Promotions Exam 3
A rubella vaccination is ordered for a client. Which statement made by the client is cause for concern?
" I have been trying to conceive a baby for a few months."
What happens during the Obedience/Punishment stage?
(Infancy) they don't really understand right from wrong, they don't understand cause and effect
What happens during the Self-Interest stage?
(Pre-school) interested in rewards (stickers), more worried about themselves than everybody else
What happens during Conformity and Interpersonal Accord stage?
(School Age) good girl, good boy, want to be approved of by friends and adults
What happens during Authority and Social Order stage?
(School Age) want to fit in, need to learn how to listen, follow certain rules
What age is a child when they are in the sensorimotor stage of Piaget's Cognitive Developement?
0-2 years old
How long do you count respirations for on an infant? Why?
1 full minute. respirations are irregular
What age does the formal operational stage of Piaget's Cognitive Development Stages take place?
11+ years old
What is the normal heart rate for a newborn?
120-160 bpm
When does a newborn go back to their birth weight after their initial weight loss?
2 weeks
What age does the preoperational stage of Piaget's Cognitive Development Stages take place?
2-7 years
What percentage of their body is the baby's head?
25%
What is the normal respiratory rate for newborns?
30-60 breaths per minute
What percentage of weight loss is normal for a baby in the first 24 hours?
5-10%
A nurse is planning care for a group of hospitalized children. Which age group does the nurse anticipate will have the most problem with separation anxiety?
6 to 18 months
What age does the concrete operational stage of Piaget's Cognitive Development Stages take place?
7-11 years old
When does object permanence develop?
9-18 months
A nurse is caring for a hospitalized school-aged child. What development-related activity is most important for the nurse to encourage?
Academic studies
The mother of an 18-month-old toddler tells the nurse in the pediatric clinic that her child is "unmanageable and into everything." What is the most important teaching to include during this clinic visit?
Accidents are the leading cause of death and injury in this age group.
The parents of a 2-year-old child who is being admitted to the hospital tell the nurse that their child is accustomed to sleeping with a favorite blanket. What should the nurse do, knowing that the blanket is worn and dirty?
Allow the parents to give it to their child
A 3-year-old child's parents have been unable to visit since the child was admitted to the hospital. The toddler has become quiet and withdrawn. To best help the child at this time, what should the nurse do?
Assign the same nurse to care for this child whenever possible
During a nap, a 3-year-old hospitalized child wets the bed. What is the best response by the nurse?
Change the child's clothes without discussing the incident.
A nurse is observing hospitalized toddlers in the playroom. What does the nurse identify as their most important need?
Contact with their parents (separation anxiety)
The nurse walking into the room of a mom that is post partum day 2 and you overhear the family saying how the baby is already cooing. what is the appropriate action for the nurse to do next?
Do respiratory assessment on the baby, newborns do not coo, these noises are a sign of respiratory distress
According to Piaget during which developmental state is the pediatric client egocentric?
Early childhood
A college student visits the health center and describes anxiety about having to declare an academic major. What developmental conflict, according to Erikson, is this client still attempting to resolve?
Identity versus role confusion
A nurse is assessing a 4-year-old child. In what stage of Erikson's psychosocial development does the nurse expect the child to be in the process of achieving?
Initiative
A nurse plans care of 4-year-old hospitalized children on the basis of their developmental level. What is the major vulnerability of children this age?
Intrusive procedures (fear of bodily harm)
While in the playroom of a pediatric unit the nurse sees several toddlers seated at a table trying to copy the same picture from a book. They are not talking to each other or sharing their crayons. What does the nurse conclude about this behavioral interaction?
It is a typical expression of toddlers' social development. (parallel play is normal)
During your assessment of a newborn, you notice that not only are there hands and feet blue (acrocyanosis) but the chest is also blue. Is this normal for a newborn within the first 24 hours after birth?
No, the chest should NEVER be blue. it is extremely concerning and a code should be called
What are the stages of Kohlberg's Theory from infancy to teens?
