Pediatrics exam 3
Manifestations of pyloric stenosis
- projectile vomit -hungry -FTT -"olive" mass (mobile, palpable, nontender) -S/S of dehydration - No pain! -metabolic alkalosis S/S
Diagnosis of appendicitis
- Obturator sign - McBurney's point - u/s
Assessment/DX of scholiosis
- Pt "diving" into pool and run fingers down their spine -x-ray: if >15 degree then it's more severe. Take age into consideration though. (called Cobb tecnique) -screen at 4th and 7th grade
Causes of encopresis
- hurts kid to poop - school bathroom rules - inappropriate place/social - dehydration - opiods - low fiber - too much dairy - ADHD
Nursing interventions for hydrocele
- investigate if persistent - illuminate and see the fluid - U/S of scrotum: see if blockage - Resolves in infants -Advise parents that there is often temporary swelling and discoloration of the scrotum that resolves spontaneously.
S/S of Esophageal atresia and tracheaesophageal fistula
*Choke/vomit on first feed= classic sign -Cyanotic, especially when feeding -Apneic -Frothy, white bubbles in the mouth. -Very round, full abdomen.
Treatment of GERD
- thicken formula with rice cereal - elevate head of bed -hold infant upright for 30 min after meal - Small, frequent meals -avoid choc, caff, spicy, tomatoes, pepperment, citrus -pharmalogical= H2 blocker, PPI, prokinetic agent
Nursing interventions for scoliosis
-Education on brace→ must wear 18 hours a day -Turning every two hours, log roll -Early mobilization -Encourage coughing and deep breathing (Incentive spirometer) - Contact sports usually restricted for up to two years
Treatment for Legg-calve-perthes disease
-Goal= ROM and position femoral epiphysis within the acetabulum with traction - Re-establish vascularization - Pain relief - Bed rest/wheelchair bound - Brace or cast - Surgical intervention = Pelvic osteotomy - Hip spica cast for 6-8 weeks post-op - Bracing: Thigh to ankle for 6-18 months → wear over clothes and may participate in some physical activities
Treatment for metatarsus adductus
-Goal= strengthen fore foot so it aligns with heel! - splints or reverse lost shoes worn 22 hrs/day for 4-6 wks - TEACH parents ROM to do at diaper change (4-8x/day)
S/S of slipped capital femoral epiphysis
-Hip/knee pain -Sciatica pain in butt
Considerations for slipped capital femoral epiphysis
-OBESITY - physical orientation - hormonal changes - trauma- ask!
Treatment for scoliosis
-surgery- posterior spinal fusion most common - nonsurgical -physiotherapeutic specific exercises - prevent/ treat respiratory dysfunction - Boston/Milwaukee brace (18+ hours/day!)
Treatment for ulcerative colitis
1. Diet modification (high protein, high cal) 2. Drugs= corticosteroids, sulfas, immunomodulating agents 3. Risk of fat sol. vit deficiency
Treatment for Wilm's tumor
1. Never palpate! 2. Nephrectomy followed by chemo/radiation
Post-op care for cleft
1. Pain management→ console baby, pain meds. 2. Prevent tension on suture line with arm splint 3. Positioning→ sit up in infant seat; no tummy time 4. Feeding 5. Monitor for infection
Triad for Hemolytic uremic syndrome
1.Acute renal failure 2. Thrombocytopenia 3. Microangiopathic hemolytic anemia
Gluten free foods
beef, fish, eggs, corn, milk, fruits, vegetables
Criteria for colic (how long/much etc.)
3x/wk for 3+hours for 3+ weeks
Caring for the newborn with a cleft lip and palate before surgical repair includes: A. Gastrostomy feedings B. Keeping the infant in near-horizontal position during feedings C. Allowing little or no sucking D. Providing satisfaction of sucking needs
D. Providing satisfaction of sucking needs
A child is admitted to the hospital with a probable DX of nephrotic syndrome. Which findings should the nurse expect to ovserve? Select all that apply: A. pallor B. edema C. anorexia D. proteinuria E. Weight loss F. Decreased serum lipids
A,B,C,D Rationale: Nephrotic syndrome is a kidney disorder that is characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia and pallor. The urine volume is decreased and the urine is dark and frothy in appearance. The child with this condition gains weight.
After teaching the family of a child with scoliosis who needs to wear a Boston brace, which of the following activities, if stated by the child and family as occasions appropriate for removal of the brace, indicates successful teaching? A When bathing, for about 1 hour per day. B While eating, for a total of 3 hours a day. C During school, for about 8 hours a day. D When sleeping, for a total of 10 hours a day.
A. RATIONALE: One of the most effective spinal braces for correcting scoliosis, the Boston brace should be worn for at least 16 to 23 hours a day, except when carrying out personal hygiene measures.
