Question 1

If a 2-year-old child received a caution on the Denver II,this would indicate that the child

Accepted Answer

A caution is failure of the child to perform a task that has been achieved by 75% to 90% of children the same age.

Question 2

General guidelines for conducting a pediatric physical examination include which of the following?

Accepted Answer

To help reduce anxiety and uncooperativeness,especially when examining young children,have a familiar caregiver present during the examination.To promote the child's feeling of security,allow the infant who cannot sit up and the younger child to sit on the caregivers lap for as much of the examination as possible.Interview the older school-age child or adolescent separately,without the caregiver.Talking to the individual without the caregiver present may yield important information not gained during a group interview (e.g.,that the patient is using drugs).Until the infant or toddler is comfortable,maintain eye contact with the caregiver while the examination is taking place.If the child is sleeping,take advantage of the situation by performing simple procedures (length,head circumference)and system examination that require a quiet room (such as the cardiac or respiratory examinations)first.

Question 3

In an assessment of home safety using the acronym GUNS,what question should you ask related to the letter U?

Accepted Answer

In the acronym GUNS,G = Are there guns in your home?
 U = Are there users of alcohol or other drugs in the home?
 N = Do you feel a need to protect yourself?
 S = Do any of the situations apply to you? 
These questions should be asked to assess for gun safety in the home.

Question 4

Normal average head growth during the first year is

Accepted Answer

Normal average head growth is 1 to 1.5 cm per month during the first year.Head growth is measured anteriorly from above the eyebrows and around posteriorly to the occipital protuberance.

Question 5

Compared with an adult's,the eustachian tube of a child is

Accepted Answer

Because the eustachian tube of a child is more horizontal,shorter,and wider than an adult's,there is an increased risk of middle-ear infection caused by migration of pathogens from the nasopharynx.

Question 6

In males,the appearance of facial hair during puberty typically occurs

Accepted Answer

Facial hair follows approximately 6 months after the emergence of axillary hair during male puberty.Testicular enlargement is usually the first area of sexual development to occur.Within about 1 year,the pubic hair becomes dark,coarse,and curly but is not fully developed.Axillary hair follows 6 months later.

Question 7

Children in which age group typically gain 3 to 6 pounds and grow 1 to 2 inches (2.5-5 cm)per year?

Accepted Answer

The school-age child (6-12 years)grows 1 to 2 inches per year and gains 3 to 6 pounds annually.Toddlers (12-24 months)grow 3 inches per year and gain 4 to 6 pounds per year.Preschoolers (2-6 years)gain an average of 5 pounds per year.Height increases between 2.5 to 3 inches per year.Adolescence is the period from 13-18 years of age.

Question 8

The nurse is teaching a new mother about prevention of sudden infant death syndrome (SIDS).Which of the following recommendations about sleeping should be included?

Accepted Answer

The American Academy of Pediatrics recommends that infants be placed on their back (supine)while sleeping because of the association between the prone position and SIDS.Soft bedding,pillows,and stuffed animals should be avoided because these items are risk factors for SIDS.The incidence of SIDS increases when infants are placed in bed with adults to sleep.

Question 9

During the first year of life,neurons become myelinated following a certain sequence ending with which part of the body?

Accepted Answer

In the first year,the neurons become myelinated,and primitive motor reflexes are replaced by purposeful movement.The myelinization occurs in a cephalocaudal and proximodistal manner (head and neck,trunk,and extremities).

Question 10

A measuring board is typically used to determine the recumbent length of a child who is under the age of

Accepted Answer

Recumbent length is measured for children less than 2 years old.A measuring board is used.Position the measuring board flat on the exam table.Place the child's head at the top of the board and the child's heels at the foot of the board,making sure the legs are fully extended.Measure and record the length.If measuring a recumbent length,always plot on the birth-to-36 month chart.

Question 11

Apgar scores are taken at 1 minute after birth and again at

Accepted Answer

The Apgar scoring system provides a quick method of assessing the need for newborn resuscitation in the delivery room.An Apgar score is given to a newborn at 1 and 5 minutes after birth.The procedure is as follows: 1)Auscultate the heart rate for 1 full minute; 
2)Measure the degree of respiratory effort; 
3)Evaluate muscle tone by attempting to straighten each extremity individually; 
4)Evaluate the newborn's reflex irritability.Use a flicking motion of two fingers against the newborn's sole to rate irritability; 
5)Inspect the newborn's color.A score of 8 to 10 demonstrates that the newborn is in good condition.

