PEDS review
A nurse is caring for a school-age child (SAC) who is receiving cefazolin via intermittent IV bolus. The child suddenly develops diffuse flushing of skin and angioedema. After discontinuing the medication infusion, which of the following meds should nurse administer first? 1. prednisone 2. epinephrine 3. diphenhydramine 4. albuterol
Epinephrine (SAC is experiencing anaphylactic reaction to cefazolin adn epinephrine treats anaphylactic reactions). Epinephrine will constrict blood vessels, stimulate heart, and bronchodialates lungs
A nurse is creating a plan of care for a SAC who has heart disease and has developed heart failure. Which of the following interventions should the nurse include in the plan?
Provide small, frequent meals for the child (the metabolic rate of the child who has HF is high b/c of poor cardiac function so need frequent meals to conserve energy). Child should be in semi-fowlers and weight should be daily
A nurse is assessing a SAC who has meningitis. Which of following priorities for nurse to report to provider? 1. reports a HA 6/10 2. petechiae on lower extremities 3. nuchal rigidity (inability to flex neck forward) 4. positive Kernig's sign
petechiae (purpuric) on lower extremities can indicate meningococcemia (risk for serious rapid complications from sepsis) HA, Pos Kernig's sign, & nuchal rigidity: expected finding of meningitis so don't notify dr
A nurse is caring for a school-age child who is receiving a blood transfusion. Which of the following manifestations should alert the nurse to a possible hemolytic transfusion reaction? 1. laryngeal edema 2. flank pain 3. distended neck veins 4. muscular weakness
Flank pain (d/t breakdown of RBC's) Muscle weakness incorrect b/c that is for electrolyte disturbance
A nurse is reviewing the lab report of a SAC who is experiencing fatigue. Which of the following findings should the nurse recognize as an indication of anemia? 1. Hematocrit 28% 2. Hemoglobin 13.5 g/dL 3. WBC count 8,000 4. Platelets 250,000
Hematocrit 28% (below expected range of 32-44%). S/sx include fatigue, lightheadedness, tachycardia, dyspnea, and pallor d/t decreased O2 carrying capacity
A nurse is assessing a SAC immediately following a perforated appendix repair. Which of the following findings should the nurse expect? 1. purulent nasogastric drainage 2. absence of peristalsis 3. passage of dark red stool with mucus 4. WBC count 6,000/mm
absence of peristalsis (immediately after repair until bowel resumes functioning). Not WBC (should be >20,000/mm for ruptured appendix)
A nurse is preparing an adolescent for a lumbar puncture. Which of the following actions should nurse take? 1. place a cardiac monitor on adolescent prior to procedure 2. apply topical analgesic cream to site 1hr prior to procedure 3. keep adolescent in semi-fowler position for 4hr following procedure 4. restrict fluids for 2hr following the procedure
apply topical analgesic cream to site 1hr prior to procedure should be in prone or flat in bed up to 12hr post-procedure to prevent spinal HA. Should encourage drinking extra fluids to replace cerebrospinal fluid
A nurse is planning care for a toddler who has a serum lead level of 4 mcg/dL. Which of the following actions should the nurse plan to take? 1. instruct the parents to decrease the Ca+ in diet 2. prepare the toddler for chelation therapy 3. refer the family to child protective services 4. schedule the toddler for a yearly rescreening
4. schedule the toddler for a yearly rescreening (Chelation therapy is used for >45 mcg/dL and can be initiated for >10 mcg/dL). Ca+ should be increased because Ca+, Vit C, and iron will decrease lead absorption.
A nurse is interviewing the parent of an 18-mo during a well-child visit. The nurse should identify that which of the following indicates a need to assess the toddler for hearing loss? 1. toddler has vocab of 25 words 2. toddler developed a mild rash following a recent varicella immunization 3. toddler's moro reflex is absent 4. toddler received tobramycin during a hospitalization 2 weeks ago
toddler received tobramycin during a hospitalization 2 weeks ago (correct) vocab at 2yoa should be >10 words, mild rash from varicella is common, Moro reflex disappears by 5 months
A nurse in the ER is caring for toddler with partial-thickness burns on right arm. Which of the following actions should the nurse take? 1. insert a NG tube 2. initiate prophylactic antibiotic therapy 3. cleanse affected area with mild soap and water 4. apply a topical corticosteriod to the affected area
Cleanse area with mild soap and water (removing any loose tissue that could cause infection) NG tube: for major burn management (to maintain decompression) ATB therapy: no b/c not given at burn site d/t decreased circulation corticosteroid: no b/c should be antimicrobial ointment to affected area
A nurse in urgent care clinic is assessing an adolescent who has an upper resp tract (URT) infection. Which of the following findings should the nurse identify as a manifestation of pertussis?
