PEDI QUESTIONS
The mother asks about giving Brian (with gastroenteritis) food after he is rehydrated. Which is the most appropriate recommendation?
Offer a regular diet. Rationale: Early reintroduction of a regular diet is an important aspect of treatment of acute diarrhea in children to prevent malnutrition.
Mild dehydration is often treated at home by administering
Oral Hydration. Rational: Oral rehydration solutions are the fluids of choice for rehydration because of their glucose-mediated and enhanced sodium absorption composition.
What nutritional support should be provided for a child with cystic fibrosis?
Pancreatic enzyme replacement, fat soluble vitamins, and mod-low carb, high protein, mod-high fat diet.
The nurse should be sure that ____ _____ and ____ ____ _____ have been determined prior to a tonsillectomy. More important, the nurse should ask if there has been a hx of bleeding, prolonged, or excessive, and whether there is a hx of any bleeding disorders in the family.
Prothrombin time (PT) and Partial Thromboplastin Time (PTT)
Kimberly, age 9 years, is brought to the clinic because of acute respiratory distress. She appears anxious and is clinging to her father. The diagnosis is asthma. Epinephrine is ordered to be given subcutaneously. The purpose of epinephrine is to
Relieve bronchospasm. R: Epinephrine is an α-adrenergic agonist, which causes mucosal vasoconstriction and subsequently relieves bronchospasm.
The physician orders a lateral neck x-ray film, for Steven with epiglottitis. The most important nursing action related to this is to
Request portable x-ray film be taken in the emergency department. R:Most practitioners prefer that the child not be transported for examination because of the dangerous nature of the illness and the potential for respiratory failure.
List seven signs of respiratory distress in pediatric patients
Restlessness, tachycardia, tachypnea, diaphoresis, flaring nostrils, retractions, and grunting.
Why are IV fluids important for a child with increased resp. rates?
The child is at risk for dehydration, and acid base imbalance.
Describe the purpose of bronchodilators.
To reverse bronchospasm
What position does a child with epiglottitis assume?
Upright sitting, with chin out, and tongue protruding "tripod position."
When is the cleft palate repaired?
Usually between 12 and 18 months of age. •Rationale: The time of cleft palate repair is individualized according to the size, shape, and degree of deformity. Most surgeons prefer to postpone the repair until 12 to 18 months of age to take advantage of palatal changes that occur with normal growth.
A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions?
Vital signs, Medical history, Assessment of breath sounds, Emergency airway equipment readily available
It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent
acute rheumatic fever.
Maria has an appendectomy. The nurse anticipates that she will remain on low intermittent gastric decompression until.
bowel motility returns. Rationale: Gastric decompression evacuates excess stomach contents, which prevents abdominal distention, nausea, and vomiting until bowel motility returns.
One of the goals for children with asthma is to prevent respiratory tract infection because infections
can trigger an episode or aggravate asthmatic state. Rational: Respiratory tract infections can trigger an asthmatic attack. An annual influenza vaccine is recommended. All respiratory equipment should be kept clean.
Jennifer Drew, a 20-year-old junior in college, is seen in the college clinic with complaints of a sore throat, muscle soreness, and general malaise for the past 3 days. Jennifer's temperature is 38.3° C (101° F). The health care provider makes a tentative diagnosis of infectious mononucleosis. On assessment, the nurse should expect to find
cervical lymphadenopathy. Rationale: The characteristic symptoms of the disease include malaise, sore throat, and fever with generalized lymphadenopathy and splenomegaly that may persist for several months.
The mother asks what to do about breastfeeding Adam (with dehydration from diarrhea). The most appropriate recommendation by the nurse is to
continue breast-feeding and give an oral rehydration solution to replace diarrheal losses.
Tommy is 5 years old and is hospitalized for a tonsillectomy and adenoidectomy. In talking with Tommy, you would expect him to complain of
difficulty breathing. Rational: As the palatine tonsils enlarge from edema, they may meet in the midline, obstructing the passage of air or food.
