EXAM 3 ch32 1209-1227, 1231-1235, ch25 838-842, 844-852, 859-863, 872-876, ch16 505-508, ch8 245-249, ch31 1192-1206

Monosymptomatic enuresis

(most common) dry during the day

What steps should the nurse perform to maintain integrity of the capillary blood gas sample and results prior to taking the sample to the lab? (Select all that apply.)

- Deliver to the laboratory immediately after collecting the blood sample - Use heparized tubes for collecting the sample - Pack the blood samples in ice prior to transporting them to the lab - On the specimen label, document the client's temperature at the time the specimen is collected

What is the recommended position for the infant while awaiting surgery? pyloric stenosis

- Flat and supine with head of the crib slightly elevated

What nursing interventions and considerations are important regarding IV fluid administration with this infant? (Select all that apply)

- The IV infusion should be set up with an infusion pump and infusion tubing - Inspect the insertion for site patency and/or infiltration hourly - If an IV board is placed to stabilize the catheter, ensure the tape is not too tight

wounds classification

- superficial - partial thickness - full thickness - complex ( muscle and/or bone)

questions for parents about lesion

- when lesions or symptoms appeared first - whether it occurred with ingested food or other substance ( like meds) -wtheter condition was related to activity like contact with plants - if any other children in class or home have similar problems - if parents or siblings have a history of allergic reaction

ethnological factors of skin lesions

1. individual 2. age 3. social environment

the time it takes for a full blown reaction to occur in poison ivy

2 days the time it takes for a full blown reaction to occur in poison ivy, oak, and sumac, with redness, swelling, and itching at the site of contact

newborn pass meconium

24-36 hrs

Nursing care of the infant with eczema should focus on which action as a priority nursing intervention? 1. Keeping the infant content 2. Maintaining adequate nutrition 3. Applying antibiotic ointment to lesions 4. Preventing secondary infection of the lesions

4. Preventing secondary infection of the lesions

how long it takes for a child to develop sensetivity to a drug that had never been administered

7 days

Which clinical manifestations in children help to distinguish between hypoglycemia and hyperglycemia? Select all that apply. A child with hypoglycemia has sweating. A child with hypoglycemia has nausea and vomiting. A child with hyperglycemia has exaggerated reflexes. A child with hyperglycemia has deep, rapid breathing. A child with hyperglycemia has tachycardia and palpitations

A child with hypoglycemia has sweating. A child with hyperglycemia has deep, rapid breathing. Rationale In a child with hypoglycemia, sweating reflects increased adrenergic nervous system activity plus increased secretion of catecholamines. Deep and rapid respirations, or Kussmaul breathing, is a sign of diabetic ketoacidosis, which indicates that the child is hyperglycemic. Nausea and vomiting are common in a child with hyperglycemia. Children with hyperglycemia show diminished reflexes on neurologic evaluation. Children with hypoglycemia have tachycardia and palpitations.

McBurney's point

A point on the right side of the abdomen, about two-thirds of the distance between the umbilicus and the anterosupirior iliac spine bony prominence of the hip

diabetes monitoring/ glycosylated Hg

A1C - assess control of diabetes glucose attaches to red blood cells and stays there for the life of the red blood cells - app 120 days so it is average glucose lever over the past 2-3 months

The school nurse is assessing a child's severely scraped knee for infection. What are signs of a wound infection? (Select all that apply.) a. Odor b. Edema c. Dry scab d. Purulent exudate e. Decreased temperature

ANS: A, B, D Signs of wound infection are odor, edema, and purulent exudate. Increased, not decreased, temperature indicates infection. A dry scab over the wound is part of the healing process.

A toddler has a deep laceration contaminated with dirt and sand. Before closing the wound, the nurse should irrigate with what solution? a. Alcohol b. Normal saline c. Povidone-iodine d. Hydrogen peroxide

ANS: B Normal saline is the only acceptable fluid for irrigation listed. The nurse should cleanse the wound with a forced stream of normal saline or water. Alcohol is not used for wound irrigation. Povidone-iodine is contraindicated for cleansing fresh, open wounds. Hydrogen peroxide can cause formation of subcutaneous gas when applied under pressure.

Which radiographic examination could be used to examine gas patterns after complaints of abdominal pain? Abdominal flat plate Upper GI examination Barium swallow examination Computed tomography (CT) scan

Abdominal flat plate An abdominal flat plate would be used to examine gas patterns in a patient who complains of abdominal pain.

Which order is appropriate for a patient diagnosed with coccidioidomycosis, prescribed fluconazole 1 month ago, continues to complain of a cough, chest pain, and headache, and has a temperature of 100.1 oF? Administer intravenous amphotericin B. Administer acetaminophen as needed for fever. Have the patient begin isolation precautions at home. Notify emergency services for immediate transportation to the hospital.

Administer intravenous amphotericin B. Rationale Intravenous amphotericin B is usually given if there is no response to fluconazole or itraconazole for coccidioidomycosis (also known as Valley Fever). Acetaminophen may be needed for fever, but will not treat the coccidioidomycosis infection. Isolation precautions are not needed at home. Though the patient may need treatment at the hospital, emergency transport is not needed.

Which order is appropriate in the child that presents to the emergency room with redness, swelling, and infiltration of the cheek and a temperature of 102.8 oF? Oral antibiotics Topical antiseptic application Admission to the pediatric ward Gentle cleansing with silver nitrate

Admission to the pediatric ward Rationale An infection of the cheek that presents with redness, swelling, and infiltration are all characteristic of cellulitis. The fever is a systemic symptom, which would likely indicate the need for hospitalization. After admission the patient is likely to receive parenteral antibiotics, not oral antibiotics. Application of a topical antiseptic or silver nitrate would not be appropriate treatment for cellulitis.

Which enzyme in the pancreas is used to convert carbohydrates to disaccharides? Bile Pepsin Lipase Amylase

Amylase Amylase is an enzyme produced in the pancreas to convert carbohydrates to disaccharides.

A 2-year-old presents with two fluid-filled vesicles on the lips and mouth that have ulcerated and crusted. Which actions should the nurse take? Select all that apply. Assess the buccal mucosa Administer oral analgesic Notify provider immediately Obtain urine and blood cultures Assess patient's airway for patency

Assess the buccal mucosa When a 2-year-old presents with two fluid-filled vesicles on the lips and mouth that have ulcerated and crusted, the nurse should assess the buccal mucosa for additional lesions. Assess patient's airway for patency When a 2-year-old presents with two fluid-filled vesicles on the lips and mouth that have ulcerated and crusted, the nurse should assess the airway to ensure lesions are not impeding airflow.

The patient is managed with NPH and regular insulin before breakfast, lunch, and dinner. When is the patient most likely to experience a hypoglycemic reaction? Never Mid-day Before lunch Before breakfast

Before lunch Regular insulin peaks in 2-3 hours with duration of 8-10 hours. NPH insulin has onset of 2-4 hours. If too much a.m. insulin or not enough breakfast food is given, most likely time for a hypoglycemic episode is before lunch-regular insulin is at peak and NPH insulin has its onset, breakfast food has been metabolized.

Complications of DM

Complications of DM hypoglycemia, hyperglycemia, DKA, coma, hypokalemia, hyperkalemia, microvascular changes, cardiovascular changes

hirschsprung disease

Congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine more males absence of ganglion cells leading to loss of retrosphincter reflex and abnormal microenvironment, as well as lack of enteric nervous system stimulation and decrease in the internal sphincter's ability to relax

Based on Henry's weight of 4000gm prior to his dehydration state, what is the expected maintenance rate (per hour) prescribed by the HCP for the intravenous fluid? (Enter numerical value only. If round is required, round to the nearest hundredth)

Convert weight from gm to kg: 4000gm = 4kg First 0-10kg multiply by weight by 100mL: 4kg x 100mL = 400mL 400mL/24hrs = 16.66mL/hr

Which nursing intervention is appropriate when administering an intravenous sulfonamide antibiotic to a pediatric patient who is on day 8 of a 10-day regimen and complains of an upset stomach and an itchy rash on the face and upper chest? Notify the provider. Slow the infusion rate. Discontinue the infusion. Document the reaction in the client's chart.

Discontinue the infusion. Rationale An upset stomach and itchy rash are signs of a drug reaction, which can be immediate or delayed. The infusion must be stopped immediately. Next, the provider would be notified. The reaction would be documented, but the infusion would be discontinued first. It is not appropriate to simply slow the infusion rate due to the risk of a worsening drug reaction.

Which signs of a wound infection are appropriate for parents to report after their child received sutures? Select all that apply. Edema Erythema Foul odor Increased heart rate Decreased temperature

Edema Erythema Foul odor Rationale Signs of a wound infection include erythema, edema, purulent exudate, foul odor, pain, and increased body temperature. Increased heart rate and decreased temperature are not signs of a wound infection.

Food items to treat hypoglycemia

Food items to treat hypoglycemia 1. 1/2 cup Odor sugar sweetened carbonated 2. 8 oz milk 3. 1 small box of raisins 4. 3 or 4 hard candies 5. 4 sugar cubes 6. 3 or 4 lifesavers 7. I candy bar 8. 1 tsp honey 9. 2 or 3 glucose tablets

short acting (regular)

Humulin R, Novolin R reaches blood in 30 min peak 2-4 hrs stays in blood for 4-8 hrs

raptured appendix management

IV fluid and electrolytes , systemic antibiotics NG suctioni preoperatively postoperatively - IV fluids, antibiotics, NG suction for abdominal decompression NPO, listen bowel sound activity pain management dressing change when anelgesics are at peak wound drain - skin care and dressing change ( saline soaked) delayed wound closure to prevent wound infection sometimes if the wound left open - saline soak dressing and and wound irrigation with antibacterial solution

Match the digestive enzyme to the appropriate gastrointestinal location. Stomach Pepsin Pancreas Lipase Small intestine Enterokinase Gallbladder Bile

Match the digestive enzyme to the appropriate gastrointestinal location. Stomach Pepsin Pancreas Lipase Small intestine Enterokinase Gallbladder Bile

systemic mycoses

North American blastomycosis cryptococcosis histoplasmosis coccidiodomycosis

Which physical finding is consistent with the presence of petechiae on the patient's upper arm? Red bruising Pinpoint spots Reddened area Torn or jagged wound

Pinpoint spots Rationale Petechiae are pinpoint, tiny spots on the superficial layers of the skin. Red or purple bruising is also known as ecchymosis and is not an example of petechiae. Reddened areas are caused by increased oxygenated blood in the dermis and are documented as erythema. The term for torn or jagged wounds is lacerations.

abrasion

Removal of the superficial layers of skin by scraping

A child with gastroenteritis is receiving treatment for dehydration. Which assessment findings indicate treatment has been effective? Serum sodium 158 mEq/L Serum potassium 3.9 mEq/L Urine output of 100 mL in 4 hours Absence of skin breakdown on anus

Serum potassium 3.9 mEq/L A normal serum potassium level is between 3.5 and 5.0 mEq/L. A serum potassium of 3.9 is considered normal and would indicate effective treatment.

which of the following is a fungal infection that lives on the skin? a. tinea corporis b. herpes simplex type 1 c. scabies d. warts

a. tinea corporis

removal of cactus spines

apply a thin layer of water-soluble household glue and cover it with gauze; when the glue dries, peel off the gauze; apply hair removal wax or body sugar, let it dry, and remove; place cellophane tape sticky side down over the spines and lift it off

enuresis

bed wetting involuntary passage of urine in children who are beyond the age when voluntary bladder control should normally have been acquired

impetigo contagiosa (staph) signs

begins as a reddish macule, becomes vesicular, ruptures early, leaving superficial and moist erosion; tends to spread peripherally in sharply marginated irregular outlines; exudate dries to form heavy honey colored crusts; pruritus common; minimal or asymptomatic systemic effects; tends to heal without scarring unless secondary infection; autoinnocuable and contagious; common in toddlers and preschoolers; may be superimposed on eczema

Which substance is necessary for absorption of vitamins A, D, E, and K? Bile Chyme Insulin Amylase

bile Rationale Bile is necessary for absorption of vitamins A, D, E, and K. Insulin is a hormone that allows the body to use sugar (glucose) from carbohydrates. Amylase is the enzyme used to help break down carbohydrates. Chyme is the partially digested food and water secretions that are delivered to the small intestines.

type 2

body fails to use insulin properly and relative insulin deficiency - predominantly insulin resistant with relative insulin deficiency - predominantly deficient in insulin, with some insulin resistance

ecchymoses

bruises; localized red or purple discolorations caused by extroversion of blood into dermis and subcutaneous tissues

An important assessment for the nurse to perform in identifying cleft palate is to: a. assess sucking ability of infant. b. assess color of lips. c. palpate the palate with a gloved finger. d. do all of the above.

c. palpate the palate with a gloved finger.

trichotillomania

compulsive hair pulling

nursing care atopic dermatitis

controlling pruritus - keep nails short, clean cotton gloves, stockings, long pants and sleeves humidified rom tepid baths wet soaks medications for pruritus exessive use of topical steroids is hazardous diet modifications ( hypoallergenic)

How can you relieve pruritis or desire to itch?

cool affected are and increase skin pH (baking soda) antipruritics (Benadryl, Atarax)

scratching relief

cooling the area increasing skin pH baking soda or burow solution, tepid bath mittens in little kids, keep fingernail short, light clothing and natural fibers antipruritic benadryl/dephehedramine or hydroxizine/atarax

topical treatments

corticosteroid therapy, chemical cautery (for warts), cryosurgery, electrodesiccation, UV therapy, laser therapy, acne therapy such as dermabrasions and chemical peels, immunomodulators antibiotics

Which of the following is acceptable in providing postoperative care for the infant with a cleft lip or palate? a. Use of tongue depressor in the mouth to assess surgical site. b. Continuous elbow restraints to prevent injury. c. Placement of infant in the prone position after cleft lip repair. d. Position the infant to prevent airway obstruction

d. Position the infant to prevent airway obstruction

Skin in the infant and small child, as compared with skin in older children and adults: a. is tightly bound to the dermis. b. is less likely to have blister formation from an inflammatory process. c. is more likely to react to a sensitizing allergen than to a primary irritant. d. is more susceptible to superficial bacterial infection.

d. is more susceptible to superficial bacterial infection. more likely to react to a primary irritant than to a sensitizing allergen

preparation for home care GER

education caregivers about administering drugs., special feeding regime, gastrostomy care, postoperative care reflux controlled after surgery gastrostomy may be removed after several months

hypercalemia cardiac indication

elevated and spreading T wave and shortening of the Q-T interval

minimizing pain of blood glucose monitoring

hold finger under warm water use ringer finger pucture finger just to the side of the finger pad

when evaluate enuresis?

if inappropriate wetting happens at least twice a week for a minimum of 3 consecutive months

GER is due to

inappropriate transient relaxation of the LES

constipation

infrequent and difficult passage of dry hard stool

primary irritant

is one that irritates any skin

children 4 and older constipatio

less than 3 stools a week

constipation in infancy

may be related to dietary practices

clinical manifestation of enuresis

may or may not feel urgency if urgency is present, child reports difficulty to wake up spontaneous voiding

anorectal manometry

measures the pressure activity of internal and external and sphincters and reflexes during rectal distention, relaxation during straining, and rectal sensation

difference of normal colon and hirschsprung disease

normal - stool enters the rectum, internal sphincter relaxes and stool is evacuated HD - internal sphincter doesn't relax

histoplasmosis

not distinctive or uniform but most appear as punched out or granulomatous ulcers; systemic manifestations include pallor, diarrhea, vomiting, irregular spiking temperature, hepatosplenomegaly, and pulmonary symptoms; IV amphotericin B for severe cases, oral ketoconazole; organism cultured from soil, especially where contaminated with fowl droppings; fungus enters through skin or mucous membranes of mouth and respiratory tract; endemic is Mississippi and Ohio River Valleys; disseminated diseases most common in infants and children

consequences of pyloric stenosis

outlet obstruction compensatory dilation hypertophy hyperperistalsis of the stomach

Danphy sign

pain with coughing

constipation associated with

painful bowel movement blood streaked or retained stool abdominal pain lack of appetite stoll incontinence

Fundoplication

passage of the gastric fundus behind the esophagus to encircle the distal esophagus complications - wrap too tight causing dysphagia, small bowel obstruction, gas bloat, wrap too loose causing symptoms to continue

traditional gauze dressing

permeable dressing that reduces the moisture content in a wound by absorbing exudate and allowing it to evaporate

Geophagia

pica for clay and dirt

toxic to the wound

povidone-iodine alcohol hydrogen peroxide

celiac crisis

precipitated by fasting, infection, ingestion of gluten watery diarrhea and vomiting rapid dehydration, electrolyte imbalance and severe acidosis

mineral oil

prevent aspiration do not give kids under 1 yo

contact dermatits main goal

prevent further exposure of the skin to the offending substnace

therapeutic tretment of wounds

provide comfort (rest) protect from infection/spread of the condition) relief of discomfor

atopic dermatitis/ symptoms

pruritus lesions may bleed appears due to genetic and environmental factors can be controlled but not cured improve in humid climate, gets worse in the fall and winter

theories about pica

psychologic ( compulsive neurosis) nutritional ( craving caused by a nutritional deficiency)

common reactions to meds

rash exanthematous, urticarial, or eczematoid widespread drug eruption because it is circular agent itching, sudden onset, fever malaise, GI upset, anemia or liver and kidney damage fixed eruption - site of administration - purplish red round or oval plaque with sharp border, disappears slowly

rapid acting insulin ( novolog)

reaches blood 15 min after injection peak 30-90 min later lasts up to 5 hrs

indication for surgery in children with GER

recurrent aspiration pneumonia apnea severe esophagitis failure to thrive children who have failed to respond to medical therapy

vitamin B deficiency

results in decreased collagen formation

causes of dermatitis

rubbing in the diaper area, plants including poison ivy, oak, and sumac; animal irritants such as wool, feathers, and furs; metal such as nickel found in jewelry and the snaps on sleepers and denim; vegetable irritants such as oleoresins, oils, and turpentine; synthetic fabrics such as shoe components; dye, cosmetics, perfumes, and soaps, and many more

bees, wasp etc treatment

scrape off stinger or pull out cleanse with soap and water apply cool compress administer antihistamine for severe reaction - epinephrine, corticosteroids wear med bracelet

child with intugumentary disorder monitor

signs of a skin infection and systemic infection

gastroschisis

simple and complicated - bowel atresia, perforation, ischemia, necrosis

intrinsic causes

specific infection drug sensitization other allergic phenomena

therapeutic management of pyloric stenosis

surgical relief - pyloromyotomy preoperatively - rehydration, metabolic alkalosis corrected ( parenteral fluids and electrolytes) stomach decompression with NG if no disbalances - immediate surgery feeding 4-6 hrs postoperatively, starting with small frequent feeding of water or electrolyte solution; if clear liquids are tolerated 24 hrs after surgery - formula; amont and interval gradually increased until full schedule established ( app 48 hrs)

hyperphasphatemia signs

tetany muscle weakness dysrhythmias hypotension

distribution pattern

the pattern in which lesions are distributed over the body, whether localized or generalized, and the specific areas associated with the lesions

chronic wounds

those that do not heal in the expected time frame or are associated with complications

acute wounds

those that heal uneventfully within 2-3 weeks

povidine-iodine

toxic to white and red blood cells and fibroblasts

chlorhexidine

toxic to white blood cells

diagnostic evaliuation

ultrasound - characteristic heterogenous mass and a bull-eye rectal examination - mucus, blood and ocasionally a low intussusception

viral infection

verruca (warts) verruca plantaris herpes simplex varicella-zoster molluscum contagiosum

Types of wound healing-tertiary intention

when suturing is delayed after injury or the wound later breaks down and is sutured or resutured when granulation is present larger and deeper scar

The nurse is providing discharge teaching to the parents of a child with pyloric stenosis. Which statements, made by the parents, indicate that teaching was effective? Select all that apply. "After surgery, I will be allowed to change my child's diapers." "This condition will affect the way my child absorbs my breast milk." "I can't talk with my friends about my child's condition because they don't understand." "We will have to get a second job to afford the medication that will cure him." "I have the number for the support group the social worker gave me this morning, and I will call today."

"After surgery, I will be allowed to change my child's diapers." Parents should be allowed to participate in the care of their child when appropriate. "This condition will affect the way my child absorbs my breast milk." Parents should understand that malabsorption is a possibility for children with pyloric stenosis. "I have the number for the support group the social worker gave me this morning, and I will call today." Having a viable support system provides comfort while caring for the child and helps to reduce anxiety.

An adolescent patient was recently diagnosed with Type 2 DM. The nurse knows that learning has taken place when the child makes which statement related to prevention? "My dad has type 1 DM. This increases my risk of having diabetes." "Being overweight puts me at risk. Even if I lose weight, I cannot change this risk." "Being overweight with abnormal lipid levels increases my risk of having type 2 diabetes." "Being Native American puts me at risk for developing Type 2 DM. I should have HbA1c testing done on an annual basis."

"Being overweight with abnormal lipid levels increases my risk of having type 2 diabetes." Being overweight with two additional risk factors poses a risk. Dyslipidemia is one of those risk factors.

Which nursing reply is appropriate when a mother asks when her infant's eczema will go away? "By adolescence." "By 3 years of age." "Eczema never goes away." "After this course of medication."

"By 3 years of age." Rationale Infantile eczema usually begins at around 2 to 6 months of age and resolves spontaneously by the age of 3. Infantile eczema does not usually persist into adolescence. Eczema that begins in adolescence may persist into adulthood or indefinitely. Eczema will not be cured by a course of medication.

Which statement by the mother indicates the need for further education regarding the prevention of diaper dermatitis? "I should change the diaper as soon as it becomes wet or dirty." "Apply diaper ointment or a barrier cream with every diaper change." "I can use a hair dryer on low to gently dry the buttocks after a diaper change." "I should make sure to rinse cloth diapers thoroughly to get rid of excess detergent."

"I can use a hair dryer on low to gently dry the buttocks after a diaper change." Rationale Use of a hair dryer or heat lamp, even on low, can cause burns and would be avoided. Instead, the diaper can be removed and the skin allowed to air dry. The diaper would be changed as soon as it becomes wet or dirty. A diaper ointment or barrier cream would be applied with every diaper change. Parents using cloth diapers would be advised to rinse all detergent from the diapers when washing them.

While meeting with an adolescent to address diabetes management, which statement by the adolescent regarding compliance with insulin usage would be concerning to the nurse? "I don't really understand the risks/complications of hypoglycemia, but I can tell when my blood sugar is low and I need to eat a snack." "I roll out of bed 10 minutes before my ride comes in the morning. Sometimes I don't have time for breakfast." "I used to skip my insulin dose when going out with friends. Now that I am a senior in high school, I understand the risk of letting my blood sugars get too high." "After my freshman orientation yesterday, my mom talked to me about what I think about taking more responsibility with managing my diabetes."

"I roll out of bed 10 minutes before my ride comes in the morning. Sometimes I don't have time for breakfast." Even though adolescent with diabetes mellitus are functionally able to perform diabetes management tasks far sooner than they can cognitively understand the implications of the action or consequences of omitting the action, this behavior is cause for concern as the adolescent does not mention the need for either blood glucose monitoring or the need for breakfast.

A home care nurse is teaching a parent and 16-year-old patient with type 1 diabetes mellitus about insulin administration and rotating sites. Which statement, if made by the patient, would indicate effective teaching? "I rotate sites between areas of my abdomen and arms." "I will use a 90-degree angle of injection with a 1/2-inch needle." "Insulin is given parenterally because the taste of an oral pill is awful." "Since giving injections into my right abdomen is more comfortable to me, I will use that side routinely."

"I rotate sites between areas of my abdomen and arms." Sites are rotated to prevent areas of adipose hypertrophy (fatty lumps), which interfere with insulin absorption and decrease variation in absorption. Preferred sites include back of upper arms, top and outer portion of thighs, abdomen, and hip.

A parent is reporting that the child has redness and pus around the gastrostomy tube site. Which statement indicates that the parent has an adequate understanding of gastrostomy tubes? "The tube site is just irritated." "The tube site is properly healed by now." "I should apply antibiotics to the gastrostomy tube." "The skin is breaking down, and my child will need surgery."

"I should apply antibiotics to the gastrostomy tube." If the child has redness and pus around the site, an infection may be present. The parent's indication that antibiotics are necessary demonstrates an adequate understanding of gastrostomy tubes and how to manage them

Which parent statement indicates effective teaching by the nurse regarding poison ivy exposure? "Itching should stop by the third week." "The full reaction should be evident by the end of the first week." "My child should avoid touching other people or shared items until the itchiness passes." "I should expect redness, swelling, and itching where my child's skin came into contact with the plant."

"I should expect redness, swelling, and itching where my child's skin came into contact with the plant." Rationale Exposure to poison ivy causes redness, swelling, and itching at the site of contact. After a few days, oozing blisters will emerge. Itching should stop 10 to 14 days after contact. The full-blown reaction to poison ivy is usually present by the second day after exposure. The reaction to poison ivy exposure is not contagious; therefore it is not necessary to avoid touching others.

The nurse is teaching a parent how to care for a child's gastrostomy tube. Which statement, made by the parent, indicates successful patient teaching? Select all that apply. "I will clean the area with alcohol." "I will apply antimicrobial ointment if indicated." "It is not necessary to clean new gastrostomy-tube." "I will make sure the tube remains closed after surgery." "If crusty drainage appears, I will use half-strength hydrogen peroxide."

"I will apply antimicrobial ointment if indicated." Applying antimicrobial ointment if indicated is an appropriate care method for a new gastrostomy. "If crusty drainage appears, I will use half-strength hydrogen peroxide." Using hydrogen peroxide is an appropriate care method for a new gastrostomy.

The nurse is giving discharge instructions to the parents of a 6-month-old boy who has been diagnosed with gastroesophageal reflux disease (GERD). Which statement by one of the parents shows a correct understanding of how to care for the infant? "I will raise his head when he sleeps so he won't choke." "I will put him to sleep on his stomach to ease the pain from GERD." "I will lay him on his back and give him a pacifier to help him sleep." "I will lay him on his right side when he sleeps to ease the gastrointestinal pain."

"I will lay him on his back and give him a pacifier to help him sleep." The infant should be placed supine, flat on the back, to prevent sudden infant death syndrome (SIDS) A pacifier will help the infant with GERD sleep and learn how to swallow properly swallow.

A nurse is preparing the family of an infant who has undergone a pyloromyotomy for discharge. The infant is currently receiving electrolyte solution during feedings. Which statements by the parent suggest successful patient teaching to ensure an optimum outcome for the infant after surgery? Select all that apply. "A yellow discharge from the surgical site is normal." "I will offer my baby full-strength breast milk in a few days." "I will report gastrointestinal issues to the primary health care provider." "We do not breastfeed, so I will offer my baby full-strength formula in a few days." "A fever of less than 102° F is not cause for concern and can be treated with antipyretics."

"I will offer my baby full-strength breast milk in a few days." If the infant is breast fed, full-strength breast milk may be introduced after electrolyte solution has been given. Correct "I will report gastrointestinal issues to the primary health care provider." The parent must report excessive vomiting or abdominal tenderness to the health care provider, as it may indicate infection. Moreover, excessive vomiting may lead to dehydration and malnutrition.

Which statement indicates effective parent teaching for medication application of a child with eczema? "Keep fingernails short, clean, and filed frequently." "I can use any brand of body lotion as an emollient." "I should allow the skin to dry before applying an emollient." "Using polyester pajamas can help to relieve nighttime itching."

"Keep fingernails short, clean, and filed frequently." Rationale Keeping fingernails short and clean can help to prevent secondary infections because the child isn't able to scratch or break the skin while scratching. Emollients would be chosen carefully because some lotions can be drying to the skin. An emollient would be applied very shortly after bathing in order to keep the moisture retained in the skin. The child would wear lightweight cotton pajamas to minimize skin irritation.

The patient with Type 2 DM receives metformin (Glucophage). What statements would the nurse include when educating the patient about the drug? Select all that apply. "If your BUN level is 20 mg/dL, the metformin will be held." "You can take metformin three times daily without regard to food." "Given that you are taking metformin twice daily, you do not need to follow a diabetic meal plan." "If you have forgotten to take your metformin, you can take 2 doses at the next scheduled time." "Metformin does not cause the body to make more insulin. As such, it rarely causes low blood glucose when used alone." "Side effects like diarrhea, nausea, and upset stomach are mild but common, and should go away after your body gets used to the medications."

"Metformin does not cause the body to make more insulin. As such, it rarely causes low blood glucose when used alone." Since Metformin does not cause the body to make more insulin, it rarely causes low blood glucose (hypoglycemia) when used alone. Hypoglycemia may occur when Glucophage is taken in combination with insulin or other diabetes pills such as repaglinide (Prandin®), nateglinide (Starlix®) or sulfonylureas. Correct "Side effects like diarrhea, nausea, and upset stomach are mild but common, and should go away after your body gets used to the medications." Minor side effects from metformin (including mild diarrhea, nausea, or upset stomach) usually go away after the body gets used to taking the medicine for several weeks.

The nurse is meeting with an early school-age patient and parent to discuss management of the patient's Type 1 DM. The nurse understands that further teaching is needed when the parent makes which statement about the child's ability to participate in care? "My school-age child is involved in after-school sports. I need to be sure to pack an extra snack to prevent hypoglycemia." "A school nurse can help with testing blood sugars and draw up the appropriate dose of insulin. My child is not yet able to give herself injections." "Since my child is at school most of the day, she and I developed a diabetic management plan and presented it to her home room teacher." "My school-age child is not able to take part in diabetic management tasks yet. I check my child's blood glucose before and after school and give insulin as needed at those times."

"My school-age child is not able to take part in diabetic management tasks yet. I check my child's blood glucose before and after school and give insulin as needed at those times." The school child is able to participate in care. A school nurse or health aide should be identified to supervise before-lunch blood glucose monitoring and assist with insulin. This way the child does not feel singled out as needing special care. Since the parent does not understand this, further teaching is necessary.

The diabetes educator is meeting with a group of parents to discuss diabetes mellitus management. Many parents have questions about the role of the child. Together the diabetes educator and parents discuss ways to improve adherence with medication administration. The diabetes educator evaluates that learning has occurred when one parent makes which statements? "I can have my toddler take part in insulin administration by having them push the plunger on the insulin syringe". "My seventeen-year-old is focused on sports. She understands the need to independently manage her blood sugars to be able to be with her team for every game". "My school-age child is reluctant to take part in after-school activities. Having her bring pre-filled insulin syringes to activities and do the injections as scheduled may encourage her to participate". "My fourteen-year-old daughter is so influenced by her peers. If I get her best friend to talk to her about diabetes and insulin control, I know that she will adhere to the plan of checking blood sugars".

"My seventeen-year-old is focused on sports. She understands the need to independently manage her blood sugars to be able to be with her team for every game". The older adolescent is influenced by current needs, like being with friends, taking part in sports, etc. The older adolescent is able to recognize consequences of behaviors and choices and take charge of decisions.

During an exercise class for patients with type 2 diabetes, the nurse instructs the patients and parents on recommended daily activity. The nurse notes the need to reinforce teaching when a parent makes which statement? "My son spends hours outside drawing and then plays his video games in his room for no more than 40 minutes." "My child likes to play basketball outside with her friends for at least an hour after school. That only leaves her with about 30 minutes of TV time after dinner." "I like to take long walks with my son to the park down the street. We do this every day; it's great! It takes us over an hour, but we have a great time! He doesn't even miss the TV!" "Our daughter is on the school's swimming team. She practices daily from 3-6 p.m. About an hour before bed, we let her wind down with some cartoons or reading."

"My son spends hours outside drawing and then plays his video games in his room for no more than 40 minutes." Light physical activity is not enough activity for prevention and management of Type 2 diabetes mellitus. Recommended is at least 60 minutes of moderate to vigorous physical activity daily and less than 2 hours per day of "screen time" sedentary activities. This is not an appropriate activity level.

Which nursing response is appropriate for the parents of a child diagnosed with neurofibromatosis asking how the child got the disorder? "We don't know exactly what causes neurofibromatosis." "Neurofibromatosis is a genetic disorder caused when one parent carries the gene." "Neurofibromatosis is caused by an overreaction of the cells of the immune system." "Exposure to certain chemicals or substances can cause the symptoms associated with neurofibromatosis."

"Neurofibromatosis is a genetic disorder caused when one parent carries the gene." Rationale Neurofibromatosis is a genetic disorder that is inherited by an autosomal dominant pattern, which means that one parent has the gene and passes it along to the child. It is not accurate for the nurse to say the cause of neurofibromatosis unknown; it is caused by a genetic mutation. Neurofibromatosis is an inherited genetic disorder; it is not caused by an immune system dysfunction or exposure to chemicals.

During the health history assessment of a pediatric patient, the nurse would ask the caregiver which questions as part of the comprehensive gastrointestinal history? Select all that apply. "Did you use cloth or disposable diapers for the child?" "Do any extended family members follow a vegan diet?" "On average, what does your child eat in a typical day?" "Do any immediate family members have gastric ulcers?" "Have you noticed any change in your child's appetite or elimination?"

"On average, what does your child eat in a typical day?" As part of a comprehensive health history of the gastrointestinal system, the nurse would ask for the typical diet of the patient. "Do any immediate family members have gastric ulcers?" The nurse should ask whether there is a family history of gastrointestinal disorders, including gastric ulcers. "Have you noticed any change in your child's appetite or elimination?" As part of a comprehensive health history of the gastrointestinal system, the nurse would ask about any change in intake or output; identified changes would warrant follow up.

The nurse is teaching the parents of a child with encopresis about potential symptoms. Which statement by the parents indicates teaching was effective? "We need to buy special lotion to combat the dry skin." "Our child's feces will have a very foul odor most of the time." "My child will have a lot of pain from straining to pass stools." "We can expect our child to vomit some blood after overeating."

"Our child's feces will have a very foul odor most of the time." Encopresis occurs when stool collects in the colon and rectum as a result of the child holding in bowel movements. This stool may leak out and produce an unpleasant odor without the child necessarily being aware of it.

Which statement does the nurse include in teaching for the parents of a child with diabetes regarding insulin injections? "Pinch the skin when injecting insulin." "Keep the needle at 30 degrees to the skin." "Inject insulin into the same area each time." "Inject insulin either into the abdomen or the thigh."

"Pinch the skin when injecting insulin." Rationale The nurse should teach that pinching will tent the skin and allow easy access of the needle to the subcutaneous tissue. The injection needle should be at 90 degrees to the skin. Insulin absorption is slowed by fat pads that develop in overused injection areas. Therefore the parents and child should be taught to work out a rotation pattern to inject into various areas of the body and enhance absorption. Insulin can be injected into any area where there is adipose tissue over muscle. The usual injection sites for insulin injections are the arms, thighs, hips, and abdomen.

Which nursing response is appropriate when advising parents who removed a tick from their 8-year-old child? "Please go to the nearest emergency room." "I'll speak to the doctor about prophylactic antibiotics." "Your child will need an immediate appointment with an infectious disease specialist." "Please monitor your child for a bull's-eye rash or signs of a viral infection for the next 30 days."

"Please monitor your child for a bull's-eye rash or signs of a viral infection for the next 30 days." Rationale People who self-remove a tick would monitor for signs of early Lyme disease. They would be instructed to promptly report a bull's-eye rash (erythema migrans) or signs of a viral infection or "flulike" illness. Treatment in the early stages of Lyme disease can help prevent the disease from reaching later stages. Going to the nearest emergency room, prophylactic antibiotics, and consultation with an infectious disease specialist are not the first actions to be taken after removing a tick.

Which nursing advice is appropriate for parents to help their child manage nocturnal enuresis? "Reduce your child's fiber intake." "Use diapers to avoid bedwetting and sleep disturbance." "Start tapering down liquids in the evening and nighttime." "Encourage the child to clean the sheets if a nighttime accident occurs."

"Start tapering down liquids in the evening and nighttime." Rationale A child who is wetting the bed can liberally drink water during the daytime, but would be encouraged to drink less liquid after 4 pm so that the child does not go to sleep with a full bladder. The parents would not put their young child in a diaper to sleep because this will not help break the habit and diapers increase the risk of rash and infection. Constipation may contribute to enuresis. Therefore the nurse would encourage the parents to provide a high-fiber diet and encourage their child to have bowel movements on a regular basis. The parents would not ask the child to clean the sheets after a bedwetting incident, because it may feel like a punishment.

A nurse is providing patient teaching to a couple whose infant has just had surgery for cleft lip. What information does the nurse provide regarding feeding to ensure the child receives adequate nutrition? Select all that apply. "Feed the infant with a straw." "Stop feeding frequently to burp." "Feed the infant in an upright position." "Use a syringe with a rubber tip for feedings." Withhold feeding for 12 hours after the surgery.

"Stop feeding frequently to burp." Burping the infant frequently will help eliminate excess air that is swallowed and enhance the feeding. "Feed the infant in an upright position." Feeding the infant in the upright position will allow gravity to assist in the feeding and decrease the likelihood that the child might choke. "Use a syringe with a rubber tip for feedings." A syringe with a rubber tip can be used to feed the child after surgery.

A parent calls the nurse line, reporting that the child with diabetes is nauseated and vomiting. What is the priority statement the nurse will include in the instructions to the parent? "Hold the regular dose of insulin." "Allow the child to decide what to eat." "Test the blood glucose level frequently." "Encourage active engagement in activities."

"Test the blood glucose level frequently." The nurse will tell parent to test blood glucose level every 3-4 hours or more often if hypoglycemic or hyperglycemic. Testing blood glucose will help parent monitor child's illness and let them know what actions to take.

The blood glucose level of a diabetic child on insulin therapy shows a rise at bedtime and a drop at 2 AM with a rebound rise after that. Which statement by the nurse is most appropriate? "The nocturnal insulin dose may need to be reduced." "The home treatment for this condition includes glucagon therapy." "The morning hyperglycemia is due to a phenomenon called insulin waning." "The health care provider may advise omission of insulin to treat this condition."

"The nocturnal insulin dose may need to be reduced." Rationale The nurse should teach the parents that the child has a type of morning hyperglycemia that can be treated by decreasing the nocturnal insulin dose to prevent the 2 AM hypoglycemia. Glucagon is prescribed as a home treatment for hypoglycemia, rather than morning hyperglycemia. Insulin waning is a progressive increase in blood glucose levels from bedtime to morning in which the child has a type of morning hyperglycemia called rebound hyperglycemia, or the Somogyi effect. The nurse should teach that omission of insulin is never advised, even during illness; an alteration in the insulin dose may be advised if needed.

When providing education to the parents of a toddler with Type 1 DM, the nurse should include which statement related to hypoglycemia? "The toddler is at great risk for severe hypoglycemia; be sure that you have a predetermined meal plan for every day and stick to it." "The toddler has varied intake from day to day. Better to allow for more food choices and work toward carbohydrate consistency." "The toddler can be fussy with respect to food. Minimize the battle by allowing the toddler to be in charge of selecting what to eat for each meal." "Toddlers are "spur of the moment" patients. Being flexible with checking blood glucose levels and giving insulin will limit the potential of on-going battles with care."

"The toddler has varied intake from day to day. Better to allow for more food choices and work toward carbohydrate consistency." A diet strategy that stresses carbohydrate consistency rather than specific food groups offers more flexibility to encourage adequate intake on the part of the toddler. Achieving consistency in dietary intake can be difficult in the toddler. Inconsistent intake, particularly of carbohydrates, contributes to blood glucose level variability.

The caregivers of a child with cleft lip ask the nurse how to decrease feeding difficulties associated with the condition. Which is the best response from the nurse regarding optimizing feeding of the child? "Stop breastfeeding." "Use a nipple with small hole." "Use a long nipple for feeding your child." "Make sure your child is lying flat during feedings."

"Use a long nipple for feeding your child." Using unique nipples and feeders specially designed for infants with cleft lip will assist the parents in decreasing feeding difficulties for infants with cleft lip.

The nurse is preparing to discharge a 10-month-old with diagnosed Herpetic Gingivostomatitis. Which statement, made by the parents, indicates that home care teaching was effective? "Our children like to share a bed most nights." "If she doesn't want to drink anything, that's alright." "She really loves to suck her thumb before she goes to sleep." "We need to wash the bottles and eating utensils in the dishwasher after every feeding."

"We need to wash the bottles and eating utensils in the dishwasher after every feeding." Children with Herpetic Gingivostomatitis can spread the disease and get recurring lesions if bottles, cups, and other utensils are not washed in hot, soapy water or the dishwasher after each use.

Which statement by the parents indicates effective nurse teaching of how to change a child's wound dressing? "Black eschar tissue is a normal part of healing." "We should use a dry gauze to cover the wound." "We need to use Povidone-iodine solution to clean the wound." "We should change the dressing when it becomes soiled."

"We should change the dressing when it becomes soiled." Rationale The frequency of dressing changes will vary according to many factors, but dressings would always be changed whenever they are loose or soiled. Black eschar tissue is not a normal part of healing. The presence of black eschar tissue will interfere with healing; therefore it usually needs to be removed. Moist dressings are preferred to promote wound healing, as dry dressings keep the wound bed dry and can adhere to the dried scab, which disturbs the healing environment. Povidone-iodine solution does little to control infection and is known to have cytotoxic effects on healthy cells.

A 7-year-old presents with scaling and several round, hairless patches on the scalp. Which statements, made by the parents, indicate that teaching on treatment was effective? Select all that apply. "We should give the oral medication with milk." "Infant shampoo should be used daily for 6 weeks." "The oral medicine should be given for at least 6 weeks." "Topical therapy will not be enough to get rid of the infection." "My children will continue to share their combs and barrettes."

"We should give the oral medication with milk." Scaling and areas patches on the scalp are indicative of tinea capitis. Oral griseofulvin is the most common treatment, and it should be given with a high-fat meal or milk for better absorption. "The oral medicine should be given for at least 6 weeks." Scaling and areas patches on the scalp are indicative of tinea capitis. Oral griseofulvin is the most common treatment, and it should be given daily for at least 6 weeks. "Topical therapy will not be enough to get rid of the infection." Scaling and areas patches on the scalp are indicative of tinea capitis. Topical therapy will not cure the infection.

The nurse is caring for a 5-month-old with red, coalesced skin in the diaper region. After educating the parents on treatment, which statements indicate to the nurse that teaching was effective? Select all that apply. "We will apply nystatin cream with each diaper change." "I will give the oral antibiotic for 10 days to treat the infection." "I will be sure to wash my hands before every diaper change." "The medication should be given with milk or applesauce." "We will add a nonabsorbent pad to the crib mattress and leave the diaper area open to air."

"We will apply nystatin cream with each diaper change." Red, coalesced skin in the diaper region indicated a candida infection. Parents should be taught to apply nystatin cream to the affected area with each diaper change. "We will add a nonabsorbent pad to the crib mattress and leave the diaper area open to air." Red, coalesced skin in the diaper region indicated a candida infection. Parents should be taught to leave the diaper area open to air for improved healing.

A nurse is caring for a child with crusted lesions on the upper torso and arm related to impetigo. Topical therapy has been initiated. Which statement, made by the parents, indicates a need for further teaching? "My child will be on medication for almost 2 weeks." "We will only have to use this ointment for a couple days." "I will allow my other child to sleep in my room for a few nights." "She will have to stay home from school until after we begin treatment."

"We will only have to use this ointment for a couple days." Two days is not enough time for the antibiotic ointment to take effect. It will be used for several days to weeks. This statement indicates the need for further teaching.

The adolescent patient and parent have completed diabetic education. Which statements by the parent would indicate an understanding of the goals of insulin therapy for diabetic management? Select all that apply. "Insulin replenishes the insulin-producing cells, the beta cells." "Insulin decreases insulin resistance and improves insulin sensitivity." "We will schedule the insulin to correspond to the child's usual meal times." "Insulin is used to balance blood glucose, independent of food intake and physical activity." "Insulin replaces the insulin the child is no longer able to make in an acceptable physiologic pattern."

"We will schedule the insulin to correspond to the child's usual meal times." This schedule, to correspond to the child's usual meal times, is in place to minimize the possibility of hypoglycemia. This is a correct goal of insulin therapy. "Insulin replaces the insulin the child is no longer able to make in an acceptable physiologic pattern." The goal of insulin therapy is to replace the insulin the child is no longer able to make in an acceptable physiologic pattern. The beta cells in the pancreas no longer produce/secrete insulin. This is a correct goal of insulin therapy.

The nurse is educating parents of a 2-month-old breastfed infant diagnosed with thrush. Which statement, made by the mother indicates the need for further teaching? "I will use this cream on my breasts for about a week." "We will wash our hands before and after every feeding." "We need to bring the baby in in about 6 weeks for blood work." "I will make sure my baby takes most of the bottle with each feeding."

"We will wash our hands before and after every feeding." The mother of a breastfed infant diagnosed with thrush should be taught that handwashing is important, but will not be sufficient to prevent recurrent infections.

Which nursing questions are appropriate when interviewing a family whose infant was recently diagnosed with eczema? Select all that apply. "How is the child's appetite?" "What does the child eat on a daily basis?" "Is there a family history of atopic dermatitis?" "Do you see the child scratching the skin frequently?" "How are you coping or managing with having a child with eczema?

"What does the child eat on a daily basis?" "Is there a family history of atopic dermatitis?" "Do you see the child scratching the skin frequently?" "How are you coping or managing with having a child with eczema? Rationale Assessing a child with eczema (and the family) includes questions about potential dietary factors, family history, and family coping skills or patterns. It also helps to ask about the child's behavior, including scratching frequency and irritability. Appetite is not a relevant factor in the assessment of children with eczema.

Which questions are appropriate to include when assessing for enuresis? Select all that apply. "What kind of medications does the child take?" "How do you respond when bedwetting occurs?" "How long does the child stay away from home?" "What kind of medical tests have been performed earlier?" "How often does the child complain of nausea or headache?"

"What kind of medications does the child take?" "How do you respond when bedwetting occurs?" "How long does the child stay away from home?" "What kind of medical tests have been performed earlier?" Rationale The nurse needs to determine the factors that are causing enuresis in the child. Questions about medication history will help to determine whether the child has any other medical conditions such as diabetes mellitus or sickle cell disease that may be causing urinary incontinence. Questions about the child staying out of the house will help to determine whether the child is facing any emotional stressors. Questions related to medical tests help to determine if the child has any urinary tract infection that may be causing enuresis. Asking the parents how they deal with the child's bedwetting is important, as punishments such as scolding or threatening are likely to have a negative emotional impact. Nausea and headache are not related to enuresis. These may be caused by taking anticholinergic drugs to reduce uninhibited bladder contractions.

The nurse is providing nutrition education to a patient newly diagnosed with Type 1 Diabetes Mellitus. The patient states, "I should have a glass of orange juice with a teaspoon of sugar if I feel lightheaded, cool, and clammy mid-morning." Which statement is the best response by the nurse? "No, 4 oz. of 100% orange juice will not have an immediate effect." "Yes, 4 oz. of 100% orange juice will quickly help to treat hypoglycemia." "Yes, 4 oz. of 100% orange juice is needed for long-term maintenance of blood glucose." "No, 4 oz. of 100% orange juice has too much sugar, a snack of cottage cheese and 7 whole grain crackers is a better option."

"Yes, 4 oz. of 100% orange juice will quickly help to treat hypoglycemia." The choice of 4 oz. of 100% orange juice is a good option when blood glucose falls during day. Hypoglycemia can be treated immediately with 15 g of easily digested (simple) carbohydrates. In 15 minutes, if symptoms are not relieved or blood glucose is 80 mg/dL or lower, repeat treatment.

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and instead take pills as an uncle does. What is the most appropriate response by the nurse? "The pills only work with an adult pancreas." "The drugs affect fat and protein metabolism, not sugar." "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." "Perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

"Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." Rationale In type 1 diabetes, the beta cells have been destroyed. It is necessary to supply the insulin no longer produced by these cells. The oral medications have different modes of action that supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes and are primarily used in type 2 diabetes mellitus. Oral hypoglycemics can supplement insulin production by the pancreas, decrease insulin resistance, or affect the liver production of glucose. In type 1 diabetes, without a pancreatic beta-cell transplant, it is unlikely that insulin would be produced.

A patient has type 1 diabetes mellitus and receives insulin. The patient asks the nurse why she cannot take pills instead. What is the best explanation by the nurse? "You will be able to use pills during what we call the honeymoon phase." "Your pancreas is unable to secrete an adequate amount of insulin." "You can take pills, but they are better to reserve for sick days when your blood glucose is variable." "You lost the ability to make insulin because of autoimmune destruction of the insulin-producing cells, the alpha cells."

"Your pancreas is unable to secrete an adequate amount of insulin." The child with Type 1 diabetes mellitus is unable to produce and secrete adequate amount of insulin. Beta cells in pancreas have been destroyed by inflammation. Medications like Metform, a biguanide, do not increase level of insulin in body, but increase sensitivity of muscle to insulin.

Interventions for intussusception

*1. Monitor for S/S of perforation and shock AEB fever, increased heart rate, changes in LOC or BP, and respiratory distress 2. ABX, IV fluids, and decompression via NG suctioning *3. Monitor for the passage of normal, brown stool, which indicates that the intussusception has reduced itself 4. Prepare for hydrostatic reduction as rx, if no signs of perforation or shock occur 5. Posthydrostatic reduction a. monitor for return o normal bowel sounds, passage of barium, and the characteristics of stool b. Admin clear fluids and advance the diet gradually as Rx 6. If surgery is required post op care is similar to that following any abdominal surgery.

Data collection: pyloric stenosis

*1. Vomiting that progresses from mild regurgitation to forceful and projectile that usually occurs after a feeding. 2. Vomitus contains gastric contents such as milk or formula. It may contain mucus, may be blood-tinged, and does not usually contain bile. 3. Hunger and irritability *4. Peristalic waves visible from left to right across the epigastrium during or immediately after a feeding. *5. Olive-shaped mass in the epigastrium just right of the umbilicus. 6. Dehydration and malnutrition 7. Electrolyte imbalance 8. Metabolic acidosis

What are the correct actions to ensure the integrity of the lab specimen and results for this client? (Select all that apply.)

- Ensure the specimens are labeled as soon as obtained prior to leaving the procure room - Verify the label of the specimen with the client's identification bracelet - Verify with the parent that the information on the identification bracelet is correct

Na 132 Cl 89 K 3.3 Bicarb 30

- Hyponatremia - Hypochloremia - Hypokalemia

The HCP prescribes Cefazolin to be give prophylactically 30 minutes prior to surgery. Based on the infants wt of 4000 gm, what dose is administered prior to surgery?

- Infant weight is 4000 gm = 4 kg 25 mg/kg therefore = 25mg x 4kg = 100 mg

The pharmacy dispenses a 60 mL syringe labeled NS with 100mg of Cefazolin. What rate should the nurse set the syringe infusion pump to infuse the prescribed medication? (Enter numerical value only. If rounding is required, round to the nearest whole number)

- Infusion rate = volume of fluid/time in hrs - Volume = 60ml - Time = 30mins (i.e 0.5hrs) - Rate = 60ml / 0.5hr = 120ml/hr

What are important interventions the nurse can provide to promote the best outcome for Henry and his parents? (Select all that apply)

- Keep the parents informed of their son's treatment plan of care throughout his hospitalization - Cluster the delivery of care to minimize disruption of the infants' sleep pattern - Allow the parents to participate as much as possible in their son's care - Communicate age appropriately with the client and parents

pH 7.58 PCO2 40 PO2 90 HCO3 35 O2 96% Base excess +1

- Metabolic alkalosis

What are appropriate nursing diagnosis based on the client's presenting signs, symptoms, and history?pyloric stenosis

- Parental anxiety related to the infant's health - Potential for alteration in electrolytes related to history of vomiting after feedings - At risk for aspiration related to vomiting episodes after feedings - At risk for malnutrition related to vomiting after each feeding

What nursing interventions and considerations are necessary regarding the placement of the intravenous catheter in a scalp vein? (Select all that apply.)

- Place the bore of the needle in the direction of the feet of the infant - Ensure the constricting band is place near the brow of the scalp, avoiding the eye sockets - Palpate the vessel for a pulse to insertion of the intravenous catheter

Based on the history provided by the parents, what is the most significant date relevant to the signs and symptoms described and/or observed? (select all that apply) pyloric stenosis

- The infant was treated with an antibiotic at 2weeks of age - Father has history of surgery for spitting up at 2months of age

Which statement is true about signs and symptoms of projectile vomiting? pyloric stenosis

- This condition may cause dehydration

What additional questions should the nurse ask the parents? (select all that apply) pyloric stenosis

- When did the episode of vomiting after feedings start? - Does the father smoke in rooms where the baby is present? - What type of work did the mother perform while pregnant?

List three etiologic factors that can result in lesions of the skin in children.

- contact with injurious agent - hereditary factors - systemic disease with cutaneous manifestations

Esophageal Atresia and Tracheoesophageal Fistula

- esophagus terminates before it reaches the stomach , ending in a blind pouch , and/or a fistula is present that forms an unnatural connection with the trachea -The condition causes oral intake to enter the lungs or a large amount of air to enter the stomach. Choking, coughing, and severe abdominal distention occurs. -Aspiration pneumonia and severe respiratory distress will develop, and death will occur without surgical intervention -Treatment includes maintenance of patent airway, prevention of pneumonia, gastric or blind pouch decompression, supportive therapy, and surgical repair.

List the signs of wound infection.

- increased erythema, especially beyond wound margin - edema - purulent exudate - odor - pain at wound/beyond margin - increased temperature

treatment for organic causes of constipation/ phase 1: clean-out and disempaction ( 3-5 days)

- oral clean out for children under 4 yo - high dose mineral oil - polyethilene glycol - magnesium hydroxide enema - milk and molasses - normal saline solution - microlax, mineral oil, hypertonic phosphate nasogastric lavage ( hospitalization) - polyethylene glycol electrolyte solution

what causes impetigo?

-B-hemolytic streptococci or staphylococci

impetigo

-a contagious bacterial infection of the skin that occurs most commonly during hot, humid months

medications used for eczema

-antihistamines -topical corticosteroids -immunomodulators -antibiotics for secondary infection

how should topical corticosteroids for eczema be administered?

-apply in a thin layer and rub into area thoroughly -apply over an extensive area

why are children who suffer from burn injuries at an increased risk for cardiovascular problems?

-because of their higher proportion of body fluid to body mass

interventions for impetigo

-contact isolation (standard precaution)- very contagious, hand washing, separate linnnens, dishes, towels, which should be washed in hot water with detergent separately -allow lesions to dry by air exposure - daily bathing with antibacterial soap -apply warm saline or other compresses to lesions 2-3x daily, followed by warm soap and water to remove crusts and allow healing- may use Burow's solution -topical antibiotics with a sterile swab, ( infection is communicable 48 hrs after starting antibiotics) - oral antibiotics if topical dont help -use emollients to prevent skin cracking

what is pediculosis capitis?

-head lice - egges (nits) close to scalp, intubation 7-10 days - lice can survive 48 hrs away from host - nits shed in the environment can hatch 7-10 days after

clinical manifestations of impetigo

-lesions that begin as vesicles or pustules surround by edema and redness -lesions progress to an exudative and crusting stage -then the initially serous vesicular fluid becomes cloudy and the vesicles rupture, leaving honey-colored crusts covering ulcerated bases -can have secondary lymph node involvement

most common sites of impetigo

-on the face -around the mouth -on hands, neck, and extremeties

when can impetigo occur?

-poor hygiene -secondarily at a site that has been injured or at an insect bite -at a site that was originally a rash, such as atopic dermatitis, poison ivy, or poison oak

therapeutic management of cleft

-surgical closure of the cleft -prevention of complications -facilitation of normal growth and development of the child

how are head lice transmitted?

-through direct contact -indirect contact- sharing of hats, towels, etc

what are the major goals of the management of eczema?

-to relieve pruritus -lubricate the skin -reduce inflammation -prevent or control secondary infections

inflammation process (3-5 days after injury)

-transient constriction of transsected blood vessels - active vasodilation of all local small vessels and increased blood flow to the area - increased permeability of small venules - plasma leaks into surrounding tissue ( edema) - blood clot around edges provides framework for future growth of capillaries - vessels line up with leukocytes (neutrophils), they pass through walls and concentrate at the injuried site to digest bacteria and debris - macrophages continue neutrophills's job - fibroblasts come from blood vessels to deposit fibrin - adjacent capillaries form buds and stretch across the supporting fibrin threads

controlling diaper rash

-use superabsorbent disposable diapers -changes diapers often -expose irritated skin to air not heat -apply opintent ( zinc oxide, petrolatum) -avoid removing skin barrier cream with each diaper change, remove waste and reapply skin barrier - use mineral oil to remove zinc oxide - avoid overwashing skin - gently wipe stool from skin using a soft cloth and warm water use disposable wipes

list 4 major goals of atopic dermatitis management

1, skin hydration 2. relief of pruritus 3. reduce flare-ups 4. prevent secondary infections

Which patient is at highest risk to develop Type 2 Diabetes Mellitus? 10-year-old Caucasian child whose father has Type 1 diabetes mellitus 5'10" 200 lb 18-year-old male taking atenolol daily, who walks 2 miles a day Overweight 16-year-old African American woman taking diphenhydramine daily 1-year-old Asian American female whose parents have Type 2 diabetes mellitus, taking one atorvastatin daily

1-year-old Asian American female whose parents have Type 2 diabetes mellitus, taking one atorvastatin daily This individual has three risk factors: family history (2) of diabetes, race, on antilipid medication (indicating a cardiac condition).

A child is diagnosed with Hirschsprung's disease. The nurse is teaching the parents about the cause of the disease. Which statement, if made by the parent, supports that teaching was successful? 1. "Special cells are not present in the rectum, which caused the disease." 2. "The protein part of wheat, barley, rye, and oats is not being digested fully." 3. "The disease occurs from increased bowel motility that leads to spasm and pain." 4. "The disease occurs because of inability to tolerate sugar found in dairy products."

1. "Special cells are not present in the rectum, which caused the disease."

premix insulin

1. 1. inject measured amount of air ( same as dosage) into long acting 2. inject measured amoun of air into rapid acting without removing the needle 3. withdraw clear insulin 4. insert the needle with clear insulin into the long acting amn withdraw

diagnostic evaluation of diabetes

1. 8 hrs fasting blood glucose level of 126 mg or more 2. a random blood glucose value of 200 mg or more accompanied by classic signs of diabetes 3. oral glucose tolerance test finding 200 mg or more in 2 hr sample 4. Hg A1C of 6.5% or more

A nurse has provided dietary instructions to the mother of a child with celiac disease. The nurse determines that the mother understands the instructions when the mother states to include which food in the child's diet? 1. Corn 2. Wheat cereal 3. Rye crackers 4. Oatmeal biscuits

1. Corn

Hirschsprung interventions medical management

1. Low fiber high cal high protein diet parenteral nutrition may be necessary in extreme situations 2. Administer stool softeners as Rx 3. Administer daily rectal irrigations with NS to promote adequate elimination and prevent obstruction

Preop for appendectomy

1. Maintain NPO 2. IV fluids and electrolytes 3. Monitor for signs of ruptured appendix and peritonitis 4. Monitor for changes in the level of pain, signs of raptured appendix and peritonitis 5. avoid pain meds because they mask the symptoms 6. antibiotics administer 6. Monitor the bowel sounds *7. Position the child in a right side lying or low to semi fowlers position to promote comfort 8. Apply ice packs to the abdomen for 20-30 minutes every hour if Rx *9. Avoid the application of heat to the abdomen and the administration of laxatives or enemas because of the risk of perforation

Pre-op interventions atresia and fistula

1. Maintain in a supine upright position to facilitate drainage and prevent aspiration of gastric secretions 2. place infant in radiant warmer in which humidified oxygen is administered intubation and mechanical ventilation may be needed 3. NPO, IV fluids 4. monitor respiratory status 5. suction secretions 6. keep the blind pouch empty of secretions by intermittent or continuous suction, monitor patency 7. leave gastrostomy tube open so air can escape, minimizing risk of regurgitating 8. broad spectrum antibiotics due to risk of pneumonia

Post-op atresia and fistula

1. Monitor VS 2. Assit in maintaining IV fluids, ABX, and nutrition 3. Monitor strict I/O 4. Monitor daily weight- dehydration FVO 5. Monitor for signs of pain 6. Maintain chest tube patency 7. Inspect surgical site for signs and symptoms of infection 8. Monitor for anatomic leaks AEB purulent drainage from chest tube, increased temp, and increased WBC count 9. If a gastrostomy tube is present, it is usually attached to a gravity drainage until the infant can tolerate feedings and the anastomosis is healed then feeding prescribed 10. Before oral feedings and removal of the chest tube, assist to prepare for an esophageal as Rx to check the integrity of esophageal anastomosis. 11. Before feeding, the gastronomy tube is elevated and secured above the level of the stomach to allow gastric secretions to pass the duodenum and swallowed air to escape through the open gastronomy tube. 12. Assist to administer oral feedings with sterile water, followed by frequent small feedings of formula as prescribed. 13. Check the cervical esophagostomy site, if present, for redness, breakdown, or exudate. Remove accumulated drainage frequently and apply protective ointment, barrier dressing, and or/collection device as Rx 14. Pacifier for NPO 15. Teach parents suctioning, gastrostomy tube care, and feedings, and skin site care 16. Instructions to the parents to identify behaviors that indicated the need for suctioning, signs of respiratory distress, and signs of a constricted esophagus (poor feeding, dysphagia, drooling, coughing during feedings, regurgitated undigested food)

Post-op interventions Hirschsprungs

1. Monitor VS 2. Measure abdominal girth daily 3. Check the surgical site for redness, swelling, and drainage 4. Check the stoma if present for bleeding or skin breakdown 5. Check the anal area for the presence of stool, redness or discharge 6. Maintain NPO status until bowel sounds return or farts 7. Maintain the NG tube to allow intermittent suction 8. Maintain IV fluids until the child tolerates oral intake 9. Monitor for dehydration and fluid overload 10. Monitor for strict intake and output 11. Obtain daily weight 12. Monitor for pain and provide comfort measures as required 13. Reinforce instructions to the parents regarding colostomy care and skin care 14. Reinforce teaching the parents about the appropriate diet and the need for adequate fluid intake.

Interventions for DKA

1. Monitor potassium level closely because when the child receives insulin to lower the blood glucose level, the serum potassium level will change; if potassium level decreases potassium replacement may be required 2. Child should be voiding adequately before administering potassium; if the child does not have an adequate output, hyperkalemia may result.

Interventions for Gastroesophageal reflux

1. Monitor the amount and characteristics of the emesis 2. Monitor the relationship of the vomiting to the times of feedings and infant activity. 3. Monitor the breath sounds before and after feedings. 4. Monitor for signs of aspiration, such as drooling, coughing, or dyspnea following feeding 5. Place suction equipment at bedside 6. Monitor I/O 7. Monitor for signs and symptoms of dehydration 8. Assist to maintain the IV fluids as prescribed 9. Complications of GERD include esophagitis, esophageal strictures, aspiration of gastric contents, and aspiration pneumonia

Surgical management: Pre-op Hirschsprung

1. Monitor the bowel function and administer bowel preparations, as Rx 2. Maintain NPO status 3. Monitor hydration and fluid and electrolyte status. IV fluids may be Rx for hydration 4. Administer ABX or colonic irrigations with an antibiotic solution as prescribed to clear the bowel of bacteria 5. Monitor strict I/O and weight 6. Measure the abdominal girth 7. Avoid taking rectal temps 8. Monitor for respiratory distress associated with abdominal distention

Pre-op interventions pyloromyotomy

1. Monitor the hydration status by checking the daily weights, I/O, and urine for specific gravity 2. Correct fluid and electrolyte imbalances IV fluids may be Rx for rehydration 3. Maintain NPO 4. Monitor the number and character of stools 5. Maintain the latency of the NG tube that is placed for stomach decompression

Post-op Interventions appendectomy

1. Monitor the temp for signs of infection 2. Maintain NPO status until bowel function returns 3. Monitor the incision for signs of infection, such as redness, swelling, drainage, and pain 4. Monitor penrose drain for drainage, which may be inserted if perforation occurred *5. Position in a right side-lying or low to semi-Fowler's position with the legs slightly flexed to facilitate drainage. 6. Change the dressing as prescribed 7. Perform wound irrigation 8. Maintain NG tube suction and the latency of the tube 9. antibiotics and analgesics

Gastroschisis

1. Occurs when the herniation of the intestine is lateral, usually on the right, of the umbilical ring. *2. There is no membrane covering the bowel *3. The exposed bowel is loosely covered in saline soaked pads, the abdomen is loosely wrapped in plastic drape. Wrapping around the exposed bowel is contraindicated, b/c if the exposed bowel expands the wrapping could cause pressure and necrosis. 4. Preoperatively: Care is similar to that for omphalocele. Surgery is performed within several hours after birth, because there is no membrane covering the sac. 5. Postoperatively: Most infants develop a prolonged ileus and require mechanical ventilation and parenteral nutrition. Otherwise care is similar to that for omphalocele.

Omphalocele

1. Occurs when there is a herniation of the abdominal contents through the umbilical ring, usually with an intact peritoneal sac. 2. The protrusion is covered by translucent sac that may contain bowel or other abdominal organs *3. Rupture of the sac results in the evisceration of the abdominal contents. Immediately after birth, the sac is covered with sterile gauze soaked in normal saline to prevent drying of the abdominal contents. A layer of plastic wrap is placed over the gauze to provide additional protection against heat and moisture loss. 4. Monitor the VS q 2-4 hrs. Temp is particularly important because the infant can lose heat through the sac. 5. Preoperatively: Maintain NPO status. IV fluids will be prescribed to maintain hydration and electrolyte balance. Monitor for signs of infection and handle the infant carefully to prevent rupture. 6. Postoperative: Control pain, prevent infection, maintain fluid and electrolyte balance, and ensure adequate nutrition.

Data Collection: Appendicitis

1. Pain in periumbilical area that descends to the RLQ. 2. Abdominal pain that is most intense at McBurney's point 3. Reffered pain that indicated the presence of peritoneal irritation 4. Rebound tenderness and abdominal rigidity 5. Elevated WBC count 6. Side-lying position with abdominal guarding to relive pain 7. Difficulty walking and pain in the right hip 8. Low-grade fever 9. Anorexia, N/V after pain develops 10. Diarrhea

*Data Collection: DM

1. Polyuria, polydipsia, polyphasic 2. Hyperglycemia 3. Weight loss 4. Unexplained fatigue or lethargy 5. Headaches 6. Occasional enuresis in a previously toilet trained child 7. Vaginitis in adolescent girls 8. Fruity odor to breath 9. Dehydration 10. Blurred vision 11. Slow wound healing 12. Changes in the LOC

The nurse is developing a plan of care for an infant after surgical intervention for imperforate anus. The nurse should include in the plan that which position is the most appropriate one for the infant in the postoperative period? 1. Prone position 2. Supine with no head elevation 3. Side-lying with the legs extended 4. Supine with the head elevated 45 degrees

1. Prone position

Postoperative interventions Cleft lip repair

1. Provide lip protection; a metal appliance or adhesive strip may be taped securely to the cheeks to prevent trauma to the suture line *2. Avoid positioning the child on the side of the repair on in the prone position because these position can cause rubbing of the surgical site on the mattress 3. Keep surgical site clean and dry; after feeding, gently cleanse the suture line of formula or serosanguineous drainage with a solution such as normal saline or as designated by agency procedure. 4. Apply ABX ointment to the site as prescribed 5. Elbow restraints should be used to prevent the infant from injuring or traumatizing the surgical site. 6. Monitor for signs and symptoms of infection at the surgical site.

Which interventions should the nurse include when preparing a care plan for a child with hepatitis? Select all that apply. 1. Providing a low-fat, well-balanced diet. 2. Teaching the child effective hand-washing techniques. 3. Scheduling playtime in the playroom with other children. 4. Notifying the health care provider (HCP) if jaundice is present. 5.Instructing the parents to avoid administering medications unless prescribed. 6.Arranging for indefinite home schooling because the child will not be able to return to school.

1. Providing a low-fat, well-balanced diet. 2. Teaching the child effective hand-washing techniques. 5. Instructing the parents to avoid administering medications unless prescribed.

The clinic nurse is obtaining data about a child with a diagnosis of lactose intolerance. Which data should the nurse expect to obtain on assessment? 1. Reports of frothy stools and diarrhea 2. Reports of foul-smelling ribbon stools 3. Reports of profuse, watery diarrhea and vomiting 4. Reports of diffuse abdominal pain unrelated to meals or activity

1. Reports of frothy stools and diarrhea

The nurse provides home care instructions to the parents of a child with celiac disease. The nurse should teach the parents to include which food item in the child's diet? 1. Rice 2. Oatmeal 3. Rye toast 4. Wheat bread

1. Rice

The nurse is caring for a 1-year-old child after cleft palate repair. On completion of feeding, the nurse should plan for which appropriate nursing action? 1. Rinsing the mouth with water 2. Cleaning the mouth with diluted hydrogen peroxide 3. Using a soft lemon and glycerin swab to clean the mouth 4. Using cotton swabs saturated with half-strength povidone-iodine (Betadine) solution to clean the mouth

1. Rinsing the mouth with water

Urine Testing (DM)

1. Second voided urine specimen is the most accurate 2. Ketone may predict an upcoming ketoacidosis 3. Urine testing in unreliable for glucose level; however, the urine should be tested for ketone when the child is ill or when the glucose level is greater than 200 mg/dL

Post-op Cleft repair all

1. Soft elbow or jacket restraints may be used to keep child from touching the repair site; remove restraints at least every 2 hours to check skin integrity and circulation and to allow for exercising the arms *2. Avoid use of oral suction or placing objects in the mouth such as a tongue depressor, thermometer, straws spoons, forks, pacifiers. 3. Provide analgesics for pain as rx 4. Reinforce instructions in feeding techniques and in the care of surgical site 5. Monitor site for infection, instruct parents to do the same. 6. Encourage the parents to hold the child 7. Initiate appropriate referrals such as a dental referral and speech therapist

The clinic nurse is reviewing the health care provider's prescription for a child who has been diagnosed with scabies. Lindane has been prescribed for the child. The nurse questions the prescription if which is noted in the child's record? 1. The child is 18 months old. 2. The child is being bottle-fed. 3. A sibling is using lindane for the treatment of scabies. 4. The child has a history of frequent respiratory infections.

1. The child is 18 months old.

List the steps for obtaining capillary blood serum in order from first step to last step

1. The heel is warmed with a warm, moist compress for 5 to 10 minutes 2. The nurse determines the appropriate site for puncturing the warmed heel 3. The area of the heal to be punctured is cleansed with an alcohol pad 4. The first drop of blood should be wiped away with sterile cotton gauze 5. The heel is gently squeezed and released in a milking fashion to obtain the specimen 6. Pressure is applied to the puncture site until bleeding has stopped 7. A bandaid is place over the puncture site

The clinic nurse is assessing jaundice in a child with hepatitis. Which anatomical area would provide the best data regarding the presence of jaundice? 1. The nail beds 2. The skin in the sacral area 3. The skin in the abdominal area 4. The membranes in the ear canal

1. The nail beds

*Diabetes Mellitus

1. Type 1 DM is characterized by the destruction of the pancreatic beta cells, which produce insulin. This results in absolute insulin deficiency. 2. Type 2 DM usually arises as a result of insulin resistance, in which the body fails to use insulin properly, in combination with relative insulin deficiency. 3. Insulin deficiency requires the use of exogenous insulin to promote appropriate glucose use and glucose levels, such as hyperglycemia, DKA and death. 4. Dx is based on the presence of classic symptoms. 5. Children may be admitted directly in to the PICU because of the manifestations of DKA, which may be the initial occurrence when they are diagnosed with DM

constipation assessment

1. abdominal pain and cramping without distention 2. palpable movable fecal masses 3. normal or decreased bowel sounds 4. malaise and headache 5. anorexia, nausea, vomiting

negative effects of dry dressing

1. allows wound surface to dray 2. does little to prevent bacterial invasion 3. adheres to the dried scab and removal disturbs the newly regenerating epithelial cells

assessment findings pediculosis capitis

1. child scratches scalp excessively 2. pruritus is caused by crawing insects and their saliva 3. nits are observable on the hair shaft 4. adult lice are difficult to see an appear as small tan or grayish specks, which may crawl quickly

contaxt provider regarding diabetes during illenness if

1. child vomits more than once 2. if blood glucose level remains above 240 mg 3. if urinary ketones remain high

skin lesion orgins

1. contact with injurious agents (infective organisms, toxic chemicals, and physical trauma) 2. hereditary factors 3. external factors (allergens) 4. systemic diseases (measles, lupus erythematosus, nutritional deficiency diseases)

constipation and encopresis interventions

1. maintain a diet high in fiber and fluids 2. monitor treatment regimen for severe encopresis for 3-6 months 3. decrease sugar and milk intake 4. administer enemas until impaction is cleared 5. monitor for hypernatremia or hyperphosphatemia when administering enemas 6. administer stool softeners or laxatives 7. encourage child to sit on the toilet for 5-10 min app 20-30 after breakfast and dinner to assist with defecation

Post-op interventions pyloromyotomy

1. monitor I/O 2. Begin small, frequent feedings post as Rx 3. Gradually increase amount and interval between feedings until a full feeding schedule has been reinstated. *4. Feed the infant slowly, burping frequently, and handle the infant minimally after feedings. 5. Monitor for abdominal distention 6. Monitor the surgical wound and for signs of infection 7. Reinforce instructions to the parents about wound care and feeding.

GER assessment

1. passive regurgitation or emesis 2. poor weight gain 3. irritability 4. hematemesis 5. heartburn 6. anemia from blood loss

3 most frequent causes of contact ermitits

1. plant 2. animal 3 metal

dressing functions

1. provide a moist healing environment 2. protect the wound from infection and trauma 3. provide compression in the event of anticipated bleeding or swelling 4. apply medication 5. absorb drainage 6. debride necrotic tissue 7. reduce pain 8. control odor

which of the following is the most common symptom of atopic dermatitis ( eczema) 1. pruritus 2. lichenified plaques 3. hyperpigmentation 4. vesicula lesions

1. pruritus

Blood glucose monitoring for DM

1. results provide information needed to maintain good glycemic control 2. Blood glucose monitoring is more accurate than urine testing 3. Requires that the child prick himself or herself several times a day, as rx 4. Reinforce instructions to the child and parents in the proper procedure for obtaining the blood glucose level. 5. Inform the child and parents that the procedure must be performed precisely to obtain accurate results 6. Stress the importance of hand washing before and after the procedure to prevent infeciton 7. Stress the importance of following instructions 8. Reinforce instructions to the child and parents to check for expiration date on the test strips used for blood glucose monitoring. 9. Calibrate the monitor as instructed 10. If results seem unreasonable reread, retest

considerations for topical therapy

1. the choice of active ingredient 2. the proper vehicle or base 3. the cosmetic effect 4. the cost 5. instructions for use 6. family preference

The HCP prescribes acetaminophen 80 mg every 4 to 6 hours for fussiness and irritability. Base on the available medication, what is the correct dose for the infant? (Enter numerical value only. If rounding is required, round to the nearest tenth)

160 mg = 5 mL 80 mg = x mL Cross multiply and divide: answer 2.5 mL

Which time correctly explains when the cleft lip is usually repaired? Immediately 2 to 3 months old 6 to 12 months old 12 to 24 months old

2 to 3 months old Rationale A cleft lip is repaired usually between 2 to 3 months. Cleft palate is often repaired between 6 to 12 months old.

surgical correction/cleft lip

2-3 months old free of any oral respiratory, or systemic infection techniques to repair - Millard, Tennison-Randall, Fisher sometimes nasal alveolar molding or taping of the upper lip done before surgery

The nurse is verifying that a mother understands how to care for her infant who has thrush. Which comment by the mother would indicate that further teaching is indicated? 1. "I will feed my baby before I apply the medication." 2. "I can put the medication in my son's bottle for him to drink." 3. "I need to thoroughly clean all bottles and nipples after every use." 4. "I will slowly put the medication in each cheek of my baby's mouth."

2. "I can put the medication in my son's bottle for him to drink."

The nurse in the hospital is giving at-home feeding instructions to a family whose child is being discharged after being born with a cleft lip. Which statement by the mother would indicate that further teaching is indicated? 1. "I am so glad that I am able to breast-feed my baby." 2. "I must always feed my baby with a syringe and not use a nipple." 3. "I will burp my baby very frequently so that she does not swallow a lot of air." 4. "I will feed my baby while sitting in a chair and holding her more upright."

2. "I must always feed my baby with a syringe and not use a nipple.

The nurse caring for a child who sustained a burn injury plans care based on which pediatric considerations associated with this injury? Select all that apply. 1. Scarring is less severe in a child than in an adult. 2. A delay in growth may occur after a burn injury. 3. An immature immune system presents an increased risk of infection for infants and young children. 4. The lower proportion of body fluid to mass in a child increases the risk of cardiovascular problems. 5. Fluid resuscitation is unnecessary unless the burned area is more than 25% of the total body surface area. 6. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults.

2. A delay in growth may occur after a burn injury. 3. An immature immune system presents an increased risk of infection for infants and young children. 6. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults.

A 2-year-old child with acute diarrhea has been diagnosed with mild dehydration. Which rehydration methods would the nurse expect the health care provider to prescribe? 1. Increase intake of water with a diet high in carbohydrates. 2. Consume oral rehydration fluid, advancing to a regular diet. 3. Begin the BRAT diet (bananas, rice, apples, and toast or tea). 4. Begin fluid replacement immediately with intravenous fluids.

2. Consume oral rehydration fluid, advancing to a regular diet.

The nurse is writing out discharge instructions for the parents of a child diagnosed with celiac disease. The nurse should focus primarily on which aspect of care? 1. Restricting activity 2. Following a gluten-free diet 3. Following a lactose-free diet 4. Giving medication to manage the condition

2. Following a gluten-free diet

The mother of an infant diagnosed with Hirschsprung's disease asks the nurse about the disorder. What should the nurse tell the mother about the disease? 1. It is complete small intestinal obstruction. 2. It is congenital aganglionosis or megacolon. 3. It is severe inflammation of the gastrointestinal tract. 4. It is condition that causes the pyloric valve to remain open.

2. It is congenital aganglionosis or megacolon.

A child admitted to the hospital with a diagnosis of gastroenteritis and dehydration weighs 17 pounds 2 ounces. The parents state that his preadmission weight was 18 pounds 4 ounces. Based on weight alone, what type of dehydration does the nurse expect? 1. Mild dehydration 2. Moderate dehydration 3. Severe dehydration 4. Acute dehydration

2. Moderate dehydration

The nurse is monitoring a child with burns during treatment for burn shock. The nurse understands that which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation? 1. Skin turgor 2. Neurological assessment 3. Level of edema at burn site 4. Quality of peripheral pulses

2. Neurological assessment

An infant is seen in the health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and is gaining weight but seems to never get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child? 1. Administer predigested formula. 2. Prepare the family for surgery for the child. 3. Administer omeprazole (Prilosec) before feeding. 4. Instruct the parents to keep a log of feedings and any reflux present.

2. Prepare the family for surgery for the child

The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the mother about the child's symptoms? 1. Watery diarrhea 2. Projectile vomiting 3. Increased urine output 4. Vomiting large amounts of bile

2. Projectile vomiting

The nurse is developing a plan of care for an infant being admitted with hypertrophic pyloric stenosis who is scheduled for pyloromyotomy. In the preoperative period, which position should the nurse suggest to document in the plan of care? 1. In an infant seat placed in the crib 2. Prone with the head of the bed elevated 3. Supine with the head at a 90-degree angle 4. Supine with the head of the bed at a 30-degree angle

2. Prone with the head of the bed elevated

The nurse is caring for a newborn infant after surgical intervention for imperforate anus. The nurse should place the infant in which position in the postoperative period? 1. Supine with no head elevation 2. Side-lying with the legs flexed 3. Side-lying with the legs extended 4. Supine with the head elevated 30 degrees

2. Side-lying with the legs flexed

The nurse is developing a plan of care for a 10-year-old girl with an exacerbation of eczema. Which problem should be addressed in the care for this child? 1. The client is at risk for infection related to viral lesions. 2. The client is at risk for infection related to scratching of pruritic lesions. 3. The client may have poor nutritional intake related to throat edema and mouth ulcers. 4. The client may have a negative body image related to the presence of thick, white crusty plaques over the elbows and knees.

2. The client is at risk for infection related to scratching of pruritic lesions.

A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition? 1. "Are the stools ribbon-like and is the infant eating poorly?" 2. "Does the infant suddenly become pale, begin to cry, and draw the legs up to the chest?" 3. "Does the vomit contain sour undigested food without bile, and is the infant constipated?" 4. "Does the infant cry loudly and continuously during the evening hours but nurses or takes formula well?"

3. "Does the vomit contain sour undigested food without bile, and is the infant constipated?"

A nurse reinforces instructions to the mother of a child diagnosed with pediculosis (head lice). Permethrin 1% (Nix) has been prescribed. Which statement by the mother regarding the use of the medication indicates a need for further teaching? 1. "I need to purchase the medication from the pharmacy." 2. "After rinsing out the medication, I need to avoid washing my child's hair for 24 hours." 3. "I need to shampoo my child's hair, apply the medication, and leave the medication on for 24 hours." 4. "I need to shampoo my child's hair, apply the medication, and leave it on for 10 minutes and then rinse it out."

3. "I need to shampoo my child's hair, apply the medication, and leave the medication on for 24 hours."

The nurse is providing instructions to the parents of a child with a hernia regarding measures that will promote reducing the hernia. The nurse determines that the parents understand care for their child if they make which statement? 1. "We will encourage our child to cough every few hours on a daily basis." 2. "We will make sure that our child participates in physical activity every day." 3. "We will provide comfort measures to reduce any crying periods by our child." 4. "We will be sure to give our child a Fleet enema every day to prevent constipation."

3. "We will provide comfort measures to reduce any crying periods by our child."

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1. Incessant crying 2. Coughing at nighttime 3. Choking with feedings 4. Severe projectile vomiting

3. Choking with feedings

The parents of a child with a cleft lip are concerned and ask the nurse when the lip will be repaired. With which statement should the nurse respond? 1. Cleft lip cannot be repaired. 2. Cleft-lip repair is usually performed by 6 months of age. 3. Cleft-lip repair is usually performed during the first weeks of life. 4. Cleft-lip repair is usually performed between 6 months and 2 years.

3. Cleft-lip repair is usually performed during the first weeks of life.

A nurse is reviewing the health care provider's documentation in the record of a child admitted with a diagnosis of intussusception. The nurse expects to note that the health care provider has documented which manifestation? 1. Scleral jaundice 2. Projectile vomiting 3. Currant jelly stools 4. Pale-colored and hard stools

3. Currant jelly stools

The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? 1. Hold the next dose of insulin. 2. Come to the clinic immediately. 3. Encourage the child to drink liquids. 4. Administer an additional dose of regular insulin.

3. Encourage the child to drink liquids. When the child is sick, the mother should test for urinary ketones with each voiding. If ketones are present, liquids are essential to aid in clearing the ketones. The child should be encouraged to drink liquids. Bringing the child to the clinic immediately is unnecessary. Insulin doses should not be adjusted or changed.

The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder? 1. Bile-stained fecal emesis 2. The passage of currant jelly-like stools 3. Failure to pass meconium stool in the first 24 hours after birth 4. Sausage-shaped mass palpated in the upper right abdominal quadrant

3. Failure to pass meconium stool in the first 24 hours after birth

Which statements about constipation are correct? Select all that apply. Constipation can be a chronic disease process. Constipation with fecal stooling is called encopresis. Most children have no underlying cause identified for constipation. Constipation is defined as an increased hardness of stool for at least 4 weeks. Constipation is associated with drugs such as diuretics, antihistamines, and antieplileptics.

Constipation with fecal stooling is called encopresis. Most children have no underlying cause identified for constipation. Constipation is associated with drugs such as diuretics, antihistamines, and antieplileptics. Rationale Statements that are correct related to constipation include: that constipation with fecal stooling is called encopresis and most children have no underlying cause identified for constipation. In addition, constipation is associated with drugs such as diuretics, antihistamines, and antieplileptics. It is not a chronic disease process and not defined as hardness of stool for 4 weeks, but for 2 weeks.

hypertrophic pyloric stenosis

Constriction of the pyloric sphincter with obstruction of the gastric outlet hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between stomach and the duodendum the stenosis develops in the first few weeks it causes projectile vomitig, dehydration, metabolic alkalosis and failure to thrive

The nurse is caring for a newborn with a cleft palate. Which assessment finding would be most concerning? Persistent cry Foul-smelling diarrhea Frequent expulsion of gas Coughing, gagging during feeding

Coughing, gagging during feeding The presence of a cleft lip and palate increases the risk for aspiration. Coughing and gagging with feeding are signs of aspiration.

A child is diagnosed with esophageal atresia and is not gaining weight as expected. Which finding on a follow-up examination indicates that the expected outcomes for this patient have not been met? Child crying Good skin turgor Elevated heart rate Decreased urinary output

Decreased urinary output The nurse should note intake and output to determine whether the expected outcome of adequate hydration is being achieved. A decreased urinary output suggests that the patient is dehydrated and the outcome has not been met.

Child has severe diarrhea from gastroenteritis. In which ways can the nurse determine whether the child is experiencing dehydration? Select all that apply. Nutritional status Increased sodium level Decreased urine output Tenting on the back of hand Child has patent skin integrity

Decreased urine output Monitoring urine intake and output is a way in which the nurse can assess the child's hydration status. Correct Tenting on the back of hand Monitoring skin turgor is a way in which the nurse can assess the child's hydration status.

The child with severe diarrhea presents to the clinic for evaluation. The nurse assesses the patient for which complications of severe diarrhea? Select all that apply. Fever Encopresis Dehydration Metabolic acidosis Metabolic alkalosis Electrolyte imbalance

Dehydration Metabolic acidosis Electrolyte imbalance Rationale Major effects of fluid and electrolyte loss are dehydration, metabolic acidosis, and electrolyte imbalance. Fever may be a cause of fluid and electrolyte loss but is not caused by it. Encopresis is most associated with constipation, not with diarrhea. Metabolic alkalosis occurs with loss of acid and not specifically with the effects of fluid and electrolyte loss.

The diabetic child is admitted to the intensive care unit with a fever. Upon assessment, the nurse notes the child's respirations are deep and rapid. What is the priority nursing intervention for this child? Administer antibiotics to the child. Administer continuous intravenous insulin. Determine the blood glucose level of the child. Obtain a sample for arterial partial pressure of oxygen

Determine the blood glucose level of the child. Rationale Deep, rapid breathing in a diabetic child may reflect hyperventilation due to metabolic acidosis or diabetic ketoacidosis. Rapid assessment of the child is a priority nursing intervention. The blood glucose level must be determined at the bedside. Antibiotics are administered to the febrile child only after obtaining appropriate specimens for culture. Continuous intravenous insulin is administered after the initial rehydration; it should not be administered until blood glucose and urine ketone levels are obtained. A blood sample needs to be obtained for determining arterial partial pressure of oxygen as part of the rapid assessment of the child; however, the sample is obtained after determining the blood glucose level at the bedside.

During a gastrointestinal physical assessment, the nurse would evaluate which signs/symptoms in a pediatric patient? Select all that apply. Diarrhea Heartburn Pain on swallowing Swelling of the inguinal nodes Change in time of bowel movement

Diarrhea As part of the gastrointestinal assessment, the nurse would assess for changes in stool consistency, including diarrhea. Heartburn As part of the gastrointestinal assessment, the nurse would assess for indigestion problems, including heartburn. Pain on swallowing As part of the gastrointestinal assessment, the nurse would assess any pain or swallowing problems, including pain on swallowing. Change in time of bowel movement As part of the gastrointestinal assessment, the nurse would assess for changes in bowel patterns.

Which diagnosis is appropriate for a teenage patient presenting to the pediatric clinic with thick, dry, red patches and silvery scales on the elbows, forearms, and scalp? Anxiety Impaired sleep Deficient knowledge Disturbed body image

Disturbed body image Rationale Teenagers are particularly sensitive to changes in body image and may be embarrassed by the psoriatic patches on the skin. The nurse can help the patient address feelings of insecurity and find ways to manage this stress. The patient may have anxiety or deficient knowledge about the disorder, but these are not likely the priority for teenage patients with a condition affecting their appearance. Impaired sleep is not usually related to psoriasis.

The nurse is teaching an adolescent with newly diagnosed type I diabetes ways to minimize discomfort with insulin injections. Which recommendations are helpful in minimizing injection discomfort? Select all that apply. Do not reuse needles. Inject insulin when it is cold. Flex or tense the muscle during injection. Remove all bubbles from the syringe before the injection. Do not move the direction of the needle-syringe during insertion or withdrawal.

Do not reuse needles. Remove all bubbles from the syringe before the injection. Do not move the direction of the needle-syringe during insertion or withdrawal.

Which nursing action is appropriate for the patient who was brought in to the emergency room with frostbite 36 hours ago and now has large blisters on the affected skin? Notify the provider. Apply a pressure dressing. Document the normal finding. Administer a bolus of normal saline.

Document the normal finding. Rationale In the 24 to 48 hours after rewarming, the presence of large blisters is a normal finding that the nurse would document. The blisters will begin to reabsorb within 5 to10 days. As this finding is normal, it is not a priority to notify the provider. Pressure dressings or a bolus of normal saline are not indicated for this patient.

he nurse is caring for a child with impetigo. Which provider order should the nurse question? Rinse lesions with water Dress the affected area with sterile gauze Administer oral Augmentin 250 mg twice per day Provide a note excusing child from school for one day

Dress the affected area with sterile gauze Impetigo lesions should be left open to air after cleaning and applying antibiotic ointment.

An infant who presents with suspected celiac crisis would have which assessment findings? Select all that apply. Drowsiness Supple elastic skin Metabolic acidosis Sweet-smelling stool Hardened black stools

Drowsiness Unusual drowsiness or fatigue can be an indication of metabolic acidosis, which is a sign of celiac crisis. Metabolic acidosis An infant with suspected celiac crisis will present with metabolic acidosis.

Which dietary modification should be made for a child with encopresis? Select all that apply. Eat granola bars Increase water intake Eat whole-grain cereals Decrease vegetable intake Decrease milk and sugar intake

Eat granola bars Eating granola bars helps a child with encopresis by increasing fiber in the diet. Correct Increase water intake Increasing fluid intake helps with softening stool. Correct Eat whole-grain cereals Eating whole-grain cereals helps a child with encopresis by increasing fiber in the diet.

The nurse notices that the parents of a child admitted with congenital diaphragmatic hernia are not holding the child. Which nursing intervention is appropriate to assist in resolution of the problem? Explain to the parents that no child is perfect. Tell the parents that they must bond with the child. Encourage to the parents to spend time away from the child. Educate the parents about the condition and the treatment.

Educate the parents about the condition and the treatment. The parents are exhibiting signs of anxiety. The nurse should provide clear and truthful information about the condition, treatment plan, and prognosis to encourage participation of the parents in the treatment plan.

During feeding, an infant with pyloric stenosis begins to cough and wheeze. Which is the priority nursing action? Elevate the infant's head Provide supplemental oxygen Obtain a STAT chest radiograph Place the infant in the supine position

Elevate the infant's head The head of the bed is elevated to promote lung expansion and swallowing and assist in clearing the aspiration. This option addresses patient safety.

Choose the conditions that affect motility in the pediatric gastrointestinal system. Select all that apply. Encopresis Constipation Pyloric stenosis Esophageal atresia Gastroesophageal reflux disease

Encopresis Encopresis affects motility in the pediatric gastrointestinal system. Correct Constipation Constipation affects motility in the pediatric gastrointestinal system. Gastroesophageal reflux disease Gastroesophageal reflux disease affects motility in the pediatric gastrointestinal system.

Which interventions are appropriate to suggest for the child with encopresis? Select all that apply. Restrict fluid intake in the child. Encourage a high-fiber diet for the child. Avoid milk and dairy products in the diet. Use mineral oil if the child has dysphagia. Relieve fecal impaction with the use of lactulose.

Encourage a high-fiber diet for the child. Avoid milk and dairy products in the diet. Relieve fecal impaction with the use of lactulose. Rationale Conservative management approaches for encopresis should be advised to the parents of the child. Intake of a high-fiber diet helps in stool formation and prevents loose stools. Thus it may reduce the occurrence of encopresis. Milk and dairy products may cause encopresis due to indigestion and therefore should be avoided. Fecal impaction, if present, should be relieved by lactulose intake. Increased fluid intake should be encouraged, and fluids should not be restricted. Mineral oils are to be avoided in children with dysphagia due to fear of aspiration.

When at home, which intervention is the most important for a child with gastroenteritis? Encouraging a proper diet Showering at least twice each day Washing hands with alcohol-based sanitizer Encouraging frequent sips of water every few minutes

Encouraging frequent sips of water every few minutes Proper rehydration to prevent the need for hospitalization is the priority for a child with gastroenteritis.

Which action should the nurse take to decrease the spread of infection from a patient with Clostridium difficile infection? Select all that apply. Enforce hand washing Monitor urine output Provide acetaminophen Enforce contact precautions Check temperature every 4 hours

Enforce hand washing Hand hygiene will help to decrease the spread of infection from a patient with Clostridium difficile infection. Enforce contact precautions Contact precautions must be strictly enforced for all staff and family members to minimize the risk of spreading the infection.

After digestion is complete, which are the simplified nutrient end products? Select all that apply. Bile Lipase Chyme Fatty acids Amino acids

Fatty acids Amino acids Rationale After digestion is complete the simplified nutrient end products include fatty acids and amino acids. Bile is an emulsifying agent for fats that facilitates the digestion of fats by lipase and is necessary for absorption of the fat-soluable vitamins A, D, E, and K. Chyme is the partially digested food and water secretions that are delivered to the small intestines.

secondary encopresis

Fecal incontinence after period of prior established fecal continence after age 4

The nurse needs to place an intravenous catheter for IV fluids. What are the potential site on an infant for the IV catheter to be place? (Select all that apply.)

Feet - Head (scalp) - Arms (forearms, hands, wrist) - Legs (ankles)

Which type of insect causes widespread bites on the child's legs? Bees Fleas Wasps Hornets

Fleas Rationale Fleas are small insects that tend to cause a widespread biting distribution on the body. Wounds from bees, wasps, and hornets typically appear in the form of a single sting, not a wide distribution of bites.

Which supplies are appropriate when removing a tick embedded in the skin? Select all that apply. Forceps Suture kit Disinfectant Sterile needle Sterile scissors

Forceps Disinfectant Sterile needle Rationale The nurse will need forceps, disinfectant, and a sterile needle to remove the tick from the patient's leg. The tick should be grasped as close as possible to the skin with the forceps, then pulled straight up and out. The sterile needle should be used to remove any remaining parts of the tick that may have become embedded in the skin. The skin around the bite should be cleansed with a disinfectant or soap. Sterile scissors aren't used to remove a tick. Sutures aren't necessary after tick removal.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant? 1. diarrhea 2. projectile vomiting 3. regurgitation of feedings 4. foul-smelling ribbon like stools

Foul-smelling ribbon-like stools Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction especially in the neonatal period, abdominal pain and distention, and failure to thrive are also clinical manifestations.

When assessing an infant with a tracheoesophageal fistula, which findings would be expected? Select all that apply. Crying when not being held Gagging during bottle feeding Blue discoloration around the mouth Coughing after latching onto breast for feeding Abnormally high platelet count and thrombin level

Gagging during bottle feeding Choking is considered one of the 3Cs of tracheoesophageal fistula. Blue discoloration around the mouth Cyanosis, or blue discoloration, is considered one of the 3Cs of tracheoesophageal fistula. Coughing after latching onto breast for feeding Coughing is considered one of the 3Cs of tracheoesophageal fistula.

A patient reports nausea, vomiting, and upper right quadrant pain. Which gastrointestinal organs may be involved? Kidney Spleen Gallbladder Small intestine

Gallbladder The hepatobiliary system, including the gallbladder, is found in the upper right quadrant and may cause pain if inflamed.

A child with diabetes who is treated with insulin is trembling and sweating profusely. The nurse learns that the child has skipped lunch. Which is the nurse's best action? Administer a glucagon injection. Give the child 3 to 6 oz of orange juice. Give the child insulin injection immediately. Ignore the symptoms because it is a normal finding.

Give the child 3 to 6 oz of orange juice. Rationale The symptoms of the patient indicate adrenergic symptoms of hypoglycemia. Therefore the nurse should give the child a simple, high-carbohydrate drink such as 3 to 6 oz of orange juice, which should be followed by a starch-protein snack. Administering a glucagon injection is reserved for hypoglycemic patients who are unconscious, unresponsive, or having seizures. An insulin injection should not be given to this patient, because the symptoms are being caused by low blood sugar. Ignoring the symptoms can lead to further deterioration in the patient's condition and may eventually lead to death.

Which is the priority nursing intervention for a diabetic child who often becomes tearful for no reason? Give the child a slice of bread. Give the child some peanut butter. Give the child cherry-flavored glucose. Give the child sugar-containing candies.

Give the child cherry-flavored glucose. Rationale Changes in behavior such as tearfulness or euphoria may be due to hypoglycemia. The priority action should be to administer a simple sugar such as cherry-flavored glucose. Simpler sugars are absorbed rapidly. Once the rapid-release carbohydrate has been given, a complex carbohydrate, such as a slice of bread, or protein, such as peanut butter, may be given. Sugar-containing candies also contain rapid-release carbohydrates; however, the child may learn to fake a reaction to get candy. Therefore commercial treatment products such as glucose are preferred.

Which is the best method for assessing control of diabetes? Urine testing Patient logbooks Self-monitoring of blood glucose Glycosylated hemoglobin (hemoglobin A1c) testing

Glycosylated hemoglobin (hemoglobin A1c) testing Rationale Glycosylated hemoglobin (hemoglobin A1c) is the best parameter for assessing control of diabetes. Urine testing for glucose is no longer used because there is poor correlation between simultaneous glycosuria and blood glucose concentrations. Patient logbooks and self-monitoring with the use of blood glucose monitors are helpful in assessing diabetes control, but hemoglobin A1c is the best method.

The nurse is caring for a child with Hirschsprung disease who has abdominal distention and hard, dry stools. Which food choices would be most appropriate? Select all that apply. Macaroni and cheese Grapes and apple slices Boiled cabbage and broccoli Cinnamon raisin granola bars Fried chicken tenders and fries

Grapes and apple slices Grapes and apple slices are high in fiber and would be included in the diet selection for a child with constipation. Boiled cabbage and broccoli Vegetables should be included in the diet selection for the child with constipation, but fresh vegetables are preferred over boiled for their nutritional value. Cinnamon raisin granola bars Granola and raisins are both high in dietary fiber and would be included in the diet selection for a child with constipation.

Which conditions can cause chronic diarrhea? Select all that apply. HIV/AIDS Celiac disease Antibiotic therapy Increased iron intake Malabsorption causes

HIV/AIDS Celiac disease Malabsorption causes Rationale Causes of chronic diarrhea include HIV/AIDS, celiac disease, and malabsorption problems. Antibiotic therapy is considered an acute cause of diarrhea. Increased use of iron causes constipation, not diarrhea.

Which finding requires nursing intervention at an early child care center to prevent the spread of lice among the children? Having regular inspections for head lice Having children store clothing in a shared bin Machine washing all towels and linens in very hot water Thoroughly vacuuming the rugs, stuffed animals, and upholstered furniture

Having children store clothing in a shared bin Rationale Preventing the spread and recurrence of lice requires a multifaceted approach. Children would store clothing items in separate bins or cubicles, not a shared bin. Regular inspections for head lice, machine washing all towels and linens in hot water, and thoroughly vacuuming all soft surfaces are all important strategies for keeping lice from spreading.

Blood supply to the liver comes from which sources? Select all that apply. Renal vein Renal artery Hepatic artery Pulmonary artery Hepatic portal vein

Hepatic artery The hepatic artery supplies oxygenated blood to the liver. Hepatic portal vein The hepatic portal vein supplies deoxygenated blood to the liver.

A child has constipation, abdominal distension, and ribbon-like stools. What does the nurse suspect? Peptic ulcer Appendicitis Pyloric stenosis Hirschsprung disease

Hirschsprung disease Rationale Hirschsprung disease is associated with constipation, abdominal distension, and ribbon-like stools. Fever, rigid abdomen, and pain in the right lower abdomen are symptoms of appendicitis. Peptic ulcer is associated with epigastric pain and generalized abdominal pain and does not have ribbon-like stool. Pyloric stenosis is usually associated with projectile vomiting and an olive-shaped mass in the right epigastrium.

Which type of dressing is appropriate when describing the application of an alginate dressing to a patient's wound? Gauze Porcine Occlusive Hydrophilic

Hydrophilic Rationale Alginate dressings are a type of hydrophilic wound dressing. Hydrophilic wound dressings are made of materials with hydrophilic properties that are nonreabsorbable, which allows them to cover the wound and absorb exudate. Gauze dressings are pads or island dressings. Porcine dressings are made from pigskin and most often used as temporary dressing for burns. Occlusive dressings include transparent adhesives, thin films, foams, and hydrocolloid dressings.

The diabetes educator is meeting with school nurses to discuss ways to increase diabetes management in the schools, allowing for students with diabetes to take part in everyday activities, before, during, and after school. The school nurses provide scenarios of their involvement with diabetes management. Which statement indicates a safe nursing action on the part of the school nurse? I had a 15-year-old diabetic child come to my office last week. She was not able to have breakfast that morning but denied symptoms of hypoglycemia, such as tachycardia or sweating. I assisted her with the a.m. dose of regular insulin. I had a 14-year-old diabetic child come to my office yesterday after school. Her coach asked that she see me because of irritability, pallor, and clammy skin. The child reported that after running 1 mile as warm-up, these symptoms developed. We tested her blood glucose. I had a 12-year-old diabetic child last week come to my office complaining of increased thirst and fatigue. I noticed deep, rapid respirations and a fruity odor to her breath. The child has a management plan that includes self-blood glucose monitoring. She obtained a reading of 104 mg/dL, so I let her go back to class. I had a 16-year-old diabetic child come to my office yesterday morning, asking about managing her diabetes when going out with friends. She wants to be a cheerleader and has to keep her weight down. She told me that skipping her evening dose of insulin would help her achieve that goal. That seemed reasonable, as then the intake would not be metabolized.

I had a 14-year-old diabetic child come to my office yesterday after school. Her coach asked that she see me because of irritability, pallor, and clammy skin. The child reported that after running 1 mile as warm-up, these symptoms developed. We tested her blood glucose. Check the child's blood glucose when the child has symptoms of hypoglycemia after running a mile, midafternoon. This is a safe nursing action as it will give information that can determine what to do next.

nursing care management malrotation and volvulus

IV fluids, NG decompression, systemic antibiotics if severe case - fluid volume resuscitation and vasopressors preoperatively postoperatively - like foe any abdominal surgery

Which medication is appropriate for a child diagnosed with enuresis? Paroxetine Imipramine Risperidone Polyethylene glycol

Imipramine Rationale Imipramine, a tricyclic antidepressant, is useful in the treatment of enuresis. Paroxetine is a selective serotonin reuptake inhibitor that is useful in the treatment of childhood depression. Risperidone is an antipsychotic medication that is useful in the treatment of childhood schizophrenia. Polyethylene glycol is useful in the treatment of encopresis.

Which medications are appropriate for the child with primary enuresis? Select all that apply. Levodopa Imipramine Oxybutynin Hydrochlorothiazide Desmopressin acetate nasal spray

Imipramine Oxybutynin Desmopressin acetate nasal spray Rationale There are many drugs that can be used for enuresis. Oxybutynin is an anticholinergic drug that reduces uninhibited bladder contractions. Imipramine is an antidepressant drug with associated anticholinergic action. Desmopressin acetate, either as nasal spray or in tablet form, helps to decrease urine output during sleep. It mimics the natural hormone vasopressin, which causes the kidneys to conserve body water and concentrate the urine. Levodopa is used in Parkinson disease. Hydrochlorothiazide is a diuretic and is not helpful in treating enuresis in children

Which characteristics of the infant gastrointestinal system result in an inability to digest complex foods? Immature liver Minimal saliva Short large intestine The location of the stomach Swallowing not under voluntary control

Immature liver The immature neonatal liver is not yet efficient in its detoxifying ability, which results in less vitamin and mineral breakdown than in older children, necessitating a breast milk or formula diet.

The child has been diagnosed with diabetic ketoacidosis (DKA). The nurse plans care based on which understanding of diabetic ketoacidosis? DKA is best treated at home DKA is best treated at a practitioner's office or clinic Immediate treatment is required because DKA is a life-threatening situation No treatment is required, because DKA is an expected outcome of type 1 diabetes mellitus

Immediate treatment is required because DKA is a life-threatening situation Rationale DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an intensive care unit for assessment, intravenous insulin administration, and fluid and electrolyte replacement. DKA is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. It is not an expected outcome of type 1 diabetes mellitus. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit.

Which are causes of chronic diarrhea? Select all that apply. Antibiotic therapy Immunodeficiency Malabsorption syndromes Upper respiratory infections Inflammatory bowel disease

Immunodeficiency Malabsorption syndromes Inflammatory bowel disease Rationale Causes of chronic diarrhea include immunodeficiency, malabsorption syndromes, and inflammatory bowel disease. Antibiotic therapy and upper respiratory infections are acute causes of diarrhea.

Which nursing actions are appropriate to include in the plan of care for a child with enuresis? Select all that apply. Teach the child that enuresis is a short-term issue. Implement a calendar to record wet and dry nights. Teach positive reinforcement instead of punishment. Teach parents to observe for side effects of any medications used. Encourage the child to maintain a regular bowel evacuation regimen.

Implement a calendar to record wet and dry nights. Teach positive reinforcement instead of punishment. Teach parents to observe for side effects of any medications used. Encourage the child to maintain a regular bowel evacuation regimen. Rationale A calendar with wet and dry nights may be helpful to motivate the child to stay dry and maintain a positive perspective on the problem. Parents need to understand that punishment such as scolding, shaming, and threatening is contraindicated. These actions have a negative emotional impact and limited success in reducing the behavior. The nurse would encourage parents to use positive reinforcement, be patient and understanding, and to communicate love and support to the child. Parents would also be taught to observe for side effects of any medications used. Parents would encourage the child to maintain a regular bowel evacuation regimen; constipation can contribute to nocturnal enuresis. It is not appropriate to teach the child that enuresis is only a short-term issue, because the nurse cannot know with certainty when the problem will resolve. Some people may experience enuresis into adulthood.

An infant diagnosed with thrush has begun treatment with nystatin oral suspension. Which assessment findings indicate to the nurse that treatment is effective? Select all that apply. Improved sleep Decreased fussiness Mucus membranes pink, intact Frequent coughs when drinking Infant drank two 4-ounce bottles yesterday

Improved sleep Lack of sleep is an indication of pain in a child with thrush. Improved sleep suggests treatment has been effective. Decreased fussiness Irritability is an indication of pain in a child with thrush. Decreased fussiness suggests treatment has been effective. Mucus membranes pink, intact The absence of lesions in the buccal mucosa is a sign that treatment for thrush has been effective.

An infant with hypertrophic pyloric stenosis has been vomiting extensively. Based on the laboratory findings, the nurse observes that the infant is dehydrated and lab work reveals metabolic alkalosis. Which laboratory finding suggests that the infant is dehydrated? Increase in pH Increase in blood urea nitrogen Increase in serum chloride levels Increase in carbon dioxide content

Increase in blood urea nitrogen Rationale An increase in blood urea nitrogen suggests that the infant is dehydrated; prolonged vomiting depletes both water and electrolytes. An increase in pH, decrease in serum chloride levels, and increase in carbon dioxide content are suggestive of metabolic alkalosis. Vomiting causes metabolic alkalosis due to depletion of water and electrolytes.

Which changes in the management of the child with type 1 diabetes mellitus are expected as a result of more exercise? Increased food intake Decreased food intake Decreased risk of insulin shock Increased risk of hyperglycemia

Increased food intake Rationale Food intake should be increased when the child is more active. During races and other competitions, more food may be required than during practice to maintain a balance between glucose and exogenously administered insulin. The child will require increased food on days of increased activity. The increased activity lowers the blood glucose level. Blood sugar must be monitored closely to avoid administration of too much insulin during a time of reduced need.

Why do infants have an increased risk for diarrhea? Select all that apply. Immature liver Increased peristalsis Large stomach capacity Increased episodes of constipation Less water absorbed from fecal mass

Increased peristalsis Increased peristalsis is one reason infants have an increased risk of diarrhea. Less water absorbed from fecal mass Less water absorbed from fecal mass is one reason infants have an increased risk of diarrhea.

A child presents with diarrhea after eating at a local restaurant. Which intervention should the nurse implement first? Restrict fluid Encourage diet restriction Inform the health department Prepare droplet precaution PPE

Inform the health department This is a public health concern. A dietary recall of possibly contaminated foods can be important in establishing the cause and minimizing the risk of spread to the publ

How is the delivery of insulin through an insulin infusion pump different from delivery of insulin through subcutaneous injections? Insulin infusion pump delivers insulin into the thigh muscles. Insulin infusion pump causes less skin infections than injections. Insulin infusion pump delivers fixed amounts of insulin continuously. Insulin infusion pump is less expensive than giving multiple injections.

Insulin infusion pump delivers fixed amounts of insulin continuously. Rationale An insulin infusion pump delivers fixed amounts of insulin continuously, similar to the release of insulin from the islet cells of the pancreas. Both the infusion pump and the injections deliver insulin into the subcutaneous tissue of either the abdomen or the thigh and not into the muscles. Because the infusion pump stays in place, skin infections are common. Delivery of insulin through infusion pumps is more expensive than delivery of insulin through injections.

Which are the most important basic assessments a nurse needs to perform for a child with gastrointestinal disease? Select all that apply. Urease test Romberg test Intake and output Height and weight Abdominal examination

Intake and output Height and weight Abdominal examination Rationale The most important basic assessments a nurse needs to perform for a child with gastrointestinal disease include intake and output, height and weight, and abdominal examination. The urease test is not a basic assessment. It involves a biopsy of the stomach. The Romberg test evaluates for neurologic function.

Which statements are appropriate regarding cleft lip? Select all that apply. It causes feeding problems. It occurs more often in males. Cleft lip occurs less often than cleft palate. It may involve more than the lip anatomy. Surgical repair usually occurs between 6 to 12 months of age.

It causes feeding problems. It occurs more often in males. It may involve more than the lip anatomy. Rationale Cleft lip causes feeding problems, occurs more often in males, and may involve more than the lip anatomy. Cleft lip occurs more often than cleft palate. Surgical repair usually occurs between 2 to 3 months of age.

Which nursing strategies are appropriate when teaching the parents of a child diagnosed with intertrigo? Select all that apply. Apply topical vitamin D analogs. Keep affected skin clean and dry. Use of a tar shampoo to remove scaly tissue. Expose the affected area exposed to air and light. Use nonmedicated powder to separate skin folds.

Keep affected skin clean and dry. Expose the affected area exposed to air and light. Use nonmedicated powder to separate skin folds. Rationale Intertrigo causes red, inflamed, moist skin in areas where opposing skin surfaces rub together. Managing the symptoms of intertrigo can include keeping the affected area clean and dry, exposing the skin to air and light, and using nonmedicated powder to separate skin folds. The use of vitamin D analogs and tar shampoo is used for psoriasis, not intertrigo.

Which are the signs and symptoms of diabetic ketoacidosis? Select all that apply. Ketonuria Ketonemia Dehydration Acetone breath Shallow, slow breathing

Ketonuria Ketonemia Dehydration Acetone breath Rationale Signs and symptoms of diabetic ketoacidosis include ketonuria, ketonemia, dehydration, and acetone breath. Kussmaul respirations (rapid and deep, not slow and shallow) are usually present.

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1. prone position 2. on the stomach 3. left lateral 4. right lateral

Left lateral position

A child with tinea corporis on the arm has begun topical treatment. Which assessment findings indicate to the nurse that treatment is effective? Less scratching is observed Child avoids going to school Erythema surrounding lesion Hairless patches noted on the arm

Less scratching is observed Decreased pruritus is a sign that treatment has been effective because the infection is improving.

Which specific findings indicate severe dehydration in a child with acute diarrhea? Select all that apply. Lethargy Sunken eyes Loss of skin turgor Bradycardia Dry mucous membranes

Lethargy Sunken eyes Loss of skin turgor Dry mucous membranes Rationale Lethargy and rapid, thready pulse indicate that the degree of dehydration is severe. These findings are not present when the degree of dehydration is moderate or mild. Sunken eyes, loss of skin turgor, and dry buccal mucous membranes can also be seen in both severe and moderate degrees of dehydration. Bradycardia is not indicative of severe dehydration.

Which parental action indicates the need for additional instruction from the nurse about the child with enuresis? Select all that apply. Limiting fluids for the duration of the day Ensuring that the child voids before sleeping Putting the child in a pull-up diaper just before bed Moving the child from the top bunk to the bottom bunk Providing positive reinforcement to the child for dry nights

Limiting fluids for the duration of the day Putting the child in a pull-up diaper just before bed Rationale To decrease the incidences of bedwetting, the nurse would instruct the parents to reduce the child's fluid intake after 4 pm and especially at dinner time to ensure a dry night. If the child receives fluids later in the day, the child is more likely to have a full bladder and wet the bed. Allowing the child to wear regular sleepwear rather than a pull-up diaper helps the child feel in control of the situation and provides positive reinforcement. The risk of enuresis is further reduced if the child voids just before sleeping and if the child sleeps in the bottom bunk rather than the top of the bunk bed because this makes it easier for the child to get out of bed and into the bathroom. The parents would not scold the child for bedwetting; instead, they would provide positive reinforcement that may motivate the child to aim for dry nights.

Which are secretions used in chemical digestion? Select all that apply. Lipase Insulin Chyme Mucous Enzymes Hydrochloric acid

Lipase Insulin Mucous Enzymes Hydrochloric acid Rationale Secretions used in chemical digestion include lipase, insulin, mucous, enzymes, and hydrochloric acid. Chyme is the result of chemical digestion. It is the partially digested food and water secretions that are delivered to the small intestines.

A child has been diagnosed with cleft palate, and the nurse is meeting with the caregivers. What are appropriate interventions by the nurse? Select all that apply. Listen to the caregivers' questions. Teach the effectiveness of verbalizing concerns. Ensure consent forms for surgery have been signed. Assure the parents that they have nothing to worry about. Encourage the parents to leave the hospital for the night, as the child will be sedated.

Listen to the caregivers' questions. Listening will help caregivers cope with a cleft palate diagnosis. Family members should be allowed to work through what has happened to their child. Correct Teach the effectiveness of verbalizing concerns. The nurse should encourage and help the caregivers to verbalize their feelings, perceptions, and fears to aid in the coping process. Correct Ensure consent forms for surgery have been signed. The nurse should ensure all consent forms for surgery have been signed by the caregivers.

Of the anatomic structures listed, which are parts of the lower gastrointestinal system? Select all that apply. Liver Ileum Stomach Esophagus Large intestine

Liver The liver is part of the lower gastrointestinal system. Its role in digestion is the production of bile. Ileum The ileum is part of the lower gastrointestinal system, and it is the area where nutrients are absorbed. Large intestine The large intestine is part of the lower gastrointestinal system. The large intestine consists of the ascending transverse and descending colon and is responsible for transporting feces to the rectum.

An infant in the 5th percentile for weight is brought in to the health care provider's office because of failure to thrive. The mother reports that the child is fed every 3 to 4 hours and has no obvious symptoms of gastrointestinal (GI) distress. Which type of GI condition would the nurse suspect? Hepatic disorder Obstructive disorder Developmental delay Malabsorption disorder

Malabsorption disorder The nurse would suspect a malabsorption disorder because the child is being fed but is not showing signs of expected physical growth.

The nurse is evaluating a patient with cleft lip to determine whether collaborative care was able to achieve the expected outcome. Which action should the nurse take to determine whether a child with cleft lip and palate is achieving adequate nutrition? Monitor feeding technique. Measure height and weight. Measure head circumference. Make sure the child is burped after each feeding.

Measure height and weight. Measuring height and weight will help the nurse to determine whether a child with cleft lip and palate is achieving adequate nutrition.

Which are clinical manifestations of gastrointestinal dysfunction in children? Select all that apply. Melena Jaundice Encopresis Failure to thrive Clubbing of fingers

Melena Jaundice Encopresis Failure to thrive Rationale Clinical manifestations of gastrointestinal dysfunction in children include melena, jaundice, encopresis, and failure to thrive. Clubbing of fingers is associated with chronic respiratory problems.

Which diagnostic test is appropriate when confirming the diagnosis of candidiasis infection of the buttocks? Skin and lesion culture White blood cell count Blood test for candida levels Microscopic examination of skin scrapings

Microscopic examination of skin scrapings Rationale Candidiasis infection is often diagnosed by its characteristic appearance but can also be confirmed by microscopic identification of scrapings taken from the lesion. A white blood cell count will not confirm a candida infection. There is not a diagnostic blood test for candida levels in a skin infection. Candida can be cultured, but this is not usually performed since the diagnosis can be easily made by the characteristic appearance of the infection.

A patient is admitted with a diagnosis of DKA. What signs and symptoms would the nurse expect to find in the patient? Select all that apply. Slow heart rate Mild disorientation Cool and clammy skin Constantly feeling tired Rapid, shallow respirations

Mild disorientation Altered consciousness in the form of mild disorientation or confusion can occur with DKA. Constantly feeling tired Lethargy, constantly feeling tired, is a common symptom in patients with DKA due to cells not receiving adequate fuel source to produce energy.

Which region is endemic for cryptococcosis? Pacific Northwest The Gulf of Mexico Mississippi River Valley Southwestern United States

Mississippi River Valley Cryptococcosis is endemic in the Mississippi and Ohio River Valleys; therefore the nurse should ask about recent travel to that region. The Gulf of Mexico may be associated with other tropical diseases, but not cryptococcosis. The Pacific Northwest and southwestern United States are not regions where cryptococcosis is commonly found.

The provider writes orders for a patient with Type 1 DM admitted with DKA. Which order should the nurse question? Fluid replacement, 0.9% sodium chloride, initial bolus. Monitor blood glucose every 3-4 hours during IV insulin infusion. Monitor for bradycardia, muscle weakness, hyperreflexia, and cardiac irregularities. Humulin insulin IV, continuous, 6 U/h until blood glucose level drops to less than 180 mg/dL.

Monitor blood glucose every 3-4 hours during IV insulin infusion. It is protocol to monitor blood glucose every hour during IV insulin infusion; therefore, this order should be questioned.

The provider writes orders for a patient with Type 1 DM admitted with elevated blood glucose levels. Which order should the nurse question? Humulin insulin IV, continuous, 6 U/h until the blood glucose level drops to less than 180 mg/dL. Fluid replacement, 0.9% sodium chloride, initial bolus. Monitor blood glucose every 3-4 hours during IV insulin infusion. Monitor for bradycardia, muscle weakness, hyperreflexia, cardiac irregularities.

Monitor blood glucose every 3-4 hours during IV insulin infusion. It is protocol to monitor blood glucose every hour during IV insulin infusion; therefore, this order should be questioned.

Which is the nurse's best action when caring for a child with diabetes who has a diminished food intake due to typhoid? Restrict the child's fluid intake. Omit insulin therapy during the illness. Monitor blood glucose of the child every 3 hours. Notify the primary health care provider if the child vomits more than three times.

Monitor blood glucose of the child every 3 hours. Rationale Illness alters diabetes management, and it is important to restore euglycemia during illness. Therefore blood glucose should be monitored every 3 hours. Encouraging adequate fluid intake is the most important intervention during an illness. It prevents dehydration and flushes out ketones. Insulin is not omitted during an illness; however, the dose may be adjusted as required. The health care provider must be notified if the child vomits more than once.

The nurse is caring for a patient diagnosed with a hiatal hernia. Which assessments should be performed to determine that treatment has been effective? Select all that apply. Palpate the abdomen. Monitor intake and output. Monitor intravenous (IV) fluids. Assess the patient for vomiting. Assess patient adherence to use of medication.

Monitor intake and output. Patients with hiatal hernia often present with vomiting, putting them at risk for inadequate nutrition. Monitoring intake and output will allow the nurse to determine whether treatment is improving the nutritional status of the patient. Assess the patient for vomiting. Patients with hiatal hernia often present with vomiting, putting them at risk for inadequate nutrition. By assessing for vomiting, the nurse can determine whether the treatment is reducing the symptoms.

A 12-year-old patient presents with painless hyperkeratotic papules on the feet and hands. Which factors should be included in patient teaching? Select all that apply. Cryotherapy will be scheduled for 1 week. Most warts will disappear without treatment. The child should remain out of school for 2 weeks. Oral antibiotics will be administered for 10-12 days. To prevent spread to other body areas do not pick at the warts.

Most warts will disappear without treatment. Painless hyperkeratotic papules on the feet and hands are indicative of warts. The nurse should tell patients and families that these lesions disappear without treatment in 2-3 years. To prevent spread to other body areas do not pick at the warts. Painless hyperkeratotic papules on the feet and hands are indicative of warts that can spread to other areas of the body. The nurse should encourage patients to avoid picking or scratching the lesions.

therapeutic management of esophageal atresia and trachoesophageal fistula

NPO IV fluids position infant to fascilitate drainage of secretions suction accumulated secretions double lumen catheter place into the upper esophageal pouch for intermittent or continous low suction keep infants head upright broad spectrum antibiotics if is concern of aspiration chest tube to drain air and fluid anastomosis ( when gap is big or child is not stabel)

A child has had contact with some poison ivy. The school nurse understands that the full-blown reaction should be evident after how many days? a. 1 day b. 2 days c. 3 days d. 4 days

NS: B The full-blown reaction to poison ivy is evident after about 2 days, with linear patches or streaks of erythemic, raised, fluid-filled vesicles; swelling; and persistent itching at the site of contact.

What kind of activity restrictions are placed on the child with recently diagnosed type 1 diabetes? Daily exercise is contraindicated. The child may not participate in sports. Swimming is acceptable, but soccer is too strenuous. No activities are restricted unless they are contraindicated because of other health conditions.

No activities are restricted unless they are contraindicated because of other health conditions. Rationale Exercise is encouraged for children with diabetes because it reduces blood glucose. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Participating in sports can be a healthy part of life for a child with type 1 diabetes. Exercise is not contraindicated in children with type 1 diabetes. Swimming is acceptable and so is soccer.

A nurse is caring for a child with fever, malaise, enlarged axillary lymph nodes, and redness on the right upper arm. The nurse notes a WBC of 14,000. What action should the nurse take next? Provide gloves for parents Administer ordered IV antibiotic Obtain an order for a blood culture Obtain an order for an orbital CT scan

Obtain an order for a blood culture The nurse would obtain an order for and draw a blood culture first to determine the infectious organism.

A child with diagnosed tinea capitis has been taking oral griseofulvin for four weeks. On assessment, the child reports right upper quadrant pain, and the nurse notes tenderness to the area on palpation and slight abdominal distention. Which prescription should the nurse complete first? Give Normal Saline bolus Administer oral analgesic Obtain abdominal CT scan Obtain liver function studies

Obtain liver function studies Griseofulvin administration can cause impaired liver function. A patient with RUQ pain and abdominal distention should have liver function tests drawn.

The nurse is caring for a child with gastroesophageal reflux disease (GERD). Which medications would the nurse anticipate being ordered? Albuterol Omeprazole Erythromycin Acetaminophen

Omeprazole Omeprazole is a proton pump inhibitor that is given to patients with GERD to decrease the amount of stomach acid and prevent symptoms.

Which diet intervention does the nurse make for a child with diabetes mellitus? Total food intake of the child should be restricted. Large snacks should be avoided during afternoons. Fat intake should be less than 50% of total calorie intake. One slice of bread may be given if the child dislikes having one small apple.

One slice of bread may be given if the child dislikes having one small apple. Rationale One slice of bread may be given if the child dislikes having one small apple. All carbohydrates are considered equivalent. Food groups are not as important as the carbohydrate content of the food. Total food intake should not be restricted in growing children. Meals and snacks must be given according to peak insulin action. If a child is more active in the afternoon, a larger snack may be given at that time. Fat intake should be less than 30% of total calorie intake.

A child is using regular insulin according to blood glucose monitoring results. At 2 pm, the child has a blood glucose of 185 mg/dl, for which the patient received 8 units of regular insulin. The nurse should expect the dose's onset and peak to be at which times? Onset 2:15 pm and peak 4:00-5:00 pm Onset 2:15 pm and peak 2:30-3:30 pm Onset 2:30-3:00 pm and peak 4:00-5:00 pm Onset 2:30-3:00 pm and peak 10:00-11:00 pm

Onset 2:30-3:00 pm and peak 4:00-5:00 pm Onset of regular insulin is 30-60 minutes and peak action is 2-3 hours after injection.

Match the diagnostic test with the reason for its use. Ova and parasites (O&P) Clinitest Guaiac test Culture and sensitivity

Ova and parasites (O&P) To detect the presence of parasites or their eggs Clinitest To diagnose malabsorption Guaiac test To detect the presence of blood Culture and sensitivity To determine what antibiotic to use

Which signs prompt the nurse to call for immediate assistance while monitoring a child admitted with acute gastrointestinal bleeding? Select all that apply. Pallor Hot extremities Poor capillary refill Increased heart rate Decreased respiratory rate

Pallor Poor capillary refill Increased heart rate Rationale Pallor, poor capillary refill, and increased heart rate should prompt the nurse to call for assistance immediately because these are symptoms of shock. Hot extremities and decreased respiratory rate are not symptoms of acute gastrointestinal bleeding. Cool extremities and increased respiratory rate are other symptoms of shock and require immediate treatment.

The nurse is evaluating how a couple is coping with their young child's diagnosis of cleft lip. For which signs does the nurse look to determine whether effective coping is taking place? Parents do not voice fears. Parents will not hold the child. Parents plan and organize all special care appointments. Parents sit quietly in the room without looking at the child.

Parents plan and organize all special care appointments. Taking control over the special care needs of the child indicates that parents are coping effectively with their child's cleft lip diagnosis.

Which documentation term is appropriate when describing a patient feeling a prickling sensation in the feet? Anesthesia Paresthesia Hypesthesia Hyperesthesia

Paresthesia Rationale The correct term to document a patient's complaint of a prickling sensation is paresthesia, which refers to abnormal sensation, such as burning or prickling. Anesthesia is the lack of sensation. Hypesthesia is diminished sensation. Hyperesthesia is excessive skin sensitivity.

Which statements are true about intussusception? Select all that apply. More common in females than males Passage of red, currant jelly-like stools Associated with sudden acute abdominal pain The cause of intussusception is usually inflammation Olive-shaped mass in the epigastrium just right of the umbilicus

Passage of red, currant jelly-like stools Associated with sudden acute abdominal pain Rationale Intussusception is associated with passage of red, currant jelly-like stools and sudden acute abdominal pain. It is more common in males than females and generally the cause is unknown (not inflammation). An olive-shaped mass in the epigastrium just right of the umbilicus is a finding associated with hypertrophic pyloric stenosis.

Which symptom does the nurse identify as the most common clinical manifestation of gastroesophageal reflux (GER) in an infant? Gagging Coughing Excessive crying Passive regurgitation

Passive regurgitation Rationale Passive regurgitation is the most common clinical manifestation of GER in an infant. Gagging, coughing, and excessive crying are some other clinical manifestations of GER in an infant; however, passive regurgitation is the most common one.

Which nursing actions should be implemented to ensure bowel patency is maintained for an infant with intussusception? Select all that apply. Restrict activity Perform an occult blood test Recommend a high-fiber diet Evaluate the consistency of the stool Take a gastrointestinal history

Perform an occult blood test The nurse would evaluate the stool for blood, as the passage of stool without blood is indicative of a successful outcome. Evaluate the consistency of the stool The nurse should observe the characteristics of the stool, including consistency to determine whether the patient has maintained bowel patency. Correct Take a gastrointestinal history The nurse should monitor the patient for return of normal bowel function. This would require having baseline information about bowel/gastrointestinal function.

Classic first symptom of appendicitis

Periumbelical pain Nausea Right sided lower quadrant pain Vomiting with fever

The nurse is assessing newborn male and female twins for the presence of anorectal malformations. Which is an anorectal malformation that the nurse may identify only in the female twin? Rectal atresia Perineal fistula Persistent cloaca Imperforate anus

Persistent cloaca Rationale Persistent cloaca is an anorectal malformation in which the rectum, vagina, and urethra drain into a common channel opening into the perineum. It is seen only in females. Rectal atresia is an anorectal malformation in which the anal opening appears normal but the patient is unable to pass the stool due to complete obstruction. It can be seen either in males or females. Perineal fistula is an anorectal malformation in which a prominent anal dimple is present along with a band of skin tissue called a bucket handle. It can be seen either in males or females. Imperforate anus is a condition in which an obvious external anal opening is absent. It can be seen either in males or females.

The nurse is preparing a child for pyloromyotomy. The child has a plasma CO2 of 30 mEq/L. Which nursing actions are appropriate before surgery? Select all that apply. Place infant in isolation Place a nasogastric tube Administer an antipyretic Assess serum electrolytes Withhold oral food and fluids

Place a nasogastric tube An infant who is moderately dehydrated would have a nasogastric tube placed for stomach decompression, and surgery would be delayed for 24 to 48 hours. Assess serum electrolytes Serum electrolytes should be assessed before surgery. Surgery should be delayed until electrolyte deficits are corrected. Correct Withhold oral food and fluids NPO (nothing by mouth) status is part of the essen

The nurse is assessing a child with a tracheoesophageal fistula who has been coughing and choking during feeding. The child is in the 45th percentile for weight, and vital signs are normal. Which nursing intervention is appropriate to ensure that the expected outcome is achieved for this patient? Administer intravenous fluids. Place child in prone position. Provide the child with a pacifier. Place child on a chalasia board.

Place child on a chalasia board. Management of a child with a tracheoesophageal fistula focuses on preventing aspiration. Placing the child in a chalasia board at a 30-degree angle would help minimize the risk of aspiration.

The nurse is attending to an infant with esophageal atresia and a tracheoesophageal fistula. The infant is choking, regurgitating, and has frothy saliva and abundant mucus. Which intervention does the nurse choose to facilitate drainage of secretions into the stomach? Monitoring airway patency Administering oxygen as needed Placing the infant in a supine position Suctioning mouth and nose as necessary

Placing the infant in a supine position Rationale The infant is placed in a supine position, because it facilitates drainage of secretions into the stomach and prevents aspiration. Airway patency is monitored to detect signs of airway occlusion. Oxygen is administered to prevent hypoxia. The mouth and nose are suctioned to relieve and prevent airway obstruction.

Which condition is appropriate when describing an elevated, firm papule on the sole of the foot? Plantar wart Varicella-zoster Herpes simplex type I Molluscum contagiosum

Plantar wart Rationale Plantar warts are elevated, firm papules with a roughened papillomatous texture that are found on the plantar surface of the feet. Varicella-zoster virus lesions tend to occur along a dermatome following the affected nerve root and are more commonly found along the posterior root ganglion. Herpes simplex type 1 causes burning and itching vesicles on the lips, nose, or genitalia. Molluscum contagiosum causes an umbilicated flesh-colored papule that is most commonly found on the trunk and face.

Parents reported to the nurse that their child is passing less than three hard stools per week for the past month. After performing oral clean out for 3 days, the child has been put on maintenance therapy. Which oral laxative is the best treatment choice for maintenance therapy? Lactulose Mineral oil Milk and molasses Polyethylene glycol

Polyethylene glycol Rationale Polyethylene glycol is the best treatment choice for maintenance therapy due to the minimal side effects and taste. Moreover, it can be mixed with any drink, which makes it easier to administer to children. It also increases fluid in the colon and the additional volume of fluid stimulates the urge to defecate. Lactulose is also an oral laxative; however, it is less effective than polyethylene glycol. Mineral oil is also an oral laxative; however, it should be given carefully to avoid the risk of aspiration. The combination of milk and molasses is not an oral laxative; it is used for enema clean out.

Which are the most common consequences of gastrointestinal disease in children? Select all that apply. Obesity Poor growth Malnutrition Malabsorption Electrolyte disturbances

Poor growth Malnutrition Malabsorption Electrolyte disturbances Rationale The most common consequences of gastrointestinal disease in children include poor growth, malnutrition, malabsorption, and electrolyte disturbances. Obesity is not associated with the consequences of gastrointestinal disease.

Which factors predispose a child to diarrhea? Select all that apply. Poor sanitation Sex of the child Age of the child Lack of clean water Nutritional deficiency

Poor sanitation Age of the child Lack of clean water Nutritional deficiency Rationale Factors that predispose a child to diarrhea include poor sanitation, age of the child, lack of clean water, and nutritional deficiency. The sex of a child does not predispose the child to diarrhea.

The parents of a 5-year-old child present to the pediatric clinic with reports that the child has a rash on the face and trunk. The nurse notes firm, solid papules. Which order should the nurse anticipate? Prepare for cryotherapy Apply salicylate ointment Administer oral penicillin Obtain STAT blood culture

Prepare for cryotherapy Firm, solid papules indicate molluscum contagiosum. Cryotherapy is used to remove lesions.

Which manifestation helps the nurse to identify hyperglycemia in a child with diabetes mellitus (DM)? Excessive sweating Presence of acetone breath Shallow normal respirations Presence of paleness or pallor

Presence of acetone breath Rationale Fruity, acetone breath is easily identified in the child with hyperglycemia. In the absence of insulin, glucose is unavailable for cellular metabolism. Consequently, fats break down into fatty acids, and glycerol in the fat cells is converted by the liver to ketone bodies. Any excess is eliminated in the urine (ketonuria) or the lungs (acetone breath). The skin appears flushed and shows signs of dehydration. The respiratory system tries to eliminate the excess carbon dioxide by increased depth and rate of breathing, which is known as Kussmaul respirations. Hypoglycemia causes sweating, paleness, and pallor. Respirations are shallow and normal in hypoglycemia.

Henry arrives to the unit, what are the priority nursing interventions? (Place interventions in order beginning with first action to last action)

Priority sequences "CAB" (Circulatory, Airways, Breathing) - Check the heart rate and circulatory - Ensure the infant's airway is clear and breathing appropriately - Inspect the intravenous site and IV fluid solution and rate of infusion - Inspect the incision site and listen for bowel sounds - Inspect the buttocks for skin breakdown and backside of infant

The nurse is caring for a child with fluid-filled, ulcerated vesicles in the mouth and throat. Which information should be included in parent teaching? Select all that apply. Provide a bland diet. Encourage oral fluids. Mild shortness of breath is expected. Notify the provider if the child does not urinate in 2 days. Absence of solid foods for a few days will not harm the child.

Provide a bland diet. Fluid-filled, ulcerated vesicles are indicative of herpes gingivostomatitis. The nurse should educate parents to provide a bland diet to decrease pain when eating. Encourage oral fluids. Fluid-filled, ulcerated vesicles are indicative of herpes gingivostomatitis. The nurse should educate parents to maintain hydrations status because throat lesions may cause the child to refuse oral intake and lead to dehydration. Absence of solid foods for a few days will not harm the child. Fluid-filled, ulcerated vesicles are indicative of herpes gingivostomatitis. The nurse should educate reassure parents that a few days without solid food will not harm the child.

The nurse is caring for a child with pyloric stenosis. The nurse notes that the abdomen is distended, skin turgor is poor, and fontanels are sunken. Which action would the nurse take? Administer acetaminophen Give IV potassium supplements Administer narcotic pain medication Provide an intravenous (IV) normal saline bolus

Provide an intravenous (IV) normal saline bolus The patient's symptoms indicate dehydration, which should be corrected with an IV fluid bolus.

Which intervention should the nurse use to reduce anxiety in parents of a child with congenital diaphragmatic hernia? Select all that apply. Provide discharge teaching. Refer parents to a support group. Inform the parents about the procedure. Teach the parents standardized feeding techniques. Allow the parents to yell in order to express emotions.

Provide discharge teaching. Providing discharge teaching will help reduce the parents' anxiety by providing an explanation of how to care for their child at home. Refer parents to a support group. Providing referral to support groups will help reduce the parents' anxiety by allowing them to meet other parents whose child is like theirs. Inform the parents about the procedure. Providing clear, truthful information will help reduce the parents' anxiety. They will have an idea on how to care for the child at home. Teach the parents standardized feeding techniques. Teaching the parents prescribed feeding techniques will help reduce their anxiety because they will know how to effectively feed their child at home.

Which nursing action is appropriate for feeding the neonate with a cleft lip? Select all that apply. Providing a high-calorie formula Using bottles with a narrow base Squeezing the cheek of the neonate Skin-to-skin contact if breastfeeding Placing the neonate in the supine position

Providing a high-calorie formula Squeezing the cheek of the neonate Skin-to-skin contact if breastfeeding Rationale The cheeks of a neonate with a cleft lip should be squeezed to achieve an adequate anterior lip seal during feeding. Neonates with a cleft lip who are breastfeeding should have skin-to-skin contact with the mother. Neonates with a cleft lip should consume high-calorie formula. Bottles with a wider base should be used for neonates for whom breastfeeding is difficult. The neonate should be positioned upright with the head supported by the caregiver's hand or cradled in the arm. This position allows gravity to direct the flow of liquid so that it is swallowed rather than entering the nasal cavity.

Stool is stored in which area of the gastrointestinal tract? Ileum Rectum Appendix Pancreas

Rectum Stool is stored in the rectum.

Which social consequences are expected in a school-age child with encopresis? Select all that apply. Rejected by peers Avoids social situations Poor school attendance Accepted by family members Adequate school performance

Rejected by peers Avoids social situations Poor school attendance Rationale The child with encopresis is not well liked by peers and often feels ashamed. The nurse will find that the child may avoid social situations that might lead to embarrassment. School performance and attendance are negatively affected, as the child's offensive odor becomes a target for scorn and derision by classmates. The child is not well accepted by family members and may be severely rejected by the parents as a result of the symptoms. Rejection by peers and parents causes further withdrawal and other behavioral manifestations. The child's school performance is not adequate due to social withdrawal and poor attendance.

Which manifestation of type 2 diabetes helps the nurse to distinguish it from type 1 diabetes? Rapid, deep breathing Absence of serum insulin Relative insulin deficiency Excessive thirst and hunger

Relative insulin deficiency Rationale Type 2 diabetes usually arises because of insulin resistance, in which the body fails to use insulin properly, combined with relative insulin deficiency. Type 1 diabetes leads to excessive hunger, thirst, and urination. Type 1 diabetes is characterized by destruction of the pancreatic beta cells, which produce insulin; this usually leads to absolute insulin deficiency. In the type I diabetic with hyperglycemia, the respiratory system attempts to eliminate the excess carbon dioxide by increased depth and rate known as Kussmaul respirations.

A patient with DKA is given normal saline and intravenous regular insulin. The nurse checks blood glucose level hourly. Which other assessment data is the best indicator of clinical improvement? Pulse 130. Temperature in normal range Patient eats a full meal and respiratory rate is normal Improved level of consciousness and increasing urine output Respiration rate of 12 to 15 and normal BP in the standing position

Respiration rate of 12 to 15 and normal BP in the standing position Respirations in normal range are indicative of normal bicarbonate level. Normal BP indicates adequate circulating fluid volume (resolution of diuresis). This is an indicator of clinical improvement.

A child with diabetes insipidus is prescribed vasopressin injections. How does the nurse prepare the injection? Select all that apply. Resuspend in water and hold it in cold running water for 2 to 3 minutes. Resuspend in normal saline and hold it in warm running water for 2 to 3 minutes. Thaw the vial for better resuspension of oil and the medications. Resuspend in oil and hold it in warm running water for 10 to 15 minutes. Shake vigorously before use and check for small brown particles in the suspension.

Resuspend in oil and hold it in warm running water for 10 to 15 minutes. Shake vigorously before use and check for small brown particles in the suspension. Rationale It is important for the nurse to prepare the vasopressin injection appropriately before administering it to the patient. Vasopressin must be resuspended in peanut oil by holding it in warm running water for 10 to 15 minutes. Then the nurse should shake it vigorously before drawing it into the syringe. Small brown particles must be seen in suspension; this indicates that the drug has been dispersed. If the injection is not mixed appropriately, only the oil will be injected, not the vasopressin. The medication is not resuspended in water or normal saline and is not thawed before administration, because these actions can affect the efficacy of the

A 9-year old boy is brought into the health care provider's office with concerns about his reaction to his parent's divorce. The child has been unusually withdrawn and stays in his room, refusing to see anyone, often not even coming out to go to the bathroom. On assessment the nurse notes a foul fecal odor coming from the child. Which complication of constipation would the nurse suspect? Tenesmus Depression Primary encopresis Secondary encopresis

Secondary encopresis The child is showing signs of secondary encopresis: he has lost continence he previously had. The encopresis is probably in reaction to the stress of his parent's divorce and will most likely resolve as the stress of the situation wanes.

Which process of healing is appropriate when describing a third-degree burn? Primary intention Tertiary intention Secondary intention Quaternary intention

Secondary intention Rationale Third-degree burns often heal by secondary intention, where the wound edges cannot be brought together. Healing occurs from the edges in and the bottom up, causing a larger scar. Primary intention occurs when all layers of the wound margins can be brought together, which is not possible with a large burn. An example of a wound healing by tertiary intention is an abdominal incision that's intentionally left open to remove or prevent infection before closing. Healing does not occur by quaternary intention.

Which terms describe the functions of the gastrointestinal tract? Select all that apply. Secretory Endocrine Absorption Circulatory Immunologic

Secretory Endocrine Absorption Immunologic Rationale The various functions of the gastrointestinal tract include secretory, endocrine, absorption, and immunologic. The cardiac system has circulatory function.

Psychogenic encopresis

Soiling is caused by emotional problems, is often related to a disturbed mother-child relationship

The nurse is caring for a child with gastroesophageal reflux disease (GERD). The child is feeding and begins to cough and gag. Which action should the nurse take first? Stop the feeding Elevate the head of the bed Auscultate the child's lung sounds Administer oxygen via nasal cannula

Stop the feeding Coughing and gagging are signs of respiratory distress. The nurse should immediately stop the feeding to ensure a patent airway.

Which are common causes of functional constipation among school-age children? Select all that apply. Stresses Hypothyroidism Environmental changes Change in toileting pattern Increased sporting activities

Stresses Environmental changes Change in toileting pattern Rationale Common causes of functional constipation among school-age children include stress, environmental changes, and change in toileting pattern. Hypothyroidism is an organic cause of constipation. Increased activity associated with sporting activities would promote normal stooling.

Which antibiotic is appropriate when treating a child that has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA)? Select all that apply. Penicillin Sulfamethoxazole/trimethoprim Doxycycline Vancomycin Cephalexin

Sulfamethoxazole/trimethoprim Vancomycin Rationale Vancomycin and sulfamethoxazole/trimethoprim are usually prescribed to treat MRSA infections. Penicillin is in the same class of medications as methicillin. Therefore it is not an appropriate treatment for MRSA infection. Cephalexin and doxycycline may be prescribed to treat some skin infections, but not one caused by MRSA. p. 1217

The nurse is caring for a 3-month-old infant diagnosed with gastroenteritis. The parents report vomiting, diarrhea, poor skin turgor, and lethargy. Which additional finding supports the diagnosis of moderate dehydration? Hypothermia Decreased respiratory rate Sunken or depressed fontanel Urine specific gravity of 1.010

Sunken or depressed fontanel A sunken or depressed fontanel is indicative of moderate dehydration.

The nurse is caring for a child with celiac disease who requires fluid resuscitation. Which assessment findings would the nurse anticipate after treatment has begun? Select all that apply. Drowsiness Sunken eyes Supple skin Skin elasticity Crying without tears

Supple skin Supple skin is a sign of adequate hydration. Good skin turgor and moist mucous membranes indicate the fluid resuscitation is successful. Skin elasticity Skin elasticity is a sign of adequate hydration. Good skin turgor indicates that the fluid resuscitation is successful.

The nurse is speaking with the family of a pediatric patient with celiac disease. Which patient symptom, reported by the parents, requires immediate action? Flaky skin Formed stools Tearless crying Abdominal distention

Tearless crying Tearless crying is an indication of dehydration and should be addressed immediately to prevent further exacerbation of the problem.

The nurse is preparing a child and the parents for a colostomy. Which situations, facilitated by the nurse, are most appropriate? Select all that apply. The child and parents should be allowed to eat lunch together. The child and parents should be allowed to witness another colostomy. The child and the parents should not be allowed to interact before the surgery. The child and parents are given the opportunity to see the equipment before surgery. The child and parents are given the opportunity to manipulate the equipment before surgery.

The child and parents are given the opportunity to see the equipment before surgery. The nurse would allow the child and parents to see the equipment before surgery. This helps to relieve some anxiety about the surgical process. Correct The child and parents are given the opportunity to manipulate the equipment before surgery. The nurse would allow the child and parents to manipulate the equipment before surgery. This helps to relieve some anxiety about the surgical process.

Several patients with encopresis are receiving bowel training. Which patient demonstrates successful use of this treatment method? The child who has had four enemas in the past week. The child who goes to the restroom after breakfast and lunch. The child whose parents provide a sticker after every trip to the bathroom. The child who sits on the toilet for 10 minutes during each visit to the bathroom.

The child who sits on the toilet for 10 minutes during each visit to the bathroom. Proper bowel training is accomplished by having the child sit on the toilet for several minutes to allow normal gastrocolic reflex and defecation.

A child with diabetes has been on insulin injections for the past 3 months. The patient's blood reports show the hemoglobin A1c is 6%. What does the nurse tell the parents? "The patient's diabetes is cured; therefore, you need not take insulin anymore." "The patient has high blood glucose, so you need to visit the endocrinologist." "The patient has anemia due to deficiency of iron, so the patient needs iron-rich food." "The patient's diabetes is under control; please continue the same regimen of treatment."

The patient's diabetes is under control; please continue the same regimen of treatment." Rationale Hemoglobin A1c of 7% or less indicates that the blood glucose is well controlled by the current regimen of treatment. Therefore the patient should be told to continue with the same treatment. Hemoglobin A1c levels usually indicate the effectiveness of the treatment over a period of 2 to 3 months. However, a normal report of hemoglobin A1c does not indicate that the diabetes is cured. Hemoglobin A1c levels are normal in the patient; therefore consultation from an endocrinologist may not be needed. Hemoglobin A1c levels do not mean reduction of hemoglobin levels and do not call for supplementation with iron-rich food.

A 4-year-old patient is diagnosed with congenital diaphragmatic hernia. What are appropriate nursing outcomes for this patient? Select all that apply. The patient's mucosa will appear pink. The patient will play outside for 3 hours. The patient will have minimal wheezing. The patient will have regular breath sounds. The patient will sit quietly while tests are run.

The patient's mucosa will appear pink. It is important that the patient not experience cyanosis, which may accompany a hernia. The patient will have regular breath sounds. An expected complication of hernia is diminished or absent breath sounds. Regular breath sounds on auscultation are an appropriate outcome.

An infant with gastroesophageal reflux disease (GERD) vomits after every feeding. Which provider orders would the nurse anticipate? Select all that apply. Daily weight Hourly breastfeeding Thicken formula feedings Daily abdominal assessment Refer infant for respiratory therapy

Thicken formula feedings Thickened liquids decrease the infant's risk for aspiration; the infant has better control when swallowing a thicker formula. Daily abdominal assessment A daily abdominal assessment is important for evaluating the child with GERD; excessive gas can worsen symptoms. Refer infant for respiratory therapy Infants with GERD are at increased risk for aspiration. Referral for respiratory therapy may be indicated.

