LVN LEVEL II PEDI EXAM 3

A child is receiving peritoneal dialysis to treat renal failure. To detect early signs of peritonitis, the nurse should stay alert for:

abdominal tenderness. Abdominal tenderness Explanation: Abdominal tenderness is an early sign of peritonitis. Redness at the catheter site indicates a skin infection. Abdominal fullness is expected during dialysate infusion. Headache isn't associated with peritonitis.

dietary reference intakes (DRI)

are a set of values established by the food and Nutrition Board of the Institute of Medicine (2006) and the National Academy of Science that can be used to assess and plan intake for individuals of different ages. p 896

ears

down and back in a child under 3yo up and back for a child over 3 yo

pica

eating earth or clay or chalk (nonfood items, pencils, sand, metal cars etc)

food jags

eating only a few foods for several days or weeks

Hypercalcemia/hypophosphatemia

hyperparathyroidism

foods high in iron

meat and green vegetables

anorexia nervosa

not eating

foods introduced to infants

one at a time, space out to give a chance to observe for reactions

fontanelles

posterior closes- 2-3 months anterior closes - 12- 18 months

nutrition

refers to taking in food and assimilating it metabolically for use by the body

delineated

represented accurately or precisely

macronutrients

the major building blocks of he body: carbohydrates, proteins, and fat

hematocrit

the ratio of the volume occupied by packed red blood cells to the volume of the whole blood as measured by a hematocrit V(packed blood cells):VWB (volume of whole blood) measured by hematocrit

sclera

white of eye

antidiuretic

a drug that limits the formation of urine

hemoglobin lab test

a hemoprotein composed of globin and heme that gives red blood cells their characteristic color

A 7-year-old child is brought to the emergency department with burns to the back of the head and the back of the right thigh. According to the Lund-Browder classifications, what percentage of body surface area is affected and should be recorded?

9 3/4 % Explanation: The back of the head in a 7-year-old is 5 1/2 %. The back of the right thigh is 4 1/4 %. Therefore, the total body surface area af-fected is 9 3/4 %.

A child with suspected rheumatic fever is admitted to the pediatric unit. When collecting data on the child's history, the nurse considers which information to be most important?

A recent episode of pharyngitis Explanation: A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Although the child may have a history of fever or vomiting or lack interest in food, these findings aren't specific to rheumatic fever.

Which intervention would be appropriate for an infant after cardiac catheterization?

Apply pressure if oozing or bleeding is noted Explanation: Applying pressure to the site is appropriate if bleeding is noted. The leg should be kept straight and immobile to prevent trauma and bleeding. The pressure dressing shouldn't be changed, but it may be reinforced if bleeding occurs. Hypothermia causes stress in infants and should be avoided.

A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?

Decrease environmental stimulation Explanation: A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure.

What are the symptoms of SIADH?

Each child may experience symptoms differently. Symptoms, in more severe cases of SIADH, may include: nausea vomiting irritability personality changes, such as combativeness, confusion, and hallucinations seizures stupor coma

When teaching parents about fifth disease (erythema infectiosum) and its transmission, the nurse should provide which information?

Fifth disease is transmitted by respiratory secretions. Explanation: Fifth disease is transmitted by respiratory secretions. The transmission mode for roseola is unknown. Rubella is transmitted by respiratory secretions, stool, and urine. Intestinal parasites, such as giardiasis and pinworms, are transmitted by stool.

A 10-year-old child being treated for common warts asks about the cause. The nurse would reveal which virus as the cause?

Human papillomavirus (HPV) Explanation: HPV is responsible for various forms of warts. Coxsackie virus is associated with hand-foot-and-mouth disease. HHV is associated with varicella and herpes zoster. HIV infections aren't associated with epithelial tumors known as warts.

hyperparathyroidism

Hypercalcemia/hypophosphatemia

A toddler is brought to the emergency department in cardiac arrest. The physician tries three times to insert an I.V. catheter but is unsuccessful. By which alternate route can the physician administer emergency medications?

