Pediatrics Exam 1

It is time to give 3-year-old David his medication. Which approach is most likely to receive a positive response? A. "It's time for your medication now, David. Would you like water or apple juice afterward?"B. "Wouldn't you like to take your medicine, David?"C. "You must take your medicine, David, because the doctor says it will make you better."D. "See how nicely John took his medicine? Now take yours."

A

What is the best advice about nutrition for the toddler? A. Encourage cup drinking and give water between meals and snacks. B. Encourage unlimited milk intake, because toddlers need the protein for growth. C. Avoid sugar-sweetened fruit drinks and allow as much natural fruit juice as desired. D. Allow the toddler unlimited access to the sippy cup to ensure adequate hydration.

A

Which statement indicates the best sequence for the nurse to conduct an assessment in a nonemergency situation? A. Introduce yourself, ask about any problems, take a history, and do the physical examination. B. Perform the physical examination and then ask the family if there are any problems in the child's life. C. Do the physical examination while at the same time asking about the child's previous illnesses; then talk about the family's concerns. D. Get a complete history of the family's health beliefs and practices, and then assess the child.

A

What is the best advice about nutrition for the toddler? •a. Encourage cup drinking and give water between meals and snacks. •b. Encourage unlimited milk intake, because toddlers need the protein for growth. •c. Avoid sugar-sweetened fruit drinks and allow as much natural fruit juice as desired. •d. Allow the toddler unlimited access to the sippy cup to ensure adequate hydration.

A The toddler should wean to the cup by age 12-15 months. Limit real fruit juice to 4-6 oz per day and milk to 16-24 oz per day. Offer water between meals and snacks

A 9-month-old infant's mother is questioning why cow's milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response? A It is permissible to substitute cow's milk for formula at this age as he is so close to 1 year old. B Cow's milk is poor in iron and does not provide the proper balance of nutrients for the infant. C As long as the mother provides whole milk, rather than skim, she can start cow's milk in infancy. D If the mother cannot afford the infant formula, she should dilute it to make it last longer.

B

A sleeping 5-month-old girl is being held by the mother when the nurse comes in to do a physical examination. What assessment should be done initially? A. Listening to the bowel sounds B. Counting the heart rate C. Checking the temperature D. Looking in the ears

B

The father of a 2-month-old girl is expressing concern that his infant may be getting spoiled. The nurse's best response is: A "She just needs love and attention. Don't worry she's too young to spoil." B "Consistently meeting the infant's needs helps promote a sense of trust." C "Infants need to be fed and cleaned if you're sure those needs are met, just let her cry." D "Consistency in meeting needs is important, but you're right, holding her too much will spoil her."

B

To gain cooperation from a toddler, what is the best approach by the nurse? A. Immediately pick the toddler up from the mother's lap. B. Kneel in front of the toddler while he or she is on the mother's lap. C. Do the nursing tasks quickly so the toddler can play. D. Ask the toddler if it is okay if you begin the needed task.

B

Using knowledge of child development, the best approach when preparing a toddler for a procedure is to :a. Avoid asking the child to make choices. b. Demonstrate the procedure on a doll. c. Plan for the teaching session to last about 20 minutes. d. Show necessary equipment without allowing child to handle it.

B

The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant's oral health? A "Start brushing her teeth after all the baby teeth come in." B "Use a washcloth with toothpaste to clean her mouth." C "Clean your baby's gums, then new teeth, with a washcloth." D "Rinse your baby's mouth with water after every feeding."

C

Newborn primitive reflexes

- Moro - Rooting and sucking - Asymmetric Tonic Neck Reflex (ATNR) - Plantar and palmar grasp - Step -Babinski

Nutrition growth and development

-4-6 mos-introduce rice cereal -6mos- fruits and vegetables --dental hygeine -8-10mos- use a cup, meats -1year- whole milk 2 years- switch to 2% milk, limit juice to 1 cup a day, allow self feeding 4 years-thumb sucking ends

Gross motor development

-5 months- head control (3 months), turns over -9 months- crawls -10 months- stands -11/12 months- stands with furniture or toys, -18 months- jumps, throws balls -2 years- runs -3 years- toileting, bowel first

Growth and development language changes

-Coos at 9 mos -10-15 words at 1 yr -2-3 word sentences at 18 months -200 words and half is understandable 2 years -asks questions at 3 years -6-8 word sentences at 5 years

