UWORLD FUNDAMENTALS part 1

The PN is assisting the RN to create a care plan for a 4 year old client admitted with a pertussis infection. Which of the following interventions should be included? SATA 1. Institute droplet precautions. 2. Monitor for signs of airway obstruction. 3. Offer small sips of fluid frequently. 4. Place client in a negative pressure isolation room. 5. Request a prescription for cough suppressants.

1, 2, 3 Pertussis (whooping cough) is caused by the highly contagious bacterium. Bordetella pertussis, which is spread through close human contact, coughing, and sneezing. Once attached to cilia in the client's upper respiratory tract, this bacterium releases a toxin that causes irritation and swelling. To prevent transmission, the nurse should implement standard (universal) and droplet precautions. During inhalation a violent, spasmodic cough and distinctive high pitched "whooping" sound are heard. It may continue until client expectorates a thick mucous plug or vomits (posttussive emesis).

After a recent outbreak of varicella in an elementary school, the PN is assisting with the development of an informative letter to parents. Which of the following instructions are appropriate to include? SATA 1. Apply calamine lotion to soothe lesions. 2. Clip your child's fingernails short. 3. Ensure that your child's vaccinations are up to date. 4. Keep your child home until lesions have crusted. 5. Place mittens on your child's hands when sleeping.

1, 2, 3, 4, 5 Varicella is an extremely contagious infection caused by the varicella zoster virus. Manifestations include fatigue, fever, and a pruritic vesicular rash. Varicella is spread by airborne droplets and direct contact with lesions. Infected persons are contagious for several days before the rash appears and until all lesions have crusted. Apply soothing lotion (eg, calamine) to lesions. Clip the child's fingernails short. Place mittens on the child during sleep. Keep the child cool and avoid overheating. Dress the child in loose-fitting, cotton clothing. Bathe the child daily and wash hands often.

The nurse is caring for a child who has had a tonsillectomy. Which of the following are appropriate nursing interventions? SATA 1. Anticipate ear pain and give acetaminophen as needed. 2. Educate parents to expect the child to develop bad breath postoperatively. 3. Encourage the child to drink cold liquids through a straw. 4. Notify the HCP about frequent, increased swallowing. 5. Use an oral suction device regularly to remove secretions from the back of the throat.

1, 2, 4 A tonsillectomy may be indicated in some cases of chronic tonsillitis, peritonsillar abscess, or obstructive sleep apnea. Postoperative bleeding is a primary concern after a tonsillectomy because the surgical site is not easily visualized and is vulnerable to irritation and trauma from swallowing and coughing. The nurse should observe for signs of postoperative bleeding (eg, frequent, increased swallowing or clearing of the throat, vomiting bright red blood) and notify the health care provider. Interventions include close observation for signs of bleeding (eg, frequent swallowing) as well as avoidance of routine oral suctioning and the use of straws. Expected findings include white, fluid-filed exudate in the throat with halitosis, low-grade fever, and referred ear pain.

Which discharge teaching instructions should the nurse reinforce to the parents of a 2 year-old with group A streptococcal pharyngitis? SATA 1. Complete all the antibiotics even if your child is feeling better. 2. Cool liquids and soft diet are recommended. 3. Keep your child home from daycare for at least a week. 4. Replace your child's toothbrush 24 hours after starting antibiotics. 5. Throat lozenges may soothe your child's sore throat.

1, 2, 4 Pharyngitis caused by group A b-hemolytic streptococcus is a contagious bacterial throat infection that can lead to renal (glomerulonephritis) or cardiac complications (rheumatic fever) if not treated. Children may refuse to eat due to pain. A soft diet and cool liquids (ice chips) should be offered rather than solid foods. It is important to complete the full course of antibiotics to prevent reinfection and complications. Toothbrushes should be replaced 24 hours after starting antibiotics, the bristles can harbor the bacteria and reinfection may occur.. Young children may have minor cold symptoms and still be infected. The health care prior should test sibling age <3 years.

The nurse is reinforcing home care instructions for the parents of a child diagnosed with rotavirus infection. Which statements by the parents indicate that teaching has been effective? SATA 1. Hand washing is extremely important in slowing the spread of rotavirus 2. I will observe my child for decreased urination and dry mucus membranes 3. I will resume breastfeeding as soon as the diarrhea subsides 4. I will use commercial baby wipes that contain alcohol 5. My child can spread the infection with contaminated hands, toys, and food.

1, 2, 5 Rotavirus is a contagious virus and the leading cause of diarrhea in children less than 5 years old, it is also the cause of many nosocomial infections each year. Rotavirus is spread via the fecal oral route. Because the virus lives easily outside a human host, transmission can occur through contact with food, toys, diapers, and hands. Meticulous handwashing and proper diaper disposal prevent the spread of the virus. symptoms include foul smelling, watery diarrhea that lasts 5=7 days and is often accompanied by fever and vomiting. Vaccination is available an d must bee given before the child is 8 months, however, vaccinated children can still acquire Rotavirus as many strains are not covered by the vaccine. Antibiotics are not effective against this viral agent.

A nurse is reinforcing education given to the parents of a child diagnosed with chronic allergic rhinitis that is triggered by household and environmental allergens. Which statements by the parents indicate that the teaching has been effective? SATA 1, My wife plans to wipe down our child's furniture with a damp rag ever other day. 2. Our child needs plastic covers for the mattress and pillow. 3. We must give away the family dog. 4. We will keep the windows open during warm weather to air out the house. 5. We will replace the carpet with hardwood floors throughout the house.

1, 2, 5 Symptoms of allergic rhinitis include sneezing, nasal drainage, nasal congestion, and pruritus of the eyes or nose. Clients and their families can help prevent these symptoms by identifying individual triggers (eg, dust, mold, pollen, dander) and implementing strategies to reduce or avoid exposure to known allergens. Key measures to reduce exposure to household and environmental allergens include: Installing high efficiency particulate air filters in the home air conditioning system. Keeping windows closed and staying indoors, particularly during tines of heavy pollen. using hypoallergenic pillow and mattress covers to prevent exposure to dust mites. Reducing or eliminating carpet and area rugs from the home. Regularly mopping hard floors and damp-dusting furniture.

A home health nurse is managing care for an adolescent client with cystic fibrosis. Which of the following potential complication should the nurse consider when developing a nursing care plan? SATA 1. Chronic hypoxemia 2. Diabetes insipidus. 3. Frequent respiratory infections. 4. Obesity. 5. Vitamin deficiencies.

1, 3, 5 Cystic Fibrosis (CF) is an inherited disorder (autosomal recessive) characterized by thickened secretions due to impaired chloride and sodium channel regulation that causes exocrine gland dysfunction. Management of a client with CF should primarily address potential complications related to the following body system: Pulmonary-Alteration in respiratory secretions. Gastrointestinal-Thickened secretions obstruct the release of pancreatic enzymes. Reproductive-Thickened reproductive secretion.

A nurse is speaking with the parent of a toddler who believes the child has hearing deficit. Which findings support this suspected diagnosis? SATA 1. Behavior appears withdrawn. 2. Intelligible speech began at age 12 months. 3. Monotone speech. 4. Seems attentive, nods, and smiles when given directions. 5. Speaks with a loud voice.

1, 3, 5 Hearing impairment in children may be related to family history, an infection, use of certain medications, or a congenital disorder. Toddlers with hearing deficits may appear shy, timid, or withdrawn, often avoiding social interaction. They may seem extremely inattentive when given directions and appear "dreamy." Speech is usually monotone, difficult to understand, and loud. Increased use of gestures and facial expressions is also comon.

A child in the emergency department had a cast placed on the right arm for a nondisplaced fracture. The client is being discharged home with pain medications. Which statement by the parent indicated that additional teaching is required? 1. A tingling or burning sensation within the first 24-48 hours is not a concern. 2. An itching sensation under the cast for the first 24-48 hours is not a concern 3. I will call the doctor if pain is severe despite medication for the first 24 hours. 4. My child should elevate the arm for the fist 24-48 hours.

