Peds Exam 2
What nursing care do we do for acute streptococcal pharyngitis?
- COOL liquids - keep mouth hydrated) - oral care (kids can reinfect with strep due to it living on the toothbrush)
What causes nasopharyngitis?
- RSV - rhinovirus - adenovirus - influenza - parainfluenza viruses
A 3 month old male was admitted to the hospital for rule out sepsis. The nurse interviews the mother who states that for the past few days the infant has had a fever, is cranky and tired, seems to be voiding large amounts, and is poorly feeding. How would you obtain the culture?
- a urine catheterization - MD /NP could obtain via supra pubic tap
Where are non-accidental bruises on the body?
- abdomen - cheeks - back - upper extremities - buttocks ** bruises UNCOMMON before the child reaches the age of mobility and will have a PATTERN (like a handprint or belt)
How is sexual abuse presented in children?
- bruising , bleeding, lacerations - hymen injury - infections (UTIs, STIs) - UTI without OBVIOUS cause - difficulty walking or sitting - inappropriate behaviors to look out for is an older child (such as a teenager) sitting on the "caregivers" lap in a setting that is not normal ** mucosal injury is tricky because it can heal rapidly
A 3 month old male was admitted to the hospital for rule out sepsis. The nurse interviews the mother who states that for the past few days the infant has had a fever, is cranky and tired, seems to be voiding large amounts, and is poorly feeding. What nursing interventions would you use to care for the infant?
- collect specimens - diagnostic procedures - administer antibiotics - monitor I/O - monitor vitals - teach the child's parents how to prevent further UTI's - arrange home care and follow up
Where are accidental bruises on the body?
- elbows - knees - forehead - shins ** over boney prominences and DO NOT have a pattern
A 3 month old male was admitted to the hospital for rule out sepsis. The nurse interviews the mother who states that for the past few days the infant has had a fever, is cranky and tired, seems to be voiding large amounts, and is poorly feeding. What symptoms would alert you to a G/U disease in the infant?
- fever - voiding large amounts - poor feeding
What are generalized clinical manifestations of a respiratory infection in a child?
- fever and meningismus - septicemia - anorexia, vomiting, diarrhea, abdominal pain - cough, sore throat, nasal blockage or discharge - where is the cough coming from? - what does it sound like? (barking) - is it dry? productive?
What are other infectious agents
- group A β-hemolytic streptococci - staphylococci - haemophilus influenzae - chlamydia trachomatis, mycoplasma organisms, pneumococci
A nurse is caring for a child with Minimal Change Nephrotic Syndrome (MCNS). Why is this child susceptible to developing an infection?
- large loss of proteins in the urine, which means loss of immunoglobulin - patients are often placed on corticosteroids, which is an immune suppressant
What is in the lower respiratory tract?
- lower trachea - bronchi - bronchioles - alveoli
How does a child get rheumatic fever from acute streptococcal pharyngitis?
- missed infection - not finishing course of antibiotics
A 6 year girl, Jo, was admitted to the pediatric floor. The child's history reveals that she had a severe throat infection. She is oliguric and has HTN. It is believed that she may be developing renal failure due to nephritis. What nursing interventions are necessary to maintain fluid balance in Jo while she is in acute renal failure?
- monitor vital signs especially blood pressure - monitor fluid and electrolytes - urine dipstick/specific gravity - strict I/O - daily weights - observe symptoms of dehydration and fluid overload
What assessments do we look for when we suspect child abuse?
- old injuries, various stages of healing, frequent injuries, seeking care at different facilities ** - history and injury don't fit together** - history doesn't fit with development of child - vague or changing history/parents give different versions - long delay between injury and seeking care - ask parent why they did not seek immediate care - lack of appropriate concern - inappropriate parent-child behavior - imprints of implement or hand
What is in the upper respiratory tract?
- oronasopharynx - pharynx - larynx - upper trachea
What is the nurses role when it comes to child abuse?
