Peds Final

Response to parent who is questioning nurse's action of reporting suspected child abuse

As a nurse, I am required by law to report suspected child abuse.

An infant is being prepared for surgical repair of a ventricular septal defect (VSD). Which of the following problems will be prevented by closing the defect? Please choose from one of the following options.

Failure to thrive

A 7 year old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history?

Functional status related to eating and mobility

Nursing actions during a lumbar puncture

Hold the infant's chin to his chest and knees to his abd. during the procedure

A nurse is teaching the mother of a 5 year old child who has CF about pancreatic enzymes. The nurse should understand that further teaching is necessary when the mother states which of the following?

I will give my son the enzymes between meals.

Medical conditions that down syndrome patients are at increased risk for

-leukemia -congenital heart defects -pneumonia

Scoliosis repair postop nursing interventions

*PCA pump for pain* -frequent neuro checks -turn pt. by log rolling -keep skin clean and dry -monitor surgical site for signs of infection.

expected finds in a child with sickle cell crisis

*Pain* -swollen joints, hands, and feet -abdominal pain -hematuria -obstructive jaundice -visual disturbances

clinical manifestation of cerebral palsy in an 8 month old

*sits with pillows propped up* -- 8 month olds should be able to sit on their own -failure to meet developmental milestones -persistent primitive reflexes (moro or tonic neck) -gagging or choking with feeding, poor suck reflex -tongue thrust -poor head control -rigid posture -assymetric crawl -hyperrelfexia

discharge instructions following cardiac catheterization of a child.

-*Give the child acetaminophen for comfort.* -Encourage fluid intake to help with the removal of dye from the body. -Advise the parents and child to monitor the site for infection.

Medication for acute asthma attack

Albuterol

A nurse is caring for an 8 year old child who has acute rheumatic fever. Which of the following assessments is the nurse's priority immediately after admission?

Auscultating the rate and characteristics of the child's heart sounds.

Finding to monitor to identify increased intracranial pressure

Increased sleeping -LOC can deteriorate following a head injury

Response to a child who has been physically abused by a family member

It is not your fault that this happened.

4 medications that can be given by ET tube in an emergency

LEAN Lidocaine Epinephrine Atropine Naloxone

A nurse is planning care for a 6 year old child who has bacterial meningitis. Which of the following nursing interventions is unnecessary in the client's plan of care?

Measure the head circumference every shift

Priority goal for the nurse to include in plan of care for a child with cerebral palsy.

Modify the environment

A nurse is assessing a child and notes several bruises. Which of the following actions should the nurse take?

Obtain a detailed history

d/c instructions for a child with sickle cell anemia after an acute crisis episode

Offer fluids to your child multiple times every day

OI is treated with which medication

Pamidronate

Nursing actions for ASA overdose

Perform gastric lavage with activated charcoal --charcoal absorbs all of the chemicals in the GI tract

proper activity for a 4 year old on contact precautions

Putting a large-piece puzzle together --A child who requires airborne precautions must remain in her room. Appropriate activities for a 4 year old include putting together large piece puzzles, using paints and crayons, playing ball, riding tricycles, playing pretend and dress up, sewing cards and beads, and reading books.

priority nursing assessment for a child who ingested kerosene

Respiratory rate ABCs

What is ketogenic diet used for

Seizures

A preceptor is working with a new nurse in the nursery. She will know further teaching of the new RN is necessary if the new nurse says

Surfactant is given IV

Dx test to confirm CF

Sweat chloride test

A nurse is obtaining vital signs from 2 month old infant. The infant's heart rate is 190/min and his temp is 40 C (104 F). The father asks the nurse why the babies heart is beating so fast. Which response by the nurse is appropriate?

The fever is causing an increase in your baby's heart rate.

Why should RR be counted for one full minute on a newborn?

The rate and rhythm of breath are irregular in newborns

education to a school aged child about new diagnosis of asthma.

avoid triggers that cause an attack

Reason for taking digestive enzymes

help digest the fat in foods

earliest indicator of improvement or deterioration of neurologic status

level of consciousness

Possible diagnosis of newborn with green amniotic fluid

meconium aspiration

nursing actions for a child experiencing a seizure

position the child laterally

nursing actions for a child having a seizure and vomiting

position the child side lying

Priority nursing actions for a child with suspected diagnosis of bacterial meningitis

place the child in isolation

nursing actions during chest physiotherapy

-administer albuterol prior to CPT

Nursing actions during a seizure

-assess the clients airway patency -remove objects from clients bed -place the client in side lying position