1. A tingling or burning sensation within the first 24-48 hours is not a concern. Parents of children with casts are taught to check for emergency signs of circulatory impairment, including changes in sensation and motor function, which could indicate early signs of compartment syndrome due to swelling within the confined space of the cast. However, some swelling is expected, so this symptoms alone is not indicated of compartment syndrome. The 6 Ps 1. Pain increasing despite elevation, analgesics, and ice. 2. Pressure: Affected extremity or digits are firm and tense, skin is tight and appears shiny. 3. Paresthesia: Tingling, numbness, or burning sensation, which is also and early sign and indicates nerve ischemia. 4. Pallor 5. Pulselessness 6. Paralysis

A client with a ventriculoperitoneal shunt has a dazed appearance and grunting and has not responded to the caregiver for 10 minutes. Status epilepticus is suspected. Which nursing intervention should be performed first? 1. Administer rectal diazepam 2. Assess for neck stiffness and Brudzinski sing 3. Draw blood for laboratory studies 4. Transport the client to CT for assessment of shunt malfunction

1. Administer rectal diazepam The client is in status epilepticus, a serious and life-threatening emergency in which a client has been seizing for 5 minutes or longer. Grunting and a dazed appearance are 2 common signs. A client with hydrocephalus (abnormal collection of cerebrospinal fluid in the head) and a ventriculoperitoneal (VP) shunt is a ta higer risk for seizures. Stopping seizure activity is the first nursing priority. IV benzodiazepines (diazepam or lorazepam) are used acutely to control seizures. However, rectal diazepam is often prescribed when the IV form is unavailable or problematic. Parents often get prescriptions for rectal diazepam and are advised to administer a dose before bringing a child to the emergency department.

The clinic nurse cares for a 4 year old who has been diagnosed with a pinworm infection. Which client symptom supports this diagnosis? 1. Anal itching that is worse at night. 2. Intestinal bleeding with anemia. 3. Poor appetite with weight loss. 4. Red, scaly, blistered rings on skin.

1. Anal itching that is worse at night. Pinworms (ei, enterobiasis) are very common in childhood and easily transmitted when microscopic, pinworm eggs, which can be found on contaminated food, drink, toys, and linens, are inhaled or swallowed. Once ingested, the eggs hatch in the intestines. During the night, the female pinworm lays thousands of microscopic eggs in the skin folds around the anus, resulting in anal itching and trouble sleep. When the infected person scratches, eggs are transferred from the fingers and fingernails to other surfaces. Pinworms infection is treated with antiparasitic medication.

The parent of an 11 month old child calls the pediatric outpatient clinic and tells the nurse that the child was exposed to measles 2 days ago during a family trip to a theme park. What is the best response by the nurse? 1. Bring the baby into the clinic for the MMR vaccine. 2. Check the baby's temperature twice a day. 3. Do not allow the child to have contact with other children. 4. Does your child have a fever or rash?

1. Bring the baby into the clinic for the MMR vaccine. The CDC and prevention recommends that the first dose of MMR vaccine be given to children between age 12-15 months to ensure optimal vaccine response. However, the vaccine is safe for children age <12 months. It could provide some protection or modify the clinical course of the disease if administered with in 72 hours of the child's initial measles exposure. immunoglobulin, if administered within 6 days of exposure, is also utilized as post exposure prophylaxis. A child who receives the MMR vaccine prior to the first birthday will need to be revaccinated at age 12-15 months and again between 4-6 years.

The nurse is reinforcing instructions related to antibiotic eye drop administration to the parent of a 5 year old with bacterial conjunctivitis. Which instruction is most important? 1. Discard tissues used to blot excess medication from the eye immediately. 2. Have your child lie down before you instill the eye drops. 3. Use warm, moist compresses to remove crusting on eyelids. 4. Wash hands before and after eye drop instillation.

1. Discard tissues used to blot excess medication from the eye immediately. Bacterial conjunctivitis (pink eye) is highly contagious. The hands must be washed properly before and after instilling eye drops and after cleaning away eye drainage or crusting, this is the single best method to prevent the spread of infection to the other eye, the parents, other family members, or anyone else. Therefore, parents should ensure that affected children wash their hands frequently and discourage them from rubbing their eyes. Tissues used to clean the eye should be discarded. The child's washcloths and towels should be kept separate. Many schools and day care centers require that children be kept at home during the time when they are most contagious,

A child is brought to the school nurse after having a permanent tooth knocked out during gym class. Which action by the nurse is appropriate? 1. Gently rinse the tooth with sterile saline and reinsert it into the gingival cavity. 2. Gently scrub the root of the tooth to remove any debris, and wrap it in sterile gauze. 3. Place the tooth in water and transport the client to the nearest emergency department. 4. Wrap the tooth in sterile gauze and advise the parent to arrange for a dental appointment.

1. Gently rinse the tooth with sterile saline and reinsert it into the gingival cavity. Dental avulsion (ie, tooth separated from the mouth) of a permanent tooth is a dental emergency. The priority nursing action is to rinse and reinsert the tooth into the gingival socket and hold it in place (eg, with a finger) until stabilized by the dentist. Reimplantation within 15 minutes of injury re-establishes blood supply, increasing the probability of tooth survival.

A nurse is reinforcing appropriate interventions with the parent of an infant who had a febrile seizure. Which instruction is appropriate to review? 1. Give acetaminophen or ibuprofen every 6-8 hours to control fever. 2. Give the infant frequent tepid sponge baths to control the fever. 3. If the infant develops another seizure, wait 15 minutes to see if it subsides. 4. Place ice bags under the arms and around the neck to control fever.

1. Give acetaminophen or ibuprofen every 6-8 hours to control fever. Febrile seizures are an alarming experience for parents. They most commonly occur in children age 6 months to 6 years, with the peak incidence at age 18 months. The etiology is unknow.

The nurse is reviewing the laboratory values of a 3 year old with nephrotic syndrome. The nurse interprets the results to most clearly reflect which physiologic process related to nephrotic syndrome? (Laboratory results: Serum albumin 2.0 g/dL (20 g/L) Serum total cholesterol 275 mg/dL Urinalysis, protein 4+) 1. Glomerular injury 2. Hepatic impairment 3. Inherited hypercholesterolemia 4. Malnutrition

1. Glomerular injury Nephrotic syndrome: Is a collection of symptoms resulting from various causes of glomerular injury. The 4 classic manifestations of nephrotic syndrome are as follows: Edema-periorbital edema is usually the first sign: peripheral edema and ascites develop later due to fluid shifts. Massive proteinuria-caused by increased glomerular permeability. Hypoalbuminemia- resulting from excess protein loss in the urine. Hyperlipidemia-related to increased compensatory protein and lipid production by the liver. Additional symptoms include decreased urine output, fatigue, pallor, and weight gain.

The most recent laboratory results for a 12 month old who is HIV positive show a CD4 lymphocyte count of 5--/mm and a CD4 lymphocyte percentage of 10%. The nurse anticipates administering which immunizations? SATA 1. HIB 2. HEP A 3. MMR 4. PCV 5. Varicella

1. HIB 2. HEP A 4. PCV Routine immunization is particularly beneficial to children who are HIV-positive as they are more susceptible to preventable diseases due to a compromised immune system. The standard vaccine schedule for a 12 month old includes Hib, PCV, MMR, Varicella, Hep A. HIV positive children who are asymptomatic and not extremely immunocompromised can receive the appropriate age specific immunizations as recommended.

The clinic nurse is reviewing self-care management of acne vulgaris with an adolescent client. Which client statement indicates a need for further instruction? 1. I have been scrubbing my face twice daily with antibacterial soap. 2. I should buy skin care products that are labeled noncomedogenic 3. Maintaining a nutritious diet will help my skin heal 4. Picking or squeezing the lesions will worsen my acne.

1. I have been scrubbing my face twice daily with antibacterial soap. Acne vulgaris is a skin disorder characterized by obstructed sebaceous glands, which form comedones (ie, blackheads, whiteheads). Bacteria consume and metabolize the obstructed sebum, and the metabolic products cause inflammation, pustules, papules, and nodules. Acne usually develops during puberty, and multiple factors influence its development (eg, overgrowth of normal bacteria, heredity, stress, hormones). Treatment includes topical and oral medication such as tretinoin (Retin-A), benzoyl peroxide, isotretinoin (Accutane), and oral contraceptive.

An adolescent client with a sore throat is diagnosed with infectious mononucleosis. Which comment by the caregiver would alert the nurse that additional instruction is necessary? 1. I need to go to the pharmacy to pick up an antibiotic prescription. 2. It is acceptable for m y child to have ibuprofen for discomfort or fever. 3. My child will be on bed rest with few activities for the next 2 weeks. 4. Participation in soccer practice will not be allowed for the next month.

