Peds Kaplan Flashcards
the RN observes the child walk up and down steps. THe nurse notes the child has a steady gait and can use short sentences. The RN estimates the child’s age to be how many months?
Ans: 24 months
Goes up and odwn stairs alone, runs well w/ wide stance, builds tower of 6-7 blocks, has a vocab of about 300 words
the young child diagnosed with autism is admitted to the ped unit w/ a tracheotomy after swallowing a small toy. The unlicensed assistant personnel reports to the nurse that the child doesn’t maintain eye contact. Which response by the nurse is best?
Ans: “The inability to maintain eye contact is a characteristic of autism”
This response offers the staff member an explanation about the lack of eye contact. While in the hospital, parents should be encouraged to stay w/ child; decrease stimulation; physical contact may upset child with autism; establish trust
the nurse performs assessments in the well-baby clinic. The RN identifies which finding is a warning sign of cerebral palsy?
Ans: The infant has poor head control after 3 months.
-The earliest indication of CP is delayed gross motor development; signs include stiff or rigid arms or legs, arching back, floppy or limp body posture.
The parent brings the 6 month old baby to the clinic for a check up. The parent reports the baby had a check up at 2 months and received the first DTaP. Which action by the nurse is most appropriate?
Ans: Give the second DTaP.
-by the age of 6 months, the child should be ready for her 3rd immunization; when the schedule has been interrupted, it’s appropriate to simply continue w/ the schedule; she is due for her 2nd DTap vaccine
which implementation is the BEST way for the RN to maintain an adequate fluid intake for a toddler with nausea, diarrhea and vomiting?
Ans: Offer oral rehydration solutions (ORS) to rehydrate
ORS contain sodium, potassium, chloride, citrate, and glucose. Amt given depends on amt of dehydration & child’s weight; if child vomiting, give small amt at frequent intervals
the RN observes the 5 yo child playing w/ several other children about the same age. The RN identifies which play activity as the one in which the child would MOST LIKELY engage in?
Ans: Children at 5 yo are involved in imitative play; will play house, play doctor, or pretend to be engaged in the occupational roles of adults around them.
the RN performs a home care visit for the child diagnosed w/ cystic fibrosis. The RN should intervene if which finding is observed?
Ans: the child takes the pancreatic enzymes 1hr after eating
-enzymes should be taken at beginning of meal or with a snack or within 30 min of eating. Chewing or crushing beads destroys enteric coating
the 4 week old infant is brought to a HCP by the parent. The infant is vomiting and has abdominal distention. The infant is diagnosed as having pyloric stenosis and is admitted to the hospita. The RN should expect the infant’s emesis to have which of these qualities?
Ans: be projectile.
-infant w/ pyloric stenosis will present w/ projectile vomiting & abdominal distention; other symptoms include weight loss, constipation, dehydration, visible peristaltic waves. Pyloric stenosis has unknown etiology & usu develops during 1st 3 weeks post firth
which intervention shoud the RN recognize as most important to promote maximum mobility in infants?
Ans: provide a safe play are
-be aware of danger of aspirating foreign objects, poisoning, burns, and falls from infant seats, high chairs, walkers and swings.
The nurse knows DTaP vaccine protects against which diseases?
Ans: diphtheria, pertussis and tetanus
-Note: pertussis is not given to kids over age of 7
the nurse cares for the newborn diagnosed with developmental dysplasia of the hip (DDH). The nurse expects which method of Tx to be used for the newborn?
Ans: Pavlik harness.
-during the early newborn period, a harness is applied to hold the hips in wide abduction; if the Tx does not acheive the correction in a few months, then surgery is indicated and a postoperative spica hip bandage or body cast is applied. Harness should be worn full time for 3-6 months until hip is stable.
the nurse instructs the 10 yo pt about how to collect a 24 hour urine specimen at home using a clean, empty jar. The nurse should recommend that the client use which jar?
Ans: 48 ounce jar
-expected amt of urine output for a 10 yo child is ~1,200 ml; since 30ml=1ounce, 1,200ml=40ounces & a 48ounce jar is needed.
a brace is ordered for the adolescent to correct a scoliosis deformity. Which statement, if made by the parent to the nurse, indicates teaching is successful?
Ans: the brace should be worn 23 hours a day
-Should be worn 23 hrs per day; nurse should assess home environment for safety hazards; teach child how to prevent falls using handrails and avoiding slippery surfaces
to prevent parent-child disturbances, the nurse should complete which action?
