Peds exam 2 study guide
for which child would nonopioid analgesics be recommended?
A child with juvenile arthritis
the nurse is counseling the parents of a 9 yo who is receiving morphine for postop pain. Which statement from the nurse accurately reflects the pain experience in children?
"it is very rare that children become addicted to narcotics"
a child diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the healthcare provider to prescribe? SATA
-Aspirin -IV immunoglobulin
a 14 yo boy is diagnosed with Hodgkin disease. When palpating for enlarged lymph nodes, the nurse would expect to find which nodes as most commonly enlarged?
-Cervical -Supraclavicular
the nurse is teaching the parent of a child with cystic fibrosis about nutrition requirements for the child. What should be included in this teaching? SATA
-Give your child high calorie foods and snacks -Feed your child foods that are high in protein -Give pancreatic enzymes with meals
the parents bring their 4 year old son to the ER. The child is receiving chemo for acute lymphoblastic leukemia. The parents report that the child has become lethargic and has had significant episodes of vomiting and diarrhea. What findings would lead the nurse to suspect the child may be experiencing lysis syndrome? SATA
-Hyperkalemia -Hypocalcemia -Hyperuricemia
an infant with a high RR is NPO and receiving IV fluids. What assessments will the nurse make to assure this infant is hydrated? SATA
-Measure skin turgor -Palpate anterior fontanel -Determine urine output
the nurse is developing a plan of care for a child with thalassemia. What info would the nurse expect to include?
-Packed RBC transfusions -Deferoxamine therapy
the nurse is assessing a child with aplastic anemia. What would the nurse expect to assess? SATA
-Tachycardia -Ecchymoses -Guaiac-positive stool -Epistaxis
the nurse is caring for a child that just returned from a coronary arteriogram in which the catheter was placed through the left femoral artery. Which nursing actions demonstrate knowledge of the procedure? SATA
-The nurse assesses the dorsalis pedis pulse in the left foot -The nurse assesses the puncture site frequently -The nurse tells the parents that the healthcare provider will discuss the results of the procedure with them
a child with suspected dyslipidemia undergoes lab testing. The nurse is reviewing the results. Which finding would the nurse interpret as supporting the dx?
-Total cholesterol level of 220 mg/dL -LDL level of 140 mg/dL
the nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? SATA
-Tuna -Salmon -Tofu -Dried fruits
the nurse is preparing a room for a child being transferred out of the ICU. The child has a trach. What items are essential for the nruse to have available at the bedside in case of emergency? SATA
-a new trach tube of the same size -a new trach tube of a smaller size -a bag valve mask
the nurse is managing children who have chronic diseases in a neighborhood clinic. What are some examples of chronic conditions? SATA
-diabetes mellitus -rheumatoid arthritis -acute asthma
the nurse is conducting a pain assessment of a 10 yo who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate pain relief. What is the appropriate action?
Obtain an order for a different medication
a nurse is teaching the parents of a child diagnosed with cystic fibrosis about med therapy. Which would the nurse instruct the parents to admin orally?
Pancreatic enzymes
a child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia?
Pernicious anemia
the nurse is reviewing the medical record of a child with ineffective endocarditis. What would the nurse expect to find? SATA
Petechiae on palpebral conjunctiva Microscopic hematuria with urinalysis Electrocardiogram with prolonged PR interval
what would be most appropriate to include in the plan of care for a child who has undergone surgery for removal of an astrocytoma?
Positioning the child on his unaffected side
the nurse is explaining the effects of heat application for pain relief. Which effect would the nurse be likely to include?
Possible release of endogenous opioids
a hospitalized child suddnely begins reporting chest pain, is tachypenic, and has tachycardia. The nurse auscultates the lung sounds and finds absent breath sounds on one side. After notifying the health care provider what action would the nurse take first?
Prepare for chest tube insertion
the nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the healthcare provider if the infant's apical pulse rate was:
80 bpm
the mother of a 4 week old infant is tearful. She reports the healthcare provider has told her that her son has a small atrial septal defect. She reports she is worried and asks the nurse more about the condition. Which statement by the parents best indicates an understanding of the nurse's teaching?
