NUR 307 Exam 2

What is an expected physical finding of JIA?

- Joint swelling, stiffness, redness and warmth that's worse in the morning or after inactivity - Mobility limitations - Fever - Rash - Limp in the morning - Delayed growth

What should be done during a seizure?

- Lower pt to bed or floor - Turn pt to side - Loosen restrictive clothing - NOTHING IN MOUTH - DO NOT RESTRAIN - Note onset and duration

What is the proper use of a peak flow meter?

- Measures how fast air comes out of lungs when you exhale forcefully - TAKE HIGHEST OF THREE READINGS, NOT AVERAGE

How is asthma diagnosed?

- Pulmonary function test - Allergy testing

Immunizations: 1 year - 3 years

12-15 mos - IPV, Hib, MenACWY, MMR, Varicella 12-23 mos - Hep A 15-18 mos - DTaP 12-26 mos - yearly influenza

Immunizations: 12 year - 20 year

16-18 years - MCV4 booster (if first dose received 13-15 yo); booster not needed if first dose received at 16 y/o Yearly: yearly influenza

What is the nursing care for treating a child with Reye's syndrome?

AVOID SALICYLATES IN CHILDREN, prevent hemorrhage (impaired liver function), seizure precautions

What are some physiological differences between adults from children?

Abdominal breathers Chest wall more compliant Higher risk for airway obstruction Higher oxygen consumption Higher RR Right bronchi is more vertical

What is the seizure that occurs more often in children between the ages of 4-12 yrs?

Absence

What is the difference between active and passive immunization?

Active - antigens "fighting" pathogen or its components; longer lasting Passive - "inactive" passively received antibodies; lasts only few weeks or months

What is strep throat?

Acute Streptococcal Pharyngitis; Highly contagious infection caused by Group A beta-hemolytic streptococcus (GABHS) leading to airway inflammation

A 5-year-old is seen in the urgent care clinic with the following history and symptoms: sudden onset of severe sore throat after going to bed, drooling and difficulty swallowing, axillary temp of 102.2, clear breath sounds and absence of cough. The child appears anxious and appears flushed. Based on these symptoms and history, the nurse anticipates a diagnosis of:

Acute epiglottitis

How do you treat hypoglycemia in an unconscious child?

Administer IM or SubQ glucagon. Once pt awake and can swallow safely, consume carbohydrate snack

What is some nursing care for the patient with cystic fibrosis?

Administer O2, encourage fluid intake, HIGH FAT HIGH CALORIE DIET, referral to pulmonologist

What are some environmental factors that affect the respiratory system?

Allergies, smoking use, chemical exposure, aerosol use or exposure, medication use

A nurse explains to the mother of a 1-year-old with a history of frequent ear infections that the primary cause of otitis media in young children is what?

An obstructed eustachian tube

What is the medication treatment for strep throat?

Antibiotics 10-day course: amoxicillin, cefdinir

The parents of a 4-month-old infant with a diagnosis of acute otitis media and fever ask the nurse about the use of antibiotics to treat this condition. What is the best response by the nurse?

Antibiotics are recommended for infants younger than 6 months with acute otitis media

What is an epidural hematoma?

Arterial bleeding between dura and skull

The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure the nurse should:

Assess the client for allergies - uses iodine

What is T1DM?

Autoimmune dysfunction causing destruction of beta cells in pancreas, leading to lack of insulin secretion; pt insulin dependent

The nurse includes information in a presentation that SIDS remains unexplained after other possible causes have been ruled out. The nurse understands that which procedure is used to rule out the possible causes of SIDS?

Autopsy

What is cystic fibrosis?

Autosomal recessive disorder causing obstruction of sodium chloride transport causing abnormally THICK AND STICKY MUCUS that plugs organ ducts and leads to organ failure

What nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child?

Avoid activities that cause pain or crying

What are signs and symptoms of croup?

BARKING COUGH , inspiratory stridor, tachypnea, respiratory distress, nasal flaring, intercostal retractions

What is hypoglycemia?

BG <70 mg/dL

How is DKA diagnosed?

BG >250 mg/dL, KETONES IN BLOOD AND URINE, METABOLIC ACIDOSIS, HYPERKALEMIA

Treatment for croup?

COOL MIST HUMIDIFIER Nebulized racemic epinephrine IVF Present agitation Corticosteroids: IM - dexamethasone, Neb: budesonide

What is a lumbar puncture (LP)?

CSF taken for analysis used to diagnose meningitis and other neurological disorders

How is a head injury diagnosed?

CT/MRI, neuro assessment

What is an assessment finding of croup?

