Ch. 2 & 4 (Normal G&D)

Question 1

developmental surveillance

Answer 1

skilled observations made by the pediatrician of a child and their family that takes into account parental concerns and the child’s developmental history

Question 2

developmental screening

Answer 2

use of a standardized objective measure that is given to the parent to assess development
- recommended at 9, 18, 24 months

Question 3

autism-specific screening is performed at what ages?

Answer 3

18 and 24 month visits

Question 4

a child with 1 predictive concern is how likely to have needs for services (speech/OT)?

Answer 4

8x more likely to be eligible

Question 5

a child with 2 predictive concern is how likely to have needs for services (speech/OT)?

Answer 5

20x more likely to be eligible

Question 6

developmental milestones fall into what categories?

Answer 6

• language
• emotional
• motor
• social
• cognitive

Question 7

milestones: newborn-1month

Answer 7

• responds to visual or auditory stimuli
• sucks in a coordinated fashion
• fixes briefly on faces or objects

Question 8

anticipatory guidance to parents of: newborn-1month

Answer 8

• discuss how newborns learn by hearing parents speak to them and examining their faces
• talk about attachment and promote the important role of the new parent in a child’s development

Question 9

milestones: 2months

Answer 9

• lifts head/chest when prone
• social smile
• tracks horizontally with gaze
• stays alert for longer periods of time

Question 10

milestones: 4months

Answer 10

• engages with environment more, which is how they learn and gain motor skills
• atonic neck reflexes fade, which allows them to roll front to back
• uses sounds to communicate
• laughs, orients to parent voice
• hands to midline
• grasp objects

Question 11

milestones: 6months

Answer 11

• sits with minimal support
• babbles
• reaches for caregivers and toys
• transfers objects from one hand to another
• primitive reflexes should be gone at this point

Question 12

anticipatory guidance to parents of: 4months

Answer 12

• now that the child is rolling, falls are more of a risk
• never leave a baby unattended on a bed or a couch

Question 13

anticipatory guidance to parents of: 6months

Answer 13

• start child-proofing the home as the child is starting to move around more and explore the environment

Question 14

persistent primitive reflexes beyond 6 months are

Answer 14

a red flag!
- warrant further evaluation

Question 15

primitive reflexes include

Answer 15

• moro
• atonic neck
• fisting

Question 16

milestones: 9 months

Answer 16

• pulls to stand, cruises
• says “mama” and “dada” indiscriminately
• 2-3 word vocabulary
• immature pincer grasp (pointer finger and thumb- can grab food with pincer grasp, probably not a spoon)
• turn pages in board book
• object permanence
• separation anxiety

Question 17

anticipatory guidance to parents of: 9 months

Answer 17

• since the child is picking up smaller objects, discuss choking risks
• could talk about beginning to baby proof the house because if child is standing with support, walking is coming next
• talk about separation anxiety

Question 18

milestones: 12 months

Answer 18

• “mama” and “dada” are applied to correct person
• one word in addition to “mama” and “dada”
• 4-5 word vocabulary
• points: sounds and gestures tell people what she wants
• joint attention: pair points with eye contact and sign or word
• first steps
• more developed pincer grasps
• understands simple commands with a gesture

Question 19

red flags: 12 months

Answer 19

• hand preference before age 1: may indicate decreased strength or tone on one side which is indicative of a neuro deficit
• minimal response to name

Question 20

milestones: 15 months

Answer 20

• 3-6 word vocabulary
• points to objects
• feeds self with spoon and cup
• stoops and recovers
• scribbles (like with markers)

Question 21

anticipatory guidance to parents of: 15 months

Answer 21

• discuss how to handle tantrums

Question 22

red flags: 15 months

Answer 22

• no words or pointing

Question 23

milestones: 18 months

Answer 23

• 10-20 word vocabulary
• jargoning
• points to 1 body part
• imitates those around her
• stacks 3 blocks
• run

Question 24

red flags: 18 months

Answer 24

• doesn’t point to show things to others
• can’t walk
• doesn’t imitate
• doesn’t gain new words
• doesn’t notice when caregiver leaves or returns

Question 25

milestones: 2 years

Answer 25

- 2-word phrases - 200-300 word vocabulary (50% understood) - follows 2-step commands - goes down stairs 2 feet at a time - feeds self with spoon and fork - jumps with 2 feet - parallel play - turns thin pages - draws a line - stacks 6 blocks

Question 26

red flags: 2 years

Answer 26

- doesn't use 2-word phrases - doesn't know what to do with common things - doesn't imitate actions or words - doesn't follow simple instructions - doesn't walk steadily - loses skills they once had

Question 27

milestones: 3 years

Answer 27

- goes up and down stairs with alternating feet - peddles a tricycle - draws circles - stacks 9 blocks - uses pronouns correctly - 3-word sentences, 75% understood - puts on shoes, undresses self, brushes teeth - knows name, age, and colors - toilet-trained during the day

Question 28

red flags: 3 years

Answer 28

- falling frequently - repetitive behaviors - no 3-word phrases - not playing pretend or not playing with other children

Question 29

milestones: 4 years

Answer 29

- draws a square or cross - hops on one foot - can manipulate buttons - 4-5 word phrases - 100% of language understood - answers "what?" and "when?" - plays cooperatively in a group (knows rules) - knows at least 4 colors

