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PEDS Final Exam
Spring 2022
1. Understand how and in which directions infants grow
Growth and development refers to the total growth of the child from birth toward maturity. Growth is
the physical increase in the body’s size and appearance caused by increasing numbers of new cells.
Development is the progressive change in the child toward maturity or maturation, completed growth
and development. As children develop, their capacity to learn and think increases.
Growth of the child follows an orderly pattern starting with the head and moving downward. This
pattern is referred to as cephalocaudal. The child is able to control the head and neck before being able
to control the arms and legs. Growth also proceeds in a pattern referred to as proximodistal, in which
growth starts in the center and progresses toward the periphery or outside (Fig. 22-1). Following this
pattern, the child can control movement of the arms before being able to control movement of the
hands. Another example of proximodistal growth is the ability to hold something in the hand before
being able to use the fingers to pick up an object. The process of growth moves from the simple to
complex.
Developmental tasks or milestones are basic achievements associated with each stage of development.
These tasks must be mastered to move successfully to the next developmental stage. Developmental
tasks must be completed successfully at each stage for a person to achieve maturity.
Each child has a unique pattern of growth. These patterns are related to height and weight. Monitoring
these patterns and recognizing deviations from the child’s normal pattern can be helpful in discovering
medical issues and concerns.
Length and Height
As the child grows, the length or height, distance from the head to the feet, increases in a predictable
pattern. The changes in a child’s length and height provide a concrete measurement of the child’s
growth. Although predictable, the increases in length and height are not uniform but are often seen in
growth spurts, or time periods during which there is rapid growth, and other periods of time when
growth is slowed. The length of the infant and the increasing height of the child are measured routinely
(see Chapter 28), and the patterns are monitored and plotted on a growth chart. The increase in length
and height seen in children and adolescents results from the skeletal growth that is taking place.
Weight
The weight gain of the child also progresses in a predictable pattern. For many different reasons, there
are variations in the weight of children of the same age, so the weight gain of each individual child is an
important factor in the growth of the child. Patterns of weight increases are monitored and plotted on
growth charts.
Body Proportions
From fetal life through adulthood, body proportions vary and change. As the fetus develops and the
child grows, the development of body systems and organs affects and changes the body proportions
CLASSROOM CLASSROOM CLASSROOM
,CLASSROOM CLASSROOM CLASSROOM
(Fig. 22-2). In early fetal life, the head is growing faster than the rest of the body and is thus
proportionately larger. During infancy, the trunk portion of the body grows significantly. The legs grow
rapidly during childhood, again changing the body proportions. The trunk portion grows as the child
grows into an adolescent, and the body proportions are those of an adult
2. Understand the importance of guardianship and why
3. How does a nurse know who the patient claims as family? Or how is family defined in peds
The family is civilization’s oldest and most basic social unit. The family’s primary purposes are to ensure
survival of the unit and its individual members and also to continue its knowledge, customs, values, and
beliefs. It establishes a primary connection to a group responsible for a person until that person
becomes independent. After the person becomes independent, the family may continue to provide a
connection and resources for the individual.
Although family structure varies among different cultures, its functions are similar. For each family
member, the family functions to provide sustenance and support in the five areas of wholeness:
physical, emotional, intellectual, social, and spiritual.
4. What is chief complaint, health history, biographical data, subjective and objective, lifestyle data
Chief Complaint
The reason for the child’s visit to the healthcare setting is called the chief complaint. In a well-child
setting, this reason might be a routine check or immunizations, whereas an illness or other condition
might be the reason in another setting. The family caregiver’s primary concern is their reason for seeking
healthcare for the child. To best care for the child, it is important to get the most complete explanation
of what brought the child to the healthcare setting. Repeating the family caregiver’s statement
regarding the child’s chief complaint helps ensure a correct understanding of what the caregiver has
said.
Health History
Information regarding the mother’s pregnancy and prenatal history is included in a health history for the
child. Any occurrences during the delivery can contribute to the child’s health concerns. The child’s
primary caregiver is usually the best source of this information. Other areas to ask questions about
include common childhood, serious, or chronic illnesses; immunizations and health maintenance;
feeding and nutrition; as well as hospitalizations and injuries.
Biographical Data
To begin obtaining a client history, collect and record identifying information about the child, including
the child’s name, address, and phone number, as well as information about the family caregiver. This
information is part of the legal record and should be treated as confidential. A questionnaire often is
used to gather information, such as the child’s nickname, feeding habits, food likes and dislikes,
allergies, sleeping schedule, and toilet-training status (Fig. 28-2). Any special words the child uses or
understands to indicate needs or desires, such as words used for urinating and bowel movements, are
included on the questionnaire.
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,CLASSROOM CLASSROOM CLASSROOM
Collecting Subjective Data
Information spoken by the child or family is called subjective data. Interviewing the family caregiver and
the child allows you to collect information that can be used to develop a plan of care for the child.
