ATI pediatrics proctored exam
Chapter 1: Family centered nursing care
1. Parenting styles
Dictatorial or authoritarian:
o Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations
Ex: The child is never allowed to watch television on school nights
Permissive:
o Parents exert little or no control over the child’s behaviors, and consult the child when making decisions
Ex: The child assists with deciding whether he will watch television
Democratic or authoritative:
o Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting
Ex: The child can watch television for 1 hr on school nights after completing all of his homework and chores
o Parents negatively reinforce deviations form the rules
Ex: The privilege is taken away but later reinstated based on new guidelines
Chapter 2: Physical assessment findings
1. Vital signs
-Usually vital signs are all high except for BP
-Temperature:
-3 – 6 months 99.5
-1 year 99.9
-3 year 99.0
-5 years 98.6
-7 years 98.2
-9 – 11 years 98.1
-13 years 97.9
-Pulse:
-Newborn 80 – 180/min
-1 weeks – 3 months 80 – 220/min
-3 months – 2 years 70 – 150/min
-2 – 10 years 60 – 110/min
-10 years and older 50 – 90/min
-Respirations:
-Newborn – 1year 30 – 35/min
-1 – 2 years 25 – 30/min
-2 – 6 years 21 – 25/min
-6 – 12 years 19 – 21/min
-12 years and older 16 – 19/min
-Blood pressure:
-Low as a baby but increases the older they get
-Infants: Systolic: 65-78/ Diastolic: 41-52
2. Head: Fontanels should be flat
Anterior fontanel:
o Closes by 12-18 months
Posterior fontanel:
o Closes by 6-8 weeks
3. Teeth
-Infants should have 6-8 teeth by 1 year old
-Children and adolescents should have teeth that are white and smooth, and begin replacing the 20 deciduous teeth with 32
permanent teeth
4. Infant Reflexes
Stepping Birth to 4 weeks
Palmar Grasp Birth to 3 months
Tonic Neck Reflex (Fencer Position) Birth to 3 – 4 months
Sucking and Rooting Reflex Birth to 4 months
Moro Reflex (Fall backward) Birth to 4 months
, Startle Reflex (Loud Noise) Birth to 4 months
Plantar Reflex Birth to 8 months
Birth to 1 year
Babinski Reflex
Chapter 3: Health promotion of infants (2 days to 1 year)
1. Physical Development
Weight:
o Doubled by 5 months
o Tripled by 12 months
o Quartered by 30 months
Height:
o 2.5 cm (1 in) per month for the first 6 months
Length:
o Increases by 50% by 12 months
Dentition:
o First teeth erupt between 6-10 months
2. Motor skill development
1 Month
o Head lag
o Strong grasp reflex
2 Months
o Lifts head when prone
o Holds hand in open position | Grasp reflex fades
3 Months
o Raises head and shoulders when prone | Slight head lag
o No grasp reflex | Keeps hands loosely open
4 Months
o Rolls from back to side
o Grasp objects with both hands
5 Months
o Rolls from front to back
o Palmar grasp dominantly
6 Months
o Rolls from back to front
o Holds bottle
7 Months
o Bears full weight on feet | Sits, leaning forward on both hands
o Moves objects from hand to hand
8 Months
o Sits unsupported
o Pincer grasp
9 Months
o Pulls to a standing position | Creeps on hands and knees instead of crawling
o Crude pincer grasp | Dominant hand is evident
10 Months
o Prone to sitting position
o Grasps rattle by its handle
11 Months
o Walks while holding onto something | Walks with one hand held
o Places objects into a container | Neat pincer grasp
12 Months
o Stands without support briefly | Sits from standing position without assistance
o Tries to build a two-block tower w/o success | Can turn pages in a book
3. Cognitive development
Piaget: sensorimotor (birth to 24 months)
Object Permanence: objects still exists when it is out of view
o Occurs at 9-10 months
4. Language development: 3-5 words by the age of 1 year
,5. Psychosocial development
Erikson: Trust vs. Mistrust:
-Learn delayed gratification
-Trust is developed by meeting comfort, feeding, simulation, and caring needs
-Mistrust develops if needs are inadequately or inconsistently met or if needs are continuously met before being vocalized
by the infant
6. Social development
Separation Anxiety: protest when separated from parents
o Begins around 4-8 months
Stranger Fear: ability to discriminate between familiar and unfamiliar people
