peds final
The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, "I don't understand how this could happen to us. We have been so careful to make sure our child is healthy." Which response by the nurse is most appropriate? A. This must be a difficult time for you and your family. Would you like to talk about how you are feeling?" B. "Why do you say that? Do you think that you could have prevented this?" C. "You shouldn't feel that you could have prevented the cancer. It is not your fault." D. "Many children are diagnosed with cancer. It is not always life-threatening."
"This must be a difficult time for you and your family. Would you like to talk about how you are feeling?"
febrile seizures
-39 degrees or higher -occurs between 6months-3 years -familial predisposition. -rare after 5 years old -males!!
sickle cell anemia complications
-acute chest syndrome
DDH in older infant/children s/s
-affected leg shorter -telescoping -trandelenburg sign -greater trochanter prominent
care for febrile seizures
-avoid tempted baths -antipyretics to lower fever -protect child during seizure
pavliv harness call dr if
-child unable to kick legs -feet swollen -harness too small -areas of skin become raw/rash
s/s cerebral palsy
-clonus -compromised skin integrity -constipation -hip dislocation -kyphoscoliosis (hump) -seizures -spasticity -speech impairment -dysphagia -UTI -visual compromise -weakness
sickle cell crisis cause
-dehydration -temp elevation -infection -acidosis -hypoxia
kids with metabolic syndrome have at least 3 of these risk factors
-excess belly fat -HTN -abnormal blood fat levels -hyperglycemia
peds seizure triggers
-flashing/bright lights (video games, flash, reflection off snow) -loud noises -extreme temp changes -dehydration -fatigue
sick cell anemia
-inherited 2 copies of gene -autosomal recessive -blacks
status epileptics what to do
-maintain airway thru positioning (sniffing positioning) -establish IV access if possible -meds (IV first, if not rectal or intranasal) (high dose sedatives) -prepare for respiratory support
Limit setting and discipling
-minimizing misbehavior -reasoning after age 3 -behavior modification: rewards -consequences: follow through with them -time out: one minute per year of age in safe area like corner, chair or stair **NOT RECOMMENDED: corporal punishment: spanking, etc.
absence seizures
-occur in 1 area of brain -brief loss of consciousness -no postural control loss -minimal/no change muscle tone -may drop things -3-12 years of age -mistaken for inattention, ADD -sudden onset -no warning -5-10 sec durations -motor movement like twitching of eyes, slight hand movements, lip smacking -not incontinent
Slipped Capital Femoral Epiphysis
-occurs during puberty -males 13-15 -females 11-13 -BLACKS! -unilateral involvement in most cases -child OVERWEIGHT! -familial involvement
nursing care for ICP
-only suction as needed -maintain ariway -mouth care -eye protection -assess for seizures -O2>90
infantile spasms
-onset between 4-18 months -associated with cognitive impairment -sudden bending forward with stiffening of arms and legs -arch back -occurs in clusters -occurs upon wakening or after feeding -stop by age 5 -underlying disorders like birth injuries, genetic disorders can cause these... sometimes no cause found -poor prognosis
fractures
-rare in infants -clavicle most common -suspected in small child that refuses to crawl/walk that were doing so -school aged at risk because sports, bikes
late signs of ICP in children
-seizures -decrease LOC -fixed/dilated pupils -papilledema -cushings triad: increased systolic/widening pulse pressure, bradycardia, irregular respirations
DDH s/s infant
-short limb on affected side -restricted abduction of hip affected side -unequal gluteal folds when prone -positive ortolani test -positive barlow test
autism spectrum disorder care
-structured routines -be consistent -learn child's likes and dislikes -disruptions in child's day can be stressful -too much sensory stimulation can prompt temper tantrums -try to distract
why do children have more risk for injury?
-vulnerability -increased joint mobility -porous bones -lack of experience -lack of protective gear (helmate) -impatience
hip spica cast care
-will wear it for 12 weeks -cover when eating -keep dry and clean -elevate above heart to dec swelling -pad rough edges -dont put anything into cast -dont put powder/lotions into cast -dont use bar to carry baby -walk child around in wagon to prevent boredom
school aged BP
100-120/60-75
newborn HR
100-170
adolescent BP
110-135/65-85
adolescent RR
12-20
school aged RR
16-22
autism usually shows up between
18-36 months. more common in MALES!
preschooler RR
20-30
toddler RR
25-40
infant RR
30-55
newborn RR
30-55
WBC adults
4,500-11,000
call 911 if seizure over
5 min
WBC children 1-3
6,000-17,500
adolescent HR
60-100
school aged HR
60-110
infant BP
65-100/45-65
preschooler HR
70-120
toddler HR
70-123
infant HR
80-130
toddler BP
90-105/55-70
preschooler BP
95-110/60-75
A nurse in the PICU is working with a family who continually demonstrates aggressive behavior toward the nurse. The nurse understands that this is most likely due to the fact that? A. Parents of a child suddenly hospitalized for acute renal failure may experience feelings of anger, guilt or fear. B. Parents do not care for the care the nurse is providing to their child and are expressing it through their behavior. C. Parents are experiencing anxiety and stress in their marriage and expect the nurse to assist them with their feelings. D. The parents are demonstrating appropriate coping behaviors and the nurse is misinterpreting their behavior.
A
Which nursing diagnosis is highest-priority for a child undergoing chemotherapy and experiencing nausea and vomiting? A. Fluid and Electrolyte Imbalance B. Alterations in Nutrition C. Alterations in Skin Integrity D. Body Image Disturbances
A. Fluid and Electrolyte Imbalance
A child with cancer has the following lab result: WBC 10,000, RBC 5, and plts of 20,000. When planning this child's care, which risk should the nurse consider most significant? A. Bleeding B. Anemia C. Infection D. Pain
A. bleeding
Neurological signs that the nurse might assess that indicates worsening of kidney failure include? (select all that apply) A. Decrease in level of consciousness B. Sudden onset of dizziness C. Worsening headache D. Fever E. Drop in blood pressure
ABC
Many medications are nephrotoxic and more dangerous for a child in acute renal failure. Which order by a physician would the nurse immediately question related to the nephrotoxic nature of the medication? A. Tylenol (acetaminophen) B. Keflex (cephalexin) C. Duramorph (morphine) D. Lasix (furosemide)
B
Maintaining fluid balance is a critical nursing intervention for someone with acute renal failure. Which interventions are essential for the nurse to implement to monitor fluid balance with the goal of maintaining fluid balance? (Select all that apply) A. Provide fluids as requested by the child B. Strict intake and output on all shifts C. Daily weights on the same scale at the same time D. Allow child to eat any foods they wish E. Monitor daily labs such as NA+, BUN, Creatinine and report abnormal values to the provider
B C E
The parent of a child undergoing chemotherapy asks the nurse why the child must wear a mask in public places. Which response by the nurse would be most appropriate? A. "Chemotherapy causes dry mouth, and the mask will help contain moisture." B. "Chemotherapy decreases immune system function, increasing the risk of acquiring an infection." C. "Chemotherapy makes the oral mucous membranes deteriorate and makes them susceptible to infection." D. "Chemotherapy kills cancer cells, and your child might spread those cells to others."
B. "Chemotherapy decreases immune system function, increasing the risk of acquiring an infection."
A child with leukemia is being discharged after beginning chemotherapy. Which of the following instructions will the nurse include when teaching the parents of this child? A. Provide a diet low in protein and high in carbohydrates. B. Avoid fresh vegetables that are not cooked or peeled. C. Notify the doctor if the child's temp is 99 degrees F. D. Increase the use of humidifiers throughout the house.
B. Avoid fresh vegetables that are not cooked or peeled.
A 9-year-old child with leukemia has been in remission for six months and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. The appropriate response by the clinic nurse to the mother is: A. There is no need to be concerned. B. Bring the child into the clinic for possible administration of a varicella vaccine. C. Keep the child out of school for a 2-week period. D. Monitor the child for an elevated temperature, and call the clinic if this happens.
B. Bring the child into the clinic for possible administration of a varicella vaccine.
After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the child is neutropenic. The nurse should perform which of the following? A. Advise the client to rest and avoid exertion B. Prevent client exposure to infections by placing them in reverse isolation C. Monitor the blood pressure frequently D. Observe for increased bruising
B. Prevent client exposure to infections by placing them in reverse isolation
A child recovering from acute renal failure due to dehydration is demanding potato chips with their lunch. The nurse assesses the morning lab values and notes the Na+ to be 150mg/dL. What is the nurse's best action related to the child's demands? A. The sodium level is normal so the child can have the potato chips with their lunch. B. The sodium level is way to high and the child absolutely can not have any sodium containing foods. C. The sodium level is elevated and it is not recommended that the child have high sodium containing foods such aspotato chips. D. The sodium level is low so the nurse can allow the child to have potato chips with their lunch.
C
A child presents to the PICU with crackles upon auscultation, a 3 day history of no urine output, a fever and generalized edema. The priority nursing diagnosis for this patient would be? A. Nutrition imbalanced: less than body requirements R/T anorexia, nausea, vomiting and a catabolic state B. Infection, Risk for R/T invasive procedures, monitoring equipment, and diminished immune function C. Fluid volume excess R/T renal dysfunction and sodium retention D. Coping: Family, Compromised R/T sudden hospitalization and uncertain prognosis
C. Fluid volume excess R/T renal dysfunction and sodium retention
Which type of electrolyte imbalance that can be life threatening is most often seen in children with a diagnosis of acute renal failure? A. Hypernatremia B. Hypercalcemia C. Hyperkalemia D. Hypermagnesemia
C. Hyperkalemia
What is the normal "stable" urine specific gravity lab value for a child? A. 1.000-1.005 B. 1.030 - 1.040 C. 1.010-1.020 D. 1.015-1.035
C. 1.010-1.020
A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient? A. Low-sodium, high-protein, and low-potassium B. High-protein, low-potassium, and low-sodium C. Low-protein, low-potassium, and low-sodium D. High-protein and high-potassium
C. Low-protein, low-potassium, and low-sodium
The healthcare provider is caring for a 3-month-old infant diagnosed with infectious gastroenteritis. The infant is lethargic and the mucous membranes are dry. Which additional finding would support a diagnosis of moderate dehydration? A. Increased capillary refill B. Increased thirst C. Anuria D. Sunken fontanelle
D
The nurse is assessing a child with the medical diagnosis of pyloric stenosis; the nurse is likely to note which of the following? A. "Currant jelly" stools B. Regurgitation C. Steatorrhea D. Projectile vomiting
D
A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which of the following would be the best intervention to include in the child's plan of care? A. Administer tube feedings. B. Offer small, frequent meals. C. Offer fluids only between meals. D. Allow the child to choose what to eat for meals.
D. Allow the child to choose what to eat for meals.
A 15-month-old toddler is recovering from surgery to remove a Wilms' tumor. Which finding best indicates that the child is free from pain? A. Decreased appetite B. Increased heart rate C. Decreased urine output D. Increased interest in play
D. Increased interest in play
A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value, which intervention would the nurse document in her plan of care? A. Monitor closely for signs of infection. B. Temp every four hours. C. Isolation precautions. D. Use a small toothbrush for mouth care.