- recognition of suspicious injuries - perform/assist in the history and physical evaluation - obtain supporting evidence - find alternative diagnosis - report suspected abuse (mandated) - remain objective in documentation (what was stated, not accusatory, non-judgmental) - call ED to let them know a child is on the way and if the child does not show up to the ED the police gets involved - advocate for the child
What are the clinical manifestations of acute streptococcal pharyngitis?
- sore throat like glass feeling - swollen lymph nodes/glands - pain in the neck - not wanting to eat/drink
What is the therapeutic management for tonsilitis?
- tonsillectomy - adenoidectomy
Is sexual abuse greater in males or females?
4 times greater in females
What is the normal amount of bruises a child can have on their body at a time?
6-8
A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a A. Spacer. B. Nebulizer. C. Peak expiratory flow meter. D. Trial of chest physiotherapy
A
A child has been admitted to the unit with acute glomerulonephritis. The test that would confirm this diagnosis is: A. Antistreptolysn-O (ASO) titer B. Urinalysis C. Blood cultures D. White blood cell (WBC) count
A
An 8-year old child with an asthma exacerbation is receiving theophylline to relieve bronchospasm. The nurse observes the child for which of the following side-effects? A. Tachycardia, agitation, vomiting. B. Bradycardia, fatigue, increased BP C. Tachypnea, drowsiness, increased pulse D. Fluid retention, ataxia, decreased blood pressure
A
Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. Which information should the nurse include when teaching the parents about the infant's care? A. Cardiopulmonary resuscitation (CPR) B. Administration of intravenous fluids C. Reassurance that the infant cannot be electrocuted during monitoring D. Advice that the infant not be left with other caretakers, such as babysitters
A
Diagnosis of cystic fibrosis includes: A. A positive quantitative sweat chloride test B. Positive blood culture C. Urinalysis demonstrating urinary casts D. Stool guiac demonstrating occult blood
A
The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic, because these symptoms are suggestive of A. Pneumothorax. B. Bronchodilation. C. Carbon dioxide retention. D. Increased viscosity of sputum
A
When caring for a child following a tonsillectomy, what should the nurse do? A. Watch for continuous swallowing B. Encourage gargling to reduce discomfort C. Postion the child on the back for sleeping D. Apply warm compresses to the throat
A
When caring for a child following a tonsillectomy, what should the nurse do? A. Watch for continuous swallowing. B. Encourage gargling to reduce discomfort. C. Position the child on the back for sleeping. D. Apply warm compresses to the throat.
A
Which of the following assessment findings in a nine month old infant diagnosed with spasmodic croup is an indication of a potential complication? A. Current respiratory rate of 69, pulse rate is 167. B. Respiratory distress is worse at night then during the day. C. Occasional crowing-type inspirations can be heard. D. Barking cough alternates with brassy nonproductive cough
A
Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung's disease? A. Monitor rectal temperature every 4 hours and report an elevation greater than 38.5° C. B. Assess stools after surgery. C. Keep the child NPO until bowel sounds return. D. Maintain IV fluids at ordered rate.
A
A 3 year child admitted to the peds floor for seizure control has a generalized tonic - clonic seizure. The first initial action the nurse should perform is the following.. A. Place child on his side and assess the child B. Take off the child's clothes and administer oxygen C. Hold the child down and try to communicate with the patient
A rationale: initial nursing action is protect the airway (always remember your A,B,C). lying the child on his side will prevent aspiration. you may want to expose the child to observe and administer oxygen if cyanosis is present or desaturation. however this is not your initial step. airway FIRST!
