Most important Peds

Many families are first-generation Americans and have many beliefs about health that were learned in their native countries. Match the culture with the health-care belief. 1. Haitians 2. Cubans 3. Arabs 4. Chinese 5. Native Americans A. Religion and medicine strongly interwoven B. Nutrition is important in good health C. Illness has a supernatural origin (voodoo) D. Believe hot-cold theory of illness E. Illness caused by the "evil eye"

1C, 2B, 3E, 4D, 5A

Iron should be administered how?

Through straw or syringe

A 12-year-old child with newly diagnosed thalassemia is brought to the clinic exhibiting delayed sexual maturation, fatigue, anorexia, pallor, and complaints of headache. The child seems listless and small for age and has frontal bossing. What should the nurse expect to note on review of the results of the laboratory tests? Macrocytosis and hyperchromia 2. Excessive red blood cell production 3. Excessive mature erythrocyte proliferation 4. Deficient production of functional hemoglobin

4

Which are early signs and symptoms of hydrocephalus in infants? 1. Confusion, headache, diplopia. 2. Rapid head growth, poor feeding, confusion. 3. Papilledema, irritability, headache. 4. Full fontanels, poor feeding, rapid head growth.

4

The nurse goes to the kindergarten classroom to evaluate a rash. A 5-year-old has patches of itchy vesicles on the chest and face. The teacher tells the nurse the child had a runny nose a couple of days ago. The nurse suspects that the rash is caused by which virus? 1. Fifth disease (Parvovirus B19). 2. Roseola (Herpesvirus type 6). 3. Scarlet fever (group A beta-hemolytic streptococcus). 4. Chickenpox (varicella zoster).

4 (1 is slapped cheek, 2 is 6mo-3yrs)

The nurse on the previous shift charted that a newborn demonstrated cutis marmorata. The nurse now caring for the baby should check which vital sign? 1. Blood pressure. 2. Respirations. 3. Skin color. 4. Temperature.

4. Cutis marmorata is transient mottling of the body when the infant is exposed to cold. It is important to check the baby's temperature. Cutis marmorata is a change in the color of the skin.

Which immunization should not be given to a child receiving chemotherapy for cancer? A. Tetanus vaccine B. Inactivated poliovirus vaccine C. Diphtheria, pertussis, tetanus (DPT) D. Measles, rubella, mumps

D

Hyperthyroidism causes vision problems TF

F: just bulging eyes

A hallmark of congenital heart disease is bradycardia TF

F: tachycardia

Partial tx for undescended testes

HcG

A child is brought to the emergency department after falling from a high swing and landing on the back. The nurse notes that the client also has hemophilia. Based on the client's history and the nature of the injury, which should the nurse assess for first?

Hematuria

Rectal biopsy is used for...?

Hirschsprung

How do you reduce anxiety in a 3 yr old with cardiac cath procedure?

Ride on a gurney to meet a nurse at the cardiac cath lab

Tympanic and oral temps are equally effective TF

T

small genitalia and long arms in males =

Klinefelter

SIADH hallmark manifestation

LOC change

Which would the nurse assess in a 4-week-old infant who has developmental dysplasia of the hip and is wearing a Pavlik harness?

Leg shortening and limited abduction.

Hypothyroid tx

Life-long meds

What assessment should you perform on a mother who took aspirin in utero?

Loud noise reaction

Are graham crackers ok for celiac disease?

No

What should you not do with Wilms tumor?

Palpate the abdomen

Tetanus timeframe

Q10y or less if injury into dirt

This diagnostic test reveals the presence of ganglion cells

Rectal biopsy

BLACK BOY WITH LIMP AND HIP PAIN

SCFE (slipped capital femoral epiphysis)

Hyperthyroidism has nervousness TF

T

Two tests that require newborn screening

PKU and hypothyroidism

If someones BP is 210/100 should you administer PRN nifedipine or call HCP first?

PRN nifedipine

A 2-year-old is brought to the emergency department for fever and ear pain. The parents report the child has had many ear infections and that polyethylene tubes have been recommended, but the parents cannot afford surgery. The child is diagnosed with bilateral otitis media. The toddler is carrying a baby bottle full of juice, and a parent is carrying a pack of cigarettes. Which one preventive measure could be taught to the parents to decrease the incidence of ear infections? 1. Wean the toddler from the bottle. 2. Give the toddler a decongestant before bedtime. 3. Encourage the parent to smoke outside the house. 4. Have the child's hearing checked.

1

The parents of an infant with hydrocephalus ask about future activities in which their child can participate in school and as an adolescent. The nurse should tell the parents which of the following is appropriate? 1. A helmet should be worn during any activity that could lead to head injury. 2. Only non-contact sports should be pursued, such as swimming or tennis. 3. Because of the risk of shunt system infection, swimming is not a sports option. 4. The child should wear a MedicAlert bracelet; then there is no need to be concerned about the shunt.

1

The nurse is caring for a child dying from leukemia. The parents want to know how comfortable the nurse is in giving doses of pain medication that are larger than customary. Which ethical principle of care are the parents asking about? 1. Double effect. 2. Justice 3. Honesty. 4. Beneficence.

1 The ethical principle of double effect states that an action has good intentions and that a bad intention is permissible if the action itself is good or neutral, the good effect must not be produced by the bad effect, and there is a compelling reason to allow the bad effect to occur if the good effect is the primary reason for the action. The child may require doses of pain relievers higher than is considered safe in order to relieve the pain. If the child dies during this treatment, the overwhelming reason for the excess medication was to make the child comfortable and decrease the intense pain.

Therapeutic level of theophylline

10-20 mcg/mL

How many calories does a baby require?

108 calories/kg/day

Which applies to cerebral palsy? Select all that apply. 1. It is the most common chronic disorder of childhood. 2. Hyperbilirubinemia increases the risk of cerebral palsy. 3. It is a progressive chronic disorder. 4. Most children do not experience any learning disabilities. 5. There is a familial tendency seen in children with cerebral palsy.

12 nonprogressive 75% have disabilites

MMR is typically given when

12-15mos

The nurse tells a parent which of the following data can be provided by a polysomnogram? Select all that apply. 1. Heart rate and respirations. 2. Brain waves. 3. Eye and body movements. 4. Cyanosis or plethora. 5. End-tidal carbon dioxide.

1235

The nurse is doing discharge teaching for a 3-month-old with a new shunt placed for hydrocephalus. Which are signs and symptoms of hydrocephalus that the parents may see if the shunt malfunctions? Select all that apply. 1. Vomiting. 2. Irritability. 3. Poor feeding. 4. Headache. 5. Sunken fontanel. 6. Seizures. 7. Inability to wake up infant. 8. Hyperactivity.

12367

A family is adopting a 3-year-old child from Russia. What suggestions can be given to the parents for incorporating the child into the family? Select all that apply. 1. Learn as much about the child as possible before adoption. 2. Expect conflict and determine how to work through it with the child. 3. Do not discuss the biological parents with the child. 4. Discuss your expectations with the child. 5. Try to maintain a part of the child's original family name.

1245

A 17-month-old is brought into the clinic, and the nurse notes the toddler has tooth decay on the maxillary upper incisors. Which tactic(s) would the nurse suggest to wean the toddler from the bottle? Select all that apply. 1. Hide the bottle and tell the toddler that it is not needed anymore. 2. Put only tap water in the bottle. 3. Give the bottle only at night. 4. Give the toddler a pacifier and take the bottle away. 5. Do not give any bottles before bed.

125

When should an anterior fontanel close?

18 months

What are the two organizations in the United States that make and govern the recommendations for immunization policies and procedures? 1. National Advisory Committee on Immunization and American Medical Association. 2. U.S. Public Health Service Centers for Disease Control and American Academy of Pediatrics. 3. National Immunization Program and Pediatric Infectious Disease Association. 4. National Institutes of Health and Minister of National Health and Welfare.

2

Three preschool children and their foreign-born parents come to a homeless shelter. The family has been homeless for 3 months. The children appear somewhat unkempt but nourished. One of the children has several enlarged cervical lymph nodes and is running a low-grade fever. Which chronic infectious illness should be suspected in the child? 1. Chlamydial pneumonia. 2. Tuberculosis. 3. Pertussis (whooping cough). 4. Asthma.

2 The chronic infectious illness for which this child is at risk is tuberculosis. The disease may present as asymptomatic or include fever, enlarged lymph nodes, anorexia, weight loss, night sweats, and, occasionally, hemoptysis. It is recommended that Mantoux skin tests be performed annually for at-risk populations such as the homeless, first-generation immigrants, and residents of correctional facilities.