o Begins 6-8 months
7. Age appropriate activities
-Rattles
-Playing pat-a cake
-Brightly colored toys
-Playing with blocks
8. Nutrition
Breastfeeding provides a complete diet for infants during the first 6 months
Solids are introduced around 4-6 months
o Iron-fortified cereal is the first to be introduced
o New foods should be introduced one at a time, over a 5-7 day period to observe for allergy reactions
Juice and water usually not needed for 1st year
Appropriate finger foods:
o Ripe bananas
o Toast strips
o Graham crackers
o Cheese cubes
o Noodles
o Firmly cooked vegetables
o Raw pieces of fruit (except grapes)
9. Injury prevention
-Avoid small objects (grapes, coins, and candy)
-Handles of pots and pans should be kept turned to the back of the stove
-Sunscreen should be used when infants are exposed to the sun
-Infants and toddlers remain in a rear-facing car seat until age 2
-Crib slats should be no farther apart than 6 months
-Pillows should be kept out of the crib
-Infants should be placed on their backs for sleep
Chapter 4: Health Promotion of Toddlers (1 to 3 years)
1. Physical development
Weight: 30 months: 4 times the birth weight
Height: Toddlers grow 7.5 cm (3 in) per year
Head circumference and chest circumference: Usually equal by 1 to 2 years of age
2. Cognitive development
o Piaget: sensorimotor stage transitions to preoperational stage 19 – 24 months
Object Permanence: fully developed
3. Language development
-1 year: using one-word sentences
-2 years: 300 words, multiword sentences by combining 2-3 words
4. Psychosocial Development
Autonomy vs. Shame and Doubt
-Independence is paramount for toddlers who are attempting to do everything for themselves
-Use negativism or negative responses to express their independence
-Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as they begin to explore the
environment beyond those most familiar to them
5. Age appropriate activities
, Parallel play: Toddlers observe other children and then might engage in activities nearby
Appropriate activities:
-Playing with blocks
-Push-pull toys
-Large-piece puzzles
-Thick crayons
-Toilet training can begin when toddlers have the sensation of needing to urinate/defecate
6. Motor skill development
15 Months
o Walks without help | Creeps up stairs
o Uses a cup well | Builds 2 tower blocks
18 Months
o Runs clumsily | Throws overhand | Jumps in place w/ both feet | Pulls/Pushes toys
o Manages a spoon w/o rotation | Turns pages 2-3 pages /time | Builds 3-4 blocks | Uses crayon to scribble spontaneously |
Feeds self
24 Months (2 years)
o Walks backwards | Walks up/down stairs w/ 2 feet on each step
o Builds 6-7 blocks | Turns pages 1 @ a time
30 Months (2.5 years)
o Balances on 1 leg | Jumps across floor / off chair w/ both feet | Walks tiptoe
o Draws circles | has good hand-finger coordination
7. Nutrition
Whole milk at 1 year old
Can start drinking low-fat milk after 2 years of age
Juice consumption should be limited to 4-6 oz. per day
-Foods that are potential choking hazards:
-Nuts -Grapes -Hot dogs
-Peanut butter -Raw carrots
-Tough meats -Popcorn
Chapter 5: Health Promotion of Preschoolers (3-6 years)
1. Physical development
Weight: Gain 2-3 kg (4.5-6.5 lb) per year
Height: Should grow 6.9-9 cm per year
2. Fine and gross motor skills
3 Years
o Toe and heel walks
o Tricycle
o Jumps off bottom step
o Stands on one foot for a few seconds
4 Years
o Hops on one foot | Skips
o Throws ball overhead
o Catches ball reliably
5 Years
o Jumps rope
o Walks backward
o Throws and catches a ball
3. Cognitive development
Piaget: preoperational stage
o Moves from totally egocentric thoughts to social awareness and the ability to consider the viewpoint of others
Magical thinking: Thoughts are all-powerful and can cause events to occur
Animism: Ascribing life-like qualities to inanimate objects
4. Psychosocial development
Erikson: Initiative vs. guilt:
-Preschoolers become energetic learners, despite not having all of the physical abilities necessary to be successful at
everything
-Guilt can occur when preschoolers believe they have misbehaved or when they are unable to accomplish a task
