MC Exam #4
nasopharyngitis what is it, bacterial or viral, treatment
the common cold viral treated at home with cool mist, antipyretic, rest, fluids
what interventions do we do when a child is experiencing a "tet" spell
-put child in knee to chest position -administer 100% O2 -give them morphine to calm them down -may start IV fluids
CCHD screening
-put pulse Ox on right hand and either foot -passing is greater than 95% with less then 3% difference -performed at 24-48 hours birth -if failed another one done then an echo
what are the two kinds of medications used to treat asthma?
-quick-relief medications/rescue medication like bronchodilator (SABS), anticholinergics, and systemic corticosteroids -long-term control medications like inhaled/oral corticosteroids, long-acting beta2-agonist (LABA), montelukast, antiallergic, monoclonal antibodies
signs of bone marrow dysfunction
fever, pallor, fatigue, anorexia, hemorrhage, bone, and joint pain
risk factors for neural tube defects
genetic mutation maternal obesity maternal diabetes mellitus low folate levels low vitamin B12 levels
what can cause an increase in ICP
head injury, brain tumors, or infections
CMs of brain tumors
headaches (worse in am); dizziness; balance problems; vision, hearing, and speech problems; frequent vomiting; and seizures (increased ICP)
complications if meningitis
hearing loss neurologic deficits (paralysis or weakness) seizures visual impairment
what can happen if a heart defect is not spotted early on?
heart failure hypoxemia
acute streptococcal pharyngitis what is it, bacterial or viral, treatment
highly contagious infection and can lead to rheumatic fever and acute glomerulonephritis if not properly treated -caused by group A beta hemolytic strep -bacterial -antibiotics, need to finish whole course of antibiotics, acetaminophen -salt-water gargles and hydration
hypertonic dehydration
hypernatremic Loss of water in excess of sodium
hypotonic dehydration
hyponatremic Loss of sodium in excess of water
if a child turning blue how do we tell if it is a problem because of the heart or the lungs
if the cyanosis worsens with crying it is most likely cardiac if the cyanosis improves with crying it is most likely pulmonary (due to lack of deep breathing)
wheezing where do we hear it, on inhalation or exhalation
in lower airways and exhalation
hypoxemia what is it, signs and symptoms
inadequate oxygenation of the blood, which is common in kids with congenital heart defects (also seen in kids with respiratory disorders and anemia) -signs and symptoms: cyanosis, tachypnea, dyspnea, clubbing, polycythemia
otitis externa what is it, bacterial or viral, treatment
infection of the inner ear -persistent moisture in ear canal that leads to bacterial or fungal overgrowth that leads to inflammation or infection -common in older children -bacterial or fungal -antibiotics, otic drops, cipro and dexamethasone
what are the two primary causes of heart failure in children and adolescents
-"over-circulation failure," occurs when blood mixes inside the heart due to a congenital heart defect -"pump failure," occurs when the heart muscle becomes damaged and no longer contracts normally
CMs of CF (GI, skin, and reproductive systems)
-GI - meconium ileus in the newborn,, intestinal obstruction caused by thick intestinal secretions, frothy and foul-smelling stools, deficiency in fat-soluble vitamins, malnutrition and failure to thrive, pancreatic fibrosis may increase the child's risk for diabetes mellitus -skin - very high concentrations of sodium and chloride in sweat, skin tastes salty, dehydration and electrolyte imbalances can occur -reproductive - can delay puberty in girls, inhibits fertility due to thick mucus, males are typically sterile due to blockage of the vas deferens
reye syndrome
-a rare but serious illness that primarily affects children and teenagers -characterized by liver dysfunction and cerebral edema, which is the accumulation of fluid in the brain -exact cause of Reye syndrome is unknown, but it is often associated with viral infections and giving aspirin -CMs: vomiting, lethargy, confusion, seizures, and loss of consciousness
directions for aspirin given in the context of Kawasaki disease
-administer with food as it can cause stomach irritation -children may bruise more easily -can cause tinnitus with higher doses -given until signs of inflammation and fever have resolved
juvenile idiopathic arthritis
-an autoimmune inflammatory disease that affects children and adolescents -occurs when the body's immune system mistakenly attacks healthy tissues in the joints, resulting in joint inflammation and pain -can also affect other tissues such as the eyes, skin, and gastrointestinal tract -no cure
how do we treat Kawasaki disease
-aspirin therapy (high dose) -cardiac monitoring for the onset and/or progression of aneurysms -intravenous gamma globulin (IVIG) -anti-platelet therapy
CMs of DDH
-hip joint laxity (hip joint may feel unstable, with an increased range of motion, and a feeling of looseness) -shortening of limb -restricted abduction -unequal gluteal folds
athetoid CP CMs
-involuntary, uncontrolled movements -movements can affect the face, arms, and legs, and can make it difficult to maintain a stable posture or hold objects -may also have difficulty with speaking and swallowing
cyanotic heart lesions how does it effect lungs, how does it effect blood flow
-right to left shunting -deoxygenated blood bypasses the lungs and goes to the body -decreased pulmonary blood flow (tetralogy of fallot) -mixed blood flow (transposition of the great vessels), heart and lungs are separate, never mixing to get oxygenated blood
what characteristics of kids' anatomy cause them to be more susceptible to respiratory infections
-small oral cavities and large tongues -greater airway resistance -smaller and shorter airway -short distance from nose to lungs -lower amount and less effective cilia -Eustachian tubes are less angled
acyanotic heart lesions how does it effect lungs, how does it effect blood flow
-still getting oxygenated blood to the heart -left to right shunting -increase in pulmonary blood flow (atrial septal defect, ventricular septal defect, patent ductus arterioles) -obstruction to blood flow from ventricles, there is contraction somewhere that is making it hard to get oxygenated blood out (coarctation of aorta, aortic stenosis)
what is the most common childhood cancer
acute lymphoblastic leukemia
when is the highest rate of respiratory infections in kids?
