Peds Exam 4
Sometimes steals money or attractive items Has difficulty owning up to misdeeds
6
The nurse is caring for a child with hemophilia who is actively bleeding from the leg. The nurse should apply
direct pressure to the injured area continuously for 10 minutes
To assess a 9-year-old's social development, the nurse asks the parent if the child:
has a best friend
A nurse is assessing the growth and development of a 10-year-old. What is the expected behavior of this child?
has a strong sense of justice and fair play
Maxillary central incisors and lateral mandibular incisors erupt Jaw begins to expand and accommodate permanent teeth
7
Uses table knife for cutting meat may need help with tough or difficult pieces Is less resistant and stubborn
7
Always on the go jumps chases skips Increases smoothness and speed in fine motor control uses cursive writing
8-9
Assumes responsibility for share of household chores Looks after all of own needs at the table b Buys useful articles exercise some choice in making purchases
8-9
Attends third and fourth grades Reads more may plan to wake up early just to read Reads classic books but also enjoys comics
8-9
Dresses self completely Likely to overdo hard to quiet down after recess More limber bones grow faster than ligaments
8-9
Gives similarities and differences between two things from Emory Counts backward from 20-1 understands concept of reversibility
8-9
Is afraid of failing a grade is ashamed of bad grades Is more critical of self Takes music and sport lessons
8-9
Is easy to get along with at home Likes the reward system Dramatizes
8-9
Is more sociable Is better behaved Is interested is boy-girl relationships but will not admit it
8-9
Lateral incisors maxillary and mandibular cuspids erupt Movement fluid often graceful and poised
8-9
Makes use of common tools such as hammer saw screwdriver Uses household and sewing utensils Helps with routine household tasks such as dusting sweeping
8-9
More aware of time can be relied on to get to school on time Can grasp concepts of parts and whole (fractions Understands concepts of space cause and effect nesting (puzzles)
8-9
Repeats days of the week and months in order knows the date Describes common objects in detail not merely their use Makes change out of a quarter
8-9
Runs useful errands Likes pictorial magazines Likes school wants to answer all the questions
8-9
conservation permanence of mass and volume Classifies objects by more than one quality has collections Produces simple painting or drawing
8-9
A young child with sickle cell anemia prefers a side-lying position with the knees sharply flexed. The nurse should assess further for:
abdominal pain
Obeys triple commands in succession Knows right and left hands Attends first grade
6
Often engages in rough play Often jealous of younger brother or sister Is a boaster
6
Says which is pretty and which is ugly of a series of drawings of faces Describes the objects in a picture rather than simply enumerating them
6
Active age constant activity Active age constant activity, Returns to finger feeding More aware of hand as a tool
6
At table uses knife to spread butter of jam on bread At play cuts folds pastes paper sews crudely if needle is threaded
6
Can share and cooperate better Has great need for children of own age Will cheat to win
6
Develops concept of numbers Can count 13 pennies
6
Does what adults are seen doing may have occasional temper tantrums Increase socialization
6
Height and weight gain continues slowly Central mandibular incisors erupt, loses first tooth, Demonstrates gradual increase in dexterity
6
When teaching the parents of a child diagnosed with tetralogy of Fallot about the cardiac defects involved with this condition, which defects should the nurse describe? Select all that apply. a) ventricular septal defect b) overriding aorta c) right ventricular hypertrophy d) aortic valve stenosis e) atrial septal defect f) pulmonary stenosis
A B C F
A nurse has just received a report from the nurse who worked the previous shift. Which child should she assess first?
A 6-year-old child with acute heart failure on 2 L of oxygen
Narrowing or Stricture of the Aortic valve
Aortic Stenosis
A child, age 6, is anxious and upset before a scheduled bone marrow aspiration. During client preparation, the nurse should keep in mind that:
describing what the child will hear, see, smell, and feel will help the child cope with the procedure.
•Question: A school-age child is admitted to the hospital in vasoocclusive sickle cell crisis. Place the prescriptions in the order of priority (first to last) that the nurse should implement them. All options must be used. a) Start an intravenous infusion. b) Draw blood for electrolyte levels and pH balance. c) Start oxygen via nasal cannula. d) Administer morphine for the pain.
C A D B
A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises would the nurse provide to the child and family? Select all that apply. a) Use cold packs to relieve joint pain. b) Restrict activity to quiet board games. c) Drink plenty of fluids. d) Avoid foods high in folic acid. e) Report a sore throat to an adult immediately. f) Wash hands before meals and after playing.
C E F
Decreased Cardiac output Fluid volume excess Ineffective breathing pattern Activity intolerance, etc
CHF
Poor feeding, sweating, Tachycardia, tachypnea, Retractions, restlessness, Fatigue, etc
CHF
Increased BP and Bounding pulse in the Upper extremities Decreased BP and Weak pulse In the lower extremities
Coarctation Of the Aorta
Localized narrowing of the aorta
Coarctation of the aorta
The nurse is caring for an infant diagnosed with a congenital heart disease. Which of the following concerns should be a priority for the nurse to address with the parents when discussing the child's condition?
Congestive heart failure
A 7-year-old child is brought to the clinic by a parent for a school physical. When the child is prepared for examination, which of the following interventions should the nurse provide to ensure the child's comfort?
Explain the purpose of the equipment being used during the examination
Provide safe environment, Helmets, carpets in home, Padding on corners, Stay active, no contact Sports, avoid ATVs And trampolines, etc
How can we Prevent bleeding Episodes?
Erikson stage For Psychosocial development
Industry vs Inferiority
Strawberry tongue and Lip, red eyes, Rash, edema peeling of the hands and feet
Kawasaki Disease
With what disorder Will you administer IVIG?
Kawasaki disease
How do you administer IVIG?
Monitor VS and for Reaction just like a Patient receiving Blood products, admin Over 10 hours.
Group care Prevent cold stress Limit stimulation Prevent crying etc
Nursing care to decrease Cardiac demands
Assess and believe child, Monitor for complications, Admin opioids and NSAIDS, provide quiet Restful environment, Admin IVF
Pain management For a child in Vaso-occulsive Crisis
What should safety Teaching focus on for this age group?
Pedestrian safety Bike safety Cooking safety Swimming safety Gun safety, etc
A child diagnosed with tetralogy of Fallot becomes upset, cries, and thrashes around when a blood specimen is obtained. The child becomes cyanotic and the respiratory rate increases to 44 breaths/min. Which action should the nurse do first?
Place the child in a knee-to-chest position
The primary Goal for a child With hemophilia?
Prevent Bleeding
Goals for a child With sickle cell disease Focuses on:
Preventing crisis And infection
Rheumatic fever Follows what infection?
Streptococcal Pharyngeal Infection
Which sign is an early indicator of heart failure in an infant with a congenital heart defect?
Tachycardia
Four anomalies: VSD Pulmonic Stenosis Overriding Aorta Right Ventricular hypertrophy
Tetrology of Fallot
A school-age child is being discharged with a diagnosis of rheumatic fever. Which instructions should be included in the teaching plan for the family?
The child should stay on penicillin and return for a follow-up appointment.
When teaching a group of parents of school-age children about growth and development, which characteristic about children of this age should the nurse include?
desire to carry a task to completion
Why is this a vulnerable Age for dental caries?
They can become Lax with dental care
Why would the Nurse administer Prostaglandin inhibitor (indomethacin)?
To close a Patent ductus arteriosus (PDA)
Which intervention is the greatest priority for the therapeutic management of a child with congestive heart failure (CHF) resulting from pulmonary stenosis?
administering furosemide to decrease systemic venous congestion
Which action should a nurse include in the care plan for a 2-month-old infant with heart failure?
allow the infant to rest before feedings
A physician orders digoxin elixir for a toddler with heart failure. Immediately before administering this drug, the nurse must check the toddler's:
apical pulse
A nurse is giving instructions to parents of a school-age child diagnosed with sickle cell anemia. The instructions should include:
avoiding areas of low oxygen concentration such as high altitudes.
A child, age 4, is admitted with a tentative diagnosis of congenital heart disease. When assessment reveals a bounding radial pulse coupled with a weak femoral pulse, the nurse suspects that the child has:
coarctation of the aorta
A mother is concerned about her 9-year-old child's compulsion for collecting things. The nurse's explanation is based on the understanding that this behavior is related to the cognitive ability to perform which functions?
concrete operations
Which assessment finding is an early sign of heart failure in a toddler?
increased respiratory rate
When assessing a child with hemophilia, the nurse identifies which condition as an early sign of hemarthrosis?
joint stiffness
The nurse is conducting health assessments for school-age children. A characteristic behavior of a 7-year-old girl is that she:
likes to play only with girls
Is this age group typically abstract thinkers
no
Opening between The ventricles
ventricular septal defect (VSD)
Can rheumatic Fever reoccur?
yes
Is successful play necessary For a positive Self image
yes
A nurse is caring for a 9-year-old child who is scheduled for surgery. The parents ask the nurse not to tell the child about the surgery until leaving for the operating room. Which response best demonstrates the nurse's role in supporting the child's rights?
"It is important to tell your child about the surgery in order to allow time for any questions to be answered."
A nurse is teaching the parents of an infant with heart failure about the administration of furosemide. The parents will be administering the medication to the infant at home. What is the most important information for the nurse to teach the parents about the drug administration?
"It's important to call the clinic if there is no urine output in 8 hours."
Takes bath without supervision performs bedtime activities alone Reads from memory enjoys oral spelling game
6
Attends second grade More mechanical in reading often does not stop at the end of a sentence skips words such as it, the, and he.
7
Brushes and combs hair acceptably without help May steal Likes to help and have a choice
7
Is becoming a real member of the family group takes part in group play Boys prefer playing with boys, girls prefer playing with girls Spend a lot of time alone does not require a lot of companionship
7
More cautious in approaches to new performances Repeats performances to master them
7
Notices that certain items are missing from pictures Can copy a diamond
7
Repeats three numbers backward Develops concept of time reads ordinary clock or watch correctly to the nearest quarter hour uses clock for practical purposes
7
What is the chief Complaint for Rheumatic fever?
Fever Joint pain Rash
A toddler with a ventricular septal defect is receiving digoxin to treat heart failure. Which assessment finding should be the nurse's priority concern?
bradycardia
Is more independent probably an influence of school Has own way of doing things
6
Knows whether it is morning or afternoon Defines common objects such as fork and chair in terms of their use
6
Likes table games checkers simple card games Giggles a lot Tries out own abilities
6
What is prostaglandin E1 Administered for?
To maintain a Patent ductus arteriosus (PDA) In infants with a Cardiac defect
The pulmonary artery Leaves the left ventricle and the aorta leaves the Right ventricle
Transposition of The great vessels
When will children With the dx of Kawasaki require A second dose of IVIG?
With prolonged fever
When developing a plan of care with a mother who expresses concern that her 10-year-old son is overweight, the nurse should expect to include which intervention?
including the child in meal planning and preparation
The nurse is planning care with the parents of a 4-month-old infant with heart failure and congenital heart disease. The parents report that their child tires easily. Which intervention is a priority for this child?
increase the number of rest periods
The mother of an infant with hemophilia tells the nurse that she is planning to do home teaching when the child reaches school age. She does not want her child in school because the teacher will not watch the child as well as she would. The mother's comments represent what common parental reaction to a child's chronic illness?
overprotection
The nurse is planning interventions for a school-aged child hospitalized with acute poststreptococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include?
playing a card game with someone the same age
A preschool-age child with sickle cell anemia is admitted to the health care facility in vaso-occlusive crisis after developing a fever and joint pain. What is the nurse's highest priority when caring for this child?
providing fluids
A nurse is planning care for a 10-year-old child in the acute phase of rheumatic fever. Which activity is most appropriate for the nurse to schedule in the care plan?
reading books
Likes to draw print color Vision reaches maturity
6
Ways to prevent Vaso-occlusive Events:
Treat and febrile illness Immediately, adequate Fluid intake, Avoid extreme temps and stress, etc
Only feed for 20 min Then NG the rest, Cut a hole in the nipple So the infant doesn't Have to suck as hard
Ways to decrease Energy spent eating For an infant with CHF
When teaching school-age children important injury prevention strategies, the nurse must use creativity to gain cooperation because children tend not to comply with:
Wearing safety apparel (helmets, knee pads, elbow pads).