Which condition presents with severe itching and scaling of the feet and between the toes? Tinea pedis Tinea cruris Tinea capitis Tinea corporis

Tinea pedis Rationale The patient's symptoms are suggestive of tinea pedis, or athlete's foot, a fungal infection that affects the feet. Tinea cruris is a fungal infection, also known as jock itch, that typically affects the groin and thighs. Tinea capitis is an itchy lesion that is found on the scalp, hairline, or neck. Tinea corporis, or ringworm, is a round scaling patch that spreads outwards and clears on the inside. Ringworm is not specifically found on the feet or between the toes.

Which medication is not appropriate for the 1-year-old child with atopic dermatitis? Corticosteroids Glucocorticoids Emollient ointment Topical immunomodulators

Topical immunomodulators Rationale Although topical immunomodulators can be very effective for atopic dermatitis, due to the risk for skin cancer and lymphoma they carry a black box warning in children under the age of 2. Corticosteroids, glucocorticosteroid, and emollients are all effective for atopic dermatitis and not contraindicated in children under the age of 2.

Which symptoms are associated with newborn hypoglycemia? Select all that apply. Tremors Jitteriness Eye rolling Hyperactivity High-pitched cry

Tremors Jitteriness Eye rolling High-pitched cry

Which medical diagnosis is appropriate for patients who compulsively pull out their hair? Alopecia Tinea capitis Trichotillomania Traumatic alopecia

Trichotillomania Rationale Trichotillomania is a disorder of compulsive hair pulling that typically requires psychologic counseling. Alopecia is a condition where there is a sudden onset of noninflammatory and asymptomatic bald patches on the head and other parts of the body that are usually covered in hair. Traumatic alopecia is hair loss that occurs around the scalp margins, often as the result of wearing tight hair styles. Tinea capitis is a fungal infection of the scalp.

What is the difference between type 1 and type 2 diabetes mellitus (DM)? Twin concordance is less in type 1 DM than in type 2 DM. Most diabetic people have type 1 DM rather than type 2 DM. Insulin therapy is required in more cases of type 2 DM than in type 1 DM. Islet-cell antibodies are found more often in type 2 DM than in type 1 DM.

Twin concordance is less in type 1 DM than in type 2 DM Rationale Twin concordance is 25% to 50% in type 1 DM and 90% to 100% in type 2 DM. Among the diabetic population, 5% to 8% of those affected have type 1 DM and 85% to 90% have type 2 DM. Insulin therapy is always required for type 1 DM. About 20% to 30% of the type 2 DM patients require insulin therapy. Islet-cell antibodies are found in 80% to 85% of type 1 DM patients and in less than 5% of type 2 DM.

An infant with gastroenteritis presents with severe diarrhea and vomiting. Which assessment finding is most concerning? Capillary refill of 3 seconds Serum potassium level of 4.9 mEq/L Two wet diapers in the last 12 hours Fontanels bulging when the infant cries

Two wet diapers in the last 12 hours Two wet diapers in 12 hours indicates dehydration and is concerning for an infant.

How is type 2 diabetes mellitus (DM) different from type 1 DM in children? Type 2 DM has an abrupt onset. Type 2 DM occurs primarily in white people. Type 2 DM is a chronic disorder of metabolism. Type 2 DM is frequently associated with a family history.

Type 2 DM is frequently associated with a family history. Rationale Type 2 DM typically occurs in children who have a family history of diabetes. Type 1 DM is only sometimes associated with a family history. Onset of type 2 DM is gradual, whereas that of type 1 DM is abrupt. Type 1 DM occurs primarily in white people. The incidence of type 2 DM is higher for Native American, African American, and Hispanic children. Both type 1 and type 2 DM are chronic metabolic disorders.

Which postoperative nursing interventions are associated with cheiloplasty? Select all that apply. Protecting the cranium Use of elbow restraints Avoiding prone position Monitoring for infection Protecting the affected limb

Use of elbow restraints Avoiding prone position Monitoring for infection Rationale Important postoperative nursing interventions associated with cheiloplasty or cleft lip surgery include use of elbow restraints, avoiding prone position, and monitoring for infection. Protecting the cranium would be associated with cranial surgeries and protecting the affected limb for musculoskeletal surgeries.

A young child is experiencing chronic constipation. Which interventions does the nurse recommend to promote regular bowel elimination? Select all that apply. Decrease activity Use of polyethylene glycol Establish bathroom use routine Increase dietary fiber and fluids Increase iron and calcium supplements Give child a bathroom time limit of 2 to 3 minutes

Use of polyethylene glycol Establish bathroom use routine Increase dietary fiber and fluids Rationale Interventions the nurse should recommend to promote regular bowel elimination include use of polyethylene glycol, establishment of bathroom use routines, and an increase of dietary fiber and fluids. Decreasing activity, increasing iron and calcium supplements, and rushing a child by only giving 2 to 3 minutes to completely evacuate the bowel promote constipation.

Which action can exacerbate respiratory distress in a patient with congenital diaphragmatic hernia? Using a nasogastric (NG) tube Elevating the head of the bed Using a facemask or bag valve mask for ventilatory support Using a high-frequency ventilation system for ventilatory support

Using a facemask or bag valve mask for ventilatory support Air can enter the stomach and further impair respiratory function.

A nurse is concerned that a child with an upper gastrointestinal hernia is experiencing an imbalance in nutrition. Which symptom should the nurse document? Bleeding Vomiting Diarrhea Constipation

Vomiting Vomiting is the clinical manifestation of hernias that can contribute to an imbalance in nutrition.

Which clinical manifestation in a child is considered the first sign suggestive of an obstruction in the pylorus? Obstipation Constipation Vomiting of gastric contents Vomiting of bile-stained material

Vomiting of gastric contents Rationale Vomiting of gastric contents is usually the first sign of obstruction in the pylorus. Vomiting is often the earliest sign of a higher obstruction and obstruction in the pylorus is considered a higher obstruction. Obstipation and constipation are usually early signs of lower obstructions and later signs of higher obstructions. Vomiting of bile-stained material occurs if there is an obstruction in the small intestine.

The nurse is caring for a child with celiac disease. The mother reports that the child attended a birthday party and ate cake. Which assessment finding would the nurse anticipate? Watery stools Peripheral edema Pronounced tachypnea More frequent eructation

Watery stools Loose stools are a result of failure to eliminate gluten from the diet by a child with celiac disease.

The nurse is caring for a child with esophageal atresia who has been diagnosed with failure to thrive. Which assessment findings indicate the expected outcomes have been met for this patient? Select all that apply. Weight gain Normal sleep patterns Increased head circumference Normal urine specific gravity Normal cognitive milestones met

Weight gain The child with esophageal atresia may experience malnutrition and dehydration. Daily weights should be obtained to assess for weight gain, which indicates successful management of the condition. Increased head circumference The child with esophageal atresia may experience malnutrition and dehydration. Daily head circumference measurements should be obtained to assess for head growth, which indicates successful management of the condition. Normal urine specific gravity The child with esophageal atresia may experience dehydration. A normal urine specific gravity indicates successful management of dehydration.

Which dietary supplements are appropriate to facilitate healing when educating the parents of a child who was burned? Select all that apply. Zinc Vitamin B Vitamin C Vitamin D Magnesium

Zinc Vitamin C Vitamin D Rationale Zinc, vitamin C, and vitamin D are essential to wound healing. Adequate protein and caloric intake are also essential to healing. Vitamin B and magnesium are not associated with improved wound healing.

IV drugs

___ __ are more likely to cause a reaction than oral drugs; stop the drug but maintain with normal saline

dermatitis

a sequence of inflammatory changes in the skin that are grossly and microscopically similar but diverse in course and causation

When advising parents about the use of sunscreen for school-age children, the nurse should tell them that: a. a waterproof sunscreen with a minimum 15 SPF is recommended for children. b. the lower the number of SPF, the higher the protection. c. sunscreens are not as effective as sunblockers. d. the sunscreen should be applied 1 hour before the child is allowed in the sun

a. a waterproof sunscreen with a minimum 15 SPF is recommended for children.

Management of brown recluse spider bites includes: a. possible skin graft. b. administration of antivenin. c. applying lemon juice mixed with baking soda directly to the bite. d. administering epinephrine and corticosteroids for impending shock.

a. possible skin graft.

Mary, age 7 years, fell and sustained a deep laceration to her chin. She was taken to the emergency department, where the laceration was sutured with the edges well approximated. The nurse expects the repair healing to take place by: a. primary intention. b. secondary intention. c. tertiary intention.

a. primary intention. primary intention occurs with clean incisions and wound edges close with minimal scarring secondary intention occurs when edges cannot be approximated so healing occurs from the edges inward and from the bottom up tertiary intention is when suturing is delayed or wound breaks down

The most effective method for tick removal in a child is to: a. use curved forceps and grasp close to the point of attachment; then pull straight up with a steady, even pressure. b. apply mineral oil to the back of the tick and wait for it to back out. c. use the fingers to pull the tick out with a straight, steady, even pressure. d. place a hot match on the back of the tick and pick it up with gloved hands when the tick falls off.

a. use curved forceps/twizzers and grasp close to the point of attachment; then pull straight up with a steady, even pressure. often painless so difficult to notice cleanse bite with soap and water after removal

classic triad of intussusception

abd pain, abd mass, bloody stools

abdominal wall defects/omphalocele

abdominal contents herniate through the umbilical ring (hernia of the umbilical cord) usually with intact peritoneal sac sac may content only small portion of the bowel or most, or other abdominal viscera like liver inspect umbilical cord for it before clamping

paresthesia

abnormal sensation such as burning or tingling

Hirschsprung's disease (congenital megacolon)

absence at birth of the autonomic ganglia in a segment of the intestinal smooth muscle wall that normally stimulates peristalsis. mechanical obstruction rectal biopsy to diagnose *the most serious complication is enterocolitis; signs include fever, severe prostration, GI bleeding, and explosive water diarrhea. *Treatment for mild or moderate disease is based on relieving the chronic constipation with stool softeners and rectal irrigations; however, surgery may be required for severe disease

anesthesia

absence of sensation

fluid accumulation

accumulation in area inhibits tissue from approximating

Celiac desease/assessment

acute of insidious diarrhea steattorhea anorexia abdominal pain and distention muscle wasting, particularly buttocks and extremities vomiting anemia irritability

celiac crisis

acute severe episodes of profuse watery diarrhea and vomiting may be precipated by - infections ( especially GI) - prolonged fluid and electrolyte depletion - emotional disturbance

phlegmon

acute suppurative inflammation of subcutaneous connective tissue that spreads

patient outcomes for GER

adequate weight gain limited spitting or vomiting good sleep habits no recurrent pneumonias

systemic therapy

adjunct to topical common drugs - corticosteroids (severe skin disorders, becasue inhibits allergic reaction) antibiotics for severe, chronic, widespread antifungal (systemic fungal infection or tinea capitus)

hypoglycemia treatment/severe reaction/unresponsiveness, unconsciousness, seizures

administer glucagon follow with plannned meal or snack whn child is able to eat or add a snack of 10% of daily calories

yellow gel

advise that the __ __ forming under hydrocolloid dressings may look like pus and has a distinct odor but is normal leakage

therapeutic management encopresis

aim - alleviate the cause of soiling detailed medical history to find cause - risk factors ( negative toilet training), comorbid conditions ( ADD), associated symptoms of bowel movements ( retention, incontinence) when, how often, under what circumstances rectal examination abdominal xray extensive and invasive bowel cleansing to remove impaction meds to remove impaction - lubricants, like mineral oil, osmotic laxatives, like lactulose or polyethelene glycon, magnesium hydroxide dietary changes - avoid milk and dairy, increase fiber, increase hydration, behavioral therapy to eliminate fear

dry wound environment

allows epithelial cells to dry out and die; impairs migration of epithelial cells across wound surface

active occlusive dressing

allows for moist wound healing

constipation

alteration in the frequency, consistency or ease of passing stool unsatisfactory defecation due to infrequent stools, difficult stool passages or perceived incomplete defecation associated with paiful bowel movement

contact dermatitis

an inflammatory reaction of the skin to chemical substances, natural or synthetic, that evoke a hypersensitivity response or direct irritation; initial reaction occurs in exposed region; early there is usually a sharp delineation between inflamed and normal skin that ranges from a faint, trasient erythema to massive bullae on an erythematous swollen base; itching, caused by primary irritant or a sensitizing agent

GER meds

antacids proton pump inhibitors histamine H2-receptor antagonists to decrease gastric acid secretion

insect bite treatment/ prevention

antipruritic agents and baths antihistamines prevent secondary infection avoid contact apply insect repellent whn exposure is anticipated

verruca plantaris management

apply caustic solution to wart and wear foam insole with hole cut to relieve pressure on wart; soak 20 minutes after 2-3 days; repeat until wart comes out

Wound care for a laceration? Puncture wound?

apply pressure with sterile gauze to affected area and cleanse with stream of tepid sterile water to evaluate irrigate with sterile saline, soak in warm soapy water for several minutes, apply clean dressing

herpes simplex virus (type 1 and type 2) management

avoidance of secondary infection; Burow solution compresses during weeping stages; topical therapy to shorten the duration of cold sores; oral antiviral for initial infection or to reduce severity in recurrence; valacyclovir an oral antiviral used for episodic treatment of recurrent genital herpes; reduces pain, stops viral shedding, and has a more convenient administration schedule than acyclovir

Which of the following is true about topical therapy for acute treatment of dermatologic problems? a. Application of heat to the area will relieve itching. b. Apply the topical application in a systematic manner following the contour of the body surface. c. Chemicals that are nonirritating to intact skin will be nonirritating to inflamed skin. d. Emollient action of soaks, baths, or lotions increases skin irritation

b. Apply the topical application in a systematic manner following the contour of the body surface.

The nurse is conducting a review of health records for incoming fifth grade students and discovers that Mary has a history of having had a severe life-threatening systemic response to a Hymenoptera sting. Which of the following is most important for the nurse to do at this time? a. Make sure that Mary has an identification bracelet to alert others of her allergy. b. Contact Mary's parents and physician and obtain an EpiPen for Mary to use if necessary at school. c. Contact Mary's parents about which hospital Mary should be taken to if a sting occurs at school. d. Talk to Mary and see if she has had skin testing to confirm her allergy.

b. Contact Mary's parents and physician and obtain an EpiPen for Mary to use if necessary at school.

During the physical exam of 8-year-old Kevin, the nurse sees a rash at the umbilicus and surrounding area. Kevin tells the nurse that the rash "comes and goes" but "does itch." The nurse recognizes the rash as contact dermatitis. Which one of the following is the most likely cause of this rash? a. Insect bite b. Nickel used in Kevin's belt c. Laundry detergent used to clean Kevin's clothes d. Kevin has developed a food allergy

b. Nickel used in Kevin's belt

Billy has been stung by a bee. A small reaction has occurred at the site. What is the most appropriate action at this time? a. Wait until Billy is at home to completely remove the stinger with forceps. b. Remove the stinger as soon as possible by scraping it off the skin. c. Wash the area with hot water and soap. d. Arrange for Billy to undergo skin testing.

b. Remove the stinger as soon as possible by scraping it off the skin. as long as stinger remains in skin, venom is pumped into wound method of removal doesn't affect venom injection, amount of time before removal did

In preparing the parents of a child with cleft palate, the nurse includes which of the following in the long-term family teaching plan? a. Explanation that tooth development will be delayed. b. explaining the importance of early intervention for speech development c. Use of decongestants and acetaminophen for care for frequent upper respiratory tract symptoms. d. All of the above.

b. explaining the importance of early intervention for speech development

Stevens-Johnson syndrome a. is rare abd occurs most often in females b. is a hypersensetivity reaction to certain drugs c. begins with generalized rash over the entire body except palms, soles, and extensor surfaces d. is caused by a bite from a flea

b. is a hypersensetivity reaction to certain drugs

Erythema multiforme exudativum (Stevens-Johnson syndrome): a. is rare and occurs most often in females. b. is a hypersensitivity reaction to certain drugs. c. begins with generalized rash over the entire body except for palms, soles, and extensor surfaces. d. is caused by a bite from a flea.

b. is a hypersensitivity reaction to certain drugs. hypersensitivity to drug or may follow URI more common in males self-resolving in 2-3 weeks but may recurr with reexposure flu like sx, inflammation of penile glans/eyes/mouth, then generalized erythematous papular rash on any cutaneous surface

Major aims of skin treatment include all of the following except: a. eliminate the cause. b. obtain an accurate account of child's symptoms. c. effective treatment and symptom relief. d. prevent complications

b. obtain an accurate account of child's symptoms. treatment directed toward eliminating factors that interfere with normal healing process maintain dry periwound area and

which og the following describes the onset of secondary enuresis? a. occurs following established stool continence b. occurs after a period of established urinary continence c. occurs following a GI illness d. occurs as a result of behavioral acting out

b. occurs after a period of established urinary continence

the major goal in treatment of contact dermatitis is a. reverse the associated immunologic changes b. prevent further exposure to offending substances c. educate on management of symptoms d. prevent transmission

b. prevent further exposure to offending substances

the major nursing consideration in assiting the family of a child with nocturnal enuresis is to prevent the child from developing alterations in a. body image b. self-esteem c. autonomy d. peer acceptance

b. self-esteem

green bilious vomiting

bowel obstruction

The nurse recognizes that which of the following is not indicated for use in promoting wound healing? a. Nutrition with sufficient protein, calories, vitamins C and D, and zinc b. Irrigation of wounds with normal saline c. Application of povidone-iodine (Betadine) solution d. Application of an occlusive dressing

c. Application of povidone-iodine (Betadine) solution antiseptics (like hydrogen peroxide) are cytotoxic to health cells and minimal effect on controlling infection

Which of the following foreign bodies is least likely to be successfully removed with tweezers? a. Small wooden splinter b. Large spines of cactus c. Embedded needle in the foot d. All of the above

c. Embedded needle in the foot wash area around splinter with soap and water before removal use bevel to expose sliver and grab with tweezers smaller prickles removed by applying glue and covering with gauze or use wax and remove once dry

During wound healing, immature connective tissue cells migrate to the healing site and begin to secrete collagen into the meshwork spaces. What is this phase called? a. Scar contracture b. Inflammation c. Fibroplasia d. Scar maturation

c. Fibroplasia

Which of the following statements about sunscreen containing PABA is false? a. It may stain clothes. b. It can cause an allergic reaction. c. It provides little protection when the child is swimming or sweating. d. It is an effective sunscreen against ultraviolet B.

c. It provides little protection when the child is swimming or sweating. PABA more effective than PABA esters, esters less likely to stain penetrates skin and may accumulate with repeated use, protection even with sweat/swim

Johnny's mother is calling the clinic because Johnny has developed a rash over his entire body. Two days ago he was prescribed amoxicillin for an ear infection, and now his mother tells the nurse she thinks Johnny may have gotten a small rash with this medication when he took it before. Which one of the following would be the best intervention by the nurse at this time? a. Question the mother about other symptoms that Johnny may have developed. b. Continue the medication and have Johnny come in tomorrow to see the practitioner. c. Stop the medication and inform the practitioner. d. Tell the mother to give only half the prescribed dose of the medication until Johnny can return to the clinic to see the practitioner.

c. Stop the medication and inform the practitioner.

Skin disorder assessment includes the objective data collected by inspection and palpation. Which one of the following is not an example of objective data? a. The lesion has an increased erythematous margin edge. b. The rash appears as macules and papules. c. The lesion is painful and itches. d. The lesion is moist

c. The lesion is painful and itches.

Which feeding practices should be used for the infant with a cleft lip or palate? a. Use a large, hard nipple with a large hole. b. Use a normal nipple and position sideways in mouth. c. Use a special nipple, positioned so it is compressed by the infant's tongue and existing palate. d. Withhold breastfeeding until after surgical correction of the defect.

c. Use a special nipple, positioned so it is compressed by the infant's tongue and existing palate.

Erythema multiforme: a. can be caused by fungal infections. b. can be caused by flea bites. c. is characterized by lesions appearing primarily on the palms, soles and extensor surfaces. d. can be life threatening

c. is characterized by lesions appearing primarily on the palms, soles and extensor surfaces. * urticarial plaque with dusky/vesicular center usually d/t viral infections or drug ingestion discontinue drug and apply cool wet compress

Epithelial wound healing: a. begins 72 hours after the wound is incurred. b. occurs by migration and proliferation of epithelial cells from the wound center toward the wound margins. c. occurs more rapidly when the wound is covered with a transparent or other occlusive-type dressing. moist and crust free d. occurs more rapidly when the skin is allowed to dry and to form an eschar, or scab.

c. occurs more rapidly when the wound is covered with a transparent or other occlusive-type dressing. moist and crust free reepithelializes in 12-15d if kept moist, 25-30d if open and dry

The priority nursing goal in the immediate care of a postoperative infant after repair of a cleft lip is to: a. keep the infant well hydrated. b. prevent vomiting. c. prevent trauma to operative site. d. administer medications to prevent drooling.

c. prevent trauma to operative site.

neurofibromatosis manifestations

cafe-au-lait spots, pigmented nevi, auxillary freckling slow growing cutaneous and subcutaneous neurofibromas

impetigo contagiosa management

careful removal or undermined skin, crusts, and debris by softening with 1:20 Burow solution compresses; topical application of bactericidal ointment; systemic administration of oral or parenteral antibiotics in severe or extensive lesions

molluscum contagiosum managemen

cases in well children resolve spontaneously in about 18 months; treatment reserved for troublesome cases; apply topical anesthetic EMLA and remove with curette; use tretinoin gel 0.01% or cantharidin liquid; curettage or cryotherapy

irritable bowel syndrome cause

cause not clear but if family has can be predisposed no abdominal physical findings when evaluating - children active healthy and normal growth

chronic and intermittent vomiting

caused by malrotation

meconium plug/ newborn

caused by meconium that has reduced water content sometimes require irrigations

curdled stomach content, mucus, fatty foods vomiting several hrs after ingestion

caused by poor gastric emptying or high intestinal obstruction

varicella-zoster virus signs

caused by same virus that causes varicella; virus has affinity for posterior root ganglia, posterior horn of spinal cord, and skin; crops of vesicles usually confined to dermatome following along course of affected nerve; usually preceded by neuralgic pain, hyperesthesias, or itching; may be accompanied by constitutional symptoms; pain in children usually minimal; postherpetic pain does not occur in children; chickenpox may follow exposure; isolate affected child from other child in a hospital or school; may occur in children with depressed immunity, can be fatal

Malrotation

caused by the abnormal rotation of the intestine around the superior mesenteric arthery during embryologic development compromise blood supply-> intestinal necrosis, peritonitis, perforation, death

secondary lesions

changes that result from alteration in the primary lesions, such as those caused by rubbing, scratching, medication, or involution and healing

compensatory speech errors

child actively shifts the place of articulation to a place lower in the vocal tract that allows him/her to produce a similar sound as the intended speech sound

nonmonosymptomatic enuresis

child has daytime urinary urgency and ocassional daytime incontinence in conjunction with other conditions such as stress

primary encopresis

child has reached age 4 without establishing fecal continence

Pica is common in

children women autistic cognitive impaired with anemia or chronic renal failure

sleep theory/enuresis

children sleep too soundly and hard to wake up from sleep to pee

diabetes millitus

chronic disorder of metabolism characterized by hyperglycemia and insulin resistance

North American blastomycosis

chronic granulomatous lesions and microabscesses in any part of the body; initial lesion is a papule undergoes ulceration and peripheral spread; pulmonary symptoms such as cough, chest pain, weakness, and weight loss; may have skeletal involvement, with bone destruction and formation of cutaneous abscesses; usual portal of entry is lungs; source of infection unknown; noninfectious; pulmonary infections may be mild and self-limiting and require no treatment; progressive disease often fatal

Seborrheic Dermatitis (Cradle Cap)

chronic recurrent inflammatory reaction of the skin mostly cap/ skullbut may be on eye lids (blepharitis), external ear canal (otitis external)nasolabial folds, inguinal region cause unknown lesions are thick, adherent, yellowish, scaly, oily patches may be pruritic or not

Atopic Dermatitis (Eczema)

chronic relapsin inflammatory skin disorder

diagnistic of hirschsprung disease

clinical signs of intestinal onstruction failure to pass meconium examination - rectum is empty, internal sphincter is tight, leakage of liquid stool confirm - rectal biopsy surgically for full thickness biopsy or by suction for histologic evidence of absence of ganglion cells

surgery of cleft lip/palate

closure of cleft lip first - 3-6 months old cleft palate surgery 6-24 months, done soon to facilitate speech development

diagnostic evaluation appendicitis

colicky cramping abdominal pain around umbilicus Mc Burneys point pain (most strong) most important finding - focal abdominal tenderness and pain rovsing sign psoas sign danphy sign rebound tenderness (not reliable) child cannot walk - pain in the right hip elevated WBC and CBC ( to rule out UTI) - above 10000 elevated c rective protein - active phase infection females - human chorionic gonadotropin ( to rule out ectopic pregnancy) ultrasound - positive with enlarged append. diameter, appen wall thickening; peroappendiceal inflammatory changes - fat streaks, phlegmon, fluid collection, extraluminal gas may use CT scan

cleft lip and cleft palate

congenital anomalies that result of failure of soft tissue or bony structure to fuse during embryonic development causes - heriditary and environmental - expusure to radiation or rubella, chromosome abnormalities and teratogenic factors

encopresis

constipation with fecal incontinence soiling is involuntary and occurs without warning

Encopresis

constipation with fecal soiling

Which clinical manifestations does the nurse observe in a child that confirms intussusception and to rule out hypertrophic pyloric stenosis? Select all that apply. Vomiting Acute abdominal pain Currant jelly-like stools Drawing the knees to the chest Palpable olive-shaped tumor in the epigastrium Palpable sausage-shaped mass in upper right quadrant

cute abdominal pain Currant jelly-like stools Drawing the knees to the chest Palpable sausage-shaped mass in upper right quadrant Rationale A child with intussusception has acute abdominal pain and passes currant jelly-like stools because venous engorgement causes leaking of blood and mucus into the intestinal lumen. The child draws the knees to the chest. A sausage-shaped mass is palpable in the upper right quadrant because in intussusception a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it. Compression of mesentery results in lymphatic and venous obstruction. Vomiting is seen both in intussusception and hypertrophic pyloric stenosis. In hypertrophic pyloric stenosis, an olive-shaped tumor is palpable in the epigastrium just to the right of the umbilicus because of the hypertrophied pylorus.

digestive defects

cystic fibrosis ( pancreatic enzymes are absent) biliary or liver disease ( bile flow is affected) lactase deficiency ( lactose intolerance)

The nurse is assisting Billy, aged 10 years, in applying an all-purpose insect repellent that contains the active ingredient DEET. Which one of the following should be included in the nurse's discussion with Billy? a. DEET is effective against most insects and arachnids, but not ticks. b. Protection will last for several hours but will need to be washed off with soap and water before he goes to bed tonight. c. DEET should be applied to the whole body including the face and hands for better protection. d. DEET must be reapplied after sweating, swimming, wiping, or exposure to rain.

d. DEET must be reapplied after sweating, swimming, wiping, or exposure to rain.

Cindy, age 8 years, is brought to the clinic with a sore on her arm. She tells the nurse that she scratched it on a piece of metal at the playground about 1 week ago. Which one of the following signs would the nurse expect to find if the sore has become infected? a. Itching at the site of the sore b. Rough edges around the sore c. No pain at the site d. Increased erythema, especially around the sore

d. Increased erythema, especially around the sore

Wound care instructions to parents should include which of the following? a. Use betadine, alcohol, and hydrogen peroxide to prevent infection. b. Use hydrocolloid dressing that just covers the wound with little overlap. c. Formation of yellow gel with a fruity odor under hydrocolloid dressings is a sign of infection. d. apply topical antibiotics after washing with mild soap and water or d. Remove the hydrocolloid dressings by raising one edge of the dressing and pulling parallel to the skin to loosen the adhesive.

d. Remove the hydrocolloid dressings by raising one edge of the dressing and pulling parallel to the skin to loosen the adhesive. d. apply topical antibiotics after washing with mild soap and water nonadherent dressings during primary healing, larger wounds may require occlussive dressings (>15% BSA seek med help) HC dressing require large margin around wound and secured with waterproof tape formation of yellow gel with fruit odor is normal leakage if gets stuck upon removal, soak in NaCl/clean water

Which one of the following statements about use of topical therapy in the pediatric population is true? a. Use of silver impregnated in dressing as foam decreases the bacterial burden and bioburden of the wound and has little absorption effect in the pediatric population. b. Application of heat provides a soothing effect to reduce inflammatory processes. c. The use of immunomodulators is suggested as first-line treatment in children younger than 2 years of age. d. Topical immunomodulators have been linked to possible skin cancer and lymphoma.

d. Topical immunomodulators have been linked to possible skin cancer and lymphoma. silver-impregnated not clear for long-term, absorption in PEDS unknown applicatio of heat often aggravates conditions, only used with certain inflammatory processes (folliculitis, cellulitis) often placed on skin and left uncovered, with occlusive dressing to prevent its evaporatuion often enjoyable if you "paint" it on with a brush topical immunomodulators are used as second line for atopic dermatitis/eczema; black boxed <2y.o.

causes of fiaper dermatitis include prolonged contact with a. urine b. feces c. detergents d. all of the above

d. all of the above

Billy has come in contact with poison ivy on a school picnic. The best intervention for the nurse to implement at this time is to: a. wash the area with a strong soap and water solution. b. apply Calamine lotion to the area. c. prevent spread by instructing Billy not to scratch the lesions. d. flush the area immediately with cold water.

d. flush the area immediately with cold water. within first 15min to neutralize the urushiol not yet bonded to the skin and prevent spread harsh soap and scrubbing contra b/c it dilutes and spread urushiol oil

the nurse is assisting the family of a child with a hx of encopresis. which one of the following should be included in the nurse's discussion with this family? a. instructing parents to sit the child on the toilet at 2 daily routine intervals b. instructing parents that child probably needs to have daily enemas for the next year c. suggesting the use of stimulant cathartics weekly d. reassuring the family that most problems resolve successfully with some relapses during periods of stress

d. reassuring the family that most problems resolve successfully with some relapses during periods of stress

mechanical friction

damages or destroys granulation tissue

uremia

decrease collagen and granulation tissue

antiinflammatory drugs

decrease the inflammatory response

pyoedema signs

deeper extension of infection into dermis; tissue reaction more severe; systemic effects are fever and lymphangitis; autoinnoculable and contagious; may heal with or without scarring

drug reaction

delayed or immediate

nursing care/ hirschsprung disease

depends on child's age and type of treatment neonatal period - to help the parents adjust to a congenital defect in their child, foster boding, prepare parents for the surgical intervention, prepare parents for care after surgery preoperative care - improve nourishment - enema, low fiber, high calorie, high protein emptying bowel with saline enemas, decreasing bacterial flora with oral and systemic antibiotics and colonic irrigations, using antibiotic solutions observe for abdominal distention ( measure with tape)

therapeutic management of GER

depends on severity if infant is thriving and has no respiratory complications - no interventions avoid some foods lifestyle modifications - weight loss and small frequent meals feeding maneur in infants - thickened with rice cereal, upright positioning, overweight infants - prethckened formula severe reflux infant - NG feeding until surgery prone position decreases GER, but due to risk of SID do not put child prone pharm treatment infants - H2 antagonists - cimetidine, - dine) or proton pump inhibitors - zole do not use metoclopramide in infants and children PPI give 30 min before evening meal no results right away

the main integumentary problem in children

dermatits

therapeutic management of vomiting

detection and treatment of the cause prevention of complications ( dehydration and malnutrition) often is a symptom of infection so solf limiting, rehydration might be needed may antiemetic drugs motion sickness - dimenhydrinate ( dramamine)

long term complications of diabetes/ macrovascular

develps over 30 years protenuria, retonopathu

acte wound/ penetrating wound

disruption oft he skin surface that extends into underlying tissue or into a body cavity

acute wound/ incision

division of the skin made with a sharp object; cut

therapeutic management of wounds

dressings, topical therapy, systemic therapy

signs of hypoglycemia

early signs: 1. adrenergic ( sweating and trembling) later - untreated adrenergic reaction is neuroglycopenic ( brain hypoglycemia) - difficulty with balance, memory, attemtion, concentration, slurred speech can lead to seizures and coma

Topical Immunomodulators

effective in reducing itching of atopic dermititis and preventing flare ups not to use in kid less than 2 yo due to link to cancer and lymphoma)

Which is most associated with a child with a fecal impaction? Dysphagia Encopresis Hematemesis Failure to thrive

encopresis Rationale Encopresis is overflow of incontinent stool causing soiling. It is often caused by fecal retention or impaction. Dysphagia is difficulty swallowing and hematemesis is vomiting bright red blood. Failure to thrive is a deceleration from growth patterns or consistently remaining below the fifth percentile for height and weight on standard growth charts. It is sometimes accompanied by developmental delays.

Nursing care enuresis

encourage regular bowel elimination to prevent enuresis calendar wet/dry nights no punishment consistent support and encouragement

complication of hirschsprung disease

entericolitis care preoperatively - monitoring vital signs (shock signs)fluid and electrolyte replacement, or blood products, observe for symptoms of bowel perforation ( abdominal distntion, vomiting, increased tenderness, irritability, dyspnea, cyanosis)

constipation in school age

environmental changes stresses changes in toileting patterns like fear to use school bathroom, early rush departure for school

coccidiodomycosis

erythema nodosum, erythema multiforme, erythematous maculopapular rash; primary lung disease usually asymptomatic, may be sign of acute febrile illness, disseminated disease is serious; IV amphotericin B, IV miconazole, intraventricular miconazole plus oral ketoconazole for CNS involvement, surgical resection of persistent pulmonary cavities; inhalation of aerospores from soil; endemic in Southwestern US; usually resolves spontaneously; increased incidence in dark-skinned races (Filipino, African-American, Mexican, Asian)

Erythema multiforme/ stevens-johnson syndrome manifestations

erythematous popular rash lesions enlarge by peripheral expansion, develop central vesicle involves most skin surfaces except scalp may extends to mucous membranes ( oral, ocular, urethral) rash precedes by fever and malaise complications - renal failure, severe eye disease self-limiting, but recovery for weeks

clinical manifestation of GER/ complications

esophagitis esophageal stricture laryngitis recurrent pneumonia anemia barrett esophagus

nursing care/ of esophageal atresia and trachoesophageal fistula

establishment of patent airway prevention of further respiratory compromise remove secretions by suction feeding tube via the mouth into the stomach

polyhydramnios

excessive amniotic fluid possible indication of esophageal atresia and trachoesophageal fistula, vecause it cannot reach GI

hyperesthesia

excessive sensitivity

pump disadvantages

expensive requires commitment math skills not to be removed for more than 1 hr skin infection is common malfunctioning possib;e

anatomic defects

extensive resection SBS

obstipation

extremely long intervals between defecations

Esophageal Atresia and Tracheoesophageal Fistula

failure of the esophagus to develop as a continuous passage during fetal development and failure of the trachea and esophagus to separate into distinct structures most common form - proximal esophageal segment terminates in a blind pouch and the distal segment is connected to the trachea or primary bronchus by a short fistula at or near the tracheal bifurcations second common type - blind pouch at each end widely separated and with no communication to trachea

Long term effects of DM

failure to grow at a normal rate delayed maturation recurrent infections neuropathy cardiovascular disease retinal microvascular disease retinal macrovascular disease

clinical manifestation hirschsprung disease/ newborn

failure to pass meconium within 24-48 hrs after birth refusal to feed bilious vomiting abdominal distention

complication of malabsorption

failure to thrive

clinical manifestation hirschsprung disease/ infancy

failure to thrive constipation abdominal distention episodes of diarrhea and vomiting signs of enterocolitis ( explosive, watery diarrhea, fever, appears significantly ill)

GER complications

failure to thrive respiratory dysphagia

Preoperative care / cleft

feeding adjustment - cup or syringe feeding

nursing care child with cleft

feeding the infant and teaching parents to feed dealing with parental reaction to defect

Signs of peritonitis

fever sudden relief from pain subsequent increase in pain guarding abdomen progressive abdominal distention tachycardia rapid shallow breathing child refrains from using abdominal muscles pallor chills irritability restlessness

molluscum contagiosum signs

flesh colored papules with a central caseous plug (uncomplicated); usually asymptomatic; common in school-age children; spread by skin-to-skin contact, including autoinoculation and fomite-to-skin contact

arthropods that cause skin lesions

flies, gnats, mosquitoes, chiggers, harvest mites, bees, wasps, hornets, yellow jackets, fire ants, black widow spiders, brown recluse spider, scorpions, ticks

diabetic ketoacidosis/ fluid and electrolyte therapy

fluid deficit should be replaced evenly over 36-48 hrs vigorous potassium administration ( after renal function established, voiding at least 25 ml/hr and insulin is given. Use cardiac monitor

acute wound/avulsion

forcible pulling out or extraction of tissue

require medical evaluation

foreign bodies such as a fishhook, pieces of glass, a difficult-to-see object, or a deeply embedded object such as a needle in a foot or near a joint

insect bites characteristics/ manifestation

foreign protein in insect saliva introduced hypersensetivity reaction papular urticaria firm papules little or no reaction in nonsensetized person

Angiogenesis

formation of new blood vessels

clinical manifestation / Esophageal Atresia and Tracheoesophageal Fistula

frothy saliva in the mouth and nose drooling choking coughing respiratory distress cyanotic and apneic because of aspiration of breastmilkand saliva stomach might be distended with air gastic contents regurgitated into trachea causing chemical pneumonitis

irritable bowel syndrome symptom

functional GI disorder alternating diarrhea and constipation flatulence bloating feeling abdominal distention lower abdominal pain ( at least 4 days per month over 2 month) feeling of urgency when need to defecate feeling of incomplete evacuation

tinea corporis signs

generally round or oval, erythematosus scaling patch that spreads peripherally and clear centrally, may involve nails; direct examination of scales microscopically diagnosis; usually unilateral; usually of animal origin from infected pets; majority of infections in children causes by M. canis and M audouinii

when difficult to determine between hyperglycemia and hypoglycemia

give simple carbs they will do no harm during hyperglycemia and improve symptoms of hypoglycemia

glucagon

given durring hypoglycemia ( IM or SQ) requires 15-20 min to elevate the blood glucose level caution - may produce vomiting, so careful with aspiration ( place child on the side)

deficiency of insulin

glucose cannot enter cells and concentrates in the blood stream

insulin therapy

goal - to maintain near normal blood glucose value while avoiding frequent episodea of hypoglycemia

diabetes: illness management

goals are: 1. restore euglycemia 2.treat urinary ketones every 3 hrs dose will need to be adjuted fluids the most important before insulin and diet to flush the ketones

treatment for organic causes of constipation/ phase 3: weaning

gradual tapering of laxatives continue high fiber fluid intake behavioral modification

fibroplasia

granulation or proliferation 5days - 4 weeks -fibroblasts migrate to healing site and begin to secrete collagen - granulation - red shiny connective tissue -> forms stronger fibers - thin epithilial layer regenerates over the surface of the wound - leukocytes disappear from the area - collagen continues to deposit and organize in layers, compressing the new blood vessels - fiberblasts disappear with maturation scar becomes pale

herpes simplex virus (type 1 and type 2) signs

grouped, burning, itching vesicles on inflammatory base, usually on or near mucocutaneous junctions (lips, nose, genitalia, buttocks); vesicles dry, forming a crust followed by exfoliation and spontaneous healing in 8-10 days; may be accompanied by regional lymphadenopathy; heal without scarring unless secondary infection; type 1 cold sores prevented by using sunscreen protecting against UVA and UVB light to prevent lip blisters; aggravated by corticosteroids; positive psychological effect from treatment; may be fatal in children with depressed immunity

candidiasis signs

grows in chronically moist areas; inflamed areas with white exudate, peeling, and easy bleeding; pruritic; characteristic appearance is diagnosis; common form of diaper dermatitis; oral form common in infants; vaginal form in older girls; may be disseminated in immunocompromised children

retraining therapy for constipation

habit training reinforcement for sitting on the toilet and defecating established time 1-2 times a day after meal time of 5-10 min should be spent

bacterial infection management

hand washing separate towels, sponges daily clothes change washed in hot water razors throw away after 1 use and not share chlorine bath BID 5-10 days (1/4 c bleach in tub) NO SQUEEZING, puncture

configuration and arrangement

he size, shape, and arrangement of a lesion or groups of lesions; discrete, clustered, diffuse, or confluent

pediculosis capitis

head lice; an infestation of the scalp by a common parasite in school-age children; lays eggs at night and at the junction of the hair shaft and skin because eggs need a warm environment; itching

clinical manifestations of GER/ children

heartburn abdominal pain chronic cough hoarse voice dysphagia asthma recurrent vomiting

nursing management celiac disease

help to adhere to diet READ LABELS, new recipies lactose intolerance? DIET - HIGH CALORY, HIGH PROTEIN, SIMPLE CARBS, LOW FATS avoid high fiber food

diagnostic evaluation pyloric stenosis

history and physical examination olive like mass ultrasound - elongated mass surrounding by a long pyloric canal upper GI radiography to rul out other causes if if no hypertrophied pylorus metabolic alterations - depletion of water and electrolytes; decreased serum of sodium and potassium; decrease serum chloride, increase pH and bicarbonate (CO2 content) - metabolic alkalosis blood urea - signs of dehydration

diagnostic evaluation of GER

history and physical examination upper GI series 24 intraesophageal pH monitoring study ( not good for children and infants due to poor acidity in them) endoscopy with biopsy ( to exclude crohns) scintigraphy - detects radioactive substances in the esophagus after a feeding of the compound and assess gastric emptying

preparation for discharge

how to clean sutures how to feed might need elbow restraints appropriate car seat

Recombinant Growth Factors

human platelets they foster the formation of new granulation tissue by stimulating the migration of fibroblasts, macrophages, smooth musle cells and capillary endorhelial cells

major goals atopic dermattiis treatment

hydrate skin relieve pruritus reduce flare-ups or inflammation prevent and control secondary infection

Neurofibromatosis: i. is an autosomal dominant genetic disorder. ii. is suspected when the 5-year-old child is seen with six or more café-au-lait spots larger than 5 mm in diameter. iii. is suspected when the infant develops axillary or inguinal freckling. iv. is known to cause developmental delays and cognitive impairment. v. has the risk of being transmitted to 75% of the offspring. vi. therapy is limited to excision of tumors that produce pain or impair function and symptomatic management of symptoms.

i. is an autosomal dominant genetic disorder. ii. is suspected when the 5-year-old child is seen with six or more café-au-lait spots larger than 5 mm in diameter. iii. is suspected when the infant develops axillary or inguinal freckling. iv. is known to cause developmental delays and cognitive impairment. vi. therapy is limited to excision of tumors that produce pain or impair function and symptomatic management of symptoms. Lisch nodules (dome clear/yellow/brown elevations on iris) common; elephantiasis may occur increased risk for learning/social/emo problems

omphalocele management

if bowel intact - put non adherent dressing to prevent damage if bowel exposed - cover with bowel bag or moist dressing to prevent excessive fluid loss, drying and temperature instability IV fluids and antibiotics silastic double lumen catheter to decompress bowel surgery nonoperative - silver sulfadiazine to enhance epithiliazation closure with skin flaps from the lateral abdominal wall if sac disrupted - silo mesh to house omphalocele postoperative - ventilation, parenteral nutrition, resume feedings once adequate bowel function established monitor for postsurgery complications

corticosteroids

impair phagocytosis, inhibit fibroblast proliferation, depress formation of granulation tissue, inhibit wound contraction

clinical manifestation of celiac disease

impaired fat absorption - steatorrhea ( excessively large, pale, oily, frothy stools), exceedingly foul smelling stools impaired nutrition absorption - malnutrition, muscle wasting ( legs, buttocks), anemia, anorexia, abdominal distention behavioral changes - irritability, uncooperativeness, apathy

zinc deficiency

impairs epithelialization

bacterial infection

impetigo contagiosa pyoderma folliculitis cellulitis staphylococcal scalded skin syndrome

primary enuresis

in children who has never achieved continence, never been dry for extended period of times

foreign body

increase inflammatory response and inhibit wound closure

signs of wound infection

increased erythema especially below the wound margin; edema; odor purulent exudate; pain; increased temperature

hypernatremia signs

increased thirst dry, sticky mucous membranes flushed skin increased temperature nausea and vomiting oliguria and lethargy

infection

increases inflammatory response and increases tissue destruction

moist wound healing

increases the rate of collagen synthesis and reepithilealization and decreases pain and inflammation;l also creates an environment for autolytic debridement or necrotic tissue, which creates a clean wound bed and enhances granulation

susceptibility by age

infants - birth marks school age - tinea ( ringworm) of scalp and acne

Which condition in the child brought to the emergency department is the likely cause of the symptoms of vomiting, fever, and diarrhea? Infection Bowel obstruction Poor gastric emptying Central nervous system disorder

infection Rationale When vomiting is accompanied by fever and diarrhea, the underlying cause may be an infection. When vomiting is green and bilious, the underlying cause may be bowel obstruction. When vomiting has curdled stomach contents, mucus or fatty foods, and occurs many hours after ingestion, the underlying cause may be poor gastric emptying. When vomiting is associated with change in the level of consciousness or a headache, the underlying cause may be a central nervous system disorder.

omphalocele postoperative complications

infection evisceration intestinal volvulus obstruction ventral hernia long term complication - GER, failure to thrive, ventral hernia, feeding issues if infant was NPO

other complications of gastroschisis

infection transient renal impairement intestinal obstruction vena cava compression subsequent decrease in blood flow to the lower extremities

folliculitis

infection of hair follicle; pimple

process of wound healing

inflammation fibroplasia scar contraction scar maturation

appendicitis

inflammation of the vermiform appendix peak 12-18, mostly boys

Neurofibromatosis causes

inherited autosomal dominant

diabetes mellitus

inhibits collagen synthesis, impairs circulation and capillary growth, hyperglycemia impairs phagocytosis

radiation

inhibits fibroblastic activity and capillary formation; may cause tissue necrosis

vitamin c deficiency

inhibits formation of collagen fibers and capillary development

impaired circulation

inhibits inflammatory response and removal or debris from wound area, reduce supply of nutrients to wound area

inflammation

initial response at the site of injury vascular and cellular response that prepares the tissue for the subsequent repair process angiogenesis and phagocytosis

bees, wasps etc mechanism and manifestation

injection of venom through stinging. vnom contain histamine, allergenic proteins local reaction - small red area, wheal, itching, heat systemic reaction - may be mild to severe, including generalized edema, pain, nausea, vomiting, confusion, respiratory impairment, shock

discharge education of esophageal atresia and trachoesophageal fistula

instruction about feeding technique semiupright feeding position small feedings observation for adequacy of swallowing - regurgitation, cyanosis, choking signs of tracheomalacea monitor for signs of GER - wheezing, labored respirations signs of respiratory difficulty and of esophageal stricture - poor feeding, chocking, dysphagia, drooling, regurgitating undigested food food restrictions, cut food and help to swallow with liquids

ketoacidosis

insulin is absent glucose unavailable body chooses alternative source - fat, which breaks into fatty acids and glycerol and converted to ketone bodies excess id eliminated in urine (ketonuria) and breath (acetone breath) potassium released from cells and excereted by kidneys

signs of malrotation

intermittent bilious vomiting recurrent abdominal pain distention lower GI bleeding

chemotherapy

interrupts the cell cycle; damages DNA or prevents DNA repair

absorptive defects

intestinal mucosal transport system is impaired

mycotic systemic infection

invades visera as well as skin - lungs not transmitted from person to person, reside in soil and airborn chronic with slow progression

post operative care/ hirschsprung disease

involves parents in care observe signs of wound infection observe irregular passage of stool sometimes anal dialtion to prevent strictures may be diverting colostomy performed teach parents to dilate anal part, care for colostomy

therapeutic management of diabetic ketoacidosis

is a state of insulin deficiency 1. rapid assessment 2. adequate insulin to reduce blood glucose level 3. fluids to overcome dehydration 4. electrolyre replacemnt ( especially potassium) priority actions: 1. venous access for admnistration fluids 2. weigh, measure child 3. place on cardiac monitor 4. at bedside determine blood glucose and ketone level 5. samples obtained for glucose, electrolytes, BUN< arterial pH, Po2, PCO2, HG, Hct, WBC, CA, phosphorus 6. administer oxygen if cyanotic nd less than 80% 7 gastric suction to unconscious 8. antibiotic to fibrile kids 9 Foley catheter?

