Pediatric Hesi Practice Test
Antibiotics are prescribed for a child with otitis media who underwent a myringotomy with insertion of tympanostomy tubes. The nurse provides discharge instructions to the parents regarding the administration of the antibiotics. Which statement, if made by the parents, indicates understanding of the instructions provided?
"Administer the antibiotics until they are gone." A myringotomy is the insertion of tympanoplasty tubes into the middle ear to promote drainage of purulent middle ear fluid, equalize pressure, and keep the ear aerated. The nurse must instruct parents regarding the administration of antibiotics. Antibiotics need to be taken as prescribed, and the full course needs to be completed.
The mother of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks the nurse why the pediatrician did not prescribe antibiotics. Which response should the nurse make?
"Antibiotics are not indicated unless a bacterial infection is present." Laryngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi and is the most common type of croup. It can be viral or bacterial. Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present.
The mother of an 8-year-old child tells the clinic nurse that she is concerned about the child because the child seems to be more attentive to friends than anything else. Using Erikson's psychosocial development theory, the nurse should make which response?
"At this age, the child is developing his own personality."
The 5-month-old client is seen in the well-child clinic. Which finding concerns the nurse? 1.The infant's head turns to the side when a noise is made at the level of the ear. 2.The infant's head lags when pulled from a lying to a sitting position. 3.The infant is drooling. 4.The infant smiles spontaneously.
2.The infant's head lags when pulled from a lying to a sitting position.
The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action?
Encourage the child to drink liquids. If ketones are present, liquids are essential to aid in clearing the ketones. The child should be encouraged to drink liquids.
The mother of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen is not effective. Which instruction should the nurse provide to the mother?
Encourage the child to lie on the right side. Splinting of the affected side by lying on that side may decrease discomfort.
A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears?
Encourage the child's parents to stay with the child.
A 10-year-old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription?
Factor VIII would be prescribed intravenously to replace the missing clotting factor and minimize the bleeding.
The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder?
Failure to pass meconium stool in the first 24 hours after birth
What are the key nursing goals for patients with burns?
Fluid and electrolyte balance •Infection control •Pain management •Prevent complications of immobility/scarring •Support nutrition for healing - Protein! •Support client psychologically
The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction?
Fluid overload. The mother of a child with sickle cell disease should encourage fluid intake of 1.5 to 2 times the daily requirement to prevent dehydration.
What foods would you teach patients and their parents to avoid?
Foods containing wheat, barley and rye include: •Most breads, cakes and baked goods •Most pastas and noodles •Beer •Seitan •Many cream-based soups or processed/packaged foods
The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? Select all that apply.
Place the infant in a private room. Wear a mask, gown, and gloves when in contact with the infant. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.
The clinic nurse reads the results of a tuberculin skin test (TST) on a 3-year-old child. The results indicate an area of induration measuring 10 mm. The nurse should interpret these results as which finding?
Positive Induration measuring 10 mm or more is positive in children 4 years or older without any risk factors
Piaget: 2 - 6 years?
Preoperational: Child uses symbols (words and images) to represent objects - Doesn't reason logically - Child egocentric
The nurse is reviewing the laboratory results for a child scheduled for a tonsillectomy. The nurse determines that which laboratory value is most significant to review?
Prothrombin time Because the tonsillar area is so vascular, postoperative bleeding is a concern. Prothrombin time, partial thromboplastin time, platelet count, hemoglobin and hematocrit, white blood cell count, and urinalysis are performed preoperatively. The prothrombin time results would identify a potential for bleeding.
A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all that apply.
Provide a soft diet. Administer ibuprofen for fever every 4 hours as prescribed and as needed. Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy. The child's fever should be treated with ibuprofen. The child is positioned on her or his affected side to facilitate drainage. A soft diet is recommended during the acute stage to avoid pain that can occur with chewing. Antibiotics are prescribed to treat the bacterial infection and should be administered for the full prescribed course.
Toddler
Push toys, dolls or stuffed animals
After a tonsillectomy, the nurse reviews the surgeon's postoperative prescriptions. Which prescription should the nurse question?
Suction every 2 hours. After tonsillectomy, suction equipment should be available, but suctioning is not performed unless there is an airway obstruction because of the risk of trauma to the surgical site.
The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for this child?
Swimming
Piaget: 12 years - adult?
The adolescent can reason abstractly and think in hypothetical terms
The day care nurse is observing a 2-year-old child and suspects that the child may have strabismus. Which observation made by the nurse indicates the presence of this condition?
The child consistently tilts the head to see. Strabismus is a condition in which the eyes are not aligned because of lack of coordination of the extraocular muscles. The nurse may suspect strabismus in a child when the child complains of frequent headaches, squints, or tilts the head to see.
The nurse is observing a 2-year-old child during mealtime. Which observation does the nurse expect as developmentally appropriate?
The child drinks from a cup
The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). What are the general contraindications associated with receiving a live virus vaccine? Select all that apply.
