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NCLEX - Pediatrics
NCLEX Review - Pediatrics
| Question | Answer |
|---|---|
| Piaget's Period for Infancy | Sensorimotor: Reflexive behavior is used to adapt to the environment; egocentric view of the world; development of object permanence. |
| Erikson's Stage for Infancy | Trust vs. Mistrust (0-18 months): Development of a sense that the self is good and the world is good when consistent, predictable, reliable care is received; characterized by hope. |
| Piaget's Period fo Toddlers & Preschoolers | Preoperational Thought: Thinking remains egocentric, becomes magical, and is dominated by perception. |
| Erikson's Stage for Toddlers | Autonomy vs. Shame and Doubt (2-3 yr): Development of sense of control over the self and body functions; exerts self; characterized by will. |
| Erikson's Stage for Preschoolers | Initiative vs. Guilt (3-5 yr): Development of a can-do attitude about the self; behavior becomes goal-directed, competitive, and imaginative; initiation into gender role; characterized by purpose. |
| Piaget's Period for School Age | Concrete Operations: Thinking becomes more systematic and logical, but concrete objects and activities are needed. |
| Erikson's Stage for School Age | Industry vs. Inferiority (6-11 yr): Mastering of useful skills and tools of the culture; learning how to play and work with peers; characterized by competence. |
| Piaget's Period for Adolescence | Formal Operations: New ideas can be created; situations can be analyzed; use of abstract and futuristic thinking; understands logical consequences of behavior. |
| Erikson's Stage for Adolescence | Identitity vs. Role Confusion (12-18 yr): Begins to develop a sense of “I”; this process is lifelong; peers become of paramount importance; child gains independence from parents; characterized by faith in self. |
| Erikson's Stage for Young Adulthood | Intimacy vs. Isolation (19-40 yr): Development of the ability to lose the self in genuine mutuality with another; characterized by love. |
| Erikson's Stage for Middle Adulthood | generativity vs. stagnation (40-65 yr): Production of ideas and materials through work; creation of children; characterized by care. |
| Erikson's Stage for Mature Adults | Ego Integrity vs. Despair (> 65 yr): Realization that there is order and purpose to life; characterized by wisdom. |
| When does birth length double? | by 4 years. |
| When does the child sit unsupported? | 8 months. |
| When does a child achieve 50% of adult height? | 2 years. |
| When does a child throw a ball overhand? | 18 months. |
| When does a child speak two- to three-word sentences? | 2 years. |
| When does a child use scissors? | 4 years. |
| When does a child tie his or her shoes? | 5 years. |
| Start of Girl's growth spurt vs. Boy's growth spurt | a girl’s growth spurt during adolescence begins earlier than a boy’s (as early as 10 years of age). |
| Tanner Stage 1 | Prepubertal |
| Tanner Stage 2 | Boys: scrotum & testes enlargement; scrotum reddens & changes texture; Girls: Breast bud with elevation of breast and papilla; enlargement of areola; Both: Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis/along labia |
| Tanner Stage 3 | Boys: Enlargement of penis (length at first); further growth of testes; Girls: Further enlargement of breast and areola; no separation of their contour; Both: Darker, coarser and more curled hair, spreading sparsely over junction of pubes |
| Tanner Stage 4 | Boys: Increased size of penis w/ growth in breadth & development of glans; testes & scrotum larger, scrotum darker; Girls: Areola and papilla form a secondary mound above level of breast; Both: adult hair, but covering smaller area; no spread to thighs |
| Tanner Stage 5 | Boys: Adult genitalia; Girls: Mature stage: projection of papilla only, related to recession of areola; Both: Pubic hair adult in type and quantity, with horizontal distribution ("feminine") |
| Concept of bodily injury in Infants | After 6 months, their cognitive development allows them to remember pain. |
| Concept of bodily injury in Toddlers | They fear intrusive procedures. |
| Concept of bodily injury in Preschoolers | They fear body mutilation. |
| Concept of bodily injury in School-age children | They fear loss of control of their bodies. |
| Concept of bodily injury in Adolescents | Their major concern is change in body image. |
| Contraindication for DTaP vaccine | History of reactions, seizures, neurologic symptoms after previous vaccine, or systematic allergic reactions |
| Contraindication for MMR vaccine | History of anaphylactic reaction to eggs or neomycin |