3 months to 5 years
what is the median survival age of an individual with cystic fibrosis
42
turner syndrome
A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted -short stature, failure to grow
klinefelter syndrome
A chromosomal disorder in which males have an extra X chromosome, making them XXY instead of XY. -present with female-like physical features
fragile X syndrome
A genetic disorder involving an abnormality in the X chromosome, which becomes constricted and often breaks -large head circumference, long face, large ears, large testes -treat behavioral issues with tegretol/prozac
acute phase of Kawasaki disease
Abrupt onset -high fever, red eyes, bright red and chapped lips, strawberry tongue, oral mucosa irritation, rash, joint pain, and irritability -cardiac manifestations: myocarditis, decreased left ventricular function, pericardial effusion, and mitral regurgitation
acute lymphoblastic leukemia
begins in bone marrow, spreads to the blood, and then to organs typically occurs between ages 2-4 years, more common in males
Novolin N
Intermediate-acting insulin -generally reaches the bloodstream about 2 to 6 hours after injection, peaks 4 to 14 hours later, and is effective for about 14 to 20 hours
what is used to diagnose rheumatic fever
Jones Criteria 1. Evidence of prior Group B Strep infection (ASO or Anti-DNAse B tier) 2. Minor Criteria (fever and arthralgia) 3. Major Criteria (carditis, subcutaneous nodules, polyarthritis, rash, and chorea) -have to have two major or one major and two minor symptoms with a history of a recent strep infection
convalescent phase of kawasaki disease
No manifestations; however, lab values have not returned to baseline
bronchiolitis what is it, bacterial or viral, treatment
RSV -inflammation of bronchioles and increase in mucus production -if contacted within the first year of life, increases the risk of asthma -CMs: cough, sneezing, fever, wheezing, deep and rapid breathing, prolonged expiration -viral -mostly supportive care, mechanical ventilation and antivirals (for severe cases) -suction excess secretions
Novolin R
Regular or short-acting insulin -usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from 2 to 4 hours after injection, and stays in the blood for 4 to 8 hours
subacute phase of kawasaki disease
Resolution of fever; irritable, peeling skin; temporary arthritis, and it lasts until all signs and symptoms have disappeared
Which nursing intervention is appropriate for assessing neurovascular function in a child with a fractured limb? a. Checking capillary refill, color, and temperature of the affected limb. b. Encouraging the child to move the affected limb to promote circulation. c. Applying ice to the affected area to reduce swelling. d. Administering pain medication on an as-needed basis.
a
isotonic dehydration
Sodium and water are lost in approximately the same amounts -the most common type of dehydration seen in children
Which of the following interventions is most appropriate for a 6-month-old infant diagnosed with DDH? a. Placing the infant in a hip spica cast b. Encouraging weight-bearing activities c. Administering analgesics for pain relief d. Providing a passive range of motion exercises
a
Which of the following statements by Kevin's mother best indicates an accurate understanding of the treatment that has been planned for Kevin? a. "Kevin's medication, plus decreasing his environmental stimuli, will help him control his behavior." b. "If I can keep Kevin on a special restricted diet, he will outgrow his ADHD in 5 to 8 years." c. "Kevin's medication will make him behave appropriately and like other kids his age." d. "I am already looking forward to Kevin's puberty when his bothersome symptoms will disappear."
a
heart failure what is it, signs of left and right sided
The inability of the heart to adequately supply blood to meet the body's needs -left: tachypnea, dyspnea, nasal flaring and retractions, wheezing -right: systemic congestion, peripheral edema, ascites, hepatomegaly, jugular vein distension
clubfoot
a birth defect characterized by the inward and downward turning of the foot and ankle
asthma
a chronic inflammatory disorder of the airways -airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness -swelling of the lung tissue in the bronchioles causes air trapping, making it difficult for the child to exhale
mixed CP CMs
a combination of two or more types of CP
febrile seizures
a common type of seizure that occurs in children, usually between the age of 6 months to 6 years -are typically characterized by a quick rise in temperature, often less than 5 minutes, and are generalized, transient, and nonprogressive -EEG readings are usually normal within 2 weeks of the seizure
A 12-year-old child with a known history of type 1 diabetes mellitus is admitted to the pediatric intensive care unit with diabetic ketoacidosis (DKA). Which of the following interventions should the nurse prioritize during the initial management of the child's condition? a. Administer a bolus of 0.9% sodium chloride solution b. Administer rapid-acting insulin subcutaneously c. Administer sodium bicarbonate to correct acidosis d. Administer potassium supplements
a
A 6-month-old infant is diagnosed with congenital hypothyroidism. Which of the following nursing interventions is the highest priority? a. Administering levothyroxine as ordered b. Monitoring for signs of respiratory distress c. Providing education about the importance of thyroid hormone replacement therapy d. Assessing for signs of developmental delays
a
A 7-year-old child with a fractured leg is in traction. Which nursing intervention is essential for the care of this child? a. Monitor the child for the development of pressure ulcers. b. Limit the child's fluid intake to prevent edema. c. Encourage the child to move the affected leg to prevent stiffness. d. Administer pain medication on an as-needed basis.
a
An adolescent is brought to the emergency department after a severe head injury. Which of the following statements accurately describes the primary and secondary injuries that may occur with severe head trauma? a. Primary injury refers to the initial physical damage to the brain tissue, while secondary injury occurs due to physiological changes that occur after the initial injury. b. Primary injury refers to the physiological changes that occur after the initial injury, while secondary injury refers to the initial physical damage to the brain tissue. c. Primary and secondary injury both refer to the initial physical damage to the brain tissue. d. Primary and secondary injury both refer to the physiological changes that occur after the initial injury.