D. Use a small and soft toothbrush for mouth care.
Assessment of a 2-year-old by a nurse in the emergency department reveals the following: edema, hematuria, hypertension, and oliguria. What would the nurse assess as the most likely cause of these symptoms? A. urinary tract infection B. pyelonephritis C. Vesicoureteral reflux D. acute renal failure
D. acute renal failure
acute SCFE or acute on chronic SCRE
EMERGENCY! hospitalized! internal pin fixation! surgery! high incidence of eventual bilateral involvement
simple febrile seizures
Last for 15 min and do not recur within 24 hours
peds neuro exam
VS cranial nerves eyes posturing LOC skin motor function reflexes
A 4-month-old with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the highest priority? A. Instituting droplet precautions B. Administering acetaminophen (Tylenol) C. Obtaining history information from the parents D. Orienting the parents to the pediatric unit
a
A 4-year-old who has been toilet-trained becomes incontinent when hospitalized for surgery. The most appropriate nursing diagnosis based on this assessment finding is: A. Anxiety related to threat to or change in health status. B. Growth and Development Altered, related to incontinence. C. Ineffective Individual Coping related to hospitalization D. Urinary Elimination, Altered, related to incontinence.
a
A 7-year-old child has just been diagnosed with a seizure disorder. The physician has prescribed carbamazepine (Tegretol) 500 mg/day. The nurse should teach the parents that common side effects of this medication include: A. Photosensitivity in sunlight. B. Hives and aching joints. C. Diaphoresis and vomiting. D. Blurred vision and papular skin rash.
a
A child with a known seizure disorder is hospitalized for an unrelated procedure. Upon walking the child back from the restroom, the nurse notes tonic-clonic movements. Which action should the nurse take first? A. Note the time, and ease the child to the floor. B. Apply oxygen via a non-rebreather face mask. C. Clear the area of objects and pad the head D. Roll the child to side-lying position to protect the airway
a
A father brings his 4-year-old to the doctor's office for a well child visit. The father is embarrassed by his child's behavior during the visit. The father states that every time the child comes for an immunization she begins to cry and scream. An appropriate response to this father is: A. "All children have a major fear of needles; preschoolers often believe pain is a punishment." B. "Your child most likely had a traumatic experience at an early age." C. "Next time the mother should accompany the child for an immunization." D. "It is best to ignore this type of behavior as the child is seeking attention."
a
A nurse is caring for a child immediately after removal of the endotracheal tube. What assessment would the nurse report immediately to the provider? A. Stridor B. Occasional pink-tinged sputum C. A few basilar lung crackles on the right D. Respiratory rate 24 breaths/min
a
A nurse is caring for a child who has just received a cast. Which of the following considerations would be important in providing care for this child? A. Assess the casted extremity every 15-30 minutes the first two hours after cast application. B. When handling the cast in the first 24 hours, use fingertips only. C. Give the child a blunt object to help with the itching under the cast. D. Apply powder to the inside edges of the cast to help decrease moisture.
a
A parent of a child with cyanotic heart defects expresses concerns regarding potential developmental problems due to lack of oxygen to the brain. Which is the most appropriate response by the nurse? A. "Regular developmental screening is needed to prior to starting school." B. "Speech therapy might be needed." C. "Physical therapy might be needed." D. "Expressive therapy might be needed."
a
An expected outcome of nursing care during immunization would include: A. Parents are fully informed and give consent for immunization. B. Parents' belief in myths regarding immunizations are reinforced. C. Parents are provided the vaccine injury sheet prior to administration of the immunization. D. Parents are complying with federal laws when vaccinating their children.
a
An infant is placed in a Pavlik harness for developmental dysplasia of the hip. Which of the following statements made by a parent indicates correct knowledge of the care of this infant? A. "The straps of the harness should never be placed next to the skin." B. "The harness should be worn for 6 hours a day." C. "It will take a long time for my child to walk and crawl." D. "I can move my child around on a large skateboard."
a
Rotavirus is a pathogen implicated in acute gastroenteritis in children under the age of 2. A priority nursing diagnosis for a child with acute diarrhea caused by rotavirus would be: A. Fluid volume, deficient related to active fluid loss B. Chronic pain related to active fluid loss C. Sleep pattern disturbed, risk for related to active fluid loss D. Nutrition imbalanced: more than body requirements related to active fluid loss
a
The nurse is preparing a 4-year-old for surgery. Which teaching technique is most appropriate? A. Allow the child to handle safe medical equipment that might be used. B. Use an anatomically correct doll to explain the procedure. C. Explain to the child that she will be put to sleep for the procedure. D. Limit the teaching to one one-hour session.
a
The nurse knows that which represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? A. Separation anxiety B. Loss of control C. Fear of bodily injury D. Fear of pain
a
The nurse notes that a 6-month-old infant who weighed 7 pounds at birth now weighs 15 pounds. What is the nurse's evaluation of the infant's current weight? A. The infant's weight is appropriate for his age. B. The infant has been consuming more calories than needed. C. The infant needs weekly follow-up to assess weight. D. The infant should be hospitalized for failure to thrive.
a
The nurse providing anticipatory guidance education to the parents of a toddler shares that the most representative type of play usually seen in toddlers would be: A. Two children sitting side by side, each playing with a toy truck B. Two children putting a puzzle together C. A child who sits on the floor by himself, playing with blocks D. The child who dresses up like a fireman
a
Which nursing assessment may indicate increased intercranial pressure in an infant? A. Overflow voiding B. Bulging fontanel only when crying C. High-pitched cry D. Minimal lower extremity movement
a
Which nursing intervention is most appropriate in order to foster the development of trust in a hospitalized infant? A. Encourage the parents to room in and participate in care B. Place pictures of the child's family at the bedside C. Offer the infant a pacifier D. Play tapes of the mother's voice
a
Which should the nurse expect to note as a frequent complication for a child with increased pulmonary blood flow congenital heart disease? A. Susceptibility to respiratory infections B. Bleeding tendencies C. Frequent vomiting and diarrhea D. Seizure disorder
a
Which stage of development is most unstable and challenging regarding development of personal identity? A. Adolescence B. Toddler hood C. Childhood D. Infancy
a
a nurse is caring for an infant that has recently been diagnosed with a congenital heart defect resulting in congestive heart failure. Which clinical signs would most likely be present? A. Tachypnea B. Weight gain C. Decreased systolic pressure D. Irregular WBC lab values
a
Which of the following interventions would not be helpful for the adolescent who is wearing a cast following a fracture experiencing the nursing diagnosis Knowledge deficit related to wearing a cast after fracture? A. Encourage independence in daily activities. B. Encourage the adolescent to participate in community activities. C. Provide contact with a peer who has undergone the same treatment. D. Teach cast care as appropriate.