"If this does not resolve by the time the child is 1 years old, he will likely need surgery"
the nurse caring for infants in the NICU relies on the use of behaviorial and physiologic indicators for determining pain. Which examples are behaviorial indicators? SATA
-the infant flails his arms and legs -the infant is crying uncontrollably -the infant grimaces
the nurse is teaching the student nurse the physiology involved in pain transmission. Which statements accurately describe a physiologic event in the nervous system related to pain transmission? SATA
-when nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed to the spinal cord and brain -myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly -once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus -peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain
the nurse administering digoxin as ordered and the child vomits the dose. What should the nurse do next?
Administer next dose as ordered in 12 hours
a child is in the Er with an asthma exacerbation. Upon auscultation the nurse is unable to hear air movement in the lungs. What action should the nurse take first?
Administer oxygen
which test result would the nurse least likely expect to find in a child diagnosed with Wilms tumor?
Elevated homovanillic acid with 24 hour urine collection
the nurse is reviewing the white blood cell differential of a 4 year old girl. Which value would lead the nurse to be concerned?
Eosinophils 10%
a nurse is administering 100% o2 to a child with a pneumothorax based on the understanding that this treatment is used primarily for which reason?
Hasten air reabsorption
the nurse is caring for a 5 year old undergoing radiation treatment for neuroblastoma. Which nursing diagnosis would be most applicable for this child?
Impaired skin integrity related to desquamation from cellular destruction
a newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the healthcare provider will most likely order which med?
Indomethacin
the nurse is discussing discharge instructions with the parents of a 6 yo who had a tonsillectomy. What is the most important thing to stress?
Inspect the throat for bleeding
during a follow up visit, the parents of a 5 month old infant diagnosed with congenital heart disease tell the nurse "we are just so tired and emotionally spent. All these tests and exams are overwhelming. We just want a normal life. We are so focused on the baby that is seems like our 3 year old is lost In the shuffle". Which nursing dx would the nurse identify as most appropriate?
Interrupted family process r/t demands of caring for the ill child
the nurse is educating the parents of a 7 yo boy with asthma about the meds that have been prescribed. Which drug would the nurse identify as an adjunct to a B2-adrenergic agonist for treatment of bronchospasm?
Ipratropium
a nurse is reviewing the medical record of a child and finds that the child has a grade III murmur. After auscultating the child's heart sounds, how would the nurse document this murmur?
Loud without a thrill
pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an example of which type?
Mixed opioid agonist-antagonist
the nurse is caring for a 7 year old girl who is undergoing a stem cell transplant. What info would the nurse include in the child's postop plan of care?
Monitoring for severe diarrhea and maculopapular rash
which tool would be least appropriate scale for the nurse to use when assessing a 4 yo childs pain?
Numeric pain intensity scale
the nurse is examining a 5 year old. Which sign or symptom is reliable first indication of respiratory illness in children?
Rapid, shallow breathing
the nurse is caring for a 16 yo with acute myelogenous leukemia who is having chemo and who has incomplete records for varicella zoster immunization. Which is the priority nursing dx?
Risk for infection r/t neutropenia and immunosuppression
the nurse is conducting a physical exam of a child with a suspected cardiovascular disorder. Which finding would the nurse most likely expect to assess if the child had transposition of the great vessels?
Significant cyanosis without presence of murmur
when conducting a physical exam of a child with suspected Kawasaki disease, which finding would the nurse expect to assess?
Strawberry tongue
bacterial pneumonia is suspected in a 4 year old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized?
Tachypnea with retractions
the nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation?
The baby seems more comfortable over my shoulder
the nurse is caring for a child who reports chronic pain. What is the priority nursing assessment?
The pain's history, onset, intensity, duration, and location
the nurse is assessing a 3 year old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?
The parents report their son is vomiting and not eating well
the nurse is providing care to several children who have been brought to the clinic by parents reporting cold-like symptoms. The nurse would most likely suspect sinusitis in which child?
a 7 year old with halitosis and thick yellow nasal discharge
the nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?
initiate pain assessment with a standardized pain scale
The nurse is reviewing the lab test results of a child diagnosed with disseminated intravascular coagulation (DIC). What would the nurse interpret as indicative of this disorder?
positive fibrin split products
