414 Peds Finals Exam

A child is receiving vincristine (Oncovin). The nurse should monitor for which side effect of this medication? a. Diarrhea b. Photosensitivity c. Constipation d. Ototoxicity

ANS: A Vincristine, and to a lesser extent vinblastine, can cause various neurotoxic effects. One of the more common neurotoxic effects is severe constipation caused from decreased bowel innervation.

What strategies should the nurse implement to increase nutritional intake for the child receiving chemotherapy? (Select all that apply.) a. Allow the child any food tolerated. b. Fortify foods with nutritious supplements. c. Allow the child to be involved in food selection. d. Encourage the parents to place pressure on the importance of eating. e. Encourage the child to eat favorite foods during infusion of chemotherapy medications.

ANS: A, B, C To increase nutritional intake for the child receiving chemotherapy, the nurse should allow the child any food tolerated, fortify foods with nutritious supplements, and allow the child to be involved in food selection. The parents should be encouraged to reduce pressure placed on eating. Some children develop aversions to certain foods if they are eaten during chemotherapy. It is best to refrain from offering the child's favorite foods while the child is receiving chemotherapy.

The treatment of brain tumors in children consists of which therapies? (Select all that apply.) a. Surgery b. Bone marrow transplantation c. Chemotherapy d. Stem cell transplantation e. Radiation f. Myelography

ANS: A, C, E Treatment for brain tumors in children may consist of surgery, chemotherapy, and radiotherapy alone or in combination. Bone marrow and stem cell transplantation therapies are used for leukemia, lymphoma, and other solid tumors where myeloablative therapies are used. Myelography is a radiographic examination after an intrathecal injection of contrast medium. It is not a treatment.

What finding is characteristic of fractures in children? a. Fractures rarely occur at the growth plate site because it absorbs shock well. b. Rapidity of healing is inversely related to the child's age. c. Pliable bones of growing children are less porous than those of adults. d. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.

ANS: B Healing is more rapid in children. The younger the child, the more rapid the healing process. Nonunion of bone fragments is uncommon except in severe injuries. The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma. Children's bones are more pliable and porous than those of adults. This allows them to bend, buckle, and break. The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact. The adult periosteum is thinner, is weaker, and has less osteogenic potential than that of a child.

Melena, the passage of black, tarry stools, suggests bleeding from which source? a. The perianal or rectal area b. The upper gastrointestinal (GI) tract c. The lower GI tract d. Hemorrhoids or anal fissures

ANS: B Melena is denatured blood from the upper GI tract or bleeding from the right colon. Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright red.

The parents of a neonate with adrenogenital hyperplasia tell the nurse that they will be afraid to have any more children. The nurse should explain that: a. it is not hereditary. b. genetic counseling is indicated. c. it can be prevented during pregnancy. d. all future children will have the disorder.

ANS: B Some forms of adrenogenital hyperplasia are hereditary and should be referred for genetic counseling. Affected offspring should also be referred for genetic counseling.

A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long? a. 2 weeks b. 4 weeks c. 6 weeks d. 8 weeks

ANS: B The approximate healing times for a femoral shaft fracture are as follows: neonatal period, 2 to 3 weeks; early childhood, 4 weeks; later childhood, 6 to 8 weeks; and adolescence, 8 to 12 weeks.

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child? a. It is unnecessary because of child's age. b. It is essential because it will be an adjustment. c. Preparation is not needed because the colostomy is temporary. d. Preparation is important because the child needs to deal with negative body image.

ANS: B The child's age dictates the type and extent of psychologic preparation. When a colostomy is performed, it is necessary to prepare the child who is at least preschool age by telling him or her about the procedure and what to expect in concrete terms, with the use of visual aids. The preschooler is not yet concerned with body image.

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland? a. Thyroid gland b. Adrenal cortex c. Anterior pituitary d. Parathyroid glands

ANS: B The glucocorticoids, mineralocorticoids, and sex steroids are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The parathyroid glands produce parathyroid hormone.

A child is having tests done to determine parathyroid function. The clinic nurse knows that the parathyroid hormone (PTH) regulates the homeostasis of what in the serum? a. Sodium b. Calcium c. Potassium d. Magnesium

ANS: B The parathyroid glands secrete PTH. Along with vitamin D and calcitonin, PTH regulates the homeostasis of serum calcium concentrations

What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis? a. Bruising and lethargy b. Anorexia and malaise c. Fatigability and jaundice d. Dark urine and pale stools

ANS: B The signs and symptoms most common in the prodromal phase are anorexia, malaise, lethargy, and easy fatigability. Bruising would not be an issue unless liver damage has occurred. Jaundice is a late sign and often does not occur in children. Dark urine and pale stools would occur during the onset of jaundice (icteric phase) if it occurs.

The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught? a. Draw the insulin in separate syringes. b. Draw the regular insulin first and then the NPH into the same syringe. c. Draw the NPH insulin first and then the regular into the same syringe. d. Check blood sugar first, and if below 120, hold the regular insulin and give the NPH.

ANS: B To obtain maximum benefit from mixing insulins, the recommended practice is to (1) inject the measured amount of air (equivalent to the dosage) into the long-acting insulin; (2) inject the measured amount of air into the rapid-acting (clear) insulin and, without removing the needle; (3) withdraw the clear insulin; and (4) insert the needle (already containing the clear insulin) into the long-acting (cloudy) insulin and then withdraw the desired amount. The blood sugar may be checked before giving the insulin, but the prescribed dose should not be withheld if the blood sugar is 120.

The nurse is teaching nursing students about childhood fractures. Which describes a compound skull fracture? a. Involves the basilar portion of the occipital bone b. Bone is exposed through the skin c. Traumatic separations of the cranial sutures d. Bone is pushed inward, causing pressure on the brain

ANS: B A compound fracture has the bone exposed through the skin. A basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bone. Diastatic skull fractures are traumatic separations of the cranial sutures. A depressed fracture has the bone pushed inward, causing pressure on the brain.

Which statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

ANS: B A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region.

When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised that a week ago the child had recovered from: a. measles. b. varicella. c. meningitis. d. hepatitis.

ANS: B Most cases of Reye syndrome follow a common viral illness such as varicella or influenza. Measles, meningitis, and hepatitis are not associated with Reye syndrome.

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." The nurse's best interpretation of this comment is that it is: a. A sign of stress. b. Common at this age. c. Suggestive of maladaptation. d. Suggestive of excessive discipline at home.

ANS: B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

A 5-year-old girl is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose" test. What is the nurse testing for? a. Deep tendon reflexes b. Cerebellar function c. Sensory discrimination d. Ability to follow directions

ANS: B The finger-to-nose test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although this test enables the nurse to evaluate the child's ability to follow directions, it is used primarily for cerebellar function. DIF: Cognitive Level: Apply REF: p. 109 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

According to Erikson, the psychosocial task of adolescence is developing: a. Intimacy. c. Initiative. b. Identity. d. Independence.

ANS: B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Initiative is the developmental stage for early childhood. Independence is not one of Erikson's developmental stages.

The vector reservoir for agents causing viral encephalitis in the United States is: a. tarantula spiders. b. mosquitoes. c. carnivorous wild animals. d. domestic and wild animals.

ANS: B Viral encephalitis, not attributable to a childhood viral disease, is usually transmitted by mosquitoes. The vector reservoir for most agents pathogenic for humans and detected in the United States are mosquitoes and ticks; therefore, most cases of encephalitis appear during the hot summer months. Tarantula spiders, carnivorous wild animals, and domestic and wild animals are not reservoirs for the agents that cause viral encephalitis.

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.

The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Erythema over joints b. Soft tissue contractures c. Swelling in multiple joints d. Morning stiffness of the joints e. Loss of motion in the affected joints

ANS: B, C, D, E Whether single or multiple joints are involved, stiffness, swelling, and loss of motion develop in the affected joints in JIA. The swelling results from soft tissue edema, joint effusion, and synovial thickening. The affected joints may be warm and tender to the touch, but it is not uncommon for pain not to be reported. The limited motion early in the disease is a result of muscle spasm and joint inflammation; later it is caused by ankylosis or soft tissue contracture. Morning stiffness of the joint(s) is characteristic and present on arising in the morning or after inactivity. Erythema is not typical, and a warm, painful, red joint is always suspect for infection.

What guidelines should the nurse follow when handling chemotherapeutic agents? (Select all that apply.) a. Use clean technique. b. Prepare medications in a safety cabinet. c. Wear gloves designed for handling chemotherapy. d. Wear face and eye protection when splashing is possible. e. Discard gloves and protective clothing in a special container.

ANS: B, C, D, E Safe handling of chemotherapeutic agents includes preparing medications in a safety cabinet, wearing gloves designed for handling chemotherapy, wearing face and eye protection when splashing is possible, and discarding gloves and protective clothing in a special container. Aseptic, not clean, technique should be used

To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Awareness of peers that diabetes is a severe disease

ANS: C Adolescence is a time when the individual has a need to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group. An adolescent is usually not future oriented. Awareness of peers that diabetes is a severe disease would further alienate the adolescent with diabetes. The peer group would focus on the differences

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. DIF: Cognitive Level: Understanding REF: p. 798

What is a common clinical manifestation of juvenile hypothyroidism? a. Insomnia b. Diarrhea c. Dry skin d. Rapid growth

ANS: C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism often have sleepiness, constipation, and decelerated growth.

Which of the following statements best describes hypopituitarism? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal intelligence.

ANS: C In children with hypopituitarism, the skeletal proportions are normal.

A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube? a. Prevent spread of infection. b. Monitor electrolyte balance. c. Prevent abdominal distention. d. Maintain accurate record of output.

ANS: C The NG tube is placed to suction out gastrointestinal secretions and prevent abdominal distention. The NG tube would not affect infection. Electrolyte content of the NG drainage can be monitored. Without the NG tube, there would be no drainage. After the NG tube is placed, it is important to maintain an accurate record of intake and output. This is not the reason for placement of the tube.

The nurse understands that a school-age child may react to death with what reaction? a. Joking b. Having no reaction c. Fearing the unknown d. Seeing it as a distant event

ANS: C They tend to fear the expectation of the event more than its realization. Their fear of the unknown is greater than that of the known. They would not joke or have no reaction. Adolescents see death as a distant event. DIF: Cognitive Level: Understanding REF: p. 799

What chemotherapeutic agent can cause an anaphylactic reaction? a. Prednisone (Deltasone) b. Vincristine (Oncovin) c. L-Asparaginase (Elspar) d. Methotrexate (Trexall)

ANS: C A potentially fatal complication is anaphylaxis, especially from L-asparaginase, bleomycin, cisplatin, and etoposide (VP-16).

Which type of play is most typical of the preschool period? a. Solitary c. Associative b. Parallel d. Team

ANS: C Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams.

The nurse would expect a 4-month-old to be able to: a. hold a cup. b. stand with assistance. c. lift head and shoulders. d. sit with back straight.

ANS: C Because development is cephalocaudal, of these choices, lifting the head and shoulders is the one that the infant learns to do first. The infant can usually sit with support at about 5 months of age and can sit alone at about 8 months.

28. The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target? a. 1 month b. 1 to 2 months c. 3 to 4 months d. 6 months

ANS: C Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If the infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed. DIF: Cognitive Level: Comprehension REF: p. 157 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

What would the nurse expect of a healthy 3-year-old child? a. Jump rope b. Ride a two-wheel bicycle c. Skip on alternate feet d. Balance on one foot for a few seconds

ANS: D 3-year-olds are able to accomplish the gross motor skill of balancing on one foot. Jumping rope, riding a two-wheel bike, and skipping on alternative feet are gross motor skills of 5-year-old children

What chemotherapeutic agent is classified as an antitumor antibiotic? a. Cisplatin (Platinol AQ) b. Vincristine (Oncovin) c. Methotrexate (Texall) d. Daunorubicin (Cerubidine)

ANS: D Daunorubicin is an antitumor antibiotic. Cisplatin is classified as an alkylating agent. Vincristine is a plant alkaloid. Methotrexate is an antimetabolite

A child has an absolute neutrophil count (ANC) of 500/mm3. The nurse should expect to be administering which prescribed treatment? a. Platelets b. Packed red blood cells c. Zofran (ondansetron) d. G-CSF (Neupogen) daily

ANS: D G-CSF (filgrastim [Neupogen], pegfilgrastim [Neulasta]) directs granulocyte development and can decrease the duration of neutropenia following immunosuppressive therapy. G-CSF is discontinued when the ANC surpasses 10,000/mm3.

Kyphosis

Abnormally increased convex angulation in the curvature of the thoracic spine Most common form is "postural" Can result from TB, arthritis, osteodystrophy, or compression fracture

Lordosis

Accentuation of the cervical or lumbar curvature beyond physiologic limits May be secondary complication of trauma or idiopathic May occur with flexion contractures of hip, congenital dislocated hip In obese children abdominal fat alters center of gravity, causing lordosis

When should the 1st Hep B vaccine be administered?

At Birth

An adolescent patient is prescribed a brace to treat scoliosis. Which assessment finding by the nurse indicates that outcomes for a priority nursing diagnosis have been met by the patient? A. Is able to explain the rationale for the bracing B. No redness or breakdown seen under the brace C. Participates in social activities with friends D. Wears brace continuously for 20 hours each day

B ~ The skin under the brace worn to treat scoliosis needs to be assessed for breakdown, especially when the brace is new. An important diagnosis would be risk for impaired skin integrity. Seeing no skin breakdown under the brace indicates the outcomes have been met for this goal. Being able to explain the rationale for the bracing and participating in social activities also indicate that outcomes for appropriate diagnoses have been met, but these do not take priority over a possible injury to the child. The brace needs to be worn continuously for 23 hours each day.

A pediatric oncology patient is undergoing chemotherapy. Which observation would lead the nurse to suspect that the patient has developed sterile hemorrhagic cystitis? A. Absence of hematuria B. Presence of proteinuria C. Complaints by the patient that it burns upon urination D. Increased sensation of thirst.

B.

Management of Opioid Side Effects

-constipation: Sennacot, miralax -Sedation: caffeine, methylphenedate -n/v: promethazine -pruritis: hydroxyzine, diphenhydramine -resp depression: naloxone -urinary retention: oxybutinin -

Effects of oxytocin - target: uterus, breasts

1) stimulates powerful contractions of uterus 2) causes ejection of milk from alveoli into breast ducts

stacks up to 4 cubes

13-18 months

dress self w\supervision

19-30 months

goes and up down stairs alone

19-30 months

kicks ball forward

19-30 months

follows object past midline

2-3 months

ride tricycles by

3 years

push up on hands and knees

4-6 months

An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? A. Administration of antibiotic B. Frequent complete assessment of the infant C. Round-the-clock administration of antitussive agents

A

A diagnostic workup is being performed on a 1-year-old child with suspected neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that which of the following findings is most specifically related to this type of tumor? A. Elevated vanillylmandelic acid (VMA) urinary levels B. Presence of blast cells in the bone marrow C. Projectile vomiting, usually in the morning D. Postive Babinski's sign"

A (Rationale: Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor compresses adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated VMA levels. The presence of blast cells in the bone marrow occurs in leukemia. Projectile vomiting occurring most often in the morning and a positive Babinski's sign are clinical manifestations of a brain tumor.)

A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma? a. Femur b. Humerus c. Pelvis d. Tibia

A ~ Osteosarcoma is the most frequently encountered malignant bone cancer in children. The peak incidence is between ages 10 and 25 years. More than half occur in the femur. After the femur, most of the remaining sites are the humerus, tibia, pelvis, jaw, and phalanges.

Which stage of development is most unstable and challenging regarding development of personal identity? A) Adolescence B) Toddler hood C) Childhood D) Infancy

A) Adolescence

The health care provider has prescribed hydroxychloroquine (Plaquenil) 5 mg/kg/day PO divided bid for a child with systemic lupus erythematosus. The child weighs 66 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 75 The correct calculation is: 66 lb/2.2 kg = 30 kg Dose of Plaquenil is 5 mg/kg/day divided bid 5 mg ´ 30 = 150 mg 150 mg/2 = 75 mg

In terms of cognitive development the 5-year-old child would be expected to: a. Use magical thinking. b. Think abstractly. c. Understand conservation of matter. d. Be unable to comprehend another person's perspective.

ANS: A Magical thinking is believing that thoughts can cause events. Abstract thought does not develop until school-age years. The concept of conservation is the cognitive task of school-age children ages 5 to 7 years. Five-year-olds cannot understand another's perspective.

The nurse has determined the rate of both the child's radial pulse and heart. What is the normal finding when comparing the two rates? a. Are the same b. Differ, with heart rate faster c. Differ, with radial pulse faster d. Differ, depending on quality and intensity

ANS: A Pulses are the fluid wave through the blood vessel as a result of each heartbeat. Therefore, they should be the same. DIF: Cognitive Level: Understand REF: p. 103 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

An adolescent boy is brought to the emergency department after a motorcycle accident. His respirations are deep, periodic, and gasping. There are extreme fluctuations in blood pressure. Pupils are dilated and fixed. The nurse should suspect which type of head injury? a. Brainstem b. Skull fracture c. Subdural hemorrhage d. Epidural hemorrhage

ANS: A Signs of brainstem injury include deep, rapid, periodic or intermittent, and gasping respirations. Wide fluctuations or noticeable slowing of the pulse, widening pulse pressure, or extreme fluctuations in blood pressure are consistent with a brainstem injury. Skull fracture, subdural hemorrhage, and epidural hemorrhage are not consistent with brainstem injuries.

strangulated hernia

cutting off the blood supply to that area cant get it back in place know there is a problem by looking at it needs to be repaired immediately considered an emergency surgery (done promptly)

Hypofunction of Testosterone

delayed sexual development or eunuchoidism

how is rubeola spread and incubation

direct contact, droplet, can survive 2 hours on surfaces and 7-18 days

Symptoms of upper UTI

high fever chills abdominal pain N/V flank pain costovertebral angle tenderness moderate to severe dehydration

Nursing actions for metatarsus adductus?

id the defect, teach parents how to stretch forefoot, instruct parents in cast care and observation of corrective device if needed

Paraphimosis

inability to return foreskin over glans- can cause constriction of penis

This happens when insulin is absent or insulin sensitivity is altered, glucose is unavailable for cellular metabolism, and the body chooses alternate sources of energy, principally fat.

ketoacidosis

What does PTH stmulate?

kidneys to retain calcium and excrete phosphate. Promotes calcium absorption by intestines. Calcium is used in muscle contractions.

Primary Nephrotic Syndrome

minimal-change nephrotic syndrome (MCNS), affects only one kidney frequently follows an infection- like pyelonephritis

Treatment for hydrocele

most resolve spontaneously in first 2 years encourage parents that everything will be ok

painful swollen salivary glands fever and muscle aches abdominal pain fatigue and loss of appetite

mumps

Gastroschisis

occurs when the bowel herniates through a defect in the abdominal wall to the right of the umbilical cord and through the rectus muscle.

*Tx for DDH in older kids?

operative reduction, tenotomy, osteotomy, difficult after 4 years

what is the decongestant prescribed to 2-12 year olds?

oxymetazoline 0.05% (children >6) or phenylephrine 0.25%

what accounts for the majority of acute illnesses in children?

respiratory tract infections

Neonatal pain response: Oxygenation

• Decreased transcutaneous oxygen saturation (TcPO 2 ) • Decreased arterial oxygen saturation (SaO 2 )

Administration of colony stimulating agents for the pediatric oncology patient are used to: A.decrease nausea. B. shrink tumor size. C. increase bone marrow response. D. decrease production of stem cells.

C.

Chromosome abnormalities

Cancer genome project - Down-syndrome: leukemia - Chromosome 11 and 12 translocation: Ewing's sarcoma - Philadelphia chromosone translocation between 9 and 22 leads to chronic myelogenous leukemia

One of the goals for children with asthma is to prevent respiratory tract infection because infections A. lessen effectiveness of medications. B. encourage exercise-induced asthma. C. increase sensitivity to allergens. D. can trigger an episode or aggravate asthmatic state.

D

Protection of caregivers

Isolation procedures - for suspected and known RSV • Hand washing • Instructions to parents • Gowns and gloves for direct contact • Group patients to prevent cross contamination

Neonatal pain response: Vital signs:

Observe for variations • Increased heart rate • Increased blood pressure • Rapid, shallow respirations

Otitis Media - Secondary observations

Otoscopy -Acute OM shows intact tympanic membranes, bright red and bulging •Tympanometry - confirms diagnosis of OME by measuring changes in air pressure in external auditory canal •Pneumatic otoscopy - assesses tympanic membrane mobility •Culture of drainage - to isolate organism •Hearing evaluation - for children with OME > 3 months

What causes the syndrome of inappropriate antidiuretic hormone Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

Oversecretion of the posterior pituitary hormone or antidiuretic hormone (ADH)

Tx for Metatarsus Adductus?

PT, orthotics, casting

What vaccines are administered by SQ route?

Polio, MMR, and varicella

how is Epstein Barr virus spread and what is the incubation period?

Saliva and 4-6 weeks

The rate of action for regular insulin

Short acting

What does ACTH control

Some secretions of adrenal cortex of te adrenal glands

What is an example of palliative care?

The Make a Wish Foundation

What is an example of an age-appropriate pain scale used on end of life care of pediatric patients?

The Wong-Baker Scale

How does a hormone find its target tissue?

The cell must have a protein identifier and receptor.

Therapeutic Management

Treatment goal—keep head of femur in acetabulum Containment with various appliances and devices Rest, no weight bearing initially Surgery in some cases Home traction in some cases Nursing care management

One cell is capable of more than one activity.

True

Which clinical finding is an overt sign of retinoblastoma in children?

Whitish reflex in the eye

What do autocrine secretions do?

act on the source cell itself

Hypofunction of mineralocorticoids - aldosterone

adrenocortical insufficiency

*s/s of DDH in older infants and kids?

affected leg shorter than the other, telescoping or piston mobility of joint, trendelenburg sign, greater trochanter is prominent and appears above line from anterosuperior iliac spine to tuberosity of ischium, marked lordosis, waddling gait

conditions that weaken defenses of the respiratory tract

allergies preterm birth bronchopulmonary dysplasia asthma history of RSV cardiac anomalies

What is a goiter?

an enlargement or "hypertrophy" of the thyroid gland

Infants

birth-1 year

Stage 1 Wilms' Tumore

cancer only in one kidney can be completely removed

What is the most common fracture in kids <10 yo?

clavicle

Preoperative Care for bladder exstrophy

cover bladder with sterile plastic wrap

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? A. Atrophic changes in the mucosal wall of the intestines B. Hypoactivity of the autonomic nervous system C. Hyperactivity of the apocrine glands D. Mechanical obstruction caused by increased viscosity of exocrine gland secretions

D

Cystic fibrosis must often affects multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is which of the following? A. Hyperactivity of the sweat glands B. Hyperactivity of parasympathetic nervous system C. Sweat chloride test >60 mEq/L D. Increased viscosity of mucous gland secretions

D

The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect? A. Suffocation B. Child abuse C. Infantile apnea D. Sudden infant death syndrome (SIDS)

D

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to A. determine what the child has eaten. B. administer diphenhydramine (Benadryl) PO stat. C. move the child to the nurse's office or hallway. D. have someone call for an ambulance and paramedic rescue squad or 9-1-1.

D

What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? A. Barrel chest B. Wheezing C. Thermal instability D. Nasal flaring and retractions

D

You are working with the parents of a pediatric oncology patient who has successfully responded to therapy but is now experiencing body image changes as a result of hair loss due to chemotherapy regimen. The parents are upset about this change in their child's appearance. Which response would be appropriate with regard to the parent's concern? A. As the therapy has been successful, it is important to focus on that rather than body image changes. B. Tell the parents that the child's hair will grow back soon. C. Tell the parents that the child's hair will grow back stronger and healthier. D. Acknowledge the parent's concern and focus on available options that may be used to help with body image concerns.

D

A 4-year-old has a right nephrectomy to remove a Wilms tumor. The nurse knows that it is essential to: A. Request a low-salt diet B. Restrict fluids C. Educate the family regarding renal transplants D. Prevent urinary tract infections

D (Because the child has only one remaining kidney, it is important to prevent urinary tract infections. Answers A, B, and C are not necessary, so they are incorrect.)

The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? A. Infection. B. Anemia. C. Nutrition. D. Grieving.

D (Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration)

A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value which intervention would the nurse document in her plan of care. A. Monitor closely for signs of infection. B. Temp every four hours. C. Isolation precautions D. Use a small toothbrush for mouth care"

D (Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production. If the platelet count is les than 20,000 than bleeding precautions need to be taken.)

Chemotherapy dosage is frequently based on total body surFace area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy? A. Measure abdominal girth B. Claculate BMI C. Ask the client about his/her height and weight D. Weigh and measure the client on the day of medication administration

D (To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total Body surface area(BSA) which requires accurate height and weight before each med administration. Simply asking the client about height/weight may lead to inaccuracies in determining BSA. Calculating BMI and measuring abdominal girth does not provide the data needed.)

A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which of the following would be the best intervention to include in the child's plan of care? a. Administer tube feedings. b. Offer small, frequent meals. c. Offer fluids only between meals. d. Allow the child to choose what to eat for meals.

D (While all options can be done to encourage nutrition, allowing the preschooler choices meets two issues: nutrition and developmental tasks.)

Acetaminophen

(Tylenol) -10-15 mg/kg/dose q 4-6 h PO -not to exceed five doses in 24 h or 75 mg/kg/day, or 4000 mg/day

appendicitis nursing care

*assist in establishing diagnosis* determine pain by change in childs behavior *younger, nonverbal children:* -rigid, side-lying position -knees flexed -decreased ROM of right hip detailed hx. and abdominal exam delay palpating abdomen until all other assessments are completed -light palpation will illicit pain w/out causing trauma post op: -IV fluids -IV ABT's -NPO analgesics to control pain -procedures are performed when analgesics are at peak effect drains- for perforation

causes of acute diarrhea

*infection and parasitic infestation:* -bacteria -viruses -parasites *associated conditions:* -URI's -UTI's -OM *dietary causes:* -overfeeding -intro to new foods -reinstituting milk too soon after diarrheal episode -osmotic diarrhea from excess sugar in formula or juice -excessive ingestion of sorbital or fructose *meds:* -ABT's -laxatives *toxic causes:* ingestion of: -heavy metals (arsenic, lead, mercury) -organic phosphates *functional causes:* -IBS *other causes:* -pseudomembranous enterocolitis -hirschsprung enterocolitis

causes of chronic diarrhea

*malabsorption syndromes:* -celiac disease -pancreatic insufficiency -short bowel syndrome -lactose intolerance -congenital enzyme deficiency inflammatory bowel disease (IBD) immunodeficiency food allergy lactose intolerance chronic nonspecific diarrhea inadequate management of acute diarrhea

malrotation and volvulus

*malrotation:* -due to abnormal rotation around the superior mesenteric artery during embryonic development *volvulus:* -occurs when the intestine is twisted around itself and compromises blood supply to intestines *bilious emesis* = classic symptom in newborn period emergent surgical intervention required to prevent: -intestinal necrosis -peritonitis -death

vomiting etiology

*malrotation:* indicated by chronic and intermittent episodes of vomiting color and consistency of emesis vary depending on cause *bowel obstruction:* -green, bilious vomiting *poor gastric emptying or high intestinal obstruction:* -curdled stomach contents -mucus -fatty foods that are vomited for several hrs after ingestion *gastric irritation by:* -certain meds -foods -toxic substances forceful vomiting = pyloric stenosis associated symptoms help identify cause fever and diarrhea w/vomiting = infection constipation w/vomiting = anatomic or functional obstruction localized abdominal pain and vomiting = appendicitis, pancreatitis, or peptic ulcer disease change in LOC or headache w/vomiting = CNS or metabolic disorder

HD diagnostic evaluation

*neonate:* -failure to pass mec -intestinal obstruction *infants and children:* -hx. (chronic constipation) -rectum is empty of feces -tight internal sphincter -leakage of liquid stool and gas *to confirm diagnosis:* -rectal biopsy -anorectal manometry (noninvasive) external sphincter contracts but internal sphincter fails to relax= HD

vomiting nursing care

*observe and report vomiting behavior and associated symptoms* 1. accurate assessment of: -type of vomiting -appearance of emesis -child behavior associated to vomiting cause of vomiting determines the nursing interventions if vomiting is due to improper feeding methods - establish proper techniques through teaching and example if vomiting is caused by GI obstruction - withhold food and implement special feeding techniques *maintain hydration and prevent dehydration* give glucose-electrolyte solution to an alter child -restores warer and electrolyte levels -include carbohydrates give small, frequent feedings or fluids or foods *position infant or child upright who is vomiting to prevent aspiration and observe for evidence of dehydration* make sure child brushes teeth + rinses mouth after vomiting to dilute the hydrochloric acid that comes in contact w/ the teeth

treatment for organic causes of constipation

*phase I: clean-out and disimpaction:* -3 to 5 days -oral clean-out method preferred for children older than 4 yrs -enema clean-out -NG lavage (hospitalization) *phase II: maintenance:* - 6 to 12 months -oral laxatives -high fiber diet -increased fluid intake -behavioral training *phase III: weaning:* -gradual tappering of laxatives -continue high fiber diet, fluid intake, behavior modification *mineral oil must be given carefully to avoid risk of aspiration. should not bed used inn children younger than 1*

HPS therapeutic management

*pyloromyotomy* pre op: -rehydration -correction of metabolic alkalosis w/ parenteral fluids and electrolytes -replacement fluid therapy - delays surgery 24-48 hrs -NGT to decompress stomach laparoscopic surgery post op: -feedings start 4-6 hrs post op -start w/ small, frequent feedings of water and electrolyte solution -if clear fluids are retained, pt can start formula 24 hrs post op

A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents? Select all that apply.

- Avoid excessive skin exposure to the sun. - Plan for adequate rest periods for the child. - A darkening of the skin receiving radiation is expected.

What should the nurse recognize as symptoms of a brain tumor in a school-age child for whom she is caring? Select all that apply.

- Blurred vision - Vomiting when getting out of bed - Intermittent headache - Declining academic performance

CT and MRI

- CT, MIR, PET and metaidobenzylguanine (MIBG) scans are being used to visualize the tumors and begin the diagnostic process - They do not hurt but the child does have to lay still

Lumbar Puncture

- Done with conscious sedation - Pt. needs to lie flat afterwards - Monitor site for bleeding or infection - It is used routinely for metastasis to the brain from leukemia and other tumors

Biopsy

- Surgical removal of tissue cells and sent to lab - Used to confirm diagnosis and stage of disease - Done under conscious sedation or as general surgery in outpatient setting - Anxiety for parents as they await diagnosis

When an adolescent with a new diagnosis of Ewing sarcoma asks the nurse about treatment, the nurse's response is based on the knowledge that (select all that apply)

- This type of tumor invades the bone. - Management includes chemotherapy, surgery, and radiation. - Affected bones such as ribs and proximal fibula may be removed to excise the tumor.

Surgery

- Used to remove all tumor or debulk, if total removal impossible - Most successful when tumor is encapsulated and has not spread - The use of surgery is declining

Bone Marrow Aspirate

- Usually done under conscious sedation - Prepare the young child as they may not be totally asleep but it should not hurt when they do the test - Educate the pt in that they will have a large band aid on their hip when they wake up - The hip will be sore but resting, initially, then playing normally will help that to go away. They need to let the nurse know if it hurts really bad as he/she can give them pain medicine - Need to monitor site for bleeding - Definitive test for leukemia and other solid tumors

Premature Infant Pain Profile

-28-40 weeks of gestational age Gestational age (0-3) Eye squeeze (0-3) Behavioral state (0-3) Nasolabial furrow (0-3) Heart rate (0-3) Oxygen saturation (0-3) Brow bulge (0-3) -0 = no pain; 21 = worst pain

Neonatal Infant Pain Scale

-32-60 weeks gestational age Facial expression (0-1) Arms (0-1) Cry (0-2) Legs (0-1) Breathing patterns (0-1) State of arousal (0-1) -0 = no pain; 7 = worst pain

Coanalgesic ajuvant drugs

-Antidepressants: amitriptyline -Anti-convulsants: Gaba -anxiolytics: lorazepam -steroids: Dexamethasone

Neonatal Pain, Agitation, and Sedation Scale

-Birth (23 weeks of gestational age) and full-term newborns up to 100 days Cry/irritability (0-2) Behavior/state (0-2) Facial expression (0-2) Extremities/tone (0-2) Vital signs—heart rate, respiratory rate, blood pressure, SaO 2 (0-2) -Pain score: 0 = no pain; 10 = intense pain Sedation score: 0 = no sedation; 10 = deep sedation

Oucher pain scale

-Consists of six photographs of a white child's face representing "no hurt" to "biggest hurt you could ever have;" also includes vertical scale with numbers from 0 to 100; scales for African-American and Hispanic children have been developed -For children from 3 to 13 years old.

Gen non pharm strategies for dealing with pediatric pain

-Consult child-life specialist. -Form a trusting relationship with child and family. -Express concern regarding their reports of pain and intervene appropriately. Take an active role in seeking effective pain management strategies. Use general guidelines to prepare child for procedure.

CRIES NEONATAL POSTOPERATIVE PAIN SCALE

-Crying: No=0, High pitched=1, Inconsolable =2 -Requires oxygen for saturation >95% No=0, <30%=1, >30%=2 -Increased vital signs HR and BP ≤preoperative state=0 HR and BP up <20% of preoperative state =1 HR and BP up >20% of preoperative state =2 -Expression None =0, Grimace =1, Grimace, grunt =2 -Sleepless No =0, Wakes at frequent intervals =1, Constantly awake =2

Guided Imagery

-Have child identify some highly pleasurable real or imaginary experience. -Have child describe details of the event, including as many senses as possible (e.g., "feel the cool breezes," "see the beautiful colors," "hear the pleasant music"). Have child write down or tape record script. -Encourage child to concentrate only on the pleasurable event during the painful time; enhance the image by recalling specific details by reading the script or playing the tape. Combine with relaxation and rhythmic breathing.

Thought Stopping

-Identify positive facts about the painful event (e.g., "It does not last long"). -Identify reassuring information (e.g., "If I think about something else, it does not hurt as much"). -Condense positive and reassuring facts into a set of brief statements and have child memorize them (e.g., "Short procedure, good veins, little hurt, nice nurse, go home"). -Have child repeat the memorized statements whenever thinking about or experiencing the painful event.

Distraction

-Involve parent and child in identifying strong distractors. -Involve child in play; use radio, tape recorder, CD player, or computer game; have child sing or use rhythmic breathing. -Have child take a deep breath and blow it out until told to stop. -Have child blow bubbles to "blow the hurt away." -Have child concentrate on yelling or saying "ouch," with instructions to "yell as loud or soft as you feel it hurt; that way I know what's happening." -Have child look through kaleidoscope (type with glitter suspended in fluid-filled tube) and encourage him or her to concentrate by asking, "Do you see the different designs?" -Use humor, such as watching cartoons, telling jokes or funny stories, or acting silly with child. -Have child read, play games, or visit with friends.

pain education for children and parents

-Involve parents in learning specific nonpharmacologic strategies and in assisting child with their use. -Educate child about the pain, especially when explanation may lessen anxiety (e.g., that pain may occur after surgery and does not indicate something is wrong); reassure the child that he or she is not responsible for the pain. -Teach procedures to child and family for later use.

LTB Pathophysiology

-Lining of larynx and trachea inflamed -Causes narrowing -Difficulty inhaling air past obstruction -Inspiratory stridor -Suprasternal retractions

interventions for newborn heel sticks etc

-Nonnutritive sucking (pacifier) -kangaroo care, -swaddling/facilitated tucking -sucrose *interventions reduce behavioral, physiologic, and hormonal responses to pain from procedures, such as heel punctures, in preterm and newborn infants

Pneumonia-Viral

-Occurs more frequently than bacterial -RSV most common virus for infant pneumonia

emotional support during pain for children

-Stay with child during a painful procedure. -Allow parents to stay with child if child and parent desire; encourage parent to talk softly to child and to remain near child's head.

Tonsillitis & Adenoiditis

-Tonsils are lymphoid tissue -Function - to filter and protect the respiratory and digestive tracks from invasion of pathogens -Antibody formation function Palatine (faucial) tonsil located on each side of oropharynx •Palatine tonsils are removed during a tonsillectomy •Pharyngeal tonsils (adenoids) located above palatine tonsils on posterior wall of nasopharynx •Pharyngeal tonsils are removed during an adenoidectomy •Causative agent for tonsillitis - may be viral or bacterial

Word-Graphic Rating Scale

-Uses descriptive words (may vary in other scales) to denote varying intensities of pain -For children from 4 to 17 years old. -"Show me how much pain you have right now by marking with a straight, up-and-down line anywhere along the line to show how much pain you have right now."

Numeric Pain Scale

-Uses straight line with end points identified as "no pain" and "worst pain" and sometimes "medium pain" in the middle (0-10, or more) -Ask child to choose number that best describes own pain. -For children as young as 5 years old, as long as they can count and have some concept of numbers and their values in relation to other numbers.

The COMFORT scale

-a behavioral, unobtrusive method of measuring distress in unconscious and ventilated infants, children, and adolescents. -eight indicators scored between 1 and 5 based on the behaviors exhibited by the patient. -observe pt unobtrusively for 2 minutes and derive the total score by adding the scores of each indicator. -The total scores can range between 8 and 40. -A score of 17 to 26 generally indicates adequate sedation and pain control. -able to detect specific changes in pain or distress intensity in critically-ill children and in young children with burns

prevent spread of infection

-careful hand washing is important -use a tissue or arm to cover noses and mouths when coughing or sneezing -dispose of tissues properly -dont share drinking cups, eating utensils wash clothes or towels with others -do not touch eyes or nose with hands if sick remove affected children from contact with other children when possible - teach well children to stay away from sick children -

Self-Report Pain Rating Scales

-children over 4 -"faces" scales (smiling faces can on pain assessment scales can result in inadequate pain rating) -can simply point to face that they associate with level of pain -have a difficult time differentiating between pain and mood

Opioids

-needed for moderate to severe pain -Morphine remains the standard -When morphine is not a suitable opioid, drugs such as hydromorphone hydrochloride (Dilaudid) and fentanyl citrate (Sublimaze) are used. -NOT codein for moderate pain b/c safety issues

pain experiences of Children with communication and cognitive deficits

-often experience spasticity, contractures, injury, infection, and orthopedic surgical treatment that may be painful. -Behaviors include moaning, inconsistent patterns of play and sleep, changes in facial expression, and other physical problems that may mask expression of pain and be difficult to interpret

components of chronic pain assessment in chronically ill children

-onset of pain; -pain duration or pattern; -the effectiveness of the current treatment; -factors that aggravate or relieve the pain; -other symptoms and complications concurrently felt; -interference with the child's mood, function, and interactions with family

Adrenocorticotropic hormone (ACTH) - adrenal cortex s/s of hypofunction

1) Acute adrenocortical insufficiency (Addison disease) 2) Hypoglycemia 3) Increased skin pigmentation

Hyperfunction of glucocorticoids: cortisol and corticosterone

1) Cushing syndrome 2) Severe impairment of growth with slowing in skeletal maturation 3) in excess tend to accelerate gluconeogenesis and protein and fat

Hormones of the Ovaries

1) Estrogen 2) Progesterone

Thyrotropin (TSH) - thyroid gland s/s of hyperfunction

1) Hyperthyroidism 2) Graves disease

Thyrotropin (TSH) - thyroid gland s/s of hypofunction

1) Hypothyroidism 2) Marked delay of puberty

Islets of Langerhans of Pancreas hormones

1) Insulin (beta cells) 2) Glucagon (alpha cells) 3) Somatostatin (theta cells)

Gonadotropins - target: gonads s/s of hyperfunction

1) Precocious puberty 2) Early epiphyseal closure

Effects of Adrenocorticotropic hormone (ACTH) - adrenal cortex

1) Promotes and maintains growth and development of adrenal cortex 2) Stimulates adrenal cortex to secrete glucocorticoids and androgens

Hormones of anterior pituitary

1) STH or GH (somatotropin, growth hormone) 2) Thyrotropin (TSH) 3) Adrenocorticotropic hormone (ACTH) 4) Gonadotrophins 5) Follicle-stimulating hormone (FSH) 6) Luteinizing hormone (LH) 7) Prolactin (luteotropic hormone) 8) Melanocyte-stimulating hormone (MSH)

Effects of Prolactin (luteotropic hormone) - target: ovaries, testes

1) Stimulates milk production 2) Maintains corpus luteum and progesterone secretion during pregnancy

Diabetes insipidus

1) The principal disorder of the posterior pituitary hypofunction 2) produces a state of uncontrolled diruresis 3) causes hyposecretion of antidiuretic hormone (ADH)

Effect on the Ovaries

1) accelerates growth of epithelial cells, especially in uterus after menses 2) promotes protein anabolism 3) promotes epiphyseal closure of bones 4) promotes breast development during puberty and pregnancy 5) plays role in sexual function 6) stimulates water and sodium reabsorption in renal tubules 7) stimulates ripening of ova

What is included in the management of Congenital Adrenal Hyperplasia?

1) assignment of a sex according to genotype; 2) administration of cortisone; 3) and, possibly, reconstructive surgery

Hyperfunction of mineralocorticoids - aldosterone

1) electrolyte imbalance 2) hyperaldosteronism

Hormones of the adrenal medulla

1) epinephrine (adrenaline) 2) norepinephrine (noradrenaline)

THs - T4 and T3 s/s of hyperfunction

1) exophthalmic goiter (Graves disease) 2) accelerated linear growth 3) early epiphyseal growth

Prolactin (luteotropic hormone) - target: ovaries, testes s/s of hyperfunction

1) galactorrhea 2) functional hypogonadism

Hyperfunction of Glucagon (alpha cells)

1) hyperglycemia 2) may be instrumental in genesis of DKA in DM

Follicle-stimulating hormone (FSH) - target: ovaries, testes s/s of hypofunction

1) hypogonadism 2) sterility 3) absence or loss of secondary sex characteristics 4) amenorrhea

Luteinizing hormone (LH) - ovaries, testes s/s of hypofunction

1) hypogonadism 2) sterility 3) impotence 4) absence or loss of secondary sex characteristics 5) ovarian failure 6) eunuchism

THs - T4 and T3 s/s of hypofunction

1) hypothyroidism 2) Hashimoto thyroiditis 3) general growth greatly reduces 4) intellectual disability in infant

Disorders of thyroid function

1) hypothyroidism, 2) autoimmune thyroiditis, 3) goiter, 4) and hyperthyroidism

Classic forms of hypoparathyroidism in childhood

1) idiopathic (deficient production of parathyroid hormone) 2) pseudohypoparathyroidism (increased parathyroid hormone production with end-organ unresponsiveness to parathyroid hormone)

Prolactin (luteotropic hormone) - target: ovaries, testes s/s of hypofunction

1) inability to lactate 2) amenorrhea

The five categories of Cushing syndrome

1) pituitary, 2)adrenal, 3) ectopic, 4) iatrogenic, 5) and food dependent

Identify the two cardinal signs of diabetes insipidus.

1) polyuria 2) polydipsia

Follicle-stimulating hormone (FSH) - target: ovaries, testes s/s of hyperfunction

1) precocious puberty 2) primary gonadal failure 3) Hirsutism 4) polycystic ovary 5) epiphseal closure

Effects on Progesterone

1) prepares uterus for nidation of fertilized ovum and aids in maintenance of pregnancy 2) aids in development of alveolar system of breasts during pregnancy 3) inhibits myometrial contractions 4) has effect on protein catabolism 5) promotes salt and water retention, especially in endometrium

Effects of Thyrotropin (TSH) - target: thyroid gland

1) promotes and maintains growth and development of thyroid gland 2) stimulates TH secretion

Effects of parathyroid hormone (PTH)

1) promotes calcium reabsorption from blood, bone, and intestines 2) promotes excretion of phosphorus in kidney tubules

Effects of THs - T4 and T3

1) regulate metabolic rate; control rate of growth of body cells 2) important of bones, teeth, and brain 3) promote mobilization of fats and gluconeogenesis

Antidiuretic hormone (ADH) vasopressin - target: renal tubules s/s of hyperfunction

1) syndrome of inappropriate antidiuretic hormone secretion (SIADH) 2) fluid retention 3) hyponatremia

What are the three components of the endocrine system?

1) the cells, which send chemicals message via hormones; 2) target cells, which receive the message; 3) and the environment through which the chemical is transported from the site of synthesis to the sites of cellular action

Pediatric Differences

1. Cancer are nonepithelial or embryonic in origin 2. Occur in deep body tissue so that it is not visible or palpable until large. So cancer more advanced at time or diagnosis 3. Tumors are fast growing and healthy child can be suddenly ill in matter of weeks 4.Due to the immature functioning of the immune system as the body's major defense.. For the young child, the body fails to attack the cancer cells and therefore protect the body and there is a higher rate of cellular growth = rapid progression of cancer 5. Leukemia being the most common primary childhood cancer

types of diarrhea

1. acute diarrhea 2. chronic diarrhea 3. intractable diarrhea of infancy 4. chronic nonspecific diarrhea (CNSD)

diarrhea predisposing factors

1. age -the younger the child, the greater the susceptibility and the more severe the diarrhea -most common in infancy -lesser threat in early childhood -constitutes minor problem in older children 2. impaired health: -malnourished or immunocompromised children are more susceptible -tends to be more severe 3. environment: -crowding -substandard sanitation -poor facilities for preparation and refrigeration of food -inadequate health education -frequency of diarrhea in infancy is r/t ingestion of contaminated milk -breast fed infants have a lower incidence

HPS nursing care

1. assessment 2. post op care -incision check q 4 hrs -VS q 2-4 hrs 3. support of infant and family child can go back to baseline feeds in 48 hrs post op

HD manifestations in childhood

1. constipation 2. *foul-smelling stools* 3. abdominal distention 4. *visible peristalsis* 5. early palpable fecal mass 6. undernourihsed, anemic appearance *ribbon-like stools*

HD manifestations in newborns

1. failure to pass mec w/in first 24-36 hrs of life 2. refusal to feed 3. *bilious vomiting* 4. abdominal distention

appendicits perforation manifestations

1. fever (high grade) 2. guarding persistent, intensifying pain 3. *sudden pain relief* 4. abdominal distention 5. rapid shallow breathing 6. pallor 7. chills 8. restlessness/irritability 9. tachycaria

appendicitis manifestions

1. first symptom = colicky, cramping, abdominal pain around the umbilicus 2. focal abdominal tenderness 3. RLQ pain 4. McBurney point -most common point of tenderness 5. rebound tenderness - pain on deep palpation w/ sudden release 6. n/v and anorexia (after pain starts) 7. low grade fever 8. stooped posture 9. elevated WBC's 10. loose stools or constipation

pica nursing care

1. history 2. physical exam 3. radiologic studies nurse should consider pica when children at risk for this condition develop: -abdominal pain -other GI symptoms -anemia

constipation nursing care

1. history: -bowel habits -diet -events associated w/ onset of constipation -drugs/other substances -consistency, color, frequency of stool *dietary modifications:* -increase fiber intake- teach parents foods high in fiber -milk/dairy relationships -fluids management of impaction/chronic constipation may require 6-12 months of behavioral/dietary/pharmacologic interventions

TEF management

1. maintain airway 2. IV fluids 3. prevent aspiration 4. surgical correction -end to end anastomosis of the esophagus -other techniques for severe cases

HPS diagnostic evaluation

1. olive-like mass is easily palpable when the stomach is empty 2. quiet infant 3. abdominal muscles are relaxed US shows elongated mass surrounding a long pyloric canal

diarrhea diagnostic evaluation

1.history: -discover cause of diarrhea -assess severity of sx's -assess risk for complications -elicit info about current sx indicating other treatable illnesses that could be causing the diarrhea *ask about:* -recent travel -exposure to untreated drinking or washing water sources -contact w/ animals or birds -day care attendance -recent tx. w/ ABTs -recent diet changes *ask about other sx. such as:* -fever -vomiting -frequency and character of stools -urine output -dietary habits -recent food intake *no labs for children w/ uncomplicated diarrhea and no evidence of dehydration* lab tests for: -severely dehydrated pt -pt on IV therapy *glucose intolerance is indicated by:* -water, expulsive stools *fat malabsorption is indicated by:* -foul-smelling -greasy -bulky *enzyme deficiency or protein intolerance is indicated by diarrhea that develops after the intro of:* -cows milk -fruits -cereal *bacterial gastroenteritis is indicated by:* -neutrophils or RBC's in stool

what is the schedule for the meningococcal vaccine? (MCV4)

11-12 years

what is the schedule for the HPV vaccine?

11-12 years (2nd dose 1-2 months after first, third 6 months later)

attempts to walk alone

12 months

what is the schedule for the hepatitis A vaccine?

12 months to 2 years 6-18 months following

speaks at least 3-4 understandable words

12-15 months

What is the schedule for the varicella vaccine?

12-15 months 4-6 years

anterior fontanel close by

12-18 months

Vaccine time allotted for Hep A

12-18 mos

walk upstairs with help, creep downstairs

13-18 months

walks and pulls toys

13-18 months

stacks up 8 cubes

19-30 months

place hands in mouth

2-3 months

What are the Development Dysplasia of the Hip (DDH) degrees?

3 degrees: acetabular dysplasia , subluxation, dislocations

Acute Leukemia Clinical Manifestations

3 main consequences (lead to bone pain) - Fatigue (for anemia) - Infection (from neutropenia) - Bleeding/eccohymosis (thrombocytopenia) Organs enlarged and eventually leads to fibrosis - Spleen, liver, and lymph glands With CNS involvement (leukemic cells infiltrate CSF) - s/sx of increase ICP - CN 7 (facial nerve), hypothalamus, and cerebrum (manifestations are related to area involved) --> difference of these is that they are not localized

brain growth reaches 80-90% of adult size by

3 years

build towers 9-10 cubes, dress/undress self

3 years

use scissors, draw stick figures with 3 parts

4 years

Tonsillitis and Pharyngitis

4+ that means their tonsil are touching so watch for airway

bears weight in standing position with support

4-6 months

no head lag when pulled up to sitting position

4-6 months

sits with support

4-6 months

pincer grasp beginning

8-9 months

prevalence of dominant hand develops

8-9 months

like competitive games and sport, social, well behaved, modest, looks up to adults, rules and best friends are important

8-9 years

plays team sports, draw 3-dimensional figures

8-9 years

understand concept of time, know date and month, understand space, cause, effect, can make change, less animistic in thinking, punctual

8-9 years

goes from crawling to creeping

9 months

moves from prone to sitting to standing position without help

9-12 months

stands alone without support

9-12 months

esophagus

<1 month frequency regurg from underdevelopment of the lower esophageal sphincter

A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a A. spacer. B. nebulizer. C. peak expiratory flow meter. D. trial of chest physiotherapy.

A

A child has a chronic cough, no retractions but diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? A. Asthma B. Pneumonia C. Croup D. Foreign body aspiration

A

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to A. prevent respiratory syncytial virus (RSV) infection. B. make isolation of the infant with RSV unnecessary. C. prevent secondary bacterial infection. D .decrease toxicity of antiviral agents.

A

Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include A. Cardiopulmonary resuscitation (CPR) B. Administration of intravenous (IV) fluids C. Foreign airway obstruction removal using the Heimlich maneuver D. Advice that the infant not be left with caretakers other than the parents

A

The most appropriate nursing intervention for a child following a tonsillectomy is to A. watch for continuous swallowing. B. encourage gargling to reduce discomfort. C. position the child on the back for sleeping. D. apply warm compresses to the throat.

A

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of A. pneumothorax. B. bronchodilation. C. carbon dioxide retention. D. increased viscosity of sputum.

A

A nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to the colo-rectal cancer is necessary if the client identifies which of the following as an associated risk factor? A. Age younger than 50 years B. History of coloractal polyps C. Family history of colorectal cancer D. Chronic inflammatory bowel disease"

A (Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.)

A child with cancer has the following lab result: WBC 10,000, RBC 5, and plts of 20,000. When planning this child's care, which risk should the nurse consider most significant? A. Hemorrage B. Anemia C. Infection D. Pain

A (The lab values presented all are normal except for the platelet count. Decreases in platelet counts place the child at greatest risk for hemorrhage.)

A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client's chemotherapy regimen is to: a. Prevent metabolic breakdown of xanthine to uric acid b. Prevent uric acid from precipitating in the ureters c. Enhance the production of uric acid to ensure adequate excretion of urine d. Ensure that the chemotherapy doesn't adversely affect the bone marrow"

A (The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to uric acid. Allopurinol doesn't act in the manner described in the other options.)

Which is a type of skin traction with legs in an extended position? a. Dunlop b. Bryant c. Russell d. Buck extension

D ~ Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calv-Perthes disease. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position.

Which should cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia b. Cold toes c. Increased respirations d. Hot spots felt on cast surface

D ~ If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. The five Ps of ischemia from a vascular injury are pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may be indicative of a respiratory tract infection or pulmonary emboli. This should be reported, and child should be evaluated.

The nurse is taking care of an adolescent diagnosed with kyphosis. Which describes this condition? a. Lateral curvature of the spine b. Immobility of the shoulder joint c. Exaggerated concave lumbar curvature of the spine d. Increased convex angulation in the curve of the thoracic spine

D ~ Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Ankylosis is the immobility of a joint. Lordosis is an exaggerated concave lumbar curvature of the spine.

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? a. Aspirin b. Corticosteroids c. Cytotoxic drugs such as methotrexate d. Nonsteroidal anti-inflammatory drugs (NSAIDs)

D ~ NSAIDs are the first drugs used in JIA. Naproxen, ibuprofen, and tolmetin are approved for use in children. Aspirin, once the drug of choice, has been replaced by the NSAIDs because they have fewer side effects and easier administration schedules. Corticosteroids are used for life-threatening complications, incapacitating arthritis, and uveitis. Methotrexate is a second-line therapy for JIA.

A woman who wishes to become pregnant again consults with the nurse about preventing her child from being born with clubfoot. She has two other children, both treated for this disorder. Which information does the nurse provide about preventing clubfoot? A. Avoid secondhand cigarette smoke while pregnant B. Fetal positioning in utero cannot be controlled C. Getting enough folic acid early in pregnancy is advisable. D. The disorder is genetic so no prevention is available.

D ~ Recent research shows that clubfoot is genetic, so no prevention is possible. In utero positioning can possibly influence the disorder as well. Second-hand smoke exposure is not related. Folic acid is important for preventing neural tube disorders.

A 4-year-old child is newly diagnosed with Legg-Calv-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

D ~ The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and nonweight bearing, which helps reduce inflammation and restore motion. Legg-Calv-Perthes is a disease with an unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient therapy and the childs age at onset.

The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

D ~ The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The affected limb should not hang down for any length of time.

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the childs immobilization status? a. Metabolic rate increases b. Increased joint mobility leading to contractures c. Bone calcium increases, releasing excess calcium into the body (hypercalcemia) d. Venous stasis leading to thrombi or emboli formation

D ~ The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. Loss of joint mobility leads to contractures. Bone demineralization with osteoporosis and hypercalcemia occur with immobilization.

The nurse uses the palms of the hands when handling a wet cast for which reason? a. To assess dryness of the cast b. To facilitate easy turning c. To keep the patients limb balanced d. To avoid indenting the cast

D ~ Wet casts should be handled by the palms of the hands, not the fingers, to avoid creating pressure points. Assessing dryness, facilitating easy turning, and keeping the patients limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast.

In taking care of a pediatric oncology patient, which diagnostic finding would indicate a critical concern for the development of bleeding? A. Absolute neutrophil count of 1000 mm3 B. Temperature of 99.2° F C. White blood cell count 18,000 mm3 D. Platelet count 50,000 mm3

D.

A 16-year-old is admitted to the hospital for acute appendicitis, and an appendectomy is performed. Which of the following nursing interventions is most appropriate to facilitate normal growth and development? A) Allow the family to bring in the child's favorite computer games B) Encourage the parents to room-in with the child C) Encourage the child to rest and read D) Allow the child to participate in activities with other individuals in the same age group when the condition permits

D. Adolescents often are not sure whether they want their parents with them when they are hospitalized. Because of the importance of the peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their ill friend. Options a, b, and c isolate the child from the peer group.

A nurse is preparing to administer immunizations to a 6 month old infant. Which is the following is an appropriate action for the nurse to take providing atruamatic care? A. administer 81mg of aspirin B. use the Z track method when injecting C. ask the parents to leave the room when injecting D. provide sucrose solution on the pacifier

D. provide sucrose solution on the pacifier

What is the child's concept of death at > 12 years {adolescents}?

Death is inevitable & irreversible but often a distant event Understand better what they are losing if someone dies If this child had a terminal illness, they recognize that they will have a different future. i.e. if a kid has cancer and is about to go to college, kid may understand that he/she cannot go now.

Non-Hodgkin Lymphoma Clinical Manifestations

Depend on anatomical site and extent of involvement - Systemic: low grade fever, anorexia with weight loss, nausea, fatigue, nigh sweats, and pruritus Painless enlargement of lymph nodes Most common: enlarged, firm, non-tender, moveable nodes in the cervical/supraclavicular Lymphoid tumors compressing various organs may cause interstitial or airway obstruction (nonproductive cough), cranial nerve palsy, or spinal paralysis, and retroperitoneal (abdominal pain/full feeling with minimal intake) Mets to the bone marrow or CNS may produce signs of leukemia Labs demonstrate increased LDH and uric acid, CT will show masses

The nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy. The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing phantom limb pain. Which prescribed medication is appropriate to administer to relieve phantom limb pain? a. Amitriptyline (Elavil) b. Hydrocodone (Vicodin) c. Oxycodone (OxyContin) d. Alprazolam (Xanax)

A ~ Amitriptyline (Elavil) has been used successfully to decrease phantom limb pain. Opioids such as Vicodin or OxyContin would not be prescribed for this pain. A benzodiazepine, Xanax, would not be prescribed for this type of pain.

Which can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection

A ~ Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

A child has been hospitalized with suspected osteomyelitis. The childs white blood cell count (WBC) is 22,000/mm3 and his C-reactive protein is 15 mg/dL. Which conclusion by the nurse is appropriate based on these laboratory values? A. The child has an infection somewhere. B. The child has osteomyelitis. C. The child is immunocompromised. D. These tests are not related to the condition.

A ~ Elevations in WBCs and C-reactive protein indicate an infection is present, but are not specific for any one kind of infection.

An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days. The nurses approach should include which action? a. Answering questions with straightforward honesty b. Avoiding discussing the seriousness of the condition c. Explaining that, although the amputation is difficult, it will cure the cancer d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy

A ~ Honesty is essential to gain the childs cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so he or she has time to reflect on the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery.

Which term is used to describe a type of fracture that does not produce a break in the skin? a. Simple b. Compound c. Complicated d. Comminuted

A ~ If a fracture does not produce a break in the skin, it is called a simple, or closed, fracture. A compound, or open, fracture is one with an open wound through which the bone protrudes. A complicated fracture is one in which the bone fragments damage other organs or tissues. A comminuted fracture occurs when small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue. These are rare in children.

The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure. Which consideration should the nurse include? a. Nasogastric intubation and urinary catheter may be required. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.

A ~ Luque-rod segmental spinal instrumentation is a surgical procedure. Nasogastric intubation and urinary catheterization may be required. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients walk by the second or third postoperative day. Casting and bracing are required postoperatively. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.

