant is pulled fro a lying to a sitting position at the age of 5 months, the infant should have no head lag when pulled to a sitting position; therefore, the nurse should report this findings to the provider
GROSS MOTOR SKILLS A nurse is assessing the gross motor skills of a 4 year old preschooler. the nurse should expect the preschooler to perform which of the following activities? a) hopping on 1 foot b) skipping on alternate feet c) jumping rope d) roller skating
a) hopping on 1 foot the nurse should expect a 4 year old preschooler to hop on 1 foot
a nurse is providing teaching about immunization schedules to the parents of a newborn who is 1 week old. which of the following pieces of information should the nurse include in the teaching? a) initial vaccines should be administered between birth and 2 weeks of age b) your child will need to begin the vaccination series over again if subsequent doses in the series are missed c) an allergic reaction to a vaccine is due to the active ingredient in the vaccine d) a vaccination should be postponed in your child has a rectal temperature of 99.5 F and head congestion
a) initial vaccines should be administered between birth and 2 weeks of age the first dose of hep B vaccine should be administered within the first 2 weeks after birth. the dose should be given before discharge from the hospital if the mother is hep B surface antigen (HBsAg) negative
A nurse is assessing a 6 year old client at a well child visit. which of the following findings requires further assessment by the nurse? a) presence of spares, fine pubic hair b) decreased head circumference compared to full height c) increased leg length in relation to height d) presence of a loose central incisor
a) presence of spares, fine pubic hair the development of sexual characteristics prior to the age 9 years in boys and 8 years in girls is an indication precocious puberty and requires further evaluation
a nurse is performing a developmental assessment on a 3-year-old-child, which of the following commands should the nurse expect the child to complete successfully? a) out your shoes on b) name the days of the week c) cut out this picture with a pair of scissors d) balance on 1 foot with your eyes closed
a) put your shoes on children should be able to pull on their shoes when they are 3 years old. they typically cannot tie their shoes until they are 5 years of age
a nurse is assessing a 6 moth 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
a) sitting alone a 6 month old infant should be able to turn over completely, sit momentarily without support, and reach to be picked up
a nurse is performing a well child assessment on a 4 year old child. which of the following should the nurse expect? a) the child is able to hop on 1 foot b) the child is 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 the nurse should expect a 4 year old child to have the gross motor ability 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 indecently roll from his back to his abdomen
a) the infant looks at his hands infants usually start to look at their hands while lying down or sitting between 12 to 20 weeks of age. convergence on near objects is usually well established by 3 months of age.
a nurse is assessing an 18 month old toddler during a well child examination. 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 an 18 month old toddler should be able to remove his or her own shoes, socks, and gloves. the nurse should report this findings to the provider
A nurse is preparing to administer an intramuscular injection to a 2 month old infant. in which of the following sites should the nurse plan to administer the injection? a) vastus lateralis b) dosogluteal c) deltoid d) abdomen 5 cm (2 in) from the umbilicus
a) vastus lateralis the vests laterals is a large developmed muscle, even in an infant. the muscle can tolerate the volume of the injection, and there are no important nerves or blood vessels in this muscle
a nurse is providing teaching about disease management to the parent of a preschooler who has a new diagnosis of asthma. which of the following parents statements indicates an understanding of the teaching? a) my child should not receive live virus vaccines b) I will encourage my chid to participate in sports c) I will give my child aspirin when she has a fever d) my child will outgrow asthma by adulthood
b) I will encourage my chid to participate in sports the parent should encourage the child to remain physically active because this promotes lung expansion and air exchange
a nurse conducting a health assessment for a 24 month old toddler at the local health department. the nurse should expect which of the following findings? a) 8 deciduous teeth b) ability to build a tower of 6 blocks c) vocabulary of 10-20 words d) slightly bowed or curved leg appearance e) head circumference greater than chest circumference
b) ability to build a tower of 6 blocks d) slightly bowed or curved leg appearance a nurse should expect a 24-month old toddler to be able to stack a short tower of 6 or 7 blocks. additionally, a 24 month old toddler will have a "pot-bellied" appearance; the legs should slightly bowed to support the weight of the comparatively large trunk 24 month old - 16 teeth > vocabulary of about 300 words and to be able to speak in 2-3 word phrases > have a head circumference that is equal to or less than chest circumference
a nurse is performing a physical assessment on 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 the babinski reflex, which is elicited by stroking the bottom of the foot and causing the toes to fan and the big toe to dorsiflex, should be present until the age of 1 year.persistence of neonatal reflexes might indicate neurological deficits
