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

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 1ATI PN PEDS PROCTOREDATI pediatrics proctored examVERSION 8Chapter 1: Family centered nursing care1. Parenting styles-Dictatorial or authoritarian:-Parents try to control the child’s behaviors and attitudes throughunquestioned rules andexpectations-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 thechild whenmaking 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 reasonfor each rulesetting-Ex: The child can watch television for 1 hr on school nights aftercompleting all of his homework and chores-Parents negatively reinforce deviations form the rules-Ex: The privilege is taken away but later reinstated based on newguidelinesChapter 2: Physical assessment findings1. Vital signs-Usually vital signs are all high except for BP-Temperature:-3 – 6 months99.5-1 year99.9-3 year99.0-5 years98.6-7 years98.2-9 – 11 years98.1-13 years97.9-Pulse:-Newborn80 – 180/min-1 weeks – 3 months80 – 220/min-3 months – 2 years70 – 150/min-2 – 10 years60 – 110/min-10 years and older50 – 90/min-Respirations:-Newborn – 1year30 – 35/min-1 – 2 years25 – 30/min-2 – 6 years21 – 25/min-6 – 12 years19 – 21/min-12 years and older16 – 19/min-Blood pressure:-Low as a baby but increases the older they get-Infants:-Systolic: 65-78Page1of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 2

