Final Exam

Question 1

Erikson stage for toddlers

Answer 1

Autonomy vs shame and doubt

Achieves autonomy and self control
Separates from parent/caregiver
Withstands delayed gratification
Negativism abounds

Question 2

Erikson stage for infants

Answer 2

Trust vs Mistrust

Question 3

Piaget stage for toddlers

Answer 3

Sensorimotor

Differentiates self from objects
Increased object permanence
Uses all senses to explore environment
Places items in and out of containers
Imitates domestic chores
Imitation is more symbolic

Question 4

Erikson stage for preschool

Answer 4

Initiative vs guilt
Age: 3-6

Likes to please parents
Begins to plan activities, make up games
Initiates activities with others
Enjoys sports, shopping, cooking, working
Negotiates soln to conflicts

Question 5

Piaget stage for pre-school

Answer 5

Preoperational stage
Age: 2-7

Question 6

Erikson stage for school-aged

Answer 6

Industry vs inferiority

Interested in how things are made and run
Success in personal and social tasks
Increased activities outside home
Increased interaction with peers
Needs support and encouragement from important people in child’s life
Inferiority occurs with repeated failures with little support or trust from those who are important to the child

Question 7

Piaget stage for school-aged

Answer 7

Concrete operational

Learns by manipulated concrete objects
Lacks ability to think abstractly
Learns that certain characteristics of objects remain constant
Understands concepts of time
Starts collections of items

Question 8

Kohlberg stage for school-aged

Answer 8

Conventional
Age 7-10: interpersonal conforming, “good child, bad child”
Age 10-12: “law and order”

An act is wrong bc it brings punishment
Beh is completely right or wrong
Does not understand the reason behind rules
If child and adult differ in opinions, the adult is right
Can put self in another person’s position
Begins to exercise the “golden rule”

Question 9

Erikson stage for adolescents

Answer 9

Identity vs role confusion

Focuses on bodily changes
Experiences frequent mood changes
Importance places on conformity to peer norms and peer acceptance
Strives to master skills within peer groups
Defining boundaries with parents and authority figures

Question 10

Piaget stage for adolescent

Answer 10

Formal operational stage

Egocentrical thinking

Question 11

Kohlberg stage for adolescent

Answer 11

Postconventional

Question 12

What are live virus vaccines

Answer 12

Attenuated (weakened) form of the virus
Closest thing to a natural infection
Ex. MMR, varicella

Question 13

What are killed virus vaccines

Answer 13

Use organisms that have been killed but can still elicit an immune response
Ex. Inactivated polio

Question 14

What are toxoid vaccines

Answer 14

Use the actual toxin for the vaccine instead of the organism itself to begin the antibody process
Ex. Tetanus

Question 15

What are recombinant vaccines

Answer 15

Use genetic altered form of the microbe instead of the whole organism
Ex. Hepatitis B

Question 16

What are conjugate vaccines

Answer 16

These are made by combining a weak antigen (typically polysaccharides) with a strong antigen (typically proteins) to illicit the immune response
Ex. Prevnar, Hib

Question 17

Nursing management of vaccines

Answer 17

Must obtain parental consent this includes providing parents with information on the vaccines being given
Know patient’s medical hx. Do they have any chronic illnesses that would prevent a certain type of vaccine?
Has child had a previous serious rxn?
Previous vaccination record for the child
Document appropriately
Report any adverse events

Question 18

Vaccine contraindications

Answer 18

Any hx of severe allergic rxn (anaphylaxis) to prior vaccine dose
Severe immunodeficiency patients should not receive live vaccinations
Egg allergy is no longer a strict contraindication for the MMR
There are protocols for egg allergic pts and the flu vaccine. This has made it possible for the majority of egg allergy pts to tolerate the flu vaccine

