Pediatrics Test 3 Cancer, skin, sensory / language, cardiac, neuro, musculoskeletal

The parents of an infant with suspected cerebral palsy ask what can be done for their child. Which response by the nurse is best? "The physician will talk with you about reversing the degenerative processes that have occurred." "The focus for the child will be to cure the underlying defect causing the disorder." "Your child will most likely need speech therapy and lower extremity bracing." "The therapies will be focused on promoting optimal development by identifying the condition early."

"The therapies will be focused on promoting optimal development by identifying the condition early." *MAXIMIZE POTENTIAL* The goal of therapy is to promote optimal development. This is done through early recognition and beginning of therapy. The underlying defect cannot be cured. It may not be possible to reverse degenerative processes. It is too soon to determine exactly what therapies and support the infant will need.

The nurse is assigned to care for an 8-year-old child with a diagnosis of a basilar skull fracture. The nurse reviews the health care provider's (HCPs) prescriptions and should contact the HCP to question which prescription? 1. Suction as needed. 2. Obtain daily weight. 3. Provide clear liquid intake. 4. Maintain a patent intravenous line.

1. Suction as needed. *Battle sign-basilar skull fracture No NG tube! Basilar fractures: DO NOT use NG tubes or nasotracheal suctioning because can cannulate the brain!!!*

A seven year old male who fell from the top of a jungle gym is awake and neurologically intact in all four extremities. When you ask what happens, he tells you he fell and then he tells you about his dog. What is his Glasgow Coma score?

15 *Just know how to score and total*

The nurse is providing discharge teaching to the parents of a toddler who has experienced a febrile seizure. The nurse knows that clarification is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child's 7-year-old brother is also at high risk for a febrile seizure." 3. "I'll give my child acetaminophen when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

2. Most children over the age of 5 years do not have febrile seizures. *Peak incidence is 18-24 months, caused by rapid rise in temperature greater than 102 degrees & runs in families*

A 1-year-old infant with a diagnosis of heart failure is prescribed digoxin (Lanoxin). The nurse takes the *apical pulse* for 1 minute before administering the medication and obtains a result of 102 beats/min. Which action should the nurse take? 1. Retake the apical pulse. 2. Withhold the medication. 3. Administer the medication. 4. Withhold the medication and notify the health care provider.

3. Administer the medication. *NOTE: Dig comes in mcg-remember this for conversion or math probs!* *infants/young children hold if hr <100* Signs of toxicity: N/V/D, anorexia, lethargy, bradycardia, rhythm disturbances, visual changes *Digibind is the antidote* [↓ K = enhanced effect of Digoxin]

A mother arrives at an emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected, and the nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia

4. Bradycardia Children respond to severe hypoxemia with bradycardia. Bradycardia is a *significant warning of impending cardiac arrest* Cardiac arrest in children generally results from prolonged hypoxemia. Kids can maintain a normal BP for a long time so by the time they exhibit hypotension, they are in decompensated shock

The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, "How does Kawasaki disease affect my child's heart and blood vessels?" On what understanding is the nurse's response based? a. Inflammation weakens blood vessels, leading to aneurysm. b. Increased lipid levels lead to the development of atherosclerosis. c. Untreated disease causes mitral valve stenosis. d. Altered blood flow increases cardiac workload with resulting heart failure.

ANS: A Inflammation of vessels weakens the walls of the vessels and often results in aneurysm. *know s/s of KD=conjunctival redness, strawberry tongue, peeling hands and feet, usually kids under 5, good prognosis, untreated can cause aneurysm*

The assessment finding that should be reported immediately if observed in a child with meningitis is: a. Irregular respirations b. Tachycardia c. Slight drop in blood pressure d. Elevated temperature

ANS: A Irregular respirations in conjunction with *BRADYCARDIA!* and increasing blood pressure are reported immediately because they could indicate increased intracranial pressure. *Meningitis=think ICP symptoms!*

What should be included in teaching a parent about the management of small red macules and vesicles that become pustules around the child's mouth and cheek? a. Keep the child home from school for 24 hours after initiation of antibiotic treatment. b. Clean the rash vigorously with Betadine three times a day. c. Notify the physician for any itching. d. Keep the child home from school until the lesions are healed.

