pediatrics review - taken from coursepoint questions

The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents?

"Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection." Parents need to understand that lack of urinary control is not the greatest problem. The larger threat is of urinary tract infection, which can result in kidney damage.

parkland formula for burn fluid resuscitation

4 mL of lactated ringers x %BSA x weight in kg 1/2 of the fluid is given in the first 8 hours and the other half given over the next 16 hours

ibuprofen cannot be given to children under ________

6 months

The nurse is caring for a child who has a hip spica cast. The child's mother asks why is there a hole cut in it. What is the best response by the nurse?

A window in placed over the abdomen in a body or hip spica cast to prevent abdominal distention and allow bowel sounds to be assessed. The window in a spica cast does not prevent compartment syndrome from happening.

The parents of a 10-month-old child bring the infant to the emergency department after finding the infant face down in the bathtub. The parent states, "I just left the bathroom to answer the phone." Which assessments are priority for the nurse to complete? Select all that apply.

AIRWAY BREATHING CIRCULATION

A 13-year-old adolescent is being released from the hospital following examination for a concussion. The parent has agreed to monitor the adolescent at home for the next 24 hours. Which instruction(s) should the nurse provide? Select all that apply.

An adolescent can be observed at home by a parent if the parent is able to assess the adolescent's level of consciousness every 1 to 2 hours while awake. The parents usually are instructed not to keep waking the adolescent during the night, because multiple wakings are disorienting and can make it difficult to tell whether the adolescent is confused. The parent should wake the adolescent at least once during the night, however, to be certain the adolescent is conscious, ask the adolescent to name a familiar object (e.g., favorite toy, name the color of some object shown to the adolescent). Being able to tell the parent one's name or where one lives is equally revealing. There is an old belief that, if an adolescent falls asleep after a head injury, the adolescent will die in one's sleep; this belief can cause the parent to keep shaking the adolescent awake or making the adolescent walk continually. The nurse should make certain the parent understands it is all right for the adolescent to sleep, but the parent must wake the adolescent at least once to assess status.

symptoms of anaphylactic shock

Bloating, abdominal pain, diarrhea and vomiting may be symptoms of anaphylaxis. Shortness of breath as well as itching of the lips, tongue and palate may also be symptoms of anaphylaxis. Hypertension and bradycardia are not associated with anaphylactic shock.

best pain scale for neonates

CRIES The CRIES Neonatal Postoperative Pain Measurement Scale is a 10-point scale named for five physiologic and behavioral variables commonly associated with neonatal pain: C = crying; R = requires increased oxygen administration; I = increased vital signs; E = expression; S = sleeplessness.

Which statement about cerebral palsy would be accurate?

Cerebral palsy is a condition that doesn't get worse. By definition, cerebral palsy is a nonprogressive neuromuscular disorder. It can be mild or quite severe and is believed to be the result of a hypoxic event during pregnancy or the birth process and doesn't run in families.

The nurse is teaching the parent of a child with cystic fibrosis about nutrition requirements for the child. What should be included in this teaching?

Children with cystic fibrosis (CF) have trouble digesting and absorbing nutrients. They tend to be underweight. For optimal health, their diets should be high in calories and high in protein, with the supplementation of fat soluble vitamins and pancreatic enzymes. This diet helps with growth and the optimal nutrients. The fat soluble vitamins (vitamins A, D, E and K) are needed, because children with CF have trouble absorbing fat and need the vitamin supplementation to aid in fat absorption. Water soluble vitamins (the B vitamins and vitamin C) do not aid in fat absorption. The child should not have a high-fat diet because the extra fat is difficult to digest and be absorbed. Pancreatic enzymes are necessary because they are missing due to the disease process. They are necessary to aid in digestion. They should be ingested with meals.

The nurse is performing an abdominal assessment on a child. Which assessment techniques demonstrated by the nurse are appropriate when performing an abdominal assessment? Select all that apply.