A child who has been limping for several weeks is brought to the clinic and undergoes radiological studies. The results show osteonecrosis. Which information does the nurse plan to teach the parents about their childs condition? A. Non-weight-bearing status and mobility limitations B. Overcorrection with serial casting for 23 years C. Surgical correction with the Z-plasty technique D. Wearing and caring for a Browne splint

A ~ Osteonecrosis is a cardinal sign of Legg-Calv-Perthes disease. This disorder is frequently treated with non-weight-bearing status and bracing or casting. The other treatment modalities are used to treat clubfoot.

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which should the nurse suggest to remove this material? a. Soak in a bathtub. b. Vigorously scrub leg. c. Apply powder to absorb material. d. Carefully pick material off leg.

A ~ Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

A young girl has just injured her ankle at school. In addition to calling the childs parents, the most appropriate, immediate action by the school nurse is to: a. apply ice. b. observe for edema and discoloration. c. encourage child to assume a position of comfort. d. obtain parental permission for administration of acetaminophen or aspirin.

A ~ Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a position of comfort, and obtaining parental permission for administration of acetaminophen or aspirin are not immediate priorities. The application of ice can reduce the severity of the injury.

Four-year-old David is placed in Buck extension traction for Legg-Calv-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. Which action should the nurse take first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify physician. d. Chart the observations and check the extremity again in 15 minutes.

A ~ The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. Pain medication should be given after the practitioner is notified. Legg-Calv-Perthes disease is an emergency condition; immediate reporting is indicated. The findings should be documented with ongoing assessment.

The nurse is taking care of an adolescent with osteosarcoma. The parents ask the nurse about treatment. The nurse should make which accurate response about treatment for osteosarcoma? a. Treatment usually consists of surgery and chemotherapy. b. Amputation of affected extremity is rarely necessary. c. Intensive irradiation is the primary treatment. d. Bone marrow transplantation offers the best chance of long-term survival.

A ~ The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy. Intensive irradiation and bone marrow transplantation are usually not part of the therapeutic management.

The nurse should monitor for which effect on the cardiovascular system when a child is immobilized? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes

A ~ The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.

A maternity nurse is providing instruction to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse would instruct the mother to A) Allow the newborn infant to signal a need B) Anticipate all of the needs of the newborn infant C) Avoid the newborn infant during the first 10 minutes of crying D) Attend to the newborn infant immediately when crying

A) Allow the newborn infant to signal a need. Trust vs Mistrust stage-This will allow the infant opportunity to gain trust.

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani click b. Unequal gluteal folds c. Negative Babinski sign d. Trendelenburg sign e. Telescoping of the affected limb

A, B ~ A positive Ortolani test and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Unequal gluteal folds, negative Babinski sign, and Trendelenburg sign are signs that appear in older infants and children. Telescoping of the affected limb and lordosis are not clinical manifestations of developmental dysplasia of the hip.

An adolescent with juvenile idiopathic arthritis (JIA) is prescribed abatacept (Orencia). Which should the nurse teach the adolescent regarding this medication? (Select all that apply.) a. Avoid receiving live immunizations while taking the medication. b. Before beginning this medication, a tuberculin screening test will be done. c. You will be getting a twice-a-day dose of this medication. d. This medication is taken orally.

A, B ~ Abatacept reduces inflammation by inhibiting T cells and is given intravenously every 4 weeks. Possible side effects of biologics include an increased infection risk. Because of the infection risk, children should be evaluated for tuberculosis exposure before starting these medications. Live vaccines should be avoided while taking these agents.

A school-age child is diagnosed with systemic lupus erythematosus (SLE). The nurse should plan to implement which interventions for this child? (Select all that apply.) a. Instructions to avoid exposure to sunlight b. Teaching about body changes associated with SLE c. Preparation for home schooling d. Restricted activity

A, B ~ Key issues for a child with SLE include therapy compliance; body-image problems associated with rash, hair loss, and steroid therapy; school attendance; vocational activities; social relationships; sexual activity; and pregnancy. Specific instructions for avoiding exposure to the sun and UVB light, such as using sunscreens, wearing sun-resistant clothing, and altering outdoor activities, must be provided with great sensitivity to ensure compliance while minimizing the associated feeling of being different from peers. The child should continue school attendance in order to gain interaction with peers and activity should not be restricted, but promoted.

The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast? (Select all that apply.) a. Less bulky b. Drying time is faster c. Molds readily to body part d. Permits regular clothing to be worn e. Can be cleaned with small amount of soap and water

A, B, D, E The advantages of synthetic casts over plaster of Paris casts are that they are less bulky, dry faster, permit regular clothes to be worn, and can be cleaned. Plaster of Paris casts mold readily to a body part, but synthetic casts do not mold easily to body parts.

A parent asks about the process of bone growth. When explaining bone development to the parent, which substances does the nurse include in the teaching session as being necessary? (Select all that apply.) A. Calcitonin B. Calcium C. Estrogen D. Thyroid hormones E. Vitamin D

A, B, E ~ Bone growth depends on several substances, including calcium, calcitonin, parathyroid hormone, vitamin D, and other minerals and enzymes. Estrogen and thyroid hormones are not required.

A nurse is teaching parents how to care for their child who is undergoing serial casting for clubfoot. Which information does the nurse provide? (Select all that apply.) A. Cast care B. Cast drying techniques C. Neurovascular assessment D. Pain management E. Wound care

A, C, D ~ Parents need to be taught how to properly care for their child's cast. The cast is left open to air for drying, so there are no special techniques needed. Specifically, the parents should not use a hair dryer, as this may cause burns. The parents should also be taught about managing the child's pain, as stretching the muscles and ligaments will be painful. They also need instruction on performing neurovascular checks and when to call the physician. Serial casting is not a surgical procedure, so wound care instructions are not needed.

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include (Select all that apply) A. lung function. B. associated allergies. C. frequency of symptoms. D. frequency and severity of exacerbations.

A, D

The nurse is caring for a child diagnosed with clubfoot. Which assessment findings does the nurse anticipate in the affected extremity? (Select all that apply.) A. Adducted forefoot B. Dorsiflexion C. Everted heel D. Plantar flexion E. Rigidity

A, D, E ~ Signs of clubfoot include plantar flexion, inverted heel, adducted forefoot, and rigidity to the point that the foot cannot be manipulated into a neutral position.

The mother of a toddler asks a nurse when it is safe to place the car safety seat in a face-forward position. The best nursing response is which of the following? A) When the toddler weighs 20 lbs B) The seat should not be placed in a face-forward position unless there are safety locks in the car C) The seat should never be place in a face-forward position because the risk of the child unbuckling the harness D) When the weight of the toddler is greater than 40 lbs

A. The transition point for switching to the forward facing position is defined by the manufacturer of the convertible car safety seat but is generally at a body weight of 9 kg or 20 lb and 1 year of age. Convertible car safety seats are used until the child weighs at least 40 lb. Options b, c, and d are incorrect

a nurse is teaching the parent of a child who has hand, foot, and mouth disease. What should be included in teaching? A. your child can be contagious when the symptoms are gone b. the incubation period is 10-21 days C. it is transmitted by droplet D. once infected, child will be a lifetime carrier

A. child can be contagious even when symptoms are gone

The health care provider has prescribed cyclosporin (Sandimmune) 5 mg/kg/day PO divided twice daily for a child with juvenile arthritis. The child weighs 110 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer in a whole number.

ANS: 125 The correct calculation is: 110 lb/2.2 kg = 50 kg Dose of Sandimmune is 5 mg/kg/day divided bid 5 mg ´ 50 = 250 mg/day 250 mg/2 = 125 mg for one dose

The health care provider has prescribed sulfasalazine (Azulfidine) 5 mg/kg PO per dose twice a day for a child with juvenile arthritis. The child weighs 55 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 125 The correct calculation is: 55 lb/2.2 kg = 25 kg Dose of Azulfidine is 5 mg/kg 5 mg ´ 25 = 125 mg

The health care provider has prescribed azathioprine (Imuran) 1 mg/kg/day PO for a child with juvenile arthritis. The child weighs 77 lb. The nurse is preparing to administer the daily dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 35 The correct calculation is: 77 lb/2.2 kg = 35 kg Dose of Imuran is 1 mg/kg/day 1 mg ´ 35 = 35 mg for the daily dose

The nurse explains that the second process of self-mobility an infant learns is seen at the age of 9 months, when the infant begins to ___________.

ANS: creep At 7 months the infant begins to crawl, using arms and dragging trunk and legs. At 9 months the infant begins to creep, holding his or her trunk above the floor. The next self-mobility activity is cruising, where the child walks from one piece of furniture to the next before it begins to walk independently.

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

ANS: A A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenal, anterior pituitary, or posterior pituitary secretory organs.

The family and child have decided that hospice care best meets their needs during the terminal phase of illness. The nurse recognizes that the parents understand the principles of this care when they make which statement? a. It will be good to be at home and care for our child. b. What a relief it will be not to need any more medicines. c. We are going to miss the support of the hospice team when our child dies. d. We know that once hospice care starts, we will not be able to return to the hospital if the care is difficult.

ANS: A A major principle of hospice care is that the family members are the principal caregivers and are supported by a team of professionals. Pain and symptom management is a priority. The family and visiting nurses administer medications to keep the child as pain and symptom free as possible. The hospice team provides bereavement support to help the family in the postdeath adjustment. This may last for up to a year or more. If the family decides they can no longer care for the child at home, readmission to a freestanding hospice or hospital is possible. DIF: Cognitive Level: Applying REF: p. 800

A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed? a. Position changes are made by log rolling. b. Assistance is needed to use the bathroom. c. The head of the bed is elevated to minimize spinal headache. d. Passive range of motion is instituted to prevent neurologic injury.

ANS: A After scoliosis repair using a Luque procedure, the adolescent is turned by log rolling to prevent damage to the fusion and instrumentation. The patient is kept flat in bed for the first 12 hours and is not ambulatory until the second or third postoperative day. A urinary catheter is placed. The head of the bed is not elevated until the second postoperative day. Range of motion exercises are begun on the second postoperative day.

The nurse is caring for an adolescent with anorexia nervosa. What pituitary dysfunction should the nurse assess for in the adolescent? a. Hypopituitarism b. Pituitary hyperfunction c. Hyperplasia of the pituitary cells d. Overproduction of the anterior pituitary hormones

ANS: A Anorexia nervosa can cause hypopituitarism. It does not cause the hyperfunction of the pituitary, hyperplasia of the pituitary cells, or overproduction of the anterior pituitary hormones.

The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone? a. Low levels of circulating thyroid hormone b. High levels of circulating thyroid hormone c. Low levels of circulating adrenocorticotropic hormone d. High levels of circulating adrenocorticotropic hormone

ANS: A As blood concentrations of the target hormones reach normal levels, a negative message is sent to the anterior pituitary to inhibit release of the tropic hormone. For example, TSH responds to low levels of circulating TH. As blood levels of TH reach normal concentrations, a negative feedback message is sent to the anterior pituitary, resulting in diminished release of TSH. Adrenocorticotropic stimulates the adrenals to secrete glucocorticoids

When is an autopsy required? a. In the case of a suspected suicide b. When a person has a known terminal illness c. With a hospice patient who dies at home d. With the victim of a motor vehicle collision

ANS: A Autopsy is usually required in cases of unexplained death, violent death, or suspected suicide. In other instances it may be optional, and parents should be informed. The cause of death is not unknown in a person with a known terminal illness, a hospice patient at home, or a victim of a motor vehicle collision. Autopsy can be requested by family, but it is not required. DIF: Cognitive Level: Applying REF: p. 812

What condition can result from the bone demineralization associated with immobility? a. Osteoporosis b. Pooling of blood c. Urinary retention d. Susceptibility to infection

ANS: A Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Pooling of blood is a result of the cardiovascular effects of immobilization. Urinary retention is secondary to the effect of immobilization on the urinary tract. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

What information should the nurse include when teaching an adolescent with Crohn disease (CD)? a. How to cope with stress and adjust to chronic illness b. Preparation for surgical treatment and cure of CD c. Nutritional guidance and prevention of constipation d. Prevention of spread of illness to others and principles of high-fiber diet

ANS: A CD is a chronic illness with a variable course and many potential complications. Guidance about living with chronic illness is essential for adolescents. Stress management techniques can help with exacerbations and possible limitations caused by the illness. At this time, there is no cure for CD. Surgical intervention may be indicated for complications that cannot be controlled by medical and nutritional therapy. Nutritional guidance is an essential part of management. Constipation is not usually an issue with CD. CD is not infectious, so transmission is not a concern. A low-fiber diet is indicated.

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included? a. Encourage the child to wear medical identification. b. Discuss with the child and family ways to limit fluid intake. c. Teach the child and family how to do required urine testing. d. Reassure the child and family that this is usually not a chronic or life-threatening illness.

ANS: A DI is a potentially life-threatening disorder if the voluntary demand for fluid is suppressed or the child does not have access to fluids. Medical alert identification should be worn. Fluid intake is not restricted in children with DI. The child is unable to concentrate urine and can rapidly become dehydrated. Fluid intake may be limited during diagnosis, when the lack of intake will result in decreased urinary output and dehydration. Urine testing is not required in DI. Changes in body weight provide information about approximate fluid balance. This is a lifelong disorder that requires supplemental vasopressin throughout life

A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program? a. Essential information is presented initially. b. Teaching should take place in the child's semiprivate room. c. Education is focused toward the parents because the child is too young. d. All information needed for self-management of diabetes is taught at once.

ANS: A Diagnosis of type 1 diabetes can be traumatic for the child and family. Most families are not psychologically ready for the complex teaching that is needed for self-management. Most structured diabetes education programs begin with essential or survival information followed by the complex background material when the family is better able to learn. Teaching can take place either as an outpatient or as an inpatient. The actual teaching area should be free from distractions that would interfere with learning. A semiprivate room would have many individuals entering and leaving the room, causing distraction. A 12-year-old child who is cognitively age appropriate needs to be included in the educational process. Most children older than the age of 8 years can be involved in blood glucose monitoring and insulin administration. Teaching all information needed for self-management of diabetes at once would be too overwhelming for a family in crisis.

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise? a. increase food intake b. decrease food intake c. increase risk of hyperglycemia d. decrease risk of insulin reaction

ANS: A Exercise is encouraged and never restricted unless indicated by other health conditions. Exercise lowers blood glucose levels, depending on the intensity and duration of the activity. Consequently, exercise should be included as part of diabetes management, and the type and amount of exercise should be planned around the child's interests and capabilities. However, in most instances, children's activities are unplanned, and the resulting decrease in blood glucose can be compensated for by providing extra snacks before (and, if the exercise is prolonged, during) the activity. In addition to a feeling of well-being, regular exercise aids in utilization of food and often results in a reduction of insulin requirements.

What intervention is contraindicated in a suspected case of appendicitis? a. Enemas b. Palpating the abdomen c. Administration of antibiotics d. Administration of antipyretics for fever

ANS: A In any instance in which severe abdominal pain is observed and appendicitis is suspected, the nurse must be aware of the danger of administering laxatives or enemas. Such measures stimulate bowel motility and increase the risk of perforation. The abdomen is palpated after other assessments are made. Antibiotics should be administered, and antipyretics are not contraindicated.

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered? a. At bedtime b. After meals c. Before meals d. After arising in morning

ANS: A Injections are best given at bedtime to more closely approximate the physiologic release of GH. After meals, before meals, and after arising in the morning do not parallel the physiologic release of the hormone.

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

The nurse is using calipers to measure skinfold thickness over the triceps muscle in a school-age child. What is the purpose of doing this? a. To measure body fat b. To measure muscle mass c. To determine arm circumference d. To determine accuracy of weight measurement

ANS: A Measurement of skinfold thickness is an indicator of body fat. Arm circumference is an indirect measure of muscle mass. The accuracy of weight measurement should be verified with a properly balanced scale. Body fat is just one indicator of weight. DIF: Cognitive Level: Remember REF: p. 80 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

What statement best describes Hirschsprung disease? a.The colon has an aganglionic segment. b.It results in frequent evacuation of solids, liquid, and gas. c.The neonate passes excessive amounts of meconium. d.It results in excessive peristaltic movements within the gastrointestinal tract.

ANS: A Mechanical obstruction in the colon results from a lack of innervation. In most cases, the aganglionic segment includes the rectum and some portion of the distal colon. There is decreased evacuation of the large intestine secondary to the aganglionic segment. Liquid stool may ooze around the blockage. The obstruction does not affect meconium production. The infant may not be able to pass the meconium stool. There is decreased movement in the colon.

An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for ? a. Central venous catheter infection, electrolyte losses, and hyperglycemia b. Hypoglycemia, catheter migration, and weight gain c. Venous thrombosis, hyperlipidemia, and constipation d. Catheter damage, red currant jelly stools, and hypoglycemia

ANS: A Numerous complications are associated with short bowel syndrome and long-term TPN. Infectious, metabolic, and technical complications can occur. Sepsis can occur after improper care of the catheter. The gastrointestinal tract can also be a source of microbial seeding of the catheter. The nurse should monitor for catheter infection, electrolyte losses, and hyperglycemia. Hypoglycemia, weight gain, constipation, or red currant jelly stools are not characteristics of short bowel syndrome with extended TPN.

A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed? a. Ondansetron (Zofran) b. Promethazine (Phenergan) c. Metoclopramide (Reglan) d. Dimenhydrinate (Dramamine)

ANS: A Ondansetron reduces the duration of vomiting in children with acute gastroenteritis. This would be the expected prescribed antiemetic. Adverse effects with earlier generation antiemetics (e.g., promethazine and metoclopramide) include somnolence, nervousness, irritability, and dystonic reactions and should not be routinely administered to children. For children who are prone to motion sickness, it is often helpful to administer an appropriate dose of dimenhydrinate (Dramamine) before a trip, but it would not be ordered as an antiemetic.

The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test? a. Hypotension b. Tachycardia c. Hypoglycemia d. Nausea and vomiting

ANS: A Patients receiving clonidine (Catapres) for a growth hormone stimulation test require close blood pressure monitoring for hypotension. Tachycardia, hypoglycemia, and nausea and vomiting do not occur with Catapres administered for a growth hormone stimulation test.

What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux? a. The medication reduces gastric acid secretion. b. The medication neutralizes the acid in the stomach. c. The medication increases the rate of gastric emptying time. d. The medication coats the lining of the stomach and esophagus.

ANS: A Pharmacologic therapy may be used to treat infants and children with gastroesophageal reflux disease. Both H2-receptor antagonists (cimetidine [Tagamet], ranitidine [Zantac], or famotidine [Pepcid]) and proton pump inhibitors (esomeprazole [Nexium], lansoprazole [Prevacid], omeprazole [Prilosec], pantoprazole [Protonix], and rabeprazole [Aciphex]) reduce gastric hydrochloric acid secretion.

What statement is most descriptive of a school-age childs reaction to death? a. Very interested in funerals and burials b. Little understanding of words such as forever c. Imagine the deceased person to be still alive d. Can explain death from a religious or spiritual point of view

ANS: A School-age children are interested in naturalistic and physiologic explanations of why death occurs and what happens to the body. School-age children do have an established concept of forever and have a deeper understanding of death in a concrete manner. Adolescents may explain death from a religious or spiritual point of view. DIF: Cognitive Level: Understanding REF: p. 816

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material? a. Soak in a bathtub. b. Vigorously scrub the leg. c. Carefully pick material off the leg. d. Apply powder to absorb the material.

ANS: A Simply soaking in the bathtub is usually sufficient for removal of the desquamated skin and sebaceous secretions. Several days may be required to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

A young girl has just injured her ankle at school. In addition to notifying the child's parents, what is the most appropriate, immediate action by the school nurse? a. Apply ice. b. Observe for edema and discoloration. c. Encourage child to assume a position of comfort. d. Obtain parental permission for administration of acetaminophen or aspirin.

ANS: A Soft tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. The nurse observes for the edema while placing a cold pack. The applying of ice can reduce the severity of the injury. Maintaining the ankle at a position elevated above the heart is important. The nurse helps the child be comfortable with this requirement. The nurse obtains parental permission for administration of acetaminophen or aspirin after ice and rest are assured.

A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he "heard a pop," that the pain is "pretty bad," and that the ankle feels "as if it is coming apart." Based on this description, the nurse suspects what injury? a. Sprain b. Fracture c. Dislocation d. Stress fracture

ANS: A Sprains account for approximately 75% of all ankle injuries in children. A sprain results when the trauma is so severe that a ligament is either stretched or partially or completely torn by the force created as a joint is twisted or wrenched. Joint laxity is the most valid indicator of the severity of a sprain. A fracture involves the cross-section of the bone. Dislocations occur when the force of stress on the ligaments disrupts the normal positioning of the bone ends. Stress fractures result from repeated muscular contraction and are seen most often in sports involving repetitive weight bearing such as running, gymnastics, and basketball.

A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include? a.Bowel cleansing b.Dietary modification c.Structured toilet training d.Behavior modification

ANS: A The first step in the treatment of chronic constipation is to empty the bowel and allow the distended rectum to return to normal size. Dietary modification is an important part of the treatment. Increased fiber and fluids should be gradually added to the child's diet. A 2-year-old child is too young for structured toilet training. For an older child, a regular schedule for toileting should be established. Behavior modification is part of the overall treatment plan. The child practices releasing the anal sphincter and recognizing cues for defecation.

What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)? a. Control pain and preserve joint function. b. Minimize use of joint and achieve cure. c. Prevent skin breakdown and relieve symptoms. d. Reduce joint discomfort and regain proper alignment.

ANS: A The goals of therapy are to control pain, preserve joint range of motion and function, minimize the effects of inflammation, and promote normal growth and development. There is no cure for JIA at this time. Skin breakdown is not an issue for most children with JIA. Symptom relief and reduction in discomfort are important. When the joints are damaged, it is often irreversible.

A 12-year-old child has failed several courses of chemotherapy. An experimental drug is available that his parents want him to receive. He has told his parents and the oncologists that he is ready to die and does not want any more chemotherapy. The nurse recognizes what to be true? a. Parents and child both need support in the decision making. b. Twelve-year-olds are minors and cannot give consent or refuse treatments. c. The oncologists needs to make the decision because the parents and child disagree. d. The parents have the right and responsibility to make decisions for their children younger than age 18 years.

ANS: A This is a family issue that requires support to help both parents and child resolve the conflict. Because the child has little chance of survival, many institutions support the childs right to refuse or assent to therapy. The institution can obtain a court order to support the childs decision if verified by the oncologists. Twelve-year-olds can give consent for therapy under certain conditions, including being an emancipated minor and receiving therapy for birth control and sexually transmitted infections. Right to self-determination is also accepted if the child is fully aware of the consequences of the actions. The practitioners cannot take the responsibility for decision making from the parent or child. Parents have the responsibility for decision making, but certain circumstances do limit their authority.

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching? a. "I should gently massage the skin under the straps once a day to stimulate circulation." b. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." c. "I should remove the harness several times a day to prevent contractures." d. "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."

ANS: A To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder because this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency? a. Type 1 diabetes b. Type 2 diabetes c. Gestational diabetes d. Maturity-onset diabetes of the young (MODY)

ANS: A Type 1 diabetes is characterized by the destruction of the pancreatic beta cells, which leads to absolute insulin deficiency. Type 2 diabetes results usually from insulin resistance. The pancreatic beta cells are not destroyed in gestational diabetes. MODY is an autosomal dominant monogenetic defect in beta cell function that is characterized by impaired insulin secretion with minimum or no defects in insulin action.

What measure is important in managing hypercalcemia in a child who is immobilized? a. Provide adequate hydration. b. Change position frequently. c. Encourage a diet high in calcium. d. Provide a diet high in calories for healing.

ANS: A Vigorous hydration is indicated to prevent problems with hypercalcemia. Suggested intake for an adolescent is 3000 to 4000 ml/day of fluids. Diuretics are used to promote the removal of calcium. Changing position is important for skin and respiratory concerns. Calcium in the diet is restricted when possible. A high-protein diet served as frequent snacks with favored foods is recommended. A high-calorie diet without adequate protein will not promote healing.

What nursing intervention is most appropriate when providing comfort and support for a child when death is imminent? a. Limit care to essentials. b. Avoid playing music near the child. c. Whisper to the child instead of using a normal voice. d. Explain to the child the need for constant measurement of vital signs.

ANS: A When death is imminent, care should be limited to interventions for palliative care. Music may be used to provide comfort to the child. The nurse should speak to the child in a clear, distinct voice. Vital signs do not need to be measured frequently.

After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time? a. Notify the practitioner. b. Insert the NG tube so feedings can be given. c. Replace the NG tube to maintain gastric decompression. d. Leave the NG tube out because it has probably been in long enough.

ANS: A When surgery is performed on the upper gastrointestinal tract, usually the surgical team replaces the NG tube because of potential injury to the operative site. The decision to replace the tube or leave it out is made by the surgical team. Replacing the tube is also usually done by the practitioner because of the surgical site.

During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. How should the nurse interpret this finding? a. Normal finding b. Abnormal finding, so child needs referral to ophthalmologist c. Sign of possible visual defect, so child needs vision screening d. Sign of small hemorrhages, which will usually resolve spontaneously

ANS: A A brilliant, uniform red reflex is an important normal finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber. DIF: Cognitive Level: Understand REF: p. 91 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

25. During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which of the following? a. Normal finding b. Sign of possible visual defect and a need for vision screening c. Abnormal finding; requiring referral to ophthalmologist d. Sign of small hemorrhages, which usually resolve spontaneously

ANS: A A brilliant, uniform red reflex is an important normal finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber. DIF: Cognitive Level: Knowledge REF: p. 155 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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 A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures. The nurse should suggest that the parents try soft, bland foods; normal saline or bicarbonate mouthwashes; and local anesthetics. Insisting that the child eat normally is not suggested. For some children, not eating may be a way to maintain some control. This can set the child and caregiver in opposition to each other. Hot and cold foods can be painful on ulcerated mucosal membranes. Substitution of high-calorie foods that the child likes and can eat should be used.

10. Which of the following data would be included in a health history? a. Review of systems b. Physical assessment c. Growth measurements d. Record of vital signs

ANS: A A review of systems is done to elicit information concerning any potential health problems. This further guides the interview process. Physical assessment, growth measurements, and a record of vital signs are components of the physical examination. DIF: Cognitive Level: Knowledge REF: p. 127 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which of the following types of seizures may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

ANS: A Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure. Generalized, simple partial, and complex partial seizures all have clinical manifestations that are observable.

When caring for the child with Reye syndrome, the priority nursing intervention should be to: a. monitor intake and output. b. prevent skin breakdown. c. observe for petechiae. d. do range-of-motion exercises.

ANS: A Accurate and frequent monitoring of intake and output is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema. Preventing skin breakdown, observing for petechiae, and doing range-of-motion exercises are important interventions in the care of a critically ill or comatose child. Careful monitoring of intake and output is a priority.

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 Acute tumor lysis syndrome results from the release of intracellular metabolites during the initial treatment of leukemia. Hyperuricemia, hypocalcemia, hyperphosphatemia, and hyperkalemia can result. Hydration is used to reduce the metabolic consequences of the tumor lysis. Oxygenation is not helpful in preventing acute tumor lysis syndrome. Allopurinol, not corticosteroids, is indicated for pharmacologic management. Pain management may be indicated for supportive therapy of the child, but it does not prevent acute tumor lysis syndrome.

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? a. Mouthwashes with plain saline b. Lemon glycerin swabs for cleansing c. Mouthwashes with hydrogen peroxide d. Swish and swallow with viscous lidocaine

ANS: A Administering mouth care is particularly difficult in infants and toddlers. A satisfactory method of cleaning the gums is to wrap a piece of gauze around a finger; soak it in saline or plain water; and swab the gums, palate, and inner cheek surfaces with the finger. Mouth rinses are best accomplished with plain water or saline because the child cannot gargle or spit out excess fluid. Avoid agents such as lemon glycerin swabs and hydrogen peroxide because of the drying effects on the mucosa. Lidocaine should be avoided in young children

A nurse is preparing to assess a 3-year-old child. What communication technique should the nurse use for this child? a. Focus communication on child. b. Explain experiences of others to child. c. Use easy analogies when possible. d. Assure child that communication is private.

ANS: A Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, experiences of others, analogies, and assurances that the communication is private will not be effective because the child is not capable of understanding. DIF: Cognitive Level: Apply REF: p. 61 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

4. Because children younger than 5 years are egocentric, the nurse should do which of the following when communicating with them? a. Focus communication on the child. b. Use easy analogies when possible. c. Explain experiences of others to the child. d. Assure child that communication is private.

ANS: A Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, analogies, experiences, and assurances that communication is private will not be effective because the child is not capable of understanding. DIF: Cognitive Level: Comprehension REF: p. 123 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

ANS: A Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel and high-pitched cry, constant low-pitched cry and restlessness, and depressed fontanel and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

ANS: A By age 7 months infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The child can scribble spontaneously at age 15 months. At age 12 months the child can release cubes into a cup.

A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include? a. Careful bathing and handling b. Monitoring of behavioral status c. Maintenance of strict isolation d. Administration of packed red blood cells

ANS: A Careful bathing and handling are important in preventing trauma to the Wilms tumor site

Which nursing intervention should not be included in the postoperative plan of care for a child undergoing surgery for a brain tumor? a. Place the child in Trendelenburg position. b. Perform neurologic assessments. c. Assess dressings for drainage. d. Monitor temperature.

ANS: A Feedback A The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding. B Increased intracranial pressure is a risk in the postoperative period. The nurse would assess the child's neurologic status frequently. C Hemorrhage is a risk in the postoperative period. The child's dressing would be inspected frequently for bleeding. D Temperature is monitored closely because the child is at risk for infection in the postoperative period.

The nurse notes that a child's gums bleed easily and he has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms? a. Platelet count of 19,000/mm3 b. Prothrombin time of 11 to 15 seconds c. Hematocrit of 34 d. Leukocyte count of 14,000/mm3

ANS: A Feedback A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential. The child should be monitored closely for signs of bleeding. B The prothrombin time of 11 to 15 seconds is within normal limits. C The normal hematocrit is 35 to 45 and, although this finding is low, it would not create the symptoms presented. D This value indicates the probable presence of infection, but it is not a reflection of bleeding tendency.

Which drug should the nurse expect to administer to a preschool child who has increased intracranial pressure (ICP) resulting from cerebral edema? a. Mannitol (Osmitrol) b. Epinephrine hydrochloride (Adrenalin) c. Atropine sulfate (Atropine) d. Sodium bicarbonate (Sodium bicarbonate)

ANS: A For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction. Epinephrine hydrochloride, atropine sulfate, and sodium bicarbonate are not used to decrease ICP.

What are the most common clinical manifestations of brain tumors in children? a. Headaches and vomiting b. Blurred vision and ataxia c. Hydrocephalus and clumsy gait d. Fever and poor fine motor control

ANS: A Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestations of brain tumors in children. Diplopia (double vision), not blurred vision, can be a presenting sign of brainstem glioma. Ataxia is a clinical manifestation of brain tumors, but headaches and vomiting are the most common. Hydrocephalus can be a presenting sign in infants when the sutures have not closed. Children at this age are usually not walking steadily. Poor fine motor coordination may be a presenting sign of astrocytoma, but headaches and vomiting are the most common presenting signs of brain tumors

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. What approach should the nurse implement? a. Answer questions with straightforward honesty. b. Avoid discussing the seriousness of the condition. c. Explain that although the amputation is difficult, it will cure the cancer. d. Help the adolescent accept the amputation as better than a long course of chemotherapy.

ANS: A Honesty is essential to gain the child's cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so there is time for reflection about the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery

The nurse has just started assessing a young child who is febrile and appears very ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. Which is the most appropriate action? a. Refer for immediate medical evaluation. b. Continue assessment to determine cause of neck pain. c. Ask parent when neck was injured. d. Record "head lag" on assessment record, and continue assessment of child.

ANS: A Hyperextension of the child's head with pain on flexion is indicative of meningeal irritation and needs immediate evaluation; it is not descriptive of head lag. The pain is indicative of meningeal irritation. No indication of injury is present. DIF: Cognitive Level: Apply REF: p. 90 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

17. The nurse is preparing to perform a physical assessment on a girl age 10 years. The nurse gives her the option of her mother staying in the room or leaving. This action should be considered which of the following? a. Appropriate, because of child's age b. Appropriate, because mother would be uncomfortable making decision for child c. Inappropriate, because of child's age d. Inappropriate, because child is same sex as mother

ANS: A It is appropriate to give the older school-age child the option of having the parent present or not. During the examination the nurse should respect the child's need for privacy. Children age 10 are minors, and parents are responsible for health care decisions. If the parent is uncomfortable, part of the nurse's role is to assist the parent by providing information. The child should help determine who is present during the examination. DIF: Cognitive Level: Comprehension REF: p. 140 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which approach would be best to use to ensure a positive response from a toddler? a. Assume an eye-level position and talk quietly. b. Call the toddler's name while picking him or her up. c. Call the toddler's name and say, "I'm your nurse." d. Stand by the toddler, addressing him or her by name.

ANS: A It is important that the nurse assume a position at the child's level when communicating with the child. By speaking quietly and focusing on the child, the nurse should be able to obtain a positive response. The nurse should engage the child and inform the toddler what is going to occur. If the nurse picks up the child without explanation, the child is most likely going to become upset. The toddler may not understand the meaning of the phrase, "I'm your nurse." If a positive response is desired, the nurse should assume the child's level when speaking if possible. DIF: Cognitive Level: Apply REF: p. 60 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

The nurse is teaching nursing students about childhood nervous system tumors. Which best describes a neuroblastoma? a. Diagnosis is usually made after metastasis occurs. b. Early diagnosis is usually possible because of the obvious clinical manifestations. c. It is the most common brain tumor in young children. d. It is the most common benign tumor in young children.

ANS: A Neuroblastoma is a silent tumor with few symptoms. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site. In only 30% of cases is diagnosis made before metastasis. Neuroblastomas are the most common malignant extracranial solid tumors in children. The majority of tumors develop in the adrenal glands or the retroperitoneal sympathetic chain. They are not benign but metastasize.

The nurse must assess a 10-month-old infant. The infant is sitting on the father's lap and appears to be afraid of the nurse and of what might happen next. Which initial action by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. b. Ask father to place the infant on the examination table. c. Undress the infant while he is still sitting on his father's lap. d. Talk softly to the infant while taking him from his father.

ANS: A Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done on the father's lap. The nurse should have the father undress the child as needed for the examination. DIF: Cognitive Level: Apply REF: p. 62 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

7. The nurse must assess 10-month-old Chad. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which of the following initial actions by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. b. Ask father to place Chad on the examination table. c. Talk softly to Chad while taking him from his father. d. Undress Chad while he is still sitting on his father's lap.

ANS: A Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done with the child on the father's lap. The nurse should have the father undress the child as needed during the examination. DIF: Cognitive Level: Application REF: p. 126 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which is the priority nursing intervention for an unconscious child after a fall? a. Establish adequate airway. b. Perform neurologic assessment. c. Monitor intracranial pressure. d. Determine whether a neck injury is present.

ANS: A Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishment of an adequate airway is always the first priority. A neurologic assessment and determination of whether a neck injury is present will be performed after breathing and circulation are stabilized. Intracranial, not intercranial, pressure is monitored if indicated after airway, breathing, and circulation are maintained.

A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock? a. Restlessness b. Rapid capillary refill c. Increased temperature d. Increased blood pressure

ANS: A Restlessness is an indication of impending shock in a child. Capillary refill is slowed in shock. The child will feel cool. The blood pressure initially remains within the normal range and then declines.

One pediatric oncologic emergency is acute tumor lysis syndrome. Symptoms that this may be occurring include what? a. Muscle cramps and tetany b. Respiratory distress and cyanosis c. Thrombocytopenia and sepsis d. Upper extremity edema and neck vein distension

ANS: A Risk factors for development of tumor lysis syndrome include a high white blood cell count at diagnosis, large tumor burden, sensitivity to chemotherapy, and high proliferative rate. In addition to the described metabolic abnormalities, children may develop a spectrum of clinical symptoms, including flank pain, lethargy, nausea and vomiting, muscle cramps, pruritus, tetany, and seizures. Respiratory distress and cyanosis occur with hyperleukocytosis. Thrombocytopenia and sepsis occur with disseminated intravascular coagulation. Upper extremity edema and neck vein distention occur with superior vena cava syndrome

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position.

ANS: A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

An adolescent girl tells the nurse that she is very suicidal. The nurse asks her if she has a specific plan. Asking this should be considered: a. An appropriate part of the assessment. b. Not a critical part of the assessment. c. Suggesting that the adolescent needs a plan. d. Encouraging the adolescent to devise a plan.

ANS: A Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as, "Have you ever developed a plan to hurt yourself or kill yourself" should be part of that assessment. Threats of suicide should always be taken seriously and evaluated. Suggesting that the adolescent needs a plan and encouraging them to devise this plan are inappropriate statements by the nurse.

A parent of a hospitalized child on chemotherapy asks the nurse if a sibling of the hospitalized child should receive the varicella vaccination. The nurse should give which response? a. The sibling can get a varicella vaccination. b. The sibling should not get a varicella vaccination. c. The sibling should wait until the child is finished with chemotherapy. d. The sibling should get varicella-zoster immune globulin if exposed to chickenpox.

ANS: A Siblings and other family members can receive the live measles, mumps, and rubella vaccine and the varicella vaccine without risk to the child who is immunosuppressed

10. When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia? a. 25% b. 50% c. 75% d. 100%

ANS: A Sickle cell anemia is inherited in an autosomal recessive pattern. If both parents have sickle cell trait (one copy of the sickle cell gene), then for each pregnancy, a 25% chance exists that their child will be affected with sickle cell disease. With each pregnancy, a 50% chance exists that the child will have sickle cell trait. Percentages of 75% and 100% are too high for the children of parents who have sickle cell trait. DIF: Cognitive Level: Analyze REF: p. 791 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. What statement explains what staging means? a. Extent of the disease at the time of diagnosis b. Rate normal cells are being replaced by cancer cells c. Biologic characteristics of the tumor or lymph nodes d. Abnormal, unrestricted growth of cancer cells producing organ damage

ANS: A Staging is a description of the extent of the disease at the time of diagnosis. Staging criteria exist for most tumors. The stage usually relates directly to the prognosis; the higher the stage, the poorer the prognosis. The rate that normal cells are being replaced by cancer cells is not a definition of staging. Classification of the tumor refers to the biologic characteristics of the tumor or lymph nodes. Abnormal, unrestricted growth of cancer cells producing organ damage describes how cancer cells grow and can cause damage to an organ

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school. Breathing is not impaired, but some postictal confusion occurs. The most appropriate initial action by the school nurse is to: a. stay with child and have someone call emergency medical service (EMS). b. notify parent and regular practitioner. c. notify parent that child should go home. d. stay with child, offering calm reassurance.

ANS: A The EMS should be called to transport the child because this is the child's first seizure. Because this is the first seizure, evaluation should be performed as soon as possible. The nurse should stay with the child while someone else notifies the EMS.

27. What is the most frequently used test for measuring visual acuity? a. Snellen letter chart b. Ishihara vision test c. Allen picture card test d. Denver eye screening test

ANS: A The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. The Ishihara Vision Test is used for color vision. The Allen picture card test and Denver eye screening test involve single cards for children ages 2 years and older who are unable to use the Snellen letter chart. DIF: Cognitive Level: Comprehension REF: p. 156 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

What test is used to screen for carbohydrate malabsorption? a. Stool pH b. Urine ketones c. C urea breath test d. ELISA stool assay

ANS: A The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of carbohydrate malabsorption. The bacterial fermentation of carbohydrates in the colon produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence of ketones in the urine, which indicates the use of alternative sources of energy to glucose. The C urea breath test measures the amount of carbon dioxide exhaled. It is used to determine the presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent assay) detects the presence of antigens and antibodies. It is not useful for disorders of metabolism.

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.

Which would be best for the nurse to use when determining the temperature of a preterm infant under a radiant heater? a. Axillary sensor b. Tympanic membrane sensor c. Rectal mercury glass thermometer d. Rectal electronic thermometer

ANS: A The axillary sensor measures the infrared heat energy radiating from the axilla. It can be used on wet skin, in incubators, or under radiant warmers. Ear thermometry does not show sufficient correlation with established methods of measurement. It should not be used when body temperature must be assessed with precision. Mercury thermometers should never be used. The release of mercury, should the thermometer be broken, can cause harmful vapors. Rectal temperatures should be avoided unless no other suitable way exists for the temperature to be measured. DIF: Cognitive Level: Apply REF: p. 85 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend that the parents: a. Ignore the "baby talk." b. Explain to the toddler that "baby talk" is for babies. c. Tell the toddler frequently, "You are a big kid now." d. Encourage the toddler to practice more advanced patterns of speech.

ANS: A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of saying that they are expressing stress. The parents should not introduce new expectations and should allow the child to master the developmental tasks without criticism.

A toddler fell out of a second-story window. She had a brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she "seems fine." Which explanation should the nurse give? a. Your child may have a brain injury and the CT can rule one out. b. The CT needs to be done because of your child's age. c. Your child may start to have seizures and a baseline CT should be done. d. Your child probably has a skull fracture and the CT can confirm this diagnosis.

ANS: A The child's history of the fall, brief loss of consciousness, and vomiting four times necessitates evaluation of a potential brain injury. The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan. The need for the CT scan is related to the injury and symptoms, not the child's age. The CT scan is necessary to determine whether a brain injury has occurred.

In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed, the nurse includes what information? a. Meticulous mouth care is essential to avoid mucositis. b. Rectal temperatures are necessary to monitor for infection. c. Intramuscular injections are preferred to intravenous ones. d. Platelet transfusions are given to maintain a count greater than 50,000/mm3.

ANS: A The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding. The child and family are taught how to perform good oral hygiene to minimize gingival bleeding and mucositis. Rectal temperatures are avoided to minimize the risk of ulceration. Hygiene is also emphasized. Intramuscular injections are avoided because of the risk of bleeding into the muscle and of infection. Platelet transfusions are usually not given unless there is active bleeding or the platelet count is less than 10,000/mm3. The use of platelets when not necessary can contribute to antibody formation and increased destruction of platelets when transfused.

1. The nurse is seeing an adolescent boy and his parents in the clinic for the first time. Which of the following should the nurse do first? a. Introduce self. b. Make family comfortable. c. Give assurance of privacy. d. Explain purpose of interview.

ANS: A The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. Clarification of the purpose of the interview and the nurse's role is the second thing that should be done. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. The interview also should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality. DIF: Cognitive Level: Application REF: p. 118 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? a. Introduce self. b. Make family comfortable. c. Explain purpose of interview. d. Give assurance of privacy.

ANS: A The first thing that nurses should do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. Clarification of the purpose of the interview and the nurse's role is the next thing that should be done. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality. DIF: Cognitive Level: Apply REF: p. 57 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

13. Where in the health history does a record of immunizations belong? a. History b. Present illness c. Review of systems d. Physical assessment

ANS: A The history contains information relating to all previous aspects of the child's health status. The immunizations are appropriately included in the history. The present illness, review of systems, and physical assessment are not appropriate places to record the immunization status. DIF: Cognitive Level: Comprehension REF: p. 127 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

12. The nurse is interviewing the mother of an infant. The mother reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which of the following headings? a. History b. Present illness c. Chief complaint d. Review of systems

ANS: A The history refers to information that relates to previous aspects of the child's health, not to the current problem. The mother's difficult delivery and prematurity are important parts of the infant's history. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth, but might include sequelae such as pulmonary dysfunction. DIF: Cognitive Level: Comprehension REF: p. 127 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" The nurse would reply: a. 5 months. b. 9 months. c. 1 year. d. 2 years.

ANS: A The infant can usually drink from a cup when it is offered at about 5 months.

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

ANS: A The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group.

The nurse is taking care of a child who is alert but showing signs of increased intracranial pressure. Which test is contraindicated in this case? a. Oculovestibular response b. Doll's head maneuver c. Funduscopic examination for papilledema d. Assessment of pyramidal tract lesions

ANS: A The oculovestibular response (caloric test) involves the instillation of ice water into the ear of a comatose child. The caloric test is painful and is never performed on an awake child or one who has a ruptured tympanic membrane. Doll's head maneuver, funduscopic examination for papilledema, and assessment of pyramidal tract lesions can be performed on awake children.

The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother either staying in the room or leaving. How should this action be interpreted? a. Appropriate because of child's age b. Appropriate because mother would be uncomfortable making decisions for child c. Inappropriate because of child's age d. Inappropriate because child is same sex as mother

ANS: A The older school-age child should be given the option of having the parent present or not. During the examination, the nurse should respect the child's need for privacy. Although the question was appropriate for the child's age, the mother is responsible for making decisions for the child. It is appropriate because of the child's age. During the examination, the nurse must respect the child's privacy. The child should help determine who is present during the examination. DIF: Cognitive Level: Apply REF: p. 77 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby was born preterm." This information should be recorded under which of the following headings? a. Past history b. Present illness c. Chief complaint d. Review of systems

ANS: A The past history refers to information that relates to previous aspects of the child's health, not to the current problem. The mother's difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the preterm birth. Sequelae such as pulmonary dysfunction would be included. DIF: Cognitive Level: Understand REF: p. 65 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is aware that the age at which the posterior fontanelle closes is _____ months. a. 2 to 3 b. 3 to 6 c. 6 to 9 d. 9 to 12

ANS: A The posterior fontanelle closes between 2 and 3 months of age.

The nurse has a 2-year-old boy sit in "tailor" position during palpation for the testes. What is the rationale for this position? a. It prevents cremasteric reflex. b. Undescended testes can be palpated. c. This tests the child for an inguinal hernia. d. The child does not yet have a need for privacy.

ANS: A The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. Privacy should always be provided for children. DIF: Cognitive Level: Understand REF: p. 107 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance: Techniques of Physical Assessment

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy.

ANS: A This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of neurologic dysfunction is present.

34. What type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular b. Bronchial c. Adventitious d. Bronchovesicular

ANS: A This is the definition of vesicular breath sounds. They are heard over the entire surface of lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions, where trachea and bronchi bifurcate. DIF: Cognitive Level: Comprehension REF: p. 166 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which figure depicts a nurse performing a test for the triceps reflex? a. b. c. d.

ANS: A To test the triceps reflex, the child is placed supine, with the forearm resting over the chest and the triceps tendon is struck with the reflex hammer. The other figures depict tests for biceps reflex (slightly above the antecubital space) patellar (knee), and Achilles (behind the foot). DIF: Cognitive Level: Analyze REF: p. 110 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is that: a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

A child with cancer being treated with chemotherapy is receiving a platelet transfusion. The nurse understands that the transfused platelets should survive the body for how many days? a. 1 to 3 days b. 4 to 6 days c. 7 to 9 days d. 10 to 12 days

ANS: A Transfused platelets generally survive in the body for 1 to 3 days. The peak effect is reached in about 1 hour and decreased by half in 24 hours

What type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular b. Bronchial c. Adventitious d. Bronchovesicular

ANS: A Vesicular breath sounds are heard over the entire surface of lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions where trachea and bronchi bifurcate. DIF: Cognitive Level: Remember REF: p. 101 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

An important nursing intervention when caring for a child who is experiencing a seizure would be to: a. describe and record the seizure activity observed. b. restrain the child when seizure occurs to prevent bodily harm. c. place a tongue blade between the teeth if they become clenched. d. suction the child during a seizure to prevent aspiration.

ANS: A When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child should not be restrained, and nothing should be placed in the child's mouth. This may cause injury. To prevent aspiration, if possible, the child should be placed on the side, facilitating drainage.

A nurse is performing an otoscopic exam on a school-age child. Which direction should the nurse pull the pinna for this age of child? a. Up and back b. Down and back c. Straight back d. Straight

ANS: A With older children, usually those older than 3 years of age, the canal curves downward and forward. Therefore, pull the pinna up and back during otoscopic examinations. In infants, the canal curves upward. Therefore, pull the pinna down and back to straighten the canal. Pulling the pinna straight back or straight up will not open the inner ear canal. DIF: Cognitive Level: Understand REF: p. 95 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

5. The nurse's approach when introducing hospital equipment to a preschooler who seems afraid should be based on which one of the following principles? a. The child may think the equipment is alive. b. Explaining the equipment will only increase the child's fear. c. One brief explanation will be enough to reduce the child's fear. d. The child is too young to understand what the equipment does.

ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. Simple, concrete explanations about what the equipment does and how it will feel will help alleviate the child's fear. The preschooler needs repeated explanations as reassurance. DIF: Cognitive Level: Analysis REF: p. 123 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? Choose all that apply. a. Roll from abdomen to back b. Put feet in mouth when supine c. Roll from back to abdomen d. Sit erect without support e. Move from prone to sitting position f. Adjust posture to reach an object

ANS: A, B Rolling from abdomen to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant.

The nurse is evaluating the laboratory results on cerebral spinal fluid (CSF) from a 3-year-old child with bacterial meningitis. Which findings confirm bacterial meningitis? (Select all that apply.) a. Elevated white blood cell (WBC) count b. Decreased glucose c. Normal protein d. Elevated red blood cell (RBC) count

ANS: A, B The cerebrospinal fluid analysis in bacterial meningitis shows elevated WBC count, decreased glucose, and increased protein content. There should not be RBCs evident in the CSF fluid.

The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a.Fever b.Vomiting c.Tachycardia d.Flushed face e.Hyperactive bowel sounds

ANS: A, B, C Clinical manifestations of appendicitis include fever, vomiting, and tachycardia. Pallor is seen, not a flushed face, and the bowel sounds are hypoactive or absent, not hyperactive.

The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching? (Select all that apply.) a. Ice b. Meats c. Raw vegetables d. Unpeeled fruits e. Carbonated beverages

ANS: A, B, C, D The best measure during travel to areas where water may be contaminated is to allow children to drink only bottled water and carbonated beverages (from the container through a straw supplied from home). Children should also avoid tap water, ice, unpasteurized dairy products, raw vegetables, unpeeled fruits, meats, and seafood.

The nurse is conducting preoperative teaching to parents and their child about an external fixation device. What should the nurse include in the teaching session? (Select all that apply.) a. Pin care b. Crutch walking c. Modifications in activity d. Observing pin sites for infection e. Full weight bearing will be allowed after 24 hours

ANS: A, B, C, D The device is attached surgically by securing a series of external full or half rings to the bone with wires. Children and parents should be instructed in pin care, including observation for infection and loosening of pins. Partial weight bearing is allowed, and the child needs to learn to walk with crutches. Alterations in activity include modifications at school and in physical education. Full weight bearing is not allowed until the distraction is completed and bone consolidation has occurred.

The nurse cautions that children who have unmet hunger needs will likely display which characteristic(s)? Select all that apply. a. Irritability b. Ineffective feeding patterns c. No predictable sleep-wake cycle d. Distrust e. Effective parent bonding

ANS: A, B, C, D Children who experience frequent hunger do not have effective parental bonding. All other options are probable outcomes for a child who has unmet hunger needs.

A child on chemotherapy has developed rectal ulcers. What interventions should the nurse teach to the child and parents to relieve the discomfort of rectal ulcers? (Select all that apply.) a. Warm sitz baths b. Use of stool softeners c. Record bowel movements d. Use of an opioid for discomfort e. Occlusive ointment applied to the area

ANS: A, B, C, E If rectal ulcers develop, meticulous toilet hygiene, warm sitz baths after each bowel movement, and an occlusive ointment applied to the ulcerated area promote healing; the use of stool softeners is necessary to prevent further discomfort. Parents should record bowel movements because the child may voluntarily avoid defecation to prevent discomfort. Opioids would cause increased constipation.

What should the teaching plan include about infant fall precautions? Select all that apply. a. Remove all unsteady furniture. b. Keep crib rails up and in locked position. c. Steady infant with hand when on changing table. d. Use tray attachment on high chair as restraint. e. Keep infant seat on the floor.

ANS: A, B, C, E The tray attachment to a high chair is an inadequate restraint. All other options are good precautions to prevent an infant from a fall.

The nurse is preparing to admit a 5-year-old child with hepatitis A. What clinical features of hepatitis A should the nurse recognize? (Select all that apply.) a.The onset is rapid. b.Fever occurs early. c.There is usually a pruritic rash. d.Nausea and vomiting are common. e.The mode of transmission is primarily by the parenteral route.

ANS: A, B, D Clinical features of hepatitis A include a rapid onset, fever occurring early, and nausea and vomiting. A rash is rare, and the mode of transmission is by the fecal-oral route, rarely by the parenteral route.

The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a.Pain is common. b.Weight loss is severe. c.Rectal bleeding is common. d.Diarrhea is moderate to severe. e.Anal and perianal lesions are rare.

ANS: A, B, D Clinical manifestations of Crohn disease include pain, severe weight loss, and moderate to severe diarrhea. Rectal bleeding is rare, but anal and perianal lesions are common.

The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a.Flatulence b.Constipation c.No urge to defecate d.Absence of abdominal pain e.Feeling of incomplete evacuation of the bowel

ANS: A, B, E Children with IBS often have alternating diarrhea and constipation, flatulence, bloating or a feeling of abdominal distention, lower abdominal pain, a feeling of urgency when needing to defecate, and a feeling of incomplete evacuation of the bowel.

In teaching a 16-year-old adolescent who was recently diagnosed with systemic lupus erythematosus (SLE), what statements should the nurse include? (Select all that apply.) a. "You should use a moisturizer with a sun protection factor (SPF) of 30." b. "You should avoid pregnancy because this can cause a flare-up." c. "You should not receive any immunizations in the future." d. "You may need to be on a low-protein, high-carbohydrate diet." e. "You should expect to lose weight while taking steroids." f. "You may need to modify your daily recreational activities."

ANS: A, B, F Teaching for an adolescent with SLE should foster adaptation and self-advocacy and include using a moisturizer with an SPF of 30, avoiding pregnancy because it can produce a flare-up, and modifying recreational activities but continuing with daily exercise as an essential part of the treatment plan. The adolescent should continue to receive immunizations as scheduled, should expect to gain weight while on steroid therapy, and would not have a specialized diet.

The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.) a.Citrus b.Bananas c.Spicy foods d.Peppermint e.Whole wheat bread

ANS: A, C, D Avoidance of certain foods that exacerbate acid reflux (e.g., caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried foods) can improve mild GER symptoms. Bananas and whole wheat bread will not exacerbate acid reflux.

A nurse is performing an assessment on a school-age child. Which findings suggest the child is getting an excess of vitamin A? (Select all that apply.) a. Delayed sexual development b. Edema c. Pruritus d. Jaundice e. Paresthesia

ANS: A, C, D Excess vitamin A can cause delayed sexual development, pruritus, and jaundice. Edema is seen with excess sodium. Paresthesia occurs with excess riboflavin. DIF: Cognitive Level: Apply REF: p. 73 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a.Spitting up b.Bilious vomiting c.Failure to thrive d.Excessive crying e.Respiratory problems

ANS: A, C, D, E Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.

The nurse should teach the family that which residual disabilities can occur for a child being treated for a brain tumor? (Select all that apply.) a. Ataxia b. Anorexia c. Dysphagia d. Sensory deficits e. Crania nerve palsies

ANS: A, C, D, E Even with children who are long-term survivors after treatment for a brain tumor, residual disabilities, such as short stature, cranial nerve palsies, sensory defects, motor abnormalities (especially ataxia), intellectual deficits, dysphagia, dysgraphia, and behavioral problems, may occur. Anorexia is not a residual disability.

What should the nurse recognize as symptoms of a brain tumor in a school-age child for whom she is caring? (Select all that apply.) a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Intermittent headache e. Declining academic performance

ANS: A, C, D, E Feedback Correct Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor. The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor. Increased intracranial pressure resulting from a brain tumor is manifested as a headache. School-age children may exhibit declining academic performance, fatigue, personality changes, and symptoms of vague, intermittent headache. Other symptoms may include seizures or focal neurologic deficits. Incorrect Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may have increased head circumference with a bulging fontanel. School-age children have closed fontanels and therefore their head circumferences do not increase with brain tumors.

The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a.Steatorrhea b.Polycythemia c.Malnutrition d.Melena stools e.Foul-smelling stools

ANS: A, C, E Clinical manifestations of celiac disease include impaired fat absorption (steatorrhea and foul-smelling stools) and impaired nutrient absorption (malnutrition). Anemia, not polycythemia, is a manifestation, and melena stools do not occur.

Which of the following data would be included in a health history? (Select all that apply.) a. Review of systems b. Physical assessment c. Sexual history d. Growth measurements e. Nutritional assessment f. Family medical history

ANS: A, C, E, F The review of systems, sexual history, nutritional assessment, and family medical history are part of the health history. Physical assessment and growth measurements are components of the physical examination. DIF: Cognitive Level: Apply REF: p. 64 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is precepting a new graduate nurse at an ambulatory pediatric hematology and oncology clinic. What cardinal signs of cancer in children should the nurse make the new nurse aware of? (Select all that apply.) a. Sudden tendency to bruise easily b. Transitory, generalized pain c. Frequent headaches d. Excessive, rapid weight gain e. Gradual, steady fever f. Unexplained loss of energy

ANS: A, C, F The cardinal signs of cancer in children include a sudden tendency to bruise easily; frequent headaches, often with vomiting; and an unexplained loss of energy. Other cardinal signs include persistent, localized pain; excessive, rapid weight loss; and a prolonged, unexplained fever.

The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations should be expected? (Select all that apply.) a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash

ANS: A, C, F Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a UTI.

The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Arthralgia b. Weight gain c. Polycythemia d. Abdominal pain e. Glomerulonephritis

ANS: A, D, E Clinical manifestations of SLE include arthralgia, abdominal pain, and glomerulonephritis. Weight loss, not gain, and anemia, not polycythemia, are manifestations of SLE.

The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a.Weight loss b.Bilious vomiting c.Abdominal pain d.Projectile vomiting e.The infant is hungry after vomiting

ANS: A, D, E Clinical manifestations of hypertrophic pyloric stenosis include weight loss, projectile vomiting, and hunger after vomiting. The vomitus is nonbilious, and there is no evidence of pain or discomfort, just chronic hunger.

The school nurse recognizes that the adverse effects of performance-enhancing substances can include what? (Select all that apply.) a. Depression b. Dehydration c. Hypotension d. Aggressiveness e. Changes in libido

ANS: A, D, E Mood changes have been observed as adverse effects of using performance-enhancing substances, including aggressiveness, changes in libido, depression, anxiety, and psychosis. Fluid retention, not dehydration, and hypertension, not hypotension, are adverse effects of performance-enhancing substances.

The nurse is caring for a child immobilized because of Russel traction. What interventions should the nurse implement to prevent renal calculi? (Select all that apply.) a. Monitor output. b. Encourage the patient to drink apple juice. c. Encourage milk intake. d. Ensure adequate fluids. e. Encourage the patient to drink cranberry juice.

ANS: A, D, E To prevent renal calculi in a child who is immobilized, a nurse should monitor output; ensure adequate fluids; and encourage cranberry juice, which acidifies urine. Apple juice and milk alkalize the urine, so they should not be encouraged.

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.) a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

ANS: A, D, E Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.

