N165- W2 Pediatric Sherpath

The nurse is evaluating a pediatric patient whose caregiver states “She keeps having panic attacks!” The nurse should evaluate the patient for signs and symptoms of which conditions that can be mistaken for a panic attack?

Select all that apply.

• Hyperthyroidism

• Mitral valve prolapse

• Consumption of multiple high-energy drinks

Which are classified as biologic factors contributing to mental health disorders in children?

Select all that apply.

• Familial predisposition

• Increased level of stress hormones

An adolescent is diagnosed with depression. Which statements or questions should the nurse include during the personal history assessment to identify the potential cause of the condition?

Select all that apply.

• “Tell me about your family at home.”

• “How often do you use drugs or alcohol?”

• “Do you have a history of long-term illnesses?”

• “Have you had any recent losses, such as a friend or loved one?”

The nurse suspects that the child has an anxiety disorder when the child reports which experiences?

Select all that apply.

• “I always shake and sweat when an assignment is due to the teacher.”

• “I get tight neck and shoulder muscles and have a lot of headaches.”

• “I have a hard time catching my breath when I’m with a group of people.”

Which statement might make the nurse suspect that a 7-year-old child has separation anxiety disorder?

“When I play at my friend’s house, I usually call to talk to my dad a few times.”

The nurse is caring for a child who developed post-traumatic stress disorder (PTSD) after witnessing a traumatic event. The nurse understands that the child is experiencing a cluster of arousal symptoms based on which observation?

A child’s teacher states that the child is unusually jumpy when classmates walk past his or her desk.

The nurse has been caring for a young adolescent girl after the divorce of her parents earlier this year. The teen reports increased sleepiness and decreased appetite and appears withdrawn. The nurse should prioritize which assessment for this patient?

Potential for self-harm or suicide

A 17-year-old patient is being discharged from the community mental health center after being assessed and treated for an adjustment disorder. The nurse develops a discharge teaching plan for the patient and parents and identifies which as a priority?

The parents should monitor for signs of social withdrawal in the patient.

A nurse is teaching the parents of an adolescent with bipolar disorder about the different phases of the disease. Which symptoms, as described by the parents, best indicate that the patient may be experiencing mania?

Select all that apply.

• Yelling at teachers or friends

• Feeling energetic with very little sleep

• Talking too quickly for others to understand

The nurse is assessing a 10-year-old child with an internalizing disorder. Which assessment finding is of the greatest concern to the nurse?

The child’s mother has a history of bipolar disorder.

A nurse is caring for an adolescent with a new diagnosis of depression. The patient has been identified to be at risk for self-harm. When evaluating the effectiveness of patient teaching, which is the most important outcome?

The adolescent confides in the school counselor about thoughts of self-harm.

The nurse is admitting a teen with a mood disorder to the inpatient unit. The nurse knows that which action is least appropriate?

Provide privacy by placing the patient in a private room away from the nursing station.

A child arrives in the emergency department several days after experiencing a sports-related concussion. The child is experiencing feelings of sadness and a mild lapse in memory. Which phrase describes the relationship of the injury to the child’s symptoms?

Secondary development of an internalizing disorder

The nurse would most likely expect which finding in a 12-year-old patient with an internalizing disorder?

The patient reports physical pain in the absence of a physical condition.

A 5-year old child is diagnosed with an internalizing disorder after sustaining a traumatic head injury (THI). The nurse understands that which factors play a role in the development of internalizing disorders?

Select all that apply.

• Age of the child

• How the injury was treated

• Location of the brain injury

A 10-year old girl tells the nurse that she is nervous at school. During the initial nursing assessment, what questions should the nurse ask the child to assess for possible generalized social anxiety disorder?

“Do you experience nervousness in any other situations?”

Which findings should the nurse expect to observe during the admission assessment of a child with a history of separation anxiety disorder?

Select all that apply.

• Fear of being harmed

• Fear of harm being done to family members or loved ones

The nurse is caring for a group of adolescents in the mental health unit and needs to complete initial morning assessments. Which patient can the nurse assess last?

A 7-year-old boy with severe separation anxiety disorder whose parents are at the bedside.

A nurse is caring for several adolescent patients in the mental health unit. Which patient should the nurse evaluate first?

A patient with severe major depressive disorder

The nurse is assessing a 13-year-old patient brought into the primary care clinic by the parent. The parent states, “I’m certain my child is bipolar; every day, a different mood!” Which is the best response by the nurse?

“It’s normal for children this age to have mood swings, and they may not be caused by bipolar disorder.”

The nurse is caring for a patient with dysthymic disorder who has been admitted to the day observation unit. When formulating the patient’s care plan, which nursing action would be most effective in monitoring the patient’s mood?

Record the activity level of the patient

A 17-year-old is diagnosed with an internalizing disorder and is having difficulty coping with the diagnosis. Which nursing intervention is the priority for this patient?

Contact the health care provider to obtain a referral for cognitive-behavioral therapy (CBT).

The nurse is creating a plan of care for a patent who has been diagnosed with an internalizing disorder. Which instruction for the patient is most important for the nurse to include?

Identify trusted adults with whom you can talk.

The community mental health nurse is caring for a teenaged patient with internalizing disorder. The nurse notes that the patient demonstrates socially isolating behaviors. Which is the best action by the nurse?

Encourage the patient to express any feelings.

The nurse is reviewing the immunization record for a healthy six-month-old patient at a well visit. The record indicates that the patient received all the recommended vaccines up to this point, including two doses each of RV1, PCV13, and DTaP. Which vaccine(s) should the nurse prepare for this visit?

Select all that apply.

• Hepatitis B (Hep B)

• Inactivated poliovirus (IPV)

• Pneumococcal conjugate (PCV13)

• Diphtheria, tetanus, & acellular pertussis (DTaP)

The parents of an infant ask for information about the vaccines their child is scheduled to receive at the upcoming four-month well visit. The nurse provides patient education handouts about which vaccine(s) typically administered at four months of age?

Select all that apply.

• Rotavirus (RV1)

• Inactivated poliovirus (IPV)

• Pneumococcal conjugate (PCV13)

• Haemophilus influenzae type b (Hib)

An infant is at the clinic for a Nine-month well visit. The nurse reviews the chart and notes the infant did not receive the third DTaP vaccine at the six month visit. Which action by the nurse is most appropriate?

Give third dose

A healthy child is brought to the clinic for a 15-month well visit. The nurse notes that the toddler received haemophilus influenzae type b (Hib) #4; measles, mumps, rubella (MMR)#1; and pneumococcal conjugate (PCV13)#4 at the one-year visit. Which vaccination(s) will the nurse prepare for this visit?

Select all that apply.

• Varicella (VAR)

• Diphtheria, tetanus, & acellular pertussis (DTaP)

Which vaccines would the nurse administer, after receiving parental consent, for an 11-year old patient who has received all recommended vaccines up until the age of 6?

Select all that apply.

• Administer HPV vaccine

• Administer the Tdap vaccine

• Administer the meningococcal B vaccine

The school nurse is auditing the students’ immunization records. The nurse reviews the record of a six-year-old who has received four doses of DTaP, three doses of IPV, two doses of MMR, and two doses of varicella since age four. The nurse makes a note to follow up with the student’s parents about which vaccine(s)?

Select all that apply.

• Influenza (LAIV)

• Inactivated poliovirus (IPV)

• Diphtheria, tetanus, & acellular pertussis (DTaP)

A 12-month-old infant is brought to the clinic for a well visit. The parents ask if their infant can receive the diphtheria, tetanus, & acellular pertussis (DTaP) vaccine today. The nurse reviews the chart and notes that the infant’s DTaP #3 was administered at age eight months. Which is the best response by the nurse?

“The last DTaP was very recent. We will schedule the next dose in two more months.”

The nurse administers a dose of the human papillomavirus (HPV) vaccine to an 11-year-old patient in the clinic. The nurse should provide which instruction to the patient’s parents?

“Your child needs the second dose in one to two months.”

A 17-year-old patient has recently been diagnosed with Hodgkin disease (a type of lymphoma or blood cancer). The nurse reviews the immunization record and notes that the patient is up to date on all regularly scheduled vaccines. The nurse prepares to administer which additional vaccine for this high-risk patient?

Pneumococcal conjugate (PPSV23)

An 18-year-old patient with human immunodeficiency virus (HIV) presents to the clinic for a second meningococcal vaccine. The nurse notes that the patient received the first Menactra vaccine nine weeks ago. Which is most appropriate nursing action?