Correct techniques include percussion of the abdomen to determine dullness along the costal margins and tympany over the remainder of the abdomen, inspection to visualize an umbilical hernia, and auscultation of all 4 quadrants of the abdomen. Auscultation should occur prior to palpation in order to not alter bowel sounds. Absence of bowel sounds can only be determined when listening for at least 5 minutes in each quadrant.

A 4-month-old infant is experiencing dermatitis in the diaper area. What treatments will be beneficial to this condition? Select all that apply.

Diaper dermatitis starts as a flat red rash in the convex skin creases. It may appear red and shiny and may or may not also have papules. Keeping the diaper area clean and dry are key to healing. Air drying may promote healing. Topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum are helpful to provide a barrier to the skin. Talc powder is not recommended.

A child is diagnosed with bacterial conjunctivitis and is prescribed topical antibiotic therapy. The child's mother asks when he can return to school. Which response by the nurse would be most appropriate?

For the child with bacterial conjunctivitis, the child may safely return to school or day care when the mucopurulent drainage is no longer present, usually after 24 to 48 hours of treatment with the topical antibiotic. There is no need to wait until the prescription is finished. The antibiotic is being given topically, not systemically. One dose of antibiotic is not sufficient to eradicate the infection. Typically 24 to 48 hours of treatment is needed to stop the drainage, which, when no longer present, indicates that the child can return to school.

The nurse is providing education to a teenaged boy diagnosed with impetigo. Which statement by the boy indicates the need for further education?

I will need to cover the lesions- WRONG -> lesions should stay open to air to aid in healing children may attend school during treatment the crusts should be removed after soaking prior to applying topical ointment

Which children would the nurse identify as needing a referral to a burn unit? Select all that apply.

Referral to a burn unit should occur for children with ~inhalation injuries; ~burns that involve the face, hands and feet, genitalia, perineum, or major joints; ~partial-thickness or second-degree burns greater than 10% of total body surface; ~burns and preexisting conditions that might affect the care (such as asthma); ~or burns and traumatic injuries such as rib fractures. Superficial or first-degree burns over 5% of the body are not a criterion for referring a child to a burn unit.

A nurse is reading a journal article about congenital heart conditions that are associated with decreased pulmonary blood flow. The nurse demonstrates understanding of the information when she identifies which anomalies as being associated with tetralogy of Fallot? Select all that apply.

Tetralogy of Fallot is a congenital heart defect composed of four heart defects: pulmonary stenosis (a narrowing of the pulmonary valve and outflow tract, creating an obstruction of blood flow from the right ventricle to the pulmonary artery); ventricular septal defect; overriding aorta (enlargement of the aortic valve to the extent that it appears to arise from the right and left ventricles rather than the anatomically correct left ventricle); and right ventricular hypertrophy (the muscle walls of the right ventricle increase in size due to continued overuse as the right ventricle attempts to overcome a high-pressure gradient).

The nurse is caring for a child admitted to the hospital for a cardiac catheterization. Upon return from the cardiac catheterization, which nursing action is priority?

The child returning from a cardiac catheterization is at risk for hemorrhage from the insertion site. The nurse will assess the dressing at the insertion site immediately upon the child's return from the procedure. Palpating pulses, maintaining IV patency, and applying a blood pressure monitor would be done after first assessing the child for bleeding. Although assessing pulses will provide the nurse with information about the circulatory status of the extremities, weak pulse strength is a later sign of hemorrhage than visually assessing the insertion site.

The meningococcal vaccine should be offered to high-risk populations. If never vaccinated, who has an increased risk of becoming infected with meningococcal meningitis? Select all that apply.

