FAMILIES EXAM 2
A nurse is caring for a child who has cystic fibrosis. Which of the following are expected findings? (select all) A. Wheezing B. Clubbing of fingers and toes C. Barrel-shaped chest D. thin, watery mucus E. Rapid growth spurts
A,B,C
Eighty percent of particles emitted from a metered dose inhaler are trapped in the oropharynx when a holding chamber is not used. A. True B. False
A. True
When preparing a child with asthma for discharge, the nurse should emphasize: A. Cold, dry environment is best for the child B. Limits should not be placed on the child's behavior C. When the child is asymptomatic, the disease is gone D. Medications must be continued even if the child is asymptomatic
D. Medications must be continued even if the child is asymptomatic
What Ericksonian stage is infancy (0-18 months)?
Trust vs. mistrust
The drug of choice for Otitis Media?
Amoxicillin
Q. 6 year old asthma patient comes into the ER where you are the triage nurse. He says it is difficult to breathe. You listen to his lungs, but do not hear wheezing. Does the fact that you do not hear wheezing make you: A. More Concerned. B. Less concerned
Answer: A: an absence of wheezing may indicate sever constriction of the alveoli
Children will have _____ pain with pneumonia?
abdominal
When administering digoxin (Lanoxin) to an infant, the medication should be withheld and the physician notified if the: 1.) pulse rate is below 60 beats/min 2.) infant is dyspneic 3.) pulse rate is below 100 beats/min 4.) respiratory rate is above 40 breaths/min
pulse rate is below 100 beats/min
The most common cause of infant hospitalization?
respiratory illness
A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The FIRST action by the nurse is to: administer 100% oxygen to relieve hypoxia. Incorrect administer meperidine (Demerol) to relieve symptoms. notify the practitioner because chest syndrome is suspected. Correct notify the practitioner because child may be having a stroke. Administration of oxygen may be ordered by the practitioner, but the first action is notification. Oxygen therapy is of little therapeutic value unless the patient has hypoxia. Pain medications may be indicated, but evaluation is necessary first. Demerol is not recommended, because it produces a metabolite that is a CNS stimulant causing: anxiety, tremors, myoclonus, and seizures. These are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. These are not signs of a stroke.
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A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse's reply should be based on knowledge that: the infant is most likely spoiled. this is a normal reaction for this age. Correct this is an abnormal reaction for this age. grandparents are not responsive to that infant.
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Adolescents respond to hospitalization with? A. Withdrawl B. Uncooperativeness C. Anger and frustration D. self-assertion E. All of the above
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Coarctation of the Aorta
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Examine the role of the nurse caring for a child in pain.
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Hypoplastic Left Heart Failure
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Kawasaki Disease
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The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of: trust. Correct industry. initiative. separation.
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The nurse is providing education to a parent of a 10-month-old infant receiving iron supplements. What will be included in the teaching? (Select all that apply.) Administer iron with meals. Place iron toward the back side of the mouth with a dropper. Correct Mix iron with milk for greater absorption. Report black, tarry stools to health care provider. Incorrect Apply barrier ointment if needed to buttocks. Correct Administration of Iron Supplements includes: Ideally iron supplements should be administered between meals for greater absorption. Liquid iron supplements may stain the teeth, therefore administer with a dropper. toward the back of the mouth (side). In older children, administer liquid iron. supplements through a straw or rinse mouth thoroughly after ingestion. Avoid administration of liquid iron supplements with whole cow's milk or milk. products as these bind free iron and prevent absorption. Educate
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Treatment of pertussis
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Ventriculoseptal Defect
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What is Galant's reflect?
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Who was Joann Eland?
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abdominal breathing is normal-heart rate changes with breathing in children listen for whole minute every time. irregular is not abnormal heart rate and breathing are connected
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hemodynamics of the 4 types of cardiac defects
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The PMI is located higher up in infants closer to the nipple due to the position of the heart. You should osculate for the apical pulse where?
4th intercostal space
Andrew is 15 years old and this is his first day following abdominal surgery. As you enter his room, he smiles at you and continues talking and joking with his visitor. Vital signs are within normal limits. He rates his pain as 8. (on a scale of 0 - 10) What do you document as his pain rating?
8
The school nurse knows that which attribute is characteristic of the psychosocial development of school-age children? A. A developing sense of initiative is very important. B. Peer approval is not yet a motivating power. C. Motivation comes from extrinsic rather than intrinsic sources. D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.
A
What risk factor for postpartum depression (PPD) is likely to have the greatest effect on the woman's condition? A. Prenatal depression B. Single-mother status C. Low socioeconomic status D. Unplanned or unwanted pregnancy
A
How should you phrase questions about inhaler usage to avoid blame?
"How often do you forget to use your inhaler?"
How can you deal with separation anxiety?
"transitional objects", "picture of the parents" and "get them out as soon as possible"-most important
preoperational (2-6)
-acquire language, confuse reality with make believe, understand words for abstract ideas, don't get that stuff looks different from another angle, figure things out by guessing, understand they aren't centre of the world
concrete operational (7-11)
-can use simple logic, cans solve problems if they have real things to work with, can organize things into classes according to many likenesses
formal operations (12-adult)
-reason deductively -can solve problems in their head, can set up hypothesis and experiment to try it out
Sensorimoter (birth-age 2)
-use their senses to learn about things, coordinate different parts of body, believe everything exists for human use , set goals and act to achieve them, learn symbols (words) for things, egocentric, believes world revolves around them
When completing the health assessment for a 2-year-old child, the nurse should expect the child to: A. engage in parallel play. B. fully dress self with supervision. C. have a vocabulary of at least 500 words. D. be one third of the adult height.
A Two-year-olds typically play alongside each other (p. 1023). The child still needs help with clothing at 2 years of age. A vocabulary of 300 words is expected at this age. The child typically has grown to one half of adult height.
Which of the following is the most appropriate response to a client who has thrown a table at the wall? A. It is unacceptable to throw furniture. Let's talk about what happened. B. What did you do that for? You damaged the wall! C. Go to your room! You cannot put others in danger.
A Limit setting-define rules and consequences.
During an otoscopic examination on an infant, in which direction is the pinna pulled? A. Down and back B. Down and forward C. Up and forward D. Up and back
A Pinna down and back Correct position for an infant's ear examination is to pull the pinna down and back. Pulling the pinna down and forward is the correct position for a child age 3 years and over. Pulling the pinna up and forward will not allow sufficient visualization of the ear. Pulling the pinna up and back will not allow sufficient visualization of the ear.
What is a hemangioma?
A conglomeration of blood vessels that can disappear as chjild gets older and if may require plastic surgeon.
The parents of a toddler state their child is having trouble sleeping. What is the nurse's BEST suggestion to improve sleep habits? A. Using a transitional object. B. Varying the bedtime ritual. C. Restricting stimulating activities during the day. D. Explaining away fears.
A transitional object may help the child ease anxiety and facilitate sleep. A consistent ritual will facilitate sleep. The child should have stimulating physical activity during the daytime. Verbal explanations are not understood by a child this age.
