Peds final
The 1-week-old child is diagnosed with hemophilia A. Neither the mother nor the father has the disease. Which statement, if made by the nurse to the parents, correctly describes the hemophilia trait?
"It is an X-linked recessive trait found primarily in males."
General rule for solid food for toddlers? Gives up nap when? Use toothpaste when?
1 tablespoon of solid food per year of age 3 years 2 years
The nurse recognizes that which child is at greatest risk for poisoning?
A 2 year old
The nurse cares for the clients i the pediatric clinic. The nurse should investigate which child for a possible speech impairment?
A 5 year old who uses single words
The school nurse assesses children enrolled in the kindergarten class. The nurse is most concerned if which finding is observed?
A child walks down stairs by placing both feet on one step. the 24 month old goes up and down the stairs alone, runs well with a wide stance, buids tower of 6-7 blocks, and has a 300 word vocabulary
The nurse is asked to explain the major difference between a clubfoot and a positional deformity to a student nurse. Which statement, if made by the nurse is appropriate?
A clubfoot is corrected with surgery and casting, but a positional deformity can be passively corrected.
In cultures that emphasize thinness and have an abundance of food? Experiences eating as? Occurs how often? (4) factors? Menses are normal but may experience?
Bulemia nervosa out of control twice a week for 3 months Induced vomiting Abuse of laxatives, enemas Excessive exercise Fasting Electrolyte imbalance
Symptoms include arthritis and arthralgia? Oral rehydration fluid is required? High fever for 3-4 days, fever drops and rash appears? All family members must be treated? Rash disappears with pressure? Diagnose pin worm? Rash will disappear but reappear if skin is irritated?
Fifths Rotavirus Roseola Pinworms Roseola Scotch tape Fifths
Most common method of suicide? Kids tell who first about suicide?
Firearms Peers, not parents.
How would the nurse test the following signs for Developmental Dysplasia of the Hip (DDH) Galeazzi Test Allis Sign Ortolani - Barlow Sign
Galeazzi Test = Asymmetry of gluteal folds Allis Sign = Shortened femur w flexion of knees Barlow - Orolani Sign = Femoral head moves out & into the acetabulum with abduction
The parent brings the 6-month-old baby to the clinic for a check-up. The parent reports the baby had a check-up at 2 months of age and received the first DTaP. Which action by the nurse is most appropriate?
Give second DTaP.
Infants are at greater risk for dehydration b/c: (4)
Greater surface area r/t body mass Total Body Water at birth 70 - 75% of Body Weight Higher rate of metabolism Immature kidneys
Hypopituitarism is deficient in? Injection is done via and when?
Growth hormone Sub-q at night
Cause of ulcers? Foods that contribute to peptic ulcers?
H. Pylori Polyunsaturated fats and fibers
Aids dysmorphic syndrome tx?
HAART or gamma globulin
Disorders of sexual development (DSD) present unique challenges to both the patient, family members and health care providers. In preparing for health promotion materials to be used in a teaching session for health care providers on this subject, which information should be included?
Health care providers should understand their own feelings and implicit bias relative to DSD.
The nurse observes parents interacting with their newborn shortly after birth. It is important for the nurse to make which assessment during this observation?
Healthy of pathologic relationships
The first year of life? The first month of life?
Infancy Newborn/neonate
Parents of a newborn bring their male son to the emergency room. The infant appears fretful and the parents state that he has not voided in several hours. Inspection of the penis reveals edema and the nurse is unable to retract the foreskin. Based on this assessment, what would the nurse anticipate as the priority action?
Inform the ER physician of the patient's condition.
Abdominal contents protrudes through the inguinal canal?
Inguinal Hernia
The 18-month-old child drinks some drain cleaner and is brought to the emergency department. Which piece of equipment is most essential for the nurse to have on hand?
Intubation tray.
Cannot think backwards? Everything is a living object? Focuses on only ONE thing? Inability to see another's point of view? Communicates a whole sentence in a few words? Searches for an object even though it is out of sight? If you change one part, you've changed everything? Continue to repeat play over & over again (Can't remember cause & effect)?
Irreversibility Animism Centration Egocentrism Telegraphic speech Object permanence Global organization Tertiary circular reasoning
The adolescent is evaluated for scoliosis. The client asks the nurse, what is scoliosis?, which statement by the nurse BEST describes scoliosis?
Is it a lateral curvature of a portion of the spine
Cleft lip/palate swallow? What to use with CL/CP?
Is normal Special nipples/feeders/large hole nipple Asepto syringe or Breck feeder (a large syringe w/ soft rubber tubing)
Treat Hyperkalemia with?
Kayexalate
Which action should the nurse take to minimize separation anxiety experienced by a toddler?
Keep toys from home in the bed with the child
What insulin must not be mixed with others in the same syringe?
Lantus
Long acting insulin? Rapid acting?
Lantus Novalog/humalog
Which lab test result is most important for the nurse to follow when monitoring the care of the client with an acetaminophen overdose?
Liver function test
Exercise is beneficial to the diabetic child because it ______ blood sugar level.
Lowers BS Levels Always eat a snack before exercising
Describe the % of TBSA that describes the severity of the following burns: Major Burns Moderate Burns Minor Burns
MAJOR BURNS > 20% TBSA MODERATE BURNS 10-20% TBSA MINOR BURNS < 10% TBSA
What immunizations are live viruses?
MMR = Measles/Mumps & Rubella VZV = Varicella Virus (Chicken Pox)
Major cause of injury in school age children?
MVA
The nurse knows MMR is a vaccine for which diseases?
Measles, mumps, rubella.
The 4 year old child was crying near the fireplace when the clothing caught fire and enveloped the child in flames. The nurse was in the home. Which action should the nurse take first?
Push the child to the ground and make the child roll
What is the first thing a parent should do if their child is having a hypercyanotic spell that can occur with Tetralogy of Fallot?
Put the child in the Knee-Chest Position
Hormonal? Normal GFR? ^Controlled by? Intrarenal B/P is? Systemic B/P must be _ for glomerular filtration? Normal GFR creates about _ urine/day?
RBC formation, B/P regulation, Vit D activation 90-120 mL/min B/P and perfusion to kidney constantly regulated >70 1-3 L
Hyperpituitarism tx?
Radiation/radioactive implants
Nursing care: PRIMARY EXCISION? DEBRIDEMENT? Hydrotherapy/Whirl Pool Cleansing wound
Removal of Escher & Closure of Wounds Painful (Pre-medicate)
The goal for a child with school phobia should be?
Return to School ASAP
6 RIGHTS?
Right patient Right drug Right dosage Right route Right time Right Documentation
Meds for ADHD? (3)
Ritalin Dexedrine Adderal
4 reflexes that disappears by 3-4 months? Step/dance reflex disappears when? Babinski? Landau? Parachute?
Rooting Tonic neck Moro Palmar grasp 3-4 weeks Fans until walks, flexes after walks 6-8 months 7-9 months
The nurse knows which signs and symptoms of rubeola are exhibited before the appearance of the rash
Runny nose, sneezing, and coughing
Symptoms of depression?
SAW-PLATS Sad facial expression Alone (lack of socializing) Withdrawn / Play alone Poor school achievement Tiredness or Tearful Low self-esteem / Hopelessness Suicidal thoughts or ↓ in weight Alterations in sleep
Major struggles for toddler? (4)
SILT Sibling rivalry Independence Limit setting Toilet training
Epidermal, minor w/ no scaring? Epidermis & Dermal Painful, Moist, Red, Blisters Minimal scaring? Epidermis, dermis & subcutaneous tissue Destruction of Nerves, Sweat Glands & Hair Follicles Lack Sensation Dry Leathery Appearance? Muscle, Fascia & Bone Dull & Dry?