Question 30

red flags: 4 years

Answer 30

- difficulties with feeding, sleep, or toileting - speech is not clear - doesn't follow 3-part commands - doesn't speak in short sentences

Question 31

milestones: 5 years

Answer 31

- skips - ties shoes - draws triangle - writes name - draws a person with head and body parts - knows left and right - asks "why" - follows 3-step commands - knows address, birthday, and phone number - knows alphabet and counts to 10

Question 32

red flags: 5 years

Answer 32

- cannot perform basic tasks independently (ie getting dressed) - difficulty attending to an activity for more than 5 minutes - doesn't talk about daily activities or experiences - extreme behavior (unusually fearful, aggressive, shy, or sad)

Question 33

live attenuated vaccines

Answer 33

contain weakened, live pathogens and cannot be given to children with immunodeficiency

Question 34

inactive vaccines

Answer 34

contain killed or inactive viruses or bacteria

Question 35

conjugate vaccines

Answer 35

- combat bacteria with polysaccharide capsules

Question 36

toxoid vaccines

Answer 36

- contain weakened toxins absorbed to aluminum or calcium salts to enhance the immune response

Question 37

subunit vaccines

Answer 37

contain only antigens from the pathogen, which leads to fewer side effects but also a weaker immune response

Question 38

mild side effects to vaccines

Answer 38

- local redness or soreness - fussiness - low-grade fever **resolves in a couple days

Question 39

at birth, newborns should receive (medication/vaccines)

Answer 39

- Hep B (1st dose) - Vit K - erythromycin

Question 40

2 month vaccines

Answer 40

- Hep B (2nd dose) - DTaP (1st dose) - H. Flu (1st dose) - PCV13 (1st dose) - inactivated polio (1st dose) - rotavirus (oral solution) (1st dose)

Question 41

4 month vaccines

Answer 41

- DTaP (2nd dose) - H. Flu (2nd dose) - PCV13 (2nd dose) - inactivated polio (2nd dose) - rotavirus (oral solution) (2nd dose)

Question 42

6 month vaccines

Answer 42

- Hep B (3rd dose) - DTaP (3rd dose) - H. Flu (3rd dose) - PCV13 (3rd dose) - inactivated polio (3rd dose) - rotavirus (oral solution) (3rd dose) - influenza (need a second dose at a min of 4 weeks after 1st dose- then 1 dose annually after)

Question 43

12 month vaccines

Answer 43

- H. Flu (4th dose/final) - PCV13 (4th dose/final) - MMR (1st dose) - varicella (1st dose) - Hep A (1st dose)

Question 44

15 month vaccines

Answer 44

- DTap (4th dose)

Question 45

18 month vaccines

Answer 45

- Hep A - if 1st dose was given at least 6 months prior (2nd dose)

Question 46

4-6 year vaccines

Answer 46

- DTap (5th dose) - inactivated polio (4th dose) - MMR (2nd dose) - varicella (2nd dose)

Question 47

11-12 year vaccines

Answer 47

- meningococcal (1st dose) - Tdap (1st dose) - HPV (1st dose)

Question 48

if HPV vaccine is given before 15 years of age, the series consists of ___ doses

Answer 48

2 doses - separated by 6-12 months - 1st dose as early as 9 years old

Question 49

if the HPV vaccine is started at 15 years or older, the teenager needs ___ doses

Answer 49

3 doses - 2nd dose 4 weeks after 1st - 3rd dose 6 months after 1st dose

Question 50

16 year vaccines

Answer 50

- meningococcal (2nd dose)

Question 51

patients with what conditions require additional immunizations?

Answer 51

- sickle cell disease - HIV - immunodeficiency - anatomic or functional asplenia - other chronic conditions

Question 52

the PPSV23 (pneumococcal polysaccharide vaccine) vaccine should be administered for children with

Answer 52

- chronic heart disease - chronic lung disease - diabetes * once over age of 2, a child with any of these conditions should receive at least one dose of PPSV23 at least 8 weeks after a previous PCV13 dose

Question 53

what conditions require one dose of PPSV23 at least 8 weeks after PCV13, as well as a second dose of PPSV23 5 years later?

Answer 53

- renal failure - malignancies - sickle cell - asplenia - HIV - children treated with immunosuppressant drugs

Question 54

the meningococcal vaccine is a "special circumstance/concern" with what health conditions?

Answer 54

- sickle cell disease - anatomic or functional asplenia - HIV

Question 55

physical developmental highlights: 0-6 months

Answer 55

- raises head and chest when prone - opens and shuts hands - brings hand to mouth - grasps and shakes toys - rolls both ways - sits with and without support of hands - supports whole weight on legs - reaches with one hand - transfers object from hand to hand

Question 56

social developmental highlights: 0-6 months

Answer 56

- smiles spontaneously - enjoys playing with people - imitates some movements & expressions - interested in mirror images - responds to expressions of emotions

Question 57

sensory developmental highlights: 0-6 months

Answer 57

- follows moving objects - recognizes familiar objects and people - finds partially hidden objects - explores with hands and mouth - struggles to get objects that are out of reach

Question 58

physical developmental highlights: 7-12 months

Answer 58

- transitions to sitting position without help - crawls forward on belly - assumes hands-and-knees positions - gets from sitting to crawling position - pulls self up to stand - walks holding on to furniture

Question 59

social developmental highlights: 7-12 months

Answer 59

- shy or anxious with strangers - cries when parents leave - enjoys imitating people in play - prefers certain people and toys - tests parental response - feeds themselves with fingers; uses utensils messily

Question 60

sensory developmental highlights: 7-12 months

Answer 60

- explores objects in different ways - finds hidden objects easily - looks at correct picture when the image is named - imitates gestures - begins to use objects correctly

Question 61

the posterior fontanel closes by what age?