Question 12

Which of the following typically occurs between 5 and 7 months of age?

Accepted Answer

Eruption of the first lower central incisors typically occurs between 5 and 7 months of age.The posterior fontanel closes by 3 months of age.The frontal sinuses develop at 7 years of age.Salivation and production of tears occurs at around 3 months.

Question 13

An infant weighing 6 pounds at birth should weigh at least

Accepted Answer

Infants should double their birth weight at 6 months and triple their birth weight by 1 year.So,an infant weighing 6 pounds at birth should weigh at least 12 pounds at 6 months of age; however,it is not uncommon for birth weight to double at 4 months.

Question 14

A 2-year-old child received no delays and one caution on the Denver II.The nurse would record these results as which of the following?

Accepted Answer

No delays and a maximum of one caution on the Denver II indicate a normal test.A delay is a failure of any item to the left of the age line.A caution is failure of the child to perform an item that has been achieved by 75% to 90% of children the same age.A suspect test is one with one or more delays or two or more cautions.In these instances,retest the child in 1 to 2 weeks.Current illness,lack of sleep,fear and anxiety,deafness,or blindness can affect a child's performance.If these or another logical rationale can explain a child's failure to successfully complete a series of Denver II items during a session,readminister the test in 1 month,providing resolution of the preexisting condition is accomplished where appropriate.

Question 15

Infants are at risk for hypothermia,bradycardia,and acidosis because they

Accepted Answer

Infants aged 6 months and younger do not have the ability to shiver when exposed to lower ambient temperatures.The absence of this important protective mechanism puts them at risk for hypothermia,bradycardia,and acidosis.Infants are typically nose breathers which causes them to have difficulty breathing when their nasal passages become blocked by edema and mucus.Cardiac output and circulating blood volume are not related to hypothermia,bradycardia,and acidosis.

Question 16

Strategies for increasing patient cooperation include all of the following,EXCEPT

Accepted Answer

Strategies for facilitating the patient's cooperation include the following.Use game playing and distraction.It is important to have different items of distraction available that can be used when a patient is not cooperative or focusing on what will be done next.Distractions include small toys that easily hook onto a stethoscope,wind-up musical toys,and humming,or whistling.Demonstrate procedures on a doll,stuffed animal or toy,or even the caregiver prior to performing them on the child.Insisting on the patient's obedience is counterproductive to obtaining cooperation.

Question 17

You are administering the Denver II during your examination of a 2-year-old child.The Denver II is a commonly used tool for assessing neuromuscular development of the child from birth through

Accepted Answer

The Denver II is a commonly used tool for assessing neuromuscular development of the child from birth through 6 years of age.The test is composed of four sections: personal-social,fine motor-adaptive,language,and gross motor.Some items on the test are easily accomplished by observing the child.

Question 18

Hydrocephalus is suspected when the circumference of the head of an infant measures above the

Accepted Answer

Hydrocephalus is suspected when the circumference of the head of an infant measures above the 95th percentile and crosses over the patient's established percentile lines from one serial measurement to the next.Hydrocephalus is an imbalance in cerebrospinal fluid production and reabsorption in the ventricles of the brain.It can result from embryological malformations of the nervous system

Question 19

Normal systolic blood pressure (BP)for a 4-year-old child is approximately

Accepted Answer

To determine the normal systolic BP in a child over the age of 1 year,you would use the following formula: 80 + (2 × age in years).For a 4-year-old child,normal systolic BP would be computed as: 80 + (2 × 4)= 80 + 8 = 88 mm Hg.Normal diastolic BP is generally two-thirds of the systolic BP.

Question 20

A rectal thermometer should be inserted into the rectum of a preschooler

Accepted Answer

To obtain a rectal temperature,place the patient in either a side-lying or prone position on the caregiver's lap or place the patient on the back of the examination table and firmly grasp the feet with the nondominant hand.After lubricating the stub-tipped thermometer,insert it gently into the patient's rectum: 1/2 inch for newborns,3/4 inch for infants,and 1 inch for preschoolers and older patients.Hold the thermometer firmly between your fingers to avoid accidentally inserting it too far.

Quiz 25: The Pediatric Patient