Intraosseously (interesting but not a need to know this is a prepu question but not one we have covered in class) Explanation: The physician can safely administer emergency medications, such as sodium bicarbonate, calcium, glucose, crystalloids, colloids, blood, dopamine, epinephrine, and dobutamine by the intraosseous route if the I.V. route is inaccessible. Emergency medications shouldn't be administered by the sublingual, topical, or subcutaneous routes.

A preschool child is admitted to the pediatric unit with acute nephritis. Which electrolyte replacement agent is used as an adjunct to treatment for this condition?

Magnesium sulfate Explanation: Magnesium sulfate is an electrolyte that is used as an adjunct to treat acute nephritis. It also is used to treat seizures and severe toxemia. Calcium glubionate, potassium chloride, and sodium lactate aren't therapeutic in acute nephritis and, in fact, may worsen the condition.

A toddler is admitted to the hospital with nephrotic syndrome. The nurse carefully monitors the toddler's fluid intake and output and checks urine specimens regularly with a reagent strip. Which finding is the nurse most likely to report?

Proteinuria Explanation: In nephrotic syndrome, the glomerular membrane of the kidneys becomes permeable to proteins. This results in massive proteinuria, which the nurse can detect with a reagent strip. Nephrotic syndrome typically doesn't cause glucosuria or ketonuria. Because the syndrome causes fluids to shift from plasma to interstitial spaces, it's more likely to decrease urine output than to cause polyuria (excessive urine output).

SIADH: treatment

The most commonly prescribed treatment for SIADH is fluid restriction of between 30 to 75 percent of normal fluid intake, depending on the severity of the disorder. If the condition is chronic, fluid restriction may need to be permanent. Treatment may also include: certain medications that inhibit the action of ADH (rarely used in children because of the side effects) surgical removal of a tumor that is producing ADH

Which laboratory test is the most accurate indicator of a client's renal function?

Creatinine clearance

Which nursing intervention is appropriate to correct dehydration for a 2-year-old child with asthma?

Give warm liquids Explanation: Liquids are best tolerated if they're warm. Cold liquids may cause bronchospasm and should be avoided. Dehydration should be corrected slowly. Overhydration may increase interstitial pulmonary fluid and exacerbate small airway obstruction. Small, frequent meals should be provided to avoid abdominal distention that may interfere with diaphragm excursion, but these won't correct the dehydration.

How is SIADH diagnosed?

In addition to a complete medical history and physical examination, to confirm diagnosis of SIADH, blood tests will need to be performed to measure sodium, potassium chloride levels, and osmolality (concentration of solution in the blood).

The nurse is providing care to a 5-year-old child with a fractured femur whose nursing diagnosis is Imbalanced nutrition: less than body requirements related to impaired physical mobility. Which of the following is most likely to occur with this condition?

Increased carbohydrate need Carbohydrate need increases because healing and repair of tissue requires more carbohydrates. Increased — not decreased — protein catabolism is present. Decreased appetite — not increased — is a problem. Digestive enzymes are decreased — not increased.

A 3-year-old child is experiencing distress after having cardiac surgery. Which sign indicates cardiac tamponade?

Muffled heart sounds Explanation: Symptoms of cardiac tamponade include muffled heart sounds, hypotension, sudden cessation of chest tube drainage, and a narrowing pulse pressure. Cardiac tamponade occurs when a large volume of fluid interferes with ventricular filling and pumping and collects in the pericardial sac, decreasing cardiac output.

A nurse on the pediatric unit who's assigned to the performance improvement committee identifies that admission assessments aren't being completed within the time frame designated in their standards. Which action should she take first?

Notify the nurse-manager so she can identify contributing factors and devise an action plan. Explanation: The nurse should notify the nurse-manager so she can identify factors that might have contributed to the admission assessment delays. After the nurse-manager gathers the information, she should devise an action plan with some staff members. After they devise the plan, they should present it at the next staff meeting and ask for input from other staff members. Performance improvement is a tool to improve client care and shouldn't be used to punish staff members. The nurse shouldn't continue to monitor the situation without devising a plan for improvement. Doing so might cause harm to future clients.

