Peds

When should you notify the physician about chest tube drainage?

>3 ml/kg/hr for 3 consecutive hours OR 5-10 ml/kg/hr

Signs of appendicitis?

Colicky, painful abdomen near umblicus (LRQ)

Excessive vomiting can cause?

metabolic alkalosis

A nurse evaluating a school-age child for signs and symptoms of adverse effects from morphine should assess for which of the following? Select all that apply.

• Constipation • Nausea and vomiting • Pruritus

Which action indicates that the parents of a 12-month-old with iron-deficiency anemia understand how to administer iron supplements? Select all that apply.

• They administer iron supplements in combination with fruit juice. • They brush the child's teeth after administering the iron supplements.

How do you feed a patient with GER/GERD?

Thicken feeds and have them sit upright

Good source of fiber?

popcorn

The nurse is caring for a 5-year-old child with a congenital heart defect. The nurse is reviewing with the parents the actions that would be necessary if the child experiences cardiopulmonary arrest and needs resuscitation. Which of the following statements by the parents indicate to the nurse that the teaching has been understood? Select all that apply.

• "I have to use compressions to circulate the blood." • "I will give two breaths for every 30 compressions." • "I will check for responsiveness before starting CPR."

A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises should the nurse provide to the client and his family? Select all that apply.

• Drink plenty of fluids. • Report a sore throat to an adult immediately. • Wash hands before meals and after playing.

The nurse is caring for a child with acute glomerulonephritis and is meeting with the family to discuss discharge instructions. Which of the following are important teaching points for the nurse to review with the child's family? Select all that apply.

• Report any signs of infection. • Restrict the intake of sodium. • Monitor fluid intake and output

How would you treat Kawaskis?

Aspirin and IV gamma globulin

The parent of a child with celiac disease asks, "How long must he stay on this diet?" Which response by the nurse is best?

"For the rest of his life."

A school-age child has a fever, joint inflammation, and a nonpruritic rash. Knowing that these are signs of rheumatic fever, the nurse should ask the parents:

"Has your child had strep throat recently?"

Which statement by the parent of a child with polycystic kidney disease and stage 2 renal disease indicates the need for more teaching?

"My child will outgrow this disease." Rationale: this is a lifelong disease

The nurse in an outpatient clinic is conducting a follow-up assessment on a child who had a severe streptococcal infection 1 week ago. The client is doing better, and the nurse is providing teaching to the parents about continuing to monitor the client for possible complications of the infection. Which information is most important for the nurse to discuss with the parents?

"Return immediately if acute flank or mid-abdominal pain occurs." Rationale: Acute glomerulonephritis is a major complication of streptococcal infections in children. The onset is often marked by a sudden occurrence of acute flank or mid-abdominal pain. The child may show signs of fluid retention, such as weight gain and edema.

A child with iron deficiency anemia is ordered ferrous sulfate, an oral iron supplement. When teaching the child and parent how to administer this preparation, the mother asks why she needs to mix the supplement with citrus juice. Which response by the nurse is best?

"The vitamin C in the citrus juice helps with iron absorption."

The nurse is caring for a child with a cyanotic heart disease. The mother tells the nurse that she often finds the child in a squatting position and asks if this is normal. Which of the following responses by the nurse is most appropriate?

"This position may help control breathlessness after exercise." Rationale: Children with congenital heart disease squat or assume a knee-to-chest position to trap blood in the lower extremities. This allows them to more easily oxygenate the blood remaining in the upper body

When teaching parents of a toddler with congenital heart disease, the nurse should explain all medical treatments and emphasize which instruction?

"Try to maintain your child's usual lifestyle to promote normal development."

After teaching the mother of a young girl about measures to help prevent urinary tract infections, which of the following statements by the mother indicates successful teaching?After teaching the mother of a young girl about measures to help prevent urinary tract infections, which statement by the mother indicates successful teaching?

"We will make sure she takes a water bottle with her to afterschool events."

A school nurse is assessing an obese 10-year-old child who wants to lose weight. Which of the following questions would be most important for the nurse to ask to develop a realistic plan of care?

"What kinds of foods do your parents serve at meal times and for snacks?"

What 4 defects make up TOF?