| Varicella (chickenpox) symptoms | Lesions that begin on the trunk and spread to the face and proximal extremities and progress through macular, papular, vesicular, and pustular stages |
| Rubella (German measles) symptoms | Discrete red maculopapular rash that starts on face and rapidly spreads to entire body and disappears within 3 days; |
| Exposure to what virus causes serious consequences to unborn fetus | German measles |
| Paramyxovirus (mumps) symptoms | Fever, headache, malaise, parotid gland swelling and tenderness; manifestations include submaxillary and sublingual infection, orchitis, and meningoencephalitis |
| Pediculosis | an infestation of lice on humans. |
| List two contraindications to live virus immunization. | Immunocompromised child or a child in a household with an immunocompromised individual |
| List three classic signs and symptoms of measles. | Photophobia, confluent rash that begins on the face and spreads downward, and Koplik spots on the buccal mucosa |
| List the signs and symptoms of iron deficiency. | Anemia; pale conjunctiva; pale skin color; atrophy of papillae on tongue; brittle, ridged, or spoon-shaped nails; and thyroid edema |
| Identify food sources of vitamin A. | Liver, sweet potatoes, carrots, spinach, peaches, and apricots |
| What disease occurs with vitamin C deficiency? | Scurvy |
| What measurements reflect present nutritional status? | Weight, skin-fold thickness, and arm circumference |
| List the signs and symptoms of dehydration in an infant. | Poor skin turgor, absence of tears, dry mucous membranes, weight loss, depressed fontanel, and decreased urinary output |
| List the laboratory findings that can be expected in a dehydrated child. | Loss of bicarbonate/decreased serum pH, loss of sodium (hyponatremia), loss of potassium (hypokalemia), elevated Hct, and elevated BUN |
| How should burns in children be assessed? | By using the Lund-Browder chart, which takes into account the changing proportions of the child’s body |
| How can the nurse best evaluate the adequacy of fluid replacement in children? | By monitoring urine output |
| How should a parent be instructed to child-proof a house? | By being taught to lock all cabinets, to safely store all toxic household items in locked cabinets, and to examine the house from the child’s point of view |
| What interventions should the nurse perform first in caring for a child who has ingested a poison? | Assessment of the child’s respiratory, cardiac, and neurologic status |
| What early signs should the nurse assess for if lead poisoning is suspected? | Anemia, acute cramping, abdominal pain, vomiting, constipation, anorexia, headache, lethargy, hyperactivity, aggression, impulsiveness, decreased interest in play, irritability, short attention span |
| Normal Urinary output for infants and children | 1 to 2 mL/kg/hr. |
| Normal respirations in newborns | 30-60 |
| Normal respirations in 1-11 month old infants | 25-35 |
| Normal respirations in 1-3 year olds (toddler) | 20-30 |
| Normal respirations in 3-5 year olds (preschooler) | 20-25 |
| Normal respirations in 6-10 year olds (school age) | 18-22 |
| Normal respirations in 10-16 year olds (adolescent) | 16-20 |
| What assessment should not be performed on a child with epiglottitis? | Do not examine the throat of a child with epiglottitis (i.e., do not put a tongue blade or any object into the throat) because of the risk of obstructing the airway completely. |
| Describe the purpose of bronchodilators. | To reverse bronchospasm |
| What are the physical assessment findings for a child with asthma? | Expiratory wheezing, rales, tight cough, and signs of altered blood gases |
| What nutritional support should be provided for a child with cystic fibrosis? | Pancreatic enzyme replacement, fat-soluble vitamins, and a moderate- to low-carbohydrate, high-protein, moderate- to high-fat diet |
| Why is genetic counseling important for the family of a child with cystic fibrosis? | Because the disease is autosomal recessive in its genetic pattern |
| List seven signs of respiratory distress in a pediatric client. | Restlessness, tachycardia, tachypnea, diaphoresis, flaring nostrils, retractions, and grunting |
| Describe the care of a child in a mist tent. | Monitor child’s temperature, keep tent edges tucked in, keep clothing dry, assess respiratory status, look at child inside tent. |
| What position does a child with epiglottitis assume? | Upright sitting, with chin out and tongue protruding (“tripod position”) |
| Why are IV fluids important for a child with an increased respiratory rate? | The child is at risk for dehydration and acid-base imbalance. |
| Children with chronic otitis media are at risk for developing what problem? | Hearing loss |