Chapter 1: Family centered nursing care
1. Parenting styles
Dictatorial or authoritarian:
o Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations
Ex: The child is never allowed to watch television on school nights
Permissive:
o Parents exert little or no control over the child’s behaviors, and consult the child when making decisions
Ex: The child assists with deciding whether he will watch television
Democratic or authoritative:
o Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting
Ex: The child can watch television for 1 hr on school nights after completing all of his homework and chores
o Parents negatively reinforce deviations form the rules
Ex: The privilege is taken away but later reinstated based on new guidelines
Chapter 2: Physical assessment findings
1. Vital signs
-Usually vital signs are all high except for BP
-Temperature:
-3 – 6 months 99.5
-1 year 99.9
-3 year 99.0
-5 years 98.6
-7 years 98.2
-9 – 11 years 98.1
-13 years 97.9
-Pulse:
-Newborn 80 – 180/min
-1 weeks – 3 months 80 – 220/min
-3 months – 2 years 70 – 150/min
-2 – 10 years 60 – 110/min
-10 years and older 50 – 90/min
-Respirations:
-Newborn – 1year 30 – 35/min
-1 – 2 years 25 – 30/min
-2 – 6 years 21 – 25/min
-6 – 12 years 19 – 21/min
-12 years and older 16 – 19/min
-Blood pressure:
-Low as a baby but increases the older they get
-Infants: Systolic: 65-78/ Diastolic: 41-52
2. Head: Fontanels should be flat
Anterior fontanel:
o Closes by 12-18 months
Posterior fontanel:
o Closes by 6-8 weeks
3. Teeth
-Infants should have 6-8 teeth by 1 year old
-Children and adolescents should have teeth that are white and smooth, and begin replacing the 20 deciduous teeth with 32
permanent teeth
4. Infant Reflexes
Stepping Birth to 4 weeks
Palmar Grasp Birth to 3 months
Tonic Neck Reflex (Fencer Position) Birth to 3 – 4 months
Sucking and Rooting Reflex Birth to 4 months
Moro Reflex (Fall backward) Birth to 4 months
, Startle Reflex (Loud Noise) Birth to 4 months
Plantar Reflex Birth to 8 months
Birth to 1 year
Babinski Reflex
Chapter 3: Health promotion of infants (2 days to 1 year)
1. Physical Development
Weight:
o Doubled by 5 months
o Tripled by 12 months
o Quartered by 30 months
Height:
o 2.5 cm (1 in) per month for the first 6 months
Length:
o Increases by 50% by 12 months
Dentition:
o First teeth erupt between 6-10 months
2. Motor skill development
1 Month
o Head lag
o Strong grasp reflex
2 Months
o Lifts head when prone
o Holds hand in open position | Grasp reflex fades
3 Months
o Raises head and shoulders when prone | Slight head lag
o No grasp reflex | Keeps hands loosely open
4 Months
o Rolls from back to side
o Grasp objects with both hands
5 Months
o Rolls from front to back
o Palmar grasp dominantly
6 Months
o Rolls from back to front
o Holds bottle
7 Months
o Bears full weight on feet | Sits, leaning forward on both hands
o Moves objects from hand to hand
8 Months
o Sits unsupported
o Pincer grasp
9 Months
o Pulls to a standing position | Creeps on hands and knees instead of crawling
o Crude pincer grasp | Dominant hand is evident
10 Months
o Prone to sitting position
o Grasps rattle by its handle
11 Months
o Walks while holding onto something | Walks with one hand held
o Places objects into a container | Neat pincer grasp
12 Months
o Stands without support briefly | Sits from standing position without assistance
o Tries to build a two-block tower w/o success | Can turn pages in a book
3. Cognitive development
Piaget: sensorimotor (birth to 24 months)
Object Permanence: objects still exists when it is out of view
o Occurs at 9-10 months
4. Language development: 3-5 words by the age of 1 year
,5. Psychosocial development
Erikson: Trust vs. Mistrust:
-Learn delayed gratification
-Trust is developed by meeting comfort, feeding, simulation, and caring needs
-Mistrust develops if needs are inadequately or inconsistently met or if needs are continuously met before being vocalized
by the infant
6. Social development
Separation Anxiety: protest when separated from parents
o Begins around 4-8 months
Stranger Fear: ability to discriminate between familiar and unfamiliar people