ANS: A To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours *CONTACT PRECAUTIONS*after treatment is initiated. Good handwashing is imperative in preventing the spread of impetigo IT IS HIGHLY CONTAGIOUS *This is a Staph infection note the vesicles rupture honey colored "GOLDEN DRAINAGE* and then crust over*

Therapeutic management of the child with ringworm infection would include which of the following? a. Administer oral griseofulvin. b. Administer topical or oral antibiotics. c. Apply topical sulfonamides. d. Apply cold compresses to affected area.

ANS: A Treatment with the antifungal agent griseofulvin is part of the treatment for the fungal disease, ringworm. *Per PPT treatments of ringworm: Oral anti-fungal medication for four to eight weeks. Griseofulvin or terbinafine for 6 weeks if over 4 years old. Take griseofulvin with *fatty foods to enhance absorption* Avoid photosensitivity reactions. Medicated shampoo - selenium sulfide 2-3 times/week, leave in for 10 min then rinse. Ringworm of the body, groin, and foot is usually treated with a topical anti-fungal agent clotrimazole (Lotrimin) or miconazole (Monistat) apply one inch beyond lesion borders*

What should the nurse recognize as symptoms of a brain tumor in a school-age child for whom she is caring? Select all that apply. a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Intermittent headache e. Declining academic performance

ANS: A, C, D, E Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may have increased head circumference with a bulging fontanel. *School-age children have closed fontanels and therefore their head circumferences do not increase with brain tumors.* *How do the clinical manifestations of ICP differ for an infant versus an older child?* *The normal intracranial pressure is 2-10 mm Hg*

The nurse is preparing to administer a new order for eardrops. Which is a potential contraindication to the use of many otic preparations? a.Ear canal itching b.Perforated eardrum c.Staphylococcus aureus otitis externa infection d.Escherichia coli ear infection

ANS: B Potential contraindications to the use of otic preparations include perforated eardrum. The other options are potential indications for eardrops. *NEVER USE ANESTHETIC EAR DROPS if TYMPANIC MEMBRANE IS RUPTURED!!!*

The nurse is preparing to administer a new order for eardrops. Which is a potential contraindication to the use of many otic preparations? a. Ear canal itching b. Perforated eardrum c.Staphylococcus aureus otitis externa infection

ANS: B potential contraindications to the use of otic preparations include perforated eardrum. The other options are potential indications for eardrops.

Which children admitted to the pediatric unit would the nurse monitor closely for development of syndrome of inappropriate antidiuretic hormone (SIADH) (Select all that apply)? a. A newly diagnosed preschooler with type 1 diabetes b. A school-age child returning from surgery for removal of a brain tumor c. An infant with suspected meningitis d. An adolescent with blunt abdominal trauma following a car accident e. A school-age child with head trauma

ANS: B, C, E Childhood SIADH usually is caused by disorders affecting the central nervous system, such as infections (meningitis), head trauma, and brain tumors. Type 1 diabetes and blunt abdominal trauma are not likely to cause SIADH. *The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day*

While completing an assessment on a 6-month-old infant, which finding should the nurse recognize as a symptom of ICP in an infant? a.Blurred vision b.Increased head circumference c.Vomiting when getting out of bed d.Headache

ANS: B-Manifestations of ICP which can be indicitive of a brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may be *irritable or lethargic, feed poorly, and have increased head circumference with a bulging fontanel.* note age of the child to answer* A-Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor but *would not be able to be verbalized by an infant.* *Note "sun setting or dolls eyes for infants* C-The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor, but *infants do not get themselves out of bed in the morning.* D-Increased intracranial pressure is manifested as a headache but could not be verbalized by an infant.

