PEDS
A parent calls the after-hours triage nurse about a 3-year-old who is sick with the flu. Which report by the parent would necessitate intervention by the nurse? 1. Acetaminophen being given every 4 hours for fever 2. Bismuth subsalicylate being used for nausea 3. Ibuprofen being given every 6 hours for body aches 4. Popsicles and gelatin desserts being used for hydration
Answer: 2 Rationale: The nurse should tell the parent not to administer any product containing aspirin or salicylates to a child with a viral infection (eg, influenza, varicella) to prevent Reye syndrome.
A school nurse observes a 3-year-old begin to choke and turn blue while eating lunch. What should be the nurse's initial action? 1. Abdominal thrusts 2. Back blows and chest thrusts 3. Blind sweep of the child's mouth 4. Call 911 for an ambulance
Answer: 1 Rationale: The Heimlich maneuver (ie, upward abdominal thrusts under the rib cage) is the primary rescue intervention for children over age 1with a foreign body airway obstruction causing respiratory distress. Back blows and chest thrusts are appropriate interventions for a choking infant under age 1. Blind sweeping of a child's mouth should not be attempted.
The nurse plans care for a child admitted with measles. Which of the following interventions will the nurse include in the plan of care? Select all that apply. 1. Advise measles vaccination for susceptible family members 2. Apply calamine lotion to reduce itching 3. Place a tracheostomy tray at the bedside 4. Place the client in a negative-pressure isolation room 5. Use a N95 respirator mask during client contact
Answer: 1,4,5 Rationale: -Recommendation of postexposure prophylaxis (ie, MMR vaccine) for eligible, susceptible (eg, unvaccinated) family members within 72 hours of exposure to decrease the severity and duration of symptoms in case they contract the disease -Implementation of airborne precautions, including a negative-pressure isolation room and use of an N95 respirator mask, during contact with the client by health care staff -Administration of vitamin A supplements to prevent severe, measles-induced vitamin A deficiency, which can cause blindness, particularly in clients in low-resource areas PT.'S at increased risk: - international travel - unvaccinated children have caused a resurgence of the disease.
The clinic nurse supervises a graduate nurse who is teaching the parents of a 2-year-old with acute diarrhea about home management. The nurse would need to intervene when the graduate nurse provides which instruction? 1. "Do not administer antidiarrheal medications to your child." 2. "Follow the bananas, rice, applesauce, and toast diet for the next few days." 3. "Record the number of wet diapers and return to the clinic if you notice a decrease." 4. "Use a skin barrier cream such as zinc oxide in the diaper area until diarrhea subsides."
Answer: 2 Rationale: When a child is experiencing acute diarrhea, the priority is to monitor for dehydration. Treatment is accomplished with oral rehydration solutions and early reintroduction of the child's normal diet (usual foods). BRAT diet is not recommended Note: -Use of antidiarrheal medications is discouraged as these have little effect in controlling diarrhea and may actually be harmful by prolonging some bacterial infections and causing fatal paralytic ileus in children. -Parents should be taught to monitor their child for signs of dehydration by checking + the amount of fluid intake + number of wet diapers + presence of sunken eyes + condition of the mucous membranes. - Protecting the perineal skin from breakdown during bouts of diarrhea can be accomplished by using skin barrier creams (eg, petrolatum or zinc oxide).
What socioeconomic indicators would the nurse identify as risk factors for a 2-month-old infant to develop failure to thrive (FTT)? Select all that apply. 1. Both caregivers work outside the home 2. Infant lives only with mother, who is currently unemployed 3. Infant's primary caregiver has cognitive disabilities 4. Parents are socially and emotionally isolated 5. Parents live together but are not married
Answer: 2,3,4 Rationale: -Poverty - most common -Social or emotional isolation - parents may lack the support system needed to assist them with the problems of child rearing -Cognitive disability or mental health disorder -Nutrition deficit (Bulimia, anorexia, etc) -Lack of nutritional education - parents may not have knowledge of proper feeding techniques or appropriate calorie intake based on age and size of the child -Domestic problems in the home FTT can lead to physiologic risk factors such as - preterm birth -breastfeeding difficulties -gastroesophageal reflux -cleft palate.
