PEDIATRIC NURSING CERTIFICATION Exam 74 Questions with Verified Answers,100% CORRECT

PEDIATRIC NURSING CERTIFICATION Exam 74 Questions with Verified Answers Alert: Parents should be assured that they c - CORRECT ANSWER ALERT:PARE - CORRECT ANSWER The principals of growth and development include - CORRECT ANSWER each child grows and develops according to a general orderly pattern that tends to resemble that of others of the same age, sex and nationality. The principles of growth and development include - CORRECT ANSWER Development proceeds in a cephalocaudal and proximodistal manner. The principles of growth and development include - CORRECT ANSWER Growth and development are interrelated and interdependent. The principles of growth and development include - CORRECT ANSWER Development proceeds general to specific (crawling,walking, skipping) The period of greatest growth is - CORRECT ANSWER Birth to 1 year (1 year/triple birthweight) weight of average newborn - CORRECT ANSWER 7 lbs. weight of average 5 month old - CORRECT ANSWER (doubles birth wt.) 14 lbs weight of average 1 year old - CORRECT ANSWER (triples birth wt.) 21 lbs BMI parameter in children and adolescents indicate the following: - CORRECT ANSWER >- 95%=obese 85%-95% = overweight <5%=Underweight Weigh children 2 years of age on a - CORRECT ANSWER standing scale wearing a gown or light clothing. Length of average newborn - CORRECT ANSWER 20 inches Growth in first year - CORRECT ANSWER 10 inches Birth length doubles at - CORRECT ANSWER 4 years of age Children younger than 24 months should NOT be measured standing because - CORRECT ANSWER the height growth chart does not include children under 2 years When standing, children should be measured while standing against a hard surface; - CORRECT ANSWER their heels, buttocks, shoulders, and head should make contact with the surface. Alert: Children under 36 months who are measured standing up and whose height is then plotted on a length growth chart will appear proportionally shorter. - CORRECT ANSWER Conversely, children over 24 months whose length is measured and then plotted on a height growth chart will appear disproportionately taller. The reason for this is that infants and toddlers have an exaggerated lumbar lordosis (curvature), that straightens when they lie down for linear growth assessment. Findings that require further evaluation include: - CORRECT ANSWER crossing multiple percentiles over a short period of time, measurement at or below the 5th percentile, and a BMI of greater than 85%. How to measure the head circumference - CORRECT ANSWER Place the tape measure over the brow and around the most prominent portion of the head to obtain the largest head circumference. Respiratory rate and pulse rate decreases and BP increases with - CORRECT ANSWER age Infants are diaphragmatic breathers therefore - CORRECT ANSWER their breathing may be irregular, so count for a full minute. Infants are____________ breathers - CORRECT ANSWER obligate nose breathers Newborn Respiratory Rate is - CORRECT ANSWER newborn rate = 35/min (range = 32-60/min) - CORRECT ANSWER 25/min Respiratory rate for 10 years = - CORRECT ANSWER 19/min BP readings vary with cuff width; a cuff that is too large will yield a lower BP and - CORRECT ANSWER a cuff that is too narrow will result in an increased BP BP cuff bladder width should be ______% of arm circumference and located ________________ - CORRECT ANSWER 40% midway between the olecranon and the acromion The BP cuff bladder should cover ____% of the arm - CORRECT ANSWER 80%-100% of the circumference of the arm A developmentally appropriate 3 1/2 year old child is likely to be most fearful of which of the following activities? - CORRECT ANSWER CXR/Rectal temp/Bed bath by RN/BP? rectal temp. Pain is a symptom that occurs when.. - CORRECT ANSWER whenever a the child says it does/all reports of pain should be taken seriously. THE 5TH VITAL SIGN PAIN assessment: determine the intensity, type, location, duration, and circumstances of the pain then - CORRECT ANSWER assess whether the child can be distracted from the pain Pain assessment: assess fro crying, facial grimaces, restlessness, irritability, insomnia, anger, diaphoresis, increased pulse and respiratory rates, as well as... - CORRECT ANSWER decreased interactions and withdrawal, diminished appetite, fatigue, and behavioral changes - CORRECT ANSWER CRIES neonatal postoperative pain measurement scale...measures crying, oxygen saturation, heart rate, BP, expression, sleeplessness PAIN SCALES: infants and toddlers - CORRECT ANSWER FLACC Pain Assessment Scale: 1. For preverbal or nonverbal children 2. Assesses the FACE, LEGS, ACTIVITY, CRY, AND CONSOLABILITY PAIN SCALE for ages 1-5 - CORRECT ANSWER CHEOPS: CHILDRENS HOSPITAL OF EASTERN ONTARIO: cry, face verbal, torso, touch, and legs PAIN