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While using an otoscope, how does the practitioner correctly examine the tympanic membrane of a toddler?
Examine the eardrum of infants and toddlers by pulling down on the ear lobe. Examine the eardrum of an older child by pulling up on the outer pinna. Additional help from colleagues or caregivers may be necessary when examining small or upset children.
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Rubeola is caused by which of the following viruses?
Rubeola is caused by the measles virus and is extremely contagious. Airborne precautions must be used when measles are suspected. Patients who are affected by measles may exhibit a high fever, cough, conjunctivitis and a rash among many other symptoms. Contraction of measles may be prevented by administration of MMR (Measles, Mumps, and Rubella) through vaccination. Human herpesvirus include a family of related viruses of which varicella/zoster virus (causes chicken pox and shingles) is a member. Parvovirus B19 may cause fifth disease, among other conditions. Coxsackievirus A16 causes hand food mouth disease.
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Parvovirus B-19 causes which of the following conditions?
Parvovirus B-19 causes fifth's disease, sometimes referred to as "slapped cheek syndrome," due to the bright-red cheeks that often present with the infection. Scarlet fever is caused by group A streptococcus infection. Roseola infantum is caused by either human herpesvirus 6 or human herpesvirus 7. Rubeola, or measles, is caused by the measles virus.
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What is the incubation period for varicella (chickenpox)?
Varicella, caused by an infection with the varicella zoster virus, has an incubation period of 10-21 days.
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Which of the following is considered a late sign of hunger in the newborn?
Crying is considered a late sign of hunger. By the time the infant cries, they may be more difficult to console or to feed, especially if breastfeeding. Feed on cue when the infant is rooting, making sucking motions, or when they are frequently bringing their hands to their face or mouth.
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Which of the following terms describes the congenital abnormality of the forebrain in which an infant is born with a diminished brain size?
Microcephaly denotes a congenital abnormality of the forebrain in which an infant is born with a diminished brain size. Potential causes include fetal alcohol syndrome, congenital rubella, and trisomy 18.
The other answers are all examples of congenital forebrain birth defects:
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Anencephaly and other neural tube defects have been linked to maternal deficiency of what nutrient?
Anencephaly and other neural tube defects have been linked to maternal deficiency of folate. This is most likely due to folate's role in methylation and nucleic acid synthesis. The other nutrients listed are all important to maternal health but have no known correlation with neural tube defects such as anencephaly.
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Periventricular leukomalacia (PVL) is the most common finding on autopsy of newborns with what condition?
Periventricular leukomalacia is the most common finding on autopsy of newborns with cerebral palsy. PVL involves the softening of the brain tissue and subsequent death of the white matter. This is caused by lack of blood flow to the periventricular area of the brain, which results in necrosis and gliosis of brain tissue. Neonates born with PVL are likely to have mental impairment, motor disorders, and compromised vision and hearing. PVL is usually diagnosed with ultrasound of the head. None of the other conditions listed typically present with this finding.
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A mother one hour post birth expresses concern because her baby's head looks slightly cone shaped. The nurse tells the mother that __________.
It is normal for a child's head to be slightly misshapen immediately following birth. The infant's skull is composed of bony plates connected by membranes (fontanelles), allowing for accommodation of the baby's growing brain. Caput succedaneum (swelling of the scalp) can also be found following a long delivery. A misshapen head usually resolves on its own and is normal but does not require any medical intervention.
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A baby is born with a heart rate of 99 beats per minute, irregular breathing, good flexion, frowns when you suction the nose, and with pink color throughout the body and limbs. What is the baby's APGAR score at one minute?
An APGAR (Appearance Pulse Grimace Activity Respiration) score is a quick assessment designed to indicate the condition of the baby after birth. Referring to the APGAR scoring method, point allocations are as follows:
Heart rate of less than 100: 1
Good flexion: 2
Frown (reflex): 1
Irregular respirations: 1
Pink skin color: 2
We add these to get the final APGAR score of 7.
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While assessing a 4-month-old infant, the nurse notices hyperpigmented nevi on the lower back. Which of the following is false regarding hyperpigmented nevi?
Hyperpigmented nevi have been previously called "Mongolian spots". They occur most commonly in dark skinned children and fade as the child ages. They are often mistaken for bruises. Sturge-Weber syndrome is a neurological disorder which is present at birth and associated with port-wine stain birthmarks.
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A baby is born with a heart rate of 60 beats per minute. The baby is not breathing, has limp limbs, is flaccid and pale. What is the baby's APGAR score at 1 minute?
An APGAR (Appearance Pulse Grimace Activity Respiration) score is a quick assessment designed to indicate the condition of the baby after birth. Referring to the APGAR scoring method, point allocations are as follows
Heart rate less than 100: 1
Poor flexion: 0
Absent reflex: 0
Apnea: 0
Pallor: 0
We add these individual scores to get the APGAR score of 1.
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A pair of new parents are concerned because their baby has lost 4% of it's birth weight at 3 days of life. The nurse instructs the parents to __________.
It is common for infants to lose up to 10% of their weight in the first week of life. Greater than a 10% loss indicates a problem. For an infant within these parameters, there is no need to make a change in feedings. Infants in the first week of life should be fed every 2-3 hours if breast feeding and every 3-4 hours if formula feeding.
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A pediatric nurse is assessing a 4-day-old infant. He notes irregular breathing of 45 breaths per minute. The nurse should __________.
It is normal for infants to breathe irregularly. Often, brief periods of apnea are present. Infants should breathe between 30 and 60 times per minute. For this purpose, noting the finding as a vital sign in the patient's chart is the correct action. No further intervention is necessary in response to a normal assessment.
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Kerry is a first-time mother caring for her new baby boy. She notices that as she touches his cheek, he turns towards that side and opens his mouth. The nurse tells Kerry that this is a reflex called __________.
The question describes the rooting reflex. The Moro reflex is shown when an infant is startled and/or feels loss of support as if he/she is falling. He/she will extend the arms above the body in a curved shape. The Babinski reflex occurs in response to stimulation of the sole of the foot. Typically, the large toe will extend or remain extended as the others move. Infants may also exhibit plantar grasp with application of pressure to the foot. In plantar grasp, the toes will flex inward. Infants displaying palmar grasp will close their fingers around an object placed in their hand.
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Which of the following findings are abnormal upon assessment of an infant on the third day of life?
Hard or firm stools are abnormal for an infant on their third day of life. Typically, infants will have meconium (dark, sticky) stools for the first several days as a result of amniotic fluid ingestion. Over the next couple days they will transition to a seedy yellow (breastfed infants) or peanut butter consistency (formula-fed infants). Acrocyanosis, blue color on the extremities, is normal in infants. Mottling is also common. Infants have a developing cardiovascular system and many capillaries that exist close to the surface of the skin. Milia are normal white spots that frequent the faces of newborns. It is important not to pick or scratch these white spots to prevent scarring. Infants are also frequently born with fine hair called lanugo covering the body's surfaces. Some babies may be born with more lanugo than others.
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Julie is a new registered nurse who is assessing a child in his third month of life. The assessment is part of a routine appointment at a public health clinic. She knows that the anterior fontanelle of most infants closes between __________.
The anterior fontanelle is commonly referred to as the "soft spot" located atop a child's head. It allows considerable brain growth until it closes, generally between 12-18 months. However, the fontanelle may close on some children as early as 9 months.
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Rubella is a viral illness that commonly affects children. Which of the following is another name for rubella?
All of the above are viral illnesses commonly found in children. Rubella may be referred to as "german measles" and is spread through droplets. The disease is generally mild, presenting with a rash that typically lasts around three days. Maternal rubella may spread to the fetus and cause severe complications.
Rubeola, also known as measles, is highly contagious and is caused by the measles virus. Chicken pox is caused by the herpes zoster (varicella) virus. Hand foot mouth disease is a viral disease caused by coxsackievirus A16. Fifth disease is caused by parvovirus B19 and presents with bright red rashes on the cheeks and other parts of the body.
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Which of the following would be considered appropriate in the treatment of a child with Lyme disease?
Lyme disease is caused by the bacteria Borrelia burgdorferi. It is a vector-borne disease that is contracted secondary to the bite of an infected tick. Administration of antibiotics is crucial to recovery. Standard precautions are adequate. Restricting fluids, diet, or activity is not necessary.
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A mother calls the clinic because her son is 5 years of age and has been experiencing incontinence of diarrhea for three days. He has a past medical history of constipation. The physician has diagnosed the child with encopresis. The nurse may recommend the family try which of the following?
Constipation is a common complaint in children. Encopresis occurs when children are incontinent of fecal matter after toilet training. Often, a child will leak stool surrounding a large fecal mass that has hardened in the rectum. Giving a child an enema may help to clear the mass and restore bowel function. Constipation should be avoided through exercise, high-fiber diet, and adequate liquid ingestion.
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