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 3ATI PN PEDS PROCTORED-Diastolic: 41-522. Head-Fontanels should be flat-Posterior fontanel:-Closes by 6-8 weeks-Anterior fontanel:-Closes by 12-18 months3. 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 20deciduous teeth with 32 permanent teeth4. Infant ReflexesSteppingBirth to 4 weeksPalmar GraspBirth to 3 monthsTonic Neck Reflex (Fencer Position)Birth to 3 – 4 monthsSucking and Rooting ReflexBirth to 4 monthsMoro Reflex (Fall backward)Birth to 4 monthsStartle Reflex (Loud Noise)Birth to 4 monthsPlantar ReflexBirth to 8 monthsBabinski ReflexBirth to 1 yearChapter 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 months2. Motor skill development1 MonthoHead lagoStrong grasp reflex2 MonthsoLifts head when proneoHolds hand in open position | Grasp reflex fades3 MonthsoRaises head and shoulders when prone | Slight head lagoNo grasp reflex | Keeps hands loosely open4 MonthsoRolls from back to sideoGrasp objects with both hands5 MonthsPage2of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 4ATI PN PEDS PROCTOREDoRolls from front to backoPalmar grasp dominantly6 MonthsoRolls from back to frontoHolds bottle7 MonthsoBears full weight on feet | Sits, leaning forward on both handsoMoves objects from hand to hand8 MonthsoSits unsupportedoPincer grasp9 MonthsoPulls to a standing position | Creeps on hands and knees instead of crawlingoCrude pincer grasp | Dominant hand is evident10 MonthsoProne to sitting positionoGrasps rattle by its handle11 MonthsoWalks while holding onto something | Walks with one hand heldoPlaces objects into a container | Neat pincer grasp12 MonthsoStands without support briefly | Sits from standing position without assistanceoTries to build a two-block tower w/o success | Can turn pages in a book3. Cognitive development-Piaget: sensorimotor (birth to 24 months)-Object Permanence: objects still exists when it is out of view-Occurs at 9-10 months4. Language development-3-5 words by the age of 1 year5. Psychosocial development-Erikson: Trust vs. Mistrust:- Learn delayed gratification-Trust is developed by meeting comfort, feeding, simulation, and caringneeds-Mistrust develops if needs are inadequately or inconsistently met or if needsarecontinuously met before being vocalized by the infant6. 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 months7. Age appropriate activities-Rattles-Playing pat-a cake-Brightly colored toys-Playing with blocks8. 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 toobserve for allergyPage3of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 5ATI PN PEDS PROCTOREDreactions-Juice and water usually not needed for 1styear-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 sleepChapter 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 age2. Cognitive development-Piaget: sensorimotor stage transitions to preoperational stage 19 – 24 months-Object Permanence: fully developed3. Language development-1 year: using one-word sentences-2 years: 300 words, multiword sentences by combining 2-3 words4. Psychosocial Development-Autonomy vs. Shame and Doubt-Independence is paramount for toddlers who are attempting to doeverything forthemselves-Use negativism or negative responses to express their independence-Ritualism, or maintaining routines and reliability, provides a sense ofcomfort for toddlers asthey begin to explore the environment beyond those most familiar to them5. 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 defecate6. Motor skill development15 MonthsPage4of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 6ATI PN PEDS PROCTOREDoWalks without help | Creeps up stairsoUses a cup well | Builds 2 tower blocks18 MonthsoRuns clumsily | Throws overhand | Jumps in place w/ both feet | Pulls/Pushes toysoManages a spoon w/o rotation | Turns pages 2-3 pages /time | Builds 3-4 blocks | Uses crayonto scribble spontaneously | Feeds self24 Months (2 years)oWalks backwards | Walks up/down stairs w/ 2 feet on each stepoBuilds 6-7 blocks | Turns pages 1 @ a time30 Months (2.5 years)oBalances on 1 leg | Jumps across floor / off chair w/ both feet | Walks tiptoeoDraws circles | has good hand-finger coordination7. 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-PopcornChapter 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 year2. Fine and gross motor skills3 YearsoToe and heel walksoTricycleoJumps off bottom stepoStands on one foot for a few seconds4 YearsoHops on one foot | SkipsoThrows ball overheadoCatches ball reliably5 YearsoJumps ropeoWalks backwardoThrows and catches a ball3. Cognitive development-Piaget: preoperational stage-Moves from totally egocentric thoughts to social awareness and the abilityto consider thePage5of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 7ATI PN PEDS PROCTOREDviewpoint of others-Magical thinking:-Thoughts are all-powerful and can cause events to occur-Animism:-Ascribing life-like qualities to inanimate objects4.Psychosocial development-Erikson: Initiative vs. guilt:-Preschoolers become energetic learners, despite not having all of thephysical abilitiesnecessary to be successful at everything-Guilt can occur when preschoolers believe they have misbehaved or whenthey are unableto accomplish a task-During stress, insecurity, or illness, preschoolers can regress to previous immature behaviors or develophabits (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-playing6. Sleep and rest-On average, preschoolers need about 12 hours of sleep-Keep a consistent bedtime routine-Avoid allowing preschoolers to sleep with their parentsChapter 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 year2. Cognitive development-Piaget: Concrete operations-Able to see the perspective of others3. Psychosocial development-Erikson: Industry vs. Inferiority-A sense of industry is achieved through the development of skills andknowledge that allowsthe child to provide meaningful contributions tosociety-A sense of accomplishment is gained through the ability to cooperate andcompete withothers-Peer groups play an important part in social development4. 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)Page6of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 8ATI PN PEDS PROCTORED5. Sleep and rest-Need 9 hrs of sleep at age 116. Dental health-The first permanent teeth erupt around 6 years of ageChapter 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 changes2. Cognitive development-Piaget: Formal operations-Increasingly capable of using formal logic to make decisions3. Psychosocial development-Erikson: Identity vs. role confusion-Adolescents develop a sense of personal identity and to come to viewthemselves as uniqueindividuals4. Age-appropriate activities-Nonviolent videogames-Nonviolent music-Sports-Caring for a pet-ReadingChapter 8: Safe Medication Administration1. 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 nottake 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 together2. Otic-Children younger than years:-Pull the pinna downward and straight back-Children older than 3 years:-Pull the pinna upward and back3. IntramuscularPage7of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 9ATI 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 deltoid4. 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 procedureChapter 9: Pain management1. Atraumatic measures-Use play therapy to explain procedures, allowing the child to perform the procedure on a doll or toy2. Pharmacological measures-Give medications routinely, vs. PRN, to manage pain that is expected to last for an extended period oftime3. Pain assessment tool-Flacc: 2 months- 7 years-Faces: 3 years and older-Oucher: 3-13 years-Numeric scale: 5 years and olderChapter 10: Hospitalization, illness, and play1. Infant-Experiences stranger anxiety between 6-18 months-Displays physical behaviors as expressions of discomfort due to inability to verbalize2. 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 regress3. 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 group5. Adolescent-Perceptions of illness severity are based on the degree of body imagesPage8of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 10ATI PN PEDS PROCTORED-Develops body image disturbance-Experiences feelings of isolation from peers-Provide factual information-Encourage contact with peer groupChapter 11: Death and Dying1. Grief and mourning-Anticipatory grief:-When death is expected or a possible outcome-Complicated grief:-Extends for more than 1 year following the loss2. 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 suchas deathresulting 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 appearance3. 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 respirations4. 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 bodyChapter 12: Acute Neurological disorders1. Meningitis-Viral (aseptic) Meningitis: supportive care for recovery-Bacterial (septic) Meningitis: contagious infection-HibandPCVvaccines decrease the incidence-Newborns:-Poor Muscle Tone-Weak CryPage9of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 11ATI 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 oftheneck-+ Kernig’s Sign: resistance to extension of the leg from a flexedposition-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-DiplopiaPage10of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 12ATI PN PEDS PROCTORED-Seizures-Bradycardia | Respiratory Changes2. 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 analysisChapter 13: Seizures1. Risk factors-Febrile Episode-Cerebral Edema-Intracranial Infection / Hemorrhage-Brain Tumors / Cyst-Toxins or Drugs-Lead Poisoning-Hypoglycemia-Electrolyte imbalances2. Generalized seizures-Tonic-clonic seizures: -Also known as Grand mal-Tonic Phase (10-30 seconds)-Loss of Consciousness | Loss of Swallowing Reflex | Apnea leading toCyanosis-Tonic Contraction of entire body: arms and legs flexed, head and neckextended-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 seconds3. Diagnostic procedures-EEG:-Abstain from caffeine for several hours prior to the procedure-Wash hair (no oils or sprays) before and after the procedure toremovePage11of44

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    ATI PN Pediatrics Proctored Exam Version 8 with Answers (166 Solved Questions), page 13ATI PN PEDS PROCTOREDelectrode gel4. 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 ofsecretions-Check for breathing, V/S and position of head-NPO until swallowing reflex has returned5. 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 Stimulator7. Complications-Status Epilepticus:-Prolonged Seizure Activity that Lasts >30 minutes or Continuous seizureactivity inwhich the client does not enter a Postictal Phase-Maintain Airway, Administer oxygen, IV accessChapter 14: Head injury1. Physical assessment findings-Minor injury:-Vomiting-Pallor-Irritability-Lethargy/drowsiness-Severe injury: Increased ICP-Infants:-Bulging fontanel-Irritability (usually 1stsign)-High-pitched cry-Poor feedingPage12of44

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