A nurse is planning to use an interpreter during a health history interview of a non-English speaking patient and family. Which nursing care guidelines should the nurse include when using an interpreter? (Select all that apply.) a. Elicit one answer at a time. b. Interrupt the interpreter if the response from the family is lengthy. c. Comments to the interpreter about the family should be made in English. d. Arrange for the family to speak with the same interpreter, if possible. e. Introduce the interpreter to the family.

ANS: A, D, E When using an interpreter, the nurse should pose questions to elicit only one answer at a time, such as: "Do you have pain?" rather than "Do you have any pain, tiredness, or loss of appetite?" Refrain from interrupting family members and the interpreter while they are conversing. Introduce the interpreter to family and allow some time before the interview for them to become acquainted. Refrain from interrupting family members and the interpreter while they are conversing. Avoid commenting to the interpreter about family members because they may understand some English. DIF: Cognitive Level: Apply REF: p. 60 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care? (Select all that apply.) a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.

ANS: A, E, F Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus. Pumping of the shunt may cause obstruction or other problems and should not be performed unless indicated by the neurosurgeon. Pain management rather than sedation should be the goal of therapy. The child is kept flat to avoid too rapid a reduction of intracranial fluid.

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.

The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding. What should the nurse do related to the tourniquet? a. Loosen the tourniquet. b. Leave the tourniquet in place. c. Remove the tourniquet and apply direct pressure if bleeding is still present. d. Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time.

ANS: B A tourniquet is applied only as a last resort, and then it is left in place and not loosened until definitive treatment is available. After the tourniquet is applied, skin and tissue necrosis occur below the site. Loosening or removing the tourniquet allows toxins from the tissue necrosis to be released into the circulation. This can induce systemic, deadly tourniquet shock.

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.

Chronic adrenocortical insufficiency is also referred to as: a. Graves disease. b. Addison disease. c. Cushing syndrome. d. Hashimoto disease.

ANS: B Addison disease is chronic adrenocortical insufficiency.

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? a. Therapy is most successful if it is started during adolescence. b. Replacement therapy requires daily subcutaneous injections. c. Hormonal supplementation will be required throughout child's lifetime. d. Treatment is considered successful if children attain full stature by adolescence.

ANS: B Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. Replacement therapy is not needed after attaining final height. The children are no longer GH deficient. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers.

The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved? a. Use of protective equipment at the family's discretion b. Education of adults to recognize signs that indicate a risk for injury c. Sports medicine program to help student athletes work through overuse injuries d. Arrangements for multiple sports to use same athletic fields to accommodate more children

ANS: B Adults close to sports activities need to be aware of the early warning signs of fatigue, dehydration, and risk for injury. School policy should require mandatory use of protective equipment. Proper sports medicine therapy does not support "working through" overuse injuries. Too many students involved in different activities create distractions, which contribute to the child losing focus. This is a contributing factor to injury.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device? a.As soon as possible after birth b. When the infant is developmentally ready to stand up c. At about ages 12 to 15 months, when most children are walking d. At about 4 years, when the healthy limb is not growing so rapidly

ANS: B An infant should be fitted with a functional prosthetic leg when the infant is developmentally ready to pull to a standing position. When the infant begins limb exploration, a soft prosthesis can be used. The child should begin using the prosthesis as part of his or her normal development. This will match the infant's motor readiness.

The nurse is caring for a child after a parathyroidectomy. What medication should the nurse have available if hypocalcemia occurs? a. Insulin b. Calcium gluconate c. Propylthiouracil (PTU) d. Cortisone (hydrocortisone)

ANS: B Because hypocalcemia is a potential complication after a parathyroidectomy, observing for signs of tetany, instituting seizure precautions, and having calcium gluconate available for emergency use are part of the nursing care

What statement is most descriptive of Meckel diverticulum? a. It is acquired during childhood. b. Intestinal bleeding may be mild or profuse. c. It occurs more frequently in females than in males. d. Medical interventions are usually sufficient to treat the problem.

ANS: B Bloody stools are often a presenting sign of Meckel diverticulum. It is associated with mild to profuse intestinal bleeding. Meckel diverticulum is the most common congenital malformation of the gastrointestinal tract and is present in 1% to 4% of the general population. It is more common in males than in females. The standard therapy is surgical removal of the diverticulum.

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: a. vitamin D. b. cortisone. c. stool softeners. d. calcium carbonate.

ANS: B Cortisone is administered to suppress the abnormally high secretions of adrenocorticotropic hormone (ACTH). This in turn inhibits the secretion of adrenocorticosteroid, which stems the progressive virilization.

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition? a. Hypopituitarism b. Diabetes insipidus (DI) c. Syndrome of inappropriate antidiuretic hormone (SIADH) d. Acute adrenocortical insufficiency

ANS: B DDAVP is the treatment of choice for DI. It is administered intranasally through a flexible tube. The child's response pattern is variable, with effectiveness lasting from 6 to 24 hours

A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take? a. Call the health care provider to report the edema. b. Elevate the foot and leg on pillows. c. Apply a warm moist pack to the foot. d. Encourage movement of toes.

ANS: B During the first few hours after a cast is applied, the chief concern is that the extremity may continue to swell to the extent that the cast becomes a tourniquet, shutting off circulation and producing neurovascular complications (compartment syndrome). One measure to reduce the likelihood of this problem is to elevate the body part and thereby increase venous return. The health care provider does not need to be notified because edema is expected and warm moist packs will not decrease the edema. The child should move the toes, but that will not help reduce the edema.

Exophthalmos (protruding eyeballs) may occur in children with which condition? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism

ANS: B Exophthalmos is associated with hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.

When communicating with dying children, what should the nurse remember? a. Adolescent children tend to be concrete thinkers. b. Games, art, and play provide a good means of expression. c. When children can recite facts, they understand the implications of those facts. d. If childrens questions direct the conversation, the assessment will be in

ANS: B Games, art, and play provide children a way to use their natural expressive means to stimulate dialogue. Adolescent children are abstract thinkers. Children may not understand the implication of facts just because they can recite them. The assessment is more complete when childrens questions direct the conversation. DIF: Cognitive Level: Analyzing REF: p. 796 TOP: Nursing Process: Evaluation

What should preoperative care of a newborn with an anorectal malformation include? a. Frequent suctioning b. Gastrointestinal decompression c. Feedings with sterile water only d. Supine position with head elevated

ANS: B Gastrointestinal decompression is an essential part of nursing care for a newborn with an anorectal malformation. This helps alleviate intraabdominal pressure until surgical intervention. Suctioning is not necessary for an infant with this type of anomaly. Feedings are not indicated until it is determined that the gastrointestinal tract is intact. Supine position with head elevated is indicated for infants with a tracheoesophageal fistula, not anorectal malformations.

The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What information should the nurse include? a. Advise bed rest until 1 week after the icteric phase. b. Teach infection control measures to family members. c. Inform the mother that the child cannot return to school until 3 weeks after onset of jaundice. d. Reassure the mother that hepatitis A cannot be transmitted to other family members.

ANS: B Hand washing is the single most effective measure in preventing and controlling hepatitis. Hepatitis A can be transmitted through the fecal-oral route. Family members must be taught preventive measures. Rest and quiet activities are essential and adjusted to the child's condition, but bed rest is not necessary. The child is not infectious 1 week after the onset of jaundice and may return to school as activity level allows.

Immobilization causes what effect on metabolism? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased levels of stress hormones

ANS: B Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and a negative nitrogen balance secondary to muscle atrophy. Decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include? a. Dilating the stoma b. Assessing bowel function c. Limitation of physical activities d. Measures to prevent prolapse of the rectum

ANS: B In the postoperative period, the nurse involves the parents in the care of the child with a temporary colostomy, allowing them to help with feedings and observe for signs of wound infection or irregular passage of stool (constipation or true incontinence). Some children will require daily anal dilatations in the postoperative period to avoid anastomotic strictures but not stoma dilatations. Physical activities should be encouraged. There is not a risk of prolapse of the rectum in Hirschsprung disease, just strictures.

An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the nurse share with the adolescent? a. A low-fiber diet is required. b. Stress management may be helpful. c. Milk products are a contributing factor. d. Pantoprazole (a proton pump inhibitor) is effective in treatment.

ANS: B Irritable bowel syndrome is believed to involve motor, autonomic, and psychologic factors. Stress management, environmental modification, and psychosocial intervention may reduce stress and gastrointestinal symptoms. A high-fiber diet with psyllium supplement is often beneficial. Milk products can exacerbate bowel problems caused by lactose intolerance. Antispasmodic drugs, antidiarrheal drugs, and simethicone are beneficial for some individuals. Proton pump inhibitors have no effect.

Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their child's gender. In teaching the parents about CAH, what should the nurse explain? a. Reconstructive surgery as a female is preferred. b. Sexual assignment should wait until genetic sex is determined. c. Prenatal masculinization will strongly influence the child's development. d. The child should be raised as a boy because of the presence of a penis and scrotum.

ANS: B It is preferable to raise the child according to genetic sex. With hormone replacement and surgical intervention if needed, genetically female children achieve satisfactory results in reversing virilism and achieving normal puberty and ability to conceive. Reconstructive surgery as a female is only preferred for infants who are genetically female. Infants who are genetically male should be given hormonal supplementation. Sex assignment and rearing depend on psychosocial influences, not on genetic sex hormone influences during fetal life. It is not advised to raise the child as a boy because of the presence of a penis and scrotum unless the child is genetically male. If a genetic female, the child will be sterile and may never be able to function satisfactorily in a heterosexual relationship.

An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason? a. Wean the infant from TPN the next day b. Stimulate adaptation of the small intestine c. Give additional nutrients that cannot be included in the TPN d. Provide parents with hope that the child is close to discharge

ANS: B Long-term survival without TPN depends on the small intestine's ability to increase its absorptive capacity. Continuous enteral feedings facilitate the adaptation. TPN is indicated until the child is able to receive all nutrition via the enteral route. Before this is accomplished, the small intestine must adapt and increase in cell number and cell mass per villus column. TPN is formulated to meet the infant's nutritional needs. Continuous enteral feedings through a gastrostomy tube is a positive sign, but the infant's ability to tolerate increasing amounts of enteral nutrition is only one factor that determines readiness for discharge.

A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed? a. Carbohydrates in the diet need to be replaced with protein. b. Additional snacks are needed to compensate for increased activity. c. The child needs to decrease his activity level to minimize episodes of hypoglycemia. d. Insulin dosage should be increased to compensate for a change in activity level.

ANS: B Most children have a different schedule during summer vacation. The increased activity and exercise reduce insulin resistance and increase glucose utilization. Additional snacks should be eaten before physical activity to increase carbohydrates and protein and compensate for increased activity. Physical activity should always be encouraged if the child is capable. The benefits include improved glucose utilization and decreased insulin requirements. In consultation with the practitioner, insulin dosage may need to be decreased because of improved glucose utilization.

What statement is true concerning osteogenesis imperfecta (OI)? a. It is easily treated. b. It is an inherited disorder. c. Braces and exercises are of no therapeutic value. d. Later onset disease usually runs a more difficult course.

ANS: B OI is a heterogeneous, autosomal dominant disorder characterized by fractures and bone deformity. Treatment is primarily supportive. Several investigational therapies are being evaluated. The primary goal of therapy is rehabilitation. Lightweight braces and splints help support limbs, prevent fractures, and aid in ambulation. The disease is present at birth. Prognosis is affected by the type of OI.

The nurse has attended a professional development program about palliative care for the pediatric population. What statement by the nurse should indicate a correct understanding of the program? a. Palliative care provides interventions that hasten death. b. Palliative care promotes the optimal functioning and quality of life. c. Palliative care does not provide pain and symptom management like hospice care. d. Palliative care is not well received in hospitals that provide end-of-life care for children.

ANS: B Palliative care is designed to promote optimal functioning and quality of life during the time the child has remaining. Palliative care does not provide interventions that are intended to hasten death. The care does provide pain and symptom management and is well received in hospitals that provide end-of-life care for children. DIF: Cognitive Level: Analyzing REF: p. 792

What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction? a. Measuring the abdomen after feedings b. Marking the point of measurement with a pen c. Measuring the circumference at the symphysis pubis d. Using a new tape measure with each assessment to ensure accuracy

ANS: B Pen marks on either side of the tape measure allow the nurse to measure the same spot on the child's abdomen at each assessment. The child most likely will be kept NPO (nothing by mouth) if a bowel obstruction is present. If the child is being fed, the assessment should be done before feedings. The symphysis pubis is too low. Usually the largest part of the abdomen is at the umbilicus. Leaving the tape measure in place reduces the trauma to the child.

What is a high-fiber food that the nurse should recommend for a child with chronic constipation? a.White rice b.Popcorn c.Fruit juice d.Ripe bananas

ANS: B Popcorn is a high-fiber food. Refined rice is not a significant source of fiber. Unrefined brown rice is a fiber source. Fruit juices are not a significant source of fiber. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.

One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation? a. Pain b. Rectal bleeding c. Perianal lesions d. Growth retardation

ANS: B Rectal bleeding is more common in UC than CD. Pain, perianal lesions, and growth retardation are common manifestations of CD.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which of the following should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.

ANS: B School-age children are able to give their own injections.

An adolescent comes to the school nurse after experiencing shin splints during a track meet. What reassurance should the nurse offer? a. Shin splints are expected in runners. b. Ice, rest, and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve pain. c. It is generally best to run around and "work the pain out." d. Moist heat and acetaminophen are indicated for this type of injury.

ANS: B Shin splints result when the ligaments tear away from the tibial shaft and cause pain. Actions that have an antiinflammatory effect are indicated for shin splints. Ice, rest, and NSAIDs are the usual treatment. Shin splints are rarely serious, but they are not expected, and preventive measures are taken. Rest is important to heal the shin splints. Continuing to place stress on the tibia can lead to further damage.

Where is the appropriate placement of a tongue blade for assessment of the mouth and throat? a. Center back area of tongue b. Side of the tongue c. Against the soft palate d. On the lower jaw

ANS: B Side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. Placement in the center back area of the tongue will elicit the gag reflex. Against the soft palate and on the lower jaw are not appropriate places for the tongue blade. DIF: Cognitive Level: Understand REF: p. 98 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance: Techniques of Physical Assessment

A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents' discharge teaching? a. Turn every 8 hours. b. Specially designed car restraints are necessary. c. Diapers should be avoided to reduce soiling of the cast. d. Use an abduction bar between the legs to aid in turning.

ANS: B Standard seat belts and car seats may not be readily adapted for use by children in some casts. Specially designed car seats and restraints meet safety requirements. The child must have position changes much more frequently than every 8 hours. During feeding and play activities, the child should be moved for both physiologic and psychosocial benefit. Diapers and other strategies are necessary to maintain cleanliness. The abduction bar is never used as an aid for turning. Putting pressure on the bar may damage the integrity of the cast.

The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching? a. "I should have the affected limb hang in a dependent position." b. "I will use an ice pack to relieve the itching." c. "I should avoid keeping the injured arm elevated." d. "I will expect the fingers to be swollen for the next 3 days."

ANS: B Teaching the parent to use an ice pack to relieve the itching is an important aspect when planning discharge for a child with a cast. The affected limb should not be allowed to hang in a dependent position for more than 30 minutes. The affected arm should be kept elevated as much as possible. If there is swelling or redness of the fingers, the parent should notify the health care provider.

A 4-year-old child is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first? a. Reposition the child and notify the practitioner. b. Notify the practitioner of the changes noted. c. Give the child medication to relieve the pain. d. Chart the observations and check the extremity again in 15 minutes.

ANS: B The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. This is an emergency condition. Pain medication should be given after the practitioner is notified. The findings should be documented with ongoing assessment.

A child in the terminal stage of cancer has frequent breakthrough pain. Nonpharmacologic methods are not helpful, and the child is exceeding the maximum safe dose for opiate administration. What approach should the nurse implement? a. Add acetaminophen for the breakthrough pain. b. Titrate the opioid medications to control the childs pain as specified in the protocol. c. Notify the practitioner that immediate hospitalization is indicated for pain management. d. Help the parents and child understand that no additional medication can be given because of the risk of respiratory depression.

ANS: B The child on long-term opioid management can become tolerant to the drugs. Also, increasing amounts of drugs may be necessary for disease progression. It is important to recognize that there is no maximum dosage that can be given to control pain. Acetaminophen will offer little additional pain control; it is useful for mild and moderate pain. Immediate hospitalization is not necessary; increased dosages of pain medications can be administered in the home environment. The principle of double effect allows for a positive interventionrelief of paineven if there is a foreseeable possibility that death may be hastened. DIF: Cognitive Level: Applying REF: p. 802

Nutritional management of the child with Crohn disease includes a diet that has which component? a. High fiber b. Increased protein c. Reduced calories d. Herbal supplements

ANS: B The child with Crohn disease often has growth failure. Nutritional support is planned to reduce ongoing losses and provide adequate energy and protein for healing. Fiber is mechanically hard to digest. Foods containing seeds may contribute to obstruction. A high-calorie diet is necessary to minimize growth failure. Herbal supplements should not be used unless discussed with the practitioner. Vitamin supplementation with folic acid, iron, and multivitamins is recommended.

The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what? a. "We'll keep the cast dry." b. "We're happy this is the only cast our baby will need." c. "We'll watch for any swelling of the foot while the cast is on." d. "We're 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 long-leg 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.

A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions? a. No restrictions of activity are indicated. b. Elevate casted arm when both upright and resting. c. The shoulder should be kept as immobile as possible to avoid pain. d. Swelling of the fingers is to be expected. Notify a health professional if it persists more than 48 hours.

ANS: B The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. The child should not engage in strenuous activity for the first few days. Rest with elevation of the extremity is encouraged. Joints above and below the cast on the affected extremity should be moved. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours.

The nurse is evaluating the laboratory results of a stool sample. What is a normal finding? a.The laboratory reports a stool pH of 5.0. b.The laboratory reports a negative guaiac. c.The laboratory reports low levels of enzymes. d.The laboratory reports reducing substances present.

ANS: B The normal stool finding is a negative guaiac. Stool pH should be 7.0 to 7.5. A stool pH <5.0 is suggestive of carbohydrate malabsorption; colonic bacterial fermentation produces short-chain fatty acids, which lower stool pH. There should be no enzymes or reducing substances present in a normal stool sample.

What therapeutic intervention provides the best chance of survival for a child with cirrhosis? a. Nutritional support b. Liver transplantation c. Blood component therapy d. Treatment with corticosteroids

ANS: B The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. Nutritional support is necessary for the child with cirrhosis, but it does not stop the progression of the disease. Blood components are indicated when the liver can no longer produce clotting factors. It is supportive therapy, not curative. Corticosteroids are not used in end-stage liver disease.

What is a principle of palliative care that can be included in the care of children? a. Maintenance of curative therapy b. Child and family as the unit of care c. Exclusive focus on the spiritual issues the family faces d. Extensive use of opiates to ensure total pain control

ANS: B The principles of palliative care involve a multidisciplinary approach to the management of a terminal illness or the dying process that focuses on symptom control and support rather than on cure or life prolongation in the absence of the possibility of a cure. In pediatric palliative care, the focus of care is on the family. Palliative care requires the transition from curative to palliative care. The transition occurs when the likelihood of cure no longer exists. Spiritual issues are just one of the foci of palliative care. The multidisciplinary team focuses on physical, emotional, and social issues as well. Pain control is a priority in palliative care. The use of opiates is balanced with the side effects caused by this class of drugs.

The parents of a newborn with an umbilical hernia ask about treatment options. The nurse's response should be based on which knowledge? a. Surgery is recommended as soon as possible. b. The defect usually resolves spontaneously by 3 to 5 years of age. c. Aggressive treatment is necessary to reduce its high mortality. d. Taping the abdomen to flatten the protrusion is sometimes helpful.

ANS: B The umbilical hernia usually resolves by ages 3 to 5 years of age without intervention. Umbilical hernias rarely become problematic. Incarceration, where the hernia is constricted and cannot be reduced manually, is rare. Umbilical hernias are not associated with a high mortality rate. Taping the abdomen flat does not help heal the hernia; it can cause skin irritation.

An 8-year-old girl has been uncooperative and angry since the diagnosis of cancer was made. Her parents tell the nurse that they do not know what to do because she is always so mad at us. What nursing action is most appropriate at this time? a. Explain to child that anger is not helpful. b. Help the parents deal with her anger constructively. c. Ask the parents to find out what she is angry about. d. Encourage the parents to ignore the anger at this time.

ANS: B To school-age children, chronic illness and dying represent a loss of control. This threat to their sense of security and ego strength can be manifested by verbal uncooperativeness. The child can be viewed as impolite, insolent, and stubborn. The best intervention is to encourage children to talk about feelings and give control where possible. Verbal explanations would not be heard by the child. The child may not be cognizant of the anger. Ignoring the anger will not help the child gain some control over the events. DIF: Cognitive Level: Applying REF: p. 799

What is an appropriate nursing intervention when caring for a child in traction? a. Removing adhesive traction straps daily to prevent skin breakdown b. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles c. Providing active range of motion exercises to affected extremity three times a day d. Keeping child prone to maintain good alignment

ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

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 Universal vaccination for hepatitis B is recommended for all newborns. Hepatitis A vaccine is recommended for infants starting at 12 months. No vaccine is currently available for hepatitis C.

The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the child's weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate? a. Skin that is cool and dry b. Blurred vision and loss of acuity c. Running and being active during recess d. Decreased appetite and food intake

ANS: B Visual disturbances such as loss of visual acuity and blurred vision are associated with hyperthyroidism. They may occur before the actual onset of other symptoms. The child's skin is usually warm, flushed, and moist. Although the signs of hyperthyroidism include excessive motion, irritability, hyperactivity, short attention span, and emotional lability, these children are easily fatigued and require frequent rest periods. Children with hyperthyroidism have increased food intake. Even with voracious appetites, weight loss occurs

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity? a. Headache and seizures b. Weakness and lassitude c. Anorexia and insomnia d. Physical restlessness, voracious appetite without weight gain

ANS: B Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Anorexia and insomnia are not characteristic of vitamin D toxicity. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism.

What is the recommended drink for athletes during practice and competition? a. Sports drinks to replace carbohydrates b. Cold water for gastrointestinal tract rapid absorption c. Carbonated beverages to help with acid-base balance d. Enhanced performance carbohydrate-electrolyte drinks

ANS: B Water is recommended for most athletes, who should drink 4 to 8 oz every 15 to 20 minutes. Cold water facilitates rapid gastric emptying and intestinal absorption. Most carbohydrate sports drinks have 6% to 8% carbohydrate, which can cause gastrointestinal upset. Carbonated beverages are discouraged. There is no evidence that these drinks enhance function.

The nurse is caring for a 6-year-old child with acute lymphoblastic leukemia (ALL). The parent states, "My child has a low platelet count, and we are being discharged this afternoon. What do I need to do at home?" What statement is most appropriate for the nurse to make? a. "You should give your child aspirin instead of acetaminophen for fever or pain." b. "Your child should avoid contact sports or activities that could cause bleeding." c. "You should feed your child a bland, soft, moist diet for the next week." d. "Your child should avoid large groups of people for the next week."

ANS: B A child with a low platelet count needs to avoid activities that could cause bleeding such as playing contact sports, climbing trees, using playground equipment, or bike riding. The child should be given acetaminophen, not aspirin, for fever or pain; the child does not need to be on a soft, bland diet or avoid large groups of people because of the low platelet count

17. Chelation therapy is begun on a child with b-thalassemia major. What is the purpose of this therapy? a. Treat the disease b. Eliminate excess iron c. Decrease risk of hypoxia d. Manage nausea and vomiting

ANS: B A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine (an iron-chelating agent) is given with oral supplements of vitamin C to increase iron excretion. Chelation therapy treats the side effect of the disease management. Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy. DIF: Cognitive Level: Understand REF: p. 799 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is to: a. discuss with parents the child's previous experiences with pain. b. discuss with practitioner what analgesia can be safely administered. c. explain that analgesia is contraindicated with a head injury. d. explain that analgesia is unnecessary when child is not fully awake and alert.

ANS: B A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and the promotion of comfort and relief of anxiety. Information on the child's previous experiences with pain should be obtained as part of the assessment, but because of the severity of injury, analgesia should be provided as soon as possible. Analgesia can be safely used in individuals who have sustained head injuries and can decrease anxiety and resultant increased ICP.

The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. How should this action be interpreted? a. Inappropriate, because of child's age b. A way to establish rapport c. Too distracting, when cooperation is important d. Acceptable, if there is adequate time

ANS: B A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the natural curiosity of young children. The nurse should establish rapport with the child. Failure to do so may cause the procedure to take longer and be more traumatic. DIF: Cognitive Level: Analyze REF: p. 64 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

The parent of a 4-year-old son tells the nurse that the child believes "monsters and boogeyman" are in his bedroom at night. The nurse's best suggestion for coping with this problem is to: a. Insist that the child sleep with his parents until the fearful phase passes. b. Suggest involving the child to find a practical solution such as a night light. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and boogeyman do not exist.

ANS: B A night light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old is in the preconceptual age and cannot understand logical thought.

The nurse discusses child-proofing the home for safety with the mother of a 9-month-old. The statement made by the mother that indicates an unsafe behavior is: a. "I put covers on all of the electrical outlets." b. "In the car, she rides in a front-facing car seat." c. "There are locks on all of the cabinets in the house." d. "I have a gate at the top and bottom of the stairs."

ANS: B A rear-facing infant car seat should be used for infants younger than 1 year of age.

A child with osteosarcoma is experiencing phantom limb pain after an amputation. What prescribed medication is effective for short-term phantom pain relief? a. Phenytoin (Dilantin) b. Gabapentin (Neurontin) c. Valproic Acid (Depakote) d. Phenobarbital (Phenobarbital)

ANS: B A recent Cochrane review reported that various medications have been used for phantom limb pain but complete pain relief has been unsuccessful. Morphine, gabapentin, and ketamine are effective for short-term pain relief.

6. When the nurse interviews an adolescent, which of the following is especially important? a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Use the same type of language as the adolescent. d. Emphasize that confidentiality will always be maintained.

ANS: B Adolescents, like all children, need an opportunity to express their feelings. Often they interject feelings into their words. The nurse must be alert to the words and feelings expressed. The nurse should maintain a professional relationship with adolescents. To avoid misunderstanding or misinterpretation of words and phrases used, the nurse should clarify the terms used, what information will be shared with other members of the health care team, and any limits to confidentiality. Although the peer group is important to this age-group, the interview should focus on the adolescent. DIF: Cognitive Level: Comprehension REF: p. 124 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

When the nurse interviews an adolescent, which is especially important? a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Emphasize that confidentiality will always be maintained. d. Use the same type of language as the adolescent.

ANS: B Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently. DIF: Cognitive Level: Understand REF: p. 62 TOP: Integrated Process: Communication and Documentation

Essential postoperative nursing management of a child after removal of a brain tumor includes which nursing care? a. Turning and positioning every 2 hours b. Measuring all fluid intake and output c. Changing the dressing when it becomes soiled d. Using maximum lighting to ensure accurate observations

ANS: B After brain surgery, cerebral edema is a risk. Careful monitoring is essential. All fluids, including intravenous antibiotics, are included in the intake. Turning and positioning depend on the surgical procedure. When large tumors are removed, the child is usually not positioned on the operative side. The dressing is not changed. It is reinforced with gauze after the amount of drainage is marked and estimated. A quiet, dimly lit environment is optimum to decrease stimulation and relieve discomfort such as headaches.

14. The nurse is taking a sexual history on an adolescent girl. Which of the following is the best way to determine whether she is sexually active? a. Ask her, "Are you sexually active?" b. Ask her, "Are you having sex with anyone?" c. Ask her, "Are you having sex with a boyfriend?" d. Ask both the girl and her parent if she is sexually active.

ANS: B Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information for the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Using gender-neutral terms is inclusive and conveys acceptance to the adolescent. Questioning about sexual activity should occur when the adolescent is alone. DIF: Cognitive Level: Application REF: p. 130 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine whether she is sexually active? a. Ask her, "Are you sexually active?" b. Ask her, "Are you having sex with anyone?" c. Ask her, "Are you having sex with a boyfriend?" d. Ask both the girl and her parent whether she is sexually active.

ANS: B Asking the adolescent girl whether she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information to the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is preferable to use gender-neutral terms. Questioning about sexual activity should occur when the adolescent is alone. DIF: Cognitive Level: Apply REF: p. 65 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

What describes a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time such as "just a minute" and "in an hour"

ANS: B At this age the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. Putting an object in a container but being able to take it out indicates tertiary circular reactions. An embryonic sense of time exists, although the children may behave appropriately to time-oriented phrases; their sense of timing is exaggerated.

Parents of a newborn are concerned because the infant's eyes often "look crossed" when the infant is looking at an object. The nurse's response is that this is normal based on the knowledge that binocularity is normally present by what age? a. 1 month b. 3 to 4 months c. 6 to 8 months d. 12 months

ANS: B Binocularity is usually achieved by ages 3 to 4 months. 1 month is too young. If binocularity is not achieved by ages 6 to 12 months, the child must be observed for strabismus. DIF: Cognitive Level: Understand REF: p. 91 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. The nurse weighing the infant today would expect her weight to be at least _____ pounds. a. 12 b. 16 c. 20 d. 24

ANS: B Birth weight is usually doubled by 6 months of age.

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which method? a. Bone grafting b. Intravenous infusion c. Bone marrow injection d. Intraabdominal infusion

ANS: B Bone marrow from a donor is infused intravenously, and the transfused stem cells migrate to the recipient's marrow and repopulate it.

A toddler's mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse's response should be based on which premise? a. An emergency laparotomy is very likely. b. The location needs to be confirmed by radiographic examination. c. Surgery will be necessary if the battery has not passed in the stool in 48 hours. d. Careful observation is essential because an ingested battery cannot be accurately detected.

ANS: B Button batteries can cause severe damage if lodged in the esophagus. If both poles of the battery come in contact with the wall of the esophagus, acid burns, necrosis, and perforation can occur. If the battery is in the stomach, it will most likely be passed without incident. Surgery is not indicated. The battery is metallic and is readily seen on radiologic examination.

26. Which of the following explains the importance of detecting strabismus in young children? a. Color vision deficit may result. b. Amblyopia, a type of blindness, may result. c. Epicanthal folds may develop in affected eye. d. Corneal light reflexes may fall symmetrically within each pupil.

ANS: B By the age of 3 to 4 months, infants are able to fixate on one visual field with both eyes simultaneously. In strabismus, or cross-eye, one eye deviates from the point of fixation. If misalignment is constant, the weak eye becomes "lazy" and the brain eventually suppresses the image produced from that eye. If strabismus is not detected and corrected by age 4 to 6 years, blindness from disuse, known as amblyopia, may occur. Color vision is not the only concern. Epicanthal folds are not related to amblyopia. In children with strabismus, the corneal light reflex will not be symmetric for each eye. DIF: Cognitive Level: Comprehension REF: p. 155 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A child, age 10 years, has a neuroblastoma and is in the hospital for additional chemotherapy treatments. What laboratory values are most likely this child's? a. White blood cell count, 17,000/mm3; hemoglobin, 15 g/dl b. White blood cell count, 3,000/mm3; hemoglobin, 11.5 g/dl c. Platelets, 450,000/mm3; hemoglobin, 12 g/dl d. White blood cell count, 10,000/mm3; platelets, 175,000/mm3

ANS: B Chemotherapy is the mainstay of therapy for extensive local or disseminated neuroblastoma. The drugs of choice are vincristine, doxorubicin, cyclophosphamide, cisplatin, etoposide, ifosfamide, and carboplatin. These cause immunosuppression, so the laboratory values will indicate a low white blood cell count and hemoglobin.

9. The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful? a. Recommend that the child keep a diary. b. Provide supplies for the child to draw a picture. c. Suggest that the parent read fairy tales to the child. d. Ask the parent if the child is always uncommunicative.

ANS: B Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the children's inner self. A diary would be difficult for a 6-year-old child, who is most likely learning to read. The parent reading fairy tales to the child is a passive activity involving the parent and child; it would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not always uncommunicative. DIF: Cognitive Level: Application REF: p. 125 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

Which statement best describes fear in school-age children? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years children experience a wide variety of fears, but new fears related predominantly to school and family bother children during this time. During the middle-school years children become less fearful of body safety than they were as preschoolers. Parents and other persons involved with children should discuss their fear with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding the fears does not end them and may lead to phobias.

he nurse is preparing a school-age child for computed tomography (CT scan) to assess cerebral function. The nurse should include which statement in preparing the child? a. "Pain medication will be given." b. "The scan will not hurt." c. "You will be able to move once the equipment is in place." d. "Unfortunately, no one can remain in the room with you during the test."

ANS: B For CT scans, the child must be immobilized. It is important to emphasize to the child that at no time is the procedure painful. Pain medication is not required; however, sedation is sometimes necessary. Someone is able to remain with the child during the procedure.

The nurse is aware that the earliest age at which the infant should be able to walk independently is _____ months. a. 8 to 10 b. 12 to 15 c. 15 to 18 d. 18 to 21

ANS: B For the majority of children, the milestone of walking alone is achieved between 12 and 15 months.

24. The nurse has just started assessing a young child who is febrile and appears ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. Which of the following is the most appropriate action? a. Ask parent when neck was injured. b. Refer for immediate medical evaluation. c. Continue assessment to determine cause of neck pain. d. Record "head lag" on assessment record and continue assessment of child.

ANS: B Hyperextension of the child's head with pain on flexion is indicative of meningeal irritation and needs immediate evaluation. No indication of injury is present. This situation is not descriptive of head lag. DIF: Cognitive Level: Analysis REF: p. 154 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which position should the nurse place a 10-year-old child after a large tumor was removed through a supratentorial craniotomy? a. On the inoperative side with the bed flat b. On the inoperative side with the head of bed elevated 20 to 30 degrees c. On the operative side with the bed flat and pillows behind the head d. On the operative side with the head of bed elevated 45 degrees

ANS: B If a large tumor was removed, the child is not placed on the operative side because the brain may suddenly shift to that cavity, causing trauma to the blood vessels, linings, and the brain itself. The child with an infratentorial procedure is usually positioned on either side with the bed flat. When a supratentorial craniotomy is performed, the head of bed is elevated 20 to 30 degrees with the child on either side or on the back. In a supratentorial craniotomy, the head elevation facilitates CSF drainage and decreases excessive blood flow to the brain to prevent hemorrhage. Pillows should be placed against the child's back, not head, to maintain the desired position.

21. The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too large and one is too small. The best nursing action is which of the following? a. Use the small cuff. b. Use the large cuff. c. Use either cuff, using palpation method. d. Wait to take blood pressure until proper cuff can be located.

ANS: B If blood pressure measurement is indicated and the appropriate size cuff is not available, the next larger size is used. The nurse recognizes that this may be a falsely low blood pressure. Using the small cuff will give an incorrectly high reading. The palpation method will not improve the inaccuracy inherent in the cuff. DIF: Cognitive Level: Comprehension REF: p. 150 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which statement accurately describes physical development during the school-age years? a. The child's weight almost triples. b. A child grows an average of 2 inches per year. c. Few physical differences are apparent among children at the end of middle childhood. d. Fat gradually increases, which contributes to the child's heavier appearance.

ANS: B In middle childhood growth in height and weight occur at a slower pace. Between the ages of 6 to 12 years, children grow 2 inches per year. In middle childhood children's weight will almost double; they gain 3 kg/year. At the end of middle childhood girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

The nurse is collecting a 24-hour urine sample on a child with suspected diagnosis of neuroblastoma. What finding in the urine is expected with neuroblastomas? a. Ketones b. Catecholamines c. Red blood cells d. Excessive white blood cells

ANS: B Neuroblastomas, particularly those arising on the adrenal glands or from a sympathetic chain, excrete the catecholamines epinephrine and norepinephrine. Urinary excretion of catecholamines is detected in approximately 95% of children with adrenal or sympathetic tumors.

The nurse is caring for a child receiving chemotherapy for leukemia. The child's granulocyte count is 600/mm3 and platelet count is 45,000/mm3. What oral care should the nurse recommend for this child? a. Rinsing mouth with water b. Daily toothbrushing and flossing c. Lemon glycerin swabs for cleansing d. Wiping teeth with moistened gauze or Toothettes

ANS: B Oral care is essential for children receiving chemotherapy to prevent infections and other complications. When the child's granulocyte count is above 500/mm3 and platelet count is above 40,000/mm3, daily brushing and flossing are recommended. Rinsing the mouth with water is not effective for oral hygiene. Lemon glycerin swabs are avoided because they have a drying effect on the mucous membranes, and the lemon may irritate eroded tissue and decay the child's teeth. Wiping teeth with moistened gauze or Toothettes is recommended when the child's granulocyte count is below 500/mm3 and platelet count is below 40,000/mm3

What is descriptive of the play of school-age children? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning.

ANS: B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play children learn about competition and the importance of winning, an attribute highly valued in the United States.

19. Rectal temperatures are indicated in which of the following situations? a. In the newborn period b. Whenever accuracy is essential c. Rectal temperatures are never indicated d. When rapid temperature changes are occurring

ANS: B Rectal temperatures are recommended when definitive measurements are necessary in infants over age 1 month. Rectal temperatures are not done in the newborn period to avoid trauma to the rectal mucosa. Rectal temperature is an intrusive procedure that should be avoided whenever possible. DIF: Cognitive Level: Comprehension REF: p. 145 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

What childhood cancer may demonstrate patterns of inheritance that suggest a familial basis? a. Leukemia b. Retinoblastoma c. Rhabdomyosarcoma d. Osteogenic sarcoma

ANS: B Retinoblastoma is an example of a pediatric cancer that demonstrates inheritance. The absence of the retinoblastoma gene allows for abnormal cell growth and the development of retinoblastoma. Chromosome abnormalities are present in many malignancies. They do not indicate a familial pattern of inheritance. The Philadelphia chromosome is observed in almost all individuals with chronic myelogenous leukemia. There is no evidence of a familial pattern of inheritance for rhabdomyosarcoma or osteogenic sarcoma cancers

20. What is the earliest age at which a satisfactory radial pulse can be taken in children? a. 1 year b. 2 years c. 3 years d. 6 years

ANS: B Satisfactory radial pulses can be taken in children older than 2 years. In infants and young children the apical pulse is more reliable. DIF: Cognitive Level: Comprehension REF: p. 148 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

What is the earliest age at which a satisfactory radial pulse can be taken in children? a. 1 year b. 2 years c. 3 years d. 6 years

ANS: B Satisfactory radial pulses can be used in children older than 2 years. In infants and young children, the apical pulse is more reliable. The apical pulse can be used for assessment at these ages. DIF: Cognitive Level: Remember REF: p. 103 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

31. The appropriate placement of a tongue blade for assessment of the mouth and throat is which of the following? a. On the lower jaw b. Side of the tongue c. Against the soft palate d. Center back area of tongue

ANS: B Side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. On the lower jaw and against the soft palate are not appropriate places for the tongue blade. Placement in the center back area of tongue elicits the gag reflex. DIF: Cognitive Level: Comprehension REF: p. 162 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The nurse is taking a health history on an adolescent. Which best describes how the chief complaint should be determined? a. Ask for detailed listing of symptoms. b. Ask adolescent, "Why did you come here today?" c. Use what adolescent says to determine, in correct medical terminology, what the problem is. d. Interview parent away from adolescent to determine chief complaint.

ANS: B The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A detailed listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time. DIF: Cognitive Level: Apply REF: p. 62 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

11. The nurse is taking a health history of an adolescent. Which of the following best describes how the chief complaint should be determined? a. Request a detailed listing of symptoms. b. Ask adolescent, "Why did you come here today?" c. Interview parent away from adolescent to determine chief complaint. d. Use what adolescent says to determine, in correct medical terminology, what the problem is.

ANS: B The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. Requesting a detailed list of symptoms makes it difficult to determine the chief complaint. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. DIF: Cognitive Level: Application REF: p. 127 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A 5-year-old child is being prepared for surgery to remove a brain tumor. Preparation for surgery should be based on which information? a. Removal of the tumor will stop the various signs and symptoms. b. Usually the postoperative dressing covers the entire scalp. c. He is not old enough to be concerned about his head being shaved. d. He is not old enough to understand the significance of the brain.

ANS: B The child should be told what he will look and feel like after surgery. This includes the anticipated size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing. Some of the symptoms may be alleviated by removal of the tumor, but postsurgical headaches and cerebellar symptoms such as ataxia may be aggravated. Children should be prepared for the loss of their hair, and it should be removed in a sensitive, positive manner if the child is awake. Children at this age have poorly defined body boundaries and little knowledge of internal organs. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin.

A 5-year-old boy is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which statement? a. Removal of tumor will stop the various symptoms. b. Usually the postoperative dressing covers the entire scalp. c. He is not old enough to be concerned about his head being shaved. d. He is not old enough to understand the significance of the brain.

ANS: B The child should be told what he will look and feel like after surgery. This includes the size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing. Some of the symptoms may be alleviated by the removal of the tumor, but postsurgical headaches and cerebellar symptoms such as ataxia may be aggravated. Children should be prepared for the loss of their hair, and it should be removed in a sensitive, positive manner if the child is awake. Children at this age have poorly defined body boundaries and little knowledge of internal organs. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin.

The nurse knows that an infant's birth weight should be tripled by: a. 9 months. b. 1 year. c. 18 months. d. 2 years.

ANS: B The infant usually triples his or her birth weight by about 12 months of age.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? a. Administer the chemotherapy between meals. b. Give an antiemetic before chemotherapy begins. c. Have the child bring favorite foods for snacks. d. Keep the child NPO (nothing by mouth) until nausea and vomiting subside.

ANS: B The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer a 5-hydroxytryptamine-3 receptor antagonist (e.g., ondansetron) before the chemotherapy is begun. The goal is to prevent anticipatory signs and symptoms. The child will experience nausea with chemotherapy whether or not food is present in the stomach. Because some children develop aversions to foods eaten during chemotherapy, refraining from offering favorite foods is advised. Keeping the child NPO until nausea and vomiting subside will help with this episode, but the child will have discomfort and be at risk for dehydration.

The nurse has received report on four children. Which child should the nurse assess first? a. A school-age child in a coma with stable vital signs b. A preschool child with a head injury and decreasing level of consciousness c. An adolescent admitted after a motor vehicle accident is oriented to person and place d. A toddler in a persistent vegetative state with a low-grade fever

ANS: B The nurse should assess the child with a head injury and decreasing level of consciousness first (LOC). Assessment of LOC remains the earliest indicator of improvement or deterioration in neurologic status. The next child the nurse should assess is a toddler in a persistent vegetative state with a low-grade fever. The school-age child in a coma with stable vital signs and the adolescent admitted to the hospital who is oriented to his surroundings would be of least worry to the nurse.

Which is most important to document about immunizations in the child's health history? a. Dosage of immunizations received b. Occurrence of any reaction after an immunization c. The exact date the immunizations were received d. Practitioner who administered the immunizations

ANS: B The occurrence of any reaction after an immunization was given is the most important to document in a history because of possible future reactions, especially allergic reactions. Exact dosage of the immunization received may not be recorded on the immunization record. Exact dates are important to obtain but not as important as a history of reaction to an immunization. The practitioner who administered the immunization does not need to be recorded in the health history. A potentially severe physiologic response is the most threatening and most important information to document for safety reasons. DIF: Cognitive Level: Analyze REF: p. 65 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as: a. eye trauma. b. neurosurgical emergency. c. severe brainstem damage. d. indication of brain death.

ANS: B The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding. Although a dilated pupil may be associated with eye trauma, this child has experienced a neurologic insult. Pinpoint pupils or bilateral fixed pupils for more than 5 minutes are indicative of brainstem damage. The unilateral fixed and dilated pupil is suggestive of damage on the same side of the brain. One fixed and dilated pupil is not suggestive of brain death.

A parent tells the nurse that 80% of children with the same type of leukemia as his son's have a 5-year survival. He believes that because another child on the same protocol as his son has just died, his son now has a better chance of success. What is the best response by the nurse? a. "It is sad for the other family but good news for your child." b. "Each child has an 80% likelihood of 5-year survival." c. "The data suggest that 20% of the children in the clinic will die. There are still many hurdles for your son." d. "You should avoid the grieving family because you will be benefiting from their loss."

ANS: B This is a common misconception for parents. The success data are based on numerous factors, including the effectiveness of the protocol and the child's response. These are aggregate data that apply to each child and do not depend on the success or failure in other children. The failure of one child in a protocol does not improve the success rate for other children. Although the son does face more hurdles, these are aggregate data, not specific to the clinic. It may be difficult for this family to be supportive given their concerns about their child. Families usually form support groups in pediatric oncology settings, and support during bereavement is common.

What is an important consideration for the nurse who is communicating with a very young child? a. Speak loudly, clearly, and directly. b. Use transition objects, such as a doll. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with child when parent is not present.

ANS: B Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child this age. Speaking in this manner will tend to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception will lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children. DIF: Cognitive Level: Understand REF: p. 61 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Psychosocial Integrity

Which communication technique should the nurse avoid when interviewing children and their families? a. Using silence b. Using clichés c. Directing the focus d. Defining the problem

ANS: B Using stereotyped comments or clichés can block effective communication, and this technique should be avoided. After use of such trite phrases, parents will often not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximal freedom of expression. By using open-ended questions, along with guiding questions, the nurse can obtain the necessary information and maintain the relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention. DIF: Cognitive Level: Understand REF: p. 59 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

2. Which of the following is considered a block to effective communication? a. Using silence b. Using clichés c. Directing the focus d. Defining the problem

ANS: B Using stereotyped comments or clichés can block effective communication. After the nurse uses such trite phrases, parents often do not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximum freedom of expression. By using open-ended questions and guiding questions, the nurse can obtain the necessary information and maintain a relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention. DIF: Cognitive Level: Application REF: p. 121 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning.

ANS: B Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

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 When the nurse examines the eye, the light will reflect off of the tumor, giving the eye a whitish appearance. This is called a cat's eye reflex. Brain tumors are not usually visible. Neuroblastoma usually arises from the adrenal medulla and sympathetic nervous system. The most common presentation sites are in the abdomen, head, neck, or pelvis. Supraorbital ecchymosis may be present with distant metastasis. Rhabdomyosarcoma is a soft tissue tumor that derives from skeletal muscle undifferentiated cells.

The nurse must check vital signs on a 2-year-old boy who is brought to the clinic for his 24-month checkup. What criteria should the nurse use in determining the appropriate-size blood pressure cuff? (Select all that apply.) a. The cuff is labeled "toddler." b. The cuff bladder width is approximately 40% of the circumference of the upper arm. c. The cuff bladder length covers 80% to 100% of the circumference of the upper arm. d. The cuff bladder covers 50% to 66% of the length of the upper arm.

ANS: B, C Research has demonstrated that cuff selection with a bladder width that is 40% of the arm circumference will usually have a bladder length that is 80% to 100% of the upper arm circumference. This size cuff will most accurately reflect measured radial artery pressure. The name of the cuff is a representative size that may not be suitable for any individual child. Choosing a cuff by limb circumference more accurately reflects arterial pressure than choosing a cuff by length. DIF: Cognitive Level: Understand REF: p. 86 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

What are favorable prognostic criteria for acute lymphoblastic leukemia? (Select all that apply.) a. Male gender b. CALLA positive c. Early pre-B cell d. 2 to 10 years of age e. Leukocyte count 750,000/mm3

ANS: B, C, D Favorable prognostic criteria for acute lymphoblastic leukemia include CALLA positive, early pre-B cell, and age 2 to 10 years. Leukocyte count less, not greater, than 50,000/mm3 and female, not male, gender are favorable prognostic criteria

A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.) a. Relieve itching with heat. b. Elevate the arm when resting. c. Observe the fingers for any evidence of discoloration. d. Do not allow the child to put anything inside the cast. e. Examine the skin at the cast edges for any breakdown.

ANS: B, C, D, E Cast care involves elevating the arm, observing the fingers for evidence of discoloration, not allowing the child to put anything inside the cast, and examining the skin at the edges of the cast for any breakdown. Ice, not heat, should be applied to relieve itching.

A 6-year-old child is scheduled for an IV urography (IVP) in the morning. Which preparatory interventions should the nurse plan to implement? (Select all that apply.) a. Clear liquids in the morning before the procedure b. Cathartic in the evening before the procedure c. Soapsuds enema the morning of the procedure d. Insertion of a Foley catheter before the procedure e. Teaching with regard to insertion of an intravenous catheter before the procedure

ANS: B, C, E The IV urography is a test done to provide information about the integrity of the kidneys, ureters, and bladder. It requires an IV injection of a contrast medium with X-ray films made 5, 10, and 15 minutes after injection. Delayed films (30, 60 minutes, and so on) are also obtained. The preparation for children ages 2 to 14 years includes cathartic on the evening before examination, nothing orally after midnight, and an enema (soapsuds) on the morning of examination. Teaching about the insertion of an intravenous catheter should be part of the preoperative preparation. Insertion of a Foley catheter is not part of the preparation for an IVP.

The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac crisis? (Select all that apply.) a.Exercise b.Infections c.Fluid overload d.Electrolyte depletion e.Emotional disturbance

ANS: B, D, E A celiac crisis can be precipitated by infections, electrolyte depletion, and emotional disturbance. Exercise or fluid overload does not precipitate a crisis.

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that apply.) a. Weight loss b. Facial edema c. Cloudy smoky brown-colored urine d. Fatigue e. Frothy-appearing urine

ANS: B, D, E A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome.

The nurse is caring for a child with retinoblastoma that was treated with an enucleation. What interventions should the nurse plan for care of an eye socket after enucleation? (Select all that apply.) a. Clean the prosthesis. b. Change the eye pad daily. c. Keep the opposite eye covered initially. d. Irrigate the socket daily with a prescribed solution. e. Apply a prescribed antibiotic ointment after irrigation.

ANS: B, D, E Care of the socket is minimal and easily accomplished. The wound itself is clean and has little or no drainage. If an antibiotic ointment is prescribed, it is applied in a thin line on the surface of the tissues of the socket. To cleanse the site, an irrigating solution may be ordered and is instilled daily or more frequently if necessary before application of the antibiotic ointment. The dressing consists of an eye pad changed daily. The prosthesis is not placed until the socket has healed. The opposite eye is not covered

A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents? (Select all that apply.) a. Apply over-the-counter creams to the area daily. b. Avoid excessive skin exposure to the sun. c. Use a washcloth when cleaning the area receiving radiation. d. Plan for adequate rest periods for the child. e. A darkening of the skin receiving radiation is expected.

ANS: B, D, E Feedback Correct: Children receiving cranial radiation are particularly affected by fatigue and an increased need for sleep during and shortly after completion of the course of radiation. Skin damage can include changes in pigmentation (darkening), redness, peeling, and increased sensitivity. Incorrect: Extra care must be taken to avoid excessive skin exposure to heat, sunlight, friction (such as rubbing with a towel or washcloth), and creams or moisturizers. Only topical creams and moisturizers prescribed by the radiation oncologist should be applied to the radiated skin.

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased intracranial pressure (ICP) in an infant? (Select all that apply.) a. Tachycardia b. Alteration in pupil size and reactivity c. Increased motor response d. Extension or flexion posturing e. Cheyne-Stokes respirations

ANS: B, D, E Late signs of ICP in an infant or child include bradycardia, alteration in pupil size and reactivity, decreased motor response, extension or flexion posturing, and Cheyne-Stokes respirations.

The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Absent bowel sounds b. Passage of red, currant jelly-like stools c. Anorexia d. Tender, distended abdomen e. Hematemesis f. Sudden acute abdominal pain

ANS: B, D, F Intussusception occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it and leading to obstruction. Clinical manifestations of intussusception include the passage of red, currant jelly-like stools; a tender, distended abdomen; and sudden acute abdominal pain. Absent bowel sounds, anorexia, and hematemesis are clinical manifestations observed in other types of gastrointestinal dysfunction.

The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.) a. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping. b. Hold the infant in the prone position after a feeding. c. Discontinue breastfeeding so that a formula and rice cereal mixture can be used. d. The infant will require the Nissen fundoplication after 1 year of age. e. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

ANS: B, E Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given 30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with GER in severe cases with complications.

A critically injured child has died and is being removed from a ventilator in the pediatric intensive care unit. What is a priority nursing intervention for the family at this time? a. Ensure that parents are in the waiting room while the ventilator is removed. b. Help the parents understand that the child is already dead and no further interventions are necessary. c. Control the environment around the child and family to provide privacy. d. Encourage them to wait to see their child until the funeral home has prepared the body.

ANS: C Around the time of death, nursing care can be invaluable to the parents. The nurse should attempt to control the environment to ensure that the family and child have privacy. Other individuals such as clergy can be present if the family wishes. Attention to religious and cultural rituals may be important to them. The family should decide where they would like to be during removal from the ventilator. The family should be allowed to be with the child if they wish rather than waiting until the funeral home has prepared the body. Explain all interventions used for the child before death. DIF: Cognitive Level: Analyzing REF: p. 810

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which of the following? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. The parents are better able to manage the disease.

ANS: C Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood glucose results.

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse? a. "For as long as you have been told." b. "Most preadolescents use the brace for 6 months." c. "Until your vertebral column has reached skeletal maturity." d. "It will be necessary to wear the brace for the rest of your life."

ANS: C Bracing can halt or slow the progress of most curvatures. They must be used continuously until the child reaches skeletal maturity. Telling the child "for as long as you have been told" does not answer the child's question and does not promote involvement in care. Six months is unrealistic because skeletal maturity is not reached until adolescence. When skeletal growth is complete, bracing is no longer effective.

At which age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

ANS: C By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible. Preschoolers and young school-age children are too young to have an adult concept of death. Adolescents have a mature understanding of death. DIF: Cognitive Level: Understanding REF: p. 816

A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest? a. Pizza b. Pretzels c. Popcorn d. Oatmeal cookies

ANS: C Celiac disease symptoms result from ingestion of gluten. Corn and rice do not contain gluten. Popcorn or corn chips will not exacerbate the intestinal symptoms. Pizza and pretzels are usually made from wheat flour that contains gluten. Also, in the early stages of celiac disease, the child may be lactose intolerant. Oatmeal contains gluten.

A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). The parents and child should be taught to recognize and report which sign or symptom immediately? a. Fatigue b. Weight loss c. Fever, sore throat d. Upper respiratory tract infection

ANS: C Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Fatigue and weight loss are manifestations of hyperthyroidism. Their presence may indicate that the drug is not effective but does not require immediate evaluation. Upper respiratory tract infections are most likely viral in origin and not a sign of leukopenia.

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.

Which is most likely to encourage parents to talk about their feelings related to their child's illness? a. Be sympathetic. b. Use direct questions. c. Use open-ended questions. d. Avoid periods of silence.

ANS: C Closed-ended questions should be avoided when attempting to elicit parents' feelings. Open- ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in helping the relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. DIF: Cognitive Level: Apply REF: p. 58 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

The nurse is teaching a child with a cast about cast removal. What should the nurse teach the child about cast removal? a. "The cast cutter will be a quiet machine." b. "You will feel cold as the cast is removed." c. "You will feel a tickly sensation as the cast is removed." d. "The cast cutter cuts through the cast like a circular saw."

ANS: C Cutting the cast to remove it or to relieve tightness is frequently a frightening experience for children. They fear the sound of the cast cutter and are terrified that their flesh, as well as the cast, will be cut. Because it works by vibration, a cast cutter cuts only the hard surface of the cast. The oscillating blade vibrates back and forth very rapidly and will not cut when placed lightly on the skin. Children have described it as producing a "tickly" sensation.

What nursing intervention is most appropriate when caring for the child with osteomyelitis? a. Encourage frequent ambulation. b. Administer antibiotics with meals. c. Move and turn the child carefully and gently to minimize pain. d. Provide active range of motion exercises for the affected extremity.

ANS: C During the acute phase, any movement of the affected limb causes discomfort to the child. Careful positioning with the affected limb supported is necessary. Weight bearing is not permitted until healing is well under way to avoid pathologic fractures. Intravenous antibiotics are used initially. Food is not necessary with parenteral therapy. Active range of motion would be painful for the child.

The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula? a. Jitteriness b. Meconium ileus c. Excessive frothy saliva d. Increased need for sleep

ANS: C Excessive frothy saliva is indicative of a tracheoesophageal fistula. The child is unable to swallow the secretions, so there are excessive amounts of saliva in the mouth. Jitteriness is associated with several disorders, including electrolyte imbalances. Meconium ileus is associated with cystic fibrosis. Increased need for sleep is not associated with a tracheoesophageal fistula.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic? a. Exercise increases blood glucose. b. Extra insulin is required during exercise. c. Additional snacks are needed before exercise. d. Excessive physical activity should be restricted.

ANS: C Exercise lowers blood glucose levels, decreasing the need for insulin. Extra snacks are provided to maintain the blood glucose levels. Exercise is encouraged and not restricted unless indicated by other health conditions.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that: a. exercise will increase blood glucose. b. exercise should be restricted. c. extra snacks are needed before exercise. d. extra insulin is required during exercise.

ANS: C Exercise lowers blood glucose levels, which can be compensated for by extra snacks.

The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication? a. Sepsis b. Osteomyelitis c. Pulmonary embolism d. Acute respiratory tract infection

ANS: C Fat emboli are of greatest concern in individuals with fractures of the long bones. Fat droplets from the marrow are transferred to the general circulation, where they are transported to the lung or brain. This type of embolism usually occurs within the second 12 hours after the injury. Sepsis would manifest with fever and lethargy. Osteomyelitis usually is seen with pain at the site of infection and fever. A child with an acute respiratory tract infection would have nasal congestion, not chest pain.

The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40° C (104° F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention? a. Administer antipyretics. b. Administer salt tablets. c. Apply towels wet with cool water. d. Sponge with solution of rubbing alcohol and water.

ANS: C Heatstroke is a failure of normal thermoregulatory mechanisms. The onset is rapid with initial symptoms of headache, weakness, and disorientation. Immediate care is relocation to a cool environment, removal of clothing, and applying of cool water (wet towels or immersion). Antipyretics are not used because they are metabolized by the liver, which is already not functioning. Salt tablets are not indicated and may be harmful by increasing dehydration. Rubbing alcohol is not used.

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 Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. It is seldom apparent before age 10 years.

An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement? a. Burp the infant. b. Withhold the next feeding. c. Vent the gastrostomy tube. d. Notify the health care provider.

ANS: C If bolus feedings are initiated through a gastrostomy after a Nissen fundoplication, the tube may need to remain vented for several days or longer to avoid gastric distention from swallowed air. Edema surrounding the surgical site and a tight gastric wrap may prohibit the infant from expelling air through the esophagus, so burping does not relieve the distention. Some infants benefit from clamping of the tube for increasingly longer intervals until they are able to tolerate continuous clamping between feedings. During this time, if the infant displays increasing irritability and evidence of cramping, some relief may be provided by venting the tube. The next feeding should not be withheld, and calling the health care provider is not necessary.

The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe? a. Steatorrhea b. Clay colored c. Currant jelly-like d. Loose stools with undigested food

ANS: C In Meckel diverticulum the bleeding is usually painless and may be dramatic and occur as bright red or currant jelly-like stools, or it may occur intermittently and appear as tarry stools. The stools are not clay colored, steatorrhea, or loose with undigested food.