Lisa's father calls the clinic and tells the nurse that Lisa (with CF) "seems very sick." Lisa's father describes her symptoms as "breathing very fast, fast heart rate, short of breath, pale, and color is bluish. The nurse recognizes these symptoms as
possible pneumothorax. Rationale: Pneumothorax, air in the pleural space, is often caused by rupture of subpleural blebs through the visceral pleura and usually causes nonspecific symptoms, which include tachypnea, tachycardia, dyspnea, pallor, and cyanosis.
An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to
prevent respiratory syncytial virus (RSV) infection. Rational: Palivizumab is a monoclonal antibody specifically used in the prevention of RSV. Monthly administration is expected to prevent infection with RSV.
Management of the child with a peptic ulcer often includes
proton pump inhibitors
The care of a newborn with a cleft lip and palate before surgical repair includes
providing nonnutritive and nutritive sucking. Rational: Infants need nutritive and nonnutritive sucking. Nutritive and nonnutritive sucking is important to the infant.
A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a
spacer.
When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration (15%) are
tachycardia, parched mucous membranes, sunken eyes and fontanels.
Five-month-old Nancy is being treated at home for mild dehydration secondary to diarrhea caused by bacteria. An early clinical sign of dehydration is usually
tachycardia. Rational: The earliest detectable sign of dehydration is usually tachycardia, the body's attempt to increase cardiac output because of the low blood volume.
Four-month-old Shannon is being treated at home for mild dehydration secondary to diarrhea caused by bacteria. An early clinical sign of dehydration is usually
tachycardia. Rational: The earliest detectable sign of dehydration is usually tachycardia, the body's attempt to increase cardiac output because of the low blood volume.
Instructions for using the metered-dose inhaler (MDI) include to:
A slow, deep breath inspiration held for 5 to 10 seconds will allow the medication to reach the narrow, deep airways. Rapid inspirations cause the medication to move through the unobstructed bronchioles to patent airways, where they are less needed.
If Mr. and Mrs. Bradley ask about fertility therapy contributing to their son's illness (CF), the most appropriate response is:
Fertility therapy has no relationship with CF, which is an inborn error of metabolism affecting the exocrine glands. •Rationale: The CF gene has been discovered on the long arm of chromosome 7 and is a genetic mutation not attributed to external factors.
Which should alert the nurse to the possibility of postoperative hemorrhage (after T&A)?
Frequent swallowing. Rationale: The most obvious sign of bleeding is the child's continuous swallowing of the trickling blood. This is often noted while the child is sleeping.
Children with chronic Otitis Media are at risk for developing what problem?
Hearing Loss
Which would you expect the health care provider to order for the diagnosis of mononucleosis?
Heterophil agglutination test. Rationale: The heterophil antibody test determines the extent to which the patient's serum will agglutinate sheep red blood cells and is the most effective diagnostic test during the earlier stages of illness and in older children.
In preparing Tommy for discharge (after T&A), the nurse teaches Tommy's parents the importance of
Hot and coarse foods should be avoided to prevent irritation and pain of the operative site.
Which type of dehydration is Nancy experiencing (from diarrhea)?
Hypertonic. Rational: Hypertonic dehydration results from excess water loss, like when a child experiences diarrhea.
________ dehydration occurs when electrolyte loss exceeds water loss.
Hypotonic
Protection of the suture line for cleft lip repair is provided by what means?
Logan bow, tape, and arm restraints •Rationale: Nursing care during the postoperative period is directed toward protecting the operative site. The Logan bow, a lip protective device that prevents trauma to the suture lines, is taped securely to the cheeks. Arm restraints are applied immediately after surgery to prevent the infant from rubbing the suture line.
Adam's physical examination and diagnostic procedures confirm a diagnosis of gastroesophageal reflux disease (GERD). Adam's mother asks what causes GERD. Based on the nurse's knowledge of GERD, the most appropriate response is:
"GERD results when the lower esophageal sphincter allows the back flow of stomach contents into the esophagus during or after feedings." Rationale: An incompetent lower esophageal sphincter causes GERD.
