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
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,-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 GraspBirth to 3 months
Tonic Neck Reflex (Fencer Position)Birth to 3 – 4 months
Sucking and Rooting ReflexBirth to 4 months
Moro Reflex (Fall backward)Birth to 4 months
Startle Reflex (Loud Noise)Birth to 4 months
Plantar ReflexBirth to 8 months
Birth to 1 year
Babinski Reflex
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
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, 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
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, -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
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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
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,-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 GraspBirth to 3 months
Tonic Neck Reflex (Fencer Position)Birth to 3 – 4 months
Sucking and Rooting ReflexBirth to 4 months
Moro Reflex (Fall backward)Birth to 4 months
Startle Reflex (Loud Noise)Birth to 4 months
Plantar ReflexBirth to 8 months
Birth to 1 year
Babinski Reflex
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
2|Page
, 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
3|Page
, -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
4|Page
