midterm PEDsss

school age bp

100-120/60-75

A 4-week-old infant is diagnosed with bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond?

"Has your infant been around any crowds?" Explanation: Acute bronchiolitis is caused by a viral infection, most often, respiratory syncytial virus. Viruses are often spread between groups of people in close contact. Hereditary and environmental complications do not relate to this disorder.

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level?

300/mm3 Explanation: The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.

Toddler/preschooler HR/BP

80-115 bpm 90 to 110/55 to 75

adolescent HR/BP

90-100bpm 100 to 120/70 to 80

Infant HR/BP

90-160 BPM 80/55

The parents of a 3-month-old infant report concerns the infant is irritable, feeds poorly, and has a rash. The nurse notes weeping, crusty lesions on the infant's cheeks and neck. Which action by the nurse is most appropriate?

Contact the health care provider to request treatment. Explanation: Infants that feed poorly, are irritable, and have a weeping, crusty rash on the checks and neck may have atopic dermatitis (infantile eczema). The nurse should contact the healthcare provider to request treatment, which may include methods to avoid allergens. Although reducing exposure to identified allergens is important, a 3-month-old infant should not be eating peanuts, so this information would not be appropriate at this time.

what foods should children avoid with a dx of Thalassemia

Foods high in iron. Appropriate choices: yogurt, granola, string cheese, saltine crackers, and apples

A hospitalized school-aged child has had surgery and has a prescription for "as necessary" (PRN) pain medication every 4 to 6 hours. Which assessment(s) will the nurse make to determine the child's current pain level before administering each dose of pain medication? Select all that apply.

Listen to the child's report of pain. Assess muscular rigidity. Assess if the child is withdrawn or responds to questions. Ask the child to describe the pain.

A 5-year-old boy is receiving an analgesic intravenously while in the hospital. What should the nurse do to determine whether the drug is being properly excreted from this child?

Monitor the child's fluid intake and output. Explanation: Monitoring intake and output is important in children receiving drugs to be certain urine excretion or an outlet for drug metabolites is adequate. The other interventions listed are not typically used to determine whether drug excretion is occurring.

The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors?

Neuroblastomas produce catecholamines. Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) differentiate neuroblastomas from other tumors. This exam is done by collecting a 24-hour urine specimen. Urinalysis provides general information about renal function. Serum chemistries help to evaluate the body's response to the cancer process. CBC with differential determines abnormal loss or destruction of cells that may indicate cancer or bone marrow suppression.

The nurse is reviewing the immunization schedule with the parent of a child who is HIV positive. What information should the nurse provide? Select all that apply.

Pneumococcal vaccination can be given. The varicella vaccine should not be given if the child is symptomatic. If the CD4 count is low, the measles, mumps, and rubella vaccine should not be given. Explanation: The nurse should emphasize that live vaccines should not be given to those infected with HIV. Children should receive routine immunizations according to the usual schedule with the killed virus vaccines, including pneumococcal and human papillomavirus vaccine. Symptomatic children should not receive the varicella vaccine, and those with low CD4 counts should not receive measles, mumps, and rubella vaccine.

To give eardrops to a 4-year-old child, what would be the best technique to use?

Pull the pinna of the ear up and back. Explanation: Pulling the pinna upward and back straightens the ear canal in the child older than 3 years of age. To administer otic drops to a child younger than 3 years, the pinna would be pulled downward and back. Pressing the pinna of the ear forward or downward would occlude the ear canal.

What behavioral responses to pain would a nurse observe from an infant younger than age 1?

Reflex withdrawal to stimulus and facial grimacing Explanation: Infants younger than age 1 become irritable and exhibit reflex withdrawal to the painful stimulus. Facial grimacing also occurs. Localized withdrawal is experienced by toddlers ages 1 to 3 in response to pain. The nurse would observe passive resistance in school-age children. Preschoolers show a low frustration level and strike out physically.

In caring for a child with sickle cell disease, the highest priority goal is:

The highest priority goals for this child are maintaining comfort and relieving pain. The child is prone to dehydration because of the kidneys' inability to concentrate urine, so increasing fluid intake is the next highest priority. Other goals include improving physical mobility, maintaining skin integrity, reducing the caregiver's anxiety, and increasing the caregiver's knowledge about the causes of crisis episodes — but these goals are not the highest priority.

A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer?

The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?

The preschooler is considered immunosuppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.

The nurse is reviewing the medical history of a 4-year-old child. What would the nurse identify as potentially indicative of a primary immunodeficiency? Select all that apply.

Warning signs associated with primary immunodeficiency include four or more new episodes of acute otitis media in 1 year, recurrent deep skin or organ abscesses, persistent oral candidiasis (thrush) or skin candidiasis after 1 year of age. A history of infections requiring IV antibiotics to heal and two or more episodes of pneumonia in 1 year are also warning signs.Warning signs associated with primary immunodeficiency include four or more new episodes of acute otitis media in 1 year, recurrent deep skin or organ abscesses, persistent oral candidiasis (thrush) or skin candidiasis after 1 year of age. A history of infections requiring IV antibiotics to heal and two or more episodes of pneumonia in 1 year are also warning signs.

The nurse is caring for a child diagnosed with juvenile idiopathic arthritis. Which statement(s) by the parents demonstrates an understanding of how to care for their child with this disease? Select all that apply.

We may note our child has a fever above 103°F (39.5°C) for a couple weeks and should monitor our child's temperature." "We need to administer medication to decrease inflammation and pain in our child." "We should encourage swimming as an activity for our child."

How is wheezing in children best heard?

as the child exhales Explanation: Wheezing occurs from obstruction in the lower trachea and bronchioles. It is an expiratory sound from difficulty pushing air through a narrowed airway. When there is obstruction of the bronchioles—as with such disease processes as asthma and cystic fibrosis—wheezing will not clear with coughing. A stethoscope is necessary to auscultate lung sounds and hear wheezing. If a child is wheezing it can be heard with the child in any position. Crying makes the lung sounds harder to hear.

significant signs of peds heart disease

reports of orthopnea, dyspnea, easy fatigability, growth delays, squatting, edema, dizziness, and frequent pneumonia

The nursing is teaching parents how to administer a prescribed otic medication for a 2-year-old toddler with otitis media. Which statement will the nurse include in the teaching?

"Be sure the ear drops are at room temperature before administering." Explanation: Otic administration refers to delivering medicine into the ear canal. To limit pain and discomfort, the ear drops should be room temperature when administered. If necessary, the container can be rolled between the palms to help warm the drops. When doing this, the ear of the child who is 2 years and younger should be pulled down and back. The ear of the child who is 3 years and older should be pulled up and back. The child should be placed supine or side-lying with the affected ear exposed, drops instilled, area anterior massaged to promote passage of the medication into the ear canal, and have the child remain in this position for a few minutes.

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first?

"Have him use his short-acting bronchodilator right away." Explanation: The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.

The nurse is planning care for a child with a pneumothorax. The nurse adds the nursing diagnosis, "Risk for injury related to potential dislodgement of chest tube" to the care plan. When writing the care plan, what should the nurse be sure to include as interventions?

Ensure a pair of hemostats are at the bedside. Monitor pulse oximetry readings. Assess lungs as directed by the physician or as the client's condition warrants. Maintain chest tube bottle in an upright position and below the level of the chest. Explanation: If the tube becomes dislodged from the child's chest, the nurse must apply Vaseline gauze and an occlusive dressing to prevent air leakage into the pleural space. A pair of hemostats should be kept at the bedside to clamp the tube should it become dislodged from the drainage container. Pulse oximetry and lung assessments help ensure proper placement of the chest tube. To maintain proper drainage, the bottle must be kept upright and below the level of the chest.