1) VDS 2) Pulmonary stenosis 3) RV hypertrophy 4) Overriding aorta

Before administering Dig? Hold if?

Apical pulse for 60 seconds, hold is HR is lower than 60

A 14-year-old male reports having right lower quadrant pain, nausea, vomiting, and a low-grade fever for the past 12 hours. A physical examination reveals rebound tenderness and a positive psoas sign. Based on these findings, what should the nurse suspect?

Appendicitis

What should the nurse do first when admitting a toddler with croup?

Assess respiratory status.

When pain suddenly goes away with appendicitis?

BAD, could indicate rupture and rebound tenderness

Rheumatic fever is caused by?

Beta hemolytic strep

A nurse is developing a teaching plan for a child with acute poststreptococcal glomerulonephritis. What is the most important point to address in this plan?

Blood pressure monitoring Rationale: can lead to HTN

A toddler with a ventricular septal defect is receiving digoxin to treat heart failure. Which assessment finding should be the nurse's priority concern?

Bradycardia Rationale: This med decreases the HR

If the catheter has blood drainage, what do you do?

Call physician and apply pressure above the catheter site

Coarctation of aorta?

Causes decreased blood supply to systemic parts of body

The nurse is caring for an infant diagnosed with a congenital heart disease. Which of the following concerns should be a priority for the nurse to address with the parents when discussing the child's condition?

Congestive heart failure

An adolescent diagnosed with thalassemia major (Cooley's anemia) is at risk for which condition?

Chronic hypoxia and iron overload Rationale: increases destruction of red blood cells (RBCs), shortens the life span of RBCs, and causes anemia. The body responds by increasing RBC production, but it can't produce adequate numbers of mature cells. This process results in chronic hypoxia. In addition, children with thalassemia major require multiple transfusions of packed RBCs. The combination of excessive RBC destruction and multiple transfusions deposits excess iron that damages organs and tissues.

Laboratory results for a child with a congenital heart defect with decreased pulmonary blood flow reveal an elevated hemoglobin (Hb) level, hematocrit (HCT), and red blood cell (RBC) count. These data suggest which condition?

Compensation for hypoxia

If child has been throwing up, give them?

Easily digested foods

An 18-month-old with a congenital heart defect is to receive digoxin twice a day. Which instructions should the nurse give the parents?

Digoxin enables the heart to pump more effectively with a slower and more regular rhythm.

If a patient comes in with chronic constipation?

Do a bowel cleanse ASAP

The physician suspects tracheoesophageal fistula in a 1-day-old neonate. Which nursing intervention is most appropriate for this child?

Elevating the neonate's head and giving nothing by mouth Rationale: because of the risk for aspiration

Signs of TEF?

Foaming at the mouth, drooling/choking, sit upright in knees to chest position

Parents of a 4-year-old with sickle cell anemia tell the nurse that they would like to have other children, but they're concerned about passing sickle cell anemia on to them. Which health care team member would be the most appropriate person for the nurse to refer them to?

Genetic counselor

Twenty-four hours after birth, a neonate hasn't passed meconium. The nurse suspects which condition?

Hirschsprung's disease

The nurse is planning care with the parents of a 4-month-old infant with heart failure and congenital heart disease. The parents report that their child tires easily. Which intervention is a priority for this child?

Increase the number of rest periods

The mother of an infant with a congenital heart defect involving decreased pulmonary blood flow tells the nurse that her child has not been gaining weight even with an increased-calorie formula. The mother states that the infant starts out with a good suck but tires and quits after 2 ounces (60 mL). The infant is receiving oxygen through a nasal cannula as necessary and is on digoxin therapy. Which action should the nurse suggest to the mother?

Increase the oxygen for feedings. Rationale: He is tiring from eating and needs more oxygen, his suck is good so we would not cut a hole in the nipple because that could choke him

An infant undergoes surgery to correct an esophageal atresia and tracheoesophageal fistula. Which nursing diagnosis has the highest priority during the first 24 hours postoperatively?

Ineffective airway clearance

A 4-year-old child is seen at the clinic for a mild iron deficiency anemia caused by a poor diet. The parents ask the nurse what type of treatment to expect. What is the most appropriate response by the nurse?

Iron replacement and change of diet

The nurse is caring for an infant with a congenital heart defect. What priority health teaching should the nurse offer to the parents of this infant?

