Peds final study guide questions

Treatment of nephrotic syndrome AND Complications for nephrotic syndrome

-Diuretics -ACE inhibitors to block aldosterone secretion -Prednisone to decrease inflammation (shrink holes so protein can't get out; immunosuppressed) -Lipid-lowering drugs for hyperlipidemia -decrease sodium -increase protein in diet (This is the one person that you can increase protein in)?????? -Anticoagulation therapy for up to 6 months -dialysis COMPLICATIONS GO IN DEPTH MORE 16. The nurse is notified that a 9-year-old boy with nephrotic syndrome is being admitted. Only semiprivate rooms are available. What roommate should be best to select? a. A 10-year-old girl with pneumonia b. An 8-year-old boy with a fractured femur c. A 10-year-old boy with a ruptured appendix d. A 9-year-old girl with congenital heart disease ANS: B 14. What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)? a. Reduce blood pressure. b. Lower serum protein levels. c. Minimize excretion of urinary protein. d. Increase the ability of tissue to retain fluid. ANS: C The objectives of therapy for the child with MCNS include reducing the excretion of urinary protein, reducing fluid retention, preventing infection, and minimizing complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Serum protein levels are already reduced as part of the disease process. This needs to be reversed. The tissue is already retaining fluid as part of the edema. The goal of therapy is to reduce edema 13. What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome? a. Low specific gravity b. Decreased hemoglobin c. Normal platelet count d. Reduced serum albumin ANS: D Total serum protein concentrations are reduced, with the albumin fractions significantly reduced. Specific gravity is high and proportionate to the amount of protein in the urine. Hemoglobin and hematocrit are usually normal or elevated. The platelet count is elevated as a result of hemoconcentration. 15. A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child? a. Stimulate appetite. b. Detect evidence of edema. c. Minimize risk of infection. d. Promote adherence to the antibiotic regimen. ANS: C 16. The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need? a. Consuming a regular diet b. Increasing protein c. Restricting fluids d. Decreasing calories ANS: C During the edematous stage of active nephrosis, the child has restricted fluid and sodium intake. As the edema subsides, the child is placed on a diet with increased salt and fluids. A regular diet is not indicated. There is no evidence that a diet high in protein is beneficial or has an effect on the course of the disease. Calories sufficient for growth and tissue healing are essential. With the child having little appetite and the fluid and salt restrictions, achieving adequate nutrition is difficult 17. A child is admitted for minimal change nephrotic syndrome (MCNS). The nurse recognizes that the childs prognosis is related to what factor? a. Admission blood pressure b. Creatinine clearance c. Amount of protein in urine d. Response to steroid therapy ANS: D Corticosteroids are the drugs of choice for MCNS. If the child has not responded to therapy within 28 days of daily steroid administration, the likelihood of subsequent response decreases. Blood pressure is normal or low in MCNS. It is not correlated with prognosis. Creatinine clearance is not correlated with prognosis. The presence of significant proteinuria is used for diagnosis. It is not predictive of prognosis. 27. The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching? a. My child needs to stay home from school for at least 1 more month. b. I should not add additional salt to any of my childs meals. c. My child will not be able to participate in contact sports while receiving corticosteroid therapy. d. I should measure my childs urine after each void and report the 24-hour amount to the health care provider. ANS: B 36. What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema? a. Place an ice pack on the scrotal area. b. Place the child in an upright sitting position. c. Elevate the scrotum with a rolled washcloth. d. Place a warm moist pack to the scrotal area. ANS: C 37. What do the clinical manifestations of minimal change nephrotic syndrome include? a. Hematuria, bacteriuria, and weight gain b. Gross hematuria, albuminuria, and fever c. Hypertension, weight loss, and proteinuria d. Massive proteinuria, hypoalbuminemia, and edema ANS: D Massive proteinuria, hypoalbuminemia, and edema are clinical manifestations of minimal change nephrotic syndrome. Hematuria and bacteriuria are not seen, and there is usually weight loss, not gain. The blood pressure is normal or hypotensive. 38. For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs? a. Appetite increases and blood pressure is normal b. Urinary tract infection is gone and edema subsides c. Generalized edema subsides and blood pressure is normal d. Diuresis occurs as urinary protein excretion diminishes ANS: D Studies suggest that the duration of steroid treatment for the initial episode should be at least 3 months. In most patients, diuresis occurs as the urinary protein excretion diminishes within 7 to 21 days after the initiation of steroid therapy. The blood pressure is normal with MCNS, so remaining so is not an improvement. There is no urinary tract infection with MCNS. 39. A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone. The nurse realizes further teaching is required if the parents state what? a. We will keep our child away from anyone who is ill. b. We will be sure to administer the prednisone as ordered. c. We will encourage our child to eat a balanced diet, but we will watch his salt intake. d. We understand our child will not be able to attend school, so we will arrange for home schooling. ANS: D The child with MCNS in remission can attend school. The child needs socialization and will be socially isolated if home schooled. The other statements are accurate for home care for a child with MCNS. 41. A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity ANS: B Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. Proteinuria generally parallels the hematuria but is not usually the massive proteinuria seen in nephrotic syndrome. Gross discoloration of urine reflects its red blood cell and hemoglobin content. Microscopic examination of the sediment shows many red blood cells, leukocytes, epithelial cells, and granular and red blood cell casts. Bacteria are not seen, and urine culture results are negative. 44. The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what? a. 2 to 3 years b. 4 to 5 years c. 6 to 7 years d. 8 to 9 years ANS: A 9. What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply.) a. Soft diet b. High protein c. Fluid restricted d. No salt added at the table e. Restriction of foods high in sodium ANS: D, E

Communication/grief support

19. The nurse is planning care for a family expecting their newborn infant to die because of an incurable birth defect. What should the nurses interventions be based on? a. Tangible remembrances of the infant (e.g., lock of hair, picture) prolong grief. b. Photographs of infants should not be taken after death. c. Funerals are not recommended because the mother is still recovering from childbirth. d. The parents should be given the opportunity to parent the infant, including seeing, holding, touching, or talking to the infant in private. ANS: D Providing care for the neonate is an important step in the grieving process. It gives the parents a tangible person for whom to grieve, which is a key component of the grieving process. Tangible remembrances and photographs can make the infant seem more real to the parents. Many neonatal intensive care units make bereavement memory packets, which may include a lock of hair, handprints, footprints, a bedside name card, and other individualized objects. Families need to be informed of their options. The ritual of a funeral provides an opportunity for the parents to be supported by relatives and friends 5. What explanation best describes how preschoolers react to the death of a loved one? a. Grief is acute but does not last long at this age. b. Children this age are too young to have a concept of death. c. Preschoolers may feel guilty and responsible for the death. d. They express grief in the same way that the adults in the preschoolers life are expressing grief. ANS: C Because of egocentricity, the preschooler may feel guilty and responsible for the death. Preschoolers may need to distance themselves from the loss. Giggling or joking and regression to earlier behaviors may help them until they incorporate the loss. The preschoolers concept of death is more a special sleep or departure. 16. The nurse is making a home visit 48 hours after the death of an infant from sudden infant death syndrome (SIDS). What intervention is an appropriate objective for this visit? a. Give contraceptive information. b. Provide information on the grief process. c. Reassure parents that SIDS is not likely to occur again. d. Thoroughly investigate the home situation to verify SIDS as the cause of death. ANS: B A home visit after the death of an infant is an excellent time to help the parents with the grief process. The nurse can clarify misconceptions about SIDS and provide information on support services and coping issues. Giving contraceptive information is inappropriate unless requested by parents. Telling the parents that SIDS is not likely to occur again is a false reassurance to the family. Investigating the home situation to verify SIDS as the cause of death is not the nurses role; this would have been done by legal and social services if there were a question about the infants death. 20. The nurse is providing support to a family that is experiencing anticipatory grief related to their childs imminent death. What statement by the nurse is therapeutic? a. Your other children need you to be strong. b. You have been through a very tough time. c. His suffering is over; you should be happy. d. God never gives us more than we can handle. ANS: B Acknowledging that the family has been through a very tough time validates the loss that the parents have experienced. It is nonjudgmental. After the death of a child, the parent recognizes the responsibilities to the rest of the family but needs to be able to experience the grief of the loss. Telling the parents what they should do is giving advice. The parent would not be happy that the child has died, and stating so is argumentative. The parents may be angry with God, or their religious beliefs may be unknown, so the nurse should not provide false reassurance by talking to them about God. 21. The sibling of a 4-year-old girl dies from sudden infant death syndrome. The parents are concerned because the 4-year-old girl showed more outward grief when her cat died than now. How should the nurse explain this reaction to the parents? a. The child is not old enough to have a concept of death. b. This suggests maladaptive coping, and referral is needed for counseling. c. The death may be so painful and threatening that the child must deny it for now. d. The child is not old enough to have formed a significant attachment to her sibling. ANS: C Children of this age believe that their thoughts can cause death. The child may feel guilty and responsible. The loss may be so deep, painful, and threatening that the child needs to deny it for a time. Denial is within the range of a normal response to the death of a sibling. Counseling is not indicated at this time. Denial is also characteristic of the childs developmental level. These children do have a concept of death, seeing it as a separation. The child also would have formed an attachment to the sibling, who was in the house and sharing the parents time and attention.

