Peds Exam 2
Which of the following actions would be expected by a nurse caring for a child post-tonsillectomy? Multiple Answer: Select all that apply. A. Position to facilitate drainage of secretions. B. Encourage coughing to clear secretions. C. Observation of the throat using a tongue blade. D. Notify the surgeon if frequent swallowing is noted.
A and D
Which statement is incorrect? A. CSF flows around the brain and spinal cord, acts as a cushion, and removes waste B. Absorption of CSF should be faster than the rate of production C. The Monro-Kellie Doctrine is a compensatory pressure mechanism of the brain, CSF, and intracranial blood D. Cushing's triad of increased ICP includes bradycardia, HTN, and slow irregular shallow respirations
B
You are caring for a 7-year-old boy who returned from surgery 6 hours ago. He has a cast on his right leg for a fractured right femur. He is complaining of increased pain, even after receiving IV Morphine 30 minutes ago. Your first action is to: A. Reposition and reassess after one hour. B. Do a complete neurovascular assessment. C. Turn on the child's favorite movie to help distract him from his pain. D. Let the medication work a little longer. Recheck child in another 30 minutes.
B
A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic (spinal brace). The patient asks how long she will have to wear the brace. The appropriate answer is: A. For as long as you have been told. B. It will be necessary to wear the brace for the rest of your life. C. Until your vertebral column has reached skeletal maturity. D. Most preadolescents use the brace for 6 months.
C
After the series of manipulation and casting is complete for an infant with clubfoot, parents ask the nurse why their infant now must wear the braces. What is the nurse's best response? A. "The Ponseti technique of serial casting and manipulation was unsuccessful in treating the clubfoot" B. "The braces prevent the need for long-term interval follow-up if worn until your infant reaches skeletal maturity" C. "While the casting corrected the deformity, the braces maintain the correction."
C
In an 8-month-old infant admitted with pertussis, the nurse should particularly assess the: A. Living conditions of the infant B. Alcohol and drug intake of the mother C. Immunization status of the infant D. Labor and delivery history of the mother
C
Parents of a child with JIA call the clinic because their child is having an acute exacerbation of the disease.You provide what education about ROM exercises of the affected area? A. "Avoid all ROM exercise during painful periods" B. "ROM exercises must be performed every day" C. "Have your child complete simple isometric exercises or tensing exercises" D. "Administer additional pain medication before completing ROM exercises"
C
The nurse is caring for an immobilized preschool child. Which of the following is MOST helpful for socialization during this period of immobilization? A. Let child have few behavioral limitations. B. Keep child away from other immobilized children if possible. C. Take child for a "walk" by wagon outside the room. D. Encourage wearing pajamas.
C
The nurse should know that Lyme disease is which of the following? A. Very difficult to prevent B. Easily treated with oral antibiotics in stages 1, 2, and 3 C. Caused by a spirochete that enters the skin through a tick bite D. Common in geographic areas where the soil contains the mycotic spores that cause the disease
C
The typical treatment plan for Legg Calve Perthes Disease (LCPD) includes which of the following? A. Traction and corticosteroids B. Four to six weeks of IV antibiotics C. Physical activity restrictions D. Immediate surgical correction
C
Treatment for Atopic Dermatitis includes which of the following? A. Oral corticosteroids B. Topical anti-fungal C. Emollient therapy D. Topical or systemic antibiotic
C
Which of the following responses demonstrates that further education is needed for a parent regarding their child with tinea capitis? A. We should have our dog checked by the veterinarian if areas of fur loss and itching are noted. B. Treatment needs to continue even after the lesions appear to have resolved. C. If treatment with an oral anti-fungal agent is effective, lesions should resolve with-in two weeks. D. Everyone in the family will need to be treated.
C
Which order for a child with a basilar skull fracture should be questioned? A. Obtain a daily weight B. Provide clear liquid intake C. Nasotracheal suction as needed D. Maintain a patient intravenous line
C
Which statement requires further education? A. The scoliosis brace prevents further spinal curvature and can be removed for bathing and physical activity events B. Shortened limb on affected side, unequal gluteal folds, and positive Barlow or Ortolani tests are signs of developmental hip dysplasia C. Treatment of Legg-Calve-Perthes disease(LCPD) requires surgical pinning of the femoral head
C
A corticosteroid has been ordered to treat inflammation in a child with Juvenile Idiopathic Arthritis. Which of the following is an important part of education for parents related to this medication? A. Child's height will increase if on this medicaiton for an extended period of time. B. Inflammation will decrease within 1-2 days C. Child will not run a fever while on this medication. D. Do not discontinue the medication abruptly.
D
At what age does Acne Vulgaris tend to cause the most infection? A. 3-5 B. 1-7 C. 6-9 D. 11-15
D
Cellulitis is often caused by A. herpes zoster. B. Candida albicans. C. human papillomavirus. D. streptococci or staphylococci.
D
Education for the prevention or treatment of fungal infections include all statements except? A.Check on and change soiled diapers regularly B.Oral nystatin is used for those with oral candidiasis C.Bottles can be a vehicle for candida and so should be disinfected between use D.After using an inhaled corticosteroid inhaler, water should be swished and swallowed E.Animals and their owners should be treated for tinea corporis infections to prevent recurrence
D
The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as which of the following? A. Eye trauma B. Indication of brain death C. Severe brainstem damage D. Neurological emergency
D
What type of medication base absorbs into the skin quickly and is non-greasy? A. Gels B. Pastes C. Ointments/oils D. creams/ lotions
D
Which of the following is considered a prevention strategy for otitis media? A. Encourage pacifier use. B. Exposure to second hand smoke. C. Feed infants in a side-lying position. D. Exclusive breast-feeding until at least 6 months of age
D
Which treatment statement for bacterial skin infections requires additional education? A."Impetigo is extremely contagious" B."If untreated with antibiotics, the cellulitis infection could cause sepsis" C. "The first-line treatment for impetigo is mupirocin (Bactroban), an antibiotic ointment" D."Topical and oral acne treatments are safe during pregnancy and when trying to conceive"
D
You are developing a nursing care plan for a child with acute bacterial meningitis.Based on the mode of transmission, which precautionary intervention would be included? A. Maintain enteric precautions B. Maintain neutropenic precautions C. No precautions are necessary if antibiotics have been started D. Maintain respiratory isolation precautions for at least 24 hours after antibiotics have been started
D
what type of babies is diaper dermatitis typically seen in?
"easy" tempermant
What is diaper dermatiis treatment?
1. remove offending agent 2. improve diaper practices 3. barrier ointment * fragrance may be irritating
What is the treatment for contact dermatitis?
1: Remove offending agent 2: Supportive treatment if needed -For pain/discomfort =Topical anesthetics -For weeping lesions =Drying agents/powders -For pruritus =Topical hydrocortisone =Oral steroids =Pramoxine (Calamine lotion)
Which of the following lesion(s) is consistent with the diagnosis of Impetigo? A. honey-colored crusts B. confluent pink macules C. erythemic areas of excoriation D. itchy brown patches
A
What is unique about pediatric burn injuries? Select all that apply. A. skin is thinner B. possible growth delay C. mature immune system D. high proportion of fluid to mass
A, B, D (higher risk for cv problems)
A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. The most appropriate initial action by the school nurse is which of the following? A. Stay with the child and make sure emergency medical services are called so the child can be evaluated. B. Notify parents and child's primary care provider. C. Notify parents that the child should be taken home to rest. D. Stay with child until they stablize, then have child return to class
A
A characteristic sign/symptom of atopic dermatitis is: A. Pruritis B. Fever C. Erythema migrans D. Vesicle eruptions
A
A child has a seizure disorder that consists of multiple staring spells throughout the day. Which of the following seizures types is this description most consistent? A. Absence seizures B. Tonic-Clonic Seizures C. Myoclonic seizures D. Atonic Seizures
A
A toddler has their first seizure at home and the parents call 911. In the emergency department after a full evaluation, the child is diagnosed with a febrile seizure. Which of the following interventions does the nurse prioritize? A. Parental reassurance B. Education about anti-epileptic drugs C. Preparing the child for an IV start for fluid administration D. Preparing the family for hospital admission
A
One of the reasons infants with an upper airway infection are at increased risk for respiratory distress while feeding is: A. They are obligatory nose breathers B. Their taste buds are affected so they don't want to eat. C. They probably have a fever so they are not hungry. D. They are not feeling well so they don't want to eat.