The nurse is assessing a 3-year-old client in the emergency department and finds dyspnea, high fever, irritability, and open-mouthed drooling with leaning forward. The parents report that the symptoms started rather abruptly. The client has not received age-appropriate vaccinations. Which set of actions should the nurse anticipate? 1. 20-gauge needle insertion at the mid-axillary line for pleural aspiration 2. 4 L oxygen at 100% per nasal cannula with bilevel positive airway pressure (BPAP) ventilation standing by 3. Intubation in the operating room with a prepared tracheotomy kit standing by 4. Nebulized racemic epinephrine with pediatric anesthesiologist standing by
Answer: 3 Rationale: When assessing a client with symptoms suggestive of epiglottitis -stridor upon auscultation - acutely ill - drooling -leaning forward -dyspnea The nurse should prepare for an emergency airway.
The nurse receives change of shift report on 4 clients. Which client should the nurse assess first? 1. 6-month-old with respiratory syncytial virus and pulse oximetry of 90% 2. 1-year-old with otitis media and a temperature of 102.5 F (39.2 C) rectally 3. 2-year-old with suspected epiglottitis 4. 3-year-old who has a barking-type cough
Answer: 3 Rationale: Epiglottitis is a medical emergency as the child can rapidly progress from being asymptomatic to having a completely occluded airway. Emergency intubation equipment should be readily available. Note: -Oxygen saturation ≥90% is the treatment goal for bronchiolitis caused by respiratory syncytial virus. - This temperature is an expected finding in the setting of otitis media and does not carry the urgency of airway impairment. - A barking-type cough is seen in viral croup syndromes. The resonant hoarse cough is secondary to narrowed airways. Croup is typically mild but can become life-threatening if the airway swells excessively. This child would need to be assessed next.
An 8-month-old infant is scheduled for a femorally inserted balloon angioplasty of a congenital pulmonic stenosis in the cardiac catheterization laboratory. Which finding should the nurse report to the health care provider that could possibly delay the procedure? 1. Auscultation of a loud heart murmur 2. Infant has been NPO for 4 hours 3. Infant has severe diaper rash 4. Slight cyanosis of the nail beds
Answer: 3 Rationale: -The presence of severe diaper rash should be reported to the health care provider (HCP). This could delay the procedure if the rash is in the groin area where access is planned for a femorally inserted arterial cannula. Yeast or bacteria may be present on the rash and could be introduced into the bloodstream with the arterial stick - A loud heart murmur can be an expected finding in a child with pulmonic stenosis. - Children are NPO for 4-6 hours or longer before the procedure. Younger children and infants may have a shorter period of NPO status and should be fed right up to the time recommended by the HCP. - Cyanosis indicates severe pulmonic stenosis with right-to-left shunt and the need for interventional catheterization or surgery without delay.
The nurse provides discharge teaching for the parents of a child newly diagnosed with hemophilia A. Which statements by the parents indicate that teaching has been effective? Select all that apply. 1. "A high-calorie, high-protein diet is best for our child." 2. "It is extremely important that we do not allow our child to become dehydrated." 3. "Our child should wear a medical alert bracelet at all times." 4. "We should avoid giving our child over-the-counter medicine containing aspirin." 5. "We should encourage a noncontact sport such as swimming."
Answer: 3,4,5 Rationale: -Avoid medications such as ibuprofen and aspirin that have platelet inhibition properties -Avoid intramuscular injections; subcutaneous injections are preferred. -Avoid contact sports and safety hazards; noncontact activities (eg, swimming, jogging, tennis) and use of protective equipment (eg, helmets, padding) are encouraged -Dental hygiene is necessary to prevent gum bleeding, and soft toothbrushes should be used. -MedicAlert bracelets should be worn at all times
A 1-year-old child who goes to day care is recovering from an episode of otitis media. Which intervention is most important for the nurse to recommend to the parents in order to prevent recurrence? 1. Exclusive breastfeeding 2. Not sending the child to day care 3. Preventing water from entering the ear 4. Smoking cessation by the parents
Answer: 4 Rationale: Otitis media, inflammation of the middle ear, commonly occurs in children under age 2. Key interventions for prevention include -avoiding exposure to tobacco smoke -obtaining routine immunizations -discontinuing use of a pacifier after age 6 months. Note: Excess water in the ears from bathing or swimming can alter the protective environment of the external ear and contribute to OTITIS EXTERNA, known as swimmer's ear
The nurse is performing a physical assessment on a 2-year-old with cold symptoms and a fever at home of 101.7 F (38.7 C). The parent is concerned about the child's ability to cooperate during the examination. Place the components of assessment in the order the nurse would perform them. All options must be used. Interact with the parent in a friendly manner 4. Play with the child using a finger puppet 3. Measure the child's height and weight 1. Auscultate the child's heart and lungs 5. Take the child's vital signs
Rationale: Want to do actions from least to most invasive