Additional Quiz Questions Flashcards
Be the best!
Define consent
An informed decision to accept treatment or to participate in research
How old must a child be to give assent to participate in a research study?
7 years old
Assent is a chid’s agreement to participate and is an adjunct to parental/legal guardian consent, not a replacement.
What dictates a nurse’s “scope of practice” which is essentially what a nurse can and cannot do as a nurse in the state which he/she is license to practice?
The State Nurse PRactice Act in each state defines the scope of practice, which is what the nurse can and cannot do as a licensed RN in that state.
What are the exceptions to nurse-patient confidentiality as outlined by HIPAA?
If the patient is a danger to himself, to others, or is being abused.
What are some basic principles of assuring patient confidentiality?
Protect patient information in public settings (elevators, hallways, etc).
Protect passwords, codes, laptops that allow access to electronic medical records.
Only access patient records for information is needed for patient care.
True or False: Assessments can be delegated to nursing assistive personnel (NAP)/unlicensed assistive personnel (UAP). Examples of NAP/UAP roles are nursing students and nursing assistants.
Assessments can never be delegated to a NAP/UAP.
List a major principle of delegation of care to a NAP/UAP.
Delegation involves the transfer of responsibility for the task but not for the ultimate outcome.
What is Shared Governance?
An administrative model that provides an active role for all nurses in decision-making and policy information.
What is research?
A scientific process to produce new knowledge driven by a research question.
A simple way to think about a research question is that it is a question without an answer in the literature.
What is the nurse’s role in research?
To identify clinical questions for study and to collect data.
What is evidence-based practice?
To identify clinical questions for study and to collect data.
What is evidence-based practice?
It is a rigorous process whereby research findings are applied to practice through the development of standards and policies that guide care.
A simple way to think about an evidence-based practice question is that it is a question with an answer found in the research literature.
What is quality improvement?
A process for continually evaluating care to assure that it is effective and aligned to best practice and existing standards of practice. It involves ongoing data collection about patient care and modifying patient care processes.
What are principles of fall prevention?
- Perform a falls risk assessment on all patients using a falls-prevention tool (e.g. Humpty Dumpty Falls Scale, GRAF-PIF).
- Provide and communicate a fall prevention plan for at-risk children.
What is the ethical principle of beneficence?
Actions taken to promote good.
What is the ethical principle of non-maleficence?
Do no harm
What is the ethical principle of justice?
Treating all people equally
What is an example of how the nurse serves as an advocate?
Defending, speaking for, and safeguarding the chid and family to the interdisciplinary team
What is an example of how the Individuals with Disabilities Education Act (IDEA) would be applied in the school setting?
The child with Down Syndrome is educated in a regular classroom with peers that are the same age and healthy. Their additional needs for special education would be guided by an Individualized Education Plan (IEP).
Describe three (3) primary ways in which growth and development progress:
Cephalocaudally - from head to toe
Proximodistally - from the trunk to the tips of the extremities
From general to specific (e.g. crawling, then walking, then running)
What is the pattern of growth by developmental category?
- Infancy (0-12 mos.) - rapid growth; head grows fastest
- Toddler and Preschooler (1-5 yrs.) - slow growth; trunk grows fastest
- School Age (6-12 yrs.) - slow growth; limbs grow fastest
- Adolescent (13-18 yrs.) - rapid growth for trunk and gonads
What is the key principle for Erikson’s psychosocial stage of infancy?
Trust
What is the key principle for Erikson’s psychosocial stage for the toddler?
Autonomy
What is the key principle for Erikson’s psychosocial stage of the preschooler?
Initiative
What is the key principle for Erikson’s psychosocial stage of the school age child?
Industry / Achievement
What is the key principle for Erikson’s psychosocial stage of the adolescent?
Identity
What are some principles of family-centered care?
- 24-access to the hospitalized child
- Sleep accommodations for parent at bedside
- Promote parental presence during procedures and CPR
- Include parents in interdisciplinary rounds
What is the purpose of the body mass index (BMI) for age?
To access for oerweight and underweight beginning as early as 2 years of age through adulthood.
What are the BMI ranges for obesity?
Overweight = 85% - 95%
BMI 25 - 29.9
What are the BMI ranges for underweight?
Underweight = < 5%
BMI <18.5
What is the average length for a newborn in inches?
Newborn = 20 inches (average)
What is the average linear growth rate in the 1st year in inches?
10 inches
What is the average linear growth rate in the 2nd year?
5 inches
What is the average linear growth rate yearly from 2 years until puberty?
2.5 inches
What is the relationship of birth length to length at 4 years?
Birth length doubles at 4 years of age. The average birth length is 20 inches. And the average length at 4 years is 40 inches.
What is the appropriate pain scale for a child from birth to 3 years?
FLACC
What is the appropriate pain scale for a child from 4-8 years?
Faces Scale/Wong
What is the appropriate pain scale for a child > 8 years?
Numeric scale, visual analogue scale
What is chronological age?
Years or months since birth.
What is mental age?
Level of cognitive function
What is bone age?
hands and wrists x-rayed to determine degree of ossification
What is adjusted/corrected age?
