How Much Do You Know

About Pediatrics

Some Differences
Obvious- body size differences
Treating a child is not like treating a
miniature adult.
Children are minors
Often have to treat the parents and
sometimes, the family, rather than just the
child

1. How many soft spots are there on the

newborns head?

Two

2. When should and infant be able to sit

alone without support?

8 months

3. At what age should a child be able to

use scissors well?

4 years

4. List 3 safety issues for adolescents

MVA
Substance abuse
Suicide/homicide

5. One ounce =____________mls

One teaspoon=__________mls

One ounce = 30 mls

One teaspoon = 5 mls

6. List five things you would measure

when examining an infant.

1.
2.
3.
4.
5.

Head circumference
Chest circumference
Abdominal girth
Weight
Length

7. The age range for an infant is defined

as which of the following time spans?
1.
2.
3.
4.

newborn to 3 months
1 month to 1 year
newborn to 6 months
3 months to 15 months

1.
2.
3.
4.

newborn to 3 months
1 month to 1 year
newborn to 6 months
3 months to 15 months

8. What are acceptable treatments for a

child with fever?
1. giving a fever reducer with Tylenol or
Motrin
2. a cold bath
3. rubbing alcohol
4. all of the above

1. giving a fever reducer with Tylenol or

Motrin
2. a cold bath
3. rubbing alcohol
4. all of the above

9. When can you start your kids on low

fat milk?
1.
2.
3.
4.

9 months
12 months
18 months
2-3 years

1.
2.
3.
4.

9 months
12 months
18 months
2-3 years

10. Boys can possibly start puberty at

age...
1.
2.
3.
4.

7 years
9 years
15 years
16 years

1.
2.
3.
4.

7 years
9 years
15 years
16 years

11. When does puberty usually start in

girls?
1.
2.
3.
4.

between 7 and 12 years

between 8 and 16 years
between 8 and 13 years
between 9 and 14 years

1.
2.
3.
4.

between 7 and 12 years

between 8 and 16 years
between 8 and 13 years
between 9 and 14 years

12. Basic first aid for a burn includes...

1.
2.
3.
4.

cooling the burn with butter

cooling the burn with cold water
cooling the burn with ice
cooling the burn with ice water

1.
2.
3.
4.

cooling the burn with butter

cooling the burn with cold water
cooling the burn with ice
cooling the burn with ice water

13. How many ounces of fruit juice

should a 3 year old have each day?
1.
2.
3.
4.

4-6 ounces
8-10 ounces
14-16 ounces
20-24 ounces

1.
2.
3.
4.

4-6 ounces
8-10 ounces
14-16 ounces
20-24 ounces

14. How many words does the typical 2

year old know?
1.
2.
3.
4.

25 words
50 words
150 words
250 words

1.
2.
3.
4.

25 words
50 words
150 words
250 words

15. Chickenpox can be...

1.
2.
3.
4.

prevented with the Varivax vaccine

reactivated to cause Shingles
a serious and life threatening infection
all of the above

1.
2.
3.
4.

prevented with the Varivax vaccine

reactivated to cause Shingles
a serious and life threatening infection
all of the above

16. The nurse is preparing to give an injection

to a preschooler. The nurse has selected
the deltoid muscle. What is the maximum
amount of solution that the nurse can give
in the deltoid of a preschooler?

1.
2.
3.
4.

0.25 mL
0.5 mL
0.05 mL
1 mL

1.
2.
3.
4.

0.25 mL
0.5 mL
0.05 mL
1 mL

17. The Epstein-Barr virus is responsible for

which of the following?

1.
2.
3.
4.

erythema infectiosum
mumps
infectious mononucleosis
roseola

1.
2.
3.
4.

erythema infectiosum
mumps
infectious mononucleosis
roseola

18. Which of the following tests is used in

diagnosing polio?
1.
2.
3.
4.

nasal culture
arterial blood gases
stool or throat culture
magnetic resonance imaging (MRI)

1.
2.
3.
4.

nasal culture
arterial blood gases
stool or throat culture
magnetic resonance imaging (MRI)

19. Which of the following methods is the most

reliable method of diagnosing dehydration
in children?
1.
2.
3.
4.

specific gravity of urine

skin turgor
blood pressure changes
weight loss

1.
2.
3.
4.

specific gravity of urine

skin turgor
blood pressure changes
weight loss

20. The majority of cases of acute

gastroenteritis in children under 2
years old in the United States are
caused by:
1.
2.
3.
4.

Shigella
Salmonella
rotavirus
Giardia

1.
2.
3.
4.

Shigella
Salmonella
rotavirus
Giardia

21. Which type of burn is most common in

children?
1.
2.
3.
4.

electrical
radiation
chemical
thermal

1.
2.
3.
4.

electrical
radiation
chemical
thermal

22. For children under 1 year of age, what is the

leading cause of unintentional injuryrelated deaths?
1.
2.
3.
4.

motor vehicle occupant injury

drowning
suffocation
fires

1.
2.
3.
4.

motor vehicle occupant injury

drowning
suffocation
fires

23. Which of the following infants is at

greatest risk of sudden infant death
syndrome?
1.
2.
3.
4.

male, full-term, 7 months old

male twin, premature, 4 months old
female, full-term, 8 months old
female, single birth, 4 months old

1.
2.
3.
4.

male, full-term, 7 months old

male twin, premature, 4 months old
female, full-term, 8 months old
female, single birth, 4 months old

24.The period of toddlerhood is from 12

months to:
1.
2.
3.
4.

15 months
24 months
18 months
36 months

1.
2.
3.
4.

15 months
24 months
18 months
36 months

25. How many calories per ounce do

breast milk and formulas provide?
1.
2.
3.
4.

10
20
30
40

1.
2.
3.
4.

10
20
30
40

26. After an IV infiltrated, what lesion

does this 2-year-old boy have?

He has a large ulcer (ulceration)

27. This patient has herpes simplex.

Describe this rash?

This patient has clustered vesicles.

28. This 9-year-old boy fell off of his bike.

What is the name of this skin lesion?

He has an abrasion.

How well do you do?

