Aqcuired Ped Disorders

A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is ______

rheumatic fever

A nurse is teaching the parents of a child who has rheumatic fever. Which of the following statements by a parent indicates an understanding of the teaching? A. "My child may take aspirin for his joint pain." B. "My child will need a blood transfusion prior to discharge." C. "I will need to wear a gown when I'm in my child's room." D. "I will apply lotion to my child's peeling hands."

A.

The nurse is caring for a child diagnosed with rheumatic fever. What 2 PRIORITY interventions would the nurse do?

1. Carefully handle the child's knees, ankles, elbows, & wrists when moving the child. 2. Administer salicylates after meals or with milk

In caring for the child with rheumatic fever which of the following medications would the nurse likely administer? A) Aspirin B) Tylenol C) Insulin D) Dilantin

A)

The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with rheumatic fever. What statement is most accurate regarding the diagnosis of rheumatic fever?

"Children who have this diagnosis may have had strept throat."

The nurse is preparing the parents and the child with Kawasaki disease for discharge from the hospital. What will the nurse teach the family about home care? Select all that apply. "Aspirin therapy should be given daily for several months as prescribed." "The child should not receive any live vaccines for 6 months." "Schedule the prescribed cardiac evaluations." "Allow the child to be active daily to increase joint range of motion." "Take the child's temperature twice daily."

"Aspirin therapy should be given daily for several months as prescribed." "The child should not receive any live vaccines for 6 months." "Schedule the prescribed cardiac evaluations." Explanation:Kawasaki disease is an acute febrile disease. It usually occurs in boys under the age of 5 years. The child runs high fevers for approximately 3 weeks before the other symptoms of strawberry tongue, cervical lymphadenopathy, edema of the hands and feet, and rash on the trunk develop. The child is very ill. The largest complication is cardiac involvement. Treatment is the administration of high-dose aspirin and the administration of intravenous immunoglobulin (IVIG). Aspirin is given up to 1 year after the acute illness. The parents will be taught to administer aspirin regularly and to be aware of any bleeding issues. Because the child has received IVIG, no live vaccines should be administrated for 3 to 6 months. The child should have regular echocardiograms and other cardiac evaluations regularly following discharge. The child should rest and not be active. Joint care should be passive. It is not necessary to take the child's temperature regularly.

The nurse reinforces home care instructions to the mother of a child recovering from Reye's syndrome. Which statement by the mother indicates a need for further teaching?

"I need to give frequent, small, nutritious meals if my child starts to vomit."

The parent of a 12-year-old child with Reye syndrome approaches the nurse wanting to know how this happened to the child, saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent?

"Sometimes it is hard to tell what products may contain aspirin."

A nurse is caring for an 8-yr-old child who has rheumatic fever. Which of the following assessments is the nurse's priority immediately after admission? 1. Auscultating the rate and characteristics of the child's heart sounds 2. Using a pain-rating tool to determine the severity of the joint pain 3. Identifying the degree of parental anxiety related to diagnosis 4. Assessing the client's erythematous rash

1. Auscultating the rate and characteristics of the child's heart sounds

Which diagnosis is related to the development of Reye's syndrome in conjunction with aspirin administration in the pediatric patient? 1. Varicella 2. Meningitis 3. Encephalitis 4. Strep throat

1. Varicella

A nurse is caring for a school-age client who possibly has Reye syndrome. Which of the following is arisk factor for developing Reye syndrome? A. Recent history of infectious cystitis caused by Candida B. Recent history of bacterial otitis media C. Recent episode of gastroenteritis D. Recent episode of Haemophilus influenzae meningitis

C. CORRECT: A recent episode of gastroenteritis, a viral illness, is a risk factor for Reye syndrome.Reye syndrome typically follows a viral illness, such as influenza, gastroenteritis, or varicella.