a b c d
Which of these are clinical signs of fractures? (Select all that apply.) A. Guarding the site B. Edema C. Ecchymosis D. Impaired ROM E. Impaired Neurovascular status F. Proximal limb weakness
a b c d
A nurse is caring for a 17-year-old female with cystic fibrosis who has been admitted to the hospital to receive I.V. antibiotic and respiratory treatment for exacerbation of a lung infection. The adolescent has a number of questions about her future and the consequences of the disease. Which statements about the course of cystic fibrosis are true? (Select all that apply.) A. Despite a voracious appetite may have failure to thrive B. The adolescent is at risk for developing diabetes C. Pregnancy and child-bearing aren't affected D. Normal sexual relationships can be expected E. Only males carry the gene for the disease. F. By age 20, the frequency of respiratory treatment should be possible to decrease
a b d
cerebral palsy
abnormality of motor function (movement) and postural tone acquired at early age. s/s usually show in first year of life. result of NONPROGRESSIVE brain lesion. on a spectrum.
types of seizures
absense, infantile spasms, tonic-clonic
SCFE s/s
acute or chronic acute <3 weeks chronic >3 weeks pain limp decreased ROM inability to bear weight limited internal rotation
Nephrotoxic drugs include
antimicrobials such as aminoglycosides, cephalosporins, tetracycline, sulfonamides, radiographic contrast, heavy metals, and non-steroidal anti-inflammatories, such as ibuprofen, indomethacin and aspirin.
stupor
aroused with only vigorous stimulation but returns to unresponsive state when stimulus removed
WBC of birth-24 H
as high as 34,000
SCFE assessment
assess ability to bear weight traumatic episode that caused it? gait pattern assessed active/passive ROM lower extremity deformity
Prevention of complications is an essential nursing intervention for children in ARF and includes
assessing daily weights on the same scale at the same time of day, careful monitoring of vital signs especially blood pressure, strict monitoring of intake and output, limiting fluid intake, and possibly limiting sodium, potassium and phosphorus in the diet so the child may not eat anything they want. pg 721
muscular affects of immobility
atrophy from tissue breakdown and loss of mass
A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? A. Warm, dry skin, pink mucous membranes, clear rhinitis B. Decreased wheezing without concurrent improvement of respiratory function C. Pulse rate of 90 beats/minute, normal sinus rhythm, capillary refill of <3 seconds D. Respirations of 18 breaths/minute, unlabored, clear breath sounds
b
A 12-year-old male is admitted to the adolescent unit with a diagnosis of slipped capitol femoral epiphysis. Which of the following activities should not be allowed prior to surgical correction? A. Ambulation with crutches, avoid bearing weight on the affected leg. B. Sitting in a wheelchair. C. Moving on a stretcher. D. Maintaining bedrest.
b
A 14-year-old boy is diagnosed with slipped capital femoral epiphysis (SCFE). He asks the nurse what caused this condition. Which of the following best answers his question? A. SCFE is a result of an injury to the hip. B. SCFE may be caused by an endocrine disorder. C. SCFE may be caused by an abnormality of the muscles. D. SCFE is caused by abnormal intrauterine position.
b
A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." The nurse's best interpretation of this comment is that it is: A. A sign of stress. B. Common at this age. C. Suggestive of maladaptation. D. Suggestive of excessive discipline at home
b
A child is suspected of having osteomyelitis. Which of the following blood values supports this diagnosis? A. Decreased white blood cell (WBC) count. B. Positive blood cultures. C. Increased hematocrit (HCT). D. Increased BUN.
b
A child with Kawasaki disease has been ordered to receive aspirin therapy. The parents are distraught as their pediatrician told them to never give aspirin to their child. What is the nurse's best response? A. "You are correct, the doctor must have made a mistake." B. "Low dose aspirin therapy is given to prevent clot formation until the platelet count returns to normal." C. "Aspirin therapy is necessary to prevent a heart attack." D. "Aspirin therapy replaces immunoglobulin therapy."
b
A child with tetralogy of Fallot squats in a knee chest position. The purpose of this knee chest position is to: A. Promote blood flow to the extremities with increased cardiac output. B. Decrease systemic venous return and increase blood flow to the lungs. C. Decrease systemic vascular resistance to improve cardiac function. D. To prevent bradycardia from occurring.
b
A parent asks the nurse why limiting the amount of time the infant feeds is important in the care of the infant with congestive heart failure. Which response by the nurse is the most appropriate? A. "Resting is essential in the care of the newborn with congestive heart failure." B. "Extending feeding time consumes calories required for the infant to gain weight." C. "Calories are not a major concern in congestive heart failure." D. "Limiting fluids is necessary in congestive heart failure."
b
A physician prescribes albuterol sulfate (Proventil) MDI for a patient with newly diagnosed asthma. When teaching the patient about this drug, the nurse should explain that it may cause: A. Nasal congestion B. Nervousness C. Lethargy D. Hyperkalemia
b
A school-age child has recently been diagnosed as having a seizure disorder. The parents express a concern about what will happen at school if the child has a seizure there. The parents are afraid other children will make fun of their child. The recommendations by the nurse would include the suggestion that: A. The child always wear a Medic Alert bracelet. B. The parents talk with the teacher about how to handle the situation. C. The nurse explains the pathophysiology of seizures to the child so his self esteem will not be affected. D. The parents make an appointment with a psychiatrist to talk about their concerns.