Welcome to Pediatric
Nursing

Nursing Care of Children

Basic Concepts

Resource Materials

ATI
Unit 1 (Ch. 1-11)
Saunders
Chapter 27-28, 39
Rosdahl
Chapter 71-74
PowerPoint 1a
Practice Questions
Applicable Handouts
Quizzes

Topics

Family-Centered Nursing Care

Cultural Awareness
Physical Assessment Findings
Health Promotion
Nutrition/Play
Medication Administration
Pain Management
Hospitalization and Illness
Death and Dying
Growth and Development Theories

Family Centered Nursing

The development of a mutually beneficial
partnership between families, the nurse and
other healthcare professionals.
Parents and children are partners in care
Involves the family giving information about
childs condition, usual behavior, and routines
Nurse completes comprehensive family
assessment
Should include the childs opinions when
possible
The nurse should be aware of the different
methods of coping and provide support and
determine familys functioning

WHAT IS A FAMILY?
Two or more people related by blood or marriage
who reside together or
More broadly-two or more individuals who come
together for the purpose of nurturing.
Nuclear

Two parents and their children

Single-parent

One parent and one or more children

Blended

At least one step parent, stepsibling, or half-sibling

Extended

At least one parent and 1 or more children and other

individuals

Same-sex

Common tie between two members of the same sex

with or without children

Foster

Children that have been placed in an approved living

environment away from the family of origin

Genogram
A diagram of relationships between family
members; medical history

Parenting

Cultural Awareness
Cultural and religious beliefs have an impact on
the interaction of family members.
(Culture-a style of behavior patterns, beliefs,
and products of human work. i.e. art, music within
a given community or population)
Religion, ethnicity, race, stereotyping, prejudice,
bias, ethnocentrism
Communication, dietary preferences, and dress
are influenced by culture
Differences in language, habits, customs,
attitudes, and beliefs can lead to feelings of
isolation and loneliness in children.

Cultural Competence
Refers to the ability of the nurse to
understand and effectively respond to the
needs of patients and families from different
cultural backgrounds
Nurse needs to understand her own cultural
background and biases
Nurse should be aware of, sensitive to, and
appreciative of cultural differences
Nonverbal behaviors (chart ATI p.11)

Culture and Nursing

Religion/Spiritual/Death rituals
Pain
Nutrition
Communication
Family patterns and gender roles
Repatterning
Using and interpreter

Pediatric Assessment
Examination of the child begins from the first contact. You
should observe the behavior of the child and parent by using
visual cues to make a proper assessment.

Premature Infant

Physical Assessment

Alter exam to meet childs developmental needs

Perform invasive portions last
Nonthreatening environment; provide privacy
Use activities that can be perceived as games to
engage the child
Involve the child and family member(s) in the
examination
Praise the child for cooperation during the exam
Adolescents may prefer to be examined without
family members present.

Physical Assessment
Hide any threatening equipment prior to the exam
Keep room warm and well lit
Tell the child what to expect as the physical exam is
being performed
Use the parents lap if desired
Allow child and parents to ask questions
Know expected vital signs for each age group
Know expected physical findings/General
appearance

Question
A nurse is caring for a 9-month-old infant.
Rank the following assessments in the
order in which the nurse should perform
them.
____ Axillary temperature
____ Respiratory rate
____ Weight
____ Heart rate

Answer
__4__ Axillary temperature
__1__ Respiratory rate
__3__ Weight
__2__ Heart rate

Which statement accurately describes the best method

for assessing a 12-month-old?
1.The nurse should assess the child on the examining
table.
2.The nurse should assess the child in a head-to-toe
sequence.
3.The nurse should have the childs mother assist in
holding her down.
4.The nurse should assess the child while she is in her
mothers lap.

Which statement accurately describes the best method

for assessing a 12-month-old?
1.The nurse should assess the child on the examining
table.
2.The nurse should assess the child in a head-to-toe
sequence.
3.The nurse should have the childs mother assist in
holding her down.
4.The nurse should assess the child while she is in her
mothers lap.

Physical Assessment Findings

Anthropometric Measurements (weight, length or
height, head circumference)

General appearance

(growth, hygiene, distress, odors,

muscle tone, eye contact, speech, follows commands)

Skin and hair characteristics

(color, temperature,
texture, moistness, turgor, lesions, CFT, skin folds, hair, nails)

Inspection of head and face

symmetry)

(fontanels, sutures, skull,

Inspection of eyes, ears, nose, sinuses, mouth

(visual acuity, conjunctiva, sclera, corneas, pupils, lashes, lids,

eye muscles, teeth, mouth odors, gums, palate, tongue)

Throat, neck
trachea, ROM)

Chest

(tonsils, gag reflex, lymph nodes, thyroid,

(circumference, shape, resp. effort, breath sounds,

breasts, apical pulse, heart rate and rhythm)

 Abdomen

(shape, umbilicus, abdominal movement,

masses, )

Inguinal, perineal areas

(genitalia, urethral and vaginal

openings, vaginal discharge, pubertal development)

Bones, muscles, joints

(ROM, posture, muscle strength,

spinal alignment)

Upper/Lower extremities

(arms, legs, hands, nails,

hips, feet)

Cognitive function/Cerebellar function

(Behavior,
LOC, Communication, balance and coordination, gait)

Sensory function (pain, tactile)

Cranial nerve function (reflexes, deep tendon)

Newborn Reflexes

Sucking and rooting reflexes (4 months)

Palmar grasp (6 months)
Plantar grasp (8 months)
Moro reflex (startle) (4 months)
Tonic neck reflex (3-4 months)
Babinski reflex (1 year-after 2 yrNeuro)
Stepping (1 month)

Skin Turgor and Capillary Refill

Tonsil Size with Infection

Facial Symmetry

Eyes

Examination of Mouth

Lymph nodes

Examining the Abdomen

Examining the Genitalia

Examining the Genitalia

Tanner Stages of Development

Heart Rate
Apical is recommended
Count 1 full minute
Listen for irregularities document and report

Apical Pulse

Respiratory Rate
Count 1 full minute
Observe chest and abdomen move
S/S Respiratory Distress include:
Grunting
Nasal Flaring
Retractions
Stridor
Tachypnea
Cyanosis

Examination of Chest

A nurse is checking the vital signs of a 3year-old child during a well-child visit.
Which of the following findings should the
nurse report to the provider?
1.Temperature 37.2 C (98.9 F)
2.Pulse 114/min
3.Respirations 38/min
4.Blood pressure 92/54 mm Hg

A nurse is checking the vital signs of a 3year-old child during a well-child visit.
Which of the following findings should the
nurse report to the provider?
1.Temperature 37.2 C (98.9 F)
2.Pulse 114/min
3.Respirations 38/min
4.Blood pressure 92/54 mm Hg

Examination of Chest

Adventitious Breath Sounds

Type

Description

Cause

Fine crackles

High-pitched, noncontinuous, heard at

end of inspiration

Air passing through

watery secretions in
the smaller airways

Sibilant rhonchi

Musical, squeaking, or
hissing noise heard
during inspiration or
expiration; generally
louder on expiration

Bronchospasm or
anatomic narrowing of
trachea, bronchi, or
bronchioles

Sonorous rhonchi

Coarse, low-pitched
sound like a snore,
heard during inspiration
or expiration; may clear
with coughing

Air passing through

thick secretions that
partially obstruct the
larger bronchi and
trachea

Chest Shape

A (Pectus excavatum) B (Pectus carinatum)

Funnel chest and pigeon chest

Blood Pressure Cuff

Whaley and Wong

Blood Pressure

 Oral

Temperature

SL cavity (> age 4)

Axillary
Axilla with direct skin contact x 3 min.
Rectal
Only when another method cannot be used
Not in newborns, cancer, diarrhea
Lubricated tip inserted - x 3 min.

