Quiz 1 Flashcards
A nurse is caring for a 10 year old who will be hospitalized for an extended period of time. Which should the nurse include in the plan of care to meet the patient’s needs according to Erikson?
Encourage patient to complete school work/Arrange for a teacher to provide lesson plans
(Industry vs Inferiority)
What is a pediatric nurse responsible for?
promoting the health and well being of the child and family
A nurse is assessing a child. The child walks well, can state their first name, and repeatedly says “all done” and “go bye-bye now.” The child has 20 deciduous teeth and their anterior fontanel is closed. The nurse should estimate that the child is how many months old?
30 months
At what age do the fontanelles close?
anterior: 18-24 months
posterior: 2-3 months
The parent of a 4 year old tells the nurse that the child believes monsters are hiding in their closet. Which statement should the nurse make?
Keep a nightlight in your child’s room
Parents of a preschooler tell the nurse that their child often refuses to go to sleep at night. Whic h suggestion by the nurse would be helpful? Select all that apply.
a. “Try using a night light in the child’s room.”
b. “Set up some familiar bedtime rituals for your child.”
c. “Keep the door closed and the lights off so that your child can fall asleep faster.”
d. “Avoid having your child watch frightening shows on TV before bedtime.”
e. “Try reading a favorite story before bedtime.”
a. “Try using a night light in the child’s room.”
b. “Set up some familiar bedtime rituals for your child.”
d. “Avoid having your child watch frightening shows on TV before bedtime.”
e. “Try reading a favorite story before bedtime.”
A nurse is assessing the psychosocial development of a toddler. The nurse should recognize that this stage is characterized by what?
Negative behaviors characterized by the need for autonomy
A child’s moral and ethical habits are a direct reflection of?
Their families
When interviewing a ped patient, the nurse should:
- Listen with a few prompts
- Ask open ended questions
Childhood schizophrenia can be characterized by:
- Symptoms that last longer than 6 months
- Core disturbance with lack of reality
- Child is in a world of their own
What age does enuresis stop?
6-8 years old
What is an exacerbation of tics brought on by?
- stress
- lack of sleep
Why do children deserve the chance to have proper healthcare?
To become productive adults and function in society
What is the portion of the tooth that wears away allowing dental decay?
enamel
Describe a binuclear family
Divorced parents that remain in the same household that continue parenting roles
What two basic concepts apply to family-centered care?
- Enabling
- Empowerment
What are erikson’s stages of development from birth to adolescence?
trust vs mistrust (birth-year)
autonomy vs shame/doubt (1-3 years)
initiative vs guilt (3-6 years)
industry vs inferiority (6-12 years)
identify vs role confusion (12-20 years)
A nurse on a peds unit is practicing family centered care. What role does the family play in the child’s life?
the family is the constant in a child’s life and primary source of strength
Describe a permissive parenting style
Parents who exert little or no control over their children
What is are characteristics of a healthy family?
- sense of trust
- communicate well and listen to each other
- affirmation and support for all members
- clear set of family rules, beliefs, and values
- respect for others
- play and share humor together
- interact with one another
- shared sense of responsibility
- traditions and rituals
- adaptability and flexibility in roles
- seek help for their problems
Describe a dictatorial/authoritarian parenting style
Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations
Which play activity is therapeutic in helping the child deal with an injection?
Needless syringe and a doll
How can a nurse comfort a 3 year old who is fearful of hospital procedures?
- Have parent stay with child as long as possible before and/or during a procedure
- AVOID Clustering invasive procedures whenever possible
- Perform the procedure as quickly as possible
- Show the child the procedure with a toy or doll prior to the procedure
- Allow the child to keep a toy with them during the procedure
- Allow a familiar toy from home in the hospital
- AVOID restraints unless you need to mummy restraint them for a procedure like stitches without sedation to keep them safe
A child who is descending the stairs by placing both feet on each step and holding onto the rail is displaying an appropriate motor skill for what age?
