Test One Nurs 366

Front 1

When should an infant be able to support themselves?

Back 1

6 months old

Front 2

When can an infant sit alone? Sit alone and engage in play?

Back 2

6 months; 8 months

Front 3

When can an infant stand independently? Toddle quickly? Begin to run?

Back 3

Approx. 12 months; 13-14 months; 15 months

Front 4

When does an infant develop palmar grasp? Pincer grasp?

Back 4

6 months palmar; 9 months pincer

Front 5

How many words should an infant know by 18-20 months? What percentage should be understood by strangers?

Back 5

20-30 words total; 50% understood

Front 6

How many words should an infant know by 22-24 months? Sentence structure? Percent understood by strangers?

Back 6

50+ words; 2 word sentences or commands; 75 % should be understood by strangers

Front 7

Red flags:

Back 7

Unable to transfer objects from hand to hand by one year.

Unable to walk alone by 18 months.

Abnormal pincer grasp by 15 months (typically functioning at 9 months; palmar 6 months).

Failure to speak recognizable words by 2 years

Front 8

Hold a crayon and color vertical strokes?

Copy a circle and cross or build a tower with small blocks?

Fine motor skill; use scissors and color within the lines?

Write a few letters and draw a person with body parts??

Back 8

2 years (24 months)

3 years (36 months)

4 years (48 months)

5 years (56 months)

Front 9

When do stranger anxiety and separation anxiety dissipate?

When do temper tantrums peak? Sibling rivalry peak?

Back 9

2 1/2- 3 years old

Typically 18 months; 1-2 years of coexistence

Front 10

When gavage feeding infants what is an appropriate catheter to use for children less than 1000 grams?

More than 1000 grams?

Back 10

5 French or 6 French

8 French

Front 11

When gavage feeding and residual gastric contents are greater than 25% what intervention should be practiced?

Back 11

Hold the feeding and aspirate gastric contents 30-60 minutes later.

Front 12

When gavage feeding and residual gastric contents are greater than 50% what intervention should be practiced?

Back 12

Hold feeding and report findings to MD.

Front 13

Appropriate amount of air to aspirate infant with while checking NG/OG placement?

Back 13

0.5-1.0 ml

Front 14

When gavage feeding hold the syringe how high above the babies head?

How long should the feeding take?

How often is the tubing replaced?

Back 14

8-12 inches

20-30 minutes

Typically q 3 days

Front 15

Signs that the tube may not be placedcorrectly are?

Back 15

Coughing, fighting the tube, cyanosis, and apnea

Front 16

F= (C x 1.8) + 32

C= (F -32) /1.8

Front 17

If administering medication PO, a syringe must be used if the amount is equivalent to what?

Back 17

oral liquids< 5 ml put in a syringe

Front 18

The four P's for hourly rounding?

Back 18

Potty, positioning, pain, and personal needs

Front 19

AIDET?

Back 19

Acknowledge, Introduce, Duration, Explain, Thank you

Front 20

Glaucoma?

Back 20

Increased IOP

Primary open angle: clogged drainage channels

Primary angle closure: lens bulging forward

Peripheral vision loss, nasuea and vomiting, tunnel vision, blurred vision, colored halos, pain around the eye

Front 21

Cataracts?

Back 21

Decreasedvision, abnormalcolor perception, glare, cloudy or blurred vision

Surgical removal of lens and placement of intraocularlens

Front 22

Age-related Macular Degeneration?

Back 22

Wet: rapid onset that can lead to permanent vision loss, leakage of blood vessel results in scarring

Dry: more common, accumulation of pigment called drusen

Loss of central vision, therapy can leave scarring

ALWASY bilateral

Front 23

Presbycusis?

Back 23

Hearing loss by damage to the organs of Corti. Ex: ototoxic chemicals, noise, calcification, vascular disease, poor nutrition, and pollution

Front 24

Meniere’s Disease?

Back 24

Tinnitus, nausea and vomiting, vertigo, aural fullness, fluctuating hearing loss, serum buildup

Antihistamines, Anticholinergics, Benzodiazepines

Safety precaution due to vertigo!!!!

Front 25

SOAPIE

Back 25

Subjective, Objective, Assessment, Planning, Implementation, Evaluation

Front 26

Rectal suppository in infants?

Back 26

Left lying with right leg flexed; 1/2 -1 inche

Front 27

Metered-dose inhaler practice?

Back 27

Have the child take a slow big breath in after the medication isreleased into the spacer ~ Hold breath for a count of 5 or 10 seconds~ Exhale and repeat~ Repeat for as many “puffs” that were ordered.

Front 28

IV maintenance fluid rates:

Back 28

≤10 kg: 100mL/kg/day (100 x kg)

11-20 kg: 1000mL (for first 10kg) + 50mL/kg for each additional kg between 10 and 20 kg.

>20 kg: 1500mL (for first 20kg) + 20mL/kg for each additional kg over 20 kg (up to maximumof 2400mL of fluid per day)

Front 29

Moro reflex disappears by?

Back 29

3 months

Front 30

Stepping reflex disappears by?

