2240 Final

What are some characteristics of severe dehydration?

-Anuria -Sunken fontanels

What might a parent report about a child that would indicate the evaluation for leukemia?

-Bone and joint pain -Petechiae -Weight loss -Bruising without cause

What diet recommendations should a nurse make to an adolescent pt to manage constipation related to opioid analgesic administration?

-Bran cereal -Prune juice -Vegetables

The nurse is assessing a child with severe cystic fibrosis. What would she see as manifestations?

-Bulky, frothy, foul smelling stools -Growth failure -Dry, nonproductive cough

What are indicators that fluid volume deficit is resolving?

-Cap refill less than 2 seconds -specific gravity of 1.003 to 1.030 -urine output of at least 1 ml/kg/hr -adequate tear production

Which describe avoidance behaviors a parent may exhibit when learning that his or her child has a chronic condition

-Refuses to agree to treatment -Withdraws from outside world -Punishes self because of guilt and shame

The nurse is monitoring a pt for side effects associated with with opioid analgesics. What side effects should the nurse expect to monitor for?

-Respiratory depression -Pruritus -Sweating

A nurse is admitting a child who has cystic fibrosis. What medications should the nurse include in the plan of care?

-Tobramycin -Fat soluble vitamins -Albuterol -Donase alfa

A nurse is performing an admission assessment for a child with cystic fibrosis. What findings should the nurse expect?

-Wheezing -Clubbing of fingers and toes -Barrel shaped chest

What A1c is the goal for a child with type 1 DM?

7

The nurse employed in a neonatal intensive care nursery receives a telephone call from the delivery room and is told that a newborn with spina bifida (myelomeningocele type) will be transported to the nursery. The maternity nurse prepares for the arrival of the newborn and places which priority item at the newborn's bedside?

A bottle of sterile NS

The nurse is caring for a child receiving IV morphine for severe postop pain. The nurse observes a lower respiratory rate, and the child can't be aroused. What would be the nurse's most appropriate action?

Administer naloxone (narcan)

A nurse is providing discharge teaching for a child with cystic fibrosis. What instructions should the nurse include?

Administer pancreatic enzymes with meals and snacks

The nurse is creating a plan of care for a newborn infant with spina bifida (myelomeningocele type). The nurse includes assessment measures in the plan to monitor for increased intracranial pressure. Which assessment technique should be performed that will best detect the presence of an increase in intracranial pressure?

Assess anterior fontanel for bulging

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. What would be the best response?

Being angry is only natural

What lab result confirms the diagnosis of lymphocytic leukemia?

Bone marrow biopsy showing blast cells

What indicates increased ICP in a newborn?

Bulging or taut anterior fontanel

A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted?

Cap refill is less than 2 seconds

A pediatrician prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription?

Checks the amount of urine output

Which represents a common best practice in the provision of services to children with chronic or complex conditions?

Children with complex conditions are integrated into regular classrooms

A nurses recommendation about mainstreaming a child with down syndrome should be based on what?

Children with down syndrome have the same need for socialization as other children

Chris, age 9, has several physical disabilities. His father explains to the nurse that his son concentrates on what he can rather than can't do and is as independent as possible. What does the nurse conclude?

Chris is using an adaptive coping style

When caring for a newborn with down syndrome, the nurse should be aware that what is the most common congenital anomaly associated with down syndrome?

Congenital heart disease

A 2-year-old child with acute diarrhea has been diagnosed with mild dehydration. Which rehydration methods would the nurse expect the primary health care provider to prescribe?

Consume oral rehydration fluid, advancing to a regular diet

In providing nourishment for a child with CF, what factor should the nurse keep in mind?

Diet should be high in carbs and protein

A newborn assessment shows separated saggital sutures, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. What diagnosis would the nurse expect?

Down syndrome

What is an assessment characteristic of moderate dehydration?

Dry mucous membranes

The nurse is caring for an infant with spina bifida (myelomeningocele type) who had the sac on the back containing cerebrospinal fluid, the meninges, and the nerves (gibbus) surgically removed. The nursing plan of care for the postoperative period should include which action to maintain the infant's safety?

Elevating the head with the infant in prone position

Pancreatic enzymes are administered to a child with CF. What would be a nursing consideration?

Enzymes can be swallowed whole or sprinkled on a small amount of food to be taken at the beginning of a meal

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on knowledge that discipline is which of the following?

Essential for the child

True or false: Infants are more vulnerable to fluid volume deficit because less of their body water is in the extracellular fluid compartment.

False

What's considered a cardinal sign of DM?

Frequent urination

Child is admitted for diabetic ketoacidosis. What assessment findings should the nurse expect?

Fruity breath order and decreasing LOC

After the shock phase after a chronic diagnosis of a child, there's a period of adjustment. What helps explain the period of adjustment?

Guilt and anger

During the first 4 days of hospitalization, Erich, age 18 months, cried inconsolably when his parents left him, and he refused the staff's attention. Now the nurse observes that Erich appears to be "settled in" and unconcerned about seeing his parents. The nurse should interpret this as which of the following?

