ATI Peds Final Review
child abuse expected findings
-Inconsistencies between parent/caregiver report and injuries -inconsistency between nature of injury and the developmental level of child -repeated injuries requiring emergency treatment -inappropriate response from parents or child - Physical neglect: failure to thrive, lack of hygiene, frequent injuries, delay in seeking health care, dull affect, school absences, self-stimulating behaviors -Physical abuse: bruises in various stages of healing, burns, fractures, lacerations, fear of parents, lack of emotional response, superficial relationships, withdrawal, aggression -emotional neglect/abuse: failure to thrive, eating disorders, enuresis, sleep disturbances, self-stimulating behavior, withdrawal, lack of social smile in infants, extreme behaviors, delayed development, attempts suicide, Parent/caregiver: reject, isolate, terrorize, ignore, verbally assault, or over pressure the child. -Sexual abuse: bruises/lacerations, bleeding of the genitalia anus or mouth, STD's, difficultly walking/standing, UTI's, regressive behavior, withdrawal, personality changes, bloody torn or stained underwear, unusual body odor. -shaken baby syndrome/ abusive head trauma: vomiting, poor feeding, listlessness, respiratory distress, bulging fontanels, retinal hemorrhages, seizures, posturing, alterations in LOC, apnea, bradycardia, blindness, unresponsiveness, bruising in an infant before 6 months of age should be deemed suspicious by the nurse
Spina Bifida
-head circumference -assess skin integrity -assess for allergies especially latex allergy -assess cognitive development -assess bowel and bladder function -assess motor development -monitor for infections -address body image concerns -offer support to the family -assist with client independence -assist with obtaining medical supplies/equipment
A nurse is caring for a child who has Kawasaki disease. Which of the following systems should the nurse monitor in response to this diagnosis?
A. Cardiovascular B. Gastrointestinal C. Integumentary D. Respiratory Correct answer: A. Cardiovascular
A nurse is preparing to measure an infant's vital signs. The nurse should use which of the following sites to assess a heart rate?
A. Carotid artery. B. Apex of the heart. C. Brachial artery. D. Radial artery. Correct answer: B. Apex of the heart.
Which neuromuscular disorder is treated with intrathecal baclofen?
A. Cerebral Palsy B. Osteogenesis imperfecta C. Spina Bifida D. SMA Correct answer: A. Cerebral Palsy
An infant is being prepared for surgical repair of a ventricular septal defect (VSD). Which of the following problems will be prevented by closing the defect? Please choose from one of the following options?
A. Failure to thrive B. Ventricular dysrhythmias C. Heart block D. Respiratory alkalosis Correct answer: A. Failure to thrive
A nurse in an emergency department is caring for a child who is experiencing an acute asthma attack. Which of the following medications should the nurse administer first?
A. Fluticasone B. Budesonide C. Montelukast D. Albuterol Correct answer: D. Albuterol
What percentage of babies that are shaken die?
30%
A nurse in an emergency department is caring for a child who is experiencing an acute asthma attack. Which of the following medications should the nurse expect to administer first?
A. Fluticasone B. Budesonide C. Montelukast D. Albuterol Correct answer: D. Albuterol
A nurse is caring for a child who has been physically abused by a family member. which of the following statements should the nurse say to the child?
A. " I promise I wont tell anyone about this" B. "Lets discuss what happened with your family" C. "Your family is bad for doing this to you" D. "It's not your fault this happened to you" Correct answer: D. "It's not your fault this happened to you"
A nurse is teaching a newly licensed nurse about reporting suspected child abuse. Which of the following statements indicates an understanding by the newly licensed nurse?
A. "Evidence must exist prior to reporting" B. "If the potential abuser commits to stopping the abuse, health care workers are not required to report" C. "I don't want to defame someone if the report is false" D. " If suspicion of abuse exist then reporting is mandatory" Correct answer: D. " If suspicion of abuse exist then reporting is mandatory"
A nurse is caring for an adolescent who has Spina bifida and is paralyzed from the waist down. which of the following statements by the client should indicate a need for further teaching?