Chronologic age minus # of weeks born prematurely
At what age does the posterior fontanel close?
2 months
At what age does the child turn to a rattling noise and tract objects with the eyes 180 degrees?
3 months
At what age does the instinctual smile emerge?
2 months
At what age does the social smile emerge?
3 months
At what age does the infant laugh?
4 months
At what age does stranger anxiety emerge?
4-6 months
At what age does the child play peak-a-boo?
7-9 months
How many words does the child say at 1 year?
5 words
How many words does the child say at 18 months?
50 words
How many words does the child say at 2 years?
400 words
When do infants roll from front to back?
4 months
When do infants roll from back to front?
6 months
When does na infant sit with support?
5-6 months
When does an infant sit without supprt?
8 months
When does pincer grasp emerge?
9 months
When does an infant clap and wave bye-bye?
10-12 months
What is the range for walking?
12-15 months
What are principles of a safe infant sleep environment?
Back to sleep
Tight fitted crib mattress
Nothing inside crib
Sharing bedroom with parent
Use of pacifier up to 6 months
When does anterior fontanel close?
15-18 months
What are the milestones of toilet training?
18-24 months - readiness
2-3 years - daytime dryness
3-5 years - nighttime dryness
When do teeth emerge?
6 months = 1st deciduous tooth
6-7 years = 1st adult tooth
6-12 years = 4 teeth are lost and replaced each year
When does a child climb stairs?
21 months
When does a child run and jump?
24 months
When does the child begin to share, take turns, and follow rules?
Between 3-5 years
At what age does a child ride a tricycle?
3 years
At what age does a child begin to dress self?
3 years
At what age does a child dress self well?
5 years
At what age does a child build tower > 6 blocks?
3 years
At what age does a child throw a ball overhand?
4 years
What are the appropriate tests for visual acuity in children?
4-5 years = LEA Symbols or HOTV chart
> 6 year = Sloan letter chart
At what age does vision mature?
7 years
List signs of puberty in the female in order of appearance and their average age of onset.
breast development (10 years)
pubic hair (11 years)
height spurt (12 years)
menarche (13 years)
List signs of puberty in the male in order of appearance and their average age of onset.
testicular enlargement (11 years)
pubic hair (12 years)
height spurt (12-14 years)
What are the elements of correct suctioning of a pediatric tracheostomy?
- Suction machine set to 80-100 mmHg
- Instill catheter to premeasured length (not until resistance)
- Do not apply suction on insertion
- Apply intermittent suction and gently rotate catheter whil catheter is being removed
State the rationale for why normal saline is contraindicated for routine use during tracheotomy suctioning.
It is associated with decreased arterial oxygen saturation and leads to nosocomial pneumonia due to removing normal flora in the lung.
How is tonsillitis managed postoperatively?
- Side-lying positioning
- Ice collar
- Analgesics
- Clear cool fluids
- Monitor for signs of hemorrhage
List signs of hemorrhage after a tonsillectomy that warrant nurse surveillance and intervention as well as parent education.
Frequently swallowing; pallor; restlessness; vomiting bright red blood
*Vomiting coffee ground, dark red, or dark brown blood is common and not concerning.
Describe the technique for instilling ear drops in the child up to 3 years of age and the child over 3 years of age.
< 3 years = pull ear down and back
> 3 years = pull ear up and back
Why is otitis media common in infants?
They have shorter, wider, less angled eustachian tubes.
List prevention strategies for otitis media.
- Feed infants upright
- Give pneumococcal vaccine
- Avoid passive smoke
- Discontinue pacifier > 6 months
What are the manifestations of otitis media?
- Bulging, red tympanic membranes
- Pain
- Fever
- Upper respiratory infection
- Rubbing the ear
List the prevention strategy for epiglottitis.
Routine childhood immunizaitons including the Hib vaccine to protect against Haemophilus Influenzae
What are the symptoms of epiglottitis?
- Keep the child calm on parent’s lap
- Prepare tracheotomy and intubation equipment
- Deer inspecting the throat as it can lead to airway closure
- Administer antibiotics as ordered
List the symptoms of laryngotracheobronchitis/croup
- “seal like” barky cough
- Inspiratory stridor
- Respiratory distress
*Is a virally-induced inflammation of the large airway (larynx)
List the treatment for laryngotracheobronchitis/croup
mild cases = oral steroids
moderate - severe cases = inhaled racemic epinephrine
List the side effects of inhaled racemic epinephrine.
Agitation, anxiety, restlessness, headache, dizziness, sleeplessness, tremors
What is the most common cause of bronchiolitis?
Respiratory syncytial virus (RSV)
What is the mode of transmission for RSV?
Spread via contact with secretions; also spreads up to 3 feet via coughing.
*Prevented in high risk infants by monthly doses of RSV-IVIF or Respigam
What is the nursing management of bronchiolitis?
Management is focused on support of systems.
1. Elevate head of bed.
2. Nasal aspiration as needed.
3. Oxygen if pulse-ox < 90%
4. Small, frequent feedings
5. Chest physiotherapy
*The use of albuterol and racemic epinephrine is not evidence based.