The mother of a child with a possible food allergy asks the nurse for information about how to test for it. Which response by the nurse would be most appropriate?

Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies.

A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply.

HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding. It cannot be contracted by using the same bathroom. It must be direct contact.

The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child's heart is beating very fast. What action by the nurse is indicated?

Myasthenia gravis is an autoimmune disorder that is characterized by weakness and fatigue. There is no cure. The disease may be aggravated by stress, exposure to extreme temperatures, and infections, resulting in a myasthenic crisis. Myasthenic crisis is a medical emergency with symptoms including sudden respiratory distress, dysphagia, dysarthria, ptosis, diplopia, tachycardia, anxiety, and rapidly increasing weakness. The symptoms reported are consistent with a crisis and prompt care is indicated. Waiting 24 hours to have the child seen by the physician is not appropriate. Questions about changes in routine and medication compliance may be asked but the first priority is to have the child seen.

A nurse is caring for a 4-year-old child who is exhibiting extreme anxiety and behavioral upset prior to receiving stitches for a deep chin laceration. Which nursing intervention is a priority?

Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen. Explanation: When a child is manifesting extreme anxiety and behavioral upset, the priority nursing intervention is to serve as an advocate for the family and ensure that the appropriate pharmacologic agents are chosen to alleviate the child's distress. Ensuring emergency equipment is readily available and lighting is adequate for the procedure is also part of the nursing function, but secondary interventions. Conducting a baseline physical assessment is important but would likely be difficult if the child was crying inconsolably or was extremely anxious.

causes of respiratory arrest (lower)

asthma, bronchiolitis, pertussis infection, pneumonia, pneumothorax

The nurse is preparing to use the FLACC behavioral scale to assess the pain level of a child. For which child will the use of this scale be the most appropriate?

postsurgical 6-year-old child who is unable to accurately report pain level Explanation: The FLACC behavioral scale is a behavioral assessment tool that is useful in assessing a child's pain when the child is unable to report accurately his or her level of pain or discomfort and is reliable for children from age 2 months to 7 years. A 7-year-old child who is getting ready to undergo a dressing change and a 4-year-old child who just had stitches placed would be able to report pain and could use the Faces, Oucher, poker chip or visual analog scales. A 10-year-old with a broken femur in traction would be able to self report pain using the numeric scale. In alert children verbally able to report pain, self report is the primary source for the measurement of pain.

causes of respiratory arrest (Upper)

burns, croup, epiglottitis, foreign-body aspiration, reflux, tracheomalacia, vascular ring

A 4-year-old child is scheduled for a magnetic resonance imaging of the skull following a bicycle accident. Which medication would the nurse administer to keep the child still during this procedure?

conscious sedation Explanation: Conscious sedation allows a child to be both pain free and sedated for a procedure. Unlike the use of general anesthesia, protective reflexes are left intact and a child can respond to instructions during the procedure. The technique is used for painful procedures, as well as for magnetic resonance imaging and endoscopy, both of which require a child to lie still for a long period of time and can be potentially frightening.

The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis?

tachycardia and respiratory distress Explanation: Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia. Increased heart rate and blood pressure are indicative of tumor lysis syndrome, which may occur with acute lymphoblastic leukemia, lymphoma, and neuroblastoma. Wheezing and diminished breath sounds are signs of superior vena cava syndrome related to non-Hodgkin's lymphoma or neuroblastoma. Respiratory distress and poor perfusion are symptoms of massive hepatomegaly which is caused by a neuroblastoma filling a large portion of the abdominal cavity.

A child with hypoplastic anemia develops hemosiderosis. What nursing instruction promotes the treatment goals?

Infuse deferoxamine at home Explanation: Treatment of anemia is through transfusion of packed red blood cells to increase erythrocyte levels. As a result of the necessary number of transfusions, hemosiderosis or the deposition of iron in body tissue can occur. Treatment for hemosiderosis is iron chelation through the use of subcutaneous infusions of deferoxamine. These infusions are to be given at home overnight for 5 to 6 nights per week. There is not enough information to determine if aspirin should be avoided. Ferrous sulfate will add more iron to the child's body and should be avoided. Children with congenital hypoplastic anemia may receive corticosteroid therapy along with transfusions of packed RBCs to raise erythrocyte levels.

The nurse is planning to supplement pain medication with nonpharmacologic techniques for a child having multiple painful procedures. Which techniques are helpful for pain relief? Select all that apply.

biofeedback aroma therapy magnet therapy guided imagery acupuncture and acupressure transcutaneous electrical nerve stimulator Explanation: All of these are forms of nonpharmacologic pain relief. Biofeedback is based on the theory people can regulate internal events such as heart rate and pain in response to a stimulus. Aromatherapy is based on the principle that the sense of smell plays a significant role in overall health. Jasmine and lavender are oils thought to be responsible for relieving pain. Magnet therapy is based on the belief that magnets can control or shift body energy lines to restore health or relieve pain. Guided imagery is a distraction technique to help a child place another meaning (a nonpainful one) on a painful procedure. Acupuncture involves the insertion of needles into critical positions (meridian lines) in the body to achieve pain relief. Acupressure involves applying deep pressure at the same points. Transcutaneous electrical nerve stimulation (TENS) involves applying small electrodes to the dermatomes that supply the body portion where pain is experienced.

What can be a sign of early heart failure disease in children?

diaphoresis

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has:

epoglossitis

in infants how does peripheral edema progress?

first in the face, then the presacral region, lastly the extremities

The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiologic effects?

impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression Explanation: Unrelieved acute pain can lead to impaired mobility; anorexia, causing poor nutritional intake; delayed wound healing; anxiety and irritability; somatic symptoms; sleep disturbances; avoidance; developmental regression; and increased parental distress. Constipation, nausea, vomiting, nocturnal enuresis, and migraine headaches are not effects of acute pain.

The nurse is caring for a child who has a depressed immune system due to chemotherapy treatments. The child is due for scheduled immunizations according to CDC recommendations. The nurse must ensure that the child does not receive which type of immunization?

live vaccine Explanation: Live vaccines can cause the infection/disease to occur in the immunocompromised person. Killed or inactivated vaccines do not contain a live virus and are generally safe for immunocompromised individuals.

The nurse is caring for a child who is receiving an intravenous immunoglobulin treatment. The client calls the nurse and reports she vomited. What action should be completed first?

Discontinue the infusion. Explanation: Clients receiving intravenous immunoglobulin are at risk for anaphylaxis. Vomiting can signal an allergic response. The first action would be to stop the infusion. The remaining activities are appropriate for inclusion in the plan of care but are not of the highest priority.

A group of students are reviewing the effects of sickle cell anemia on the various parts of the body. The students demonstrate a need for additional study when they identify what as an effect?

High urine specific gravity Explanation: Low urine specific gravity (hyposthenuria) occurs with sickle cell anemia. Chest syndrome is an acute manifestation of sickle cell anemia. Pulmonary hypertension is a chronic manifestation of sickle cell anemia. Cholelithiasis is a chronic manifestation of sickle cell anemia.

The nurse is caring for a child who is receiving a skin test to determine the presence of allergies. A positive skin test for one particular allergen shows the mediation of which type of immune globulin?

IgE Explanation: Skin testing is done to detect the presence of IgE in the skin that responds to a particular allergen. IgM is part of the body's primary response, and IgG is part of the body's secondary response to infection. IgA is present in the mucous membranes of the body to fight against infection.

Which immunoglobin occurs most frequently in plasma and is the major immunoglobulin synthesized during secondary response?

