PEDS

A child is to be admitted to the orthopedic unit following a Harrington rod insertion for the treatment of scoliosis. The nurse is assisting in preparing a plan of care for the child. The nurse plans to monitor which priority item in the immediate postoperative period?

*Capillary refill, sensation, and motion in all extremities* When the spinal column is manipulated during surgery, altered neurovascular status is a possible complication; therefore, neurovascular assessments including circulation, sensation, and motion should be done every 2 hours.

A 3-year-old child has returned to his room following a tonsillectomy. Which finding needs immediate notification of the registered nurse?

*Nasal flaring and rib retractions*

The nurse is reviewing the health record of a child with a diagnosis of celiac disease. Which clinical manifestation should the nurse expect to note documented in the health record?

*Profuse watery diarrhea and vomiting* Celiac disease causes profuse watery diarrhea and vomiting

The nurse reinforces home care instructions to the parents of an infant following surgical intervention for imperforate anus and tells the parents about the procedure for anal dilation. Which statement by the parents indicates the need for further teaching?

*"I will insert a glycerin suppository before the dilation."* Following this surgery, anal dilation at home by the parents is necessary to achieve and maintain bowel patency. Inserting a glycerin suppository before dilation is not a component of this procedure.

The mother of a child who had a myringotomy with insertion of tympanostomy tubes calls the nurse and tells the nurse that the "tubes" fell out. The nurse should make which response to the mother?

*"This is not an emergency. I will speak to the health care provider and call you right back."* The size and appearance of the tympanostomy tubes should be described to the parents following surgery. They should be reassured that if the tubes fall out, it is not an emergency but that the health care provider should be notified. The tubes cannot be replaced without surgical intervention.

The nurse is preparing to feed a 1-year-old hospitalized child. The nurse prepares the amount of formula to be given to this child, knowing that generally a 1-year-old consumes approximately which amount?

*175 mL per feeding* A 1-year-old child consumes approximately 175 mL (6 ounces) of formula per feeding.

Which test would the nurse anticipate for a teenage client who has been treated for vaginal Candida infections repeatedly in the last 6 months to assist in the identification of the underlying chronic pathology?

*Blood glucose level* A blood glucose level is an indicator of diabetes mellitus. In females, monilial infections of the genitourinary tract are a common symptom of diabetes mellitus. Pap smears are specific for detecting cancer of the cervix. A throat culture may show a candidal infection, but this test is unrelated to an undiagnosed underlying chronic disease. An infection of the blood (diagnosed by a blood culture) is indicative of an acute systemic disease.

The nurse is assisting in preparing a plan of care for a child who will be returning from surgery following the application of a hip spica cast. Which would be the priority action in the plan of care for this child on return from the procedure?

*Check circulation in the feet.* During the first few hours after a cast is applied, the primary concern is swelling that may cause the cast to produce a tourniquet-like effect and restrict circulation. Therefore, circulatory assessment is a priority. Turning the child side to side at least every 2 hours is important because it allows the body cast to dry evenly and prevents complications related to immobility; however, it is not as important as checking circulation.

An infant returns to the nursing unit following surgery for an esophageal atresia with tracheoesophageal fistula (TEF). The infant is receiving intravenous (IV) fluids, and a gastrostomy tube is in place. The nurse assisting in caring for the infant should ensure that which action is done to the gastrostomy tube?

*Elevated* In the immediate postoperative period, the gastrostomy tube is elevated, allowing gastric contents to pass to the small intestine and air to escape. This promotes comfort and decreases the risk of leakage at the anastomosis.

A 3-year-old child has returned to his room following a tonsillectomy. Which finding needs immediate notification of the registered nurse?

*Nasal flaring and rib retractions* Nasal flaring and rib retractions are signs of respiratory distress, a major concern following a tonsillectomy. These signs require immediate notification. The vital signs are normal for a 3-year-old child. Drooling slightly blood-tinged saliva and refusal to take sips of liquids are common after a tonsillectomy.

The nurse assigned to care for a child with mumps is monitoring the child for the signs and symptoms associated with the common complication of mumps. The nurse monitors for which sign/symptom that is indicative of this common complication?

*Nuchal rigidity* The most common complication of mumps is aseptic meningitis, with the virus being identified in the cerebrospinal fluid. Common signs include nuchal rigidity, lethargy, and vomiting. A red, swollen testicle may be indicative of orchitis. Although this complication appears to cause most concern among parents, it is not the most common complication. Although mumps is one of the leading causes of unilateral nerve deafness, it does not occur frequently. Muscular pain, parotid pain, or testicular pain may occur, but pain does not indicate a sign of a common complication.

A child with a diagnosis of pertussis (whooping cough) is being admitted to the pediatric unit. As soon as the child arrives in the unit, which action should the nurse do *first*?

*Place the child on a pulse oximeter.* To adequately determine whether the child is getting enough oxygen, the child is placed on a pulse oximeter. The pulse oximeter will then provide ongoing information on the child's oxygen level. The child is also immediately placed on a cardiorespiratory monitor to provide early identification of periods of apnea and bradycardia. The nurse would then gather data including taking the child's temperature and weight and asking the parents about the child. A - B - C

A nursing student is asked to discuss the pathophysiology related to childhood leukemia during a clinical conference and reviews the planned presentation with the nursing instructor. The nursing instructor advises the student to review the disorder before the clinical conference if the student states that which is associated with this type of cancer?

*Reed-Sternberg cells are found on biopsy.* In leukemia, normal bone marrow is replaced by malignant blast cells. As the blast cells take over the bone marrow, eventually RBC and platelet production is affected and the child becomes anemic and thrombocytopenic. The reticuloendothelial system is affected, thus disturbing the body's defense system and rendering these children unable to fight infections normally. The Reed-Sternberg cell is found in Hodgkin's disease.