a nurse is caring for a 3 year old child on a pediatric unit. the nurse should identify which of the following as an appropriate toy for the child a) jump rope b) coloring books and crayons c) checkers game d) jack in the box
b) coloring books and crayons preschoolers have increasing fine motor control and imagination. they enjoy toys that allow creativity and self expression 5 yr old >jump rope 6 yr old > checkers
GROSS MOTOR SKILL 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 the nurse should expect a 3 year old child to have the fine motor ability to copy a circle. 4 yr old > ability to copy a square 5 yr old > can tie her shoes > can draw stick figures with 7 to 9 parts > can print letter of her name
a nurse is assessing a 4 year old child's cognitive development during a well child visit. which of the following should the nurse expect the child to display? a) conservation b) development of the superego c) concrete operational thought d) separation anxiety
b) development of the superego this is the development of a conscience. preschoolers begin to develop an understanding of right from wrong. while they night not be unable to understand the "why" of acceptable vs unacceptable behaviors, they learn the concepts though punishment and reward and the principles to which their parents adhere.
GROSS MOTOR SKILL A nurse is assessing a 9 month old infant. which of the following findings should the nurse report to the provider as possible developmental delay? a) grasping a small abject with just the thumb and index finger b) dropping a tube when passing from 1 hand to the other c) falling from a standing position to sitting d) losing balance when leaning sideways while sitting
b) dropping a tube when passing from 1 hand to the other the ability to pass a cube from a hand to the other is a fine motor skill expected of a 7 month old infant . therefore, the nurse should identify the 9 month old infant's inability to perform this task as a possible developmental delay and should report this findings to the provider.
a nurse is caring for a school aged child who begins to have a tonic clonic seizure when leaving the bathroom. which of the following actions should the nurse take first? a) obtain a portable suction machine and suction tuning b) ease the child to the floor in Sims position c) Time the length of the seizure d) notify the child's parents
b) ease the child to the floor in Sims position the greatest risk to the child is an injury resulting from a fall; therefore, the nurse should firs gently ease the child to the floor to decrease the change on injury and our the child on the left side to prevent aspiration
a nurse is observing the behavior of a 2 year old child. which of the following should the nurse expect to observe when the child is in an activity room with other toddlers? a) paying a simple game with another child b) engaging in play near other children c) sharing crayons with another toddler d) jumping on 1 foot without help
b) engaging in play near other children the nurse should identify that toddler play happens in parallel to that of other children. as socialization begins, the child plays alongside other children, not with them
A nurse is assessing a 6 year old child who began treatment for pneumococcal pneumonia 4 days ago. which of the following findings should the nurse identify? a) dullness with chest percussion b) heart rate 118/min c) conjunctival discharge d) respiratory rate 28/min
b) heart rate 118/min the nurse should identify that a heart rate of 118/min is within the expected reference range for 6 year old child. a child who has an acute pneumococcal infection will exhibit tachycardia
a nurse is caring for a toddler at well child visit when the mother calls, "Help! My baby is chocking on his food." Which of the following findings indicates the toddler has an airway obstruction? a) flushing of the skin b) inability to cry or speak c) presence of nausea and mild emesis d) capillary refill time of 1.5 sec
b) inability to cry or speak when the client has no sound passing through the vocal cords, a complete airway obstruction is evident. the nurse should use the Heimlich maneuver to dislodge water is obstructing the trachea
a nurse is assessing a 9 month old during a well child visit. which of the following findings indicates that the infant has a developmental delay? a) creeping on hands and knees b) inability to vocalize vowel sounds c) using a crude pinterm-23cer grasp d) standing by holding onto a support
b) inability to vocalize vowel sounds the infant should begin vocalizing vowel sounds at the age of 7 months. buy the age of 10 months, the infants should be able to say at least 1 word. 9 months > they should creep on hands and knees; begin to stand while holding onto furniture at the age of 10 months > should demonstrate a crude pincer grasp; the use of dominant hand is also evident 10 months > ability to stand while holding onto a support
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 if the child becomes uncooperative
b) minimize physical contact with the child initially the nurse initially minimize physical contact with the toddler and process fro the least traumatic to the most traumatic procedures
A nurse is assessing a 9-month-old-infant, which of the following findings should the nurse report to the provider as a delay in developmental a) using a pincer grasp to pick up blocks b) requiring support to sit for prolonged periods c) turning the head toward the parent's voice d) reaching for the mother and saying "mama)
b) requiring support to sit for prolonged periods an infant should be able to sit unsupported by the age of 8 months. the nurse should report this findings to the provider because it is an indication of a delay in gross motor development.