The child has a disorder that caused a severely deficient immune system. The child had a previous anaphylactic reaction to the vaccine.
The nurse is describing Piaget's cognitive developmental theory to pediatric nursing staff. The nurse should tell that staff that which child behavior is characteristic of the formal operations stage?
The child has the ability to think abstractly.
A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). She asks the nurse how to position her new infant for sleep. In which position should the nurse tell the parent to place the infant?
Back rather than on the stomach Nurses should encourage parents to place the infant on the back (supine) for sleep. Infants in the prone position (on the stomach) may be unable to move their heads to the side, increasing the risk of suffocation.
A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis?
Bone marrow biopsy showing blast cells Rationale:Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy, which is considered positive if blast cells are present
A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted?
Capillary refill is less than 2 seconds.
A pediatrician prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription?
Checks the amount of urine output Rationale: In hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering potassium chloride intravenously would be to assess the status of the urine output. Potassium chloride should never be administered in the presence of oliguria or anuria
The school nurse obtains histories from 4 mothers whose 6-year-old children have increased lead levels. Which child will the nurse refer IMMEDIATELY?
Child 4: "My child is in the 5th percentile for height and weight."
The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?
Choking with feedings Any child who exhibits the "3 Cs"—coughing and choking with feedings and unexplained cyanosis—should be suspected to have tracheoesophageal fistula.
Preschooler
Coloring books, tricycle, or toy dish set
Piaget: 7 - 12 years?
Concrete operational: Child can think logically about concrete objects - Add and subtract - Understands conversation
The 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 is the most appropriate activity for this child?
Crayons and a coloring book 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.
A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition?
Decreased wheezing A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving.
A child with β-thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate being prescribed?
Deferoxamine is classified as an antidote for acute iron toxicity.
The nurse is monitoring a 3-month-old infant for signs of increased intracranial pressure. On palpation of the fontanels, the nurse notes that the anterior fontanel is soft and flat. On the basis of this finding, which nursing action is most appropriate?
Document the finding. The anterior fontanel is diamond-shaped and located on the top of the head. The fontanel should be soft and flat in a normal infant, and it normally closes by 12 to 18 months of age.
The nurse is assessing a newborn after circumcision and notes that the circumcised area is red with a small amount of bloody drainage. Which nursing action is most appropriate?
Document the findings. The penis is normally red during the healing process after circumcision. A yellow exudate may be noted in 24 hours, and this is part of normal healing. The nurse would expect that the area would be red with a small amount of bloody drainage.
A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do?
Eat a small box of raisins or drink a cup of orange juice before soccer practice.
Scoliosis Braces?
•Important to remind patients that braces should be worn ~18-23 hours/day •Take brace off to shower/bathe •Wear t-shirt under brace to minimize skin irritation •Brace should be worn while sleeping •Assess skin for pressure-related issues •Teach isometric exercises to strengthen abdominal muscles •Braces discontinued after end of spinal growth
What would you consider for different age groups when it comes to death & dying?
•Infants & Toddlers: Do not understand concept of death, but do sense caregiver's emotions. Maintain routine and avoid unusual separation. •Preschool: Concrete thinkers - no concept of death as permanent. Utilize play therapy and avoid euphemisms. •School-aged: Understand death permanence, but struggle with causality. May have guilt/fear over "causing" death. •Adolescent: understand death as adults do, but can struggle to express emotions. May react with risk-taking behaviors.
What would you consider for other age groups?
•Infants: Parental presence and comfort is very important •Preschool: Concrete thinkers - show them equipment •School-aged: beginning logical and abstract thought; provide models and visual aids •Adolescent: discuss body changes, encourage peer interaction
Burns - Sterile technique!!!
•Wear cap, gown, mask, and gloves •Sterile technique with wound care •Topical antibacterial: silver sulfadiazine, silver nitrate or mafenide •Need to maintain warm, moist environment •Patients may require escharotomy or wound grafting
A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. What is the nurse's best response?
"Sometimes age has to do with the decision for radiation therapy." Radiation therapy is usually delayed until a child is 8 years old, whenever possible, to prevent retardation of bone growth and soft tissue development.
The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information?
"The child does not experience pain at the primary tumor site." Rationale: Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site.
The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent?
"The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination." Adequately protecting children with cystic fibrosis from communicable diseases by immunization is essential. In addition to the basic series of immunizations, a yearly influenza immunization is recommended for children with cystic fibrosis.
A 2-year-old child is treated in the emergency department for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement by the parents indicates an understanding of measures to provide safety in the home?
"We will be sure not to leave hot liquids unattended."
The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characteristics of von Willebrand's disease? Select all that apply.
1. Easy bruising occurs. 2.Gum bleeding occurs. 3.It is a hereditary bleeding disorder. 4.Treatment and care are similar to that for hemophilia. The disorder causes platelets to adhere to damaged endothelium.
The nurse educator is preparing to conduct a teaching session for the nursing staff regarding the theories of growth and development and plans to discuss Kohlberg's theory of moral development. What information should the nurse include in the session? Select all that apply.
1. Individuals move through all 6 stages in a sequential fashion. 2. Moral development progresses in relationship to cognitive development. 3.A person's ability to make moral judgments develops over a period of time. 4.The theory provides a framework for understanding how individuals determine a moral code to guide their behavior. 5.In stage 1 (punishment-obedience orientation), children are expected to reason as mature members of society. 6. In stage 2 (instrumental-relativist orientation), the child conforms to rules to obtain rewards or have favors returned.
The mother of an 8-year-old asks the nurse what type of toys are best for her child. What is the nurse's BEST response?
1. Table games, sports equipment or craft kits. Development of fine motor skills, collaborate play
The nurse visits a family with three young children who live in a house built in 1952. The nurse counsels the family on lead poisoning. Which statement indicates that teaching is effective?
1."I plan to scrape paint off the walls after the children go to bed tonight." 2."My children eat meals whenever they are hungry." 3."I wet-mop my floors and wash the window sills weekly." 4."I'm going to leave a patch of dirt uncovered so the children will have somewhere to dig."
A mother brings her 20 month old girl to the health clinic. The nurse counsel the mother about toilet training. Which statement, if made by the mother to the nurse, indicates the family's readiness for toilet training? Select all that apply. 1."My child's diapers are usually dry when she awakens from her nap." 2."My child does not mind wearing wet or dirty diapers." 3."I am looking forward to taking the next two weeks off." 4."My child can sit still for 2-3 minutes." 5."My child's bowel movements occur any time during the day." 3."I am looking forward to taking the next two weeks off."
1."My child's diapers are usually dry when she awakens from her nap." 3."I am looking forward to taking the next two weeks off." 3."I am looking forward to taking the next two weeks off."
The nurse instructs the parents of the child diagnosed with celiac disease. The nurse determines teaching is effective when the parents make which statement?
1."My child's diet should be high in calories, high in protein, and restrict foods containing rye, oats, wheat, and barley."
A brace is ordered for the adolescent to correct a scoliosis deformity. Which statement, if made by the parent to the nurse, indicates that teaching is successful?
1."The brace should be worn at least 18 hours/day."
The child diagnosed with attention deficit hyperactivity disorder is prescribed methylphenidate. Which statement, if made by the parents, indicates understanding of the medication teaching?
1."We should monitor our child's weight and provide frequent, nutritious foods for our child to eat."
The nurse is providing teaching to the parents of a 2-year-old with otitis media. Which statement indicates that further teaching is needed?
1."We will give our child the antibiotic until he feels better."
The nurse is assessing students for scoliosis. Which student would the nurse refer to the pediatrician for additional assessment of the spine?
1.A 13-year-old girl whose skirt hem is longer on one side than the other.
The nurse is providing care for a child diagnosed with lead poisoning. What physical assessment findings does the nurse expect? 1.Anemia, hearing impairment and distractibility 2.Tinnitus, confusion, hyperthermia 3.Polycythemia, hypoactivity and impaired liver function 4.Shortness of breath, dependent edema and clubbing
1.Anemia, hearing impairment and distractibility
The nurse is teaching a class on burn prevention to parents of small children. What will the nurse include?
1.Apply SPF lotion to the child 15 minutes before sun exposure. 2.Install smoke detectors in every room of the house 3.Keep all pot handles turned away from the front of the stove 4.Install covers over electrical outlets 5.Avoid the use of space heaters 6.Never leave a small child unattended
The school nurse is assessing a child for symptoms of attention deficit hyperactivity disorder. Which symptom is characteristic of the disorder. SELECT ALL THAT APPLY.
1.Constant fidgeting and squirming 1.Difficulty paying attention to details 2.Easily distracted 3.Talking constantly, even when inappropriate
Ten hours after the client with 50% burns is admitted, her blood glucose level is 140 mg/dL. What is the nurse's best action?
1.Documents the finding
A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to sickle cell crisis. Which factor, if identified by the mother as a precipitating factor, indicates the need for further instructions?
1.Fluid overload
The parent brings the 6-month-old baby to the clinic. The parent reports that the baby had a check-up at 1 month of age and received the first dose of DTaP. Which action by the nurse is MOST appropriate?
1.Give the second dose of DTaP.
The nurse is providing care to a child in sickle cell crisis. Which action is the PRIORITY?
1.Monitor oxygen saturation
After the nurse provides dietary restrictions to the parents of a child with celiac disease, which statement by the parents indicates effective teaching?
1.Our child must maintain these dietary restrictions lifelong."
The client has a large burned area on the right arm. The burned area appears pink, has blisters, and is very painful. How will the nurse categorize this injury?
1.Partial-thickness superficial
Which interventions are appropriate for the care of an infant? Select all that apply.
