PEDS Ch. 13, 23, 24

The nurse is monitoring the intake and output of a client with deep partial-thickness burns. The child weighs 75 pounds. The nurse will contact the physician if the child's urine output drops below how many milliliters per hour? (Round you answer to the nearest whole number.)

34 Explanation: The child with burns should have a urine output of at least at least 1 mL/kg/hour. The calculations for this scenario are: *75 pounds divided by 2.2 kg= 34.09 (34) kg *1 mL X 34 kg= 34 mL/hour

Hemophilia

A bleeding disorder with bruised areas on the skin.

When can a child use sunscreen?

A child under 6 months of age should not use sunscreen but have a hat and light clothing on.

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care?

Avoiding further abdominal palpation Explanation: After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.

The nurse caring for a child with leukemia documents which signs as clinical or diagnostic features of the disease. Select all that apply.

Bruising Anorexia Sore throat Lymphadenopathy

Cellulitis

Cellulitis may spread rapidly. Affected skin appears swollen and red and may be hot and tender. Bacterial skin infection. Caused by staph

When considering the developmental pharmacokinetics of children, what accurately describes the factors that affect medication distribution in children?

Children have a higher proportion of total body water, a lower proportion of body fat, and an immature blood-brain barrier. These all affect the distribution of medication in a child's body.

Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor?

Christmas Factor Factor IX is also known as plasma thromboplastin component or Christmas factor; factor X is Stuart factor; factor VIII is antihemophilic factor; and factor VII is proconvertin.

Herpes simplex virus type 1

Cold sore, fever blister Requires oral antiviral agent - Acyclovir Oral herpes spreads through close personal contact, such as kissing. Oral herpes causes tiny, fluid-filled lesions called cold sores or fever blisters, which can recur.

The student nurse is preparing a presentation on ways to prevent medication errors in children. What information should the student include? Select all that apply.

Double-check medication calculations prior to administration. Utilize the Joint Commission's "Do Not Use" abbreviation list. Verify orders for dosages that are unusually large or small. Use 2 client identifiers prior to administering medications.

The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of:

Ewing sarcoma.

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?

Factor VIII

identify hemophilia A as involving a problem with:

Factor VIII

Candidiasis of diaper area

Fungal diaper rash. Appearance of beefy red central erythema with satellite pustules. fire engine red and pimples.

Tinea capitis

Fungal infection. AKA Ring worm of the scalp. Fungus - long treatment (sometimes for 4 weeks or 2 months, tx hard on the body)

Urticaria

Hives. Histamine release of the mast cells. Response to a virus or being sick. IT can also be from a drug reaction. Ex) Stephen Johnson Syndrome Heat makes them worse and they exacerbate and they itch more. Ice is good come and go for 2 weeks

The young boy has had his spleen surgically removed. Which statements by the boy's parents prior to discharge indicates that an adequate amount of learning has occurred?

If he gets a fever, I'm going to call our physician right away." "Before he goes to the dentist, we'll make sure he gets antibiotics." "He's going to need several vaccines." "He's going to get really good at washing his hands."

The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication?

Let the child hold the medication cup.

A 14-year-old experiencing difficulty breathing is sent for a radiograph. The nurse knows that difficulty breathing may be indicative of:

Mediastinal mass Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph).

A group of nursing students are reviewing the process of blood cell formation. The students demonstrate understanding of this process when they place the formation events in their proper sequence. What is the proper sequence?

Multipotent stem cell Myeloid progenitor Megakaryocyte/erythroid progenitor Megakaryocyte Platelets

Baby acne

Onset at 4 weeks of age No treatment necessary

The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment.

Oral steroids and vincristine through an intravenous line High-dose methotrexate and 6-mercaptopurine Low doses of 6-mercaptopurine and methotrexate Chemotherapy through an intrathecal catheter Explanation: During induction, the child receives oral steroids and IV vincristine. During consolidation, the child receives high doses of methotrexate and 6-mercaptopurine. During maintenance, the child receives low doses of methotrexate and 6-mercaptopurine. During central nervous system prophylaxis, the child receives intrathecal chemotherapy.

Contact allergic dermatitis

Poison Ivy - streaked blisters surrounding one large blister.

A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis would best apply to him during therapy?

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy

Irritant diaper dermatitis

Sharp demarcated edges. Peak age is 9 to 12 months --> giving them more solid foods. The skin is becoming in contact with stool that has different contents. Water only for wash NO whipes! Remove diaper --> allows them to heal better. Can use a hair dryer 3 to 5 minutes when changing diaper. Allow child to have diaper free periods throughout the day for healing.

The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which disorder?

Thalassemia

In caring for a child with sickle cell disease, the highest priority goal is:

The child's fluid intake will improve.

In caring for a child with sickle cell disease, the highest priority goal is:

The child's fluid intake will improve. Explanation: The highest priority goals for this child are maintaining comfort and relieving pain. The child is prone to dehydration because of the kidneys' inability to concentrate urine, so increasing fluid intake is the next highest priority. Other goals include improving physical mobility, maintaining skin integrity, reducing the caregivers' anxiety, and increasing the caregivers' knowledge about the causes of crisis episodes, but these goals are not the highest priority.