Signs and symptoms of diabetes

20. What clinical manifestation is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination ANS: D Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease. 32. A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when? a. Lunch and dinner b. Breakfast and lunch c. 0830 to his midmorning snack d. Bedtime and breakfast the next morning ANS: A Intermediate-acting (NPH and Lente) insulins reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours. 12. The nurse is preparing to admit a 7-year-old child with type 2 diabetes. What clinical features of type 2 diabetes should the nurse recognize? (Select all that apply.) a. Oral agents are effective. b. Insulin is usually needed. c. Ketoacidosis is infrequent. d. Diet only is often effective. e. Chronic complications frequently occur. ANS: A, C, D

Fluid requirement calculations for the pediatric patient

20mL/kg bolus NS + 1.5x maintenance 24h maintenance D5NS - FOR DEHYDRATION Maintenance 24h 100mL/kg for first 10 50mL/kg for next 10 20mL/kg for any more 2. Nurses should be alert for increased fluid requirements in which circumstance? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure ANS: A 2. In what condition should the nurse be alert for altered fluid requirements in children?(Select all that apply.) a. Oliguric renal failure b. Increased intracranial pressure c. Mechanical ventilation d. Compensated hypotension e. Tetralogy of Fallot f. Type 1 diabetes mellitus ANS: A, B, C

Signs and symptoms of retinoblastoma

<5yo most common 1st symptom - whitish glow in pupil - cat's eye reflex (leukocoria) 2nd symptom - strabismus decreased vision, late blindness persistant painful+erythematous eyes often glaucoma May spontaneously regress 1. What childhood cancer may demonstrate patterns of inheritance that suggest a familial basis? a. Leukemia b. Retinoblastoma c. Rhabdomyosarcoma d. Osteogenic sarcoma ANS: B 30. The mother of an infant tells the nurse that sometimes there is a whitish glow in the pupil of his eye. The nurse should suspect which condition? a. Brain tumor b. Retinoblastoma c. Neuroblastoma d. Rhabdomyosarcoma ANS: B 39. The nurse should expect to care for which age of child if the admitting diagnosis is retinoblastoma? a. Infant or toddler b. Preschool- or school-age child c. School-age or adolescent child d. Adolescent ANS: A The average age of the child at the time of diagnosis is 2 years, and bilateral and hereditary disease is diagnosed earlier than unilateral and nonhereditary disease.

Family models

I THINK I PUT THIS IN ANOTHER QUIZLET family systems theory Family Stress theory Developmental Theory

Nursing assessment/interventions for treating burn patient and preventing complications

INFO AND QUESTIONS

How to determine communication style with a pediatric patient, developmental needs

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Nursing interventions when assigned to a child with possible poisoning

LOOK FOR ANYTHING IN NOTES 6. What is a significant secondary prevention nursing activity for lead poisoning? a. Chelation therapy b. Screening children for blood lead levels c. Removing lead-based paint from older homes d. Questioning parents about ethnic remedies containing lead ANS: B Screening children for lead poisoning is an important secondary prevention activity. Screening does not prevent the initial exposure of the child to lead. It can lead to identification and treatment of children who are exposed. Chelation therapy is treatment, not prevention. Removing lead-based paints from older homes before children are affected is primary prevention. Questioning parents about ethnic remedies containing lead is part of the assessment to determine the potential source of lead. 7. What is an important nursing consideration when a child is hospitalized for chelation therapy to treat lead poisoning? a. Maintain bed rest. b. Maintain isolation precautions. c. Keep an accurate record of intake and output. d. Institute measures to prevent skeletal fracture. ANS: C The iron chelates are excreted though the kidneys. Adequate hydration is essential. Periodic measurement of renal function is done. Bed rest is not necessary. Often the chelation therapy is done on an outpatient basis. Chelation therapy is not infectious or dangerous. Isolation is not indicated. Skeletal weakness does not result from high levels of lead. 17. A child with acetaminophen (Tylenol) poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed? a. Carnitine (Carnitor) b. Fomepizole (Antizol) c. Deferoxamine (Desferal) d. N-acetylcysteine (Mucomyst) ANS: D The antidote for acetaminophen (Tylenol) poisoning is N-acetylcysteine (Mucomyst). Carnitine (Carnitor) is an antidote for valproic acid (Depakote), fomepizole (Antizol) is the antidote for methanol poisoning, and deferoxamine (Desferal) is the antidote for iron poisoning 18. A child with diazepam (Valium) poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed? a. Succimer (Chemet) b. EDTA (Versenate) c. Flumazenil (Romazicon) d. Octreotide acetate (Sandostatin) ANS: C The antidote for diazepam (Valium) poisoning is flumazenil (Romazicon). Succimer (Chemet) and EDTA (Versenate) are antidotes for heavy metal poisoning. Octreotide acetate (Sandostatin) is an antidote for sulfonylurea poisoning. 23. A child with corrosive poisoning is being admitted to the emergency department. What clinical manifestation does the nurse expect to assess on this child? a. Nausea and vomiting b. Alterations in sensorium, such as lethargy c. Severe burning pain in the mouth, throat, and stomach d. Respiratory symptoms of acute pulmonary involvement ANS: C Severe burning pain in the mouth, throat, and stomach is a clinical manifestation of corrosive poisoning. Nausea and vomiting; alterations in sensorium, such as lethargy; and respiratory symptoms of acute pulmonary involvement are clinical manifestations of hydrocarbon poisoning. 24. A child with acetylsalicylic acid (aspirin) poisoning is being admitted to the emergency department. What early clinical manifestation does the nurse expect to assess on this child? a. Hematemesis b. Hematochezia c. Hyperglycemia d. Hyperventilation ANS: D An early clinical manifestation of acetylsalicylic acid (aspirin) poisoning is hyp 25. A child with cyanide poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed for the child? a. Atropine b. Glucagon c. Amyl nitrate d. Naloxone (Narcan) ANS: C Amyl nitrate is the antidote for cyanide poisoning. Atropine is an antidote for organophosphate poisoning, glucagon is an antidote for a beta-blocker poisoning, and naloxone (Narcan) is an antidote for an opioid poisoning 2. The nurse is administering activated charcoal to a preschool child with acetaminophen (Tylenol) poisoning. What potential complications from the use of activated charcoal should the nurse plan to assess for? (Select all that apply.) a. Diarrhea b. Vomiting c. Fluid retention d. Intestinal obstruction ANS: B, D Potential complications from the use of activated charcoal include vomiting and possible aspiration, constipation, and intestinal obstructtion. Diarrhea and fluid retention are not potential complications of activated charcoal administration. 20. The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What intervention is essential in this childs care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if childs lips become bright, cherry-red in color. ANS: B

Contraindications for immunizations

no allergies neomycin, streptomyci, polymixin B for IPV/MMR no bakers yeast Hep B No eggs influenza Live vaccines = MMR, Varicella, Rota/adenovirus, yellow fever, typhoid/cholera, BCG?, intranasal influenza, HZV??? live vaccines shouldn't be given w/ •Acute illness with high fever •Hypersensitivity reaction •Recent immunoglobulin therapy •Cancer treatments •Pregnancy or <1yo •live vaccine or IgG within past 4 weeks due to destruction from immune system NO rotavirus w/ intusseption hx No pertussis??? 3. A 4-month-old infant comes to the clinic for a well-infant checkup. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations should include which? a. DTaP and IPV can be safely given. b. DTaP and IPV are contraindicated because she has a cold. c. IPV is contraindicated because her sister is immunocompromised. d. DTaP and IPV are contraindicated because her sister is immunocompromised. ANS: A These immunizations can be given safely. Serious illness is a contraindication. A mild illness with or without fever is not a contraindication. These are not live vaccines, so they do not pose a risk to her sister. 5. Which muscle is contraindicated for the administration of immunizations in infants and young children? a. Deltoid b. Dorsoglutealc. Ventrogluteal d. Anterolateral thigh ANS: B The dorsogluteal site is avoided in children because of the location of nerves and veins. The deltoid is recommended for 12 months and older. The ventrogluteal and anterolateral thigh sites can safely be used for the administration of vaccines to infants. 25. The nurse is preparing to administer a measles, mumps, rubella, and varicella (MMRV) vaccine. Which is a contraindication associated with administering this vaccine? a. The child has recently been exposed to an infectious disease. b. The child has symptoms of a cold but no fever. c. The child is having intermittent episodes of diarrhea. d. The child has a disorder that causes a deficient immune system. ANS: D The MMRV (measles, mumps, rubella, and varicella) vaccine is an attenuated live virus vaccine. Children with deficient immune systems should not receive the MMRV vaccine because of a lack of evidence of its safety in this population. Exposure to an infectious disease, symptoms of a cold, or intermittent episodes of diarrhea are not contraindications to receiving a live vaccine. 20. What immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine b. Inactivated poliovirus vaccine c. Diphtheria, pertussis, tetanus (DPT) d. Measles, mumps, rubella (MMR) ANS: D The vaccine used for MMR is a live virus and can cause serious disease in immunocompromised children. The tetanus vaccine, inactivated poliovirus vaccine, and DPT are not live vaccines and can be given to immunosuppressed children. The immune response is likely to be suboptimum, so delaying vaccination is usually recommended. 23. A young childs parents call the nurse after their child is bitten by a raccoon in the woods. The nurses recommendation should be based on what knowledge? a. Antirabies prophylaxis must be initiated immediately. b. The child should be hospitalized for close observation. c. No treatment is necessary if thorough wound cleaning is done. d. Antirabies prophylaxis must be initiated as soon as clinical manifestations appear. ANS: A 14. An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department. She has completed the tetanus immunization series, receiving the last tetanus toxoid booster 8 years ago. What care is necessary for therapeutic management of this adolescent to prevent tetanus? a. Tetanus toxoid booster is needed because of the type of injury. b. Human tetanus immunoglobulin is indicated for immediate prophylaxis. c. Concurrent administration of both tetanus immunoglobulin and tetanus antitoxin is needed. d. No additional tetanus prophylaxis is indicated. The tetanus toxoid booster is protective for 10 years. ANS: A

