FINALLY PEDSSS

Stimulus for preschooler's

crayons and coloring books, puppets, felt, and magnetic boards, play dough, books and recorded stories.

Which statement made by a parent of a child with nephrotic syndrome indicates an understanding of discharge teaching?

"I should check his urine for protein when he goes to the bathroom."

DTaP: Diphtheria (C. diphtheriae), Tetanus (Clostridium tetani), and Acellular Pertussis:

- Five doses: 2 months; 4 months; 6 months; 15-18 months; booster 4-6 years

Pneumococcal Conjugate:

- Prevnar: Four doses at 2 months, 4 months, 6 months, and 15 months. - One catch-up dose can be given through age 5 if any doses were missed. - Polysaccharide conjugate vaccine

How would a patient with pyloric stenosis present?

-FTT(failure to thrive) - Moderate to severe dehydration

What are the signs and symptoms of TOF?

-Prominent heart murmur-Growth retardation/FTT (failure to thrive) -Polycythemia and clotting disorders -Cyanosis: (not affected by o2 administration) SEVERE breathing difficulties, clubbed fingers, acidosis-surgical repair is completed by 6 month of life -Long term issue

What 4 defects make up Tetralogy of Fallot?

-Ventricular Septal Defect (VSD) -Pulmonary Stenosis -An overriding Aorta -Right Ventricular Hypertrophy

Tet Spells (Hypercyanotic Spells)

-heart rate drops very quickly -child gets dizzy IMMEDIATE intervention is knee to chest OR have child squat -administer morphine to calm the kid -Administer 100% oxygen

sickle cell anemia

-hereditary disorder -involves abnormal form of Hgb -affects African americans -insufficient oxygen (hypoxia) causes the cells to take on sickle shape -very short life span-cells clump together and obstruct blood flow -sickling is reversible with treatment

treatment for sickle cell

-pain control - analgesics and heating pad -hydration; IV fluids -oxygenation -bedrest -transfusions PREVENTION is key to controlling SC

situations that contribute to or trigger sickling (7)

-stress-fever-infection-pain -dehydration** -exposure to cold (hypothermia) -any situation that can cause hypoxia

A pediatric clinic nurse teaches parents how to care for their toddler who has nasal congestion. What anatomical difference between children and adults is a concern with congestion in children? A. Children this age should not have congestion. B. Larger tonsils trap mucus, leading to gagging .C. The narrow trachea can become obstructed easily. D. Phlegm can migrate into the eustachian tubes.

.C. The narrow trachea can become obstructed easily.

Signs of compartment syndrome

1. Pain 2. Poikilothermia 3. Pallor 4. Paresthesias 5. Pulselessness

Immunizations 12 months - 3 years

12 to 15 months: inactivated poliovirus (third dose between 6 to 18 months); Haemophilus influenzae type B; pneumococcal conjugate vaccine; measles, mumps, and rubella; and varicella 12 to 23 months: hepatitis A (Hep A), given in two doses at least 6 months apart 15 to 18 months: diphtheria, tetanus, and acellular pertussis 12 to 36 months: yearly seasonal inactivated influenza vaccine; live attenuated influenza vaccine by nasal spray (must be 2 years or older) Follow the current CDC recommendations for administration of the COVID-19 vaccine to children 12 months to 3 years of age.

Which of the following is an example of emotional abuse? 1) Failing to provide medical care for a child 2) Blaming a child when something goes wrong 3) Shaking an infant when the infant cries 4) Depriving a child of food

2) Blaming a child when something goes wrong

The pediatric nurse plans care for a child experiencing sickle cell crisis. Which nursing intervention is appropriate for this patient? 1) Encouraging an increased amount of activity 2) Monitoring respiratory status and oxygenation 3) Using only nonpharmacological pain interventions to avoid an acute pulmonary event 4) Implementing fluid restrictions

2) Monitoring respiratory status and oxygenation

Which clinical manifestations should the nurse monitor for when conducting a scoliosis screening for a school-aged child? (Select all that apply.) 1) Lordosis 2) Prominent scapula 3) Pain 4) A one-sided rib hump 5) Uneven shoulders and hips

2) Prominent scapula 4) A one-sided rib hump 5) Uneven shoulders and hips

Which is the appropriate nursing intervention when providing care to a child diagnosed with nephrotic syndrome who is edematous and on bedrest? 1) Monitoring BP every 30 minutes 2) Repositioning every 2 hours 3) Limiting visitors 4) Encouraging fluids

2) Repositioning every 2 hours

Which clinical data noted by the nurse during the shift assessment indicate that the pediatric client may be experiencing compartment syndrome? (Select all that apply.) 1) Pink, warm extremity 2) Dorsalis pedis pulse present 3) Prolonged capillary refill time 4) pain not relieved by pain medication 5) Paresthesia of leg

3) Prolonged capillary refill time 4) pain not relieved by pain medication 5) Paresthesia of leg

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well? a. Recheck the infant's blood pressure. b. Alert the physician. c. Withhold oral feeding. d. Increase the oxygen rate.

Alert the physician.

When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure? a. The right arm b. The left arm c. All four extremities d. Both arms while the child is crying

All four extremities

A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). What does the nurse expect this child to receive following gastric lavage? a. Activated charcoal .b. N-acetylcysteine. c. Vitamin K. d. Syrup of ipecac.

Answer: b. N-acetylcysteine. Rationale: Gastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen.

How does one diagnose pertussis?

Although at first the symptoms of the illness may be mild with dry cough, within 2 weeks the cough often progresses to the coughing spells characteristic of the disease, which then continue to increase in severity and frequency.

Pertussis Treatment

Although many cases of pertussis can be treated at home, hospitalization is often required when an infant demonstrates apnea, respiratory compromise, and neurological impairment secondary to anoxic episodes. Airway maintenance and adequate hydration and nutrition are priorities in treatment. Infants with pertussis can be very ill and sometimes require extended periods of hospitalization.

Influenza:

Annually from infancy through old age Inactivated virus

The nurse is interviewing parents of an infant with pyloric stenosis. What would the nurse expect the parents to report? a. Diarrhea b. Projectile vomiting c. Poor appetited. d. Constipation

Answer: b. Projectile vomiting Rationale: Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting.

A frightened mother calls the pediatricians office because her child swallowed dishwashing detergent. What is the most appropriate action? a. Induce vomiting by giving the child syrup of ipecac .b. Take the child to the local emergency department. c. Give the child activated charcoal mixed with juice. d. Give the child milk to soothe affected mucous membranes.

Answer: b. Take the child to the local emergency department.

What does the nurse expect the appearance of the stools of a child with celiac disease to be? a. Ribbon like. b. Hard, constipated. c. Bulky, frothy. d. Loose, foul-smelling

Answer: c. Bulky, frothy.

What is the nurse's first action when planning to teach the parents of an infant with a CHD? a. Assess the parents' anxiety level and readiness to learn. b. Gather literature for the parents. c. Secure a quiet place for teaching. d. Discuss the plan with the nursing team.

Assess the parents' anxiety level and readiness to learn.

Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

Atrial septal defect

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac syndrome? A) "The soup we eat at our house is all made from scratch." B) "She loves hotdogs, and we always cut hers up into small pieces." C) "I have learned to make my own bread with no gluten." D) "Even though milk and pudding are good for her we don't give her those foods."

B) "She loves hotdogs, and we always cut hers up into small pieces."

In which of the following psychological disorders does a patient fabricate symptoms of disease or injury in order to undergo medical​ tests, hospitalization, or even medical or surgical​ treatment? A. battered child syndrome B. Munchausen syndrome C. sudden infant death syndrome D. shaken baby syndrome

B. Munchausen syndrome

What is the classic symptom of idiopathic (immunological) thrombocytopenia purpura (ITP)? Bruising Fever Nosebleed Irregular pulse

Bruising The classic symptom of ITP is easy bruising, which results in petechiae and Purpura. Approximately 30% of the patients also have nose bleeds.

A practicing nurse explains to a nursing student that which is the most common cause of acute renal failure in children? A. Congenital renal problems B. Glomerulonephritis C. Hemolytic uremic syndrome D. Tylenol (acetaminophen) overdose

C. Hemolytic uremic syndrome Hemolytic uremic syndrome is most often associated with children eating undercooked meat and is the most common cause of acute renal failure in the pediatric population. Tylenol overdose is associated with liver failure.

Late shock s/s

Confusion Unconsciousness Cardiac arrest

Diuresis has not occurred on a child with nephrotic syndrome after a month on corticosteroids. What protocol can the nurse encourage to bring about diuresis?

Cyclophosphamide (Cytoxan), an antisuppressant

Beneficence

Doing good or causing good to be done; kindly action

Eczema family teaching

Education must include the prevention of skin scarring at the affected site by preventing secondary infections. The family should try to identify if any foods cause exacerbations of their child's eczema and avoid any known allergens. Common allergens are pets, environmental allergens, and contact allergens. The family should be taught to avoid prolonged sun exposure and to apply sunscreen to prevent sunburns, which will highly irritate the site. Oral antihistamines and anti-inflammatory medications may be required if the pruritus is so intense that the child is experiencing sleep deprivation.

A parent reports that her 5-year-old child, who has had all the recommended immunizations, had a mild fever 1 week ago and now has bright red cheeks and a lacy red maculopapular rash on the trunk and arms. Which diagnosis does the nurse anticipate on the basis of the current data?1)Rubeola (measles) 2)German measles (rubella) 3)Chickenpox (varicella) 4)Fifth disease (erythema infectiosum)

Fifth disease (erythema infectiosum)

The caregivers of a child report that their child had a cold and complained of a sore throat. When interviewed further they report that the child has a high fever, is very anxious, and is breathing by sitting up and leaning forward with the mouth open and the tongue out. The nurse recognizes these symptoms as those seen with which of the following disorders? a) Spasmodic laryngitis b) Epiglottitis c) Tonsillitis d) Laryngotracheobronchitis

Epiglottitis Correct Explanation:The child with epiglottitis may have had a mild upper respiratory infection before the development of a sore throat, and then became anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. The child with tonsillitis may have a fever, sore throat, difficulty swallowing, hypertrophied tonsils, and erythema of the soft palate. Exudate may be visible on the tonsils. The child with acute laryngotracheobronchitis develops hoarseness and a barking cough with a fever, cyanosis, heart failure and acute respiratory embarrassment can result.

Fifth Disease Treatment

Families must be taught to wash hands frequently and to teach the child to cover the mouth and nose when coughing or sneezing. Once the rash is present, it is unlikely that the child is contagious. Pregnant caregivers should understand potential risks for miscarriage or stillbirth.

Munchausen's syndrome by proxy (MSBP)

Harm or significant injury to a child by another individual, often the mother, who typically has some healthcare knowledge and who inflicts harm to the child to receive attention from others.

Immunizations 6-12 years

If not given between 4 and 5 years of age, children should receive the following vaccines by 6 years of age: diphtheria and tetanus toxoids and pertussis (DTaP); inactivated poliovirus; measles, mumps, and rubella (MMR); and varicella. Yearly seasonal influenza vaccine: inactivated influenza vaccine (IIV) or live, attenuated influenza vaccine (LAIV) by nasal spray. 11 to 12 years: tetanus and diphtheria toxoids and pertussis vaccine (Tdap); human papillomavirus (HPV) vaccine, and meningococcal vaccine. Follow the current CDC guidelines for administration of the COVID-19 vaccine to children 6 to 12 years of age.

What is it important to assess in a child receiving prednisone to treat nephrotic syndrome?

Infection

DI vs SIADH

It is important that the nurse can distinguish between SIADH and diabetes insipidus (DI). DI is the opposite of SIADH. In DI, less ADH is produced and secreted, and the child's urine has a very low specific gravity. DI causes the child to produce copious urine.

Attending kindergarten is an important milestone for a young child. Which immunizations, if all prior immunizations are complete, would be needed for a 5-year-old attending kindergarten?

MMR, IPV, and DTP

Based on their egocentric and magical thinking, how may preschoolers view thier hospitalization?