What are components of the pathophysiology of asthma?
- Bronchoconstriction
- Chronic inflammation
- Increased mucous production
*Above leads to airway obstruction and air trapping.
What are the clinical manifestations of asthma?
- Cough (often 1st sign)
- Chest tightness
- SOB
- Wheezing
- Respiratory distress
What is the management of asthma?
- Individual Asthma Management Plan
- Monitor peak flow meter
- Avoid triggers
- Medicaitons: long-term controller (e.g., Montelukast (Singulair); bronchodilator (albuterol)) during an acute attack.
What is the rationale for a metered dose inhaler (MDI) with an attached spacer and how are they used and cared for?
An MDI is used with a spacer attached so that the MDI medication is puffed into the spacer and then inhaled. This increases delivery of medication to the lung.
*The spacer should be cleaned and dried regularly to avoid contamination.
What are side effects of asthma medications and how are they managed?
Bronchodilators: increased HR, sleeplessness, tremors, nervousness, headache, vomiting
Controller medications: thrush, sore throat, dry mouth, hoarseness
*To prevent thrush, rinse mouth or brush teeth after taking medicaiton
What are the risk factors for bronchopulmonary dysplasia (BPD)?
Gestational age >30 weeks
Neonatal mechanical ventilation
High inhaled oxygen concentrations
What are the greatest threats for foreign body aspiration?
Dried beans
Peanuts
What is a neonatal symptoms of cystic fibrosis?
Failure to pass meconium in the first 72 hours of life.
What are symptoms of cystic fibrosis?
- Steatorrhea (stool fat)
- Frequent respiratory infections
- Failure to thrive
- Wet, chronic cough
- Wheezing respiration
- Barrel chest
How are secretions cleared in cystic fibrosis?
Mechanical clearance of secretions (ThAIRapy best, cough and deep breathing, chest physiotherapy, flutter mucous clearance device)
Medication clearance of secretions using aerosolized Pulmonzyme (recombinant human deoxyribonuclease)
What are the principles of nutrition management for the patient with cystic fibrosis?
- Administer pancreatic enzymes with meals and snacks (suspend in teaspoon of applesauce)
- High-calorie, high-protein diet
- Give vitamins A, D, E, K (fat soluble)
What are basic principles of infection management and control for the child with cystic fibrosis?
Treat infection promptly and aggressively because bacteria leads to progressive lung disease; Do not promote socialization among children with CF due to the risk of cepacian (special type of bacteria)
What is MOST likely a complication of hypernatremia?
Seizure activity and other neurological disorders; cerebral edema, decrease level of consciousness, hyperreflexia, and hyper-irritability.
Common with hypertonic dehydration. Seen in infants with diarrhea getting large quantities of fluids high in sodium. Children with NG tube feedings high in protein are also at risk due to the excessive solute load on the kidneys.
Clinical manifestations of pain
Tight facial muscles, irregular breathing, and rigid posture
Clinical manifestations of opioid withdrawal
- Sympathetic nervous system: nasal stuffiness, tachypnea, diaphoresis, chills, fever, and mottled skin
- Neuro system: tremors, seizures, irritability, insomnia
- GI system: vomiting, diarrhea, poor feeding, nausea
*These symptoms occur 24 hours after abrupt opioid discontinuation.
What are basic principles of infection management and control for the child with cystic fibrosis?
Treat infection promptly and aggressively because bacteria leads to progressive lung disease; Do not promote socialization among children with CF due to the risk of cepacian.
What are the signs and symptoms of mild and severe carbon monoxide poisoning?
Mild: headache, vertigo, nausea, fatigue
Severe: confusion, seizures, loss of consciousness
How is carbon monoxide poisoning managed?
Move to fresh air/outside
Provide 100% oxygen
How is carbon monoxide poisoning prevented?
Carbon monoxide detectors
Vent gas appliances
Service gas appliance
Never run vehicle in closed garage
What is the normal range for the pH on an arterial blood gas?
pH 7.35 - 7.45
What is the normal range for HCO3 on an arterial blood gas?
HCO3 (called Bicarb): 22-26
What is the normal range for CO2 on an arterial blood gas?
CO2: 35 - 45
Define pH range for acidosis
pH <7.35 = acidosis
Define the pH range for alkalosis
pH 7.45 = alkalosis
Analyze the following acid-base imbalance:
pH = 7.32
CO2 = 47
HCO3 = 25
Respiratory acidosis
The pH is low indicating acidosis.
The CO2 is high indicating a respiratory source.
The HCO3 is normal indicating it is not a metabolic source.
*This is typical in respiratory distress or arrest.
Analyze the following acid-base imbalance:
pH = 7.30
CO2 = 39
HCO3 = 18
Metabolic acidosis
The pH is low indicating acidosis.
The HCO3 is low indicating a metabolic source.
The CO2 is normal indicating it is not a respiratory source.
*This is typical in diarrhea.
What are complications of vomiting?
Dehydration
Metabolic acidosis
Aspiration