The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. Which response by the nurse is most accurate?
"There is a 25% chance of a sibling having SCA." R: SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, there is a 25% chance that each subsequent child will have the disorder.
A full-blown reaction will be evident in approximately
2 days.
Carlos is a 10-month-old infant who is brought to the clinic. His mother states he has been irritable and his skin looks pale to her. The suspected diagnosis is iron deficiency anemia. Iron deficiency anemia is often caused by an inadequate supply of iron. Discuss what information would be important to obtain in asking Carlos's mom about his diet.
A diet that lacks iron-fortified formula and cereals can lead to anemia. An excessive intake of cow's milk can also lead to an inadequate supply of iron and decreased intake of solid foods, and it can cause blood loss in the gastrointestinal tract because of an allergy to the milk protein.
Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary?
A, D, E, K. Rational: A, D, E, and K are the fat-soluble vitamins, which need to be supplemented in higher doses for the child with cystic fibrosis.
List seven nursing diagnoses appropriate for David (with CF).
A. Ineffective Airway Clearance related to secretion of thick, tenacious mucus B. Ineffective Breathing Pattern related to mechanical airway obstruction C. Altered Nutrition, Less Than Body Requirements, related to inability to digest nutrients D. High Risk for Infection related to impaired body defenses E. Activity Intolerance related to imbalance between oxygen supply and demand F. Altered Growth and Development related to chronic illness G. Altered Family Processes related to child with chronic illness
What is the most important nursing consideration in the management of cellulitis?
Administration of oral or parenteral antibiotics. R:
In completing a nursing care plan for Tommy (after T&A), which intervention(s) is/are most appropriate?
Application of an ice collar, Administration of acetaminophen (Tylenol) elixir, and Offering cool liquids as tolerated. ***Suction equipment should be available in the event that a hemorrhage occurs. However, the posterior pharynx should not be suctioned due to the potential trauma to the operative site.
A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)?
Assesses the severity of asthma. Rational: The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline.
Repeated episodes of bronchiolitis not associated with RSV in young children require follow-up testing for which disorders?
Asthma, cystic fibrosis. R: Because of the nature of asthma and cystic fibrosis, the airways are more reactive and/or mucus production is increased, causing a perfect medium for bacterial growth. Children with asthma and cystic fibrosis are more likely to display repeated symptoms of bronchiolitis before the diagnosis of a chronic disorder.
Steven's parents ask what causes epiglottitis. Based on the nurse's knowledge of epiglottitis, the most appropriate response is
Bacterial, usually Haemophilus influenzae.
Why is genetic counseling important for the family of a child with cystic fibrosis?
Because the disease is autosomal recessive in it's genetic pattern.
Lisa, age 7 years, has CF. She lives with both parents and a 4-year-old sister who also has CF. Lisa's mother tearfully tells the nurse that she is pregnant and worried that this child will also have CF. Based on the nurse's knowledge of genetics and CF, the nurse understands that
CF can be diagnosed prenatally.
Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include?
CPR is essential for all parents and caregivers to know, especially when an infant has a history of apnea of infancy that is being monitored at home.
Juan is a newborn just delivered to Mr. and Mrs. Gonzales. He has a cleft lip and palate (CLP).
Cleft lip. •Rationale: Surgical repair of cleft lip can be done during the first week of life when the infant is free of any oral, respiratory, or systemic infection.
A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child's mother calls the clinic nurse because the child is also occasionally vomiting. What should the nurse recommend?
Continue to give ORS frequently in small amounts.
What should the nurse include when teaching an adolescent with Crohn disease?
Coping with stress and adjusting to chronic illness. Rational: Crohn disease is a chronic disease with life-altering complications. The nursing interventions include helping the child cope with stress and adjust to the illness.
