When assessing a child's growth pattern (i.e. what percentiles they fall into)..what discrepencies should you look for?

If they are over and above 5-95% and additionally, if there is a SIGNIFICANT DIFFERENCE BETWEEN THEIR HEIGHT AND WEIGHT(in relation to each other)...i.e. the child is in the 100 percentile for weight but only the 25th percentile for height

Why is FUNCTIONAL maturation a more appropriate definition of growth than PHYSICAL maturation?

Because athough the child may appear to be of appropriate size (height, weight, organ size), the organs themselves may not be functioning correctly

Define GROWTH

An increase in the number and size of cells as they divide and synthesize new proteins ---> Results in increased size and weight of the whole or any of its parts

3 components or definitions of MATURATION

1. An increase in competence and adaptability 2. A QUALITIVE change 3. Functioning at a higher level

What is defined as the "Process of systematically modifying or altering" and "Trending from simple to more complex"

DIFFERENTIATION

When do humans experience their MOST RAPID period of growth (postnatal)? When is does the 2nd most (haha I think I made up a phrase) RAPID PERIOD of growth occur?

INFANCY -First and most rapid period of growth PUBERTY - "second most" rapid period of growth

At what age, on average, should a BIRTH HEIGHT/LENGTH BE DOUBLED?

By age 4

Who on average, experiences, growth spurts/puberty first? (Girls or Boys)

GIRLS

5 Major Factors (and some examples of each) that can INFLUENCE GROWTH

1. Heredity (ex: sickle cell, inherited disorders) 2. Nutrition (Giving whole milk too early - within first year they should only get breastmilk/formula) 3. Gender - (Boys are most likely to sustain injuries which can alter growth) 4. Disease (Asthma, chronic illness/hospitalization can cause regression) 5. Environment - (Hazards: toxic water supply, Socioeconomic influences: lower socioeconomic groups tend to have deficient nutrition and poorer health, Season: Winter or "flu seasons" can be a concern if child not immunized or is exposed to crowds)

Why should you be concerned if a child has not completed the appropriate Erikson Psychosocial stage of Development for his or her age group?

Because any delay in achieving the marker of the stage (ie. trust in the trust/mistrust category) will delay the child from achieving the next stage; or in some cases the child will not advance to the next stage

1. What are the 5 stages (for children) of ERICKSON'S PSYCHOSOCIAL DEVELOPMENTAL theory? (and what are the age groups for each)

1. Trust vs. Mistrust (birth to 1 year) 2. Autonomy vs. Shame and Doubt (1 to 3 years) 3. Initiative vs. Guilt (3 to 6 years) 4. Industry vs. Inferiority (6 to 12 years) 5. Identity vs. Role Confusion (12 to 18 years)

What are the 4 phases (and corresponding age groups of children) of PIAGET'S COGNITIVE DEVELOPMENTAL THEORY?

1. Sensorimotor (birth to 2 years) 2. Preoperational (2 to 7 years) 3. Concrete Operations (7 to 11 years) 4. Formal Operations (11 to 15 years)

What are the 3 levels of KOHLBERG'S MORAL DEVELOPMENT theory?

1. Preconventional level 2. Conventional level 3. Postconventional, Autonomous, or Principled level

What is the most widely used DEVELOPMENTAL SCREENING tool?

The DENVER II

According to FOWLER, how many stages of SPIRITUAL DEVELOPMENT are there? What are they?

There are 5: STAGE 0: UNDIFFERENTIATED STAGE 1: INTUITIVE-PROJECTIVE STAGE 2: MYTHICAL-LITERAL STAGE 3: SYNTHETIC-CONVENTION STAGE 4: INDIVIDUATING-REFLEXIVE

A child with a HEALTHY BODY IMAGE will most likely also be? Why is this important?

They will also be CONFIDENT; this is important because it will help them face the world/new situations without hesitation

What are the patterns of human growth? Which one comes first, which is second?

First pattern is CEPHALOCAUDAL (head to tail direction. Second pattern is: PROXIMODISTAL (near to far or midline-to-peripheral)

Which developmental age period is a CRITICAL PERIOD IN THE DEVELOPMENT OF A SELF-CONCEPT?

MIDDLE CHILDHOOD - 6 TO 11 OR 12 YEARS

Which of the following statements helps explain the growth and development of children? A) Development proceeds at a predictable rate. B) Sequence of developmental milestones is predictable. C) Rates of growth are consistent among children. D) At times of rapid growth there is also acceleration of development.

B) Sequence of developmental milestones in predictable.

Which of the following statements explains why it can be difficult to assess a child's dietary intake? A) No systematic assessment tool has been developed for this purpose. B) Biochemical analysis for assessing nutrition is expensive. C) Families usually do not understand much about nutrition. D) Recall of children's food consumption is frequently unreliable.

D) Recall of the children's food consumption is frequently unreliable

The nurse is assessing a 3-year-old African-American child who is being seen in the clinic for the first time. The child's height and weight are in the 20th percentile on the commonly used growth chart from the National Center for Health Statistics. When interpreting these data, the nurse should recognize which of the following? A) Child's growth is within normal limits. B) Child's growth is not within normal limits. C) The growth chart is not accurate for African-American children. D) The growth chart is not useful until several measurements are plotted over time.

A) Child's growth is within normal limits. The growth charts are population based and include all children without regard to race or ethnicity.

What are periods of "SENSITIVE", "CRITICAL", "VULNERABLE", OR "OPTIMAL" periods of growth?

These are times when a child may be more susceptible to positive or negative influences in their environments. (i.e. The first trimester is a "sensitive" period of growth for the fetus)

During fetal development, the ______ is the fastest growing body part; during childhood, the _______ are the most rapidly growing part.

Fetus: The Head Childhood: The Legs

By what age should birth weight be DOUBLED?

Should be doubled by the end of 4 to 7 months

In what portion of the bones does ACTIVE GROWTH IN LENGTH take place?

At the EPIPHYSEAL CARTILAGE PLATE (OR GROWTH PLATE)

When is the rate of metabolism or (BMR) highest for a person in their lifetime?

When they are a NEWBORN infant

What determines the caloric requirements of a child?

Their rate of metabolism (BMR)

Why is the intake of fluids so critical to patients with a fever?

Each degree of temperature increases the basal metabolic rate 10%, with a corresponding increase in fluid requirements

What is an effective way to prevent neonatal hypothermia?

Skin-to-skin or Kangaroo care (you all knew this, I'm sure...)

TEMPERAMENT is defined as? And it refers to??

Defined as the manner of thinking, behaving, or reacting characteristic of an individual. It refers to the way in which a person deals with life

Optimum development for a child exists when?

Their "degree of fit" is high: When environmental expectations and demands "fit with" the child's style of behavior and the parent's ability to navigate this period.

The id, the ego, and the superego are all components of personality according to?

FREUD

1. For an infant to achieve "trust" according to Erikson, what must happen? 2. What are the beneficial results of developing trust? 3. If trust is not attained what is the consequeance? 4. What Erikson stage/age range is this?

1. An infant must receive consistent, love care by a mothering person. 2. The trust the infant has in the mother/parents will extend to the world and they will develop FAITH and OPTIMISM. 3. Mistrust is the consequence and it develops when basic needs are not met and/or trust building experiences are deficient/lacking 4. Trust v. Mistrust (birth to 1 year)

1. For an infant to achieve "trust" according to Erikson, what must happen? 2. What are the beneficial results of developing trust? 3. If trust is not attained what is the consequeance? 4. What Erikson stage/age range is this?

1. An infant must receive consistent, love care by a mothering person. 2. The trust the infant has in the mother/parents will extend to the world and they will develop FAITH and OPTIMISM. 3. Mistrust is the consequence and it develops when basic needs are not met and/or trust building experiences are deficient/lacking 4. Trust v. Mistrust (birth to 1 year)

If a 2 year old child is made to feel small or self-conscious, what will be the result according to Erikson? What psychosocial stage is a 2 year old in?

The child will develop negative feelings of SHAME and DOUBT. At 2 years old, a child fits into the AUTONOMY vs. SHAME and DOUBT phase

What are the favorable outcomes of the "Autonomy vs. Shame and Doubt" stage? How can a parent/caregiver promote positive development at this age?

SELF-CONTROL AND WILLPOWER -Parents should allow toddlers to make choices (ie. what shirt to wear, snack selection) and they should praise the child when they acquire new skills (walking, going up a step, etc)

At what Psychosocial stage do children develop a "CONSCIOUS"?

Initiative vs. Guilt (3 to 6 years)

When a child is between 6-12 years of age, what negative feelings (according to Erikson) may develop if they are given unrealistic goals by their parents or too much is expected of them?

They may develop feelings of INADEQUACY AND INFERIORITY

If a child in the INDUSTRY VS. INFERIORITY STAGE are given realistic goals or attainable "work" - both in which the child can make real achievements, what will be the positive benefit of this? (How will the child feel)

The child will develop a sense of COMPETENCE

What are the negative results if a teenager cannot resolve "core conflicts" (such as fitting in with peer group, deciding on future occupation, integrating their own concepts and values with those of society)? What Erikson stage is this?

If these conflicts cannot be resolved, ROLE CONFUSION will occur in the teen. This is the "IDENTITY vs. ROLE CONFUSION" stage of Erikson's model

DEVOTION AND FIDELITY to others and to values will develop in a teen if he successfully completes the tasks described in what psychosocial stage?

IDENTITY VS. ROLE CONFUSION (Erikson)

According to Piaget (Cognitive Development) when do children understand that objects have PERMANENCE? Explain this concept.

