PEDS Cardio, Endocrine, and immunizations
Clinical Manifestations of Juvenile Hypothyroidism
-Decelerated growth -Myxedematous skin changes: Dry skin Sparse hair Periorbital edema -Constipation -Sleepiness -Mental decline
Goiter
-Hypertrophy of the thyroid gland -Congenital -Usually results from maternal ingestion of antithyroid drugs during pregnancy -Acquired -Result of neoplasm, inflammatory disease, dietary deficiency (but rarely in children), or increased secretion of pituitary TSH
Tetralogy of Fallot
-four defects that result in mixed blood flow: Pulmonary stenosis, Ventricular septal defect, Overriding aorta, Right ventricular hypertrophy. -clinical manifestations: cyanosis at birth-progressive cyanosis over the first year of life, systolic murmur, episodes of acute cyanosis and hypoxia (blue spells)
clinical manifestations of heart failure: pulmonary congestion
-tachypnea -dyspnea -retractions (infants) -flaring nares -exercise intolerance -orthopnea -cough, hoarseness -cyanosis -wheezing -grunting
A nurse is caring for a child who has short stature. Which of the following diagnostic tests should be completed to confirm growth hormone (GH) deficiency? (Select all that apply.) A. CT scan of the head B. Bone age scan C. GH stimulation test D. Serum IGF-1 E. DNA testing
A. CT scan of the head B. Bone age scan C. GH stimulation test D. Serum IGF-1
A nurse is teaching a parent about posttraumatic stress disorder (PTSD). Which of the following should be included in the teaching? (Select all that apply.) A. Children who have PTSD require psychotherapy. B. A clinical manifestation of PTSD is phobias. C. Depression is seen within 1 day after the incident. D. PTSD develops following a traumatic event. E. There are six stages of PTSD.
A. Children who have PTSD require psychotherapy. B. A clinical manifestation of PTSD is phobias. D. PTSD develops following a traumatic event.
A nurse is teaching the parent of a child who has a growth hormone deficiency. Which of the following are complications of untreated growth hormone deficiency? (Select all that apply.) A. Delayed sexual development B. Premature aging C. Advanced bone age D. Short stature E. Increased epiphyseal closure
A. Delayed sexual development B. Premature aging D. Short stature
A nurse is preparing to admit an infant who experienced an apparent life-threatening event. Which of the following prescriptions by the provider should the nurse anticipate? (Select all that apply.) A. EEG B. ECG C. Urine culture D. Arterial blood gases E. Blood culture
A. EEG B. ECG E. Blood culture
Which of the following procedures uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? A. Echocardiography B. Electrophysiology C. Electrocardiography D. Cardiac catheterization
A. Echocardiography
A nurse is assessing a child. Which of the following are clinical manifestations of myopia? (select all that apply) A. Headaches B. Photophobia C. Difficult reading D. Difficulty focusing on close objects E. Poor school performance
A. Headaches C. Difficult reading E. Poor school performance
A nurse is planning to administer immunizations to a 4-year-old child who has up-to-date immunizations. Which of the following should the nurse anticipate giving? (Select all that apply.) A. Inactivated poliovirus (IPV) B. Haemophilus influenzae type b (Hib) C. Measles, mumps, rubella (MMR) D. Varicella (VAR) E. Hepatitis B (HepB) F. Diphtheria, tetanus, pertussis (DTaP)
A. Inactivated poliovirus (IPV) C. Measles, mumps, rubella (MMR) D. Varicella (VAR) F. Diphtheria, tetanus, pertussis (DTaP)
Which of the following helps nurses understand how the respiratory tract in children is different from that in adults? A. Infants rely almost entirely on diaphragmatic-abdominal breathing. B. Smooth muscle development in the airways increases until about age 12 years. C. The configuration of the chest at birth is not as round as it becomes by adulthood. D. With age there is a decrease in both number of alveoli and branching of terminal bronchioles.
A. Infants rely almost entirely on diaphragmatic-abdominal breathing.
Which of the following statements best describes Cushing syndrome? A. It is caused by excessive production of cortisol. B. Treatment involves replacement of cortisol. C. The major clinical features are exophthalmia and pigmentary changes. D. The diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.
A. It is caused by excessive production of cortisol.
A nurse is reviewing sick day management with a parent of a child who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Monitor blood glucose levels every 3 hr. B. Discontinue taking insulin until feeling better. C. Drink 8 oz of fruit juice every hour. D. Test urine for ketones. E. Call the health care provider if blood glucose is greater than 240 mg/dL.
A. Monitor blood glucose levels every 3 hr. D. Test urine for ketones. E. Call the health care provider if blood glucose is greater than 240 mg/dL.
A nurse is assessing a child with short stature. Which of the following findings would indicate a growth hormone deficiency? A. Proportional height to weight B. Height proportionally greater than weight C. Weight proportionally greater than height D. BMI greater than height/weight ratio
A. Proportional height to weight
A nurse is caring for a child who is suspected of having cystic fibrosis. Which of the following tests should the nurse prepare to administer to confirm this diagnosis? A. Sweat chloride B. Pulmonary function test C. Arterial blood gases D. Chest percussion
A. Sweat chloride
Which of the following is an early sign of heart failure that the nurse should recognize? A. Tachypnea B. Bradycardia C. Inability to sweat D. Increased urinary output
A. Tachypnea
A nurse is caring for an infant. Which of the following are clinical manifestations of coarctation of the aorta? (Select all that apply.) A. Weak femoral pulses B. Cool skin of lower extremities C. Severe cyanosis D. Clubbing of the fingers E. Heart failure
A. Weak femoral pulses B. Cool skin of lower extremities E. Heart failure
A nurse is caring for a child who has cystic fibrosis. Which of the following are expected findings? (Select all that apply.) A. Wheezing B. Clubbing of fingers and toes C. Barrel-shaped chest D. Thin, watery mucus E. Rapid growth spurts
A. Wheezing B. Clubbing of fingers and toes C. Barrel-shaped chest
A nurse is teaching a child who has asthma how to use a peak flow meter. Which of the following should be included in the teaching? (Select all that apply.) A. Zero the meter before each use. B. Record the average of the attempts. C. Perform three attempts. D. Deliver a long, slow breath into the meter. E. Sit in a chair with feet on the floor.
A. Zero the meter before each use. C. Perform three attempts.
Therapeutic management of the child with rheumatic fever includes A. administration of penicillin. B. avoidance of salicylates (aspirin). C. strict bed rest for 4 to 6 weeks. D. administration of corticosteroids if chorea develops.
A. administration of penicillin.
The most profound complication of prolonged middle ear disorders is A. loss of hearing. B. failure to thrive. C. visual impairment. D. tympanic membrane rupture.
A. loss of hearing.
A nurse is teaching a parent about acetaminophen (Tylenol) poisoning. Which of the following statements by the nurse should be included in the teaching? A. "Nausea begins 24 hours after ingestion." B. "Pallor can appear as early as 2 hours after ingestion." C. "Jaundice will appear in 12 hours if your child is toxic." D. "Children can have 4 grams of acetaminophen per day."
B. "Pallor can appear as early as 2 hours after ingestion."
A nurse is caring for a child in the postoperative period following a tonsillectomy. Which of the following is an appropriate action for the nurse to take? A. Encourage the child to blow her nose gently. B. Administer analgesics on a schedule. C. Offer orange juice. D. Position the child supine.
B. Administer analgesics on a schedule.
A nurse is providing instruction to the teacher of a child who has attention-deficit/hyperactivity disorder (ADHD). Which of the following classroom strategies should be included in the teaching? (Select all that apply.) A. Eliminate testing. B. Allow for regular breaks. C. Combine verbal instruction with visual cues. D. Establish consistent classroom rules. E. Decrease stimuli in the environment.
B. Allow for regular breaks. C. Combine verbal instruction with visual cues. D. Establish consistent classroom rules. E. Decrease stimuli in the environment.
A nurse is caring for a 2-year-old child who is cyanotic and is in the hospital for a cardiac catheterization to repair cardiac defects. The child will be transferred to the pediatric ICU following the procedure. Which of the following is an appropriate nursing action when providing care to this child? A. Place on NPO status for 12 hr prior to the procedure. B. Check for iodine or shellfish allergies prior to the procedure. C. Elevate the affected extremity following the procedure. D. Limit fluid intake following the procedure
B. Check for iodine or shellfish allergies prior to the procedure.
A nurse is assessing an infant. Which of the following should the nurse recognize as clinical manifestations of heart failure? (Select all that apply.) A. Bradycardia B. Cool extremities C. Peripheral edema D. Increased urinary output E. Nasal flaring
B. Cool extremities C. Peripheral edema E. Nasal flaring
The nurse is assessing a child with a cardiac problem. The child's extremities are cool with thready pulses, and urinary output is diminished. This is most suggestive of which of the following? A. Increased afterload B. Decreased contractility C. Increased stroke volume D. Decreased cardiac output
B. Decreased contractility
When planning care for a 4-month-old child admitted with respiratory distress caused by respiratory syncytial virus (RSV) and bronchiolitis, it is essential to include which of the following? A. Give antibiotics. B. Ensure adequate hydration. C. Administer cough syrup. D. Feed 4 oz of formula every 4 hours.
B. Ensure adequate hydration.
A nurse is providing teaching to the parent of a child who has attention-deficit/hyperactivity disorder. The nurse should include which of the following as a characteristic of impulsivity? A. Loses things B. Frequently interrupts C. Is easily distracted D. Talks excessively
B. Frequently interrupts
A nurse is teaching an adolescent who has diabetes about clinical manifestations of hypoglycemia. Which of the following should be included in the teaching? (Select all that apply.) A. Increased urination B. Hunger C. Signs of dehydration D. Irritability E. Sweating and pallor F. Kussmaul respirations
B. Hunger D. Irritability E. Sweating and pallor
A 13-year-old girl is brought to the clinic with the complaint of insomnia and hyperactivity. Other symptoms include gradual weight loss despite a good appetite; warm, flushed, and moist skin; and unusually fine hair. These manifestations are most suggestive of which of the following? A. Hypothyroidism B. Hyperthyroidism C. Hypoparathyroidism D. Hyperparathyroidism
B. Hyperthyroidism
A nurse is caring for a child who is receiving a bronchodilator medication by nebulized aerosol therapy. Which of the following are appropriate actions for the nurse to take? (Select all that apply.) A. Instruct the child that the treatment will last 30 min. B. Obtain vital signs prior to the procedure. C. Tell the child to take slow deep breaths. D. Determine if the child should use a mask. E. Attach the device to an air source.
B. Obtain vital signs prior to the procedure. C. Tell the child to take slow deep breaths. D. Determine if the child should use a mask. E. Attach the device to an air source.
The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. Because of the sudden, severe nature of the disease, the family needs a great deal of emotional support. The most appropriate nursing action is which of the following? A. Prepare the family for the child's impending death. B. Prepare the family for each procedure. C. Prepare the family for the long-term consequences of paralysis. D. Reassure the family that flaccid paralysis is not problematic.
B. Prepare the family for each procedure.
In providing nourishment for a child with cystic fibrosis (CF), which of the following factors should the nurse keep in mind? A. Fats and proteins must be greatly curtailed. B. The diet should be high in calories and protein. C. Most fruits and vegetables are not well tolerated. D. The diet should be high in easily digested carbohydrates and fats.
B. The diet should be high in calories and protein.
A nurse is caring for a child who has depression. Which of the following findings are associated with this diagnosis? (Select all that apply.) A. Prefers being with peers B. Weight loss C. Report of low self-esteem D. Sleeping more than usual E. Hyperactivity
B. Weight loss C. Report of low self-esteem D. Sleeping more than usual
A nurse is assessing a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status? (Select all that apply.) A. Oxygen saturation 95% B. Wheezing C. Retraction of sternal muscles D. Warm extremities E. Nasal flaring
B. Wheezing C. Retraction of sternal muscles E. Nasal flaring
Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include all of the following except A. lung function. B. associated allergies. C. frequency of symptoms. D. frequency and severity of exacerbations.
B. associated allergies.
A nurse is preparing to administer varicella vaccine to an adolescent. Which of the following questions should the nurse ask to determine whether there is a contraindication to administering the vaccine? A. "Do you have an allergy to eggs?" B. "Have you ever had encephalopathy following immunizations?" C. "Are you currently taking corticosteroid medication?" D. "Do you have a hypersensitivity to yeast?"
C. "Are you currently taking corticosteroid medication?"
A nurse is providing teaching to the mother of an infant who is to start taking digoxin (Lanoxin). Which of the following instructions should the nurse include? A. "Do not offer your baby fluids after giving the medication." B. "Digoxin increases your baby's heart rate." C. "Give the correct dose of medication at regularly scheduled times." D. "If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount."
C. "Give the correct dose of medication at regularly scheduled times."
A nurse is teaching the parent of a child who has strabismus. Which of the following should be included in the teaching? A. "Your child should be fitted for contact lenses." B. "Wearing glasses with convex lenses will correct this problem." C. "Placing a patch over the strong eye is needed." D. "Special lenses can correct the vision."
C. "Placing a patch over the strong eye is needed."
A nurse is teaching an adolescent who has diabetes about foot care. Which of the following should the nurse include in the teaching? A. "You should inspect your feet once a week." B. "You should cut your toe nails in a rounded fashion." C. "You can use cornstarch on your feet." D. "You can use over-the-counter callus removers."
C. "You can use cornstarch on your feet."
The nurse should recognize that when a child develops diabetic ketoacidosis, this is which of the following? A. Expected outcome B. Best treated at home C. A life-threatening situation D. Best treated at practitioner's office or clinic
C. A life-threatening situation
A nurse is caring for a child who has bronchiolitis. Which of the following are appropriate actions for the nurse to take? (Select all that apply.) A. Administer oral prednisone. B. Initiate chest percussion and postural drainage. C. Administer humidified oxygen. D. Suction the nasopharynx as needed. E. Administer oral penicillin.
C. Administer humidified oxygen. D. Suction the nasopharynx as needed.
Nursing interventions for the child after a cardiac catheterization would include which of the following? A. Allow ambulation as tolerated. B. Monitor vital signs every 2 hours. C. Assess the affected extremity for temperature and color. D. Check pulses above the catheterization site for equality and symmetry.
C. Assess the affected extremity for temperature and color.
The parent of a 10-year-old child with diabetes asks the nurse why home blood glucose monitoring is being recommended. The nurse should base the explanation on which of the following? A. It is an easier method of testing. B. Parents are better able to manage the diabetes. C. Children have a greater sense of control over the diabetes. D. Fewer visits to the primary care provider will be necessary.
C. Children have a greater sense of control over the diabetes.
Which of the following is an important nursing responsibility when a dysrhythmia is suspected? A. Order an immediate electrocardiogram. B. Count the radial rate every 1 minute for 5 minutes. C. Count the apical rate for 1 full minute and compare with radial rate. D. Have someone else take the radial rate simultaneously with the apical rate.
C. Count the apical rate for 1 full minute and compare with radial rate.
A nurse caring for a child who is receiving oxygen therapy and is on a continuous oxygen saturation monitor that is reading 89%. Which of the following is the priority action for the nurse to take? A. Increase the oxygen flow rate B. Encourage the child to take deep breaths C. Ensure proper placement of the sensor probe D. Place the child in the Fowler's position
C. Ensure proper placement of the sensor probe
Nursing considerations related to the administration of oxygen in an infant include which of the following? A. Discontinue during feedings so child can be held. B. Assess infant to determine how much oxygen should be given. C. Ensure uninterrupted delivery of the appropriate oxygen concentration. D. Direct oxygen flow so that it blows directly into the infant's face in a hood.
C. Ensure uninterrupted delivery of the appropriate oxygen concentration.
A nurse is caring for a child who is in the postoperative period following a tonsillectomy. Which of the following is a clinical finding of postoperative bleeding? A. Hgb of 11.6 and Hct of 37% B. Inflamed and reddened throat C. Frequent swallowing and clearing of the throat D. Blood-tinged mucus
C. Frequent swallowing and clearing of the throat
Which statement accurately expresses the genetic implications of cystic fibrosis (CF)? A. It is inherited as an autosomal dominant trait. B. It is a genetic defect found primarily in nonwhite population groups. C. If it is present in a child, both parents are carriers of the defective gene. D. There is a 50% chance that siblings of an affected child will also be affected.
C. If it is present in a child, both parents are carriers of the defective gene.
Nursing care of the infant and child with heart failure would include which of the following? A. Force fluids appropriate to age. B. Monitor respirations during active periods. C. Organize activities to allow for uninterrupted sleep. D. Give larger feedings less often to conserve energy.
C. Organize activities to allow for uninterrupted sleep.
A nurse is caring for a child who has swallowed paint thinner. The child is lethargic, gagging, and cyanotic. Which of the following is an appropriate action for the nurse to take? A. Induce vomiting with syrup of ipecac. B. Insert a nasogastric tube and administer activated char coal. C. Prepare for intubation with a cuffed endotracheal tube. D. Administer chelation therapy using deferoxaminemesylate.
C. Prepare for intubation with a cuffed endotracheal tube.
A nurse is caring for a child who has respiratory distress. Which of the following are early clinical manifestations? (Select all that apply.) A. Bradypnea B. Peripheral cyanosis C. Tachycardia D. Diaphoresis E. Restlessness
C. Tachycardia D. Diaphoresis E. Restlessness
It is generally recommended that a child with acute streptococcal pharyngitis can return to school A. when his or her sore throat is better. B. if no complications develop. C. after taking antibiotics for 24 hours. D. 3 days after initial throat cultures.
C. after taking antibiotics for 24 hours.
A nurse in the emergency department is assisting with the admission of a child who experienced an obstructed airway in which the parent performed CPR. Which of the following statements by the parent requires clarification? A. "I pushed on my son's abdomen." B. "I tilted my son's head back while lifting his chin." C. "I listened for sounds of breathing by my son." D. "I used my finger to check my son's mouth."
D. "I used my finger to check my son's mouth."
A nurse is teaching a group of parents about influenza. Which of the following should be included in the teaching? A. "Amantadine will prevent the illness." B. "Rimantadine is administered intramuscularly." C. "Zanamivir can be given to children 1 year and older." D. "Oseltamivir should be given within 48 hours of onset of symptoms."
D. "Oseltamivir should be given within 48 hours of onset of symptoms."
A nurse is teaching an adolescent about the appropriate use of his asthma medications. Which of the following should the client be instructed to take as needed before exercise? A. Fluticasone/salmeterol (Advair) B. Montelukast (Singulair) C. Prednisone (Deltasone) D. Albuterol (Proventil)
D. Albuterol (Proventil)
One of the goals for children with asthma is to prevent respiratory tract infection. This is because respiratory tract infection does which of the following? A. Increases sensitivity to allergens B. Causes exercise-induced asthma C. Lessens effectiveness of medications D. Can trigger an episode or aggravate asthmatic state
D. Can trigger an episode or aggravate asthmatic state
What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? A. Give tepid water baths to reduce fever. B. Encourage food intake to maintain caloric needs. C. Have the child wear heavy clothing to prevent chilling. D. Give small amounts of favorite fluids frequently to prevent dehydration.
D. Give small amounts of favorite fluids frequently to prevent dehydration.
A nurse is planning to perform a peripheral vision test on a child. Which of the following is an appropriate action for the nurse to take? A. Place the child 10 feet away from the chart. B. Show a set of cards to the child one at a time. C. Cover the child's eye while performing the test on the other eye. D. Have the child focus on an object while performing the test.
D. Have the child focus on an object while performing the test.
An immediate intervention when an infant chokes on a piece of food would be to do which of the following? A. Administer mouth-to-mouth resuscitation. B. Open the infant's mouth and perform a blind finger sweep. C. Have the infant lie quietly while a call is placed for emergency help. D. Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades.
D. Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades.
Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress which of the following? A. Be extremely concerned about cyanotic spells. B. Relax discipline and limit setting to prevent crying. C. Reduce caloric intake to decrease cardiac demands. D. Promote normality within the limits of the child's condition.
D. Promote normality within the limits of the child's condition.
A nurse is preparing to administer immunizations to a 6-month-old infant. Which of the following is an appropriate action for the nurse to take in providing atraumatic care? A. Administer 81 mg of aspirin. B. Use the Z-track method when injecting. C. Ask the parents to leave the room during the injection. D. Provide sucrose solution on the pacifier.
D. Provide sucrose solution on the pacifier.
Which of the following heart defects causes hypoxemia and cyanosis because desaturated venous blood is entering the systemic circulation? A. Coarctation of the aorta B. Atrial septal defect C. Patent ductus arteriosus D. Tetralogy of Fallot
D. Tetralogy of Fallot
A nurse is caring for a child who is receiving oxygen. Which of the following is a clinical manifestations of oxygen toxicity? A. Increased blood pressure B. Hyperventilation C. Decreased PaCO2 D. Unconsciousness
D. Unconsciousness
The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to A. strike the chest wall with a flat-hand position. B. percuss before and after positioning for postural drainage. C. percuss over the entire trunk anteriorly and posteriorly. D. cover the skin with a shirt or gown before percussing.
D. cover the skin with a shirt or gown before percussing.
Skin testing for tuberculosis (TB) is recommended A. every year for all children older than 2 years. B. every year for all children older than 10 years. C. every 2 years for all children starting at age 1 year. D. periodically for children who are high-risk populations.
D. periodically for children who are high-risk populations.
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it A. liquefies secretions. B. improves oxygenation. C. promotes less labored ventilation. D. soothes inflamed mucous membranes.
D. soothes inflamed mucous membranes.
The primary therapy for secondary hypertension in children is A. a low-salt diet. B. weight reduction. C. increased exercise and fitness. D. treatment of underlying cause.
D. treatment of underlying cause.
Indomethacin may be given to close which congenital heart defect (CHD) in newborns?
Patent Ductus Arteriosus
For the child with hypoplastic left heart syndrome, which drug may be given to allow the patent ductus arteriosus (PDA) to remain open until surgery?
Prostaglandin E
S/S of Acute Adrenocorticoid Insufficiency (Adrenal Crisis)
Weakness, fatigue, nausea, vomiting, loss of appetite, weight loss, low blood pressure, abdominal pain, fever, and confusion or coma
Hyperaldosteronism manifestations
hypertension, hypokalemia, and polyuria that fails to respond to ADH administration
A nurse is completing a physical assessment of a child with suspected glaucoma. Which of the following findings confirm this diagnosis? A. Epiphora B. Absent red reflex C. Strabismus D. Blepharospasm E. Report of pain
A. Epiphora (excessive tearing) D. Blepharospasm (spasmodic winking) E. Report of pain
A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following manifestations support this diagnosis? (Select all that apply.) A. Erythema marginatum (rash) B. Continuous joint pain of the digits C. Tender, subcutaneous nodules D. Decreased erythrocyte sedimentation rate E. Elevated C-reactive protein
A. Erythema marginatum (rash) E. Elevated C-reactive protein
A nurse is assessing a child. Which of the following are clinical manifestations of epiglottitis? (Select all that apply.) A. Hoarseness and difficulty speaking B. Difficulty swallowing C. Low-grade fever D. Drooling E. Dry, barking cough F. Stridor
A. Hoarseness and difficulty speaking B. Difficulty swallowing D. Drooling F. Stridor
Which of the following blood oxygenation tests is the photometric measurement of oxygen saturation? A. Oximetry B. Capnography C. Arterial puncture D. Transcutaneous oxygen and carbon dioxide monitoring
A. Oximetry
A nurse is planning to administer immunizations to a 2-month-old infant. Which of the following should the nurse anticipate giving? (Select all that apply.) A. Rotavirus (RV) B. Diphtheria, tetanus, pertussis (DTaP) C. Haemophilus influenzae type b (Hib) D. Hepatitis A (HepA) E. Pneumococcal (PCV) F. Inactivated poliovirus (IPV)
A. Rotavirus (RV) B. Diphtheria, tetanus, pertussis (DTaP) C. Haemophilus influenzae type b (Hib) E. Pneumococcal (PCV)
Which of the following statements best describes hypopituitarism? A. Skeletal proportions are normal for age. B. Weight is usually more retarded than height. C. Growth is normal during the first 3 years of life. D. Most of these children have subnormal intelligence.
A. Skeletal proportions are normal for age.
A nurse is admitting a child who has cystic fibrosis. Which of the following medications should the nurse anticipate including in the plan of care? (Select all that apply.) A. Tobramycin B. Solu-medrol C. Fat-soluble vitamins D. Albuterol E. Dornase alfa
A. Tobramycin C. Fat-soluble vitamins D. Albuterol E. Dornase alfa
Which of the following is an important nursing consideration when chest tubes will be removed from a child? A. Explain that it is not painful. B. Administer analgesics before procedure. C. Explain that only a Band-Aid will be needed. D. Expect bright red drainage for several hours after removal.
B. Administer analgesics before procedure.
A nurse is planning care for a child who has cystic fibrosis. Which of the following interventions should she include in the plan of care? A. Provide a low-calorie, low-protein diet. B. Administer pancreatic enzymes with meals and snacks. C. Promote an increase in fluids after 1800. D. Restrict physical activity.
B. Administer pancreatic enzymes with meals and snacks.
Which of the following types of croup is always considered a medical emergency? A. Laryngitis B. Epiglottitis C. Spasmodic croup D. Laryngotracheobronchitis
B. Epiglottitis
An appropriate nursing intervention when caring for a child with pneumonia is which of the following? A. Avoid placing child on the affected side. B. Monitor the respiratory status frequently. C. Place in a Trendelenburg position. D. Administer antitussive agents around the clock.
B. Monitor the respiratory status frequently.
A nurse is planning caring for a child who has asthma. Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Perform chest percussion. B. Place the child in an upright position. C. Monitor oxygen saturation. D. Administer bronchodilators. E. Administer dornase alfa (Pulmozyme) daily
B. Place the child in an upright position. C. Monitor oxygen saturation. D. Administer bronchodilators.
A nurse is teaching an adolescent to self-administer a corticosteroid medication per dry powder inhaler (DPI). Which of the following should be included in the teaching? (select all that apply) A. Shake the device prior to use B. Rinse and expectorate after administration C. Inhale with medication administration D. Exhale quickly after medication administration E. Attach a spacer to the device prior to use
B. Rinse and expectorate after administration C. Inhale with medication administration
A nurse is assessing a toddler for possible hearing loss. Which of the following are clinical manifestations of a hearing impairment? A. Uses telegraphic speech B. Speaks loudly C. Repeats sentences D. Appears shy E. Is overly attentive of the surroundings
B. Speaks loudly D. Appears shy
A nurse is teaching a child who has type 1 diabetes mellitus about self care. Which of the following statements by the child indicates understanding of the teaching? A. "I should skip breakfast when I am not hungry." B. "I should increase my insulin with exercise." C. "I should drink a glass of milk when I am feeling irritable." D. "I should draw up the NPH insulin into the syringe before the regular insulin."