What food choice by the parent of a 2 year old child with celiac disease indicates a need for further teaching? A. Oat cookie B. Rice cake C. Corn muffin D. Meat patty
A. oat cookie
THe nurse, reinforcing home care instructions, prepares a list for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? Select all that apply A. Use the fingertips to lift the cast while it is drying B. Keep small toys and sharp objects away from cast C. Use a padded ruler or another padded object to scratch the skin under the cast if it itches D. Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold E. Contact the health care provider if the child complains of numbness or tingling in the extremity F. Elevate the extremity on pillows for the first 24-48 hours after casting to prevent casting.
Answer B,E,F Rationale- While the cast is drying, the palms of hands are used to lift the cast. If the fingertips are used, indentations in the cast could occur and cause constant pressure on the underlying skin. Small toys and sharp objects are kept away from the cast, and no objects (including padded objects) are placed inside of the cast because of the risk of altered skin integrity. A heating pad is not applied to the cast or fingers. Cold fingers could indicate neurovascular impairment and the HCP should be notified. THe extremity is elevated to prevent swelling and the HCP is notified immediately if any signs of neurovascular impairment develop.
An 18 month old child is being discharged after surgical repair of hypospadias. Which postoperative nursing care measure should the nurse stress to the parents as they prepare to take this child home? A. Leave diapers off to allow site to heal B. Avoid tub baths until the stent has been removed C. Encourage toilet training to ensure that the flow of urine is normal D. Restrict the fluid intake to reduce urinary output for the first few days.
Answer B- Avoid tub baths until the stent has been removed Rationale- After hypospadias repair, the parents are instructed to avoid giving the child a tub bath until the stent has been removed to prevent infection. Diapers are placed on the child to prevent the contamination of the surfical site. Toilet training should not be an issue during this stressful period. Fluids should be encouraged to maintain hydration.
The nurse is reviewing the record of a child with a DX of pyloric stenosis. Which data should the nurse expect to note as having been documented in the child's record? A. Watery diarrhea B. Projectile vomit C. Increased urine output D. Vomiting large amounts of bile
Answer B- projectile vomit
The child with cryptorchidism is being discharged after orchiopexy, which was performed on an outpatient basis. The nurse should reinforce instructions to the parents about which priority care measure? A. Measuring I/O's B. Administering anticholinergics C. Preventing infection at surgical site D. Applying cold, wet compressess to the surgical site
Answer C- Preventing infection at surgical site The most common complications associated with orchiopexy are bleeding and infection. The parents are instructed in postoperative home care measures including the prevention of infection, pain control and activity restriction.
The nurse is performing a neurovascular check on a hospitalized kid who had a cast applied to the lower leg. The child complains of tingling in the toes distal to the fracture site. Which action should the nurse take? A. elevate the extremeity B. Document the finding C. Notify the RN D. Ambulate the child with crutches
Answer C. Notify the RN Rationale- Reduced sensation to touch or complaints of numbness or tingling at a site distal to the fracture may indicate poor tissue perfusion. This finding should be reported to the RN or HCP.
The nurse is assisting a health care provider during the exam of an infant with hip dysplasia. The HCP performs the Ortolani maneuver. Which best describes the reason for performing the Ortolani maneuver? A. Determining the extent of ROM B. Checking for assymetry on the affected side C. Pushing the unstable femoral head out of the acetabulum D. Reducing the dislocated femoral head back into the acetabulum
Answer D- Reducing the dislocated femoral head back into the acetabulum Rationale: With the OM, the examiner reduces the dislocated femoral head back into the aetabulum. A positive OM is a palpable clunk as the femoral head moves over the acetebular ring. Options 1 and 2 are data collection techniques for the ID of the clinical manifestations of hip dysplasia but they do not describe the OM. When performing the Barlow maneuver, the examiner pushes the unstable femoral head out of the acetabulum.
A health care provider has prescribed oxygen as needed for a 10- month old infant with heart failure. In which situation should the nurse administer the oxygen to the child? A. when the child is sleeping B. When changing the child's diapers C. When the mother is holding the child D. When drawing blood for electrolyte levels
Answer D- when drawing blood for electrolyte levels. Rationale: oxygen administration may be prescribed for the infant with HF for stressful periods, especially during bouts of crying or invasive procedures. Drawing blood is an invasive procedure that would likely cause the child to cry.