Impetigo

The main symptom is red sores that form around the nose and mouth. The sores rupture, ooze for a few days, then form a yellow-brown crust. Highly contagious. AKA school sores

The student nurse is preparing to care for a recently placed gastrostomy tube. Which action would prompt further instruction from the overseeing nurse?

The student obtains an antimicrobial soap to clean the area surrounding the tube. The skin around a gastrostomy tube requires cleaning at least once a day. Routine site care includes gentle cleansing with sterile water or saline for newly placed tubes, or for established tubes, soap and water followed by rinsing or cleaning with water alone. To clean under an external disc or bumper, a cotton-tipped applicator may be used.

A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. The nurse recognizes that this is the likely cause of this type of anemia:

Vitamin B12 deficiency

Pernicious Anemia

deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias.

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to:

notify a health care provider if the child develops an upper respiratory infection. Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important.

atopic dermatitis

same family as asthma and allergic rhinitis Eczema - dry and itchy. Goals: hydrate the skin, no soap in the bathtub, shampoo at the very end and then get them out. Pat them dry, cover them with lotion and vasoline, hydrocortisone for itching they open things up and infection can arise (finger nails short!!)

The nurse is caring for a mom and her baby on a postpartum unit. The mom states she has received advice not to use baby powder on newborns. She asks the nurse if this is true, and if so, why. Which nurse response is correct?

"Baby powder should not be used on newborns due to the risk of aspiration upon application."

The nurse is evaluating parents' understanding of atopic dermatitis. Which statement shows their understanding?

"Flare-ups of lesions are not uncommon following therapy."

The nurse is reviewing the integumentary system during a presentation to a group of nurses. Which statement made by the nurse is the most accurate regarding the integumentary system?

"The largest organ of the body helps regulate body temperature."

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation?

"You will feel pressure on your hip from the needle."

The nurse is reviewing the laboratory test results of a child with thalassemia. Which results would the nurse expect to find with the hemoglobin electrophoresis? Select all that apply.

A2 and F

The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device?

An implanted port Explanation: An implanted port requires a special (Huber) needle placed through the skin into the port, which is implanted surgically under the skin and over a bony prominence. The peripherally inserted central catheter (PICC) and tunneled catheters (Broviac, Hickman, Groshong) do not require a special needle for access. A multilumen catheter has more than one lumen but is not a port.

Cradle Cap Tx:

Antiseborrheic shampoos , mustela, mineral oil

An adolescent is to receive topical retinoid therapy for his moderately severe acne. The nurse would instruct the adolescent about which adverse effects? Select all that apply.

Burning Photosensitivity Dryness

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order?

Deferasirox Explanation: Deferasirox is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dL. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edentate calcium disodium is indicated for blood lead levels greater than 45 mcg/dL. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dL; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.

Lyme Disease

Note annular red rings in erythema chronicum migrans Fatigue, flu-like symptoms, and bulls eye rash

To give eardrops to a 4-year-old, what would be the best technique to use?

Pull the pinna of the ear up and back.

Tinea corporis

Ringworm of the skin. As an outer ring that is raised and a clear center. Anti-fungal cream for 3 to 4 weeks

Warts

Viral agent Plantar's wart need to be treated in office Local destructive therapy

The nurse is discussing the use of over-the-counter ointments to manage a mild case of diaper rash. What ingredients should the nurse instruct the parents to look for in a compound? Select all that apply.

Vitamin A, Vitamin D, and Zinc

To gain a preschooler's cooperation to swallow an oral medication, your best approach would be to:

ask if he would like to take his medicine in a cup or through an oral syringe.

Scabies`

mite burrowing under skin Treat the entire family with permethrin 5% or ivermectin 1% Primary manifestation is pruritus, reaction to eggs and feces under the skin

Cradle Cap

white or yellow scales, dandruff on scalp.

The nurse is assessing a child who has had an open wound for the last 2 weeks with no signs of healing. The parents report they have been using over-the-counter antibiotic ointment with no signs of improvement. The child is active in football in the fall and the swim team in the winter. What disorder does the nurse suspect?

Community acquired MRSA Explanation: Risk factors for community acquired MRSA (CA-MRSA) are turf burns, towel sharing, participation in team sports, or attendance at day care or outdoor camps. The condition usually presents with a moderate to severe skin infection or with an infection that is not responding as expected to therapy. Impetigo is a readily recognizable skin rash infection. Staphylococcal scalded skin syndrome results from infection with S. aureus that produces a toxin, which then causes exfoliation, and it has abrupt onset. Folliculitis is an infection of a hair follicle.

The nurse has an order to give a rectal suppository to a 3-month-old child. In addition to lubricating the suppository, what will the nurse do before or during the procedure?

For the administration of rectal medications, the child is placed in a side-lying position and the nurse must wear gloves or a finger cot. The suppository is lubricated, then inserted into the rectum, followed by a finger, which is inserted up to the first knuckle joint. The little finger should be used for insertion in infants. After the insertion of the suppository, the buttocks must be held tightly together for one or two minutes until the child's urge to expel the suppository passes.

A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child?

Antiemetic Explanation: Radiation therapy causes nausea because it destroys rapid-growing cells. Among these are the cells of the stomach lining, the reason that nausea occurs.