C. "I should drink a glass of milk when I am feeling irritable."
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? A. "Injections are usually continued until age 10 for girls and age 12 for boys." B. "Injections continue until your child reaches the fifth percentile on the growth chart." C. "Injections should be continued until there is evidence of epiphyseal closure." D. "The injections will need to be administered throughout your child's entire life."
C. "Injections should be continued until there is evidence of epiphyseal closure."
Which of the following is a measure of chest wall and lung distensibility? A. Resistance B. Ventilation C. Compliance D. Alveolar surface tension
C. Compliance
A nurse is caring for a child who has type 1 diabetes. Which of the following is a clinical manifestation of diabetic ketoacidosis? (Select all that apply.) A. Blood glucose 58 mg/dL B. Weight gain C. Dehydration D. Mental confusion E. Fruity breath
C. Dehydration D. Mental confusion E. Fruity breath
Which of the following should the nurse include when discussing a child's precocious puberty with the parents? A. The child is not yet fertile. B. Heterosexual interest is usually advanced. C. Dress and activities should be appropriate to chronologic age. D. Appearance of secondary sexual characteristics does not proceed in the usual order.
C. Dress and activities should be appropriate to chronologic age.
A nurse is assessing a child. Which of the following is an early indication of hypoxemia? A. Nonproductive cough B. Hypoventilation C. Nasal flaring D. Nasal stuffiness
C. Nasal flaring
A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, play baseball, and swim. The nurse's response should be based on knowledge that A. exercise is contraindicated. B. the level of activity depends on the type of insulin required. C. exercise is not restricted unless indicated by other health conditions. D. soccer and baseball are too strenuous, but swimming is acceptable.
C. exercise is not restricted unless indicated by other health conditions.
A child is developing respiratory failure. Signs that the hypoxia is becoming severe include A. tachypnea. B. tachycardia. C. somnolence. D. restlessness.
C. somnolence
Which of the following is the primary clinical manifestation of diabetes insipidus? A. Oliguria B. Glycosuria C. Nausea, vomiting D. Polyuria, polydipsia
D. Polyuria, polydipsia
A nurse is teaching a group of parents about infants who have failure to thrive. Which of the following characteristics should be included in the teaching? A. They have been neglected. B. They come from an impoverished environment. C. They manifest colicky behaviors. D. They exhibit developmental delays.
D. They exhibit developmental delays.
The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. Which of the following should be the nurse's next action? A. Notify the surgeon. B. Perform oral intubation. C. Try inserting a larger tube. D. Try inserting a smaller tube.
D. Try inserting a smaller tube.
DM Type 1
Type 1 DM believed to be autoimmune disease, arising when a person with a genetic predisposition is exposed to a precipitating event such as viral infection Heredity is prominent factor in etiology
Signs of acute heart failure
decreased urine output, gallop heart rhythm, tachycardia, and respiratory distress
Captopril (Capoten)
-ACE inhibitor, reduce afterload by causing vasodilation, resulting in decreased pulmonary and SVR. -Monitor BP before and after medication administration -Monitor for evidence of hyperkalemia -Instruct parents to monitor BP frequently
Nursing Management of DI
-Accurate I&O -Observe for signs of fluid overload -Seizure precautions -Administer ADH-antagonizing medicines
Interventions for Addison's Disease
-Administer oral cortisol (Solu-Cortef) When hospitalized: -Replace fluids and electrolytes -Monitor closely for signs of hypovolemic shock -Educate parents about medications (side effects and administration routinely and regularly), home free of stress, hydration, and medical alert bracelet -Do NOT stop steroids suddenly
Pheochromocytoma
-Adrenal tumor that secretes catecholamines (epinepherine and norepinephrine) -May occur around adrenal medulla, along paraganglia of aorta, or at thoracolumbar sympathetic chain -Children often have bilateral, multiple, benign tumors -Increased production of catecholamines; may mimic other disorders
Lymphocytic Thyroiditis
-Also known as Hashimoto disease or juvenile autoimmune thyroiditis -Most common cause of thyroid disease in children and adolescents -Accounts for largest percent of juvenile hypothyroidism -Occurs more frequently after age 6 years
Rheumatic fever treatment
-Antibiotic prophylaxis: penicillin
Clinical manifestations of DI
-Cardinal signs: polyuria and polydipsia -First sign is often enuresis accompanied by insatiable thirst -Infants: Irritability relieved with feedings of water but not milk Dehydration often occurs
Diagnosis of Cushing Syndrome
-Confirm excess cortisol levels -X-rays: evaluate for osteoporosis and take skull films to look for enlargement of sella turcica -Laboratory tests: -Fasting blood glucose -Serum electrolytes -24-hour urine
medication for Kawasaki disease
-Gamma globulin (IVGG) -Aspirin
Therapeutic Management of Lymphocytic Thyroiditis
-Goiter may be transient, asymptomatic -May resolve spontaneously within 1-2 years -Oral TH often decreases the goiter significantly -Surgery contraindicated for this disorder
Digoxin (lanoxin)
-Improves myocardial contractility -Monitor the pulse and withhold the medications as ordered. Infant's pulse <90. Child's pulse <70. -Monitor for toxicity as evidenced by bradycardia, dysrhythmias, nausea, vomiting, or anorexia. -Monitor serum digoxin levels -Give water following administration if the child has teeth to prevent tooth decay -Direct medication to the side and back of the mouth to administer -If a dose is missed, do not give an extra dose or increase the next dose.