Tympanic
Rapid (2 sec), noninvasive, convenient

Temporal
Scan across forehead

Temperature
Position for taking
axillary temperature.

Axillary
96.6 98.0 F
Oral
97.6 98.6 F
Rectal or tympanic
98.6 100.0
F

Palpation of Peripheral Pulses

Head Circumference

Head circumference is measured by wrapping the

paper
tape over the eyebrows and the around the
occipital

Fontanels

Measuring length-height

Body Mass index is also

measured in the older child

Measuring Infant Weight

Double birth weigh by about 6 months

Triple birth weight by 1 year

A nurse is assessing a 12-month-old infant at

a well-child visit. Which of the following
findings should the nurse report to the
provider?
1.Closed anterior fontanel
2.Eruption of six teeth
3.Birth weight has doubled
4.Birth length increased by 50%

A nurse is assessing a 12-month-old infant at

a well-child visit. Which of the following
findings should the nurse report to the
provider?
1.Closed anterior fontanel
2.Eruption of six teeth
3.Birth weight has doubled
4.Birth length increased by 50%

Measure the chest with a tape measure placed

just under the axilla and at the nipple line.

The nurse accurately measures the child and then

places height and weight on appropriate growth grids
for the childs age and gender.

Common Milestones

Growth and Development

Infancy
Toddler
Preschooler
School Age Child
Adolescent

Stages of Growth and

Development
Infancy
Neonate
Birth to 1 month

Infancy
1 month to 1 year

Early Childhood
Toddler
1-3 years

Preschool
3-6 years

Middle Childhood
School age
6 to 12 years

Late Childhood
Adolescent
13 years to
approximately 18
years

Principles of Growth and Development

Health Promotion
Growth is an orderly process, occurring in
systematic fashion.
Rates and patterns of growth are specific to
certain parts of the body.
Wide individual differences exist in growth
rates.
Growth and development influence by a
multiple factors.

Principles Continued
Development proceeds from the simple to the
complex and from the general to the specific.
Development occurs in a cephalocaudal and
a proximodistal progression.
There are critical periods for growth and
development.
Rates in development vary.
Development continues throughout the
individual's life span.

Growth Pattern

Key Definitions
Growth- increase in size of structure
Development- complexity in thought,
behavior, skill, or function; includes growth;
process that continues over time
Cephalocaudal- head-to-toe progression
of growth and development
Proximodistal- trunk-to-periphery
progression of growth and development
Developmental task -skill or competency
unique to a stage of development

Developmental Tasks
Physical (sit, walk, crawl, motor development,
sensory development)
Psychological (imitation, trust, self-esteem,
socialization)
Cognitive (recognition, following direction,
concepts of time and space, magical
thinking, abstract thought)

Common Milestones to Know

Closure of anterior/posterior fontanel

Fading of newborn reflexes
Doubling and tripling of weight
Sitting up without support
Walking
Riding a tricycle
Supporting own head
Pincer grasp

Health Promotion of the Infant

(Birth to 1 Year)

Theorist

Type of Development

Stage

Erikson

Psychosocial

Trust vs. mistrust

Freud
Piaget

Psychosexual
Cognitive

Oral
Sensorimotor

The infant trusts that their feeding, comfort, stimulation,

and caring needs will be met.

Physical Development
Posterior fontanel closes @ 2-3 mos.
Size tracked by weight, length, head
circumference
Gross motor skills
-Holds head up
-Rolls over (5-6 mos.)
-Holds head steady when sitting (6 mos.)
-Gets to sitting alone; pulls up to standing (9 mos.)
-Stands holding on or alone (12 mos.)
-6 mos. doubles birth weight

Age

Gross

Fine

1 month

Head lag

Grasp reflex

2 months

Lifts head off mattress

Holds hand open

3 months

Raises head and shoulders Looses grasp reflex

4 months

Rolls back to side

Puts objects in mouth

5 months

Rolls front to back

Grasps

6 months

Rolls back to front

Holds bottle

7 months

Bears full weight

Objects hand to hand

8 months

Sits unsupported

Begins pincer grasp

9 months

Pulls to standing

Good pincer grasp

10 months Changes prone to sitting

Grasps rattle by handle

11 months Walks holding on

Object in container

12 months Sits from standing

Tries 2-block tower

Head ControlHead Lag

Newborn

Age 6 months

Head Control

Hypotonia

Sitting Up

Age 6 months

Age 2 months
Age 8 months

Ambulation
Nine to 12-months

13 month old

Fine Motor Development

Brings hands together

Grasps rattle
Looks for items that are dropped from view
Transfers objects (6 mos.)
Pincer grasp (9 mos.)
Bangs two toys together (9 mos.)
Can nest one object inside another (12
mos.)

Fine Motor Development

Cognitive Development
Initial reflexes replaced by voluntary
movements
-Object permanence (peek-a-boo) 9 months
-Discrimination between persons
-Comprehension of word meanings
Language
-Responds to noises
- ooos and aahs
-Laughs and squeals
-Turns head to sound of rattle
-Pronounces single syllable words
- Begins 2-3 word phrases

Psychosocial Development
Personal-Social
-Bonding with parents during first month
-Regards faces
-Smiles in response to others
-Regards own hands
-Works to reach toys
-Feeds self finger foods
-Waves goodbye/Plays pat-a-cake
-Drinks from a cup with handles
Separation Anxiety-latter half of first year
Stranger Fear
(Encourage parents not to leave infant long periods of time)
Self-concept (separate from parents)By end of first
year

Separation Anxiety
Protest
Despair
Denial or detachment
Encourage and plan to have parents be part
of care
Respect infants usual schedule as much as
possible

Body Image Changes

Mouth is a pleasure producer
Hands and feet objects of play
Discovers smiling causes others to react

Age Appropriate Activities

Solitary play
Short attention spans
Toys that stimulate the senses and
encourage development
-Rattles, mobiles, teething toys
-Nesting toys
-Pat-a-cake, balls
-Reading books

Red Flags in Infant Development

Unable to sit alone after age 8 months
Unable to transfer objects from hand to hand by
age 1 year
Abnormal pincer grip or grasp by age 15 months
Unable to walk alone by 18 months
Failure to speak recognizable words by 2 years.

Nutrition

Breastfeeding recommended
Iron-fortified formulas
Cows milk NOT recommended
Solids: Introduced ~ 6 mos.
-Iron fortified cereals
-Pureed/strained foods one at a time
-Decrease milk/formula as solids increase
-Weaning when can drink from cup ~ 6mos
Milk, eggs, wheat, citrus fruits, peanuts, peanut
butter, and honey should be delayed until the first
year of life.

Breastfeeding offers many physical and emotional

benefits for the infant. This new mother is learning to
breastfeed her baby.

Early childhood caries. This

child has had major tooth decay
related to sleeping as an infant
and toddler while sucking
bottles of juice and milk.

Health Promotion and Prevention

Hyperbilirubinemia (immature liver) Jaundice

Child Abuse (physical, emotional, neglect, sexual)
Dentition: 6-8 teeth by end of first year
Immunizations:
-Birth
Hep B
-2 mos.
Hep B, Rota, DTaP, Hib, PCV, IPV
-4 mos.
Rota, DTaP, Hib, PCV, IPV
-6 mos.
Hep B, Rota, DTaP, PCV, IPV
-6-12 mos. Flu

Health Promotion and Prevention

Diaper rash treatment and prevention
-Change diapers frequently
-Cleanse with water, dry thoroughly
-Use of skin barriers
-Diaper open to air when possible

Injury Prevention
Suffocation (Plastic bags, balloons, firm crib, back to
sleep)

Falls (rails up on crib, restraints in infant seats, safety gates)

Poisoning (Avoid lead exposure, poison control number
near phone, safety locks on cabinets)

Burns Check (temp of bath water, cover electrical

outlets, sunscreen)

Motor Vehicles (rear-facing care seat in back seat till

20lbs)

Bodily damage (sharp object out of reach, shaken baby,

unattended animals, heavy objects that could be pulled)

Drowning (leaving unattended in bathtub)

Infant Seats
Infants should use approved rear-facing car
seats in the back seat, preferably in the middle,
(away from air bags and side impact).
Infants should be in rear facing car seats for the
first year of life and until they weigh 9.1 kg (20
lb).
It is recommended to have infants ride rear
facing until they have reached the weight limit
allowed for the car seat (as long as the top of the
infants head does not extend above the top of
the seat back).
A five-point harness or T-shield should be part of
a convertible restraint.

Health Promotion Toddler

12 months to 3 years
Theorist

Type of Development

Erikson

Psychosocial

Stage
Autonomy vs.
shame

Freud

Psychosexual

Anal

Piaget

Cognitive

Sensorimotor
transitions to
preoperational

A nurse is performing a developmental

screening on a 10-month-old infant. Which of
the following fine motor skills should the infant
be able to perform? (Select all that apply.)
1.Grasp a rattle by the handle
2.Try building a two-block tower
3.Use a crude pincer grasp
4.Place objects into a container
5.Move objects from hand to hand

A nurse is performing a developmental

screening on a 10-month-old infant. Which of
the following fine motor skills should the infant
be able to perform? (Select all that apply.)
1.Grasp a rattle by the handle
2.Try building a two-block tower
3.Use a crude pincer grasp
4.Place objects into a container
5.Move objects from hand to hand

Physical Development
Anterior fontanel closes by 18 mos. of age
At 12 mos. triples birth weight
30 mos. four times birth weight
15 months

Walks without help

Uses cup well

Builds tower 2 blocks

18 months

Assumes a standing
position

Manages spoon
Turns pages in book

2 years

Walks up and down

stairs

Tower of 6-7 blocks

2.5 years

Jumps both feet

Stands 1 foot
momentarily

Draws circles
Good hand-finger
coordination

Developmental Skills
Steady gait
Climbing stairs
Jumping, standing on 1 foot for
short periods
Stacking blocks increasingly
higher numbers
Drawing stick figure
Undressing and feeding self
Toilet training

 Psychosocial/Moral Development

Independence
Separation anxiety
Egocentric (their point of view)
Reward for good behavior; punishment for bad behavior

Self-Concept/Body Image
See themselves as separate form their parents
Usefulness of various body parts
Gender identity by age 3

Cognitive Development

Concept of object permanence fully developed

Memory of events that relate to them
Language to 400 words; 2-3 word phrases
Imitation

Age-appropriate Activities

Parallel play
Filling and emptying containers
Playing with blocks
Reading books
Push/Pull toys
Tossing a ball

Nutrition
Picky eaters food jags
Toddlers should consume 24 to 30 oz of milk per day
May switch from drinking whole milk to drinking low-fat
milk (2% fat) at 2 years of age
Juice consumption should be limited to 4 to 6 oz per
day
Appropriate finger foods include ripe bananas; toast
strips; graham crackers; cheese cubes; noodles; and
peeled chunks of apples, pears, or peaches
Foods that are potential choking hazards (nuts,
grapes, hot dogs, peanut butter, raw carrots, tough
meats, popcorn) should be avoided

Health Promotion and Prevention

Child Abuse
Upper respiratory infections, otitis media
Temper tantrums
Toilet training
Discipline (well defined boundaries)
Immunizations:
12-15 mos.

Hib. PCV, IPV, MMR, Varicella

12-23 mos.
15-18 mos.
12-36 mos.

Hep A
DTaP
Flu vaccine

Injury Prevention
Drowning (unattended in bathtub, pool supervision)
Falls (Doors and windows locked, safety gates)
Suffocation (toys with small parts, drawstrings from

clothing, food items in small pieces-no seeds, nuts, popcorn)

Poisoning (lead paint, safety locks, child proof containers)

Burns (Pot handles to back of stove, water temp)
Motor vehicles (approved car seat, supervise while
playing outside)

Bodily damage (sharp objects, strangers, unknown

animals)

Car Seats
Toddlers should be in approved rearfacing car seats in the back seat until they
weigh 9.1 kg (20 lb). Toddlers may then sit
in approved forward-facing car seats in the
back seat. Toddlers may usually remain in
car seats until 4 years of age and/or 40 lb

Red Flags-Toddler

Not walking by 15 months

Not running by 20 months
No mature pincer by 12 months
Not understanding no by 11 months
First words by 14 months
Following 1 step directions by 18 months
Not using purposeful communication by 14
months
Not imitating by 16 months

Health Promotion and the

Preschooler (3 to 5 years)

Stages of Development

Theorist

Type of Development

Stage

Erikson

Psychosocial

Initiative vs. Guilt

Freud

Psychosexual

Phallic

Piaget

Cognitive

Preoperational

Growth and Development

Gains about 5 lbs per year
Grows 2.5-3 inches per year
Alternating feet on stairs; going up and down
stairs easily
Hopping
Walking heel-to-toe
Dressing without help
Copies shapes on paper
More detailed stick figures
Plays on playground equipment

Cognitive Development
Preconceptual: Judgment, artificialism,
animism, imminent justice
Intuitive: Classification, cause and effect
Language: Vocab continues to increase,
sentences, color identification, likes talking
Time: Concepts of past, present and
future; Comprehension of days of week

Psychosocial/Moral Development
Self-concept/Body image

Guilt
Social acceptability
Mastering skills and feeling good
May regress in times of stress
Greatest fear: Bodily harm
Sex-role identification
Magical thinking

Age-appropriate Activities

Associative play
Playing ball
Puzzles
Riding tricycles
Pretend and dress-up
Role play
Painting
Sewing and beading
Reading books

Nutrition
Typically consumes half the calories of an
adult
Continue to be picky up to age 5
Parents need to ensure balanced nutrition

Health Promotion and Prevention

Child abuse
Otitis media
Accidents (poisoning and drowning)
Sleep disturbances (night terrors)
Vision screening
Immunizations: 4 to 6 years
-DTaP, IVP, MMR, Varicella, flu vaccine

Injury Prevention
Drowning (Pool safety)
Poisoning
Motor vehicles
-Approved car seat
-Booster seat UNTIL adult seat belts fit
correctly

Red flags: Preschool

Inability to perform self-care tasks, hand
washing simple dressing, daytime toileting
Lack of socialization
Unable to play with other children
Able to follow directions during exam
Performance evaluation of pre-school teacher
for kindergarten readiness

Health Promotion School-Age Child

5 to 12 years

Theorist

Type of Development

Erikson

Psychosocial

Freud
Piaget

Psychosexual
Cognitive

Stage
Industry vs.
Inferiority
Latency
Concrete
operations

Physical Development

Gains 4.4- 8.8 lbs per year

Grows about 2 inches per year
Females: breast buds, pubic hair, menarche
Males: Enlargement of testicles, changes in
scrotum, pubic hair
Permanent teeth
Improved coordination
Visual acuity 20-20

School Years: fine motor

Writing skills improve
Fine motor is refined
Fine motor with more focus
Building: models legos
Sewing
Musical instrument
Painting
Typing skills
Technology: computers

 Cognitive Development

Concrete thought
Simple analogies
Understands time, days, seasons
Defines many words, understands rules of grammar
Classifies more complex information
Understands emotions

Self-concept/Body Image
Develop healthy self-respect by finding out the areas
they excel
Need encouragement
Solidification of body image
Curiosity about sexuality: sex education
Emphasis on modesty, privacy

Psychosocial Development
Sense of industry achieved through
achievements in learning
Same-sex companions
Most friends are from school
May rival same-sex parent
Nervous behaviors (nail-biting)
Fears of ridicule from peers, teachers
Begins to understand rules, understanding
justice

Age-appropriate Activities

Competitive and cooperative play

Simple board and number, card games
Hopscotch, jump rope
Collect rocks, stamps, cards, coins
Ride bicycles
Build simple models
Organized sports
Jigsaw puzzles
Hobbies

Health Promotion and Prevention

Eating adult proportion foods; needs
quality nutritious snacks
Child abuse
Scoliosis
Obesity
Cancers
Respiratory Infections
Asthma

Health Promotion and Prevention

Immunizations: DTap if not @ 4-5yrs
IVP
MMR
Varicella
Age 11-2
Tdap, MMR, HPV, MCV4
Substance abuse (Teach children to say no)
Dental health (Brushing, flossing, regular check ups,
appropriate snacks)

Injury Prevention

Fracture prevention
Avoid trampolines
Teach children to swim
Teach fire safety
Keep firearms locked up
Motor vehicles (car or booster seat until adult seats
fit properly)

Children < 13 years old, safest in the back

seat

Red flags: School Age

School failure
Lack of friends
Social isolation
Aggressive behavior: fights, fire setting, animal
abuse

Health Promotion Adolescent

12 to 20 years

Stages of Development

Theorist

Type of Development

Erikson

Psychosocial

Stage
Identity vs. Role
confusion

Freud

Psychosexual

Genital

Piaget

Cognitive

Formal
operations

Physical Development
Acne
Females 95% of adult height by 13, Widening
hips
Males 95% of adult height by 15, shoulders
broaden
Male sexual maturation: size testes, pubic hair,
rapid growth of genitalia, axillary hair, downy hair
upper lip, chance in voice
Sleep habits change

 Cognitive Development

Able to think at adult level

Abstract thought, deal with principles
Evaluate quality of own thinking
Longer attention span
Peer group jargon

Psychosocial Development
Develops a sense of personal identity
May become a par of a peer group that influences
behavior
Work habits begin to solidify
Increased interest in the opposite sex
Risky behaviors; often view themselves as invincible

Moral/Self-Concept/Body Image
Rules are not seen as absolutes
Having healthy relationships with peers, family,
teachers
Identifies skill or talent
Participation in sports or hobbies, community
Concerned with lean bodies portrayed in the
media
Comparing pubertal development
Common to have depression or eating disorders
due to poor body image

 Adolescent
As teenagers gain independence they begin to
challenge values
Critical of adult authority
Relies on peer relationship
Mood swings especially in early adolescents

Adolescent Behavioral Problems

Anorexia
Attention deficit
Anger issues
Suicide

 Age Appropriate Activities

Nonviolent video games

Nonviolent music
Sports
Caring for a pet
Career-training programs
Reading
Social events (movies, school dances)

Nutrition
Rapid growth; high metabolism: tend to be deficient in
iron, calcium, and vitamins A and C
Eating disorders
Anorexia nervosa
Bulimia
Obesity (diet high in fat without adequate activity)

Health Promotion and Prevention

Immunizations: TdaP, HPV, Hep B, IVP, MMR,
Varicella, MCV4
(Above if not @ 12-20)

Scoliosis
Child abuse
Motor vehicles leading cause of death
Homicides 2nd leading cause of death
Substance Abuse
Sexual experimentation, STDs, Pregnancy

Injury Prevention

Drivers education courses

Use of seat belt
Teach dangers of drinking and driving (MADD)
Screen for substance abuse
Helmet use with bicycles, motorcycles,
skateboards, roller blades, snowboards
Teach not to swim alone
Teach proper use of sporting equipment

Adolescent Teaching

Relationships
Sexuality STDs / AIDS
Substance use and abuse
Gang activity
Driving
Access to weapons

A nurse is providing anticipatory guidance to

the parent of a 13-year-old. The nurse should
recommend which of the following screenings
for the adolescent? (Select all that apply.)
1.Body mass index
2.Blood lead level
3.Height
4.Weight
5.Scoliosis

A nurse is providing anticipatory guidance to

the parent of a 13-year-old. The nurse should
recommend which of the following screenings
for the adolescent? (Select all that apply.)
1.Body mass index
2.Blood lead level
3.Height
4.Weight
5.Scoliosis

Functions of Play:
-Physical/Sensorimotor development

(exploration,
joint and muscle, muscle coordination, gross/fine motor skill, kinesthetic
stimulation)

-Cognitive development (senses, numbers, colors, shapes,

textures, problem solving, critical thinking, hand-eye coordination, creativity,

importance of objects)

-Social development (social skills, right from wrong, roles)

-Emotional development (sense of belonging, coping
strategies, self-awareness, sense of security and self-worth)

-Moral development (ethical behavior, sharing, awareness

of feeling of others, self-awareness-who they are in perspective of
the world)

Types of Play
Solitary (Begins in infancy and is common in
toddlers)
Parallel (Involves child playing next to another
child but not with that child-Characteristic of
toddlers, no sharing)
Associative (Interaction with other childrenBegins late toddlerhood and extends through
preschool years)
Cooperative (Organized play of groups, usually
involves a leader
Onlooker (Child is a bystander, observes but
does not join in)

Play
Therapeutic
Guided by health care team to assist child in coping with
hospitalization)
Supervised play with medical equipment to be used with child
Enhances compliance with therapy and nursing care
Provides emotional outlet during stressful periods

Dramatic
An emotional outlet
Provides child with opportunity to act out stressful events
Used by psychologists as a means of communicating
traumatic events

A nurse is teaching a parent about parallel play in

children. Which of the following statements by
the nurse should be included in the teaching?
1.Children sit and observe others playing.
2.Children exhibit organized play when in a group.
3.The child plays alone.
4.The child plays independently when in a group.