A nurse is caring for a child who is post/op following a surgical removal of a Wilms tumor. Which of the following assessments is an indication to continue NPO status? a. Abdominal girth 1 cm larger than yesterday b. Report of pain at the operative site c. Absent bowel sounds d. Passing of flatus every 30 mins

C. Indication that GI motility is absent and a reason to continue NPO status

True or false: for a Wilm's tumor, it is treated with chemo and radiation before surgery

False; more common to treat with surgery (nephrectomy) then chemo/radiation after

When caring for a child with Kawasaki disease, the nurse would know that:management includes administration of aspirin and IVIG.joint pain is a permanent problem.antibiotics should be administered every 8 hours by IV.steroid creams are used for the hand peeling.

management includes administration of aspirin and IVIG. Explanation:Kawasaki disease is an acute systemic vasculitis. It is the most common form of acquired heart disease in children. The treatment is directed to reduce the inflammation in the walls of the coronary arteries and prevent thrombosis. Children are given high-dose aspirin therapy four times a day and they receive an infusion of IV immunoglobulins (IVIG) to prevent cardiac complications. Joint pain is common but not necessarily a permanent problem associated with Kawasaki disease. Antibiotics and steroid creams are not used to treat this disorder.

A nurse is caring for a child who has Kawasaki disease. Which of the following systems should the nurse monitor in response to this diagnosis.

Cardiovascular Kawasaki disease--acute systemic vasculitis

ASO titer for child with suspected rheumatic fever

"This test will confirm if your child had a recent streptococcal infection" a blood test that measures anti-streptolysin O antibodies in the blood

The nurse is caring for a child hospitalized with Reye syndrome who is in the acute stage of the illness. The nurse would assess the child most carefully for what finding? - Indications of increased intracranial pressure - An increase in the blood glucose level - A presence of protein in the urine - A decrease in the liver enzymes

- Indications of increased intracranial pressure Rationale: Reye syndrome is characterized by brain swelling, liver failure, and death in hours if treatment is not initiated. Therefore, increased intracranial pressure could occur. Liver enzyme levels typically increase. Blood glucose levels and protein in the urine are not characteristic of this illness.

A nurse is providing teaching to the parent of a child who has neuroblastoma. Which of the following statements should the nurse include in the teaching?

-Chemotherapy and radiotherpay may be necessary for treatment -Your child will need a bone biopsy -Your child will need surgery for resection of the tumor

A nurse is teaching the parent of a child who has Wilm's tumor. Which of the following statements should the nurse include in the teaching? Select all apply

-Surgery is done usually within 48 hours of diagnosis -Palpating the tumor can cause spread of the tumor -Further treatment will start immediately after surgery

When administering corticosteroids to the child with rheumatic fever, which of the following should the nurse recognize as an important aspect of giving this classification of medications for this diagnosis? A)The drug should be stopped gradually by giving decreasing dosages. B)The drug will be given for the rest of the child's life. C)The drug should be taken for a full course, usually 10 days. D)The drug should be taken using a metered-dose inhaler

A)

A nurse is admitting a 9-year-old child who has acute rheumatic fever. When obtaining the client's history, it is appropriate for the nurse to ask the parent which of the following questions? 1. "Has your son had a sore throat recently?" 2. "Was your son born with this cardiac defect?" 3. "Has your child had any injuries recently?" 4. "Have you given your child aspirin in the past 2 weeks?"

1. "Has your son had a sore throat recently?" Rheumatic fever typically develops 2-6 wks after an untreated or ineffectively treated strep infection

the nurse is caring for a child diagnosed with a Wilms tumor. prior to treatment, the client is at highest risk for _____ which could cause_____ 1. trauma to the tumor/ anxiety/ or infection 2. delay in beginning of treatment/ separation from caregivers/ spread of the cancer

1. trauma to the tumor2. spread of the cancer

A child is diagnosed with Wilms' tumor. In planning teaching interventions, what key point should the nurse emphasize to the parents? A. Do not put pressure on the abdomen. B. Frequent visits from friends and family will improve morale. C. Appropriate protective equipment should be worn for contact sports. D. Encourage the child to remain active.

A

The nurse is caring for a child with rheumatic fever who has polyarthritis. What lab result would the nurse most anticipate with this child's diagnosis and symptoms?

Increased eythrocyte sedimentation rate (ESR)

A nurse is teaching to the guardian of a child who has Kawasaki disease. Which of the following statements by the guardian indicates an understanding of the teaching? SATA A. "My child will likely be irritable for the next few weeks." B. "I will notify my child's doctor if the skin on her hands or feet begins to peel." C. "I will ensure my child does not receive any live vaccinations for at least 18 months." D. "I will keep a record of my child's temperature until she has no fever for several days." E. "My child will have joint stiffness primarily at the end of the day."