A nurse is caring for an infant. Which of the following are clinical manifestations of coarctation of the aorta? (select) A. Weak femoral pulses B. Cool skin of lower extremities C. Severe cyanosis D. Clubbing of the fingers E. Heart failure
A, B, E C-a client with coarctation exhibits adequate oxygenation of the blood. Therefore, severe cyanosis is not present. D-Clubbing results from chronic hypoxemia
A nurse is teaching a child who has asthma how to use a peak flow meter. Which of the following should be included in the teaching? (select all) A. Zero the meter before each use B. Record the average of the attempts C. Perform three attempts D. Deliver a long, slow breath into the meter E. Sit in a chair with feet on the floor
A, C B-Record highest number D-Short and fast breath E-Standing
A nurse is admitting a child who has cystic fibrosis. Which of the following medications should the nurse anticipate including in the plan of care? (select all) A. Tobramycin B. Solu-medrol C. Fat-soluble vitamins D. Albuterol E. Dornase alfa
A, C, D, E B-corticosteroid use has been associated with short stature, glucose intolerance and cataracts and should not be included in the plan of care
A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following would support the diagnosis? (select all) A. Rash B. Continous joint pain of the digits C. Tender, subcutanous nodules D. decreased erythrocyte sedimentation rate E. Elevated C-reactive protein F. Elevated Antistreptolysin (ASO) titer
A, E, F B-migratory joint pain of the large joints C-nontender, subcutaneous nodules D-increased erythrocyte sedimentation rate
Cystic Fibrosis affects which of the following organs? A. Pancreas B. Liver C. Gastrointestinal D. Respiratory E. Reproductive
A,B,C, D, E ...anywhere with mucous
A nurse is caring for a client with postpartum depression. Which of the following are expected findings? A. Rapid decline in estrogen and progesterone. B. Postpartum physical discomfort. C. Anxiety about assuming new role. D. Concerns about how to pay the bills E. disappointment in the characteristics of the fetus.
A,B,C,D E-is impaired mother-infant bonding According to ATI this is not an expected finding but in a class quiz it was included.
Identify contributing factors of PP depression (Select all that apply) A. Fatigue from the work of labor & birth B. Disappointment in the characteristics of the NB C. Individual or family socioeconomic factors D. Anxiety about assuming a new role as a mom E. Rapid increase in estrogen/progesterone F. PP physical discomfort and/or pain G. Supportive family
A,B,C,D,F E-decrease G-unsupportive
Following parental teaching, the nurse is evaluating the parents' understanding of environmental control for their child's asthma management. The parents have understood teaching if they state: A. "We will replace the carpet in our child's bedroom with tile" B. "We're glad the dog can continue to sleep in our child's room" C. We'll be sure to use the fireplace often to keep the house warm in the winter" D. We'll keep the plant in our child's room dusted"
A. "We will replace the carpet in our child's bedroom with tile"
An infant has recurrent otitis media. What question may reveal the cause? A. Did you get the baby a bottle in bed B. Does water ever get into the babies ears C. Have you noticed a lot of wax in the ears D. Can the baby combine 2 words
A. Bottle feeding in bed can predispose the infant since fluids can pool in the pharyngeal cavity, increasing the risk of otitis media. Cerumen in the external ear canal does not predispose to otitis media. Water trapped in the external ear canal by cerumen may cause otitis externa.
Q. An early sign of congestive heart failure that the nurse should recognize is: A. tachypnea. B. bradycardia. C. inability to sweat. D. increased urine output.
A. Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic. Urine output usually will be decreased due to decreased kidney perfusion.
An AMPLAZER device is used got repair this cardiac anomoly?
ASD
Kawasaki disease is a microvascular disease characterized by high fever for more than 5 days, mucosal inflammation, conjunctivitis, erythema of the hands and feet and peeling of the hands and feet. What is used to treat it?
Aspirin and IVIG to decrease inflammation. Fever is unresponsive to antipyretics.
Which should you do first auscultation or ENT?
Auscultation
A patient shows delayed learning of language, difficulty making eye contact or holding a conversation, difficulty with executive functioning, which relates to reasoning and planning, narrow, intense interests, poor motor skills' and sensory sensitivities. This is most likely? A. Autism B. ADHD C. Learning Disorder D. Conduct disorder
Autism spectrum disorder
Which of the following is the least common in children? A. Learning disabilities B. ADHD C. Anxiety disorders D. Autism
Autism. So is schizophrenia
What Ericksonian stage is the toddler (1.5 to 3)
Autonomy vs. shame and doubt
A child has had a tonsillectomy. Which of the following are not signs of bleeding? A. Frequent swallowing B. mouth breathing and pulse of 95 C. Bright red vomitus D. Frequent clearing of the throat
B
The nurse is ready to begin a physical examination on an 8-month-old infant. The child is sitting contentedly on his mother's lap, chewing on a toy. What should the nurse do FIRST? A. Elicit reflexes B. Auscultate heart and lungs C. Examine eyes, ears, and mouth D. Examine head, systematically moving toward feet
B...This may disturb or upset the child, making auscultation and the remainder of the physical examination difficult. Auscultation should be performed while the child is quiet. This may disturb or upset the child, making auscultation and the remainder of the physical examination difficult. Although this is the way most physical examinations proceed, the nurse should perform the assessment for a child in an order that moves from least disturbing to most disturbing from the child's perspective
This disease often begins like a common cold. Later there is fever, cough and difficulty breathing. The lining of the throat and larynx gets red and swollen, and a barking cough develops. The voice gets hoarse and breathing can get rapid and noisy. A. Flu B. Hand, foot and mouth disease C. Strep throat D. Croup
C
Which intervention is appropriate for a preschooler with epiglottitis and severe respiratory distress? A.Parental antibiotics B. Oxygen by face mask C. Intubation D. Electrocardiogram
C
A nurse is providing teaching to a mother of an infant who is to start taking digoxin (Lanoxin) Which of the following should be included in the instructions? A. Do not offer your baby fluids after giving this medication B.Digoxin increases your babies heart rate C. Give the correct dose of medication at regularly scheduled times D. If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount
C A-digoxin can be given without regard to food or fluids B-Digoxin slows the heart rate by increasing contractility of the heart C-The correct amount should be given at the correct time since toxicity is a major concern! D-It is not recommended to repeat doses since toxicity is a major concern
A nurse is planning care for a child who has cystic fibrosis. Which of the following interventions should she include in the plan of care? A. Provide a low calorie, low protein diet B. Promote an increase in fluids at 1800 C. Administer pancreatic enzymes D. Restrict physical activity
C A-should be high protein high calorie diet B-fluids should be increased all day not just after 1800 D-physical activity promotes mobilization of secretions and should be encouraged
Informed consent is valid when: (Select all that apply.) A. universal consent is used. B. it is completed only for major surgery. C. a person is over the age of majority and competent. D. information is provided to make an intelligent decision. E. the choice exercised is free of force, fraud, duress, or coercion.
C, D, E The age of majority is usually 18 years. The term competent is defined as possessing the mental capacity to make choices and understand their consequences. Enough information is provided so that the person can make an intelligent decision. The person giving consent does so voluntarily; that is, freely without coercion, any form of constraint, force, fraud, duress, or deceit. Universal consent is not sufficient. Informed consent must be obtained for each surgical or diagnostic procedure. Informed consents must be obtained for major and minor surgery, diagnostic tests, medical treatments, release of medical information, postmortem examination, removal of a child from the health care provider against medical advice, and photographs for medical, educational, or public use.
