Peds Test 1

Peds Test 1 Susie and her daughter are cleaning the kitchen. While Susie is cleaning the kitchen she asks her daughter to help her sweep the floor. After the kitchen is clean, Susie gives her daughter a piece of candy and praises her for doing such a good job. A couple weeks later, the floor needs to be swept again. When Susie goes into the kitchen to sweep the floor, she notices her daughter sweeping the floor. Which theoretical framework is being displayed? A.Ecologic Theory B. Temperament Theory C. Behaviorism D. Social Learning Theory - Answer: C. Behaviorism. Chapter 4 pg. 73 Principles of Pediatric Nursing 7th edition. Watson and Skinner showed that behaviors can be elicited by positive reinforcement, or stopped wit negative reinforcement. A mother brings her two year old to the pediatrician for a routine check up; it is their first time coming to this pediatrician. During your assessment of the child, the mother asks "why are you measuring my child's head? The nurses at our old pediatrician's office stopped doing that when my child turned one year old." What is your response? A.) "We usually measure the circumference of the child's head until they know how to read." B.) "Its a good thing you switched to this pediatrician's office because head circumference is supposed to be measured routinely until the child is 2 to 3 years old." C.) "There is no medical reason to continue measuring the child's head as long as our office does, we just do it for insurance purposes." D.) "Measuring the child's head is a discreet way to assess for child abuse." - Answer: B pg. 122 (textbook, 6th edition) The head circumference of infants and young children is routinely measured until 2 to 3 years of age to ensure that adequate growth for brain development has occurred. Siri is an eight year old girl who has a broken arm with a cast. She understands that this is not a permanent change, she knows the cast will eventually be removed and that her arm will go back to normal. Which of the following developmental theories is she exhibiting? a. The concept of Self Efficacy b. Piaget's developmental stage termed the formal operational stage c. The concept of conservation d. Erikson's identity vs role confusion stage - The answer is c. the concept of conservation. Principles of Pediatric Nursing p. 104. "During the school age years, the child learns the concept of conservation (that matter is not changed when its form is altered). At earlier ages a child believes that when water is poured from a short, wide glass into a tall, this glass, there is more water in the taller glass. The school-age child recognizes that although it may look like the taller glass holds more water, the quantity is the same." "The school-age child understands that an incision will heal, that a cast will be removed, and that an arm will look the same as before once the intravenous infusion is removed." You are the nurse to four patients at a pediatric clinic. Of the following patients, choose the patient you would make priority. A. Twelve month old female visiting for a check up with a respiratory rate of 39 and diaphragmatic breathing. B. Thirteen month old male Caucasian with a new 7 cm dark bluish patch on his sacrum that his mother repeatedly says is caused by his twin brother rough housing with him. C. Fourteen month old male with soft and flat anterior fontanel and pink and moist mucous membranes. D. Three month old female that gets startled by loud noises with pulse of 115. - Answer: B-Cannot find a specific page in the book, but in lecture it was mentioned that if a parent that keeps repeating a sibling caused injury outside of age group abilities, it is most likely false and abuse may be present (if quickly reading this seems like Mongolian spot).This is the child you would want to thoroughly assess for signs of abuse. With A: A 1 year old's normal respirations are 25-40 respirations per minute so 39 is within normal range and diaphragmatic breathing is normal for this age (pg 135, 137). With C: Fontanels close between 12 and 18 months and are normally soft and flat, this boy has normal anterior fontanel (pg 124). With D: Only infants experience hearing loss do not get startled by loud noises and 115 is within normal range for an infant (pg 129, 140) When instructing patients and adolescents on the practices of proper sleep hygiene, which statements should the nurse include in the teaching? Select all that apply. A. Go to bed and get up around the same time each day, even on weekends. B. Sleep can be made up by sleeping in C. Gradually slow down activity an hour or two before bedtime D. Establish a consistent bedtime routine to prepare for sleep E. Take naps in the late afternoon or evening if you are tired. - Answer: A,C,D-- Pg. 189-Parents Want To Know- There are simple behaviors that can help promote adequate sleep such as going to bed and waking up at the same time every day, establishing a bedtime routine and a "wind-down" period a couple of hours before bed. B is incorrect because sleep that is "lost" cannot be "made up". E is not correct because taking naps during the late afternoon or evening interrupts the normal sleep pattern and routine. A six year old child has been admitted to the hospital awaiting surgery for an I&D (incision and drainage) of a left lower extremity abscess. Upon assessing the patient, the nurse listens to the child's heart and notices an irregular rhythm. What should the nurse do first in this situation? A. Call the Physician immediately