a
The nurse concludes that the teaching about sickle cell anemia has been understood when an adolescent with the disorder makes which statement? a. "I'll start to have symptoms when I drink less fluid." b. "I'll start to have symptoms when I have fewer platelets." c. "I'll start to have symptoms when I decrease my iron intake." d. "I'll start to have symptoms when I have fewer white blood cells."
a
What is the most common clinical manifestation of Legg-Calve-Perthes disease? a. Pain in the affected hip and groin area b. Swelling and redness in the affected hip c. Limited range of motion in the affected hip d. Fever and general malaise
a
What is the primary goal of treatment for a newborn with clubfoot? a. Correcting the foot deformity b. Preventing further deformity c. Reducing pain and discomfort d. Improving the child's ability to walk
a
Which nursing intervention is appropriate for a child with JIA? a. Encouraging bed rest to prevent joint damage. b. Administering nonsteroidal anti-inflammatory drugs (NSAIDs) as needed for pain relief. c. Administering steroids prophylactically to prevent uveitis. d. Encouraging high-impact physical activities to promote joint flexibility.
a
DKA what is it, CMs, treatment
a life-threatening condition that occurs when the body breaks down alternative sources of energy, such as ketones, due to the unavailability of glucose for cellular metabolism -the excess ketones produced are eliminated in urine (ketonuria) or by the lungs (acetone breath), which can result in a decrease in serum pH and the onset of ketoacidosis -CMs: excessive thirst, frequent urination, abdominal pain, vomiting, and altered mental status -treatment: fluid and electrolyte replacement, insulin administration, and monitoring for complications such as cerebral edema
spina bifida cystica
a more severe form of spina bifida that occurs when a sac or cyst forms on the baby's back, and it may contain spinal cord tissue and nerves -there are two types: meningocele and myelomeningocele
encephalocele
a neural tube defect that occurs when the brain tissue protrudes through an opening in the skull -this can result in a sac-like structure on the baby's head that contains brain tissue and cerebrospinal fluid
cerebral palsy (CP)
a nonprogressive, neuromuscular disorder that leads to impairment of motor function, especially that of muscle control, coordination, and posture -can cause abnormal perception and sensation; visual, hearing, and speech impairments; seizures; and cognitive disabilities -RFs: maternal infection, premature birth, shaken baby syndrome, meningitis, low birth weight -CMs: delayed milestones, abnormal muscle tone, abnormal reflexes, abnormal posture, balance and coordination problems, seizures, speech and language difficulties, intellectual disability
Legg-Calve-Perthes Disease
a rare condition that causes aseptic necrosis of the femoral head, which can be unilateral or bilateral -progresses through several stages, including synovitis, necrotic, fragmentation, and reconstruction -CMs: an intermittent painless limp, hip stiffness, limited range of motion, hip, thigh, and knee pain, shortening of the affected leg, and muscle wasting
extension posturing
a severe dysfunction at the level of the midbrain -it is demonstrated by a backward arching of the legs and arms, flexed wrists and fingers, an extended neck, a clenched jaw, and possibly an arched back
flexion posturing
a severe dysfunction of the cerebral cortex -it is demonstrated by the arms, wrists, elbows, and fingers flexing and bending inward onto the chest, and the legs extending and rotating internally
anencephaly
a severe neural tube defect that affects the development of the brain and skull -brain and skull fail to develop properly, resulting in a baby being born without parts of their brain and skull -Infants with anencephaly are usually stillborn or die shortly after birth
Which clinical manifestation of increasing intracranial pressure (ICP) will the nurse expect to assess in the 2-year-old diagnosed with meningitis? Select all that apply. a. Seizures b. Vomiting c. Hyperactivity d. Bulging fontanels e. Subnormal temperature f. Decreased respiratory rate g. Difficulty with speech h. Decreased blood pressure
a, b, f, g
The nurse is assessing clients during routine well-child visits. Which child is least likely to suffer from iron deficiency anemia? a. A 2-month-old formula-fed baby b. A 9-month-old exclusively breastfed baby c. A 2-year-old who consumes a large amount of milk d. A 3-month-old who was born prematurely
a. A 2-month-old formula-fed baby
A 2-year-old child is brought to the emergency department after the sudden onset of high fever, drooling, and respiratory distress. Which actions would the nurse perform? Select all answers that apply. a. Assess the child's temperature b. Start an intravenous line c. Draw a blood sample for a complete blood count and differential (CBC with diff) d. Examine the child's throat with a flashlight and tongue depressor for swelling. e. Assess the oxygen saturation, and administer an oxygen mask if it is less than 94%. f. Ask the parents to remain in the waiting room during examinations and interventions.
a. Assess the child's temperature b. Start an intravenous line c. Draw a blood sample for a complete blood count and differential (CBC with diff) e. Assess the oxygen saturation, and administer an oxygen mask if it is less than 94%.