Nursing interventions when caring for CHF patient

-improve cardiac function= digoxin given at regular intervals & parents need to know how to measure it: cannot mix w/fluids or foods, need to have water/brush teeth AFTER (can cause tooth decay), if dose missed do not give extra dose or increase next dose, if child vomits don't give more, slow HR & poor feeding & vomiting signs of toxicity, GI disease= side effect, do not give if bradycardic -ACE inhibitors purpose is to reduce afterload on heart & make it easier to pump=inhibit normal fxn of renin & angiotensin in kidneys, blocks conversion of angio1 to angio2 to increase vasodilation, vasodilation decreases vascular resistance (any time there is vasodilation it decreases BP), "prils", side effects= HTN, cough, renal dysfunction -rid body of excess fluid & sodium= K+ wasting diuretics, may be put on fluid restriction to decrease excess fluid, low sodium diet -decrease workload of heart= bedrest, maintain temp, semi-fowler position, neutral environment, NO cold stress, reduce effort of breathing, treat infections, sedative sometimes used to decrease cardiac workload -increase tissue oxygenation= give cool humidified oxygen to maximize O2 available for inspiration, an oxygen hood, cannula, face tent, cool humidification necessary to counteract dryness of oxygen= frequent temp checks MORE INFORMATION? 7. What statement best identifies the cause of heart failure (HF)? a. Disease related to cardiac defects b. Consequence of an underlying cardiac defect c. Inherited disorder associated with a variety of defects d. Result of diminished workload imposed on an abnormal myocardium ANS: B HF is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the bodys metabolic demands. HF is not a disease but rather a result of the inability of the heart to pump efficiently. HF is not inherited. HF occurs most frequently secondary to congenital heart defects in which structural abnormalities result in increased volume load or increased pressures on the ventricles. 13. What nutritional component should be altered in the infant with heart failure (HF)? a. Decrease in fats b. Increase in fluids c. Decrease in protein d. Increase in calories ANS: D Infants with HF have a greater metabolic rate because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of average infants, yet their ability to take in calories is diminished by their fatigue. The diet should include increased protein and increased fat to facilitate the childs intake of sufficient calories. Fluids must be carefully monitored because of the HF. 17. A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition? a. Cyanosis b. Heart failure c. Decreased pulmonary blood flow d. Bounding pulses in upper extremities ANS: B As blood is shunted into the right side of the heart, there is increased pulmonary blood flow and the child is at high risk for heart failure. Cyanosis usually occurs in defects with decreased pulmonary blood flow. Bounding upper extremity pulses are a manifestation of coarctation of the aorta. 38. A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which? a. Serum sodium b. Serum potassium c. Serum glucose d. Serum chloride ANS: B A fall in the serum potassium level enhances the effects of digoxin, increasing the risk of digoxin toxicity. Increased serum potassium levels diminish digoxins effect. Therefore, serum potassium levels (normal range, 3.55.5 mmol/L) must be carefully monitored. 42. Heart failure (HF) is a problem after the child has had a congenital heart defect repaired. The nurse knows a sign of HF is what? a. Wheezing b. Increased blood pressure c. Increased urine output d. Decreased heart rate ANS: A A clinical manifestation of heart failure is wheezing from pulmonary congestion. The blood pressure decreases, urine output decreases, and heart rate increases. 47. What medication used to treat heart failure (HF) is a diuretic? a. Captopril (Capten) b. Digoxin (Lanoxin) c. Hydrochlorothiazide (Diuril) d. Carvedilol (Coreg) ANS: C Hydrochlorothiazide is a diuretic. Captopril is an ACE inhibitor, digoxin is a digital glycoside, and carvedilol is a beta-blocker.

Education related to tonsillectomy

-until fully awake, position patient to facilitate drainage of secretions on ab/side and prevent aspiration -examine emesis or secretions for new blood - risk for bleeds for ~2w, dark brown emesis is old blood from surgery, look for bright red blood or frequent swallowing esp. during sleep -discourage them from coughing, blowing nose, using straws, or clearing throat to avoid irritating surgical area, no routine suction -restrict oral intake until hemorrhage is ruled out (ice chips, water, freeze pops); soft foods first -pain meds at regular intervals for @ least first 24-48hrs; can be given PO liquid if tolerated (IV otherwise); give amoxicillin to prevent infections; give anti-nausea & local anesthetics (freeze pops) 5. When caring for a child after a tonsillectomy, what intervention should the nurse do? a. Watch for continuous swallowing. b. Encourage gargling to reduce discomfort. c. Apply warm compresses to the throat. d. Position the child on the back for sleeping. ANS: A 36. The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? a. I can use an ice collar on my child for pain control along with analgesics. b. My child should clear the throat frequently to clear the secretions. c. I should allow my child to be as active as tolerated. d. My child should gargle and brush teeth at least three times per day. ANS: A 38. A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in the immediate postoperative period. The nurse should take what action? a. Notify the health care provider. b. Continue to assess for bleeding. c. Give the child a red flavored ice pop. d. Position the child in a Trendelenburg position. ANS: B Some secretions, particularly dried blood from surgery, are common after a tonsillectomy. Inspect all secretions and vomitus for evidence of fresh bleeding (some blood-tinged mucus is expected). Dark brown (old) blood is usually present in the emesis, as well as in the nose and between the teeth. Small amounts of dark brown blood should be further monitored. A red-flavored ice pop should not be given and the Trendelenburg position is not recommended. 39. A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does not want to drink anything, saying, My tummy hurts. The following health care prescriptions are available: acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse implement to relieve the childs pain? a. Ice chips b. Tylenol PO c. Tylenol PR d. Popsicle ANS: C 58. What medication is contraindicated in children post tonsillectomy and adenoidectomy? a. Codeine b. Ondansetron (Zofran) b. Amoxil (amoxicillin) c. Acetaminophen (Tylenol) ANS: A Codeine is contraindicated in pediatric patients after tonsillectomy and adenoidectomy. In 2012, the Food and Drug Administration issued a Drug Safety Communication that codeine use in certain children after tonsillectomy or adenoidectomy may lead to rare but life-threatening adverse events or death. Zofran, amoxicillin, and Tylenol are not contraindicated after tonsillectomy and adenoidectomy.

Risk factors for respiratory distress in a newborn

Excessive/thick/static secretions CNS depression immobility low or high humidity sleep position of infants Cardiac disease LOOK FOR MORE STRAIGHTFORWARD INFO AND ALSO QUESTIONS p159

Nursing interventions for patient with increased ICP

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Patient/family education for scabies/pediculosis capitis/cellulitis/impetigo