A 4 y/o child sustains a fall at home and is brought to the ER by the mom. After an xray, it is determined that the child has a fractured arm, and a plaster cast is applied. The nurse reinforces instructions to the mother regarding cast care for the child. Which statement by the mom indicates the need for further teaching? A. "The cast may feel warm as it dries" B. "I can use lotion or powder around the cast edges to relieve itching" C. "A small amount of white shoe polish can touch up a soiled white cast" D. "If the cast becomes wet, a blow dryer set on the cool setting may be used to dry it"
Answer- B. "I can use lotion or powder around the cast edges to relieve itching" Rationale- The mom needs to be instructed not to use lotion or powders on the skin around the cast edges or inside the cast because they can become sticky or caked and cause skin irritation. Options A,C and D are appropriate actions.
A patient with an open fracture of the left tibia and soft tissue damage underwent a surgical reduction and fixation of the tibia with debridement of nonviable tissue and drain placement. When assessing the patient during the postoperative period, the nurse will be most concerned about a. fever with chills and night sweats. b. light yellow drainage from the wound. c. pain on movement of the affected limb. d. muscle spasms around the affected bone.
Answer: A Rationale: Fever, chills, and night sweats are suggestive of osteomyelitis. The other clinical manifestations are typical after a fracture repair.
A patient is hospitalized for initiation of regional antibiotic perfusion for acute osteomyelitis of the right femur. Which intervention will be included in the plan of care? a. Frequent weight-bearing exercise b. Immobilization of the right leg c. Avoid administration of NSAIDs d. Support right leg in a flexed position
Answer: B Rationale: Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. NSAIDs are frequently prescribed to treat pain. Flexion of the affected limb is avoided to prevent contractures.
Nurse Rose is caring for a neonate with congenital clubfoot. The child has a cast to correct the defect. Before discharge, what should the nurse tell the parents? a. The cast will be removed in 6 weeks b. A new cast is needed every 1 to 2 weeks c. A short leg cast is applied when the baby is ready to walk d. The cast will be removed when the baby begins to crawl
Answer: B. Because a neonate grows so quickly, the cast may need to be changed as often as every 1 to 2 weeks. A cast for congenital clubfoot isn't left on for 6 weeks because of the rapid rate of the infant's growth. By the time a baby is crawling or ready to walk, the final cast has long since been removed. After the cast is permanently removed, the baby may wear a Denis Browne splint until he's 1 year old.
The nurse is is monitoring the daily weight of an infant with heart failure. Which findings alerts the nurse to suspect fluid accumulation and thus need to notify the RN? A. Bradypnea B. Diaphoresis C. Decreased BP D. weight gain of 1 lb/day
Answer: D weight gain of 1 lb/day
The nurse explains to the parent of a child with intussusception that a barium enema is to be given. The parent demonstrates to the nurse an understanding of the diagnosis when the parent states, "Intussusception is a: A. part of the bowel that is bulging like it's about to burst." B. piece of the bowel that is telescoped like a sleeve over itself." C. narrowed area of the bowel that does not easily pass stool." D. growth which projects from the lining of the bowel causing bleeding."
B. piece of the bowel that is telescoped like a sleeve over itself
Boys growth plates close ______ Girls growth plates close ____
Boys- 18 y/o Girls- 4 yrs after period starts
A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? a) I will encourage my child to perform prescribed exercises b) I will have my child wear soft fabric clothing under the brace c) I should apply lotion under the brace to prevent skin breakdown d) I should avoid the use of powder because it will cake under the brace
C - The use of lotions or powders under a brace should be avoided because they can become sticky and cake under the brace, causing irritation. Options A, B, and D are appropriate interventions in the care of a child with a brace.
The nurse is caring for an infant with congenital heart disease is monitoring the infant closely for signs of heart failure. The nurse should observe for which early sign of HF? A. Pallor B. Cough C. Tachycardia D. slow and shallow breathing
C. Tachycardia Rationale: The early signs of HF include tachycardia, tachypnea, profuse scalp sweating, fatigue, irritability, sudden weight gain and resp. distress. A cough may occur with HF as a result of mucosal swelling and irritation but it is not an early sign. Pallor may be noted in the infant with HF but it is also not an early sign.
A nurse who works with overweight children monitors them carefully for signs and symptoms of which of the following musculoskeletal illnesses? A. Legg-Calve-Perthes B. Duchenne muscular dystrophy C. Slipped capital femoral epiphysis D.Scoliosis
C. slipped capital femoral epiphysis
When teaching the child with scoliosis being treated with a Boston brace about exercises, the nurse explains that the exercises are performed primarily for which of the following purposes? A To decrease back muscle spasms. B To improve the brace's traction effect. C To prevent spinal contractures. D To strengthen the back and abdominal muscles.
D. RATIONALE: Exercises are prescribed for the child with scoliosis wearing a Boston brace to help strengthen spinal and abdominal muscles and provide support. Typically, children wearing a Boston brace do not complain of muscle spasms. Performing exercises provides no effect on the brace's traction ability. Spinal contractures do not occur when a Boston brace is worn.
A 6-year-old is diagnosed with Legg-Calve Perthes disease of the right femur. An important part of the child's care includes instructing the parents: A. To increase the amount of dietary protein B. About exercises to strengthen affected muscles C. About relaxation exercises to minimize pain in the joints D. To prevent weight bearing on the affected leg
D. To prevent weight bearing on the affected leg
Common disorder that causes pain and decreased hip motion; more common in males
Legg-calve-perthes disease
Dehydration manifestations
Less active, sleepy, or lethargic Crying without tears Decreased frequency of urination/wetting diapers Sunken eyes Cool, clammy skin Weak pulse Tachycardia/pnea
Can result in long term deformity if not treated aggressively
Epiphyseal fracture
Used to treat Talipes equinovarus; When patient is mobilized and stretching foot, taping and fitting into molded split which is on for 3 months but home therapy is done up until 2 years
French method
Passage of gastric contents into esophagus b/c lower esophageal sphincter relaxes/weakens
GERD
Difference b/t GERD and pyloric stenosis
GERD= goes into adulthood PS= corrects in infancy
From Group A beta-hemolytic strep infection; Antigen-antibody complex get trapped in glomeruli membrane and cause inflammation, edema and obstruction
Glomerulonephritis
bones from front half of foot turn inward (pigeon toed)
Metatarsus adductus
Assessment for glomerulonephritis (a/a trapped in glomeruli) for Renal, cardio and neuro
Renal- proteinuria, tea colored urine (hematuria) then oliguria, foamy urine Cardio- Edema, HTN, hypervolemia --->CHF (s/s) Neuro- Encephalopathy- H/A, irritable, seizures, coma
Child falls off mom's lap and foot gets caught-->twists to lower leg-->pain and inability to bear weight
Toddler's fracture
Trachea and esophagus don't separate during embryonic development
Tracheosophageal fistula
defective valve that guards bladder to ureter b/c urinary inserts into bladder (primary) or valve scarring from lots of UTI's (secondary) pee-->bladder contracts--> backflows in ureters-->stasis-->infection or hydronephrosis
Vesicoureteral reflux
malignant renal tumor arising from renal tissue
Wilm's tumor (nephroblastoma)
immune mediated reaction to gluten and accumulation of amino acid glutamine
celiac disease
Testes don't descend (either one or both) (starts at 7 months GA should be descended by 6 weeks)
cryptorchidism
esophagus doesn't develop normally between 4-6 weeks gestation
esophageal atresia
opening where there should be a closing
fistula
Protrusion of organ through the wall of the cavity which it is contained
hernia
Peritoneal fluid communicating with the scrotal area
hydrocele
abnormal urethral placement (closer to the anus the more severe)
hydrospadias
Treatment for Toddler's fracture
long leg cast for 4-6 wks
A distinction between slipped capital femoral epiphysis and legg-calve-perthes disease
obesity! and hormones
Biggest complication of appendicitis
peritonitis
Best way to diagnosis GERD
ph probe study (passed transnasally attached to monitor which measures reflux of acid contents from stomach into esophagus
Used to treat Talipes Equinovarus; Specific manipulations and casting in the off weekly for 6-8 weeks followed by a brace for 6 months
ponseti method
most common cause of gastric outlet obstruction in infants; common in 1st born males; DX first 3-5 weeks
pyloric stenosis
Posterior and inferior slippage of the proximal femoral epiphysis at the femoral neck occurring through the physeal plate
slipped capital femoral epiphysis
Red flag for Leggs-Calve-Perthes disease
wake up with pain
Nursing care for Wilm's tumor
- No contact sports to keep only kidney safe! - Treat UTI's ASAP
Diff DX for hematemesis (bloody vomit)
- bright red= upper GI tract (or post-op tonsillectomy - Coffee ground= chronic
hygiene education for UTI's
- wipe front to back! - no tight clothes/diapers - separate knees upon urination -don't hold it in!
Best test for kidney function. Normal level is >90 in kids over 1 y/o
GFR
closing where there should be an opening
atresia
Type of hernia that is a medical emergency and restricts blood flow
strangulated
Manifestations of intussception
-otherwise healthy infant with periodic severe pain -knees drawn to chest - nonbilous vomiting -currant red jelly stools -Empty RLQ (Dance sign)
Treatment for colic
-Breastfed mom- avoid milk, take calcium supplements - No soy formula - Evaluate for GERD
In teaching a group of parents about monitoring for UTI's in preschollers, the nurse would mention which finding as most indicative of the need to have child evaluated? A. The child voids only twice in any 6 hr period B. The child exhibits incontinence after being toilet trained C. The child has difficulty sitting still for more than a 30 minute period D. The child's urine smells strongly of ammonia after it stands for more than 2 hours
B. The child exhibits incontinence after being toilet trained Rationale- A child who exhibits incontinence after being toilet trained would be evaluated. Most urine smells of ammonia after standing for more than two hours so this doesn't necessarily indicate UTI. The other options are not reasons to suspect problems with the urinary tract
Lactose intolerance manifestations
Bloating Lower abdominal pain Gurgling or rumbling sounds Gas Loose stools or diarrhea, sometimes the stools are foamy vomiting
The nurse provided discharge instructions to the parents of a 2-year-old child who had an orchiopexy to correct cryptorchidism. Which statement by the parents indicate that further teaching is necessary? a) "I'll check his temperature." b) "I'll give him medication so he'll be comfortable." c) "I'll check his voiding to be sure there's no problem." d) "I'll let him decide when to return to his play activities."
D - Rationale: Cryptorchidism is a condition in which one or both testes fail to descend through the inguinal canal into the scrotal sac. Surgical correction may be necessary. All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury. This prevents dislodging of the suture, which is internal. Normally, 2-year-olds want to be active; allowing the child to decide when to return to his play activities may prevent healing and cause injury. The parents should be taught to monitor the temperature, provide analgesics as needed, and monitor the urine output.
3 days of nonbloody diarrhea then it progresses to bloody; colon could rupture; E-coli correlation
Hemolytic uremic syndrome
Nursing diagnosis for pre-op cleft lip/palate
Prevention of infection and nutrition
Nursing diagnosis for post-op cleft lip/palate
Safety and prevention of trauma
Patient teaching for cryptorchidism (undescended tests)
Self exam for cancer! Very high risk (esp 13-28 y/o) 1. Feel testes for lump/hardness while sitting indian style. 2. Same day, every month 3. Might be swollen and enlarged but not painful (cancer doesn't hurt)
common cause of intestinal obstruction in kids less than 2; proximal segment of bowel telescopes into lumen of distal segment of bowel
intussception
Major risk factor of ulcerative colitis
positive family history
Treatment for hydrospadias
surgery but don't circumcise prior so the foreskin could be used during surgery
inflammation of mucosal layer of large intestine and rectum; Diarrhea >2 weeks
ulcerative colitis
Manifestations of celiac disease
-brittle hair/nails -diarrhea >2 wks -FTT -ab distention/pain -muscle atropy -fatigue
Labs for ulcerative colitis
1. sedimentation rate- increased b/c inflammation in body 2. Serum albumin and iron= low
A child is admitted with a possible appendicitis. Which order should the nurse question before implementing? A. Fleets enema daily B. Medicate the client for pain, every four hours as needed C. Nothing by mouth (NPO) D. Monitor oral temperature every four hours
A. Fleets enema daily
A nurse reinforcing instructions about diet to a mother of a 5 year old lactose intolerant child would tell the mother which supplement will be required? A.Fats B.Zinc C.Protein D.Calcium
D - Calcium
Clinical manifestations of GERD
- Sandifer maneuver (neuro SXS like arching of the back and rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities, associated with GERD) - Barret esophagus precancerous lesions with chronic GERD - pulmonary aspiration -FTT - apnea -esophagitis -vomit -irritability
Management of nephrotic syndrome
- low salt diet - corticosteroids - albumin and lasix - immunosuppressants - Don't place nephrotic pt in room with an infectious client
Labs for Hemolytic uremic syndrome
- CBC (anemia) - Coombs - Thrombocytopenia - BUN and creatinine elevated (uremia) - Urinalysis- humaturia, proteinuria, casts and pyruia
Diff. DX for bright hematochezia (bloody stool)
- E-coli (infections) -Anal fissures - Anything that effects lower GI tract
Post-op instructions after hernia surgery
- observe for SS of hematoma or infection may resume - normal diet and activity but NO strenuous activity or play for TWO TO THREE WEEKS.