ACD

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess? Hirsutism or striae Strawberry tongue Malar rash Café au lait spots

Strawberry tongue

A nurse is caring for an 18-month-old toddler who has Kawasaki disease (KD). The child is receiving intravenous immune globulin (IVIG). The guardian asks the nurse to administer the child's scheduled measles, mumps, and rubella (MMR) vaccine before discharge. Which of the following statements should the nurse provide? A. "Your child will not be able to receive the MMR vaccine for at least 3 months after discharge." B. "I cannot administer routine vaccines to children while they are in the hospital." C. "Your child can receive the MMR vaccine once his fever is gone." D. "I can administer the measles and rubella vaccines, but I cannot administer the mumps vaccine."

A

The nurse is caring for a child with Kawasaki disease who is receiving IV immunoglobulin. The child's parent wants to know why this treatment is required. The nurse explains that this therapy is given to: 1. Fight the infection. 2. Minimize rash. 3. Prevent heart disease. 4. Reduce spleen size.

3. Prevent heart disease.

Which of the following instructions would Nurse Courtney include in a teaching plan that focuses oninitial prevention for Sheri who is diagnosed with rheumatic fever? A. Treating streptococcal throat infections with an antibiotic B. Giving penicillin to patients with rheumatic fever C. Using corticosteroid to reduce inflammation D. Providing an antibiotic before dental work

A

The nurse is assessing a 4-year-old child who presents with hematuria and an abdominal mass. The parents report no other observable changes, and the child denies any complaints. Assessment reveals a firm, non-tender mass in the right upper quadrant of the abdomen. Based on this information, which condition should the nurse suspect? A. Wilms tumor B. Ruptured appendix C. Meckel's diverticulum D. Splenomegaly

A. Wilms tumor Wilms tumor (nephroblastoma) is the most common primary renal malignancy in children. The client is often asymptomatic, but hematuria is reported in 25% of cases. Physical examination typically reveals a firm, non-tender mass on one side of the upper abdomen or on either flank (although both kidneys may be affected).

When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of: A. valvular heart disease B. pulmonary hypertension C. superior vena cava syndrome D. hypertrophy of the right ventricle

A. valvular heart disease

the nurse is caring for a child with a Wilm's tumor. which assessment findings does the nurse anticipate? SATA a. hematuria b. hypertension c. abdominal mass d. vomiting e. unexplained bruising

A, B, C

A child has been diagnosed with Kawasaki disease. Which of the following signs and symptoms wouldthe nurse expect to see? A. Reddened and crusty eyes B. Vertigo C. Purpural rash over torso D. Diarrhea

A.

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? A. Administering penicillin B. Avoiding salicylates (aspirin) C. Imposing strict bed rest for 4 to 6 weeks D. Administering corticosteroids if chorea develops

A.

When caring for a client with rheumatic fever, the nurse formulates a nursing diagnosis of Activity intolerance related to reduced cardiac reserve and enforced bed rest. Before the nurse can eliminate this nursing diagnosis, the client must meet which outcome measurement criterion? A. Erythrocyte sedimentation rate returns to normal. B. Pulse doesn't rise above 150 beats/minute with activity. C. Temperature remains normal with salicylate administration. D. Pericardial friction rub is diminishing in intensity.

A. Erythrocyte sedimentation rate returns to normal.

the nurse has been asked to prepare the child for Wilms Tumor immediate surgery. which actions should the nurse take? SATA a. call report to the preoperative nurse b. educate caregiver about what to expect c. consult a child life specialist d. prepare surgical consent e. place child on organ transplant recipient list

ABCD

Expected findings in Kawasaki disease

Acute phase: onset of high fever that is unresponsive to antipyretics, with development of other manifestations. -Fever greater than 38.9 C (102 F) lasting 5 days to 2 weeks and unresponsive to antipyretics -irritability -red eyes without drainage -bright red, chapped lips -strawberry tongue with white coating or red bumps on the posterior aspect. -red oral mucous membranes with inflammation including the pharynx. -swelling of the hands and feet with red palms and soles-nonblistering rash-bilateral joint pain -enlarged lymph nodes -cardiac manifestations: myocarditis, decreased left ventricular function, pericardial effusion, and mitral regurgitation. Subacute phase: resolution of fever and gradual subsiding of other manifestations -irritability -peeling skin around the nails, on the palms and soles -temporary arthritis Convalescent No manifestations seen except altered lab findings. Resolution in about 6-8 weeks from onset.