CXR = STEEPLE SIGN, increased RR, severe stridor

The nurse observes an 18-month-old who has been admitted with a respiratory tract infection who is drooling and sitting forward with an open mouth and protruding tongue. What should the nurse do first?

Call the rapid response team

The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type 1 diabetes mellitus. What information should the nurse provide about this condition?

Characterized mainly by insulin deficiency.

What procedure helps with cystic fibrosis?

Chest physiotherapy (SCHEDULE TREATMENT BEFORE MEALS, OR SEVERAL AFTER TO AVOID VOMITING), bronchodilator 30 min-1 hr

What do you LISTEN for in a respiratory assessment?

Child speak in whole sentences, wheezes, crackles, ronchi, rub

What are s/s of SEVERE RESPIRATORY DISTRESS?

Child unable to speak anymore, cyanotic, collapses - If no immediate intervention, child can go into resp arrest and die within 4 min

How is SIDS diagnosed?

Autopsy

What intervention should be beneficial in reducing the risk of Reye syndrome?

Avoidance of aspirin for children with varicella or those suspected of having influenza

How do you treat foreign body aspiration?

BACK BLOW AND CHEST THRUST

What does cloudy CSF indicate?

Bacterial meningitis - increased glucose, increased protein and WBC, positive gram stain

How is epiglottitis diagnosed?

Clinical suspicion - Oral exam can lead to obstructed airway!!

A 2-year-old child has just been diagnosed with type 1 diabetes. Th e nurse is providing education to the parents regarding signs of hypoglycemia. Which of the following information should the nurse include in her teaching session?

Child's behavior will resemble a burst of anger or a temper tantrum.

The family of a young child has been told that the child has DI. What information should the nurse emphasize to the family?

Children should wear MedicAlert tags if they are over 5 years old.

The most appropriate nursing intervention when caring for a child experiencing a seizure is to:

Describe and document the seizure activity observed

If the child is under age six, what is the primary muscle used for breathing?

Diaphragm

What isolation precaution is used for meningitis?

Droplet

How is a seizure diagnosed?

EEG (elecroencephalogram)

What are s/s of brain herniation?

Fixed/Dilated pupils, decreased LOC, abnormal RR and posturing, HTN

What is hyperthyroidism caused by?

Graves' disease most common, occurring during adolescence

What is a head injury?

Head trauma resulting in injury to the scalp, skull, brain or blood vessels

What is hyperglycemia?

High blood sugar >125

What is DKA caused by?

INFECTION/ILLNESS, UNTREATED OR UNDIAGNOSED T1DM, MISSED INSULIN DOSE

A 12 year old child is in the urgent care clinic with a complaint of fever, headache, and sore throat. A diagnosis of group A beta hemolytic streptococcus (GABHS) pharyngitis is established with a rapid strep test, and oral penicillin is prescribed. The nurse knows which of the following statements about GABHS is correct?

Children with a GABHS infection are at increased risk for the development of rheumatic fever and glomerulonephritis

The parent of a child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asked the nurse why this child is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response?

Children younger than three years usually exhibit worse symptoms because their immune system's are not as developed.

The nurse is preparing to teach a client who is newly diagnosed with asthma on how to prevent asthma triggers. Which trigger should the nurse include in the teaching​ plan?

Cigarette smoke

Who is at risk for getting strep throat?

Close contact with infected people, school-age children

What are some clinical manifestations of hypothyroidism?

Cold intolerance, receding hair, hair loss, brittle hair, facial and eyelid edema, dull-blank expression, thick tongue, slow speech, anorexia, brittle nails, constipation, dry coarse scaly skin

What is a tympanostomy and when/why is it performed?

Combined with myringotomy (incision to drain excess fluid from ear) - Placement of pressure equalizing tubes into ears to prevent future fluid buildup

Which is the nurse's best response to the parent of a child diagnosed with epiglottitis who asked what the treatment will be?

Complete a course of IV abx

What is the postictal phase of a seizure?

Confusion, sleepiness, agitation (seizure subsides and pt return to baseline)

What is a tonic seizure?

Stiffening of muscles, loss of consciousness

What are s/s of hypoglycemia?

Cool/clammy skin, shakiness, blurred vision, decreased LOC "cool and clammy need some candy"

What are risk factors for acquiring RSV?

Crowded places Exposure to other children Children younger than 2-years-old

What is the treatment for a concussion?

Usually self-resolving in 1-2 weeks

What are some s/s of asthma?

Wheezing, SOB, cough, chest tightness, anxiety, use of accessory muscles

When providing discharge teaching to a patient who is newly diagnosed with asthma, which of these points should the healthcare provider emphasize?

"Eliminate or reduce exposure to known asthma triggers."