A. "I only need to straight catheterize myself twice every day" B. "I carry a water bottle with me because i drink a lot of water." C. "I use a suppository every night to have a bowel movement." D. " I do wheelchair exercises while watching TV." Correct answer: A. "I only need to straight catheterize myself twice every day"
A nurse is teaching the mother of a 5 year old child who has cystic fibrosis about pancreatic enzymes. The nurse should understand that further teaching is necessary when the mother states which of the following?
A. "I will give my son the enzymes between meals." B. "The enzyme probably won't cause many adverse effects." C. "The enzyme helps him digest fat." D. "I will put the enzyme crystals in his applesauce." Correct answer: A. "I will give my son the enzymes between meals."
A nurse is teaching the mother of a child who has cystic fibrosis and has a prescription for pancreatic enzymes three times per day. Which of the following statements indicates that the mother understands the teaching?
A. "My child will take the enzymes to improve her metabolism." B. "My child will take the enzyme following meals." C. "My child will take the enzyme to help digest the fat in foods." D. "My child will take the enzyme two hours before meals." Correct answer: C. "My child will take the enzyme to help digest the fat in foods."
A preceptor is working with a new nurse in the nursery. She will know further teaching of the new RN is necessary if the new nurse says?
A. "Surfactant is necessary for premature babies." B. "Surfactant is given IV." C. "Surfactant decreases surface tension and helps premature babies breath." D. Surfactant is kept in the refrigerator and should be warmed to room temperature before giving." Correct answer: B. "Surfactant is given IV."
A nurse is providing education to a school aged child who has a new diagnosis of asthma. Which of the following statements should the nurse include in the teaching?
A. "Take cromolyn sodium at the first sign of breathing difficulty." B. " You should stop playing basketball, but you can swim instead." C. "Use your peak expiratory flow meter once a week." D. "Avoid triggers that cause an attack." Correct answer: D. "Avoid triggers that cause an attack."
A nurse is obtaining vital signs from 2-month-old infant. The infants heart rate is 190/min and his temperature is 40 C. The father asks the nurse why the babies heart is beating so fast. Which response by the nurse is appropriate?
A. "This is within expected range for your baby." B. "The fever is causing an increase in your baby's heart rate." C. "As your baby begins to fall asleep, his heart rate will decrease." D. "Your baby's heart is beating fast in an attempt to cool down his body." Correct answer: B. "The fever is causing an increase in your baby's heart rate."
A nurse reports an incident of suspected child abuse. One of the parents of the child becomes upset and demands to know the reason for the nurse's action. which of the following responses by the nurse is appropriate?
A. "as a nurse, i'm required by law to report suspected child abuse." B. "I am unable to discuss this, but can contact my supervisor to speak with you." C. "The provider will be coming to explain the situation." D. " I reported the incident to my supervisior who decided to contact the authorities." Correct answer: A. "as a nurse, i'm required by law to report suspected child abuse."
A nurse is teaching an assistive personnel to measure a newborns respiratory rate. Which of the following statements indicates an understanding of why the respiratory rate should be counted for a complete minute?
A. "newborns are abdominal breathers" B. "newborns do not expand their lungs fully with each respiration." C. "actively will increase the respiratory rate." D. "the rate and rhythm of breath are irregular in newborns." Correct answer: D. "the rate and rhythm of breath are irregular in newborns."
Down Syndrome is trisomy:
A. 23 B. 20 C. 21 D. 19 Correct answer: C. 21
You are a school nurse on a playground. Which child are you most concerned about?
A. A child scratching their head. B. A child who skinned their knee. C. A child who is squatting after running. D. A child who is yelling Correct answer:C. A child who is squatting after running.
A nurse is caring for a child who has rheumatic fever. When obtaining the child's medical history from the parents, the nurse should recognize that significance of which of the following data as the possible source of the child's infection?