The nurse is caring for a 2-year-old child who has a history of meningitis as an infant. The child is not speaking and does not turn the head to the sound of a rattle. Which type of hearing loss in a child is usually irreversible and may have resulted from a previous infection with meningitis? a. Conductive b. Sensorineural c. Central d.Mixed

ANS: B-When hearing loss is caused by malformations, auditory nerve damage, or infection, *the loss is usually permanent* Conductive-Damage caused by inflammation or obstruction usually causes a temporary and reversible hearing loss.

What is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. The first stage of the coagulation process is abnormally stimulated.

ANS: C Leukemia is a group of malignant disorders of the bone marrow and the lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia

The nurse assesses a *major burn* as: a.Partial-thickness burn involving 25% of the body surface b.Partial-thickness burn involving 10% of the body surface c.Full-thickness burn involving 10% of the body surface d.Full-thickness burn involving 5% of the body surface

ANS: C A full-thickness *burn involving 10% or more of the body surface is considered a major burn. and would require fluid resuscitation.* *also don't need to memorize the modified rule of nine. Just know it is the tool used to determine percentage of burn injury.*

When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity? a.Fever b.White blood cell count of 8000 cells/mm3 c.Tinnitus and dizziness d.Decreased blood urea nitrogen (BUN) levels

ANS: C Examples of aminoglycosides are=Gentamicin, tobramycin, amikacin, streptomycin, neomycin. Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels *Just know that aminoglycosides are nephro and ototoxic*

Which of the following is the primary clinical manifestation of scabies? *SCABIES IS CONTAGIOUS!* a. Edema b. Redness c. Pruritus d. Maceration

ANS: C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. *Takes about 4-6 weeks after initial contact for symptoms to occur!! eww.*

A parent comments that her infant has had several ear infections in the past few months. The nurse understands that infants are more susceptible to otitis media because: a.Infants are in a supine or prone position most of the time. b.Sucking on a nipple creates middle ear pressure. c.They have increased susceptibility to upper respiratory tract infections. d.The eustachian tube is short, straight, and wide.

ANS: D An infant's eustachian tubes are shorter, wider, and straighter, allowing microorganisms easy access to the middle ear.

The nurse is performing a neurological assessment on a 10-month-old infant using a *modified Glasgow Coma Scale* What score will the nurse give for "verbal" if the child is babbling? a. 1 b. 2 c. 4 d. 5

ANS: D If babbling, the 10-month-old infant receives a score of 5 for responses

A patient taking Rifampin for meningitis calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct? a."You will need to stop the medication, and it will go away." b."It's possible that the TB is worse. Please come in to the clinic to be checked." c."This is not what we usually see with these drugs. Please come in to the clinic to be checked." d."This is an expected side effect of the medicine. Let's review what to expect."

ANS: D Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about this side effect. The other options are incorrect.

Which of the following is characteristic of eczema? SATA 1. Triggered by food allergies and topical irritants 2. A family history of asthma 3. No family history of asthma 4. History of cancer

Choices 1 and 2 Eczema is triggered by food allergies, topical irritants like soaps and laundry detergent, and is also linked to a family history of asthma. *aka atopic dermatitis*

A patient who has been told by the health care provider that the cells in a bowel tumor are poorly differentiated asks the nurse what is meant by "poorly differentiated." Which response should the nurse make? "a. ""The cells in your tumor do not look very different from normal bowel cells."" b. ""The tumor cells have DNA that is different from your normal bowel cells."" c. ""Your tumor cells look more like immature fetal cells than normal bowel cells. d. ""The cells in your tumor have mutated from the normal bowel cells.

Correct Answer: C Rationale: An undifferentiated cell has an appearance more like a stem cell or fetal cell and less like the normal cells of the organ or tissue. The DNA in cancer cells is always different from normal cells, whether the cancer cells are well differentiated or not. All tumor cells are mutations form the normal cells of the tissue."

A child is diagnosed with Wilms' tumor. In planning teaching interventions, what key point should the nurse emphasize to the parents? 1. Do not put pressure on the abdomen. 2. Frequent visits from friends and family will improve morale. 3. Appropriate protective equipment should be worn for contact sports. 4. Encourage the child to remain active."