Bill, age 8 years, is brought to the clinic because of acute respiratory distress. He appears anxious and is clinging to his father. The diagnosis is asthma. What symptoms support the diagnosis of moderate persistent asthma in a child over 5 years of age?
Daily symptoms
The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect?
Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death.
While providing care to Katherine (sickle cell crisis) nurse should emphasize to her the importance of which measure?
Drinking large amounts of fluids. Rational: large amounts of fluids provides hydration, which is important in decreasing the viscosity of the blood and preventing further obstruction of blood vessels.
David is the 3-year-old son of parents who are 38 and 40 years old. Mr. and Mrs. Bradley have been married for 15 years and underwent fertility therapy to have a child. David has a history of frequent colds increasing in severity during the past year. In addition, David has been losing weight, although he eats well. Mrs. Bradley has noticed during the past year that David has been having large bulky, foul-smelling bowel movements. David is admitted to the pediatric unit for a workup for cystic fibrosis (CF). What genotype would Mr. and Mrs. Bradley need to be if their son, David, is diagnosed with CF?
Each would need to carry the recessive gene for CF. •Rationale: CF is inherited as an autosomal recessive gene; the child must inherit the defective gene from both parents.
What is most descriptive of atopic dermatitis (eczema) in the infant?
Eczema is associated with hereditary allergies. R: The majority of children with atopic dermatitis have a family history of eczema, asthma, food allergies, or allergic rhinitis. This suggests a genetic predisposition.
The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted?
Elevate the area above the level of the heart.
Maria is a 10-year-old girl who is brought to the emergency department by her parents because of generalized abdominal pain. She has had slight diarrhea for the past few hours. Her temperature is 37.5° C (99.5° F). Bowel sounds are present. The diagnosis is a possible appendicitis. Several diagnostic tests are ordered. The most appropriate nursing intervention in the preoperative period is:
Ensure that diagnostic tests are administered as soon as possible to prevent delay in treatment. Rational: Successful treatment of appendicitis is based on prompt recognition of the disorder; the primary nursing objective is to assist in establishing a diagnosis.
How is the diagnosis of RSV established?
Enzyme-linked immunosorbent assay (ELISA) of nasal secretions
Kimberly's father asks the nurse whether she can still participate in sports, with her asthma. The nurse's response should be based on an understanding that
Exercise should be encouraged. R: It has been found that moderate or even strenuous exercise is advantageous for children with asthma, provided the asthma is under control.
What are the physical assessment findings for a child with asthma?
Expiratory wheezing, rales, tight cough, and signs of altered blood gasses.
True or False: Carlos is an overweight infant so he could not be anemic because of nutritional causes.
False •Rationale: Although many infants with iron deficiency anemia are underweight, it can also occur in those who are overweight. These babies are often known as "milk babies." They are often fed a diet composed mostly of cow's milk with little solid foods and have an increased amount of fecal blood loss. These chubby infants are often pale, have poor muscle development, and may be prone to infections.
True or False: Physical effects of anemia are very obvious; therefore, counseling families on medication and diet changes is easy and effective.
False •Rationale: Physical effects of anemia are often subtle, and parents may not consider their child ill. Stressing the expected physical and behavioral improvements may encourage parents to adhere to the treatment plan.
A mother calls the clinic nurse for advice regarding her child and possible contact with poison ivy. After hearing a description of the plant, the nurse confirms it is poison ivy. If the contact was in the past 15 minutes, which action should the nurse recommend to the mother?
Flush the skin with cold running water. R: Flushing the skin with cold running water within 15 minutes of contamination will neutralize the urushiol not yet bonded to the skin.
Sally is a 6-year-old girl who is being seen for her well-child examination. During the assessment, the nurse notices several round scaly patches in her scalp. Sally's mother states they have gotten worse in the past month and that Sally seems to be losing her hair where the patches are located. What is the most likely cause of Sally's scalp lesions?
Fungal infection.