Answer 61

1-2 months

Question 62

the anterior fontanel closes by what age?

Answer 62

12-18 months

Question 63

infants should gain approximately how much weight during their first 5-6 months of life?

Answer 63

1.5lb (680g) per month

Question 64

birth weight should double by age __ and triple by age ___ and quadruple by age ___

Answer 64

birth weight should double by 5 months of age and triple by 12 months of age and quadruple by 30 months of age

Question 65

how much do infants grow in the first 6 months of life?

Answer 65

approximately 1 in (2.5 cm) per month

Question 66

growth occurs in spurts after what age?

Answer 66

6 months

Question 67

birth length increases by __% by the age of 12 months

Answer 67

50%

Question 68

when do the first teeth erupt?

Answer 68

around 6 and 10 months

Question 69

how many teeth should erupt by the end of the first year of age?

Answer 69

6-8 teeth

Question 70

what are some indications of teething?

Answer 70

- sucking or biting their fingers or hard objects and drooling - difficulty sleeping - mild fever - rub their ears - decreased appetite for solid foods

Question 71

the number of teeth a child should have can be identified with what equation?

Answer 71

age in months - 6 = number of teeth child should have

Question 72

physical developmental highlights: toddler (1-3 years)

Answer 72

- walks alone (13 months) - pulls toys behind when walking - begins to run (24 months) - kicks a ball (24 months) - beginning to dress self (24 months) - two foot jumps (30 momths) - stands on tiptoes (30 months)

Question 73

social developmental highlights: toddler (1-3 years)

Answer 73

- tolerates some separation (15 months) - imitates behavior of others (15 months) - temper tantrums common (18 months) - increased independence from parents (24 months) - likes to play with other children - parallel play

Question 74

cognitive developmental highlights: toddler (1-3 years)

Answer 74

- forms memories of events that relate to them (13+ months) - finds objects in several hiding spots (19+ months) - object permanence fully develops (19+ months) - sorts by shape and color (24+ months) - plays make-believe (house, mom, dad) (24+ months) - uses 2-3 word phrases (24+ months)

Question 75

what physical developmental highlights can a toddler do at 24 months?

Answer 75

- begin to run - kick a ball - beginning to dress self

Question 76

what physical developmental highlights can a toddler do at 30 months?

Answer 76

- two foot jumps - stand on tiptoes

Question 77

when can a toddler walk alone?

Answer 77

13 months

Question 78

what social developmental highlights can a toddler do at 15 months?

Answer 78

- tolerate some separation - imitate behavior of others

Question 79

temper tantrums are common at age ___

Answer 79

18 months (toddler)

Question 80

increased independence from parents begins around age ___

Answer 80

24 months (toddler)

Question 81

around what age do toddlers form memories of events that relate to them?

Answer 81

13+ months

Question 82

what cognitive developmental highlights can a toddler do at 19+ months?

Answer 82

- find objects in several hiding places - object permanence fully developed

Question 83

what cognitive developmental highlights can a toddler do at 24+ months?

Answer 83

- sort by shape and color - play make believe (house, mom, dad) - uses 2-3 word phrases

Question 84

at 30 months old, toddlers should weigh ___x their birth weight

Answer 84

4x their birth weight

Question 85

toddlers grow approximately ____ per year (weight)

Answer 85

1.8-2.7kg (4-6lb) per year

Question 86

toddlers grow about ___ per year (height)

Answer 86

7.5 cm (3in) per year

Question 87

at what age should a child have an established dental provider?

Answer 87

by 1 year old

Question 88

dental care of child

Answer 88

- flossing and brushing should be done by the adult caregiver (removes plaque the best) - brush teeth after meals and at bedtime - nothing to eat or drink, except water, is given to the child after bedtime cleaning

Question 89

what is the consequence to starting potty training too early?

Answer 89

training may take longer

Question 90

when do children start to show signs of readiness to begin potty training?

Answer 90

18 months - 3 years - toddler age

Question 91

signs of readiness to start potty training include

Answer 91

- recognizing sensation of needing to urinate or defecate ** - ability to communicate to go potty ** - voluntary control of anal and urethral sphincters (dry for at least 2 hours of time) ** - able to sit for short periods of time - able to dress/undress for toileting - interest in sitting on the potty **main signs

Question 92

nursing care of toddler ready to being potty training

Answer 92

- get them used to sitting on the training toilet - getting the child in the mindset of going to bathroom (a relaxing place) - give them something to do while sitting on the training toilet for a little while

Question 93

physical developmental highlights: preschooler (3-6 years)

Answer 93

- climbs well - walks up and down stairs - kicks ball - runs easily - pedals a tricycle - bends over without falling - eruption of deciduous (primary) teeth is finalized by the beginning of the preschool years

Question 94

social developmental highlights: preschooler (3-6 years)

Answer 94

- egocentric** (everything is all about them, temper tantrums may still occur) - imitates adults and playmates - show affection for familiar playmates - can take turns in games - understands "mine" and "his"/"hers" - enjoys talking - associative play - putting puzzles together - computer programs

Question 95

cognitive developmental highlights: preschooler (3-6 years)

Answer 95

- makes mechanical toys work - matches an object in hand to picture in book - sorts objects by shape and color - completes 3-4 piece puzzles - language primary form of communication - feel good about gaining independence

Question 96

eruption of deciduous (primary) teeth is finalized by what age?