Nursing Care Acute Adrenocorticoid Insufficiency (Adrenal Crisis)
-Initially administer steroid IV hydrocortisone (A-hydroCort) and antibiotics -Administer IV fluids to reverse dehydration, electrolyte imbalances and hypovolemia -Constantly assess child and recognize signs and symptoms of adrenal crisis (vital signs q 15 min) -Review lab values often -Understand that cortisone and sodium chloride treatments are given rapidly to rectify an ominous situation -Explain treatment and child's response
Therapeutic Management of DI
-Instruct parents on difference between DI and diabetes mellitus (DM) -Daily hormone replacement of vasopressin -Unresponsiveness usually indicates nephrogenic DI
Hyperthyroidism and Graves Disease
-Most common cause of hyperthyroidism in childhood is ---Graves disease -Cause appears to be autoimmune response to TSH receptors, but no specific etiology -Enlarged thyroid gland and exophthalmos -Peak incidence at 12-14 years of age, but may be present at birth -Familial association -Diagnosis based on increased levels of T4 and T3 with suppressed TSH
Complications with a cardiac cath
-N/V -Low-grade fever -loss of pulse in the catheterized extremity -transient dysrhythmias -acute hemorrhage from entry site
Furosemide (Lasix) or chlorothiazide (Diuril)
-Potassium-wasting diuretics rid the body of excess fluid and sodium. -Encourage a diet high in Potassium (bran cereals, potatoes, tomatoes, bananas, oranges, and orange juice). -Monitor I & O -Monitor for adverse effects such as hypokalemia (muscle weakness, irritability, excessive drowsiness, and increased or decreased HR), nausea, vomiting, and dizziness. -Monitor daily weight.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
-Produced by hypersecretion of the posterior pituitary (increased ADH) -Signs and symptoms: fluid retention, hypotonicity -Kidneys unable to reabsorb water -Anorexia, nausea and vomiting, irritability, personality changes -Symptoms disappear when ADH is decreased
Chronic Adrenocortical Insufficiency: Addison Disease
-Rare in children -When it occurs, usually result of neoplasm or lesion of adrenal glands or idiopathic cause -Symptoms appear gradually after 90% of adrenal tissue is nonfunctional
Therapeutic management of hyperaldosteronism
-Replacement of potassium -Administration of spironolactone (Aldactone)to block effects of aldosterone
Hear defects that cause hypoxemia
-Tetralogy of Fallout -single ventricle -transposition of the great arteries
Diabetes Insipidus (DI)
-The principal disorder of the posterior pituitary -Results from hyposecretion of antidiuretic hormone (ADH) -Produces uncontrolled diuresis -Primary causes: familial or idiopathic -Secondary causes: trauma, tumors, granulomatous disease, aneurysm
Nursing Care management of Goiter
-Thyroid enlargement at birth may compromise newborn's airway -Large goiters may be obvious; smaller nodules evident only on palpation -Thyroid hormone (TH) replacement necessary for treatment of hypothyroidism
S/S of Addison's Disease
-Weakness, fatigue, dizziness, and rapid pulse -Dark skin noted on hands and face, weight loss, dehydration, loss of appetite intense salt craving, muscle aches, nausea, vomiting, diarrhea, and intolerance to the cold
Tricuspid atresia
-a complete closure of the tricuspid valve that results in mixed blood flow. An atrial septal opening needs to be present to allow blood to enter the left atrium. -clinical manifestations: Infants-cyanosis, dyspnea, tachycardia; Older children-hypoxemia, clubbing of fingers
Transposition of the great arteries
-a condition in which the aorta is connected to the right ventricle instead of the left, and the pulmonary artery is connected to the left ventricle instead of the right; a septal defect or a PDA must exist in order to oxygenate the blood. -clinical manifestations: murmur depending on presence of associated defects, severe or less cyanosis depending on the size of the associated defect, cardiomegaly, and heart failure.
Patent ductus arteriosus (PDA)
-a condition in which the normal fetal circulation conduit between the pulmonary artery and the aorta fails to close and results in increased pulmonary blood flow. -clinical manifestations: murmur (machine hum), wide pulse pressure, bounding pulses, asymptomatic (possibly), and heart failure.
Atrial Septal defect (ASD)
-a hole in the septum between the right and left atria that results in increased pulmonary blood flow. -manifestations: loud, harsh murmur with a fixed split second heart sound, heart failure, asymptomatic (possibly).
Ventricular septal defect (VSD)
-a hole in the septum between the right and left ventricle that results in increased pulmonary blood flow. -manifestations: loud, harsh murmur auscultated at the left sternal border, heart failure. -many close spontaneously.
Nursing actions for hypoxemia
-a hypercyanotic spell can result in severe hypoxemia, which leads to cerebral hypoxemia, and should be treated as an emergency. -Immediately place the child in the knee-chest position, attempt to calm the child, and call for help.