While assisting with a lumbar puncture procedure on an infant or small child, the nurse should do which of the following? 1. Have the patient in a clean diaper to avoid contamination of the site. 2. Monitor the patient's cardiorespiratory status at all times. 3. Position the patient in the prone position with the head to the left. 4. Start an intravenous line to facilitate use of conscious sedation.

2 (abc) no diaper

The clinic is doing a lead screening program for children in a low-income Hispanic community. The nurse working in the program wants to tell the parents the reasons to have their children screened for lead poisoning. Select all that apply. 1. Young children absorb 10% of the lead to which they are exposed. 2. Homes built between 1900 and 1950 may contain lead-based paint. 3. The blood level of lead should be below12.8 mcg/dL. 4. Lead can affect any part of the body, but the brain and kidneys are at greatest risk. 5. Foods such as fruit, candy, and antacids contain lead.

2, 4. 1. Young children absorb most of the lead that enters their body. 2. Homes built between 1900 and 1950 most likely contain lead-based paints. 3. The acceptable blood level is 5.0 mcg/dL or less. 4. Lead can affect any part of the body, but the brain, nervous system, kidneys, and blood are likely to be most affected.

Which applies to brain tumors? Select all that apply. 1. Brain tumors are the most common malignancy in the United States. 2. Although an exact cause is unknown, an association has been linked to paints and radiation. 3. All children with brain tumors present with very similar manifestations. 4. Brain tumors in children usually occur below the cerebellum. 5. Symptoms of brain tumors always appear rapidly.

24

Which does the nurse include in discharge teaching for a 15-year-old with systemic lupus erythematosus? Select all that apply. 1. High-protein diet. 2. Low salt intake. 3. Exposure to the sun. 4. Killed-virus vaccines. 5. Systemic corticosteroids. 6. Antimalarials.

2456

A 12-year-old cut a hand while climbing a barbed-wire fence. What should the nurse discuss with the parents regarding need for tetanus vaccine? Select all that apply. 1. No tetanus vaccine is necessary; it is too soon since the child's scheduled Tdap was given. 2. Tetanus is a potentially fatal disease. 3. Puncture wounds are less susceptible to tetanus. 4. There will be mild soreness at the injection site. 5. Tdap should be administered. 6. Td should be administered.

25

A nurse is working in a well-child clinic administering immunizations to preschoolers. Which procedure will minimize local reactions to the injections? 1. Apply EMLA cream 1 hour before. 2. Change the needle on the syringe after drawing up the biological drug. 3. Inject into the vastus lateralis or ventrogluteal muscle. 4. Use distraction such as telling the child to hold the breath.

3

Which should the nurse teach the parent of a child with suspected meningitis? 1. Antibiotics are not initiated until the cerebrospinal fluid cultures are definitive for specificity to prevent resistance. 2. Antibiotics are useless against viral infections, so they are not used for meningitis. 3. Antibiotics should be started before the cerebrospinal fluid cultures are definitive; culture results may take up to 3 days. 4. Antibiotic initiation is based on the age, signs, and symptoms of the child, not on the causative agent.

3

An 11-month-old was born at 28 weeks' gestation and required 2 weeks of ventilation. The baby is currently well and is being seen in the clinic. The physician recommends that the baby receive preventive therapy for respiratory syncytial virus (RSV) for the next 5 months since winter is approaching. Which medication will be ordered? 1. Respiratory syncytial virus immune globulin (RespiGam). 2. Ribavirin. 3. Palivizumab (Synagis). 4. Pneumococcal vaccine.

3 The American Academy of Pediatrics recommends that infants born before 32 weeks' gestation and younger than 2 years who have chronic lung disease should receive palivizumab (Synagis) monthly as a prophylactic to prevent respiratory syncytial virus during the winter months.

Parents are concerned that their pediatrician suspects Turner syndrome in their newborn. Which physical characteristics lead to this suspicion? 1. Cleft lip and palate. 2. Weak, high-pitched cry. 3. Webbed neck and lymphedema. 4. Long arms and small genitalia.

3 (and low posterior hairline)

An infant at 12 hours of age has a positive Coombs test result and a bilirubin level of 18 mg/dL. The provider has ordered an exchange transfusion for the infant. As the transfusion is proceeding, the nurse should watch for which sign? 1. Increasing jaundice. 2. Lethargy. 3. Temperature instability. 4. Irritability.

3. The signs of a blood exchange transfusion reaction are focused on an unstable temperature. If the newborn becomes too cool, the infant could develop respiratory distress or bradycardia. If the baby's temperature becomes too high, there would be a dramatic change in blood pressure, with either hypertension or hypotension causing vascular collapse. If the baby becomes hyperthermic, the donor red blood cells could also be damaged, further increasing the jaundice. Lethargy and irritability would be symptomatic of a number of risks that a newborn might encounter, such as sepsis, dehydration, or hypothermia.

A parent calls the nurse for dosing information for Pepto-Bismol and aspirin for children who are 8 and 9 years old and are ill. Which does the nurse advise? Select all that apply. 1. 15 ml of Pepto-Bismol after every diarrhea stool. 2. 81 mg baby aspirin every 4 hours. 3. No medications are necessary. 4. Pepto-Bismol contains aspirin. 5. Diet as tolerated. 6. Reye syndrome is associated with aspirin use.

3456

Which applies to encephalitis? Select all that apply. 1. Usually caused by a bacterial infection. 2. A chronic disease. 3. Most commonly seen after a varicella infection in the newborn population. 4. Newborns diagnosed with encephalitis often have extensive neurological problems. 5. Can be seen with meningitis.

45 most seen after a herp derp

legal age and weight for no booster seat

60lbs and 8yrs

Burns to chest and face priority

AIRWAY not pain

Clubfoot tx

ASAP weekly casting until fully grown

Ear that is pearly gray, not movable, and slightly bulging action....

Ask about cold, runny nose, or ear pain

Brace dx

Impaired skin

A child is brought to the emergency department after being accidentally struck in the lower back region with a baseball bat. When gathering assessment data, the nurse discovers that the child has hemophilia. The nurse should immediately assess for which data?

Presence of hematuria

Should you perform ROM exercises with elbow restraints on a baby?

Ya

Cardiac cath priority postop

assess site for bleeding

When during the day is growth hormone given?

before bedtime

when do you give iron?

betwixt meals

confirmatory test of aplastic anemia

bone marrow biopsy

Test for UTI

c/s and urinalyis

Tet of Fallot =

clubbed fingers

weak pedal pulses =

coarctation of the aorta

A child with developmental dysplasia of the hip is placed in a Pavlik harness. The nurse should demonstrate to the parents how to place the child in this harness by placing the child's legs in which position?

flexd and abducted

Kawasaki disease tx

gamma globulin and aspirin

The home care nurse is visiting a child newly diagnosed with diabetes mellitus. The nurse is instructing the child and parents regarding actions to take if hypoglycemic reactions occur. The nurse should tell the child to take which action?\ Administer glucagon immediately if shakiness is felt. 2. Drink 8 ounces (235 ml) of diet cola at the first sign of weakness. 3. Report to a hospital emergency department if the blood glucose is 60 mg/dL (3.4 mmol/L). 4. Carry hard candies whenever leaving home in case a hypoglycemic reaction occurs.

hard candies

Do you need to remove a Pavlik harness to change a diaper?

no

Should you ask a child for permission before each step in an assessment?

no

Strabismus and amblyopia tx

occlusive therapy

Seizures that originate in one hemisphere are called ______________________.

partial/focal

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement?

penicillin

iron deficiency anemia symptoms

tachycardia

Do all 50 states require PKU testing?

yes

When an infant is born with a herniation of the abdominal wall with intestine present and the peritoneal sac absent, it is called __________

Gastroschisis

When an infant is born with a herniation of the abdominal wall with intestine present and the peritoneal sac absent, it is called ______________________.

Gastroschisis

Spica cast

rigid mold that encircles one or both arms or legs and the chest or trunk

Which class of drugs are contraindicated for those under 8 years of age? And why?

tetracyclines. tooth discoloration and hypoplasia

A 5-month-old with a lumbar myelomeningocele is admitted to the unit with an Arnold-Chiari malformation. The infant has which other diagnosis? 1. Hydrocephalus. 2. Anencephaly. 3. Tethering of the spinal cord. 4. Perinatal hemorrhage.