1.Provide swaddling. 2.Talk in a loud voice. 3.Provide the infant with a bottle of juice at nap time. 4.Hang mobiles with black and white contrast designs. 5.Caress the infant while bathing or during diaper changes. 6.Allow the infant to cry for at least 10 minutes before responding. Holding, caressing, and swaddling provide warmth and tactile stimulation for the infant. To provide auditory stimulation, the nurse should talk to the infant in a soft voice and should instruct the mother to do so also. Additional interventions include playing a music box, radio, or television, or having a ticking clock or metronome nearby. Hanging a bright shiny object in midline within 20 to 25 cm of the infant's face and hanging mobiles with contrasting colors, such as black and white, provide visual stimulation.
The nurse is caring for a 12-year-old child with attention deficit hyperactivity disorder who is prescribed methylphenidate. What finding MOST concerns the nurse?
1.The heart rate is 119 beats/minute.
The nurse is teaching a group of parents about otitis media. What does the nurse include in the teaching?
1.The toddler has a stiff neck and light sensitivity. - Not an expected finding! - Meningitis
An adolescent is in the postoperative recovery area after surgery for scoliosis repair involving placement of a Harrington rod. What is the PRIORITY nursing action?
1.Use log-rolling procedure when changing positions.
The nurse in outpatient surgery prepares the 2-year-old child for a myringotomy for placement of tympanostomy tubes. It is most important for the nurse to take which action? 1.Use bright objects to distract the toddler during the preoperative assessment. 2.Allow the toddler to play with a toy stethoscope before auscultation. 3.Demonstrate the use of the stethoscope before auscultation. 4.Give the toddler choices when possible during the preoperative assessment.
2. Allow the toddler to play with a toy stethoscope before auscultation.
The nurse observes a child walk up and down steps. The child has a steady gait and can use short sentences. How old does the nurse know the child is likely to be?
24 months - 2 years
The nurse meets with the parent of a 13-year-old boy in the pediatric health care provider's office. The parent voices concern that the child has recently become clumsy and uncoordinated. Which response by the nurse is BEST? 1."Your son might have attention deficit hyperactivity disorder." 2."I'll talk with the health care provider about assessing for subtle motor dysfunction." 3."Your son's clumsiness is expected at this age." 4."This may be an early sign of depression."
3."Your son's clumsiness is expected at this age."
A 2 yr. old comes in with burns from the bathtub to both legs, what % of body is this?
30% (15 x 2)
During a routine screening at a clinic, an otoscope examination of a child's ear reveals a tympanic meme brane that is pearly gray, slightly bulging , and not moveable. What action should the nurse take next?
As the child if he/she has a cold, runny nose or any ear pain lately.
A patient is brought into the emergency department after suffering from third degree burns in an explosion. The patient has burns on approximately 40 percent of his body. The nurse weighs the patient and notes that he weighs 70 lbs. Calculate the rate of IV fluid this patient must receive in the first 24 hours using the Parkland formula.
4 ml x TBSA (total body surface area) x Wt. (kilos) 4 ml x 40 x (70/2.2) = 5091
Beat vacation for sickle cell anemia?
A bus trip to the museum of natural history O2 is important!
The nurse caring for a child who sustained a burn injury plans care based on which pediatric considerations associated with this injury? Select all that apply.
A delay in growth may occur after a burn injury. An immature immune system presents an increased risk of infection for infants and young children. Infants and young children are at increased risk for protein and calorie deficiency, because they have smaller muscle mass and less body fat than adults.
A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should ask the child and parent about a history of a severe allergy to which substance?
A previous dose of hepatitis B vaccine or component
To take vital signs of a 4-month-old child, which order will give the most accurate results?
A. Respiratory rate, heart rate, then rectal temperature.
The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. Which assessment findings are specifically characteristic of this disease? Select all that apply.
Abdominal pain Painless, firm, and movable adenopathy in the cervical area
The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents?
Administer the iron through a straw.
Movies, computer games
Adolescent
The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which is the most appropriate suggestion to the mother?
Allow the bottle if it contains water. A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, sweetened water, or any other sweet liquid because of the risk of nursing (bottle-mouth) caries. If a bottle is allowed at nap time or bedtime, it should contain only water.
A 16-year-old client is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing intervention is most appropriate to facilitate normal growth and development postoperatively?
Allow the client to interact with others in his or her same age group.
The maternity nurse is providing instructions to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse instructs the mother to take which measure?
Allow the newborn infant to signal a need.
An infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. Which intervention should the nurse suggest to the parent?
Apply a cold pack to the injection site. On occasion, tenderness, redness, or swelling may occur at the site of the DTaP injection. This can be relieved with cold packs for the first 24 hours, followed by warm or cold compresses if the inflammation persists.
The clinic nurse reviews the record of an infant and notes that the primary health care provider (PHCP) has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant?
Foul-smelling ribbon-like stools Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction, especially in the neonatal period; abdominal pain and distention; and failure to thrive are also clinical manifestations.
The nurse is caring for a child after a tonsillectomy. The nurse monitors the child, knowing that which finding indicates the child is bleeding?
