ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions)

Name: ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions)
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ATI PN PEDS PROCTORED
ATI pediatrics proctored exam
VERSION 8
Chapter 1: Family centered nursing care
1. Parenting styles
-Dictatorial or authoritarian:
-Parents try to control the child’s behaviors and attitudes through unquestioned rules and
expectations
-Ex: The child is never allowed to watch television on school nights
-Permissive:
-Parents exert little or no control over the child’s behaviors, and consult the child when
making decisions
-Ex: The child assists with deciding whether he will watch television
-Democratic or authoritative:
-Parents direct the child’s behavior by setting rules and explaining the reason for each rule
setting
-Ex: The child can watch television for 1 hr on school nights after
completing all of his homework and chores
-Parents negatively reinforce deviations form the rules
-Ex: The privilege is taken away but later reinstated based on new
guidelines
Chapter 2: Physical assessment findings
1. Vital signs
-Usually vital signs are all high except for BP
-Temperature:
-3 – 6 months 99.5
-1 year 99.9
-3 year 99.0
-5 years 98.6
-7 years 98.2
-9 – 11 years 98.1
-13 years 97.9
-Pulse:
-Newborn 80 – 180/min
-1 weeks – 3 months 80 – 220/min
-3 months – 2 years 70 – 150/min
-2 – 10 years 60 – 110/min
-10 years and older 50 – 90/min
-Respirations:
-Newborn – 1year 30 – 35/min
-1 – 2 years 25 – 30/min
-2 – 6 years 21 – 25/min
-6 – 12 years 19 – 21/min
-12 years and older 16 – 19/min
-Blood pressure:
-Low as a baby but increases the older they get
-Infants:
-Systolic: 65-78
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ATI PN PEDS PROCTORED
-Diastolic: 41-52
2. Head
-Fontanels should be flat
-Posterior fontanel:
-Closes by 6-8 weeks
-Anterior fontanel:
-Closes by 12-18 months
3. Teeth
-Infants should have 6-8 teeth by 1 year old
-Children and adolescents should have teeth that are white and smooth, and begin replacing the 20
deciduous teeth with 32 permanent teeth
4. Infant Reflexes
Stepping Birth to 4 weeks
Palmar Grasp Birth to 3 months
Tonic Neck Reflex (Fencer Position) Birth to 3 – 4 months
Sucking and Rooting Reflex Birth to 4 months
Moro Reflex (Fall backward) Birth to 4 months
Startle Reflex (Loud Noise) Birth to 4 months
Plantar Reflex Birth to 8 months
Babinski Reflex Birth to 1 year
Chapter 3: Health promotion of infants (2 days to 1 year)
1. Physical Development
-Weight:
-Doubled by 5 months
-Tripled by 12 months
-Quartered by 30 months
-Height:
-2.5 cm (1 in) per month for the first 6 months
-Length:
-Increases by 50% by 12 months
-Dentition:
-First teeth erupt between 6-10 months
2. Motor skill development
 1 Month
o Head lag
o Strong grasp reflex
 2 Months
o Lifts head when prone
o Holds hand in open position | Grasp reflex fades
 3 Months
o Raises head and shoulders when prone | Slight head lag
o No grasp reflex | Keeps hands loosely open
 4 Months
o Rolls from back to side
o Grasp objects with both hands
 5 Months
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ATI PN PEDS PROCTORED
o Rolls from front to back
o Palmar grasp dominantly
 6 Months
o Rolls from back to front
o Holds bottle
 7 Months
o Bears full weight on feet | Sits, leaning forward on both hands
o Moves objects from hand to hand
 8 Months
o Sits unsupported
o Pincer grasp
 9 Months
o Pulls to a standing position | Creeps on hands and knees instead of crawling
o Crude pincer grasp | Dominant hand is evident
 10 Months
o Prone to sitting position
o Grasps rattle by its handle
 11 Months
o Walks while holding onto something | Walks with one hand held
o Places objects into a container | Neat pincer grasp
 12 Months
o Stands without support briefly | Sits from standing position without assistance
o Tries to build a two-block tower w/o success | Can turn pages in a book
3. Cognitive development
-Piaget: sensorimotor (birth to 24 months)
-Object Permanence: objects still exists when it is out of view
-Occurs at 9-10 months
4. Language development
-3-5 words by the age of 1 year
5. Psychosocial development
-Erikson: Trust vs. Mistrust:
- Learn delayed gratification
-Trust is developed by meeting comfort, feeding, simulation, and caring needs
-Mistrust develops if needs are inadequately or inconsistently met or if needs are
continuously met before being vocalized by the infant
6. Social development
-Separation Anxiety: protest when separated from parents
-Begins around 4-8 months
-Stranger Fear: ability to discriminate between familiar and unfamiliar people
-Begins 6-8 months
7. Age appropriate activities
-Rattles
-Playing pat-a cake
-Brightly colored toys
-Playing with blocks
8. Nutrition
-Breastfeeding provides a complete diet for infants during the first 6 months
-Solids are introduced around 4-6 months
-Iron-fortified cereal is the first to be introduced
-New foods should be introduced one at a time, over a 5-7 day period to observe for allergy
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ATI PN PEDS PROCTORED
reactions
-Juice and water usually not needed for 1st year
-Appropriate finger foods:
-Ripe bananas
-Toast strips
-Graham crackers
-Cheese cubes
-Noodles
-Firmly cooked vegetables
-Raw pieces of fruit (except grapes)
9. Injury prevention
-Avoid small objects (grapes, coins, and candy)
-Handles of pots and pans should be kept turned to the back of the stove
-Sunscreen should be used when infants are exposed to the sun
-Infants and toddlers remain in a rear-facing car seat until age 2
-Crib slats should be no farther apart than 6 months
-Pillows should be kept out of the crib
-Infants should be placed on their backs for sleep
Chapter 4: Health Promotion of Toddlers (1 to 3 years)
1. Physical development
-Weight:
-30 months: 4 times the birth weight
-Height:
-Toddlers grow 7.5 cm (3 in) per year
-Head circumference and chest circumference:
-Usually equal by 1 to 2 years of age
2. Cognitive development
-Piaget: sensorimotor stage transitions to preoperational stage 19 – 24 months
-Object Permanence: fully developed
3. Language development
-1 year: using one-word sentences
-2 years: 300 words, multiword sentences by combining 2-3 words
4. Psychosocial Development
-Autonomy vs. Shame and Doubt
-Independence is paramount for toddlers who are attempting to do everything for
themselves
-Use negativism or negative responses to express their independence
-Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as
they begin to explore the environment beyond those most familiar to them
5. Age appropriate activities
-Parallel play: Toddlers observe other children and then might engage in activities nearby
-Appropriate activities:
-Playing with blocks
-Push-pull toys
-Large-piece puzzles
-Thick crayons
-Toilet training can begin when toddlers have the sensation of needing to urinate or defecate
6. Motor skill development
 15 Months
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ATI PN PEDS PROCTORED
o Walks without help | Creeps up stairs
o Uses a cup well | Builds 2 tower blocks
 18 Months
o Runs clumsily | Throws overhand | Jumps in place w/ both feet | Pulls/Pushes toys
o Manages a spoon w/o rotation | Turns pages 2-3 pages /time | Builds 3-4 blocks | Uses crayon
to scribble spontaneously | Feeds self
 24 Months (2 years)
o Walks backwards | Walks up/down stairs w/ 2 feet on each step
o Builds 6-7 blocks | Turns pages 1 @ a time
 30 Months (2.5 years)
o Balances on 1 leg | Jumps across floor / off chair w/ both feet | Walks tiptoe
o Draws circles | has good hand-finger coordination
7. Nutrition
-Whole milk at 1 year old
-Can start drinking low-fat milk after 2 years of age
-Juice consumption should be limited to 4-6 oz. per day
-Foods that are potential choking hazards:
-Nuts
-Grapes
-Hot dogs
-Peanut butter
-Raw carrots
-Tough meats
-Popcorn
Chapter 5: Health Promotion of Preschoolers (3-6 years)
1. Physical development
-Weight:
-Gain 2-3 kg (4.5-6.5 lb) per year
-Height:
-Should grow 6.9-9 cm per year
2. Fine and gross motor skills
 3 Years
o Toe and heel walks
o Tricycle
o Jumps off bottom step
o Stands on one foot for a few seconds
 4 Years
o Hops on one foot | Skips
o Throws ball overhead
o Catches ball reliably
 5 Years
o Jumps rope
o Walks backward
o Throws and catches a ball
3. Cognitive development
-Piaget: preoperational stage
-Moves from totally egocentric thoughts to social awareness and the ability to consider the
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ATI PN PEDS PROCTORED
viewpoint of others
-Magical thinking:
-Thoughts are all-powerful and can cause events to occur
-Animism:
-Ascribing life-like qualities to inanimate objects
4. Psychosocial development
-Erikson: Initiative vs. guilt:
-Preschoolers become energetic learners, despite not having all of the physical abilities
necessary to be successful at everything
-Guilt can occur when preschoolers believe they have misbehaved or when they are unable
to accomplish a task
-During stress, insecurity, or illness, preschoolers can regress to previous immature behaviors or develop
habits (nose picking, bed-wetting, thumb sucking)
5. Age appropriate activities
-Preschooler’s transition to associative play
-Play is not highly organized, but cooperation does exist between children
-Appropriate activities:
-Playing ball
-Putting puzzles together
-Riding tricycles
-Playing pretend dress up activities
-Role-playing
6. Sleep and rest
-On average, preschoolers need about 12 hours of sleep
-Keep a consistent bedtime routine
-Avoid allowing preschoolers to sleep with their parents
Chapter 6: Health promotion of School-Age children (6-12 years)
1. Physical development
-Weight:
-Gain 2-3 kg (4.4-6.6 lb.) per year
-Height:
-Grows 5 cm (2 in.) per year
2. Cognitive development
-Piaget: Concrete operations
-Able to see the perspective of others
3. Psychosocial development
-Erikson: Industry vs. Inferiority
-A sense of industry is achieved through the development of skills and knowledge that allows
the child to provide meaningful contributions to society
-A sense of accomplishment is gained through the ability to cooperate and compete with
others
-Peer groups play an important part in social development
4. Age appropriate activities
-Competitive and cooperative play is predominant
-Play simple board and number games
-Play hopscotch
-Jump rope
-Ride bicycles
-Join organized sports (for skill building)
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ATI PN PEDS PROCTORED
5. Sleep and rest
-Need 9 hrs of sleep at age 11
6. Dental health
-The first permanent teeth erupt around 6 years of age
Chapter 7: Health promotion of Adolescents (12 to 20 years)
1. Physical development
-Girls stop growing at about 2-2.5 years after the onset of menarche
-In girls, sexual maturation occurs in the following order:
-Breast development
-Pubic hair growth
-Axillary hair growth
-Menstruation
-In boys, sexual maturation occurs in the following order:
-Testicular enlargement
-Pubic hair growth
-Penile enlargement
-Growth of axillary hair
-Facial hair growth
-Vocal changes
2. Cognitive development
-Piaget: Formal operations
-Increasingly capable of using formal logic to make decisions
3. Psychosocial development
-Erikson: Identity vs. role confusion
-Adolescents develop a sense of personal identity and to come to view themselves as unique
individuals
4. Age-appropriate activities
-Nonviolent videogames
-Nonviolent music
-Sports
-Caring for a pet
-Reading
Chapter 8: Safe Medication Administration
1. Oral
-This route of medication administration is preferred for children
-Avoid mixing medication with formula or putting it in a bottle of formula because the infant might not
take the entire feeding, and the medication can alter the taste of the formula
-Use the smallest measuring liquid medication for doses of liquid medication
-Avoid measuring liquid medication in a tsp. or tbsp.
-Administer the medication in the side of the mouth in small amounts
-Stroke the infant under the chin to promote swallowing while holding the cheeks together
2. Otic
-Children younger than years:
-Pull the pinna downward and straight back
-Children older than 3 years:
-Pull the pinna upward and back
3. Intramuscular
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ATI PN PEDS PROCTORED
-Use a 22-25 gauge, 1/2-1 inch needle
-Vastus lateralis is the recommended site in infants and small children
-Other sites:
-Ventrogluteal and deltoid
4. Intravenous
-Avoid terminology such as “bee sting” or “stick”
-Apply EMLA to the site for 60 minutes prior to attempt (helps numb)
-Keep equipment out of site until procedure begins
-Perform procedure in a treatment room (don’t do it in their room)
-Allow parents to stay if they prefer
-Swaddle infants
-Offer nutritive sucking to infants before, during, and after the procedure
Chapter 9: Pain management
1. Atraumatic measures
-Use play therapy to explain procedures, allowing the child to perform the procedure on a doll or toy
2. Pharmacological measures
-Give medications routinely, vs. PRN, to manage pain that is expected to last for an extended period of
time
3. Pain assessment tool
-Flacc: 2 months- 7 years
-Faces: 3 years and older
-Oucher: 3-13 years
-Numeric scale: 5 years and older
Chapter 10: Hospitalization, illness, and play
1. Infant
-Experiences stranger anxiety between 6-18 months
-Displays physical behaviors as expressions of discomfort due to inability to verbalize
2. Toddler
-Limited ability to describe illness
-Limited ability to follow directions
-Experiences separation anxiety
-Can exhibit an intense reaction to any type of procedure
-Behavior can regress
3. Preschooler
-Fears related to magical thinking
-Can experience separation anxiety
-Might believe illness and hospitalization are a punishment
-Explain procedures using simple, clear language
-Avoid medical jargon
-Give choices when possible, such as, “Do you want your medicine in a cup or spoon?”