The nurse is caring for an infant with respiratory syncytial virus​ (RSV) in the hospital. The parents ask if their child will need to be on oxygen. Which response by the nurse is​ accurate?

"If oxygen levels fall below 90%, we will start oxygen"

Which of the following should be included in peak flow measurement teaching?

"Inhale deeply, put your mouth over mouthpiece, then exhale hard and fast."

The school nurse is talking to a 14-year-old about managing type 1 diabetes mellitus. Which statement indicates the student's understanding of the disease?

"It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin."

The nurse has completed discharge teaching for the family of a 10-year-old diagnosed with diabetes insipidus (DI). Which statement best demonstrates the family's correct understanding of DI

"My child will have to use the bathroom more often than other children."

A clinician is providing teaching for inhaled corticosteroid technique. Which information should be included in teaching?

"Press the canister down, breathe in slowly and deeply, hold your breath for a few seconds and then slowly exhale."

How is strep throat diagnosed?

"RAPID STREP" throat culture

The nursing instructor asks a nursing student about SIDS. Which statement by the student indicates further teaching is needed?

"The incidence of SIDS has been found to be higher in breastfed infants and infants that use a pacifier."

The nurse is working with a group of new nurses and discussing the importance of maintaining fluid balance in an infant with RSV. Which statement demonstrates an understanding of maintaining fluid balance in infants?

"We should encourage the parents to count diapers."

A health care provider is evaluating the management of a child with a history of asthma. Which of the following statements from the child's mother would be most concerning to the health care provider?

"When my child has an attack, she usually has to use her rescue inhaler 4 times before her breathing improves."

What is Diabetic Ketoacidosis?

(DKA): life threatening condition with high BG levels and ketones in blood and urine, characterized by uncontrolled hyperglycemia; more common with T1DM

What is growth hormone excess?

(Gigantism) Pituitary gland tumor/lesion or hypothalamus dysfunction resulting in overproduction of GH, causing increased growth of bone/cartilage and increased protein synthesis

What is juvenile idiopathic arthritis?

(JIA): chronic autoimmune inflammatory disease affecting joints and other tissues; wears down and damages articular cartilage

What is hyperthyroidism?

(Thyrotoxicosis): Too much thyroid hormone being secreted

What are red flags to look out for with tonsillitis?

- ASSESS FREQUENT SWALLOWING - ASSESS THROAT CLEARING = signs of bleeding - assess for history of bleeding disorder

What pt education can the nurse provide for tonsillitis?

- AVOID RED FOODS/LIQUIDS - avoid spicy food, straws, coughing and blowing nose

What medications would be used for asthma treatment?

- Albuterol (short-acting, rescue inhaler) - Corticosteroid (long-acting, maintenance/daily)

What is the treatment for hyperthyroidism?

- Anti-thyroid medication: methimazole - Thyroidectomy - Radioactive iodine therapy

What is some nursing care for DM?

- Blood sugar monitoring; monitor as directed - Insulin administration; DO NOT SKIP WHEN SICK - Illness care - Hypoglycemia management - Obtain daily weight

What is the nursing care for JIA?

- Control pain, minimize damage from inflammation - Assist pt with exercise program - Encourage participation in physical therapy program - Heat or warm moist packs to joints before exercise - Promote appropriate exercises - Self care and allow time for completion - Well balanced diet - Interdisciplinary care

What labs can you expect to see with JIA?

- Elevated CRP, elevated ESR, elevated WBC

What is some patient teaching regarding SIDS prevention?

- Firm mattress, no blankets or toys, encourage pacifier use, prevent overheating - Breastfeeding - Routine health checkups and immunization at birth

Who is at risk for JIA?

- Immunogenic susceptibility - Environmental triggers - Genetic predisposition

What are some causes of hypothyroidism?

- Iodine deficiency - Thyroidectomy - Radiotherapy - Infections

What are some common seizure triggers?

- Sleep deprivation - Illness/fever - Increased stress - Not eating well - Electrolyte imbalance - Flashing bright lights/patterns

What is a clonic seizure?

1-2 min rhythmic jerking of extremities

What are s/s of growth hormone deficiency?

DELAYED GROWTH, hypoglycemia, micropenis, slow tooth eruption, high-pitched voice

The nurse caring for a 14-year-old girl with diabetes insipidus (DI) understands which of the following about this disorder?

DI is treated with vasopressin on a lifelong basis.

The healthcare provider prepares to administer a corticosteroid to a patient with a diagnosis of asthma. What is the rationale for administering this drug to this patient?

Decrease airway swelling

A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because she knows that this condition can lead to which of the following pregnancy complications:

Decreased cognitive development in the fetus

What is Growth Hormone Deficiency?