Frequent swallowing Frequent swallowing, restlessness, a fast and thready pulse, and vomiting bright red blood are signs of bleeding.
An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note?
Fruity breath odor and decreasing level of consciousness
The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply.
Give the child a teaspoon of honey. Prepare to administer glucagon subcutaneously if unconsciousness occurs. Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If possible, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker.
The nurse is giving preoperative instructions to a 14-year-old female client who is scheduled for surgery to correct a spinal curvature. Which statement by the client best demonstrates that learning has taken place? A) I will read all the literature you gave me before surgery. B) I have had surgery before when I broke my wrist in a bike accident, so I know what to expect. C) All the things people have told me will help me take care of my back. D) I understand that I will be in a body cast and I will show you how you taught me to turn.
I understand that I will be in a body cast and I will show you how you taught me to turn.
A mother arrives at a clinic with her toddler and tells the nurse that she has a difficult time getting the child to go to bed at night. What measure is most appropriate for the nurse to suggest to the mother?
Inform the child of bedtime a few minutes before it is time for bed. Informing the child of bedtime a few minutes before it is time for bed is the most appropriate option.
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5 × 109/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care?
Initiate bleeding precautions. 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 anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is has a low platelet count usually less than 50,000 mm3 (50.0 × 109/L), bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage.
The nurse is preparing to administer exogenous surfactant to a premature infant who has respiratory distress syndrome. The nurse prepares to administer the medication by which route?
Intratracheal Respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant, resulting in hypoxia and acidosis. It is common in premature infants and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route.
A mother brings her 2-week-old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 1 mg/dL (60.5 mcmol/L). The nurse reviews this result and makes which interpretation?
It is negative. It is characterized by blood phenylalanine levels greater than 20 mg/dL (1210 mcmol/L); normal level is 0 to 2 mg/dL (0 to 121 mcmol/L). A result of 1 mg/dL is a negative test result.
The nurse is conducting a home safety class. It is MOST important for the nurse to include which information in the teaching plan?
Keep a smoke detector in each bedroom.
Which action is BEST for the nurse to take to reduce separation anxiety on the part of the hospitalized toddler?
Keep toys from home in the bed with the child
Scoliosis is?
Lateral deviation of the spine that results in: •Poor posture •Uneven hips and/or scapulae •Uneven waistline Onset: Adolescence Risk: Family Hx, female gender
An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time?
Left lateral position The nurse positions the infant on the side lateral to the repair or on the back upright and positions the infant to prevent airway obstruction by secretions, blood, or the tongue. From the options provided, placing the infant on the left side immediately after surgery is best to prevent the risk of aspiration if the infant vomits.
A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying, and trying to climb out of the tent. Which is the most appropriate nursing action?
Let the mother hold the child and direct the cool mist over the child's face. Cool mist therapy may be prescribed to liquefy secretions and to assist in breathing. If the use of a tent or hood is causing distress, treatment may be more effective if the child is held by the parent and a cool mist is directed toward the child's face (blow-by).
A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition?
Limited range of motion in the affected hip In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis.
A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem?
Metabolic alkalosis
Medications for ADHD
Methylphenidate •Side effects: insomnia, weight loss, tachycardia •Nursing: Monitor height/weight, BP and heart rate; give at least 6 hours prior to bedtime; avoid caffeine Dextroamphetamine •Side effects: insomnia, tachycardia, palpitations, may alter insulin needs •Nursing: Monitor blood sugar, give in AM to prevent insomnia, contraindicated with MAOIs
The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriate nursing action?
Move the infant to a private room. RSV is a highly communicable disorder and is transmitted via droplets and direct contact with respiratory secretions. Use of contact, droplet, and standard precautions during care is necessary. Using good hand-washing technique and wearing gloves, gown, and a mask should be done to prevent transmission. An infant with RSV should be placed in a private room to prevent transmission.
What developmental milestones would you include for the different age groups?
Neuromuscular development proceeds from head to toe, trunk to peripheral and gross to fine. •Sphincter control for toilet training ~30 months •Undresses without help; copies a circle ~ 3 years •Throws overhead, brushes teeth ~ 4 years •Dresses without help ~ 5 years •Ties knots ~ 6 years •Eye development complete and fine motor for handwriting~ 8 years
A 7-year-old child is seen in a clinic, and the pediatrician documents a diagnosis of nighttime (nocturnal) enuresis. The nurse should provide which information to the parents?
Nighttime (nocturnal) enuresis is usually outgrown without therapeutic intervention. Nighttime (nocturnal) enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bedwetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system.
A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion?
Normal saline infusion Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. Dextrose solutions are added to the treatment when the blood glucose level decreases to an acceptable level.
The nurse is performing an initial assessment on a newborn infant. When assessing the infant's head, the nurse notes that the ears are low-set. Which nursing action is most appropriate?
Notify the pediatrician. Low or oddly placed ears are associated with various congenital defects and should be reported immediately.