The mother of a 4 year old child brings the child to the clinic and tells the pediatric nurse specialist that the child's abdomen seems to be swollen. During further assessment of the subjective data, the mother tells the nurse that the child has been eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of a Wilm's tumor, would avoid which of the following during the physical assessment? A. Palpating the abdomen for a mass. B. Assessing the urine for hematuria C. Monitoring the temperature for presence of fever D. Monitoring the blood pressure for presence of hypertension

B

The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever? A)"This disorder is caused by genetic factors." B)"Children who have this diagnosis may have had strep throat." C)"Being up to date on immunizations is the best way to prevent this disorder." D)"The onset and progression of this disorder is rapid."

B

A nurse is assessing a child who has neuroblastoma of the adrenal gland. Which of the following are manifestations of metastasis from the primary site? SATA a. Weight gain b. Bone pain c. Periorbital ecchymosis (panda sign) d. Proptosis (protrusion of eyeball) e. Weight loss

B, C, D, E

A nurse is caring for a child who was admitted with suspected rheumatic fever. The provider prescribes an anti-streptolysin O (ASO) titer. The parent asks the nurse the purpose of the test. Which of the following responses should the nurse make? A. "This test will indicate if your child has rheumatic fever." B. "This test will confirm if your child had a recent streptococcal infection." C. "This test will indicate if your child has a therapeutic blood level of an aminoglycoside." D. "This test will confirm if your child has immunity to streptococcal bacteria."

B.

Aspirin has been ordered for the child with rheumatic fever (RF) in order to: A. Keep the patent ductus arteriosus (PDA) open. B. Reduce joint inflammation. C. Decrease swelling of strawberry tongue. D. Treat ventricular hypertrophy of endocarditis.

B.

The nursing care plan for a toddler diagnosed with Kawasaki Disease (mucocutaneous lymph nodesyndrome) should be based on the high risk for development of? A. Pulmonary embolism B. Coronary artery aneurysms C. Vesicular rash D. Chronic arthritis

B.

A nurse is caring for a toddler who has a Wilms' tumor. Which of the following actions should the nurse take? A. Palpate the child's abdomen to identify the size of the tumor. B. Prepare the child for surgery. C. Teach the parents about dialysis. D. Obtain a 24-hour urine specimen from the child.

B. Prepare the child for surgery.

A nurse is caring for a child who has a Wilms' tumor. Which of the following actions should the nurse take? a. Palpate the child's abdomen to identify the size of the tumor. b. Prepare the child for surgery. c. Teach the parents about dialysis. d. Obtain a 24-hour urine specimen from the child.

B. Removal of the tumor occurs within 24-48 hours of admission

A nursing student is caring for a child with Wilms tumor. Which action by the student causes the faculty member to intervene? a. Assesses the urinary output per protocol b. Involves the parents in the childs care c. Palpates the abdomen in four quadrants d. Provides frequent nutritious snacks

C

A child is admitted to the hospital with a diagnosis of Wilm's tumor, Stage II. Which of the following statements most accurately describes this stage? A) The tumor is less than 3 cm. in size and requires no chemotherapy. B) The tumor did not extend beyond the kidney and was completely resected. C) The tumor extended beyond the kidney but was completely resected. D) The tumor has spread into the abdominal cavity and cannot be resected

C)

A nurse is teaching the parent of a child who has a Wilms' tumor. Which of the following statements should the nurse include in the teaching? SATA a. "Your child will need to have chemo for 12 months." b. "Wilms' tumors are typically genetic in nature." c. "Surgery is done usually within 48 hours of diagnosis." d. "Palpating the tumor could cause spread of the cancer." e. "Further treatments will start immediately after surgery."

C. "Surgery is done usually within 48 hours of diagnosis." D. "Palpating the tumor could cause spread of the cancer." E. "Further treatments will start immediately after surgery."

The nurse is reinforcing teaching with the caregivers of a child with rheumatic fever. What statement made by the caregivers best indicates an understanding of the treatment for this disorder? A)"She will be on a high sodium diet until the symptoms go away." B)"Keeping her involved in her regular sports activities will be important." C)"We don't let her watch TV, but while she is in bed we will let her watch some." D)"If she cuts herself, we know to keep that part of her body elevated above the heart."

C)"We don't let her watch TV, but while she is in bed we will let her watch some."

Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasakidisease (KD) states: A. "The arthritis in her knees is permanent. She will need knee replacements." B. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." C. "I know she will be irritable for 2 months after her symptoms started." D. "I will continue with high doses of Tylenol for her inflammation.

C.

The nurse is caring for a patient with rheumatic fever. The nurse anticipates which of the following laboratory values? A. Decreased erythrocyte sedimentation rate B. Decreased C reactive protein level C. Elevated antistreptolysin O titer D. Elevated red blood cell count

C.

A nurse is caring for a child who is postoperative following surgical removal of Wilm's tumor. Which of the following assessments is an indication to continue NPO status? A. Abdominal girth 1cm larger than yesterday B. Report of pain at the operative side. C. Absent bowel sounds. D. Passing of flatus every 30 min.

C. Absent bowel sounds

A 4-year-old has a right nephrectomy to remove a Wilms tumor. The nurse knows that it is essential to: A. Request a low-salt diet B. Restrict fluids C. Educate the family regarding renal transplants D. Prevent urinary tract infections

D

A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect: a. Gross hematuria b. Dysuria c. Nausea and vomiting d. An abdominal mass

D

David, age 15 months, is recovering from surgery to remove Wilms' tumor. Which findings best indicates that the child is free from pain? a. Decreased appetite b. Increased heart rate c. Decreased urine output d. Increased interest in play

D

In developing a plan of care for the child diagnosed with rheumatic fever, the nursing intervention, which is the highest priority for this child, is to: A)Position the child to relieve joint pain B)Monitor the C-reactive protein and ESR levels C)Provide age-appropriate diversional activities D)Promote rest periods and bed rest

D)

A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart from the identifiedsymptoms of the disease. she may also likely develop which of the following? A. Sepsis B. Meningitis C. Mitral Valve Disease D. Aneurysm Formation

D.

A 7-year-old child has been diagnosed with rheumatic fever. Which of the following physical findingswould the nurse expect to assess? A. Vesicular rash over the face and chest B. Yellow pigmentation of the sclerae of the eyes C. Palpable mass in the upper right quadrant of the abdomen D. Warm and swollen knees and elbows

D.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? A. Low blood pressure and decreased heart rate B. Decreased heart rate and impalpable pulse C. Irritability and dry mucous membranes D. Peeling hands and feet and fever

D.

When caring for a child with Kawasaki disease, the nurse should understand that: a. The child's fever is usually responsive to antibiotics within 48 hours. b. The principal area of involvement is the joints. c. Aspirin is contraindicated. d. Therapeutic management includes the administration of gamma globulin and aspirin.

D.

A nurse is preparing a nursing care plan for a child diagnosed with a Wilm's tumor. Which nursing care guideline is recommended as part of the preoperative plan for a child undergoing surgery to remove a Wilms tumor? A. Measure the abdomen every 6 hours B. Inform the child of potential side effects C. Wrap the abdomen with a secure brace D. Avoid palpating the abdomen

D. Avoid palpating the abdomen Preoperative guidelines for removal of a Wilms tumor include several special considerations. One such consideration involves avoid applying pressure to the abdomen. The Wilms tumor is often encapsulated and palpation of the abdomen should be avoided to prevent rupture and possible dissemination of cancer cells of the Wilm's tumor to adjacent areas.

The nurse is assessing a child admitted to the hospital with a diagnosis of rheumatic fever. Which significant question should the nurse ask the child's mother during the assessment?

Has any family member had a sore throat within the past few weeks?

The nurse is caring for a child with a Wilms tumor. Which assessment findings does the nurse anticipate? Select all that apply.​

Hypertension Hematuria Abdominal mass​

The nurse is caring for child who present to the emergency department with reports of a fever for 5 days. The nurse notes a diffuse maculopapular rash, reddened cracked lips, erythema of hands, and bilateral conjunctivitis and suspects Kawasaki disease. Which nursing action is priority? -Administer acetaminophen. -Initiate intravenous access. -Assess cervical lymph nodes. -Place the child on a soft diet.

Initiate intravenous access. A child with signs of Kawasaki disease is at risk for dehydration due to a prolonged fever and oral pain. The priority for the nurse is to establish intravenous access to begin IV fluids. Placing the child on a soft diet will be done after ensuring IV access. Pain is not a priority, and children with Kawasaki disease are given aspirin because of the anti-inflammatory properties of aspirin, instead of acetaminophen. Because the child already has the required four signs of Kawasaki disease, assessing cervical lymph nodes is minimally helpful and could be performed later.