Correct answer: 1. Do not put pressure on the abdomen. Palpation of Wilms' tumor can cause rupture and spread of cancerous cells. Frequent visitation might allow the child to be exposed to more infections, and activity and sports are discouraged because of the risk of rupture of the encapsulated tumor. *PALPATION could cause cancer spread!*

Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge? a. "I rotate my insulin injection sites every time I give myself an injection." b."I keep records of my glucose levels and insulin sites and amounts." c."I'll be glad when I can take a pill for my diabetes like my uncle does." d."I keep Lifesavers in my school bag in case I have a low-sugar reaction."

c. Children with type 1 diabetes will require life-long insulin therapy.

What is the concern of a 14-year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes? a. The child's weight b. The privacy of the child c. Development of a sense of industry d.Peer group acceptance

d Peer group acceptance, along with body image, are issues for the early adolescent with type 1 diabetes.

The laboratory results of a patient with disseminated intravascular coagulation are likely to include: decreased levels of fibrin split products. increased levels of fibrinogen. increased platelet counts. prolonged prothrombin and partial thromboplastin times.

prolonged prothrombin and partial thromboplastin times.

A 2-year-old is seen in the pediatrician's office with a bacterial middle ear infection. Which medication does the nurse anticipate being prescribed for the child?

Amoxicillin is the first-line drug for most children with bacterial otitis media.

The nurse is caring for a 7-year-old girl in an outpatient clinic diagnosed with amblyopia that is unrelated to any other disorder. The parents ask "What are these drops for?"

"Atropine drops blur vision in the "good" eye to treat amblyopia in the other eye* Educate the parents on how and why we use *atropine drops* (this is an anticholinergic eye drop)

This is a newer drug that is used at the muscle group to decrease the contractures at the LOWER EXTREMITIES.

Botox *also can be to treat strabismus* *Also can be used to treat nursing students from the creases left in their foreheads after silently saying "WTF", reading 45 powerpoints & 355 pages for one test*

Significant warning of impending cardiac arrest in pediatrics?

Bradycardia

The nurse is caring for a child following the insertion of a ventriculoperitoneal shunt to relive hydrocephalus. which priority intervention should the nurse include in the plan of care a. place the child in a supine position b. place the child flat in bed c. place the child in a semi fowlers position d. place the child in an upright position

B flat for 24 hours-you want to avoid too rapid decompression of CSF

A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect: a. Gross hematuria b. Dysuria c. Nausea and vomiting d. An abdominal mass

CORRECT: D The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms' tumor. Nausea and vomiting are rare in children with Wilms' tumor."

What is the reason children dx: cancer under 3-5 should not be treated with radiation? What are other tx options?

Children 3-5 years (different sources give different ages-Im going with under 5) are usually not given radiation because of possible long-term side effects with brain and bone development. *brain and bones are still developing* Instead, they are treated mainly with surgery and chemotherapy.

What nurse teaching is important related to scabies treatment?

Entire family must be treated at the same time. Whole body (except eyes and mouth) application of *permethrin 5% OR lindane cream 1% (if over two years old)* remains on child for 4 - 14 hours then washed off. Repeat in one week.

A child with lymphoma is receiving radiation therapy. The nurse should be familiar about the most common side effect of this treatment? Fatigue Seizures Neuropathy Lymphadenopathy

Fatigue is the most common side effect of radiation therapy. For children, the fatigue may be especially distressing, because it means they cannot keep up with their peers.

Home care education for children with eczema includes: 1. Applying moisturizers 2 to 3 times a day. 2. Wearing wool and cotton clothing. 3. Keeping the environment warm and humidified.

Goals of treatment: hydrate and lubricate, reduce pruritus, minimize inflammatory changes, determine triggers.

What prompts a parent to consider their child might have a disability?