Administer the meningococcal vaccine immediately.

The nurse should advise parents about which mild reaction that may occur one to two weeks after receiving the live, attenuated influenza vaccine [LAIV)?

Fever

The nurse is reviewing the patient education handout with the parent of a patient. The parent asks, “Can you tell me if any of these risks are really serious?” Which does the nurse identify as an example of a rare, but serious, reaction a patient may experience following vaccination?

Seizure

A four-month-old infant is in the clinic to receive vaccinations. The infant experienced redness and swelling at the injection site following the first dose of diphtheria, tetanus, & acellular pertussis (DTaP). The infant’s parent asks whether the infant should receive the second dose. How should the nurse respond?

Explain that this was a mild reaction and is not a contraindication for the next dose.

In which ways can healthcare reform improve immunization rates?

Select all that apply.

• Provide free or low-cost vaccinations

• Increase the number of clinics providing vaccinations

• Increase the availability of vaccines without need for health care provider referral

Which vaccinations are appropriate to administer at a one-month well visit?

Hep B #1

An unimmunized five-month-old infant is brought to the clinic. The parents decide to vaccinate the infant. Based on the catch up schedule, what vaccines will the infant need to receive today?

Select all that apply.

• Inactivated poliovirus (IPV)

• Pneumococcal conjugate (PCV13)

• Haemophilus influenzae type b (Hib)

• Diphtheria, tetanus, & acellular pertussis (DTaP)

The nurse is reviewing the immunization record of a 10-week-old infant in the clinic for a well visit. The infant received the second dose of Hepatitis B (Hep B) and the first dose of rotavirus (RV1) at eight weeks of age. Which vaccines should the nurse prepare to administer at this visit?

Select all that apply.

• Inactivated poliovirus (IPV)

• Pneumococcal conjugate (PCV13)

• Haemophilus influenzae type b (Hib)

• Diphtheria, tetanus, & acellular pertussis (DTaP)

An 11-year-old patient is in the clinic for a well visit. The nurse notes that the patient has previously received three doses of Hep B, two doses of Hep A, four doses of Hib, four doses of PCV, four doses of IPV, two doses of MMR, and one dose of VAR. Which vaccines will the nurse plan to administer today?

Select all that apply.

• Varicella (VAR)

• Human papillomavirus (HPV)

• Meningococcal conjugate vaccine

• Tetanus and diphtheria toxoids and acellular pertussis (Tdap)

A two-year-old child is in the clinic for a well visit. The nurse notes that the patient’s vaccinations are up to date. Which additional vaccination would the nurse suggest to the provider after noting a recent diagnosis of type one diabetes mellitus?

Pneumococcal polysaccharide (PPSV23)

A 12-year-old with Hodgkin disease (a type of lymphoma or blood cancer) visits the clinic for a well child visit. The nurse reviews the immunization record and sees that the patient is up to date on all regularly scheduled vaccinations and also received 1 dose of PPSV23 at age 7. The patient later received 1 dose of meningococcal vaccine, 1 dose of Tdap, and 3 doses of HPV vaccine at age 11, and the annual influenza vaccine each year. Which vaccination does the nurse suggest that the patient receive at this visit?

PPSV23 vaccine

A 15-year-old patient is in the clinic for a well visit. The nurse notes that the patient received the first Hep B vaccination with Recombivax HB over eight months ago and the second dose four months ago. Which action is most appropriate?

No action is necessary because Recombivax HB is a dose-dose series.

A nine-year-old patient comes to the clinic before a trip to China. The nurse reviews the record and notes that the patient has received the following vaccine doses: 3 Hep B, 2 RV1, 5 DTaP, 4 HIB, 4 PCV13, 2 MMR, and 2 Varicella. Which vaccination(s) will the nurse recommend?

Hep A

A 12-year-old patient was recently diagnosed with sickle cell disease. The nurse notes that the patient is up to date with regular vaccines including completion of the four-dose series of PCV13 by age 15 months. The patient received one dose of PPSV23 and one dose of meningococcal vaccine nine weeks ago. Which vaccine does the nurse expect to administer today?

Administer a dose of meningococcal vaccine.

The nurse is teaching the parents of an infant about adverse vaccine reactions. The nurse explains that which of these is considered a medical emergency?

Seizure

The nurse teaches the parents of an infant about which sign of a mild reaction that may occur after vaccination?

Loss of appetite

The nurse is caring for a four-year-old patient receiving chemotherapy for non-Hodgkin’s lymphoma. The patient is up to date on regularly scheduled vaccines. Which additional vaccine dose does the nurse recommend for this patient?

Hib

A nurse is studying rates of immunization among immigrant families in a large city. The nurse plans to gather data on how improved communication affects the rate of immunization in this population. Which are examples of communication that the nurse would expect to improve immunization rates?

Select all that apply.

• Documentation of vaccinations administered

• Use of interpreters for teaching patients and families with a language barrier

• Providing vaccine information sheets prior to obtaining consent to vaccinate

A nurse is planning to teach a class on overcoming barriers to immunization through patient and family education. Which examples of this should the nurse include?

Select all that apply.

• Educate parents about the safety of vaccinations.

• Educate parents about the difference between mild and serious vaccine reactions.

• Educate parents about the individual and societal importance of vaccination.

The parents of a young child explain that they do not want the child vaccinated because they are afraid the child will suffer permanent injury as a result of adverse immunization effects. In which way(s) should the nurse address the concerns of these parents?

Select all that apply.

• Provide a printed vaccine information sheet describing the safety of vaccination.

• Verbally educate the parents about the common, mild adverse effects of vaccination.

Which vitamin deficiency can lead to the disease associated with bowed legs and caused by a softening of the growth plates?

Vitamin D

What is the recommended dosage of elemental iron to treat iron deficiency anemia?

3 to 6 mg/kg/day

Which statement is appropriate when considering whether failure to thrive (FTT) is acute or chronic?

Chronic FTT will have both weight and height/length below accepted standards.

Which failure to thrive (FTT) cause is appropriate for a 6-month-old with a history of hypoplastic left heart syndrome?

Increased metabolism of calories

Which treatments can be used to address diaper dermatitis during infancy?

Select all that apply.

• Change diaper frequently

• Leave skin exposed and open to air

• Use of skin protectants such as zinc oxide or petroleum

• Use of absorbent material to wick away moisture

Which strategies can be helpful in the prevention of sleep issues during infancy?

Select all that apply.

• Establishing a bedtime routine

• Putting the infant to bed drowsy

Colic is defined by crying for more than ____ hours, more than ____ times per week, and for more than ____ weeks.

3,3,3

Which symptoms are associated with food allergies?

Select all that apply.

• Vomiting

• Wheezing

• Growth failure

• Abdominal pain

• Rash

Match the common cause of failure to thrive with the age at which it is most likely to be seen.

• Neonate

  Failed breastfeeding

• Early Infancy

  Maternal depression

• Late Infancy

  Delayed introduction of nutritional foods

• After Infancy

  lack of appropriate nutritional diet

The American Academy of Pediatrics recommends ______ international units (IUs) of vitamin D per day as a supplement for infants who are breastfeeding as the sole source of their nutrition

400

Which nutritional concerns may be observed in the 11-month-old infant who is exclusively breastfed with no other food intake?

Select all that apply.

• Acute failure to thrive (FTT)

• Iron deficiency anemia

• Vitamin D deficiency

What are known protective measures against Sudden Infant Death Syndrome (SIDS) during Infancy?

Select all that apply.

• Supine position to sleep

• Use of a pacifier

• Breastfeeding

Which statement by the mother indicates understanding of an apparent life-threatening event (ALTE)?

“My baby experienced an apparent life-threatening event, but he did not experience a SIDS event that was stopped.”

Which statement(s) regarding infant colic should be included in nursing education material given new mothers?

Select all that apply.

• “Infant colic usually resolves around 12 to 16 weeks of age.”

• “There is usually no underlying cause of infant colic.”

• “Oral administration of probiotic may be helpful in treating infant colic.”

What other health issues are often seen in infants diagnosed with atopic dermatitis?

Select all that apply.

• Asthma

• Allergic rhinitis

A toddler who was 33 inches in height on his or her second birthday would be expected to measure approximately ____ inches in height on his or her third birthday.

36

A toddler who weighs 22 lbs at 1 year of age would be expected to weigh approximately ____ lbs by the third birthday.

32

Which characteristics are typical of the toddler’s physical appearance?

Select all that apply.