b
A wheelchair bound child with cerebral palsy has been admitted to the Pediatric unit. The nurse is writing the plan of care and knows that a priority nursing diagnosis for this child would be: A. Ineffective airway management B. Skin integrity alteration, risk for C. Fluid volume deficit D. Spiritual distress, child
b
An infant has been admitted with the diagnosis of dehydration. The physician has ordered a fluid bolus of 300 mL to be administered over 5 hours. What is the hourly rate the pump will be set at? A. 62.5 mL B. 60 mL/hr C. 150 mL/hr D. 30 mL/hr
b
The mother of a 5 year-old who is hospitalized is upset that she must leave her child to go home for a short time. What should the nurse suggest to this concerned parent? A. Return as soon as possible to attend to her daughter's needs. B. Leave a personal article with the child and reassure her that she will return within a specific time frame like after lunch. C. Call a family relative to stay at all times with the child when the mother leaves. D. Ask a nurse to sit at the child's bedside in her absence.
b
The nurse is discussing nutrition with an adolescent with Crohn's disease. The nurse would recommend which of the following diets? A. A low carb diet B. A high protein diet C. A high fiber diet D. A low fat diet
b
When the nurse is assessing the hips of a newborn and feels a "clunk" of dislocated femoral head, this is a positive: A. Barlow's sign B. Ortolani test C. Lawsuit D. Bryant's
b
Whenever the parents of a 10-month-old leave their hospitalized child for short periods, he begins to cry and scream. The nurse explains that this behavior demonstrates that the child: A. Needs to remain with his parents at all times. B. Is experiencing separation anxiety. C. Is experiencing discomfort. D. Is extremely spoiled.
b
Which medical condition involves the large intestine, with only the innermost layer of bowel mucosa being affected? A. Celiac Disease B. Ulcerative Colitis C. Appendicitis D. Crohn's Disease
b
Which pediatric patient should the nurse assess first? A. A 14-month-old with a 2-day history of acute gastroenteritis, low grade fever of 100.4 degrees F, sleeping in his stroller, holding a bottle of apple juice. The child's vital signs are HR 152, RR 26. B. A 2-month-old exclusively breast-fed infant with a chief complaint of vomiting after each feeding and then wanting to feed again. The infant was born 3 weeks prematurely. She is awake and alert but crying in her father's arms. Her vital signs indicate tachycardia.
b
Nursing management of the child with a fever includes: (Select all that apply.) A. Giving aspirin to reduce fever every 4 to 6 hours B. Removing unnecessary clothing C. Encouraging increased fluid intake D. Keeping extra blankets nearby
b c
The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the MOST APPROPRIATE nursing action? A. Initiate strict enteric precautions. B. Move the infant to a room with another child with RSV. C. Leave the infant in the present room because RSV is not contagious. D. Inform the staff that they must wear a mask, gloves, and a gown when caring for the child.
b d
skeletal affects of immobility
bone demineralization caused from calcium leaving the bone
Decorticate posturing
bringing everything into core. above brainstem
infant signs of ICP
bulging fontanelles increased head circumference scalp veins prominent widening suture lines macewen sign (percussion on scull) frontal bossing (big forehead) sunset eyes (low eyes) irritable high pitched cry lethargic LOC
1-2 years old toys
by end of 2nd year, builds tower of 4 blocks. scribbles on paper can undress self throws a ball
A 14-year-old has been diagnosed with insulin-dependent diabetes. Which technique is most appropriate in order to facilitate coping with this diagnosis? A. Give the adolescent specific instructions. B. Encourage increased dependence on parents for several weeks. C. Introduce the adolescent to another teenager who is successfully managing his diabetes. D. Warn the teen of the consequences of noncompliance.
c
A mother of a 15-month-old brings her son to the clinic. While doing a nursing assessment, the mother makes the following comments. Which comment merits further investigation by the nurse? A. "My son cries sometimes when I leave him at his grandparent's house." B. "My son always takes his blanket with him." C. "My son is not crawling yet." D. "My son likes to eat mashed potatoes."
c
A preschooler has been diagnosed with Kawasaki disease. The parents ask if cleaning their carpets caused this disease. The nurse's best response would be: A. "Yes, it is caused by wet carpets after they have been cleaned." B. "It is an inherited disorder so one of you parents must have had the disease as a child." C. "The underlying cause is largely unknown but it is thought to be triggered by an infection." D. "No, that is not possible. It is caused solely by genetic factors."
c
A teenager with Crohn's disease is reviewing his diet with the dietitian after her teaching session. The teen demonstrates understanding of his diet when he states: A. "I can eat pizza every day." B. "I cannot eat any meat, and should follow a gluten free diet." C. "I can have an Ensure milkshake with my meals." D. "I should avoid all meat and dairy."
c
An 18-month-old child is seen in the emergency department with respiratory distress and is admitted with a diagnosis of pneumonia. Following the initial workup, the baby is still short of breath but is rubbing his eyes as if he is sleepy. The mother wants to lay the baby down for his nap. The infant refuses to lie down. The nurse would suggest: A. Rocking the baby until he is asleep and then lay him down. B. The mother hold him in her arms while he sleeps. C. The mother allow the baby to sleep in an upright position. D. A sleeping pill to help the baby rest
c
The mother of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make? A. "The child may be allergic to antibiotics." B. "The child is too young to receive antibiotics." C. "Antibiotics are not indicated unless a bacterial infection is present." D. "The child still has the maternal antibodies from birth and does not need antibiotics."
