Vital Signs
What instrument is used to measure a child's oxygen saturation?
Pulse oximeter
Oxygen saturation is measured using a pulse oximeter.
What should the nurse assess first when a child has difficulty breathing?
Airway and breathing
Airway and breathing are immediate priorities.
At what age do most infants begin sitting without support?
Around 6–9 months
Sitting independently commonly develops during this period.
What does nasal flaring indicate?
Increased work of breathing
Nasal flaring is a sign of respiratory distress.
What does ABC stand for in emergency assessment?
Airway, Breathing, Circulation
These guide initial emergency priorities.
What is the normal resting heart rate range for a toddler approximately 1–3 years old?
About 98–140 beats/min
Heart rate varies with age, activity, and clinical condition.
What does capillary refill assess?
Peripheral perfusion
It provides information about circulation.
What developmental stage is associated with parallel play?
Toddlerhood
Toddlers commonly play alongside, rather than cooperatively with, other children.
What sound is commonly associated with narrowed lower airways?
Wheezing
Wheezing is a musical sound caused by narrowed airways.
A toddler is crying during assessment. What should the nurse do?
Use a calm approach and involve the caregiver
Caregiver involvement can help comfort the child.
What is the preferred pulse assessment site for an infant?
Apical pulse
The apical pulse is assessed with a stethoscope over the chest.
What instrument is used to examine the ear canal and tympanic membrane?
Otoscope
An otoscope allows visualization of the ear.
What is a typical language milestone around age 2?
Combining two words
Two-word phrases are an important developmental milestone.
What does stridor suggest?
Upper airway obstruction or narrowing
Stridor requires prompt evaluation.
Why should the nurse assess an infant's respiratory rate for a full minute?
To obtain an accurate count of irregular breathing
Infant breathing can be irregular.
What should the nurse do if a child has an unexpectedly elevated respiratory rate?
Reassess while the child is calm and evaluate respiratory effort
Activity and crying can affect respiratory rate; assess for distress.
What finding may indicate dehydration in an infant?
Sunken fontanelle
A sunken fontanelle can be a sign of dehydration.
Which developmental theory is associated with trust versus mistrust?
Erikson
This is the first psychosocial stage, occurring during infancy.
What is the significance of intercostal retractions?
Increased respiratory effort
Retractions indicate increased work of breathing.
A child is lethargic and difficult to arouse. What is the priority?
Immediate assessment and escalation
Altered responsiveness is a potentially serious finding.
What is a common early sign of hypoxia in a child?
Restlessness or agitation
Behavioral changes may occur before late signs such as cyanosis.
What does auscultation mean?
Listening to internal body sounds
A stethoscope is commonly used for auscultation.
What is an appropriate way to communicate with a preschooler?
Use simple, concrete explanations
Preschoolers benefit from clear, age-appropriate language.
A child has an oxygen saturation of 88%. What should the nurse do?
Immediately assess and support airway and breathing, and escalate care
This is concerning for hypoxemia and requires prompt intervention.
What is the most important goal of pediatric assessment?
Identify health problems early and promote child safety
Early recognition supports timely care.