A. A classmate with fifth disease. B. A sibling who had a sore throat 3 weeks ago. C. The father who had gastritis 2 weeks ago. D. A neighbor's child who has chickenpox. Correct answer: B. A sibling who had a sore throat 3 weeks ago.
A nurse is caring for a child who is having a seizure. Which of the following actions should the nurse take? (select all that apply)
A. Assess the clients airway patency. B. Place a tongue depressor in the clients mouth. C. Remove objects from the clients bed D. Place the client in a side-lying position. E. Restrain the client Correct answers: A. Assess the clients airway patency. C. Remove objects from the clients bed D. Place the client in a side-lying position.
A nurse is caring for a child who is experiencing a seizure. Which of the following actions should the nurse take?
A. Attempt to stop the seizure B. Restrain the child's arms C. Use a padded tongue blade D. Position the child laterally Correct answer: D. Position the child laterally
A nurse is caring for an 8 year old child who has acute rheumatic fever. Which of the following assessments is the nurse's priority immediately following admission?
A. Ausculating the rate and characteristics of the child's heart sounds. B. Using a pain-rating tool to determine the severity of the joint pain. C. Identifying the degree of parental anxiety related to the diagnosis. D. Assessing the client's erythematous rash. Correct answer: A. Ausculating the rate and characteristics of the child's heart sounds.
A nurse is caring for a child who is suspected of having Legg-Calve-Perthes disease. The nurse should prepare the child for which of the following diagnostic procedures?
A. Bone biopsy B. Genetic testing C. MRI D. Xray Correct answer: D. Xray
A nurse is admitting a toddler who has respiratory syncytial virus (RSV). Which of the following actions should the nurse take?
A. Initiate airbourne precautions. B. Keep thermometer in the toddler's room. C. Allow the toddler to play in the common room. D. Place the toddler in a room that has negative air pressure. Correct answer: B. Keep thermometer in the toddler's room.
A nurse is providing discharge instructions to the parent of a 10-year-old child following a cardiac catheterization. Which of the following instructions should the nurse include?
A. Keep the child home for 1 week. B. Give the child acetaminophen for discomfort. C. offer the child clear liquids for the first 24 hours. D. Assist the child to take a tub bath for the first 3 days. Correct answer: B. Give the child acetaminophen for discomfort.
A nurse is planning care for a 5-month-old infant who is scheduled for a lumbar puncture to rule out meningitis. Which of the following actions should a nurse include in the plan of care?
A. Keep the infant NPO for 6 hours prior to the procedure. B. Apply an and eutectic mixture of lidocaine and prilocaine cream topically 15 min prior to the procedure. C. Place the infant in an infant seat for 2 hours following the procedure. D. Hold the infant's chin to his chest and knees to his abdomen during the procedure. Correct answer: D. Hold the infant's chin to his chest and knees to his abdomen during the procedure.
Down syndrome patient have an increased risk for several medical complications and assessment findings. Which complications listed below are down syndrome patients more likely to have? (select all that apply)
A. Leukemia B. Congenital heart defects C. Pneumonia D. Hypertonic Correct answer: A. Leukemia B. Congenital heart defects C. Pneumonia
You are called to the delivery of a mom with ruptured membranes as the nursery nurse. You are told that the fluid is green. You know there is potential for which diagnosis?
A. Meconium Aspiration B. Surfactant insufficiency C. BPD D. Asthma Correct answer: A. Meconium Aspiration
A doctor prescribed a ketogenic diet for your patient what diagnosis would you suspect your patient has?
A. Meningitis B. Seizures C. Reyes syndrome D. None of the above Correct answer: B. Seizures
A nurse is planning care for a child who has cystic fibrosis and a prescription to receive chest physiotherapy (CPT). Which of the following actions should the nurse plan to take?
A. Percuss each lung segment for 15 minutes. B. Perform CPT immediately after the child eats. C. Administer albuterol prior to CPT D. Perform vibration during the clients inspirations. Correct answer: C. Administer albuterol prior to CPT
A nurses is caring for a child who is having a tonic-clonic seizures and vomiting. Which of the following actions is the nurse's priority?
