Peds Test #1
-Focus was on a particular type of cognitive
development concerned with moral decisions.
-He presented stories involving moral dilemmas to children and adults and asked them to
solve the dilemmas.
-Based on the explanations given, he established three levels of moral reasoning.
Although he provided age guidelines, he stated that they are approximate and that many
people never reach the highest (post-conventional) stage of development - ANS
Kohlberg's Theory of Moral Development
\-Infant and toddler vital sign measurement sequence - ANS 1. Respirations
2. Apical Heart Rate
3. Blood pressure
4. Temperature
*-Count respirations (1st) (before disturbing the child)
-Infants: count for one minute
-Infants are episodic breathers; it is normal for them to vary their respiratory rate and
pattern
-Infants use abdominal/diaphragmatic muscles more
-Older children (>6 yrs) rely more on thoracic/intercostal muscles
-Count apical heart rate (2nd)
-Infants/young children: count for one minute
-> 2 years of age: ok to use radial pulse
-Measure blood pressure (3rd)
-Measure temperature (LAST)
\-Non-pharm techniques provide coping strategies that help decrease pain perception
-Examples of non-pharmacologic techniques - ANS -Positioning, swaddling -Breathing,
relaxation techniques
-Splinting -Calm environment (low noise, reduced lighting)
-Heat or cold application -Distraction (video games, cartoons, videos)
-Being held or rocked -Sucrose pacifiers for infants during procedures
-Biofeedback -Guided imagery
-Positive self talk -Behavioral contracting
-Therapeutic exercise -Hypnosis
-Massage -Acupuncture
\-Plan the nursing care for an infant or child in acute pain that integrates pharmacologic
interventions and developmentally appropriate nonpharmacologic (complementary)
therapies. - ANS Mild Pain
-Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS)
Moderate to Severe Pain
-Acetaminophen/opioid combination (vicodin, tylenol #3)
,-Opioids
-Combination of nonopioids and opioids:
-Treats pain centrally (opioids) and peripherally (nonopioids)
- Provides increased analgesia with less adverse effects
-Coanalgesics or adjuvants
-Used alone or with opioids to control pain symptoms and opioid side effects
-Examples
-Diazepam (Valium), midazolam (Versed)-relieve anxiety, cause sedation and provide
amnesia
-Stool softners and laxatives for constipation
Antiemetics for n/v
-Diphenhydramine-itching
-Transmucosal and transdermal
-Numby Stuff
-2% lidocaine with epinephrine 1: 100,000
-IV, PICC, implantable port needle insertion, LP
-Apply 10 min before procedure
-LidoSite Topical System
-Single prefilled patch filled with 10% lidociane and 0.1% epinephrine
-Apply 10 min before procedure
- *EMLA should be applied to skin 60 minutes before procedure
Non-pharm methods
-Gate Control Theory→Inhibitory neuron stimulation reduces pain sensation
-Can Enhance Effects of Analgesics
-Methods
-Distractions
-Stimulations
-Best pain management approaches are combination (esp. mod-severe pain)
-Non-pharm techniques provide coping strategies that help decrease pain perception
\(select all that apply)
Which of the following are milestones specific to the toddler stage of development?
-Walks alone, climb stairs
-Language development; no, dada, mama
-Explores environment, no understanding of danger
-Engages in parallel play
-Less protest at naptime, but dislikes bedtime - ANS -Walks alone, climb stairs
-Language development; no, dada, mama
-Engages in parallel play
,\A 4-year-old scores two failures on the Denver
II. Which of the following statements is most accurate?
-The child is not as intelligent as expected for age and should be referred to a learning
specialist.
-The child has a speech problem and should be referred to a speech therapist.
-The child is at risk for school problems and should be retested.
-The failures are to be expected in preschoolers who may not be cooperative with testing.
- ANS The child is at risk for school problems and should be retested.
\A 6-month-old child returns from surgery. PRN
orders are available for pain management. The nurse would administer the pain
medication when the baby is observed:
-Crying loudly, grimacing, restlessness.
-Displaying a change of color, decreased temperature.