Dry hacking cough
A nurse is teaching the parent of an infant who has Pavlik harness for the treatment of developmental dysplasia of the hip. The nurse should identify which of the following statements by parent indicates an understanding of the teaching? 1. I should remove the harness at night to allow my infant to stretch her legs 2. I will need to adjust the straps of the harness once each week 3. I should apply baby powder to my infant's skin twice daily 4. I will place my infant's diapers under the harness straps
I will place diapers under harness straps (so strap doesn't get poo on it)
A nurse is planning care for SAC who is in the oliguric phase of acute kidney injury (AKI) and has sodium level of 129 mEq/L. Which of the following interventions should the nurse include in the plan? 1. administer ibuprofen to the child for a temp >100.4 2. assess the child's bp q8hr 3. weigh the child weekly at various times of the day 4. initiate seizure precautions for child
Initiate seizure precautions for child b/c 129 mEq/L indicates hyponatremia and places child at increased risk for neurological deficits and seizure activity.
A nurse is reviewing the lab report of an infant who is receiving tx for severe dehydration. The nurse should ID which of following laboratory values indicates effectiveness of current treatment? 1. K+ of 2.9 2. Na+ of 140 3. urine specific gravity 1.035 4. BUN 25 mg/dL
Na+ 140 mEq/L (Norm = 134-140) Normal ranges: K+ : 4.1-5.3 USG: 1.005-1.030 (indicates concentrated urine) BUN: 5-18 (indicates kidneys are not excreting BUN as should)
A nurse is caring for a 15yoa pt with head injury. Which of the following findings should nurse ID as indications child is developing syndrome of inappropriate antidiuretic hormone secretion (SIADH)? 1. Na 148 2. urine specific gravity 1.020 3. mental confusion 4. weak peripheral pulses
Mental confusion (d/t altered pituitary function and oversecretion of antidiuretic hormone. Oversecretion of ADH leads to decreased urine output, hyponatremia, and hypoosmolality d/t overhydration. As hyponatremia becomes more severe, mental confusion and other neurological manifestations (e.g. seizures) occur)
A nurse is assessing a 4yoa child at a well-child visit. Which of the following developmental milestones should the nurse expect to observe? 1. identifies right from left hand 2. uses a utensil to spread butter 3. cuts an outlined shape using scissors 4. draws a stick figure with 7 body parts
cuts an outlined shape using scissors (#1 = 6oa #2 = 6yoa #4 = 5yoa)
A nurse is caring for an infant who has RSV. Which of following actions should nurse implement for infection control? 1. have designated stethescope in infant's room 2. place the infant in a room equipped with negative airflow 3. administer palivizumab as prescribed for infant 4. remove gloves after leaving infants room
have designated stethescope (RSV is spread via direct contact and resp secretions so droplet precautions should be initiated). Gloves should be removed BEFORE leaving room palivizumab is used for prophylaxis in at-risk infants
A nurse is reviewing the lumbar puncture of SAC who is suspected of having bacterial meningitis. Which of following findings should nurse ID as an indication of bacterial meningitis? 1. decreased cerebrospinal fluid pressure 2. decreased WBC count 3. increased protein concentration 4. increased glucose level
increased protein concentration in spinal fluid can indicate bacterial meningitis the other three are findings associated with bacterial meningitis
A nurse is assessing an infant who has ventricular septal defect. Which of following findings should nurse expect? 1. loud, harsh murmur 2. dysrhythmias 3. weak femoral pulses 4. high blood pressure
loud harsh murmur d/t left-to-right shunting of blood and hypertrophy of heart muscle Coarctation of aorta = weak femoral pulses & elevated BP
A nurse is preparing to admiister an immunization to a 4yoa. Which of following should nurse do? 1. place child in prone position for immunization 2. request the child's caregiver leave room during immunization 3. administer immunization using a 24-gauge needle 4. inject immunization slowly after aspirating for 3 seconds
should use 22-25 gauge needle to minimize discomfort (should inject immunization rapidly and do not aspirate)
A nurse in the ER is doing a physical assessment on a 2-week old male newborn. Which of following is priority finding to report to dr? 1. excoriated scrotal area 2. multiple capillary hemangiomas 3. depressed posterior fontanel 4. substernal retractions
substernal retractions (ABCs and this is breathing since is increased resp effort which could progress to resp failure)
A nurse is assessing a toddler who has gastroenteritis and is exhibiting manifestations of dehydration. Which of following is nurse's priority? 1. skin breakdown 2. hypotensio 3. hyperpyrexia 4. tachypnea
tachypnea (use ABC approach). Tachypnea is result of kidneys being unable to excrete hydrogen ions and produce bicarbonate which leads to metabolic acidosis
A school nurse is preparing to administer atomextine 1.2 mg/kg/day PO to SAC weighing 75lbs. Available is 40 mg/capsule. How many capsules should nurse administer per day?