A nurse is teaching a parent about parallel play in

children. Which of the following statements by
the nurse should be included in the teaching?
1.Children sit and observe others playing.
2.Children exhibit organized play when in a group.
3.The child plays alone.
4.The child plays independently when in a
group.

Pediatric Medications
Rights of medication administration:
Client
Medication
Dose
Time
Route
Documentation

Volume
Technique/approach
Documentation
Right to refuse
Right to know
potential side effects

ADMINISTRATION OF MEDICATIONS
Pediatric dosages are based on body weight,
BSA, and maturation of body organs
Neonates and infants have immature kidney
and liver function, alkaline gastric juices, and an
immature blood-barrier
Some med dosages are based on age
Children have gastric acid production and
slower gastric emptying
Pediatric clients are more sensitive to
medications

They have absorption of topical meds

They have lower blood pressure
They have higher body-water content
They have serum protein-binding sites (until
age 1)
Higher risk for medication errors
Limited sites for IV medications
Check for med food allergies, have appropriate
dose, evaluate childs cooperation and tissue
integrity

ORAL MEDICATIONS
Liquids, pills, tablets, and caplets.
Do not mix meds with formula
Preferred route, measured in milliliters
5 mL (1 tsp); 30 mL (1 oz)
Use plastic, needleless syringes, medicine cup
Crush tablets and dissolve
Do not crush enteric-coated or time-released
tablets
Divide tablets only if scored

Administration of Medications
If child has NGT, OGT, or GT give via this route
Flush tubes after med administration
Give suspensions/elixirs when available
Raise or lower tube to control rate of flow (gravity)

Rectal
Substitute for oral (child with nausea and vomiting)
Tylenol, sedatives, morphine, anti-emetics
Cut lengthwise

Optic, Otic, Nasal

Warm to room temperature.
To instill the solution in a child under 3 years
of age, pull the pinna of the ear down and
back.
In a child over 3, the pinna is pulled up and
back.
Have parent hold child
Hyperextend childs neck for nasal meds

Subcutaneous/Intradermal
May apply local anesthetic prior to injection
Use 3/8 to 5/8; 26-30 gauge needle
Change needed if used to puncture rubber
top of vial
Inject small volumes (up to 0.5 mL)
SQ 90 angle or 45 angle if minimal SQ
tissue
Intradermal 15 angle to form bleb

INTRAMUSCULAR INJECTIONS

The vastus lateralis for children < 2 years

After age 2 ventral gluteal site (2 ml)
Deltoid (1 ml)
Children have reported that injections are the
most stressful and painful experiences of
health care.
See chart ATI p. 103

Position for IM Injection

INTRAVENOUS MEDICATIONS
Children are at risk for fluid overload.
All children receiving IV fluids should receive
those fluids through a volumetric infusion pump.
Site assessment includes color of site, tension
of skin, and skin temperature.
Peripheral venous access
Central venous access

Pediatric Pain Management

Nurses are accountable for the assessment of
pain; considered the 5th vital sign
Pain is what ever the child says it is
Effectiveness of treatment should evaluated in
timely manner
Assessment more difficult in infants and younger
children
Temporary changes in vital signs associated with
anxiety and pain
Children receiving opiates need to be monitored
closely for respiratory depression

Assessment of Pain
Subjective data: quality, intensity, strength,
severity, timing, location, aggravating
factors, associated symptoms
Objective data: Facial expressions,
moaning, crying, decreased attention span
Temporary increase in BP, pulse, RR with
acute pain, then return to normal
See ATI pg. 114-115 for appropriate
routes for pain meds

Common Pain Scales

FLACC Postoperative Pain Tool 2 mo-7 yrs
(Faces, Legs, Activity, Cry, Consolability)

CHEOPS1 to 5 years
(Childrens Hospital of Eastern Ontario Pain Scale)

FACES3 years and older

VAS7 years and older
(Visual Analog Scale)

NIPS Neonates and infants

(Neonatal Infant Pain Scale)

See ATI chart pg. 111

Neonatal characteristic facial responses

to pain

NIPS

Flacc Behavioral Pain Assessment Scale

Non-pharmacologic Measures

Positioning
Breathing and relaxation techniques
Splinting
Calm environment (low noise, lighting)
Ice
Warm blankets
Guided imagery
Distraction (video games, cartoons, video)
Holding, rocking
Sucrose pacifiers for infants during procedures

Coping with Hospitalization

Infant: Stranger anxiety 6-18 mos.
May experience sleep deprivation
Toddler: Experience separation anxiety
Preschooler: May experience separation anxiety
Fears of bodily harm
Believe hosp/illness punishment
School-age: Fear of loss of control
May sense not being told the truth
May have stress related to separation from
peers and regular routine

Hospitalization and Illness

Hospitalization is stressful for both parent and
child
The family is also a client when the child is ill
Must deal with separation, loss of control, bodily
injury, and pain
Separation anxiety
Regression: protest (crying)
despair (withdrawn and quiet)
detachment (lack of protest)

Coping with Hospitalization

Adolescent:

Separation from peers

Social isolation
Feels loss of control
Understands cause and affect
Body image disturbance
Worries about outcome
May not be compliant

Help by:
Promoting feelings of self-determination
Allow choices when appropriate

Allowing the child to dress up as a

doctor or a nurse helps prepare the child
for the hospitalization experience.

The childs anxiety and fear often will be

reduced if the nurse explains what is going to
happen and demonstrates how the procedure
will be done by using a doll.

Age-Related Interventions
Interventions should be
based on the
developmental level of the
child
Teach family what to
expect
Encourage parents to stay
during hospital stay
See ATI p. 125

Death and Dying

The Dying Child

How Death is Perceived
Infants and toddlers have no clear concept of
death.
Preschoolers may view death as a kind of sleep.
School-age children begin developing the
concept of death as final.
Adolescents may have an adult-like concept of
death
ATI p.132 (chart)

The Dying Child

The nurse can:
Promote
socialization.
Provide avenues for
self-expression.
Deal directly with the
childs questions.
Allow death to occur
with dignity.
See ATI pg. 133-135

Family of the Dying Child

Family begins anticipatory
grieving.
Denial, anger, and
depression.
Parents have many fears.
Religious rituals, such as
baptism and blessing of an
ill infant, may provide great
comfort to the family.
Siblings (have fear, grief,
may show resentment

Parents of the Dying Child

Families need help to focus on the time that
remains with the child.
Nurse should use openness and honesty with
the child and family.