MAYBE A LITTLE BIT OF STUFF 17. When giving instructions to a parent whose child has scabies, what should the nurse include? a. Treat all family members if symptoms develop. b. Be prepared for symptoms to last 2 to 3 weeks. c. Carefully treat only areas where there is a rash. d. Notify practitioner so an antibiotic can be prescribed. ANS: B The mite responsible for the scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. Initiation of therapy does not wait for clinical symptom development. All individuals in close contact with the affected child need to be treated. Permethrin, a scabicide, is the preferred treatment and is applied to all skin surfaces. 30. A child has been diagnosed with scabies. Which statement by the parent indicates understanding of the nurses teaching about scabies? a. The itching will stop after the cream is applied. b. We will complete extensive aggressive housecleaning. c. We will apply the cream to only the affected areas as directed. d. Everyone who has been in close contact with my child will need to be treated. ANS: D Because of the length of time between infestation and physical symptoms (30 to 60 days), all persons who were in close contact with the affected child need treatment. Families need to know that although the mite will be killed, the rash and the itch will not be eliminated until the stratum corneum is replaced, which takes approximately 2 to 3 weeks. Aggressive housecleaning is not necessary, but surface vacuuming of heavily used rooms by a person with crusted scabies is recommended. The prescribed cream should be thoroughly and gently massaged into all skin surfaces (not just the areas that have a rash) from the head to the soles of the feet. 19. The school reviewed the pediculosis capitis (head lice) policy and removed the no nit requirement. The nurse explains that now, when a child is found to have nits, the parents must do which before the child can return to school? a. No treatment is necessary with the policy change. b. Shampoo and then trim the childs hair to prevent reinfestation. c. The child can remain in school with treatment done at home. d. Treat the child with a shampoo to treat lice and comb with a fine-tooth comb every day until nits are eliminated. ANS: C Many children have missed significant amounts of school time with no nit policies. The child should be appropriately treated with a pediculicide and a fine-tooth comb. The environment needs to be treated to prevent reinfestation. The treatment with the pediculicide will kill the lice and leave nit casings. Cutting the childs hair is not recommended; lice infest short hair as well as long. With a no nit policy, treating the child with a shampoo to treat lice and combing the hair with a fine-tooth comb every day until nits are eliminated is the correct treatment. The policy change recognizes that most nits do not become lice. 19. The nurse is talking to the parents of a child with pediculosis capitis. Which should the nurse include when explaining how to manage pediculosis capitis? a. You will need to cut the hair shorter if infestation and nits are severe. b. You can distinguish viable from nonviable nits, and remove all viable ones. c. You can wash all nits out of hair with a regular shampoo. d. You will need to remove nits with an extra-fine tooth comb or tweezers. ANS: D Treatment consists of the application of pediculicide and manual removal of nit cases. An extra-fine tooth comb facilitates manual removal. Parents should be cautioned against cutting the childs hair short; lice infest short hair as well as long. It increases the childs distress and serves as a continual reminder to peers who are prone to tease children with a different appearance. It is not possible to differentiate between viable and nonviable eggs. Regular shampoo is not effective; a pediculicide is necessary. 9. What often causes cellulitis? a. Herpes zoster b. Candida albicans c. Human papillomavirus d. Streptococci or staphylococci ANS: D 8. What does impetigo ordinarily results in? a. No scarring b. Pigmented spots c. Atrophic white scars d. Slightly depressed scars ANS: A Impetigo tends to heal without scarring unless a secondary infection occurs. 7. The nurse is caring for a 5-year-old child with impetigo contagiosa. The parents ask the nurse what will happen to their childs skin after the infection has subsided and healed. Which answer should the nurse give? a. There will be no scarring. b. There may be some pigmented spots. c. It is likely there will be some slightly depressed scars. d. There will be some atrophic white scars. ANS: A Impetigo contagiosa tends to heal without scarring unless a secondary infection occurs. 6. Which nursing consideration is important when caring for a child with impetigo contagiosa? a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions. ANS: C A major nursing consideration related to bacterial skin infections, such as impetigo contagiosa, is to prevent the spread of the infection and complications. This is done by thorough hand washing before and after contact with the affected child. Corticosteroids are not indicated in bacterial infections. Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states, such as tinea capitis.

Complications of anemia

Heart failure Angina Paresthesia Confusion Injury related to falls Depressed mood Over supplementation of oxygen can proliferate anemia 2. What physiologic defect is responsible for causing anemia? a. Increased blood viscosity b. Depressed hematopoietic system c. Presence of abnormal hemoglobin d. Decreased oxygen-carrying capacity of blood ANS: D Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition depends on the decreased oxygencarrying capacity of the blood. 4. A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason? a. Allow her parents to come visit her. b. Fight the infection that she now has. c. Increase her energy so she will not be so tired. d. Help her body stop bleeding by forming a clot (scab). ANS: C 7. What statement best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. Diagnosis is easily made because of the infants emaciated appearance. c. It results from a decreased intake of milk and the premature addition of solid foods. d. Clinical manifestations are related to a reduction in the amount of oxygen available to tissues. ANS: D In iron-deficiency anemia, the childs clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed. The bone marrow produces red blood cells that are smaller and contain less hemoglobin than normal red blood cells. Children who have iron deficiency from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk. 43. The nurse is caring for a school-age child with severe anemia and activity intolerance. What diversional activity should the nurse plan for this child? a. Playing a musical instrument b. Playing board or card games c. Participating in a game of table tennis d. Participating in decorating the hospital room ANS: B 45. What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia? a. Prolonged use of oxygen can decrease erythropoiesis. b. Prolonged use of oxygen can interfere with iron production. c. Prolonged use of oxygen interferes with a childs appetite. d. Prolonged use of oxygen can affect the synthesis of hemoglobin. ANS: A Oxygen administration is of limited value, because each gram of hemoglobin is able to carry a limited amount of the gas. In addition, prolonged use of supplemental oxygen can decrease erythropoiesis. Prolonged use of oxygen does not interfere with iron production, a childs appetite, or affect the synthesis of hemoglobin. 3. What are signs and symptoms of anemia? (Select all that apply.) a. Pallor b. Fatigue c. Dilute urine d. Bradycardia e. Muscle weakness ANS: A, B, E Signs and symptoms of anemia include, pallor, fatigue, and muscle weakness. Tachycardia, not bradycardia, and dark urine, not dilute, are signs and symptoms of anemia.

Identifying assessments and treatments for children with Hirschsprung disease, intussusception, gastroesophageal reflux and pyloric stenosis

OH GOD DO IT THOUGH

Sickle cell anemia - causes, risk factors, nursing interventions

MORE ON THIS THOUGH The black African, Mediterranean, and Southern and Southeast Asian ethnicities are at higher risk for sickle cell anemia disease. Infarction of renal vessels occurs in renal involvement in sickle cell disease. 10. What condition occurs when the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia ANS: B 11. The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. What statement most accurately reflects inheritance of SCA? a. SCA is not inherited. b. All siblings will have SCA. c. Each sibling has a 25% chance of having SCA. d. There is a 50% chance of siblings having SCA. ANS: C 12. The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration? a. Decreased blood viscosity b. Deficiency in coagulation c. Increased red blood cell (RBC) destruction d. Greater affinity for oxygen ANS: C 13. A school-age child is admitted in vasoocclusive sickle cell crisis (pain episode). The childs care should include which therapeutic interventions? a. Hydration and pain management b. Oxygenation and factor VIII replacement c. Electrolyte replacement and administration of heparin d. Correction of alkalosis and reduction of energy expenditure ANS: A 14. A child with sickle cell anemia (SCA) develops severe chest and back pain, fever, a cough, and dyspnea. What should be the first action by the nurse? a. Administer 100% oxygen to relieve hypoxia. b. Notify the practitioner because chest syndrome is suspected. c. Infuse intravenous antibiotics as soon as cultures are obtained. d. Give ordered pain medication to relieve symptoms of pain episode. ANS: B These are the symptoms of chest syndrome, which is a medical emergency. Notifying the practitioner is the priority action. Oxygen may be indicated; however, it does not reverse the sickling that has occurred. Antibiotics are not indicated initially. Pain medications may be required, but evaluation by the practitioner is the priority. 15. In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasoocclusion and hypoxiaischemia cycle. What information should the nurse share with parents in a teaching plan? a. Encourage drinking. b. Keep accurate records of output. c. Check for moist mucous membranes. d. Monitor the concentration of the childs urine. ANS: C 32. A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement? a. Notify the health care provider. b. Place the child on bed rest. c. Administer a dose of hydrocodone (Vicodin). d. Start O2 per the hospitals protocol. ANS: A Any number of neurologic symptoms can indicate a minor cerebral insult, such as headache, aphasia, weakness, convulsions, visual disturbances, or unilateral hemiplegia. Loss of vision is usually the result of progressive retinopathy and retinal detachment. The nurse should notify the health care provider. 33. What pain medication is contraindicated in children with sickle cell disease (SCD)? a. Meperidine (Demerol) b. Hydrocodone (Vicodin) c. Morphine sulfate d. Ketorolac (Toradol) ANS: A 47. A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan? a. Exercise as a distraction b. Heat to the affected area c. Elevation of the extremity d. Cold compresses to the affected area ANS: B

Parent education related to hip dysplasia/clubfeet

MORE almost nothing on hip dysplasia 18. Parents ask the nurse if there was something that should have been done during the pregnancy to prevent their childs cleft lip. Which statement should the nurse give as a response? a. This is a type of deformation and can sometimes be prevented. b. Studies show that taking folic acid during pregnancy can prevent this defect. c. This is a genetic disorder and has a 25% chance of happening with each pregnancy. d. The malformation occurs at approximately 5 weeks of gestation; there is no known way to prevent this. ANS: D Cleft lip, an example of a malformation, occurs at approximately 5 weeks of gestation when the developing embryo naturally has two clefts in the area. There is no known way to prevent this defect. Deformations are often caused by extrinsic mechanical forces on normally developing tissue. Club foot is an example of a deformation often caused by uterine constraint. Cleft lip is not a genetic disorder; the reasons for this occurring are still unknown. Taking folic acid during pregnancy can help to prevent neural tube disorders but not cleft lip defects. 41. A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk. ANS: C Serial casting is begun shortly after birth, before discharge from the nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention. 43. The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what? a. Well keep the cast dry. b. Were happy this is the only cast our baby will need. c. Well watch for any swelling of the foot while the cast is on. d. Were getting a special car seat to accommodate the cast. ANS: B The common approach to clubfoot management and treatment is the Ponseti method. Serial casting is begun shortly after birth. Weekly gentle manipulation and stretching of the foot along with placement of serial longleg casts allow for gradual repositioning of the foot. The extremity or extremities are casted until maximum correction is achieved, usually within 6 to 10 weeks. If parents state that this is the only cast the infant will need, they need further teaching 31. The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. What is the most appropriate way to position and feed this neonate? a. Prone with the head turned to the side b. On the side c. Supine in an infant carrier d. Supine, with defect supported with rolled blankets ANS: A The prone position with the head turned to the side for feeding is the optimum position for the infant. It protects the spinal sac and allows the infant to be fed without trauma. The side-lying position is avoided preoperatively. It can place tension on the sac and affect hip dysplasia if present. The infant should not be placed in a supine position.