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify what as an assessment finding?

Jerky movements of the face & upper extremities

The practical nurse (PN) is caring for a school-aged child with Reye's syndrome. What action is most important for the PN to implement?

Monitor intake and output

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? -Low blood pressure and decreased heart rate -Decreased heart rate and impalpable pulse -Irritability and dry mucous membranes -Peeling hands and feet and fever

Peeling hands and feet and fever Kawasaki disease is an acute sytemic vasculitis. Symptoms begin with very high fevers. One of the signs of Kawasaki disease is the peeling hands and feet and in perineal region.The child is usually tachycardic and laboratory values would indicate increased platelets and decreased hemoglobin. Another classic sign of Kawasaki is the strawberry tongue. The other symptoms are not necessarily characteristic of Kawasaki disease.The child should be evaluated if there are impalpable pulses because this could indicate a heart defect or some other serious illness.

The nurse is implementing the plan of care with acute rheumatic fever. What would the nurse expect to administer if ordered?

Penicillin Corticosteroids Nonsteroidal anti-inflammatory drugs

What is an appropriate nursing intervention for the child diagnosed with Kawasaki disease who is receiving high-dose aspirin therapy and reports joint pain? Administer ibuprofen to ease the joint pain. Call the healthcare provider and request a higher dose of aspirin. Disregard the complaints because the child is just irritable. Provide age-appropriate bed rest activities.

Provide age-appropriate bed rest activities. Explanation: Providing age-appropriate bed rest activities can act as a diversion to the joint pain that the child is having, and the bed rest serves as a comfort measure. Ibuprofen should not be administered to the child on aspirin therapy because it antagonizes the irreversible platelet inhibition that is induced by aspirin. The aspirin administered to a client with Kawasaki disease is administered for its antiplatelet effects, not to decrease joint pain. Therefore, requesting an increase in the aspirin dose would be inappropriate nursing care. Finally, the child's reports should not be disregarded.

The nurse assists with preparing a nursing care plan for a child who has Reye's syndrome. Which is the priority nursing intervention?

Providing a quiet atmosphere with dimmed lights

A nurse in a pediatric clinic is discussing the pathophysiology of Reye syndrome with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the disorder?

Reye syndrome causes fatty changes in the liver

CRASH and burn

Signs of Kawasaki disease Conjunctivitis Rash Arthritis Strawberry tongue Hands peeling Burn--uncontrolled high fever persisting longer than 5 days

The nurse is examining a 2 year-old child with a tentative diagnosis of Wilm's tumor. The nurse would be most concerned about which statement by the mother?

Wilm's tumor is a malignant tumor of the kidney that can lead to kidney dysfunction; therefore, a recent decrease in urinary output should be investigated further as it may be a sign of renal dysfunction. Increasing abdominal girth is a common finding in Wilm's tumor, but does not require immediate intervention by the nurse.

The nurse will administer what medication to children with Kawasaki disease both in the acute and later stages of the illness? penicillin aspirin intravenous immune globuliniron

aspirin Explanation:Aspirin is important in reducing the inflammation of Kawasaki disease as well as helping to limit platelet aggregation. Larger doses are given during the acute process and smaller doses during the convalescent period. Intravenous immune globulin (IVIG) is a medication given immediately on diagnosis. The other medications are not appropriate.

A 5 y/o has been diagnosed with Wilms tumor. What is the priority nursing intervention for this child? 1. educate the parents about dialysis, as the kidney will be removed 2. measure abdominal girth every shift 3. avoid palpating the child's abdomen 4. monitor BUN and creatinine every 4h

avoid palpating the child's abdomen (excessive papations of abdomen can cause seeding of tumor, leading to metastasis)

The nurse is caring for a child with Kawasaki disease in the acute phase. Which of the following clinical manifestations would the nurse expect to observe? a. Osler nodes b. Cervical lymphadenopathy c. Strawberry tongue d. Chorea e. Erythematous palms f. Polyarthritis

b. Cervical lymphadenopathy c. Strawberry tongue e. Erythematous palms

Which action by the school nurse is important in the prevention of rheumatic fever? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

c. Refer children with sore throats for throat cultures.