c
The mother of an infant diagnosed with bronchiolitis asks the nurse what causes this disease. The nurse's response would be based on the knowledge that the majority of infections that cause bronchiolitis are a result of: A. Ribavirin B. Mycoplasma pneumoniae C. Respiratory syncytial virus (RSV) D. Hemophilus influenzae
c
The nurse conducts developmental screenings at a community center for infants and young children. The nurse explains that the purpose of these screenings is to: A. Reverse degenerative processes that have occurred. B. Recognize early infection in order to prevent spread to individuals in close contact with the child. C. Recognize a disorder early so strategies can be developed to promote optimum development. D. Measure intelligence and readiness for school.
c
The nurse is providing discharge instructions for a child who has suffered a head injury within the last four hours. The nurse will recognize the need for additional teaching when the mother states: A. "I will call my doctor immediately if my child starts vomiting." B. "I won't give my child anything stronger than Tylenol for headache." C. "My child should resume all their normal activities after we get home." D. "I recognize that continued amnesia about the injury is not uncommon."
c
The nursing plan of care for a child with severe dehydration as a result of acute diarrhea includes the nursing diagnosis Fluid Volume: Deficient, related to excess losses and inadequate intake. Which nursing outcome is the most appropriate for this child? A. The parents will seek prompt attention for the child's worsening condition preventing the development of severe dehydration. B. Parents will be able to successfully treat the child's diarrhea at home with oral rehydration fluids. C. The child will exhibit signs of normal hydration. D. Child will engage in normal activities.
c
The school nurse sees a 14-year-old child who presents with fatigue and a nagging cough of 3 weeks' duration that has become productive with thick mucus and is much worse at night. The school nurse suspects pertussis (whooping cough), because vaccine protection wanes in 5-10 years. What is the school nurse's first nursing action? A. Encourage fluids to prevent dehydration. B. Report the case to the Centers for Disease Control and Prevention (CDC). C. Isolate the child and contact the parents. D. Provide emotional support to parents.
c
When performing a pediatric abdominal assessment, what would be the first action by the nurse? A. Palpation of the abdomen for a mass B. Auscultation for bowel sounds C. Inspecting for abdominal distention D. Percussion for hollow sounds due to gas in the bowel
c
Which of the following is an assessment finding with developmental dysplasia of the hip in a 5-year-old child? A. Asymmetry of gluteal and thigh fat folds. B. Positive Ortolani-Barlow maneuver. C. Telescoping of the femoral head into the pelvis. D. Limited abduction of the affected hip.
c
Which of the following is the best indicator of brain function in a child with a moderate brain injury? A. Pupil response B. Vital signs C. Level of consciousness D. Gross motor strength
c
Which would be an appropriate nursing diagnosis for a child hospitalized with congestive heart failure? A. Readiness for Enhanced Nutrition B. Fluid Volume Deficit C. Cardiac Output, decreased D. Activity Intolerance
c
A mother refuses to have her child receive any immunizations based on her religious beliefs. The priority nursing diagnosis when planning health teaching for this family is: A. Acute pain related to injection and associated anxiety. B. Risk for injury related to vaccine reaction. C. Risk for infection related to incomplete immunization series. D. Knowledge deficit (Parent) related to potential side effects of vaccines.
c d
When planning teaching interventions for a child who has just undergone a cardiac catheterization and is being discharged home, it is a priority to teach parents to monitor for: (Select all that apply.) A. Developmental delays B. Nutritional needs C. Signs of infection D. Bleeding
c d
seizures eitology
causes can be unknown, genetic factors, acquired (birth injury, congenital defect of CNS, infection)
sickle cell patho
cells sickle from tigger, obstruction, leads to inc RBC destruction, hypoxia, tissue ischemia and infarction, and organ damage.
general s/s seizures
changes in LOC involuntary movements posturing changes in perception/behavior/sensations
coma
child cannot be aroused. unconscious
ages 1-3 years play and toys
cloth books, large pencils and paper, wooden puzzles, playing kitchen, toy telephone, riding big wheel, play with soft ball and bat, molding water/sand, music, stories, books
mild TBI
concussion -caused by direct blow to head, face, neck or to somewhere else on the body that results in transmission of an impulsive force of the head. short lived impairment that usually resolves spontaneously. no abnormality seen on imaging studies. hockey #1, football #2
infancy type 1 diabetes family issues
coping with stress sharing burden of care to avoid burnout
A 16-year-old is admitted to the hospital for acute appendicitis, and an appendectomy is performed. Which of the following nursing interventions is most appropriate to facilitate normal growth and development? A. Allow the family to bring in the child's favorite computer games B. Encourage the parents to room-in with the child C. Encourage the child to rest and read D. Allow the child to participate in activities with other individuals in the same age group
d
A 2-year-old child with tetralogy of Fallot becomes upset during a routine blood draw. The child turns blue and the respiratory rate increases to 45 breaths per minute. Which of the following interventions should the nurse do first? A. Notify the provider and request sedation. B. Assess for irregular heart rhythm and rate. C. Reassure the child that the pain will be mild. D. Position the child with the knees to the chest.
d
A 4-year-old scores three "failures" on a developmental screening test. Which statement is the most accurate? A. The child is not as intelligent as expected for age and should be referred to a learning specialist. B. The child has a speech problem and should be referred to a speech therapist. C. The child is at risk for school problems and should be retested. D. The child should be referred for a further diagnostic developmental evaluation.
d
A child is brought to the emergency department with suspected epiglottitis. Which nursing intervention would be considered unsafe? A. Allowing the child to remain in the position of choice. B. Placing intubation equipment at the bedside. C. Encouraging parents to comfort the child. D. Examining the throat.
d
A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the MOST APPROPRIATE nursing action? A. Tell the mother that the child must stay in the tent. B. Place a toy in the tent to make the child feel more comfortable. C. Call the health care provider and obtain a prescription for a mild sedative. D. Let the mother hold the child and direct the cool mist over the child's face.
d
An 18-month-old child is observed having a seizure. The nurse notes that the child's jaws are clamped. The priority nursing responsibility at this time would be: A. Start oxygen via mask. B. Insert padded tongue blade. C. Restrain child to prevent injury to soft tissue. D. Protect the child from harm from the environment.
d
An inexperienced mother is playing with her 6-month-old in the playroom. The nurse taught the mother about toys that are developmentally appropriate for the infant. The nurse will know the teaching has been successful when the mother selects: A. Blocks B. Tricycle C. Puzzles D. Rattles
d
During a well-child visit for an 8-month-old girl, her parents express concern that their older child was already sitting alone at this age. The child was born 6 weeks premature but had no major difficulties during the neonatal period. The best response of the nurse to the parents is: A. "Your observations are good. Your child is demonstrating a developmental delay and probably has cerebral palsy." B. "You shouldn't jump to conclusions. All children are individuals, and it is not fair to compare one child to another." C. "You have nothing to worry about. Your child's development is completely normal." D. "Can you tell me more about how your child is feeding and turning over?"
d
The Glasgow Coma Scale is used to measure neurologic functioning. Which of the following criteria would indicate the lowest level of functioning for an infant or young child? A. Confused. B. Irritable, cries. C. Eyes open only to pain. D. No response to painful stimuli.
d
The nurse concludes that a parent of an otherwise healthy child with varicella (chickenpox) has an accurate understanding of the disease when the parent states: A. "I will give my child acetaminophen 120 mg 3 times a day for the duration of the illness." B. "I will take my child to our primary care provider to request acyclovir." C. "I will take my child to our primary care provider to request antibiotics." D. "I will send my child back to school when all the lesions are dry and crusted over."
d
The nurse is discussing sexually transmitted infections (STIs) with a 17-year-old student. To correctly plan the teaching lesson, the nurse utilizes Piaget's theory to determine the adolescent's cognitive abilities. The educational plan should be based on the: A. Sensorimotor reactions. B. Limited cause and effect understanding. C. Concrete thinking. D. Mature abstract thinking.
d
The nurse is discussing the risks and benefits of vaccines with a family, and must secure signed, informed consent for the children to be immunized. The nurse emphasizes that which of the following reactions to vaccines is very rare? A. Fever of 100ºF (37.8ºC) B. Urticaria around the injection site C. Maculopapular rash D. Encephalopathy
d
The nurse teaches parents that absolute contraindications for pediatric immunizations include: A. Respiratory illness with low-grade fever B. soreness, redness, and swelling at the previous injection site C. febrile seizure one month after the previous injection of the vaccine D. anaphylactic reaction to previous immunization
d
The parents of a 2-year-old arrive at a hospital to visit their child. The child is in the playroom when the parents arrive. When the parents enter the playroom, the child does not readily approach the parents. The nurse interprets this behavior as indicating that? A. The child is withdrawn B. The child is self-centered C. The child has adjusted to the hospitalized setting D. This is an expected pattern of separation
d
What three diseases does the MMR vaccine prevent? A. Malaria, meningitis, and rabies B. Multiple sclerosis, muscular dystrophy, and rheumatism C. Myopathy, mesothelioma, and ringworm D. Measles, mumps, and rubella
d
Which nursing intervention is most developmentally appropriate for a hospitalized 10-year-old? A. Encourage dependency on parents while the child is hospitalized. B. Obtain a complete health history from the child. C. Encourage the child to play with safe medical equipment. D. Allow the child to assist with dressing changes if they wish to do so.
d
Which of the following is the correct position for the nurse to maintain in a child in Bryant's traction? A. The lower leg is suspended in a padded sling. B. Leg is in extended position without hip flexion. C. The arm is kept flexed and is suspended horizontally. D. Hips are flexed at a 90-degree angle, with buttocks off the mattress.
d
Which of these diseases does not currently have a vaccine? A. Swine flu B. Seasonal flu C. Rotavirus D. Common cold
d
Respiratory affects of immobility
decreased O2 demand, diminished vital capacity leading to dyspnea, acidosis. atelectasis.
CV affects of immobility
decreased deficiency of orthostatic neuro reflexes. orthostatic hypotension. altered distribution of blood volume. venous stasis
metabolic affects of immobility
decreased metabolic rate which leads to decreased tissue healing or hypercalcemia
cerebral palsy symptoms
determined by where the lesion is in the brain.
toddler normal developmental task
develop sense of mastery and autonomy
school aged kids normal developmental tasks
develop skills in athletics, cognitive, artistic, and social areas.
infancy normal developmental tasks
develop trusting relationship
preschooler normal developmental tasks
developing initiative in activities and confidence self
confusion
disorientation to time place, or person. loss of clear thinking
GI affects of immobility
distension from poor muscle tone. shallow respirations and other complications. decreased emptying of colon so constipation. anorexia
HTN meds
diuretics beta blockers (count pulse) take BP at home give guidelines when to hold meds
3-6 year old dramatic play
dolls, house, dress up, puppets
2-3 years old toys
draws circle and other shapes learns to pour learns to dress self
cognitive growth 3-6 year old
educational tv shows, music, stories, books
diagnose seizure
eeg
children <10 years old
endocrine disorders bilateral involvement
cerebral palsy associated with
epilepsy speech impairment cognitive dysfunction vision compromise
types of seizures
epileptic (abnormal discharging of brain) and non epileptic (have physical cause)
toddler with type 1 family issues
establish schedule manage the picky eater limit setting and coping with toddlers lack of cooperation share burden of care
decerebet posturing
everything away. lesions of the brain stem.
major causes of brain damage in childhood
falls MVA bike injuries
leading causes of TBI in peds are
falls and MVAs
acute chest syndrome s/s
fever cough chest pain tachypnea wheezing hypoxia give O2 to prevent this!
hip spica cast call dr if
fever increase pain increase swelling drainage/foul odor from cast cold toes
treatment DDH >18 mo
hard to treat after 4 yrs. open surgical reduction. pelvic and/or femoral osteotomy
GU affects of immobility
hard to void in supine position, urinary retention, UTI
There are several things that can cause acute renal failure, including
hemolytic uremic syndrome, nephritic syndrome, and severe dehydration
sickle cell tx
hydroxyurea -inc hemoglobin folic acid- helps make new RBCs bone marrow transplant
secondary HTN
identifiable cause
developmental dysplasia of the hip occurs
in utero
adolescent priorities DM management
increasing insulin requirements during puberty DM management and glucose control more difficult weight and body image concerns start ongoing discussion of transition to new diabetes team integration DM into new lifestyle
why are kids at risk for intracranial regulation impairment?
infants are top heavy, neck muscles and cranial bones poorly developed, unfused sutures, and excessive spinal mobility.
cystic fibrosis
inherited autosomal recessive -
autism most common developmental delays
language/cognitive skills fine/gross motor skills
9-12 months toys
large blocks toys that pop apart and go back together nesting cups laughs at jack-in-the-box peek-a-boo uses push-and-pull toys
complex febrile seizures
last over 15 min and recur within 24 hours. greater risk for developing epilepsy
school aged family issues
maintain parental involvement in insulin and blood glucose management while allowing for independence self care for special occasions continue educating school and caregivers
school aged type 1 DM priorities
make diabetes regimen flexible to allow for participation in school or peer activities child leading short and long term benefits of control
if bilateral dislocations
marked lordosis waddling gait
status epileptics
more than 30 min of either continuous seizure activity OR 2+ sequential seizures without full recovery of consciousness in between
6-12 years old activities
musical instrument starting hobbies playing board/video games ball sports skating dance lessons water and snow skiing biking reading crafts word puzzles schoolwork
bone healing time frame
neonatal-2-3 weeks early childhood-4 weeks later childhood-6-8 weeks -adolescence-8-12 weeks
autism spectrum disorder red flags
no babbling, pointing, or other gestures by 12 months. no single words by 16 months. no 2 word spontaneous phrases by 24 mo any loss of language or social skills
prognosis sickle cell
no cure except possibly bone marrow transplant -bacterial infections are leading cause of death in this population -strokes can occur
primary HTN
no known cause
3-6 months toys
noise making objects that are easily grasped (rattles) stuffed animals soft toys with contrasting colors
generalized seizure= tonic-clonic seizures
originate in bilaterally symmetric fashion tonic, clonic, and tonic-clonic activity
assessment of fractures- the 6 Ps
pallor parasthesia paralysis pulse polar pain
obesity cause
partially inheritable and partially acquired
treatment for DDH 0-6 mo
pavliv harness
3-6 year old stress relief
pens, paper, glue, scissors
post-ictal phase
period immediately following activity until resumption of pre seizure state
skin affects of immobility
pressure ulcers, decreased healing capacity
infancy type 1 diabetes management priorities
prevent and treat hypoglycemia, avoid extreme fluctuations in blood glucose levels
toddler type 1 DM management priorities
prevent hypoglycemia avoid extreme fluctuations in glucose levels due to irregular food intake.
preschooler type 1 DM priorities
prevent hypoglycemia coping with unpredictaable appetite and activity positively reinforcing cooperation with regimen trusting other caregivers
autism spectrum disorder
problems with social skills, empathy, communication and flexible behavior.
3-6 years old associative play
puzzles games nursery rhymes songs
gloscow coma scale
quantifies LOC. scored between 3-15 eye opening, verbal, and motor
HTN child risk factors
race socioeconomic status lack of health insurance nutrition physical activity
preschooler family issues
reassure child that diabetes is no ones fault educating other caregivers
treatment DDH 6-18 months
reduction under GA, hip spica cast for 2-3 months
family issues with adolescent with DM
renegotiating parent and teens roles in DM management to be acceptable to both learning coping skills to enhance ability to self manage preventing and intervening in DM related family conflict monitor for s/s depression, eating disorders, risky behavior support transition to independence
lethargy
slumber where speech/movement are limited. aroused with moderate stimulation
concussion s/s
some seen right away, some later on -headache -nausea -dizzy -poor balance -light/sound sensitive -insomnia -hyper/hyposomnia -fogginess -cognitive fatigue -inattention -memory deficit -irritable -lability -sad -anxious
12-18 years activities
sports, school activities like yearbook, drama, club participation, quiet activities like reading, tv, computer and video games, music
delirum
state of disorientation, fever, irritability and mental/motor excitement
s/s fractures
swelling pain/tenderness diminished functional use bruising, severe musclar rigidity, crepitus deformity muscle spasms
diagnosis of concussion based on
symptoms, structural imaging which is usually normal, and neuro exam
6-9 months toys
teething toys increasingly desires social interaction soft toys that can be manipulated and mouthed
autism etiplogy
unknown
newborn BP
varies based on GA
types of sickle cell crisis
vasoocclusive (thrombotic)...dont massage around this!!! splenic sequestration aplastic crisis hydration is important!
birth-3 months toys
visual stimuli of mobiles black and white patterns mirrors music boxes tape players rocking and cuddling moves arms/legs when adults sing/talk likes varying stimuli-different rooms, sounds, visual images
metabolic syndrome characteristics
waist circumference BP
fractures -epiphyseal injuries
weakest part of the long bones is the cartilage growth plate - epiphyseal plate. it is still growing so it is a frequent site for injury. it may affect future bone growth. treatment can include open reduction and internal fixation