Question 19

Vaccine nursing considerations

Answer 19

Mild fever or mild illness such as a cold are not contraindications to receiving immunizations
Redness, swelling, and pain at the site of injection along with mild fever after immunization is normal
Some vaccinations can cause other “normal” rxns
Prophylactic Tylenol is NO longer recommended
Injectable live virus vaccines MUST be given SQ
Inactive virus vaccines are typically given IM but can be given SQ in some instances

Question 20

Asthma triggers

Answer 20

Infection (viruses)
Irritants
GERD
Allergies
Cold Exercise

Question 21

Asthma obstructive mechanisms

Answer 21

Inflammatory response
Mucus production
Bronchial muscle contraction in response to foreign stimuli

Question 22

Asthma symptoms

Answer 22

Classic signs: dyspnea, wheezing, cough
Cough –> cough with mild wheeze –> worsening wheeze with mild difficulty with breathing- particularly with exertion –> difficulty with breathing with severe wheeze at rest

Question 23

What is status asthmaticus

Answer 23

Unrelenting, respiratory distress with bronchospasms unresponsive to tx measures

Question 24

Asthma diagnosis

Answer 24

Based on hx of recurrent problems
Pulmonary function tests (PFTs)
Can do methacholine challenge if unsure of dx
Peak expiratory flow rate (PEFR)

Question 25

Asthma assessment

Answer 25

Tripod position
Use of accessory muscles
Speak in short, panting phrases
Breath sounds are coarse- often with decreased airflow
Inspiratory/expiratory wheezing

Question 26

Asthma severity classification

Answer 26

Tx & education based on severity classification:
intermittent
mild persistent
mod persistent
severe persistent

Question 27

Chronic asthma management

Answer 27

B-agonist prn (albuterol or xopenex)
Trigger avoidance

Question 28

Asthma controller medications

Answer 28

Inhaled corticosteroids
Long-acting bronchodilators
Leukotriene modifiers- singulair/montelukast
Oral prednisone -long term is rare
Allergy shots- desensitization to allergens if allergies play a major role

Question 29

Patho of bronchiolitis/RSV

Answer 29

Virus invades mucosal cells
Cells die: debris
Irritation leads to increased mucus & bronchospasm
Air trapping

Question 30

S/S of bronchiolitis

Answer 30

Infant <1 yr
Recent upper respiratory infection exposure
Gradual onset of respiratory distress
Crackles throughout
Expiratory wheezing
Extreme tachypnea (60-100)
Cyanosis
Typically worsen for 5 days

Question 31

Bronchiolitis treatment/management

Answer 31

Viruses won’t respond to antibiotics, respiratory treatments, or steroids
Suction, position, avoid over stressing
Humidified oxygen
Monitor cardiac apnea
IV fluids (NPO) if poor intake or tachypnea

Question 32

Physical abuse signs

Answer 32

Bruises on uncommonly injured surfaces
Hand shape marks & bruising
Bite marks
Rope, belt, or cord marks, usually seen on the mouth, buttocks, legs, back & arms
Multiple bruises or fractures in various stages of healing

Question 33

Submersion burns

Answer 33

Physical abuse sign
Scald burns with clear lines of demarcation (glove or stocking distribution)

Question 34

Shaken baby syndrome S/S

Answer 34

Difficulty breathing or apnea
Cyanosis
Irritability
Seizures
Vomiting
Inability to make sounds
Extreme sleepiness or unable to arouse

Question 35

Moxibustion

Answer 35

involves the burning of mugwort, a small spongy herb, to facilitate healing

Question 36

Coining

Answer 36

Alternative treatment for minor illnesses-involves rubbing heated oil on the skin and then rubbing a coin over the area in a linear fashion until a red mark is seen

Question 37

Cupping

Answer 37

Alternative therapy in which heated glass cups are applied to the skin along the meridians of the boy, creating suction as a way of stimulating the flow of energy

Question 38

Nursing documentation for physical abuse

Answer 38

describe what you see
measure and record bruises
document parent demeanor
photographs
document who and when report is made