May view illness or hospitalization as punishment for misdeeds

ADHD clinical manifestations

Must have at least 6 Fidgets with fingers, hands, objects • Often leaves his or her seat in the classroom when expectations are to stay seated • Experiences forgetfulness at school with homework assignments and at home with daily activities • Becomes easily distracted and excited when distracted • Seems to not listen and does not follow through with explained expectations of desired actions • Talks excessively and blurts out answers before called upon in class • Interrupts, intrudes on others, and does not have the capacity to wait for his or her turn • Cannot pay attention to detail and makes frequent mistakes that are considered careless • Has difficulty playing quietly and has problems with focusing on play without frequent changes in play activities

Myopia

Nearsightedness Because The Light Rays Fall In Front Of The Retina -nearsightedness -can see close -difficulty seeing far

Nursing Considerations for Cushing's Syndrome

Nursing care includes ensuring that there is an order for slowly tapering corticosteroids if the child is on these medications. Fast withdrawal or abrupt discontinuation of corticosteroids results in Cushing's syndrome. Be aware of the need to support the child's immune function and monitor the child for the development of infections. Families need to understand that mood swings are expected with the hypersecretion of ACTH and that the mood disorder may last weeks to months after treatment is discontinued.

Nursing considerations Meningococcal meningitis

Nursing considerations for meningitis include meticulous maintenance of a patent IV catheter for antibiotic therapy, symptoms management, and fluid as needed. Care should be taken to keep antibiotics administration on time and therapeutic serum values of antibiotics on target. Keep the child's condition guarded, and until the causative agent is identified, maintain the child on strict airborne and contact isolation. The combination of these two forms of isolation is often termed respiratory isolation and should be left in place for 24 to 48 hours after the administration of antibiotics begins. Some institutions require that three doses of antibiotics be administered before respiratory isolation is discontinued. Monitor the child for increasing ICP and head circumferences. If there is a change in head circumference, the child may be experiencing the complication of meningitis called obstructive hydrocephalus.

Which physical assessment technique will the nurse omit when caring for a 2-year-old diagnosed with Wilms' tumor?

Palpating the abdomen

A nurse is collecting data during a well-baby visit with a 4 mo old infant. Which of the following immunizations should the nurse plan to administer to the infant? (SATA) Measles, mumps, rubella, (MMR) Polio (IPV) Pneumococcal vaccine (PCV) VaricellaRotavirus vaccine (RV)

Polio (IPV) Pneumococcal vaccine (PVC) Rotavirus (RV)

Clinical manifestations of Meningococcal meningitis

Poor feeding habits • Fever • A child who is irritable, is inconsolable when held, or has a high-pitched cry • Lethargy • Bulging fontanels • Opisthotonos positioning: Hyperextension of the child's neck and back, or nuchal rigidity in which the child holds the neck very still • Kernig's sign: Resistance and sudden pain with knee extension when the child is in a supine position with knees flexed up (FIG. 27.7) • Brudzinski's sign: When the child's neck is flexed during supine position, the child will suddenly flex the knees and hips (FIG. 27.8)

Ear infections

Recurrent ear infections can cause speech delays.

Justice

Respecting the rights of others and giving them what is rightfully theirs

FLACC Scale

Scale for 2-7 years face, legs, activity, cry, consolability

The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone?

Should be delayed

Nephrotic Syndrome Clinical manifestations

Signs of nephrotic syndrome include the following: • Fatigue • Decreased appetite (anorexia) • Fluid accumulation (edema) • Weight gain with abdominal swelling • Golden-yellow, foamy urine (may be blood in urine) • Diarrhea • Loss of appetite • High blood pressure

Type of fracture most common in abuse?

Spiral

Congenital heart defects signs and symptoms

Tachycardia. Arrythmias. Grunting. Failure to thrive. Growth retardation. Dyspnea. URIs. Murmurs. Decreased perfusion.

Blood product administration

The administration of blood products may be required for a child with a severe anemia. The most commonly administered blood product is PRBC, in which most of the serum and WBCs have been removed. Each blood product is different and has unique properties.

Adrenal Crisis Manifestations

The medulla of the adrenal gland produces epinephrine (adrenalin) and norepinephrine that affect the child's stress response as well as the glucocorticoids cortisol and corticosteroid. If the adrenal glands produce too much adrenalin, the child may experience tachycardia, tremors, restlessness, hypertension, and nausea/vomiting. If they produce too little adrenalin, the child may experience weakness, dry lips and skin, feeding difficulties, and vomiting. Older children with adrenal insufficiency may experience dizziness, muscle weakness, weight loss, and poor appetite.

Pertussis clinical manifestations

The hallmark symptom is an uncontrollable and violent cough, sometimes followed by vomiting. With the severe coughing episodes, cyanosis can occur, the eyes can roll back, and the level of consciousness can change. Seizures and, in rare cases, encephalopathy, have been associated with the illness.

Nursing considerations Anorexia

The nurse needs to understand the anxiety associated with eating for a child with an eating disorder. These children may become angry, disruptive, and manipulative in order to avoid consuming calories, to binge in secret, or to eat their preferred non-food substance. Make sure the child does not have an opportunity to purge (vomit) after meals or to engage in other harmful eating behaviors. The nursing goals for children with eating disorders include securing a weight within 10% of expected for age and height; resolving underlying emotional and psychological problems; correcting malnutrition; preventing severe consequences such as type 2 diabetes, anemia, electrolyte and cardiac dysfunction; and assisting with a treatment plan to restore the child's perception of health and healthy body image. Left untreated, eating disorders can be fatal; therefore, it is imperative to identify and treat them early. Parents must be educated on the need to participate fully in therapy. Nurses can be instrumental in becoming involved with adolescent education and prevention through community action.

Fifth Disease Clinical manifestations

The virus causes a low-grade fever and a mild rash with a characteristic "slapped cheek" appearance on the face and a lacy red rash on the child's limbs and trunk that resolves in approximately 7 to 10 days.

Early shock s/s

Three common symptoms of early shock are hypovolemia, hypotension, and a change in mental status

MMR: Measles, Mumps, and Rubella:

Two doses: 12-15 months; 4-6 years Live virus

A 6-month-old infant is due for the last dose of hepatitis B vaccine. Which site should the nurse select for administering the injection?

Vastus lateralis

Which CHD results in increased pulmonary blood flow? a. Ventricular septal defect b. Coarctation of the aorta c. Tetralogy of Fallot d. Pulmonary stenosis

Ventricular septal defect

Immunizations 11-12

Yearly seasonal influenza vaccine: inactivated influenza vaccine or live attenuated influenza vaccine by nasal spray. Recommendation can be season-specific. Meningococcal vaccine: receive 2nd dose @ 16 years of age if received 1st dose received at 11-12 years of age. Follow the current CDC guidelines for administration of the COVID-19 vaccine to adolescents 12 to 20 years of age

What is sometimes seen with a scabies infection?

characteristic burrow under the skin between the fingers

Non-maleficence (do no harm)

do no harm or to inflict the least possible harm to reach a beneficial outcome.

What do the scabies burrows contain?

eggs and feces of the mite

Ericksons Infant: Trust vs. Mistrust

encourage parent to visit or room in encourage parent to participate in care try to stick to a routine and same nurse keep scary objects out of view provide swaddling, soft talk and soothing allow for non nutritive sucking for comfort

Ericksons:Toddlers: Autonomy vs. Shame and Doubt

encourage parents to be there as much as possible do not have parents sneak out when child is asleep bring security objects inset limits, give choices on simple decisions teach parents about regression in their child promote ritualistic behavior before bedtime teach parents about hazards

Cushing's syndrome treatment

f Cushing's syndrome is related to the chronic use of steroid hormones, a gradual tapering down and discontinuing of the medication may improve the syndrome. Surgery may be required if an adrenal tumor is causing the syndrome. Before the child or teen has surgery, the medical team may prescribe medications that inhibit cortisol production along with medications that help to reduce the side effects of high blood pressure and high blood glucose.

Emotional abuse or Neglect

failure of the parent or caregiver to provide an appropriate supportive environment

Encopresis

fecal incontinence; a medical diagnosis given to a child 4 or older who had previously been potty trained but is now soiling clothing during the day time.

osteomylelitis

infection of the bone

Stimulus for Toddlers

measuring cups or spoons, wooden puzzles or building blocks, and push-pull toys.

Stimulus for Newborn's and Infants

mobiles, music, and mirrors. Rocking and Cuddling

osteogenesis imprefecta (OI)

or brittle bone disease, is the most common genetic disorder of the bone

Autonomy

patients have the right to have control over their own bodies and make their own decisions. Such as refusing treatement, medications, procedures, testing and surgeries if they wish.

Egocentric and magical thinking is typical of what age of children?

preschoolers

Proximal Distal Development

the young infant slowly masters movement. The first movements are primitive reflexes that over time become purposeful movement.

Sexual abuse

when an adult uses a child or adolescent for sexual purposes

Cushing's Syndrome Clinical manifestations

• Central obesity (adipose tissue on the chest, face, and abdomen) • Decreased glucose tolerance • Poor wound healing • Muscle weakness and atrophy from increased glucogenesis • Easy bruising • Osteoporosis • Acne • Hirsutism (male-pattern hair growth in females) • Hypertension • Mood disorder • Decreased linear growth

Hepatitis B vaccinations:

- Three doses: Birth-2 months; 1-4 months; 6-18 months - Inactivated virus

A pediatric nurse examines the abdomen of a preschool-aged child brought to the doctor's office by the grandmother because of vomiting over the last several days. Upon inspection, the nurse observes that the child's stomach is distended. Based on these data, which condition does the nurse suspect? 1) Intestinal obstruction 2) Kidney failure 3) Displaced abdominal organs 4) Omphalitis

) Intestinal obstruction -Sx are a distending abdomen and vomiting

What are nursing considerations for ASD?

- One on one care- give directions w/o rationales - minimize touch to prevent outburst - Provide calm & non-stimulating enviroment - Be very supportive & Empathetic to the parents

Varicella:

- Two doses, one at 12-15 months and one at 4-6 years

s/s of sickle cell anemia (4)

- abdominal and joint pain -joint swelling -low H/H (pallor and fatigue) anemic -SOB or dyspnea

Osteomyelitis treatment

- coarse of broad spectrum antibiotics - exact antibiotics will be given after culture - evaluate response to antibiotic therapy 2-3 days after initial dose - if effective, IV is d/c and oral is given for 4-8 weeks at home - if resistance is met, IV antibiotics are given for much longer - monitor ESR which is a good indication of resolved infection if decreased - palliative measures; rest, oral pain medication, good nutrition, and diversional activity - teach importance of antibiotic compliance

nursing care; OI

- surgery to reduce fractures, correct spinal deformities, and straighten long bones- rods for stabilization- introduction of biphosphate- ensure to rule out child abuse- nutritional and hydrational therapy- pain management- assess vitals and neuro- encourage play and interaction

when a child is referred to a healthcare provider after scoliosis screening, the plan is to defer treatment and watch the child. the nurse determines that the child's curvature must be less than?

20°

An infant who is diagnosed with a mild heart defect will not have surgical intervention for at least 2 years. Which information should the nurse include in the discharge teaching regarding management in the home environment? 1 "Your child will have a low grade fever until the defect is repaired" 2 "It is important for your child to maintain normal activity" 3 "It is important to avoid antipyretics for the treatment of fever" 4 "Your child is not at risk for congestive heart failure"

2 "It is important for your child to maintain normal activity"

When talking to the parents of a school-aged cancer patient, the pediatric nurse identifies which as the most common cancer found in children?

2) Acute lymphocytic leukemia

Wong-Baker FACES Pain Rating Scale

3 years and above, adults with disabilities, need to have a concept of numbers

5. Which percentage of reported cases of child abuse in the United States reflects child neglect?1) 12% 2) 16% 3) 24% 4) 52%

4) 52%

Rapid response

A designated team designed to rapidly assemble at a child's bedside or clinic room to provide emergency response skills and resuscitation if needed. In acute care settings, a patient's condition can worsen rapidly, and the health-care team needs to have assistance immediately. RRTs were developed to offer family and staff an option to request and receive support from health-care professionals above and beyond those present on the floor. RRTs give nurses support in responding to emergencies in which a patient's condition suddenly becomes much worse but the patient has not fully "coded" or gone into cardiopulmonary arrest. The activation of an RRT can be done by anyone who sees a patient's condition change so dramatically that assistance is required right away to prevent him or her from experiencing full cardiopulmonary arrest. Most institutions post the number to call for an RRT at each patient's bedside.

