PED Final Exam
The parents of a 10-year-old boy with cystic fibrosis restrict him from camping, sleepovers with friends, and school field trips. They time his respiratory treatments and log his diet, choosing most foods for him. They have him seen medically between scheduled appointments and call their physician frequently with concerns. The nurse considers these behaviors indicative of:
vulnerable child syndrome ***Parents "see" the child as more fragile and dependent than he actually is. Resultant protective behaviors on the part of the parents interfere with the boy's ability to grow and develop as normally as possible within the restraints of his illness.
After teaching a mother how to remove a tick from her 6-year-old boy's arm, the nurse determines that additional teaching is needed when the mother makes what statement?
"I'll grasp the tick and pull it away quickly." ***When removing a tick, the mother should use fine-tipped tweezers while protecting her fingers with a tissue, paper towel, or latex gloves. The mother should grasp the tick as close to the skin as possible and pull upward with steady, even pressure. Once removed, the mother should place the tick in a sealable plastic bag in the freezer in case the child becomes sick and identification of the tick is needed.
The nurse is providing a class to a group of parents about child rearing. One of the participants reports that she regularly uses spanking as a form of discipline for her 5-year-old son. What is the best response by the nurse?
"Many studies show that spanking can lead to aggression in children."
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate?
"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." ***When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption).***
Bookish parents have a 3yearold boy with a difficult temperament. Which guidance will be most successful for the nurse to use?
"Provide a place for him to roughhouse." ***Suggesting that the parents provide a place where the child can roughhouse would be best for the child and them.
A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching?
"Red meat is a good option; he loves the hamburgers from the drive-thru." ***While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive-thru as it is also high in fat, fillers, and sodium
The nurse is providing education concerning discipline to the parents of a 2yearold girl. Which of the nurse's comments follows the strategies for good discipline?
"Tell what will result in her being sent to her room." ***It is important to make the consequence known before the bad behavior. This way the child has the opportunity to avoid misbehaving. Effective discipline is performed in close proximity to the misbehavior. It is important to set a good example and avoid hypocritical behavior.
The mother of a 15-year-old child reports that her husband is very strict with her son. She voices concerns about the future impact of this style of parenting on him later in life. What response by the nurse is most appropriate?
"The children who have parents who are authoritarians often are resentful later in life." ***Parenting style has an impact on the future of children. The authoritative parenting style is associated with negative effects on self-esteem, happiness, and social skills and increased aggression and defiance.
*Developmental Surveillance and Screening
*Developmental Surveillance and Screening
The nurse is assessing infants in the newborn nursery. Who is most likely to have a major anomaly?
12-hour-old Caucasian male with café-au-lait spots on his trunk ***A major anomaly is an anomaly or malformation that creates significant medical problems and requires surgical or medical management. Café-au-lait spots are a major anomaly.
The nurse is preparing a child for a lumbar puncture. How far ahead of the procedure should the nurse apply the EMLA cream?
3 hour ***For a deeper procedure such as a lumbar puncture, the nurse needs to apply the cream 2 to 3 hours before the procedure. For a superficial procedure, the EMLA cream should be applied at least 1 hour before the procedure.
A parent is disciplining the 5-year-old daughter by putting her in time-out. How long should the child be in time-out?
5 minutes The amount of time that a child spends in time-out is typically 1 minute per year of age; for example, a 3-year-old would spend 3 minutes in time-out.
*Child Life Specialist
A child life specialist or CLS is an individual who is specifically trained in the developmental impact of illness, injury, and trauma of a child and his/her family. Member of a multidisciplinary team and works in conjunction with other HCP and parents to foster an atmosphere that promotes the child's well-being.
Hypotonia
A condition characterized by low muscle tone usually detected within a few minutes of birth. The newborns will have the poor muscle strength and may not able to keep their knees or elbows bent. DownSyndrome
A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which of the following? Select all answers that apply
A) Complaints of stiff neck B) Photophobia C) Vomiting
A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. Which of the following would the nurse do first?
ASSES FOR PATENT AIRWAY
What action is not appropriate for a 14-month-old child with iron deficiency anemia?
Allowing the infant to drink the iron supplement from a small medicine cup
BURNS
BURNS
Bacterial meningitis
Bacterial meningitis
Boxes 27.2 & 27.3
Boxes 27.2 & 27.3
Grade of murmur
Characteristics of Heart Murmurs Intensity Grade I—soft and hard to hear Grade II—soft and easily heard Grade III—loud without thrill Grade IV—loud with a precordial thrill Grade V—loud, audible with a stethoscope Grade VI—very loud, audible with a stethoscope or with the naked ear
A 4-year-old is brought to the emergency department with a burn. Which of the following would alert the nurse to the possibility of child abuse?
Clear delineations are noted between burned and unburned skin areas
The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. Which of the following would the nurse include as a major congenital anomaly?
Cleft palate
Nurse's responsibility related to informed consent
Determine whether parent/legal guardian understands what they are signing Ask specific questions to assess parent/legal guardian's knowledge related to the consent Clarify and resolve knowledge deficits Ensure the consent form is completed with signatures for parents or legal guardians Serve as a witness to the consent process Children over the age of 8 may be asked to sign an assent form
A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. Which of the following would be the priority?
Ensuring a patent airway
major congenital anomalies
Examples include spina bifida, anencephaly, heart defects and orofacial clefts.
FAILURE TO THRIVE
FAILURE TO THRIVE
A 2-year-old child has been returned to the nursing unit after an inguinal hernia repair. Which pain assessment tool should the nurse use to assess this child for the presence of pain?
FLACC tool **The FLACC (face, legs, activity, cry, consolability) tool should be used with a 2-year-old child.
The nurse is teaching techniques for effective discipline to the parents of a 9yearold girl. The girl is misbehaving, and the parents wish to use the extinction discipline. Which action should they take?
Going home early from shopping ***Going home early from shopping if the child misbehaves is an example of extinction discipline.
The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely?
Grieving related to the child's poor prognosis
The nurse is caring for families with vulnerable child syndrome. Which situation would be most likely to predispose the family to this condition?
Having an infant who is reluctant to feed properly
The parents of an 11-year-old girl tell the school nurse that their child has a very "slow to warm up" temperament, and that they are concerned with her starting a new school. Which activities should the nurse tell the child's teacher to initially avoid based on this information? Select all that apply.
Having the child introduce herself by standing at the front of the class and telling something interesting about herself Assigning the child a role-play scenario to perform with another student in front of the class Encouraging the child to join the drama club, which is practicing for an upcoming play
The nurse is caring for an 8-year-old boy with otitis media with effusion. Which situation may have caused this disorder?
He is experiencing recurrent nasal congestion ***Recurrent nasal congestion contributes to the presence of otitis media with effusion.
Health Supervision Visit
History and physical assessment Developmental/behavioral assessment Sensory screening (vision and hearing) Appropriate at-risk screening Immunizations Health promotion
The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a violaceous color with discharge and a foul odor. The nurse suspects which of the following infections?
INVASIVE BURN CELLULITIS
IRON DEFICIENCY ANEMIA
IRON DEFICIENCY ANEMIA
The nurse is caring for a 3-day-old girl with Down syndrome whose mother had no prenatal care. What is the priority nursing diagnosis?
Imbalanced nutrition, less than body requirements related to the effects of hypotonia
Bladder capacity
Infant: 1ml/kg/hr age in years + 2 oz
The nurse is weighing an underweight infant diagnosed with failure to thrive (FTT) and notes that the baby does not make eye contact and is less active than the other infants. What would be a probable cause for the FTT related to the infant's body language?
Maternal abuse ***Infants with FTT related to maternal neglect may avoid eye contact and be less interactive than other infants. Inorganic causes of FTT include neglect, abuse, behavioral problems, lack of appropriate maternal interaction, poor feeding techniques, lack of parental knowledge, or parental mental illness.
The nurse is assessing a 2-week-old boy who was born at home and has not had metabolic screening. Which sign or symptom indicates phenylketonuria?
Musty or mousy odor to the urine **Children with phenylketonuria will have a musty or mousy odor to their urine, as well as an eczema-like rash, irritability, and vomiting. I
A 3-year-old child has sustained significant severe burns and is ordered to receive 100% oxygen. Which of the following would the nurse use to administer the oxygen?
Non-rebreather mask
Otitis media
Otitis media
A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease?
Playing in the woods about a week ago ***Lyme disease is caused by the bite of an infected tick, with a rash appearing 7 to 14 days after the tick bite. Ticks are commonly found in wooded areas. Therefore, reports of the child playing in the woods about 7 days ago would support the diagnosis of Lyme disease
*Role of Child Life Specialists in Atraumatic Care
Provide programs to prepare children for hospitalization and painful procedures Provide support during medical procedures *Therapeutic play and activities to support normal growth and development Educate child and family about health conditions Teach and support coping and pain management strategies Sibling support; advocacy for the child and family Grief and bereavement support
Car seat safety
Rear facing carseat can be faced front at 20 lbs/2yo Sit in rear seat; > 40 lbs - may sit in booster seat, forward facing with two point restraint - in the rear seat
Teaching Adolescents
Sensitive to maintaining body image Feelings of control and autonomy
The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect?
Spooning of nails ***A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings
A 16-year-old boy complains to the school nurse of headaches and a stiff neck. Which of the following signs and symptoms would alert the nurse that the child may have bacterial meningitis?
Sunlight is "too bright"
TAC v EMLA
TAC v EMLA
The nurse is reviewing the therapist's documentation in the medical record of an assigned client who has cerebral palsy. The therapist has noted the parents may be experiencing vulnerable child syndrome. Which observation of the family unit best supports this potential diagnosis?
The parents report they feel their child requires more therapy than the care team has indicated will be needed. ***Vulnerable child syndrome is a clinical state in which the parents' reactions to a serious illness or event in the child's past continue to have long-term psychologically harmful effects on the child and members of the family unit. The parents view the child as being at higher risk for medical, developmental, or behavioral problems. Parents exhibit excessive unwarranted concerns and seek health care for their child very frequently. Requests for additional therapy would be consistent with this syndrome.
Uninvolved parents are indifferent.
They do not provide rules or standards.
Vulnerable Child Syndrome
Vulnerable Child Syndrome
A group of students are reviewing information about major and minor congenital disorders. The students demonstrate understanding of the information when they identify which of the following as a minor disorder?
Webbed neck
DL: infants
dependent on others for all things; trust is developed when their needs are met
Dl; adolescents
fear injury and pain; loss of control is a key factor; anger withdrawal, or general lack of cooperation may occur
Dl: school-age
generally hospitalized because of long-term illnesses or trauma; more realistic understanding for reason for illness;
activities of school nurses
health education family/community involvement physical education health services nutrition services counseling, psych and social services healthy school environment health promotion for staff
Morbidity
illness rates measures of prevalence of disease or degree of disability in a population at a particular time -presented as a rate per unit of population
EMLA and iontophoretic lidocaine are applied to ____ skin, not to open wounds or lacerations.
intact
Hypoplastic left heart syndrome
is a birth defect that affects normal blood flow through the heart. As the baby develops during pregnancy, the left side of the heart does not form correctly.
Transposition of great vessel
is a congenital heart defect in which the position of the two major vessels that carry blood away from the heart, the aorta and the pulmonary artery, is switched (transposed).
TAC (tetracaine, epinephrine, cocaine)
is commonly used for lacerations that require suturing. The agent can be applied directly to the wound with a cotton ball or swab for 20 to 30 minutes until the area is numb.
Permissive or laissez-faire parents have _____ control over the behavior of their children. Uninvolved parents are indifferent.
little
Maple sugar urine disease requires a______diet and supplementation with thiamine.
low-protein diet
Increased reflex action and seizures are typical of....
maple sugar urine disease.
DL: toddlers
mastering accomplishments; shame vs. doubt; resurgence in separation anxiety
basic guidelines on how ro treat bacterial meningitis?
medical emegerncyget an LP and CulturesIV antibiotic treatment
Physiologic measurements in childrens pain assessment are:
of limited value as sole indicator of pain.
Frequent swimming would put the child at risk for.....
ottis externa
phenylalanine diet is an intervention for....
phenylketonuria
What antecedents are common for the "Vulnerable Child Syndrome?"
preterm birthcongenital anomolynewborn jaundicehandicapping conditionterminal illness or mortal accidentcrying or feeding problems in the first 5 yrs of life
A behavioral pain tool should be used when the child is ____ or doesnt have the language skills to express pain
preverbal
The authoritative or democratic parent shows some ____ for the child's opinions.
respect
The FACES, numeric, and Oucher scales are all _____-report pain rating tools.
self reporting Self-report measures are not sufficiently valid for children younger than 3 years of age because many are not able to accurately self-report their pain.
What consequences are common for the "Vulnerable Child Syndrome?"
separation difficulty from parents and vice versachild anxiety that potentiates parental fearsexcessive parental controllack of consistent and firm discipline despite the disease or disorder (1166)
Minor congenital anomalies
structural changes that pose no significant health problem in the neonatal period and tend to have limited social or cosmetic consequences for the affected individual. Examples include single palmar crease and clinodactyly.
Cleft palate is a symptom of....
symptom of velo-cardio-facial/DiGeorge syndrome.
table 27.1, page 981
table 27.1, page 981
Teaching Preschool Children:
the nurse and the family assume all responsibility for what is learned, how it is learned and when it is learned. Begin with their developmental learning age Play out the parts Repeat what they say they know
~Mortality vs morbidity~
~Mortality vs morbidity~
A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would anticipate preparing the girl for which diagnostic tests as ordered?
Electrocardiographic monitoring
The nurse is educating the parents of a 6-year-old boy how to manage the child's introduction into elementary school. The child has an easy temperament. Which should the nurse suggest?