A. Place a pillow under the child's head B. Position the child side-lying C. Loosen restrictive clothing D. clear the area of hazards Correct answer: B. Position the child side-lying
You are the nurse caring for a new mom and baby. The mom asks you what she can do to prevent SIDS? (select all that apply)
A. Place baby on their back to sleep. B. Put pillows and stuffed animals in the crib with the baby. C. Don't co sleep with your baby. D. Don't smoke around your baby. Correct answers: A. Place baby on their back to sleep. C. Don't co sleep with your baby. D. Don't smoke around your baby
A nurse is planning care for a 6-year-old who has bacteria meningitis. Which of the following interventions is unnecessary in the the clients plan of care?
A. Place the client in a semi-Fowler's position B. Admit the client to a private room C. Measure head circumference every shift D. Implement seizure precautions Correct answer: C. Measure head circumference every shift
A nurse in a pediatricians office is contacted by a parent whose child just ingested half a bottle of vitamins with added ferrous sulfate. which of the following instructions should the nurse provide to the parent?
A. Provide a high-carbohydrate meal B. Give the child syrup of ipecac C. Contact the poison control center D. Bring the child to the office for a rapid infusion of deferoxamine Correct answer: C. Contact the poison control center
A nurse is caring for a child who has a suspected diagnosis of cystic fibrosis. Which of the following diagnostic tests will confirm the diagnosis?
A. Sweat chloride test. B. A sputum culture. C. A stool fat content analysis. D. Pulmonary function tests. Correct answer: A. Sweat chloride test.
The anacronym "Crash and Burn" is for which diagnosis?
A. Tetralogy of Fallot B. Hemophilia C. Congential heart defects D. Kawasaki disease Correct answer:D. Kawasaki disease
Which 4 defects are found in Tetralogy of Fallot
A. VSD, Pulmonary stenosis, overriding aorta, right ventricular hypertrophy. B. ASD, left ventricular hypertrophy, overriding pulmonary vessel, aortic stenosis. C. VSD, Pulmonary stenosis, aortic stenosis, left ventricular hypertrophy. D. ASD, Pulmonary stenosis, overriding aorta, right ventricular hypertrophy. Correct answer: A. VSD, Pulmonary stenosis, overriding aorta, right ventricular hypertrophy.
The nurse observes a child for neurological disorders. Which is the earliest indicator of improvement of deterioration of neurological status
A. Vital signs B. Motor function C. Level of consciousness D. Reflexes Correct answer: C. Level of consciousness
A 7-year-old child with cerebral palsy has been admitted to the hospital. which information is most important for the nurse to obtain in the history?
A. age the child learned to walk B. parents expectations of the child's development C. functional status related to eating and mobility D. birth history to identify cause of cerebral palsy Correct answer: C. functional status related to eating and mobility
Osteogenesis imperfecta is treated with which medication?
A. intrathecal baclofen B. pamidronate C. botox injections D. none of the above Correct answer: B. pamidronate
A nurse is caring for a child who has a suspected diagnosis of bacterial meningitis. Which of the following actions is the nurse's priority
A. prepare the client for a lumbar puncture. B. Administer an intravenous antibiotic. C. obtain blood cultures. D. Place the child in isolation. Correct answer: D. Place the child in isolation.
A home health nurse is developing a plan of care for a child who has hemiplegic cerebral palsy. which of the following goals is the priority for the nurse to include in the plan of care?
A. provide respite services for the parents B. improve the clients communication skills C. foster self-care activities D. modify the environment Correct answer: D. modify the environment
A nurse is assessing a child and notes several bruises. which of the following actions should the nurse take?
A. report the suspected abuse to authorities B. Obtain a detailed history C. Ask a psychiatrist to talk to the parents D. Separate the child from the parents Correct answer: B. Obtain a detailed history
The heathcare provider is caring for an infant with a diagnosis of congential heart defect. The baby's pulse is 158 and respiratory rate is 74. Which of the following is the best position for the baby to be placed?
A. side lying with a blanket roll at back. B. supine with the legs slightly elevated C. Prone position with the head elevated. D. Upright in an infant seat. Correct answer: D. Upright in an infant seat.
What is the most common movement disorder of children?
A. spina bifida B. cerebral palsy C. SMA D. muscular dystrophy Correct answer: B. cerebral palsy
Approximately what size is an infants heart?
A. the size of a pin head B. the size of a walnut C. the size of an elephant. D. the size of a baseball. correct answer: B. the size of a walnut
6 types of poisioning
Acetaminophen (tylenol) Acetylsalicylic Acid (aspirin) Iron Hydrocarbons Corrosives Lead
What can happen if a frustrated parent shakes a baby?
Blindness seizures Learning disabilities Death
A 3-month old with flu like symptoms has
Bronchiolitis
IV daily maintenance rate for children
First 10 Kg= 100ml per Kg Second 10 Kg= 50ml per Kg remaining Kg= 20ml per Kg
Kawasaki disease
Kawasaki disease is a disease in which blood vessels throughout the body become inflamed.[1] The most common symptoms include a fever that lasts for more than five days and is not controlled by usual medications, large lymph nodes in the neck, a rash in the genital area, and red eyes, lips, palms or bottoms of the feet. Other symptoms include sore throat and diarrhea. Within three weeks of the onset of symptoms the skin from the hands and feet may peel. Recovery then typically occurs. In some children, coronary artery aneurysms may form in the heart.[1] The cause is unknown. It may be due to an infection triggering an autoimmune response in those who are genetically predisposed. It is not spread between people. Diagnosis is usually based on a person's signs and symptoms. Other tests such as an ultrasound of the heart and blood tests may support the diagnosis. Other conditions that may present similarly include scarlet fever and juvenile rheumatoid arthritis.[1] Initially treatment is typically with high doses of aspirin and immunoglobulin. Usually with treatment fever resolves within 24 hours and there is a full recovery. If the coronary arteries are involved ongoing treatment or surgery may occasionally be required.[1] Without treatment coronary artery problems occur in up to 25% and about 1% die.[3][4] With treatment the risk of death is 0.17%.[4]
4 medications that can be given down an ET tube during an emergency?
L-Lidocaine E-Epinephrine A-Atropine N-Naloxone
Airborne precautions activity
Large puzzle
What is NOT one of the emergency medications that can be given via endotracheal tube?
Narcotics
Neural tube defects
Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn't close completely.
Sickle cell anemia teaching
Offer fluids to your child multiple times
Scoliosis repair intervention
PCA pump
Sickle cell crisis
Pain and fluids
ingested kerosene priority
Respiratory rate
Suctioning has been effective if
clear breath sounds
heart failure assessment
daily weight ausculating heart sounds cap refill I & O's hypokalemia
RSV precautions
droplet
Interventions for juvenile idiopathic arthritis
exercise relaxation techniques and pain management evaluate analgesics PT support groups ROM activities encourage self care well balanced diet w/ plenty of fluids teach family exacerbation worsens w/illness routine exams apply heat/warm moist packs to joints prior to exercise Meds: NSAIDs, methotrexate, corticosteroids-prednisone, etanercept
Cystic Fibrosis diet
increase calories increase protein
Infant in a vehicle crash, monitor for increased ICP signs and symptoms
increased amount of sleep
Sweat chloride test
ion diaphoresis
Spina bifida surgery care
latex free environment
Meningitis and reyes
monitor for ICP seizure precautions head circumference in infants
Ingestion of acetylcylic acid
perform gastric lavage with activated charcoal
Cerebral palsy sign/symptoms
sits up with pillows
ASO titer
strep infection can lead to rheumatic fever
at home suctioning tips
suction for less than 10 seconds
Impetigo contagiosa
wash clothing in hot water
SIDS need further teaching if states
we will keep infant in bed with us
1 week old with oxygen going home needs further teaching
we will rotate the probe every 24 hours-because it should be rotated every 3-4 hours