Brian is 4 years old and his brother Adam is 5 months old. Both children are brought to the clinic by their mother because of diarrhea and fever. In addition, Brian has vomited twice. The nurse assesses the children and determines that they are mildly dehydrated. Which is the most appropriate method of rehydrating Brian?
Give an oral rehydration solution. Rational: Oral rehydration solutions are successful in treating the majority of children with isotonic, hypotonic, or hypertonic dehydration. Clear liquids such as fruit juices and gelatin are not used for rehydration because of their high carbohydrate content, very low electrolyte content, and high osmolality.
Ms. Drew is admitted to the hospital to prevent the spread of mononucleosis. Which precaution should be implemented?
Good hand-washing techniques only. Rationale: The mechanism of spread has not been proved, although it is believed to be transmitted by direct intimate contact with oral secretions. Therefore, good hand-washing techniques and body substance isolation would be sufficient precautions for the nurse to take.
What type of isolation measures are indicated for health personnel, caring for patient with RSV?
Good hand-washing; gown and glove to prevent cross contamination. R: RSV is highly virulent, and health care personnel should take precautions to avoid spreading the virus to uninfected hospital personnel, visitors, and patients in the hospital.
Steven is a 4-year-old child who is brought to the emergency department by his parents because he is "very sick." Symptoms include a fever of 40° C (104° F), stridor, and sore throat. He is agitated, is drooling, and wants to sit up. Acute epiglottitis is the probable diagnosis. Which should the nurse do first?
Have a pediatric tracheostomy set available. R: set should be available in the event the child's airway becomes completely occluded and intubation is not possible.
What is the most appropriate action to stop an occasional episode of epistaxis?
Have the child sit up and lean forward.
What is the most common postoperative complication following a tonsillectomy? Describe the S&S of this complication.
Hemorrhage; frequent swallowing, vomiting fresh blood, and clearing throat.
Iron deficiency anemia can be caused by more than nutritional deficiencies of iron. Discuss other causes of iron deficiency anemia.
Impaired absorption of iron can result from presence of iron inhibitors, malabsorptive disorders, or chronic diarrhea. Blood loss can occur with acute or chronic hemorrhage or parasitic infection. Excessive demands for iron required for growth may be present in premature babies, adolescents, or pregnant girls.
What are associated problems with CLP?
Inadequate nutrition, otitis media, hearing loss, dental/orthodontic problems, and speech problems. •Rationale: Missing teeth and teeth that are malformed or malpositioned can interfere with feeding. Otitis media results from improper drainage of the middle ear as a result of inefficient functioning of the eustachian tube. Recurrent otitis media can lead to hearing impairment. Extensive orthodontics and prosthodontics are usually needed to correct problems of malpositioned teeth and maxillary arches. Defective speech can result from insufficient palate functioning, faulty dentition, and hearing loss.
The nurse should anticipate that the first treatment for epiglottitis will be
Intubation. R: The primary management goal of epiglottitis is to stabilize the airway; this can be done by intubation or tracheostomy.
_________ dehydration occurs when electrolytes and fluids are present in approximately balanced proportions.
Isotonic
A child is status post hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care?
Keeping the child on a high-calcium diet, Avoiding live plants and fresh vegetables, Practicing good hygiene
What is the significance of sodium and chloride in diagnosing CF?
Latest evidence-based research indicates that there is a biochemical abnormality related to a decrease in cellular permeability to chloride; this abnormality is present from birth, with sweat chlorides two to five times greater in affected individuals. •Rationale: A clinical feature of CF is a striking elevation of sweat electrolytes. Although sodium and chloride are affected, the defect appears to be primarily a result of abnormal chloride movements.
Which diet is most appropriate for the child with celiac disease?
Low-gluten diet. Rational: Celiac disease is characterized by intolerance of gluten, the protein found in wheat, barley, rye, and oats. A low-gluten diet is indicated for life.
Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations?
Mechanical obstruction caused by increased viscosity of exocrine gland secretions. Rational: Children with cystic fibrosis have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas.