Decreased release of Growth Hormone (GH) from the anterior pituitary gland; Congenital defect, pituitary tumor or trauma interferes with production or release of GH

What is a brain herniation?

Downward movement of brain tissue due to cerebral edema

What are clinical manifestations of otitis media?

Drainage from affected ear Fever Pulling at ear Increased crying/irritability Bulging red tympanic membrane

What statement should the nurse include when discussing a child's precocious puberty with the parents?

Dress and activities should be appropriate to the chronologic age.

The nurse is examining a child with bronchiolitis. Which symptom should the nurse interpret as a sign of dehydration?

Dry, sticky mucous membranes

A nebulizer treatment hWhat is the best time for the nurse to administer the treatment?

During naptime

Why are children more at risk for developing otitis media?

Ear canal shape is different than adult

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism?

Early identification

The student nurse asks if any precautions are necessary while caring for a child with croup in an outpatient setting. What is the best information for the nurse to provide?

Enforce hand washing

What does tonsillitis look like?

Enlarged tonsils, peritonsillar exudate or white patches on tonsils, halitosis, sore throat

A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response to this parent who's child is diagnosed with epiglottitis and is in severe distress and in need of intubation?

Epiglottitis is rapidly progressive, you could not have predicted his symptoms would worsen so quickly

What structures does otitis media affect?

Eustachian tube - accumulation of fluid in the middle ear

What are s/s of growth hormone excess?

Excessive height, delayed puberty, vision issues, prominent forehead and jaw, headache, increased sweating, large hands and feet

What is one of the main symptoms of cystic fibrosis?

Excessively salty sweat, saliva and tears

The nurse is examining a client newly diagnosed with asthma. Which pathological characteristic should the nurse expect in this client during physical​ examination?

Expiratory wheezing

What are the major causes of head injuries in children?

Falls, sports, MVA, abuse

What are some barriers to getting a vaccine?

Family and community, Health care provider, system barrier

Who is at risk for T1DM?

Family history, age (children, young adults)

Who is at risk for getting asthma?

Family history, race (African American), poverty and pollution

What are risk factors for seizures?

Fever, cerebral edema, infection (meningitis), toxin exposure, electrolyte imbalances, hypoglycemia

What are symptoms of meningits?

Fever, headache, NUCCHAL RIGIDITY, PHOTOPHOBIA, POSITIVE KERNIG'S AND BRUDZINSKI'S SIGNS, seizures Infant: poor feeding, bulging fontanels, high-pitched cry

Of the following foods, the most appropriate to offer first to an alert child in the postoperative period following a tonsillectomy would be:

Flavored ice pop

An early indication of hemorrhage in a child who has had a tonsillectomy is:

Frequent swallowing

How is growth hormone deficiency treated?

GH replacement therapy (somatropin) via SubQ injections, DC THERAPY ONCE EPIPHYSEAL FUSION HAS OCCURED

How is precocious puberty diagnosed?

GnRH stimulation test. Increased LH, FSH, testosterone and estradiol. MRI of brain

What does epiglottitis present as?

HOARSE OR MUFFLED VOICE, DROOLING, DYSPHAGIA, respiratory distress, tripod position

A 19-month-old with croup is crying as a nurse tries to auscultate breath sounds. What is the nurse's most appropriate intervention/

Hand the stethoscope to the child to examine before auscultating his lungs

A child is given a preliminary diagnosis of acute epiglottitis. Which initial nursing intervention is the most appropriate?

Have emergency airway equipment readily available

What is the most common cause of DI in children?

Head trauma, tumors, or infection to the hypothalamus

What are s/s of hyperthyroidism?

Heat intolerance, nervousness/anxiety, weight loss, smooth velvety skin

What is Reye's syndrome?

Hepatic mitochondrial injury causing increased ammonia levels

What vaccines prevent meningitis?

Hib, PCV (infants) MENINGOCOCCAL (students living in dorms)

How is hypothyroidism diagnosed?

High TSH >4.0, low T4, ultrasound of thyroid, blood lipid levels, x-ray to evaluate bone growth

How is growth hormone excess treated?

Hypophysectomy, radiation therapy, somatostatin, dopamine agonist

What is diabetes insipidus?

Hyposecretion of ADH causing polyuria, polydipsia, hypernatremia, weight loss and dehydration

What is neurogenic DI?

Hypothalamus or pituitary tumor causes decreased ADH release

A 7-year-old is tested for diabetes insipidus (DI). Twenty-four hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale, with a low specific gravity. Which is the most likely reason for this?

In DI, fluid restriction does not cause urine concentration.

What is hydrocephalus?

Increased CSF due to impaired reabsorption or issue with CSF outflow

What are some contraindications for a LP?

Increased ICP, coagulopathy disorder

How is growth hormone excess diagnosed?

Increased insulin-like growth factor (IGF-1), x-ray to determine bone age, CT/MRI to detect possible tumor

A three-year-old is diagnosed with acute epiglottitis. Which sign would indicate the nurse that the child's respiratory distress is increasing?

Increasing heart rate

The mother of a 2-month-old infant breastfeeds and thinks that it is easier to have her infant sleep with her. Which factor places the infant at an increased risk for SIDS?

Infant suffocation

What is meningitis?

Infectious organisms enter CNS through bloodstream causing inflammation of the meninges (membranes around brain and spinal cord)

A parent of a school-age child with GH deficiency asks the nurse how long his son will need to take injections for his growth delay. Which of the following is an appropriate response by the nurse?

Injections should be continued until there is evidence of epiphyseal closure

After many episodes of otitis media, a 3-year-old child is to undergo a myringotomy and have tubes implanted surgically. What should the nurse include in the discharge preparation for this family?

Insert earplugs during the child's bath

What is the treatment for DM?

Insulin

What is T2DM?

Insulin resistance and decreased insulin production develops slowly over time

What is asthma?

Intermittent and irreversible inflammatory disorder of the airway; Triggers causing inflammation and hyperresponsiveness, leading to bronchoconstriction and airway obstruction

A mother called 911 after finding her 2-month-old son unresponsive. The infant was brought to the ED and pronounced dead with the preliminary findings of SIDS. Which type of questions should the nurse ask the parents?

Investigative questions

The nurse is planning care for a school-age child with bacterial meningitis. What intervention should be included?

Keep environmental stimuli to a minimum

What is nephrogenic DI?

Kidney infection causes inadequate response to ADH

What are s/s of diabetes insipidus?

LARGE AMOUNTS OF DILUTE URINE, polydipsia, S/S DEHYDRATION, hypotension, anorexia

What is a thyroid storm?

LIFE THREATENING EMERGENCY; High level of thyroid. Sudden onset of irritability, fevers, tremors, anxiety, diaphoresis, tachycardia -> QUICKLY PROGRESSES heart failure and shock

What is the difference between an adult and child respiratory anatomy in the lower airway?

Larynx separates upper from lower Smaller amount of alveoli Different muscles used to breathe than adults

What happens if strep throat is left untreated?

Leads to rheumatic fever (inflamed heart, joints, brain, skin swell) Acute glomerulonephritis (inflammation and damage of glomeruli)

What is the treatment for hypothyroidism?

Levo (synthroid tab), gradually increase dose

How is Reye's syndrome diagnosed?

Liver biopsy, increased AST, increased ALT, bilirubin, ammonia

What is an absence seizure?

Loss of consciousness for a few seconds; Resembles "DAYDREAMING"

What is an atonic seizure?

Loss of muscle tone - FALLING SEIZURE, individual remains unconscious

What is status eplilepticus?

MEDICAL EMERGENCY Seizure lasting longer than 5 min or having more than 1 seizure in a 5 min period, without returning to level of consciousness

Which vaccines are live virus?

MMR Varicella

A 3 year old child is brought into the ED in her parents arms. The child's mouth is open and she is lethargic. The parent states that she had suddenly became ill within the past two hours. What should the nurse do first?

Maintain the child in an undisturbed upright position

How do you treat a severe head injury? (Meds)

Mannitol - decrease ICP phenobarbital - induce coma, reduce metabolic demands anticonvulsants

How do you treat a severe head injury? (Procedure)

Mechanical ventilation, ICP monitoring, craniecotmy

What is diabetes mellitus?

Metabolic disorder characterized by chronic hyperglycemia

A pediatric client who has asthma has the ability to speak in​ phrases, shortness of breath with mild​ exertion, and audible expiratory wheezing. Which type of asthma exacerbation is the client experiencing based on the assessment​ findings?

Mild

A pediatric client who has asthma has the ability to speak in​ sentences, shortness of breath on​ exertion, and wheezing being noted on auscultation. Which type of asthma exacerbation is the client experiencing based on the assessment​ findings?

Minimal

What are the nursing interventions for DKA?

Monitor BG hourly, VS, electrolytes (especially K)

What is the nursing care associated with DI?

Monitor I&Os, urine specific gravity, daily weights

What are the nursing interventions for hypothyroidism?

Monitor VS, RR, assess feeding difficulties, treat with synthetic thyroid, supplemental vitamin D for bone growth, monitor thyroid levels

What nursing intervention is appropriate when caring for an unconscious child?

Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema.

What is the treatment for Reye's syndrome?

Monitor for ICP, IVF, supportive care, maintain airway

What are some signs of an obstructed airway?