Children become aware of OBJECT PERMANANCE in the SENSORIMOTOR stage (birth to 2 years). -With Object permanence, the child understands that the item or person still exist even though they/it are no longer visible.

According to Piaget, in the PREOPERATIONAL phase of cognitive development, REASONING IS____________ and ________________

INTUITIVE and TRANSDUCTIVE

By the time enters school, they should be able to form structurally complete sentences of ____ to _____ words

5 to 7

In this level of moral development (Kohlberg), children do things based on their consequences and labels (i.e. is it pleasurable or has it been given the label "bad" or "good")

Preconvential Level

Children whose moral actions are spurred by the desire to please or help others; or they know their behavior will be met with approval, are in what Moral Development Stage?

Convential Level

At the CONVENTIAL LEVEL of Moral Development (Kohlberg), children are concerned with? What do they value?

They are concerned with conformity and loyalty. They value the maintenance of family, group, or national expectations regardless of consequence

What/who has the most significant impact on a child's body image?

Significant others exert the most important and meaningful impact on a child's body image (ie. parents/siblings who give labels such as skinny, fat, pretty, ugly, etc.)

What is this the definition for "The value that an individual places on oneself and refers to an overall evaluation of oneself"

Self-Esteem

What are 4 aspects that a child will assess when forming self-esteem?

1. Competence 2. Sense of control 3. Moral worth 4. Worthiness of love and acceptance

What is the WORK of a child?

PLAY!

When an infant smiles or coos at a parent to provoke a parental response, what type of play is this?

Social-affective play

When a child derives pleasure from stimulating the senses (ie. feeling wet mud/sand in their fingers, seeing bright colors). What kind of play is this?

Sense-Pleasure play

Components of SKILL PLAY

-Grasping and manipulating an object -Repeating an action over and over again -Exercising new abilities (like getting on a play car)

What is one of the most important types of play in a child's process of identification?

DRAMATIC, or PRETEND, PLAY

What is the predominant form of play in the preschool child?

DRAMATIC (PRETEND) PLAY

At what age is it appropriate to introduce COMPETITIVE GAMES to a child? Why?

When they are school-age; if you try before this you will see that they are lose interest quickly. A child younger than school age (ie preschooler) hates to lose, will try to cheat, change the rules or demand exceptions

Why is play important for social development?

Through play, children acquire concern for others and the ability to delay gratification or even reject gratification at the expense of another.

Social TYPES OF PLAY (5)

1. Onlooker play 2. Solitary play 3. Parallel play 4. Associative play 5. Cooperative play

What is the characteristic style of SOCIAL play for TODDLERS?

PARALLEL PLAY - They play besides, not with, other children using similar toys

What is the predominant form of play for infants?

SENSORIMOTOR

7 functions of PLAY

1. Sensorimotor Development 2. Intellectual Development 3. Socialization 4. Creativity 5. Self-Awareness 6. Therapeutic Value 7. Moral Value

Studies have shown that positive parent-child interactions during play can enhance?

Early childhood brain development

What are 3 important hormones for growth?

1. Growth hormone (duh?? he he) 2. Thyroid hormone 3. Androgens

What is probably the single most important influence on GROWTH?

NUTRITION

When children fail to have high-quality interpersonal relationships with mothering persons, they experience _______ __________.

EMOTIONAL DEPRIVATION

What is the most prominent feature of emotional deprivation in the first year of life?

DEVELOPMENTAL DELAYS

What is the most prominent feature of emotional deprivation in the first year of life?

DEVELOPMENTAL DELAYS

What is the most prominent feature of emotional deprivation in the first year of life?

DEVELOPMENTAL DELAYS

What does the term "MASKED DEPRIVATION" describe?

Children reared in homes in which there is a distorted parent-child relationship or otherwise disordered home environment. Infants do not thrive if the caregiver is hostile, fearful of handling them, or indifferent to them or their needs.

Due to our modern life (things in our home), children are at a high risk of harm from __________.

CHEMICALS

A child with a good, positive balance in his/her "EMOTIONAL BANK" will be able to withstand?

STRESS

Children who are undergoing significant amounts of STRESS will resemble?

Abused or Depressed Children

When a caregiver knows a child is STRESSED, what is a very important intervention?

LISTENING - caregivers must listen so they are aware of a child's fears and concerns. Additionally, they must let the child know they are important and that what they say matters.

Like adults, children can develop negative coping strategies, can you name a few?

Cheating Stealing Lying

How can you help prepare a child for a stressful event?

Role playing the scenario or talking it through beforehand.

If children are given the opportunity to learn to solve problems themselves, they will be able to?

View new situations as opportunities to learn and will not be as vulnerable to the control of others

When children view "macho" movies, they may learn? When they view "slasher" movies, they may develop?

Macho movies can instill a belief that violence is an appropriate way to solve conflicts. Slasher movies can give the child a fearful view of the world

What type of media has the most impact on children in North America?

TELEVISION

On average how much TV do children watch per week (in U.S.)

21 hours per week

How much television does the American Academy of Pediatrics recommend that a child less than 2 watch? How much for a child older than 2?

Under 2, the AAP recommends NO television viewing. Over 2, TV viewing should be 2 hours a day or less

Television viewing has been linked to ______ ______ and ______ ______

Body Fat & High Cholesterol

How can a parent influence how much television a child watches (other than setting time limits and just plain turning the TV off)

They can act as role models and engage in activities outside of TV viewing (ie. crafting, exercise, reading, and sports)

Video games allow the player to be the aggressor so they are an ideal environment for a child to learn what?

Violent Behavior

Where should computers be located in the home?

In a public area like the kitchen or family room

The four ways in which scores are recorded on a Denver II assessment are? The 3 possible "results" of the Denver II test?

1. The scoring levels are: ADVANCED, OK, CAUTION, and DELAY 2. The test results can be: NORMAL, SUSPECT, OR UNTESTABLE

If a child receives a "Suspect" or "Untestable" score on a DENVER II assessment, what should be done?

The child should be rescreened in 1 to 2 weeks to rule out temporary factors

Telephone triage has increased access to?

HIGH QUALITY HEALTH CARE SERVICES

Which of the following is the most accurate method of determining the length of a child less than 12 months of age? A) Standing height B) Estimation of length to the nearest centimeter or 1/2 inch C) Recumbent length measured in the prone position D) Recumbent length measured in the supine position

D) Recumbent length measured in the supine position

Which of the following explains the importance of detecting strabismus in young children? A) Color vision deficit may result. B) Amblyopia, a type of blindness, may result. C) Epicanthal folds may develop in affected eye. D) Ptosis may develop secondarily.

B) Amblyopia, a type of blindness, may result

Which of the following observations suggests that an abnormality may be present in a full-term neonate? A) Absence of tears B) Engorged breasts C) Lack of a sucking reflex D) Inability to visually fix and follow object

C) Lack of a sucking reflex

Which of the following findings on physical assessment of a neonate would indicate the need for further observation and examination? A) Epstein pearls B) Cyanotic hands and feet C) Babinski reflex D) Low-set ears

D) Low-set ears

Superficial palpation of the abdomen is often perceived by the child as tickling. Which of the following measures by the nurse is most likely to minimize this sensation and promote relaxation? A) Palpate another area simultaneously. B) Ask child not to laugh or move if it tickles. C) Begin with deeper palpation and gradually progress to superficial palpation. D) Have child "help" with palpation by placing his or her hand over the palpating hand.

D) Have child "help" with palpation by placing his/her hand over the palpating hand

When assessing a preschooler's chest, the nurse would expect: A) Respiratory movements to be chiefly thoracic. B) Anteroposterior diameter to be equal to the transverse diameter. C) Intercostal retractions on respiratory movement. D) Movement of the chest wall to be symmetric bilaterally and coordinated with breathing.

D) Movement of the chest wall to be symmetric bilaterally and coordinated with breathing

Which of the following methods should the nurse use to view the tonsils and oropharynx of a cooperative 6-year-old child? A) Ask child to open mouth wide and say "Ahh." B) Ask child to open mouth wide, and then place tongue blade in the center back area of the tongue. C) Examine mouth when child is crying to avoid use of tongue blade. D) Pinch nostrils closed until child opens mouth, then insert tongue blade.

A) Ask the child to open mouth wide and say "ahh."

The nurse is assessing skin turgor in a child. The nurse grasps the skin on the abdomen between the thumb and index finger, pulls it taut, and quickly releases it. The tissue remains suspended, or tented, for a few seconds, then slowly falls back on the abdomen. Which of the following evaluations can the nurse correctly assume? A) The tissue shows normal elasticity. B) The child is properly hydrated. C) The assessment is done incorrectly. D) The child has poor skin turgor.

D) The child has poor skin turgor

The nurse is using the C.R.I.E.S. pain assessment tool on a preterm infant in the neonatal intensive care unit. Which of the following is a component of this tool? A) Color B) Reflex C) Oxygen saturation D) Posture of arms and legs

C) Oxygen Saturation

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on knowledge that: A) Children tend to be overmedicated for pain. B) Giving large doses of opioids causes euthanasia. C) Narcotic addiction is common in terminally ill children. D) Large doses of opioids are justified when there are no other treatment options.