result of gastroschisis possibly

jejunoileal atresia ischemic enteritis malrotation

tinea cruris signs

jock itch; skin response similar to tinea corporis; localized to medial proximal aspect of thigh and crural fold; may involve scrotum in boys; pruritic; rare is preadolescent children; health education regarding personal hygiene

ketoacidosis decrease

ketoacidosis dehydration electrolyte imbalance acidosis coma death

another theory/enuresis

kidneys of these childe fail to concentrate urine duirng sleep because if insufficient secretion of antidiuretic hormone

long acting insulin

lantus 6-14 hrs to start working no peak or very small 10-16 hrs later stays in blood 20-24 hrs

furuncle

larger lesion with more redness and swelling at a single follicle (boil)

tinea capitis

lesions in scalp but may extend to hairline or neck; characteristic configuration of scaly, circumscribed patches or patchy, scaling areas of alopecia; generally asymptomatic but severe, deep inflammatory reaction may occur that manifests as boggy, encrusted lesions; pruritic; microscopic examination of scales is diagnostic; person-to-person transmission; animal-to-person transmission; rarely, permanent loss of hair; atopic individuals more suspectible

topical corticosteroid therapy

local antiinflammatory directly to the area large amount may mask sign of infection teach parents - apply thin layer, no more than 5-7 days ( can cause dipegmentation)

tinea cruris management

local application of tolnaftate liquid; wet compresses or sitz baths may be soothing

preventing the spread of pediculosis

machine wash all washable clothing, towels, and bed linens in hot water and dry them in a hot dryer for at least 20 minutes; dry-clean non-washable items; thoroughly vacuum carpets, car seats, pillows, stuffed animals, rugs, mattresses, and upholstered furniture; seal nonwashable items in plastic bags for 14 days if unable to dry clean or vacuum; soak combs, brushes, and hair accessories in lice-killing products for 1 hour or in boiling water for 10 minutes; in day care centers, store items such and hats, scarves, and other headgear in separate cubicles; discourage sharing of items such as hats, scarves, hair accessories, combs, and brushes; avoid physical contact with infected individuals and their belongings, especially clothing and bedding; inspect children in a group setting regularly for head lice; provide educational programs on the transmission of pediculosis

staphylococcal scalded skin syndrome signs

macular erythema with sandpaper texture of involved skin; epidermis becoming wrinkled in <2 days, and large bullae appearing; infants subject to fluid loss; impaired body temperature regulation; secondary infections, such as pneumonia cellulitis, and septicemia; heals without scarring

nursing care for vomiting

main goal - observation and reporting of vomiting behavior and associated symptoms; implementation of measures to reduce the vomiting rehydration and prevention of dehydration ( monitor fluid and electrolyte balance) make sure to brush teeth after vomiting to dilute hydrochloric acid on teeth prevention of aspiration if vomits important to include carbs and small frequent meals interventions determined by cause improper feeding - teaching proper techniques probable GI obstruction - withhold food or implement special feeding techniques

treatment of esophageal atresia and trachoesophageal fistula

maintenance of a patent airway prevention of pneumonia gastric or blind pouch decompression supportive therapy surgical repair of anomaly

complications from appendiceal perforation

major abscess phlegmon enterocutaneous fistula pertonitis partial bowel obstruction

nursing care of constipation

major task - educate parents regarding normal stool patterns, participate in the education and treatment of the child guide parents in food high in fiber reassure parents about prognosis with normal habits instructions about treatment plan for parents discuss toilet habits

Celiac Disease

malabsorption syndrome caused by an immune reaction to gluten/ intolerance *intolerence to gluten, the protein component of wheat, barley, rye and oats is characteristic accumulation of glutamine, toxic to GI mucosa. intestinal villi atrophy intestinal villous atrophy occurs and affects absorption of ingested nutrients symptoms - @1-5yo 3-6 months period between introduction and onset symptoms risk of malignant lymphoma of the small intestine

monitoring blood glucose

manually or with the device from fingertip or other site like forearm

intertrigo

mechanical trauma and aggravating factors of excessive heat, moisture, and sweat retention; affected areas kept clean and dry, skin folds kept separated with a generous supply of nonmedicated powder, expose to air and light, remove excess clothing

therapeutic management enuresis

medication complimentary alternative INITIAL TREATMENT- reward system ( chart with stars) retention control ( drink while alert and delays urination as long as can to stretch the bladder), kegel, pelvic muscle exercise waking schedule - child is awakened during the nightat intervals to void conditional therapy - trains child to wake up after the stimulus is givel like urine alarm ( system detects moisture, the buzzer buzz to wake up child

diagnostic techniques

microscopic examination, cultures, skin scrapings or biopsy, cytodiagnosis, patch testing, wood light examination, allergic skin testing, and blood count and sedimentation rate

feeding child with cleft

might have growth failure, so weekly weight check difficulty to achieve a seal bottles/nipple with wider base cheeck support (squeezing the cheecks together to decrease the weidth of the cleft) infant feeding requires compression and suction child cannot extract milk from breast, so special bottles are needed encourage mother (1) to express milk for bottle feeding; (2) skin to skin contact; (3) after bottle feeding to allow non nutritional sucking cleft children are noidy eaters burp every oz of feeding or 2-3 times during feeding

pyloric stenosis interventions

monitor I/O, vomiting episodes, stools, daily weights, signs of dehydration and electrolyte imbalance prepare child and parents for pyloromyotomy

special problems/ nursing care/ of esophageal atresia and trachoesophageal fistula

monitor for pneumonia, atelectasis, pneumothorax and laryngeal edema monitor for anastomic leaks and signs of infection - purulent chest tube drainage, increased WBC, temperature fluctuation provide paccifer to promotehealthy sucingafter surgery careful teahcing sucing and swallowing after surgery encourage bonding with infant through visitation

Intussusception

most common cause of intestinal obstruction 3month-6yo, male prox

constipation in early childhood

mostly due to environmental changes or normal development

carbuncle

multiple boils; more extensive lesion with widespread inflammation and pointing at several follicular orfices

injury to deeper tissue

muscles and nerve unable to regenerate - repair by substituting fibrous connective tissue for the injuried tissue Scar serves as a patch to preserve continuity of the tissue

long term complications of diabetes/ microvascular

nephopathy retinipathy neuropathy

conditions predisposing to GER

neurologic impairement chronic respiratory disorders esophagial atresia obesity genetic bronchopulmonary dysplasia scoliosis cycstic fibrosis cerebral palsy

potassium

never give before knowing the levesl and urinary voiding is observed never give as rapid bolus

therapeutic management IBS

no cure involves controlling symptoms and regular bowel habits management depends - constipation or diarrhea constipation predominant - increase fiber and supplements diarrhea predominent - diet changes, PPI, loperamide, may be probiotic cognitive-behavioral therapy, hypnotherpay, coping skills

fungal management

no exchange of grooming items and clothing affected children use separate towels, wear protective cap at nigth check all animals in the house ketoconazole and 1% selenium sulfide shampoos to treat it - 5-10 min 3 times a week griseofulvin drug take with high fat food and continue all the way side effects - headache, GI upset, fatigue, insomnia, photosensetivity periodic checking to monitor leukopenia and assess liver and renal function other meds - terbinafine, itraconazole, fluconazole

family support /atopic dermatitis

no lesions will be produced disease isnot contagious remissions may happen talk about stress

diabetes monitoring/ urine

no longer used tests for ketones only test for ketones should be done every 3 hours during illness

insulin

no need to refrigirate but keep at temp 15-29 C freezing renders insulin inactive opened bottles store at room temp or in the fridge for up to 28-30 days, then throw away practice with simple saline injections any adipose tissue over muscle, 90degree pinch technique is the most effective fr tenting skin preferred sites - thigh, abdomen, part of hip, arm rotate sites - paper doll to mark site, few times a week parent give injection into the site that child cannot reach site other than excersing extremity

nutrition/ diabetes

no special foods or supplements timing of food consumption should be during peak insulin action between meals should eat snack to avoid hypoglycemia, but also depends on the activity level concentrated sweets discouraged, reduced fat, increased fiber

intermediate acting insulin

novolin N reaches blood 2-6 hrs later peaks 4-14 hrs stays in blood 14-20 hrs

recommended daily fiber intake

number in years +5 gr per day

postoperative care/ cleft palate

observation for airway obstruction, hemorrhage and larengeal spasm face mask for O2 tongue stirtch to prevent it obstructing airways, tapered to the cheek observe vital signs and O2 saturation ( stridor, croup, difficulty breathing and swallowing) 24 hrs - clear liquids 2 weeks liquid diet 6 weeks soft diet no use of utensils or straws elbow restrains to keep hands away from mouth opiates for pain 24-48 hrs, after that acetominphen

nursing care/ pyloric stenosis

observation for clinical features regulation of fluid therapy reestablishment of of normal feeding patterns child -alert but fails to gain weight and has a history of vomiting after feeding preoperatively - restoring hydration and electrolyte balance, NPO, IV fluids with glucose and electrolytes, monitor I/O, description of vomitus, character of stools vital signs ( especially regarding electrolytes), skin and mucous membranes NG patency and functioning, amount and type of drainage postoperative - child vomits 24-48 hrs, so IV fluids, monitor vital signs, liquid balance, I/O, pain management, monitor incision for sign of infection, dressings feedings usually start 12-24 after surgery, beginning clear liquids, observation infant's reaction to feedings

hospital management of children with ketoasidosis

observe and record vital signs (pulse, respiration, temperature, BP), weight, IV fluids, electrolytes, insulin, blood glucose level, I/O frequently observe for elevated temperature and report immediately ( infection) collect urine for test volume, specific gravity, glucose and ketone values keep diabetic flow sheet next to bed - ongoing records of vital signs, urine and blood tests, amount of insulin given, I/O let child be involves - keeping I/O records, testing blood and urine, admnistering insulin

cleft palate/lip

occurs when right and left halves of the palate fail to join medially. this deviation leaves an opening between the mouth and nasal cavities that interferes with sucking and thus the baby's ability to nurse. it can also lead to inhalation of food into the nasal cavity and lungs, possibly resulting in pneumonia. this condition can be repaired surgically.

pyloric stenosis

occurs when the circumferential muscle of the pyloric sphincter becomes thickened , resulting in elongated and narrowing of the pyloric canal palpable as an olive-like mass in the upper abdomen

tinea corporis management

oral griseofulvin; local application of antifungal preparation such as tolnaftate, haloprogin, miconazole, clotrimazole; apply 1 inch beyond periphery of lesion; continual application 1-2 weeks after no sign of lesion

tinea pedis management

oral griseofulvin; local applications of tolnaftate liquid and antifungal powder containing tolnaftate; acute infections-compresses or soaks followed by application of glucocorticoid cream; elimination of conditions of heat and perspiration by clean, light socks and well-ventilated shoes; avoidance of occlusive shoes

tinea capitis management

oral griseofulvin; oral ketoconazole for difficult cases; selenium sulfide shampoo; topical antifungal agents

treatment for organic causes of constipation/ phase 2: maintenence ( 6-12 months)

oral laxatives - polyethylene glycol - mineral oil - lactulose - magnesium hydroxide high fiber diet increased fluid intake behavioral training

cellulitis management

oral or parenteral antibiotics; rest and immobilization of both affected area and child; hot, moist compresses to the area

cleft palate risks for the child

otitis media hearing loss

rebound tenderness

pain with deep palpation with sudden release

psoas sign

pain with left side with right hip extension

stress

pain, poor sleep; releases catecholamines that cause vasocontriction

clinical manifestation encopresis

painful expulsion of hard pellet like stools voluntary retention is temporary with history of painful and blood streaked stools involuntary retention - abdominal pain, distention, moodiness, poor appetite, accumulation of stools with periodic passage of volunous stools child may look stiffened, stay in the corner with straight legs and bright red face, doing a little dance, crawling, hiding behind furniture, hide soiled underwear may avoid social gatherings

nursing management/ wound descriptions

palpate and inspect skin color, shape, size, character and distribution of the lesion describe each lesion separately depth of wound evidence of healing signs of infection temperature, moisture, tecture, elasticity and presence of edema generalized or localized precipitating factors feelings (painful, itching...)

first symptoms of appendicitis

periumbelical pain nausea right lower quadrant pain vomiting and fever perforation usually within 48 hrs after first symptoms

pica diagnosis

physical examination ( abdominal pain, GI symptoms, anemia) history radiologic studies

diagnostic evaluation/enuresis

physical examination to rule out physical causes detailed history of voiding, including toilet training baseline count of accidents and time of the day dignostic of bladder capacity (hold off till strongest urgency)

GER positioning

place infant in the supine position during sleep to reduce the incidence of SID) unless the risk of death from aspiration or other serious complications of GER greatly outweighs the risks associated with the prone position prone position is acceptable only while the infant is awake in children older than 1 yo, position with the head of the bed elevated

Diagnosis of malrotation and volvulus

plain abdominal radiograph and lateral decubitus view - bowel distention proximal to the distention lateral view - air fluid levels in the distended bowel upper GI series - most accurate

verruca plantaris signs

plantar wart; located on plantar surface of feet and because of pressure, are practically flat; may be surrounded by a collar of hyperkeratosis; destructive techniques tend to leave scars, which may cause problems with walking, apply topical anesthetic EMLA

clinical manifestations of type 1 diabetes

polyphagia polyuria polydipsia weight loss enuresis and nocturia irritability shortened attention span lowered frustration tolerance dry skin blurred vision poor wound healing fatigue flushed skin headache frequent infection

cardianal sign of diabetes

polyuria

skin of young children

poorly adherent to dermis causing to separate easily during inflammation adn blister formation

pain and discomfort management

positioning rest distraction individual preferences for severe pain - pain medication before wound dressing change

nursing care. /gastroschisis

positioning to prevent rapture or disturbance of silo gradual silo reduction viscera protected with moist dressing thermoregulation monitor adequate fluid volume - fluid replacement GI decompression before surgery via NG tube major concerns - heat and moisture loss postoperative care - monitor sign of complications and assessment of bowel function, pain management parenteral nutritional support several days or week to return back to normal and full feedings consultation with feeding

prolonged exposure of bowel to amniotic fluid

predisposes to paralitic ileus and hypomotility

Gastroschisis: Management

prenatal - protection of the bowel from the effects of amniotic fluid initial management - covring the exposed bowel with a transparent plastic bowel bag or loose moist dressing if the opening through which protruding is occuring is small and strangulating, the opening is made bigger IV fluids, antibiotics double lumen NG tube for bowel decompression fluid replacement increased 2-3 times because of large losses from exposed viscera adequate termoregulation initially after surgery silastic silo might be placed till closure in surgery usually infants operated within 24 hr due to temperature instability, risk infection and fluid loss postoperative care - mechanical ventilation ( due to increased abdominal pressure), pain management ( 72 hrs) with morphin and phentanyl, nutritional support (parenteral and enteral). Prolonged parenteral nutrition may cause liver failure.

nursing care/ intussusception

preparation for hospitalization, hydrostatic reduction and possible surgery preoperatively - NPO, CBC and urinalysis, signed parent consent, preanesthetic sedation if perforation occured - IV fluids, systemic antibiotics, bowel decompression postprocedural - observation of vital signs, blood pressure, intact sutures, dressing and the return of bowel sounds observation for passage of water soluble contrast and the stool pattern

major nursing function related to bacterial skin infection

prevent the spread of infection prevent complications

What is the difference between a primary irritant and a sensitizing agent?

primary irritant irritates any skin, sensitizing agent irritates immunologically changed indiv

sensitizing agent

produces an irritation on those individuals who have met the irritant or something chemically related to it, have undergone an immunologic change, and have become sensitized; irritates in relatively low concentrations only person who are allergic to it

Morning Hyperglycemia: insulin waning

progressive rise in the blood glucose levels from bedtime to morning treated by increasing nocturnal insulin

clinical manifestation of hypertrophic pyloric stenosis

projectile vomiting ( 3-4 ft from child when in a side lying position, 1 ft or more in back lying; occurs shortly after feeding or in several hrs; may follow each feeding or intermittently; nonbilious or blood tinged) infant hungry, eagerly accepts 2nd feeding after vomiting no evidence of pain or discomfort poor weight gain signs of dehydration istended upper abdomen redily palpable olive-shaped tumor in the epigastrium just right to the umbelicus visible gastric peristalsis waves that move from left to right across the epigastrium

management of simple constipation

promotio of regular bowel movement - change the diet to have more fiber and fluids and eleminate food causing constipation - establish bowel routine - sometimes stool softening agents are helpful if vomiting - investigate further

Nursing care of appendicitis

prompt recognition preliminary assessment of severity of pain- plays, layes, position of laying history, abdominal examination do not palpate. light palpating with stethoscope not hand ask child - hop on 1 foot, puff out/pull in abdomen, lift and drop heel 2-3 times

postoperative care Cleft lip

protection of the operative site avoid prone to prevent suture damage pain management thin layer of antibiotics for sutures for 3 days, following application of petroleum jelly for several weeks clean sutures using water position the infant to prevent airway obstruction by secretions, blood or tongue perform aspiration of mouth and nasopharyngeal suction to prevent aspiration monitor for bleeding - excessive swallowing is a sign

clinical manifestations of pediculosis

pruritus caused by crawling insects and insect saliva on the skin, nits observable on the hair shaft, distribution in the occipital area, behind ears, nape of neck, eyebrows, and eyelashes occasionally

forceful vomiting caused

pyloric stenosis

therapeutic management intussusception

radiologist guided pneumoenema ( gas enema) ultrasound-guided hydrostatic enema IV fluids NG decompression antibiotic therapy may surgery ( to reduce invagination)

types of insulin

rapid, short, intermediate, long acting

vomiting on a certain day in kids at the same time

rarely organ disease

Morning Hyperglycemia: Somogyi Effect

rebound hyperglycemia occurs at any time but often elevated blood glucose level at bedtime and drop at 2 am witha reboun rise following treatment - decrease nocturnal insulin to prevent 2 am hypoglycemia

early sign of type 2 diabetes in adolescents

recurrent vaginal and UTI especially with candida albicans

anemia

reduces oxygen supply to tissue

peripheral vascular disease

reduces oxygen supply to wounds

protein deficiency

reduces supply of amino acids for tissue repair

Morning Hyperglycemia: true dawn phenomenon

relatively normal level till 3 am and then begins to rise

acute wound/ abrasion

removal of the superficial layers of skin by rubbing or scraping

Wound Care

remove carefully to protect intact skin if area has hair - remove remove dressing parellel to the skin if sticks too mcuh soak with saline or clean water picture framing technique is useful - apply pressure - unless artery severed, clean with sterile water or normal saline - examine wound - remove foreign material - topical analgesic - suture punctured wounds irrigate with sterile saline and soak ina basin of warm soapy water for severel minutes caution parents against popping wounds or kissing t to make it better

Encopresis

repeated voluntary or involuntary passage of feces of normal or near normal consistency in places not appropriate for that purpose according to the individual's own sociocultural setting event must happen at least once a month for a minimum of 3 months and at least 4 yo child must not be caused by laxatives or general medical condition

Sandifer syndrome

repetitive stretching and arching of the head and neck that can be mistaken for a seizure, but most likely represent a physiologic neuromuscular response attempting to prevent acid refluxate from reaching the upper portion of the esophagus

heat application

reserved for folliculitis or cellulitis

preoperative care/ nursing care/ of esophageal atresia and trachoesophageal fistula

respiratory assessment, airways management, thermoregulation, fluid and electrolyrte management and pareteral nutritional suport suction the mouth and nasopharynx, intermittent or continuous until surgery indwelling catheter passed orally or nasally to the end of the pouch sometimes percutanous gastrostomy is made and left open so that air entering stomach can escape emptyed by gravity feedings through the gastrostomy tube and irrigations with fluid are contraindicated before surgery position for optimum drainage and avoid aspiration - head elevated 30 degrees

kussmaul respirations

respiratory system tryes to eleminate excess of carbon dioxide

management of chronic constipation

restoring regular evacuation of stool shrinking destended rectum promoting regular toileting routine bowel cleansing modification of diet bowel habit training behavioral modification easy passage of stool and prevent stool retention

Which is the most common cause of diarrhea in children under 5? Rotavirus Salmonella Escherichia coli Clostridium difficile

rotavirus Rationale The most common cause of diarrhea in children under 5 is rotavirus. There is a high incidence of Salmonella species and Escherichia coli in the summer months, but rotavirus is the most common cause of diarrhea in children under 5. Clostridium difficile is associated with alteration of normal intestinal flora by antibiotics.

diabetes monitoring/ blood glucose

self-monitoring ( can change insulin amount)

folliculitis, furuncle, and carbuncle management

skin cleanliness; local warm, moist compresses; topical application of antibiotic agents; systemic antibiotics in severe cases; incision and drainage of severe lesions followed by wound irrigations with antibiotics or suitable drain implantation' autoinocuable and contagious; furuncle and carbuncle tend to heal with scar formation; never squeeze

GER diet

small frequent feedings with predigested formula - nutrition via NG tube if severe regulrgiation and poor growth - thicken formula by adding rice cereal, cross cut nipple - bresst feeding may continue or express to thicken with cereal - burp infsnt frequently and handle infant minimally after feeding - monitor for coughing during feeding and other signs of aspiration - toddlers - feed solid first, then liquids - instruct parents to avoid feeding the child fatty food, chocolate, tomato, carbonated, fruit juices, citrus, spicy - child should avoid play afer feeding and avoid feeding just before bedtime

pyoedema management

soap and water cleaning; wet compresses; bathing with antibacterial soap as prescribed; do not share washcloths or towels; mupirocin to nares and lesions as prescribed; systemic antibiotics

tracheomalacia

softening of the tissues of the trachea happens whendilated proximal pouch compresses the trachea in fetal life clinical signs - barking cough, stridor, wheezing, recurrent respiratory tract infection, cyanosis and sometimes apnea

additional problems with cleft

speech impairment rotated, missing or malformed teeth differences in skeletal facial development hearing loss improper drainage of the middle ear due to inefficient function of the eustaschian tube leads to often otitis media ( so pressure-equalizing tubes are inserted) orthdonist will have to allign teeth and laxillary arches

celiac disease symptoms

steatorrhea ( fatty, foul, frothy bulky stool) general malnutrition andominal distention secondary vitamin deficiency

scorpions

sting by means of hooked caudal stinger intense local pain. erythema, numbness, burning, restlessness, vomiting ascending motor paralysis with seizures, weakness, rapid pulse, exsessive salivation, thirst, dysuria, pulmonary edema, coma symptoms subside in few hours death in children less than 4 yo within 24 hrs keep child quite, in dependent position administer antivenin relieve pain admit to ped ICU

Which diagnostic test does the nurse request to detect carbohydrate malabsorption in a child? Stool pH Urease test Rectal manometry Esophageal pH monitoring

stool pH Rationale The nurse requests the stool pH test to detect carbohydrate malabsorption in a child. Stool pH less than 5 suggests carbohydrate malabsorption because colonic bacteria ferment undigested carbohydrates and fermentation produces short-chain fatty acids which lower stool pH. The urease test is used to determine the presence of Helicobacter pylori in the stomach. The urease test involves staining and placing the stomach biopsy in Christensen urea medium, which turns color in the presence of H. pylori. H. pylori synthesizes urease, the enzyme which hydrolyses urea to form ammonia and carbon dioxide. Rectal manometry is used to measure anal sphincter function and detect constipation and Hirschsprung disease. It records reflex responses of the anal sphincter to transient distention of the rectal balloon. Esophageal pH monitoring is used to determine the frequency and duration of gastric acid reflux into the esophagus. A probe is placed through the nose into the distal esophagus and pH is recorded over time.

other therapies for enuresis

stream interruption training fluid restriction overlearning self-monitoring (motivation therapy)

diseases associated with constipation

strictures ectopic anus hirschsprung disease systemic - hypothyrodism, hypercalcemia, chronic lead poisonins, hyperparathyrodism related to drugs - antacids, diuretics, antiepileptics, antihistamines, opioids, iron supplementation spinal cord

wounds

structural or physiologic disruptions of the skin that activate normal or abnormal tissue repair responses

ticks

sucking blood head and mouth are burried in skin firm siscrete pruritic nodules may cause urticaria pull tick cleanse wound with soap

clinical manifestation of intussusception

sudden acute abdominal pain child screaming and drawing the knees onto the ches child appearing norma and comfortable between episodes of pain vomiting lethargy passage of red, current jelly - like stools ( stool mixed with blood and mucus tender distended abdomen palpable sausage shaped mass in upper right quadrant empty lower right quadrant (dance sign) eventual fever, prostration, and other signs of peritonitis chronic case - diarrhea, anorexia, weight loss, occasional vomiting, periodic pain atypical cases - lethargy primary symptoms

alopecia areata

sudden onset of asymptomatic, noninflammatory, round, bald patches in hairy parts of the body

Blocks out ultraviolet rays by reflecting sunlight

sun blockers most often recommended are zinc oxide and titanium dioxide ointments

Partially absorbs ultraviolet light

sunscreens not recommended for <6mo, but may applied over small areas not covered by clothes

fungal infection

superficial infection transmitted from person to person, from animals to humans fungus multiply at arate that equals the rate of keratin production diagnosis - made from microscopic examinatin of scrapings taken from the advancing periphery of the lesion

therapeutic management malrotation and volvulus

surgery to remove the affected area complication - short bowel syndrome

therapeutic management hirschsprung disease

surgery: soave pull-through, swenson procedure, duhamel procedure removes aganglionic portion, restoring normal motility, preserve function of sphincters

therapeutic management appendicitis

surgical removal before perforation - appendic litigated with the stapler and removed antibiotics preoperatively IV fluid and electrolytes

Appendectomy

surgical removal of the appendix

neurofibromatosis/ managements

symptomatic treatment surgical removal of tumors high mutation rate

varicella-zoster virus management

symptomatic; analgesics for pain; mild sedation sometimes helpful; local moist compresses; drying lotions sometimes helpful; ophthalmic variety-use systemic corticotropin or corticosteroids; acyclovir; lidocaine topical anesthetic

Erythema multiforme/ stevens-johnson syndrome management

syptomatic and supportive ,aintanence of adequate intake of fluids, calories and protein moist wound care, hydrogels treatment of complications monitoring of urine volume and specific gravity, hemoglobin and hematocrit, serum electrolyet levels, total body weight

staphylococcal scalded skin syndrome management

systemic administration of antibiotics; gentle cleaning with saline, Burow solution, or 0.25% silver nitrate compresses

types of wound healing-primary intention

takes place when all layers of the wound margins are neatly approximated ( surgical incision) unless infected - will heal with minimum scarring

poison ivy, oak, or sumac management

the earlier the skin is cleansed, the greater the chance of removing the urushiol before it attaches to the skin; cleanse with isopropyl alcohol and cold water; a shower with soap and warm water to follow; clean clothes, tools, shoes, and any other objects that had contact with the plants with alcohol and then water; treatment of lesions includes calamine lotion, soothing Burow solution compresses, or Aveeno baths to relieve discomfort; topical or oral corticosteroids may be used for more severe reactions if it is known the contact - rinse with cold water within 15 min clothing washed

Meconium ileus/newborn

the initial manifestation of cystic fibrosis, is the luminal obstruction of the distal small intestine by abnormal meconium.

fungal infection

tinea capitis tinea corporis tinea cruris tinea pedis candidiasis

acute wound/laceration

torn or jagged wound; accidental cut wound

traumatic alopecia

traction around scalp margins from tight hair styles

dosage insulin

twice daily combo rapid and intermediate same syringe injected before breakfasts and before the evening meal amount depends on glucose values regular insulin 30 min before meal usually before breakfast 60-75 % of daily dose SQ BID, multiple time or continuous

possible risk factors of enuresis

twins both parents are enuretic emotional factors (regressionn) ADHD

volvulus

twisting of the intestine on itself

Erythema multiforme/ stevens-johnson syndrome causa

unknown associated with ingestion of some drugs often follows respiratory tract infection

urticaria

usually allergic response to drugs or infection; manage by local soothing and antipruritic applications, antihistamines, epinephrine or ephedrine, cortisone, severe upper respiratory tract involvement may require tracheostomy

cryptococcosis

usually on face, anceiform, firm, nodular, painless eruption; CNS manifestations include headache, dizziness, stiff neck, signs of increased ICP, low-grade fever, mild cough, lung infiltration; acquired by inhalation of dust but may enter through skin; prognosis serious; noninfectious; increased invidence

brown recluse spider

venom injected via fangs, contains powerful necrotoxin transient erythema followed by bleb or blister mild to severe pain in 2-8 hr purple, star shaped area in 3-4 days necrotic ulceration in 7-14 days systemic reaction - fever, malaise, restlessness, nausea, vomiting, joint pain genelized petechial eruption, wound heal with scar apply cool compress locally administer antibiotics, corticosteroids relieve pain wound may require skin graft

pica risks

visceral larva migrans ( after eating dirt) toxic risk ( lead in paint) intestinal obstruction or perforation dental injury malnutrition

Which nursing advice is appropriate to provide the parents of a child with enuresis? Select all that apply. Promote using diapers or pull-ups. Avoid caffeinated beverages after 4 PM. Avoid using negative reward techniques. Encourage drinking fruit juices after 4 PM. Encourage bladder emptying before going to bed

void caffeinated beverages after 4 PM. Avoid using negative reward techniques. Encourage bladder emptying before going to bed. Rationale Enuresis can be managed by certain changes in habits. Caffeinated beverages and carbonated beverages should be avoided after 4 PM, as they promote diuresis and may cause bedwetting. The parents would not use negative reward techniques such as scolding, embarrassing, threatening, or teasing the child, as the child may feel guilty. The child would be motivated to empty the bladder just before going to bed to prevent bedwetting. The child would be encouraged to use regular sleepwear instead of diapers or pull-ups, as the latter can be habit-forming and can also be embarrassing for the child. Fruits and juice drinks cause diuresis, so they should be avoided after 4 PM.

bladder capacity theory/enuresis

volume of urine voided after maximum delay of micturition

verruca signs

warts; usually well-circumscribed, gray or brown, elevated, firm papules with a roughened finely papillomatous texture; occur anywhere but usually appear on exposed areas such as fingers, hands, face, and soles; may be single or multiple; asymptomatic; common in children; tend to disappear spontaneously; course unpredictable; most destructive techniques tend to lead to scars; autoinnocuable; repeated irritation will cause to enlarge; apply topical anesthetic EMLA

primary healing at home

wash hands wash wound with mild soap and watwr topical antibiotics non adherent dressing

medical identification of diabetes

wear bracelet with phone number of medical personnel

types of wound healing-secondary intention

wounds from ulceration and laceration in which the edges cannot be approximated, such as avulsion or 3rd degree burn healing from edges inward and from the bottom of the wound upward until the defect is filled larger scar

The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL? Select all that apply. 1. Administer regular insulin. 2. Encourage the child to ambulate. 3. Give the child a teaspoon of honey. 4. Provide electrolyte replacement therapy intravenously. 5. Wait 30 minutes and confirm the blood glucose reading. 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs.

3. Give the child a teaspoon of honey. 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs. Hypoglycemia is defined as a blood glucose level less than 70 mg/dL. Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If possible, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack is given if the next meal is not planned for more than 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose paste is squeezed onto the gums, and the blood glucose level is retested in 15 minutes; if the reading remains low, additional glucose is administered. If the child remains unconscious, administration of glucagon may be necessary, and the nurse should be prepared for this intervention. Encouraging the child to ambulate and administering regular insulin would result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis. Waiting 30 minutes to confirm the blood glucose level delays necessary intervention.

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1. Prone position 2. On the stomach 3. Left lateral position 4. Right lateral position

3. Left lateral position

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1. Diarrhea 2. Metabolic acidosis 3. Metabolic alkalosis 4. Hyperactive bowel sounds

3. Metabolic alkalosis

The nurse has provided dietary instructions to the mother of a child with celiac disease. The nurse determines that further instruction is needed if the mother states that she will include which food item in the child's nutritional plan? 1. Corn 2. Chicken 3. Oatmeal 4. Vitamin supplements

3. Oatmeal

A 12-year-old girl is admitted to the hospital with suspected appendicitis. What nursing interventions should be implemented preoperatively? 1. Applying a heating pad for 5-minute intervals as prescribed 2. Administering acetaminophen (Tylenol) as needed for pain, as prescribed 3. Placing the adolescent in a fetal position, side-lying with legs drawn up to chest 4. Inserting a nasogastric tube and attaching it to low intermittent suction; measuring drainage as prescribed

3. Placing the adolescent in a fetal position, side-lying with legs drawn up to chest

A mother brings her child to the well-child clinic and expresses concern to the nurse because the child has been playing with another child diagnosed with hepatitis. The nurse performs an assessment on the child, knowing that which finding is unassociated with hepatitis? 1. Hepatomegaly 2. The presence of jaundice 3. The presence of left upper abdominal quadrant pain 4. The presence of dark-colored, frothy urine in the urine specimen

3. The presence of left upper abdominal quadrant pain

Epidermal necrosis and erythema maltiforme are associated with which of the following conditions 1. neurofibromatosis 2. alopecia areate 3. stevens-johnson syndrome d. intertrigo

3. stevens-johnson syndrome

When does rapid-acting insulin peak? 2 hours after injection 5 hours after injection 15 to 30 minutes after injection 30 to 90 minutes after injection

30 to 90 minutes after injection

Which nursing advice is appropriate for the parents of a child with cat scratch disease when discussing the time frame it resolves? 1 to 2 weeks 2 to 4 weeks 4 to 6 weeks 6 to 8 weeks

4 to 6 weeks Rationale Cat scratch disease occurs after the bite or scratch from an animal, usually a cat or kitten. It is caused by the gram-negative bacterium Bartonella henselae. The disease is usually benign and resolves spontaneously in about 4 to 6 weeks. Cat scratch disease usually does not go away complete within the first 2 weeks to a month, but should resolve by 6 to 8 weeks after the bite occurred.

How soon in development are the esophagus and stomach considered identifiable? At full term Third trimester 4 weeks gestation 26 weeks gestation

4 weeks gestation Rationale Development of the esophagus and stomach are considered identifiable at 4 weeks gestation. At full term the mechanical functions of digestion are relatively immature but intact. At 26 weeks of gestation, uncoordinated contractions of the gastrointestinal (GI) tract occur, but emptying is slow. By the third trimester motility of the GI tract is improving.

The nurse is collecting data on an infant with a diagnosis of suspected Hirschsprung's disease. Which question to the mother willmost specifically elicit information regarding this disorder? 1. "Does your infant have diarrhea?" 2. "Is your infant constantly vomiting?" 3. "Does your infant constantly spit up feedings?" 4. "Does your infant have foul-smelling, ribbon-like stools?"

4. "Does your infant have foul-smelling, ribbon-like stools?"

The nurse is providing discharge instructions to the mother of a child with herpetic gingivostomatitis. Which response by the mother indicates the need for further teaching? 1. "I will offer my child soft, bland foods." 2. "I will encourage my child to drink fluids." 3. "I will give my child frozen ice pops to assist with fluid intake." 4. "I will not give my child anything to eat for 2 days to allow the lesions to heal and crust over."

4. "I will not give my child anything to eat for 2 days to allow the lesions to heal and crust over."

The mother of a child with hepatitis A tells the home care nurse that she is concerned because the child's jaundice seems worse. Which response should the nurse make to the mother? 1. "You need to change the child's diet." 2. "The child probably is infectious again." 3. "You need to call the health care provider." 4. "In many situations, the jaundice worsens before it resolves."

4. "In many situations, the jaundice worsens before it resolves."

A 1-year-old child is diagnosed with intussusception, and the mother of the child asks the nurse to describe the disorder. Which statement is correct about intussusception? 1. "It is an acute bowel obstruction." 2. "It is a condition that causes an acute inflammatory process in the bowel." 3. "It is a condition in which a distal segment of the bowel prolapses into a proximal segment of the bowel." 4. "It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."

4. "It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."

The nurse is counseling the young mother of a small child recently diagnosed with impetigo. The nurse should make which statement that provides the best information about impetigo? 1. "The main treatment while your daughter has impetigo will be to force fluids." 2. "Your daughter probably caught the impetigo because you don't wash her hands enough." 3. "There is no risk of passing impetigo to the other children once you begin the prescribed antibiotics." 4. "You will need to prevent any of the fluid from the blisters around your daughter's mouth from coming into contact with your other children, especially if they already have skin injuries."

4. "You will need to prevent any of the fluid from the blisters around your daughter's mouth from coming into contact with your other children, especially if they already have skin injuries."

The nurse is preparing to care for an infant who has esophageal atresia with tracheoesophageal fistula (TEF). Surgery is scheduled to be performed in 1 hour. Intravenous fluids have been initiated, and a nasogastric (NG) tube has been inserted by the health care provider. The nurse plans care, knowing that which intervention is of highest priority during this preoperative period? 1. Monitor the temperature. 2. Monitor the blood pressure. 3. Irrigate the NG tube every 5 to 10 minutes. 4. Aspirate the NG tube every 5 to 10 minutes.

4. Aspirate the NG tube every 5 to 10 minutes.

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which symptom of this disorder documented? 1. Watery diarrhea 2. Ribbon-like stools 3. Profuse projectile vomiting 4. Bright red blood and mucus in the stools

4. Bright red blood and mucus in the stools

A home care nurse instructs the mother of a 5-year-old child with lactose intolerance about dietary measures for her child. The nurse should tell the mother that it is necessary to provide which dietary supplement in the child's diet? 1. Fats 2. Zinc 3. Protein 4. Calcium

4. Calcium

An infant is seen in the health care provider's office for complaints of frequent vomiting and spitting up after feedings. Findings indicate that the infant is not gaining weight and gastroesophageal reflux is suspected. Which would the nurse anticipate being prescribed initially in the care of this child? 1. Place in prone position after each feeding. 2. Administer omeprazole (Prilosec) before feeding. 3. Instruct parents to keep a log of feedings and any reflux present. 4. Change the formula to predigested formula and feed small, frequent feedings.

4. Change the formula to predigested formula and feed small, frequent feedings

A school-age child with type 1 diabetes mellitus has soccer practice . The school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? 1. Eat twice the amount normally eaten at lunchtime. 2. Take half the amount of prescribed insulin on practice days. 3. Take the prescribed insulin at noontime rather than in the morning. 4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.

4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant? 1. Diarrhea 2. Projectile vomiting 3. Regurgitation of feedings 4. Foul-smelling ribbon-like stools

4. Foul-smelling ribbon-like stools

An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? 1. Sweating and tremors 2. Hunger and hypertension 3. Cold, clammy skin and irritability 4. Fruity breath odor and decreasing level of consciousness

4. Fruity breath odor and decreasing level of consciousness

During a home care visit, an older client complains of chronic constipation. What should the nurse tell the client to do? 1. Increase potassium in the diet. 2. Include rice and bananas in the diet. 3. Increase the intake of sugar-free products. 4. Increase fluid intake to at least eight glasses a day and increase dietary fiber.

4. Increase fluid intake to at least eight glasses a day and increase dietary fiber.

A child is diagnosed with intussusception. On performing an assessment of the child, the nurse keeps in mind which finding as a characteristic of this disorder? 1. The presence of fecal incontinence 2. Incomplete development of the anus 3. The infrequent and difficult passage of dry stools 4. Invagination of a section of the intestine into the distal bowel

4. Invagination of a section of the intestine into the distal bowel

A nurse is caring for a child who was brought to the clinic complaining of severe abdominal pain and is suspected of having acute appendicitis. The child is lying on the examining table, with the knees pulled up toward the chest. The nurse assists the health care provider with further assessment of the progression of the child's pain, knowing that the health care provider will palpate the abdomen in which location? 1. Midway between the liver and the gallbladder 2. Midway between the left iliac crest and the umbilicus 3. Midway between the left inguinal area and the acetabulum 4. Midway between the right anterior superior iliac crest and the umbilicus

4. Midway between the right anterior superior iliac crest and the umbilicus

A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? 1. Potassium infusion 2. NPH insulin infusion 3. 5% dextrose infusion 4. Normal saline infusion

4. Normal saline infusion Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level decreases to an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.

After hydrostatic reduction for intussusception, the nurse should expect to observe which client response? 1. Abdominal distention 2. Currant jelly-like stools 3. Severe colicky-type pain with vomiting 4. Passage of barium or water-soluble contrast with stools

4. Passage of barium or water-soluble contrast with stools

The nurse is initiating nasogastric tube feedings in a child. When initiating this procedure the nurse should perform which action? 1. Microwave the formula. 2. Place the child in a prone position. 3. Encourage the child to point the head downward. 4. Position the child so that the head is slightly hyperflexed.

4. Position the child so that the head is slightly hyperflexed.

A nurse is preparing to care for a newborn infant following creation of a colostomy for the treatment of imperforate anus. In the immediate postoperative period, the nurse plans to inspect the stoma and expects to note which finding in the colostomy? 1. Bleeding 2. Gray in color 3. Dark blue in color 4. Red and edematous

4. Red and edematous

The parents of a child with a cleft palate are concerned and ask the nurse when the palate will be repaired. The nurse should plan to base the response on which information about cleft palate repair? 1. Cannot be repaired 2. Repair usually is performed by age 8 weeks 3. Repair usually is performed by 2 months of age 4. Repair usually is performed between 6 months and 2 years

4. Repair usually is performed between 6 months and 2 years

A nurse is assessing a child with a diagnosis of suspected appendicitis. In assessing the intensity and progression of the pain, the nurse palpates the child at McBurney's point. In performing this assessment, the nurse understands that McBurney's point is located midway between which area? 1. Left anterior inferior iliac crest and umbilicus 2. Left anterior superior iliac crest and umbilicus 3. Right anterior inferior iliac crest and umbilicus 4. Right anterior superior iliac crest and umbilicus

4. Right anterior superior iliac crest and umbilicus

The nurse is providing a yearly summer educational session to parents in a local community. The topic of the session is prevention and treatment measures for poison ivy. The nurse instructs the parents that if the child comes into contact with poison ivy to take which action? 1. Immediately report to the emergency department. 2. Avoid becoming concerned if a rash is not noted on the skin. 3. Apply calamine lotion immediately to the exposed skin areas. 4. Shower the child immediately, lathering and rinsing the exposed skin several times

4. Shower the child immediately, lathering and rinsing the exposed skin several times.

The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis? 1. Provide less frequent, larger feedings. 2. Burp the infant less frequently during feedings. 3. Thin the feedings by adding water to the formula. 4. Thicken the feedings by adding rice cereal to the formula.

4. Thicken the feedings by adding rice cereal to the formula.

The school nurse is conducting pediculosis capitis (head lice) assessments. Which finding indicates a child has a "positive" head check? 1. Maculopapular lesions behind the ears 2. Lesions in the scalp that extend to the hairline or neck 3. White flaky particles throughout the entire scalp region 4. White sacs attached to the hair shafts in the occipital area

4. White sacs attached to the hair shafts in the occipital area

which of the following would the nurse not inclusde while educating the family abaout managing atopic dermatits? 1. keep fingernails cut short 2. long pants and long sleeves are recommended 3. avoid irritating products 4. use fabric softeners to decrease fabric irritants

4. use fabric softeners to decrease fabric irritants

Which location is appropriate when looking for evidence of nits when inspecting a child for head lice? Against the scalp 6 mm from the scalp At the ends of the hair shaft On the child's shoulders or shirt

6 mm from the scalp Rationale Nits are tiny, whitish, oval specks adhering to the hair shaft, approximately 1/4 inch (6 mm) from the scalp. Nits are not found against the scalp or the ends of the hair shaft. Any suspected nits that have fallen onto a child's clothing need to be differentiated from dandruff or lint.

surgical correction:cleft palate

6-12 mo cannot do earlier - not to restrict skeletal growth of the midface cannot do later - after first words will delay speech common techniques - Veau-Wardill-Kilner V-Y pushback and Furlow double=opposing Z-plasty if displays nasal air emission or hypernasality will need additional surgery

Which triage finding is appropriate to assess first regarding skin injuries? 8 cm laceration to the wrist 4 cm ecchymosis on the knee Large abrasion to the forearm Localized erythema after poison ivy exposure

8 cm laceration to the wrist Rationale A laceration is a torn or jagged wound. Patients presenting with these wounds should be assessed first due to the potential for bleeding or infection. Ecchymosis is another term for bruising. Unless widespread, which can indicate a bleeding issue, it is not the highest priority in an emergency room or clinic setting. An abrasion is the removal of the superficial layers of the skin by scraping or rubbing. While it may be uncomfortable, it is not the priority assessment. Localized erythema after poison ivy exposure does not require immediate intervention.

Based on the Henry's presenting signs and symptoms, what does the nurse anticipate the HCP will prescribe? (Select all that apply.)polyric stenosis

9. Based on the Henry's presenting signs and symptoms, what does the nurse anticipate the HCP will prescribe? (Select all that apply.) - Initiation of intravenous fluid - Place the infant on NPO - Anticipate that the HCP may consider surgery for the infant

Which injury requires more frequent dressing changes by the nurse? A 4-cm laceration on the forearm A 7-cm pressure ulcer on the sacrum A second-degree burn on the hand and forearm An abdominal surgical wound from a procedure 1 week ago

A 7-cm pressure ulcer on the sacrum Rationale A 7-cm pressure ulcer on the sacrum will likely need more frequent dressing changes due to the risk of contamination from voiding or stooling. The wound would also need more frequent dressing changes should it become infected. A 4-cm laceration, second-degree burn on the upper extremities, and surgical wounds that are older and healing normally are not likely to need frequent dressing changes.

Which are true statements associated with pica? Select all that apply. A nonfood pica example is hair. Pica is considered an eating disorder. A food pica example is coffee grounds. Pica is more common in men and children. Pica is clearly associated with protein deficiency.

A nonfood pica example is hair. Pica is considered an eating disorder. A food pica example is coffee grounds. Rationale True statements associated with pica include: pica is considered an eating disorder in which food and nonfood items are eaten compulsively and excessively for at least one month. A food pica example is coffee grounds and a nonfood pica example is hair. Pica is more common in various groups including women (not men) and children. Pica is clearly associated with both iron and zinc deficiency (not protein deficiency)

The nurse is caring for an infant with gastroesophageal reflux disease (GERD). Which action by a parent, observed by the nurse, indicates teaching was effective? The infant is fed every 1 to 2 hours. A pacifier is clipped to the infant's car seat. The infant is placed on the stomach to sleep. The parent administers acetaminophen when the infant cries.

A pacifier is clipped to the infant's car seat. Using a pacifier reduces crying and encourages swallowing in infants with GERD.

A health care provider prescribes haloperidol (Haldol), PO, 0.5 mg, twice a day, for a child with schizophrenia. The medication label states: "Haloperidol (Haldol) oral concentrate, 1 mg/1 ml." The nurse prepares to administer one dose. How many milliliters should the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.

ANS: 0.5 Follow the formula for dosage calculation. Desired ———- ´ Volume = ml per dose Available 0.5 mg ———- ´ 1 ml = 0.5 ml 1 mg

The health care provider has prescribed cyclosporin (Sandimmune) 5 mg/kg/day PO divided twice daily for a child with juvenile arthritis. The child weighs 110 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer in a whole number.

ANS: 125 The correct calculation is: 110 lb/2.2 kg = 50 kg Dose of Sandimmune is 5 mg/kg/day divided bid 5 mg ´ 50 = 250 mg/day 250 mg/2 = 125 mg for one dose

A health care provider prescribes methylphenidate hydrochloride (Ritalin), PO, 20 mg, twice a day, for a child with attention deficit hyperactivity disorder. The medication label states: "Methylphenidate hydrochloride (Ritalin), 10 mg/1 tablet." The nurse prepares to administer one dose. How many tab(s) should the nurse prepare to administer one dose? Fill in the blank. Record your answer as a whole number.

ANS: 2 Follow the formula for dosage calculation. Desired ———- ´ Quantity = Tablets per dose Available 20 mg ———- ´ 1 = 2 tabs 10 mg

A health care provider prescribes paroxetine (Paxil), 20 mg, PO, daily for a child with depression. The medication label states: "Paroxetine (Paxil) 10 mg/1 tablet." The nurse prepares to administer one dose. How many tablet(s) should the nurse prepare to administer one dose? Fill in the blank. Record your answer as a whole number.

ANS: 2 Follow the formula for dosage calculation. Desired ———- ´ Quantity = Tablets per dose Available 20 mg ———- ´ 1 = 2 tabs 10 mg

A health care provider prescribes sertraline (Zoloft) PO, 50 mg, daily, for a child with depression. The medication label states: "Sertraline (Zoloft) oral concentrate, 20 mg/1 ml." The nurse prepares to administer one dose. How many milliliters should the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.

ANS: 2.5 Follow the formula for dosage calculation. Desired ———- ´ Volume = ml per dose Available 50 mg ———- ´ 1 ml = 2.5 ml 20 mg

A health care provider prescribes clonidine hydrochloride (Kapvay), PO, 0.3 mg, daily for a child with attention deficit hyperactivity disorder. The medication label states: "Clonidine hydrochloride (Kapvay), 0.1 mg/1 tablet." The nurse prepares to administer one dose. How many tablet(s) should the nurse prepare to administer one dose? Fill in the blank. Record your answer as a whole number.

ANS: 3 Follow the formula for dosage calculation. Multiply 1 mg ´ 10 kg to get the dose = 10 mg Desired ———- ´ Quantity = Tablets per dose Available 0.3 mg ———- ´ 1 tab = 3 tabs 0.1 mg

The health care provider has prescribed azathioprine (Imuran) 1 mg/kg/day PO for a child with juvenile arthritis. The child weighs 77 lb. The nurse is preparing to administer the daily dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 35 The correct calculation is: 77 lb/2.2 kg = 35 kg Dose of Imuran is 1 mg/kg/day 1 mg ´ 35 = 35 mg for the daily dose

The health care provider has prescribed hydroxychloroquine (Plaquenil) 5 mg/kg/day PO divided bid for a child with systemic lupus erythematosus. The child weighs 66 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 75 The correct calculation is: 66 lb/2.2 kg = 30 kg Dose of Plaquenil is 5 mg/kg/day divided bid 5 mg ´ 30 = 150 mg 150 mg/2 = 75 mg

Deficiency of which vitamin or mineral results in an inadequate inflammatory response? a. A b. B1 c. C d. Zinc

ANS: A A deficiency of vitamin A results in an inadequate inflammatory response. Deficiencies of vitamins B1 and C result in decreased collagen formation. A deficiency of zinc leads to impaired epithelialization.