A 5 year old has a fever and sore throat. The tonsils are size 3/4. What is the tonsil size? A. Midway between the tonsillar pillar and the uvula B. Barely visible outside the tonsillar pillar C. Touching the uvula D. Touching each other
C-3/4 is Touching the uvula. A-2/4 is midway B-1/4 is barely visible D-4/4 touching each other
An 8 year old child is having an asthma exacerbation. Which situation would be of greatest concern? A. Oxygen saturation of 95% B. Respiratory rate of 24 bp C. Wheezing not heard D. The child sometimes forgets to take inhalers
C-Bronchoconstriction has become so sever that air is no longer moving in or out
A 4 year old has sickle cell disease. What is the initial nursing intervention? A. Antibiotics B. Ice packs C. Oral and IV fluids D. Folic acid supplments
C-CORRECT ...oral and IV fluids should be done first to prevent sickling A-antibiotics only needed for infection B-painful joints should be treated with ice packs and analgesics and NOT cold packs. D-folic acid will help correct anemia
Which tympanic membrane color is normal? A. Deep red B. Light pink C. pinkish grey D. Yellowish white
C-pinkish grey
A nurse observes a 2 year old squatting and panting after chasing a ball. What should be the nurses first action? A. Tell the child that he cannot play ball. B. Ask the child if he has a sore throat or achy joints C. Check for sweating, skin color and tachycardia D. remove the child from the playground
C-sqauting in the knee-chest position increases pulmonary blood flow and improves systemic arterial oxygen saturation. The child may squat to relieve hypoxia. Squatting after exercise is a sign of cyanotic heart disease. D-Assess before implementing B-Assess cardiovascular system first. A-asses before implementing
3.The nurse notices that a toddler is more cooperative when taking medicine from a small cup rather than from a large cup. This is an example of which characteristic of preoperational thought? A. Egocentrism B. Irreversibility C. Inability to conserve D. Transductive reasoning
C. The inability to see situations from other perspectives does not facilitate medication administration. The inability to reverse actions physically initiated does not facilitate medication administration. The smaller cup makes it look like less medicine. Focusing on particulars does not explain the cooperation with the smaller medication cup.
A nurse is checking the vital signs of a 3-year old child during a well-child visit. Which of the following findings should the nurse report to the provider? A. Temperature 37.2 C (99 F) B. Pulse 114/min C. Respirations 30/min D. Blood pressure 88/54
C. 30 breaths/minabove expected range
A nurse is performing an assessment on an infant. Which should the nurse do last? A. Check heart rate and respiratory status B. Assess deep tendon reflexes C. Assess ears and mouth D. Evaluate genitalia.
C. Assess ears and mouth Assess ears, nose and throat (ENT) last. The more traumatic/invasive examinations should be performed last. ENT should be assessed last when doing a respiratory assessment too
Q. A diagnosis of rheumatic fever is being ruled out for a child. Which lab test(s) is/are the most reliable? A. Throat culture B. C-reactive protein (CRP) C. Antistreptolysin-O titer (ASO) titer D. Elevated white blood cell count (WBC) E. Erythrocyte sedimentation rate (ESR)
C. C. Antistreptolysin-O titer (ASO) titer. The most reliable and best standardized lab for antistreptococcal antibodies is C, an Antistreptolysin-O (ASO) titer. A throat culture indicates a current streptococcal infection. C-reactive protein (CRP) laboratory test indicates inflammation. An elevated white blood cell (WBC) may indicate a possible infection but does not indicate a causative agent. An erythrocyte sedimentation rate (ESR) indicates inflammation.
Vital signs change with ____ pain but not with ____ pain?
Acute, Persistent
_________ dilates the bronchioles and ________ decrease the inflammation for asthma?
Albuterol, Corticosteroids
Q. A nurse is assessing a child. What are clinical manifestations of epiglottitis? (Select all that apply) A. Hoarseness and difficulty speaking B. Difficulty swallowing C. Low-grade fever D. Drooling E. Dry, barky cough F. Stridor
Answer: A, B, D, F. Why not C-low grade fever is a sign of Laryngotracheobronchitis (LTB or croup). Epiglottitis is a sever form of croup that is charactorized by the predictive signs of absence of cough, drooling and agitation along with stridor but not the typical barking cough. Why not E-no dry, barking cough like LTB or Acute Spasmodic Laryngitis. Epiglottitis is the only one in the croup family that doesn't have the dry, barky cough.
According to Erickson, disease can interfere with which stage of development in a 12 year old? A. Trust versus mistrust B. Industry versus inferiority C. Identity versus role confusion D. Intimacy versus isolation
Answer: B-industry versus inferiority A-infant C-adolescent D-young adult
A nurse is caring for a child in the post-operative period following a tonsillectomy. Which of the following is an appropriate action for the nurse to take? A. Encourage the child to blow her nose softly B. Offer orange juice. C. Position the child supine D. Administer analgesics on schedule
Answer: D. Why not A-blowing nose at all causes pressure. Why not B-Citrus causes discomfort. Why not C-the child should be placed on stomach or side-lying to assist with drainage. D-analgesics are needed for pain relief.
A child with asthma is having a pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to: A. confirm the diagnosis of asthma. B. Determine the cause of asthma. C. Identify "triggers" of asthma. D. Assess the severity of asthma.
D. Assess the severity of asthma. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm, and obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared to the child's baseline.
Q. One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection: A. Lessens effectiveness of medications. B. Encourages exercise-induced asthma. C. Increases sensitivity to allergens. D. Can trigger an episode or aggravate an asthmatic state.
D. Can trigger an episode or aggravate an asthmatic state. D-The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean.
The most accurate method of determining the length of a child less than 12 months of age is: A. standing height. B. estimation of length to the nearest centimeter or ½ inch. C. recumbent length measured in the prone position. D. recumbent length measured in the supine position.
D. Infants are generally unable to stand to obtain a height measurement. Measurement should not be estimated since an accurate measurement is required to determine growth. The infant should be measured in the supine, not the prone, position. The crown-heel length measurement is the most accurate measurement in infants....
Which statement by a parent indicates that education about asthma management has been effective? A. Both inhalers should be used before exercise B. The beclomethasone is to be used only when my child is wheezing C. both medications should be taken on a regular basis D. Alberterol should be taken as needed when my child is short of breath. Beclomethasone should be taken every day to prevent asthma attacks.
D. Know difference between rescue and controller medications! Parents often mix them up, leading to poorly controlled asthma.
Q. Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is: A. Atrophic changes in the mucosal wall of intestines. B. Hypoactivity of the autonomic nervous system. C. Hyperactivity of the sweat glands. D. Mechanical obstruction caused by increased viscosity of mucous gland secretions.
D. Mechanical obstruction caused by increased viscosity of mucous gland secretions.
Q. Which is considered a mixed cardiac defect? A. Pulmonic stenosis B. Atrial septal defect C. Patent ductus arteriosus D. Transposition of the great arteries
D. Transposition of the great arteries Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow. Transposition of the great arteries allows the mixing of blood in the heart. It creates 2 separate circulations. The only way the patient lives is if PDA or another defect allows shunting of blood. Once PDA closes patient dies.
A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to: A. confirm the diagnosis of asthma. B. determine the cause of asthma. C. identify "triggers" of asthma. D. assess the severity of asthma.
D. assess the severity of asthma. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm, and obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared to the child's baseline
Q. The doctor suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent: A. pulmonary infection. B. right-to-left shunt of blood. C. decreased workload on left side of heart. D. increased pulmonary vascular congestion.
D. increased pulmonary vascular congestion. The increased pulmonary vascular congestion is the primary complication. The shunt of blood is left to right. The increased pulmonary vascular congestion is the primary complication. A PDA allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary congestion can occur.
Q. A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates: A. liquefying secretions. B. improving oxygenation. C. promoting ventilation. D. soothing inflamed mucous membrane.
D. soothing inflamed mucous membrane. D-The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation. By humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed.
The pediatric nurse is performing a developmental age assessment on a 2 month old infant. What is consistent with the infants chronological age? A. The infant grasps objects with both hands B. The infant plays with her own toes C. The infant rolls overt from front to back and from back to front D. The infant lifts the head 45 degrees when in the prone position
D. typically this occurs between 1 and 6 months A-occurs between 4 and 6 months B-occurs between 4 and 6 months C-occurs between 4 and 6 months
A consequence of poorly controlled asthma?
