Peds - Exam Two

Question 1

How do you introduce solid foods to an infant?

Answer 1

 Solids are introduced around 4 to 6 months of age
 New foods should be introduced one at a time, over a 4 to 7 day period, to observe for signs of allergy or intolerance, which can include fussiness, rash, vomiting, diarrhea, and constipation
 Vegetables or fruits are started first between 6 to 8 months of age
 Citrus fruits, mean, and eggs are not started until after 6 months of age
 Breast milk intake should decrease with the increased intake of solid foods
 Table foods that are cooked, chopped, and unseasoned are appropriate by 9 months of age

Question 2

What are some interventions to reduce unintentional injury?

Answer 2

 Aspiration of foreign objects
o Small objects should be avoided
o Age-appropriate toys should be provided
o Clothing should be checked for safety hazards
 Bodily harm
o Sharp objects should be kept out of reach
o Anchor heavy objects and furniture
o Do not leave infants unattended with any animals present
 Burns
o Check bath water temperature
o Working smoke detectors should be kept in the home
o Handles of pots and pans should be kept turned to the back of the stove
o Use sunscreen when outside
o Cover electrical outlets
 Drowning
o Do not leave infants unattended in the bath or near any water sources
 Falls
o Keep crib mattresses in lowest position possible
o Restraints should be used in seats
o Place safety gates at the top and bottom of stairs
 Poisoning
o Exposure to lead paint should be avoided
o Toxins and plants should be kept out of reach
o Keep cabinets with cleaning supplies locked
o Know the number for poison control
o Keep medications in child proof containers
 Motor-vehicle injuries
o Use infant safe car seats
 Suffocation
o Plastic bags should be avoided
o Keep balloons away from infants or keep an eye on infant if there is one around
o Keep pillows out of the crib
o Place infants on their back for sleep

Question 3

What factors influence physiological response to medications?

Answer 3

 Elimination of drug may take longer d/t immature liver enzyme system
 Dosages are influenced by weight and height, differences in expected absorption, metabolism, and clearance
 The nurse must calculate every medication to determine the safety of the dose before the medication is administered

Question 4

What is implemented for airway obstruction?

Answer 4

 Emergency abdominal thrusts and back blows are recommended to dislodge food or foreign bodies from the airway
 Infant
o If object is visualized, it is removed trying not to push the object deeper into the throat
o If unsuccessful, infant is positioned prone with the head lower than the trunk, support head and neck, perform 5 forceful back blows, switch to have the infant on their back, deliver 5 thrust in the midsternal region

Question 5

What restraints are used for IV insertion?

Answer 5

 Mummy restraint is a short-term restraint that might be necessary for examination or treatments such as a venipuncture or placement of an NG tube
o Can be modified to expose an arm, leg, or chest as needed

Question 6

How do you teach a parent to give medication?

Answer 6

 Teach importance of administering the medication and completing the prescribed course of treatment
 The use of teaspoon in the home is not advised for infants or children.
o Better to use a dropper, syringe, or measured cup
 Do not mix the medication with formula, food, or water
 Shake medication before giving it
 Only scored tablets can be divided
 Medications should be able to come in liquid, suspension, or chewable tablets
 Do not chew ER tablets
 Do not dilute medication in water
 Never refer to medication as “candy”

Question 7

Where should you assess a pulse rate?

Answer 7

Brachial artery, located inside the upper arm between the elbow and shoulder

Question 8

What happens if you have an iron deficiency anemia left untreated?

Answer 8

 Progresses slowly
 In severe cases, the heart muscle becomes too weak to function. If this happens, heart failure follows
 Children with long standing anemia may also show growth retardation and cognitive changes
 Screening procedures are suggested at 9 and 24 months for full-term infants and earlier for low-birth-weight-infants

Question 9

What do you administer ferrous sulfate with for a pediatric patient?

Answer 9

Vitamin C aids in absorption so it is suggested to administer the medication with juice

Question 10

What foods are high in iron for infants?

Answer 10

Boiled egg yolk, liver, leafy green vegetables, Cream of Wheat, dried fruits, dry beans, crushed nuts, and whole-grain bread

Question 11

What teaching would you give parents of a child with cryptorchidism?

Answer 11

Parents are told to teach the growing child the importance of self-examination of the testes

Question 12

Why would a scrotum be enlarged unilaterally on a newborn?