The nurse is admitting a child with frostbite. What health care prescription should the nurse question and verify? a. Massage the injured tissue. b. Apply a loose dressing after rewarming. c. Avoid any application of dry heat to the area. d. Administer acetaminophen (Tylenol) for discomfort.

ANS: A A frostbite victim should not have injured tissue rubbed. It is contraindicated because it can cause damage by rupture of crystallized cells. After rewarming, a loose dressing is applied to the affected skin, and analgesia is administered if indicated. Dry heat is not applied.

A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). In preparing for discharge, the nurse should include what in the home care instructions to the parents? a. Following a high-fiber diet b. Using stimulant laxatives c. Using ice packs on the abdomen when pain occurs d. Sitting on the toilet for 30 minutes after each meal

ANS: A A high-fiber diet with possible addition of bulk laxatives is beneficial for children with RAP. Bulk-forming laxatives such as psyllium are recommended. Stimulant laxatives may produce painful cramping for the child. Warm packs, such as a heating pad, may help ease the discomfort. Bowel training is recommended to assist the child in establishing regular bowel habits. Thirty minutes is too long for the child to sit on the toilet. The time should be limited to 15 minutes.

A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed? a. Position changes are made by log rolling. b. Assistance is needed to use the bathroom. c. The head of the bed is elevated to minimize spinal headache. d. Passive range of motion is instituted to prevent neurologic injury.

ANS: A After scoliosis repair using a Luque procedure, the adolescent is turned by log rolling to prevent damage to the fusion and instrumentation. The patient is kept flat in bed for the first 12 hours and is not ambulatory until the second or third postoperative day. A urinary catheter is placed. The head of the bed is not elevated until the second postoperative day. Range of motion exercises are begun on the second postoperative day.

The management of a child who has just been stung by a bee or wasp should include applying what? a. Cool compresses b. Antibiotic cream c. Warm compresses d. Corticosteroid cream

ANS: A Bee or wasp stings are initially treated by carefully removing the stinger, cleansing with soap and water, applying cool compresses, and using common household agents such as lemon juice or a paste made with aspirin and baking soda. Antibiotic cream is unnecessary unless a secondary infection occurs. Warm compresses are avoided. Corticosteroid cream is not part of the initial therapy. If a severe reaction occurs, systemic corticosteroids may be indicated.

What condition can result from the bone demineralization associated with immobility? a. Osteoporosis b. Pooling of blood c. Urinary retention d. Susceptibility to infection

ANS: A Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Pooling of blood is a result of the cardiovascular effects of immobilization. Urinary retention is secondary to the effect of immobilization on the urinary tract. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included? a. Encourage the child to wear medical identification. b. Discuss with the child and family ways to limit fluid intake. c. Teach the child and family how to do required urine testing. d. Reassure the child and family that this is usually not a chronic or life-threatening illness.

ANS: A DI is a potentially life-threatening disorder if the voluntary demand for fluid is suppressed or the child does not have access to fluids. Medical alert identification should be worn. Fluid intake is not restricted in children with DI. The child is unable to concentrate urine and can rapidly become dehydrated. Fluid intake may be limited during diagnosis, when the lack of intake will result in decreased urinary output and dehydration. Urine testing is not required in DI. Changes in body weight provide information about approximate fluid balance. This is a lifelong disorder that requires supplemental vasopressin throughout life.

A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program? a. Essential information is presented initially. b. Teaching should take place in the child's semiprivate room. c. Education is focused toward the parents because the child is too young. d. All information needed for self-management of diabetes is taught at once.

ANS: A Diagnosis of type 1 diabetes can be traumatic for the child and family. Most families are not psychologically ready for the complex teaching that is needed for self-management. Most structured diabetes education programs begin with essential or survival information followed by the complex background material when the family is better able to learn. Teaching can take place either as an outpatient or as an inpatient. The actual teaching area should be free from distractions that would interfere with learning. A semiprivate room would have many individuals entering and leaving the room, causing distraction. A 12-year-old child who is cognitively age appropriate needs to be included in the educational process. Most children older than the age of 8 years can be involved in blood glucose monitoring and insulin administration. Teaching all information needed for self-management of diabetes at once would be too overwhelming for a family in crisis.

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise? a. food intake b. ¯food intake c. risk of hyperglycemia d. ¯risk of insulin reaction

ANS: A Exercise is encouraged and never restricted unless indicated by other health conditions. Exercise lowers blood glucose levels, depending on the intensity and duration of the activity. Consequently, exercise should be included as part of diabetes management, and the type and amount of exercise should be planned around the child's interests and capabilities. However, in most instances, children's activities are unplanned, and the resulting decrease in blood glucose can be compensated for by providing extra snacks before (and, if the exercise is prolonged, during) the activity. In addition to a feeling of well-being, regular exercise aids in utilization of food and often results in a reduction of insulin requirements.

What intervention is contraindicated in a suspected case of appendicitis? a. Enemas b. Palpating the abdomen c. Administration of antibiotics d. Administration of antipyretics for fever

ANS: A In any instance in which severe abdominal pain is observed and appendicitis is suspected, the nurse must be aware of the danger of administering laxatives or enemas. Such measures stimulate bowel motility and increase the risk of perforation. The abdomen is palpated after other assessments are made. Antibiotics should be administered, and antipyretics are not contraindicated.

A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when? a. Lunch and dinner b. Breakfast and lunch c. 0830 to his midmorning snack d. Bedtime and breakfast the next morning

ANS: A Intermediate-acting (NPH and Lente) insulins reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours.

What statement best describes Hirschsprung disease? a. The colon has an aganglionic segment. b. It results in frequent evacuation of solids, liquid, and gas. c. The neonate passes excessive amounts of meconium. d. It results in excessive peristaltic movements within the gastrointestinal tract.

ANS: A Mechanical obstruction in the colon results from a lack of innervation. In most cases, the aganglionic segment includes the rectum and some portion of the distal colon. There is decreased evacuation of the large intestine secondary to the aganglionic segment. Liquid stool may ooze around the blockage. The obstruction does not affect meconium production. The infant may not be able to pass the meconium stool. There is decreased movement in the colon.

A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed? a. Ondansetron (Zofran) b. Promethazine (Phenergan) c. Metoclopramide (Reglan) d. Dimenhydrinate (Dramamine)

ANS: A Ondansetron reduces the duration of vomiting in children with acute gastroenteritis. This would be the expected prescribed antiemetic. Adverse effects with earlier generation antiemetics (e.g., promethazine and metoclopramide) include somnolence, nervousness, irritability, and dystonic reactions and should not be routinely administered to children. For children who are prone to motion sickness, it is often helpful to administer an appropriate dose of dimenhydrinate (Dramamine) before a trip, but it would not be ordered as an antiemetic.

What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux? a. The medication reduces gastric acid secretion. b. The medication neutralizes the acid in the stomach. c. The medication increases the rate of gastric emptying time. d. The medication coats the lining of the stomach and esophagus.

ANS: A Pharmacologic therapy may be used to treat infants and children with gastroesophageal reflux disease. Both H2-receptor antagonists (cimetidine [Tagamet], ranitidine [Zantac], or famotidine [Pepcid]) and proton pump inhibitors (esomeprazole [Nexium], lansoprazole [Prevacid], omeprazole [Prilosec], pantoprazole [Protonix], and rabeprazole [Aciphex]) reduce gastric hydrochloric acid secretion.

A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock? a. Restlessness b. Rapid capillary refill c. Increased temperature d. Increased blood pressure

ANS: A Restlessness is an indication of impending shock in a child. Capillary refill is slowed in shock. The child will feel cool. The blood pressure initially remains within the normal range and then declines.

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material? a. Soak in a bathtub. b. Vigorously scrub the leg. c. Carefully pick material off the leg. d. Apply powder to absorb the material.

ANS: A Simply soaking in the bathtub is usually sufficient for removal of the desquamated skin and sebaceous secretions. Several days may be required to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

A young girl has just injured her ankle at school. In addition to notifying the child's parents, what is the most appropriate, immediate action by the school nurse? a. Apply ice. b. Observe for edema and discoloration. c. Encourage child to assume a position of comfort. d. Obtain parental permission for administration of acetaminophen or aspirin.

ANS: A Soft tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. The nurse observes for the edema while placing a cold pack. The applying of ice can reduce the severity of the injury. Maintaining the ankle at a position elevated above the heart is important. The nurse helps the child be comfortable with this requirement. The nurse obtains parental permission for administration of acetaminophen or aspirin after ice and rest are assured.

A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he "heard a pop," that the pain is "pretty bad," and that the ankle feels "as if it is coming apart." Based on this description, the nurse suspects what injury? a. Sprain b. Fracture c. Dislocation d. Stress fracture

ANS: A Sprains account for approximately 75% of all ankle injuries in children. A sprain results when the trauma is so severe that a ligament is either stretched or partially or completely torn by the force created as a joint is twisted or wrenched. Joint laxity is the most valid indicator of the severity of a sprain. A fracture involves the cross-section of the bone. Dislocations occur when the force of stress on the ligaments disrupts the normal positioning of the bone ends. Stress fractures result from repeated muscular contraction and are seen most often in sports involving repetitive weight bearing such as running, gymnastics, and basketball.

What test is used to screen for carbohydrate malabsorption? a. Stool pH b. Urine ketones c. C urea breath test d. ELISA stool assay

ANS: A The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of carbohydrate malabsorption. The bacterial fermentation of carbohydrates in the colon produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence of ketones in the urine, which indicates the use of alternative sources of energy to glucose. The C urea breath test measures the amount of carbon dioxide exhaled. It is used to determine the presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent assay) detects the presence of antigens and antibodies. It is not useful for disorders of metabolism.

A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include? a. Bowel cleansing b. Dietary modification c. Structured toilet training d. Behavior modification

ANS: A The first step in the treatment of chronic constipation is to empty the bowel and allow the distended rectum to return to normal size. Dietary modification is an important part of the treatment. Increased fiber and fluids should be gradually added to the child's diet. A 2-year-old child is too young for structured toilet training. For an older child, a regular schedule for toileting should be established. Behavior modification is part of the overall treatment plan. The child practices releasing the anal sphincter and recognizing cues for defecation.

What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)? a. Control pain and preserve joint function. b. Minimize use of joint and achieve cure. c. Prevent skin breakdown and relieve symptoms. d. Reduce joint discomfort and regain proper alignment.

ANS: A The goals of therapy are to control pain, preserve joint range of motion and function, minimize the effects of inflammation, and promote normal growth and development. There is no cure for JIA at this time. Skin breakdown is not an issue for most children with JIA. Symptom relief and reduction in discomfort are important. When the joints are damaged, it is often irreversible.

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching? a. "I should gently massage the skin under the straps once a day to stimulate circulation." b. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." c. "I should remove the harness several times a day to prevent contractures." d. "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."

ANS: A To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder because this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency? a. Type 1 diabetes b. Type 2 diabetes c. Gestational diabetes d. Maturity-onset diabetes of the young (MODY)

ANS: A Type 1 diabetes is characterized by the destruction of the pancreatic beta cells, which leads to absolute insulin deficiency. Type 2 diabetes results usually from insulin resistance. The pancreatic beta cells are not destroyed in gestational diabetes. MODY is an autosomal dominant monogenetic defect in beta cell function that is characterized by impaired insulin secretion with minimum or no defects in insulin action.

What measure is important in managing hypercalcemia in a child who is immobilized? a. Provide adequate hydration. b. Change position frequently. c. Encourage a diet high in calcium. d. Provide a diet high in calories for healing.

ANS: A Vigorous hydration is indicated to prevent problems with hypercalcemia. Suggested intake for an adolescent is 3000 to 4000 ml/day of fluids. Diuretics are used to promote the removal of calcium. Changing position is important for skin and respiratory concerns. Calcium in the diet is restricted when possible. A high-protein diet served as frequent snacks with favored foods is recommended. A high-calorie diet without adequate protein will not promote healing.

After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time? a. Notify the practitioner. b. Insert the NG tube so feedings can be given. c. Replace the NG tube to maintain gastric decompression. d. Leave the NG tube out because it has probably been in long enough.

ANS: A When surgery is performed on the upper gastrointestinal tract, usually the surgical team replaces the NG tube because of potential injury to the operative site. The decision to replace the tube or leave it out is made by the surgical team. Replacing the tube is also usually done by the practitioner because of the surgical site.

The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Fever b. Vomiting c. Tachycardia d. Flushed face e. Hyperactive bowel sounds

ANS: A, B, C Clinical manifestations of appendicitis include fever, vomiting, and tachycardia. Pallor is seen, not a flushed face, and the bowel sounds are hypoactive or absent, not hyperactive.

The nurse is caring for a child with neurofibromatosis. What local manifestations does the nurse expect to assess in this child? (Select all that apply.) a. Pigmented nevi b. Axillary freckling c. Café-au-lait spots d. Slowly growing cutaneous neurofibromas e. Wheals that spread irregularly and fade within a few hours

ANS: A, B, C, D Local manifestations of neurofibromatosis include pigmented nevi, axillary freckling, café-au-lait spots, and slowly growing cutaneous neurofibromas. Wheals that spread irregularly and fade within a few hours are characteristic of urticaria.

The nurse is conducting preoperative teaching to parents and their child about an external fixation device. What should the nurse include in the teaching session? (Select all that apply.) a. Pin care b. Crutch walking c. Modifications in activity d. Observing pin sites for infection e. Full weight bearing will be allowed after 24 hours

ANS: A, B, C, D The device is attached surgically by securing a series of external full or half rings to the bone with wires. Children and parents should be instructed in pin care, including observation for infection and loosening of pins. Partial weight bearing is allowed, and the child needs to learn to walk with crutches. Alterations in activity include modifications at school and in physical education. Full weight bearing is not allowed until the distraction is completed and bone consolidation has occurred.

An infant with an isolated cleft lip is being bottle fed. Which actions should the nurse plan to implement to assist with the feeding? (Select all that apply.) a. Use an NUK nipple. b. Use cheek support. c. Enlarge the nipple opening. d. Position the infant upright. e. Thicken the formula with rice cereal.

ANS: A, B, D A bottle-fed infant with an isolated cleft lip should be fed with cheek support (squeezing the cheeks together to decrease the width of the cleft), which may help the infant achieve an adequate anterior lip seal during feeding. Systems that have a wider base, such as an NUK (orthodontic) nipple or a Playtex nurser, allow the infant with a cleft lip to feed more successfully. The infant should be positioned upright with the head supported. This position helps gravity to direct the flow of liquid so that it is swallowed rather than entering into the nasal cavity. Enlarging the nipple opening would allow too much milk too fast for an infant with a cleft palate. Thickening the formula with rice cereal is done for infants with gastroesophageal reflux, not cleft lip.

The nurse is teaching a school-age child about factors that can delay wound healing. What factors should the nurse include in the teaching session? (Select all that apply.) a. Deficient vitamin C b. Deficient vitamin D c. Increased circulation d. Dry wound environment e. Increase in white blood cells

ANS: A, B, D Factors that delay wound healing are a dry wound environment (allows epithelial cells to dry), deficient vitamin C (inhibits formation of collagen fibers), and deficient vitamin D (regulates growth and differentiation of cell types). Decreased, not increased, circulation delays healing. An increase in the white blood cell count may occur but does not delay healing.

The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast? (Select all that apply.) a. Less bulky b. Drying time is faster c. Molds readily to body part d. Permits regular clothing to be worn e. Can be cleaned with small amount of soap and water

ANS: A, B, D, E The advantages of synthetic casts over plaster of Paris casts are that they are less bulky, dry faster, permit regular clothes to be worn, and can be cleaned. Plaster of Paris casts mold readily to a body part, but synthetic casts do not mold easily to body parts.

In teaching a 16-year-old adolescent who was recently diagnosed with systemic lupus erythematosus (SLE), what statements should the nurse include? (Select all that apply.) a. "You should use a moisturizer with a sun protection factor (SPF) of 30." b. "You should avoid pregnancy because this can cause a flare-up." c. "You should not receive any immunizations in the future." d. "You may need to be on a low-protein, high-carbohydrate diet." e. "You should expect to lose weight while taking steroids." f. "You may need to modify your daily recreational activities."

ANS: A, B, F Teaching for an adolescent with SLE should foster adaptation and self-advocacy and include using a moisturizer with an SPF of 30, avoiding pregnancy because it can produce a flare-up, and modifying recreational activities but continuing with daily exercise as an essential part of the treatment plan. The adolescent should continue to receive immunizations as scheduled, should expect to gain weight while on steroid therapy, and would not have a specialized diet.

The nurse is preparing to admit a 7-year-old child with type 2 diabetes. What clinical features of type 2 diabetes should the nurse recognize? (Select all that apply.) a. Oral agents are effective. b. Insulin is usually needed. c. Ketoacidosis is infrequent. d. Diet only is often effective. e. Chronic complications frequently occur.

ANS: A, C, D The clinical features of type 2 diabetes include the following: oral agents are effective, ketoacidosis is infrequent, and diet only is often effective. Insulin is only needed in 20% to 30% of cases and chronic complications occur infrequently.

The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Spitting up b. Bilious vomiting c. Failure to thrive d. Excessive crying e. Respiratory problems

ANS: A, C, D, E Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.

The nurse is preparing a community outreach program for adolescents about the characteristic differences between type 1 and type 2 diabetes mellitus (DM). What concepts should the nurse include? (Select all that apply.) a. Type 1 DM has an abrupt onset. b. Type 1 DM is often controlled with oral glucose agents. c. Type 1 DM occurs primarily in whites. d. Type 2 DM always requires insulin therapy. e. Type 2 DM frequently has a familial history. f. Type 2 DM occurs in people who are overweight.

ANS: A, C, E, F Characteristics of type 1 DM include having an abrupt onset, primarily occurring in whites, and not being controlled with oral glucose agents (insulin is required for therapy). Type 2 DM frequently has a familial history, occurs in people who are overweight, and does not always require insulin therapy (it is used in 20% to 30% of patients).

The nurse is teaching parents of a school-age child how to cleanse small wounds. What should the nurse advise the parents to avoid using to cleanse a wound? (Select all that apply.) a. Alcohol b. Normal saline c. Tepid water d. Povidone-iodine e. Hydrogen peroxide

ANS: A, D, E Caution caregivers to avoid cleansing the wound with povidone-iodine, alcohol, and hydrogen peroxide because these products disrupt wound healing. Normal saline and tepid water are safe to use when cleansing wounds.

The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Arthralgia b. Weight gain c. Polycythemia d. Abdominal pain e. Glomerulonephritis

ANS: A, D, E Clinical manifestations of SLE include arthralgia, abdominal pain, and glomerulonephritis. Weight loss, not gain, and anemia, not polycythemia, are manifestations of SLE.

The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Weight loss b. Bilious vomiting c. Abdominal pain d. Projectile vomiting e. The infant is hungry after vomiting

ANS: A, D, E Clinical manifestations of hypertrophic pyloric stenosis include weight loss, projectile vomiting, and hunger after vomiting. The vomitus is nonbilious, and there is no evidence of pain or discomfort, just chronic hunger.

The school nurse recognizes that the adverse effects of performance-enhancing substances can include what? (Select all that apply.) a. Depression b. Dehydration c. Hypotension d. Aggressiveness e. Changes in libido

ANS: A, D, E Mood changes have been observed as adverse effects of using performance-enhancing substances, including aggressiveness, changes in libido, depression, anxiety, and psychosis. Fluid retention, not dehydration, and hypertension, not hypotension, are adverse effects of performance-enhancing substances.

The nurse is caring for a child immobilized because of Russel traction. What interventions should the nurse implement to prevent renal calculi? (Select all that apply.) a. Monitor output. b. Encourage the patient to drink apple juice. c. Encourage milk intake. d. Ensure adequate fluids. e. Encourage the patient to drink cranberry juice.

ANS: A, D, E To prevent renal calculi in a child who is immobilized, a nurse should monitor output; ensure adequate fluids; and encourage cranberry juice, which acidifies urine. Apple juice and milk alkalize the urine, so they should not be encouraged.

The nurse is explaining the purpose of using a vacuum-assisted closure (VAC) device to assist in the healing of a wound. What should the nurse explain as the purpose of using a VAC device? a. The device will decrease capillary flow. b. The device applies gentle continuous suction. c. The device will allow the wound to remain open. d. The device will prevent the formation of granulation tissue.

ANS: B A VAC device uses a technique that involves placing a foam dressing into the wound, covering it with an occlusive dressing, and applying gentle continuous suction. The negative pressure of the suction is applied from the foam dressing to the wound surfaces. The mechanical force removes excess fluids from the wound, stimulates formation of granulation tissue, restores capillary flow, and fosters closure of the wound.

A 6-year-old boy with very fair skin will be joining his family during a beach vacation. What should the nurse recommend? a. Keep him off the beach during the daytime hours. b. Use sunscreen with an SPF of at least 15 and reapply it every 2 to 3 hours. c. Apply a topical sunscreen product with an SPF of 30 in the morning. d. Dress him in long pants and long-sleeved shirt and keep him under a beach umbrella.

ANS: B A sunscreen with an SPF (sun protection factor) of at least 15 is recommended. The sunscreen should be reapplied every 2 to 3 hours and after the child is in the water or sweating excessively. During a beach vacation, avoiding the beach during daytime hours is impractical. The highest risk of sun exposure is from 10 AM to 3 PM. Sunlight exposure should be limited during this time. An SPF of 30 is good, but reapplying it is necessary every 2 to 3 hours and when the child gets wet. Long pants and a shirt are impractical. The beach umbrella can be used with the sunscreen to limit exposure to the sun.

The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding. What should the nurse do related to the tourniquet? a. Loosen the tourniquet. b. Leave the tourniquet in place. c. Remove the tourniquet and apply direct pressure if bleeding is still present. d. Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time.

ANS: B A tourniquet is applied only as a last resort, and then it is left in place and not loosened until definitive treatment is available. After the tourniquet is applied, skin and tissue necrosis occur below the site. Loosening or removing the tourniquet allows toxins from the tissue necrosis to be released into the circulation. This can induce systemic, deadly tourniquet shock.

The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved? a. Use of protective equipment at the family's discretion b. Education of adults to recognize signs that indicate a risk for injury c. Sports medicine program to help student athletes work through overuse injuries d. Arrangements for multiple sports to use same athletic fields to accommodate more children

ANS: B Adults close to sports activities need to be aware of the early warning signs of fatigue, dehydration, and risk for injury. School policy should require mandatory use of protective equipment. Proper sports medicine therapy does not support "working through" overuse injuries. Too many students involved in different activities create distractions, which contribute to the child losing focus. This is a contributing factor to injury.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device? a. As soon as possible after birth b. When the infant is developmentally ready to stand up c. At about ages 12 to 15 months, when most children are walking d. At about 4 years, when the healthy limb is not growing so rapidly

ANS: B An infant should be fitted with a functional prosthetic leg when the infant is developmentally ready to pull to a standing position. When the infant begins limb exploration, a soft prosthesis can be used. The child should begin using the prosthesis as part of his or her normal development. This will match the infant's motor readiness.

A toddler's mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse's response should be based on which premise? a. An emergency laparotomy is very likely. b. The location needs to be confirmed by radiographic examination. c. Surgery will be necessary if the battery has not passed in the stool in 48 hours. d. Careful observation is essential because an ingested battery cannot be accurately detected.

ANS: B Button batteries can cause severe damage if lodged in the esophagus. If both poles of the battery come in contact with the wall of the esophagus, acid burns, necrosis, and perforation can occur. If the battery is in the stomach, it will most likely be passed without incident. Surgery is not indicated. The battery is metallic and is readily seen on radiologic examination.

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition? a. Hypopituitarism b. Diabetes insipidus (DI) c. Syndrome of inappropriate antidiuretic hormone (SIADH) d. Acute adrenocortical insufficiency

ANS: B DDAVP is the treatment of choice for DI. It is administered intranasally through a flexible tube. The child's response pattern is variable, with effectiveness lasting from 6 to 24 hours.

A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take? a. Call the health care provider to report the edema. b. Elevate the foot and leg on pillows. c. Apply a warm moist pack to the foot. d. Encourage movement of toes.

ANS: B During the first few hours after a cast is applied, the chief concern is that the extremity may continue to swell to the extent that the cast becomes a tourniquet, shutting off circulation and producing neurovascular complications (compartment syndrome). One measure to reduce the likelihood of this problem is to elevate the body part and thereby increase venous return. The health care provider does not need to be notified because edema is expected and warm moist packs will not decrease the edema. The child should move the toes, but that will not help reduce the edema.

Parents are concerned that their 6-year-old son continues to occasionally wet the bed. What does the nurse explain? a. This is likely because of increased stress at home. b. Enuresis usually ceases between 6 and 8 years of age. c. Drug therapy will be prescribed to treat the enuresis. d. Testing will be necessary to determine what type of kidney problem exists.

ANS: B Further data must be gathered before the diagnosis of enuresis is made. Enuresis is the inappropriate voiding of urine at least twice a week. This child does meet the age criterion, but the parents need to be questioned about and keep a diary on the frequency of events. If the bedwetting is infrequent, parents can be encouraged that the child may grow out of this behavior. Drug therapy will not be prescribed until a more complete evaluation is done. Additional assessment information must be gathered, but at this time, there is no indication of renal disease.

What should preoperative care of a newborn with an anorectal malformation include? a. Frequent suctioning b. Gastrointestinal decompression c. Feedings with sterile water only d. Supine position with head elevated

ANS: B Gastrointestinal decompression is an essential part of nursing care for a newborn with an anorectal malformation. This helps alleviate intraabdominal pressure until surgical intervention. Suctioning is not necessary for an infant with this type of anomaly. Feedings are not indicated until it is determined that the gastrointestinal tract is intact. Supine position with head elevated is indicated for infants with a tracheoesophageal fistula, not anorectal malformations.

What finding is characteristic of fractures in children? a. Fractures rarely occur at the growth plate site because it absorbs shock well. b. Rapidity of healing is inversely related to the child's age. c. Pliable bones of growing children are less porous than those of adults. d. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.

ANS: B Healing is more rapid in children. The younger the child, the more rapid the healing process. Nonunion of bone fragments is uncommon except in severe injuries. The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma. Children's bones are more pliable and porous than those of adults. This allows them to bend, buckle, and break. The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact. The adult periosteum is thinner, is weaker, and has less osteogenic potential than that of a child.

Immobilization causes what effect on metabolism? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased levels of stress hormones

ANS: B Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and a negative nitrogen balance secondary to muscle atrophy. Decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include? a. Dilating the stoma b. Assessing bowel function c. Limitation of physical activities d. Measures to prevent prolapse of the rectum

ANS: B In the postoperative period, the nurse involves the parents in the care of the child with a temporary colostomy, allowing them to help with feedings and observe for signs of wound infection or irregular passage of stool (constipation or true incontinence). Some children will require daily anal dilatations in the postoperative period to avoid anastomotic strictures but not stoma dilatations. Physical activities should be encouraged. There is not a risk of prolapse of the rectum in Hirschsprung disease, just strictures.

A mother has just given birth to a newborn with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" What is the most appropriate nursing action? a. Encourage the mother to express her feelings. b. Explain in simple language that the baby has a cleft lip. c. Provide emotional support until the practitioner can talk to the mother. d. Tell the mother a pediatrician will talk to her as soon as the baby is examined.

ANS: B It is best to explain in simple terms the nature of the defect and to reinforce and help clarify information given by the practitioner before the newborn is shown to the parents. Parents may not be ready to talk about their feelings during the first few days after birth. The nurse should provide information about the child's condition while waiting for the practitioner to speak with the family after the examination. The mother needs simple explanations of her child's condition during this period of waiting.

An infant requires surgery for repair of a cleft lip. An important priority of the preoperative nursing care is which? a. Initiating discharge teaching b. Performing baseline physical and behavioral assessment c. Observing for allergic reactions to preoperative antibiotics d. Determining whether this defect exists in other family members

ANS: B It is essential to assess the infant before surgery to obtain a baseline. Postoperative changes can be identified and a determination can be made regarding pain or change in status. The parents are not ready for discharge teaching. Their focus is on the congenital defect and surgery. Although a remote possibility, allergic reactions rarely occur on the first dose. Determining whether this defect exists in other family members is an important part of the history but is not a priority before surgery.

Parents phone the nurse and say that their child just knocked out a permanent tooth. What should the nurse's instructions to the parents include? a. Place the tooth in dry container for transport. b. Hold the tooth by the crown and not by the root area. c. Transport the child and tooth to a dentist within 18 hours. d. Take the child to hospital emergency department if his or her mouth is bleeding.

ANS: B It is important to avoid touching the root area of the tooth. The tooth should be held by the crown area; rinsed in milk, saline, or running water; and reimplanted as soon as possible. The tooth is kept moist during transport to maintain viability. Cold milk is the most desirable medium for transport. The child needs to be seen by a dentist as soon as possible. Tooth evulsion causes a large amount of bleeding. The child will need to be seen by a dentist because of the loss of a tooth, not the bleeding.

A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed? a. Carbohydrates in the diet need to be replaced with protein. b. Additional snacks are needed to compensate for increased activity. c. The child needs to decrease his activity level to minimize episodes of hypoglycemia. d. Insulin dosage should be increased to compensate for a change in activity level.

ANS: B Most children have a different schedule during summer vacation. The increased activity and exercise reduce insulin resistance and increase glucose utilization. Additional snacks should be eaten before physical activity to increase carbohydrates and protein and compensate for increased activity. Physical activity should always be encouraged if the child is capable. The benefits include improved glucose utilization and decreased insulin requirements. In consultation with the practitioner, insulin dosage may need to be decreased because of improved glucose utilization.

What statement is true concerning osteogenesis imperfecta (OI)? a. It is easily treated. b. It is an inherited disorder. c. Braces and exercises are of no therapeutic value. d. Later onset disease usually runs a more difficult course.

ANS: B OI is a heterogeneous, autosomal dominant disorder characterized by fractures and bone deformity. Treatment is primarily supportive. Several investigational therapies are being evaluated. The primary goal of therapy is rehabilitation. Lightweight braces and splints help support limbs, prevent fractures, and aid in ambulation. The disease is present at birth. Prognosis is affected by the type of OI.

What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction? a. Measuring the abdomen after feedings b. Marking the point of measurement with a pen c. Measuring the circumference at the symphysis pubis d. Using a new tape measure with each assessment to ensure accuracy

ANS: B Pen marks on either side of the tape measure allow the nurse to measure the same spot on the child's abdomen at each assessment. The child most likely will be kept NPO (nothing by mouth) if a bowel obstruction is present. If the child is being fed, the assessment should be done before feedings. The symphysis pubis is too low. Usually the largest part of the abdomen is at the umbilicus. Leaving the tape measure in place reduces the trauma to the child.

What is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. White rice b. Popcorn c. Fruit juice d. Ripe bananas

ANS: B Popcorn is a high-fiber food. Refined rice is not a significant source of fiber. Unrefined brown rice is a fiber source. Fruit juices are not a significant source of fiber. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.

An adolescent comes to the school nurse after experiencing shin splints during a track meet. What reassurance should the nurse offer? a. Shin splints are expected in runners. b. Ice, rest, and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve pain. c. It is generally best to run around and "work the pain out." d. Moist heat and acetaminophen are indicated for this type of injury.

ANS: B Shin splints result when the ligaments tear away from the tibial shaft and cause pain. Actions that have an antiinflammatory effect are indicated for shin splints. Ice, rest, and NSAIDs are the usual treatment. Shin splints are rarely serious, but they are not expected, and preventive measures are taken. Rest is important to heal the shin splints. Continuing to place stress on the tibia can lead to further damage.

A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents' discharge teaching? a. Turn every 8 hours. b. Specially designed car restraints are necessary. c. Diapers should be avoided to reduce soiling of the cast. d. Use an abduction bar between the legs to aid in turning.

ANS: B Standard seat belts and car seats may not be readily adapted for use by children in some casts. Specially designed car seats and restraints meet safety requirements. The child must have position changes much more frequently than every 8 hours. During feeding and play activities, the child should be moved for both physiologic and psychosocial benefit. Diapers and other strategies are necessary to maintain cleanliness. The abduction bar is never used as an aid for turning. Putting pressure on the bar may damage the integrity of the cast.

The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching? a. "I should have the affected limb hang in a dependent position." b. "I will use an ice pack to relieve the itching." c. "I should avoid keeping the injured arm elevated." d. "I will expect the fingers to be swollen for the next 3 days."

ANS: B Teaching the parent to use an ice pack to relieve the itching is an important aspect when planning discharge for a child with a cast. The affected limb should not be allowed to hang in a dependent position for more than 30 minutes. The affected arm should be kept elevated as much as possible. If there is swelling or redness of the fingers, the parent should notify the health care provider.

A 4-year-old child is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first? a. Reposition the child and notify the practitioner. b. Notify the practitioner of the changes noted. c. Give the child medication to relieve the pain. d. Chart the observations and check the extremity again in 15 minutes.

ANS: B The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. This is an emergency condition. Pain medication should be given after the practitioner is notified. The findings should be documented with ongoing assessment.

A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long? a. 2 weeks b. 4 weeks c. 6 weeks d. 8 weeks

ANS: B The approximate healing times for a femoral shaft fracture are as follows: neonatal period, 2 to 3 weeks; early childhood, 4 weeks; later childhood, 6 to 8 weeks; and adolescence, 8 to 12 weeks.

The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what? a. "We'll keep the cast dry." b. "We're happy this is the only cast our baby will need." c. "We'll watch for any swelling of the foot while the cast is on." d. "We're getting a special car seat to accommodate the cast."

ANS: B The common approach to clubfoot management and treatment is the Ponseti method. Serial casting is begun shortly after birth. Weekly gentle manipulation and stretching of the foot along with placement of serial long-leg casts allow for gradual repositioning of the foot. The extremity or extremities are casted until maximum correction is achieved, usually within 6 to 10 weeks. If parents state that this is the only cast the infant will need, they need further teaching.

A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions? a. No restrictions of activity are indicated. b. Elevate casted arm when both upright and resting. c. The shoulder should be kept as immobile as possible to avoid pain. d. Swelling of the fingers is to be expected. Notify a health professional if it persists more than 48 hours.

ANS: B The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. The child should not engage in strenuous activity for the first few days. Rest with elevation of the extremity is encouraged. Joints above and below the cast on the affected extremity should be moved. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours.

A school-age child has been bitten on the leg by a large snake that may be poisonous. During transport to an emergency facility, what should the care include? a. Apply ice to the snakebite. b. Immobilize the leg with a splint. c. Place a loose tourniquet distal to the bite. d. Apply warm compresses to the snakebite.

ANS: B The leg should be immobilized. Ice decreases blood flow to the area, which allows the venom to work more destruction and decreases the effect of antivenin on the natural immune mechanisms. A loose tourniquet is placed proximal, not distal, to the area of the bite to delay the flow of lymph. This can delay movement of the venom into the peripheral circulation. The tourniquet should be applied so that a pulse can be felt distal to the bite. Warmth increases circulation to the area and helps the toxin into the peripheral circulation.

The nurse is evaluating the laboratory results of a stool sample. What is a normal finding? a. The laboratory reports a stool pH of 5.0. b. The laboratory reports a negative guaiac. c. The laboratory reports low levels of enzymes. d. The laboratory reports reducing substances present.

ANS: B The normal stool finding is a negative guaiac. Stool pH should be 7.0 to 7.5. A stool pH <5.0 is suggestive of carbohydrate malabsorption; colonic bacterial fermentation produces short-chain fatty acids, which lower stool pH. There should be no enzymes or reducing substances present in a normal stool sample.

The parents of a newborn with an umbilical hernia ask about treatment options. The nurse's response should be based on which knowledge? a. Surgery is recommended as soon as possible. b. The defect usually resolves spontaneously by 3 to 5 years of age. c. Aggressive treatment is necessary to reduce its high mortality. d. Taping the abdomen to flatten the protrusion is sometimes helpful.

ANS: B The umbilical hernia usually resolves by ages 3 to 5 years of age without intervention. Umbilical hernias rarely become problematic. Incarceration, where the hernia is constricted and cannot be reduced manually, is rare. Umbilical hernias are not associated with a high mortality rate. Taping the abdomen flat does not help heal the hernia; it can cause skin irritation.

The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught? a. Draw the insulin in separate syringes. b. Draw the regular insulin first and then the NPH into the same syringe. c. Draw the NPH insulin first and then the regular into the same syringe. d. Check blood sugar first, and if below 120, hold the regular insulin and give the NPH.

ANS: B To obtain maximum benefit from mixing insulins, the recommended practice is to (1) inject the measured amount of air (equivalent to the dosage) into the long-acting insulin; (2) inject the measured amount of air into the rapid-acting (clear) insulin and, without removing the needle; (3) withdraw the clear insulin; and (4) insert the needle (already containing the clear insulin) into the long-acting (cloudy) insulin and then withdraw the desired amount. The blood sugar may be checked before giving the insulin, but the prescribed dose should not be withheld if the blood sugar is 120.

What is an appropriate nursing intervention when caring for a child in traction? a. Removing adhesive traction straps daily to prevent skin breakdown b. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles c. Providing active range of motion exercises to affected extremity three times a day d. Keeping child prone to maintain good alignment

ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

What is the recommended drink for athletes during practice and competition? a. Sports drinks to replace carbohydrates b. Cold water for gastrointestinal tract rapid absorption c. Carbonated beverages to help with acid-base balance d. Enhanced performance carbohydrate-electrolyte drinks

ANS: B Water is recommended for most athletes, who should drink 4 to 8 oz every 15 to 20 minutes. Cold water facilitates rapid gastric emptying and intestinal absorption. Most carbohydrate sports drinks have 6% to 8% carbohydrate, which can cause gastrointestinal upset. Carbonated beverages are discouraged. There is no evidence that these drinks enhance function.

The nurse is caring for a child with erythema multiforme (Stevens-Johnson syndrome). What local manifestations does the nurse expect to assess in this child? (Select all that apply.) a. Papular urticaria b. Erythematous papular rash c. Lesions absent in the scalp d. Lesions enlarge by peripheral expansion e. Firm papules that may be capped by vesicles

ANS: B, C, D Local manifestations of erythema multiforme include an erythematous popular rash, lesions involving most skin surfaces except the scalp and lesions that enlarge by peripheral expansion. Papular urticaria and firm papules capped by vesicles are characteristics of an insect bite

A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.) a. Relieve itching with heat. b. Elevate the arm when resting. c. Observe the fingers for any evidence of discoloration. d. Do not allow the child to put anything inside the cast. e. Examine the skin at the cast edges for any breakdown.

ANS: B, C, D, E Cast care involves elevating the arm, observing the fingers for evidence of discoloration, not allowing the child to put anything inside the cast, and examining the skin at the edges of the cast for any breakdown. Ice, not heat, should be applied to relieve itching.

The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Erythema over joints b. Soft tissue contractures c. Swelling in multiple joints d. Morning stiffness of the joints e. Loss of motion in the affected joints

ANS: B, C, D, E Whether single or multiple joints are involved, stiffness, swelling, and loss of motion develop in the affected joints in JIA. The swelling results from soft tissue edema, joint effusion, and synovial thickening. The affected joints may be warm and tender to the touch, but it is not uncommon for pain not to be reported. The limited motion early in the disease is a result of muscle spasm and joint inflammation; later it is caused by ankylosis or soft tissue contracture. Morning stiffness of the joint(s) is characteristic and present on arising in the morning or after inactivity. Erythema is not typical, and a warm, painful, red joint is always suspect for infection.

The nurse is caring for a child with psoriasis. What local manifestations does the nurse expect to assess in this child? (Select all that apply.) a. Development of wheals b. First lesions appear in the scalp c. Round, thick, dry reddish patches d. Lesions appear in intergluteal folds e. Patches are covered with coarse, silvery scales

ANS: B, C, E Local manifestations of psoriasis include lesions that appear in the scalp initially and round, thick dry patches covered with coarse, silvery scales. Development of wheals is seen in urticaria. Lesions in intergluteal folds are characteristic of intertrigo.

The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac crisis? (Select all that apply.) a. Exercise b. Infections c. Fluid overload d. Electrolyte depletion e. Emotional disturbance

ANS: B, D, E A celiac crisis can be precipitated by infections, electrolyte depletion, and emotional disturbance. Exercise or fluid overload does not precipitate a crisis.

What are characteristics of diabetic ketoacidosis? (Select all that apply.) a. Pallor b. Acidosis c. Bradypnea d. Dehydration e. Electrolyte imbalance

ANS: B, D, E Characteristics of diabetic ketoacidosis include acidosis, dehydration, and electrolyte imbalance. Respirations are rapid (Kussmaul respirations), not slow, and flushing, not pallor, would occur.

The emergency department nurse is admitting a child with a temperature of 35° C (95° F). What physical effects of hypothermia should the nurse expect to observe in this child? (Select all that apply.) a. Bradycardia b. Vigorous shivering c. Decreased respiratory rate d. Decreased intestinal motility e. Task performance is impaired

ANS: B, D, E Hypothermia has varying physical effects depending on the child's core temperature. At 35° C (95° F), a child would experience vigorous shivering, decreased intestinal motility, and task performance impairment. Bradycardia and decreased respiratory rate are physical effects observed as the body temperature continues to decrease.

The nurse is teaching the family of a child with type 1 diabetes about insulin. What should the nurse include in the teaching session? (Select all that apply.) a. Unopened vials are good for 60 days. b. Diabetic supplies should not be left in a hot environment. c. Insulin can be placed in the freezer if not used every day. d. After it has been opened, insulin is good for up to 28 to 30 days. e. Insulin bottles that have been opened should be stored at room temperature or refrigerated.

ANS: B, D, E Insulin bottles that have been "opened" (i.e., the stopper has been punctured) should be stored at room temperature or refrigerated for up to 28 to 30 days. After 1 month, these vials should be discarded. Unopened vials should be refrigerated and are good until the expiration date on the label. Diabetic supplies should not be left in a hot environment. Insulin need not be refrigerated but should be maintained at a temperature between 15° and 29.5° C (59° and 85° F). Freezing renders insulin inactive.

The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Absent bowel sounds b. Passage of red, currant jelly-like stools c. Anorexia d. Tender, distended abdomen e. Hematemesis f. Sudden acute abdominal pain

ANS: B, D, F Intussusception occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it and leading to obstruction. Clinical manifestations of intussusception include the passage of red, currant jelly-like stools; a tender, distended abdomen; and sudden acute abdominal pain. Absent bowel sounds, anorexia, and hematemesis are clinical manifestations observed in other types of gastrointestinal dysfunction.

The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.) a. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping. b. Hold the infant in the prone position after a feeding. c. Discontinue breastfeeding so that a formula and rice cereal mixture can be used. d. The infant will require the Nissen fundoplication after 1 year of age. e. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

ANS: B, E Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given 30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with GER in severe cases with complications.

To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Awareness of peers that diabetes is a severe disease

ANS: C Adolescence is a time when the individual has a need to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group. An adolescent is usually not future oriented. Awareness of peers that diabetes is a severe disease would further alienate the adolescent with diabetes. The peer group would focus on the differences.

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse? a. "For as long as you have been told." b. "Most preadolescents use the brace for 6 months." c. "Until your vertebral column has reached skeletal maturity." d. "It will be necessary to wear the brace for the rest of your life."

ANS: C Bracing can halt or slow the progress of most curvatures. They must be used continuously until the child reaches skeletal maturity. Telling the child "for as long as you have been told" does not answer the child's question and does not promote involvement in care. Six months is unrealistic because skeletal maturity is not reached until adolescence. When skeletal growth is complete, bracing is no longer effective.

A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest? a. Pizza b. Pretzels c. Popcorn d. Oatmeal cookies

ANS: C Celiac disease symptoms result from ingestion of gluten. Corn and rice do not contain gluten. Popcorn or corn chips will not exacerbate the intestinal symptoms. Pizza and pretzels are usually made from wheat flour that contains gluten. Also, in the early stages of celiac disease, the child may be lactose intolerant. Oatmeal contains gluten.

The nurse is teaching a child with a cast about cast removal. What should the nurse teach the child about cast removal? a. "The cast cutter will be a quiet machine." b. "You will feel cold as the cast is removed." c. "You will feel a tickly sensation as the cast is removed." d. "The cast cutter cuts through the cast like a circular saw."

ANS: C Cutting the cast to remove it or to relieve tightness is frequently a frightening experience for children. They fear the sound of the cast cutter and are terrified that their flesh, as well as the cast, will be cut. Because it works by vibration, a cast cutter cuts only the hard surface of the cast. The oscillating blade vibrates back and forth very rapidly and will not cut when placed lightly on the skin. Children have described it as producing a "tickly" sensation.

The nurse is caring for a child with a decubiti on the buttocks. The nurse notes that the dressing covering the decubiti is loose. What action should the nurse implement? a. Retape the dressing. b. Remove the dressing. c. Change the dressing. d. Reinforce the dressing.

ANS: C Dressings should always be changed when they are loose or soiled. They should be changed more frequently in areas where contamination is likely (e.g., sacral area, buttocks, tracheal area). The dressing should not be retaped, removed, or reinforced.

The nurse understands that medications delivered by which route are more likely to cause a drug reaction? a. Oral b. Topical c. Intravenous d. Intramuscular

ANS: C Drugs administered by the intravenous route are more likely to cause a reaction than the oral, topical, or intramuscular route.

What nursing intervention is most appropriate when caring for the child with osteomyelitis? a. Encourage frequent ambulation. b. Administer antibiotics with meals. c. Move and turn the child carefully and gently to minimize pain. d. Provide active range of motion exercises for the affected extremity.

ANS: C During the acute phase, any movement of the affected limb causes discomfort to the child. Careful positioning with the affected limb supported is necessary. Weight bearing is not permitted until healing is well under way to avoid pathologic fractures. Intravenous antibiotics are used initially. Food is not necessary with parenteral therapy. Active range of motion would be painful for the child.

The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula? a. Jitteriness b. Meconium ileus c. Excessive frothy saliva d. Increased need for sleep

ANS: C Excessive frothy saliva is indicative of a tracheoesophageal fistula. The child is unable to swallow the secretions, so there are excessive amounts of saliva in the mouth. Jitteriness is associated with several disorders, including electrolyte imbalances. Meconium ileus is associated with cystic fibrosis. Increased need for sleep is not associated with a tracheoesophageal fistula.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic? a. Exercise increases blood glucose. b. Extra insulin is required during exercise. c. Additional snacks are needed before exercise. d. Excessive physical activity should be restricted.

ANS: C Exercise lowers blood glucose levels, decreasing the need for insulin. Extra snacks are provided to maintain the blood glucose levels. Exercise is encouraged and not restricted unless indicated by other health conditions.

The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication? a. Sepsis b. Osteomyelitis c. Pulmonary embolism d. Acute respiratory tract infection

ANS: C Fat emboli are of greatest concern in individuals with fractures of the long bones. Fat droplets from the marrow are transferred to the general circulation, where they are transported to the lung or brain. This type of embolism usually occurs within the second 12 hours after the injury. Sepsis would manifest with fever and lethargy. Osteomyelitis usually is seen with pain at the site of infection and fever. A child with an acute respiratory tract infection would have nasal congestion, not chest pain.

The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs? a. Gastrointestinal perforation may have occurred. b. The object may have been aspirated. c. The object may be lodged in the esophagus. d. The object may be embedded in stomach wall.

ANS: C Gagging and drooling may be signs of esophageal obstruction. The child is unable to swallow saliva, which contributes to the drooling. Signs of gastrointestinal (GI) perforation include chest or abdominal pain and evidence of bleeding in the GI tract. If the object was aspirated, the child would most likely have coughing, choking, inability to speak, or difficulty breathing. If the object was embedded in the stomach wall, it would not result in symptoms of gagging and drooling.

The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40° C (104° F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention? a. Administer antipyretics. b. Administer salt tablets. c. Apply towels wet with cool water. d. Sponge with solution of rubbing alcohol and water.

ANS: C Heatstroke is a failure of normal thermoregulatory mechanisms. The onset is rapid with initial symptoms of headache, weakness, and disorientation. Immediate care is relocation to a cool environment, removal of clothing, and applying of cool water (wet towels or immersion). Antipyretics are not used because they are metabolized by the liver, which is already not functioning. Salt tablets are not indicated and may be harmful by increasing dehydration. Rubbing alcohol is not used.

When does idiopathic scoliosis become most noticeable? a. In the newborn period b. When the child starts to walk c. During the preadolescent growth spurt d. During adolescence

ANS: C Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. It is seldom apparent before age 10 years.

An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement? a. Burp the infant. b. Withhold the next feeding. c. Vent the gastrostomy tube. d. Notify the health care provider.