Answer 96

the beginning of the preschool years (~3 years)

Question 97

physical developmental highlights: school-age (6-12 years)

Answer 97

- rapid growth in height and weight - prepubertal changes - permanent teeth eruption - differences in the rate of growth and maturation between boys and girls becomes apparent

Question 98

social developmental highlights: school-age (6-12 years)

Answer 98

- peer group play - bully - make crafts - collect things/engage in hobbies - play board and card games - join organized competitive sports - need for privacy

Question 99

general cognitive developmental highlights: school-age (6-12 years)

Answer 99

- conceptual thinking - learn to tell time - see perspective of others - solve problems - classifies more complex information

Question 100

cognitive developmental highlights: early school-age

Answer 100

- judgement guided by rewards and punishment

Question 101

social developmental highlights: later school-age

Answer 101

- treats other the way they want to be treated - awareness of self in relation to others - opinions of peers and teacher more valuable

Question 102

physical developmental highlights: adolescent (12-20 years)

Answer 102

- sexual maturation - differs male to female

Question 103

female sexual maturation occurs in the order of

Answer 103

- breast development - pubic hair growth (some girls experience hair growth before breast development) - axillary hair growth - vaginal discharge - menstruation

Question 104

male sexual maturation occurs in the order of

Answer 104

- testicular enlargement - pubic hair growth - penile erection - growth of axillary hair - increase in muscularity - early voice changes - early facial hair growth

Question 105

social developmental highlights: adolescent (12-20 years)

Answer 105

- begins with close, same-sex friendships during early adolescence - transitions from friendships to intimate relationships - mood swings - compares self to peers - view self as invincible, risky behaviors increase - body image

Question 106

cognitive developmental highlights: adolescent (12-20 years)

Answer 106

- capable of evaluating the quality of their own thinking - highly imaginative and idealistic - able to maintain attention for longer periods of time - increasingly capable of using formal logic to make decisions - thinking beyond current circumstances - able to understand how the actions of an individual influence others

Question 107

erikson's stage of development

Answer 107

- 8 stages - include name, age, psychosocial crisis, positive outcome and negative outcome

Question 108

erikson's stage of development: stage 1

Answer 108

- name: infancy - age: day 1-1.5 years - psychosocial crisis: trust vs. mistrust - positive outcome: feelings of trust - negative outcome: fear or mistrust

Question 109

erikson's stage of development: stage 2

Answer 109

- name: early childhood - age: 1.5-3 years - psychosocial crisis: autonomy vs shame and doubt - positive outcome: self sufficiency - negative outcome: lack of independence

Question 110

erikson's stage of development: stage 3

Answer 110

- name: play age - age: 3-5 years - psychosocial crisis: initiative vs guilt - positive outcome: discovers ways to initiate actions - negative outcome: guilt form actions or thoughts

Question 111

erikson's stage of development: stage 4

Answer 111

- name: school age - age: 5-12 years - psychosocial crisis: industry vs. inferiority - positive outcome: development of sense of competence - negative outcome: no sense of mastery

Question 112

erikson's stage of development: stage 5

Answer 112

- name: adolescence - age: 12-18 years - psychosocial crisis: identity vs. role confusion - positive outcome: awareness of uniqueness of self - negative outcome: inability to identify the appropriate roles of life

Question 113

erikson's stage of development: stage 6

Answer 113

- name: young adult - age: 18-25 years - psychosocial crisis: intimacy vs isolation - positive outcome: development of loving, sexual relationships - negative outcome: fear of relationships with others

Question 114

erikson's stage of development: stage 7

Answer 114

- name: middle adult - age: 25-65 years - psychosocial crisis: generative vs. stagnation - positive outcome: sense of contribution to continuity of life - negative outcome: feeling one's activities are trivial

Question 115

erikson's stage of development: stage 8

Answer 115

- name: late adult - age: 65+ years - psychosocial crisis: ego integrity vs despair - positive outcome: sense of unity in life's achievements - negative outcome: regret over lost opportunities of life

Question 116

psychosocial crisis: trust vs. mistrust

Answer 116

trust or mistrust that basic needs, such as nourishment and affection, will be met - trust: when baby is crying in the crib, parent comes to soothe the baby, feed the baby, change the baby, etc. - mistrust: when baby is crying in the crib and no one come to soothe

Question 117

psychosocial crisis: autonomy vs. shame and guilt

Answer 117

develop a sense of independence in many tasks

Question 118

psychosocial crisis: initiative vs. guilt

Answer 118

take initiative on some activities- may develop guilt when unsuccessful or boundaries overstepped *age of magical thinking

Question 119

psychosocial crisis: industry vs. inferiority

Answer 119

develop self-confidence in abilities when competent or sense of inferiority when not