The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which action should the nurse perform immediately?
Notify the surgeon. Rationale:Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the surgeon immediately.
A 4-year-old is admitted after a thermal burn injury with the following vital signs: blood pressure, 60/40; heart rate, 150 beats/min; respiratory rate, 35/min. Which action will the nurse take FIRST?
Obtain intravenous access and administer fluids
The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment?
Palpating the abdomen for a mass
A parent brings her 4-month-old infant to a well-baby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to administer which immunizations to this infant?
Rationale: DTaP, Hib, IPV, PCV, and RV are administered at 4 months of age. DTaP is administered at 2, 4, and 6 months of age; at 15 to 18 months of age; and at 4 to 6 years of age. Hib is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. IPV is administered at 2, 4, and 6 months of age and at 4 to 6 years of age. PCV is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. The first dose of MMR vaccine is administered at 12 to 15 months of age; the second dose is administered at 4 to 6 years of age (if the second dose was not given by 4 to 6 years of age, it should be given at the next visit). The first dose of HepB is administered at birth, the second dose is administered at 1 month of age, and the third dose is administered at 6 months of age. Varicella-zoster vaccine is administered at 12 to 15 months of age and again at 4 to 6 years of age
Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia?
Red blood cells that are microcytic and hypochromic
Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply.
Reduce exposure to environmental organisms. Use strict aseptic technique for all procedures. Ensure that anyone entering the child's room wears a mask. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand washing, ensuring that anyone entering the child's room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the child's room and by not leaving standing water in the child's room.
The nurse has just administered ibuprofen to a child with a temperature of 102° F (38.8° C). The nurse should also take which action?
Remove excess clothing and blankets from the child.
The nurse notes that a 6-year-old child does not recognize that objects exist when the objects are outside of the visual field. Based on this observation, which action should the nurse take?
Report the observation to the pediatrician.
The nurse is reviewing a primary health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply.
Restrict fluid intake. Give meperidine, 25 mg intravenously, every 4 hours for pain.
Otitis Media s/s? Infection of inner ear (flat Eustachian tube)
Risk factors: - Smoking exposure - Going to bed with a bottle - Allergies (allergen/mold exposure) Pulling at ears - Tugging, head rolling, crying Decreased appetite Red, bulging tympanic membrane Decreased pain after tympanic membrane ruptures Suck aggravates pain Fever 104 common - Fever chills N/V HA Untreated: Hearing impairment •Mastoiditis (infection of mastoid bone) •Meningitis
Scoliosis severity:
Scoliosis varies in severity. In more severe cases, it may cause: •Back pain •Functional impairment •Heart and lung issues related to the spine and/or rib cage compressing the heart or lungs
Scoliosis treatment?
Scoliosis varies in severity. In more severe cases, it may cause: •Back pain •Functional impairment •Heart and lung issues related to the spine and/or rib cage compressing the heart or lungs
Piaget: 0 - 2 years? Used to develop education plan
Sensorimotor: - Infant explores world through direct sensory and motor contact - Object permanence and separation anxiety develop during this stage
A parent of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. Using Erikson's psychosocial development theory, which instructions should the nurse provide to the parent? Select all that apply.
Set limits on the child's behavior. Provide a simple explanation of why the behavior is unacceptable.
Complications from sickle cell anemia?
Sickled red blood cells often get stuck in the smaller blood vessels - this can cause thrombosis and hemolysis. This can result in: •Damage to the kidneys, eyes and capillary beds of the hands/feet •Increased risk for stroke and heart attack •Hepatosplenomegaly (enlargement of the liver and spleen) •Pulmonary hypertension
The nurse is preparing to care for a child after a tonsillectomy. The nurse documents on the plan of care to place the child in which position?
Side-lying Rationale: A tonsillectomy is the surgical removal of the tonsils. The child should be placed in a prone or side-lying position after the surgical procedure to facilitate drainage.
The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indication that the child may be experiencing airway obstruction?
The child is leaning forward, with the chin thrust out. Epiglottitis is a bacterial form of croup. A primary concern is that it can progress to acute respiratory distress. Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, the use of accessory muscles for breathing, and the presence of stridor. Note: Epiglottitis causes tachycardia and a high fever.
A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother?
The flowers from your garden are beautiful, but should not be placed in the child's room at this time." For a hospitalized neutropenic child, flowers or plants should not be kept in the room, because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.
The nurse is caring for a 12-year old with ADHD who is prescribed methylphenidate. What finding MOST concerns the nurse?
The heart rate is 119 bpm.
The clinic nurse is assessing jaundice in a child with hepatitis. Which anatomical area would provide the best data regarding the presence of jaundice?
The nail beds Jaundice, if present, is best assessed in the sclera, nail beds, and mucous membranes.
A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease?
The presence of Reed-Sternberg cells in the lymph nodes Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the classic characteristic of this disease.
The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis?
Thicken the feedings by adding rice cereal to the formula. Small, more frequent feedings with frequent burping often are prescribed in the treatment of gastroesophageal reflux. Feedings thickened with rice cereal may reduce episodes of emesis.