A
Parents bring a 7-year-old to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. The PRIORITY INITIAL nursing action is: A. Calmly ask the child to point to where the pain is worst and to wiggle fingers. B. Send the child to radiology so that an x-ray film can be taken. C. Initiate an intravenous line and administer morphine for the pain. D. Have the parents hold the child so that the nurse can examine the arm thoroughly.
A
The parent of a 3-year-old arrives at the clinic and tells the nurse that their child has been scratching continuously. Which assessment finding is most consistent with scabies? A.Fine grayish red lines between the fingers B.Erythematic edematous honey-crusted lesions on the face C.Flesh-like or pink papules with white central exudate on the torso D.Red to brownish-gray patches and papules with thickened skin on the neck
A
The two main physiological responses that cause the symptoms in asthma are: A. Bronchospasm and inflammation/edema of mucous membranes in small airways B. Infection and inflammation of the upper airway C. Bacteria invasion leading to swelling and inflammation D. Edema and accumulation of the mucus and cellular debris leading to obstruction of the bronchioles
A
What immunization would be recommended for the primary prevention of epiglottitis? A. Hib (Haemophilus Influenzae type B) B. Rotavirus C. Hepatitis B D. MMR (Measles, Mumps and Rubella)
A
Which of the following conditions is associated with spina bifida? A. Hydrocephalus B. Plagiocephaly C. Iron Deficiency Anemia D. Legg Calve Perthes Disease (LCPD)
A
What are some early signs of lymes disease? (3-31 days) a. fever b. erythema migrans rash c. neck stiffness d. paresthesia
A, B
Which of the following recommendations should be included with providing education about acne management? Please select all that apply. A. Avoid oil-based skin care products B. Picking pimples can make them worse C. There are no concerning side effects with OTC acne products D. Accutane is a common drug that is used for most types of acne
A, B
Who is at risk for contracting tinea corporis? Select all that apply. A. A child petting a dog B. A child playing football C. A child building a sand castle
A, B
What are some late signs of lymes disease? a. joint pain b. severe HA c. chest pain d. memory problems
A, B, C, D
What type of medications are used for Cellulitis treatment? Select all that apply. A. Steroids B. Analgesics C. Prostaglandins D. Antibiotics
A, B, D
Which items should every patient with asthma should have? SELECT ALL THAT APPLY A. Asthma Action Plan B. SABA-2 inhaler or nebulizer solution C. Inhaled corticosteroid inhaler or nebulizer solution D. Peak flow meter
A, B, D
Which of the following are clinical manifestations of increased intracranial pressure in children? SELECT ALL THAT APPLY A. High-pitched cry B. Sunken fontanel C. Diplopia, blurred vision D. Headache
A, C, D
Which interventions should the nurse caring for an infant with RSV include in the plan of care? SELECT ALL THAT APPLY A. Place infant in private room B. Prepare for antibiotic administration C. Position infant so their neck is slightly extended D. Place infant in a tent that delivers cool, humidified airE. Wear a mask, gown, and gloves when in contact with the infant
A, C, D,E
The nurse is creating a care plan for a child whois at risk for seizures. Which interventions apply if the child has a seizure? SELECT ALL THAT APPLY A. Time the seizure B. Restrain the child C. Insert padded tongue blade into child's mouth D. Place the child in a prone position E. Move nearby furniture away
A, E
What statement requires more teaching? A. Topical corticosteroids should be used for at least 10 days for best anti-inflammatory treatment. B. Topical corticosteroids can be applied directly to lesion. C. Topical corticosteroids can lead to resistance and thinning of skin if used for more that 5-7 days.