Mouth breathing, snoring, apnea

During a well child examination, which of the following comments made by the parent would indicate the possibility of a growth hormone deficiency?

My child outwears his clothes before he outgrows them

A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend?

Myringotomy

What are some nursing interventions for a child with epiglottitis?

NO THROAT CULTURE, NO TONGUE DEPRESSOR, NO NOT PUT ANYTHING IN MOUTH, DO NOT LAY PT SUPINE, keep family calm, encourage compliance with vaccine schedule

What should you monitor for in a respiratory assessment?

Nasal flaring Grunting Retractions or change of location in retractions Increased tachypnea Increased tachycardia Decreased in SpO2 Increased need for O2 Increased irritability Decreased responsiveness Bradypnea Bradycardia

The mother of a child with cystic fibrosis tells the nurse that her child makes "snoring" sounds when breathing. The nurse is aware that many children with cystic fibrosis have:

Nasal polyps

A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion?

Normal saline infusion

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment, the nurse notes that the child is becoming irritable and the pupils are unequal and sluggish. The most appropriate nursing action is to:

Notify the practitioner immediately

Who is at risk for T2DM?

Obesity, HTN, hyperlipidemia, genetics, race, (African American, American Indian, Hispanic), inactivity

In the postoperative period following a tonsillectomy, the child should be:

Observed for subtle signs of hemorrhage

What is hypothyroidism?

Occurs d/t absent non-functioning thyroid gland

An 8-year-old with type 1 diabetes mellitus is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first?

Offer the child 8 oz of milk.

Pain medication for the child in the postoperative period following a tonsillectomy should be administered:

Orally or IV at regular intervals

A 16-year-old with cystic fibrosis is admitted with increased shortness of breath and possible pneumonia. Which nursing activity is most important to include in the patient's care?

Perform postural drainage and chest physiotherapy every 4 hours

What is an asthma action plan?

Plan for decision making and immediate intervention when asthma symptoms deviate from baseline Green: well Yellow: worse Red: medical alert

A nurse is obtaining a health history of a 7-month-old who has repeated episodes of otitis media. What question is the most important for the nurse to include in the interview with the mother?

Please describe your child's feeding pattern

What are the 3 Ps of diabetes?

Polydipsia: thirst Polyuria: large amounts of dilute urine Polyphagia: extreme hunger

A 12-year-old with type 2 diabetes mellitus presents with a fever and a 2-day history of vomiting. The nurse observes that the child's breath has a fruity odor and breathing is deep and rapid. Which should the nurse do first?

Prepare the child for an IV infusion.

A nurse is assessing a child with short stature. Which of the following findings would indicate a growth hormone deficiency?

Proportional height to weight

How do you treat hypoglycemia in a conscious child?

Provide 15g of quickly absorbed carb (4-6 oz soda/juice, 8 oz milk), recheck BG in 15 min, repeat if necessary. Follow with snack containing complex carb and protein

How is precocious puberty manifested in males?

Pubic and facial hair, enlargement of testices and penis, muscle growth, deepening of voice

How is precocious puberty manifested in females?

Pubic hair, breast development, menstruation

A 9-year-old is diagnosed with cystic fibrosis. Which of the following must the nurse keep in mind when developing a care plan for the child?

Pulmonary secretions are abnormally thick

Is DKA a medical emergency or can it wait?

RAPID ONSET, MEDICAL EMERGENCY

How do you get Reye's syndrome?

RECENT VIRAL INFECTION (especially influenza), USE OF ASPIRIN

How is JIA diagnosed?

Radiographic studies, X-rays, slit lamp eye examination - performed every 6 mos

Immunizations: 6 year - 12 years

Receive by 6 y/o: DTaP, IPV, MMR, Varicella 11-12 years: Tdap, HPV, MenACWY Yearly: yearly influenza

What are other risk factors for developing otitis media?

Recent upper respiratory illness, CIGARETTE SMOKE EXPOSURE, daycare, family history

Which intervention should the nurse explain to the parents of a child recovering from croup?

Recognizing signs of respiratory distress

How does cystic fibrosis affect the respiratory system?

Recurrent PNA, wheezing, coughing, clubbing, chronic respiratory infections, sinusitis

How can the nurse provide therapeutic communication to parents who have lost a child due to SIDS?

Referral to therapy groups, mental health services

The nurse is assessing a child recently brought to the ED. Based on the notes, which observations would cause the nurse to suspect epiglottitis?

Refusal to lie down

What is RSV?

Respiratory Syncytial Virus; common respiratory virus that causes mild, cold-like symptoms

Which clinical manifestation should the nurse expect to observe in the client with​ asthma?