The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child's diet? A) Bananas B) Toast C) Oatmeal D) Potatoes

A) bananas

The nurse is caring for a child who experiences frequent ear infections. The child's mother wants to know why this is occurring. Which anatomical differences in the pediatric patient increase the risk for otitis media? (Select all that apply.) A. Impaired drainage B. Longer, thinner eustachian tubes C. Shorter, horizontal eustachian tubes D. Typical lying-down position of infants E. Underdeveloped cartilage lining

A. Impaired drainage C. Shorter, horizontal eustachian tubes D. Typical lying-down position of infants E. Underdeveloped cartilage lining

5. A 4-year-old girl is brought to the emergency department. She has a "frog-like" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. Which nursing action is the priority for this patient? A. Maintain the airway. B. Obtain a throat culture. C. Start an intravenous line. D. Transport for a chest x-ray.

ANS: A

A nurse is planning to speak with a parent support group about childhood autism. What will the nurse include? a. Significant signs of the disorder manifest by 1 year of age. b. The earliest signs of autism are impulsivity and overactivity. c. Autism is usually diagnosed when the child goes to elementary school. d. Medications can cure childhood autism.

ANS: A Failure to use eye contact and look at others, poor attention span, and poor orienting to one's name are significant signs of dysfunction by 1 year of age.

A child is being treated for nephrotic syndrome. Which assessment finding indicates that an important goal for this child is being met? A. Decreased abdominal girth B. Diminished urine output C. Improved rash D. Increased weight over a week

ANS: A The combination of fluid retention and protein loss through the urine produces ascites, or a swollen belly. Decreasing abdominal girth signifies that the disease is being successfully treated. Urine output is already diminished in nephrotic syndrome. There is no rash. Increasing weight means increased fluid retention, which would not be an improvement.

A child is admitted to the hospital with suspected hemolytic uremic syndrome (HUS). Laboratory results indicate elevated BUN, creatinine, and potassium. Which action by the nurse takes priority? A. Administer antibiotics. B. Apply cardiac monitoring. C. Insert a urinary catheter. D. Obtain a stool sample.

ANS: B An elevated potassium can cause serious, even fatal, dysrhythmias. The nurse applies cardiac monitoring first for patient safety. Inserting a urinary catheter and sending a stool sample are appropriate but do not take priority. Antibiotics are not given in HUS because they exacerbate the condition.

The interventions that would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis would be: a. wearing splints at night to prevent extension contractures. b. applying moist heat packs upon awakening. c. taking a warm tub bath the evening before. d. sleeping with two pillows under the head.

ANS: B Application of moist heat, with a compress or by tub bath upon awakening, will help to lessen stiffness.

A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end. The nurse responds that antibiotic therapy will probably last for: a. 2 weeks. b. 6 weeks. c. 2 months. d. 3 months.

ANS: B Because osteomyelitis is an infection in the bone, antibiotics are given intravenously for 4 to 6 weeks.

The parent of a child with osteomyelitis asks why his child is in so much pain. The nurse's response will be based on the understanding that the pain of osteomyelitis is caused by: a. the pressure of inelastic bone. b. purulent drainage in the bone marrow. c. the cast applied on the extremity. d. circulatory congestion of the skin.

ANS: B Osteomyelitis is an infection of the bone. Inflammation produces an exudate that collects under the marrow and cortex of the bone. The vessels are compressed and thrombosis occurs, producing ischemia and pain

The nurse explains that use of stimulants will decrease hyperactivity in the autistic child. What is a negative aspect of stimulants? a. Sedating the child b. Impairing cognition c. Causing hypotension d. Creating fluid retention

ANS: B Stimulants that decrease the hyperactivity in the autistic child also impair cognition and may increase the potential of self-injuring behavior.

The nurse assessing a child with juvenile rheumatoid arthritis notes the child's right knee and ankle are swollen, warm, and tender and with a temperature of 38.8 C (102 F) and abdominal pain. These findings suggest that this child has the ___________ type of juvenile rheumatoid arthritis. a. psoriatic b. enthesitis c. systemic d. acute febrile

ANS: C The systemic form of juvenile rheumatoid arthritis is associated with an elevated temperature, erythrocyte sedimentation rate (ESR), and C-reactive protein; abdominal pain; and a macular rash.

What is an appropriate nursing intervention for a hospitalized child who is autistic? a. Place the child in a location where she can watch all of the activity on the unit. b. Use the child's chronological age as a guide for communication. c. Keep the child's room free of toys or objects that she might want to take home with her. d. Organize care to provide as few disruptions to the routine as possible.

ANS: D

Strabismus

Abnormal alignment of the eyes that interferes with binocular vision; both eyes do not properly align with each other (also called cross-eye or wall-eye in lay terms).

An adolescent patient has blood drawn by the clinic nurse for laboratory studies confirming an infection with the Epstein-Barr virus. The clinic nurse is teaching the adolescent and parents about the appropriate treatment. Along with rest and acetaminophen (Tylenol) for pharyngitis, which other point does the nurse include in the educational session? 1)Tepid baths three times a day 2)Oral care and the use of mouthwash 3)An extended absence from contact sports 4)Frequent follow-up clinic appointments

An extended absence from contact sports

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? (Select all that apply.) A) Corn flakes B) Bananas C) Skim milk D) Rye bread E) Oatmeal F) Applesauce

B) Bananas C) Skim milk f)applesauce

When does separation anxiety manifest for an infant?

Between 4 to 8 months

When does stranger fear manifest for an infant?

Between 6 to 8 months

Immunizations for 12 months

Birth: hepatitis B (Hep B) 2 months: diphtheria and tetanus toxoids and pertussis (DTaP), rotavirus vaccine (RV), inactivated poliovirus (IPV), Haemophilus influenzae type B (Hib), pneumococcal vaccine (PCV), and Hep B 4 months: DTaP, RV, IPV, Hib, PCV 6 months: DTaP, IPV (6 to 18 months), PCV, and Hep B (6 to 18 months); RV; Hib 6 to 12 months: seasonal influenza vaccination yearly (the inactivated influenza vaccine is available as an intramuscular injection)

Bulimia Nervosa Clinical manifestations

Bulimia is characterized by an excessive appetite and insatiable eating, including sneaking and hiding food. Bulimia is defined as recurrent episodes of binge eating followed by guilt; humiliation; shame; and then self-induced vomiting, dieting, and exercise. The child will try to cover up or hide the behaviors associated with bulimia. Often the child or teen is of normal weight.

At what age is an infant able to distinguish themselves as being separate from their parents?

By the end of the first year

The nurse is collecting data for a child with idiopathic celiac disease. The caregiver tells the nurse that the child has bulky and greasy stools. What should the nurse suspect the child is experiencing? A) Pica B) Invagination C) Steatorrhea D) Polyuria

C) Steatorrhea

A child with pertussis is in the catarrhal stage of the disease. Which assessment findings correlate with this condition? (Select all that apply.) A. Chronic cough lasting weeks B. Intense cough causing vomiting C. Low-grade fever D. Sweating and fatigue after coughing E. Upper respiratory symptoms

C. Low-grade fever E. Upper respiratory symptoms

A 1-year-old child has the following arterial blood gas values (ABGs): pH: 7.28, PCO2: 58 mm Hg, PO2: 77 mm Hg, HCO3: 14 mEq/L, O2 saturation: 88%. Which interpretation of the results by the nurse is the most accurate? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis

A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic? a. Place the infant in a knee-chest position .b. Administer oxygen .c. Administer morphine sulfate. d. Calm the infant.

Calm the infant.

Which drug is an angiotensin-converting enzyme (ACE) inhibitor? a. Captopril (Capoten) b. Furosemide (Lasix) c. Spironolactone (Aldactone) d. Chlorothiazide (Diuril)

Captopril (Capoten) Capoten is a drug in an ACE inhibitor.

Four children are in the pediatric clinic waiting to be seen. Which patient should the nurse see first? A. Afebrile, parent reports harsh barky cough B. Pulling on ear, temperature 103°F (39.5°C) C. Salty-tasting sweat, poor weight gain D. Wheezing, retracting, no wet diapers today

D. Wheezing, retracting, no wet diapers today

A beneficial effect of administering digoxin (Lanoxin) is that it a. Decreases edema b. Decreases cardiac output c. Increases heart size d. Increases venous pressure

Decreases edema

Tx for Cushing's Disease

Depends on cause.. Tumor removal Hormone replacement

Physical Neglect

Deprivation of food, clothing, shelter, supervision, medical care, and education

When conducting a child's physical assessment, the pediatric nurse recognizes that the child's "slapped cheek" facial rash is associated with which virus? 1)Epstein-Barr 2)Fifth disease 3)Varicella-zoster 4)Hepatitis A

Fifth disease

Haemophilus influenzae Type B (Hib):

Four doses: 2 months; 4 months; 6 months; and 15 months Polysaccharide conjugate vaccine

Stimulus for school-age children

Games, books, puzzles, schoolwork, crafts, tape-recordings, computers, and video games.

The nurse is preparing to administer a long-acting insulin. Which insulin is considered long acting?

Glargine

Which laboratory result indicates good metabolic control for a child with type 1 diabetes mellitus?

Glycosylated hemoglobin value of 8%

Peak Flow

Green Zone: • Peak flow measurements are between 80% and 100% of the child's personal best when not experiencing asthma symptoms. • The child is instructed to take his or her daily medications and participate in all normal activities. Yellow Zone: • Peak flow measurements are between 50% and 80% of the child's personal best when not experiencing asthma symptoms. • The child experiencing asthma symptoms in the yellow zone is instructed to slow down, take his or her fast-acting inhaler now, and keep his or her inhaler available throughout the day. Red Zone: • Peak flow measurements are below 49% of the child's personal best when not experiencing asthma symptoms. • The child is experiencing a severe asthma attack and should be seen by his or her health-care provider, be taken to the closest emergency department, or the parent should call 911. All medications should go with the child for evaluation.

What immunizations should an infant receive at birth?

Hepatitis B (Hep B)

A nurse is reviewing the immunization record of a 9-month-old with the parents. Which immunizations would the nurse expect to see listed?

Hepatitis B; diphtheria, tetanus, and pertussis (DTaP); Hib; IPV; and PCV

What are the two most important factors when caring for a child with pertussis?

Hydration and nutrition

S/S of Cushing's Disease

Hyperglycemia Electrolyte problems Pheochromocytoma

What are some symptoms of pertussis?

Initially, the symptoms resemble those of a cold, including runny nose, congestion, and sneezing. After 1 to 2 weeks, the patient has repeated, violent, prolonged coughing fits that can last up to 30 to 60 seconds. Thick, tenacious secretions obstruct the bronchi and bronchioles of the lungs, often leading to atelectasis and pneumonia.

Preschoolers are in the _____________________ stage of Erikson's Psychosocial Development.

Initiative vs. Guilt

Idiopathic Thrombocytopenic Purpura (ITP) Nursing Considerations

Nursing considerations for ITP include the following: • Because the child is at risk for bleeding, the child should be carefully monitored for signs of internal bleeding. These signs include headache, stomachaches, painful joints, and hematuria. • Family members should be taught to maintain a safe environment for the child and to choose quiet play activities such as coloring, painting, reading, puzzles, clay work, or crafts. • Nursing care includes teaching families about maintaining safety until treatment allows a rise in the circulating platelet counts. The nurse will administer IVIG for a goal of a rapid rise in platelets, and prednisone to decrease the formation of antiplatelet antibodies. New treatments include the administration of anti-D antibody (one dose) before the administration of prednisone. Children may be hospitalized for the time required to elevate the platelets. This provides safety and monitoring for the onset of bleeds.

The nurse caring for a child with nephrotic syndrome is alert to which classic symptoms of this disorder? (Select all that apply.)