Complications of strep infection

Rheumatic fever (most common 5-15 around 2-4 weeks after strep throat) - self limiting AI illness involving joints, skin, brain, heart S/S - fever, fatigue, flat or raised painless rash w/ ragged edge, migrating joint pain w/ red+hot+swollen, chorea w/ outbursts of unusual behavior, chest pain and murmur, Tx w/ penicillin, salicylates for inflammatory joint S/S, bedrest in acute phase Glomerulonephritis (most common XXX) - XXX LOOK FOR REAL INFORMATION NEED IT glomerulonephritis and NOT nephrotic syndrome caused by acute streptococcal pharyngitis 9. What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis? a. Infarction of renal vessels b. Immune complex formation and glomerular deposition c. Bacterial endotoxin deposition on and destruction of glomeruli d. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation ANS: B After a streptococcal infection, antibodies are formed, and immune-complex reaction occurs. The immune complexes are trapped in the glomerular capillary loop. Infarction of renal vessels occurs in renal involvement in sickle cell disease. Bacterial endotoxin deposition on and destruction of glomeruli is not a mechanism for postinfectious glomerulonephritis. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation is the pathology of renal involvement with bacterial endocarditis. 43. The nurse is preparing to admit a child to the hospital with a diagnosis of acute poststreptococcal glomerulonephritis. The nurse understands that the peak age at onset for this disease is what? a. 2 to 4 years b. 5 to 7 years c. 8 to 10 years d. 11 to 13 years ANS: B 4. It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition? a. Otitis media b. Diabetes insipidus (DI) c. Nephrotic syndrome d. Acute rheumatic fever ANS: D Group A hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute streptococcal pharyngitis. 30. What action by the school nurse is important in the prevention of rheumatic fever (RF)? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts. ANS: C Nurses have a role in prevention, primarily in screening school-age children for sore throats caused by group A streptococci. They can actively participate in throat culture screening or refer children with possible streptococcal sore throats for testing. Routine cholesterol screenings and blood pressure screenings do not facilitate the recognition and treatment of group A hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses. 52. The test that provides the most reliable evidence of recent streptococcal infection is which? a. Throat culture b. Mantoux test c. Antistreptolysin O test d. Elevation of liver enzymes ANS: C Antistreptolysin O (ASLO) titers measure the concentration of antibodies formed in the blood against this product. Normally, the titers begin to rise about 7 days after onset of the infection and reach maximum levels in 4 to 6 weeks. Therefore, a rising titer demonstrated by at least two ASLO tests is the most reliable evidence of recent streptococcal infection.

Principle of family centered care

-child is essential member of the family unit -nursing care is most effective when delivered with the belief that the family is the patient -care is most productive when family is trusting as well as child b/c consent as well as anxiety in mom can cause anxiety in child -provides a caring, supportive environment where the child can grow, mature, maximize potential -family is a constant in the child's life= helps ease anxiety when family is around 8. Parents of a hospitalized toddler ask the nurse, What is meant by family-centered care? The nurse should respond with which statement? a. Family-centered care reduces the effect of cultural diversity on the family. b. Family-centered care encourages family dependence on the health care system. c. Family-centered care recognizes that the family is the constant in a childs life. d. Family-centered care avoids expecting families to be part of the decision-making process. ANS: C 2. What is a major premise of family-centered care? a. The child is the focus of all interventions. b. Nurses are the authorities in the childs care. c. Parents are the experts in caring for their child. d. Decisions are made for the family to reduce stress. ANS: C 10. What are core principles of patient- and family-centered care? (Select all that apply.) a. Collaboration b. Empowering families c. Providing formal and informal support d. Maintaining strict policy and procedure routines e. Withholding information that is likely to cause anxiety ANS: B, C

Patient education for using peak flow meter

-deep breath to forceful single blow, repeat 3x -done at same time, once in morning and again at night, whenever symptomatic -used to monitor or measure the lung function of a kid with respiratory issues (usually asthma) -should be done daily to determine how much activity can be tolerated -obtain baseline of what pt's normal lung function is (if not possible to establish baseline, use height/weight charts) -80-100%= ideal -50-79% increase medications and check more frequently -below 50%= call doctor & possible hospitalization 53. A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the yellow zone, this means that the asthma control is what? a. 80% of a personal best, and the routine treatment plan can be followed. b. 50% to 79% of a personal best and needs an increase in the usual therapy. c. 50 % of a personal best and needs immediate emergency bronchodilators. d. Less than 50% of a personal best and needs immediate hospitalization. ANS: B The interpretation of a peak expiratory flow rate that is yellow (50%79% of personal best) signals caution. Asthma is not well controlled. An acute exacerbation may be present. Maintenance therapy may need to be increased. Call the practitioner if the child stays in this zone. 25. A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate? a. To assess severity of asthma b. To determine cause of asthma c. To identify triggers of asthma d. To confirm diagnosis of asthma ANS: A Peak expiratory flow rate monitoring is used to monitor the childs current pulmonary function. It can be used to manage exacerbations and for daily long-term management. The cause of asthma is known. Asthma is caused by a complex interaction among inflammatory cells, mediators, and the cells and tissues present in the airways. The triggers of asthma are determined through history taking and immunologic and other testing. The diagnosis of asthma is made through clinical manifestations, history, physical examination, and laboratory testing. 53. A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the yellow zone, this means that the asthma control is what? a. 80% of a personal best, and the routine treatment plan can be followed. b. 50% to 79% of a personal best and needs an increase in the usual therapy. c. 50 % of a personal best and needs immediate emergency bronchodilators. d. Less than 50% of a personal best and needs immediate hospitalization. ANS: B The interpretation of a peak expiratory flow rate that is yellow (50%79% of personal best) signals caution. Asthma is not well controlled. An acute exacerbation may be present. Maintenance therapy may need to be increased. Call the practitioner if the child stays in this zone.

Clinical manifestations of leukemia

1. Leukemic cells crowd out normal WBCs, RBCs, and platelets - causing anemia with fatigue, dyspnea and pallor 2. Frequent infections and flu-like symptoms 3. Enlarged lymph nodes and spleen 4. Bleeding, bruising and petechiae 5. Bone and joint pain as leukemic cells increase pressure in the bone marrow LOOK MORE INTO THIS THOUGH 12. After chemotherapy is begun for a child with acute leukemia, prophylaxis to prevent acute tumor lysis syndrome includes which therapeutic intervention? a. Hydration b. Oxygenation c. Corticosteroids d. Pain management ANS: A 16. A young child with leukemia has anorexia and severe stomatitis. What approach should the nurse suggest that the parents try? a. Relax any eating pressures. b. Firmly insist that the child eat normally. c. Serve foods that are either hot or cold. d. Provide only liquids because chewing is painful. ANS: A 21. What description identifies the pathophysiology of leukemia? a. Increased blood viscosity b. Abnormal stimulation of the first stage of coagulation process c. Unrestricted proliferation of immature white blood cells (WBCs) d. Thrombocytopenia from an excessive destruction of platelets ANS: C 22. A child with leukemia is receiving intrathecal chemotherapy to prevent which condition? a. Infection b. Brain tumor c. Central nervous system (CNS) disease d. Drug side effects ANS: C

Normal weight loss for newborns

A 5-7% weight loss during the first 3-4 days after birth is normal. A 10% weight loss is sometimes considered normal, but this amount of weight loss is a sign that the breastfeeding needs to be evaluated. ~7% of birthweight in 1st week Weight loss of 10% needs evaluation by lactation consultant mild (4-5% body weight loss) alert Vitals + turgor WNL "Tacky" mucus membranes, flat fontanelles, dull eyes decreased UOP and frequency moderate (6-10% body weight loss) fussy, lethargic abnormal vitals + turgor dry mucus membranes, sunken fontanelles and eyes severe (10%+ body weight loss) drowsy, limp extreme vital changes Minimal/no UOP w/ sp gravity >1.03 10. What amount of fluid loss occurs with moderate dehydration? a. <50 ml/kg b. 50 to 90 ml/kg c. <5% total body weight d. >15% total body weight ANS: B Moderate dehydration is defined as a fluid loss of between 50 and 90 ml/kg. Mild dehydration is defined as a fluid loss of less than 50 ml/kg. Weight loss up to 5% is considered mild dehydration. Weight loss over 15% is severe dehydration. 33. An infant weighed 8 lb at birth and was 18 inches in length. What weight and length should the infant be at 5 months of age? a. 12 lb, 20 inches b. 14 lb, 21.5 inches c. 16 lb, 23 inches d. 18 lb, 24.5 inches ANS: C Infants gain 680 g (1.5 lb) per month until age 5 months, when the birth weight has at least doubled. Height increases by 2.5 cm (1 inch) per month during the first 6 months. Therefore, at 5 months the infant should weigh 16 lb and be 23 inches in length. 13. The presence of which pair of factors is a good predictor of a fluid deficit of at least 5% in an infant? a. Weight loss and decreased heart rate b. Capillary refill of less than 2 seconds and no tears c. Increased skin elasticity and sunken anterior fontanel d. Dry mucous membranes and generally ill appearance ANS: D A good predictor of a fluid deficit of at least 5% is any two four factors: capillary refill of more than 2 seconds, absent tears, dry mucous membranes, and ill general appearance. Weight loss is associated with fluid deficit, but the degree needs to be quantified. Heart rate is usually elevated. Skin elasticity is decreased, not increased. The anterior fontanel is depressed. 14. Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infants status, which finding is indicative of achieving this goal? a. Irritability when awake b. Capillary refill of more than 5 seconds c. Appropriate weight gain for age d. Positioned in high Fowler position to maintain oxygen saturation at 90% ANS: C Appropriate weight gain for an infant is indicative of successful feeding and a reduction in caloric loss secondary to the HF. Irritability is a symptom of HF. The child also uses additional energy when irritable. Capillary refill should be brisk and within 2 to 3 seconds. The child needs to be positioned upright to maintain oxygen saturation at 90%. Pos