1. I need to go to the pharmacy to pick up an antibiotic prescription. Mononucleosis is caused by the Epstein-Barr virus. It is typically seen in adolescence from the sharing of drinks, kissing, or other direct exposure to saliva. Symptoms may include fatigue, fever, sore throat, splenomegaly, hepatomegaly, and swollen lymph nodes. Antibiotic treatment is inappropriate for a viral infection. Inadvertent intake of antibiotic (amoxicillin) can cause a rash. Treatment for mononucleosis is management of symptoms and includes hydration, rest, control of pain, and reducing fever as necessary. Sore throat is treated with saline gargles or anesthetic troches. Complications include airway obstruction (eg, stridor, difficult breathing) from swollen lymph nodes around the neck and severe abdominal pain (splenic rupture). These should be reported to the HCP immediately.

The nurse is caring for a 4 year old client with cystic fibrosis who uses a high frequency chest wall oscillation (HFCWO) vest for chest physiotherapy. After reinforcing education with the client's parents, which statement by a parent requires further teaching? 1. I will allow my child to have a snack while using the HFCWO vest to encourage cooperation. 2. I will give my child the nebulized bronchodilator treatment during therapy with the HFCWO vest. 3. I will perform manual chest percussion on my child if the HFCWO vest is broken or unavailable. 4. My child will use the HFCWO vest once in the morning, once in the evening and as needed.

1. I will allow my child to have a snack while using the HFCWO vest to encourage cooperation Chest physiotherapy (CPT) describes techniques of airway clearance, which is an important component of treatment for clients with cystic fibrosis that loosens and drains thick respiratory secretions. CPT can be performed by percussing (ie, clapping) the chest with a cupped hand or by wearing an inflatable high-frequency chest wall oscillation (HFCWO) vest. The HFCWO vest inflates and deflates rapidly, causing vibration over the chest wall and mobilizing secretions into the large airway that the child can expectorate. The HFCWO vest's rapid vibrations may include nausea and vomiting in some clients. Therefore, the client should avoid meals and snacks 1 hour before, during, or 2 hours following CPT to prevent gastrointestinal upset. The nurse may suggest other more appropriate ways to ensure compliance with CPT, such as allowing the child to watch a favorite television show or reading the child a story while wearing the HECWO vest.

The parent of a 6 year old calls the nurse and reports that the child was playing outside in the snow and the child's feet now appear red and swollen. What is the best response by the nurse? 1. Bring the child to the HCP office immediately. 2, Give your child something warm to drink. 3. Massage the child's feet gently until they warm up. 4. Place the child's feet in warm water immediately.

4. Place the child's feet in warm water immediately. The clinical indications of a cold injury include redness and swelling of the skin (chilblains or pernio) and blanched skin with hardness of the affected area (frostbite). For any cold injury, it is important to re-warm the area as soon as possible to restore blood flow and reduce the risk of permanent tissue damage. The recommendation for re-warming is immersion of the affected area in warm water (1004 F [40 C]) for about 30 minutes or until the are turns pink in cases of frostbite. The face and ears can be re-warmed with the application of warm facecloths.

The nurse is reviewing teaching with the parents of a child who has tinea capitis (ringworm of the scalp) and is newly prescribed griseofulvin oral suspension and 1% selenium sulfide shampoo. Which statement by the child's parent requires the nurse to intervene? 1. I will discontinue the griseofulvin once the ringworm stops itching and the scales go away. 2. I will give the griseofulvin suspension to my child after consumption of high fat food, like ice cream. 3. I will monitoring my child for increased sensitivity to sunlight while taking griseofulvin. 4. I will wash my child's scalp a few times per week with the medicated shampoo.

1. I will discontinue the griseofulvin once the ringworm stops itching and the scales go away. Tinea capitis (ringworm of the scalp) is a contagious fungal infection that lives on the surface of the scalp, resulting in scaly, pruritic, erythematous, circular patches with hair loss. The infection is transmitted via direct contact with infected persons, pets, or objects (eg, hairbrushes, bedding, towels, hats). Treatment include 1% selenium shampoo, combined with antifungal medication (griseofulvin oral suspension.

The nurse is reinforcing teaching about how to use a metered-dose inhaler to a 9-year-old with asthma

1. Shake the inhaler and attach it to spacer. 2. Exhale completely 3. Place lips tightly around the mouth piece. 4. Deliver one puff of medication into spacer. 5. Take a slow deep breath, and hold it for 10 seconds. 6. Rinse mouth with water.

The nurse is reinforcing teaching for parents of a child diagnosed with fifth disease. Which statement by a parent indicates a need for further teaching? 1. Our child should be feeling much better in 7-10 days 2. Our child's condition is communicable until the rash disappears 3. We will ensure our child covers the mouth and nose when coughing or sneezing 4. We will give our child ibuprofen to treat the joint pain

2 Fifth disease (slapped face, or erythema infectiosum) is a viral illness caused by the human parvovirus and affects mainly school-age children. The virus spreads via respiratory secretions, and the period of communicability occurs before onset of symptoms. The child will have a distinctive red rash on the cheeks that gives the appearance of having been slapped. The rash spreads to the extremities and a maculopapular rash develops, which then progresses from the proximal to distal surfaces. The child may have general malaise and joint pain that are typically well controlled with nonsteroidal anti-inflammatory drugs such as ibuprofen. Affected children typically recover quickly within 7-10 days. Once these children develop symptoms (eg, rash, joint pains(, they are no longer infectious. Isolation is not usually required unless the child is hospitalized with aplastic crisis or immunocompromising condition.

The nurse is evaluating a parent's understanding of home care management for a 2 week old client after initial cast placement for treatment of congenital clubfoot. Which of the following statements by the parent indicate a correct understanding? SATA 1. Cradling my baby in my arms my causes stress and damage to the cast. 2. I will check my baby's toes several times a day to ensure that they are pink and warm. 3. My baby should alternate between sleeping on the stomach and back. 4. My baby will need to have a new cast applied weekly for 5-8 weeks. 5 When I bathe or diaper my baby. I will be sure to keep the cast dry.

2, 4, 5 Clubfoot (ie, talipase equinovarus) is a congenital bone deformity and soft tissue contracture manifested by one or both feet being turned inward. The health care provider typically begins management of the deformity soon after birth by manipulation and stretching of the affected foot and placing a long-leg cast. Weekly recasting over 5-8 weeks (ie, Ponseti method) is necessary to gradually reposition the foot. To maintain the correction after successful casting, the client commonly wears custom shoes secured to a bar brace. To prevent recurrence, long-term follow up continues until the child attains skeletal maturity. The nurse should teach parents about cast care, which includes monitoring the client's circulation (eg, toes pink and warm) and keeping the cast dry during diapering and bathing to prevent skin irritation or infection.

A nurse receives report on a group of clients. Which client should the nurse assess first? 1. A preschool age child with a hast cough, expiratory wheezes, and mild intercostal retractions. 2. A toddler playing with small toys who appears in distress, has circumoral cyanosis, and cannot speak. 3. A toddler with a barking cough, infrequent inspiratory stridor, and oxygen saturation of 94% on room air. 4. An infant with an axillary temperature of 100.1 F (37.8 C) who is tugging at the left ear.

2. A toddler playing with small toys who appears in distress, has circumoral cyanosis, and cannot speak. Aspiration of a foreign body occur most often in the toddler age group. Swallowing of objects such as buttons. small parts of toys, or food particles can be life-threatening and result in airway obstruction due to the small diameter of the airway. Manifestations include chocking, gagging, cyanosis, and inability to speak when the object is lodged in the larynx.

A child received the varicella immunization. The day after the injection, the parent calls the nurse to say that the child has discomfort, slight redness, and 2 vesicles at the injections site. Which instruction should the nurse reinforce? 1. Administer aspirin to decrease discomfort. 2. Cover the vesicles with a small bandage until they are dry. 3. Isolate the child from other children for 21 days to avoid exposure. 4. Make an appointment with the HCP as soon as possible.

2. Cover the vesicles with a small bandage until they are dry. The varicella immunization is administered t prevent infection of varicella zoster, commonly known as chickenpox. Side effects of the immunization include discomfort, redness, and a few vesicles at the injection site. Covering the vesicles with clothing or a small bandage will reduce the risk of transmission from any exudate. Once the vesicles have dried, or crusted, a dressing is no longer necessary.

A nurse is reinforcing teaching to the parent of a child who has a new diagnosis of absence seizures. which statement by the parent indicate understanding of the teaching? 1. My child may experience incontinence. 2. My child may seem confused afterwards. 3. My child may stare and seem inattentive. 4. My child will notice unusual odors prior to the event.

