N483 Exam #1 Questions With
Complete Answers
atraumatic care - ANSWER do no harm
prevent and minimize child's separation from family
promote a sense of control
prevent/minimize pain and bodily injury
family-centered care - ANSWER families are supported in their care
decisions and needs of all members are considered
nurse-family partnership
empowerment
core concepts of family-centered care - ANSWER family strengths
trust and respect
choices
support
flexibility
collaboration
information-sharing
preparing child and parent for procedure - ANSWER give child a job
lots of praise
prepare the child and keep developmental stages in mind
allow child to manipulate equipment before procedure
give parent time to ask questions alone, discuss how child may respond, offer
guidance on what parent can do, reinforce role of support
health promotion maintenance - ANSWER hospital: bed alarm, siderails, arm
bands, hugs tags, back to sleep, anti-skid socks
home: babyproofing, back to sleep, keep meds out of reach, battery safety, toilet
locks, magnets, covering outlets, keep weapons out of reach, put gates at stairs
roles of the nurse - ANSWER preparing child/parent for procedure
health and safety promotion
health teaching and healthcare planning
anticipatory guidance (based on developmental stage)
family advocacy
therapeutic relationship building
ethical decision making
culturally responsive care
,maintenance fluid requirement (MFR) formula - ANSWER 100 ml/kg for the first
10 kgs
50 ml/kg for the second 10 kg
20 ml/kg for each kg over 20 kg
MFR is the amount of fluid in 24hrs required to maintain fluid needs
calculating urine output - ANSWER healthy infants/children make 3-4 ml/kg/hr
minimum for infants/children is 1 ml/kg/hr
adolescent minimum is 0.5 ml/kg/hr
adult (over 40 kg) = 30 ml/hr minimum
nervous system in children - ANSWER incomplete cortical function
intact but immature ANS
at 8 months infants have less than 1/2 of the myelin sheath so impulses are
slower and less predictable
infants may not look flushed when they have a fever, for example
temperature control measures are less developed
skull is not rigid, fontanels are open (anterior fontanel is open longer and
provides information on ICP and hydration)
soft and flat = normal
sunken = dehydrated
bulging = IICP
neuro status: assess activity level, LOC, quality of cry (high-pitched cry = insult
to nervous system)
cardiovascular system in children - ANSWER the younger the child, the more RR
and HR vary with illness
breaths to heart ratio is 1:4
increased HR during inhalation and decreased HR during exhalation
prolonged tachycardia = decompensation of the heart muscle
radial pulse isn't reliable until at least 6 years old, need to check apical pulse
(smaller blood volume and less developed left ventricle)
lower BP d/t small left ventricle, immature nervous control, low body mass,
check infant's BP on the popliteal pulse
normal findings: pink mucous membranes and nail beds, generally consistent
skin color (acrocyanosis is only normal in the first 1-2 days of life), strong
pulses, brisk cap refill, appropriate urine amount
pulmonary system in children - ANSWER higher metabolic rate and respiratory
rate predisposes child to stress quicker
less alveolar surface area
proportionally more dead space
wide horizontal eustachian tube which can lead to otitis media and cause
respiratory problems
small/short airways (edema/occlusion here can lead to distress)
, very active secretory glands = more mucus = increased occlusion
intercostal muscles are less developed and diaphragm can tire out
weaker larynx
softer and thinner chest wall
measure RR in one full minute
respiratory distress - ANSWER first signs: tachycardia, tachypnea, agitation and
irritability, retractions, nasal flaring, prolonged expirations with wheezing
as distress continues --> grunting and head bobbing, stridor and prolonged
inspiratory time, cyanosis, deteriorating ABG and prolonged desaturations
late signs = decreased LOC, bradypnea, apnea, hypotension
respiratory assessment - ANSWER respiration regularity, adequacy, work of
breathing, equality/symmetricity of chest expansion
counting respirations in infants = observe abdominal movements for 60 seconds
GI system in children - ANSWER smaller stomach = lower HCL concentration
can't digest thick mucus secretions = throwing up and dehydration
increased intestinal motility (younger = more pronounced)
risk for diarrhea and dehydration
large intestine is shorter = less water resorption
increased risk for diarrhea during illness
pancreatic enzymes low until 4-6 months, can't digest anything besides
milk/formula until 6 months>
liver is immature until 1 year old --> less bile (impaired fat absorption), lower
prothrombin (increased bleeding), lower albumin (less effective drug
metabolism, prone to losing fluids into extravascular volume (3rd space), less
glycogen storage and synthesis (hypoglycemia happens fast)
GI assessment - ANSWER abdominal exam, abdominal girth, feeding tolerance,
overall hydration
GU system - ANSWER immature kidneys <2 years old (decreased ability to
concentrate urine, decreased ability to excrete nitrogen wastes, decreased
ability to conserve alkaline buffer or actively separate H+, decreased ability of
acid-base balance/pH balance, less predictable drug excretion
small bladder capacity, short urethra (prone to UTI)
GU assessment - ANSWER edema is located centrally in eyes/face and in the
genital area
consider the adequacy of urine output
daily weights to determine loss and gain
urinalysis: color, clarity, specific gravity, RBCs, WBCs, protein, nitrates
growth patterns and chart interpretation - ANSWER different growth charts for
different populations (down syndrome, gender, preterm, age, etc)
Complete Answers
atraumatic care - ANSWER do no harm
prevent and minimize child's separation from family
promote a sense of control
prevent/minimize pain and bodily injury
family-centered care - ANSWER families are supported in their care
decisions and needs of all members are considered
nurse-family partnership
empowerment
core concepts of family-centered care - ANSWER family strengths
trust and respect
choices
support
flexibility
collaboration
information-sharing
preparing child and parent for procedure - ANSWER give child a job
lots of praise
prepare the child and keep developmental stages in mind
allow child to manipulate equipment before procedure
give parent time to ask questions alone, discuss how child may respond, offer
guidance on what parent can do, reinforce role of support
health promotion maintenance - ANSWER hospital: bed alarm, siderails, arm
bands, hugs tags, back to sleep, anti-skid socks
home: babyproofing, back to sleep, keep meds out of reach, battery safety, toilet
locks, magnets, covering outlets, keep weapons out of reach, put gates at stairs
roles of the nurse - ANSWER preparing child/parent for procedure
health and safety promotion
health teaching and healthcare planning
anticipatory guidance (based on developmental stage)
family advocacy
therapeutic relationship building
ethical decision making
culturally responsive care
,maintenance fluid requirement (MFR) formula - ANSWER 100 ml/kg for the first
10 kgs
50 ml/kg for the second 10 kg
20 ml/kg for each kg over 20 kg
MFR is the amount of fluid in 24hrs required to maintain fluid needs
calculating urine output - ANSWER healthy infants/children make 3-4 ml/kg/hr
minimum for infants/children is 1 ml/kg/hr
adolescent minimum is 0.5 ml/kg/hr
adult (over 40 kg) = 30 ml/hr minimum
nervous system in children - ANSWER incomplete cortical function
intact but immature ANS
at 8 months infants have less than 1/2 of the myelin sheath so impulses are
slower and less predictable
infants may not look flushed when they have a fever, for example
temperature control measures are less developed
skull is not rigid, fontanels are open (anterior fontanel is open longer and
provides information on ICP and hydration)
soft and flat = normal
sunken = dehydrated
bulging = IICP
neuro status: assess activity level, LOC, quality of cry (high-pitched cry = insult
to nervous system)
cardiovascular system in children - ANSWER the younger the child, the more RR
and HR vary with illness
breaths to heart ratio is 1:4
increased HR during inhalation and decreased HR during exhalation
prolonged tachycardia = decompensation of the heart muscle
radial pulse isn't reliable until at least 6 years old, need to check apical pulse
(smaller blood volume and less developed left ventricle)
lower BP d/t small left ventricle, immature nervous control, low body mass,
check infant's BP on the popliteal pulse
normal findings: pink mucous membranes and nail beds, generally consistent
skin color (acrocyanosis is only normal in the first 1-2 days of life), strong
pulses, brisk cap refill, appropriate urine amount
pulmonary system in children - ANSWER higher metabolic rate and respiratory
rate predisposes child to stress quicker
less alveolar surface area
proportionally more dead space
wide horizontal eustachian tube which can lead to otitis media and cause
respiratory problems
small/short airways (edema/occlusion here can lead to distress)
, very active secretory glands = more mucus = increased occlusion
intercostal muscles are less developed and diaphragm can tire out
weaker larynx
softer and thinner chest wall
measure RR in one full minute
respiratory distress - ANSWER first signs: tachycardia, tachypnea, agitation and
irritability, retractions, nasal flaring, prolonged expirations with wheezing
as distress continues --> grunting and head bobbing, stridor and prolonged
inspiratory time, cyanosis, deteriorating ABG and prolonged desaturations
late signs = decreased LOC, bradypnea, apnea, hypotension
respiratory assessment - ANSWER respiration regularity, adequacy, work of
breathing, equality/symmetricity of chest expansion
counting respirations in infants = observe abdominal movements for 60 seconds
GI system in children - ANSWER smaller stomach = lower HCL concentration
can't digest thick mucus secretions = throwing up and dehydration
increased intestinal motility (younger = more pronounced)
risk for diarrhea and dehydration
large intestine is shorter = less water resorption
increased risk for diarrhea during illness
pancreatic enzymes low until 4-6 months, can't digest anything besides
milk/formula until 6 months>
liver is immature until 1 year old --> less bile (impaired fat absorption), lower
prothrombin (increased bleeding), lower albumin (less effective drug
metabolism, prone to losing fluids into extravascular volume (3rd space), less
glycogen storage and synthesis (hypoglycemia happens fast)
GI assessment - ANSWER abdominal exam, abdominal girth, feeding tolerance,
overall hydration
GU system - ANSWER immature kidneys <2 years old (decreased ability to
concentrate urine, decreased ability to excrete nitrogen wastes, decreased
ability to conserve alkaline buffer or actively separate H+, decreased ability of
acid-base balance/pH balance, less predictable drug excretion
small bladder capacity, short urethra (prone to UTI)
GU assessment - ANSWER edema is located centrally in eyes/face and in the
genital area
consider the adequacy of urine output
daily weights to determine loss and gain
urinalysis: color, clarity, specific gravity, RBCs, WBCs, protein, nitrates
growth patterns and chart interpretation - ANSWER different growth charts for
different populations (down syndrome, gender, preterm, age, etc)