Helping the child deal with minor stresses ***The child with an easy temperament will adapt to school with only minor stresses. The slow-to-warm child will experience frustration. The difficult child will be moody and irritable and may benefit from a preschool visit.
Pain assessment tools
Pain assessment tools
Parenting styles
Parenting styles
TEMPERAMENT
TEMPERAMENT
Disorders with decreased pulmonary blood flow
Tetralogy of Fallot
mortality
death rates numbers of individuals who have died over a specific period (can be overall or from specific cause) -presented in rates per unit of population (usually 1,000 or more) -infant mortality (death under 12 months) often used as indirect measure of the general health of a population
The health department nurse and the school nurse would favor an autonomous person, but there is still more ____ supervision than with home health nursing.
direct
The parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond?
"Remind her in simple terms what will happen in the dentist's office." ***Due to the girl's temperament, it is best if the parent's talk to the dentist before the first visit to find out exactly what the dentist will be doing and then describe to the child in simple terms what will occur.
A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be:
Initiate appropriate isolation precautions and begin intravenous antibiotics. ***Bacterial meningitis is a medical emergency and requires prompt hospitalization and treatment. Deterioration may be rapid and may occur in less than 24 hours, leading to long-term neurologic damage, and even death. Intravenous antibiotics will be started immediately after the LP and blood cultures have been obtained. Appropriate isolation needs to be initiated in any child with suspected or diagnosed bacterial meningitis.
The nurse has applied EMLA cream as ordered. How does the nurse assess that the cream has achieved its purpose?
Lightly tap the area where the cream is. ***The nurse should verify that sensation is absent by lightly tapping or scratching the area.
Newborn screening client education by developmental level
Ongoing collection of skilled observations made over time -Noting and addressing parental concerns -Obtaining a developmental history -Making accurate observations -Consulting with relevant professionals Are brief assessment that identify children who warrant more attention Development is a longitudinal process
murmurs
Patent ductus arteriosus (PDA) ➢Harsh, continuous, machine-like murmur under left clavicle
The nurse is caring for a 2-year-old girl with persistent otitis media with effusion. Which intervention is most important to the developmental health of the child?
Reassessing for language acquisition ***Reassessing for language acquisition would be most important to the health of the child. There is a risk of otitis media with effusion causing hearing loss, as well as speech, language, and learning problems. P
The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find?
Ring-like rash on lower leg ***A ring-like rash at the site of the tick bite is characteristic for Lyme disease.
The nurse is preparing to administer a topical anesthetic for a 10-year-old girl with a chin laceration. The nurse would expect to apply what as ordered in preparation for sutures?
TAC (tetracaine, epinephrine, cocaine) **TAC (tetracaine, epinephrine, cocaine) is commonly used for lacerations that require suturing. The agent can be applied directly to the wound with a cotton ball or swab for 20 to 30 minutes until the area is numb.
Consent forms
The decision maker (person who consents) must be of legal age in that state, with full civil rights and be competent Information in the consent form must be simple, concise, appropriate to the level of education and language of the decision maker Decision to participate must be voluntary, without coercion, force, or influence of duress Have a witness to the process of obtaining informed consent Have that witness sign the consent form
Teaching School age Children:
Unless extremely ill - they want to participate in their care Need to cooperate and achieve (Industry vs. shame) Teach together with the parents
CHD
accounts for the largest per structural anomalies that are present at birth CHD accounts for one percent of all birth defects CHD is classified based on the hemodynamic characteristics Disorders with decreased pulmonary blood flow •Tetralogy of Fallot •Tricuspid atresia Disorders with increased pulmonary blood flow •Patent ductus arteriosus (PDA) -Harsh, continuous, machine-like murmur under left clavicle •Atrial septal defect (ASD) •Ventricular septal defect (VSD) Past Health History - for all CHD Problems occurring after birth Congenital malformation Birth history (any NICU stays?) Frequent infections Chromosomal abnormalities Prematurity Autoimmune disorders Use of medications, such as corticosteroids *failure to thrive > feeding habits
While caring for a hospitalized child, the nurse notes the father does not take into consideration the wishes or opinions of the child. During a period of discussion the father explains to the nurse that he feels his child is best served having clearly outlined rules and expectations. This is most consistent with which style of parenting?
authoritarian
DL: preschoolers
better verbal and developmental skills; interpret words literally and have an active imagination; egocentric
The nurse obtains a nutrition history for a school-age child. The parent indicates the child's favorite beverage is apple juice and consumes three large glasses per day. The mother asks if this is a good thing.Which of the following would be the best response for the nurse to reply to the mother?
Apple juice has quite a bit of sugar and no fiber. Could you substitute an apple for one of those servings?