PEDS FINAL REVIEW
Identify pain assessment tools which would be age-appropriate for the following children. 3 week old infant: 4 month old infant: 2 yr old: 4 yr old: 14 yr old:
3 week old infant: NIPS, CRIES 4 month old infant: CRIES, FLACC 2 yr old: FLACC 4 yr old: FLACC, Faces, OUCHER, poker chip 14 yr old: Numeric 1-10, APPT (Adolescent Pediatric Pain Tool), possibly FLACC
8. The clinic has organized a class for several parents of children newly diagnosed with sickle cell disease. The nurse explains that problems with sickle cell can include: (Select all that apply) A. Aplastic crisis B. Sequestration of blood C. Hemarthrosis D. Polycythemia E. Vaso-occlusive crisis
A. Aplastic crisis B. Sequestration of blood E. Vaso-occlusive crisis
A nurse is teaching a group of new mothers about well-child care. The nurse should advise that an infant should be seen for health promotion visits: A. At 1 month, 2 months, 4 months, 6 months, 9 months, and 12 months. B. When the mother feels that the infant is showing signs of illness. C. Every other month for the first year of life. D. Every month for the first year of life.
A. At 1 month, 2 months, 4 months, 6 months, 9 months, and 12 months.
A mother asks the nurse about feeding her newborn. The nurse's best response that includes the recommendations made by the American Academy of Pediatrics (AAP) concerning feeding infants is: A. Begin exclusive breastfeeding with no water, juice, or other foods. B. Introduce solid foods beginning at 4 months of age. C. Breastfeed exclusively for the first year of life. D. Introduce table foods only after the infant tooth eruption.
A. Begin exclusive breastfeeding with no water, juice, or other foods.
30. In teaching a mother about use of the Pavlik harness, the nurse would include which of the following? (Select all that apply) A. Keep the baby in the harness for 23 of the 24 hours of a day B. Dress the baby with an undershirt and socks under the harness C. Use a specially designed car seat which prevents abduction of the hips D. Use baby lotion and baby powder to prevent rubbing of the skin against the harness E. Feed the baby upright to maintain abduction of the hips
A. Keep the baby in the harness for 23 of the 24 hours of a day B. Dress the baby with an undershirt and socks under the harness E. Feed the baby upright to maintain abduction of the hips
Most common inflammation of glomeruli of kidney Most often a response to: Group A beta-hemolytic streptococcus Ages 2-6 years More common in males History of strep infection Signs emerge 10-21 days after Immune complex reaction on glomerular capillary wall Inflammation & destruction decreased GFR Increased vascular permeability RBC excreted Na, H20 retained edema S/S - some asymptomatic, others acute onset
Acute Glomerulonephritis
4. A child has just begun topical antibiotic treatment for impetigo. The nurse explains to the mother that the child can return to daycare: Immediately After 24 hours As soon as lesions are crusted When crusts fall off
After 24 hours
25. During his physical examination, Bob, 14, reports that the long whip-like scars on his back occurred as a result of falling backward against a rough bedroom floor when he was playing with a friend. The nurse should respond in which way? Ask additional questions regarding the cause of injury and any other injuries noted. Discuss the fact that his clumsiness is a part of his adolescence and that he will outgrow it. Instruct Bob in the importance of exercise and good nutrition to avoid easy bruising. Tell him you do not believe him and you want to know if his parents caused his injuries.
Ask additional questions regarding the cause of injury and any other injuries noted.
11. A child with leukemia has the following lab results: Hgb 8, HCT 24.2, WBC 8,000, platelets 150,000. What is the priority nursing assessment? Monitor for fever Assess for bruising or bleeding Determine intake and output Assess for pallor, fatigue, tachycardia
Assess for pallor, fatigue, tachycardia
4. Constant involuntary writhing motions seen in cerebral palsy
Athetosis
Parents are concerned because they cannot stay for long hours to visit their infant in the NICU. Which of the following statements by the nurse is most appropriate? A. "One of you might take a leave of absence to be here more." B. "Parents often feel this way; let me get you the number of a support group." C. "Perhaps the grandparents can make the visits for you." D. "Why can't you visit after work every day?
B. "Parents often feel this way; let me get you the number of a support group."
The nurse assesses a 6-year-old who was admitted 4 hours ago following an appendectomy. The child had morphine intravenously for pain immediately after surgery. The nurse notes that the child has shallow respirations and is lying very still. When asked if he has pain, the child very quickly says, "No!" The most appropriate action by the nurse would be to: A. Reassess the child in one hour. B. Administer the prescribed dose of morphine. C. Call the physician to report signs of respiratory distress. D. Ask the child's parents to notify the nurse if the child complains of pain.
B. Administer the prescribed dose of morphine.
10. A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises should the nurse provide to the child and his family? Select all that apply. A. Avoid foods high in folic acid B. Drink plenty of fluids C. Use cold packs to relieve joint pain D. Report a sore throat to an adult immediately E. Restrict activity to quiet board games F. Wash hands before meals and after playing
B. Drink plenty of fluids D. Report a sore throat to an adult immediately F. Wash hands before meals and after playing
Which of the following actions would you take first if you found an infant to be severely hypothermic? A. Place the infant in passive skin-to-skin contact with the parent B. Place the infant under a warmer with a skin probe attached to the chest C. Perform tactile stimulation to see if more movement will raise the temperature D. Check the parents' room for adequate temperature
B. Place the infant under a warmer with a skin probe attached to the chest
A 6-month old child is undergoing a routine check-up. Select all the findings the nurse would expect to find during an assessment of this child. A. Uses pincer grasp well. B. Presence of the anterior fontanel. C. Picks up small objects. D. Weight has doubled since birth. E. Sits with support. F. Grasps rattle.
B. Presence of the anterior fontanel. D. Weight has doubled since birth. E. Sits with support. F. Grasps rattle.
The parents of a preterm infant in neonatal NICU are concerned about their infant experiencing pain from so many procedures. The nurse's response should be based on the knowledge that preterm infants: A. May react to painful stimuli but are unable to perceive the pain experience B. React to pain in much the same manner as children and adults C. Do not have the cortical and subcortical centers that are needed for pain perception D. Lack neurochemical systems associated with pain transmission and modulation
B. React to pain in much the same manner as children and adults
23. The nurse should recommend to the parents of a child who is dying that the sibling usually needs to: A. Be protected from the reasons for the death B. Receive information about what is happening C. Be observed for the abnormal signs of anger or jealousy D. Be excused from any of the care or chores related to the sick child
B. Receive information about what is happening
A 2-year-old has just been diagnosed with sickle cell anemia. The nurse has explained the diagnosis to the family as well as provided information about the treatment plan. The nurse will anticipate the need for additional teaching when the mother makes which statement? A. "My husband loves to fly his small plane. I guess we'll have to take a commercial plane for our trips from now on." B. "If my child gets the flu bug, she might develop a sickling crisis" C. "My child will need extra iron tablets because of her anemia" D. "During a sickling crisis, my child will probably be hospitalized for pain control and hydration therapy"
C. "My child will need extra iron tablets because of her anemia"
21. A hospice nurse makes an initial visit to the home of a terminally ill child to meet the family members and explore the parents' wishes. Which question should the nurse ask first? A. "Will you consider a do not resuscitate (DNR) or allow natural death (AND) order?" B. "How do you feel about interventions that will prolong your child's life?" C. "What can I do for you and your family?" D. "Do you want life-saving interventions withheld?"
C. "What can I do for you and your family?"
20. A male adolescent waiting for a heart transplant asks the nurse for assistance in planning his funeral in case the heart does not become available. The best response by the nurse is: A. "Your parents should help you, not me." B. "You are not dying yet." C. "What can I do to help you?" D. "Why? Do you think you are dying?"
C. "What can I do to help you?"
A 1 year old who weighed 6 lbs, 4 oz at birth is seen in the clinic. The nurse would expect the child to weigh at least: A. 12 lbs, 8 oz B. 15 lbs, 10 oz C. 18 lbs, 12 oz D. 24 lbs, 15 oz
C. 18 lbs, 12 oz
9. An 8 year old is being admitted in vaso-occlusive crisis. When creating the care plan, to which of the following actions should the nurse give priority? A. Administering high concentration of oxygen to provide adequate oxygenation B. Evaluating the acid-base status and administering sodium bicarbonate as necessary C. Assessing pain and administering pain medication as necessary D. Replacing Factor VIII
C. Assessing pain and administering pain medication as necessary
19. An adolescent experiencing status asthmaticus was rushed to the Emergency Department by ambulance. The parents arrive and ask to see their child. The triage nurse at the reception desk knows that the adolescent was pronounced dead on arrival. At this moment, the triage nurse's best intervention is to: A. Tell the parents that they must wait because only the doctor can talk with them. B. Ask the parents to please take a seat in the waiting room. C. Immediately escort the parents to a quiet, private room. D. Immediately tell the parents, "I'm sorry, but your child didn't make it."
C. Immediately escort the parents to a quiet, private room.
Which infant behavior is most indicative of effective pain control measures? A. Sucking vigorously on a pacifier B. Mild moaning or whimpering C. Relaxed with occasional movement of arms or legs D. Alert and moving about frequently in the crib
C. Relaxed with occasional movement of arms or legs
A 3-month-old former 25-week premature baby has been exposed to prolonged oxygen therapy. As a result of the oxygen therapy, this baby is at high risk for developing: A. Cerebral palsy B. Hyperkalemia C. Retinopathy of prematurity D. Hydrocephalus
C. Retinopathy of prematurity
Which is the best predictor of morbidity and mortality risks in a neonate? A. Gestational age alone B. Weight alone C. Weight and gestational age
C. Weight and gestational age
34. The nurse is teaching the family about caring for their 7-year-old with Type I DM. What information should the nurse provide about Type I DM? It's managed through diet, exercise, and oral medication. Can be prevented by proper nutrition and activity. Characterized mainly by insulin resistance. Characterized mainly by insulin deficiency.
Characterized mainly by insulin deficiency.
Failure of testicle to descend Complications - infertility & malignancy Most descend spontaneously by 3 months Orchiopexy at 1 yr if not descended Hernia repair if needed
Cryptorchidism
Which infant would be the highest risk for poisoning? A. A 2-week old infant B. A 6-week old infant C. A 3-month old infant D. A 6-month old infant
D. A 6-month old infant
22. The sibling of a dying child may feel: A. Left out and unimportant B. Concern for his own health C. Physical symptoms similar to those of his sibling D. All of the above
D. All of the above
Which of these measures used by a nurse will help relieve parental anxiety related to the changing appetite in the toddler who is gaining weight along the 50th percentile? A. Teach the mother to avoid disciplining the toddler within 30 minutes of eating. B. Instruct the mother to feed the toddler alone without any distractions. C. Suggest ways to have the toddler eat higher-calorie foods. D. Discuss the growth of the toddler as compared to the growth chart.
D. Discuss the growth of the toddler as compared to the growth chart.
A 3-year-old is hospitalized with a fractured femur. The pain assessment tool most appropriate for this child is: A. FLACC Scale B. Poker Chip tool C. Number Scale D. Faces Pain rating Scale
D. Faces Pain rating Scale
A nurse is performing a physical assessment on a neonate. Which finding might indicate that the neonate's respiratory status is worsening? A. Acrocyanosis B. Arterial CO2 of 40 and PO2 of 80 C. Periorbital edema D. Grunting and nasal flaring
D. Grunting and nasal flaring
The mother of a preterm neonate asks the nurse when she can start breast-feeding. The nurse should explain that breast-feeding can be initiated when her infant: A. Achieves a weight of at least 3lbs B. Indicates an interest in breast-feeding C. Does not require supplemental oxygen D. Has adequate sucking and swallowing reflexes
D. Has adequate sucking and swallowing reflexes
What is the role of the peer group in the life of school-age children? A. Provides an opportunity to learn dominance and hostility B. Allows them to remain dependent on their parents for a longer time C. Decreases their need to learn appropriate sex roles D. Provides them with security as they gain independence from their parents
D. Provides them with security as they gain independence from their parents
A 16-year-old female complaining of abdominal pain is waiting in the exam room with her mother. It is important that the nurse assess whether the girl is sexually active. What action should the nurse take to gather the data? A. Ask the mother to leave the room when sexual history questions will be asked. B. Ask the girl if she is sexually active, as the mother needs to know and be involved. C. Let the physician ask the question, so the girl does not have to discuss it twice. D. Suggest to the girl and mother that the mother can join her after the exam.
D. Suggest to the girl and mother that the mother can join her after the exam.
The nurse is teaching the parents of a 5-year-old about pain management at home following outpatient surgery. The nurse should include in the discharge teaching the information that: A. He will only need pain medicine for the next 24 hours. B. Pain medicine should be given when he says he hurts. C. Pain medicine should be avoided if possible to decrease chances of addiction. D. The physician should be called if prescribed pain medication is not relieving his pain.