and notify him of the heart rate rhythm irregularity. B. Ask the child to take a deep breath and hold it while you listen to his/her heart rate. C. Continue assessing the patient and when you have finished, call the Physician. D. Ask the parent if he/she knows that the child has an irregular heart rhythm. - Answer: B Page 125 (New Book) Children often have a normal cycle of irregular rhythm associated with respiration called sinus arrhythmia in which the child's heart rate is faster on inspiration and slower on expiration. When any rhythm irregularity is detected, ask the child to take a deep breath and hold it while you listen to the heart rate. The rhythm should become regular during inspiration and expiration. Other rhythm irregularities are abnormal. Your patient is a 15 year old female admitted to the hospital with pneumonia. According to Piaget, which nursing application is acceptable when taking care of this patient? A. Provide a separate recreation room for teens who are hospitalized. B. Take health history and perform examinations without parents present. C. Give clear and complete information about health care and treatment, also provide both written and verbal instructions. D. Introduce adolescent to other teens with the same health problem. - C, you should give clear and complete information about health care and treatment and also make both written and verbal instructions available. Found in the textbook (new edition) pg. 71 table 4-3. A 5 month old baby is sleeping in his crib when suddenly he hears a loud boom. In response, his arms and hands straighten and knees flex. The reaction the baby had is referred to as the _______. A) Babinski Reflex B) Knee Jerk reflex C) Moro Reflex D) Tonic Neck Reflex - The answer is C) Moro Reflex. The Moro Reflex: Elicited when the new born is startled by a loud noise or lifted slightly above the crib and then suddenly lowered. In response the new born straightens arms and hands outward while the knees flex. Slowly the arms return to the chest, as in an embrace. The fingers spread, forming a C, and the newborn may cry. This reflex may persist until 6 months of age. Principles of Pediatric Nursing, Page 139, Table 5-20 The mother of a 5yr old states "I can not get him to stop sucking on a pacifier." What is the nurses best response? A This is normal he will grow out of it B Thumb sucking is harmful at his age c try giving your child different options such as rubbing a blanket D My mother told me to put vinegar on the pacifier. this worked for me - Answer C pg. 171. parents can promote the process of stopping thumbsucking and pacifier use by praising a child for not doing it and offering alternative comforting measures. A two-year-old is brought by his parents to the ER for a high fever, nausea, vomiting, and diarrhea. He is found to be severely dehydrated and is admitted to the pediatric floor. After several hours of IV fluid and antibiotics, the physician orders follow-up lab work. What would the nurse do when performing these procedures? Select all that apply. A. Explain the procedure to the child and parents as soon as the doctor orders it B. Make the child feel comfortable by offering a favorite drink or toy C. Explain to the parents and child that you are using a 23-gauge butterfly and explain the different lab tests that will also be completed D. Allow the child to cry E. Reward the child with a sticker and praise after the procedure - Answer: B,D,E pg 87 (new book), table 4-14. Communicating with a toddler. A is incorrect because you want to avoid telling the child about the procedure too far in advance as they can become very anxious and upset. C is incorrect because you want to use simple terminology such as "I need to get a little blood so we can see if you are getting better." B,D,E are correct ways to communicate with a toddler and help calm them before, during, and after a procedure such as a blood draw. A mom notices her 1 month old infant is extremely cranky, has a rectal temp. of 100.6, and a rash across her abdominal region. What should the mom do first? A. administer antipyretics B. give baby a tepid bath to reduce fever C. call physician D. turn on netflix and hope it all goes away - Answer: C pg.182 "Families want to know", instruct parents to call provider if rectal temp is higher than 100.4, skin rash appears, or baby is unusually irritable. Antipyretics and a tepid bath are both good ideas but the physician should be notified first. A preschool child wakes up from surgery and begins trying to pull out the IV line because he believes it is causing all the pain he has experienced. The nurse should consider which characteristic of preoperational thought to better understand what this preschool child is thinking in this situation. A. Egocentrism B. Transductive reasoning C. Centration D. Animism - Answer B. Transductive reasoning is when a child connects two events in a cause and effect relationship simply because they occur together in time. The child believes all the pain from surgery is related to the I.V. line. The nurse may try to explain that it is not or if the I.V. is not absolutely necessary perhaps it could be removed. Page # 89. A nurse is educating a parent regarding the psychosocial stage of development for their 2 week old baby. Which of the following information did the nurse include in the discussion? A. Infants should be disciplined whenever they cry or don't listen B. Parents should let their baby cry themselves to sleep C. Infants should have their