ANS: C If bolus feedings are initiated through a gastrostomy after a Nissen fundoplication, the tube may need to remain vented for several days or longer to avoid gastric distention from swallowed air. Edema surrounding the surgical site and a tight gastric wrap may prohibit the infant from expelling air through the esophagus, so burping does not relieve the distention. Some infants benefit from clamping of the tube for increasingly longer intervals until they are able to tolerate continuous clamping between feedings. During this time, if the infant displays increasing irritability and evidence of cramping, some relief may be provided by venting the tube. The next feeding should not be withheld, and calling the health care provider is not necessary.

After spinal fusion surgery the nurse should check for signs of what? a. Seizure activity b. Increased intracranial pressure c. Impaired color, sensitivity, and movement to the lower extremities d. Impaired pupillary response during neurologic checks

ANS: C In addition to the usual postoperative assessments of wound, circulation, and vital signs, the neurologic status of the patient's extremities requires special attention. Prompt recognition of any neurologic impairment is imperative because delayed paralysis may develop that requires surgical intervention.

The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago. Gastrostomy feedings have not been started. What do nursing actions related to the gastrostomy tube include? a. Keep the tube clamped. b. Suction the tube as needed. c. Leave the tube open to gravity drainage. d. Lower the tube to a point below the level of the stomach.

ANS: C In the immediate postoperative period, the gastrostomy tube is open to gravity drainage. This usually is continued until the infant is able to tolerate feedings. The tube is unclamped in the postoperative period to allow for the drainage of secretions and air. Gastrostomy tubes are not suctioned on an as-needed basis. They may be connected to low suction to facilitate drainage of secretions. Lowering the tube to a point below the level of the stomach would create too much pressure.

The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session? a. "Bisphosphonate therapy is not beneficial for OI." b. "Physical therapy should be avoided as it may cause damage to bones." c. "Lift the infant by the buttocks, not the ankles, when changing diapers." d. "The infant should meet expected gross motor development without assistive devices."

ANS: C Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Bisphosphonate and physical therapy are beneficial for OI. Lightweight braces will be used when the child starts to ambulate.

Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time? a. Send the child to radiology so radiography can be performed. b. Initiate an intravenous line and administer morphine for the pain. c. Calmly ask the child to point to where the pain is worst and to wiggle fingers. d. Have the parents hold the child so that the nurse can examine the arm thoroughly.

ANS: C Initially, assessment is the priority. Because the child is alert but upset, the nurse should work to gain the child's trust. Initial data are gained by observing the child's ability to move the fingers and to point to the pain. Other important observations at this time are pallor and paresthesia. The child needs to be sent for radiography, but initial assessment data need to be obtained. Sending the child for radiography will increase the child's anxiety, making the examination difficult. It is inappropriate to ask parents to restrain their child. These parents are upset about the injury. If restraint is indicated, the nurse should obtain assistance from other personnel.

What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? a. Scoliosis b. Lordosis c. Kyphosis d. Ankylosis

ANS: C Kyphosis is an abnormally increased convex angulation in the curvature of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits. Ankylosis is the immobility of a joint.

The nurse should know what about Lyme disease? a. Very difficult to prevent b. Easily treated with oral antibiotics in stages 1, 2, and 3 c. Caused by a spirochete that enters the skin through a tick bite d. Common in geographic areas where the soil contains the mycotic spores that cause the disease

ANS: C Lyme disease is caused by Borrelia burgdorferi, a spirochete spread by ticks. The early characteristic rash is erythema migrans. Tick bites should be avoided by entering tick-infested areas with caution. Light-colored clothing should be worn to identify ticks easily. Long-sleeve shirts and long pants tucked into socks should be worn. Early treatment of the erythema migrans (stage 1) can prevent the development of Lyme disease. Lyme disease is caused by a spirochete, not mycotic spores.

A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). What nursing consideration should be included? a. Monitor heart rate. b. Administer NSAIDs between meals. c. Check for abdominal pain and bloody stools. d. Expect inflammation to be gone in 3 or 4 days.

ANS: C NSAIDs are the first-line drugs used in JIA. Potential side effects include gastrointestinal (GI), renal, and hepatic side effects. The child is at risk for GI bleeding and elevated blood pressure. The heart rate is not affected by this drug class. NSAIDs should be given with meals to minimize gastrointestinal problems. The antiinflammatory response usually takes 3 weeks before effectiveness can be evaluated.

The nurse is preparing to care for a newborn with an omphalocele. The nurse should understand that care of the infant should include what intervention? a. Initiating breast- or bottle-feedings to stabilize the blood glucose level b. Maintaining pain management with an intravenous opioid c. Covering the intact bowel with a nonadherent dressing to prevent injury d. Performing immediate surgery

ANS: C Nursing care of an infant with an omphalocele includes covering the intact bowel with a nonadherent dressing to prevent injury or placing a bowel bag or moist dressings and a plastic drape if the abdominal contents are exposed. The infant is not started on any type of feeding but has a nasogastric tube placed for gastric decompression. Pain management is started after surgery, but surgery is not done immediately after birth. The infant is medically stabilized before different surgical options are considered.

An occlusive dressing is applied to a large abrasion. This is advantageous because the dressing will accomplish what? a. Deliver vitamin C to the wound. b. Provide an antiseptic for the wound. c. Maintain a moist environment for healing. d. Promote mechanical friction for healing.

ANS: C Occlusive dressings, such as Acuderm, are not adherent to the wound site. They provide a moist wound surface and insulate the wound. The dressing does not have vitamin C or antiseptic capabilities. Acuderm protects against friction.

What is the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy

ANS: C Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus infection. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.

A 4-month-old infant is discharged home after surgery for the repair of a cleft lip. What should instructions to the parents include? a. Provide crib toys for distraction. b. Breast- or bottle-feeding can begin immediately. c. Give pain medication to the infant to minimize crying. d. Leave the infant in the crib at all times to prevent suture strain.

ANS: C Pain medication and comfort measures are used to minimize infant crying. Interventions are implemented to minimize stress on the suture line. Although crib toys are important, the child should not be left in the crib for prolonged periods. Feeding begins with alternative feeding devices. Sucking puts stress on the suture line in the immediate postoperative period. The infant should not be left in the crib but should be removed for appropriate holding and stimulation.

The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign? a. Petaling b. Posturing c. Paresthesia d. Positioning

ANS: C Paresthesia distal to the injury or cast is an ominous sign that requires immediate notification of the practitioner. Permanent muscle and tissue damage can occur within 6 hours. The other signs of ischemia that need to be reported are pain, pallor, pulselessness, and paralysis. Petaling is a method of placing protective or smooth edges on a cast. Posturing is not a sign of peripheral ischemia. Finding a position of comfort can be difficult with a fracture. It would not be an ominous sign unless pain was increasing or uncontrollable.

What is a characteristic of children with depression? a. Increased range of affective response b. Tendency to prefer play instead of schoolwork c. Change in appetite resulting in weight loss or gain d. Preoccupation with need to perform well in school

ANS: C Physiologic characteristics of children with depression include changes in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping patterns, insomnia or hypersomnia, and constipation. Children who are depressed have sad facial expressions with absent or diminished range of affective response. These children withdraw from previously enjoyed activities and engage in solitary play or work with a lack of interest in play. They are uninterested in doing homework or achieving in school, resulting in lower grades.

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

ANS: C Serial casting is begun shortly after birth, before discharge from the nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

The nurse is teaching the girls' varsity sports teams about the "female athlete triad." What is essential information to include? a. They should take low to moderate calcium to avoid hypercalcemia. b. They have strong bones because of the athletic training. c. Pregnancy can occur in the absence of menstruation. d. A diet high in carbohydrates accommodates increased training.

ANS: C Sexually active teenagers, regardless of menstrual status, need to consider contraceptive precautions. Increased calcium (1500 mg) is recommended for amenorrheic athletes. The decreased estrogen in girls with the female athlete triad, coupled with potentially inadequate diet, leads to osteoporosis. Diets high in protein and calories are necessary to avoid potentially long-term consequences of intensive, prolonged exercise programs in pubertal girls.

When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation? a. Anorexia b. Bradycardia c. Sudden relief from pain d. Decreased abdominal distention

ANS: C Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Anorexia is already a clinical manifestation of appendicitis. Tachycardia, not bradycardia, is a manifestation of peritonitis. Abdominal distention usually increases in addition to an increase in pain (usually diffuse and accompanied by rigid guarding of the abdomen).

A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube? a. Prevent spread of infection. b. Monitor electrolyte balance. c. Prevent abdominal distention. d. Maintain accurate record of output.

ANS: C The NG tube is placed to suction out gastrointestinal secretions and prevent abdominal distention. The NG tube would not affect infection. Electrolyte content of the NG drainage can be monitored. Without the NG tube, there would be no drainage. After the NG tube is placed, it is important to maintain an accurate record of intake and output. This is not the reason for placement of the tube.

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation? a. Place in the Trendelenburg position. b. Apply moist heat to the abdomen. c. Allow the child to assume a position of comfort. d. Administer a saline enema to cleanse the bowel.

ANS: C The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help with the discomfort. If appendicitis is a possibility, administering laxative or enemas or applying heat to the area is dangerous. Such measures stimulate bowel motility and increase the risk of perforation.

An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested. What is the first action the nurse should take? a. Wait for the child's parents to arrive. b. Move the child out of the parking lot. c. Have someone notify the emergency medical services (EMS) system. d. Help the child stand to return to play.

ANS: C The child was involved in a motor vehicle collision and at this time is not able to move his extremities. The child needs immediate attention at a hospital for assessment of the possibility of a spinal cord injury. Because the child cannot move his extremities, the child should not be moved until his cervical and vertebral spines are stabilized. The EMS team can appropriately stabilize the spinal column for transport. Although it is important to notify the parents, the EMS system should be activated and transport arranged for serious injuries. The only indication to move the child is to prevent further trauma.

A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? a. Pyloric stenosis b. Intussusception c. Hirschsprung disease d. Celiac disease

ANS: C The clinical manifestations of Hirschsprung disease in a 3-day-old infant include abdominal distention, vomiting, and failure to pass meconium stools. Pyloric stenosis would present with vomiting but not distention or failure to pass meconium stools. Intussusception presents with abdominal cramping and celiac disease presents with malabsorption.

The school nurse is seeing a child who collected some poison ivy leaves during recess. He says only his hands touched it. What is the most appropriate nursing action? a. Soak his hands in warm water. b. Apply Burow's solution compresses. c. Rinse his hands in cold running water. d. Scrub his hands thoroughly with antibacterial soap.

ANS: C The first recommended action is to rinse his hands in cold running water within 15 minutes of exposure. This will neutralize the urushiol not yet bonded to the skin. Soaking his hands in warm water is effective for soothing the skin lesions after the dermatitis has begun. Antibacterial soap removes protective skin oils and dilutes the urushiol, allowing it to spread.

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician? a. Weigh on admission and daily. b. Replace fluid volume deficit over 48 hours. c. Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride. d. Give intravenous regular insulin 2 units/kg/hr after initial rehydration bolus.

ANS: C The initial hydrating solution is 0.9% normal saline. Potassium is not given until the child is voiding 25 ml/hr, demonstrating adequate renal function. After initial rehydration and insulin administration, then potassium is given. Dextrose is not given until blood glucose levels are between 250 and 300 mg/dl. An accurate, current weight is essential for determination of the amount of fluid loss and as a basis for medication dosage. Replacing fluid volume deficit over 48 hours is the current recommendation in diabetic ketoacidosis in children. Cerebral edema is a risk of more rapid administration. Intravenous regular insulin 2 units/kg/hr after initial rehydration bolus is the recommended insulin administration for a child of this weight. Only regular insulin can be given intravenously, and it is given after initial fluid volume expansion.

What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)? a. Apply ice packs to relieve acute swelling and pain. b. Administer acetaminophen to reduce inflammation. c. Teach the child and family correct administration of medications. d. Encourage range of motion exercises during periods of inflammation.

ANS: C The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.

What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)? a. High calorie diet because of increased metabolic needs b. Home schooling to decrease the risk of infections c. Protection from sun and fluorescent lights to minimize rash d. Intensive exercise regimen to build up muscle strength and endurance

ANS: C The photosensitive rash is a major concern for individuals with SLE. Adolescents who spend time outdoors need to use sunscreens with a high SPF, hats, and clothing. Uncovered fluorescent lights can also cause a photosensitivity reaction. The diet should be sufficient in calories and nutrients for growth and development. The use of steroids can cause increased hunger, resulting in weight gain. This can present additional emotional issues for the adolescent. Normal functions should be maximized. The individual with SLE is encouraged to attend school and participate in peer activities. A balance of rest and exercise is important; excessive exercise is avoided.

What is a physiologic effect of immobilization on children? a. Metabolic rate increases. b. Venous return improves because the child is in the supine position. c. Circulatory stasis can lead to thrombus and embolus formation. d. Bone calcium increases, releasing excess calcium into the body (hypercalcemia).

ANS: C The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. With the loss of muscle contraction, there is a decreased venous return to the heart. Calcium leaves the bone during immobilization, leading to bone demineralization and increasing the calcium ion concentration in the blood.

An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia? a. Cold, clammy skin and lethargy b. Hunger and hypertension c. Thirst, being flushed, and fruity breath d. Disorientation and pallor

ANS: C The signs of hyperglycemia are thirst, being flushed, and fruity breath. The skin is not cold or clammy, and there is not hunger and hypertension. Disorientation and pallor are signs of hypoglycemia

A parent calls the clinic nurse because his 7-year-old child was bitten by a black widow spider. What action should the nurse advise the parent to take? a. Apply warm compresses. b. Carefully scrape off the stinger. c. Take the child to the emergency department. d. Apply a thin layer of corticosteroid cream.

ANS: C The venom of the black widow spider has a neurotoxic effect. The parent should take the child to the emergency department for treatment with antivenin and muscle relaxants as needed. Warm compresses increase the circulation to the area and facilitate the spread of the venom. The black widow spider does not have a stinger. Corticosteroid cream has no effect on the venom.

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? a. Surgical therapy is indicated. b. Place in prone position for sleep after feeding. c. Thicken feedings and enlarge the nipple hole. d. Reduce the frequency of feeding by encouraging larger volumes of formula.

ANS: C Thickened feedings decrease the child's crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.

A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture? a. It will create difficulty because the child is left handed. b. It will heal slowly because this is the weakest part of the bone. c. This type of fracture requires different management to prevent bone growth complications. d. This type of fracture necessitates complete immobilization of the shoulder for 4 to 6 weeks.

ANS: C This type of fracture (Salter type III) can cause problems with growth in the affected limb. Early and complete assessment is essential to prevent angular deformities and longitudinal growth problems. The difficulty for the child does not depend on the location at the epiphyseal plate. Any fracture of the dominant arm presents obstacles for the individual. Healing is usually rapid in the epiphyseal plate area. Complete immobilization is not necessary. Often these injuries are surgically repaired with open reduction and internal fixation.

The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest? a. Hamburger on a bun b. Spaghetti with meat sauce c. Corn on the cob with butter d. Peanut butter and crackers

ANS: C Treatment of celiac disease consists primarily of dietary management. Although a gluten-free diet is prescribed, it is difficult to remove every source of this protein. Some patients are able to tolerate restricted amounts of gluten. Because gluten occurs mainly in the grains of wheat and rye but also in smaller quantities in barley and oats, these foods are eliminated. Corn, rice, and millet are substitute grain foods. Corn on the cob with butter would be gluten free.

What statement is characteristic of type 1 diabetes mellitus? a. Onset is usually gradual. b. Ketoacidosis is infrequent. c. Peak age incidence is 10 to 15 years. d. Oral agents are available for treatment.

ANS: C Type 1 diabetes mellitus typically usually has its onset before the age of 20 years, with a peak incidence between ages 10 and 15 years. Type 1 has an abrupt onset, in contrast to type 2, which has a more gradual appearance. Ketoacidosis occurs when insulin is unavailable and the body uses sources other than glucose for cellular metabolism. Ketoacidosis is more common in type 1 diabetes than in type 2. At this time, oral agents are available only for type 2 diabetes.

The nurse is facilitating a conference between the teachers and parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity disorder (ADHD). What does the nurse stress? a. Academic subjects should be taught in the afternoon. b. Low-interest activities in the classroom should be minimized. c. Visual references should accompany verbal instruction. d. The child's environment should be visually stimulating.

ANS: C Verbal instructions should always be accompanied by visual or written instructions. This provides the child with reinforcement and a reference to expectations. Academic subjects should be taught in the morning when the child is experiencing the effects of the morning dose of medication. Low-interest activities should be mixed with high-interest activities to maintain the child's attention. Environmental stimulation should be minimized to help eliminate distractions that can overexcite the child.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What should nursing care include? a. Feed glucose water only. b. Elevate the patient's head for feedings. c. Raise the patient's head and give nothing by mouth. d. Avoid suctioning unless the infant is cyanotic.

ANS: C When a newborn is suspected of having a tracheoesophageal fistula, the most desirable position is supine with the head elevated on an inclined plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. The oral pharynx should be kept clear of secretions by oral suctioning. This is to prevent the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

The nurse is caring for a child who has a temperature of 30° C (86° F). What physical effects of hypothermia should the nurse expect to observe in this child? (Select all that apply.) a. Reduced urinary output b. Injury to peripheral tissue c. Increased blood pressure d. Tachycardia e. Irritability with loss of consciousness f. Rigid extremities

ANS: C, D, E Hypothermia has varying physical effects depending on the child's core temperature. At 30° C (86° F), a child would experience an increase in blood pressure, tachycardia, and irritability followed by a loss of consciousness. Reduced urinary output from a decrease of blood flow to the kidneys, injury to peripheral tissue, and rigid extremities are physical effects observed as the body temperature continues to decrease.

The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the nurse include in the teaching? (Select all that apply.) a. Oranges b. Bananas c. Lima beans d. Baked beans e. Raisin bran cereal

ANS: C, D, E Lima beans have 13.2 g of fiber in 1 cup, baked beans have 10.4 g of fiber in 1 cup, and raisin bran cereal has 7.3 g of fiber in 1 cup. One orange has only 3.1 g of fiber, and 1 banana has only 3.1 g of fiber, so they are not recommended as high-fiber foods.

The parents of an infant with a cleft palate ask the nurse, "What follow-up care will our infant need after the repair?" Which is an accurate response by the nurse? a. "Your infant will not need any subsequent follow-up care." b. "Your infant will only need to be evaluated by an audiologist." c. "Your infant will only need follow-up with a speech pathologist." d. "Your infant will need follow-up with audiologists and orthodontists."

ANS: D A cleft palate means that audiologists will evaluate the child's hearing throughout early childhood and work closely with otolaryngologists to determine if pressure-equalizing (PE) tubes are needed. An infant with a cleft palate will also go through multiple phases of orthodontic intervention to align the teeth and the maxillary arches. Follow-up will be needed as the child grows. Following up with only an audiologist or only a speech pathologist would not be adequate.

The nurse is caring for a child after a cleft palate repair who is on a clear liquid diet. Which feeding device should the nurse use to deliver the clear liquid diet? a. Straw b. Spoon c. Sippy cup d. Open cup

ANS: D Acceptable feeding devices after a cleft palate repair include open cup for liquids, but rigid utensils such as spoons, straws, and hard-tipped sippy cups should be avoided to prevent accidental injury to the repair.

A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs? a. The infant's IV line has infiltrated. b. The infant has not voided since surgery. c. The infant's mother states the infant is tolerating the feeding okay. d. The infant is taking the Pedialyte without vomiting or distention.

ANS: D After a pyloromyotomy, feedings are usually instituted within 12 to 24 hours, beginning with clear liquids. They are offered in small quantities at frequent intervals. Supervision of feedings is an important part of postoperative care. The feedings are advanced only if the infant is taking the clear liquids without vomiting or distention. Feedings would not be advanced if the infant has not voided, the IV line becomes infiltrated, or the mother states the infant is tolerating the feedings.

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse's response should be based on which knowledge? a. It is unsafe. b. It is acceptable for up to 24 hours. c. It is acceptable for families with very limited resources. d. It is suitable for up to 3 days if stored in the refrigerator.

ANS: D Bacterial counts are unaffected if insulin syringes are handled in an aseptic manner and stored in the refrigerator between use. The syringes can be used up to 3 days and result in a considerable cost savings. Bacterial counts remain low for up to 72 hours with proper technique. The family's resources are not an issue; if a practice is unsafe, the family should not be encouraged to endanger the child by reusing equipment.

The nurse is assisting the family of a child with a history of encopresis. What should be included in the nurse's discussion with the family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

ANS: D Children may be unaware of a prior sensation and be unable to control the urge after it begins. They may be so accustomed to bowel accidents that they may be unable to smell or feel them. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Sitting the child on the toilet is not recommended because it may intensify the parent-child conflict. Enemas may be needed for impactions, but long-term use prevents the child from assuming responsibility for defecation. Stimulant cathartics may cause cramping that can frighten children.

What blood glucose measurement is most likely associated with diabetic ketoacidosis? a. 185 mg/dl b. 220 mg/dl c. 280 mg/dl d. 330 mg/dl

ANS: D Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 330 mg/dl; 185, 220, and 280 mg/dl are values that are too low for the definition of ketoacidosis.

What statement applies to the current focus of the dietary management of children with diabetes? a. Measurement of all servings of food is vital for control. b. Daily calculate specific amounts of carbohydrates, fats, and proteins. c. The number of calories for carbohydrates remains constant on a daily basis; protein and fat calories are liberal. d. The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

ANS: D Essentially the nutritional needs of children with diabetes are no different from those of healthy children. Children with diabetes need no special foods or supplements. They need sufficient calories to balance daily expenditure for energy and to satisfy the requirement for growth and development.

What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)? a. Elevate the child's legs. b. Place a foot cradle on the bed. c. Place a pillow under the child's knees. d. Assist the child to dorsiflex the feet and rotate the ankles.

ANS: D For a child who is immobilized, circulatory stasis and DVT development are prevented by instructing patients to change positions frequently, dorsiflex their feet and rotate the ankles, sit in a bedside chair periodically, or ambulate several times daily. Elevating the legs or placing a foot cradle on the bed will not prevent DVTs. A pillow under the knee would impair circulation, not improve it.

What clinical manifestation is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination

ANS: D Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.

A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? a. Hyperkalemia b. Hyperchloremia c. Metabolic acidosis d. Metabolic alkalosis

ANS: D Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

An infant is born with a gastroschisis. Care preoperatively should include which priority intervention? a. Prone position b. Sterile water feedings c. Monitoring serum laboratory electrolytes d. Covering the defect with a sterile bowel bag

ANS: D Initial management of a gastroschisis involves covering the exposed bowel with a transparent plastic bowel bag or loose, moist dressings. The infant cannot be placed prone, and feedings will be withheld until surgery is performed. Electrolyte laboratory values will be monitored but not before covering the defect with a sterile bowel bag.

What statement is correct regarding sports injuries during adolescence? a. Conditioning does not help prevent many sports injuries. b. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. c. More injuries occur during organized athletic competition than during recreational sports participation. d. Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

ANS: D Injuries occur when the adolescent's body is not suited to the sport or when he or she lacks the insight and judgment to recognize that an activity exceeds his or her physical abilities. More injuries occur when an adolescent's muscles and body systems (respiratory and cardiovascular) are not conditioned to endure physical stress. Injuries do not occur from fatigue but rather from overuse. All sports have the potential for injury to the participant, whether the youngster engages in serious competition or in sports for recreation. More injuries occur during recreational sports than during organized athletic competition.

What term describes invagination of one segment of bowel within another? a. Atresia b. Stenosis c. Herniation d. Intussusception

ANS: D Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Atresia is the absence or closure of a natural opening in the body. Stenosis is a narrowing or constriction of the diameter of a bodily passage or orifice. Herniation is the protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed.

What clinical manifestation should be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Colicky, cramping, abdominal pain around the umbilicus

ANS: D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain becomes constant and may shift to the right lower quadrant. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.

The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time? a. Bedtime b. With a meal c. Midmorning d. 30 minutes before breakfast

ANS: D Proton pump inhibitors are most effective when administered 30 minutes before breakfast so that the peak plasma concentrations occur with mealtime. If they are given twice a day, the second best time for administration is 30 minutes before the evening meal.

What clinical manifestation occurs with hypoglycemia? a. Lethargy b. Confusion c. Nausea and vomiting d. Weakness and dizziness

ANS: D Some of the clinical manifestations of hypoglycemia include weakness; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, confusion, and nausea and vomiting are manifestations of hyperglycemia.

Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement? a. "All therapies require extended periods of bed rest." b. "Conservative therapy will be required until puberty." c. "Our child cannot attend school during the treatment phase." d. "Surgical correction requires a 3- to 4-month recovery period."

ANS: D Surgical correction involves additional risks of anesthesia, infection, and possibly blood transfusion. The recovery period is only 3 to 4 months rather than the 2 to 4 years of conservative therapies. The use of non-weight-bearing appliances and surgical intervention does not require prolonged bed rest. Conservative therapy is indicated for 2 to 4 years. The child is encouraged to attend school and engage in activities that can be adapted to therapeutic appliances.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention? a. Sports drink and fruit b. Glucose tabs and protein c. Glass of water and crackers d. Milk and peanut butter on bread

ANS: D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Milk supplies lactose and a more prolonged action from the protein. The bread is a complex carbohydrate, which with the peanut butter provides a sustained action. The sports drink contains primarily simple carbohydrates. The fruit contains additional carbohydrates. A protein source is needed for sustained action. The glucose tabs are simple carbohydrates. Complex carbohydrates are needed with the protein. Crackers are a complex carbohydrate, but protein is needed to stabilize the blood sugar.

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

ANS: D The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but a short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.

What is an important consideration in the diagnosis of attention deficit hyperactivity disorder (ADHD)? a. Learning disabilities are apparent at an early age. b. The child will always be distracted by external stimuli. c. Parental observations of the child's behavior are most relevant. d. It must be determined whether the child's behavior is age appropriate or problematic.

ANS: D The diagnosis of ADHD is complex. A multidisciplinary evaluation should be done to determine whether the child's behavior is appropriate for the developmental age or whether it is problematic. Learning disabilities are usually not evident until the child enters school. Each child with ADHD responds differently to stimuli. Some children are distracted by internal stimuli and others by external stimuli. Parents can only provide one viewpoint of the child's behavior. Many observers should be asked to provide input with structured tools to facilitate the diagnosis.

An older school-age child asks the nurse, "What is the reason for this topical corticosteroid cream?" What rationale should the nurse give? a. The cream is used for an antifungal effect. b. The cream is used for an analgesic effect. c. The cream is used for an antibacterial effect. d. The cream is used for an anti-inflammatory effect.

ANS: D The glucocorticoids are the therapeutic agents used most widely for skin disorders. Their local anti-inflammatory effects are merely palliative, so the medication must be applied until the disease state undergoes a remission or the causative agent is eliminated. It does not have an antifungal, analgesic, or antibacterial effect.

18. The school nurse is reviewing the process of wound healing. What is the initial response at the site of injury? a. Contraction b. Maturation c. Fibroplasia d. Inflammation

ANS: D The initial response at the site of injury is inflammation, a vascular and cellular response that prepares the tissues for the subsequent repair process. Fibroplasia (granulation or proliferation), the second phase of healing, lasts from 5 days to 4 weeks. During contraction and maturation, the third and fourth phases of wound healing, collagen continues to be deposited and organized into layers, compressing the new blood vessels and gradually stopping blood flow across the wound.

A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family? a. Safe administration of daily enemas b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as the child returns home d. Changes in stooling patterns to report to the practitioner

ANS: D The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop. Constipation is avoided because a firm stool will place strain on the suture line. Daily enemas are contraindicated after surgical repair of a rectal malformation. Fiber and stool softeners are often given to keep stools soft and avoid tension on the suture line. The child needs to recover from the surgical procedure. Then bowel training may begin, depending on the child's developmental and physiologic readiness.

What is characteristic of children with posttraumatic stress disorder (PTSD)? a. Denial as a defense mechanism is unusual. b. Traumatic effects cannot remain indefinitely. c. Previous coping strategies and defense mechanisms are not useful. d. Children often play out the situation over and over again.

ANS: D The third phase of adjustment to PTSD involves the children playing out the situation over and over to come to terms with their fears. Denial is frequently used as a defense mechanism during the second phase. For some children, traumatic effects can remain indefinitely. Coping is a learned response. During the third stage, the children can be helped to use their coping strategies to deal with their fears.

The nurse is teaching parents the proper use of a hip-knee-ankle-foot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement? a. "Alcohol will be used twice a day to clean the skin around the brace." b. "Weekly visits to the orthotist are scheduled to check screws for tightness." c. "Initially, a burning sensation is expected and the brace should remain in place." d. "Condition of the skin in contact with the brace should be checked every 4 hours."

ANS: D This type of brace has several contact points with the child's skin. To minimize the risk of skin breakdown and facilitate use of the brace, vigilant skin monitoring is necessary. Alcohol should not be used on the skin. It is drying. Parents are capable of checking and tightening the screws when necessary. If a burning sensation occurs, the brace should be removed. If several complaints of burning occur, the orthotist should be contacted.

The nurse is caring for an immobilized preschool child. What intervention is helpful during this period of immobilization? a. Encourage wearing pajamas. b. Let the child have few behavioral limitations. c. Keep the child away from other immobilized children if possible. d. Take the child for a "walk" by wagon outside the room.

ANS: D Transporting the child outside of the room by stretcher, wheelchair, or wagon increases environmental stimuli and provides social contact. Street clothes are preferred for hospitalized children. This decreases the sense of illness and disability. The child needs appropriate limits for both adherence to the medical regimen and developmental concerns. It is not necessary to keep the child away from other immobilized children.

The parents of a 2-month-old girl bring her in for treatment. The infant has had infrequent bowel movements since birth, and the parents describe the recent appearance of ribbon-like-foul smelling stools when changing her diaper. What other clinical manifestation might the nurse observe? Abdominal bruising Abdominal distention Appropriate weight gain Relaxing internal sphincter

Abdominal distention Abdominal distention is a clinical manifestation of Hirschsprung disease that the nurse might observe. Increased gas can contribute to abdominal distention.

Diaper Dermatitis

Acute inflammation occurring in the diaper area. Contact dermatitis is most common. Most common contact dermatitis in childhood primarily on convex surface of folds

A diabetic patient arrives at the ER with tachycardia, diaphoresis, and unresponsive to voice. Which intervention is the priority action? Administer 50% dextrose IV per protocol Administer oxygen 2 L per nasal cannula Administer prescribed insulin subcutaneous (SQ) Administer naloxone hydrochloride (narcan) per protocol

Administer 50% dextrose IV per protocol Given symptoms, patient needs IV glucose.

Urinalysis of a patient with type 1 diabetes mellitus shows ketones, glucose, and high concentrations of H + ions. On examination the nurse finds that the patient's skin is dry, the radial artery pulse is weak, and the level of consciousness is decreased. The nurse alerts the provider and prepares to perform which interventions? Select all that apply. Administer insulin. Administer intravenous fluids. Administer furosemide. Administer amitriptyline. Administer potassium supplements.

Administer insulin. Administer intravenous fluids Administer potassium supplements. Rationale The symptoms and signs of the patient indicate diabetic ketoacidosis (DKA). Therefore the nurse should administer insulin, which is required to move the extracellular glucose into the cells of the tissues in the body. This patient is at high risk of hypokalemia due to the action of insulin, which pushes potassium into the cells, so the patient should be given potassium. Intravenous fluids are required to correct the dehydration in DKA. Insulin therapy should be started after the initial rehydration bolus, because serum glucose levels fall rapidly after volume expansion. Amitriptyline is indicated in cases of diabetic neuropathy. Furosemide is a diuretic and potassium-lowering drug; hence it is contraindicated in DKA.

The nurse is caring for a child with intussusception who presented with vomiting and diarrhea. Laboratory values reveal elevated serum sodium and elevated hematocrit. Which priority action should the nurse take to achieve the expected outcomes for this patient? Asses the child's A1c Increase dietary iron Notify the provider immediately Encourage the child to sit up in a chair Administer intravenous (IV) normal saline

Administer intravenous (IV) normal saline Elevated serum sodium and hematocrit indicate dehydration and should be treated with IV fluids.

A child with diabetes insipidus is admitted to the hospital. Which nursing interventions are most important for this child? Select all that apply. Monitor temperature. Check airway and breathing. Monitor blood glucose levels. Administer intravenous fluids. Monitor urine volumes regularly.

Administer intravenous fluids. Monitor urine volumes regularly. Rationale In diabetes insipidus there is a deficiency of vasopressin, which is characterized by polydipsia and polyuria. A nurse should be aware that dehydration can occur in children who are not able to drink fluids voluntarily. Therefore in these cases the nurse should administer intravenous fluids and monitor urine volumes regularly. Although dehydration can cause hyperthermia (and temperature is monitored in all hospitalized patients), this is not a priority intervention. Checking airway and breathing are less important, because diabetes insipidus does not hamper respiration and circulation. Blood glucose levels should be monitored in cases of diabetes mellitus.

A child with celiac disease presents with severe diarrhea, a thready pulse, and low blood pressure. Which actions should the nurse take? Select all that apply. Insert a Foley catheter Administer intravenous saline Administer oral pain medication Obtain serum electrolyte levels Administer a nebulizer treatment

Administer intravenous saline The child exhibits signs of celiac crisis. The nurse should begin fluid resuscitation. Obtain serum electrolyte levels Metabolic acidosis is a symptom of celiac disease. The nurse should monitor the child's electrolyte levels.

Which nursing action is appropriate for the child that comes into the school health office after being stung by an insect, is wheezing and appears restless, and is wearing a medical alert bracelet for a bee allergy? Notify the child's pediatrician. Administer the child's injectable epinephrine. Administer a cold compress to reduce swelling and pain. Call the child's parents to come pick the child up from school.

Administer the child's injectable epinephrine. Rationale The child is showing signs of anaphylaxis and needs prompt treatment to prevent serious complications — even death. The nurse must administer injectable epinephrine to reduce the potentially fatal reaction that occurs after a bee sting in allergic individuals. Treatment must be immediate; there is no time to notify the child's pediatrician or call the child's parents before the injection is administered. A cold compress may help reduce pain from the sting but will not prevent or reduce an anaphylactic reaction.

Which order is appropriate in the child that presents to the emergency room with redness, swelling, and infiltration of the cheek and a temperature of 102.8 oF? Oral antibiotics Topical antiseptic application Admission to the pediatric ward Gentle cleansing with silver nitrate

Admission to the pediatric ward Rationale An infection of the cheek that presents with redness, swelling, and infiltration are all characteristic of cellulitis. The fever is a systemic symptom, which would likely indicate the need for hospitalization. After admission the patient is likely to receive parenteral antibiotics, not oral antibiotics. Application of a topical antiseptic or silver nitrate would not be appropriate treatment for cellulitis.

Which substance use is associated with increased incidence of cleft lip? Select all that apply. Aspirin Alcohol Folic acid Anticonvulsant Cigarette smoking

Alcohol Anticonvulsant Cigarette smoking Rationale Increased incidence of cleft lip is closely associated with alcohol use, anticonvulsant use, and cigarette smoking. Aspirin use in young children is associated with Reye syndrome but not cleft lip. Folic acid may protect against clefting.

A child is experiencing a fever, rigid abdomen, and is bending over, holding the right lower abdomen. The nurse anticipates which diagnosis? Peptic ulcer Appendicitis Dehydration Pyloric stenosi

Appendicitis Rationale Fever, rigid abdomen, and bending over, holding the right lower abdomen are symptoms of appendicitis. Peptic ulcer is associated with epigastric pain and generalized abdominal pain, but the patient should not have a rigid abdomen. Dehydration could be caused by excessive fever, but the severe pain does not indicate dehydration. Pyloric stenosis is usually associated with projectile vomiting and an olive-shaped mass in the right epigastrium.

Which conditions are associated with acute, severe pain? Select all that apply. Pica Appendicitis Intussusception Hirschsprung disease Hypertrophic pyloric stenosis

Appendicitis Intussusception Rationale Appendicitis and intussusception has acute, severe pain. Pica is an eating disorder characterized by the compulsive and excessive ingestion of both food and nonfood substances for at least 1 month. Hirschsprung disease is a mechanical obstruction of part of the intestine. Its symptoms include failure to pass stool, vomiting, and abdominal distention but not acute, severe pain. Hypertrophic pyloric stenosis has no evidence of pain except chronic hunger.

A toddler diagnosed with HSV continues to pick at the vesicles. What action should the nurse take to best prevent spread of the infection? Restrict visitors to only parents Apply bilateral elbow restraints Place patient on reverse precautions Apply lactic acid ointment to lesions

Apply bilateral elbow restraints Wrist restraints will prevent the child from bending the elbow and scratching or picking at vesicles. They should be applied to prevent spread of the disease.

Which medication is appropriate when treating the child with an itchy round lesion on the thigh and scrotum? Oral griseofulvin Oral nystatin solution Selenium sulfide washes Apply clotrimazole topically

Apply clotrimazole topically Rationale Itchy round lesions found on the thigh and scrotum are likely indicative of tinea cruris, or jock itch. The infection is best treated with topical antifungals like clotrimazole. Oral griseofulvin or nystatin are not the best options for localized skin infections. Selenium sulfide washes are used to treat tinea capitis, not tinea cruris.

Which nursing action is appropriate when providing care of a child with a forehead laceration that is bleeding profusely and the parents are hysterical? Tell the parents to calm down. Apply pressure to the wound with a clean gauze. Prepare a suture kit and sterile gloves for the provider. Notify the provider that the child needs to be seen immediately

Apply pressure to the wound with a clean gauze. Rationale Head wounds tend to bleed heavily, which can be very distressing to both the parents and the child. The nurse would first apply direct pressure to the wound using a clean piece of gauze to help slow the bleeding. Telling the parents to calm down isn't helpful or therapeutic. Bleeding needs to be controlled before it can be determined if the wound requires sutures. Depending on the severity of the wound, the child may or may not need to be seen urgency.

A young teen with a fever and a history of constipation who has been experiencing 10/10 right-sided abdominal pain, suddenly stops crying and states, "I feel better." What is the nurse's best action? Give an enema Assess the abdomen Prepare for discharge Assess for bowel movement

Assess the abdomen Rationale A young teen with a fever and history of constipation who has been experiencing 10/10 right-sided abdominal pain and who suddenly stops crying because "I feel better" may be experiencing perforation of the appendix that will lead to peritonitis. Careful assessment of the abdomen is appropriate for the nurse to do. Giving an enema is contraindicated for severe abdominal pain. Preparing for discharge and assessing for bowel movement are not appropriate inventions.

What would be an appropriate nursing "at risk" diagnosis? (Select all that apply)

At risk for alteration in comfort related to surgical procedure and hospitalization - At risk for alteration in hemodynamic status related to post-surgical procedure - At risk for aspiration related to pyloric stenosis condition and status post general anesthesia

Which treatment measures are appropriate for the teenage patient presenting with severe pruritus that gets worse at night and red inflammatory lesions on the hands, feet, and face? Select all that apply. Use of loratadine or fexofenadine. Take 2 to 3 showers a day to clean the skin. Take a hot bubble bath at night before bed. Avoid using harsh soap while bathing or showering. Regular use of an emollient like Aquaphor or Cetaphil.

Avoid using harsh soap while bathing or showering. Regular use of an emollient like Aquaphor or Cetaphil. Rationale The patient likely has atopic dermatitis, also called eczema. Patients with eczema are often advised to avoid harsh or scented soaps, which can help keep skin from drying out. Regular use of an emollient like Aquaphor, Cetaphil, or Eucerin is essential for keeping skin hydrated and controlling symptoms such as itching. Loratadine and fexofenadine are nonsedating antihistamines and may be a good choice for daytime itching. A slightly sedating antihistamine is a better choice for nighttime pruritus, as these medications can cause drowsiness. Taking multiple showers a day, especially without an emollient, can dry out the skin and make itching worse. Hot bubble baths can also dry the skin and should be avoided.

During abdominal assessment, the nurse notes hypoactive bowel sounds, abdominal distention, vomiting, and currant jelly stools. Which interventions would the nurse expect to provide for this patient? Select all that apply. Antipyretic Barium enema IV normal saline Intravenous antiemetic Abdominal ultrasonography

Barium enema A definitive diagnosis can be made and treatment provided simultaneously with a barium enema, which allows hydrostatic reduction of the intussusception to be done. Correct IV normal saline IV normal saline is given to prevent dehydration from vomiting. Correct Intravenous antiemetic An antiemetic would be administered to treat vomiting. Correct Abdominal ultrasonography Abdominal ultrasonography is useful in identifying the location of the intussusception and the amount of edema in the area.

Which nursing advice is appropriate for the parent of a toddler that was found playing in a patch of poison ivy 5 minutes ago? Place the child in a hot bath for 10 to 15 minutes. Bathe the child with cold running water immediately. Use a washcloth to wipe the child's skin with rubbing alcohol. Administer ibuprofen immediately and every 4 to 6 hours for relief of itching.

Bathe the child with cold running water immediately. Rationale Flushing the child's skin with cold running water within 15 minutes of exposure can help to neutralize the extremely potent oil, called urushiol, that bonds to the skin. Using hot water or rubbing alcohol will not neutralize urushiol. Ibuprofen will not prevent or relieve itching caused by poison ivy.

The nurse is caring for a child with Hirschsprung disease who has been diagnosed with colon inflammation. Which provider orders would the nurse anticipate? Select all that apply. Administer a suppository as needed. Provide oral fluids as desired. Begin preoperative checklist. Increase dietary fiber and fluids. Initiate intravenous administration of normal saline.

Begin preoperative checklist. Complications from Hirschsprung disease may indicate the need for surgery. Initiate intravenous administration of normal saline. A patient with an inflamed colon is at risk for deficient fluid volume and should be given IV fluid resuscitation.

Which type of insect is appropriate when assessing the child with a stomachache and a bite that is swollen, painful, and erythematous? Scorpion Mosquito Black widow spider Brown recluse spider

Black widow spider Rationale A black widow spider produces a swollen, painful, and reddened bite site. It can also cause systemic symptoms such as a stomachache, dizziness, and weakness. A scorpion bite causes intense localized pain, numbness, and burning at the site of the bite as well as systemic symptoms such as vomiting, excessive salivation, thirst, and weakness. A mosquito bite causes intense itching and a red, swollen bite, but does not cause systemic symptoms. A brown recluse spider bite causes a centralized area of necrosis surrounded by a purplish ulceration and blistering. Brown recluse spider bites do not cause abdominal pain.

What is the similarity between gastroschisis and omphalocele? Both have similar prognoses. Both contain a translucent peritoneal sac. Both are congenital abdominal wall defects. Both are often associated with other anomalies.

Both are congenital abdominal wall defects. Rationale Gastroschisis and omphalocele are common forms of congenital abdominal wall defects. Because gastroschisis is generally an isolated defect, it has a good prognosis with survival rates above 89%. Omphaloceles, which can be associated with other serious anomalies, do not always have such high survival rates. Whereas omphalocele is usually covered by a translucent peritoneal sac, gastroschisis is not covered by a peritoneal sac. Whereas omphalocele is often associated with other anomalies such as cardiac, neurologic, and skeletal anomalies, gastroschisis is usually not associated with other congenital anomalies.

Gastroschisis

Bowel herniates through a defect in the abdominal wall to the right of umbilical cord and through rectus muscle no membrane covering the exposed bowel

clinical manifestation hirschsprung disease/ childhood

CONSTIPATION RIBBONLIKE FOUL SMELLING STOOLS ABDOMINAL DISTENTION VISIBLE PERISTALSIS EASY PALPABLE FECAL MASS UNDERNOURISHED ANEMIC APPEARANCE

The nurse walks into a patient's room shortly after surgical correction of intussusception and notices that the patient is very lethargic. Which nursing action is a priority? Assess pain Check vital signs Check urine output Call the rapid response team

Call the rapid response team The patient is exhibiting signs of possible sepsis or peritonitis. The nurse should call the rapid response team and to stay with the patient and initiate cardiopulmonary resuscitation (CPR) if indicated.

Which condition is appropriate for an infant with a severe diaper rash that has been resistant to the use of diaper rash creams, is inflamed, and crosses the inguinal folds? Intertrigo Atopic dermatitis Diaper dermatitis Candida albicans infection

Candida albicans infection Rationale The characteristics of a Candida albicans infection include a diaper rash that is resistant to home treatment, is inflammatory, or produces a maculopapular rash that crosses the inguinal folds. Atopic dermatitis — more specifically diaper dermatitis — is irritation that occurs with exposure to a chemical or physical irritant. Intertrigo is an inflamed area where skin folds have rubbed together.

Which are malabsorptive causes of chronic diarrhea? Select all that apply. Crohn disease Celiac disease Ulcerative colitis Lactose intolerance Short-bowel syndrome

Celiac disease Lactose intolerance Short-bowel syndrome Rationale Malabsorptive causes of chronic diarrhea include celiac disease, lactose intolerance, and short-bowel syndrome. Ulcerative colitis and Crohn disease are inflammatory bowel diseases.

A patient with type 2 diabetes mellitus complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing actions should the nurse perform first? Check the patient's blood glucose level. Instruct the patient to take a Glucophage tablet. Instruct the patient to take 6 units of regular insulin. Provide the patient with 8 oz of orange juice with 1 tsp sugar.

Check the patient's blood glucose level. Checking the patient's blood glucose level will provide objective data of the patient's status. From this data, interventions can be implemented

Which topical therapy is appropriate for the patient with several finger warts? Laser therapy Dermabrasion Chemical cautery Ultraviolet light therapy

Chemical cautery Rationale Chemical cautery is a particularly effective treatment for warts. Warts can also be removed with cryosurgery and electrodesiccation. Dermabrasion is a treatment best used for acne. Laser therapy can be used to treat psoriasis or acne. Ultraviolet light therapy can be used to remove birthmarks.

A nurse is caring for a child recently diagnosed with celiac disease. Which lunch selections are most appropriate? Select all that apply. Roast beef sandwich on pumpernickel toast with fruit salad. Apples and cream oatmeal with dried pineapples and pecans. Chicken stir-fry with white rice, carrots, onions, and broccoli. Roasted turkey sandwich on multigrain bread with potato chips. Fresh ham on a corn tortilla with mashed potatoes and mandarin oranges

Chicken stir-fry with white rice, carrots, onions, and broccoli. Children with celiac disease do not need to eliminate white rice from their diet. Rice of any kind can be used as a substitute for grains that contain gluten. Fresh ham on a corn tortilla with mashed potatoes and mandarin oranges. Children with celiac disease do not need to eliminate corn from their diet. Corn should be used as a substitute.

The nurse is evaluating a patient with encopresis. Which findings would the nurse expect on assessment after taking patient history? Select all that apply. Child has fecal stains in the underwear. Child plays video games for hours alone. The child is captain of the middle school soccer team. Child spends weekends having sleepovers with friends. Urinalysis reveals the child's fourth urinary tract infection in 16 months.

Child has fecal stains in the underwear. Having soiled clothing is indicative of encopresis. Child plays video games for hours alone. Social withdrawal is indicative of encopresis. Urinalysis reveals the child's fourth urinary tract infection in 16 months. Frequent urinary tract infections and urinary incontinence are indicative of encopresis.

Which patient findings indicate to the nurse that treatment of encopresis complications has been effective? Select all that apply. The child does not attend school events. Child talks about the condition with the nurse. The child's skin is clean, dry, and free of excoriation. Child chooses a cheeseburger, soda, and a sugar cookie for lunch. Parents report the child has a bowel movement every 6 to 8 hours.

Child talks about the condition with the nurse. Verbalizing positive, realistic feelings about self and verbalizing appropriate ways to achieve control over bowel incontinence are indications that treatment has been effective. The child's skin is clean, dry, and free of excoriation. Maintenance of skin integrity is an indication that treatment has been effective. Parents report the child has a bowel movement every 6 to 8 hours. Following a regular bowel schedule is one effective treatment for children with encopresis.

Which drug may be prescribed for a critically ill infant in an intensive care unit and is a histamine receptor antagonist that suppresses gastric acid production? Bismuth Sucralfate Cimetidine Lansoprazole

Cimetidine Rationale Cimetidine is the histamine receptor antagonist that suppresses gastric acid production. Histamine-receptor antagonists are given to critically ill infants to prevent stress ulcers and these drugs have fewer side effects. Bismuth and sucralfate are mucosal protective agents that form a barrier over ulcerated mucosa and protect against acid and pepsin. Lansoprazole is a proton pump inhibitor that inhibits the hydrogen ion pump in the parietal cells and blocks the production of acid.

Which diarrheal disturbances match with the corresponding gastrointestinal anatomy? Select all that apply. Colon (colitis) Appendix (appendicitis) Small intestines (gastritis) Colon and intestines (enterocolitis) Stomach and intestines (gastroenteritis)

Colon (colitis) Colon and intestines (enterocolitis) Stomach and intestines (gastroenteritis) Rationale Diarrheal disturbance and gastrointestinal anatomy matches include colon (colitis), colon and intestine (enterocolitis), and stomach and intestines (gastroenteritis). A small intestinal diarrheal disturbance is called enteritis. Appendicitis is not a diarrheal disturbance but an inflammation of the appendix.

A child has been diagnosed with Type 1 Diabetes Mellitus (DM) and the parent asks the nurse what this means. What is the best response by the nurse? "The child is at risk of DKA because of low blood sugar." "You do not have to worry about hypoglycemia with your child." "It is normal to have a variation in the blood glucose level, but now the sugar will be maintained at an elevated level." "In the absence of insulin, the child is unable to metabolize fats, proteins, and carbohydrates and use them for energy."