D. The physician should be called if prescribed pain medication is not relieving his pain.
The nurse is a patient advocate for a child receiving a venipuncture. The nurse should discuss pain management with the physician and suggest: A. Sedation B. Subcutaneous lidocaine C. Intravenous analgesia D. Topical application of EMLA or ELA-MAX
D. Topical application of EMLA or ELA-MAX
33. The nurse is caring for a child who complains of constant hunger, constant thirst, frequent urination, and recent weight loss without dieting. The nurse can expect that care for this child will include: Limiting daily fluid intake. Weight management consulting. Strict intake and output monitoring. Frequent blood glucose testing
Frequent blood glucose testing
14. Famous coma scale used to assess level of consciousness. reduce environmental
Glasgow
Barley, Bran, Couscous, Farina, Graham flour, Orzo Rye, Semolina, Wheat, Wheat bran, Wheat germ, Wheat starch
Grains Containing Gluten
One of the most infectious diseases in the world. If vaccinations stopped ~ 2-3 million people would die worldwide. Direct contact w/ droplets or airborne Communicable 4 days pre-rash to 4 days after rash appears Prodrome: anorexia & malaise Koplik's spots appear in mouth (x 1-3 days) High fever, conjunctivitis, coryza, cough Maculopapular rash 4-7 after prodrome Starts on face, spreads to trunk & extremities Symptoms gradually subside in 4-7 more days Complications - diarrhea, OM, pneumonia, bronchitis, LTB, encephalitis, death
Measles (Rubeola)
Contact with or inhalation of respiratory droplets Communicable: Up to 5 days before swelling - 5 days after S/S - malaise, fever, & parotid gland swelling Earache, HA, pain w/ chewing, appetite and activity Complications: Orchitis in postpubertal males Viral meningitis (< 10%) Stiff neck, photophobia, HA
Mumps (parotitis)
Unknown causes May be diagnosed prenatally CT, MRI, and X-rays Treatment = Surgery w/in 24-48 hrs! Clinical manifestations - Spinal fluid-filled meningeal sac Hydrocephalus (85%) Seizures Symptoms vary by location Lowest = mild weakness, bowel & bladder issues Highest = paralysis of legs, weakness & sensory loss of trunk, loss of bowel & bladder control Nursing Care Myelodysplasia Initial care pre-op Protection of the sac Warm, sterile saline guaze Positioning Feedings Measure HC daily/Neuro status Post-op Care Prone or side-lying positions Observe for bleeding or CSF leakage Monitor HC daily Assess change in neuro status Post-op Teaching Intermittent catheterization Positioning; feeding ROM S/S infection, increased ICP
Myelodysplasia (Meningomyelocele) or Spina Bifida
Stuffy nose, sneezing Yawning Mottled Tachypnea (>60 bpm at rest) Sweating Hyperthermia
NAS ANS signs
High pitched cry Hyperirritability, inconsolability, restlessness Increased muscle tone, exaggerated muscle tone Tremors Sneezing, hiccups, yawning Short, unquiet sleep Seizures
NAS CNS signs
Excoriated buttocks Pressure-point abrasions (knees, elbows) Facial scratches
NAS Cutaneous signs
Disorganized, vigorous suck Sensitive gag reflex Vomiting, diarrhea Poor feeding and weight loss
NAS GI signs
Airborne precautions if hospitalized Careful respiratory assessment Cool mist vaporizer Suction gently Supportive care Photophobia - dim lights; shades Skin care: clean and dry, no soaps
Nursing Care: Measles (Rubeola)
Standard and droplet precautions Supportive care Soft & blended foods: avoid foods that increase salivary flow - can cause pain Warm or cool compresses to parotid area Assess for meningeal irritation Scrotal support if testicular swelling
Nursing Care: Mumps
Dx: Fecal fat, duodenal biopsy, clinical improvement, special serum antibodies Tx: Gluten free diet, dietitian Teaching: allowed foods, risks of non-compliance
Nursing Management - Celiac Disease
Desmopressin Imipramine Oxybutinin
Nursing Management -Enuresis Medications
Macrolide antibiotics - erythromycin, azithromycin Corticosteroids prn Treat close contacts Droplet precautions until abx X 5 days Cardiac monitor and pulse ox Observe coughing spells O2 prn Crash cart? Humidification, gentle suctioning prn Supportive care Reduce crying Teach parents s/s of respiratory failure and dehydration
Pertussis - Treatment/Nursing Care
16. Surgical closure of the ductus arteriosus would do which of the following? Stop the loss of unoxygenated blood to the systemic circulation Decrease the edema in the legs and feet Increase the oxygenation of blood Prevent the return of oxygenated blood to the lungs
Prevent the return of oxygenated blood to the lungs
Delayed neuromuscular maturation Small bladder capacity
Primary enuresis
14. Which is most important for the nurse to emphasize when counseling parents about home management of a child waiting for corrective surgery for a congenital heart defect? Reducing caloric intake to decrease cardiac demands. Relaxing discipline and limit setting to prevent crying. The need to be extremely concerned about cyanotic spells. Promoting normal growth and development within the limits of the child's condition.
Promoting normal growth and development within the limits of the child's condition.
17. An untreated Tet (hypercyanotic) spell can lead to: (Select all that apply) Seizure Tremors Endocarditis Loss of consciousness Death CVA
Seizure Loss of consciousness Death CVA
27. What is the treatment of choice for a newborn with talipes equinovarus?
Serial casting
26. Which of the following would put a parent at high risk for being a child abuser? Being poor and a member of a minority group Choosing to have a baby without being married Having less than a high school education Severe disappointment with the sex of the baby
Severe disappointment with the sex of the baby
11. An intervention for an infant with NAS would be to
Stimuli
3. When bathing a young child with eczema, the nurse tells the mother to have the bathwater: (Select all that apply) As warm as the child can tolerate. Hot to the touch on the inner wrist. Tepid to the touch. Cool with soap bubbles added. Without perfumed soap or bubble bath.
Tepid to the touch. Without perfumed soap or bubble bath.
Radiant warmer vs. Isolette Away from windows & drafts Keep skin dry Warm & humidify oxygen Hat and swaddled when out of isolette Kangaroo care Avoid cold surfaces
Thermoregulation Nursing Care
32. Four newborns have blood drawn for the Guthrie test for phenylketonuria. The nurse would question the results of the baby: Whose test was performed at 48 hours of age Who was breast fed for the 24 hours before the test Who was fed glucose water followed by formula for 30 hours Who was tested immediately after birth
Who was tested immediately after birth
24. When planning a strategy to address child abuse, the nurse should: Lecture parents suspected of child abuse on the evils of violence Report suspected abuse whenever a child with bruises is admitted Stop parental visitation immediately if abuse is suspected Work with pregnant teen groups to teach parenting skills
Work with pregnant teen groups to teach parenting skills
1. A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath the next morning, he asks for Mommy. The nurse's best reply is which of the following? a. "Mommy will be here after lunch." b. "Mommy always comes back to see you." c. "Your mommy told me yesterday that she would be here today about noon." d. "Mommy had to go home for a while, but she will be here today."
a. "Mommy will be here after lunch."
1. Samantha, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. Which of the following is the best nursing action? a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.
a. Apply a Band-Aid.
1. When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as which of the following? a. Punishment b. Threat to child's self-image c. Loss of parental love d. Loss of companionship with friends
a. Punishment
1. Which of the following represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain
a. Separation anxiety
1. An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler would be which of the following? a. Provide for privacy. b. Encourage parents to room-in. c. Explain procedures and routines. Encourage contact with children of the same age.
b. Encourage parents to room-in.
1. The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering antibiotics. The child starts to cry and tells the nurse, "Do it later, O.K.?" The nurse should do which of the following? a. Start the IV because allowing the child to manipulate the nurse is bad. b. Start the IV because unlimited procrastination results in heightened anxiety. c. Postpone starting the IV until the child is ready so that the child experiences a sense of control. d. Postpone starting the IV until the child is ready so that the child's anxiety is reduced.
b. Start the IV because unlimited procrastination results in heightened anxiety.
Identify other procedures which may require sedation: What level of sedation for these procedures?
burn debridement, bone marrow aspiration, dental procedures for young child Mild to moderate
1. Two hospitalized adolescents are playing pool in the activity room. Neither of them seems very enthusiastic about the game. The nurse should recognize that: a. this activity is too demanding for the adolescents. b. this activity is better suited for younger children. c. they may be enjoying themselves but have lower energy levels than healthy children. d. they are probably depressed and showing less enthusiasm is part of the experience of their hospitalization / illness.
c. they may be enjoying themselves but have lower energy levels than healthy children.
is the result of inadequate production of pulmonary surfactant, a substance produced in the lungs that keeps alveoli from collapsing on expiration. The syndrome occurs more frequently in premature White babies than in babies of African descent and almost twice as often in boys as in girls. s/s Nasal flaring, retractions, grunting, tachypnea, cyanosis, apnea = can cause severe distress Prevents exchange of O2 & CO2 Leads to hypoxia, respiratory acidosis, metabolic acidosis
respiratory distress syndrome (RDS)
18. Congestive heart failure is more common with which disorders? (Select all that apply) VSD PDA Tetrology of Fallot ASD Coarctation of the aorta
VSD PDA ASD
Which of the following is the most appropriate nursing action when intermittently gavage-feeding a preterm infant? A. Allow formula to flow by gravity B. Insert tube through nares rather than mouth C. Avoid letting infant suck the tube D. Apply steady pressure to syringe to deliver formula to stomach in a timely manner
A. Allow formula to flow by gravity
Which of the following signs would alert the nurse that a baby with respiratory distress is hypoglycemic? A. Jitteriness B. Hunger C. Increased respiratory rate D. Need for supplementary oxygen
A. Jitteriness
31. Which of the following are priority nursing diagnoses for an adolescent who must wear a Boston brace for treatment of her scoliosis? (Select all that apply) A. Mobility: Physical, Impaired B. Urinary Elimination, Impaired C. Skin Integrity, Risk of Impaired D. Knowledge, Deficient E. Body Image, Disturbed
A. Mobility: Physical, Impaired C. Skin Integrity, Risk of Impaired D. Knowledge, Deficient E. Body Image, Disturbed
A new school counselor asks the school nurse to present an educational program for the parents of young adolescents. Which of the following would be a priority for inclusion into the program? (Select all that apply.) A. Opportunities available in the community to promote physical activity. B. The current clothing styles, so their child can "fit in." C. Signs and symptoms of sleep deprivation. D. Driver's education classes. E. Signs of depression and substance abuse.