Question 120

psychosocial crisis: identity vs. role confusion

Answer 120

experiment with and develop identity and roles

Question 121

psychosocial crisis: intimacy vs. isolation

Answer 121

establish intimacy and relationships with others

Question 122

psychosocial crisis: generative vs. stagnation

Answer 122

contribute to society and be part of a family

Question 123

psychosocial crisis: ego integrity vs. despair

Answer 123

assess and make sense of life and meaning of contributions

Question 124

family systems theory

Answer 124

change has a domino affect

Question 125

family system theory: what to assess

Answer 125

- family's ability to accept new ideas, resources, and opportunities

Question 126

family stress theory

Answer 126

stress affects families

Question 127

family stress theory: what to assess for

Answer 127

- coping and resiliency of each family member

Question 128

Duvall's Developmental stages theory

Answer 128

families develop and change - as a family grows the dynamics of the family evolve and change

Question 129

Duvall's Developmental theory: what to assess for

Answer 129

- anticipatory guidance effectiveness

Question 130

family systems theory: common interventions

Answer 130

- interacting with family members as a group - being a skillful communicator - anticipatory guidance to help prepare and cope with change

Question 131

family stress theory: common interventions

Answer 131

- use crisis intervention strategies to help family members cope with existing challenges

Question 132

Duvall's Developmental theory: common interventions

Answer 132

- provide anticipatory guidance to prepare for the transition into the next family stage

Question 133

sociocultural theory of development

Answer 133

a person's cognitive development is largely influenced by their surrounding culture - religious - farming - musician

Question 134

parents and caregivers relinquish control when their children begin ___

Answer 134

attending school

Question 135

___ influences affect psychological development

Answer 135

outside influences

Question 136

socialization is fostered by

Answer 136

- school - peers - community: family, neighborhood, school, youth organization, etc.

Question 137

general principles of communication

Answer 137

- remember the child- call by name - recognize the child's perception - be aware of facial cues - use simple terminology - be aware of double meanings - individualize information given - understand the patient's learning style - use routine and structure - leave your baggage at the door

Question 138

things to consider to establish rapport

Answer 138

how will you... - approach a child? - incorporate their likes? - share your thoughts and observations? - demonstrate listening? - handle a parent who is talking unfavorably about their child? what tone and vocabulary will you use?

Question 139

pediatric health history includes

Answer 139

- demographic information - chief complaint - present history - past history (from birth) - review of systems - family medical history (risk factors) - psychosocial history - sexual history - family dynamic (getting to know the family) - nutritional assessment

Question 140

past medical history includes

Answer 140

- birth history (gestational age) - dietary history - illness, injuries, hospitalizations, surgeries - allergies (medicine, environmental) - medications and immunizations - growth and development - habits

Question 141

review of systems: order of questioning

Answer 141

- order of questioning should begin with least invasive and move towards the most invasive

Question 142

a comprehensive physical exam includes

Answer 142

- general growth - skin - HEENT - chest - respiratory - CV - GI - GU/GYN - musculoskeletal - neurologic - endocrine - hematology/lymphatic - allergic/immunology - psychiatric - physical appearance - state of nutrition - behavior - personality - interactions with parents, siblings, nurse - posture - development** - gross motor - fine motor - language - social skills

Question 143

physical examination of an infant: position

Answer 143

- before able to sit alone: supine or prone, preferably in parent's lap - before 4-6 months: can place on exam table - after able to sit alone: sitting in parent's lap whenever possible - if on the table, place with parent in full view

Question 144

physical examination of an infant: sequence

Answer 144

- if quiet, auscultate heart, lungs, abdomen - record HR and RR - palpate and percuss same areas - proceed in usual head to toe direction - perform traumatic procedures last (eyes, ears, mouth [while crying]) - elicit reflexes as body part is examined - elicit moro reflex last

Question 145

physical examination of an infant: preparation

Answer 145

- completely undress if room temp permits - leave diaper on male infant - gain cooperation with distraction, bright objects, rattles, talking - smile at infant, use soft gentle voice - pacify with bottle of sugar water or feeding - enlist parent's aid for restraining to examine ears and mouth - avoid abrupt, jerky movements

Question 146

physical examination of a toddler: position

Answer 146

- sitting or standing on or by parent - prone or supine in parent's lap

Question 147

physical examination of a toddler: sequence

Answer 147

- inspect body area through play: "count fingers" "tickle toes" - use minimum physical contact initially - introduce equipment slowly - auscultate, percuss, palpate whenever quiet - perform traumatic procedures last (eyes, ears, mouth [while crying]) - elicit reflexes as body part is examined

Question 148

physical examination of a toddler: preparation

Answer 148

- have parent remove outer clothing - remove underwear as body part is examined - allow to inspect equipment, demonstrating use of equipment is ineffective - if uncooperative, perform procedures quickly - use restraint when appropriate, request parent's assistance - talk about examination if cooperative, use short phrases - praise for cooperative behavior

Question 149

physical examination of a preschool child: position

Answer 149

- prefer standing or sitting - usually cooperative prone or supine - prefer parent's closeness

Question 150

physical examination of a preschool child: sequence

Answer 150

- if cooperative, proceed in head-to-toe directions - if uncooperative, proceed as with toddler

