Developmental Milestones and Age-Appropriate Care
The NCLEX frequently tests growth and development milestones. Key milestones: 2 months (social smile, lifts head), 6 months (sits with support, transfers objects), 9 months (stranger anxiety, pincer grasp developing), 12 months (walks with support, says 1-2 words, separation anxiety peaks), 2 years (runs, 2-word phrases, parallel play), 3 years (rides tricycle, knows age/sex, associative play begins), 5 years (skips, ties shoes, cooperative play). Erikson's stages are heavily tested: Trust vs. Mistrust (infant), Autonomy vs. Shame (toddler), Initiative vs. Guilt (preschooler), Industry vs. Inferiority (school-age), Identity vs. Role Confusion (adolescent).
Pediatric Medication Safety and Dosage Calculations
Medication safety is paramount in pediatrics. All pediatric doses must be verified against safe-dose ranges based on the child's weight in kilograms. The NCLEX tests your ability to: convert pounds to kilograms (divide by 2.2), calculate mg/kg/dose, determine if a prescribed dose is within the safe range, and calculate appropriate doses. For IV medications, know how to calculate drip rates for pediatric volumes (microdrip sets deliver 60 gtt/mL). High-alert pediatric medications include chemotherapy agents, insulin, opioids, and IV potassium. Always use the two-patient-identifier system and verify medication with another nurse for high-alert drugs.
Common Childhood Diseases and Nursing Interventions
High-yield pediatric conditions: Croup (barky cough, stridor — cool mist humidifier, racemic epinephrine for severe), Epiglottitis (drooling, tripod position — do NOT examine throat, prepare for intubation), RSV/bronchiolitis (wheezing in infants — supportive care, contact isolation), Kawasaki disease (fever >5 days, strawberry tongue, peeling skin — IVIG and aspirin), pyloric stenosis (projectile vomiting in 2-8 week olds — olive-shaped mass, surgical pyloromyotomy), intussusception (currant jelly stools, sausage-shaped mass — air/barium enema reduction), and sickle cell disease (vaso-occlusive crisis — hydration, pain management, oxygen).
Family-Centered Care and Pediatric Communication
The NCLEX emphasizes family-centered care in pediatrics. Parents are integral to the care team and should be involved in decision-making, care procedures, and education. Age-appropriate communication is essential: use simple concrete terms for preschoolers, allow school-age children to participate in their care, and respect adolescents' need for privacy and autonomy. Therapeutic play helps children process hospitalization — allow medical play with toy stethoscopes, use dolls for procedure preparation, and maintain routines as much as possible. Pain assessment requires age-appropriate tools: FLACC for infants/nonverbal, Wong-Baker FACES for 3-7 years, numeric scale for 8+ years.