needs met in a timely manner D. Comfort the child by providing food, clean clothing and limited touch - Answer: C pg 80-81 Erickson's theory of psychosocial development during the infancy stage is "Trust Versus Mistrust". The task of the first year of life is to establish trust in the people providing care. Trust is fostered by provisions of food, clean clothing, touch (not limited) and comfort. If basic needs are not met, the infant will eventually learn to mistrust others. Parents who meet their babies needs in a timely manner are promoting a sense of trust with them. A 4-year-old girl and her mother are in the pediatrician's office for a well-child check. The girl clutches her doll and hides her face as she sits on her mother's lap. She doesn't want her vital signs taken. What is the best way to facilitate her cooperation? A. Speak to the mother, tell the mother the child is old enough to understand and make her obey. B. Smile, ask the child if she'd like to hold your stethoscope, show her how to listen to her doll's heart. Take turns using the stethoscope and listen to her heart at this time. C. Promise her a piece of candy and a sticker if she lets you listen to her heart. D. Show the child and mother all of the equipment in the room and explain how they'll be used to take her vital signs. - Answer: B. pp.101-102. The preschool child uses associative and dramatic play as part of her developmental growth. By allowing the child to handle medical equipment, using dramatic play and remaining on her mother's lap, this will not only give her time to acclimate to her surroundings, but it will build trust for future interactions. A 17-year-old teenage boy asked his father why he could not invite friends over to play video games. His father says "because this is my house and I told you so". What is the parenting style that this father displays? A. Permissive B. Authoritarian C. Authoritative D. Indifferent - Answer: B pg. 22-23 (Table 2-2) (new textbook). Authoritarian parents demonstrate high control and low warmth. The behavior of the parent is highly controlling, issues commands and expects them to be obeyed, little communication with the child, inflexible rules and permits little independence. Therefore boys often are rebellious and aggressive. A 1 year old male is brought to the clinic for nausea and diarrhea. The nurses assesses his vital signs, which are: respirations of 34, heart rate of 125 BPM, O2 Sat of 97% and a temp of 101.6. What should the nurse do first? A. Administer oxygen B. Administer a hypotonic solution C. Administer a antipyretic D. Assist the child with a rebreathing bag - Answer is C. Providing the doctor gives the order, antipyretics would be the top priority in this situation. There is no indication that a hypotonic solution is required. The O2 sat is within range, as is the respirations and pulse rate for this age. Text book Table 5-9 on page 122 a one year old respirations are normal withing 25-40 RPM. Table 5-11 on page 125 Heart rate is within range 80-130. (of the new book) Sophie is a 9 year-old girl who's older sister was hospitalized due to a serious illness. She is in stable condition, but cannot communicate and is hooked up to lots of machines that scare Sophie. What strategies can the nurse implement to assist Sophie in understanding what is happening with her sister? SELECT ALL THAT APPLY A. Allow her to ask questions and discuss fears and other feelings she may be having. B. Tell her not to worry because the doctors and nurses are going to make her sister all better. C. Avoid the truth as the details of why her sister is hospitalized or what her treatment will involve may scare Sophie. D. Assure Sophie that she did not cause the illness and that her sister isn't sick because she was bad. E. Tell Sophie it is ok to express her feelings about how her sister's hospitalization has disrupted her family's life. - Answer: A, D, & E. from pg. 227 "Families Want to Know" A. Allow the siblings to ask questions and discuss fears and other feelings. B. is incorrect because that is false reassurance, and even the best care can still result in a lost life or a return to "normal" may not be possible. C. is incorrect because the nurse should be truthful. Explain why the child is hospitalized, what the treatment involves, and how long the hospitalization is expected to last. With respect to the child's cognitive level. D. Assure siblings that they did not cause the illness and that the hospitalized child did nothing wrong. If a sibling had some involvement in or responsibility for the health crisis, referral for mental health counseling may be needed. E. Encourage siblings to express their feelings related to the disruptive effect of the child's hospitalization on family life. Nurse Natasha is assessing Gerald, a 5 month old baby boy. As the nurse palpates the infants skin, she notes, "skin cool, soft, dry and doughy". What is abnormal about this skin assessment? A. Temperature B. Texture C. Moistness D. Resilience - Answer: D The infants skin should be taut, elastic and mobile because of the balanced distribution of intracellular and extracellular fluids. To evaluate the skin turgor, pinch a small amount of skin on the abdomen between the thumb and forefinger, release the skin, and watch the speed of recoil (Figure 5-3). Skin that is elastic rapidly returns to its previous contour and is expected. Skin that tents or feels doughy takes longer to resume its original contour and is commonly associated with