Keep feedings small, but frequent.

Nursing care for gastroschisis and omphalocele?

Keep wound moist with NS, covered, thermoregulated, prophalactically give antibiotics

How do you involve the child in treatment and procedure?

Let child hear cardiac monitor

Signs of Dig toxicity?

N/V, visual disturbances, bradycardia

Describe Aortic stenosis?

Obstructive, pulmonary congestion

Presentation of of infective endocarditis?

Osler's nodes on pads of fingers and janeway spots on soles and palms

A nurse is caring for a 2-year-old child with tetralogy of Fallot (TOF) who is scheduled for surgery in 24 hours. What intervention is the most important for the nurse to include in the plan of care?

Position the child with knees to the chest Rationale: TOF consists of four congenital anomalies: pulmonic stenosis, intraventricular septal defect, overriding aorta, and right ventricular hypertrophy. Interventions for care include high flow oxygen, morphine, beta-blockers and positioning with knees to chest

What are you preventing in PDA?

Preventing pulmonary vascular congestion

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

Proteinuria Rationale: the glomerular membrane of the kidneys becomes permeable to proteins, resulting in massive proteinuria

A preschool-age child with sickle cell anemia is admitted to the health care facility in vaso-occlusive crisis after developing a fever and joint pain. What is the nurse's highest priority when caring for this child?

Providing fluids Rationale: During a vaso-occlusive crisis, sickle-shaped red blood cells (RBCs) clump together and obstruct blood vessels, causing ischemia and tissue damage. Therefore, the highest priority is providing I.V. and oral fluids, which promotes hemodilution and aids the free flow of RBCs through blood vessels

The nurse is assessing an adolescent who has been diagnosed with aplastic anemia. Which of the following should be the priority assessment for the nurse?

S/S of infection Rationale: lowering of all blood cells->causes neutropenia->which puts patient at risk for infection

An infant, age 8 months, has a tentative diagnosis of congenital heart disease. During physical assessment, the nurse measures a heart rate of 170 beats/minute and a respiratory rate of 70 breaths/minute. How should the nurse position the infant?

Sitting in an infant seat Rationale: Findings suggest respiratory distress, so positioning the child at a 45 degree angle

When obtaining a health history from the mother of a 7-year-old child diagnosed with acute rheumatic fever, the nurse should focus questions to determine if the child was recently ill with which condition?

Sore throat Rationale: generally follows infection with streptococci within about 2 weeks

Patient was on TPN, but now they are going home?

Stimulate adaptation of small intestine with enteral feeds

Earliest sign of HR with congenital defects?

Tachycardia

Which sign is an early indicator of heart failure in an infant with a congenital heart defect?

Tachycardia Rationale: sleeping heart rate greater than 160 beats/minute and/or respiratory rate greater than 60 breaths/minute in infants

The nurse is teaching the parents of an 8-month-old about what the child should eat. The nurse should include which information in the teaching plan?

The infant's diet can be changed from formula to whole milk when the infant is 12 months old.

A 5-year-old child returns to the pediatric unit following a cardiac catheterization using the right femoral vein. The child has a thick elastoplast dressing. Which assessment finding requires immediate intervention?

The pedal pulse of the right leg isn't detectable. Rationale: Using the femoral vein during catheterization can cause the affected blood vessels to spasm or cause a blood clot to develop, altering circulation in the leg. The inability to detect the pedal pulse in the affected leg is an ominous sign and requires immediate intervention.

First sign of Reye's syndrome?

Vomiting

A young child with sickle cell anemia prefers a side-lying position with the knees sharply flexed. The nurse should assess further for:

abdominal pain.

A physician orders digoxin elixir for a toddler with heart failure. Immediately before administering this drug, the nurse must check the toddler's:

apical pulse. (If below 60 you hold the med)

A nurse is giving instructions to parents of a school-age child diagnosed with sickle cell anemia. The instructions should include:

avoiding areas of low oxygen concentration such as high altitudes.

Which meal would be most appropriate for a 15-year-old with glomerulonephritis with severe hypertension?

baked chicken, rice, beans, orange juice Rationale: the best choice is no salty foods in the answer

The nurse is planning care for a child with acute glomerulonephritis. The nurse should report which finding to the primary care provider?

blood pressure of 140/92 mm Hg Rationale: The elevated blood pressure may indicate hypertension, which is a serious complication of acute glomerulonephritis.