Not meeting developmental milestones

A child with newly diagnosed leukemia has been admitted for the initial round of chemotherapy. What common signs and symptoms of leukemia related to bone marrow involvement would the nurse expect to find either in the child's history or during the assessment? Petechiae, infection, and fatigue Headache, papilledema, and irritability Decreased intracranial pressure, psychosis, and confusion Muscle wasting, weight loss, and fatigue

Petechiae, infection, and fatigue Correct These are signs of infiltration of the bone marrow: petechiae from lowered platelet count, infection from the decreased number of effective leukocytes, and fatigue from the anemia. Headache, papilledema, and irritability are not signs of bone marrow involvement. Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement.

The mother of a 9-month-old child reports her child's eyes are often *misaligned*. The nurse confirms this during the examination. What action is indicated?

Report the findings to the physician. Binocularity vision is normally present by 3-4 months. If noted after the age of 6 months it should be evaluated by a pediatric ophthalmologist. In a newborn's eyes, strabismus is a normal finding.

Ringworm, frequently found in schoolchildren, is caused by?

Ringworm is caused by *fungus*, is NOT a worm which invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. *contagious* *-Ringworm risk increases if the child: is malnourished -has poor hygiene -lives in a warm climate -has contact with other children or pets that have ringworm -is immunocompromised by disease or medication*

Which patient below with ICP is experiencing Cushing's Triad? A patient with the following: A. BP 150/112, HR 110, RR 8 B. BP 90/60, HR 80, RR 22 C. BP 200/60, HR 50, RR 8 D. BP 80/40, HR 49, RR 12

The answer is C. These vital signs represent Cushing's triad. There is an increase in the systolic pressure, widening pulse pressure of 140 (200-60=140), bradycardia, and bradypnea.

Elevated IgE and eosinophil indicates?

asthma and allergic rhinitis

Why is it difficult to diagnosing childhood cancer?

symptoms resemble common childhood illnesses :( *headache, Malaise, pallor, N/V/D, cachexia (super skinny), weight loss, pain, Masses.*

Parents bring their child to the clinic. They inform the nurse, "Our child is not talking as much as his peers, doesn't seem to know as much as his peers and is displaying challenging behaviors." What should nurse suspect and teach?

the nurse suspects this child may have Autism, hearing loss,or learning disabilities *hearing loss can lead to speech delay* ---->Nurses role in hearing loss prevention: Be aware of ototoxic meds as they tend to have peak and trough levels: o Vancomycin o aminoglycosides

A 16-year-old male who has diagnosed with tinea pedis questions the nurse about how he may have contracted the condition. What information may be provided to the boy by the nurse? a) "This condition is common in individuals with lowered immunity." b) "You may have gotten the condition from a community shower or gym area." c) "It is unlikely you will be able to determine the cause of the infection." d) "You likely had an infection in another area of your body and it has spread"

b)"You may have gotten the condition from a community shower or gym area." Explanation: Tinea pedis is commonly known as athlete's foot. It is a fungal infection. The fungi are able to readily grow in *warm, moist conditions* such as shower areas.

The nurse is examining 12-month-old. The nurse finds perianal inflammation with lesions that cross the inguinal folds. This is most likely caused by which of the following? a. Impetigo b. Candidiasis c. Urine and feces d. Infrequent diapering

b. Candidiasis (Fungal infection caused by Candida albicans) AKA *yeast infection* *treatment is lotrimin or nystatin cream=same tx as oral thrush (oral candidiasis) except oral is treated with oral suspension*

I am old enough to know better....

but still too young to care

A mother brings her 2-year-old to the pediatrician's office. Which of the following symptoms suggests to the nurse that the child has strabismus? 1. The child places his head close to the table when drawing. 2. The child rubs his eyes frequently. 3. The child closes one eye to see a poster on the wall. 4. The child is unable to see objects in the periphery of his visual field.

1. The child places his head close to the table when drawing. This is suggestive of refractive error, myopia (nearsightedness), able to see objects at close range. Strabismus is where the eyes are misaligned and not working together correctly.

I am old enough to cooperate with audiometry testing& having my visual acuity tested. How old am I?

3yo

At what age is it no longer ok for an infant to look cross eyed?

6 months

The situation in which the nurse would suspect a hearing impairment is a(n): a. 3-month-old infant with a positive Moro reflex. b. 15-month-old toddler who is babbling. c. 24-month-old toddler who communicates by pointing. d. 13-month-old who is speaking one-syllable words.

ANS: C The child who is not making verbal attempts by 18 months should undergo a complete physical examination.

When caring for the child with Kawasaki disease, the nurse should know which of the following? a. Child's fever is usually responsive to antibiotics within 48 hours. b. Principal area of involvement is the joints. c. Aspirin is contraindicated. d. Therapeutic management includes administration of IVIg and aspirin.

ANS: D High-dose IVIG and aspirin therapy is indicated to reduce the incidence of coronary artery abnormalities. *side note: Remember we postpone live immunizations for pts given IVIG* *Intravenous immunoglobulin: A sterile solution of concentrated antibodies extracted from healthy people that is administered directly into a vein. IVIG is used to treat disorders of the immune system or to boost the immune response to serious illness*

Language development expected in 18 & 24 month old?

An 18-month-old child has a 3 word vocabulary. *A 24-month-old child uses 25-50 words and uses 2 word sentences. "my juice!*

The nurse is assessing the results of diagnostic tests on a client's cerebrospinal fluid (CSF). Which values and observations does the nurse correlate as most indicative of bacterial meningitis? (select all that apply.) A. Clear B. Cloudy C. Normal protein level D. Increased protein level E. Normal glucose level F. Decreased glucose level /How will the presentation and management for bacterial meningitis and viral meningitis be the same? How will it be different?/

B. Cloudy D. Increased protein level F. Decreased glucose level Rationale: *Viral meningitis does not cause cloudiness or increased turbidity of CSF. Protein levels are slightly increased, and glucose levels are normal.* In bacterial meningitis, the presence of bacteria and white blood cells causes the fluid to be cloudy. *Bacterial=Bad=isolation!*

"I am babbling." How old am I." "I said my first word, how old do you think I am?" "I know 25-50 words and several 2 word sentences. How old do you think I am?

Babble- 4-6 months 1st word-12 months 25-50 words and several 2 word sentences-2 yo

A commonly prescribed medication in CP pts which inhibits neuronal activity in the brain and spinal cord.

Baclofen

These are drugs used to relax muscle groups in CP patients. They are given to decrease OVERALL spasicity.

Baclofen, Dantrolene & Valium - Be care, as these drugs are HEPATOTOXIC. Children will need periodic liver function tests.

The pediatric nurse understands that the most common cancer found in children is: 1. Non-hodgkin's lymphoma 2. Acute lymphocytic leukemia 3. Chronic lymphocytic leukemia 4. Ewing's sarcoma

Correct: 2. the most common form of cancer found in children is acute lymphocytic leukemia.

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? SATA • 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse • 6-month-old with a heart rate of 144 beats per minute • 16-year-old child with a heart rate of 64 beats per minute • 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning • 4-year-old child whose digoxin level was 1.6 ng/mL from a blood draw this morning

HOLD these 3 patients: • 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse (s/s dig toxicity) • 16-year-old child with a heart rate of 64 beats per minute (older children hold if less than 70 bpm) • 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning (therapeutic range-0.5-2) The nurse should not administer digoxin to children with the following issues: The adolescent with an apical pulse under 70 beats per minute, the child with a digoxin level above 2 ng/mL, and the child who exhibiting signs of digoxin toxicity.

The combination of increased oxygen requirements with smaller oxygen reserves makes pediatric patients especially susceptible to: Abuse Hypoxia Epilepsy Ischemia

Hypoxia

Which skin conditions we learned are contagious?

ImpetiGO (Cant GO to school until treated 24 hours ABT), ringworm (fungus not a worm-treat with antifungal), Scabies (treat with frontline-j/k-permethrin) & Lice