dehydration. Textbook: Principles of Pediatric Nursing (page 106) A first time mom is at the pediatrician's office for her daughters four month old checkup. The mother voices concern about her daughter not being able to sit up yet. How should the nurse respond to the concerned mother? A) "It just takes time, babies do what they want, when they want". B) "Most babies do not start sitting up without support around nine months of age". C) "I would recommend that you start seeking therapy now, you don't want that baby falling behind". D) "Babies tend to start sitting up at the age of 6 months, no need to worry". - Answer B. Page 133 table 5-14 (new book) For gross motor milestones, babies around nine months of age, start getting into the sitting position and sits without support. The nurse is providing teaching to a mother of a 6 month old infant regarding the proper way to give feedings and have a balanced nutrition for the infant. Which of the following would be the best way to teach the mother how to provide nutrition to her baby appropriately. Select all that apply. A. Introduce soft finger foods B. Introduce a cup for drinking instead of a bottle C. Give slivers of meats periodically to the child D. Provide the mother with information of the fluorination of water for the child E. Breastfeeding is the only way the infant will get proper nutrition - Answer: A, B, D. The importance of nutrition in the first year of life is detrimental to the growth and development of the infant. The birth weight will triple before the end of the first year of life. Parents will need to know how to properly provide nutrition at the appropriate developmental milestone. See chart 7-1 on page 138 in Principles of Nursing 6th edition. Anne is a 4 year old girl admitted to your pediatric floor with RSV. According to Erikson, which of the following nursing applications would be appropriate while caring for Anne? Select all that apply. A). Offer medical equipment for play to lessen anxiety about strange objects B). Encourage parents to leave the room during treatment C). Accept the child's choices and expressions of feelings D). Be alert to children who appear more comfortable with male or female nurses, and try to accommodate them. E). Show the child equipment that will be used during treatment - Answer: A, C, and D. According to Erikson, nursing applications should be focused on offering medical equipment for play to lessen anxiety about strange objects, be alert to children who appear more comfortable with male or female nurses, and try to accommodate them, and accept the child's choices and expressions of feelings. Found in textbook (old edition) page 81 table 4-3. Shirley brings her 6 month old daughter Heather into the ER with C/O N,V&D that started 12 hours ago. Although she has tried to give Heather Pedialyte, the baby has not been able to keep it down. She also reports changing the baby's diaper at least 4 times during this period with loose watery stools each time. While performing your physical assessment, you would expect to find Heather's anterior fontanelle to be A- Flat and firm B- Closed by this age C- Tense and bulging D- Soft and sunken - Answer is D- Soft and sunken, which indicates dehydration. A- Flat and firm is a normal finding, B- the anterior fontanelle closes between 12 and 18 months of age, C- Tense and bulging indicates increased intracranial pressure. Principles of Pediatric Nursing pg 109. Amanda,RN is preparing her 7 year old patient, Lilly for hospital admission due to pneumonia, she notices that Lilly is crying and keeps asking her mother when can she go home. How can Amanda help her patient to feel more comfortable and less afraid of being in the hospital? select all that apply a. provide an opportunity for Lilly to ask questions and give honest answers b. tell Lilly it will all be over soon and she will be home before she knows it c. explain all procedures and expectations d. give Lilly an chance to express her fears e. continue to provide care and hope that Lilly calms down once she is settled in - Answers: A,C,D (page 256 old text book) Assist child and family who are not prepared for a hospital admission to adapt to the experience by orienting them to the environment, providing an opportunity for questions, offering truthful responses, and explaining all procedures and expectations. Discuss anticipated plan of care for the child and involve the family in the childs care. Give family an opportunity to express their fears and concerns. A mother takes 4 year old Easton to get his shots. RN Lacy walks in the room and Easton starts crying. He asks the nurse "Is this going to hurt"? What should RN Lacy's response be? A. Not unless you're a wimpy baby. B. Yes, it may hurt but you can cry and afterwards you can pick out a sucker. C. Oh yes, definitely. Shots are awful. D. Yes, but shots are necessary and will save you from getting really sick in the future. - B. Chapter 11 Power Point Table 11-8 While working on the floor of a hospital, you have four new patients admitted. One is a 15-year-old boy with the flu, a 3-year-old girl with a UTI, a 30-year-old pregnant female with preeclampsia, and a 73-year-old male with pneumonia. Which of these patients is at the highest risk for a stressful experience? A. 15-year-old boy B. 30-year-old pregnant female C. 3-year-old girl D. 73-year-old male - Answer: C Pg 223 (New Textbook). Toddlers are the group most at risk for a stressful experience as a result of illness and hospitalization. This group is old