Answer 12

 Could indicate the presence of a hydrocele – excessive amount of fluid in the sac that surround the testicle, and it causes he scrotum to swell

Question 13

What teaching would you give for a child with frequent UTI’s?

Answer 13

 Proper amounts of fluid to maintain sterility and flushing of the bladder
 Encourage proper self-cleaning (wiping front to back)
 Remind the child to void frequently

Question 14

What interventions would be appropriate for a child with impetigo?

Answer 14

 Systemic antibiotics
 Parents are instructed to wash the lesion 3-4 times a day
 Ointments may be used for topical application
 Prevention of the disease by treating small cuts promptly is important

Question 15

What assessment findings would you find for suspicion of Hirschsprungs?

Answer 15

 Newborns – failure to pass meconium in first 24 to 48 hours
 Infant – constipation, ribbon like stools, abdominal distention, anorexia, vomiting, and failure to thrive may be evident

Question 16

What interventions for feeding a child with pyloric stenosis?

Answer 16

 IV fluid to replenish fluid and electrolytes
 Thickened feedings may be prescribed by the physician
 The infant is burped before as well as during feedings to remove any gas accumulated in the stomach
 Feedings are done slowly
 The infant is placed on the right side after feedings to facilitate drainage into the intestines
 Fowler’s position is preferred to aid gravity in passing milk through the stomach

Question 17

What is the treatment of choice for intussusception?

Answer 17

 Barium enema, with surgery scheduled if reduction is not achieved
o Recurrence rate after barium enema reduction is approx. 10%

Question 18

What interventions are appropriate for GERD?

Answer 18

 Careful burping
 Avoid overfeeding
o Feedings can be thickened with cereal, which can help increase the caloric density
 Proper positioning
o After feeding, place in an upright position or propped on the left side
o The body is inclined about 30 – 40 degrees and the infant is held in place by a Fowler’s sling

Question 19

What assessment finding would show ineffectiveness of treatment for gastroenteritis?

Answer 19

 Bowel movements are not reduced by the interventions or medications given

Question 20

What is the best way for a parent to prevent BPD?

Answer 20

Prevention of preterm births is the best way to prevent BPD

Question 21

What is a preventative intervention for SIDS?

Answer 21

 Infants should be placed on a firm mattress with no loose bedding surrounding the infant
 The use of a pacifier may be protective
 High risk infants – home apnea monitors have been used to warn parents of an impending problem and enable them to try and resuscitate the infant manually
 Place child in a back-lying position

Question 22

How would you clear an airway of an infant with a cold?

Answer 22

 The nurse can teach the parent that instilling a few drops of saline solution into the nose and then suctioning with a bulb syringe is the best way to clear the nostrils.

Question 23

What interventions would be effective for a child with meningitis?

Answer 23

 Nursing responsibilities include performing frequent neurological checks and maintaining an accurate recording of the child’s vital signs and I&O
 Room should be dimly lit and noise kept to a minimum
 The nurse should carefully raise and lower the sides of the crib to avoid jarring the bed
 The nurse avoids startling the child and so uses a soft voice and gentle touch
 Frequent monitoring of the child’s vital signs is necessary
o A slow HR, irregular respirations, and increased BP may indicated an increased ICP

Question 24

Why are infants susceptible to ear infections?

Answer 24

 Their eustachian tubes are shorter, wider, and straighter

 When infants lie flat for long periods, microorganisms have easy access from the eustachian tube to the middle ear

Question 25

What immunizations should a 2 month receive?

Answer 25

	Hepatitis B
	Rotavirus
	DTaP
	Hib
	Pneumococcal conjugate (PCV13)
	IPV

Question 26

What are signs of feeding readiness in an infant?

Answer 26

 Interest in solid foods
 Voluntary control of the head and turn
 Disappearance of the extrusion reflex

Question 27

How can a parachute reflex be assessed?

Answer 27

 Thrusting the infant downward into the crib

o The infant will protectively extend the arms

Question 28

How can you promote sensorimotor stimulation in a 1 year old?

Answer 28

Push-pull toys

Activity boxes

Question 29

What is a pincer reflex?

Answer 29

The use of the index finger and thumb to grasp an object

Question 30

What are the deciduous teeth that first erupt?

Answer 30

Lower incisors

Question 31

What should a sippy cup be introduced?

Answer 31

Around 5-6 month

Question 32

What age can an infant sit alone?

Answer 32

8 months

Question 33

What age does the birth weight triple?

Answer 33

Doubles by 6 months

Triples by 1 year