3 years old
A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurse’s best response to the parents about this behavior?
a. “Your child is showing a normal response to the stress of hospitalization.”
b. “Your child is not coping effectively with hospitalization. We’ll need to get a psychological consult from the doctor.”
c. “It is helpful for parents to stay with children during hospitalization.”
d. “You can avoid this if you wait to leave after your child falls asleep.”
a. “Your child is showing a normal response to the stress of hospitalization.”
What are expected findings of an infant in pain?
- Loud cry
- Rigid body or thrashing
- Local reflex withdrawal from pain stimulus
- Expressions of pain
- Lack of association between stimulus
- INCREASED CRYING EPISODES
Action a nurse can take to promote sleep for a toddler who has difficulty sleeping during hospitalization:
Provide bedtime rituals
Describe weight trends
- newborns lose 10% of body weight after birth
- birth weight doubles by 5 months, triples by 12 months
A nurse in an emergency department is caring for an infant who has a 2-day history of vomiting and an elevated temperature. Which of the following should the nurse recognize as the most reliable indicator of fluid loss?
a. Body weight
b. Skin integrity
c. Blood pressure
d. Respiratory rate
a. Body weight
If an infant has increased BUN and sodium, what may it be indicative of?
Dehydration
Which statement accurately describes an event associated with an infant’s physical development?
a. Anterior fontanel closes by age 6 to 10 months.
b. Binocularity is well
established by age 8 months.
c. Birth weight doubles by age 5 months and triples by age 1 year.
d. Maternal iron stores persist during the first 12 months of life.
c. Birth weight doubles by age 5 months and triples by age 1 year.
What is an appropriate toy for a toddler?
A toy the child can pull will help develop muscles
What is a major component at all play stages?
sensorimotor activity as they develop muscles and movement
What will indicate that a child is developing object permanence?
child looks for the toy the parent hides
Define egocentrism
unable to see things from the perspectives of others; they can only view things from their personal points of view
Describe a preschool stage of moral development
Actions are determined as good or bad in terms of consequence
Why is exercise essential for children?
for muscle development, tone, balance, coordination
The nurse evaluates a three-year-old child for developmental delays. When the nurse notes that the child has difficulty maintaining balance while walking, what other assessments does the nurse perform? SATA
- The nurse assesses overall muscle tone and strength
- the nurse assesses for speech impairments and delays
- the nurse assesses deep tendon and primitive reflexes
- the nurse assesses level of consciousness and orientation
- the nurse assesses for developmental milestone variances
- The nurse assesses overall muscle tone and strength
- the nurse assesses for speech impairments and delays
- the nurse assesses deep tendon and primitive reflexes
- the nurse assesses for developmental milestone variances
What age group is vulnerable to dental caries?
4-8 years
What is the most common chronic disease in children?
dental caries
A 12 year old who enjoys collecting stamps, playing soccer, and participating in Boy Scouts is in what erikson stage?
industry
What is encopresis?
- fecal incontinence
- More common in males
- May be secondary to constipation or impaction
- Emotional stress
How does an infant socialize?
grasping reflex (grasping hair)
What is erikson’s theory based on?
freud’s theory
What age can a baby sit without support?
8 months
What is the age range for a neonate?
birth-28 days
During 1800s-1900s, how were such children were viewed as?
Something people didn’t talk about
What is the most important influence on a child’s growth?
Nutrition
What are motor skills of a preschooler?
able to balance on one foot
What are effective means of preventing dental caries in peds?
- Take a child to see a dentist by 4 years old
- start brushing teeth at first eruption
- Proper hygiene
What are gross motor skills of a 24 month old?
walking up and down stairs
A 15 year old is admitted to the ER. They speak very little English and mainly Spanish. Another nurse on shift speaks a little Spanish. What do you do?
Call professional interpreter
What is the most important factor to consider when communicating with children?