The following people have an increased risk of becoming infected with meningococcal meningitis: ~college freshman living in dormitories, ~children 11 years old or older, ~children who travel to high risk areas, and ~children with chronic health conditions.

presentation of intussusception

The intestine prolapses and then telescopes into another section of the intestine. The child would experience difficulty defecating when obstructed, and bloody stool with mucus in the underwear. The child may experience colicky abdominal pain and decreased appetite. s/s do NOT include rectal pain or increased UTIs

What would the nurse include in the teaching plan for parents and their child with a pruritic rash? Select all that apply.

To reduce pruritus, teaching would include keeping the child's nails trimmed short, using distraction to prevent scratching, using pressure on the skin rather than scratching, and making sure the child's hands are clean. Cool baths and compresses would help relieve itching.

crohn's has a __________ distribution while ulcerative colitis has a __________ distribution

UC - continuous crohn's - segmental

The nurse is providing teaching to the parent of a 4-year-old child being treated for otitis media. When discussing the condition, the parent indicates an understanding of the information provided when making which statement?

a brief hearing loss after the infection is an ABNORMAL development Otitis media may develop with a complication known as mastoiditis. This presents as a lump behind the ear. It is a serious complication and must be reported and treatment sought.

A client asks the nurse why a healthy newborn would be at risk for hypoxemia. How should the nurse reply?

a newborn only has half the number of alveoli developed, placing the newborn at risk The smaller numbers of alveoli place the newborn at a higher risk for hypoxemia and carbon dioxide retention because this is where gas exchange occurs. This is also more pronounced if the newborn is premature. Newborns consume twice as much oxygen (6 to 8 L) as adults (3 to 4 L). This is due to higher metabolic and resting respiratory rates.

The nurse has received morning report on a group of pediatric clients. Which pediatric client will the nurse see first?

a school-age child with dysphagia, drooling, and a hoarse voice epiglottis!!! should always be a priority because the airway can quickly close

The nurse is caring for a 3-month-old infant with history of congenital heart disease. The infant is brought to the emergency department with nausea and vomiting for 3 days. Admission laboratory results confirm dehydration. The nurse realizes that the dehydrated infant is at risk for:

a stroke Children who have defects that cause decreased pulmonary blood flow have decreased oxygen saturation. To compensate, the kidneys produce erythropoietin to stimulate the bone marrow to make more red blood cells. The increased red blood cells makes the blood more viscous. If an infant with heart disease becomes dehydrated the infant can develop thrombi from the increased amounts of red blood cells and the viscosity of the blood. This places the infant at risk for a cerebrovascular accident (stroke).

The nurse is administering digoxin as prescribed and the child vomits the dose. What should the nurse do?

administer next dose as prescribed in 12 hours Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose.

A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? Select all that apply.

antibiotics vitamin supplements TPN

The nurse is preparing a child for a lumbar puncture. What action is appropriate when applying a lidocaine and prilocaine topical cream (EMLA)?

apply the EMLA cream 2-3 hours before the procedure

A school-aged child has come to the clinic with symptoms of a urinary tract infection. The child reports dysuria, frequency and hesitancy. What nursing assessment is most important for the nurse to complete?

assess for bladder distention keeping a distended bladder can cause reflux and continue to harbor bacteria

The nurse is caring for an adolescent who suffered a thoracic spinal cord injury 8 weeks ago. While assessing the adolescent, the nurse notes a blood pressure of 185/95 mm Hg, heart rate of 130 beats/minute, flushed face, and a report of a severe headache. What is the priority action by the nurse?

assess the child's indwelling urinary catheter to see if it is obstructed Autonomic dysreflexia is an emergent situation that is caused by a full bladder in a child with a spinal cord injury. It is characterized by extreme hypertension, tachycardia, flushed face and severe occipital headache. Assessing and emptying the bladder is the first action in treating this disorder.

A child with Down syndrome is having a well child check-up. What is the best way for the nurse to assess this child's developmental milestones?

assess the sequence of the milestones

A nurse has admitted a 3-year-old female diagnosed with a urinary tract infection. When developing the plan of care, what should the nurse do first?

assess usual voiding patterns The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action.