(attempt to walk if one foot touches a surface)

Back 30

2 months

Front 31

Tonic neck disappears by?

(head faces the arm most extended by the infant)

Back 31

4-6 months

Front 32

Rooting reflex disappears by?

(move head in direction of side of lip being stimulated and make sucking motion)

Back 32

3-4 months

Front 33

Sucking reflex disappears by?

Back 33

10-12 months

Front 34

Babinski reflex disappears by?

(big toe remains extended or extends itself when the sole of the foot is stimulated, abnormal except in young infants.)

Back 34

2 years

Front 35

During an infant exam start where and end where?

What vital sign should be taken last?

Back 35

Start with heart, lung and bowel sounds and end with mouth and ear inspection. (least invasive to most invasive).

Temp

Front 36

Pulse Rate in Children

Back 36

Infants100-180

1 week to 3 months 100-220

3 months to 2 years 80-160

2 years to 10 years 70-110

10 years to adult 55-95

Front 37

Pain Assessment in Children

FLACC

Back 37

Face, Legs, Activity, Cry, Consolability

Front 38

Respiration Rate in Children

Back 38

Neonates-RR=30-60

Infants-RR=30-40

Toddlers-RR=25-40

Preschoolers-RR=20-30

School Age-RR=18-20

Adolescents-RR=16-18

Panic levels: < 10 or > 60

Front 39

Blood Pressure Cuff size?

Back 39

Two-thirds of the upper arm; 100 % of the circumference

Small: inaccurately high BP

Large: inaccurately low BP

Front 40

Infants grow in height approximately how many inches in the first year?

Back 40

Typically 12 inches (1 inch per month)

Front 41

Infants can lose what percent of birth weight in the first 3-4 days and still be considered healthy? Will put on how much weight each day after that?

Back 41

Up to 10% percent; 1/2 -1 oz each day after that

Front 42

When does a child's birth weight double? Triple?

Back 42

6 months; 1 year

Front 43

When is it appropriate to introduce solid foods?

Back 43

4-6 months; wait to introduce whole milk, honey, and eggs till 1 year of age

Front 44

When do the anterior and posterior fontalles close?

Back 44

Posterior: 2-3 months (triangle)

Anterior: 9-18 months (diamond)

Front 45

What is the most common eye deficit in children?

Back 45

Strabismus (cross-eyes)

Front 46

At what age during infancy do infection rates peak?

Toddlers and preschoolers have high rates of what type of infection?

Once over the age of 5, what type of infection becomes predominate?

Back 46

4-6 months

Viral infection

Bacterial infection

Front 47

Degree of respiratory distress with intercostal retractions?

Back 47

Mild respiratory distress

Front 48

Degree of respiratory distress with substernal/subcostal retractions?

Back 48

Moderate respiratory distress

Front 49

Degree of respiratory distress with supraclavicular retractions?

Back 49

Severe respiratory distress

Front 50

Nursing Interventions for respiratory distress:

Back 50

Promote rest and comfort, fever control, infection control (hand washing), good nutrition and hydration, and provide the individual with cool mist to increase comfort.

Front 51

How are Croup Symptoms classified?

Back 51

Hoarseness, barking cough, and inspiratory stidor.

Affects the larynx, trachea and bronchi.

Front 52

Acute epiglotitis. Bacterial or viral? Prevention by what method?

Signs and symptoms?

Back 52

Inflammation of the epiglottis. Bacterial by origin and can be prevented by administering the Hib vaccine.

Tripod positioning, sore throat, fever, and pain with a rapid onset.

Front 53

Acute Laryngotracheobronchitis (LTB). Bacterial or viral?

Caused by what agents?

Signs and Symptoms and treatment?

Back 53

LTB is viral by origin. Caused by RSV, parainfluenzavirus, influenza A and B.

Inspiratory stridor, supraclavicular retractions, barking or "seal cough". Epi and steroids.

Front 54

Bacterial Tracheitis (bacterial)

Back 54

Inflammation of the upper trachea, caused by Staphylococcus typically.

Clinical manifestations similar to LTB and thick purulent secretions are produced.

Front 55

Bronchiolitis.

Back 55

Presenting symptoms: apnea and poor feeding.

*** Must isolate (gloves, gown, and mask) and should monitor 02 levels in the infant.

Prevention: Palivizumab (Synagis) in high risk infants November- April

Front 56

Asthma

Back 56

Inflammation and constriction of the airways that traps air in the alveoli. Scar tissue make airways less elastic (airway remodeling)

Symptoms: coughing at night, chest tightness, wheezing, SOB

Diagnosis: 20 % increase in PEF (peak expiratory flow) after using albuterol is DIAGNOSTIC.

Front 57

Mild intermittent asthma

Mild persistant asthma

Moderate persistant

Severe persistant

Back 57

Symptoms that occur less than or equal to 2 times a week

Symptoms 3-6 times a week

Daily symptoms

Continual symptoms

Front 58

Slow release asthma drugs: q 12 hours (LONG ACTING)

Back 58

Salmeterol, Formoterol, and Bambuterol

Front 59

Asthma medications:

Back 59

Always start on an inhaled corticosteroid (Budesonide/ Fluticasone) and then move to a long acting bronchodilator.