Ans: Discuss w/ parents any problems or fears abt childrearing that they may have
-important that parents ecome active listeners, become actively involved in kid’s educations, & look at things from the kids’ point of view
The home care nurse visits the 3 yo child diagnosed at birth w/ phenylketonuria. The nurse assesses the child’s intake for the previous week. The nurse is MOST concerned if the child’s parent makes which statement?
Ans: my child’s favorite lunch is a peanut butter and jelly sandwich.
-PB not allowed on diet; can have a jelly sandwich made w/ low-protein bread
the nurse plans care for the infant diagnosed w/ a myelomeningocele. Which principle of nursing care is most important to apply when caring for this infant?
Ans: asepsis
-infection may cause meningitis and damage the brain; the CNS is very delicate; asepsis is extremely important
The woman delivers a healthy 8-lb, 2-oz infant. She mentions to th eRN that her baby’s “soft spot” seems very large. Which statement by the nurse is most appropriate?
Ans: the baby’s anterior “soft spot” will remain for approx 1-1.5yrs
-it takes the anterior fontanel 12 to 18 months to close. Posterior fontanel closes at 2 months
The home care nurse monitors the pediatric client diagnosed w/ a chronic seizure disorder. The nurse should intervene if which finding is observed?
Ans:The parent takes the child’s temperature using an oral electronic thermometer
-Seizures can occur w/o warning; it’s dangerous to have a thermometer in the mouth bc the child may start seizing
the 18 month old child drinks some drain cleaner and is brought to the ER. Which piece of equipment is most essential for the nurse to have on hand?
a. intubation tray
b. EKG machine
c. dialysis machine
d. gastric lavage tube
Ans: intubation tray
-intubation tray most essential piece of equipment for the nurse to have on hand; w/ this caustic substance, there’s a potential for massive swelling, which would compromise respirations; intubation tray should be immediately available so that airway is protected
the 1 week old child is diagnosed with hemophilia A. Neither the mother nor the father has the disease. Which statement by the RN to the parents correctly describes the hemophilia trait?
Ans: It is an X-linked recessive trait found primarily in males
-this trait very rarely shows itself in females, since their second sex chromosome is also X they would need to have the disease linked to both chromosomes in order to show the disease; since males’ 2nd sex chrom is Y, they show disease more frequently. A woman with the trait linked to one X chromosome and not the other is called a “carrier”
which guideline is appropriate for the RN to give a mother concerning the developmental age of her 7 yo child?
Ans: the child’s periods of shyness should be tolerated
-a 7 yo girl may become shy at times bc she experiences a conflict re: her independence from her mother; to allow the daughter to become independent, the mother should allow these episodes of shyness
the RN teaches the parent how to care for a child with impetigo. The RN knows that the greatest danger associated with an impetigo infection is the risk of which complication?
Ans: Developing glomerulonephritis secondary to streptococcus infection
-can be caused by beta hemolytic streptococcus, the same organism responsible for glomerulonephritis
the school RN assesses children enrolled in the kindergarten class. The RN is most concerned if which finding is observed?
a. child throws and catches a ball
b. child is able to neatly tie shoelaces
c. child eats with fingers
d. child walks down stairs by placing both feet on one step
Ans: d. child walks down stairs by placing both feet on one step
- should be able to walk down stairs using alternating feet by age 4; indicates a delay.
- this age group is more aware of hands as a tool; not unusual that 5 yo kids revert to finger feeding
The child with ADHD is taking methylphenidate. THe RN knows that methylphenidate is prescribed for this child for which effect?
a. CNS depressant
b. antianxiety
c. sedative
d. CNS stimulant
Ans: d. CNS stimulant
-pharmacological therapy is useful in mngt of ADD; CNS stimulants improve concentration and adaptive behavior
antidote for acetaminophen (Tylenol)?
mucomyst
MMR vaccine is for:
measles, mumps, rubella
-needs to be given at age 12-15 months and again at 4 to 6 years
the 7 yo child is admitted to the hospital w/ a Dx of idiopathis hypopituitarism. Which clinical manifestation is the nurse most likely to observe?
a. abnormal body proportions
b. early sexual maturation
c. delicate features
d. coarse, dry skin
Ans: c. delicate features
-clients characteristically have fine skin and delicate features; also have increased insulin sensitivity and premature aging common later
the child is admitted w/ lead poisoning. Which Sx does the RN expect to see?
a. anemia, hearing impairment, and distractibility
b. tinnitus, confusion, hyperthermia
c. polycythemia, hypoactivity, impaired liver functioning
d. SOB, dependent edema, bounding pulse
Ans: a. anemia, hearing impairment, and distractibility
- a. CORRECT - also includes irritability, sleepiness, nausea, vomiting, ab pain, increased intracranial pressure; Tx includes chelation
b. indicates aspirin poisonign
c. chelating agents are excreted through kidneys; nurse should monitor renal system
d. indicates congestive heart failure
note: lead toxicity is also known as “plumbism”
Cerebral Palsy
group of nonprogressive, PERMANENT but changing motor impairment syndromes; may be spastic, hypotonic, dystonic, or a combo of all; indications include poor head control after 3 months, stiff or rigid arms/legs, pushing away or arching the back, limp body posture. It’s important to maximize the child’s functioning.