Componants of the health history

-Demographics -Chief complaint and history of present illness -Past health history -Review of systems -Family health history -Developmental history -Functional history -Family composition, resources, and home environment

A mother of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. The nurse most appropriately tells the mother to: 1. Punish the child every time the child says "no", to change the behavior 2. Allow the behavior because this is normal at this age period 3. Set limits on the child's behavior 4. Ignore the child when this behavior occurs

3. set limits

The nurse is caring for a hospitalized 30-month-old who is resistant to care, is angry, and yells "no" all the time. The nurse identifies this toddler's behavior as A. problematic, as it interferes with needed nursing care. B. normal for this stage of growth and development. C. normal because the child is hospitalized and out of his routine.

B

What approach by the nurse would most likely encourage a child to cooperate with an assessment of physical and developmental health? A. Explain to the child what's going to happen when the child asks questions. B. Explain what is going to happen in words the child can understand. C. Force the child to cooperate by having a parent hold him or her down. D. Give the child a sticker before beginning the examination.

B

Which assessment finding is considered normal in children? A. Irregular respiratory rate and rhythm B. Split S2 and sinus arrhythmia C. Decreased heart rate with crying D. Genu varum past the age of 5 years

B

Weight changes in 4-6 monts

Double weight

T or F? The nurse is eliciting a health history from an adolescent. It is recommended that the nurse acts like the teenager's peer in order to gain respect and acceptance

False

Adolescent HR and RR

HR- 55-95 RR-12-18

Infant HR and RR

HR- 80-150 RR- 25-55

School-age HR and RR

HR-60-100 RR- 14-22

Preschooler HR and RR

HR-65-110 RR-20-25

Leading cause of death during first month of life

SIDS

One of the participants attending a parenting class asks the teacher "what is the leading cause of death during the first month of life?

SIDS

A nurse is evaluating the developmental level of a 2-year-old. Which of the following does the nurse expect to observe in this child?

Uses a fork to eat

play at 2 years

children play independanctly but among children

Weight changes by 6 mos

double

Flacc scale

face, legs, activity, cry, consolability 0-3

T or F Questions about the use of car seats or smoke detector should be included in the developmant hx part of health assessment

false

imaginative play

house (toddlers)

Grade schooler Eriksons

industry v inferiority

Calculatio of body mass index

lbs devided by height in incches squared all times by 703 or kgs devided by height in meters squared times 10,000

Weight changes by 2.5 years

quadruple

Weight changes is 2.5 years

quadruple weight

weight changes by 1 year

triple

Weight changes in 1 year

triple weight

Questions about the parent's employment status and occupation are relevant to the overall well-being of a child?

true

Eriksons infant

trust vs mistrust

Gross motor skills

•5 months- head control (3 months), turns over •9 months- crawls •10 months- stands •11/12 months- stands with furniture or toys, •18 months- jumps, throws balls •2 years- runs •3 years- toileting, bowel first

The nurse needs to take the blood pressure of a preschool boy for the first time. Which action would be best in gaining his cooperation? A. Taking his blood pressure when a parent is there to comfort himB. Telling him that this procedure will help him get well faster.C. Explaining to him how the blood flows through the arm and why the blood pressure is importantD. Permitting him to handle equipment and see the dial move before putting the cuff in place

D

Which stage of development is most unstable and challenging regarding development of personal identity?

Adolescence

The nurse is assessing developmental milestones for a 7-month-old premature infant born at 28 weeks' gestation. What would be the adjusted age upon which the nurse would base the assessment? a. 2 months b. 3 months c. 4 months d. 5 months

C

Which of these is most concerning? A. School Ager with BP of 88/65 B. Infant with RR of 50 C. 4 year old with HR of 65 D. Toddler with RR of 14

D RR of 14

The nurse is conducting a physical assessment of a teenager and asks about his daily routine. What aspect of the health history is the nurse assessing? a. developmental history b. functional history c. family health history d. demographics

B. Functional history

A 5-year-old boy visits the pediatric office with an upper respiratory infection. Which approach would give the nurse the most information about the child's developmental level? A. Playing a game with the child. B. Talking with the child about the teddy bear next to him. C Using a screening tool during a follow-up office visit. D. Asking the 10-year-old sibling about the child.

C

Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior? A Crying when left with the sitter may indicate difficulty with building trust. B Stranger anxiety should not occur until toddlerhood; this concern should be investigated. C Separation anxiety is normal at this age the infant recognizes parents as separate beings. D Perhaps the sitter doesn't meet the infant's needs; choose a different sitter.

C

The mother of a 15-month-old is concerned about a speech delay. She describes her toddler as being able to understand what she says, sometimes following commands, but using only one or two words with any consistency. What is the nurse's best response to this information? A. The toddler should have a developmental evaluation as soon as possible. B. If the mother would read to the child, then speech would develop faster. C. Receptive language normally develops earlier than expressive language. D. The mother should ask her child's physician for a speech therapy evaluation.

C

Your patient said her baby had four Dtap shots at 2mo, 4mo, 6 mo and at 17 months old. Her baby is 2 now. You would tell her -- A. that completes the series B. Come back for last one in three months. C. Come back in a year D. Come back between ages of four and six

D.

A 2-year-old is having a temper tantrum. What advice should the nurse give the mother? A. For safety reasons, the toddler should be restrained during the tantrum. B Punishment should be initiated, as tantrums should be controlled. C. The mother should promise the toddler a reward if the tantrum stops. D. The tantrum should be ignored as long as the toddler is safe.

D

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse? A "It's okay to start puréed solids at this age if fed via the bottle." B "Infants don't require solid food until 12 months of age." C "Solid foods should be delayed until age 6 months, when the infant can handle a spoon on his own." D "The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods."

D

What are the expected post pain/post hospital behavior

Tendency to cling to parent, demand parents attention, nightmares, bed wetting

Warning Signs Indicating Problems With Sensory Development

Young infant does not respond to loud noises. Child does not focus on a near object. Infant does not start to make sounds or babble by 4 months of age. Infant does not turn to locate sound at age 4 months. Infant crosses eyes most of the time at age 6 months.

Wong-Baker FACES scale

a pain assessment tool that asks patients (often children) to select one of several faces indicating expressions that convey a range from no pain through the worst pain

Eriksons toddler

autonomy vs shame and doubt

anterior fontanel closes

12-18 months

A clinic nurse assesses the communication patterns of a 5-month-old infant. The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant: •1. Uses simple words such as "mama" 2. Uses monosyllabic babbling 3. Links syllables together 4. Coos when comforted

2

posterior fontanel closes

2-3 months

•1. Which age group has the greatest potential to demonstrate regression when they are sick? •1. Adolescent 2. Young Adult 3. Toddler 4. Infant

3 toddler

Risk factors fro heart alterations in children

-History of prematurity, very low birthweight, or other neonatal intensive care complication -Congenital heart disease -Recurrent urinary tract infections, hematuria, proteinuria, known renal disease or urologic malformations, family history of congenital renal disease -Malignancy, bone marrow transplant or solid organ transplant -Treatment with medications that raise BP -Systemic illnesses associated with hypertension such as neurofibromatosis and tuberous sclerosis -Increased intracranial pressure

Warning signs indicating problems with language development

-Infant does not make sounds at 4 months of age. -Infant does not laugh or squeal by 6 months of age. -Infant does not babble by 8 months of age; infant does not use single words with meaning at 12 months of age (mama, dada).

Aspects of the past health history

-Prenatal or perinatal history, past illnesses, other developmental problems -Prior history of illnesses, accidents, or injuries in past -Any operations or hospitalizations child has had -Child's diet and allergies -Child's immunization status -Any medications child is taking -Menstrual history in adolescent females

Assessing growth and development of a premature infant

-Use the infant's adjusted age to determine expected outcomes. -Subtract the number of weeks that the infant was premature from the infant's chronological age. -Plot growth parameters and assess developmental milestones based on adjusted age.

Risk factors that increase child's stress level in hospital

-difficutl temperment, lack of fit between parent and child, male 6 mos to 5 years

How do you document pain?

-duration, patterm, treatment, effectiveness, aggreavting factors

Toddler HR and RR

HR-70-120 RR- 20-30

Teenager Eriksons

Identity vs role confusion

Exceptions to Recommended Breastfeeding

Infants with galactosemia Maternal use of illicit drugs and a few prescription medications Maternal untreated active tuberculosis Maternal HIV infection in developed countries

Pre-schooler Eriksons

Initiative v guilt