Nurses can provide families with a memento of

the child who dies by creating a plaster cast of
the childs hand, or a hand or foot print.

The Nurse of the Dying Child

Requires confidence, empathy, and
competence.
Must manage personal stress.
Must be comfortable with own mortality.
Experiences denial, anger, depression, guilt,
and ambivalence.

Any Questions or Comments?

Basic Concepts Review

1. What development stage is the sense of

industry?
1.
2.
3.
4.

Adolescent
Preschool
School-age
Toddler

1. What development stage is the sense of

industry?
1.
2.
3.
4.

Adolescent
Preschool
School-age
Toddler

2. By what age does the average baby triple

their birth weight?
1.
2.
3.
4.

9 months
12 months
15 months
18 months

2. By what age does the average baby triple

their birth weight?
1.
2.
3.
4.

9 months
12 months
15 months
18 months

3. The normal heart rate (bpm) for a newborn

is:
1. 90-120
2. 70-100
3. 80-120
4. 100-160

3. The normal heart rate (bpm) for a newborn

is:
1. 90-120
2. 70-100
3. 80-120
4. 100-160

4. The normal respiratory rate for a 1 to 6week old is:

1. 18-25
2. 38-68
3. 20-30
4. 30-60

4. The normal respiratory rate for a 1 to 6week old is:

1. 18-25
2. 38-68
3. 20-30
4. 30-60

5. Two kids are playing next to each other, but

aren't sharing their toys or playing together.
They are likely...
1. newborns
2. toddlers
3. preschoolers
4. school age children

5. Two kids are playing next to each other, but

aren't sharing their toys or playing together.
They are likely...
1. newborns
2. toddlers
3. preschoolers
4. school age children

6. An assessment of the skull of a normal 10month-old baby should identify which of the
following?
1. Closure of the posterior fontanel
2. Closure of the anterior fontanel
3. Overlap of cranial bones
4. Ossification of the sutures

6. An assessment of the skull of a normal 10month-old baby should identify which of the
following?
1. Closure of the posterior fontanel
2. Closure of the anterior fontanel
3. Overlap of cranial bones
4. Ossification of the sutures

7. The nurse has weighed a newborn in

preparation for the newborn's discharge. The
nurse informs the parents that the newborn
weighs 2.7 kg which is equivalent to
approximately
1. 6 lb
2. 7 lb
3. 8 lb
4. 9 lb

7. The nurse has weighed a newborn in

preparation for the newborn's discharge. The
nurse informs the parents that the newborn
weighs 2.7 kg which is equivalent to
approximately
1. 6 lb
2. 7 lb
3. 8 lb
4. 9 lb

8. The nurse is reinforcing teaching with the

parents of a newborn who requires apnea
monitoring. The nurse should reinforce that
when the alarm sounds on the apnea
monitor, the parent should first
1. silence the alarm
2. look at the newborn
3. gently tap the newborn's foot
4. grasp the bulb syringe

8. The nurse is reinforcing teaching with the

parents of a newborn who requires apnea
monitoring. The nurse should reinforce that
when the alarm sounds on the apnea
monitor, the parent should first
1. silence the alarm
2. look at the newborn
3. gently tap the newborn's foot
4. grasp the bulb syringe

9. The nurse in the newborn nursery has just

received report. Which of the following infants
should the nurse see first?
1. A two-day-old infant lying quietly alert with a
heart rate of 185.
2. A one-day-old infant crying and the anterior
fontanel is bulging.
3. A 12-hour old infant being held; the
respirations are 45 breaths per minute and
irregular.
4. A five-hour-old infant sleeping with the hands
and feet blue bilaterally.

9. The nurse in the newborn nursery has just

received report. Which of the following infants
should the nurse see first?
1. A two-day-old infant lying quietly alert
with a heart rate of 185.
2. A one-day-old infant crying and the anterior
fontanel is bulging.
3. A 12-hour old infant being held; the
respirations are 45 breaths per minute and
irregular.
4. A five-hour-old infant sleeping with the hands
and feet blue bilaterally.

10. What is the most appropriate nursing

intervention for a newborn experiencing
acrocyanosis?
1. Administer IV fluids.
2. Suction vigorously.
3. Place in the Trendelenburg position.
4. Assess temperature.

10. What is the most appropriate nursing

intervention for a newborn experiencing
acrocyanosis?
1. Administer IV fluids.
2. Suction vigorously.
3. Place in the Trendelenburg position.
4. Assess temperature.

11. Which is the preferred method of taking a

newborn's temperature?
1. Rectal
2. Tympanic
3. Axillary
4. Oral

11. Which is the preferred method of taking a

newborn's temperature?
1. Rectal
2. Tympanic
3. Axillary
4. Oral

12. The nurse notes that a 5-month-old has

significant head lag when she attempts to
pull the infant to a sitting position. Based on
this assessment, the nurse recognizes that
the infant:
1. Has some degree of mental retardation.
2. Needs further assessment and evaluation.
3. Has been neglected by the parents.
4. Is developing normally.

12. The nurse notes that a 5-month-old has

significant head lag when she attempts to
pull the infant to a sitting position. Based on
this assessment, the nurse recognizes that
the infant:
1. Has some degree of mental retardation.
2. Needs further assessment and evaluation.
3. Has been neglected by the parents.
4. Is developing normally.

13. Which nursing intervention is most

developmentally appropriate for a
hospitalized 10-year-old?
1. Encourage dependency on parents while the
child is hospitalized.
2. Obtain a complete health history from the child.
3. Encourage the child to play with safe medical
equipment.
4. Allow the child to assist with dressing changes.

13. Which nursing intervention is most

developmentally appropriate for a
hospitalized 10-year-old?
1. Encourage dependency on parents while the
child is hospitalized.
2. Obtain a complete health history from the child.
3. Encourage the child to play with safe medical
equipment.
4. Allow the child to assist with dressing
changes.

14. The nurse notes that a 6-month-old infant

who weighed 7 pounds at birth now weighs
15 pounds. What is the nurse's evaluation of
the infant's current weight?
1. The infant's weight is appropriate for his age.
2. The infant needs weekly follow-up to assess
weight.
3. The infant has been consuming more calories
than needed.
4. The infant should be hospitalized for failure to
thrive.

14. The nurse notes that a 6-month-old infant

who weighed 7 pounds at birth now weighs
15 pounds. What is the nurse's evaluation of
the infant's current weight?
1. The infant's weight is appropriate for his age.
2. The infant needs weekly follow-up to assess
weight.
3. The infant has been consuming more calories
than needed.
4. The infant should be hospitalized for failure to
thrive.

15. Which action by the parents of a 16-month-old

toddler indicates that they understand how to best

minimize separation anxiety during their childs
hospitalization?
1. The parents bring the childs favorite tot to the hospital
2. The parent explain all the procedures to the child
3. The parents remain with the child during the hospital
stay
4. The parents bring the siblings to visit the child

15. Which action by the parents of a 16-month-old

toddler indicates that they understand how to best

minimize separation anxiety during their childs
hospitalization?
1. The parents bring the childs favorite toy to the hospital
2. The parent explain all the procedures to the child
3. The parents remain with the child during the
hospital stay
4. The parents bring the siblings to visit the child

16. The nurse is assessing a 6-month-old infant

during a well-child visit. The nurse makes all of
the following observations. Which of the
following assessments made by the nurse is an
area of concern indicating a need for further
evaluation?
1.
2.
3.
4.

Absence of Moro reflex.

Closed posterior fontanel.
Two pound weight gain in 2 months.
Moderate head lag when pulled to sitting position.

16. The nurse is assessing a 6-month-old infant

during a well-child visit. The nurse makes all of
the following observations. Which of the following
assessments made by the nurse is an area of
concern indicating a need for further evaluation?
1.
2.
3.
4.

Absence of Moro reflex.

Closed posterior fontanel.
Two pound weight gain in 2 months.
Moderate head lag when pulled to sitting
position.

17. A nurse is assessing a 2-year-old boy with the

following vital signs: temperature 97.8 F
axillary, apical pulse 100, respirations 28 breaths
per minute, blood pressure 125/80. Which action
by the nurse would be most appropriate?
1. Reevaluate the childs temperature in 1 hour.
2. Report the blood pressure to the physician.
3. Assess for additional signs of respiratory distress in
the child.
4. Determine why the child has tachycardia.

17. A nurse is assessing a 2-year-old boy with the

following vital signs: temperature 97.8 F
axillary, apical pulse 100, respirations 28 breaths
per minute, blood pressure 125/80. Which action
by the nurse would be most appropriate?
1. Reevaluate the childs temperature in 1 hour.
2. Report the blood pressure to the physician.
3. Assess for additional signs of respiratory distress in
the child.
4. Determine why the child has tachycardia.

18. A nurse plans to offer an infant a pacifier

during the period he is NPO. The rationale for
this intervention is based on which theorist?
1. Piaget
2. Erikson
3. Freud
4. Kohlberg

18. A nurse plans to offer an infant a pacifier

during the period he is NPO. The rationale for
this intervention is based on which theorist?
1. Piaget
2. Erikson
3. Freud
4. Kohlberg

19. The new mother asks the nurse whether or not

she should pick up the baby when he cries.
According to Eriksons theory of psychosocial
development, the nurses most appropriate reply
should take into consideration his
developmental task, which is:
1. Trust vs. mistrust
2. Intimacy vs. isolation
3. Autonomy vs. doubt and shame
4. Identity vs. role and confusion

19. The new mother asks the nurse whether or not

she should pick up the baby when he cries.
According to Eriksons theory of psychosocial
development, the nurses most appropriate reply
should take into consideration his
developmental task, which is:
1. Trust vs. mistrust
2. Intimacy vs. isolation
3. Autonomy vs. doubt and shame
4. Identity vs. role and confusion

20. The neonatal or newborn period of life is

defined as the first:
1.
2.
3.
4.

24 hours
7 days
48 hours
28 days

20. The neonatal or newborn period of life is

defined as the first:
1.
2.
3.
4.

24 hours
7 days
48 hours
28 days

21. A nurse is assessing the psychosocial

development of a toddler. The nurse is aware
that this stage is characterized by which of the
following?
1.Imaginary playmates
2.Eriksons stage of initiative versus guilt
3.Demonstrations of sexual curiosity
4.Negative behaviors characterized by the need
for autonomy

21. A nurse is assessing the psychosocial

development of a toddler. The nurse is aware
that this stage is characterized by which of the
following?
1.Imaginary playmates
2.Eriksons stage of initiative versus guilt
3.Demonstrations of sexual curiosity
4.Negative behaviors characterized by the need
for autonomy

22. A nurse is collecting data from a 3 month

old. Which of the following findings should be
reported to the provider?
1.Unable to raise head when in prone position
2.Unable to sit without support
3.Unable to pick up an object with his fingers
4.Unable to bring an object to mouth

22. A nurse is collecting data from a 3 month

old. Which of the following findings should be
reported to the provider?
1.Unable to raise head when in prone position
2.Unable to sit without support
3.Unable to pick up an object with his fingers
4.Unable to bring an object to mouth

23. What should be the expected weight of an

infant at 12 months of age whose birth weight
was 3600 grams?
1.5600 grams.
2.7200 grams.
3.11 kilograms.
4.15 kilograms.

23. What should be the expected weight of an

infant at 12 months of age whose birth weight
was 3600 grams?
1.5600 grams.
2.7200 grams.
3.11 kilograms.
4.15 kilograms.

24. A nurse performs a head-to-toe assessment

on a newborn. Which finding should be of
greatest concern to the nurse?
1.Capillary refill time of 2 seconds.
2.Transient mottling of the skin.
3.Irregular respirations.
4.Negative Babinski reflex.

24. A nurse performs a head-to-toe assessment

on a newborn. Which finding should be of
greatest concern to the nurse?
1.Capillary refill time of 2 seconds.
2.Transient mottling of the skin.
3.Irregular respirations.
4.Negative Babinski reflex.

25. The nurse is performing a physical

assessment on a 6-month-old baby. Which
nding should the nurse understand as
abnormal for this child?
1.The childs posterior fontanel is open.
2.The childs anterior fontanel is open.
3.The child has the beginning signs of tooth
eruption.
4.The child is able to track and follow objects.

25. The nurse is performing a physical

assessment on a 6-month-old baby. Which
nding should the nurse understand as
abnormal for this child?
1.The childs posterior fontanel is open.
2.The childs anterior fontanel is open.
3.The child has the beginning signs of tooth
eruption.
4.The child is able to track and follow objects.

26. Which developmental milestones would the nurse

expect a 10- month- old infant to display during a
routine health maintenance visit? Select all that apply:
1.Holding his head erect
2.Self- feeding
3.Demonstrating good bowel and bladder control
4.Sitting on a firm surface without support
5.Bearing the majority of his weight on his legs
6.Walking alone

26. Which developmental milestones would the nurse

expect a 10- month- old infant to display during a
routine health maintenance visit? Select all that apply:
1.Holding his head erect
2.Self- feeding
3.Demonstrating good bowel and bladder control
4.Sitting on a firm surface without support
5.Bearing the majority of his weight on his legs
6.Walking alone