All patients should have a rescue medication, such as albuterol, levabuterol, or terbutaline, regardless of the severity (intermittent or persistent).

Front 60

What is the purpose of ipatropium bromide (Atrovant) for asthma?

Back 60

Anticholinergic- dries up secretions and typically used with albuterol.

Front 61

What are the three simple goals of asthma treatment?

Back 61

Sleep, Learn, and Play.

Front 62

What is the Fi02 and what is the value for room air?

Back 62

Fi02 is fraction of inhaled are and it is equal to 21% in room air (0.21).

Front 63

When are oxygen tanks considered full and when are they considered empty?

Back 63

Full: 5500 PSI

Empty: 500 PSI

Front 64

Nasal canuli:

Back 64

0-6 liters per minute

24%- 40% 02 delivery

**Must use less than 2 liters in infants

Front 65

Simple face mask:

Back 65

6-10 liters per minute

35%-55% 02 delivery

**Must run more than 6 liters per minute or patient will rebreathe C02

Front 66

Venturi Mask:

Back 66

3-15 liters per minute

24%-50% 02 delivery

** Most accurate and tells what percent of 02 the patient is receiving specifically.

Front 67

Oxymizer (in home):

Back 67

1-15 liters per minute

23%-60% 02 delivery

Front 68

Non-rebreather Mask:

Back 68

6-15 liters

70%-100% 02 delivery

** No C02 rebreathed, to ensure adequate flow the bag must remain 1/3- 2/3 full.

Front 69

Partial Rebreather Mask:

Back 69

6-10 liters

40%-70% 02 delivery

**Some C02 rebreathed, bag must remain 1/3- 1/2 full

Front 70

Sodium concentration: Na+

Potassium concentration: K+

Calcium: Ca+

Magnesium: Mg+

PT (prothrombin time):

PTT (partial thromboplastin time):

Back 70

135-145 mEq/L

3.5-5 mEq/L

9-10.5 mg/dL

1.3- 2.1 mEq/L

11-12.5 seconds

60-70 seconds

Front 71

Hemoglobin (Hgb):

Hematocrit (HCT):

Blood Urea Nitrogen (BUN):

Creatine:

Glucose:

Back 71

14-18 gm/dL, if less than 9 gm/dL transfusion is required

42-52 %

7-20 mg/dL

.5-1.1 mg/dL

60-100 mg/ dL

Front 72

Phosphorus:

Platelets:

WBC:

RBC:

Back 72

2.4- 4.1mg/dL

150,000- 450,000 per microliter

4,500- 10,000 per microliter

4.7-6.1 million per microliter

Front 73

Hyponatremia:

Back 73

Medications (diuretics), water gain

Abdominal cramps, headaches, seizures, muscle weakness, tremors, and twitching, lethargy

0.9 % Sodium chloride or lactated ringers

Front 74

Hypernatremia:

Back 74

Water deficit

Polyuria, agitation and restlessness, dry and flushed skin, intense thirst, low grade fever, tachycardia

IVhypotonic saline .45% NaCl or D5W GOSLOW!

Front 75

Hypokalemia:

Back 75

Surgery and alcoholism, hyperaldosteronism, burns or trauma, and cancer

Muscle cramps, abdominal distension, constipation, weak irregular pulses, abnormal EKG

Front 76

Hyperkalemia:

Back 76

Renal failure, traumatic injury, sever infection, burns, acidosis and fast growing cancers.

Diarrhea, hypotension, irregular HR, leg weakness, numbness and tingling, convulsions and cardiac arrest.

Infusion of insulin or glucose, kayexalate or dialysis

Front 77

Hypocalcemia

Hypercalcemia

Back 77

Common in older adults, Rhabdomyolysis, Hypoparathyroidism

Metastaticmalignancy (lung, breast, ovary, and prostate), hyperparathyroidism, thiazidediuretictherapy

Front 78

Hypomagnesium

Hypermagnesium

Back 78

Cardiac irritability and cardiac dysrhythmias.

Retards neuromuscular conduction and can lead to respiratory depression.

Front 79

Low hemoglobin:

High hemoglobin:

Back 79

Anemia or bleeding, bone marrow suppression, over hydration.

Dehydration, polycythemia vera, and cystic fibrosis (compensating for lower levels of 02)

Front 80

Low hematocrit:

High hematocrit:

Back 80

Overhydration, hemorrhage, anemia, bone marrow suppression.

Dehydration and polycythemia vera.

Front 81

Low BUN levels:

High BUN levels:

Back 81

Liver failure, low protein diet, malnutrition, and overhydration

CHF, GI bleed, hypovolemia, kidney disease, kidney failure, UTI, and shock

Front 82

Low creatine:

High creatine:

Back 82

Common in the elderly, decreased muscle mass, muscular dystrophy, and paralysis.

Impaired renal function, high meat diets, chemotherapy, cephalosporins