• Leaner

• Flattened plantar arch

• Inward curve of the spine

Identify the gross motor capability of the toddler.

Select all that apply.

• Ascending the stairs

• Throwing a ball overhand

Identify fine motor capabilities for the toddler.

Select all that apply.

• Drawing a circle

• Stacking blocks or toys

• Drinking from a sippy cup

What anticipatory guidance can the nurse give parents of a toddler to support the toddler’s need for increasing autonomy?

Allow the toddler to practice feeding with a spoon.

Which cognitive advancements are expected between 19 and 24 months?

Domestic mimicry

Which behaviors are expected in the toddler?

Select all that apply.

• Throwing tantrums

• Crying when the toddler’s parent leaves for work

• Developing a sense that bad behavior is punished

• Insisting on same book being read every morning

Which toy is appropriate to encourage cognitive development in the toddler?

Stacking cups

Which physical changes are normally seen as an infant transitions into a toddler?

Select all that apply.

• Protruding abdomen

• Excessive curve of the back

• Wide gap between knees when standing erect

Which head circumference measurement would be expected for a two-year-old whose head circumference was 18 inches at the 12-month checkup?

19.5 inches

Which would be the expected adult height for a toddler who is 34 inches tall at the 30-month checkup? 

68 inches

Match the activity with the age at which it is first exhibited.

• 15 months

  • walking independently

• 18 months

  • turning pages as they are read to

• 24 months

  • dressing themselves

• 36 months

  • stacking multiple blocks to build towers

How does the ability for a 24-month-old to build a two-block tower demonstrate a toddler’s fine motor development?

The ability to stack one block on top of another demonstrates an improvement in a toddler’s hand-eye coordination.

What important parental guidance advisory needs should caregivers be reminded of when discussing motor development in the toddler?

Motor development in this age group is far ahead of development of judgment and perception.

When caring for a toddler in the hospital, which nursing intervention is most developmentally appropriate?

Scheduling evening medications to follow the toddler’s bedtime routine.

Which one of the following developmental characteristics explains why a toddler frequently uses the words me, I, and mine?

egocentrism

Which report by a parent would indicate normal social development of the 2-year-old patient?

"He will play next to another child and watch the child, but won't interact with the child."

A 3-year-old is using both the left and right hand interchangeably when writing and eating. The dominant hand should prevail by ___ years of age.

4

A preschooler who was 37 inches/94 cm tall on his or her third birthday would be expected to measure ____ inches/cm on his or her fifth birthday.

43 inches/109 cm

A preschooler who weighed 33 lbs (15 kg) on his or her fourth birthday would be expected to weigh ____ lbs/kg on his or her fifth birthday.

38 pounds/17.23 kg

Which social/personal skills are milestones for the preschool child?

Select all that apply.

• Caring for a doll

• Dressing oneself

• Personal hygiene

Which behavior observed by the nurse represents normal social development of the preschool child?

Select all that apply.

• The child steals a toy from another child.

• The child is playing a game with another child.

• The child is arguing about the rules of the game.

• The child blames a mess on an imaginary friend.

Which cognitive skills are milestones for the preschool child?

Select all that apply.

• Knowing what tired and hungry mean

• Knowing what a fork and blanket are used for

Which action by the nurse when caring for the preschool child is appropriate, given preschoolers’ level of independence?

Allowing the child to put on the exam gown by him- or herself

A parent reports concern that her preschool child is not as coordinated at sports as other children. Which statement by the nurse is most appropriate to address this concern?

“Children develop differently and practicing will help.”

Which motor skills should be developed in the preschool child?

Select all that apply.

• Playing hopscotch

• Drawing a picture of his or her home and pets

• Balancing on each foot for one second

Which action by the nurse would be most appropriate when preparing the preschool child for a medical procedure?

Allow the child to practice the procedure on a stuffed bear

A parent reports concern that his or her preschool child has difficulty following directions. The nurse should recommend which actions by the parent to help the child with this task?

Giving the child specific direction

Which activity for play therapy would be most appropriate for the nurse to suggest for the hospitalized preschool child?

Coloring with colored pencils

Which health problems are linked to childhood obesity?

Select all that apply.

• Sleep apnea

• Hyperlipidemia

• Depression

While offering education to an overweight child, the nurse should recommend ___ minutes of increased physical activity per day.

Use numbers only.

60