o Begins 6-8 months
7. Age appropriate activities
-Rattles
-Playing pat-a cake
-Brightly colored toys
-Playing with blocks
8. Nutrition
Breastfeeding provides a complete diet for infants during the first 6 months
Solids are introduced around 4-6 months
o Iron-fortified cereal is the first to be introduced
o New foods should be introduced one at a time, over a 5-7 day period to observe for allergy reactions
Juice and water usually not needed for 1st year
Appropriate finger foods:
o Ripe bananas
o Toast strips
o Graham crackers
o Cheese cubes
o Noodles
o Firmly cooked vegetables
o Raw pieces of fruit (except grapes)
9. Injury prevention
-Avoid small objects (grapes, coins, and candy)
-Handles of pots and pans should be kept turned to the back of the stove
-Sunscreen should be used when infants are exposed to the sun
-Infants and toddlers remain in a rear-facing car seat until age 2
-Crib slats should be no farther apart than 6 months
-Pillows should be kept out of the crib
-Infants should be placed on their backs for sleep
Chapter 4: Health Promotion of Toddlers (1 to 3 years)
1. Physical development
Weight: 30 months: 4 times the birth weight
Height: Toddlers grow 7.5 cm (3 in) per year
Head circumference and chest circumference: Usually equal by 1 to 2 years of age
2. Cognitive development
o Piaget: sensorimotor stage transitions to preoperational stage 19 – 24 months
Object Permanence: fully developed
3. Language development
-1 year: using one-word sentences
-2 years: 300 words, multiword sentences by combining 2-3 words
4. Psychosocial Development
Autonomy vs. Shame and Doubt
-Independence is paramount for toddlers who are attempting to do everything for themselves
-Use negativism or negative responses to express their independence
-Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as they begin to explore the
environment beyond those most familiar to them
5. Age appropriate activities
, Parallel play: Toddlers observe other children and then might engage in activities nearby
Appropriate activities:
-Playing with blocks
-Push-pull toys
-Large-piece puzzles
-Thick crayons
-Toilet training can begin when toddlers have the sensation of needing to urinate/defecate
6. Motor skill development
15 Months
o Walks without help | Creeps up stairs
o Uses a cup well | Builds 2 tower blocks
18 Months
o Runs clumsily | Throws overhand | Jumps in place w/ both feet | Pulls/Pushes toys
o Manages a spoon w/o rotation | Turns pages 2-3 pages /time | Builds 3-4 blocks | Uses crayon to scribble spontaneously |
Feeds self
24 Months (2 years)
o Walks backwards | Walks up/down stairs w/ 2 feet on each step
o Builds 6-7 blocks | Turns pages 1 @ a time
30 Months (2.5 years)
o Balances on 1 leg | Jumps across floor / off chair w/ both feet | Walks tiptoe
o Draws circles | has good hand-finger coordination
7. Nutrition
Whole milk at 1 year old
Can start drinking low-fat milk after 2 years of age
Juice consumption should be limited to 4-6 oz. per day
-Foods that are potential choking hazards:
-Nuts -Grapes -Hot dogs
-Peanut butter -Raw carrots
-Tough meats -Popcorn
Chapter 5: Health Promotion of Preschoolers (3-6 years)
1. Physical development
Weight: Gain 2-3 kg (4.5-6.5 lb) per year
Height: Should grow 6.9-9 cm per year
2. Fine and gross motor skills
3 Years
o Toe and heel walks
o Tricycle
o Jumps off bottom step
o Stands on one foot for a few seconds
4 Years
o Hops on one foot | Skips
o Throws ball overhead
o Catches ball reliably
5 Years
o Jumps rope
o Walks backward
o Throws and catches a ball
3. Cognitive development
Piaget: preoperational stage
o Moves from totally egocentric thoughts to social awareness and the ability to consider the viewpoint of others
Magical thinking: Thoughts are all-powerful and can cause events to occur
Animism: Ascribing life-like qualities to inanimate objects
4. Psychosocial development
Erikson: Initiative vs. guilt:
-Preschoolers become energetic learners, despite not having all of the physical abilities necessary to be successful at
everything
-Guilt can occur when preschoolers believe they have misbehaved or when they are unable to accomplish a task
