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NCLEX - Pediatrics

NCLEX Review - Pediatrics

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: CocoDiva
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