-Demonstrating shortness of breath, lack of responsiveness.
-Sleeping more, refusing to eat. - ANS Crying loudly, grimacing, restlessness.
Rationale:
A child's response to pain depends on his or her developmental stage. The infant is
unable to describe or quantify pain because of limited vocabulary. Infant behaviors, such
as crying, facial expressions, and change of activity are used to identify pain and
distress.
\A 6-month-old infant is in for a well baby
check-up. Which of the following is an unexpected finding?
-There is no head lag when pulled to a sitting position.
-The baby vocalizes through babbling "baba baba".
-The baby passes a rattle from one hand to the other.
-No interest is shown in surroundings or in toys present. - ANS -No interest is shown in
surroundings or in toys present.
Rationale:
The developmental milestones for a 6-month-old infant include babbling with repetitive
sounds, interest in surroundings and toys, no head lag when pulled to a sitting position,
sitting with support, grasping objects and placing them in the mouth, transferring objects
from one hand to the other, and bearing weight on the legs when held in a standing
position.
\A mother asks the pediatric nurse about what she should begin to feed her 6-month-old
infant. The correct response is:
Egg whites are the least allergenic food to be introduced into the baby's diet.
Rice cereal is the first solid introduced that is least allergenic of the cereals.
Formula is the only source of nutrition given for the first year.
Fruits and vegetables are good sources of iron. - ANS Rice cereal is the first solid
introduced that is least allergenic of the cereals.
Introduction of solid food is recommended at age 4 to 6 months, when the
gastrointestinal system has matured sufficiently to handle complex nutrients. The suck
, reflex and tongue-thrust reflex diminish at 4 months of age. Rice cereal is the first solid
food because it is a rich source of iron and rarely induces allergic reactions.
**Fruits and vegetables, good sources of vitamins and fiber, are introduced after cereal,
one at a time to determine allergic reactions. Egg whites are highly allergenic.
\A mother of a 4-year-old tells the nurse that
her son is a "picky eater." The nurse should inform the mother that she should:
Increase the amount of carbohydrates in the daily menu plan.
-Administer vitamins twice a day to her child.
-Be more concerned with the quantity of food than the quality of food.
-Recognize this is common for preschoolers as their caloric requirements have
decreased slightly. - ANS -Recognize this is common for preschoolers as their caloric
requirements have decreased slightly.
-The preschooler will be influenced by others' eating habits and demonstrate their likes
and dislikes for food preferences. The caloric requirement decreases slightly, to 90
kcal/kg/day. Quality, not quantity, is important. It is not necessary to give vitamins after
infancy unless the child is at nutritional risk.
\A nurse assesses the height and weight measurements on an infant and documents
these measurements at the 75th percentile. The nurse notes that the measurements two
months ago were at the 25th percentile. How should the nurse interpret these data?
-The infant is not gaining enough weight.
-The infant has gained a significant amount of weight.
-The previous measurements were most likely inaccurate.
-These measurements most likely are inaccurate. - ANS -The infant has gained a
significant amount of weight.
Rationale:
A comparison of these two sets of measurements shows that the infant has crossed two
percentiles, going from the 25th to the 75th percentile, and therefore has gained a
significant amount of weight. This rationale makes all other answers incorrect.
\A pediatric healthcare nurse visit should include:
-Family-centered care and partnership for primary care provision.
-Different nurses for each visit to gather different perspectives.
-Instruction on how to raise children according to U.S. norms.
-Brief record keeping to prevent other staff from accessing the information. - ANS
-Family-centered care and partnership for primary care provision.
Rationale:
Pediatric home healthcare visits by the nurse should be family-centered, a trusting
relationship, provision of unbiased information, primary care of acute and chronic
conditions, continuously available care with nurse continuity, referrals as needed with
care coordination, maintenance of comprehensive records, and provided in a culturally
appropriate manner.
\A teenager refuses to wear the clothes his mother bought for him. He states he wants to
look like the other kids at school and wear clothes like they wear. The nurse explains this
behavior is an example of teenage rebellion related to internal conflicts of:
-Focus was on a particular type of cognitive
development concerned with moral decisions.