A child, age 4, is admitted with a tentative diagnosis of congenital heart disease. When assessment reveals a bounding radial pulse coupled with a weak femoral pulse, the nurse suspects that the child has:

coarctation of the aorta. Rationale: because it causes signs of peripheral hypoperfusion, such as a weak femoral pulse and a bounding radial pulse

Which behavior by a neonate attempting an initial feeding should indicate to the nurse that the neonate may have tracheoesophageal fistula?

coughing, choking, and cyanosis that occur after several swallows of formula

A mother brings a 15-month-old child to the well-baby clinic. She states the child has been taking approximately 18 to 20 oz (540 to 600 mL) of whole milk per day from a bottle with meals and at bedtime. The nurse should suggest that she begin weaning the child from the bottle to avoid risking:

dental caries.

Which behavior exhibited by the parents of an infant with pyloric stenosis should the nurse correctly interpret as a positive indication of parental coping?

discussing the infant's care realistically

When discussing appropriate iron-rich food selections with the mother of an 11-month-old infant with iron deficiency anemia, which food choices verbalized by the mother indicates successful teaching?

eggs, fortified cereals, meats, and green vegetables

The nurse reviews with the parents how to care for their child with sickle cell anemia at home. The nurse determines that the parents understand the basic principles of care when they state that they will:

encourage their child to drink as much liquid as possible. Rationale: Hydration and pain management is the best way to prevent sickle cel crisis

An infant is having a 2-month checkup at the pediatrician's office. The physician tells the parents that she's assessing for Ortolani's sign. The nurse explains that the presence of Ortolani's sign indicates dislocation of the:

hip

Intussusception?

is telescoping of an intestine that can cause decreased blood supply to that part of the body

When teaching the mother of a toddler diagnosed with lead poisoning, what should the nurse include as the most serious complication if the condition goes untreated?

neurologic deficits

A 10-year-old with glomerulonephritis reports a headache and blurred vision. The nurse should immediately:

obtain the child's blood pressure. Rationale: Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension.

The mother of a child with tetralogy of Fallot asks the nurse why her child has clubbed fingers. The nurse bases the response on the understanding that clubbing is due to which factor?

peripheral hypoxia Rationale: Clubbing of the fingers is one common finding in the child with persistent hypoxia, which leads to tissue changes in the body because of the low oxygen content of the blood (hypoxemia). It apparently results from tissue fibrosis and hypertrophy from the hypoxemia and from an increase in capillaries in the area, which occur as the body attempts to improve the blood supply

A 4-year-old child is having a sickle cell crisis. The initial nursing intervention should be to:

provide oral and I.V. fluids. Rationale: Initial nursing interventions for the child in a sickle cell crisis include providing hydration and oxygenation to prevent more sickling. Pain relief is also a concern. However, painful joints are treated with analgesics and warm packs because cold packs may increase sickling.

A child is diagnosed with nephrotic syndrome. When planning the child's care, the nurse understands that the primary goal of treatment is to:

reduce the excretion of urinary protein.

Signs of Rheumatic fever?

self limiting, affecting joints, brain, polyartritis

Which finding would indicate that an infant with a tracheoesophageal fistula (TEF) needs suctioning?

substernal retractions Rationale: With a TEF, overflow of secretions into the larynx leads to laryngospasm. This obstruction to inspiration stimulates the strong contraction of accessory muscles of the thorax to assist the diaphragm in breathing. This produces substernal retractions. The laryngospasm that occurs with a TEF resolves quickly when secretions are removed from the oropharynx area.

During physical assessment of a 4-month-old infant with Hirschsprung's disease, the nurse should most likely note which finding?

weight less than expected for height and age Rationale: Infants with Hirschsprung's disease typically display failure to thrive, with poor weight gain due to malabsorption of nutrients. Would have a distended abdomen

Which statements by the mother of a toddler should lead the nurse to suspect that the child is at risk for iron deficiency anemia? Select all that apply.

• "He drinks over 4 glasses of milk per day." • "I cannot keep enough apple juice in the house; he must drink over 10 oz (300 mL) per day."