The nursing student is presenting a clinical conference and discusses the cause of β-thalassemia. The nursing student informs the group that a child at greatest risk of developing this disorder is which of these?
This disorder is found primarily in individuals of Mediterranean descent.
A nursing student is presenting a clinical conference to peers regarding Freud's psychosexual stages of development, specifically the anal stage. The student explains to the group that which characteristic relates to the anal stage?
This stage is associated with toilet training.
The nurse is evaluating the developmental level of a 2-year-old. Which does the nurse expect to observe in this child?
Uses a cup to drink By age 2 years, the child can use a cup and spoon correctly but with some spilling. By age 3 to 4 years, 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.
The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP?
Vomiting Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center. Children with open fontanels (posterior fontanel closes at 2 to 3 months; anterior fontanel closes at 12 to 18 months) compensate for ICP changes by skull expansion and subsequent bulging fontanels. When the fontanels have closed, nausea, excessive vomiting, diplopia, and headaches become pronounced, with headaches becoming more prevalent in older children.
The mother of a 3-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse should tell the mother that the most appropriate toy for a 3-year-old is which?
Wagon Toys for the toddler must be strong, safe, and too large to swallow or place in the ear or nose. Toddlers need supervision at all times. Push-pull toys, large balls, large crayons, large trucks, and dolls are some of the appropriate toys.
Sickle Cell Anemia is?
What causes sickle cell anemia? •Genetic disorder that results in defective hemoglobin •Hemoglobin causes RBCs to become sickle-shaped in presence of low oxygenation •Higher prevalence in African American population
The parent of a 6-year old tells the nurse that the child's grandparent died recently. The parent asks about how to talk about death and support their child during grief. What do you need to consider in responding?
What do you need to consider in responding? Age group's understanding of: •finality/irreversibility of death •causality of death
Cody is a 16-year-old male admitted for sickle-cell crisis. What developmental considerations should you consider as you plan care?
•Importance of body-image and peer group; encourage socialization.
Immunizations?
dTap, IPV, HepB - 1 - 2 months HepB - At birth 30 days apart to get again MMR and Varicella (can't get until 1 yr old)
Lead Poisoning - Treatment
•A serum lead level >5mcg/dL is considered too high, but treatment usually not started unless lead level >45 mcg/dL due to risks of treatment •In acute lead poisoning, chelation with dimercaprol and edetate calcium disodium (EDTA) can be administered -> binds to the lead to cause elimination via urine •Risk for renal toxicity and seizures
A parent brings their 18-month-old into the clinic for a routine check-up. The parent asks about what milestones to expect over the next year. What psychosocial and cognitive developments would you tell the parent about?
•Beginning to establish independence •Tantrums common •Parallel play begins Toddler stage: Erickson (autonomy vs. shame/guilt) - Needs to establish independence - Exerting themselves often results in tantrums
A parent brings their 18-month-old into the clinic for a routine check-up. The parent asks about what milestones to expect over the next year. *18 mos., child is moving into toddler stage* What developmental milestones would you tell the parent about?
•By 18 months: scribbles, climbs stairs •By 24 months: jumps/hops, builds 5-6 block tower •By 30 months: walks on tiptoes, stands on 1 foot
What factors can precipitate a sickle cell crisis?
•Dehydration •Deoxygenation from respiratory tract infection •Stress •Infection •High altitudes or extremes in temperature
A parent brings their 18-month-old into the clinic for a routine check-up. The parent asks about what milestones to expect over the next year. What sources or guidelines would you think about when formulating your response?
•Erikson's stages •Height/weight growth charts •Denver II •Cognitive development •Play development
Celiac Disease
•Gastrointestinal disorder caused by an allergic reaction to gluten •Immune reaction in the intestine leads to diarrhea, bloating, gas and malabsorption of food •Malabsorption results in: •Anemia (r/t iron and B12 deficiency) •Osteoporosis (r/t calcium deficiency) •Celiac disease is a differential diagnosis that should be considered in children with failure to thrive
What psychosocial and cognitive information would you include for the different age groups?