After spinal fusion surgery the nurse should check for signs of what? a. Seizure activity b. Increased intracranial pressure c. Impaired color, sensitivity, and movement to the lower extremities d. Impaired pupillary response during neurologic checks

ANS: C In addition to the usual postoperative assessments of wound, circulation, and vital signs, the neurologic status of the patient's extremities requires special attention. Prompt recognition of any neurologic impairment is imperative because delayed paralysis may develop that requires surgical intervention.

The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago. Gastrostomy feedings have not been started. What do nursing actions related to the gastrostomy tube include? a. Keep the tube clamped. b. Suction the tube as needed. c. Leave the tube open to gravity drainage. d. Lower the tube to a point below the level of the stomach.

ANS: C In the immediate postoperative period, the gastrostomy tube is open to gravity drainage. This usually is continued until the infant is able to tolerate feedings. The tube is unclamped in the postoperative period to allow for the drainage of secretions and air. Gastrostomy tubes are not suctioned on an as-needed basis. They may be connected to low suction to facilitate drainage of secretions. Lowering the tube to a point below the level of the stomach would create too much pressure.

What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Maintain the child NPO (nothing by mouth). b. Turn the child frequently. c. Restrict fluids. d. Encourage fluids.

ANS: C Increased secretion of ADH causes the kidney to reabsorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids but not food. Frequently turning the child is not necessary unless the child is unresponsive. Encouraging fluids will worsen the child's condition.

The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session? a. "Bisphosphonate therapy is not beneficial for OI." b. "Physical therapy should be avoided as it may cause damage to bones." c. "Lift the infant by the buttocks, not the ankles, when changing diapers." d. "The infant should meet expected gross motor development without assistive devices."

ANS: C Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Bisphosphonate and physical therapy are beneficial for OI. Lightweight braces will be used when the child starts to ambulate.

Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time? a. Send the child to radiology so radiography can be performed. b. Initiate an intravenous line and administer morphine for the pain. c. Calmly ask the child to point to where the pain is worst and to wiggle fingers. d. Have the parents hold the child so that the nurse can examine the arm thoroughly.

ANS: C Initially, assessment is the priority. Because the child is alert but upset, the nurse should work to gain the child's trust. Initial data are gained by observing the child's ability to move the fingers and to point to the pain. Other important observations at this time are pallor and paresthesia. The child needs to be sent for radiography, but initial assessment data need to be obtained. Sending the child for radiography will increase the child's anxiety, making the examination difficult. It is inappropriate to ask parents to restrain their child. These parents are upset about the injury. If restraint is indicated, the nurse should obtain assistance from other personnel.

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 Kyphosis is an abnormally increased convex angulation in the curvature of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits. Ankylosis is the immobility of a joint.

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years b. Boys, 12 years; girls, 10 years c. Boys, 9 years; girls, 8 years d. Boys, 10 years; girls, 9-1/2 years

ANS: C Manifestations of sexual development before age 9 in boys and age 8 in girls is considered precocious and should be investigated.

A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). What nursing consideration should be included? a. Monitor heart rate. b. Administer NSAIDs between meals. c. Check for abdominal pain and bloody stools. d. Expect inflammation to be gone in 3 or 4 days.

ANS: C NSAIDs are the first-line drugs used in JIA. Potential side effects include gastrointestinal (GI), renal, and hepatic side effects. The child is at risk for GI bleeding and elevated blood pressure. The heart rate is not affected by this drug class. NSAIDs should be given with meals to minimize gastrointestinal problems. The antiinflammatory response usually takes 3 weeks before effectiveness can be evaluated.

The nurse is preparing to care for a newborn with an omphalocele. The nurse should understand that care of the infant should include what intervention? a. Initiating breast- or bottle-feedings to stabilize the blood glucose level b. Maintaining pain management with an intravenous opioid c. Covering the intact bowel with a nonadherent dressing to prevent injury d. Performing immediate surgery

ANS: C Nursing care of an infant with an omphalocele includes covering the intact bowel with a nonadherent dressing to prevent injury or placing a bowel bag or moist dressings and a plastic drape if the abdominal contents are exposed. The infant is not started on any type of feeding but has a nasogastric tube placed for gastric decompression. Pain management is started after surgery, but surgery is not done immediately after birth. The infant is medically stabilized before different surgical options are considered.

he nurse is often the individual who is in the optimum position to suggest tissue donation to a family (after consultation with the practitioner). What will occur if a family chooses organ or tissue donation? a. The funeral will be delayed. b. Cremation is the preferred method of burial. c. Written consent is required for tissue or organ donation. d. An open casket cannot be used subsequent to this procedure.

ANS: C Organ and tissue donation cannot proceed without the familys written informed consent. There is usually no delay in the funeral. Organs are usually retrieved before actual death, and tissue must be removed soon after. No obvious disfigurement of the body occurs, and an open casket can be used for the funeral. DIF: Cognitive Level: Analyzing REF: p. 812

What is the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy

ANS: C Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus infection. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.

Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner? a. PPP results from a central nervous system (CNS) insult. b. PPP occurs more frequently in girls. c. PPP may be viewed as a variation in sexual development. d. PPP results from hormonal stimulation of the hypothalamic gonadotropin-releasing hormone (Gn-RH).

ANS: C PPP may be viewed as a variation in sexual development. PPP results from hormone stimulation other than the hypothalamic Gn-RH. Isolated manifestations of secondary sexual development occur. PPP can be missed if these changes are viewed as variations in pubertal onset. CPP results from CNS insult, occurs more frequently in girls, and results from hormonal stimulation of the hypothalamic Gn-RH

The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign? a. Petaling b. Posturing c. Paresthesia d. Positioning

ANS: C Paresthesia distal to the injury or cast is an ominous sign that requires immediate notification of the practitioner. Permanent muscle and tissue damage can occur within 6 hours. The other signs of ischemia that need to be reported are pain, pallor, pulselessness, and paralysis. Petaling is a method of placing protective or smooth edges on a cast. Posturing is not a sign of peripheral ischemia. Finding a position of comfort can be difficult with a fracture. It would not be an ominous sign unless pain was increasing or uncontrollable.

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.

The nurse is teaching the girls' varsity sports teams about the "female athlete triad." What is essential information to include? a. They should take low to moderate calcium to avoid hypercalcemia. b. They have strong bones because of the athletic training. c. Pregnancy can occur in the absence of menstruation. d. A diet high in carbohydrates accommodates increased training.

ANS: C Sexually active teenagers, regardless of menstrual status, need to consider contraceptive precautions. Increased calcium (1500 mg) is recommended for amenorrheic athletes. The decreased estrogen in girls with the female athlete triad, coupled with potentially inadequate diet, leads to osteoporosis. Diets high in protein and calories are necessary to avoid potentially long-term consequences of intensive, prolonged exercise programs in pubertal girls.

14. When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation? a. Anorexia b. Bradycardia c. Sudden relief from pain d. Decreased abdominal distention

ANS: C Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Anorexia is already a clinical manifestation of appendicitis. Tachycardia, not bradycardia, is a manifestation of peritonitis. Abdominal distention usually increases in addition to an increase in pain (usually diffuse and accompanied by rigid guarding of the abdomen).

Parents tell the nurse they do not want to let their school-age child know his illness is terminal. What response should the nurse make to the parents? a. Have you discussed this with your health care provider? b. I would do the same thing in your position; it is better the child doesnt know. c. I understand you want to protect your child, but often children realize the seriousness of their illness. d. I praise you for that decision; it can be so difficult to be truthful about the seriousness of your sons illness.

ANS: C Terminally ill children develop an awareness of the seriousness of their diagnosis even when protected from the truth. Acknowledging parents feelings but giving them truthful information is the appropriate response. Asking about discussing this with the health care provider is avoiding the issue. Sharing your own feelings by stating I would do the same thing and giving praise for the decision is nontherapeutic. DIF: Cognitive Level: Applying REF: p. 795

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. The nurse should provide which explanation? a. This attitude is helpful to give parents time to cope. b. This will help the child cope effectively by denial. c. Terminally ill children know when they are seriously ill. d. Terminally ill children usually choose not to discuss the seriousness of their illness.

ANS: C The child needs honest and accurate information about the illness, treatments, and prognosis. Because of the increased attention of health professionals, children, even at a young age, realize that something is seriously wrong and that it involves them. Thus, denial is ineffective as a coping mechanism. The nurse should help parents understand the importance of honesty. Parents may need professional support and guidance from a nurse or social worker in this process. Children will usually tell others how much information they want about their condition. DIF: Cognitive Level: Analyzing REF: p. 795

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation? a. Place in the Trendelenburg position. b. Apply moist heat to the abdomen. c. Allow the child to assume a position of comfort. d. Administer a saline enema to cleanse the bowel.

ANS: C The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help with the discomfort. If appendicitis is a possibility, administering laxative or enemas or applying heat to the area is dangerous. Such measures stimulate bowel motility and increase the risk of perforation.

An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested. What is the first action the nurse should take? a. Wait for the child's parents to arrive. b. Move the child out of the parking lot. c. Have someone notify the emergency medical services (EMS) system. d. Help the child stand to return to play.

ANS: C The child was involved in a motor vehicle collision and at this time is not able to move his extremities. The child needs immediate attention at a hospital for assessment of the possibility of a spinal cord injury. Because the child cannot move his extremities, the child should not be moved until his cervical and vertebral spines are stabilized. The EMS team can appropriately stabilize the spinal column for transport. Although it is important to notify the parents, the EMS system should be activated and transport arranged for serious injuries. The only indication to move the child is to prevent further trauma.

A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? a. Pyloric stenosis b. Intussusception c. Hirschsprung disease d. Celiac disease

ANS: C The clinical manifestations of Hirschsprung disease in a 3-day-old infant include abdominal distention, vomiting, and failure to pass meconium stools. Pyloric stenosis would present with vomiting but not distention or failure to pass meconium stools. Intussusception presents with abdominal cramping and celiac disease presents with malabsorption.

Parents ask the nurse, When should palliative care be initiated? What is the best response by the nurse? a. When curative care is not feasible. b. When the childs prognosis is uncertain. c. It should be included along the continuum of care. d. It should begin when curative treatments are no longer appropriate.

ANS: C The current approach by palliative care experts promotes the inclusion of palliative care along the continuum of care from diagnosis through treatment, not merely at the end of life. It should not wait to be initiated when curative care is not feasible, the childs prognosis is uncertain, or curative treatments are no longer appropriate. DIF: Cognitive Level: Applying REF: p. 791

Which of the following is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 20 years. d. Oral agents are often effective for treatment.

ANS: C The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults.

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician? a. Weigh on admission and daily. b. Replace fluid volume deficit over 48 hours. c. Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride. d. Give intravenous regular insulin 2 units/kg/hr after initial rehydration bolus.

ANS: C The initial hydrating solution is 0.9% normal saline. Potassium is not given until the child is voiding 25 ml/hr, demonstrating adequate renal function. After initial rehydration and insulin administration, then potassium is given. Dextrose is not given until blood glucose levels are between 250 and 300 mg/dl. An accurate, current weight is essential for determination of the amount of fluid loss and as a basis for medication dosage. Replacing fluid volume deficit over 48 hours is the current recommendation in diabetic ketoacidosis in children. Cerebral edema is a risk of more rapid administration. Intravenous regular insulin 2 units/kg/hr after initial rehydration bolus is the recommended insulin administration for a child of this weight. Only regular insulin can be given intravenously, and it is given after initial fluid volume expansion

What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)? a. Apply ice packs to relieve acute swelling and pain. b. Administer acetaminophen to reduce inflammation. c. Teach the child and family correct administration of medications. d. Encourage range of motion exercises during periods of inflammation.

ANS: C The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.

What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)? a. High calorie diet because of increased metabolic needs b. Home schooling to decrease the risk of infections c. Protection from sun and fluorescent lights to minimize rash d. Intensive exercise regimen to build up muscle strength and endurance

ANS: C The photosensitive rash is a major concern for individuals with SLE. Adolescents who spend time outdoors need to use sunscreens with a high SPF, hats, and clothing. Uncovered fluorescent lights can also cause a photosensitivity reaction. The diet should be sufficient in calories and nutrients for growth and development. The use of steroids can cause increased hunger, resulting in weight gain. This can present additional emotional issues for the adolescent. Normal functions should be maximized. The individual with SLE is encouraged to attend school and participate in peer activities. A balance of rest and exercise is important; excessive exercise is avoided.

What is a physiologic effect of immobilization on children? a.Metabolic rate increases. b. Venous return improves because the child is in the supine position. c. Circulatory stasis can lead to thrombus and embolus formation. d. Bone calcium increases, releasing excess calcium into the body (hypercalcemia).

ANS: C The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. With the loss of muscle contraction, there is a decreased venous return to the heart. Calcium leaves the bone during immobilization, leading to bone demineralization and increasing the calcium ion concentration in the blood.

A preschooler is found digging up a pet bird that was recently buried after it died. What is the best explanation for this behavior? a. He has a morbid preoccupation with death. b. He is looking to see if a ghost took it away. c. He needs reassurance that the pet has not gone somewhere else. d. The loss is not yet resolved, and professional counseling is needed.

ANS: C The preschooler can recognize that the pet has died but has difficulties with the permanence. Digging up the bird gives reassurance that the bird is still present. This is an expected response at this age. If the behavior persists, intervention may be required. DIF: Cognitive Level: Understanding REF: p. 813

An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia? a. Cold, clammy skin and lethargy b. Hunger and hypertension c. Thirst, being flushed, and fruity breath d. Disorientation and pallor

ANS: C The signs of hyperglycemia are thirst, being flushed, and fruity breath. The skin is not cold or clammy, and there is not hunger and hypertension. Disorientation and pallor are signs of hypoglycemia.

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? a. Surgical therapy is indicated. b. Place in prone position for sleep after feeding. c. Thicken feedings and enlarge the nipple hole. d. Reduce the frequency of feeding by encouraging larger volumes of formula.

ANS: C Thickened feedings decrease the child's crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.

A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture? a. It will create difficulty because the child is left handed. b. It will heal slowly because this is the weakest part of the bone. c. This type of fracture requires different management to prevent bone growth complications. d. This type of fracture necessitates complete immobilization of the shoulder for 4 to 6 weeks.

ANS: C This type of fracture (Salter type III) can cause problems with growth in the affected limb. Early and complete assessment is essential to prevent angular deformities and longitudinal growth problems. The difficulty for the child does not depend on the location at the epiphyseal plate. Any fracture of the dominant arm presents obstacles for the individual. Healing is usually rapid in the epiphyseal plate area. Complete immobilization is not necessary. Often these injuries are surgically repaired with open reduction and internal fixation.

The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest? a. Hamburger on a bun b. Spaghetti with meat sauce c. Corn on the cob with butter d. Peanut butter and crackers

ANS: C Treatment of celiac disease consists primarily of dietary management. Although a gluten-free diet is prescribed, it is difficult to remove every source of this protein. Some patients are able to tolerate restricted amounts of gluten. Because gluten occurs mainly in the grains of wheat and rye but also in smaller quantities in barley and oats, these foods are eliminated. Corn, rice, and millet are substitute grain foods. Corn on the cob with butter would be gluten free.

What statement is characteristic of type 1 diabetes mellitus? a. Onset is usually gradual. b. Ketoacidosis is infrequent. c. Peak age incidence is 10 to 15 years. d. Oral agents are available for treatment.

ANS: C Type 1 diabetes mellitus typically usually has its onset before the age of 20 years, with a peak incidence between ages 10 and 15 years. Type 1 has an abrupt onset, in contrast to type 2, which has a more gradual appearance. Ketoacidosis occurs when insulin is unavailable and the body uses sources other than glucose for cellular metabolism. Ketoacidosis is more common in type 1 diabetes than in type 2. At this time, oral agents are available only for type 2 diabetes.

What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? a. The prognosis for full recovery is excellent. b. Death usually occurs by 6 months of age. c. Liver transplantation may be needed eventually. d. Children with surgical correction live normal lives.

ANS: C Untreated biliary atresia results in progressive cirrhosis and death usually by 2 years of age. Surgical intervention at 8 weeks of age is associated with somewhat better outcomes. Liver transplantation is also improving outcomes for 10-year survival. Even with surgical intervention, most children require supportive therapy. With early intervention, 10-year survival rates range from 27% to 75%.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What should nursing care include? a. Feed glucose water only. b. Elevate the patient's head for feedings. c. Raise the patient's head and give nothing by mouth. d. Avoid suctioning unless the infant is cyanotic.

ANS: C When a newborn is suspected of having a tracheoesophageal fistula, the most desirable position is supine with the head elevated on an inclined plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. The oral pharynx should be kept clear of secretions by oral suctioning. This is to prevent the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

Which neurologic diagnostic test gives a visualized horizontal and vertical cross-section of the brain at any axis? a. Nuclear brain scan b. Echoencephalography c. CT scan d. Magnetic resonance imaging (MRI)

ANS: C A CT scan provides a visualization of the horizontal and vertical cross-sections of the brain at any axis. A nuclear brain scan uses a radioisotope that accumulates where the blood-brain barrier is defective. Echoencephalography identifies shifts in midline structures of the brain as a result of intracranial lesions. MRI permits visualization of morphologic features of target structures and permits tissue discrimination that is unavailable with any other techniques.

The nurse is planning care for an 8-year-old child with a concussion. Which is descriptive of a concussion? a. Petechial hemorrhages cause amnesia. b. Visible bruising and tearing of cerebral tissue occur. c. It is a transient and reversible neuronal dysfunction. d. A slight lesion develops remotely from the site of trauma.

ANS: C A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head. Petechial hemorrhages along the superficial aspects of the brain along the point of impact are a type of contusion, but are not necessarily associated with amnesia. A contusion is visible bruising and tearing of cerebral tissue. Contrecoup is a lesion that develops remote from the site of trauma as a result of an acceleration-deceleration injury.

15. When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet: a. is lacking in protein. b. indicates they live in poverty. c. may provide sufficient amino acids. d. should be enriched with meat and milk.

ANS: C A diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Combinations of foods contain the essential amino acids necessary for growth. Many cultures use diets that contain this combination of foods. It is not indicative of poverty. A dietary assessment should be done, but many vegetarian diets are sufficient for growth. DIF: Cognitive Level: Application REF: p. 135 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A child has been seizure-free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which intervention in the response? a. Medications can be discontinued at this time. b. The child will need to take the drugs for 5 years after the last seizure. c. A step-wise approach will be used to reduce the dosage gradually. d. Seizure disorders are a lifelong problem. Medications cannot be discontinued.

ANS: C A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure-free for 2 years and has a normal electroencephalogram (EEG). Medications must be gradually reduced to minimize the recurrence of seizures. Seizure medications can be safely discontinued. The risk of recurrence is greatest within the first year.

33. When auscultating an infant's lungs, the nurse detects diminished breath sounds. The nurse should interpret this as which of the following? a. Suggestive of chronic pulmonary disease b. Suggestive of impending respiratory failure c. An abnormal finding warranting investigation d. A normal finding in infants less than 1 year of age

ANS: C Absent or diminished breath sounds are always an abnormal finding. Fluid, air, or solid masses in the pleural space all interfere with the conduction of breath sounds. Further data are necessary for diagnosis of chronic pulmonary disease or impending respiratory failure. Diminished breath sounds in certain segments of the lungs can alert the nurse to pulmonary areas that may benefit from chest physiotherapy. Further evaluation is needed in all age-groups. DIF: Cognitive Level: Comprehension REF: p. 165 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action: should be to a. place on side. b. take blood pressure. c. stabilize neck and spine. d. check scalp and back for bleeding.

ANS: C After determining that the child is breathing and has adequate circulation, the next action is to stabilize the neck and spine to prevent any additional trauma. The child's position should not be changed until the neck and spine are stabilized. Blood pressure is a later assessment. Less urgent, but an important assessment, is inspection of the scalp for bleeding.

What type of chemotherapeutic agent alters the function of cells by replacing a hydrogen atom of a molecule? a. Plant alkaloids b. Antimetabolites c. Alkylating agents d. Antitumor antibiotics

ANS: C Alkylating agents replace a hydrogen atom with an alkyl group. The irreversible combination of alkyl groups with nucleotide chains, particularly deoxyribonucleic acid (DNA), causes unbalanced growth of unaffected cell constituents so that the cell eventually dies. Plant alkaloids arrest the cell in metaphase by binding to proteins needed for spindle formation. Antimetabolites resemble essential metabolic elements needed for growth but are different enough to block further DNA synthesis. Antitumor antibiotics are natural substances that interfere with cell division by reacting with DNA in such a way as to prevent further replication of DNA and transcription of ribonucleic acid (RNA).

A 3-year-old child is hospitalized after a submersion injury. The child's mother complains to the nurse, "Being at the hospital seems unnecessary when he is perfectly fine." The nurse's best reply should be: a. "He still needs a little extra oxygen." b. "I'm sure he is fine, but the doctor wants to make sure." c. "The reason for this is that complications could still occur." d. "It is important to observe for possible central nervous system problems."

ANS: C All children who have a submersion injury should be admitted to the hospital for observation. Although many children do not appear to have suffered adverse effects from the event, complications such as respiratory compromise and cerebral edema may occur 24 hours after the incident. The mother would not think the child is fine if oxygen were still required. The nurse should clarify that different complications can occur up to 24 hours later and that observations are necessary.

The nurse is preparing a child for possible alopecia from chemotherapy. What information should the nurse include? a. Wearing hats or scarves is preferable to a wig. b. Expose head to sunlight to stimulate hair regrowth. c. Hair may have a slightly different color or texture when it regrows. d. Regrowth of hair usually begins 12 months after chemotherapy ends.

ANS: C Alopecia is a side effect of certain chemotherapeutic agents and cranial irradiation. When the hair regrows, it may be of a different color or texture. Children should choose the head covering they prefer. A wig should be selected similar to the child's own hairstyle and color before the hair loss. The head should be protected from sunlight to avoid sunburn. The hair usually grows back within 3 to 6 months after the cessation of treatment.

A nurse is assessing a patient admitted for an asthma exacerbation. Which breath sounds does the nurse expect to assess? a. Rubs b. Rattles c. Wheezes d. Crackles

ANS: C Asthma causes bronchoconstriction and narrowed passageways. Wheezes are produced as air passes through narrowed passageways. Rubs are the sound created by the friction of one surface rubbing over another. Pleural friction rub is caused by inflammation of the pleural space. Rattles is the term formerly used for crackles. Crackles are the sounds made when air passes through fluid or moisture. DIF: Cognitive Level: Analyze REF: p. 102 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Most infants begin to fear strangers at age: a. 2 months c. 6 months b. 4 months d. 12 months

ANS: C Between ages 6 and 8 months fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months infants are just beginning to respond differentially to the mother. At age 4 months the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age.

Chemotherapeutic agents are classified according to what feature? a. Side effects b. Effectiveness c. Mechanism of action d. Route of administration

ANS: C Chemotherapeutic agents are classified according to mechanism of action. For example, antimetabolites resemble essential metabolic elements needed for growth but are different enough to block further deoxyribonucleic acid (DNA) synthesis. Although the side effect profiles may be similar for drugs within a classification, they are not the basis for classification. Most chemotherapeutic regimens contain combinations of drugs. The effectiveness of any one drug is relative to the cancer type, combination therapy, and protocol for administration. The route of administration is determined by the pharmacodynamics and pharmacokinetics of each drug.

While caring for a critically ill child, the nurse observes that respirations are gradually increasing in rate and depth, with periods of apnea. What pattern of respiration will the nurse document? a. Dyspnea b. Tachypnea c. Cheyne-Stokes respirations d. Seesaw (paradoxic) respirations

ANS: C Cheyne-Stokes respirations are a pattern of respirations that gradually increase in rate and depth, with periods of apnea. Dyspnea is defined as distress during breathing. Tachypnea is an increased respiratory rate. In seesaw respirations, the chest falls on inspiration and rises on expiration. DIF: Cognitive Level: Understand REF: p. 102 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is counseling parents of a child beginning to show signs of being overweight. The nurse accurately relates which body mass index (BMI)-for-age percentile indicates a risk for being overweight? a. 10th percentile b. 9th percentile c. 85th percentile d. 95th percentile

ANS: C Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight. DIF: Cognitive Level: Apply REF: p. 79 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

18. With the National Center for Health Statistics criteria, which one of the following body mass index (BMI)-for-age percentiles would indicate the patient is at risk for being overweight? a. 10th percentile b. 75th percentile c. 85th percentile d. 95th percentile

ANS: C Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children who are greater than or equal to the 95th percentile are considered overweight. Children whose BMI is between the 10th and 75th percentiles are within normal limits. DIF: Cognitive Level: Comprehension REF: p. 139 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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 Children with leukemia are at risk for invasion of the CNS with leukemic cells. CNS prophylactic therapy is indicated. Intrathecal chemotherapy does not prevent infection or drug side effects. A brain tumor in a child with leukemia would be a second tumor, and additional appropriate therapy would be indicated.

Which type of seizure involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired

ANS: C Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected. Partial seizures are caused by abnormal electric discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex. A seizure disorder that is acquired is a result of a brain injury from a variety of factors; it does not specify the type of seizure.

What is an appropriate screening test for hearing that can be administered by the nurse to a 5-year-old child? a. The Rinne test b. The Weber test c. Conventional audiometry d. Eliciting the startle reflex

ANS: C Conventional audiometry is a behavioral test that measures auditory thresholds in response to speech and frequency-specific stimuli presented through earphones. The Rinne and Weber tests measure bone conduction of sound. Eliciting the startle reflex may be useful in infants. DIF: Cognitive Level: Understand REF: p. 97 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

30. An appropriate screening test for hearing that the nurse can administer to a 5-year-old child is which of the following? a. Rinne test b. Weber test c. Conventional audiometry d. Eliciting the startle reflex

ANS: C Conventional audiometry is a behavioral test that measures auditory thresholds in response to speech and frequency-specific stimuli presented through earphones. The Rinne and Weber tests measure bone conduction of sound. Eliciting the startle reflex may be useful in infants. DIF: Cognitive Level: Comprehension REF: p. 161 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A young child's parents call the nurse after their child was bitten by a raccoon in the woods. The nurse's recommendation should be based on which statement? a. Child should be hospitalized for close observation. b. No treatment is necessary if thorough wound cleaning is done. c. Antirabies prophylaxis must be initiated. d. Antirabies prophylaxis must be initiated if clinical manifestations appear.

ANS: C Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immune globulin (HRIG) as soon as possible. Hospitalization is not necessary. The wound cleansing, passive immunization, and immune globulin administration can be done as an outpatient. The child needs to receive both HRIG and rabies vaccine.

The nurse is monitoring a 7-year-old child post-surgical resection of an infratentorial brain tumor. Which vital sign findings indicate Cushing's triad? a. Increased temperature, tachycardia, tachypnea b. Decreased temperature, bradycardia, bradypnea c. Bradycardia, hypertension, irregular respirations d. Bradycardia, hypotension, tachypnea

ANS: C Cushing's triad is a hallmark sign of increased intracranial pressure (ICP). The triad includes bradycardia, hypertension, and irregular respirations. Increased or decreased temperature is not a sign of Cushing's triad.

Calculate the absolute neutrophil count (ANC) for the following: WBC count of 5000 mm3; neutrophils (segs) of 10%; and nonsegmented neutrophils (bands) of 12%. a. 110/mm3 b. 500/mm3 c. 1100/mm3 d. 5000/mm3

ANS: C Determine the total percentage of neutrophils ("polys," or "segs," and "bands"). Multiply white blood cell (WBC) count by percentage of neutrophils. WBC = 1000/mm3, neutrophils = 7%, and nonsegmented neutrophils (bands) = 7% Step 1: 10% + 12% = 22% Step 2: 0.22 5000 = 1100/mm3 ANC

Although a 14-month-old girl received a shock from an electrical outlet recently, her parents find her about to place a paper clip in another outlet. The best interpretation of this behavior is: a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age and represents typical behavior for a toddler. Only some awareness exists of a causal relation between events.

A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children? a. Complete blood cell count (CBC) b. Lumbar puncture c. Bone marrow biopsy d. Computed tomography (CT) scan

ANS: C Feedback A A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. B A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. C The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. D A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis.

Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS). The nurse should assess for: a. Liver failure b. CNS deficit c. Kidney failure d. Respiratory distress

ANS: C Feedback A TLS is related to intracellular electrolytes overloading the kidney as a response to the rapid lysis of tumor cells. This does not affect the liver. B TLS does not affect the CNS. C In TLS, the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy. Because of the large volume of these cells, their intracellular electrolytes overload the kidneys and, if not monitored, can cause kidney failure. D TLS does not affect the lungs and cause respiratory distress.

The nurse should base a response to a parent's question about the prognosis of acute leukemia (ALL) on the knowledge that: a. Leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. b. Research to find a cure for childhood cancers is very active. c. The majority of children go into remission and remain symptom free when treatment is completed. d. It usually takes several months of chemotherapy to achieve a remission.

ANS: C Feedback A With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. B This statement is true, but it does not address the parent's concern. C Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%. D About 95% of children achieve remission within the first month of chemotherapy. If a significant number of blast cells are still present in the bone marrow after a month of chemotherapy, a new and stronger regimen is begun.

The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs? a.Gastrointestinal perforation may have occurred. b.The object may have been aspirated. c.The object may be lodged in the esophagus. d.The object may be embedded in stomach wall.

ANS: C Gagging and drooling may be signs of esophageal obstruction. The child is unable to swallow saliva, which contributes to the drooling. Signs of gastrointestinal (GI) perforation include chest or abdominal pain and evidence of bleeding in the GI tract. If the object was aspirated, the child would most likely have coughing, choking, inability to speak, or difficulty breathing. If the object was embedded in the stomach wall, it would not result in symptoms of gagging and drooling.

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

A nurse notes that a 10-month-old infant has a larger head circumference than chest. The nurse interprets this as a normal finding because the head and chest circumference become equal at which age? a. 1 month b. 6 to 9 months c. 1 to 2 years d. to 3 years

ANS: C Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference before age 1. Chest circumference is larger than head circumference at to 3 years. DIF: Cognitive Level: Remember REF: p. 80 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The most common clinical manifestation(s) of brain tumors in children is/are: a. irritability. b. seizures. c. headaches and vomiting. d. fever and poor fine motor control.

ANS: C Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestation(s) of brain tumors in children. Irritability, seizures, and fever and poor fine motor control are clinical manifestations of brain tumors, but headaches and vomiting are the most common.

29. During an otoscopic examination on an infant, in which direction is the pinna pulled? a. Up and back b. Up and forward c. Down and back d. Down and forward

ANS: C In infants and toddlers the ear canal is curved upward. To visualize the ear canal, it is necessary to pull the pinna down and back to the 6 to 9 o'clock range to straighten the canal. In children over the age of 3 and adults, the canal curves downward and forward. The pinna is pulled up and back to the 10 o'clock position. Up and forward and down and forward are positions that do not facilitate visualization of the ear canal. DIF: Cognitive Level: Comprehension REF: p. 160 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. How should this question be considered? a. Unnecessary information because child is age 3 years b. An important part of the family history c. An important part of the child's past history d. An important part of the child's review of systems

ANS: C Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the past history. Developmental milestones provide important information about the child's physical, social, and neurologic health and should be included in the history for a 3-year-old child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental milestones. DIF: Cognitive Level: Understand REF: p. 65 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse observes yellow staining in the sclera of eyes, soles of feet, and palms of hands. How should the nurse document these findings? a. Normal b. Erythema c. Jaundice d. Ecchymosis

ANS: C Jaundice is defined as the yellow staining of the skin, usually by bile pigments. Yellow staining is not a normal appearance of the skin. Erythema is redness that results from increased blood flow to the area. Ecchymosis is large, diffuse areas, usually black and blue, caused by hemorrhage of blood into the skin. DIF: Cognitive Level: Understand REF: p. 89 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

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 Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may result secondary to the increased number of WBCs. The coagulation process is unaffected by leukemia. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow.

Which is the initial clinical manifestation of generalized seizures? a. Being confused b. Feeling frightened c. Losing consciousness d. Seeing flashing lights

ANS: C Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.

What statement related to clinical trials developed for pediatric cancers is most accurate? a. Are accessible only in major pediatric centers b. Do not require consent for standard therapy c. Provide the best available therapy compared with an expected improvement d. Are standardized to provide the same treatment to all children with the disease

ANS: C Most clinical trials have a control group in which the patients receive the best available therapy currently known. The experimental group(s) receives treatment that is thought to be even better. The protocol outlines the therapy plan. Protocols are developed for many pediatric cancers. They can be accessed by pediatric oncologists throughout the United States. Consent is always required in treatment of children, especially for research protocols. The protocol is designed to optimize therapy for children based on disease type and stage

A nurse is assessing a child with an unrepaired ventricular septal defect. Which heart sound does the nurse expect to assess? a. S3 b. S4 c. Murmur d. Physiologic splitting

ANS: C Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. These are the sounds expected to be heard in a child with a ventricular septal defect because of the abnormal opening between the ventricles. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2 , which widens on inspiration. It is a significant normal finding. DIF: Cognitive Level: Analyze REF: p. 103 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

36. What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 b. S3, S4 c. Murmur d. Physiologic splitting

ANS: C Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 and S2 are normal heart sounds. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If it is heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding. DIF: Cognitive Level: Comprehension REF: p. 168 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The nurse has documented that a child's level of consciousness is obtunded. Which describes this level of consciousness? a. Slow response to vigorous and repeated stimulation b. Impaired decision making c. Arousable with stimulation d. Confusion regarding time and place

ANS: C Obtunded describes a level of consciousness in which the child is arousable with stimulation. Stupor is a state in which the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Confusion is impaired decision making. Disorientation is confusion regarding time and place.

An appropriate nursing intervention when caring for an unconscious child should be to: a. change the child's position infrequently to minimize the chance of increased ICP. b. avoid using narcotics or sedatives to provide comfort and pain relief. c. monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. give tepid sponge baths to reduce fever because antipyretics are contraindicated.

ANS: C Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema. The child's position should be changed frequently to avoid complications such as pneumonia and skin breakdown. Narcotics and sedatives should be used as necessary to reduce pain and discomfort, which can increase ICP. Antipyretics are the method of choice for fever reduction.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted: a. Behavior that encourages bullying and sexism. b. Behavior that reinforces poor peer relationships. c. Characteristic of social development of this age. d. Characteristic of children who later are at risk for membership in gangs.

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.

22. A nurse is preparing to perform a physical assessment on a toddler. Which approach should the nurse use for this child? a. Always proceed in a head-to-toe direction. b. Perform traumatic procedures first. c. Use minimal physical contact initially. d. Demonstrate use of equipment.

ANS: C Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimal physical contact initially to gain the child's cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for toddlers. DIF: Cognitive Level: Apply REF: p. 77 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face b. Buttocks c. Oral mucosa d. Palms and soles

ANS: C Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark skin unless they are in the mouth or conjunctiva. DIF: Cognitive Level: Remember REF: p. 89 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance: Techniques of Physical Assessment

22. Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face b. Buttocks c. Oral mucosa d. Palms and soles

ANS: C Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark-skinned individuals unless they are in the mouth or conjunctiva. DIF: Cognitive Level: Comprehension REF: p. 152 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Generally the earliest age at which puberty begins is: a. 13 years in girls, 13 years in boys b. 11 years in girls, 11 years in boys c. 10 years in girls; 12 years in boys d. 12 years in girls, 10 years in boys

ANS: C Puberty signals the beginning of the development of secondary sex characteristics. This begins in girls earlier than in boys. Usually a 2-year difference occurs in the age at onset. Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys do.

The most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old would be to: a. ride a tricycle. b. spend time in an infant swing. c. play with push-pull toys. d. read large picture books.

ANS: C Push-pull toys are appropriate to promote sensorimotor stimulation for a 1-year-old child.

A nurse is assigned to four children of different ages. In which age group should the nurse understand that body integrity is a concern? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: C School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are oversensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to toddlers, preschoolers, or adolescents. DIF: Cognitive Level: Understand REF: p. 61 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

An 8-year-old girl asks the nurse how the blood pressure apparatus works. What is the most appropriate nursing action? a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure. DIF: Cognitive Level: Apply REF: p. 61 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

8. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is which of the following? a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child so that the child can then observe during the procedure. A nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety in asking how the blood pressure apparatus works, just requesting clarification of what will occur. DIF: Cognitive Level: Comprehension REF: p. 123 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is: a. "Epilepsy is easily treated." b. "Very few children have actual epilepsy." c. "The seizure may or may not mean that your child has epilepsy." d. "Your child has had only one convulsion; it probably won't happen again."

ANS: C Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures. The treatment of epilepsy involves a thorough assessment to determine the type of seizure the child is having and the cause, followed by individualized therapy to allow the child to have as normal a life as possible. The nurse should not make generalized comments regarding the incidence of epilepsy until further assessment is made.

During a routine health assessment, the nurse notes that an 8-month-old infant has significant head lag. Which is the nurse's most appropriate action? a. Teach parents appropriate exercises. b. Recheck head control at next visit. c. Refer child for further evaluation. d. Refer child for further evaluation if anterior fontanel is still open.

ANS: C Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Reduction of head lag is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated. DIF: Cognitive Level: Apply REF: p. 89 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

23. During a routine health assessment the nurse notes that the 8-month-old infant has a significant head lag. Which of the following is the most appropriate action? a. Recheck head control at next visit. b. Teach parents appropriate exercises. c. Schedule child for further evaluation. d. Refer child for further evaluation if anterior fontanel is still open.

ANS: C Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Head control is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated. DIF: Cognitive Level: Comprehension REF: p. 154 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

When assessing development in a 9-month-old infant, the nurse would expect to observe the infant: a. speaking in 2-word sentences. b. grasping objects with palmar grasp. c. creeping along the floor. d. beginning to use a spoon rather sloppily.

ANS: C The 9-month-old tries to creep, has developed pincer movement, and can grasp a spoon without keeping food on it.

Which is the most appropriate vision acuity test for a child who is in preschool? a. Cover test b. Ishihara test c. HOTV chart d. Snellen letter chart

ANS: C The HOTV test consists of a wall chart of these letters. The child is asked to point to a corresponding card when the examiner selects one of the letters on the chart. The cover test determines ocular alignment. The Ishihara test is used for the detection of color blindness. The Snellen letter chart is usually used for older children. DIF: Cognitive Level: Understand REF: p. 93 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. How should the nurse assess this diet? a. Indicates they live in poverty b. Is lacking in protein c. May provide sufficient amino acids d. Should be enriched with meat and milk

ANS: C The diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Many cultures use diets that contain this combination of foods. It is not indicative of poverty. Combinations of foods contain the essential amino acids necessary for growth. A dietary assessment should be done, but many vegetarian diets are sufficient for growth. DIF: Cognitive Level: Understand REF: p. 66 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Where in the health history should the nurse describe all details related to the chief complaint? a. Past history b. Chief complaint c. Present illness d. Review of systems

ANS: C The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the child's health, not to the current problem. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system. DIF: Cognitive Level: Understand REF: p. 64 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is aware that the earliest age at which an infant is able to sit steadily alone is _____ months. a. 4 b. 5 c. 8 d. 15

ANS: C The infant can sit alone without support at about 8 months of age.

The abnormal finding in an evaluation of growth and development for a 6-month-old infant would be: a. weight gain of 4 to 7 ounces per week. b. length increase of 1 inch in 2 months. c. head lag present. d. can sit alone for a few seconds.

ANS: C The infant should be holding the head up well by 5 months of age. If head lag is present at 6 months, the child should undergo further evaluation.

What is the single most important factor to consider when communicating with children? a. The child's physical condition b. Presence or absence of the child's parent c. The child's developmental level d. The child's nonverbal behaviors

ANS: C The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child's physical condition is a consideration, developmental level is much more important. The parents' presence is important when communicating with young children but may be detrimental when speaking with adolescents. Nonverbal behaviors will vary in importance, based on the child's developmental level. DIF: Cognitive Level: Understand REF: p. 60 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

3. What is the single most important factor to consider when communicating with children? a. Presence of the child's parent b. Child's physical condition c. Child's developmental level d. Child's nonverbal behaviors

ANS: C The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Nonverbal behaviors vary in importance based on the child's developmental level and physical condition. Although the child's physical condition is a consideration, developmental level is much more important. The presence of parents is important when communicating with young children, but may be detrimental when speaking with adolescents. DIF: Cognitive Level: Comprehension REF: p. 177 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. Which statement made by the mother indicates a correct understanding of the teaching? a. "I should expect my child to have a few episodes of vomiting." b. "If I notice sleep disturbances, I should contact the physician immediately." c. "I should expect my child to have some behavioral changes after the accident." d. "If I notice diplopia, I will have my child rest for 1 hour."

ANS: C The parents are advised of probable posttraumatic symptoms that may be expected. These include behavioral changes and sleep disturbances. If the child has these clinical signs, they should be immediately reported for evaluation. Sleep disturbances are to be expected.

Peer relationships become more important during adolescence because: a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and strength and power. During adolescence the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in the personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.

At about what age does the Babinski sign disappear? a. 4 months b. 6 months c. 1 year d. 2 years

ANS: C The presence of the Babinski reflex after about age 1 year, when walking begins, is abnormal. Four to 6 months is too young for the disappearance of the Babinski reflex. Persistence of the Babinski reflex requires further evaluation. DIF: Cognitive Level: Understand REF: p. 109 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target? a. 1 month b. 1 to 2 months c. 3 to 4 months d. 6 months

ANS: C Visual fixation and following a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If the infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed. DIF: Cognitive Level: Understand REF: p. 93 TOP: Integrated Process: Nursing Process: Problem Identification MSC: Area of Client Needs: Health Promotion and Maintenance

What is an important priority in dealing with the child suspected of having Wilms tumor? a. Intervening to minimize bleeding b. Monitoring temperature for infection c. Ensuring the abdomen is protected from palpation d. Teaching parents how to manage the parenteral nutrition

ANS: C Wilms tumor, or nephroblastoma, is the most common malignant renal and intraabdominal tumor of childhood. The abdomen is protected, and palpation is avoided. Careful handling and bathing are essential to prevent trauma to the tumor site. Before chemotherapy, the child is not myelosuppressed. Bleeding is not usually a risk. Infection is a concern after surgery and during chemotherapy, not before surgery. Parenteral therapy is not indicated before surgery

The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the nurse include in the teaching? (Select all that apply.) a. Oranges b. Bananas c. Lima beans d. Baked beans e. Raisin bran cereal

ANS: C, D, E Lima beans have 13.2 g of fiber in 1 cup, baked beans have 10.4 g of fiber in 1 cup, and raisin bran cereal has 7.3 g of fiber in 1 cup. One orange has only 3.1 g of fiber, and 1 banana has only 3.1 g of fiber, so they are not recommended as high-fiber foods.

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? (Select all that apply.) a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone

ANS: C, D, E Assessment findings in a neonate with meningitis include bulging anterior fontanel, weak cry, and poor muscle tone. Headache and photophobia are signs seen in an older child.

The nurse is taking care of a child who had a thyroidectomy. The nurse recognizes what as a positive Chvostek sign? a. Paresthesia occurring in feet and toes b. Frequent sharp flexion of wrist and ankle joints c. Carpal spasm elicited by pressure applied to the nerves of the upper arm d. Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland

ANS: D A positive Chvostek sign is a facial muscle spasm that is elicited by tapping the facial nerve in the region of the parotid gland. Paresthesia occurring in the feet and toes and frequent sharp flexion of the wrist and ankle joints can be signs of hypoparathyroidism but are not part of a positive Chvostek sign. Carpal spasm elicited by pressure applied to nerves of the upper arm is called a positive Trousseau sign.

At which developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School age d. Adolescence

ANS: D Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death. Toddlers and preschoolers are too young to have difficulty coping with their own death. They fear separation from their parents. School-age children fear the unknown such as the consequences of the illness and the threat to their sense of security. DIF: Cognitive Level: Understanding REF: p. 799

A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs? a. The infant's IV line has infiltrated. b. The infant has not voided since surgery. c. The infant's mother states the infant is tolerating the feeding okay. d. The infant is taking the Pedialyte without vomiting or distention.

ANS: D After a pyloromyotomy, feedings are usually instituted within 12 to 24 hours, beginning with clear liquids. They are offered in small quantities at frequent intervals. Supervision of feedings is an important part of postoperative care. The feedings are advanced only if the infant is taking the clear liquids without vomiting or distention. Feedings would not be advanced if the infant has not voided, the IV line becomes infiltrated, or the mother states the infant is tolerating the feedings.

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse's response should be based on which knowledge? a. It is unsafe. b. It is acceptable for up to 24 hours. c. It is acceptable for families with very limited resources. d. It is suitable for up to 3 days if stored in the refrigerator.

ANS: D Bacterial counts are unaffected if insulin syringes are handled in an aseptic manner and stored in the refrigerator between use. The syringes can be used up to 3 days and result in a considerable cost savings. Bacterial counts remain low for up to 72 hours with proper technique. The family's resources are not an issue; if a practice is unsafe, the family should not be encouraged to endanger the child by reusing equipment.

How might the quality of life for a terminally ill child and his family be enhanced by nurses? a. Tell the family what is best. b. Leave the family alone to deal with their tragedy. c. Remain objective and uninvolved with family grieving. d. Advocate for and implement pain and symptom relief measures.

ANS: D By increasing personal remembering, the nurse can advocate for and provide the best possible care for the child and family. This is supportive for the family and helps the nurse reduce the stress of caregiving. If the nurse tells the family what is best, this removes the decision making from the parents. It also increases pressure on the nurse to be the expert. The nurse is in a supportive role. The nurse should not leave the family alone to deal with their tragedy. Becoming involved is an objective, deliberate choice. Ideally, the nurse achieves detached concern, which allows sensitive, understanding care because the nurse is sufficiently detached to make objective, rational decisions.

What blood glucose measurement is most likely associated with diabetic ketoacidosis? a. 185 mg/dl b. 220 mg/dl c. 280 mg/dl d. 330 mg/dl

ANS: D Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 330 mg/dl; 185, 220, and 280 mg/dl are values that are too low for the definition of ketoacidosis.

What factor is most important for parents implementing do not resuscitate (DNR) orders? a. Parents beliefs about euthanasia b. Presence of other children in the home c. Experiences of the health care team with other children in this situation d. Acknowledgment by health care team that child has no realistic chance for cure

ANS: D Earlier implementation of DNR orders, use of less aggressive therapies, and greater provision of palliative care measures are associated with an honest appraisal of the childs condition. Euthanasia involves an action carried out by a person other than the patient to end the life of the patient suffering from a terminal condition. DNR orders do not involve euthanasia but give permission for health care providers to allow the child to die without intervention. Parents state that regardless of the number of children they have, the death of a child is a new experience and nothing can prepare them for it. Health professionals may base their discussions with families on prior experiences, but families base their decision on an honest appraisal of their childs condition. DIF: Cognitive Level: Applying REF: p. 794

What statement applies to the current focus of the dietary management of children with diabetes? a. Measurement of all servings of food is vital for control. b. Daily calculate specific amounts of carbohydrates, fats, and proteins. c. The number of calories for carbohydrates remains constant on a daily basis; protein and fat calories are liberal. d. The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

ANS: D Essentially the nutritional needs of children with diabetes are no different from those of healthy children. Children with diabetes need no special foods or supplements. They need sufficient calories to balance daily expenditure for energy and to satisfy the requirement for growth and development.

What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure? a. Cretinism b. Dwarfism c. Gigantism d. Acromegaly

ANS: D Excess GH after closure of the epiphyseal plates results in acromegaly. Cretinism is associated with hypothyroidism. Dwarfism is the condition of being abnormally small. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates.

The nurse is caring for a child with suspected diabetes insipidus. Which of the following clinical manifestations would the nurse expect to observe? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polyuria and polydipsia

ANS: D Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate.

What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)? a. Elevate the child's legs. b. Place a foot cradle on the bed. c. Place a pillow under the child's knees. d. Assist the child to dorsiflex the feet and rotate the ankles.

ANS: D For a child who is immobilized, circulatory stasis and DVT development are prevented by instructing patients to change positions frequently, dorsiflex their feet and rotate the ankles, sit in a bedside chair periodically, or ambulate several times daily. Elevating the legs or placing a foot cradle on the bed will not prevent DVTs. A pillow under the knee would impair circulation, not improve it.

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.

The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder? a. Gigantism b. Hyperthyroidism c. Cushing syndrome d. Growth hormone deficiency

ANS: D Hypopituitarism can lead to a growth hormone deficiency. An overproduction of the anterior pituitary hormones can result in gigantism (caused by excess growth hormone production during childhood), hyperthyroidism, or hypercortisolism (Cushing syndrome).

A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? a. Hyperkalemia b. Hyperchloremia c. Metabolic acidosis d. Metabolic alkalosis

ANS: D Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

An infant is born with a gastroschisis. Care preoperatively should include which priority intervention? a. Prone position b. Sterile water feedings c. Monitoring serum laboratory electrolytes d. Covering the defect with a sterile bowel bag

ANS: D Initial management of a gastroschisis involves covering the exposed bowel with a transparent plastic bowel bag or loose, moist dressings. The infant cannot be placed prone, and feedings will be withheld until surgery is performed. Electrolyte laboratory values will be monitored but not before covering the defect with a sterile bowel bag.

What statement is correct regarding sports injuries during adolescence? a. Conditioning does not help prevent many sports injuries. b. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. c. More injuries occur during organized athletic competition than during recreational sports participation. d. Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

ANS: D Injuries occur when the adolescent's body is not suited to the sport or when he or she lacks the insight and judgment to recognize that an activity exceeds his or her physical abilities. More injuries occur when an adolescent's muscles and body systems (respiratory and cardiovascular) are not conditioned to endure physical stress. Injuries do not occur from fatigue but rather from overuse. All sports have the potential for injury to the participant, whether the youngster engages in serious competition or in sports for recreation. More injuries occur during recreational sports than during organized athletic competition.

What term describes invagination of one segment of bowel within another? a. Atresia b. Stenosis c. Herniation d. Intussusception

ANS: D Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Atresia is the absence or closure of a natural opening in the body. Stenosis is a narrowing or constriction of the diameter of a bodily passage or orifice. Herniation is the protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed.

A 12-year-old boy is in the final phase of dying from leukemia. He tells the nurse who is giving him opiates for pain that his grandfather is waiting for him. How should the nurse interpret this situation? a. The boy is experiencing side effects of the opiates. b. The boy is making an attempt to comfort his parents. c. He is experiencing hallucinations resulting from brain anoxia. d. He is demonstrating readiness and acceptance that death is near.

ANS: D Near the time of death, many children experience visions of angels or people and talk with them. The children mention that they are not afraid and that someone is waiting for them. If the child has built a tolerance to the opioids, side effects are not likely. At this time, many children do begin to comfort their families and tell them that they are not afraid and are ready to die, but the visions usually precede this stage. There is no evidence of tissue hypoxia. DIF: Cognitive Level: Applying REF: p. 798

What clinical manifestation should be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Colicky, cramping, abdominal pain around the umbilicus

ANS: D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain becomes constant and may shift to the right lower quadrant. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.

Type 1 diabetes mellitus is suspected in an adolescent. Which of the following clinical manifestations may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing

ANS: D Poor wound healing may be present in an individual with type 1 diabetes mellitus.

A child will start treatment for central precocious puberty. What synthetic hormone will be injected? a. Thyrotropin b. Gonadotropins c. Somatotropic hormone d. Luteinizing hormone-releasing hormone

ANS: D Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone, which regulates pituitary secretions. Thyrotropin, gonadotropins, and somatotropic hormone are not the appropriate therapies for precocious puberty.

The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time? a. Bedtime b. With a meal c. Midmorning d. 30 minutes before breakfast

ANS: D Proton pump inhibitors are most effective when administered 30 minutes before breakfast so that the peak plasma concentrations occur with mealtime. If they are given twice a day, the second best time for administration is 30 minutes before the evening meal.

Several nurses tell their nursing supervisor that they want to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral serves what purpose? a. It is improper because it increases burnout. b. It is inappropriate because it is unprofessional. c. It is proper because families expect this expression of concern. d. It is appropriate because it can assist in the resolution of personal grief.

ANS: D Some nurses find shared remembrance rituals useful in resolving grief. Attending funeral services can be a supportive act for both the family and the nurse. Burnout is a state of physical, emotional, and mental exhaustion. It results from prolonged involvement with individuals in situations that are emotionally demanding. Attending the funeral of a child can be an effective coping measure. Attending funerals does not detract from the professionalism of care. Although it is important to consider the familys expectations, the act of attending the funeral provides a sense of closure with the family and facilitates the grief process for the nurse. DIF: Cognitive Level: Analyzing REF: p. 819

Manifestations of hypoglycemia include which of the following? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizziness

ANS: D Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, or coordinating; sweating; and pallor.

What clinical manifestation occurs with hypoglycemia? a. Lethargy b. Confusion c. Nausea and vomiting d. Weakness and dizziness

ANS: D Some of the clinical manifestations of hypoglycemia include weakness; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, confusion, and nausea and vomiting are manifestations of hyperglycemia

Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement? a. "All therapies require extended periods of bed rest." b. "Conservative therapy will be required until puberty." c. "Our child cannot attend school during the treatment phase." d. "Surgical correction requires a 3- to 4-month recovery period."

ANS: D Surgical correction involves additional risks of anesthesia, infection, and possibly blood transfusion. The recovery period is only 3 to 4 months rather than the 2 to 4 years of conservative therapies. The use of non-weight-bearing appliances and surgical intervention does not require prolonged bed rest. Conservative therapy is indicated for 2 to 4 years. The child is encouraged to attend school and engage in activities that can be adapted to therapeutic appliances.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which of the following? a. Fat b. Fruit juice c. Several glasses of water d. Complex carbohydrate and protein

ANS: D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention? a. Sports drink and fruit b. Glucose tabs and protein c. Glass of water and crackers d. Milk and peanut butter on bread

ANS: D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Milk supplies lactose and a more prolonged action from the protein. The bread is a complex carbohydrate, which with the peanut butter provides a sustained action. The sports drink contains primarily simple carbohydrates. The fruit contains additional carbohydrates. A protein source is needed for sustained action. The glucose tabs are simple carbohydrates. Complex carbohydrates are needed with the protein. Crackers are a complex carbohydrate, but protein is needed to stabilize the blood sugar.

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

ANS: D The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but a short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration

Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved? a. Central b. Skeletal c. Peripheral d. Autonomic

ANS: D The autonomic nervous system (composed of the sympathetic and parasympathetic systems) controls involuntary functions. In combination with the endocrine system, it maintains homeostasis. The central, skeletal, and peripheral subdivisions of the nervous system are not part of the neuroendocrine system.

A 7-year-old child is in the end stages of cancer. The parents ask you how they will know when death is imminent. What physical sign is indicative of approaching death? a. Hunger b. Tachycardia c. Increased thirst d. Difficulty swallowing

ANS: D The child begins to have difficulty swallowing as he or she approaches death. The childs appetite will decrease, and he or she will take only small bites of favorite foods or sips of fluids in the final few days. The pulse rate will slow. DIF: Cognitive Level: Analyzing REF: p. 806

A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family? a. Safe administration of daily enemas b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as the child returns home d. Changes in stooling patterns to report to the practitioner

ANS: D The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop. Constipation is avoided because a firm stool will place strain on the suture line. Daily enemas are contraindicated after surgical repair of a rectal malformation. Fiber and stool softeners are often given to keep stools soft and avoid tension on the suture line. The child needs to recover from the surgical procedure. Then bowel training may begin, depending on the child's developmental and physiologic readiness.

The nurse is teaching parents the proper use of a hip-knee-ankle-foot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement? a. "Alcohol will be used twice a day to clean the skin around the brace." b. "Weekly visits to the orthotist are scheduled to check screws for tightness." c. "Initially, a burning sensation is expected and the brace should remain in place." d. "Condition of the skin in contact with the brace should be checked every 4 hours."

ANS: D This type of brace has several contact points with the child's skin. To minimize the risk of skin breakdown and facilitate use of the brace, vigilant skin monitoring is necessary. Alcohol should not be used on the skin. It is drying. Parents are capable of checking and tightening the screws when necessary. If a burning sensation occurs, the brace should be removed. If several complaints of burning occur, the orthotist should be contacted.

The nurse is preparing to administer a prescribed dose of desmopressin acetate (DDAVP) intramuscularly (IM) to a child with diabetes insipidus. What action should the nurse take before drawing the medication into a syringe? a. Mix the medication with sterile water. b. Mix the medication with sterile normal saline. c. Have another nurse double-check the medication dose. d. Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.

ANS: D To be effective, vasopressin must be thoroughly mixed in the oil by being held under warm running water for 10 to 15 minutes and shaken vigorously before being drawn into the syringe. If this is not done, the oil may be injected minus the antidiuretic hormone. Small brown particles, which indicate drug dispersion, must be seen in the suspension

The nurse is caring for an immobilized preschool child. What intervention is helpful during this period of immobilization? a. Encourage wearing pajamas. b. Let the child have few behavioral limitations. c. Keep the child away from other immobilized children if possible. d. Take the child for a "walk" by wagon outside the room.

ANS: D Transporting the child outside of the room by stretcher, wheelchair, or wagon increases environmental stimuli and provides social contact. Street clothes are preferred for hospitalized children. This decreases the sense of illness and disability. The child needs appropriate limits for both adherence to the medical regimen and developmental concerns. It is not necessary to keep the child away from other immobilized children.

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing for: a. glucose is needed before administration of insulin. b. glucose is needed four times a day. c. glycosylated hemoglobin is required. d. ketonuria should be done when it is suspected.

ANS: D Urine testing is still performed to detect evidence of ketonuria.

Prolonged steroid therapy has caused a child to have Cushing syndrome. To lessen the cushingoid effects, the steroid should be administered at which time? a. In the PM b. After lunch c. QD in the AM d. QOD in the AM

ANS: D When cushingoid features are caused by steroid therapy, the effects may be lessened with administration of the drug early in the morning and on an alternate-day basis. Giving the drug early in the day maintains the normal diurnal pattern of cortisol secretion. If given during the evening, it is more likely to produce symptoms because endogenous cortisol levels are normally low and the additional supply exerts more pronounced effects. An alternate-day schedule allows the anterior pituitary an opportunity to maintain more normal hypothalamic-pituitary-adrenal control mechanisms.

The most common cause of death in the adolescent age-group involves: a. Drownings. b. Firearms. c. Drug overdoses. d. Motor vehicles.

ANS: D 36% of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but do not cause the majority of deaths.

Pulses can be graded according to certain criteria. Which is a description of a normal pulse? a. 0 b. +1 c. +2 d. +3

ANS: D A normal pulse is described as +3. A pulse that is easy to palpate and not easily obliterated with pressure is considered normal. A pulse graded 0 is not palpable. A pulse graded +1 is difficult to palpate, thready, weak, and easily obliterated with pressure. A pulse graded +2 is difficult to palpate and may be easily obliterated with pressure. DIF: Cognitive Level: Remember REF: p. 85 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance: Techniques of Physical Assessment

Which is 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 to treat fever associated with influenza

ANS: D Although the etiology of Reye syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye syndrome, so use of aspirin is avoided. No immunization currently exists for Reye syndrome. Reye syndrome is not correlated with head injuries or bacterial meningitis.