Communicating with the child and the family caregiver requires knowledge of growth and development
and an understanding of communication techniques.
Collecting Objective Data
Information you observe directly is called objective data. Objective data to collect include baseline
measurements of the child’s height, weight, temperature, pulse, respiration, and blood pressure. Data
are also collected by examination of the body systems. Often the physical examination for a child does
not proceed in a head-to-toe manner as in adults but rather in an order that takes the child’s age and
developmental needs into consideration. Aspects of the examination that might be more traumatic or
uncomfortable for the child are done last.
Lifestyle
School history includes information regarding the child’s current grade level and academic performance,
as well as behavior at school. The child’s interactions with teachers and peers often give insight into
areas of concern that might affect the child’s health. Social history offers information about the child’s
environment, including the home setting, family caregivers’ occupations, siblings, family pets, religious
affiliations, and economic factors. The people who live in the home and those who care for the child are
important data, especially in cases of separation, divorce, and other living situations. Personal history
relates to data collected about such things as the child’s hygiene, sleeping, and elimination patterns.
Activities, exercise, special interests, and the child’s favorite toys or objects are included. Questions
about relationships and how the child emotionally handles certain situations can help in understanding
the child. Discuss any behaviors such as thumb sucking, nail biting, or temper tantrums. Nutrition
history of the child includes information regarding eating habits and preferences, as well as nutrition
concerns that might indicate illness.
5. What is the point of a repeat neurological exam in pts with head injury and what assessment
would the nurse use to assess neurological states?
The child is monitored closely for any signs of change in their neurologic status, using tools such
as the Glasgow Coma Scale, so concerns can be detected and treated immediately.
6. What are droplet, contact, and standard precautions, when are they each used
Standard Precautions: blend the primary characteristics of universal precautions and body substance
isolation. Standard precautions apply to blood; all body fluids, secretions, and excretions, except sweat;
nonintact skin; and mucous membranes. Standard precautions are intended to reduce the risk of
transmission of microorganisms from recognized or unrecognized sources of infection in healthcare
settings. Health care providers follow standard precautions in the care of all clients.
o Perform hand hygiene before and after every patient contact:
o Gloves, gowns, eye protection as required.
o Safe disposal or cleaning of instruments and linen.
CLASSROOM CLASSROOM CLASSROOM
, CLASSROOM CLASSROOM CLASSROOM
o Cough etiquette: Patients and visitors should cover their nose or mouth when coughing,
promptly dispose of used tissues, and practice hand hygiene after contact with respiratory
secretions.
Infection control is important in the pediatric hospital setting. The ill child may be especially vulnerable
to pathogenic (disease-carrying) microorganisms. Precautions must be taken to protect the children,
families, and personnel. Microorganisms are spread by contact (direct or indirect); droplet (coughing,
sneezing, talking); vehicle (food, water, blood, or contaminated products); airborne (particles in the air);
or vector (mosquitoes, vermin) means of transmission. Each type of microorganism is transmitted in a
specific way, so precautions are tailored to prevent the spread of specific microorganisms. For clients
documented or suspected of having highly transmissible pathogens, health care providers must follow
transmission-based precautions. These precautions are in addition to the standard precautions.
Transmission-based precautions include three types: contact precautions, droplet precautions, and
airborne precautions. Certain diseases may require more than one type of precaution. See Nursing
Process and Care Plan for the Child Placed on Transmission-Based Precautions.
Contact Precautions
o In addition to standard precautions:
o Private room preferred; cohorting allowed if necessary.
o Gloves required upon entering room.Change gloves after contact with contaminated secretions.
o Gown required if clothing may come into contact with the patient or environmental surfaces or
if the patient has diarrhea.
o Minimize risk of environmental contamination during patient transport (e.g., patient can be
placed in a gown).
o Noncritical items should be dedicated to use for a single patient if possible.
Droplet Precautions
o In addition to standard precautions:
o Private room preferred; cohorting allowed if necessary.
o Wear a mask when within three feet of the patient.
o Mask the patient during transport.
o Cough etiquette: Patients and visitors should cover their nose or mouth when coughing,
promptly dispose of used tissues, and practice hand hygiene after contact with respiratory
secretions.
7. Nursing interventions related to ostomies
Infants and children may have an ostomy (also called a stoma) surgically created for various disorders
and conditions that prevent the child from having normal bowel or bladder elimination. A colostomy is
made by bringing a part of the colon through the abdominal wall to create an outlet for fecal material
elimination. Colostomies can be temporary or permanent. A new colostomy may be left to open air or a
bag, pouch, or appliance may be used to collect the stool. An ileostomy is a similar opening in the small
CLASSROOM CLASSROOM CLASSROOM
PEDS Final Exam
Spring 2022
1. Understand how and in which directions infants grow
Growth and development refers to the total growth of the child from birth toward maturity. Growth is
the physical increase in the body’s size and appearance caused by increasing numbers of new cells.
Development is the progressive change in the child toward maturity or maturation, completed growth
and development. As children develop, their capacity to learn and think increases.
Growth of the child follows an orderly pattern starting with the head and moving downward. This
pattern is referred to as cephalocaudal. The child is able to control the head and neck before being able
to control the arms and legs. Growth also proceeds in a pattern referred to as proximodistal, in which
growth starts in the center and progresses toward the periphery or outside (Fig. 22-1). Following this
pattern, the child can control movement of the arms before being able to control movement of the
hands. Another example of proximodistal growth is the ability to hold something in the hand before
being able to use the fingers to pick up an object. The process of growth moves from the simple to
complex.
Developmental tasks or milestones are basic achievements associated with each stage of development.
These tasks must be mastered to move successfully to the next developmental stage. Developmental
tasks must be completed successfully at each stage for a person to achieve maturity.
Each child has a unique pattern of growth. These patterns are related to height and weight. Monitoring
these patterns and recognizing deviations from the child’s normal pattern can be helpful in discovering
medical issues and concerns.
Length and Height
As the child grows, the length or height, distance from the head to the feet, increases in a predictable
pattern. The changes in a child’s length and height provide a concrete measurement of the child’s
growth. Although predictable, the increases in length and height are not uniform but are often seen in
growth spurts, or time periods during which there is rapid growth, and other periods of time when
growth is slowed. The length of the infant and the increasing height of the child are measured routinely
(see Chapter 28), and the patterns are monitored and plotted on a growth chart. The increase in length
and height seen in children and adolescents results from the skeletal growth that is taking place.
Weight
The weight gain of the child also progresses in a predictable pattern. For many different reasons, there
are variations in the weight of children of the same age, so the weight gain of each individual child is an
important factor in the growth of the child. Patterns of weight increases are monitored and plotted on
growth charts.
Body Proportions
From fetal life through adulthood, body proportions vary and change. As the fetus develops and the
child grows, the development of body systems and organs affects and changes the body proportions
CLASSROOM CLASSROOM CLASSROOM
,CLASSROOM CLASSROOM CLASSROOM
(Fig. 22-2). In early fetal life, the head is growing faster than the rest of the body and is thus
proportionately larger. During infancy, the trunk portion of the body grows significantly. The legs grow
rapidly during childhood, again changing the body proportions. The trunk portion grows as the child
grows into an adolescent, and the body proportions are those of an adult
2. Understand the importance of guardianship and why
3. How does a nurse know who the patient claims as family? Or how is family defined in peds
The family is civilization’s oldest and most basic social unit. The family’s primary purposes are to ensure
survival of the unit and its individual members and also to continue its knowledge, customs, values, and
beliefs. It establishes a primary connection to a group responsible for a person until that person
becomes independent. After the person becomes independent, the family may continue to provide a
connection and resources for the individual.
Although family structure varies among different cultures, its functions are similar. For each family
member, the family functions to provide sustenance and support in the five areas of wholeness:
physical, emotional, intellectual, social, and spiritual.
4. What is chief complaint, health history, biographical data, subjective and objective, lifestyle data
Chief Complaint
The reason for the child’s visit to the healthcare setting is called the chief complaint. In a well-child
setting, this reason might be a routine check or immunizations, whereas an illness or other condition
might be the reason in another setting. The family caregiver’s primary concern is their reason for seeking
healthcare for the child. To best care for the child, it is important to get the most complete explanation
of what brought the child to the healthcare setting. Repeating the family caregiver’s statement
regarding the child’s chief complaint helps ensure a correct understanding of what the caregiver has
said.
Health History
Information regarding the mother’s pregnancy and prenatal history is included in a health history for the
child. Any occurrences during the delivery can contribute to the child’s health concerns. The child’s
primary caregiver is usually the best source of this information. Other areas to ask questions about
include common childhood, serious, or chronic illnesses; immunizations and health maintenance;
feeding and nutrition; as well as hospitalizations and injuries.
Biographical Data
To begin obtaining a client history, collect and record identifying information about the child, including
the child’s name, address, and phone number, as well as information about the family caregiver. This
information is part of the legal record and should be treated as confidential. A questionnaire often is
used to gather information, such as the child’s nickname, feeding habits, food likes and dislikes,
allergies, sleeping schedule, and toilet-training status (Fig. 28-2). Any special words the child uses or
understands to indicate needs or desires, such as words used for urinating and bowel movements, are
included on the questionnaire.
CLASSROOM CLASSROOM CLASSROOM
,CLASSROOM CLASSROOM CLASSROOM
Collecting Subjective Data
Information spoken by the child or family is called subjective data. Interviewing the family caregiver and
the child allows you to collect information that can be used to develop a plan of care for the child.
Communicating with the child and the family caregiver requires knowledge of growth and development
and an understanding of communication techniques.
Collecting Objective Data
Information you observe directly is called objective data. Objective data to collect include baseline
measurements of the child’s height, weight, temperature, pulse, respiration, and blood pressure. Data
are also collected by examination of the body systems. Often the physical examination for a child does
not proceed in a head-to-toe manner as in adults but rather in an order that takes the child’s age and
developmental needs into consideration. Aspects of the examination that might be more traumatic or
uncomfortable for the child are done last.
Lifestyle
School history includes information regarding the child’s current grade level and academic performance,
as well as behavior at school. The child’s interactions with teachers and peers often give insight into
areas of concern that might affect the child’s health. Social history offers information about the child’s
environment, including the home setting, family caregivers’ occupations, siblings, family pets, religious
affiliations, and economic factors. The people who live in the home and those who care for the child are
important data, especially in cases of separation, divorce, and other living situations. Personal history
relates to data collected about such things as the child’s hygiene, sleeping, and elimination patterns.
Activities, exercise, special interests, and the child’s favorite toys or objects are included. Questions
about relationships and how the child emotionally handles certain situations can help in understanding
the child. Discuss any behaviors such as thumb sucking, nail biting, or temper tantrums. Nutrition
history of the child includes information regarding eating habits and preferences, as well as nutrition
concerns that might indicate illness.
5. What is the point of a repeat neurological exam in pts with head injury and what assessment
would the nurse use to assess neurological states?
The child is monitored closely for any signs of change in their neurologic status, using tools such
as the Glasgow Coma Scale, so concerns can be detected and treated immediately.
6. What are droplet, contact, and standard precautions, when are they each used
Standard Precautions: blend the primary characteristics of universal precautions and body substance
isolation. Standard precautions apply to blood; all body fluids, secretions, and excretions, except sweat;
nonintact skin; and mucous membranes. Standard precautions are intended to reduce the risk of
transmission of microorganisms from recognized or unrecognized sources of infection in healthcare
settings. Health care providers follow standard precautions in the care of all clients.
o Perform hand hygiene before and after every patient contact:
o Gloves, gowns, eye protection as required.
o Safe disposal or cleaning of instruments and linen.
CLASSROOM CLASSROOM CLASSROOM
, CLASSROOM CLASSROOM CLASSROOM
o Cough etiquette: Patients and visitors should cover their nose or mouth when coughing,
promptly dispose of used tissues, and practice hand hygiene after contact with respiratory
secretions.
Infection control is important in the pediatric hospital setting. The ill child may be especially vulnerable
to pathogenic (disease-carrying) microorganisms. Precautions must be taken to protect the children,
families, and personnel. Microorganisms are spread by contact (direct or indirect); droplet (coughing,
sneezing, talking); vehicle (food, water, blood, or contaminated products); airborne (particles in the air);
or vector (mosquitoes, vermin) means of transmission. Each type of microorganism is transmitted in a
specific way, so precautions are tailored to prevent the spread of specific microorganisms. For clients
documented or suspected of having highly transmissible pathogens, health care providers must follow
transmission-based precautions. These precautions are in addition to the standard precautions.
Transmission-based precautions include three types: contact precautions, droplet precautions, and
airborne precautions. Certain diseases may require more than one type of precaution. See Nursing
Process and Care Plan for the Child Placed on Transmission-Based Precautions.
Contact Precautions
o In addition to standard precautions:
o Private room preferred; cohorting allowed if necessary.
o Gloves required upon entering room.Change gloves after contact with contaminated secretions.
o Gown required if clothing may come into contact with the patient or environmental surfaces or
if the patient has diarrhea.
o Minimize risk of environmental contamination during patient transport (e.g., patient can be
placed in a gown).
o Noncritical items should be dedicated to use for a single patient if possible.
Droplet Precautions
o In addition to standard precautions:
o Private room preferred; cohorting allowed if necessary.
o Wear a mask when within three feet of the patient.
o Mask the patient during transport.
o Cough etiquette: Patients and visitors should cover their nose or mouth when coughing,
promptly dispose of used tissues, and practice hand hygiene after contact with respiratory
secretions.
7. Nursing interventions related to ostomies
Infants and children may have an ostomy (also called a stoma) surgically created for various disorders
and conditions that prevent the child from having normal bowel or bladder elimination. A colostomy is
made by bringing a part of the colon through the abdominal wall to create an outlet for fecal material
elimination. Colostomies can be temporary or permanent. A new colostomy may be left to open air or a
bag, pouch, or appliance may be used to collect the stool. An ileostomy is a similar opening in the small
CLASSROOM CLASSROOM CLASSROOM