Retractions and wheezing

The most appropriate nursing diagnosis for a child with type 1 diabetes mellitus is which of the following?

Risk for infection related to reduced body defenses.

What is the treatment for epligottitis?

SECURE AIRWAY WITH INTUBATION, antibiotics, corticosteroids

What is some nursing care for a head injury?

STABILIZE CERVICAL SPINE, S/S INCREASED ICP, maintain airway, monitor VS/LOC/EKG

How does cystic fibrosis affect the GI system?

STEATORRHEA (fatty, malodorous stool), cholelithiasis, prolonged prenatal jaundice, abdominal pain

What position should the patient be in after LP?

SUPINE for several hours - headache is common, monitor for CSF leak

What is family-centered care for strep throat?

Salt water gargle, oral rehydration (ice chips/frozen juice pops) Get rid of toothbrush 24 hrs after start abx, replace after 10 days

What is some nursing care for seizures?

Seizure precautions (padded rails, suction/O2 at bedside), MONITOR SERUM LEVELS OF ANTIEPLIEPTICS (affects renal and hematological function)

What are some nursing interventions for meningitis?

Seizure precautions, neuro status, provide quiet room and dim light

A pediatric client who has asthma is unable to​ speak, has shortness of​ breath, and has diminished breath sounds. Which type of asthma exacerbation is the client experiencing based on the assessment​ findings?

Severe

What is precocious puberty?

Sexual maturity that begins earlier than normal (before 8 F, before 9 M) causing early appearance of secondary sex characteristics d/t overproduction of GnRH or sex hormones; usually idiopathic but may be secondary to tumor

What is a clinical manifestation of ICP in infants?

Shrill, high-pitched cry

Which child is in greatest need of emergency medical treatment?

Six-year-old who has a high fever, no spontaneous cough and frog-like croaking

Why are children more at risk for airway obstruction?

Smaller airway

After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question?

So hypothyroidism can be treated by exposing to our baby to a certain light, right?

A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. Based on the nurse's knowledge of seizures, the nurse recognizes this as:

Status eplilepticus

The parents of an 18-month-old toddler are anxious to know why their child has experienced several episodes of acute otitis media. What should the nurse explain to the parents about why toddlers are prone to middle ear infections?

Structural differences between eustachian tubes of younger and older children

A 13-year-old with type 2 diabetes mellitus asks the nurse, "Why do I need to have this hemoglobin A1c test?" The nurse's response is based on which of the following?

To determine how controlled the child's blood sugar has been.

Which should be the reasoning behind prescribing antibiotics to a child with RSV?

To treat a concurrent bacterial infection

How is DKA treated?

Treat underlying cause (infection), IVF and insulin, bicarb for severe acidosis

How is precocious puberty treated?

Treatment not usually required. GnRH analog therapy. Surgical excision of tumor

How is DM diagnosed?

Two abnormal test results - Casual BG >200 - Fasting BG >126 - Hgb A1C >6.5%

What is the treatment for otitis media?

Tylenol/NSAIDs for pain Abx Tympanostomy

Which is the reason a student takes metformin (Glucophage) three times a day?

Type 2 diabetes mellitus.

What is a seizure?

Uncontrolled electrical discharge of the neurons in the brain

What is the difference between an adult and child respiratory anatomy in the upper airway?

Upper airway is shorter and narrower Small oral cavities and large tongue Larynx and glottis higher in neck

A nurse is caring for an infant who is very fussy and has a diagnosis for DI. Which parameter should the nurse monitor while the infant is on fluid restrictions?

Urine output

What lab values should you expect with DI?

Urine: DECREASED SPECIFIC GRAVITY <1.005, DECREASED OSMOLALITY, DECREASED SODIUM Blood: INCREASED OSMOLALITY >300, INCREASED SODIUM

A young mother brings her new baby, diagnosed with congenital hypothyroidism, to the clinic so she can learn how to administer levothyroxine. The nurse should include which of the following instructions?

Use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula

The nurse is teaching the mother of a child with cystic fibrosis how to do postural drainage. The nurse should tell the mother to:

Use cupped hands during percussion

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the child's younger brother had when he was an infant. The nurse should base a response on which information?

Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.

What procedures are done for a seizure?

Vagal nerve stimulator, craniotomy (to remove brain tissue causing seizure)

What is the treatment for DI?

Vasopressin, desmopressin

What is a subdural hematoma?

Venous bleeding between dura and arachnoid

What is croup? (Patho)

Viral infection leading to inflammation of larynx, trachea, bronchioles (lower respiratory structures)

What does clear CSF indicate?

Viral meningitis - normal glucose and protein, slightly elevated WBC, negative gram stain

What is otitis media?