D) Large doses of opioids are justified when there are no other treatment options

Which of the following is the most consistent indicator of pain in infants? A) Increased respirations B) Increased heart rate C) Clenching the teeth and lips D) Facial expression of discomfort

D) Facial expression of discomfort

The nurse is starting an intravenous (IV) line on a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that: A) Children tolerate pain better than adults. B) Children become accustomed to painful procedures. C) Children often lie about experiencing pain. D) Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

D) Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

Which of the following is an important consideration when using the FACES Pain Rating Scale with children? A) Children color the face with the color they choose to best describe their pain. B) The scale can be used with most children as young as 3 years of age. C) The scale is not appropriate for use with adolescents. D) The scale is useful in pain assessment, but is not as accurate when assessing physiologic responses.

B) The scale can be used with most children as young as 3 years of age.

Nonpharmacologic strategies for pain management: A) May reduce pain perception. B) Make pharmacologic strategies unnecessary. C) Usually take too long to implement. D) Trick children into believing they do not have pain.

A) May reduce pain perception

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference a nurse suggests that they consider administering a placebo instead of the usual pain medication. This decision should be based on knowledge of which of the following? A) This practice is unjustified and unethical. B) This practice is effective in determining whether a child's pain is real. C) The absence of a response to a placebo means the child's pain has an organic basis. D) A positive response to a placebo will not occur if the child's pain has an organic basis.

A) This practice is unjustified and unethical

A child who has been receiving morphine intravenously will now start receiving it orally. The nurse should anticipate that, to achieve equianalgesia (equal analgesic effect), the oral dose will be which of the following? A) Same as the IV dose B) Greater than the IV dose C) One half of the IV dose D) One fourth of the IV dose

B) Greater than the IV dose

Transdermal fentanyl (Duragesic) is being used for an adolescent with cancer who is in hospice care. The adolescent has been comfortable for several hours but now complains of severe pain. The most appropriate nursing action is to: A) Administer meperidine (Demerol) IM. B) Administer morphine sulfate immediate release (MSIR) IV. C) Use a nonpharmacologic strategy. D) Place another fentanyl patch on the adolescent.

B) Administer morphine sulfate immediate release (MSIR) IV

The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. Which of the following is an important consideration in managing the child's pain? A) Give only an opioid analgesic at this time. B) Increase the dosage of analgesic until the child is adequately sedated. C) Plan a preventive schedule of pain medication around the clock. D) Give the child a clock and explain when he or she can have pain medications.

C) Plan a preventive schedule of pain medication around the clock

The nurse is caring for a child with multiple injuries who is comatose. The nurse should recognize that pain: A) Cannot occur if child is comatose. B) May occur if child regains consciousness. C) Requires astute nursing assessment and management. D) Is best assessed by family members who are familiar with child.

C) Requires astute nursing assessment and management

A child is being seen in the emergency department with multiple facial abrasions and lacerations. Lidocaine, adrenaline, and tetracaine (LAT) is applied topically to the wounds. The purpose of this combination therapy is which of the following? A) To cleanse the wound B) To prevent infection of the wound C) To provide anesthesia to the wound D) To promote scab formation

C) To provide anesthesia to the wound

The nurse is caring for a 12-year-old boy who sustained major burns when he put charcoal lighter on a campfire. The nurse observes that he is "very brave" and appears to accept pain with little or no response. The most appropriate nursing action related to this is which of the following? A) Request a psychologic consultation. B) Ask the child why he does not have pain. C) Praise the child for his ability to withstand pain. D) Encourage continued bravery as a coping strategy.

A) Request a psychologic consultation

3 types of measures to assess a child's pain

1.Behavioral - No talking; Guarding 2. Physiologic - B/P, H/R, Resp all up 3. Self-Report - "oughie", "hurts"

Characteristics of a facial pain in an infant (4)

1. Eyes squeezed 2. Brow bulged 3. Nasolabial furrow 4. Widespread mouth

What ages is the FACES pain assessment appropriate for (according to Taha lecture)

3 years to 6 years

Who should you use the FLACC pain scale on?

Children 1 - 3 years of age and people who are non-verbal

What are the three appropriate PAIN ASSESSMENT tools for Neonates?

1. CRIES 2. PIPP 3. NPASS

Children with communication and/or cognitive impairment are at greater risk for undertreatment of _______

PAIN

What level of IQ is considered "sublevel" or defines "intellectual disability"

IQ of less than 75

5 ways to prevent INTELLECTUAL DISABILITY in a baby/child?

1. Rubella immunization 2. Genetic counseling 3. Use of Folic Acid supplements 4. Education about Fetal Alcohol Syndrome 5. Education about Lead Exposure

What is the most common cause of DOWN SYNDROME?

Extra chromosome 21 (causes 92-95% of cases)

What is the skeletal defect common with Down Syndrome?

ATLANTOAXIAL INSTABILITY

What is the 2nd most common genetic cause of cognitive impairment after Down Syndrome?

FRAGILE X SYNDROME

What is an important nursing intervention when a child with Downs/Fragile X is born?

Referral to an early intervention program

What are 2 common ototoxic drugs?

GENTAMYACIN & LASIX

What defines LEGAL BLINDNESS?

Acuity of 20/200 or less

What is the best visual acuity that a toddler usually has? (ie. 20/80, 20/40, etc)

20/40

If Strabismus is still present after 6 months of age, what should be done?

Further tests need to be performed to find cause

What is the most common sign of RETINOBLASTOMA?

Cat's eye reflex

What are the 3 types of AUTISM SPECTRUM DISORDERS?

1. Autistic Disorder 2. Asperger Syndrome 3. Pervasive Developmental disorder not otherwise specified

What is the most important component of effective communication? (What is the key skill a nurse should use when conducting an interview)

Active LISTENING

The 3 stages of early social communication (and the ages of each) - hint: applies to infants/toddlers

1. PERLOCUTIONARY STAGE (0 to 8-9 months) - unintentional communication behavior, child is reflexive to stimuli 2. ILLOCUTIONARY STAGE (8-9 to 12-15 months)- true intent in communication efforts, child communicates with signals/gestures 3. LOCUTIONARY STAGE (12-15 to 18-24 months) - intentional communication behaviors and use of symbols, child communicates intentionally with gestures, vocalizations, and verbalizations

What is one of the best ways to gain information about a child's physical, intellectual, and social development?

Watch them PLAY!

When assessing PAIN, what 5 things should you ask about?

1. TYPE (sharp, throbbing, dull) 2. LOCATION (specify location by having child point to the area and then ask if it "spreads" anywhere else) 3. SEVERITY (Rating scales 1-10 or Faces scale) 4. DURATION (Onset, duration, frequency) 5. INFLUENCING FACTORS (events that cause/increase pain, events/things that decrease/relieve pain, times of temporary relief, and positions that exacerbate or relieve the pain)

Every NUTRITIONAL ASSESSMENT should begin with?

A DIETARY HISTORY

What is ANTHROPOMETRY?

The measurement of height, weight, head circumference, proportions, skinfold thickness, and arm circumference in young children

If a child displays delayed wound healing, what Vitamin may they be deficient in?

VITAMIN C (it's not just for scurvy, mates)

Poor turgor reflects a deficiency in....

Water and Sodium

Excess Vitamin A can cause?

Pruritis and Jaundice

Most hair problems (alopecia, stringy-ness, dryness) are caused by deficiencies in?

Protein and calories

A deficiency in Vitamin D affects the skull/head how?

It can cause softening of cranial bones, prominence of frontal bones, flattening of skull and depression in the middle. Additionally, it can delay the fusion of sutures.

If a child's thyroid is ENLARGED, what should you suspect?

An IODINE deficiency

What vitamin is essential for good eyesight, health of the eye structures?

VITAMIN A

If the tympanic membrane is calcified (responsible for hearing loss)..an excess of this Vitamin may be the cause?

VITAMIN D (excess)

If one of the questions asks about any part of the body being dry, rough, scally, fissured, or cracking...the answer is most likely a deficit in ___________

RIBOFLAVIN (see assessment chart - causes dryness and it's complications on the skin, conjunctiva, nose, lips, and tongue)

Dental caries are due to an excess of?

Carbohydrates

Rapid pulse and arrhythmias can be attributed to a deficiency in?

Potassium

How does excess sodium affect the heart?

Increases B/P

What are 4 things that you should take in to account when taking a child's blood pressure?

1. Limb sizes vary and cuff selection must accomodate the circumference. 2. Excessive pressure on the antecubital fossa affects the Korotkoff sounds 3. Children easily become anxious, which can elevate B/P 4. BP values change with age and growth

If you absolutely cannot find the appropriately sized B/P cuff, should you choose one that is oversized or undersized?

Use the oversized cuff or use another site that more appropriately fits the cuff site

What is one of the most common causes of ORTHOSTATIC HYPOTENSION?

HYPOVOLEMIA (which may be induced by diuretics, vasodilators, prolonged immobility or bedrest)

What is WRYNECK or TONTICOLLIS?

It is the condition in which the child will hold their head to one side with the the chin pointing to the opposite side as a result of injury to the sternocleidomastoid muscle

What is a sign of MENINGEAL irritation and calls for immediate medical evaluation?

HYPEREXTENSION OF THE HEAD WITH PAIN ON FLEXION

FLACC stands for?

FACE LEGS ACTIVITY CRY CONSOLABILITY

How should you take infant/toddler VITAL signs? (which do you do first, last)

1. RESPIRATIONS FIRST (before disturding child 2. APICAL HEART RATE SECOND 3. BLOOD PRESSURE 4. TEMPERATURE (last)

What does CRIES stand for?

CRYING REQUIRING INCREASED OXYGEN INCREASED VITAL SIGNS EXPRESSION SLEEPLESSNESS

1.What are the categories of the NIPS pain assessment? 2. What does NIPS stand for?