4. School-age child
-Ability to describe pain
-Increasing ability to understand cause and effect
-Provide factual information
-Encourage contact with peer group
5. Adolescent
-Perceptions of illness severity are based on the degree of body images
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ATI PN PEDS PROCTORED
-Develops body image disturbance
-Experiences feelings of isolation from peers
-Provide factual information
-Encourage contact with peer group
Chapter 11: Death and Dying
1. Grief and mourning
-Anticipatory grief:
-When death is expected or a possible outcome
-Complicated grief:
-Extends for more than 1 year following the loss
2. Current stages of development
-Infants/toddlers (birth-3 years):
-Have little to no concept of death
-Mirror parental emotions
-Can regress to an earlier stage of behavior
-Preschool (3-6):
-Magical thinking allows for the belief that thoughts can cause an event such as death
resulting in feeling guilt and shame
-Interpret separation from parents as punishment for bad behavior
-View dying as temporary
-School-age (6-12):
-Begin to have adult concept of death
-Fear often displayed through uncooperative behavior
-Adolescent (12-20):
-Can have adult-like concept of death
-Can have difficulty accepting death
-Rely more on peers than the influence of parents
-Can become increasingly stressed by changes in physical appearance
3. Physical manifestations of death
-Sensation of heat when the body feels cool
-Decreased sensation and movement in lower extremities
-Swallowing difficulties
-Bradycardia/hypotension
-Cheyne-strokes respirations
4. After death
-Allow family to stay with the body as long as they desire
-Allow family to rock the infant/toddler
-Remove tubes and equipment
-Offer to allow family to assist with preparation of the body
Chapter 12: Acute Neurological disorders
1. Meningitis
-Viral (aseptic) Meningitis: supportive care for recovery
-Bacterial (septic) Meningitis: contagious infection
-Hib and PCV vaccines decrease the incidence
-Newborns:
-Poor Muscle Tone
-Weak Cry
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ATI PN PEDS PROCTORED
-Poor Suck | Refuses Feedings
-Vomiting/Diarrhea
-Bulging Fontanels (late sign)
-3 Months – 2 Years:
-Seizures with a High-Pitched Cry
-Bulging Fontanels
-Poor Feedings | Vomiting
-Possible nuchal rigidity
-Brudzinki’s sign and Kernig’s sign not reliable for diagnosis
-2 Years – Adolescence:
-Seizures (often initial sign)
-Nuchal rigidity
-Fever/chills
-Headache/vomiting
-Irritability/restlessness that can progress to drowsiness/stupor
-Petechiae or purpuric type rash (with meningococcal infection)
-+ Brudzinski Sign: flexion of extremities with deliberate flexion of the
neck
-+ Kernig’s Sign: resistance to extension of the leg from a flexed position
-Laboratory Tests
-Blood Cultures | CBC | CSF Analysis
-Viral CSF
-Clear Color | Slightly Elevated WBC & Protein | Normal Glucose | -
Gram
-Bacterial CSF
-Cloudy Color | Elevated WBC | Elevated Protein | Decreased Glucose |
+Gram
-Diagnostic Procedures
-Lumbar Puncture (Definitive Diagnostic Test)
-Empty Bladder
-EMLA Cream 45min – 1-hour prior
-Side-lying Position, Head Flexed, Knees Drawn up to Chest
-Remain in Flat Position to prevent Leakage and Spinal HA
-Nursing care:
-Droplet precautions
-Maintain NPO status if the client has decreased LOC
-Decrease environmental stimuli
-Medications:
-IV antibiotics for bacterial infections
-Complications:
-ICP:
-Newborns and Infants
-Bulging or Tense Fontanels
-Increased Head Circumference
-High-Pitched Cry | Irritability
-Distended Scalp Veins