He may be experiencing detachment, which is the third stage of separation anxiety

A nurse is teaching the parent of an infant who has Down Syndrome. What statement by the parent indicates an understanding of the teaching?

I should place a cool mist humidifier in his room

What statement expresses accurately the genetic implications of cystic fibrosis?

If it's present in a child, both parents are carriers of this defective gene

Platelet count for a child with leukemia is 19,500. What interventions should the nurse include in the plan of care?

Initiate bleeding precautions

Bone marrow is administered by what route?

Intravenous infusion

A nurse is teaching a group of caregivers about separation anxiety. Which of the following information should the nurse include in the teaching?

Kicking a stranger is an example

When pain is assessed in an infant, what would be inappropriate for the nurse to assess?

Localization of pain

Kyle, age 6 months, is brought to the clinic. His parent says, "I think he hurts. He cries and rolls his head from side to side a lot." This most likely suggests which feature of pain?

Location

What immunization shouldn't be given to a child receiving chemo for cancer?

MMR

A child with CF is receiving recombinant human deoxyribonuclease (rhDNase). This drug: a. may cause mucus to thicken. b. may cause voice alterations. c. is given subcutaneously. d. is not indicated for children younger than 12 years.

May cause voice alterations

Parents have learned that their 6 year old has autism. The nurse may help the parents to cope by explaining that the child may have what?

May have an extremely developed skill in a particular area

What should the pediatric nurse understand about nonpharmacologic strategies for pain management?

May reduce pain perception

What's the earliest recognizable clinical manifestation of cystic fibrosis (CF)?

Meconium ileus

Would metabolic acidosis or alkalosis occur in a child with diarrhea?

Metabolic acidosis

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem?

Metabolic alkalosis

Weight loss less than 5 percent is what level of dehydration?

Mild

Weight loss of 5 to 10 percent is what level of dehydration?

Moderate

A child admitted to the hospital with a diagnosis of gastroenteritis and dehydration weighs 17 lb 2 oz (7.8 kg). The parents state that his preadmission weight was 18 lb 4 oz (8.3 kg). Based on weight alone, what type of dehydration does the nurse expect?

Moderate dehydration

What drug is usually the best choice for patient controlled analgesia (PCA) for a child in the immediate postop period?

Morphine

A child has diabetic ketoacidosis. What type of IV infusion should the nurse plan to administer?

NS

What would a nurse need to know about physiologic measurements in children's pain assessment?

Of limited value as sole indicator of pain

What's characteristic of type 1 DM?

Onset is usually younger than 18

The nurse is caring for an infant with gastroenteritis who is being treated for dehydration. The nurse reviews the health record and notes that the primary health care provider has documented that the infant is mildly dehydrated. Which assessment finding should the nurse expect to note in mild dehydration?

Pale skin color

The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. How should the nurse respond?

Patiently continue to answer questions

Most parents of children with special needs tend to experience chronic sorrow. What explains chronic sorrow?

Periods of intensified sorrow and loss that occur in waves over time

Kelly, age 8 years, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. What is the most appropriate action by the school nurse?

Preparing Kelly's classmates and teachers for changes they can expect

When assessing a child for the extent of dehydration, the nurse would note which of the following as severe dehydration?

Resp: deep and rapid, Tears: absent; sunken eyes, Anterior fontanel: sunken

What is a priority nursing diagnosis for the preschool child with chronic illness?

Risk for delayed growth and development related to chronic illness or disability

An appropriate nursing diagnosis for a child with a cognitive dysfunction who has a limited ability to anticipate danger would be what?

Risk for injury

Weight loss of greater than 10 percent is what level of dehydration?

Severe

A nurse is reviewing the diagnostic findings for a preschool age child who's suspected of having cystic fibrosis. What finding should the nurse recognize as an indication?

Sweat chloride content 85

CF is suspected in a toddler. Which of the following tests is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

Sweat chloride test

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. Which of the following would the nurse want to teach the parents?

Terminally ill children know when they are seriously ill

A nurse is providing a parent info regarding autism. What statement by the parent indicates understanding?

The onset usually occurs before 3 years of age

What causes down syndrome?

There is no known cause

What should a nurse keep in mind when planning to communicate with a child who has autism?

They may exhibit monotone speech and echolalia

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. The nurse should explain which of the following to the parents?

This is part of normal adolescence

True or false: The nurse caring for a child with a neural tubal defect (myelomengocele) would want to be aware that there is at high risk for latex allergy.

True

What is the most descriptive pathophysiology of leukemia?

Unrestricted proliferation of immature WBCs occurs

What is a myelomeningocele?

a type of spina bifida that results from failure of the neural tube to close during embryonic development.

What is spina bifida?

central nervous system defect that results from failure of the neural tube to close during embryonic development.