GROSS MOTOR SKILL 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 4 yr old > can cut out shapes with scissors 5 yr old > moving heel to toe > printing letters with a pencil
a nurse is discussing disciplinary techniques with the guardian of a preschooler. which of the following actions indicates to the nurse that the guardian is using an age-appropriate disciplinary technique? a) the guardian explains to the child why her behavior is unacceptable b) the guardian places the child in time-out after misbehaving c) the guardian allows the child to choose the consequences of her misbehavior d) the guardian assigns an extra chore for the child's misbehavior
b) the guardian places the child in time-out after misbehaving the nurse should encourage the guardian to continue to use time-out as a form of discipline. this technique is effective with a preschooler if carried out correctly. the nurse should review the process of suing time-outs with the guardian (e.g. ensuring the time out takes place in a safe and quite location) and recommend that the length of the time out is 1 minute for each year of the child's age
A nurse in a provider's 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 the nurse should expect an 8-month-old infant to have a heightened fear of strangers. the infant is expected to cling to her parent and turn away when approached by a stranger
a nurse is a provider's office is observing children playing in the waiting room. the nurse should expect to identify parallel behavior in which of the following age groups? a) infants b) toddlers c) preschoolers d) school-age children
b) toddlers toddlers demonstrates parallel play infants - demonstrate solitary pla preschoolers- demonstrate associative play school age children - demonstrate cooperative play
a nurse is providing a education for a group of parents about toddler language development during a well child visit. which of the following findings should the parent expect in an 18 month old toddler? a) ability to refer to self by name b) vocabulary of 10 or more words c) following simple directional commands d) naming a single color
b) vocabulary of 10 or more words at 18 months, children typically have a vocabulary of 10 or more words
***a nurse is reviewing recommended immunizations with the guardian of a 2 month old infant. which of the following statements should the nurse make? a) your baby can receive the varicella vaccine at 6 months of age b) your baby can start the pneumococcal vaccine now c) your baby should receive the flu vaccine before 6 months o age d) your baby can start the measles, mumps, and rubella vaccine now
b) your baby can start the pneumococcal vaccine now the infant can receive the first dose of the pneumococcal vaccine now, with 2 additional doses at 4 months and 12 months of age > varicella - 1 yr of age > annual influenza - 6 mo & older > MMR - starting @ 12 months
a nurse is assessing a 24-month-old toddler who has a new diagnosis of autism spectrum disorder (ASD). which of the following findings should the nurse expect? a) wanting to be held frequently b) ability to build a tower of 10 cubes c) impaired language skills d) ability to stand on 1 foot
c) impaired language skills the nurse should expect a 24-month-old toddler who has ASD to exhibit impaired language skills (e.g. failing to respond to his or her name, pointing to objects instead of speaking)
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 hear disease b) hearing loss c) neurological disorder d) amblyopia
c) neurological disorder the moro reflex, also known as the starle reflex, is elicited b striking the surface next the the newborn to starle him/her. a classic pattern of abduction and extension of the arms is expected. this reflex should be gone by 4 months of age; its presence after 4 months of age is associated with a neurological disorder
a nurse is preparing to perform a routine heel puncture on a newborn. which of the following actions should the nurse take? a) administer tolmetin prior to the procedure b) apply a entice mixture of local anesthetics (EMLA) cream to the newborn's heel after the procedurterm-19e c) prepare concentrated sucrose for oral administration d) place the newborn in an extended position
c) prepare concentrated sucrose for oral administration the nurse should provide the newborn with oral sucrose 2 minutes prior to performing the heel puncture. this practice, along with non-nutritive sucking, has been showing to decrease the pain the newborn experiences during the heel puncture.
during a well child visit, the guardian of a toddler reports that the toddler takes several hours to fall asleep at night. which of the following recommendations should the nurse make? a) vary the time the toddler goes to bed each night b) allow the toddler to watch television before bedtime c) provide the toddler with a favorite stuffed animal at bedtime d) increase the toddler's activity prior to bedtime
c) provide the toddler with a favorite stuffed animal at bedtime providing the toddler with a favorite soft toy at bedtime can help the toddler feel more secure and facilitates sleep
a nurse is assessing a 4 year old child for growth and developmental milestones during a well child visit.which of the following findings suggests a possible delay in development? a) inability to tie shoes b) adding 3 parts to a stick figure c) speaking using 2 or 3 word sentences d) inability to walk backward
c) speaking using 2 or 3 word sentences a 4 year old child should be speaking in 4 to 5 word sentences. speaking I 2 to 3 word sentences in typical of a 2 year old child 5 yr old > tying shoelaces > walking backward
GROSS MOTOR SKILL a nurse is assessing a 3 year old child during a well child examination. which of the following findings should the nurse report to the provider? a) the child wets the bed when sleeping b) the child cannot catch a ball c) the child cannot walk on tip toe d) the child build a tower of 10 cubes
c) the child cannot walk on tip toe the nurse should identify that a child should be able to take a dew steps on tiptoe by 30 months of age. therefore, the nurse should report this findings to the provider.
A nurse is assessing a 7 year old child's psychosocial development. which of the following findings should the nurse recognize as an indicator for further evaluation? a) the child prefers playmates of the same sex b) the chid is competitive when playing board games c) the child complains daily about going to school d) the child enjoys spending time alone
c) the child complains daily about going to school complaining every day about going to school is an unexpected finding for a 7 year old child. the child is in Erikson's psychosocial development stage of industry vs. inferiority. children at this state want to learn and master new concepts. if the child complaints daily about going to School, further evaluation is warranted.
a nurse is assessing a 6 month old infant at a well child visit. which of the following findings indicates the need for further assessment? a) the infant is grabbing the feet and pulling them to the mouth b) the infant has a closed posterior fontanel c) the infant's legs remained crossed and extended when supine d) the infant's weight has doubled
c) the infant's legs remained crossed and extended when supine legs that are crossed and extended when supine is an unexpected findings and requires further assessment. at 6 months of age, the infant's legs flex at the knees when the infant is supine. crossed and extended legs when supine is associated with cerebral palsy
a nurse is assessing a 30 month old toddler during a well child visit. which of the following findings requires further assessment by the nurse? a) primary dentition is complete b) the toddler is unable to hop on 1 foot c) the toddler's birth weight is tripled d) the toddler is able to state her first and last name
c) the toddler's birth weight is tripled the toddler's birth weight should triple by 12 months of age. by 30 months of age, the toddler's birth weight should be quadrupled
a nurse is creating a plan of care for an 18 month old toddler who has cerebra palsy. which of the following interventions should the nurse include? a) use a mobile walker for the toddler b) discourage activities involving repetitive joint movement c) use manual jaw control when feeding the toddler d) discourage the use of wrist saints
c) use manual jaw control the nurse should encourage the parent to include the use of manual jaw control during feedings. children diagnosed with cerebral palsy can lose haw control, and more effective control can be achieved by providing stability to the jaws during feeding
a nurse is providing teaching about disease management strategies to a 9 year old client who has cystic fibrosis. which of the following statements should the nurse include? a) thorough and effective pulmonary clearance can help prevent the need for a lung transplant when you get older b) you should eat these kinds of foods because thy will help you grow big and strong c) your mucus is think because cystic fibrosis interferes with how your glands work d) your medication follows a certain schedule to help you sleep better
c) your mucus is think because cystic fibrosis interferes with how your glands work a 9 year old child should understand that the production of thick mucus is part of the disease process
a nurse is providing teaching to the parents of school-age child with asthma about medications for bronchospasm. which of the following inhaled medications should the nurse instruct the parents to use to relieve an acute asthma attack? a) salmeterol b) cromolyn c) fluticasone d) albuterol
d) albuterol albuterol is a short-acting-beta-2 adrenergic agonist that is used to provide immediate relief for an acute asthma attack. one or two puffs every 4 to 6 hours pun is the usually prescribe dose for a school-age child if higher or more frequent boded are needed, the provider should evaluate the client for worsening asthma.
