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Flashcards in Learn system Pediatrics 1 & 2 Deck (18)
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1

Caring for dehydrated toddler, ordered 100mL NS over 4 hrs. Using 60 gtt microdrip set, RN should regulate IV to deliver what rate?
a. 25 gtt/min
b. 15 gtt/min
c. 60 gtt/min
d. 100 gtt/min

(25 ml X 60 gtt)/ 60 minutes = 25 gtt/min

2

Assessing a 9 mth old for developmental delay. WOTF supports this?
a. delayed startle reflex
b. inability to sit without support
c. powerlessness to pull self up
d. inability to stand alone

b. inability to sit w/out support.. By the age of 7 mths, infants should be able to sit alone with support, roll back and forth, reach for objects, and may even begin to crawl. Most infants start to pull themselves up around 8 mths, and are able to stand alone for short periods around 11 mths of age. The ability to stand alone is present in infants at 9-11 mths

3

Ax-ing 4 mth old infant. WOTF prompts further eval?
a. head lag when pulled from lying to sitting position
b. disappearance of moro and tonic-neck reflexes
c. ability to hold rattle but inability to pick it up
d. infant can roll from back to side, but not back to front

a. head lag when pulled from lying to sitting- by 4-6 mths, head control is well established. The moro and tonic neck reflexes nmlly disappear at 3-4 mths. Infants typically pick up objects at 6 mths old. Inability to roll from back to front is nml for 4 mth olds

4

At 6 mths old, RN should expect to find what reflex?
a. stepping
b. Babinski
c. extrusion
d. moro

b. Babinski reflex (stroking bottom of foot and watching toes fan out and big toe dorsiflex) is present until 1 yr. Stepping reflex gone by 4 wks, extrusion gone by 4 mths, and moro reflex is gone by 3-4 mths.

5

Appropriate toy for a 4 year old child?
a. brightly colored mobile
b. plastic stethoscope
c. jigsaw puzzle
d. beads and string

b. plastic stethoscope- preschool play centers on imitative, imaginative and dramatic play. Preschoolers like to imitate adults, thus a plastic stethoscope would be appropriate. Option a is good for a young infant, a puzzle is too difficult for 4 yr olds, and beads could be dangerous to preschoolers

6

3 yr old dxd w/ DM. Toy that will promote therapeutic play?
a. puppet dressed as a nurse
b. book about hospitalization
c. doll and a syringe w/ no needle
d. stuffed bear w/bandages to apply

c. doll and a syringe w/ no needle. The preschooler will have a lot anxiety about the frequent needles required for finger sticks and insulin injections. This will help relieve their anxiety and will promote imitative play

7

Routine Phys exam, appropriate instruction to parents?
a. establish a set bedtime and follow a nightly routine
b. encourage active play prior to bedtime to tire the child
c. let the child stay up until tired
d. reward the child w/ a cookie if bedtime is pleasant

a. All children, especially toddlers, need a strict routine. Preschool-age children test limits and consistency in routines is important.

8

12 mth old nutrition teaching. Need for further teaching?
a. my child can drink 4 oz juice qday
b. I should give my child cereal and apple slivers for a snack
c. my child should be introduced to the same food as the family
d. my infant should drink 2 qt of skim milk per day.

d. 2 qts of milk every day is too much, Skim milk doesn't contain iron, thus, placing the infants at a greater risk for iron-deficiency anemia. It also does not contain enough fat for infants. A & B are correct, answer C allows the infant to be introduced to new appropriate foods like mashed potatoes, green beans, bread and finely chopped meats

9

Child w/ bacterial endocarditis will require long-tm antibiotics and a PICC. RN should tell parents?
a. The PICC line will last several weeks w/ proper care
b. The public health nurse will rotate the site q3 days
c. you will need to make certain the arm board is on at all times
d. your child will go to the OR to have the line placed

a. PICC lines may remain in place for up to 6 mths w/ proper care. Arm boards are not required to immobilze the arm as PICC lines are very flexible. PICC lines are inserted at the bedside w/ the use of a local anesthetic. Sometimes, fluoroscopy may be needed to insert the PICC line, but this is done in radiology. On larger ped units, children will be taken to the txmt room so that their bed remains a safe place. Nothing should be done there if possible

10

2 mth old infant brought to clinic for routine immunizations. WOTF should RN give?
a. HIB, Td, HBV and IPV (polio vaccine)
b. DTaP, MMR, and IPV
c. DTaP, HIB, IPV, and HBV
d. HIB, MMR, Td, and IPV

c. DTaP, HIB, IPV, and HBV are all recommended to be given at 2 mths. In some cases, the 1st dose of HBV is given to neonates prior to discharge from the hospital, in which case the 2nd dose is given along w/ the 1st dose of the other vaccines listed. Td (tetanus, diphtheria) vaccine is only given to adolescents and adults, and the MMR vaccine is typically given at 15 mths. MMR can't be given to p's

11

RN caring for 3 yr old post-op for malfunctioning ventriculo peritoneal shunt. RN should use wotf to determine pain?
a. ask the parents
b. use the FACES pain scale to rate the pain
c. use the numeric rating scale
d. rely on VS changes, such as increased HR

b. The FACES pain scale can be used to determine pain in children as young as 3 yrs old. Never rely on parents or anyone else to determine pain, the numeric pain scale is appropriate for 5 yr olds and up, and VS changes are not reliable indicators of pain

12

Yearly H. axmt of 14 yr old girl. WOTF requires further eval?
a. acne vulgaris on her face
b. She has not gotten taller since her last visit
c. her menstrual cycle is irregular
d. there is a lateral curvature to her spine

d. This indicates scoliosis and requires f/u w/x-rays and referral to othropedic surgeon. Acne is nml, 14 yr old girls typically have reached at least 95% of their adult ht, and menstrual irregularities could be due to exercise (some athletic girls don't exp. menarche until 14th or 15th bday).

13

8 yr old w/ fx'd femur and in skeletal traction. WOTF appropriate action for RN?
a. allow the child to play video games daily
b. take the child to the playroom daily, in the bed.
c. assign roommates for the child who are of similar ages
d. have the hospital tutor visit daily to assist w/ homework

d. School age children are in stage of industry v. inferiority (Erikson), and will worry about falling behind their peers in school work. It is important to make arrangements w/ the school to provide the child's homework

14

18 mth old child, parent teaching for safety, correct statement?
a. I have locked my meds in the cabinet
b. I know that once child understand 'no', they will be safe
c. I watch my child every second
d. I will make my child vomit if she swallows anything

a.

15

30 mth old, wotf is not an expected finding?
a. primary dentition is complete
b. legs appear bowed
c. birth wt is tripled
d. abdomen is pot-bellied

c. birth wt is tripled. This is an expected finding at 12 mths of age, by 30 mths, the birth wt should be quadrupled. Primary dentition is expected to be complete by 30 mths, bowed appearing legs is nml due to the toddlers large trunk and pot-belly

16

CI to pertussis immunization?
a. hx of fever of 101 after previous immunization
b. sibling that had an AE to pertussis vaccine
c. documented hx of egg allergy
d. known neurologic or seizure d/o

d. a known neuro or seizure d/o puts the child at higher risk of an AE to the pertussis vaccine. Other valid CIs include fever >105 or extreme lethargy following previous pertussis immunization

17

infant on droplet precautions, RN can best prevent spread of droplets by?
a. having infant wear mask in playroom
b. wearing sterile gloves w/ diaper changes
c. wearing a gown & mask when feeding infant
d. using contact precautions when caring for infant

c. wearing a gown and mask will decrease the chance of spreading infected respiratory droplets mixed w/ burped baby milk

18

Caring for child who is dying, who's 4 yr old sibling is visiting, wotf indicates a 4 yr olds perception of death?
a. death is the same as going to sleep
b. death is caused by magical thinking
c. death is permanent and lasting
d. death is the result of a wish
e. death is a punishment

a, b, d, and e