Iatrogenic

Of or relating to illness caused by medical examination or treatment. induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures

A 3-year-old is admitted to the pediatric unit with pneumonia. He has a productive cough and appears to have difficulty breathing. The parents tell the nurse that the toddler hasn't been eating or drinking much and has been very inactive. Which interventions would be included in the care plan to improve airway clearance? Select all that apply:

Perform chest physiotherapy as ordered • Encourage coughing and deep breathing • Perform postural drainage. • Maintain humidification with a cool mist humidifier Explanation: Chest physiotherapy and postural drainage work together to break up congestion and then drain secretions. Coughing and deep breathing are also effective to remove congestion. A cool mist humidifier helps loosen thick mucus and relax airway passages. Fluids should be encouraged — not restricted. The child should be placed in semi-Fowler or high Fowler position to facilitate breathing and promote optimal lung expansion.

The nurse is caring for a 16-year-old female admitted for poor insulin regulation. When the nurse walks into her room and sees her eating a hamburger and fries brought in by a friend, the adolescent looks at the nurse with an expression of guilt. Which response by the nurse would be most appropriate?

Politely suggest the teen remove the food; then ask how she feels the disease is changing her life Explanation: Politely suggesting removal of the food and then asking how the adolescent feels about her poor insulin regulation and her life would be the best approach. The nurse is taking the appropriate action from a dietary and health perspective, but she's also fostering a relationship and encouraging open communication with the teen. The first two responses are inappropriate because of their scolding tone, which may create more resistance than dietary compliance. Requiring visitors to check in at the nurses' station isn't an appropriate use of the nurses' time, nor does it encourage the teen to take responsibility for her disease.

A 14-year-old is seen in the pediatrician's office with a history of mild sore throat, low-grade fever, and a diffuse maculopapular rash. She now complains of swelling of her wrists and redness in her eyes. The nurse interprets these findings as indications of which condition?

Rubella Explanation: Rubella presents with a diffuse maculopapular rash, mild sore throat, low-grade fever and, occasionally, conjunctivitis, arthralgia, or arthritis. Rubeola is associated with high fever, which reaches its peak at the height of a generalized macular rash and typically lasts for 5 days. Roseola involves high fever and is abruptly followed by a rash. Varicella presents with fever, small erythematous macules on the trunk or scalp which progress to papules, and clear vesicles on an erythematous base

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

SIADH occurs when excessive levels of antidiuretic hormones (hormones that help the kidneys, and body, conserve the correct amount of water) are produced. The syndrome causes the body to retain water and certain levels of electrolytes in the blood to fall (such as sodium). SIADH is rare in children.

What causes SIADH?

SIADH tends to occur in people with heart failure or people with a diseased hypothalamus (the part of the brain that works directly with the pituitary gland to produce hormones). In other cases, a certain cancer (elsewhere in the body) may produce the antidiuretic hormone, especially certain lung cancers. Other causes may include the following: meningitis - inflammation of the meninges, the membranes that cover the brain and spinal cord. encephalitis - inflammation of the brain. brain tumors psychosis lung diseases head trauma Guillain-Barré syndrome (GBS) - a reversible condition that affects the nerves in the body. GBS can result in muscle weakness, pain, and even temporary paralysis of the facial, chest, and leg muscles. Paralysis of the chest muscles can lead to breathing problems. certain medications damage to the hypothalamus or pituitary gland during surgery

The spaces between the ribs (intercostal) are delineated during inspiration is an abnormal finding in an infant

The presence of intercostal retractions is a sign of respiratory distress from an obstruction or a disease such as pneumonia, which causes the infant to have to work to breathe.

Which finding would concern the nurse who's caring for an infant after a right femoral cardiac catheterization?

Weak right dorsalis pedis pulse Explanation: The pulse below the catheterization site should be strong and equal to the unaffected extremity. A weakened pulse may indicate vessel obstruction or perfusion problems. Elevated temperature and decreased urine output are relatively normal findings after catheterization and may be the result of decreased oral fluids. A small amount of bloody drainage is normal; however, the site must be assessed frequently for increased bleeding.

A 2-year-old child is brought to the emergency department with suspected croup. The child appears frightened and cries as the nurse approaches him. The nurse needs to listen to the child's breath sounds. The best way to approach the 2-year-old child is to:

allow the child to handle the stethoscope before listening to his lungs. Explanation: Toddlers are naturally curious about their environment and letting them handle minor equipment is distracting and helps them gain trust with the nurse. The nurse should only expose one area at a time during data collection and should approach the child slowly and unhurriedly. The parent or caregiver should be encouraged to hold and console the child. Also comfort the child with objects with which he's familiar. The child should be given limited choices to allow autonomy such as, "Do you want me to listen first to the front of your chest or your back?"

bulimia

binge and purge

infants

birth weight is doubled by 5 months and tripled by 1 year

toddlers

encourage self feeding

assessments

infant head to toe- auscultating while infant is quiet toddler- feet to head- auscultating while the toddler is quiet, and let him touch the stethoscope before touching him with it preschooler- head to toe if the child is willing, allow him to touch and play with equipment school age and adolescents- head to toe and get permission

inspiratory and expiratory stridor

is heard when someone has aspirated a foreign object such as a piece of meat

Reye's syndrome

is sudden (acute) brain damage and liver function problems of unknown cause. The syndrome has occurred in children who have been given aspirin when they have chicken pox or the flu. Children with Reye syndrome get sick very suddenly. The syndrome often begins with vomiting, which lasts for many hours. The vomiting is quickly followed by irritable and aggressive behavior. As the condition gets worse, the child may be unable to stay awake and alert. Other symptoms of Reye syndrome: Confusion Lethargy Loss of consciousness or coma Mental changes Nausea and vomiting Seizures Unusual placement of arms and legs (decerebrate posture) -- the arms are extended straight and turned toward the body, the legs are held straight, and the toes are pointed downward Other symptoms that can occur with this disorder include: Double vision Hearing loss Muscle function loss or paralysis of the arms or legs Speech difficulties Weakness in the arms or legs

Intraosseous access (interesting but not a need to know)

may be easily established by users with little training and is more rapidly achieved than intravenous access.[10] Manual insertion with force had previously been the primary method for intraosseous insertion, but automated intraosseous insertion devices such as the EZ-IO (Vidacare Corp, San Antonio, Tex)[11] , have recently gained popularity.[12] Studies have suggested these automated devices are safe and highly successful on first attempts in both children and adults. Blood obtained through intraosseous access may be used to obtain most laboratory values, including pH level, PCO2 level, and ABO and Rh typing.[17] The results of these standard laboratory tests may differ slightly from results obtained with venous blood samples because of low flow and stasis in the bone marrow. All medications and blood products can be safely administered through the intraosseous line, and the onset of action and peak drug levels are comparable to those of intravenous administration. Intraosseous needles left in the marrow for longer than 72 hours are at a higher risk of local infection; thus, needles should be removed as soon as permanent venous access is established.

breastfeeding

should be given a vit D supplement

micronutrients

substances needed in small quantities for healthy body functioning: vitamins and minerals

Intraosseous vascular access (interesting but not a need to know)

was first introduced by Drinker in 1922 as a method for accessing noncollapsible venous plexuses through the bone marrow cavity to systemic circulation. The method was abandoned with the development of intravenous catheters until the 1980s, when intraosseous access was reintroduced, particularly for rapid fluid infusion during resuscitation. Based on previous guidelines, intraosseous access was suggested for children aged 6 years or younger,[2] although recent studies have shown that it is safe in older children and adults.[3, 4, 5, 6] Successful infusions in newborns have further suggested that access via the intraosseous route is faster than access via umbilical veins. According to the Emergency Cardiovascular Care Guidelines in 2000, intraosseous access is recommended in all children after 2 failed attempts of intravenous access or during circulatory collapse. In 2005, the American Heart Association recommended intraosseous access if venous access cannot be quickly and reliably established.

foods high in zinc

whole grain and meats

hypertelorism

widely spaced eyes

The nurse auscultates the first heart sound, interpreting this sound as occurring:

with closure of the mitral and tricuspid valves Explanation: The first heart sound occurs during systole with closure of the mitral and tricuspid valves.

candida infection

yeast infection