Dysplasia
Executive functioning deficits are observable in children with? A. ADHD B. ODD C. LEARNING DISORDERS D. AUTISM AND ASBERGERS E. ALL OF THE ABOVE
E
Which of the following medications is used to treat congestive heart failure? A. Digoxin B. Lasix C. Captopril D. A and B only E. All of the above
E. All of the above. Digoxin is an Inotrope, which increases cardiac contractility. By increasing contractility though it reduces heart rate. Lasix is a diuretic which reduces the FVE and pulmonary edema that occurs with congestive heart failure. It may causes electrolyte imbalances and potassium wasting Captopril is an after load reducer, which decreases systemic resistance and lowers blood pressure. Watch for a drop in blood pressure 1-2 hours after dose.
Which of the following is not a defect found in Tetrology of Fellot? A. Ventricular Septal Defect B. Overriding aorta C. Pulmonary stenosis D. Right ventricular hypertrophy E. Left ventricular hypertrophy
E. Left Ventricular Hypertrophy does not occur with Tetrology of Fellot. The defects cause a shift in pressure from the left to the right, which is what is responsible for the right to left shunting of blood. This increase in pressure is what causes the hypertrophy of the right side.
A patient who is 4 days postpartum seems like she may have postpartum blues. What can be done to assess her further?
Edinburgh Postnatal Depression Scale
ADD is different from ADHD? T/F
F
Autism is the same in all people? T/F
F
Stimulant medication alone should resolve the condition of ADHD? T/F
F
If a child does not hyperactivity he does not have ADHD? T/F
F The hyperactive cases are easier to diagnose than the day dreamer cases but there are several subtypes
Autism is not treatable? T/F
F. Early diagnosis and intervention can significant improve outcomes
A 4 year old would have the plantar grasp? T/F
False
Nothing is really wrong with children with ADHD. The symptoms result from bad parenting? T/F
False
Only boys have the hyperactivity subtype of ADHD? T/F
False
Teachers can diagnose ADHD? T/F
False
Drug holidays should occur at the begin- ning and end of the school year. T/F
False- While drug holidays used to be rec- ommended, it is now recommended that medication regi- mens stay stable throughout the year.
Using stimulants increases the risk that children with ADHD will become drug addicts and criminals? T/F
False-However, the comorbid conditions of conduct disorder and oppositionai defiant disorder have been associated with increased criminal behavior. Children who receive stimulant medications are LESS likely to abuse drugs than those who do not-maybe self-medication?
Children outgrow ADHD as they age? T/F
False-symtpoms may change though
______ is better for assessing peripheral pulse?
Femoral
Which route is preferred?
Oral
____ increases absorption of iron while ____ decreases absorption of iron?
Orange juice, milk
Which defect may be necessary to sustain life in a child with a cyanotic heart defect?
PDA
What 2 defects are necessary for survival with hypoplastic left heart syndrome?
PFO (patent foramen ovale) and PDA (Patent Ductus Artheriosis)
Definition of pain
Pain is whatever the experiencing person says it is, existing whenever he or she says it does
This is the reflex in which newborns will squeeze a hand that is put in their hand?
Palmar grasp?
Inform parents that a high temperature can be normal for a 3 month compared to a 13 year old. Why is that?
The younger you are the higher the normal temperature is
You notice magnolia spots (dermal malanosites) when assessing a young child. What do you tell the parents?
These may look like bruises or signs of abuse but they will go away over time.
+What does the detachment stage of separation look like?
They are happy and they want to give you kisses. They have detached from the people that they were bonded with and are doing an artificial attachment with the nurses.
+What happens when a child is in the despair stage of separation?
They are much calmer. Nurses may think they are doing much better. Misconstrued in some ways.
Mother comes in with an infant who has a temperature of 37.5 C (99.4 F). You should tell her?
This is within the expected range for a 3 month old. Infants have a normal range that is higher than older children
Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is MOST likely to minimize this sensation and promote relaxation? A. Palpating another area simultaneously B. Asking the child not to laugh or move if it tickles C. Beginning with deeper palpation and gradually progressing to superficial palpation D. Having the child "help" with palpation by placing his or her hand over the palpating hand
This would not promote relaxation and would make it more difficult to perform the abdominal assessment. This may only contribute to the child's laughter or may prove frustrating to both the child and the nurse. Deeper palpation enhances the "tickling" sensation, not lessen it. This allows the nurse to perform the assessment while including the child in the care.
Which principle should the nurse teach the parent concerning administering liquid iron preparations to the child with iron-deficiency anemia? 1.) allow the preparation to mix with saliva and bathe the teeth before swallowing 2.) warm the medication before administering 3) administer between meals 4.) administer in the bottle of formula
administer between meals
You should use the ___ pulse with infants?
apical pulse
The characteristic behaviors of __________________ may be apparent in infancy (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years).
autism spectrum disorder
Sitting upright and leaning forward with chin out, mouth open and tongue protruding is called the ____ position and is done in response to obstruction of the airways secondary to ______ ?
Tripod position, Epiglottitis
A round chest is normal in children ? T/F
True
Hepatomegaly is normal in children? T/F
True
Transitional objects can be brought into the operating room? T/F
True
pits in ears may indicate hearing problems? T/F
True
The liver can easily be palpated in children? T/F
True....
A cardiac defect characterized by increased pulmonary blood flow? A. Hypoplastic Left Heart Syndrome B. Coarctation of the aorta C. Tetrology of Fellot D. VSD
VSD-causes an increase in pulmonary blood flow. A-Mixed blood flow B-Obstruction to blood flow C. Decreased pulmonary blood flow
An important approach to the care for a 7-year-old child diagnosed with attention deficit hyperactivity disorder is to encourage: 1.) a diet high in processed foods 2.) regular use of sedatives 3.) strict discipline 4.) a structured, one-on-one environment
a structured one-on-one environment
Q. A nurse is caring for a child who is in the postoperative period following a tonsillectomy. Which of the following is a clinical finding of post-operative bleeding? A. Hgb of 11.6 and Hct of 37% B. Inflamed and reddened throat C. Frequent swallowing and clearing of the throat. D. Blood-tinged mucous
C. Frequent swallowing and clearing of the throat. A-These values are within the expected range. B-inflamed reddened throat is an expected finding. C-frequent swallowing and clearing the throat indicates that there is an increased amount of fluid in the back of the throat, which is a sign of post-operative bleeding. D-blood-tinged mucous is an expected finding following a tonsillectomy.
A 7-year-old child is brought to the emergency room where you are the triage nurse. He is in respiratory distress. You anticipate the MD will order what first? A. Leukotriene‐blocking agent (controller medication) B. Steroid C. Short‐acting beta‐agonist D. Mast cell inhibitor
C. Short‐acting beta‐agonist
A 2 year old has tetrology of Fellot. Which position relieves cyanosis? A. Head of bed elevated 45 degrees B. Lying flat in bed C. Squatting D. Lying on right side
C. Squatting
A 2 year old child has a fever and a muffled voice. Which finding would indicate epiglottis? A. Clear speech B. Mild fever C. Tripod postion D. Gradual onset of symptoms
C. Tripod postion
A 17 year old with asthma is brought to the ED. The nurse performs a physical assessment and identifies that the patient is experiencing an acute exacerbation. Identify the assessment that supports this conclusion. (select all) A. Fever B. Crackles C. Wheezing D. Hypotension E. Tachycardia
C. Wheezing
A 4 year old has a bounding radial pulse and a weak femoral pulse. What is the diagnosis?