3. My child may stare and seem inattentive. Absence seizures occur in children age 4-12 and usually disappear at puberty. Clinical manifestations include a brief loss of consciousness and an appearance of inattention or daydreaming (the absence attack) without loss of postural body tone. However, slight loss of tone may lead to dropping objects held in the hands. Most absence seizures last less than 10 seconds and often go unrecognized. Following an attack, behavior and awareness immediately return to normal. The child does not experience a postictal period but usually has no recollection that a seizure has occurred. A child may have multiple absence seizures each day. Treatment includes the use of anticonvulsant medication.

A 3 month old child with developmental dysplasia of the hip (DDH) is being fitted for a Pavlik harness. Which statement made by the parent indicates a need for further instruction? 1. I should leave the harness on during diaper changes, 2. I will adjust the harness straps every 3-5 days 3. I will inspect the skin under the straps 2-3 times daily 4. The harness should keep my baby's legs bent and spread apart.

2. I will adjust the harness straps every 3-5 days DDH is instability or dislocation of the hip joint that may be present at birth or develop during the first few years of life. Nonsurgical treatment methods such as the Pavlik harness are most successful when initiated during the first 6 months of life. After this time, surgery is generally required. The Pavlik harness is the most common tool used to treat early DDH. It maintains the infant's hips in a slightly flexed and abducted position (ei, legs bent and spread apart), allowing for proper hip development. Pavlik harnesses are typically worn for 3-5 months or until the hip joint is stable. The straps are assessed every 1=2 weeks by the HCP and adjusted as necessary to account for infant growth. However, parents should not alter the strap placements at home as incorrect positioning can lead to damage to the nerves or vascular supply of the hip.

The nurse is caring for a 7 year old client diagnosed with nephrotic syndrome who will be discharged soon. Which statement by the parent indicates the need for further teaching? 1. I'll provide a healthy diet without added salt for my child. 2. I'll organize playdates to keep my child's spirits up during relapses 3. I'll restrict my child's fluids if I notice swelling or rapid weight gain 4. I'll test for protein in my child's urine every day..

2. I'll organize playdates to keep my child's spirits up during relapses Nephrotic syndrome, an autoimmune disease, affects children age 2-7 and is characterized by increased permeability or the glomerulus to proteins (eg, albumin, immunoglobulins, natural anticoagulants). Loss of albumin in urine leads to hypoalbuminemia, this causes decreased plasma oncotic pressure, which allows fluid to leak out of the vascular spaces. Reduced plasma volume (hypovolemia) activates kidneys to retain salt and water (via the renin-angiotensin-aldosterone system). Clients experience generalized edema, weight gain, loss of appetite (from ascites), and decreased urine output. The loss of immunoglobulins causes increased susceptibility to infection. Caregivers should minimize the risk of infection during relapses (eg, limiting visitors).

The nurse is providing teaching to the parents of a 1 year old who was just prescribed a 10 day course of amoxicillin for acute otitis media. Which of the following instructions are appropriate for the nurse to include in the teaching? SATA 1. Give your child OTC decongestants to help speed up recovery. 2. If your child develops loose stools, please discontinue the antibiotic. 3. Return to the clinic if your child does not improve within 45-72 hours. 4. Stop administering the amoxicillin if your child is feeling better in 5-7 days. 5. Your child may need a hearing screening after the ear infection has resolved.

3, 5 Acute otitis media is an infection of the middle (inner) ear that causes inflammation and obstruction of the eustachian tube. A dysfunctional eustachian tube inhibits drainage of fluid from the middle ear and creates an opportunity for bacterial growth. As the infected fluid builds up, bulging and erythema of the tympanic membrane occur. If symptoms do not improve within 48-72 hours of initiating antibiotic therapy, the client should return for further assessment to determine if a different antibiotic is required to treat for drug-resistant pathogens. Potential complication of AOM include conductive hearing loss or mastoiditis caused by the spread of the infection to the mastoid bone behind the ear. The child may need a hearing screening after the infection resolves to assess for hearing changes.

A 12 month old with Kawasaki disease received IV immunoglobulin (IVIG) 2 months ago. The child is in the clinic for follow up and scheduled immunizations. Which vaccine should be delayed? SATA 1. Hib 2. Hep B 3. MMR 4. PCV 5. Varicella

3. 5 Kawasaki disease is treated with aspirin and IVIG to prevent coronary artery aneurysms. Antibodies acquired from the IVIG therapy will remain in the body for up to 11 months and may interfere with the desired immune response to live vaccines. Therefore, live vaccines (eg, varicella, MMR) should be delayed for 11 months after IVIG administration as this therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity.

The mother of a 6 year old child with cystic fibrosis has received instruction on the use of pancreatic enzymes. Which statement made by the mother indicates a need for further teaching? 1. I need to monitor the total amount of this medication that I give to my child every day. 2. I should give this medication with or just before my child has a meal or snack. 3. It is okay for my child to chew this medication. 4.. It is okay to open the capsule and sprinkle the medicine on a tablespoon of applesauce.

3. It is okay for my child to chew this medication. In CF, usually thick mucus obstructs the pancreatic ducts, preventing pancreatic enzymes (amylase, trypsin, and lipase) from reaching the small intestine. The result is malabsorption of carbohydrates, fats, and proteins, the inability to absorb fat soluble vitamins (A, D, E & K) is of particular concern. Gastrointestinal signs & symptoms of CF include flatulence, abdominal cramping, ongoing diarrhea, and/or steatorrhea. They are taken with or just before meals, should be swallowed whole or sprinkled on an acidic food and should not be crushed or chewed.

The PN is assisting the RN in performing well-child examination in a pediatric clinic. Which finding requires further evaluation? 1. Bilateral bowlegs (genu varum) in 15 month-old 2. Chest rounded with the anteroposterior diameter equal to the lateral diameter in an infant. 3. Lateral curvature to the spine noted on examination of a 10-year old girl 4. Presence of an 53 heart in a 2 year old

3. Lateral curvature to the spine noted on examination of a 10-year old girl. The finding in this client indicates scoliosis, one of the most commonly diagnosed spinal deformities characterized by lateral curvature of the spine and spinal rotation. Although scoliosis may result from congenital or pathologic conditions, it is most often idiopathic. The condition is commonly first noticed during periods of rapid growth, particularly during early adolescence in girls. Screenings may occur in schools or at well child office visits for girls age 10-12 years and boys age 13-14 years. Early detection and prompt treatment may reduce the need for surgical intervention.

The nurse is caring for an infant with osteogenesis imperfecta admitted with a new fracture. The client also has old fractures in multiple stages of healing but not bruising, abrasions, or redness or the skin. Which nursing intervention should be included in the plan of care? 1. During diaper changes, carefully lift the infant by the ankles. 2. Lift from under the arms when picking up the infant. 3. Obtain blood pressure manually to avoid cuff over-tightening. 4. Request a social work consultation to assess for child abuse.

3. Obtain blood pressure manually to avoid cuff over-tightening. Osteogenesis Imperfecta (brittle bone disease) is a rare genetic condition resulting in impaired synthesis of collagen by osteoblasts. Collagen allows bone to be somewhat flexible while still maintaining strength. Impaired collagen causes bones to be frail and easily fractured. Clinical manifestations can range from mild defects to lethal disease in utero. OI is usually transmitted by autosomal dominant inheritance. Care of the infant with OI includes: Checking BP manually. Lifting the infant by slipping a hand under the broadest areas of the body (eg, back, buttocks). Repositioning the infant frequently using supportive devices and gel padding to avoid molding of soft bones of the skull.

The nurse monitors a child who has been treated for an acute asthma exacerbation. Which finding is the best indicator that treatment has been effective? 1. Episodes of spasmodic coughing have decreased. 2. No wheezes are audible on chest auscultation. 3. Oxygen saturation has increased from 88% to 93%. 4. Peak expiratory flow rate has dropped from 212 L/min to 127 l/min.

3. Oxygen saturation has increased from 88% to 93%.

A nurse is caring for a 2 year old with a new diagnosis of strabismus. Which intervention should the nurse anticipate? 1. Eye drops in the abnormal eye. 2. Measurement of intraocular pressure. 3. Patching the stronger eye. 4. Correction with laser surgery.

3. Patching the stronger eye. Strabismus (crossed eye) is a disorder involving misalignment of the eyes caused by a congenital defect or acquired weakness of an eye muscle. One eye may appear deviated inward (esotropia) or outward (exotropia). When the visual axes are not in alignment, the brain perceives 2 images (diplopia) and suppresses the weaker image to compensate. If left untreated age 4-6, permanent reduction or loss of visual acuity in the affected eye (amblyopia) can occur.

A nurse is planning to test the visual acuity of a 7 year old. Which is the best way to test visual acuity in this child? 1. Have the child focus on a bright object and follow the target. 2. Have the child view a set a cards one at a time. 3. Position the child at a distance of 10 ft (3 m) from a chart. 4. Shine a light the child's eyes at a distance of 16 in (40.6 cm).

3. Position the child at a distance of 10 ft (3 m) from a chart. Visual acuity testing in children ages 6 and older is generally assessed by use of the Snellen letter chart. The child is positioned 10 ft (3 m) from the chart and asked to read the letters, beginning with the lines of large text to small text. Standard testing for visual acuity is at 20 ft (6 m), however, the American Academy of Pediatrics recommends testing at 10 ft as it is easier to maintain the child's attention and provides a more accurate result. Ig the child wears glasses, they remain in place. Both eyes should remain open while one eye at a time is cover to read the chart.

The nurse on a pediatric unit is caring for a school age child with suspected Reye Syndrome. Which subjective client data is most consistent with this condition? 1. No history of varicella vaccine administration. 2. Recent exposure to bats. 3. Recent influenza infection. 4. Recent use of acetaminophen for fever.

3. Recent influenza infection. Children who develop Reye syndrome have often had a recent viral infection, especially varicella or influenza. Clinical manifestations of Reye syndrome include fever, lethargy, acute encephalopathy, and altered hepatic function. Elevated serum ammonia levels are an expected laboratory finding. In addition, acute encephalopathy manifests with vomiting and a severely altered level of consciousness, it can rapidly progress to seizures and/or coma. The risk of developing Reye syndrome increases if aspirin is used to treat the fever associated with varicella or influenza. As a result, the use of acetaminophen or ibuprofen for fever management in children has increased significantly.

The nurse just administered routine immunizations to a healthy 15 month old. What information should the nurse reinforce with the caregivers before they leave the clinic? 1. Call the office if the toddler's temperature is higher than 100 F. 2. Fussiness and anorexia are common for 1 week after immunizations. 3. Redness at the injection sites and a mild fever are common. 4. The toddler's activity level should be restricted for 24 hours.

3. Redness at the injection sites and a mild fever are common. Common side effects of immunization include a mild fever and soreness and redness at the injection site. Caregivers should be instructed to apply a cool compress to the injection site and taught how to correctly calculate the dose of acetaminophen or ibuprofen needed for these symtoms.

The summer camp nurse and parent of a 9 year old with juvenile idiopathic arthritis (JIA) are discussing appropriate physical activities for the child. Which of the following activities should be included? SATA 1. Dodgeball 2. Reading a book 3. Stationary bicycling 4. Swimming 5. Yoga

3. Stationary bicycling 4. Swimming 5. Yoga Children with JIA are at high risk for becoming deconditioned due to decreased muscle strength and endurance and overall capacity for exercise. They tend to tire quickly even when the disease is in remission. Both aerobic and anaerobic exercise can help minimize this risk, and resistance training can increase muscle strength and endurance, Exercise may also have a positive effect on low bone density, a secondary condition often associated with JIA. In general, low impact, weight bearing, and non weight bearing exercises that involve range of motion and stretching to preserve joint mobility and strengthen muscles are best. High impact activities and those that cause overtiring and joint pain should be avoided. Swimming is often consider the ideal activity for children with JIA.

Prior to discharge of a child with a ventriculoperitoneal (VP) shunt, the nurse reinforces teaching to the caregiver about when to contact the health care provider. The caregiver shows understanding of the instructions by contacting the health care provider about which symptom? 1. A temperature of 99 F (37.2) that occurs during the evening. 2. The child cannot recall items eaten for lunch the previous day. 3. The child vomits after awakening from a nap and again 1 hour later. 4. The VP shunt is palpated along the posterolateral portion of the skull.

3. The child vomits after awakening from a nap and again 1 hour later. The caregiver of a child with a ventriculoperitoneal shunt must understand symptoms of increased intracranial pressure, which indicate shunt malfunction. Vomiting may be a sign of increased ICP and would require that the health care provider be contacted.

A 4 year old admitted with Wilms tumor (nephroblastoma) is scheduled for a right nephrectomy in the morning. Which nursing action is a priority pre-operatively? 1. Assessment of the child's emotional maturity level. 2. Auscultating for adventitious breath sounds 3. Monitoring blood pressure closely 4. Reinforcing instructions not to palpate the abdomen.

4. Reinforcing instructions not to palpate the abdomen. Wilms tumor (nephroblastoma) is a kidney tumor that usually occurs in children age <5. Most often it involves only one kidney, and the prognosis is good if the tumor has not metastasized. An unusual contour in the child's abdomen is suggestive of Wilms tumor and confirmatory diagnosis is made by ultrasound. Once the diagnosis is suspected or confirmed, the abdomen should not be palpated, as this can disrupt the encapsulated tumor. It is important to post the sign "DO NOT PALPATE ABDOMEN" at the bedside. It is also essential that the child be handled carefully during bathing.

The nurse is a clinic is caring for an 8 month old with a new diagnosis of bronchiolitis due to respiratory syncytial virus (RSV). Which instructions can the nurse anticipate reviewing with the parent? 1. Administering a cough suppressant and antihistamine. 2. Prophylactic treatment of family members. 3. Temporary cessation of breastfeeding. 4. Use of saline drops and a build syringe to suction nares.

4. Use of saline drops and a build syringe to suction nares. Bronchiolitis is a common viral illness of childhood that is usually caused by RSV. It typically begins with viral upper respiratory symptoms (eg, rhinorrhea, congestion) that progress to lower respiratory tract symptoms such as tachypnea, cough, and wheezing. Most children can be managed in the home environment. Breastfeeding should be continued and additional fluids offered if there is a risk of dehydration due to frequent coughing and vomiting. Saline nose drops and then suctioning the nares.

A nurse is caring for a child who is receiving oxygen at 2 L/min by nasal cannula and observes the current oxygen saturation and pulse plethysmographic waveform on pulse oximeter. Which intervention should be the nurse's initial action? 1. Auscultate the child's lung fields. 2. Have the child take slow, deep breath. 3. Increase the oxygen flow rate to 3 L/min. 4. Verify the position and integrity of the finger probe.

4. Verify the position and integrity of the finger probe. The first action of the nursing process is assessment. The nurse should first evaluate the accuracy of the reading by evaluating the pulse plethysmographic waveform. Waveforms that are irregular or erratic may contain artifact caused by a loose, misapplied, or damaged pulse oximeter or by client movement. After ensuring that the probe has been properly applied and positioned to provide an accurate reading, the nurse should perform a thorough physical assessment and intervene as appropriate.

The parent of a 15 month old calls the nurse and says that the child developed a rash and mild fever after receiving a routine MMR, and varicella (MMRV) vaccine in the pediatric clinic 5 days ago. What is the best response by the nurse? 1. Apply OTC hydrocortisone cream to the rash. 2. Bring your child to the clinic this afternoon. 3. This is a common reaction to the MMRV vaccine. 4. What is your child's temperature right now?

4. What is your child's temperature right now? Some children have a mild reaction to the MMRV vaccine within 5-12 days after the first dose. Problems include low-grade fever, mild rash, swelling and erythema at the injection site, irritability, and restlessness. Although rare, fever after MMRV vaccination can lead to febrile seizures. Therefore, it is important for the nurse to determine the child's temperature to evaluate the risk for a febrile convulsion. it would also be important for the nurse to instruct the parent to monitor the child's temperature and administer acetaminophen for a fever above 102 F (38.9 C). Children with a history of seizures should be vaccinated with separate MMR and varicella vaccines instead of the combination MMRV vaccine.

Painful procedures (eg, capillary heel sticks, immunizations) are frequently required to provide optimal care but may cause considerable stress or alterations in a client's status (eg, vital sign changes, instability) without proper management. Nonpharmacological pain management is a method for stopping or reducing the sensation of pain and may eliminate or decrease the need for pharmacological intervention.

Appropriate nonpharmacological pain-management interventions for infants and newborns include: Offering concentrated sucrose, if prescribed, which is associated with reduced indicators of pain (eg, presence and duration of crying, grimacing). Assisting the parent to hold the infant skin-to skin (kangaroo care), which provides sensory stimulation that is calming and reduces indicators of pain. Offering nonnutritive sucking interventions (eg, pacifiers), which help calm the infant during painful procedures. Swaddling the infant, which provides a sense of comfort and security and reduces the heart rate and incidences of crying. Educational objective: Nurses performing painful procedures should implement pain management techniques to promote the client's comfort and stability.

Endometrial cancer arises from the inner lining of the uterus and forms after the development of unregulated endometrial overgrowth (ie, hyperplasia). Although typically slow growing, it can metastasize to the myometrium (ei, uterine muscle tissue), cervix, and nearby lymph nodes and eventually beyond the pelvis. Many signs of endometrial cancer are nonspecific (eg, lower back or abdominal pain), but hallmark symptoms is abnormal uterine bleeding (eg, heavy, prolonged, intermenstrual, and/or postmenopausal bleeding).

As with many cancers, the client's family and genetic history (eg, BRCA mutation carrier) are significant risk factors, however, prolonged estrogen exposure without adequate progesterone is the greatest risk factor for developing endometrial cancer risk include: Conditions associated with infrequent or anovulatory menstrual cycles (eg, polycystic ovary syndrome, infertility, late menopause, early menarche) Obesity Tamoxifen (a medication given for breast cancer)

Systemic lupus erythematosus is an autoimmune disorder (the body's immune system erroneously attacks body tissues) that results in inflammation and damage to many body parts. Symptoms vary widely among affected individuals, but most experience painful/swollen joints, extreme fatigue, skin rashes, and kidney problems. The symptoms typically appear for periods of time (called flares) alternating with periods of remission. There is no cure for SLE, but it can be treated with immunosuppressants (eg, corticosteroids) or immunomodulators (eg, hydroxychloroquine). Pneumonia and annual influenza vaccinations are recommended for those with SLE as they are more susceptible to infections. These individuals should avoid contact with sick people and report fever their health care provider.

Both physical and emotional stress can exacerbate SLE. Therefore, clients should follow a healthy lifestyle (eg, 7-8 hours of sleep, no smoking). Balanced exercise with alternating periods of rest is recommended. Sunlight is known to worsen the rash of SLE and should be avoided when possible (especially between 10 am-4 pm): protective clothing and sunscreen application are recommended during periods of sun exposure. The rash of SLE should be cleansed with only mild soap. Harsh soap and chemicals should be avoided. The rash is not due to bacterial infection.

Bacterial meningitis: is inflammation of the meninges of the brain and spinal cord caused by infection. General manifestations in infants and children age <2 include fever, restlessness, and a high-pitch cry. One common acute complication of bacterial meningitis is hydrocephalus, an increase in intracranial pressure (ICP) resulting from obstruction of cerebrospinal fluid flow. Increase ICP can progress to permanent hearing loss, learning disabilities, and brain damage.

Bulging/tense fontanels and increasing head circumference are important early indicators of increased ICP in children. Frequent assessment for developing complications is vital for any client with suspected bacterial meningitis.

Select all that apply: 4 year old client with failure to thrive: Describes a client with poor growth due to inadequate caloric intake, inadequate food absorption, or excess caloric expenditure. In children, a weight that is <80% of ideal weight for height, weight that is below the 3rd to 5th percentile on growth charts, or persistent decrease in growth over time on growth charts support the diagnosis of FTT.

Causes of FTT are typically multifactorial but may be related to certain medical conditions: (eg, low birth weight, prematurity, congenital anomalies) or influenced by psychosocial risk factors, including: Domestic violence in the hone and/or history of child neglect or abuse. Caregiver or child with negative attitudes toward food (eg, fear of obesity, anorexia, food restriction) Poverty or food insecurity (which is the greatest risk factor) Disordered feeding behaviors (eg, unstructured mealtimes)

CYSTIC FIBROSIS is a generic disorder involving the cells that line the respiratory, gastrointestinal, and reproductive tracts. A defective protein responsible for transporting sodium and chloride causes the secretions from exocrine glands in these areas to be thicker and stickier than normal. These abnormal secretions plug smaller airway passages and ducts in the GI tract. Secretions of impaired digestive enzymes in the GI tract result in ineffective absorption of essential nutrients. The sticky respiratory secretions lead to an inability to clear the airway and a chronic cough. the client eventually develops chronic lung disease (bronchiectasis). As a result of these changes the client's life span is shortened, most affected individuals live only into their 30s.

Chest physiotherapy helps remove sticky secretions that cause ineffective airway clearance. Clients and parents should receive genetic testing and counseling as CF is transmitted in an autosomal recessive inheritance pattern. Spiritual support should be offered as client's must deal with the impact of CF on life span and future pregnancies.

Toddlers experience a phenomenal growth in language skills. They have many ways of communicating, some of them nonverbal: however, they enjoy and learn as family members and others talk and read to them. When toddlers do not enjoy these interactions or are not expressing themselves verbally, speech and hearing deficits should be explored. Many deficits in speech and hearing are correctable: otherwise, therapy may enhance quality of life.

Educational objective: If toddlers are not expressing themselves verbally and do not enjoy and learn as family members talk or read to them, speech and hearing deficits should be explored.

Holter monitor A Holter monitor continuously records a client's electrocardiogram rhythm for 24-48 hours. Electrodes are placed on the client's chest and a portable recording unit is kept with the clients. At the end of the prescribed period, the client returns the unit to the HCP office. The data can then be recalled, printed, and analyzed for any abnormalities.

Client's instructions include the following: 1. Keep a diary of activities and any symptoms experienced while wearing the monitor so that these may later be correlated with any recorded rhythm disturbances. 2. Do Not bathe or shower during the test period 3. Engage in normal activities to stimulate conditions that may produce symptoms that the monitor can record.

Pulmonary embolism is a potentially life-threatening medical emergency occurring when a blood clot, fat of air embolus, or tissue (eg, tumor) travels via the venous system into the pulmonary circulation and obstructs blood flow into the lung. This prevents deoxygenated blood from reaching the alveoli, which leads to hypoxemia due to impaired gas exchange and cardiac strain due to congested blood flow in the pulmonary arteries.

Clinical manifestations of PE range mild (eg, anxiety, couth) to severe (eg, heart failure, sudden death). However, many clients initially have mild, nonspecific symptoms, that are often misdiagnosed and inadequately managed, greatly increasing the likelihood of progression to shock and/or cardiac arrest. Clinical manifestations of PE include: Pleuritic chest pain (ie, sharp lung pain while inhaling) Dyspnea and hypoxemia Tachypnea and cough (eg. dry or productive cough with bloody sputum) Tachycardia Unilateral leg swelling, erythema, or tenderness related to deep vein thrombosis.

Complete physical examination: The nurse should plan to assess the toddler client in a nonthreatening environment, taking time to develop rapport prior to beginning the examination. This can be achieved by talking to the toddler about favorite objects and slowly initiating contact. Parent involvement, such as holding the child and assisting the child with examination activities, reduces anxiety and encourages cooperation in toddler clients. Age-appropriate games or toys may be used if needed to gain client's cooperation.

Educational objective: The nurse should allow a parent to interact with the toddler and assist with the examination process to encourage client cooperation. Examination of a toddler should proceed from least to most invasive, allowing the client to inspect pieces of equipment before use. Use minimal physical contact initially.

Delay of congenital pulmonic stenosis in the cardiac catheterization laboratory. Severe diaper rash should be reported to the supervising registered nurse and the health care provider. The presence of a rash could delay the procedure if it is located in the groin area, where access is obtained for arterial cannulation. There is a risk of infection as Candida a yeast, or bacteria may be present on the rash and could be introduced into the bloodstream with the arterial stick.

Educational objective: The nurse should report severe diaper rash to the registered nurse and health care provider in an infant who has an interventional catherization procedure planned. If the rash is near the groin area, the procedure may be delayed due to possible contamination at the insertion site.

Rooting and sucking are a part of an infant's natural reflexes. Nonnutritive sucking assists in helping the infant to feel secure. Some parents become very concerned about their infants sucking fingers, thumbs, or a pacifier and try to stop the behavior. As a rule, if thumb sucking stops before the permanent teeth begin to erupt; misalignment of the teeth and malocclusion can be avoided. Parents should be taught that teasing and punishing a child for using a pacifier or sucking the thumb is not an effective method for getting the child to stop. This can increase the child's anxiety and cause the child to increase the behavior.

Educational objective: The risk of teeth misalignment and malocclusion occurs when a child uses a pacifier or sucks the thumb after the eruption of the permanent teeth.

Chronic bronchitis is characterized by excessive mucus production, chronic cough, and recurrent respiratory track infections. Interventions help reduce viscosity of mucus, facilitate secretion removal, and promote comfort include the following:

Increasing oral fluids to 2-3 L/day if not contraindicated prevents dehydration and keeps secretions thin. Cool mist humidifier increases room humidity of inspired air. Guaifenesin (Robitussin) is an expectorant that reduces the viscosity of thick secretions by increasing respiratory tract fluid, drinking a full glass of water after taking the medication is recommended. Abdominal breathing with the huff, a forced expiratory cough technique, is effective in mobilizing secretions into the large airways so that they can be expectorated. Chest physiotherapy (postural drainage, percussion, vibration). Airway clearance handheld devices, which use the principle of positive expiratory pressure to help loosen secretions when the client exhales through the mouthpiece.

Kawasaki disease (KD) is a childhood condition that causes inflammation of arterial walls (vasculitis). The coronary arteries are affected in KD, and some children develop coronary aneurysms. The etiology of KD is unknown, there are no diagnostic tests to confirm the disease, and it is not contagious. KD has the following 3 phases: 1. ACUTE-sudden onset of high fever that does not respond to antibiotics or antipyretics. The child becomes very irritable and develops swollen red feet and hands. The lips become swollen and cracked, and the tongue can also become red (strawberry tongue) 2. SUBACUTE- skin begins to peel from the hands and feet. The child remains very irritable. 3. CONVALESCENT- symptoms disappear slowly. The child's temperament returns to normal.

Initial treatment consists of sublingual infusion of IV immune globulin (IVIG) and aspirin. IVIG creates high plasma oncotic pressure; signs of fluid overload and pulmonary edema develop if it is given in large quantities. Therefore, the child should be monitored for symptoms of heart failure (eg, decreased urinary output, additional heart sounds, tachycardia, difficulty breathing).

Total parenteral nutrition Best action. (check the blood glucose) A complication of total parenteral nutrition is hyperglycemia, as evidenced by excessive thirst, increased urination, abdominal pain, headache, fatigue, and blurred vision. The development of hyperglycemia is related to the following: Excessive dextrose infusion Increased production of counterregulatory hormones in response to acute illness High infusion rate Administration of medications such as corticosteroids Infection

Interventions to resolve TPN-associated hyperglycemia include reducing the amount of carbohydrate in the TPN solution, slowing down the infusion rate, and administering subcutaneous insulin. The PN should collaborate with the RN and HCP before implementing these interventions.

Regression during hospitalization: It is a normal response to the stress of an unfamiliar environment, the fear and pain of invasive procedures, and the change in a child's normal routine. Toilet-trained children may start bed-wetting, and children who gave up the bottle or pacifier may ask for it. .

It is important for the nurse to explain that this behavior is completely normal and that the child will gain back previous milestones after discharge. Educational objective: Hospitalization can be very stressful for a child. Regressive behaviors during hospitalization are a normal response to changes in routine. The nurse should inform the caregivers that this behavior is temporary and that the child will regain lost milestones rapidly after discharge.

Gastroesophageal reflux disease (GERD) occurs when chronic reflux of stomach contents causes inflammation of the esophageal mucosa. The lower esophageal sphincter (LES) normally prevents stomach contents from entering the esophagus. Any factor that decreases the tone of the LES (eg, caffeine, alcohol), delays gastric emptying ( eg, fatty foods), or increases gastric pressure (eg, large meals( can precipitate GERD.

Lifestyle and dietary measures that may prevent GERD and associated symptoms include: Weigh loss, as excessive abdominal fat may increase gastric pressure. Small, frequent meals with sips of water or fluids to help facilitate the passage of stomach contents into the small intestine and prevent reflux from becoming overly full during meals. Avoid GERD triggers such as caffeine, alcohol, nicotine, high-fat-foods, chocolate, spicy foods, peppermint, and carbonated beverages. Chewing gum to promote salivation, which may help neutralize and clear acid from the esophagus. Sleeping with the head of the bed elevated. Refraining from eating at bedtime and/or lying down immediately after eating.

Bacterial meningitis: is an infection that causes inflammation of the membranes covering the brain and spinal cord (eg, meninges). Inflammation and bacterial growth within the meninges lead to increase cerebrospinal fluid (CSF) volume and increased intracranial pressure (ICP). Without intervention, increased ICP may lead to nerve ischemia and permanent functional impairment (eg, hearing loss, visual impairment, paralysis), brain herniation, or death. The nurse should perform the following interventions:

Maintain the head of the bed elevated at 30 degrees with the head and neck midline to reduce ICP by promoting drainage of cerebral venous blood and CSF. Implement seizure precautions due to potential neurologic irritability from increased ICP. Ensure a restful environment (eg, quiet, dimly lit, cool temperature) by reducing potentially irritable stimuli>

Phenylketonuria (PKU): Is one of a few genetic inborn errors of metabolism. Individuals with PKU lack the enzyme (phenylalanine hydroxylase) required for converting the amino acid phenylalanine into the amino acid tyrosine. AS unconverted phenylalanine accumulates, irreversible neurologic damage can occur. A low-phenylalanine diet is essential in the treatment of PKU. Phenylalanine cannot be entirely eliminated from the diet as it is an essential amino acid and necessary for normal development. The diet must meet nutritional needs while maintaining phenylalanine levels within a safe range (2-6 mg/d: {120-360 umol/L} for client age <12) There is no known age at which the diet can be discontinued safely, and lifetime dietary restrictions are recommended for optimal health.

Management of the client with PKU includes: Monitoring serum levels of phenylalanine. Including synthetic proteins and special formulas (eg, Lofenalac, Phenyl-Free) in the diet. Eliminating high-phenylalanine (eg, meats, eggs, milk) from the diet. Encouraging the consumption of natural foods low in phenylalanine (most fruits and vegetable) Educational objective: Phenylketonuria requires lifetime dietary restrictions, infants should be given special formulas (eg, Lofenalac). For children and adults, high-phenylalanine foods (eg, meats, eggs, milk) should be restricted and replaced with protein substitutes.

Arteriovenous fistula (AVF) The creation of an AVF for hemodialysis access involves an anastomosis between an artery and a vein (usually the cephalic or basilic vein). The fistula permits the arterial blood to flow through the vein, causing the vein to become larger in diameter and the walls to thicken, enabling blood to flow at high pressures. After the AVF is placed, it takes 2-4 months for it to mature to accommodate the repeated venipunctures necessary for hemodialysis access. The major complications of an AVF are infection (especially in end-stage kidney disease and diabetes), stenosis, thrombosis, and hemorrhage. Clients are taught the following preventive interventions:

Report numbness or tingling of the extremity to the HCP to prevent neuromuscular damage. Do not allow anyone (other than dialysis personnel) to draw blood or take blood pressure measurements on the extremity to prevent thrombosis. Avoid wearing restrictive clothing or jewelry to prevent thrombosis. Do not use the arm with vascular access to carry heavy objects (more than 5 lb); however, exercise to increase strength could include squeezing a soft ball or sponge several times a day. check the function of the vascular access several times a day by feeling for vibration to assess for patency, stenosis, and clotting. Do not sleep on the arm with vascular access or use creams or lotions on the site. Monitor for signs of infection and bleeding after dialysis and report immediately. Keep the site clean to help prevent infection.

Risk factors of sudden infant death syndrome" Maternal/antenatal-Substance use (eg, cigarettes, alcohol, illicit drugs). Maternal age<20. Inconsistent prenatal care. Infant-Prematurity or low birth weight. Sleep environment. Prone-/side-sleep position. Soft sleep surface, loose bedding. Bed-sharing. Smoke exposure.

Sudden infant death syndrome (SIDS) is the unexpected, unexplained death of an infant age <1 year, occurring most frequently in those age <6 months during sleep/naps. The nurse should reinforce teaching with parents regarding placement of the infant during sleep (eg, on their back, on a firm surface, without loose or soft items) to prevent suffocation. The nurse may also encourage pacifier use during sleep, which is protective against SIDS.

Raynaud phenomenon is a vasospastic disorder resulting in an episodic vascular response related to cold temperatures or emotional stress. It most commonly affects woman age 15-40. Vasospasms induce a characteristic color change in the appendages (eg, fingers, toes, ears, nose). When vasoconstriction occurs, the affected appendage initially turns white from decreased perfusion, followed by a bluish purple appearance due to cyanosis. clients usually report numbness and coldness during this stage. when blood flow is subsequently restored, the affected area becomes reddened, and clients experience throbbing or aching pain, swelling, and tingling. Acute vasospasms are treated by immersing the hands in warm water.

Teaching: Wear gloves when handling cold objects Dress in warm layers, particularly in cold weather. Avoid extremes and abrupt changes in temperature Avoid vasoconstricting drugs (eg, cocaine, amphetamines, ergotamine, pseudoephedrine) Avoid excessive caffeine intake Refrain from use of tobacco products Implement stress-management strategies (eg, yoga, tai chi) If conservative management is unsuccessful, calcium channel blockers may be prescribed to relax arteriole smooth muscle and prevent recurrent episodes

Chronic venous insufficiency occurs when the valves in the veins of the lower extremities consistently fail to keep venous blood moving forward, which causes chronic increased venous pressure. The increased pressure pushes fluid out of the vascular space and into the surrounding tissues, where tissue enzymes break down red blood cells.

The destruction of red blood cells releases hemosiderin (a reddish-brown protein that stores iron), which causes a brownish skin discoloration. chronic edema and inflammation causes the tissue to harden and appear leathery. Affected skin is highly prone to breakdown and ulcerations (eg, venous leg ulcers), commonly on the inside of the ankle.

During the initial postoperative period, a client needs respiratory interventions to keep the lungs expanded and prevent atelectasis and postoperative pneumonia. Atelectasis is maximal during the second postoperative night. Clients can be asymptomatic or have increased work of breathing, hypoxia, and basal crackles. Postoperative pan, opioid respiratory depression, limited mobility, and reluctance to take a deep breath due to anticipated pain contribute to postoperative atelectasis

The elderly and postoperative abdominal and thoracic surgery clients are at increased risk for atelectasis. The incentive spirometer encourage the client to breathe deeply with maximum inspiration. This action improves ventilation and oxygenation by expanding the lungs, encourages coughing, and prevents or improves atelectasis. It is most appropriate prescription for this client.

A significant reduction in platelets after initiation of heparin or low-molecular weight heparin (eg, enoxaparin {Lovenox}) therapy can indicate heparin induced thrombocytopenia, a severe, potentially lethal complication. HIT is an in platelet count (eg, <50% of pretreatment levels and/or platelet count <150,000/mm {15x10/L{) and a paradoxical increase in risk for arterial and venous thrombosis (eg, deep venous thrombosis, pulmonary embolism).

The nurse should notify the health care provider immediately of decreased platelet levels and anticipate stopping enoxaparin therapy and initiating a nonheparin anticoagulant (eg, rivaroxaban)

Myxedema coma refers to a state of severe hypothyroidism causing decreased level of consciousness (eg, lethargy, stupor) that may progress to a comatose state. Myxedema coma is characterized by hypothermia, bradycardia, hypotension, respiratory muscle fatigue, and mechanical obstruction by an edematous tongue. and mechanical obstruction by an edematous tongue. Clients with sings of respiratory failure (eg, slow or shallow breathing, low oxygen saturation) will require emergent endotracheal intubation and mechanical ventilation.

The nurse should provide respiratory support (eg, ventilation with a bag-valve-mask) and prepare to assist with intubation. Oral medication should never be administered to clients with a decreased level of consciousness due to risk for aspiration. Clients with myxedema coma require thyroid hormone replacement with IV levothyroxine to correct the hypothyroid state.

Chest compressions for infants: although rare, cardiac arrest in infants can occur and usually stems from a respiratory etiology. The American Heart Association provides guidelines for basic life support of infants (<12 months), including certain CPR modifications (eg, the location of pulse check) and the timing of emergency services notification and retrieval of the automatic external defibrillator AED.

The rescuer should check the infant's brachial pulse for no longer than 10 seconds. During an unwitnessed collapse, a single rescuer should shout for nearby help, activate the emergency response system (eg, call emergency services via mobile device if located outside a health care setting), and then provide approximately 2 minutes of CPR at a rate of at least 100 compressions/min before retrieving the AED.

Parallel play with parents of toddlers: Play is an important developmental task of child hood and reflects the child's physical, social, and emotional health. Parallel play is independent play near other children with minimal group interaction and is typical of toddlers (age 12-36 months)

Toddlers engaging in parallel play may share toys and verbalized thoughts, but they primarily focus on doing their own activities rather than directly interacting with others in organized play.

Skin cancer are most often caused by damage to the skin's DNA. This damage is typically due to exposure to ultraviolet (UV) radiation, primarily from the sun, but also from other sources (eg, tanning beds, sunlamps). The instructions to prevent sunburn and other sun-related damage include: Avoid the sun, if possible, especially between 10 am and 4 pm. UV rays are not blocked by cloud coverage and can be reflected off water, sand, snow, and concrete. As a result, clients can burn in the shade or even during outdoor winter activities (eg, skiing).

Wear protective clothing (eg, long sleeves, wide-brimmed hats, umbrellas) when possible. Avoid the use of tanning beds as they emit UV radiation. Because sunscreen is washed off with swimming and sweating, it should be reapplied even for products labeled "water resistant" or "very water resistant" Apply sunscreen: Use a broad-spectrum sunscreen to block UVA and UVB rays. Choose a sunscreen with SPF?15 for daily or SPF>30 for outdoor activities and sun-sensitive individuals

Esophagogastroduodenoscopy (EGD) A sudden temperature spike 1-2 hours after an EGD could be a sign of perforation or a developing infection. The PN should notify register nurse immediately.

When monitoring a client who had an EGD 1 to 2 hours prior. The NP immediate finding to report is Fever

Meniere disease (endolymphatic hydrops) results from excess fluid accumulation in the inner ear. Clients have episodic attacks or vertigo, tinnitus, hearing loss, and feeling of fullness or pressure in the ear. The disorder typically affects only one ear and can lead to permanent hearing loss. Attacks of Meniere disease can result in a total loss of proprioception, and clients often report feeling "pulled to the ground" (drop attacks), making clients safety a priority. Vertigo can be severe and is associated with nausea, vomiting, and feelings of anxiety. Self-care for Meniere disease may include.

consuming a low sodium diet to decrease the potential for fluid excess within the inner ear. Intake of potassium and other electrolytes does not need to be restricted.

The nurse assists with a community teaching program for parents and caregivers of infants. Which statement by a participant indicates that teaching has been successful? a. After age 6 months, it is safe to use honey to sweeten my infant's formula b. I should wait until my infant is 1 year old to introduce egg products c. I will switch my 1 year old to low fat milk instead of commercial formula d. My infant should be able to pick up small finger foods by age 10 months

d. My infant should be able to pick up small finger foods by age 10 months The pincer grasp, a thumb to forefinger movement, develops at age 8-10 months. This is the time to start offering small finger foods, such as crackers or cut-up pieces of nutritious foods. Caregivers should inform their health care provider if the infant does not achieve this significant milestone in fine motor development.

During the client interview for a developmentally normal 18 month old, the parent expresses concern about the small amount of food the child consumes. What is the nurse's priority intervention? a. Check the child for parasitic infection b. Consult a pediatric nutritionist for suspected earing disorder c. Notify the health care provider d. Reinforce teaching about the toddler's nutritional needs

d. Reinforce teaching about the toddler's nutritional needs Starting at approximately age 1 year, the very high metabolic demands of infancy slow down to keep pace with the moderate growth of toddlerhood. During this phase, toddlers are increasingly picky about their food choices and schedules. Although to the parents it may appear that the child is not consuming enough calories, intake over several days actually meets nutritional and energy needs. Parents should be educated concerning what constitutes a healthy diet for toddlers and which foods they are more likely to consume. Some effective strategies for dealing with a toddler during this stage of decreased appetite pickiness include: Set and enforce a schedule for all meals and snacks offer the child 2 to 3 choices of food items Do not force the child to eat Keep food portions small

The parent of an 8 year old client asks the nurse for guidance on how to help the client cope with the recent death of the other parent. When developing a response to the parent, the nurse considers that a school aged child is most likely to do what? a. React anxiously to altered daily routines b. Realize that death eventually affects everyone c. Think about the religious or spiritual aspects of death d. Understand that death is permanent but the curious about it

d. Understand that death is permanent but the curious about it Understanding a child's perception of illness and death can empower caregivers to support the child during the loss of a loved one. A child's developmental stage as well ass the caregiver's view of death and relationship with the child will influence coping during bereavement.

Thoracentesis The pleural space ins the area between the visceral pleura (membrane lining the lungs) and the parietal pleura (membrane lining the chest cavity). A pleura effusion refers to excess fluid in the pleural space. Small pleural effusions are often asymptomatic, but larger effusions cause dyspnea, diminished breath sounds, and pain.

when a pleural effusion causes respiratory difficulty, a thoracentesis is performed to remove the fluid. A needle is inserted into the pleural space, and fluid is removed.