A. Opportunities available in the community to promote physical activity. C. Signs and symptoms of sleep deprivation. E. Signs of depression and substance abuse.
Which of the following complementary therapies for pain management are appropriate for infants? Select all that apply. A. Pacifier B. Stories A. Imagery B. Oral sucrose solution C. Music
A. Pacifier B. Oral sucrose solution C. Music
The parents of a 20-month old child are ready to begin toilet training with their child. Which signs would indicate this child was ready to begin toilet training? (Select all that apply.) A. Regular bowel movements. B. Appropriate age. C. Expresses desire to use toilet. D. Increased number of wet diapers. E. Wakes up from a nap dry. F. Able to dress and undress himself.
A. Regular bowel movements. B. Appropriate age. C. Expresses desire to use toilet. E. Wakes up from a nap dry. F. Able to dress and undress himself.
28. A young infant has just had a new cast applied for correction of clubfoot. For which of the following symptoms would the nurse instruct the parents to call the physician? (Select all that apply) A. Unusual fussiness or irritability B. Tingling or burning sensation C. Blue or white toes D. Swelling or inability to move toes E. Sudden unexplained fever
A. Unusual fussiness or irritability C. Blue or white toes D. Swelling or inability to move toes E. Sudden unexplained fever
A nurse is going to do a presentation to her 6-year-old daughter's Brownie troop on hand washing. Which method of instruction would be most effective in promoting active involvement in children of this age? A. Use a special lotion that will show all the girls how well they wash their hands. B. Give the girls a booklet showing other girls washing their hands appropriately. C. Give a demonstration of the effectiveness of hand washing. D. Show a short video of children washing their hands appropriately.
A. Use a special lotion that will show all the girls how well they wash their hands.
13. Drug withdrawal in newborn from Mother's drug use, Neonatal (2 words).
Abstinence Syndrome
. A child has been diagnosed with eczema. While taking the nursing history, the nurse will assess for a family history of: Scabies Cellulitis Impetigo Asthma
Asthma
1. A late sign of increased intracranial pressure(cardiac).
Bradycardia
10. General cause of most cerebral palsy.
Brain Insult
-viral infection -small airways -RSV (most common) -Oct/Nov to March How spread? Contact with resp secretions or indirect via contaminated surfaces
Bronchiolitis
Immunologic disorder - intolerance to gluten Chronic malabsorption s/s: Chronic diarrhea, impaired growth, abdominal distension., appetite, energy, muscle wasting
Celiac Disease - Gluten-sensitive enteropathy
2. A movement and posture disorder.
Cerebral Palsy
12. A child's CBC indicates severe thrombocytopenia after chemotherapy. Nursing interventions related to this finding should include: Select all that apply. Encourage foods high in iron. Limit physical contact with child. Remove fresh flowers from the room. Clear the floor of the room to prevent falls and bruises. Minimize needle sticks and intrusive procedures.
Clear the floor of the room to prevent falls and bruises. Minimize needle sticks and intrusive procedures.
excessive heat loss resulting in the use of comechanisms (such as increased respirations and nonshivering thermogenesis/use of brown fat stores) to main-tain core body temperature close to 37.0°C (98.6°F)
Cold Stress
-inflammation of upper airways - larynx & epiglottis -mostly viral - LTB,
Croup Syndromes
Robert, a 6-year-old had an appendectomy yesterday for a ruptured appendix. He is NPO, and has intravenous morphine ordered as needed every two hours for pain. What pain scales would be appropriate for Robert?
Faces, Oucher, Poker chip, maybe Numeric, possibly Word Graphic
Transmission: Respiratory secretions; Blood Communicability: Week before symptoms; Not contagious once rash appears Symptoms vary by stage Stage 1 - Mild symptoms (fever, HA, malaise) x 2-3 days, then no S&S x 1-7 days Stage 2 - "Slapped face" appearance = fiery red cheeks with circumoral pallor 1-4 days later: Lace-like symmetric erythematous, maculopapular rash on trunk and limbs - no longer contagious Stage 3 - Rash fades over 1-3 weeks may be mildly pruritic Complications - patients w/ hemolytic conditions (SCA) can have a transient crisis
Fifth Disease - Erythema Infectiosum
assessment for NAS
Finnegan Score
7. Caused by an imbalance between the production and absorption of CSF.
Hydrocephalus
Symptoms: jitteriness, lethargy, poor feeding, hypothermia Assess: Frequent glucose s in 1st 4 hours; Glucose < 40-45 Intervention: Early feedings or IVs for low glucose
Hypoglycemia
Protect surgical site Urethral stent - √ color & amt of urine Encourage fluids Double diapering Medications - Analgesics, abx, anticholinergics Teaching - Restrictions, urine leakage, blood
Hypospadias & Epispadias - Hypospadias Repair Postoperative Care
MMR & Varicella vaccines: are contraindicated in ?
