peds final
The nurse is preparing to post a sign above the crib of an infant with a Wilms tumor. Which statement should the nurse post?
"Do not palpate abdomen."
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."
normal UOP
1-3ml/kg/hr
nasal cannula
1-6L
The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse?
1-week-old newborn whose oxygenation is not improving with oxygen
non-rebreather
10-16L
fluid requirements
100 mL per kg for the first 10kg 50 mL per kg for second 10kg 20 mL per kg for the remainder of kg Divide total by 24 hours to get mL/hr
A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.
13.3
perrla assesses what cranial nerve
3
A health care provider has prescribed cephalexin 30 mg/kg PO daily in 4 divided doses for a child diagnosed with impetigo. The child weighs 30 lb (14 kg). How many milligrams should the child receive each day?
420
The nurse is administering digoxin as prescribed and the child vomits the dose. What should the nurse do?
Administer next dose as prescribed in 12 hours.
A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm?
Albuterol
The nurse is caring for a 6-month-old with a cleft lip and palate. The mother of the child demonstrates understanding of the disorder with which statements? Select all that apply.
"I know my baby takes a lot longer to feed than most children this age." "It really worries me that my baby may have some other disorders that haven't been detected yet." "I wonder if my baby will develop speech problems when language development begins?" "Thankfully there are doctors that specialize in correcting this type of disorder."
The nurse is working with a group of caregivers of children diagnosed with asthma. Which statement made by a caregiver is most accurate regarding the triggers that may cause an asthma attack?
"My sister and her family love animals, and when we go to their house my daughter always has an asthma attack."
cpr ratio for child
15:2 for 2man
BSA formula
1600ml/m2/day
Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis?
Avoid making noise when in the child's room.
A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions require placing a client in an isolated room with limited access, wearing gloves during contact with the client and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between clients?
Contact precautions
DDST
Denver Developmental Screening Test - describes tasks children should be able to complete
The student nurse is preparing a presentation on ways to prevent medication errors in children. What information should the student include? Select all that apply.
Double-check medication calculations prior to administration. Utilize the Joint Commission's "Do Not Use" abbreviation list. Verify orders for dosages that are unusually large or small. Use 2 client identifiers prior to administering medications.
increased ICP s/s
HA, vomiting
bacterial infections
HIB, pneumococcal conjugate
The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for?
Irritability, fever, and vomiting
Which characteristic is true of cerebral palsy?
It appears at birth or during the first 2 years of life.
Airborne precautions
N95 mask
appendicitis comfort
NG tube, inflammtion of appendix, removal
A 16-year-old boy reports to the school nurse with headaches and a stiff neck. Which sign or symptom would alert the nurse that the child may have bacterial meningitis?
Sunlight is "too bright"
The nurse is caring for a school-age child with reports of generalized joint pain and a pharyngitis. During assessment, the nurse notes a cardiac murmur. Which action by the nurse is priority?
Swab throat for culture.
rescue asthma med
albuterol
erikson school age
industry vs inferiority
stage 5 tanner
mature
stage 4 tanner
projection of areola and nipple - continued penile growth
standard precautions
used for all patients, wash hands, wear gloves
most common IM site for children
vastus lateralis
9m toy
with button and pulls
The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever?
"Children who have this diagnosis may have had strep throat."
The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?
"He likes to stop and squat wherever he walks."
A child has an order for an erythrocyte sedimentation rate (ESR). The child's mother asks what the purpose of the test is. What is the best response by the nurse?
"This test will tell if your child has an infection or inflammation somewhere in their body."
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with asthma. Which statement best indicates an understanding of the management and treatment for this diagnosis?
"We have taken the carpet out of our house and let my mom take our dog."
suck and swallow assesses what cranial nerve
5,7,9,12
Which assessment finding by the nurse would warrant immediate action?
A child with periorbital cellulitis reports changes in vision and pain with eye movement.
wilms tumor s/s
HTN, abd pain, pallor, cough, chest pain, abd pain, abd mass, hematuria
A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?
Peeling hands and feet; fever
The nurse is providing staff education regarding the use of the BroselowTM tape for pediatric emergencies. What would the nurse include in the education plan?
The tape is useful to estimate the child's weight based on the length.
The nurse is teaching a growth and development class to parents of school-age children. What does the nurse teach the parents about the cognitive abilities of their children?
They are able to classify objects.
The nurse has received the morning report on a group of pediatric clients. Which pediatric client will the nurse see first?
a child reporting dark brown urine and a fine sandpaper rash
cerebellar effcts
ataxia, weakness, paresis, loss of motor control, ^BP, decreased HR and RR, unstable temp
increased pulmonary BF
atrial septal defect, ventricular septal defect, patent ductus arteriosis, atrioventricular canal defect
obstruction to BF TX
cardiac cath, risk for valve replacement, endocarditis prophylaxis.
cytotoxan
cause hemorrhagic cystitis
vincristine
causes constipation, may cause foot drop
polycythemia
increased RBC - CVA risk
infratentorial brain tumor post op
lie flat, side-lying, keep head and neck midline
iron deficient anemia labs
low HGB HCT, FE and feritin
8y toy
nerf gun
Hirchsprung's disease
obstruction due to inadequate motility
A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. Which room is appropriate for this infant?
private room near the nurses' station
HLHS, transposition TX
shunt
mixed BF
transposition of great arteries/vessels, truncus arteriosis, HLHS
hypotonic
treats cellular dehydration - 1/2 NS
surgical shunt
tricuspid atresia TX
birth-1y erikson
trust vs mistrust
comfort care measures
tylenol, med admin, topical
duchene MD
x-linked recessive
face mask
5-10L
acetaminophen tox
>150mg/kg
Which collaborative action(s) will the nurse perform when caring for an infant with transposition of the great arteries scheduled for surgical repair of the defect? Select all that apply.
Provide education to the parents. Auscultate lung sounds frequently. Apply a continuous pulse oximeter. Keep oxygen saturation above 80%.
The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which test as most helpful in determining the extent of the child's hypoxia?
Pulse oximetry
decreased pulmonary BF s/s
TET spells, cyanosis, tachycardia, dyspnea, clubbing
The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this?
The boy rises from the floor by walking his hands up his legs.
A 16-year-old child is admitted to the hospital for treatment after a motor vehicle crash. Review of the child's record reveals that the child is an emancipated minor. What does this mean?
The child has the legal right to consent to and make decisions for treatment.
When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding?
The liver size increases in right-sided heart failure.
down syndrome
The most common chromosomal abnormality, causing mental retardation, susceptibility to heart disease, and other health problems; and distinctive physical characteristics, such as slanted eyes and stocky build.
tumor lysis syndrome
USG 1.003, potassium of 5.6, decreased calcium
A health care provider and other health team members are discussing congenital heart disorders that increase pulmonary blood flow. Which disorders are topics for this discussion? Select all that apply.
Ventricular septal defect Patent ductus arteriosus Atrioventricular canal defect
Which nursing intervention(s) are appropriate for the plan of care designed for a child diagnosed with hemophilia who is experiencing an episode of active bleeding? Select all that apply.
administering acetaminophen as prescribed for pain applying splints to extremities scheduling physical therapy for 48 hours after bleeding stops encouraging self performance of active range-of-motion exercises
leukemia drugs
allopurinol, neupogen, epogen, zofran, corticosteroids, cytosine, arabinside, doxorubicin
leukemia s/s
anemia, bruising, recurrent URI, bone pain, fever, abd pain, pancytopenia
Cystic fibrosis is an example of which type of inheritance?
autosomal recessive
A child being treated for leukemia is diagnosed with neutropenia. What nursing instructions directly prevent client infections? Select all that apply.
avoid large crowds inspect the skin dialy for scratches or scrapes remove house plants, flowers and goldfish from the hme environment stay away from people who have obvious colds, rashes or other infections
systolic murmur
best heard over 3rd and 4th intercostal and L sternal border
Allupurinol
blocks uric acid formation, treat TLS
how to get child to take a deep breath
blow out pen light
mononucleosis
contact, fatigue, malaise, fever, abd pain, anorexia - avoid contact sports - +epstein barr
8-12m cognitive
coordination of secondary schemes
obstruction to BF s/s
cyanosis, murmur, fatigue, SOB
hypothyroidism
decreased T3, T4
VSD repair
defect between ventricles is patched to keep blood from going to lungs, pressure gradiant shunt improved to right ventricle
The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition?
degeneration of muscle fibers
burns risk
dehydration, infection, pain
lasix
diuretic of choice - monitor for dehydration
celft lip post op
elbow restraints, elevate HOB, no shaprs, supine, dont lay on operative side
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:
epiglottitis.
communicable diseases
erythma infectiosum, impetigo
TEF (Tracheoesophageal Fistula)
failure of esophagus to develop
Hirchsprung's disease signs
failure to pass meconium, FTT
colic
feeding and crying disorder
trasfusion reactions
fever, chills, low back pain, tachycardia, hypotension, tachypnea, shock, flushing, wheezing, dyspnea, NV, headache, JVD
meningitis s/s
fever, increased ICP, kernig and brudzinski, photophobia, rash
VP shunt s/s of infection or blockage
fever, malaise, ^WBC, CSF bacteria, low glucose, nuchal rigitity
croup s/s
fever, resp failure, seal cough
asthma prevention
flovent, advair, pulmicort
burns dietary
fluids and increased protein
11-adult cognitive
formal operationla thought
how to confirm NG placement
gastric secretion w/ PH of 5, abd xray, listen for aspiration of air
contact precautions
gown and gloves
The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?