What is a common clinical manifestation of Hodgkin disease? a. Petechiae b. Bone and joint pain c. Painful, enlarged lymph nodes d. Nontender enlargement of lymph nodes

ANS: D Asymptomatic, enlarged cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful

How does the nurse assess a child's capillary refill time? a. Inspecting the chest b. Auscultating the heart c. Palpating the apical pulse d. Palpating the skin to produce a slight blanching

ANS: D Capillary refill time is assessed by pressing lightly on the skin to produce blanching, and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary refill time. DIF: Cognitive Level: Understand REF: p. 102 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

35. The nurse must assess a child's capillary refill time. This can be accomplished by doing which of the following? a. Inspect the chest. b. Auscultate the heart. c. Palpate the apical pulse. d. Palpate the nail bed with pressure to produce a slight blanching.

ANS: D Capillary refill time is assessed by pressing lightly on the skin to produce blanching, and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary refill time. DIF: Cognitive Level: Comprehension REF: p. 166 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

What pain management approach is most effective for a child who is having a bone marrow test? a. Relaxation techniques b. Administration of an opioid c. EMLA cream applied over site d. Conscious or unconscious sedation

ANS: D Children need explanations before each procedure that is being done to them. Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures. For bone marrow aspiration, conscious or unconscious sedation should be used. Relaxation, opioids, and EMLA can be used to augment the sedation

What side effect commonly occurs with corticosteroid (prednisone) therapy? a. Alopecia b. Anorexia c. Nausea and vomiting d. Susceptibility to infection

ANS: D Corticosteroids have immunosuppressive effects. Children who are taking prednisone are susceptible to infections. Hair loss is not a side effect of corticosteroid therapy. Children taking corticosteroids have increased appetites. Gastric irritation, not nausea and vomiting, is a potential side effect. The medicine should be given with food

Daily toothbrushing and flossing can be encouraged for the child on chemotherapy when the platelet count is above which? a. 10,000/mm3 b. 20,000/mm3 c. 30,000/mm3 d. 40,000/mm3

ANS: D Daily toothbrushing and flossing are encouraged in children with platelet counts above 40,000/mm3.

Children taking phenobarbital (phenobarbital sodium) and/or phenytoin (Dilantin) may experience a deficiency of: a. calcium. b. vitamin C. c. fat-soluble vitamins. d. vitamin D and folic acid.

ANS: D Deficiencies of vitamin D and folic acid have been reported in children taking phenobarbital and phenytoin. Calcium, vitamin C, and fat-soluble vitamin deficiencies are not associated with phenobarbital or phenytoin.

11. The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful? a. Suggest that the child keep a diary. b. Suggest that the parent read fairy tales to the child. c. Ask the parent if the child is always uncommunicative. d. Ask the child to draw a picture.

ANS: D Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the child's inner self. It would be difficult for a 6-year-old child who is most likely learning to read to keep a diary. Parents reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers. DIF: Cognitive Level: Apply REF: p. 64 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

Which statement, if made by a nurse to the parents of a child with leukemia, indicates an understanding of teaching related to home care associated with the disease? a. "Your son's blood pressure must be taken daily while he is on chemotherapy." b. "Limit your son's fluid intake just in case he has central nervous system involvement." c. "Your son must receive all of his immunizations in a timely manner." d. "Your son's temperature should be taken frequently."

ANS: D Feedback A The child's temperature must be taken daily because of the risk for infection, but it is not necessary to take a blood pressure daily. B Fluid is never withheld as a precaution against increased intracranial pressure. If a child had confirmed CNS involvement with increased intracranial pressure, this intervention might be more appropriate. C Children who are immunosuppressed should not receive any live virus vaccines. D An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their child's temperature as often as necessary.

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on which statement? a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccination to prevent Haemophilus influenzae type B meningitis has decreased the frequency of this disease in children.

ANS: D H. influenzae type B meningitis has been virtually eradicated in areas of the world where the vaccine is administered routinely. Bacterial meningitis remains a serious illness in children. It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases. The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms. Meningitis is an extension of a variety of bacterial infections. No genetic predisposition exists. Vaccinations are not available for all of the potential causative organisms.

38. Superficial palpation of the abdomen is often perceived by the child as tickling. Which of the following measures by the nurse is most likely to minimize this sensation and promote relaxation? a. Palpate another area simultaneously. b. Ask child not to laugh or move if it tickles. c. Begin with deeper palpation and gradually progress to superficial palpation. d. Have child "help" with palpation by placing his or her hand over the palpating hand.

ANS: D Having the child "help" with palpation by placing his or her hand over the palpating hand will help minimize the feeling of tickling and enlist the child's cooperation. Palpating another area simultaneously will create the sensation of tickling in the other area also. Asking the child not to laugh or move will bring attention to the tickling and make it more difficult for the child. Superficial palpation is done before deep palpation. DIF: Cognitive Level: Comprehension REF: p. 170 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

39. During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is which of the following? a. Abnormal and requires further investigation b. Abnormal unless it occurs in conjunction with knock-knee c. Normal if the condition is unilateral or asymmetric d. Normal because the lower back and leg muscles are not yet well developed

ANS: D Lateral bowing of the tibia (bowlegged) is an expected finding in toddlers when they begin to walk. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children. DIF: Cognitive Level: Comprehension REF: p. 173 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

During examination of a toddler's extremities, the nurse notes that the child is bowlegged. What should the nurse recognize regarding this finding? a. Abnormal and requires further investigation b. Abnormal unless it occurs in conjunction with knock-knee c. Normal if the condition is unilateral or asymmetric d. Normal because the lower back and leg muscles are not yet well developed

ANS: D Lateral bowing of the tibia (bowlegged) is common in toddlers when they begin to walk. It usually persists until all their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children. DIF: Cognitive Level: Understand REF: p. 108 TOP: Integrated Process: Nursing Process: Problem Identification MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse should recommend medical attention if a child with a slight head injury experiences: a. sleepiness. b. vomiting, even once. c. headache, even if slight. d. confusion or abnormal behavior.

ANS: D Medical attention should be sought if the child exhibits confusion or abnormal behavior, loses consciousness, has amnesia, has fluid leaking from the nose or ears, complains of blurred vision, or has an unsteady gait. Sleepiness alone does not require evaluation. If the child is difficult to arouse from sleep, medical attention should be obtained. Vomiting more than three times requires medical attention. Severe or worsening headache or one that interferes with sleep should be evaluated.

32. When assessing a preschooler's chest, the nurse would expect: a. respiratory movements to be chiefly thoracic. b. anteroposterior diameter to be equal to the transverse diameter. c. retraction of the muscles between the ribs on respiratory movement. d. movement of the chest wall to be symmetric bilaterally and coordinated with breathing.

ANS: D Movement of the chest wall should be symmetric bilaterally and coordinated with breathing. In children younger than 6 or 7 years, respiratory movement is principally abdominal or diaphragmatic. The anteroposterior diameter is equal to the transverse diameter during infancy. As the child grows, the chest increases in the transverse direction, so that the anteroposterior diameter is less than the lateral diameter. Retractions of the muscles between the ribs on respiratory movement are indicative of respiratory distress. DIF: Cognitive Level: Comprehension REF: p. 163 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The statement made by a parent that indicates correct understanding of infant feeding is: a. "I've been mixing rice cereal and formula in the baby's bottle." b. "I switched the baby to low-fat milk at 9 months." c. "The baby really likes little pieces of chocolate." d. "I give the baby any new foods before he takes his bottle."

ANS: D New solid foods should be introduced before formula or breast milk to encourage the infant to try new foods.

A mother calls the pediatrician's office because her infant is "colicky." The helpful measure the nurse would suggest to the parent is to: a. sing songs to the infant in a soft voice. b. place the infant in a well-lit room. c. walk around and massage the infant's back. d. rock the fussy infant slowly and gently.

ANS: D One technique the nurse can offer parents of a fussy infant is to rock the infant gently and slowly while being careful to avoid sudden movements.

The nurse would advise a parent when introducing solid foods to: a. begin with one tablespoon of food. b. mix foods together. c. eliminate a refused food from the diet. d. introduce each new food 4 to 7 days apart.

ANS: D Only one new food is offered in a 4- to 7-day period to determine tolerance.

The role of the peer group in the life of school-age children is that it: a. Gives them an opportunity to learn dominance and hostility. b. Allows them to remain dependent on their parents for a longer time. c. Decreases their need to learn appropriate sex roles. d. Provides them with security as they gain independence from their parents.

ANS: D Peer-group identification is an important factor in gaining independence from parents. Through peer relationships children learn ways to deal with dominance and hostility. They also learn how to relate to people in positions of leadership and authority and explore ideas and the physical environment. Peer-group identification helps in gaining independence rather than remaining dependent. A child's concept of appropriate sex roles is influenced by relationships with peers.

The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death? a. Papilledema b. Delirium c. Doll's head maneuver d. Periodic and irregular breathing

ANS: D Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Papilledema is edema and inflammation of optic nerve. It is commonly a sign of increased ICP. Delirium is a state of mental confusion and excitement marked by disorientation for time and place. The doll's head maneuver is a test for brainstem or oculomotor nerve dysfunction.

When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. What is the best explanation for this? a. Some form of cancer b. Local scalp infection common in children c. Infection or inflammation distal to the site d. Infection or inflammation close to the site

ANS: D Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location. Tender lymph nodes are not usually indicative of cancer. A scalp infection would usually not cause inflamed lymph nodes. The lymph nodes close to the site of inflammation or infection would be inflamed. DIF: Cognitive Level: Analyze REF: p. 89 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

What specific gravity of the urine is desired so that hemorrhagic cystitis is prevented? a. 1.035 b. 1.030 c. 1.025 d. 1.005

ANS: D Sterile hemorrhagic cystitis is a side effect of chemical irritation to the bladder from chemotherapy or radiotherapy. It can be prevented by a liberal oral or parenteral fluid intake (at least one and a half times the recommended daily fluid requirement). The urine should be dilute so 1.005 is the expected specific gravity

A 17-month-old child would be expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Tertiary circular reaction

ANS: D The 17-month-old is in the fifth stage of the sensorimotor phase: tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips b. Rides tricycle c. Broad jumps d. Walks up and down stairs

ANS: D The 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and the ability to broad jump are skills acquired at age 3. Tricycle riding is achieved at age 4.

The nurse is using the Centers for Disease Control and Prevention (CDC) growth chart for an African-American child. Which statement should the nurse consider? a. This growth chart should not be used. b. Growth patterns of African-American children are the same as for all other ethnic groups. c. A correction factor is necessary when the CDC growth chart is used for non- Caucasian ethnic groups. d. The CDC charts are accurate for US ferer African-American children.

ANS: D The CDC growth charts can serve as reference guides for all racial or ethnic groups. US African-American children were included in the sample population. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. No correction factor exists. DIF: Cognitive Level: Understand REF: p. 77 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is performing a Glasgow Coma Scale on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record? a. 8 b. 11 c. 13 d. 15

ANS: D The Glasgow Coma Scale (GCS) consists of a three-part assessment: eye opening, verbal response, and motor response. Numeric values of 1 through 5 are assigned to the levels of response in each category. The sum of these numeric values provides an objective measure of the patient's level of consciousness (LOC). A person with an unaltered LOC would score the highest, 15. The child who opens eyes spontaneously, obeys commands, and is oriented is scored at a 15.

A nurse is preparing to test a school-age child's vision. Which eye chart should the nurse use? a. Denver Eye Screening Test b. Allen picture card test c. Ishihara vision test d. Snellen letter chart

ANS: D The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity for school-age children. Single cards (Denver—letter E; Allen—pictures) are used for children ages 2 years and older who are unable to use the Snellen letter chart. The Ishihara vision test is used for color vision. DIF: Cognitive Level: Apply REF: p. 92 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

At what age should the nurse expect the anterior fontanel to close? a. 2 months b. 2 to 4 months c. 6 to 8 months d. 12 to 18 months

ANS: D The anterior fontanel normally closes between ages 12 and 18 months. Two to 8 months is too early. The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes between ages 2 and 8 months, the child should be referred for further evaluation. DIF: Cognitive Level: Remember REF: p. 90 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Postoperative positioning for a child who has had a medulloblastoma brain tumor (infratentorial) removed should be which? a. Trendelenburg b. Head of bed elevated above heart level c. Flat on operative side with pillows behind the head d. Flat, on either side with pillows behind the back

ANS: D The child with an infratentorial procedure is usually positioned flat and on either side. Pillows should be placed against the child's back, not head, to maintain the desired position. The Trendelenburg position is contraindicated in both infratentorial and supratentorial surgeries because it increases intracranial pressure and the risk of hemorrhage.

37. Examination of the abdomen is performed correctly by the nurse in the following order: a. Inspection, palpation, percussion, and auscultation b. Inspection, percussion, auscultation, and palpation c. Palpation, percussion, auscultation, and inspection d. Inspection, auscultation, percussion, and palpation

ANS: D The correct order of abdominal examination is inspection, auscultation, percussion, and palpation. Palpation is always performed last because it may distort the normal abdominal sounds. Auscultation is performed before percussion. The act of percussion can influence the findings on auscultation. DIF: Cognitive Level: Comprehension REF: p. 168 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. Which is the most essential part of the nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

ANS: D The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of an injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing is indicative of neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What information should the nurse recognize as important when discussing this with the family? a. BMT should be done at the time of diagnosis. b. Parents and siblings of the child have a 25% chance of being a suitable donor. c. If BMT fails, chemotherapy or radiotherapy will need to be continued. d. Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

ANS: D The most successful BMTs come from suitable HLA-matched donors. The timing of a BMT depends on the disease process involved. It usually follows intensive high-dose chemotherapy or radiotherapy. Usually, parents only share approximately 50% of the genetic material with their children. A one in four chance exists that two siblings will have two identical haplotypes and will be identically matched at the HLA loci. The decision to continue chemotherapy or radiotherapy if BMT fails is not appropriate to discuss with the parents when planning the BMT. That decision will be made later.

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

An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse's response should be based on knowledge that: a. This indicates that the adolescent is homosexual. b. This indicates that the adolescent will become homosexual as an adult. c. The adolescent should be referred for psychotherapy. d. The adolescent should be encouraged to share his feelings and experiences.

ANS: D These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society's reaction to the behavior. The nurse's first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentially, appreciate his feelings, and remain sensitive to his need to talk it. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing their self-labels one or more times during their adolescence.

Total-body irradiation is indicated for what reason? a. Palliative care b. Lymphoma therapy c. Definitive therapy for leukemia d. Preparation for bone marrow transplant

ANS: D Total-body irradiation is used as part of the destruction of the child's immune system necessary for a bone marrow transplant. The child is at great risk for complications because there is no supportive therapy until engraftment of the donor marrow takes place. Irradiation for palliative care is done selectively. The area that is causing pain or potential obstruction is irradiated. Lymphoma and leukemia are treated through a combination of modalities. Total-body irradiation is not indicated.

Which following parameters correlates best with measurements of the body's total protein stores? a. Height b. Weight c. Skinfold thickness d. Upper arm circumference

ANS: D Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skinfold thickness is a measurement of the body's fat content. DIF: Cognitive Level: Understand REF: p. 72 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

16. Which of the following parameters correlates best with measurements of total muscle mass? a. Height b. Weight c. Skinfold thickness d. Upper arm circumference

ANS: D Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skinfold thickness is a measurement of the body's fat content. DIF: Cognitive Level: Comprehension REF: p. 138 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests: a. diabetic coma. b. brainstem injury. c. upper respiratory tract infection. d. leaking of cerebrospinal fluid (CSF).

ANS: D Watery discharge from the nose that is positive for glucose suggests leaking of CSF from a skull fracture and is not associated with diabetes or respiratory tract infection. The fluid is probably CSF from a skull fracture and does not signify whether the brainstem is involved.

The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that: a. Children in 5th grade are too young for sex education. b. Children should be discouraged from asking too many questions. c. Correct terminology should be reserved for children who are older. d. Sex can be presented as a normal part of growth and development.

ANS: D When sex information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.

Which are clinical manifestations of increased intracranial pressure (ICP) in infants? (Select all that apply.) a. Low-pitched cry b. Sunken fontanel c. Diplopia and blurred vision d. Irritability e. Distended scalp veins f. Increased blood pressure

ANS: D, E Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants. Diplopia and blurred vision is indicative of ICP in children. A high-pitched cry and a tense or bulging fontanel are characteristics of increased ICP. Increased blood pressure, common in adults, is rarely seen in children.

Otitis Media - Classifications

AOM - acute otitis media -Rapid onset -Lasts 3 weeks or less •OME - otitis media with effusion -Inflammation of middle ear with fluid •Chronic OM with effusion -Lasts > 3months

What is the leading cause of death in adolescents?

Accidents/unintentional injuries

What are some cell changes that take place as result of hormone action?

Activate/deactivate enzyme systems. Induce secretory activity. Stimulate mitosis.

Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or her first remission with what cancer?

Acute myeloblastic leukemia (AML)

Risk Factors for Asthma

Age Atopy Heredity Gender Mother <age 20 years Smoking (maternal and grandmaternal) Ethnicity (African-Americans at greatest risk) Previous life-threatening attacks Lack of access to medical care Psychological and psychosocial problems Linkages to allergic and inflammatory genes on chromosome 5

Rhabdomyosarcoma therapeutic management

All rhadomyosarcomas are high-grade tumors with the potential for metastases Complete removal of the primary tumor is advocated whenever possible Tumors are treated with chemotherapy and sometimes radiation

Pneumonia - primary observations

All signs of hypoxia •Fever •Retractions •Decreased breath sounds over areas of consilidation

Therapeutic Management of Sports Injuries

Alleviate repetitive stress Rest as primary therapy Usually means reduced activity and alternative exercises, not bedrest (P)RICE therapy NSAID with care Promote nutrition Promote growth and development

Rest/sleep

Allow for times of uninterrupted rest - ie. get VS and bath at same time - working around respiratory treatment times - Plan ahead to not have to wake up child for a medication • Infections increase BMR

Septic Arthritis

Also called suppurative, pyogenic, and purulent arthritis May result from extension of soft tissue infection May involve any joint but most common in hip, knee, shoulder Usually involves only one joint

What does the hormone do to the cell?

Alters the chemical process of the cell

This test is almost certain to indicate diabetes.

An oral glucose tolerance test (OGTT) finding of 200 mg/dl or more in the 2-hour sample

What is the GH?

Anabolic, tissue building, hormone

Anabolic hormones stimulate what?

Anabolism (building up) in target cells.

Medication list

Antineoplastic agents Antibiotics: gentamycin, vancomycin, amikacin, cefipime, cefotetan, clindamycin, imipenem/cilastatin, meropenem, piperacilllin/tazobactam, and prophalyatic trimethoprim-sulfamethoxazole (Bactrim). Antifungal: nystatin, amphotericin B and caspofungin. Antiviral: acyclovir and ganciclovir. Antiemetic: ondansetron (EBP), diphenhydramine, metaclopramide, Colony stimulating factors: erythropoietin and G-CSF (filgastrin). Non-opioids: acetaminophen and ibuprofen Opioids: morphine, fentanyl, hydromorphone. Stool softeners: docusate and polyethylene glycol 3350 (Mira Lax) (EBP) Uric acid reducer: allopurinol (used in leukemia and Non-Hodgkin's Lymphoma.)

Define pain in end of life care for pediatric patients.

Any uncomfortable feeling that prevents patient relaxation or rest

Treatment options for viral hepatitis/ goals of mgmt

Are limited. Goals include early detection, support and monitoring of the disease, recognition of chronic liver disease, and prevention of spread of the disease. The most effective measure in prevention and control of hepatitis in any setting is hand washing.

Brain tumor clinical manifestations

Are r/t their location and size: (een via CT scan or MRI) and can be a result of increased ICP Most common - Headache - especially upon awaking - Vomiting - not related to feeding Other changes - Neuromuscular changes like ataxia and muscle-weakness to paralysis - Behavioral and personality changes - Cranial nerve neuropathy nystagmus, visual disturbance, difficulty with swallowing - Vital sign disturbance (↑BP, ↓ HR & RR) - Other signs infant can have cranial enlargement with tense/bulging fontanel, papilledema, and seizures

Brain Tumor Post-operative Care

Assessment (VS) Temperature measurement is particularly important b/c of hyperthermia from surgery in the hypothalamus or brainstem and from certain types of general anesthesia Assess drainage-circle soiled area to monitor for signs of continuous bleeding - Colorless drainage may be CSF leaking → Report IMMEDIATELY - Foul smelling odor from dressing may indicate infection → Report finding and obtain a culture Turning as allowed - Prevent pressure against the operative side also if tumor is large then patient not placed on operative side to prevent shift of the brain leading to further trauma. Neurologic checks to monitor for signs of increased ICP NPO until gag reflex returns (loss is common with infratentorial craniotomy) Monitor I and O for concerns related to DI and SIADH. Pain management may have opioid if necessary to treat pain Low stimulation, HOB elevated, and other comfort measures Support Family - Ultimately, promote return to optimum functioning. May need consult to OT and PT with durable medical equipment.

Asthma

Asthma - comes from Greek word for panting A chronic inflammatory disorder of the airways in which mast cells, eosinophils, and T lymphocytes play a role Inflammation causes wheezing, breathlessness, chest tightness, and cough May be called Reactive Airway Disease Triggers bring on asthma attacks Allergens are common triggers, however not all asthma attacks are brought on by an allergic response Asthma attacks are usually reversible in children Chronic asthma episodes may result in airway remodeling Irreversible structural changes due to prolonged inflammation of the airway that cause loss of pulmonary function

Pathophysiology Asthma

Asthmatic patient - lungs are more reactive than normal to triggers Inflammation results when contact is made with a trigger Mast cells, T lymphocytes, macrophages, and epithelial cells release inflammatory mediators. Eosinophils and neutrophils migrate to the airway, causing injury Chemical mediators play role in inflammatory response. Leukotrienes - prolonged airway constriction Histamine - affects smooth muscle and mucus secretion Autonomic control of bronchial smooth muscle is also affected as a result of the inflammatory process leading to:Airway Inflammation Edema of mucous membranes Airway Obstruction Accumulation of tenacious secretions Airway HyperresponsivenessSpasm of smooth muscle of bronchi and bronchioles which decreases caliber of airways

When is the best time to administer growth hormone?

At night

Where is the pituitary gland located?

At the base of the brain in the sella turcica. (saddle in the sphenoid). Attached to the hypothalamus by infundibulum.

Cystic Fibrosis (CF)

Autosomal recessive genetic disease Abnormal gene is located on the long arm of chromosome 7 95% known cases occur in Caucasians Most common lethal genetic illness among Caucasian children Approximately 3% of U.S. Caucasian population are symptom-free carriers

Pharmacological Agents - Rescue Meds Albuterol (Ventolin) Beta- Adrenergic Agonist

Available in: Inhaler Liquid for nebulizer treatments Oral •Parents should be educated on the routes of administration of Ventolin Using your albuterol more than one time per week means that the patient's asthma is out of control Regularly scheduled use of this medication is NOT recommended. (This needs to be stressed to patients and parents).

Asthma Treatment/Prevention Strategies

Avoidance of triggers Peak Expiratory Flow Meter Pharmacological agents Patient Education

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend A. controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. C. trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement. D. bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.

B

When developing a care plan for the child diagnosed with cystic fibrosis, which of the following must the nurse keep in mind? A. CF is an autosomal dominant hereditary disorder B. Pulmonary secretions are abnormally thick C. Obstruction of the endocrine glands occurs D. Elevated levels of potassium are found in the sweat

B

The pediatric nurse understands that the most common cancer found in children is: A. Non-hodgkin's lymphoma B. Acute lymphocytic leukemia C. Chronic lymphocytic leukemia D. Ewing's sarcoma"

B (1. No - this is not a common cancer in children 2. YES! this is the most common form of cancer found in children is acute lymphocytic leukemia. 3. No - this is not a common cancer in children 4. No - this is not a common cancer in children)

A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention? A. Fatigue and Anorexia B. Fever and Petechiae C. Swollen lymph nodes in the neck and lethargy. D. Enlarged liver and spleen

B (Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.)

A preschool-aged child is to undergo several painful procedures. Which of the following techniques is most-appropriate for the nurse to use in preparing the child? A. Allow the child to practice injections on a favorite doll. B. Explain the procedure in simple terms. C. Allow a family member to explain the procedure to the child. D. Allow the child to watch an educational video.

B (Preschoolers have the cognitive ability to understand simple terms. Use of a favorite doll is contraindicated because it is ""part"" of that child and he/she might perceive the doll is experiencing pain.)

After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following? a. Advise the client to rest and avoid exertion b. Prevent client exposure to infections c. Monitor the blood pressure frequently d. Observe for increased bruising

B (Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are responsible for the body's defense against infection. Rest and avoid exertion would be related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and observing for bruising would be related to platelets and sign and symptoms of bleeding.)

A 9-year old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. The appropriate response by the clinic nurse to the mother is: A. There is no need to be concerned. B. Bring the child into the clinic for a vaccine. C. Keep the child out of school for 2 week period. D. Monitor the child for an elevated temperature, and call the clinic if this happens.

B (Rationale: immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the them. If the child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella zoster immune globulin within 96hrs of exposure. Options 1,3,4, are incorrect because they do nothing to minimize the chances of developing the disease.)

The nurse is conducting a staff in-service on casts. Which is an advantage to using a fiberglass cast instead of a plaster of Paris cast? a. Cheaper b. Dries rapidly c. Molds closely to body parts d. Smooth exterior

B ~ A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive and have a rough exterior, which may scratch surfaces. Plaster casts mold closer to body parts.

A new nurse is caring for a child after spinal fusion to correct scoliosis. Which action by the new nurse causes the experienced nurse to intervene? A. Assesses neurological status and vital signs every hour B. Instructs patient to turn by pulling on side rails C. Monitors chest tube for air leakage and drainage D. Promotes use of the incentive spirometer each hour

B ~ After spinal fusion, the patient must be logrolled to turn. Logrolling involves two nurses turning the patient as one single unit so that the spine is maintained in a straight line. The other actions are appropriate.

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

B ~ Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma.

The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

B ~ Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

An adolescent with a fractured femur is in Russells traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action? a. Maintaining continuous traction until 1 hour before the scheduled surgery b. Maintaining continuous traction and checking position of traction frequently c. Releasing traction every hour to perform skin care d. Releasing traction once every 8 hours to check circulation

B ~ When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscles normal contracting ability to again cause malpositioning of the bone ends. Continuous traction must be maintained to keep the bone ends in satisfactory realignment. Releasing at any time, either 1 hour before surgery, once every hour for skin care, or once every 8 hours would not keep the fracture in satisfactory alignment.

Which is an appropriate nursing intervention when caring for a child in traction? a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity three times a day. d. Keep the child in one position to maintain good alignment.

B ~ traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

The nurse teaches parents how to help their children learn impulse control and cooperative behaviors. This would occur during which of the stages of development defined by Erikson? A.Trust versus mistrust B.Initiative versus guilt C.Industry versus inferiority D.Autonomy vs. Shame and doubt

B) Initiative vs Guilt. The stage of initiative versus guilt occurs from ages 3 to 6 years, during which children develop direction and purpose. Teaching impulse control and cooperative behaviors during this stage help the child to avoid risks of altered growth and development. In the autonomy versus sense of shame and doubt stage, toddlers learn to achieve self-control and willpower. Trust versus mistrust is the first stage, during which children develop faith and optimism. During the industry versus inferiority stage, children develop a sense of competency.

A pediatrician orders Russell traction for a 12-year-old patient with Legg-Calv-Perthes disease. Which interventions are appropriate for the nurse to include in the care plan for this patient? (Select all that apply.) A. Bony areas are massaged frequently. B. Child is lying in a supine position. C. Hip is flexed and abducted. D. Skin is inspected every 12 hours. E. The child uses a trapeze to move.

B, C, E ~ Russell traction is a type of skin traction used to stabilize femur fractures until a callus forms or to correct bone deformities or contractures, as in Legg-Calv-Perthes disease. With this type of traction, the child lies supine with hip flexed, abducted, and immobile. The child can help with repositioning using a trapeze above the bed. The nurse should assess the skin more often than every 12 hours and should not massage bony prominences.

A clinic nurse is conducting a staff in-service for other clinic nurses about signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session? (Select all that apply.) a. Bone fractures b. Abdominal mass c. Sore throat and ear pain d. Headache e. Ecchymosis of conjunctiva

B, C, E ~ The initial signs and symptoms of rhabdomyosarcoma tumors are related to the site of the tumor and compression of adjacent organs. Some tumor locations, such as the orbit, manifest early in the course of the illness. Other tumors, such as those of the retroperitoneal area, only produce symptoms when they are relatively large and compress adjacent organs. Unfortunately, many of the signs and symptoms attributable to rhabdomyosarcoma are vague and frequently suggest a common childhood illness, such as earache or runny nose. An abdominal mass, sore throat and ear pain, and ecchymosis of conjunctiva are signs of a rhabdomyosarcoma tumor. Bone fractures would be seen in osteosarcoma and a headache is a sign of a brain tumor.

A school-age child is being seen in the oncology clinic for possible Hodgkin's disease. During the course of the nursing assessment, which findings would be expected? Select all that apply. a) fever. b) painless cervical nodes. c) painful cervical nodes. d) poor appetite. e) complaints of night sweats"

B, D (Painless cervical nodes are a hallmark sign of HD. In addition to this, night sweats also are characteristic. Fever, poor appetite, and painful cervical nodes are more characteristic of infection.")

A pediatric patient has been diagnosed with leukemia and presents with a white blood cell (WBC) count of 80,000 mm3. Which statement if provided by a nursing student indicates that additional teaching is needed with regard to pathophysiological mechanisms of leukemia? A. The increase in WBC provides protection against bacterial infections. B. Although the WBC count is elevated, there are increased blast cells which help to protect the patient against infection. C. The amount of white blood cells is greatly increased, which affords protection against viral infections. D. Increases in white blood cells are expected but associated with a low leukocyte count.

B.

A nurse is evaluating the developmental level of a 2-year-old. Which of the following does the nurse expect to observe in this child? A) Uses a fork to eat B) Uses a cup to drink C) Uses a knife for cutting food D) Pours own milk into a cup

B. By age 2 years, the child can use a cup and can use a spoon correctly but with some spilling. By ages 3 to 4, the child begins to use a fork. By the end of the preschool period, the child should be able to pour milk into a cup and begin to use a knife for cutting.

A clinic nurse assesses the communication patterns of a 5-month-old infant. The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant: A) Uses simple words such as "mama" B) Uses monosyllabic babbling C) Links syllables together D) Coos when comforted

B. Using monosyllabic babbling occurs between 3 and 6 months of age. Using simple words such as "mama" occurs between 9 and 12 months. Linking syllables together when communicating occurs between 6 and 9 months. Cooing begins at birth and continues until 2 months.

What does calcitonin lower?

Blood calcium and phosphate ion concentrations by inhibiting release of calcium and phosphate from bones.

A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children?

Bone marrow biopsy

The nurse understands that the type of precautions needed for children receiving chemotherapy is based on which actions of chemotherapeutic agents?

Bone marrow suppression

The nurse explains that by the age of 6 months an iron-rich formula should be offered because the infant has: a. limited ability to produce red blood cells. b. ineffective digestive enzymes. c. exhausted maternal iron stores. d. need of the iron to support dentition.

C

The nurse is assessing a child with croup and a sore throat in the ED. The child is drooling and agitated. The nurse knows that examining the child's throat using a tongue depressor might precipitate which of the following? A. Profuse coughing B. Inspiratory stridor C. Complete obstruction D. Increased agitation

C

The nurse teaches the caregiver of the infant diagnosed with nasopharyngitis to call the physician if which of the following occurs? A. Coughing B. Infant becomes irritable C. Shows signs and symptoms of an ear infection D. Low-grade fever

C

Which of the following statements by the family of a child with asthma indicates a need for additional home care teaching? A. "We need to identify what things trigger his attacks" B. "He is to use his bronchodilator inhaler before the steroid inhaler" C. "We'll make sure that he avoids exercise to prevent attacks" D. "He should increase his fluid intake regularly to thin secretions"

C

A client is admitted to the hospital for a colon resection and in preparation for surgery the physician orders neomycin. The nurse understands the main reason why this antibiotic is especially useful before colon surgery is because it: A. Will not affect the kidneys B. Acts systemically without delay C. Has limited absorption from the GI tract. D. Is effective against many different organisms

C (Because neomycin is limited absorption form the GI tract, it exerts it antibiotic effect on the intestinal mucosa. In preparation of GI surgery, the level of microbial organisms will be reduced.)

A child being treated for Acute Lymphocytic Leukemia (ALL) has a white blood cell (WBC) count of 7,000/mm3. the nursing care plan lists risk for infection as a priority nursing diagnosis, and measures are being taken to reduce the child's exposure to infection. the nurse determines that the plan has been successful when which outcome has been met? A. child's WBC count goes up. B. child's WBC count goes down. C. child's temperature remains within normal range. D. parents demonstrate good hand washing technique."

C (In leukemia, the WBCs that are present are immature and incapable of fighting infection. increases or decreases in the number of WBCs can be related to the disease process and treatment, and not related to infection. the only value that indicates the child is infection-free is the temperature. the use of proper handwashing technique is a measure or intervention used to meet a goal. but is not a goal itself. STRATEGY: the core issue of the question is knowledge of an indicator of infection in a client who is immunosuppressed from leukemia. recall that temperature and WBC counts are frequently used as indicators of infection. recall that in leukemia the WBCs are abnormal so choose the option related to temperature.)

A child is admitted to the hospital with a diagnosis of Wilm's tumor, Stage II. Which of the following statements most accurately describes this stage? A. The tumor is less than 3 cm. in size and requires no chemotherapy. B. The tumor did not extend beyond the kidney and was completely resected. C. The tumor extended beyond the kidney but was completely resected. D. The tumor has spread into the abdominal cavity and cannot be resected.

C (The staging of Wilm's tumor is confirmed at surgery as follows: Stage I, the tumor is limited to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V, bilateral renal involvement is present at diagnosis.)

A school nurse is conducting a staff in-service to other school nurses on idiopathic scoliosis. During which period of child development does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. Preadolescent growth spurt d. Adolescence

C ~ Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. Idiopathic scoliosis is seldom apparent before age 10 years. Diagnosis usually occurs during the preadolescent growth spurt.

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove harness several times a day to prevent contractures. c. Return to clinic every 1 to 2 weeks. d. Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

C ~ Infants have a rapid growth pattern. The child needs to be assessed by the practitioner every 1 to 2 weeks for possible adjustments. Lotions and powders should not be used with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness.

The nurse is taking care of a 10-year-old child who has osteomyelitis. Which treatment plan is considered the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy

C ~ Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.

A parent calls the nursing call center stating that his child, who has a cast after surgical treatment of a clubfoot, is very fussy even after acetaminophen (Tylenol) administration and that the childs toes seem cool. What advice does the nurse give the parent? A. Elevate the affected extremity and apply ice for 20 minutes. B. Make four cuts to the top of the cast, each about 1 inch long. C. Take your child to the nearest emergency department now. D. Try giving your child a dose of ibuprofen (Pediaprofen) instead.

C ~ Parents always need to observe for complications of casting, including neurovascular compromise. A child who is excessively fussy and whose toes are cool should be seen by a health-care provider to assess circulation and possibly modify or change the cast. The parent should be told to take the child to the nearest emergency department (ED). The other answers are inappropriate. If circulation is compromised, elevation and ice will make the problem worse. The parent should not be instructed to modify the cast. Although ibuprofen may manage the child's pain better than acetaminophen, the priority instruction is to send the parent to the ED.

Which type of traction uses skin traction on the lower leg and a padded sling under the knee? a. Dunlop b. Bryant c. Russell d. Buck extension

C ~ Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calv-Perthes disease.

A neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation? 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.

C ~ Serial casting is begun shortly after birth before discharge from 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.

The nurse is caring for a school-age child diagnosed with juvenile idiopathic arthritis (JIA). Which intervention should be a priority? a. Apply ice packs to relieve stiffness and pain. b. Administer acetaminophen to reduce inflammation. c. Teach the child and family correct administration of medications. d. Encourage range-of-motion exercises during periods of inflammation.

C ~ The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that NSAIDs should not be given on an empty stomach and to be alert for signs of toxicity. Warm moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range-of-motion exercises should not be done during periods of inflammation.

A mother brings her daughter to the clinic after noticing the childs new swimsuit fits baggily on one side of her bottom and the childs right thigh looks quite odd compared to the other one. Which assessment question would provide the nurse the most important information? A. Do her joints dislocate easily? B. Does she fatigue easily? C. Has your child been limping? D. When did you see her in a swimsuit last?

C ~ The mother seems to have noticed thigh and buttock muscle wasting, which are signs of Legg-Calv-Perthes disease. Other signs and symptoms include hip or knee soreness or stiffness, pain that increases with activity and decreases with rest, a painful limp, joint dysfunction, and limited ROM. Asking about a limp would be the most important question, as it is specific to this disease process.

A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI). Further teaching is indicated if the parents make which statement? a. We will be very careful handling the baby. b. We will lift the baby by the buttocks when diapering. c. Were glad there is a cure for this disorder. d. We will schedule follow-up appointments as instructed.

C ~ The treatment for OI is primarily supportive. Although patients and families are optimistic about new research advances, there is no cure. The use of bisphosphonate therapy with IV pamidronate to promote increased bone density and prevent fractures has become standard therapy for many children with OI; however, long bones are weakened by prolonged treatment. Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Follow-up appointments for treatment with bisphosphonate can be expected.

The nurse is caring for a 12-year-old child with a left leg below the knee amputation (BKA). The child had the surgery 1 week ago. Which intervention should the nurse plan to implement for this child? a. Elevate the left stump on a pillow. b. Place ice pack on the stump. c. Encourage the child to use an overhead bed trapeze when repositioning. d. Replace the ace wrap covering the stump with a gauze dressing.

C ~ Use of the overhead bed trapeze should be encouraged to begin to build up the arm muscles necessary for walking with crutches. Stump elevation may be used during the first 24 hours, but after this time, the extremity should not be left in this position because contractures in the proximal joint will develop and seriously hamper ambulation. Ice would not be an appropriate intervention and would decrease circulation to the stump. Stump shaping is done postoperatively with special elastic bandaging using a figure-eight bandage, which applies pressure in a cone-shaped fashion. This technique decreases stump edema, controls hemorrhage, and aids in developing desired contours so the child will bear weight on the posterior aspect of the skin flap rather than on the end of the stump. This wrap should not be replaced with a gauze dressing.

A mother of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. The nurse most appropriately tells the mother to: A) Punish the child every time the child says "no", to change the behavior B) Allow the behavior because this is normal at this age period C) Set limits on the child's behavior D) Ignore the child when this behavior occurs

C) Set limits on the child's behavior-According to Erikson, the child focuses on independence between ages 1 and 3 years. Gaining independence often means that the child has to rebel against the parents' wishes. Saying things like "no" or "mine" and having temper tantrums are common during this period of development. Being consistent and setting limits on the child's behavior are the necessary elements.

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome? (Select all that apply.) a. Palpable distal pulse b. Capillary refill to extremity less than 3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

C, D, E ~ Indications of compartment syndrome are severe pain not relieved by analgesics, tingling of extremity, and inability to move extremity. A palpable distal pulse and capillary refill to the extremity less than 3 seconds are expected findings.

A pediatric oncology patient has been discharged home following a course of chemotherapy. Which information should be included as part of discharge planning with regard to health promotion? A. No further treatments are needed and the patient can resume routine health assessments as developmentally appropriate. B. There are no restrictions based on activity and/or contacts with friends and family members. C. Certain restrictions will be in place related to immunizations that can be administered. D. The patient should limit fluid intake for several months in order to prevent overhydration from occurring.

C.

Which finding if observed would warrant intervention regarding the administration of an antiemetic in a chemotherapy protocol for a pediatric patient? A.Providing the medication on a scheduled basis regardless of the patient's clinical symptoms. B. Administering the medication via the parenteral route prior to infusion of chemotherapy protocol. C. Providing medication with sips of water following clinical symptoms of nausea and/or vomiting. D.Administering 30 to 60 minutes prior to initiation of therapy.

C.

A nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which of the following is the most appropriate activity for this child? A) Large picture books B) A radio C) Crayons and coloring book D) A sports video

C. In the preschooler, play is simple and imaginative and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh. Large picture books are most appropriate for the infant. A radio and a sports video are most appropriate for the adolescent.

Cancer Diagnosis

CBC w/ Absolute Neutrophil Count (ANC) - This will test for degree of anemia, platelet count and competency of the immune system Concern if ANC <500 ANC = WBC x seg(neutrophils) + bands Electrolyte panel - Looks at renal and liver function in terms of toleration of chemotherapy - LDH, creatinine, Uric acid may be elevated in leukemia - Bone metastasis leads to elevated alkaline phosphatase - Renal function is monitored during tx phase Tumor markers - Metabolites or part of the cancer cells that can be detected in serum urine - EX: a-fetoprotein(serum) or catecholamine(neurobalstoma)(urine)

Treatment: Radiotherapy

Can be used for curative purposes or relief of symptoms by shrinking tumor. It is usually done in conjunction with chemo/surgery It has a cytotoxic effect by damaging pyrimidine bases or cause single/double strand breaks. It is done daily over 2-7 weeks Immediate effects are localized to area being irradiated and skin site may be tender, warm, and swollen tx includes no lotion, wash daily with small amount of soap, and if desquamation occurs notify practitioner for care Radiation sickness is the anorexia and N/V that occurs most with GI irradiation. Antiemetic ~ 30min prior to procedure may help, this is the same for chemotherapy. Malaise is the other common SE due to radiation to the thyroid gland. Sterility and other concerns with full body irradiation.

What does ADH cause to happen?

Causes kidneys to reduce water excretion keeping water in the bloodstream. In high concentrations it raises blood pressure.

Signs and Symptoms of Septic Arthritis

Characteristic appearance Joint is warm, tender, painful, swollen Frequently follows traumatic injury Fever, leukocytosis, increased sedimentation rate Neisseria gonorrhoeae is frequent cause of septic arthritis in sexually active teens Other pathogens

Ewings Sarcoma Therapeutic Management

Chemo/high dose radiation Limb sparing surgery or amputation (RARE)

Neuroblastoma Therapeutic Management

Chemotherapy is main form of treatment Surgery to biopsy, debulk with the goal is to remove as much tumor as possible Radiotherapy is more for palliation or emergency management (spinal cord compression or hepatomegaly)

Secondary Observations

Chest xray • Blood gases • Throat culture • Pulse oximeter • ELISA test from nasalwashing- enzyme linked immunosorbant assay • IFA- immunoflourescent antibody

Pneumonia - Secondary observations

Chest xray •CBC - WBC differential to determine viral vs. bacterial •Sputum culture

Genetic Base

Chromosome 13- retinoblastoma (Rb-1 gene) that may lead to osteosarcoma Chromosome 11- nephroblastoma (Wilms' tumor) - WT1 gene

Inflammatory bowel disease most common feature

Chronic diarrhea In addition to GI symptoms, both CD and UC are characterized by extraintestinal and systemic inflammatory responses. Whereas the inflammation found with UC is limited to the colon and rectum, the chronic inflammatory process of CD can involve any part of the GI tract from the mouth to the anus. The natural history of both diseases continues to be unpredictable and characterized by recurrent flare-ups that can severely impair patients' physical and social functioning.

Nutrition

Clear liquids to soft diet • Decrease milk initially

NON-InfectiousCongenital Diaphragmatic Hernia

Clinical manifestations Diagnosis Therapeutic management Fetal surgery After birth Nursing care management

Asthma

Clinical manifestations Dyspnea Wheeze Cough Diagnostic evaluation Therapeutic management General Allergen control and avoidance Drug therapy to prevent/relieve bronchospasm Maintain health and prevent complications Promote self-care Support child and family Wheeze is a good thing because if you don't hear anything can be a problem Use albuterol

SFCE (Cont.)

Clinical manifestations Episode of trauma with acute displacement Gradual displacement without definite injury Intermittent displacement (or combination of all) Diagnostic evaluation

Otitis Meadia with Effusion

Clinical manifestations Prevention PCV 7 vaccine Breastfeeding Preventing exposure to tobacco smoke Prognosis Nursing care management Select all apply question for prevention

Orthopedic Infections

Clinical manifestations Severe pain Fever Irritability, position of affected limb/extremity Diagnostic evaluation Therapeutic management

The Child with a Fracture

Common injury in children Methods of treatment different in pediatrics than in older adult population Rare in infants, except with MVC Clavicle most frequently broken bone in children, especially younger than age 10 School age—bike, sports injuries

Nursing Considerations

Complete bedrest and immobility of limb Pain management concerns Long-term IV access (for antibiotic administration) Nutritional considerations Long-term hospitalization/therapy Psychosocial needs

Types of Fractures

Complete vs. incomplete Simple vs. compound Compound or open—fractured bone protrudes through the skin Complicated—bone fragments have damaged other organs or tissues

Role of prevention

With knowledge of risk factors, this may aid in prevention of adult cancers only. Known carcinogens in children are radiation and several drugs given to the mother during pregnancy May be focused on teaching smoking prevention and exposure to sunlight for lung and skin cancer Adolescent teaching - Females: self breast exams, yearly pap smear, and now receiving the HPV vaccine -Males: testicular self exams Neuroblastomas may have connection with Fetal alcohol syndrome, cigarette or marijuana smoking by parents

Pharyngitis S/S

Younger children- fever, general malaise, anorexia, moderate sore throat, headache. Mild to moderate hyperemia Older children-fever (may reach 104) headache, anorexia, dysphagia, abdominal pain, vomiting, mild to bright red, edematous pharynx, hyperemia of tonsils and pharynx, may extend to soft palate and uvula, often abundant follicular exudate that spreads and coalesces to form pseudo membrane on tonsils, cervical glans enlarged and tender

bronchiolitis caused by the respiratory syncytial virus.

___ Place the infant in a private room. ___ Place the infant in a room near the nurse's station.

Cushing syndrome

a characteristic group of manifestations caused by excessive circulating free cortisol

Biliary atresia

a progressive inflammatory process that causes both intrahepatic and extrahepatic bile duct fibrosis, resulting in eventual ductal obstruction.

acute diarrhea

a sudden increase in frequency and a change in consistency of stools caused by an infectious agent in the GI tract may be associated with: -upper respiratory or urinary tract infections, -ABT therapy -laxative use self-limiting (14 day duration) subsides without specific treatment

diarrhea

a symptom that results from disorders involving digestion, absorption, and secretory functions caused by: abnormal intestinal water and electrolyte transport transport of fluid and electrolytes in the developing GI tract is r/t the childs age young infant- intestinal mucosa is more permeable to water than that of an older child -more fluid and electrolytes are lost than in older children higher mortality and morbidity among infants and children <5 higher incidence in low-income homes and communities worldwide

intractable diarrhea of infancy

a syndrome that occurs in the *first few months of life* persists for longer than 2 wks w/ no recognized pathogens refractory to treatment common cause: -acute infectious diarrhea that was not managed adequately

The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor? a. Abdominal swelling b. Weight gain c. Hypotension d. Increased urinary output

a. Abdominal swelling The initial assessment finding with a Wilms (kidney) tumor is abdominal swelling. Weight loss, not weight gain, may be a finding. Hypertension occasionally occurs with a Wilms tumor. Urinary output is not increased, but hematuria may be noted.

Identify the three methods for treating Graves disease.

a. Antithyroid drugs, which interfere with the biosynthesis of thyroid hormone, includ- ing propylthiouracil (PTU) and methimazole (MTZ, Tapazole) b. Subtotal thyroidectomy c. Ablation with radioiodine (131I iodide)

18. In which of the conditions are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron-deficiency anemia

a. Aplastic anemia' ANS: A Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed. Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Iron- deficiency anemia results in a decreased amount of circulating red cells. DIF: Cognitive Level: Understand REF: p. 800 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

26. The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention? a. Carefully follow universal precautions. b. Determine how the child became infected. c. Inform the parents of the other children. d. Reassure other children that they will not become infected.

a. Carefully follow universal precautions. ANS: A Universal precautions are necessary to prevent further transmission of the disease. It is not the role of the nurse to determine how the child became infected. Informing the parents of other children and reassuring children that they will not become infected is a violation of the child's right to privacy. DIF: Cognitive Level: Apply REF: p. 807 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

The nurse is conducting a staff in-service on renal ultrasounds. Which statement describes this diagnostic test? a. Computed tomography uses external radiation to visualize the renal system. b. Visualization of the renal system is accomplished without exposure to radiation or radioactive isotopes. c. Contrast medium and x-rays allow for visualization of the renal system. d. External radiation for x-ray films is used to visualize the renal system, before, during, and after voiding.

a. Computed tomography uses external radiation to visualize the renal system. A renal ultrasound transmits ultrasonic waves through the renal parenchyma allowing for visualization of the renal system without exposure to external beam radiation or radioactive isotopes. Computed tomography uses external radiation and sometimes contrast media to visualize the renal system. An intravenous pyelogram uses contrast medium and external radiation for x-ray films. The voiding cystourethrogram visualizes the renal system with injection of a contrast media into the bladder through the urethral opening and use of x-ray before, during, and after voiding.

Which is instituted for the therapeutic management of minimal change nephrotic syndrome? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis

a. Corticosteroids Corticosteroids are the first line of therapy for minimal change nephrotic syndrome. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.

19. What is a possible cause of acquired aplastic anemia in children? a. Drugs b. Injury c. Deficient diet d. Congenital defect

a. Drugs ANS: A Drugs, such as chemotherapeutic agents and several antibiotics (e.g., chloramphenicol), can cause aplastic anemia. Injury, deficient diet, and congenital defect are not causative agents in acquired aplastic anemia. DIF: Cognitive Level: Understand REF: p. 800 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect? a. Fever with a positive blood culture b. Proteinuria and edema c. Oliguria and hypertension d. Anemia and thrombocytopenia

a. Fever with a positive blood culture Symptoms of urosepsis include a febrile UTI coexisting with systemic signs of bacterial illness; blood culture reveals presence of urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome (MCNS). Oliguria and hypertension are symptoms of acute glomerulonephritis (AGN). Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome (HUS).

The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

a. Infection Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with minimal change nephrotic syndrome. The child will most likely have neurologic signs and symptoms.

Diabetes is a great imitator of what conditions?

a. Influenza b. Gastroenteritis c. Appendicitis

The clinical features of Graves disease in children consist of factors related to excessive motion. Identify those factors.

a. Irritability b. Hyperactivity c. Short attention span d. Tremors e. Insomnia f. Emotional lability

13. Why is meperidine (Demerol) not recommended for children in sickle cell crisis? a. May induce seizures b. Is easily addictive c. Not adequate for pain relief d. Given by intramuscular injection

a. May induce seizures ANS: A A metabolite of meperidine, normeperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with sickle cell disease are particularly at risk for normeperidine-induced seizures. Meperidine is no more addictive than other narcotic agents. Meperidine is adequate for pain relief. It is available for IV infusion. DIF: Cognitive Level: Understand REF: p. 795 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

4. The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron-deficiency anemia is common during toddlerhood? a. Milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by age 1 month. d. Dietary iron cannot be started until age 12 months.

a. Milk is a poor source of iron. ANS: A Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life. DIF: Cognitive Level: Understand REF: p. 789 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

9. Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process? a. Normal adult hemoglobin is replaced by abnormal hemoglobin. b. There is a lack of cellular hemoglobin being produced. c. There is a deficiency in the production of globulin chains. d. The size and depth of the hemoglobin are affected.

a. Normal adult hemoglobin is replaced by abnormal hemoglobin ANS: A Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron-deficiency anemia affects the size, depth, and color of hemoglobin. DIF: Cognitive Level: Apply REF: p. 791 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation.

The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

a. Oliguria and hypertension The principal feature of acute renal failure is oliguria; hypertension is a nonspecific clinical manifestation. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure.

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate nursing goal related to this? a. Prevent infection. b. Stimulate appetite. c. Detect evidence of edema. d. Ensure compliance with prophylactic antibiotic therapy.

a. Prevent infection High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

25. The nurse is planning care for an adolescent with AIDS. Which is the priority nursing goal? a. Preventing infection b. Preventing secondary cancers c. Restoring immunologic defenses d. Identifying source of infection

a. Preventing infection ANS: A Because the child is immunocompromised in association with HIV infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. Preventing secondary cancers is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration. Case finding is not a priority nursing goal. DIF: Cognitive Level: Apply REF: p. 806 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A 6-year-old child is having a generalized seizure in the classroom at school. Place in order the interventions the school nurse should implement starting with the highest-priority intervention sequencing to the lowest-priority intervention. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e).

a. Take vital signs. b. Ease child to the floor. c. Allow child to rest. d. Turn child to the side. e. Integrate child back into the school environment. ANS: b, d, a, c, e The nurse should ease the child to the floor immediately during a generalized seizure. During (and sometimes after) the generalized seizure, the swallowing reflex is lost, salivation increases, and the tongue is hypotonic. Therefore, the child is at risk for aspiration and airway occlusion. Placing the child on the side facilitates drainage and helps maintain a patent airway. Vital signs should be taken next and the child should be allowed to rest. When feasible, the child is integrated into the environment as soon as possible.

27. The nurse is conducting a staff in-service on inherited childhood blood disorders. Which statement describes severe combined immunodeficiency syndrome (SCIDS)? a. There is a deficit in both the humoral and cellular immunity with this disease. b. Production of red blood cells is affected with this disease. c. Adult hemoglobin is replaced by abnormal hemoglobin in this disease. d. There is a deficiency of T and B lymphocyte production with this disease.

a. There is a deficit in both the humoral and cellular immunity with this disease. ANS: A Severe combined immunodeficiency syndrome (SCIDS) is a genetic disorder that results in deficits of both humoral and cellular immunity. Wiskott-Aldrich is an X-linked recessive disorder with selected deficiencies of T and B lymphocytes. Fanconi syndrome is a hereditary disorder of red cell production. Sickle cell disease is characterized by the replacement of adult hemoglobin with an abnormal hemoglobin S. DIF: Cognitive Level: Understand REF: p. 809 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Which should the nurse recommend to prevent urinary tract infections in young girls? a. Wear cotton underpants. b. Limit bathing as much as possible. c. Increase fluids; decrease salt intake. d. Cleanse perineum with water after voiding.

a. Wear cotton underpants. Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids/decreasing salt intake, or cleansing the perineum with water after voiding decrease urinary tract infections in young girls.

Intussusception is characterized by

abdominal pain and blood in stools. It occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it.

Effect on Somatostatin (theta cells)

able to inhibit secretion of both insulin and glycogen

Gonadotropins - target: gonads s/s of hypofunction

absent or incomplete spontaneous puberty

Hydrocele

accumulation of fluid in scrotum- usually there when baby is born

What do paracrine secretions do?

act on neighboring cells

Beta Agonists

act on the beta20adrenergic receptors located in the lungs to dilate airways, ie. Albuterol (Proventil, Ventolin), Epinephrine(Adrenalin, Primatene, Bronkaid, Bronitin) Side Effects: insomnia, jitteriness, restlessness, palpitations, chest pain.

this is given to high risk clients who have varicella or mononucleosis

acyclovir

*Nursing actions for scoliosis?

address concerns of body image and concerns of prolonged tx of condition, preop care: labs/teaching/how to log roll/PCA pump; postop care: log roll/braces/skin care/vitals/neurovascular status; assess family issues

What is the American College of Rheumatology Diagnostic Criteria?

age of onset <16 years, 1 or more affected joints, duration of arthritis >6 weeks, exclusion of other forms of arthritis

the etiology and course of the infections are influened by

age of the child season living conditions preexisting medical problems

chronic nonspecific diarrhea (CNSD)

aka irritable colon of childhood & toddler's diarrhea common cause of chronic diarrhea in 6-54 months old lasts over 2 weeks: -loose stools with undigested food food particles children w/ CNSD: -grow normally -no evidence of malnutrition -no blood in their stool -no enteric infection may be caused by: -poor dietary habits -food sensitivities -excessive intake of juices and artificial sweeteners (ex: sorbitol)

eight indicators of pain in COMFORT scale

alertness, calmness/agitation, respiratory response, physical movement, blood pressure, heart rate, muscle tone, facial tension.

Nephrotic Syndrome

an alteration in kidney function secondary to increased glomerular basement membrane permeability to plasma protein refers not to a specific disease but rather to a clinical state characterized by edema, massive proteinuria, hypoalbuminemia, hypoproteinemia, hyperlipidemia, and altered immunity affects male children age 2-7 than any other group

constipation

an alteration in the frequency, consistency, or ease of passing stool unsatisfactory defecation due to infrequent stools, difficult passage of stools, or perceived incomplete defecation 4yrs+ can be diagnosed when there is *<3 stools/week* associated with: -painful bowel movements -blood-streaked or retained stool -abdominal pain -lack of appetite -stool incontinence can arise secondary to organic disorders or in association with systemic disorders *structural disorders of the intestine that cause constipation:* -strictures -ectopic anus -Hirschsprung disease (HD) *systemic disorders that cause constipation:* -hypothyroidism -hypercalcemia (from hyperthyroidism or Vit. D excess) -chronic lead poisoning *drugs that cause constipation:* -antacids -diuretics -antiepileptics -antihistamines -opioids -iron supplements most children have *idiopathic* or *functional constipation* b/c no underlying cause can be identified *spinal cord lesions/injury:* -causes loss of rectal tone and sensation -causes chronic fecal retention and overflow incontinence chronic constipation: -from environmental or psychosocial factors or both

Ribavirin (Virazole)

an antiviral respiratory medication used mainly in hospitalized children with severe RSV. Administration is via hood, face mask, or oxygen tent.

Pica

an eating disorder characterized by the compulsive and excessive ingestion of both food and nonfood substances. Pica is more common in children, women (especially during pregnancy), individuals who have autism or cognitive impairment, and individuals with anemia or chronic renal failure.

Chronic diarrhea

an increase in stool frequency and increased water content with duration of more than 14 days and is often caused by chronic conditions.

chronic diarrhea

an increase of stool frequency and increased water content with duration of more than 14 days caused by chronic conditions: -malabsorption syndromes -inflammatory bowel disease (IBD) -immunodeficiency -food allergy -lactose intolerance -chronic nonspecific diarrhea -inadequate management of acute diarrhea

Neurogenic bladder

an interrupted nerve supply from myelomeningocele or spinal cord tauma impairs bladder voiding function and leads to incomplete bladder emptying

GI bleeding in infants and children/mgmt

an uncommon but potentially serious problem. The first step in management is to assess the magnitude of blood loss and restore the child's hemodynamic stability. Investigation for the source and cause is undertaken because treatment in children depends on the severity and cause of the GI bleeding.

Treatment for UTI

antibiotics- parenteral with pyelonephritis oral or IV prophylactic antibiotic with vesicoureteral reflux encourage fluid intake to dilute the urine and flush the bladder

Symptoms of celiac disease

appear when solid foods such as beans and pasta are introduced in the child's diet between the ages of 1 and 5 years.

Anorectal malformations

are among the more common congenital malformations caused by abnormal development. These malformations may range from simple imperforate anus to include other associated complex anomalies of genitourinary and pelvic organs, which may require extensive treatment for fecal, urinary, and sexual function.