SUPERFICIAL (1st Degree) PARTIAL THICKNESS (2nd Degree) FULL THICKNESS (3RD Degree) FULL THICKNESS + UNDERLYING TISSUE (4TH Degree)
What to do when there is an avulsed tooth (knocked out)?
Save Tooth Hold by crown (not root) If Dirty (Rinse w/H2O or NS) Place back in mouth, cold milk or under tongue
Scoliosis usually occurs between the ages of? Scoliosis Affects what % of the Population?
10-15 years old, during rapid skeletal growth 2-3%
Which intervention should the nurse recognize as most important to promote maximum mobility in infants?
Provide a safe play area.
_ is a minimally invasive test that uses a special x-ray technology called fluoroscopy to visualize your child's urinary tract and bladder?
VCUG
Using 100-50-20/24 hour method 10 x 100 = 1000 10 x 50 = 500 17 x 20 = 340 Total = 1840 / 24 hrs In one hour = 77ml/hr Using 4-2-1 Hourly Method 4 x 10 = 40 2 x 10 = 20 1 x 17 = 17 Total = 77ml/hr
..
know how to do a punnett square
..
(correlate with picture) Anterior Surfaces of Legs & Thighs (9 + 6) = 15 Both Sides of her Hands = (1.25 x 4) = 5 Anterior Surfaces of Upper & Lower Arms = (4 + 3) = 7 Anterior Trunk = 13 15 + 5 + 7 + 13 = 40%TBSA
..
Can give Tylenol, not aspirin.
..
Go over math!
..
Know everything about DDST 2
..
Make sure the infants shoes are not hard
..
NUTRITION? High Protein & Calories w/ additional vitamins (Vit. A, C & Zinc)
..
No tight or waterproof diapers. Wash without alcohol.
..
The nurse instructs the parent about the appropriate way to instill ear drops in the right ear of the 2 year old child. The nurse determines teaching is effective if the parent makes which statement?
"I should pull my child's ear down and back." (under 3 years old-pull ear down and back; over 3 years old-pull ear up and back)
The home care nurse visits the 3-year-old child diagnosed at birth with phenylketonuria. The nurse assesses the child's intake for the previous week. The nurse is most concerned if the child's parent makes which statement?
"My child's favorite lunch is a peanut butter and jelly sandwich." peanut butter is not allowed
The woman delivers a healthy 8-lb, 2-oz infant. She mentions to the nurse that her baby's "soft spot" seems very large. Which statement, if made by the nurse, is most appropriate?
"The baby's anterior "soft spot" will remain for approximately 1 1/2 years."
A brace is ordered for the adolescent to correct a scoliosis deformity. Which statement, if made by the parent to the nurse, indicates teaching is successful?
"The brace should be worn 23 hours a day."
The young child diagnosed with autism is admitted to the pediatric unit with a tracheotomy after swallowing a small toy. The unlicensed assistive personnel reports to the nurse that the child does not maintain eye contact. Which response by the nurse is best?
"The inability to maintain eye contact is a characteristic of autism."
Parkland Formula 24 Hour Fluid Resuscitation V (Volume) = 4 x (Wt-kg) x (% TBSA Burn) V = Volume of Fluid to infuse in the first 24 hours ½ is given within the first 8 hours ½ given over the next 16 hours Child = 4 x 37kg x 40% = 5920 ml (24 hrs) 5920/2 = 2960 for the 1st 8 hours = 370mL/hour 2960 for the next 16 hours = 185mL/Hour
..
Patient & family participate in care to enhance control and independence
..
The Body Responses to Pain Moderate/Superficial Pain (sympathetic response) Oxygen Saturations? Skin? Muscle Tone? Pupils? Response to Severe/Deep Pain (parasympathetic response) Pupils Nasal Secretions GI system General
(Decreased) (Moist) (Increased) (Dilate) (Constrict) (Increase) (Increases) (Stimulates liver, bladder & kidneys)
CL repair called? Diet after? CP repair called? Diet after? Has to learn to?
(cheiloplasty) - metal appliance secured to cheeks Clear liquids followed by formula (Palatoplasty) Can feed normally (soft, blenderized diet) Breathe through nose
CRIES acronym and for who? FLACC acronym and for who? FACES - age? NUMERIC - age?
- Cries, Requires o2, increased vital sign, Expression, sleepless (Newborns & Infants) - Face, Legs, activity, cries, consolably (2 months - 7 years, Cognitive Impaired) Self-Report Pain Scale (3 years) Self-Report Pain Scale (5 years)
Patho of HUS: Small glomerular arterioles become swollen & occluded w/ deposits of ? _ are damaged as they attempt to move through the blood vessels? Damaged RBC's are removed by the ? This leads to decrease in ? (4) Renal damage occurs & produces: _uria, _uria, _ casts, Increase in _, _, and _?
-platelets & fibrin clots (Intravascular coagulation) -RBC's -spleen -RBC (anemia) & decrease Hct & Hgb, and a decrease in platelets (Thrombocytopenia) -proteinuria, hematuria, Urinary casts Increase in BUN, Increase in Creatinine, Increase in Serum Reticulocytes
Toddler age? Preschooler age?
1-3 3-5
Which statement made to the nurse by the parent of an 8-month-old child, indicates a possible delay in the child's development? 1. "My child has almost doubled the birth weight" 2. "My child smiles at me when I walk in the room." 3. "My child doesn't seem to like the grandparents" 4. "My child can't say 'mama' yet"
1. "My child has almost doubled the birth weight" An infants birth weight should double by 5 months; since the infant is 8 months old, the fact that the child has only now almost doubled the birth weight may indicate a possible delay in development.
The nurse assesses the child admitted with a diagnosis of acute asthma. The nurse determines which observation by the parents is significant when determining the cause of the acute asthma attack? 1. "My child slept on a new pillow last night" 2. "My child plays indoor tennis three times per week" 3. "My child takes a daily vitamin supplement" 4. "My child is allergic to shellfish"
1. "My child slept on a new pillow last night" Asthma is chronic inflammatory disorder if the airways; allergies is one of the predominant factors causing asthma bedding often triggers childhood allergies, which could have precipitated the attacks pillows should be stuffed with either foam rubber or Dacron and either placed in a zippered allergen-impermeable cover or washed in hot water weekly.
The nurse counsels the parents of a child with Down's syndrome. Which statement, if made by the parents to the nurse, indicates further teaching is necessary? 1. "My child's development will become more rapid in time" 2. "My child's motor skills will always be slow" 3. "Play is a good way to teach my child" 4. My child responds to affection"
1. "My child's development will become more rapid in time" Usually mildly to moderate retarded; socially may be 2-3 years beyond mental age.
BUN? Creatinine? Potassium? Phosphorus? Magnesium? Calcium (total)? Sodium? Hemoglobin? Hematocrit? Art bicarbonate? Art Paco2?
10-20 mg/dL (BUN) 0.5-1 mg/dL (creatinine) 3.5-5 mEq/L (potassium) 3-4.5 mg/dL (phosphorus) 1.3-2 mEq/L (magnesium) 9-10.5 mg/dL (calcium) 135-145 mEq/L (sodium) 12-17mmol/L (hemoglobin) 38-50% 22-26 mEq/L 35-45 mmHg
Scoliosis is a spinal curve of?
11 Degrees or More
The nurse understands which principle serves as the basis for managing childhood weight problems? 1. Allow for slower weight gain compared to linear growth. 2. Allow for slow weight loss, approximately one pound per week. 3. Allow for weight loss only by exercise 4. Allow for weight loss only under care proper supervision
1. Allow for slower weight gain compared to linear growth. Encourage diet high in complex carbohydrates ad fresh fruits and vegetables; encourage physical activity
The nurse identifies which reaction as an adverse effect most often identified with the measles, mumps, and rubella (MMR) immunizations? 1. Arthritis 2. Convulsions 3. High-pitched cry 4. Paralysis
1. Arthritis Arthritis is a worrisome adverse effect that can occur following the MMR immunization; other adverse effects include rash and fever.
After an aspirin overdoes, it is most important for the nurse to assess for which problem? 1. Bleeding 2. Nausea 3. Tinnitus 4. Decreased Temperature
1. Bleeding Aspirin has a potent platelet-inhibiting action that leads to an increased risk for bleeding, such as gastrointestinal hemorrhage; this would be the most life-threatening complication
The neighbor of the nurse comes running to the nurses house saying "I just found my 2-year-old in the kitchen surrounded by several bottles of cleaning solutions and the bottles are all open!" Which action by the nurse is best? 1. Call the poison control center. 2. Ask the child is the child drank anything. 3. Give the child ipecac syrup with two glasses of water 4. Give the child a mixture of milk and burned toast.
1. Call the poison control center. Assess the child, initiate steps to stop the exposure (empty the mouth of pills, plants, etc) and call the poison control center for instruction
The nurse instructs the parents of a 7-year-old child diagnosed with cystic fibrosis about required dietary modification. Which adjustment is likely be made in a normal diet? 1. Increased protein 2. Increased fat 3. Increased carbohydrate 4. Increased potassium
1. Increased protein Children with cystic fibrosis tend to need additional protein for growth since they have increased metabolic needs due to a high incidence of infection.
The 4-year-old child sustains a deep marital-thickness burn. Based on an understanding of growth and development, the nurse anticipates which hospital experiences will probably be the most upsetting to the child? 1. Intramuscular (IM) injections 2. Daily examination by the health care provider 3. Taking oral medicine when a parent is not there. 4. Having the nurse say "no" to requests.
1. Intramuscular (IM) injections A 4-year-old child has many fears, particularly a fear of mutilation; injections would probably be the most upsetting experience for a 4-year-old; encourage understanding by playing with puppets, dolls; demonstrate equipment; talk at child's eye level; administer medication IV
The nurse knows vitamin E is given to premature infants to prevent which condition? 1. Oxidation of red blood cells 2. Complications of circumcision 3. Fat- soluble vitamin deficiency 4. Respiratory distress syndrome
1. Oxidation of red blood cells Fragie cells break apart since the cell walls are weakened in the absence of sufficient vitamin E
The nurse counsels the parent of an infant diagnosed with non-organic failure to thrive (NFTT). The nurse notes the parent appears depressed and is expressing feelings of inadequacy and resentment toward the infant. Which approach by the nurse is most appropriate? 1. Structure environment so the parent feels accepted. 2. refer the parent to a family therapist 3. Tell the parent he/she is unfit to parent 4. recommend the parent attend child care classes.
1. Structure environment so the parent feels accepted. Help parents increase self-esteem by making them feel accepted nurse should empathize with parents about the difficulty of child rearing.
Adolescent age?
13-19
Acute is defined as less than? Chronic is defined as lasting greater than? Most common cause of diarrhea in children is? and occurs between?
14 days 14 days Rotavirus 3 to 24 months
Platelet range? Life span? RBC range? Life span? WBC range?
150-400 8-10 days 4.5-5.5 120 days 4.5-13.5
Thumb sucking peaks when?
18-20 months
No whole milk for? Solid foods not introduced until?
1st year of life 4-6 months (when extrusion reflex is gone)
When does gender identity begin?
2 years
A parent calls the clinic to report that the child has been exposed to varicella zoster (chicken pox). The nurse should tell the parent that the incubation period for chickenpox is which length of time?
2-3 weeks
The nurse interviews a 15-year-old client. The nurse is most concerned if the adolescent makes which statement? 1. "Sometimes I feel really tired" 2. "I dont perspire like other kids" 3. "I can be a real klutz sometimes" 4. "I have two pimples on for forehead"
2. "I dont perspire like other kids" With adolescence there is an increase, not decrease, in sweat production.
The 8-month-old child is about to receive an immunization injection when the child begins to cry. Which comment by the nurse is the most appropriate? 1. "Don't cry. It was be better if you try to behave." 2. "I know you are frightened. It will be over with soon." 3. "A big person like you shouldn't cry. You know it isn't going to hurt." 4. "Please stop crying. There is nothing to be afraid of."
2. "I know you are frightened. It will be over with soon." This is the best response because it does not minimize the colds reaction; responds to the childs feeling tone and says that it will all be over soon.
The 4-year-old child is brought to the emergency department with a diagnosis of acute epiglottitis. Which assessment finding is most significant? 1. Increased fever. 2. Drooling of saliva 3. Increased cough and dyspnea 4. increased heart rate.
2. Drooling of saliva Drooling, agitation, and absence of spontaneous cough are predictive of epiglottitis; do not attempt throat inspection unless immediate intubation can be performed.
The nurse instructs the 10-year-old client about how to collect a 24-hour urine specimen at home using a clean, empty jar. The nurse should recommend that the client use which jar?
48-ounce jar.
Surgical repair of a congenital heart defect is performed on the 5-month-old infant. Which measure is most important to incline in the postoperative care plan? 1. Administer pain medications to the client to prevent crying. 2. Elevate the client's head to reduce respiratory effort. 3. Administer laxatives to the client to prevent straining. 4. Milk the chest tubes to maintain tube patency.
2. Elevate the client's head to reduce respiratory effort. Elevating the head of the bed assists with respiratory effort, and is an essential component of postoperative care.
The nurse cares for the infant immediately after insertion of a shunt due to hydrocephalus. Which observation by the health care provider immediately? 1. The infant is lying flat in bed 2. The infant's pupils are dilated. 3. The suture line is pink. 4. Bowel sounds are heard in all quadrants
2. The infant's pupils are dilated. This indicates increase intracranial pressure.
The school nurse assesses the physical development of school-age children. Which is the most valuable tool for this assessment? 1. The thickness of skin folds over the deltoid muscle and scapula. 2. The weight and height compared to standard tables. 3. The rate of increase in head circumference 4. Selected biochemical tests for nutritional status
2. The weight and height compared to standard tables. Growth charts are the basic tool of nutritional assessment of a school-aged child.
An infant is found to have an excessive amount of oral secretions after birth. During the first feeding the infant has a choking episode accompanied by cyanosis. The nurse knows that these symptoms are indicative of which problem? 1. Pyloric stenosis 2. Tracheoesophageal defect 3. Cleft palate 4. Hydrocephalus
2. Tracheoesophageal defect Tracheoesophageal defects are a group of congenital anomalies in which the esophagus ends in a blind pouch, and the trachea is attached to the esophagus via a fistula; infant will exhibit respiratory difficulty from birth, and experience choking with the first feeding.
The 17-month0old-child sucks a thumb, especially at night when quieting for sleep. Which suggestion by the nurse is best? 1. put a negative reinforcer, such as red pepper, on the thumb 2. dont intervene; it will subside. The behavior usually peaks at 24 months. 3. It is a common form of self-stimulation. It should be discouraged. 4. It will cause the teeth to malformed. I would wrap the thumb at bedtime.
2. dont intervene; it will subside. The behavior usually peaks at 24 months. This behavior usually peaks at 24 months; thumb sucking is normal and expected behavior in the toddler period.
Check Urine Ketones if BG ›?
240
Word knowledge in preschooler?
2100 words
The nurse observes the child walk up and down steps. The nurse notes the child has a steady gait and can use short sentences. The nurse estimates the child's age to be how many months?