A nurse is performing an assessment on a 4 month old admitted with r/o hydrocephalus and possible placement of a v/p shunt. The nurse would be correct in performing the following assessments of the infant? Select all that apply A. Monitor for a bulging or full anterior fontanel B. Monitor for high pitch cry C. Monitor for pedal edema D Monitor for a headache
A B rationale: the signs of ICP in an infant bulging AF, vomiting, irritability, high pitch cry, wide split sutures, increased HC, sunsetting, headache can not be assessed in an infant. pedal edema is associated with other disorders
A newborn is being delivered with a known myelomeningocele. The nurse attending the delivery will perform the following activities. Select all that apply A. Sterile saline and gauze dressings B. Latex free environment C. Nasogastric tube to straight drainage D. Lay the child supine or side lying position E. Establish IV access and administer antibiotics F. Rectal temperature
A B D E rationale: maintain a sterile environment, heat loss and protect the area from trauma. Infant should be placed prone. rectal temp should be avoided due to rectal prolapsed. NGT to straight drain is associated with G/I disorders
While performing an exam on a 7 month old infant, the nurse would suspect cerebral palsy in the following finding(s)? Select all that apply A. Tongue extrusion B. Positive tonic neck reflex C. Absence moro reflex D. No head lag- pull to sitting E. Scissoring of legs in ventral suspension
A B E rationale: a 7 month old should have an absent moro and no head lag. persistent tonic neck, tongue extrusion and scissoring are suspicious of cerebral palsy
A 4 month old infant has a tonic clonic seizure. It is important during this time for the nurse to do the following interventions? Select all that apply A. Time and observe the infant's reactions B. Place an oral airway during the infant's seizure C. Administer anticonvulsants as ordered D. Restrain the infant E. Ensure a bag and mask is at bedside
A C E rationale: during a seizure the nurse should note characteristics and length of the seizure and do not restrain. do not place anything in the pt's mouth. remove harmful items or equipment. stay with the pt. nurse may need to administer medications
A 10-month old is admitted after receiving a ventriculoperitoneal shunt. Which assessment would indicate malfunction in this shunt? A. Cries but quiet when held B. Irritable and vomiting C. Has increased abdominal girth D. Has a fontanel that is full and soft
B
A complication seen shortly after birth which is indicative of cystic fibrosis in a newborn is: A. Insulin dependent diabetes B. Meconium ileus C. Neonatal sepsis D. Meconium aspiration pneumonia
B
A premature infant with apnea of prematurity is being discharged from the hospital on an apnea monitor. Which statement by the parents demonstrates that they understand the discharge instructions? A. If the baby stops breathing I will call 911 and wait for them to arrive. B. Rubbing the baby's back or feet may stimulate him to breathe. C. If the baby stops breathing for 10 seconds I'll start CPR. D. The apnea monitor will stimulate the baby to breath.
B
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37º C. The nurse suspects croup. What should she recommend? A. Control fever with acetaminophen and call if cough gets worse tonight. B. Try a cool-mist vaporizer at night and watch for signs of difficulty breathing. C. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement. D. Admit to the hospital and observe for impending epiglottitis
B
The nurse is caring for a 4 year old in the emergency room. The child is sitting quietly in bed, leaning forward, and has a frightened look on his face. Epiglottitis is suspected and the following medical orders are written. Which order should be questioned by the nurse? A. Give misted oxygen 6 LPM by face tent. B. Obtain and send throat culture and sensitivity. C. Insert IV and begin 35 ml/hour of D5 0.25NS. D. Portable x-ray of lateral neck.