•Infants: by 3 months, smiles at parent; stranger anxiety begins ~ 7 months; by 9 months: "dada" •Preschool: decreased tantrums, imitates adult patterns and roles; by 5 years, beginning cooperative play •School-aged: begins logical thought patterns; sensitive to criticism; by 7 years, enjoys team sports/activities • Adolescent: Body image is very important, as are peer relationships/peer pressure; moodiness and conflict with adults may occur
Expected growth and development:
•Infants: double birth weight by 4 months; triple birth weight by 1 year; grow 10 inches during first year. *Rapid during first year. Slower in toddler stage. •Preschool: gain 2 kg and grow 2 inches per year. •School-aged: gain 2 kg per year and grow 2 inches per year. *Slow and steady •Adolescents: gain 2-3 kg and grow 3-4 inches per year. *Growth spurt
Lead Poisoning -Signs/Symptoms
•Lead accumulates in the brain, liver, kidneys and bones. •The signs & symptoms of lead poisoning include: •Anemia •Renal impairment or failure •Constipation •Loss of appetite/weight loss •Developmental delay •Learning Difficulties •Hypoactivity/inattention •Hearing loss •Seizures
Lead Poisoning - Risks
•Lead is a heavy metal often in the dust or peeling paint of older homes (typically those built before 1978 in US) •May also be found in contaminated drinking water from older pipes or industrial leaks •Hobbies (stained glass) or occupational exposures (printers, plumbers) •Cigarette smoke •Children 6- 72 (6 yrs) months are at highest risk •Deficiencies in Vitamin C, zinc, calcium and iron lead to greater lead absorption •Lead poisoning leads to negative/delayed neurocognitive development and anemia
What suggestions would you provide parents and teachers to help manage ADHD behaviors?
•Maintain a consistent daily schedule •Minimize distractions while child is completing tasks •Provide specific place for child to keep clothes, toys, lunch box, etc. •Set small, reachable goals •Reward positive behavior •Use charts/checklists to keep the child on task •Limit choices •Find activities in which the child can be successful •Provide outlet for energy
What nursing actions will you take for the child with otitis media?
•Monitor for s/s of complications •Assess hearing •Administer medications: •Antibiotics •Analgesics - ibuprofen or acetaminophen •Antihistamines •Decongestants NEVER GIVE ASPIRIN!
Cody's parents report that he is often moody and they have noticed that he is clumsy and appears uncoordinated at times. They ask you whether you think he is depressed or if this is related to the sickle cell disease. What might you consider in your response?
•Moodiness and clumsiness are normal in adolescence •Assess impact of disease on self-image
uWhat else would you consider monitoring in relation to fluids/electrolytes?
•Need to maintain indwelling catheter to monitor urinary output for at least first 36 hours - Need I&O! •Monitor for electrolyte disturbances •Hyponatremia (due to loss) •Hyperkalemia (due to cell lysis from burns) •Expect mild hyperglycemia (due to stress response) •Monitor for both dehydration and fluid overload
What assessment findings do you expect for the patient with sickle cell anemia?
•Pain - especially of joints and abdomen •Swelling of hands and feet •Tachycardia and cardiac murmurs - Increased risk for stroke/heart attack •Delayed growth and development •Vision problems •Jaundice - Hepatosplenomegaly (enlargement of liver/spleen) - Pulmonary hypertension •Hemoglobin 7-10g/dL •Sickled cells on peripheral blood smear
Nursing Actions - Otitis Media
•Position on side of involved ear to promote drainage •Important to prevent water getting into ears: no swimming, immersive bathing
Treatment for sickle cell disease?
•Prevention: •Fluid intake •Avoidance of triggers •Treatment: •Prophylactic penicillin for young children (2 months-5 years) •Hydroxyurea - stimulates production of fetal hemoglobin •Bone marrow transplant in childhood •Blood transfusions
What nursing actions would you include for the patient with sickle cell crisis?
•Provide analgesics - patient controlled analgesia with morphine or hydromorphone •IV hydration (1600 ml/m2/day for a child / 3-5 L/day for adult)
For burns >10% of BSA in children, need to emergently rehydrate in first 24 hours!!
•Rapid for first 8 hours, then more slowly for next 16 hours •Parkland formula: 4 ml X TBSA (%) X body weight (kg) = total fluid for 24 hours •Give 50% in first 8 hours and 50% over next 16 hours
The 18-month-old has an umbilical hernia that requires repair. What should you consider as you prepare the child and parent for the surgery and hospitalization?
•Separation anxiety is still likely; encourage parental presence •But allow for beginning independence - encourage child activities
Treatment for scoliosis?
•Spinal fusion with instrumentation •Harrington rods - rods inserted bilaterally and screwed into spine •Frequent neuro checks are needed for 48 hours post-surgery •Log roll patient
Lead poisoning - Prevention
•Testing for lead in homes and water •Regular removal of dust/paint chips in homes contaminated with lead •Keeping children away from dust and potentially contamination •If parents work in an occupation with known lead exposure, shoes should be removed prior to coming home and kept away from children. Parent should undress and shower before touching children. •Any lead paints or materials for hobbies should be locked away.
A parent brings their 18-month-old into the clinic for a routine check-up. The parent asks about what milestones to expect over the next year. What physical growth expectations would you tell the parent about?
•The toddler should gain about 2 kg per year until puberty •Height growth of 3-4 inches per year until age 4 - Weight gain should be slow and steady - Emphasizing normal weight gain is key for edu.
Surgical treatments for Otitis media?
•Ventilatory tubes - inserted into Eustachian tube for ventilation/alleviate pressure •Myringotomy - incision made in tympanic membrane to relieve pressure/release purulent fluid •Tympanoplasty - reconstruction of ossicles and tympanic membrane (ruptured)