-Bradycardia | Respiratory Changes
-Children
-Headache
-N/V
-Diplopia
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ATI PN PEDS PROCTORED
-Seizures
-Bradycardia | Respiratory Changes
2. Reye Syndrome
-Affects the liver (liver dysfunction) and brain (cerebral edema)
-Follows a viral illness (Influenza | Gastroenteritis | Varicella)
-Giving Aspirin for treating fevers
-Laboratory tests:
-Elevated liver enzymes (ALT and AST)
-Elevated serum ammonia
-Diagnostic procedures:
-Liver biopsy/CSF analysis
Chapter 13: Seizures
1. Risk factors
-Febrile Episode
-Cerebral Edema
-Intracranial Infection / Hemorrhage
-Brain Tumors / Cyst
-Toxins or Drugs
-Lead Poisoning
-Hypoglycemia
-Electrolyte imbalances
2. Generalized seizures
-Tonic-clonic seizures: -Also known as Grand mal
-Tonic Phase (10-30 seconds)
-Loss of Consciousness | Loss of Swallowing Reflex | Apnea leading to
Cyanosis
-Tonic Contraction of entire body: arms and legs flexed, head and neck
extended
-Clonic Phase (30-50 seconds)
-Violent jerking movements of the body
-Postictal State (30 minutes)
-Remains semiconscious but arouses with difficulty and confused
-No recollection of the seizure
-Absence seizure: petit mal or lapses
-Onset between ages 5 – 8 years and ceases by the teenage years
-Loss of Consciousness lasting 5 – 10 seconds
-Minimal or no change in behavior
-Resembles daydreaming or Inattentiveness
-Can drop items being held, but the child seldom falls
-Lip Smacking | Twitching of Eyelids or Face | Slight Hand Movements
-Myoclonic seizure:
-Brief contraction of muscle or groups of muscle
-No postictal state
-Atonic or akinetic seizure:
-Muscle tone is lost for a few seconds
3. Diagnostic procedures
-EEG:
-Abstain from caffeine for several hours prior to the procedure
-Wash hair (no oils or sprays) before and after the procedure to remove
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ATI PN PEDS PROCTORED
electrode gel
4. Nursing care
-Initiate Seizure Precautions:
-Pad side rails of Bed | Crib | Wheelchair
-Keep bed free of objects that could cause Injury
-Have Suction and Oxygen Equipment available
-During a Seizure:
-Protect from Injury (move furniture away, hold head in lap)
-Maintain a position to provide a patent airway
-Suction Oral Secretions
-Side-lying Position (decreases risk of aspiration)
-Loosen restrictive clothing
-Do NOT restrain the child
-Do NOT put anything in the child’s mouth
-Do NOT open the jaw or insert an airway during seizure
-This can damage teeth, lips, or tongue
-Remain with the child
-Note onset, time, and characteristics of seizure
-Allow seizure to end spontaneously
-Post-Seizure:
-Side-lying position to prevent aspiration and facilitate drainage of
secretions
-Check for breathing, V/S and position of head
-NPO until swallowing reflex has returned
5. Medications
-Antiepileptic Drugs (AEDs):
-Diazepam (Valium) | Phenytoin | Carbamazepine | Valporic Acid |
6. Therapeutic procedures
-Focal Resection: of an area of the brain to remove epileptogenic zone
-Corpus Callostomy: separation of two hemispheres in the brain
-Vagal Nerve Stimulator
7. Complications
-Status Epilepticus:
-Prolonged Seizure Activity that Lasts >30 minutes or Continuous seizure activity in
which the client does not enter a Postictal Phase
-Maintain Airway, Administer oxygen, IV access
Chapter 14: Head injury
1. Physical assessment findings
-Minor injury:
-Vomiting
-Pallor
-Irritability
-Lethargy/drowsiness
-Severe injury: Increased ICP
-Infants:
-Bulging fontanel
-Irritability (usually 1st sign)
-High-pitched cry
-Poor feeding
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