Developmental level
What is the light reflex test used in newborns? What is an expected finding?
corneal light reflex
expected finding: symmetric
Describe the Hirschberg test
penlight points at eyes at midline
assess for ocular alignment
if the dot of light is seen in different spots, this is lazy eye
normal in newborns
The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate
a. color vision.
b. ocular alignment.
c. peripheral vision.
d. visual acuity.
b. ocular alignment.
What does nasal flaring indicate?
risk of acute respiratory failure
What does a presence of drooling indicate?
risk of aspiration because child can’t swallow
If a 6 month old still has the moro reflex, what does this indicate?
developmental delay
What can tetanus cause? What is the immunization for it?
lock jaw
rigidity of muscle
death
Tdap
Describe Stark Law
provider doesn’t have full control of pt
pt/parents have choices
What should a nurse do for the parents of a hospitalized child?
encourage them to talk
- listen to concerns
What are the benefits of hospitalization for kids?
kids learn to manage stress and coping skills
A nurse on a pediatric unit is caring for a toddler. Which of the following behaviors is an effect of hospitalization? ( Select all that apply.)
a. Believes the experience is a punishment
b. Experiences separation anxiety
c. Displays intense emotions
d. Exhibits regressive behaviors
e. Manifest disturbance in body image
b. Experiences separation anxiety
c. Displays intense emotions
d. Exhibits regressive behaviors
When does puberty start?
around 9-15 years old
females: 95% of height achieved at menarche
males: 95% of height achieved at 15
A 13-year-old girl asks the nurse how much taller she will become. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on knowing that:
a. Growth cannot be predicted.
b. The pubertal growth spurt lasts about 1 year.
c. Mature height is achieved when menarche occurs.
d. Approximately 95% of mature height is achieved when menarche occurs.
d. Approximately 95% of mature height is achieved when menarche occurs.
What are the stages of development?
Neonatal: birth to 4 weeks
Infancy: 1-12 months
Toddler: 1-3 years
Preschool: 3-6 years
School age: 6-12 years
Adolescence: 12-20years
What is the average length of a full term newborn? How are they measured?
48-53 cm (19-21 in)
from head to heel in recumbent position
The primary critical observation for Apgar scoring is the:
A. Heart rate
B. Respiratory rate
C. Presence of meconium
D. Evaluation of the Moro reflex
A. Heart rate
How long should a nurse listen to RR and HR?
1 full minute
HR @ apical
RR (abdominal)
A 2-week-old infant is displaying an irregular breathing pattern, with periodic increases in respiratory rate that return to normal. The infant is otherwise eating well and has no other signs of respiratory distress. What should the nurse tell the family about this breathing pattern during family teaching?
This breathing pattern is normal for the infant’s age.
What is the most accurate route for temp for infants?
rectal
Where does the baby receive clotting factors from?
mom
if there is a high chance to bleed out, give vitamin K
Who is at greater risk for under treatment of pain?
child w/ communication and cognitive impairment
The nurse is caring for a 10-year-old boy with autism on the pediatric unit, immediately after a spinal fusion with titanium rods implanted. The child is able to communicate a little verbally and attends special classes for children with autism. He has a short attention span, according to the mother. The child’s pain management is of great concern to his mother. What information about this child should the nurse take into account when providing medication for pain?
A.Children with autism do not perceive pain as do regular children.
B.Children with neurologic disorders, such as autism, are at greater risk than other children for undertreatment of pain.
C.EMLA cream would be contraindicated for use prior to restarting the child’s intravenous line.
D.Distraction and guided imagery can be used to help make this child comfortable.
B.Children with neurologic disorders, such as autism, are at greater risk than other children for undertreatment of pain.
A 5-year-old child with brain cancer has intractable pain. What is the best non pharmacological strategy for pain management to help with the medications the child is receiving?
Guided Imagery
What are pharmacologic strategies for children?
1st: Tylenol & Motrin
A 2-year-old child has been returned to the nursing unit after an inguinal hernia repair. Which pain assessment tool should the nurse use to assess this child for the presence of pain?
a. FACES pain rating tool
b. Numeric scale
c. Oucher scale
d. FLACC tool
d. FLACC tool
What are nonpharmacologic strategies for pain? (5s)
swaddle
shush
swing
suck
side lying
to soothe baby and reduce pain perceptions
Describe palliative care and who is involved
to relieve from pain and to comfort
nurse, physician, anesthesiologist
A nurse is planning palliative care for a child with severe pain. Which should the nurse expect to be prescribed for pain relief?
a. Opioids as needed
b. Opioids on a regular schedule
c. Distraction and relaxation techniques
d. Nonsteroidal anti-inflammatory drugs
b. Opioids on a regular schedule
If a pt has a bad prognosis and wants to die, but the parents refuse, what will happen?
Dr will take care of it by calling ethics committee
Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together?
a. Blended
b. Nuclear
c. Binuclear
d. Extended
a. Blended
A nurse is assessing a family’s structure. Which describes a family in which a mother, her children, and a stepfather live together?
a. Blended
b. Nuclear
c. Binuclear
d. Extended
a. Blended
What is a traditional nuclear family?
married couple
biologic kids
What is a nuclear family?
two parents and kids (biologic/adoptive/step/foster)
What is a single parent?
one parent and one more children
What is a blended family?
aka reconstituted
At least one stepparent, stepsibling, or half-sibling
What is an extended family?
at least one parents, one or more children, and other individuals (might not be related)
Describe an authoritative/democratic parenting style
Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting.
A nurse is assisting a group of guardians of adolescents to develop skills that will improve communication within the family. The nurse hears one guardian state “My son knows he better do what I say.” Which of the following parenting styles is the parent exhibiting?
A. Authoritarian
B. Permissive
C. Authoritative
D. Passive
A. Authoritarian
Describe a passive parenting style
Parents are uninvolved, indifferent, and emotionally removed.
What gross/fine motor skills should a 1 month old have?
gross: head lag
fine: strong grasp reflex
A nurse is assessing a 1-month-old infant at a well-child visit. Which of the following findings should the nurse expect?
a. Absent rooting reflex
b. Head lag
c. Respiratory rate of 50/min
d. Apical heart rate of 90/min
b. Head lag
What gross/fine motor skills should a 2 month old have?
gross: lifts head off mattress when prone
fine: holds hands in open position, grasp reflex fading
What gross/fine motor skills should a 3 month old have?
gross: raises head/ shoulders off mattress when prone
fine: no longer has a grasp reflex, keeps hands loosely open
What gross/fine motor skills should a 4 month old have?
gross: rolls from back to side
fine: grasps object w/ both hands
What gross/fine motor skills should a 5 month old have?
gross: rolls from front to back
fine: uses palmar grasp dominantly
What gross/fine motor skills should a 6 month old have?
gross: rolls from back to front
fine: holds bottle
What gross/fine motor skills should a 7 month old have?
gross: bears full weight on feet, sits leaning forward w/ both hands
fine: moves objects from hand to hand
What gross/fine motor skills should a 8 month old have?
gross: sits unsupported
fine: begins using pincer grasp
What gross/fine motor skills should a 9 month old have?
gross: pulls to a standing position, creeps on hands/knees
fine: fine pincer grasp, dominant hand preference evident
What gross/fine motor skills should a 10 month old have?
gross: changes from prone to sitting
fine: grasps rattle by its handle
What gross/fine motor skills should a 11 month old have?
gross: cruises or walks while holding onto something
fine: places objects into container, neat pincer grasps
What gross/fine motor skills should a 12 month old have?
gross: sits down from standing w/o assistance, walks w/ 1 hand held
fine: tries building two block tower w/o success, can turn pages in book
What is the sucking and rooting reflex? When is it seen?