Immunoglobulin tx in last 3-11 months Immunodeficiency (congenital or acquired) Pregnancy
15. A nurse has admitted a child with a ventricular septal defect to the unit. An appropriate nursing diagnosis for this child is: Acute pain related to the effects of a congenital heart defect. Impaired gas exchange related to altered pulmonary blood flow. Deficient fluid volume related to congenital heart defect. Hypothermia related to decreased metabolic state.
Impaired gas exchange related to altered pulmonary blood flow.
8. The goal of therapy for a child with disabilities is to promote the highest level of
Independence
One of most frequent causes of intestinal obstruction during infancy Portion of intestine prolapses and telescopes back Most common in infancy and in males Abrupt onset Acute pain Vomiting bilious Brown stool reddish "currant jelly" Palpable abdominal mass
Intussusception
35. A nurse is interviewing the parent of a 9-year-old girl. The parent expresses concern because the girl already has pubic hair and is starting to develop breasts. Which statement would be most appropriate? Your daughter: Should get her period in approximately 6 months. Is developing early and should be evaluated for precocious puberty. Is experiencing body changes that are appropriate for her age. Will need further testing to determine the underlying cause.
Is experiencing body changes that are appropriate for her age.
29. What are three characteristics of developmental dysplagia of the hip in an infant?
Limited abduction of affected hip; asymmetry of gluteal & thigh fat folds; telescoping of the thigh
6. Identified by a sac-like protrusion on the back.
Myelomeningocele
Inflammatory bowel disease Potentially life threatening Can deteriorate rapidly! Related to: Ischemia & inflammation Bacterial colonization Enteral feedings Immature GI mucosa
Necrotizing Enterocolitis
Characterized by: Edema - protein loss osmotic pr Retain Na+ and H2O Massive proteinuria Lose albumin, immunoglobulins Hypoalbuminemia, hypoproteinemia Lost in urine Hyperlipidemia/hypercoagulability - r/t liver stim Altered immunity Symptoms - gradual, progressive edema, anorexia, wt gain, HTN, irritability, decreased UO, foamy/frothy urine
Nephrotic Syndrome
5. Urinary problem associated with spina bifida (2 words).
Neurogenic Bladder
Best prevention for hypothermia?
Neutral Thermal Environment
Infants = 2 mL/kg/hr Children = 0.5 to 1 mL/kg/hr Adolescent = 40 to 80 mL/hr
Normal Urine Output - important!
~80% of deaths are children <1 yr of age Respiratory droplet & contact with secretions Communicable: ~ 1week after exposure until 5 days into antibiotic treatment Most contagious before paroxysmal cough Complications = pneumonia, atelectasis, OM, encephalopathy, seizures, death Catarrhal stage: (~ 2wks) = runny nose, low-grade fever, mild nonproductive cough Paroxysmal stage: (1-6wks) = "whooping cough" more severe at night Convalescent stage: (6-10 wks) = coughing spells gradually subside
PERTUSSIS - Whooping cough
Starts with URI Inflammation, edema & increased mucus production block airways
Pathophys - Croup Syndromes
Symptoms Occ. Emesis projectile vomiting Visible peristaltic waves Hyperactive bowel sounds Palpable olive-sized mass Dehydration, electrolyte imbalances
Pyloric Stenosis
Respiratory Failure Bronchopulmonary Dysplasia (BPD) Patent ductus arteriosus (PDA) Retinopathy of prematurity (ROP) Intraventricular hemorrhage (IVH)
RDS complications
Prevent if possible Surfactant replacement - meds = beractants (Survanta, Exosurf, Curosurf) Support oxygenation and ventilation UAC for ABG monitoring Correct acid base abnormalities Supportive care
RDS treatment
Leading cause of hospitalization 1st yr Most children infected by age 2 Immunosuppression; VLBW, lung disease (BPD), neuromusc d., congenital hrt defects
Risk factors for Bronchiolitis
6. The nurse is working with a teenager diagnosed with eczema. The nurse will explain: Skin appearance will improve in a few days Avoiding foods with eggs & milk will speed healing Scarring is not likely to occur if treatment plan is followed This problem will not likely recur past adolescence
Scarring is not likely to occur if treatment plan is followed
Stress, UTI, DM, sleep disorder
Secondary enuresis
3. Hypertonia with uncontrolled movement seen in cerebral palsy
Spasticity
9. A myelomeningocele is sometimes called this (2 words).
Spina Bifida
Mary (age 3) is scheduled for sedation to have an abscess drained. What emergency equipment should be on hand when monitoring a child having sedation? What scales or tools can you use to rate her pain after the procedure?
