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ATI PEDS PROCTORED FINAL EXAM
LATEST REAL QUESTIONS AND
CORRECT ANSWERS GRADE A
A nurse is documenting findings from a physical examination. Which of the following statements indicates correct charting? - ANSWER..> Regular heart rate and rhythm: S1, S2 heard. This is clear, concise charting for heart sounds. When performing an otoscopy examination on a 2-year old child, the nurse should pull the pinna - ANSWER..> down and back This is the correct technique for straightening an ear canal of a 2 year old because it curves upward. A nurse is testing a child for strabismus. Which of the following is the correct technique fro performing this examination? - ANSWER..> perform the cover-uncover test This test identifies whether a child has strabismus or nonbinocular vision. When assessing a school age child for scoliosis, it is important to have the child? - ANSWER..> bend forward with the knees straight and the arms dangling. This position allows for any adequate visualization of any asymmetry.
A nurse is performing an annual physical examination on an adolescent. Which of the following should be included in the general survey? - ANSWER..> the patient makes good eye contact This information is included in the general survey. The survey includes identifying the patients demeanor, mood and interactions with others. Which of the following communication techniques is most appropriate fro a nurse to employ during the physical examination of a 10 year old?
- ANSWER..> Use books and other visual aids to advance the interview A nurse is examining an 18-month-old child ears during a well child visit. Which of the following techniques should the nurse use? - ANSWER..> have the parent hold the child securely in their lap. The parents lap is the most secure and safe position for a child. A nurse is obtaining a problem-oriented history from a preschool-aged child. The nurse should consider that children form this age group typically can? - ANSWER..> describe the symptoms Preschoolers are usually able to describe symptoms to their problems. Which of the following techniques is appropriate when obtaining a blood pressure on a child? - ANSWER..> Use a cuff with bladder covering 80 to 100% of the arm circumference A nurse is performing an abortion examination on a preschooler. Which of the following instructions should the nurse give to the child when performing abdominal palpitation - ANSWER..> Place your hand under mine
if they put it into a large volume they may not be able to take it all in sometimes for babies we put it into a nipple and its not attached to anything and let them suck it through the nipple ***IM, IV meds- make sure the IV is patent and choose your sight wisely for IM medications *** Choose your tools wisely- right size needle and right size syringe we use rectal meds with kids sometime bc it does absorb well/ quickly and we do not have to do an IM injection if you have a child who does not take meds at all and they just spit everything out Hospitalization causes many issues - Stress is the Big one. This can be positive and negative, please explain. What is the child most afraid of - 3 things? - ANSWER..> Painful procedure losing control what will happen to them object permanence = 9 months mile stone
web X *stress from everyone happens after we come from the hospital bc we dont know all of the things thats going to happen or take place
- for a child it is very different bc they dont understand as much and they do not know how to manage themselves when it comes to pain *most things they're afraid of is
- loss of control/independence
- bodily harm
- pain: when we take something away they do not realize why were need to take it away, OR CUT INTO THEIR BODY we can help with the anxiety and fear by---fear increases itself in pain perception. We can decrease that pain perception by taking some of that away have times explaining what they understand have their parents with them How do we communicate with children - ANSWER..> clearly slowing, make sure the child is interactive, get on their level, show examples web X
- explain, in-turn they will understand
makes noise when walking in if its a visual interpreter if a language issue face them when we speak to them to get attention
- start convo with kids, talk to parents too, but mostly with the kids cognitive issues - ANSWER..> speak to child at the level they understand
- might be 21, but understands at the level of a 14 yr What will ease their stress - remember each stage has a different fear as well as the 3 basic fears (example - Infants from 6 mos. through toddler hood - fear of separation) - ANSWER..> Let parents stay expalin something to them toy blanket choices web X Infants from 6 mos
- doesn't care who is taking care of them, just wants needs to be met
(physical, emotional)
- recognize who ind. is and starts to become attached to that ind. that has been providing basic care
- we need to respect separation anxiety
- separation anxiety 6-18 mts *temperament issues, difficult child, slow to warm child separation anxiety is 24 mts or longer *cognitive impairment and disability s.a goes on longer bc parents are a little more protective and keeps children close.