A.
Which of the following is usually the only symptom of pediculosis capitis (head lice)? A. Pruritus (Itching) B. Vesicles C. Scalp rash D. Localized inflammatory response
A.
Which of the following is a physiologic effect of immobilization on children? A. Circulatory stasis can lead to thrombus and embolus formation. B. Metabolic rate increases. C. Bone calcium increases, releasing excess calcium into the body (hypercalcemia). D. Venous return improves, since child is in supine position.
A. The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi.
What are some bacterial skin infection causes? select all that apply. A. Cellulitis B. Impetigo C. Acne D. HPV E. Candida
A. Cellulitis B. Impetigo C. Acne
The nurse is doing a neurologic assessment on a 1-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest which of the following? A. Expected on neurologic assessment for this age B. Severe brain damage C. Decorticate posturing D. Decerebrate posturing
A. These are the three reflexes that are present in a healthy 2-month-old infant.
A 5-year-old presents to the ED after they fell offa bunk bed. A head injury is suspected. Which isa late sign of increased intracranial pressure? A. Nausea B. Irritability C. Headache D. Bradycardia
D
A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? A. Foreign body in trachea B. Bronchiolitis C. Pneumonia D. Asthma
D
What are important education topics surrounds Isotretinoin?
Accutane is teratogenic -monthly pregnancy tests -2 forms of birth control -suicidal ideation
A child is diagnosed with Reye's Syndrome and is admitted. Which nursing intervention should be implemented? A. Assess skin for rash B. Monitoring urine output C. Changing body position every 2 hours D. Providing a quiet atmosphere with dimmed lighting
D
Which of the following statements best describes a subdural hematoma? A. Bleeding occurs between the dura and the skull. B. Bleeding occurs between the dura and the cerebrum. C. Bleeding is generally arterial, and brain compression occurs rapidly. D. The hematoma commonly occurs in the parietotemporal region.
B
A school-ager with a painful, erythematous lesion with purulent drainage of the left knee is in the emergency department. The lesion is diagnosed as cellulitis. Which of the following provider orders takes priority? A. Daily weights and strict I & O B. Bacterial wound culture, CBC with diff/plt, CRP, ESR C. Left Knee MRI with and without contrast D. Wound cleanse and non-adherent dressing application
B
Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is which of the following? A. Hypoactivity of autonomic nervous system B. Mechanical obstruction caused by increased viscosity of mucous gland secretions C. Hyperactivity of sweat glands D. Atrophic changes in mucosal wall of intestines
B
In which of the following conditions do you expect the child to be in contact precautions? A. Cystic Fibrosis B. RSV C. Pneumonia D. Asthma
B
Of the following children, the one who is most likely to be hospitalized for treatment of croup is: A. A 3-year-old with nasal discharge and fatigue B. A 1-year-old using accessory muscles to breathe (retractions) C. A 4-year-old child with a temporal temperature of 100 F D. A 2-year-old child whose barky croupy cough worsens at night
B
TRUE or FALSE: All acute otitis media (AOM) infections are bacterial and require antibiotic treatment A. TRUE B. FALSE
B
The nurse plans to assess a child in the emergency department. The child has rapid respirations, retractions, is sitting in a tripod position, and is drooling. Examining the child's throat using a tongue depressor might precipitate which of the following? A. Sore throat B. Complete obstruction C. Inspiratory stridor D. Respiratory tract infection
B
The nurse uses the five Ps to assess ischemia in a child with a fracture. Which of the following findings is considered a late and ominous sign? A. Petaling B. Paresthesia C. Posturing D. Positioning
B
What is a prevention strategy for molluskum contagiosum? A. sharing towels B. Avoid scratching C. cryotherapy
B
Which of the following is characteristic of fractures in children? A. Pliable bones of growing children are less porous than those of the adult. B. Rapidity of healing is inversely related to the age of the child. C. Fractures rarely occur at the growth plate site because it absorbs shock well. D. Periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared with the adult.
B
Which of the following is the best recommendation to prevent mosquito bites in children? A.Use insect repellent with less that 50% DEET as primary ingredient B.Wear long sleeves, pants and hats when possible C.Avoid time outdoors in summer evenings
B
Which of the following interventions are appropriate to use when caring for a newborn with unrepaired myelomeningocele? SELECT ALL THAT APPLY A. Follow the 'back to sleep' guidelines to prevent SIDS B. Ensure the myelomeningocele is regularly moistened with sterile Normal Saline C. Avoid diapers on top of the affected area D. Apply hydrogen peroxide to the skin surrounding the myelomeningocele E. Provide all nutrition intravenously
B, C
What are the stages in order with Impetigo? A. honey colored crust B. pruritic erythematic edematous lesion C. vesicle with surrounding erythema D. Vesicle bursts
B, C, D, A
RN is providing education to an adolescent girl with mild acne. Which of the following points are appropriate to include? SELECT ALL THAT APPLY A. Use oil-based moisturizers when possible B. Benzyl peroxide containing products can cause some drying of skin C. Try to wash your face gently twice daily D. Avoid sunscreen as it can occlude pores E. Picking the pimples can lead to more skin irritation and redness
B, C, E
What are fungal skin infection causes? Select all that apply. A. HPV B. Candida C. Impetigo D. Tinea Corporis
B, D
Which cast care instructions should be included for a child with a plaster cast of the left forearm? SELECT ALL THAT APPLY: A. Use fingertips to lift cast while it is drying B. Keep small toys and sharp objects away from the cast C. Use a padded ruler to scratch under the cast D. Elevate the extremity for the first 48 hours after casting to reduce swelling E. Contact the health provider if any of the 5Ps develop
B, D, E
What are some viral skin infection causes? Select all that apply. A. Acne B. Mulluscum Contagiosum C. Candida D. HPV E. Tinea Corporis
B, and D
A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures, and antimicrobial agents. The nurse knows that antibiotic therapy should begin: A. Once the diagnosis is confirmed. B. Blood labs had been drawn and antibiotic medication is delivered to unit. C. After the child's fluid and electrolyte balance is stabilized. D. As soon as the practitioner is notified of the culture results.
B.
At an appointment for a routine physical exam for her 5-year-old child, a parent mentions "it seems like the kids frequently have warts (human papillomavirus), is there anything we can do"? The nurse correctly replies: A. No, this is common in childhood and there is no way to prevent the spread. B. Hand washing is an important component of reducing the spread. C. Yes, over the counter emollients applied to the wart can help reduce the spread. D. Yes, use of adapalene (Differin) by all family members will help reduce the spread.
B.
To help prevent the development of oral candidiasis (thrush), the nurse should educate which of the following? A. Do not rinse mouth after use of an inhaled corticosteroid inhaler. B. Rinse and spit out water after use of an inhaled corticosteroid inhaler. C. Brush and floss teeth twice daily. D. Do not use a short-acting beta-2 antagonist (bronchodilator) inhaler and an corticosteroid inhaler in the same day.
B.
What is the treatment for Impetigo? A. Treintoin B. Topical Anitibitics C. Steroids D. Oral antibiotics
B. D Mupiroicin D: widespread infection
What are three main types of HPV warts?