SCALE for ages 4-8 - CORRECT ANSWER FACES: 1. uses picture of 6 faces that range from happy because it doesn't hurt to hurts the most. 2. child over age 3 can select the face that best depicts his or her pain PAIN SCALES: for older children and adolescents (8 years and older that understand concept of numbers and rank order) - CORRECT ANSWER VISUAL ANALOG SCALE (straight line or numbered line that goes from no pain to the most pain possible NUMERIC SCALE (using 0 as no pain and 10 as worst pain imaginable 10 PAIN INTERVENTIONS: - CORRECT ANSWER punishment rt measures actions 4. stay w/child let child help w/procedure 5. give meds s delay 6. PCA as young as 5yrs 7. Morphine/Motrin 8. EMLA/lidocaine 9. oral sucrose-infants 10. doll PRINCIPALS OF AGE - CORRECT ANSWER MENTAL AGE: level of cognitive function When the child's mental age and chronologic age differ, provide toys, teach safety, and communicate on the basis of mental age. principals of age - CORRECT ANSWER BONE AGE the tarsals and carpals are X-rayed to determine the degree of ossification principals of age - CORRECT ANSWER adjusted/corrected age-chronologic age minus number of weeks born prematurely before 37wks/1st 2 years of life GROWTH AND DEVELOPMENT assessments - CORRECT ANSWER 1. Developmental history taking 2. Developmental screening 3. Growth measurement 4. Parent teaching regarding developmental milestones (ANTICIPATORY GUIDANCE) and what caretakers should do to promote physiologic, cognitive, and psychosocial development and safety. Developmental milestones fontanel/temp. - CORRECT ANSWER posterior fontanel closes at approximately 2 months/anterior 18m/poor ability to regulate temperature control because of poorly developed sweating and shivering mechanisms Developmental Milestones hearing/touch - CORRECT ANSWER Hearing and touch are well developed at birth; all infants should have a hearing test in the neonatal period, especially those who are receiving ototoxic medications Developmental milestones: vision - CORRECT ANSWER Vision is poor. Black and white are the colors best seen by the neonate (1st 28 days). The neonate begins to focus on nearby faces. By 3 months, the infant develops binocular vision; the eyes can follow an object 180'. Developmental Milestones: Weight - CORRECT ANSWER Birth weight doubles at 5 months.Birthweight triples by 12 months. Length increases by 50% from birth. Alert: Parents should be assured that they cannot spoil an infant. - CORRECT ANSWER It is important to hold and comfort a crying infant in order to meet basic needs for establishing trust. Development: 0-3 months - CORRECT ANSWER The social smile is the infant's first social response. It initiates social relationships, indicates memory traces, and signals the beginning of thought processes Notices own hands. Turns head to sound. rooting/moro reflex tonic neck-fencing Babinski no pillows see reflexes Reflexes: - CORRECT ANSWER rooting: stroke cheek and face turns Moro-Startle reflex- with loud noise or sudden movement, limbs extend, fingers spread Tonic Neck-Fencing-when supine with head turned to one side, arm and leg on that side will flex and arm and leg on opposite side of body will extend Babinski-stroke outer sole of foot from heel to ball of foot and toes will hyperextend 0-3 months - CORRECT ANSWER at age 3 months, most primitive reflexes begin to disappear except for the protective and postural reflexes no pillows in bed posterior fontanel closes at 2 months when held, the infant begins to hold up own head. protective and postural reflexes - CORRECT ANSWER Babinski Reflex - CORRECT ANSWER the last reflex to disappear; if present after 2 years, may indicate a CNS abnormality Anticipatory Guidance/Injury Prevention 0-3months - CORRECT ANSWER Crib safety: soft pillows, crib bumpers, blankets, and stuffed animals should not be placed in the crib as they pose suffocation hazards for the neonate. Anticipatory Guidance and Injury prevention: 0-3 months: SIDS - CORRECT ANSWER SIDS: Sudden infant death syndrome the sudden death of an infant in which a postmortem examination fails to confirm the cause of death: Place infants on their back to sleep. Sleeping on the side and stomach has been associated with increased rated of SIDS ALERT: The American Academy of Pediatrics recommends against co-sleeping because of its association with increased incidence of SIDS. - CORRECT ANSWER Peak age of SIDS is 3 months; higher incidence in premature infants and during winter and spring months. Anticipatory Guidance and Injury Prevention 0-3 months - CORRECT ANSWER Car seat: Car seats should be placed rear facing throughout infancy. Bath Safety: Constantly hold an infant in a bath tube b/c of the risk of drowning. Poisoning teaching - CORRECT ANSWER Ensure that poisons are kept in their original container. In the event of ingestion of a potentially hazardous substance, call poison control, give nothing by mouth, and avoid inducing vomiting because of potential harm to the upper gastrointestinal tract. Syrup of ipecac is no longer recommended. Diet and Nutrition 0-3 months - CORRECT ANSWER 0-3 months Breast milk or iron-fortified infant formula is the only nutritional requirement for infants in the first 4-6 months of life. Do not heat breast milk in microwave as the heat will destroy the immunoglobulins. Sufficient breast milk intake is monitored via appropriate weight gain and number of wet diapers; feedings occur approximately every 3 hours. 