Pain diaries

are commonly used to assess pain symptoms and response to treatment in children and adolescents with recurrent or chronic pain

distraction and hypnosis

are effective interventions for needle-related pain and distress in children and adolescents

digestion, absorption, and metabolism

are necessary for the body to convert nutrients into forms it can use. Nutrients are composed of six major substances: carbohydrates, proteins, fats, vitamins, minerals, and water. The most common consequences of gastrointestinal (GI) disease in children include malabsorption, fluid and electrolyte disturbances, malnutrition, and poor growth.

Congenital esophageal atresia (EA) and tracheoesophageal fistula (TEF)

are rare malformations that represent a failure of the esophagus to develop as a continuous passage and a failure of the trachea and esophagus to separate into distinct structures.

Gastroschisis and omphalocele

are two of the more common forms of congenital abdominal wall defects.

What should you do in an emergency fracture situation?

assess 6 P's, limit extremity movement, cover open wounds with sterile or clean dressing, immobilize limb, use a soft splint (pillow/folded towel), reassess neurovascular status, elevate, add ice, call 911

Functional Disability Inventory

assesses the child's ability to perform everyday physical activities and has established psychometric properties with different populations

when do mycoplasmal infections occur?

autumn and early winter

Postoperative care for bladder exstrophy

avoid abduction of legs change dressings monitor UOP and characteristics watch for signs of obstruction, bladder spasms, urine or blood draining from meatus

The nurse is conducting teaching for an adolescent being discharged to home after a renal transplant. The adolescent needs further teaching if which statement is made? a. "I will report any fever to my primary health care provider." b. "I am glad I only have to take the immunosuppressant medication for two weeks." c. "I will observe my incision for any redness or swelling." d. "I won't miss doing kidney dialysis every week."

b. "I am glad I only have to take the immunosuppressant medication for two weeks." The immunosuppressant medications are taken indefinitely after a renal transplant, so they should not be discontinued after two weeks. Reporting a fever and observing an incision for redness and swelling are accurate statements. The adolescent is correct in indicating dialysis will not need to be done after the transplant.

14. A school-age child is admitted in vasoocclusive sickle cell crisis. What should be included in the child's care? a. Correction of acidosis b. Adequate hydration and pain management c. Pain management and administration of heparin d. Adequate oxygenation and replacement of factor VIII

b. Adequate hydration and pain management ANS: B The management of crises includes adequate hydration, minimization of energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. Hydration and pain control are two of the major goals of therapy. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII are not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels. DIF: Cognitive Level: Apply REF: p. 796 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to: a. prevent vomiting. b. bind phosphorus. c. stimulate appetite. d. increase absorption of fat-soluble vitamins.

b. Bind phosphorus Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate. Serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of fat-soluble vitamins.

23. A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. What is the purpose of these drugs? a. Cure the disease b. Delay disease progression c. Prevent spread of disease d. Treat Pneumocystis carinii pneumonia

b. Delay disease progression ANS: B Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system and delaying disease progression. At this time, cure is not possible. These drugs do not prevent the spread of the disease. P. carinii prophylaxis is accomplished with antibiotics. DIF: Cognitive Level: Understand REF: p. 806 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Inte

One of the clinical manifestations of chronic renal failure is uremic frost. Which best describes this term? a. Deposits of urea crystals in urine b. Deposits of urea crystals on skin c. Overexcretion of blood urea nitrogen d. Inability of body to tolerate cold temperatures

b. Deposits of urea crystals on skin Uremic frost is the deposition of urea crystals on the skin. The urea crystals are present on the skin, not in the urine. The kidneys are unable to excrete blood urea nitrogen, leading to elevated levels. There is no relation between cold temperatures and uremic frost.

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is the preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

b. It is the preferred means of renal replacement therapy in children. Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. Renal transplantation can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

Which best describes acute glomerulonephritis? a. Occurs after a urinary tract infection b. Occurs after a streptococcal infection c. Associated with renal vascular disorders d. Associated with structural anomalies of genitourinary tract

b. Occurs after a streptococcal infection Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A â-hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies.

The nurse is conducting a staff in-service on newborn defects of the genitourinary system. Which describes the narrowing of the preputial opening of the foreskin? a. Chordee b. Phimosis c. Epispadias d. Hypospadias

b. Phimosis Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis

15. The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics? a. Are often ordered but not usually needed b. Rarely cause addiction because they are medically indicated c. Are given as a last resort because of the threat of addiction d. Are used only if other measures, such as ice packs, are ineffective

b. Rarely cause addiction because they are medically indicated ANS: B The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild to moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and are given around the clock. Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with pain. Few, if any, patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vasoocclusive crisis. Ice is contraindicated because of its vasoconstrictive effects. DIF: Cognitive Level: Apply REF: p. 796 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Which is an objective of care for a 10-year-old child with minimal change nephrotic syndrome? a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid.

b. Reduce excretion of urinary protein. The objectives of therapy for the child with minimal change nephrotic syndrome include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimization of complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Excretion of urinary protein and fluid retention are part of the disease process and must be reversed.

Which is included in the diet of a child with minimal change nephrotic syndrome? a. High protein b. Salt restriction c. Low fat d. High carbohydrate

b. Salt restriction Salt is usually restricted (but not eliminated) during the edema phase. The child has little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.

The nurse is teaching parents about prevention of urinary tract infections in children. Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

b. Short urethra in young girls The short urethra in females provides a ready pathway for invasion of organisms. Increased fluid intake and frequent emptying of the bladder offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.

A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer? a. Spironolactone (Aldactone) b. Sodium polystyrene sulfonate (Kayexalate) c. Lactulose (Cephulac) d. Calcium carbonate (Calcitab)

b. Sodium polystyrene sulfonate (Kayexalate) Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels.

24. Which immunization should be given with caution to children infected with human immunodeficiency virus (HIV)? a. Influenza b. Varicella c. Pneumococcal d. Inactivated poliovirus (IPV)

b. Varicella ANS: B The children should be carefully evaluated before being given live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcal, and inactivated poliovirus (IPV) are not live vaccines. DIF: Cognitive Level: Apply REF: p. 806 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show: a. bacteriuria, hematuria. b. hematuria, proteinuria. c. bacteriuria, increased specific gravity. d. proteinuria, decreased specific gravity.

b. hematuria, proteinuria Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

Vesicoureteral Reflux

backflow of urine fromt eh baldder into the ureters during voiding, this prevents ocmplete emotying of the bladder and creates a reservoir for bacterial growth

Cephalosporin's

bactericidal - inhibit bacterial cell wall synthesis. Examples: Ceclor, Cefazolin (Ancef, Kefzol), Cephalexin (Keflex), Ceftriaxone (Rocephin)

Penicillin's

bactericidal - inhibit bacterial cell wall synthesis. Examples: Ampicillin, Nafcillin, Amoxicillin, Piperacillin. Patient Teaching - watchfor hypersensitivity reactions.

Sulfonamides

bacteriostatic - inhibit the growth of bacteria - especially useful for the treatment of UTI's. Examples: Sulfamethoxazole (Bactrim, Azo-Gantanol), Sulfasoxazole (Pediazole, Gantrisin) Patient Teaching -increase fluid intake and avoid Vitamin C and Aspirin as they interact with sulfonamides. May cause photosensitivity.

*Preop actions for slipped capital femoral epiphysis?

bed rest and traction

Nocturnal enuresis

bedwetting at night

Tx for OI?

biphosphate therapy with IV pamidronate to promote ^ bone density and prevent fractures, braces, splints, PT, surgery

complications of rubella?

birth defects

Antihistamines

blocks the action of histamine Examples: Oral - Dipenhydramine (Benadryl), Terfenadine (Seldane) Laratadine (Claritin) Inhaler - Cromolyn Side Effects: Sedation - should not be taken with other CNS depressants

What does the parathyroid hormone (PTH) increase?

blood calcium levels by stimulating osteoclast production and inhibiting osteoblast production.

What is glucagon controlled by?

blood glucose concentrations

What is insulin controlled by?

blood glucose concentrations

WHat does PTH decrease?

blood phosphate levels.

What is a complicated fracture?

bone fragments have damaged other organs or tissues

What is classified as idiopathic or congenital clubfoot?

bony abnormality almost always requiring surgical intervention

Prepare child before potentially painful procedures

but avoid "planting" the idea of pain. • For example, instead of saying, "This is going to (or may) hurt," say, "Sometimes this feels like pushing, sticking, or pinching, and sometimes it doesn't bother people. Tell me what it feels like to you." • Use "nonpain" descriptors when possible (e.g., "It feels like heat" rather than "It's a burning pain"). This allows for variation in sensory perception, avoids suggesting pain, and gives the child control in describing reactions. • Avoid evaluative statements or descriptions (e.g., "This is a terrible procedure" or "It really will hurt a lot").

The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching? a. "These injections will help with the hypertension." b. "We're glad the injections only need to be given once a month." c. "The red blood cell count should begin to improve with these injections." d. "Urine output should begin to improve with these injections."

c. "The red blood cell count should begin to improve with these injections." Anemia in children with CRF is related to decreased production of erythropoietin. Recombinant human erythropoietin (rHuEPO) is being offered to these children as thrice-weekly or weekly subcutaneous injections and is replacing the need for frequent blood transfusions. The parents understand the teaching if they say that the red blood cell count will begin to improve with these injections.

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. "You will need to decrease the number of calories in your child's diet." b. "Your child's diet will need an increased amount of protein." c. "You will need to avoid adding salt to your child's food." d. "Your child's diet will consist of low-fat, low-carbohydrate foods."

c. "You will need to avoid adding salt to your child's food." For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

2. Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. What should the nurse explain? a. The venipuncture discomfort is very brief b. Only one venipuncture will be needed c. A topical application of local anesthetic can eliminate venipuncture pain d. Most blood tests on children require only a finger puncture because a small amount of blood is needed

c. A topical application of local anesthetic can eliminate venipuncture pain ANS: C Preschool children are concerned with both pain and the loss of blood. When preparing the child for venipuncture, the nurse will use a topical anesthetic to eliminate any pain. This is a traumatic experience for preschool children. They are concerned about their bodily integrity. A local anesthetic should be used, and a bandage should be applied to maintain bodily integrity. The nurse should not promise one attempt in case multiple attempts are required. Both finger punctures and venipunctures are traumatic for children. Both require preparation. DIF: Cognitive Level: Apply REF: p. 789 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

22. Which is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

c. Acquired immunodeficiency syndrome (AIDS) ANS: C AIDS is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. Wiskott-Aldrich syndrome, idiopathic thrombocytopenic purpura, and severe combined immunodeficiency disease are not viral illnesses. DIF: Cognitive Level: Remember REF: p. 806 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

6. Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

c. Adequate dosage will turn the stools a tarry green color. ANS: C The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced, then gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth. They should be administered through a straw and the mouth rinsed after administration. DIF: Cognitive Level: Apply REF: p. 789 TOP: Integrated Process: Teaching/Learning

5. The nurse is teaching parents of an infant about the causes of iron-deficiency anemia. Which statement best describes iron-deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of an infant's emaciated appearance. c. Clinical manifestations are similar regardless of the cause of the anemia. d. Clinical manifestations result from a decreased intake of milk and the preterm addition of solid foods.

c. Clinical manifestations are similar regardless of the cause of the anemia. ANS: C In iron-deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed in iron-deficiency anemia. The bone marrow produces red cells that are smaller and contain less hemoglobin than normal red cells. Children who are iron deficient 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. DIF: Cognitive Level: Apply REF: p. 789 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? a. pH b. Osmolality c. Creatinine d. Protein level

c. Creatinine The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.

Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a. Risk for Injury related to malignant process and treatment b. Fluid Volume Deficit related to excessive losses c. Fluid Volume Excess related to decreased plasma filtration d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces

c. Fluid Volume Excess related to decreased plasma filtration Glomerulonephritis has a decreased filtration of plasma, which results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration.

16. Which statement best describes b-thalassemia major (Cooley anemia)? a. All formed elements of the blood are depressed. b. Inadequate numbers of red blood cells are present. c. Increased incidence occurs in families of Mediterranean extraction. d. Increased incidence occurs in persons of West African descent.

c. Increased incidence occurs in families of Mediterranean extraction. ANS: C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. Sickle cell disease is common in persons of West African descent. DIF: Cognitive Level: Understand REF: p. 799 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

11. The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs.

c. Increased red blood cell destruction occurs. ANS: C The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen- carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. Increased adhesion and entanglement of cells occurs. DIF: Cognitive Level: Apply REF: p. 791 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

7. Iron dextran is ordered for a young child with severe iron-deficiency anemia. What nursing considerations should be included? a. Administer with meals b. Administer between meals c. Inject deeply into a large muscle d. Massage injection site for 5 minutes after administration of drug

c. Inject deeply into a large muscle ANS: C Iron dextran is a parenteral form of iron. When administered intramuscularly, it must be injected into a large muscle. Iron dextran is for intramuscular or intravenous (IV) administration. The site should not be massaged to prevent leakage, potential irritation, and staining of the skin. DIF: Cognitive Level: Apply REF: p. 790 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Which should the nurse recommend for the diet of a child with chronic renal failure? a. High in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K

c. Low in phosphorus Dietary phosphorus is controlled by the reduction of protein and milk intake to prevent or control the calcium-phosphorus imbalance. Protein should be limited in chronic renal failure to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease.

3. The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? a. Game of "hide and seek" in the children's outdoor play area b. Participation in dance activities in the playroom c. Puppet play in the child's room d. A walk down to the hospital lobby

c. Puppet play in the child's room ANS: C Because the basic pathologic process in anemia is a decrease in oxygen-carrying capacity, an important nursing responsibility is to assess the child's energy level and minimize excess demands. The child's level of tolerance for activities of daily living and play is assessed, and adjustments are made to allow as much self-care as possible without undue exertion. Puppet play in the child's room would not be overly tiring. Hide and seek, dancing, and walking to the lobby would not conserve the anemic child's energy. DIF: Cognitive Level: Apply REF: p. 789 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation 4. The nurse is teaching parents about the importance of iron in a

Which is a major complication in a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

c. Water and sodium retention Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

20. Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood- clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon- shaped

c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient ANS: C The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency, hemophilia A or classic hemophilia; and factor IX deficiency, hemophilia B or Christmas disease. The inheritance pattern is X-linked recessive. The disorder involves coagulation factors, not platelets, and does not involve red cells or the Y chromosomes. DIF: Cognitive Level: Understand REF: p. 801 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a. poor appetite. b. increased potassium intake. c. reduction of edema. d. restriction to bed rest.

c. reduction of edema This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 pounds in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

Nursing actions for fractures?

calming pt and reassuring pt, assess 6 Ps: pain, pulse, pallor, paresthesia, paralysis, pressure

A sleep diary

can be useful in keeping a record of activities surrounding sleep, including bedtime, time to fall asleep, number of night awakenings, waking in the morning, and especially any pain or other circumstance that interfered with sleeping. The sleep diary was validated using sleep actigraphy in healthy 13- to 14-year-old children

stomach

capacity = 200 mL (2 months) 2600 (adult) HCL acid level at adult level by 6 months

Care guide

care of client t- temperature extremity or infection r- ropes hang freely a- alignment c- circulation check (5 P's) t- type and location of fracture i- increases fluid intake o- overhead trapeze n- no weights on bed or floor

Nursing actions for OI?

careful handling to prevent fractures, family education, occupational planning, and genetic counseling, don't hold by the ankles,

Hyperfunction of the adrenal medulla

caused by tumors: pheochromocytoma neuroblastoma ganglioneuroma

Hypertrophic pyloric stenosis is recognized by

characteristic projectile vomiting, malnutrition, dehydration, and a palpable mass in the epigastrium. Surgical relief of the pyloric obstruction by pyloromyotomy is the standard therapy for this disorder.

who can use topical vapor rubs?

children older than 2 years.

complications of pertussis

children: pnuemonia, convulsions, apnea, encephalopathy, death adults: weight loss, loss of bladder control, passing out, rib fractures

What is Juvenile Idiopathic Arthritis?

chronic inflammation of synovium with join effusion, destruction of cartilage, and ankylosis of joints as disease progresses

Treatment for bladder exstrophy

closure during first 48-72 hours can do shortly after first 24 hours if baby is stable

Treatment for enuresis

combination of medication and behavioral modification Meds: antidiuretics, anticholinergics, tricyclic antidepressants fluid intake, voiding modifications fluid restriction, bladder exercises, timed voiding, enuresis alarms, reward system

anorectal malformations

congenital malformations caused by abnormal development male defects vs female defects *therapeutic management:* -anoplasty -colostomy -PSARP *nursing care:* -assessment and identification of defect -pre op care -post op care -fam support and educaton -discharge planning and home care

pink or red color in whites of eyes swelling of conjunctiva tearing yellow/green pus from eyes crusting of eye lids in morning What disease?

conjunctivitis

intussusception therapeutic management

conservative treatment: -radiologist-guided pneumoenema (gas enema) -ultrasound-guided hydrostatic enema hold procedure if there are signs of: -shock -peritoneal irritation -intestinal perforation prior to hydrostatic reduction: -IV fluids -NG decompression -ABT therapy if conservative treatment is unsuccessful --> surgical reduction and fixation or excision of nonviable segment of colon

encopresis

constipation with fecal soiling

30. The nurse is reviewing first aid with a group of school nurses. Which statement made by a participant indicates a correct understanding of the information? a. "If a child loses a tooth due to injury, I should place the tooth in warm milk." b. "If a child has recurrent abdominal pain, I should send him or her back to class until the end of the day." c. "If a child has a chemical burn to the eye, I should irrigate the eye with normal saline." d. "If a child has a nosebleed, I should have the child sit up and lean forward."

d. "If a child has a nosebleed, I should have the child sit up and lean forward." ANS: D If a child has a nosebleed, the child should lean forward, not lie down. A tooth should be placed in cold milk or saliva for transporting to a dentist. Recurrent abdominal pain is a physiologic problem and requires further evaluation. If a chemical burn occurs in the eye, the eye should be irrigated with water for 20 minutes. DIF: Cognitive Level: Apply REF: p. 805 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

1. Which child should the nurse document as being anemic? a. 7-year-old child with a hemoglobin of 11.5 g/dl b. 3-year-old child with a hemoglobin of 12 g/dl c. 14-year-old child with a hemoglobin of 10 g/dl d. 1-year-old child with a hemoglobin of 13 g/dl

d. 1-year-old child with a hemoglobin of 13 g/dl 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. Anemia is defined as a hemoglobin level below 10 or 11 g/dl. The child with a hemoglobin of 10 g/dl would be considered anemic. The normal hemoglobin for a child after 2 years of age is 11.5 to 15.5 g/dl. DIF: Cognitive Level: Understand REF: p. 789 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

21. The nurse is conducting a staff in-service on childhood blood disorders. Which describes the pathology of idiopathic thrombocytopenic purpura? a. Bone marrow failure in which all elements are suppressed b. Deficiency in the production rate of globin chains c. Diffuse fibrin deposition in the microvasculature d. An excessive destruction of platelets

d. An excessive destruction of platelets ANS: D Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and a normal bone marrow. Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma. DIF: Cognitive Level: Understand REF: p. 804 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

The nurse is caring for a child with acute renal failure. Which clinical manifestation should the nurse recognize as a sign of hyperkalemia? a. Dyspnea b. Seizure c. Oliguria d. Cardiac arrhythmia

d. Cardiac arrhythmia Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiograph anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia.

29. An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. Of what are these manifestations most suggestive? a. Air emboli b. Allergic reaction c. Hemolytic reaction d. Circulatory overload

d. Circulatory overload ANS: D The signs of circulatory overload include distended neck veins, hypertension, crackles, dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Allergic reactions are manifested by urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure. DIF: Cognitive Level: Apply REF: p. 811 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Which is a common side effect of short-term corticosteroid therapy? a. Fever b. Hypertension c. Weight loss d. Increased appetite

d. Increased appetite Side effects of short-term corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

8. The nurse is recommending how to prevent iron-deficiency anemia in a healthy, term, breastfed infant. Which should be suggested? a. Iron (ferrous sulfate) drops after age 1 month b. Iron-fortified commercial formula by age 4 to 6 months c. Iron-fortified infant cereal by age 2 months d. Iron-fortified infant cereal by age 4 to 6 months

d. Iron-fortified infant cereal by age 4 to 6 months ANS: D Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. The mother can supplement the breastfeeding with iron-fortified infant cereal. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated. Providing iron- fortified commercial formula by age 4 to 6 months should be done only if the mother is choosing to discontinue breastfeeding. DIF: Cognitive Level: Apply REF: p. 789 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

12. Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

d. Painful swelling of hands and feet; painful joints ANS: D A vasoocclusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vasoocclusive phenomena. DIF: Cognitive Level: Understand REF: p. 791 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Which is an advantage of peritoneal dialysis? a. Treatments are done in hospitals. b. Protein loss is less extensive. c. Dietary limitations are not necessary. d. Parents and older children can perform treatments.

d. Parents and older children can perform treatments. Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Treatments can be done at home. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis.

Which is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

d. Severe dehydration The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

28. Several complications can occur when a child receives a blood transfusion. Which is an immediate sign or symptom of an air embolus? a. Chills and shaking b. Nausea and vomiting c. Irregular heart rate d. Sudden difficulty in breathing

d. Sudden difficulty in breathing ANS: D Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia. DIF: Cognitive Level: Understand REF: p. 810 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn? a. Absence of a urethral opening is noted. b. Penis appears shorter than usual for age. c. The urethral opening is along the dorsal surface of the penis. d. The urethral opening is along the ventral surface of the penis.

d. The urethral opening is along the ventral surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Urethral opening along ventral surface of penis is known as epispadias.

Which clinical manifestation would be seen in a child with chronic renal failure? a. Hypotension b. Massive hematuria c. Hypokalemia d. Unpleasant "uremic" breath odor

d. Unpleasant "uremic" breath odor Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urinary output occurs. Hyperkalemia is a concern in chronic renal failure.

A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions? a. WBC <1; specific gravity 1.008 b. WBC <2; specific gravity 1.025 c. WBC >2; specific gravity 1.016 d. WBC >2; specific gravity 1.030

d. WBC >2; specific gravity 1.030 WBC count in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary tract inflammatory process. The urinalysis specific gravity for children with normal fluid intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient antidiuretic hormone secretion.

The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to: a. neurologic manifestations that occur with dialysis. b. physiologic manifestations of renal disease. c. adolescents having few coping mechanisms. d. adolescents often resenting the control and enforced dependence imposed by dialysis.

d. adolescents often resenting the control and enforced dependence imposed by dialysis. Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviors. These are a function of the child's age, not neurologic or physiologic manifestations of the dialysis. Feelings of anger, hostility, and depression are functions of the child's age, not neurologic or physiologic manifestations of the dialysis. Adolescents do have coping mechanisms, but they need to have some control over their disease management.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a. blood pressure will stabilize. b. the child will have more energy. c. urine will be free of protein. d. urinary output will increase.

d. urinary output will increase. An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

Gastroesophageal reflux (GER)

defined as the transfer of gastric contents into the esophagus. This phenomenon is physiologic, occurring throughout the day, most frequently after meals and at night; therefore, it is important to differentiate GER from gastroesophageal reflux disease (GERD). GERD represents symptoms or tissue damage that result from GER.

What is congenital clubfoot?

deformity of the ankle and foot causing forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus

complications of varicella?

dehydration pneumonia bleeding problems bacterial infection of the skin sepsis toxic shock bone/joint infection death

Therapeutic management of GER

depends on its severity. No therapy is needed for an infant who is thriving and has no respiratory complications. Nursing care of GI reflux is aimed at identifying children with suggestive symptoms, helping parents with home care feeding and positioning and caring for a child undergoing surgical intervention.

Antidiuretic hormone (ADH) vasopressin - target: renal tubules s/s of hypofunction

diabetes insipidus

How does the pancreas function as an exocrine gland?

digestion

Melanocyte-stimulating hormone (MSH) - target: skin s/s of hypofunction

diminished or absent skin pigmentation

how does conjunctivitis spread and what is the incubation period?

direct contact (viral and bacterial) depends on infection for incubation

How is hand, foot, mouth disease spread and incubation period?

direct contact and 4-6 days

how is rubella spread and incubation

direct contact, droplet and 12-23 days

how is pertussis spread and incubation

direct contact, droplet and 7-10 days

how is varicella spread and incubation

direct contact, droplet, and from person with shingles and 10-21 days

how is mumps/paramyxovirus spread and incubation

direct contact, droplet, surfaces/contaminated objects 12-25 days

Therapy for hyperthyroidism

directed at retarding the rate of hormone secretion and may include drug therapy, thyroidectomy, or radioiodine therapy

vomiting therapeutic management

directed towards detection and treatment of the cause of vomiting and prevention of complications (dehydration, malnutrition) further investigation if: -dehydration -progressively severe vomiting -persistent vomiting for more than 24 hrs -hx. or physical fail to suggest diagnosis oral rehydration of parenteral fluids - if vomiting lead to dehydration antiemetic drugs when: -unable to tolerate PO meds -post op vomiting -chemotherapy-induced vomiting -cyclic vomiting syndrome -acute motion sickness *Ondansetron (Zofran):* -antiemetic -less side effects -beneficial when child cannot tolerate PO or there is post op vomiting *Dimenhydrinate (Dramamine):* -for children prone to motion sickness -administer before a trip

*Tx for 6-18 mos DDH?

dislocation unrecongized until child begins to stand and walk, use traction and cast immobilization (spica)

Malabsorption syndromes

disorders associated with some degree of impaired digestion or absorption. They include digestive defects, absorptive defects, and anatomic defects.

Teaching for parents for urethral malposition correction

double diapering to protect stent restrict infant or toddler from activities that put pressure on the surgical site (playing on riding toys) avoid holding the infant or child straddled on the hip limit the child's activities for 2 weeks encourage fluid intake- offer fruit juice, fruit-flavored ice pops, fruit-flavored juices, flavored ice cubes, and gelatin complete antibiotics to avoid infections watch for signs of infections: fever, swelling, redness, pain, strong smelling urine, or change in flow of the urinary system urine will be blood tinged for a few days, call the physician if urine is seen leaking from any area other than the penis

what precaution for rubella, fifth disease, pertussis, and mumps?

droplet

How is Erhythemia infectiosum (fifth disease/parvovirus B19) spread and what is incubation period?

droplet and blood 4-14 days sometimes up to 20 days

What are endocrine glands?

ductless glands that release hormones that control metabolic processes.

pica

eating disorder compulsive and excessive ingestion of food and nonfood substances for *at least 1 month* food picas: -coffee grounds -uncooked cereals nonfood picas: -clay -soil, stones -paint -ice -hair -paper -ruber -feces pica is common in: -children -women (espec. during pregnancy) -pts w/ autism or cognitive impairment -anemia -chronic renal failure in some cultures, pica is OKAY *causes of pica:* -psychologic theories: compulsive neurosis -nutritional theories: craving cause by a nutrient deficiency pica is associated with: -iron deficiencies -zinc deficiencies *consequences of pica:* -intestinal obstruction or perforation -dental injury -malnutrition

Symptoms of Nephrotic Syndrome

edema- develops rapidly over a few days to 2 weeks, dramatic weight gain- face, periorbital, abdomen (ascites), scrotum, extremities increased BP irritable due to increased ICP albuminuria- foamy urine malnourished- dull eyes, dull brittle hair, skin lesions

What is Osteogensis Imperfecta (OI)?

excessive fragility and bone defects, defective periosteal bone formation and reduced cortical thickness of bones > hyperextensibility of ligaments

obstipation

extremely long intervals between defecation

insensible loss

fever increased metabolic rate increased body surface area contributes to this loss

signs and symptoms associated with respiratory tract infections

fever poor feeding and anorexia vomiting diarrhea abdominal pain nasal blockage nasal discharge cough respiratory sounds sore throat meningismus

Symptoms of lower UTI in preschooler

fever hematuria urgency dysuria frequency cloudy urine foul-smelling urine dehydration abdominal pain enuresis

Symptoms of lower UTI in infant

fever hematuria vomiting irritability lethargy foul-smelling diapers poor feeding failure to gain weight

What is the immediate nursing management goal of Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

fluid restriction

Three important groups of hormones secreted by the adrenal cortex

glucocorticoids, mineralocorticoids, and sex steroids

The appropriate emergency measure when a child with diabetes is having a hypoglycemic reaction is to administer this

glucose

What is Follicle -Stimulating Hormone also known as?

gonadotropic hormone

What are prostaglandins?

group of compounds, paracrine substances, that mimic hormones. Produced by tissues for a particular organ. Regulate cellular response to hormones, wide variety of functions. Act locally. Very potent,

Nasal steroids

have an anti-inflammatory effect on nasal passageways. Examples: Beclomethasone, (Beconase, Vancenase) Dexamethasone (Decadron), Flunisolide (Nasalide) Side Effects: Prolonged use of topical adrenergics and corticosteroids can have a rebound effect in that congestion may result and condition be exacerbated. Adrenergic side effects: nervousness, insomnia, palpitations, and tremors. Nasal steroids - local mucosal irritation and dryness.

incarcerated hernia

having trouble getting it back where it came from skin is the same color as surrounding skin (so there does not seem like there is a blood flow issue) does not need to be repaired immediately but does need to be prepared should schedule elective surgery to have it repaired

Local reaction headache loss of appetite tiredness What immunization creates these side effects?

hep A

Wilms' Tumor/Nephroblastoma

highly metastatic, cancerous tumor of kidney usually between 2 & 5 years genetic link- gene missing

Diagnosis of enuresis

historical data how family managing problem, how toilet trained, stressors UA and urine culture bladder capacity uroflow measurement ultrasound scans for residual urine

What is prolactin (PRL)

hormone found in males and females. Promotes milk production in females. Decreases testosterone levels in males if too high.

What is the usual treatment of diabetes insipidus?

hormone replacement

What are pancreatic islets?

hormone-producing islands of cells, acini.

What are local hormones?

hormones that are not transported through the bloodstream

What is stored in the posterior pituitary?

hormones that are produced by the hypothalamus. (ADH/OT)

*What should the family report in casts?

hot spots (could lead to infection), pain, swelling, discoloration,

CPT Vest

http://www.bing.com/videos/search?q=cpt+vest&&view=detail&mid=DA0C614FD748992B6569DA0C614FD748992B6569&FORM=VRDGAR

Hyperfunction of Insulin (beta cells)

hyperinsulinism

HD nursing care

if diagnosed in newborn period: -help parents adjust to congenital defect -foster infant-parent bonding -prepare parents for medical-surgical intervention -prepare parents to care for child after surgery if malnourished, hold surgery and adjust diet to: -low fiber -high calorie -high protein *enterocolitis:* -biggest complication of HD emergent pre op care: -monitor VS and BP for signs of shock -monitor F&E replacements -observe for sx. of bowel perforation (fever, increasing abdominal distention, vomiting, increased tenderness, irritability, dyspnea, cyanosis) measure abdominal circumference w/ a *paper tape measure* -at the level of the umbilicus or at the widest part of the abdomen -point of measurement is marked w/ a pen IBS symptoms can persist post op

reduce body temperature

if temp is high, important to control fever for comfort - nurse should verify that parent knows how to take childs temperature appropriately. make sure parent knows how to administer antipyretic if prescribed - make sure give the correct amount because medication can accumulate in childrens body and have an adverse effect on the child -incourage cool liquids

*s/s of scoliosis?

ill-fitting clothes, abnormal school screening,

a nurse is teaching a group of parents about communicable diseases. what is the most important appropriate method to prevent communicable diseases? A. handwashing B. avoiding persons with active disease C. covering your cough D. obtaining immunizations

immunizations

Risk factors for communicable diseases?

immunocompromised crowded living conditions poor sanitation poor nutrition poor oxygenation/circulation chronic illness not immunized recent exposure

What causes JIA?

immunologic susceptibility, environmental or external trigger

Where is the receptor for a steroid located?

in the nucleus.

Phimosis

inability to retract the prepuce at an age when it should be retractable- 3 years

Acromegaly

includes typical facial features of the head, lips, nose, tongue, jaw, and paranasal and mastoid sinuses overgrowth; separation and malocclusion of the teeth in the enlarged jaw; disproportion of the face to the cerebral division of the skull; increased facial hair; thickened, deeply creased skin; and an increased tendency toward hyperglycemia and diabetes mellitus

Nonopioids for pain

including acetaminophen (Tylenol, paracetamol) and NSAIDs -are suitable for mild to moderate pain -known for the antipyretic, antiinflammatory, and/or analgesic actions -usually the first analgesics for pain related to tissue injury, also known as nociceptive pain.

what is a cardinal sign a child is feeling better?

increase in activity

What is up-regulation?

increase in number of receptors on target cell due to prolonged decrease in the level of a hormone.

Melanocyte-stimulating hormone (MSH) - target: skin s/s of hyperfunction

increased skin pigmentation

what are signs of clinical deterioration?

increasing respiratory distress increased respiratory rate increased heart rate worsening hypoxia poor perfusion reduced LOC lethargy

appendicitis

inflammation of the vermiform appendix (blind sac at the end of the cecum) most common cause of emergent surgery in peds caused from obstruction of the lumen of the appendix due to hardened fecal materal peak incidence = between 12 and 18 yrs old boys> girls first symptom = periumbilical pain followed by: -nausea -RLQ pain -vomiting w/ fever perforation occurs more in children b/c they cannot verbalize their symptoms -can occur w/in 48 hrs of initial symptoms perforation complications: -abscess -phlegmon: an acute suppurative inflammation of SQ CT that spreads -enterocutaneous fistula -peritonitis -partial bowel obstruction

Effects of sex hormones - androgens, estrogens, progesterone

influence development of bone, reproductive organs, and secondary sex characteristics

TIV: mild local reaction, and fever LAIV: headache, cough, and fever Rare: risk for guillain-barre syndrome What immunization causes these side effects

influenza

hypersensitivity to eggs LAIV younger then 2 years immunosuppresion chronic disease What immunization can you not have?

influenza

Risk factors of UTI

infrequent voiding- results in incomplete emptying of the bladder and urinary stasis poor hygiene, inadequate cleansing after bowel movements, an irritated perineum, uncircumcised male in first 6 months of life, constipation, masturbation, sexual abuse, and sexual activity in adolescent females

What should parents have available when their infant is being treated with cortisol and aldosterone?

injectable hydrocortisone

Discharge teaching for parents for bladder exstrophy

instruct on dressing changes, diapering, and the need to immediately report any signs of infection or change in renal function emphasize the need for routine follow up visits after surgery to assess urinary function and to ensure that the next stages of surgery for continence control are performed at the appropriate time in child's development encourage parents to participate in all aspects of the infant's care, including bathing, feeding, and wound care

What hormone is partially or completely deficient in diabetes mellitus?

insulin

designed to deliver fixed amounts of regular insulin continuously, thereby imitating the release of the hormone by the islet cells

insulin pumps

This is the focus of type 1 Diabetes Mellitus.

insulin replacement, diet, and exercise

What is the function of the endocrine system?

integrates body systems (homeostasis) by using chemical messengers (hormones) communication.

diarrhea pathophysiology

invasion of GI tract by pathogens results in: -increased intestinal secretions of enterotoxins, cytotoxic mediators -decreased intestinal absorption secondary to intestinal damage or inflammation noninflammatory diarrhea is the most common diarrheal illness -resulting from action of enterotoxin that is released after attachment to mucosa

Postoperative care of the child with abdominal surgery

involves assessing the abdomen, providing hydration and nutrition, intravenous fluids, proper positioning, wound care, and psychologic support.

Retinoblastoma

is a congenital intraocular malignant tumor, arises from the retina may be in one or both eyes. It has hereditary component (test for RB1 gene located on chromosome 13q14).

reducible hernia

is a hernia in which the contents of the hernial sac can be returned to their normal position can push it back where it came from

Constipation

is a symptom, not a disease. It is defined as a decrease in bowel movement frequency or increased stool hardness for more than 2 weeks. Constipation with fecal soiling is encopresis. The majority of children have idiopathic or functional constipation because no underlying cause can be identified. Transient illness, withholding and avoidance secondary to painful or negative experiences with stooling, and dietary intake with decreased fluid and fiber all play a role in the etiology of constipation.

CBT

is an evidence-based psychological approach for managing pediatric pain -uses strategies that focus on thoughts and behaviors that modify negative beliefs and enhance the child's ability to solve pain-related problems that result in better pain management.

The FLACC Pain Assessment Tool

is an interval scale that includes the five categories of behavior: F acial expression, L eg movement, A ctivity, C ry, C onsolability

Diarrhea

is caused by abnormal intestinal water and electrolyte transport.

Intussusception

is one of the most common causes of intestinal obstruction during infancy

Retinoblastoma clinical manifestations

is the presence of a whitish "glow" in the pupil, known as the cat's eye reflex, or leukocoria, which is a visualization of the tumor as the light falls on the mass.

Sleep Habits Questionnaire

is useful for assessing sleep behaviors in school-age children with chronic or recurrent pain, - has also been evaluated for use in preschool and toddlers using parent proxy

Inflammatory bowel disease Treatment

it is individualized and managed according to the type and the severity of the disease, its location, and the response to therapy.

What is classified as mild or positional clubfoot?

it may correct spontaneously or require passive exercise or serial cating

Retinoblastoma Nursing care

knowledge deficit related to testing and care also ineffective family coping as the nurse supports family - guilt of transmission of gene. Need to teach that the entire family needs to have regular eye care and for those at risk for 2nd tumor continued follow-up. May include genetic counseling

What is type 2 OI?

lethal, stillborn or die in early infancy, severe bone fragility with multiple fractures at birth

a nurse is caring for an adolescent client who has monoculeosis. The nurse assess fever, fatigue, swollen lymph nodes, sore throat, and sore upper abdomen. What instructions should the nurse discuss with parents? (select all that apply) A. take antibiotics B. drink plenty of fluids C. avoid participating in strenuous activities D. allow for periods of rest E. take aspirin as needed for fever and discomfort F. gargle with saltwater every 2 to 3 hour

liquids avoid strenuous activities allow for periods of rest gargle with saltwater every 2 to 3 hours

intussusception nursing care

listen to parents describe childs physical and behavioral symptoms severe colicky abdominal pain w/ vomiting = intussusception pre op (done in case child ends up needing surgery): -NPO -CBC, urinalysis -signed parental consent -preanesthetic sedation post op: -F&E balance -pain management -VS q 4 hrs -check for abdominal distention -NGT PRN -clear fluids, advances as tolerated seen in CF or celiac kids

side effect of IPV

local reaction at injection site

Hep B side effects?

local reaction, temp of 37.7 or higher

Expectorants

loosen and thin respiratory secretionsExamples: Guaifenesin - most common OTC drug (Robitussin, Humabid) Side Effects: Palpitations, insomnia, restlessness, and nervousness. Pt. should be taught to report a fever and force fluids to keep secretions thin.

what is a characteristic of a child with acute infection?

loss of appetite.

Bladder Exstrophy

lower abdominal wall and anterior bladder wall are missing; most frequent in boys- most frequently associated with epispadias appears as an angry red mass continuous drainage of urine- can lead to excoriation of skin can be life threatening because of infection corrected as soon as possible will look wet and shiny- will cause posterior wall of bladder to protrude and be there open

lower respiratory tract

lower trachea bronchi bronchioles alveoli

What does exercise do for the child with diabetes?

lowers blood sugar levels

what are the principles of management of a patient with respiratory failure?

maintain ventilation and maximize oxygen delivery correct hypoxemia and hypercapnia treat underlying cause minimize extrapulmonary organ failure apply specific and nonspecific therapy to control oxygen demands anticipate complications.

diarrhea therapeutic management

major goals: -assessment of fluid and electrolyte imbalance -rehydration -maintenance fluid therapy -reintroduction of an adequate diet *oral rehydration:* -to treat infants and children w/ acute diarrhea and dehydration -effective, safer, less painful, and less costly than IV rehydration *oral rehydration solutions* -enhance and promote the reabsorption of sodium and water -reduce vomiting, duration of illness, and the need for IV infusions -after rehydration ORS can be used during maintenance fluid therapy by alternating the solution with a low-sodium fluid (ex: breast milk) *older children* -ORS with a regular diet

Goal of surgery for urethral malposition

make urinary and sexual function normal also for cosmetic reasons

most common consequences of GI dysfunction in children

malabsorption fluid and electrolyte disturbances malnutrition poor growth

Hypofunction of sex hormones - androgens, estrogens, progesterone

male feminization

Symptoms of Wilms' Tumor/ Nephroblastoma

may be asymptomatic abdominal mass- unilateral or bilateral- firm with several lobes usually parent will palpate mass while bathing their child hematuria, HTN, abdominal pain may be present

Peptic ulcers

may be classified as acute or chronic, and peptic ulcer disease (PUD) is a chronic condition that affects the stomach or duodenum

Diagnosis of urethral malposition

may be seen on ultrasound- can be missed will document physical findings; genetic testing is often done

Environmental and psychological factors

may exert a powerful influence on children's pain perceptions and may be modified by using psychosocial strategies, -education, -parental support, -cognitive-behavioral interventions.

mild to moderate fever cough, runny nose, red eyes, sore throat Koplik's spots (tiny white spots) appear in mouth red or reddish-brown rash beginning on the face spreading downward

measles (rubeola)

HPV4 side effects?

mild local reaction rare- risk for allergic response

PCV side effect

mild local reactions

What is type 1 OI?

mild to no bone fragility, blue sclerae

HD therapeutic management

most require surgery rather than medical therapy operative procedures: -Soave pull-through -Swenson procedure -Duhamel procedure surgery is performed after child is: -stabilized w/ fluid and electrolyte replacement -colonic cleansing w/enemas surgery = end to end anastomosis or removal with colostomy then reversal

Pediatric Pain Questionnaire

multidimensional pain instrument to assess patient and parental perceptions of the pain experience in a manner appropriate for the cognitive-developmental level of children and adolescents -three components of the PPQ (1) VASs; (2) color-coded rating scales; (3) verbal descriptors to provide information about the sensory, affective, and evaluative dimensions of chronic pain.

The Adolescent Pediatric Pain Tool

multidimensional pain measurement instrument used with children and adolescents to assess pain location, intensity, and quality -count the number of words selected in each of three categories—evaluative (0-8), sensory (0-37), and affective (0-11)—and calculate a percentage score for each one

What is the body's response to a fracture?

muscles contract and physiologically splint the injured area

Parent teaching for Wilms' Tumor

need to be taught home care and to keep follow up visits; let child do as many positive things as possible- parents will try to overprotect them

Secretory cells of the hypothalamus are called?

neurosecretory cells

Assessment of Fractures— The Five Ps

neurovascular assessment 5-Ps pain pulse pallor paresthesia paralysis

constipation in newborn period

newborns pass a first meconium stools within 24-36 hrs of birth if a newborn does not pass meconium stool w/in those hrs they should be assessed for: -intestinal atresia or stenosis -HD -hypothyroidism -meconium plug -meconium ileus *meconium plug:* -caused be meconium that has reduced water content -usually evacuated after digital exam -may require irrigations w/ a hypertonic solution or contrast medium *meconium ileus:* -luminal obstruction of the distal small intestine by abnormal meconium -tx. = same as meconium plug -initial sign of CF -early surgical intervention may be needed to evacuate the small intestine

*Tx for Slipped Capital Femoral Epiphysis?

non-weight bearing, surgery

Hypofunction of Glucagon (alpha cells)

none

Hypofunction of the adrenal medulla

none

Postoperative care for surgery for urethral malposition

observe for edema, dysuria, bleeding, infection, and pain will have a urinary stent in place to keep new urethra hole open double diaper for protection Maintain hydration measure I & O teach parents to monitor temp, urine for cloudiness or foul odor, and to report any signs of UTI immediately pain medication- prn

Malrotation of the intestine

occurs as a result of the abnormal rotation of the intestine around the superior mesenteric artery during embryologic development and may manifest in utero or be asymptomatic throughout life. It is the most serious type of intestinal obstruction because, if the intestine undergoes complete volvulus (the intestine twisting around itself), compromise of the blood supply will result in intestinal necrosis, peritonitis, perforation, and death.

Cirrhosis

occurs as an end stage of many chronic liver diseases, including biliary atresia and chronic hepatitis. Infectious, autoimmune, or toxic factors and chronic diseases such as hemophilia and cystic fibrosis can cause severe liver damage. A cirrhotic liver is irreversibly damaged.

intussusception

occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery w/ it common cause of obstruction between 3-6months old -under age 2, up to age 6 males> can result in total bowel obstruction idiopathic cases caused by hypertrophy of intestinal lymphoid tissue secondary to viral infx.

umbilical hernia

occurs when fusion of the umbilical ring is incomplete at the point where the umbilical vessels exit the abdominal wall common in newborn period typically resolves by 3-5 yrs old more common in: -premies -low birth weight babies *nursing care:* -reassure parents the defect is not harmful -teach parents not to tape or strap abdomen to flatten the protrusion --> skin irritation -observe for complications r/t a hematoma or infx. -strenuous activity restricted for 2-3 weeks post op

hypertrophic pyloric stenosis (HPS)

occurs when the circumferential muscle of the pyloric sphincter becomes *thickened* results in elongation and narrowing of the pyloric canal HPS causes: -outlet obstruction -compensatory dilation -hypertrophy -hyper-peristalsis of the stomach usually develops in first few weeks of life causing: -*non bilious vomiting* - after feeding -projectile vomiting -fussy and hungry after vomiting if not diagnosed early, can lead to: -dehydration -metabolic alkalosis -FTT boys 4-6x > girls white > african american

Hypertrophic pyloric stenosis

occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel.

Obstruction in the GI tract

occurs when the passage of nutrients and secretions is impeded by a constricted or occluded lumen or when there is impaired motility (paralytic ileus).

Omphalocele

occurs when there is failure of the caudal or lateral infolding of the abdominal wall at approximately the third week of gestation. With the deficiency in the abdominal wall, the bowel is unable to complete its return to the abdomen between the tenth and twelfth week of gestation and is usually covered by a translucent peritoneal sac.

how do achieve adequate fluid intake?

offer small amounts of favorite fluids at frequent intervals. -oral rehydration solutions are a good source (pedialyte) for infants. -water or low carb flavored drink for older children. -clear liquids if child is vomiting dont give fluids with caffeine because they can act as a diuretic. -if infants are breast feeding, they should continue to breast feed - do not force fluids. gentle persuasion with preferred beverages or Popsicle is usually successful.

constipation in childhood

often due to environmental changes or control over body functions child who has experienced discomfort when pooping may hold it, but when they finally poop it hurts so they hold it again constipation in school-age children results from: -environmental changes -stress -changes in toileting patterns school-age children are scared to use school bathroom b/c of a lack of privacy

how to promote comfort

older children can manage nasal secretions with little difficulty young infants breathe through ther nose and made need help to clear secretions by using a bulb syringe to remove secretions use of saline nose drops to help clear secretions is another option 2-12 year olds can take a decongestant if they are able to tolerate them every 4 hours.

Irritable bowel syndrome (IBS)

one of the most common adult problems treated by gastroenterologists. Recently, IBS has been identified as a cause of recurrent abdominal pain in 21% to 45% of school-age children. The cause of IBS is not clear, but it is believed to involve a combination of autonomic and psychologic factors.

constipation in infancy

onset frequently occurs during infancy and may result from organic causes such as: -HD -hypothyroidism -strictures often r/t dietary practices less common in breastfed babies when constipations occurs from changing to cows milk from human milk: -add/increase amt. of veggies and fruit in diet -increase fluids (sorbitol-rich juices)

Symptoms of Urethral Malposition

opening found along the shaft of penis- can be anywhere; dimple or pit along ventral or dorsal side of penile shaft- check for opening

coanalgesic drugs

or adjuvant analgesics , may be used alone or with opioids to control pain symptoms and opioid side effects -diazepam (Valium) and midazolam (Versed); for anxiety relief and moderate sedation -stool softeners and laxatives for constipation - antiemetics for nausea and vomiting -diphenhydramine for itching -steroids for inflammation and bone pain -dextroamphetamine and caffeine for possible increased pain and sedation

complications of mumps

orchitis encephalitis meningitis oophoritis mastitis deafness

upper respiratory tract

oronasopharynx pharynx larynx upper part of the trachea

PPQ eight areas of inquiry:

pain history, pain language, the colors children associate with pain, emotions children experience, the worst pain experiences, the ways children cope with pain, the positive aspects of pain, the location of their current pain.

Post op care for Wilms' Tumor

pain management gentle handling encourage to TCDB monitor fluid management- daily weight, I&O, urine specific gravity, BP chemotherapy- monitor for side effects, infection, function or remaining kidney protect remaining kidney from infection and injury

diarrhea etiology

pathogens that cause diarrhea are spread by the *fecal-oral route* through contaminated food or water or are spread from person to person where there is close contact *risk factors:* -lack of clean water -poor hygiene -nutritional deficiency -poor sanitation infants - more susceptible b/c their immune system has not been exposed to many pathogens and has not acquired protective antibodies *rotavirus:* -most common cause of serious gastroenteritis among children -almost all children are affected once by 5 yrs old ABT administration: -alter the normal intestinal flora -results inn overgrowth of bacteria -causes diarrhea

common cold symptoms severe coughing (fits, violent and rapid, and loud "whooping" sound)

pertussis

Diagnosis of Cryptorchidism

physical examination Ballard gestational scale- done upon birth ultrasound CT scan MRI

What are the three "polys" of diabetes mellitus?

polyphasia polydipsia polyuria

Cause of peptic ulcers

poorly understood, but contributing factors include interference with the normal protective mechanisms of the mucosal lining and the presence of Helicobacter pylori

peritonits management

pre op: -IV F&E -systemic ABT's -NG suction post op: -IV fluids -ABT's -NG suction for abdominal decompression

Hyperfunction of Testosterone

precocious puberty, early epiphyseal closure

Hyperfunction of the Ovaries

precocious puberty, early epiphyseal closure

What is hematogenous osteomyelitis?

preexisting infection spreads to bone; infective emboli travel to arteries in the bone metaphysis causing abscess formation and bone destruction

What determines severity of sprains?

presence of joint laxity

*What is the goal of tx in slipped capital femoral epiphysis?

prevent further slippage, prevent complications, and restore function

How pituitary dysfunction is manifested

primarily by growth disturbance

Management of PUD

primarily medical and consists of administration of medications to treat the infection and to reduce or neutralize gastric acid secretion.

what may be prescribed as a decongestant for a child older than 4 years old?

pseudophedrine

intestines

rapid growth spurts at toddler and teenage years

why are infants prone to fluid and electrolyte deficits when they have respiratory illness?

rapid respiratory rate precludes adequate oral fluid intake presence of fever increases the total fluid turnover in infants.

fluid balance and loss

rapid water loss lg. extracellular volume

what are the primary objectives if respiratory arrest occurs?

recognize the situation immediately initiate resuscitative measures opening the airway positioning administering supplemental oxygen positive pressure ventilation cardiopulmonary resuscitation

Treatment for Nephrotic Syndrome

reduce proteinuria and edema prevent infection oral corticosteroids, diuretics, potassium (as ordered by physician) Cytoxan (can be given to improve symptoms but usually makes them more immunocompromised)

Inflammatory bowel disease

refers to ulcerative colitis (UC) and Crohn disease (CD).

What do T4 and T3 do?

regulate rate of metabolism of carbohydrates, lipids, and proteins. INcrease metabolic rate, regulates tissue growth. T4 is in greater amounts. T3 is more potent. Released from carbohydrates.

Nursing actions for congenital clubfoot?

reinforce and clarify orthopedist's explanations and instructions, care of the child with a cast, encourage normal development

What does LH stimulate?

release of egg (ovulation) from ovary. stimulates seretion of testosterone.

How does the pancreas function as an endocrine gland?

releases insulin to lower blood sugar, and glucagon to increase blood suger.

Nursing actions for JIA?

relieve pain, promote general health, facilitate compliance, encourage heat and exercise, support child

What is classified as tertologic or syndromic clubfoot?

requires surgical correction with high incidence of recurrence

assessment should include

respiratory rate depth and rhythm heart rate oxygenation hydration status body temp LOC activity level level of comfort

What are the effectors of the endocrine system?

responsive body parts - autonomic nervous system

what are the cardinal signs of respiratory failure?

restlessness tachypnea tachycardia diaphoresis

Appendicitis common signs & symptoms

right lower quadrant abdominal pain, tenderness, and fever. Diagnosis is not always straightforward. Prolonged symptoms and delayed diagnosis often occur in younger children, in whom the risk of perforation is greatest because of their inability to verbalize their complaints.

identity vs

role confusion

a nurse is teaching a group of parents about complications of communicable disease. What following communicable disease may lead to pnuemonia? (select all that apply) A. rubella B. rubeloa C. pertussis D. varicella E. mumps

rubeola pertussis varicella

a nurse is assessing a client who has pertussis. What are the clinical manifestations? Select all that apply. A. runny nose B. mild fever C. whooping sounding cough D. swollen salivary glands E. red rash

runny nose mild fever whooping sounding cough

*What is scoliosis?

s-shaped curvature of spine noticed after growth spurt; lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis

What has improved diabetes management and can be used successfully by children?

self-monitoring blood glucose

What is compartment syndrome?

serious complication from compression of nerves, blood vessels, and muscles in a closed space > tissue death

What is type 3 OI?

severe bone fragility leads to severe progressive deformities, normal sclera, marked growth failure,

*What are the 2 devices for DDH?

short leg hip spica cast, Pavlik harness

*S/s of DDH in infants?

shortened limb on affected side, restricted abduction of hip on affected side, unequal gluteal folds when infant prone, positive Ortolani test, positive barlow test

why can organisms move more rapidly in younger children?

shorter respiratory tract which causes more extensive involvement

What is type 4 OI?

similar to type 1 with white sclerae

why is a child at increased risk for choking?

smaller airways

What is a soft tissue traumatic injury?

soft tissue injury includes injuries to muscles, ligaments, and tendons from sports injuries and mishaps during play

What is the schedule of influenza TIV vaccine?

start at 6 weeks then yearly

tx for clubfoot?

started soon after birth: serial casting, browne splint, surgery

S/s of JIA?

stiffness, swelling, loss of mobility in affected joints, warm to touch, usually without erythema, tender to touch in some cases, s/s increase with stress, growth retardation

Effects of mineralocorticoids - aldosterone

stimulate renal tubules to reabsorb sodium, thus promoting water retention but potassium loss

Effects of Gonadotropins - target: gonads

stimulates gonads to mature and produce sex hormones and germ cells

when should stool cultures be done

stool cultures are performed ONLY when: blood, mucus, or polymorphonuclear leukocytes, are present in the stool sx. are severe hx. of traveling to a developing country a specific pathogen is suspected if hx. of recent ABT use - test stool for C. diff specimen w/ pH <6 and presence of reducing substances indicates: -carbohydrate malabsorption -secondary lactase deficiency diarrhea with dehydration: -increased hgb -increased hct -increased creatinine -increased BUN normalize w/ rehydration

intussusception diagnostic evaluation

subjective findings lead to diagnosis ultrasound reveals a heterogenous mass and a "bulls eye" rectal exam reveals: -mucus -blood

What is a hormone?

substance secreted by an endocrine gland into the blood stream that acts on a specific target tissue to produce a given response.

Treatment for Wilm's Tumor

surgery to remove kidney and affected lymph nodes- usually scheduled ASAP; chemotherapy and/or radiation if tumor has metastisized then prognosis is poor

Treatment of phimosis

surgery- circumcision- removal of foreskin; painful for older children Betamethasone cream (0.05%) applied twice daily for 4-8 weeks to the outer prepuce- an effective alternative to surgery for phimosis and has few side effects often child is able to achieve foreskin retraction without surgery

Treatment for urethral malposition

surgical correction 6 months-1 year or earlier moves position of urethra to correct urinary function should be done before toilet training age infant is not circumcised before surgery- will use foreskin as skin graft

Treatment for appendicitis before perforation

surgical removal of the appendix (appendectomy).

s/s of a fracture?

swelling, pain, tenderness, deformity, diminished functional use, bruising, muscular rigidity, crepitus

s/s of strain?

swollen and painful to the touch over time

diarrhea nursing care

teach caregivers to monitor for signs of dehydration and the amount of fluids taken by mouth -especially the # of wet diapers or voidings -assess the frequiency and amount of stool losses educate onn ORT, including: -administration of maintanence fluids -replacement of ongoing losses ORS should be administered in small quantities at frequent intervals teach parents that a slightly higher stool output initially occurs w/ continuation of a normal diet and with ongoing replacement of stool losses *if hospitalized:* -obtain accurate weight -monitor I/O -parenteral therapy with NPO for 12 to 48 hrs -monitor IV *accurate measure of output is essential to determine whether renal blood flow is sufficient to permit the addition of potassium to the IV fluids* avoid taking temps rectally bc they stimulate the bowel, increasing passage stool instruct parents to frequently and properly wash their hands and to dispose of soiled diapers, cloths, and bed linens everyone caring for the child must be aware of the "clean" and "dirty" areas, especially in the hospital, where the sink in the childs room is used for many purposes

diarrhea prevention

teach parents not to give their child *adult* meds that prevent traveler's diarrhea when traveling, only let child drink bottled water and carbonated beverages child should avoid: -tap water -ice -unpasteurized dairy products -raw veggies -unpeeled fruits -meets -seafood *rotavirus vaccine*

Nursing care for UTI

teach parents to prevent UTIs- teach child to wipe front to back, wash child's perineum daily, discourage bubble baths and hot tubs

The diagnosis of hypoparathyroidism is made on this

the basis of clinical manifestations associated with decreased serum calcium and increased serum phosphorus

what helps determine the cause of vomiting?

the childs: 1. age 2. pattern of vomiting 3. duration of symptoms

vomiting

the forceful ejection of *gastric* contents through the mouth self-limiting (usually) under CNS control accompanied by nausea and retching *causes of vomiting:* -acute infections -disease -increased intracranial pressure -toxic ingestions -food intolerances -allergies -mechanical obstruction of the GI tract -adrenal insufficiency -nephrologic disease -pregnancy -psychogenic problems *complications:* -acute fluid volume loss (dehydration) -electrolytes disturbances -malnutrition -aspiration -Mallory-Weiss syndrome (small tears on the distal esophageal mucosa)

Lymphocytic thyroiditis, also known as Hashimoto disease or juvenile autoimmune thyroiditis

the most common cause of thyroid disease in children and adolescents and accounts for the largest percentage of juvenile hypothyroidism

The main physiologic action of Thyroid Hormone

to regulate the basal metabolic rate and control the processes of growth and tissue differentiation

constipation therapeutic management

treatment depends on cause and duration of symptoms complete hx. and physical exam needed to determine appropriate management irrigation w/ a hypertonic solution or water-soluble enema to facilitate passage of obstruction if due to HD: -surgical tx. - resection of the intestine and saline irrigations *for infant:* -educate parents on normal bowel habits -short, transient periods = no intervention -mild constipation- resolves as solid food is introduced into diet -hard stools or anal fissures - stool softeners (malt extract or lactulose) -NO DONT TAKE RECTAL TEMPS (are u dumb???) *management of simple constipation:* -change diet to more fiber and fluids -eliminate constipating foods -establish pooping routine -stool softeners (docusate or lactulose) or MiraLax if there are other symptoms assoicated w/ constipation such as: -vomiting -abdominal distention -pain -evidence of growth failure investigate condition further *management of chronic constipation:* -requires months or yrs to resolve -relapse is common -restore regular evacuation of stool -shrink distended rectum to its normal size -promote regular toileting routine -include: bowel cleansing, maintenance therapy to prevent sol retention, diet modification, bowel habit training, and behavioral modification -after impaction is removed, maintenance therapy for 6-12 months is needed *maintenance therapy includes:* -stool softeners + laxatives -PEG = most favorable changes in diet = helpful but not effective when done alone -encourage intake of fiber (age in yr + 5 grams = rec. intake/day) *retraining therapy:* -habit training -reinforcement for sitting on toilet -emotional support allow 5-10 min for kid to poop

Diagnosis of Wilms' Tumor/ Nephroblastoma

ultrasound, MRI of lungs, liver, spleen, and brain parents are usually allowed to stay with child during diagnostic tests

Diagnosis of hydrocele

upon palpation, round, smooth non tender mass can be transilluminated- detect presence of fluid

Diurnal enuresis

urinary incontinence during the day

*How is Slipped Capital Femoral Epiphysis diagnosed?

very obese, inable to bear weight b/c of sever pain, limp on affected side, pain in groin/thigh/knee, affected leg is externally rotated, loss of abduction and internal rotation, shortening of lower extremity

what are most infections caused by?

viruses particularly RSV- respiratory syncytial virus rhinovirus nonpolio enterovirus adenovirus parainfluenza virus influenza virus human metapneumovirus group A beta-hemolytic streptococci (GABHS) staphylococci

how to ease respiratory efforts

warm or cool mist moisture soothes inflammed membranes and helps with hoarseness or laryngeal involvement steam from a hot shower or humidifier mist tents in hospital

What is the epiphysis?

weakest point of long bones in the cartilage growth plate

Nursing Care for Nephrotic Syndrome

weigh daily monitor BP IV infusions of albumin administer diuretics, steroids improve nutritional status (low sodium diet) prevent infection- patients are immunocompromised, screen visitors for signs of infection proper handwashing observe for signs of infection

What is a greenstick fracture?

when a bone is angulated beyond teh limits of bending; bone has a break but not all the way through

What is a plastic deformation fracture?

when the bone is bent but not broken, the bone will straighten slowly but not completely

when do the most common respiratory pathogens appear in epidemics?

winter and spring months

Adrenergics

work by constricting the small blood vessels in the upper respiratory tract. As blood vessels constrict, nasal secretions are better able to drain. Examples: Phenylephrine (Neo-Synephrine), Ephedrine (Vicks, Vatornol).

diameter of the airway is smaller in

younger children and subject to considerable narrowing from edematous mucous membranes and increased production of secretions.