- allow parent to participate in much of the care as they choose too, or are able to do
- parents may sit back and expect the nurse to do most of it bc you're the nurse AS A CONSUMER GOING INTO A HOSPITAL SETTING PPL JUDGE
- parents assume hcp is judging bc their child is ill and they didnt provide good care for the child
- parents tend to hang back, so we need to invite them and empower them to let them know we want them to participate
- we want parents to tell us whats going on with the child
goes with chronological order solitary play (infants) parallel play (toddlers) onlooker play- if it is consistent it becomes a red flag bc it becomes a social problem:
- autism
- physical disability the child doesnt want ppl to know about - shy
- cant hear
- parents telling them they're not good enough leading to dev. delays/level associative cooperative (school age & adolescents) more organized and competitive organized *pts who are active are healthy *pts who are inactive are sick maybe a temp inactivity, but we need to recognize this as well if a toddler is taking into a playroom and sits there and stares, is it bc there are afraid, or unfamiliar with the area, or indeed they do not want to participate
we communicate with play
- we have them draw pictures
- color
- paint a picture
- build something for us
- read to us choosing what type of play lets us know where they are at intellectually & dev. PLAY SHOULD BE APART OF CARE PLANNING Benefits of play - ANSWER..> TEMPERMENT does not change intellectual development, learn, consequence toddlers are onlooker ego centric babys = solotary toddler parrel play preschool - associate
- some are going to be hesitant all there life, sit back and watch others and are hesitant that they just dont jump right in- these are the SLOW TO WARM
- easy going people who go with the flow (these kids do well in a hospital setting* difficult Temperament do not do as well bc these kids dont like change and they dont like having to re-learn things, so they tend to struggle more with the stress level children with rural setting have more difficulty children with a disability do better in a hospital setting bc they are comfy with having that type of environment Nutrition is the single most important factor in the growth and development of children - so we know that nutrition is a concept that is seen throughout - and should be focused on. Toddlers particularly are picky eaters - so they may incur physiological anorexia and physiological anemia due to the milk ingestion. Are food fads that different children encounter harmful? No, and are usually self- limiting. Adolescents have many different needs for greater caloric intake and more concentrated iron, folic acid, (Bvit) and protein. You will need to understand those differences as well as discuss eating disorders. - ANSWER..> Breast milk or formula until 1year of age.. no other milk!!! solid foods start around 6months.. rice cereal, iron fortified,
choking with toddlers is a real concerns.. they are also picky eater. which is not a problem unless losing weight. web-x infancy & adolescents is the greatest rate of growth (physiologically & cognitively) in between those we slow growing until adolescents infant nutritional needs
- require breast milk and if they do not get breast milk then they get formula
- they do not get any type of cows milk or table food to atleast 6mts- 1 yr (cows milk not until 1 yr)
- feeding is frequent with low volume bc there so little, but as they grow they can handle more volume with less frequency
- 6mts we start with solid foods like rice (less allogenic), vegetables, fruits--- add vegetable b4 the fruit--add less sweet 1st
- add meat last bc it is hardest to digest
caloric intake like an adult 1800 cal bc so active 6 meals a day bf snack, lunch snack, dinner snack adolescents higher protein iron (men for muscle mass) (women menstrual cycle) anemia
- fatigue
- headaches
- infections Restraints - are used for procedures to keep children safe. Be knowledgeable of the different types of restraints that may be used and why and the nursing interventions to keep them safe. - ANSWER..> web x
- procedures only we have physical restraints and chemical restraints. We do not dictate who gets the chemical restraint physical restrains if needed (nurse)
- stitches chemical restrains if needed
- after cardiac cath, we need chemical
- sedation from over using/ over exerting themselves if a child has cerebral palsy or muscular dystrophy and he is in a wheelchair we have to restrain them in the chair bc he is not slipping and falling and thats when we want to be checking on the restraints Consents - for invasive procedures - for children who is responsible to sign consents and what is important to know about them. - ANSWER..> stay with the pt and check q so often dont need consent for circumcision (papoose board) no consent for an elbo arm for someone with an iv
legal guardian or parent someone over the age of 18 emancipated adult someone who is pregnant court order now they are able to speak for themselves have to understand the language 2 nurses to document that they made every legal attempt to contact the legal guardian or parent in case of emergency
means to keep children safe
- limit activity
- limit what they use for safety purposes
- limit where they can go
- use restraints in a motor vehicle in case they get into an accident discipline is about education and helping kids make the proper decision and knowing they're consequences if they did not make the right decision and if they were willing to accept those consequences time-out can be used in hospital setting "redirect" have to have rules in a play room or ppl are going to get hurt disciplinary tactics that are demeaning
- spanking striking yelling
- name calling
- wishing they were never born Pain is a frequent assessment done on all patients - what about pain assessments in children? What is different, and what are the myths and fallacies re: pain management in children - ANSWER..> web x
- pain is expressed differently in different ppl
- parents can tell us if this is a real pain a child is feeling or if this is a behavioral issue
- are they withdrawn bc they're angry or upset, or scared, or are they in pain
children experience pain
- ask child about pain
- assess it by
- flacc (toddlers)
- faces (3 and up)
- crying scale (infants)
- numerical scale (10-12) all nurses have to use the same scale!!!!!!! if you start with that scale, it has to be used throughout pt care What drug is most frequently used for severe or postoperative pain in children. - ANSWER..> morphine. titrate web x pain in children
- morphine is the opiod of choice
- nsaids