Nursing interventions for juvenile idiopathic arthritis

-care is primarily in outpatient setting -assist the client with exercise program -teach relaxation techniques and nonpharmological pain management -evaluate pain and response to analgesics -encourage a support group -encourage the child to participate in a physical therapy program to increase mobility and prevent deformities. -Encourage activity as tolerated -apply heat or warm moist packs to the child's affected joints prior to exercise. -encourage warm baths -encourage self care by allowing adequate time for completion -well balanced diet, adequate fluid intake

Nursing actions for a client with RSV

-keep thermometer in toddler's room

SIDS prevention

-place baby on their back to sleep -Don't co sleep with your baby -don't smoke around your baby

nursing care for an infant pre op spina bifida repair

-provide a latex free environment Children with spina bifida have a very high risk for developing a latex allergy.

You are a school nurse on a playground. Which child are you most concerned about?

A child who is squatting after running.

Expected findings in Kawasaki disease

Acute phase: onset of high fever that is unresponsive to antipyretics, with development of other manifestations. -Fever greater than 38.9 C (102 F) lasting 5 days to 2 weeks and unresponsive to antipyretics -irritability -red eyes without drainage -bright red, chapped lips -strawberry tongue with white coating or red bumps on the posterior aspect. -red oral mucous membranes with inflammation including the pharynx. -swelling of the hands and feet with red palms and soles -nonblistering rash -bilateral joint pain -enlarged lymph nodes -cardiac manifestations: myocarditis, decreased left ventricular function, pericardial effusion, and mitral regurgitation. Subacute phase: resolution of fever and gradual subsiding of other manifestations -irritability -peeling skin around the nails, on the palms and soles -temporary arthritis Convalescent No manifestations seen except altered lab findings. Resolution in about 6-8 weeks from onset.

A nurse is preparing to measure an infant's vital signs. The nurse should use which of the following sites to assess a heart rate?

Apex of the heart

Nurse is caring for a 3 month old who is sneezing, coughing, nasal congestion, intermittent fever, and apneic spells. These symptoms are associated with which of the following diagnosis?

Bronchiolitis

A nurse is caring for a child who has Kawasaki disease. Which of the following systems should the nurse monitor in response to this diagnosis.

Cardiovascular Kawasaki disease--acute systemic vasculitis

Most common movement disorder of children

Cerebral palsy

neuromuscular disorder is treated with intrathecal baclofen

Cerebral palsy

After suctioning the tracheostomy, the nurse should use which of the following findings to determine that the procedures was effective?

Clear breathe sounds --clear breathe sounds indicate that there are no remaining secretions obstructing or potentially obstructing the clients airway.

A nurse is caring for an adolescent who has spina bifida and is paralyzed from the waist down. Which of the following statements by the client should indicate to the nurse a need for further teaching?

I only need to catheterize myself twice every day

Nurse's responsibility when child abuse is suspected

If suspicion of abuse exists then reporting is mandatory.

PURPLE crying

P--peak of crying. U--unexpected crying R--resists soothing P--pain like face L--long lasting E--evening

CRASH and burn

Signs of Kawasaki disease Conjunctivitis Rash Arthritis Strawberry tongue Hands peeling Burn--uncontrolled high fever persisting longer than 5 days

4 defects are found in tetralogy of fallot

VSD pulmonary stenosis overriding aorta right ventricular hypertrophy

VSD

Ventricular septal defect A hole in the septum between the right and left ventricle that results in increased pulmonary blood flow -loud harsh murmur auscultated at the left sternal border -heart failure -many VSD's close spontaneously

Approximate size of an infants heart

Walnut

Teaching a parent to care for a child with impetigo

Wash clothing in hot water --change clothes every day and wash all clothes in hot water

The healthcare provider is caring for an infant with a diagnosis of a congenital heart defect. The baby's pulse is 158 and the RR is 74. Which of the following is the best position for the baby to be placed? Please choose from one of the following options.

upright in an infant seat

A nurse is caring for a child who has rheumatic fever. When obtaining the child's medical history from the parent, the nurse should recognize the significance of which of the following data as the possible source of the childs infection?

A sibling who had a sore throat 3 weeks ago

Teaching parents about endotracheal suctioning at home

Apply suction for less than 10 seconds --prolonged suctioning can cause damage to tissues and induce hypoxia.

Instructions given to parent whose child just ingested half a bottle of vitamins with added ferrous sulfate

Contact the poison control center

Trisomy 21

Down syndrome