Diagnosis of nephrotic syndrome
- swollen eyes= first symptom - HX is key! (glomerularnephritis is sore throat, impetigo, proceeds strep; nephrotis has to do with the liver/fluid retention, - Urine dipstick- protein - Check BP -CBC -Lasix (Not K+ sparing)
Patient teaching about nocturnal enuresis
-Decrease fluids after 6pm - Teach child to urinate immediately before sleep - No caffeine, aspartame, and carbonated drinks (irritate bladder) - Chart or reward system for dry nights - Don't punish or embarrass - Alarm therapy - most effective
Celiac Disease labs
-IgA protein, vitamin and mineral levels -Serological blood test for tissue transglutaminase (if + then endoscopy with small bowel biopsy)
Manifestations of ulcerative colitis
-delayed growth and development! (b/c of malabsorption) - bloody diarrhea -anal fistula - abdominal cramping - loss of appetite
Manifestations
-rebound tenderness -increased WBC -RLQ pain -gas pains -normal-hypoactive bowel sounds -low grade temp
Nurse interventions for glomerulonephritis
-salt/water restricted diet - diuretics - Q4 BP -Daily weight check
Labs for glomerulonephritis (from strep infection; a/a complex gets trapped in glomeruli)
1. Urinalysis- protein, RBC, WBC, elevated specific gravity 2. Blood work- ASO titer; elevated sedintation rate (inflammation); elevated BUN and creatinine (glomeruli damage)
What age does appendicitis peak at?
9-11 y/o
The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? a) Restrict fluids as prescribed. b) Care for the arteriovenous fistula. c) Encourage foods high in potassium. d) Administer analgesics as prescribed.
A - Rationale: Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis).
A nurse is assigned to care for a client with nephrotic syndrome. The nurse assesses which important parameter on a daily basis? a) weight b) albumin levels c) activity tolerance d) blood urea nitrogen (BUN) level
A - The client with nephrotic syndrome typically presents with edema, hypoalbuminemia, and proteinuria. The nurse carefully assesses the fluid balance of the client, which includes daily monitoring of weight, intake and output, edema, and girth measurements. Albumin levels are monitored as they are prescribed, as are the BUN and creatinine levels. The client's activity level is adjusted according to the amount of edema and water retention. As edema increases, the client's activity level should be restricted.
The most appropriate means of rehydrating a 7 month old with diarrhea and mild dehydration is A. Oral rehydration therapy with electrolyte serum B. Replacing milk-based formula with a lactose based forumla C. Administering intravenous Dextrose 5% 1/4 normal saline D. Offering bananas, rice, and applesauce along with oral fluids
A. Oral rehydration therapy Rationale- The most appropriate means of hydrating a 7 month old with diarrhea and mild dehydration is to provide oral electrolyte serum. Answer B is incorrect because formula feedings should be delayed until sxs improve. Answer C is incorrect because the 7 month old has sxs of mild dehydration which can be managed with oral fluid replacement. Answer D is incorrect because a BRAT diet is no longer recommended. In the even it's used, it would be instituted after rehydration has taken place
An important nursing consideration in the care of a child with celiac disease is to: A. Refer to a nutritionist for detailed dietary instructions and education B. Help the child and family understand that diet restrictions are usually only temporary C. Teach proper hand washing and Standard Precautions to prevent disease transmission D. Suggest ways to cope more effectively with stress to minimize symptoms
A. Refer to a nutritionist for detailed dietary instructions and education
A 4 month old infant has gastroesophageal reflux disease (GERD) but is thriving without other complications. What should the nurse suggest to minimize reflux? A. Thicken formula with rice cereal B. Give larger, less frequent feedings C. Give continuous nasogastric tube feedings D. Place in Trendelenburg position after eating
A. Thicken formula with rice cereal
A mother calls the pediatrician's office because her infant is "colicky." The helpful measure the nurse would suggest to the parent is to: a. sing songs to the infant in a soft voice. b. place the infant in a well-lit room. c. walk around and massage the infant's back. d. rock the fussy infant slowly and gently.
ANS: D One technique the nurse can offer parents of a fussy infant is to rock the infant gently and slowly while being careful to avoid sudden movements
3. Which of the following nursing interventions should be implemented to manage a client with appendicitis? 1. Assessing for pain 2. Encouraging oral intake of clear fluids 3. Providing discharge teaching 4. Assessing for symptoms of peritonitis
Answer: 4. Assessing for symptoms of peritonitis The focus of care is to assess for peritonitis, or inflammation of the peritoneal cavity. Peritonitis is most commonly caused by appendix rupture and invasion of bacteria, which could be lethal. The client with appendicitis will have pain that should be controlled with analgesia. The nurse should discourage oral intake in preparation for surgery. Discharge teaching is important; however, in the acute phase, management should focus on minimizing preoperative complications and recognizing when such may be occurring.
Dr. Smith suspects tracheoesophageal fistula in a 1-day-old neonate. Which nursing intervention is most appropriate for this child? a. Avoiding suctioning unless cyanosis occurs b. Elevating the neonate's head and giving nothing by mouth c. Elevating the neonate's head for 1 hour after feedings d. Giving the neonate only glucose water for the first 24 hours
Answer: B. Because of the risk of aspiration, a neonate with a known or suspected tracheoesophageal fistula should be kept with the head elevated at all times and should receive nothing by mouth (NPO). The nurse should suction the neonate regularly to maintain a patent airway and prevent pooling of secretions. Elevating the neonate's head after feedings or giving glucose water are inappropriate because the neonate must remain on NPO status.