IgG is the most frequent antibody in plasma and is the major immunoglobin to be synthesized during the secondary response. IgG represents about 75% of all serum antibodies. Most of the newborn's IgG is transferred via the placenta to the fetus. The infant develops passive immunity to antigens in which the mother has developed antibodies. The infant begins to manufacture IgG after about 6 months of age. IgG reaches 50% of its adult level at 1 year of age and full adult level at age 7 years. IgD is only found in about 1% of plasma. Its function is to signal for B cells to be activated. IgA protects the mucous membranes against the invasion of microbes. IgM is the first antibody to respond to infection.

The nurse is caring for a child with HIV. The doctor will most likely order which test to monitor the child's progress?

lymphocyte immunophenotyping T-cell quantification Explanation: Lymphocyte immunophenotyping T-cell quantification is for ongoing monitoring of progressive depletion of CD4 T lymphocytes in HIV disease. The nurse would expect the physician to order a complement assay (C3 and C4) for ongoing monitoring of systemic lupus erythematosus. IgG subclasses measure the levels of the four subclasses of IgG and are used to determine immunodeficiencies. Immunoglobulin electrophoresis is ordered for immunodeficiency and autoimmune disorders, not to monitor systemic lupus erythematosus.

The nurse notices that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. What would be the best intervention?

Continue to assess for bleeding. Explanation: Children will have a small amount of blood mixed with saliva following a tonsillectomy. Suctioning or coughing could irritate the surgical site and cause hemorrhage.

Meperidine

contraindicated or ongoing pain management in a child with vaso-occlusive (sickle-cell) crisis bc it increases risk for seizure/neurotoxicity

The nurse is caring for a client who is in a sickle cell crisis. The child is hospitalized for pain management during the crisis. The parents tell the nurse that they do not think their child needs any pain medication because the child is sleeping a lot. How should the nurse respond?

"I understand why you think your child is not in pain; sleep is often a way for children to cope with pain." Explanation: Sleep or play may be a coping strategy for the child in pain, and sleep may reflect exhaustion of the child who is coping with pain; therefore, the nurse and parents should not assume the child is pain-free. There is no need to wait for the child to express the pain level to the nurse. Often, children deny pain or may assume that others know how they are feeling and thus will not verbalize their pain. Telling the parents that the medication must be given as prescribed does not address the parents' concern.

A young child is hospitalized with pneumonia. Upon admission the client states not having pain but just a bad cough. A few hours later, the child he begins reporting pain in the right lower back. This first report of feeling pain refers to:

pain threshold. Explanation: Pain threshold refers to the point at which the child first feels the pain. The pain tolerance refers to the maximum level of pain a person can tolerate. Usually, this is measured on the analog scale. The duration of pain indicates how long the pain has been occurring. For example, if the pain is postoperative it is referred to as acute pain. If it has been occurring for 3 months and is persistent it is considered chronic pain. The pain peak is when the client describes the pain at its worst. Depending on the problem that may be minutes, days, or months. For example, a client may have a condition where the pain is worse on day 3 of the illness instead of day 1.

A hospitalized toddler being treated for pneumonia requires supplemental oxygen. The respiratory rate is 44 breaths/min and the oxygen saturation is 90% on room air. Which oxygen delivery device would be best for this toddler?

nasal cannula Explanation: The best form of oxygen delivery for this toddler is a nasal cannula. The nasal cannula is the most comfortable and the most likely to stay in place. The nasal cannula provides up to 44% more oxygen delivery than room air. Oxygen can be delivered up to 4 liters via nasal cannula. The child can eat or talk with the nasal cannula in place. Oxygen delivered should be humidified. The simple face mask can provide 35% to 60% of oxygen via a flow rate of 6 to 10 liters. It is used when there is increasing respiratory difficulty. Children have difficulty keeping it in place. A nonrebreather is used for serious respiratory problems. It can deliver 95% oxygen via 10 to 12 liters flow. A partial rebreather is also needed when an increased amount of oxygen delivery is needed. This mask can provide 50% to 60% oxygen set at 10 to 12 liters flow.