Proteinuria Grossly bloody urine Fatigue Generalized edema

Bulimia Treatment

Psychotherapy is the mainstay of treatment and includes behavior modification. Medications such as antidepressants may be required to support the child. Other interventions are specific to the type of eating disorder being treated.

Hemolytic Uremic Syndrome (HUS) Nursing Considerations

The family experiences stress and anxiety not knowing what is wrong with their child and will be concerned about the high level of care required right after a confirmed diagnosis. Providing emotional support while answering all questions will be important to the well-being of the family. Because of the severity of the diagnosis, family members will be fearful of the potential of poor outcomes or the threat of death. Teach families about safe food preparation and washing of fruits and vegetables to prevent HUS. Part of anticipatory guidance for new parents is to remind them that adequate and safe food preparation reduces the likelihood of contamination and illness.

Nursing considerations Bulimia

The nurse needs to understand the anxiety associated with eating for a child with an eating disorder. These children may become angry, disruptive, and manipulative in order to avoid consuming calories, to binge in secret, or to eat their preferred non-food substance. Make sure the child does not have an opportunity to purge (vomit) after meals or to engage in other harmful eating behaviors. The nursing goals for children with eating disorders include securing a weight within 10% of expected for age and height; resolving underlying emotional and psychological problems; correcting malnutrition; preventing severe consequences such as type 2 diabetes, anemia, electrolyte and cardiac dysfunction; and assisting with a treatment plan to restore the child's perception of health and healthy body image. Left untreated, eating disorders can be fatal; therefore, it is imperative to identify and treat them early. Parents must be educated on the need to participate fully in therapy. Nurses can be instrumental in becoming involved with adolescent education and prevention through community action.

Nephrotic Syndrome treatment

Treatment is generally supportive. Conduct daily weights at the same time of day and on the same scale. Treat fluid retention with diuretics, and manage hypertension. Administer corticosteroids to decrease the size of the pores through which proteins are lost. When the level of serum proteins is very low, the child may require IV administration of albumin. A nutritionist will follow the child and initiate a low-salt, high-protein diet. In severe cases, immunosuppressive therapy may be required.

What is involved in the trust of Erikson's psychosocial developmental task for the infant?

Trust feeding, comfort, stimulation, & caring needs will be met

Amblyopia

Unilateral or bilateral decrease of best corrected vision in an otherwise healthy eye often because of asymmetric refractive error (deflection from a straight path or change in direction of light) or the presence of strabismus.

What can occur in children with scabies?

a vesiculopustular lesion

A nurse is assisting with conducting a well-child visit with a child who is scheduled to receive the recommended immunizations for 11- to 12-year-olds. Which of the following immunizations should the nurse administer? Select all that apply. A Inactivated influenza (IIV)​​​​​​​ B Pneumococcal (PCV) C Meningococcal (MCV4) D Tetanus and diphtheria toxoids and pertussis (Tdap) E Rotavirus (RV)

a) Inactivated Influenza c)meningococcal d)Tdap

Before giving a dose of digoxin (Lanoxin), the nurse checked an infant's apical heart rate and it was 114 bpm. What should the nurse do next? a. Administer the dose as ordered. b. Hold the medication until the next dose. c. Wait and recheck the apical heart rate in 30 minutes. d. Notify the physician about the infant's heart rate.

a. Administer the dose as ordered.

Adolescence: Identity vs. Role Confusion

assess knowledge and encourage questions involve in decisions ask if they want their parent there create few restrictions encourage to wear street clothes and perform normal grooming more concerned with the present not the future

School Age: Industry vs. Inferiority

assess what the child knows direct questions to the child when teaching use visuals when communicating suggest ways to maintain control positive feedback including decision making encourage active participation allow privacy always explain everything for understanding try to work something out to keep up with school

what is an expected assessment finding in a child with suspected scoliosis?

asymmetry of the shoulders

A nurse assessing a preadolescent child for scoliosis would: a. ask the child to bend forward at the waist, and would observe the child's back for asymmetry. b. observe the gait while the child is walking forward heel to toe. c. have the child flex the knees and look for uneven knee height. d. look at the child's shoulders and hips while fully clothed.

b. observe the gait while the child is walking forward heel to toe.

A child presents with a barking cough and when auscultating the lungs, the nurse notes stridor upon inspiration. The nurse suspects that the child has which respiratory infection? a)Epiglottitis b)Tonsillitis c)Croup d)Asthma

c)Croup

The grandmother of a young preschool age child presents with epiglottitis and tells the nurse that she does not understand the definition of the diagnosis. The nurse would be most correct in stating that epiglottitis is a(n): a)Form of croup b)Life-threatening infection of the lung c)Swelling of the throat that can cause obstruction d)Upper airway infection related to inflammation

c)Swelling of the throat that can cause obstruction

You are providing preoperative teaching to the parents of a 12 month old who is having surgery to repair a ventricular septal defect (VSD). Identify the location in the heart where this defect is found; a)at the termination of the aorta b)at the mitral valve c)between the left and right ventricles d)between the left and right atria

c)between the left and right ventricles

What condition is defined as reduced visual acuity in one eye despite appropriate optical correction? a.Myopia b.Hyperopia c.Amblyopia d.Astigmatism

c.Amblyopia

A 3-year-old patient is admitted to the hospital with suspected congenital heart disease. Upon auscultating the heart sounds and a full assessment, which clinical finding confirms the nurse's suspicion?a)Capillary refill less than 2 seconds b)S1 & S2 c)Warm extremities d)S3 & S4

d)S3 & S4

What sign or symptom is most worrisome in terms of degree of airway compromise?a)Fever b)Wheezing c)Cough d)Stridor

d)Stridor

Encopresis clinical manifestations

no sensation or urge to deficate due to enlargement of the colon the intestinal walls and the nerves located within them stretch and cause a diminishing of sensation. severe constipation with abd pain lack of appetite avoidance of bowel movements passage of VERY LARGE stools that may clog the toilet.

Coarctation of the Aorta Clinical manifestations

• Heart murmur to the left sternal border area • Tachycardia • An enlarged heart evidenced on chest x-ray • Tachypnea, particularly with feeding or crying • Difficulty eating, due to shortness of breath from extra blood flow to lungs, and fatigue • Weak or absent lower extremity pulses, which result from decreased cardiac output • Lower blood pressures to the lower extremities than to the upper limbs • Possible development of CHF as the PDA closes • Hepatomegaly from fluid overload associated with CHF • Vertigo, headaches, and leg pain • Increased oxygen saturation and blood pressures in the upper extremities as compared to the lower extremities • Low weight or slow weight gain due to inability to finish feeds

What are some interventions you would perform on a patient who was diagnosed with pyloric stenosis?

■NPO ■Position child on Right side Pre-op ■Post op-Maintain NGT. Monitor I & O ■Introduce clear fluids slowly as ordered.

An adolescent client reports recurrent abdominal pain with diarrhea and blood stools. Which type of inflammatory bowel disease does the nurse suspect based on these data? 1) Necrotizing enterocolitis (NEC) 2) Ulcerative colitis (UC) 3) Crohn's disease 4) Appendicitis

2) Ulcerative colitis (UC)

What is the primary symptom in croup?1)Dysphagia 2)Cough 3)Fever 4)Pain

2)Cough Croup is a general term applied to a number of conditions whose chief symptom is a barking

The pediatric nurse is interpreting laboratory values for a patient suspected of having ulcerative colitis. Which finding does the nurse anticipate based on the diagnosis? 1) Microcytic anemia 2) Decreased sedimentation rate 3) Decreased WBC count 4) Protein in the urine

1) Microcytic anemia -Other lab findings for ulcerative colitis may include elevated sedimentation rate, elevated WBC with left shift, and ANAs

On the basis of a child's complaint of abdominal pain, the nurse suspects a Wilms' tumor. An abdominal mass associated with Wilms' tumor will be detected in which location?

1) On one side

A school-aged child is tentatively diagnosed with acute lymphocytic leukemia. The clinic nurse reviews the child's laboratory results and recognizes that which finding reflects the best prognosis?

4) WBC count less than 5000/mm3

Which of the following should the nurse include as appropriate teachings pertaining to the Epstein-Barr virus? (Select all that apply.) 1) Rest 2) Fluids 3) Avoid contact sports 4) Oral care 5) Personal hygiene

1) Rest 2) Fluids 3) Avoid contact sports

The nurse is providing care to a child diagnosed with impetigo. The child's parents ask what caused this to occur. Which organism does the nurse include when educating the parents about impetigo? 1) S. aureus 2) HPV 3) Pseudomonas aeruginosa 4) E. coli

1) S. aureus

4. Which clinical manifestation noted during a physical examination causes the nurse to suspect physical abuse? 1) Traumatic alopecia 2) Extremity fractures 3) Unilateral ecchymosis of the eye 4) Weight below the 10th percentile

1) Traumatic alopecia

9. Which is a priority nursing action when providing care to a school-aged child who is experiencing abuse? 1) Meeting the child's immediate psychological needs 2) Planning for the child's long-term physical needs 3) Earning the trust of the child's parents 4) Engaging the child in play to encourage expression of anxiety

1) Meeting the child's immediate psychological needs

The nurse administers the first does of the measles, mumps, and rubella (MMR) vaccine to a 13-month-old patient. At which time would the parent be reminded to have the second dose of the vaccine provided? 1. At age 18 months 2. At age 10 years 3. Between 2 to 4 years of age 4. Between 4 to 6 years of age

4. Between 4 to 6 years of age

Hemolytic Uremic Syndrome (HUS) Clinical manifestations

A young child with HUS may present with vomiting, severe abdominal pain, and watery or bloody diarrhea. The child will appear quite ill, pale, fatigued, and dehydrated and may demonstrate unexplained, small bruises visible only in the lining of the mouth. Because of the damaged red blood cells, the very small blood vessels of the kidneys become clogged. Because the kidneys are no longer able to eliminate waste products, uremia develops, and the child experiences fluid retention. High blood pressure and edema lead to the need for dialysis.

The pediatric nurse is observing a student nurse teach a child how to use a peak flow meter. Which instruction by the student requires intervention by the pediatric nurse? A. "Exhale for as long as you can to empty your lungs." B. "Keep your tongue away from the mouthpiece." C. "Stand up straight and tall when using the meter." D. "Write down the highest of the three readings."

A. "Exhale for as long as you can to empty your lungs."

6. A nurse is educating the parents of a 5-year-old with bacterial otitis media. Which discharge instruction is most important? A. "Bring her back if she is not better in 1 week." B. "Do not allow your child to swim in the future." C. "Give the full course of antibiotics even if she is better." D. "Ice packs are a good way to manage her ear pain."

ANS: C

The nurse has reviewed dietary restrictions for celiac disease with concerned parents. Which grain will the nurse explain can be eaten with celiac disease? a. Wheat b. Oats c. Barley d.Rice

Answer: d. Rice

The nurse, assessing an elevated erythrocyte sedimentation rate (ESR) for an infant with gastroenteritis, recognizes that this confirms the _______________ process that is part of this disease.

Answer: inflammatory

A 7-year-old child has been scheduled for a tonsillectomy. Which of the following would be most important to assess prior to surgery? a) Bleeding and clotting time b) Blood pressure both lying down and sitting up c) Specific gravity of urine d) Pulse and respiratory rate

Bleeding and clotting time Correct Explanation:Because removal of tonsils leaves a large denuded area, not a simple suture line, hemorrhage following surgery can occur.

Although the child with type 1 diabetes had her prescribed insulin at 7:30 AM, the child is complaining of hunger and thirst and is drowsy at 10:30 AM. What should the nurse do first? a. walk the patient in the hall for 10 minutes. b. allow the patient a short nap .c. give her a cup of orange juice. d. test her blood with a glucometer and give insulin according to the sliding scale

Give her a cup of orange juice

A child with diabetes is brought to the emergency department. He is flushed and drowsy, and his skin is dry. His father states that the child has been feeling progressively worse since the morning. What is this child most likely experiencing? a. Somogyi phenomenon. b. dawn syndrome. c. ketoacidosis. d. water intoxication.

