Exam 3 Study Guide
Which of the following is the most appropriate nursing diagnosis for the child with acute glomerulonephritis?
Fluid Volume Excess related to decreased plasma filtration
Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness?
Give child as much control as possible.
what is celiac Disease
Gluten Intolerance
Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which of the following responses?
Guilt and anger
dx for pyloric stonosis is
H&H, Olive Mass, X-ray, Ultrasound, metabolic alkalosis and severe water and electrolyte depletion
s&s for a pt with anorexia
HR<50BPM, hypotensive crisis, tachycardia, decreased fat, missed menstrual cycle, binge and purge behavior
A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show which of the following?
Hematuria, proteinuria
what is an x-linked recessive disease that is linked to von willibrand
Hemophilia
what are nursing consideration for Crohn's
High Protein and carb diet. Low Roughage diet with no milk or green.
Which statement by the mother of a child with nephrotic syndrome indicates that the nurse's discharge teaching was effective?
I've been checking the urine for protein so I'll be able to do it at home
What are classic signs of Hirschprung?
Inadequate Weight Gain, food refusal, vomiting, ab distention
Which of the following is a common side effect of corticosteroid therapy?
Increased Appetite, Short Stature in Development
Which of the following describes the pathologic changes of sickle cell anemia?
Increased red blood cell destruction occurs.
What are potential nursing consideration with patients having a cleft palate
Otitis Media, Speech Problems, Frequenting Burping Required, and a Upright Feeding Position
The mother of an infant with hemophilia tells the nurse that she is planning to do home teaching when the child reaches school age. She does not want her child in school because the teacher will not watch the child as well as she would. The mother's comments represent what common parental reaction to a child's chronic illness?
Overprotection
What is priority for a patient with a sickle cell crisis
Pain Management in Hesi, IV Fluid is a real world situation
Which of the following clinical manifestations should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis?
Painful swelling of hands and feet; painful joints
Which observation made of the exposed abdomen is most indicative of pyloric stenosis?
Palpable olive-like mass
An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect?
Poor Skin Turgor, Weight Loss, lethargy, and tachycardia, prolonged cap refill
Nursing Considerations for Short Bowel Syndrom
Preserve as much of bowel as possible, maintain optimal nutritional status, G&D, stimulate intestinal adaptation with enteral feedings, minimize complications, special formula with a lot of protein to gain weight, due to steroid use they may have short stature. Nutritional therapy, monitor site for infection, I&O, Urine specific gravity, daily weights, stool for blood, ph
The nurse is planning care for an adolescent with AIDS. Which of the following is the priority nursing goal?
Prevent Infection
what are the main nursing considerations for a patient who has sickle cell anemia?
Prevention of going out in the cold and make sure a lot of replenishment to prevent dehydration, and area of low 02
nursing considerations for nephrotic syndrome
Provide skin care to edematous skin Do not use adhesive bandages or tape "may pull skin with tape" No IM injections Elevate HOB Turn child frequently Scrotal support Small, frequent feedings Prevent contact with those who have infection Anticipate diuresis in 1 - 3 weeks
Sickle Cell Disease is an Autosomal
Recessive Disease
The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of which of the following?
Reduction of edema
Which of the following is an important nursing consideration in the care of a child with celiac disease?
Refer to a nutritionist for detailed dietary instructions and education.
The nurse should include which fact when teaching an adolescent group about the human immunodeficiency virus (HIV)
The virus can be spread through many routes, including sexual contact Explanation: HIV can be spread through many routes, including sexual contact and contact with infected blood or other body fluids. The incidence of HIV in the adolescent population has increased since 1995, even though more information about the virus is targeted to reach the adolescent population. Only about 25% of all new HIV infections in the United States occurs in people younger than age 22
An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include which of the following?
Teach family signs of central venous catheter infection.
Which of the following immunizations should be given with caution to children infected with HIV?