24 months.
The nurse talks with a group of adolescents about their nutritional needs. Which statement is best? 1. "You have a need for fatty foods." 2. "You need vitamin supplements daily." 3. "You have an increased need for most nutrients." 4. "You need to increase you intake of iron."
3. "You have an increased need for most nutrients." Adolescents have an increase need for nearly all nutrients due to their rapid growth and high activity levels.
The nurse considers the developmental stage of a child before choosing a toy. A push-pull toy is appropriate for which age group? 1. 6 weeks- 3 months 2. 6-8 months 3. 18-20 months 4. 4-5 years
3. 18-20 months Child able to walk and learns to coordinate walking with pushing or pulling a toy.
Prior to surgery for myelomeningocele, which action does the nurse perform to care for the area of the defect? 1. Cleanses the defect and leaves the defect open to air 2. Applies a dry, sterile dressing 3. Applies a moist, sterile dressing 4. Applies antibiotic and leaves the area open to air
3. Applies a moist, sterile dressing Before a surgical correction, it is critical to protect the area of a myelomeningocele from a punctured a myelomeningocele is a protrusion of spinal cord contents through a defect in the vertebral column, skin over the area is thing and friable; preoperatively the infant should be positioned on the side with a moist, sterile dressing over the defect to prevent infection.
The 3-year-old child is brought to the emergency department with a history of vomiting and diarrhea for the past three days. Which finding is the nurse most likely see? 1. Shortness of breath 2. Slow heart rate 3. Sunken eyes 4. Tremors
3. Sunken eyes A 3-year-old child who as had vomiting and diarrhea for 3 days will exhibit signs of fluid volume deficit.
The nurse supervises the family caring for the child diagnosed with cerebral palsy. The nurse should intervene if which finding is observed? 1. The parent allows the child to rest prior to a physical therapy session 2. the child wears a helmet when ambulating in the house 3. The older sister places a toy in the child's hands 4. The parents offer high-calorie snacks to the child
3. The older sister places a toy in the child's hands Important to offer child with cerebral palsy incentives to move; place toy out of the immediate reach of the child.
The 1-year-old child is admitted to the hospital for a bone marrow aspiration. The nurse expects the test to be performed using which site? 1. Sternum 2. Iliac crest 3. Tibia 4. Scapula
3. Tibia The tibia is used in children up to two years old to obtain bone marrow aspirations analgesia or anesthesia is used
Normal potassium level? Calcium level?
3.5-5 8.5-10.2
Which urine test would be considered abnormal? ph range? specific gravity range?
4 The expected pH of urine is 4.8 to 7.8. A specific gravity of 1.020 is within the normal specific gravity range of 1.015 to 1.030
Hgb A1c: Normal Value? Diabetics Children OK at?
4 - 6% 6.5 - 8%
Which artery should the nurse use to assess the pulse rate of an infant during cardiopulmonary resuscitation? 1. Femoral artery 2. Apical artery 3. carotid artery 4. Brachial artery
4 Brachial artery The brachial artery near the axilla in the infant; infant's arteries are naturally small; femoral, carotid, and apical pulses may be difficult to palpable gently palpating just under the axilla can provide the rescuer with an accurate assessment of the circulation to administer CPR to the infant, use 2-3 fingers for compressions; depress sternum 1/2-1 inch, and perform at least 100 compressions per minute.
Booster seat is used until: what height? Weight? Age?
4'9 35-80 pounds 7-8
When can the infant have: Cereal/rice? Vegetables/fruit juice? Meats? Egg yolk?
4-6 months 6-8 months 8-10 months 11-12 months
The 3-year-old is seen in the local clinic for croup. The child's parent asks the nurse what to do for the child at home to alleviate symptoms. Which suggestion by the nurse is most appropriate? 1. "Just let your child rest and call the health care provider if your child gets worse" 2. "Place a pan of water below the window in the bedroom and leave the window open." 3. "Place your child in the bathroom with hot water running and leave your child there until there is improvement." 4. "Stand with your child in front of an open freezer."
4. "Stand with your child in front of an open freezer." Cool air will constrict edematous blood vessels; use a cold-water vaporizer or take child to cool basement or garage offer fluids that child likes.
The nurse understands that which food is most likely to cause an allergy in a 6-month-old infant? 1. Cereals 2. Vegetables 3. Fruits 4. Eggs
4. Eggs Egg and meat proteins are highly allergenic compared with vegetables and grain proteins introduce meat and eggs only when a child is close to nine months of age, when the child is less likely to develop an allergy to them
The infant is able to assume a sitting position, plays peek a boo, and is starting to say mama and dada. The nurse identifies that these behaviors are characteristics of which age?
9 months at 9 months the baby is able to pull self up and sit upright and say "mama and dada"
The 2-year-old child is brought to the clinic for extensive facial burns. The child's parent states that they resulted from the child's running into a lighted cigarette. The child is holding on to the parent and doesn't want to let go to be examined. Which is best rationale for the nurse to suspect this parent is abusing the child? 1. The unjust is on the face. 2. The parent is upset about the accident 3. The child is clinging to the parent, refusing to cooperate with the nurse. 4. There is little relationship between the extent of the child's burns and the history.
4. There is little relationship between the extent of the child's burns and the history. The most important criterion is incompatibility between the history and presenting injury.
An 8-month-old child presents with stunted growth, and chromosomal studies show that the child has only 45 chromosomes. The nurse should identify that the child's condition is due to which diagnosis? 1. Klinefelter's syndrome 2. Down's syndrome 3. Phenylketonuria 4. Turner's syndrome
4. Turner's syndrome Genetic abnormally resulting from a females having only one X chromosomes clinical manifestations included short stature, webbed neck, low posterior hairline, and shield-shaped chest.
Using the 4 - 2 - 1 Method Determine how much fluid a child weighing 45 kg should receive per hour?
45 kg 4 x 10 = 40 2 x 10 = 20 1 x 25 = 25 Total = 85 ml/hr
Surgery if curve is greater than _ degrees? Scoliosis is a curve of ______?
45-50 10-11 (45 degrees requires surgery)
5201 plan for preschoolers?
5 Servings of Fruit & Vegetables 2 Hours of Screen Time 0 Sugary Sweetened Beverages 1 Hour of Physical Activity
How many steps are included in the assessment process for scoliosis?
5 steps
A 6-year-old child with acute renal failure (ARF) is being transferred out of the intensive care unit. Which children, considering their diagnoses, would be the most appropriate roommate for this child?
5-year-old child who has a fractured femur
What % of children will have a chance of having sickle cell disease if one parent has the disease & one parent is a carrier?
50%
Birth Weight Doubles by? Triples by? Height increases ? Birth Height increases by _% by 1 year Posterior fontanel fuses (closes) by? Anterior fontanel fuses (closes) by?
6 months 1 year of age 1" per month by 6 months 50% 6-8 weeks of age 12-18 months of age
Age for school age?
6-12
MAJOR BURNS? MODERATE BURNS? MINOR BURNS?
> 20% TBSA, (2nd Degree) 10-20% TBSA, (2nd Degree) < 10% TBSA, (2nd Degree)
A child with diabetes has a BG level of 325. The order is to administer insulin using an insulin/carb ratio with meals of 1:10. The child eats 85 carbs. The child also has a correction factor of BG - 100 / 30 for BG greater than 180 How much insulin should this child receive?
85/10 = 8.5 units 325-100 = 225/30 = 7.5 units Total is 8.5 + 7.5 = 16 units
Nitrogenous Waste Products in Blood? Toxic Amounts of Nitrogenous Waste Products in Blood? The inability of the kidneys to excrete waste material, concentrate urine & conserve electrolytes?