*a school nurse is caring for a child who is experiencing an cute asthma attack. which of the following mediations should the nurse pain to administer to the child? a) zafirlukast b) budesonide c) montelukast d) albuterol
d) albuterol the nurse should plan to administer albuterol to a child who is experiencing an acute exacerbation of asthma. this is considered a rescue medication due to its rapid onset of action. albuterol is a beta-adrenergic agonies that promotes bronchodilation and suppresses histamine release in the lungs
a nurse is providing teaching to the guardians of a 4 month old infant on how to play with the infant. which of the following play activities should the nurse suggest for this infant? a) show the infant a board book with large pictures b) imitate the sounds of different farm animals for the infant c) give the infant a large push-pull toy d) allow the infant to splash in the bathtub
d) allow the infant to splash in the bathtub the nurse should suggest allowing this 4 month old infant to splash in the bathtub as a play activity. splashing is appropriate for the developmental age go the infant and provides tactile stimulation. however, the nurse should emphasize and teach bath safety to prevent injury. 9-12 month > board book with large pictures provides visual stimulation > imitating animal sounds provide auditory stimulation > push-pull toys provide kinetic stimulation
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 building towers with block is an appropriate activity for a 2-year-old-child. and promotes fine-motor development. Also, knocking blocks down provides a means of dealing with the stress of hospitalization.
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 the nurse should maintain droplet precautions for a client who has meningococcal meningitis for 24 to 72 hours after the initiation of antibiotic therapy. disease transmission can occur through large-droplet particles when client is talking. there no drainage of infected body fluids with meningitis, so contact precautions are not necessary
a nurse is caring for a child with cystic fibrosis who has a pulmonary infection. which of the following findings is the nurse's priority? a) blood streaking of the sputum b) dry mucous membranes c) constipation d) inability to clear secretions
d) inability to clear secretions think ABC priority the inability to clear secretions is the priority finding because the child has a compromised airway
GROSS MOTOR SKILL 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 ball overhead d) standing on 1 foot
d) standing on 1 foot the nurse should expect a 3 year old child to have the gross motor ability to stand on 1 foot for a few seconds
GROSS MOTOR SKILL A nurse is assessing the fine motor skills of a 3 year old preschooler. which of the following findings should the nurse expect? a) the preschooler can draw a stick figure that has 7 parts b) the preschooler a print her first name c) the preschooler can cut out a picture using scissors d) the preschooler builds a tower of 9 cubes
d) the preschooler builds a tower of 9 cubes the nurse should expects a 3 year old preschooler to have the fine motors skills needed to build a tower of 9 to 10 blocks
a nurse is caring for a toddler who has asthma. the parents are concerned about the hospitalizations. which of the following actions should the nurse take to decrease the child's anxiety a) provide privacy b) give the child a thorough explanation before providing care c) encourage roomie-in d) tell the child you will help fix her
encourage rooming-in