Complications of Guillain-Barre syndrome

AKA infectious polyneuritis - Acute demyelinating peripheral polyneuropathy w/ progressive paralysis -Typically 10d after nonspecific viral infection -less severe in children -self-limiting w/ 2d-2w for musc fxn, longer for full recovery b/c ongoing fatigue S/S from inflammation and edema of nerves Initial - musc tenderness, weakness, paresthesia Rapid ascending flaccid paralysis and loss of reflexes urinary incontinence/retention + constipation Immobility related fx Can affect BP, HR, RR Intercostal and Phrenic nerve involvement WHAT? Eventual difficulty swallowing and maintaining airway before resp insufficiency and death by resp/cardiac Tx w/ steroids, IVIG, Plasmapheresis Symptomatic relief 11. An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barr syndrome [GBS]). When explaining this disease process to the parents, what should the nurse consider? a. Paralysis is progressive with little hope for recovery. b. Disease is inherited as an autosomal, sex-linked, recessive gene. c. Disease results from an apparently toxic reaction to certain medications. d. Muscle strength slowly returns, and most children recover. ANS: D Recovery usually begins within 2 to 3 weeks, and most patients regain full muscle strength. The paralysis is progressive with proximal muscle weakness occurring before distal weakness. The recovery of muscle strength occurs in the reverse order of onset of paralysis. Most individuals regain full muscle strength. Better outcomes are associated with younger ages. GBS is an immune-mediated disease often associated with a number of viral or bacterial infections or the administration of vaccines 12. A 12-year-old child with Guillain-Barr syndrome (GBS) is admitted to the pediatric intensive care unit. She tells you that yesterday her legs were weak and that this morning she was unable to walk. After the nurse determines the current level of paralysis, which should the next priority assessment be? a. Swallowing ability b. Parental involvement c. Level of consciousness d. Antecedent viral infections ANS: A Assessment of swallowing is essential. Both pharyngeal involvement and respiratory function are usually involved at the same time. The child may require ventilatory support. The inability to swallow also contributes to aspiration pneumonia. Parental involvement is important after the physiologic assessment is complete. The child is answering questions and describing the onset of the illness, which demonstrates she is alert and oriented. Information regarding antecedent viral infections can be obtained after the child is assessed and stabilized.

Types of hemophilia

ANYTHING MORE? CANT FIND IN NOTES -Hemophilia A: deficiency in Factor VIII -Hemophilia B (Christmas disease): deficiency in Factor IX -Transmitted from mother to son; X linked recessive 21. What statement is descriptive of most cases of hemophilia? a. X-linked recessive deficiency of platelets causing prolonged bleeding b. X-linked recessive inherited disorder in which a blood clotting factor is deficient c. Autosomal dominant deficiency of a factor involved in the blood-clotting reaction d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped ANS: B 35. A child with hemophilia A will have which abnormal laboratory result? a. PT (ProTime) b. Platelet count c. Fibrinogen level d. PTT (partial thromboplastin time) ANS: D 39. The nurse is caring for a child with hemophilia A. The childs activity is as tolerated. What activity is contraindicated for this child? a. Ambulating to the cafeteria b. Active range of motion c. Ambulating to the playroom d. Passive range of motion exercises ANS: D

Treatment and signs and symptoms of Kawasaki disease

Acute systemic vasculitis most common in <5yo Diagnosis (4 of 5 with fever of 101+ for 5+ days) Erythema and sometimes peeling of palms/soles Bilateral conjunctivits w/o exudate Strawberry tongue Polymorphous rash - WHAT Cervical adenopathy (1+cm) MARKED irritability, high risk of coronary aneurysm, myocarditis, and MI self limiting BUT should... Tx with IVIG (within 10 days) and salicylate therapy (6-8 weeks) I/os to not overload heart soft loose clothing, mouth care, cold towels 31. When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care? a. Aspirin is contraindicated. b. The principal area of involvement is the joints. c. The childs fever is usually responsive to antibiotics within 48 hours. d. Therapeutic management includes administration of gamma globulin and salicylates. ANS: D High-dose intravenous gamma globulin and salicylate therapy are indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. The fever of Kawasaki disease is unresponsive to antibiotics. It is responsive to anti-inflammatory doses of aspirin and antipyretics. 32. Nursing care of the child with Kawasaki disease is challenging because of which occurrence? a. The childs irritability b. Predictable disease course c. Complex antibiotic therapy d. The childs ongoing requests for food ANS: A Patient irritability is a hallmark of Kawasaki disease and is the most challenging problem. A quiet environment is necessary to promote rest. The diagnosis is often difficult to make, and the course of the disease can be unpredictable. Intravenous gamma globulin and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to eat. Soft foods and fluids should be offered to prevent dehydration. 51. A child is recovering from Kawasaki disease (KD). The child should be monitored for which? a. Anemia b. Electrocardiograph (ECG) changes c. Elevated white blood cell count d. Decreased platelets ANS: B The most serious complication of KD is the development of coronary artery aneurysms and the potential for myocardial infarction in children with aneurysm formation. The nurse should monitor any ECG changes. 1. The nurse is caring for a child with Kawasaki disease in the acute phase. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Osler nodes b. Cervical lymphadenopathy c. Strawberry tongue d. Chorea e. Erythematous palms f. Polyarthritis ANS: B, C, E Clinical manifestations of Kawasaki disease in the acute phase include cervical lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic fever.

Risk factors for otitis media

Age (highest prev @ 3-6 months) Group childcare, Seasons of fall and winter, due to exposure to colds, flu, and increased allergens Babies fed from a bottle, especially lying down, or prop fed, pacifier use past 6 months Poor air quality (especially irritants in the air, e.g., cigarette smoke) Family history, Down syndrome Enlarged adenoids, Cleft palate 4. It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition? a. Otitis media b. Diabetes insipidus (DI) c. Nephrotic syndrome d. Acute rheumatic fever ANS: D Group A hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute streptococcal pharyngitis. 9. An infants parents ask the nurse about preventing otitis media (OM). What information should be provided? a. Avoid tobacco smoke. b. Use nasal decongestants. c. Avoid children with OM. d. Bottle- or breastfeed in a supine position. ANS: A

Complications of jaundice

COMPLICATIONS - PROBABY JUST WHAT IS STATED THOUGH 31. A new mother wants to be discharged with her infant as soon as possible. Before discharge, what should the nurse be certain of? a. The infant has voided at least once. b. The infant does not spit up after feeding. c. Jaundice, if present, appeared before 24 hours. d. A follow-up appointment with the practitioner is made within 48 hours. ANS: D The American Academy of Pediatrics recommends that newborns discharged early receive follow-up care within 48 hours in either a primary practitioners office or the home. The child should void every 4 to 6 hours. Spitting up small amounts after feeding is normal in newborns; it should not delay discharge. Jaundice within the first 24 hours of life must be evaluated. 8. What is an infant with severe jaundice at risk for developing? a. Encephalopathy b. Bullous impetigo c. Respiratory distress d. Blood incompatibility ANS: A Unconjugated bilirubin, which can cross the bloodbrain barrier, is highly toxic to neurons. An infant with severe jaundice is at risk for developing kernicterus or bilirubin encephalopathy. Bullous impetigo is a highly infectious bacterial infection of the skin. It has no relation to severe jaundice. A blood incompatibility may be the causative factor for the severe jaundice. 9. When should the nurse expect breastfeeding-associated jaundice to first appear in a normal infant? a. 2 to 12 hours b. 12 to 24 hours c. 2 to 4 days d. After the fifth day ANS: C Breastfeeding-associated jaundice is caused by decreased milk intake related to decreased caloric and fluid intake by the infant before the mothers milk is well established. Fasting is associated with decreased hepatic clearance of bilirubin. Zero to 24 hours is too soon; jaundice within the first 24 hours is associated with hemolytic disease of the newborn. After the fifth day is too late. Jaundice associated with breastfeeding begins earlier because of decreased breast milk intake.