0-3mo Diet and Nutrition - CORRECT ANSWER 3-6 mo. Introduction of a cup can begin at 6 months Solid foods in the form of infant cereals not be introduced until 6 months of age to prevent the development of food allergies later in life. Fluoride supplements should start at 6 months for those without fluoridated community water or using bottled water Introduce new foods one at a time to identify food allergies. General nutrition guidelines for infancy - CORRECT ANSWER Give no more than 30oz. (900mls) of milk each day. Adequate fat intake is needed for myelinization of the brain; therefore, skim milk and 2% milk are not appropriate during the first 2 years of life. Diet and Nutrition/Feeding Guidelines - CORRECT ANSWER Vitamin D supplementation should be started at birth for breast-fed infants; it is already added to formula. Iron should be started at age 4 months because the iron stores received before birth are beginning to be depleted. Do not prop up a baby bottle; propping increases the risk of aspiration and otitis media. Guidance - CORRECT ANSWER The infant's gums should be wiped with a moist washcloth once per day. Discipline The infant understands the word "no". Limit setting can begin at age 10-12 months. Failure to Thrive FTT - CORRECT ANSWER SLEEP DISTRUBANCES: growth hormone is released during sleep. Assess for inadequate feeding techniques, such as bottle propping, insufficient burping, diluting formula, or giving too much water. Assess for degree of stimulation and parental knowledge of child development. Developmental Milestones ages 1-3years - CORRECT ANSWER Anterior fontanel closes by 18 months. Separation anxiety continues to be present from late infancy; often increases in intensity through the middle of toddlerhood. Toddler age 1-3 - CORRECT ANSWER Transitional objects such as special blankets and stuffed animals may ease the transition to sleep and being alone. The toddler exhibits magical thinking (believes that thoughts affect actions). Language and Communication/ALERT - CORRECT ANSWER By 12 m. the toddler uses five words By 18 m. the toddler uses up to 50 words but can point to objects when asked. By age 2yr., the toddler uses 400 words in 2-3 word phrases and comprehends many more words. At age 3, the toddler is a chatterbox, using about 11,000 words a day. THE TODDLER SHOULD TALK BY AGE 3; if not, seek further evaluation and assess the toddler's hearing. ALERT FOR TODDLER - CORRECT ANSWER The toddler should TALK by age 3y.; if not, seek further evaluation and assess the toddler's hearing. The toddler plants feet wide apart and WALKS by age 15 months; if not seek further evaluation. Developmental approaches to care - CORRECT ANSWER Avoid separation from parents; keep parent in child's line of vision. Toddlers are slow to warm up because of stranger anxiety. Allow time for the toddler to become acquainted with you. Talk in a friendly voice. Reactions to illness and hospitalization - CORRECT ANSWER The toddler may regress, losing milestones previously achieved. Provide choices where possible. Promote parental/caregiver presence and involvement. Car seat-after 2yrs or if they have outgrown the rear-facing weight or height limit for their car safety seat, they can use a forward-facing car safety seat with a harness. age 1-3years - CORRECT ANSWER prevent choking/aspiration: Avoid nuts, popcorn, hot dogs, grapes, hard candy and latex balloons. Toddler 1-3 years Diet and Nutrition - CORRECT ANSWER The toddler eats less than during infancy because of decreased growth rates. Portion size is 1 tsp. /year of age for each serving. The toddler feeds himself; provide finger foods to promote autonomy. Toddler age 1-3 years ALERT - CORRECT ANSWER The toddler, at age 12 months, should be changed from formula or breast milk to whole milk until at least age 2 years. Milk intake should be limited to 24 oz/day to assure intake of other nutritious foods. The fat content in whole milk is necessary for children up to 2 years of age to promote myelinization of the brain. Toddler issues - CORRECT ANSWER The toddler will have 20 deciduous teeth by 3 years of age. All toddlers should have a dental home and be evaluated every 6 months, starting at 12 months of age.