1.FACIAL EXPRESSION ARMS CRY LEGS BREATHING PATTERN STATE OF AROUSAL 2. NEONATAL INFANT PAIN SCALE

The diagnosis of mental retardation is based on the presence of which of the following criteria? A) Intelligence quotient (IQ) of 75 or less B) IQ of 70 or less C) Subaverage intellectual functioning, deficits in adaptive skills, and onset at any age D) Subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age

D) Subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age

The primary goal in caring for the child with mental retardation is to: A) Encourage play. B) Promote optimum development. C) Help families develop a care plan and have them stay with it. D) Develop vocational skills.

B) Promote optimum development.

The parents of a cognitively impaired child ask the nurse for guidance with discipline. The nurse should make recommendations based on which of the following? A) Discipline is ineffective with cognitively impaired children. B) Discipline is not necessary for cognitively impaired children. C) Behavior modification is an excellent form of discipline. D) Physical punishment is the most appropriate form of discipline.

C) Behavior modification is an excellent form of discipline.

The genetic testing of a child with Down syndrome showed that the disorder was caused by chromosomal translocation. The parents ask about further genetic testing. Nursing recommendations should include which of the following? A) No further genetic testing of the family is indicated. B) The child should be retested to confirm the diagnosis of Down syndrome. C) The mother should be tested if she is over age 35. D) The parents can be tested, since it might be hereditary.

D) The parents can be tested, since it might be hereditary.

A 2-week-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold, that "he's like a rag doll. He doesn't cuddle up to me like my other babies did." The nurse's best interpretation of this behavior is which of the following? A) Sign of maternal deprivation B) Sign of detachment and rejection C) Suggestive of autism associated with Down syndrome D) Result of the physical characteristics of Down syndrome

D) Result of the physical characteristics of Down syndrome

The parents of a child with fragile X syndrome want to have another baby. They tell the nurse that they worry another child might be similarly affected. Which of the following is the most appropriate nursing action? A) Reassure them that the syndrome is not inherited. B) Assess for family history of the syndrome. C) Recommend that they do not have another child. D) Explain that prenatal diagnosis of the syndrome is now available.

D) Explain that prenatal diagnosis of the syndrome is now available.

A 6-year-old has difficulty hearing faint or distant speech. His speech is normal, but he is having problems with his school performance. This hearing loss would most likely be classified as: A) Slight. B) Severe. C) Moderate. D) Inattentiveness rather than hearing loss.

A) Slight.

Early detection of a hearing impairment is critical because of its effect on a variety of areas of a child's life. Which one of these is of primary importance? A) Reading development B) Speech development C) Relationships with peers D) Performance at school

B) Speech development

Which of the following is defined as reduced visual acuity in one eye despite appropriate optical correction? A) Myopia B) Hyperopia C) Amblyopia D) Astigmatism

C) Amblyopia

A 5-year-old has bilateral eye patches in place after surgery yesterday morning. Today he can be out of bed. Which of the following is the most important nursing intervention? A) Reassure the child and allow his parents to stay with him. B) Allow the child to assist in feeding himself. C) Speak to the child when entering the room. D) Orient the child to his immediate surroundings.

D) Orient the child to his immediate surroundings

What is the single most common chronic disease of childhood?

Dental Caries

What are the most common cause of death and disability to children in the U.S.?

Injuries

Most common cause of death in children older than 1 year of age?

Motor vehicle related accidents - primarily from a failure to use proper restraints

What children (age group) are most at risk for bicycling fatalities?

5-9 year olds

What is the leading cause of death FROM injury infants?

Mechanical suffocation

Which ,disorder is characterized by inattentiveness, impulsivity, & at times hyperactivity?

ADHD - Attention deficit hyperactivity disorder

How are birth weight and mortality related?

The lower the birth weight, the higher the mortality

Which age group of children have the LOWEST rate of death?

5 to 14 years

#1 cause of death in INFANTS?

Congenital anomalies

Define MORBIDITY

The prevalence of a specific illness in the population at a particular time

What is the chief illness of childhood?

The common cold

Which groups of children are at risk for poor health (i.e. they have have higher morbidity rates)

1. Homeless children 2. Children living in poverty 3. LBW children 4. Children with chronic illnesses 5. Foreign-born adopted children 6. Children in daycare centers

What are the two basic concepts in FAMILY-CENTERED CARE?

ENABLING & EMPOWERMENT

What is this a definition of (according to the book): "the diagnosis and treatment of human responses to actual or potential health problems"

NURSING

What is the key theme/belief to recognize in order to provide FAMILY-CENTERED CARE?

The FAMILY is the CONSTANT in a child's life while the service systems and support personnel within those systems fluctuate

What is the overriding goal of ATRAUMATIC CARE?

FIRST, DO NO HARM 1. Prevent or minimize the child's separation from the family 2. Promote a sense of control 3. Prevent or minimize bodily injury and pain

Why is touch and physical presence (from/by the nurse) so important when giving support to a child?

Because they facilitate nonverbal communication

JEOPARDY TIME - Here are 4 definitions, you give the terms: 1. The obligation to promote the patient's well-being 2. The patient's right to be self-governing 3. The concept of fairness 4. The obligation to minimize or prevent harm

1. BENEFICENCE 2. AUTONOMY 3. JUSTICE 4. NONMALEFICENCE

What is considered the leading cause of NEONATAL death in the United State?

Low birth-weight

Eighty percent of childhood illnesses are attributable to infections, with __________ __________ infections occuring two to three times more often than all other illnesses combined.

RESPIRATORY TRACT infections

What is the study of population characteristics?

DEMOGRAPHY

Poor children are more likely to be ________ and have _________ ________ problems

Obese & Untreated Dental problems

A family is: 1) Mom, Dad and children only 2) All people within a household 3) Whatever an individual considers it to be 4) Only those who affect an individually spiritually and emotionally

3) Whatever an individual considers it to be

What are the stages of DUVALL'S DEVELOPMENTAL STAGES OF THE FAMILY?

STAGE I - Marriage and an independent home: the joining of families STAGE II - Families with infants STAGE III - Families with preschoolers STAGE IV - Families with school children STAGE V - Families with teenagers STAGE VI - Families as launching centers STAGE VII - Middle-aged families STAGE VIII - Aging families

Define GENERATIONAL CONTINUITY?

When parents rear their own children in much the same way as they themselves were reared (this is the majority rule)

An ONLY CHILD is: 1. Selfish and spoiled 2. Have many of the same characteristics as firstborn children 3. Have little imagination and are unoriginal 4. Can be immature underachievers

2. Have many of the same characteristics as firstborn children

What is frequently a more meaningful disciplinary measure than parental intervention for children of large families?

SIBLING DISAPPROVAL or OSTRACISM

3 PARENTAL STYLES OF CONTROL

1. Authoritarian or Dictatorial 2. Permissive or laissez-faire 3. Authoritative or Democratic

3 flaws of CORPORAL or PHYSICAL PUNISHMENT?

1. It teaches children that violence is acceptable 2. It may physically harm the child if it is the result of parental rage 3. Children become accustomed to spanking, requiring more severe corporal punishment each time.

When reprimanding a child, should you use "I" or "You" messages?

Use "I" messages rather than "You" - focuses on the behavior and does not cause ridicule of the child (Example: I am upset when Johnny is punched; I don't like to see him hurt"

What is the rule for the length of time a child should be in "time out"?

1 minute per year of age

When do most authorities believe an adopted child should be told that he/she is in fact an adopted child?

At an age young enough so that, as they grow older, they do not remember a time when they did not know they were adopted.

What/How is the ideal way to inform a child of a divorce/separation?

The initial disclosure should include both parents and siblings; followed by individual discussions with each child

What is this the definition for "the affiliation of a set of persons who share a unique cultural, social, and linguistic heritage"

ETHNICITY

Define CULTURE:

A pattern of learned beliefs, values, and practices that are shared within a group; it includes practices; customs; views on roles and relationships, including parenting; and communication patterns and language

What is this the definition for: "A division of humans possessing traits that are transmissible by descent and that are sufficient to characterize a distinct human type"

RACE

PRIMARY GROUPS vs. SECONDARY GROUPS

PRIMARY GROUPS (Family, Peers) - those who one has intimate, continued, face-to-face contact with. They can exert a considerable amount of control on each other. SECONDARY GROUPS (Church & Professional Associations) - Groups that have limited, intermittent contact and in which there is generally less concern for members' behaviors

ROLES are ___________ creations

They are cultural creations; the culture prescribes patterns of behavior for persons in their respective social positions

SOCIOECONOMIC class relates to a family's __________ and _______ levels.

Economic & Education

The most overwhelming adverse influence on health is _____________ status

SOCIOECONOMIC

What is one of the most significant health problems related to poverty?

High Infant Mortality Rate

Define: POVERTY & LOW-INCOME

POVERTY - defined as families living without "adequate resources"; can be VISIBLE(lack of money, deteriorating housing) or INVISIBLE (limited employment opportunities, inferior education opportunities, absence/lack of public/health services). LOW-INCOME - Having a family income (for a family of four) that is less than twice the federal poverty threshold with at least one parent working 50 or more weeks during the year

Scholastic achievement is strongly related to the value system of the _____ _______

PEER GROUP

Lower birth weight ='s what?

Higher mortality

Define: Infant Mortality Rate

Number of deaths per 1,000 live births during the first year of life

Age of the NEONATAL period

Firth to 28 days of life

Age of POSTNATAL period? (for baby)

28 days to 1 year

Just in case... What are the 10 rights listed in the UNITED NATION's DECLARATION - THE RIGHTS OF A CHILD?

1. To be free from discrimination 2. To develop physically and mentally in freedom and dignity 3. To have a name and nationality 4. To have adequate nutrition, housing, recreation, and medical services 5. To receive special treatment if handicapped 6. To receive love, understanding, and material security 7. To receive an education and develop his/her abilities 8. To be the first to receive protection in disaster 9. To be protected from neglect, cruelty, and exploitation 10. To be brought up in a spirit of friendship among people

At what level of prevention (primary, secondary, tertiary) is the main goal PROTECTION from disease/illness?

PRIMARY

When a child receives an annual flu shot or other immunization, what level of care/prevention is this?

PRIMARY

At what level of prevention/care is the main goal EARLY DETECTION AND TREATMENT of disease/injury?

SECONDARY PREVENTION

Give 3 examples of SECONDARY PREVENTION?

1. TB screenings, Lead screenings 2. Isolation of communicable illnesses 3. Early intervention programs such as Head Start

Why is screening for lead poisoning important? A child with what disorder might have high levels of lead?

Screening for lead is important because high levels can cause brain damage. Children with PICA may have high levels of lead.

At what level of prevention is the main goal to OPTIMIZE FUNCTION FOR CHILDREN WITH DISABILITY OR CHRONIC DISEASE?

TERTIARY PREVENTION

A child with Cerebral Palsy who receives occupational/speech therapy is receiving what level of prevention/care?

TERTIARY

Stressors require that families do what to deal with the change?

Adapt

More Jeopardy! Here are some definitions, you give the terms: 1. BLOOD RELATIONSHIP 2. MARITAL RELATIONSHIP 3. FAMILY UNIT BORN INTO 4. A TERM USED TO ACCOMODATE INCREASING VARIETY OF FAMILY STYLES

1. CONSANGUINEOUS 2. AFFINAL 3. FAMILY OF ORIGIN 4. HOUSEHOLD

In Duvall's what is the marker for stage transitions? ie. what determines the stage a family is in?

AGE OF OLDEST CHILD

As a nurse what is important to know when caring for a child of divorced parents?

WHO HAS CUSTODY

When writing a Home Health care plan for a child, what is important to remember?

That NO ONE knows the child better than the family

Physiology: When serum sodium levels are high, _____ is secreted and increases permeability of kidney's ____ _______ and _____

ADH Distal tubules and ducts

Which system assists in regulating fluid and electrolytes?

Angiotensin-renin + Aldosterone

How does the large surface area of the GI tract affect fluid and electrolyte balance?

In the GI tract water and sodium are reabsorbed and POTASSIUM is SECRETED..due to it's large are changes in F & E balance can occur rapidly

Where is the thirst center located? What stimulates thirst?

-Located in the hypothalamus -A decrease in intravascular volume stimulates thirst

What is the normal urine output of a child?

1 mL/kg/hr

Because of immature kidney function what conditions are children more prone to?

Conditions that affect F & E status (diarrhea, vomiting, high fever)

What may indicate dehydration in an infant?

A sunken fontanel

Why do children have higher Heart and Respiratory rates than adults?

They have a higher METABOLIC RATE

With what conditions are water needs DECREASED in children?

-Congestive Heart Failure -Mechanical Ventilation -Renal Failure -Head trauma/Meningitis

What is the #1 sign that something is wrong with a child's F & E/Hydration status?

TACHYCARDIA

What may be the first subtle sign of HYPOVOLEMIA

Increased HR

At what percent does the fluid or blood volume in a child have to decrease before BLOOD PRESSURE will be affected?

25%

Describe the rate/quality of respirations in a child with DEHYDRATION or HYPOVOLEMIA?

-Tachypnea -Apnea -Deep shallow respirations

If a child has MOIST BREATH SOUNDS and/or COUGH what may you suspect?

FLUID OVERLOAD

What level of BUN in a child indicates DEHYDRATION?

BUN > 100 mg/dL

What is the most accurate indicator of fluid status?

WEIGHT (i.e. Weight changes = substantial fluid loss or gain)

Hgb & Hct -When will they increase? -When will they decrease? (As relates to fluid status)

-H & H will INCREASE in extracellular fluid volume LOSS -H & H will DECREASE in extracellular fluid volume EXCESS

Normal values of URINE SPECIFIC GRAVITY for a NEONATE, INFANT and CHILD/ADULT?

NEONATE: 1.001 to 1.020 INFANT: 1.010 TO 1.020 OLDER CHILD/ADULT: 1.010 TO 1.030

What does low specific gravity indicate? What does high specific gravity indicate?

LOW specific gravity = FLUID EXCESS OR KIDNEY DISEASE HIGH specific gravity = FLUID DEFICIT (HYPOVOLEMIA)

What is the formula for calculating MAINTENANCE doses of IV fluids?

100 mL of fluid for the 1st 10 kg of weight 50 mL of fluid for the 2nd 10 kg of weight 20 mL of fluid for any additional kg

How often should Nasogastric Output be measured?

q4h

What unit of measurement are Electrolytes usually done in?

mEq or Milliequivalent

When does the STEPPING REFLEX disappear?

By 2 months

What 3 reflexes should disappear by 3-4 months? (1 should disappear by 3 months exactly, I will indicate in answer)

1. Rooting - disappears @ 3-4 months 2. Palmar grasp - disappears @ 3-4 months 3. Moro (startle) - dissapears by 3 months

When does the plantar grasp disappear?

8 to 10 months

What reflex disappears at 4 to 6 months? Which disappears at 8 to 10 months? and finally what reflex disappears at 10 to 12 months?

1. Tonic neck (gone by 4-6) 2. Plantar grasp (gone @ 8-10) 3. Sucking (gone by 10-12)

Now lets do the reflexes in CHRONOLOGICAL order of when they disappear, earliest to latest: 1. _________ relex disappears by 2 months 2. __________ disappears by 3 months 3. ________ & __________ _______reflexes disappear by 3-4 months 4. ________ reflex disappears by 4-6 months 5. _________ disappears by 8-10 months 6. _________ disappears by 10-12 months 7. _________ disappears by 2 years

01. Stepping 2. Moro (startle) 3. Rooting & Palmar grasp 4. Tonic Neck 5. Plantar grasp 6. Sucking 7. Babinski

If an infant still displays reflexes after the time in which they would have normally disappeared, what could this indicate?

Neurological Development problems (Cerebral Palsy for example)

When doing a physical assessment on an infant, what should you do first & what should you do last?

First: HEART & LUNG sounds Last: EAR & THROAT exams

What are ages of "School-age" children, according to Taha lecture?

6-12 years.

As part of an ADOLESCENT assessment you need to include HEADSS, what does this acronym stand for?

H-HOME LIFE E-EDUCATION A-ALCOHOL D-DRUGS S-SEXUAL ACTIVITY S-SUICIDE

PULSE RATES: Neonate? 1-year? 2-year? 4-year? 6-year? 10-year?

Neonate: 70-190 1 yr: 80-160 2 yr: 80-130 4 yr: 80-120 6 yr: 75-115 10 yr: 70-110

PULSE RATES for 14 year olds? 18 year olds?

14 yr: 65-105/Males: 60-100 18 yr: 55-95/Males: 50-90

RESPIRATORY RATES FOR: 1. Pre-term 2. Newborn 3. Toddler 4. School-age 5. Adolescent

1. Pre-term: 40-60 2. Newborn: 30-40 3. Toddler: 25 4. School-age: 20 5. Adolescent: 16

If these respiratory rates are observed, you need to go into panic mode

<10 or >60

If a child deviates from normal height measurements for his/her age (i.e. they are way taller or shorter than other kids their age), what should you suspect?

ENDOCRINE problems

When should a child have DOUBLED their birth weight? When should they have TRIPLED?

Double birth weight by 5-6 months Triple birth weight by 1 year

If a child over 1 year is drinking lots and lots of milk but little solid foods, what may they develop?

ANEMIA

Juvenile arthritis is manifested by what sign?

Inflammation of the eye

How should you manipulate the pinna when doing an ear exam on a child under 3?

Pull down and back

Give terms for these acronyms: 1. ROM 2. LOM 3. BOM 4. OME

1. Right otitis media 2. Left otitis media 3. Bilateral otitis media 4. Otitis media with Effusion

Chronic effusion can lead to? And also to this developmental problem because of poor hearing?

Can lead to HEARING LOSS & also to SPEECH PROBLEMS

1. A child with poor respirations will have what coloring? 2. When a child is this color, it's panic mode...

1. Dusky color = poor respirations 2. Blue = Very, very BAD

5 Possible sites of RETRACTIONS in a child?

1. Supraclavicular 2. Suprasternal 3. Intercostal 4. Subcostal 5. Substernal

If you observe these signs, you should prepare the child for intubation (they are red flags of respiration)

Grunting &/or Nasal flaring

Types of respirations that will be exhibited with upper airway problems vs. lower airway problems?

Upper airway = STRIDOR (inflammation of upper airway or foreign body infiltration) Lower airway = WHEEZES (asthma = expiratory wheezes)

If you do chest/abdomen measurements on a child, what should you do so that the next nurse will measure correctly?

Mark the child where you measured

Define: EPIDEMIOLOGY

The science of population health applied to the detection of morbidity and mortality in a population

What is the most important factor to identify when communicating with a child (so it will be successful)?

The child's DEVELOPMENTAL STAGE

How should you palpate lymph nodes (for assessment)?

Use the distal portion of the fingers and gently but firmly press in a circular motion along the regions where nodes are normally present

What is the most important procedure for examining the heart?

AUSCULTATION

What causes the S1 sound?

Closure of the tricuspid and mitral valves

What causes the S2 sound?

Closure of the Pulmonic and Aortic valves

The administration of ______ with or without nonnutritive sucking has been shown to have calming and pain-relieving effects for invasive procedures in neonates

SUCROSE

Name two anesthetic creams that aid in providing atraumatic care to a child?

LMX (Lidocaine) and EMLA

Poorly controlled acute pain can predispose patients to?

CHRONIC PAIN SYNDROME

How does a neonate produce heat?

Nonshivering thermogenesis - involves increased metabolism and oxygen consumption

An infant's rate of fluid exchange is __ times greater than in the adult

Seven

What are the 5 cardinal signs of RESPIRATORY DISTRESS in a NEWBORN?

1. Tachypnea 2. Nasal flaring 3. Grunting 4. Intercostal retractions 5. Cyanosis

4 potential birth injuries which require careful evaluation are:

1. Subgaleal hemorrhage 2. Fractured clavicle 3. Facial paralysis 4. Brachial plexus paralysis

When providing care for an infant/neonate, the nurse must remember that they (the baby) are easily what? & What can this cause?

They are easily OVERSTIMULATED -This can cause hypoxia, oxygen desaturation, and elevated intracranial pressure

If an infant displays these signs: poor feeding, lethargy, and respiratory difficulties; what may be the cause (along with a million other ones ;)

CONGENITAL HYPOTHYROIDISM

What is the treatment for CONGENITAL HYPOTHYROIDISM?

-Lifelong THYROID HORMONE REPLACEMENT therapy & synthetic LEVOTHYROXINE SODIUM

What is the only monosomy compatible with life?

TURNER SYNDROME

What is caused by a trisomy of chromosome 21?

Down Syndrome

Infant weight should double by ___ months of age and triple by ____ months of age

Double - 6 months Triple - 12 months

In the sensorimotor phase of cognitive development, what is the major accomplishment for infants?

OBJECT PERMANENCE - realization that an object still exists even though they can no longer see it. (ie. Daddy still exists even though he went to another room, etc)

Separation anxiety begins around what ages? When does Stranger anxiety begin?

Separation anxiety around 4 - 8 months; infants will cling to mother/father Stranger anxiety - 6-8 months, infants will again cling to parents, hide their faces and/or turn away from the stranger

What is an essential mineral for building "Caries-resistant" teeth?

FLOURIDE

Children who are immune compromised should not be given what type of vaccines? (Give an example vaccine)

Live virus vaccines (ex: Varicella)

If an infant is at risk for a Vitamin D deficiency, when should they start receiving supplements?

2 months of age

What may decrease the severity of measles in some children?

Vitamin A supplementation

It is especially important to take a detailed dietary intake assessment for people/children who are? Why?

-VEGETARIANS; particularly in children/pregnant or lactating women -To plan for adequate nutritional intake

People with Cystic fibrosis, Renal dialysis, Gastrointestinal malabsorption, prolonged Anorexia are at a heightened risk for?

Protein-energy Malnutrition

What is the most important NURSING INTERVENTION for families with infants suffering from COLIC?

To reassure parents that they are not doing anything wrong and that the infant is not experiencing any physical or emotional harm

4 factors that place an infant for high risk for SIDS?

1. Sleeping in PRONE position (remember always "BACK to sleep" 2. Soft Bedding - Dress the infant warm enough that you don't need to cover with blankets, make sure sheets fit tautly, don't put stuffed animals in cribs, etc...anything they can suffocate on). 3. Sleeping in a noninfant bed w/ parents/siblings (no co-sleeping!) 4. Maternal prenatal smoking

How can you prevent POSITIONAL PLAGIOCEPHALY or baby head-dent as I like to call it?

-Give baby "tummy time" when awake -Alternate infant's head position during sleep

What is ALTE - Apparent Life-Threatening Event?

An event in which an infant exhibits a combination of apnea, change in color, change in muscle tone, choking, gagging, or coughing which involves significant intervention and even CPR by caregiver

When is the toddler stage?

12-36 months of age

What is the major gross motor skill acquired during toddlerhood? What is the major cognitive achievement of toddlerhood?

-Gross Motor: LOCOMOTION -Cognitive: LANGUAGE

Gender identity (a sense of maleness or femaleness) is formed by what age?

3

3 effective DISCIPLINE techniques for TODDLERS?

1. Rewarding 2. Ignoring or extinction 3. Time-out

Define PHYSIOLOGIC ANOREXIA (for toddlers)

- When a toddler (around 18 months of age) will manifest a decreased nutritional need with a decreased appetite

The most common clinical manifestations of this disease are WHITE PUPIL REFLEX and STRABISMUS..

RETINOBLASTOMA

What is the most common HEREDITARY cause of cognitive impairment?

FRAGILE X

How are hearing disorders classified?

According to the LOCATION of the defect

What are the 4 classifications of hearing disorders?

1. Conductive 2. Sensorineural 3. Mixed Conductive-Sensorineural 4. Central Auditory Imperception

The S1 heart sound is synchronous with what pulse?

The CAROTID PULSE - if you have a hard time distinguishing between S1 & S2, palpate the carotid pulse - S1 will match up

What is an important diagnostic sign of atrial septal defect?

FIXED SPLITTING - when S2 does not change will inspiration

What is a signifigant sign of COARCTATION of the aorta?

Absence of FEMORAL PULSES

What is the ROMBERG SIGN?

It is when a child will fall or lean to one side as they are standing with eyes closed and heels together. This is called the ROMBERG test and it is to assess CEREBELLAR FUNCTION

FLACC stands for?

F-FACE L-Legs A-ACTIVITY C-CRY C-CONSOLABILITY

5 categories of COANALGESIC ADJUVANT DRUGS & the specific drugs used in each category

1. ANTIDEPRESSANTS - Amitriptyline & Nortriptyline 2. ANTICONVULSANTS - Gabapentin & Carbamazepine 3. ANXIOLYTICS - Lorazepam & Diazepam 4. CORTICOSTEROIDS - Dexamethasone 5. OTHERS - Clonidine & Mexiletine

If an opioid has caused SEVERE RESPIRATORY DEPRESSION, what drug will be given to reverse this?

NALOXONE (Narcan)

If an opioid is given orally when will the PEAK DRUG EFFECT occur?

1 to 2 hours after administration

Which pain med's are recommended to be given IV due to their short half lives (also because IV can relieve pain in as little as 5 min's)

MORPHINE, FENTANYL, & HYDROMORPHONE

Surgery and trauma can generate a ______ _______ which will increase demands on the cardiovascular and respiratory systems

CATABOLIC STATE

Review time! What are the categories of the APGAR score?

1. Heart Rate 2. Respiratory Effort 3. Muscle Tone 4. Reflex irritability 5. Color

The Jewish Circumsion ritual for male infants is called _______, performed by a _______, will be be done when infant is ______ days old, infant may be given _______ _______ before procedure

1. BERITH, or BRIT 2. MOHEL 3. 8 days old 4. Sweet wine

What are the best ways to thaw human breastmilk? How should you not thaw breastmilk?

1. Place the milk under a warm flow of tap water or to let frozen milk thaw in refrigerator overnight 2. Do NOT thaw in Microwave - destroys antiinfective factors and Vit. C content

How many wet diapers should a newborn have per day?

6 to 10

Which of the following has had the greatest impact on reducing infant mortality in the United States? A) Improvements in perinatal care B) Decreased incidence of congenital abnormalities C) Better maternal nutrition D) Improved funding for health care

A) Improvements in perinatal care Improvements in perinatal care, particularly respiratory care and care of mother-baby dyad before delivery, have had the greatest impact.

According to Piaget, at what stage of development do children typically solve problems through trial and error? A) Sensorimotor B) Preoperational C) Formal operational D) Concrete operational

A) Sensorimotor During the sensorimotor stage infants and young toddlers develop a sense of cause and effect.

Which of the following characteristics best describes the fine motor skills of a 5-month-old infant? A) Transfers objects from one hand to another B) Crude pincer grasp C) Able to build a tower of two cubes D) Able to grasp object voluntarily

D) Able to grasp object voluntarily This is an appropriate fine motor skill for a 5-month-old infant.

The nurse is assessing a 6-month-old infant who smiles, coos, and has strong head lag. The nurse should recognize which of the following? A) This is normal development for a 6-month-old. B) The child is probably mentally retarded. C) A developmental and neurologic evaluation is needed. D) The parent needs to work with the infant to stop the head lag.

C) A developmental and neurologic evaluation is needed. The head lag should be almost gone by 4 months of age. This child requires further evaluation to determine whether there is a developmental or neuromuscular deficit that needs to be addressed.

According to Erikson, infancy is concerned with acquiring a sense of which of the following? A) Trust B) Industry C) Initiative D) Separation

A) Trust The task of infancy is the development of trust. If the infant is not successful with this task, then mistrust develops.

A parent of a 10-month-old infant tells the nurse that the baby cries and screams whenever the infant is left with the grandparents. The nurse's reply should be based on which of the following? A) The infant is most likely spoiled. B) Stranger anxiety is common for an infant of this age. C) Separation anxiety should have disappeared between 4 and 8 months of age. D) The grandparents are not responsive to infant.

B) Stranger anxiety is common for an infant of this age. The infant is experiencing stranger anxiety, which is expected for this age infant, usually developing between 6 and 8 months of age and beginning to disappear at about 1 year of age.

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning? A) 4 months B) 6 months C) 10 months D) 14 months

C) 10 months At 10 months of age, infants say sounds with meaning.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. The nurse's reply should be based on which of the following? A) A pacifier should be substituted for the thumb. B) Thumb-sucking should be discouraged by age 12 months. C) Thumb-sucking should be discouraged when the first teeth begin to erupt. D) There is no need to restrain nonnutritive sucking during infancy.

D) There is no need to restrain nonnutritive sucking during infancy Nonnutritive sucking reaches its peak at about 18 to 20 months of age. Most toddlers give up nonnutritive sucking on their own.

Which of the following is the most appropriate recommendation for relief of teething pain? A) Rub gums with aspirin to relieve inflammation. B) Apply hydrogen peroxide to gums to relieve irritation. C) Give child a frozen teething ring to relieve inflammation. D) Have child chew on a warm teething ring to encourage tooth eruption.

C) Give child a frozen teething ring to relieve inflammation. Cold reduces inflammation and should be used for relief of teething irritation.

The mother of a 3-month-old breast-fed infant asks about giving her baby water, since it is summer and very warm. The nurse should recommend that: A) Fluids in addition to breast milk are not needed. B) Water should be given if the infant seems to nurse longer than usual. C) Water once or twice a day will make up for losses due to environmental temperature. D) Clear juices would be better than water to promote adequate fluid intake

A) Fluids in addition to breast milk are not needed. The child will nurse according to needs. Additional fluids are not necessary for the breast-fed baby.

The parent of a 12-month-old says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much mess." The nurse's best response is which of the following? A) "It's important not to give in to this kind of temper tantrum at this age." B) "Maybe you need to try a different type of spoon, one designed for children." C) "It's important to let him make a mess. Just don't worry about it so much." D) "He is at the age when he should begin to feed himself. Let's think of ways to make the mess more tolerable."

D) "He is at the age when he should begin to feed himself. Let's think of ways to make the mess more tolerable." At 12 months children should be self-feeding. Since they eat primarily finger foods, providing some concrete strategies to the parent as to how to minimize the mess would be helpful.

The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper and her mother nurses her back to sleep. Which of the following should the nurse suggest to help them deal with this problem? A) Put her in parents' bed to cuddle. B) Start putting her to bed while still awake. C) Allow the infant to cry for 30 minutes, then rock the infant back to sleep before putting her back in the crib. D) Give her a bottle of formula instead of breastfeeding her so often at night.

B) Start putting her to bed while still awake. Parents need to develop bedtime rituals that involve putting child in bed when awake. This will allow the infant to become accustomed to falling asleep somewhere besides the parent's arms or in the parent's presence.

A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. Which of the following instructions should the nurse include at this time about injury prevention? A) "Never shake baby powder directly on him because it can be aspirated into his lungs." B) "Do not permit him to chew paint from window ledges, since he might absorb too much lead." C) "When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall." D) "Keep doors of appliances closed at all times."

C) "When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall." Rolling over from the abdomen to the back occurs between 4 and 7 months of age. This is the appropriate anticipatory guidance for this age related to the prevention of injuries.

Which of the following infants are at risk for developing vitamin D-deficient rickets? A) Lacto-ovovegetarians B) Those who are breastfed exclusively C) Those using yogurt as primary source of milk D) Those exposed to daily sunlight

C) Those using yogurt as primary source of milk Yogurt may not be supplemented with vitamin D; thus the infant may be at risk for the development of rickets.

Macrominerals refer to those minerals with daily intake requirements greater than 100 mg. Which of the following is a macromineral? A) Iron B) Calcium C) Fluoride D) Vitamin D

B) Calcium Calcium is a macromineral.

Which of the following food combinations will generally provide the appropriate amounts of essential amino acids for an individual who is vegetarian? A) Grains and legumes B) Grains and vegetables C) Legumes and vegetables D) Milk products and fruit

A) Grains and legumes Grains and legumes form complete proteins when eaten together, thus providing appropriate amounts of essential amino acids.

Which of the following is most descriptive of kwashiorkor? A) This alteration has a multifactorial etiology. B) This alteration occurs primarily in breast-fed infants. C) This alteration results from excessive amounts of vitamin K. D) This alteration is related to inadequate calories, but adequate protein.

A) This alteration has a multifactorial etiology. Cultural, environmental, and infectious components contribute to kwashiorkor, a deficiency of protein with an adequate supply of calories.

A 3-month-old bottle-fed infant is allergic to cow's milk. Which of the following is the best substitute to teach the parents to use? A) Goat's milk B) Soy-based formula C) Skim milk diluted with water D) Casein hydrolysate milk formula

D) Casein hydrolysate milk formula The milk protein is broken down in these formulas, thus making it a safe alternative for the infant who has an allergy to cow's milk.

Which of the following statements best describes colic to parents who are inquiring as to whether their infant is experiencing this alteration? A) The infant will experience periods of abdominal pain, which result in weight loss. B) Periods of abdominal pain and crying occur in infants primarily over age 6 months. C) Colic manifests as paroxysmal abdominal pain or cramping manifested by episodes of loud crying. D) Colic is usually the result of poor or inadequate mothering.

C) Colic manifests as paroxysmal abdominal pain or cramping manifested by episodes of loud crying. Colic, or paroxysmal abdominal pain, occurs primarily in infants under the age of 3 months and is manifested by episodes of excessive crying and the infant drawing the legs up toward the abdomen

Which of the following interventions lowers the risk of sudden infant death syndrome (SIDS)? A) Keeping the window open if smoking near the infant B) Placing the infant in the supine position for sleeping C) Letting the infant sleep with the parents instead of alone in crib D) Making certain infant is kept very warm while sleeping

B) Placing the infant in the supine position for sleeping The Back to Sleep Campaign is credited with reducing the rate of SIDS in the United States.

The nurse is instructing a group of parents about head injuries in children. The nurse should explain that infants are particularly vulnerable to acceleration-deceleration head injuries because: A) Anterior fontanel is not yet closed. B) Nervous tissue is not well developed. C) Scalp of head has extensive vascularity. D) Musculoskeletal support of head is insufficient.

D) Musculoskeletal support of head is insufficient. The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants of acceleration-deceleration head injuries.

Thermoregulation presents a potential problem for neonates. The primary cause of this potential thermoregulation instability would be: A) Their renal function is not fully developed. B) Their small body surface area favors heat loss. C) They have a thin layer of subcutaneous fat that provides poor insulation. D) They maintain a flexed posture that promotes heat loss.

C) They have a thin layer of subcutaneous fat that provides poor insulation. Infants have small amounts of subcutaneous fat, which does not provide insulation and thus prevents them from retaining heat.

Which of the following factors makes the neonate more prone to problems of dehydration and acidosis? A) Immature lungs alter neonate's ability to regulate fluid balance. B) Immature kidneys cannot concentrate urine. C) Rate of fluid exchange is less than in adults. D) Rate of metabolism is less in relation to body weight.

B) Immature kidneys cannot concentrate urine. The kidneys' immature state interferes with the regulatory effect that the kidneys perform in adults, thus increasing the risk of dehydration and acidosis.

Which of the following statements is an accurate representation of the Apgar scoring system? A) It is predictive of infant morbidity. B) It is an evaluation of newborn well-being. C) It determines the predictive growth pattern in the first month of life. D) It determines the diagnosis of cerebral palsy.

B) It is an evaluation of newborn well-being. Apgar scoring is a reflection of newborn well-being and includes evaluation of heart rate, respiratory effort, muscle tone, reflex irritability, and color.

A woman has given birth to a healthy boy. When the nurse brings the newborn to its mother for feeding, she is shocked at the elongated appearance of the baby's head. The nurse should reassure her by saying which of the following? A) "All newborn babies' heads are shaped this way." B) "After the soft spot closes, the head will return to normal." C) "The infant's head is molded during delivery and will return to normal in a few days." D) "The infant's head shape has changed during delivery, and it will take approximately 6 months for it to return to normal."

C) "The infant's head is molded during delivery and will return to normal in a few days." Molding of the head takes place as the baby moves through the birth canal, and the head will return to a normocephalic shape within a few days.

The nurse is assessing a newborn's reflexes. Stroking the outer sole of the foot assesses which reflex? A) Perez B) Babinski C) Glabellar D) Dance or step

B) Babinski This is a description of the Babinski reflex. This reflex disappears after 1 year; if present beyond 1 year of age, it may indicate neurologic deficit(s).

Which of the following statements reflects accurate information about patterns of sleep and wakefulness in the infant? A) Cycles of sleep states are uniform in infants of the same age. B) The alert quiet state is the best stage for infant stimulation. C) States of sleep are independent of environmental stimuli. D) Irregular breathing is common during deep sleep.

B) The alert quiet state is the best stage for infant stimulation. The infant is awake and visually exploring the surroundings during the alert quiet state; thus it is the best time for stimulation.

Which of the following findings would the nurse consider normal in assessing the anterior fontanel of a neonate? A) Flat B) Closed C) Sunken D) Bulges when infant is asleep

A) Flat This is the expected finding for the assessment of the fontanels.

The nurse is using a bulb syringe to suction a neonate after delivery. Which of the following is an important consideration? A) Compress bulb after insertion. B) Clear pharynx before nasal passages. C) Use two bulb syringes, one for pharynx and one for nares. D) Use bulb syringe until secretions are removed because mechanical suction is contraindicated.

B) Clear pharynx before nasal passages. Clearing the pharynx before the nasal passages will minimize the potential aspiration of amniotic fluid.

Nursing care for the neonate with caput succedaneum should include which of the following? A) Monitor for signs of shock. B) Monitor for signs of infection. C) Reassure family that no specific treatment is needed. D) Reassure family that swelling will resolve within 3 months.

C) Reassure family that no specific treatment is needed. Caput succedaneum, an area of swelling above the bones of the skull, can occur in a vertex delivery. It usually subsides within a few days with no intervention.

Which of the following is important in providing a neutral thermal environment for a low-birth-weight infant in an incubator? A) Use wool blankets. B) Avoid using disposable diapers. C) Maintain high humidity atmosphere. D) Closely monitor both incubator and rectal temperatures.

C) Maintain high humidity atmosphere. A high humidity atmosphere within the isolette minimizes evaporative heat loss, which helps the infant maintain a neutral thermal environment.

While nipple feeding a high-risk neonate, the nurse observes occasional apnea, pallor, and bradycardia. This has not occurred with previous feedings. The most appropriate nursing action is which of the following? A) Resume gavage feeding until asymptomatic. B) Let neonate rest before nipple feeding again. C) Recognize that this may indicate an underlying illness. D) Use a high-flow, pliable nipple because it requires less energy to use.

C) Recognize that this may indicate an underlying illness. Poor feeding behaviors in a neonate who has previously fed without difficulty may indicate an underlying problem and should be further investigated.

A mother planned to breastfeed her infant before giving birth at 35 weeks of gestation. The infant is stable and receiving oxygen. Which of the following is the most appropriate nursing action related to feeding this infant? A) Assist mother in expressing breast milk. B) Evaluate infant's ability to breastfeed. C) Explain to mother that infant is too small to receive breast milk. D) Reassure mother that infant formula is a good alternative to breastfeeding.

B) Evaluate infant's ability to breastfeed. Preterm infants are able to breastfeed when they demonstrate readiness. A careful evaluation of readiness includes behavioral state, presence of efficient suck reflex, maintenance of body temperature, and respiratory status.

Which of the following is the most appropriate intervention to reduce stress in a preterm infant at 33 weeks of gestation? A) Skin-to-skin contact with parent B) Sensory stimulation involving several senses at a time C) Tactile stimulation until signs of overstimulation develop D) An attitude of extension when prone or side-lying

A) Skin-to-skin contact with parent The individualized approach of skin-to-skin contact and gentle massage has been demonstrated to reduce stress in preterm infants.

Which of the following interventions may decrease the incidence of physiologic jaundice in a healthy term infant? A) Institute early and frequent feedings. B) Place infant's crib near window for exposure to sunlight. C) Bathe infant when axillary temperature is 36.3�C (97.3�F). D) Suggest that mother initiate breastfeeding when danger of jaundice is past.

A) Institute early and frequent feedings. Early, frequent feedings in full-term infants increases intestinal motility, enhancing the excretion of unconjugated bilirubin.

The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which of the following should the nurse include? A) Send child to his or her room if child has one. B) If child cries, refuses, or is more disruptive, try another approach. C) Select an area that is safe and unstimulating, such as a hallway. D) General rule for length of time is 1 hour per year of age.

C) Select an area that is safe and unstimulating, such as a hallway. The area must be unstimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities.

The nurse is discussing toddler development with a parent. Which of the following interventions will foster the achievement of autonomy? A) Help toddler complete tasks. B) Provide opportunities for toddler to play with other children. C) Help toddler learn the difference between right and wrong. D) Encourage toddler to do things for self when capable of doing them.

D) Encourage toddler to do things for self when capable of doing them. Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable.

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that: A) Nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. B) Bowel control is accomplished before bladder control, so the parent should focus on bowel training first. C) The toddler must have the gross motor skill to climb up to the adult toilet before training beginning. D) The universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

B) Bowel control is accomplished before bladder control, so the parent should focus on bowel training first. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The sensation to defecate is stronger than that of urination. The completion of bowel training will give the toddler a sense of accomplishment that can be carried onto bladder training.

Which one of the following statements is most characteristic of the motor skills of a 24-month-old child? A) Toddler walks alone but falls easily. B) Toddler's activities begin to produce purposeful results. C) Toddler is able to grasp small objects but cannot release them at will. D) Toddler's motor skills are fully developed but occur in isolation from the environment.

B) Toddler's activities begin to produce purposeful results. Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new toy.

The nurse notices that a toddler is more cooperative taking medicine from a small cup rather than from a large cup. This is an example of which of the following characteristics of preoperational thought? A) Egocentrism B) Irreversibility C) Inability to conserve D) Transductive reasoning

C) Inability to conserve The smaller cup makes it look like less medicine to the child at this stage of cognitive development.

A hospitalized toddler clings to a worn, tattered blanket. She screams when anyone tries to take it away. What is the best explanation for her attachment to the blanket? A) The blanket encourages immature behavior. B) The blanket is an important transitional object. C) She has not mastered the developmental task of individuation-separation. D) She has not bonded adequately with her mother.

B) The blanket is an important transitional object. The blanket is an important transitional object that provides security when she separated from parents.

Which of the following characterizes the development of a 2-year-old child? A) Engages in parallel play B) Fully dresses self with supervision C) Has a vocabulary of at least 500 words D) Has attained one third of his or her adult height

A) Engages in parallel play Two-year-olds play alongside each other, otherwise known as parallel play.

Which of the following should the nurse recommend to the parents to help a toddler cope with the birth of a new sibling? A) Give the toddler a doll with which he or she can imitate the parents. B) Discourage the toddler from helping with care of new sibling until the baby is much older. C) Prepare the toddler about 1 to 2 weeks before the birth of a new sibling. D) Explain to the toddler that a new playmate will soon come home.

A) Give the toddler a doll with which he or she can imitate the parents. The toddler can participate in the activity of caring for a new family member, which will make him or her feel included and important.

A 2-year-old child has recently started having temper tantrums where she holds her breath and sometimes faints. The nurse should: A) Refer the child for a respiratory evaluation. B) Refer the child for a psychologic evaluation. C) Explain to the parent that this is not harmful. D) Explain to the parent that child is spoiled.

C) Explain to the parent that this is not harmful. The rising carbon dioxide levels restart the breathing process when a child holds her breath; thus the process is self-limiting and not harmful.

Which statement characterizes toddlers' eating behavior? A) They have increased appetites. B) They have few food preferences. C) Their table manners are predictable. D) They become fussy eaters.

D) They become fussy eaters. Toddlers have physiologic anorexia, which contributes to picky, fussy eating. This usually begins about 18 months of age.

For a toddler with sleep problems, the nurse should suggest to the parents to: A) Use a transitional object at bedtime. B) Vary the bedtime ritual. C) Restrict stimulating activities throughout the day. D) Explain away their fears.

A) Use a transitional object at bedtime. Transitional objects may help ease the toddler's anxiety and facilitate sleep.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which of the following instructions should be included? A) Flossing is not recommended at this age. B) Toddlers are old enough to brush their teeth effectively. C) The parent should brush the toddler's teeth with plain water if he or she does not like toothpaste. D) The toddler's toothbrush should be small and have hard, rounded, nylon bristles.

C) The parent should brush the toddler's teeth with plain water if he or she does not like toothpaste. Some toddlers do not like the flavor of toothpaste, so water can be used for teeth brushing at this age.

Which of the following statements about bottle-mouth caries should be taught to the parents? A) This syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple. B) Giving a bottle of milk or juice at nap time or bedtime predisposes the child to this syndrome. C) This syndrome can be completely prevented by breastfeeding. D) Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome.

B) Giving a bottle of milk or juice at nap time or bedtime predisposes the child to this syndrome. Sweet liquids, or the sugars in milk and even breast milk, pooling in a toddler's mouth during sleep increase the incidence of dental caries.

A parent brings a 2-year-old to the clinic for a well-child checkup. Which of the following statements by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? A) "We locked all the medicines in the bathroom cabinet." B) "We turned the thermostat down on our hot water heater." C) "We placed gates at the top and bottom of the basement steps." D) "We stopped using the car seat and put our child in the seat belt now that he is older."

D) "We stopped using the car seat and put our child in the seat belt now that he is older." A car seat should be used until the child is 18 kg (40 pounds), approximately 4 years old.

When explaining the proper restraint of toddlers in motor vehicles to a group of parents, the nurse should include this advice: A) Safety belts should be worn snugly over the toddler's abdomen. B) Place the car seat in the front passenger seat if there is an airbag. C) Use lap and shoulder belts when child is over 3 years of age. D) Place the car seat in the back seat of the car facing forward.

D) Place the car seat in the back seat of the car facing forward. Car seats are required for toddlers to prevent injury in case of a motor vehicle accident. The car seat should be placed in the back seat, forward facing.

The nurse should teach parents of toddlers how to prevent poisoning by instructing them to: A) Consistently use safety caps. B) Store poisonous substances in a locked cabinet. C) Keep ipecac in the home. D) Store poisonous substances out of reach.

B) Store poisonous substances in a locked cabinet. This is an appropriate action to prevent the curious toddler from getting into poisonous substances and products.

The primary reason for universal screening of young children for lead poisoning is that: A) Children with lead poisoning rarely have symptoms. B) Water and food in the United States are usually contaminated with lead. C) Most children are exposed to lead through herbal products. D) Most children in the United States are exposed to toxic amounts of lead.

A) Children with lead poisoning rarely have symptoms. In the early stages of lead poisoning, children are asymptomatic.