-He presented stories involving moral dilemmas to children and adults and asked them to
solve the dilemmas.
-Based on the explanations given, he established three levels of moral reasoning.
Although he provided age guidelines, he stated that they are approximate and that many
people never reach the highest (post-conventional) stage of development - ANS
Kohlberg's Theory of Moral Development
\-Infant and toddler vital sign measurement sequence - ANS 1. Respirations
2. Apical Heart Rate
3. Blood pressure
4. Temperature
*-Count respirations (1st) (before disturbing the child)
-Infants: count for one minute
-Infants are episodic breathers; it is normal for them to vary their respiratory rate and
pattern
-Infants use abdominal/diaphragmatic muscles more
-Older children (>6 yrs) rely more on thoracic/intercostal muscles
-Count apical heart rate (2nd)
-Infants/young children: count for one minute
-> 2 years of age: ok to use radial pulse
-Measure blood pressure (3rd)
-Measure temperature (LAST)
\-Non-pharm techniques provide coping strategies that help decrease pain perception
-Examples of non-pharmacologic techniques - ANS -Positioning, swaddling -Breathing,
relaxation techniques
-Splinting -Calm environment (low noise, reduced lighting)
-Heat or cold application -Distraction (video games, cartoons, videos)
-Being held or rocked -Sucrose pacifiers for infants during procedures
-Biofeedback -Guided imagery
-Positive self talk -Behavioral contracting
-Therapeutic exercise -Hypnosis
-Massage -Acupuncture
\-Plan the nursing care for an infant or child in acute pain that integrates pharmacologic
interventions and developmentally appropriate nonpharmacologic (complementary)
therapies. - ANS Mild Pain
-Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS)
Moderate to Severe Pain
-Acetaminophen/opioid combination (vicodin, tylenol #3)
,-Opioids
-Combination of nonopioids and opioids:
-Treats pain centrally (opioids) and peripherally (nonopioids)
- Provides increased analgesia with less adverse effects
-Coanalgesics or adjuvants
-Used alone or with opioids to control pain symptoms and opioid side effects
-Examples
-Diazepam (Valium), midazolam (Versed)-relieve anxiety, cause sedation and provide
amnesia
-Stool softners and laxatives for constipation
Antiemetics for n/v
-Diphenhydramine-itching
-Transmucosal and transdermal
-Numby Stuff
-2% lidocaine with epinephrine 1: 100,000
-IV, PICC, implantable port needle insertion, LP
-Apply 10 min before procedure
-LidoSite Topical System
-Single prefilled patch filled with 10% lidociane and 0.1% epinephrine
-Apply 10 min before procedure
- *EMLA should be applied to skin 60 minutes before procedure
Non-pharm methods
-Gate Control Theory→Inhibitory neuron stimulation reduces pain sensation
-Can Enhance Effects of Analgesics
-Methods
-Distractions
-Stimulations
-Best pain management approaches are combination (esp. mod-severe pain)
-Non-pharm techniques provide coping strategies that help decrease pain perception
\(select all that apply)
Which of the following are milestones specific to the toddler stage of development?
-Walks alone, climb stairs
-Language development; no, dada, mama
-Explores environment, no understanding of danger
-Engages in parallel play
-Less protest at naptime, but dislikes bedtime - ANS -Walks alone, climb stairs
-Language development; no, dada, mama
-Engages in parallel play
,\A 4-year-old scores two failures on the Denver
II. Which of the following statements is most accurate?
-The child is not as intelligent as expected for age and should be referred to a learning
specialist.
-The child has a speech problem and should be referred to a speech therapist.
-The child is at risk for school problems and should be retested.
-The failures are to be expected in preschoolers who may not be cooperative with testing.
- ANS The child is at risk for school problems and should be retested.
\A 6-month-old child returns from surgery. PRN
orders are available for pain management. The nurse would administer the pain
medication when the baby is observed:
-Crying loudly, grimacing, restlessness.
-Displaying a change of color, decreased temperature.
