PEDS FINAL

"Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving."

The nurse is caring for a 9-year-old female who is unconscious in the PICU. The child's mother has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response

The absolute neutrophil count is 400/mm3, and the child is neutropenic.

The nurse is caring for a child being treated for ALL. Laboratory results indicate that the child has a white blood cell count of 5000, with 5% polys and 3% bands. Which of the following responses is most appropriate?

The child's condition is improving and progressing to a less advanced stage of Reye syndrome.

The nurse is caring for a child with Reye syndrome in the PICU. At noon, the nurse notes that the child is comatose with sluggish pupils. When stimulated, the child demonstrates decerebrate posturing. At 2 p.m., the nurse notes that the child remains unchanged except that the child now demonstrates decorticate posturing when stimulated. The nurse concludes that:

Anemia. Infection.

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply

Administer blow-by oxygen and call for additional help.

The nurse is caring for a child with meningitis. The parents call for the nurse as "something is wrong." When the nurse arrives, she notes that the child is having a generalized tonic-clonic seizure. Which of the following should the nurse do first?

Assess the child's temperature and blood pressure

The nurse is caring for a child with meningitis. The parents call for the nurse as "something is wrong." When the nurse arrives, she notes that the child is having a generalized tonic-clonic seizure. Which of the following should the nurse do first?

Hypokalemia.

The nurse is caring for a preschool female diagnosed with CHF. She is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse suspects which laboratory finding?

Supraventricular tachycardia.

The nurse is caring for a toddler who has been hospitalized for 2 days with vomiting due to gastroenteritis. During morning assessment, she is sleeping and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child?

Allow parents to hold and rock their child. Make frequent position changes.. Feed the child when sucking the fists. Change bed linens only when necessary. Organize nursing activities.

The nurse is caring for an infant with CHF. The following are interventions to decrease cardiac demands on the infant. Select all that apply

"My child's 7-year-old brother is also at high risk for a febrile seizure."

The nurse is providing discharge teaching to the parents of a toddler who has experienced a febrile seizure. The nurse knows that clarification is needed when the mother says:

Aplastic crisis, splenic sequestration, Vaso occlusive crisis

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply

Administer rectal diazepam.

The nurse is working in the emergency room when an ambulance arrives with a 9-year-old male who has been having a generalized seizure for 35 minutes. The paramedics have provided blow-by oxygen and monitored vital signs. The patient does not have intravenous access yet. Which of the following medications should the nurse anticipate administering first?

Right to left.

A 3-month-old has been diagnosed with a VSD. The flow of blood through the heart with this type of defect is:

Overhydration

A nurse instructs the parent of a child with sickle cell anemia about factors that might precipitate a pain crisis in the child. Which of the following factors identified by the parent as being able to cause a pain crisis indicates a need for further instruction?

A private room that is dark and quiet with minimal stimulation

A toddler is being admitted to the hospital with a diagnosis of bacterial meningitis. Select the best room assignment for the patient.

Prostaglandin E

For the child with hypoplastic left heart syndrome, what drug may be given to allow the PDA to remain open until surgery? _________________

AS.

Parents report that their 6-year-old has been seen by the school nurse for dizziness that occurred when standing in line for recess and homeroom since the start of the school term. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks the child if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has:

Infective endocarditis RF.. Cardiomyopathy. KD

The following are examples of acquired heart disease. Select all that apply.

The initial white blood cell count on diagnosis.

The mother of a child who is newly diagnosed with ALL asks the nurse "What is the prognosis?" Which of the following is correct regarding prognostic factors for determining survival for such a child?

Lipid profile

The mother of a toddler reports that the baby's father has just had a myocardial infarction. Because of this information, the nurse recommends the child have a(n):

Identify her parents and state her own name

The nurse is caring for a 3-year-old female with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to:

One oral anticonvulsant medication to observe effectiveness and minimize side effects.

The nurse is caring for a 5-year-old female recently diagnosed with epilepsy. She is being evaluated for anticonvulsant medication therapy. The nurse knows that the child will likely be placed on which kind of regimen?

Obtunded.

The nurse is caring for a child who has been in an MVA. The child continues to fall asleep unless her name is called or she is gently shaken. The nurse knows that this state of consciousness is referred to as:

Intravenous fluids at 11 /2 times regular maintenance.

The nurse is caring for a child who has just been admitted to the pediatric floor with a diagnosis of bacterial meningitis. When reviewing the child's plan of care, which of the following orders would the nurse question?

Decreased perfusion of the brain and increased metabolic needs of the brain.

The nurse is caring for a child who has sustained a closed-head injury. The nurse knows that brain damage can be caused by which of the following factors?

Apply direct pressure 1 inch above the puncture site

The nurse is caring for a child who has undergone cardiac catheterization. During the recovery phase, the nurse notices the dressing is saturated with bright red blood and a 6-inch circle of blood on the crib sheet. The nurse's first action is to:

Send the spinal fluid and blood cultures to the laboratory.

The nurse is caring for a child who is being admitted with a diagnosis of meningitis. The child's plan of care includes the following: administration of intravenous antibiotics, administration of maintenance intravenous fluids, placement of a Foley catheter, and obtaining cultures of spinal fluid and blood. Select the procedure the nurse should do first.

"I will make sure not to give my child any products containing aspirin when my child is ill."

The nurse is providing education concerning Reye syndrome to a mothers' group. She knows that further education is needed when a mother states:

Apply pressure to the nose for at least 10 minutes.

Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed?

The partial thromboplastin time

. Which of the following will be abnormal in a child with the diagnosis of hemophilia?

COA

In which of the following CHDs would the nurse need to take upper and lower extremity BPs?

PDA (patent ductus arteriosus)

Indomethacin may be given to close what CHD in newborns? _________________

Supraventricular tachycardia.

The nurse in the pediatric telemetry unit has been reviewing heart rhythms in children. The most common dysrhythmia in pediatrics is:

Administering oxygen.

The nurse is caring for a child with sickle cell anemia who has a vaso-occlusive crisis. Which of the following interventions should improve tissue perfusion?

Polycythemia. Blood clots. CVA. Developmental delays. Brain damage

Hypoxic spells in the infant with CHD can cause which of the following? Select all that apply

Swimming. Golf. Hiking. Fishing.

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply

VSD. Right ventricular hypertrophy. PS. Overriding aorta

The parent of an infant newly diagnosed with TOF is asking the nurse which defects are involved. Select all that apply

COA.

The school nurse has been following an 8-year-old female who comes to the office frequently. She has come mainly for vague complaints of dizziness and headache. Today, she is brought after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. Calling for the ambulance, the nurse suspect she has:

Prostaglandin E.

Which medication should the nurse give to a patient who is diagnosed with transposition of the great vessels?

50th percentile height and weight for age

Which of the following assessments indicate that the parents of a 7-year-old are following the prescribed treatment for CHF?

Polycythemia

While looking through the chart of an infant with a CHD of decreased pulmonary blood flow, the nurse would expect what laboratory finding?

"Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?"

The emergency room nurse is caring for a 5-year-old child who fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which of the following statements is a priority for the nurse at this time?

"Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis."

The nurse is caring for a 13-month-old with meningitis. The child has experienced increased ICP and multiple seizures. The child's parents ask if the child is likely to develop CP. Select the nurse's best response.

Eliminates excess iron.

The nurse is caring for a child diagnosed with thalassemia major who is receiving the first chelation therapy. What information should the nurse teach the parent regarding the therapy?

Morphine.

. Which of the following analgesics is most effective for a child with sickle cell pain crisis?

Ischemia. Injury. Dysrhythmias. Conduction delay

A child with a history of cardiac surgery requires an annual electrocardiogram. What can the electrocardiogram detect? Select all that apply

Computed tomography scan of the head and dilation of the eyes

A 2-month-old infant is brought to the emergency room after experiencing a seizure. The nurse notes that the infant appears lethargic with very irregular respirations and periods of apnea. The parents report that the child is no longer interested in feeding and that, prior to the seizure, the infant rolled off the couch. What additional testing should the nurse immediately prepare for?

Hypoplastic left heart syndrome.

A child with a CHD undergoes the Norwood procedure. This procedure is used to correct:

The extremity should be immobilized. The extremity should be elevated. Factor VIII should be administered.

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply.

Chronic hypoxia and iron overload

A nurse is doing discharge education with a parent who has a child with betathalassemia (Cooley anemia). The nurse informs the parent that the child is at risk for which of the following conditions?

Swimming

A nurse is reviewing home care instruction with the parent of a child diagnosed with hemophilia. Which of the following activities should the nurse suggest to the parent as a safe activity for the child?

"Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside."

The nurse is preparing to assess a 6-year-old male with altered consciousness in the PICU. His parents ask if they can stay during his morning assessment. Select the nurse's best response.

The ventricle of the brain to the peritoneum.

The nurse is preparing to give preoperative teaching to the parents of an infant with hydrocephalus. The nurse knows that the most common treatment for hydrocephalus includes the surgical placement of a shunt connecting which of the following?

"She should avoid being in a car at night."

The nurse is providing discharge instructions to the parents of a 13-year-old girl who has been diagnosed with epilepsy. Her parents ask if there are any activities that she should avoid. Select the nurse's best response.

Flat in the crib

The nurse is working in the PICU caring for an infant who has just returned from having a ventriculoperitoneal shunt placed. Which position initially will be most beneficial for this child?

Leg pain. Fever. Bruising Enlarged lymph nodes.

Which of the following can be manifestations of leukemia in a child? Select all that apply.

The child needs to be taken to a physician when sick. Emotional stress should be avoided. It is important to keep the child well hydrated. It is important to make sure the child gets adequate nutrition.

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell anemia? Select all that apply.

Metabolic disorders. Trauma. Hypoxic episode. Dehydration. Endocrine disorders.

Which of the following has the potential to alter a child's level of consciousness? Select all that apply

Assess the central nervous system for infiltration. Give intrathecal chemotherapy

Which of the following is a (are) reason(s) to do a spinal tap on a child with a diagnosis of leukemia? Select all that apply

Administer factor per the home care protocol

Which of the following measures should the nurse teach the parent of a child with hemophilia to do first if the child sustains an injury to a joint causing bleeding?

"I will mix the digoxin in some of his formula to make it taste better for him."

Which statement by the mother of an infant boy with CHF who is being sent home on digoxin indicates she needs further education on the care of her child?

In either direction.

An infant has been diagnosed with an ASD, or AVC defect. The flow of blood through the heart with this type of defect is:

Defects with increased pulmonary blood flow. Defects with decreased pulmonary blood flow. Mixed defects. Obstructive defects

CHDs are classified by which of the following? Select all that apply

Latex

An 18-month-old with a myelomeningocele is going to undergo a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies listed on the medical record. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff?

. Loosen the child's clothing, and call for help

An 8-year-old child is attending a Cub Scout camp picnic. He has a history of epilepsy and has had generalized seizures since the age of 3. The child falls to the ground and has a generalized seizure. Which of the following is the best action for the nurse to take during the child's seizure?

Feeding formula that is supplemented with additional calories.

A nursing action that promotes ideal nutrition in an infant with CHF is:

Severe diaper rash.

A 1-year-old child is being prepared for a cardiac catheterization procedure. Which of the following findings about the child might delay the procedure?

Apical pulse rate

An infant with CHF is receiving digoxin to enhance myocardial function. What should the nurse assess prior to administering the medication?

Squatting

During play, a toddler with a history of TOF might assume which of the following positions?

A soft toothbrush should be used for mouth care.

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child's platelet count is 20,000/mcL. Based on this laboratory finding, what information should the nurse provide to the child and parents?

TOF

A 10-year-old child is recovering from a severe sore throat. The caregiver now states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause of this syndrome is _________________________.

Severe heart failure and hypoplastic left heart syndrome

Heart transplant may be indicated for a child with which of the following symptoms?

Glucose.

The nurse is caring for a child with Reye syndrome stage III. The child is comatose with sluggish pupils. The child is currently maintaining his own respirations, and all vital signs are within normal range. In order to treat a common manifestation, what medication would the nurse expect to have readily available?

TOF

The 6-month-old who has a "tet spell" could have the CHD defect of decreased pulmonary blood flow called ___________________________.

Call for additional help, and prepare to administer mannitol.

The emergency room nurse is caring for an unconscious 6-year-old girl who has had a severe closed-head injury and notes the following changes in her vital signs. Her heart rate has dropped from 120 to 55, her blood pressure has increased from 110/44 to 195/62, and her respirations are becoming more irregular. After calling the physician, which of the following should the nurse expect to do?

Attempt to keep the environment dark and quiet, and encourage minimal stimulation.

The nurse is caring for a 16-year-old female who remains unconscious 24 hours after sustaining a closed-head injury in an MVA. She responds to deep painful stimulation with decorticate posturing. The child has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action

"Pain medication is necessary to promote comfort."

The nurse is caring for a 2-year-old male in the PICU with a head injury. The child is comatose and unresponsive at this time. The parents ask if he needs pain medication. Select the nurse's best response.

"Your daughter's defect is small and will likely close on its own by the time she is 2 years old."

The nurse is caring for a 3-month-old with a VSD. The physicians have decided not to repair it surgically. The parents express concern that this is not best for their child and ask why their daughter will not have an operation. The nurse's best response to the parents is:

Left to right.

. A 5-month-old has been diagnosed with an ASD. The flow of blood through the heart with this type of defect is:

1. Bleeding of the mucous membranes. 2. The child bruises easily. 3. Excessive menstruation. 4. The child has frequent nosebleeds.

A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a (are) clinical manifestation(s) of von Willebrand disease? Select all that apply.

Pulses.

A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess:

An intravenous infusion of factor VIII.

A 10-year-old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ER. The nurse should prepare which of the following?

Feeding in semi-Fowler position.

A 2-month-old is being treated with furosemide for CHF. Which of the following plans would also be appropriate in helping to control the CHF?

An absence seizure.

A 5-year-old female has been diagnosed with a seizure disorder. Her teacher noticed that she has been having episodes where she drops her pencil and simply appears to be daydreaming. This is most likely called:

Bone marrow aspirate.

A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over varies area of the body. The physician suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following?

Chickenpox or flu.

A 6-year-old is receiving aspirin therapy for KD. Exposure to what illnesses should be a cause to discontinue therapy and substitute dipyridamole (Persantine)?

Coronary thrombosis. Coronary stenosis. Coronary artery aneurysm.

A child has been diagnosed with KD. The parents are asking questions about the child's outcome. The nurse explains the most serious complications. Select all that apply.

Bacterial meningitis.

A child is being evaluated in the emergency room for a possible diagnosis of meningitis. The nurse is assisting with the lumbar puncture and notes that the CSF is cloudy. The nurse is aware that cloudy CSF most likely means:

PDA (patent ductus arteriosus)

A newborn is diagnosed with a CHD. The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as

A child of Mediterranean descent.

A nurse educator is providing a teaching session for the nursing staff. Which of the following individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)?

Give Demerol 25 mg intravenously every 4 hours as needed for pain. Restrict oral fluids.

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply.

The procedure is done to prevent further sickling during a vaso-occlusive crisis.

The nurse is caring for a child with sickle cell anemia who is scheduled to have an exchange transfusion. What information should the nurse teach the family?

To prevent splenic sequestration.

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy?

KD

The nurse is caring for a 3-year-old boy whose caregiver noticed that his eyes are reddened with no discharge, and his palms and soles of the feet are red, swollen, and peeling. Upon examination, the nurse's assessment includes dry, cracked lips and a "strawberry tongue." The nurse most likely suspects ______________________________.

Brudzinski sign.

The nurse is caring for a 6-month-old infant diagnosed with meningitis. When she places the infant in the supine position and flexes his neck, she notes that the infant flexes his knees and hips. The nurse knows that this is referred to as:

High-pitched cry

The nurse is caring for a 6-month-old infant with a diagnosis of hydrocephalus. Which of the following signs best indicates increased ICP in this child?

CHF (congestive heart failure)

The nurse is caring for a 9-month-old who was born with a CHD. Assessment reveals an HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of ___________________.

Place a cooling blanket on the child.

The nurse is caring for a 6-year-old female with a skull fracture who is unconscious and has severely increased ICP. The nurse notes the child's temperature to be 104°F (40°C). Which of the following should the nurse do first?

"You should immediately bring her to the emergency room as these may be symptoms of a shunt malfunction."

The nurse receives a phone call from the parents of a 9-year-old female who is complaining of a headache and blurry vision. The child has been healthy but has a history of hydrocephalus and received a ventriculoperitoneal shunt at the age of 1 month. The parents also state that she is not acting like herself, is irritable, and sleeps more than she used to. They ask the nurse what they should do. Select the nurse's best response.

"Have the parents follow up with his pediatrician as this is likely an atonic seizure."

The school nurse is called to the preschool classroom to evaluate a child. He has been noted to have periods where he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse's best response.