Question 151

physical examination of a preschool child: preparation

Answer 151

- request self-undressing - allow to wear underpants if shy - offer equipment for inspection, briefly demonstrate use - make up story about procedure (ie. im seeing how strong your muscles are [BP]) - use paper dolls technique - give choices when possible - expect cooperation, use positive statements (open your mouth)

Question 152

physical examination of a school-age child: position

Answer 152

- prefer sitting - cooperative in most positions - younger child prefers parent's presence - older child may prefer privacy

Question 153

physical examination of a school-age child: sequence

Answer 153

- proceed head-to-toe direction - may examine genitals last in older child

Question 154

physical examination of a school-age child: preparation

Answer 154

- request need for privacy - request self-undressing - allow to wear underpants - give gown to wear - explain purpose of equipment and significance of procedure, such as otoscope to see eardrum, which is necessary for hearing - teach about body function and care

Question 155

physical examination of an adolescent: position

Answer 155

- prefer sitting - cooperative in most positions - offer option of parent's presence

Question 156

physical examination of an adolescent: sequence

Answer 156

- proceed head-to-toe direction - may examine genitals last

Question 157

physical examination of an adolescent: preparation

Answer 157

- allow to undress in private - give gown - expose only area to be examined - respect need for privacy - explain findings during examination: Your muscles are firm and strong - matter-of-factly comment about sexual development: your breasts are developing as they should be - emphasize normalcy of development - examine genitalia as any other body, may leave to end

Question 158

nutritional status exam includes

Answer 158

- dietary history - anthropometric measures - general growth percentiles for age - height, weight, head circumference, BMI - body systems impacted by nutrition

Question 159

what are the body systems impacted by nutrition?

Answer 159

- skin and hair: decreased skin turgor, dry/brittle skin, thin hair - HEENT: dehydration- under eyes, dry lips, dry mucosal membranes in mouth and nose - chest: concave - abdomen: concave (thin), constipated: distended abdomen - neuro: decreased/delayed cognitive abilities, slow and groggy, lethargic

Question 160

infant and toddler vital sign order

Answer 160

1st: respirations first (before disturbing the child) 2nd: apical heart rate 3rd: (temoral) temperature 4th: SpO2 5th: BP

Question 161

the width of the bladder of the BP cuff should be approximately ____% of the circumference of the upper arm midway between the ___ and ____

Answer 161

the width of the bladder of the BP cuff should be approximately __40__% of the circumference of the upper arm midway between the __olecranon__ and __acromion__

Question 162

the length of the bladder of the cuff should encircle ____% of the circumference of the upper arm midway between the ___ and ____

Answer 162

the length of the bladder of the cuff should encircle __80-100__% of the circumference of the upper arm midway between the __olecranon__ and __acromion__

Question 163

in children, are lymph nodes typically palpable?

Answer 163

yes - lymph nodes react with what is going on with the body - concerned when they are enlarged and not going away or are unilateral

Question 164

in children, can eye abnormalities result in blindness?

Answer 164

sometimes, yes

Question 165

could craniosynostosis and torticollis be seen in children?

Answer 165

yes

Question 166

craniosynostosis

Answer 166

a birth defect in which the bones in a baby's skull join together too early - occurs before brain is fully formed - as brain grows, skull becomes more misshapen

Question 167

torticollis

Answer 167

rare condition in which the neck muscles contract, causing the head to twist to one side (ie. chin to shoulder) - stiff neck; painful to turn head

Question 168

in children, do tonsils typically appear large or small?

Answer 168

large - grow into their tonsils - allow up to age 8 years to have normal size tonsils

Question 169

are child lung, cardiac and abdominal sounds similar to or different than adults?

Answer 169

similar to

Question 170

do genitals of children need to be examined?

Answer 170

maybe - tanner stages

Question 171

in children, are musculoskeletal abnormalities congenital or acquired?

Answer 171

they can be either congenital or acquired

Question 172

in children, developmental assessments are ___

Answer 172

ongoing

Question 173

neurological assessment of children can be __

Answer 173

challenging

Question 174

where should you place your stethoscope on a child to assess cardiac?

Answer 174

apical - apex of the heart

Question 175

what part of the stethoscope do you use to assess cardiac in children?

Answer 175

start with diaphragm - bell for murmurs

Question 176

what are you listening for when assessing cardiac in children?

Answer 176

- HR (whooshing sound) - S1 - S2 - murmur (functional murmur: if murmur is heard when patient is sitting down, but goes away when sat up) - hand on chest for thrills

Question 177

what pulses can you feel in children?

Answer 177

- radial, brachial (harder in younger), pedal, femoral

Question 178

pacifier: yes or no, according to AAP 2022 safe sleep?

Answer 178

full-term baby, with mom who is exclusively breastfeeding: don't introduce until breastfeeding is established and only during nap-time, wean by 6 months NICU babies: recommended as a soothing technique

Question 179

babies consume breastmilk or formula ONLY for the first ____ of life

Answer 179

4-6 months

Question 180

how are new foods introduced?

Answer 180

- one at a time - repetition of the same food before starting a new one

Question 181

50-90% of reactions are _____, not ____

Answer 181

50-90% are sensitivities, not allergies

Question 182

primary source of calories when introducing new foods

Answer 182

fluids - breastmilk/formula

Question 183

why is it easy to confuse adjustment with dislike of new foods?