Coarctation of the Aorta
A 2 year old has suspected croup. Which finding reflects increasing respiratory distress? A. Bradycardia B. Flushed skin C. Decreased level of consciousness D. Intercostal retractions
D
A nurse is caring for a 2 year old who is cyanotic and is in the hospital for a cardiac catheterization to repair cardiac defects. The child will be transferred to the pediatric ICU following the procedure. Which of the following is an appropriate nursing action when providing care to this child? A. Place on NPO status for 12 hours prior to the procedure B. Elevate the affected extremity after the procedure C. Limit fluid intake following the procedure D. Check for iodine allergies prior to procedure
D
A nurse is preparing to assess a preschool-age child. Which of the following is an appropriate action by the nurse to prepare the child? A. Use medical terminology to describe what will happen B. Separate the child from the parents during the examination C. Keep medical equipment visible to the child D. Allow the child to role-play using miniature equipment
D
Breathing is difficult and there is a strong cough, which may produce yellow or green phlegm, and/or is so severe that it cause vomiting or turning red in the face. Fever may also be present. A. Pertussis (Whooping cough) B. Asthma C. Common cold D. Pneumonia and bronchitis
D
First, there is a very red rash on the cheeks that looks as if the child has been slapped. After one to four days, a red, lace-like rash appears on the arms, then the rest of the body. The rash may last one to three weeks and there may also be a fever. The illness is often mild in children, who may not feel sick. A. Measles (Rubeola) B. Roseola C. Rubella (German measles) D. Fifth disease
D
New mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression. The nurse can prepare the mother for this by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to A. Stay home and avoid outside activities to ensure adequate rest B. Be certain that you are the only caregiver for your baby in order to facilitate infant attachment. C. Keep feelings of sadness and adjustment to your new role to yourself. D. Realize that this is a common occurrence that affects many women.
D
Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth? A. Postpartum depression B. Postpartum psychosis C. Postpartum bipolar disorder D. Postpartum blues
D
Which is found upon physical assessment of asthma? A. Sounds of wheezing during normal breathing B. Increased nasal secretions or nasal polyps C. Atopic dermatitis, eczema, or other allergic skin conditions D. All of the above
D
When assessing a preschooler's chest, the nurse would expect: A. respiratory movements to be chiefly thoracic. B. anteroposterior diameter to be equal to the transverse diameter. C. intercostal retractions on respiratory movement. D. movement of the chest wall to be symmetric bilaterally and coordinated with breathing.
D At this age breathing is a coordinated function and is primarily abdominal or diaphragmatic. Thoracic breathing occurs in older children, particularly girls. Anteroposterior diameter is equal to transverse diameter in infants. As the child grows, the chest normally increases in the transverse direction; thus the anteroposterior diameter is less than the lateral diameter. Intercostal retractions indicate respiratory distress. The preschool-age child should have symmetric chest movement bilaterally and a coordinated breathing pattern.
The nurse is preparing a plan to teach a mother how to administer 1½ teaspoons of medicine to her 6-month-old child. The nurse should recommend using: A. a household measuring spoon. B. a regular silverware teaspoon. C. a paper cup measure in 5-ml increments. D. a plastic syringe (without needle) calibrated in milliliters.
D Household measuring spoons can be used if other more precise devices are not available. A dinner table utensil is not acceptable because household teaspoons vary greatly in size. A paper cup does not contain calibration for the additional 2.5 ml that is needed. This offers the most accurate measurement. The nurse should teach the mother to give the child 7.5 ml of the medication.
The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry green color. The nurse should explain that this is a/an: A. symptom of iron-deficiency anemia. B. adverse effect of the iron preparation. C. indicator of an iron preparation overdose. D. normally expected change caused by the iron preparation.
D These descriptions are not relevant. If the stools do not become a tarry green color, it may indicate administration issues. These descriptions are not relevant. If the stools do not become a tarry green color, it may indicate administration issues. These descriptions are not relevant. If the stools do not become a tarry green color, it may indicate administration issues. An adequate dosage of iron turns the stools a tarry green color.
The most consistent indicator of pain in infants is: A.increased respirations. B. increased heart rate. C. squirming and jerking. D. facial expression of discomfort.
D These responses vary, depending on infant and pain. These responses vary, depending on infant and pain. These responses vary, depending on infant and pain. This is the most consistent behavioral manifestation of pain in infants
The MOST important nursing consideration when caring for a child with sickle cell anemia is to: A. refer parents and child for genetic counseling. B. help the child and family to adjust to a short-term disease. C. observe for complications of multiple blood transfusions. D. teach parents and child how to minimize crises.
D Parents need specific instructions about changes in the child's condition that they should watch for, penicillin administration, adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is having parents who are properly prepared to care for them.
The nurse expects which characteristic of fine motor skills in a 5-month-old infant? A. Strong grasp reflex B. Neat pincer grasp C. Able to build a tower of two cubes D. Able to grasp object voluntarily
D This is characteristic of a 1-month-old infant. This is characteristic of an 11-month-old infant. This is characteristic of a 15-month-old infant. This is appropriate for a 5-month-old infant....
The nurse needs to give an injection in the deltoid to a 4-year-old child. The BEST approach to use is to: A. smile while giving the injection to help child relax. B. tell the child that you will be so quick that the injection will not even hurt. C. explain that the child will experience a little stick in the arm. D. explain with concrete terms, such as putting medicine under the skin.
D- This is too abstract. The young child will not correlate a smile with relaxation. Distraction techniques are more appropriate. The nurse does not know that the injection will not hurt the child. Lying or distorting the truth is never appropriate. This response will block trust, especially if the injection does hurt the child. The child may visualize an actual stick being placed in the arm. Children at this age are very literal. By using concrete terms the nurse helps the child understand what the nurse is going to do.
A 4-year-old girl is brought to the emergency room. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should: A. examine her oral pharynx and report to the physician. B. make her lie down and rest quietly. C. auscultate her lungs and make preparations for placement in a mist tent. D. notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
D-Examination of the oral pharynx may cause total obstruction. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Preparation should be made to care for her if an obstruction occurs. Sitting upright, drooling, agitation, and a froglike cough indicate epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.
Which of the following is NOT true regarding vital signs in pediatrics? A. Normal ranges for heart rate decreases as children get older. B. Normal ranges for respiratory rate decreases as children get older. C. Blood pressure increases as children get older D. D. normal ranges for temperature increase as children get older
D-decreases
A nurse is assessing a child's ears. Which of the following is an expected finding? A. Light reflex at the 2 o'clock potion B. Tympanic membrane is red in color C. Bony landmarks are not visible D. Cerumen is present bilaterally
D-ear wax is normal in both ears A-5 or 7 o'clock B-pearly pink, grey color C-bony landmarks should be visible
A physician orders Digoxin for a toddler with heart failure. Before giving the drug the nurse must check the toddlers? A. urine output B. Serum sodium level C. weight D. apical pulse
D-pulse. Digoxin may decrease the heart rate and heart failure may cause a pulse deficit. Therefore, the nurse should measure the toddlers apical pulse before giving the drug to prevent further bradycardia, The serum sodium level does not affect digoxin.
Which of the following is NOT an Acyanotic heart defect with increased pulmonary flow? A. VSD B. PDA C. ASD D. Transposition of the Great Arteries
D.
It is important that a child with Group A ß-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent: A. Otitis media. B. Diabetes insipidus. C. Nephrotic syndrome. D. Acute rheumatic fever.
D. Acute rheumatic fever. Otitis media and diabetes insipidus are not sequelae to GABHS. Otitis media and diabetes insipidus are not sequelae to GABHS. Children are at risk for glomerulonephritis, not nephritic syndrome. Children with Group A ß-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis.