The nurse is caring for a newborn infant with spina bifida (myelomeningocele) who is scheduled for surgical closure of the sac. In the preoperative period, which is the priority problem?

infection

What occurs with myelomeningocele?

protrusion of the meninges, cerebrospinal fluid, nerve roots, and a portion of the spinal cord

What lab finding in a child with type 1 DM indicates they are experiencing diabetic ketoacidosis?

Low arterial pH

The nurse assesses a two-year-old child hospitalized child with a serious gastroenteritis that was hospital-acquired (nosocomial). The nurse knows this gastroenteritis is caused by what virus?

Rotavirus

The child with down syndrome should be evaluated for what before participating in some sports?

Atlantoaxial instability

The nurse is talking with the parent of a child newly diagnosed with a chronic illness. The parent is upset and tearful. The nurse asks, "With whom do you talk when something is worrying you?" How would the nurse's response be interpreted?

Part of assessing patient's available support system

Nursing interventions to help the siblings of a child with a complex or chronic condition cope would include which of the following?

Suggesting to the parents ways of showing gratitude to the siblings who help care for the child with a disability or chronic condition.

What assessment indicates to a nurse that a 2 year old is in need of pain medication?

The child is lying rigidly in bed and not moving

When assessing pain in any child, what should the nurse consider?

The child's behavioral, physiologic, and verbal responses are valuable when assessing pain

Lindsey, age 5, will be starting kindergarten next month. She has cerebral palsy and needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they didn't realize her disability is so severe. The best interpretation of this situation is what?

This is a normal anticipated time of parental stress

The nurse caring for a child in pain must understand what about using distraction?

Must be developmentally appropriate to refocus attention

A nurse on a pediatric unit is caring for a toddler. Which of the following behaviors is an effect of hospitalization?

-Experiences separation anxiety. -Displays intense emotions. -Exhibits regressive behaviors.

How should you manage a diabetic child who is sick?

-Monitor glucose every 3 hours -Test urine for ketones -Call provider if glucose is greater than 240

A nurse is planning care for an infant experiencing pain. What interventions should the nurse include in the plan of care?

-Offer a pacifier -Use swaddling -Encourage kangaroo care

The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Who should the nurse invite to the conference?

Family and key health professionals involved in child's care

A school aged child with leukemia experienced severe nausea and vomiting when receiving chemo for the first time. What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?

Administer an antiemetic before therapy begins

A nurse is teaching the parents of a down syndrome child about atlantoaxial instability? What are some signs and symptoms?

-Persistent neck pain -Loss of established motor skills -Loss of established bowel or bladder control -Changes in sensation

A nurse is assessing a child who has leukemia. What are early manifestations?

-Petechiae -Anorexia -Unsteady gait

What are nursing interventions for a child with leukemia who's at risk for infection?

-Reduce exposure to environmental organisms -Use strict aseptic technique for all procedures -Ensure that anyone entering the child's rook wears a mask

A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of therapeutic play

-Allows the child to express feelings -The nurse can gain insight into the child's feelings -The child can deal with concerns and feelings

What interventions should the nurse implement for a child older than 2 with type 1 DM that has a glucose of 60?

-Give the child a tsp of honey -Prep to administer glucagon subcutaneously if child loses consciousness

What are manifestations of hypoglycemia?

-Hunger -Irritability

What medications are the most effective choices for treating pain associated with inflammation in children?

-Ibuprofen -Ketorolac

A nurse is assessing an infant. What are manifestations of pain?

-Loud cry -Lowered eyebrows -Rigid body

Urine is positive for ketones. Mother should take what actions?

Encourage child to drink liquids

What intervention will encourage a sense of autonomy in toddlers with disabilities?

Encouraging independence in as many areas as possible

When taking care of a newborn with a myelomeningocele, the nurse know which of the following would be done to protect the protruding sac?

-Keep the infant in a prone position -Protect the sac with a sterile, moist NS dressing -Keep the dressing cover clean

The diagnostic criteria for autism include delayed or abnormal functioning in what areas before 3 years of age?

-Language as used in social communication -Symbolic or imaginative play -Social interaction

Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness?

Give child as much control as possible

A common parental reaction to a child with special needs is parental overprotection. What behavior demonstrates this?

Giving inconsistent discipline

A child has type 1 DM. What are manifestations of ketoacidosis?

-Dehydration -Mental confusion -Fruity breath

The nurse is preparing to give oral care to a school age child with mucositis secondary to chemo administered to treat leukemia. What preparations should the nurse use for oral care for this child?

-Chlorhexidine gluconate (Peridex) -Antifungal troches (lozenges) -Lip balm (aquaphor)

The nurse is assessing a child who has presented in the clinic with diarrhea. The nurse understands which of the following are risks for a child with diarrhea?

-Dehydration -Loss of fluid and electrolytes -Metabolic acidosis

Which of the following deficits would the nurse be assessing for when a child has a neural tube defect, such as, myelomeningocele?

-Dislocated hips -Hydrocephalus -Clubfoot -Sensori motor disturbances

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent: a. infection. b. brain tumor. c. drug side effects. d. central nervous system (CNS) disease.

CNS disease