Answer 183

babies have to adapt to texture

Question 184

food introduction is a ____ process

Answer 184

slow progressive process - should NOT be rushed

Question 185

nursing questions to ask infants caregiver regarding nutrition

Answer 185

- how much baby is drinking (# oz/day) - what kinds of foods - type of preparation/source of food - likes/dislikes

Question 186

positional plagiocephaly (how does it differ from brachiocephaly?)

Answer 186

one sided flat shape of their head (brachiocephaly would be both sides) - increase since "back to sleep" campaign began advocating for prone sleeping positioning - may be combined with torticollis

Question 187

positional plagiocephaly: nurse interventions

Answer 187

- educate parents on importance of tummy time during awake hours - use a boppy pillow to get them off their head - hang toy on opposite side of the crib to get them to turn their head and lay on opposite side - teach parents passive range of motion-moving head back and forth

Question 188

how is positional plagiocephaly treated?

Answer 188

skull-molding helmet can prevent surgical correction - have to go every 2 weeks to get readjusted - cannot use helmet once the anterior fontanel closes - if introduced early, it won't be on long; if introduced late, it will be a longer process

Question 189

common health concerns of school-aged children (6-12 years)

Answer 189

- obesity

Question 190

when is a child considered obese?

Answer 190

- their BMI for gender and age is >95% when compared with children of the same age and sex

Question 191

therapeutic management of obesity

Answer 191

- Diet modification (not dieting) - Exercise/physical activity - Behavior modification - Get a nutrition expert involved - Counseling - Pharmacological (Orlistat) - Family interventions

Question 192

prevention of obesity

Answer 192

- Limit sugar consumption - Increase fruits and veggies - Limit electronic time - Limit the location of electronics - Breakfast daily - Limit eating out - Family meals and food prep - Limit portion size - Increasing physical activity

Question 193

common health concerns of adolescents (13-18 years)

Answer 193

- puberty (abnormal development)

Question 194

progression through Tanner Stages is very stressful for someone who

Answer 194

does not identify as their biological gender

Question 195

female tanner stage 2 (beginning)

Answer 195

- early or pre; age 8-11 years - thelarche-breast bud is forming - beginning changes to nipple, areola

Question 196

female tanner stage 2 (middle)

Answer 196

- pubarche = few strands of pubic and axillary hair visible - begins approx. 2-6 months after thelarche

Question 197

female tanner stage 2 (end)

Answer 197

- physiologic leukorrhea begins - increased vaginal discharge in preparation for menstruation - growth spurt begins

Question 198

female tanner stage 2-3

Answer 198

- middle (9-12 years) - breast, axillary, and genital hair growth continues - breasts and hair development progress to adult like appearance - peak height and weight velocity occurs approx. 6-12 months before onset of menses (age 12) - fat mass accumulates

Question 199

female tanner stage 3-4

Answer 199

- late (10-14 years) - onset of menses - scant volume, irregular cycle with no ovulation for first 6-14 months - growth plateaus approx. 2-2.5 years after onset of menses

Question 200

female past age 14, tanner stage __

Answer 200

5

Question 201

concerns warranting further assessment: female puberty

Answer 201

- secondary sex characteristics before the age of 8 in females - absence of menarche (1st period) past the age of 15

Question 202

tanner stage of breast development: stage 2 (pubertal)

Answer 202

breast bud stage- small area of elevation around papilla; enlargement of areolar diameter *usually 2 years after this, the female will start their period

Question 203

tanner stage of breast development: stage 3

Answer 203

further enlargement of breast and areola with no separation of their contours

Question 204

tanner stage of breast development: stage 4

Answer 204

projection of areola and papilla to form a secondary mound (may not occur in all girls)

Question 205

tanner stage of breast development: stage 5

Answer 205

mature configuration; projection of papilla only caused by recession of areola into general contour

Question 206

tanner stage of female pubic hair development: stage 1 (prepubertal)

Answer 206

no pubic hair

Question 207

tanner stage of female pubic hair development: stage 2

Answer 207

- course few little hairs (downy straight hair) sparse growth of long, straight, downy, and slightly pigmented hair extending along labia; between stages of 2 and 3 begins to appear on pubis

Question 208

tanner stage of female pubic hair development: stage 3

Answer 208

- extends a little, a little more curly - hair darker, coarser, and curly and spread sparsely over entire pubis in the typical female triangle

Question 209

tanner stage of female pubic hair development: stage 4

Answer 209

- extending and more in volume - pubic hair denser, curled, and adult in distribution but less abundant and restricted to the pubic area

Question 210

tanner stage of female pubic hair development: stage 5

Answer 210

- hair goes onto thighs and legs - hair adult in quality, type, and pattern with spread to inner aspect of thighs

Question 211

tanner stage of female pubic hair development: the average span for stages 2-5

Answer 211

11-14 years

Question 212

concerns warranting further assessment: male puberty

Answer 212

- secondary sex characteristics before the age of 9 in males - absence of genitalia enlargement by age 14

Question 213

male tanner stage 2 (beginning)

Answer 213

- early or pre (age 9-14 years) - testicular enlargement - initial changes to size of testicles

Question 214

male tanner stage 2 (middle)

Answer 214

- scrotal changes begin - reddening and textural changes to scrotal skin

Question 215

male tanner stage 2 (end)

Answer 215

- sparse pubic hair - slight hair growth at base of penis

Question 216

male tanner stage 2-3

Answer 216

- middle (10-14 years) - testicles, scrotum, and genital hair growth continues, penis growth and ejaculation occur - Genitalia and hair development progress to adult like appearance - Growth spurt begins, muscle mass increases, early voice changes and facial hair growth - gynecomastia may develop - breast development disappears within 2 years of onset

Question 217

male tanner stage 3-4

Answer 217

- late (age 13-16 years) - axillary hair develops, facial hair extends to neck - final voice changes - peak height velocity and weight velocity around age 14 with continued growth until age 18-20 years

Question 218

tanner stage 5 for males may not occur until what developmental age?