Azotemia Uremia Acute Kidney Injury - AKI (renal failure)
The nurse is assessing an 11-year-old child receiving conscious sedation to set a fractured leg. Which assessment finding indicated that the child might need respiratory support?
Absent gag reflex
Leading cause of deaths in toddlers?
Accidents
When there is a fecalith, what does that mean? What is the cardinal sign? Will have a sudden relief of pain with a? Tx for a ruptured appendix?
Acute appendicitis Pain at the lower right quadrant at Mcburneys point also Rebound tenderness Perforation Triple antibiotic therapy
What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed?
Adjust activities to the child's tolerance level.
Which age group believe they are invincible and bad things will not happen to them?
Adolescent
What is an advantage to teach to the family about continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents who require dialysis?
Adolescents can carry out procedures themselves.
How to determine amount of teeth?
Age in months-6= expected # of teeth
_ is given to reduce uric acid crystals in urine?
Allopurinol
Fluid replacement:
Allow 100ml/kg for the first 10kg Allow 50ml/kg for the second 10kg Allow 20ml/kg for the remainder of weight in kg Divide total amount by 24 hours = rate in ml per hour
The 5 1/2-year-old child comes to the clinic for a routine exam. The parent reports that the child likes to jump and climb, questions everything, and is often observed interacting with an "imaginary" best friend. The nurse should advise the parent to take which action?
Allow the child to engage in imaginary play. preschool age children will normally play with imaginary friends (not school age)
Have both male & female parts?
Ambiguous Genitalia
Blood shunts from right to left or left to right. Which way does shunting occur with an Acyanotic vs Cyanotic heart defects?
An Acyanotic heart defect is one in which there is a ... Left to right shunting of blood. A Cyanotic heart defect is one in which there is a ... Right to left shunting of blood.
the 18 month old toddler diagnosed with cystic fibrosis is admitted to the hospital with a respiratory infection. The nurse should expect to see which characteristic feature of cystic fibrosis?
An altered viscosity of mucus
The child is admitted with lead poisoning. Which symptom does the nurse expect to see?
Anemia, hearing impairment, and distractibility.
Amenorrhea and Refusal to maintain body weight at 85% of normal? Anorexia nervosa: Contract? Bathroom? Focus on _ not_? Asses for _?
Anorexia nervosa Do behavior contract Lock bathroom after meals Weight gain; food consumed Dehydration
Play patterns in preschooler?
Associative to cooperative
The use of therapeutic interventions to Eliminate or Minimize the psychological and physical distress experienced by children and families ? Goals of atraumatic care:(3) Example?
Atraumatic care 1) Minimize the child's separation from family 2) Promote a sense of control 3) Prevent bodily injury and pain EMLA cream
Treat nephrosis?
Prednisone 2mg/kg
Major fear of body mutilation?
Preschooler
Fixed splitting (s2 does not change during inspiration) is a sign of what?
Atrial septal defect
What age group has magical thoughts that are all powerful?
Preschooler
Which sleep problem should the child not be disturbed? Nightmare or Sleep Terror?
Answer: Sleep Terror Nightmares (scary dream = real to child) Sleep terrors (child does not wake up)
What medication for pinworms stains red? "slap rash"?
Antiminths Erythema infectiosum (fifths disease)
Unexplained respiratory pause of 20 seconds or more? Management with meds?
Apnea Theophylline/Caffeine
Tx of eczema: When to apply emollients? Avoid?
Apply emollients after bathing Lotions due to high alcohol and o2 content
The nurse plans care for the infant diagnosed with a myelomeningocele. Which principle of nursing care is most important to apply when caring for this infant?
Asepsis.
Who has magical thoughts that are "all powerful? Who takes word meaning literally?
Preschooler Preschooler
When assessing the 9 month old child, the nurse expects which reflex to be present?
Babinski's Babinski dissapears at 12 months
Identify 3 ways to collect urine from an infant?
Bag Child Catheterize Child Suprapubic Tap
A child in renal failure has hyperkalemia. Which foods should be avoided?
Bananas, carrots, and green leafy vegetables
The four-week-old infant is brought to health care provider by the parent. The infant is vomiting and has abdominal distention. The infant is diagnosed as having pyloric stenosis and is admitted to the hospital. The nurse should expect the infant's emesis to have which of these qualities?
Be projectile.
Bile flow from the liver to the gallbladder is blocked. This causes the bile to be trapped inside the liver, quickly causing damage and scarring of the liver cells (cirrhosis), and eventually liver failure? If bile cannot be released into the intestine then it accumulates and backs up into the liver causing? Surgery is called? (This is when a segment of the intestine is anastomosed to the bile ducts to aid in bile drainage) Other tx? (Used to treat pruritus & hypercholesterolemia) S&S of biliary atresia? (4)
Biliary Atresia Cholestasis Kasai procedure Ursodeoxycholic Acid Jaundice Dark urine Light colored stools (No bile) Pruritus
Toilet training, which is controlled first?
Bowel is controlled before bladder
Anatomical factors that lead to UTI? Acidic or alkalotic environment can lead to uti? Preventing UTI?
Bubble baths and uncircumcised males, SHORT URETHRA Acidic Cotton panties, no bubble baths, acidify urine, dont be dehydrated
Who "Magical ideas cause illness" And illness is a result of bad behavior?
Preschoolers
Who dislikes bedtime and nightmares are common? Wake up child during nightmare?
Preschoolers Don't wake up child
Child with ADHD is given methylphenidate. Methylphenidate is a?
CNS stimulant
What are the advantages to taking 2 times a day Ritalin or Dexedrine or Adderall? Besides medications what is used to treat ADHD?
Can dose as needed in am and noon while at school and won't interfere with sleep at night. Behavior Modifications
Intolerance to Dietary Gluten?
Celiac Disease
The child with attention deficit hyperactive disorder (ADHD) is taking methylphenidate. The nurse knows that methylphenidate is prescribed for this child for which effect?
Central nervous system stimulant.
The nurse knows DTaP vaccine protects against which diseases?
Diphtheria, pertussis, tetanus.
Rash appears in 3 stages? Cause intense anal itching?
Chicken pox and fifths pinworms
The parent of the child diagnosed with frequent acute otitis media asks the nurse why this keeps happening to the child. The nurses' response should be based on which explanation?
Children have a shorter auditory, or Eustachian, tube
The 15 month old child crawls but is not yet able to walk. The parents are concerned and ask the nurse if this is normal. Which is the best initial response by the nurse?
Children often set their own pace
Which parameters would confirm clinical diagnosis of urinary infections (UTI) in young children?
Clean catch specimen reported as being cloudy in appearance and Pyuria
The 6-month-old baby has a cyanotic congenital heart defect. The nurse knows that a cyanotic congenital heart defect is associated with which symptom?
Clubbing of the fingers.
Osteomyelitis is treated with antibiotics called Mycins. What are important nursing interventions when administering Mycins?
Collect Blood Cultures First Monitor Peaks & Troughs of Medication
Letters of the alphabet can be used to make words, and that words can be combined to make sentences. Learns to count, and learns numbers can be used to tell time? The same object in a different shape is still the same? Can group objects according to similarities or can place objects in a sequential series?
Combinational Skills Conservation Classification
3 aspects for pediatric nursing: What's on the bottom of the pyramid?
Community Culture Family Health promotion
In teaching a group of nursing students about factors that could lead to the development of urinary tract infections, which critical aspect should the nursing instructor focus on?
Concept of urinary stasis
For infants: Top 4 causes of death?
Congenital anomlies LBW Maternal complications SIDS
Play for school age?