Ketoacidosis

Nephrotic Syndrome Nursing considerations

Nursing considerations for a child with nephrotic syndrome include emotional support for the entire family. The edematous appearance of the child can frighten the parents, who need support to process and understand the pathology of the disease. Monitor vital signs and daily weights carefully and report any changes to the health-care team. Protect the child's skin because edema causes the skin to become vulnerable to breakdown. Provide a low-sodium diet to minimize edema. Monitor for problems with skin integrity, GI distress, poor nutrition, and fatigue. Teach families to look for symptoms of a relapse after the child is discharged. These symptoms include the appearance of albumin in the child's urine (frothy, golden-colored, and viscous) as well as changes in the child's weight, fatigue level, and appetite.

Nursing Considerations for Attention-Deficit Hyperactivity Disorder

Parents need support and education when they have a child with ADHD. When the child is in the hospital, the parents might find controlling the child's behaviors especially challenging because their routines and familiar processes are thrown off. Families should be given education about local and national support groups and organizations that specialize in locating resources and offering ideas for behavior modification. Nurses need patience when a child with ADHD is hospitalized because his or her symptoms can worsen, leading to mood swings and aggression. Nurses need to assess for the side effects associated with the use of psychostimulant therapy. These include decreased appetite, nervousness, insomnia, weight loss, tics, headaches, and stomachaches. Teach families not to allow their child to consume caffeine or decongestants and instruct them that ADHD medications should never be taken with monoamine oxidase inhibitors (MAOIs), a group of antidepressant drugs. If the child is taking pemoline, liver function tests must be conducted because this drug is associated with life-threatening liver failure.

______ is common with pertussis infections, and oral intake is often difficult because of coughing episodes and difficulty breathing.

Post-coughing emesis

What is an initial sign of nephrosis that the nurse might note in a child?

Preorbital edema

The nurse is caring for a 3-year-old with a head injury. Which assessment would lead the nurse to report the probability of increasing intracranial pressure (ICP)? a. Temperature increase from 37.2° C (99° F) to 37.7° C (100° F) b. Increase in blood pressure with an attendant decrease in pulse c. Increase in respirations d. Equilateral pupils

b. Increase in blood pressure with an attendant decrease in pulse

Which statement made by a parent of an adolescent with anorexia nervosa indicates an understanding of this condition? a. "There really isn't anything to worry about. Don't they say you can never be too thin?" b. "My daughter just doesn't have much of an appetite." c. "She is just trying to punish me for divorcing her father." d. "She seems to see herself as fat, even though her weight is below normal."

d. "She seems to see herself as fat, even though her weight is below normal."

Treatment Anorexia

• Plot the child's weight and height on a national growth chart. If the child is significantly under or over the expected weight for height and sex, further assessment is warranted. • Draw metabolic panels to assess for type 2 diabetes, lipid panels to assess for elevated serum lipids, and electrolyte panels to determine if there are imbalances, including metabolic alkalosis from vomiting. • If the child has engaged in pica, tests for lead or other toxins may be necessary, and a complete blood count (CBC) may be needed to test for anemia. • Assess blood pressure and cardiac function, including orthostatic blood pressures to detect true hypotension, and electrocardiogram (ECG) to detect dysrhythmias associated with severe electrolyte imbalances. • Assess for evidence of malnutrition: thinning hair and hair loss, brittle fingernails, dry skin, enamel loss on teeth, amenorrhea, mood changes, bradycardia, hypothermia and cold intolerance, and loss of libido. Russell's sign, bite marks on fingers and knuckles, may be present from the child inducing vomiting. • Assess for use of laxatives, diuretics, enemas, and diet pills; report any use immediately to the health-care provider.

A child presents to the pediatric clinic with a "slapped cheek" facial rash. The nurse understand that this typical rash is associated with which virus? 1) Varicella 2) Epstein-Barr 3) Fifth disease 4) Roseola

3) Fifth disease

Nystagmus

Involuntary back-and-forth movements of the eyes, most often noticeable when the patient gazes at rapidly moving or fixed objects.

What interventions will the nurse perform when feeding a child with pyloric stenosis? (Select all that apply.) a. Give a formula thinned with water. b. Burp the infant before and during feeding. c. Give the feeding slowly. d. Refeed if the infant vomits. e. Position infant on left side after feeding.

Answer: B, C, D

Following surgery for pyloric stenosis, an infant awoke from anesthesia hungry and crying. What is the most appropriate nursing action? a. Delay feeding the child for 6 hours. b. Offer regular formula thinned with water. c. Give small amounts of regular formula thickened with cereal. d. Allow 1 ounce of glucose water at frequent intervals.

Answer: d. Allow 1 ounce of glucose water at frequent intervals.

Anorexia Nervosa clinical manifestations

Diagnostic criteria for anorexia nervosa include four main attributes. Children voluntarily refuse to maintain a normal body weight for their age, height, and size and weigh 85% or less of an expected normal weight. They have a tremendous fear of gaining weight, viewing themselves as "fat" even when being significantly underweight. They deny their condition, maintain a disturbingly poor body image, and do not recognize the seriousness of their condition. Females will experience amenorrhea, the absence of at least three menstrual periods in a row.

Celiac disease Treatment

Interventions for celiac disease include the following: • Instruct the parents of the patient to provide the child with a gluten-free diet. • Correct any electrolyte disturbances. • Restore fluids if the child presents with dehydration from diarrhea, tachycardia, poor skin turgor, and elevated urine specific gravity.

The nurse is educating the parent of a child diagnosed with croup about return precautions. What symptom should the nurse include? a)Nosebleeds b)Increased respiratory rate c)Productive cough d)Tiredness

b)Increased respiratory rate

A 3-year-old girl presents to the emergency department with signs of respiratory distress. The child has epiglottitis associated with high fever, is apprehensive and drooling. Which intervention should be avoided? a)Listening to the child's lungs b)Inspecting the child's mouth and throat with a tongue blade c)Assessing the child's vital signs d)Weighing the child

b)Inspecting the child's mouth and throat with a tongue blade

A 2 month old with a congenital heart defect is admitted to the PICU with congestive heart failure. Which intervention should the nurse include in the infant's plan of care? a)Giving larger feeds less often to conserve energy b)Organizing activities to allow for uninterrupted sleep c)Monitoring respirations during active periods d)Forcing fluids appropriate for age

b)Organizing activities to allow for uninterrupted sleep

A nurse is collecting data during a well-baby visit with a 4-month-old infant. Which of the following immunizations should the nurse plan to administer to the infant? a) MMR b) Polio (IPV) c)Pneumococcal Vaccine (PCV) d) Varicella e) Rotavirus Vaccine(RV)

b)Polio (IPV) c) Pneumoccocal Vaccine(PCV) e) Rotavirus Vaccine (RV)

An infant with congestive heart failure is receiving digoxin (Lanoxin). The nurse recognizes a sign of digoxin toxicity, which is: a)restlessness b)vomiting c)decreased respiratory rate d)increased urinary output

b)vomiting

Characteristics of Autism Spectrum Disorder (ASD)

• pervasive and severe impairment in the child's communication skills and social interactions • repetitive and restrictive behaviors. • will not relate comfortably with others • does not want to be touched, cuddled, or comforted by others .• 10% of children with ASD have a co-existing chromosomal or genetic condition • 40% of children with ASD have above average intellect

How does the nurse describe a person who is bulimic? a. Severely underweight b. Alternates binge eating with purging c. Introverted perfectionist d. Has extremely close family relationships

b. Alternates binge eating with purging

The pediatric nurse tells the parents that this type of sickle cell anemia crisis is caused by an increasing rate of RBC destruction, which leads to severe anemia and a state of jaundice. Which type of sickle cell crisis is this child experiencing? 1) Sequestration crisis 1) Hyperhemolytic crisis 3) Vaso-occlussive crisis 4) Aplastic anemia crisis

1) Hyperhemolytic crisis

A child is diagnosed with attention-deficit hyperactivity disorder (ADHD). Which characteristics would the nurse assess in this child? (Select all that apply.) a. Social anxiety b. Impulsivity c. Hyperactivity d. Distractibility e. Inattention

b. Impulsivity c. Hyperactivity d. Distractibility e. Inattention

An adolescent patient presents in the emergency department with confusion. The health care provider suspects diabetic ketoacidosis (DKA). A STAT serum glucose id sone, and the result is 715 mg/dL. Which clinical manifestations does the nurse anticipate upon assessment of this patient? 1) Tachycardia, dehydration, and abdominal pain 2) Sweating, photophobia, and tremors 3) Dry mucous membranes, blurred vision, and weakness 4) Dry skin, shallow rapid breathing, and dehydration

3) Dry mucous membranes, blurred vision, and weakness

A child with a refractive error in which the light rays fall in front of the retina would have what issue? 1) Inability to see colors 2) Inability to see close up 3) Inability to see far away 4) Inability to see in his or her periphery

3) Inability to see far away

10. Which is a component of constructing patient-centered goals when planning care for a school-aged patient who is being abused? 1) Family-centered 2) Past-oriented 3) Measurable 4) Based on medical principles

3) Measurable

2. Which is the most common form of child abuse around the world that the nurse should assess for when caring for children? 1) Physical 2) Emotional 3) Neglect 4) Sexual

3) Neglect

The nurse is caring for a child with severe anemia. The laboratory reports that the child's platelet count is below 18,000/mm3. Which action should the nurse take next? 1) Let the child sleep 2) Give oral iron 3) Prepare for blood transfusion 4) Give pain medication

3) Prepare for blood transfusion

What type of fracture is often associated with child abuse? 1) Greenstick fracture 2) Hairline fracture 3) Spiral fracture 4) Buckle fracture

3) Spiral fracture

Abnormal alignment of the eyes that interferes with binocular vision is known as what visual impairment? 1) Amblyopia 2) Nystagmus 3) Strabismus 4) Esotropia

3) Strabismus

The interventions that would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis would be: a. wearing splints at night to prevent extension contractures. b. applying moist heat packs upon awakening. c. taking a warm tub bath the evening before. d. sleeping with two pillows under the head.

b. applying moist heat packs upon awakening.

The general dietary measure to include in a teaching plan for the child with type 1 diabetes mellitus is to: a. control intake of carbohydrates and consume fewer calories. b. focus on complex carbohydrates and eat foods high in fiber. c. obtain most calories from proteins and fats. d. eat a diet low in fat and low in complex carbohydrates.

b. focus on complex carbohydrates and eat foods high in fiber.

A nurse is collecting data from a child who is in the PACU post-operatively following a tonsillectomy. Which of the following indicates postoperative bleeding? a)Blood-tinged mucus b)Inflamed, red throat c)Frequent swallowing and clearing of the throat d)HGB 11.6 and HCT 37%

c)Frequent swallowing and clearing of the throat

Which pattern of breathing is characterized by slow, deep, labored respirations?a)Cheyne-Stokes breathing b)Bradypnea c)Kussmaul's breathing d)Hyperventilation

c)Kussmaul's breathing

Which insulin type is intermediate acting and cloudy with an onset of 1-2 hours, a peak of 6-12 hours, and a duration of 18-26 hours? a)Humalog b)Regular c)NPH d)Lantus

c)NPH

8. Which pediatric patient is at increased risk for child abuse, necessitating a focused nursing assessment? 1) A 3-year-old child who is toilet-trained 2) A 1-year-old child who was born at 41 weeks' gestation 3) A 9-month-old child, born prematurely, who is diagnosed with reflux 4) A 10-year-old child who is active in sports and recently made the honor roll

3) A 9-month-old child, born prematurely, who is diagnosed with reflux

The nurse is educating the stand at the clinic about child abuse. Which of the following should the nurse include as an example of an act of omission? 1) A parent calling his or her child stupid 2) A parent burning his or her child with a cigarette 3) A parent who can't provide enough food for his or her child 4) A parent who sexually abused his or her child

3) A parent who can't provide enough food for his or her child

Which is the priority teaching point for the nurse to include in the discharge instructions for the parents of a child who was admitted in a sickle cell crisis? 1) Rapid weaning of pain medications 2) A diet high in protein 3) Adequate hydration 4) Restriction of activities

3) Adequate hydration

A pediatric nurse is performing a respiratory assessment on an 18 month old child. The nurse most likely uses which recommended technique? 1 Assess the child's respiratory status when fully awake and active. 2 Assesses breath sounds by listening to all lung fields and alternating sides for comparison. 3 Assess the resonance of the lungs and underlying organs by using auscultation. 4 Assess for normal breathing using palpation.

2 Assesses breath sounds by listening to all lung fields and alternating sides for comparison.

When diagnosing schizophrenia in a young child, it is essential that an experienced and well-trained health care provider assess the child for an accurate diagnosis because there are many symptoms that overlap with those of _________ 1) Anxiety disorder 2) ADHD 3) Autism spectrum disorder 4) ARFID

3) Autism spectrum disorder

When a child eats an excessive amount of calories and follows with purging behaviors of enemas, laxatives, diuretics, self-induced vomiting behaviors, extreme exercise, or a combination of these, the disorder is known as ___________. 1) Anorexia nervosa 2) Pica 3) Bulimia 4) Binge eating

3) Bulimia

For which patient would the nurse consider the diagnosis of juvenile idiopathic arthritis (JIA)? 1) 17 year old with inflammation in more than one joint that lasts for at least 6 weeks 2) 6 year old with inflammation in more than one joint that lasts for at least 6 weeks 3) 16 year old with inflammation in one joint that lasts for at least 2 weeks 4) 7 year old with inflammation in one joint that lasts for at least 6 weeks

2) 6 year old with inflammation in more than one joint that lasts for at least 6 weeks

The pediatric nurse examines a 5 week old infant who has been observed having projectile, non bilious vomiting. Upon palpation, the nurse feels an olive-shaped mass in the midepigastrium. Based on these data, which condition does the nurse suspect? 1) Rectal atresia 2) Pyloric stenosis 3) Intussusception 4) Malrotation of the intestine

2) Pyloric stenosis

What is the nurse's priority action if Munchausen's syndrome by proxy is suspected? 1) Call the police 2) Request consultation from a social worker 3) Request consultation from occupational therapist 4) Ask the physician to prescribe anti anxiety medication

2) Request consultation from a social worker

Which term should the nurse use when talking with other members of the health-care team about a common side effect of chemotherapy that makes oral consumption difficult? 1) Thrombocytopenia 2) Stomatitis 3) Petechiae 4) Purpura

2) Stomatitis -Inflammation of the mouth and is often painful

3. Which child factor that contributes to abuse should the nurse assess for when abuse is suspected? 1) Low self-esteem 2) Temperament that is demanding 3) Stress that is chronic in nature 4) Poverty-level socioeconomic status

2) Temperament that is demanding

While assisting an RN to assess a 4-month-old during a clinical rotation, the nursing student is asked to explain which psychosocial stage the infant is expected to accomplish during the first year of life. Which response by the student is correct? 1. Sensorimotor 2. Trust versus mistrust 3. Autonomy versus shame and doubt 4. Oral fixation

2. Trust versus mistrust

An endocrinologist orders a test(s) for a child to diagnose adrenal crisis. Which test(s) does the nurse anticipate based on the child's diagnosis? (Select all that apply.) 1) CT scan of the brain 2) White blood cell count 3) Chest radiography 4) Blood test to determine electrolyte levels 5) Aldosterone levels

3) Chest radiography 4) Blood test to determine electrolyte levels 5) Aldosterone levels

20. Which individuals are mandatory reporters of child abuse? (Select all that apply.) 1) Parents 2) Grandparents 3) Childcare providers 4) Commercial film developers 5) Child protective services employees

3) Childcare providers 4) Commercial film developers 5) Child protective services employees

A child presents with a rounded face, muscle weakness, and poor wound healing. The nurse knows that these symptoms are consistent with what disorder? 1) Hypothyroidism 2) Diabetes mellitus 3) Cushing's syndrome 4) Hyperthyroidism

3) Cushing's syndrome

Which of the following is true of diabetes insipidus? 1) DI is treated with insulin 2) Small amounts of urine are produced 3) DI is the opposite of SIADH 4) ADH is overproduced and over secreted

3) DI is the opposite of SIADH

7. Which is a child factor that may increase the risk for abuse? 1) Substance abuse 2) Lack of respite care 3) Developmental delay 4) History of divorce

3) Developmental delay

Nursing care for child with ASD

• Minimize touch and explain to the child when touch is needed .• Give the autistic child time to prepare for the next activity. • Understand that autistic children may be withdrawn and quiet .• Acknowledge that autistic children may have trouble with interpersonal relations, including avoiding eye contact and having unusual language disturbances. • Stress to the parents that the autistic child might feel overwhelmed in a new environment.

15. Which is a nursing responsibility when providing care to a child who is being abused? 1) Filing a report with child protective services 2) Taking photographs of the child's injuries on a personal cell phone 3) Determining who is abusing the child 4) Washing a child who is being sexually abused upon arrival to the department

1) Filing a report with child protective services

Linda, a licensed practical nurse (LPN) sees that it is time for her 5 year old patient's digoxin. How should Linda prepare to administer this medication? (Select all that apply.) 1 Confirm the dose on hand matches the ordered dose. 2 Take the patient's temperature before administration. 3 Take the child's pulse for one full minute. 4 Use two identifiers to confirm the correct patient is receiving the medication. 5 Ask the patient if she would like to take the medication.

1 Confirm the dose on hand matches the ordered dose. 3 Take the child's pulse for one full minute. 4 Use two identifiers to confirm the correct patient is receiving the medication.

Which statement by the nurse accurately describes the difference between the respiratory tract system of a child and an adult? 1 The epiglottis in the younger child is longer and flaccid, making it more susceptible to swelling that may lead to airway occlusion. 2 The larynx and the glottis are lower in the younger child's neck, which makes the child more prone to aspiration. 3 The nares in children are larger in size, shallow in depth, underdeveloped and less easily occluded. 4 There are fewer

1 The epiglottis in the younger child is longer and flaccid, making it more susceptible to swelling that may lead to airway occlusion

Which statement accurately describes the structures of the heart? 1 The right atrium and ventricle circulate deoxygenated blood to the lungs. 2 The left atrium and ventricle circulate deoxygenated blood to the lungs. 3 The atria, ventricles, heart valves and cardiac vessels are formed and begin primitive functioning around the sixth week of pregnancy. 4 Oxygenated blood cycles to the right atrium and ventricle to pumped to the rest of the body.

1 The right atrium and ventricle circulate deoxygenated blood to the lungs.

The nurse explains that a ventricular septal defect (VSD) will allow: 1 blood to shunt from left to right causing increased pulmonary blood flow and no cyanosis 2 blood to shunt right to left causing decreased pulmonary flow and cyanosis 3 no shunting because of high pressure in the left ventricle 4 increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating blood volume

1 blood to shunt from left to right causing increased pulmonary blood flow and no cyanosis

A nurse is caring for a child newly diagnosed with type I diabetes. The nurse plans her care based on the understanding: 1 there is an absolute deficiency of insulin 2 oral hypoglycemic agents will help to control the disease 3 the pancreas is still producing small amounts of insulin 4 metformin is the first line of medication used in treating pediatric type I diabetics

1 there is an absolute deficiency of insulin

A toddler presents to the clinic with several common childhood symptoms. The health care provider thinks that the child may have a Wilms' tumor. Which symptom does the nurse expect to see? 1) Abdominal mass 2) Diarrhea 3) Cough and congestion 4) A sore throat

1) Abdominal mass

Which is the priority nursing action when providing care for a school-aged child admitted to the hospital experiencing an adrenal crisis? 1) Administering prescribed fluids and electrolytes 2) Clustering care to enhance rest 3) Monitoring for stool output 4) Providing pain relied and tepid baths

1) Administering prescribed fluids and electrolytes-Nurse must monitor closely for signs of hypovolemic shock. The nurse understands that peripheral circulation must be checked often (capillary refill, color, pulses, and extremity temperature)

An adolescent is brought to the ED. The patient reports decreased urine output, headaches, and abdominal swelling. Based on these data, which condition does the nurse suspect? 1) Chronic glomerulonephritis 2) Vesicoureteral reflux 3) Acute hematuria 4) Unexplained proteinuria

1) Chronic glomerulonephritis

The nursing goals for children with eating disorder include which of the following? (Select all that apply.) 1) Correcting malnutrition 2) Resolving underlying emotional and psychological problems 3) Reaching a weight within 50% of expected for age and height 4) Encouraging the use of laxatives in order to have regular bowel movements 5) Assisting with a treatment plan to restore a healthy body image

1) Correcting malnutrition 2) Resolving underlying emotional and psychological problems 5) Assisting with a treatment plan to restore a healthy body image

A child has been diagnosed with SIADH. Which interventions will likely be included in the child's plan of care? 1) Diuretic medication and fluid restriction 2) Diuretic medication and 0.9% normal saline 3) Desmopressin and fluid restriction 4) Desmopressin and 0.9% normal saline

1) Diuretic medication and fluid restriction

Which clinical manifestations assessed when performing a genitourinary assessment for a child diagnosed with hemolytic uremic syndrome could indicate the need for dialysis? (Select all that apply.) 1) Edema 2) Tachypnea 3) Bradycardia 4) Fluid retention 5) High BP

1) Edema 4) Fluid retention 5) High BP

Which of the following tests may be used to assist in making the diagnosis of ulcerative colitis? (Select all that apply.) 1) Hematest of stool 2) TSH 3) Barium enema 4) Colonoscopy 5) Esophageal biopsy

1) Hematest of stool 3) Barium enema 4) Colonoscopy

What are some indicators of Munchausen's syndrome by proxy (MSBP)?

1. Child is under 6 years of age with a history of many illnesses, hospitalizations, and "strange" symptoms .2. Perpetrator is usually the mother, who has some health-care knowledge. 3. Father is not present in the health-care interaction, is uninvolved, or is absent from the home/family. 4. Possible positive family history of parent with MSBP or another sibling who has experienced this type of abuse. 5. Claimed medical history of the child by the mother is not supported by evidence found by health-care professionals. 6. Child has both a history of multiple hospitalizations and experiences with multiple blood tests, x-rays, and other invasive procedures. 7. The child does not display the symptoms during hospitalization, symptoms are not witnessed by another, and the child's condition improves when the mother is not present. 8. The child's clinical signs and symptoms cannot be explained or substantiated by a known disease etiology. 9. A history of one or more unusual illnesses or death of another child in the family. 10. Child's condition improves while in the health-care environment .11. Specimens of blood do not match a specimen of blood from the child. 12. Findings of chemicals in the child's body secretions (urine, blood, or stool).

The nurse is providing care to an infant diagnosed with congenital clubfoot. Which parental statement regarding the child's care indicates correct understanding of the information provided? 1 "We will need to go to physical therapy once a week for the next year." 2 "We will need to undergo a series of casting procedures to stretch and move the deformity into alignment." 3 "We will need to come back once every three months for recasting of the foot." 4 "We know that surgical correction is the on

2 "We will need to undergo a series of casting procedures to stretch and move the deformity into alignment."

For which patient would the nurse consider the diagnosis of juvenile idiopathic arthritis (JIA)? 1 7 year old with inflammation in one joint that lasts for at least 6 weeks 2 6 year old with inflammation in more than one joint that lasts for at least 6 weeks 3 16-year-old with inflammation in one joint that lasts for at least 2 weeks 4 17 year old with inflammation in more than one joint that lasts for at least 6 weeks

2 6 year old with inflammation in more than one joint that lasts for at least 6 weeks

A child diagnosed with aplastic anemia is admitted to the hospital. The parents ask the nurse what aplastic anemia is. Which response by the nurse is accurate? 1) "Aplastic anemia causes proliferation of WBCs" 2) "Aplastic anemia is characterized by abnormally shaped red blood cells" 3) "Aplastic anemia is caused by the bone marrow producing inadequate cells" 4) "Aplastic anemia is a disorder that occurs after a viral illness"

3) "Aplastic anemia is caused by the bone marrow producing inadequate cells"

A child diagnosed with aplastic anemia is admitted to the hospital. The parents ask the nurse what aplastic anemia is. Which response by the nurse is accurate?

3) "Aplastic anemia is caused by the bone marrow producing inadequate cells."

Which child should the nurse refer for further assessment because of a probable diagnosis of ASD? 1) A 6 year old boy who chatters constantly to anyone who will listen 2) An 18 month old child who walks around the area using the furniture to provide balance 3) A 4 year old girl who doesn't make eye contact with her mother and resists the mother's touch 4) A 3 year old boy who joins one group of children then moves to another group of children without joining their activities

3) A 4 year old girl who doesn't make eye contact with her mother and resists the mother's touch

Which factors associated with Munchausen's syndrome by proxy should the nurse include in an educational session regarding this topic? (Select all that apply.) 1) The child is usually under the age of 10 years 2) The child often displays symptoms during the hospitalization 3) The child has had multiple hospitalizations in the medical history 4) The perpetrator is usually the father with some knowledge of health care 5) The claimed history is not supported by evidence found in health-care providers

3) The child has had multiple hospitalizations in the medical history 5) The claimed history is not supported by evidence found in health-care providers -child is usually under the age of 6 years -the perpetrator is typically the mother with some knowledge of healthcare

19. Which factors associated with Munchausen syndrome by proxy should the nurse include in an educational session regarding this topic? (Select all that apply.) 1) The child is usually under the age of 10 years. 2) The child often displays symptoms during the hospitalization. 3) The child has had multiple hospitalizations in the medical history. 4) The perpetrator is usually the father with some knowledge of health care. 5) The claimed history is not supported by evidence found by health-care providers.

3) The child has had multiple hospitalizations in the medical history. 5) The claimed history is not supported by evidence found by health-care providers.

The nurse is administering packed RBCs to a child with sickle cell disease (SCD). When should the nurse monitor the child closely because of the risk of reaction? 1) 6 hours after the transfusion is given 2) At the end of the administration of the transfusion 3) The first 20 mL of blood administered 4) Never; children with SCD do not have reactions

3) The first 20 mL of blood administered

The nurse is working on a pediatric oncology floor and is speaking with the family of a child who will require chemotherapy treatment. Which statement made by the nurse accurately describes the administration of a chemotherapy drug regimen to prevent metastasizing? 1) The induction phase focuses on combating the involvement the CNS and other vital organs 2) Intensification requires the administration of a single drug in low doses 3) The induction phase requires the administration of multiple drugs in high doses 4) The maintenance phase requires no chemotherapy treatments

3) The induction phase requires the administration of multiple drugs in high doses

17. Which are clinical manifestations of sexual abuse that the nurse should include when assisting with the assessment process? (Select all that apply.) 1) Radar gaze 2) Poor hygiene 3) Vaginal discharge 4) Positive chlamydia culture 5) Ecchymosis located on the inner thighs

3) Vaginal discharge 4) Positive chlamydia culture 5) Ecchymosis located on the inner thighs

A nurse is caring for a 7-year-old patient immediately after a tonsillectomy. What is the best position for this patient? 1)High Fowler's 2)Partly on the back and partly on the side 3)Partly on the side and partly on the abdomen 4)Supine

3)Partly on the side and partly on the abdomen

While teaching a course for expecting fathers, the nurse emphasizes that, according to Erikson's theory, the infant needs a sense of: 1. Belonging 2. Family 3. Trust 4. Warmth

3. Trust

The mother of a toddler states, "My daughter seems to be at an increased risk for complications associated with respiratory infections." Which response by the nurse is accurate? 1 "You are incorrect in your assessment."Younger children do not breathe as deeply as do older children." 2 "Air passages are more likely to become blocked with mucus because younger children make more mucus than older children. "3 "The younger child's airway is smaller and more easily occluded." 4 "The younger child's airway is smaller and more easily occluded."

4 "The younger child's airway is smaller and more easily occluded."

The nurse walks into the pediatric patient's room and notices that the child is standing and leaning forward with the arms resting on the knees. The nurse knows that this position assists in breathing by doing which of the following? 1 Depressing the lower sternum, which causes a decrease in anteroposterior diameter. 2 Expanding the diaphragm so that the child can take deeper breaths. 3 Tilting the head back to maximize the effort to draw air into the lungs via the nose. 4 Increasing the abilit

4 Increasing the ability to use the thoracic and neck muscles to draw air into the lungs.

Which statement made by the mother of a child suffering from eczema alerts the nurse to the need for more teaching? 1) "I will keep the affected areas clean and dry to prevent infection" 2) "We will stop using bubble bath" 3) "I will apply a consented lotion after bath time" 4) "I will use baby wipes to clean the affected areas between baths"

4) "I will use baby wipes to clean the affected areas between baths"

The nurse is providing care to an infant diagnosed with congenital clubfoot. Which parental statement regarding the child's care indicates correct understanding of the information provided? 1) "We will need to come back once every 3 months for recasting of the foot" 2) "We will need to go to physical therapy once a week for the next year" 3) "We know that surgical correction is the only medical intervention needed" 4) "We will need to undergo a series of casting procedures to stretch and move the deformity into alignment"

4) "We will need to undergo a series of casting procedures to stretch and move the deformity into alignment"

13. The nurse suspects that a child is being sexually abused. Which nursing action is appropriate? 1) Using a personal cell phone to collect images for documentation 2) Asking a novice nurse to assist in the data collection 3) Reviewing institutional policy regarding reporting abuse to authorities 4) Bathing the child after the collection of evidence

4) Bathing the child after the collection of evidence

The overproduction and excretion of ADH from the posterior pituitary results in which symptoms? 1) Kidneys absorb less water 2) Decreased fluid retention 3) Hypernatremia 4) Decreased urine output

4) Decreased urine output

Which causative agent would be responsible for causing osteomyelitis in an infant? 1) Group B streptococci 2) Staphylococcus aureus 3) Neisseria gonorrhoeae 4) E. coli

4) E. coli

A parent reports that her 5 year old child, who has had all the recommended immunizations, had a mild fever 1 week ago and now has bright red cheeks and a lacy red maculopapular rash on the trunk and arms. Which diagnosis does the nurse anticipate based on the current data? 1) Rubeola (measles) 2) German measles (rubella) 3) Chicken pox (varicella) 4) Fifth disease

4) Fifth disease

Which assessment data cause the nurse to suspect that a 16 month old has celiac disease? 1) Clay-colored stools and dark urine 2) History of early passage of meconium in the newborn period 3) History of chronic, progressive constipation 4) Foul-smelling stools, flatulence, and weight loss

4) Foul-smelling stools, flatulence, and weight loss -Diarrhea is also a common finding in celiac disease

A nurse is treating a school-age child for nephrotic syndrome. Which of the following orders should the nurse question? 1) Diuretics 2) Antibiotics 3) Corticosteroids 4) IV fluids

4) IV fluids -Fluids will contribute to fluid overload

Durin the assessment of a child, the nurse notices the presence of vesicles that are oozing honey-colored fluid on the child's legs. Which condition would the nurse suspect? 1) Nodule 2) Tinea capitis 3) Wheal 4) Impetigo

4) Impetigo

14. Which is a behavioral indicator of abuse when providing care to a pediatric patient? 1) Ecchymosis 2) Rash 3) Vaginal discharge 4) Radar gaze

4) Radar gaze

1. Which health-care provider is mandated by law to report suspected child abuse? 1) Baptist priest 2) Day-care provider 3) Basketball coach 4) Registered nurse

4) Registered nurse

The pediatric nurse teaches parents of a preschool-aged child diagnosed with anemia that it is important to identify the cause of anemia so treatment can be tailored to their specific needs. The nurse tells the parents that their child's anemia is caused by increased destruction of RBCs that occurs with which condition noted in the medical history? 1) Bone marrow failure 2) Acute blood loss 3) Myelodysplastic syndrome 4) Sickle cell anemia

4) Sickle cell anemia

6. Which environmental influence should the nurse include when assessing a child's risk for abuse? 1) A history of cruelty to animals 2) A lack of follow-through for medical follow-up 3) The use of multiple health-care providers 4) The family frequently relocates to different geographical locations.

4) The family frequently relocates to different geographical locations.

Which topic is the priority for the nurse who is teaching the family of an infant diagnosed with osteogenesis imperfecta? 1) Cast care 2) Tract care 3) Postoperative spinal surgery care 4) Trunk and extremity support during everyday care

4) Trunk and extremity support during everyday care

The nurse is treating a school-aged child with nephrotic syndrome. Which of the following interventions need further instruction? 1) Count daily weights at the same time of day 2) Administer corticosteroids 3) Request a referral for a nutritionist 4) Use a different scale each day

4) Use a different scale each day

The nurse is assessing a young child during a sickle cell crisis. Which nursing action is appropriate in assessing the child's pain level? 1) Administering anti anxiety medication around the clock 2) Using a numerical pain scale for assessment purposes 3) Administering anti nausea medication around the clock 4) Using the Wong-Baker FACES scale for assessment purposes

4) Using the Wong-Baker FACES scale for assessment purposes

increased intracranial pressure s/s

Assessments of ICP include identifying associated clinical signs and symptoms of occipital headache, vomiting (projectile vomiting in older children), altered mental status, visual disturbances, and generalized neck pain. Assess the child for hypertension, bradycardia, and bradypnea. A young child may demonstrate increased head circumference and a bulging anterior fontanel. Sunset Eyes: The white of the sclera is visible above the iris. • Posturing: Can be decerebrate, indicating damage to nerve pathway between the spinal cord and the brain, which is typically found with brainstem injuries, or decorticate, caused by a stroke, another anterior brain injury, or brain hemorrhages within the cerebral hemispheres (FIG. 27.14) • Seizures: May be generalized or focal • Macewen's Sign: A resonant "cracked pot" sound occurs when the child's suture lines are percussed (tapped). Enlarged bluish scalp veins are usually present as well. • Diplopia: Double vision • Unequal Pupils: PERRLA (Pupils Equal, Round, and Reactive to Light and Accommodation) should be performed to assess for this condition • Sudden change in feeding habits • Irritability, restlessness, and crying with holding or cuddling

DKA Management and Treatment

Often the diagnosis of T1D occurs when the child first presents with diabetic ketoacidosis (DKA). DKA is a dangerous toxic state that requires intensive care. Typically, a child with DKA presents to the emergency department and then is rapidly transferred to the PICU for close monitoring and treatment. The child is treated with normal saline boluses for dehydration correction and IV insulin drips (continuous infusion) until the blood glucose level reaches 250 to 300 mg/dL. At that time, the IV fluid is switched to D51/2NS to prevent hypoglycemia rebound. The insulin infusion (insulin drip) is titrated to prevent the blood glucose level from dropping more than 50 mg/dL per hour. After stabilization, the child is weaned from IV insulin to subcutaneous injections before being transferred to the pediatric unit for intensive family teaching about managing diabetes. Under no circumstances should the child receive IV solutions with potassium until the child's urine output is well-established.

Celiac disease nursing considerations

Reinforce the importance of following a gluten-free diet, including a restriction of breads, pasta, and snacks that contain rye, wheat, oats, or barley. Many commercially prepared frozen food items and desirable childhood snacks contain gluten, and families must become astute at reading and analyzing food labels. Unrestricted food items include eggs, fish, poultry, pork, beef, dairy, fruits, vegetables, rice, and cornmeal. With the increasing incidence of celiac disease in the general population, many wheat-alternative breads and cereals are now available. The growing awareness of the disease is also prompting grocery stores and restaurants to provide gluten-free food and menu choices. Support is available for families from the American Celiac Society, the Gluten Intolerance Group, and the Celiac Disease Foundation. Written instructions should be provided for families and follow-up is imperative to assess a child's risk for episodes of celiac crises. Research has shown that measuring celiac disease-related antibodies is one way to closely predict a child's clinical outcomes and monitor long-term compliance with a gluten-free diet. As a child's antibody levels decrease, health-care professionals can be more confident that the child's diet is free of glutens (Nachman et al., 2011). Antibodies currently being tested include anti-tissue transglutaminase (tTG) antibodies, deamidated gliadin peptide (DGP) antibodies, and endomysial antibodies (EMA) (National Institute of Diabetes and Digestive and Kidney Diseases, 2019).