Viral or bacterial infection of the middle ear

What is epiglottitis? (Patho)

Viral or bacterial inflammation of the epiglottis and surrounding structures, leading to compromised airway

What are some s/s of Reye's syndrome?

Vomiting, confusion, coma, seizure, death

What are other s/s of DM?

Warm/dry skin, dehydration, weak pulses, decreased skin turgor, fruity breath odor, KUSSMAUL RESPIRATIONS, weakness, lethargy

How is DI diagnosed?

Water deprivation test

What are physical assessment findings of respiratory distress? What do you LOOK for?

Work of breathing, color changes to lips, nail beds, change in posture, respiratory rate, nasal flaring, dyspnea, accessory muscle use

You are caring for a toddler with croup. Which of the following clinical manifestations would you not see with croup?

Worsening symptoms during the day that improve with sleep

How is growth hormone deficiency diagnosed?

X-ray to determine bone age, GH stimulation testing, decreased insulin-like growth factor (IGF-1)

Who does croup primarily affect?

6 mos-6 yrs Boys more than girls

What age group is at risk for otitis media?

6-24 mos

What is the HgbA1C goal for DM?

<7.5%

What are s/s of strep throat?

Sore throat Pain with swallowing Fever Cervical lympadenopathy Foul breath odor Tonsillar edema and exudate (white patches)

How can you prevent SIDS?

ABCs of safe sleep A: Alone B: on their Back C: in a Crib

What is an intracerebral hemorrhage?

Accumulation of blood within brain tissue

What is tonsillitis?

Bacterial or viral infection causing tonsil inflammation

What are s/s of DKA?

3 P's, kussmaul respirations, fruity breath odor, GI upset

Who is at risk for acquiring tonsillitis?

5-15 y/o Frequent exposure to germs (at daycare or school)

Immunizations: 3 year - 6 year

4-6 years: DTaP, MMR, Varicella, IPV 3-6 years: yearly influenza

Four sick children with type 1 diabetes have been admitted to the hospital. Which child is most at risk of developing hypoglycemia? Th e child with:

Bacterial sepsis

Which symptom is most common characteristic of a child with croup?

Barking cough

What does hyperthyroidism present as?

Behavioral problems (hyperactivity, easily distracted), goiter, weight loss, hot flashes, tachycardia, fine tremors, exophthalmos

Immunizations: 2 days - 1 year

Birth - HepB 2 mos - DTaP, RV, IPV, Hib, PCV, Hep B, 4 mos - DTaP, IPV, Hib, PCV 6 mos - DTap, IPV, PCV, Hep B, RV, Hib 6 - 12 mos - seasonal influenza

What does an absence seizure look like?

Blank staring, eye fluttering, lip smacking, picking at clothes

What finding is a clinical manifestation of ICP in children?

Blurred vision

How does a child get cystic fibrosis?

Both parents have to be carriers of the mutated gene

Which group of children is more likely to get a head injury?

Boys 2x likely than girls Infant/Toddlers because of large head

Which finding is the best indication that a client with ineffective airway clearance needs suctioning?

Breath sounds

What medications treat cystic fibrosis?

Bronchodilators, anticholinergics, mucolytics, PANCREATIC ENZYMES (with meals and snacks), FAT-SOLUBLE VITAMINS (A, D, E, K)

How are the live virus vaccines given?

SubQ

The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside?

Suction equipment and oxygen

Nursing care for child with RSV?

Suctioning for secretions, hydrate, keep calm, administer O2

What is SIDS?

Sudden Infant Death Syndrome; unexplained and unexpected death of an infant <12 months old

What is the treatment for tonsillitis?

Surgical tonsillectomy, antibiotics, warm salt-water gargles,

How is cystic fibrosis diagnosed?

Sweat chloride test, genetic testing, stool analysis

Which intervention should the nurse identify as a preventive measure for bronchiolitis?

Synagis (palivizumab)

A parent tells the nurse​ "When my older child had RSV years​ ago, the doctor prescribed a bronchodilator. Why has my child not been prescribed one this​ time?" When describing why bronchodilators are no longer routinely​ prescribed, which side effect of bronchodilators should the nurse​ describe?

Tachycardia

A client has been taught how to use a peak flowmeter at home for asthma control. The daily peak flow is​ 75% of the baseline. Which action should the client take in this​ situation?

Take her bronchodilator and recheck the peak flow readings in the yellow zone

What would the nurse advise the parent of a child with a barky cough gets worse at night?

Take the child outside to more humid night air for 15 minutes

What does RSV manifest as?

Temperature instability Respiratory distress Tachypnea Apneic episodes Lethargy Decreased LOC Dehydration Tachycardia Cyanosis Hypoxemia