Peds 3-7 PrepU
A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development?
After age 12 children can think in the abstract, including complex problem solving.
The nurse is talking with the parents of an 8-year-old child who has been cheating at school. Which comment by the nurse would be appropriate as a first step?
"Be sure the adults in the child's life, including you, as parents, demonstrate positive behavior."
A high school athlete comes to the emergency department with hypertension, aggressiveness, and psychosis. What question would be important for the nurse to ask the client?
"Do you take anabolic steroids?" hey produce euphoria and lessened fatigue. Unfortunately, steroid use can also lead to early closure of the epiphyseal plate, acne, elevated triglyceride levels, hypertension, aggressiveness, and possibly psychosis. side effects: joint pain, swelling, diabetes
The nurse is teaching a group of caregivers of school-age children about the importance of setting a consistent bedtime for the school-age child. Which statement made by a caregiver indicates an understanding of the sleep patterns and needs of the school-age child?
"My child sleeps between 11 and 12 hours a night."
A neonate is to receive a hepatitis B vaccine within a few hours after birth. What is the bestapproach for the nurse to take when giving this medication?
Administer the medication in the neonate's vastus lateralis with a 25-gauge needle. 22-25 gauge needle= recommended for neonates dorsogluteal site= not used until school age volume of medication should not exceed .5 mL per injection
While treating a minor playground injury for an 8-year-old girl, the school nurse discovers that the injury was the result of bullying. What should be the nurse's first action?
Assess the situation with the help of the school staff and parents.
Which assessment is most important for determining an accurate dose of a pediatric medication?
Body surface area
The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation?
Boys grow at a slower, steadier rate than do girls.
Infant
Ch.3
Toddler
Ch.4
Preschool
Ch.5
School aged children
Ch.6
A bilingual family tells the nurse their desire for their child to learn Spanish as well as English. English is the predominant language spoken in the home. The parents ask the nurse when is the best time to teach the child a second language. What time period would the nurse respond?
During the preschool years
When auscultating bowel sounds, which of the following frequencies would the nurse identify as normal?
Five to 10 per minute
Ch.10
Health Assessment of Children
The nurse is reviewing vital signs taken by the unlicensed assistive personnel on a group of toddlers. Which warrants follow up by the nurse?
Heart rate 60 beats/min, respiratory rate 40 breaths/min
Ch.13
Key Pediatric Nursing Interventions
A nurse is assessing a 2-year-old's language development. What would the nurse expect to assess?
Use of a two-word noun-verb sentence
A nurse is presenting a class on toilet training to a group of parents with toddlers. Which information would the nurse include in the class? Select all that apply.
Using training pants that slide down easily and quickly Praising the child when he or she urinates or defecates Putting the child on the potty chair at regular intervals during the day 1-2 weeks to mentally prepare for training limit time on chair to no longer than 10 min regular intervals
A mother of a 9-month-old 18-pound (8.2 kg) infant asks the nurse about choosing the best car seat. What should the nurse recommend?
a rear-facing 5-point harness restraint infants until they are 2 should have a rear facing car seat 5 point harness= up to 40 pounds front facing= 40-80 pounds
The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response?
as soon as the first tooth erupts After the first tooth erupts, parents can use a soft bristle tooth brush.
nb vital signs
axillary or temporal temperature -- no rectal don't want to rupture mucosa femoral pulses -- rule out coarctation of aorta nb reflexes head circumference assessment of gestational age
further assessments
chest x-ray= asthma, check for hyperventilation sputum culture= pneumonia, tb, cystic fibrosis fluoroscopy= masses or abscesses assoc w/pneumonia sweat chloride= cystic fibrosis
A nurse is educating a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan?
client should restrain the baby in the car seat
The nurse is assessing eye alignment in a 6-year-old child. Which assessment method is mostappropriate?
covering one eye and then removing the cover
The nurse is providing education to the woman about foods commonly associated with allergies in infants and young children. What items should be included in this list? Select all that apply.
cow's milk peanut butter strawberries
radial pulse
difficult to take in a child younger than 2 years
secondary prevention interventions
hearing and vision screenings
Height
infant gains about 0.5 to 1 in in length for first 6 m
An infant is breastfed. When assessing the stools, which findings would be typical?
less constipation than bottle fed infants looser and appear seedy bottle fed babies have less stool
symmetry
mirror image in shape and position from one side of the body to another expected finding
when do infants sit
most don't sit steadily until 8 months
natal teeth loose= abnormal
natal teeth at 1-2 months can be finding of other congenital abnormalities
A toddler is brought to the pediatric clinic by the caregiver because the child "doesn't feel well." As the nurse interviews the caregiver about why the client is there, which goal is the nurse prioritizing at this point?
Determining the chief complaint
The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem?
"He doesn't respond if I wave to him."
The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which general question would the nurse direct to the child's parents?
"Is there a family history of hypertension, heart disease, or diabetes?"
The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse?
"Normal growth and development for this age results in an average weight gain of 7 pounds per year."
An adolescent's parent states not knowing what to do with the adolescent. The parent reports the teenager is taking two or three showers a day when not that long ago the parent could barely get the teen to take a shower at all. What should the nurse's reply be to the parent?
"Reinforce the family rules but also allow the adolescent to develop one's own routine."
A mother brings her 8-year-old daughter into the doctor's office because over the past year her tonsils have increased in size to the point that the mother is concerned that her breathing will be obstructed. The girl has no pain, fever or other symptoms. Following this data collection, which instruction is best?
"This may be normal growth of lymphatic tissue for this age."
The mother of a 15-month-old son is returning to work and wants to place her son in the day care close to work; however, they will only accept potty-trained children. Which response from the nurse will best address this situation in answering the mother's questions of how best to potty train her son?
"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." maturation of anal spinchter seldom takes place before 18-24 months
A 15-year-old client tells the nurse he has been having wet dreams and is ashamed and afraid he will get into trouble because he believes his parents think he is too young to understand or know about sex. To which statement would be the most appropriate for the nurse to respond?
"Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen."
A mother of a toddler asks the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate?
"You'll probably notice that your daughter is uncomfortable in wet diapers."
warning signs of problems with sensory development
- infant does not respond to loud noises - child does not focus on a near object - infant does not babble until 4 m - infant does not turn to locate sound at 4m - crosses eyes most of the time at 6m
walking
12-15m
The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit?
24 pounds (10.8 kg) and 30 inches (75 cm) 1 year= tripled birth weight, grown 10-12 inches
blood pressure monitoring begins as part of assessment at
3 years
transition to sleep schedule
4 months shouldn't keep child up until they fall asleep-- regular scheduled bedtime
apical pulse of a 4 year old
4th intercostal space midclavicular line
bowel sounds
5-10 per minute
strabismus should be noted after
6 months
normal HR for preschool aged children
65-110 bpm
Adolescent
Ch.7
Parents bring a toddler age 19 months to the clinic for a regular checkup. When palpating the toddler's fontanels (fontanelles), what should the nurse expect to find?
Closed anterior and posterior fontanels by 18 m anterior and posterior fontanels should be closed anterior: 9-18 m posterior: 2-3 m
Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching?
Reasoned with the child to stop the behavior The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place.
The school nurse is performing a vision screening for a 7-year-old child. Which finding should trigger a referral?
Slight misalignment of the eyes misalignment of eyes (Strabismus)-- interferes with vision and eye development
The nurse is taking vital signs on a 6-month-old infant. The caregiver reports that over the past 12 hours, the infant has had vomiting, diarrhea, and has been pulling on the ears. Which method(s) would be appropriate for taking this infant's temperature?
Temporal Axillary
The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely?
The child has a leaner body mass than a girl at this age.
A parent tells the nurse that no matter what is asked of the toddler, the toddler says, "No." What suggestion might the nurse make to help the parent handle this situation?
give the toddler secondary, not primary, choices
respiration rate for a 1-month old
The respirations of a 1-month-old infant are normally irregular and periodically pause.
The nurse is assessing speech development in the 2-year-old whose family uses both Spanish and English in the home. What finding is of concern?
The toddler speaks 15 words between the two languages. 20m should use 20 words
apical pulse on an infant
between sternum and left nipple
When assessing an infant's chest the nurse notes the chest is enlarged on one side. What information is most important to obtain from the family about this finding?
diaphragmatic hernia- intestine herniated into the chest cavity enlarged chest on one side
foamy or foul smelling odors
digestive problems or illness
The nurse is assigned to care for a 15-month-old toddler. When developing a care plan addressing the nutritional needs of the toddler, which client goal(s) demonstrate the nurse's understanding of these needs? Select all that apply.
drink from a cup stop drinking from a bottle while in bed in next 2 w drink suggested amount of milk and other fluids bottle feeding promotes dental carries at this age infants breast feed for at least 12 m
What physiological changes would the nurse expect to address in a 10-year-old child? Select all that apply.
eruption of permanent teeth pulse rate between 70 to 80 20/20 vision eye globe= done by 10 years eruption of permanent teeth= correlate with final head growth IgG and IgA reach adult levels LV enlarges --> bp down
The nurse plans an activity for a chronically ill hospitalized child. Which activity is the bestchoice to provide stimulation for the child?
painting a picture When providing stimulation for the chronically ill school-age child, the nurse should encourage activities that end in a product.
The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex:
should have disappeared. primitive not protective reflex
Where is the point of maximal impulse (PMI) found in a 5-year-old child?
the fourth intercostal space most intense cardiac pulsation up until the age of 4: 3-4 intercostal spafe 4-6: 4th ICS medial to left midclavicular line 7+: 5th ICS to the left midclavicular line
nurse will measure head circumference
until 1 to 2 years of age
child converts to adult dosing
w/ reaches 110 lbs (50 kg)
BMI
weight in pounds x 703/ height in inches ^2