Cooperative play
How can a nurse practitioner assess compliance with Fe Therapy?
Examine the stool = Should be tarry green or black
Has symptoms of fetal aids syndrome, refer to? If an infant seroconverts, what does that mean?
Craniofacial abnormalities developed own antibodies and developed HIV
Failure of testes to descend?
Cryptorchidism
Information the nurse needs in the ER following a drug overdose? What is the antidote for an overdose of a narcotic drug?
DAT-MF Drug Time of ingestion Amount of drug taken Mode of administration Factors that led to overdose Narcan
Med for hemophilia?
DDAVP and PT
Bacteria vaccines?
DTHPP Diptheria Tetanus Pertussis PVC HIB
What is the most important assessment to determine dehydration in infants and children?
Daily Weight
Cradle cap tx: Shampoo? Scales removed? Wash hair with?
Daily with sulfur and salicyclic acid With fine tooth comb Every bath
The 7-year-old child is admitted to the hospital with a diagnosis of idiopathic hypopituitarism. Which clinical manifestation is the nurse most likely to observe?
Delicate features.
The home care nurse visits the home of the toddler diagnosed with non-organic failure to thrive (NFTT). The nurse instructs the toddler's mother about mealtime. Which suggestion by the nurse is most appropriate?
Develop a structured routine for bathing, sleeping and playing
The clinic nurse teaches the parent how to care for a child with impetigo. The nurse knows that the greatest danger associated with an impetigo infection is the risk of which complication?
Developing glomerulonephritis secondary to streptococcus infection.
To prevent parent-child disturbances, the nurse should complete which action?
Discuss with the parents any problems or fears about childrearing that they may have.
Hypothyroidism S&S?
Dry Skin, Periorbital Puffiness, Sparse Hair
2 topical or transdermal medications?
EMLA and LMX4
Peritoneal Dialysis: _ is drained Dialysate, dwell time, and additives are _! Abdominal cavity acts as a semipermeable membrane for dialysis
Effluent prescriptions
Prevent dental caries? (5)
Eliminate bedtime bottle by 14 months No juice in bottle ever Give water in bottle at night Do NOT use bottle as pacifier Do NOT coat pacifier
An adolescent is hospitalized with severe bulimia. What common symptom would the nurse expect to see?
Eroded tooth enamel related to purging
Failure of the esophagus to develop as a continuous passage from the throat to the stomach? Failure of the trachea and esophagus to separate? TEF should be suspected if the mother has _ during pregnancy? TEF has excessive _ and _? 3 C's? Tx that allows drainage of saliva thru side of neck) (can do "Sham" feedings)?
Esophageal Atresia Tracheoesophageal Fistula polyhydramnios saliva & drooling Coughing, Choking, Cyanosis Cervical esophagostomy
Failure of abdominal wall to fuse & bladder remains outside body?
Exstrophy of Bladder
What are 3 reasons to consider surgical repair of a urinary tract anomaly? (4 Answers)
FREQUENT UTI'S SEVERE ANOMALIES NON-COMPLIANT W/MEDS INTOLERANCE TO MEDS
_is a method designed to meet the emotional, social, cultural, and developmental needs of children and families while providing healthcare?
Family Centered Care
Scoliosis is more likely to progress in? Curves should be kept less than _____ degrees to prevent long term problems.
Females 30 degrees
Absence of what pulses is a sign of coarctation of the aorta?
Femoral
"Slapped face appearance"? Caused by herpes virus?
Fifths Chicken pox and roseola
E. Coli causes?
Hemolytic uremic syndrome (HUS)
What is it: x-linked recessive transmitted by the mother seen in male children?
Hemophilia
Transmitted via fecal oral? Don't give if allergic to bakers yeast? Don't give if allergy to eggs? Don't give if older than 12 months?
Hep A and rotavirus Hep B Influenza Rotavirus
Vaccinations: At birth? 2 months? 6 months? 12 months? Dont give over 4? Given subq (3)?
Hep B Dtap, polio, Hib, PVC, rotavirus Flu Hep A, mmr, varicella Hib, PVC MVP, mmr, varicella, polio
Diet for renal failure?
High Carbs, Fat & Calcium Low Protein, K+ & Sodium Fluid Restrictions
Children with thalassemia will have _ rbc's? What is hemophilia?
High level of RBC's Disturbance in clotting factors
Congenital absence of parasympathetic ganglion nerve cells in intestinal tract Leads to absence of peristalsis ^? Clnical manifestations in: Newborns? Infants? Older children? External sphincter contracts normally but Internal sphincter fails to relax? These children will have a temporary
Hirschsprung disease Failure to pass meconium Failure to thrive Foul smelling ribbon like stools Anorectal manometer Colostomy
Children often set their own pace
Hug your child after a task is correctly performed
Fluid in scrotum?
Hydrocele
Main med for sickle cell?
Hydroxyurea
Exopthalamus is seen with?
Hyperthyroidism
A child's electrolyte laboratory results notes a greater loss in water then electrolytes. The nurse understands that this is what type of dehydration?
Hypertonic Isotonic - loss of electrolytes & H2O = amounts Hypotonic - Electrolyte loss is greater than H2O loss Hypertonic - H2O loss is greater than electrolyte loss
Projectile vomiting is a common symptom for which disease process?
Hypertrophic Pyloric Stenosis
Urethral opening located behind the glans penis? Meatal opening located on the dorsal surface of penis?
Hypospadias Epispadias
The nurse visits the family with 3 small children who live in a 3 bedroom home built in the 1952. The nurse counsels the family about how to avoid lead poisoning. the nurse determines that teaching is effective if the parents make which statement?
I wet mop all of the floors and wash all the window sills weekly
High Sensitivity? High Specificity?
Identify those w/ disease only (+) (Low False +) Identify those w/ out disease (-) (Low False -)
ADHD is a disorder in (3)? ADHD children are under aroused where? Risk factors for ADHD?
Inattention Impulsiveness Hyperactivity BIS- Behavioral inhibition system Chronic low level lead exposure
The nurse can prevent digitalis toxicity by monitoring labs and heart rates of children. Which lab is critical to monitor
Monitor K+ Levels A low potassium level can increase the risk of digitalis toxicity.
"Shift to the left mean? What are bands?
More bands than segs immature neutrophils
Which medication should the nurse have available for the treatment of acetaminophen overdose?
Mucomyst.
S & S only occur when parent is present (Resolution of symptoms occur after child is separated from the caregiver)?
Munchausen Syndrome by Proxy or Factitious Disorder
The nurse in the well-child clinic receives a phone call from the parent of the 6 month old who received the DTaP vaccine 3 days ago. The nurse is most concerned if the parent makes which statement?
My baby is crying continuously
The nurse in the well-child clinic counsels the parent of the newborn about normal growth and development. The nurse determines teaching is effective if the parent makes which statements?
My baby will double his birth weight at 5 months
The nurse counsels the parent of a 12 year old diagnosed with chickenpox about when the child can return to school. The nurse determines that teaching is effective if the parent makes which statement?
My child can return to school when the lesions are crusted
Medications are used to treat Juvenile Idiopathic Arthritis (JIA) Identify 3 Classification of drugs used
NSAID'S Cytotoxic Drugs Corticosteroids Biologic Agents
Hemophilia, give _ not _?
NSAIDS not aspirin
3 meds that can cause Medication Toxicity?
NSAIDS, Chemo, Antibiotics
Fluid Restrictions is the treatment for which Urinary Disease? (Nephrosis or Nephritis)?
Nephritis
Decreased glomerular filtration and oliguria (small urine output) Hypervolemia Causes Circulatory Overload & Edema Has _ and _? Will have a positive? Diet for nephritis?