When caring for a 12-month-old infant with dehydration and metabolic acidosis, nurse May expects to see which of the following? a. A reduced white blood cell (WBC) count b. A decreased platelet count c. Shallow respirations d. Tachypnea
Answer: D. The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations. Altered WBC and platelet counts aren't specific signs of metabolic imbalance.
High fiber foods
Apple- most practical broccoli whole grains beans spinach raisins- cavity/choking hazard
Which of the following conditions most commonly causes acute glomerulonephritis? A. A congenital condition leading to renal dysfunction. B. Prior infection with group A Streptococcus within the past 10-14 days. C. Viral infection of the glomeruli. D. Nephrotic syndrome.
B Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection, resulting in scant, dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.
1. The nurse reviews the record of a child who is suspected to have glomerulonephritis and expects to note which finding that is associated with this diagnosis? a) Hypotension b) Brown-colored urine c) Low urinary specific gravity d) Low blood urea nitrogen level
B. Brown colored urine Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Hypertension is also common. Blood urea nitrogen levels may be elevated. A moderately elevated to high urinary specific gravity is associated with glomerulonephritis.
Which of the following would alert the nurse to possible peritonitis from a ruptured appendix in a child suspected of having appendicitis? A. Colicky abdominal pain with guarding of the abdomen B. Temperature of 102.4 degrees F, absent bowel sounds, and sudden relief from abdominal pain C. Periumbilical pain that progresses to the right lower quadrant of the abdomen with an elevated WBC D. Low-grade fever of 100.4 degrees F, with the child demonstrating difficulty walking and assuming a side-lying position with the knees flexed toward the chest
B. Temp of 102.4, absent bowel sounds and sudden relief from abdominal pain
Treatment of appendicitis
Basically can't do anything but IV antibiotics, hydrate and appendectomy -NO enema -NO heating pad on abdomen -NO tylenol (masks fever) -NO pain management because we need to know how it's progressing
An infant with hydrocele is seen in the clinic for a follow-up visit at 1 month of age. The scrotum is smaller than it was at birth, but fluid is still visible on illumination. Which of the following actions is the physician likely to recommend? A.Massaging the groin area twice a day until the fluid is gone. B. Referral to a surgeon for repair. C. No treatment is necessary; the fluid is reabsorbing normally. D. Keeping the infant in a flat, supine position until the fluid is gone.
C A hydrocele is a collection of fluid in the scrotum that results from a patent tunica vaginalis. Illumination of the scrotum with a pocket light demonstrates the clear fluid. In most cases the fluid reabsorbs within the first few months of life and no treatment is necessary. Massaging the area or placing the infant in a supine position would have no effect. Surgery is not indicated.
An infant returns to the unit after surgical repair of a cleft lip located on the right side. The best position is: A.Prone B.Supine C.Left side D.Right side
C - on the side opposite the repair to prevent contact of suture lines with linens, supine runs the risk of aspiration from vomiting
A nurse reviews the record of an infant and notes a suspected diagnosis of esophageal atresia with tracheoesophageal fistula (TEF). What clinical manifestation is likely? A.Incessant crying, B.Night coughing, C.Choking with feeding, D.Projectile vomiting
C - suspect TEF with the 3 C's = Coughing and Choking during feeding and Cyanosis
The nurse is preparing to admit a 3 year old with intussusception. Which of the following clinical manifestations would the nurse expect to observe? Select all that apply: A. Hematemesis B. Scaphoid abdomen C. Tender, distended abdomen D. Sudden acute abdominal pain E. Passage of red, currant jelly-like stools
C,D,E
A child diagnosed with a hernia is scheduled for surgical repair in 2 weeks.The nurse instructs parents about hernial strangulation signs.The nurse tells the parents which would require physician notification? A.Fever B.Diarrhea, C.Vomiting, D.Constipation
C-signs=vomiting, pain, irreducible mass
The LVN/LPN is reviewing the discharge plans for a newborn with hypospadias. What statement by the parents indicates their understanding of the plan of care for hypospadias? A. "A special support will be worn after surgery." B. "Our child will need frequent blood tests." C. "Our child won't be circumcised until after surgery so the skin can be used during the repair." D. "Our child will have to be catheterized frequently."
C. "Our child won't be circumcised until after surgery so the skin can be used during the repair."
A 6 y/o girl has a HX of repeated UTIs. She has been DXed with vesicoureteral reflux. Which of the following nursing responses would be most accurate to the mother who asks what the major complications are? A. Damage to the ovaries that could lead to fertility problems B. Minimal change nephrosis which results in kidney damage and HTN C. Development of pyelonephritis and possible renal damage from the reflux of urine D. Hemolytic syndrome that results in damage to the kidneys and abnormal spilling of protein
C. Development of pyelonephritis and possible renal damage from the reflux of urine. Rationale- VR is the abnormal reflux of urine from the blader back up the ureters and possibly into the kidneys. Residual urine that isn't voided promotes growth of bacteria and results in a high incidence of UTIs. This infected urine could reflux into the kidneys, resulting in pyelonephritis. VR isn't associated with hemolytic syndrome, minimal change nephrosis or damage to ovaries
Parents of a 5-year old child with encopresis are angry that the child is defecating in the playroom and his closet and not going to the bathroom to have a bowel movement. The first topic of teaching the nurse will do with the parents is which of the following? A. Bowel function and the prevention and treatment of constipation. B. The need to sit the child on the toilet every hour. C. The utilization of behavior modification to reverse the condition. D. Psychological factors associated with disorder.
Correct Answer: A. Bowel function and the prevention and treatment of constipation. The most likely cause of the encopresis is constipation or impaction. Therefore, parents need to be instructed on bowel function. Often the leakage of stool is not under the child's control and may be due to an overflow of stool as a result of the constipation or impaction. Of course, further evaluation is needed to detect any other problems the child might have. Psychological factors may be an issue but is not the first topic to be addressed. The child should not be put on the toilet every hour, as this adds to the child's stress. Behavior modification is not appropriate at this point.
A 7-year-old child is seen in a clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. The nurse should provide which information to the parents? a) Primary nocturnal enuresis does not respond to treatment. b) Primary nocturnal enuresis is caused by a psychiatric problem. c) Primary nocturnal enuresis requires surgical intervention to improve the problem. d) Most children outgrow the bed-wetting problem without therapeutic intervention.
D - Rationale: Primary 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 bed-wetting 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. The condition is not caused by a psychiatric problem.
A nurse reviews a 3wk old infant's record and notes the physician documented a Dx of suspected Hirschsprung's disease. The nurse knows which symptom led mom to seek health care? A.Diarrhea B.Vomiting C.Regurgitation D.Foul smelling, ribbon like stool
D-Hirschsprugs's manifestations=Chronic constipation beginning in the 1st month and results in foul smelling, ribbon like stool, Bowel obstruction, Abdominal pain, Distention, Failure to thrive-Delayed passage or absence of meconium is the cardinal sign
Which meal selection is suitable for the client hospitalized with nephrotic syndrome? A. Tuna sandwich, pickle spear, potato chips, and iced tea B. Ham slice,tossed salad with dressing, gelatin and coffee C. Tomato soup, cracker, peanut butter sandwich and milk D.Hamburger steak,baked potato,lima beans and milk
D. Hamburger steak,baked potato,lima beans and milk
A 2-year-old girl is brought to the office by her parents after blood was noticed in her urine. The parents say the patient has had intermittent abdominal pain during the past two months but has been otherwise well. On physical examination, the abdomen is slightly distended and a mass is palpated in the right upper quadrant. Results of urinalysis are positive for blood and protein. Which of the following is the most likely diagnosis? (A) Cystic nephroma (B) Cystitis (C) Mesoblastic nephroma (D) Neuroblastoma (E) Wilms tumor
E), Wilms tumor, because the clinical presentation of hematuria, abdominal pain of two months' duration, and a palpable mass in the right upper quadrant of the abdomen is characteristic of this tumor. Option (A), cystic nephroma, is incorrect because this tumor typically presents as an asymptomatic benign mass in the kidney that is found incidentally. Option (B), cystitis, is incorrect because this condition does not include a retroperitoneal mass. Option (C), mesoblastic nephroma, is incorrect because this condition is exceedingly rare; in more than 90% of cases, it presents before 1 year of age. Option (D), neuroblastoma, is incorrect because although it can present with intra-abdominal mass, proteinuria and hematuria are rarely associated with this condition. In addition, neuroblastomas also present more often in children younger than 1 year of age, making this diagnosis less likely in the patient
Manifestations of vesicoureteral reflux (backflow in ureter)
UTI SXS! (fever, vomit, chills, straining, painful stream, enuresis, strong odor, ab/back pain) Do septic work up if pt comes in with these SXS
Obstruction of the vermiform appendiceal lumen at the end of the cecum; pain in periumbilical area which migrates to RLQ
appendicitis
Foods with gluten
bread, pasta, wheat flour, malted milk, barley, bran, rye
Age for surgical intervention for cleft palate/lip
lip: 2-3 months palate: 12-24 months Lip should be first b/c the need to latch. Palate should be done before speech development