enough to understand that their routine has been disrupted, but they do not understand why. The nurse's role in caring for a child with a chronic condition include the following: A. providing health supervision from infancy transition into adulthood B. Collaborating with multidisciplinary healthcare teams C. Partnering with parents or caregivers to manage the child's care at home D. Referring the family to appropriate community services E. Include the parents in procedures and allow the parent to assistant in efforts to hold down the child. - Answer: ABCD page 248 in the new book under role's of the nurse with chronic conditions. E is incorrect because even though it is best to include parents in the care of their child, the parent should not be asked to help hold a child down during a procedure the medical staff is performing. Karen is a new nurse to the pediatric floor and she will be receiving a new admit to the floor soon. The doctors orders indicate that an IV must be started on arrival. Which statements made by the nurse would indicated no further education is needed on IV administration? A. Central lines are commonly used for short-term intravenous medication therapy. B. Common infusion sites include hands and feet, although scalp veins are sometimes used in infants. C. Infusion pumps require frequent monitoring. D. Never check or maintain the IV site, It will irritate the patient. E. Syringe pumps are often used to administer medications when minimal fluid is to be given to a patient. - Correct Answers: BCE. page 233 ( Table 11-7) Variations in Medication Administration to Children. A is incorrect because:Central lines are commonly used for long-term intravenous medication therapy. D is incorrect because: Careful maintenance of sites is needed. Susan is an 8 year old that has fallen off of the swings in her backyard and injured her arm. Susan's mother Mary, is at work so Bob (Mary's boyfriend) takes Susan to the ER for treatment. Susan's father learns of the accident and meets everyone at the ER. Who has the legal authority to give informed consent for Susan's treatment? A. Susan B. Susan's father C. Boyfriend with a letter of proxy D. Since this is not an emergency, no consent needed - Answer: C pg 13 (old textbook). When parents are divorced and have joint custody either parent my give consent. However, (in some states) when only one parent has custody, the other does not have legal authority to give consent. The proxy consent granted in writing to the boyfriend allows him to legally give consent. If this were an emergency ( to preserve life or limb) consent is not required. The nurse is providing pre-op care for 3 year old male patient that is to undergo an appendectomy later this morning. Which of the following does the nurse know is a stressor/fear for him during his hospital stay? select all that apply A. Patient beliefs his guts are going to fall out of his stomach when they cut him open. B. He is going to have this tube in his arm the rest of his life C. He is afraid his body will be ugly after surgery. D. Separation from friends at school. E. There are monsters in the hospital that will hurt him if his parents leave his side. - Answer: A, B, E Pg 250 old book C is incorrect, while the toddler is fearful of injury and pain to his body, it is not until Adolescents that the fear of disfigurement, scaring come into play. D is incorrect: The toddler and preschooler fear separation from parents, while the school age and adolescent fear separation from friends. A 9 year old boy is having his tonsils removed. His mother, step-dad, and sister on in the room with him for comfort before his surgery. The surgeon has explained the procedure to him and his parents. You as the nurse have the consent form ready to be signed. Who is the most appropriate person to sign the consent? A. 9 year old patient B. anyone in the room with the patient C. His mother D. His step dad - C. His mother should be the person to give consent for surgery. If it was an emergency consent would not be required. (chp 1 powerpoint handout pg 9) A 2-year-old patient is sitting with their mother as two nurses enter the patient's room. The mother sits the child on the bed and walks to the other side of the room so the nurses can give the patient a shot. The patient begins to scream and cry. The nurses try to comfort the patient, but the patient resists. With developmental stages and stressors in mind for the toddler group, this patient is displaying stages of: A. Bodily injury or mutilation B. Loss of self-control C. Stranger anxiety D. Separation anxiety - The answer is D: Separation anxiety. Tables 11-1 & 11-2, Ch. 11 of Principles of Pediatric Nursing A family comes in to get their 12-year old son's eyes tested before he starts school. As the nurse, what are some of the procedures you may utilize when using a standardized vision chart in this situation? (select all that apply) A. use the Snellen-E chart to assess the child's vision B. Make the child stand between 10-20 feet away from the vision chart C. Tell the child to put both of his hands by his sides so that he is not distracted while doing the test D. Utilize the Snellen Letter chart for this child E. refer the family to an appropriate eye clinical - correct answer: B , D Why A,C,E are wrong: The Snellen E chart is used for preschool age children; The child should cover one eye at a time so that each eye can be individually assessed; & eye exams are something that can be conducted at the pediatric clinic