head trauma
cleft lip follow up
hearing, speech, sinus, dental
viral infections
hep a-e, roseola, erythema infectiosum, pharyngitis
s/s right sided HF
hepatosplenomegaly, ascites, JVD, weight gain
methotrexate
high dose can be lethal, may require antidote
neuroblastoma s/s
racoon eyes, supraorbital ecchymosis
cognitive birth-1m
sensorimotor
A nurse is caring for a newborn with congenital heart disease (CHD). Which finding would the nurse interpret as indicating distress?
subcostal retraction at the time of feeding
SCD crisis s/s
sudden headache, impaired speech, decreased arm movement
dehydration s/s
sunken eyes, absence of tears
why do TEF patients have GT tube
surgery is done in steps, this allows nutrition
cancer treatment
surgery, radiation, chemo, corticosteroids
Droplet precautions
surgical mask, gown, gloves
The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client?
tachycardia
glomerulonephritis
tea colored urine, ^BP, edema
roseola s/s
temp, pinkish flat rash
gowers sign
tests for MD, showing weak muscles
blalock taussig shunt
tetrology of fallot TX
The nurse is caring for a 12-year-old with cerebral palsy who is unable to communicate verbally. Which pain assessment tool is the most appropriate for the nurse to use when assessing pain in this client?
Face, leg, activity, cry, and consolability (FLACC) descriptors
A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia?
Increased RBC
A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority?
Maintaining fluids through an intravenous line
A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which would the nurse instruct the parents to administer orally?
Pancreatic enzymes
Parents are told their infant has a hypoplastic left heart. How would the nurse explain this condition to the family?
This is a problem where the left side of the heart did not develop properly.
ondansetron
give before chemo
iron deficient anemia s/s
underweight, milk baby, irritable, fatigue, innocent mumur
increased pulmonary BF s/s
wet lungs, cough, wheezing, abc breath sounds, SOB, tachypnea, poor feeding, FTT, poor wt gain, fatigue, possible murmur
when to administer oxygen
when sat is below 90
hemophilia
x-linked gentic disorder - female carrier, male effected
While assessing a neonate with a ventricular septal defect (VSD), the nurse notes crackles and retractions. The nurse obtains the following vital signs: temp 100.2°F (38°C), pulse 134 bpm, respirations 64 breaths/minute, oxygen saturation 97% on room air. What will the nurse do first?
Give furosemide intravenously.
A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta?
Pulses weaker in lower extremities compared to upper extremities
A 6-month-old boy is brought to the doctor's office with a high fever. The physician diagnoses the child as having a viral infection of some kind and recommends acetaminophen to reduce the fever. After 3 days, the mother returns with the child. The fever is gone, but a rash of discrete, rose-pink macules approximately 2 to 3 mm and flat with the skin surface appears. Which condition should the nurse suspect?
Roseola
To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups?
Teach injury prevention and proper safety practices.
beta thealassemia CM
anemia, pallor, poor feeding, bronzed freckles complexion, enlarged spleen/liver
periorbital cellulitis intervention
antibiotics and anelgesics
interventions for colic baby
assess, movement, alternate positions, reduce stimuli, alter intake
scoliosis
asymmetry of shoulders
neupogen
bone marrow stim
stage 3 tanner
breast buds form to mounds and pubic hair is scant
hemoptysis in CF
complication of coughing up blood from lungs
CAB
compressions, airway and breathing
7-11 cognitive
concrete operational
4y toy
connect 4
Priority in vasoocclusive crisis
hyhdration
adolescence erikson
identity vs role confusion
erikson preschooler
initiative vs guilt
iron deficient anemia TX
intake more iron
varicella s/s
macules, papules, vesicles, crusts
rights of med admin
med, patient, time, route, dose
DDAVP
monitor UOP, anti-diuretic hormone
mixed BF s/s
murmur, cyanosis, clubbing, CHF, ashen skin
FTT nonorganic
not due to medical issues
acne aggravating factors
oily hair, oil-based makeup, hands on face, heredity, stress
strabismus
one eye deviated
stage 2 tanner
onset of puberty - breast buds and pubic hair
intussusception s/s
pain, currant jelly stool, sausage-shape mass in intestine
rheumatic fever
results from not completing strep antibiotics
The nurse is positioning an infant who has just had his left-sided cleft lip repaired. What positions are acceptable for this infant? Select all that apply.
right side-lying supine
Hirchsprung's disease TX
saline enema, high calorie diet, low fiber -- colostomy care
common rashes
scarletina - sandpaper, MMR - measles, rubella - discrete, varicella - centripetal, shingles - vesicular, erythema infectiosum - lacy
4-8m cognitive
secondary circular reactions
The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for:
seizures.
A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits?
semi-Fowler
child with recurrant ear infections
should be screened for hearing loss
decreased pulmonary BF TX
shunt
6-7m social interaction
sits erect, bounces when held, transfers objects between hands
36m toy
small building blocks
3m toy
small teething ring
Asthma triggers
smoke, fumes, strong odor, pet dander, exercise, hormones, URI, allergies
The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as:
spastic.
neutropenia precautions
strict hand washing - avoid ill people, large crowds, raw veggies, live plants
A child enters the acute care setting following a burn injury. The nurse should check for which immunization booster?
tetanus
The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip (DDH). Which finding would help confirm this diagnosis?
A distinct "clunk" is heard with Barlow and Ortolani maneuvers.
things to do before entering toddler space
brief eye contatc, smile, soft voice, get down on childs level
dehydration risk factors
children due to greater surface area to body mass, metabolism, immature kidneys functin, greaters fluid requirement
The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be:
chronic lack of oxygen.
obstruction to BF
coarctation of aorta, aortic stenosis/atresia, pulmonic stenosis/atresia
CP characteristics
hypertonicity, poor control of posture, balance and coordinated motion
pyloric stenosis
hypertrophy of pyloris muscle - olive shaped mass in RUQ
rheumatic fever labs
increased ESR, increased Creactice protein, elevated ASp
top 2 signs of increased ICP in infatns
increased HC, bulging fontanelle
bacterial menigitis
increased neutrophil and protein, low glucose
leukemia TX
induction, intesification or consolidation, CNS prophylactic therapy
croup TX
maintain airway, o2, hydration, cool mist, racemic epi, corticosteroids, albuterol
increased ICP goals
maintain airway, osmotic diuretics, eye care, nutrition
digoxin
monitor for toxicity - arrhythmias, NV, anorexia -- 0.8-2. give over at least 5. min
increased pulmondary BF TX
mostly spontaneous, or surgical reconstruction
hypertonic
moves fluid out of cells - D5 1/2
neuroblastoma
nervous sytem tumor
myelomeningocele
neural tube defect
isotonic fluids
neutral - LR and NS
pyloric stenosis s/s
no weight gain, hungry, vomtiting
CP definition
nonprogressive disorder of posture and movement due to an insult to brain - CANNOT be cured
The nurse is monitoring a playgroup of children on the pediatric unit. The nurse predicts the school-age child will most likely be participating in which activity?
painting pictures in the art corner of the room
The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatment(s) would the nurse expect to administer if prescribed? Select all that apply.
penicillin corticosteroids nonsteroidal anti-inflammatory drugs
head lice treatment
permethrin, pyrethrin
Which condition is a part of normal newborn screening?
phenylketonuria
24m toy
playing dress up
intussusception
portion of intestine invaginates or telescopes into itself
when to use log roll
post op harrington rods - post spinal fusion
2-7 cognitive
preoperational
stage 1 of tanner
prepuberty
Which child(ren) will the nurse avoid immunizing with a live-virus vaccine? Select all that apply.
preschool-age child receiving radiation therapy toddler with a severe acute illness
1-4m cognitive
primary circular reactions
mixed BF TX
prostaglandin E, septosotomy, heart meds
A nurse is developing the plan of care for a 7-year-old child diagnosed with congenital heart disease and a history of hypercyanotic spells. Which interventions would the nurse include in the child's plan of care to address these spells? Select all that apply.
provide supp. oxygen give parenteral morphine sulfate
12-18m toy
pull and go car
how to deal with temper tantrum
remain close and do not make eye contatc, do not restrain
decrease pulmonary BF
tetrology of fallot, tricuspid atresia
The nurse is performing a physical examination on a sleeping newborn. Which body system should the nurse examine last?
throat
The nurse is caring for a child with a skin disorder. The child presented with papules that progressed to vesicles with a honey-colored exudate. What treatment would the nurse expect to be ordered to treat this disorder? Select all that apply.
topical mupirocin ointment cool compresses to assist in removing crusts on vesicles regular hygiene measures
school age social interaction
understands reversibility of matter, identifies objects, adding and subtracting
erikson toddler
autonomy vs shame & doubt
The nurse is providing education to the parents of a child diagnosed with pinworms. Which statement is most important for the nurse to include in the teaching?
"Make sure your child washes hands before eating."
A nurse is taking care of a teenager who reports involuntary discharge of semen while sleeping. The nurse observes that the client is confused and does not know about the pubertal changes that are taking place in his body. Based on this information, what is the highest priority area that should be reviewed with the client?
Educate the client about the changes that occur during adolescence.