1 capsule
A nurse is teaching the patient of a 6-mo infant about care seat use. Which of the following statements by parent indicates she understands teaching? 1. I should secure the car seat using lower anchors and tethers instead of the seat belt 2. I should position the car seat harness one inch above my baby's shoulders 3. I will make sure the care seat is placed at a 90-degree angle 4. I will pad my baby's care seat with a blanket for traveling long distances
1. I should secure the car seat using lower anchors and tethers instead of the seat belt (LATCH system: provides cushion in front and back rest for car seat). Don't put padding, harness should be at or below infant's shoulders, and seat should be at 45* angle
A nurse is caring for a preschooler who has been receiving IV fluids via peripheral IV cath. When preparing to discontinue the IV fluids and cath, place in order: (listed on adjacent card)
1. turn off pump 2. occlude the IV tubing 3. remove tape 4. apply pressure over cath insertion site
A nurse is caring for a toddler who has spastic (pyramidal) cerebral palsy. Which of the following findings should the nurse expect (SATA)? 1. negative Babinski reflex 2. ankle clonus 3. exaggerated stretch reflexes 4. uncontrollable movements of the face 5. contractures
2. Ankle clonus 3. exaggerated stretch reflexes (and spasticity) 5. contractures (d/t tightening of muscles)
A nurse is assessing a 3yoa at visit. Which of the following manifestations should nurse report to provider? 1. bp 90/50 2. RR 45/min 3. weight 14.5 kg (32lbs) 4. HR 110/min
RR of 45/min (norm: 20-25/min so this is indication of acute respiratory distress) BP norm: 86-118/44-74 weight is average for 3yoa HR norm: 80-120/min
resp rate 24/min, HR 115/min, Temp 98.4. S/sx is rhinits with clearn nasal drainage for 2 days. Occasional nonproductive cough for 2 days, history of asthma. Pt allergic to neomycin. What should immunization nurse do? 1. withhold MMR vaccine 2. withhold DTaP 3. Withhold influenza vaccine 4. withhold TB skin test
Withhold MMR vaccine b/c allergy can cause anaphylactic reaction and MMR contraindications for allergy to neomycin (and eggs, gelatin)
A nurse is providing teaching to the parent of an infant who has diaper dermatitis. The nurse should instruct the parent to apply which of the following to the affected area? 1. zinc oxide 2. antibiotic ointment 3. talcum powder 4. antiseptic solution
zinc oxide (dermatitis caused by contact with an irritant such as urine, feces, soap, or friction and takes form of scaling, blisters, or papules with erythema. Providing a protective barrier such as zinc oxide, against the irritants allows skin to heal)
A charge nurse is an ER preparing an in-service for a group of newly licensed nurses about the manifestations of a child maltreatment. Which of the following should charge nurse include as a potential indication of physical abuse? 1. recurrent UTIs 2. symmetric burns of lower extremities 3. failure to thrive (FTT) 4. lack of sub-q fat
symmetric burns of the lower extremities (e.g. cigar or iron) UTIs for sexual abuse, FTT example of physical neglect d/t malnutrition and sub-q fat is also physical neglect d/t poor health care
A school nurse is assessing an adolescent who has scoliosis. Which of the following findings should nurse expect? 1. increase in anterior convexity of lumbar spine 2. increase curvature of thoracic spine 3. lateral flexion of neck 4. a unilateral rib hump
unilateral rib hump (with hip flexion) b/c C-shaped curvature of thoracic spine results in asymmetry of ribs, shoulders, hips, & pelvis (NOT increased curvature of thoracic spine b/c s/x of kyphosis)
A nurse is teaching the parents of SAC who has a new diagnosis of osteomyelitis of the tibia. Which of the following statements by a parent indicates an understanding of the teaching? 1. my child will have a cast until healing is complete 2. my child will receive antibiotics for several weeks 3. my child can return to playing sports once they have been discharged 4. my child needs to be in contact isolation
will receive antibiotics for several weeks (4 weeks and surgery might be needed if antibiotics are not successful)
A nurse is caring for a preschooler who is scheduled for hydrotherapy treatment for wound debridement following a burn injury. Which of the following actions should the nurse take prior to the procedure? 1. apply topical antimicrobial ointment to the child's wound 2. place a mesh gauze dressing over the child's wound 3. administer an analgesic to the child 4. initiate prophylactic antibiotic therapy for the child
administer an analgesic to the child (hydrotherapy is painful so child needs analgesia and/or sedation)
A nurse is caring for SAC who is receiving chemo and is severely immunocompromised. Which of the following actions should nurse take? 1. use surgical asepsis when providing routine care for child 2. administer the MMR vaccine to child 3. screen child's visitors for indications of infection 4. infuse packed RBCs
3. screen child's visitors for indications of infection
A hospice nurse is caring for a preschooler who has terminal illness. One of the preschooler's parents tell the nurse they cannot cope anymore and are thinking about moving out of the house. Which of following should nurse say? 1. it is important that you provide emotional support for your family at this time 2. you have to do what you feel is best. Everything will turn out fine 3. I know how you feel... 4. let's talk about some ways you have handled previous stressors in your life
4. let's talk about some ways you have handled previous stressors in your life