| What is the most common postoperative complication following a tonsillectomy? Describe the signs and symptoms of this complication. | Hemorrhage; frequent swallowing, vomiting fresh blood, and clearing throat |
| Normal pulse in newborns | 100-160 |
| Normal pulse in 1-11 month old infants | 100-150 |
| Normal pulse in 1-3 year olds (toddler) | 80-130 |
| Normal pulse in 3-5 year olds (preschooler) | 80-120 |
| Normal pulse in 6-10 year olds (school age) | 70-110 |
| Normal pulse in 10-16 year olds (adolescent) | 60-90 |
| Basic differences between cyanotic and acyanotic defects | Acyanotic: Has abnormal circulation; however, all blood entering the systemic circulation is oxygenated. Cyanotic: Has abnormal circulation with unoxygenated blood entering the systemic circulation. |
| Two objectives in treating CHF | to reduce the workload of the heart and increase cardiac output |
| Digoxin Management | hold if bradycardic; therapeutic levels should be 0.8-2; admin regularly and do NOT skip doses; do not mix with formula/food; monitor for s/s of toxicity (vomiting, anorexia, diarrhea, abdominal pain, fatigue, muscle weakness, and drowsiness) |
| Differentiate between a right-to-left and a left-to-right shunt in cardiac disease. | A right-to-left shunt bypasses the lungs and delivers unoxygenated blood to the systemic circulation, causing cyanosis. A left-to-right shunt moves oxygenated blood back through the pulmonary circulation. |
| List the four defects associated with tetralogy of Fallot. | VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy |
| List the common signs of cardiac problems in an infant. | Poor feeding, poor weight gain, respiratory distress and infections, edema, and cyanosis |
| What are the two objectives in treating congestive heart failure? | Reduce the workload of the heart and increase cardiac output. |
| Describe nursing interventions to reduce the workload of the heart. | Give small, frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutral thermal environment. Organize activities to disturb child only as indicated. |
| What position would best relieve the child experiencing a tet spell? | Knee-chest position or squatting |
| What are common signs of digoxin toxicity? | Diarrhea, fatigue, weakness, nausea, and vomiting; the nurse should check for bradycardia prior to administration. |
| List five risks in cardiac catheterization. | Arrhythmia, bleeding, perforation, phlebitis, and obstruction of the arterial entry site |
| What cardiac complications are associated with rheumatic fever? | Aortic valve stenosis and mitral valve stenosis |
| What medications are used to treat rheumatic fever? | Penicillin, erythromycin, and aspirin |
| Signs of ICP vs. shock | The signs of increased intracranial pressure (ICP) are the opposite of those of shock. Shock: increased pulse, decreased blood pressure; Increased ICP: decreased pulse, increased blood pressure |
| Most common presenting symptom of brain tumors | Headache on awakening is the most common presenting symptom of brain tumors. |
| Feeding interventions for a child with cerebral palsy | Feed infant or child with cerebral palsy using nursing interventions aimed at preventing aspiration. Position child upright, and support the lower jaw. |
| What are the physical features of a child with Down syndrome? | Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes |
| Describe scissoring. | A common characteristic of spastic cerebral palsy in infants; legs are extended and crossed over each other, feet are plantar flexed |
| What are two nursing priorities for a newborn with myelomeningocele? | Prevention of infection of the sac and monitoring for hydrocephalus (measure head circumference, check fontanel, assess neurologic functioning) |
| List the signs and symptoms of increased ICP in older children. | Irritability, change in LOC, motor dysfunction, headache, vomiting, unequal pupil response, and seizures |
| What teaching should parents of a newly shunted child receive? | Information about signs of infection and increased ICP; understanding that shunt should not be pumped and that child will need revisions with growth; guidance concerning growth and development |
| State the three main goals in providing nursing care for a child experiencing a seizure. | Maintain patent airway, protect from injury, and observe carefully. |
| What are the side effects of Dilantin? | Gingival hyperplasia, dermatitis, ataxia, GI distress |
| Describe the signs and symptoms of a child with meningitis. | Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig sign, positive Brudzinski sign; infant may not show all classic signs even though very ill |
| What antibiotics are usually prescribed for bacterial meningitis? | Ampicillin, ceftriaxone, or chloramphenicol |