Describe the care of a child in a mist tent.
Monitor child's temp, keep tent edges tucked in, keep clothing dry, assess resp. status, look at child inside the tent.
Adam, a usually healthy 2-month-old infant, was brought to the pediatrician's office by his mother for excessive vomiting for 2 days. On examination, you note that he is irritable and has not gained any weight since his last checkup. His mother states that he "throws up after every feeding." What should the nurse assess first?
Mucous membranes. Rational: Assessing mucous membranes will help determine whether Adam is dehydrated. Discussing his urinary output with his mother, assessing skin turgor, or assessing fontanels can also help determine hydration status.
What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation?
Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate.
If the child has a severe reaction, which medication may be necessary?
Oral corticosteroids suppress the inflammatory response and may be used for a severe reaction.
Katherine is a 16-year-old African-American admitted with vasoocclusive sickle cell crisis. Katherine complains of weakness and fatigue. On assessment, the nurse finds that Katherine has a fever of 38° C (100° F) with a right-upper-quadrant abdominal pain on palpation. In addition to the above, the nurse's assessment would most likely reveal
Painful joints. Rationale: Sickle cells obstruct the blood vessels, causing occlusion and ischemia and resulting in mild to severe bone and joint pain.
What are the most common signs and symptoms of leukemia related to bone marrow involvement?
Petechiae, infection, fatigue
Lisa (with CF) tells the nurse that she would like to play soccer "like my friends." The nurse's recommendation should be based on knowledge that physical exercise is:
Physical exercise is an important adjunct to daily chest physical therapy to maintain pulmonary hygiene. It stimulates mucus secretion and provides a sense of well-being and increased self-esteem in the child.
Nancy's dehydration increases and she is hospitalized with parenteral fluid therapy. Which replacement is not added until kidney function is reestablished?
Potassium. Rational: Potassium is not administered until kidney functions are appropriate because of the risk of hyperkalemia, which causes cardiac arrhythmias, respiratory failure, mental confusion, and numbness of extremities.
A child has a nasogastric (NG) tube after surgery for acute appendicitis. What is the purpose of the NG tube?
Prevent abdominal distention. Rational: The NG tube is used to maintain gastric decompression until intestinal activity returns.
Jessica is a 6-week-old infant who was born prematurely and weighed 1.8 kg (4 pounds) at birth. Jessica has progressed steadily in weight and other aspects of her development. Her parents are in their thirties and live in a middle-class neighborhood. In addition, they have a 4-year-old son Sam who attends preschool three mornings a week. Recently, Sam has had an upper respiratory tract infection, and now Jessica has been hospitalized with respiratory symptoms that are suggestive of bronchiolitis. What is the most prevalent etiologic agent causing bronchiolitis in young infants?
Respiratory syncytial virus (RSV). R: RSV is responsible for at least 50% of children admitted for bronchiolitis.
What is the most important nursing consideration when caring for a child with sickle cell anemia?
Teach the parents and child how to minimize crises. R: Children and their families need specific instructions on how to minimize crises, including preventing infections; maintaining adequate hydration; and addressing environmental concerns, such as avoidance of extreme cold.
Which statement best describes Hirschsprung disease?
The colon has an aganglionic segment. Rational: Hirschsprung disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine as a result of the lack of ganglionic cells; therefore, it is referred to as aganglionic megacolon. Hirschsprung disease is associated with a neonate's inability to pass meconium or an older child's inability to pass feces. There is a lack of peristalsis in the affected segment of the infant or child with Hirschsprung disease. The infant or child with Hirschsprung disease will be seen with constipation or the passage of ribbon-like stools.
The most appropriate time to perform bronchial postural drainage is
The most effective time for bronchial drainage is before meals and before bedtime to prevent the interaction of excessive amounts of mucus and food intake, thereby increasing the risk of vomiting.
Which clinical manifestations should lead the nurse to suspect that Maria's appendix has ruptured?