Education for teens related to STI's

EASY LOOK FOR IT 40. A sexually active adolescent asks the school nurse about prevention of sexually transmitted infections (STIs). What should the nurse recommend? a. Use of condoms b. Prophylactic antibiotics c. Any type of contraception method d. Withdrawal method of contraception ANS: A When used appropriately, condoms provide a barrier to the organisms that cause STIs. Prophylactic antibiotics are not recommended; they are effective only against bacteria, not viruses. Only condoms create a physical barrier that prevents contact with the organisms. 41. What statement is true about gonorrhea? a. It is caused by Treponema pallidum. b. Treatment of all sexual contacts is essential. c. Topical application of medication to the lesions is necessary. d. Therapeutic management includes multidose administration of penicillin. ANS: B The treatment plan should include finding and treating all sexual partners. Gonorrhea is caused byNeisseria gonorrhoeae. Syphilis is caused by T. pallidum. Systemic therapy is necessary to treat this disease. Primary treatment is with different antibiotics because of N. gonorrhoeaes resistance to penicillin 42. What statement regarding chlamydial infections is correct? a. The treatment of choice is oral penicillin. b. The treatment of choice is nystatin or miconazole. c. Both men and women may have asymptomatic infections. d. Clinical manifestations include small, painful vesicles on the genital areas. ANS: C The incidence of asymptomatic chlamydial infections is as high as 50% of men and 75% of women. Symptoms of chlamydial infection in men include meatal erythema, tenderness, itching, dysuria, and urethral discharge. Oral penicillin, nystatin, and miconazole are not the antibiotics of choice. Small, painful vesicles on genital areas are clinical manifestations of herpetic infections. 43. What is true about pelvic inflammatory disease (PID)? a. It can be prevented by proper personal hygiene. b. It is easily prevented by compliance with any form of contraception. c. It may have devastating effects on the reproductive tract of affected adolescents. d. It can potentially cause life-threatening and serious defects in the future children of affected adolescents. ANS: C 44. It is important that women with anogenital warts caused by the human papillomavirus (HPV) receive adequate treatment because this sexually transmitted infection increases the risk of what? a. Gonorrhea b. Cervical cancer c. Chlamydial infection d. Urinary tract infection ANS: B

Assessing pediatric patient with a bone fracture - characteristics and complications

FIND SOMETHING PLEASE

Skins lesions - macule, papule, vesicle

Flat nonpalpable - Macule (<1cm ie freckle, rubella, petechiae) or Patch (>1cm ie vitiligo or mongolian spot) Elevated, firm spot - Papule (<1cm ie warts) or Nodule (1-2cm, deeper in dermis Mat Pat flat, Pano Macule - Flat, brown mole less than 1 cm in diameter Papule - A papule is elevated; palpable; firm; circumscribed; less than 1 cm in diameter; and brown, red, pink, tan, or bluish red Vesicle - A vesicle is elevated, circumscribed, superficial, less than 1 cm in diameter, and filled with serous fluid.

Fluid imbalance causes in infants and children

GIVE SOME NOTES, PRETTY SELF EXPLANITORY ITS ON THERE GREAT LIST 3. What factor predisposes an infant to fluid imbalances? a. Decreased surface area b. Lower metabolic rate c. Immature kidney functioning d. Decreased daily exchange of extracellular fluid ANS: C The infants kidneys are functionally immature at birth and are inefficient in excreting waste products of metabolism. Infants have a relatively high body surface area (BSA) compared with adults. This allows a higher loss of fluid to the environment. A higher metabolic rate is present as a result of the higher BSA in relation to active metabolic tissue. The higher metabolic rate increases heat production, which results in greater insensible water loss. Infants have a greater exchange of extracellular fluid, leaving them with a reduced fluid reserve in conditions of dehydration. 5. Which is true regarding an infants kidney function? a. Conservation of fluid and electrolytes occurs. b. Urine has color and odor similar to the urine of adults. c. The ability to concentrate urine is less than that of adults. d. Normally, urination does not occur until 24 hours after delivery. At birth, all structural components are present in the renal system, but there is a functional deficiency in the kidneys ability to concentrate urine and to cope with conditions of fluid and electrolyte stress such as dehydration or a concentrated solute load. Infants urine is colorless and odorless. The first voiding usually occurs within 24 hours of delivery. Newborns void when the bladder is stretched to 15 ml, resulting in about 20 voidings per day. Phototherapy and radiant warmers can cause it, vomiting, diarrhea, diabetes esp. ketoacidosis, strenuous exercise, heatstroke

Recommended immunizations for pediatric population

Hep B (3) MMR (2) Varicella (2) Dtap (5)- first @ 2 months, none after 7y IPV (4) PCV13 (4) - 1,2,4,6, no severe illness HiB (4) - no <6 weeks or severe illness, no older than 6 (little risk) HPV (3)- NO <11yo HZV - prior shingles or 60+ TDap - if caring for <2yo and booster q10y w/ exposure PCV23 for at risk MORE IN DEPTH SCHEDULE PLZ 2. A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. What should the nurse explain? a. This cannot be prevented. b. Infants do not feel pain as adults do. c. This is not a good reason for refusing immunizations. d. A topical anesthetic can be applied before injections are given. ANS: D 4. The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine? (Select all that apply.) a. The hepatitis B vaccination series should be begun at birth. b. The adolescent not vaccinated at birth does not have a need to be vaccinated. c. Any child not vaccinated at birth should receive two doses at least 4 months apart. d. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart. ANS: A, D 5. The nurse is planning to administer immunizations to a 6-month-old infant. Which interventions should the nurse implement to minimize local reactions from the vaccines? (Select all that apply.) a. Select a needle length of 1 inch. b. Administer in the deltoid muscle. c. Inject the vaccine into the vastus lateralis. d. Draw the vaccine up from a vial with a filter needle. e. Change the needle on the syringe after drawing up the vaccine and before injecting. ANS: A, C 27. What immunization is recommended for all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines ANS: B 13. Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which therapeutic intervention? a. Restrict oral fluids. b. Institute strict isolation. c. Use good hand-washing technique. d. Give immunizations appropriate for age. ANS: C Good hand washing minimizes the exposure to infectious organisms and decreases the chance of infection spread. Oral fluids are encouraged if the child is able to drink. If possible, the intravenous route is not used because of the increased risk of infection from parenteral fluid administration. Strict isolation is not indicated. When the child is immunocompromised, the vaccines are not effective. If necessary, the appropriate immunoglobulin is administered.

Signs and symptoms of hydrocephalus/plagiocephaly

Hydrocephalus is WHAT S/S are WHAT Plagiocephaly is flattening of a side of childs head from prolonged pressure, and can cause facial asymmetry WHAT ELSE 34. What clinical manifestations suggest hydrocephalus in an infant? a. Closed fontanel and high-pitched cry b. Bulging fontanel and dilated scalp veins c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure ANS: B Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. A closed fontanel, high-pitched cry, constant low-pitched cry, restlessness, a depressed fontanel, and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation. 35. A pregnant woman asks about prenatal diagnosis of hydrocephalus. The nurses response should be based on which knowledge? a. It can be diagnosed only after birth. b. It can be diagnosed by chromosome studies. c. It can be diagnosed with fetal ultrasonography. d. It can be diagnosed by measuring the lecithin-to-sphingomyelin ratio. ANS: C Hydrocephalus can be diagnosed by fetal ultrasonography as early as 14 weeks of gestation. Most incidents of hydrocephalus are not chromosomal in origin. The lecithin-to-sphingomyelin ratio can be used to determine fetal lung maturity. 39. A 6-year-old child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What sign or symptom does the child have that indicates a revision is necessary? a. Tachycardia b. Gastrointestinal upset c. Hypotension d. Alteration in level of consciousness ANS: D In older children, who are usually admitted to the hospital for elective or emergency shunt revision, the most valuable indicators of increasing intracranial pressure are an alteration in the childs level of consciousness, complaint of headache, and changes in interaction with the environment. 20. After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which pediatric issues? a. Sudden infant death syndrome (SIDS) b. Plagiocephaly c. Failure to thrive d. Apnea of infancy ANS: B Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.

Treatment of precocious puberty

LOOK INTO THIS 6. A child will start treatment for central precocious puberty. What synthetic hormone will be injected? a. Thyrotropin b. Gonadotropins c. Somatotropic hormone d. Luteinizing hormonereleasing hormone ANS: D Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormonereleasing hormone, which regulates pituitary secretions. Thyrotropin, gonadotropins, and somatotropic hormone are not the appropriate therapies for precocious puberty.

Signs and symptoms and complications of PDA

MORE 19. The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication? a. Hypoxemia b. Right-to-left shunt of blood c. Decreased workload on the left side of the heart d. Pulmonary vascular congestion ANS: D In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular congestion. Hypoxemia usually results from defects with mixed blood flow and decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure would stop this. There is increased workload on the left side of the heart with a PDA.