1 Arnold-Chiari malformation is a herniation of the brainstem into the cervical spinal canal through the foramen magnum.

Which should the nurse teach the child and parents about montelukast (Singulair) ordered for moderate persistent asthma? Select all that apply. 1. This is an add-on medication to the child's regular medications. 2. It can be given when the child needs it. 3. It is not to be used to treat acute episodes. 4. The parents will need to give up smoking. 5. The child will require chest physiotherapy in conjunction with the medication.

13 PO leukotriene modifier

The nurse working in the newborn nursery has to draw a heel-stick blood sample before an infant's discharge. What can the nurse do to decrease the pain the infant feels from this procedure? Select all that apply. 1. Wrap the heel in a warm, damp cloth. 2. Use EMLA before doing the stick. 3. Swaddle the infant. 4. Have the infant do non-nutritive sucking. 5. Do the stick while the infant is asleep.

134

Which is assessed to diagnose pediculosis capitis? Select all that apply. 1. Crawling insects. 2. White flakes in the hair. 3. Nits attached close to scalp. 4. Inflammatory papules. 5. Dark brown hair.

134

Which is assessed to diagnose pediculosis capitis? Select all that apply. 1. Crawling insects. 2. White flakes in the hair. 3. Nits attached close to scalp. 4. Inflammatory papules. 5. Dark brown hair.

134

An innocent murmur has which characteristics? Select all that apply. 1. Short induration. 2. S2 murmur. 3. Loudest in the pulmonic area. 4. Fixed and can be heard in many positions. 5. Grade III or less.

135

27. The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations should be expected? (Select all that apply.) A. Vomiting B. Jaundice C. Failure to gain weight D. Swelling of the face E. Back pain F. Persistent diaper rash

ACF

A 15-year-old girl who is an avid basketball player comes to the clinic for menstrual irregularities. She skips meals and has lost some weight. She mentions that she has menstrual periods every 2 weeks. Women who have menstrual periods more often than every 21 days are ______________________.

Anovulatory. Young women who have periods more frequently than every 21 days, after ruling out sexually transmitted diseases, are anovulatory. These young women have adequate estrogen levels but inadequate progesterone levels. Unopposed estrogen can place a young woman at risk for endometrial carcinoma.

Intusseption priority postop

Assess bowel sounds

What labs do you need when administering K+

BUN and Cr

4 yr old what's normal: A. Temper tantrum if told to share toys B. x C. Agressiveness when boasting in story telling D. Separation anxiety

C A and D are toddler based

Toddler toys: A. Build a house with blocks B. Ride a tricycle C. Possessiveness of toys D. Look at a picture book for 15 min.

C Everything else is preschooler

Growth hormone excess effects

Diabetes - polyuria and polydipsia

S/s combined to indicate increased ICP

Hypertension, bradycardia, and irregular respirations (Cushing's triad)

honey colored crust

Impetigo

A 12-year-old girl with a thoracic myelomeningocele has had numerous urinary tract infections and has difficulty doing her clean intermittent self-catheterization. She and her parents are seeking an alternative way to empty her bladder. The surgeon has offered to do a Mitrofanoff procedure. The surgeon will use the ______________________ to create a continent conduit between the bladder and the abdominal wall.

appendix A 12-year-old girl with a thoracic myelomeningocele has had numerous urinary tract infections and has difficulty doing her clean intermittent self-catheterization. She and her parents are seeking an alternative way to empty her bladder. The surgeon has offered to do a Mitrofanoff procedure. The surgeon will use the ______________________ to create a continent conduit between the bladder and the abdominal wall.

fungal scalp

tinea capitus

struggle between dependency and independence leads to temper tantrums

toddlers

pneumonia priority

bulb suctioning

What is associated with Downs Syndrome

congenital heart disease

According to Freud, the most significant achievement of toddlers is

toilet training

machinery murmur =

ventricular septal defect

juvenile rheumatoid arthritis HALLMARK complication

visual problems

ddvap is for

von willebrand autosomal dominant

Acne tx

wash with hot water and soap

3 signs of VP shunt

fontanelles, LOC, pupils

Phenytoin side effect

gingival hyperplasia

CF interventions

hypertonic saline tx, high calorie/fat, frequent snacks

Asthma retractions are found on inspiration or expiration?

inspiration

Signs of meningitis

kernig and brudzinsk signs

What are common sources of lead?

lead paint, imported toys, soil

Growth hormone excess leads to...

polyuria and polydipsia (s/s of diabetes)

VSD surgery prevents

return of oxygenated blood to lung