"In the absence of insulin, the child is unable to metabolize fats, proteins, and carbohydrates and use them for energy." Because insulin-secreting beta cells of pancreas are destroyed by inflammation, a child with Type I DM is unable to produce and secrete insulin. This response is an appropriate, concise explanation of pathophysiology of DM type 1.

After surgery to create a colostomy, a child who is still on NPO (nothing by mouth) status requests a meal. Which response is appropriate for the nurse? "Let me check with the surgeon." "The surgeon said you still can't eat anything." "I will ask your parents to bring you some food." "You cannot eat until I can hear your belly gurgle when I listen to it or when you pass gas."

"You cannot eat until I can hear your belly gurgle when I listen to it or when you pass gas." This would an appropriate response by the nurse. They explained to the patient not only that they would not be able to eat but why.

The mother of a 2-month-old infant with persistent vomiting voices concern that the baby has an intestinal problem. Which response from the nurse is appropriate to evaluate the need for further evaluation? "It would be more concerning if diarrhea develops." "Can you describe the amount and frequency of vomiting?" "Vomiting is an indication of a serious gastrointestinal problem." "Food remains in an infant's stomach for a short period and may result in vomiting."

"Can you describe the amount and frequency of vomiting?" This response would be appropriate because the nurse realizes it is necessary to gather a full history of the baby's current condition. The nurse knows that it is possible the mother may be confusing spitting up, which is normal, with persistent vomiting.

The nurse has taught a patient with type 2 diabetes mellitus about the clinical manifestations and evaluates that learning has occurred if the patient makes which statement? "I can expect that my blood sugars will increase when I am sick or under stress." "If I follow the diabetic diet, I will be able to control my symptoms of both hyperglycemia and hypoglycemia." "This darkening of the skin on the back of my neck is a result of high blood sugars and is nothing to worry about." "I understand that yeast infection, frequent urination, and high levels of energy are common in the diabetic patient."

"I can expect that my blood sugars will increase when I am sick or under stress." Infection, injury, surgery, and times of stress are among things that will increase blood glucose levels.

most common sites of pediculosis capitis

-occipital area -behind the ears and at nape of neck -occasionally the eyebrows and eyelashes

extrinsic causes

-physical, chemical or allergic irritants -infectious agents such as bacteria, fungi, viruses or animal parasites

clinical manifestations of eczema

-redness -scaliness -itching -minute papules- firm,elevated, circumscribed lesions <1 cm in diameter -fluid-filled vesicles -weeping, oozing, crusting of lesions

eczema

-superficial inflammatory process involving primarily the epidermis -associated with family history of the disorder, allergies, asthma,or allergic rhinitis

*Hypoglycemia

1. A blood glucose level <70 2. occurs as the result of too much insulin, not enough food, or excessive activity. Signs: headache, nausea, sweating, tremors, lethargy, hunger, confusion, slurred speech, tingling around the mouth, and anxiety

*Diabetic Ketoacidosis

1. A complication of DM that develops when a severe insulin deficiency occurs 2. A life-threatening condition 3. Hyperglycemia that progresses to metabolic acidosis occurs 4. Develops over a period of several hours to days 5. The blood glucose level is more than 300 mg/dL and urine and serum ketones are positive. 6. Manifestations of DKA: hyperglycemia, Kussmaul's respirations, acetone breath, increasing lethargy, and decreasing LOC

Which nurse finding is appropriate to isolate from others at a community pediatric clinic? An eczema flare A child who is frantically scratching the head A wound check after getting stitches 2 days ago A burn after accidentally touching the stove this morning

A child who is frantically scratching the head Rationale Many skin conditions aren't contagious and don't require isolation, but the child who is scratching the head may have lice, which is highly contagious. A child suspected of having lice should be isolated from the other children in the waiting area until the diagnosis is known. Eczema isn't contagious and doesn't require isolation. Children who are visiting for a wound check or a minor burn do not require isolation.

The nurse in the emergency department is triaging patients. Which child must be seen first? A child with severe bloody diarrhea A child with a severe burn on the leg A child screaming, crying, and holding the abdomen A child with stridor who appears anxious

A child with stridor who appears anxious Rationale Using the ABC (airway, breathing, and circulation) prioritization approach, the child with stridor from a foreign body in the throat must be seen first. Stridor indicates partial or complete obstruction from the foreign body in the throat. A child with severe bloody diarrhea; a severe burn on the leg; and screaming, crying, and holding the abdomen are not priorities before airway obstruction. p. 844

The health care provider has prescribed sulfasalazine (Azulfidine) 5 mg/kg PO per dose twice a day for a child with juvenile arthritis. The child weighs 55 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 125 The correct calculation is: 55 lb/2.2 kg = 25 kg Dose of Azulfidine is 5 mg/kg 5 mg ´ 25 = 125 mg

A health care provider prescribes risperidone (Risperdal), PO, 2 mg, twice a day, for a child with schizophrenia. The medication label states: "Risperidone (Risperdal) oral concentrate, 1 mg/1 ml." The nurse prepares to administer one dose. How many milliliters should the nurse prepare to administer one dose? Fill in the blank. Record your answer as a whole number.

ANS: 2 Follow the formula for dosage calculation. Desired ———- ´ Volume = ml per dose Available 2 mg ———- ´ 1 ml = 2 ml 1 mg

The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Steatorrhea b. Polycythemia c. Malnutrition d. Melena stools e. Foul-smelling stools

ANS: A, C, E Clinical manifestations of celiac disease include impaired fat absorption (steatorrhea and foul-smelling stools) and impaired nutrient absorption (malnutrition). Anemia, not polycythemia, is a manifestation, and melena stools do not occur.

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child? a. It is unnecessary because of child's age. b. It is essential because it will be an adjustment. c. Preparation is not needed because the colostomy is temporary. d. Preparation is important because the child needs to deal with negative body image.

ANS: B The child's age dictates the type and extent of psychologic preparation. When a colostomy is performed, it is necessary to prepare the child who is at least preschool age by telling him or her about the procedure and what to expect in concrete terms, with the use of visual aids. The preschooler is not yet concerned with body image.

A parent of a 6-month-old infant calls the nurse hotline and reports that an infant has had loose stools for the past 12 hours. Which question is most pertinent in the nurse's assessment? Can you describe the number and character of the stools? How much fluid has the infant consumed in the past 24 hours? Do you think the infant caught a bug from a family member?

Can you describe the number and character of the stools? Asking the parent to describe the number and character of the stools is the most pertinent question, as it will help characterize the infant's current symptoms.

A nursing student receives report that a child has the diagnosis of failure to thrive. The nurse explains what failure to thrive means. Which statements are included in this explanation? Select all that apply. Deceleration from growth patterns The inability to maintain body functions conducive to life A psychological condition where the patient has no desire to live A condition that is sometimes accompanied by developmental delays Consistently remaining below the fifth percentile for height and weight on standard growth charts

Deceleration from growth patterns A condition that is sometimes accompanied by developmental delays Consistently remaining below the fifth percentile for height and weight on standard growth charts Rationale Failure to thrive is a deceleration from growth patterns or consistently remaining below the fifth percentile for height and weight on standard growth charts. It is sometimes accompanied by developmental delays. Failure to thrive does not mean the patient does not have the ability or desire to live.

Which long-term problems are associated with either cleft lip or cleft palate? Select all that apply. Dental Hearing loss Respiratory infections Neurologic dysfunction Social acceptance concerns

Dental Hearing loss Respiratory infections Social acceptance concerns Rationale Long-term problems most associated with cleft lip or cleft palate include dental problems, hearing loss, respiratory infections, and social acceptance concerns. Neurologic dysfunction is not usually associated with cleft lip or cleft palate.

Which processes are necessary for the body to convert nutrients into forms it can use? Select all that apply. Digestion Absorption Metabolism Elimination Reabsorption

Digestion Absorption Metabolism Rationale Processes necessary for the body to convert nutrients into forms it can use include digestion, absorption, and metabolism. Elimination is a function of the gastrointestinal system but not necessary for the body to convert nutrients into forms it can use. Reabsorption is a renal function.

A child with type 1 diabetes mellitus who is taking insulin is seen in the school's clinic. The nurse develops a teaching plan for the child regarding food and exercise because the child has told the nurse that she will begin basketball practice. Which instruction should the nurse provide to the child? Withhold insulin on the day of basketball practice. Eat lunch 2 hours earlier on the day of basketball practice. Joining the basketball team should be delayed for 1 more year. Eat an extra snack of carbohydrates before the basketball practice starts.

Eat an extra snack of carbohydrates before the basketball practice starts. Because exercise lowers blood glucose levels, the child must be taught how to prevent hypoglycemia. The extra snack before practice will avert the hypoglycemia.

avulsion

Forcible pulling out or extraction of tissue

If appendicitis were suspected, in which area of the abdomen would the nurse expect the patient to report pain? Upper left quadrant Middle left quadrant Upper right quadrant Lower right quadrant

Lower right quadrant The nurse would expect the patient to report pain in the lower right quadrant if appendicitis were suspected. The appendix is located in the lower right quadrant.

An infant with pyloric stenosis has a nasogastric tube in place. Which assessment finding would be of most concerning to the nurse? Patient is in Fowler's position. Respirations are rapid and shallow. Hyperactive bowel sounds on auscultation. Urine output was 100 mL in the last 3 hours.

Respirations are rapid and shallow. Rapid respirations are an indication of respiratory distress and would be of most concern to the nurse.

clinical manifestations of appendicitis

Right lower quadrant abdominal pain, fever rigid abdomen decreased or absent bowel sounds vomiting constipation or diarrhea anorexia tachycardia rapid shallow breathing pallor lethargy irritability stooped posture

Which condition is appropriate for the child with an itchy, grayish-brown rash that is primarily found on the hands and wrists? Scabies Eczema Mosquito bites Poison ivy exposure

Scabies Rationale A scabies rash appears grayish-brown, threadlike, and with a black dot at the end of each spot. The rash is itchy and primarily found on the hands and ankles on children older than 2 years of age. Eczema is an itchy, red, and swollen inflammatory lesion. Mosquito bites are itchy, red, and swollen spots. The itchy rash that appears as a reaction to poison ivy exposure is red with weeping blisters.

Place the sections of the colon in the order in which they appear along the gastrointestinal tract..

The cecum is the first part of the colon, and the rest of the colon is divided into ascending, transverse, descending, and sigmoid.

A nurse is caring for a 15-year-old girl who is experiencing polyuria, polydipsia, and polyphagia. The girl is underweight and reports being extremely fatigued over the past 3 days. The nurse anticipates testing will confirm which diagnosis Type 1 diabetes Type 2 diabetes Pheochromocytoma Congenital adrenal hyperplasia

Type 1 diabetes Rationale Polyuria, polydipsia, and polyphagia in an underweight girl under the age of 20 are suggestive of type 1 diabetes. Type 2 diabetes progresses gradually, and polyuria, polydipsia, and polyphagia are not observed as often. Pheochromocytoma is a rare tumor characterized by the secretion of catecholamines. Congenital adrenal hyperplasia is characterized by the secretion of excessive amounts of cortisol precursors and androgens.

Which physiologic alteration is characterized by destruction of pancreatic beta cells that produce insulin? Type 1 diabetes Type 2 diabetes Gestational diabetes Impaired glucose tolerance

Type 1 diabetes Rationale Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta cells.

Longest light waves, causing only minimum burning but playing a significant role in photosensitive and photoallergic reactions

UVA waves cannot be blocked by sunscreen/sunblock

Shorter light waves, responsible for tanning, burning, and most of the harmful effects attributed to sunlight

UVB waves max exposure from 10am-3pm higher exposure at increased elevations closer to equator

Which nursing assessment components are appropriate when determining the causes of enuresis that have occurred several times over the preceding 2 weeks in a 6-year-old child? Select all that apply. Urinalysis Glucose testing Metabolic panel Physical examination Complete blood count Water deprivation test

Urinalysis Glucose testing Metabolic panel Physical examination Water deprivation test Rationale The nurse expects the health care provider will order a urinalysis to determine if the child has a urinary tract infection. Glucose testing and a water deprivation test can help determine whether the child has diabetes mellitus or diabetes insipidus. A physical examination will help determine whether the child has sustained any physical injuries that could cause enuresis. A metabolic panel can provide valuable information about the health of the child's kidneys and whether they may be the cause of the enuresis. A complete blood count will not provide the information to help determine the cause of enuresis.

The nurse is demonstrating appropriate oral hygiene for a repaired cleft lip before patient discharge. Which actions does the nurse demonstrate to protect the repair site from complications or infection while it is healing? Brush the child's teeth. Use a cotton swab to clean the mouth. Use alcohol to clean the cleft lip repair site. Clean using a rolling motion horizontally along the suture line.

Use a cotton swab to clean the mouth. The nurse should demonstrate how to use a cotton swab or saline to clean the area after a feeding to remove debris.

A 4-year-old child develops cellulitis after being bitten by a dog. Which intervention should the nurse implement to determine whether treatment has been effective? Measure the child's dietary intake Assess the child's medication adherence Record the amount of purulent drainage noted at the site Use a skin marker to clearly mark the boundaries of the redness

Use a skin marker to clearly mark the boundaries of the redness The nurse would mark the boundaries of erythema to clearly assess the recession of induration, and effectiveness of treatment.

Which treatment is appropriate for the child with widespread dermatitis? Avoid taking baths or getting the skin wet. Give the child frequent baths using hot water. Use of cool moist compresses on inflamed skin. Avoid using toys to prevent contamination of bath water.

Use of cool moist compresses on inflamed skin. ationale Cool moist compresses can be particularly effective for widespread dermatitis. Tepid or cool baths can also have the same effect. Hot water can further irritate inflamed skin. Children may be more compliant with the therapeutic baths if they can play with bath toys.

Henry is on strict I & O and wears a diaper. How does the nurse determine the output? (Select all that apply)

Weigh the soiled diapers and convert the gram weight using the formula 1 gram = 1 mL - Zero the scale with a clean, dry diaper prior to measure the soiled diaper to obtain the weight

Which type of allergy is appropriate to ask the parents of a child who presents to the pediatric clinic with an itchy lesion lasting over 1 week? Bees Latex Peanuts Ragweed

Peanuts Rationale The itchy lesion lasting over 1 week is indicative of eczema or atopic dermatitis. Both eczema and atopic dermatitis have been associated with food allergies, particularly peanut allergy. Asking about food allergies can help to narrow the diagnosis. Bee, latex, and ragweed allergies are not associated with eczema or atopic dermatitis.

Gastroesophageal reflux

a backflow of the content of the stomach into the esophagus that is often the result of incompetence of the lower esophageal sphincter

Which drug of choice is appropriate for the child diagnosed with pediculosis capitis? Diethyltoluamide Crotamiton cream 10% Permethrin 1%, cream rinse Ivermectin, administered orally

Permethrin 1%, cream rinse Rationale Permethrin 1% cream rinse (or simply pyrethrin) are the drugs of choice for a pediculosis capitis infestation, also known as head lice, in children. Diethyltoluamide (DEET) is the active ingredient in insect repellant. Crotamiton and ivermectin are both used to treat scabies, not head lice.

Which nurse finding is appropriate for a wound that occurred 3 weeks ago? Pink scar tissue Elevated scar line Wound edges close together Profuse bleeding when disturbed

Profuse bleeding when disturbed Rationale A fragile wound, characterized by profuse bleeding when disturbed, is observed during the initial phases of wound healing and should be resolved by 6 weeks. Four weeks after the injury, the wound enters the third and fourth phases of wound healing. Pink and elevated scar tissue with the wound edges close together are expected findings after 4 weeks.

erythema

a reddened area caused by increased amounts of oxygenated blood in the dermal vasculature

Which of the following does the nurse include in the educational plan when instructing parents about the use of topical corticosteroids? a. Do not use this cream on a fungal infection. b. Apply a thick layer of the cream and rub into the skin well. c. Do not use for longer than 3 days in chronic conditions. d. All of the above should be included.

a. Do not use this cream on a fungal infection. topical corticosteroids can worsen inflammation caused by fungus or bacteria should apply only a thin film at recommended intervals, wash hand between applications limit use of topical corticosteroids to 5-7d (may cause depigmentation)

scabies

an endemic infestation caused by the mite; lesions are created as the impregnated female burrows into the stratum corneum of the epidermis (never into living tissue) to deposit her eggs and feces; 30-60 days after host becomes sensitized, the inflammatory response and intense itching occur; generally in interdigital areas, axillary-cubital, popliteal, inguinal; must treat anyone person has come in contact with

remember with glucose pump

at least 4 times daily blood glucose measurement inflammation irritation, so clean the site thoroughly before the needle is inserted and then covered with a transparent dressing site is changed and rotated 48-72 hrs

management strategiest to control atopic dermatitis

avoid exposure to skin irritants avoid overheating administer antihistamines, topical immunomodulators, topical steroids, and sometimes sedatives enhancing skin hydration tepid bath with mild soap, followed by emollient within 3 min to assist in trapping moisture no babbla bath colloid bath - 2 cups of starch to a tub of water

Jimmy, age 9 years, has fallen and scraped his knee at school. He is brought to the school nurse for treatment. Which one of the following does the nurse recognize as being least likely to promote healing? a. Changing the dressing when it becomes loose or soiled. b. Washing the injury with hydrogen peroxide and applying a dry gauze dressing. c.Applying an occlusive dressing. d. Washing the area with mild soap and water and applying a topical antibiotic with a nonadherent dressing.

b. Washing the injury with hydrogen peroxide and applying a dry gauze dressing.

steve, age 8, has been diagnosed with tinea capitis. Which of the following does the nurse include in the teaching plan for steve and his parents? a. no animal to person transmission is associated with this infections b. Steve can continue to share hair-groming articles with his younger brother c. Griseofulvin should be administered with high-fat foods d. treatment may be discontinued once symptoms subside

c. Griseofulvin should be administered with high-fat foods

care of bacterial skin infection in children may include all of the following except a. good hand washing b. changing clothes daily and washing in hot water c. punctuirng the surface of the pustule d. applying topical antibiotics

c. punctuirng the surface of the pustule

diabetes mellitus

chronic disorder of metabolism characterized by hyperglycemia and insulin resistance.

Which condition is assessed by placing a gloved finger in the newborn's mouth? Cleft palate Hypoglycemia Mongolian spots Erythema toxicum neonatorium

cleft palate Rationale The cleft palate is detected through visual inspection of the oral cavity or by palpating the hard palate and soft palate with a gloved finger. Detecting hypoglycemia does not require a gloved finger in the mouth of the infant. Erythema toxicum neonatorum is a newborn rash that does not occur in the mouth. Mongolian spots occur on the skin of newborns.

diagnostic evaluation esophageal atresia and trachoesophageal fistula

clinical signs radiographic studies - radioopaque catheter is inserted into the hypopharynx and advanced until it encounters an obstruction careful bronchoscopic examination to vizualize fistula

long term problems after gastroschisis surgery

complications - bowel adhesions, bowel obstruction, necrotizing enterocolitis, parenteral nutrition - related cholestasis, poor weight gain

cofactors those that delay or disrupt wound healing include

compromised perfusion, malnutrition, and infection

most common cause on encopresis

constipation medical conditions, causing constipation may lead to encopresis or painful defecation may lead to voluntary retention and causing ancopresis large bore stool-> pain-> avoid defecating-> stool hardens because looses water-> more painful defecation-> eventually lost urge to defecate to to stretched rectal valve

therapeutic management of constipation

depend on cause and duration fascilitate passage of obstruction ( irrigation with a hypertonic solution/water soluble enema or surgical treatment) ininfants - malt extract or lactulose for hard stools or fissures

diagnostic vomiting

description of vomitus relations to meals and specific foods behavior presence of pain, constipation, diarrhea or jaundice physical examination of the hydration status abdominal examination urinalysis for protein, blood, serum electrolytes, radiographic studies radiograph of chest and abdomen endoscopy of upper GI psychiatric evaluation

type 1 diabetes

destruction of pancreatic Beta cells, which produce insulin absolute insuline deficiency

type 1 diabetes mellitus

destruction of the pancreatic

therapeutic management celiac disease

dietary management ( gluten free diet) eleminate - wheat, rye, barley, oats substitutes - corn, rice, millet children may have lactose intolerance supplements - iron, folic acid, fat soluble vitamins

Hypesthesia (hypoesthesia)

diminished sensation

seborrheic dermatitis nursing management

direct treatment - removing scales or crust daily shampooing with mild soap. but may be shampoos with sulfur and salicilic acid apply shampoo and allow to stay until crust softens, rinse and comb with fine-tooth comb

nursing care management for GER

directed - identifying children, educationg parents regarding home care, feeding, positioning, medications reschedule family feeding time to accomodate more often feeding routine while breastfeeding parents should avoid - tobacco, caffeine, spicy, chocolate, alcohol.

insulin therapy during ketoacidosis

do not give insulin until urinary ketones and blood glucose level obtained continuous IV 0.1 U/kg/hr ( regular insulin) start immediately after rehydration bolus when blood glucose fall to 250-300 - dextrose is added to the iV goal - maintain blood glucose levels between 120-240 insulin binds to the walls of the tubes, so run insulin before startin ginfusion through tubing

eye

do not put anything in a wound that you would not put in the __

pica

eating disorder characterized by the compulsive and excessive ingestion of food and nonfood substances for at least 1 month associated with iron and zinc deficiency

nursing care encopresis

education regarding normal defecation, toilet training explain regimine to parents bowel retraining with mineral oil regular toileting routine ( 10-15 min after meals) placing foor stool might help relax the abdomen enemas might help with impaction positive reinforcement

diabetes/ exercise

encouraged to replenish spent glucose - give extra snack decrease insulin during exercises

epidermal injuries

epidermis but might extend to dermis - initially filled by a blood clot and necrotic debris - subsequently dehydrates to form a scab - labile tissues are constantly destroyed and replaced - injury results in regeneration

encopresis assessment

evidence of soiling of clothing 2. scratching or rubbing of the anal area 3. fecal odor 4. social withdrawal

nursing care IBS

family support (not threat to health) education

vomiting

forceful expulsion of gastric contents through the mouth usually self-limiting and requires not treatment complications - fluid deficiency, electrolyte disturbances, malnutrition, aspiration and mallory-weiss syndrome ( small tearts in the distal esophagus)

cellulitis signs

inflammation of the skin and subcutaneous tissues with intense redness, swelling, and firm infiltration; lymphangitis "streaking" frequency seen; involvement of regional lymph nodes common; may progress to abscess formation; fever and malaise systemic effects; hospitalization may be necessary for a child with systemic symptoms; otitis media may be associated with facial cellulitis

Priritus

most common symptom - itching

verruca management

not uniformly successful; local destructive therapy is individualized according to location, type, and number; surgical removal, electrocautery, curettage, cryotherapy, caustic solutions , x-ray treatment, laser

wound primary importance

prevent scratching

therapeutic management of diabetes

replacement of insulin

Peritonitis

results from perforated appendix

Vitamin A deficiency

results in inadequate inflammatory response

immunocompromise

results in inadequate or delayed inflammatory response

drug therapy enuresis

second line desmopressin (synthetic analog of antidiuretic and reduces nighttime urination),must be tapered down to avoid relapse anticholinergic for overactive bladder and poor response to desmopressin - reduces inhibited bladder contractions. example - oxybutynin imipramine (3rd line)tricyclic antidepressant - inhibits urination, cardiotoxic. use 4-6 months and weane down within 4 weeks

Allodynia

sensation of pain from normally nonpainful stimuli due to overgrowth in some wounds of nerve endings

primary lesions

skin changes produced by a causative factor; common in pediatric skin disorders are macules, papules, and vesicles

wood splinters

small ones may be removed with a needle and tweezers that have been sterilized with alcohol or a flame; the area around is washed with soap and water before removal is attempted; exposed with the needle and then grasped firmly by the tweezerrs and pulled out

Clinical manifestation of GER/ infants

spitting up, regurgitation, recurrent vomiting excessive crying irritability arching the back stiffening poor weight gain respiratory problems ( cough, wheeze, stridor, gagging, choking with feedings) feeding refusal

nursing care diaper dermatitis

take care of wetness (change diapers often) take care of pH take care of fecal irritants

Vaccuum-assisted closure

technique that involves placing a foam dressing into the wound, covering it with the occlusive dressing and apply gentle suction

Intussuception

telescoping of one portion of the bowel into another. Results in an obstruction of the intestinal contents.

rovsing sign

tenderness in the right lower quadrant pain with flexion and internal rotation of the right hip

urushiol

the offending substance in poison ivy, oak, and sumac

postoperative care/ nursing care/ of esophageal atresia and trachoesophageal fistula

thermoregulation double lumen catheter to low suction or gravity drainage parenteral nutrition gastrostomy tubeuntil feeding tolerated if thoracotomy - chest tube pain management tracheal suctioning only with premeasured catheter and caution gastrostomy feeding may be initiated if tolerated before oral feeding and chest tube removal - contrast study or esophagram to verify integrity observe during first feeding if can swallow start feeding sterile water until sufficient amount tolerated - supplement oral intake by bolus or continuus gastrostomy feedings

parent teaching for topical antibiotic use

thin layer (pea size) - more is not helpful but harmful limited number of days carefully wash hands after it

hydrogen perioxide

toxic to fibroblasts; can cause subcutaneous gas formation and mimics gas-forming infection

Soave pull through

transanal endorectal procedure pulls the end of normal bowel through the muscular sleeve of the rectum, from which the aganglionic mucosa has been removed

GERD or GER

transfer of gastric contents into the esophagus mostly after meals physiologic GER peaks at 4 months resolves by 1 yo

psoriasis

unknown, hereditary dispositions, may be triggered by stress; tar preparations in combination with UVB light or natural sunlight, topical corticosteroids, topical vitamin D analogue, phenol and saline solutions followed by a tar shampoo to remove scales, keratolytic agents, acitretin, emollients may provide relief

dysfunctional detrusor activity theory /enuresis

unstable bladderdetrusor muscle spontaneously contracts to produce bed-wetting, either because of abnormal innervation or as a result of other unknown reasons

black widow spider

venom injected through clawlike appendage has neurotoxic action area becomes swallen, painful erythematous dizziness, weakness and abdominal pain may produce delirium, paralysis, seizures cleanse with antiseptic apply cool compress administer antevenin administed muscle relaxant ( calcium gluconate) analgesics or sedatives hydrocortisone or diazepam IV

sign of celiac disease

villious atrophy, hyperplasia of the crypts infiltrTION OF THE EPITHILIAL CELLS WITH LYMPHOCYTES - REDUCED ABSORPTIVE SURFACE

Appendicitis

when the appendix becomes inflamed or infected, perforation may occur within a matter of hours, leading to peritonitis, sepsis, septic shock, and potential death. Treatment is surgical removal.

hypokalemia cardiac indication

widening Q-T interval and appearance of a U wave after a flattened T

relief symptoms/wounds

wound healing prevent infection provide relief of pruritus

acute wound /puncture

wound with a relatively small opening compared with the depth

celiac disease

permanent intestinal intolerance to dietary gluten, that causes damage to the villi in the small intestine

A pre-school child newly diagnosed with Type 1 DM and parent meet with the nurse. Which statement best explains why play therapy can be effective in dealing with diabetes mellitus when meeting with the patient? "Play therapy with other children helps the child act out frustration." "Play therapy is appropriate for this age for normal development." "Play therapy with dolls and diabetes equipment helps the child express concerns regarding injections and finger sticks." "Play therapy with age-appropriate toys can distract the child from thinking about the need for insulin and special diet."

"Play therapy with dolls and diabetes equipment helps the child express concerns regarding injections and finger sticks." Play therapy can help the child express concerns about insulin injections and being different from the other children and can help the child deal effectively with diabetes mellitus.

interventions for eczema

-avoid exposure to skin irritants such as soaps, detergents, diaper wipes, powder, etc -avoid excessive bathing and washing of affected areas -use tepid bath water and lubricate skin immediately after bath -intermittently apply cool, wet compresses for short periods to soothe skin and alleviate itching -pat skin dry between cooling treatments -administer antihistamines and corticosteroids as prescribed -prevent scratching -keep skin cool and dry, avoid latex -monitor lesions for signs of infection

Skin symptoms

-localized or migrate - constant or intermittent - aggravated by specific activity

A nurse is assigned to care for a child who is scheduled for an appendectomy. Select the prescription(s) that the nurse anticipates will be prescribed. Select all that apply. 1. Initiate an IV line. 2. Maintain an NPO status. 3. Administer a Fleet enema. 4. Administer intravenous antibiotics. 5. Administer preoperative medications. 6. Place a heating pad on the abdomen to decrease pain.

1. Initiate an IV line. 2. Maintain an NPO status. 4. Administer intravenous antibiotics. 5. Administer preoperative medications.

The mother of a child with an umbilical hernia calls the clinic and reports to the nurse that the child has been vomiting and is complaining of pain in the abdominal area. Which instruction to the mother is most appropriate? 1. Contact the health care provider. 2. Keep the child on clear liquids. 3. Apply an ice pack to the abdomen. 4. Administer acetaminophen (Tylenol).

1. Contact the health care provider.

*Sick day rules for Diabetic Child

1. Always give insulin, even if the child doesn't have an appetite, or contact the HCP for special instructions 2. Test blood glucose levels at least every four hours 3. Test for urinary ketones with each voiding 4. Notify the HCP if moderate or large amounts of urinary ketones are present 5. Follow the child's usually meal plan 6. Encourage liquids to aid in clearing ketones 7. Encourage rest, especially if urinary ketones are present. 8. Notify the HCP if vomiting, fruity odor, to the breath, deep rapid respirations, decreasing level of consciousness, or persistent hyperglycemia occurs.

The nurse is reviewing the laboratory test results for an infant suspected of having hypertrophic pyloric stenosis. The nurse should expect to note which value as the most likely laboratory finding in this infant? 1. Blood pH of 7.50 2. Blood pH of 7.30 3. Blood bicarbonate of 22 mEq/L 4. Blood bicarbonate of 19 mEq/L

1. Blood pH of 7.50

Interventions for Cleft lip/ Cleft palate

1. Check eating ability, sucking, swallowing, breathing, secretions 2. Monitor fluid, weight/calories 3. Modify feeding techniques; plan to use special nipples and feeders 4. Hold the child in an upright position and diet the formula to the side and back of the mouth to prevent aspiration 5. Feed small amounts gradually and burp frequently 6. Keep suction equipment and a bulb syringe at the bedside. 7. ESSR method for feeding (enlarge the nipple, stimulate sucking reflex, swallow, rest) 8. teach parents special feeding or suctioning techniques 9. encourage parents to express feelings, and bonding

Data Collection intussusception

1. Colicky abdominal pain that causes the child to screw and draw their knees to the abdomen 2. Vomiting of gastric contents 3. Bile-Stainsd fecal emesis *4. Currant jelly-like stools that contain blood and mucus. 5. Hypo or hyperactive bowel sounds 6. Tender and distended abdomen, possibly with a palpable sausage-shaped mass in the upper right quadrant.

*Interventions for Hypoglycemia

1. Confirm hypoglycemia with a blood glucose 2. Administer glucose immediately. Rapid release followed by a complex carb and protein 3. Give child an extra snack if next planned meal is more than 30 minutes away. 4. If child becomes unconscious squeeze cake frosting or glucose paste on the gums, monitor for 15 minutes, if reading is still low, administer more glucose 5. If child remains unconscious may need to administer glucagon 6. In hospital, prepare to administer IV dextrose

When assessing a child treated for intussusception, which behavioral finding would indicate the expected outcomes had been met for that child? Guarding Flexing the legs Crying while standing Knocking over blocks

Knocking over blocks The expected outcome for the child with intussusception is to be pain free and exhibit age-appropriate play, which may include playing with blocks.

Interventions for pediculosis capitis

1. use pediculicide 2. daily removal of nits with extra fine nit comb (discard or soak in boiling water for 10 min) 3. grooming items not to be shared 4. bedding and clothing to change daily, laudered in hot water with detergent and dried in a hot dried for 20 min. continue it for a week 5. if not washed immediated - keep intightly sealed bag for 2 weeks and then wash 6. the same with toys or dry clean 7. vaccccuum carpets frequently and discard dust bag

identify 3 factors that nursing interventions aim to alter when tretaing diaper rash

1. wetness 2. pH 3. fecal irritants

Hyperglycemia

1. Elevated blood glucose >200 mg/dL 2. Signs include polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, and syncope.

Post-op interventions Cleft palate repair

1. Feedings are resumed by bottle, breast, or cup per surgeon preference; some surgeons prescribe the use of aseptic syringe for feeding or a soft cup such as a sip cup. 2. Oral packing may be secured to the palate 3. Do not allow the child to brush his or her teeth 4. Reinforce instructions to the parents to avoid offering hard food items to the child, such as toast or cookies.

The mother of a 3-year-old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding noted on assessment of the child's skin? 1. Fine grayish red lines 2. Purple-colored lesions 3. Thick, honey-colored crusts 4. Clusters of fluid-filled vesicles

1. Fine grayish red lines

Data collection esophageal atresia and tracheoesophageal fistula

1. Frothy Saliva in the mouth and nose, drooling 2. The 3 C's coughing, choking during feeding, cyanosis 3. Regurgitation and vomiting 4. Abdominal distention 5. Increased respiratory distress during and after feeding.

Interventions for Celiac Disease

1. Gluten free diet 2. Lifelong elimination of gluten sources 3. Mineral and vitamin supplements including iron, folic acid, and Vit A, D, E, K 4. Reinforce teaching the parents about gluten free diet and to read food labels carefully for hidden sources of gluten 5. Reinforce instructions to the parents regarding measures to prevent celiac crisis 6. Inform the parents about the Celia sprue organization.

Data Collection peritonitis

1. Increased fever 2. Progressive abdominal distention 3. Tachycardia and tachypnea 4. Pallor 5. Chills 6. Restlessness and irritability 7. Sign of ruptured appendix is the sudden relief and return of pain

A nurse has been assigned to care for a neonate just delivered who has gastroschisis. Which concern should the nurse address in the client's plan of care? 1. Infection 2. Poor body image 3. Decreased urinary elimination 4. Cracking oral mucous membranes

1. Infection

A 2-year-old child is admitted to a hospital burn unit with partial- and full-thickness burns involving 35% of body surface area. After admission assessment and review of the health care provider's prescriptions, the priority nursing intervention should focus on which action? 1. Inserting a Foley catheter 2. Inserting a nasogastric tube 3. Sedating with morphine sulfate 4. Restricting intravenously administered fluids

1. Inserting a Foley catheter

Interventions for Hyperglycemia

1. Instruct the parents to notify the HCP when: a. BG results remain elevated b. moderate or high ketonuria is present c. child is unable to take food or fluids d. the child vomits more than once e. illness persists

Hirschsprung Disease Data Collection

1. Newborn a. failure to pass meconium stool b. refusal to suck c. abdominal distention d. bile-stained vomitus 2. Children a. Failure to gain weight b. Abdominal distention c. Vomiting d. Constipation alternating with diarrhea *e. Ribbon like and foul smelling stools

petechiae

pinpoint, tiny, and sharp circumscribed spots in the superficial layers of the epidermis

The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.) a. Citrus b. Bananas c. Spicy foods d. Peppermint e. Whole wheat bread

ANS: A, C, D Avoidance of certain foods that exacerbate acid reflux (e.g., caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried foods) can improve mild GER symptoms. Bananas and whole wheat bread will not exacerbate acid reflux.

hypoglycemia treatment/mild reaction/adrenergic symptoms

10-15 mg of simple carb ( preferrable liquid) - 3-6 oz orange juice follow with starch-protein snack

hypoglycemia treatment/nocturnal reaction

10-15 mg of simple carbs follow with snack of 10% of daily calories

hypoglycemia treatment/moderate reaction/neuroglycopenic symptoms

10-15 mg of simple carbs repeat in 10-15 min if symptoms persist follow with larger snack watch child closely

A patient with Type 1 diabetes mellitus is admitted to the emergency department in DKA. Which action should the nurse take first? Correct the hypokalemia Determine cause of the ketoacidosis Administer regular insulin intravenously Initiate fluid replacement with 0.9% saline

Initiate fluid replacement with 0.9% saline The nurse will initiate fluid replacement with 0.9% saline IV to restore intravascular volume to raise blood pressure and ensure glomerular perfusion. This is priority.

The nurse is caring for an infant with gastroesophageal reflux disease (GERD). Which assessment findings indicate potential complications? Select all that apply. Blood pressure of 80/66 10th percentile on the growth chart Two teeth erupting from the top gums Crackles heard in the lungs on auscultation Elevated axillary temperature of 103.6° F

10th percentile on the growth chart Being in the 10th percentile can indicate poor weight gain and failure to thrive, which is a complication of GERD. Crackles heard in the lungs on auscultation Crackles in the lungs can indicate aspiration, a complication of GERD. Correct Elevated axillary temperature of 103.6° F A fever indicates infection and may be related to aspiration pneumonia, a complication of GERD.

Which is the most effective treatment option for children with type 1 diabetes Oral agents Insulin and diet Diet and oral agents

Insulin and diet Rationale Insulin and dietary changes are the current treatment for children with type 1 diabetes. Dietary changes alone are not effective in treating type 1 diabetes. Oral agents are effective against type 2 diabetes, not type 1. Diet and oral agents are used to treat type 2 diabetes, not type 1 diabetes.

A nurse provides home care instructions to the mother of a child who had a cleft palate repair 4 days ago. Which statement by the mother indicates the need for further instruction? 1. "I will use a short nipple on the bottle." 2. "I need to buy some straws for drinking." 3. "I can give my child the pacifier in 2 weeks." 4. "I will give my child baby foods or baby food mixed with water."

2. "I need to buy some straws for drinking."

The nurse is collecting data on a child brought to the health care clinic by the mother with a 1-week-old cat scratch. While assessing the scratch the nurse notes redness, heat, swelling, and red streaking surrounding the area. The child states that the scratch hurts. Cellulitis is diagnosed. When providing home care instructions, which statement by the mother indicates a need for further teaching? 1. "The child should rest in bed." 2. "I will apply cool moist soaks every 4 hours." 3. "I should take the child's temperature and watch for a fever." 4. "The affected extremity should be elevated and immobilized."

2. "I will apply cool moist soaks every 4 hours."

The nurse is providing discharge instructions to the mother of a child who had a cleft palate repair. Which statement should the nurse make to the mother? 1. "You should use a plastic spoon to feed the child." 2. "You need to use a short nipple on the child's bottle." 3. "You can allow the child to use a pacifier but only for 30 minutes at a time." 4. "You need to monitor the child's temperature for signs of infection using an oral thermometer."

2. "You need to use a short nipple on the child's bottle."

Parents bring their child to the emergency department and tell the nurse that the child has been complaining of colicky abdominal pain located in the lower right quadrant of the abdomen. The nurse suspects that the child has which disorder? 1. Peritonitis 2. Appendicitis 3. Intussusception 4. Hirschsprung's disease

2. Appendicitis

Which are causes of acute diarrhea? Select all that apply. Laxative use Antibiotic therapy Malabsorption syndromes Upper respiratory infections Inflammatory bowel disease

Laxative use Antibiotic therapy Upper respiratory infections Rationale Causes of acute diarrhea include laxative use, antibiotic therapy, and upper respiratory infections. Malabsorption syndromes and inflammatory bowel disease are causes of chronic diarrhea.

An infant born with an imperforate anus returns from surgery with a colostomy. The nurse assesses the stoma and notes that it is red and edematous. What is the best nursing action based on this finding? 1. Elevate the buttocks. 2. Document the findings. 3. Apply ice immediately. 4. Call the health care provider.

2. Document the findings.

The nurse is preparing to care for a newborn infant who will be returning from surgery with a colostomy that was created for imperforate anus. When the infant arrives, the nurse assesses the stoma and notes that it is red and edematous. Which is the most appropriate nursing intervention? 1. Elevate the buttocks. 2. Document the findings. 3. Apply ice immediately. 4. Call the health care provider.

2. Document the findings.

The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What should the nurse expect to note as the most likely finding in this infant? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

2. Metabolic alkalosis

A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine if this child is experiencing a long-term effect of cleft palate, which question should the nurse ask? 1. "Was the child recently treated for pneumonia?" 2. "Does the child play with an imaginary friend?" 3. "Is the child unresponsive when given directions?" 4. "Has the child had any difficulty swallowing food?"

3. "Is the child unresponsive when given directions?"

The school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which statement, if made by a parent, indicates a need for further instruction? 1. "It is extremely contagious." 2. "It is most common in humid weather." 3. "Lesions most often are located on the arms and chest." 4. "It might show up in an area of broken skin, such as an insect bite."

3. "Lesions most often are located on the arms and chest."

The nurse is caring for an infant after repair of an inguinal hernia. Which of these assessment findings indicate that the surgical repair was effective? 1. A clean, dry incision 2. Abdominal distention 3. An adequate flow of urine 4. Absence of inguinal swelling with crying

4. Absence of inguinal swelling with crying

The mother of an 18-month-old child tells the clinic nurse that the child has been having some mild diarrhea and describes the child's stools as "mushy." The mother tells the nurse that the child is tolerating fluids and solid foods. The most appropriate suggestion regarding the child's diet would be to give the child which items? 1. Jell-O, strained cabbage, and custard 2. Fluids only until the "mushy" stools stop 3. Rice and mashed potatoes diluted with skim milk 4. Applesauce, strained bananas, and strained carrots

4. Applesauce, strained bananas, and strained carrots

A topical corticosteroid is prescribed by a health care provider for a child with atopic dermatitis (eczema). Which instruction should the nurse give the parent about applying the cream? 1. Apply the cream over the entire body. 2. Apply a thick layer of cream to affected areas only. 3. Avoid cleansing the area before application of the cream. 4. Apply a thin layer of cream and rub it into the area thoroughly.

4. Apply a thin layer of cream and rub it into the area thoroughly.

Permethrin (Elimite) is prescribed for a child with a diagnosis of scabies. The nurse should give which instruction to the parents regarding the use of this treatment? 1. Apply the lotion to areas of the rash only. 2. Apply the lotion and leave it on for 6 hours. 3. Avoid putting clothes on the child over the lotion. 4. Apply the lotion to cool, dry skin at least 30 minutes after bathing.

4. Apply the lotion to cool, dry skin at least 30 minutes after bathing.

An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder? 1. "Does the child have any food allergies?" 2. "What do the bowel movements look like?" 3. "Has the child eaten any food in the last 24 hours?" 4. "Can you describe the type of pain that the child is experiencing?"

4. "Can you describe the type of pain that the child is experiencing?"

A 3-year-old child is seen in the health care clinic, and a diagnosis of encopresis is made. The nurse reviews the assessment findings and expects to note documentation of which sign of this disorder? 1. Diarrhea 2. Malaise and anorexia 3. Nausea and vomiting 4. Evidence of soiled clothing

4. Evidence of soiled clothing

A nurse is caring for a child with diagnosed cellulitis on the left lower leg. The nurse notes erythema spreading toward the knee and warmth over the area. The child complains of pain. Which priority action should the nurse take? Give IV pain medicine Administer an IV antibiotic Assess the white blood cell count Obtain an ultrasound of the leg

Administer an IV antibiotic The nurse would administer an IV antibiotic to treat the infection.

Pyloromyotomy*

An incision through the muscle fibers of the pylorus, which may be performed by laparoscopy

A 3-year-old child with impetigo has been admitted for observation. Upon entering the room, the nurse notes both parents and a sibling sitting on the patient's bed. Which actions are most important for the nurse to take? Select all that apply. Place patient on reverse isolation and restrict visitors Educate the parents about the spread of the disease Recommend prophylactic antibiotics for the sibling Escort parents and sibling to visitors hand washing station Encourage parents to keep siblings apart until the rash has resolved

Educate the parents about the spread of the disease Parents of children with impetigo should be taught about how easily the disease can be spread. Escort parents and sibling to visitors hand washing station The patient and family should be taught the importance of proper hand hygiene. The nurse should escort the family to the hand washing station to prevent spread of the disease. Encourage parents to keep siblings apart until the rash has resolved Parents should be encouraged to isolate the infected child to prevent spread of the disease to other children.

What are the consequences of increased peristalsis in the infant? Increased risk of vomiting Increased risk of diarrhea Increased hydrochloric acid concentration Decreased vitamin and mineral breakdown

Increased risk of diarrhea Peristalsis is faster due to a shorter large intestine with less lining to absorb water from stool. As a result, infant stools have a softer consistency, and diarrhea is common.

A young patient newly diagnosed with diabetes is admitted with a BP of 85/58 mm Hg, pulse of 120 bpm, respirations 42, blood glucose level of 450 mg/dL, pH of 7.07 and bicarbonate level of 13 mEq/L. The patient is lethargic and slow to respond to touch. Which conditions will the nurse need to monitor? Select all that apply. Monitor blood pH Check level of consciousness Monitor level of potassium Maintain Fluid intake and output Monitor for bradycardia

Monitor blood pH Ketosis will put the child into an acidotic state and therefore the nurse will need to monitor the child's pH. Correct Check level of consciousness Since the patient is lethargic, the patient's level of consciousness will need to monitored. Correct Monitor level of potassium The potassium levels in the patient will need to be addressed since the patient is developing DKA. Correct Maintain Fluid intake and output This patient is developing DKA and will need to have fluid intakes and output monitored.

Which portion of the upper gastrointestinal system is initially responsible for the mechanical breakdown of food? Liver Mouth Esophagus Large intestine

Mouth The mouth is initially responsible for food breakdown. The mouth is where digestion begins.

The nurse is caring for a child who presents with abdominal distention and currant jelly stools. Since admission, the patient's blood pressure has decreased and the patient has become lethargic. Which is the priority nursing action for this patient? Notify the health care provider Administer intravenous (IV) pain medication Prepare the patient for abdominal ultrasonography Prepare the patient for magnetic resonance imaging (MRI) of the chest and abdomen

Notify the health care provider Decreased blood pressure and lethargy indicate shock, which can be life threatening. The health care provider should be notified immediately.

A 19-year-old with Type 1 DM is taking 30 units of NPH insulin each morning and 15 units at night. Because of persistent morning glycosuria with some ketonuria, the evening dose is increased to 20 units. This worsens the morning glycosuria, and now moderate ketones are noted in urine. The patient complains of sweats and headaches at night. The next step in management is: Switch from NPH to regular insulin Decrease morning dose of insulin Increase morning dose of insulin Obtain blood glucose levels at 2 a.m.

Obtain blood glucose levels at 2 a.m. A glucose reading in middle of night will disclose hypoglycemia because of insulin therapy and lead one to consider Somogi phenomenon. Episodic hypoglycemia at night is followed by rebound hyperglycemia. This condition, Somogi phenomenon, develops in response to excessive insulin administration.

Which healing mechanism is appropriate for the immunocompromised child who sustained a skin injury after falling? Poor inflammatory response Decreased collagen formation Reduced amino acids for tissue repair Inhibition of new capillary bed formation

Poor inflammatory response Rationale A compromised immune system is associated with poor inflammatory response and wound healing. Decreased collagen formation is associated with a vitamin B1 deficiency. Reduced amino acid availability is associated with protein deficiency. Vitamin C deficiency can cause inhibited capillary formation.

The blood glucose of a patient newly diagnosed with Type 1 diabetes mellitus has a blood glucose level of 310 mg/dL. Which type of insulin would the nurse expect to be ordered at this time? NPH Regular Lantus NPH + regular

Regular Regular insulin is short-acting insulin. Onset is 30-60 min. This is correct insulin choice for blood glucose level of 310 mg/dL.

Which diagnostic test differentiates between aspiration of gastric contents from reflux and aspiration of gastric contents from poor oropharyngeal muscle coordination in a child? Scintigraphy Endoscopy with biopsy Upper gastrointestinal series 24-hour intraesophageal pH monitoring

Scintigraphy Rationale Scintigraphy can differentiate between aspiration of gastric contents from reflux and aspiration of gastric contents from poor oropharyngeal muscle coordination. It assesses gastric emptying by detecting radioactive substances in the esophagus after ingesting a radioactive compound. Endoscopy with biopsy is used to assess the presence and severity of esophagitis, strictures, and Barrett esophagus and to exclude disorders such as Crohn disease. An upper gastrointestinal series is used to evaluate the presence of anatomic abnormalities such as pyloric stenosis, malrotation, annular pancreas, hiatal hernia, or esophageal stricture. A 24-hour intraesophageal pH monitoring study is used as the gold standard in the diagnosis of gastroesophageal reflux, but it does not differentiate between aspiration of gastric contents from reflux and aspiration of gastric contents from poor oropharyngeal muscle coordination.

sign of intussusception reduction

passing of normal brown stool

tinea pedis signs

on intertiginous areas between toes or on plantar surface of feet; lesions vary and can be maceration and fissuring between toes, patches with pinhead-sized vesicles on plantar surface; pruritic; direct microscopic examination of scrapings; most frequent in adolescents and adults, rare in children, but occurence increases with wearing of plastic shoes; transmission to other individuals rare despite general opinion to contrary; ointments not successful

secondary enuresis

onset of wetting after established urinary continence

wet compress

ool the skin by evaporation, relieve itching and inflammation, and cleanse the area by loosening and removing crusts and debris