Which transmission-based precautions would the nurse use when caring for a 4-year-old child admitted with pertussis? a. Droplets b. Contact c. Respirator d. Standard
a. Droplets
Which clinical manifestation will the nurse anticipate when providing care to a toddler who is diagnosed with acute lead poisoning? Select all answers that apply. a. Emesis b. Nausea c. Diarrhea d. Anorexia e. Hypophosphatemia f. Seizures g. Pica h. Irritability
a. Emesis b. Nausea d. Anorexia e. Hypophosphatemia f. Seizures g. Pica h. Irritability
Which of the following respiratory infections would require an antibiotic? Select all answers that apply. a. Streptococcal pharyngitis b. Mononucleosis c. Pertussis d. Viral otitis media e. Bronchiolitis f. Bronchitis
a. Streptococcal pharyngitis c. Pertussis
Which complications would the nurse recognize as associated with frequent episodes of otitis media in infants? Select all answers that apply. a. Mastoiditis b. Heart failure c. Hearing loss d. Gastroenteritis e. Bacterial meningitis
a. Mastoiditis c. Hearing loss e. Bacterial meningitis
The parents of a child who has just been diagnosed with hemophilia A ask the nurse what symptoms of bleeding they should look for in the future. Which symptoms would the nurse list? Select all answers that apply. a. Nosebleeds b. Blood in the urine c. Fast clotting of injuries d. Dark-colored tarry stools e. Frequent fevers f. Painful and swollen joints g. Easy bruising
a. Nosebleeds b. Blood in the urine d. Dark-colored tarry stools f. Painful and swollen joints g. Easy bruising
Which physiologic responses to bronchiolitis would the nurse expect to observe in the pediatric intensive care unit? Select all answers that apply. a. Wheezing b. Bradycardia c. Sternal retractions d. Nasal flaring e. Prolonged expiratory phase
a. Wheezing c. Sternal retractions d. Nasal flaring e. Prolonged expiratory phase
The assessment that would lead the nurse to suspect that a newborn infant has a ventricular septal defect is: a. a loud, harsh murmur with a systolic tremor b. cyanosis when crying c. blood pressure is higher in the arms than in the legs d. a machinery-like murmur
a. a loud, harsh murmur with a systolic tremor
Kawasaki disease what is it, who does it affect, contagious?, phases
acute systemic inflammatory illness in all blood vessels throughout the body (systemic vasculitis) -most often affects children younger than five years old - it is not contagious and will resolve on its own within 8 weeks -Three phases: acute phase, subacute, convalescent
pulmonary/aortic valve stenosis (PVS, AVS) cyanotic or acyanotic lesion, what is it, treatment?
acyanotic -PVS - narrowing of pulmonary valve or artery that results in obstruction of blood flow from ventricles -AVS - valve from heart to body does not open properly and causes a pressure build up -obstructive defects -can do balloon angioplasty to help open these up, or valve replacement if significant enough
ventricular/atrial septal defect (VSD, ASD) cyanotic or acyanotic lesion, what is it
acyanotic -VSD - hole in septum between right and left ventricle -ASD - hole in septum between right and left atria -increase in pulmonary blood flow -it is more pressure to push the blood out into the body than to push the blood back and forth through these holes -blood is oxygenated -pulmonary congestion
coarctation of the aorta cyanotic or acyanotic lesion, what is it
acyanotic -narrowing of the lumen of the aorta usually near the PDA -blood is effectively sent to the head, arms, and chest but then ineffectively sent to the lower part of the body -blood pressure in arms is higher than in lower extremities, bounding pulses in upper extremities, pink on top half of body and more blue on bottom half -obstructive defect -when this is suspected we do a 4 point BP test (get BP on all 4 extremities then compare them)
PDA (patent ductus arteriosus) cyanotic or acyanotic lesion, what is it, intervene?
acyanotic heart lesion -an unclosed hole that is connecting the aorta and pulmonary artery -this hole is present when the baby is still inside the mother so it can bypass the lungs (because it doesn't need oxygenated blood) -it is supposed to close when the baby is born so it can now receive oxygenated blood -you can sometimes hear this within the first couple days of an infant being born, but it can go away on its own sometimes -supposed to resolve on its own so we only intervene if it becomes severe and a problem for the child -intervene by fluid restricting, indomethacin, and then surgery if still not closed
treatment of CF
airway clearance therapies bronchodilator medication physical exercise aggressive treatment of pulmonary infections aerosolized antibiotics home intravenous antibiotic therapy
what are late signs of increase ICP
alterations in pupillary response, posturing (flexion and extension), bradycardia, decreased motor response, decreased response to painful stimuli, Cheyne-Stokes respirations, optic disc swelling, decreased consciousness, and coma
CMs of a child with severe fluid loss
altered mental status thready pulses decreased BP tachypnea
rheumatic fever/rheumatic heart disease
an inflammatory disease that occurs as a reaction to a group A beta-hemolytic streptococcus infection (GABHS), more commonly referred to as step throat - most common among late childhood and adolescents and can affect the joints, skin, brain, and heart -when it causes heart valve (most commonly the mitral valve) damage it becomes known as rheumatic heart disease
cystic fibrosis what is it, diagnostics
an inherited, autosomal recessive trait (both parents are carriers) -characterized by mucus glands that secrete excess amounts of "thick, tenacious mucus, which leads to mechanical obstruction of organs, an increase in the sodium and chloride content of sweat; and autonomic nervous system abnormalities -increased risk of infections -poor digestion of nutrients due to the prevention proteins needed for digestion from reaching the intestines -diagnostics: done 24-48 hours after birth, sweat chloride test (>60mEq is a (+) result) -no cure
mannitol
an osmotic diuretic that can be given by IV to decrease intracranial pressure and cerebral edema
neuroblastoma
arises from immature nerve cells in infants and young children (under 5) -often begins in the adrenal glands -more common in males -poor prognosis due to invasiveness -Symptoms include the impaired ability to walk, changes in eyes, pain in various locations of the body, diarrhea, and high BP
when can we start giving kids decongestants?
at 6 years
A 10-year-old child is admitted to the hospital with a diagnosis of type 1 diabetes mellitus. Which of the following nursing interventions is the highest priority? a. Providing education about carbohydrate counting b. Administering insulin as ordered c. Monitoring blood glucose levels d. Assessing for signs of hypoglycemia
b
A 16-year-old adolescent with cerebral palsy has difficulty communicating and expressing herself. The nurse is caring for the adolescent and wants to promote communication. Which of the following interventions would be most appropriate for this adolescent? a. Using sign language to communicate with the adolescent b. Providing a communication device with picture symbols and text c. Encouraging the adolescent to write down their thoughts and feelings d. Prescribing a muscle relaxant to decrease muscle tone and improve speech
b
A 3-month-old infant is brought to the pediatric clinic for a well-baby checkup. The nurse notes that the infant is underweight and not meeting developmental milestones. Which of the following factors may contribute to the infant's condition related to ACEs? a. Family history of diabetes b. Maternal use of tobacco during pregnancy c. Delay in receiving routine vaccinations d. Overfeeding the infant with formula
b
A 3-year-old child is brought to the emergency department with a febrile seizure. Which of the following is the priority nursing intervention? a. Administer antipyretics as ordered b. Check the child's airway and breathing c. Administer an antiepileptic medication d. Initiate seizure precautions
b
A nurse is preparing a teaching session for parents on the prevention of childhood hearing loss. What does the nurse identify as being the most common cause of hearing impairment in children? a. Congenital rubella b. Chronic otitis media c. Auditory nerve damage d. Congenital ear damage
b
A nurse is providing discharge teaching to the parents of a child who underwent surgery for DDH. Which of the following statements by the parents indicates a need for further teaching? a. "We'll make sure to keep our child's legs in the abduction brace as directed." b. "We know that we'll need to limit our child's physical activity for a few weeks." c. "We'll need to give our child pain medication regularly for the first few days after surgery." d. "We understand that our child will need to return for follow-up appointments with the orthopedic surgeon."
b
The nurse is caring for a child recovering from a tonsillectomy. Which fluid or food item should be offered to the child? a. Cold soda pop b. Green Jell-O c. Butterscotch pudding d. Cool cherry-flavored Kool-Aid
b
The parent of a child diagnosed with Reye syndrome asks the nurse what they can do to support their child's recovery. Which of the following should the nurse include in their response? a. Encourage the child to eat a high-fat diet to promote liver function b. Monitor the child for signs of dehydration and administer fluids as ordered c. Administer aspirin as needed to manage fever and pain d. Encourage the child to engage in physical activity to prevent muscle atrophy
b
The school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which statement, if made by a parent, indicates a need for further instruction? a. "It is extremely contagious." b. "Lesions most often are located on the arms and chest." c. "It is most common in humid weather." d. "It might show up in an area of broken skin, such as an insect bite."
b
Which action would the nurse be responsible for during a lumbar puncture for an 18-month-old toddler? a. Having the mother hold the child in her arms b. Keeping the child immobilized with restraints c. Collecting the aspirated drainage in a culture tube d. Maintaining the continuous flow of local anesthetic
b
Which medication is typically used to reduce intracranial pressure in children with severe head injuries? a. Antiepileptics b. Mannitol c. Narcotic analgesics d. Antibiotics
b
The nurse provides discharge instructions to the parents of a child who has undergone a tonsillectomy. Which statement indicates that the parents need further teaching? a. "I won't let her use a straw to drink." b. "Cherry milkshakes will ease the pain." c. "I shouldn't let her gargle for at least 10 days." d. "She'll be able to play with friends in 1 week."
b. "Cherry milkshakes will ease the pain."
A child is hospitalized and diagnosed with bacterial meningitis. What can the nurse anticipate will be included in the plan of care and treatment? Select all that apply. a. Ice packs to the back of the neck and feet to reduce body temperature b. Antibiotic therapy c. Administering tepid baths as needed d. Antiviral medications e. Acetaminophen
b. Antibiotic therapy c. Administering tepid baths as needed e. Acetaminophen
The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome? Select all that apply. a. Palpable distal pulse b. Capillary refill to an extremity of < 3 seconds c. Severe pain not relieved by analgesics d. Inability to move extremities e. Tingling of extremity
b. Capillary refill to an extremity of < 3 seconds c. Severe pain not relieved by analgesics d. Inability to move extremities e. Tingling of extremity
signs of increased ICP in infants
bulging fontanel (soft spot), separation of cranial sutures, irritability, restlessness, increased sleeping, high-pitched crying, poor feeding, setting-sun signs, and distended scalp veins
Which intervention is important in the care of a hospitalized toddler with cystic fibrosis? a. Discouraging coughing b. Performing postural drainage c. Encouraging active exercise d. Providing small frequent meals
b. Performing postural drainage
impetigo
bacterial skin infection characterized by isolated pustules that become crusted and rupture -dry, honey colored crust
An 8-month-old infant becomes hypercyanotic while blood is being drawn. What should be the nurse's first action? a. Assess for neurologic defects b. Place the child in the knee-chest position c. Begin cardiopulmonary resuscitation d. Prepare the family for imminent death
b. Place the child in the knee-chest position
An infant is admitted to the pediatric unit with bronchiolitis caused by a respiratory syncytial virus (RSV). Which interventions would the nurse expect to provide for the infant? Select all answers that apply. a. Limiting fluid intake b. Supplementing oxygen when SpO2 is 90% or less c. Instilling saline nose drops d. Beginning corticosteroids early e. Maintaining droplet precautions f. Providing epinephrine g. Nasal suctioning to remove mucus h. Administering inhaled bronchodilators
b. Supplementing oxygen when SpO2 is 90% or less c. Instilling saline nose drops e. Maintaining droplet precautions g. Nasal suctioning to remove mucus h. Administering inhaled bronchodilators
A 2-year-old child presents to the emergency department with a seizure that lasted for less than 5 minutes. The child's temperature is 103.1°F, and the mother reports that the child has had a fever for the past day. Which of the following is the most likely diagnosis? a. Epilepsy b. Meningitis c. Febrile seizure d. Encephalitis
c
A 7-year-old child fell from a tree and has an elbow dislocation with soft tissue injury. What is the priority nursing intervention? a. Administer pain medication as ordered b. Immobilize the affected arm in a sling c. Assess the neurovascular status of the affected arm d. Apply ice to the affected area
c
A child with sickle cell anemia is admitted with a vaso-occlusive crisis. What nursing intervention is not a priority? a. Pain management b. Fluid management c. Ambulation d. Warm packs
c
A newborn assessment shows a separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of ____. a. Microcephaly b. Fragile X syndrome c. Down syndrome d. Cerebral palsy
c
A nurse is caring for a newborn with developmental dysplasia of the hip. Which of the following assessments should the nurse prioritize? a. Assessing the newborn's weight b. Measuring the newborn's head circumference c. Checking the newborn's hip range of motion d. Assessing the newborn's heart rate
c
A nurse is providing discharge education for the parents of a child who has had a cast applied for a fractured arm. Which statement by the parents indicates a need for further teaching about cast care? a. "We should keep the cast dry and avoid getting it wet." b. "We should elevate the affected arm to reduce swelling." c. "We should let the child use the arm as much as possible to avoid stiffness." d. "We should check the skin around the cast for redness, swelling, or irritation."