| How is a child usually positioned after brain tumor surgery? | Flat or on either side |
| Describe the function of an osmotic diuretic. | Osmotic diuretics remove water from the CNS to reduce cerebral edema. |
| What nursing interventions increase intracranial pressure? | Suctioning and positioning, turning |
| Describe the mechanism of inheritance of Duchenne muscular dystrophy. | Duchenne muscular dystrophy is inherited as an X-linked recessive trait. |
| What is the Gowers sign? | Gowers sign is an indicator of muscular dystrophy; to stand, the child has to “walk” hands up legs. |
| First sign of renal failure | decreased urinary output |
| Compare the signs and symptoms of acute glomerulonephritis (AGN) with those of nephrosis. | AGN: gross hematuria, recent strep infection, hypertension, and mild edema; nephrosis: severe edema, massive proteinuria, frothy-appearing urine, anorexia |
| What antecedent event occurs with acute glomerulonephritis (AGN)? | Beta-hemolytic streptococcal infection |
| Compare the dietary interventions for acute glomerulonephritis (AGN) and nephrosis. | AGN: low-sodium diet with no added salt; nephrosis: high-protein, low-salt diet |
| What is the physiologic reason for the lab finding of hypoproteinemia in nephrosis? | Hypoproteinemia occurs because the glomeruli are permeable to serum proteins. |
| Describe safe monitoring of prednisone administration and withdrawal. | Long-term prednisone should be given every other day. Signs of edema, mood changes, and GI distress should be noted and reported. The drug should be tapered, not discontinued suddenly. |
| What interventions can be taught to prevent urinary tract infections in children? | Avoid bubble baths; void frequently; drink adequate fluids, especially acidic fluids such as apple or cranberry juice; and clean genital area from front to back. |
| Describe the pathophysiology of vesicoureteral reflux. | A malfunction of the valves at the end of the ureters, allowing urine to reflux out of the bladder into the ureters and possibly into the kidneys |
| What are the priorities for a client with a Wilms tumor? | Protect the child from injury to the encapsulated tumor. Prepare the family and child for surgery. |
| Explain why hypospadias correction is performed before the child reaches preschool age. | Preschoolers fear castration, achieving sexual identity, and acquiring independent toileting skills. |
| Describe feeding techniques for a child with cleft lip or palate. | Use lamb’s nipple or prosthesis. Feed child upright, with frequent bubbling. |
| List the signs and symptoms of esophageal atresia with TEF. | Choking, coughing, cyanosis, and excess salivation |
| What nursing actions are initiated for the newborn with suspected esophageal atresia with TEF? | Maintain NPO immediately, and suction secretions. |
| Describe the postoperative nursing care for an infant with pyloric stenosis. | Maintain IV hydration, and provide small, frequent oral feedings of glucose or electrolyte solutions or both within 4 to 6 hours. Gradually increase to full-strength formula. Position infant on right side in semi-Fowler position after feeding. |
| Describe why a barium enema is used to treat intussusception. | A barium enema reduces the telescoping of the intestine through hydrostatic pressure without surgical intervention. |
| Describe the preoperative nursing care for a child with Hirschsprung disease. | Check vital signs and take axillary temperatures. Provide bowel cleansing program, and teach about colostomy. Observe for bowel perforation; measure abdominal girth. |
| What care is needed for a child with a temporary colostomy? | Family needs education about skin care and appliances. Referral to an enterostomal therapist is appropriate. |
| What are the signs of anorectal malformation? | A newborn who does not pass meconium within 24 hours; meconium appearing through a fistula or in the urine; an unusual-appearing anal dimple |
| What are the priorities for a child undergoing abdominal surgery? | Maintain fluid balance (I&O, nasogastric suction, monitor electrolytes); monitor vitals; care for any drains; assess bowel function; prevent infection of incision and other complications; and support child and family with appropriate teaching. |
| Normal Hgb in Children | Newborn: 14 to 24 g/dL; Infant: 10 to 17 g/dL; Child: 9.5 to 15.5 g/dL |
| Describe the information families should be given when a child is receiving oral iron preparations. | Give oral iron on an empty stomach and with vitamin C. Use straws to avoid discoloring teeth. Tarry stools are normal. Increase dietary sources of iron. |