What is cystic fibrosis?
hereditary dysfunction of exocrine glands, causing obstructions bc of flow of thick mucus; involves dysfunction in sweat glands, respiratory, and GI systems (particularly pancreas); voracious appetite early in disease and loss of appetite later; difficulties w/ eating d/t respiratory difficulties; Tx includes postural drainage, chest physiotherapy, breathing exercises, expectorants, mucolytic agents, replacement of pancreatic enzymes, aerosol therapy w/ bronchodilators, & mucolytics assists in loosening secretions so they may be removed, relief of bronchospasm, decreases edema of the mucosa, & liquefies bronchial secretions
developmental milestones for 3 yo:
copies a circle, builds bridge w/ 3 cubes, less negative than toddler, decreased tantrums, learns from experience, rides triclycle, walks backward and downstairs w/o assistance, undresses w/o help; has 900 word vocab, may invent imaginary friend
Developmental milestones for 4 yo:
climbs and jumps well, laces shoes, brushes teeth, has 1,500 word vocab, skips and hops on one foot, throws overhead
Developmental milestones for 5 yo:
runs well, jumps rope, dresses w/o help, 2,100 word vocab, tolerates increasing periods of separation from parents, beginning of cooperative play, gender-specific behavior, skips on alternate feet, ties shoes
the 6 month old baby has a cyanotic congenital heart defect. The nurse knows that a cyanotic heart defect is associated with which symptom?
a. pedal edema
b. clubbing of the fingers
c. obligate nose breathing
d. warm, dry skin
Ans: b. clubbing of the fingers
- Add’l symptoms that occur in pts w/ congenital heart defects include costal retractions and failure to thrive. Cyanotic congenital heart disease includes tetralogy of Fallot, transposition of the great vessels, truncus arteriosis, tricuspid Atresia, hypoplastic left heart
A 5 1/2 year old child comes to the clinic for a routine exam. The parent reports that the child likes to jump and climb, questions everything, and is often observed interacting w/ an “imaginary” best friend. The nurse should advise the parent to take which action?
a. encourage child to play more often w/ other children
b. tell child that the playmate is not real
c. allow child to engage in imaginary play
d. never leave the child alone
Ans: c. allow child to engage in imaginary play
-having imaginary friends is a normal and common occurrence in kids btwn ages 4-6; usu by the time the child is 6, s/he outgrows the imaginary friend
The home care RN visits the home of the toddler diagnosed w/ nonorganic failure to thrive (NFTT). The RN instructs the toddler’s mother about mealtime. Which suggestion by the nurse is most appropriate?
a. give toddler 10 min to eat meal
b. insist toddler eat certain foods
c. develop structured routine for bathing, sleeping, and playing
d. invite other children to eat w/ toddler
Ans: c. develop structured routine for bathing, sleeping, and playing
-children respond better if ADLs are structured; unstructured lifestyle will be reflected in child’s unwillingness to eat. NFTT is d/t causes unrelated to disease, e.g. parents’ inadequate nutrition info, disturbances in maternal-child attachment, or an inability by the kid to separate from parents; feed child in same way each meal and allow about 30 min for eating. Never force feed!
The 5 month old infand is brought to the clinic by a parent for a well-baby check up. The RN expects to make which observation?
a. the infant sits w/o support
b. infant transfers an object from hand to hand
c. infant puts their feet to their mouth when lying supine
d. infant appears afraid of strangers
Ans: c. infant puts their feet to their mouth when lying supine
-can also roll over from abdomen onto back, able to hold head erect and steady when in sitting position; able to grasp objects voluntarily, takes objects directly to mouth
The RN cares for pts in a ped clinic. The RN should investigate which child for a possible speech impairment?
a. 3 month old who babbles
b. 8 month old who laughs
c. 4 year old who shows an understanding of speech
d. 5 year old who uses single words
Ans: d. 5 year old who uses single words
-should have vocab of 2,100-3,000 words and use complete sentences containing 5-7 words