Celiac disease clinical manifestations

The assessment of celiac disease includes the following: • Flare-ups and celiac crises associated with a precipitating event, such as gluten ingestion, infections, prolonged fasting, or exposure to anticholinergic drugs, which will present as acute abdominal pain, severe diarrhea, electrolyte imbalances, and possible metabolic acidosis • The passage of steatorrhea or greasy, bulky, and very malodorous stools that appear frothy and full of fat • Organic FTT, including weight loss or lack of gain, muscle wasting, and anemia • Anorexia and abdominal pain, which are common Anticipate laboratory studies of antigliadin antibodies (IgG and IgA) and a 72-hour quantitative fecal fat study. Also anticipate sending the child for a biopsy of the jejunum to assess for a flat mucosal surface with hyperplasia.

Hemolytic Uremic Syndrome (HUS) Treatment

The child with HUS often requires a PICU stay. There is no known cure for HUS. The child's symptoms of initial dehydration followed by fluid retention will be treated, as will electrolyte disturbances, anemia, and discomfort. IV nutrition and antihypertensives may be required. Mortality in HUS is increased with dehydrated patients; therefore, IV fluids should be initiated right after diagnosis is confirmed (Ardissino et al., 2016). Antibiotics will be administered although this treatment does not decrease the duration of GI symptoms (bloody diarrhea). Platelet infusions may be required for associated low platelet counts. Dialysis is required for BUN levels greater than or equal to 80 mg/dL. Prevention starts with public health measures to reduce exposure to E. coli and teaching families to thoroughly wash fruits and vegetables.

A child is brought to the emergency department late one evening and is diagnosed with croup. The child was noted to have a shrill, harsh respiratory sound when breathing in. This symptom is referred to as which of the following? a) Stridor b) Barking cough c) Hoarseness d) Wheezing

a) Stridor Correct Explanation:In the child with croup syndrome, inspiratory stridor (shrill, harsh respiratory sound) is often noted.

A nurse is reinforcing teaching with an adolescent about the prescribed use of his asthma medications. Which of the following medications should the nurse instruct the patient to use as needed before exercise?a)Albuterol b)Fluticasone/Salmeterol c)Prednisone d)Montelukast

a)Albuterol

The nurse is caring for an adolescent with congestive heart failure. Which clinical finding indicates adherence to the prescribed medical regimen? a)No change in daily weight b)A pulse rate of 120 beats/min c)Nausea or vomiting d)Weight gain

a)No change in daily weight

The initial survival of the newborn with hypoplastic left heart is dependent on which one of the following? a)Patent ductus arteriosus and patent foramen ovale b)Immediate heart transplant following birth c)Patent ductus venosus d)Immediately administering Indocin

a)Patent ductus arteriosus and patent foramen ovale

The four defects found in child diagnosed with Tetraology of Fallot are: a)ASD b)VSD c)pulmonary artery stenosis d)enlarged right ventricular wall e)overriding aorta positioned near the septal defect

a)VSD c)pulmonary artery stenosis d)enlarged right ventricular wall e)overriding aorta positioned near the septal defect

The nurse assesses an infant with suspected congenital heart disease. The nurse notes which findings are specific to patent ductus arteriosus?(SATA) a)Wide pulse pressure b)Weak pulses c)Fluctuating blood pressures d)Right to left shunt e)Systolic heart murmur

a)Wide pulse pressure c)Fluctuating blood pressures e)Systolic heart murmur

The assessment finding that would lead the nurse to suspect that a newborn infant has a ventricular septal defect (VSD) is: a)a loud harsh murmur b)cyanosis when crying c)blood pressure that is higher in the arms than in the legs d)a soft murmur

a)a loud harsh murmur

The nurse is preparing an education program on hearing impairment for a group of new staff nurses. What concepts should be included? (Select all that apply.) a. A child with a slight hearing loss is usually unaware of a hearing difficulty. b. A clinical manifestation of a hearing impairment in children is avoidance of social interaction. c. A child with a severe hearing loss may hear a loud voice if nearby. d. Children with sensorineural hearing loss can benefit from the use of a hearing aid. e. A clinical manifestation of hearing impairment in an infant is lack of the startle reflex.

a. A child with a slight hearing loss is usually unaware of a hearing difficulty. b. A clinical manifestation of a hearing impairment in children is avoidance of social interaction. c. A child with a severe hearing loss may hear a loud voice if nearby. e. A clinical manifestation of hearing impairment in an infant is lack of the startle reflex.

The nurse is assessing a 16-year-old female for characteristics of anorexia nervosa. Which assessment finding(s) would lead the nurse to suspect the possibility of this diagnosis? (Select all that apply.) a. Amenorrhea b. Severe weight loss c. Oily skin d. Hypertension e. Lanugo on back

a. Amenorrhea b. Severe weight loss e. Lanugo on back

The nurse is planning the care of an adolescent with anorexia nervosa. What characteristic(s) cause this disorder? (Select all that apply.) a. Discomfort relative to emerging sexuality b. Fear of intimacy c. Pervasive high self-esteem d. Egocentricity e. Inability to meet developmental needs

a. Discomfort relative to emerging sexuality b. Fear of intimacy d. Egocentricity e. Inability to meet developmental needs

A nurse is conducting a well-child visit with a 5-year-old child. Which of the following immunizations should the nurse plan to administer to the child? ( Select all that apply." a. Dtap b. IPV c. MMR d. PCV e. Hib

a. Dtap b. IPV c. MMR

30. What intervention(s) would the nurse caring for a child with infectious meningitis include? (Select all that apply.) a. Isolation precautions b. Provision of brightly lit room c. Observation for increasing intracranial pressure d. Preparation for spinal tap e. Seizure precautions

a. Isolation precautions c. Observation for increasing intracranial pressure d. Preparation for spinal tap e. Seizure precautions

In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)? a. Trisomy 21 detected on amniocentesis b. Family history of myocardial infarction c. Father has type 1 diabetes mellitus d. Older sibling born with Turner syndrome

a. Trisomy 21 detected on amniocentesis

A nurse assessing a preadolescent child for scoliosis would: a. ask the child to bend forward at the waist, and would observe the child's back for asymmetry. b. observe the gait while the child is walking forward heel to toe. c. have the child flex the knees and look for uneven knee height. d. look at the child's shoulders and hips while fully clothed.

a. ask the child to bend forward at the waist, and would observe the child's back for asymmetry.

3. The nurse caring for a child with a new diagnosis of type 1 diabetes mellitus plans the care based on the understanding that: a. there is an absolute deficiency of insulin. b. insufficient quantities of insulin are produced by the pancreas .c. oral hypoglycemic agents can control it. d. insulin deficiency is caused by another disease affecting the pancreas.

a. there is an absolute deficiency of insulin.

Preschooler: Initiative vs. Guilt

acknowledge child's fears about hospitalization orient them to the hospital encourage presence of parent nutrition: try to bring in food they want provide constant environment provide as much mobility as possible assess perception by asking them to draw or tell story use dolls to show procedures to become comfortable have parents read to the child

Physical abuse

acts of commisssion caused by either a parent or caregiver that result in actual physical harm or are considered to have the potential to cause physical harm. Examples: Shaken baby syndrome, repeated injury to the skin, nervous system, or skeletal system, Children who present with evidence of repeated injury.

Which acute respiratory condition is the most common in early childhood? a) Asthma b) Croup c) Broncholitis d) Pneumonia

b)Croup Explanation:Croup is the most common acute respiratory condition in early childhood (6 months to 6 years). The cardinal sign is a "barking cough." Croup is an upper airway obstruction caused by some type of inflammation.

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting up and leaning forward in a tripod position to breath. The nurse further notes that the child's mouth is open and the tongue is out. The signs the nurse noted indicate the child likely has which of the following? a) Cystic fibrosis b) Epiglottitis c) Asthma d) Tuberculosis

b)Epiglottitis Correct Explanation:The child with epiglottitis is very anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. This is called the "tripod" position. Immediate emergency attention is necessary.

The nurse is teaching the parents information about appropriate heart rate and blood pressure readings for their child. Which of the following measurements are considered normal for a preschool-aged child? (Select all that apply.) a)Heart rate of 60 beats per minute b)Heart rate of 100 beats per minute c)Blood pressure of 90/55 mm Hg d)Blood pressure of 110/60 mm Hg e)Blood pressure of 95/60 mm Hg

b)Heart rate of 100 beats per minute d)Blood pressure of 110/60 mm Hg e)Blood pressure of 95/60 mm Hg

The nurse is caring for a 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child? a) Discouraging the child from coughing b) Applying an ice collar c) Providing fluids by straw d) Placing the child on his side

c)Providing fluids by straw Correct Explanation:Providing fluids by straw may cause trauma to the surgical site and should be avoided. Applying an ice collar, if ordered, helps relieve pain. Placing the child on his side, until he is fully awake, facilitates safe drainage of secretions. The child should be discouraged from coughing, clearing his throat, and blowing his nose to avoid trauma to the surgical site.

A worried mother calls the nurse and tells her that her son has developed a horrible croupy cough and is having trouble breathing. Which of the following would be the best intervention for the nurse to recommend to the mother? a) Administer an analgesic to the boy b) Administer cough syrup to the boy c) Run a hot shower to fill the bathroom with steam and have the boy stay there d) Have the boy drink a full glass of water to clear out the mucus

c)Run a hot shower to fill the bathroom with steam and have the boy stay there Correct Explanation:One emergency method of relieving croup symptoms is for a parent to run the shower or hot water tap in a bathroom until the room fills with steam, then keep the child in this warm, moist environment as this relaxes the airway tissues and widens the bronchi lumens. If this does not relieve symptoms, parents should bring the child to an emergency department for further evaluation and care. Caution parents not to give cough syrup routinely to children as many produce little effect and the risk of overdose, incorrect dosing, and adverse events is greater than the benefit of the syrup. An analgesic might help alleviate pain due to inflammation and irritation of the throat from coughing, but it is not the priority intervention in this case. Drinking would likely be painful for this child and would not provide lasting benefit.

What is the most appropriate classroom intervention for a child with attention-deficit hyperactivity disorder (ADHD) for the school nurse to suggest? a. Seat the child in the back of the room to prevent distractions for other children. b. Pair the child with a student buddy to offer reminders to pay attention. c. Divide work assignments into shorter periods with breaks in between. d. Separate the child from others to increase his focus on schoolwork

c. Divide work assignments into shorter periods with breaks in between.

The finding the nurse would expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta is a blood pressure that is: a)higher on the right side b)higher on the let side c)decreased in the arms and elevated in the legs d)decreased in the legs and elevated in the arms

d)decreased in the legs and elevated in the arms

The nurse is performing a physical assessment on a 3-year-old child. The parents state that the child excessively rubs the eyes and often tilts the head to one side. What visual impairment should the nurse suspect? a. Strabismus b. Astigmatism c. Hyperopia, or farsightedness d. Myopia, or nearsightedness

d. Myopia, or nearsightedness

Scabies

• Intense itching that becomes worse at night, often interrupting a child's healthy sleeping pattern • Skin "burrows" that appear linear, S-shaped, or curved and that run along the superficial skin on the extremities, neck, legs, or trunk with a characteristic rash of macules, papules, and bright-red erythema (may be 1 to 10 cm in length) (FIG. 36.7) • Rashes that intensify between the child's fingers, wrists, buttocks, knees, elbows, and genitals • The presence of rash and "burrows" on other members of the family • Skin scrapings from burrow tract marks that reveal mites, ova, and feces under microscopic evaluation

ICP treatment

• Stabilizing the airway and administering CPR as needed • Maintaining a patent airway • Providing a source of oxygen to maintain stable oxygen saturations and ABGs • Suctioning the child carefully and only if needed (suctioning can cause rebound increased ICP) • Monitoring the child's pediatric GCS score; if the team determines the value is 8 or less, the child will need to be intubated STAT • Elevating the HOB • Treating the child's presenting seizure activities if needed • Turning down the lights and providing an environment with low visual and auditory stimulation • Preparing to assist the team in transferring the child to the highest level of care, such as the PICU • Assisting in the rapid transfer to a diagnostic department, such as MRI or CT scanning • Carefully managing the child's IV to maintain a portal for emergency medications such as diuretics and anticonvulsants • Administering diuretics or corticosteroids, or both