sucking: infant turns their head toward side that is touched and starts to suck
rooting: stroking cheek or edge of the infant’s mouth
expected age: birth to 4 months
What is the palmar reflex? When is it seen?
infant grasps
expected age: birth to 4 months
What is the plantar reflex? When is it seen?
toes curl
expected age: birth to 8 months
What is the moro reflex? When is it seen?
infant startled
expected age: birth to 4 months
What is the tonic neck reflex (fencer position)? When is it seen?
baby turns head and arm to one side and extends arm
expected age: birth to 3 to 4 months
What is the babinski reflex? When is it seen?
toes fan out
expected age: birth to 1 year
What is the stepping reflex? When is it seen?
holding infant up and feet touch surface, making stepping movements
expected age: birth to 4 weeks.
What is the expected temp for a 3 and 6 month old? What is the recommended route?
99.5
axillary and rectal
What is the expected temp for a 1 year old? What is the recommended route?
99.9
axillary and rectal
What is the expected temp for a 3 year old? What is the recommended route?
99.0
axillary, tympanic, oral, rectal
What is the expected temp for a 5 year old? What is the recommended route?
98.6
axillary, tympanic, oral, rectal
What is the expected temp for a 7 year old? What is the recommended route?
98.2
axillary, oral, tympanic
What is the expected temp for a 9 and 11 year old? What is the recommended route?
98.1
axillary, oral, tympanic
What is the expected temp of a 13 year old? What is the recommended route?
97.9
axillary, oral, tympanic
What are the expected heart rates of each age group?
newborn: 110-160/min
infant: 90-160/min
toddler: 80-140/min
preschooler: 70-120/min
school aged: 60-110/min
adolescent: 50-100/min
What is the expected respiration rate for each age group?
newborn: 30-60/min
infant: 25-30/min
toddler: 25-30/min
preschooler: 20-25/min
school aged: 20-25/min
adolescent: 16-20/min
What is the average blood pressure for each age group?
newborn: 64/41
infant: 85/50
toddler:
male (85-91/37-46)
female (86-89/40-49)
preschooler:
male (91-98/46-53)
female (89-93/49-52)
school aged:
male (96-106/55-62)
female (94-105/56-62)
adolescent: <120/<80
What piaget stage is a child in from birth to 24 months? Describe it.
sensorimotor stage
separation: infants learn to separate from objects in environment
object permanence: infants learn that object still exists when out of view
mental representation: ability to recognize and use symbols
What is the immunization schedule?
birth: hep B
2 month: B DR HIP
(hep B, DTap, Rotavirus, Haemophilus influenzae type B [Hib], Inactivated polio [IPV], Pneumococcal [PCV])
4 month: DR HIP
6 month: B DR HIP Flu
12 month: MAD HPV
(MMR, Hepatitis A, DTap, Hib, PCV, Varicella)
4-6 years: Very DIM
(Varicella, DTap, Influenza/IPV, MMR)
11-12 years: MITH
(Meningitis, Influenza, TdaP, HPV)
16-18 years: Men Flu
(MENingitis booster & Annual flu shot)
What is mumps? What precautions should be in place?
painful swelling salivary glands
droplet precautions
A nurse is performing a pre-college assessment on an adolescent. Which of the following immunization should the nurse anticipate administering?
Meningococcal polysaccharide vaccine
Which approach would be best to use to ensure a positive response from a toddler?
a. Assume an eye-level position and talk quietly.
b. Call the toddler’s name while picking him or her up.
c. Call the toddler’s name and say, “I’m your nurse.”
d. Stand by the toddler, addressing him or her by name.
a. Assume an eye-level position and talk quietly.
What piaget stage is a child in at 2 years? Describe it.
preoperational stage
have memories of events
playing house
What erikson stage is a child in from 1-3 years? Describe it.
autonomy vs shame/doubt
Mastering environment and building self-esteem
What gross/fine motor skills should a 15 month old have?
gross: walk w/o help, creep upstairs
fine: uses a cup, builds a two tower block
What gross/fine motor skills should a 18 month old have?
gross: runs clumsily, falls, throws a ball overhand, jump in place, pull/pushes
fine: manages spoon, turns pages in a book, builds a 3-4 block tower
What gross/fine motor skills should a 2 year old have?
gross: walks up/down stairs w/ both feet
fine: builds 6-7 block tower, turns several pages
What gross/fine motor skills should a 2.5 year old have?
gross: jumps across floor, stands on one foot , tiptoes
fine: draws circles, good finger-hand coordination
What piaget stage is a preschooler in? Describe it.
preoperational stage
- magical thinking
- animism (lifelike qualities to inanimate objects)
- centration (focus on one aspect instead of alternatives)
- time
What piaget stage is a school age child in? Describe it
concrete operations
transitions from perceptual to conceptual thinking
What erikson stage is a school age child in? Describe it
industry vs inferiority
achieved through the development of skills and knowledge
What piaget stage is an adolescent in? Describe it
formal operations
capable of evaluating the quality of their own thinking
What erikson stage is an adolescent in? Describe it
identity vs role confusion
develop personal sense of identity
A nurse is caring for a 6-month-old infant. Which of the following findings would indicate to the nurse that the client is experiencing pain following the procedure?
A. Decreased Heart Rate
B. Decreased respiratory rate
C. Increased formula consumption
D. Increased crying episodes
D. Increased crying episodes
A nurse is providing health promotion teaching to an adolescent. Which of the following information should the nurse include in the teaching?
Your need for sleep will increase during periods of growth
What is the order of VS measurement for infant and toddlers?
RR
HR
BP
Temp
The nurse assisted with the delivery of a newborn. Which nursing action is most effective in preventing heat loss by evaporation?
a. Warming the crib pad
b. Closing the doors to the room
c. Drying the infant with a warm blanket
d. Turning on the overhead radiant warmer
c. Drying the infant with a warm blanket
- If newborn is stable and can be placed with parents to initiate early attachment and bonding – Warm with dry blanket to prevent heat loss*
A new mother asks the nurse, “What are those small white spots on my baby’s nose?” Which response by the nurse would be most appropriate?
A) “Those are small glands that look like whiteheads but will disappear soon.”
B) “Those white spots are lesions containing pus and are caused by a minor skin infection.”
C) “Newborns retain sweat, which causes those white bumps on their skin.”
D) “Often newborns have a rash of this type, which fades in a few days.”
A) “Those are small glands that look like whiteheads but will disappear soon.”
What are milia?
pin point spots
newborn acne
caused by enlarged sebaceous glands on nose, chin, FH
A newborn has small, whitish, pinpoint spots over the nose, which the nurse knows are caused by retained sebaceous secretions. When charting this observation, the nurse identifies it as:
a. Milia
b. Whiteheads
c. Lanugo
d. Mongolian spots
a. Milia
What is a sign of meningocele?
sacral dimple
What is polydactyl?
one or more extra fingers
How is developmental dysplasia tested?
barlow test
ortolan test
The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? (Select all that apply.)
a. Positive Ortolani click
b. Unequal gluteal folds
c. Negative Babinski sign
d. Trendelenburg sign
e. Telescoping of the affected limb f. Lordosis
a. Positive Ortolani click
b. Unequal gluteal folds
A 12-year-old male has short stature because of a constitutional growth delay. What should the nurse be the most concerned about?
a. Proper administration of thyroid hormone
b. Proper administration of human growth hormones
c. Child’s self-esteem and sense of competence
d. Helping child understand that his height is most likely caused by chronic illness
and is not his fault
d. Helping child understand that his height is most likely caused by chronic illness and is not his fault