The sudden relief of pain occurs after rupture of the appendix. This symptom is brief, followed by an increase in pain that is diffuse and accompanied by rigid guarding of the abdomen because of peritonitis.
When discussing nutrition with Lisa (w/CF) and her family, the nurse recommends continued supplementation of vitamins A, D, E, and K. This is important because
The uptake of fat-soluble vitamins is decreased because of pancreatic insufficiency.
In discussing treatment of GERD, which is the most appropriate, immediate intervention to discuss with Adam's mother?
Thicken feedings with rice cereal, Do not feed more frequently than every 3 hours, Avoid placing the child supine after feedings. Rationale: Thickening feedings and using a cross-cut nipple are indicated to decrease GERD symptoms. Feedings should be spaced at least every 3 hours so proper digestion can occur between feedings. This lessens the possibility of regurgitation. The infant should be held or positioned as upright as possible or on his side after feedings to prevent aspiration.
Brian, 16 years of age, has acne vulgaris. He is beginning to use tretinoin (retinoic acid, Retin-A) and benzoyl peroxide (Acne-Clear) as topical medications. The nurse should explain that significant improvement usually takes how long after initiation of therapy?
Tretinoin (Retin-A) interrupts the abnormal follicular keratinization that produces microcomedones, the precursors of comedones, and takes at least 2 to 3 months for significant improvement to be apparent.
Tony is 3½ years old and his brother, John, is 6 months old. Both children are brought to the clinic by their mother because of vomiting, loose stools, and fever. The nurse assesses the children and determines that they are mildly dehydrated. Identify four clinical indicators of mild dehydration
Urine specific gravity >1.020, Capillary Refill >2, External jugular vein visible when supine.
Discuss the guidelines for use of ribavirin aerosol therapy.
Use for infants at high risk because of other abnormalities, especially chronic lung disorders and immunodeficiency; infants less than 6 months old; and severely ill infants. Special precautions such as mask and goggles are required for caregivers; no pregnant personnel should be involved.
Describe feeding techniques for a child with cleft lip or palate.
Use lamb's nipple or prosthesis. Feed child upright, slowly, with frequent bubbling.
The school nurse is conducting an assessment for pediculosis capitis (head lice) on a group of school-age children. Which describes a child with a positive head check?
White sacs attached to the hair shafts in the occipital area
Ms. Drew (with Mono) is ready for discharge and inquires about her activity level. The most appropriate response is
additional rest periods are necessary, and very strenuous activities should be avoided. Rational: Additional rest periods are encouraged because of fatigue caused by the illness. Very strenuous activities are avoided to prevent secondary complications and fatigue.
When giving instructions to a parent whose child has scabies, the school nurse should tell the parent to
be prepared for symptoms to last 2 to 3 weeks. R: The mite responsible for scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate.
A 4-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and complained of gastric pain an hour ago but "feels fine" now. The parent is not certain when the child ingested the iron tablets. The most appropriate recommendation by the nurse to the parent is to
bring the child to the hospital immediately. Rational: The child should be transported to the hospital immediately for assessment and possible gastric lavage. The period of concern for complications of iron toxicity is from 30 minutes to 6 hours. Activated charcoal does not bind iron and, therefore, is not a course of treatment for this child.
Increased mucous gland secretion and mucus viscosity (in CF) result in mechanical obstruction, which leads to chronic complications of the bronchi, small intestine, pancreatic ducts, and bile ducts. Describe them:
bronchi: Chronic pneumonia and emphysema small intestine: Meconium ileus pancreatic ducts: Malabsorption syndrome bile ducts: Portal hypertension
After using the topical medications for 1 week, for acne, Brian calls the nurse to report that his skin is red and peeling. The nurse should recommend that Brian
continue using both medications because erythema and peeling are normal at this time.
Kimberly needs instructions about using a metered-dose inhaler (MDI). The nurse should explain that the MDI is used to
is a self-contained, hand-held device that allows for intermittent delivery of a specified amount of medication into the airways.
Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include
lung function, frequency of symptoms, frequency and severity of exacerbations.
The pulmonary problems associated with CF are related to
mechanical obstruction caused by the increased viscosity of mucous gland secretions.
Some of the most dreaded potential outcomes of hypertonic dehydration are related to
neurologic disturbances. Rationale: Cerebral changes in hypertonic dehydration are serious and may result in permanent damage and are therefore the most dreaded potential outcomes.
The mother asks about giving the children antidiarrheal medications. Based on the nurse's knowledge of these medications, the appropriate response is that they are
not recommended. Rationale: Antidiarrheal agents are not indicated in acute infectious diarrhea in infants and young children because of the toxicity and adverse effects that may occur, such as worsening of the diarrhea because of slowing of motility and ileus or a decrease in diarrhea, with continuing fluid losses and dehydration.
A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to
notify practitioner because chest syndrome is suspected. R: Severe chest pain, fever, a cough, and dyspnea are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately.
A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to
notify the healthcare provider immediately and be prepared to assist with a tracheostomy or intubation. Rational: Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.
The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of
pneumothorax. Rational: The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible.
Katherine's parents are receiving instructions about their daughter's disease (sickle cell) teaching should include
provide them with factual information regarding sickle cell anemia, teach them the signs and symptoms of crises, and stress the need for their child to maintain her immunization schedule.
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it
soothes inflamed mucous membrane.
The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend
trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.
Instructions for Brian (He is beginning to use tretinoin (retinoic acid, Retin-A) and benzoyl peroxide (Acne-Clear) as topical medications) should include
use sunscreen and wear a hat or visor to minimize sun exposure.
Dietary management of a child with inflammatory bowel disease (IBD) should include
vitamin supplements. Rational: Multivitamins, iron, and folic acid supplementation are recommended for the child with IBD.
Clothing the child was wearing in contact with poison ivy should be
washed in hot water and detergent.
The most appropriate nursing intervention for a child following a tonsillectomy is to
watch for continuous swallowing.
Carlos is diagnosed with iron deficiency anemia and is to take an oral iron supplement, ferrous sulfate (Fer-Iron). What nursing instructions would you give his mother?
•Iron absorbs better in an acidic environment. Iron supplements should be administered between meals and given with a citrus fruit or juice. •Oral iron will turn stools a tarry green or black color. Parents should be aware this is a normal and expected change. •Liquid iron may cause a temporary stain on teeth. If possible, administer medication through a syringe or medicine dropper placed toward back of the mouth. Brushing the infant's teeth after administration reduces the discoloration. •Store the medication safely away from the reach of children in the home. Iron ingested in large quantities is toxic and may be fatal.
Sally's mother is worried about the other two younger children and hopes that they will not get the lesions. Name four things that would be important to instruct Sally's mother at this time. (Tinea Capitis)
•It is often transmitted from one person to another or from animals to humans. •Emphasize good hygiene. •Do not allow children to exchange grooming items, headgear, scarves, or hats. •Do not share towels. •Infected children should wear a cap at bedtime if they sleep with another to prevent spread.
Name at least two types of treatment prescribed for children with tinea capitis that would be appropriate for Sally.
•Oral griseofulvin •Selenium sulfide shampoos •Topical antifungal agents •Oral ketoconazole for difficult cases
Sally's pediatrician decides to treat her with griseofulvin (Gris-PEG, Grifulvin V). What are important considerations to teach Sally's mother about this medication? (Tinea Capitis)
•The medication is frequently ordered for weeks to months. •The medication should not be discontinued until the prescribed time. •Emphasize the importance of maintaining the prescribed dosing schedule. •High-fat foods are best for the drug's absorption. •Headaches, gastrointestinal upset, fatigue, insomnia, and photosensitivity may occur from the medications. •Periodic laboratory work may be needed to monitor leukocytes and liver and renal function.