A nurse is teaching an adolescent about the appropriate use of his asthma medications. Which of the following should the client be instructed to take as needed before exercise? A. Fluticasone (Adair) B. Montelukast (Singular) C.Prednisone (Deltasone) D. Albuterol (Proventil)
D. Albuterol-SABA A-combination medication B-maintenance medication C-Steroid medication used for exacerbations
Cloudy lens is?
catarct
What can one do to prevent false attachment charactoried by false feelings of love by the chid to the nurses?
consistency in caregiving
Tetrology of fellot is treated by?
decreasing pulmonary resistance-knees-to-chest, OXYGEN, comforting and morphine
Cystic fibrosis is caused by?
defective chloride ion transport across exocrine and epithelial. Decreased H2O flows across cell membranes, causing abnormal accumulation of viscous, dehydrated mucus
A child is happy to see the nurse and wants to hug them. They are in this stage of separation?
detachment
Artificial attachment occurs during this stage of separation?
detachment stage
Children do not outgrow autism but studies show that _______________ can significant improve outcomes?
early diagnosis and treatment
Infants response to hospitalization is mostly?
emotional-crying
_______ disease may present as a slap to the face of a child?
fifths disease
The Ballard Scale is used to measure?
gestational age
How should you feed an infant with CHF?
give frequent small feedings or tube feedings
beclamethosone (vancenase) bedesonide (pulmicort) fluticasone (flovent/flonase) mometasone (nasonex) triamcinolone (nasocort)
glucocorticoids decrease inflammation/airway edema/vascular permeability/ mucus nasonex and nasocort are intranasal
Chronological age minus number of weeks of prematurity equals expected ________________________
growth and developmental age
What is a risk associated with too much corticosteroids?
growth retardation
What risk factors can we mitigate during hospitalization?
have parents present
This is used to diagnose sickle-cell anemia?
hemoglobin electrophoresis
Why is nasal flaring common in infant?
infants have large tongues and breathing through their mouth is difficult
Why is IV immunoglobulin given to treat Kawasaki disease?
it reduces inflammation
Pruritis is a sign of _______?
itchiness
They determine intake by the weight of the infant or child in?
kg
The assessment of the pediatric population proceeds from _______ to _______ distressing but otherwise cephalo-caudal (head-to-toe)?
least to most distressing (do the less traumatic/invasive procedures first)
Down syndrome can present with hands that have ______ lines?
linear
This increases in toddlers in response to hospitalization?
negativism
What can help pickiness of toddlers eating habits?
offer finger foods
The nurse is assessing a child admitted with possible Kawasaki's disease. A characteristic sign or symptom that the nurse should observe and document would be: 1.) cardiac dysrhythmia 2.) decreased urine output 3.) peeling skin on fingers 4.) decreased level of consciousness
peeling skin on fingers
Drug of choice for tonsillitis or pharyngitis caused by strep throat?
penicillin
describe a shot as a ______ A. bee sting B. pinch C. stab
pinch...USE LITERAL TERMS
Viral exanthema are ______ caused by virus?
rashes
__________ ,or going back to a previous stage of development, is common in the hospital setting.
regression
NEW
ritualistic behavior
This group responds to hospitalization with loss of control and boredom?
school age child (bordom is huge)
+What happens when a child is in the protesting stage of separation?
screaming and crying and don't want nurse to touch them
Three types of measures for assessing pain have been developed to measure pain in children, behavioral, physiological and self-report. _______ is the gold standard for assessing pain?
self-report
All age children experience?
separation anxiety transitional objects, picture of parents and get them out as soon as possible
A kid who doesn't want to go to school, has a phobia and uses somatic symptoms to be excused from school has?
separation anxiety disorder
Braden scale is used to assess?
skin integrity
A means of diagnosing asthma?
spirometry
What is Tanner staging?
staging of breasts, public hair, tescticles, physical characteristic of puberty
Hold newborn up and their feet on the table and they will begin stepping. This is the ___ reflex?
stepping
Carnitatum-
sternum poked out a little bit
If you put a tongue depressor in an infants mouth they start to suck on it. This is the ___ reflex?
suck and swallow reflex
The first manifestation of sexual maturity in males?
testicular enlargement
Why does thorasic softness contribute towards respiratory illness?
thorasic softness means not as good at moving air in ands out
Why is aspirin given to patients with Kawasaki disease?
to reduce inflammation
If untreated acute pain can become persistent pain? T/F
true
Trush is white on tongue. If you try to scrape it off and it doesn't come off its ___ and if it comes off its _______?
trush, milk
Chronological age - _______ = developmental age?
weeks premature
We determine the dose of medication based on _____?
weight
Discuss the care of the child who has congestive heart failure
weight gain is important prior to surgery...poor weight gain and poor feeding are 2 symptoms of CHF
A woman uses her rescue inhaler every morning and night and corticosteriods for emergencies. Her asthma is out of control. Why?
wrong order
You are making a home visit on Jean (G2 TPAL 1102) who is 4 days postpartum with her 2nd child, a healthy term newborn. Her history is significant for postpartum depression after the preterm birth of her 1st baby. She tells you she is having a bad day. "I cried when my son spilled his juice. The baby ate every 2 hrs last night and my mom can't help me today. I am really tired! I even forgot you were coming." What is your assessment given the data? What are your nursing responsibilities based on your assessment?
• Seems like the Postpartum Blues • Be purposeful, ask questions • Establish trust • Obtain data→Edinburgh Postnatal Depression Scale • Speak with provider about your observations as needed
Why is heart rate and respirations counted for a full minute in children and infants?
because rate rate can have normal variation based on breathing. This would be abnormal in adults.
This is huge for school-ager?
bordom
When examining a child with a respiratory illness you should do this first?
Inspection: count RR, look fro retractions, nasal flaring and grunting
A nurse is caring for a child with croup. Which is the therapy for croup? A. Metaprotenol B. Albuterol C. Nebulized racemic epinephrine (Racepinephrine) D. Ipratropium bromide (Atrovent)
C-decraeses inflammation and edema in the airways
Children with CHF may receive Synergis shots to prevent _____ infection?
RSV
A high-pitched or shrill cry may be associated with increased ______?
Intracranial pressure ICP ventricles filled
Why is it easy for things to get caught in children's airway?
It is cone shaped as opposed to cylindrical
Galantes reflex
It is elicited by holding the newborn in ventral suspension (face down) and stroking along the one side of the spine. The normal reaction is for the newborn to laterally flex toward the stimulated side.
Strawberry tongue is associated with?
Kawasaki disease
An infant with tetralogy of Fallot is experiencing a tet attack involving cyanosis and dyspnea. Which position should the infant be placed in? 1.) Fowler's 2.) Knee-chest 3.) Trendelenburg's 4.) Prone
Knee-chest
If albuterol and corticosteroids don't work you can add a ________ for better control of asthma?
LABA
What are some signs to look for with Autism?
Lack of or delay in spoken language Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects) Little or no eye contact Lack of interest in peer relationships Lack of spontaneous or make-believe play Persistent fixation on parts of objects
What is the difference between and height and length?
Length is laying down and height is standing up
What is the difference between length and height?
Length is lying down and height is standing up
School age children benefit from a sense of industry and are in the concrete operational stage. How might this be applied to pain management?
Let them push the button on the PCA, provides a sense of industry. Concert operations-my heart has this problem and needs this.
When the time to repolarize the ventricles is longer than normal this is called?
Long QT syndrome
A foot ball player drops dead on the field while running at full speed. What is a possible cause?
Long QT syndrome. Increasing heart rate usually causes a shorting of the QT interval. In patients with long QT syndrome this kind of exersion during sports can cause them to die suddenly. Chemotherapy can also cause QT syndrome.
What is a long-term side-effect of using prednisone (Deltasone) to manage Asthma in children?
May interfere with a child's growth
The first possible sign that an infant may have cystic fibrosis?
Meconium ileus
Infant reflexes?
Moro, Galant's reflex, rooting, suck & swallow, palmar and plantar grasp, tonic neck, dance or step
Clap hands to test the ___ reflex?
Moro-arms and legs go out and come back in response to loud noise. TELLS US WHAT? THEY CAN HEAR
For infants who are less than 10kg they need?