-Demonstrating shortness of breath, lack of responsiveness.
-Sleeping more, refusing to eat. - ANS Crying loudly, grimacing, restlessness.
Rationale:
A child's response to pain depends on his or her developmental stage. The infant is
unable to describe or quantify pain because of limited vocabulary. Infant behaviors, such
as crying, facial expressions, and change of activity are used to identify pain and
distress.
\A 6-month-old infant is in for a well baby
check-up. Which of the following is an unexpected finding?
-There is no head lag when pulled to a sitting position.
-The baby vocalizes through babbling "baba baba".
-The baby passes a rattle from one hand to the other.
-No interest is shown in surroundings or in toys present. - ANS -No interest is shown in
surroundings or in toys present.
Rationale:
The developmental milestones for a 6-month-old infant include babbling with repetitive
sounds, interest in surroundings and toys, no head lag when pulled to a sitting position,
sitting with support, grasping objects and placing them in the mouth, transferring objects
from one hand to the other, and bearing weight on the legs when held in a standing
position.
\A mother asks the pediatric nurse about what she should begin to feed her 6-month-old
infant. The correct response is:
Egg whites are the least allergenic food to be introduced into the baby's diet.
Rice cereal is the first solid introduced that is least allergenic of the cereals.
Formula is the only source of nutrition given for the first year.
Fruits and vegetables are good sources of iron. - ANS Rice cereal is the first solid
introduced that is least allergenic of the cereals.
Introduction of solid food is recommended at age 4 to 6 months, when the
gastrointestinal system has matured sufficiently to handle complex nutrients. The suck
, reflex and tongue-thrust reflex diminish at 4 months of age. Rice cereal is the first solid
food because it is a rich source of iron and rarely induces allergic reactions.
**Fruits and vegetables, good sources of vitamins and fiber, are introduced after cereal,
one at a time to determine allergic reactions. Egg whites are highly allergenic.
\A mother of a 4-year-old tells the nurse that
her son is a "picky eater." The nurse should inform the mother that she should:
Increase the amount of carbohydrates in the daily menu plan.
-Administer vitamins twice a day to her child.
-Be more concerned with the quantity of food than the quality of food.
-Recognize this is common for preschoolers as their caloric requirements have
decreased slightly. - ANS -Recognize this is common for preschoolers as their caloric
requirements have decreased slightly.
-The preschooler will be influenced by others' eating habits and demonstrate their likes
and dislikes for food preferences. The caloric requirement decreases slightly, to 90
kcal/kg/day. Quality, not quantity, is important. It is not necessary to give vitamins after
infancy unless the child is at nutritional risk.
\A nurse assesses the height and weight measurements on an infant and documents
these measurements at the 75th percentile. The nurse notes that the measurements two
months ago were at the 25th percentile. How should the nurse interpret these data?
-The infant is not gaining enough weight.
-The infant has gained a significant amount of weight.
-The previous measurements were most likely inaccurate.
-These measurements most likely are inaccurate. - ANS -The infant has gained a
significant amount of weight.
Rationale:
A comparison of these two sets of measurements shows that the infant has crossed two
percentiles, going from the 25th to the 75th percentile, and therefore has gained a
significant amount of weight. This rationale makes all other answers incorrect.
\A pediatric healthcare nurse visit should include:
-Family-centered care and partnership for primary care provision.
-Different nurses for each visit to gather different perspectives.
-Instruction on how to raise children according to U.S. norms.
-Brief record keeping to prevent other staff from accessing the information. - ANS
-Family-centered care and partnership for primary care provision.
Rationale:
Pediatric home healthcare visits by the nurse should be family-centered, a trusting
relationship, provision of unbiased information, primary care of acute and chronic
conditions, continuously available care with nurse continuity, referrals as needed with
care coordination, maintenance of comprehensive records, and provided in a culturally
appropriate manner.
\A teenager refuses to wear the clothes his mother bought for him. He states he wants to
look like the other kids at school and wear clothes like they wear. The nurse explains this
behavior is an example of teenage rebellion related to internal conflicts of:
