PEDIATRICS

A pediatric nurse is assessing children in a community outreach clinic. The nurse would expect an infants first primary teeth to erupt at age:

-The first 2 primary teeth (central incisors) usually erupt around the age of 7 months. -All primary teeth should be visible by 3 years of age.

The nurse is assessing a 7 year old patient and auscultates expiratory wheezes throughout the lungs. The nurse should administer which prescribed medication?

-Albuterol is a short acting beta agonist administered via nebulizer or metered dose inhaler. -Albuterol is the drug of choice for acute bronchospasms and bronchoconstriction.

A patient is taking tacrolimus after receiving a kidney transplant. Which of the following symptoms indicates that the patient is experiencing a side effect of this medication?

-Tacrolimus is an immunosuppressant used after organ transplants to reduce the risk of organ rejection. -Common side effects include infection, tremor, hypertension, hyperkalemia, decreased urine output and edema, headache, diarrhea, and hypophosphatemia.

A nurse is administering somatrem to a 7 year old patient. The patients mother asks about the purpose of this medication. Which of the following describes somatrem?

-Used to treat growth failure caused by hormone deficiency. -Somatrem is an analogue of growth hormone and is indicated only for the long term treatment of children with growth failure caused by a deficiency of endogenous growth hormone.

A patient has recently been prescribed to tetracycline for the treatment of acne vulgaris. The nurse should include which of the following in her teaching plan?

-Wear sunscreen for prolonged exposure to sunlight. A common side effect of tetracycline is photosensitvity. -The patient should be instructed to apply sunscreen before being exposed to the sun. -Food and milk will decrease the absorption of tetracycline. -Tetracycline is pregnancy category X and should not be taken while pregnant.

A 16 year old patient is prescribed erythromycin for the treatment of pelvic inflammatory disease. The nurse should instruct the patient to take the medication:

-All antibiotic prescriptions should be taken until completed to avoid the development of resistance. -The resolution of symptoms may occur long before the bacteria are eliminated, therefore, stopping the antibiotic before completion can lead to the infection not being completely resolved or the infection recurring. -Taking antibiotics with an antacid can result in decreased absorption and effectiveness. -Erythromycin can be taken with or without food.

Which of the following nursing actions would be inappropriate when caring for a child with HIV?

Offering large amount of fresh fruits and vegetables to improve immuoresponse. -HIV children are immunocompromised. -Giving of fresh fruits and vegetables will predispose them to microrganisms and pesticides. -AIDS is caused by infection with HIV, a retrovirus that produces lymphocytopenia.

A primipara mother has delivered a newborn baby with a cleft lip. While assessing the newborn, the nurse should be alert for which of the following at risk for being compromised?

-Because of the defect, the child may be unable to form the mouth around the nipple, thereby requiring special devices to allow for feeding and sucking. -Some infants having cleft lip have an accompanying deviated nasal septum that can impair air movement. -However, there is no mention of a deviated septum.

A 6 year old girl is admitted to the hospital with pneumonia. Her treatment includes inhalation therapy and postural drainage. Postural drainage should be scheduled at which time?

-Before meals. Postural drainage facilitates the removal of secretions. The procedure should be performed before meals, not after, to decrease the risk of vomiting. -If done after meals, the nurse should wait 2 hours to reduce the risk of vomiting.

A nurse is performing a developmental assessment on a 11 month old. Which of the following findings is of most concern?

-Birth weight should be tripled by 12 months and doubled by 6 months. -Ability to stand alone may happen at this age, but is usually accomplished by 20-24 months. -Head circumference larger than chest is normal for this age. -Most 11 month olds are unable to walk alone.

An X-ray confirms that the epiphyseal plate of a 10 year old is fractured. The nurse would anticipate that the damage may result in which of the following?

-Bone growth disruption. -The epiphyseal plates have a high activity of osteoblasts and is an important area of bone growth, therefore any disruption may result in bone growth disruption. -Increase in the length of long bones occurs at the epiphyseal plate, a cartilage cells grow away from the shaft, they are replaced by bone, thereby increasing bone length.

A 11 month old is brought to the ER for diarrhea and vomiting. The mother tells the nurse that her doctor said to "force fluids". She asks how much she should force the child to drink. How would you answer her?

"Forcing fluids is not forcing your child to drink plenty of fluids by to gradually give fluids frequently." -Forcing fluids doesn't literally mean forcing the child to drink plenty of fluids. -Excessive fluid intake may also contribute to diarrhea. -For a short time, infants are NPO to minimize the risk of vomiting. -After a short time, infants may be allowed small sips of clear fluid, an oral rehydration solution, or breast milk. -Gradually, the infants oral intake is increased, changing to soft then regular diet. -With patients with diarrhea, it is very important to regulate electrolyte and fluid balance by oral or IV rehydration therapy. -Diarrhea in infants is always serious because water accounts for 75% of infant body weight and infants have such a small extracellular fluid reserve that sudden losses of water exhaust the supply quickly.

A 13 year old girl who was diagnosed with structural scoliosis after a routine screening at school is being fitted with scoliosis brace. Which of the following statements by the patient indicates effective use of the brace?

"I look forward to taking this thing off to take my bath everyday." -The brace should be removed for only 1 hr per day for hygiene and skin care. -The patient will start by wearing the brace only a few hrs a day and gradually increase to 23 hours a day. -Wearing the brace only at night would be true only after radiologic studies indicate the spine has reached skeletal maturity. -The patient is then slowly weaned off the brace.

After receiving iron therapy, the pediatric patient is ready for discharge. Which of the following statements by the mother would indicate the need for further instruction?

"I shall encourage my child to eat yellow vegetables." -The mother needs additional teaching if she stresses the importance of intake of yellow vegetables to improve anemia. -Yellow vegetables are not good sources of iron. -Children are at high risk for iron deficiency anemia because they need more daily iron in proportion to their body weight than do adults. -Lean meats, whole grain beads, and fish are good sources of non-heme iron in vegetables.

The nurse is assessing a 5 month old girl who is confined due to congential clubfoot. The infant is scheduled for corrective serial casting. Which of the following deformities would be present?

-Inversion and adduction of the foot. In clubfoot, the infant will have inversion, adduction, and equinus (plantar flexion) of the foot and ankle. -The feet of many newborns turn in because of intrauterine position. This simple deviation needs no correction if the feet can be brought into the midline position by easy manipulation.

A 5 year old with HIV is planning to begin school in the fall. His parents informed the nurse that they do not plan on telling the school about their sons HIV status. What response by the nurse would be most appropriate?

"It is your right to maintain confidentiality." -A patient has the legal right to withhold their HIV status from the school. -Health care workers cannot break patient confidentiality by informing a school of a persons illness. -HIV is a sexually transmitted infection and will not spread via airborne or droplets so, face masks are not required.

The nurse is assessing a 4 month old suspected of having cerebral palsy. Upon initial interview, which of the following statements by the mother would indicate that the infant may have cerebral palsy?

"My baby cannot lift her head up, she is floppy." -Hypotonia is an early manifestation of cerebral palsy. -The infant should be able to support their head by age 4 months. Infants with cerebral palsy may also have an irregular posture, muscle stiffness, and spasticity. -By age 6 months, the infant should be able to roll over. -Sitting up without support also begins around 6 months. -Tilting of the hip is an indication of hip dysplasia.

A nurse is making her plan of care for a patient with an atrial septal defect. Upon assessment, the nurse expected to find:

-A murmur is heard over the pulmonic area because of the extra amount of blood crossing the pulmonic valve makes it close consistently later than the aortic valve. -The second heart sound will be split and fixed. -Dyspnea and fatigue occur due to being shunted away from the systemic circulation and into the pulmonic circulation. -An ASD is an abnormal communication between the 2 atria, allowing blood to shift from the left to the right atrium. -A child with a loud machine murmur, poor feeding, and fatigue is characteristic of patent ductus arteriosus.

The nurse is caring for an 8 year old with increased ICP. Which statement by the parent would indicate the need for the nurse to reinforce the purpose for elevating the head of the bed 15 to 30 degrees?

"When the head is raised it reduces the risk of blood clots." -DVTs are prevented with the use of anti-coagulation, compression stockings, sequential compression devices, and exercise. -Having the head of bed at 15 to 30 degrees will not affect the risk for lower extremity thrombosis. -This statement by the parent indicates the need for further teaching. -A patient with an ICP SHOULD have their bed elevated to 15-30 degrees for optimal outcome. -This will help increase venous outflow, which decreases ICP. -Elevating the head of the bed too much can decrease cerebral perfusion pressure, causing hypoxia and ischemia.

child with a history of seizures, controlled with an anticonvulsant, is brought to the clinic. His mother states that he has been very sleepy. To correct this, she reported that she cut his anticonvulsant dosage in half. How would you respond to the mother?

"Your should not change the dosage without talking tot he physician first." -Anticonvulsants often cause drowsiness, interfering with daily activities. -Anticonvulsants should not be stopped or reduced without consulting the physician, as this may increase the risk of seizures. -Anticonvulsant dosages should be tapered, never stopped suddenly, because the body becomes dependent on it. -Rapid withdrawal may precipitate a seizure.

The physician orders lidocaine-prilocaine cream to apply to the patients skin before IV insertion. How long before the IV insertion should the nurse apply the cream?

-1-2 hrs. Lidocaine-prilocaine cream reaches satisfactory dermal analgesia levels 1 hr after application. -It reaches its maximum after 2-3 hrs. -It should be applied at least 1 hr before the insertion of an IV catheter. -For some patients, it can be applied 2 hrs before needle insertion to provide maximum relief.

A 5 month old girl is admitted to the hospital with chronic constipation, foul smelling, ribbon like stool and abdominal distention. Upon assessment, the nurse suspects Hirschprung disease. The diagnosis is confirmed if a barium enema reveals:

-A barium enema is generally ordered to confirm the diagnosis. -On x-ray film, the barium will outline a narrow, nerveless distal colon with proximal dilation. -An abnormal dilation of the colon is called megacolon.

To confirm the diagnosis of acute lymphoblastic leukemia, the nurse would prepare the patient for which of the following tests?

-A bone marrow biopsy is performed to confirm the diagnosis of leukemia through the examination of abnormal calls in the bone marrow. -With ALL bone marrow overproduces immature lymphocytes and soon becomes unable to continue normal production of other blood components. -ALL is the most common type of leukemia in children. -A lumbar puncture is performed to detect invasion into the CNS, but is not used to confirm the diagnosis. -An abnormal CBC may suggest leukemia, but it is not used to confirm the diagnosis. -A blood culture may be performed if infection is suspected.

After a cleft palate repair, why should the use of a drinking straw be avoided?

-A child with cleft palate repair should not use a straw because it or any sharp object could tear the suture line. -Feedings are resumed shortly after surgery to improve nutritional status. -It is important that no tension is placed on the suture. -When the child begins eating soft food, he or she should not use hard utensils, because the child will invariably put it against the roof of the mouth and possibly disrupt the sutures.

A 3 year old is admitted to the hospital suspected of having congenital heart disease. Which of the following assessment findings is most likely to be seen?

-A child with congenital heart disease is likely to have activity and exercise intolerance. -The child often self limits activity and takes frequent rest periods. -Other signs and symptoms include shortness of breath, cyanosis, heart murmur, under developed muscles, poor feeding, and respiratory infections.

A 18 month old girl is admitted to the hospital with acute laryngotracheobronchitis. She is placed in a mist tent with compressed air. Which of these symptoms would be an early sign of hypoxia?

-A child with laryngotracheobronchitis is placed in a mist tent primarily to increase O2 and CO2 exchange. -Early signs of hypoxia include restlessness, headache, fatigue, shortness of breath, and cyanosis. -Laryngotracheobronchitis or croup is the inflammation of the larynx, trachea, and major bronchi. -Barking cough is a sign of croup.

A 6 month old infant is seen in the ER for dehydration related to vomiting. Upon assessment by the nurse, which of the following clinical assessments would develop by a child with a 12% fluid loss?

-A fluid loss of 10% or more indicates severe dehydration. -In addition to the signs and symptoms that develop during mild and moderate dehydration, the child would develop signs of shock. -This includes hypotension, cool and mottled extremities, capillary refill of greater than 3 seconds, and lethargy.

A nurse is preparing a blood transfusion for an anemic toddler. Which of the following blood transfusion matches would cause a hemolytic reaction?

-A negative blood to a B negative patient. -A hemolytic reaction occurs with a Rh or ABO incompatibility. -The Rh factor is the presence of proteins on the cell, which is what the bosy reacts to. -Rh negative blood can donate to Rh positive blood if its the same type, because there are no protein. -O negative is the universal donor, because it does not have A or B properties, and A and B blood types do not have O antibodies. -AB patients can receive both A and B blood types, as long as there is a Rh compatibility.

A 9 year old male is diagnosed with Wilms tumor. Which of the following would the nurse expect to note as the most common symptom?

-Abdominal mass. Wilms tumor, or nephroblastoma, is a malignant tumor of the kidneys. -It typically occurs in children and has a high survival rate. -The most common symptom is an asymptomatic abdominal mass, which occurs in 80% of patients. -Other common symptoms may include hematuria and abdominal pain.

A 15 month old boy is seen at the outpatient department for a fever. His mother says that 3 days ago her child had a cough and runny nose. She also observed him pulling on his right ear. Based on these findings, the nurse should suspect?

-Acute otitis media generally follows a respiratory infection, either bacterial or viral. -Children often have rhinitis and perhaps a low grade fever for a number of days. -Suddenly they will have a high grade fever and a sharp constant pain in one or both ears. -Older children can verbalize reports of pain. -The infant becomes extremely irritable and frequently pulls or tugs at the affected ear in an attempt to gain relief from pain. Inflammation of the middle ear is the most prevalent disease of childhood after respiratory tract infections. -Acture otitis externa is inflammation of the external ear canal. -Sinusitis is inflammation of the sinuses.

A 10 year old girl is diagnosed with asthma. Which of the following statements by the parents indicates a need for additional home care teaching?

-Additional teaching is needed if the family states that the child with asthma should avoid exercise to prevent attacks. -Children with asthma should be encouraged to exercise as tolerated. -If exercise induces asthma exacerbation's, then a short acting beta agonist should be used 15 minutes before exercise. -Asthma is a chronic, obstructive airway disease characterized by inflammation and bronchoconstriction. -It is caused by a spasm of the bronchial tubes or the swelling of the bronchial mucosa after exposure to various stimuli. -Identifying triggers, using a bronchodilator before inhaler, and increasing fluid intake are appropriate measures for asthma management.

When providing postoperative care for a child with a cleft palate, the nurse would place the child in which of the following positions?

-After a cleft palate, the child should be places lying on their side to facilitate drainage and maintain a patent airway. -While in recovery, the child is placed on its abdomen to facilitate drainage as this is more effective drainage than side lying. -Infants with a cleft palate cannot suck effectively because pressing their tongue or a nipple against the roof of their mouth could force milk up into their pharynx, leading to aspiration. -If the child is placed in the supine position, he or she may aspirate. -Trendelenburg will increase the risk of aspiration.

Following enucleation of a patient with retinoblastoma, it is important for the nurse to do which of the following nursing actions?

-After enucleation, the surgeon will insert an implant in the empty socket. -Bright red drainage would indicate hemorrhage. -Enucleation is the removal of the eye. -Enucleation is performed where there is no chance of preserving vision in the affected eye. -There will be no pupil reactivity in the affected eye, it has been removed and replaced with an implant.

While caring for a child after undergoing a tonsillectomy, the child should be placed in what position to help facilitate drainage of secretions?

-After surgery, place the child in the prone or side lying position. -This allows blood and unswallowed saliva to drain from the childs mouth rather than back to the pharynx where it may be aspirated. -A tonsillectomy is the removal of all or part of the tonsils in the pharynx. -Chronic tonsillitis is the main indication for removal of tonsils.

While assessing a newborn, the nurse suspects the presence of phenylketonuria. Which of the follow tests would confirm the diagnosis? .

-All newborns receive a heel stick to test the serum for several metabolic disorders. -The tandem mass spectrometry can measure the levels of several amino acids to confirm the presence of PKU. -The Guthrie test was once the only method used to measure the serum phenylalanine levels, but is frequently being replaced with tandem mass spectrometry. -Liver enzyme analysis can be done to measure the activity of phenylalanine hydroxylase, but this is generally not done. -Urinalysis can detect ketones in the urine of a child with PKU, however, this does not confirm the diagnosis

Which of the following defects refers to the incomplete closure of the umbilical ring, resulting in the protrusion of the omentum and intestine through the opening?

-An umbilical hernia is a protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord. -This creates a bulging protrusion under the skin at the umbilicus. -Umbilical hernias occur most frequently in African American children and more often in girls than in boys. -The structure is generally 1 to 2 cm in diameter but may be as big as an orange when children cry or strain. -If the defect is more than 2 cm, surgery for repair will generally be indicated to prevent intestinal strangulation or intestinal obstruction. -This is usually done when the child is 4-6 years of age. -Inguinal hernias result from incomplete closure of the tube between the abdomen and the scrotum, leading to the descent of a portion of the intestine. -Non communicating hydroceles have residual peritoneal fluid trapped within the lower segment of the processus vaginalis. -A communicating hydrocele is commonly associated with hernias because the processus vaginalis remains open from the scrotum to the abdominal cavity.

A patient has been taking levocabastine ophthalmic drops, an antihistamine, for the treatment of allergic conjunctivitis. Which of the findings indicates that the patient is experiencing a side effect to this medication?

-Antihistamine eye drops most commonly cause headache. -Other side effects include burning, rhinitis sinusitis, blurred vision, and pruritus. -Diplopia, tinnitus, and orange tears are not associated with the use of antihistamine eye drops.

An 18 year old has been diagnosed with asthma. The nurse is providing patient education and warns the patient not to use which medication?

-Aspirin blocks the COX-1 enzyme, decreasing prostaglandin release and causing the overproduction of leukotrienes. -This results in allergy like effects and an asthma axacerbation. -Patients affected by aspirin induced asthma are also sensitive to all NSAIDs.

Carrie, a 5 year old with an umbilical hernia is transferred to the post operative care unit. The priority nursing responsibilities for postoperative care include:

-Assess for hemorrhage. If the hernia is more than 2 cm, surgery for repair will generally be indicated to prevent intestinal strangulation or intestinal obstruction. -This is usually done when the child is 4-6 years of age. -After surgery, the child returns with a pressure dressing, which remains in place until the sutures are well healed. -It is necessary to frequently check the wound site for any sign of hemorrhage.

After undergoing a surgical resection of the femur due to osteogenic sarcoma, the nurse should immediately:

-Assess for neurologic and circulatory function. -After a bone resection, the patient is at risk for circulatory and neurological impairment due to swelling. -The nurse should assess the extremity for warmth, pulses, capillary refill, sensation, and motor function. -Surgical resection of an osteogenic sarcoma usually involves the entire bone and joint. -The resected bones and joints are replaced with a metal prostheses, allograft, or some other device. -Anti emetics should be given if the patient is suffering from nausea, but this is not a priority immediately after a major surgery. -Pain is expected after surgery and is less pertinent than perfusion to the distal extremity.

A 10 year old male is admitted to the hospital with a fracture of the left femur. The patient is placed in skeletal traction for 2 days. The nurse immediately suspects peripheral neurovascular impairment due to:

-Assess neurovascular status of left lower extremity, including temperature, color, pulses, edema, and capillary refill. -Compare findings with the unaffected extremity. -Children in traction need to be assessed carefully for neurovascular impairment, as do children in casts. -The extremity in traction should be checked every 15 minutes during the first hour, hourly for 24 hours, and every 4 hours thereafter for any signs of pallor, coldness, tingling, absent peripheral pulse, edema or pain.

A child has just returned to the surgical floor after undergoing a tonsillectomy. Which of the following actions is most appropriate?

-Assess the childs swallowing pattern. After a tonsillectomy, the patient is at high risk for hemorrhage in the first 12-24 hrs postpartum. -The nurse should inspect for signs of hemorrhage, such as increased frequency of swallowing, blood on the oropharynx, and nausea.

The nurse is caring for a child scheduled for surgery due to osteogenic sarcoma. Which of the following interventions should be implemented?

-Avoid bearing weight on the affected leg. -Children with osteogenic sarcoma should not bear weight on the affected extremity while waiting for tests or surgery. -The bone is weak due to the aggressive tumor and weight may cause the bone to fracture. -Massaging and exercising the leg may place too much pressure on the weakened bone. -Tumors are highly vascular, therefore, the area may be inflamed and feel warm. -Using warm compresses will increase inflammation and pain.

The nurse is caring for a 2 year old with acute otitis media. Which of the following instructions should be included in the teaching plan for the parents of the child?

-Avoiding contact with people who have upper respiratory infections. -Acute otitis media generally follows a respiratory infection, it is important to avoid contact with people having upper respiratory infections. -Inflammation of the middle ear is the most prevalent disease of childhood after respiratory infections. -There is a higher incidence of acute otiits media in formula fed infants than those who are breast fed because of the more slanted position that formula fed infants are held in while feeding. -This allows milk to enter the Eustachian tube. -Most cases of acute otitis media are caused by bacteria and treated with antibiotics such as amoxicillin. -If the infection is viral, antivirals are reserved for severe cases only.

A first time mother rushed her 3 day old neonate to the ER for diarrhea and vomiting. She thinks that her first breast milk, which is yellowish in color, is the cause of her child's condition. She asks the nurse if she could feed her baby with formula milk instead of breast milk. How should you answer her?

-Breastfeeding may actively prevent diarrhea by providing more antibodies and an intestinal environment less friendly to invading organisms. -Colestrum is a thin, watery, yellow fluid composed of protein, sugar, fat, water, minerals, vitamins, and maternal antibodies. -For the first 3 or 4 days after birth, colostrum production continues.

A 9 year old diagnosed with leukemia is also being treated for epilepsy. The physician prescribes carbamazepine 100 mg PO twice per day. The nurse should question this order because:

-Carbamazeoine causes bone marrow suppression. -In a patient with leukemia, bone marrow suppression is already a concern, and the use of carbamazepine could worsen her condition.

The parents of a 15 year old with cystic fibrosis want to go on an extended vacation in the Caribbean. What anticipatory guidance should the nurse give the adolescent and her parents?

-Caution parents to keep their children from overexertion or heat exposure. -If children with CF become overheated, especially in places with humid temperature like the Caribbean, they begin to lose excessive sodium and chloride through perspiration and become dehydrated. -Encourage parents to offer water frequently and to prevent overexertion. -Cystic fibrosis is a chronic disorder of the endocrine glands characterized by abnormally thick secretions. -Cystic fibrosis affects the pancreas, respiratory system, gastrointestinal tract, salivary glands, and reproductive tract. -Parents of a child with cystic fibrosis, regardless of vacations in the -Caribbean need to assume a great deal of responsibility for the care of their child and familiarize themselves with the childs care.

When planning care for a 10 month old infant with dehydration, which of the following interventions would be the most accurate for monitoring hydration status?

-Changes in weight is the most objective method to measure volume depletion. -An acute loss or gain of weight reflects the loss or gain of fluid. 1 kg in acute weight loss reflects 1 liter of fluid loss.

An 8 month old infant recently had a seizure and is lethargic and bradycardia upon arriving at the ER. The X-ray result revealed a retinal hemorrhage. The nurse suspects that the child is showing signs and symptoms of:

-Characteristic signs of shaken baby syndrome include retinal hemorrhages, multiple fractures of long bones, and subdural hematomas. -There is usually no external signs of injury. -Risk factors for parents include substance abuse, unrealistic expectations for the child, and high levels of emotional stress. -If there is a fall or bump to the head, a possible finding could be mastoid fracture, but it is not shown in this situation.

The nurse observes the formation of new lesions on a patient suspected of having chickenpox. What necessary infection control precautions must the nurse implement?

-Chicken pox is contagious 1 to 2 days before the appearance of lesions and up to 6 days after all the lesions have crusted over. -The nurse must isolate the patient to prevent transmission to other patients. A private room with negative pressure must be provided for the patient. -Chicken pox is an airborne infection. A non immune nurse should wear a respirator mask. -A regular surgical mask will not protect against airborne viruses. -A nurse with acquired immunity (either through immunization or natural disease) does not have to wear a respirator mask. -Wearing gloves is necessary when coming in contact with the patient.

A toddlers parents ask the nurse how long the child is required to use a front facing car seat. How should the nurse respond?

-Children should use a front facing car seat from about age 2 until he or she weighs 40 pounds. -Booster seats should be used after the child outgrows a car seat until the child is 4 foot 9 inches tall. -At age 8 and/or 4 foot 9 inches, the child should use a regular seat belt.

The nurse is assessing a child with a high grade fever. The childs mother tells the nurse that she will dress her child warmly if she has a fever and chills. Which of the following is a correct response form the nurse?

-Children with a fever should wear one layer of light clothing. -Do not bundle up, because this increases the childs temperature. -Dressing a warm clothing will not comfort the child and will not prevent chills, but it will increase the child's temperature. -Parents should be instructed NOT to use clod baths or ice. -The child may be placed in a lukewarm bath to slowly lower the temperature.

The nurse is caring for a newborn diagnosed with esophageal atresia and a tracheoesophageal fistula. Symptoms characteristic of this condition include:

-Choking and coughing when being fed and unexplained cyanosis. -The initial feeding of a newborn will reveal the presence of an esophageal atresia with a tracheoesophageal fistula. -The infant will begin to choke and cough since the normal route for swallowing is not present. -The abnormality will also cause excessive drooling by the infant and cyanosis. -Esophageal atresia is when the esophagus terminates in a blind pouch and does not connect to the stomach. -Also, there is a fistula that connects the stomach to the trachea, leading to aspiration.

Which of the following should be avoided if the neonate has hypospadias?

-Circumcision should be delayed until after surgical repair because the foreskin is used for grafting. -Hypospadias refers to the condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface of the penile shaft.

The parents of a 9 year old patient were informed by the nurse that asthma attacks may occur spontaneously or in response to a trigger. Which of the following common irritants might trigger an asthma attack?

-Common triggers of an asthma attack include dust mites, animal dander, mold, perfumes, allergens, infections, stress, exercise, chemicals, and smoke. -Asthma is a chronic, obstructive airway disease characterized by inflammation and constriction of the airway. -It is caused by a spasm of the bronchial tubes or the swelling of the bronchial mucosa after exposure to various stimuli.

A newborn baby with myelomeningocele is scheduled for surgical closure within 24 hrs. The main reason for surgical repair is to do which of the following?

-Minimize infection and prevent further damage to the spinal cord and roots. -Surgery for neural tube disorders is done as soon after birth as possible (usually within 24 to 48 hrs) to reduce the risk of infection through the exposed meninges and to prevent further damage to the nervous tissue.

The nurse is caring for a patient with an autistic disorder. Upon assessment the nurse records that the child has a labile mood. Which of the following symptoms suggest a labile mood?

-Crying suddenly followed immediately by giggling and laughing. -Children with autistic disorders often have a labile mood. -They also may react with over responsiveness to sensory stimuli, such as light or sound. -The impairment in communication is shown in both verbal and nonverbal skills. -Language may be totally absent. If a child does speak, grammatical structure may be impaired, such as the use of "you" when "I" is intended.

A 5 week old boy is admitted to the hospital for pyloric stenosis. While assessing the infant, the nurse is likely to note which of the following?

-Early after birth an infant with pyloric stenosis begins to regurgitate or occasionally vomits. -As obstruction of the pylorus continues, the vomiting becomes projectile. -Projectile vomiting is the most common symptom of pyloric stenosis. -The pyloric sphincter is the opening between the lower portion of the stomach and the beginning portion of the intestine, the duodenum. -If hypertrophy or hyperplasia of the muscle surrounding the sphincter occurs, it is difficult for the stomach to empty, a condition called pyloric stenosis.

The nurse is assessing a 5 year old diagnosed with hemolytic uremic syndrome (HUS). Which of the following signs and symptoms are associated with this disease?

-HUS is a disease characterized by hemolytic anemia, thrombocytopenia, and acute renal injury. -It is generally caused by a gastrointestinal infection such as E coli. -Blood diarrhea and fever develops, followed by symptoms of hemolytic anemia such as fatigue and low urine output due to acute renal injury. -Other signs and symptoms include hematuria, hypertension, edema, abdominal pain, and encephalopathy.

A teenager is prescribed a hormonal oral contraceptive. Which of the following findings indicates to the nurse that the patient is experiencing a serious side effect?

-Heat and swelling of the right lower extremity. -Patients taking hormonal oral contraceptives have a 3 to 5 times higher risk of venous thromboembolism than those not taking hormonal contraceptives. Signs of a venous thrombosis include swelling, warmth, pain, tenderness, and redness in the affected area.

While assessing a 15 year old girl, the nurse notes enlargement of the lymph nodes. Which of the following laboratory and diagnostic study findings will confirm Hodgkins lymphoma?

-Hodgkins disease is confirmed by biopsy of the lymph nodes with microscopic examination. -Blood tests are also ordered to assess function of major organs and safety for chemotherapy. -Lymphomas are malignancies of the lymphocytes, causing uncontrolled proliferation. Lymphomas usually present as a solid tumor on lymphoid tissue.

A 6 month old infant with hydrocephalus is admitted to the hospital due to an enlarged head circumference, bulging fontanels, and sunset eyes. What is the priority nursing care?

-Hydrocephalus can cause an increase in ICP. -To prevent complications of increased ICP, the nurse should assess for; frontal bossing, dilated scalp veins, diplopia, vomiting, tense fontanels, irritability, decreased level of consciousness, and changes in vital signs. -Increase in ICP can cause brain stem compression, which could result in respiratory or cardiac failure.

The nurse is assessing a neonatal boy. Upon assessment, the nurse notes that the urethral opening is at the lower aspect of the penis. Based on these findings, the nurse is correct to suspect which of the following disorders?

-Hypospadias refers to the condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface of the penile shaft and is generally corrected with surgery. -Cryptorchidism is undescended testes in newborns that generally descend by the first year of life. -Epispadias refers to the condition in which the urethral opening is located on the dorsal or superior surface of the penis.

The nurse is assessing a patient suspected of having Hodgkins lymphoma. The nurse would expect to note lymphadenopathy in which most common area?

-In Hodgkins lymphoma, lymphadenopathy is seen in the cervical nodes (60-80%), axilla nodes (20%), and inguinal nodes (20%). -Other signs and symptoms of Hodgekins lymphoma include the presence of Waldeyer ring (in the throat, occipital area, or epitrochlear area), splenomegaly, hepatomegaly, superior vena cava syndrome, and CNS symptoms.

A 3 year old boy is rushed to the hospital. Laboratory and diagnostic findings reveal a brain lesion. Which of the following is considered the most common assessment finding associated with a brain tumor?

-In children with a brain tumor, the most common symptom is a headache. -The headache associated with a brain tumor usually occurs on arising in the morning. -It may be intermittent because of pressure changes related to position and the ability of the cranium to expand to some degree. -Brains tumors take up space within the cranium and increase ICP.

A 4 year old child is assessed by the nurse. The child has fair skin, musty odor from the urine, stunted growth, and intellectual disability. Based on this findings, the nurse should suspect which of the following metabolic disorders?

-In untreated children with phenylketonuria (PKU), the hallmark of the disease is intellectual disability. -Other characteristics include fair skin, abnormal gait and posture, stunted growth, and urine with musty odor. -PKU is an autosomal recessive metabolic disorder. -Absence of the liver enzyme phenylalanine hydroxylase prevents conversion of phenylalanine, an essential amino acid, into tyrosine. -As a result, excessive phenylalanine builds up in the blood stream and tissues causing permanent damage to brain tissue. -Branched-charin ketoaciduria, or maple syrup urine disease, causes an inability to break down branched chain amino acids, leading to a buildup of waste products.

The nurse is administering inhalation therapy to a child with pneumonia. Inhalation therapy is expected to achieve which of these effects?

-Inhalation therapy, depending on the medication used will reduce the viscosity of secretions and promotes the action of cilia. -This will promote gas exchange in the alveoli. -Inhalation therapy can also dilate the airway and reduce inflammation. -The susceptibility to pneumonia is affected by the viscosity of mucus gland secretions in the respiratory tract.

The nurse is caring for a patient suspected of having hemophillia. Which of the following tests would the nurse expect to be ordered to confirm the diagnosis?

-Specific clotting factor assays will be done after a platelet count, aPTT, and PT are done for screening. -Clotting factor assays must be done to confirm diagnosis.

A 3 year old girl is diagnosed with thalassemia major. The long term complications seen in a child with thalassemia major are related to which of the following?

-Iron overload. Thalassemia major may lead to lethal iron overload. -Thalassemia causes an abnormal production of a protein responsible for iron absorption. -In addition, patients require frequent blood transfusions with iron rich RBCs. -Iron overload is the biggest threat to patients with thalassemia. -Thalassemia major is a genetic disorder that causes a decrease in hemoglobin formation. -Thalassemia major in children can cause symptoms of anemia, such as pallor, fatigue, weakness, irritability, and dyspnea. -The child may require frequent blood transfusions and chelation treatment to prevent iron overload.

A 16 year old girl is seen in the ER with intermittent episodes of loose stools and recurrent dull, crampy abdominal pain felt at the periumbilical area. Based on the assessment, what disorder is most likely?

-Irritable bowel syndrome causes either intermittent episodes of loose and normal stools or recurrent abdominal pain. -Irritable bowel syndrome or chronic nonspecific diarrhea appears slightly more often in girls than in boys. -The cause is unknown, but it is associated with low fat intake (without fat slowing absorption, stool passes rapidly through the bowel). -Excessive fluid intake also may play a role. The episodes of diarrhea may occur several times a week, or as frequently as twice a day.

A 7 year old African American boy complains of fever, swelling of hands and feet and yellow sclera. He is diagnosed with sickle cell disease. What is the cause of tissue damage found in children with sickle disease?

-Ischemia from obstructed circulation. RBCs become characteristically elongated and crescent shaped (sickled) when they are exposed to low oxygen tension, a low blood pH, or increased blood viscosity, such as occurs with dehydration. -These abnormally-shaped cells become trapped when trying to transverse capillaries which reduces blood flow to vital organs. -When RBCs sickle, they do not move freely through vessels. -Stasis and further sickling causes blockage, ischemia, and tissue hypoxia, resulting in acute pain and cell destruction. -The resulting tissue damage is caused by hemolysis of abnormally shaped RBCs resulting from abnormal hemoglobin properties originating from a genetic mutation - not simply deoxygenated blood cells. -RBCs originally begin with adequate O2 until the cell misshapen - this due to tension or stress.

The nurse observes the formation of new lesions on a patient suspected of having chickenpox. What necessary infection control precautions must the nurse implement?

-Keep the patient in isolation. Wear gloves when providing skin care to the patient. -Non-immune staff are required to wear a respirator mask. -Chicken pox is contagious 1 to 2 days before the appearance of lesions and up to 6 days after all lesions have crusted over. -The nurse must isolate the patient to prevent transmission to other patients. -A private room with negative pressure must be provided for the patient. -Chicken pox is an airborne infection. A non-immune nurse should wear a respirator mask. N95 of higher. -A regular surgical mask will not protect against airborne viruses. A nurse with acquired immunity (either through immunization or natural disease) does not have to wear a respirator mask.

A 6 month old infant is found to have mild diarrhea accompanied by cramping at the lower abdomen after being breast fed. Based on these findings, what is the most likely cause?

-Lactose intolerance is the inability to digest lactose due to a deficiency in lactase. -Secondary lactose intolerance can be caused by injury to the small intestine while primary lactose intolerance is genetic and cannot be treated. -Some children become lactose intolerant after diarrhea and will need a lactose free formula for rehydration before being returned to the usual formula or breast milk.

An infant with clubfoot will have his final cast removed today. Which member of the health care team can the nurse expect to be consulted?

-Leg, foot, and ankle exercises are important to improve the strength and motion of the infants lower extremities. -A physical therapist should be consulted to develop an exercise plan for the patient.

The nurse is preparing to administer 6 units of Lispro before breakfast. How many minutes before meals should the nurse administer this type of insulin?

-Lispro is a rapid acting insulin with an onset of 15 minutes. -Clinical trials demonstrate the optimal time for preprandial administration is 15 minutes, rather than the 30 minute interval used for regular insulin.

A 17 year old patient with scoliosis is being cared for by a nurse. Which of the following will be most difficult for this patient?

-Looking different from her friends. -Peer influence is strong during adolescence. -A physical deformity may be viewed as abnormal. Therefore, the patient needs help with coping.

The nurse is assessing an 8 year old boy suspected of having Rocky Mountain spotted fever. Which of the following signs and symptoms would the nurse expect to find?

-Maculopapular rash that begins on the wrists and ankles and spreads centripetally. -Rocky Mountain spotted fever starts with a fever, usually within a few days of a tick bite. -Along with a headache and mylagia, a maculopapular rash develops 2-6 days after the onset of a fever. -The rash first appears in the wrists and ankles, then spreads centripetally to the trunk. -Rocky mountain spotted fever is the most common rickettsial disease seen in the US and is transmitted by ticks. It can be a life threatening illness if undiagnosed or untreated.

A 10 year old male is admitted to the acute care facility after having a tonic-clonic seizure. What priority nursing action would the nurse do immediately after the seizure?

-Maintain a patient airway with the child lying on his side until he is alert and responsive. -The first priority nursing action is to maintain a patent airway with the child lying on his side. -The side-lying position reduces the risk of aspiration. -Respiratory distress may indicate aspiration. This should be prevented by using the side-lying position.

A child is brought to the ER with a high fever, photophobia, and a headache. What important sign would the nurse use to check for meningeal irritation?

-Meningeal irritability is assessed by eliciting a positive Brudzinski's and Kernig's signs, as well as an inability to flex the neck forward (nuchal rigidity). -Brudzinski's sign: after forced flexion of the neck there is a reflex of the hip and knee and abduction of the leg.

A 3 month old is admitted to the hospital with severe diarrhea for 3 days. The child has a fever, sunken fontanels, and dry skin. She is to receive nothing by mouth, only IV fluids. To prevent circulatory overload while she is receiving IV therapy, it is essential to take which of the following measures:

-Monitoring the rate of IV flow. -It is essential to maintain the prescribed rate of flow to prevent circulatory overload while assessing the infants response to treatment. -Dehydration of any cause may be a life threatening situation in infants. Initial therapy is directed toward restoring extracellular fluid volume. -Rectal temperature is often elevated, both pulse and respiration's are weak and rapid, skin is pale and cool, and the infant may appear apprehensive and lethargic. -Dehydrated infants have depressed fontanels, sunken eyes and poor skin turgor. Urine output will be scanty and concentrated.

A woman with HIV recently gave birth to a baby boy. She asked the nurse why her baby is infected. Which of the following can be a reason for transmission from the mother to the child?

-Mother to child transmission of HIV can occur through the placenta, during delivery, and through breast milk. -HIV positive mothers should take antiretroviral medications throughout pregnancy and should avoid breastfeeding. -Infants are then administered antiretrovirals to lower the risk.

A child with myasthenia gravis complains of difficulty with chewing and facial movements. The physician orders neostigmine to improve muscle tone. What time should the patient take this medication to improve muscle tone while chewing?

-Neostigmine has a half life of only 50 minutes, so it should be taken about 30 minutes before meals to improve tone of the muscles of mastication. -Neostigmine is an acetylcholinesterase inhibitor. It prevents the breakdown of acetylcholine to increase activation of nicotinic and muscarinic receptors, leading to muscle contraction.

The nurse determines that teaching about sudden infant death syndrome has been effective when the patients mother states:

-No definite cause of death is found at autopsy. -SIDS is the term used to describe sudden, unexpected death of any infant for whom a postmortem exam fails to determine the cause of death. -Recent findings suggest an increased incidence of SIDS in infants who sleep in the prone position. -Prematurity, low birth weight, exposure to smoke or drugs, non breastfed, sharing a bed with parents, and exposure to mold all increase the risk of SIDS. -Genetic disorders and breast feeding do not increase the risk of developing SIDS. -Respiratory distress syndrome does not cause SIDS.

The nurse is caring for a child with congestive heart failure. Which of the following indicates the child and her parents are following the prescribed medical regimen?

-Normal weight for age demonstrates adequate nutritional intake and lack of edema (from too much fluid intake). -Diuretics may be administered to decrease edema, thus reducing preload and afterload. -Daily weights are a good way to gauge the diuretics effectiveness. -Be certain that children are weighed at the same time, with the same scale, in the same clothing every day so measurements are accurate and any weight loss can be noted easily.

A 2 year old boy has an elevated lead level in his blood and urine. His treatment includes the administration of a chelating agent, edetate calcium disodium. Before the first dose of the chelating agent is given, which of these actions by the nurse is important?

-Observe urine output. Chelating agents bind to heavy metals, making them nontoxic and allow them to be eliminated in the urine. -Measuring intake and output will ensure that kidney function is adequate to handle the lead being excreted. -If kidney function is not adequate, chelating agents may lead to nephrotoxicity or kidney damage. -Lead interferes with red blood cell function by blocking the incorporation of iron into the protoporphyrin compound that makes up the heme portion of hemoglobin in red blood cells. -Kidney destruction may also occur causing excess excretion of amino acids, glucose and phosphates. -One of the effects of excessive lead levels is encephalopathy. -The child has symptoms of lethargy, impulsiveness and learning difficulties.

When developing a plan of care for a patient with cystic fibrosis, which of the following must the nurse keep in mind?

-Obstruction of the exocrine glands occurs. -Cystic fibrosis is characterized by the abnormal transport of chloride and sodium across epithelium. -This leads to thick, viscous secretions. -Exocrine glands become obstructed due to the inability of the thick secretions to move. -Cystic fibrosis affects the exocrine glands of the pancreas, lungs, liver, and intestines. -Cystic fibrosis is an autosomal recessive disorder. -Sweat contains an elevated level of sodium due to abnormal chloride and sodium transport.

A 14 year old adolescent with moderate cognitive impairment is admitted for knee surgery. During the rehabilitation period, the nurses first nursing action is to:

-Obtaining info about the adolescents usual routine helps in providing suggestions in modifying the hospital routine. -Maintaining a normal routine helps minimize the amount of stress to which the adolescent is exposed and helps her adjust to hospitalization. -Using the childs own personal care items is important to help promote a more familiar, routine environment for self-care. -However, the childs normal routine needs to the assessed to adapt the hospital routine appropriately.

The nurse is assessing a 3 year old suspected of having retinoblastoma. Which of the following is the most common finding in a child with retinoblastoma?

-On examination, the childs pupil appears white (red reflex is absent) or described as a "cats eye". -Retinoblastoma is a rare malignant tumor of the retina. -It is usually diagnosed before the age of 5 and the cure rate is one of the highest among all childhood cancers.

A 6 month old boy is diagnosed with cryptorchidism. He is scheduled for surgery. What surgical intervention will the nurse prepare the child to correct the condition?

-Orchiopexy is a surgical procedure for undescended testes. The testicle is manipulated into the scrotum and sutured in place. -Children with cryptorchidism may be given chorionic gonadotropin hormone to stimulate testicular descent, but this therapy is not always successful and surgery may be required. -Orchiectomy is removal of the testis due to malignancy. -Aclerotherapy is an injection of a drug to decrease the size of blood vessels. -Meatotomy is a surgical repair of a split penile glans.

A 5 year old is prescribed fulfamethoxazole/trimethoprim for the treatment of otitis media. Which severe adverse reaction is most common in drugs containing sulfa?

-Stevens-Johnson syndrome is a rare hypersensitivity reaction often caused by antibiotics, most frequently sulfa-containing drugs such as sulfamethoxazole, a sulfonamide. -Stevens-Johnson syndrome is a life-threatening condition in which call death causes the epidermis to separate from the dermis.

A newborn baby is diagnosed with a neural tube defect, specifically, meningocele. Which of the following definitions most accurately describes meningocele?

-Out-pouching of the meninges through the cranium or vertebre. -A meningocele, a type of spina bifida, is a sac that contains meninges and CSF protruding outside the vertebrae. -The spinal cord is not involved and therefore, there is usually no long term neurological damage. -The meningocele appears as a protruding mass at the center of the lumbar region. -The protrusion may be covered by a layer of skin or only a clear dura matter. -Myelomeningocele is a herniation of the spinal cord, meninges, and CSF into a sac that protrudes through a defect in the vertebral arch. -The nerves are often exposed and at risk for developing meningitis.

A patient has been prescribed pancrelipase due to pancreatic insufficiency. The nurse should instruct the patient:

-Pancreatic enzymes are enteric coated to avoid gastric irritation. The patient should swallow whole and not chew or crush the medication. -Pancreatic enzymes should be taken with every meal to aid digestion.

The nurse is discharging a 5 year old that underwent a tonsillectomy. What important instruction should the nurse give to the child's parents to prevent further complications?

-Parents need careful instruction concerning the danger signs of hemorrhage (frequent swallowing, clearing the throat, increasing restlessness). -The most dangerous period for the child after a tonsillectomy are the first 24 hrs, when the clots covering the denuded surgical area are forming, and days 5 to 7, when the clots begin to lyse or dissolve. -If new granulation tissue is not yet present when the clots dissolve, hemorrhage from the denuded surface can occur.

A nurse is admitting a 14 year old patient with tuberculosis. Which of the following should be included in the patient education?

-Patients diagnosed with tuberculosis must be in isolation for 2 weeks. -After 2 weeks, the patient is no longer contagious. The patient will have to take multiple drugs for at least 9 months. -The patient will always test positive, even after treatment. -The patient could relapse if he is under stress or sick.

The nurse is discharging a child with sickle cell anemia after treatment for a sickle cell crisis. Which of the following, if stated by the parents, indicates the need for further instruction?

-Patients with sickle cell anemia should get adequate fluid intake to prevent dehydration, especially in hot weather and during activity. -Dehydration, infection, and acidosis can trigger a sickle cell crisis. -The child needs adequate rest in order to reduce stress and illness. -Children with sickle cell anemia need to be followed closely at regular health care visits. -The parents should bring their child in at the first sign of infection to prevent complications. -Children should attend regular school activities except contact sports which would result in rupture of an enlarged spleen.

A physician prescribes acetaminophen, 200 mg every 6 hrs for a 12 month old child who weighs 8 kg. The bottle concentration is 100 mg/ml and has a maximum dosage of 60 mg/kg/day. What should the nurse do next?

-Pediatric dosing of acetaminophen should not exceed 60 mg/kg/day, which is equivalent to 480 mg for this patient. -The prescribed dose was 800 mg a day. -Hence, the physician should be notified and the dose should be changed.

Angela, a 3 year old, is rushed to the ER due to cyanosis precipitated by crying. Her mother notes that after playing she gets tired easily. She is diagnosed with tetralogy of Fallot. The immediate nursing intervention for cyanosis is:

-Place her in the knee chest position. -With tetralogy of Fallot, there is a ventricular septal defect that causes a right to left shunt. -This results in deoxygenated blood entering the systemic circulation. -When a child squats or is in the knee chest position, the pressure in the left side of the heart decreases, resulting in less deoxygenated blood being shunted to the left side of the heart. -Next action of the nurse is to administer O2 and morphine sulfate to reduce O2 demand and increase O2 supply.

After the corrective casting is done, an infants congenital club foot is exposed to potential problems. Which of the following is an appropriate nursing diagnosis for her?

-Potential for alteration in tissue perfusion. -Like all casts, clubfoot casting can cause vascular compromise and diminished perfusion. -The parents of the infant should be taught the signs and symptoms of vascular compromise. -Correction is achieved best if it is begun in the newborn period. -A cast is applied while the foot is placed in a corrected position. -Although the deformity involves the ankle, the cast extends above the knee to ensure firm correction. -There is a potential for alteration in skin integrity, but this is not harmful as altered tissue perfusion.

A 4 year old boy is admitted and diagnosed with acute glomerulonephritis. The nurse understands that the patient is experiencing complications of the disease when:

-Presence of adventitious lung sounds may indicate the presence of fluid in the lungs, which can be a result of fluid overload. -An elevated leukocyte count is expected with glomerulonephritis since the disease can be due to the presence of a streptococcal infection.

The nurse is caring for a 14 year old girl with scoliosis and a curvature greater than 50 degrees. The patient underwent a posterior spinal fusion with implants. Postoperatively, the priority nursing action to prevent complications is:

-Prevent neurologic deficit. Perform a neurovascular assessment of the lower extremities frequently. -Assess the lower extremities for warmth, sensation, movement, and pulse strength. -Neurologic dysfunction may result from bleeding or compression caused by a bone particle dislodged during the spinal fusion. -An indwelling catheter is in place for 24 hrs because voiding may be difficult due to the horizontal position that must be maintained.

The nurse is caring for a 3 year old toddler diagnosed with cerebral palsy. What teaching measures to prevent contractures should the nurse reinforce to the toddlers parents?

-Preventing contractures is important to maintain motor function. -Contractures can be prevented with the use of leg braces, passive exercises, and active exercises. -These exercises can be incorporated into play activities. -Children need to learn self care measures so they can gain self esteem from accomplishing these tasks and achieve optimal independence.

The parents of a 3 year old ask the nurse what are the defects associated with tetralogy of Fallot. The correct response by the nurse is: It is called a tetalogy because 4 anomalies are present:

-Pulmonary valve stenosis, ventricular septal defect (usually large ), overriding of the aorta, and hypertrophy of the right ventricle. -Because of the pulmonary stenosis, pressure builds up in the right side of the heart. -Blood then shunts from this area of increased pressure into the left ventricle and the overriding aorta (Aortic opening is directly over the septal defect). -The extra involved to force blood through the stenosed pulmonary artery causes the 4th deformity, hypertrophy of the right ventricle.

A child is admitted to the hospital with croup. The nurse expects the physician to order which nebulizer treatment?

-Racemic epinephrine acts on adrenergic receptor sites, causing a reduction in airway inflammation and edema. -It is most commonly used in croup and when stridor is present. -Ipatropium is an anticholinergic used for the treatment of asthma and chronic obstructive pulmonary disease. -Salmeterol is a long acting beta agonist used for the treatment of asthma and chronic obstructive pulmonary disease. -Theophylline is a xanthine derivative used to treat apnea of prematurity and sometimes chronic obstructive pulmonary disease or asthma.

The nurse is caring for an infant admitted with gastroesophageal reflux. Which of the following symptoms is an early indication that the infant has gastroesophageal reflux?

-Regurgitation occurs almost immediately after feeding or when the infant is laid down after a feeding. -If the reflux is large, the infant does not retain sufficient calories and will fail to thrive. -Gastroesophageal reflux is a neuromuscular disturbance in which the lower esophageal sphincter and the lower portion of the esophagus are lax and allow regurgitation of gastric contents into the esophagus.

The nurse is caring for a child with rubella. Which of the following should the nurse include in the care plan?

-Rubella causes joint pain, fever, headache, and a rash. -Acetaminophen can be used to reduce the fever and relieve joint pain.

A 14 year old girl has returned to the nursing unit after undergoing an appendectomy. To help relieve her discomfort and facilitate drainage, the nurse should place her in which position?

-Semi-Fowlers position. After an appendectomy, some patients have a Penrose drain inserted. -To facilitate drainage and improve comfort, the patient should be placed in low to semi-Fowlers with the knees flexed. -The appendix, a pouch attached to the cecum, may become inflamed after an upper respiratory or other body infection, but the cause of appendicitis is generally obscure. -In some instances, fecal material enters the appendix, hardens, and obstructs the appendix lumen. -Inflammation and edema develop, leading to compression of blood vessels and cellular necrosis.

A 9 year old boy is rushed to the ER after falling from his bicycle. While assessing the child, the nurse should observe the extremities closely for which of the following signs and symptoms of a fracture?

-Signs and symptoms of a bone fracture include deformity, edema, pain, and muscle spasms. -Fever may be associated with a fracture if an infection develops.

An 8 year old child is seen at the clinic with complaints of pain, pustular drainage of the eyes and sensitivity to light. Upon assessment you observed reddened watery eyes. Based on the initial data, these symptoms are indicative of:

-Signs and symptoms of all types of conjunctivitis include watery eyes with reddened conjunctiva and sensitivity to light. -Bacterial conjunctivitis involves one or both eyes, has mucopurulent drainage, grittiness of the eyes, crusting, and may cause the eye lids to stick together. -Viral conjunctivitis involves one or both eyes, is often associated with a respiratory infection, and causes watering and itching. -Allergic conjunctivitis occurs in both eyes, involves itching and a foreign body sensation. -Opthalmia neonatorum is conjuncitvitis of a newborn after being exposed to gonorrhea or chlamydia in the birth canal. -Stye is an infection of the sebaceous sweat glands of the eye. -Keratitis is inflammation and infection of the superficial layers of the cornea.

To ensure optimum care for a patient with acute glomerulonephritis, the nurse priority intervention should include:

-Sodium and fluid intake should be limited due to edema and fluid retention. -Glomerulonephritis comprises a specific set of renal diseases that causes inflammation and proliferation of glomerular tissue. -Acute glomerulonephritis is often caused by a streptococcal infection such as impetigo or strep throat.

A patient taking doxycycline for the treatment of acne vulgaris is experiencing many side effects. To alleviate the most common side effect, the nurse should instruct the patient to do which of the following?

-Take the medication with meals. Doxycycline frequently causes GI upset and nausea. -The patient can take the medication with meals to alleviate these side effects. -Taking doxycycline on an empty stomach can worsen GI symptoms. -Remaining flat after administration can also worsen symptoms. -The patient should avoid prolonged exposure to sunlight due to the risk of photosensitivity.

The nurse is inspecting a 4 year old mouth at a routine office visit. The child should have how many teeth?

-The average child should have all 20 primary teeth by the age of 3 years. -Each child varies, but by the age of 4 years, the child should have all of their primary teeth. -Permanent teeth start to erupt around age 6. There are 32 permanent teeth (including the wisdom teeth).

The nurse is caring for a 10 year old girl diagnosed with meningitis. This nurse would expect which of the following symptoms?

-The common triad of symptoms in adults is fever, neck stiffness, and mental status changes. -However, this only occurs in 44% of adults with meningitis and in ever fewer children. -Fever, headache, photophobia, nausea, vomiting, lethargy, and irritability are the most common symptoms in children.

A child is admitted to the hospital after accidentally consuming a bottle of acetaminophen. The nurse would expect to observe which clinical manifestations of acetaminophen poisoning?

-The early signs and symptoms of acetaminophen poisoning include nausea, vomiting, diaphoresis, and anorexia. -This is followed by elevated liver enzymes and bilirubin.

A 7 month old infant suspected of cerebral palsy is being assessed by the nurse. Which of the following activities, as stated by the patients mother, indicates the possible presence of cerebral palsy?

-The infant is unable to roll over. In cerebral palsy, damage to the motor centers of the brain cause abnormal muscle tone, reflexes, and motor skills. -The infant should be able to roll over by 6 months of age. Not reacting or moving to a loud or startling stimulus may be a problem with sensory organs. -A child should be able to use a spoon by 13-20 months of age.

A 3 year old girl is seen in the ER for aspirating a coin. Upon assessment, the child has a violent cough, dyspnea, and choking. Chest X-ray reveals the presence of a radiopaque object. The child undergoes a bronchoscopy in order to remove the coin. After the procedure, the nurses first action is:

-The most common complications after undergoing a bronchoscopy are bronchospasms and hypotension related to sedation. -Bronchospasms can cause airway obstruction and lead to respiratory failure, hypoxia, and hypercapnia. -Bronchoscopy is the insertion of a bronchoscope down the airway to visualize the lungs and remove foreign objects, obtain biopsies, and stop bleeding. -A less critical, but important nursing action is to assess for a gag reflex. -Once the gag reflex has returned, the child may resume a diet after passing a bedside swallow test.

A 8 year old is prescribed clindamycin for the treatment of osteomyelitis. Which of the following symptoms indicates to the nurse that the patient is having an adverse reaction?

-The most common side effects of clindamycin include diarrhea, abdominal pain, nausea, and vomiting. -High doses, both oral and IV can cause a metallic or bitter taste.

A nurse has given home care instructions to the parent of a child with head lice. Which of the following statements indicates that the instructions are correctly understood?

-The parent should be advised that anyone can get lice. -Since it is transmitted from one person to another, all family members should receive treatment. -The child does not have to be contained once treatment is completed. The shampoo is a pediculocide. -Head lice are parasites, not bacteria.

The physician just applied a cast to a 6 year old with a broken leg. Which of the following should the nurse do first?

-The skin surrounding the cast should be cleaned before the maternal dries to the skin. -The cast should not rest on hard surfaces. Instructing the patient on proper cast care should be completed, but is not the top priority at this time.

Which of the following actions should be included in the teaching plan for the parents of a preschool aged child with pediculosis capitis?

-The teaching plan should include measures for eliminating the infestation and preventing its spread. -This is done by machine washing all clothing and linens in hot water for at least 30 minutes. -Medicated shampoo is the preferred treatment.

A 4 month old infant is brought to the hospital for recurrent vomiting. The child is diagnosed with gastroenteritis. To decrease vomiting, the child should be NPO for approximately how long?

-To decrease vomiting, withholding food and fluid for a time (NPO), depending on the age of the child. On the average, 3-6 hr are usually sufficient. -If there is nothing in the stomach, vomiting cannot occur. -More than 6 hrs is too long to withhold any food or milk. -This would compound the problem by adding to the dehydration and malnutrition.

Which of the following is the priority nursing action to minimize risk of infection for a child with skeletal traction?

-To minimize the risk of infection at the pin sites, perform pin site care according to the institutions policy. -Adhere to standard precautions and use aseptic technique. -Pin site care helps keep the area clean.

When developing a teaching plan that focuses on initial prevention of rheumatic fever, which of the following instructions should the nurse include?

-Treating streptococcal throat infections with antibiotics. -A course of antibiotics should be given to a child with strep throat, impetigo, and tonsillitis to prevent rheumatic fever. -Ibuprofen or corticosteroids are prescribed to reduce inflammation and joint pain, but will NOT prevent rheumatic fever.

The nurse is caring for a teenager recently diagnosed with celiac disease. When providing discharge instructions, the nurse should tell the patient to avoid:

-Wheat. The basic problem in celiac disease is a sensitivity or immunologic response to protein, particularly the gluten factor of protein found in wheat, rye, oats, and barley. -When children with celiac disease ingest gluten, changes occur in the intestinal mucosa that prevents absorption of foods across the intestinal mucosa. -Rice, cheese and milk do not contain gluten.

An infant with secondary lactose intolerance is being discharged. The nurse should instruct the mother to avoid feeding the infant which of the following?

-With lactose intolerance the child is unable to consume any dairy products or diarrhea and abdominal pain will develop. -The infant will need to be introduced to a lactose free formula initially before slowly returning dairy milk to the diet. -Most infant formulas are milk based and should be avoided by those with lactose intolerance. -The foods to which a baby is allergic or intolerant can pass from through the mothers breast milk. -In some cases, removal from the mothers diet of the foods to which the baby is allergic or intolerant, for example cows milk products, can sometimes help. -When the cause of the damage to the gut is removed, for example by taking the food to which a breastfed baby is allergic out of the mothers diet, the gut will heal, even if the baby is still fed breast milk.

An 11 year old complains of severe pain after an appendectomy. The physician orders fentanyl 25 mcg I.V., every 2 hrs as needed. How soon after administration can the patient expect to feel relief?

1 minute. -Fentanyl when administered IV has an onset of 1 minute, a peak of 3-5 minutes, and a duration of 30-60 minutes.

A toddler has an infection with an elevated temperature. The nurse is preparing to administer acetaminophen elixir, every 4 hours. If the maximum daily dosage of acetaminophen is 60 mg/kg and the patient weighs 22 lb, which of the following dosages is acceptable?

80 mg every 4 hours. -The maximum daily dose for this patient s 600 mg, or 100 mg every 4 hours. -Since this is the maximum safe dose, effectiveness can still be achieved with a lower dose while increasing patients safety. 80 mg every 4 hours is equivalent to 480 mg per day. 22 lb = 10 kg 10 kg X 60 mg/kg = 600 mg per day maximum. 600 mg/6 doses = 100 mg per dose maximum

A child comes to the ER with RLQ pain and vomiting. Which of these test results, if elevated, would be indicative of acute appendicitis?

80-85% of patients with appendicitis have an increased WBC count (leukocytosis). An increase in neutrophils always occurs.

The parents of a 7 year old with Cystic Fibrosis are concerned about having another child and passing their affected genes to their future children. Which of the members of the health care team should the nurse refer the parents to?

A genetic counselor is specially trained in genetic disorders and can provide the parents with education, screening, and treatment options.

An 8 year old with rheumatic fever is being discharged from the hospital. The nurse would expect the physician to describe which type of medication to prevent the recurrence of rheumatic fever?

Antibiotics. -Rheumatic fever is caused by Streptococcus pyogenes bacteria. -To prevent the recurrence and potential complications like endocarditis, the patient needs to be on long term antibiotic treatment. -Antiarrhythmics and anti emetics are not needed for the treatment of rheumatic fever.

A 3 year old boy is found choking by his mother after ingesting an earring. His mother immediately rushes him to the hospital. What emergency measures should the nurse do for a child who has aspirated a foreign object?

Abdominal thrusts. -A series of upward abdominal thrusts are recommended for children and adults. -Infants should receive alternating back blows and chest thrusts. Aspiration occurs most frequently with infants and toddlers. -When a child aspirates a foreign object, the immediate reaction is choking and hard, forceful coughing. -Usually, this dislodges the object. However, the airway may become completely obstructed and require intervention. -A finger sweep should ONLY be done on an unconscious patient if an object is visible. Never perform a blind finger sweep.

A 6 year old is scheduled for brain surgery for the removal of a tumor. What preoperative nursing intervention is a priority?

Administer stool softeners as prescribed. -Before and after brain surgery, the child should receive stool softeners with bowel movements. -Straining will increase intracranial pressure.

A child is receiving chemotherapy after surgery for a neuroblastoma. Which of the following nursing interventions can help prevent or reduce nausea and vomiting during chemotherapy?

Administering an antiemetic 30 minutes before chemotherapy. -Antiemetics counteract nausea most effectively when given before administration of an agent that causes nausea. -Continued therapy helps to control any nausea or vomiting that does develop. -Neuroblastomas are treated with surgical resection, chemotherapy, radiation therapy, or a combination. -Eating before chemotherapy enhances nutrition, but may increase the risk of vomiting.

A 6 month old infant with hydrocephalus is admitted to an acute care facility for insertion of a ventriculoperitoneal shunt. What is the best position for this patient pose operatively?

After the placement of a VP shunt, the patient should be positioned flat to avoid a rapid decrease in ICP.

A patient with cystic fibrosis is prescribed pancreatin. The nurse explains to the patient that this medication:

Aids digestion. -Pancreatin contains the pancreatic enzymes amylase, lipase, and protease. It is used to aid digestion for patients with cystic fibrosis.

A 15 year old males left leg is placed in skeletal traction. The primary purpose of this measure for him is to:

Align the ends of the fractured bone. -Skeletal traction is used primarily to align the ends of the fracture. -Skeletal traction involves the use of a pin or wire passed through the skin into the end of a long bone. -With skeletal traction, ropes and pulleys are attached to weights to exert a pull on the extremity at the pin site. -Cotton gauze squares usually are placed around the ends of the pins. -Immobilization also prevents further trauma to tissue and will reduce pain.

A 7 year old with cerebral palsy is hospitalized for complications. Before discharge, the patients mother expresses concern over the child's ability to use utensils while eating. Which of the following people should be consulted to assist in patient care and education?

An occupational therapist has specialized training to help patients adapt to their physical limitations in order to perform their activities of daily living.

The parents of a newborn ask the nurse what is the chied danger associated with a tracheoesophageal fistula?

Aspiration into the lungs. -Emergency surgery for the infant with a tracheoesophageal fistula is essential to prevent the development of pneumonia from leakage of stomach secretions into the lungs or an electrolyte imbalance from lack of oral intake. -Tracheoesophageal fistula is a serious disorder because during feeding, milk can fill the blind esophagus and overflow into the trachea, resulting in aspiration.

A child is admitted to the hospital due to an acute asthma exacerbation. The nurse is assessing the patient and immediately calls the physician after discovering which of the following?

Auscultated wheezes during an asthma attack is a sign of airway collapse and should be treated as a medical emergency.

The nurse is caring for a child scheduled for surgery due to Wilm's tumor. Which of the following nursing actions is a priority?

Avoiding abdominal palpation. -It is important that the child's abdomen not be palpated too vigorously, because this could lead to rupture and metastasis. -These tumors metastasize rapidly as a result of the large blood supply to the kidneys and adrenal glands.

The nurse administered bacitracin ophthalmic ointment to a teenager with conjunctivitis. Which of the following symptoms indicates that the patient is experiencing a side effect of this medication?

Bacitracin ointment commonly causes blurred vision, but is usually lasts only a few minutes.

After several days in traction, the patient has a long leg fiber glass cast applied to his left leg. Before the patient is discharged, the nurse should instruct the patient on which of the following?

Be sure to keep you cast dry." -Keeping the cast intact and keeping it dry are important for the integrity of the cast and healing of the fracture. -Discharge teaching for a patient going home with a cast requires detailed instruction to cast care. It is important to instruct the child to keep his cast dry. -Cover with a plastic bag to shower and no swimming allowed. -Remind children that autographs are not allowed because fiberglass is a porous material. -Be certain that the child knows not to put anything inside the cast. -If itching occurs inside the cast blowing some cool air into it from a hair dryer can be comforting. -Damage to the cast should be reported.

When providing patient education to a patient prescribed to clindamycin - benzoyl peroxide gel, the nurse should include which of the following side effects?

Benzoyl peroxide gel is a topical gel used to treat acne. -It commonly causes photosensitivity, hair bleaching, pruritus, peeling, and irritation.

When planning ongoing nursing care for a child with recurrent nephrotic syndrome, which of the following areas of potential disturbances should be a priority consideration?

Body image. -Self concept and body image disturbances related to changes in appearance and social isolation should be considered. -A child with nephrotic syndrome will manifest generalized edema, periorbital, pedal and pretibial edema. -With marked edema, the child may appear paile and have respiratory distress.

The nurse is preparing a 7 year old boy with leukemia for discharge. Which of the following discharge instructions should be included?

Call the physician if toy develop bruises. -Bruising is a sign of thrombocytopenia, a low platelet count due to under production. This may be a sign of disease relapse. -Protamine sulfate binds to heparin, destroying its anticoagulant ability. -Vitamin K is used in the synthesis of clotting factors. -Protamine sulfate and vitamin K have no affect on platelet production or thrombocytopenia.

A 4 year old African American is brought to the clinic for frequent nosebleeds and has pale mucous membranes. He is diagnosed to have iron deficiency anemia. He is scheduled to start iron therapy. The mother asks the nurse what is the cause of her sons illness. Which of the following is the correct response of the nurse?

Chronic blood loss. -Chronic blood loss is associated with iron deficiency anemia. -In this scenario, chronic nose bleeds is the most likely cause. -Children are at a high risk for iron deficiency anemia because they need more daily iron in proportion to their body weight than do adults.

A 90 lb pediatric patient with non-Hodgkins lymphoma is administered vincristine at a starting dose of 50 mcg/kg IV. What is the correct dose in micrograms?

Convert the patients weight to kilograms then multiply the result by 50. 90 lb/2.2 kg=40.909090909090 40.90909090909 kg X 50 mcg - 2045.45 mcg

A 4 year old is admitted to the ER after accidentally ingesting a bottle of her mothers iron supplements 5 hours ago. Which of the following medications can the nurse expect the physician to order?

Deferoxamine is a chelating agent that removes excess iron from the blood stream. Activated charcoal is sometimes used during overdoses to prevent absorption by the GI tract. In this patient scenario, the iron is most likely already digested and absorbed.

The nurse is caring for a 5 year old who has frequent involuntary urination at night. She is diagnosed with nocturnal enuries. What is the most likely cause?

Delayed bladder maturation. -In young children, nocturnal enuresis is primarily a problem of delayed or incomplete neuromuscular maturation of the bladder. -The condition is benign and self-limiting. Up to 20% of 5 year olds have nocturnal enuresis. -UTIs may cause enuresis after a child is old enough to control the bladder.

A 2 year old child is admitted due to cardiac defect complications including fluid overload. The physician prescribes furosemide, 10 mg IV to be given every 2 hours, times 4 doses. The nurse would recognize which of the following laboratory results as a side effect of furosemide?

Furosemide is a loop diuretic that can cause severe fluid loss and electrolyte depletion. Hypokalemia is a common side effect of this medication. Potassium: 3.5-5 Magnesium: 1.3-2.1 Hemoglobin 14-18 (males), 12-16 (females). Sodium: 135-145.

A male infant was measured at 8 pounds 2 ounces at birth. Assuming the infant grows at a normal rate, what is the weight change at 6 months of age?

Double the birth weight. -Normally, infants double their birth weight by 6 months of age, but each child may vary. -Weight triples by 1 year.

A patient with a history of congestive heart failure is prescribed naproxen for the treatment of rheumatoid arthritis. The nurse should instruct the patient to report which of the following symptoms?

Edema and weight gain. -Fluid retention and edema is a major concern with NSAIDs, especially in patients with cardiovascular compromise, such as heart failure. -They can have a significant deterioration of hemodynamic function. Patients should report any signs of weight gain, edema, and fluid retention. -Constipation and diarrhea are common side effects of NSAID use, but are not a big deal.

A child is admitted to the hospital with an acute asthma exacerbation. Which of the following assessment findings is most likely to occur?

Expiratory wheezes. -During an asthma attack, expiratory wheezes by airway narrowing are common. -Stridor is common with croup. -Fine crackles are usually heard with pneumonia, atelectasis, and fluid overload.

A 4 year old has a foreign body in her eye. During examination, the child refuses to allow the nurse to inspect her eye. What should the nurse say to the child? "Would you like hold my flashlight?"

Getting toddlers involved in the exam can help reduce anxiety. -The nurse should allow the toddler to hold safe equipment and let them pretend to be the nurse.

A 9 year old girl is admitted to the hospital with cystic fibrosis. She also has a history of frequent respiratory infections. The childs susceptibility to respiratory infections is directly related to the fact that cystic fibrosis causes which of these physiological alterations?

Formation of mucous plugs in the bronchioles. -Children with cystic fibrosis have a generalized dysfunction of the exocrine glands. -Mucus secretions of the body, particularly in the pancreas and the lungs have difficulty flowing through gland ducts. -Bacteria thrive in the excessively thick mucus of the lungs. Secretions accumulate in the respiratory tract, causing obstruction, air trapping and increasing the incidence of respiratory infections. -Cystic fibrosis is a chronic disorder of the exocrine glands characterized by abnormally thick pulmonary secretions. -Cystic fibrosis affects the pancreas, respiratory system, gastrointestinal tract, salivary glands and reproductive tract.

The nurse is caring for a patient with thalassemia major. What body appearance is associated with thalassemia major?

Frontal bossing and upper teeth protrusion. -As bone marrow becomes hyperactive, this results in the characteristic change in the shape of the skull (parietal and frontal bossing) and protrusion of the upper teeth, with marked malocclusion. -Thalassemia major is a beta chain hemoglobin defect, symptoms do not become apparent until the childs fetal hemoglobin has largely been replaced by adult hemoglobin during the second half of the first year of life. -Hypogonadism, pallor, and a protruding abdomen due to hepatomegaly are likely to occur.

A toddler with Clostridium difficile is prescribed a medication for peptic ulcer prophylaxis. Which of the following would the nurse expect to be prescribed?

Famotidine is a histamine 2 receptor antagonist used to treat GERD or prevent peptic ulcer disease by decreasing gastric acid secretion.

A nurse is assessing a 5 year old with multiple deformities of the limbs and joints. She also has a thin upper lip, small teeth, and trouble learning in school. The nurse suspects that these signs are most likely the result of which of the following?

Fetal alcohol syndrome (FAS). -Physical features of FAS include deformities such as a small head and brain, sunken nasal bridge, thin upper lip, small teeth, and an upturned nose. -FAS can also cause vision difficulties, intellectual disability, short attention span, delayed mental development, and poor impulse control. -Down syndrome symptoms include short stature, short wide neck, slanted eyes, low set ears, hypotonia, intellectual disability, and learning disabilities. -Klinefelters syndrome presents in males as less facial and body hair, reduced muscle mass and strength, broad hips, gynecomastia, and hypogonadism. -Signs and symptoms of mercury poisoning are manifold and systemic, including peripheral neuropathy, skin discoloration (pink), swelling, shedding of the skin, tremors, visual and hearing impairment, and fatigue.

A 5 year old with severe osteomyelitis has not been responding to first line therapy. The nurse is ordered to initiate vancomycin IV every 6 hrs to the patient. If the recommended dose is 10 mg/kg, what is the total daily dose of vancomycin if the patient weighs 44 lbs?

First convert the weight in lbs into kg, then multiply the patients weight by 10 mg per dose, 4 doses per day.

A 16 year old diagnosed with exercise induced asthma has been prescribed albuterol. The nurse should instruct the patient to use his inhaler:

For exercise induced asthma, the patient should take 2 puffs of albuterol 15 minutes before activity to allow time for the medication to work.

According to routine immunization schedule, which of the following immunizations should a child receive during the first month of life?

Hepatitis B. The first dose of the hepatitis B vaccine should be given at birth and the second dose at one month. -The first dose of MMR (measles, mumps, rubella) should be given at age 12-15 months. -The first dose of DTaP (Diphtheria, teranus, and pertussis) should be given at 2 months. -The polio vaccine should be given at 2, 4, and 6-18 months.

The mother of a 2 year old girl tells the ER nurse that she found the child playing an empty bottle of aspirin and that there were pieces of aspirin in her mouth. The nurse should observe the child for symptoms of salicylate poisoning which include?

Hyperventilation is a symptom of salicylate poisoning that causes loss of carbon dioxide and respiratory alkalosis. -Other symptoms include tinnitus, tachycardia, hypotension, arrhythmia's, CNS depression, tremors, nausea and vomiting. -Aspirin causes hyperventilation, leading to respiratory alkalosis. -After the kidneys compensate by excreting bicarbonate, metabolic acidosis may occur due to over compensation.

The nurse is preparing to initiate a heparin infusion on a 8 year old patient. Before initiating the infusion, it is critical that the nurse assesses the patients:

In children, heparin infusion dosages are calculated based on the patients weight.

A nurse is caring for a preterm infant. Upon assessment, the infant has a wide pulse pressure and presence of a machine like murmur at the left sternal border. She suspects patient ductus arteriosus. Which of the following promote closure of the ductus arteriosus?

Indomethacin is a non steroidal anti inflammatory agent that inhibits prostaglandin synthesis. -One reason that the ductus arteriosus remains open in fetal life is stimulation by prostaglandins, particularly PGE2, from the placenta and the low oxygen level of the fetal blood. -After birth, when the PGE level falls and the oxygen level increases, the ductus arteriosus is stimulated to close. -Medical management for the preterm infant may consist of administration of oral or IV Indomethacin therapy, a prostaglandin inhibitor. -This lowers the PGE level and leads to ductus closure.

After a child comes to the ER with aspirin overdose, the nurse should take which of the following priority actions?

Initiate gastric lavage as ordered. -Aspirin is a poison frequently ingesting by children. -The immediate treatment is to remove the drug from the child's stomach by inducing vomiting, gastric lavage, or administering activated charcoal. -Gastric lavage and activated charcoal are the processes used in cleaning out the contents of the stomach. This is useful in removing ingested poisons.

The nurse is caring for a toddler diagnosed with intussusception. When assessing a child for possible intussusception, which of the following would be least likely to provide valuable information?

Intussusception does not have a familial tendency, obtaining family history is not helpful information.

A toddler was prescribed azithromycin for an ear infection. His mother is worried about the side effects of the medication. The nurse explains that the most common side effects are non life threatening and include:

Many antibiotics commonly cause GI side effects such as nausea, vomiting, abdominal pain, diarrhea, and cramping.

The nurse is caring for a child with a high grade fever. The childs mother asks if she should give her child aspirin. How should the nurse respond?

No, give acetaminophen instead of aspirin. -Caution parents not to give aspirin to children with a fever because aspirin is associated with Reyes syndrome. -Reyes syndrome is a potentially fatal disease that causes acute encephalopathy and fatty liver. -The cause is unknown, but it is associated with children taking aspirin for a viral illness. -An antipyretic should be given to children with a fever. -Acetaminophen is an excellent antipyretic and it is the drug most often prescribed to reduce fever in children.

The diagnosis of acute lymphoblastic leukemia is confirmed. The hematologic values include: white blood cell count of 6,000 cells/ml with a low blast cells, platelet count of 50,000, hemoglobin of 6 g/dl, and hematocrit of 16%. Which of these measures should be included in the patients plan of care?

Observing for dyspnea on exertion. -Bone marrow suppression results in anemia from decreased RBC production. -The patients hemoglobin and hematocrit are abnormally low, leading to symptoms of anemia such as fatigue, pallor, tachycardia and dyspnea on exertion. -With ALL, bone marrow overproduces immature lymphocytes and soon becomes unable to continue normal production of other blood components. -All is the most common type of leukemia in children.

When developing a teaching plan for the parents of a child with aortic stenosis, the nurse would keep in mind that this disorder involves which of the following?

Obstruction of blood from the left ventricle. -Stenosis of the aortic valve prevents blood from passing freely from the left ventricle of the heart into the aorta. -It causes pressure in the heart as the heart attempts to force blood through the narrowed valve and therefore leads to hypertrophy of the left ventricle. -If left ventricular failure occurs, pressure in the left atrium increase, resulting in back pressure in pulmonary veins and subsequent pulmonary edema.

The nurse is caring for a neonate diagnosed with congenital hip dysplasia. When examining a newborn for dysplasia of the hip, the nurse would assess for which of the following?

Ortolani sign assists in detecting congenital hip dysplasia. -While the infant lies flat, flex the hips and knees to 90 degrees. -Place the index fingers over the greater troochanter of the femur and your thumb on the internal side of the thigh over the lesser trochanter. -Abduct the hips while applying upward pressure over the greater trochanter, and listen for a clicking sound. -A clicking or clunking sound is a positive Ortolanis sign and occurs when the child stands on the affected hip and the pelvis tilts downward on opposite side. This is a sign of weak abductor muscles.

A patient with multiple partial thickness burns receives Tramadol as needed. The nurse assessed the effectiveness of this medication by monitoring the patients: .

Pain rating. -Tramadol is a weak opioid receptor agonist used to treat pain. -Pain medication effectiveness should be measured by the change in pain rating

A 10 year old boy had a knee injury several months ago after playing basketball and has attributed his knee pain to this event. The nurse suspects osteogenic sarcoma after noting which common symptom?

Palpable mass close to the knee. -The most important physical finding is a tender, palpable mass that is large in size. -An osteogenic sarcoma is a malignant tumor of the bone that primarily affects the long bones such as the distal femur and proximal tibia.

A 3 year old is rushed to the ER due to a seizure. The parents state that the seizure started with a twitch in the fingers and progressed to the arm and face. What type of seizure is the parent describing?

Partial (focal seizures). -Partial seizures originate from a specific brain area and often only affect a part of the brain. Clonic jerking may start in the hand or toe and then spread. -A partial seizure with sensory signs may include numbness, tingling, paresthesia, or pain originating in one area and spreading to other parts of the body. -Petit mal (absence seizure) is classified as a generalized seizure. They usually last less than 20 seconds and always involve loss of consciousness. Rhythmic blinking and twitching of the mouth or an extremity often indicate a petit mal seizure is starting. -Typical tonic-clonic seizures are generalized seizures. There is usually 3 stages: 1. Aura-strange, dizzy, ominous feeling that can last minutes or hours. 2. Tonic phase person loses consciousness and muscles tense. This only lasts a few seconds. 3. Clonic phase is when muscles contract and relax rapidly in convulsions. -Status epilepticus refers to a seizure that lasts continuously for more than 5 minutes. -Or a series of seizures from which the child does not return to his or her previous level of consciousness. This is a medical emergency!!

The nurse is assessing a 4 year old complaining of a fever, chills, headache, and malaise with firm and tender cervical lymph nodes. What laboratory test is used to confirm the diagnosis of infectious mononucleosis?

Positive Epstein-Barr virus antibody test. -Epstein Barr virus antibody test is used to confirm diagnosis if the Monospot test is nagative and the patient has symptoms of mononucleosis. -A monospot test, or heterophile antibody test, is a quick test used for mono. -Mono is usually caused by the Epstein-Barr virus and causes severe fatigue and malaise. -Swollen tonsils and lymph nodes, stomach ache, and flu like symptoms are generally present.

A mother brings her 7 year old daughter to the clinic after several nights of bedwetting. The mother explains that her daughter never wet the bed until her baby brother was born. The nurse explains that this situation is considered what defense mechanism?

Regression is the reversion to an earlier stage of development. -This is common in children when exposed to new stressors, such as a new sibling. -Regression is the attempt to repel ones own desires and impulses by excluding it from ones consciousness.

The nurse is preparing a care plan for a 5 year old with enuresis. Which of the following is an important nursing action to promote dryness?

Retention control training. -To promote dryness, it is necessary to teach children retention training whereby the child drinks fluids and delays urination as long as tolerated to stretch the bladder for the purpose of accommodating larger amounts of urine. -Enuresis is primarily a problem of delayed or incomplete neuromuscular maturation of the bladder. -The condition is benign and self-limiting.

A 5 year old with a respiratory syncytial virus infection has a low grade fever. His mother asks the nurse if aspirin is a good medication for fever and pain related to the infection. The nurse warns the mother to avoid giving aspirin to her child because it is linked to:

Reyes syndrome. -Although the exact cause of Reyes syndrome is unknown, the use of aspirin in children during a viral infection has been linked to the development of Reyes syndrome. -Reyes syndrome can cause hypoglycemia, rash, vomiting, and even damage to the brain and liver. -The use of aspirin in children has not been linked to the development of amyotrophic lateral sclerosis, Crohns disease, or rheumatic fever.

The nurse is caring for a 5 year old girl who is hospitalized following abdominal surgery. She develops a fever of 39.5 degrees Celcius, a sore throat, and a red, macular rash on her chest and abdomen. Her tonsils are inflamed and enlarged. Based on these findings, the nurse would follow the protocol care for:

Scarlet fever. -Symptoms of scarlet fever begin abruptly and include fever, sore throat, rash, and a bright red tongue. -The rash appears 12-72 hrs after the onset of a fever. -The tonsils are inflamed and often covered with a white coating. -Scarlet fever is caused by streptococcus pyogenes and most commonly affects children age 4-8 yrs.

A nurse is caring for a 2 year old child that has been hospitalized for 12 hrs. Which of the following situations would most affect the child's behavior?

Separation from parents. -Between the ages of 6 months and 2.5 years, separation anxiety is very common and should be avoided. -If separation anxiety is avoided, the child will be able to better handle other stressors.

A 6 year old is brought into the ER with severe diarrhea. What is the priority nursing action?

Start IV solution as ordered. -Treatment focuses on rehydration and regulating electrolyte balance by oral or IV solutions. -Fluid must be given to replace the deficit that has occurred and to replace the continuing loss until the diarrhea improves. -All children with severe diarrhea should have a stool culture taken to rule out infectious disease and to help guide proper antibiotic therapy. However, rehydration is the priority.

An acute, severe prolonged asthmatic attack that is not responsive to usual treatment is referred to as which of the following?

Status asthmaticus. -Status asthmaticus is an acute, prolonged, and severe asthmatic attack that is unresponsive to usual treatment. -Hospitalization is usually required. -Asthma is a chronic, obstructive airway disease characterized by wheezing. It is caused by a spasm of the bronchial tubes, or the swelling of the bronchial mucosa after exposure to various stimuli. -Mild intermittent asthma is characterized by brief exacerbation's occurring less than 3 times per week. -Mild persistent asthma is characterized by exacerbation's 3 or more times per week or 3-4 nighttime symptoms per month. -Moderate persistent asthma is characterized by daily exacerbation's and one or more nighttime exacerbation's per week. -Severe persistent asthma is characterized by continual symptoms, frequent exacerbation's and frequent nighttime symptoms.

A teenager is being seen by a nurse during a sports physical. The patient complains of how her acne is perceived by others. This patient is in what stage of development?

Teenagers are very concerned with how they appear to others. They struggle to form their identity and role in the world. Eriksons stages of psychosocial development: Trust vs. Mistrust 0-18 months. Autonomy vs. Shame and Doubt 18 months - 3 years. Initiative vs. Guilt 3-5 years. Industry vs. Inferiority 6-12 years. Identity vs. Role Confusion 12-18 years. Intimacy vs. Isolation 19-40 years. Generativity vs. Stagnation 40-65 years. Integrity vs. Despair 65-death.

Which of the following immunizations would the nurse expect to administer to a child who is HIV positive and severely immunocompromised?

Tetanus. -Tetanus is an inactivated vaccine and can safely be adminisgtered to patients who are immunocompromised from HIV. -Patients who are immunocompromised due to HIV should avoid all "live" vaccines due to the risk of severe illness and death with the exception of MMR and varicella. -MMR and varicella, although live viruses, are still recommended by the CDC because of the low incidence of complications in individuals with HIV. -MMR and varicella would not be administered to a patient during a period when they are severely immunocompromised. -Oral typhoid, tuberculosis, yellow fever, and polio are all live virus vaccines that are contraindicated.

A teenager is seen in the clinic due to a mild respiratory infection. The nurse observes Koplik's spots on the oral mucosa. Next, the nurse inspects:

The skin. -Koplik's spots are a sign of rubeola (measles). -A maculopapular rash will appear on the skin within a few days of fever onset. -Koplik's spots are often not seen because they may disappear within one day.

A 10 year old girl is brought to the ER by her parents because of nausea, vomiting, and abdominal pain. The nurse suspects acute appendicitis. It would be most important to obtain which of the following information?

The time of the last meal. -When a child suspected of having an acute appendicitis is admitted, it is important to keep the child NPO and to determine when the child last ate. -If the diagnosis is confirmed, the surgery will be performed without delay as an emergency measure. -Treatment for appendicitis is surgical removal of the appendix by laparoscopy before it ruptures. -Symptoms of appendicitis includes nausea, vomiting, RLQ and periumbilical pain, and anorexia. -Vomiting usually follows the onset of pain. Vomiting that precedes pain is suggestive of an intestinal obstruction.

A nurse is caring for a child that has been hospitalized multiple times for leukemia. After observing the child using several coping mechanisms, the nurse designs a plan of care that includes:

Therapeutic play is a great way for the child to act out past experiences and feelings to reduce the trauma and anxiety to hospitalization.

Which of the following disorders leads to cyanosis and tachycardia caused by complete mixing of deoxygenated and oxygenated blood in the left side of the heart resulting in systemic desaturation and variable pulmonary obstruction?

Tricuspid atresia occurs when the tricuspid valve fails to develop. -Without the tricuspid valve, there is no comminication between the right atrium and the right ventricle. -Tricuspid atrasia allows no blood to flow from the right atrium to the right ventricle. -Instead, blood crosses through an arterial septal defect, into the left atrium, bypassing the lungs and the step of oxygenation. -Blood reaches the lungs for oxygenation by being shunted back through a ventricular septal defect into the pulmonary artery. -These structural abnormalities result in the systemic circulation, causing cyanosis and tachycardia.

The nurse is assessing an adolescent with a von Willebrand disease. She complains of epistaxis and heavy menstrual blood flow. What is likely the cause of this disease?

Von Willebrand disease is the most common hereditary coagulation disorder, characterized by a deficiency of von Willebrand factor, a protein required for platelet adhesion.

The nurse is assessing an adolescent with von Willebrand disease. She complains of epistaxis and heavy menstrual blood flow. What is likely the cause of this disease?

Von Willebrand disease is the most common hereditary coagulation disorder, characterized by a deficiency of von Willebrand factor, a protein required for platelet adhesion.

The nurse is caring for a preschooler with nephrotic syndrome. Which of the following signs and symptoms is a characteristic of minimal change nephrotic syndrome?

Weight gain, edema, and proteinuria. -Clinical manifestations of nephrotic syndrome include edema, proteinuria, and weight gain due to fluid overload. -Minimal change disease is idiopathic in origin and causes nephrotic syndrome. -Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged and allow the leakage of proteins into the blood. -Fever would occur only if there is an infection.

The nurse is caring for a patient with acute asthma. Which signs for asthma exacerbation does the nurse expect to find during a physical assessment?

Wheezing and sternal retractions. -Due to a combination of environmental and genetic factors, the airway becomes inflamed and constricted for those with asthma. -This leads to clinical signs found on assessment including wheezing and dyspnea. Increased work of breathing resulting in increased respiratory rate and even retractions may be seen especially for children. -Anxiety may result from respiratory distress, and may exacerbate an asthma attack, but this is a psychological assessment finding, not a physical finding resulting from bronchospasm.