100mL/kg/day
Refrain from offering choices to children when there aren't any. You should only give them ____ maximum? A. 1 B. 2 C. 3 D. 4
2
A normal I:E ratio is ___:___?
2:1
+What are the 3 stages of separation that children experience when hospitalized?
Protest, despair and detachmnet
Autism usually appears within the first 3 years of life? T/F
T
The nurse should provide interventions to relieve pain and other symptoms in the dying patient, even when those interventions entail risks of hastening death A. True B. False
T
There is no known single cause of autism? T/F
T
Tracheostomy care for children involves oxygen supplmental oxygen and application of the 5 second rule? T/F
T
Dermal Malanosites can appear to be sign of abuse? T/F
T-mongolian spots
A cardiac defect that results in decreased pulmonary blood flow, resulting in cyanosis at birth and blue spells?
TOF
Behaviors related to oppositional defiant disorder may be more evident in one setting than another? A. True B. False
TRUE
An early indicator of heart failure in an infant?
Tachycardia
What is a risk associated with too much albuterol?
Tachycardia You can give every 4 hours while coughing if coughing they can do it again
An early sign of heart failure in a toddler?
Tachypnea
Discuss the myths about pain in children.
1. Infants can't feel pain. 2. Children have no memory of pain. 3. Children are not in pain if they can sleep. 4. Parents exaggerate their child's pain. 5. Repeated painful experiences teach the child how to be more tolerant Children recover more quickly than adults. 7. Children tell you if they are in pain. 8. Children have a high risk of addiction.
What differences between children and adults predispose children to respiratory illness?
1. Prematurity of lungs 2. Congenital anomalies 3. Airway size 4. Thoracic softness 5. Shorter Right Main Stem Bronchus 6. Immunologic innocence 7. Mouthing
What are the 3 goals of pain management in children?
1. Relieve pain 2. Maximize functioning 3. Minimize side effects of medications
Q. A 5-year-old child is brought to the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) A. Vital signs B. Throat culture C. Medical history D. Assessment of breath sounds E. Emergency airway equipment readily available
A,C,D,E: Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.
Q.When caring for a child after a tonsillectomy, the nurse should: A. watch for continuous swallowing. B. encourage gargling to reduce discomfort. C. position the child on the back for sleeping. D. apply warm compresses to the throat.
A- This is the most obvious early sign of bleeding from the operative site. Gargling should be avoided because of potential trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage. Cold is preferred. Ice collars and cold liquids are encouraged.
A pediatric nurse is doing a developmental age assessment on a 7-month old infant. What is consistent with the infants age? A. The infant eats with the fingers B. The infant brings objects to his mouth C. the infants grasp is strong D. the infant sits alone to play
A-Occurs between 10 and 12 months (fine motor skill) B-Correct C-Occurs between 1 and 3 months D-Typically occurs between 7 and 9 months
A nurse is caring for a child who is suspected of having cystic fibrosis. Which of the following tests should the nurse administer to confirm this diagnosis? A. Sweat chloride B. Pulmonary function C. Arterial blood gases D. Chest percussion
A-cystic fibrosis is a chloride ion dysfunction. Children with this have an abnormal amount of chloride and sodium in their sweat.
A toddler with a VSD is receiving digoxin for heart failure. Which finding should be the priority concern? A. Tachycardia B. Bradycardia C. Hypertension D. Hyperactivity
B. Bradycardia-Digoxin enhances the force of contractions and decreases the heart rate. An early sign of digoxin toxicity is bradycardia. The nurse should always measure the apical pulse rate before giving each dose.
The nurse should explain to the parents that their child is receiving Lasix for severe congestive heart failure because it is a/an: A. Diuretic. B. Alpha-blocker. C. Form of digitalis. D. ACE inhibitor.
A. Diuretic Furosemide (Lasix) is a diuretic used to eliminate excess water and salt to prevent reaccumulation of the fluid. Lasix is a diuretic. Lasix is a diuretic. Lasix is a diuretic.
Q. An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to: A. Prevent respiratory syncytial virus (RSV) infection. B. Make isolation of infant with RSV unnecessary. C. Prevent secondary bacterial infection. D. Decrease toxicity of antiviral agents.
A. Prevent respiratory syncytial virus (RSV) infection.
Which finding on newborn examination requires immediate action? A. Red reflex absent in right eye B. Eyes are low-set bilaterally C. Uvula has two lobes D. Left side has two lobes
A. Red reflex is absent. Ophthalmic emergency. Light not being transmitted to the retina which can cause blindness.
Q. A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a: A. Spacer. B. Nebulizer. C. Peak expiratory flow meter. D. Trial of chest physiotherapy.
A. Spacer. The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. A peak expiratory flow meter is a measure of pulmonary function not related to medication administration. Chest physiotherapy is unrelated to medication administration.
A 3-year-old child is brought to the emergency room. The child's mouth is open, and he is drooling and lethargic. The mother reports these symptoms began suddenly within the last 2 hours. Which intervention should the nurse perform first? A. Maintain the child in an undisturbed, upright position B. Assess the child's throat using a small tongue depressor C. Obtain intravenous access and draw blood cultures D. Provide cool liquids to soothe the child's throat and provide hydration
A. Sudden onset of these symptoms likely indicates epiglottitis. The child is at high risk for airway obstruction, and should be left alone in an upright position to avoid further irritation of the epiglottis until the need for intubation or tracheotomy is determined. Because of the potential for airway obstruction and respiratory interventions, the child should not eat or drink anything.
Symptoms of asthma include which? A. Cough B. Wheezing C. Shortness of breath D. Chest tightness E. Episodic, worse at night
ABCDE
_______________ is the most common psychiatric disorder in childhood and adolescents?
ADHD
What does an exam of Tetralogy of Fallot show? A. Cyanosis B. Clubbing of fingers and toes C. Murmurs D. Hypercyanotic spells E. ALL
ALL
Which of the following can cause an ECG artifact? A. Movement B. burping C. crying D. ALL
ALL
Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? A. Inactivity B. Clings to parent C. Depressed, sad D. Regression to earlier behavior
B These are characteristics of despair. In the protest phase, the child aggressively responds to separation from parents. These are characteristics of despair. These are characteristics of despair.
A nurse is assessing a 6 month old. Which of the following reflexes should the infant exhibit? A. Moro B. Plantar grasp C. Stepping D. Tonic neck
B (birth to 6 months) A-Birth to 3 months C-Birth to 4 weeks D-Birth to 3 weeks
A nurse is assessing an infant. Which of the following should the nurse recognize as clinical manifestations of heart failure? A. Bradycardia B. Cool extremities C. Peripheral edema D. Increased urinary output E. Nasal flaring
B, C, E A-tachycardia D-decreased unless being treated with Lasix
A nurse is planning caring for a child who has asthma. Which of the following interventions should be included in the plan of care? (select all) A. Perform chest percussion B. Place the child in an upright position C. Monitor oxygen saturation D. Administer brochodilators E. Administer dornase alfa (Pulmozyme) daily
B,C,D A-used to remove mucous plugs in kids with Cystic fibrosis E-dornase alfa is a mucolytic used to thin mucous secretions for children with cystic fibrosis
A nurse is assessing a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status? (select all) A. Oxygen saturation of 95% B. Wheezing C. Retractions of sternal muscles D. Warm extremities E. Nasal flaring
B,C,E
A patient with sickle cell disease should use ice packs to relieve pain? A. True B. False
B-vasocontriction would make sickle cell much worse. Warm packs would relieve pain.
Which of the following foods would not be appropriate for a client with cystic fibrosis? A. Roasted pork tenderloin B. Fried chicken C. Skim milk shake D. Egg omelet
B. Cystic fibrosis clients should have high-nutrient, low-fat diets, since fats are especially difficult for these clients to digest. Fried foods should be avoided.