c
The nurse must restart a peripheral intravenous (IV) infusion on a child. Which would the nurse do to promote the child's sense of security? a. Inform the child that it will feel like a bee sting b. Ask the child if the parents should leave the room c. Take the child to the treatment room for the procedure d. Tell the child that it is important to have a new IV started
c
What is the most common trigger for diabetic ketoacidosis in children? a. Overeating carbohydrates b. Excessive exercise c. Stress and illness d. Skipping insulin injections
c
What is the most important intervention for the management of diabetic ketoacidosis in children? a. Administration of oral hypoglycemic agents b. Monitoring of vital signs c. Intravenous administration of insulin and fluids d. Restriction of dietary carbohydrates
c
What is the primary goal of treatment for scoliosis in children and adolescents? a. To correct the curvature of the spine b. To alleviate pain and discomfort c. To prevent further progression of the curve d. To improve overall mobility and function
c
Which hormone deficiency is screened for in newborns to detect potential cases of diabetes? a. Cortisol b. Thyroxine c. Insulin d. Glucagon
c
Which nursing intervention is appropriate for preventing the development of osteomyelitis in a child with a fracture? a. Encouraging the child to move the affected limb to promote circulation. b. Applying heat to the affected area to reduce swelling. c. Administering prophylactic antibiotics as prescribed. d. Immobilizing the affected limb with a cast for a prolonged period.
c
Which nursing intervention would the nurse implement for an infant with a myelomeningocele awaiting surgical corrections of defects? a. Using disposable diapers. b. Performing neurologic checks above the site of the lesion. c. Placing the infant in the prone position. d. Washing the area below the defect with a nontoxic antiseptic.
c
Which of the following nursing interventions is most appropriate for a child with Legg-Calve-Perthes disease? a. Encouraging the child to participate in high-impact physical activities. b. Administering nonsteroidal anti-inflammatory drugs (NSAIDs) as needed for pain relief. c. Instructing the child to avoid weight-bearing activities on the affected hip. d. Applying heat to the affected hip for 20-30 minutes several times a day.
c
An infant is diagnosed with bacterial meningitis. Which of the following is a priority nursing intervention? a. Administering oral antibiotics b. Keeping the infant in a supine position c. Encouraging the infant to drink fluids d. Isolating the infant from other infants
d
Which parental statement would make the nurse consider further teaching for the parents of a 3-year-old child with cystic fibrosis? a. "We will need to carefully track our child's caloric intake." b. "Our child will need skin care after each bowel movement." c. "We'll have to move to a very warm climate." d. "Our child will be taking pancreatic enzymes with meals."
c. "We'll have to move to a very warm climate."
At which site would the nurse expect to find internal bleeding when assessing a 10-year-old boy with hemophilia who has fallen while playing on the playground? a. Epiphyses b. Cerebrum c. Abdomen d. Joints
d
do we do an electrocardiogram or echocardiogram if we suspect there is a heart defect?
echocardiogram because it is a mechanical defect not an electrical defect -can show were the defect is and how the blood is flowing through the heart
Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries
c. Atrial septal defect
Which nursing intervention is appropriate for a child with a suspected growth plate injury? a. Encourage the child to move the affected limb to promote circulation. b. Apply heat to the affected area to reduce swelling. c. Administer pain medication on an as-needed basis. d. Immobilize the affected limb with a cast or splint.
d
Which assessment findings would indicate a possible asthma exacerbation? Select all answers that apply. a. Fever b. Hypotension c. Tachycardia d. Wheezing e. Stridor
c. Tachycardia d. Wheezing
Which of the following children would most likely need an iron supplement? a. 5-year-old female b. 10-year-old female c. 13-year-old male d. 14-year-old female
d
development dysplasia of the hips (DDH)
congenital disorder where the hip joint fails to develop properly in newborns or infants -occurs when the ball and socket joint of the hip don't fit together correctly, causing the hip joint to be unstable or even dislocated -if left untreated, DDH can lead to pain, limited mobility, and arthritis later in life -treatment includes the use of a special harness or brace to hold the hip in the correct position while it develops
scabies
contagious, parasitic infection of the skin with intense pruritus -female burrows into epidermis to deposit eggs and feces -common in daycares -can treat with ivermectin
signs of respiratory failure in an infant
cyanosis (despite supplemental O2) increased respiratory effort gasping head bobbing 'see-saw' breathing stridor
Tetralogy of Fallot (TOF) cyanotic or acyanotic lesion, what is it
cyanotic -"tet" spells - when the O2 requirements exceed the blood supply (crying and feeding), will turn blue during crying and feeding -a combination of 4 defects that mix the blood flow (VSD, aorta overrides VSD, pulmonary stenosis, and right ventricular hypertrophy) -have some oxygenated blood but not as much as we need
transposition of the great vessels cyanotic or acyanotic lesion, what is it, how do they survive?
cyanotic -aorta is connected to the right ventricle instead of the left -pulmonary artery is then connected to the left ventricle instead of the right -there are two systems that do not intertwine -in one system blood flows from the body to the heart back to the body and the back to the heart, then other system goes out to the lungs and back to the heart on repeat -in order for the infant to survive they have to have a PDA or septal defect -this intertwines the systems -to keep that PDA open until surgery we can give prostaglandins -can give these kids 100% O2 and they can stay cyanotic
A 10-year-old child presents to the emergency department with symptoms of vomiting, lethargy, confusion, and seizures. The child's mother reports that the child had a recent viral illness and was given aspirin to treat a fever. Which of the following is the most likely diagnosis? a. Febrile seizure b. Meningitis c. Encephalitis d. Reye syndrome
d
A 14-year-old client with scoliosis has been admitted to the hospital for corrective spinal surgery. Which of the following nursing interventions would be most appropriate for this client during the postoperative period? a. Administering pain medication as needed b. Encouraging the client to walk around the unit as soon as possible c. Assisting with range-of-motion exercises for the arms and legs d. Monitoring the client's vital signs and respiratory status
d
A 3-month-old infant with cerebral palsy has difficulty with feeding and is unable to suck effectively. Which of the following interventions would be most appropriate for this infant? a. Recommending the use of a spoon or fork to feed the infant b. Referring the infant to a speech therapist for evaluation c. Encouraging the parents to feed the infant more frequently d. Prescribing a specialized feeding bottle with a soft nipple
d
A 6-month-old infant is diagnosed with cerebral palsy. The nurse notes increased muscle tone in the infant's legs and hips, which is causing spastic movements. Which of the following interventions would be most appropriate for this infant? a. Encouraging the infant to use a walker to promote mobility b. Prescribing a muscle relaxant to decrease muscle tone c. Recommending that the parents perform stretching exercises on the infant's legs d. Administering botulinum toxin A injections to the affected muscles
d
A 7-month-old infant was brought to the emergency department after falling from a crib. The infant has a bulging fontanel, irritability, and a high-pitched cry. Which of the following nursing interventions should the nurse prioritize? a. Administering pain medication b. Performing a head-to-toe assessment c. Placing the infant in a quiet, dark room d. Alerting the health care provider
d
A child with autism is hospitalized with asthma. The nurse should plan the care so that the ____. a. parents need not be at the hospital b. child is supported through the autistic crisis c. parents' expectations are met d. child's routine habits and preferences are maintained
d
A newborn infant is diagnosed with esophageal atresia. Which assessment finding supports this diagnosis? a. Slowed reflexes b. Passage of large amounts of frothy stool c. Diaphragmatic breathing d. Continuous drooling
d
A nurse is providing education to a client about the prevention of meningitis. Which of the following statements by the client indicates a need for further education? a. "I will avoid close contact with people who have meningitis." b. "I will wash my hands frequently to prevent the spread of infection." c. "I will get vaccinated against meningitis if recommended by my health care provider." d. "I will take antibiotics if I develop symptoms of meningitis."
d
Which vitamin is essential for preventing neural tube defects in newborns? a. Vitamin C b. Vitamin E c. Vitamin B12 d. Folic acid
d
Which treatment would the nurse anticipate for an infant admitted with acute laryngotracheobronchitis? a. Intravenous (IV) antibiotics and hydration b. Nasopharyngeal suctioning and antipyretics c. Antiviral medication and oxygen d. Corticosteroids and nebulized racemic epinephrine
d. Corticosteroids and nebulized racemic epinephrine
According to the Jones criteria, which of the following sets of symptoms would indicate a positive diagnosis of rheumatic fever? a. Carditis, fever, and an elevated WBC count b. Positive strep throat culture, arthritis, and chorea c. Recent scarlet fever, carditis, fever, and arthralgia d. Elevated C-reactive protein, carditis, and fever
d. Elevated C-reactive protein, carditis, and fever
Which statement must the nurse emphasize to the family when preparing a school-aged child with persistent asthma for discharge? a. A cold, dry environment is desirable b. Limits should not be placed on the child's behavior c. The health problem is gone when the symptoms subside d. Medications must be continued even when the child is asymptomatic
d. Medications must be continued even when the child is asymptomatic
When caring for a child with Kawasaki disease, the nurse should know which of the following? a. Aspirin is contraindicated b. Principal area of involvement is the joints c. Child's fever is usually responsive to antibiotics within 48 hours d. Therapeutic management includes the administration of gamma globulin and salicylates
d. Therapeutic management includes the administration of gamma globulin and salicylates
otitis media what is it, bacterial or viral, treatment
infection of the middle ear typically preceded by an upper airway infection that causes congestion and inflammation in the ear -causes obstruction of eustachian tube and a build up of fluid in middle ear -common in younger children -bacterial -antibiotics, acetaminophen
laryngotracheobronchitis what is it, bacterial or viral, treatment
inflammation of larynx, trachea, and bronchioles most common in young children -also known as croup -hallmark symptom is barking cough -can also hear inspiratory stridor on auscultation -dyspnea, tachypnea -viral -nebulized epinephrine, corticosteroids, and intubation (if severe)
epiglottitis what is it, bacterial or viral, treatment
inflammation of the epiglottis considered medical emergency -swelling of the epiglottis and surrounding structures leading to airway compromise -common in children who have not had their HIV vaccines -CMs: high fever, ST, hoarse voice, drooling, dysphagia, respiratory distress -do not put anything in their mouth -bacterial or viral -secure airway with intubation, antibiotics and corticosteroids -do not lay patient on back
bacterial meningitis what is it, CMs, treatment
inflammation of the protective membranes covering the brain and spinal cord caused by various types of bacteria -CMs: fever, headache, a stiff neck, and confusion -diagnostics: blood culture, CBC, LP culture of CSF -at increase risk for seizures -treatment: dexamethasone, antibiotics, analgesics
tonsillitis what is it, bacterial or viral, treatment
inflammation of tonsils most commonly seen in the school-age child -bacterial or viral -antibiotics, antipyretics, tonsillectomy
myelomeningocele
is the most severe form of spina bifida, and it occurs when the sac or cyst on the baby's back contains spinal cord tissue and nerves -can cause severe neurological problems, including paralysis, and surgery is required to repair the defect as soon as possible after birth
why are we hesitant to give steroids to children?
it can increase their risk of uveitis (inflammation in the eyes)
pediculosis
lice infestation itching and irritation of the scalp, as well as visible lice or nits on the hair shafts or scalp
CMs of a child with moderate fluid loss
listless, irritable mental status decreased pulses normal BP tachypnea
lantus
long-acting insulin -takes 6 to 14 hours to start working. There is a very minimal peak around 10 to 16 hours later. It stays in the blood for 20 to 24 hours
Novolog
rapid-acting insulin begins to work about 15 minutes after injection, peaks in about 30 to 60 minutes, and lasts as long as 5 hours
risk factors for a heart defect in the infant
maternal infection maternal substance abuse unmanaged diabetes FHx of congenital heart defect infant has down syndrome
mononucleosis what is it, bacterial or viral, treatment
mono (Epstein-Barr virus) -"kissing disease" because spread through saliva -after infection, child should refrain from participating in contact sports because the spleen becomes enlarged and it risks rupturing -CMs: fever, sore throat, exudative pharyngitis, rash, swollen lymph nodes, extreme fatigue, and hepatosplenomegaly -viral -rest, fluids, antipyretics, and a pain reliever (ibuprofen or acetaminophen)
osteosarcoma
most common bone cancer in children, typically 10-25 years -typically found in long bones (femur) -surgery, chemo, and amputation -Symptoms can be confused with growing pains, localized pain, palpable mass, limping, and progressive limited ROM
chest physiotherapy
most common in kids with cystic fibrosis -its mechanical percussion, vibration, or huffing -use gravity and positioning to loosen the secretions -do before meals or an hour after meals
spastic CP CMs
most common type -stiffness and tightness in the muscles, which can affect movement and cause difficulty with fine motor skills -can also cause difficulty with speech, swallowing, and breathing.
signs of increased ICP in children
nausea, headache, forceful vomiting, blurred vision, increased sleeping, an inability to follow simple commands, a decline in school performance, and seizures
inhalation therapy
nebulized aerosol therapy metered-dose/dry powder inhaler -used when kids are struggling to breath -encourage deep breathing
what kind of kids are at an increase risk of developing respiratory infections
premature daycare second hand smoke allergies chronic illnesses (cardiac defects) malnutrition
ataxic CP CMs
problems with balance and coordination, which can make it difficult to walk or perform precise movements -may also have tremors or shaking movements
what are the signs of hypoxia in an infant
restlessness tachypnea decreased SpO2 advantageous breath sounds cyanosis
signs of respiratory distress in an infant
retractions use of accessory muscles nasal flaring grunting anxiety tachycardia
type 1 diabetes CMs
polyuria, polydipsia, polyphasic, glycosuria
meningocele
occurs when the sac or cyst on the baby's back contains only cerebrospinal fluid and meninges -may not cause any neurological problems, but surgery is usually required to remove the sac
spina bifida occulta
occurs when the spinal cord and nerves develop normally, but the backbones (vertebrae) do not close completely -this may cause a dimple, tuft of hair, or birthmark on the baby's back, but usually does not cause any symptoms or disabilities
management of CP
physical therapy, occupational therapy, speech therapy, education, and recreation -medications: baclofen, diazepam, botulinum toxin A injections
manifestations of an acyanotic heart defect
slow growth get tired easy (feeding) developmental delays pale chest deformities tachypnea heart murmur unusual pulsations
lymphoma
starts in lymphocyte cells in the immune system -affects lymph nodes, lymph tissue, and then metastasized -good prognosis with radiation and chemo -There are two main types: Hodgkin's Lymphoma, Non-Hodgkin's Lymphoma -Symptoms include swollen lymph nodes in the neck, armpit, or groin, weight loss, fever, sweats, nonproductive cough, and weakness
how to we identify the difference between respiratory distress and respiratory failure
there is a change in mental status with respiratory failure
B-thalassemia major
this is characterized by an autosomal recessive disorder characterized by the reduced production of one of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with beta thalassemia major) -chipmunk faces
what is the best way to differentiate between viral and bacterial meningitis
through laboratory testing of cerebrospinal fluid (CSF) obtained through a lumbar puncture -In bacterial meningitis, the CSF will show elevated levels of white blood cells and bacteria, while in viral meningitis, the CSF will show elevated levels of white blood cells but no bacteria
when a child is becoming hypoxic what is our first priority?
to see if there is anything blocking the airways that we can suction out
stridor where do we hear it, on inhalation or exhalation
upper airways and on inhalation
Wilms tumor (nephroblastoma)
usually in one kidney typically found in children 3-4 years old -do not palpate the abdomen (risk of rupture and spread) -Symptoms include the swelling or lump in the belly, urinary retention and hematuria, anemia, fever, pain, nausea, poor appetite (more common in children with anomalies)
define respiratory failure
when the compensatory mechanisms are not longer able to sustain gas exchange
pertussis what is it, bacterial or viral, treatment
whooping cough -highly contagious infection can easily be prevented with immunizations (dTAP) -characterized by distinct sounding cough -CMs: LG fever, rapid coughing, high pitched inhalation with whoop sound, vomiting, cyanosis -bacterial -antibiotics, O2 therapy, suctioning -droplet precautions and high fowlers position