The children should be carefully evaluated before giving live viral vaccines such as varicella, measles, mumps, and rubella
Which assessment findings indicate to the nurse a child has Down syndrome? (Select all that apply.)
Transverse palmar crease, Protruding tongue, High arched narrow palate
A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that melena, the passage of black, tarry stools, suggests bleeding from which area?
Upper gastrointestinal (GI) tract
Hypospadias refers to which of the following?
Urethral opening along ventral surface of penis
A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response would be which of the following?
Urinary output will increase.
Why does a patient with sickle cell having swelling of hands and feet
Vaso-Occlusive Crisis - sickling process prevents blood from returning to circulation so it may enter hands and feet but doesn't circulate back
A toddler is brought to the emergency department with sudden onset of abdominal pain, vomiting, and stools that look like red currant jelly. To confirm intussusception, the suspected cause of these findings, the nurse expects the physician to order:
a barium enema. Explanation: A barium enema commonly is used to confirm and correct intussusception. Performing a suprapubic aspiration or inserting an NG tube or an indwelling urinary catheter wouldn't help diagnose or treat this disorder.
When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is:
congenital heart disease.
S&S of uti school age kids
dysuria, frequency, urgency, elevated temperature, hematuria, flank pain, incontinence, squatting, odorous urine, abd pain
The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include:
elevating the head but give nothing by mouth.
A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include:
encouraging and helping mother to breastfeed.
What are S&S of a infant with Hirschprung?
failure to pass meconium w/i 24-44h?
A common parental reaction to a child with special needs is parental overprotection. Parental behavior suggestive of this includes:
giving inconsistent discipline.
After surgery for TEF a Nurse is responsible for
giving the 1st feeding of water to the patient
tx for celiac disease?
gluten free diet, see dietician
What are used to dx hirsprung
hx of constipation, rectal exam, be, rectal bx, cxr
Pyloric stenosis can best be described as:
hypertrophy of the pyloric muscle.
What is a possible complications from short bowel syndrom
increase gastric acid to be relieved from zantac
What does the nurse teach the parent after surgery for TEF
infant behavior afgter surgery, and any S&S of respiratory diress, regurgitation, or dysphagia which could cause biliary atresia
Invagination of one segment of bowel within another is called:
intussusception.
An Important priority for caring for Cleft Suture lines
is to clean is with a cotton swab with hydrogen peroxide and saline. If necessary abx to prevent infection.
what can lead poisoning effect the patient
it affects the brain and cause mental delays
what is the pathology of lead
it is slowly excreted in kidney, attaches to rbc and is stored in long bones
what are S&S of a child with Sickle Cell?
jaundice, yellow sclera, frequent infection LGF, growth delay, cardiomegaly, enuresis/nocturia, and swelling of extremities
what is the most common source of lead poisoning
lead based pain, lead pipes for drinking water, and dust and soil from lead smelters
What drug do pt may need prophylactically due to infections
low dose of PCN due to splenectomy "shock due to lack of o2"
managment of recurrent uti involves
low dose of bactrim/septra and/or keflex
Which of the following is a priority nursing goal for an infant with intussusception?
managing pain
An infant with pyloric stenosis experiences excessive vomiting that can result in:
metabolic alkalosis.
what are post op procedures for hirschprung?
ng for sxn, strict I&O, IVF, assess for bowel sounds, encourage bonding and attachment
what are nursing considerations for children with aids
no breast feeding from patients, low dose azt in parents to prevent aids in kids, make sure kids go home in azt and can help prolong survival rate, immunization, bactrim to prevent pneumonia
nursing considerations for prednisone
place in somethign to make it less bitter. take a dose immediately if a dose is skipped. take morning dose to reduce side effects
An infant, age 3 months, undergoes surgical repair of a cleft lip. After surgery, the nurse should use which equipment to feed the infant?
rubber dropper or breek
What is one of the major physical characteristics of the child with Down syndrome?
short stature, transverse palmar crease, and Hyperflexibility
septra and bactrium can cause
steven johnson syndrome
Nursing interventions to help the siblings of a child with special needs cope include:
suggesting to the parents ways of showing gratitude to the siblings who help care for the child with special needs.
what are nursing considerations for managment of VCUR
take entire dose of abx, fluids to flush uti, teach proper toilet hygiene and encourage to void q2h, and take vitamin c
VCUR can faciliate bacteria from bladder back into
the kidney and cause ESRD
A child has just been diagnosed with fragile X syndrome. The nurse recognizes that fragile X syndrome is:
the second most common genetic cause of mental retardation.
Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize her disability was so severe. The best interpretation of this situation is that:
this is a normal anticipated time of parental stress.
what is the goal of uti care
to preserve renal function
S&S of UTI in infants?
under 1 year show nonspecific symptoms such as: slow weight gain, elevated temperature, feeding difficulties, irritable, n/v/d, abd distention, sepsis
what are irritative symptoms in absence of bacteria for UTI
vaginitis, urethritis, pinworms, and bubble baths
Which is used to treat moderate to severe inflammatory bowel disease?
Corticosteroids
When a child with mild cognitive impairment reaches the end of adolescence, which characteristic should be expected?
Achieves a mental age of 8 to 12 years
Which of the following is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells?
Acquired immunodeficiency syndrome (AIDS)
What are S&S of a child with Intussesception
Acute Colicky Pain, "sausage-like" mass in URQ, Green Billious Mesis, Currant Jelly-Like Stools
what is a treatment for lead poisoning
chelation therapy, hydration diet and High iron diet, monitor for seizures, and remove environmental factors
Which of the following should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations?
Adequate dosage will turn the stools a tarry green color.
14. A school-age child is admitted in vaso-occlusive sickle cell crisis. The child's care should include which of the following?
Adequate hydration and pain management
What is a classical sign of intussusception?
Curant Jelly Like Stool
UTI may progress to
renal scarring, HTN, and renal insufficiency
why do kids with sickle cell have large bellies
Ascites and organ sequestering
what medications for crohns?
Steroids- Antiinflammatory, Aminosalicylates - manages uc and crohns, ABX for infections
A nasogastric tube inserted during surgery to correct an infant's intussusception is no longer freely removing gastric secretions. Which of the following should the nurse do next?
Aspirate the tube with a syringe.
Which therapeutic management treatment is implemented for children with Hirschsprung disease?
Surgical removal of affected section of bowel
what are the 3 phases of feeding post NEC surgery causing short bowel syndrome
1st - TPN 2nd - enteral feedings post ng or g -tube 3rd - use to sustain growth and developmment g-tube feeding for life
When both parents have sickle cell trait, what is the chance their children will have sickle cell anemia?
25%
what are S&S for patients with Hemophilia
Excessive Bruising, Prolonged Bleedings, Hemarthrosis, Prolonged PTT
A nurse should suspect possible visual impairment in a child who displays which characteristic?
Excessive rubbing of the eyes
3. A nurse is planning preoperative care for a newborn with tracheoesophageal fistula (TEF). Which interventions should the nurse plan to implement? (Select all that apply.) a. Positioning with head elevated on a 30-degree plane b. Feedings through a gastrostomy tube c. Nasogastric tube to continuous low wall suction d. Suctioning with a Replogle tube passed orally to the end of the pouch e. Gastrostomy tube to gravity drainage
A, D, E
The nurse is caring for a boy with probable intussusception. He had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, he passed a normal brown stool. Which of the following is the most appropriate nursing action? A. Notify the physician. B. Measure the abdominal girth. C. Auscultate for bowel sounds. D. Take vital signs, including blood pressure.
A. Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in treatment plan is indicated. Measurement of the abdominal girth may be indicated, but notifying the physician is the priority. Auscultating for bowel sounds may be indicted, but notifying the physician is the priority.
2. A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.) a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries
ADE Due to low sodium and potassium
what are used to manage hemophilia
Factor VIII and DDVAP
tx of uti involves
antibiotics for 10 days, with a followup to see if it is working and a possible change to iv may be neccessary for antibiotics
Which of the following immunizations should not be given to a child receiving chemotherapy for cancer?
Measles, rubella, mumps
The nurse should suspect a hearing impairment in an infant who demonstrates which behavior?
Absence of babbling by age 7 months
What are tx for Intussesception?
Air Enema if it Doesn't work BE, ABX, and SX as a last resort, IVF and NG for decompression
What is a classic sign for Pyloric Stenosis
An Olive-Shaped Mass in the epigastrium to right of umbilicus during palpation
1. The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Finger sticks for blood work instead of venipunctures b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene e. Administration of packed red blood cells
BCD
2. Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowling
BDE
What are treatments for Sickle Cell Disease
Bedrest, Hydration, Electrolyte Replacement, Pain Management, Blood Replacement, Antibiotics, and Hydroxyurea
S&S for bulimia
Binge-eating episodes at least twice a week, compensatory behavior to control weight - vomiting, laxative use, exercise, diet pills, amphetimines, mood disorder, depression, and hx of substance abuse
Excessive vomiting can result in which of the following in an infant with pyloric stenosis?
Metabolic alkalosis = loss of hydrogen ions
The school nurse is informed that a child with HIV will be attending school soon. Which of the following is an important nursing intervention?
Carefully follow universal precautions.
What Possible Complications can come from TPN use
Central line infections Metabolic complications Technical complications
Which represents a common best practice in the provision of services to children with special needs?
Children with special needs are being integrated into regular classrooms. Normalization refers to behaviors and interventions for the disabled to integrate into society by living life as persons without a disability would
Which of the following statements best describes iron deficiency anemia in infants?
Clinical manifestations are similar regardless of the cause of the anemia
Which is an implanted ear prosthesis for children with sensorineural hearing loss?
Cochlear implant
Laboratory results for a child with a congenital heart defect with decreased pulmonary blood flow reveal an elevated hemoglobin (Hb) level, hematocrit (HCT), and red blood cell (RBC) count. These data suggest which condition?
Compensation for hypoxia Explanation: A congenital heart defect with decreased pulmonary blood flow alters blood flow through the heart and lungs, resulting in hypoxia. To compensate, the body increases the oxygen-carrying capacity of RBCs by increasing RBC production, which causes the Hb level and Hct to rise. In anemia, the Hb level and Hct typically decrease. Altered electrolyte levels and other laboratory values are better indicators of dehydration. An elevated Hb level and HCT aren't associated with jaundice.
what are S&S for Crohn's Disease?
Mild to severe Diarrhea, ab pain, anorexia, weight loss, anal lesions, fistulas
Which of the following explains why iron deficiency anemia is common during toddlerhood?
Milk is a poor source of iron.
S&S of patient with nephrotic syndrome
Dark, foamy, frothy urine Decreased urine output Vomiting and diarrhea Anorexia, pallor, listless Edema Dependent body edema Weight gain Periorbital edema - in a.m. Abdominal ascites Scrotal edema Ankle edema by midday
What are 3 classical S&S of TEF
Drooling accompanied with Coughing, Choking, and Cyanosis, Accompanied distress during feeding
Which of the following types of restraints is best for the nurse to use for a child in the immediate postoperative period after cleft palate repair?
Elbow Restraints
After Surgery Patients should be on
Elbow and Restraints
Which intervention will encourage a sense of autonomy in a toddler with disabilities?
Encourage independence in as many areas as possible.
Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include which of the following?
Inject deeply into a large muscle.
When assessing a 4-month-old infant diagnosed with possible intussusception, the nurse should expect the mother to relate which of the following about the infant's crying and episodes of pain?
Intermittent with knees drawn to the chest.
Invagination of one segment of bowel within another is called which of the following?
Intussusception
The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which of the following should be suggested?
Iron-fortified infant cereal by age 4 to 6 months
A nurse is admitting an infant with biliary atresia. Which is the earliest clinical manifestation of biliary atresia the nurse should expect to assess?
Jaundice
S&S of a patient with biliary Atresia
Jaundice, dark urine, hepatomegaly, cirrhosis, spleenomegaly, hypoalbumimia, ascites, and coatupathy
what treatment is used for biliary atresia
Kasai Procedure - bild duct reconstruction using part of jejunum
What are nursing considerations for patients with Hemophilia?
No Rectal Temp Readings, Elevate immobilized Join, Genetic Counseling, ways to prevent bleeding and risk for injury, recognition and control of bleeding, no circumcision
Influenza, Pneumococcal and IPV are
Not Live Vaccines
The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which of the following is the most appropriate nursing action?
Notify practitioner.
Which of the following best describes acute glomerulonephritis?
Occurs after a streptococcal infection
Which of the following are the primary clinical manifestations of acute renal failure?
Oliguria and hypertension
42. The nurse is caring for an infant with suspected pyloric stenosis. Which of the following clinical manifestations would indicate pyloric stenosis?
Olive Shaped Mass, Visible Peristalsis, Projectile Vomiting by 3rd week, and Weight Loss
After teaching the parents of an infant who has had a pyloromyotomy about proper postoperative feeding techniques, the nurse determines that they have understood the teaching when they position the infant in the crib after feeding with head elevated and lying on: 1. Left side. 2. Abdomen. 3. Right side. 4. Back.
Right Side Positioning the infant on the right side with the head elevated facilitates passage of food through the pyloric sphincter into the intestine. Lying on the left side would inhibit the passage of food through the pyloric sphincter into the intestine. Positioning the infant on the abdomen is associated with an increased risk for sudden infant death syndrome. Positioning a healthy infant on his back is appropriate; however, positioning the infant with a pyloromyotomy on the right side with his head elevated facilitates passage of food through the pyloric sphincter into the intestine
A school nurse is performing hearing screening on school children. The nurse recognizes that distortion of sound and problems in discrimination are characteristic of which type of hearing loss?
Sensorineural
Which of the following is the most common cause of acute renal failure in children?
Severe dehydration
What is a AE for long time steroid use
Short Stature
What is a Universal screening of all newborns are now recommended?
Sickle Cell Disease
The nurse is caring for an infant with a suspected urinary tract infection. Which of the following clinical manifestations would be observed? (Select all that apply.) a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash
Vomiting,Failure to Gain Weight, Persistent Diaper Rash
Which of the following should the nurse recommend to prevent urinary tract infections in young girls?
Wear cotton underpants.
A nurse is admitting a child with Crohn disease. Parents ask the nurse, "How is this disease different from ulcerative colitis?" Which statement should the nurse make when answering this question?
With Crohn's the inflammatory process involves the whole GI tract
Which of the following is descriptive of most cases of hemophilia?
X-linked recessive inherited disorder in which a blood-clotting factor is deficient
The nurse is teaching the parent of a child experiencing severe edema associated with acute glomerulonephritis about the child's diet. Which of the following information should the nurse include in the teaching?
You will need to avoid adding salt to your child's food.
S&S of celiac disease?
acute diarrhea, watery stools, pale, offensive odor, ab pain, an anorexia
A young child with HIV is receiving several antiretroviral drugs. The purpose of these drugs is to:
delay disease progression.
what kind of diet is for a patient with biliary atresia
predigested fat and administration of Vit ADEK
what are types of education for family members for pts with sickle cell
prevent tissue de-oxygentation, promote hydration, prevent infection, pain management, genetic counseling and emotional support
Caring for the newborn with a cleft lip and palate before surgical repair includes:
providing satisfaction of sucking needs.
The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics:
rarely cause addiction because they are medically indicated.
what is used to tx hisrschprun
removal of aganglionic portion, temp colostomy for children >20lbs and 2nd sx to correct bowel. ng for decompression