Suction apparatus, a bag-valve mask for assisted ventilation, an oxygen supply, and antagonists to sedative medications. Faces, Oucher, FLACC
13. Parents of a child with neutropenia secondary to chemotherapy have been taught about protective isolation. The nurse notes a need for further education when the parents: Bring the child's toys from home. Encourage friends to visit by phone rather than in person. Take the child to the playroom for entertainment. Wash their hands before entering the room but not when leaving.
Take the child to the playroom for entertainment.
Teaching: Incision care No tub baths x 2 days Avoid straddling on hip or straddle toys x 2 weeks S/S of infection
Teaching: Cryptorchidism
Infection of tonsils Viral (80%) or bacterial S/S:Persistent redness of tonsils, discomfort Breathing/swallowing difficulties Low grade fever Frequent infections Peak age 4-7 years
Tonsillitis Also see Pharyngitis
- bacterial H. influenza B life threatening!
Tracheitis/Epiglottis
Cause: Slow absorption of lung fluid or excess fluid in lungs S/S: Grunting, nasal flaring, mild retractions, mild cyanosis, tachypnea = no marked distress Treatment: Oxygen, possible IVF's, time, NPO if RR > 60 Who: Increased risk in C/S infants, large infants
Transient Tachypnea (TTN)
When you assess him at 8:00 a.m., he reports a pain level of 6. He states that he has a sharp pain in his abdomen that has lasted about 5 minutes. He was last medicated at 7:00. What will you do for his pain? Would he be a good candidate for PCA? Why or why not?
Try nonpharmacologic techniques, stay with him. Comfort measures, distraction - read to him, simple game, music. If these don't help, call MD for extra med. Check previous medication history to see frequency of pain and med dosing. Morphine dose may not be enough or he may need additional med like Toradol ordered. Yes, he is 6. Even some 5 year olds can use.
12. Used to help drain excess fluid from the ventricles.
VP Shunt
Spread: Airborne & direct contact with lesions Communicable: 1-2 days before rash all lesions crusted Acute onset: mild fever, malaise, anorexia, HA, mild abdominal pain, skin rash Complications - secondary infx (cellulitis, sepsis, meningitis, pneumonia), thrombocytopenia, Reye's syndrome Rash begins on trunk, scalp, face Macule papule vesicle crust over 1-5 days of eruption = itchy Lesions at all stages - do not erupt together Oral lesions affect PO intake Crusts can last 1-3 wks
Varicella (Chicken pox)
1. Sharon, age 8 years, is being admitted to the hospital from the emergency room with an injury from falling off of her bicycle. Which of the following will help her most in her adjustment to the hospital? a. Explain hospital schedules to her, such as mealtimes. b. Use terms, such as "honey" and "dear," to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, since she is young, to her room and hospital facility.
a. Explain hospital schedules to her, such as mealtimes.
1. Greg, age 2.5 years, was admitted to the pediatric unit yesterday. His parents are making plans to visit as often as possible during his hospitalization. Greg's parents complain to the nurse that the child "cries, screams, and throws himself' whenever they leave the hospital to eat. The nurse should do which of the following? a. Explain that his behavior is a normal response to hospitalization. b. Explain that this behavior will diminish in a few days. c. Encourage the parents not to leave the child's room. d. Encourage the parents to leave when the child is asleep.
a. Explain that his behavior is a normal response to hospitalization.
1. The parents of a 4-month-old infant cannot visit except on weekends. Which action by the nurse indicates an understanding of the emotional needs of a young infant? a. Place her in a room away from other children. b. Tell the parents that frequent visiting is unnecessary. c. Assign her to different nurses so she will have varied contacts. d. Assign her to the same nurse as much as possible.
d. Assign her to the same nurse as much as possible.
Rhinitis Low grade fever, wheezing, cough, tachypnea, retractions, labored breathing Poor feeding, V&D Risk of dehydration cyanosis, decreased mental status Decreased breath sounds as airflow decreases.
s/s Bronchiolitis
Inspiratory stridor, 'seal-like' barking cough, hoarseness. worse at night
s/s: Croup
How does cold stress occur
through the mechanisms of evaporation, convection, conduction, and radiation