Nephritis (PAHTO) hematuria and azotemia ASO titer Fluid Restrictions Low K+ Diet (During Oliguria)
This disease causes decreased absorption of plasma protein Causing Hyperalbuminuria, Interstitial fluid losses (Edema) Hypovolemia & Hyperlipidemia (Nephritis or Nephrosis)?
Nephrosis or Nephrotic Syndrome
Hypertrophic Pyloric Stenosis two signs? A segment of the bowel telescopes into another segment? Intussusception two signs? Diagnosis and Tx for Intussusception?
Projectile vomiting and palpable olive shaped mass in the upper abdomen Intussusception Sausage shaped mass in URQ and Current Jelly stools (blood & mucous) Barium enema (air or water)
Comparisons of renal disease: (nephrosis/nephritis) Edema? Causes? Glomerular? Age of onset? Onset of Disease? Blood pressure? Urine? Blood? Diet? Medications? Prognosis? Complications?
Nephrosis: Ascites & Facial Weight Gain Nephritis: Moderate Facial Nephrosis: Ideopathic Nephritis:Follows Strep Infect Nephrosis: Leaks Protein/ Nephritis:Swelling & Exudate Nephrosis: Pre School (2-7yrs) Nephritis: Early School Age (6-7yrs) Nephrosis: Gradual Nephritis: 1-3 weeks after infection Nephrosis: Normal Nephritis: Increased B/P, Cerebral Edema, Seizures Nephrosis: Massive Protein Nephritis: Bloody/Coke Tea Colored Nephrosis: Decreased Pro and Albumin Nephritis: Increased BUN, Positive ASO, Decreased C3 Nephrosis: Decreased sodium, increased protein, fluids are okay Nephritis: Regular, No Added Na+, Limit Fluids Nephrosis: Steroids Nephritis: Seizure Meds, B/P Meds Nephrosis: Good if Responds to Steroids Nephritis: Good Nephrosis: Hypovolemia, Shock Nephritis: HTN, Sz, Cerebral Edema
Which WBC is responsible for: Bacteria? Allergies/parasites/cancers? Healing tissues? Chronic inflammation? Early inflammation?
Neutrophils Eosinophils Basophils lymphocytes monocytes
What is the normal bone marrow range for Blast Cells &what is the range for a child with ALL (Acute Lymphatic Leukemia)?
Normal Blast Cell Range = 1-5% ALL > 25% BLAST CELLS
Treatment of diarrhea should START with?
ORT- Oral rehydration therapy
Poor Renal perfusion due to?
Obstruction, Stones, strictures, stenosis or thrombosis
Hemolytic uremic syndrome occurs when?
Occurs b/t 6 months & 5 years
Which implementation is the best way for the nurse to maintain an adequate fluid intake for a toddler with nausea, vomiting, and diarrhea?
Offer oral rehydration solutions (ORS) to rehydrate.
Infant: Freud? Erikson? Piaget? Separation anxiety is shown when? Stranger fear? Toddler: Freud? Erikson? Piaget? Kohlberg? Preschool: Freud? Erikson? Piaget? Kohlberg? School age: Freud? Erikson? Piaget? Kohlberg? Adolsecnt: Freud? Erikson? Piaget? Kohlberg?
Oral Trust vs. Mistrust Sensory motor 4-6 months 6-8 months Anal Autonomy vs shame and doubt Preconceptual/Preoperational Pre-moral/Pre-conventional Phallic or oedipal Initiate vs. guilt Preoperational Pre-conventional Latency period Industry vs. Inferiority Stage of concrete operations Conventional Genital stage Identity vs. Role confusion Formal operations Post conventional
Surgery for cryptochordism = ?
Orchiopexy
Antithyroid Drug? Side effects? Report what?
Propylthiouracil Lethargy & Somnolence & Leukopenia Report Fever/Sore Throat ASAP
When a child sustains a fracture the primary assessment includes assessing the 6 P's. What are the 6 P's?
PAIN (Tenderness) PULSE (Distal to Injury) PALLOR (Cap Refill) PARESTHESIA (Sensation) PARALYSIS (Movement) PRESSURE (Tightness)
Most common opportunistic infection?
PCP pneumocystis pneumonia
sickle cell prophylaxis? (2)
PNC and MCV4
The nurse cares for the newborn diagnosed with developmental dysplasia of the hip (DDH). The nurse expects which method of treatment to be used for the newborn?
Pavlik harness.
A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (3)
Persistent diaper rash, vomiting, and failure to gain weight
Narrowing of preputial opening of foreskin?
Phimosis
#1 cause of death in adolescents? #1 cause of accidental injury in adolescents?
Physical injury MVA
The nurse observes the five-year-old child playing with several other children about the same age. The nurse identifies which play activity as the one in which the child is MOST likely to engage?
Playing with a toy telephone and imitating the doctor.
3 poly's?
Polyphagia Hunger & Increased Food Intake Polyuria Increased Urinary Output Polydypsia Fluid Losses Increases thirst
Bone marrow sites? (2)
Posterior ileac crest and sternum
What are the 2 most common sites for a bone marrow aspiration?
Posterior iliac crest Sternum
Rejection is the most common cause of transplant failure Recipient must be immunosuppressed with?
Prednisone
Rules for car seats? (4)
Semi-reclined Rear Facing Middle of back seat No Airbag
The nurse understands that, according to Erickson, adolescence is regarded as the period associated with establishment of which developmental goal?
Sense of identity and intimacy
Malabsorption of nutrients r/t loss of intestine? 1st and last stage of tx?
Short Bowel Syndrome Start and discontinue TPN
You will see dactylitis (hand foot syndrome) with who?
Sickle cell patient
Vocabulary for: 18 months? 2 years? 3 years? Type of play in: 18 months? 2 years? 3 years?
Single words 300 words, 2-3 word sentences (telegraphic) 900 words, use simple complete sentences Solitary play Parallel play (side by side) Associative (share but play alone)
If correct BP cuff size is not available, use what?
Slightly larger size (not smaller)
Most important way to prevent sickle cell crisis? What should be applied to a site where sickle cell crisis is occurring?
Stay hydrated Heat
Name the steps to EMERGENCY Burn CARE in Order!
Stop Burn Process Assess ABC'S Remove Burned Clothing/Jewelry Provide Reassurance Cover Burn Keep Warm Transport (Call 911)
Hyperthyroidism Post-Op - Observe for S & S of Laryngospasms:?
Stridor, Hoarseness, Throat Tightness
Tx of PUD: Antacids H2 Blockers? (3) - Proton Pump Inhibitors? (3) (Mucosal protective agents)? (Inhibits growth of microorganisms - H. Pylori)?
Tagamet, Zantac, Pepcid Prevacid, Prilosec, Protonix Sucralfate Bismuth
Describes the 5 stages from prepubertal to adult (breast/sex development and pubic hair)?
Tanner stages of development
Teething pain, no _ and _? Give something _?
Teething powders or aspirin Cold
Take the HR and respirations before? ^observe both for how long?
Temperature 1 minute
The nurse performs a home care visit for the child diagnosed with cystic fibrosis. The nurse should intervene if which finding is observed?
The child takes the pancreatic enzymes one hour after eating. enzymes should be taken at beginning of meal
Which guideline is appropriate for the nurse to give the mother concerning the developmental age of her 7-year-old child?
The child's periods of shyness should be tolerated.
The nurse performs assessments in the well-baby clinic. The nurse identifies which finding is a warning sign of cerebral palsy (CP)?
The infant has poor head control after 3 months.
The 5 month old infant is brought to the clinic by a parent for a well- baby check up. The nurse expects to make which observation?
The infant puts their feet to their mouth when lying supine
The 4 month old infant is seen in the well-child clinic. The nurse is most concerned if which finding is observed?
The infant's head lags when pulled from a lying to a sitting position The nurse anticipates no head lag at 4 months of age
The 18 month old child is admitted to the hospital. When the parents leave, the child starts to cry loudly, and the nurses attempt to console the child. After a while the child stops crying and becomes quiet and withdrawn. The nurse thinks that the child has accepted the situation and has adjusted well to the separation. Which statement is TRUE?
The nurse fails to see that the child has entered the second stage of separation anxiety
The home care nurse monitors the pediatric client diagnosed with a chronic seizure disorder. The nurse should intervene if which finding is observed?
The parent takes the child's temperature using an oral electronic thermometer.
2 types of IBD? Ulcerative colitis, where and layers? Blood is + for? Crohn Disease can affect any part of the GI tract from the? Layers? Blood is + for? Meds for IBD: (Prednisone/Prednisolone stop the inflammatory process)? (Decrease the frequency)? (Decreases inflammation by inhibiting prostaglandin synthesis)? (Absorption decreased w/ Sulfasalazine)? (Decreases inflammation in the terminal ileum & colon)? (Chemotherapy agents - used if corticosteroids not affective)? Food for IBD? Avoid?
Ulcerative Colitis & Crohn Disease Colon & Rectum (Usually the Distal colon) And only affects the mucosa & submucosa perinuclear antineutrophil cytoplasm antibody - pANCA) mouth to the anus; affects all layers of the bowel. (transmural) Anti-Saccharomyces cerevisiae antibodies - (ASCA) FASCIA Corticosteroids Aminosalicylates Sulfasalazine Folic Acid Asacol Immunomodulatory High calorie, high protein BRAN
Diagnose UTI?
Urine dipstick (test for enzyme leukocyte _ase)
What type of play is characteristic of the toddler & preschooler? (2 Answers)
Toddler: Parallel Preschooler: Associative
Complete myelination occurs in who?
Toddlers
Reactions of pain influenced by memory, physical restraint, separation from parents and emotional reaction of others? Who has heightened fear of body mutilation? Who Use stalling behaviors "Wait a minute", "I'm not ready"? Worried about being "normal"?
Toddlers Preschoolers School age Adolescents
Meds for acne? (3)
Tretinoin Isotretinoin Benzoyl peroxide
Oliguria is defined how? S&S of AKI? (2)
UO less then 50cc in 24hrs Cardiac Arrhythmia's (increased K+) Azotemia = Retention of wastes
Transplant rejection will have: DECREASE _? INCREASED _? INCREASED _?
UOP B/P SERUM CREATININE
Retrograde flow of bladder urine into ureters?
Vesicoureteral Reflux
A toddler is hospitalized with acute renal failure (ARF) secondary to severe dehydration. The nurse should assess the child for what possible complications?
Water intoxication The child with acute renal failure has the tendency to develop water intoxication or hyponatremia
One symptom of Duchenne Muscular Dystrophy is the Gower Sign. Describe the Gower Sign.
When a child has to use their hands and arms to "walk" up their own body from a squatting position due to lack of muscle strength.
What should be included in the admission assessment when caring for an autistic child? (3)
Will parents to stay Child's deficits & strengths Child's communication methods
Nephroblastoma Embryonic Tumor of Kidney? Signs? Pre-op palpate?
Wilms Tumor Abdominal mass usually Confined to One Side (Left)(Firm & Non-Tender) Don't palpate!
Treat diaper dermatitis with H2O impermeable barriers/protective sealants such as? Antifungals such as?
Zinc oxide, aquaphor, Desitin Nystatin
Anti-Nausea? (3) Prokinetic Drug? H2 Blockers (Antisecretory drugs) (3) Proton Pump Inhibitors (block production of acid) (3) Promote gastric emptying - taken off market in 2000 b/c or serious cardiac complications?
Zofran, Tigan , Phenergan Reglan Tagamet, Zantac, Pepcid Prevacid, Prilosec, Protonix Propulsid
Meds: Antipsychotic? antihistamine (stimulates appetite)?
Zyprexa Periactin
Give iron on what type of stomach? Assessing compliance with iron therapy is done by?
acidic Evaluating the stools
Urine specimen results for a pediatric patient note greater than 100,000 colony forming units (CFUs) but the patient denies any complaints with urination. Based on this information the nurse would suspect that the patient has
asymptomatic bacteriuria.
Visual fixation should be present when?
by 3-4 months old
Cause of GER is r/t dysfunction of the? Diagnosis is made with? _ is performed to determine if esophagitis or strictures are present? _ which can detect radioactive contrast in the esophagus after feeding? Treatment of GER? (4) Surgery for GER? Avoid what? (5)
lower esophageal sphincter (LES) Upper GI series & PH Probe Endoscopy Scintigraphy Small frequent thickened feedings Prone or Left side lying HOB elevated Medications Nissan fundoplication caffeine, chocolate, spicy foods, alcohol, tobacco
UTI Neonate (birth-1mo): Increased association w/ ?
malformed or low set ears
Hemodialysis is more rapid correction which can cause? Hemodialysis is how often?
muscle cramping & hypotension Every other day for 4 hours a day
A 3-year-old child is scheduled for surgery to remove a Wilms' tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation should be based on knowledge that
chemotherapy with or without radiotherapy is indicated.
Colic rule of 3?
crying for 3 hours/day More than 3 days/week Lasting more than 3 weeks
What is thalassemia? tx for iron overload?
destruction of RBC=low hemoglobin (will have high RBC) Chelation therapy
External defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to ensure
development of normal body image.
For infants, Most consistent indicator of distress is a?
facial expression of discomfort
Watery, explosive stools is most often related to? Foul smelling, greasy, bulky stools is often r/t?
glucose intolerance fat malabsorption
The nurse anticipates that the child with a diagnosis of idiopathic hypothyroidism will be given which hormone?
growth hormone
An organ that cannot be reduced is called an? A hernia in which the blood supply to the organ is impaired is called a? The most common type of hernia is an?
incarcerated hernia strangulated hernia umbilical hernia
Absorption of ? Protein excreted? Loss of above = ? Causes decrease in _ pressure? Causes fluid loses (Edema) Leads to _ and _? and INCREASE _ and _? DECREASED ? Abdominal?
plasma protein (Albumin) (Hyperalbuminuria) Hypoalbunminemia colloidal osmotic Hypovolemia and hyperlipidemia(hypercholesterolemia) AND WEIGHT and Facial Edema SERUM PROTEIN ASCITES Nephrotic syndrome (nephrosis)
The nurse cares for the infant diagnosed with a cyanotic congenital heart defect. The nurse understands that chronic hypoxia from this disorder can result in which finding?
polycythemia
A 5-year-old child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to the child's parent that the first action is to have the child evaluated for
possible urinary tract infection.
The 3 day old infant is born with a myelomeningocele The nurse caring for the neonate should place the infant in which position?
prone
A young child is diagnosed with vesicoureteral reflux. The nurse should know that this is usually associated with
recurrent kidney infections.
The nurse knows that which type of feeding is most commonly used with infants who are intolerant of cow's milk?
soy-based formula
For hemodialysis Report loss of _, S&S of _, bulging, or pain immediately!
thrill, infection. bulging, pain
The most important indicator of hydration is: Have diarrhea, don't give?
weight loss BRAT (bananas, rice, applesauce, toast); give high protein high calorie
Complications of burns: SHOCK Fluid Loss Destruction of RBC AIRWAY COMPROMISE Provide O2 SEPSIS?
↓ LOC & Lethargy Staphylococci (3rd day) Pseudomonas (5th day)