Peds Exam 3 (Ch. 14, 19, 24)

What are some findings that indicate sepsis in a pediatric patient?

- Absolute neutrophil count less than 500 - increased BUN - increased potassium - decreased platelets - metabolic acidosis.

What is a rhabdomyosarcoma?

A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children.

Which medication should the nurse provide to premedicate the child prior to radiation treatment?

Antiemetic Explanation: Radiation has systemic effects. Radiation sickness that includes nausea and vomiting is the most frequently encountered systemic effect. It also occurs to some extent as a result of the release of toxic substances from destroyed tumor cells. To counteract this, a child is prescribed an antiemetic before each procedure.

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor and his parents. Which assessment is priority?

Assessing the child's level of consciousness Explanation: The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure.

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis?

Bone marrow aspiration Explanation: Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor create suspicion of leukemia.

The nurse is administering medications to the child with congestive heart failure. Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?

Digoxin Explanation The use of large doses of digoxin at the beginning of therapy to build up the blood levels of the drug to a therapeutic level is known as digitalization.

Which medication would the nurse expect to be prescribed for atrial fibrillation?

Digoxin is indicated for atrial fibrillation. Explanation: It increases the contractility of the heart muscle by decreasing conduction and increasing force

What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant?

Greater than 90 bpm (preferably 100 bpm) Explanation: Digoxin is a cardiac glycoside that works by increasing the contractility of the heart muscle. It decreases conduction and increases the force of the heart beat. The result is a slowing of the heart rate. An 8 month old has a normal range of heart rate of 80--150 BPM awake resting and 80-130 BPM sleeping. The accepted practice for this age child is to hold the digoxin if the the heart rate is 90 or less. It would be safe to administer the drug if the heart rate is 100. If the child has a heart rate of 150 further assessment should be made prior to administering the drug.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

Iliac crest or spine Explanation: Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.

Slightly yellow sclera could be indicative of which disease?

In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells.

A 6-year-old girl is diagnosed with pulmonary stenosis. What is the likely treatment?

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions Explanation: Balloon angioplasty by way of cardiac catheterization is the procedure of choice for pulmonary stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed valve. As the balloon is inflated, it breaks valve adhesions and relieves the stenosis.

A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate?

Less than 90 bpm Explanation: Prior to administering each dose of digoxin, the nurse would count the apical pulse for 1 full minute, noting rate, rhythm, and quality. The nurse would withhold the dose and notify the health care if theapical pulse is less than 60 in an adolescent, less than 90 in an infant.

Where should the nurse expect to note edema in a 12-year-old with suspected right ventricular heart failure?

Lower extremities Explanation: Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities.

Do infants need treatment for asymptomatic atrial septal defect (ASD)?

Most infants do not need surgical repair for ASD Explanation: Most infants do not need surgical repair for an ASD unless they are symptomatic. The hole will close spontaneously 87% of the time.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?

Notify the doctor immediately. Explanation: The nurse would notify the doctor immediately. Cardiac tamponade is a medical emergency and should be addressed. The child can die if intervention is postponed. It would not be appropriate to perform any interventions until confirming that this is the actual diagnosis.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?

Place the infant in the knee-chest position. Explanation: Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot.

What causes idiopathic thrombocytopenic purpura?

Result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. -bleed risk (insufficient platelets)

A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits?

Semi-Fowler Explanation: Due to the hemodynamic changes accompanying the underlying structural defect, oxygenation is key. Provide frequent ongoing assessment of the child's cardiopulmonary status. Assess airway patency and suction as needed. Position the child in the Fowler or semi-Fowler position to facilitate lung expansion.

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

Serum potassium & sodium levels Explanation: Spironolactone is a potassium sparing diuretic that competes with aldosterone to result in increased water and sodium excretion (spares potassium). Used to manage edema due to heart failure and for treatment of hypertension. Serum potassium and sodium levels should be evaluated in someone taking this medication.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

Serum potassium level Explanation: Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug.

What would be an expected finding of an 8-month-old infant with a suspected congenital heart defect?

Softening of nail beds is the first sign of clubbing due to chronic hypoxia. Rounding of the fingernails is followed by shininess and thickness of nail ends.

Which infection is often seen in children prior to being diagnosed with rheumatic fever?

Streptococcal infection Explanation: Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. The onset of rheumatic fever is often slow and subtle.

Where are the most common sites for childhood cancer?

The blood, lymph, brain, bone, kidney, and muscle.

A school nurse finds a 10-year-old's blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect?

The child will need the blood pressure checked two more times. Explanation: The child will need the blood pressure checked two more times. It is routine to check the blood pressure on three separate occasions to get the most accurate analysis of the blood pressure.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding?

The liver size increases in right-sided heart failure. Explanation: The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure.

Why does a child recently diagnosed with leukemia receive a spinal tap?

To determine whether leukemic cells have invaded the central nervous system

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:

femoral pulse weaker than brachial pulse Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta.