NURS 211L ATI Peds Proctored exam 2022/2023 – West Coast University | NURS211L ATI Peds Proctored exam – A Grade

NURS 211L ATI Peds Proctored exam (updated 2022/2023) – West Coast University ATI pediatrics proctored exam Chapter 1: Family centered nursing care 1. Parenting styles -Dictatorial or authoritarian: -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: -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: -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 -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 -Posterior fontanel: -Closes by 6-8 weeks -Anterior fontanel: -Closes by 12-18 months 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 Babinski Reflex Birth to 1 year Chapter 3: Health promotion of infants (2 days to 1 year) 1. Physical Development -Weight: -Doubled by 5 months -Tripled by 12 months -Quartered by 30 months -Height: -2.5 cm (1 in) per month for the first 6 months -Length: -Increases by 50% by 12 months -Dentition: -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 -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 -Begins around 4-8 months -Stranger Fear: ability to discriminate between familiar and unfamiliar people -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 -Iron-fortified cereal is the first to be introduced -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: -Ripe bananas -Toast strips -Graham crackers -Cheese cubes -Noodles -Firmly cooked vegetables -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 -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 or 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 -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 -During stress, insecurity, or illness, preschoolers can regress to previous immature behaviors or develop habits (nose picking, bed-wetting, thumb sucking) 5. Age appropriate activities -Preschooler’s transition to associative play -Play is not highly organized, but cooperation does exist between children -Appropriate activities: -Playing ball -Putting puzzles together -Riding tricycles -Playing pretend dress up activities -Role-playing 6. Sleep and rest -On average, preschoolers need about 12 hours of sleep -Keep a consistent bedtime routine -Avoid allowing preschoolers to sleep with their parents Chapter 6: Health promotion of School-Age children (6-12 years) - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - Chapter 36: Communicable Diseases 1. Conjunctivitis -Spread: Direct contact (viral/bacterial -Expected findings: -Pink or red color in the sclera of the eyes -Crusting of the eyelids in the morning 2. Epstein-Barr virus (EBV)/mononucleosis -Spread: saliva -Expected findings for infectious mononucleosis: -Fever -Swollen lymph glands -Splenomegaly -Hepatic involvement -Complications: ruptured spleen (no contact sports) 3. Erythema infectiosum (fifth disease)/parvovirus B19 -Spread: droplet/blood -Expected findings: -Rash (7 days to several weeks): -Red rash on face (slapped cheek), which appears from day 1 to 4 4. Mumps/paramyxovirus -Spread: droplet -Expected findings: -Painful, swollen parotid glands 5. Pertussis (whooping cough)/Bordetella pertussis -Spread: direct contact/droplet/indirect contact with freshly contaminated articles -Expected findings: -Common cold manifestations: -Runny nose/congestion, sneezing, mild fever, and mild cough -Severe coughing starts in 1-2 weeks: -Coughing fits -Violent and rapid coughing -Loud “whooping” sound upon inspiration 6. Rubella (German measles)/rubella virus -Spread: droplet -Expected findings: -Red rash that starts on the face and spreads to the rest of the body, lasting 2- 3 days -Complications: -Birth defects (deafness; heart defects; mental, liver, and spleen damage) in fetus of women infected during pregnancy 7. Rubeola (measles)/rubeola virus -Spread: droplet -Expected findings: -Cough, runny nose, red eyes, and sore throat -Rash: -Koplik spots (tiny white spots) appear in mouth 2 days before rash 8. Varicella (chicken pox)/varicella-zoster virus -Spread: droplet (airborne) -Expected findings: -Manifestations 1-2 days prior to rash: -Fever/fatigue -Rash: -Macules start in center of trunk, spreading to the face and proximal extremities -Progresses from macules, to papules, to vesicles, and crust formations follow 9. Nursing care -Do not administer aspirin, due to the risk of Reye Syndrome -Provide calamine lotion for topical relief -Keep the child’s fingernails clean and short 10. Medications -Antihistamine -Antiviral therapy: -Acyclovir for high-risk clients who have varicella Chapter 37: Otitis Media 1. Risk factors -Most common in the first 24 months of life and again when children enter school ages (5-6) 2. Medications -Acetaminophen/ibuprofen: -For analgesia and reduce fever -Antibiotics 3. Therapeutic procedures -Myringotomy and placement of tympanoplasty tubes -A small incision is made in the tympanic membrane -The tubes come out spontaneously (usually in 6-12 months) -Instruct parents to notify the provider when tubes come out -This is usually does not require replacement of tubes Chapter 38: HIV/AIDS 1. HIV/AIDS -HIV infection is a viral infection in which the virus primarily infects a specific subset of T-lymphocytes, the CD4 T cell causing immune dysfunction -This leads to organ dysfunction and a variety of opportunistic illnesses in a weakened host 2. Expected findings -Mild: -Lymphadenopathy -Hepatomegaly -Splenomegaly -Dermatitis -Parotitis -Severe: -Multiple serious bacterial infections -Kaposi’s sarcoma: skin infection -Pneumocystis carinii pneumonia -Wasting syndrome 3. Laboratory findings -Ages >6: -CD4 T-lymphocyte count= lower than 500=some immunosuppression -CD4 T-lymphocyte count=lower than 200=severe immunosuppression 4. Nursing care -Diet high in calories and protein -Provide good oral care -Prevent infection using standard precautions -Does not need special precautions -Teach the child and parents to avoid individuals who have colds/infections/viruses -Encourage immunizations: -Pneumococcal vaccine and yearly influenza vaccine 5. Medications -Antiretroviral -Antibiotics -IV gamma globulin Chapter 39: Organ neoplasms 1. Wilms’ tumor (Nephroblastoma) -Is a malignancy that occurs in the kidneys or abdomen -Tumor is usually unilateral -Most cases diagnosed between 2-3 years of age -Metastasis is rare -Expected findings: -Painless, firm, nontender abdominal swelling or mass -Fatigue, malaise, and weight loss -Fever -Diagnostic tests: -Abdominal ultrasonography -Abdominal and chest CT scan -Bone marrow aspiration (rule out metastasis) -Nursing care: -IF WILM’S TUMOR IS SUSPECTED DO NOT PALPATE THE ABDOMEN (can cause spread) 2. Neuroblastoma -Is a malignancy that occurs in the adrenal gland -Usually manifested during toddler years -Half of all cases have metastasized before diagnosis -Expected findings: -Half of children who have a Neuroblastoma have few findings -Manifestations of metastasis: -Ill appearance -Periorbital ecchymosis -Bone pain -Irritability -Diagnostic procedures: -Skull, neck, chest, abdominal and bone CT scans -Bone marrow aspiration (rule out metastasis) 3. Chemotherapy -Provide an antiemetic prior to administration -Observe the mouth for mucosal ulcerations -Educate about the SE of chemotherapy: -Mouth sores -Loss of appetite -Nausea/vomiting -Hair loss -Diarrhea/constipation -Increased risk of infection -Easy bruising or bleeding -Fatigue 4. Radiation -Nurse: wear lead aprons -Instruct the child and family not to wash off marks on the skin that outline the targeted areas -Avoid use of soaps, creams, lotions, and powders unless prescribed -Keep the areas protected from the sun by wearing a hat and long-sleeved shirts 5. Complications -Encourage the child to avoid crowds while undergoing chemotherapy -Avoid fresh fruits and vegetables -Avoid invasive procedures -Administer filgrastim: -Is a granulocyte colony-stimulating factor that stimulates WBC production -Given SC daily -Administer epoetin alfa: -Given SC 2-3 times per week -Stimulate RBC production -Administer Oprelvekin -Given SC daily -For PLT formation -Encourage the use of soft toothbrush -Mucositis and dry mouth: -Lubricate the child’s lips -Avoid hydrogen peroxide and lemon glycerin swabs Chapter 40: Blood Neoplasms 1. Leukemia -Is the term of a group of malignancies that affect the bone marrow and lymphatic system -Diagnostic procedures: -Bone marrow aspiration or biopsy analysis: -Topical anesthetic such as EMLA cream 45 min-1 hr prior -CSF analysis: -Have the child empty their bladder -EMLA cream 45 min-1 hr prior -Side-lying position with the head flexed and knees drawn up toward the chest, and assist in maintaining the position (during procedure) -Remain in bed 4-8 hr in a flat position to prevent leakage and a resulting spinal headache (after) Chapter 43: Pediatric Emergencies 1. Obstructed airway -Children/adolescents: -Use abdominal thrusts -Infants: -Combination of back blows and chest thrusts -Remove any visual obstruction or large debris from the mouth, but do not perform a blind finger sweep 2. Drowning -Encourage parents of toddlers to lock toilet seats when their child is at home -Instruct parents to not leave the child unattended in the bathtub -Inform parents not to leave the child unattended in a swimming pool, even if the child can swim -Encourage parents to provide life jackets when boating 3. SIDS -Risk factors: -Maternal smoking during pregnancy -Co-sleeping with parent or adult -Prone or side-lying sleeping -Low birth weight -Education on risk reduction: -Place the infant on the back for sleep -Avoid exposure to tobacco smoke -Prevent overheating -Use a firm, tight-fitting mattress in the infant’s crib -Remove pillows, quilts, and stuffed animals from the crib during sleep -Offer pacifier at naps and night -Encourage breastfeeding -Avoid co-sleeping 4. Poisoning -1st thing to do is call poison control center -Acetaminophen: N-acetylcysteine given orally -Supplemental iron: -Emesis or lavage -Chelation therapy using deferoxamine mesylate Chapter 44: Psychosocial issues of infants, children and adolescents 1. ADHD -Expected findings: -Inattention: -Difficulty in sustaining attention -Easily distracted -Forgetfulness -Hyperactivity -Impulsivity -Medications: -Methylphenidate, Dextroamphetamine: -Increases dopamine and norepinephrine levels -Give 30 min before meals -Give last dose of the day prior to 1800 to prevent insomnia -Atomoxetine 2. Autism spectrum disorder -Expected findings: 7-Distress when routines are changed -Unusual attachment to objects -Delayed or absent language development -Withdrawn, labile mood -Avoiding eye contact -Nursing care: -Decrease environmental stimulation -Introduce the child to new situations slowly -Encourage support groups for parents