| List dietary sources of iron. | Meat, green leafy vegetables, fish, liver, whole grains, legumes |
| What is the genetic transmission pattern of hemophilia? | It is an X-linked recessive chromosomal disorder transmitted by the mother and expressed in male children. |
| Describe the sequence of events in a vaso-occlusive crisis in sickle cell anemia. | clumping of red blood cells blocks small blood vessels; therefore, the cells cannot get through the capillaries, causing pain and tissue and organ ischemia. Lowered oxygen tension affects HgbS, which causes sickling of the cells. |
| Explain why hydration is a priority in treating sickle cell disease. | Hydration promotes hemodilution and circulation of the red cells through the blood vessels. |
| What should families and clients do to avoid triggering sickling episodes? | Keep child well hydrated. Avoid known sources of infections. Avoid high altitudes. Avoid strenuous exercise. |
| Nursing interventions and medical treatments for a child with leukemia are based on what three physiologic problems? | Anemia (decreased erythrocytes); infection (neutropenia); bleeding thrombocytopenia (decreased platelets) |
| How is congenital hypothyroidism diagnosed? | Newborn screening revealing a low T4 and a high TSH |
| What are the symptoms of congenital hypothyroidism in early infancy? | arge, protruding tongue; coarse hair; lethargy; sleepiness; and constipation |
| What are the outcomes of untreated congenital hypothyroidism? | Mental retardation and growth failure |
| What are the metabolic effects of PKU? | CNS damage, mental retardation, and decreased melanin |
| What two formulas are prescribed for infants with PKU? | Lofenalac and Phenex-1 |
| List foods high in phenylalanine content. | Meat, milk, dairy products, and eggs |
| What are the three classic signs of diabetes? | Polydipsia, polyphagia, and polyuria |
| Differentiate the signs of hypoglycemia and hyperglycemia. | Hypoglycemia: tremors, sweating, headache, hunger, nausea, lethargy, confusion, slurred speech, anxiety, tingling around mouth, nightmares. Hyperglycemia: polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, and syncope |
| Describe the nursing care of a child with ketoacidosis. | Provide care for an unconscious child, administer regular insulin IV in normal saline, monitor blood gas values, and maintain strict I&O. |
| Describe developmental factors that would impact the school-age child with diabetes. | Need to be like peers; assuming responsibility for own care; modification of diet; snacks and exercise in school |
| What is the relationship between hypoglycemia and exercise? | During exercise, insulin uptake is increased and the risk for hypoglycemia occurs. |
| List normal findings in a neurovascular assessment. | Warm extremity, brisk capillary refill, free movement, normal sensation of the affected extremity, and equal pulses |
| What is compartment syndrome? | Damage to nerves and vasculature of an extremity due to compression |
| What are the signs and symptoms of compartment syndrome? | Abnormal neurovascular assessment: cold extremity, severe pain, inability to move the extremity, and poor capillary refill |
| Why are fractures of the epiphyseal plate a special concern? | Fractures of the epiphyseal plate (growth plate) may affect the growth of the limb. |
| How is skeletal traction applied? | Skeletal traction is maintained by pins or wires applied to the distal fragment of the fracture. |
| What discharge instructions should be included concerning a child with a spica cast? | Check child’s circulation. Keep cast dry. Do not place anything under cast. Prevent cast soilage during toileting or diapering. Do not turn child using an abductor bar. |
| What are the signs and symptoms of congenital dislocated hip in infants? | Unequal skin folds of the buttocks, Ortolani sign, limited abduction of the affected hip, and unequal leg lengths |
| How would the nurse conduct a scoliosis screening? | Ask the child to bend forward from the hips, with arms hanging free. Examine the child for a curve in the spine, a rib hump, and hip asymmetry. |
| What instructions should a child with scoliosis receive about a skeletal brace? | The child should be instructed to wear the brace 23 hours per day; wear a T-shirt under brace; check skin for irritation; perform back and abdominal exercises; and modify clothing. The child should be encouraged to maintain normal activities as able. |
| What care is indicated for a child with juvenile rheumatoid arthritis? | Prescribed exercise to maintain mobility; splinting of affected joints; and teaching about medication management and side effects of drugs. |
Created by:
camellia
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