The nurse is caring for a 7-year-old boy experiencing respiratory distress who is scheduled to have a chest radiograph. What would be most important for the nurse to include in the child's plan of care?

assisting the child to lay still

The nurse is taking a health history of a 2-year-old girl presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction?

bilious vomiting Bilious vomiting is never considered normal and suggests an obstruction. Projectile vomiting is associated with pyloric stenosis. The gender and the age of the child are not consistent with pyloric stenosis. Effortless vomiting is often seen in gastroesophageal reflux. Bloody emesis can signify esophageal or gastrointestinal bleeding.

late signs of intracranial pressure

bradycardia fixed and dilated pupils irregular respirations early signs include: increased BP and sunset eyes

The nurse is caring for a 2-month-old with a cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after surgery and wonders if it is possible. How should the nurse respond?

breastfeeding is likely to be possible, but check with the surgeon first

The nurse is talking to the parents of a 2-month-old infant who has been admitted to the hospital with sepsis. The parents report being confused since their older children also had the flu but they recovered without incident. What information can the nurse provide to the parents?

children this young do not have mature immune systems to fight infection they lack immunoglobin M, which is necessary to fight bacterial infections

clubbing of the fingers occurs because of ________ hypoxia

chronic The first sign of clubbing is softening of the nail beds, followed by rounding of the fingernails, then shininess and then thickening of the nail ends. Clubbing of the fingernails occurs because of chronic hypoxia in the child with severe congenital heart disease; therefore, immediately applying oxygen is not needed but follow-up may be warranted.

A group of students are reviewing information about respiratory arrest in children. The students demonstrate understanding of this information when they identify what common causes of respiratory arrest involving the upper airway? Select all that apply.

croup and epiglottis (lower airway includes asthma, pertussis, and pneumothorax)

presentation of hirschbrung disease

difficulty defecating chronic constipation abdominal distention decreased appetite loose stool or diarrhea that may be bloody soiling of underwear do NOT include rectal pain or increased UTI's

While hospitalized, a child develops scarlet fever. Isolation has been prescribed by the health care provider. The nurse would place this child in what type of isolation?

droplet

The adolescent has been diagnosed with gastroesophageal reflux disease (GERD). Which statements by the teen indicates that adequate learning has occurred? Select all that apply

famotidine may make me tired omeprazole could give me a headache (can also result in diarrhea) it sounds like the physician is reluctant to give me a prokinetic because of the side effects (prokinetics can cause CNS effects)

parents of children with sickle cell should call their provider in the event of any ____________ illness

febrile doesn't matter if it's a low grade fever- still call! Fever causes dehydration, which can trigger problems in a child with sickle cell anemia.

The nurse is caring for a child diagnosed with acute post-streptococcal glomerulonephritis. When assessing the child, what findings does the nurse anticipate? Select all that apply.

generalized edema weight gain headache dark urine protein in the urine blood in urine hyperlipidemia

in the acute phase, what medications are given to manage kawasaki disease?

high dose aspirin and immunoglobin The parent would be taught to avoid vaccines, especially varicella and measles, mumps, rubella vaccine, for several months following IVIG infusion due to the IVIG preventing the body from building antibodies and rendering the vaccines ineffective.

During the assessment of a child, the nurse notes weak distal peripheral pulses, wheezing in all lung fields upon auscultation, pulse oximeter level 88%, tachycardia, and short shallow respirations with tachypnea. Which nursing diagnosis does the nurse identify related to these assessment findings? Select all that apply.

impaired gas exchange ineffective breathing pattern decreased cardiac output ineffective tissue perfusion (peripheral)

The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The infant will be managed medically. What action(s) will the nurse incorporate into the teaching plan? Select all that apply.

keep the child upright for 30 minutes after meals give the child small frequent feedings administer a prokinetic to empty the stomach quickly thicken the formula with oatmeal cereal omeprazole should be give 1-1.5 hours BEFORE meals