Obedience/Punishment, Self-interest, Conformity & Interpersonal Accord, Authority & Social Order, Social Contract
Which reactions does a nurse expect of a 4-year-old child in response to illness and hospitalization?
Out-of-control behavior, regression to overdependency, and fear of bodily mutilation
What nursing intervention best meets the developmental needs of hospitalized preschool-age children?
Providing materials for simulating activities
What are the stages of Piaget's Cognitive Development from youngest age to oldest?
Sensorimotor (0-2 years old), preoperational stage (2-7 years old), concrete operational (7-11 years old), formal operational stage (11+ years old)
What are retractions?
Skin pulling between and around the ribs during inhalation.
A nurse is trying to involve a hospitalized preschooler in therapeutic play. Why is this so important?
The child can work out ways of coping with fears.
A worried mother reports that her teenage child wears unusual clothes and make-up and refuses to wear the clothes the mother buys. What does the nurse suspect as the cause for this behavior?
The child is displaying group identity to develop a personal identity.
According to Erikson's theory, what psychosocial developmental changes are observed in middle childhood?
The child is engaged in tasks and activities, the child can differentiate between industry and inferiority
How does the nurse apply the identity versus role confusion stage in the care delivery of an adolescent ?
The nurse helps hospitalized adolescents in decision-making about their treatment plan during the identity versus role confusion stage of Erikson's theory. The nurse provides education and anticipatory guidance for the parent about the changes and challenges to the adolescent.
What do Piaget's stages mean?
The stage the child is in determines how they see the world. Piaget believed that all students pass through the stages in order and cannot skip any stage.
What is Kohlberg's theory?
Theory of Moral Development
After a prolonged period in a regional hospital far from home to which the parents were unable to travel, an 18-month-old toddler becomes depressed, withdrawn, and apathetic. Eventually the toddler begins playing with toys and relating to others, even strangers. When the parents visit, the child ignores them. The parents tell the nurse that their child has forgotten them. How does the nurse explain the child's behavior?
This signifies typical behavior in toddlers who are separated from their parents for prolonged periods and that their child will need special attention from them.
When is autonomy vs shame and doubt?
Toddler age
What are Erickson's stages from infant to adolescent?
Trust vs Mistrust, Autonomy vs Shame & Doubt, Initiative vs Guilt, Industry vs Inferiority, Identity vs Role Confusion
A school nurse is teaching the parents of school-aged children about the importance of immunizations for the childhood communicable diseases. What preventable disease may have the complication of encephalitis?
Varicella
What is the normal blood pressure of a newborn?
Varies with age, weight, activity. Average systolic 65-95 mmHg. Average diastolic 30-60 mm Hg.
What is development defined as?
a continuous, orderly series of conditions that leads to activities, new motives for activities, and patterns of behavior
At what time should a baby have tripled their birth weight?
at 1 year
At what time should a baby have doubled their birth weight?
at 6 months
What happens during trust vs mistrust?
attachment & bonding happens
When is a child's rapid growth period?
birth-2 years
What is circumaural cyanosis?
bluish circle around mouth
How do you check to make circumaural cyanosis isn't just bruising?
by opening mouth and checking the mucous membranes, if they're pale then it is circumaural cyanosis
What does the change in the pressure of the heart cause to happen to the baby?
causes closure of ductus arteriosus, foramen ovale, ductus venosus
What is a sign for physical readiness for toilet training?
child removes own clothing
What is the sensorimotor stage?
children learn from what they do. learning if they throw a ball, it will bounce
When a newborn is sleeping, what may happen to the heart rate?
could go down to 80
When a newborn is crying, what may happen to the heart rate?
could go up to 180
What is acrocyanosis?
cyanosis of hands and feet
What does the ductus venosus do?
diverts blood from liver. constricts/closes within 1-3 hours after birth and then baby will utilize liver after birth
What does the foramen ovale do (located in the heart)?
diverts blood from lungs minutes after birth
What does the ductus arteriosus do (located in heart)?
diverts blood from pulmonary artery to aorta
When is initiative vs guilt?
early school age
In Erikson's stage III (initiative vs guilt), the behavior typical of children would be?
exploring physical and social behavior
When is acrocyanosis normal?
for first 24 hours after birth
When the baby is in utero, where is it getting its oxygenation from?
from mom through umbilical cord and placenta
What is the thermal stimulation for the baby to start breathing when it is born?
going from warm temperature controlled womb to the cold outside of the womb
When is industry vs inferiority?
grade-schooler
What are the areas that are assessed when looking at development of a child?
gross motor skills, fine motor skills, social, language
When walking past a newborn baby, you notice that the baby is shaking. Why would the baby be shaking?
hypoglycemia
A baby that you are assessing was born just a few hours ago and when you listen to the heart you hear a patent ductus arteriosus murmur. When would this be concerning to the nurse?
if the baby was symptomatic
If a newborn has a short period of apnea (which is normal), when does it become a concern to the nurse?
if the period of apnea lasts longer than 20 seconds
What is growth defined as?
increase in physical size of whole/parts or an increase in number/size of cells. CAN BE MEASURED
What are examples of "growth" in children?
increase in size, increase in height, increase in weight
When is trust vs. mistrust?
infant-first year of life
What happens during identity vs role confusion?
loyalty, friendships, want to fit in, learning who they are
What is the mechanical stimulation for the baby to start breathing on its own?
mechanical stimulation is the compression as the baby is coming out, especially if vaginal birth
What is the formal operational stage?
middle school/ high school age, hypothesis, science, think things through, looking at what they think about careers
What are the respiratory signs of distress in an infant?
nasal flaring, grunting, increase in respiratory rate, retractions, diminished breath sounds, apnea >20 seconds
Where should we listen for apical heart rate?
near apex (by nipple)
What happens during autonomy vs shame & doubt?
need to learn how to do thing sand not be made to feel ashamed aboutout them. (potty training & self-maintenance)
What is the sensory stimuli for the baby to start respirations?
noise, light, pain, basically everything that happens when they are born (ex: like when someone scares you)
What is the most common heart murmur in newborns? What causes it?
patent ductus arteriosus (PDA) caused by the ductus arteriosus not closing all the way
What is the preoperational stage?
preschool aged kids. learning language, able to talk, use symbols, egocentric, everyone thinks the way that they think, learning to count, learn about past and present
After a baby is born, there is a pressure change in what side of the heart?
pressure rises in the left side of the heart with first breath
What pulses are you unable to check on a newborn because they are too difficult to feel?
radial and pedal
From birth to 2 years old how would you describe the pace of growth?
rapid
What affect does crying have on respiratory rate?
respiratory rate will increase
What is the concrete operational stage?
school age kids, can see different point of view (their friends think differently than them), logical though (understand that a pound of feathers is the same as a pound of metal)
What are the types of anxiety that are normal for children?
separation anxiety, fear of darkness, fear of bodily harm
When assessing femoral pulse on a new born, what would you expect to find?
should be equal bilaterally
What happens during initiative vs guilt?
teaching them how to do things, be successful, make friends
When is identity vs Role Confusion?
teenager
Does a baby normally breathe through its mouth or nose?
they are obligatory nose breathers
What happens during industry vs inferiority?
they learn about networking, fitting in, making friends
What do Erickson's stages relate to?
they look at the different psychosocial development that children go through
Which developmental stage is considered the pre-conventional level according to Kohlberg's theory?
toddler and preschool aged children
What happens during Social Contract stage?
want to do things that will benefit them and others, learning morally right and legally right are not always the same thing
How does inflation happen when the baby is starting to breathe on its own outside of the uterus?
when baby takes first breath in, alveoli are inflated and all the fluid is pushed out
What is the chemical stimulation for the baby to start breathing on its own?
when there is an increase in PCO2 at birth, and it decreases the O2, that signals the brain to stimulate respirations