According to Erickson an 8 year old is in which stage? A. Trust versus mistrust B. Industry versus inferiority C. Identity versus role confusion D. Intimacy versus isolation E. Initiative versus guilt
B. Industry versus inferiority
A nurse is assessing a postpartum client who is exhibiting tearfulness, insomnia, lack of appetite, and a feeling of letdown. The nurse knows these findings are characteristic of? A. Postpartum psychosis B. Postpartum depression C. the letting go phase D. Postpartum fatigue
B. Postpartum depression
Why are children predisposed to otitis media? A. Nasopharynx B. Horizontal eustachian tubes C. Excessive cerumen D. External ear canal
B. Short and horizontal, promoting entry of nasopharyngeal secretions. Feeding children upright can lower risk. Children will pull on their ears when they have an infection and will get a fever.
Q. The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C. The nurse suspects croup and should recommend: A. controlling fever with acetaminophen and calling if the cough gets worse during the night. B. Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. C. Trying over-the-counter cough medicine and coming to the clinic in the morning if there is no improvement. D. Admitting to the hospital and observing for impending epiglottitis.
B. Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. The child does not have a temperature to manage. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency room if they develop. Cool mist is recommended to provide relief. Cough suppressants are not indicated. This is characteristic of laryngotracheobronchitis, not
Q. After a patient returns from cardiac catheterization, the nurse assesses that the pulse distal to the catheter insertion site is weaker. The nurse should: A. elevate the affected extremity. B. record the data on the nurse's notes. C. notify the physician of the observation. D. apply warm compresses to the insertion site.
B. record the data on the nurse's notes. Elevation is not necessary; the extremity is kept straight. The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. It should gradually increase in strength. Because a weaker pulse is an expected finding, the nurse should document this and continue to monitor. The insertion site is kept dry.
Greene developed collaberative problem solving. This promotes the idea that kids do well if they _____ versus kids do well if they _______?
CAN, WANT TO
Cardiomegaly, Hepatomegaly, poor weight gain and diaphoresis are all signs of ?
CHF
It is time to give a 3-year-old boy his medication. Which approach is MOST likely to receive a positive response? A. "It's time for your medication now. Would you like water or apple juice afterward?" B. "Wouldn't you like to take your medicine?" C. "You must take your medicine, because the doctor says it will make you better." D. "See how nicely this boy took his medicine? Now take yours."
Correct: A. This statement provides the child with a structured choice with two acceptable options. B. Posed as a question, this approach allows the child the option to say "no." C. This statement can elicit negative behavior from the child; the nurse is abdicating responsibility to the doctor. Encouraging competition is not appropriate for this age group.
Once the PDA Closes babies with this defect will progress to cyanosis and die?
HLHS
The HEENT assessment is for these?
Head, Eyes, Ears Nose and Throat
A cardiac defect that results in mixed blood flow? A. Hypoplastic Left Heart Syndrome B. Tetrology of Fellot C. Coarctation of the Aorta D. VSD
Hypo Plastic Left Heart Syndrome
Avoid this route when administering pain medication?
IM, bad absorption
This route of pain medication administration provides steady blood levels?
IV route
What Ericksonian stage is the adolescent (12-18)?
Identity vs. role confusion
What nursing action should be implemented for a child in a hypercyanotic spell (tet spell)?
Immediately place them in the knee-chest position
What are the 3 characteristics of ADHD?
Inattention, hyperactivity and impulsivity
What are the 4 types of heart anomalies?
Increased pulmonary flow, decreased pulmonary flow, obstructive and mixed
At birth systemic blood pressure ___________ and pulmonary blood pressure __________?
Increases, decreases
What Ericksonian stage is the school age (6-12)?
Industry vs. inferiority
What are three nursing diagnoses made for asthma?
Ineffective Breathing Pattern Ineffective Airway Clearance Impaired Gas Exchange
RSV is caused by?
Infection of the epithelial cells in the lungs
Describe the pathophysiology of Otitis Media in children?
Infectious particles have easy access to the middle ear through the short and open Eustachian tubes
What is happening at the cellular level with asthma ?
Inflammation, bronchospasm and mucous secretion
What Ericksonian stage is the play age (3-6)?
Initiative vs. guilt
The stages for preschool, school age and adolescents are ______ , ________ and ______?
Initiative, industry, identity
Describe the consequences of untreated pain in children.
Physiological: TACHYCARDIA, TACHYPNEA, VASCONTRICTION ...IF UNTXT GOES ON FOR VDAYS AND WASTES ENERGY...->IF UNTREATED ACUTE PAIN BECOMES PERSISTENT PAIN!!!!!!!!!!!!!!!!!!!!!!!!!!!! DEPRESSED IMMUNE SYSTEM...AFFCETS NEURAL ACTIVITYSO WANT TO TXT EARLY...CHANGES MOTOR ACTIVITY->NO EXERCISE Behavioral NO SCHOOL, NOT SLEEPING, EATING HABITS, MOTOR ACTIVITY, PLAYING,
Sandy (G 2 TPAL 1001) is single and 20 weeks pregnant with a history of depression treated with Zoloft until she learned of this pregnancy. She is quiet as you talk with her on the nurse triage phone. She cries as she tells you she hasn't eaten for 5 days, her weight is down 5 lbs from 2 weeks ago and she can't sleep. "I am all alone-no one helps me. I don't have money or food for my daughter. Work fired me because I was sick so much." What are her risk factors? What is your nursing assessment and interventions?
RISK FACTORS • Single status • Poor social support • Adverse life events • Low socioeconomic/uninsured status • Personal history of depression • Discontinuing antidepressant medication ASSESSMENT AND DIAGNOSIS: • Seems to be a continuation of depression during the pregnancy • Since she is not eating, this is urgent and she needs to be seen today for evaluation and treatment • She is greater than 20 weeks gestation and needs to go back on her antidepressants • Public health referral
Antistreptolysin-O (ASO) titer is the most reliable test for?
Rheumatic fever It detects antibodies to streptococcus, GABHS causes rheumatic fever
SAD PERSONS is a mnemonic for a scale that assesses suicide risk in adolescents. What does SAD PERSONS stand for?
S-sex (males are higher risk) A-age (age 15 and older higher risk) D-depression or affective disorder P-previous suicide attempt E-ethanol use R-Rational thinking loss S-social supports lacking O-rganized plan N-negligent parenting S-school problems
Bordom is huge for the ____ child? A. Toddler B. Pre-school C. School Age D. Adolescent
School Age
You should use an appropriate voice when talking to a child. It should be?
Soft and a little bit high-pitched
This grade of tonsillitis goes all the way to the uvula, obstructing the airway?
Stage 4 or +4
Medication doses for pediatric population is based on ________
WEIGHT Amoxicillin 60-80mg/kg/24 hours
You receive a call from postpartum woman's partner. He sounds worried. "Today we can't leave her alone. She just seems out of it. She doesn't take care of herself or the baby. We have to stay with her when she breastfeeds or she becomes frantic. My sister said today she called the baby a monster. What can we do, she is not herself?" You know that 5 weeks ago she had a very long labor and a C/S - something she said she most feared during prenatal visits. She has a past history of counseling in her late teens. What are her mental signs and symptoms? What are her behavioral signs and symptoms? What is your nursing assessment and recommendations?
What are her mental signs and symptoms? Extreme confusion=Seems out of it Hallucinations=Called baby a monster What are her behavioral signs and symptoms? Not functioning=doesn't take care of herself or the baby Extreme agitation=she becomes frantic What is your nursing assessment and recommendations? Becoming an unsafe situation Bring her to ER for evaluation Breastfeeding may need to end based on treatment with medications
Horse voice is associated with?
croup