B
A 6 yr child is admitted with c/o's , fever, headache, lethargy, nuchal rigidity + Brudzinski and + Kernig sign. These symptoms are associated with what condition? A. Myelomeningocele B. Meningitis C. Intracranial hemorrhage D. Increase intracranial pressure
B rationale: classic symptoms of meningitis
A nurse is expecting delivery of a myelomeningocele. The nurse is aware that this defect in comparison to a meningocele will have the following... A. An open sac over the lumbar area B. Lower extremity paralysis C. Infections of the spinal fluid
B rationale: lower extremity paralysis is found only with myelomeningocele. meningocele is not always associated with paralysis. infection is a risk, but not a given
A child with the spina bifida is placed on a bowel program at the clinic. The nurse assigned to the patient knows this is a result of... A. Lack of mobility causes constipation B. Lack of innervations in the anal sphincter or colon causes incontinence or constipation C. Lack of mobility causes spasticity in the colon and results in constipation
B rationale: spina bifida can result in nerve damage to the lower part of the body which can effect bowel and bladder problems
A child has been admitted to the hospital with a diagnosis of "rule out nephrotic syndrome". The nurse would assess the child for? Select all that apply A. Hematuria B. Edema C. Proteinuria D. Dehydration
B C
The 7 yr child who fell from the jungle gym was admitted to the peds floor. Rule out epidural hematoma. The nurse should do the following interventions and assessments? Select all that apply A. Assess head circumference B. Neuro checks C. Lay the child supine and hyperextend the neck D. Report vomiting or c/o's headache E. Suction PRN
B D rationale: you do not want to do anything that could exacerbate ICP, like suctioning. position the child in semi-fowler's and don't obstruct veins in the neck with hyper-extension
A 2-year-old child is hospitalized with acute laryngotracheobronchitis (viral croup syndrome). What is the most important nursing consideration in caring for this child? A. Administer antibiotics as ordered B. Prevent cross contamination to other patients C. Prevent respiratory obstruction D. Provide psychological support
C
A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. What is the most appropriate initial nursing intervention? A. Attempt to calm the infant by placing him in his mother's lap and offering him a bottle B. Alert the physician to the situation and ask for an oder for a stat chest x-ray C. Suction secretions, provide 100% oxygen via mask and anticipate respiratory failure D. Bring the emergency equipment to the room and begin valve-mask ventilation
C
A 5-year old girl has been sent to the school nurse for urinary incontinence three times in the past two days. The nurse should recommend to her parents that the first action is to have her daughter evaluated for what condition? A. School phobia B. Emotional causes C. Possible UTI D. Possible structural defects of the urinary tract
C
A teenage child is being treated for renal failure. The nurse would ensure that the child follows a: 1. High-sodium diet 2. High protein diet 3. Low sodium and K+ diet 4. Low-fiber diet
C
Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, supplementation of which vitamins is necessary? A. C and D B. A, E, and K C. A, D, E, and K D. C and folic acid
C
Pancreatic enzymes are administered to a child with cystic fibrosis. Nursing considerations should include which of the following? A. Hold all pancreatic enzymes if child is concurrently receiving antibiotic therapy B. Decrease the dose of pancreatic enzymes if child is experiencing frequent, large stools C. Pancreatic enzyme capsules can be swallowed whole or sprinkled on food with meals D. Administer pancreatic enzyme capsules between meals if possible
C
The nurse is caring for a toddler who is not toilet trained. The doctor has ordered intake and output measurement. The nurse will most accurately measure the urine by: A. Estimating output as small, moderate, or large and recording on the child's chart B. Weighing each diaper and recording the amount of urine output as the weight of the diaper C. Subtract the weight of the dry diaper from a wet diaper and record this amount D. Determine urine output by the number of diapers changes in each 24-hour period
C
The nurse is teaching the parents of a preschooler information about urinary tract infection and means of reducing their recurrence. Which statement by the parents indicates the need for additional teaching? A. "I should get her to drink a lot of water and juices." B. "I will buy her underwear a little large." C. "Soaking in a bubble bath will reduce the meatal irritation." D. "If I notice her starting to wet the bed again, I will need to have her checked for another urinary tract infection."
C
The nurse would include which of the following in the care of a child with acute glomerulonephritis? A. Careful handling of edematous extremities B. Observing the child for evidence of hypotension C. Providing fun activities for the child on bedrest D. Feeding the child a protein-restricted diet
C
What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? A. Teach parents to position the infant on the left side B. Reinforce the parent's knowledge of the infant's development needs C. Teach the parents how to do infant CPR D. Have the parents keep an accurate record of intake and output
C
A 7 year old girl falls from the jungle gym and lands on her head. The child is examined in the ER and is suspected to have an epidural hematoma. The nurse knows this disorder has the following characteristics A. Slow onset venous bleed and symptoms present a week later B. Slow onset arterial bleed and symptoms present 48 hrs after the trauma C. Rapid onset arterial bleed and symptoms present within minutes or hours after the trauma
C rationale: if the epidural bleed is arterial in nature it can be rapid and fatal. it also can be a delayed onset of symptoms from the initial impact. immediate surgical intervention with a craniotomy to evacuate the hematoma. children at risk for seizures
A 7 month old infant is brought into the ER for injuries stemming from a bookcase falling on her immediately prior to arrival to the hospital. The parents reported the child was pulling herself up using the bookcase when it toppled over. Which clinical findings would lead the nurse to suspect child maltreatment? Select all that apply A. Crying B. Hugging the mother tightly C. Spiral fracture of her leg D. A yellow color bruise on the buttocks
C D
A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. What should the nurse do? A. Examine her oral pharynx and report to the physician. B. Make her lie down and rest quietly. C. Auscultate her lungs and make preparations for placement in a mist tent. D. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
D
A 6-month old infant is experiencing acute respiratory distress secondary to RSV bronchiolitis. The infant is NPO. What is the rationale for the infant's NPO status? A. Hypoxia reduces gastrointestinal peristalsis B. Milk and formula increase mucous production C. Bronchial irritation will cause vomiting D. Tachypnea predisposes an infant to aspiration
D
A child with asthma is having pulmonary function tests. Which explains the purpose of the peak expiratory flow rate (PEFR)? A. Confirm diagnosis of asthma B. Determine cause of asthma C. Identify "triggers" of asthma D. Assess severity of asthma
D
A urinalysis is ordered for a child with a throat culture positive for group A beta-hemolytic streptococcus. The mother asks why this test is being ordered. The nurse explains: A. The urinalysis will indicate whether an HIV infection is also present. B. Urinary tract infections are common with streptococcal infections and need to receive prompt treatment. C. Pyelonephritis is a potential complication of antibiotic therapy. D. Group A beta hemolytic streptococcus infections can be followed by the complication of acute glomerulonephritis
D
Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is A. Atrophic changes in mucosal wall of intestines. B. Hypoactivity of autonomic nervous system. C. Hyperactivity of sweat glands. D. Mechanical obstruction caused by increased viscosity of mucous gland secretions
D
One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection A. Lessens effectiveness of medications. B. Encourages exercise-induced asthma. C. Increases sensitivity to allergens. D. Can trigger an episode or aggravate asthmatic state
D
The nurse assesses the neonate immediately after birth. The presence of what symptom would cause a tracheoesophageal fistula to be suspected? A. Jaundice B. Oligohydraminos C. Absence of sucking D. Excessive amount of frothy saliva in the mouth
D
The nurse is caring for a 6 year old after surgery to remove tonsils and adenoids. Which of the following assessment findings would alert the nurse to a possible post-operative complication? A. Child refuses to wear an ice collar. B. Child's pharyngeal secretions are brown-tinged. C. Child requires analgesia every 4 hours for pain. D. Child is swallowing while sleeping
D
The child is diagnosed with meningitis. The PNP is performing a spinal tap. What results from CSF fluid would be indicative of meningitis? A. Clear CSF and high protein B. Low protein and low glucose C. No WBC in the gram stain and cloudy CSF D. Cloudy CSF and many WBC in the gram stain
D rationale: lumbar puncture is often performed to rule out meningitis. normal CSF is clear and colorless, low protein, few WBC and normal glucose. CSF suspicious of meningitis is cloudy, high protein, low glucose and many WBC
A nurse is caring for a child with Minimal Change Nephrotic Syndrome (MCNS). Formulate one nursing diagnosis related to the presence of edema in this child
Fluid excess related to fluid accumulation in tissues and third spaces
A 6 year girl, Jo, was admitted to the pediatric floor. The child's history reveals that she had a severe throat infection. She is oliguric and has HTN. It is believed that she may be developing renal failure due to nephritis. What type of diet would you anticipate for Jo?
a low Na and fluid restricted diet
What is omission in terms of physical abuse?
allowing significant other to abuse the child AND DID NOT REPORT THE ABUSE.
What causes tonsilitis?
can be viral (mostly) or bacterial (similar to strep throat)
What kind of care do we do for a child who has a generalized respiratory infection?
cluster our care - do as much as we can at once and give the child a longer period of rest time so they can recover from the stress they are enduring
What are inflicted burns?
contact with hot solids object as irons, curling irons, radiators, cigarettes, hot liquids
Why do infants get abused?
crying and screaming
What is physical abuse?
deliberate maltreatment of another individual that inflicts pain or injury & may result in permanent or temporary disfigurement or even death (spanking)
What is neglect?
deprivation of food, clothing, shelter, supervision, medical care, education
Why do toddlers get abused?
domestic issues (toilet accidents, temper tantrums, disobedience)
A nurse is caring for a child with Minimal Change Nephrotic Syndrome (MCNS). What is the rationale for developing meticulous skin care?
edema and altered immunity places the child at risk for skin breakdown and infection
How do children under three months get antibodies?
from maternal antibodies
What pre-op care do we do for a child getting a tonsillectomy?
get a CBC (specifically the platelet count)
What causes acute streptococcal pharyngitis?
group A β-hemolytic streptococcal infection that puts kids at risk for rheumatic fever
What happens with infection rates in toddlers and preschool aged kids?
high rate of viral infections
What happens with infections in children over 5?
increase in mycoplasma pneumoniae and β-hemolytic streptococcal infections
Why do children use accessory muscles to breathe (retractions) when they are in respiratory distress?
increased rib pliability
How do infants and children breathe different than adults?
infants are nasal breathers and younger kids are abdominal breathers and use abdominal muscles to breathe around 5-6 years of age because they do not have the muscles in the chest to help them be diaphragmatic breathers
What happens with infection rates in children ages 3-6 months?
infection rate increases so people AROUND THEM need to be vaccinated so they can be protected
What is tonsilitis?
inflammation of the tonsils
What are submersion burns?
inflicted immersion (in the bathtub) are associated with soiling accident seen in toddlers
A 6 year girl, Jo, was admitted to the pediatric floor. The child's history reveals that she had a severe throat infection. She is oliguric and has HTN. It is believed that she may be developing renal failure due to nephritis. What lab work might you anticipate the physician may order?
lab work the MD/NP may order in suspected acute post- strep. GNP: - ASO antibody titers (antistreptolysin-O) - U/A, electrolytes, BUN, creat, erythrocyte sedimentation rate - throat culture for beta strep
What is emotional abuse?
lack of affection, attention and emotional nurturance or anything that destroys or impairs the child's self esteem. (bullying)
What are the manifestations of shaken baby syndrome?
manifestations of brain injury from cerebral hemorrhage and/or cerebral edema (there is a reaction that is almost like Jell-O and causes hemorrhages in the brain and injuries are INTERNAL) - irritability, lethargy, vomiting, seizures, apnea, choking, coma - retinal hemorrhages - intercranial bleeding - rib fractures - hematoma
What is an upper respiratory tract infection in a child?
nasopharyngitis "common cold"
A 3 month old male was admitted to the hospital for rule out sepsis. The nurse interviews the mother who states that for the past few days the infant has had a fever, is cranky and tired, seems to be voiding large amounts, and is poorly feeding. What would an important nursing goal for the infant?
prevention of further UTI's
What is sexual abuse?
rape, molestation, prostitution, incest, trafficking where the perpetrator gains trust (someone who knows the child and the child is comfortable with)
A 6 year girl, Jo, was admitted to the pediatric floor. The child's history reveals that she had a severe throat infection. She is oliguric and has HTN. It is believed that she may be developing renal failure due to nephritis. What intervention may have prevented the acute glomerulonephritis?
recognition and treatment of a recent strep infection (skin or throat)
What is shaken baby syndrome?
repetitive violent shaking while held by trunk seen in infants under age 1
What are infectious viruses seen in children?
respiratory syncytial virus (RSV)
What is Acute Streptococcal Pharyngitis?
strep throat
How do we prevent children from becoming infected with various infectious agents?
vaccines
What do children's chests look like?
younger the child, they look like mini-COPD patients