Relaxation With a slightly older child:

• Ask child to take a deep breath and "go limp as a rag doll" while exhaling slowly; then ask child to yawn (demonstrate if needed). • Help child assume a comfortable position (e.g., pillow under neck and knees). • Begin progressive relaxation: starting with the toes, systematically instruct child to let each body part "go limp" or "feel heavy." If child has difficulty relaxing, instruct child to tense or tighten each body part and then relax it. • Allow child to keep eyes open, since children may respond better if eyes are open rather than closed during relaxation.

CAM therapies are grouped into five classes:

• Biologically based—foods, special diets, herbal or plant preparations, vitamins, other supplements • Manipulative treatments—chiropractic, osteopathy, massage • Energy based—Reiki, bioelectric or magnetic treatments, pulsed fields, alternating and direct currents • Mind-body techniques—mental healing, expressive treatments, spiritual healing, hypnosis, relaxation • Alternative medical systems—homeopathy; naturopathy; ayurvedic; traditional Chinese medicine, including acupuncture and moxibustion

Hyperthermia

• Body temperature exceeds the set point resulting from environmental factors, such as heat stroke, salicylate poisoning, seizures, hyperthyroidism • Antipyretics of NO value because the set point is already normal • Cooling measures are used.

School-Age Child responses to pain

• Demonstrates behaviors of the young child, especially during actual painful procedure, but less before the procedure • Exhibits time-wasting behavior, such as "Wait a minute" or "I'm not ready" • Displays muscular rigidity, such as clenched fists, white knuckles, gritted teeth, contracted limbs, body stiffness, closed eyes, wrinkled forehead

With an infant or young child:

• Hold in a comfortable, well-supported position, such as vertically against the chest and shoulder. • Rock in a wide, rhythmic arc in a rocking chair or sway back and forth, rather than bouncing child. • Repeat one or two words softly, such as "Mommy's here."

Neonatal pain response: Other physical observations

• Increased muscle tone • Dilated pupils • Decreased vagal nerve tone • Increased intracranial pressure • Laboratory evidence of metabolic or endocrine changes: Hyperglycemia, lowered pH, elevated corticosteroids

Causative Agents

• RSV • Chlamydia trichomatous • Group A beta hemolytic strep • Staphylococcus aureus • Haemophilus influenza bacillus HIB Pneumococcus • adenovirus • parainfluenza • mycoplasma pneumoniae

Newborn and Young Infant responses to pain

• Uses crying • Reveals facial appearance of pain (brows lowered and drawn together, eyes tightly closed, and mouth open and squarish) • Exhibits generalized body response of rigidity or thrashing, possibly with local reflex withdrawal from what is causing the pain • Shows no relationship between what is causing the pain and subsequent response

Young Child responses to pain

• Uses crying and screaming • Uses verbal expressions, such as "Ow," "Ouch," or "It hurts" • Uses thrashing of arms and legs to combat pain • Attempts to push what is causing the pain away before it is applied • Displays lack of cooperation; need for physical restraint • Begs for the procedure to end • Clings to parent, nurse, or other significant person • Requests physical comfort, such as hugs or other forms of emotional support • Becomes restless and irritable with ongoing pain • Worries about the anticipation of the actual painful procedure

Complications of MAT

•Conductive hearing loss •Perforated or scarred ear drum •Mastoiditis •Cholesteratoma •Intracranial infections (meningitis)

Primary Observations

•Fever-Febrile seizures •Meningismus-signs of meningitis without infection of meninges •Anorexia •Nasal Blockage •Nasal Discharge •Cough •Vomiting •Diarrhea •Abdominal pain •Restlessness -1st sign of obstruction Early to Intermediate signs of respiratory difficulty -Dyspnea, tachypnea -Retractions -Fine inspiratory rales -Audible expiratory grunt -Nasal flaring •Late signs of respiratory difficulty -Cyanosis -Flaccidity -Inertness -Unresponsiveness -Apneic episodes -Diminished breath sound

Chronic OM - Primary observations

•Hearing loss •Difficulty communicating •Feeling of fullness •Tinnitus •Vertigo

Bronchiolitis - Primary Observations

•History of 1-2 day URI •Nasal flaring •Intercostal and subcostal retractions •Increased respiratory rate •Elongated expiratory phase •Wheezing

Pneumonia - Complications

•Pneumothorax -Asymmetrical breathing -Absence of lung sounds -Chest pain -Dyspnea •Empyema

Post-op care tonsillectomy

•Potential for hemorrhage for 14 days post op •Position prone or semi-prone immediately after surgery •Observe for bleeding -Patient at highest risk during first 24 hours. The most obvious sign of bleeding is the childs continuous swallowing of the trickling blood. While the child is sleeping note the frequency of swallowing. If continuous bleeding is suspected notify the surgeon immediately., •IF hemorrhage is suspected: -Look in throat carefully with tongue blade -Assess for •Increased pulse •Frequent swallowing •Pallor •Emesis of bright red drainage •Restlessness •Decreased B/P - Late sign of shock -Notify surgeon immediately

Health Promotion Disease Prevention

•Primary -Handwashing -Immunization - Pneumococcal vaccine •Secondary -Early recognition of progression of URI to pneumonia •Tertiary -Continue routine as close to normal as possible

Epiglottitis - Primary Observations

•Rapid onset of sore throat •Difficulty swallowing •Fever -Toxic - out of proportion •Rapid progression to severe respiratory distress •Absence of spontaneous cough •Drooling •Agitation/ restlessness Tripod positioning -Sitting upright -Leaning forward -Chin thrust out -Mouth open -Tongue protruding Voice is thick and muffled with froglike croaking on inspiration •Supra or substernal retractions •Throat is red and inflamed with large cherry red edematous epiglottis

Chronic Tonsillitis Treatment

•T&A - tonsillectomy and adenoidectomy •MAT - myringotomy and tubes often done at same time if necessary

Chronic Tonsillitis Primary observations

•Tonsils hypertrophied •Repeated infections •Difficulty swallowing •Difficulty breathing •Enlarged cervical lymph nodes •Mouth breathing

Vaccines administered between 4-6 years old

DtaP, IPV, MMR, varicella, and PPSV

What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease?

Enlarged, painless, firm cervical lymph nodes

If a family member is present during a pediatric code, what should you ensure happens if they seem to be unsteady on their feet?

Ensure that they have a place to sit

How does a steroid enter a cell?

Enter the cell by diffusion because both the hormone and cell wall are fats, lipids.

Urethra opens on dorsal (upper) surface of penis, associated with bladder exstrophy

Epispadia

Other Pharmacological Treatment

Expectorants Thin hyperviscous mucus Increase flow of respiratory secretions Aid in expectoration Allergy injections Not usually very successful Only selected individuals get relief from allergy injections No allergy injections should be given without emergency equipment and medications on hand in case of anaphylactic reaction

Pre-op care tonsillectomy

Explain according to appropriate growth and development norms •Bleeding and clotting studies may be ordered pre-op •Assess for loose teeth

Without the use of carbohydrates for energy, fat and protein stores are replenished as the body attempts to meet its energy needs T or F

False

What are some signs that a middle/high school aged child is grieving?

Flashbacks/nightmares Depression/withdrawal/loss of interest Substance abuse Peer relationship problems

Juvenile Idiopathic Arthritis (JIA)

Formerly called JRA (juvenile rheumatoid arthritis JIA Possible causes Peak ages—1 to 3 years and 8 to 10 years Often undiagnosed

Special issues with childhood survival: Adbomen

GI tract - Chronic malabsorption w/issues of weight and diarrhea Liver - fibrosis and liver affecting function Urinary system - nephritis and chronic cystitis Ovaries/ testes - Concern with infertility - Male sperm banking - EBP increasing physician/pt dialogue

What are exocrine glands?

Glands with ducts that release to the outside of the body, such as sweat and sebaceous glands.

Contact Isolation

Gowns •Gloves •Strict handwashing •Masks not needed since RSV is spread by droplet. -If nurse is in close contact and child is coughing excessively, the nurse may choose to wear a mask. •Parents should also follow isolation procedures

Acute Streptococcal Pharyngitis

Group A β-hemolytic streptococci (GABHS) Diagnostic evaluation Rapid antigen testing Culture Manifestations/treatment regimen Risk for serious sequelae Acute rheumatic fever Acute glomerulonephritis Scarlet fever (though rarely seen in United States) Nursing care management This is bacteria This can have systemic complications Antibiotic treatment Culture take 48 hours Puss pocket, swollen glands, red and fever to have strep You can have it close nasal drip, cough 24 hours and they aren't contagious

Osteosarcoma Diagnostics

Grows on top of the bone→"star" appearance on scans Bone biopsy needed to rule out trauma/infection

What hormones do the anterior pituitary secrete?

Growth Hormone (GH), Thyroid Stimulating Hormone (TSH), Adrenocorticotropic hormone (ACTH), Follicle Stimulating Hormone (FSH), Luteneinizing Hormone (LH), Prolactin (PRL)

This should alert the nurse to the possibility of hypothyroidism

Growth cessation or retardation in a child whose growth has previously been normal

Treatment for cryptorchidism

HCG administration surgery- orchiopexy to reposition testicle into scrotal sac 35-50 times greater risk of testicular cancer

mild local reactions and low grade fever rare temp great then 38.5, vomiting and crying What immunization creates this side effect?

Hib

Vaccines that should be administered between 12-15 months

Hib, PCV, IPV, MMR, varicella

Vaccines at 12-15m:

Hib, PCV, MMR, VAR, Hep A

What is the process by which a nonsteroid enters a cell?

Hormone binds to receptor on cell membrane. Hormone passes message on to 2nd receptor inside the cell which carries out the cellular changes.

Special issues with childhood survival: Head and Neck

Hormones - As the result of gland dysfunction. Follow-up needed and if found will require replacement therapy CNS - Necrosis and demylenizaion of white matter. This leads to sleepiness, lethargy, seizures. Damage to grey matter can lead to learning disabilities and chronic HA

What are tropic hormones?

Hormones that target other endocrine glands to stimulate their growth/secretions. Cause a series of reactions to achieve ultimate goal, domino affect.

Bronchiolitis - Secondary Observations

Hyperinflation on chest xray •Atelectasis •Pulse oximetry - decreased Hgb saturation •Increased ESR - erythrocyte sedimentation rate -Sign of inflammation

Urethra opens on ventral (lower) surface of the penis occurs with congenital inguinal hernias, undescended testes, and chordee

Hypospadias

Two types of urethral malposition

Hypospadias Epispadias

How does the hypothalamus control the pituitary gland?

Hypothalamic releasing hormones stimulate cells of anterior pituitary to release hormones. Nerve impulses from the hypothalamus stimulate nerve endings in the posterior pituitary gland to release hormones.

What are the major endocrine glands?

Hypothalamus, pituitary gland, pineal gland, thyroid gland, parathyroid gland, thymus, adrenal gland, pancreas, sex organs.

What is the order of operations for the thyroid?

Hypothalamus, thyrotropin releasing hormone (TRH), anterior pituitary, Thyroid stimulating hormone (TSH), Thyroid

Oxytocin is produced by?

Hypothalmus in response to uterine and vaginal wall stretching and stimulation of breasts.

A nurse is planning to administer immunizations to a 4 year old who has up to date immunizations. What should the nurse anticipate giving? (select all that apply) A. IPV B. Hib C. MMR D. VAR E. Hep B F. DTaP

IPV MMR' VAR DTaP

diarrhea IV therapy

IV fluids are initiated whenever the child is unable to ingest sufficient amounts of fluid and electrolytes to: 1. meet ongoing daily physiologic losses 2. replace previous deficits 3. replace ongoing abnormal losses *pts that require IV fluids:* -severe dehydration -uncontrollable vomiting -inability to drink for any reason (ex: extreme fatigue, coma) -severe gastric distention IV solution is selected based on probably type and cause of dehydration

Luteinizing hormone (LH) - ovaries, testes s/s of hyperfunction

Identical to Follicle-stimulating hormone (FSH) 1) precocious puberty 2) primary gonadal failure 3) Hirsutism 4) polycystic ovary 5)early epiphyseal closure

What is a principal nursing consideration in working with children with hypopituitarism?

Identifying children with growth problems

OM—Antibiotic Therapy?

If over age 6 months—"watchful waiting" up to 72 hours for spontaneous resolution Antibiotics if <2 years with persistent acute symptoms of fever and severe ear pain Antibiotics if <6 months Topical relief—heat or cold or benzocaine drops (Rx) Know this

When is FSH not present?

In prepubertal girls/boys

What are signs that an elementary school child is grieving?

Inattention/difficulty concentrating Somatic complaints Sleep disturbances Disruptive behavior

Secondary Observations Asthma

Increased WBC's Chest xray Sputum cultures Blood gases Eosinophil count increased Decreased pulmonary function tests

While completing an assessment on a 6-month-old infant, which finding should the nurse recognize as a symptom of a brain tumor in an infant?

Increased head circumference

Clinical manifestations are indicative of acute adrenocortical insufficiency of the adrenal gland (Cushing syndrome).

Increased irritability, headache, diffuse abdominal pain, weakness, nausea and vomiting, diarrhea, fever, and central nervous system (CNS) symptoms

What acromegaly?

Increased levels of GH after growth years.

What is gigantism?

Increased levels of GH during the growth years.

What causes the clinical manifestations of pheochromocytoma?

Increased production of catecholamines

What is exogenous osteomyelitis?

Infectious agent invades bone following a penetrating wound, open fracture, contamination in surgery, or secondary extension from abscess or burn

Rhabdomyosarcoma Clinical Manifestations

Initial s/s related to site of tumor/compression of adjacent organ. Organs. Symptoms initially are vague and resemble common childhood illnessess Locations of Tumor and common manifestations: - Orbit: rapid development of bilateral proptosis, ecchymosis of conjuctiva, & loss of extraocular movements - Nasopharynx: stuffy nose, pain, epitaxis, nasal obstruction, palpable nodes of neck, visible mass (late stage) - Paranasal sinuses: swelling, discharge, & sinusitis - Retroperitoneal: generally "silent tumor"; signs of obstruction, abdominal mass, & pain - Perineum: superficial mass & bowel/bladder dysfunction from tumor compression

A child with non-Hodgkin lymphoma will be starting chemotherapy. What intervention is initiated before chemotherapy to prevent tumor lysis syndrome?

Intravenous (IV) hydration containing sodium bicarbonate

Viral hepatitis

Is caused by five types of virus: hepatitis A, B, C, D, and E virus. Whereas hepatitis A and E viruses are spread by the fecal-oral route, hepatitis B and C viruses are transmitted primarily by the parenteral route. Transmission of hepatitis D occurs from blood or sexual contact.

Rhabdomyosarcoma

It comes from the primitive muscle cells called rhabdomyoblasts that instead of becoming striated muscle cells: they just grow out of control from embryonic meschyme cells in muscles, tendons, fascia, lymphatic or vascular tissue Most common locations: head and neck, especially orbit followed by retroperitoneal High grade tumor with potential for metastasis (so may have PET scan to determine sites

What is palliative care? When does it begin? How does it promote death? Does it continue after the death of the child?

It is care that promotes patient comfort & family involvement (siblings + mom/dad, etc.); It begins within 6 months of death; It promotes a graceful, natural death rather than prevention of death; Yes, it promotes healing and family unity after death of the child.

What is the main physiologic action of the thyroid hormone?

It regulates the basal metabolic rate and thereby controls the processes of growth and tissue differentiation.

Nursing Interventions

Keep airway patent Provide rest in recovery phase Cool humidified environment Monitor blood gases/pulse oximetry Administer O2 Help control anxiety in child and parents Refer to support groups Patient education

What is the thyroid gland?

Largest endocrine gland. Located on the anterior neck, wrapping the anterior portion of the trachea, below the larynx. Vascular with two large lateral lobes, connected by the isthmus.

Acute Leukemia Patho

Leukemia is a broad term given to a group of malignant diseases of the bone marrow and lymphatic system Unrestricted proliferation of immature WBC in the blood-forming tissues of the body Cellular destruction occurs through the process of infiltration of the immature blast saturating the bone marrow with subsequent competition for metabolic elements

What is the pancreas?

Located behind te stomach and on the left side of the abdomen. Functions as a mixed gland.

Pharmacological Agents 2 types

Long Term Control Preventive Medications Quick Relief Rescue Medications

Special issues with childhood survival: Chest

Lungs - Chronic pneumonia or fibrosis of the lungs Heart - restrictive cardiomyophathy

Pregnancy or hypersensitivity to yeast: what immunization can you not have?

MCV2 and MCV4

local reactions( rash, fever, swollen glands in cheeks, neck, and under the jaw) possibility of joint pain lasting for days risk for anaphylaxis and throbocytopenia What immunization creates these side effects?

MMR

pregnancy allergy to gelatin and neomycin history of thrombocytopenia or thrombocytopenic purpura immunosuppresion recent transfusion with blood products or immunoglobulins What immunization contraindications?

MMR

What vaccines require the child to be 12-15 months old to be administered?

MMR and Varicella

LTB Plan of Care / Implementation

Maintain adequate respiratory exchange -High humidity -Cool mist -O2 -Nebulized epinephrine -Corticosteroids •Increased fluids (unless respirations > 60/min) -Keep NPO for resp. rate > 60 to decrease risk of aspiration and reduce work of breathing Observe for early signs of impending airway obstruction -Increased pulse -Increased respirations -Increased retractions -Nasal flaring -Restlessness

Tips for Using Inhalers in Children

Make sure there are no foreign bodies in inhalers Spacers will help to eliminate hand/breath coordination problems Spacers increase the amount of medication that can get to lungs Patients should always carry fast acting inhalers with them at all times

Effects of Luteinizing hormone (LH) - ovaries, testes

Male: Stimulates differentiation of Leydig cells, which secrete androgens, principally testosterone Female: Stimulates secretion of progesterone by corpus luteum; produces rupture of follicle with discharge of mature ovum

Nephroblastoma (Wilms tumor) patho

Malignant renal and intra-abdominal tumor of childhood arises from undifferentiated metanephrogenic blastoma (responsible for renal/genital development). Metastasis can occur through he blood Thing Good day, Wilms, old CHAP C: chromosome 11 deletion of tumor suppressor gene H: hemi hypertrophy A: age at presentation 2-4 year olds P: palpable flank mass

Ewings Sarcoma

Malignant small, round cell tumor that grows in the bones or in the tissue around bones - often in legs, pelvis, ribs, arms, or spine (long bones) Possible alteration in STAG2 and TP53 gene

Define precocious puberty.

Manifestations of sexual development before age 9 years in boys or age 8 years in girls

Behavioral Contracting Informal:

May be used with children as young as 4 or 5 years old: • Use stars, tokens, or cartoon character stickers as rewards. • Give a child who is uncooperative or procrastinating during a procedure a limited time (measured by a visible timer) to complete the procedure. • Proceed as needed if child is unable to comply. • Reinforce cooperation with a reward if the procedure is accomplished within specified time.

Therapeutic Management of Osteomyelitis

May have subacute presentation with walled-off abscess rather than a spreading infection Prompt, vigorous IV antibiotics for extended period (3 to 4 weeks or up to several months) Monitor hematologic, renal, hepatic responses to treatment

Peak Expiratory Flow Meter*

Measures maximum flow of air that can be forcefully exhaled in 1 second Actually predicts an asthma attack. Peak flow values decrease before an acute asthma attack Establish a personal best value - for comparison purposes Use at least 2 x per day initially - Then decrease to 1 x per day 3 Zones - Green, Yellow, Red Green Zone 80 - 100% of personal best Green means GOMeans asthma is under control Use only preventive medications Yellow Zone - 50-80% of personal best Yellow means caution Indicates asthma is under poor control even if patient feels OK Action Plan is implemented Patient should start taking aerosols q4h and may need to take an oral corticosteroid if ordered by physician Red Zone - below 50% of personal best Red means danger Start taking aerosols immediately Notify the physician Go to the emergency room

Presentation (Cont.)

Meconium ileus Distal intestinal obstruction syndrome Excretion of undigested food in stool—increased bulk, frothy, and foul Tissue wasting Prolapse of the rectum

JIA—Therapeutic management

Medications: NSAIDs SAARDs Corticosteroids Cytotoxic agents Immunomodulators Disease-modifying antirheumatic drugs (DMARDs)

What does the endocrine system influence?

Metabolic activities of cells by means of hormones

Classification of Asthma

Mild Intermittant Symptoms < 2 times/week, exacerbations brief Mild Persistent Symptoms > 2 times/week; not every day - exacerbations may produce minor limitation to activities; Use of rescue inhaler > 2days/week, but not daily Moderate Persistent Daily symptoms and use of inhalers, exacerbations may last for days and produce some limitations to activities Severe Persistent continual symptoms - frequent exacerbations; Extremely limited activity tolerance

What should the nurse be alert to in the care and treatment of acute adrenocortical insufficiency in regard to the monitoring of electrolyte levels?

Monitor and observe for signs of hypokalemia or hyperkalemia (e.g., weakness, poor muscle control, paralysis, cardiac dysrhythmias, and apnea).

Acute Laryngitis

More common in older children and adolescents Usually caused by virus Chief complaint: hoarseness Generally self-limiting and without long-term sequelae Therapeutic management Nursing care management Humidifier helps to treat Upper airway viral

RSV - Respiratory Syncitial Virus

Most common cause of bronchiolitis •Occurs late fall and winter months •Lasts 3-10 days •Primary Observations -Hypoxia signs -Wheezing, Rales, Rhonchi -Fever -Paroxysmal Non-productive cough - "chokey cough"

Acute LTB (laryngotracheobronchitis)

Most common croup syndrome •Affects children < 5 years of age •Usually caused by viral agent -Parainfluenza -RSV •Usually preceded by URI

Neuroblastoma patho

Most common extracranial solid tumor of child Tumors originate from embryonic neural crest cells (neural blasts) that normally give rise to the adrenal medulla and the SNS → therefore, majority of the tumors arise from the adrenal glad or retroperitoneal sympathetic chain Diagnosis usually is made after metastasis has occurred

Hodgkins Disease Clinical Manifestations

Most common finding is enlarged, firm, non-tender moveable nodes in the supraclavicular or cervical area Mediastinal lymphadenophaty may cause a persistent, nonproductive cough Enlarged retroperitoneal nodes may produce unexplained abdominal pain Systemic symptoms: low-grade or intermittent fever (Pel-Ebstein disease), anorexia nausea, weight loss, night sweats, and pruritus Look at lab values, high values amy indicate metastases

Long Term Control Inhaled Steroids

Most effective long term control therapy for persistent asthma These medications focus on the inflammation in the airways They help prevent asthma attacks They DO NOT help in the acute attack, but still must be given - some doctors do double puffs if in an attack. These drugs are very safe and do NOT inhibit growth. Rinse mouth after use to decrease risk of yeast infection Examples: Budesonide (Pulmocort) (administered by inhaler or nebulizer) fluticasone/salmeterol (Advair) (Combination of inhaled steroids and long acting bronchodilators) Salmeterol (Serevent) Fluticasone (Flovent)

Non-Hodgkin Lymphoma Therapeutic Management

Multi-agent chemotherapeutic regiments are administered for 6-24 months Aggressive approach: radiotherapy and chemotherapy

Scoliosis (Cont.)

Multiple potential causes; most cases idiopathic Generally becomes noticeable after preadolescent growth spurt May have complaint of "ill-fitting clothes" School screening controversial

Identify the most common early symptom of hypoparathyroidism.

Muscle cramps are an early symptom, progressing to numbness, stiffness, and tingling in the hands and feet.

Pneumonia-Primary Atypical

Mycoplasma pneumoniae is causative agent -Sometimes called "walking pneumonia"

Fluids and Electrolytes

NPO if respirations > 60 •Small frequent feedings •Adequate hydration - to keep secretions thin -know what fluid requirements are for your patient and increase to account for insensible water loss •IV therapy •Accurate I&O •Watch for signs of dehydration

Pharyngeal Tonsillitis (Adenoiditis) Primary observations

Nasal speech •Mouth breathing •Elevated temperature •Hearing difficulty •Pharyngeal pain

Upper Respiratory Tract Infections (URIs)

Nasopharyngitis—"common cold" Caused by numerous viruses RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses Clinical manifestations Fever—varies with age of child Irritability, restlessness Decreased appetite and fluid intake Nasal inflammation Vomiting and diarrhea Home management—varies with age Virus- 10 to 14 days Just wait it out Fever and irritability- Tylenol Watch the fluid because they can become dehydrated They breath those the nose so make sure it's clear

Patient Education Asthma Medication Delivery Devices

Nebulizer Inhaler Diskus Fast-acting inhaler Spacers

Are hormones regulated by positive or negative feedback?

Negative feed back

What are some signs of hypoglycemia?

Nervousness, pallor, tremulousness, palpitations, sweating, hunger, weakness, dizziness, headache, drowsiness, irritability, loss of coordination, seizures, and coma

Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 18. The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which childhood cancer?

Neuroblastoma

What is the posterior pituitary?

Neurohypophysis. Downward projection of brain. Made of neural tissue. Stores hormones.

Diagnostic Evaluation of JIA

No definitive diagnostic tests Elevated sedimentation rate in some cases Antinuclear antibodies common but not specific for JRA Leukocytosis during exacerbations Diagnosis based on criteria of American College of Rheumatology

JIA—Therapeutic Management

No specific cure Goals of therapy—preserve function, prevent deformities, and relieve symptoms Iridocyclitis/uveitis Inflammation of iris and ciliary body Unique to JRA Requires treatment by ophthalmologist

Does the thymus grow?

No. it appears smaller in adults than children because it does not change in size.

Neonatal pain response: Facial expression:

Observe characteristics, timing, orientation of eyes and mouth • Grimaces • Brow furrowed • Chin quivering • Eyes tightly closed • Mouth open and squarish

Neonatal pain response: Vocalizations:

Observe quality, timing, and duration • Crying • Whimpering • Groaning

Neonatal pain response: Changes in state:

Observe sleep, appetite, activity level • Changes in sleep-wake cycles • Changes in feeding behavior • Changes in activity level • Fussiness, irritability • Listlessness

Neonatal pain response: Body movements and posture:

Observe type, quality, and amount of movement or lack of movement; relationship to other factors • Limb withdrawal • Thrashing • Rigidity • Flaccidity • Fist clenching

Stress Fractures

Occur as result of repeated muscle contraction Often seen in repetitive weight-bearing sports (running, gymnastics, basketball) Tibial fracture most common Symptoms Therapeutic management

Orthopedic Infections

Osteomyelitis Inflammation and infection of bony tissue May be caused by exogenous or hematogenous sources

Otitis Media - Primary observations

Otalgia - earache -Fussiness -Pulling at ears -Sucking increases ear pain -Rolls head from side to side -Decreased appetite •Otorrhea - purulent drainage from ear

Treatment Adenoiditis

PCN •Antipyretics •Analgesics •Nursing measures -Throat lozenges -Saline gargle -Compresses to throat

Nursing Problems OM

Pain •Skin Tissue Integrity •Potential Complications

recurrent pain in children

Pain that is episodic and recurs is defined as recurrent pain —the time frame within which episodes of pain recurs every 3 months or more frequently. -Recurrent pain syndromes in children include: --migraine headache, --episodic sickle cell pain, --recurrent abdominal pain (RAP), --recurrent limb pain

chronic pain in children

Pain that persists for 3 months or more or beyond the expected period of healing is defined as chronic pain . -Complex regional pain syndrome and chronic daily headache are the most common types of chronic pain conditions in children.

Nephroblastoma Clinical Manifestations

Painless swelling or mass within the abdomen - Mass is firm, non-tender, does not cross midline and deep within the flank (may have bilateral masses if both kidneys involved) DO NOT PALPATE Other manifestations occur secondary to compression from the mass - Hematuria - Anemia s/t hemorrhage within the tumor or persistent hematuria (pallor and lethargy) - Hypertension s/t over excretion of renin - Weight loss and fever Could metastasize → lung involvement (dyspnea, cough, SOB, CP)

Pharmacologic Interventions—Strep

Penicillin Oral Needs 10-day treatment to decrease risk of rheumatic fever and glomerulonephritis post strep Issues with medication compliance IM: Penicillin G Resolves compliance issue (one injection) Painful injection Penicillin G procaine is less painful injection CANNOT give penicillin G by IV route Erythromycin if penicillin allergy Other antibiotics Really have to educate

The nurse notes that a child's gums bleed easily and he has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms?

Platelet count of 19,000/mm3

What fluid is the best choice when a child with mucositis asks for something to drink?

Popsicle

Airway maintenance

Positioning - in Fowler's position •Nasal suctioning •Aerosol treatments followed by P&PD •Supportive devices -O2 -humidity -apnea monitor •Eye, ear, nose drops •Encourage parents to stay with child

Hematogenous Osteomyelitis

Preexisting infection spreads to bone Source may be furuncles, skin infections, URI, abscessed teeth, pyelonephritis, etc. Any organism can cause osteomyelitis Infective emboli travel to arteries in the bone metaphysis, causing abscess formation and bone destruction

Osteosarcoma Therapeutic management

Preoperative Chemotherapy Surgical resection or amputation may be needed

Injuries and Health Problems Related to Sports Participation

Preparation for sports AAP classification of sports according to strenuousness and probability of collision AAP guidelines for inclusion or exclusion from specific sports based on medical and/or surgical condition of child

Family teaching

Prepare for discharge •Classes for CPR and apnea monitoring •Stress importance for following through on all meds -antibiotics should be taken until gone •Refer to appropriate health agencies

Asthma Treatment Goals

Prevent acute exacerbations Prevent disability Minimize physical and psychologic morbidity Help child live as normally as possible

Therapeutic Management of OI

Primarily supportive care Drugs Bisphosphonate therapy with pamidronate, olpadronate, neridronate, or alendronate Promote bone density and prevent fractures May rule out OI if multiple fractures occur Nursing care management Caution with handling to prevent fractures Family education and support Occupational planning and home support Genetic counseling

Health Promotion/ Disease Prevention

Primary Avoid allergens Leukotriene Modifiers Secondary Peak Flow meter Tertiary Learn to live productively with asthma Support groups - Kid's camps

Legg-Calvé-Perthes Disease (Cont.)

Prognosis Self-limited disease Outcome has wide variations due to multiple factors Therapeutic management Nursing care management Identification of affected children and referral Teaching care and management Compliance issues with child/family

Prolactin is inhibited by what hormone?

Prolactin release inhibiting hormone (PRIH)

How can you care for a dying child & the child's family?

Provide privacy -- do not put them in a shared room Keep the family routine Give attention to the siblings of the dying child (involve a child life expert)

What are the Adrenal glands?

Pyramid-shaped glands located on top of each kidney.

Therapeutic Management of Sports Injuries

RICE Rest the injured part Ice immediately (max 30 minutes at a time) Compression with wet elastic bandage Elevation of the extremity ICES—Ice, Compression, Elevation, Support Immobilization and support (casts or splints as appropriate to injury)

Tx for soft tissue injuries?

RICE: rest, ice immediately up to 30 min, compression by wet elastic bandage, and elevation; immobilize and support

intussusception immunocompromised What immunization contraindications?

RV

irritability mild, temporary diarrhea or vomiting What immunization creates this side effect?

RV

a nurse is planning to administer immunizations to a 2 month infant. Which of the following should the nurse anticipate giving? (select all that apply) A. RV B. DTaP C. Hib D. Hep A E. PCV F. IPV

RV DTaP Hib PCV IPV

Vaccines that should be administered at 4 months

RV, DtaP, Hib, PCV, IPV

Vaccines administered at 6 months

RV, DtaP, Hib, PCV, IPV (6-18 months), Hep B

Vaccines that should be administered at 2 month well baby check up

RV, DtaP, Hib, PCV, IPV, Hep B

Psychological implications

Reduce anxiety in child •Involve parents •Familiarize with equipment

Signs of SEVERE Respiratory Distress in Children with Asthma

Remains sitting upright, refuses to lie down Sudden agitation Agitated child who suddenly becomes quiet Diaphoresis Pale Inability to talk/speak in full sentences Know this

Status Asthmaticus

Respiratory distress continues despite vigorous therapeutic measures Concurrent infection in some cases Therapeutic intervention ALBUTEROL Emergency treatment—epinephrine 0.01 ml/kg subQ (maximum dose 0.3 ml) IV magnesium sulfate IV ketamine IV corticosteroids Continuous neb of albuterol Watch that heart rate Potassium and blood level go down: lead to cardiac effect Can effect the heart Magnesium relaxs the muscle: watch can stop breathing

Morbidity

Respiratory problems are the MOST COMMON cause of illness in infancy and childhood. •Average of 4-5 infections per year

Why do Newborns and infants have the greatest risk for developing respiratory problems?

Respiratory system relatively small (even in full term babies) •Increased amount of dead air space in lungs of infants - accounts for rapid rate •Immature immune function •Closer proximity of respiratory structures •Greater body surface area - greater insensible water loss through respiratory effort •Risk of aspiration - greater in infants and children

Increased Viscosity of Mucous Gland Secretion

Results in mechanical obstruction Thick, inspissated mucoprotein accumulates, dilates, precipitates, coagulates to form concretions in glands and ducts Respiratory tract and pancreas are predominantly affected

What is a priority nursing diagnosis for the 4-year-old child newly diagnosed with leukemia?

Risk for Infection related to immunosuppressed state

Nursing Diangosis

Risk for injury/medication safety Chemotherapy and N/V fluid/electrolyte balance Neutropenia: risk for infection Anemia: activity intoelerance Thrombocytopenia: risk for bleeding Chemotherapy and radiotherapy: altered comfort, N/V and imbalance nutrition < body requirements Surgery/steroids: altered body image Hemorrhagic cystitis: impaired urinary elimination Disease process: pain (acute/chronic) Disease process: pain (acute/chronic) Family considerations: interrupted family process, ineffective coping, anticipatory grieving

Are large or small amounts of hormones needed to get desired response?

Small amounts. Hormones are very potent and have long-lasting effects in target cells.

What is another name for the growth hormone?

Somattropin (STH)

TX for right lower lobe pneumonia with discomfort on the right side

Splinting of the affected side by lying on that side may decrease discomfort.

Slipped Capital Femoral Epiphysis (SCFE)

Spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction Occurs shortly before or during accelerated growth periods or puberty Usually idiopathic, multifactorial Obesity, puberty hormone changes, bone changes

Asthma Severity Classification in Children 5 Years and Older

Stage I—mild, intermittent asthma Stage II—mild, persistent asthma Stage III—moderate, persistent asthma Stage IV—severe, persistent asthma Clinical features of each classification

How is it diagnosed?

Staging - Type, severity and spread of cancer cells at the time of diagnosis - Stage 1 is best prognosis as disease limited to the primary site and highest stage of classification means extensive metastasis is present, so often leads to poor prognosis - Various tests may be needed to determine actual stage Nursing Considerations for the testing is that most are painful, so consider conscious sedation for most procedures

What does the growth hormone do?

Stimulates increase in size and rate of body cells (mitosis). Controls growth of the body. Promotes growth of long bones , muscles, and other tissues.

What does glucagon do?

Stimulates liver to breakdown glycogen. Stimulates liver to convert noncarbohydrates into glucose. Stimulates break down of fats. Increases blood glucose levels.

Brain tumor therapeutic management

Surgery - total removal/debulking of tumor with goal of minimal residual neurologic damange Radiotherapy - Used to treat most tumors to reduce tumor burden before surgical removal and for palliative symptom management Chemotherapy - Can be used in combination with surgery and/or radiation Establish baseline to compare preoperative and postoperative changes is essential -Long term SE: infection, seizures requiring tx, neurological deficits, hydrocephalus (requires VP shut), and potentially endocrine (DI vs SIADH)

Myringotomy and Tubes (MAT)

Surgery performed for chronic OM with effusion •Never used as first line treatment, but only after conservative methods have been tried •Myringotomy - incision into the tympanic membrane •Tubes - small teflon tubes placed in area of eardrum not instrumental for hearing -Sometimes called PE tubes - pressure equalizer tubes -Tubes facilitate drainage and allow ventilation of middle ear Surgery may be done under local or general anesthesia - most are done under general •Tubes fall out after 6-12 months •While in place - children should avoid getting water in ears -Physician preference varies regarding water in ears •Ear wicks should be prevented from getting wet after surgery

Hormones activate which cells?

Target cells which are identified by specific receptors for the hormone to bind to.

Therapeutic Management

Team approach to treatment Bracing Exercise Surgical intervention for severe curvature (various systems of instrumentation and fusion) Harrington, Dwyer, Zielke, Luque, Cotrel-Dubousset, Isola, TSRH (Texas Scottish Rite Hospital), and Moss Miami

Describe the Somogyi effect and its treatment.

The Somogyi effect may occur at any time but often entails an elevated blood glucose level at bedtime and a drop at 2 am, with a rebound rise following. The treatment for this phenomenon is decreasing the nocturnal insulin dose to prevent the 2 am hypoglycemia. The rebound rise in the blood glucose level is a result of counterregulatory hormones (epinephrine, growth hormone, and corticosteroids), which are stimulated by hypoglycemia.

What does the hypothalamus connect?

The endocrine and nervous system.

Biliary atresia causes

The exact cause of biliary atresia is unknown, although immune- or infection-mediated mechanisms may cause the progressive process. Early diagnosis is critical; the outcome in children surgically treated before 2 months of age is much better than in patients with delayed treatment.

The nurse should base a response to a parent's question about the prognosis of acute lymphoblastic leukemia (ALL) on the knowledge that

The majority of children go into remission and remain symptom free when treatment is completed.

Hodgkin's Disease Patho

The malignancy originates in the lymphoid system and primarily involves the lymph nodes It metastasizes to non-nodal or extra-lymphatic sites especially like the spleen, liver, bone marrow, lungs, and mediastinum but it can really spread to any system Diagnosis demonstrates + Reed-Sternberg cell (large abnormal lymphocyte) from the lymph node. Differentiates it from NHL but other virus can have Reed Sternberg cells (EBV)

Scoliosis

The most common spinal deformity Complex spinal deformity in three planes Lateral curvature Spinal rotation causing rib asymmetry Thoracic hypokyphosis May be congenital or develop during childhood

Treatment: Chemotherapy

This is the primary form of treatment for most of the pediatric cancers. Protocols- combinations used to maximize lethal impact at the different stages of cellular mitosis. They allow for optimum cell-cycle destruction with minimum toxic effects and decreased resistance by the cancer cells. - VAC -vincristine (plant alkaloid that arrest cells in the metaphase of mitosis), - doxorubicin (antibiotic that reacts with DNA and prevents replication), - cyclophosphamide (an alkylating agent causes unbalanced growth leading to cell death by replacing a H+ ion with alkyl group). - Another common agent is methotrexate (antimetabolites resemble metabolic elements needed for cell growth but are altered in structure to inhibit further synthesis of DNA/RNA). Needs to be given via a central line; this lessens the chance of skin or tissue damage from infiltration/extravasation. Understanding drug action and side effects are important (see notes). This allows the nurse to anticipate pt. symptoms because almost all drugs show no selective cytotoxicity for malignant cells, it affects all cells with high rate of proliferation such as bone marrow, hair, skin, and epithelial cells of the GI tract. Leads to the SE needing more nursing care than the cancer.

What two causes is terminal diagnosis categorized into? Define both of these terms.

Trauma: caused by outside forces. Can be accidental (car accident, drowning) or non-accidental (intentional injury, abuse) AND Physiologic: caused by physiologic forces within the body. i.e. diseases (cancer) & congenital defects (Edwards syndrome)

Alteration in serum and tissue potassium can lead to cardiac arrest. T or F

True

Insulin is needed for the entry of glucose into the muscle and fat cells. T or F

True

Urinary fluid losses cause the excessive thirst (polydipsia) observed in diabetes. T or F

True

When the glucose concentration in the glomerular filtrate exceeds the renal threshold (6180mg/dl), glucose spills into the urine (glycosuria), along with an osmotic diversion of water (polyuria), which is a cardinal sign of diabetes. T or F

True

Non-Hodgkin Lymphoma patho

Tumors originating from malignant disorders of the lymphoreticular system. The disease can also spread to other parts of your lymphatic system. These include the lymphatic vessels, tonsils, adenoids, spleen, thymus and bone marrow

The most common organic cause of pituitary undersecretion

Tumors, especially craniopharyngiomas, in the pituitary or hypothalamic region

characterized by destruction of the pancreatic cells, which produce insulin; this usually leads to absolute insulin deficiency. Type 1 DM has two forms. Immunemediated DM results from an autoimmune destruction of the cells; it typically starts in children or young adults who are slim, but it can arise in adults of any age. Idiopathic type 1 refers to rare forms of the disease that have no known cause.

Type 1 diabetes

arises because of insulin resistance, in which the body fails to use insulin properly, combined with rel- ative (rather than absolute) insulin deficiency. People with type 2 can range from being predominantly insu- lin resistant with relative insulin deficiency to being predominantly deficient in insulin secretion with some insulin resistance. It typi- cally occurs in those who are over 45 years of age, are overweight and sedentary, and have a family history of diabetes.

Type 2 diabetes

Classification of OI—Type I

Type I-A—mild bone fragility, blue sclera, normal teeth, presenile deafness Type I-B—same as A except with abnormal dentition Type I-C—same as B but no bone fragility Two thirds of all cases are type I

Classification of OI—Type IV

Type IV-A—mild to moderate bone fragility, normal sclera, short stature, variable deformity, autosomal dominant Type IV-B—same as A except abnormal dentition (dentinogenesis imperfecta) Approximately 6% of OI cases are type IV-B

Asthma Types and Categories

Types Recurrent wheezing usually precipitated by a viral respiratory tract infection (e.g., RSV) Chronic asthma associated with allergy persisting into later childhood and often adulthood Associated with girls who develop obesity and early-onset puberty by age 11 Cough-variant asthma Categories Intermittent, mild persistent, moderate persistent, and severe persistent

Bone Healing and Remodeling

Typically rapid healing in children Neonatal period—2 to 3 weeks Early childhood—4 weeks Later childhood—6 to 8 weeks Adolescence—8 to 12 weeks

Diagnosis of UTI

UA for hematuria WBCs nitrites culture

Diagnosis for Nephrotic Syndrome

UA for protein- 3+ to 4+ may reveal up to 15 g protein hematuria

Risk of kidney damage increase with:

UTI in infant less than 1 year of age delay in diagnosis and effective antibacterial treatment for an upper UTI anatomic obstruction of nerve supply interruption recurrent episodes of upper UTI

Acute Leukemia Therapeutic Management

Use of IV chemotherapeutic agents with tx divided into phases to achieve remission CNS prophylactic therapy - Children with leukemia are at an increased risk for invasion of the CNS by the leukemic cells - Radiation is sometimes used for resistant CNS disease or testicular relapse Bone marrow transplantation can be done if relapse occurs - NOT recommended for children at ALL during the first remission b/c of the excellent results possible with chemo

Behavioral Contracting Formal:

Use written contract, which includes: • Realistic (seems possible) goal or desired behavior • Measurable behavior (e.g., agrees not to hit anyone during procedures) • Contract written, dated, and signed by all persons involved in any of the agreements • Identified rewards or consequences that are reinforcing • Goals that can be evaluated • Commitment and compromise requirements for both parties (e.g., while timer is used, nurse will not nag or prod child to complete procedure)

Child in a Cast

Used for immobilization to promote healing and ensure proper alignment Nursing care management Application Progress of healing Assessment Support skin and circulation Support family and ADLs Removal

Child in Traction

Used in severe or complex injuries Types: Skin Skeletal Nursing care management Never released by the nurse unless emergency or under direct supervision of the provider Careful assessment Pin site care Pain management Support to patient Education and discharge planning with family

Long Term Control Oral Steroids

Used to treat severe persistent asthma Steroids have potential side effects Growth retardation Decreased immunity Osteoporosis Weight gain Hyperglycemia Never stop steroids suddenly or adrenal crisis can result

Biotherapy

Using remodeled monoclonal antibodies to target cancer cells only. Important b/c this can potentially limit SE of therapy - EX: rituximab used to treat non-Hodgkins lymphoma

Pharyngitis

Usually caused by Group A beta hemolytic streptococci •Can lead to more serious problems -Rheumatic Fever -AGN •Abrupt onset •Tonsils and pharynx may be red and covered with exudate

pregnancy cancers of blood and lymphatic system allergy to gelatin neomycin corticosteriods immuosuppressions What immunization can you not have?

Varicella vaccine

Avoidance of Triggers Common Asthma Triggers

Viral illness Upper respiratory tract infections Cold air Environmental irritants Smoke (tobacco or wood) Chemicals Stress Weather Exercise induced asthma Allergies (dust, mold, food, pets, etc.)

Predisposing Factors

Viral infections in infancy predisposes child to asthma Indoor exposure to tobacco smoke has been linked to asthma in children Children with asthma who live in homes where the parents smoke have increased: emergency room visits use of medications recovery times after hospitalization for asthma

Primary Observations Later Warning Signs - Asthma Attack

Wheezing Grunting respirations Paroxysmal cough Dyspnea/Tachypnea breathlessness Unable to complete 1-2 syllables at a time Upright posturing Impaired mucociliary function - mucus plugs Tightness in chest Inability to focus on a task Retractions Diaphoresis

Presentation

Wheezing respiration; dry, nonproductive cough Generalized obstructive emphysema Patchy atelectasis Cyanosis Clubbing of fingers and toes Repeated bronchitis and pneumonia

half adult height by

2 years

looks for objects to hand and back again

4-5 months

plays actively with hand and feet

4-5 months

reaches for objects beyond grasp

4-5 months

separation anxiety

4-8 months

JIA (Cont.)

90% children have negative rheumatoid factor Symptoms may "burn out" and become inactive Chronic inflammation of synovium with joint effusion, destruction of cartilage, and ankylosis of joints as disease progresses

needs praise and recognition, enjoys games with peers of same gender, demonstrates independence

6-7 years

stranger anxiety

6-8 months

STH or GH - target: bones s/s of hypofunction

1) Epiphyseal fusion with cessation of growth 2) Prepubertal dwarfism 3) Generalized growth retardation 4) Hypoglycemia

Effect of Testosterone

1) accelerates protein anabolism for growth 2) promotes epiphyseal closure 3) promotes development of secondary sex characteristics 4) plays role in sexual function 5) stimulates testes to produce spermatozoa

Effect on the adrenal medulla

1) produce vasoconstriction of heart and smooth muscles (raise blood pressure) 2) increase blood glucose via glycolysis 3) inhibit GI activity 4) activate sweat glands

Effect of glucocorticoids: cortisol and corticosterone

1) promote normal fat, protein, and carbohydrate metabolism 2) mobilize body defenses during periods of stress 3) suppress inflammatory reacction

thryoxine (T4) and Triiodothyronine (T3) are

2 iodine containing compounds released by the thyroid.

What is the schedule of RV vaccination?

2 months 4 months

What is the schedule of Haemophilus influenza type B (Hib) vaccination?

2 months 4 months 12-15 months

What is the schedule of DTaP vaccination?

2 months 4 months 6 months 15-18 months 4-6 years 11-12 years booster every 10 years

What is the schedule for PCV vaccine?

2 months 4 months 6-18 months 4-6 years

The pituitary is divided into how many sections?

2 sections. The anterior and the posterior.

initiative vs

guilt

fever and sore throat malaise and poor appetite painful sores in mouth, blisters that become ulcers skin rash that is flat or raised red spots usually on hands soles of feet

hand, foot, and mouth disease

General signs of obstruction in the GI tract

include colicky abdominal pain, nausea and vomiting, abdominal distention, and decreased stool output.

what age grous reacts more severely to acute respiratory infections?

infants and young children 6 months and 3 years old

Balanoposthitis

infection of glans penis

industry vs

inferiority

Complications of uncorrected Cryptorchidism

infertility malignancy if not corrected the higher temperature in the abdomen than in the scrotum results in morphologic changes to the testis that are apparent by 18 months of age

What is osteomyelitis?

inflammation and infection of bony tissue

What does insulin do?

Promotes formation of glycogen from glucose. INhibits conversion of noncarbohydrates into glucose. Enhances movement of glucose into adipose and muscle cells. Decreases blood glucose levels. Enhances synthesis of proteins and fats.

What is caused by decreased levels of GH?

dwarfism

Symptoms of lower UTI in school age child

dysuria enuresis hematuria strong smelling urine diarrhea frequency or hesitancy mood changes abdominal pain suprapubic or flank pain dehydration

complications of rubeloa?

ear infections pneumonia diarrhea encephalitis death

assessing respiratory system

ears nose mouth and throat chest lungs

Enuresis can be result of

familial tendencies difficulty in arousing decreased bladder capacity abnormal circadian rhythms abnormalities of urethra developmental delays sleep apnea

Osteosarcoma

Cancer originating in the bone (osteoid tissue). Cells look like normal bone cells, but the bone tissue is not as strong as normal bone tissue Possible mutation in tumor suppressor gene TP53

How are fractures diagnosed?

xrays

Effects of Melanocyte-stimulating hormone (MSH) - target: skin

promotes pigmentation of skin

binocular vision 20/40

19-30 months

brushes teeth w/supervision

19-30 months

sips and hops on one foot, throws ball overhead

4 years

What causes cancer

1. Immune disorders 2. Chromosome abnormalities 3. Genetic base

What is ACTH controlled by?

Corticotropin -releasing hormone

Otitis Externa

"Swimmer's ear" Infections of the external ear canal Etiology: Staphylococcus or Corynebacterium Clinical manifestations Nursing care management Outside of ear

Torticollis

"Wry neck" Congenital or acquired limited neck motion with neck flexed to affected side Long-term effects Physical therapy Nursing care management

Diclofenac

-0.5-0.75 mg/kg q 6-12 h PO -Maximum 3 mg/kg day or 200 mg/day

Indomethacin

-1-2 mg/kg q 6-12 h -Maximum 4g/kg/day or 200 mg/day

Effects of thyrocalcitonin

1) regulates calcium and phosphorus metabolism 2) influences ossification and development of bone

Identify the three principal microvascular complications of diabetes.

1. Nephropathy 2. Retinopathy 3. Neuropathy

Antimicrobials

1. Penicillins 2. Cephalosporins 3. Sulfonamides -

jumps with both feet

13-18 months

can hold and mark with a crayon

10-12 months

can place small objects into a container

10-12 months

can self feed finger foods

10-12 months

can turn multiple pages in a book

10-12 months

abstract thinking, write a story, influenced by TV, radio, knows limits, like to discuss and debate, aware of effect on others

10-12 years

catches a fly ball, balance on one foot for 15 sec

10-12 years

rules are important interest in opposite sex, developing social competency, respects parents, obedient

10-12 years

concepts of object permanence developed, speaks 10 words

18 months

drink from cup wihout spilling

18 months

how much output is sufficient for a child who weighs less than 30kg

1ml/kg/hour

Vaccines that should be administered between 12-23 months

1st dose of Hep A (2nd dose 6 months after 1st)

speaks 2-3 word sentences 50% words understandable

24 months

How long does it take Hip spica cast to dry?

24-48 hours, newer casts take 5-20 min to dry and are lighter

TEF manifestations

3 C's: 1. coughing 2. choking 3. cyanosis if fed- infant may swallow normally but suddenly cough and gag --> fluid through nose and mouth

holds rattle by

3 months

when does infection rate increase?

3 to 6 months period between maternal antibody disappearance and the infants own antibody production.

balance on one foot for a few seconds and alternate feet going upstairs

3 years

will give first and last name by

30-36 months

name body parts, gives full name, speaks 3 to 5 word sentences

36 months

rolls from abdomen to side

4 months

rolls from belly to back

5 months

draws a person with at least 6 parts, ties shoe laces

5 years

walk backward heel-to-toe, skips on alternate feet and jumps rope

5 years

by what age are viral respiratory tract infections less frequent?

5 years old but... incidence of Mycoplasma pneumoniae and GABHS infections increase.

Vaccine time allotted for 3rd dose IPV & Hep B

6-18mos

holds bottle

6-7 months

transfer object between hands

6-7 months

learning to tell time, know value of currency

6-7 years

legibly prints letters, rides 2 wheel bike, bathe and dress self, use knife, fork, and spoon

6-7 years

Influenza vaccine can be given starting at what age?

6 months

begin to use a cup

6 months

rolls from back to belly

6 months

Home Care tonsillectomy

7-10 day activity restriction •Pain medications •T&A diet according to Dr's preference -Decreased milk -Soft, non coarse foods •Parents should call the Dr if child -develops a fever > 101 -Vomits bright red emesis

sits alone without support

7-8 months

What is the pituitary gland?

A two-lobed organ (front and back) that secretes major hormones.

Epiglottitis

A type of croup syndrome •Most common in children 2-5 years •Most commonly caused by H. Influenza type B (haemophilus influenza - HIB)

A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) A. Vital signs B. Throat culture C. Medical history D. Assessment of breath sounds E. Emergency airway equipment readily available

A, C, D, E

The nurse observes a 10-month-old infant using her index finger and thumb to pick up pieces of cereal. This behavior is evidence that the infant has developed: a. the pincer grasp. b. a grasp reflex. c. prehension ability. d. the parachute reflex.

ANS: A By 1 year, the pincer-grasp coordination of index finger and thumb is well established.

What is the leading cause of death for pediatrics?

Accidents & unintentional injuries

Hyperpituitary causes this

Acromegaly

Primary prevention

Actions taken to prevent health problems •Reduces probability of occurrence of disease by the inclusion of specific protection mechanisms •Examples: -Prenatal care -Education to prevent teen pregnancy - Handwashing -Immunizations

JIA (Cont.)

Actually a heterogeneous group of diseases Pauciarticular onset (involves ≤4 joints) Polyarticular onset (involves ≥5 joints) Systemic onset (high fever, rash, hepatosplenomegaly, pericarditis, pleuritis, lymphadenopathy)

Infectious Mononucleosis

Acute, self-limiting infection; common in younger than 25-year-olds Etiology: EBV principal cause Clinical manifestations Diagnostic evaluation CBC Monospot Therapeutic management Nursing considerations Avoid contact sports to protect spleen from injury Pass by saliva

What is the anterior pituitary?

Adenohyphophysis. Upward projection of pharynx. Made of glandular tissue. Produces and releases hormones.

At which age does the child have the most trouble with the concept of death?

Adolescents > 12; they often understand better what they are losing

American College of Rheumatology Diagnostic Criteria

Age of onset younger than 16 years One or more affected joints Duration of arthritis more than 6 weeks Exclusion of other forms of arthritis

Nursing Concerns—Post-Op Tonsillectomy

Airway Positioning Bleeding Observation—frequent swallowing? Prevention of recurrent bleeding HOB elevated Maintain quiet environment Minimize agitation/crying NO suctioning Comfort Position them 90 degrees to help swelling Ice collar Med to help: steroids depends how severe Ibuprofen Risk for dehydration is huge Frequent swallowing is key can lead to tonsil bleeding Hydration

Differentiating Between "Allergies" and "Colds"

Allergies occur repeatedly and are often seasonal Allergies are seldom (not often) accompanied by fever Allergies often involve itching in the eyes and nose Allergies usually trigger constant and consistent bouts of sneezing Allergies are often accompanied by ear and eye problems Know this

What are the 2 types of pancreatic cells?

Alpha cells, secrete glucagon. Beta cells secrete insulin.

What changes take place in a cell when a hormone causes the opening or closing of ion channels?

Alters plasma membrane permeability and/or changes membrane potential.

nonsteroids are produced from what?

Amino acids, protein based

Celiac disease

An absorptive defect characterized by intolerance to gluten. It is thought to be either an inborn error of metabolism or an immunologic response

Plan of Care / Implementation- OM

Antibiotics •Analgesics •Antipyretics •Heat or ice to ear for comfort •Lay on affected side to facilitate drainage •Cleanse external ear with sterile q-tips & peroxide •Moisture barriers to external ear (Aloe Vesta, Vaseline

Fever reduction

Antipyretics - lower set point of hypothalmus - relieve discomfort • Minimal clothing • Expose skin to air • Decrease room temperature • Increase circulating air • Cool compresses to head Sponge bath - usedcautiously only if other measures not working • Most appropriate for hyperthermia • If used for hyperpyrexia(fever), MUST be used only in conjunction with antipyretic

CDH

It can be a problem Respiratory distress

Nursing Care Management

Assessment GOAL: Promote healing, prevent injury or complications Pulses, CRT, skin color, and temperature Palpation of cast for hot spots Alleviate pressure on nerves, treat pain Compartment syndrome Promote nutrition and hydration Support growth and development Support family system

A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT). The donor is the child's own umbilical cord blood that had been previously harvested and banked. This type of BMT is termed

Autologous

An immediate intervention to teach parents for when an infant chokes on a piece of food would be to A. have infant lie quietly while a call is placed for emergency help. B. position infant in a head-down, face-down position and administer five quick back slaps. C. administer mouth-to-mouth resuscitation. D. give some water by a cup to relieve the obstruction.