Aortic stenosis
-a narrowing of the aortic valve -clinical manifestations: Infants- faint pulse, hypotension, tachycardia, and poor feeding tolerance. Children: intolerance to exercise, dizziness, chest pain, and possible ejection murmur.
Coarctation of the aorta
-a narrowing of the lumen of the aorta, usually at or near the ductus arteriosus, that results in obstruction of blood flow from the ventricle. -clinical manifestations: elevated blood pressure in the arms, bounding pulses in the upper extremities, decreased blood pressure in the lower extremities, cool skin of lower extremities, weak or absent femoral pulses, heart failure in infants; dizziness, headaches, fainting, or nosebleeds in older children.
Pulmonary stenosis
-a narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles. -clinical manifestations: systolic ejection murmur, asymptomatic (possibly), cyanosis varies with defect, worse with severe narrowing, cardiomegaly, heart failure
Quality patient outcomes of heart failure
-adequate cardiac output -decreased cardiac demands -improved respiratory function -no evidence of fluid excess -adequate support and education
Nursing actions for complications with cardiac cath
-apply direct continuous pressure at 2.5 cm above the catheter entry site to localize pressure over the location of the vessel puncture. -position the child flat to reduce gravitational effect on the rate of bleeding -Notify the provider immediately -prepare for possible administration of replacement fluids and/or medication to control emesis.
Metoprolol or carvedilol (Coreg)
-beta-blockers, which decrease HR and BP, and promote vasodilation. -Monitor BP and HR prior to administration -Monitor for adverse effects such as dizziness, hypotension, and headache.
Prostaglandin E
-causes vasodilation and smooth muscle relaxation therefore increasing dilation and patency of the ductus arteriosus. -used when infants exhibit cyanosis within the first few days of life as the ductus arteriosus, which provided pulmonary blood flow, begins to close.
Truncus arteriosus
-failure of septum formation, resulting in a single vessel that comes off of the ventricles -clinical manifestations: heart failure, murmur, variable cyanosis, delayed growth, lethargy, fatigue, poor feeding habits
Digoxin instructions
-give at regular intervals, usually every 12 hrs -direct medications to the side or back of mouth slowly -do not mix with food or other fluids -giver water after administration if teeth have grown in -if dose is missed, do not give an extra dose -do not give a second dose if child vomits -notify physician if two consecutive doses have been missed -frequent vomiting, poor feeding, or bradycardia can be signs of toxicity -therapeutic levels: 0.8-2 mcg/L
Acute onset manifestations of Kawasaki Disease
-high fever >102 (38.9 C) lasting 5 days to 2 weeks that is unresponsive to antipyretics -irritability -red eyes w/o drainage -strawberry tongue w/ white coating or red bumps on the posterior aspect -red oral mucus membranes -swelling of hand and feet with red palms and soles -nonblistering rash -bilateral joint pain -enlarged lymph nodes
Hypoplastic left heart syndrome
-left side of the heart is underdeveloped. An ASD or patent foramen ovale allows for oxygenation of the blood. -mild cyanosis, heart failure, lethargy, cold hands and feet, once PDA closes, progression of cyanosis and decreased cardiac output result in eventual cardiac collapse.
Interventions for Kawasaki disease
-monitor vital signs and cardiac status, and cardiac monitoring -assess client for HF (decreased urine output, gallop heart rhythm, tachycardia, respiratory distress). -Monitor I & O -Administer IV fluids to prevent dehydration. Offer clear liquids and soft foods -Administer IV gamma globulin according to facility policy. -Administer aspirin as prescribed. -Provide care to promote comfort due to clinical findings. -oral hygiene -apply cool cloths to skin -apply skin lotions to maintain hydration -provide for calm, quiet environment -promote rest by clustering care
Treating a Hypercyanotic spell
-place infant in knee-chest position -employ a calm, comforting approach -administer 100% oxygen by face mask -give morphine Sub-Q or through existing IV -begin IV fluid replacement and vol. expansion, if needed. -repeat morphine administration.
subacute phase of kawasaki
-resolution of the fever and gradual subsiding of other clinical manifestations -irritability -peeling skin around the nails, on the palms and soles
Clinical manifestations of heart failure: impaired myocardial function
-tachycardia -sweating (inappropriate) -decreased urinary output -fatigue -weakness -restlessness -anorexia -pale, cool extremities -weak peripheral pulses -decreased blood pressure -gallop rhythm -cardiomegaly
Rheumatic fever clinical manifestations
-usually occurs within 2-6 weeks following an untreated or partially treated upper respiratory infection (strep throat) with GABHS. -Fever -Tachycardia, cardiomegaly, prolonged PR interval, new or changed heart murmur, muffled heart sounds, pericardial friction rub, and report of chest pain, which may indicate carditis. -Nontender, subcutaneous nodules over bony prominence -Large joints with painful swelling, indicating polyarthritis (may be present for a few days and then disappear without treatment, frequently returning in another joint. -pink, nonpruritic macular rash on the trunk and inner surfaces of extremities that appears and disappears rapidly, indicating erythema marginatum. -CNS involvement (chorea) including involuntary, purposeless muscle movements; muscle weakness; involuntary facial movements; difficulty performing fine motor activities; labile emotions; and random, uncoordinated movements of the extremities. -Irritability, poor concentration, and behavioral problems
clinical manifestations of heart failure: systemic venous congestion
-weight gain -hepatomegaly -peripheral edema, especially periorbital -ascites -neck vein distention
Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.
1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm.