Answer 218

- end of adolescence

Question 219

tanner stages of male genitalia development: stage 1 (prepubertal)

Answer 219

- no pubic hair; essentially the same as during childhood

Question 220

tanner stages of male genitalia development: stage 2

Answer 220

- initial enlargement of scrotum and testes; reddening and textural changes of scrotal skin; sparse growth of long, straight, downy, and slightly pigmented hair at base of penis

Question 221

tanner stages of male genitalia development: stage 3

Answer 221

initial enlargement of penis, mainly in length; testes and scrotum further enlarged; hair darker, coarser, and curly and spread sparsely over entire pubis

Question 222

tanner stages of male genitalia development: stage 4

Answer 222

- increased size of penis with growth in diameter and development of glans; glans larger and broader; scrotum darker; pubic hair more abundant with curling but restricted to pubic area

Question 223

tanner stages of male genitalia development: stage 5

Answer 223

testes, scrotum, and penis adult size and shape; hair adult in quality and type with spread to inner surface of thighs

Question 224

gynecomastia

Answer 224

- extra breast tissue - could be unilateral or bilateral - extra estrogen surge *not concerned unless it continues to occur for 2 years or greater, or it happens after puberty- concerned for tumor (pituitary/adrenal/testicular)

Question 225

when does gynecomastia occur?

Answer 225

70% of males going through puberty - normal

Question 226

how is gynecomastia resolved?

Answer 226

usually resolves in under 2 years

Question 227

when do babies start to see color?

Answer 227

2 months

Question 228

how far away can a 1 month old baby see?

Answer 228

10 inches

Question 229

rolling back to stomach happens around what age?

Answer 229

5 months - begin rolling at 4 months

Question 230

transferring objects hand to hand doesn't usually happen before what age?

Answer 230

3 months

Question 231

head lag

Answer 231

the head falls backward when not supported due to lack of strength in neck muscles - occurs until around 4 months (when the neck muscles get stronger)

Question 232

crawling occurs around what age?

Answer 232

start around 8 months - backwards first

Question 233

when does walking usually occur?

Answer 233

as early as 10 months, usually 11-12 months - if there is a delay, could be related to family history OR need interventions

Question 234

what would we be concerned about if the anterior fontanel closes too early?

Answer 234

cranial stenosis - brain would not be able to grow due to restricted head size

Question 235

how much do infants grow from 6-12 months of life?

Answer 235

0.5 inch per month

Question 236

vocabulary: 9 months

Answer 236

2-3 words

Question 237

vocabulary: 12 months

Answer 237

4-5 words

Question 238

vocabulary: 18 months

Answer 238

10-20 words

Question 239

vocabulary: 24 months (2 years)

Answer 239

>200-300 words - 2 word phrases - 50% understood

Question 240

vocabulary: 36 months (3 years)

Answer 240

3 word phrases 75% understood

Question 241

vocabulary: 4 years

Answer 241

4-5 word phrases 100% understood

Question 242

young school age covers the ages of

Answer 242

6, 7, 8 and 9 years

Question 243

older school age covers the ages of

Answer 243

10, 11 and 12 years

Question 244

how do male and female puberty (sexual development differ)?

Answer 244

females: mature top to bottom males: mature bottom to top

Question 245

what occurs characteristically during adolscence

Answer 245

- should know right from wrong - testing limits - experimenting - rebellious - undergoing puberty

Question 246

what is the purpose of anticipatory guidance?

Answer 246

preparing the family for what to expect

Question 247

how would the nurse handle a parent who is talking unfavorably about their child?

Answer 247

- offer the parent a break (may be stressed out) - maybe the parent needs more resources - ask if there is anything you can do to help them - if very heated- ask them to come out of the room, take a walk with them

Question 248

when would you do a tympanic temperature on a child with a history of ear infections?

Answer 248

as the last vital sign

Question 249

what is the equation for how much a baby should be consuming in oz per day?

Answer 249

weight (lb) x 2.5 oz = total amount in oz that they should be eating/day

Question 250

maternal iron stores decrease around what age?

Answer 250

4-5 months

Question 251

iron needs to be introduced to babies around what age? what is it usually introduced as?

Answer 251

4 months - rice cereal

Question 252

when are solid foods introduced?

Answer 252

around 4 months - 1 food at a time for several days - usually start with rice cereal for several weeks before starting other foods (may combine rice cereal with breast milk to soften and serve on a spoon)

Question 253

allergies are mediated by

Answer 253

IgE - means that if you are allergic to something, you have a IgE in your blood

Question 254

if a baby crosses __ percentiles, concern is warranted

Answer 254

crosses 2 percentiles

Question 255

expected range for urine specific gravity

Answer 255

1.005-1.020