B

The most appropriate time to perform bronchial postural drainage is A. immediately before all aerosol therapy. B. before meals and at bedtime. C. Immediately on arising and at bedtime. D. thirty minutes after meals and at bedtime

B

Complications of phimosis

Balanoposthitis Paraphimosis

Acute LTB - Primary Observations

Barking or seal-like cough •Coryza •Hypoxia •Respiratory acidosis

Primary Observations Chronic Symptoms

Barrel chest Prominent sternum Hunched shoulders

Why is it important to assess the parental history in children with constitutional growth delays?

Because these children frequently have parents who experienced similar slow growth patterns and delayed sexual maturation

Early Phase Treatment

Beta adrenergic agonists - Bronchodilators Relax bronchial smooth muscles Inhibit vascular permeability Decrease mast cell degranulation Increase water influx into mucus Increase ciliary action Purse lip breathing Epinephrine subcutaneously or inhaled Theophylline (aminophylline) po or IV

Quick Relief Rescue Medications

Beta-Adrenergic Agonists - Short acting bronchodilators Anticholinergics (Atrovent)

Pharmacological Agents Rescue Medication

Beta-Adrenergic agonists Relieves symptoms such as coughing, shortness of breath. Relaxes the airways and bronchodilates. Should be used ONLY for an impending asthma attack, not every day.

What is schedule for Hep B vaccinations?

Birth 1-2 months 6-8 months

Action of Leukotriene Modifiers

Block inflammation and bronchospasm produced by the release of leukontrienes during the inflammatory process Alternative to low-dose inhaled steroids in mild-moderate persistent asthma Initial therapy or add-on therapy with patients of poorly controlled asthma With an inhaled steroid in patients requiring higher steroid doses, to reduce these doses in patients with mild-moderate persistent asthma. They do not help in an acute asthma attack Example of Leukotriene Modifier - Singulair

What are the 3 factors that target cell activation depends on?

Blood levels of the hormones. Number of receptors on the target cells. MOre receptors = greater response. The affinity of those receptors for the hormone. *number of receptors on target cells may change.

Brain tumor patho

Brain tumors in general are a neoplasm arising from a cell in the cranium and can include glial cells, nerve cells, neuroepithelium, cranial nerves, blood vessels, pineal glands, and hypophyisis Majority are infratentorial (posterior brain) - s/s of increased ICP frequent

OM and Infant Feeding Methods

Breast-fed infants have less OM than bottle-fed infants Immunoglobulin A Position in breast-feeding may decrease reflex in eustachian tubes

Asthma Interventions

Breathing exercises and physical therapy Chest physiotherapy (CPT) Hyposensitization Prognosis

Bronchodilators

Bronchodilators may be administered via oral or inhalation routes. Xanthines, ie. Theophylline (Aminophyllin, Bronchodyl, Elixophyllin, Slo-Bid, TheoDur, Theo-24, Quibron T., Uniphyl) Side Effects: Palpations, nausea, vomiting, weakness, dizziness, chest pain, convulsions. Watch for drug interactions - Theophylline should not be used with Cimetidine (Tagamet), Allopurinol, Oral Contraceptives, Flu Vaccine, or large amounts of caffeine. Some xanthines come in time released preparations and should not be crushed or chewed.

Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary? A. C, D B. A, E, K C. A, D, E, K D. C, folic acid

C

a nurse is preparing to administer varicella to an adolescent. Which of the following questions should the nurse ask to determine whether there is a contraindication to administering the vaccine? A. do you have egg allergy B. have you every had encepolopathy following an immunization C. are you currently taking corticosteriods D. do you have a hypersensitivity to yeast?

C. are you taking corticosteriods

Which tool measures body fat most accurately? a. Stadiometer b. Calipers c. Cloth tape measure d. Paper or metal tape measure

Calipers are used to measure skinfold thickness, which is an indicator of body fat content. Stadiometers are used to measure height. Cloth tape measures should not be used because they can stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made. DIF: Cognitive Level: Understand REF: p. 80 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Clinical manifestations are indicative of hyperfunction of the adrenal gland (Cushing syndrome).

Centripetal fat distribution, "moon" face, muscular wasting, thin skin and subcutaneous tissue, poor wound heal- ing, increased susceptibility to infection, decreased inflammatory response, excessive bruising, petechial hem- orrhages, facial plethora, reddish purple abdominal striae, hypertension, hypokalemia, alkalosis, osteoporosis, hypercalciuria and renal calculi, psychoses, peptic ulcer, hyperglycemia, virilization, amenorrhea, and impotence

Pathophysiology

Characterized by several unrelated clinical features Respiratory system GI system small intestine Pancreas Bile ducts Growth patterns Reproductive system Skin

Quality pt Outcomes for Cancer Children

Child and family educated on disease and tx Tx admin on schedule with appropriate drug doses SE of tx managed Tx complications prevented Child and family coping skills supported Quality of life during tx maintained Child and family adjusted to chronic illness Growth and development maintained during tx General nursing care plan

Special issues with childhood survival: Secondary malignancies

Child is a risk for bone and soft tissues tumors and Nonhogkins lymphoma

What are steroids produced from?

Cholesterol

Congenital anomalie, ventral curvature of penile shaft

Chordee

Asthma

Chronic inflammatory disorder of airways Bronchial hyperresponsiveness Episodic Limited airflow or obstruction that reverses spontaneously or with treatment Etiology and pathophysiology Swelling and mucous

A sex is assigned to the child with this

adrenogenital hyperplasia that is consistent with the genotype

Post-op Plan of Care/Implementation tonsillectomy

Clear liquids post nausea -NO RED OR BROWN LIQUIDS (except po pain meds that are red) -No straws -No milk, ice cream, etc for first 24 hours •Ice collar •No oral temperature •No vigorous tooth brushing, coughing, clearing throat, gargling, or putting items in mouth Analgesics as ordered •Bedrest until completely awake •No strenuous activity •Most children if less than 2 years are kept in hospital for 23 hours

What is the hypothalamus?

Collection of specialized cells located in the lower central part of the brain. Not a gland, part of the brain.

Nephroblastoma Therapeutic Management

Combined tx w/ surgery chemotherapy Surgery: - Unilateral tumor: resection of tumor to possible nephrectomy and adjacent adrenal gland - Bilateral tumor bilateral nephrectomy (will require RRT post-operatively) with an attempt to salvage least affected (to provide some renal function) Considerations: - may need chemotherapy pre-op and post-op to shrink tumors or radiating post-operative late stage Educate pt/parents on preotection of the remaining kidney no contact sports and s/s of UTI due to need for prompt tx

Nursing Considerations

Concerns of body image Concerns of prolonged treatment of condition Preoperative care Postoperative care Support of adolescent development Family issues

Decongestants

Consist of adrenergics and topical corticosteroids.

Wong-Baker FACES Pain Rating Scale

Consists of six cartoon faces ranging from smiling face for "no pain" to tearful face for "worst pain" -provides three scales in one: facial expressions, numbers, and words. -Brief word instructions: Point to each face using the words to describe the pain intensity. Ask child to choose face that best describes own pain, and record appropriate number.

What is another name for adrenocorticotropic hormone (ACTH)?

Corticotropin

What is Thyroid Stimulating Hormone (TSH)?

Controls secretions of hormones from the thyroid gland. COntroled by thyrotropin releasing hormone

Late Phase Treatment

Corticosteroids Suppress inflammation and normal immune response Watch for side effects Do not discontinue abruptly Can be given IV, po, IM, or inhaled

Primary Observations Early Warning Signs - Asthma Attack

Coughing - especially at night Runny nose Itchy eyes "Allergic salute" Fussy Anxious Hard to console Peak expiratory flow rate (PEFR) will fall 12-18 hours before wheezing occurs

Adrenocorticotropic hormone (ACTH) - adrenal cortex s/s of hyperfunction

Cushing syndrome

Epiglottitis TX

DO NOT LOOK IN MOUTH WITH TONGUE BLADE UNLESS PREPARED TO INTUBATE •Treatment - intubation and antibiotics •Prevention - HIB vaccine •Epiglottitis is considered a medical emergency - life threatening

Nursing Care for Wilms' Tumor

DO NOT palpate abdomen

contraindicated: an occurrence of encephalopathy 7 days after seizures within 3 days history of uncontrollable, inconsolable crying after prior immunization lasting more then 3 hours, 48 hours after immunization. what immunization?

DTaP

local reaction at the injection site fever irritability crying that cannot be consoled and lasts up to three hours seizures rare- acute encephalopathy What immunization creates this side effect?

DTaP

Vaccine/s at 4y:

DTaP, IPV, Influenza (yearly), MMR, Varicella

What is the child's concept of death at 7-12 years of age?

Death as sad & irreversible but not necessarily inevitable Permanent, but for old people Fear of the process: will it hurt to die? May ask questions again & again to make sense of it

What is the child's concept of death at 2-6 years of age?

Death is a reversible & temporary separation (may have less anxiety) Do not comprehend the "permanentness" of death May view death as a spirit that "comes to get them" -- causes sleep issues & they may be afraid of the dark Still absorb emotions of those around them

What is down-regulation?

Decrease in number of receptors on a target cell due to prolonged increase in the level of hormone.

Presentation (Cont.)

Delayed puberty in females Sterility in males Parents report children taste "salty" Dehydration Hyponatremic/hypochloremic alkalosis Hypoalbuminemia

What are the 5 stages of grief? Is there a specific order that these all happen in?

Denial Anger Bargaining Depression Acceptance No, the grieving child/parent/sibling can go through all these stages at different times. They can also go through two stages at the same time, etc.

What does the FSH stimulate?

Development (maturation) of egg containing follicles in ovaries. Follicular cells to secrete estrogen. production/maturation of sperm cells.

Pharyngitis plan of care and nursing measures

Diagnosed by throat culture •Plan of Care -Oral PCN -Erythromycin or cephalosporin's if allergic to PCN •Nursing Measures -Warm or cold compresses -Saline gargles -Stress importance of taking all of antibiotics

Therapeutic Management and Nursing Considerations

Diagnosis made from blood culture, joint fluid aspirate, and x-rays Treatment goals Prevent destruction of joint cartilage Decompress the joint to maintain circulation to the epiphysis Eradicate the infection Prevent secondary bone infection or hematogenous spread

RSV - Secondary Observations

Diagnosis made on basis of mucus sent to virology lab from aspirations form nasopharyngeal mucus - Nasal Washing

Fractures (Cont.)

Diagnostic Evaluation—x-ray is the most useful diagnostic tool Therapeutic management goals Nursing considerations

Hyperfunction of sex hormones - androgens, estrogens, progesterone

adrenogenital syndrome

Special issues with childhood survival: Bone

Disrupts bone growth and leads to asymmetry, fractures, scoliosis, and kyphosis. Especially a concern during growth spurts

What does the ADH target?

Distal convoluted tubules

How can you communicate with children & families about death as a nurse?

Do not dodge the issue; ask open ended questions {ask the child how they feel}, be available, provide age appropriate info Follow their lead; be patient, repeat info as needed. Be an active & engaged listener Use the word death; avoid clichés, use non-technical terms Deal with your own emotions

What is an appropriate nursing action before surgery when caring for a child diagnosed with a Wilms' tumor?

Do not palpate the abdomen.

Palatine Tonsillitis Primary observations

Drooling or painful swallowing •Elevated temperature •Pus in tonsillar crypts •Bright red, enlarged tonsils

Vaccines that should be given at 15-18 months?

DtaP

Hypopituitary causes this

Dwarfism

Etiology of UTIs

E. coli, Staphylococcus, Klebsiella, Proteus, Pseudomonas aeruginosa, Enterobacter, Enterococcus Urinary stasis enhances risk of UTI- may be caused by an abnormal anatomic structure or abnormal function Neurogenic bladder Vesicoureteral Reflux

Secondary prevention

Early diagnosis and prompt treatment of disease by measures such as screening •Examples: -Screening for streptococcus infections -Teaching parents early S&S to look for

What is the primary nursing responsibility regarding hypopituitarism and hyperpituitarism?

Early identification of children with excessive growth rates

Diagnostic Evaluation

Early infancy screening DNA testing Sweat chloride test Chest radiography History and physical exam

Retinoblastoma Tx

Early stage needs unilateral irradiation and cryotherapy. There is an attempt to preserve useful vision in the affected eye with need to continue monitoring eye health because it can become bilateral. In bilateral disease, the attempt is to preserve useful vision in least affected eye. Advanced tumor requires enucleation (removal of eye). If enulcleation needed, then discussion surrounding child appearance post-op. Teach socket care and the use a conformer to help keep socket shape while awaiting the prosthesis. Once prosthesis in place, need teaching surrounding cleaning and what happens with accidental dislodgement. Later the child can do this task.

Fractures

Epiphyseal Injuries Weakest point of long bones is the cartilage growth plate (epiphyseal plate) Frequent site of damage during trauma May affect future bone growth Treatment may include open reduction and internal fixation to prevent growth disturbances

Antipyretics

Examples: Acetaminophen, Ibuprofen Pediatric concerns - give correct dose for age and weight

How does a nonsteroid enter a cell?

Facilitated diffusion. Requires a receptor on the target cell membrane.

Kussmaul respirations are characteristic of respiratory acidosis. T or F

False

Type 2 DM is the predominant form of diabetes in the pediatric age group, and type 1 diabetes is less common. T or F

False

Hyperpyrexia

Fever • An elevation in set point such that body temperature is regulated at a higher level. Usually above 100.4 F (38 C) • Treated with antipyretics

fever, runny nose, headache red rash on face (slapped cheek) secondary itchy rash may appear on rest of body, especially on soles of feet

Fifth disease

use of dolls in long term pain control

For long-term pain control, offer the child a doll, which represents "the patient," and allow child to do everything to the doll that is done to them; emphasize pain control through the doll by stating, "Dolly feels better after the medicine."

Clinical Manifestations of Fracture

Generalized swelling Pain or tenderness Diminished functional use May have bruising, severe muscular rigidity, crepitus

Etiology/Incidence Asthma

Genetic predisposition 6.5 % risk for children to develop asthma if neither parent has asthma 19 % risk for children to develop asthma if one parent has asthma 63.6 % risk for children to develop asthma if both parents have asthma #1 reason for school absences 3rd leading cause of hospitalizations in children Can onset at any age, but 80-90% have symptoms by age 4 or 5 Boys affected more than girls until adolescence. Then trend reverses

The nurse would advise a mother who is concerned because her 10-month-old is lethargic to__________.

Go to the Emergency Department

What are adrenal androgens?

Gonadocorticoids located in the zona reticularis. Supplement sex hormones from the gonads. May be converted to estrogen after menopause. COntribute to onset of puberty, appearance of secondary sex charateristics. Sex drive in females.

What is FSH controlled by?

Gonadotropin-releasing hormone (GnRH)

What stimulates secretion of the growth hormone?

Growth hormone releasing hormone (GHRH)

mild local reaction and fever fainting (shortly after receiving) headache what immunizations causes these side effects

HPV2 and HPV4

Diseases prevention

Health Promotion •Strategies to improve or maintain the healthful state of individuals, families, and communities Disease Prevention •Strategies developed to avoid disease

What happens when epinephrine and norepinephrine are released?

Heart rate and blood pressure increase, vasoconstriction. respiratory airways dilate, increases depth of breathing. blood glucose level increases, metabolic rate increases.

What is the antidiuretic hormone? (ADH)

Helps to help avoid dehydration or water overload

Vaccine/s at 12m:

Hep A, Hib, PCV, MMR, VAR

Vaccine/s at birth:

Hep B

allergy to bakers yeast: what immunization can you not have?

Hep B

Vac at 1m

Hep B (1-2mos)

Vaccine/s at 2m:

Hep B, Rota, DTaP, Hib, PCV, IPV

Vaccine/s at 6m:

Hep B, Rota, DTaP, Hib, PCV, IPV, Influenza (yearly)

Developmental Dysplasia of Hip (DDH)

Hip instability after birth High association with breech delivery Pathophysiology Diagnostic evaluation Ortolani and Barlow tests (universal screening until walking) Galeazzi sign Older children with limp, leg discrepancy Radiographic exam

What does the placenta secrete?

Human chorionic gonadotropin(hCG)

What is another name for the pituitary gland?

Hypophysis

Tx for osteomyelitis?

IV antibiotics for 3-4 weeks to several months,

Immune Disorders

Immunodeficient child more likely to develop various cancers like lymphoma. This can be from AIDS, after solid organ transplant, or previous cancer Virus or apoptosis allows pro-oncogens become onocogene sometimes due to lack of tumor suppressor genes

Bacterial Tracheitis

Infection of mucosa of upper trachea - can resemble both LTB and Epiglottitis •Symptoms similar to LTB but unresponsive to LTB therapy •Thick purulent tracheal secretions common •Respiratory difficulty secondary to copious secretions. •Treated with O2 therapy, antipyretics and antibiotics •May require intubation and mechanical ventilation.

Bacterial Tracheitis

Infection of the mucosa of the upper trachea Distinct entity, features of croup and epiglottitis in older children (5-7 yrs) Clinical manifestations Thick, purulent secretions Respiratory distress Stridor May develop life-threatening obstruction or respiratory failure Life threatening Know signs and symptoms

fever sore throat swollen lymph glands increased WBC atypical lymphocytes splenomegaly enlarged liver

Infectious Mononucleosis

Exogenous Osteomyelitis

Infectious agent invades the bone following penetrating wound, open fracture, contamination in surgery, or secondary extension from an abscess or burn

Bronchiolitis

Inflammation of fine bronchioles and small bronchi •Most common in children < 2 years with peak incidence at 6 months •Some children may develop asthma after having bronchiolitis during the first year of life

Pneumonia

Inflammation of the alveoli and pulmonary insterstitium. •Classified by part of lung affected -Lobar - can affect part of or all of a lobe -Lobular - terminal bronchioles and nearby lobules -Interstitial - Alveolar walls •Pneumonitis - localized acute inflammation of the lung without toxemia associated with lobar pneumnonia

What should the nurse teach parents about oral hygiene for the child receiving chemotherapy?

Inspect the child's mouth daily for ulcers.

What are the most common causes of hypoglycemia?

Insulin reactions; bursts of physical activity without additional food; or delayed, omitted, or incompletely consumed meals

The rate of action for Neutral protamine Hagedorn (NPH)

Intermediate acting

JIA—Management

JIA—Management

Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS). The nurse should assess for

Kidney failure

Neuroblastoma Clinical Manifestations

Last test: urine/blood for catecholamine produced by the cells Depends on location and stage of the disease Abdominal: firm, non-tender, irregular mass in the abdomen that crosses the midline (do not palpate), urinary frequency or retention Distant metastasis: supraorbital echomyosis, periorbital edema, and proptosis (exophalmos), lymphadenopathy, hepatomegaly, and skeletal pain, pallor, weakness, irritability, anorexia, and weight loss Neurologic impairment, respiratory obstruction from a thoracic mass, or varying degrees of paralysis from compression of the spinal cord

Classification of OI—Type II

Lethal; stillborn or die in early infancy Severe bone fragility with multiple fractures at birth Autosomal recessive inheritance

A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, anemia, and fatigue is exhibiting symptoms most suggestive of

Leukemia

Long Term Control Preventive Medications

Leukotriene modifiers Inhaled steroids Long acting bronchodilators (Serevent & Foradil)

Drug Therapy for Asthma

Long-term control meds Inhaled corticosteroids, cromolyn sodium and nedocromil, long-acting 2-agonists, methylxanthines, and leukotriene modifiers Quick-relief ("rescue") medications Short-acting 2-agonists, anticholinergics, and systemic corticosteroids are used as quick-relief (or rescue) medications Ask how much to see if it's controlled or not Because uncontrolled can lead to damage in adult hood

11-12yr Vaccine

MCV, HPV, Tdap

NHL different from Hodgkin's in several respects:

NHL is usually diffuse rather than nodular The cell type is evenly split between B-cell and T-cell lineages Dissemination occurs earlier, more often, and more rapidly due to undifferentiated cell type

What meds are used for JIA?

NSAIDs, DMARDs, corticosteroids, biologic agents ; med notes in PPT

What does the Posterior Pituitary contain?

Nerve fibers and neuroglial cells called pituicytes.

Does the Posterior Pituitary release hormones?

No

What is the most appropriate nursing action when the nurse notes a reddened area on the forearm of a neutropenic child with leukemia?

Notify the physician.

Pharmacologic Treatments for URI

OTC pediatric cold remedies are not recommended for treating "common cold" Antihistamines ineffective in most cases Antipyretics for comfort from fever Cough suppressants for dry cough-older children only Caution alcohol content Decongestant to shrink swollen nasal passages Nose drops more effective than oral administration It's a functional cough, so never give a cough suppressants Need to cough to keep those secretions moving Antihistamines treats allergies

Neonatal pain response: Skin:

Observe color and character • Pallor or flushing • Diaphoresis • Palmar sweating

Hypothyroidism

One of the most common endocrine problems of childhood

Nursing Problems T A

Oxygenation •Hydration •Nutrition •Pain •Potential complications

What hormones do the posterior pituitary secrete?

Oxytocin (OT), Antidiuretic Hormone (ADH)

Clinical Manifestations

Pancreatic enzyme deficiency Progressive COPD associated with infection Sweat gland dysfunction Failure to thrive Increased weight loss despite increased appetite Gradual respiratory deterioration

*Tx for newborns-6mos DDH?

Pavlik harness to abduct the hip

What is the pineal gland also known as?

Pineal body

Which nursing intervention should not be included in the postoperative plan of care for a child undergoing surgery for a brain tumor?

Place the child in Trendelenburg position.

Pneumonia-Bacterial

Pneumococcus bacteria is most common agent -May be preceded by viral pneumonia

Long Term Control What are leukotrienes?

Potent mediators released from mast cells, eosinophils, and basophils They cause bronchoconstriction and mucus secretion Attract and activate inflammatory cells in airways of patients with asthma

Hormone action can stimulate what kind of synthesis inside the cell?

Protein synthesis (speed up)

Hodgkins Therapeutic Mangement

Radiotherapy is the main tx Chemotherapy is used for stage IV only Major concern of combination tx is serious late effects (long-term considerations) Follow-up care after remission is very important to detect relapse and second malignancies

The rate of action for NovoLog insulin

Rapid acting

What are signs that a preschooler may be grieving?

Regressive behaviors Increased anxiety Decreased verbalization

Respiratory Management

Remove excessive mucous secretions CPT Bronchodilator medication Forced expiration Aggressive treatment of pulmonary infections Home IV antibiotic therapy Aerosolized antibiotics Steroid use/nonsteroidal antiinflammatory Transplantation

What is the definitive treatment of growth hormone deficiency?

Replacement of growth hormone

GI Management

Replacement of pancreatic enzymes High-protein, high-calorie diet as much as 150% RDA Prevention/early management of intestinal obstruction Reduction of rectal prolapse Salt supplementation Oral glucose-lowering agents or insulin injections as needed Diet and exercise management

What are the gonads?

Reproductive glands, ovaries, testes, placenta

Allergic Rhinitis

Seasonality vs. year-around Pathophysiology Clinical manifestations Diagnosis and treatment Immunotherapy OTC medications Oral Inhaled Nasal sprays Nursing considerations Treats meds- antihistamines Drowsiness or hyper Ben. Not recommended for kids

Lower Respiratory Interferences Bronchitis

Secondary observations -Chest xray reveals diffuse alveolar hyperinflation •Treatment - aimed at relieving symptoms -Fever reduction -Adequate hydration •Cough suppressants are rarely indicated because we want child to cough up secretions

What does the pineal gland do?

Secretes melatonin. regulates circadian rhythms. Affects moods and emotions.

Legg-Calvé-Perthes Disease

Self-limited, idiopathic, occurs in children ages 3 to 12, more common in males ages 4 to 8 Avascular necrosis of femoral head 10% to 15% of cases have bilateral hip involvement Most have delayed bone age

The hypothalamus stimulates the anterior pituitary by?

Sending out hormones

Classification of OI—Type III

Severe bone fragility leads to severe progressive deformities Normal sclera, marked growth failure Most are autosomal recessive, but some are autosomal dominant inheritance

Which hormones target reproductive tissues/glands?

Sex hormones

Osteomyelitis

Signs and symptoms begin abruptly; resemble symptoms of arthritis and leukemia Marked leukocytosis Bone cultures obtained from biopsy or aspirate Early x-rays may appear normal Bone scans for diagnosis

What inhibits the secretion of growth hormone?

Somatostatin (SS)

Diagnostic Evaluation

Standing radiographs to determine degree of curvature Asymmetry of shoulder height, scapular or flank shape, or hip height Often have a primary curve and a compensatory curve to align head with gluteal cleft

Asthma Complications

Status asthmaticus Medical emergency- resulting in respiratory failure and death if not treated Chronic bronchitis Chronic emphysema Atelectasis Pneumothorax Death

What are 2 hormone classifications?

Steroid and nonsteroid

Clinical Manifestations of JIA

Stiffness Swelling Loss of mobility in affected joints Warm to touch, usually without erythema Tender to touch in some cases Symptoms increase with stressors Growth retardation

What do releasing hormones do?

Stimulate the synthesis and release of hormones

What does Oxytocin (OT) stimulate?

Stimulates uterine contractions (smooth muscle), and milk ejection reflex.

What can influence hormone levels?

Stress, infection, changes in balance of fluid and minerals in blood. (example: calcium levels)

What is a steroid made of?

Structural lipids.

Which syndrome reamins the leading cause of death for infants 1 month - 1 year of age? What is the peak age for this syndrome? How can new parents protect their baby from this syndrome?

Sudden Infant Death Syndrome (SIDS); 2-4 months; put baby on back while sleeping (SIDS has been reduced by 40% by doing this)

"Allergic Salute"

Swipe up the nose and line up the nose

Primary Prevention

Synagis (palivizumab)is the only primary prevention product available in U.S. for RSV •Monoclonal antibodies specifically for RSV •Given IM x 5 months (Nov. - March) •Given by home-health nurses •Patient must meet criteria to receive Synagis

What does the adrenal cortex do?

Synthesizes and releases steroid hormones called corticosteroids.

Vaccines administered between 11-12 years old?

TdaP, HPV, Meningococcal (MCV4)

Positive Self-Talk

Teach child positive statements to say when in pain (e.g., "I will be feeling better soon," or "When I go home, I will feel better, and we will eat ice cream").

What is pediatric death usually a result of?

Terminal diagnosis

Hormones of the Testes

Testosterone

What controls the release of epinephrine and norepinephrine?

The sympathetic nervous system (Fight or flight)

Enuresis

urinary incontinence occuring in a child who is capable of obtaining bladder control

What does the thymus secrete

Thymosins and tymopoietin

What controls T4 and T3

Thyroid stimulating hormone (TSH)

What is another name for Thyroid Stimulating Hormone?

Thyrotropin

What is the function of hormones?

To alter metabolic activity. They are target specifc and have a predictable response.

What does endocrine mean?

To secrete within

Types of Fractures (Cont.)

Transverse Oblique Spiral Comminuted—small fragments of bone are broken from the fractured shaft and lie in surrounding tissue Greenstick—compressed side of bone bends, but tension side of bone breaks, causing incomplete fracture

Bone marrow/stem cell transplants

Treatment of choice from some cancer, like leukemia. Need a good human leukocyte antigen (HLA) match Pt. undergoes total body irradiation and intensive chemo to kill all cancer cells and all bone marrow cells Then the transplant takes place there is a considerable wait for engraftment The use of cord blood for hematopoietic stem cell is on the rise. As well as autologous (pt's own marrow collected from disease free tissues)

Acanthosis nigricans may be found in as many as 90% of children with type two diabetes and is characterized by velvety hyperpigmentation. T or F

True

Skeletal Limb Deficiency

Underdevelopment of extremities Minor to serious abnormalities Pathophysiology Therapeutic management Nursing care management

Classification of Respiratory Interferences

Upper Respiratory- Nose and Pharynx (Nasopharyngitis) - Croup Syndromes (involve epiglottis and larynx) • epiglottitis • laryngitis • laryngotracheo bronchitis (LTB) • Lower Respiratory - Bronchitis - Bronchiolitis - Pneumonia

Can be acute or chronic in infants is more common in males- first 3 months of life uncircumcised males 5-10 times more likely than circumcised males to develop after 3 months more common in females

Urinary Tract Infection

non -pharm supplementation for pain relief

Use nonpharmacologic interventions to supplement, not replace, pharmacologic interventions, and use for mild pain and pain that is reasonably well controlled with analgesics.

Otitis Media - etiology

Usually caused by strep pneumoniae or Haemophilis influenza •Usually preceded by URI from eustachian tubes being blocked. •Passive smoke is a significant factor in the development of OM •Children in daycare have increased risk •May be caused in infants by bottle propping

high fever fatigue loss of appetite headache macules start in truck and face, spreading to rest of the body, progressing to papules vesicles to follow scabs appear in one week

Varicella (chicken pox)

Otitis Media

Very common in children ages 6 mos to 2 years •Decreases with age except for a slight increase around age 5-6 when beginning school

The most reliable method of determining fluid loss?

Weight is the most reliable method of measurement of body fluid loss or gain. One kilogram of weight change represents 1 L of fluid loss or gain.

Ewings Sarcoma

XRAY: showing an "onion skin" appearance Bone biopsy to confirm CT to look for metastasis (lung is common)

Assessing the child with cancer

You need a complete history including: presenting illness, previous illnesses, family history of cancer, present state of health of immediate family, developmental milestones, and any psychosocial or family concerns You need to include the information in a review of systmes Physical exam and document any abnormalities

WHat are the 3 layers te adrenal cortex is divided into?

Zona glomerulosa, zona fasciculata, zona reticularis

*Tx for scoliosis?

bracing, exercise, surgery: spinal fusion, luque-rods

What are non-brain contusions?

bruise; damage to soft tissue, subcutaneous tissue, and muscles > escape of blood into tissues (ecchymosis) causing black and blue discoloration

Primary enuresis

child has never had a dry night attributed to maturational delay and small functional bladder not associated with stress or psychiatric cause

Secondary enuresis

child who has been reliably dry for at least 6 months begins bedwetting associated with stress, infections, and sleep disorders

Treatment of celiac disease

consists primarily of dietary management.

what can place a child as risk for infection?

deficiencies of the immune system. malnutrition anemia fatique

Acute diarrhea

defined as a sudden increase in frequency and a change in consistency of stools, often caused by an infectious agent in the GI tract.

*How is scoliosis diagnosed?

do a standing radiograph, check asymmetry of shoulder height/scapular or flank shape/hip height,

Intussusception treatment

either nonsurgical hydrostatic reduction or surgical reduction.

Antitussives -

have a direct action on the cough center in the medulla 1. Narcotic - contain codeine or hydrocodone (Dimetane DC, Robitussin A-C) 2. Non-Narcotic - Dextramethorphan (Vicks 44, Robitussin DM) Side Effects: drowsiness, dizziness. Pt. should not drink liquids for 30minutes after taking liquid, lozenges, or chewable tablets. Watch intake of alcohol.

Hypofunction of parathyroid hormone (PTH)

hypocalcemia (tetany)

Treatment of EA and TEF

includes maintenance of a patent airway, prevention of pneumonia, gastric or blind pouch decompression, supportive therapy, and surgical repair of the anomaly.

biliary system

liver is down (up to 2 cm below costal margin) enzyme deficiencies up to at least 6 months old

What do you need to watch for in biologic agents

liver tests

What is tx like for epiphyseal injuries?

open reduction and internal fixation to prevent growth disturbances

Toddlers Play?

parallel play

complications of mononucleosis

ruptured spleen

What does LH promote?

secretions of sex hormones

HPS projectile vomiting

side-lying position -child ejects vomit 3 to 4 feet back-lying position -child ejects vomit 1+ feet occurs shortly after a feeding may follow each feeding or appear intermittently *nonbilious vomit that may be blood tinged*

s/s of osteomyelitis?

similar to arthritis and leukemia, positive blood cultures and marked leukocytosis,

*Emergency tx for slipped capital femoral epiphysis?

surgery!

symptomatic Meckel diverticulum treatment

surgical removal

Effects of a contusion?

swelling, pain, diability

What are strains?

tears to a musculotendinous unit

What is the goal of fracture tx?

to regain alignment and length, restore function, prevent further injury

Appendicitis

typically a result of obstruction of the lumen, usually by a fecalith.

What does ADH prevent?

urine formation

*What should you teach the family about casts?

use specially designed car seats and restraints available, explain procedure for removing casts, skin care, remove hazards at home

varicella side effects?

varicella like rash that is local or generalized (vesicles on the body) siezure

to avoid rebound nasal congestion

vasoconstrictive nose drops or sprays should not be administered for more than 3 days.

Diabetic ketoacidosis (DKA) is a state of medical emergency. The nurse must recognize that the priority is to obtain this for administration of fluids, electrolytes, and insulin.

venous access

complications of hand, foot, and mouth disease?

viral or aseptic meningitis

Steroid hormones are insoluble in what?

water

when is RSV season?

winter and early spring

RSV - Mode of Transmission

•RSV is spread by droplet - not considered an air-born transmission •Virus is very viable and has been found alive on non-porous surfaces 6-8 hours after exposure •Because the virus remains alive so long, contact isolation is required of all persons entering the room.

Plan of Care - Implementation

•Ribavirin is the only specific anti-viral agent used rarely to treat certain individualized cases of RSV. •Controversial due to concerns about high cost, aerosol delivery, potential toxic side effects, conflicting reports of efficacy trials.

CRIES

-used by nurses who work with premature and full-term infants in the neonatal intensive care setting -physiologic and behavioral indicators of pain: C rying, R equiring increased oxygen, I ncreased vital signs, E xpression, S leeplessness. -0 to 2, with a total possible pain score, representing the worst pain, of 10. A pain score greater than 4 is considered significant.

Visual Analog Pain Scale

-vertical or horizontal line that is drawn to certain length, such as 10 cm (4 inches), and anchored by items that represent extremes of the subjective phenomenon being measured, such as pain -Ask child to place mark on line that best describes amount of own pain. -For children as young as 4.5 years old, preferably 7 years old.

Consolability

0= Content, relaxed 1= Reassured by occasional touching, hugging, or talking to; distractible 2=Difficult to console or comfort

Activity

0= Lying quietly, normal position, moves easily 1= Squirming, shifting back and forth, tense 2=Arched, rigid, or jerking

Cry

0= No cry (awake or asleep) 1=Moans or whimpers, occasional complaint 2= Crying steadily, screams or sobs, frequent complaints

Face

0= No particular expression or smile 1=Occasional grimace or frown, withdrawn, disinterested 2=Frequent to constant frown, clenched jaw, quivering chin

STH or GH - target: bones s/s of hyperfunction

1) Prepubertal gigantism 2) Acromegaly (after full growth is attained) 3) Diabetes mellitus 4) Postpubertal hypoproteinemia

Thyroid hormones

1) THs - T4 and T3 2)Thyrocalcitonin

Effects on Glucagon (alpha cells)

1) acts as antagonists to insulin, thereby blood glucose concentration by accelerating glycogenolysis 2) able to inhibit secretion of both insulin and glycogen

Disorders of adrenal function

1) acute adrenocortical insufficiency, 2) chronic adrenocortical insufficiency, 3) Cushing syndrome, 4) and Congenital Adrenal Hyperplasia

How a diagnosis of diabetes can be obtained

1) an 8-hour fasting blood glucose level of 126 mg/dl or more, 2) or a random blood glucose value of 200 mg/dl or more accompanied by classic signs of diabetes

What does education of families managing diabetes include?

1) an explanation of diabetes 2) meal planning 3) administering insulin injections 4) monitoring general hygienic practices 5) promoting exercise 6) record keeping 7) and observing for complications

Hyperfunction of parathyroid hormone (PTH)

1) hypercalcemia 2) hypophosphatemia

Hormones of the adrenal cortex

1) mineralocorticoids: aldosterone 2) sex hormones: androgens, estrogens, progesterone 3) glucocorticoids: cortisol (hydrocortisone and compound F) corticosterone (compound B)

Effects on Insulin (beta cells)

1) promotes glucose transport into the cells 2) increases glucose utilization, glycogenesis, and glycolysis 3) promotes fatty acid transport into cells and lipogenesis 4) promotes amino acid transport into cells and protein synthesis

Effects of STH or GH (somatotropin) - target: bones

1) promotes growth of bone and soft tissues 2) effects linear growth 3) conserves carbohydrate utilization and promotes fat mobilization 4) ineffective for linear growth after epiphyseal closure 5) hyperglycemic effect (anti-insulin action)

What is the nurse's best response to a mother whose child has a diagnosis of acute lymphoblastic leukemia and is expressing guilt about not having responded sooner to her boy's symptoms?

"It is not uncommon for parents not to notice subtle changes in their children's health."

appendicitis therapeutic management

*appendectomy* *pre op:* -ABTs -IV fluids and electrolytes laparoscopic surgery -common for nonperforated appendicitis -3 incisions: umbilicus, left lower abd. quadrant, and suprapubic area -small telescope inserted through the LLQ incision, and an endoscopic stapler is inserted through the umbilical incision -appendix is ligated w/ stapler and removed through umbilical incision

Which of the following interventions would be an appropriate nursing intervention when caring for a child with pneumonia? A. Encourage rest B Instruct the child to avoid lying on the affected side c. Administer analgesics D. Place the child in the Trendelenburg position

A

A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? A. Malaise B. Seizures C. Neuropathy D. Lymphadenopathy

A (Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers.)

Tonsillitis

Pathophysiology and etiology Clinical manifestations Therapeutic management Medical Surgical Controversial May be indicated with massive hypertrophy Nursing care management Snoring in kids are not normal so look for tonsil

Otitis Media (OM)

Pathophysiology and etiology Impact of passive smoke inhalation/crowded living conditions Clinical manifestations Diagnostics Therapeutic management Pharmacologic Surgical Nursing considerations Prevention of recurrence In the ear Second hand smoke increase the chance of otitis media To prevent you can breast feed Infection can lead to the brain Antibiotic

Legg-Calvé-Perthes Disease (Cont.)

Pathophysiology—cause unknown but involves disturbed circulation to the femoral head with ischemic aseptic necrosis After resolving, may have normal femoral head or may have severe alteration Diagnostic evaluation

Asthma Action Plan

Peak flow meter Green is good where you want to be-80 to 100% of that peak flow 80-100% -300 240-300 Yellow-concern need to use rescues inhaler- 150-240 50-80% Red is critical- below 50% Below 150 on the peak flow Pg 1232

hirschsprung disease (HD)

a congenital anomaly that results in mechanical obstruction from inadequate motility of the intestine 4x more common in boys absence of ganglion cells in the affected areas of the intestine -prevents peristalsis results in accumulation of stool occurs in conjunction w/ congenital diagnoses

Meckel diverticulum

a congenital malformation of the GI tract characterized by bloody stools

A hernia

a protrusion of a portion of an organ or organs through an abnormal opening. The danger of herniation arises when the protrusion is constricted, impairing circulation, or when the protrusion interferes with the function or development of other structures.

Name the disorders that can result from an overproduction of the anterior pituitary hormones.

a) Gigantism (caused by excess growth hormone production during childhood) b. Hyperthyroidism c. Hypercortisolism (Cushing syndrome) d. Precocious puberty from excessive gonadotropins

When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as: a. uremia. b. oliguria. c. proteinuria. d. pyelonephritis.

a. Uremia Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urinary output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.

Hepatitis causes

by viruses such as the hepatitis viruses, Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Other causes are nonviral (abscess, amebiasis), autoimmune, metabolic, drug induced, anatomic (choledochal duct cyst and biliary atresia), hemodynamic (shock, heart failure), and idiopathic (sclerosing cholangitis and Reye syndrome).

*Nursing actions for cast applications?

explain procedure, use distraction, assess extremities, check for hot spots, assess circulation status

Goals of surgical treatment of bladder exstrophy

closure of the bladder and abdominal wall urinary continence with preservation of renal function creation of functional and normal appearing genitalia correction to promote later sexual functioning

when does infectionrelated asthma occur?

cold weather

Non-Communicating Children's Pain Checklist-Revised

pain measurement tool specifically designed for children with cognitive impairments -six subscales (vocal, social, facial, activity, body and limbs, physiologic signs), -scored based on the number of times the items are observed over a 10-minute period -(0 = not at all; 1 = just a little; 2 = fairly often; 3 = very often).

McBurney's point

pain w appendicitis located 2/3 the distance along a line between the umbilicus and the anterior superior iliac spine most common point of tenderness

Meckel diverticulum most common clinical presentation in children

painless rectal bleeding, abdominal pain, or signs of intestinal obstruction

Parathyroid Glands

parathyroid hormone (PTH)

Older Infant responses to pain

• Uses crying • Shows a localized body response with deliberate withdrawal from what is causing the pain • Reveals expression of pain or anger • Demonstrates a physical struggle, especially pushing away from what is causing the pain

Pyelonephritis

an upper UTI that involves the ureters, renal pelvis, and renal parenchyma

What is metatarsus Adductus?

angulation of tarsometatarsal joint, AKA "Pigeon Toed"

Which statement, if made by a nurse to the parents of a child with leukemia, indicates an understanding of teaching related to home care associated with the disease?

"Your son's temperature should be taken frequently."

Naproxen

(Naprosyn) -Children >2 years old: -5-7 mg/kg/dose every 12 h -Maximum 20 mg/kg/day or 1250 mg/day

Choline magnesium trisalicylate

(Trilisate) -10-15 mg/kg q 8-12 h PO -Maximum dose 3000 mg/day

Hirschsprung disease

(also known as congenital aganglionic megacolon) is a mechanical obstruction caused by inadequate motility of part of the intestine. Hirschsprung disease requires surgical removal of aganglionic segments of bowel.

Ibuprofen

(children's Motrin, children's Advil) -Children >6 months old: -5-10 mg/kg/dose q 6-8 h -Maximum dose 30 mg/kg/day or 3200 mg/day

vomiting pathophysiology

*nausea:* -desire to vomit -discomfort felt in the throat or abdomen associated with: -salivation -pallor -sweating -tachycardia *retching:* a series of spasmodic movements during inspirations, creating a negative intrathoracic pressure and contraction of the abdominal muscles -projectile vomiting w/ vigorous peristaltic waves *cyclic vomiting syndrome:* bouts of vomiting that can last from hours to several days (rare)

Pneumonia-Aspiration

-Entry of oropharyngeal, particulate matter, or gastric contents into the lower airway

HD manifestations in infancy

1. *FTT* 2. constipation 3. abdominal distention 4. episodes of diarrhea and vomiting 5. *signs of enterocolitis* -explosive, watery diarrhea -fever -appears significantly ill

common assessments

1. *health hx.:* -past medical hx -past surgical hx -family hx -hx of present illness -home interventions -growth and development -nutrition -parent/pt perception of problem 2. *physical exam:* -least to most invasive 3. *lab testing (require MD order):* -electrolytes -stool cx -OB testing -amylase/lipase 4. *Dx testing (require MD order):* -KUB -ph probe -upper or lower GI barium testing

vomiting diagnostic evaluation

1. *history:* -description of vomitus -relationship to meals or specific foods -behavior -presence of pain -constipation -diarrhea -jaundice 2. *physical history:* -assessment of hydration status -abdominal exam 3. *further evaluation by analyzing urine for:* -blood -protein -serum electrolytes -radiographic studies plain radiograph of chest or abdomen or an ultrasound may show abnormalities brain scans - for when tumors are considered endoscopy - if physician suspects esophagitis

GI assessment

1. *inspection:* -LOC -skin color and hydration status -abd. Shape, size, & symmetry -abdominal movements -ecchymosis -hernias 2. *auscultation:* -all 4 quad -hyper vs hypo vs absent -irritable vs calm w exam -use pacifier if needed 3. *percussion:* -dullness vs tympany -liver dullness = 2 cm down in babies/toddlers -dullness with bladder distention 4. *palpation:* -light followed by deep -parent lap/distractions/knees -warm hands, avoid tickling -note any tender areas -attempt to reduce hernias

HPS manifestations

1. *nonbilious projectile vomiting* 2. visible peristalsis 3. FTT in infant who is "always hungry" 4. dehydration 5. metabolic alkalosis

Match the type of fracture to its definition. a. Transverse b. Oblique c. Spiral d. Comminuted 1. Slanting and circular, twisting around the bone shaft 2. Small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue 3. Crosswise at right angles to the long axis of the bone 4. Slanting but straight between a horizontal and a perpendicular direction

1. ANS: C 2. ANS: D 3. ANS: A 4. ANS: B

starts crusing

11 months

The mother of a 5-year-old child asks the nurse questions regarding the importance of vigilant use of sunscreen. Which information is most important for the nurse to convey to the mother? a.) Appropriate use of sunscreen decreases the risk of skin cancer. b.) Repeated exposure to the sun causes premature aging of the skin. c.) A child's skin is delicate, and burns easily. d.) In addition to causing skin cancer, repeated sun exposure predisposes the child to other forms of cancer.

A (While all of the answer choices are correct, recommending the use of sunscreen to decrease the incidence of skin cancer (a) is the best response.)

the moon face

A characteristic sign of excess cortisol, whether from exogenous steroid therapy or a malfunction of the adrenal gland

Acute Spasmodic Laryngitis

A croup syndrome •Common in older children and adolescents •Recurrent paroxysmal attacks of laryngeal obstruction that occur at night. •Allergies and hypersensitivities often coexist. •Treatment - symptomatic -Increase fluids -Increase humidity

What is cortisol/hydrocortisone?

A glucocorticoid located in the zona fasciculata. regulates glucose metabolism, stimulates synthesis of glucose from noncarbohydrates. Is controlled by corticotropin releasing hormone (CRH) and ACTH from anterior pituitary.

Osteogenesis Imperfecta (OI)

A group of heterogeneous inherited disorders of connective tissue Characterized by excessive fragility and bone defects Defective periosteal bone formation and reduced cortical thickness of bones Hyperextensibility of ligaments

What is aldosterone?

A mineralocorticoid located in the zona glomerulosa. Targets the proximal convoluted tubules and increases blood volume and pressureby promoting conservation of sodium ions and water (Na homeostasis)

What is the correct sequence used when performing an abdominal assessment? Begin with the first technique and end with the last. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d). a. Auscultation b. Palpation c. Inspection d. Percussion

ANS: c, a, d, b The correct order of abdominal examination is inspection, auscultation, percussion, and palpation. Palpation is always performed last because it may distort the normal abdominal sounds. DIF: Cognitive Level: Apply REF: p. 104 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A 5-year-old child is hospitalized with osteomyelitis and will be going home in the next few days on intravenous (IV) antibiotics. Which action by the nurse is the most appropriate? A. Ensure that a valid permit for a PICC line is on the chart. B. Locate a pharmacy that will supply the IV medications. C. Research the patients insurance for home infusion coverage. D. Teach the child about a PICC line using a doll.

A ~ A child going home on IV antibiotics will need a PICC line inserted for home infusion therapy. The nurse should ensure that a consent for this procedure is on the chart. Researching pharmacies and infusion companies can be done by the social worker. Teaching the child with a doll is appropriate, but does not take priority over legal responsibilities.

A teen has a scoliosis curve of 35. What treatment option does the nurse prepare the child and family for? A. Bracing B. Continued screening C. Exercise therapy D. Surgical intervention

A ~ A curve of 35 is considered mild scoliosis. Bracing is the treatment of choice at this point. Continued screening is inappropriate, as the child has scoliosis. Research has shown that exercise alone does not improve outcomes. Surgical intervention is reserved for more serious cases.

The rate of action for Lantus insulin

Long acting

history of Guillain-Barre Syndrome: what immunization can you not have?

MCV4

An example of a disease process that is based on a "two-hit" hypothesis leading to a cancer diagnosis is: A. Fanconi anemia. B. Wiskott Aldrich syndrome. C. Klinefelter syndrome. D. Retinoblastoma.

D.

Pharmacologic Interventions

First-line antibiotics Amoxicillin PO 80 to 90 mg/kg/day, divided twice daily ×10 days Second-line antibiotics Amoxicillin-clavulanate (Augmentin), azithromycin Cephalosporins IM If highly resistant organism or noncompliant with oral doses IM is painful Reconstitute with 1% lidocaine (without epinephrine) to decrease pain of injection Analgesic-antipyretic drugs Acetaminophen Ibuprofen (only if >6 months of age) No steroids, antihistamines, decongestants, antibiotic ear drops Pain used acetaminophen and ibuprofen

Vaccine/s at 4m:

Rota, DTaP, Hib, PCV, IPV

low grade fever sore throat red rash tath starts on teh face adn spread to the rest of the body lasting 2-3 days

Rubella (German measles)

pain assessment for children with chronic illness, esp complex pain

The most important aspect is the relationship that develops between the child and the family. -offers health care providers a sense of what the pain experience means to the child and family. -pain can interfere with the child's ability to eat, sleep, and perform daily activities and routines and may be complicated by side effects of medical treatments, and complications associated with disease management.

agranulocytosis (severe leukopenia)

The most serious side effect of antithyroid drugs used to treat Graves disease

What does the hypothalamus control?

The pituitary gland by producing chemicals that either stimulate or supress hormone secretions from the pituitary.

diabetes insipidus (DI), also known as neurogenic (DI)

The principal disorder of posterior pituitary hypofunction

What does calcitonin increase?

The rat at which calcium and phosphate are deposited in the bones. (osteoblasts)

DDH

Therapeutic management Pavlik Harness vs. casting Nursing care management Assessment of skin integrity Education and support of family Promotion of normal growth and development

Patient Education

There are many different types of inhalers There are many different doses of inhalers Don't let your pediatric patients and parents go home and use a long-acting inhaler in a situation where a short acting inhaler is needed - EDUCATE Deaths have occurred due to lack of knowledge about onset, peak, and duration of the medications.Don't let your patients continue to expose themselves to their allergens just because their medications control their symptoms. They need to know their triggers and then take whatever measures are necessary to reduce exposure to them.

What is the child's concept of death at < 2 years of age?

They do not have a real understanding of death. They see it through their parents eyes & absorb the emotion of those around them.

Cortisone

This is administered to suppress the abnormally high secretions of adrenocorticotropic hormone (ACTH)

What are the adrenal glands divided up into?

Two sections. The adrenal cortex, the outer region; and the adrenal medulla, the inner region.

Tertiary prevention

Treatment, care, and rehabilitation activities to limit the disability caused by disease and prevent reoccurrence •Examples: -Teach about child with RSV being more susceptible to respiratory infections for next two years -Teach about suctioning -Teach use of apnea monitor

Complementary and alternative medicine

a group of diverse medical and health care systems, practices, and products that are not currently considered part of conventional medicine.

Cystitis

a lower UTI that involves the urethra or bladder

Short-bowel syndrome (SBS)

a malabsorptive disorder that occurs as a result of decreased mucosal surface area, usually because of extensive resection of the small intestine, resulting in a diminished ability to absorb a regular diet normally. Specialized enteral and parenteral nutrition is a major element of care for children with SBS.

Pediatric Quality of Life Scale

a multidimensional scale with both parent and child versions that is recommended for assessing physical, emotional, social, and academic functioning as they relate to the child's pain.

mouth

frequent introduction of bacteria from oral fixation and exploration

Effects of Antidiuretic hormone (ADH) vasopressin - target: renal tubules

acts on distal and collecting tubules making them more permeable to water, thus increasing reabsorption and decreasing excretion of urine

Nursing actions for osteomyelitis?

complete bed rest, immobility of the limb, pain management, long-term IV access, nutritional considerations, psych support

GI maturity

complete by around 2 yrs of age

WHat inhibits the pineal gand?

daylight

WHat does the thymus promote?

development of T cells, immunity.

How is JIA diagnosed?

elevated sedimentation rates, antinuclear antibodies, leukocyotosis during exacerbation, radiographs, American College of Rheumatology Diagnostic Criteria

at what age are infants presumed to have a lower infection rate because of the protective function of the maternal antibodies

healthy full term infants younger than 3 months old however, they may be susceptible to specific respiratory infections, namely pertussis during this time period.

complications of fifth disease?

immune compromised are at risk for serous complications, anemia, secondary infections

Hepatitis

is an acute or chronic inflammation of the liver that can result from infectious or noninfectious causes.

Hypofunction of the Ovaries

lack of or repression of sexual development

Tx for JIA?

none

What do inhibiting hormones do?

shut off the synthesis/release of hormones

Children who have significant difficulties in communicating with others about their pain

significant neurologic impairments (e.g., cerebral palsy), cognitive impairment, metabolic disorders, autism, severe brain injury, communication barriers (e.g., critically ill children who are on ventilators or heavily sedated or have neuromuscular disorders, loss of hearing, or loss of vision)

The clinical manifestations and course of uncomplicated acute viral hepatitis

similar for most of the hepatitis viruses. Usually the prodromal, or anicteric, phase (absence of jaundice) lasts 5 to 7 days. Anorexia, malaise, lethargy, and easy fatigability are the most common symptoms. The transaminases, rather than the bilirubin, will often be elevated in acute hepatitis, and hepatomegaly may be present. Some mild cases of acute viral hepatitis do not cause symptoms or can be mistaken for influenza.

*What are the actions for the DDH reduction devices?

skin care 2-3x/day, massage healthy skin, put diaper under straps,

What is a spiral fracture?

slanting and circular, twisting around the bone shaft

What is an oblique fracture?

slanting but straight between a horizontal and a perpendicular direction

What is comminuted fractures?

small fragments of bone are broken from fractured shaft and lie in surrounding tissue

*What is Slipped Capital Femoral Epiphysis?

spontaneous displacement of the proximal femoral epiphysis

Stage 2 Wilms' Tumor

spread to fat or soft tissue, blood vessels can be completely removed

Stage 4 Wilms' Tumor

spread to lungs, liver, bone, brain, lymph nodes outside abdomen cannot be completely removed

Stage 3 Wilms' Tumor

spread within abdomen, possibly lymph nodes cannot be completely removed

*What is treatment for DDH like?

start ASAP to prevent further complications,

intussusception manifestations

sudden onset of: -crampy abdominal pain -inconsolable crying -drawing up of knees to chest in a healthy child between episodes- child appears normal as obstruction progresses: -*bilious vomiting* -increased lethargy *classic triad:* 1. abdominal pain 2. abdominal mass 3. bloody stools *chronic case:* -diarrhea -anorexia -weight loss -occasional vomiting -periodic pain can be life-threatening

What do the testes secrete?

testosterone

the viral infection rate remains high during

toddler and preschool years.

What are sprains?

torn or stretched ligament by force > rapid onset of swelling

tx for fractues?

traction and immobilization,

Cryptorchidism

undesecended testicles- 1 or both testicles fail to descend into scrotum

the principles for pharmacologic pain management in children should include:

• Using a two-step strategy • Dosing at regular intervals • Using the appropriate route of administration • Adapting treatment to the individual child

Legs

0= Normal position or relaxed 1=Uneasy, restless, tense 2=Kicking, or legs drawn up

tonic neck and moro reflexes disappearing

1 to 4 months

Cryptorchidism can occur due to:

low testosterone levels or structural defect- shortened spermatic cord

*postop actions for slipped capital femoral epiphysis?

non-weight bearing with crutch ambulation

Hypofunction of glucocorticoids: cortisol and corticosterone

1) Addison disease 2) Acute adrenocortical insufficiency 3) impaired growth and sexual function

Hormones of posterior pituitary

1) Antidiuretic hormone (ADH) vasopressin 2) Oxytocin

Name the two hormones secreted by the thyroid gland

1) thyroid hormone (TH), which consists of the hormones thyroxine (T4) and triiodothyronine (T3), 2) calcitonin

What hormones are released by the adrenal medulla?

epinephrine and norepinephrine.

What do the ovaries secrete?

estrogen and progesterone

What are secondary sexual characteristics controlled by?

estrogen and testosterone.

What is a transverse fracture?

crosswise at right angles to the long axis of the bone

Stage 5 Wilms' Tumor

found in both kidneys cannot be removed

What is the parathyroid gland?

four, small, yellowish, bean-shaped, encapsulated glands located on the posterior surface of the thyroid.

What is a compound or open fracture?

fractured bone protrudes through the skin

What is a buckle/torus fracture?

from compression of the porous bone > appears as a raised or bulging projection

Secondary Nephrotic Syndrome

from multisystem disorder- diabetes, systemic lupus, sickle cell anemia

This cannot enter the cell when there is a deficiency in insulin.

glucose

What is LH controlled by?

gonadotropin releasing hormone (GnRH)

What is luteinizing hormone (LH) also known as?

gonadotropins

what precaution for varicella?

airborne

how much output should a patient greater than 30kg produce per hour?

at least 30ml per hour

Where is the thymus located?

behind the sternum in the mediastinum

tracheoesophageal fistula (TEF)

congenital defect resulting in a connection between the esophagus and trachea failed separation of the esophagus and trachea maternal hx. of polyhydramnios (50%)

Which of the following statements best represents infectious mononucleosis? A. Herpes simplex type 2 B. Leukopenia is often paired with the diagnosis C. Amoxicillin is used to treat the pharyngitis D. Physical assessment and blood tests are used as test results to establish the diagnosis

D

Anti-inflammatory

Corticosteroids Examples: Prednisolone (Solu Medrol) Prednisone, (Pediapred), Dexamethasone (Decadron) Side Effects: Convulsions, headache, mood swings, CHF, hypertension, growth suppression, peptic ulcers, muscle weakness, decreased immune response, masks infections.

A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to A. examine the child's oropharynx and report the assessment to the healthcare provider. B. make the child lie down and rest quietly. C. auscultate the child's lungs and make preparations for placement in a mist tent. D. notify the healthcare provider immediately and be prepared to assist with a tracheostomy or intubation

D

A child drowns in the bathtub after being left unattended by the mother. The mother in the ER is crying and stating that she wishes God would just take her and she would do anything to bring the child back. This is an example of: A. Anger B. Depression C. Grief D. Bargaining

D

A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)? A. Confirms the diagnosis of asthma B. Determines the cause of asthma C. Identifies the "triggers" of asthma D. Assesses the severity of asthma

D

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it A. liquefies secretions. B. improves oxygenation. C. promotes ventilation. D. soothes inflamed mucous membrane.

D

A pediatric oncology patient has developed a nose bleed. Which finding would account for this occurrence? A. Increased white blood cell count B. Increased neutrophils C. Decreased hemoglobin and hematocrit D. Decreased platelet count

D

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent A. otitis media. B. diabetes insipidus. C. nephrotic syndrome. D. acute rheumatic fever

D

What is a complication of JIA?

Iridocyclitis uveitis= inflammation of iris and ciliary body

Effect of Follicle-stimulating hormone (FSH) - target: ovaries, testes

Male: stimulates development of seminiferous tubules; initiates spermatogenesis Female: stimulates graafian follicles to mature and secrete estrogen

*What is the most important intervention you can provide to the dying child?

PAIN CONTROL

What are the glandular functions?

endocrine and exocrine

How is clubfoot diagnosed?

by ultrasound before birth

Hypofunction of Insulin (beta cells)

diabetes mellitus

trust vs

mistrust

autonomy vs

shame and doubt

Adolescent responses to pain

• Less vocal with less physical resistance • More verbal in expressions, such as "It hurts" or "You're hurting me" • Displays increased muscle tension and body control

Pneumonia Plan of Care/Implementation Symptomatic Treatment

•Airway Management •Pain and fever control •Fluids •Rest •Antibiotic therapy •Elevate HOB •Lie on affected side to reduce pleural pain •O2 Therapy