A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.

low grade fever macular rash papular rash vesicle formation crusting over rash appears within 24 hours of the fever

An infant with a high respiratory rate is NPO and is receiving IV fluids. What assessment(s) will the nurse make to assure this infant is hydrated? Select all that apply.

measure skin turgor palpate anterior fontanel determine urine output

A hospitalized toddler being treated for pneumonia requires supplemental oxygen. The respiratory rate is 44 breaths/min and the oxygen saturation is 90% on room air. Which oxygen delivery device would be best for this toddler?

nasal cannula The nasal cannula is the most comfortable and the most likely to stay in place. The nasal cannula provides up to 44% more oxygen delivery than room air. Oxygen can be delivered up to 4 liters via nasal cannula. The child can eat or talk with the nasal cannula in place. The oxygen should be humidified. The simple face mask can provide 35% to 60% of oxygen via a flow rate of 6 to 10 liters. It is used when there is increasing respiratory difficulty. Children have difficulty keeping it in place. A nonrebreather (face) mask is used for serious respiratory problems. It can deliver 95% oxygen via 10 to 12 liters flow. A partial rebreather mask is also needed when an increased amount of oxygen delivery is needed. This mask can provide 50% to 60% oxygen set at 10 to 12 liters flow.

A 3-year-old child has sustained severe burns and is ordered to receive 100% oxygen. What would the nurse use to administer the oxygen?

nonrebreather mask

A toddler is being seen in the clinic. The parents describe a 2-day history of vomiting and diarrhea. The nurse's assessment finds the toddler is listless, has pale and slightly dry mucous membranes, and has decreased skin turgor. Based on this assessment, what intervention would the nurse implement first?

oral rehydration therapy

A 5-year-old boy is diagnosed with congenital aplastic anemia. Which symptoms should be considered when developing the plan of care? Select all that apply.

pallor fatigue easy bruising cyanosis

The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatment(s) would the nurse expect to administer if prescribed? Select all that apply.

penicillin (10 day course) corticosteroids NSAIDS

what antibiotic is used to treat scarlet fever?

penicillin V

The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease?

perianal skin tags or fissures other common signs: poor growth pattern hunger abdominal tenderness

most reliable indicator of a fracture

point tenderness

A child has been prescribed spironolactone. Which laboratory values should be reviewed when following up on this medication? Select all that apply.

potassium and sodium Spironolactone is a potassium-sparing diuretic that competes with aldosterone to result in increased water and sodium excretion (spares potassium).

Which collaborative actions will the nurse perform when caring for an infant with transposition of the great arteries scheduled for surgical repair of the defect? Select all that apply.

provide education ausculate lung sounds frequently apply a continuous pulse ox keep O2 sat above 75% (should be 75-85%) you would NOT want to administer indomethacin because we want to keep the PDA OPEN to allow for some mixing of the oxygen-rich and oxygen-poor blood so the body is getting at least some oxygen

congential heart defects that DECREASE pulmonary blood flow

pulmonary stenosis coarctation of the aorta

The nurse is caring for a 2-year-old girl with persistent otitis media with effusion. Which intervention is most important to the developmental health of the child?

reassessing for language acquisition

Which nursing problems could be associated with a child with primary immunodeficiency?

risk for infection altered skin integrity delayed growth and development!!

acute glomerulonephritis often follows _________ infection

strep A upper respiratory

instructions for taking corticosteroids

take WITH food don't discontinue abrubtly glucose levels often rise when taking steroids steroids often mask symptoms of infection

The nurse is caring for a 3-year-old child with the surgical repair of hypospadias. The preschooler returned from the postanesthesia care unit with an indwelling urinary catheter. What parental teaching is most helpful?

the catheter insertion site will leave only a minimal scar Hypospadias is a urethral defect in which the opening is on the ventral surface rather than at the end of the penis. If left untreated, it may mean the boy will not be able to void standing as the aim will be different; in addition, it will cause interference with the deposition of sperm during intercourse. The completed surgery requires the use of a catheter. The catheter, along with the penis, is taped to the abdomen to reduce pressure on the urethral sutures. The tube insertion site will leave only a minimal scar, if any. A hypospadias repair should have no long-term consequences.

The nurse is doing discharge teaching for a child who has had a tonsillectomy. The nurse tells the client and family that the child should have plenty of fluids. In addition, the nurse would explain to the child's caregiver that the child may:

the child may vomit old, dark blood, but the caregiver should call the clinic if the child has bleeding between the 5th and 7th days postoperatively Bleeding is most often a concern within the first 24 hours following surgery and between the fifth to seventh days postoperatively. Bright, red-flecked emesis or oozing indicates fresh bleeding. If at any time following the surgery there is bright red bleeding, frequent swallowing, or restlessness, the care provider should be notified. A mild earache may be expected around the third day. Encourage fluid intake but avoid irritating liquids such as orange juice. Be aware that milk and ice cream products tend to cling to the surgical site and make swallowing more difficult; thus they are poor choices despite the old tradition of offering ice cream after a tonsillectomy.

A 6-month-old infant develops roseola. When obtaining information from the parent, what would the nurse expect the parent to report?

the infant's temperature fell when the rash appeared Roseola is characterized by high temperatures (101°F to 106°F; 38.3°C to 41.1°C) for 3 to 5 days. The fever resolves abruptly. The rash appears 12 to 24 hours later. The rash is pinkish red, and the spots are flat or raised and blanch when touched. There are no papules or pustules associated with roseola. The infant may be lethargic while experiencing high fever but energy returns to normal once the fever is gone and the rash occurs.

A 4-year-old child is scheduled for an echocardiogram. The nurse is explaining this procedure to the child's parents. Which information would the nurse likely include? Select all that apply.

the test uses sound waves to check the heart's structures the test will not cause the child any pain An echocardiogram is a noninvasive ultrasound procedure used to assess heart wall thickness, size of heart chambers, motion of valves and septa, and relationship of great vessels to other cardiac structures. It should not cause any pain for the child. No sedation or anesthesia is needed for an echocardiogram. However, the child needs to lie still throughout the test. (A chest x-ray or radiograph would expose the child to radiation.) ( An electrocardiogram, not an echo, records the electrical activity of the heart.)

A child with a burn develops a wound infection. Which intervention would be the most effective form of treatment?

topical antibiotics applied to the wound site

wheezing is not associated with ______ respiratory infections

upper wheezing IS associated with bronchiolitis, asthma, cystic fibrosis, and chronic lung disease

congenital heart defects that INCREASE pulmonary blood flow

ventricular septal defect, patent ductus arteriosus, and atrioventricular canal defect

The student nurse is caring for a child who is being treated for a near-drowning episode that happened in cold water. What statement by the student would indicate a need for the nursing instructor to intervene?

warming blanket using a warming blanket is incorrect because if the child's temperature is very low, it is better to allow the temperature to come up slowly - keeps the child from having a jump in metabolic requirement and oxygen demand Victims of near-drowning should be administered 100% oxygen. They may be given a bronchodilator to prevent bronchospasm and have an NG tube inserted to decompress the stomach.

The nurse receives a call from a parent whose toddler received a prescription for amoxicillin one teaspoon every 8 hours. The child has received 2 doses and the parent is noticing unusual symptoms. Which symptoms may indicate a severe penicillin allergy? Select all that apply.

wheezing uticaria serum sickness

A child has been diagnosed with hand, foot and mouth disease. The child's mother wants to know how long it will take for her child to feel better. What information should be provided to the child's parent?

your child will likely feel better in about a week Hand, foot, and mouth disease is a self-limiting virus. The condition normally self-resolves in a week. Antibiotic and antiviral therapies are not normally needed for treatment.