Common, plantar, Flat
11. Which of the following is the best description of diaper candidiasis? A. Generalized erythemic vesicles and bullae B. Confluent flesh-colored macules and papules C. Pink scales and patches with areas of excoriation D. Confluent erythemic papules with satellite lesions
D
The nurse is monitoring a child with a burn injury. Which assessment provides the most appropriate guide to determine the adequacy of fluid resuscitation? A.Skin turgor B.Level of edema at burn site C.Capillary refill D.Oral fluid intake in 24 hours
C and urine output monitoring
A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action should be which of the following? A. Place on side. B. Take blood pressure. C. Stabilize neck and spine. D. Check scalp and back for bleeding.
C.
Parents bring their child to an outpatient clinic. The child is seated in a tripod position and appears to be drooling. They had a sudden onset of sore throat with dysphagia, dyspnea, and dysphonia.What is the priority nursing intervention? A. Inspect the throat and obtain throat swab B. Establish a peripheral IV for an antibiotic infusion C. Contact emergency medical services for transport to emergency department
C. CALL EMS!
Lyme Disease is caused by which of the following? A. Virus B. Fungus C. Parasites D. Bacteria
D. bacteria
A child has a right femur fracture and is placed in skin traction until surgery can be performed.The nurse notes an absent dorsalis pedis pulse.Which action should be completed first? A. Administer an analgesic B. Release the skin traction C. Apply ice to the affected extremity D. Notify the provider
D. notify provider
How long does it take for a child to recover from a concussion?
Depends* NO SPECIFIC TIME
How do you prevent the spread of impetigo?
Handwashing and keep child home for 1st 24 hours with treatment
What is Pediculoisis capitus treatment?
LICE *wash clothes and bedding on hot *Vacuum * Topical antilice shampoo *Lice comb for manual removal
What is the most important part of a neuro assessment?
LOC or behaivor changes
What is the treatment for scabies?
Permetherin cream: over 2 months of age Oral scabicide (ivermectin): severe cases and kids >15kg
What is the treatment for atopic dermatitis?
Reduce itching* daily bathes w/ oatmeal moisture/creams steroids allergy management
Fever is a common symptom in osteomyelitis, TRUE or FALSE? True False
True
James is a 16-month-old hospitalized after a 5-day course of worsening symptoms of an infection affecting both the upper and lower airway due to RSV. He is being admitted to the hospital as his symptoms worsen. What signs and symptoms would an infant have that is sick enough to be admitted to the hospital with RSV? 1. Vital signs - What are expected values for a healthy 16-month-old? What might VS before this sick child? 2. Breathing - What is the rate, pattern, lung sounds, visual appearance of breathing? 3. General physical appearance? 4. Other signs? 5. Psychosocial?
VS: RR increased, HR increased, o2 down, rapid then slowing, diffuse crackles (rhales), retractions, irritable
How is an NG tube placed in a child with battle signs and raccoon eyes?
With imaging!
James was admitted earlier today with a diagnosis of RSV. He continues with his initial presentation despite humidified O2, IV fluids and steroids.VS 1 hour ago (created per previous slide: 101.9 F, HR 136, RR 34) His Mom notes that she is relieved that he is quieter.Your thoughts? Your next actions?
Worst possible outcome: death; becomes lethargic
What are some treatments to consider after an animal bite?
antibiotics, rabies shot, tetanus booster, wound care, provider visit for severe bite
What type of pneumonia is worse? bacterial or viral?
bacterial abrupt, high fever, retractions
What are some considerations with a human bite?
blood bourne pathogens exposure, such as hepatits, or HIV
Is coup and contrecoup secondary or primary injury?
both primary
What is a secondary injury?
complication of primary injury
Lice infestations are related to socioeconomic status. True false
false
What are some HPV prevention stratgies?
handwashing, avoiding skin to skin with infected
What is the most serious concern you would have for a patient post-tonsillectomy?
hemorrhage
Where does candidiasis tend to grow best?
moist area
What do you do with insect bites?
monitor and cleanse site
What do you do with insect stings?
remove stinger without tweezer, epipen?
What is a primary injury?
time of initial injury