Clinical manifestations of scoliosis

Often noticed during pre-pubescent growth spurt, family hx Note discrepancy of scapula and hip height and alignment, shape and asymmetry of flanks + ribs when bending down complaints of poorly fitting clothes MORE? JUST A BIT? Sociometer can measure rotation Xray to confirm 28. What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? a. Scoliosis b. Lordosis c. Kyphosis d. Ankylosis ANS: C 29. When does idiopathic scoliosis become most noticeable? a. In the newborn period b. When the child starts to walk c. During the preadolescent growth spurt d. During adolescence ANS: C

Sign and symptoms for allergic reaction

Runny nose/sneezing/watery or inflamed eyes Rashes/eczema/hives/urticaria N/V/cramps laryngospasm/difficulty breathing shock Anaphylactic (Type I): With Type I reactions, the symptoms will appear almost immediately and include reactions to pollen, dust, animal dander, and food. These reactions can range from your run-of-the-mill daily allergies to more serious reactions such as anaphylactic shock. Cytotoxic (Type II): Unlike Type I, these symptoms appear within minutes to hours of contact with the allergen. Your immune system creates antibodies that damage cells by activating what is called the "complement system" to fight off the allergen in your body, leading to inflammation. This cell damage can lead to conditions including anemia (lack of red blood cells) and Graves' disease (the overproduction of thyroid hormones). Immunocomplex (Type III): These symptoms appear after several hours. The antibodies react with the allergens to form immune complexes. This is common in diseases like lupus, an autoimmune disease where the person's immune system attacks vital cells and organs disrupting function. Symptoms can include high fever, abdominal or chest pain, and swelling in the limbs. Medical care should be sought out if these symptoms appear. Cell-mediated (Type IV): Also known as "delayed hypersensitivity," the symptoms won't appear until hours or days after the exposure and are usually connected with bacterial diseases. 8. The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. What nursing action is most appropriate to initiate? a. Recheck the rate of drug infusion. b. Stop the drug infusion immediately. c. Observe the child closely for next 10 minutes. d. Explain to the child that this is an expected side effect. ANS: B When an allergic reaction is suspected, the drug is immediately discontinued. Any drug in the line should be withdrawn, and a normal saline infusion begun to keep the line open. The intravenous infusion is stopped to minimize the amount of drug that infuses. The infusion rate can be confirmed at a later time. Observation of the child for 10 minutes is essential, but it is done after the infusion is stopped. These signs are indicative of an allergic reaction, not an expected response.

Nursing priorities when caring for seizure patient

SEIZURE PRECAUTIONS 1. The nurse is caring for a 12-year-old child who is on fall precautions secondary to seizures. What interventions should be included in the childs care plan? (Select all that apply.) a. Place a call light and desired items within reach. b. Keep the bed in the highest position with the two side rails up. c. Turn off the lights and television at night. d. Keep personal belongings and clutter contained in one area of the floor. e. Have the child wear an appropriate-size gown and nonskid footwear. ANS: A, E 28. What is important to incorporate in the plan of care for a child who is experiencing a seizure? a. Describe and record the seizure activity observed. b. Suction the child during a seizure to prevent aspiration. c. Place a tongue blade between the teeth if they become clenched. d. Restrain the child when seizures occur to prevent bodily harm. ANS: A 29. 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. What is the most appropriate initial action by the school nurse? a. Stay with child and have someone else call emergency medical services (EMS). b. Notify the parent and regular practitioner. c. Notify the parent that the child should go home. d. Stay with the child, offering calm reassurance. ANS: A Because this is the childs first seizure and it lasted more than 5 minutes, EMS should be called to transport the child, and evaluation should be performed as soon as possible. The nurse should stay with the recovering child while someone else notifies EMS. 32. The nurse is teaching the parents of a 3-year-old child who has been diagnosed with tonic-clonic seizures. What statement by the parent should indicate a correct understanding of the teaching? a. I should attempt to restrain my child during a seizure. b. My child will need to avoid contact sports until adulthood. c. I should place a pillow under my childs head during a seizure. d. My child will need to be taken to the emergency department [ED] after each seizure. ANS: C Parents should try to place a pillow or folded blanket under the childs head for protection. The parent should not try to restrain the child during the seizure. The child does not need to go to the ED with each seizures; the nurse can teach parents certain criteria for when their child would need to be seen. Discussing what will happen in adulthood is not appropriate at this time. 42. A 2-year-old child starts to have a tonic-clonic seizure. The childs jaws are clamped. What is the most important nursing action at this time? a. Place a padded tongue blade between the childs jaws. b. Stay with the child and observe his respiratory status. c. Prepare the suction equipment. d. Restrain the child to prevent injury. ANS: B It is impossible to halt a seizure once it has begun, and no attempt should be made to do so. The nurse must remain calm, stay with the child, and prevent the child from sustaining any harm during the seizure. The nurse should not move or forcefully restrain the child during a tonic-clonic seizure and should not place a solid object between the teeth. Suctioning may be needed but not until the seizure has ended. 39. The nurse is caring for a child with tetanus during the acute phase. What should the nurse plan in the care for this child? a. Playing music on a radio b. Giving frequent back rubs c. Providing bright lighting in the room d. Clustering nursing care to limit distractions ANS: D In caring for a child with tetanus during the acute phase, every effort should be made to control or eliminate stimulation from sound, light, and touch. Although a darkened room is ideal, sufficient light is essential so that the child can be carefully observed; light appears to be less irritating than vibratory or auditory stimuli. The infant or child is handled as little as possible, and extra effort is expended to avoid any sudden or loud noise to prevent seizures

Types of immunities after immunization Natural vs Artificial Passive vs Active

WAS THERE A QUESTION ON OUR SELF-ASSESSMENTS? Passive immunity is introduced from outside body, short term, and no memory cells but takes effect immediately Active immunity takes effect over time (weeks) but lasts long-term to lifelong through creation of memory cells, is produced inside body Natural Active Immunity - highly complex immune system involving T and B cells ETC. Natural passive immunity - pregnancy and breastfeeding Artificial active immunity - when exposed to vaccination Artificial passive - IgG Passive vs Active Active - produced by own body system, lasts years-life Passive - immunity from other source ie. injection of IgG -rabies, tetanus, varicella, smallpox common Artificial - antibodies are produced elsewhere Natural immunity - innate immunity or resistance to infection or toxicity Acquired immunity - immunity from exposure to the invading agent ie bacterial/virus/toxin Active immunity - A state in which immune bodies are actively formed against specific antigens, either naturally by having had the disease or artificially Passive Immunity - Temporary immunity from the mother to the fetus via the placenta Herd Immunity - A majority of the population is vaccinated, and the spread of certain diseases is stopped

How to decrease risk for Reye syndrome

dont take aspirin (what age?) younger than 16y ESPECIALLY when recovering from chickenpox/flu-like symptoms 7. Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39 C (102.2 F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what medication? a. Decongestants to ease stuffy nose b. Antihistamines to help the child sleep c. Aspirin for pain and fever management d. Benzocaine ear drops for topical pain relief ANS: D 24. What intervention should be beneficial in reducing the risk of Reye syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin for children with varicella or those suspected of having influenza ANS: D 47. When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised if a week ago the child had recovered from what? a. Measles b. Influenza c. Meningitis d. Hepatitis ANS: B 48. If an intramuscular (IM) injection is administered to a child who has Reye syndrome, the nurse should monitor for what? a. Bleeding b. Infection c. Poor absorption d. Itching at the injection site ANS: A The nurse should watch for bleeding from the site. Because of related liver dysfunction with Reye syndrome, laboratory studies, such as prolonged bleeding time, should be monitored to determine impaired coagulation.

Morbidity/mortality statistics

mortality -number of deaths per 1000 Neonatal (first 28d) - Congenital, LBW, RDS, Maternal comps Infant (first 1y) - SIDS, congenital, Injuries, infection, homicide After 1y accident-related injuries are most common -falls when able to rollover -Asphyxiation from crawling/swallowing -water/traffic once mobile -MVAs once late childhood/adolescence OVERALL motor 1st, drowning 2nd -low birth weight (>2500g) -> premature= #1 cause of death-neonates most vulnerable for mortality WHAT??? I THOUGHT IT WAS CONGENITAL 1. The clinic nurse is reviewing statistics on infant mortality for the United States versus other countries. Compared with other countries that have a population of at least 25 million, the nurse makes which determination? a. The United States is ranked last among 27 countries. b. The United States is ranked similar to 20 other developed countries. c. The United States is ranked in the middle of 20 other developed countries. d. The United States is ranked highest among 27 other industrialized countries. ANS: A Although the death rate has decreased, the United States still ranks last in infant mortality among nations with a population of at least 25 million. The United States has the highest infant death rate of developed nations. 6. What do mortality statistics describe? a. Disease occurring regularly within a geographic location b. The number of individuals who have died over a specific period c. The prevalence of specific illness in the population at a particular time d. Disease occurring in more than the number of expected cases in a community ANS: B Mortality statistics refer to the number of individuals who have died over a specific period. 5. The nurse is planning a teaching session to adolescents about deaths by unintentional injuries. Which should the nurse include in the session with regard to deaths caused by injuries? a. More deaths occur in males. b. More deaths occur in females. c. The pattern of deaths does not vary according to age and sex. d. The pattern of deaths does not vary widely among different ethnic groups. ANS: A 4. In addition to injuries, what are the leading causes of death in adolescents ages 15 to 19 years? a. Suicide and cancer b. Suicide and homicide c. Drowning and cancer d. Homicide and heart disease ANS: B 3. What is the major cause of death for children older than 1 year in the United States? a. Heart disease 2 b. Childhood cancer c. Unintentional injuries d. Congenital anomalies ANS: C 2. Which is the leading cause of death in infants younger than 1 year in the United States? a. Congenital anomalies b. Sudden infant death syndrome c. Disorders related to short gestation and low birth weight d. Maternal complications specific to the perinatal period ANS: A 7. The nurse should assess which age group for suicide ideation since suicide in which age group is the third leading cause of death? a. Preschoolers b. Young school age c. Middle school age d. Late school age and adolescents ANS: D